Human Limits

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

Photo of Michael J. Joyner, M.D.

Archive for September, 2013

Cracking The Sub-Two Hour Marathon

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Why You Need To Be Doing Burpees

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Is Bruce Springsteen the new Gary Player?


Today is Bruce Springsteen’s 64th birthday, and below is a recent picture of Bruce at the beach in Rio.   I was never much of a Springsteen fan and never understood the whole Boss phenomenon until I went to a concert last year and saw him do 3-4 hours of nonstop music at Wrigley Field.   The music was outstanding and the energy was incredible.  The picture tells he must be doing something right to go that hard for that long in his 60s!




Simple Program

Evidently Springsteen has been following a simple fitness program for the last 30 years.  He alternates running 4-6 miles with strength training every other day.  He also watches what eats and is mostly vegetarian.  Incredibly, when you consider the entertainment world, he has been able to stay away from drugs.   He also finds places to exercise when he is on the road, for example he was spotted at a 24-Fitness in Portland, Oregon last year.


Parallels with Gary Player?

I have done a number of posts on the great golfer Gary Player who is still going strong as he approaches age 78 in a few months.   Both men are among the greatest performers in the history of the respective fields.  Both have essentially been on tour full time for decades.   Both exercise and watch what they eat.  Both find places to exercise when the logistics are not ideal.   Both have connected with their fans on a long term basis.  Both love what they do, and both keep pushing.   If you look at almost anything that has been written on healthy aging, both men are examples of what to do and how to age well.


Happy Birthday Bruce!

Here is to Bruce as he turns 64.  I urge his many fans to celebrate his birthday by following his example and getting a good workout in today!




Wellness & Health Insurance

Several posts ago I wrote about the idea that people with certain controllable risk factors might be charged higher health insurance premiums.   This issue has come to a head at Penn State University where a comprehensive wellness program, with financial incentives/penalties is being implemented.   The obvious motivation for such programs is to reduce the cost of health care borne by large employers.  A couple of things stand out related to the news reports on this topic:


Who Runs It?

From what I can tell Penn State is using a third party contractor to administer the program.  In addition to focusing on the obvious stuff like smoking, diabetes, blood pressure, obesity, and physical activity; the third party contractor seems to be taking a deep dive into all sorts of behaviors that might or might not be linked to health and health care spending.   Why?   My guess is that over time the vendor can match answers to their surveys with health insurance claims data and use this data for all sorts of purposes.   These might include things like even more granular rate structures or perhaps helping companies determine who to hire or not hire based on projected future health care costs.    Like all big data some of it is about efficiency, but how easy and tempting will it be to hijack this information for other purposes?  How do we ensure that such data really is being used to make people healthier vs. mostly making the bottom line healthier?  Recent revelations in many areas of life make it pretty clear that privacy guarantees should be viewed with skepticism.


Focus on Fundamentals

If you take a big picture look at behavior and health data only a few things stand out.  Don’t smoke, be active, watch your weight, eat a bit better and avoid excessive drinking.  Also if your lipids, blood pressure or blood glucose is out of whack get it treated. I am all for ideas about controlling stress and health.  However, there is pretty good evidence that people who are able to follow basic health guidelines are protected from many of the stresses of life .  The fact that so-called third party wellness programs apparently want so much information has me scratching may head and tends to reinforce the idea that they want the data for other reasons.


Other Options?

Penn State is located in a relatively isolated area of central Pennsylvania and it seems to me that there are other less invasive options to improve the health of the university community.  Is the community biking and walking friendly?  Are highly effective smoking restrictions in place?  My guess is the University serves a lot of meals every day, have the choices in the cafeterias and eateries been cleaned up?  Is there a community wide public health approach to issues like exercise, blood pressure, cholesterol and diabetes?  Why not partner with the local health care providers and go after these big ticket items?  There are experts in all aspects of nutrition, exercise, public and behavioral health on the faculty of the University.  Have these experts been engaged to design and evaluate a comprehensive program and share the results with others so we all learn?  Why outsource this to a third party vendor who can monetize it?


My Take

I think it is a good idea to charge different health insurance rates based on a few simple things that people have control over.  I would start with smoking, obesity, lipids, blood pressure and diabetes.   Physical activity and physical fitness are harder to assess (there is no blood test), but they should be included as well.   However, I think charging different insurance rates for controllable health risks needs to be part of a comprehensive approach that makes it easier for people to change their behavior.   Using third party vendors and letting them capture the data, crunch the numbers, repurpose it and monetize it is not the way to go.   We all own the problem of public health and high health care costs and we need to develop inclusive local and regional solutions.  An “Us vs. Them” approach needs to be avoided


Making Sense of Suffering?

We all suffer about something.  Sometimes we are simply prisoners of our misplaced and unfulfilled desires, sometimes terrible things out of our control happen to us, sometimes suffering results from things we choose to do.  Suffering can be physical, mental or both.  Can we make any sense of it? Can suffering ever be a good thing?  Lance Armstrong used to talk about managing his suffering during a tough race, how does that physical suffering compare to what he is experiencing in exile from the fame and glory he pursued so relentlessly and ruthlessly?  These general topics were the topic of a challenging essay about suffering by Pico Iyer I recently read that got me thinking about a few things.


Explaining Suffering

All major religions, theories about psychology, philosophical systems and the arts try to explain why we suffer and perhaps what we can do about it.   Buddhism is noted for its linkage between our inability to grasp impermanence, attachment to things, desire and ultimately suffering.  The beginning of the novel the “A Burn-Out Case” starts with the comment:


“I feel discomfort, therefore I am alive” and ends with “I suffer, therefore I am”…….


Graham Greene who wrote the book suffered from manic-depressive disease and by all accounts surely knew what he was talking about.


What Can We Do?

There is a line of reasoning that goes something like we don’t always have control over the circumstances we find ourselves in, but we do have at least some control over how we respond to the circumstances we are in.  The basketball coach John Wooden simplified that idea and simply said “don’t permit what you cannot do to interfere with what you can do”.   But what happens when you find yourself in an unimaginable set of circumstances like a concentration camp?  That is what happened to the psychiatrist Viktor Frankl and his book Man’s Search For Meaning shows that it is possible to do constructive things and remain hopeful in the bleakest of circumstances.  What lessons can we learn from his experiences that apply to the more routine ways that we all suffer?


John Wooden, whose approach to basketball had a mystical element as he sought to teach his players lessons they could use later in life, developed a “pyramid of success”.  At the bottom of the version below he says among other things:


“Don’t look at the scoreboard……Adversity is your asset…..Seek significant change”


How many of us have the courage to stop looking at the scoreboard, use adversity constructively and really change significantly in the face of it?  Gary Player the golfer said his ability to do well in big tournaments was based on his ability “accept adversity”.   Did the death of his mother at age 8 and seeing his older brother leave for World War II give him the adaptability needed to make the best of any situation later in life?   How do we develop the resilience to manage our own suffering and make the best of whatever situation we find ourselves in?


No Answers

I have no answers to the questions I have raised and I have no metaphysical explanations about suffering, what it might mean, or where it comes from.  I do know that books by and about Graham Greene, Viktor Frankl and John Wooden have been very helpful to me as I confront my own circumstances and the fear and suffering associated with daily life.





Can You Get Too Much Exercise?


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How The Body Responds to Blood Loss: Mayo Clinic News Network



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Whose Cubicle Is It?

The New York Times website was down last week forcing East Coast wannabes to find other sources of brain candy to start their days.  One thing that popped up was a brief profile of serial innovator and serial disrupter Elon Musk who has taken on banking, electric cars, rocketry and a couple of other industries.  Musk is interesting because he is not an expert at any one thing and perhaps his lack of deep expertise keeps him from being a prisoner of the conventional wisdom about most things.


Musk is also a controversial figure, but perhaps his example raises a few questions for us all about how we can avoid being prisoners of the conventional wisdom.


Here are a few:

  1. How many of us routinely get out of our comfort zone a try something new? In addition to being fun and challenging novelty helps us keep growing new brain cells and connections as we age.
  2. How often do you do things without your smartphone, GPS device, tablet, heart rate monitor or some other electronic gizmo?  Many techie execs are sending their kids to electronic free schools.  Is there something they know that the rest of us don’t?  Does every human activity including working out require tracking?
  3. If your work world is a part of a passive Dilbert style cubicle culture are you simply giving in or doing something different?  There is actually a lot of research on workplace culture and (no surprise here) those who work for supportive organizations and managers do better and it is possible to make your workplace more creative.
  4. When was the last time you gave a presentation without Power Point?   A lot of discussion is taking place about how power point and the internet are shaping cognition.  There is probably not a lot we can do about this except beware of the risk and get out of the box and avoid power point once in awhile.   Old time track and field athletes and swimmers routinely complain that “the kids can’t do math in their head anymore” because they did not grow up calculating splits off an analog stop watch.  Ask a younger person how many phone numbers they have memorized and the answer is who cares I have them on my speed dial.   Will anyone be able to give or follow verbal directions to a restaurant in the age of GPS?
  5. Everyone is yapping about strength training and high intensity training.   When was the last time you did pushups, sit-ups, burpees, or jumped rope?   It is always interesting to look at basic military fitness standards and see how you compare.  Talk is cheap, pushups are free.
  6. How many of us are afraid to ask questions about or provide input on things where we have little or no expertise?  A lot of times experts become experts by mastering what is known and not what is unknown.  They then work in an environment that reinforces their expertise and prevents them from seeking a broader perspective or wider solutions.  It can be intimidating to challenge a self-assured expert, but in fields like medicine about 30-40% of the facts behind the expertise are proven wrong or at least subject to serious challenge and revision every 10 years or so.   What would Elon Musk do in the face of that much uncertainly masquerading as truth or expertise?


Not everyone can start building electric cars or shooting rockets into space.  However, most of us can spend a few minutes every day or perhaps a few hours every week doing something different and taking a few chances.   We can also spend at least some time untethered to the electronic environment.  Do this routinely and the odds are you will get smarter, healthier, enjoy your work more, and perhaps make a few discoveries along the way.