Oct 16

If your professional scope includes prevention and performance (or, as we call it, human achievement), you eventually get the impossible question. It doesn't really matter the domain (work, life, hobby, sport) or which of the 5 ELEMENTS for thriving is being discussed; any time a question starts with "what is the best way to...", it's impossible to answer without more (or better) information. For example, one of the most classic, yet totally reasonable impossible questions we often get is: "What's the best exercise?" And while we might occasionally give in to reflex and provide a snarky answer like "any one a person will consistently do", more typically the answer is "it depends" (on the goals, priorities, and limitations), and the conversation navigates to the pursuit of leveling up.

While it's never safe to assume, people MOVE, exercise, and train for all sorts of reasons; lowering health risks in the most time-efficient manner is one of the most common goals. This goal lives somewhere between Level 2 and 3 on the 5-level scale we've outlined below. This goal is so common that it has prompted significant research over the years as exercise scientists try to provide evidence-based answers supporting people who feel time is their biggest barrier. The rise in popularity of high-intensity interval training, which trades intensity for duration, has shown especially great outcomes. Whether it's the increasingly trendy Norwegian 4x4 protocol (4 min on, 3 min off x 4 rounds), which now has its own free app, or any number of other protocols, as shown in this recent review, the approach clearly works.

More recently, another approach has surfaced, which makes a different trade: frequency (instead of intensity) for duration. The idea, often called the Weekend Warrior approach, which we first mentioned in Oct of 2024, compresses a full week's worth of exercise into one or two days. For example, committing 3-5 hours to a challenging day hike on the weekend instead of "walking 30-60 minutes most days of the week", as guidelines often suggest, would be a classic weekend warrior's trade. The results of this trade are also generally positive, with several studies published this year supporting the idea. This study published by the American Heart Association in January showed that as long as the total volume achieved was >= 150 minutes per week, the outcomes for individuals with hypertension were both strongly positive and about the same whether exercise was concentrated into 1-2 days or distributed more evenly throughout the week; about a 30% risk reduction. This review of studies from May shows a similar finding for neuropsychological risks (from Alzheimer's and Parkinson's to depression and anxiety). Even bones and joints fared about the same, although interestingly, those with multiple impacted areas (called musculoskeletal multimorbidity) actually did a bit better using a weekend warrior approach, as shown in this August study. One area that isn't quite as clear, however, relates to sleep.

While a 2025 study showed a clear pattern favoring frequency - those with as little as 10 minutes of daily exercise had improved sleep quality (deep non-REM and REM sleep) compared to weekend warriors - other studies suggest that, in broad terms, anything is still infinitely better than nothing. This study from August, for example, showed that higher volume moderate to vigorous physical activity, regardless of whether it was performed throughout the week or in a concentrated, weekend-warrior pattern, lowered the risk of sleep disorders (to about the same extent) when compared to those who were less active or sedentary. Stay tuned.

So what's the best exercise? 

Impossible as it may seem, if the levels below make sense, the answer is: whatever helps you maintain what you've achieved (today) and/or primes and readies you to pursue the next level. 

___________

Level 1 - First MOVE: Anything is better than nothing; do it as often as you can. Expect to feel better (e.g., more energy, better mood, better recovery) 

Level 2 - Progress to exercise: Get consistent. Expect to feel consistently better and note some functional changes (e.g., feel stronger or more stable or less winded; see some changes in blood work or blood pressure).

Level 3 - Progress to training: Get a goal and add more "load" (frequency and/or intensity and/or duration) in a measured and preferably tracked way to stimulate growth until that goal is achieved. Expect significant changes in the areas above, and also outwardly, notice changes in muscle mass and how clothes are fitting.

Level 4 - Progress to complete training: Dedicate training blocks to all distinct components of fitness. Expect to be and feel significantly stronger, faster, and more powerful than you have in a while. Expect others to notice. Invite them to join.

Level 5 - Make it a lifestyle: Perform at level 4 so regularly that you feel worse when you don't. You may not even need a training plan because you have an identity and there's no more powerful blueprint than that. Expect to become an inspiration for those around you. Expect them to seek you out for answers. Expect yourself to respond humbly, "It takes dedication, but if I can do it, anyone can".

___________

Let us know if you're thinking about leveling up and how we can help.

Have a great weekend, 

Mike E.

Oct 2

We never say it's easy. Although simple - not super complicated - it takes consistent effort and can therefore feel hard. But because it unleashes the freedom to thrive, it's worth it. 

This is one of the fundamental arguments we've been making since late September 1998, when Pro-Activity (the entity) was formed 28 years ago. While a LOT has changed as our understanding of "Human Achievement" has been tempered and refined, the key principles and essential truths, including this one, have remained. Of course, we humans don't always love the truth. There are countless ways we try to bend and shape reality to smooth out its edges. Reflections with their pesky imperfections have become digitally enhanced photos, and here in the States we spend more on aesthetic procedures (cosmetic surgery, etc.) than the gross domestic product of one in every five nations on earth - yikes. 

However, when it comes to health, vitality, and thriving, the evidence has always pointed to a sweet spot and the Goldilocks principle that helps us make sense of it. We can certainly overdo it (too hot), but since challenging ourselves forces us to stay strong and not doing so leads to the weakness of underuse (too cold), actively seeking "just right" has always made the most sense.

Recently, however, the lines have been blurred. For example, the list of potential benefits of the appetite-curbing injectables for those with cardiometabolic disease is impressive; yet, our growing understanding of adverse side effects suggests they're not right for everyone.  And even in a world where our "intelligence" is faster (and maybe more dangerous) than ever, it's impossible to predict the long-term risks.

Take glucosamine, for example, the joint supplement historically considered safe for those suffering joint pain. Along with meniscus removal and steroid injections, the long-term data now suggest the benefit may not outweigh the risk, in this case because of an association with Alzheimer's disease. Even a well-established "go-to" for inflammation control like Ibuprofen is back under the microscope for its risk of trading a long-term pain problem for the short-term one it helps solve.

So, yeah, I found myself skeptical when I decided to dive deeper into a study that found participants gained lean muscle and showed modest strength improvement even without exercise when put on a 12-week cycle of Creatine at twice the widely recommended dose. To clarify, I'm not skeptical that supplementing the energy apparatus with creatine appears safe and has positive benefits (I mentioned it as recently as August 28th in this blog, and it is one of very few supplements I take regularly). However, the implication, which is bound to appear in headlines soon enough, that we can (or should attempt to) get stronger without the struggle of effort against resistance seemed questionable. 

To be clear, that's not what the study suggested. Even while the Creatine-only (no exercise) group outperformed the placebo + no-exercise group, and did about the same as the exercise-only group on a few measures, the Creatine + Exercise sub-group outperformed all other groups in nearly every measure, especially those related to the kind of strength and endurance useful in daily life. Distilled all the way down to a far more reasonable headline: making more energy available appears helpful, but USING that added energy to do the work of growth is even better. 

For those who cannot safely exercise for one reason or another, this study might be very welcome news and an interesting avenue to explore. For those of us who can, the long-term trade-off of doubling the dose is yet to be determined. For now, at least for me, it's wait and see.

Have a great weekend,

Mike E.

Sept 18

I recently finished a podcast that featured Mike Rowe as a guest. You know, the guy from "Dirty Jobs" and the narrator for Discovery's "The Deadliest Catch". Although I don't agree with everything he says (I never do), I find his professional journey both fascinating and hard to believe. There simply can't be that many folks who were in the opera, sold trinkets on QVC, spent a day as a roadkill collector, and started a foundation that funds job training. However, the thing that stuck with me this time was the idea of anagnorisis - a term dating back to ancient Greece for the point in a story when the hero has a sudden realization, when the situation finally makes sense. Imagine the end of the movie "The Usual Suspects" or, as he describes, "The Sixth Sense". It seems we might be inching closer to an anagnorisis when it comes to movement-related or musculoskeletal pain.

At Pro-Activity, we've been framing pain associated with movement (skeletal and soft working tissues) as a harbinger or precursor for a while. We are fond of saying that "movement is a window into future health"- a nod to the fact that how well and how often we humans MOVE is one of our most reliable long-term predictors of future thriving.  A 2025 study, for example, has shown that muscular power (the ability to produce force quickly) is a very strong predictor of premature death - up to 6X more effective than grip strength, which has been established as a gold-standard reference point over decades. Even as large studies on blocking inflammation with medication haven't shown great clinical benefit, resistance exercise, a clear investment in healthy movement, has proven to lower inflammation does; even more so when paired with aerobic exercise, by as much as a staggering 45%.

Yet, many people still think of the onset of movement-related pain as an isolated event - essentially the effect of some momentary cause - instead of a warning light that our whole system may be straining to keep up with everyday tasks. This week we spotted a new review that might signal a change in the narrative.

Published in the Journal of Veteran Studies in May, this review examined the existing literature on musculoskeletal injuries (strains/sprains and other soft tissue injuries) in military populations. These injuries account for 80–85% of all recorded injuries, making them by far the number one cause. Using the evidence as a guide, the authors made a strong case that these injuries happen far more frequently during routine, mostly non-combat activities in service personnel who are over-tired, under-recovered, or stressed (emotionally or physiologically). They further showed that integrated, multi-pronged prevention approaches (e.g., ELEMENTS) are an effective strategy, but coordinated efforts are still lacking at the scale needed to effect change in such a massive organization.

In plain English, these authors provide the evidence that our movement health evolves and changes across our lifespan. Today's cranky joints or sore tendons may not only be local tissue strain but also the earliest warning signs of a body that isn't quite keeping up with the stresses it faces. Therefore, without a deliberate effort to balance the load and improve resilience, today's aches may signal tomorrow's chronic diseases.  Perhaps this explains another 2026 study, which showed that the number of pain sites a person reported was a strong predictor of future cardiovascular disease and premature death during a 14 year follow-up period - anagnorisis.

Here's the good news: the working parts we call "the movement system" are some of the most adaptable and responsive we have. It doesn't take much to keep them strong and healthy, but it does take something. We're here when you're ready.

Have a great weekend,

Mike E.

Sept 4

We all know the feeling of trying to operate on short sleep. Whether it was caused by a child's nightmare, seemingly endless overtime, travel starting well before sunrise, or swirling thoughts demanding more time to sort out the day's stresses before nodding off, the telltale signs of poor sleep are the same: a brain that isn't as fast or sharp as it should be and a body that feels like it's dragging. While we know what we really need is rest - the kind of sleep that lets us sink deep into recovery mode - when we're in the thick of it, we also know it's never quite that simple. The good news is that despite notable changes in the brain's ability to function - and therefore all the risks associated with not being sharp - the long term negative health effects of acute sleep deprivation (1-2 days) appear minimal. The other edge of this particular sword, however, is that a few days can easily be the slippery slope to chronic sleep deprivation, where the negative health effects pile up quickly as reviewed here and discussed last week. 

In moments like these, it might seem like our only option is to settle for an incomplete solution, like loading up on caffeine to push through the day. However, new research suggests we may have better options. Two approaches proved equally effective in a small group study where participants were kept awake in a lab for 30 hours and then tested on memory and recall three days later.

Let's start with the obvious one: taking a nap was effective. One subgroup was randomly assigned to sleep for 90 minutes before participating in the learning task. Not surprisingly, they significantly outperformed the control group. Less intuitively, however, a second group that performed 20 minutes of moderate physical activity before the learning task also significantly outperformed the control group. Even less intuitively, the physical activity group experienced about the same benefit as the napping group. When the research team studied the participants' brain scans (EEG), they found each intervention tapped a different, but equally effective pathway.

According to a summary of the study released by McGill University, "Napping appeared to help the brain recharge, making it easier to take in and remember new information. Exercise, by contrast, helped the brain use its remaining resources more efficiently, without making participants feel more tired."

While it'd be ideal if we never needed this tactic, we know that our clients are often required to closely manage personal energy stores. And since a short walk might be far easier to implement than an extended nap when trying to get through a long day, 20 minutes of MOVE as a countermeasure is worth knowing.

Have a great weekend,

Mike E.

