Slow Down and Tune In

When I heard that Javan Belcher, the Kansas City Chiefs linebacker, had shot Kasandra Perkins, the mother of his three month old daughter, nine times in front of his own mother, then took his life in front of the Chief's coaching staff, the first thing I felt was an overwhelming sadness. I often hear tragic sports stories but this one really confused me. I thought about how maybe this catastrophe was the result of numerous concussions affecting the frontal lobe of Javan's brain and altering his mood and judgement. I wondered about cultural and racial issues that contributed to this tragedy. I thought maybe this was just two explosive people who were unfortunately in the limelight. I thought about gun violence and legislation to restrict gun sales and how divided our country is even after tragedies such at this one. I thought about the shootings this summer in Aurora Colorado that injured 58 and killed 12, recalled the shooting of Arizona Congresswoman Gabrielle Giffords, and of course the countless shootings in our country that we hear about so often that just seem to blend together.  I thought about this all day Saturday and into Sunday and really could not make heads or tails of my emotions about this subject.  I was so frustrated by the media's concern about whether the Chiefs would play on Sunday and why they should or should not. There was discussion about how it would disrupt the season and the player's preparation. Sports casters recalled how games were played after Kennedy was assassinated and after 9/11, but no one mentioned that this game should not have been played out of respect for Kasandra Perkins. 

On Sunday night I saw this press conference with the Chief's quarterback Brady Quinn whose greatest NFL moment was probably his comments following this tragedy. When Quinn was finished,  I went right to my laptop and watched the comments two or three more times.  He was so right on. We are all incredibly distracted by our technology. We could be surrounded by friends and family in the most beautiful place in the world, doing our favorite thing in the world and many of us would want to check our email, twitter, Facebook, or post an Instagram. As a result, we probably miss little cues in one another that may have come naturally before. I have tried to make a conscious effort and will make even more of one now, to put down my phone when I can, stop checking my email four times per hour,  and stop posting my life as it happens.  I want to be more connected to the people around me and take time out from technology to tune in to my surroundings and the feelings of others.As our world of technology has accelerated we have become a distracted society. We ask as a formality how people are doing, but do not listen to the answer, nor do we feel entitled to say how we really feel when we are casually asked how we are doing.  Quinn's palpable guilt that he did not pick up on his teammate's mental suffering and homicidal potential is something I never want to feel, and I am in just as much danger as Quinn was of missing these cues in the people around me because I am rarely truly tuned into the present. 

 When I get home from work, I'm going to try and put my phone in the drawer and not look at it until bedtime. This weekend, when I'm watching my son play soccer or my daughter at the park I will leave my phone in the car. I think that we can all learn something from Brady Quinn's eloquent comments if we all just slow down and take time to really smell the flowers of our daily lives. 

Start Now!

The busiest month of the year for gym memberships is January. After people have eaten their way through the holidays they realize the outfit they wanted to wear for New Year's Eve can't be zipped up, and the top button of the shirt cannot be buttoned they then resolve that this will be the year they join a gym and get in shape. Why wait? Start doing the things you want, feeling how you want to feel, and living the way you want now. When you wake up tomorrow, plan to eat better, join the gym or go to the yoga class you've been planning on going to for the past 6 months and I promise you will start to feel better mentally and physically. I suggest picking a goal to meet in 3 months, whether it be losing 10 lbs, running a 10k, or getting in shape for your ski trip. Pick the date and write the goal on a big piece of paper and hang it on your refrigerator. Tell your friends and family what you are doing and make it happen.

For me, I have to get in better shape and I have to be lighter to do the things I want outside the office. Last week was my first week back to surfing after a knee surgery in October. It was painfully obvious to me that I do not bounce back the way I did when I was 20 or 30. I'm still strong, and I can paddle and catch waves but not nearly the way I want to. I'm not going to wait, I'm going to start fixing this problem tomorrow. I'm going to lose some extra weight, surf more, and surf the way I should and want to. Three months from now, I know I'll be where I want. 

Shifting Baselines of Obesity and Diesel

Contagiousness of Obesity-see the NYTimes summary of the article and link to the original New England Journal Article.


