Blog Archives

Nov 8

As Ryan tells it, Mary was interested in making a health improvement. She was engaged in the education sessions he provided at her workplace and she always had good questions, truly an inquisitive mind. Mary wanted to lose some weight and was organizing and strategizing how best to do so. In the world of health change, she was "contemplating", commonly referred to as the step before taking action. She felt there were more pros than cons, but it still had to fit within the many other priorities in her life. Understanding how easily we get off course in this stage, Ryan was careful to give something proven effective but not drastic. He suggested having a "calorie cutoff time", which effectively shifts the last meal of the day to a slightly earlier hour and consistently "closes the kitchen" to allow a slightly longer burn-only period, which is known to improve how well we can process FUEL (especially sugar and fat) and may even lead to weight loss since eating late can be detrimental to health. A few months later Mary was down 10 lbs and feeling good about making a positive health change...and rightfully so, since most studies show even a small weight loss can improve several health markers.

Of course, weight loss isn't the only outcome that matters, and shutting off calorie intake isn't the only viable strategy. Perhaps strength and fitness are on your mind - according to the Mayo Clinic if you can't do 10 perfect push-ups (all ages and more if you're younger) it probably should be. 

Could even 1 minute of daily exercise between now and New Year's Day make a difference? This study from 2021 says, for some folks, the answer is yes. 

Could small dietary changes known to increase our body's Omega 3 and 6 availability (such as eating fish twice weekly and adding walnuts and almonds daily) lower cancer risk? This study out last month says, that for 19 different cancer types, the answer is yes. 

Could adding in 5 minutes of exercise-like activity into our day lower blood pressure to a healthy range? This study, out last Wednesday says, especially in cases when we trade sedentary time for exercise, the answer is yes.

Many people feel the urge to take their foot off the gas and maybe even coast into the end of the year when it comes to health. Given the known risks of the season, this is not a great strategy for most. On the other hand, since small investments add up to meaningful outcomes, we believe now is a fantastic time of year to start building a habit. You might be surprised with how quickly that investment compounds into real results.

Have a great weekend,
Mike E.

Oct 25

Fatigue is a complex phenomenon. It is both physical and mental (body and mind) and can be impacted by the places we are in and people we are with - some that energize us and others that, well, don't. Most importantly, however, fatigue has significant power over our performance. When we are ready and fresh we are capable of amazing things but when we are tired or drained, we tend to be clumsy and struggle. It might show up as fumbling over our words or having difficulty staying relaxed in stressful situations, or as we've seen in every type of athlete we serve (traditional, industrial, lifestyle, etc), it might show itself in the momentary lapse in coordination or reaction time that so often precedes an injury. With that in mind, fatigue is a big target when it comes to prevention efforts. Understanding it better opens the door for approaches that can improve our resistance to it and put the odds more firmly in our favor.

One of the most important insights over the last 10+ years has been that in addition to training our body and its tissues to handle greater loads in order to become more fatigue-resistant, training our brain to handle greater loads during times of fatigue can also improve our ability to ENDURE. Brain Endurance Training (BET) as it is sometimes called, is an approach that not only challenges an athlete physically, such as cycling, but cognitively as well using tasks that load working memory for example, in order to improve physical performance. Some studies have shown it works well.

 For example, in 2015 a team from Denmark reported significant improvements in endurance using a "time to exhaustion" test in healthy subjects who were randomly assigned to either perform endurance exercise only or endurance exercise accompanied with cognitively loaded tasks like a "2 backtest" where a person is shown a sequence of items and asked to quickly recall which appeared 2 ago (try it here). Another study in 2021 had similar findings showing a 32% increase in muscular endurance in a group that had both types of training concurrently and a 2023 study showed significant improvements for those who performed the mentally fatiguing tasks prior to the physical exercise.

