The Diane Rehm Show will host Christopher McDougall (author of Born To Run), Amby Burfoot (winner of Boston Marathon, 1968, Editor at large: Runners World) and myself on Monday. The topic will be “Running In America. We should cover a lot of ground. Both Amby and Christopher are knowledgeable and entertaining. It should be an interesting show. The discussion will be on NPR starting at 11 am. If I’m early, according to the schedule, it appears I could stop in for a spot of tea.

You can tweet your questions to the show on twitter or ask via the show’s Facebook page. More information on calling and email is available at the show’s website.

The Diane Rehm Show is  archived online and is available as a podcast through iTunes or as an rss feed.. I highly recommend Diane’s intelligent discussions and diverse subjects as food for the brain.

Best Meme: Exercise is Medicine. Trademarked and owned by the American College of Sports Medicine

Best Public Domain Meme: Exercise is good for what ails you. It’s mine and probably someone else’s too. You can have it for free as an open source code for life.

Best Runner of The Year: Usain Bolt

Best Marathon Victory of The Year: Meb Keflezighi bringing it home at the New York Marathon.

Best Running Magazine: Runner’s World. (with Runner and Marathon & Beyond close by)

Best Secret of Success: Avoid over training and the terrible too’s. Too much, too soon, too fast,  too often, with too little rest. Khalid Khannouchi, says that rest is the secret ingredient for success for the aging runner. Of course, I’d guess good genetics, and a lot of hard work helps too! This past summer Khalid received the Golden Foot Award of the American Academy of Podiatric Sports Medicine. He is also deserves to be known as one of the nicest people of the year.

Best Running Politician: And controversial in this slot would is Sarah Palin. But as a marathoner, and one who isn’t sure what papers she reads daily, she did know that George Sheehan is one of her favorite authors and philosophers. Bonus points for that put her over the top.

Best Basketball Playing Politician: Barack Obama. Now, Barack needs to publicly announce he has given up cigarettes and taken up running and he has a chance at the position above this one.

Best Book: Born To Run, by Chris McDougall. Best running read for a long time and  clearly dominated in the running world.

Best Fitness Book For Nonrunners: The Body Fat Solution, by Tom Venuto. While I’m more of a fan of cardio, and cardio out of your comfort zone more than HIIT, Tom Venuto has much advice for those trying to lose weight. Motivation, often a weak point, is well covered here.

Best Quick Workout Book I Haven’t Read Yet: Cardio Strength Training by Robert Dos Remedios. It’s new and it’s on order. I’m sometimes forced to get a workout in with only 20-40 minutes available. Coach dos Remedios has written up a bunch of short plans including some 15 minute plans. That may be a bit short, but I like to see what others are thinking of and I’m sure there are plenty of fine ideas here for those who like to mix in strength training. His text on “Power Training” is incredibly thorough.

Best Humor Running Book: The Runner’s Rule Book by Mark Remy

Best Out of Print Running Book: Running and Being by George Sheehan

Best Vacation Spot: Hawaii. Clearly the choice on both the right, left, and center. Pick an island, any island. You can’t go wrong.

Best Publisher: Rodale Press. Rodale publishes Runner’s World, Runner Magazine, and tons of books on fitness and health topics.

Best Game To Quit: World of Warcraft. How many games could keep so many people playing for so many hours? 5 year anniversary just passed, time for a change and the rest of life. Besides, sitting still for 5 hours in front of a TV screen or computer monitor has serious adverse health effects.

Best Revealed Wisdom: Hip strength and core strength is important. Abductors help ITB syndrome and gluteal muscles can help Patellar tendinitis (tendinopathy) and resistant patellofemoral pain sydnrome.

Best New Thought On Exercise: Exercise isn’t only good for what ails you, but sustained movement may have driven evolution of the hominid brain.

Best Sports Medicine Publication: Medicine and Science in Sports and Exercise. Official publication of the ACSM

Best Science Magazine: Science Magazine. (Nature is right up there too.)

