Blog Archives

we love a challenge: nudging the nervous system

July 5

In our weekly scour of the health literature, we often find information that we hope to never need. While many studies have no relevance to our efforts, others carry important messages even when their primary message is not immediately applicable. This week, tucked away in the Journal of the American Medical Association's Internal Medicine pages was such a study. 

At face value, a study about minimizing the negative side-effects of chemotherapy might not seem directly in line with Pro-Activity's health-facing (upstream, preventative, etc) efforts. However, when we consider what this study is telling us, it is perfectly in line as it is evidence, in a highly concentrated way, of one of the core messages we often deliver - future quality of life (happier people) is more easily achieved when we push ourselves to stay strong now.

The harsh reality of chemotherapy is that, while powerful and at times nearly miraculous in its ability to kill cancerous cells, it often has spillover effects causing a negative impact on nearby healthy tissues. Since the nervous system supplies all cells and tissues of the body (even those that have gone rogue), it is especially susceptible. Like having a "pinched nerve" that never quite goes away, patients undergoing chemotherapy often experience nerve-related symptoms such as burning, pain, weakness, and balance problems called chemotherapy-induced peripheral neuropathy (CIPN); a recipe for lower quality of life that no one wants. Interestingly however, when patients demanded more from their nervous system, in this case by stimulation with specific exercises, they were able to cut their risk by 50-70%.

In a randomized trial that involved 3 groups: the first was a control group which had the usual care, the second was a group that received nervous system stimulation through whole-body vibration and a third which was given a sensorimotor exercise protocol (designed to stimulate the nervous system through balance, stability, sensory challenges, etc) twice per week, the results were clear and impressive: stimulating the nervous system, even in the presence of toxic chemical agents, added resilience. Or said more plainly, when we challenge our systems to MOVE deliberately and appropriately, they work hard to respond and adapt.

Although in this case it was tested with chemical stress, the response is very similar to that which is reported with exercises that challenge our balance as we age (e.g. Tai Chi) or dynamic warm-up protocols which are known to significantly lower injury rates in athletes - when we tell our body we need something and give it a little time to respond, it almost always does.

It doesn't take much to keep our nervous system strong and resilient but it does take something - give it a nudge with a few minutes of balance work today.

Have a great weekend,

Mike E.

lower back pain? walk it off

June 28

The text was simple enough "Is there any chance I can grab a few minutes for a consult?". What ensued was a conversation I've had too many times to count over the years. The pain was severe, making it, even for a healthy and fit individual, a little scary; something that can't go away fast enough and ideally never returns. After we went through the potential red flags and found none were present, we concluded that it was following a well-known pattern, one that was big on "hurt" but, thankfully, not as big on "harm". It was safe to MOVE.

Now came the hard work, coaxing the body to do so and understanding the need to strike a balance between "enough" to stimulate but not "so much" to aggravate or set things back. In this case, the idea was first to control inflammation and normalize movement (as quickly as able) but still watch for signs of overload in the irritated area, what we often refer to as "optimal loading", which is relative to the person, rather than just "rest". Before we got off the phone I made the last and maybe most important point - this kind of back pain doesn't have to happen again, but without effort, it almost always does for those who don't stay ahead of it. Within 96 hours, this individual was golfing.

Back pain is common and can be severely debilitating. With the right information and a willingness to build up the body's resilience through optimal loading, it doesn't have to be. While the number of times we've seen this over the decades is almost uncountable, it's always nice to see the finding in print, this time in one of the most prestigious research journals on the planet. 

After following 700 randomly assigned individuals with debilitating (but not structurally worrisome) lower back pain, getting a consultation and a professionally guided loading schedule, in this case using walking as the movement of choice, lowered the risk of recurrence by 28% and nearly doubled the time between flare-ups compared to those who were in the control group.

Bodies are far more likely to bark at us as we inch closer to the edges of our capacity (and therefore resilience). Peak Summer can be one of those times. With a little guidance and the willingness to "walk it off", maybe this year it doesn't have to be. Reach out if we can help.

Have a great weekend,

Mike E.

trading away health: all part of the process

June 21

There's really no need to make it complicated - the more industrialized the diet we choose, the harder it is on our bodies. This is the general theme that rang through 3 new studies all published in the last 2 weeks. While each evaluated a different problem - the first, the connection between salt and a common skin condition, the second, the connection between junk food and anxiety and the third, the link between a common artificial sweetener and major heart events - the takeaway was the same: the trade-off for a highly processed diet (which are often loaded with salt, fat, and sweeteners to achieve shelf-life and brain-teasing flavor) is future health. 

The first study looked at the results of more than 200,000 urine samples and found that as sodium content increased, so did the likelihood a person was diagnosed with eczema, one of the most common (+/- 30 million Americans) skin conditions. For every 1 gram of sodium excreted in the urine, the likelihood of eczema went up 11%. Although they're not exactly sure why, the general consensus is that as the body tries to rid itself of excess salt (not only through urine but sweat) it gets stored or even trapped in the skin creating a chronic irritant. This adds plausibility to some studies which have shown flares tend to be more common in the winter months - less sweating means more trapped salt.

The next study looked at fat consumption and its connection to behavior. While it's important to point out that this was an animal study (lab rats), the results paint a very clear picture that is worth at least considering: A diet that was engineered to achieve +/-10% greater fat than the "Standard American Diet" resulted in behaviors that suggest greater anxiety, negative changes in the gut biome and even genetic changes associated with unhealthy changes in brain chemistry.

The last study looked at a commonly used artificial sweetener and sugar substitute (xylitol) and whether it increased the risk of major cardiac events. The short answer, from a research team that looked at more than 3,000 subjects, was yes, as much as 57% in the highest consumption group compared to the lowest, which showed signs of an increased likelihood of developing blood clots. Of course, as always, there is nuance and this risk, especially in those who don't over-do it, may not entirely outweigh the benefits of this low-glycemic sweetener, but it should give pause to those who are consuming lots of highly processed sweets.

 Of course, sometimes the hardest thing to do is to find the "what to do" which fills the void left when so many studies tell us "what not to do".  This time of year we are in luck - fresh fruit and veggies are easier than ever to come by and we know that consuming more of them can counteract and fill the gap. Not only do they increase water and potassium (which helps to counterbalance the effects of high sodium) but the fiber on board helps us to rebalance the gut and even tamp down cravings for the kinds of treats that are loaded with fats and sweeteners. 

Step away from the dietary machine...and find a farm stand...chances are they are selling the FUEL that your future self wants more of now.

Have a great weekend,

Mike E.

beliefs drive behavior? safety in movement

June 14

Imagine you wake up one day with a stiff knee. Maybe it presents with some slight but nagging discomfort; more annoying than worrisome. If you're anything like most you'd probably not think much of it and might even try to ignore and "push through" it. 

But what if it was there again the next day or even the next 15 in a row.

Would you tend to want to get it moving or would you be more inclined to avoid movement and give it rest? Would it worry you?

Although the worldwide statistics would suggest that for as many as 4 of every 5 people (or more) this situation is only hypothetical, they are critical questions for the remaining 20% because, for nearly 1 of every 5, there was a day or days just like this that acted to signal a warning sign, possibly that something "wasn't right" with someone's knee(s). The stiffness may have been formally labeled "knee osteoarthritis" (OA) but even if not, the likely feature was discomfort, at least initially, with movement.

The irony of course is that despite it often being uncomfortable and sometimes fatiguing to move with knee OA, the condition usually responds favorably to movement. In fact, various forms of exercise are at or near the top of the recommendation list endorsed by groups like the American Academy of Orthopedic Surgeons in their clinical practice guidelines.

So if we know it works, why doesn't everyone do it?

This is the fundamental question that a research team in Australia pondered. Their hypothesis was, in an oversimplified way: when we are in discomfort long enough, our beliefs about it (and what effects it) might change; even though we consciously know movement is good for us, we might actually fear it deeper in our subconscious.

In a really cool experiment that, if you have 10 minutes and are at a computer you can take for yourself at this link, they found that below the cognitive surface, people with painful knee OA were significantly more likely to associate movement with danger (as in, something to avoid) than those without pain or knee OA. For many, this could be a very big deal because if our day-to-day actions are rooted in our beliefs, this may present a significant barrier for those with stiff knees. It may even be one of the reasons why so many gravitate away from movement, which might actually make things worse. This is, of course, all very preliminary...but interesting nonetheless.

There was a time when health care recommended rest to help manage knee osteoarthritis because they weren't sure movement was the answer, but that changed at least 30 years ago. Today, we know it as "the best, non-drug treatment for improving pain and function in OA", just like it says front and center on the Arthritis Association's website.

Keep those stiff joints moving - let us know if you need a nudge.

Have a great weekend,

Mike E.

No Matter the Blueprint, 8 Factors Guide the Build-Out

June 7

I remember feeling excited and maybe even a bit vindicated in 2022 when the American Heart Association announced their latest update to the list of "most important things known to lower heart risk"...which was being called Life's Essential 8. The excitement had to do with them finally and definitively including sleep to their known risk factors; something that seemed so obvious given the research on the subject. I quickly created a free account and performed their "My Life Check" online risk calculator (found here) to see where I stood. It was relatively quick and easy, a solid tool for those of us who try to stay ahead of heart disease...and of course, all the outcomes that these same root risks are connected to, including aches, pains, and more. 

Their 8, which although not perfect for everyone but solid for most, includes four behaviors and four clinical values all graded on a 0-100 point scale (and then averaged), considered within the context of life stress and healthy connections. While we use terms like MOVE, FUEL, RECOVER, ENDURE, CONNECT they say:

1. Eat Better - which they define as close to a DASH Diet

2. Be More Active - which they define as 150 moderate minutes of exercise per week or more

3. Quit Tobacco - which they grade from never smoking to being a current smoker (or other)
4. Get Healthy Sleep - which they define as 7-9 hours per night (not more, not less)

5. Manage Weight - which uses a sliding scale based on BMI

6. Control Cholesterol - which they define as less than 130 mg/dL of "non-HDL" cholesterol

7. Control Blood Sugar - which they define as having no history of diabetes AND fasting glucose < 100 mg/dL

8. Control Blood Pressure - which they define as < 120 systolic and < 80 diastolic mmHg.

All while considering known health risks like isolation, inadequate social connection/contact, and inadequate stress management via unhealthy coping skills.

Perhaps not surprisingly, when I saw a new study, that compared the relatively simple my life check score to the odds of future heart events and with more complex signs of biological aging encoded on our DNA (methylation profiles), I was eager to dive in. The initial findings were also not particularly surprising: As healthy lifestyle scores increased, future heart event risk decreased. For every 13 points a person's health score went up, the likelihood of a future heart event or dying was cut by around 1/3rd. Interestingly however, there was also a strong link with biological aging which meant that for those who were genetically susceptible to accelerated biological aging, having a healthy lifestyle had an even greater impact, lowering their risk by closer to 40% for heart-related events and more than 75% for dying during the study period. Ultimately this meant that while the 8 health factors accounted for as much as 20% of an average person's total heart risk, they accounted for twice as much (40%) for those with the risk of accelerated biological aging.

We may not control our cellular blueprint, but the build-out is largely up to us.

Have a great weekend,

Mike E.

Enjoy the Warmth to Endure the Heat

May 31

Like most teams and groups, ours at Pro-Activity has a text string...well several, because also like most groups and teams, ours is always running in different directions and doesn't get to be together to trade stories, compare notes, and get information in person very often. It's equally likely to get a birthday wish or funny story as it is to get a research article, podcast recommendation, or account of a self-experiment. Today it was Aaron sharing a self-experiment he may not have meant to run when he was out for, well, a run last week. In essence, some of the normal indicators he tracks (via Garmin wearable) were telling him that his system was a bit more stressed than expected. He found that the temps (> 80 deg. F) had gotten just hot enough to place extra strain on his heart. Although this change is exactly what we know to expect, is something we often talk about this time of year and, if handled correctly can be beneficial, it's also easy to not recognize and maybe even ignore when not front of mind. It's one of the reasons why we reintroduce the following mantra every single year around now: "heat stress is heart stress" - even in well-trained athletes.

A recent article in the Journal of Occupational and Environmental Hygiene which outlined the risk factors associated with fatal heat-related illness made this very clear. The authors reviewed data and records from the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) and found 9 cases of heat illness that led to death. Almost all of the risks related back to heart stress and the health required to handle it.

Of those who died, all of them were men under 50 years old, 8 were performing physical work at a moderate or heavier level in the heat, and 6 were overweight or obese. 5 were using stimulants which are known to stress the cardiac system and 4 had a history of heart disease of one type or another. The authors concluded that 4 major risk factors were present: Lack of Acclimatization, Inadequate Training, Underlying Cardiovascular Disease, and Stimulant Drugs. They went on to say that in at least 4 of the cases, fluids and air-conditioning, which were provided, were not enough or used too late.

This all leads to one really important conclusion in my opinion - it doesn't have to be this way. With an effort to ramp appropriately, an effort to understand where we are in that process, and the ability to make small adjustments along the way, we can be ready for what we know is coming in, officially in the next 3 weeks if it doesn't get here sooner.

So what should we do NOW to be ready for Summer - which officially starts on June 20?

1. Graded exposure is key. It is generally accepted that the body will adapt after +/- 2 weeks of exposure to heat. While doing so naturally by spending progressively more time in temps greater than 70-ish degrees will usually do it, in some cases other exposures such as hot baths and/or saunas as studied here may speed up the process. Unfortunately as a stand-alone strategy (without working on fitness for example) the results may be temporary.

2. Ramping Up Takes Energy. Anything that forces the body to adapt draws on our resources. For those who don't have a wearable to see the change in cardiac balance (HRV) or resting heart rate, changes in sleep, or the desire to be more sedentary might be an easy tip-off that your body is ramping as shown here. This is one of the main reasons we often emphasize getting a little more rest when able this time of year.

3. There are Benefits. The beauty of our physiology is that as long as we don't expect instant changes (number 1 above) and we respect the process (number 2 above), we will adapt and our health will actually improve some. As shown here, it's reasonable to expect that once we are through the acclimatization period, we will show increased signs of fitness, like a lower resting heart rate, which may be one of the simplest and most consistent predictors of future health. The average reduction was 6 beats per minute. To put that into perspective, one recent study showed that when taken lying down even a 1 beat per minute change signified a measurable cardiac performance change as measured by exercise testing.

It's unofficially Summer...which means it's time to ramp up our cardiac fitness to be ready for the actual Summer season again. If we embrace the warmth now and respect the adaptation process, we will be far more ready for the heat later.

Have a great weekend,

Mike E.

The Bat Phone

May 24

Most people know the basic story of Batman. Secret crime-fighter, lots of cool gadgets and only 1 phone call away when the police commissioner (Gordon) needs help. Way back, when Batman was a TV show, the commissioner would pick up a direct-line red phone to relay information about a high risk situation and within seconds, the problem was being dealt with.

Although far more entertaining than a typical risk monitoring and reporting system, the bat phone "system" is not all that different than other systems we rely on to stay safe. Smoke detectors monitor our homes and prompt us to call for help when it's needed. We teach even our youngest citizens how to make that call and what to expect when they do. The sooner we call, the faster help can arrive and assess the threat.

In the late 1990's we started seeing a similar pattern when people were at high risk of aches and pains. When those whose bodies were giving warning signs got to us quickly they usually did better, faster than others who waited and let things get even more tangled. It was easier for us and better for them so we started sharing our direct phone numbers. Within a year the clinical research started suggesting the approach had merit. Studies like this one were reporting better outcomes in less time for those who got the help they needed quickly. As the model got more refined, it became clear that it not only mattered "when" the call was placed, but also "who" picked up on the other end. It didn't have to be a superhero, but they needed the right plan, and it was easier to remember 1 number...and so the triage hotline idea was born.

15 years later, it was data from the US Military on low back pain which backed up the approach; they showed significant time and cost savings when guidelines designed to get people moving quickly were followed... but only when those guidelines were followed. Fast forward another decade to the present and the research has gotten even more refined. 

In a review of 3,000 studies, of which 31 met the criteria, this study (published earlier this year) showed that early response or "MSK Triage" as we sometimes call it, works well when it accomplishes 2 critical goals: 

(1) it helps the person experiencing pain understand what they are feeling, why and the likely progression so they can worry less and 

(2) gets them appropriately active - not too little, not too much, just right.

Anything that worked against those two goals, for example by either slowing down the first call, causing the person to become a more passive participant in their recovery or adding significant medical complexity to their path (strong pain meds and advanced images like MRI), tended to do worse; very similar to what we see on the ground in workplaces everyday. 

With Summer coming, this is often a time of year when bodies get a little overdrawn and tend to grumble and groan. While it's definitely better to build capacity and resilience to the risks we will face, and there's still time to do it, please know that we are standing by should you need to pick up the phone...capes not included.

Have a great weekend,

Mike E.

less hack, more lifestyle

May 17

I got a chance to watch the "Hack Your Health" documentary on Netflix last night. Although the title made me a little skeptical, it was an interesting big-picture review of one of the most exciting areas of health research today, the trillions of microbes we work with every day to get through life - the microbiome. 

There were interesting stories (ever wonder what 20 years of competitive eating actually does to a person?), well-known experts including a bestselling author, and several of the key voices in the space (such as researchers from Stanford U, and UC Cork, IRE) and confirmation of key themes many may already know at some level.

Here are the six that stood out to me:

(1) What we feed and cultivate flourishes, what we neglect struggles to survive.

(2) High microbe diversity (i.e. lots of different types in an ecosystem) is linked with health

(3) Since most people living in the US are not even close to consuming enough of what feeds the healthy microbes (fiber), our biome is getting less diverse and closer to a profile linked with disease (high-inflammatory, etc).

(4) This isn't just a US problem. The more "Western" daily intake becomes (i.e. high sugar, high fat, high process) anywhere in the world, the less diverse the biome becomes.

(5) There are quick responses (even in 1 day the body responds) but no quick fixes (it takes MONTHS to make changes permanent)

(6) And, especially one with LOTS of plant varieties consumed each day is the best next step for most of us.

So while it's never easy to thread the needle of "infotainment" which both appeals to a broad audience and is scientifically rigorous, the latest research continues to point generally in this same direction - the claims appear accurate.