In 2007 researchers from Harvard looked at data from the Framingham Study, which followed the population of Framingham Mass for more than 35 years and were able to reconstruct familial and social networks within the town's population. Their findings were very impressive. In short, if you are close to people who are obese either by relationship, family, or proximity you had a higher likelihood of becoming overweight or obese yourself. As with all things in life the more we get accustomed to certain things the less out of the ordinary they seem. For instance, when I was a kid growing up Natalie on Facts of Life was the overweight girl, today she does not seem particularly overweight as everyone else has gotten quite a bit bigger as well over the past 30 years so my baseline point of reference has changed. What used to seem obese to me is now mildly overweight and I have a new baseline for what obesity is.



What does Facts of Life have to do with my weight today. Well according to the study the more people you have in your life that are overweight you are more comfortable with your weight being slightly higher than it should be and slowly over time every one's baselines shift upward. Here is where the concept of an Obesity Epidemic becomes real. As more people gain weight and develop social networks, which is even easier to do today, more people will be exposed and more people will be more comfortable with their increasing weights. Over time, people will be more comfortable with their extra 5 or 10 pounds and so will the people in their close network. You can see how over 30 years this would spread through a population.

Fortunately, the study also showed that for people who were losing weight, and I imagine exercising, their behaviour was also contagious in that their cohort lost weight, were in better condition, and likely had better health.  However, so few people were in this group that the researchers could not make any firm conclusions. It does make sense to me though that the inverse of the contagiousness of obesity would be the contagiousness of diesel. The more fit and healthy you are, the more fit and healthy your network will be. The more you do, the more your, mom, your brother and your college roommate will do as well. As a community physician I routinely talk about my own exercise program, admit to failings in diet, and encourage people to do the same in their peer groups. I think with this simple exercise we can all imagine making a positive impact on our own communitys' health.

Framingham Studya

Midlife Cardiovascular Fitness Predicts Healthy Aging - General Medicine

It seems obvious that people who exercise throughout their lives would be healthier than those who do not. Often times people who have not exercised for many years feel that the window is closed for them and it's "too late to start". The good news is that it's never to late to start. This is the summary of an article that was published in the Archives of Internal Medicine this past September. In short, the study followed a patient population for 26 years and found that the people in the top 20% of fitness for their age group had a 50% lower rate of developing chronic illness when compared with the group in the bottom 20%. Time to hit the road!

Midlife Cardiovascular Fitness Predicts Healthy Aging

Better fitness was associated with lower risk for chronic conditions during the next 26 years.

Robust midlife cardiovascular (CV) fitness is associated with lower cardiovascular-related mortality, but what about morbidity? Researchers assessed relations between fitness and several chronic conditions (ischemic heart disease, congestive heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer disease, and lung or colon cancer) in older individuals by linking a preventive medicine registry to Medicare data. About 19,000 participants (mean age at entry, 49; 79% men) received full baseline fitness and medical assessments and were stratified into five quintiles of fitness. Most participants had relatively favorable CV risk profiles at entry.

During a median 26-year follow-up, participants in the highest fitness quintile had about half the prevalence of chronic conditions than did those in the lowest quintile. In adjusted analyses, each metabolic equivalent increase in baseline fitness was associated with roughly 6% reduction in risk for developing a chronic condition.

Comment: Although these results are not surprising, they add another motivation for encouraging midlife cardiovascular fitness: This approach can lower risk for frailty and comorbidities while improving quality of life in older people.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine October 4, 2012

CITATION(S):

Willis BL et al. Midlife fitness and the development of chronic conditions in later life. Arch Intern Med 2012 Sep 24; 172:1333. (http://dx.doi.org/10.1001/archinternmed.2012.3400)

When I was 9 years old I started exercising in earnest and haven’t stopped for the last 33 years. I have ran in 5k’s and 10k’s, tried martial arts, surfed, swam and worked with trainers. Looking back I would say that the hardest part is getting and staying motivated as well as keeping it interesting. When I see patients in my office I try and explain to them that many of their problems can be resolved without medications. When I tell them that they need to start exercising regularly and intensely most of them tell me they don’t have time or they don’t know how. It may be possible to not have time some of the time but not all the time. Ideally, I would like people who are starting an exercise program to work with a trainer or in a class setting, however some people can just budget 30 minutes at home and this works too. Here is a simple workout which can be done at home in  30 minutes or less. The beginner work out is geared towards people who haven’t exercised in years. The advanced work out is for people who are trying to regain a basic level of fitness in order to resume an active lifestyle. 