Best Must Read Running Humor Blog: Mark Remy’s Daily Views Mark occasionally takes some hits on his blog, but he is consistently funny and occasionally controversial. And this summer, he pointed out a new member of the running community: Eminem, seen on the Jonathan Ross show. Jonathan is occasionally involved in controversies himself.

Best Running Blogs: Runner’s World Blogs. There are others, but overall the blogs at runner’s world are a great assortment and worth reading. Read them all and pick your own favorites, if you haven’t already. There is something for everyone. If you’ve missed Amby Bufoot’s two blogs, put them on your list: Foot Loose and Peak Performance. General fitness blogs: Leigh Peele’s Diet, Fitness, Life is also worth a look. Leigh tells the truth about diet, fitness, and trends at her new and likely permanent domain.

Best Music Video of The Year: Ima let you finish, but Beyoncé’s “Put A Ring On It” is it. This, it should be noted, was also selected by that exemplar of fine taste, Kanye West.

Best New Music Act: Florence and the Machine.

Best Commitment: Work on fitness and health. Made by many, kept by many, and in line to be the best commitment for next year too!

Best Thing Avoided: The Tiger Woods/ Mark Sanford life style. Thanks to those who helped with this one. More reasons why working out, running, and staying home is better than golf and politics.

Best Connector: The Internet. Intertubes, interwebs and all!

Happy New Year, everyone. I hope your year gets off on the right foot! Make your plans and commitments and get off to a good start!

The New York Times has a short portrait of Dr. Eric Heiden. Dr. Heiden was the first athlete to win 5 gold medals in an Olympics. Eric is a fine sports orthopedist and he is still an inspiration to athletes and skaters around the world. He trained under Dr. James Andrews, another excellent sports medicine doc. Dr. Heiden’s patients have said he is straight forward, honest, and humble. The Times didn’t paint him entirely that way, but the story is still an interesting read. His performance in 1980 was riveting. Even if you had no interest in skating, you’d turn it on to watch him in those Olympics. And yes, 1980 was also the year of the miracle U.S. hockey team. (And 1980 was also the year of an unfortunate summer Olympics boycott in response to the Soviet invasion of Afghanistan in 1979.)

Way back then technology was so bad you’d actually have to watch the Olympics live instead of taped, cut, and canned the way we can now. But, wouldn’t it be nice to have an option to see the next Olympics live? The upcoming Winter Olympics will be held in Vancouver, Canada this February. Vancouver is a fine venue with beautiful surroundings and friendly people. I was lucky enough to attend two meetings there. My last visit to Vancover was a few years ago as a participant with the Joint Commission on Sports Medicine and Sports Science. I’d be happy to visit Vancouver again. But, I’ll be watching the Olympics next year by satellite.

Sense and Sensibility

Note: There are several comments, but the interface on word press blogs will only show them if you click on the title and view only this blog entry.

The media seems to have decided that barefoot running is the trend that can’t be stopped, and should perhaps be encouraged. “Throw away your shoes” seems to be the dominant theme, if not the only thing we hear. And no one wants to stand against the tide and seek balance.  I’ve run barefoot on the beach for miles, and enjoyed it. And I’ve done that for years starting in middle school. During high school, I enjoyed barefoot running along the beach during the run up to soccer season. And, even at that time professional football teams were said to do the same. But the current persistent hyping of barefoot is as balanced as are the discussions on health care reform. Some years back, HMOs were touted as the solution to all of our health care needs. But, they aren’t singing that tune any more.

Now we are told that we evolved to run barefoot. Shoes are tiny coffins for feet and have stopped evolution. Tiny coffins that stopped evolution? Really? Evolved to run barefoot? Well, yes we did evolve to run barefoot. But we’ve had 30,000 years to develop body coverings and improved aids to motion, comfort and speed. We’ve made shoes – one shoe fits either foot, domesticated horses (and even tamed elephants) to catch  a ride, added lifts to our sandals to move faster in battle (Caesar), made steam and coal powered engines for trains, boats, sailboats, steam boats, shoes – designed for right or left foot, made cars, bicycles, airplanes and rocket ships that have carried us to the moon.

