Biggest Loser Group

Like many people, I struggle with my body weight.  I obviously treat health and wellness for a living, and I know what I need to do, but I need a support structure to help keep me accountable.

One tool that has helped me immensely is MyFitnessPal (www.myfitnesspal.com), which I will discuss in another post.

The most helpful intervention I've ever had, though, is a Biggest Loser Group started by one of my high school friends, Dan Stewart.

Our group, Dan's Friends are Losers, is a Facebook group started by Dan, and has been incredibly successful in creating a positive atmosphere that has kept us accountable.

This is a picture of Dan and I from April.  It's a bit cloudy- we took it right after Dan and I did two hours of mixed martial arts training at his gym in New Jersey.  Dan was training for his first MMA competition (which he won!  I think by a 1st round Kimura), and I visited his gym on my cross-country drive moving to the Pacific Northwest.

Dan has many great attributes a coach and motivator, and these are things I try to bring into my medical practice when I coach and motivate patients, the most important being positive energy and focusing on what I can do to help patients get better.

One thing that I've learned is that people can be in one of two modes, and you can't be in both simultaneously:
Mode 1: "What can I do to improve and get better" mode
Mode 2: "How do I make excuses for why I can't get better" mode

Dan is great at making sure we stay in Mode 1, keep our eyes on the prize, and focus on continuously improving.  Dan asks no less from me, and I owe it to my patients to try and be a positive motivator like Dan.

This is Kate.  She was my "summer buddy" - I life guarded at the pool in her home town of Roosevelt, NJ back in 1989, and she taught me everything I know about 1970s rock music, and kept me in good spirits while I hung out at the pool.  Kate is one of those great friends you lose track with over time, and we've reconnected through our Loser's group.

Kate's lost an enormous amount of weight - I think it's well over 100 bs, and is again a source of positive inspiration.  Whenever I think of Kate, she reminds how important weight loss really needs to be through a lifestyle change, and not just a periodic deprivation.

Scott and I went to high school together, but did not know each other then.  Scott's a great example of how you can make friends through the support group.  He won one of the rounds, and has managed to keep losing weight even after he "won."

More importantly, through our Loser group, I've developed a friendship with Scott.  I find him a thoughtful, philosophical colleague who constantly broadens the way I think about things.

This is Mike and I.  Mike and I first met as 9 year olds playing soccer, and what I've realized from getting to know Mike again while we are middle-aged guys in our early 40s is that you don't really know people when you are 9 years old.  Before Mike and I became friends again as adults, the most I could tell you about Mike was that he had a great cross pass for a 9 year old.  It's been enjoyable getting to know Mike the adult.

Ok, enough reminiscing.  What are some of the best tactics for weight loss I've learned a Loser?

Some tactical tips:
1. Go to bed early.  Sleep is necessary for proper healing.  Also, it's really hard to eat when you are asleep
2. Don't eat after dinner.  Most of my weight gain happens from night eating
3. Keep yourself accountable
4. Buy cheap jeans at Costco.  One of my favorite tricks is to buy a pair of jeans one size too small from Costco, and wear those when walking the dog in the morning.  Powerful incentive to stay on task
5. Keep tempting foods out of your sight-line.  Whenever people bring in "gifts" of chocolate or pastry, I immediately give it to my medical assistant to hide from me.  Even if I don't eat it, I think about it all day and then make bad food decisions.
6. Create opportunities for incidental exercise.  I have a Jungle Gym XT and Pull up bar set up both at the office and at home, which allows me to bang out a few quick reps .... BAM!- just did 5 pull ups before writing point #7
7. Focus on the positive.  I constantly repeat the mantra of "I want to be the best possible version of myself everyday" to remind myself of my goals
8. Focus on being better, not perfect. Better is obtainable, perfect isn't
9. Focus on what I can do, not on what I can't do
10. Express gratitude to the people in my life who have helped me get where I am today.  That starts with my girlfriend and my dog, extends to my partner Garrett and the rest of my practice, and most definitely includes my patients and my Loser group who inspire me every day

As Dan would say, "I'm a Loser, and that makes me a Winner!"

Tips for Weekend Warriors

Are you a weekend warrior?  For many busy professionals, the weekend is the only real time we can get to workout.  Here are some tips to help maximize the weekend warrior experience and prevent injury.

1. Start light.  

Warm-ups in general are a bit overrated, but for the weekend warrior, they are important to help loosen the muscles up.  

I find some light jogging intermixed with a few deep squats helps loosen up the legs, and arm circles to warm up the shoulders can be helpful.

2. Pay special attention to the groin.

The groin is particularly susceptible to injury in weekend warriors.  The groin muscles (technically the adductor muscle group) are not commonly used in every day activity, but are used frequently in sports, and therefore are prone to overuse injuries if you only use them on the weekend.

