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The Pros And Cons Of CrossFit: A Physician’s Perspective

I’ve been following (and often participating in) fitness trends for decades. From Jim Fixx’s outdoor running to Jane Fonda’s work out videos, to Conan-the-Barbarian body building, to step aerobics, to Tae Bo, to hot yoga, to Zumba, and now CrossFit… America’s exercise pendulum has been swinging wildly across the spectrum of possible physical activities. So have we finally reached a balanced mix of strength and cardio for optimum fitness? Maybe.

CrossFit is a system of exercise and nutrition (founded in 2000 by Greg Glassman) that claims to “forge elite fitness.” Their Reebok-sponsored annual games boast that the winners have proven themselves to be “the fittest on earth.” CrossFit advocates a mix of aerobic exercise, gymnastics (body weight exercises), and Olympic weight lifting. Workouts are typically short—30 minutes or less—and intense, requiring maximal physical exertion.

I’ve attended multiple regional Cross Fit competitions, watched national games, competed in a CrossFit style competition, and worked out with several CrossFit athletes as well as attempted their work outs (WOD) on occasion, though I am not a member of a CrossFit gym. All this is to say that I’ve spent a good deal of time contemplating the merits of CrossFit, both as an athlete and as a physician trained in sports medicine. And here’s what I think:


Difficulty. High intensity interval training (HIIT) is an effective and highly efficient way to improve muscle strength and cardio-vascular endurance. In my opinion, CrossFit’s greatest contribution to the fitness industry is its emphasis on HIIT, something that has not been sufficiently emphasized in the past.

Nutrition. CrossFit emphasizes the importance of healthy nutrition as part of its fitness strategy. This is sorely lacking in other systems/regimens. While I might quibble with some of the more extreme “Paleo” proponents within the CrossFit community, there’s no arguing that a diet rich in fruits and vegetables, lean protein, healthy oils, and complex carbohydrates (no sugars or refined flours) is a healthy way to eat.

Community. Peer support encourages consistency in participation. CrossFit does a good job in building community and making everyone feel welcome. All levels of fitness (and all ages) are welcome to join a CrossFit gym and participate to the best of their ability in the workout of the day (WOD).

Affordability. CrossFit gyms are relatively inexpensive to outfit (less high-tech equipment) and are easy to scale. For this reason they provide greater access to people at all income levels, which is a huge plus.

Portability. CrossFitters learn how to use their own body weight to create challenging exercise routines anywhere, anytime. There is no longer any excuse not to get a good workout in, whether you are traveling and can’t get to the gym or you are too busy to break free from the kids to do a more formal work out.


Frequent Injury. CrossFit injury rates are substantially higher than most other fitness regimens. Herniated disks, muscle and tendon ruptures, rhabdomyolysis are not uncommon. In fact, most CrossFit athletes that I know presume that “injury just comes with the territory” and I frequently see Facebook photos of bloody/blistered hands as some kind of badge of honor. I myself sustained a low back injury even when carefully observing my technique during a CrossFit workout, and a dear friend actually ripped off one of the heads of his bicep when attempting an Olympic weight maneuver, while another friend fractured her wrist after falling down during a series of box jumps to exhaustion. Trust me when I say that if you do CrossFit long enough, you’re bound to become injured in some way.

Challenging Technique. Correct exercise form is hard to master, and since many CrossFit moves derive from gymnastics and Olympic weight lifting (sports that take many years to perfect), it is incredibly important to perform movements according to correct mechanical form. Although CrossFit experts strongly agree that good form is the key to safe and effective exercise, the fact is that people don’t always follow directions. In fact, most athletes that I’ve watched at CrossFit gyms suffer from poor form in one or more of their moves – sometimes because of inexperience, and other times because they are too exhausted to perform their final rep(s) correctly and their attention has waned. Functional movement is freer than the usual, controlled weight scenarios in a gym’s circuit training machines. And with that freedom comes the benefit of activating more muscles at a time, but the danger of injury, especially for new initiates or older athletes.

Peer Pressure. The flip side of having a “strong community” that encourages participation, is that the same community may push participants to engage in unsafe exercise practices. I’ve often seen well-meaning CrossFit instructors encourage people to pick up heavier weights than they feel comfortable with in order to push them to become stronger. There is a fine line between healthy encouragement to challenge yourself, and dangerously heavy weight lifting. It’s normal to want to “keep up with the Joneses” to your right and left during a WOD, but when Mr. Jones is a 250 pound tower of muscle, you might not want to be lifting the same weights.