August 21

Most people generally understand why basketball players and industrial workers wear high-top footwear: ultimately, to protect their ankles. However, exactly why this design works is less clear. Stiff material surrounding the ankle might restrict motion, similar to preventative bracing in athletes, which has been shown to reduce the rate of ankle sprains by as much as 64%. However, restricting motion may also involve unwelcome performance trade-offs. One recent study, for example, showed reductions in measures of directional speed, while another found that performance losses were restricted to complex agility tasks and not straight-line movements. A closer look at boot design in 2023 revealed similar trade-offs. The authors suggested that, similar to a tactical boot, a snug but still flexible upper portion (boot shaft) might be preferable over a rigid design to allow for sensory feedback (proprioception) without restricting movement. This is similar to how a neoprene sleeve works: joint compression helps provide better information to the brain without significant movement restriction. Interestingly, according to new research, a similar change may occur as we age, regardless of footwear choice.

A research team from South Australia wanted to explore age-related changes in the ankle and the muscles that control it during walking. They recruited more than 100 subjects between the ages of 26 and 86 and used specialized equipment called EMG, which tracks muscle activation patterns and force during walking. They found a clear pattern that changed subtly but meaningfully with age: opposing muscles were simultaneously activated (called co-contraction) and the "push off" was less forceful. While less push-off likely relates to age-related changes in strength and tendon health at the Achilles complex, co-contraction is perhaps less obvious.

To understand co-contraction, imagine performing a plank exercise - if done correctly, the muscles of the entire "core" (abdomen, sides and lower back) contract simultaneously, allowing muscle forces to limit movement by creating strong stabilization around the spine. The muscles of the older ankle—those on the shin in the front and in the calf complex behind—adopted a similar strategy. By co-contracting the muscles around the ankle, the older subjects enhanced stability, a pattern the researchers described as  "safety-first walking". However, like wearing a stiff boot, the trade-off was reduced performance: walking was slower and more energy demanding per step. The team also theorized that co-contraction may negatively impact the ability to react to balance challenges, such as recovering from a wobble. One author described it this way: "The nervous system adopts a safety-first approach, compensating for age-related changes by favoring stability over performance. These changes can also increase fatigue and make walking longer distances more challenging, while reducing the ability to recover from trips or slips -- a key factor in falls among older adults." When combined with another study from earlier this year that showed other adaptive changes, such as increased postural sway as we age, the case for managing our risks early is strong. 

Unsurprisingly, the best answer appears to be movement-related training - balance and coordination exercises - which have a strong base of evidence, as well as challenging ourselves by integrating graded and uneven terrain into our regular walking routine. Of course, like all exercise routines, building up slowly and steadily to find, test and stretch our limits is the best way to stimulate these systems without overstressing them or putting ourselves in harm's way. One small study from earlier this year found that using trekking poles, such as those used in Nordic Walking, was associated with various positive changes in gait parameters. 

We often say that movement is a window into future health. This time, it's the ankle in the frame. Keeping them strong but flexible and able to react quickly will allow us to MOVE well into the future.

Have a great weekend,

Mike E.

August 7

August can be a tricky month in the healthy lifestyle calendar year. Officially, it is still the throes of Summer, as the thermometer and thick air so often remind us. Unofficially, with back-to-school ramping up all month across the US, it is most often a transition month, back to the routine. For some, getting back into the routine feels like losing something - perhaps the freedom of a less intense schedule - and may create a time crunch as the lazy days of summer wane. For others, that same shift can feel more like an exhale - a return to the order of a predictable schedule - packed as it may be. Neither sensation changes the facts: no matter the season, it's always the right time to invest in our health, even if only a little. With this in mind, this week we searched for simple strategies, proven in research yet accessible enough for those wanting meaningful results to integrate into real life. We found two that fit the bill. Both are randomized controlled trials, often considered the gold standard for scientific rigor. Both tested interventions designed to improve metabolic health (abdominal fat and blood markers) in adults who were at risk, but not being treated for any specific disease.

The first builds on a theme we've discussed previously: while consistency typically beats intensity, enough volume, all at once, can level the playing field for weekend warriors. The study, published in Nature Communications in January, showed that compared to a placebo group (which learned about exercise but wasn't required to complete any), both the group doing high-intensity interval training once per week AND the group doing it three times per week saw positive metabolic changes. Over the course of 32 weeks, both groups lost inches and body fat, although blood markers were generally unchanged. Specifically, the training plan was a high-intensity walking program. After a 4-week ramp-up period designed to ready bodies for heavier training loads, the plan included a 5-minute warm-up (zone 1 cardio as explained here), four near-max-effort intervals lasting 4 minutes each (achieving high zone 4 or low zone 5 heart rates) with 3 minutes of active recovery (zone 2) in between. The intervals were then followed by a 5-minute cool down, meaning the entire workout required 35 minutes. Participants were randomly assigned to complete the workout 3 times per week to achieve 12 total intervals (group 1), or to complete all 12 intervals in 3 rounds on the same day separated by a 15-30 minute break between bouts. In practical terms, the workout entails 5 minutes at an easy pace, 4 minutes as fast as you can walk (uphill if a flat surface isn't challenging enough) followed by 3 minutes of recovery at a pace slow enough to carry on a conversation. This sequence is repeated until the higher intensity effort has been completed four times, followed by 5 minutes of easy walking to cool down. The results were impressive. Both groups achieved meaningful body fat reductions (2-3%) and improved cardiorespiratory fitness. Although the group training three times per week performed slightly better than those performing the weekend warrior, all-at-once protocol, the differences were small.

The second study might be even simpler. Penn State University researchers decided to further examine data from the Habitual Diet and Avocado Trial (HAT), a privately funded research collaborative studying the impact of eating 1 avocado daily for 6 months in a group with metabolic risk and/or obesity, which began in 2021. What they found was certainly intriguing; however, first, a disclaimer: the private funding for HAT comes from HAAS, an avocado industry group. However, despite their very clear vision to make the avocado "America's preferred healthy food at every meal," they are a small player, not even appearing on the top 50 industry groups by lobbying spend, so we felt the risk of major bias was acceptable. Now, the results. 

Since the original 2022 research on daily avocado consumption, which sadly did not show a meaningful difference in visceral fat, subsequent reviews of the data have shown promise, including improved diet quality and gut microbiome makeup for the individuals in the trial. Now, in this June 2026 study, researchers found that daily consumption was associated with reductions in the concentration of LDL particles - the protein bits that carry "bad" (LDL) cholesterol throughout the body. Researchers estimate the change equates to a 4% risk reduction, which is meaningful but modest. To put this in perspective, lifestyle heavy hitters like smoking cessation, overall healthy eating patterns, and adequate physical activity might be expected to lower risk by 20-40% and the humble avocado is not quite ready to dethrone a daily serving of beans (38% risk reduction) and greens (12-15% risk reduction), but for those of us who feel there's no bad time for a good guacamole, it's a recipe we can feel good about.

MOVE intensely, FUEL with intent, and enjoy what's left of Summer.

Have a great weekend,

Mike E.

July 24

No one really knows for sure, but one reason "green exercise" - nature-based movement like walking, hiking, biking, trail running, etc. - is such a powerful driver of health is because it engages us fully. We experience sights, smells, sounds, and sensations "out there" that we just don't get in the gym. Adding a little extra focus to navigate the potential randomness of the terrain creates an activity profile that keeps us strong, fit, and moving well, as reviewed here in May.

Of course, one of the more interesting twists is that simply being in nature, even without much movement, can have a strong positive impact. Research on forest bathing - oversimplified as a mindfulness-in-nature practice of Japanese origin - is certainly intriguing, especially for stress modulation, immune function, and psychological well-being; evidence that not all sedentary time is negative. Understanding the line between healthy sedentary time - the kind that helps us RECOVER day to day and may actually improve our capacity to ENDURE - and the harmful kind has not been easy, but we're getting closer.
 

For a while there, it seemed "screens" were the root of the problem. For example, excessive screen time in adolescence has been linked to poorer cognitive development and early cardiovascular risk, which strongly supports limiting it. However, the research for adults is more nuanced. In 2023, this review showed a generally negative connection between screen time and mental health (with slight differences in studies done before and after the pandemic). Yet, one finding suggested that the *way* screens were used might carry more weight than originally thought. In a single sentence in the article summary, the authors stated: "Recreational screen time was associated with depression and screen time for schoolwork was not." How we interface with screens may matter more than "if" and "how long".

The thread was taken further in 2024 when a research team looked back at data on recreational and mindless screen time - in this case, TV time in the 1990s - a precursor to the "scrolling" tractor beam which pulls so many of us in today. Their findings were clear: as TV time increased, so did a variety of cardiovascular risks, including blood pressure, unhealthy blood markers, and metabolic risk. Then, last year another review highlighted the nuance, drawing a clear distinction between passive screen time - the kind where content is absorbed with low brain effort (scrolling) - and active screen time where we might be engaged in tasks like emailing, writing, searching or brain-games. Passive screen time dragged on health; one study showed more than 3.5 hours per day was particularly detrimental, but active screen time actually offered several benefits.

Then, earlier this month, the Alzheimer's Association published another study - the first of its kind - which showed actual structural changes in the brain associated with sedentary time by type. They looked back at data from a long-term and comprehensive heart-health study that began in the late 1980s. This study included data on total sedentary time, encompassing both passive (TV time) and active/engaged (work-related) sedentary time, and included brain MRIs. When the research team compared brain scans to sedentary time, the connection was clear. While passive sedentary time was associated with negative brain changes on MRI - some of which are linked to Alzheimer's disease - brain-engaged (active) sedentary time showed a generally positive correlation, a finding which was most pronounced in men.

Once again, our health risk sits on a spectrum. While getting plenty of brain-engaged movement is probably closer to ideal - see "Take a Hike", our June 19th blog - even when we're not moving, how we do it matters. Whether it's our senses (forest bathing) or our brain (active screen time, puzzles, etc), we thrive when challenged. Now is as good a time to find one as any.

Have a great weekend,
Mike E.

July 10

Back in 2019, we read a showstopper study that quickly became one of my favorites. It was by no means perfect. For example, using only men in the sample group made it far from generalizable, but the findings were so significant, simple, and clear that they begged people to explore further. The punchline, which we've discussed numerous times here, was that in a group of more than 1500 firefighters who were, on average, about 40 years old, the ability to perform 40 continuous push-ups translated to a status of near heart-attack proof (96% reduced risk) over the next decade. This, of course, led to conversations and plenty of impromptu testing sessions where someone would wonder enough to get on the floor and try...and usually realize, 40 is a LOT for an average person. Anyone who can get even close is both strong and fit, which we know are critical predictors of future health.

Since that time, other studies relaying the predictive power of the push-up have been published. For example, in female soldiers, after statistical scrubbing, the number of push-ups completed was one of the six risk factors identified (and one of two measures of physical capacity) that had a significant relationship with injury risk, as discussed here. A similar association was found in professional firefighters in South Africa: more push-ups related to lower risk of injury. However, in an interesting and counterintuitive twist, higher physical capacity—including that measured by the push-up test—correlated with increased general discomfort and soreness. This finding underscored the need for a well-designed recovery plan for those who tend to push themselves toward their physical limits, as this tendency drives higher capacity. However, in a world where seeing is believing, new research may have unlocked a better understanding of why.

Published on June 30th, a study using an artificial intelligence model to assess CT scans of 1,722 people found that muscle density—specifically whether the muscles in the chest and upper back had fatty streaks (like a marbled steak)—was a stronger predictor of heart attack incidence and severity risk than similar scans of the liver or even the torso. For every 10-point increase in image brightness, which suggests greater muscle density, a 31% risk reduction was noted. Individuals with below-average muscular density—lower than the group's median—had a 58% greater likelihood of having a heart attack and an 85% greater likelihood of dying from one over the next ten years. Practically speaking, this means the quality of our chest and upper back muscles—a result of regular strenuous pushing and pulling—may be more important than other metrics we commonly use to estimate health, such as weight or body fat. However, there are caveats.

Push-ups (and pull-ups if aiming for balanced training) are complex full-body movements that require not only strength but also the ability to load the shoulders and wrists and stabilize the trunk. Unfortunately, this blocks a fair number of people from getting the full benefit of using these movements as either tests or training. This study from 2025 showed that as many as 1 in every 20 participants could not complete a single push-up, most often due to discomfort or some other orthopedic limitation. The important thing to remember here is that there are MANY ways to modify them, whether finding a way to keep the wrists in neutral, dropping to a knee to reduce strain, or even using a wall to start less intensely...so please don't let that stop you.

So what's a good goal?

