Older Bolder Life

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Question of the Day

Question of the Week: Masking in the Car

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From a friend and former client in Dallas several days ago –

…I probably just had one of the most bizarre experiences of a very bizarre 2020 so far. I had driven to the upscale grocery we usually shop near home, pulled into a parking space and before I could shut off the engine and grab my mask (hanging clearly exposed from the rear view mirror), a young woman hustled to my passenger side window, banged on it with a fist, and began shouting.

I rolled the window down a couple of inches to see what all the hubbub was about, and she was literally screaming about me not wearing a mask while driving alone in my own vehicle. Gov. Abbot has mandated mask-wearing in public spaces where close contact might be expected, but in no way does that mean my damned car, right?…

The Short and Sweet Answer About Masks in Cars, With a But…

Hell no, you don’t in any way, shape, or form have to wear a mask when traveling alone in your own vehicle. Most authorities on masking extend not wearing a mask acceptability to include when traveling with members of your own household or family in a personal vehicle.

Anecdotally here locally I don’t see as many folks as even two weeks ago wearing masks in a vehicle when traveling alone, but there are some who choose to do so every day I’m out and about.

There are of course some exceptions to the no need for a mask in the car approach, most of which are simply common-sense, which clearly seems to be lacking in the majority these days.

If you’re traveling with or transporting someone who is sick, masking is of course a reasonable idea, as is protecting yourself when traveling with folks from multiple households, like in a carpool, though from what I hear and read, carpools have for the most part gone the way of the dinosaur. Perhaps just as common (or moreso today) is using a ride-share service; while I’ve not seen formal studies of how contaminated ride-share vehicles are with regard to COVID-19, taxis and ride share vehicles are often viral and bacterial incubators and anecdotally I’d personally avoid them like the plague (no pun intended) currently.

There are those I suppose who draw some sort of personal comfort from the idea of wearing their masks full time, including in the car; given the actual problems associated with chronically wearing masks – particularly cloth masks that attract all sorts of viral and bacteria bad-guys when damp – it’s quite easy to build an argument that living in fear and ignoring the science of when not to mask is not a healthy behavior and needs to change.

Arguments could be made that for those who make multiple stops during a day, for example a delivery driver, staying masked makes sense so potentially contaminated hands aren’t manipulating a mask dozens (if not hundreds) of times a day. (Next time you’re out, sit a minute and watch how frequently mask-wearers touch their face and masks – it’s astounding.)

I haven’t wanted to go there on the blog, but of course there’s a pile of solid, historically validated science out there that would blow the “everybody mask all the damn time” mandates out of the water; I haven’t had time to go there in detail here, but perhaps will post a compiled list of some of the more illuminating data out there in the next few days.

Stay safe out there my friends.

Question of the Week: Living a Demanding Life

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In response to yesterday’s post briefly explaining my absence from the blog here on the Older Bolder Life for a few weeks, reader Paul offered this comment / question –

And there in lies the rub. How do advise your clients who live demanding lives and want to remain healthy? I am on tour for 3 months with an outdoor show and I can tell you the diet is the first thing to go.

Upon seeing Paul’s comment early this morning, my initial response was “what a great question”, and it resonates very well with commentary I hear literally almost daily from friends, clients, and family. After thinking about it for a minute, I thought it worthy to respond in a bit more detail, channeling (at least attempting to anyway) what I’d say to Paul if we were sitting in the coffee shop (or a drift boat on the river) enjoying a break and a cup of hot coffee. During that hypothetical conversation I’d offer up the following points…

Real Life Happens (Almost Every Damned Day) In Ways We Hadn’t Planned For

Most of us, at the least the people that I run with and help through Older Bolder, have to work for a living to pay bills, buy groceries, keep a roof over the family’s head, and educate the occasional offspring. Work tasks often vacuum up huge chunks of time as well as physical, emotional, and cognitive resources we’d prefer to spend in other places, doing other things.

I get that point, and understand damn well that real life rarely proceeds according to the plans we’ve laid out – whether it’s for the day, week, year or whatever time frame you’d care to define. (Working in medicine, it was absolutely guaranteed that urgencies and emergencies would interrupt every single day – it wasn’t a matter of would it happen, it was just a matter of when).