For example, one study in the British Medical Journal this month showed an increased risk for those who consume a heavily processed diet with high processed meat consumption linked to the greatest increased risk. Another in the journal Nature showed that as traditionally rural cultures urbanize (and intake shifts toward a Western diet), the microbiome demonstrates a pattern associated with disease. Finally, and further along in the risk spectrum, as reported in the Journal of the American Medical Association on May 1, men with early-stage prostate cancer who consume the most plant-based foods have the slowest progression in the disease over time, about half the rate of those who eat the least.

And if one of the researchers featured in the documentary and at the forefront is right - most of what is knowable in this area is still unknown - so perhaps his simple tips toward eating better is a good starting point. 

It's gardening season - maybe you will be the one to decode either the remaining ingredients or the recipe for a better-tasting 60-plant super-smoothie - if so, let us know!

Have a great weekend,

Mike E.

Sleep, It Does The Body Good

May 10

If the CDC estimates are correct, roughly 2 million US men and 12 million US women, that is, 4% and 19% of the population over 50 respectively, have lost enough bone strength to be diagnosed with osteoporosis. It's a way bigger problem than most people consider because when we overlay the millions of falls our parents and grandparents experience every year, things get pretty grim.

To me, one of the more interesting things about this risk is that for a long time those of us in our working years could feel OK about putting off thinking about it. After all, it's a problem mostly faced in our retirement years and we're not there yet. However, more recently, like several other injuries & diseases where age appears to be a major risk factor, what we do today tells us more about how we will live tomorrow, than ever before.

For example, 20 years ago suggesting that common age-related brain disease (e.g. dementia) was similar enough to other common lifestyle related diseases (e.g. diabetes type 2) to call it "the same problem at a different site" would've been a fringe idea. The idea that Alzheimer's disease was actually "Type 3 Diabetes", originally attributed to a researcher from Brown University in 2005, being reported on in an alternative medicine journal in 2009 probably shouldn't surprise us. 

Yet, while we've learned a lot since then, and the understanding of age-related diseases has been refined, one take-away seems clear: what we do early in life (pay now), strongly predicts what we will be able to do later (or pay later); and as it turns out, it's not only our brain but in our moving parts too.  One study that makes my list of "super interesting" (although too old to really call it current), showed that muscular strength (grip) and lifestyle choices (nonsmoker, physically active) predicted a long and healthy life. This is probably why this research, led by a physician in Colorado really grabbed my attention.

Ultimately beginning with initial studies several years ago, she found that RECOVER now matters for bone strength tomorrow in a very big way. Specifically, in both men and women, when sleep was disrupted or fragmented, bone mineral loss was more pronounced. In younger women, it was even more significant because their bodies more actively used the minerals being released, representing a "decoupling" which likely leads to the disease in the future. Although the study is ongoing (want to join?) the big message seems clear enough - like so many other health risks we face, all 3 legs of the stool matter:

Weight bearing MOVE is well known to stimulate bone growth - this position statement adds more.

FUEL, especially low inflammatory and high in particular nutrients (such as the Mediterranean Diet), gives our body the right inputs to build.

And now, even without the cool milk-mustache, a debate on value for another day, we can say that getting enough high quality sleep helps us RECOVER....all the way to our bones.

Have a great weekend,

Mike E.

has risk met its match?

May 3

One of the upsides of having put most of a career into a single focus is that you get to witness change happen. Sure, many of us who are at or nearing the peak of our "earning years" (generally mid 40's to mid 50's, data here) might also be resisting the transition from "seasoned veteran" to "old timer" but with any luck, tucked within those titles, is a bit of wisdom gained along the way. For me, and although a few generations ago in terms of health information and trends, it seems like only yesterday when a fair amount of our effort was directed at debunking myths that questioned the value of healthy habits like exercise. Despite mountains of evidence to the contrary, some of the most common misconceptions like "I have arthritis and so I've been told exercise will make it worse" and "I strained my back and was told bed rest was best" were hard to crack, but it was nice to see them make their way to the rearview. A few that are a bit more nuanced, like "my work is all the exercise I need" and "I've heard running is bad for your knees" have hung on longer than they should've, but in general, also seem to be getting closer to the history books. 

One of the greatest changes in the broader narrative, which I've mentioned previously because I'm a fan, is the transition from "exercise is (generally) good" to "exercise is so powerful it can be dosed like medicine to prevent and reverse disease", which has its own growing evidence mountain. Just this week some additional research was thrown onto the pile which made the case even clearer and therefore the headlines even more powerful.

First, an interesting finding presented at the European Society of Cardiology's prevention conference made it super simple - take the stairs and live longer. After performing a study of combined studies (meta-analysis) which included nearly 1/2 Million participants across 9 different studies, the conclusion was clear. From the press release: "Compared with not climbing stairs, stair climbing was associated with a 24% reduced risk of dying from any cause and a 39% lower likelihood of dying from cardiovascular disease.".

Next, an even larger bundle of studies published in the British Journal of Sports Medicine, in this case including 20 Million observations, made the "why" far more clear: as fitness improves, risk drops - to the tune of nearly 20% per 1 unit of fitness (aka Metabolic Equivalent of Task or "MET") gained. This is really great news because it strongly supports the notion that we highly value progress, even if our personal potential isn't yet within reach.

Next, and bringing some of the jargon closer to something practical, earlier this year, the world got an update to one of the fitness master documents, a list of common activities and the fitness (in METs) required to complete them known as The Compendium of Physical Activities. This makes it easy to know where we stand from a fitness perspective and what a one-unit jump might require. My favorite in the updated list might be that some of the Monty Python silly walks are listed...but I'm still searching.

Last, I was really excited to see some new research tackle a really important question - what is the best dose of exercise to reduce lower back pain? For this, the authors used MET-minutes, which gives us a good idea of 2 critical parameters of exercise: "How intense?" and "How long?". As it turned out, just like medicine, it was a "sweet spot" - too little didn't help and too much was too much. The minimal dose to get an effect was 520 MET-minutes per week and the maximum effect was achieved at 920 MET-minutes. If we used "brisk walking" (as defined by the CDC and cross-referenced in the Compendium) as our activity of choice, it would take somewhere between 85 and 175 minutes per week to get an effect, with the maximal effect coming in between 150 and 300 minutes. Not ironically, these numbers just happen to be almost exactly what most studies point to as the amount of moderate physical activity needed to maintain or improve health.

Whether you MOVE for enjoyment for prevention or treatment, when we find the right dosage for our goals and needs, it works. It just happens to be a wonderful time of year to get a bit more of it.

Have a great weekend,

Mike E.

caution: early warning signs and future risk

Apr 26

One of the most important but often unsung heroes of health & longevity is "the precursor" aka "the early warning sign". Like that small yellow plastic a-frame that says "slippery" after someone just mopped the floor, they can be easy to pass by without much thought, but for those who are both paying attention and understand the message, can be highly valuable indicators that the time for change, in this case shortening our stride length to keep from falling, is now. Although equally easy to miss if not paying attention, changes in our day to day can be important indicators of our future health. For example, and as shown earlier this month, moving slower or less may not only be a well-known risk of developing disease (risk drops at/above 8K steps per day) but may also tell us our heart is struggling to keep up with the demands of life. It's not just physical health. A 2018 study showed that physical activity patterns predicted depression in adolescents and last year, similar patterns predicted accelerated aging at the genetic level. Although wearables make this much easier to see, it's not the only way.

It turns out it's not just movement data and it doesn't necessarily require tech to capture it. Earlier this week a study of more than 15,000 individuals from a team in China showed that sleep patterns also had predictive value. Using a very simple method to create a "sleep score" which ranged from 0 healthy sleep factors to 4 healthy factors, and then comparing those with healthy patterns (those who scored at least "3") over time, created a very simple matrix of persistently unfavorable (unhealthy), favorable to unfavorable (declining), unfavorable to favorable (improving) and persistently favorable (healthy). Perhaps not surprisingly, compared to individuals with regularly unhealthy sleep patterns, those with regularly healthy sleep had the best risk profile (20% lower risk of cardiovascular disease), which was even more pronounced in those who had a high genetic risk for heart disease (35% lower risk).

 Want to know what your sleep score is? Try it out using the four factors below - each is worth 1 point and scoring at least 3 points total would indicate "favorable sleep".

(1) Bedtime between 10P and 12A daily

(2) Sleep duration of at least 7 but not more than 8 hours regularly

(3) Daytime sleep (napping) of 60 minutes per day or less

(4) Rating of "sleep quality" as at least "fair" on a four-point scale of "very poor, poor, fair, or good"

Sometimes life isn't subtle - our risk jumps in front of us like a flashing sign. Other times, we won't notice it unless we slow down enough to pay attention. Daily actions and the routines they become often act like early signs cautioning us that something is a little off and it's time to get back on track. Movement and sleep can be great places to start. If you've got a smartphone with a health app or wear a smartwatch you may have all the information you need. Let us know if you need help interpreting it.

Have a great weekend,

Mike E.

the reset button: move more, hurt less

Apr 19

Imagine being asked to put your hand into a bucket of ice-cold water and keep it there until it was so uncomfortable you had to take it out. Then imagine 7,000 (or thereabout) other people doing this same thing. It might sound like some sort of cruel and unusual punishment, but in actuality, it is one of the most commonly used methods to assess pain tolerance, a surprisingly adaptable "warning system" that helps us to safely interface with the world around us by allowing us to quickly determine whether or not something is likely to cause us harm. Accidentally touch something "too hot", that is, beyond the threshold of our tolerance such as a pan on the stove, and our brain quickly knows to pull back from the source because it could cause severe harm. Step outside on a cool morning and feel the less intense, sub-threshold warmth of the sunshine and we might find ourselves turning into it because this level of the same kind of stress (thermal) is not a threat. For most of us, pain is a reliable threat-detection system, however in some situations, such as in chronic pain, things can get a bit miscalibrated, and our brain can overreact keeping our default setting so close to the threshold that the feeling of pain and the level of threat or risk become decoupled. Not surprisingly, lots of study goes into understanding how the system works in hopes of guiding how to keep it working well and even to reset it if the need arises.

One of the more interesting findings in the last few years came from a research team in Norway in 2023 which found a link between movement habits and pain tolerance. Specifically, they found that as leisure time physical activity went up, so did pain tolerance on the hand submersion (aka Cold Pressor) test. Even with as much as 8 years between measurements, those who were physically active or became physically active, had a higher tolerance - suggesting that not only do our tissues physically toughen with regular use, but that our threat-detection system which protects those tissues, also adapts to account for this new resilience.

It is probably not, however, an endless potential. It is far more likely another of our many physiological Goldilocks phenomena, in this case where the brain progressively turns the volume up, possibly to the point of over-sensitive when it's not being adequately used and down, possibly to the point of non-functional in the case of excessive stimulation. One study for example showed that both elite athletes ("too hot") and non-athletes ("too cold") were less accurate than non-elite athletes ("just right") when it came to tasks that required "listening to their bodies", called interoception. The question then, especially for those that may have long-standing aches or pains (e.g. > 90 days) or multiple body areas that are always cranky which can be a sign of this decoupling is "How can we start to reset things"?

While the initial answer is almost always "it depends" and therefore quickly followed by "that's why you have us, let's dive into it and find out", the eventual answer might include FUEL changes toward lower-inflammatory eating (such as those described in this study), an emphasis on tactics known to increase how well we RECOVER through better sleep (known to impact our pain sensitivity) and, with even more evidence out last month from the same Norway based team described above normalizing physical activity patterns, which often means MOVE more to reset pain tolerance and lower the likelihood of chronic pain.

Resetting can be challenging, sometimes to the point of daunting when we've got an ache or pain that's been with us for a bit. However, the more we learn the more confident we are when we say it can be done. We're here when you're ready.

Have a great weekend,

Mike E.

predicting future production

Apr 12

One of the coolest things about the often long-standing relationships we have with clients is witnessing their families grow up. Although always a reminder of how fast time flies, it's super cool to be hearing about tales of rec-sports or dance recitals one minute and then, in what feels like a snap of the fingers, hearing that the kids are heading off to college or applying for a job "at the company". While most people don't think of the large employer clients we connect with as "family businesses", so often, in fact, they are, with generations of men and women learning the literal "tricks of the trade" from their parents and grand-parents; good jobs with an ever-evolving skill set. New tools and process improvements are tested all the time - and scanning for a better way is all part of gaining a performance edge in the marketplace. Now, while sometimes this means producing more, often it's about producing better - a higher quality product or a better outcome, preferably via a process that is less risky for those "doing" it.  

With that in mind, anytime I see research that points in that general direction, I'm excited to share it. This time, it is about improving health risks today to maximize the next generation's ability to work a full career tomorrow. Taken from a VERY LONG observation of 1200+ individuals, if we want our kids to not have the aches, pains, and illnesses that we are dealing with today, 45 years later the punchline is - "Invest in Fitness", specifically cardiorespiratory (aerobic) fitness.

In the mid-1970's when Finland was starting their "global worst to first" countrywide health turnaround, an amazing accomplishment we've discussed in the past, they began tracking several measures of fitness in school-aged children (12-19 years old). In addition to standard height and weight measurements, and similar to the US Presidential Fitness test from way back when (now the "FitnessGram"), they also included measurements of muscular endurance, strength, and power, using tests like the flexed arm hang, situps, pull-ups and standing broad jump, along with running tests to measure aerobic fitness.

Where it gets interesting is that researchers were able to track down many of those Finnish adolescents when they were in their prime earning years (37-44 years old) and again in their late earning years (57-64). More than 1200 agreed to complete a questionnaire known as the "Work Ability Index" which has been shown to accurately capture a person's ability to be productive at work and also the amount of illness absence they experienced at those times of life.  

After statistical scrubbing to account for known accelerators (like low levels of education and occupations that include heavy physical work) and decelerators (like volume and intensity of leisure time physical activity), they found that only cardiorespiratory fitness was associated with higher future productivity at work and lower odds of illness absence. The researchers concluded, "Enhancing CRF in the first decades of life might contribute to better work capacity and productivity in the labor force, which would have implications for health, quality of life, society, and the economy.".

We don't know what the future holds, but even in a world where computers might do most of the heavy thinking and robots the heavy lifting, it's probably reasonable to assume most of our kids WILL have to work for a living. Nudging their fitness now is likely to be one of the best investments we can make for when that time comes.

Have a great weekend...maybe get out and play,

Mike E.

the "big 3" of brain health

Apr 5

Preventing injury/illness/disease is essentially managing the risks we face. If we avoid those with catastrophic potential and minimize exposure to those known to chip away at our defenses over time, we put the odds of a stronger, happier life in our favor. A simple idea requiring a level of effort and endurance few have the fortitude to pull of the fundamental challenges we wrestle with every day.

As we see it, a big part of achieving our mission is to both find the common roots and make them easier to get to at. And while most of the risks we face can be categorized under 5 themes (ELEMENTS), a steady stream of new information demands that we revisit, refocus and refine all the time. This time, and thanks to a multinational team who tested the 12 risks that have been previously shown to account for 40% of the world's dementia risk, it's in our understanding of how we might be able to narrow the list down to 3 and keep the most vulnerable areas of our brain out of harm's way.

The 12 risks include 9 which had been identified prior to 2017 including less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes and, low social contact along with 3 which were added to the list in the 2020 publication: excessive alcohol consumption, traumatic brain injury and air pollution exposure.

Now, using data from nearly 40,000 people in the UK to test against these risks, the research team was able to determine that after accounting for age and sex, the most vulnerable areas of the brain (referred to as the "last in, first out" network because it includes areas of the brain that develop late and tend to deteriorate early) were most strongly impacted by alcohol intake frequency, a diagnosis of diabetes and air pollution exposure, in particular Nitrogen Dioxide (NO2), which can be tracked here.

So what do we do about it? Thankfully, when we follow the evidence - the answer is "start at the beginning", MOVE and FUEL.

MOVE - meeting physical activity guidelines not only significantly lowers the risks associated with alcohol consumption in those who drink, it also makes a major impact on diabetes risk, interestingly, even in those who are exposed to high levels of air pollution.

FUEL - diets heavy in plants, especially veggies, not only help with diabetes risk, they have also been shown to lower the impact of air pollution on our health.

When we get to the roots the advice is clear: Protect your brain with more of the same.

Have a great weekend,

Mike E.

Take a leap of fitness with cranberries

Mar 29

In an effort to keep it brief - here is a 1 paragraph summary of years of data collection and dozens of research articles...and also something you probably already know if you've read this blog for a while:

Healthy foods, naturally loaded with antioxidants and polyphenols (aka "plants"), when consumed regularly, have consistently proven to enhance human performance -- disease resistance and athletic performance alike. Those with very high concentrations (esp. berries, leafy greens, and beets) have been especially well-studied, and have proven benefits and few (if any) negative side effects. Generally speaking except in rare cases, we should all probably eat more of them.

In truth, there's not that much more to say - lots of good, not much (if any) bad, fairly easy to access and consume so outside of special cases (allergy, etc) we recommend - but for those who are a bit more geeky with this stuff, exactly what these foods unlock is always fascinating. This time, a research team from Canada found that after 28 days of cranberry supplementation (**note** the study team used an extract to more easily control the dose, not the whole fruit), well-trained runners improved their times by nearly 2% in an event that stressed the aerobic system (a 1500m time trial) and had better recovery markers in an event that stressed the anaerobic energy system (a 400m time trial). In plain English, this means that loading up on cranberries, which rank at/near the top in their concentration of polyphenols and antioxidants, allowed runners to go faster for longer during submaximal efforts and bounce back faster after maximal efforts with around the same benefit as several other evidence-based performance enhancing supplements.

Of course, since most people are not "well-trained athletes" and therefore might not even notice a 2% improvement because they rarely (if ever) stress their systems this way, it wouldn't surprise us if this one slides into the "meh, who cares" pile and not the "interesting enough to use" pile of daily information...which, at least in my opinion, would be a mistake. 

We know that the cardiovascularly-taxing heat ramp-up is right around the corner, a drain that most of us will experience as we try to power through greater levels of fatigue during the first few weeks. And since acclimation is slow, but workloads go up fast, we are walking a fine line with our health while doing so. The unprepared among us will be more vulnerable to fully preventable injury (or worse), something we see every year as the temperatures climb. If adding in some fresh and healthy foods now is enough to keep us below the risk threshold during the next 60 days, it's well worth the effort. For those not into the "earthy" flavor of well-studied beetroot juice (sadly, it tastes a bit like dirt), a handful of cranberries (and preferably walnuts + 1-2 cups of spinach, which together makes an easy-to-prep & tasty salad which can be leveled-up even further with added blueberries) can go a long way. So, while the official leap day was last month, it'd be (April) foolish to push off thinking about heat readiness until tomorrow (get it? ). 