The short answer here is: progress; anything more than yesterday is a step in the right direction. However, realizing that such an answer is probably unfulfilling, aiming for at least 10 high-quality push-ups daily is a great first goal for most people, while working toward 20 or more for strivers is backed by both experts and evidence. The Mayo Clinic for example provides a recommended standard by age about half way down the page here and although 40 was the gold standard in the firefighter study above, what tends to get less attention is that the risk reduction in that study was generally stepwise: those who could do more than 10 push-ups had a 64% reduction in risk, while those who could grind out 20 or more dropped their risk by another 20%. Doing so at least a few times per week increases the likelihood that the muscle quality will improve over time. Of course, incorporating some pulling, hinging, squatting, and carrying to ensure all fundamental movements stay strong is even better.

Reach out if you're ready for a routine that'll help you stand strong against the number 1 killer of Americans for the last 100 years by this Fall.

Have a great weekend,

Mike E.

July 2

We knew the "dog-days" would come; they always do. According to the Old Farmer's Almanac, this year they are right on time.  Even without our modern understanding of phenomena like the "heat dome" we are currently living under, astronomers from ancient Egypt and Greece knew that when Sirius (the dog star) rose—typically between July 3rd and August 11th—it would get hot. Unfortunately, this week could be a record breaker. Statistically speaking, this means injury risk, which tends to climb with the mercury, will also be higher than ideal. 

According to this study, which analyzed US industrial workplace data from 2023, the risk increases rapidly when temperatures exceed 85 degrees Fahrenheit. While not consistent across all sectors (utilities, for example, did not follow the pattern), the data showed that the odds of having an injury increased by an average of 3% when temperatures reached 90 degrees, 10% at 100 degrees, and 20% at 110 degrees - a classic "J"-shaped, exponential risk curve. 

The good news about highly predictable events like midsummer heat waves, however, is that we can prepare. We can build cardiac reserve by doing aerobic work 4-6 weeks in advance. We can start the acclimation process early by using controlled heat exposure 2-3 weeks prior, and we can have effective cooling strategies ready to deploy when the temperature spikes. The less good news is that not everyone chooses to. Therefore, a bit like releasing a procrastinator's guide to last-minute gift ideas on Christmas Eve, this week we are sharing a few evidence-based tips and tricks for managing the heat when we're in the thick of it. These tips are taken from three domains where excessive heat can have major consequences: the workplace, the elite playing field, and military operations.

(1) It's Personal: Perhaps the most important thing to remember is that since our movement system (cardiac & muscular tissues especially) both generates and dissipates heat, the baseline health of that system and the habits that impact it play a major role. Practically, this means individuals with lower fitness, higher age, extra body mass or habits that strain the system (tobacco, alcohol) struggle more in the heat than individuals without those risk factors. This May 2026 study, which examined indicators of cardiac workload in heavy agricultural work performed in the heat, showed that individuals with a higher baseline risk reached a cardiac strain threshold sooner and required more rest than those with a lower baseline risk profile.

(2) Not all cooling strategies are the same: While well-timed rest-breaks and efforts to lower body temperature are critical for performing in the heat, some work faster than others. This study compared various methods and found that although whole-body water immersion remains the gold-standard for rapidly lowering body temperature, limb immersion was a reasonably close second. Immersing the hands up to the elbows and the feet up to the knees outperformed sitting in air conditioning, which in turn outperformed resting without air conditioning. While limb immersion wouldn't be easy on a job site or at an athletic event, it might still be possible. If not, this 2024 review on heat mitigation tactics in construction and this small 2026 study on recreational soccer players showed that cooling vests show promise. However, this small study on factory workers showed that creating an "Oasis"—which consisted of 5 minutes of seated rest combined with hydration, iced towels, water dousing, and fanning—had a more potent effect than working in a cooling vest for an hour.
 

(3) There are signs: Like most risks we face, the body tells us when we are pushing toward our limits. The sooner we recognize the early signs in ourselves and those around us, the better chance we have to make changes before harm occurs. Excessive or unshakeable fatigue, brain fuzz and fog, gastrointestinal distress, rapid heart rate, muscle cramps or pain, and feeling (or looking) unsteady while walking are all signs that heat stress has progressed to strain. Since these typically occur before emergency signs like confusion or collapse, diligently monitoring those around us can prevent a situation from worsening. Time is essential; as discussed here, call for help, but begin cooling immediately. The first 30 minutes, sometimes called "the golden half hour," are critical.

Most of our clients' territory is under the heat dome. Whether on the jobsite or celebrating 250 years with family and friends at a backyard barbecue, managing and mitigating our risks can ensure we get through this first thermal test strong enough to take on the next one, which is almost definitely right around the corner.

On behalf of the entire team, Happy Independence Day.

Have a great weekend,

Mike E.

June 19

As we navigated the switchback and glanced down into the riverbed, we finally saw it. It was the item we had been hiking toward for a few miles, but having only heard about it secondhand, we weren’t exactly sure when we’d get there. For movie lovers, it felt a little like the scene in “Stand By Me” when they find Ray Brower. For those who don't get the reference, you’re missing a classic - make time to watch it - but I digress. Rusted and broken apart many feet below, the remains of a steam engine and the site of an on-the-job accident from 100 years prior were on display.

Of course, the steam-engine was a good excuse, but the real reason we were out there was to make the most of the season, enjoy the natural beauty of one of the national parks, and perhaps gain some of the well-documented direct physical, mental and even social health benefits of hiking—that is, MOVE, ENDURE, and CONNECT all in one—with the indirect benefits on FUEL via metabolic efficiency and RECOVER via improved sleep quality. This 2026 review does a great job outlining the cardiovascular, metabolic, psychosocial, neurological, and even immune benefits of hiking, something that might be particularly important for us middle-aged Americans if the decline discussed in this paper is accurate. However, one of the more interesting bits, in my opinion, is that, with a little external resistance—like a day pack or rucksack for the ambitious—it may provide a rare all-in-one activity that achieves both the aerobic and strength stimulus needed for longevity and quality of life.

According to new research published in the British Medical Journal earlier this month, which reviewed data from nearly 150,000 people over 30 years, the optimal mix of physical activity requires both aerobic and strength work. Those who performed only aerobic exercise needed more than 45 MET-hours per week to achieve optimal results (cutting their risk in half). However, when combined with 2 hours of strength training per week, the required aerobic dose dropped significantly, in some cases to 30 MET-hours or less. This, of course, begs 2 important questions:

1. What does this actually mean?

2. How do we know if we're getting close?

We don't often discuss metabolic equivalents of task (METs) or their time-bound counterparts, MET-minutes and MET-hours. In fact, looking back in the archive, I found they were mentioned only 3 times since 2020, but that doesn't diminish their importance. Very briefly, they are one way we compare physical activities by considering both time and intensity. For example, we know running is more demanding than walking, even if on the same course, because running is more intense. However, there is a point in time when, after walking long enough, the walker has done more work than the runner. The MET-minute (or hour) levels this playing field by considering the work intensity, which is defined by the average amount of Oxygen consumed while performing the task (the MET) and the duration. Using data from the 2024 version of the Compendium of Physical Activities (here), we can compare various activities. 

Leisurely walking alone would require almost 18 hours per week, a fairly steep commitment without strength training. That number drops to 12 hours for those who incorporate strength training, which is doable but still a lot. However, finding some trails with hills and adding ski poles for greater balance (Nordic walking) cuts the commitment down to just over 5 hours for the week or 3.5 hours if a couple of strength sessions are also included. Adding on a daypack cuts the time requirement even further. Of course, the Compendium contains thousands of different activities, ranging from household chores and yard work to athletic endeavors; all of them count. To see how much you need, divide 45 by the MET value of your chosen activity if you're not logging any strength training, or divide by 30 if you are in the gym at least 90 minutes each week.

Summer officially starts on Sunday. I hope you've got some fun and active health investments planned.

Have a great weekend,

Mike E.

June 5

With Memorial Day in the rearview and the official start of Summer on the near horizon, now is when we typically talk about the strain of the season. For clients who receive formal education, this month our team will dive deeper into heat, discussing both tried-and-true topics—like proper energy management, acclimation, and cooling techniques required to stay ahead of fatigue—and far less obvious connections, such as gastric distress associated with heat-induced leaky gut. One intriguing connection that didn't quite make the cut (yet) is the impact of heat on mental health and specifically depressive symptoms. It is an emerging science, but the evidence became much clearer this week. Let's start by framing what we know.

As detailed in this 2025 perspective paper, three prevailing theories attempt to explain depressive illness: The "monoamine theory", which emphasizes changes in brain chemical messengers (neurotransmitters) like serotonin and dopamine; the "neurogenesis theory" which emphasizes structural changes in the brain associated with a lack of new cell production; and finally "the inflammation theory" which suggests that depression is triggered by immune system over-activation and excess pro-inflammatory cytokines. The authors argue that since changes in brain chemistry (theory 1) and our ability to sprout and grow new cells (theory 2) are both consequences, not causes, the most plausible driver is poorly regulated inflammation (theory 3). 

While still just a theory, the idea that an excessive or prolonged immune response drives depressive symptoms is certainly an intriguing one. Such a mechanism would explain cases like this one, which include a close connection between depressive symptoms and flu-like symptoms. It would also explain the connection between a pro-inflammatory diet and depression shown here and why exercise—known to lower whole-body inflammation through muscle activation—is also a potent antidepressant. For example, a Cochrane review published in January of this year rigorously reviewed the latest research and found that exercise was as effective as gold-standard treatments like medication and psychological counseling. However, things became more interesting a few weeks ago when a small but well-designed pilot study showed that treating individuals with an anti-inflammatory typically used for Rheumatoid Arthritis had a strong antidepressant effect, outperforming other approved and widely used medications.

So what does this have to do with heat?

While we can't be 100% sure, simple logic would require that if inflammation drives depression risk and prolonged heat exposure drives inflammation (even when fluids are available, as shown here), then heat exposure should also link with depressive symptoms. At least 1 research team that analyzed data from over 100,000 subjects across 263 cities in China showed this was indeed the case.

This isn't a mind-body connection; once again, the research has shown it's all one thing. Having a plan for when things overheat goes a long way toward ensuring the experience is well-managed and temporary. Let us know if we can help.

Have a great weekend,

Mike E.

May 22

It's been said that the month of March comes in like a lion and goes out like a lamb. For those of us whose temperatures touched the mid 90s early this week, the realization that this year's March little lamb was less "fleece as white as snow" and more "baby bighorn" ready to assert itself came all at once. Before we acclimate, temperatures like this drain us quickly. And while the nearly 40-degree drop in high temperatures by Saturday may feel like a reprieve, the challenge to our physiology and the energy apparatus in particular as we switch back and forth between our internal "heat" and "AC" units is costly. If you're feeling more fatigued than usual, respect the need to RECOVER. However, those hoping to reach further and leverage the summer months to find a health or performance edge this year may find inspiration in Spain and Norway.

From Good to Great

First, as initially published last Fall and reviewed earlier this week, a large randomized trial led by a research team in Spain compared the well-proven Mediterranean diet (MED diet) alone to a "stacked" intervention that added moderate calorie restriction (a reduction of 600 calories per day) and physical activity, showing even better results. Although several studies have shown that the MED diet alone can strongly lower risk - including a near 50% reduction in heart-related incidents - in the current study of over 4,500 adults tracked for 6 years, the risk of developing metabolic disease (Type 2 Diabetes) was reduced by an additional 31%, a powerful boost. The results build on a 2023 study that showed improvements in lean mass and reductions in dangerous visceral fat. Stacking habits, in this case FUEL (quality up, calories down) and MOVE (activity up), continue to impress.

Striving for high AQ

A few hours North (by plane), another team of researchers has been studying a different route to a similar place, building on the idea that even very brief, intense bursts of activity can kickstart health improvements. Rather than focusing on the strong results associated with adherence to local food guidelines (diets based on Nordic Nutrition Recommendations), this team was more intent on showing the impact of even a little intense exercise. In an article published earlier this month the authors cite studies from the last twenty years to argue that (1) "Cardiovascular fitness is the best indicator of current and future health. Good cardio fitness reduces the risk of over 30 lifestyle diseases as well as premature death by 40 to 50 percent," and (2) since even a few minutes per day at a high intensity (approximately 85% of maximum heart rate) is enough to make a significant difference, a lack of time is not as limiting as many believe. To support individuals testing the idea, they created a new activity tracking method and phone app that incorporates movement intensity via heart rate monitor data (Apple Watch, Garmin, etc) to provide an "Activity Quotient".