Some changes in the daily life game are more or less voluntary, like my excursion into the world of a commercial kitchen laid out yesterday; many (perhaps most) bumps along life’s scheduling road are simply out of our control.

One of, and by no means the only one, the key points to be made here responding to Paul’s comment is this – there will always be daily challenges and obstructions to living the healthiest lifestyle we can. Some days (weeks, or even months) we win the battle, some days it’s a draw, and some days we get hit below the belt and stumble. It happens, and will happen again to all of us.

How we prepare for, and respond to those eventualities, is where we all have, at least in my humble opinion, the greatest opportunity – and like most things in life, making the most out of those opportunities requires sharpening a few skills…

Hone the Art Being Brutally Objective About Yourself

As I shared yesterday, I got into a bit of trouble physically last quarter because I really wanted to learn the ins and outs of working in an upscale, busy, creative commercial kitchen. Of the many lessons I learned, one was this – there’s a reason you don’t see a lot of 60+ year olds in busy restaurant kitchens. The work is fast, even furious at times, and often amazing physical. As much as a I really really wanted to dive in and do that, given the bundle of other business and family responsibilities I have on my plate (as do we all), it took me a while to listen to my wife and objectively measure the pros and cons of my little adventure.

Like most humans walking the planet today, I had developed a bit of a blind spot that allowed me to wander down a path that ultimately wasn’t the best one for me now, and like most of us, there was a price to be paid. Being objective about things we need to face up to in our lives can be damned hard – things like am I over-working, overweight, eating or drinking the wrong things, under or over active, and so on so forth.

Hone the art of being brutally objective about yourself, and find a partner, mentor, or friend who will pull alongside and steer you back to reality.

When Sh*t Happens, Flex and Pivot

When life throws those curve balls, sometimes we need to flex and / or pivot. For example, when I found my activity demands changing rapidly, and after struggling for a few weeks, I began to fiddle with my macros (upping carbs and good fats) in response. Flexing my macros and my eating schedule (I’m a long time time restricted feeding fan) made significant improvements; one of the most interesting parts of health and nutrition game is that sometimes we all have to run that N=1 experiment to see how we can make this human machine run optimally.

Sometimes we need to pivot; for sake of discussion here I’m using pivot to denote making a bigger change for our long term good. Sometimes making a pivot means leaving the good behind for the better ahead.

Metabolic Flexibility Still Wins the Day

At least from where I sit, the absolutely most critical thing anyone can (and really should) do to improve their health and function in life is to develop a robust ability to be metabolically flexible.

For sake of discussion here, let’s define that as developing the metabolic machinery (hello mitochondria!) to process multiple substrates to provide energy for our daily function, namely the fats we all so efficiently and amply store, and not just exist from one glucose spike to the next, stuffing our faces with fast-burning carbs every two hours every danged day.

Being metabolically flexible brings a host of benefits to the table, though I’d argue that top of the list is experiencing more even, sustained energy production, effortlessly by the way, which opens up a whole new world of ability to complete life tasks – actually doing things every day – which is what life is all about.

Developing metabolic flexibility is within the reach of just about every human on the planet, but you’ll have to be intentional about it, and be willing to spend a bit of time in nutritional ketosis.

Functional Fitness Still Matters

Another point I’d make to Paul in response to his question is so simple as to be in essence common sense – the point being that functional fitness really does matter.

All of us, regardless of age, need varied, interesting, and sustainable exercise that promotes strength, endurance, cardiovascular condition, and flexibility. What does that look like for you? YOU get to decide what your program looks like; and you don’t have to spend thousands on gyms, gear, or coaching to get it done, you just have to do it.

Functional fitness still matters, and always will; figure out how to make it a non-negotiable part of your day and week. (Think you don’t have time? How much screen time do you spend waste each day?)

Mind the S’s (Stress and Sleep)

Though it occasionally garners an eye roll from coaching clients, I’d gently remind Paul that many of us, due to the demands of the day, neglect managing stress and sleep. These are big topics, bigger than space and time allow for deep exploration here, but suffice it say that unmanaged stress and disordered or too little sleep can have profound impacts on health and wellness.

Two Final Thoughts…

Finally, I’d close my hypothetical chat with Paul with these two encouragements. One, life can, at times, be a bitch, throwing us curve ball after curve ball that we can’t hit. Relish the victories, dust yourself after the losses, and get back in the game. Sisson opines that we should strive for 80% compliance with a healthy lifestyle; I’d argue 90% or better is just as easy and still allows for that occasional stumble.