We're "there" again, it's time to prepare because with climbing temps comes added heart stress associated with ramping up to meet the demands, something we can not only deal with but benefit from if we respect it. Now is the time for a leap of fitness - healthy FUEL can help.

Have a great weekend,

Mike E.

slowing down time

Mar 22

We humans have a strange relationship with "time". While our physiology is programmed around the standard 24 hours of it, meaning we rely on it as an anchor of daily life, we also live in a world that constantly crams more into it, ultimately straining our ability to keep track of it. To add to the complexity, how we perceive time depends on the situation we are in. Most of us have experienced time "flying" when we're having fun, an often touted positive feature of the "flow state", and still we try to slow it down or even press pause to savor moments we might never have again. We want to believe it is a constant, one of the few hard rules we can count on, but the truth is, it's not.

Now, while intentionally changing time much beyond setting it forward or back to "save" some daylight as the seasons change seems like a recipe for chaos, giving it a little less prominence in how we measure our life might be warranted. For example, while we usually mark our "lifetime" exclusively in years, using our biological clock might make more sense since, variable as it might be, it more accurately predicts how much life we will squeeze into our years; something we are getting far more skilled at measuring. For example, unhealthy sleep patterns accelerate our biological clock (and therefore our rate of aging) as do a combination of unhealthy lifestyle factors like smoking, drinking, being physically inactive, carrying excess weight, and eating poorly. The good news is that it appears that reversing those behaviors has a positive impact, effectively slowing time.

One study out this month confirmed that eating a healthy diet (the brain-protective MIND diet, a version of the Mediterranean diet) slowed aging and those who did so significantly reduced their likelihood of developing dementia along the way. Another study, out in January of this year showed that not only IF we are physically active but WHEN and HOW during a typical day impacts our rate of aging. Individuals who got plenty of vigorous physical activity and those who got two peaks (i.e. a ramp-up relatively early in the day and then another ramp-up later in the day) had the best future health, with the most sedentary of 5 groups doing worst during the follow-up period.

So while the saying "Time and Tide wait for no one" (circa 1225) seems as true now as it probably did then, how fast our biological "time flies" is more within our control than we realize. 

Spring is officially here - the nice weather will follow soon if it's not in your location yet. It's a great time to slow things down and savor the time we have.

Have a great weekend,

Mike E.

Use It or Lose It - Toning Happiness

Mar 15

If you're anything like me, you approached this week with mixed emotions. We lost an hour of sleep but gained more light - which meant dragging into Monday a little more than usual but noticing (and loving) the fact that the sky wasn't dark by dinner time. Light can have a powerful effect on us - uplifting, stimulating and positive when we have the right "dose", preferably from a natural source, and disruptive when we have either too little or too much. For example at least 8 different studies were mentioned here when reviewing light as a factor within the architecture we interface with, and how it impacts our wellbeing. Said more simply, having the "right dose" of light at the "right time", can help us feel AND function better, something we may be reminded of after we adapt to the (rather abrupt) change.

Of course, as we've touched on many times, most of the energy sources that power our physiology work in a similar fashion. The "goldilocks phenomenon" of "not too little, not too much, just right" - applies to all 5 ELEMENTS at some level and shines a metaphorical light one of the principles that governs so much of our experience and achievement - we (do in fact) adapt to the stress we're under, growing stronger when we push ourselves "enough" to stimulate growth, weaker when we don't and injured when we overload or otherwise ignore our safe limits. 

As it turns out, new research on the subject says our happiness works this way too. When college students were taught techniques known to improve well-being in a course called "The Science of Happiness", it worked. 6 weeks after they got started, there were notable improvements in a variety of scores. However, 2 years later when a subsample of the same group was retested, the effect had mostly worn off....with one important exception; those who continued USING what they learned continued to have the benefit, with well-being scores exceeding their peers who had fallen out of the practice. This led the senior researcher to suggest that our mental health functions just like our physical health - much better when we stimulate it:

"It's like going to the gym -- we can't expect to do one class and be fit forever. Just as with physical health, we have to continuously work on our mental health, otherwise the improvements are temporary."

Spring is officially only 5 days away - it's a great time of year to step into the light and "tone up" those parts that might have gotten a little soft this winter - all of them.

Have a great weekend,

Mike E.

if it was easy...

Mar 8

My oldest daughter (now a senior in college) has become a very strong writer. Knowing my wife and I hold the skill in high regard, she occasionally sends us a copy of a recently submitted paper to read. The latest was about an epic moment involving a "crossbar challenge" issued to a youth soccer team by an over-confident (among other things) coach and the not-so-tasty crunch of the Cicada-snack he dined on after he lost the bet. It was a legendary moment of justice for the pre-teen version of herself and one that the paper brought back in living color. Now, while I'd like to believe that we put her on a solid foundation by valuing the skill from an early age, there is not a doubt in my mind that over the last four years (savings-draining as they may have been) the environment she has been in has challenged her, creating the kind of push and pull that nudges us forward and refines us along the way.

The environment we find (or put) ourselves in has a funny way of doing this; like a living maze, placing or removing barriers on our path, making certain choices harder or easier, and ultimately shaping the road we travel and therefore the experiences we have. Not surprisingly, as some recent research published by the American Heart Association points out, these environmental barriers (or lack of) have a powerful role in shaping our future health experience too. When our maze makes it easy (or cheap) to regularly eat highly processed and prepared foods because they exist in high density, we tend not only to FUEL this way but pay the price with a double-digit increased risk of heart failure. After examining the records of hundreds of thousands of individuals over the course of time, there was, on average, a 16% increased risk for those who lived in places with the easiest access compared to those who had "the barrier" of a lower number and/or density of fast food, bars and pubs. Of course, when we consider another recent study that showed regular consumption of sugar-sweetened or artificially sweetened beverages (staples in the same establishments) increases the risk of heart rhythm disorders, also by double digits, the case for "making it harder" to ultimately "make it better", gets clearer. For example, some data suggests that making soda more expensive improves health outcomes lending even more credence to the adage often used by people who see value in challenging themselves to do hard things - "if it were easy, everyone would do it". 

Life doesn't come with an operator's manual, but there are rules of thumb that seem to stand the test of time: "Easy isn't always best" often seems to fit, maybe because when it comes to injury/illness/disease risk "pay now (personal effort) or pay later (quality of life)" does too.

And for the youth coaches out there who are at risk of being a little overstuffed the lesser-known "never underestimate a competitive kid" might be worthy of your attention....unless you prefer the taste of Cicada over that of victory. :)

Have a great weekend,

Mike E.

what your ring finger says about you (or doesn't)

Mar 1

When you get a minute to stop what you're doing, take a look at your hands. Seriously, this seemed equally strange to me, but give it a shot. Rest them on a flat surface with all fingers loosely together. Now, counting from thumb to little finger where your thumb is "1" and pinky is "5", take a look at your 4th finger (the "ring" finger) and specifically, how long it appears in comparison to your 2nd (the index finger). Does it appear significantly longer? If so, new research says you might have the makings of a professional soccer player (or at the very least an endurance athlete).

The theory, admittedly oversimplified, is that exposure to high concentrations of particular hormones while developing pre-birth, most notably testosterone, will be reflected in structural differences in our skeletal system which can be measured in the ratio between our ring finger and our index finger. What the research team found was that as the ringer fingers of 133 professional soccer players got shorter (by comparison to index fingers and therefore the ratio got closer to 1 to 1), VO2 Max, the gold standard of endurance capacity, was lower. Said another way, long ring fingers were associated with better aerobic capacity.

Of course, before we go checking our kids and finding a sports agent, we might want a few more questions like:

Is this real science? Yes, there have been more than 300 studies on this phenomenon since 2020.

Should I believe it? Well....while there are times when truth is stranger than fiction and so open-mindedness, even to the very strange, is probably the best policy, this one seems "unequivocal" at best; which is a nice way of saying it's hardly conclusive and although wildly interesting, not reliable. For example, this 2022 study is one of several that have found that the intriguing conclusions of small studies have not reliably been replicated in larger ones, making it hard to consider this more than an interesting coincidence. 

So while we are very likely to see this research pop up in social media outlets (if it's not there already) like so many others that make the rounds there, for at least the foreseeable future we will continue to suggest exercise to maximize aerobic capacity (and therefore health) and not rely on ring finger length for much more than a fun icebreaker should you need one.

On the other hand, if you use this information to kickstart a global search for the next soccer phenom by examining ring fingers everywhere - remember me when you're famous!

Have a great weekend,

Mike E.

can't outrun a bad diet? maybe reset instead

Feb 23

The funny thing about "news" is that it's not always new. Eating too much sugar is bad for us. Not new and probably not surprising since just about everyone knows excessive sugar is not good. We've heard it hijacks our brain, puts our metabolism on a roller-coaster, and quickly elevates our risk of SEVERAL of the major health risks we face. Generally speaking, new as this isn't, it's still true. Sweetened beverages (whether natural sugar or artificial in most cases) add double-digit cancer risk, significantly increase our risk of cardiometabolic disease (as much as 30%), and have even been related to both pain threshold (we hurt faster) and intensity (we hurts worse).

The latest study, a REALLY big one out this month from a team at Harvard, looked at both the connection between drinking sugary beverages regularly and cardiac events like heart attack, etc. but also whether physical activity could counteract the effect. When they examined 13,000 cardiac events over more than 3 MILLION person-years there was a big bump in risk; on average about 20% - not a surprise and maybe not even news. However, interestingly, they also added proof that exercise alone is not enough to fully "right" the risk. They found that while non-exercisers experienced a risk jump of around 18% per daily sugary beverage consumed, individuals who met the physical activity guidelines STILL experienced a 12% risk jump per serving. The old adage said by sages in running clubs everywhere is true - we can't outrun a bad diet. However, all hope is not lost, we may have a reset option.

As it turns out, in another study this week by a researcher who has spent years learning what fasting can do for our health, 5 days per month on a diet that limits enough intake to get the benefits of fasting without actually fasting showed significant promise. Compared to controls who ate a generally healthy Mediterranean diet, those who ate a "fast-mimicking diet" for 5 days out of the month over a 3-4 month period had:

1. Lower risk for diabetes as measured by blood markers

2. Reduced abdominal fat and fat deposited in the liver

3. Improvements in their risk for metabolic syndrome

4. Improvements in immune system functioning

5. 2.5-year reduction in "biological age" (a marker of cell/tissue functioning)

So what is a fast-mimicking diet?

Officially, the team described it as: "comprised of plant-based soups, energy bars, energy drinks, chip snacks, and tea portioned out for 5 days as well as a supplement providing high levels of minerals, vitamins, and essential fatty acids."

However, you can find out more, including some free recipes on the blog of the lead researcher HERE.

Our brains may light up on it enough to crave it, but without plenty of nutrients and fiber to balance its effects on our health, we definitely don't "run on it" very well. If it's time for a reset, consider setting down the sugar and reaping the rewards of risk reduction.

Have a great weekend,

Mike E.

pump up your endure

Feb 16

If you're old enough to remember them, you probably didn't think of them as innovators or trendsetters at the time. Yet, these two legends were not only among the first to get comedic mileage out of Arnold Schwarzenegger's signature accent (more than 30 years before the recent Superbowl ad), and likely among the first "stars" to go full groutfit many years before it was cool to do so they were also on the cutting edge of the science of happiness apparently, ready to pump up not only muscles but mood. If Hans and Franz as renaissance men seem outlandish, it did to us too but the coincidences don't lie. As exaggerated and blatantly sarcastic as their version might have been, the idea that pushing our bodies physically can have an incredible impact far beyond fitness and strength gains has a growing research base.

We've previously mentioned this massive review of research which included more than 120,000 subjects. The take-home message, that physical activity performed as well or better than usual care was impressive. To quote the authors "the effect size reductions in symptoms of depression (−0.43) and anxiety (−0.42) are comparable to or slightly greater than the effects observed for psychotherapy and pharmacotherapy (SMD range=−0.22 to −0.37)". In particular higher intensities seemed to hold great promise and, as shown in August of last year, resistance training may play an important role. This study showed a clinically significant mental health boost almost immediately and again between 4 and 8 weeks for individuals doing resistance exercise a few times per week for 25 minutes per session. The exact mechanism driving the benefit hasn't yet been determined, but the authors concluded that the effect wasn't due to strength gains alone. Then, earlier this month another review of the available research made it clear that muscle-loading activities like resistance training hold great promise for lowering anxiety and depression, and improving wellbeing. 

Life throws curves. There are ups and downs around every corner. It's hard work to ENDURE. While we certainly don't have to have a terminator's physique, an all-grey sweatsuit or even log hours in the gym to pull it off, pushing some heavy things around can have an impressive role in pumping us up - in body, mind, and mood. If you haven't in a while, it's a great time to start. Let us know if we can help.

Have a great weekend,

Mike E.

language - the fine line on stress

Feb 9

Words are powerful. Language matters. Not only in "what" we say, but "how" we say it. History has demonstrated this over and over again and more recently research has proven it. Powerful speeches whether in front of great crowds or on our phones in the forms of "shorts" or "reels" can stir feelings inside of us and move us toward action. Said more simply, words can shape our thoughts (and therefore beliefs) while simultaneously stirring the emotions that spark our actions - they deserve more attention (and probably intention) than we often give them. This TED Talk from 2017 is a fantastic example of how and why. 

In the realm of prevention and health promotion, where we spend most of our time at Pro-Activity, the idea carries important significance. We have seen many times that how a person "frames" their health, that is the words they use to describe it to themselves or others, can have major implications on how their experience plays out. Studies on the topic are beginning to provide insight as to why. For example, this study from 2022 showed some interesting (but far from conclusive) connections between how a person labels discomfort and how they move, with particular emphasis on lower back pain. It lends some support to what is sometimes called the "fear-avoidance model of pain" which, in an oversimplified way, suggests that when we limit ourselves by avoiding "threats" that have caused pain in the past we can unknowingly make our bodies even more sensitive, getting closer to our natural threshold and more easily "bubble over" the next time we are "challenged" in a similar way.

As it turns out, some new research out last week lends even further support to the idea. In a study that tracked how +/- 370 people appraised stressful situations - that is, whether they tended to label them as "threats" or "challenges" in their internal dialog - those who interpreted stressful events as something to be feared (i.e. threats) had worse future physical and mental health. 

So what's the difference between the two? After all, that's where the proverbial "rubber meets the road"...

The answer most often is - resources. When a person considers a knowingly hard situation but believes they have the resources (skills, tools, people to lean on, tenacity, toughness, creativity, etc) to handle it, they are more likely to see it as a challenge than a threat. When there is a mismatch between what is needed and what is available, the situation is far more likely to feel threatening. The bad news is, we are living through a time with many potentially stressful situations to confront on any given day. Some of them are new, and most of them are hard. The good news is, we are also living through a time when resources, especially the information on "how" to solve many challenges and "who" has already figured it out are easy to access and often free.  The challenge now is often not to find a solution, but to determine which (of potentially many) is the right one.

So although he almost definitely didn't mean it this way in March of 1933 when he said it, FDR was pretty close to the mark when he said, "The only thing we have to fear is fear itself".

And should you find yourself facing some health risks that we can help with - reach out, we love a challenge :)

Have a great weekend,

Mike E.

changing fast and slow

Feb 2

In an effort to get the most from my professional knowledge/skills and give back when possible, I coach youth sports, primarily competitive high schoolers. It is one of those perfect challenges - frustrating enough of the time to hold teachers who do it 8 hours per day in very high regard (as I question if it's worth the effort) and yet amazingly rewarding when the kind of breakthrough which radically changes the trajectory of someone's life occurs. Sometimes the breakthrough is in the sport but most of the time it's due to lessons where sport mimics life. "Consistency beats Intensity" and "work smarter, not harder" have been two particularly grueling lessons over the years. The idea that the climb from a current level to a desired future level (i.e. "change") is something that is most often achieved with patience and a process similar to painstakingly adding coats of varnish to wood or clear coat to a custom paint job like that which was said to be used by Da Vinci when creating The Mona Lisa is not a particular favorite at a time of life (or a time of the world) when just about everything is available instantly, on-demand. You can imagine how much of a boost it can be therefore when we find situations that don't necessarily behave that way, when change happens quickly.

Last week we talked about one such scenario - the "warm-up" effect - and how powerful it can be for those willing to invest a few minutes in readying their physiology for action. Of course, this isn't just for adult bodies - we know that a similar pattern of priming for young athletes can reduce the incidence of serious injuries like ACL tears (example 1, example 2) in those who complete it, something I've seen first-hand both positively with low injury rates in those who take it seriously and negatively with serious, yet preventable injuries in those who do not. However, changing the MOVE inputs to get better or safer outputs is not the only domain that responds quickly. How our bodies respond to changes in FUEL inputs does too. Some great new preliminary research out this week showed that from an immune system perspective, significant change can happen in as little as 2 weeks with different outputs resulting from changes to inputs.

Specifically, the research team showed that across an age range of 18 years to 50 years in a tightly controlled setting, there was a consistent change in how the immune system responded to differing diets. When participants were given a low-fat vegan diet for 2 weeks, their "first line of defense" (innate immunity) ramped up, while when they ate a high-fat/low-carb ketogenic diet for 2 weeks their "next line of defense" (adaptive immunity) ramped up; this is both impressive and fast. On the other hand, many studies have shown that those who apply the "layered", slow, and steady approach can also have great benefits. One of the most recent showed across a sample of more than 100,000 individuals, a healthy diet tracked closely with better metabolic health which was not super surprising, especially in light of this one which reviewed a bunch of the "how" and "why".

When we boil it all down one of the big takeaways is something we all inherently know and use every day to survive and (hopefully) thrive: change is fast...slow...and always. We constantly react to subtle changes in our environment (homeostatic) and, since certain things have to be very fast to keep us alive we even "predict" and anticipate when it benefits us (allostasis). Those systems can definitely get off track if we don't provide them the right support. Still, perhaps one of the reasons we have examples of humans thriving in nearly every imaginable environment (and some that seem unimaginable) is because, not unlike the way our "dual process brain" was described by a Nobel prize winner in 2011, our entire system is uniquely purposed for the demands of a "both and' world. If we take care of it, it works well.