We’ve gone from eating nuts and greens to meat and back to nuts and greens. We’ve made other aids like glasses, robot flown drones, satellites to explore the rest of the solar system. But wait, did we evolve for this? Or is it wrong? Should we be barefoot and living in trees or in caves? Could we run faster without shoes?

It is said that shoes don’t help prevent injuries. But does running barefoot? Does wearing “unbalanced” shoes help? Do those shoes help you burn more calories? One person’s opinion quoted in the NY Times was that they did, they made her legs sore, so they must burn more calories. To me, that just shows that she overdid it and was a victim of the “terrible too’s” – too far, too fast, too soon, (too often and too little rest).

Could we run faster without shoes? Since 1960, only at the Mexico City Olympics,  has the Olympic marathon been won as slowly as Abebe Bikila ran it while winning in Rome in what was a world record time in 1960 (2:15:16, an impressive time). In 1964, Bikila wore (Puma running) shoes in Tokyo, ran faster, and set another world record. He took 3 minutes off of his previous world record, running 2:12:11. The current world record of 2:03:59 is held by Haile Gebrselassie, who does wear shoes while racing. Of course the shoes the elite runners wear during races are usually racing flats. During training, there will be some variety, and some elite runners incorporate barefoot drills into their regimen.

Running barefoot should strengthen the intrinsic muscles of the foot. Those are the muscles that start in the foot and end in the foot. It could also have a strengthening effect on muscles in the leg. And for those who do need more support, it could have these muscles working harder than they should and not feel very good. Running barefoot or with minimalist shoes helps balance and joint position sense. Over cushioned shoes are distinctly bad for joint position sense (proprioception).  So yes, running shoes can cause many problems through bad fit, bad design, mismatch of foot to shoe, and in many other ways. That has been the subject of many lectures and articles. Unfortunately, there no longer seems to be a balance in approach to shoes versus barefoot, when it should be shoes and barefoot.

Looking at 30,000 (ya) year old to 2 (mya) million year old bones will tell you where we’ve been, but won’t tell you where we are as a species now. Wired magazine had a recent article quoting a renowned anthropologist who felt that running barefoot was the way to go, and that evolution would have taken care of plantar fasciitis and runner’s knee. Unfortunately, that may be a nice hypothesis, but we are all built differently and have different needs. Some are knock kneed, some are bow legged, some legs are just right. Some people have high arches, some have low, and some are just right. Some of us have 20/15 vision and can fly jets, others could run barefoot and naked in the sun without sunscreen and never get a melanoma, but that is not wise for most of us. Some can run a marathon in 2:05, others in 3:05 or 5:05, but there are vast differences between them.

In evolution there are many expressions of genes called “phenotypes”. There is no one size fits all. Regarding melanoma, skin color and vitamin D, an excellent example of evolution is apparent. With Africa the presumed origin of the genus homo, migration from Africa led to genetic (genotype) changes in the genes that affected melanin. Putting it simply, the northerners had a mutation that led to less melanin in the skin and a lighter mutation. This allowed for better absorption of UV and production of Vitamin D in the northern climes (less light, less intense solar impact). It is another example of differences through evolution and adaptation to the environment with survival of those best suited to the environment.

While some wonder if human evolution has stopped, many believe it continues in many ways. Social relations, altruism, tribalism, and many things have deep roots, but also morph and change. There are differences between us and among us. We all aren’t prepared to comfortably run barefoot. But some of us are. Those who are and those who want to should start slowly with a few minutes and gradually build on that. Don’t look at it as necessarily a cure all for everything. It will feel great for some, and not so great for others. It may solve some problems in some, it may create problems or not solve problems in others. So, no, I am not claiming that barefoot is all good, all the time, for everyone. And I’m not claiming that barefoot is awful,  bad for everyone, something for everyone to avoid, always. (There is no simple answer, there are few informative studies. But, to quote Leigh Peele with her classic and often used statement “it depends“).

