fat · fitness · health

Today in Not News, “Fatter people not taken as seriously by their doctors as less fat people”

Sometimes, when you see a repeated injustice, you get cynical or resigned and roll your eyes. And sometimes, you get teed off. I’m guessing you can guess which one I’m more predisposed to.

Sam shared this twitter story (here and here) from Jen Curran, who had elevated protein levels in her urine during her pregnancy, and she was told to “lose 40 pounds” and come back. Weeks, and a second opinion, later, she learned that she had blood cancer. Her regular doctor ignored what she was saying, and focused on her size instead (as she was pregnant, no less). This is not news.

And it pisses me off.

How is this STILL happening to larger bodied people? How is it that doctors are looking at our sizes, our weights, and our BMIs as if they are useful pieces of data unto themselves?! Do fatter people get cancer? Broken vertebrae? Appendicitis?

We are far past critical mass here–it is long past time for doctors to take a long hard look at their biases. Because make no mistake, that is exactly what this is. In their core, many doctors believe that fatness is of bigger importance to their patients’ health than almost any other factor. The proof of this supremacy is in their persistent focus on weight, above the narratives provided to them by the patients. Every fat person has a story about how their needs and concerns were ignored as their doctor asked them about trying to lose weight.

And this bias is causing life and death decisions to be made, and fatter people are dying.

As an example, people with more body fat are more likely to die after a cancer diagnosis. Is this because of something intrinsic about body fat, or is it because fat people go longer before they reach a diagnosis? Are doctors more reticent to be aggressive with treatments because they are distracted by the “elephant” in the room, possibly assuming that the fat person doesn’t do their part to take care of themselves? Obviously, doctors are not listening to their fat patients as openly–does that mean they miss critical complications until they are too difficult to treat? How much of the “fat is bad for you when you have cancer” conversation is colored by these unconfronted fat biases?

When I was a fat teenager, I dreaded going to the doctor. No conversation at the doctor did not also include a conversation about my weight. I had nearly disabling low back pain from carrying a heavy book bag for years, including on the couple miles walk home from school each day. Did they offer me exercises to strengthen my core muscles? No. I needed to lose weight.

Depression? Have you tried to lose weight?
Irritable bowel syndrome? What have you done to try to lose weight?
Broken bones in your hand after punching a kid in the hallway for calling you a “freak?” Well, you get the idea. I’m pretty sure my weight came up in that conversation, too.

And, I’m sorry to say it doesn’t get a ton better when you go from being a medically fat person to a merely, nearly fat person.

I changed doctors last year after a frustrating conversation along these lines. I am no longer medically “overweight,” but I am just barely so. Over about six years, I changed from a BMI of about 32 to about 24, just under the “normal” threshold. I have also reduced my health risk factors in innumerable ways–I eat more produce, less processed food, and less added sugar and salt. I do some kind of intentional exercise most days of the week. I don’t smoke or drink alcohol. I have been working hard on managing stress (still a work in progress), and I try to get enough quality sleep. I see a therapist regularly to help me manage my depression and trauma.

And when I went in to get a referral for a physical therapist, what did he say? “Your BMI is ok, it’s in the normal zone, but just barely. You might want to do some work to bring that down.” This had NOTHING to do with my current medical concerns. In fact, the opposite. As I have increased my activity levels over the years, underlying imbalances I’ve lived with for nearly two decades have become problematic. It may not have mattered that my muscles and nerves were out of whack when I wasn’t pushing them. But the more physically fit I’ve become, the more I’ve become aware of how my surgical history has permanently impacted how my body works. I was there to see him so I could continue to be physically active, something I’m sure he would recommend as a part of “fixing” my BMI to a lower end of “normal.”

I challenged him on this and reminded him that I was a weightlifter. That maybe some of the “extra” weight I was carrying might be muscle. He said most people overestimate how much that is a factor. I don’t disagree with him, but I kinda wanted him to lie down on the floor, so I could prove I could deadlift him up off of it.