This is the time of year when an immune system "boost" could be very valuable. Start today and you'll be hitting the winter homestretch STRONG.

Have a great weekend,

Mike E.

move skillfully - to prime is to retain

Jan 26

My Grandfather was an amazing performer. In addition to having an infinite love for his family and the skill to infuse it into a pasta fagioli that felt like a hug from someone who cared, even in his upper 90's he could sit down at a piano and leave onlookers gaping in amazement. It was one of my favorite pastimes - to watch "Pop" absolutely wow whoever was watching that day. Not only could he move his hands where and when they needed to be, but he did it by memory, rarely with sheets of music, and pulled in onlookers with a smile, a head nod, or a wink.

Perhaps not surprisingly I've always thought it would be awesome to be able to play like that someday when I grew up. And since "someday" hasn't quite gotten here yet (even though I've sincerely tried to grow up), it's still on my list of items to do. Couple that with a very real professional interest in movement-related skill, whether playing an instrument or a sport or using the tools of a trading day to day and it's probably no surprise that when new research demonstrates a better way to do so, I pay attention. It is another of the many reasons I am such a big fan of priming the nervous system with an active warm-up before any motor tasks because, in addition to readying the tissues of the body, it stimulates the brain to activate those tissues faster and more accurately. Take for example this 2022 study from Northern Iowa University which showed an active warm-up could improve piano skill acquisition in those pursuing a degree in music by getting their heart rate beating faster (but not too fast); something I'll put to good use whenever I get around to those lessons. Last week, however, thanks to a team in Denmark, our understanding got even more refined.

Their idea was relatively simple - if they tested motor learning in a hand-eye coordination task which required each subject to accurately control the force and timing of a pinching movement in response to what they saw on a screen, and then retested the subjects a week later without any further practice, they could determine who was most-able to retain the new skill. One subgroup had a moderate-intensity warm-up on a stationary bike, and another completed a high-intensity exercise session (also on a stationary bike) following the task, which is also known to help with skill retention. A third had neither the warm-up nor the post-activity exercise and a fourth group had both. As it turned out, all of the "active" groups did better than the control group (who did neither), but the group who did both performed the best overall

Of course, this was a relatively small study and so there are still unanswered questions (there always are) but the principle remains - whether it is playing an instrument, operating a machine, dominating a sport, or navigating the uneven and slippery terrain of a winter parking lot, building and maintaining movement skill is a critical factor in our ability to "do"...safely. If we can prime the process with a few minutes of warm-up or solidify the learning with a few minutes of post "practice" exertion or both, we can more skillfully MOVE into the future that we envision for ourselves.

Have a great weekend,

Mike E.

breaking the stress cycle

Jan 19

Stress generally gets a bad rap. We've mentioned this before and while it seems the overall perception may be changing, I suspect if asked "Is stress bad for our health?", most people would instinctively answer "yes" and not "it depends", which is far more accurate. 

On the one hand, we know that intense stress (such as traumatic experiences) or early life stress, or the unfortunate circumstance of both together ("ACEs") can create lasting harm. Two recent studies out late last year made the link even more clear. One study showed that excessive stresses experienced by an expectant mother were passed on to the developing child and linked to a greater likelihood of future behavior challenges. Around the same time, a second study showed that the impact of excessive early life stress on the brain might actually be greater than the harm done by a physical injury like a concussion. This of course all seems bad. On the other hand, however, we know that small doses of physiological stress (e.g. exercise), in most situations, are one of our best ways to improve health. We also know that at some level stress is different from person to person. Certain factors can be protective against the risk of harm and particular traits, like grit (the passion and perseverance for long-term goals) can actually turn stressful events from negative to positive, from potential harm into periods of growth. So it's nuanced and it depends... 

To make it even a little more complex, some new evidence suggests that our perception of our stress can actually shape our reality; and possibly set us up for future cardiometabolic risk by influencing an accumulation of cholesterol and triglycerides, pushing blood pressure higher, influencing weight and fat accumulation and the many health risks that come with some or all of those factors. The trouble is, the details are still fuzzy; but thanks to brand new research which seems to have taken us another step closer to the root causes, things are getting more clear.

We've known for a while and have previously mentioned the significant link between chronic inflammation and the progression of disease. When inflammatory markers are high, disease risk is also high. One of the best reasons to make lifestyle modifications like improving fitness and eating better is that they are both known to lower inflammation and in so doing lower the risk of heart disease, brain disease, metabolic disease, and even pain. But physical health is not the only thing that drives inflammation, how we perceive and cope with stress plays an important role too. By using a simple survey, not ironically called the "perceived stress scale", researchers were able to show that high perceived stress was closely linked to both inflammation and future metabolic health risk. With that in mind, focusing on actions known to positively impact perceived stress (like sleep quality) could be a very valuable way to get on the right side of risk. Unfortunately, the jury is still out on interventions like mindfulness. 

So is stress bad for our health?

Well, it depends...but it doesn't HAVE to be. Try the survey and if you score higher than a 27, consider taking action to break a sweat, eat a healthy meal, and get a good night's sleep in order to break the stress cycle and chip away at risk...or of course, reach out; we'd be happy to help you get started.

Have a great weekend,

Mike E.

preventative maintenance of the brain

Jan 12

If you stop at the study's headline, it might seem like bad news. In a sample of more than 350,000 people at/near mid-life (approx. 55 years old), more than 1 of every 1,000 were diagnosed with dementia in their next decade of life; a rate that is in line or higher than in previous studies.

After all, even though rare in comparison to leading conditions like heart disease, cancer, diabetes, or joint disorders (where nearly 70% of Americans have 1 and 14% have 3 or more) it still means that hundreds of thousands of people are experiencing significant cognitive declines far before the "golden years" - which is not the quality of life in retirement most of us imagine for ourselves. However, the details provide hope and maybe even a few reasons to be optimistic.

Walking backward (or "upstream") from the disease to the associated risks, it becomes clear that, a lot like those other conditions, this one is further within our control than we originally thought. Of the 15 identified risk factors, at least 13 were at some level modifiable. Interestingly more than 1/3rd of the risk factors were either other chronic diseases (heart/artery/metabolic disease near the top) or known risk factors shared with them (poor strength, high resting levels of inflammation, and habitual alcohol consumption outside of accepted guidelines). More evidence that cognitive decline is in large part, another, in the growing list of lifestyle diseases...and therefore more a consequence of the choices we make than a fate associated with our genetic blueprint (which increased the risk 2-3X depending on the number of known genetic factors).

So what should preventative maintenance for the brain include?

1. Exercise Enough: 7 of the risk areas are known to be improved by a MOVE habit. It gets even better if you do it with others or primarily outdoors.

2. Eat Well: 6 of the factors could be related to dietary choices. Be sure to consider sources of Vitamin D (identified as an independent risk).
3. Protect Your Hearing: This is especially important in the industrial environment and increases risk by more than 50%.

4. Avoid Heavy Alcohol: This was one of the strongest risk factors identified (>=4X risk if a person had a use disorder).

5. Control Inflammation: Although at some level the first 4 can help here, this risk factor was substantial (2.5X risk in some models), so adding in a focus on Sleep which is known to have an impact, is probably worth it.

While it's unlikely that we can avoid the risk entirely, the more we learn about brain health, the less it seems we have to fear. Like heart disease, metabolic disease, several forms of cancer, and many (if not most) musculoskeletal disorders, with a little preventative maintenance this "machine" we're walking around in can stay strong and work well for many many years.

I hope your 2024 is off to a healthy start.

Have a great weekend,

Mike E.

"change weeK": an open door

Jan 5

The calendar has flipped, 2024 is here, and (if history is any indicator) most Americans, whether "considering" or actually "doing", are a few days into some version of change that so often comes with the New Year. Although not the only target, health improvement is usually near the top of the traditional resolution list, so it's a safe bet that you don't have to look very far to find stories about people trying to use resolution season as a lever to get healthier. 

Netflix for example, has released a new 4 part documentary called "You Are What You Eat", which takes a well-timed and entertaining look at the Stanford University Identical Twin Study which compared a healthy omnivore diet and a plant-based (healthy vegan) diet in genetic identicals; the same study we blogged about on 12/8. Although the documentary has been far more entertaining than the medical journal, the punchline remains - while both groups improved, the plant-based group outperformed the healthy-omnivore group on several measures. Along similar lines and out last week, in a study of more than 120,000 people who attempted to "cut carbs" for longer-term weight loss, "how" appeared to matter. Cutting carbs (in general) may work in the very short term, but in the longer term, it's more nuanced. The researchers concluded that "only low-carb diets that emphasized high-quality protein, fat, and carbohydrates from whole grains and other plant-based foods were associated with less weight gain".

Of course, changes in food intake are not the only way to move the wheels of health change. A focus on just about any modifiable health factor can work. For example, along with challenging oneself to eat well or exercise, abstaining from alcohol during January has become increasingly popular. There isn't a ton of strong clinical evidence relating to the effectiveness of month-long health challenges, but what is available is promising. One small study that looked at a 28-day food and fitness challenge showed signs that things were moving in the right direction for those who took it on and this review of month-long "dry" efforts (e.g. Dry-uary, Feb-Fast, Dry July & other public health campaigns) showed that those who gave up alcohol enjoyed both physical and mental health benefits (including a positive impact on sleep), even if they didn't complete 30 full days. As a bonus, one of the most common indirect health indicators (financial stress) was reduced, with users most often citing "saving more" as a benefit of drinking less. Couple this with some interesting findings from military medicine that showed a relationship between alcohol consumption and chronic pain and the case for giving ourselves a reset in this way gets stronger.

The possibilities are nearly endless. Resolving to keep a consistent bedtime or to stop taking in calories within a few hours of that bedtime could both be impactful. Resolving to be more altruistic or "prosocial" by performing a small and new daily act of kindness could have an almost immeasurable ripple effect. Or, for those who prefer a more well-worn path, simply finding a way to tax our muscles every day (increasing step counts, 30-second 1/2 squat holds for blood pressure improvement, a few flights of stairs for fitness or a few push-ups for strength and mobility) can have a surprisingly powerful impact.

For those who receive our monthly health promotion content, we will be diving in a bit deeper. For those that don't - here are some key takeaways: we humans don't always like to change, and we may even avoid it...but we most definitely can, sometimes know we should, and occasionally have a window of time that makes it easier. Now is one of those times; the door is open. Whether you do it for the future you or because you need it now to be there for those around you - your health is worth taking a step. We are here and ready to help.

Have a great weekend,

Mike E.

2023 - bursts, bundles, and the biome

Dec 29

The 52nd week of the year always feels like it should be a lull between the waves. Most of the previous year is in the history books and the next one is forming quickly on the horizon, but if everything goes well, there's a brief pause to reflect on the past and think about the future. Of course, it doesn't always work out that way - the world is as busy as ever and times to reflect can be hard to come by, but this morning I had such a block. An hour or so to flip back through another year of blogs about prevention, health promotion and population health. Another year which tells the story of what the research community has been looking at. Here are the headlines:

Short bursts of physical activity got a fair amount of attention this year. Whether it was a few minutes of stair climbing, incidental bouts of intensity as part of normal daily living or simply standing more frequently, the idea that although "more" is still probably better in most cases, "something" (hard enough to get the heart pumping daily) is infinitely better than "nothing" when it comes to health was clear in 2023. And while MOVE took top billing in the second half of the year, it slipped to second this year overall representing 24% of the featured topics.

The power of bundling also featured prominently in 2023. While this makes total sense given the well-known interplay between the ELEMENTS, it is not unimportant as it suggests the wider conversation is (finally!) embracing the fact that in the complexity of the real world there is really no such thing as a single, isolated health-habit. Everything we do and everyone we interact with has an impact on...well...everything we do and everyone we interact with. It all adds up and with nearly 20% of our blog topics featuring this storyline in 2023, it seems the world is starting to embrace it.

The last big storyline this year was the biome - or microbiome to be specific. While not a new discovery (the term dates back to 2001 and the field that it grew from the 1800's) the deep and powerful connections it has to our health are some of the most important learnings in a generation. It certainly wasn't the only theme in the FUEL category in 2023, but it was one of the more prominent and likely the one that drove ELEMENT 2 to the top spot, accounting for more than 30% of the blogs this year. 

RECOVER (with emphasis on sleep), ENDURE (resilience, robustness, toughness, grit, etc.) and CONNECT (social dynamics and relationships) filled the gaps, each between 7.5% and 10% of the topic list.

There's no telling where 2024 will take us but if there's any truth to Einstein's famous quote "if you want to know the future, look at the past", it'll include stories of people, connected in purpose, standing on the platform of health, achieving great things.

It has been a pleasure to be a part of your story this year. Thank you for being a part of ours.

Have a great weekend, see you in 2024,

Mike E.

peak week - managing thresholds

Dec 22

I had never heard the term "holiday heart" before yesterday. Scanning the health-headlines as I often do, I saw an editorial in the Journal of Thoracic and Cardiovascular Surgery written by a team from the Medical College of Wisconsin that caught my eye. In less than 1000 words the authors put some important data behind a few themes I've been writing about this month and at some level all year:

(a) we each have a threshold

(b) the consequences of crossing it can be powerfully negative and long-lasting

(c) if we pay attention, the body provides warning signs
(d) and while it's probably better to operate far away from those thresholds (build capacity, etc), life is hard, so knowing how to navigate choppy waters is critical

The next 7 days are one of those classically choppy times. For those who celebrate any of the many holidays, religious and not, which fall during this time of year, last minute shopping, gift giving, travel, festive meals and more might be peaking. For those who don't, even the sprint-to-the-finish of another calendar year can ratchet up the physiological loads. If we don't pay attention, our heart may pay the price.

As it turns out, "holiday heart syndrome" a term coined in the 1970's, is the common name used for a phenomenon which includes a spike in heart-rhythm disorders, most commonly atrial fibrillation, which seems to be tied to the excess of the holidays. While binge-drinking, which is known to have a strong impact on the heart, is the top suspect (as many of 1/3 of individuals with a-fib link it to alcohol), it is not the only one. Electrolyte imbalance from a common dietary shift toward salty foods and away from fruits & veggies can be enough to push us into risky territory and adding in some stress, fatigue and even possible dehydration (either seasonal or alcohol induced or both) and we've got a recipe for conduction disorders. According to the editorial "Holiday Heart Syndrome often presents with symptoms of palpitations, shortness of breath (dyspnea), anxiety, weakness and chest pain among others."

So what can we do to prevent crossing the threshold? Simply put, we can respect the fact that we have one and manage it like we would during any other period of peak-load.

(1) First monitor (and likely add) hydration, especially if salt intake is up this time of year. All the same rules from the summer apply. Clear urine once per day and/or using the top-off-test (if no urge to urinate within 30 minutes of drinking 16 oz of water, likely some dehydration) are good rules of thumb.

(2) Get fruits and veggies "in" early and often. Not only will this also add water, it will help counterbalance the holiday foods by adding in potassium (to balance sodium) and fiber (to balance sugar). As always, there is no shortcut here. Potassium supplements should NOT be taken without medical guidance.

(3) De-stress with exercise. Even a few bouts of stair-climbing can go a long way.

(4) Protect your bed and wake times to ensure your sleep is maximally restorative.

(5) Send a “thank you” or “well done” to someone who you think deserves it this year - not only will it light up their day, it’ll have surprisingly positive effects on yours!

Enjoy peak week...but not too much.

Have a great weekend,

Mike E.

standing with the "Late-majority"

Dec 15

Those who subscribe to the Diffusion of Innovation theory believe that a relative few of any group drive change in a predictable way. In essence, the less than 3% known as "innovators" find something that solves a problem and begin tinkering with it. Through their willingness to be first (and often deal with high prices and less-than-perfect designs) when they give something a thumbs up, they inspire a larger group of friends/colleagues who pass it on to others and eventually almost everyone, except the 16% who resist change known as "laggards", is on board with the solution.

When it comes to personal ergonomics, ironic as it might seem for someone who consults in this space often, I don't really consider myself an "innovator". Most of the gadgets out there create nearly as many problems as they solve, so I tend to pass until there is solid evidence backing them up. Unproven solutions, usually at the height of their cost, just seem like a gamble, and "wait and see" usually prevails. Every once in a while, however, a product or solution makes its way through the diffusion gauntlet and in so doing drives the cost way down. The tinkerers and the trendsetters have done their job and even items that maybe aren't "the best thing since sliced bread" get interesting.

The electric standing desk may be one such solution. When they first hit the market (YEARS AGO), the idea was cool but they were clunky and expensive. The evidence said they had some merit as part of a comprehensive plan for specific needs, but for wide use as a preventative tool, the costs still outweighed the benefits. In essence, static standing wasn't that much better than static sitting since the body is built to MOVE. Then, as the lockdown-driven demand for at-home-ergo solutions caught fire, standing desks went from trendy to mainstream. After all, if you're buying a desk anyway...but while it was pretty clear that if used properly a standing desk doesn't "harm" us, the question of "does it help?" still wasn't definitive, so I still waited.

Then something happened. As the pandemic chapter got further and further into the rearview, the price for non-commercial versions continued to drop (still a little too expensive for commercial grade in my opinion), and at the same time some research, such as this study, was beginning to suggest that if used properly it might give a metabolic boost. I'm still not sure I can get into the habit of using it often enough - 4 uses every hour seems like a lot - however, in one "late-majority" person's opinion, it's now worth a test - so I'll let you know.

On the other hand, if you're an innovator at heart and way past this trend you're probably frustrated even reading this it might be better to jump on this new research and just change your phone screen to grayscale so you can use the 35 minutes gained from that visual-boredom to take a'll be trendy before you know might even already be, clearly, I'm the wrong guy to ask. :)

Have a great weekend,

Mike E.

plan ahead for gremlins everywhere

Dec 8

There's really no reason to belabor it. Most of us know the risk exists, can see it coming, and still get caught up in it year after year. Almost a quarter century ago a group of researchers studied the "holidaze" phenomenon and concluded that the evidence of its existence could be measured on the scale to the tune of +/- 1 lb of net body weight gained per year during adulthood. While they found a post-holiday "loss" was common, maybe in the form of New Year's resolutions, it wasn't enough to offset the total amount gained during the pre-holiday and holiday season. The obvious conclusion was "avoiding the risk is better than reacting to it".

