Author: armstrong.wou@gmail.com

I saw the above meme this morning. The list could certainly go on.

Early in my career (immediately following graduation from my first graduate program in exercise physiology) I worked at a racquet/fitness club where there was a salesman who was quite good at tearing down excuses for not joining. One of his best was the excuse of “no time.” He would pull apart your daily schedule—“How many hours do spend sleeping? …working? …eating? …watching T.V.? …?” Quite quickly, he would expose just how much time one had for exercise. He would demonstrate that “life is about choices.”

I have written several times lately about the effect that COVID-19 policies have had on obesity rates—now nearing 40% of the US population; an average weight gain of 29 lb over the period of COVID-19. Indeed, policies can be faulted, but…. Each of us decides for ourselves whether we would move or sit during the lockdowns (which, incidentally, were not for the entire period!). Each decided whether or not to snack on healthy foods or junk food. Many of us were working from home and had a choice of how to use the time gained by not commuting. There was certainly opportunity. It is true that the opportunity was greater for some than others and factors such as geography and socioeconomics play a role, but ultimately, we do make the choices within our circumstances.

As a society, we not only have to make the best individual choices given our circumstances, but we also have to support policies and decisions that best affect the community at-large. We must do better.

Individually, we can take more responsibility. Consider what choices we make and own these. Small personal choices can have big impacts. Lack of opportunity? Really or are we creating excuses? There are always choices (choices beyond just diet and exercise—choices that affect our Spiritual, Physical, Intellectual, Emotional, and Social well-centeredness). Choose wisely.

Be your best today; be better tomorrow.

Carpe momento!

Kudos to those who have maintained their exercise habits over the last 20 months during the pandemic. I applaud those who have dramatically transformed themselves during this time. (Several friends have lost in excess of 50 pounds!) Still the data show that Americans on average gained weight—29 lbs, including those who have lost weight!

“A Harris Poll from February concluded that 42 percent of American adults experienced weight gain since the beginning of the pandemic, with an average gain of 29 pounds.”¹

It is never too late to turn the tide. It is never more important that we turn the tide.

So, what do we have to do? Beside systemic changes in community planning, community health, health care, and public schools, we can begin with personal changes—small changes. We can begin with baby steps.

Assuming 3500 kcal per pound of fat, at an average gain of 29 pounds, the average American needs to create an average daily caloric deficit of 278 kcal. Honestly, when I went to calculate this, I thought the number would be more overwhelming. This is not a lot to cut. It is slightly more than a 20 oz sugared pop (soda). It is a package of chips or snack food. I is the average “serving” of alcohol. It is a little less on the plate at each meal. Moreover, it is beginning to meet the minimum daily activity levels. The average person takes 2,000 steps per mile. The CDC recommends a goal of 10,000 steps per day. Very few Americans meet these or the ACSM/AHA Guidance of 150 minutes of moderate physical activity per week. Using the ‘100-kcal rule’ (i.e., for every mile walking, jogging, or running, the average person expends 100 kcal), one could suggest increases their current daily activity by 5,560 steps. This is cumulative, so it is just a matter of creating opportunity (or taking advantage of the opportunity) to move more—walking instead of driving, parking farther from your destination, taking stairs, instead of elevators or escalators, getting up and taking periodic movement breaks, etc., as well as initiating a daily exercise routine. Remember: baby steps.

I also stress the importance of resistance exercise to maintain or (better) build lean tissue. Lean mass is more metabolic (i.e., expends more energy) than fat. It also permits more physical activity to further improve body composition and health. It doesn’t require expensive equipment or gym memberships. Calisthenics or body-weight exercises can be quite effective—especially when the goals are more health-related than performance-related. The movements don’t have to be elaborate. Stick to variations of the basic-5 (squat, deadlift or hip-hinge, bench or horizontal press, horizontal/vertical pull, and overhead press) with a progressive overload (i.e., doing a little more each session). Strengthening exercises are often neglected in ‘weight-loss’ programs because, after all, we are focused on losing weight. Muscle increases body weight. So, let the scale guide your body composition changes, but don’t be overly focused on the numbers on the scale. Use the mirror, the fit of clothing, etc. to track your progress.