But of course, my BMI in that moment, or any, wasn’t really relevant. BMI is a poor tool for estimating body fat. And body fat is a poor tool for estimating health. What we’re really seeing time and again, people like Jen and me, and so many others, is the biases of our doctors, who see fat and can’t see anything else.

Fat bias is a habit, and habits are hard to break. Doctors who are serious about improving the health of their patients need to begin the hard work of challenging their own assumptions in these moments. To stop themselves before they bring up their patient’s size and ask themselves, “If this patient were smaller and came to me with these concerns, what would I suggest to them?” Fat people know they’re fat. Most of them have tried, and failed repeatedly, to be less fat. Ask them what they are doing to take care of themselves. Ask them what they are hoping to get from the appointment. Ask them what they think is going on. And for goodness sake, treat them like people, not just bodies.

Standing woman helping with a blood pressure reading for a seated woman.
Photo from Unsplash.

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

Dancing · health · training

If You Stack A Cord of Wood, Do You Still Need to Workout?

Functional fitness (aka functional movement) is a thing now. That’s exercises that train our muscles for regular life activities, like squatting to pick up something we’ve dropped, or reaching for something on a high shelf (or even climbing onto the kitchen counter to reach something, as I did a few days ago). But, do our regular life activities support our workouts? Can movement with a function substitute for a workout? 

I asked myself this question a couple of weeks ago, when a cord of wood was dumped in our driveway at 8 a.m. Just looking at it was pretty daunting. Even though I knew from previous years the stacking wouldn’t take more than an hour (for two of us), all those logs in a giant, jumbled mound sitting in a bed of dust and bits of scattered bark said, “Cancel anything else you planned for the day. I’m the boss of you today.”  

60% of a cord of wood stacked in the garage. My mountain bike resting against the logs, for some scale perspective.

Sorry to break it to you, bossy logs, my day was actually a lot fuller. It went like this. Meditation for 30 minutes. Trip to the farmer’s market to stock up on spectacular veggies and fruit. Breakfast with my partner at the local coffee shop on our way home. (Tried a new wildberry paleo muffin with honey and finishing salt. Not bad. Plus the hard boiled eggs I’d brought with me to supplement the baked goods.) Stacked all the wood in the garage. Filled one plastic tub and the ash can with bark and wood remnants to use as kindling. Swept the garage floor, finishing touches with the shop vac. Swept and hosed the driveway. Cleaned the house. Removed, washed and wrestled every slip cover back on to couches, benches, chairs and stools. Caught up on email. Had a work call. Went for a tempo run in the mountains. Collapsed on the couch and watched German television (Dark-– a great mind game of a show). 

Technically, I did “only” a 50-minute workout. Even though I pushed on my run, it was a lighter day in the arc of my current training. Except … I also stacked wood for another hour, which is physically demanding. And I cleaned, a lighter physical demand than the other two, but very taxing (plus, dishpan hands—can anyone recommend a truly effective hand cream?). 

How should I count my workout for the day? 50 minutes. Some percentage of wood stacking and cleaning, plus 50 minutes? Why does it matter? 

Three reasons: First, because if I don’t account for all that activity, then I wonder why I’m so tired during my workout the next day. Second, because actual movement makes you stronger. Why not give myself some credit, instead of partaking of the female tendency to downplay accomplishments?! And third, instead of doing a series of functional movement exercises, I engaged in the actual movement that the exercises prepare us for. And by the way, no functional fitness exercise is going to fully prepare me for the incredibly awkward and disparate shapes and sizes of logs, with all their sharp, pokey bits, plus the arm and chest abrasions, not to mention the wood dust in the eyes. 

How incredibly satisfying to finish the task.

I gave myself another 50 mins of workout credit for the day. Added it to the tally in the back of my mind. Felt good about my strength. Decided I’d done some next level functional fitness. 

Biking around New York City is another place this actual movement vs workout question comes up. Some days I might bike from place to place for an hour or more. Though I’m not pushing, as I would in a workout, the activity is not nothing. I’ve developed a personal algorithm for Citibike. I count 30% of the time toward my total workout time on that day. A bonus. My movement serves a function.  

Functional movement is an excellent concept. Or as this article in Women’s Health puts it, “your butt isn’t there just to look pretty.” Our health is a resource, not simply an end goal in itself. We want to be healthy so we can participate in and contribute to the world (and get the chores done). Also, to have fun, as Catherine pointed out in her piece about functional movement and parkour.  

So, how can we think about actual movement’s contributions to our workouts? 

Like this: Our daily activity strengthens and prepares us to be better athletes. 

Here’s one life activity that prepares us for everything (and that a lot of us here at Fit Is A Feminist Issue like to do): Dancing. I love it. Not for a workout, not choreographed, just turning up the volume, drowning in music and dancing my not-just-pretty butt off. A woman described to me recently being bored on a treadmill, loving the music she was listening to and wanting to get off the exercise machine and dance. She asked, “What should I do?” She was worried that dancing wouldn’t count as a workout. I said, “Dance.” Dance is uncategorizable. A daily activity. A workout. A practice of freeing the mind and body. Others here have written buoyant posts about dance. Catherine’s a dancing queen, Christine is dancing for 100 Days and Sam’s looking for more no-regrets opportunities to dance like a sexy Muppet. 

Dance is the ultimate functional movement, preparing us for joy. And if you’re dancing for no functional or workout reason, my personal algorithm says—give yourself time and a half bonus credit (150%) in your workout log!   

fitness · Guest Post · health · illness · injury

Keeping Fit While Healing from Hysterectomy, Part 2 (The Lifting Edition)

It is now nearly 10 weeks after my complete, laparoscopic hysterectomy, and I figure it’s about time for an update on my progress! When I last wrote, it had been about a month, and I was working on following my own fitness plan. (If you haven’t read that post, you can find it here.) My goals at that time were to do what I could to maintain healthy habits and to preserve as much strength as I could without compromising healing. The plan was to do a bands-based resistance program and daily walking. Today, I’ll discuss some overall impressions and get into the weeds a bit about where I’m at with lifting. I’ll do a separate post about my ongoing efforts to return to running.

So, how did the plan go?

During that first month of exercises (post-op weeks 3-6), my strength and endurance varied quite a bit from day to day. Some days I felt great and had to force myself to keep things easy, other days, all I could handle was lifting up and washing the dishes in the sink. I did my best to honor the time I needed to rest. There was one week when I seemed tired all the time, and I wasn’t sure if that meant I’d been overdoing it or if it was something else going on. I rested a few days, and then I returned to my resistance bands and walking but with reduced volume. For several days there, I was tired before I got started but found that a little movement helped my mood and energized me, which reinforced that those were the right decisions.

For the most part, pain continued to not be a major concern. I had some discomfort for sure, but it was most often a generalized achiness, especially on the right side of my abdomen, rather than sharp pains. Bending over at the waist and pushing/pulling heavy objects were the most-limited movements, giving me the immediate feedback that I was still healing inside. Sometimes I thought some activity I’d done had exacerbated the aches, but plenty of times I couldn’t correlate the pain to any particular increase in activity.

The only time I had severe pain, it was while I was out wandering through a neighborhood garage sale with my husband. I hadn’t done anything strenuous in the previous 24 hours or so, and suddenly, every step resulted in a tearing feeling in my side. It completely stopped me in my tracks and brought tears to my eyes. We very gingerly walked home, with shallow, baby steps so I wouldn’t jostle my insides any further, and I laid down on the sofa for the rest of the day. This happened to be only a couple days before the 6-week post-op appointment with my surgeon, so I mentioned it to her at that time. Her hypothesis was that it was “scar tissue disease” that had formed and was being pulled and separated again, causing the tearing feeling I had. Her response to this surprised me–she advised me to stay as active as possible. She didn’t want scar tissue to limit my activities down the road, so the more I can prevent these tissues from sticking and forming together, the better off I’ll be long term.

Back to the gym
At that 6-week appointment, my doctor released me to “gradually return to regular activities.” She made it clear that she didn’t want me holding back too much, as that would slow down my progress. “You can’t hurt anything now,” she said after examining my vaginal sutures, which were apparently healing as expected. So, I left the appointment with her blessing to get back to the gym, to do all the stretching, twisting and bending that I felt ready to do.

I have been back to lifting for a little over 2 weeks now. I decided to go with a 4-day upper/lower split program that I’ve done before. I’ve modified the lifts to avoid undue abdominal pressure (no push-ups, planks, or similar poses). I wasn’t a great squatter before the surgery, but now I’ve gone back to light goblet squats just to parallel. I’m trying to feel out how my pelvic floor responds to the increased loading. As far as I can tell, it’s going ok, although honestly, there isn’t an obvious way to measure it.* My surgeon informed me that my pelvic floor was “more pliable than predicted,” given that I have never been pregnant. She did not know if this was due to my being a lifter or to my history of obesity. It’s not clear to me how careful I need to continue to be to protect my pelvic floor health going forward. And as discussed in the first post, there’s very few evidence-based resources out there to help people navigate this situation.

I’m lifting about 60% (in terms of both weight and volume) of what I was doing before surgery. My preferred programming is usually pretty high volume, and I hope to keep working on increasing it over the next few weeks. I started with 2-3 sets, and I plan on adding a set every couple of weeks until I’m back to doing 5 sets of the major lifts. Only after I get the volume up do I expect to progress the weights heavier again. I’ve dropped out almost all accessory lifts other than those I do to maintain mobility, and I’m focussing on the big, multijoint movements. Here’s how that looks:

Lower 1:
Goblet Squat, 1×6-8, lower weight by 10%, 2xAMRAP (as many reps as possible)
Leg Curl (Machine), 3×12-15
Offset Split Squat, 3×12-15
Monster Walks and lower body mobility work

Upper 1:
Upright Dumbbell Press, 1×6-8, lower weight by 10%, 2xAMRAP
Assisted Chin-up, 2×6-8, 1×10-12
Incline Dumbbell Bench Press, 3×12-15
Cable Row, 3×15-20
shoulder mobility work

Lower 2:
Deadlift, 2×5-6, 1×8-10
Goblet Squat, 3×15-20
Pallof Press, 2×12-15
Alternating Reverse Lunge, 2×15-20
Monster walks and lower body mobility work

Upper 2:
Bench Press, 1×6-8, lower weight by 10%, 2xAMRAP
1-arm Dumbbell Row, 2×8-10, 1×12-15
Arnold Press, 3×15
Palms Down Cable Pulldown, 3×15
Dumbbell Lat Raise, 2xAMRAP (up to 20)
Dumbbell Reverse Fly, 2xAMRAP (up to 25)
shoulder mobility work

The mobility work is feeling especially important right now, as it seems like I’m stiff any time I’m not warmed up. I’m hoping that feeling will decrease as I get back to the rest of my usual routines and is not a new normal. I’m aware that I’m recovering from this surgery in my forties, and older lifters are frequently discussing the increased need for mobility work to keep lifting. I’ve never been sure how true that would be for me, since these folks are usually lifelong athletes, and I’m a relative noob. I have neither the benefit of a foundation of strength, nor the detriment of a lifetime of activity-related aches and pains.

So as far as the lifting part of my recovery plan goes, I’m feeling pretty good about it. The old advice to “lift nothing over 10 pounds,” clearly wasn’t the right advice for me. I was able to do more than that after the first two weeks of total rest, and I didn’t injure myself or create problems for my healing. Even still, my muscles are acting like I haven’t lifted in two months, and I was especially sore with lactic acid burn the first week back. It’s a bit disappointing to be so stiff and sore, given I was continuing to train in some fashion for most of the last couple months. However, I’m pleased that I kept it part of my routine, so that it usually does not feel hard to get myself to the gym–that moment of “ugh, do I really have the energy to do this?!” is less common than it might have been. It’s too early to know how the hysterectomy might impact my lifting options long term. I’m considering going back to the physical therapist to have her evaluate where I’m at, to see if there’s anything I’m missing as I continue to recover. Regardless, it’s clear to me from my experience that the typical lifting advice is more conservative than necessary, at least for some of us.