The gremlins tend to be everywhere this time of year. Maybe you've got a Christmas cookie coworker who is like willpower kryptonite this time of year. Maybe it's the holiday parties with rich food and alcohol. It might have nothing to do with the holiday season and is more the shift in the stress/rest balance of trying to get those annual goals checked off in the homestretch that does us in. Maybe it's all of the above. If it's any, having a few tactics on hand can be valuable.

This was the conclusion from a team based in The Ohio State University's Medical Center which recently published findings of a survey they conducted related to health habits during the holiday season. Not shockingly exercise habits were sharply down, 45% of people said they stopped, and almost 67% said their nutrition suffers. Add in the 50% who feel more tired and stressed and the 33% who consume more alcohol this time of year and it's no wonder health takes a hit. The good news is, it probably doesn't have to.

If we boil their recommendations down we get a well-known logic - anything that throws off our routine (upstream/inputs) increases the odds of more problems later (downstream/outputs) - so protect our routines. This might most easily be done by going even further upstream anticipating risks and planning ahead to prevent them from becoming problems.

Specifically, they recommended: 

Of course, on the other end of the spectrum, we know that some people turn this time of year into a challenge - a chance to improve rather than simply slow the decline. For those folks we add one simple (not at all new) tactic based on a very cool study from Stanford U - Eat More Plants.

In a cool randomized clinical trial of identical twins (that is, genetic identicals), a team showed that a "healthy vegan" diet (that is, whole plants, not vegan junk food) outperformed a "healthy omnivore" diet (eat anything in moderation, avoid the high process, minimize added sugar) over an 8 week period. Specifically, LDL Cholesterol fell, insulin levels improved and body weight dropped more in the healthy-vegan group than the healthy-omnivore group. 8 weeks from now is the beginning of February. Improving through the holidays may be uncommon, but isn't impossible.

Have a great weekend,

Mike E.

quieting our holiday zombie

Dec 1

It took until Tuesday but then the realization hit, I was really, really tired. Objectively it made total sense; the unofficial start of the "bustle season" came with full force and like a moth to the flame, I went all in. The quick trip to pick up a college kid that resulted in a few extra hours of brake lights, the last-minute leaf-management strategy that I finally had time to execute, the eat/drink/be-merry of a day built around that exact formula, and the long days that follow after the holiday-season moves out of pre-season had given me plenty of ways to burn energy. No complaints, we do this to ourselves and I knew that my dragging was self-induced and right on cue. The risk of course, for those of us who join the sprint this time of year, is that attempting to fit "more" into a fixed volume container eventually results in spillover when we overdraw our time and energy resources.

While this spillover brings a significant drop in our situational awareness which can have catastrophic results in environments where a low-margin of error is often required (e.g. driving), it is not limited to high-risk situations and is not only the result of short-term fatigue. Anything that drains our energy and attentional resources faster than we can replenish them can put us into this state. Commonly referred to as "presenteeism", this phenomenon was identified at least 50 years ago and in plain English refers to being physically present, that is not absent, but not being FULLY present - there in body, but maybe not in spirit or full focus - being at least partially "checked out".  It is most commonly studied in the workplace because it can (but does not always) have a significant drag on productivity; however, it does not conveniently stay at work. Whether due to a health burden, which had traditionally been thought to be the cause, or the other known precursors like fatigue, the risk goes everywhere we go and has an impact on everyone around us. 

One study this year showed that when we tip the balance toward fatigue via insufficient sleep, we lose self-efficacy, optimism, hope, and resiliency ("psychological capital") faster, which as if those are not problematic enough, leads to burnout, lower satisfaction and likely more. But there's good news: as we continue to learn more about the root causes we realize we can impact them with the right strategies. In a study of more than 12,000 individuals out this week, three clear connections were found between day-to-day actions and presenteeism - not surprisingly, variations on the same themes we know to maximize our capacity - whether by raising our threshold to spillover or ensuring we recover as full as possible when we rest. Each is important by itself, however, given their impact on each other, they also have the potential to compound. 

(1) Daily Exercise - especially good when we are mentally tired but physically "pent up" (e.g. those that sit for more than 11 hours per day which nearly triples risk)

(2) Going to bed Empty (known to improve sleep quality)

(3) Getting a full human night's sleep, which is more than an elf, even if you play one this time of year. 

If we start investing a little in quieting our holiday zombie now, we can cross the 2023 finish line with enough energy to enter 2024 strong. May the gift-giving of the season start with a daily investment in yourself today. Happy Homestretch.

Have a great weekend,

Mike E.

gratitude works

Nov 24

When I first learned about Positive Psychology, the (far oversimplified) less-traditional practice of diving into mental health with an eye toward the "upside" like resilience, happiness and growth, instead of the more traditional focus on rehabilitating the negative (disease, disorder and trauma) it felt like a game changer. It was clear that within their profession, at least some psychologists were trying to reorient back toward attaining "health" (flourishing, thriving, etc) rather than "avoiding disease"...something that can seem nuanced at first but is clearly spelled out by authorities like the World Health Organization in their constitution. As funding led to research, we began to understand the difference more fully and where our efforts should be.

As it turned out, gratitude, whether it be a momentary appreciation for something good in life or a cultivated practice of recognizing such things, became one of the most widely studied components. The "what went well" exercise described by one of the profession's giants in the early 2000's, which in the most basic form is writing down 3-5 unique experiences that "went well" each day for a few weeks, showed promise across several of life's domains and across a large portion of the lifespan. Gratitude also shows up near the top in a framework Dr. Paul Conti recently discussed with Andrew Huberman on his podcast - part of a 4 part series and a great listen on mental health. In a review of 19 different studies it even showed a clear benefit on cardiovascular risk, adding more evidence that there is no "physical" or "mental" health...just health with all systems playing a role. However, as is the case with many health practices, knowing the "best" way to do it has not been as clear.

Not surprisingly then, when this study from the University of California came across my feed I was intrigued. The researchers tested a variety of gratitude practices to find out which had the most impact. The punchline? Taking the time to sit down, think through the details and write a letter was most powerful.

And so, in the spirit of the season here's a quick one to you:

To our clients, friends and the employer teams who have invited us into your spaces, stories and lives, I know I speak on behalf of the entire Pro-Activity Family when I say, it is both an honor and a privilege to play a small role in your big thing. We have had the unique fortune to witness up close what it takes to make the components and assemble the structures that become homes and buildings. We've seen the magic that goes into bringing power and water and heat to those structures and to keep them well lit and warm when nature intends otherwise, 24/7, 365. In some places we have seen the effort, nothing short of an act of daily love that goes into making those products that mop up messes while in others those that help fuel the bodies doing the mopping. And we have had the great honor to walk with many of you as you journey through life and in health. When we give thanks this week and into the holiday season please know that YOU are among those we are most thankful for.

Now it's your turn - write one for someone you're thankful for and enjoy a health bump.

Have a great weekend,

Mike E.

exercise and infection risk: prepping for winter's peak

Nov 17

Prevention and Performance are games of "seasons". While it is not at all uncommon for a traditional athlete (sport) to have an annual training plan that starts at a peak race or game and plots blocks of time dedicated to ramping up readiness at the right rate. It is a lot less common for work-athletes (who use their body to earn a paycheck) or lifestyle athletes (the game of life) to think in these terms. Staying out of the reaction rut, where we just deal with whatever life throws our way and in the plan-ahead mindset can be tricky. "Paying Now" to avoid "Paying Later" makes total sense when we stop to think about it but is no-less hard to pull off.

This time of year the stakes get increasingly higher for those who are committed to tamping down injury/illness/disease risk. Changes in temperature and daylight patterns can add risk and as the CDC shows fairly clearly HERE, our immune function gets put to the test. While the research has shown that sleep efficiency (getting to sleep, staying asleep, and doing so deeply while we are there) remains one of the best ways to keep our defenses strong, nutrition and exercise become increasingly powerful as we age. In fact, exercise can have such powerful effects, under some circumstances, it might be too good...and thanks to some research this week we are closer to understanding why.

It starts with a phenomenon that every serious athlete must consider - pushing hard enough in training or in competitive events seems to add risk for infection. For example, marathon runners are well-known to have an increased risk for upper respiratory symptoms after peak training or in the days after the event. However, there debate rages on as to why as this paper explains. In short, the risk is real but it was hard to pin down a mechanism.

Then a research team from a lab within the US Department of Energy stepped in. They designed and kicked off a study of serious work-athletes: wildland firefighters which required a dozen volunteers to gear up in their typical 40 lbs of helmets, packs, gloves, and more and do a "strenuous training exercise" in the heat and hills of California. Loosely translated, this meant 45 minutes of running around the woods, in heavy gear, with heat. The team then collected and analyzed blood, urine, and saliva samples across nearly 4,700 variables. They found more than 100 that were significantly different from the start.

As it turned out, the researchers were able to show that as the demands on the body transitioned from "moderate" to "intense", that is the physical loads became exhausting, the body shut down the inflammation system in the nose/throat/lungs presumably to make it easier to get more oxygen in, ramped up secondary microbe fighting agents in the mouth (as found in saliva) and opened the pathways required to burn fuel more efficiently (sugar/fat) and transport it to the muscles more effectively. Said another way, in less than 45 minutes the body traded a temporary boost in physical function for a temporary reduction in immune function...which is exactly the kind of request a marathoner is asking for on race day.

What's the take-home on this?

Exercise has a sweet spot when it comes to our immune function. Some is good, more is probably better but too much is too much. While there is no "bad" season to exercise, if you're a high-intensity or long-duration exerciser, now is the season to consider secondary defenses like hand-washing, and distancing after extreme bouts while doubling down on nutrition and sleep. 

Here's to a healthy winter peak - it'll be here before we know it.

Have a great weekend,

Mike E.

sleeping slow and low

Nov 10

If I'm being honest, I am fascinated by the powerful pull of the click-bait quiz. You know, those pop-ups and posts in social media that start with something like "people who _____ do these five things..." where the blank is always something shockingly specific to some conversation you had recently, an image you paused over for a split second or something you dared to search for as if Siri and Alexa were trading your interests in some backroom deal over at the Zuckerberg house. It's one of the reasons we've shared "Fun Fact Friday" on our LinkedIn page this year - to help provide at least one feed of information that has actual science at its base. It's been an interesting experiment.

Sleep health is one of those topics. Not surprisingly, as we've learned more about the powerful impact of sleep on health and performance, people are seeking out information about it more often. It has far outpaced the other 2 basic lifestyle pillars (exercise and nutrition) in the last 20 years according to internet traffic trends, pulling away from "exercise" about 20 years ago and "nutrition" 10 years ago. Add in the technology to track sleep reasonably accurately and funding that follows public interest and we've got a recipe that makes "sleep health", which is critical to overall health, more accessible than ever.

If however, you've missed the trend - here are the basics:

Sleep is broken into stages that until recently have not been uniformly labeled. This makes it more confusing than it has to be. Those in the "simple is better" camp (like us) prefer the 2 category system, Rapid-Eye-Movement (REM) and Non-Rapid-Eye-Movement (NREM) where NREM is further broken into 3 stages, very light (N1), light (N2) and deep (N3) with each stage having important functions and features (a good overview of the basics can be found here). While historically much of the focus in sleep research has been on REM sleep which typically happens in the second half of a normal 7-8 hour bout, more recently it has been Deep Non-REM (N3) which has been gaining attention. One of the reasons is its role in future brain health.

While we've known for a while that sleep overall and deep non-REM in particular tends to decline as we age, a study published in the Journal of the American Medical Association late last month showed that the decline isn't standard across all people and therefore probably shouldn't be considered inevitable or normal. The authors observed that those who had a more significant decline in this type of sleep also had a more significant decline in brain health, and therefore a significantly higher risk of dementia and Alzheimer's disease in the future. Specifically, for every 1% loss in deep non-REM (or "slow wave sleep" as it is referred to in the research community), individuals experienced +/- 30% increased risk of developing one of these diseases.

If we follow the logic that (1) it's a problem but (2) it's not uniform and inevitable then it might be reasonable to think (3) we can probably influence it in some way or another...which does seem to be the case.

As it turns out, when we are in this stage of sleep (as measured by "brain wave" activity on EEG) we are susceptible to certain sounds. Some research has shown that particular frequencies when played during this stage can keep us there longer and wildly, even relaxing words played at the right time seem to have some potential. Of course, if the idea of wearing a brain monitor and being whispered to all night long seems strange, vigorous exercise later in the day (oversimplified) may prompt the body to need more deep restorative sleep and diets low in saturated fat and high in fiber which may allow the nervous system to get into a state of "rest and relax" (parasympathetic state), also seem to have a positive impact.

The key takeaway seems to be more of the same - if we eat and move well we are more likely to sleep well, with plenty of slow waves at low frequencies...which, not surprisingly makes it easier to eat and move well the next day.

The most important first step therefore is the one we seek...even for those rockin' 8 days per week. Whether you're heading to Brooklyn or home countin' sheep - keep working those ELEMENTS and get some sleep. OK, OK, this is better left to Aaron. :)

Have a great weekend,

Mike E.

optimal dose: turkey trot as easy as 1-2-3

Nov 3

Exercise science is always evolving. Google Scholar has more than 43,000 academic titles from this year alone. It's enough to bog down even the most efficient and committed information consumer who tries to keep up. Here's the good news - it's pretty rare to see many big changes; most of the new information confirms what we already know and adds a few refinements.

For example, in general, we know when people MOVE often enough, vigorously enough, and for long enough to challenge their current capacity in some way on most days, they can prevent and reverse many injuries/illnesses/diseases. Doing so in a variety of ways (not just one motion repeated always) keeps us versatile enough for the twists and turns of life and provides layers of resilience to the stressors we face. Of course, "regularly" and "enough" leave a lot to the imagination so professional organizations, government agencies, universities, and other non-profits often attempt to quantify, prove and someday simplify the phenomenon enough that it becomes practical to the average citizen. Eventually, we have guidelines such as those from the CDC which broadly read:

Exercise most days of the week, enough to accumulate 75 minutes of vigorous or 150 minutes of moderate-intensity work saving at least 2 days per week for strength/resistance training.

Which is further distilled by professionals who commonly prescribe as follows:

Perform at least 30 minutes of movement per day where the majority of those minutes can be at a low (incidental movement) to moderate intensity (slightly winded) with 5-15 minutes performed closer to maximum intensity (out of breath). On at least 1/2 of the days (per week) complete these minutes using muscle loading / resistance-oriented activities including organized sports. Grow this number to 60 minutes per day for better results or for children.

And for a long time, this is where things have stayed. Sure there have been new ideas and concepts, but in the grand scheme, very few resulted in big shifts or could be considered game-changers. Trading intensity for volume however may be one. The idea that we may need to invest a whole lot LESS time to get the same (or even better) results if we are willing to work a bit harder during that time is a really big deal that just keeps gaining steam. The idea that our muscles can be FAR more than those rubber bands that move our bones and, when asked just the right way, can be a mechanism that clears inflammation and can release large-scale disease-clearing defenses, is big news.

We saw it again this week with one of the most change-resistant subspecies on the planet - the runners.

Yes, this research, which tested a small group of runners on a newer protocol, discovered that changing the volume/intensity balance could produce excellent results and the recipe was as simple as 1-2-3: 1 part max, 2 parts moderate, and 3 parts easy. Specifically, after a warm-up, the runners were asked to run 5 or 6 minutes of 1-minute intervals which were further broken down into 30 seconds easy (about 30% max) which ramped to 20 seconds moderate (40-55% max) which further ramped to max (84%) or near max (75%) effort for 10 seconds. They completed 2 to 3 rounds of this protocol (10-18 minutes total), 3 times per week for six weeks and compared their 5 km (3.1 miles) racing times before and after.

Translated for the non-runners this means that instead of a training plan which often includes sessions of 30+ minutes to achieve new performance, these folks were able to do it in roughly 1/2 the total time and with less than 15 minutes of maximal effort per week when their exercise "dose" was more fully optimized to their goal. Even better, not only did they improve their performance they also had a significant increase in their cardiorespiratory fitness, one of the most important markers of injury/illness/disease resistance we know of.

It's not too late to get ready for your local turkey trot. Invest 45 minutes per week and you might not only cross a finish line you might change the trajectory of your health.

Get out there and get winded for a few seconds today.

Have a great weekend,

Mike E.

give 12%, get on a better path

Oct 27

I've mentioned the Methuselah Foundation in the past.  They fund longevity research, of which calorie restriction is a well-known go-to strategy. For some reason, when otherwise healthy mice and non-human primates are fed 25% (or so) less than they might typically take in, they live stronger, longer. Until the early 2000s this effect was not well studied in humans. Few debated that designing a study like this would be complex and wildly costly. But at the same time, if such a simple tactic, to simply cut down on personal energy consumption, actually worked, the implications would be massive. In 2007 with the help of the National Institute of Health and the National Institute on Aging the "Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy", aka the CALERIE study (clever!) was launched. The design turned out to be simple indeed - they would recruit a few hundred folks, randomly assign a group who would attempt to reduce calorie intake by 25% without reducing key nutrients, and track everything they possibly could for years. The findings were impressive.

About a decade after the start, results started to pour in. 4 major themes emerged:

(1) Cardiometabolic profile improved
(2) Markers of inflammation improved
(3) Biological Aging slowed
(4) Physical function improved or maintained

But there was a twist - the actual calorie reduction achieved was about 1/2 of that attempted. On average, participants reduced calories by only 12%, which on a standard 2000-calorie-per-day diet equates to 240 calories. To put that in more real-world terms, eliminating a 20 oz soda daily or subbing something healthy for a couple of processed snacks throughout the day could drastically alter even a generally healthy person's trajectory.

Now for some that might be good enough - "no need to know more - it works, let's do it".

However, as science does, the dive into "why" became the next unknown...until now.

Using muscle biopsies taken at baseline, year 1 and year 2 from a subsample of the CALERIE population researchers at NIH were able to determine that the real impact of calorie restriction was at the genetic level. By eating slightly less on a consistent basis, the body "turned up" (upregulation) genes that preserve muscle function, strength, fuel efficiency (both sugar and fat) and also "turned down" (downregulated) those associated with the processes linked to both disease and aging, sometimes referred to as "inflammaging".

