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Better Health, One Step at a Time

May 30, 2012

I’m usually a touch overcommitted.  There are so many exciting things to be part of now that the connected health marketplace is blossoming.  However, that makes it hard at times for me to practice what I preach.  Although our Center is not specifically about prevention, we tend to get involved because of our interest in connected health in the fitness market and in the Quantified Self.

By far and away, the biggest proliferation of connected health devices has been in the activity monitoring space, so I am inevitably trying, testing, wearing two or three of them at any given time.  And they remind me every day how active or inactive I am. 10,000 steps a day is a nice benchmark – most days I get to 5000. 7000 is high.  10,000 is rare.  Stated another way, I’m at a plateau in my quest for a healthier lifestyle.  How can I get there?  Do I have to give up some of the exciting work-related things that keep me a touch overcommitted?

When I first started monitoring my activity, it became quickly apparent to me just how inactive I am on an average day in the office.  Meeting after meeting means lots of time in a chair.  I just learned of a study from Australian researchers published two years ago that found that spending more than four hours a day in front of a computer or television was associated with a doubling of serious heart problems, even among people who exercised regularly.  Stated more dramatically, if you sit for more than 4 hours per day, your risk of heart attack is roughly equivalent to someone who smokes.  My own Body Media armband data from a recent Sunday illustrates this principle.  I was catching up on computer work in the morning and went out to do yard work in the afternoon.   The vertical axis is kilocalories and the horizontal axis time.

You can see just how low the calorie burn is during the first part of the graph (period of inactivity) compared to the second part.  When we sit for long periods of time, our body tells our metabolic machinery to make more fat for storage and this contributes to obesity, diabetes, hypertension and risk of heart attack.

So what is the solution?

I’m calling it “small frequent activities.”  You can use your activity monitoring data to help you with this.  If you are tracking steps, set a reminder on your phone or computer to check your step count a few times/day.  Find some activities that you can do which enable you to get in 10 minutes of walking or at least standing.  Fit those into your schedule in a way that is not disruptive.  Use your step count as a tool to measure success.

This is not to excuse you from setting a work out goal and a longer-term activity goal.  Think of daily step count as a batting average and these 10-minute excursions as individual at bats. Both are important to achieving success.  But if you work out for 30 minutes per day, and walk an additional 3000 steps, your heart attack risk will be lower if you spread those 3000 steps out in small, frequent activity increments.

Can the same logic be applied to calories taken in?  I don’t believe research has been published to confirm it, but intuitively it makes sense.  In fact, recently in the New York Times, Claudia Dreifus wrote about a mathematician, Carson Chow, who has built a mathematical model to explain why our country has put on so much weight over the last 20 years.  One of the things Chow notes in his model is that, “if you eat 100 calories fewer a day, in three years you will, on average, lose 10 pounds — if you don’t cheat.”  In one way, this sounds like useless advice because most of us vary our caloric intake on a given day by way more than 100 calories (there are 100 calories in 8 ounces of soda).  But there is something empowering about these data.  Dr. Chow has created a simulator that you can access to see how small changes in your diet or activity make a difference long term.

The insight here is to make small adjustments and stick to them. Climb a few flights of stairs each day and don’t put that teaspoon of sugar on your berries in the morning.  Take a conference call while walking around your office.  Sustained over time these adjustments lead to better health and they are not so overwhelming as the New Year’s resolution of going to the gym or the diet that drops 30 lbs in two months only to see it creep back on over time.

I guess the baseball analogy holds well again.  Hitters make adjustments in the middle of the game according to what the pitcher is throwing. They tend to get more hits the second time through the order. And if they do that consistently, their batting average rises.

22 Comments leave one →
  1. May 31, 2012 12:32 am

    I make a point to stand up and walk around a bit when the phone rings. That’s my trigger to move some.

    • May 31, 2012 12:16 pm

      Great example of finding something in your environment to cue you to be more active.

  2. Jim Hutchinson MD permalink
    May 31, 2012 10:54 am

    But then you may be in the 10% group in which a NY Times article indicates that exercise may be damaging to your health. No matter the widgets or scientific studies people are just more complex and continue to foil our best efforts. Of course we know from that very early study of the cardiac death rates between the driver vs. the person who collected fares on the double decker buses in London and had to climb the stairs multiple times a shift. Seated drivers had the much higher risk of a cardiac event.

    I’ll chance being in the 90% group and continue exercise. Meanwhile you may enjoy this little video lecture

  3. May 31, 2012 12:15 pm

    Thanks, Jim. I have seen that video and admire both the message and the production.

  4. June 1, 2012 10:51 am

    Joe – I’ve witnessed a proliferation of stand-up desks in offices. Do you have any idea (or have you read anything to suggest) whether standing up in front of your computer mitigates some of what you talk about in this post?

    • June 1, 2012 10:54 am

      I can’t cite specific literature, but I believe standing is better than sitting. walking is better than standing.

  5. Rick Valencia permalink
    June 10, 2012 11:50 pm

    Joe, I wish I could upload a picture for your readers. Last week I went by Life Technologies to visit with CEO Greg Lucier. He took me to his executive staff meeting room and it is equipped with a bunch of standing treadmill “desks” around a raised conference table. Everyone walks during his staff meetings. With current technologies and our general state of poor health, why do we automatically treat work as a place we go to sit all day?