But what about average/everyday folks - could there be benefits for individuals who aren't super concerned about their cycling endurance and really just want to think more clearly and minimize health risks?  The answer seems to be yes. Last week, findings from a team from the University of Birmingham showed that along with physical performance, both attention and cognition (executive function) could be improved to a greater extent when physical exercise was combined with cognitive loading tasks even when the subjects were fatigued. Although the best protocols are still likely a way off, finding ways to challenge body and mind seems to promote a better ability to ENDURE in each. 

Not sure if we will see puzzles in the gym anytime soon, but for those who might benefit from being a bit more fatigue-resistant, throwing in some MOVE in the midst of a mentally tiring day might go a long way.

Have a great weekend,
Mike E.

Oct 11

Lower back pain is a complex beast. Decades of trying to make it simple have mostly failed and, even after nearly 80 years (since World War Two when it burst onto the scene) and hundreds of billions of dollars spent annually since, making "spinal pain" (lower back and neck) the most costly condition of 154 when ranked in 2020, we haven't fully decoded it yet. What we can say with some level of confidence is that if your back is hurting it is almost definitely a whole picture thing and not just a single or even a few simple factors.

Here's what we know: Occupational exposures like heavy physical work are often pointed to as the culprit. While they certainly add risk, they have not proven to be the sole "cause". In one recent review, and beyond the usual number 1 predictor (a history of lower back pain), the strongest predictors included both work-related risks (carrying heavy loads, heavy work, and awkward postures) as well as personal health risks (higher body weight, anxiety/depression) as well as unhealthy behaviors (smoking and maladaptive behaviors). Said another way, the movement risk (biomechanical) is real...but so is the psychological and psychosocial risk. Other studies have shown that metabolic disease (small vessel disease like diabetes) may add risk, while others have focused on dietary risk (especially high inflammation), poor sleep, and the benefits of social support.

Finally, sedentary time alone is a strong possible driver.  If this all sounds like a tangled mess, well, we agree.

With that in mind, a team in Finland set out with the hope of unraveling some of it. They decided to take on the metabolic component by looking at energy utilization (glucose uptake and percentage of fat) in the muscles of the lower back by reducing sedentary time by 1 hour per day in a sample of overweight but otherwise healthy individuals with back pain. They recruited +/- 60 subjects and randomly assigned them to either the control group or the movement group. The headline findings were interesting but certainly not earth-shattering: those who reduced sedentary time slowed (or stopped) the progression of pain but didn't reverse it and standing alone wasn't enough to improve the metabolic efficiency of the back muscles. The fine print however was far more intriguing.

As it turned out, step count, that is, actual movement and not "just" posture change WAS associated with metabolic improvements in muscle and, when compared to previous studies, standing, like many interventions might have a minimally effective dose. An average 42-minute per day increase for six months in this study wasn't enough, but double that and throw in some professional support on managing discomfort as was the case in this study, and things improved. Of course, this is not the end of the line, there is still more to unravel. Until then, we continue to suggest a strategy that stands on the evidence:

MOVE enough - even if the best you can do right now is get out of your chair more frequently, posture change is good. FUEL clean - lower your dietary inflammatory load by increasing the healthy stuff and decreasing the metabolic stressors like low-quality, sugary/fatty & processed foods. RECOVER fully - keep your system relaxed with enough sleep. Build ENDURE - managing stress plays a bigger role in pain than most realize and last but certainly not least CONNECT - find a few people who have similar goals and band together; social support can help with all of the above.

Lower back pain continues to be common and frustratingly complex for too many Americans. Until we've got the whole mess untangled, go with what you know - a healthier body is a stronger, happier, and more resilient one.

Have a great weekend,
Mike E.