*Fun fact–in research, apparently they measure internal abdominal pressure by inserting a balloon up the rectum of test subjects. Then, when they do particular lifts, researchers can measure changes in the pressure upon the balloon. For the record, I will not be signing up for this, even in the interest of science!

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

fitness · health

High maintenance life followup: Catherine’s profile

Hey readers– did you catch Natalie’s post on Saturday? Nat realizes she is high maintenance!

If you haven’t gotten to it yet, do check it out. But if you’re too busy, here’s the tl:dr version:

  1. Natalie does a lot-a-lot of varied physical activity in her daily life.
  2. She combines movement with social connection, getting a twofer benefit.
  3. She does physical activities she enjoys, often directed at a goal (e.g. charity ride, pretty garden).
  4. She doesn’t expect or get disappointed that her physical activities don’t produce a thin body.
  5. She knows and accepts that with regular varied physical activity comes some pain; she’s decided that this pain is better for her than the pain she gets from inactivity.
  6. To support and maintain her life of physical activity, she makes sure she has the right meds, medical devices, and professional support (e.g. chiropractor).
  7. It may be connected, or it may be an independent fact about Nat, but she takes the best selfies of anyone I know.

This is all awesome. Yay Nat!

Making up the list above made me think about my own activity and social habits. How am I doing on 1–7, and what do I want? Here’s my rundown:

1.I do some varied physical activity– I cycle, I walk, and I do yoga regularly. I like to swim, hike, and lift weights, too. I’d like to do the latter more often and more consistently.

2. Cycling, walking and going to yoga with friends helps keep me on track. I schedule road rides with friends once or twice a week. On vacation, I just did a couple of hikes and also swam with friends. My friend Pata and I are combining forces to schedule visits to the YMCA for weight and strength work. Swimming will remain an occasional group activity treat for the summer.

3. Yes, doing activities for enjoyment is what it’s all about. I don’t have any event goals right now, but I’m tracking my workout days on Facebook, on the 219 in 2019 group. I’m up to 100 workout days now– I’m tracking days I work out rather than individual workouts. So far I seem to be active on average 3 days a week. I’d like to get that number up to 5, as I think I’ll feel better physically.

4. Disconnecting physical activity from body shape and size has gotten a bit easier as I’ve gotten older. My 57-year-old body is larger and a different shape than it used to be. I have some negative feelings about this. At the same time, I’m grateful that my body can do the above-mentioned activities, and I want to help maintain and even improve my functional fitness.

5. Pain: for me, it’s not about the pain after exercise (there is that, but I don’t mind it much). It’s the discomfort I feel during exercise that I have trouble with. That is, in this body at this point in time, I have to exert myself a lot more to do the things I used to do with less exertion. This sucks in a big way. Of course, I can go slower, go for shorter times and distances, take breaks, and also try to give myself a big break– I’m out there doing it, so stop being so self-judgy, Catherine! This part is hard. Like Nat, less activity makes my body less happy and less comfortable, so this is the road I’m taking. But it’s not easy.

6. Support is so important to maintaining physical activity for me, too. I go to acupuncture and therapy, which help a lot. I take meds for anxiety, and getting enough sleep is my highest priority. I’m lucky and privileged that I have access to good medical care and a work schedule and home environment that allow me to get enough sleep. I mentioned the support of friends and community in 2, but it bears repeating: my friends are on similar paths, and we find that traveling together makes the journey easier. Writing for and reading this blog is an enormous help as well; the solidarity with other bloggers, commenters and readers helps sustain me.

7. Now, to the best part: the selfies. Here are but a few of her masterpieces.

Inspired, here are a few of mine:

So readers: what sorts of maintenance do you find you do? What’s hard? What’s easy? What’s on your wish list? We’d love to hear from you.

fitness · health · illness · self care

The Latest Weird Thing About a Stiff Neck

Last year, I wrote about how my neck gets stiff when I am anxious and about how I get anxious when my neck gets stiff so it’s hard to parse which came first.

A few weeks ago, I discovered that there is another factor to consider in the whole stiff neck issue.

For almost 30 years, I have been getting semi-regular headaches that start with pain and stiffness in my neck. I haven’t been tracking them per se but my estimate is that I have them at least once every two months but sometimes I will have several in a month.

I’ve been blaming it on ‘sitting funny’ or not stretching my neck properly or any of a myriad of things that make these headaches kind of my own fault* for not paying closer attention to my body.

However, I recently had some interesting information come my way that puts that stiff neck in a whole different context.

My dear friend M, a GP who has gone back to school to specialize in Neurology,  has been preparing for her Royal College Exams and she was practicing for the part of the exam where she essentially demonstrates the results of her years of study by seeing practice patients. A couple of weeks ago, I was at her house for several days in a row to help her study and on the third day, I had one of these neck-based headaches so I decided to let her use me as a practice patient for the headache section of her studies.

She asked me when the headache came on, where it was localized, and so on. Then she connected my headache to my sleepiness from two days before and my lack of focus the previous day.

The author, a middle-aged white woman with shoulder length brown hair, wearing a black shirt and glasses is not looking directly at the camera. She is sitting in a room with green walls and there is a white door behind her.
I just happened to take this photo the day before my conversation with M. I was participating in a web chat about writing and I was having trouble concentrating. I was tired, I knew I was going to have a headache the next day because of the specific way that my neck was aching. I did some stretches and took some ibuprofen in hopes of warding it off but it didn’t work – it never does, actually but I always try it.

I was expecting her to respond with ‘Christine, you have a headache’ but instead, she said, ‘Christine, you’re having migraines.’**

I’ve always thought of migraines as ‘have to lie in a dark room with a cloth over your eyes’ type of headaches. My headaches are bad but I can (mostly) still function so I never considered that they were anything more complex than an elaborate neck ache.

M says that my neck pain is actually a symptom of the migraine, rather than the cause of my headache. (It’s no wonder that no amount of stretching seemed to get rid of it.)

Timeline graph of migraine symptoms. The background is purple and the timeline is orange. The graph illustrates that there are a few hours or days of symptoms that precede a migraine, the migraine itself lasts from 4-72 hours and there there is a 24-48 hour recovery period.
I had no idea that things like concentration and difficulty sleeping could precede a migraine. This graph was found here: https://americanmigrainefoundation.org/resource-library/timeline-migraine-attack/

Learning that I have migraines explained a lot of things, including a certain type of ‘out of phase’ feeling I have beforehand that I recognize as a regular occurrence but hadn’t connected to my headaches. It also explains two feelings I have after my headaches pass. One that I call a ‘headache ghost’ where it kind of haunts me, as if it could return at any second, but it doesn’t hurt any more. And a ‘headache hangover’ where I feel all wrung out, hungry, unsettled and regretful.

This is all interesting to me, of course, but the thing that really sticks is how different I felt about my headache once I called it a migraine.

With rare exceptions, I have always tried to just carry on with my normal tasks when I have a headache. Sometimes it has been awful – intense pain, nausea, disorientation – but I refused to give in to something as ‘small’ as a headache.***

Now that I know these things are migraines, I suddenly found myself giving them the respect they deserve. I’m not saying that I am going to take to my bed at the first twinge of impending migraine but I am planning to take it easier on myself and I may just head to bed instead of fighting through nausea and pain to complete the things on my list for the day.

So, what does all of this have to do with fitness as a Feminist issue?

Fitness, for me, is about learning to take good care of myself and respecting what my body tells me.

Acknowledging that trying to ignore my headaches was dismissing and disrespecting my body’s signals shows me that that is one area in which fitness has eluded me.

I was being hard on myself for not stretching enough (something that helps me feel fit) when that wasn’t the problem at all. I may or may not have been ‘working hard enough’ but I was too quick to decide that I was to blame and I didn’t see the big picture.

And, the fact that I automatically dismissed pain and illness as ‘not bad enough’ because it was ‘just a headache’ tells me a lot about how I have internalized our society’s ideas about rest, laziness, and the notion that you need to earn the right to rest, even when you are sick.

I don’t know if this expression is localized but here in Newfoundland and Labrador when something is awful we’ll say that it’s not ‘fit.’  As in, the weather’s not fit to go out in, or that clothes is not fit to wear to the party, or, that someone is not fit to talk to.

Even though I didn’t know I was having migraines, I knew I was having really bad headaches but because I thought I brought them on myself, I didn’t rest the way I needed to.

And that’s not fit.

For the record, over the next few months I will be doing some tracking to see what my triggers are and to see just how often my migraines actually occur. And I will be going VERY easy on myself every time one happens.

*Is blaming ourselves for our ailments wise or helpful? It hasn’t helped me so far, I tell ya. I mean, I get that recognizing behaviours that lead to issues can identify actions to take but I wish we could all detour past the blame and just get to the action part.

**NOTE: M is able to make this diagnosis, of course, but she is not my doctor so I have also brought this information to my own doctor for follow-up.

***Yes, I hear how ridiculous this is. Heaven forbid I take things down a notch when I am ill in any way. Yes, I get on my own nerves. SIGH.

aging · fitness · health

How Bettina learned to stop worrying and love the physio (well, maybe ‘love’ is a strong word)

My mother has back problems. And shoulder problems, neck problems, and arm problems. In short, she’s a chronic pain patient. It started when she was in her early fourties. One day, her shoulder started hurting and never stopped. The rest came as she went along. She tried cycling, she got back problems. She tried swimming, she got elbow problems. Knitting, lifting anything even remotely heavy, too much yoga (and you never know in advance what “too much” is), sitting anywhere with even the hint of a draft, are all out of the question. Being my mother – one of the most strong-willed people I know – she soldiers on. She’s now 71 and still does light yoga, a lot of hiking, and a huge amount of daily physio exercises.

I’m in my mid-30s now. Needless to say, one of my main fears is that I will run into the same issues. Granted, I have a few things going for me that might, at least, buy me some time and at best, prevent me from ever having the same amount or intensity of issues. My mother was born in rural post-war Germany, when good nutrition wasn’t a given. As the daughter of farmers, she spent a lot of time crouching in potato fields when she was young. She worked as a nurse for years and did a lot of heavy lifting. She didn’t really exercise regularly until she was middle-aged.

I, on the other hand, started swimming when I was in primary school (at the insistence of my mother, because it was supposed to be good for my back). I’ve always exercised regularly. I was well-nourished from the start. I’ve never worked a physical job. And yet.

So, in anticipation of Really Bad News, I postponed visiting the orthopaedist for a Really Long Time. But earlier this year, fear finally got the better of me, so I went. “I don’t want to end up like my mother”, I told him, and asked what I had to do to prevent it. “Are you in any pain?” he asked, which I happily denied. He looked at me slightly funny, but gave me a thorough examination. Apparently apart from a tendency to hunch and wonky hips, there’s absolutely nothing wrong with me. But just so my insurance could get its money’s worth out of the visit (by paying more money), he prescribed me five sessions of physiotherapy.

Photo of a bendy wooden doll. Bettina is trying to get her body to stay that flexible.
Photo by Kira auf der Heide on Unsplash

I went to the physiotherapist and got similarly quizzical looks. It seems like if you’re not in pain, you’re not supposed to be there? I was surprised. And I realised my privilege of being relatively young, fit and “healthy”-looking has a consequence I hadn’t really considered much: people mostly concerned with healing don’t expect me. That was an interesting experience.