And two, always be exploring, learning, and testing. There’s a wealth of great free information available today at your fingertips, experts to query, and consultants to engage. Ask questions, experiment, make changes in your diet and routine, and pay damned close attention to what your body is telling you. It’s NEVER too late to make changes that will lead better health and rewarding function.

Git ‘er done.

Question of the Week: What is Mechanical Low Back Pain?

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From a client this week –

…my husband finally went to see our internist about a nagging low back pain that just won’t go away. He’s 80 pounds or more overweight, sedentary, and thinks Ibuprofen is something we all just have to take constantly to get by. His doctor’s PA told him he had “mechanical low back pain” and that it would just go away with time, what does that mean?…

A Quick Primer on What “Mechanical Low Back” Pain Means

Before a quick overview of what the term mechanical low back pain might refer to, of course I have to remind you that I’m not providing medical advice here, simply reviewing key concepts related to the question above.

In the arena of spinal pain and symptoms, one way to describe discomfort (or symptoms) is to divide them into one of two types (though they can both occur at the same time) – mechanical symptoms versus what are described as radicular symptoms (you might hear the term radiculopathy used).

Radicular symptoms refer to those symptoms generated when a nerve is irritated, and usually occur somewhere along the specific nerve’s course through the body and limbs. Think of a herniated disc “pinching” a nerve; let’s use as an example a far lateral disc herniation at L5S1 (the lowermost disc in the entire spinal column between the 5th lumbar vertebra (backbone) and the sacrum, pushing on the exiting L5 nerve root at that level. There may be some back pain produced in this scenario, but symptoms (could be pain, numbness, tingling, weakness) would potentially show up in the hamstring region, the front of the lower leg, and maybe even the top of the foot (all areas involved with the L5 nerve root).

Mechanical pain, on the other hand, typical represents symptoms produced by irritation or dysfunction of any other structure that’s NOT nerve tissue.

The most likely suspects are muscle, ligament, bone, joint, and the discs themselves (they’re a type of joint actually between the backbones (vertebrae) – a jelly like center (the nucleus pulpous) surrounded by a very interesting, multilayered harder (and specialized) cartilage-like casing. Most spine gurus agree that at least the outer third of the disc shell is supplied by nerve tissue and can generate pain; for a time it was thought discs didn’t have a direct nerve supply.

By far and away the lion’s share of mechanical low back pain is generated by muscles and ligaments, though as we charge through life we all accumulate some “wear and tear” changes in these spinal structures, that can (at least now and again) get inflamed, generate pain, and limit our function.

The good news here is that almost all of us will have a spell of mechanical low back pain at some point in our lives, and the overwhelming majority of the time, symptoms go away pretty damned quickly, and without much attention or intervention. Consider those episodes a proverbial “shot across your bow” imploring you to optimize your health, nutrition, and fitness if you’re not living that way now.

On the other hand, mechanical low back (or other spinal) pain that won’t respond to rest or a brief period of decreased activity, perhaps a very short course of anti-inflammatories, and maybe simple local measures (icing/heat) – and that continues to impact daily function – probably needs to be looked into with more than a pat on the head and encouragement that “it’ll get better in a few days”.

We’ll be digging into the topic of spinal pain more deeply through the fall…

Question of the Day 4 June: Target Heart Rates

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From Cyndie in Kentucky this week –

…A friend working with a trainer has been telling me that walking isn’t enough of a workout to help me drop some weight. Her trainer says that you have to get your heart rate up really high to make fat burn, and told her to take my age (42) from 220 to get my target heart rate. That sounds really high and is hard for me to do walking, this doesn’t sound right to me…

Cyndie, appreciate the opportunity today to answer your question, and you’re right, the information passed on from your friend’s trainer is actually not correct.

The rule of thumb the trainer appears to have suggested you use, the 220 – your age calculation, is a commonly used rule of thumb (for example, used here by the Mayo Clinic) to estimate an individual’s Maximum Heart Rate target. There are of course potential flaws in using a rule of thumb calculation here, as there are of course other issue that may modify the results, such as medications you’re taking (i.e. beta blockers), your overall health, your overall fitness level, your fitness history (how long have you been working out and what types of exercise have you done), your injury history, and more.