While this does not specifically relate to fasting or time-restricted eating, both of which have become far more commonplace since the beginning of the study, it may be hitting similar targets. More remains to be discovered.

Until then, if you're the type of person who sees giving up a few snacks as a worthy tradeoff for better health and stronger aging, the proof is quite literally in the pudding...and anywhere else a few hundred empty calories might be found.

Have a great weekend,

Mike E.

Getting Unstuck - The Mushy Middle

Oct 20

I'm not sure when I first heard the term "the mushy middle". It's been used to describe a political view that isn't polarized to one extreme or another (many people on many issues and in at least 1 person's opinion, not a bad thing). It's also been used to describe writing or storytelling that tends to somehow lose its way between the "beginning" and "end" (been there!). For me, however, it perfectly represents the trap of being (mathematically) average from a health perspective, that is, of being in the middle of the bell-shaped population curve when health risk is plotted.

In plain terms, it's a trap because BOTH time (duration) and age (often correlated but not the same) are risk factors for many injuries and diseases - so even if we are OK being average today, the longer we linger there and leave things "up to nature", the worse things inevitably get. Just like it's hard to build a solid foundation on an unstable or deteriorating platform...standing on mushy ground increases the likelihood we'll sink. From a physical activity perspective, the middle accounts for around 6 of every 10 Americans, which is almost exactly what the math would predict (+/- 1 standard deviation = 68%).

Am I in the middle?

It's pretty simple to determine if this is us. If we are not one of the +/- 15% of Americans who have significant disability associated with mobility or independent functioning AND we are also not one of the +/- 24% who currently meet the physical activity guidelines of at least 75 minutes per week of vigorous aerobic activity (or 150 min moderate) AND resistance exercise (strength, muscle loading, etc) at least 2 times per week, we're there.

Here's the good news - even if we have two of the most commonly cited barriers standing between us and the change we need (time and resources), we can buy ourselves some time by minimizing the impact of being there. Three studies in the last 60 days have pointed the way.

1 - From The University of Connecticut, a team showed that adding an extra 3,000 steps per day (about 2 minutes of walking per waking hour) could lower blood pressure risk as we age.

2 - From the Massachusetts General Hospital, a team showed that a hormone (myokine called irisin) which is secreted from our muscles after as little as fifteen minutes of strenuous effort, can "untangle" and clear the plaques associated with Alzheimer's disease in the aging brain.

Or if you're REALLY pressed for time

3 - From Tulane University, a team showed that taking the stairs 5 times per day was enough, even without exercise, to cut cardiovascular risk by 20%, about 2-3 minutes worth of work (turn 1 of the "UConn walks" above into a stair climb). 

Being in the middle for a little while doesn't have to become another mushy story that goes on and on. The antidote to "stuck" is almost always "MOVE". Let us know if you need ideas.

Have a great weekend,

Mike E.

Feed the Gut Biome, Prime the Brain

Oct 13

While I have a strong belief there are things in this world that are "unseeable" but no less "real", I am admittedly a bit skeptical about the unlucky nature of the number 13 or the fear of that number falling on a Friday. The History Channel tells us there's an actual name for this fear - paraskevidekatriaphobia - and that it is real enough to cause massive economic losses. Meanwhile, NPR has tried to help us actually pronounce the term (a practice they say helps rid us of it). Yet, I find myself wondering if this year, by falling in October, the most unlucky part of Friday the 13th might be that it's easier for the Halloween priming messages to buy and load up on sugar to break through. We know for example that ultra-processed foods tend to poke at our emotions to a greater extent than low-processed foods, which likely drives us toward purchase, consumption, and ultimately poorer health. Now don't get me wrong, I'm SURE I will find myself sifting through the leftover candy bowl to see if there are any Heath Bars left in the mix in a few weeks (I love those things), but, minimizing the impact of the unofficial overeating season (October 31st to January 1st) or avoiding altogether the potentially addictive gravity of the ultra-processed foods it tends to feature, would certainly not be a bad thing. 

For those of us trying to stay on the right side of risk, the question becomes - in our modern environment, where these foods are easy to get and relatively inexpensive, can this risk actually be avoided? Well, according to some new evidence from a research team in Germany, there's good news, if we get started soon.

Building on discoveries that clearly show the connection between the gut microbiome and our day-to-day decisions, the team decided to test the suggestibility of certain foods before and after influencing the bacterial makeup of the biome. In more simple terms they fed a random 1/2 of the study participants a plant-based fiber which is known to "feed" healthy bacteria (PREbiotic, which is different than PRObiotic) for 2 weeks, and the other 1/2 a placebo. They then studied a variety of markers from brain imaging on Functional MRI to blood and even stool samples to understand what was driving an association (if one existed). Then, after a washout period to get participants back to baseline, they switched the fiber and placebo groups and reran the experiment. What they found was interesting, if not stunning.

When individuals were "primed" with a healthier biome they experienced reduced activity in the reward centers of their brain when they were tempted with ultra-processed food. That is, if their brain was re-wired in just 2 weeks, it didn't "light up" the same way when high-sugar and high-fat foods were presented.

While this study does not claim that if we feed the healthy bacteria in our gut we will definitely be able to resist the powerful pull that the junk food industry has on our emotions, for those of us who see wisdom in the age-old maxim "know thyself" (originally interpreted as "know your limits"), it may provide a tool that helps us extend those limits and avoid the traps of the season.

If you start now, Friday the 13th might just be the luckiest day your future self has had in a while.

Have a great weekend,

Mike E.

secondary measures- as simple as salad

Oct 6

We've blogged about the powerful impact of nitric oxide (NO) from dietary sources in the past. If you've missed those, here's the recap:

In summary - dietary nitrates sourced from plants appear to enhance our performance and protect our cardiovascular system, lowering our odds of a major injury to the heart and arteries - a primary prevention (keeping something from going wrong in the first place) effect. The story got even better last month however when a new discovery showed that healthy nitrate consumption might also be critical to deploying a secondary prevention measure (minimizing harm when something does go wrong) by our red blood cells that we're only starting to understand.

Following a line of research that has shown that our red blood cells not only transport Oxygen around our system but also have a role in regulating pressures and lowering them in extreme cases, researchers wanted to know how it all works. Using a mouse model the team from Sweden was able to prove that:

(a) low oxygen states (such as heart attack) can act as a triggering event for secondary measures and

(b) when enough nitric oxide is present, the red blood cells can release the protective signal required to minimize damage.

Of course, knowing that mice aren't humans and mouse models aren't perfect, the team did something especially cool to go one step further in proving its utility. In the last step of their experiment, they re-ran the mouse heart attack model, but this time using human red blood cells from 3 different groups. The first group got a placebo, the second got a nitrate supplement and the third consumed healthy high-nitrate veggies. The two groups with preloaded nitrate (and therefore higher concentrations of NO available) showed the same powerful effect, a 50% improvement in recovery after the simulated heart attack.

A bit like seatbelts and airbags we hope you'll never have a need...but having a secondary prevention measure on board if you do, can be the difference between a scare and catastrophe. This time it's as simple as salad.

Have a great weekend,

Mike E.

25 years later - maps, journeys, and the path ahead

Sept 29

By 2016 nearly 20 years had passed since we incorporated and our model and approach were starting to get noticed by professional colleagues and peers. While it seemed outlandish (and even misguided) in 1998 to make prevention, and health promotion the central goals of a healthcare practice, the results were adding up and at every turn, the research was backing up our claim that it could be done. Around that time we began teaching a continuing education course for professional peers (mostly physical therapists) that covered key concepts. With as many as 1 of every 3 healthcare professionals feeling burned out at any given time, many were looking to redirect their skills and experience the often inspiring "give AND get" that our team enjoys while helping people achieve this way. Acknowledging that it isn't always an easy journey, we called one of the key assignments the "pathway project". It was designed to challenge the professional to use research and evidence to map the course from our influences and daily behaviors to common diseases. As they scoured the evidence, they developed a better understanding of "how we got here" and more importantly, as they compared notes, the root causes that needed to be dealt with to turn things around. 

Although a growing and important problem, the map on mental health concerns like depression had wide gaps. The evidence of a clear connection with our day-to-day behaviors and the influences that drive them was only beginning to emerge and many people were still assuming much of it was not within our personal control. Although clearly incomplete, having a family history or genetic risk was often used as the likely explanation. In the last few years, however, the path has become far more visible.

For example and as we've previously mentioned, in February of this year we learned that regular physical activity can actually outperform "usual care" (medications) for common mental health concerns and that higher intensities are particularly powerful. One cool study in August even validated the dynamic warm-up that we use with so many of our clients. How we time our physical activity can make a difference it seems. It turns out that priming our systems with movement and physical activity BEFORE the workday can increase resilience and well-being as compared to waiting until afterward. Then, a few weeks ago another massive study that tracked more than 1/4 Million people over 9 years made the pathway even more clear. Researchers from The University of Cambridge were able to compare the preventative impact of genetics and lifestyle, drill down the risk-lowering contribution each of 7 specific lifestyle habits made, and even show a few physical health markers that connect the dots. 

Here's the breakdown:

First - our genetics do matter, but not as much as our lifestyle. According to the study, those with a high-risk gene profile had up to a 25% increased risk compared to those with a low-risk profile. However, this was less than 1/2 the impact that lifestyle had. Those with unhealthy lifestyles had a 57% increased risk compared with those with the healthiest lifestyles and 41% increased risk compared with individuals with even moderately healthy lifestyles. This effect suggests that most of the benefit comes with even doing a little bit, an effect that was maintained even after genetic risk was accounted for.
Next - there were as many as 7 different habits that had a risk-lowering impact. Healthy Sleep (7-9 hours) had the strongest effect, lowering risk by 22%. The others lowered personal risk as follows:

Never Smoking: 20%

Regular Social Connections: 18%

Physical Activity: 14%

Low to Moderate Sedentary Time: 13%

Moderate (or less) Alcohol Consumption: 11%

Healthy Diet: 6% 

Last - they were able to fill in key gaps on the map that link behaviors to the eventual disease. In addition to notable changes on MRI of the brain structure in people who led healthy lifestyles, simple blood markers of inflammation (C-reactive protein) and metabolism dysfunction (high triglycerides) were far more likely in those who had a high risk of future depression. Depression may "end up" in the brain but it appears to run through metabolism and immune system health.

Mental Health concerns are impacting as many as 50 Million Americans each year - it's a big problem. The risks we face are real and likely impact every one of us at some level. HOWEVER with a map in hand, the support of those around us, and the willingness to work hard at risk-lowering, "Stronger, Happier People through Better Health" is not just a mission is a reasonable expectation. 25 years later we are excited to be walking the journey to health with you.

Thank you for allowing us to play a role in your journey. Let us know if you need a map.

Have a great weekend,

Mike E.

stress test results predict cancer too

Sept 22

The most well-known stat related to heart disease is that it is the leading killer in America, a title it has held for decades. Lesser known, but not insignificant, is the fact that after the 1960s, Heart Disease has claimed a steadily DECREASING percentage of lives lost each year. While primary prevention efforts, including a better understanding of the impact of smoking, poor diet, and lack of exercise have definitely played a leading role, there are other levers, like catching people who are at risk before a major event that have helped keep things moving in the right direction. The electrocardiogram and testing the heart under "load" during a cardiac stress test has been especially important in this role. It's such a simple concept - when we stress the system with a specific load, we can measure whether the heart is behaving in a normal/predictable manner under that load.

This week, from a research team at the Mayo Clinic, we learned that exercise capacity can tell us about other disease risks too, including the number 2 killer, Cancer. While this makes total sense, a body that has less physical capacity or is not able to recover quickly from physical stress is at greater risk in general (for injury, illness, and disease), this study of more than 13,000 individuals tracked over 10+ years gives very strong proof.

Individuals who had poor fitness (less than 8 METS) were at 42% greater risk of dying in the 10 years after the test than those who had good fitness (10+ METS) and those whose heart rate recovered less than 13 beats per minute from the peak in the first minute after stopping the test were at 36% greater risk during the time.

Do-It-Yourself. While this can be determined in a clinical setting with a treadmill, it is not the only way and may not be the most accessible way for most. As was shown in 2020 and we've blogged about previously, if you have 4 flights of stairs and a stopwatch you can get a good idea of where you're at in a few minutes. The process is relatively straightforward. Climb 60 steps as fast as possible w/o running (and preferably with a handrail for safety but not "pulling"). If you can complete the test in 45 seconds or less, you are near or above the standard and at lower risk over the next 10 years. If the test takes more than twice as long (90 sec or more), you are in the "at-risk" category and may want to consider working to improve. Maybe even better yet, as we've mentioned before, visiting those same stairs a few times daily, can improve where we're at between 5% and 12% in as little as 6 weeks.

 There aren't that many long levers when it comes to health improvement. Now more than ever, fitness is one. Get up and get moving!

Have a great weekend,

Mike E.

stress buffering: remembering recess

Sept 15

It might have been my favorite "subject" during my educational journey. Movement + Freedom to decide how, what could be better? At some point, it was replaced with gym class (Phys. ed) which checked off most of the same boxes but added structure. Then, eventually, it was gone. Although it's fair to assume not everyone remembers recess with such nostalgia, for me it was a chance to burn some pent-up energy, let my mind decompress, and was usually positive; something that might even help to lay down the framework for future habits and well-being. I sometimes wonder how much more productive I'd be as an adult if there was still an unstructured break to go out and run around in the middle of the day. Apparently, I'm not the only one. If you search the term "adult recess" on just about any web browser, you'll discover a fairly long list of articles that relate "play" back to wellness, leadership, productivity, and more. 

But how does it work? And does it work for everyone?

In short, we don't fully know, however this week we got closer to an answer.

First - whether we point to studies of modern-day hunter-gatherers as proof that we humans are built to move A LOT or, maybe as articulated here we (as dynamic systems) actually ARE movement, most of us have experienced the challenge of "being fully still" (no screen, no movement, just be) for longer than a few minutes during waking hours. It's no surprise then that when we "contain" ourselves for extended periods, whether in a desk chair tucked behind a monitor, standing behind a machine, in a vehicle or perhaps off to the side somewhere watching our kids, we are functioning outside of our default and it's tiring. As we tap into our reserves, cognitive and emotional especially, we feel depleted, which often equates to the sensation of stress.

Although it gets a bad rap, stress isn't inherently bad. It's almost like a Goldilocks phenomenon where there is a "just right" sweet spot ("eustress") between too little ("sustress") and too much ("distress") as discussed here. One way it can get confusing is that we can have too much in one domain (such as psychosocial overload) even while having too little in another (physical under-load). This may be why the outlet of movement-based play is so effective, not only does it help us to avoid the trap of slumping into a chair after a long day of doing too much of the same, but it also stimulates the under-loaded areas while resting the often over-loaded. With that in mind, we have been advocating for a 5-10 minute "movement test" as a way to help know the difference between physical and psychosocial fatigue for years. Feel more energized and less stressed after movement? Keep going - you need the movement to free up the energy log jam and ultimately clear your brain!  

By 2018, the research community began adding to the idea. As it turns out, because we are all one system (i.e. no such thing as "body and mind"), a carryover effect is not only available, it seems automatic; when we move we soak up existing social or emotional over-stress while getting the bonus of creating a buffer against future stress. In a review of 14 different studies on the subject, those who got adequate physical stress via physical activity and eventually fitness tended to absorb psychosocial stress more effectively. Those who did so with a group in nature may even get an extra resilience boost.  

By 2021 evidence of a dose-response relationship was emerging. Higher movement intensities created stronger buffers against future stress. The link was clear - finding the sweet spot of daily physical stress helps us to reset the way our system manages other stress, especially psychosocial stress which impacts our mental health and wellbeing. With that in mind, the results of this 2022 review of more than 2 million person-years of data shouldn't surprise us. The authors concluded that if less active adults met physical activity guidelines (+/- 20 minutes per day) more than 1 of every 10 cases of depression would have been prevented, powerful stuff.

For the parents and caregivers out there, especially those who remember recess fondly, the most recent proof might be the one for you to know. As a team in Switzerland reported last week, the same effect holds true for kids. Those who met physical activity guidelines (1 hour per day for kids) were able to deal with future psychosocial stress better than those who didn't.

Simple enough - if you need a stress reliever, go play, preferably outside.

Have a great weekend,

Mike E.

ancient medicine, modern results

Sept 8

While most people know of his contribution of "non-maleficence" (aka "do no harm") which has been deeply ingrained in the practice of medicine, Hippocrates' second most famous quote, which it seems isn't actually his, may be closer to the mark than we ever thought before. This time, even in the most literal sense. 

"Let Food Be Thy Medicine"

Confirmed here in 2013, the famous quote that food IS medicine was probably not the first (or ever) uttered by the great ancient physician. Although the connection between diet and health (and other lifestyle habits like exercise) is made clear in much of his work, the direct line, food being the equivalent to medicine, isn't there. That doesn't make it any less true apparently. Maybe it's the new frontier of the gut biome or maybe the medical community is just finding its way back to its roots, but everywhere we look we just keep finding evidence that lifestyle can be used to correct a growing number of ills, and get as good or even better results to pills and procedures. This week, two different studies jumped off the page.

The first was an observational study of food used as medicine in the most literal sense - the physicians actually prescribed it in areas where healthy food options, specifically fresh fruits and veggies are hard to come by or too costly for consumers who need them. In a special program where physicians could prescribe fruits and veggies, families in 12 different US regions were able to take the prescriptions to local markets and get steeply discounted or even free fruits and veggies. The lifestyle result? Consumption went up - about 1/2 to 1 full serving per day on average. The medical result? Blood sugar improved, blood pressure improved, and body weight improved.

The second was a far more rigorously controlled study - a "Randomized Controlled Trial" (close to the gold standard of interventional research). In this case, participants were separated into 2 groups and randomly given resistant starch, which, as the name implies is a starch that is resistant to digestion and instead tends to ferment in the large intestine. Of course, as we've previously written about, there seems to be a link between the fermentation of foods and gut health which held true here too. As it turned out, in 100 individuals with non-alcoholic fatty liver disease (the most common form of liver disease), a daily dose of resistant starch, in this case, taken from corn but found in a variety of other healthy foods like oats, rice, legumes, and even green bananas, was enough to improve the gut biome. Even more impressive it also appeared to improve their inflammatory profile, rebalance liver enzymes, and cut their triglycerides by as much as 40% in 4 weeks, all very meaningful results.

