Author Archives: caitlinburke

Is walking speed an indicator of health?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Is walking speed an indicator of health?

Walking speed is an indicator of health to some extent, but it’s not a straight linear relationship. For example, race walkers are generally in good health because they are trained athletes, not because their walking speed is fast. The health indicator aspect comes in at ordinary walking speeds.

When investigators studying aging say that speed at normal walking gait among people over 45 years old is a critical measure that predicts health or even longevity, they are talking about walking speeds on the order of 3 miles an hour. Being unable to sustain walking speeds above half that pace is a good predictor of worse health outcomes (which probably doesn’t come as a surprise to anyone). Walking speeds do fall off at advanced age, so the fact that a 70-year-old is not walking as fast as they did when they were 30 is not necessarily cause for concern.

Walking speed is a well-studied measure, and there is even a simple test, called the 6-Minute Walk Test, used by clinicians to assess patients with serious cardiovascular and lung conditions and to monitor their progress. Investigators are also finding associations between slower walking speeds and other conditions.

So the idea is not that you should train your walking speed to reach some benchmark, but more that walking speed at one’s normal gait is an easily measured and reliable indicator of basic aerobic conditioning, which is an important dimension of health (and “walking independence,” which is an important dimension of healthy aging).

https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/six-minute-walk-test

My answer on Quora

“Is a fitness tracker right for you?” A repeatedly missed opportunity in mainstream media

The Washington Post recently dropped a link to this article from December in one of its newsletters, and I finally realized I’ve seen a lot of these takes over the last few years as wearables have become ubiquitous: maybe you should stop using a fitness tracker, if you’re letting it tell you what to do and it’s making you anxious. These articles feature lots of precious quotes about losing the ability to simply enjoy taking a walk and so on. Not infrequently, the tracker that ends up getting junked is one that was provided gratis by an employer or an insurance company. It’s a basically good idea for an article that is routinely undermined by superficial and extremely incomplete treatment.

Employers and insurance companies often provide simple trackers such as devices from Fitbit, who aggressively courts this business. Based on wristwatches, these devices are easy to use and interact with, and they promise to provide a wealth of data (particularly around notoriously hard-to-measure activities such as sleep). It is common to fall down a whole series of rabbit holes, seeing what it tracks, seeing how you can influence that, and fretting about numbers that don’t seem “good enough.” If you learn more about the technology or just observe very closely, you soon see the weaknesses in the measurements themselves or in the conclusions drawn from them – from simple miscounts of steps to poor extrapolations of mileage to some truly laughable “sleep detection” failures. And once the trust is gone, the brain goes all kinds of bad places.

One problem with mainstream media articles on issues around fitness trackers is that they almost always assume a Fitbit-like wrist device and flatten the discussion to the category of “trackers” as if that is the only form factor. Although some “rah rah fitness tracker!” product pieces discuss the wide variety of options, I don’t think I have ever seen an article about user ambivalence go on to discuss the different types of trackers available. Some people will prefer a simpler device that gives them gentle nudges to move about more during the day, or something that tracks without constant readouts a glance away. Bellabeat makes jewelry-style trackers that can be worn as clips, pendants, or bracelets and that have no screen. There are several simple – and inexpensive – pedometers that can be clipped on or hung from a loop for people who just want to track a step goal, which can also, for that matter, be done with free apps on a smartphone. I understand a bit about how an article is planned in these environments, but this is a great example of how a specific focus robs the piece of value for the reader. In this case the reader is invited to relate to the person who is stressed by the tracker (or to judge that person as weak or not “getting it”), nothing is learned, and the comments section fills up with predictable trash.

Another problem with these articles is the narrative around the value – or risks – of the fitness tracker. Like a lot of issues involving productivity, health, and happiness, the dysfunctional-fitness-tracker story is typically framed around the individual who either can’t seem to get the process right or who is, perhaps rightfully, frustrated by being told what to do by a little piece of metal and plastic. Very few issues involving productivity, health, and happiness are fully in the individual’s control. Between schedules, commutes (or home environments that making working there a challenge), family commitments, and everything else, any change a person wishes to make almost always touches multiple moving parts, many of which touch other people who might push back in ways that are impossible (or inappropriate) to reject.