Using the rule of thumb above, your target maximal heart rate would be 178. But that’s not really the number you need to be thinking about…

You Really Want to Your Use Your Heart Rate Guides to Work Aerobically to Burn Fat

When you go through your day completing most of your routine tasks (clinically called activities of daily living), you’re not exercising anywhere near your maximal heart rate; your body is working aerobically to burn fuels efficiently using oxygen. In the right setting metabolically, that includes burning fat as fuel, which from your question is what you’re trying to do.

If you significantly up the intensity of your effort (exercise or really aggressive ADLs), there is a point at which your body is forced to change over to another fuel processing system – anaerobic work – think of this like the maximal effort you might make when doing repetitive sprints as part of a training program. That’s stressful, inducing the production of stress hormones (which among other things slows down fat burning), and can lead to overtraining, excessive inflammation, and injury.

So you really want to know your maximal aerobic training heart rate.

Thankfully, a host of smart men and women have done the hard work and derived some fairly easy calculations to discover that number. My favorite is Dr. Maffetone’s 180 Formula.

Simply put, you subtract your age from 180, and modify that number using the four criteria he’s listed at the link above. From what you’ve shared, it appears your calculations would be 180 – 42 = 138, with another 5 subtracted as you’re just getting back into training (Dr. Maffetone’s modifier [b]), making your maximal aerobic training target a heart rate of 133.

Note that’s the maximal suggested target rate, and brisk walking, or walking hills should readily get you in the range of 85% to 90% of your maximal aerobic target, and will very likely aid in burning fat, which you’ve stated is your primary goal.

These numbers are of course rule of thumb guidelines, and must be modified specifically to match your own unique and specific health and fitness. Keep up the good work and get out there walking – I’m a huuuuuge fan of walking as a fitness and weight loss tool.

Question of the Day: How Often Should I Weigh?

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Interesting question from John about how often to check in on the scales…

I’ve just now been converting to a healthy diet (more or less classic paleo) over the past six weeks or so. I’m what most would consider a huge guy – I weigh over 420 pounds – and realize that it’s going to take me months (maybe years) to recover my body. I dropped 15 pounds in the first two week, and now progress is much slower. Weighing every day, and even every week is pretty discouraging given the big challenge facing me, what would you advise?

I’m on the road today, but wanted to share a few quick thoughts with John, given in particular that I personally faced a similar, and at one point, discouraging challenge. (As an aside, I happen to be a data nerd and love tracking all sorts of metrics, but I stopped doing weekly weight checks as I’ll share below.)

That said, several quick thoughts…

Attaboy John, You’ve Made the Right Choice to Get Started

First, an enthusiastic attaboy for making the decision to get started on your journey to recover your health, fitness, and function. Never doubt that it can be done; I weighed over 400 pounds myself a little over three years ago, and am a today few weeks away from having lost half my former body weight.

It’s not a glamorous process, but a very attainable one, and you’ve gotten off to a great start thus far. My first piece of heartfelt advice is this: recognize it’s going to take a months to reach your targets (whatever they might be at this point), focus on working your persistence and patience muscles daily.

Remember that Body Weight is Only One of Many Meaningful Metrics

For those of us facing the daunting challenge of dropping significant excess body weight, using the scale as our only measure of success, especially early on, can be discouraging given the rate of change we see, particularly if weighing daily (which I don’t advise for you), or at this stage in the game, even weekly.

Look for other tangible and valuable measures of success; clothes fit better and then you’ll find the need to drop a size or two. As you move more in daily life, walking becomes easier, your endurance will improve, and exercise for strength and endurance will become something you’ll look forward to. Sleep will improve, heartburn will resolve, and I’ll bet the barn your mood and attitude will begin to reshape too.

Numbers on a scale may not end up being the most valuable indicator of progress at all.

How Often to Weigh? Consider This Option With A Long Way to Go…

When it’s all said and done, how often to weigh eventually boils down to a matter of personal preference, and there’s clearly no right or wrong answer as long as the scale doesn’t become an instrument or focus of an obsession.