Sept 27

With the Summer season officially in the rearview as of Sunday, it shouldn't have come as a surprise that Tuesday morning "already" felt a bit like Fall, but it still did. The air was brisk, the sky had some grey and, as it tends to when the air is cooler (at least for me), the first sip of coffee was especially satisfying. Now, while I try to be conscious of the line between actual coffee (with nothing, often considered a healthy habit) and coffee-flavored drinks with enough sugar to have a nutritional profile closer to a dessert (not quite as wonderful), I admit to having mixed feelings when I answered "yes" last Spring to a highschooler doing a science project that asked me if I thought I drink coffee regularly enough for it to be considered a caffeine addiction. And so, like I often do, I've tried to keep an eye on the related research to make an informed decision as to whether this is a habit I should work to change. For those who might also wonder, today's blog is for you.

Let's start with the last time we covered the topic (January 6, 2023). Then, the general consensus was that consumption of up to 4 cups per day in healthy, well-rested individuals, did not appear to have a negative impact and might even have a small positive benefit on health. However, in groups who were up against either a health condition, such as a higher risk of fracture (osteopenia or osteoporosis), high blood pressure (160/100 mmHg or higher), or musculoskeletal pain or were chronically under-rested (less than 6 hours of sleep per night) there was a higher risk, the effect was negative. More than 1.5 years later, we have more information, but the punchline is similar.

Broadly, for otherwise healthy people, the news on coffee consumption (and by proxy caffeine) is mostly, but not all, good. In moderate doses (generally considered 2-4 cups per day) and when taken early enough to not interrupt sleep, there are positives including lower markers of inflammation (CRP), lower risk of Parkinson's Disease, a lower risk of a cardiometabolic disease cluster (called "multimorbidity") and a neutral effect on blood pressure. On the other side of the spectrum, one review this year reported an increased risk of lung cancer in habitual coffee drinkers, a risk that has been hard to pin down in previous years, something the authors acknowledged in the last line of their conclusion when they stated: "Further studies, especially with a prospective design, are required to expand our knowledge on the association between coffee consumption and risk of lung cancer.".  

For individuals already struggling with a disease, condition, or at high risk of one, the take-away is a bit more nuanced. The news for those with a history of colorectal cancer appears positive - the likelihood of recurrence in habitual coffee drinkers was significantly lower (-32%) than in non-drinkers, while the news for those with chronic pain was more complex; coffee consumption was associated with the known relationship between chronic pain and mental health concerns like depression and anxiety.

And so, like so much in health and human physiology - it seems the answer is "it depends". If you are otherwise taking care of yourself, generally healthy, are a non-smoker, and consume up to a few cups of coffee and/or tea per day (200-300 mg of estimated caffeine) preferably without added sugar, should you look to trim back your consumption? Probably not, you're likely not harmed and may even be lowering your health risk. On the flip side, if you have one or more health conditions (especially those that may be impacted by stimulants such as high blood pressure and/or anxiety), aren't getting enough sleep, or are already at the high end of consumption (more than 4 cups per day), a more thorough dive into your risk picture is probably a good idea.

We wish it were as simple as "hold the cream and sugar", but until then, we'll keep an eye on it and report back.

Have a great weekend,

Mike E.

Sept 13

I was standing on the sideline chatting with a friend recently and he was telling me about his most recent physical. Now, this wasn't any ordinary physical where the doctor might review some blood work and vital signs, this was a comprehensive physical mandated by his employer because his is a key strategic role there. He described a battery of tests and a long review with the specialist which took somewhere in the realm of 6 hours (and a lot of dollars) to complete. The bad news was, at/near "middle age" he wasn't perfect and sadly there was no fountain of youth, but the good news was he was doing pretty well all things considered, and on the right track. After a pause in the conversation, I asked "So, what did he tell you to do from here?", having a sneaking suspicion I might not be surprised. "Eat well and exercise mostly," he said...and I smiled thinking how clear things can be at the 30,000-foot view.

