Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

Jack Wilmore an Appreciation

My teacher, colleague and friend Jack Wilmore died last weekend at the age of 76.   He is survived by his wife of more than 50 years Dottie, their three daughters and families.

 

After graduating in the middle 1960s with his Ph.D. from Oregon, Jack taught at Ithaca College, Cal, UC Davis, Arizona, Texas, and Texas A&M. He was named Distinguished Professor at both Texas and Texas A&M. Given the rivalry (hatred?) between The University of Texas and Texas A&M, I wonder if anyone else has ever held such high academic rank at both places.

 

I was lucky enough to work in Jack’s exercise physiology lab at the University of Arizona as an undergrad and medical student from the late 70s through the middle 80s. While there are a million stories to tell, I think there is a three-fold “bigger narrative” about what Jack Wilmore accomplished and left for us all.

 

The Emergence of Exercise Science

The first part of the narrative is about how Jack and a few key colleagues around the country and world realized that physical education as known in the 1950s and 60s had to become more scientific and more intellectually rigorous. This led to a real flowering of what we now call Exercise Science or Kinesiology at essentially all of the big research universities and other academic institutions in North America, and the developed world.   This flowering led to the development of majors in related fields that have grown tremendously over the last 20-30 years. On many campuses these major are now among the most popular science majors. They are also key “pipeline” majors for undergrads interested in graduate or professional training in a number of health related fields. Very few people can say they participated in the broad based re-engineering of higher education on a worldwide basis; Jack Wilmore was a major player in this movement.

 

The Cutting Edge of Research

Jack was also at the forefront of a number of exercise related research themes starting in the 1960s. A short list includes:

  • A number of pioneering studies and books on body composition that among other things anticipated the “obesity epidemic” by several decades.
  • Early studies on female athletes.
  • Major contributions on topics related to adult fitness and cardiac rehab. Like the story for body composition and obesity, these contributions were several decades ahead of the current concerns about the health consequence of physical inactivity on the population as a whole.
  • The pioneering development of semi-automated and automated “metabolic carts” to measure oxygen consumption.   This really was the first wave of innovation in this area and again Jack anticipated what came decades later with the automated commercial systems that are used all over the world today.
  • Physiology studies that included topics like human performance, thermoregulation, the physiology of maximum oxygen uptake (VO2max), and the lactate threshold.
  • The genetics of training adaptations.

 

The other interesting thing is that Dr. Wilmore was a superb classroom teacher. You hear a lot about faculty at big universities being buried in the lab and uninterested or ineffective at undergraduate teaching.   Jack was the best classroom teacher I had as an undergrad. He was organized, engaged, and able to really transmit his interest and expertise to students.

 

All of his scientific and educational achievement was accomplished with an eye toward collaboration and what could be learned from others. Jack’s collaborative spirit brings me to the third element of the three-fold narrative.

 

Jack the Good Guy!

Over the last couple of days I have received all sorts of anecdotes about something helpful Jack did for someone. Things like a thoughtful and supportive question to a student at a conference, or a key letter for a younger colleague as they climbed the academic ranks. The comments from his many collaborators focus on his generosity and ability to put his ego aside while looking for solutions vs. having his way.

 

In Tucson, Jack had a sign on his desk that said “don’t let the urgent crowd out the important”.   When you combine that maxim with his ability to channel vs. suppress the energy of young people, his availability, and his ability to frame almost anything in a positive context you can see in retrospect how it all came together. Thus, there is a long, long list of people who benefited from and loved working with Dr. Wilmore. Nobody ever worked for him.

 

At the end of VO2 max tests on highly trained athletes, Jack had a knack for drifting out of his nearby office to the treadmill lab. As the test reached a climax with the runner going all out he would encourage us with a “beautiful job” just at the point of exhaustion. It was something we all wanted to hear but we never got to say it to him.

 

Beautiful job, Jack!…….

 

Grieving & “The Election”

The U.S. election a couple of weeks ago is being hailed as all sorts of things. However, if you look back over the last few elections it seems to me like the voters are pretty unsettled and that it more like a serve and volley between parties.   This has then led to a cycle of each side over-interpreting their “victories” as either a mandate for their world view, a repudiation of the other side’s, or both.   This over reading of things probably makes compromise on issues like entitlement reform, immigration, health care and energy policy harder rather than easier.   The lack of compromise then leads the voters to blame the party they see as in power and vote for the other side in the next election.   This summary may be an over simplification but it seems to me like it explains a lot of things.

 

Why is Compromise So Hard?