The summer peak may be getting smaller in the rearview, but that doesn't mean the good stuff has to be gone. Maybe this is your year for a fall garden or if nothing else, to refill your prescription of that new ancient medicine the next time you're cruising a produce section.

Have a great weekend,

Mike E.

the humble banana: villain or misunderstood?

Sept 1

If you're old enough to remember watching the nightly news to get information you're probably old enough to remember all the hooks used to keep you there..."Your _____ (pillow?) might be killing you! Film at 11". As information has become even more accessible and condensed, the tweet-able headline (X-able?) has become even more critical if whatever a source has to say is to cut through the noise. Andrew Warner gets it - in May of 2021, the blogger wrote an outrageous headline...about outrageous headlines. It's a little like stepping into the matrix of clickbait. Nutritional information is notorious for this. Since everyone is a consumer of food (of one type or another) but very very few care to consume the details of what food is doing with, for, and to us, the headlines often win the day. So when I saw a press-release headline that read "The Right Combo: Getting the Most Health Benefits from Fruit Smoothies" earlier this week, I knew I had to dive in; let's pick it apart a bit.

In general, it's fair to say that at Pro-Activity we are pretty big fans of the smoothie so any article that highlights the smoothie as the nutritional delivery mechanism of choice tends to get my attention.  Not only do we have a handful of our own recipes, we often recommend smoothies in general as an easy-to-prepare, tasty, and nutrient-dense starting point for those looking to FUEL better as they journey toward better health. Whether it's the "Jersey Slime", heavy on spinach giving a strikingly green color and similar to the one described here which demonstrated an inflammation-lowering effect in 1 week in people who consumed it daily, or the "Berry Bomb", as the name implies, is loaded with berries and similar to this one proven to lower muscle soreness after intense effort and this one proven to improve blood vessel function or any other number of recipes we've seen, for most medically-uncomplicated folks, a smoothie can be a great option. When I started to read the release, however, I found myself wondering how fast we would start to see the misinterpretations pop up.

The basic gist of the article is that foods that contain high amounts of a particular enzyme (a protein that makes biochemical reactions happen faster) known to be involved in the process that makes them turn brown when bruised or left on the countertop, such as bananas, apples and avocados called Polyphenol Oxidase (PPO) have a, now confirmed, ability to block another important nutrient, limiting the available concentration of it when the two food-types are consumed together. In headline form - a banana in a smoothie blocked the flavanol (recommended for its cardiometabolic protective effect) provided by berries in the same smoothie by up to 84%.

Here's where it's bound to get muddy "out there". The ability of one food to block the healthy properties of another does not make it unhealthy or even something that should be avoided...however, when "bioavailability of flavanol" is important to us (and it probably should be), either keeping the foods apart in preparation or eating them at different times of day could make a difference. This was found in the study as well; when the two food types were actively mixed before consumption (that is, blended together) the reaction was stronger than when they were not mixed but consumed in the same sitting. From the UC press release: "He also said bananas remain a great fruit to be eaten or consumed in smoothies. For those who want to consume smoothies with bananas, or other high PPO activity fruits and vegetables such as beet greens, the suggestion is to not combine them with flavanol-rich fruits such as berries, grapes, and cocoa." With that in mind, substituting a low PPO food in your berry (or other high flavanols) smoothie, such as mango which will bring a bit of sweetness the banana is known for, may make sense. 

The bottom line is - bananas aren't "bad", so when the hype arrives, resist! They check a LOT of boxes: naturally occurring, minimally processed, nutrient-dense, inexpensive, biodegradable carrying case and have even made for a shockingly fun minor league baseball mascot to name a few...I mean, seriously a bases-loaded backflip catch?... but I digress. They're also not the perfect food for every situation or goal. If you find what is, please DO let me know.

Have a great weekend,

Mike E.

have the rhythm of a dancer?

Aug 25

It might be one of the simplest and most straightforward health risk screenings. Place a couple of fingers on an area of the body where a pulse can be picked up (wrist and side of neck being the most common) and pay attention to the rhythm of the heart rate after a person has been resting for a few minutes. The expectation is that it is both steady (beating at regular intervals) and if counted, within a normal pace range, such as 15-20 beats in a 15-second period (60-80 beats per minute). 

But what if it's not? What if instead of "beat, beat, beat" we feel "beat, beat, long pause, beat"? Is there cause for concern?

The short answer is, not always, but quite possibly because, as far as simple clinical tests go, a manual pulse check has a surprisingly high "true positive" rate and so when something is "off", it's probably worth running a few more diagnostics to find out why.

According to the CDC, Atrial Fibrillation, the most common type of heart rhythm disorder (arrhythmia) impacts around 12 million Americans and is a major risk factor for stroke and other cardiac events. Interestingly, it also tends to go hand in hand with other health risks, most notably musculoskeletal health concerns, which add the heaviest burden on quality of life in those with the problem one key reason they are often the primary target of our efforts. Interestingly, there also appears to be some evidence that conditions (such as autoimmune disorders) and habits (such as a pro-inflammatory lifestyle) that relate to high levels of inflammation (reference 1, reference 2) may be possible triggers for the disease's onset.

If this is the case, we would expect the same levers that work so well to lower inflammation and musculoskeletal pain risk (like eating a healthy diet and getting proper sleep) to also lower the risk of developing A-fib. Although not conclusive, a study of patients being treated for the condition revealed lifestyle-related health risks in most, and a 2022 study on the often touted Mediterranean Diet appeared to point in a similar direction.

Exercise on the other hand can be a bit more complex. While the evidence strongly supports general fitness to lower the risk of cardiovascular disease (including heart rhythm disorders like a-fib) with almost all studies concluding "more is better", there does seem to be a ceiling where too much can be too much. Elite Endurance athletes and those who train like them may be increasing the risk. On the other extreme, the "minimal dosage" required to maintain health and prevent disease has been a little less clear...until this week.

Deep in the halls of the European Society of Cardiology Conference in Amsterdam, a poster presentation by a team from Taiwan shared a very interesting discovery - individuals who had at least moderate fitness, defined as "achieving 8.57 to 10.72 METS" on a treadmill stress test had a 98.4% likelihood of NOT developing A-fib in the next 5 years. Interestingly, those with high fitness (>10.72 METS) had exactly the same risk...i.e. no substantial risk-lowering benefit above around 11.0 Metabolic Equivalents of Task (MET).

Translated out of exercise-physiology speak and into plain English - having enough fitness to complete activities and tasks that use 11 times the effort required to sit in a chair almost guarantees our heart will stay in rhythm for the next five years. It also adds that having more than that, although great for many things, is not particularly helpful for this thing.

What is an example of such an activity?

Well, according to this extensive list, running a 9-minute mile, cycling between 15 and 17 mph, rowing at somewhere around 175 watts or competitive-level ballroom dancing would all do the trick!

May we all have the rhythm and timing of a dancer, especially at the most important metronome of all - our heartbeat.

Have a great weekend,

Mike E.

hold that pose and lower blood pressure

Aug 18

“Dripping water hollows out stone, not through force but through persistence.”
- Ovid (Roman Poet, 43 BC - 18 AD)

120 Million. That's a big number and the approximate number of Americans who are living with hypertension which is, heartbeat by heartbeat, overburdening and eventually wearing to the point of harm, the inside lining of the arterial pipes. It is a patient little health gremlin, lulling us into believing it's not really that big of a deal. After all, many people can't feel it and can still "do" everything without any obvious symptoms. Yet there it is, heartbeat by heartbeat hammering away until irreparable harm is done. If we consider that there are around 35 million heartbeats per year for the average adult, we understand why it doesn't take that long to take its toll.

It's not all bad news though. Hypertension is preventable by most, treatable for many and even little things can add up to big results. If blood pressure (combined with heart rate) acts as a "body tachometer" telling us how "revved up" we are, it stands to reason that it has been associated with stress and pain. It also makes sense then that anything which helps us to slow or otherwise calm down can help. 

We've known for a while for example that some of our greatest levers include exercise which pushes our stress-threshold higher over time, nutritional approaches that lower the inflammatory load and balance the intake of foods that naturally constrict the arterial pipes like highly processed foods with those that relax them (nitric oxide and potassium-containing fruits and veggies especially) and sleep which gives us a chance to relax and repair. These are not the only approaches though. Stress management, breathing exercises, and even social connectedness may have a role in protecting us.

More recently, however, research teams have tried to take the conversation deeper - attempting to find the signal through the noise. Comparing various dietary approaches for example has helped us to contrast what might work (there are many) with what actually does for most.  The DASH which promotes low-process, high-fiber, and naturally occurring foods usually scores at or near the top. Under the header of the exercise, the story has been less clear until recently. This year, 2 cool new studies have made the case for holding still...right where we are...for minutes on end. In exercise-jargon: Isometric exercises.

The first study which was published in March showed that office workers who spent 16 minutes per day (4 rounds of 2-minute "holds" with 2 minutes break in between), 3 times per week, either performing a wall-squat or a sustained gripping exercise at 30% of their maximum could lower their blood pressure in a meaningful way in as little as 3 months. They went on to show that after the initial 3 months, they could maintain the changes by dropping it down to only 1 day per week. While the wall squat out-performed the gripping task, both were effective.

The second, out last month, reviewed 270 different studies on the blood pressure lowering impacts of exercise and found that, on average, the isometric exercise outperformed the other modes which included: aerobic, resistance, high-intensity interval, and even combined aerobic & strength. The effect was strongest for systolic blood pressure ("the top number"). Aerobic exercise, specifically running, took the top spot for diastolic ("the bottom number").

It takes effort to control risk factors and ultimately prevent disease but sometimes not as much as we might think. Pretty good terms, not only for those required to meet certain work standards but also for those who look forward to a long healthy life after that phase is over.

Maybe this week try sitting for a few minutes without the chair :)

Have a great weekend,

Mike E.

the multiplier effect of a regular bedtime

Aug 11

Although it wasn't always as widely accepted as it is today, the fact that adequate time to RECOVER each day is critical to our future health doesn't seem super provocative or even controversial these days. Although sleep is not the only way to recover, we can't live very well without it; and both quantity and quality matter. Whether in the context of injuries, illnesses, accidents (motor vehicle and/or work-related), or disease - good sleep predicts good health - an idea that is taking root with more and more folks and supported by extensive research that is uncovering what matters most and why. While "7-8 hours of uninterrupted sleep" continues to be the gold standard for most adults we also know how fast we fall asleep (latency), how rested we feel when we wake, whether we need an alarm to get going, and if we are sleepy enough to "nod off" during the day, can all provide clues as to whether our sleep is of high enough quality to actually RECOVER. A growing understanding of sleep's "stages" (in part from the wider use of wearable sensors that track heart rate and movement) has helped more people understand their personal patterns and risks.

At the same time, and on a track that turns out to be more parallel than we ever knew, other researchers have been working to decode the "the largest endocrine organ" (gut microbiome) - something that was first mentioned as early as 1988 but now more than ever is being recognized as a critical factor in our health. Like sleep, it appears to impact many disease risks that were previously not thought to be related. One of the key learnings so far has been that microbial diversity (having a gut populated with a wide variety) is generally a good thing.

While our food choices likely have the most direct influence on our gut health (as previously mentioned, consuming a variety of plants each week appears correlated with the greatest gut diversity) they are not the only influencer. We know that our exercise habits impact our gut makeup and other system-wide "stressors" such as alcohol (consumption or abstinence) and possibly even early life stress can play a role. Sleep health makes the list here too. The bottom line seems to be that although it is often easier to separate our day-to-day actions, the various environments we spend time in, and the body systems they impact into neat little compartments, they're actually all connected. 

As messy as "it's all connected" might feel, the beauty of interconnectedness is that when we start doing something positive for our health we get a multiplier effect down the road. People who start to eat right often find it easier to exercise. People who quit an unhealthy habit often unlock the energy to replace it with a good alternative. Last week, as published in the European Journal of Nutrition, a consistent bedtime appears to have this power. 

A research team discovered that small alterations in our sleep/wake routine (which they called "social jet lag"), such as "sleeping in on the weekends" results in changes in both our dietary habits and gut diversity. Individuals who had more than a 90-minute change in their sleep pattern, even if they got the same number of total hours, (e.g. sleeping 12A-8A on the weekends instead of a typical 10P-6A weekday routine) tended to BOTH eat differently AND have alterations in their gut biome. It wasn't clear if one "caused" the other, but it adds a new wrinkle - not only are they "all connected" but the crossroads of health may run through the gut.

Respect the routine - bedtimes are not only for the kids these days.

Have a great weekend,

Mike E.

the 4th headline: 5 of 12 cuts 2 by 32!

Aug 4

It's the second leading cause of death worldwide (and sadly number one in America for children and middle-aged adults). Like most risks we face the ones that lead to cancer are probably not 100% avoidable. We inherit certain risks (genes) and might face stressful enough life circumstances to experience a significant risk bump. But still, the more we learn, the more we can confidently say that we humans, with even a very little bit of effort focused on "strengthening the host", are pretty hearty and cancer is just the latest in a long list of unwelcome guests that we can close the door on.

It starts with a very cool experiment in 2017 where researchers had healthy folks ride a bike to exhaustion. They then collected a blood sample, centrifuged off a few factors, and dripped the remaining "serum" onto a dish of human lung cancer cells. Compared to a control group the post-exercise serum killed off more than 50% of the lung cancer cells and sharply slowed a human aging factor. Other similar studies showed similar results with other forms of cancer. Various scientific reviews such as this one in late 2017 and this one in 2020 of how it all works followed, but the oversimplified headlines are:  

1 - Exercise appears to "supercharge" our blood and therefore make the internal environment very inhospitable to unruly & rogue cells.

2 - Exercise should be a part of the conversation throughout the cancer journey, from prevention to treatment and beyond.

Of course, the work never stops and researchers have been working hard to refine exact dosages, whether it combines well with other treatments, etc. but the take-home message has generally been a good one - for those that can tolerate it, exercise is a powerful lever when cancer risk is high.

Then, in April of this year, another cool study popped up. As it turned out, even short bouts of low to moderate-intensity exercise, in this case lightly pedaling a bike (enough to get the heart rate up to 100 beats per minute for 10 minutes) in newly diagnosed breast cancer patients was enough to get a significant immune system boost. As if the first two headlines weren't promising enough, this seemed to both reinforce them and add an important third to the conversation:

3 - It takes a lot less "load" (duration x intensity x frequency) than you might imagine.

But then last week, maybe the most persuasive of them all, especially for those in the "prevention stage" of the journey, was published in the Journal of the American Medical Association. After analyzing the health data collected via wearable sensor from nearly 23,000 people for a 7-year period (on average), it turned out there was a sharp risk reduction for those individuals who had a few minutes of "exercise-like" activity during their normal day, or "Vigorous Intermittent Lifestyle Physical Activity" (VILPA) as the research team called it. Specifically, those who got huffing and puffing through normal activities (carrying groceries, climbing stairs, lifting a child, etc) in 1-2 minute bursts for at least 3 minutes total per day saw an 18% risk reduction over the next 7 years. Those who spent a total of 4.5 minutes (in 1-2 minute bursts) combatting the country's 12th leading risk factor did even better yet, experiencing a 32% risk reduction. That is:

4 - 5 minutes of MOVE (the US' 12th risk factor) cuts Cancer (killer #2) risk by nearly 1/3rd (32%).

Park further away, get off the subway 1 stop earlier, take the stairs or dust off that bike helmet - if it leads to enough MOVE to break a sweat, it can work.

Have a great weekend,

Mike E.

connect is the bridge

July 28

I can't remember exactly when "engagement" became something of a buzzword. I remember sitting in a meeting with an employer client many years ago (maybe the early 2000s) as someone from human resources reviewed the results of the recent "employee engagement survey". Soon after, it seemed like the term was everywhere, being used as a way of describing whether people felt connected to whatever it was they were doing - in this case their work. 

The Gallup Organization, well known for its analysis and insights from surveys around the world, started diving into the idea and tracking the information needed to connect the dots. The results were stunning. The current global average for example is 23%, meaning more than 3 out of every 4 people do NOT feel energized and excited at work. It's as if somewhere around the turn of the century a societal switch from viewing a career as a "life's work", something that added to the greater good (and gave meaning and purpose along the way) to a "grind", where people traded irrecoverable personal energy for a paycheck, was flipped. 

Since that time many groups, teams, and organizations have begun working to understand and improve the human connection, whether at work or at home. Articles have been written on how to instill engagement, what the best in the world like the Navy Seals do, and how the best-in-class organizations (where the average is 72%) are both more productive and happier. It has played a role in stoking a larger conversation, awareness, and research agenda of how far it all goes and what can be done. 

A few weeks back we discussed a recent surgeon general's report which raised the flag on the health implications - which are substantial - and since then, we've spent some time diving into some of the latest research in hopes to get closer to the roots of the problem. A few recent studies have helped. Here are the critical take-aways:

One size doesn't fit all - taken from some very interesting research on the multi-sensory social and sales experience customers receive at Canadian wineries, a research team showed that different people have different needs based on their comfort level with the situation, in this case, novice, expert or enthusiast. For the novices, i.e. those attempting to engage, the basic requirement for success was human connection. In the press release, the first author was quoted as saying "The answer is quite simply connection. People desire connection to enhance their experience...". Well said.

Well-being is the end result, but trust gets the ball rolling - two new studies, 1 from earlier this year and another from last month helped to make the pathway clearer, in a sense by walking backward. Starting from the end goal, "well-being" (which includes positive mental health, happiness, etc.), the researchers in the first team showed that engagement, in technical terms "social participation", was a critical first step but that participating alone wasn't enough. Like the winery experience, a sense of belonging and connectedness was required to lead to well-being. The second study went 1 step further and showed that before participation, and therefore at the very root of engagement, sits trust. Specifically,  individuals who generally believe that the people around them are reliable and would act in their best interest are more likely to engage, connect, and ultimately enjoy higher levels of well-being.