Way down here in the weeds where most of us spend our days, it doesn't always seem so simple. Super easy access to cheap and tasty (but harmful) food on every shelf combined with fewer and fewer requirements to MOVE during the day has resulted for many, in poorer metabolism earlier in life, less muscle and bone mass ("working tissues") during our peak years, a shorter distance to the risk threshold and ultimately a dwindling number of fully healthy years. And while there is a strong argument for "earlier is better" when it comes to building preventative habits and the reserves they create, "now" with a goal of "consistently" is almost always next best if there's been a gap. In fact, new research out this week showed that our working tissues aren't the only ones that build reserves from healthy habits. 

As described in a press release from the University of Michigan, even our fat cells get stronger and more efficient. Habitual movers, which were generally defined as individuals who performed physical activity at least 4 times weekly for 2 years, had differences in both structure and function when researchers compared their fat cells to counterparts who were not exercisers but were otherwise similar. Just like exercisers tend to retain "cellular muscle memory" which allows their muscles to respond faster and better to training, especially if they've been away from resistance exercise for a while, it turns out that the fat cells of those who performed endurance exercise regularly had better blood flow, more cellular powerplants (mitochondria) and were better able to store fat in a healthy way; under the skin and away from higher risk areas like organs in times of weight gain. This kind of adaptation may even cross generations, which, if this animal study holds true in humans, is especially important for future fathers and daughters.

When we do the right things consistently and give our bodies time to adapt, they do, even if the changes in the mirror aren't obvious or fast.  Before there are results, there are actions, and the faster we turn them into habits, the better off we'll be. 

If you didn't get started 2 years ago, now is a great time.

Have a great weekend,

Mike E.

Aug 30

Around the country, school is back in session, or close to it. First-day school pictures are starting to pop up on social media feeds - some with smiling faces and some with that "ugh!" look. And then there are those like my son (old enough to drive and much to the chagrin of my wife), who have been in "the game" long enough to "forget" about this time-honored tradition. Now, while it's entirely possible that he's become something of a grand master at this game of awkward photo chess played in households around the globe, it is equally possible that, like so many of us every day, his brain wasn't fully engaged and he was just trying to get out the door on time. This may be a bigger deal than it seems and one that might set us up for something less than our best, risky on a variety of fronts. For those of us who are driving first thing in the morning or in safety-sensitive roles at work, not feeling fully awake could be disastrous. For those who are working hard to focus and learn (like our kids), the same physiology could be keeping them from achieving their best...and if so, perhaps a few minutes of priming and "activation" using one of the most effective tactics known, would be worth the investment.

At its very root, this was the theory a team from Japan set out to test with a group of middle-school children. They provided a protocol of 7 light movements (stretching and low-intensity dynamic body-weight movements) each lasting between 10-20 seconds and then measured oxygen levels in the part of the brain known to handle higher-order tasks (prefrontal cortex) which sits directly behind our forehead. In essence, they were testing the idea that movement, even at very light intensities for less than 3 minutes total, could prime the brain for better performance. The answer, as published early this week, was "yes"; however some movements were better than others.

Dynamic movements that involved multiple muscle groups and a postural challenge (such as movement from a stretched position or one requiring stabilization) showed a more significant effect than static stretching alone. Or said another way, although it doesn't have to be strenuous to get the effect if you feel a movement is so easy or ingrained that you could "do it in your sleep" it is unlikely to do much to activate the brain...so maybe you could.

We are entering the transition zone - that period where the lazy days of Summer give way to the routine (and maybe racing) of the Fall. On the one hand, and with any luck, cooler temps will be here soon. On the other hand, there are more people on the roads, more demands for our attention, and therefore quite possibly more tired bodies and brains. If you haven't done the inventory in a while it's an easy way to prime the physiological pump...and the pulleys, levers, vessels, and synapses too.

Whether you join us the next time we cross paths or you take the idea home with you and share it with your family, it's never a bad thing to start the day well.

Happy Labor Day, have a great weekend,
Mike E.