This willingness to, in essence, blame the individual is particularly annoying to me when a very reasonable quote about the challenges of developing a good food pattern comes from someone who sells coaching or instruction in “intuitive eating.” If it’s intuitive, you don’t need a coach for it. But it’s not even intuitive – the term is used for a variety of practices that involve deliberate food choices, changing your emotional relationship with food, and otherwise being more present and mindful and positive about eating (as opposed to using a reward/punishment frame). I love all those things, and I definitely love an anti-dieting frame for talking about eating, but calling any of that “intuitive” just seems like an extra twist of the knife in the back of everyone who finds it nothing of the kind, ie, almost everyone.

Most surprisingly, I can’t remember seeing a mainstream media article address both user ambivalence AND the source of the tracker. There is a separate genre of article – the discussion of privacy issues around insurance- or employer-provided devices (example linked above) – that clearly details the contextual issues that probably should make an individual reluctant to use a device from those sources. But even mentioning those issues is rare in the “is your fitness tracker making you obsessed” articles, even when quoting people who received the tracker from an employer or insurance company. It beggars belief that these articles have no room for a single quote along the lines of “Yeah, maybe the company-provided device or wellness program isn’t the right path. Some people just need [a different form factor | a free phone app | something that lets them control their data in a particular way].”

The end result is the same careful instruction in learned helplessness that characterizes the fitness / health / wellness industry as a whole: A small insight into a problem. A narrow, narrow discussion of one way of resolving it. An overall emphasis on the individual, with near-zero acknowledgement of the family, work, and social contexts that individuals spend their whole lives in. And no meaningful information about the kinds of questions a person should ask about what they want from a fitness tracker (or other form of accounting – could be a paper calendar with stickers!) that will help them get what they need when embarking on a deliberate change or management of a behavior – or even a hint that such self-understanding is a possibility.

What must you do to lose weight?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

It said on Google that one must walk/run 5 miles a day in order to lose weight. That can’t be true, is it?

Statements this simple are never true, but this kind of statement persists because it has a grain of truth. People who do, in fact, exercise at that level find it relatively easy to manage their weight, but it’s important to note that the exercise is almost never (well, never, but one feels the need to say “almost” just in case) the only action they are taking that supports weight management. As an aside, an actual board-certified internal medicine doctor told me in the 1980s that jogging 3 miles a day would make the pounds “melt away,” so I have to chuckle a bit at the update to “walk/run” and “5 miles.”

One of the problems with “walk/run 5 miles a day in order to lose weight” as stated, of course, is that it makes it sound like that is a transitional condition, achievable by one activity: you walk/run enough, you lose weight, you’re done. But it’s really describing a healthy level of daily exercise, although in a clumsy way that can use a lot of improvement. For example, bodies respond better to a mix of exercise – some harder, most easier – and regular strength training helps support joint health, balance, and resilience and is associated with healthier, independent living into old age.

So let’s read it as “people who routinely exercise about an hour a day find it easier to manage their weight the way they’d like to – and do other things, too, like succeed in school and work and enjoy their social interactions more.” At a fast walking pace, 5 miles takes about 75 minutes; at a jogging pace, about an hour (5 mph is the speed at which people generally find it more efficient to jog rather than use a walking gait). Also, that advice meshes nicely with the famous “10,000 steps a day” recommendation, which grew out of a visual pun on the name of pedometer product sold in Japan years ago.