The standard answers to this question are about a politically polarized country, safe districts that reward uber-partisans, the 24 hour news cycle, and money in politics to name a few. However, is their a root cause of all of this? Could it be that both the political elite and general public are involved in a “grieving process” over the changes confronting the world and the challenges they are generating for the U.S. The steps in grieving include:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

 

My medical colleagues who do palliative care tell me that the process is not linear and that patients and families hopscotch from one stage to another but almost everyone ends up at acceptance over time.

 

Grieving About Change?

The aging population, globalization, and technology are leading to a transformation of human society on the order of that seen with the adoption of agriculture about 10,000 years ago and the emergence of the Industrial Revolution over the last 3-400 years. The only difference is that the current changes are happening in only a few generations vs. hundreds or thousands of years. Along these lines, many of the assumptions that underpinned U.S. economic and political “clout” and perhaps made compromise easier after World War II were things like.

  • Plenty of workers for every retiree
  • Life expectancy at age 65 on the order of 10 years (it is now closer to 20 years)
  • Plenty of medium skilled high wage jobs in manufacturing
  • A huge industrial base after WW II compared to the devastation everywhere else
  • A monolithic foreign policy foe in the Soviet Union

 

All of this is gone and I would argue that a political grieving process is in full swing. I would also argue that these factors explain most or part of all sorts of things ranging from the burgeoning national debt, income stagnation and inequality, to our uncertainty about how to respond to the mess in the Middle East.

 

An Example

I see a combination of denial, anger and bargaining particularly over issues like Medicare and Social Security reform. These are signature programs for the Democrats that they are loathe to change. They are also on the road to financial insolvency over the next couple of decades. Some seniors get angry when the topic of change comes up falsely arguing they have paid for their benefits. The Republicans are for reform until they get worried about the political fall-out of change or can attack a Democrat for advocating change.

 

This example is just one of many about how both the political elite (who are likely aware of the big trends I have outlined) and the general public are having trouble coming to grips with how the world is changing. Some people have moved beyond denial, anger and bargaining to depression – an acquaintance of mine was so depressed about the situation he seriously considered not voting figuring that it was essentially impossible to address the problems confronting the country. But the point is that we need a realistic discussion about a host of topics and possible solutions as we try to adapt to the changes that are coming.

 

Not the Only Example

In the next couple of posts I am going to use the “grieving” model to discuss other topics like why so few people follow health living guidelines as I try to understand the mismatch between what people understand and what they do.

 

How low can marathon times go?

 

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What Kind of Mind Game Will It Take to Run a 2-Hour Marathon?

 

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The NCAA vs. Reality

The most recent piece of bad news on the academic and financial integrity front for big time college sports in the United States is the news of a zombie major and related courses at the University of North Carolina. These courses were used to buff up the grades of “student-athletes” and make it easier for them to remain academically eligible. The news is especially troubling because the University of North Carolina (UNC) is an elite academic institution and a member of the Association of American Universities. This is a group of the 62 leading research institutions in the United States that includes the Ivy League, Stanford, and many major public universities.

 

Since the story broke I have had a number of e-mail exchanges with friends over the last week about this topic and the thing I find puzzling is why UNC had to go this far (or turn a blind eye) to keep marginal students eligible for big time and big money college sports. Some approaches used at the big schools to keep athletes eligible are legitimate and are known as “academic support services”. However, there are several approaches that can be used that are more or less “within” the rules but make it essentially possible to cheat and avoid a lot of scrutiny and thus get by. Here are some:

 

1.  Create an Easy Major

A number of schools have created “safe harbor” majors that generally lack rigor and can make it relatively easy for less able or less interested students to get the grades needed to be academically eligible to compete in sports. These schemes are well known and if UNC did not have such a major, my bet is they will develop one. If UNC had one, then the scandal makes them look even more incompetent than they are.

 

2.  Gaming Transfer Credits

It is possible for student athletes to take courses at junior colleges or via distance learning and use passing grades in such courses to remain eligible. If this is done discretely it can work well.   However, usually the word gets out and things ultimately implode.   My favorite story is one from the 1990s that focused on a small Christian Bible School that offered correspondence courses for ministers.   When interest in some of their offerings skyrocketed, the folks running the school felt their prayers had been answered and were gratified to know that college athletes were interested in biblical history. What really happened is that some assistant coaches had figured the school and its courses to be an easy mark to keep people eligible by systematically cheating on the tests and getting the needed grades. If this had stayed small time, it might still be going on.

 

3.  Johnny Football and On-Line Courses

The next big thing in the keep them eligible world is going to be on-line courses.   Johnny Manziel used this approach while at Texas A&M. My guess is that the next major academic scandal in college sports will have an on-line element.