Whether part of a work team, a family, or a community group the people around us play a major role in our health and safety (as we do in theirs). Those who are energized, focused, and find enjoyment in whatever they are doing are not only more productive, they tend to be healthier and safer too. Not surprisingly it's a two-way street, those who take healthy actions tend to find enjoyment and happiness.

No matter why we're traveling, if point A is trust and point B is well-being, CONNECT is the bridge. The stronger we build it, the more traffic it can take.

Have a great weekend,

Mike E.

peak loads - recover well

July 21

You don't have to go very far to find the heat this year. Whether it's scrolling through the headlines pointing to various record-breaking temperatures or just being outside for more than a few minutes in most places, the Summer of 2023 has brought the haze, heat, humidity, and, of course "all of the above". And while officially we're only 1/3rd of the way through Summer (June 21-Sept 22), we are more than halfway through the "unofficial Summer" (Memorial Day to Labor Day, aka 100 days of Summer) and we are near the historical peak for the energy-sapping, body-inflaming temperatures. So while we hope everyone gets through the summer without any issues, our experience (historically and this year) pretty clearly shows that heat brings our bodies right to the edge of their capacity and a few extra tactics to keep the odds in our favor is a good idea in Mid-July to Mid-August.

If you've missed it in previous blogs or our recent training sessions or materials, there are a few key points worth knowing:

1. The effects of heat are "double-edged". While small loads with adequate rest (equivalent to sauna use for example) can improve fitness as our cardiovascular system adapts, large total loads and/or inadequate rest can negatively impact our physical abilities, especially fatigue-resistance (endurance).

2. While maintaining hydration is critical to maintaining our body temperature, it is not our only cooling strategy. Whether in the form of "pre-cooling" (before activity) or "per-cooling" (during activity) employing strategies specifically targeted at lowering the body temperature such as ingesting ice slurry, can improve performance. Using cold air or immersion after strenuous work can also speed recovery.

3. While heat can deplete us faster, it can also make it harder to get adequate sleep since our body temperature has to fall before we nod off. Cooling strategies might help here too. While the research is far from conclusive, there is some evidence that suggests a cold shower after a hard physical effort can help. Either way, our sleep continues to be our best chance to recover, so in addition to getting in an extra hour whenever possible, cutting off calories and bright lights a few hours before bedtime and keeping the room dark and cool when we get there can help.

And now, a counterintuitive twist. While starting an intense outdoor exercise program this time of year is typically NOT on our list of recommendations, movement, and exercise can still pay dividends if done thoughtfully. Foam rolling or other forms of self-massage for example can reduce soreness after a taxing effort, and according to some very new analysis, when individuals face very heavy recovery loads (in this case planned major surgery) even slight fitness improvements enhance recovery. This doesn't have to mean long hours of effort or even effort for a long time. Even three, 20-second bursts on a stationary bike (whether done all in a row or with hours of rest in between) and powering up 60 stairs a few times per day (also with hours in between bouts) have been shown to stimulate meaningful improvements. In other studies, 6 sessions of effort over a two-week period provided enough stimulus to get a bump.

The take-home message here is the heat can get us down...but it probably doesn't have to. We are about to climb the peak of the season and there's always risk as we get to the edges of our capacity. Now is the time to reassess, make a few small adjustments, and RECOVER well so we can enjoy the remaining weeks of Summer and stride into Fall.

Have a great weekend,

Mike E.

do you know your pure score?

July 14

Simplicity is so refreshing. It's clean and easy to apply. Of course, it's also really hard to find in real life, since the world is complex. The more we dig, the more nuance we find which can be tiring; so tiring in fact, our mind tends to avoid it, instead reducing complex information into more simplistic terms, "one OR the other", "yes OR no" saving "both-and" for when we have the time, energy and open-mindedness to really dig in. Psychologists call this tendency of reducing large streams of information into 2 fundamentally opposing camps "The Binary Bias", and it turns out, despite failing to capture the gradient of real life, to be super common across a wide variety of situations.

When it comes to health information, this tendency often surfaces. It is MUCH easier for us to "pick a camp" than it is to sift through the details where we often realize there are always caveats and contextual factors. For example, a recent study once again showed that exercise was a good thing at midlife from a heart health perspective. No surprise. However, it also showed that too much of a good thing could be not-so-good. High amounts, at very high intensities, were actually associated with worsening of the same heart risks that the proper dosage helped. So exercise is good? Yes, but...

Nutrition tends to follow these same lines. Can healthier eating make a difference to our future selves? Of course, but "healthier" is a very wide spectrum and never as simple as we'd like. With that in mind, we tend to gravitate toward tried and true principles, rules of thumb that work for most people in most situations. If you've heard us say "Eat More Plants" for example, this is why. While neither prescriptive nor applicable in every situation, it simplifies A LOT of the available research, including the 2018 conclusion from a massive dataset that showed that individuals who ate 30 different plant varieties per week had the most diverse gut biome, an important marker of health. It boils down a ton of information into an easy-to-understand concept that is applicable to most Americans while avoiding the tendency to simplify things into "good vs. bad". Every once in a while, however, new information emerges that helps us take the concepts even further. In this case, it comes from the PURE study, a very large study that tracked nearly one-quarter of a million participants across 80 different countries for a decade or more. It showed that, in general, "Eat More Plants" holds true and is good advice for the masses. It also showed (however) that to get the most health benefits the variety and dosage of those plants matter and certain animal-based foods can also provide benefits. 

In an effort to simplify what we know about healthy eating, the researchers categorized and scored foods into 6 types & dosages, assigning 1 point for each. Compared to those who scored only 1 point, those who consumed enough of the good stuff to score 5 or more points on average were substantially healthier, cutting their risk by more than 20%. 4 of the categories are plant-based and 2 are animal-based. 

The scoring is as follows:

Fruit - give yourself a point if you consume 2-3 servings per day (juice does not count)

Vegetables - give yourself a point if you consume 2-3 servings per day

Legumes - give yourself a point if you consume 3-4 servings per week

Nuts - give yourself a point if you consume 1 serving per day

Fish - give yourself a point if you consume 2-3 servings per week*

Dairy - give yourself a point if you consume 2 services per day*

*In a press release the author of the study suggested that the same health outcomes gained with moderate amounts of fish and whole-fat dairy can be achieved by moderate consumption of meat and grains, "as long as they are unrefined whole grains and unprocessed meats", each at 1 serving per day,

Eating to prevent disease is not simple. There are many moving parts. However, the more we learn the simpler it gets. Perhaps the very best news is we don't have to be perfect - 5 out of 6 is 83% - and for each point gained, a significant risk reduction is noted; 6% for major cardiovascular events and 8% for dying.

The gardens are popping everywhere, enjoy the bounty and the better health that comes with it.

Have a great weekend,

Mike E.

what i did last summer

July 7

To the dismay of my children, we're not really known for our vibrant Summer vacations. An occasional beach week perhaps but not a lot like friends and family who "always go to the shore" or have some other great downtime tradition. Thinking back, many (maybe even most) of our family vacations have been functional; a planned trip to "chase" a member of the family who is doing something. Many trips are associated with two serious soccer-playing daughters who grew up to be serious rugby-playing daughters, one or both of the parents competing in endurance events for a while there or even the not-so-little-anymore brother who is carving his path on the water with an oar in hand, the adventure of the day has often dictated the downtime.

This time it was a trip to Ottawa, Canada, and the surrounding region to watch one of the rugger-daughters do her thing. It was only my second time in the city and the last was during a Winter cold enough to freeze "the World's longest ice rink" (not so in 2023 apparently), so it was an entirely different experience this time. Walking the city (no ice skates required), seeing a team help a boater navigate the canal, watching the changing of the guard at the National War Memorial, and enjoying the very walkable paths that flank the river was time well spent. Besides the occasional reminder that my heart was in-fact pounding while watching my kid on the field (Garmin really should include a parent-spectating mode), it was relaxing and enjoyable.

However, perhaps one of my favorite moments was an exchange with one of the locals who, as legend (and stereotype) sometimes has it, lived up to the billing of friendly and cordial at least in my experience. It only took a moment. I walked into a pizza shop where we had previously placed an order. The person at the register asked if I was there for a pickup. Almost reflexively I said "Yes, two large pies" and then there was a pause. She tilted her head a little and looked at me blankly. Not really knowing what to do, I just looked back. It was only a second of course, but then she smiled and said "Oooh, pies...right...I was thinking like 'coconut creme' or something". It dawned on me that "New Jers-eese" doesn't always translate and I got a good laugh.

I don't know how much current research exists on the impact of vacations on health. Mostly because I decided not to look too far and instead just enjoy some downtime. Whether you've got something great planned or, like me, are mostly just chasing kids this time, I hope you find some moments to be going slow enough to appreciate the little my n=1 study, it feels like a good thing.

Have a great weekend,

Mike E.

magic in the margins - where to invest our 20%

June 30

"The best part of being a small business owner is the freedom, you get to work 1/2 days...any 12 hours you want...and only on days that end in 'Y'."

 It might have just hit me at the right time of life to make it perfectly relatable, but, delivered with just enough of an eye-roll to make it funny, that phrase became an instant favorite, one I often use to explain a "typical day". Of course, it's not limited to those of us who work in small businesses. From commutes to actual time on-the-job to off-hours communication catch-up and prep, when asked, most people feel they spend most of their waking hours at (or around) work. The statistics seem to support the idea. According to the Bureau of Labor Statistics in 2022 during the work-week, American adults spent on average up to 5 hours per day on "leisure time activities", that is "time not working". 

The good news is, that's about 20% of a day, enough time to be powerful if invested wisely. The not-so-good news is that most of those hours were spent "watching TV", which, although not clear exactly why (likely its sedentary nature), appears more likely to be harmful than helpful to health, especially as the daily dosage increases. What if, like money, we could "invest" some of today's "little bit extra", in this case downtime, in hopes it too would grow for when we really need it in the future. Is it even possible? If so, how much would we need to invest and which "vehicles" would promise the greatest return? Are there any ways to make "automatic investments", like deducting a certain amount before it "hits" the paycheck?

We're closer to the answers than you might think.

First, the more we learn about how the body ages the more we realize how much power over our lifespan we really have. We can't outright slow time and add hours to the day just yet, but as measured by its imprint on our "epigenetic clocks" (in technical terms DNA methylation)  we can slow time's day to day impact and therefore extend both our number of days and how much we can get done in each of them. More simply, it appears we can slow the rate at which we age more than we ever thought and so, yes, our time investments can indeed grow and pay off. 

Next, not unlike financial investments the "return" is heavily impacted by both the amount we invest and how consistently we do so. A small but regular investment definitely can add up if put into the right portfolio. For example, we've mentioned the power in even a few minutes of MOVE each day in an otherwise sedentary life, but that doesn't change the fact that for most people, as outlined in this 2020 paper, more is usually better.

Last, automatic financial investments are held in high regard for a reason, they tend to work; quietly growing our assets in the background, even without a lot of active energy on our part; set it and forget it. Although most investments in health are active processes, there are a few time investments that appear to, like the magic of compounding interest, pay health related dividends automatically, even when that isn't what we set out to do. Near the top of the list? Volunteering. 

According to a study from a team of North American researchers published a few months ago, volunteering appeared to decelerate the epigenetic clock (loosely, slow the rate of aging) in a sample of more than 4,000 American adults. It's too early to tell exactly why, but the effect was real enough for the researchers to call it a "potential resilience factor for aging biology".

Whether it's getting ready for someday or in the moments we hope to savor when someday arrives, we could all probably use a little more time. Invest wisely.

Have a great weekend,

Mike E.

positively "affected"; building buffers

June 23

I remember the feeling well. I've probably talked about it in this blog at one point or another. It was around mile 8 of my first marathon, an unseasonably cold day in Philadelphia. There I was, running with (quite literally) thousands of others, packed tightly enough that I could easily reach out and physically contact the person next to me because it was still early enough in the race that the course hadn't thinned itself out yet. Despite the number of people, it was eerily quiet, with most people focused on executing their race strategy like I was supposed to be. It was past the high-energy stage of the race and not yet to the harder stages, a strange limbo portion, and I was amazed at how alone I could feel in a sea of people doing the exact same thing at the exact same time. Thankfully a fun distraction presented itself and I was able to put my energy into it; a story for another day.

We live in the most connected time in the history of the world. With today's tech, we are a few clicks from connecting with the majority of the world's population, a virtual version of those packed marathon streets, and as ironic as it may seem, we are also living in a time when more people feel more disconnected than ever. According to a health advisory issued by the US Surgeon General's office last month, which described loneliness and isolation as an epidemic in the United States, it is taking a huge toll on our health.

Somewhere around page 30 of the full 81-page report, the authors get into the prevailing theory of how it all works. Although wildly oversimplified, as creatures that run in packs, feelings of isolation go against our nature and can lead to harmful levels of stress in those who don't have adequate buffers. Without those buffers we inch closer and closer to our injury/illness/disease threshold, increasing our odds for a variety of diseases and possibly even accidents.

So how do we build these buffers?

Well, the easy answer is to invest time and energy into the communities where we live/work/learn/play/pray. To engage, get involved, and ultimately CONNECT. However, as outlined in a very interesting article this month, we can also cultivate positive affect - said more simply, do things that bring us excitement and find the joy (hidden as it might sometimes be) in the things we already do. As it turns out, across a population of more than 4,000 people studied for a decade or more, those individuals who regularly felt "enthusiastic", "excited", "strong", "interested", "proud", "alert", "inspired" (or other similar terms taking from the positive affect scale) were not only less likely to experience harm but were almost fully protected against the negative health effects of loneliness.  

May we all find a little time to do what energizes us and invest in our health along the way.

Have a great weekend,

Mike E.

walking and the brain

June 16

I had a little time to get out and do something I haven't done in too long. The simple act of putting one foot in front of the other, sometimes fast enough to be running, sometimes not, mostly away from the rest of the world and listening only to the sounds of nature. It was refreshing. My thoughts were clear, my body was "good tired" and I felt more like myself than before I set out; a great reminder that I was missing being "out there" more than I realized.

Whether it's a hike in the woods, an occasional trail run, a jog through town or just a stroll around the block, getting out and moving with no particular agenda is one of the surest ways to reset for me - and according to the research, it's probably the same for you.

We've known for a while that walking (and other forms of aerobic effort) can be a great creativity hack. A 2014 study out of Stanford really just validated what some of history's greatest thinkers, innovators, and artists had known from experience for centuries - movement, especially walking, stokes the brain. We also know that doing it "out there" seems to have additional benefits. Although some research suggests it's the sounds of the natural world which make the biggest contribution, there is still a lot of learning to do. An article published late last month in the American Journal of Lifestyle Medicine even suggests that it is the "7th Pillar of Lifestyle Medicine", an effect that may be particularly powerful on blood pressure and stress levels (as measured by cortisol) for urban residents.

But do you "have to" immerse yourself in the forest to get benefits? Of course not. The list of beneficial effects of moving in almost any way in almost any place is too long to fit into one blog. However, new research out this month adds a cool one that is worthy of mention - movement helps the functional connectivity (loosely defined as "organization of the circuitry") of our brain, even into later life and even in the case of mild impairment. This is not a small thing. We may not be gaining many new neurons as we age (especially if struggling to sleep), but we can stimulate those we have and it's not just puzzles and brain games that help.

If you're not already, it's a great time of year to nudge those moving tissues into action. If you wind up writing an amazing symphony or literary work or taking our understanding of unified field theory to the next level, just tag us in your social media post! :)

Have a great weekend,

Mike E.

It Just Works. Even Now: FUEL 2 RECOVER

June 9

As Tuesday came to a close I found myself sitting in the cell phone lot at the Newark (NJ) airport waiting to pick up a family member. Out of seemingly nowhere, the sky got grey and a warm dry wind blew. It was strange like it wanted to be a summer afternoon thunderstorm, but without the temperature drop and dark was just grey. Then, the smell said it all. The smoke from the wildfires hundreds of miles North was here...and there...and almost everywhere apparently. It was a new twist, something we hear about but usually don't experience much in the Eastern US and so, a new risk to consider.

Not surprisingly, others were asking similar questions, and the "experts", some qualified and some not, were emerging to answer the question that was on everyone's mind - should we be worried?

The short answer is, we don't conclusively know. Risk is always relative to our personal circumstances and since we could never know all of the factors that play into the calculus, our best bet is to consult the evidence, make an informed guess, and ultimately adapt accordingly. With that in mind, we unleashed the geekdom on the questions we've been asked this week, and here's what we came up with, without any fluff:

1. High levels of fine particulate matter (PM2.5) in the atmosphere is a known health risk and shouldn't be ignored. 

2. Duration of the exposure matters (a lot) but even short-term exposure adds some risk. 

3. Wildfire-related smoke does bring risk and possibly even more risk than other sources of particulate, but a person's baseline health is critical to any risk assessment.

4. The more vulnerable a person is, the more they are impacted by the particulate from wildfires. One study showed for example that older asthma sufferers struggled more on "smoke days" but the risk for others, including those who were older but didn't have a respiratory illness, was fairly minimal.

5. Since inflammation is a known component of the body's response, "right-sizing" the immune/inflammatory response should factor in. Things that raise our baseline inflammation (like eating inflammation-promoting foods) directly impact how we personally respond. For example, there are known and significant connections between the dietary inflammatory index of our food and respiratory illness, including how a person with asthma reacts after exertion. Eating low inflammatory now and for the days after things resolve may be particularly important.

6. It doesn't end there. Since minimizing our risk is really about maximizing our recovery, especially during sleep, our sleep quality is critical during periods of increased risk...and since both sleep quality and duration are connected to the air we breathe (although "oxidative stress" is a likely culprit, the mechanisms are not fully known), we should work hard now more than ever to protect our sleep.

7. It gets even more important because sleep quality has a major role in our immune function, a system we lean more heavily on with increased exposure to new stressors.

8. Brand new research makes an even stronger case for "FUEL 2 RECOVER". Higher inflammatory eating (especially high sugar, high fat, high process) literally alters our brain activity while we rest, making full recovery from the day-to-day almost impossible.

So what should we DO?

There are many possible approaches. "In" the moment, it's always smart to minimize exposure to whatever extent possible. This is of course, especially true for those who are among the more vulnerable to respiratory or inflammatory conditions. The CDC has more than 20 resources on a page for health professionals HERE, including one really cool tool that