There’s nothing wrong with this benchmark of exercise, but it doesn’t have to be exactly 10,000, and it doesn’t have to be walking/running – regular daily activity can be a mix of lots of activities, and as noted above, should include some resistance exercise, too, like lifting weights or body weight calisthenics (pushups, pull-ups, etc). Also it probably shouldn’t be daily running – your body works best with a mix of some intense (higher heart rate) exercise and a lot of lower-intensity exercise; otherwise you can quickly overtax your recovery capacity. For many athletes in competition, who can’t afford an unplanned break due to injury or exhaustion, that ratio is 20% high-intensity, 80% lower intensity. So let’s say, in the prescription above, 2 days of running and 5 of walking for a good balance. Plus, of course, some strength workouts work mixed in.

But that exercise, that calorie burn, is the tip of the iceberg of exercise benefit. People get LOTS of health benefits from an hour a day of exercise, including just plain finding themselves to be in a better mood more often. People who exercise at that level often find that all kinds of choices they want to make are easier – it is easier to get to sleep at night, sleep is more restful, and so it is easier to pay attention to things during the day, and it is easier to make deliberate choices about healthy eating rather than just grabbing something because it’s front of them or they need a treat. When people feel better they usually do more of the things they want to do.

So, a bit like “eat less, move more,” “walk/run 5 miles a day in order to lose weight” is not false, but there is so much more to it to make it work well.

My answer on Quora

Why don’t fitness apps work?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Why do you think many fitness and/or nutrition apps are not very effective? I’m writing a paper for my class and I would love to know what you think these apps are missing. What features do you like and dislike? All comments are appreciated.

I think a lot of apps are only as effective as your capabilities allow. If you’re careful about weighing/measuring foods and reading labels, a calorie tracker will work well. If you’re consistent and attentive in your exercise, a fitness tracker will work well. So like a lot of things: they work well for people who “don’t need them” – ie, already have the skills and habits. Designing something that both provides a pleasant and useful experience for the novice and enables configuration to satisfy the expert is a classic challenge, so as a practical matter, the “best” tool might have to be replaced periodically, and unless someone discovers a deep, intrinsic motivation, that sets the stage for them simply abandoning the tool instead.

Some apps are thoughtfully designed to reinforce common psychological responses – by making a note of streaks, personal bests, and trends or by offering indicators that can be collected for activities or patterns that are typically sustained and/or repeated over time (eg, monthly threshold “step count” badges at Garmin). Some apps build in features to support advanced management of patterns outside the ordinary Western diet and mealtimes (MacroFactor app’s support for training- vs nontraining-day calorie/macro settings and for indicating fasting periods). Fitocracy was a fun demonstration of the way that using game-design techniques could encourage someone to develop consistency and also explore new activities, but it quickly ran up against the enormous need for creative design, fantastically broad subject-matter expertise, and constant updates that are probably required to keep that experience engaging.

Part of the challenge for these apps is that eating patterns and exercise patterns are highly variable, so it’s not practical to design a single app or device that will serve all kinds of users well, over and above the novice/expert issue. That means that people might never learn about the niche option that would suit them best. Selecting a product might, in essence, require knowledge a user can’t have, because so many people are seeking a product to tell them something they don’t know yet.

And many people have extremely negative feelings and experiences around food, exercise, and their relationships to social experiences such as rejection or the fear that can come with a diagnosis like heart disease. To the extent that apps (and devices) are marketed as a way to change habits, they only work if someone makes the effort to learn how to fit them into a new pattern, which is a lot of cognitive load for anyone but runs up against additional resistance in the presence of negative feelings.

My answer on Quora

Is underachievement a common thing among gifted people?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Is underachievement a common thing among gifted people?

Sure. I doubt we know any hard and fast proportions, because (in the US), there is no institution that is able to recognize gifted and talented people in any consistent way, particularly for fields that are not, at some level, math-related. I came up through gifted and advanced-placement classes in school, and as far as I can tell, the main things the kids in those classes had in common were involved, affluent parents; plenty of nutritious food; and stable, supportive home lives. These are pretty good springboards for success, but an anonymous poll of those parents would probably yield a lot of stories of “underachievement” – whatever that even means.

There are a lot of reasons kids can excel (or not) in class, let alone life – native interest, teaching/training quality, health status, specific cognitive or neurological issues, and so on. I don’t think any of those are necessarily linked to (anyone’s) intelligence in any meaningful way. Also, there is a persistent idea among involved, affluent parents that gifted kids require special learning opportunities and teaching, which is rather strange, given that intellectually gifted children can probably succeed in any teaching environment. To the extent that they benefit from “enrichment” in their learning environments, it seems obvious that kids who are not as “gifted” would benefit even more.

I can tell you one thing I missed out on as a kid who found school easy: plain talk about how important it is to develop good time management and study skills. I am in great company in this regard, and I am sure that I and many others are great disappointments to people in our lives because we lost ground struggling to put those pieces together later than we should have. As I hear people bitch about NYC phasing out their gifted-and-talented program, I can’t help thinking that all of us could probably benefit in school from some plain talk along the lines of: real life involves needing to pay attention to things you couldn’t possibly care less about, there is no such thing as reading it once and getting it (learning almost anything requires multiple passes), and good time management is like this crazy super ninja skill that makes almost anything seem magically achievable.

My answer on Quora

Do fitness trackers actually work?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Do Wearable fitness trackers actually work?

Yes and no. Complex fitness trackers, like Garmin watches, are excellent for people who already want to exercise a lot and use metrics to meet performance and recovery goals. For those people, the value of wearables is unquestionable – it’s just a question of which model gives them the right mix of features, and they’ll come to that question with lots of knowledge and specific preferences.

Simple fitness wearables, especially those that are designed to blend in better with non-exercise clothing, work on the principle that if you give people information, they will make better choices. In general, that doesn’t hold across the board for people (look at the range of ideas out there about vaccination, for example), but at least in the case of wearables, you are usually talking about people who are already interested enough to buy one.

When people ask whether fitness wearables work, they usually mean “do people who wear fitness trackers exercise more?” Any stimulus for behavior change has to have 3 elements: the person has to know what to do, it has to be achievable, and the stimulus has to be salient. That’s different from “you have to really want to” – it means you have to notice it and respond to it in a predictable way.

The design of a fitness tracker can make or break the response even of a person who wants to use a fitness tracker. I tested a Nike Fuel Band almost 10 years ago. In many ways it was a nice device, although I wasn’t really the ideal user for it. It had one “feature,” though, that made me hate it. You set an activity goal and throughout the day, as you racked up more activity, a line of colored dots would change from red to green. So far, so good, right? But any changes to the activity goal only took effect the following day. While I was testing it, I had an injury early one day, and then was followed around by this red line all day even though it would have been absurd for me to pursue the goal. I was actually amazed by how angry it made me, and I’m a confident, knowledgeable exerciser who was just testing the thing for a week. (I have a dim memory of really enjoying some of the other ways it presented information, but at this remove, all I can remember clearly is that infuriating red line!)

I believe the rationale for limitations like that is “accountability” – to reduce the temptation, if a goal is not being met, to simply make the goal easier. OK but we’re talking about a goal that is supposed to serve the individual, not a test that’s being graded by some outside authority figure. Accountability is going to look different for different people, and the concept of a rigid daily goal with a constantly visible indicator is problematic. Among other things, it “punishes” you for having a rest day. You should have goals but you should also have a clear and healthful balance between “getting the check mark” and putting your foot down (or, perhaps, feet up) when you need to.

In principle, pedometer-based trackers are great for people who want to move more because they offer a clear indicator of how much movement is being done. This can be disheartening but the key as a beginner is to choose an attainable initial goal, even if it seems easy right away. I always urge people to think carefully about what they want out of a tracker to be sure they are not going to resent what it tracks or how it presents information. This can be a long conversation that ultimately touches on things that are unknowable or not much fun to talk about, especially for someone who is struggling to be more active and whose strongest associations with exercise are some crappy middle-school gym class experience. Fortunately, there are quite a few inexpensive options out there to let a person dip their toe in while they learn what will end up being most important – and most helpful.

So do fitness wearables work? Yes and no. Can they work? Definitely.

My answer on Quora

Perceived Effort in Rowing vs Running

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Why don’t I feel as exerted exercising on a rowing machine as I do with jogging, even when the rowing machine is on highest resistance?

I am not much of a runner but I erg a half-million meters or more per year. Running has always struck me as much more difficult just because of the impact factor (and as a consequence, I do it less). Proficiency, familiarity, experience, and some of the variations in people’s bodies can all account for different perceptions of exertion.

My first high-volume exercise experience, in my teens, was lots of cycling, and I also started doing some barbell training before I started using the erg. I think both of those probably helped, to some extent, with the technique and rhythm/control aspects of the erg. I had to work a lot harder to learn, practice, and become proficient in technique for a smoother, more efficient running stride. So I too find rowing “easier” than running, although I can certainly get a good workout with either one. Someone who grew up loving cross-country running and first used an erg much later might have the opposite experience.

As others have said, if the machine you are using is on “the highest resistance,” and assuming it’s a rowing ergometer, you are probably putting unnecessary pressure on your back and breaking form. There are a few technologies out there, though, and I only have experience with how the Concept2 machines work. For those, though, you should adjust according to the drag factor readout on the performance monitor, and choose a drag factor that suits your age class, weight class, and expertise – somewhere in the range of 100 to 135 for most people. The highest drag factors should be reserved for very short tests.

Concept2 ergometers can produce the desired drag factor at very different damper settings depending on how clean the flywheel assembly is, how old the machine is, and on the environmental conditions (pressure, humidity). With an unfamiliar machine, you should always check the drag factor before you settle on a damper setting.

At a hotel, I once used a very sad, lonely Concept2 erg that could only eke out a drag factor of about 100. A new machine (at sea level) ranges from <90 at the lowest damper setting to >200 at the highest. If you can’t get a normal (up to 140) drag factor out of a Concept2 at a gym, you should probably tell the staff to get someone in to give it some care (or consider replacing it).

Is 10,000 steps a day good for you?

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

Is reaching a daily target of 10,000 steps good for you health-wise?

Sure – one of the largest studies to look at this question (using accelerometry-monitored activity) just added some evidence to this pile. Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank cohort study

The number 10,000, however, is completely artificial, as is the idea that it should be steps. Almost any amount of daily activity improves health outcomes – not just walking, not just over an hour a day. I have read that 10,000 became popular because it was part of the marketing for a pedometer in the Japanese market (where the number 10,000 is sort of a visual pun in that context). What 10,000 Steps Will Really Get You

It is common to see people try to tear down this number, or insist that it is an inadequate guideline because people should also be doing resistance exercise, or claim the “real” number is higher or lower, but it’s important to look at what question they think they’re answering when they say that.

Studies that try to address this have to choose an outcome to test – in the case of the new accelerometer-based study, that outcome was association with heart disease, and others have simply used all-cause mortality. It’s very unlikely that any of these study designs is directly measuring the “causal” element for those outcomes. For example, if runners are more likely to be hit by a car, does that mean running is dangerous? In the PLOS-published study above, did the exercise prevent heart disease, or were people who were less likely to get heart disease also more likely to enjoy exercise?

But the outcomes they test might not be the most relevant for recommending exercise in general, which can help regulate moods and sleep. No matter what you’re going to die of, you might as well be happier and better rested, right? Also, fairly modest amounts of physical ability are associated with living independently (in the sense of not needing direct assistance for activity of daily living) for longer. Prevention in Older Adults – Fundamentals – Merck Manuals Consumer Version Staying active throughout life is the best way to address this, because older adults who have already lost muscle mass have a particularly hard time adding exercise into their lives.

It is possible that there is truly an ideal, optimal exercise plan that would maximize the potential benefit of exercise in every person who followed it, but it’s more likely that individuals can benefit more than enough from any number of activities as long as they are practiced regularly, ideally daily. In meantime, the good news is that even though many studies show “more is better,” benefits are usually visible with modest amounts, too.