Aug 16

Understanding a problem is at the heart of solving it. Whether we prefer the way Charles Kettering (American Inventor and Businessman) said it "A problem well-defined is half solved" or we lean toward Einstein's approach "If I had an hour to solve a problem, I'd spend 55 minutes thinking about the problem and 5 about solutions", the first step in being a problem solver is almost definitely being a problem understand-er.

When it comes to the declining musculoskeletal health (the body's moving tissues) in the US over the last 30 years, sometimes it feels like a poorly understood problem. Just like there are 88 unique risk factors for heart disease and therefore thousands of potential risk combinations per person (as mentioned here), movement disorders are simply not simple. We may want them to be about some singular biomechanical "fault" or completely encapsulated in the cause and effect of a moment when we first felt pain but that just isn't so. This is one of the main reasons we put such an emphasis on communicating the evidence in every opportunity AND why we try to approach the problem from all 5 known vantage points (MOVE, FUEL, RECOVER, ENDURE, CONNECT). With any luck, it helps to broaden the understanding of those who have their sights set on living as healthy as possible for as long as possible. 

This year has already produced some important insights from military populations, members of the trucking industry, and recreationally active US adults. Here are the headlines worth knowing, sorted by release date and which population the theory was tested with:

Jan 2024 - Mental Workload & Static Postures are correlated with musculoskeletal disorders in truckers (Industry)

Feb 2024 - Strength & Fitness measures predicted 2 of every 3 injuries (CAN Military)
Mar 2024 - Health & Fitness measures (BMI & Aerobic Fitness) were superior to movement assessment at predicting injury in young/healthy individuals (US Military)

Apr 2024 - Inflammatory Markers, Lack of Health Behaviors, and History of Pain predict musculoskeletal injury (Recreationally Active US Adults)

Jun 2024 - Muscular Power and Unhealthy Behaviors (smoking) predicted injuries and dropout in Marine Recruits (US Military)

Jul 2024 - Painful movement today predicts future injury tomorrow (US Military)

And now, the 5 minutes on solutions. Pick "any", work toward "all": 

Move often throughout the day, preferably enough to be a little winded. 

Do something for your strength & fitness every day. Evolve toward power movements.

Lower inflammatory load with healthy fuel and work on sleep hygiene.

Avoid known system-wide stressors like smoking.

Check-in with your movement daily and prime it for success (body inventory). Let us know if you need help (schedule a consult).

And last, but certainly not least....

Have a great weekend,

Mike E.

Aug 2

I mentioned a few weeks back that I had taken a trip out of the US. It was a fun-tiring kind of thing like vacations so often are. Yet, on my way back home, as the hours of trains, planes, and automobiles slowly passed, I noticed an annoying little ache in my right leg. It didn't have the features of anything serious (blood clots, etc.) - but it was there, steadily making itself known. With a pretty clear line from my hip region to the front of my shin, all signs pointed to sciatic nerve irritation. Of course, having seen this kind of thing so many times, I knew not to worry, but I also knew ignoring it would only prolong it. 

After thinking through the possible causes for the irritation it was pretty clear to me that between 5 time zones, lots of time sitting during transit and 10 days of vacation food, my system was pretty revved up. Data from my Garmin confirmed it - my resting heart rate was up significantly from my norm, my heart rate variability (a measure of system stress) had gone in the wrong direction and my "training status", Garmin's way of telling us when we are (or aren't) in the training-load sweet spot, was reading "strained". Essentially my sciatic nerve was a window into what my entire system was dealing with - I was exhausted and my body was shooting up a flare.

The good news is, I knew what I had to do. It would be a rebuild of the same 3 legged stool we so often share with clients and talk about here: 

1. Get moving. Exercise is one of the most potent ways we have to "soak up" inflammation and lower the overall load. Just enough to stimulate me without further exhausting myself. A few minutes of stretching after breaking a sweat and doing a little resistance felt amazing. The fact that the sciatic pain was mostly gone after the exercise told me all I needed to know - irritation, not injury.