Glorification of the mesomorph. There’s no doubt that committed CrossFitters develop enviably lean, muscular bodies. However, I wince a bit at the tendency for CrossFitters to promote the idea that their way is “THE best way” to be fit, and the bravado surrounding their competitions for “fittest on earth” is exclusionary and unfair. Just because an athlete was born with a different body type, ill-suited to Olympic weight lifting for example, doesn’t mean they can’t be fittest on earth (a rather subjective measure – why not an Ironman as the fittest?) There’s not much variation in the body types of those who are at the top of the CrossFit heap (i.e. large muscle mass, not too short or tall), which speaks to the fact that ultimately this sport is not optimal for all-comers (nor is the position of linebacker on a football team).

My bottom line: CrossFit must be approached with caution, though it provides some excellent HIIT and nutrition principles that can optimize one’s health. If you enjoy strength training (more than cardio or yoga for example) and like camaraderie but can resist the temptation to push yourself into the injury zone, then CrossFit may be for you.

I personally recommend (and participate in) what I would call “CrossFit light” – meaning workouts of similar CrossFit intensity but without extreme weight/maneuvers, and scaling up slowly (especially when new to exercise or a Masters athlete), adding additional cardiovascular training, and eating a diet slightly higher in complex carbohydrates than is generally recommended by strict “paleo” type CrossFitters. And of course, I do not believe that my way is the best or only way to be fit. If you like running, cycling, yoga, Pilates, or even step aerobics – good for you! Aim to be active for an hour/day – and add a little strength training in as you can. If you do that much, you may not be the “fittest on earth” but you’ll be doing more exercise than 96% of Americans!

Hilarious Women’s Running Shirt – You Want One?

Does my butt look fast in these pants?

Since I started running (in earnest) a couple of years ago, I’ve been doing what I can to stay motivated. Running is a great sport because 1) it’s cheap 2) you can do it anywhere 3) it’s hard. So, because of #3 I welcome all opportunities to make running fun – and wearing amusing shirts during races seems like as good a strategy as any.

The idea for the “Does my butt look fast in these pants?” shirt came from a sign I saw at a recent marathon. A guy was cheering on the ladies with a homemade sign that read: “Your butt looks fast in those pants!” I laughed so hard it took me a quarter mile to recover. So I shamelessly stole his idea and made a Better Health women’s running shirt out of it. If you think it’s cool and want one too – I’d be happy to print you one. The larger the batch we order, the less expensive it will be.

So if you’re looking for a funny Christmas gift… or if you just want to thwart the race competition by making it impossible for them to pass you without sputtering out a laugh, let me know. Email me if you’d like to order a shirt and we’ll discuss details.  My email is:  (They are made of Nike dry-fit fabric, come in the colors shown only, and are available in Ladies S, M, L – if guys show interest I suppose we could order a run of men’s shirts too?). Let’s prepare to GET BETTER HEALTH this season… and run our way to victory in the battle of the bulge. :lol:

Are Women More Motivated By A Chubby Fitness Trainer?

I was taken aback by a recent conversation I had with a gym owner. She is interested in encouraging middle-aged women to come to the gym for beginner-level fitness classes and was planning a strategy meeting for her staff and key clients. I asked if I could join and she said that I was expressly un-invited. Slightly miffed I asked why that was so – after all, I’m a rehab physician who has devoted my career to getting people moving.

“You’re too advanced.” She said. “Beginners wouldn’t relate to the way you work out, we’re really more focused on creating a less intimidating environment for women.”

“You mean, like the Planet Fitness ads? The ones where athletes are not welcome?” I asked, confusedly.

“I don’t like those ads but the idea is the same. Beginners feel deflated by working out with people who are in far better shape. They don’t even want their instructor to look too fit.”

“You’re kidding me. Women would actually prefer working out with a chubby trainer?”

“Yes. In fact, I’ve had some women come to the gym and actually request NOT to be paired up with some of our personal trainers specifically because they look too fit. They are afraid they will be asked to work too hard, beyond their comfort zone.”

“So why are they coming to the gym in the first place?” I asked. “What is motivating them if they don’t want to work out hard or change their bodies in the direction of athletic-looking trainers?”

