220 in 2020 · fitness · Guest Post · health

Getting a new perspective on self-care (Guest post)

So I have completed the “220 (days of exercise) in 2020,” 4 months ahead of schedule and am pretty damn pleased with myself. You should see my muscle definition!

I want to share a few thoughts I wish I had realized years ago because I spent the majority of my adult life struggling with weight loss and trying to make exercise part of that. As in, whenever I did any form of movement it was hoping that it would contribute to making my body smaller and more attractive. Sure, sure, healthy too but primarily smaller and more attractive. Thing is, exercise and weight loss are only loosely connected. Of course you can use it to burn calories and tip the scales in favour of weight loss but that’s not really the point because nutrition is the major determining factor here. And then of course the entire story of weight cycling and just how damaging that is etc.

Not all of HAES (Health at Every Size) is a good fit for me and the way I think about my body but the part of the HAES movement I can absolutely get behind of is this: large bodies still need to be treated well, just as medium sized or small bodies do. These things are independent of each other. Bodies need good nutrition; they need rest and they need movement. They need doctor’s visits and they need mental health support because being flooded with stress hormones 24/7 is a pretty damn damaging thing to a body.

So that is what this exercise thing is about, a part of the self-care puzzle. I used to buy into the idea that self-care is letting myself off the hook and eating whatever and how much I want to eat, relax on the sofa and have a good time with smoke and drink if I fancied it. But really there’s nothing self-caring or self-compassionate about it because at the end of the day no matter what stories we tell ourselves about it, that doesn’t change biological reality. Well at least I don’t buy into that whole “affirmation changing reality” thing.

Now don’t get me wrong, this is hard. First of all, it’s years and decades of thinking one way and then trying to change that. It takes time and effort and while I do have “an acre of greens” in the fridge as my partner lovingly mocks it, and have had for years, it’s really hard to get away from the constant barrage of treat food that isn’t really a treat given that it’s a daily feature, so more like a staple. There’s the time, money, effort and all those things. I have actually realized that working out regularly is easier than eating well regularly because for exercise you’re done at some point in the day. Complete a morning workout and you can feel good about yourself for the rest of the day, knowing that any additional movement is good and likely but still, you’ve done the thing. Eating well, relaxation, mental health practices etc are much harder because it requires a sustained effort throughout all waking hours and a litany of decision points. So, it’s hard and requires a mindset of learning and growing rather than all or nothing on/off the wagon thinking.

So what did I do this year for the exercise thing? I just started, focusing on the things I felt I could do. There has been a lot of walking and especially initially I did a fair bit of semi guided dance sessions. Body groove on demand is really really good for that because it is very inclusive of many abilities, genders, bodies and ethnicities. I felt very much represented by the cast in the videos and it was fun. It helped me gain some confidence in my ability to move and to show up, which in itself is maybe the most important skill to develop.

I then went through a series of programmes on daily burn, there are some beginner ones that helped with the whole thing of getting into the spirit of doing uncomfortable things. Like getting down on the ground and up again repeatedly or like sticking to the exercise for a few seconds longer etc. Then moved on to more demanding ones, I like kickboxing and circuit training, barre, yoga and pilates.

The rewarding part has been trying to increase my ability to do things. For example, there’s a pilates move I just can’t do so I found a ten minute video (on Pilatesology) that is a preparation for that move. Still working on being able to do a full push up, or burpee, clean lunges, and so on. It’s rewarding to feel stronger just for the sake of feeling stronger. And more agile, mobile, fit. Whatever size or whatever appearance.

Below is my gym. This, and a sports bra if you are of the booby persuasion is plenty. Onwards to 300!

Image may contain: one or more people

TabeaD is a university lecturer and enjoys gardening, crafting and making art. After struggling with her weight as a very large person for decades, she has started to increasingly explore ways to drop the struggle and make peace with her body while finding ways to be healthy and active. Over the years she has engaged in swimming, various forms of dance, tai chi, yoga and weight training although she has struggled with consistency and motivation throughout, which has led her to engage in “220 in 2020.”

fun · habits · health · motivation

Christine works out with Wakeout

I’ve been having big fun with the Wakeout app.

Wakeout, which bills itself as ‘Exercise for busy people,’ delivers exactly what it promises – short, fun workouts to do in a variety of settings.  

As you probably know, I find it challenging to decide what exercise to do when and how long to do it for. Wakeout helps me sidestep those issues because I can set a reminder in advance (always useful for me!) and then I only have to choose the location and duration of my exercise. 

The duration choices are short  – one, three, or six 30-sec exercises (although you can do multiple Wakeouts in a row) and the settings are limited – you can choose home, office, travel, or outdoors and then select different categories within each. Even though there is a lot of possibility contained within each category, I find the process of choosing to be quite straightforward in this case. 

A light haired dog sleeps on a partially-made bed. There are bookshelves in the background.
This morning, I had to do my Wakeout on my chair instead of the edge of the bed because Khalee had made other plans.

I really like that the exercises are done in 30 second bursts instead of by reps – I love a timer but I hate counting reps. I appreciate just sinking into the movement and not having to focus on counting.

And I like the types of movements the app gets me to do.  

It’s not just bicep curls or squats, it’s movements on all sorts of different planes. For example, 

In a recent Wakeout, I was holding a pillow and moving sort of sideways figure eight with my arms – as if I were in a pillow fight and had an opponent on either side of me. This exercise had me moving my arms in a whole different way than I would normally do and I felt like my range of movement increased over all. 

I am much too used to working forward, sideways, or up-and-down and I forget about making more circular sorts of movements. Wakeout’s prompt to move different, helped me to engage different muscles or at least to engages the same muscles in different ways and that really really felt great.

One of my favourite exercises that I had to do involved standing in front of the counter in the kitchen and reaching upward into a high cupboard. That specific movement felt great for my arms, my back and my legs and I have repeated it often even when I wasn’t doing the app – sure, sometimes I was just reaching for something in the cupboard but mostly it was for a little extra stretch.

The app keeps track of your workouts and tells you your accumulated minutes and how many minutes it will take to reach the next level. I also enjoy this encouraging feature and it’s rewarding to push a little hard to get that visible (on the screen) result.  One of my ongoing challenges with consistent exercise is how hard it is to SEE the benefits of my efforts. This small visual makes a big difference for me. 

