Tag Archives: Quora

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

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

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’s 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