“They’re just interested in staying the way they’ve always been. Maybe they’ve started putting on weight after they hit their 40′s and 50′s and just want to get back to where they were in their 30′s. They’re not interested in running marathons or lifting the heaviest weights in the gym. They don’t want to be pushed too hard, and they prefer trainers who look healthy but not extreme.”

Medically speaking, it doesn’t take extreme effort to be healthy. Many studies have shown that regular walking is adequate to stave off certain diseases, and weight loss success stories (chronicled at the National Weight Control Registry for example) usually result from adherence to a calorie-restricted diet and engagement in moderate exercise.

In a sense, these women who “don’t want to work that hard” are right – they don’t have to perform extreme feats to be healthy. However, I am still fascinated by the preference for “average looking” trainers and the apparent bias against athleticism. This must be a fairly common bias, though, because national gym chains (like Planet Fitness) have picked up on it and made it the cornerstone of their marketing strategy. “No judgments” – except if you’ve got buns of steel, I guess.

When I choose a trainer I am looking for someone who embodies the best of what exercise can offer. An athlete who has practiced their craft through years of sweat and effort… because that’s my North Star. Sure, I may never arrive at the North Star myself, but I like to reach. And that’s what motivates me.

But for others, having a professional athlete for a trainer may be a mindset misfit. If your aspiration is to be healthy but not athletic, then it makes sense to find inspiration in those who embody that attitude and lifestyle. The important thing is that we all meet the minimum exercise requirements for optimum health. According to the CDC, that means:

* 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week


* muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest,  shoulders, and arms).

How you get there, and with whom you arrive, is up to you. Chubby or steely – when it comes to health and fitness the best mantra is, “whatever works!”

Your Nagging Fitness Questions Answered With Scientific Evidence

I just finished reading a great little book called, “Which Comes First, Cardio Or Weights? Fitness Myths, Training Truths, And Other Surprising Discoveries From The Science Of Exercise” by Alex Hutchinson, Ph.D. I’m very grateful to Alex for patiently sifting through over 400 research studies in a quest to answer (with evidence, not subjective opinion) some of our most nagging exercise questions.

Alex is the perfect guy to do this exercise myth-busting as he is a competitive runner, professional journalist, and has a Ph.D. in physics. His writing is crisp, uncluttered, and bears the understated humor of a Canadian. To be honest, I enjoyed his book so much that I was contemplating blogging about most of his conclusions. However, I don’t want to teeter on the edge of copyright infringement, so I’ll just provide you with some highlights from my favorite sections of the book:

1. Do compression garments help you exercise? I’ve wondered this many times as I jiggled my way down the road on a long run. I’ve always liked the theory behind tight outer-garments, that they reduce unnecessary movement during running, thus making one’s movement more efficient and reducing the bounce and drag on muscles and skin. They may also help with blood return to the heart and reduction in peripheral edema, speeding recovery from exercise. Believing the plausibility of the argument, I have indeed sprung for some rather expensive running tights.

So what does the scientific literature have to say about compression garments’ role in exercise? Apparently there is nothing conclusive yet. Small studies have shown no clear improvement in exercise economy, athletic power or endurance, or recovery from exercise. The only measurable benefits appear to have occurred in those who believed that the compression garments would help their performance. A nice reminder of the importance of the “mind-body” connection in athletic pursuits. Bottom line: if you like how you feel in compression garments, by all means wear them. But don’t expect any dramatic improvements in anything more than your jiggle factor.

2. Will sitting too long at work counteract all my fitness gains? The short answer to this question is: possibly. I was surprised to note that at least one large study found that sitting for more than six hours per day increased one’s risk of death by 18-37% regardless of how much exercise one performed in the other eighteen hours of the day. Long periods of sitting appear to be quite bad for your health, so getting up and moving around every hour or more is important if you have a sedentary job or lifestyle.

3. Does listening to music or watching TV help or hurt my workout? Listening to faster-tempo music can result in increased exercise effort (in many cases completely unconsciously), while TV-watching usually results in a reduced exercise effort. This is because watching videos requires visual attention and subtle changes in balance and movement occur to accomplish it.

4. Will stretching help me avoid injuries? As a person with limited flexibility, I found this section of the book to be quite comforting. As I have blogged previously, stretching has not been shown to reduce the risk of injury or post-exercise soreness. In fact, it can decrease power and speed for certain athletes, though it is important for those who intend to perform great feats of flexibility (such as gymnastics).

5. Should I take pain killers for post-workout soreness? Interestingly, non-steroidal anti-inflammatory drugs (NSAIDs) are not particularly effective in reducing post-exercise pain and can even interfere with muscle repair. NSAIDs block prostaglandins, which are important in collagen synthesis. While NSAIDs are useful in reducing inflammation and swelling in acute injuries (such as an ankle sprain), general muscle soreness isn’t a good reason to pop some ibuprofen.

6. Will drinking coffee help or hinder my performance? I’m one of the few people I know who doesn’t drink coffee, so I was surprised to discover that I may have been missing out on an important exercise enhancer. According to decades of research, caffeine is likely to improve your exercise performance. Studies have shown that pure caffeine (not necessarily in its coffee form) enhances sprint performance as well as endurance activities up to two hours. In 2004 the World Anti-Doping Agency removed caffeine from its list of restricted substances, so expect to see some caffeinated athletes in this summer’s Olympics.

7. What’s the best way to breathe during exercise? If you’ve ever marveled at your own panting, you’ve also probably wondered if there is a more efficient way to breathe – or at least a less embarrassing way. The answer is no. Studies have shown that people who consciously work to make their breathing less labored expend more energy and get less oxygen in the process. So, keep on breathing the way your body wants to… you’re naturally more efficient at it than you think.

I hope that these little tidbits have whet your appetite for more of Alex’s excellent insights. I have fully equipped myself with fast-paced music and a little caffeine, as I move my inflexible, jiggly, panting self down the road on another long run.

The Primal Games: My Life Outside The Comfort Zone

This weekend I accidentally stepped way outside my comfort zone. A friend of mine had invited me to compete in the Primal Games – an event that she described as a “fun time for all fitness levels with some guys dressed up as cave men.” Sounded innocent enough. And it appealed to my sense of whimsy, so I signed up without a second thought. A couple of weeks prior to the event I decided to do a little more research and discovered that this competition *might* be a bit more challenging than I had originally thought. The event website was somewhat vague, but alluded to things like “Atlas balls,” climbing over walls, obstacle trail run, military crawls, and medicine ball tosses. Hmmm. I’d never attempted to scale a wall in my life, nor was I too thrilled about the idea of hoisting around beach-ball-sized cement objects. I was getting nervous.

I soon discovered that my nervousness was more than well-founded. As I arrived at the event, the temperature was rising above 90 degrees Fahrenheit as I was greeted by shirtless male competitors (see photo above). Apparently, almost everyone at the Primal Games was on a team of some sort already, and many had prepared for the event for over a year (mostly at CrossFit gyms). As I gingerly approached the registration tent a well-muscled woman wrote a number in permanent marker on my arm and calf. I was branded and there was no turning back, so I decided to spend some time watching the other athletes warm up. I was astonished by some of their capabilities.

Take this guy for example (photo at left). He was able to hurdle the “women’s wall” that I struggled to scale and climb over. I stood there, staring aghast at the fellow like some kind of animal in headlights. I realized that I belonged on the sidelines as a spectator, not a competitor – but alas, I was in it for the duration.

The women at the event were only slightly less intimidating. Some looked like Olympic weight lifters, others were lean, mean, muscle machines. Very few were as old as I was. My fantasies of a day tossing water balloons back and forth with people in spandex and super-hero capes were fading fast.

And so the games began – three individual events arranged in heats, requiring a whole lot of “hurry up and wait.” My first challenge was a 1.5 mile trail run with obstacles. The distance seemed fairly innocuous so I took off at full tilt when they blew the air horn for my group. About a half-mile in I began passing members of the group that started ahead of mine. I wondered if I had misjudged my pace, but figured I’d deal with that later. I navigated jumping over some hay bales (no problem for a former dairy farmer), threw myself into the Army low-crawl and bolted across a boardwalk to come into the finishing stretch. And that is when I hit the wall. Literally.

I had never scaled a wall in my life and apparently there’s some technique to it. I ran up to the 6-foot obstacle, jumped up and grabbed the ledge and then hung there like some kind of limp towel. Nope, that was definitely not the right way to do it. Race officials tried to explain more successful strategies to me as I failed to scale the wall in a second embarrassing attempt. I opted for the penalty Burpees and crawled under the wall… only to face the next, slightly shorter wall. There was no way around it this time – I had to do it. A miss was a disqualification on the shorter wall.