Basic Workout (repeat circuit three times)

High knees marching in place 30-60 seconds. This can be more or less intense  either by slowing down, speeding up, or increasing the duration. If marching in place is too difficult then hold on to a chair or table top to assist with balance. 

Plank or Modified Plank 30-60 seconds. There are a lot of variations on this exercise. To make it less difficult, reduce the time. To increase difficulty lift one foot or one arm off the floor for 10 seconds then go to the next limb. This is an excellent exercise for strengthening your abdominal muscles, improving balance, and building overall core streng 

1. 
   

Military Press with resistance band. Repeat 15-20 repetitions slowly. The goal of this exercise is to build up the muscles in the shoulder girdle. The resistance bands require stabilization of the shoulder which will decrease the likelihood of rotator cuff injuries in the future. 

Sit ups 15-20 repetitions. Another variation is a reverse sit up where your back if flat on the ground and you roll your lower back up so your knees come up towards your torso 

Standing lunges are great for balance and hip flexibility. Start in the neutral position, step forward with alternate legs. In order to get back to neutral, press off with your front leg. To make the exercise easier take a smaller step and go less deep into the lunge

1. Stand on 1 foot 30 seconds each side. Excellent for balance, core strength and hip stabilization. To make it less difficult hold onto a table or chair with just your fingertips. To make it more difficult, flex forward at your waist and extend the tucked foot towards the wall behind you. 

Body weight squats 15-20 repetitions. The goal of this exercise is to build strength and flexibility in the lower extremities. Keep your feet approximately shoulder width with toes rotated slightly outward. Squat down with you butt over your heels and your back as straight as you can If you start to flex forward at your waist, move your feet a little wider and do not go as deep into the squat. 

It’s been a long time since I’ve gotten up at 5:45am on the regular to work out.  Today, I got to VERT at 5:50AM and met one of the trainers Avery Drost outside. The last time I remember working out before daylight consistently was when I was in high school and college training for football. It was never easy to do, and I never looked forward to it, but once I got going it was on! Today was Abe’s first day of school and I want to be able to walk him down to school regularly so about a week ago I moved my 7am workout back to 6am.  It’s been rough, but just adding that little bit of discipline to my day makes me feel like I can do anything. As I’ve gotten older, I’ve missed the discipline that athletics gave me when I was young and it feels great to have even just a taste of it again. We’ll see where I am when it's cold and dark and it doesn’t get light until 7am, but for now I know what I’ll be doing Monday, Wednesday, and Friday at 6am. Thanks Avery! 

Surf and Stoke

I surfed Venice this morning for 2 hours with my friend from high school, Earl Richmond, who is one of the more diesel 42 year old guys I know.  He looks like a white Jerry Rice at 42 years old.  His fitness is purely functional, he does no lifting, no stretching, no classes, no training, but exercises 3 hours on a typical day. At the time of publication, he told me that he is running about 3 miles a day to stay loose, climbing, hiking, and surfing in a river near his home in Buena Vista. Exercise has always been a huge part of his life and the shape he keeps himself in allows him to enjoy any activity presented to him, whether it be a game of frisbee golf, a multi pitch rock climb, or just a good old fashioned surf in some waist high clean peelers in Venice on a sunny summer day. Of note, there was what appeared to be a group of surfing Hasidic Rabbis but on closer inspection it was a group of advertising and design types out for a Saturday morning surf and their stoke was fantastic...great to see.

Super Warm Up

I got to  VERT and was handed a post it with the following warm up. If you're not warmed up this will definitely get you there and if you are warmed up it's a fantastic work out on it's own, I was doubled over going into the third set of burpees...but I made it in 21:06. Next time I'll do better.

Warm Up by Zach 

2:00 Minute Versaclimber (ok to run in place with high  knees)

20 Burpees

20 push ups

20 jumps onto a 36 inch platform (substitute 20 broad jumps)

20 kettle bell swings (ok to substitute 20 push ups or 20 squat jumps)

20 V-ups

20 burpies 

2:00 Minutes on Versaclimber (ok to run in place with high knees)