    • June 12, 2012 9:08 pm

      This is an interesting ‘mini’ trend. Others have standing meetings (literally) or walking meetings. For balance, consider Daniel Kahnemann’s book “Thinking Fast and Slow”. In it, he discusses how it is natural for people to want to sit down when in the midst of completing complex mental tasks. It is hard to put a lot of effort into mental problem solving while walking. I guess the best course of action would be to have routine, reporting out meetings while walking or standing and save the brainstorm or problem solving sessions for the conference table.

  6. Lisa permalink
    June 12, 2012 1:42 pm

    Will it also help to have tools to evaluate/correlate the effect of different nutrients on personal health, over a period of time ? For example, evaluate the effect of high/low/normal potassium over a period of time on a person’s stress level. What system, or set of analytical tools, can we use in our daily life so that we can conveniently know where our nutrition and health indicators are and take corrective steps during the day ? Before we start driving, we check all the indicators in our car’s dashboard. What indicators can we have for our own body+mind+intellect before we being our daily chores ?

  7. June 12, 2012 9:11 pm

    This is very thoughtful. I’m sure we don’t fully appreciate all of the health status indicators we could sense in this way. One I’ve dreamed of for many years would be a ‘caloric intake’ sensor.

  8. June 14, 2012 1:38 pm

    Very good points.. especially that it’s better to take several small steps than one big one, which is usually unrealistic over time.

  9. June 17, 2012 3:02 am

    Just got back from the Continua summit in Berlin where someone showed me a small pedometer that you could read out just by touching their phone. Really easy – just touch the devices and an exercise graph popped up on the screen. One tap on the screen and I was back in phone mode.

    I know this is not a new system but I never adopted so far because the solutions on offer are too fiddly. Now I will – the message being to make it EASY.

    • June 17, 2012 9:42 am

      Thanks so much for sharing this. I’d love an introduction to the firm, or a web link or something. I completely agree that simple is key

      • June 18, 2012 9:28 am

        The device I used was made by A&D Medical using technology from Sony and connecting with a Sony Android phone (formerly Ericsson). I think you know who to contact but otherwise mail me privately.

  10. July 3, 2012 11:25 am

    I recently experienced a rather acute bout of a rare autoimmune disease. Within a short period of time, I went from playing pick-up soccer 3x/week to being unable to dress myself or turn the keys in the ignition.

    The experience taught me to set small goals, to celebrate incremental achievements, and to be forgiving and kind to my body. For those suffering from chronic diseases/conditions, moving forward, even at a snail’s pace, seems more humane and “sticky.”

    We need to change the dialog about health choices away from “achievement” and goal setting to a model based on do-able choices.

    Here’s what I mean: when I was super sick, I gave myself three choices per day:

    1. swim at the gym
    2. soak in hot tub at gym
    3. simply drive to gym then go home again.

    Many days, before my meds kicked in, all I could do was drive (using remote start!) because suiting up was impossible. The lure of a warm soak soon overwhelmed the pain struggling into a bathing suit, and soon enough, I was swimming 40-60 laps per day.

    By allowing “drive to the gym” as a prescribed activity, I put myself in the path of the gym every day. And on those days, it felt good to tick off “drive to gym,” as good as it would eventually feel to tick off “swim 40 laps.”

    • July 5, 2012 8:23 am

      I think you make some very wise remarks, Natasha

      With the olympics coming up I am reminded about the big gap between achievements and the more modest targets people can usefully set for themselves. Too often we talk about measurements in a competitive landscape whereas the benefit comes from being prepared to set your own targets and measuring what you did. You are your own best judge.

    • July 5, 2012 2:25 pm

      This is a fascinating exchange. I confess, if I took ‘drive to the gym’ out of this context, I’d say it does not cut it. perhaps the key to setting small goals, is the discipline to keep pushing oneself to the next small goal. If you had never gotten beyond ‘drive to the gym’, you would not have done yourself much good.

      • selfhealthmobile permalink
        July 7, 2012 1:39 pm

        @jkvedar Can we sum this up as Pushing vs. Choosing? Goal oriented achievement ostensibly is setting your sight on something, and then working towards it. But what if you can’t find focus on a goal? When one’s trajectory is downwards, how can one set “goals”? Might we not consider a more forgiving approach, by creating gentle, obtainable choices and doing away with the “achievement” and “guilt” that’s baked into goal-centered therapy?

  11. July 8, 2012 6:56 am

    We talk a lot about obesity.

    I refer you to a personal site from Rosie Hardman:

    Despite the url it is not a company trying to sell something, rather a personal and highly intelligent story from someone who has struggled with obesity for many years. She tells lessons that are valuable for all of us who are trying to find solutions.

    Joe, this goes further than the context of your post but I trust you will find it interesting reading. I did.

  12. July 8, 2012 6:15 pm

    interesting indeed. thanks.

  13. August 16, 2012 5:45 am

    Better healthcare will mean that current healthcare services around the world will need alot more funding in order to create jobs such as homecare or nursing, improve facilities, research into medicine and opperations and also improve their equipment.

    Sam Apex

    • August 16, 2012 5:06 pm

      I have to disagree, Sam. We already spend more on labor costs than other industries and have made really no efforts to use those resources more efficiently. We need to focus on making our current providers more effective and efficient rather than hiring new ones.

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