Panting, sweating, and wearing all black in the midday sun, I somehow muscled my way over the short wall in the least elegant way known. I jogged ahead to the water slide, took a hard dive onto my chest and bolted to the finish line with no energy to spare. That performance was good enough for an 11th place finish in my age group (the “Masters women” – which hardly seemed a fair category title considering my lack of mastery of this challenge!)

The second event appeared deceptively straight forward. I had three minutes to launch 6 medicine balls backwards over a wall. But for every 7 feet closer to the wall you got, you had to do increasing numbers of penalty Burpees. I figured I’d be pretty good at this since I’m built more like a water buffalo than a gazelle, but no dice. This event was 70% technique, and figuring out how to get the ball to make the correct-shaped arc (so it cleared the wall) had a steep learning curve. Even the strongest-looking women often missed the wall because their ball ended up going straight up and down instead of backwards. I opted to get as close to the wall as possible and just “gut out” the high reps of Burpees.

I was relieved to see a familiar face in the crowd as I approached my med ball toss challenge. The owner of my home gym had arrived, video phone in hand, to memorialize my event. She was my only fan, and asked if I’d mind if she yelled out encouragements during my event. I agreed hesitantly, both nervous about the permanency of the video that was being made of my potential “flailings” and unsure if her shouts would induce panic or perseverance. Luckily for me it turned out to be the latter. And here’s the video to prove it:

The final event was a true soul-sucker. I watched some of the men compete, and they made it look easy. It was a combination of cement (aka Atlas) ball carries (up and down a field) and tire rope pulls. Again, as a “water buffalo” I figured I’d have an advantage on this one, but here is where I crumbled. As they started the timer, I ran out to the end of the tire pull rope and started dragging it towards myself, hand-over-hand. The weight of the tractor tire was startling, and it moved at about 1/5 the speed of the men’s pulls as I realized that this event was MUCH harder than it looked. I finally got the tire across the line and had to drag it back to the start. I was the slowest in my heat and could tell this wasn’t going to go well.

And then the race official pointed to the Atlas ball that I needed to pick up and put on my shoulder. I had never even touched one before. I squatted down, got my arms under it and used my quads to get it on my lap. The weight (75lbs) took my breath away. I knew there was no way I was going to be able to get this thing up and down the field and I lost heart. Somehow I managed to muscle it up to my shoulder, where it perched on my clavicle ominously. I started taking steps across the field. The weight was crushing. I marveled at the women in lanes next to me who were managing to make it down the field. Time stood still in the 95 degree heat with no shade and no relief anywhere in site.

By some miracle I got that ball all the way up and back, and made it through the next tire pull. Then back to the start again where the official instructed me to pick up the same Atlas ball and do a second lap. I felt the will drain out of my body. There was just no way I could do it. I struggled to get it on my shoulder again and made it on my third attempt but then got about 20 feet down the field and dropped the ball. I tried to get it up again but couldn’t. I tried to carry it like a baby in front of me but it broke through my arm hold. I asked the official if I could take a penalty and get a lighter ball. Nope. That was not an option. So I spent the last few minutes in a futile effort to move the ball down the field and then finally the merciful timer signaled the end of the heat. I was the only woman who couldn’t get the ball back the second time.

And it was at that point that the infamous words of Dirty Harry Callahan came to me, “A man’s gotta know his limitations.” I had certainly found mine, and the humble pie was bitter-sweet. On the one hand, I was pretty amazed that I had not given up and gone home at any of several understandable points during the day. On the other, I was keenly aware of my physical limitations – and had to bow the knee to the truly gifted athletes who won the day. Would I do this again? Hmmm. Ask me once my cuts and bruises are healed. All I can say is that other competitions seem less frightening now, and maybe that’s the best gift that the Primal Games has given me.

In the future when I’m asked to join friends for a half-marathon or similarly grueling event, all I need to ask is, “does it include Atlas balls?” And if the answer is, “no” then I’m in! Thanks to the Primal Games my comfort zone has permanently expanded. I hope you’ll join me in the zone sometime, my friends! Misery loves company, after all. ;-)

P.S. The team winners of the Primal Games:

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