Let me share a quick story from my own experience; early on in my own recovery journey, I charted weekly weights, though found three or four months in that dropping anywhere from 1-2 pounds per week seemed discouraging, even with an occasional 3 pound week mixed in. Looking at where I was, and comparing to my end goals (>200 pound loss), on some days prompted that voice of self doubt to creep in, usually something along the lines of “who in the hell do you think you are to imagine you could drop this much weight; you’ll never get there, etc…”.

A friend, actually a former 800m Olympic runner back in the day, encouraged me one day to quit focusing so much on the scale, and focus more on my daily process – eating good food that’s been well-prepared in line with my goal macros and that day’s fitness pursuits (whether fun or a grind it out workout). She challenged me to move to monthly weigh-ins, which I did over two years ago and continue to this day. For those of us with goals of dropping a lot of pounds, I still advise considering a trial of at least a couple of months weighing only monthly.

And to be frank, in my own experience, changing my wardrobe has been a hell of lot more gratifying – and reinforcing – than dropping big numbers on the scale.

I’d certainly encourage you to eschew the daily weight checks, and weigh no more often than weekly. If monthly checks leave you feeling a data void, consider twice a month on the first and fifteenth.

More to come…

Today’s Question: METs and Meaningful Exercise

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Today’s question of the day comes from Sue K. in Dallas (emphasis mine) –

…a friend told me her trainer insists that all of her exercise be tracked by METs, and that if anyone doesn’t do it that way, they’re framing their entire approach to exercise wrong. When I asked her to define for me what a MET actually was, she wasn’t sure, but said they were something related to units of exercise. I’m just coming back to the workout and exercise game after 20 years of sedentary life, have things changed and I’ve totally missed out on something here?…

Sue, in a nutshell, of course the answer is no, you don’t have to frame your thinking about exercise around the concept of METs to “do it the right way”. METs do have their place in describing physical activity; for instance, you may see METs listed on various pieces of exercise equipment in a gym, though as described, the trainer’s admonition doesn’t hold water.

So Just What is a MET?

A bit of background is in order here. We all understand that muscle cells consume oxygen as they generate the energy to contract, more calories are burned as you burn more oxygen (we as humans burn approximately 5 calories of energy to consume 1 liter of oxygen).

One MET is defined as the amount of oxygen consumed while at rest; it’s roughly 3.5 ml of O2 per kg of body weight, per minute. METs are measures of metabolic cost, and have been tabulated as the ratio of metabolic rate (expressed as the rate of energy consumption) against a given physical activity – for example, walking, running, resistance exercise, housework, they’ve even calculated the METs required for sex.

More practically, one MET is for practical purposes the amount of energy produced relative to your body mass at rest; reading this blurb on your computer requires one MET of energy at rest.

The Master MET List: The Compendium of Physical Activity

The powers that be have compiled a fairly comprehensive list of the METs required to complete a host of different physical activities – it’s posted in The Compendium of Physical Activity, most recently updated in 2011. There are several apps that list the various MET values for different activities as well.

Here’s a sample list from the Compendium –

METs and Exercise for Most of Us

In defense of the (reported) trainer’s comment above, you could reasonably argue that if you know the particular MET value for a given physical activity, how long that activity is performed, and some basic metrics about the person performing the activity, you can estimate the caloric burn (consumption) that person should experience as a result.

That said, while I used the concept of METs in roughly developing rehabilitation plans for severely compromised patients (strokes, massive cardiac events, brain injuries, etc.), I’ve never framed exercise goals in terms of METs for anyone at anytime otherwise.

Why not? There are a host of reasons, though most importantly two in particular.

One, the concept of using METs to track exercise often tends to be framed in the context of “calories in, calories out” (and its kissing cousin – “a calorie is a calorie is a calorie”), which as we now understand, particularly in the context of someone above their ideal body weight and metabolically compromised, probably doesn’t hold water and can lead one down the wrong path.

And two, for most of us, tracking METs, really tracking your METs for both exercise and all activities during a given day, can end up being a handful (to say the least), and can smack of (at least in some contexts) compulsive behaviors and orthorexia. It’s critical to remember that for almost everyone, your food plan determines 80% of your body composition, with exercise (again, for most of us) impacting roughly 10%.

Your approach to activity simply doesn’t have to be that complicated; move, move, move (at aerobic levels of exertion) + lift heavy things occasionally + sprint now and again wins the day for just about everyone.