On the subject of barefoot running, my views have evolved. My first interview on this topic was with a journalist who wanted everything black and white and refused to accept the possibility that in my opinion some may have a foot better designed for barefoot running than others. There was a refusal to accept that while I didn’t think barefoot was all good, I didn’t think it was all bad. The quotes used in that article didn’t reflect a nuanced approach but were couched as a warning not to run barefoot. This was not what I felt was correct for all. Not long after that another journalist got it right. I pointed the second journalist to the same barefoot subject pictured in the first article. The runner was shown with beautiful “C” shaped, mud covered feet after completing his first marathon barefoot. She wrote about it in the Orlando Sentinel, along with suggestions on how to start barefoot running. (The Philadelphia Inquirer and Washington Post within the past few months had recent quotes on starting barefoot running slow and easy and a little at a time in the context of a review of “Born To Run”.)

But, as we look at the one size fits all solution, we see a trend in approaches to a variety of injuries. While many years ago, people were told to stop running, they then were told that almost all injuries came from foot problems. Now it is core weakness. No one solution fits all problems. Each problem is really solved only by a “total approach” that looks at the injury in a multi-faceted way, and looks for what changes can be made in training, equipment, muscle imbalances, stretching and strengthening. One “fix” is not enough to get it right.

Insulin is a nice medicine. We don’t all need to inject it though. L-Dopa is good for Parkinsons, but we all don’t need to take it as a supplement.  Prozac is helpful for many, running does it for others. One size doesn’t fit all, nor does one solution.

NY Times Article

Best quote:

“In 95 percent of the population or higher, running barefoot will land you in my office,” said Dr. Lewis G. Maharam, medical director for the New York Road Runners, the group that organizes the New York City Marathon. “A very small number of people are biomechanically perfect,” he said, so most need some sort of supportive or corrective footwear.”

Pithy quote:

“The shoe arguably got in the way of evolution,” said Galahad Clark, a seventh-generation shoemaker and chief executive of the shoemaker Terra Plana, based in London. “They’re like little foot coffins that stopped the foot from working the way it’s supposed to work.”

Related Posts:

Comments on Chris McDougall’s fine book at http://www.drpribut.com/blog/?p=325

Bipedal Beginnings: http://www.drpribut.com/blog/?p=331

Evolution and Exercise: What Made the Brain Get Bigger: http://www.drpribut.com/blog/?p=368

Walk This Way: Oldest Bare Footprints – 1.5+ Million Years Old: http://www.drpribut.com/blog/?p=215

For more information and to visit a community forum I recommend the Runner’s World Barefoot Runners Forum with links and discussions on all things barefoot.

Music: Barefoot by Ray Collins Hot Club

To view comments please click on the title of this entry. There are several comments, but we are currently having some interface issues. For more discussion visit the active Runner’s World Forum linked to above.

The Numbers You Can’t See

These are the hidden numbers. This is the truth from the recent Washington Post/ABC poll on opinions entitled “What Do Insured Think of Health Reform”. Three questions asked and three answered by a significant majority who clearly are positive on health care reform  in spite of all the negatives spun every hour on every station and in every newspaper. And we wonder why other polls have the papers dying, surviving only on life support.

Here are the numbers graphed from the poll.

Majority favors health care reform. Minority in panic mode.

Those are the real numbers which include those who believe their coverage, costs, and quality of care will be the same, no better, no worse, with the proposed health care reforms. A solid majority still believes that health care reform will not leave them worse off, not cost more, and will not provide worse quality of care. Every hour we hear and read more and more misleading information.

Today’s Washington Post quoted Robert J. Bendon of Harvard’s School of Public Health and Kennedy School of Government as saying “recent polls show most Americans do not anticipate any aspect of their health care improving if the president’s health-reform proposals were enacted.” This is not exactly the truth. It is as true as last weeks misleading graph shown on This Week with George Stephanopoulos. “This Week” was informed that their graph omitted significant numbers and declined to respond or correct their misinformation.

Here is an image of the misleading graph, missing those who felt that their care would remain as good as it is today. The numbers and missing numbers speak for themselves. No wonder people aren’t sure what to think. They are not being given reliable, accurate, and truthful information by those whose charge it is to do so. Anyone care to explain the constant “grin” by some of those delivering the misleading figures?

Misleading Graph, Missing Data

When Obama speaks a certain segment of the population seems to get red in the face and lose control. This seems to be a serious manifestation of OPS (Obama Panic Syndrome) which is difficult, if not impossible to treat. When Obama talked about Diabetic amputations he did make a mistake in the specifics of payment but was correct in the general cost. He said that the surgeon was paid over $35,000 immediately for the surgery. Surgeons never are paid immediately, and they receive nowhere near that amount. The American College of Surgeons states that Medicare payment to the surgeon for a foot amputation is under $800.

The cost that Obama mentioned was the total cost as declared in numerous articles, studies, and reviews on diabetic foot and limb care. The $35,000 – $50,000 or more cost of an amputation is often used. It just is not the amount the surgeon receives. When I listened to news clips, I misheard what he said as total cost. But he did mistakenly say this was what the surgeons received. Some felt that doctors and surgeons had been impugned. I did not feel that way. I believed Obama was again mentioning the benefits of limb preservation and preventative care in Diabetes as he has done before. Perhaps not as artfully as previously, but still an important and valuable reminder of the value of preventative care, which is not handled as well as it could be by many private insurance plans and even Medicare. So a reality check and a quick web search shows that Obama was mistaken about the surgeon reimbursement, and he must have meant total cost, and not physician reimbursement. There was no cause for OPS to set in.

Diabetes is a serious illness that requires careful management, dietary support, and exercise to minimize complications. The complications from diabetes can include painful neuropathy, renal failure, eye and vision problems and limb amputations. Diabetes is the major cause of the majority of non-traumatic amputations. More than 50% of those who have had one limb amputated go on to have the other amputated within 5 years.

According to Hospital Management Magazine ( and echoed by many other sources): “the direct cost of an amputation associated with the diabetic foot is estimated to be between $30,000 and $60,000. The estimated cost for three years of subsequent care for individuals whose ulcer has healed without the need for amputation has been estimated to be between $16,000 and $27,000.”

“With relatively low investment the number of amputations can be significantly reduced. Aggressive management of the diabetic foot can prevent amputations in most cases. Even when amputation takes place, the remaining leg and the person’s life can be saved by good follow-up care from a multidisciplinary foot team. Education of people with diabetes and healthcare providers is essential. Healthcare providers need to be trained in order to detect problems early and take appropriate action.”

Medscape reports similar numbers and notes that 57,000 amputations per year (about 150/day) are performed. They also note that 5 – 17% will die during the surgery and an additional 2-23% will die within 30 days of the surgery. The 5 year survival rate is only 40% and 25% in the elderly.

If you listen closely, you’ll hear others talk about the cost of diabetes, diabetic ulcerations, and amputations in diabetics. You’ll hear them talk about preventative care and the importance of maintaining a healthy body weight, eating healthy, not smoking, and regular exercise ( 30 minutes moderate exercise x 5 days/week, 2 days/week strength training). I recently heard Mike Huckabee speak about these very issues at the Annual meeting of the American Podiatric Medical Association.  If I recall correctly he did mention the same numbers as total cost of an amputation. Huckabee also mentioned that he thought maintaining healthy life habits was worthy of an insurance discount. He said this to cheers from those assembled. When Obama says the same thing, OPS sets in, and instead of cheers, I often hear mumbles asking how will the government measure this, and why will they be in our business and private lives.

My opinion is that both the media covering this could use more physicians to help them discern truth from lie and Obama needs more physicians to help review his examples, analagies, and specifics. And we all need to rise above special interests, people who represent and are paid by special interests and keep a cool and objective head as we examine this difficult problem. Maintaining a balance between a “public” option and private insurance firms is important as is determining a fair and proper way to pay for changes. But this is clearly the time for change.