My answer at Quora

Coping with Cat Allergy

My guilty pleasure is Quora, which I dip into if a question intrigues me. Sometimes I “archive” the more interesting topics here.

I am fairly allergic to cats. My girlfriend has a cat, and whenever I go over, I feel miserable. How can I avoid this problem without getting some sort of medical therapy like shots every week?

I am a lifelong cat owner who developed a cat allergy in my late 20s. I have chosen to keep having cats, because I had my first cat at age 4, and I just love having a cat at home.

At some point, you may elect to end this relationship because the cat makes life too uncomfortable for you. That is fair. Asking her to rehome the cat is not fair to her (or her cat). You should make sure you have some antihistamines available. (Diphenhydramine is the fastest, and drowsy-making; chlorpheniramine works well, but is too much like a sledgehammer for me! In my experience, the best nondrowsy antihistamine is fexofenadine, but my mom actually finds relief from loratadine – in any case, try around.) Note, this is just for your comfort while you figure out what the best long-term plan is for you.

I use a daily immune suppressant + antihistamines at night. I occasionally use an inhaler. I have never wanted to do shots; that form of therapy is lengthy and very inconvenient, and the success rate is not that great. Cats are not my only allergy, which has been a factor in my decision. I react less to my own cat than to stranger’s cats, which I take to be evidence that sensitivity drops with time. (When I was first diagnosed, I was almost unable to work for about a month; now I occasionally benefit from resting for a sick day or two.)

Others have suggested cat wipes. You can also wipe down surfaces with allergen-denaturing stuff, use air cleaners, and use monthly clean-water soaks for the cat. All of these have the effect of clearing away active allergen. I found all that environmental stuff very helpful when I was first diagnosed, but now (about 20 years on), just having a HEPA filter in the HVAC system at home keeps me in reasonably good shape, with the drug therapy.

In your girlfriend’s position, I would be sympathetic and want to help, but I would have limits. I would be happy to do some environmental work, and I would be very grateful if you offered to help. (I have a soft spot for the single-room air cleaners designed for kids – I have one shaped like a penguin, and it always makes me smile.) Personally, I would never consider keeping my cats off the bed, and if she is like me, that may be a deal breaker, but on the other hand, environmental changes and a little drug therapy might work well, depending on the seriousness of your reaction and the possibility that exposure alone will help desensitize you.

My answer on Quora

Oprah, Weight Watchers, and “Impossible”

Ready to head back? Cartoon by Robert Leighton (2003)

So Oprah is on Weight Watchers. She recently bought WW stock, which then appreciated like gangbusters, so she has that going for her, which is nice.

I’m seeing a lot of posts chewing over this news, many with disappointment and general comments about the “impossibility” of losing weight. Even if you are Oprah, and rich, and capable, and surrounded by opportunities for help and support.

It’s not impossible to lose weight, but it’s difficult, frustrating, and draining to do things you dislike for reasons that are tied to sadness. If you are mired in a belief that “inside every overweight woman is the woman she knows she can be,” then your framing is your prison. Because if that woman is “inside” you, she IS you.

You can’t take good care of something you hate.

Acceptance in its various forms is often denigrated as passivity, as giving up, as the sweatpants and pint of ice cream of the soul. But sweatpants and ice cream are a perfectly enjoyable part of anyone’s life, and then you put them away, have a good night’s sleep, and get dressed for work and have an apple or whatever and life goes on. You can choose to make a habit of healthful living, and you can choose to make a habit of self-care and enjoyment, too.

Ultimately we are what we repeatedly do. If you keep punishing yourself for some notional failure, trying every 30-day fix out there in hopes something will stick, what will stick is restless program-hopping and the sense of failure. Give yourself the gift of walking away from that. Don’t try to change everything at once, but instead choose one small thing and practice it until you don’t have to think about it anymore. Then build on that track record of success.

“Ready to Head Back?” by Robert Leighton (2003)