Tag Archives: fitness

Should Fitness Be A Vital Sign?

The skeptical cardiologist routinely probes his patients’ activity and exercise levels and encourages them to engage in 150 minutes of moderate exercise weekly. However, I’m somewhat skeptical of the benefit of treating such assessments as a vital sign (like blood pressure or heart rate)  as a recent AHA scientific statement suggests.

I can only envision still another item  on a chart checklist that will have to be recorded in the EHR or already over-worked physicians will have their payments withheld.

The AHA statement suggests that ideally we should be measuring  our patients’ fitness by obtaining  maximal oxygen consumption (VO2 max) utilizing an expensive and rarely utilized cardiopulmonary exercise test. Failing that we should consider doing a treadmill stress test. Failing that, rather than utilizing my simple question to patients: “How active have you been?”,  the statement recommends doctors utilize some sort of formal questionnaire to estimate their patients’ cardiorespiratory fitness (CRF) such as the one at World Fitness Level.

I went online to take this CRF estimator (based on this paper) and I remain skeptical.

The online site and  a free smartphone app both ask the following questions:

  • Country and City
  • Ethnicity
  • Highest Level of Education
  • Gender/Age/Height/Weight
  • Resting and Maximal Pulse
  • How often do you exercise?
  • How long is your workout each time? (over/under 30 minutes)
  • How hard do you train? (I had to choose between “I go all out”or “Little hard breathing and sweating”)

 

screen-shot-2016-12-03-at-11-33-13-amWhen you have finished answering the questions you are given an estimate of your fitness age. When I did this online a few days ago and answered truthfully I got the result to the right: I had the fitness of a 41 year old with an estimated VO2 max of 49 ! (interestingly this estimate corresponds exactly with VO2 max derived from a recent stress test I completed.)

I used the app (which unlike the online version did not ask me my waistline measurement) and changed a few parameters:

  • I increased my resting heart rate or pulse  from 60 to 68 beats per minute (BPM)
  • I increased my maximal heart rate from what I know is 158 BPM to what the app calculated (173 BPM, which makes no sense)
  • I switched from exercising 2-3 times per week  and longer than 30 minutes  at “all out” level to the lowest level for all 3 questions.

The change was dramatic and depressing: I went from 39 years old to 67 years old in the bat of an eyelid!img_8073

 

 

 

The app and online site direct you to a non-profit site where you can get information on a 7 week program to increase your fitness level. I haven’t checked this out.

I’ll be trying out this CRF estimator on my patients: assessing whether it adds anything to my usual line of questioning on activity and fitness.

I encourage you to give the CRF estimator a try. Let me know in the comments how you feel it works for you. Does it motivate you to exercise more knowing that, for example, your fitness age is substantially higher than your chronological age?

Can The Garmin Vivosmart (Or Any Inactivity Monitor) Make You Healthier?

Americans do a lot of sitting. We sit in our cars, we sit watching TV , we sit reading or when interfacing with our computers and often our work involves many hours of sitting in front of a computer.

All this sitting or sedentariness  has been associated with an increased risk of obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease (CVD) mortality,

One recent study concluded

 “limiting sitting to <3 h/day and limiting television viewing to <2 h/day may increase life expectancy at birth in the USA by approximately 2.0 and 1.4 years, respectively, assuming a causal relationship.”

Even if you make your way to the gym and  meet current physical activity guidelines, excessive sedentary behavior may have adverse implications, particularly if you are older.

Recent studies suggests that longer-term consequences of not engaging in moderate to vigorous physical activity (too little exercise) are different from those of habitual sedentary behavior.

Dr. James Levine has been a leader of the “anti-chair mafia” and research on the negative effects of sedentariness and has written a book entitled “Get Up! Why Your Chair is Killing You and What You Can Do About It” , available here.

Sitting Is Not NEAT!

The energy expended during daily life (exclusive of purposeful exercise) has been measured with special sensor equipped underwear and is termed non exercise activity thermogenesis (NEAT).

Individuals who are lean have high NEAT. They are up and moving around 2 and  1/4 hours per day more than those who are obese and burn an extra 350 kcl/day of energy.

I advise all my patients to move as much as possible during their normal work or leisure day. Take frequent walking breaks, climb stairs, attach your computer to a treadmill, do anything to avoid prolonged sitting.

Activity and Inactivity Monitoring

You can now easily monitor your activity during the day with one of multiple smartphone apps and/or an associated wearable.

The skeptical cardiologist plunged into the wearable activity monitor world recently and purchased a Garmin Vivosmart (engadget review entitled “where fitness band meets smartphone”  here.)

I chose it from all the competing devices because of the following features

  • pairs with iPhone to sync data and display iPhone calls/messages-
  • monitors movement during sleep
  • monitors inactivity
  • monitors steps taken

I plan to report more extensively on all the features of this cool gizmo after I’ve had it longer.

Promotion of Physical Activity

The Vivosmart does a number of things that are designed to promote physical activity.

steps
The Vivosmart telling me I have taken 11, 639 steps. These were all taken during work, walking between patient rooms and between the hospital, the OR and my office. A read out on my steps motivates me to move more, take stairs, and embrace movement as a valuable thing.

It counts your steps pretty reliably and can monitor your heart rate when paired with a chest heart rate monitor.

It will help you visualize how close you are to reaching your steps per day goal and congratulate you when you reach it.

In addition it monitors your activity and takes note of your inactivity.

If you haven’t moved sufficiently in one hour it vibrates and displays “MOVE!” on its LEDs. If you don’t move enough to satisfy its criteria it will remind you every 15 minutes thereafter to MOVE!.

This sounds good on paper but it didn’t; work that well in practice for me.

A typical day at the office for me involves a lot of brief bursts of walking, some stair climbing, and a fair amount of standing.

MOve
The Vivosmart inactivity monitor, telling me that I have been inactive for 41 minutes. In 19 minutes it will warn me to move by vibrating and flashing. I’ve been active this whole time, however, never sitting more than 10 minutes.

For instance, I walk to the patient exam room and sit down to take the patient’s history. At some point I stand up and exam the patient. When the visit is done I either walk back to my office to complete the office note or go to the next exam room. There is very little prolonged sitting occurring but these frequent, brief bursts of activity do no reset the Garmin Vivosmart.

Prolonged sitting is really what we want to avoid but the Vivosmart will only reset your inactivity meter if you walk continuously about 200 steps. Standing still even if interspersed with brief bursts of walking for less than two min,tes will not reset it.

If your job or normal day consists mostly of sitting for prolonged periods of time then this reminder to move may be helpful. However, for zero dollars you could  program your cell phone to go off every hour and serve essentially the same function.

I heartily endorse anything that gets my patients up and moving and off the couch. I think the Garmin Vivosmart (and other similar fitness trackers) is a step in the right direction and can lend focus and motivation to the goal of keeping active during the day.

To accurately measure NEAT, however, we may need magic wired underwear, something the public may not be ready for :).

-spending entirely too much time sitting and blogging,

-ACP