 

 

Summary

There are all sorts of other strategies that have been used over the years and some great anecdotes about them. They include things like ghost written term papers and bogus class attendance. A less known problem is the academically qualified athlete who is discouraged from doing something rigorous because it might interfere with practice time or their commitment to the “the program”. This summer I talked with a mid-major basketball player who wanted to be a dentist but was shunted away from pre-dentistry into another major on the advice of his coach.   Did the coach have the player’s best interest at heart, or was he trying to ensure he developed a top mid-major program and then got a multi-million dollar offer from a bigger school? Most universities try to manage conflict of interest by their faculty who consult, start companies, or develop intellectual property. Maybe they should try it for their coaches and athletic departments. Maybe the NCAA should acknowledge the reality of what is going on and mandate it.

 

Everything You Need to Know About Endurance Training in One Race!

Last Saturday was the 50th anniversary of Bob Schul’s victory in the 5,000 meter race at the Tokyo Olympics.   Schul, who was from the United States ran 13:48.8 and beat Harald Norpoth of Germany and Bill Dellinger also from the U.S. The great Kip Keino of Kenya was 5th anticipating his Olympic success in 1968 and 72, and also anticipating the rise of the Kenyan runners. It was a close race run on a slow and muddy dirt track. The last few laps of the race were very fast in spite of the conditions.

 

Training Methods 101

The race also serves as a short primer on training methods:

  • Schul was interval trained and literally did intervals twice a day almost every day. I looked up some of his old workouts in the classic book “How They Train” by Fred Wilt. He might do a brief warmup and then 30-40 times 100 meters in the morning. The afternoon would include a brief warm up and then many longer intervals between 150-400 meters.   My guess is that this sometimes added up to about 70-80 miles per week.
  • Norpoth was a disciple of Ernst Van Aaken the originator of so-called long slow distance (LSD) training that included very high mileage. He did long slow runs up to 30 miles or more and also restricted his diet to get as skinny as possible. Mileage well in excess of 100 miles per week was done and perhaps only about 5% of the total was anything near race pace.
  • Dellinger, who was later the track coach at Oregon, was coached by the legendary innovator Bill Bowerman and did the sort of mixed training popular today which would include longer runs, intervals, hills, and sprints. This program also featured the classic hard-easy pattern advocated by Bowerman.
  • Also in the race was Ron Clarke, who ultimately set 19 distance running world records. Clarke did a lot of long fast continuous runs with surges and raced often and fast. He did what we might call threshold training.  Clarke also frequently ran more than 100 miles per week in training. What he did in the 1960s also seems similar to what anecdotal reports indicate the East Africans are doing today.

 

Take Home Messages

The narrative above makes me an unbeliever in the idea that there is a “best way” to train or that much has really changed in the last 50 years. You can also find similar stories and varied approaches in other endurance sports with examples of success stemming from all sorts of programs.

 

However, all of the training programs outlined above were marked by several hours a day of training at least a couple of days a week or more. They would all also evoke essentially maximal physiological adaptations in most people. All of the programs also included at least some fast running. In talking with LSD trainers who were successful in the 1960s and early 70s, many have told me that in addition to their training they also ran a whole lot of races including “doubling” at track meets by running multiple events.   This clearly supplemented the limited formal speed work they did in their regular training.

 

Another take home message is that depending on where you live and what resources are available one program might more sense than another. For example if you live in an urban area where finding the right course for a long run can be challenging, maybe an interval focused program on a track or in a park makes the most sense. If you live in a place full of trails, hills and mountains perhaps one of the less interval focused programs would make more sense.

 

Whatever the program there is no substitute for consistency and at least some fast running. Consistency also means staying injury free, so at least some easy days every week make sense as well. Also, don’t forget to ask yourself “what is the purpose of this workout?” and perhaps “what is the ultimate goal of this training program?” If you can’t answer those questions maybe you should rethink things.

 

What Happens if Life Expectancy Keeps Rising?

The US Centers for Disease Control (CDC) recently released its annual report on life expectancy. The data covers 2012 and show life expectancy continuing to rise in the US. The chart below is the current data and the overall average is a little over a month higher than the estimate for 2011.   Additionally, there were gains in most ethnic subgroups. The green bars in the chart also show that the average person who makes it to 65 will likely live another 19 plus years. That number is also trending upwards.

 

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US Life Expectancy Still “Low”

Life expectancy is still relatively low in the US compared to other rich countries with numbers in the low 80s. The reasons for this are complex and center on issues primarily related to economics, behavior, and to a lesser extent access to medical care.   The chart below is from an excellent 2007 report from the Social Security Administration, it shows that for men life expectancy at age 65 is going up faster for those in the top half of income compared to the bottom.

 

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For example for men born in 1912 both groups could expect to live about 15 more years. For those born in 1941 those in the lower half could only expect 16 years of additional life compared to their better off counterparts could expect about 21 years of additional life.

 

How High Can Life Expectancy Go?

In previous posts I have tried to dissect out how much of some of these life expectancy gaps are due to things like differences in health behaviors and or economics. If life expectancy for people who are less well off “catches up” with the numbers for the better off it could have major implications for the overall number. There was also a great longer article in the Atlantic about the implications of a population wide life expectancy of 100. The article also highlighted a debate in the epidemiology community. Some people see life expectancy continuing to rise while others see it flattening out somewhere in the 80s. There is also some speculation that it might decline due to the obesity epidemic and a rise in diseases like diabetes.   The next chart is from a classic 1990 paper and shows what happens to life expectancy at age 50 for both men and women if cancer, cardiovascular disease and diabetes are eliminated. Life expectancy rises but tops out at 90 for men and 96 for women.

 

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This type of analysis argues that while life expectancy might continue to rise, it is not going to get 100 anytime soon without the development of some sort of magic bullet anti-aging therapy. It is also interesting to note that populations of “guideline followers” who don’t smoke, exercise, don’t get fat etc. frequently live to about 90.

 

Structure of Society

The next two charts are “population pyramids” for the US. The first is for 2000 and the second is an estimate for 2050. As life expectancy increases and the average woman has fewer children the population will age.

 

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The key point is that there are going to be a whole lot more old people that there used to be and the next chart shows the implications for this in terms of the number of workers to retirees.   Today there are about 35 people receiving Social Security benefits for every 100 workers. In 2050 that number will be about 50 per 100 or perhaps as high as about 55 per hundred. Some version of these ratios will ultimately affect all programs directed at our aging population.

 

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Something Has Got To Give

As a result of the aging population, the long term implications of programs like Social Security and Medicare on the US Federal Budget have been well known for many years. There has been some recent good news on the economic front in terms of the relative robustness of the US economic recovery compared to historical trends for recoveries after financial meltdowns. Additionally, health care spending has moderated and there is some positive news on the federal debt. All of this has provided the President and Congress with a window of opportunity to address some of the fundamental issues associated with an aging population. However, for Social Security and Medicare none of the choices will be “fun” for political decision makers because solutions include things like:

  • Raising the retirement age
  • Cutting or restructuring benefits
  • Raising taxes

 

Given the gridlock in Washington, my personal bet is that nothing will happen until the later 2020s when the problem of how to finance social programs for an aging population becomes more acute as a result of increasing Federal debt and concerns about the solvency of the trust funds linked to the programs. Coming up with long terms solutions sooner rather than later would surely be less painful in the long run. However, I don’t expect any sudden outbreaks of either the political courage or the negotiating skills needed to address the fiscal challenges of an aging population until there is a crisis.

 

The Obesity Tax vs. Sin Taxes & Big Soda

There is lots of interesting news on the obesity front and I thought it might be fun to highlight a couple issues and raise a few questions.

 

How Fat Are We?

The chart below shows the trends in obesity or overweight in the US over the last 50 years. Things might be leveling off a bit, but the question really is how much worse can it get. In fact some epidemiologists are asking if eventually all Americans will be obese or overweight. For those of you not familiar with the definitions of obesity and overweight you can find them here.

 

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How Much Does Obesity Cost?

The estimates are all over the place, but according to Forbes it is on the order of 450 billion per year or a little less than 3% of GDP (16.8 Trillion) or about 70% of what we spend on national defense. Some of this is medical costs, but some of it is productivity, fuel costs, food costs, you name it.   It is also a lot of money any way you look at it and I believe that the $450 billion estimate is only for obesity and not for overweight. Of course things scale as both individuals and society as a whole moves up the scale, so the combined costs of overweight and obesity are likely significantly higher than those for obesity alone.

 

What About Big Soda?

The other related news is that there are soda tax questions on the ballot this fall in San Francisco and Oakland, and given the 0 for 30 plus track record of similar ballot questions, some are calling this the “last stand” for soda taxes. As you might imagine this initiative is facing major opposition from so-called big soda, a phrase used by activists to conjure up images of big tobacco and big oil. At the same time “big soda” is promising to voluntarily reduce calorie consumption from their products by 20% by the year 2025. Skeptics have called this a move to avoid or delay regulation right out of the safer cigarette playbook.

 

Who Pays?

While there is way more to obesity that sugar and sugary drinks, it seems to me that all of us are paying essentially a hidden obesity/overweight “tax”. Thus it might make more sense for those who use products linked to obesity to actually pay a real tax for their behavior.   This could raise revenue to cover some of the costs of the problem and might also lead to behavior changes to reduce the magnitude of the problem. Comprehensive tobacco control took decades to happen. Given the costs and health consequences of obesity, how long will a comprehensive program for calorie control take to emerge? It is almost certainly coming one way or the other.