Risk reduction doesn't have to be complicated or time-consuming, but consistency definitely helps. Summer (unofficially) starts this weekend. We can come out the other side stronger if we go for the win.

Happy Memorial Day Weekend, 

Mike E. 

May 8

Rightfully so, brain health has become one of the hottest health topics today. Accounting for a large portion of the neurological conditions, driving illness and disability worldwide, it has received increasing attention. Once thought to be mostly inheritable and encoded in our genes, we now know that our day-to-day habits and lifestyle greatly contribute to our future brain health. Simply put, we have far more power to prevent these conditions than we previously imagined, and all 5 ELEMENTS (Move, Fuel, Recover, Endure, and Connect) play a role.

One of the most fascinating discoveries in the last 20 years is the role of the "glymphatic system". Discovered around 2012, this system is believed to work like a washing machine, pumping fluid in and out of the brain to capture and remove metabolic waste while we sleep.  Research from earlier this year supports this idea, making the value of sleep, especially deep (non-REM) sleep when this system is most active, obvious. 

However, sleep is certainly not the only factor we can control to improve future brain health. Our FUEL choices can also have a significant impact. Diets known to lower inflammation, such as the Mediterranean and Nordic diets, showed promise in this 2025 review, although more studies are needed before causality can be considered definitive. An animal study published earlier this week showed an interesting connection between arginine (an amino acid found in a variety of foods, including poultry, beans, legumes, and seeds) and some of the plaques associated with Alzheimer's Disease. 

Stress and Social Connections also factor in. While psychological stress has been associated with a significant (3X) increase in the risk of self-reported cognitive decline - a risk worsened when combined with other health risks like obesity- the power of CONNECT may play an outsized role in keeping those risks at bay. As published last month in a study on "Super Agers" - individuals who exhibit cognitive abilities on par with those 20-30 years younger than their chronological age - social connections and the brain structures supporting them stood out.

However, perhaps the most intriguing recent finding is also the simplest. A study from a Penn State University team showed (also in animal models) that the abdomen functions like a hydraulic system: one big pressure-regulated vessel. Every time there is enough movement to cause our abdominal muscles to contract even slightly, the pressure gradient - and therefore our circulation patterns - changes. This creates a chain reaction that reaches the brain, stimulating changes in the surrounding fluid. Researchers likened this process to rinsing a dirty sponge by running it under clean water and squeezing it out.

It's unlikely to replace adequate physical activity or the many brain benefits of taxing the muscles any time soon, but if you need a boost, it certainly won't hurt - stand up and MOVE your brain.

Have a great weekend,

Mike E.

Apr 24

Adaptation is one of the cornerstones of biology. Although challenging, tiring, and often frustrating, those who successfully adapt and change have better odds of keeping up with the world's evolving demands. The idea has a strong foundation of structural evidence - the lengthening of the giraffe's neck over generations of natural selection is a classic example - however, modern life has introduced a time compression problem that adds significant complexity. Simply put, fundamental changes are happening in decades instead of millennia, and many signs suggest our health and quality of life are suffering as a result of not keeping pace.

Our all-or-nothing stress response is a commonly cited example. "Fight, flight, or freeze" is almost definitely better suited for the laws of the jungle than for the simmering stress of the modern world. This may partly explain why hypertension remains a major and puzzling problem in the US, affecting nearly half of adults. Of course, this is not the only adaptation curve we appear to be falling behind. Super convenient food delivery apps may have made this top-ten inventions list from the last 30 years, but as the energy required to hunt, gather, forage, and farm has given way to scroll and click, the problem of sedentary diseases has worsened - a risk identified at least 5 years ago. Unfortunately, the unintended consequences (aka second-order effects) of modern life don't end there.

Modern food production methods continue to pose a significant risk. The upside of tasty, long-lasting, and relatively inexpensive food sounds great; however, as the growing case against a high intake of ultra-processed food, which now includes a heavy toll on the behavioral and emotional health of children as young as five, continues to emerge, the cost overshadows the benefit. Sadly, the risks aren't limited to what happens after the food is picked. Research presented at the American Association for Cancer Research last week suggests that pesticide use is a serious problem, even, and perhaps especially, for healthy eaters. A University of Southern California team suggests that modern farming methods, which include heavy pesticide use, may explain higher lung cancer rates in young, non-smokers who consume higher quantities of fruits and vegetables, as well as in the agricultural workers who handle them. 

How we CONNECT is also increasingly under scrutiny. The 2026 edition of the World Happiness Report confirms what many of us suspect: social media use, especially the passive scrolling apps heavily favored in Western Europe and North America, significantly drags on well-being. Unfortunately, other research suggests the impact doesn't end there. Device use in classrooms was linked to poorer cognitive control in adolescents earlier this month, and an extensive report last year from MIT showed that as reliance on artificial intelligence for writing increased, brain connectivity "scaled down". From a health and quality of life perspective, things may be just a little too convenient.

So what is the antidote?

At the risk of sounding like a podcast sound bite, the answer, when properly dosed, may in fact be to find challenges, do hard things, get out of our comfort zone, and, as the more crude version of the same platitude suggests, "embrace the suck". A randomized controlled trial from a team in Brazil published in February showed that inducing a healthy dose of discomfort through brief, intense exercise (a concept known as "interoceptive exposure") was more effective than a tried-and-true relaxation technique for individuals with panic disorder. Similarly, adding controlled doses of stress and pressure has shown promising results in youth athletes. This approach has also recently been advocated for in medical training to ready care staff for environments that can rapidly deteriorate.

Far more study is needed to draw a firm conclusion on this topic, but one thing seems certain: not all adaptation is positive. If the conveniences of life are dulling your edge, it's a great time of year to find an adventure that MOVES you in the direction of your limits. We're built for it.

Have a great weekend,
Mike E.

Apr 10

I can't be sure what my initial inputs were, but recently, my social media algorithm appears to have concluded that the best way to complete its mission and keep me hooked longer is to appeal to both "hunt" and "gather". Videos about big cats stalking the watering hole, alongside ways to improve lower-body power and running speed, have become a feature in the steady stream of someday backyard DIY project ideas. And, while I've always been a sucker for the entertainment of narrated nature [I blame you, Sir David Attenborough!] I take some solace in the fact that the clips on increasing power might provide benefit if carried over to real life.

I think it may have all started last year when the Mayo Clinic published this paper showing that power (the ability to produce force quickly) significantly outperformed strength (the ability to produce absolute force regardless of speed) in predicting longevity in middle-aged subjects - about 5x better. I found the distinction fascinating and wanted to learn more. An editorial in the same issue suggested adding measures of power to other standards - such as physical activity, cardiorespiratory fitness, strength, and body composition - when trying to understand and anticipate future health risk. The logic made sense to me. Since many regular daily activities, such as climbing stairs, require the rapid application of strength, having more power relative to our body weight is beneficial, especially as we age, because power tends to decline earlier than absolute strength. This 2018 study supports that idea. 

Men between 77 and 101 years old, already past average life expectancy, were asked to complete jump testing. Unsurprisingly, those who were successful - able to generate enough power to get off the ground - were much healthier than those who could not. However, and equally unsurprisingly, even in these super-agers, the drop in average relative power was substantial with age, from 59 watts per kilogram for men in their 20's, shown here, to 23 watts per kilogram. If power is this important and drops off so significantly, investing energy now to improve or maintain it could have a very high payoff later. With several studies, including this one from January, showing that only a few minutes per week can yield improvements comparable to longer sessions of moderate activity, power sessions may be the best tactic when time is of the essence. However, for those not quite ready to jump into intensity just yet or who may have more time to invest, there are, of course, other ways to span the gap. 

Another new study examining the benefit of stacking small doses of Sleep, Physical Activity, and Nutrition (SPAN) showed an equally impressive effect. After reviewing the health records of nearly 60,000 individuals over an average 8-year period, researchers found that the optimal combination - which translated to a gain of approximately 9.5 extra healthy years - was 7.2 to 8 hours of sleep, at least 42 minutes of moderate to vigorous physical activity (MVPA) and a dietary score roughly in the top 1/3rd (a score of 57.5 to 72.5 out of 100) per day. However, even for those not yet achieving such high marks, very small doses of each can yield meaningful benefits in both lifespan (years lived) and healthspan (years lived disease-free). The team found that adding 5 minutes of sleep, ~2 minutes of MVPA, and five points in dietary quality (e.g., adding ½ serving of vegetables or 1.5 servings of whole grains per day) resulted in one additional year of life. Adding healthy years required a bit more: 24 additional minutes of sleep per day, 3.7 minutes of MVPA per day, and a 23-point increase in dietary quality. That combination resulted in 4 more healthy years, which, if this study, which says it boosted physical activity and brain benefits in some of the planet's longest-lived people, and this one, which showed better sleep in thousands of US adults, are accurate, a gardening habit yields more than just fresh and healthy foods. 

The best course of action almost definitely includes "all of the above". If you haven't hopped, skipped, bounded, or sprinted lately, it might be a great way to get to the garden... just not while carrying the yard tools.

Have a great weekend,

Mike E.

Mar 27

If you read the summary and imagine a lab where mice walk around in back braces, that's not quite it—but, unsurprisingly, the headline was an attention grabber. It read: "Scientists discover a hormone that might stop lower back pain at the source." The concept opened a door to another dimension of back pain management that we rarely discuss. For those having trouble finding relief, this could be a very interesting new avenue. Let's start by setting the stage.

The first and possibly most important concept is that pain, while a universal experience commonly depicted as our threat detection system, is almost always temporary. When we remove the threat, things typically return to the baseline. However, sometimes when aches linger long enough, a more lasting imprint develops, and the warning bells continue to alert. This is both a source of great frustration for the person experiencing it and a complex puzzle for any professionals consulted to unwind it. Lower back pain, the world's most disabling condition, is known to be particularly tricky in this way. While many people find relief through combinations of physical activity, efforts to improve sleep quality, and systematic reductions in stressors that rev up the nervous system (like smoking or emotional distress), a small group still struggles to find a formula that works for them. For these people, changes in nutrition may offer a growing source of hope.

While, as recently as 2017, the guidelines for non-invasive treatment for low back pain have not included nutritional recommendations, a growing list of studies, as pointed out here in a review published last year, suggests they should. Exactly why healthy eating improves pain, however, is less clear. Some research points to a definite connection between pro-inflammatory diets and pain sensitivity; it seems foods that drive inflammation go hand-in-hand with pain sensitivity. Yet, it was alcohol intake that was identified as the strongest predictor in another study. Some experts argue that, as shown here, this idea puts the proverbial "cart before the horse" because pain (like depression) could be as much the cause of poor eating as the effect of it. Realistically, it is almost certainly bidirectional and therefore self-reinforcing: poor dietary choices sensitize our nervous system, which, when threatened or chronically irritated, drives us toward comfort foods as shown here. So, the link is clear, but the mechanism is murky, which leads us to the current study and the potential roles of calcium and vitamin D.

A research team affiliated with Johns Hopkins University administered parathyroid hormone to mice with various spinal conditions known to induce pain, ranging from degenerative changes to instability. In something that sounds a bit like science fiction, they found that the bony tissues began to show signs of healing. But that wasn't all. Like a watchdog that has decided there is no visible threat, the nerve-endings in the area began to pull back, allowing for pain desensitization and thus the freedom and desire to move more. Considering other related findings, calcium and vitamin D may play central roles in the biochemistry of back pain. Here's the logic:

Since (1) reducing inflammation through dietary improvements has been shown to improve chronic pain, (2) calcium sensing receptors are closely linked with inflammation, (3) parathyroid hormone (which worked this time) is tightly linked with calcium and vitamin D regulation and (4) vitamin D supplementation has shown promising results for back pain sufferers who are deficient, it is clear these nutrients matter. However, since it is still very early days and risks may prove to outweigh rewards, the most practical application we can all benefit from now is understanding that foods naturally high in calcium and enough sunshine to stimulate vitamin D production (but not too much) may have very real impacts on aches and pains, especially when coupled with movements that promote flexibility and strength. Luckily enough, gardening season, which features all 3, is here or very close...try the leafy greens.

Have a great weekend,

Mike E.

Mar 13

With daylight saving time upon us and even a little tease of warmth this week, it might feel like Spring is in the air. While officially still a week away, Winter has certainly felt long enough. If you're anything like me, you're itching to open the windows or step outside and soak up some sunshine. Of course, these next few weeks also tend to be an important "on ramp" for most of us as our bodies might be a little stiffer or more likely to feel sore coming out of the Winter season, especially if our activity loads accelerate too fast. Add in heat acclimation, which is only a few weeks away, and it's easy to spot a reasonable risk trend on the horizon. Research findings from the last few decades support this idea. 

For example, in 2004, one study showed a clear preventive benefit for early-season injury rates among sub-elite athletes when pre-season training loads were dialed back and the "ramp" period was given proper respect. Another from around the same time period on US Army Cadets showed a much higher risk (1-3 times) of soft-tissue injuries during Summer Basic Training, even though overall loads were generally on par with Fall and Winter groups. The authors pointed to heat's effect as one possible cause. However, in my opinion, nothing could be more interesting than what we have (and haven't) learned from "The Boys of Summer" and their gnarled-looking but highly functioning shoulders.

Not surprisingly, in Major League Baseball, where money is less of an object, it started with the hope of using high tech to predict and ultimately prevent future injuries in elite-level athletes. I mean, it makes sense. Given the amount of money invested in those same shoulders, the cost of X-rays and MRIs didn't seem like much. Unfortunately, it didn't work all that well. Within a small study published in 2002, of the professional pitchers who were asymptomatic, meaning who had shoulders that felt and functioned fine, almost 80% showed clinically significant "damage" to the cartilage of the shoulder (labrum). 5 years later, another study searched for a correlation between "degenerative changes" and other abnormal X-ray findings of the shoulder and time spent on the disabled list for 50 pitchers from the St. Louis Cardinals organization. No significant correlation existed. Then, in 2022, another study on elite-level rock climbers yielded similar results: about 80% of normally functioning and pain-free shoulders had abnormal scans...which brings us to today and the question of whether non-athletes and otherwise everyday folks have similar findings.

 According to this study, published last month in the Journal of the American Medical Association, the answer is yes, and the rates are even higher. The research on approximately 600 Finnish adults aged 40 to 76 found that virtually all participants, regardless of symptoms, had abnormal findings. Specifically, almost all (96%) of those who had no pain or other symptoms, as well as almost all (98%) of those who did, had abnormal imaging findings. This was so impressive that the authors called into question the value of shoulder images for individuals over 40 years old in cases without significant physical trauma.

In the study's conclusion, they said it this way:

"In this population-based study, rotator cuff (RC) abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms. These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain."

There are more layers to peel back on this one but for now, much like what we've learned about other stiff and achey joints (and what works best to help them), when there's no major or obvious cause of the pain we feel, scary images and the negative worries they produce might not be high (or even on) the list.

Call us if you need to dive deeper.

Have a great weekend,

Mike E.

Feb 27

It seems unlikely that when Chuck Hillman sat in the mall and experienced a moment of curiosity watching his son play, he knew it would kickstart a major new finding - that physical activity significantly improved brain activity (especially in children). It seems even less likely that he knew the results would become one of the internet's most loved images, especially for those of us who promote a healthy lifestyle as a way to thrive. As he described it here in 2021, the moment pulled him in a direction away from his primary focus, the aging brain, and toward proving the strong cognitive benefit gained from moving our bodies. His team has since shown that whether we exercise habitually or perform a single bout and whether we choose moderate intensity (enough to be only slightly out of breath) or higher intensity (enough to break a sweat), the brain does better when we MOVE.

While we don't know exactly why movement is such a powerful brain stimulator, it might be as simple as increased blood flow. If this were the case, anything that helps drive blood upward against gravity could be beneficial. Muscle activation, especially of the large lower-body muscles, would certainly fit the bill. Certain exercise types (running, jumping, etc) might even be better than others (cycling, swimming) due to the higher upward pressures generated with greater impact. Interestingly, in 2018, a team from New Mexico demonstrated this phenomenon when they compared blood flow to the brain following cycling, walking, and running in a small group. All activities were helpful, but running produced the greatest improvement. Since then, a growing number of studies linking movement and brain health have emerged. These two review articles from 2025 (here and here) provide a good summary of what the last few decades of science have produced. 

Now, on the other end of the spectrum, a team from the University of Southern California studying blood flow patterns in older adults with and without cognitive decline, found that those whose blood flow most closely matched the patterns of healthy adults had the least likelihood for negative changes and disease markers, such as those seen in Alzheimer's disease. The researchers believe they may have unlocked an inexpensive early indicator that can help in the realm of prevention and management. Similarly, further North in San Francisco, a different team showed in a mouse study that certain proteins, typically released from the liver as a result of exercise, helped repair the structures that protect the brain (blood-brain barrier) from inflammation-related wear. The approach even reversed some signs of cognitive decline.

Although the research is certainly not simple, the core idea is: when we get moving, we not only push blood around the system but upward as well...and protect both body and brain in the process.

Have a great weekend,

Mike E.

Feb 13

Maybe you saw the Super Bowl ad. Mike Tyson, up close, talking about eating whole food. Maybe you liked the message and the choice of messenger. Maybe you hated them both. Maybe you didn't think that much about it and were just there for the funny or entertaining ones (+1 for the Dunkin' ad in my opinion)...but despite some important points made in articles which reviewed the ad like this one, including the nuance between "processed" and "ultra processed", the core idea that, our health is greatly impacted by the foods we eat (and an increasing number of those are harming us), is not particularly controversial. This week 2 new studies drove the point home and helped explain why.

The first is a new look at old data. In 2019, a research team showed, in a well-controlled trial, that an ultra-processed diet actually caused people to eat more calories and gain weight. This, of course, was big news at the time. However, since then, discoveries made the data worth a second look. What the research team found this time might help us understand more fully why ultra-processed foods get a hold on our health - they bypass the natural tradeoff between nutrients and calories found in healthy whole foods, a tradeoff which may cause us to stop eating one while we search for the other. 

In essence, they proved an idea that is often discussed when people talk about eating behaviors, that we not only crave tastes and textures that stimulate our brain, but nutrients and energy that drive our physiology...and when we get the right combination, we tend to be satisfied. Because ultra-processed foods have both high nutrient load (they're often fortified with vitamins) and high calorie load, there is no trade-off, and subjects tend to overconsume. The team found that while those who consumed mostly unprocessed foods actually ate more by volume, they took in 300 fewer calories on average, which is enough to make a substantial difference in health over the course of time. 

A second study, published by the American Academy of Neurology, drove the point home even further. This time, it was data on the diets of more than 100,000 US Women starting at midlife and tracked for more than twenty years. The researchers on this one found clear evidence that those who adhered closely to a Mediterranean diet had a double-digit lower risk of all forms of stroke. The team based their scoring on the diet originally referred to as the Traditional Mediterranean, described here, which was "characterized by a high intake of vegetables, legumes, fruits and nuts" as well as unrefined grains, olive oil, and fish, with a lower intake of dairy and meat. High nutrient, low process. 

Of course, this isn't the first time we've talked about the benefits of the Mediterranean diet. Given the fact that there are already more than 1500 citations this year on the topic, it's unlikely to be the last. Maybe next time for the other lovers of good olive oil, we'll cover this one...lookout inflammation.

Until then, have a great weekend,
Mike E.

Jan 30

Sometimes, there are just so many interesting bits to share that we have to cut out any of the unnecessary verbiage in order to get it all in and try to keep it at least reasonably short. This is one of those weeks. No big lead in and no hook needed - the info itself is interesting enough (at least in one author's opinion).

First, the tried and true. This week saw the drop of 2 reviews, which provided what we might call new old news; that is, reinforcement of information we've talked about many times before: (1) Tea, especially green tea, is a powerful health agent, and (2) so are blueberries. 

Of course, the authors go deeper in their review of the evidence, showing not only the benefits related to prevention of heart disease, cancer, and metabolic health risk (among others) for tea drinkers, especially those who get 2-3 brewed cups per day, but they also point to some new twists that we may not have heard as much about. Specifically, they outline benefits for brain health, muscle and bone health, inflammatory profiles, and even antimicrobial (antibacterial, antiviral) effects. Oh, and for those who aren't used to seeing single digits in the forecast but have this week...it's warm too!

As for the blueberries, a similar theme came through again - they're still amazing from a global health perspective. This is in part because of the great role they play in keeping our vessels healthy, but there's more here as well. The authors go beyond vessel health to point out the great impacts they have on the gut-microbiome, on cardiometabolic risks like blood pressure, triglycerides, and cholesterol, as well as strong effects on inflammation, cellular stress, and even brain health. A cup a day could go a long way.

The next study, which grabbed my attention, was less along the lines of "tried and true" and felt more like "the other shoe"...dropping...on the Keto diet. This one was an assessment of longer-term effects and, unlike many short-term studies which have been intriguing, it wasn't great news. The caveat is that this was a mouse study, and so we can't make direct line comparisons, but even with that considered, the results should probably prompt more questions for those leaning toward higher-fat diets. While the researchers found that the mice that were kept on a longer term keto diet didn't gain as much weight as those on the western diet (which on the surface seems like a good thing), the tradeoffs, which included significantly more fatty liver disease, losses in lean muscle mass and poorer blood sugar control when carbs were reintroduced, caused the research team to recommend caution. Once again, except in very specific cases, extreme diets (all carbs, no carbs, etc) over the long term appear to struggle under scrutiny. Which gets us to our last category for the week, research that might seem "too good to be true".

One of the great promises of exercise is that it keeps our bones strong. Since the late 1800's, thanks to German anatomist Julius Wolff, we've known that our bones adapt to the loads they are placed under, getting thicker and stronger as a result of physical activity. However, now a team from Hong Kong may have found the exact mechanism. They reported their discovery of the Piezo1 protein, which acts as a physical activity sensor and prompts the bones to add strength rather than store fat. This means they have essentially figured out how to turn bone strengthening on at the cellular level, no exercise required. Again, this study was in mice, so let's not overgeneralize, but for those who don't love exercise (or have an injury or illness that makes it impossible), quotes like this, from the lead author, are exciting news. "By activating the Piezo1 pathway, we can mimic the benefits of exercise, effectively tricking the body into thinking it is exercising, even in the absence of movement." Of course, there are (literally) thousands of other benefits of exercise beyond bone health, so we probably shouldn't write it off just yet, but this is undoubtedly a fascinating discovery.

There's more to come on these topics, but until then, have a great weekend,
Mike E.

Jan 16

First, the recap. We started the year like we often do, talking about steps we could take in order to make it a stronger and happier one. We discussed the results of a survey of thousands of individuals across 29 countries, which revealed 3 health tactics that were cited most often as a possible direction for setting a few New Year's resolutions. 2 of the 3 were fairly tried and true: MOVE more, as measured by exercise minutes, and ENDURE better (that is, distress less). However, the third, "incorporate more home cooking", struck a different chord because it has the potential to unlock many other healthy doors along the way, including literally growing health in the garden. Then, last week, we folded in the idea that energy, and the body's ability to efficiently use it, may be the most important door of them all to unlock this year. 

Whether we buy it or grow it, the full physiological benefit of a home-cooked meal lies in our body's ability to transform the stored energy in the food into a usable form AND transport it from cell to cell in a well-regulated way. Energy flowing too easily acts like a leaky bucket, and we drain quickly, while the opposite, too much resistance, is like a log jam where it builds up but never quite gets where we want it to be. We gave an example of how the sensation of fatigue, an early energy management warning sign associated with health decline and even death after the age of 50, when it becomes excessive or persistent, isn't always low energy reserves (running on empty) but also potentially energy stagnation (the log jam).

The idea can help us understand why yet another large study showed that inadequate time to RECOVER was a highly significant predictor of life expectancy. Cellular energy systems can't perform as well when sleep quality is lower, so this finding probably shouldn't surprise us. Using data from every county in the US in order to smooth out differences in risk from town to town, short sleep, defined as less than 7 hours, was a stronger predictor of early death than all but 2 risk factors considered. Only smoking and obesity, both of which are linked to smoldering low-grade inflammation, which is in itself an energy-intensive scenario, had a greater impact. It may also help to explain the global doubling of cancer cases from 1990 to 2023 and the grim forecast released last week of a continued surge over the next 25 years. As we are learning, a hallmark of cancer is the change it makes to the energy transformation and communication apparatus, commonly known as the Warburg effect. There is even a theory, published last week by a team from Italy, that suggests the negative impacts on the same energy apparatus may be the bridge between emotional distress and poorer physical health. Common roots indeed.

So what's the action? Where do we start if we want to lower our risk by investing in our own energy apparatus?

We'll cover that in our final segment next week.

Until then, have a great weekend, 

Mike E.

Jan 2

President Dwight D. Eisenhower is quoted as saying, "Plans are worthless, but planning is everything." In an excerpt from that speech in 1957, he goes on to clarify, "There is a very great distinction because when you are planning for an emergency, you must start with this one thing: the very definition of 'emergency' is that it is unexpected, therefore it is not going to happen the way you are planning."

I love that quote. While planning for a healthy life is definitely not the same as the war-planning he was referring to, the main point holds. The act of gathering current information to help inform, envision and prepare for the potentials of the future is one of the best ways we have to gain power over it; to be adaptable enough, resilient enough and ultimately ready enough, to both absorb and grow from whatever life throws at us this year, even while acknowledging things almost definitely won't actually go according to plan. And so, with another calendar flip upon us, it's a great time to do some planning in hopes of unlocking an even better way to maximize our effort this year.  

Under the header of "gathering current information" and against the backdrop of 2025, a year that again proved that investments in any of the ELEMENTS, even very small ones, can pay off, zooming out to look at our entire personal health "portfolio" is a great first step. If we are anything like the 16,000 individuals across 29 countries surveyed in this study, 3 tactics could be particularly impactful to include in our plan. While the first two, (1) working to build the skills to ENDURE emotional distress in a world that seems more tightly-wound than ever, and (2) increasing our MOVE-minutes per day, didn't surprise me much, the third got me thinking. The act of "home cooking, which can be so much more than good FUEL, could easily become a central power-habit that others lock onto this year. Using the kitchen or family table in order to CONNECT is definitely not perfect for every situation, but the known benefits certainly deserve an effort where possible. However, for those who are really ready to let things compound in 2026, planning to support that effort with fresh ingredients sourced from a garden may open a whole new portal to better health.

This review, for example, showed a strong mental health benefit and even some physical function gains for those willing to roll up their sleeves and step into the garden, but that might just be the tip of the iceberg. Not a lettuce joke, but enjoy!. For most of us, there's exploration and learning to be done to build gardening skills. And since there's a beneficial link between curiosity and brain health, stimulating our brain while also getting the gut-health benefit enjoyed by gardening families (but not by those who don't), as shown here, seems like a no-brainer. Who knows, it might even send you down a similar wormhole as me, considering how to unlock an important, long-term investment by way of soil improvement. While it may not be an emergency just yet, it is a problem we probably shouldn't ignore if we'd like to turn the tide on the sliding food quality discussed here. To be honest, I didn't expect to have the "magic of composting" on my personal resolution list, but here we are. 

Of course, this won't be the only path we walk down in 2026. There will undoubtedly be more fascinating updates and nuances to be learned and leveraged. As always, we resolve to scour and dive deep each week in hopes of elevating the strategies that work and combat the growing risk of  "mis-", "dis-", and even "mal-" information on health mentioned here.

From the entire team, we wish you a stronger and happier 2026 through better health. Reach out any time we can support your planning...or, if you've got it dialed in already, send some gardening tips or pics you're proud of when the time comes!

Happy New Year,
Mike E.

Dec 19

I can already imagine the social media clickbait. A title like "everything you've ever been told about diet is wrong," which overlays an image of a person with a perfect physique or a distinguished-looking professional in a lab coat. Then, for those who decide to expand beyond the headline, a short summary of one or both of the two studies out this week, quite possibly burying or leaving out critical details, depending on the source. Maybe it's a sign of the times, or maybe it's just what commandeers our attention. Either way, since I prefer to pick them apart for my own understanding, I figured, why not share? So, for others who might be curious, here's my summary of the deeper dive. 

Study 1 - from the Annals of Internal Medicine (a publication of the American College of Physicians), dated 12/16/25. The big finding on this one is that after a review of randomized controlled trials, researchers found little to no benefit in measures of heart health by reducing saturated fat in certain groups. At face value, this is a potentially big finding with implications for everything from public policy to health advice. The risk, however, is in missing the details, which make this a far more narrow finding, limited to a far more narrow group of people in a relatively short time frame. 

What the research team really found was that in at-risk groups, lowering saturated fat produced a significant benefit, while in low-risk groups (i.e., healthy people), there was little to no additional benefit in a 5 year period. There is nuance here, and it's important. First, it's entirely possible that a risk "floor" exists - healthy people (those at low risk) didn't get even healthier. However, if current projections are correct, this is, sadly, a very small number of people. The most recent statistics show that 2 out of 10 US adults transition from high risk to diagnosable heart disease in their 20's and 30's, with more and more each year. By the time we are in our retirement years, more than 7 out of every 10 have been diagnosed. This means not only are there very, very few who are in the applicable low-risk category, but in a disease that takes decades to develop, a 5-year window is probably not long enough to set a lifetime plan to. 

In addition to a risk-floor, it is also possible that the strategies that lower risk (in those who have it) are not the same as the things that prevent risk (in those who don't). There might definitely be more important levers for these few, but to me, it seems shortsighted to ignore the up to 25% risk lowering effect seen when the at-risk group changed from saturated fats to polyunsaturated fats. There's almost definitely more to come on this one, but one thing feels certain: the headline doesn't quite capture the story.

Study 2 - this one from The Lancet as part of their December 2025 Europe Regional Health journal. The sexy headline finding on this massive data review (63,000 participants over 9 years on average) was that certain plant-based diets were associated with an increase in cardiovascular disease risk. Unfortunately, anyone who stops there will likely be misled. What the study really found was that when they compared the effect of dietary choices across 3 different known risks including: dietary makeup which ranged from mostly plant-based, such as the often heralded Mediterranean diet to minimally plant-based which might be something closer to a standard American diet as well as quality (high nutrient to low nutrient) and level of processing (low process to ultra-processed), all 3 groupings mattered. 

While a mostly plant-based diet is widely regarded as a powerful preventative choice (which might be scary in some professions), it probably shouldn't surprise anyone that more data now supports what seems obvious - when we eat highly nutritious foods that are close to their natural state (fruits, veggies, nuts, seeds, legumes, etc) we do significantly better than when we try to use only the parts that are easy, convenient or taste good. In much the same way that fruit and fruit juice may come from the same source but can yield very different effects, something that is minimally changed from how it started is wildly different than something that has been significantly altered to look, smell, or taste different and sit on a shelf longer before it spoils. Junk food is junk food, even if it started as a plant.

At the end of the day, these two big studies, which are sure to make waves in some areas and might even sell some news, don't change things all that much for me. Author Michael Pollan may still be able to lay claim to the most accurate and simplest take on how to eat for health - "Eat Food, Not Too Much, Mostly Plants.

Have a great weekend,
Mike E.

Dec 5

Tuesday was the first dreary day of the season here in New Jersey. It started sleeting just in time for the morning commute, and then things settled into a cold rain for most of the rest of the day. The good news is that when it comes to seasonal weather change, we humans are expert-level adapters; such a day won't feel all that cold in a month or so. The less-good news is, the process takes a few weeks, and with Winter still (officially) out on the horizon, we're only just beginning our "winterizing" phase.

The winter months come with a unique set of risks. Although there isn't a ton of strong research documenting the phenomenon, and we don't really know whether it is due to decreased consumption or increased fluid loss (or both), it's not uncommon to feel a little dried out during the colder months. Add to this our tendency to move a little less easily (tissue stiffness) and a little less often this time of year, and it's no surprise that soft tissues and joints tend to be a little more cranky. As if that weren't enough to be tedious, unlike most animals, which burn extra calories staying warm, we do the opposite and add body mass, which, of course, tends to be in the wrong direction for a long list of health indicators, including brain age, according to a release last week.

If only there were a few simple (and intuitive) tactics that could put the odds back on our side...well, we're so glad you asked. :) Two new, otherwise unrelated studies out in the last week can provide direction.

The first was a review on the impact of increasing body temperature before exercise or athletics, quite literally warming up. For anyone who gets regular workplace visits from our team, the results should DEFINITELY NOT be a surprise - while it doesn't make a person stronger (per se), muscle warm-up consistently improved power output and speed.  Specifically, for every 1°C increase in muscle temperature, performance improved by about 3.5%. The interesting twist on this one, however, was that passive warm-ups (such as sitting in a sauna to raise body temperature), although not nearly as practical as a quick dynamic warm-up, by and large produced similar results. The study authors, however, still favored mimicking the intended movements when able due to the added benefit of priming the nervous system. One author was quoted as saying, "While both active and passive warm-ups result in better speed and power, a lot of research shows that the warm-up exercises should be similar to the exercise you will be doing." He went on to say, "The practice actually helps us to activate our muscles more and to use more efficient movement patterns -- the nervous system can learn on the spot."  

The second study, which wasn't exactly targeting body temperature, did show interesting preventative effects that could be very beneficial this time of year. This time, it was the impact of a hot cup of flavanols on arterial performance in sedentary healthy individuals. The researchers used unprocessed cocoa, but high-quality green tea would work well here too. They found that after the dose of flavanols, declines in arterial performance from prolonged sitting were effectively halted. Interestingly, this was consistent across both low and high-fitness subgroups, ruling out baseline fitness as a possible driver. Of course, given that exercise snacks (bouts lasting < 1 min) have also been shown to improve arterial responsiveness similarly, combining both strategies is probably better than 1 alone. 

For most of us, it's bound to get colder from here. Add some flavanols to your hydration and prime your power with some warm-up movements to lower risk, especially while we are in the early phases of adaptation.

Have a great weekend,
Mike E.

Nov 21

I am always drawn to stories about people who seem to quietly make words like "unstoppable", "invincible", and "limitless" their personal brand statement. Whether in the smashing of a 20-year-old course record in NYC a few weeks ago or in becoming the first female Army Ranger to compete (and then complete) the Best Ranger Competition, something 70% of the best-of-the-best entrants aren't able to do, 2025 has been a good year for human achievement. However, to me, where things get really amazing is when we try to understand how these "otherwise normal humans" work through the choice to stop and instead keep going; to deal with inevitable setbacks, leverage the years (or even decades of preparation), and ultimately find a way to ENDURE.

It's tempting to believe that the ability to conquer such amazing challenges is heavily, if not solely, psychological. Whether we call it grit, resilience, or extreme discipline, people who ENDURE seem to tap into an almost super-human toughness. Interestingly, however, new findings suggest otherwise. The limits of our performance are located, anatomically speaking, further south and are far more predictable than we might expect. While we've known for a while that over the very short term (minutes) our ability to physically perform work is largely limited by resource delivery (for example, getting oxygen to the muscles), which is measurable and therefore predictable, over the longer term (hours or days) things get a little less clear. We humans, with our advanced ability to "push past" our limits, haven't always seemed to fit the models that explain how other species survive by finding the balance between energy availability and activity intensity in tasks such as migration, hibernation, or others. It's not quite as simple as "calories in and calories out," but as new research out this week has shown, it's closer than we might think.

According to nutrition labels, the average human burns about 2,000 calories per day. Some portion, called the Basal Metabolic Rate or BMR (1500-1700 calories perhaps) is required for basic functions like breathing, digestion, and alertness to danger. Online calculators such as this one can provide a reasonable estimate by taking into account age, sex, height, and weight. The remaining calories burned get added with the activity requirements of our day, whether occupational or recreational, to give us a total daily energy expenditure (TDEE). Ultra-endurance athletes who might train more than 20 hours per week can obviously far exceed the 2,000 per day threshold and, of course, get the performance benefits of doing so. Impressive as they might be, they, too, however, have limits. As we learned this week, the amount of energy they can consume, convert, and utilize before they either can't keep up or things begin to breakdown trying is finite.

To determine this limit, a team of researchers recruited 14 world-class ultra-endurance athletes. It measured their energy expenditure across training and competition of varying intensities and durations over the course of an entire year. As it turns out, a biological limit did, in fact, exist, and it was approximately 2.5 times the BMR for each, a finding that confirmed previous research. While they found that the athletes had far higher peaks in short term capacity, as much as 6-7 times BMR in bouts lasting hours or even a few days, things consistently leveled out by the one month mark ultimately proving that even at the world class level, our ability to push ourselves in activities that last for more than 4 weeks is governed by the gut and its ability to supply energy...which appears to be capped.

There is almost definitely more to learn here, but when it comes to pushing our performance, the real discipline might start with the dinner plate.

Have a great weekend,
Mike E.

Nov 7

When was the last time you had a great night's sleep? You know, the kind of sleep where you wake up refreshed, feeling rested, energized, and ready to conquer the day. If it's been a while, you probably shouldn't feel alone. According to recent data reported by Garmin, the wearable tech giant that measures and scores sleep for its millions of users, only 5 of every 100 people are super-sleepers, scoring in the "excellent" range (at least 90 of a possible 100) on average. The rest of us sit closer to 70, which may partly explain why we spend an estimated $64 billion per year trying to improve it. According to this market survey, many are willing to spend even more. 

While supplements led all categories in the survey above, new research suggests it might be time to reconsider, especially for those leaning on melatonin. As reported by the American Heart Association earlier this week, results of a 5-year look at the effects of long-term melatonin use (defined as 1 year or more) showed that users had nearly twice the risk of developing heart failure as non-users and 3.5X the risk of being hospitalized for the condition. While research on the effectiveness of many other sleep supplements is limited, and some show more promise than others, those looking for a safer and more effective option might do better in the produce section.

As summarized in this 7-minute companion video we asked AI to create, most research on the subject shows that both "what" we eat and "when" we eat it can have an impact on how well we sleep. Refined carbohydrates, saturated animal fats, and any calories within an hour or two of sleep are generally negative, and fiber is generally positive, but exactly "how" they impact us is still coming to light. A review from February of this year showed that not every measure of sleep dysfunction was related to a high dietary inflammatory index, a reasonable estimate for diet quality, which may be good news for those who struggle to limit or eliminate unhealthy foods. Even better, finding ways to add healthy foods may be a very strong stand-alone strategy.  

New research from the University of Chicago and Columbia University last week showed that individuals who ate at least 5 servings (cups) of fresh fruit and vegetables during the day enjoyed 16% better sleep quality that same night as compared to those who did not. It was the first study to show such an immediate and objectively measured effect. While fiber and naturally sourced magnesium (nuts, seeds, and legumes in addition to fruits and veggies) also trended toward a positive impact, red and processed meat consumption trended toward more sleep disruption. 

So, whether it's berries with breakfast, grab & go fruit at lunch, or the "good full" of a dinner that starts with a salad, we can rest-easy knowing an investment of 5 servings today was a good one...quite literally.

Have a great weekend,
Mike E.

Oct 24

For some, it started with an injury from way back when. For others, it was a more gradual combination of tissues that got a little bit stiffer with age and a change in the strength-to-bodyweight ratio, which allowed things to get a little irritated. For many, it's easy to notice after not moving for a while, like those first few steps out of bed in the morning or standing up from a kneeling position. However, for most, as discussed here, it's probably time for a reframing of the conversation.

Osteoarthritis (OA) is a massive, worldwide problem. Some recent data shows that more than 600 million people across the globe work through it every day. The knee(s) is the most common site, accounting for 56% of the cases. Not surprisingly, a significant amount of effort is directed at finding out how to prevent, reverse, and better manage the problem. The good news is, over the last few decades, a lot has changed, including how we talk about the disease; instead of "degeneration" with the sound of inevitability, there is renewed hope in the many promising ways to manage it. The less good news, as is the case with many complex problems, there is no single best or definitive strategy. And so, with that in mind, this week we thought it might be helpful to review some of the current narratives around knee pain with an eye toward those that have a strong or growing evidence base. 

Dial-in Your Diet: Healthy Eating improves knee pain trajectory - the connection between diet and pain of all types continues to gain strength. There appears to be a particular benefit for knee pain sufferers who get adequate fiber. Whether it's this 2017 study, which showed between 24-44% lower odds of experiencing moderate or severe knee pain for those who consumed the most fiber, or this review from a few months back, which included more than 30,000 people over 20 years and showed a 27% risk reduction for those who got enough fiber, the connection is worth our attention. For those wondering "how much is enough?", the research team found that the benefit started between 14 and 27 grams per day. To provide perspective, this equates to only a few servings of common fruits, veggies, nuts, seeds, or legumes as listed here.

Out with the Old: Exercise (and yes, even running) helps - The old narrative, that running is somehow "bad" for the knees, thankfully, seems to be on the way out. A few years back, one review was inconclusive at best, with some data showing the repeated and rhythmic joint loads of running actually had a protective effect. Then, last year, another review concluded there wasn't a link between common forms of physical activity (including running) and disease progression. Yet another, which surveyed 37,000 marathoners, found the usual suspects (a history of hip/knee injuries, advancing age, family history, and body mass index) added risk, but years running, number of marathons, weekly mileage, and average pace were not predictors. In fact, just last week, an extensive review that compared a variety of exercise types to determine which was best found that aerobic exercise, which includes running, outperformed the rest. 

More than "mass" alone - For years, we've known that elevated body weight (usually measured by body mass index, a weight-to-height ratio) is related to knee pain and OA. The compressive forces at the knee during even routine daily activities like climbing steps can near the injury-risk threshold when we are carrying extra weight. However, a more nuanced narrative, that it's not only our weight-to-frame ratio that matters, but the source of the weight that counts, is emerging. This 2024 review showed that both muscle mass index (a ratio of muscle mass to height), as well as sarcopenic obesity (i.e., both low muscle mass AND excess bodyweight), were related to knee OA, but low muscle mass without obesity (sarcopenia) was not. Of course, this was not a perfect review (as pointed out in follow-up commentary here), but it provides an interesting new vantage for those of us trying to ease the knees - lose the weight if able, but stay strong.

There are, of course, many others, including regenerative therapies and approaches to whole body inflammation that should be on the radar, but staying strong, feeding on plenty of fiber, and maximizing movement remain near the top of the list.

Have a great weekend,
Mike E.

Oct 10

Legendary UCLA Basketball Coach John Wooden once said: “Little things make big things happen.”. It's a philosophy many would agree with, whether in sport or in other domains of life, and one that I was happy to see recognized, even if indirectly, earlier this week on Pro-Activity's "Athlete of the Week" post. The accomplishment is clearly a "big thing"; however, the years of steady build-up can't be understated. When we first met Mike, he was a busy professional, a Dad, and an involved member of the local community. He decided it was time to invest in his health, and along with a few of the other ELEMENTS, he got moving, literally, in that direction. What made him different from many, however, is that he never stopped. Running miles became cycling miles, which eventually became hiking miles. Mountains became milestones with selfies from epic (and enviable) locations, and as the post makes clear, steady steps forward became summits with the included bonus of strength, fitness, and health - exactly the kind of adventure many of us hope for in retirement.
 

But maybe you find yourself asking the question we so often get: "Could it really be that simple"? 

Thankfully, the answer is yes...but we should never confuse "simple" with "easy", something a cool new study reinforces this week.

Some history - Before 2010, the American Heart Association promoted "The Simple 7", a group of habits and health measures that they advised to be the most critical in preventing heart disease. The habits included: Avoiding Smoking, Eating Healthy, Getting Active, Maintaining a Healthy Weight, Managing Blood Pressure, Controlling Cholesterol, and Maintaining Healthy Blood Sugar levels. Those who were able to achieve some or all 7 had significantly better health and saved money on healthcare. Then, with growing evidence that showed the connection between sleep habits and health, they added "Get Healthy Sleep" and rebranded the habit cluster as "Life's Essential 8" (4 health behaviors and 4 health factors).

Around that same time, a research team was tracking the health habits of more than 4,000 young adults across 4 major cities in the US in an attempt to understand exactly how protective, over a longer term, these habits could be. With at least 20 years of data, as reported this week in the Journal of the American Medical Association, they found resounding evidence that the effect was massive and that consistency was critical. 

Individuals who achieved and maintained a high healthy habit score (80% average score or better across all 8 markers as listed on page 11 here) and remained consistent over the course of time were nearly 10 TIMES less likely to have heart disease or a heart-related incident by the end of the study period when compared to those who averaged 50% or less. However, the effect wasn't only seen at the two ends of the spectrum. Every 10-point difference in average score changed a person's risk by 53%. 

It's not always easy, but it isn't super complicated - get started as early as possible and keep going until it's a habit - there are amazing views that await!

Have a great weekend,
Mike E.

Sep 26

The story on hydration can be complicated. While we know that dehydration (too little) negatively impacts performance, both physical and mental, we also know that the other extreme, excessive intake of fluids to the point of impairing electrolyte balances (e.g., hyponatremia), can be equally (if not more) dangerous; a counterintuitive risk being seen in some vulnerable groups during heat waves. While some experts have suggested the narrative on dehydration has gone too far, heavily influenced by marketing designed to make us worry - pointing to many of us who rarely leave home without a water bottle in tow as evidence - others cite many known benefits for mind and body and conclude it's worth the effort to get right...which isn't always easy in a world of distractions. While our body has an elegant method for knowing when we need more fluid (thirst) and a variety of processes to deal with scenarios when we truly can't get it, it's relatively easy to misinterpret the signs or miss them entirely. Naturally, therefore, many look for guidance, which in itself can be complicated.

The old rule of thumb (8 x 8-ounce glasses = 64 fluid ounces) has been debated, with sources like the Mayo Clinic suggesting significantly more fluid overall based on guidance from the National Academy of Sciences.  They cite 90 to 125 ounces for women and men, respectively, of which 20% comes from fresh foods. However, they also recognize that the "right" amount can vary significantly depending on personal factors, so "it depends". As someone who isn't always great about sipping on water throughout the day but has found a clear connection between running a little dry and the signs of a more strained system (poorer sleep quality, delayed recovery after exercise and for the wearable crowd, altered measures of heart rate and HRV), any time there's a simpler method being tested I try to pay attention. With that in mind, a new study which focused on something closer to a functional daily intake - an amount that is far enough above dehydration to minimize system strain without being overly concerned with perfection - caught my eye this week.

The study team compared the stress responses in a small, 32 person, group which was made up of roughly half that were in a low hydration state, habitually consuming less than 50 ounces (1.5L) of water per day and half that were adequately hydrated, consuming between 68 oz (2L) to 85 oz (2.5L) per day for women and men respectively. They confirmed hydration status both in the lab (urine osmolality) and by real-world observation (darker urine color first thing in the AM). They then put both groups through a battery of tests known to induce stress, one of which is the gold-standard "Trier Social Stress Test," and monitored 3 markers of stress at various time intervals afterward, including anxiety (as measured by a validated survey), heart rate, and changes in cortisol (a hormone we release in stressful situations). While the sensation of anxiety and the heart rate changes were similar, they found that in the low-hydration group, there was an exaggerated stress response, as measured by cortisol, 50% greater than in the hydrated group. Given the known connection between exaggerated stress responses and poorer long-term health, hitting the minimum in otherwise healthy individuals is a solid first step for those who regularly do not.

What's the catch?

It is worth noting that in the press release made by the UK University where the study was performed, the team made it clear that funding for this study was provided by the research division of a consumer products company, which owns at least one famous water brand. Not enough to dismiss the findings in my opinion, but perhaps enough to suggest the findings should be replicated and verified to make them stronger, which is almost always the case.

Bottom line on this one is that, in addition to keeping an eye on urine color as a reasonable hydration indicator for most of us, if you've got a deadline looming or some other known stressor on the horizon, topping off the tank might be a simple stress-reducing strategy.

Have a great weekend,
Mike E.

Sep 12

Sometimes the health headlines are pretty sparse. The team has to really dive deep to find something that is both interesting and applicable to serve as the focal point of the weekly blog. This week wasn't one of those times. While the FUEL-related headlines over the last few months have been dominated by the pros and cons of appetite-lowering drugs, this week, it was like something let loose, and a backlog of healthy eating studies poured onto the scene. The theme doesn't change much, but the details are getting more and more dialed in.

First, and maybe most importantly, a great new study helped to reinforce an important concept - the compounding effect of stacking good habits by combining FUEL with other ELEMENTS. Whether yours is a "SPAN" (combined emphasis on Sleep + Physical Activity + Nutrition) approach or some other combination, this new study out late last month showed that 2 out of 3 could also have a strong effect. A team compared the effects of a healthy Mediterranean diet (with no other restrictions or parameters) to a combined protocol of calorie-restricted Mediterranean (approximately 600 calories per day less) and regular physical activity, such as a brisk walk and/or balance and strength exercise over a six-year period. In 5,000 adults 55 and older, who were at risk for diabetes, the combined group outperformed the diet-only group (which we know to be powerful by itself) by an impressive 31%. Yet it doesn't end there, especially for those who are ready to zoom further in. 

One really cool study in the British Journal of Ophthalmology, which caught our eye (pun intended) reported on the impact of dietary fat intake on vision in children. They found a clear link between saturated fat intake and nearsightedness, which was significantly less in those who consumed more Omega-3 PolyUnsaturated Fatty Acids (PUFA). While studies like this are only the start of the discussion and not universally applicable, it's probably fair to assume that it's not only carrots which help maintain or improve vision health...if the fats in your diet lean heavily toward saturated fats, it may be time to consider foods rich in Omega 3s like certain types of fish, nuts/seeds and perhaps soybeans. There's definitely more to learn here, but it's possible (and maybe likely) that given the pro-inflammatory profile of saturated fats and the small "pipes & wires" (vessels & nerves) that supply the eye, fats with a better profile are, quite literally, easier on the eyes.

A little lower down the anatomy ladder, another great FUEL study out recently showed that older adults could "rebuild" their oral biome by supplementing a popular endurance-enhancing root vegetable. Yes, it's beetroot juice for the win again, but this time as a way to lower blood pressure by restoring the bacterial makeup of the mouth. Participants, who were broken into groups by age in this double-blind placebo placebo-controlled study, drank a few ounces of nitrate-rich beetroot juice twice daily for 2 weeks. While the older participants saw a notable blood pressure benefit, their younger counterparts, who had a healthier biome in this regard (and therefore maybe didn't need as much of a reset), did not. The takeaway on this one is that our bacterial profiles likely change with age, and although we're not sure if this is "cause" or "effect", there does appear to be a link to this change with heart health. The good news is, these changes are, in part, reversible by eating a diet rich in plant-based nitrates. Beets and arugula are near the top of the list; however, another family of plants may do this and more, according to a couple of studies we had previously missed.

Putting a little more power in the cruciferous column, this randomized controlled trial last year compared the effects of the powerhouse veggie family, which includes broccoli, cauliflower, brussels sprouts, cabbage, and others, with root vegetables and squash. As it turned out, the cruciferous veggies outperformed when it came to blood pressure-lowering effects, but that's not all...another study out this past May showed an intake of +/- 1 serving per day had a significant impact on as many as SEVEN different types of cancer. Specifically, the minimum effective "dose" ranged from 3 to 7.4 servings per week, depending on the type of cancer studied. Those who ate the minimum weekly dose had lower odds of developing cancer (on average) by 23%. Impressive.

Once again, it seems that when we focus on quality foods, mostly plants and not too much, we can put prevention on the menu. Fold in some physical activity and consistently restful sleep, and we've got a very strong platform to build on. Now is as good a time as any.

Have a great weekend,
Mike E.

Aug 29

Muscles may finally be making their way to the main stage. Sure, there has always been a crowd that cares - just walk into any gym, fitness studio, or whatever trendy term is being used today to find them - but solidly typecast in athletics and aesthetics, they've had a hard time crossing over into the mainstream conversation on health. Not even their proven track record for lowering injury risk when strong, in this recent study by 25% or more, even for healthy and fit athletes, has gotten them a shot at the big-time. Recently, however, the idea of maintaining muscle mass and prizing power is gaining traction with a larger and more widespread audience. 

While we clinical folks might like to believe that it's the rising importance of "sarcopenia", that is, abnormal age-related muscle loss, that's driving the conversations, results like these, which show a generally low understanding even among professionals, suggest otherwise. Ironically, it may be the attention-grabbing "baby with the bathwater" headlines associated with popular appetite suppression medications that are providing the spark. While there is much hope for the health impact of lowering body fat this way, possible side-effects of doing so too aggressively, which include strength and muscle mass loss, may be driving the conversation beyond muscle as a body mover, to muscle as sugar sponge and, maybe most importantly, myokine maker.

First, let's review the concept of a sugar-sponge. It's a relatively simple idea. Every time we load our muscles via exercise, active hobbies, or physical work, we are priming them, like squeezing a sponge, to soak up blood sugar for energy production. All physical activity works, but combining resistance (the more muscles engaged, the better) and aerobic exercise is even more effective in both the short term and the long term. However, the trouble with this analogy is that sponges work both ways - they not only "soak up" the overflow (in this case, blood sugar) but they also release whatever they're storing when we next squeeze them, which is where things really get interesting for muscles.

Somewhere around 2008, researchers started using the term "myokine" to refer to certain small proteins produced by muscles and known to play important roles in our health. From reducing inflammation to improving metabolism and lots in between, these proteins play big roles. However, it wasn't until more recently that we learned of their critically important role in supporting brain and nervous system health as well as in lowering cancer risk. It turns out that one of the reasons exercisers have a significantly lower risk of certain types of cancer is directly related to these powerful little proteins. Just last week, an impressive new paper profiled an experiment where researchers added a few droplets of a blood sample taken from cancer survivors after a single bout of high-intensity exercise to a petri dish of aggressive breast cancer cells and showed that they could slow the rate of growth by as much as 30% compared to a sample taken at rest. In plain English, after an hour of exercise and for at least the first 30 minutes of recovery, our blood becomes a potent anti-cancer agent...adding yet another reason to make muscle work a priority.

OK, it's not actually magic, the results in the mirror never seem to show up as fast as we'd like, but within minutes, the myokines will be on the move and the benefits will start. If it's been a while since you wrung out your sponges and soaked up some sugar, there's never a bad time to restart the habit. Whether a structured routine or something as simple as a few push-ups and air squats by your bedside, it all counts. 

Have a great weekend,

Mike E.

Aug 15

Our brains LOVE leaderboards and rankings. They are one of the most popular tools used to gamify learning for a reason and, if well designed, can improve motivation and striving. Although it's more nuanced than simply generating a list, for example, one study showed that the boost in motivation was more powerful for those at the top and the bottom than the middle, the essential premise that social comparison is one of the most powerful levers related to human motivation holds. Preseason rankings get us to scroll, Top 10 lists get us to click, and labels that indicate something has been listed among "the best" grab our attention. Not surprisingly, the rise of "super foods" is not all that much different.

According to the Harvard School of Public Health, the banana was the first real superfood, given that title around the time of World War I to help market the fruit to American consumers. It worked, but the term went dormant for decades until the blueberry was given the label for its powerful antioxidant capacity. From there, things snowballed. Growers and sellers began to realize the power such a label had in grabbing our attention (and our money), and despite the fact that it is more pop culture than rigorous science, many scrambled to show their product belonged on the list. Grape growers, for example, funded research to make their case in a paper that was published only a few weeks ago in hopes they might ascend the rankings to be up near greens, grains, berries, and seeds, which currently hold 4 of the top 5 spots.

We are often just as curious about foods on the other end of the spectrum. Although "junk food" doesn't seem to have the same branding power as "super food" (maybe because there are so darn many of them), "ultra processed food" is a term that is definitely gaining popularity as a way of pointing out that health is not only the result of "what" (ingredients and nutrient profile), but also "how" things are prepared.  A few days ago, the American Heart Association published a scientific advisory that dove a little deeper. Unsurprisingly, the essential conclusion was "limit their consumption". This is generally in line with a study published a week earlier, which compared the impact of minimally processed versus ultra-processed diets on weight loss. Even when the diets were "nutritionally balanced", people got double the benefit when eating minimally processed. Then on Monday of this week, the British Medical Journal dropped the results of a massive study which propelled one particular food to super-villain status.

If you guessed "the egg", guess again. Although often the center of debate, at least for its role in raising cholesterol and for the time being, the egg (when consumed in relatively low doses) has been taken off the naughty list, according to a recent study. The French Fry, however, is another story. After working with the health data of more than 200,000 people, which spanned more than 5 MILLION person-years cumulatively, researchers found that it wasn't consumption of the starchy spud per se that drove metabolic disorders in the more than 22,000 individuals who developed type 2 diabetes during the time, but rather how it was prepared that mattered. Individuals who consumed 3 servings of fries per week increased their likelihood of developing the disease by 20%, a number which continued to grow in cases when consumption was higher. Those who ate similar portions of potatoes prepared differently (mashed, boiled, baked, etc.) did not experience an increased risk. Of course, replacing those same three servings with whole grains (which are often on the superfood list) was even better, lowering the risk by 8%.

Simply put, we continue to learn it's never quite as simple as we might like when it comes to nutrition. Just as the effect of what we eat extends far beyond the individual nutrients contained within, how foods are prepared plays a significant role in determining what winds up on our plate. Can you guess which other foods have made the top 10 according to our research? Ask a member of the team, they got the list hot off the press just a few hours ago.

Have a great weekend,
Mike E.

Aug 1

Move enough, Fuel with high-quality sources, Recover fully, repeat. It's a remarkably simple formula that produces impressive results for just about anyone who can figure out how to make it work in their life. However, not unlike the difference between longevity (years alive, aka lifespan) and healthy years (disease-free years, aka healthspan) - which is more than a decade on average in America - the gap between "should do" and "can do" often feels more like a chasm. This is especially true for anyone who gets caught in the all-too-common trap of all-or-nothing thinking and misses the many available rewards for those who even do a little bit. 

The good news is, there are many rewards for implementing micro-habits. For example, just this week, 3 great new studies provided additional proof that the "3-legged stool" we so often talk about (Physical Activity, Healthy Diet, and Restorative Sleep) are each extremely powerful in helping us maximize our health.

 MOVE: The first showed that a 15-minute "fast walk" per day lowered the risk of dying prematurely by 20% in a group of 85,000 high-risk individuals in the Southeastern US over a 15+ year observation period. Interestingly, the short/fast walk provided 5X the benefit in 1/12th the time when compared to long-slow walking minutes. The long, slow walkers got a 4% average benefit at the 3-hour per day mark. 

 FUEL: The next showed that achieving and maintaining one of 3 healthy diets decelerated the progression toward disease in a sample of nearly 2,500 seniors over a 15-year period as compared to a reference diet, which accelerated the same progression. The net gain was as much as 10%.

 RECOVER: The last showed a link between low sleep quality (i.e., more than just hours per day) and 172 different diseases...92 of which had at least a 20% increased risk when sleep quality was low and 42 of which had double or more the risk. 

 The less good news is, the trade-off for the stronger statistical confidence research teams get when isolating single habits (a good thing), is a more limited understanding of the synergies and compounding effects we can get with stacked habits or something closer to a diversified habit portfolio or index-fund of habits for those who use similar tactics for a financially healthy future. Unfortunately, there just aren't that many studies that look at combinations...but there are 2 this year that considered the combined benefit of Sleep, Physical Activity, and Nutrition, and how powerful it could be to help us SPAN the gap (see what we did there?).

The first, published in February of this year, showed that people who maintained the optimal daily SPAN of at least 7.2 hours of sleep, 42 minutes of moderate to vigorous physical activity and a dietary score of at least 57.5 on a 100 point scale (which gives points for adding fruits/veggies/whole grains and cutting back on processed meat, refined grains and sugary beverages) had 64% lower risk of dying during the 15 year study period when compared to those in the bottom 20% who averaged 5.5 hours of sleep, 7.3 minutes of physical activity and a dietary score of 36.5. However, and where it really got interesting, was in teasing out the benefit available for those in the bottom 20% if they could nudge each habit a little bit. While a "minimum dose" of 15 extra minutes of sleep, 1.6 extra minutes of physical activity and a diet quality bump of 5 points (1/2 serving of veggies per day) could cut risk by 10% - about the same amount as adhering to a healthy diet in the study above - combining an extra 1.25 hours of sleep with 12 minutes of physical activity and 25 diet points could cut the risk of dying in half. 

The second SPAN study (in pre-print), which looked at the same population to assess gains in disease-free "healthspan" years, found that those in the top 20% gained more than 9 years of healthspan compared to those in the lowest 20% which just about closes the average gap. In addition, by getting as little as 19 additional minutes of sleep, 4 extra minutes of physical activity and adding 21 diet quality points (such as by adding a cup of veggies and a couple of servings of fish per week) the folks who were most likely to struggle in the healthspan gap (alive but not healthy) could add 4 additional disease free years.

The power of small investments in a diversified portfolio allowed to compound over time isn't reserved for financial investments, and the quality of life divide is neither inevitable nor impassable...we just have to be willing to SPAN the gap. Let us know if we can help.

Have a great weekend,
Mike E.