I'm changing the way I talk about walking

I spend a lot of time trying to convince people to be more physically active. I spend time on top of that trying to convince people that we should change the built environment, parking policies, and traffic laws to allow people to be more physically active.

One of my old standby stories is of a person who's spent most of his life sitting on the couch watching TV. He goes in for a routine operation, has a catastrophic adverse event, and ends up paralyzed as a result. When he wakes up the surgeon and the anesthesiologist gather to tell him the bad news. The first question out of this man's mouth, a man who has not walked further than from the bed to the bathroom, the bathroom to the kitchen, the kitchen to the sofa, or the car to his office cubicle in years, is this: "When will I walk again?"

I've even posted the story here from time to time

My point with the story has always been to get people to approach the world from a perspective of abundance. Don't take for granted the gifts you have today. Our bodies were designed by millions of years of evolution to move bipedally. If we forsake that, we end up less healthy and less happy. 

But yesterday I listened to Enter the Exos, a new-ish episode in Rose Eveleth's always thoughtful series Flash Forward. 

In the episode, Rose spends a predictable amount of time talking about the possibility that robotic exoskeletons, or even powered clothing, will make us faster, stronger, and less prone to injury:

I'm talking about the one on the left.

I'm talking about the one on the left.

But she spends an even greater amount of time talking with people with various disabilities about their perception of exoskeletons. This is the part that got me. William Peace, blogger of Bad Cripple, has this to say

Your typical bipedal person exposed to a barrage of misleading news stories is led to believe all paralyzed people share one goal in life--walking. Please cue the soaring inspirational music accompanied by the brave and noble young man or woman struggling to walk surrounded by health care professionals, computer scientists, and engineers who share the same ritualized ideal. 

There is so much to unpack there. I walk, and I like doing it, so I've always thought that other people without the ability would want it. And maybe they would, if the technology were developed that could be applied to people with all kinds of disabilities (cerebral palsy is a lot different than spinal cord injury is a lot different than post-polio, etc). But bipeds like me have a hard time imagining that someone wouldn't want to get closer to the way I move, just like people with normal hearing are mystified by deaf culture. When I put myself in the position of someone who is in a wheelchair or needs another assistive device, I can see and hear the condescension in my words.

So I'm changing my pitch. I'm going to lean more on the "move through space" message and delete the "walking" part. I plan to work harder on the infrastructure message, with curb cuts and tactile crosswalks and protected walking lanes and a hundred other easy fixes that make life better not only for differently abled people, but for people who can walk and bike without difficulty like me.

And I'm going back to my perspective of abundance: we don't have functioning exoskeletons or other sexy fixes for paralysis or weakness yet, but we're all cyborgs already. Most of us carry a device in our pocket that literally has the world's knowledge at our fingertips. We should harness that technology to find safer routes for human-powered transportation of all kinds. And people who can't walk have a 235 year history of constantly improving wheelchair technology whose potential could be unleashed with a little more attention paid to the way we design our environment and laws.

How to break up with your phone, Double Arrow Metabolism edition: Days Six and Seven

Saturday's (Come back to [real] life) assignment: Get back in touch with what makes me happy in my offscreen life. I'm asked to complete an exercise:

  • I've always loved to...ride my bike
  • I've always wanted to...publish something non-academic
  • When I was a kid, I was fascinated by...reptiles
  • If I had more time, I would like to...write more
  • Some activities that I know put me into flow are...none. Ever. Don't get me started.
  • People I would like to spend more time with include...friends from college

I'm supposed to make a list of specific fun, off-phone things to do in the next few days. Here goes:

  1. Visit the Monet to Matisse exhibit at the Wichita Art Museum
  2. Volunteer for Bike Walk Wichita
  3. Meal plan for the week
  4. Ride my bike every day
  5. Visit the herpetarium at the Sedgwick County Zoo

Sunday's (Get physical) assignment: Make some time to get back in touch with your body by doing something physical and enjoyable. I plan to commute by bike to my volunteer activity with Bike Walk Wichita today. Two birds, one stone.

The second assignment is to buy an alarm clock so as to more effectively banish my smartphone from my bedroom. I've been thinking about doing this for a while. My trusty, rusty old clock radio from college has been commandeered by my daughter, so now when I wake up in the night I can't tell what time it is without looking at my phone. My beloved George Nelson clock is hard enough to read during the day:


I'm not super-pumped about the style of the normally reliable Wirecutter's top pick, so I'll add "shop in-person for a clock radio" to my list of non-phone activities for the weekend. 

Just minutes a day

Remember the proliferation of exercise gadgets in the 1990s? You had the knee squeezer:

The sit-up machine: 

I don't see how this is better than a sit-up.

I don't see how this is better than a sit-up.

The aluminum pretzel:

I'm sensing a theme here...

I'm sensing a theme here...

And many, many others. What they all had in common (in addition to being highly inefficient ways to part you from your money) was their promise to turn you from "before" to "after" in some small period of time daily, usually under 30 minutes. 

Newsflash: doing anything--anything--physical for 30 minutes a day is going to help you out. It doesn't have to be a gymnastics routine. Hell, try doing push-ups, planks, and crunches for 30 minutes a day. It's a lot of work.


Both pictures are "after." Where can I buy those shorts? Rowrrr.

Both pictures are "after." Where can I buy those shorts? Rowrrr.

But that's all an aside. Here's the thing I'm really thinking of today: I’m not sure how may times I’ve had a parent or grandparent of young kids tell me how much physical activity he or she gets as a result of “chasing around a two-year old.” I’ve always been suspicious of the claim. Don’t get me wrong--parenting, especially at the toddler phase--is exhausting. But it tends to be exhausting in the way a stakeout is exhausting, mostly from monotony and sleep deprivation. It’s emotionally taxing because of the lingering self-doubt about the quality of your parenting and the everyday small decisions you fear will lead to some real harm if made improperly. Physically, it never seemed demanding at all with my two kids. There was some lifting, sure. But most of the parents I see in public with their kids are sitting somewhere gazing into their smartphones. It’s the kids who are doing all the physical activity. The parents are unlikely to take twenty steps in an hour, it seems. [note: none of this cynicism applies to daycare workers, most of whom really hustle]

Obviously I’m a little jaded. As I write this, I’m sitting in a fairly spectacular local park, taking part in a fundraiser. I can see eleven parents from my perch at a picnic table (at least I think they’re parents. They’re sitting adjacent to the playground with small children zipping between them. Oh, and there are 12 if you count me). Of the 12, twelve are either writing (that’s me), texting, or eating. Zero are interacting with children in any physical way. In an unusual turn of events, I’m actually primed for some moral superiority, since the kids and I got here by bicycle, in the #familypeleton, so I have the ~3.5 miles to the park and the 3.5 miles home on my side. That's enough self-congratulation for the day. My point is, being with your kids might bring you joy most of the time, but it won't bring you physical activity unless you do it self-consciously, just like any other activity. 

What got me thinking of this is the fact that I’ve had innumerable conversations with people about physical activity over the last decade in which one or both of us advocated for “Simple strategies to add physical activity to your routine!” These discussions were often irrationally enthusiastic about the awesomeness of parking at the far end of the parking lot, or substituting a rake for a leaf-blower, or using a whisk instead of an electric mixer. You get my drift, I hope. Here’s the problem: it’s almost all bunk. Desperate, depressing bunk. And I say this as the person who has on many occasions been on the giving end of this advice. Now, before Blue Zones fans come at me with pitchforks and torches (both good ways to “Add physical activity to your routine!”, by the way), let’s perform a little thought experiment.


Let’s imagine that you wake up from a routine surgical procedure to find a doctor solemnly standing over your bed.

“Justin, I have some bad news,” she says as she pulls up a chair. Your name is Justin in this dream, by the way.

“Your appendectomy went fine. You’re going to heal right up. But you had a rare complication of the anesthesia, and it appears you’re now paralyzed from the neck down. The good news [doctors always try to segue into the good news as quickly as possible, amiright?] is that you’re still able to breathe on your own, so you shouldn’t have any trouble talking, and you won’t need a ventilator.” As you try to shake off the last remains of the sleeping medicine, and as your spouse softly weeps at your side, the doctor goes on. “But you won’t be able to do any intentional physical activity beyond breathing, talking, smiling, and blinking.” She then explains that the condition is likely permanent, at least as permanent as you are.

As you let this news settle over you, what will you miss? Will you miss your thighmaster or ab cruncher or aluminum pretzel time? I hope not. But if so, that's cool. Will you miss mowing the lawn? Maybe, if you’re one of the guys Lowe’s advertises to in the springtime. Will you miss using a whisk? Well, I guess, insofar as you’ll miss cooking in general. (note: Julia Child has a great old clip in which she talks about how normal cooking should lead to the cook getting sweaty. It’s awesome. You should look for it. I'd link it, but I can't find it, and I'm in a hurry.) But I’m willing to wager that the walk across a shimmering, sweaty, oil-stained parking lot upon which you’ve intentionally parked your automobile far, far from the entrance to the big box store is something that approximately zero percent of us would miss. Zero percent of responders to this scenario would miss running a vacuum cleaner, or washing their tile floor by hand, or any of the 1,000 other “strategies” I’ve heard in this regard.

What would you miss? Dancing with family at weddings, maybe. The spray of water on your face as you waterski. I’d desperately, achingly, miss my morning cycling route that takes me through the sunrise in summertime and through a crystal wonderland in the winter. I know this because I've been sick lately, and I fear the cold air would make me sicker. I’d miss the bike ride to school with my kids. I’d miss the competent, reassuring thud of a frisbee into my outstretched hand. I’d miss the brace of cool water against my face the first time I dive into a pool in the springtime. I’d miss...nothing at all related to parking.

Here’s my point: Movement isn’t just a utilitarian product of 85 million years of evolution. It isn’t just a means of getting from point A to point B. It is a source of joy. So, sure, park at the edge of the Target parking lot. But even better, leave your car at home and find joy in the 30-minute bike ride or hour walk to the store because it brings you joy, is good for the planet, and it saves you money. Instead of burying your face in your smartphone while your kids play, take pleasure in helping your kids hunt fireflies or throw snowballs or walk around the neighborhood for 30 minutes in the evening. Take a big step, not a small one. Move because it makes you feel good, not because it adds steps to your FitBit.


Links for Tuesday, November 21, 2017: more on the new HTN guideline, Gymnastics coaches throwing robot shade, the last iron lungs, Germany bans smartwatches, and Raymond Chandler hated US healthcare

Thoughtful post on the new HTN guideline by Dr. Allen Brett

Representative quote: "Consider, for example, a healthy white 65-year-old male nonsmoker with a BP of 130/80 mm Hg, total cholesterol level of 160 mg/dL, HDL cholesterol of 60 mg/dL, LDL cholesterol of 80 mg/dL, and fasting blood glucose of 80 mg/dL — all favorable numbers. The calculator estimates his 10-year CV risk to be 10.1%, making him eligible for BP-lowering medication under the new guideline. To my knowledge, no compelling evidence exists to support drug therapy for this person."

A gymnastics coach says the Boston Dynamics robot flip was a 3.5/5.0

'In a back salto, says Mazloum, “you want to be able to go as high as you can, and you want to be able to land as close to where you take off as possible.” To do that, the gymnast has to squat, throw her arms up by her ears so her body is a straight line (in gymnast-speak, opening the shoulder angle and the hip), then contract into a “closed” position again. By these standards, Atlas’ trick is “not the cleanest flip,” explains Mazloum.

Here’s Mazloum’s critique: Atlas didn’t quite get to that open position, “so it didn’t really get the full vertical that we look for. That’s why it went backwards a little bit.”'

The last of the iron lungs

Get your kids vaccinated for polio, folks.

Germany has banned smartwatches for kids

If I understand this correctly, it is not because smartwatches cause kids to be distracted monsters (although I don't doubt that that statement is at least a little bit true). The decision stems from the capability of bad guys to hack in and monitor the location of little Dick and Jane:

You have to wonder who thought attaching a low-cost, internet-enabled microphone and a GPS tracker to a kid would be a good idea in the first place. Almost none of the companies offering these “toys” implement reasonable security standards, nor do they typically promise that the data they collect—from your children—won’t be used be used for marketing purposes. If there ever was a time to actually sit down and read the terms and conditions, this was it.
Get your shit together, parents.

Asking parents to destroy them might be a bit of an overreaction, though.

Raymond Chandler paints a dark picture of American healthcare in a newly-discovered story

The title, "It’s All Right – He Only Died," sounds like the title of a video residencies would show interns to convince them that quality improvement and patient safety are part of their job.

The doctor who turned away the patient, Chandler writes, had “disgrace[d] himself as a person, as a healer, as a saviour of life, as a man required by his profession never to turn aside from anyone his long-acquired skill might help or save”.


Super four-pack of links July 11, 2017: the five percent and healthcare money, video game addiction, exercise to prevent diabetes, activity inequality, and evil coconut oil

Super-user sounds great, right? Who doesn't want to be super at something? Only this video (in Memphis-style) refers to the 5% of Americans that account for ~50% of health care spending in a year.

To paraphrase the end of the video: "There's almost nothing insurance companies won't charge, and Americans won't pay." How do you keep yourself from becoming a super-user? Everything medical is a matter of risk, so don't believe anyone who tells you there's a rock-solid simple way to keep from falling into that 5%, at least temporarily. But overwhelmingly, if you can keep a steady job you don't hate, if you can abstain from smoking, if you can get even a small amount of daily exercise (more is better, obviously), if you can keep your alcohol intake to a minimum, if you can abstain from recreational drugs (this includes marijuana, obviously), and if you can choose to eat mostly plant-based foods in semi-sane quantities, you're gonna stay out of The Five Percent.

What does excess immersion into video games mean for young men?

I've tried to set the Weeds audio above to play at about the 46 minute mark. But if that doesn't work, fast forward to the 46 minute mark. Not because the discussion of what "Trumpism" is isn't interesting (it is), but because the discussion that follows helped me think more deeply about the problem of excess immersion into video games that young people, especially young men, are experiencing. I've blogged about this before, and I talked about it at a recent speaking engagement. We seem to be creating a generation of youths who are increasingly isolated in very immersive video games, and then they're growing up into increasingly isolated and lonely people, particularly after age 40. As Ezra Klein says in the piece: if this were a problem of drug abuse, I think we would be acting collectively to do something about it. That's an apt comparison, since game addiction and drug addiction seem to have some physiology in common. But since the solution to technological problems currently seems to be "more technology," we are kinda-sorta just plowing ahead and hoping that video games fix themselves. I'm not optimistic. I think we need to start introducing programs to help kids moderate their exposure to video games and increase their exposure to the world at a young age. Dylan Matthews, who generally defends the idea of video games as a pacifying technology for people who can't or won't work, ends with this quote: "When we're in our eighties, we're all gonna be doing, like, flight simulator stuff. That's, like, how we'll spend--or, VR stuff, at least--that's what retirement's going to look like." Yuck. No. No. No. 

A new meta-analysis shows that African-Americans who exercise may not derive the same protective benefit from type 2 diabetes as other races

(brief Healio write-up here)

 I'm not ready to sign on to this point; race is a very blunt instrument when it comes to genetics. As the cost of gene sequencing falls, I think we'll not only be able to tease out drug effects in people with specific genetic features; we'll be able to more precisely target interventions like physical activity. Maybe certain people in this collection of studies would have benefited more from strength training, while others needed more endurance-oriented activities. Maybe some would have benefited from a specific combination of drug and activity. We don't know the answers to these things now, but we will soon. 

Smartphone data shows that countries with the highest "activity inequality" are more likely to have large obese populations: 

More differences in activity within the population equals more obese people. 

More differences in activity within the population equals more obese people. 

So it isn't a surprise that the same investigators found that the higher the walkability of a city, the lower the "activity inequality":

Texas is not a place with a great deal of walkability. 

Texas is not a place with a great deal of walkability. 

The cynical take on this study is something like, "Of course people who are inactive weigh more!" Fair enough. But the obvious policy implication of the study is that, to affect the activity level of the inhabitants of a city, the built environment must give opportunities for activity.

ADDENDUM (make it a five-pack): How coconut oil got a reputation for being healthy in the first place. I don't love coconut oil, but even if I did, I'd think of it like I think of butter: an ingredient to be used sparingly, mostly for flavor. 

RIP Warner Blackburn: sadness at the Dirty Kanza

I finished the Dirty Kanza 200 yesterday, and I plan to write about the experience in detail. But for now, I want to mention Warner Blackburn, a man who died during the 50-mile race. He was given CPR on the course by a friend of mine and taken to the hospital, where he died of an apparent heart attack.

I suppose the most cyclist-y thing to say is that "Warner died doing what he loved" or some such crap. But I don't know that. I don't know that Warner even liked cycling. He left almost no trace on the internet. Maybe he was doing the DK 50 on a bet, or maybe he was trying to support a family member. My wife makes fun of me because I automatically assume that people in cycling and other outdoorsy pursuits are nice, even though I'm not the warmest cuddliest type around. So I'll say this: whether Warner liked cycling, or whether he was trying to support someone else, or whether he was trying to support a cool event for the local community, he went out on a high note. 

FWIW, for anyone thinking of starting exercising after a long period of physical inactivity, please take the Physical Activity Readiness Questionnaire first. It's a little too sensitive, meaning it may flag a few people who aren't that high risk, but if you have a "yes" anywhere on the form, it's worth talking to your doctor about before you go out and hit it too hard.

Things you can control right now

There are a lot of things you can't control: the weather, the stock market, your neighbor's loud music. But many, many things are under your control, as pointed out by Lori Deschene. And how well you do at seizing control makes a huge difference in your health and happiness:

Right now, you can control:

1. How many times you smile today.

7. When you pull out your wallet for luxuries.

11. How often you notice and appreciate small acts of kindness.

17. The type of food you eat.

21. How much exercise you get.

22. How many times you swear in traffic. [I'd amend this to say that you can control how often you're in traffic at all. If you're swearing at traffic, chances are you are the traffic.]

27. The attention you give to your loved ones when you see them.

28. How much you enjoy the things you have right now.

41. Whether you formulate a new plan or act on your existing one. [this is my favorite]

44. Whether you smoke or drink. [unless you’re an alcoholic, in which case you are in control of whether or not you seek help from a qualified practitioner]

50. How much rest you get at night.

Source: tinybuddha.com