If you hear anything about BMI (body mass index; body weight in kilograms divided my height in meters-squared), take it with a grain of salt. Low BMI (what is often considered healthy) may, in fact, be unhealthy; and, certainly, a BMI greater than 30 kg·m^-2 is unhealthy unless you are an incredibly lean bodybuilder or powerlifter/athlete. A BMI of 24-26 kg·m^-2 is, in my professional opinion, the sweet spot for health. Much less and one is likely under-muscled (and can be under-fat or over-fat). Overall, if you are getting leaner (without pursuing ‘six-pack’ abs) and more muscled (hypertrophy + strength), you are getting healthier.

The road to better health is travelled a step at a time. It requires commitment and consistency. There are no shortcuts. There are no magical hack. The road is faster with hard work, but moderate effort will lead to optimal health. Daily. Moderation. Consistency. These are important words. The average American did not gain 29 pounds overnight. They won’t be lost overnight, as well. It won’t happen, though, without immediate and progressive change. If we take no steps, we will continue down a path of decreasing health—and, therefore, increasing hospitalizations (regardless of the status of one’s vaccinations and the variants of viral infection) and cost of health care). Without change, America will soon exceed an obesity rate of 40%!

If you have already started to make changes, congratulations! Stick to it. You can and your will succeed.

Be your best today; be better tomorrow.

Carpe momento!

¹https://thehill.com/policy/healthcare/572357-number-of-states-with-high-obesity-prevalence-nearly-doubles-since-2018-cdc?fbclid=IwAR0zdljQ9Gf7VNpK5ewtXUpzW20ZepTSZ00G9gCVngui4AiNsBNT2CUIl3E

“Be faithful to that which exists within yourself.”—Andre Gide

I am feeling frustrated and uninspired going into the start of my Fall term teaching. I am feeling a burden of division and control that I have not experienced before. This is the first term back after four terms of remote teaching and having no face-to-face interaction with my students and colleagues.

I am not ordinarily an anxious person, but I am experiencing periods of anxiety—like the other shoe is going to suddenly drop. I am feeling the anxiety of losing what I do well. Nevertheless, I trust in my heart and my experience (and in my growing base of knowledge). I trust in my Purpose.

I know that there is no cost to being “faithful to that which exists within yourself.” There is only reward. Anything that appears to be a cost—a penalty—is only momentary. The reward of being faithful to oneself is eternal.

To be “faithful to that which exists within yourself” is not to be dogmatic or to cause division. It is not to resist growth and change. It is to act with integrity and conviction. It is to understand one’s Purpose (even when said Purpose is not entirely clear).

To be “faithful to that which exists within yourself” is not to be self-centered. Indeed, it is quite the opposite. It is to be other­-centered.

To be “faithful to that which exists within yourself” is to allow space for the soul to speak. It is to listen when it speaks.

I know my frustration will wane the moment I address my first class of students. After all, they are why I do what I do. They are my inspiration to do what I do the best I can—and to strive to do it better. Outside controls may affect how I do can or can’t do what I do, but what exists within me is what allows be the control over how I respond.

Be your best today; be better tomorrow.

Carpe momento!

I grew up with libraries, books, and the Encyclopedia. I remember in graduate school (Master’s degree time) having to take a list of descriptors to the Librarian to do a literature search. I would have to come back a day later to pick up the results (10¢ a hit—so you better pick your descriptors wisely). Prior to that, we had the Science Citation Index—volumes of bound citations that should make one grateful for the Internet). Today, of course, I can do it myself in minutes using the university library search tools. We also have Google Scholar. Nevertheless, it seems, most find their information via basic Internet searches (which are biased by your algorithms) or haphazardly from their social media feeds. We tend to be fed a constant diet of information that conforms to our narrative –furthering our confirmation biases. And adding to this narrowing of information is the practice of ‘shadow banning’ and censorship under the guise of “fact-checking” on social media. As such, we are fed a diet of controlled information.

I noticed the other day (actually, I noticed it quite a while ago) that those who would control information are quick to point out that studies that do not support their narrative are “not peer-reviewed”, but hide the fact when the study supports their narrative. The limitations of studies are identified when the results are contrary to one’s biases, but justified when the study supports said biases. All the while, these sources claim to “follow the science.” Science, however, is rarely cut-and-dry. Science tests hypotheses and draws conclusions from the cumulative results. In essences, it weighs the scales of supporting evidence. It addresses contrary evidence—and, sometimes, has to concede that the evidence is equivocal or that the hypothesis was not supported.

In the last 18-months, there seems to be a flood of studies that are released ahead of print. (I have one such paper that has released in January, but has still not gone “to print.”) In some cases, this is an advantage of the digital age. In some cases, this is confusing because it leads to a potential release of information prematurely. This is where we need to use critical thinking skills (and where I wish such skills were being more effectively taught in K-12!). “Pre-print” or “ahead of print” may or may not be “peer-reviewed.” In general, they have been and the status should be reported (and it often is—we just choose not to look). Peer-reviewed should be an indication that the article has been scrutinized by “experts” in the field. The level of scrutiny varies among journals, which makes it challenging to assess the information. Over all, we must scrutinize the information for ourselves. We must did deeper.

Often, the popular media will highlight one study, and this what we base our understanding on. In addition, the popular media are selective in the conclusions drawn from the one study. Unlike scientific reviews, they do not gather information from other studies (often contradictory studies) to draw conclusions. As a result, we are often misled. We are fed a narrative.

We must learn to gather information for ourselves. Our access is better than it was in the ‘60s and ‘70s with World Book or Britannica. We have the Internet, if we use it wisely. We have an accumulation of information, if we take the effort to dig through it. Scientific literature can be hard to read, but we can learn. A great starting point in gathering information is to read peer-reviewed scientific review papers (and meta-analysis papers) on a given topic—and following up with articles cited in the bibliography. We can read books rather than “book.” We can read that which challenges our biases with an open mind. We can (must) question all that we have been taught and (especially) all the information we are being fed. It just takes a little effort and critical thinking.

Be your best today; be better tomorrow.

Carpe momento!!

I grew up with Sesame Street—when the show was very new. I grew up with the “letter of the day.” So, today’s letter of the day is J. Why J? Because it is a letter I don’t think we are hearing enough about in our current media. Specifically, I want to talk about “Neiman’s J.”^3-5

I have written about Neiman’s J several times. Interestingly (for me at least), I keep seeing it—the J-shape curve—appear in papers relating to BMI, exercise, etc. as these relate to infection, hospitalization, admission to the ICU, ventilation, and death in the current health crisis.^1-2 Consistently, these and other studies suggest moderation. Moderate exercise—exceeding the proposed guidelines, but not to an extreme. Moderate body composition—healthy, not over-fat and not under-muscled (the ideal result of maintaining Neiman’s J of physical activity). Healthy eating. No smoking. Low-to-moderate consumption of alcohol. Seven to eight hours of sleep nightly.

We don’t hear about these preventative health measures. A friend shared an article in The Atlantic⁶ about the you-know-what and how it is here forever and “this is how we live with it.” The subtitle was: “We can’t avoid the virus for the rest of our lives, but we can minimize its impact.” Frankly, I found nothing of value in the article. It suggests that through vaccination or infection (preferably vaccination) the virus will transition to an endemic—much like the flu and common cold. But, accepting that the virus will go the way of other viruses is not going to solve much. People still get very sick from virus like the cold and flu. People still die. Neiman’s J, however, tells us that we can minimize our risk of infection. The extensive work in exercise immunology informs us that we can make ourselves less-hospitable hosts to viral infection. Diet, exercise, and weight loss do not zero our risk, but they do significantly impact our risk of severe infection. They should be addressed in our pandemic preparedness!

The vaccine is effective in flattening the J in the short term. It keeps the ends of the J out of the hospital (and the morgue).

In the long-term, we want to be moving toward the base of the J—where the risk of infection is lowest. This should be a priority in pandemic preparedness. It should be a public health priority. Moving to the base of the J will significantly reduce health care costs across the country. It warrants significant consideration.

Be your best today; be better tomorrow.

Carpe momento!

¹Gao, M., Piernas, C., Astbury, N. M., Hippisley-Cox, J., O’Rahilly, S., Aveyard, P., & Jebb, S. A. (2021). Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study. The Lancet (online). doi: 10.1016/S2213-8587(21)00089-9

²Kompaniyets, L., Goodman, A. B., Belay, B., Freedman, D. S., Sucosky, M. S., Lange, S. J., Gundlapalli, A. V., Boehmer, T. K., & Blanck, H. M. (2021). Body Mass Index and Risk for COVID-19-Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death—United States, March-December, 2020. Morbidity and Mortality Report, 70:1-8.

³Nehlsen-Cannarella, S. L., Neiman, D. C., Balk-Lamberton, A. J., Markoff, P. A., Chritton, D. B., Gusewitch, G., & Lee, J. W. (1991) The effects of moderate exercise training on immune response. Med Sci Sports Exerc 23(1):64-70.

⁴Neiman, D. C. (1990) The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. Int J Sports Med 11(16):467-473.

⁵Nieman, D. C. (1994) Exercise, upper respiratory tract infection, and the immune system. Med Sci Sports Exerc 26:128-139.

⁶https://www.theatlantic.com/science/archive/2021/08/how-we-live-coronavirus-forever/619783/?utm_campaign=the-atlantic&utm_medium=social&utm_source=facebook&fbclid=IwAR2ydXHKvxPUFpnQDJm5CZRlapB0yKXCMBi0TPX-rsiSrQVoYpyT2nnxIF8

Last night I watched The Tomorrow’s War, starring Chris Pratt. An entertaining movie, albeit with questionable physics. It got me thinking about COVID-19. (Do we really need a prompt to get us thinking about current pandemic?) It got me thinking: Could we prevent the hospitalizations and death toll, if we could travel back 30 years? If we knew 30 years ago that there was a way to minimize the devastation, would we act accordingly?

According to Mokdad and others (1999)¹:

“The prevalence of obesity (defined as a body mass index ≥30 kg/m²) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases).”

Current statistics suggest that the current prevalence of obesity in the United States exceeds 36%. Interesting, those who were 18- to 29-year-olds in 1998 (who saw the greatest increases in obesity) are now 41 to 52 years old. The highest rates of obesity in 1998 were in 50- to 59-year-olds (23.8%), who are now 73 to 82 years old—at the cusps of the highest risks for hospitalization and death from COVID-19.

We know that obesity is a central factor in the severity of COVID-19 infection—along with the prevalence of pre-existing conditions associated with COVID-19. Obesity is a complex problem that is not easily solved by telling people to eat right, exercise, and lose weight. It is not a problem of will or a problem of genetics. It is an economic and social problem that requires a community solution. What was happening from 1991-1998 to feed the growing prevalence of obesity had started before the early ‘80s and has persisted (i.e., magnified) until today.

If we could travel back to 1991, knowing what we know today, could we have turned the tide of obesity and hypokinetic disease and spared millions from the traumatic effects of the SARS-CoV-2 virus? Would we have been willing to change society?

We can’t change the past, but we can affect the future. We can reverse the trends. We must reverse the trends. The cost of obesity and its associated health issues (hypertension, diabetes, heart disease, respiratory illness, cancer, etc.) already approach trillions of dollars annually. These costs were only magnified by the COVID-19 pandemic. Sadly, I see little commitment among the federal and state governments to address the issue. There are no such preventative strategies in the President’s 27-page Pandemic Preparedness Plan². It is also not what I would consider a “plan” per se. We, indeed, need an Apollo-style commitment to a healthy America. Perhaps a commitment to developing time-travel should be considered.

Be your best today; be better tomorrow.

Carpe momento!

¹Mokdad, A. H., Serdula,  M. K., Dietz, W. H, et al. (1999). The spread of the Obesity Epidemic in the United States, 1991-1998. JAMA, 282(16):1519-1522.

²https://www.whitehouse.gov/wp-content/uploads/2021/09/American-Pandemic-Preparedness-Transforming-Our-Capabilities-Final-For-Web.pdf

September 11, 2001 the people of these United States of America we brought together by two towers and four planes. Twenty years later, are we any greater as a nation? Any more United? Where do we stand? Is the world any better for how we responded and how we remember? These are questions we must ask ourselves.

Be your best today; be better tomorrow.

Carpe momento!

“Everyone has his own specific vocation or mission in life; everyone must carry out a concrete assignment that demands fulfillment. Therein he cannot be replaced, nor can his life be repeated, thus, everyone’s task is unique as his specific opportunity to implement it.”—Viktor E. Frankl

I need to remind myself now and then that I am where I am supposed to be—albeit, sometimes, where I don’t particularly want to be. I need to remember that I am raising my children where the experiences and the relationships they are making are shaping who they are becoming for God’s Purposes. Likewise, the opportunities I experience are serving more than myself. It is about grattitude (gratitude + attitude). It about being content and seeing the opportunity in, well, everything.

Be your best today; be better tomorrow.

Carpe momento!

“There are powers inside of you which, if you could discover and use, would make of you everything you ever dreamed or imagined you could become.”—Orison Swett Marden

I believe in Purpose. I believe that we are called upon to draw on the good and the bad that has brought us to where we are this moment. I believe in opportunity and responsibility. Sadly, I believe that we (myself included) don’t often believe in ourselves as we should.

What is it that we are to do in this moment with the powers inside us? What are we to do with our opportunity to be (extra)ordinary? One may think: “But, I am just a…”, however, we are—in this moment—“just a…” to have a significant impact on those with whom we interact (and on those who are affected in our wake). “Just a…” may be a stepping stone to another opportunity tomorrow. It may be what we are to remain for some Purpose. We are not insignificant. That is, we are not insignificant unless we choose to be. We matter to someone(s) to something. We choose to embrace opportunity or to let it pass. The power is within us to do all that we Purposed to do and become. Discover it. Use it.

Be the best today; be better tomorrow.

Carpe momento!

“Comfort is one of the biggest enemies of progress.”–Ayomide Ojebuoboh¹

Ayomide Ojebuoboh’s opinion article in Medpage Today, “Researchers Are Focused on the Wrong Things,” struck a chord to me, not only as researcher/educator, but also as a community leader (in the sense that we are all leaders in our communities and circles of influence). Yes, the focus of the article was on medical research, but the theme should affect us all. We are nearly all presently entrenched in our comfort zones. COVID-19 has revealed this quite effectively over the past eighteen months. (I hate repeatedly using the COVID-19 example, and long for the day when it is passé; but, presently, it is low-hanging fruit.) Ojebuoboh writes that “we should be engaging communities, not just studying them.” We, here, is medical researchers, but we should all be more engaged with our communities. Medical and academic researchers often fall into a trap of “publish or perish.” As such, we learn more and more about less and less until we know everything about absolutely nothing. “Science”, as has been revealed over the last year and a half, has become a process of proving ourselves right rather than a process of learning what we don’t know.

When I hear the layperson and/or the politician claim they “follow the science,” my stomach knots, because I know it is bullsh**. It simply means that believe the science that affirms their beliefs. It is also a statement that is intended to put down the opposing view as being uneducated or ill-informed. If one truly “follows the science,” one questions everything—one reaches beyond their comfort zone and confidence level to explore the unknown and to expose their ignorance. Science literally cannot be “followed” because it is the edge of uncertainty. It is exploring the unknown and testing hypothesis. Science is a process. It is not a physical thing that can lead. Scientists may lead (and sometimes down a wrong path or a dead-end path, but that is science), but their results do not. Science is data that informs decisions. Wisdom requires knowledge (i.e., data or science) coupled with the willingness to challenge of presumptions.

When Ayomide Ojebuoboh states that “comfort is one of the biggest enemies of progress,” she is speaking to more than just her colleagues in medicine. She is speaking to me. She is speaking to all of us.

Many have entrenched themselves in political ideologies, theologies, and their limited worldviews. As such, they (we) have limited their (our) progress. Wisdom seeks knowledge (i.e., information or data) that challenges one’s worldview. Wisdom engages with the “opposition” and seeks, as Stephen Covey wrote in the Seven Habits of Highly Effective People, to “first understand,  then to be understood.” We need to become comfortable with being uncomfortable.

Our progress as a society and as human beings has been stifled by our unwillingness to be uncomfortable—by our unwillingness to engage in discussion (rather than soundbites on social media). We demand to be heard, but refuse to listen. We allow ourselves to be limited by our bias. We often hear the phrase: “unconscious bias.” I believe, however, that we suffer more from our conscious bias—by our unwillingness to allow our views to be challenged. I find “unconscious bias” to be a phrased used by those who are more demanding that you listen to their views than are willing listen to your views. Suffice it to say that we all have bias (conscious or unconscious) and it limits our capacity to grow—to progress. Thus, we have to willfully challenge our biases and to allow them to be challenged by others in respectful discourse. Otherwise, we are doomed as a society.

Be your best today; be better tomorrow.

Carpe momento!

¹https://www.medpagetoday.com/opinion/second-opinions/94349?xid=nl_mpt_DHE_2021-09-04&eun=g1854320d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Top%20Cat%20HeC%20%202021-09-04&utm_term=NL_Daily_DHE_dual-gmail-definition