The reason we don't use them much during the week is that when you walk at a normal pace, the way your bring your thigh forward is with a group of muscles called the hip flexors (muscles in the front of your thigh and pelvis, including the rectus femoris and iliopsoas).

When you run or move more quickly, you rotate your pelvis, which engages your groin muscles to bring the thigh forward.  One way to image this is to stride as far forward as you can with your left thigh, which will rotate your pelvis so that the left side is further forward than your right side.  From this position, if you want to bring your thigh forward, you would have to use your right groin muscles in addition to your hip flexors.

Some strategies to help protect your groin:

1. Some deep squats and light jogging, as noted above

2. The butterfly stretch (http://www.ehow.com/how_2312300_do-butterfly-stretch.html) after warming up

3. The upward facing dog stretch (http://www.ehow.com/how_2277775_do-upward-facing-dog-pose.html) to help stretch the abdominal muscles.  This is important because the groin muscles and your rectus abdominus muscle (the six-pack muscles) share a common insertion point on your pubic bone.  I sometimes remind patients of this by referring to their adductor longus (one of the groin muscles) as the "seven pack" to remind them that it is part of the same group as the abdominal muscles, and therefore need to be stretched together.

4. If you are doing a kicking sports (e.g., soccer), be careful on your first few kicks that you don't slam your instep into the ground instead of the ball.  This is a common mechanism where soccer player often give themselves a particularly hard-to-heal type of groin injury called a sports hernia.

3. Try to fit in one high intensity workout during the week

Try to spend at least 30 minutes during the week in which you are exerting yourself to more than 50% of your maximum capacity.  This will help stave off de conditioning during the week.

As a practical matter, you may need to do this in short spurts.  Things like sprinting up the stairs every day when you get to work, or racing your son across the backyard when you get home, are great ways to build in short bursts of high intensity contractions.

In another upcoming essay, I will be talking more about strategies for "How to be more Awesome," which I consider an important part of the Kinemedics Philosophy.  One part of this, for parents in particular, is the importance of being excellent in the presence of your children.  I can't stress enough how important this is.  So, even little things like having your child see you do 10 push ups or  2 pull ups in front of them has some important ancillary benefits beyond their obvious health impact.

So, think of this nugget about short bursts of high intensity exercise as a variation of finding time to put more Awesome into your day.

4. Prime yourself for the weekend

One key way to make sure your weekend workouts go well is to make sure you don't go into the workouts tired.  The most important thing you can do to optimize your Saturday workout is to be healthy Friday night, and the same applies for Sunday morning and Saturday night.  

Some strategies:

1. Don't drink too much- 2 drinks is a reasonable number for most people

2. Get enough sleep.  Don't stay out more than 2 hours past your normal bedtime, and try to stay close to your normal bedtime

I realize this is tough for some people, as they prize their social time, may be in a new relationship that requires more effort, etc.  What I say is that optimizing your health is about embracing a healthy lifestyle.  As we learned recently, not even Dennis Hopper can continue to live the Dennis Hopper lifestyle forever (it may even catch up to Jack Nicholson eventually).  So if you are a partier and carouser, you will have to change some time.  That time is now.

Have a fantastic weekend!

Thoughts about Crossfit, the Denominator Effect

Every year, as a member for the editorial board for the American College of Sports Medicine's Health & Fitness journal, we are asked to fill out a survey about trends in fitness.  One of the questions was on a scale of 1-10, how "hot" a trend is Crossfit.  I said Crossfit clearly is a 10.

Like many health care practitioners, I often get a skewed perspective of new fitness trends, since I primarily see patients when they get injured.  Inevitably, as new fitness trends emerge, I will start seeing a corresponding increase in injuries.  A decade ago, I started seeing yoga injuries, followed by Zumba injuries, followed by P90X injuries, and more recently Crossfit injuries.

I think it's essential to keep in mind what I call the "Denominator Effect."  What is relevant is not the total number of injuries, but rather how many injuries I am seeing, divided by the number of people participating in that activity.  Of course, as something gains in popularity, the number of injuries will go up, but I need to know the rate of injury increase.  The other major factor- for those who are NOT injured, how much benefit are they seeing.

Let me cut to chase before going into detail- I really like Crossfit.

For those not familiar with Crossfit, it is a form of high intensity training.  High intensity training is, for those who are physically ready to handle it, arguably the single best form of exercise one can perform.  The American College of Sports Medicine recommends aerobic conditioning, strength training, balance training, flexibility training, and a training plan as part of their exercise prescription, and Crossfit is a convenient way to hit all of those exercise goals.

The typical Crossfit workout starts with a well designed warm up for 5-10 minutes, followed by 15-20 minutes of weight training (focused on classic Olympic lifts or power-lifting techniques), followed by 15-20 minutes of the "Workout of the Day" (called the "WOD" in Crossfit parlance), followed by a cool down/ stretch.

The Workout of the Day often combines different calisthenic movements for time.  For example, it may include a 200 meter sprint, followed by kettle bell swings, followed by pull-ups, then repeated, with the goal of finishing as quickly as possible.

I can't speak definitively about all Crossfits, but I have had a very positive experience at Sasquatch Crossfit in Redmond, Washington- http://sasquatchcrossfit.com/index.html.

Things I liked about the Crossfit experience:

1. Attentive care: The trainers sincerely cared about their team, and focused on creating a positive experience.  I consider myself in reasonably good shape, but I had some major deficits that needed to be addressed, particularly horrible kinesthetic awareness and hip range of motion.  I was concerned about my poor form causing an injury, but the trainers took time to work with me to enhance my form, and encouraged me to perform more simple motions so that I could develop proper range.

2. Focus on full range of motion.  One of the things that the Crossfit experience taught me was the benefit of exercising through full range.  Prior to training with Crossfit, I would encourage patients (and myself) to limit themselves through shorter arcs of motion, like half squats instead of full squats.  I was wrong.  I found that by practicing full range of motion, I dramatically improved strength in the ranges I had not previously challenged.  Perhaps more importantly, my flexibility and functional range of motion dramatically improved.

3. Supportive environment.  The team philosophy is very strong.  At Saquatch CrossFit, the owner Tim is one of the trainers, and having worked with all 4 trainers, there was a consistent quality and philosophy across the trainers.  I remember doing one particularly grueling exercise (repeated lunges with a barbell), and having Tim cheer me on from the finish line and another trainer, Everett, walk next to me to correct form and provide motivation was inspiring.  While it's theoretically possible I would be able to maintain that level of intensity on my own, but realistically I don't think I have the level of pure intrinsic motivation, and the coaches really helped in making me feel like I was part of something bigger than myself.

So those are the pros.  What are the cons?
1. Not for everyone.  The workouts are challenging, so people with low baseline levels of fitness will struggle.  I routinely found my heart rate within 80-99% of my maximum, so if you have cardiac issues, I would discuss this with your physician before starting Crossfit.  If you have musculoskeletal conditions, seeing a Board Certified Sports Medicine specialist familiar with Crossfit (..... like, of course, Garrett Hyman and I at Lake Washington Sports & Spine) can help figure out how to participate safely.
2. Knowing your limits.  With some of the exercises, it can be tempting to lift as heavy as you can.  It is much more important to focus on proper form.  In fairness to all the trainers I worked with at Crossfit, they were very attentive to this issue, but I suspect some people may be tempted to lift heavy before they learn proper form and expose themselves to injury risk.  I am a beginner, so I know I can lift heavier with bad form, but that's not my goal.
3. Inherent risks with high intensity training.  All forms of high intensity training have increased risk, so I think when assessing the risk of training for Crossfit, it really needs to be compared to other high intensity modalities like Martial Arts training, Zumba, P90X, etc.  Reviewing the scientific literature, I have seen evidence for the benefits of Crossfit (e.g., http://www.ncbi.nlm.nih.gov/pubmed/23439334), but I have not seen data on the injury rate.  In my personal opinion, I think the risk is probably on the lower end of high intensity training modalities IF you listen to your trainers.  Compared to martial arts training, you don't have as high a risk of someone else injuring you, and compared to P90X, you have supervision to assess your form.
4.Deterioration of form with fatigue.  Crossfit is tiring, so it's especially important to be attentive to form as you tire yourself out.
5. Specific areas for potential injury- all can be prevented with focus on form.
    A. The low back.  Any type of loaded flexion with twisting movements can expose the back, particularly the disks, to injury.  The back is particularly vulnerable during kettle bell swings.
    B. Knees/Hips.  You are generating  force through the "kinetic chain," so if the forces are not transmitted smoothly with proper form, both knees and hips can be injured.
    C. Shoulders: As with the knees and hips, the shoulders are the base for the kinetic chain in the upper body, and therefore care must be made to transmit forces with proper form.

Overall Thoughts and Feedback for Patients:
1. Crossfit, when done with proper form under the guidance of good trainers, can be a complete package in terms of meeting the American College of Sports Medicine's recommendations for exercise.
2. It's high intensity, so it can create better results than lower intensity exercise, but also has risk of injury inherent to all forms of high intensity exercise.
3. You need to do a realistic assessment of your capabilities, both in starting Crossfit and in advancing your loads.
4. If you are unsure of your capabilities, working with Sports Medicine physicians like those at Lake Washington Sports & Spine can help in meeting your exercise goals.