Changes – David Bowie

Chris McDougall’s book “Born To Run” is probably the most fun and enjoyable book I’ve seen written about running. The prose is wonderful. The story telling is rich. And Chris develops both his characters and presents his thoughts on the evolution of running in a careful and thorough manner.  While I would disagree with the apparent conclusion that Chris and some others have reached that we have all evolved so well that barefoot running is right for everyone, I found so much else in this book that I recommend it whole heartedly. Chris covers diverse people and topics ranging from Barefoot Ted to Professors Bramble and Lieberman. I’ve read and thought about much of the scientific literature that Chris mentions in his book.  And I have a take on it that is much the same.  I will try to detail my take on some of the issues, but will not be casting any polemics towards this thoroughly enjoyable book. The science is only a small part of the book. The story is the thing. But the science is still worth thinking about.

This year is the 200th anniversary of the birth not only of Abraham Lincoln but also that of Charles Darwin. Darwin’s “Origin of Species” was published 150 years ago.  It is worth a look at how we got here, where we are, and how we fit into society and the world. We should look at why many of us like to run. Why is movement good for us and is life enhancing in many ways, and even life extending.

We’ll try to take a look at how we evolved to stand upright and run. We’ll look at what are the purposes, benefits and drawbacks of shoes in society and sport. What aspects of barefoot running are good and is barefoot the way to go for all of us? And up front, I’ll admit to having spent significant time running barefoot myself. Hopefully over the next few months we’ll have posts up detailing this and more.  With a long and ever changing list of topics to write on blog about, I’ll do my best to keep this at the forefront of my “to blog” list.

But I’ll again recommend reading “Born To Run”. It will make for enjoyable and thought provoking summer reading and you won’t have to wait for serial publication of the next chapter. You’ll just want to keep reading to find out what happens next. And after I finish the last 20 pages, Born To Run will sit in an honored place on my bookshelf. Right next to George Sheehan’s “Running And Being” and “This Running Live” and next to Amby Burfoot’s “The Runner’s Guide To the Meaning Of Life”. Murakami’s “What I Talk About When I Talk About Running”  is there too, along with many others, but a bit further over on the shelf.

If you’d like to see some of the details on hominid development of endurance running, see Bramble and Lieberman’s article from Nature (2004).

It just doesn’t add up when you mix and match numbers that aren’t meant to be simply added together. When you have numbers that represent things that can’t be merely added together and derive from different measuring systems, you can’t simply join them together. If you thoughtlessly and carelessly put the numbers together, you could crash a space landing craft, as happened when meters and feet were jumbled together by NASA and NASA’s private industry contractors some years back. In 1999, this resulted in the Mars Climate Orbiter plunging and crashing onto the surface of Mars. And that was “rocket science”.

The numbers I’m talking now  are health care cost numbers that have been bandied about both left and right. The latest bit of what I call the 3 D’s (dumb, deceptive, and dangerous) of thinking and posturing was seen in David Broder’s column today in which he quoted Democratic Senator Ron Wyden (D Oregon) as saying:

“As you look at what is being proposed [in two Senate committees] you don’t see savings in the 10-year budget. That’s why the discussion has shifted to finding new money to finance expanded coverage. But at home, when you tell people we’re already spending $2.5 trillion a year on health care and now we’re going to spend $1 trillion more, it just doesn’t add up.”

No, unfortunately that doesn’t add up at all. Nor should it. You can’t take a yearly figure, the $2.5 trillion dollars and then seemingly add $1 trillion more to it and now you don’t make any sense at all. And this comes from a democratic senator who 3 years ago proposed his very own healthcare and health insurance reform bill. His bill declared savings of over $1 trillion over 10 years. The savings was declared by having the cost not climb by the amount it would have been anticipated to climb over that period. This form of logic and calculation has been used by nearly everyone speaking about healthcare costs. We’ll let it be. But both Weyden and Broder should know better than to jumble these numbers up in such a deceptive manner.

You can’t take a yearly figure and then add to it a 10 year cost to it, pretending that the 10 year cost is an annual, yearly expenditure. That is deceptive and dangerous, and likely calculating rather than merely dumb. It is intended to mislead rather than enlighten. We shouldn’t expect that from elected officials, representatives to government, appointed officials, pundits, talk show hosts and participants. Nor should it be acceptable from columnists both noted and those of little renown, nor should it come from bloggers. Yet this sort of unexamined rhetoric and misleading numbers appears often. I have no explanation for this phenomena.

Certainly there are good features in Weyden’s program. Many of these I wrote about back under Bush 41. A more global amortization of costs and risks, elimination of prior existing condition clauses and more. And Wedyen specifically promised a plan as good as what those in the federal government have. And that is a very fair, and well administered system. But that was great 20 years ago. We do need something outside the current system to serve as a model, example, and fail safe system. And we do need it to be cost effective.

We need to cut health care costs. We need to lessen the risk of chronic disease. We need any addition to the system to be paid for in some manner by itself. We also need to look at the costs to the economy of chronic illness, absenteeism, lack of productivity caused by illness. We need to look at the costs to the economy of health related bankruptcy. We need to examine the health fairs, such as those in Tennessee where people come from several states away to sit and stand in lines of people, hundreds long, to receive treatment in groups inside tents giving the appearance of an American refugee camp. There is more, but you’ve seen it elsewhere and either related to what you’ve read or ignored it.

There are a few proposals that may help control costs. The first was a bill proposed in the senate that the premiums charged (yes, there will be and should be premiums charged) for a government system should be at acturarial prices. The other proposals include what may ultimately be cost savers such as shared electronic medical records, and incentives for healthy lifestyle. Of course in some camps the term “lifestyle” has other connotations. But here and where it is applied to heathy living choices it means:

1. No smoking.
2. Healthy body weight.
3. A healthy diet including a variety of vegetables eaten every day.
4. Meet the recommended exercise requirements:
5. 30 minutes of moderate exercise x 5 days per week or 20 minutes of vigorous exercise x 3 days per week (Not enough in my book. I think you should add 10 minute warm up and 5 minute cool down to high intensity training. But then you are actually exercising for 35 minutes.)

Exercise is one of the most important components of a cost reduction plan for health care. In combination these items would all help reduce the incredibly high 65% over weight and obese figures for the U.S. adult population. Childhood obesity also bodes poorly for the future. As we compare these numbers and our health care dollars spent with other nations, one could observe that we far “out weigh” the other nations. Along with obesity, an awful diet, and a loss of regular physical education in schools we are becoming sicker at earlier ages and less productive as individuals and a nation. The costs of chronic disease occurring earlier in life than they should if one adheres to the 4 healthy life habits are an incredible economic burden. A delay in onset of chronic disease, meaning it will occur later in life, and compression of illness, meaning it appears so late in life, that you don’t suffer for years and years with the chronic disorder, will dramatically reduce the cost of the chronic diseases to society.

According to the peer reviewed journal article by Reeves and Rafferty (2005), only 3% follow the healthy life habits mentioned above. So get a move on, shape up, and help reduce health care costs. And don’t forget that we do need a lean, efficient, and effective health care system. This means changes and reform. And perhaps a blog entry entitled the “7 Habits of Highly Effective and Healthy People”. We’ve got 4 above, and I have no problem suggesting another 3.

References on Fitness, Life Choices, Health, and Chronic Diseases

1. Reduced Disability and Mortality Among Aging Runners: A 21-Year Longitudinal Study. Chakravarty, Eliza F. MD, MS; Hubert, Helen B. PhD; Lingala, Vijaya B. PhD; Fries, James F. MD. Archives of Internal Medicine. Volume 168(15), 11/25 August 2008, p 1638–1646
2. Effects of Exercise Modality on Insulin Resistance and Functional Limitation in Older Adults: A Randomized Controlled Trial. Davidson, Lance E. PhD; Hudson, Robert MD, PhD; Kilpatrick, Katherine MD; Kuk, Jennifer L. PhD; McMillan, Kathleen MSc; Janiszewski, Peter M. MSc; Lee, SoJung PhD; Lam, Miu PhD; Ross, Robert PhD. Archives of Internal Medicine: Volume 169(2), 26 January 2009, p 122–131
3. Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD Study . Jakicic, J.M., Jaramillo, S.A., Balasubramanyam, A., Bancroft, B., Curtis, J.M., Mathews, A., Pereira, M., (…), Ribisl, P.M.    2009    International Journal of Obesity
   Article in Press. 20 January 2009; doi:10.1038/ijo.2008.280.
4. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Luft, A.R., Macko, R.F., Forrester, L.W., Villagra, F., Ivey, F., Sorkin, J.D., Whitall, J., (…), Hanley, D.F.    2008    Stroke; a journal of cerebral circulation 39 (12), pp. 3341-3350
5. Laukkanen JA, Kurl S, Salonen R, et al. The predictive value of
   cardiorespiratory fitness for cardiovascular events in men with
   various risk profiles: a prospective population-based cohort study.
   Eur Heart J. 2004;25:1428–37.
6. Katzmarzyk PT, Church TS, Blair SN. Cardiorespiratory fitness
   attenuates the effects of the metabolic syndrome on all-cause and
   cardiovascular disease mortality in men. Arch Intern Med. 2004;
   164:1092–7.
7. Physical Activity and Coronary Heart Disease in Men: The Harvard Alumni Health Study . Sesso, Howard D. ScD; Paffenbarger, Ralph S. Jr MD, DrPH; Lee, I-Min MBBS, ScD
   Circulation Volume 102(9), 29 August 2000, pp 975-980
8. Healthy Lifestyle Characteristics Among Adults in the United States, 2000. Mathew J. Reeves, PhD; Ann P. Rafferty, PhD.  Arch Intern Med. 2005;165:854-857.

His Excellency: George Washington – by Joseph Ellis

A fine introduction to the life of George Washington. A portrait of Washington as a person, rather than as a staid, dry, wooden icon. The book demonstrates how Washington, with the goal of independence and a successful start to a nation, grew as a person, focuesed, and achieved everything that was possible. Ethics, morals, bravery, strength of will and character resulted in Washington finding and then staying true to what was good for his country. Washington took as his personal aide de camp, an individual who he trusted the most, one of his slaves. His slaves were set free in his will.

Another souce of excellent material on Washington is the database of the papers of George Washington at the University of Virginia. One shouldn’t take a sentence from any person, let alone Washington, and have it represent an everlasting truth. Two hundred year old wisdom, is old, but as a life, and example of channeled drive, Washington’s life was exemplary. Washington’s stand alone statements are probably a better than the actions of his physicians, whose 200 year old knowledge led them to bleed him to death. While bleeding and leaches still serve a minor purpose, eventually we found they weren’t all they were they were cracked up to be. Among my favorite letters of Washington, were those regarding the care and treatment of prisoners. He felt it awful enough to have your freedom removed, and that maltreatment was counter productive. The commanding officers in charge of prisoners were to make rounds daily.  His letters to General Howe to secure a prisoner exchange and to seek out the where abouts of Ethan Allen are fascinating. Howe denied knowledge of Ethan Allen’s well being and whereabouts saying he was being held in Canada. In actuality he was captured and held with others as a common criminal, clapped in irons and sent under extraordinary rendition to England. His ship stopped in Cork, Ireland where the people took up a collection for Ethan Allen to help him and the other prisoners to purchase provisions. Fearing reprisals, King George ultimately declared he and the others sent to England from Canada to be returned to America and declared to be Prisoners of War. Much of this is covered in Ethan Allen’s own writings.

Born To Run – Chris McDougall

I’m only a third of the way through this book and haven’t found if there is a July 4th link yet. But it is a great story and well worth reading this summer. Chris went off to live among the Tarahumara Indians in Mexico for a few months and found his running improved. But the story is the thing.  Read it and enjoy!

Nick Heil has a short and fun article up at Outside Magazine.  He is testing out his Vibram FiveFingers and channelling the Tarahumara Indians while quoting me and Barefoot Ted. Nick is the author of  “Dark Summit”, an excellent book about a  disasterous outing on Mount Everest.