A screen cap of the Wakeout app.  A black background with green text and images. It says 'Awesome' at the top and then shows an image of a green bear with sunglasses surfing through some planets. Below the image are some stats revealing that the user is at Activity level 5 and that they can reach the next level  in 12.5 active minutes.  They have 6 total wakeouts, a 6 day streak, and 9 active minutes. At the bottom is a green button inviting them to wakeout again.
Sure, it’s only a small thing but I love seeing these numbers and knowing exactly what I have to do to get to the next level. Even if the level itself only has meaning inside the app, it coaxes me to keep moving.

Often, I will shy away from short workouts because of the decisions involved – trying to figure out what is ‘enough’ to do is especially tricky for people with ADHD. The Wakeout app removes some of my obstacles to bothering with a short workout – I can just open the app and do what it says and not have to think too much about it. 

Obviously, I would have to either do a lot of Wakeouts to become seriously fit but I find these small bursts of activity encouraging and rewarding and they really feel great.

I haven’t been through all of the workouts yet, of course, but from the ones I have seen so far, I would like to see a greater variety of body types/sizes and abilities represented in the demos. (To be fair, though there may be greater variety than there currently appears to be. I may just not have seen everyone yet.)  

I like that the demo models aren’t all white but not having seen the entire range of workouts yet I cannot comment on whether the diversity of the models is truly representative or just a nod to inclusion. I am hoping that it is the former rather than the latter.

Overall, I really enjoy the workouts and features in this app. I didn’t it like it much when one of the reminders made me feel entirely responsible for our sedentary society but that’s on my overdeveloped guilt reflex, not on the makers of the app!

I don’t know if it would be helpful or frustrating for someone who already spends a large part of their day exercising. It might be enjoyable to try some different movements – especially if any part of their day was spent at desk work – or it might be annoying to do these small exercises that might not work their bodies hard enough for their liking. 

As far as I can tell, Wakeout is only available for Apple products so far. You get a 7 day free trial and then you can purchase a monthly plan for $6.99 which you can share with up to 6 people. I enjoyed it enough to sign up for the monthly plan but I wish I could include my family members who use other non-Apple devices. 

feminism · fitness · fitness classes · health · inclusiveness

What’s the top thing you would change about the fitness industry today? (Group post)

Image description: Tracy’s minimalist home workout gear: overhead shot of running shoes, a cloth basket with a tennis ball and workout bands and a few other indiscernable items, set atop a yoga mat on a wood laminate plank floor.

When Sam and I started the blog back in 2012, we were committed to offering feminist thoughts on fitness and to trying to incorporate our feminism into our fitness lifestyles as we approached our 50th birthdays. Now, as we approach our 56th birthdays in the next couple of months, we continue to reflect on the ways the fitness industry could be friendlier, more inclusive, and more approachable. We are both super pleased that we have managed to carve out and support a community of others who are seeking an alternative to the usual messaging.

I’ve been doing the virtual Superhero workouts with Alex (for more info, check out ABH Movement) a few times a week, and on Friday evening she had a team happy hour on Zoom. She sent around four questions for us to ponder before we met, with the plan to discuss them. We didn’t make it to all of them (because by the time we did a full round where we each talked about when we first started doing fitness classes, happy hour had already spilled into 90 fascinating minutes). But Kim and I thought the final question would make a great group blog post: What’s the top thing you would change about the fitness industry today?

So I did the thing we do: I asked the Superhero team and the blog regulars for their answer to this question. And here’s what people had to say.

Nicole: I would take away the nutrition advice that some gyms provide. I don’t think there is a good way to do it in that environment. Also, it should be illegal for the instructor to say “did you indulge a little last night? Hungover? It’s OK, that’s why you are here!” No, I’m not here for that at all. Ever.

Tracy I (me): If I could wave a magic wand I would banish “weight loss” as a fitness goal from the entire industry. I would replace it with learning to believe in yourself and to love (or at least neutrally accept and value) and trust your body and appreciate it for what it can do, whatever that may be. Also: to encourage other women along the way to do the same. No comparing (I wrote about comparing back in the day)! ❤️

Cate: So many things– I’m 100% with both Tracy and Nicole on this — but I’d add I’d strip out any admonishment or encouragement to focus on anything except form. I have been lucky enough to find some amazing coaches — like Alex — plus yoga teachers and spin instructors who really understand how to support people to work for the next dimension while also emphasizing form, safety, alignment and the specific strength, needs and possibilities of your own body. But occasionally I wander into a class — like at the Y, or with a spin substitute — whose whole coaching is “harder!”. I went to a “boot camp” class at the Y a few years ago where the (20 something) instructor mocked me for doing my lunges slowly and carefully. This is obviously damaging for individual bodies and psyches, but also, I think, one of the biggest things that turns newbies away from fitness.

Sam: Oh there’s so much I would change if I ran the zoo. (Sorry, I can never resist that line from Dr. Suess.) But the most important thing for me would be a much greater emphasis on inclusion and diversity. I want room in my fitness world for people of all races, and genders and ages and physical abilities. Along with inclusion and diversity, I want to end the assumptions about who does what. I want more women in the weight room and more men in the yoga studio.

Coach Alex: As a coach, I desperately want everyone to know that if you don’t enjoy something, you don’t need to do it to “get in shape”. There’s this notion that certain movements/ways of exercising are most effective or necessary for the progress you want to make, and that’s simply untrue.

So many people struggle with developing a consistent and healthy relationship with fitness because it’s either a chore they feel they “have” to do OR they are fearful of starting in the first place (fitness is scary and intimidating). The reality is the fitness industry promotes fad diets, exercise trends, and equipment that ultimately will keep you hopping on and off the bandwagon- but if you find movement you LOVE (whether it’s weightlifting, Zumba, a sport, cycling, etc…) then THAT’S what’s going to keep you coming back. If you do burpees because you think you have to (but you hate them), you’re going to dislike that workout and dread coming back. I wish more people knew that just the act of MOVING is enough to keep you healthy and make fitness gains, and once you find a form of movement that sparks joy for you, that’s where the fun really starts 😜❤️

Chippy (Virtual Superhero teammate): What id like to change is that women are allowed to have muscles and that doesn’t make you unattractive. Those muscles take a tremendous amount of work and are beautiful. Strong is beautiful and there needs to be a cultural shift that goes with that for women 😊

And we’d love to hear from you. If you could change one thing about today’s fitness industry, what would it be?

health · illness · sex

Sex and Trauma After Hysterectomy

CW: This post addresses trauma, flashbacks and PTSD, although it does not directly describe traumatic events. Sex and personal anatomy are referenced.

Six weeks after my hysterectomy, my gynecologist gave me the OK to return to all physical activities–including sex. And a few weeks after that, my husband and I found an opportunity to explore what that meant. I was eager to enjoy a regular sex life again. Before the surgery, while I hadn’t had any pain associated with intercourse specifically, I was afraid of potentially magnifying the pain I was already experiencing. I also felt increasingly alienated from my reproductive system as the months dragged on before the surgery–like my uterus and the surrounding architecture were fighting against me, forcing this mutant litter of fibroids upon me, despite my lifelong disinclination to ever becoming pregnant.

But instead of easing our way back into a regular sex life, I found myself heading into becoming frozen–stuck in place, nearly nonverbal, unresponsive as a possum hoping you won’t drive over it in the middle of the road. I managed to softly say, “no, no, no, no, no,” and everything stopped.

This was the first sign I had that something about the hysterectomy had been emotionally traumatic for me.

I recognized the feeling. My therapist and I had identified that I had many of the markers of PTSD long before the hysterectomy. I can be jumpy for no reason, startled by everyday noises. I can experience emotions disconnected from the present moment–overwhelming dread being the most common. I get heightened into fight or flight at the grocery store, or walking down the street, or driving, and have to work my way back down into my emotional window of tolerance. In these moments of panic or dread or rage, I know that they don’t make sense. I’m aware that they aren’t a true response to something in the present, but a ghost of terrible moments in the past.

But while I knew this about myself, I was not prepared for it to get worse with surgery. Nowhere did I read that this can be a risk, and it seems especially surprising given my past traumas are not sexual. Many of the resources I found as I prepared for the surgery mentioned that many women mourn the loss of their womb, that connection to motherhood in their bodies. I get that, but I wasn’t concerned about it for me. I have never wanted to be a mother, and I’ve always viewed my reproductive system as a sort of vestigial set of organs, that maybe protects my heart and definitely inconveniences me one week out of every month.

My surgeon knew of my PTSD symptoms as well–she got a firsthand look at them on our very first appointment. Her office is unfortunately located in a hospital associated with some of my past trauma, and from about two blocks away, through the entire hour-plus visit, and until I was able to leave, I was in a full-on panic attack flashback. I hyperventilated, found myself crying, and felt totally overwhelmed by the emotions flooding over me. Honestly, I felt completely ridiculous trying to explain to the nurses why I was so clearly struggling with self-control. For the next visit, they prescribed me some Xanax to take before I arrived.

Past traumas increase our risk of future trauma. Our nervous system remembers the feelings of threat, hopelessness, dread and loss of control. It is not a surprise that I was at increased risk of new trauma, but I am surprised that a procedure performed completely under anesthesia can result in trauma. According to my therapist, our bodies can remember what our conscious minds cannot. She equated it to the feelings you have when a tooth is extracted at the dentist–thanks to the novocaine, you don’t feel pain, but your body registers the pressure and physical trauma of the loss of a tooth. And so, apparently, my body registered the hysterectomy as a threat, and now I am finding myself urgently needing to protect myself from future perceived threats.

Now I am startled by simple, intimate experiences. I’ve had to ask my husband to ask permission before he reaches out to stroke my back or leans in for a kiss. Without the “warning,” I can’t breathe through my startle response and reorient to the present moment. Sex scares me. Even the thought of a nonsexual item like a tampon entering my vagina makes me feel anxious–my breathing becomes shallow, my heart starts to race. I am increasingly on edge, so much closer to fight-or-flight than I was before.

You might be asking yourself how common this is. In an admittedly cursory search, I didn’t find a lot of information, but this very recent study found 16.4% of participants experienced multiple symptoms of PTSD 2-3 months after hysterectomy. This older study from the Mayo clinic found a smaller, but robust, increase in the number of people showing signs of anxiety and depression after hysterectomy than compared to a similar population who had not had a hysterectomy. Now, neither of these studies can show us causation–does getting a hysterectomy make people more likely to develop these mental health concerns? Or is it that certain mental health conditions or predispositions make it more likely that someone gets a hysterectomy? Since we can’t do placebo hysterectomies on half of a cohort and then see if there’s a difference in prevalence of PTSD symptoms, I’m not sure how we can suss that out.

Regardless, I can’t help but believe that people would benefit from knowing about these risks in advance. At a minimum, people like me with a history of trauma could potentially work with their mental health professionals in advance to develop a treatment plan, should it be necessary. That is why I’ve decided to write about it, even though it feels very personal. It would be my hope that more patients and doctors can be aware of these risks and be encouraged to talk about them.

It has been a year since I first wrote about my hysterectomy here. At that time, all I was concerned about was my physical health and fitness afterwards–I wanted to stay as strong and physically resilient as I could as I healed. Those physical concerns are in the past now. I can lift however I want. I can run without pain. But I’m still dealing with the consequences of my hysterectomy, and I can’t help but wonder how long these new ghosts will haunt me.

Photo description: a pathway leading towards a sunset or sunrise.

Marjorie Hundtoft is a middle school science and health teacher. She can be found reorienting to the present, picking up heavy things and putting them back down again in Portland, Oregon.

220 in 2020 · fitness · habits · health · motivation · rest · running · schedule · strength training · training · walking · yoga

220 in 2020: goal achieved, now what? Hint: keep going

image description: Tracy selfie. She’s smiling, wearing a Buff on her head and a workout tank, upper left arm tattoo of flower visible, home workout equipment (e.g. running shoes, cans of beans, chairs, blanket, bin with resistance bands, yoga mat on floor) in background.

A few of us have blogged about participating in “220 in 2020,” which is basically a group where you keep track of your workouts, with a goal of working out at least 220 times in 2020. Cate and Sam started talking about it back in 2017, when they did “217 in 2017.” It got Sam to think more explicitly and more expansively about what counts. And Cate has talked about the motivating power of this type of group and how it’s altered her relationship to working out. I jumped on board last year, with the 219 in 2019 group that spun off of the Fit Is a Feminist Issue Challenge group that Cate, Christine and I hosted for a few months in the fall of 2018.

Reflecting on “what counts” is not a new thing for me. Way back when Sam and I started the blog in 2012, I was already wondering what a workout actually is for me. I revisited that question when I joined the 219 in 2019 group. Then I concluded that “if these challenges are meant to get us moving, then whatever gets us moving counts.”

I just hit the goal of 220 workouts in 2020 on the weekend. It sort of snuck up on me. In fact, I didn’t even notice when I first posted it. It’s not something I “had my eye on” the way I did last year. I’ve even wondered whether it seems like a bit of an impossibility or something people view with skepticism.

Last year, using as my basic criterion “if it gets me moving then it counts,” I managed to get in the 219, with a few extra but not many. The vast majority of sessions I counted were either yoga classes, runs, or resistance training sessions. I had a sort of minimum time limit of about 20 minutes before I would count something as a workout. Yoga and personal training were always an hour. And most of my runs are at least 20 minutes and sometimes considerably longer.

By the time 2020, going on the momentum of 2019, I had successfully incorporated conscious movement into my routine every day. Sometimes, especially but not only while I was in Mexico in January and February, I would do something twice a day, like yoga and running, or yoga and a 10K walk. Starting with Adriene’s “Home” yoga challenge in January, I have actually done yoga almost every day since the beginning of the year. When I started to notice the numbers really racking up on my “count” in the 220 in 2020 group, I began to count two things in a day as one workout (like run+yoga OR walk+yoga) unless one of those things was super exerting or considerably longer than an hour). It’s almost as if I felt bad!

But the fact is, the goal of being able to record a new workout often did motivate me to get moving. And once I had yoga as part of my daily routine, I didn’t want to break that streak of daily yoga. But for me yoga alone is not enough — it counts, but I need to either run, walk, or do some resistance training as well.

Another woman in the 220 in 2020 group also hit her 220 on the weekend. And she asked me, “what now?” My first answer was “keep going.” Which is sort of obvious. I went on to wonder whether there is any reason to keep recording and reporting my workouts, though. The group has achieved its purpose for me — over the past 18 months of being part of a group like this I have integrated physical activity into my daily life in a way I hadn’t quite before. This is made easier this year by my sabbatical, so I am much freer than I usually am. For at least a few more months I get to set my own hours. That allowed me to kick into high gear in the fall, with hot yoga every day (oh, how I miss hot yoga! The pandemic has effectively taken that out of my life for the indefinite future). I made a smooth transition to Yoga with Adriene when I went to Mexico for the winter. That gave me a headstart on the transition to online everything that the pandemic has foisted upon us.

The running/walking + yoga combo was just starting to feel old when I discovered, through Cate, the online Superhero workouts with Alex in late April. That was just the thing I needed to add a new dimension of challenge to my fitness life. I had set resistance training and even running aside for awhile, having injured myself last spring and endured a very slow recovery. For me the perfect balance is a routine that includes yoga, resistance training, and running/walking. I don’t tend to take a day off, opting instead for active rest, combining a more restorative yoga practice with a walk.

This commitment to a routine that includes daily physical activity has also been amazing for my mental health. I have had a tough couple of years that culminated in the finalization of my divorce in early January. Sometimes it felt as if regular physical activity was the only thing I could commit to as part of a daily schedule.

When I stepped away from being a regular on the blog at the end of last summer, it was partly because I had very little left to say publicly about fitness. That still holds true, with the occasional blog post (I think I’ve blogged about 5 times since I “left”) and my daily progress tracking in the 220 in 2020 group being the extent of it. Once in awhile I feel compelled to make some social commentary (like my commentary on “the covid-19” weight-gain jokes, which aren’t funny).

As I hit my 220 target early, with almost half a year stretching out before me, I feel that it’s cemented what started when Sam and I embarked on our Fittest by 50 Challenge and started the blog in 2012. The big shift for me during our challenge was to a more internal and personal relationship with fitness. I realize full well, for example, that no one else really cares, nor should they, what I do. This isn’t to say I haven’t felt supported, encouraged, and motivated by the group. It isn’t to say either that I haven’t enjoyed watching the fitness lives of other members — their accomplishments, their routines, the adventurous and exciting things they do. It is to say that, in the end, I do this for myself. And I’ve experienced the benefits in my life.

So the answer to the question, “what now?” actually is, “keep going.” Not to accumulate a higher number (though I will, if I keep reporting in the group), but because it’s now a thing I do that is a positive part of my life. And recognizing that, it makes no sense to stop. I also think it’s pretty awesome, and I’m not going to worry if that makes me sound boasty or whatever, because sometimes I think we are not boasty enough. We minimize things we do that are actually awesome. And since (as noted above) no one else really cares, and since I definitely do care, well…it makes sense for me to regard reaching this fitness milestone about 5 1/2 months early as an actual achievement. [high-fiving myself now despite slight discomfort at what I just said, which discomfort highlights that I’ve internalized the message about how women shouldn’t be self-congratulatory about what they do even though I actually think we should]

So that’s my “challenge group” story for 2020. Do you have one? If so, let us know in the comments how that helps you (or, if you fly solo, why that works best for you).

covid19 · cycling · fitness · health · running · walking

Multi-use pathway: tough to navigate at the best of times

In my little city of London, Ontario we have a fantastic system of pathways–The Thames Valley Parkway– that run mostly along the river, through parks and wooded areas. It’s long and lovely, covering over 40 km of ground.

Image description: Map of London, Ontario’s pathways and bike routes. A yellow line snaking alongside the river indicates the Thames Valley Parkway.

Not surprisingly people use it a lot, not just for leisure but also for commuting from one end/side of the city to the other, for walking their dogs, for exercise. But that’s not the sense in which it’s “multi-use.” That refers to the modes of moving along the path — people walk, run, ride their bikes, travel on their inline skates and skateboards and non-motorized scooters, and in wheelchairs and mobility scooters. The posted speed limit is 20 kilometres per hour. At the moment, there are signs asking people to respect the covid-19 physical distancing guidelines to remain at least 2m apart.

Our local CBC asked the following question recently: “Between cyclists and pedestrians on the Thames Valley District Parkway, who gets the right of way?” They posted the same question on their FB page. As someone who has been using the pathway for a long time, not just during the pandemic, I wasn’t surprised that most replies didn’t even mention the pandemic.

Yes, the physical distancing guidelines raise a whole new set of issues about giving others their space. And (apparently), COVID-19 restrictions have increased the use of the pathway system because our other options, like gyms and yoga studios, are all closed. Plus, kids are home and many adults are either working from home (giving them in some cases more flex in their schedules) or not working. With outdoor exercise being touted (rightly) as an effective way to nurture your mental and physical health at the same time, health experts have emphasized its importance for us during the isolation of the pandemic.

Most people who commented in the thread said that the usual rules of the road should apply, not just during the pandemic, but all the time (how it should be “all the time” was a recurring theme). That would mean pedestrians have the right of way. But not all agreed. Some thought, for example, that since pedestrians can more easily duck out of the way, cyclists should have the right of way. The fact is, the TVP is not a road and the city has not spelled out any guidelines for its use other than “share the path.” The convention is that on the two-lane pathway, pedestrians and cyclists alike use the right-hand lane.

The CBC London comment thread had the usual complaints about cyclists from pedestrians — they don’t ring their bell or say anything to let you know they’re approaching, they pass too closely, they go too fast, they ride in packs (or side-by-side). And there were the usual complaints about pedestrians from cyclists — they take up too much space instead of keeping to the right, they are wearing earbuds so they don’t hear you when you call out, they are sometimes erratic.

The path itself is anywhere from 2.4 to 4 metres wide. That makes it logistically impossible to maintain a two metre distance from everyone you might encounter, whether you’re on foot or on a bicycle, regardless of how much you’d like to keep a safe distance at all times.

Remember too that not everyone on foot is walking. I use the path as both a walker and a runner, and have also used it a lot as a cyclist. My view of what’s irritating, because in general that is how I would describe my reaction when other people’s use of the path creates friction for my use of it, depends a lot on what “mode” I’m in. As one person said to the CBC, “When you’re a pedestrian, you want to think the faster people should get out of your way, but now that I’ve been biking a bit more, I realize I have the opposite mindset when I’m on a bike.” Similarly, when I’m riding my bicycle (or even when I’m running), I get grumpy when people are walking together and taking up the whole lane. But of course, walking in the park together is a thing. An enjoyable thing. And now that we are physical distancing, walking with a friend required that you be further apart than usual.

The other morning when I was out running, I kept as far to the right as possible (I always do that for my own sense of safety from the fast cyclists). Most cyclists who needed to go around me gave a wide berth, but not 2m. I had the easiest time with the people who were running or walking in the other direction because I could (and did) just step a few feet onto the grass as I passed them. Indeed, when possible, I enjoy running on the softer edges beside the paved part, but it’s not always flat enough to do that without risk of turning onto an ankle. The most challenging obstacle I faced was the group of four people walking their large dogs. Between the people and the dogs on leashes, they were literally spread out over both sides of the path, creating a real blockade for cyclists. I did my usual thing and ran off the pathway to navigate around them, but I was annoyed.

I think the worst thing cyclists do besides passing too closely happens when there are pedestrians or runners coming towards me in the other lane and a cyclist approaching them from behind who wants to pass them. It has never been clear to me why it makes more sense from the cyclist’s point of view to ride straight into the path of a pedestrian or runner (me!) in the other lane instead of waiting for a clear passing opportunity. It would be as if you were driving on a two-lane highway and you just kept going at speed, passing cars in front of you without any regard for whether there was on-coming traffic. It wouldn’t even occur to you but quite honestly, 9/10 cyclists do this as if it’s the most reasonable choice in the world.

I’m sensitive too to the issue raised about being in the “slipstream” of a runner or cyclist who passes me (or vice versa if I pass someone). I don’t really know what to do about that, so I just hope for the best. Did that slipstream thing get debunked or at least, did someone say it was overly simplistic? Regardless, it’s hard not to think about mini-droplets hanging in the air and how long they may linger there. Sometimes I try to hold my breath but I have considered that possibly that makes me then gasp for air with an extra deep inhale at exactly the wrong moment. On a related note: I have noticed that some people sort of turn their head away and fewer people say “hello” (we live in a city where the norm is to say hello to others on the path). Thankfully some data show that being outside reduces transmission risk a lot.

I am sort of onside with the view that there is no clear right-of-way rule that can easily apply in every case when it comes to the pathway. This is unfortunate because clear rules would be helpful. But I am aware that just because something annoys me doesn’t make it wrong. For example, I have been the cyclist too, and if there are lots of people walking it is exhausting to continually ring your bell or say “on your left.” Indeed, “on your left” can sometimes confuse people or startle them (though typically they will thank you for letting them know).

On the water, when boating, there are clear rules about sail boats having the right of way over power boats. But there is also a sort of convention that the boat who can easily maneuver out of the way should do so if it would be more difficult for the other boat (that’s the reasoning behind why a boat under sail typically has the right of way), even if the other boat technically has the right of way. And really, from the safety point of view, you need to be sensible — if you’ve technically got the right of way but holding your ground might mean you’re going to get run over (like if you’re sailing and a freighter is coming up behind you at twice your speed), then you get out of the way.

I operate kind of like that on the pathway. And most others do too. And as several people on the CBC London Facebook thread said, usually it goes pretty smoothly. And that is amazing considering how busy the TVP can be at times. But I have also taken to going as early in the morning as possible if I’m going to be on the path. And sometimes I don’t have the energy to put up with the added stress, so I just avoid the pathway altogether. I’ve adopted a general policy, that I expect I will maintain for as long as the physical distancing guidelines are required (read: until there is a vaccine and most people have been inoculated): I run alone.

I am still experimenting with physical-distanced walking with friends and I have to say I don’t love it. I need and like to connect in-person with a friend from time to time. But it’s hard to keep proper distance (some people disagree and say it’s easy — that’s not been my experience) and I feel like a jerk if I keep dwelling on it. It also proliferates the navigational challenges of encountering other pairs or larger groups of people walking, running, or cycling together. So, personally I have found it stressful, especially on the pathway. To be quite honest, my preferred way of doing physical-distanced visits with friends is to each bring our own chair and set them up at least six feet apart whether at the park or in someone’s yard. No navigating required. Public health recommendations uncompromisingly followed.

What’s obvious is that in the absence of totally separate pathways, like on the Vancouver seawall where the walking path is distinct from the cycling path, we will need to find a safe way to enjoy these spaces together. The safety and health issues of physical distancing are just one more thing to add to the mix this year. If we’re mostly out there to improve our sense of well-being, and we are truly all in this together, then the both the individual and public health benefits are best achieved by being chill instead of annoyed.

covid19 · Guest Post · health · illness

COVID-19 and the Gym: Building Engineers Weigh In (Guest Post)

by Sarah and Cara

As mechanical engineers who consult on heating, ventilating, and air conditioning (HVAC) systems, we’ve been closely following the evolving body of knowledge about how the SARS-CoV-2 novel coronavirus (the virus which causes COVID-19) spreads through the air. We thought some folks might be interested to know some of what we’ve learned, and how that’s affecting our thoughts on returning to the gym.

Some of the science so far

So far, we know that droplets in the air we breathe out (and in) are infectious to varying degrees depending on the size of the droplets – and that those droplets have the potential to be propelled for varying distances.

Relatively large and heavy droplets fall on and contaminate surfaces. This is a whole other topic, but it seems to be relatively well-known and understood. Also it can be controlled with frequent cleaning, so it’s less important from an engineering point of view. At the moment, our big concern (and the focus of this post) is with the smaller, lighter droplets known as aerosols. 

Scientists and engineers take particular note of so-called “superspreading” events (such as the ones that were mentioned in  Saturday’s post because they point to clues about how an infection is transmitted in a variety of real-world situations.

In the example of the choir in Washington State one mildly symptomatic person infected 52 of their 60 fellow choristers over the course of one or two 2.5 hour practices. Besides sitting close together, it is thought that the act of singing, itself, might have contributed to transmission, as aerosol emission has been correlated with loudness of vocalization.

The dance fitness classes in Cheonan, South Korea gives valuable insight into what factors which affect the risks of exercising indoors. Sports facilities are generally considered to represent a higher risk of transmission due to the warm, moist indoor air coupled with the turbulent air flow generated by intense physical exercise, which can cause more dense transmission of droplets.

Six instructors who were infected at a workshop went on to teach classes for about a week. Not all of them were necessarily even symptomatic. Secondary cases were identified from fitness dance classes with as few as 5 people in a ~60 square meter (~645 square foot) studio. Notably, an instructor who taught 7-8 person Pilates and yoga classes at one of the same facilities did not infect any of her students. Together, these us some insight as to how transmission risk might be mitigated in the short term for group fitness classes : very small class size, limits on movement to maintain physical distance, less aerobically- and movement-intense activities.

In the long term, engineers and building owners will have to address the significant concern that was raised by another notable case of a restaurant in Guangzhou, China one patron infected eight others who were sitting more than 6 feet / 2m away. It appears that air flow from the HVAC system helped carry infectious aerosols from one table to another.

A restaurant seating plan
with arrows showing airflow direction and circles showing the location of those who were infected
https://wwwnc.cdc.gov/eid/article/26/7/20-0764-f1

The role of HVAC in controlling transmission

The possibility that a normal HVAC system can carry it through the air over distances greater than the current physical distancing guidelines is a major concern. While we don’t yet know for sure how infectious COVID-19 is in aerosol form, the Epidemic Task Force of the American Society for Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE, the leading industries standards organization) have stated: “Transmission of SARS-CoV-2 through the air is sufficiently likely that airborne exposure to the virus should be controlled.” 

In hospitals, aerosols are controlled by continuously moving lots of air through infectious spaces to dilute them, adding lots of fresh air, careful airflow design, and HEPA filtration.  All the air in a typical patient room is filtered about once every four minutes. While gym ventilation is actually comparable to that of hospitals – gyms need comparatively good ventilation to keep them from smelling bad – the circulating air may have little or no filtration. Even if a gym’s air handling equipment is modified with HEPA filters, to achieve that circulation the HVAC system draws air from one side of the space and blows it on the other side. Just like in the restaurant example above, air exhaled by someone will move through the breathing zone of those nearby.  

When outdoor temperatures permit, it may be possible to make temporary changes such as opening existing windows and doors to encourage wind and buoyancy-driven natural ventilation in order to increase airflow and dilute contaminants in an existing fitness space. The openings need to be large to make a difference : a crossfit gym with a roll-up garage door and a back door propped open will be safer than a studio with a small open window. Openings on more than one side of the room gives better access to cross-breezes; openings high and low in the space will drive buoyancy flows, especially if the gym is warmer than the outside air.  When natural ventilation is working well, the indoor air will smell like outside, and match the outdoor temperature and humidity levels, so the comfort of the occupants will vary accordingly.

Other approaches to improve airflow in gym spaces, such as redesigning the air distribution to direct fresh air directly onto each occupant, will be expensive and disruptive to install – and unfortunately, still not proven to be entirely effective against airborne infection. There are some HVAC solutions that will reduce the concentration of infectious aerosol droplets in the air in buildings, notably increasing outdoor air volumes; HEPA filtration; and UV lights that sterilize air above the heads of occupants.  These solutions reduce, but do not eliminate, the risk of virus transmission.

What are the risks?

As gym patrons, we miss the motivation of exercising together with others, and access to equipment we don’t have at home. As we start to evaluate the risk of returning to indoor activity, there are a number of airborne infection risk factors which must consider in our decision making:

  • Indoor exposure: Whether an office, a store, or a gym, shared indoor environments have inherent transmission risk. Each additional person occupying the space with us increases the risk.
  • Extended exposure: Being the same place with specific other people for an extended period of time (15 minutes or more). 
  • Stationary exposure: Being in the same position relative to other individuals for an extended period of time, especially if the air conditioning system is blowing past the person next so that you are breathing their air.
  • Increased respiratory droplet exposure:  Intense aerobic activity, shouting and deliberate sudden exhalation reportedly increase the amount and spread of respiratory droplets. A low-intensity yoga class represents a lower risk than, for example, a Kiai (shout) filled karate class or high-intensity cardio class.
  • Mechanical system efficacy and state of maintenance: Many gyms and other fitness spaces are tenants in older or repurposed commercial spaces which are not always in the good repair. HVAC systems lose effectiveness as they get older, and may distribute air poorly. Some owners may even shut off HVAC systems due to safety concerns but these actions could actually increase risk if they reduce the outdoor air flow into the space. 

Controlling the risks 

For any given hazard, there are many different possible ways to address or mitigate the associated risks. Those who have taken a workplace health and safety course may recognize this hierarchy which is commonly used to rank the effectiveness of the various controls.

Heavily adapted (by Cara) from The National Institute for Occupational Safety and Health (NIOSH) guide to Controlling exposures to occupational hazards.[Content source: National Institute for Occupational Safety and Health National Institute for Occupational Safety and Health] 

Preventing infection using an engineering control – like the fresh air system inside a gym  – or administrative controls such as cleaning –  is necessarily less effective than substituting a lower risk activity – such as exercising outside in places where physical distancing can be maintained.

Is outdoors actually safer?

Both published research to date and epidemiological consensus appears to indicate outdoor activities are extremely low risk: a recent, not yet peer-reviewed study of infections in Chinese cities outside Hubei province in January and February showed that less than 1 in 300 outbreaks (only 1 out of 7000 individual infection events) could be traced to contact that occurred outdoors. B.C.’s provincial health officer has been quoted going so far as to say “the risk [of catching the virus] would be infinitesimally small if somebody walks [or runs] by you.” 

The evidence is strong that for the foreseeable future, substituting parks, backyards or even gym driveways will be a reasonably safe way to enjoy exercise with others, while indoor workouts will remain high risk until either the risk of exposure to infection can be eliminated, or effective engineering controls can be implemented. We want to support our fitness spaces, and we are hopeful that the summer weather will allow everyone to use the outdoors to bridge the gap until it’s safe to be together inside again.

Pictured: Yoga practitioners in supine spinal twists on colorful yoga mats in a wide, spaced circle  around an instructor in a park on a sunny day:  2018 Madison Yoga Challenge, Lung Cancer Research Foundation (LCRF)(Flikr) Photo from:Lung Cancer Research Foundation (LCRF)

Cara is an active promoter and designer of sustainable buildings, specializing in multi-unit residential and municipal facilities, enjoys dancing, Jeet Kune Do, acroyoga and circus arts, and bikes to get places.  

Sarah specializes in existing residential and commercial high-rises, and the systems that make them habitable. She spends far too much time poking around the guts of buildings and not nearly enough time on road bikes, sailing dinghies, or skis.

We’re both professional engineers.

 

 

 

fitness · health · illness · self care · strength training · training

How much is too much? Some thoughts with lots and lots of links

So we all know that this isn’t the best time to get into the best shape of your life, no pressure from us, relax and do what it takes to help you cope in these stressful, strange times, but we also know that exercise–some exercise–is good for dealing with stress and anxiety.

So that’s from the point of view of mental health and emotional well-being but there’s also the idea that exercise helps with our immune response.

Yoyo penguin

Okay, how much? Maybe mild to moderate exercise two to three times a week.

According to Alex Hutchinson, everyone agrees that regular, moderate exercise is good for your health.

“Doing regular moderate exercise lowers your risk compared to doing nothing; studies typically find that near-daily moderate exercisers report about half the typical number of upper-respiratory tract infections. That’s an important message for anyone who’s tempted to slack off their fitness routine until life returns to normal.”

Got it. Get moving. Check!

Now!

Okay, but we’ve got lots of time, right? Why not exercise lots more.

The worry is that too much is bad for your immune system. Again from Hutchinson, “If you ramp the dose up too high, your risk climbs steadily until you’re more vulnerable than if you’d done nothing at all. For that reason, Oregon-based elite track coach Jonathan Marcus recently argued on Twitter that athletes should avoid the type of gut-busting workouts that might put them at higher risk. “To train hard now is irresponsible,” he wrote.

(Short version: It looks like intensity is okay, what sets back your immune response is long duration exercise.)

Moderation seems to be key.

Here are two sports scientists writing for The Conversation, How much exercise is OK during the coronavirus pandemic?

“Both too much and too little are bad while somewhere in the middle is just right. Scientists commonly refer to this statistical phenomenon as a “J-shaped” curve. Research has shown exercise can influence the body’s immune system. Exercise immunity refers to both the systemic (whole body cellular response) and mucosal (mucous lining of the respiratory tract) response to an infectious agent, which follows this J-shaped curve.

A large study showed that mild to moderate exercise — performed about three times a week — reduced the risk of dying during the Hong Kong flu outbreak in 1998. The Hong Kong study was performed on 24,656 Chinese adults who died during this outbreak. This study showed that people who did no exercise at all or too much exercise — over five days of exercise per week — were at greatest risk of dying compared with people who exercised moderately.”

Exercise dog!

Interestingly, exercise rates are on the rise during the covid-19 pandemic among everyday exercises and down for elite athletes. In a way, that’s not a surprise for serious competitive athletes. All of their competitions are cancelled. They are just in maintenance mode mostly. For us, everyday types, we actually have some time, some of us, and exercise is one of the few things we can do outside. We’re moving more and they’re moving less and maybe we’ll all meet in the moderate middle. Go us!

It’s the same I think for strength training and weight lifting. The moderates like me, have installed home TRX-es and bought the odd kettlebell. I’m glad I got mine before they all sold out. But some of the serious gym rats I know have just out and out declared it bulking season and say that if there aren’t big weights available, they’re just waiting it out and doing lots less.

Okay, but not everybody is moved to moderation. Some people are making a personal challenge out of these odd times, like the 13-year-old boy who ran 100 miles in Quarantine Backyard Ultra or the man who ran a marathon on his PAris balcony during lockdown.

And none of this is shared with any advice giving intentions. If you care what sports scientists have to say about how much exercise is best during a pandemic, then go follow the links above and read away. If you need, from the point of view of your mental health and well-being to do more or do less, than do what you need to do.

It’s the moderation point that interested me, and I thought I’d share. Thanks for reading!

advice · death · disability · Fear · health · self care

8 Lessons for Living with Uncertainty From a Perennially Vulnerable Adult

I get it. You’re facing down the barrel of your mortality right now, and the mortalities of your parents, grandparents, children and other people you care for. It sucks. Random, horrible things can happen and change your life forever. Or end it. But this isn’t news. Life can change in an instant, and it can be completely out of your control, and that has always been true. The only difference is now you are being forced to face the reality you could comfortably deny as long as your life was banally humming along. Welcome to my world.

At the age of 24 I went from a healthy, active person to someone with a disabling, life-threatening immune condition. Random chance, totally bad luck, threw me a curve ball that kept me in the hospital for a month, left me missing a big chunk of one lung and unable to walk up a flight of stairs without assistance. I spent 8 months on high-dose Prednisone and three years after that on weekly chemotherapy drugs to keep my body from attacking itself and killing me. I hate stories about how some horrible cancer diagnosis “was the best thing that ever happened to her” or how some terrifying ordeal “helped him have gratitude for the important things in life.” I don’t think my immune conditions (I’ve developed more over the years) have made me a wiser, better person. But I have learned from the experience, and I’d like to offer you these potentially comforting observations I’ve noted along the way.

The hardest part is the not knowing. It took about half a year before I had a diagnosis. Even with a diagnosis, the prognosis was up in the air. At one point I was told that I had only a 50% chance of living past 5 years. Later on, I was told they really didn’t know, there was just too little data to base any predictions upon. I believe that knowing is always easier than not knowing. How do you live your life day to day when you can’t plan for the future? You will make very different decisions when you know that something is temporary than when it may be indefinite. Coming to a place of accepting that you don’t know, living in the moment while planning for the future is the best balance I can suggest. For me, I have had to learn over the years to consider my barriers and limitations as flexible unknowns–I have to push against the boundaries to test them–is this a real limitation or simply something I feared would limit me? It’s a constantly moving target, and I’ve learned to be flexible as situations have changed.

Your life is at increased risk. You can get used to it. In fact, if you are going to get on with your life, you have to get used to it. We can only hit the pause button for so long, and then we need to get back into the swing of things. You will need groceries, a paycheck, a new pack of underwear. I live my life every day with the awareness that my condition can come back. Every time I have a cough, I have to consider, “Does this feel more serious than just a cold? Am I being irresponsible if I wait it out before going to the doctor?” Every little aberration in how my body moves and feels carries a heightened awareness to it, and yet, I don’t go around constantly anxious about my future. I notice it, I pay attention, and then I move on. Most of the answers to my questions come with time and patience. If you can avoid insisting on instant reassurance, you will find that you fare better.

Most people facing their own mortality don’t have the benefit of a social circle that understands. Don’t take it for granted. When I got sick, I was alone. Only about 6000 people in the entire United States have been diagnosed with the condition I’m facing. Not to mention, my peers at the time of 20-somethings could not even kind of relate to my ordeal. Lucky for you, pretty much everyone around you is dealing with some version of the same fear right now. You can support each other because you understand your shared uncertainties. On the other hand, you are at higher risk than I was for “social contagion.” The downside of collective awareness is that your anxieties can compound upon each other, fear can beget more fear, and as social animals, we are built to mirror each other’s emotions. Compassion and empathy are important, but I encourage you to temper them with calm and mindful acts of support.

It isn’t helpful to let the current situation dominate your thoughts. Practice the discipline of reframing your thinking, and you will experience less stress. This would be an excellent time to limit your exposure to social media, too. You don’t need other people’s fear speaking voices in your head. For those of you who like that woo-woo shit, feel free to increase your focus on your “gratitude practice” right now. Me, I’m going to limit my exposure to the news and increase work on some neglected projects around the house. This seems like an excellent time to begin planning my basement remodel. This sort of intentional shift of focus gives me something productive to put my energies towards rather than stirring up fears of the unknown.

On a related note, don’t let fear be your guiding principal. Consider making important decisions when your mind is feeling more calm–like right after a good meal with some satisfying, slow-digesting carbohydrates in it. Your fear-based decision might be making people like me less safe, if it means you switch to antibacterial soap, for example, and increase the likelihood of superbugs. The panic that has led to emptying store shelves isn’t doing the community any good, either. Consider finding other ways to take care of yourself than giving in to the hedonic needs of your fear.

If someone near you gets sick, when it is safe to do so, literally embrace them and return them back into your life. I developed mysterious lung symptoms and a persistent, low grade fever just about the same time SARS was in all the news. When I was released from the hospital, we didn’t know why I had nearly died, but we did know it wasn’t an infectious process. Despite this, I was treated like a pariah. No one would hug me, hold my hand, pat my shoulder. People would literally take a step back when I told them what had happened to me. It was like they were afraid that my near-death would rub off on them. It was exceptionally isolating in an experience that already left me alone in so many ways. So I ask that you please, please, welcome back the folks who become sick. Love and support them, touch their hands, kiss them on the cheek, and help to reintegrate them back into your world.

You don’t know what’s going to get you. That’s always been true, you’re just now having to face it. I used to feel like I knew better than most people what was likely to kill me. However, even when my condition was quite severe, I still could get hit by the proverbial bus. That hasn’t changed, and it’s true for all of us. None of us know what is going to get us in the end. We can’t live our lives dancing around the edges, hoping nothing will ever take us down. We have to live the best life we can with the life we’ve been given. Uncertainty will always be a part of the equation. Part of making the best of it is keeping that in mind and keeping it in perspective. That’s how I live my life every day, and I encourage you to do the same.

Photo description: Two wrinkled hands, one bare and one with a black and white checkered sleeve, holding each other over a leather background.

Marjorie Hundtoft is a middle school science and health teacher. She can be found picking up heavy things and putting them down again, and wondering when the gym will be closed, in Portland, Oregon.

aging · fitness · health

Health and wealth and years of happy living

I’m staying at a beautiful resort in Tucson, Arizona. I love it here in the desert. I’ve come here twice to ride my bike in the winter. See here and here.

But this year I’m not here to ride my bike. I’m here for the annual Workshop in Normative Ethics, hosted by the Philosophy department at the University of Arizona. It’s a great conference and it’s at this very lovely resort/conference center. Thanks Mark!

While I’m staying here this came across my newsfeed, Rich people don’t just live longer, they also get more healthy years.

From the article, “According to a new study, wealthy men and women don’t only live longer, they also get eight to nine more healthy years after 50 than the poorest individuals in the United States and in England.”

“In both countries, wealthy women tended to live 33 disability-free years after age 50 — eight to nine more than poor women, the study found. Wealthy men tended to live 31 disability-free years after 50 — eight to nine more than poor men.”

Wealth mattered more than education and more than social class.

I guess I’m not shocked. Here in Arizona, I was struck by the very fit seniors staying at this resort. I listened in on their tennis lessons while reading some conference materials outside. Nice to have a keen coach giving you advice on your serve. But there’s not just tennis here. There’s also golf. And swimming. And biking. And hiking trails. And a gym.

The other thing that’s got me thinking about wealth is my knee replacement. I’m waiting nearly a year and a half for it in Canada. I know people in Canada who don’t wait. They travel south to the US for joint replacements. I even looked up prices. It was easy to look because I’ve posted so much about it on social media that there are many ads in my newsfeed for American hospitals marketing their wait free services to Canadians. $49,500. Wow. Guess, I’m waiting.

The knee replacement will be covered fully by my province’s health plan when it happens. Note though that none of the conservative strategies–injections, knee brace, physio–are covered by that plan. Instead my workplace benefits paid for that. I’m very grateful.

But if I were an American without health insurance or if I had benefits didn’t cover the full cost of knee replacement and I was trying to juggle launching three twenty somethings with my own pain and lessening activity levels, chances are I’d wait for surgery longer than the wait here in Canada. Waiting means, for most people, being less active.

I’m wealthy by most measures but I’m not “fly to the US and pay out of pocket for joint replacement” wealthy. I am “knee brace and physio” covered by workplace benefits wealthy. But it all seems very clear to me that in terms of staying active, wealth makes a difference.

And I guess I’m not surprised that wealth means both more years of life and more healthy years but the number of years did surprise me. Colour me naive. I know. Also, I’m curious to see what the results would be in Canada.