2. Get rest. Not only full night's sleep but perhaps even more importantly, monitor how rested we feel upon waking. Almost a week later, I woke up today feeling refreshed. 

3. Eat well. Being back at home can definitely help here. Not eating out every meal is a fast way to add nutrients and minimize sugar by incorporating more fresh fruits & veggies. Shifting to water as the default beverage of choice didn't hurt either.

This is of course perfectly in line with the latest research on the subject. One study out this week showed that unhealthy diets (in this case either too much sugar or not enough nutrients) were linked with accelerated biological aging (years of living near the threshold) and another from early in July showed a link between similarly unhealthy diets (this time sugar-sweetened beverages like soda) and lower back pain which combined with another study from earlier in the year which connected pro-inflammatory diets to back pain makes the connection even stronger.

We throw a lot at our bodies this time of year. It's easy to go from revved up to broken down. There's no need to get that far. Reach out if we can help.

Have a great weekend,

Mike E.

July 19

As ironic as it may seem for someone who spent his first 20 working years logging the kinds of miles that would easily classify as "super commuter", I don't consider myself particularly well-traveled. Having only been outside the US a couple of times before this past week, I was both looking forward to and dreading the idea of a trip to Europe to watch my middle daughter take on a few of the other up-and-comers in her age group on the rugby pitch. Maybe it's just my age group, but the idea of a "European Vacation" conjures up something sort of hilarious to watch (a classic movie in one humble opinion) but maybe not to experience.

I'm happy to report that, generally speaking, all went smoothly in Chapter 1: Getting There. Security was shockingly easy, the airport was busy but simple to navigate, the trains to my local destination were slam-packed but ran on time and people were friendly and helpful. The only real issue was - WOW the timezone shift got me. For the first 3 days, I went to bed early, woke up in the middle of the night for a few hours and by the time I finally fell back asleep I was so exhausted I could've easily slept the next day away. It felt a little bit like what "light sleepers" describe, especially as we age; something I've never really struggled with. No surprise, when a new randomized study that claimed to show a significant improvement in sleep popped up in the headlines this week, I dove in.

The mechanism? Simple enough really - it was a dosing study on MOVE, and it once again showed there's a sweet spot. 

While high intensity or heavy loads of movement (work, exercise, etc) right before sleep tend to impair the quality and duration, it turned out lighter loads done during the post-work, pre-sleep time period had the opposite effect. More specifically, when researchers had people shift some of their physical activity to the "ramp down" period and had them do light to moderate intensity, bodyweight exercises for a few minutes, twice per hour starting 4 hours before bedtime, sleep duration improved with no negative impact on sleep quality...a very simple add on to make sleep hygiene tactics even more effective.

It doesn't take a major timezone shift to have sleep be a little "off" this time of year. The heat and the workloads tend to be up (or way up) and oddly enough this can leave us both tired AND unable to settle into the depths we need to RECOVER. If "3 minutes chair squats, calf raises and standing knee raises with straight leg hip extensions for 20s each over three rounds" can give us 30 minutes of rest, it's probably worth the effort. I know I'll be trying it on the way back!

Have a great weekend,

Mike E.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 answers...to 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.

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.

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.

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.

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.

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.

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: 

• Doing a little dietary downfield blocking by making the early meals of the day higher quality and more likely to last by adding a bit more protein and lowering the carb count at breakfast.

• Working hard to work hard by making sure some energy exertion, exercise when able, and active events when not, is part of the day

• Respecting Rest by keeping a normal bed/wake time whenever possible

• Limiting the number of drinks to a healthy dose and making sure you're consuming water too can minimize the impact

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.

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.

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.

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.

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.

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 statement...it 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.

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.

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.

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.

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.

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.

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 things...in my n=1 study, it feels like a good thing.

Have a great weekend,

Mike E.

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.

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 clouds...it 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: