Category Archives: Fitness

Paleo Fitness

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

“If Paleo Fitness is supposed to be great, has anyone measured the fitness of Amazon Native to see how they perform? Specifically, what is their blood pressure, heart rate, VO Max, Mile Run time, Pull-ups, Push-ups, Deadlifts?“

Generally people in traditional societies have remarkable health markers, which is the basis for claiming that prior lifeways are more healthful. I think you would find, though, that in terms of actual, functional fitness that takes a person into a high-quality-of-life advanced age, the sheer number of pull-ups/pushups, the mile run time, or max power production, eg, in a deadlift, is simply irrelevant. Those things are not what constitute “great fitness.” A lot of the gym/fitness-test-based metrics for fitness are not actually about fitness itself but rather run the gamut from impressive speed to impressive strength to cool tricks you can do with the human body. For the first 3, which are actual health markers, some of the groups who have been studied extensively (eg, Hadza people) are absolutely in better shape and retain their good markers later in life than most Westerners – yes, even for VO2 max.

As I understand it, Paleo Fitness, the book, is not actually about paleolithic or nomadic/seminomadic lifeways per se – it’s about trying to bring our overall activity level up to something consistent with evolutionary pressures. It emphasizes spontaneity and “play”-style movements, and Edwards also emphasizes how aversive and frankly hostile a lot of the general claims about fitness/exercise are (“sweat is your fat crying,” “no pain, no gain”). He seems like a wonderful person, and his recommendations look like fun! But it’s only “Paleo” in a snappy, eye-catching sense: Edwards is coming from the basic idea of the mismatch between human body evolution and the modern, “developed”-society patterns of sitting on your butt all day, sure, but he is offering correctives to that mainly from the play angle rather than “how can I do heavy work.” (Indeed, one of his catch phrases is “Working out is not working out” precisely because structured exercise like performance-oriented running or lifting programs are enjoyable to very few people, and – starting every January – abandoned by people in droves.)

10,000 years ago, food insecurity was possibly the greatest threat to human groups, and food acquisition required a fair bit of movement, so you wanted to be up to it but you also didn’t want to waste calories. Ancient people were kind of on the “see food” diet – they didn’t survive by passing up calories, or by expending more than they took in just to test themselves. Part of what any fitness program is about includes calorie deficit, simply because our built environments are awash in calories in a way that our brains haven’t caught up with. So modern fitness programs are, in many ways, from a completely different world to that inhabited by people still living by ancient lifeways. If you showed any fitness book to people living hunter-gatherer lifestyles, they’d probably wonder why anyone needed it. If you told people that it was valuable to have a very fast mile time or a huge deadlift, they’d probably think you were nuts, even if they might well also think it would be cool to see someone demonstrate that. Ironically, one of the most impressive “paleo” activities out there, and one that no fitness program claiming “Paleo” roots ever emphasizes, is simply being able to follow a large animal at a walking pace until it collapses from exhaustion. That combination of terrain familiarity, strategy, orienteering, and sheer endurance is a form of fitness Paleolithic people could actually use.

Links:
My answer at Quora
Exercised: Why Something We Never Evolved to Do is Healthy and Rewarding, by Daniel E. Lieberman
Paleo Fitness, by Darryl Edwards with Brett Stewart and Jason Warner

Can a Fitness Tracker Help You Lose Weight?

Sure, but a fitness tracker can’t tell what behavioral changes will result in a change in your body fat percentage or a smaller waist.*

Last week, a Washington Post writer reported “Apple told me it does not track research about weight loss because that is not the focus of the Apple Watch.” So far, good. Then he added, “(That’s disappointing.)” I applaud Apple for declining to make weight claims, because a watch simply cannot “make” that happen. Changing your daily habits consistently enough to change your body in a sustainable way requires a lot of moving parts, and a fitness tracker isn’t a mind reader—it just collects and displays the information that the maker has set as defaults or that you ask it to display. Fitbit, in contrast to Apple, makes weight claims because it has gone in heavy with providing devices to wellness programs and other contexts that have (of course) additional information available for users.

A fitness tracker can nudge you in a particular direction, but you have to have at least the direction (if not a destination) in mind. Is it more steps? Is it more sleep? Is it a particular mix of high- vs moderate-intensity exercise? (To which I would guess most new users of fitness trackers would say, “a what?”) Is it number of minutes of exercise per week? Is it spending less time sitting? It doesn’t know what’s important to you. And I don’t think any of them have integrated food records—food recording is a whole thing with enough twists and turns to earn a master’s degree, and the most a fitness tracker will do is import a calorie total from a dedicated food tracker. And that’s the other common theme, also hit in the article linked above—the writer even passes along the opinion of the WeightWatchers Chief Scientific Officer to present the typical, binary-opposition response to any discussion of exercise and weight, “But a fitness gadget still can’t automate what Foster considers most important data in weight loss: what you eat.” Of course, says the CSO at the company dedicated to helping people adjust how and what they eat.

What you eat and what your activity pattern is, along with how much and how restfully you sleep, contribute to the condition of your body—from your health to your performance to your body fat percentage to your waist size to your alertness during the day, and on and on. Your fitness tracker can assess your sleep, too—sort of**—but again, just observing it (or including some nudges to remind you that it’s important) isn’t enough to make change happen. People rarely end up with unhelpful eating, activity, and sleep patterns because they want that; they have made a variety of choices against the backdrop of many external factors that are not always easy to change—or, in some cases, identify.

Fitness trackers are undermined by two main issues: People buying one for the first time don’t necessarily know what they want, and once they have one, they almost never know how to configure it to be most helpful. In the early years of Fitbit availability, they were often called “glorified pedometers,” and even the first release of Apple Watch was essentially in that category. There is nothing wrong with a glorified pedometer—for people who just want to nudge more activity into their day (lots of people!), tracking and gradually increasing daily steps is a great approach (and Apple kind of lives this strategy in its track record of offering simple initial versions of hardware and then building on them). But pedometers are simple enough that very little explanation is needed, and as these devices have become more and more glorified, one wonders if people are expecting more simplicity rather than less, as if every new capability is as easy to understand and act on as a steps goal.

Modern fitness trackers are not that simple, and people aren’t prepared to do homework when they get a fun new device (or have it given to them by a workplace wellness program). Someone on Quora recently asked whether it was OK that his watch showed well over 200 “heart points” for the week after he completed a 10k running event, because the “recommended” number of weekly “heart points” is 150. Which brings up another risk: that using a cutesy name to differentiate your exact same base fitness recommendations as every other device—based on CDC, WHO, and AHA† recommendations for the minimum recommended activity level—may increase the probability of that default being misinterpreted.

The WeightWatchers expert said their users don’t use trackers consistently. This makes perfect sense. WeightWatchers members don’t need to rely on a fitness tracker; WeightWatchers is a supportive system that offers them an accounting method for food and basic activity tracking. Indeed, the WeightWatchers points system is a pretty good (and accessible) framework for approaching these things. The recent UCLA assessment of use of the Oura ring‡ (a very simple, screen-free device) found that personalized feedback based on fitness tracker results helps people improve their behaviors and get better results, a classic for the annals of “well, yeah,” but it’s important to have the data. And it’s not like this is easy; having live humans provide that feedback is labor-intensive and costly, and fitness trackers can’t offer that automatically. My own fitness tracker has an “insights” feature that is supposed to do something like this but has literally never, not one single time, told me anything other than the absolutely simplest thing to guess at and thus nothing insightful at all. I have configured that thing to kingdom come and look at it at least 25 times a day, and it still can’t figure out what I care about on its own.

Is it possible to build something inexpensive and easily accessed that can help a person get the most out of a fitness tracker from day 1? I think it could be done to some extent in a booklet or website—and working on a project like that sounds like a dream job to me—but it would go far beyond the user manual (“this option is on that screen”) and deep into helping people identify and prioritize different kinds of goals at a much more granular level than “fit into the clothes I used to wear.” Indeed, it would probably end up being a kind of choose-your-own-adventure curriculum of quizzes and knowledge base that would require a multidisciplinary team and regular updates to do well. Because at the end of the day, a fitness tracker is not a trainer or a coach (or a doctor or a dietician). It’s a compass. It can help you stay on your route, but it can’t plan the route for you.

—

*Weight loss as a goal is a blunt instrument – for example, weight loss is a common feature of serious illnesses such as cancer and dementia. People almost always mean fat loss or an aesthetic goal. Unfortunately, there are no good, cheap, easy options for measuring body fat percentage accurately, and what people really want is probably localized fat loss, anyway, which isn’t really how fat loss works. For most people, the easiest way to track whether a “weight loss” plan is working is monitoring changes in waist measurement.

**Sleep tracking in a fitness tracker is generally a mix of accelerometer and heart rate data, trying to estimate a rest state from a lack of motion and using heart rate patterns that have been observed in sleep studies to be correlated with one sleep stage or another. Any avid “quantified self” enthusiast can tell tales of a watch that said they were in deep sleep while they were reading in bed or perhaps in REM sleep while playing a video game.

†CDC, https://www.cdc.gov/physicalactivity/basics/adults/index.htm ; WHO, https://www.who.int/news-room/fact-sheets/detail/physical-activity ; AHA, https://www.heart.org/en/news/2018/08/21/google-just-launched-heart-points-here-are-5-things-you-need-to-know .

‡”Lifestyle Modification Using a Wearable Biometric Ring and Guided Feedback Improve Sleep and Exercise Behaviors: A 12-Month Randomized, Placebo-Controlled Study.” The study compared simply using the ring with some generic information provided with using the ring while also receiving personalized, reinforcing messages. You’ll never guess which group showed the most improvements. https://pubmed.ncbi.nlm.nih.gov/34899398/

Is Fitbit the best?

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

“Is Fitbit the best fitness tracker, or is it just the best known brand?“

Fitbit was early to market with wearable trackers. Wearable pedometers had been around for a while but were mostly a niche product (even after the release of Manpo-Kei, a Japanese product with a punning name that is the origin of the “10,000 steps a day” recommendation). There was also a chest-strap-based Polar product, paired with a watch-style display, that was released in the 1980s – Polar is still a top heart-rate monitor brand. The availability of small accelerometers helped launch the wearable fitness tracker market in earnest, and Fitbit was the first to market a small wearable (a clip-on, if I recall correctly), dedicated to fitness tracking, using this technology (a couple of years after Nokia incorporated it into a phone and around the same time Apple incorporated it into a miniature iPod – also a clip-on device).

The combination of being so early to market, launching the product at a tech conference attended by an extremely interested demographic, and a savvy marketing approach, which included actively reaching out to corporate wellness programs, gave its devices both a ready group of enthusiasts and wide distribution. Add to that some notable PR nightmares – like users’ sexual activity being exposed in people’s online public profiles in 2011 and a US Senator, a few years later, calling Fitbit out by name for its casual approach to user privacy – and Fitbit definitely acquired a brand awareness that would be hard for any other tracker to match.

Arguably, the best fitness trackers are in the Garmin product line – the first Forerunner model was released some 4 years before the Fitbit was just a model circuit board in a wooden box. However, Garmin’s early focus was on portable GPS devices, and Garmins were long of interest only to niche groups like competitive athletes and other people interested in navigation support (sailors, pilots, multisport and remote outdoor athletes). Also, their devices were fairly large and expensive in the era when Fitbit was gaining traction. They were simply not aimed at the same groups of people. Now, of course, both companies have much larger product lines, with overlapping devices.

My answer at Quora

Setting goals on a fitness tracker

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

“How should I set my Apple fitness move goal?“

By the “should” I am going to assume this means “what is a good goal” rather than the mechanics of setting goals.

Apple Watch offers a bunch of different dimensions for goal setting – including active calories and time standing – so the first thing to do is explore what goals can be set and decide which are meaningful to you.

Then it’s time to decide what level of goal to set. There are two main philosophies here: set a goal that stretches you a little, and set a goal you know you can hit. Your approach depends on your personality and how you expect the watch to help you. Another dimension is whether you are using the watch as a tool to help increase your overall activity or more as a way to manage it.

Identifying a move goal requires a combination of practicality and unflinching honesty. If I need goals that make me stretch – ie, that in the grand scheme can be easy to miss (say, because I came down with a cold, I had to tend to an urgent problem, or major weather made it unsafe to get to a facility with specific equipment) – but I also need to see that closed circle/green check mark, then I need to find a satisfying way to account for those stretch goals while not frustrating myself regularly with missed “gold stars”. If I am starting from low activity and wanting to work up, then the level of these goals – or maybe even which goals I set – will change, and I also need a plan for that.

Apple Watch has defaults based on demographics, so one way would be to accept those defaults and then see how you feel when you meet/miss them. (I believe these goals will nudge up if you meet them consistently – a way to account for increasing your activity level over time, although you and the algorithm might have different ideas about the velocity of those changes!) You should also explore the other metrics that are not goal based and see if there’s something highly reinforcing for you; this could be something trend-oriented (ie, not right for a daily goal) and meaningful enough to you that you will check it regularly and act on it.

TL;DR – factors in choosing and setting goals

There are a lot of questions that go into the goals an individual should set. Do you expect those goals to change over time? How responsive are you to nudges in general, and to indicators of success or failure in particular? Do you need reinforcement for a lot of different behaviors, or do you have one “lynchpin” behavior that causes other desired behaviors to fall into line? If you are looking to make changes in several behaviors, what is the priority? Or do you need to try prioritizing different behaviors to see if one of them can help guide the others? What is your daily schedule like? Are you looking to move more on a daily basis, or are you more interested in weekly trends? What are the features on your device, and which of those interest you enough to pay attention to them?

The number one thing to keep in mind with a new fitness tracker is that it will take time to understand how it will best help you. Give yourself that time, and permission to change course while you figure out the right direction.

My answer on Quora

How much exercise is enough?

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

“Is walking for 45 minutes a day enough to not have a sedentary lifestyle if you sit behind a desk for 7 hours a day?“

Medically, we don’t really have a clear, single definition of “sedentary lifestyle,” beyond knowing that a society in which a large number of people work in a sitting position means people do need to make purposeful effort to ensure they have adequate movement during the day. Most studies and government-issued guidelines around sedentary behavior cite health risks as being more common above a threshold of around … 7 hours a day (perhaps the reason you mention that number), although some suggest it is lower.

There are, of course, definitions of sedentary behaviors, and there are studies of health outcomes with respect to different kinds of sedentary behaviors. For example, there is research showing that hours of television watching is associated with poorer health outcomes, but the evidence for sitting to do other activities “behind a desk” (more cognitively demanding, such as work or using a computer for something other than just watching video) is not as negative, so we can’t even necessarily think of the mere fact as sitting across time as defining a “sedentary lifestyle.”

In the US, the guideline for adequate weekly activity to improve health outcomes works out to about 25 minutes a day of walking – less for vigorous exercise like running. The data we do have about exercise indicates that health benefits continue to accrue as exercise level increases, to a point that far exceeds 45 minutes a day. For people who like evolutionary explanations, investigators who work with societies that still practice hunter/gatherer lifestyles tend to find they are active on the order of 3 to 5 hours a day, of which over an hour is moderate to vigorous physical activity, so about triple the recommended level, and almost double 45 minutes a day. Very importantly, their activity levels don’t drop off with age as much as the activity levels of people living in westernized societies; they remain quite active throughout the life course.

This still leaves us with the question of what we should aim for. Studies that look for associations with better outcomes at different levels of steps per day keep finding more up to about 16,000. At that level, it’s hard to analyze effectively because there are not enough people who do it, or not enough people with different characteristics who do it. For example, it is possible that people who routinely walk more than 2 hours a day are different in many ways from people who walk 5,000 to 10,000 steps a day, and so it would not be possible to compare the two groups solely on the basis of walking volume.

From what we do know, 45 minutes a day, assuming that covers at least 5000 steps, will certainly be helpful, and it greatly exceeds the US activity guidelines (which are more of a starting point than a limit). More is almost always better. From a healthy aging perspective, being active consistently and daily – and including some strength training – is a key to a higher quality of life, and greater independence, for longer.

My answer on Quora

Sitting or standing, which is best?

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

“Is sitting or standing better for health, and in what amount? I’ve seen articles suggesting both.“

The idea behind recommending more standing rests on the high modern prevalence of being expected to be seated quietly for long stretches of time, and the observation that this is associated with poorer health outcomes. Newpapers and magazines know that a lot of their readers have sedentary jobs, so they tend to emphasize the results that recommend less sitting. Standing does involve more activity for the body in term of maintaining balance, and so on, but standing for long periods, especially with minimal movement otherwise, is also associated with health risks.

The research question, for the people doing the studies, has never really been “What should a person do all day, sit or stand?” Or at least, I don’t think any investigators have seriously asked that question. The questions investigators ask have always been more like “Hmm, it looks like people who sit a lot have more heart disease than people who are on their feet a lot [eg, in the classic London Transport Workers Study (1949–1952), comparing drivers and conductors] – what is the specific mechanism for this? How much is too much? Are there easy ways to mitigate this for people in jobs requiring being seated” and, separately, “Prolonged standing is associated with back pain and vascular problems in the lower leg – what are the specific mechanisms here? How much is too much? Are there easy ways to mitigate this for people in jobs requiring long durations of standing?”

Studies are usually constructed to address very specific questions. The idea is to make the participants in the control and treatment groups as similar as possible so you can identify a dose-response relationship: you know the thing is having an effect, because different amounts (or the presence vs absence of it) are reliably associated with a particular outcome. But you want to minimize “confounding” – factors that could be contributing to a different outcome and whose relationship to the treatment are unknown or hard to determine. In practice, that may result in exclusions or controls that are strict enough to make generalizing to actual real-life behavior quite difficult. For example, the studies of pharmaceuticals that are submitted to the FDA to support approval, even those intended for use in very serious conditions, often exclude participants who are using a large number or specific forms of other medications, even though in real life, anyone eligible for the medication under study might also need those other medications. Studies are, therefore, best thought of as contributions to an overall picture, rather than definitive answers to broad questions.

It is common for a new study with surprising results or for the most recent very large study of a specific question to be reported in general-audience media more or less on their own, with little if any context. General-audience publications often report the latest results in isolation, creating the impression that “they” used to say one thing, and now “they” are saying another, when that is very rarely the case. It’s also common for general-audience publications to see things in terms of two sides or some other binary opposition (“sitting is bad, so you should stand instead”). But from the point of view of clinical practice, a single study is only valuable as a point of information in a larger whole. If the conclusion is surprising, investigators don’t usually think “see, everyone was wrong before!” They think, “maybe there is another question we should be asking so we can tell the difference between when we can expect this result and when we can expect the other result that this seems to contradict.” That interplay rarely makes it into a newspaper article or blog post.

Most clinicians will tell you that when it comes to almost anything, “the dose makes the poison.” It’s good to drink plenty of water, for example, but it is possible to drink too much and have serious health consequences. That is true of standing and sitting as well. Doing too much, especially with minimal other movement, of either one is associated with poorer health outcomes. That said, a lot of people don’t really have the flexibility to switch between sitting and standing during their work day, so telling people to mix them up is not very helpful. Fortunately, there is another set of guidelines that can help all of us: getting at least the minimum (ideally more) recommended physical activity – a combination of sustained activity, like walking or running, and muscle-strengthening activities, like climbing, pushups, or lifting weights.

My answer on Quora
US Physical Activity Guidelines

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