Luckily, my physio is awesome and adaptable, and was happy with damage prevention rather than control. He realised quickly that I actually do a fair amount of sports. So in the first session, we did a test that’s normally administered to athletes to discover their musculoskeletal weaknesses.

My lower back, hips, and shoulders are my weak points, with the lower back being the weakest. So my physio has been giving me exercises to do at home to strengthen it, and I’ve been trying to incorporate them into my routine. Honestly, I don’t enjoy them much. They’re exhausting, which probably means they’re working, and fairly boring. But that’s why I went, wasn’t it? To do things to hopefully prevent me from being in pain. So I’m going to take a page out of Sam’s book and try to do my un-fun physio exercises regularly. I’m also trying to focus on yoga routines that centre on my “problem areas” and incorporate asanas that are similar to the exercises I’m supposed to do, like Warrior 3, or chaturanga.

So what’s the verdict after four out of five sessions? I have a better awareness of my weak points and how to correct them. I have a bunch of exercises I can do at home. I’m curious to see if they will bring long-term improvement. Watch this space to find out how long my newly-found love… er, tolerance of physio lasts.

Do any of you have experience with physiotherapy? And how to be disciplined and make it stick, even if the benefits aren’t immediately obvious?

fitness · fitness classes · Guest Post · habits · health · Metrics · motivation · Tools · trackers

A WayBetter way to exercise? (Guest post)

Elan Paulson is an exercise-curious, occasional guest blogger on FIAFI.

The world of business has many concepts to describe how it sells things to people. One is innovation. According to Clayton M. Christiansen here and in other places, there are two main kinds of innovation.

  • Sustaining innovation refers to how businesses with many resources (those that dominate the market) make a product better for their target consumers.
  • Disruptive innovation refers to how businesses with fewer resources explore new ways of meeting the demands and interests of new or underserved consumers.

According to Christiansen, sustainers focus on improving a product, while disruptors challenge sustainer dominance by focusing on changing processes (of product creation, distribution, etc.). Disruption occurs when the innovation becomes mainstream.

There’s more to say about these concepts, including my critique of them as lens for sense-making, but for the moment I want to use them to understand WayBetter, a subscription service that has emerged in the health and wellness app industry.

In its About section, one of the WayBetter co-founders describes its services as “a whole category of games that help people stick to their commitments” because “life is better when you can turn work into play.”

This is what he means: Users bet their own money that they can accomplish a specific time-bound exercise goal. After the allotted time, users who achieved the behaviour-based goal receive back their own money (through a point system) as well as a cut of what was ponied up by those who did not meet the goal. Picture-taking and sync-ups with exercise tracking technology are put in place to minimize cheating.

In Christiansen’s terms, WayBetter is a disruptive innovation for how it has found a new process to promote exercise behaviours. (Its name suggests that it has literally found a “better way” to exercise). While other companies sell on-site, group-based fitness memberships and training services, WayBetter offers the flexibility of anytime, anywhere activity as well as the support of a group. WayBetter emphasizes how the process is fun: pay yourself for exercising. WayBetter has developed a market not in exercise programming but in exercise motivating.

However, WayBetter is a disruptor not because it turns “work into play” but because one could regard this as a betting service, or a form of gambling. (Waybetter). On one hand, the “game” is betting on yourself, and getting back your money simply by doing the exercise that you said you would do. On the other hand, an enterprising exerciser could choose “runbets” that other exercisers might be less likely to complete, thus maximizing their chance of a higher return than what they initially bet. WayBetter turns exercise into a game of predictive markets, and exercisers into investors.

So, it’s possible to think about WayBetter as a disrupter not for how it reaches underserved consumers (read unsuccessful/unmotivated exercisers) but for how it has created a new market—one of venture capitalism. Motivate yourself not simply to do exercise but to earn money off of the failure of others to motivate themselves to exercise.

At the moment, WayBetter’s dietbet claims 700,000 users, and the runbet website boasts that users have logged over 1,677,000 miles. I don’t know details about its income, but WayBetter takes a rake of each bet and uses third-party advertising. With no compensation, stock, acquisitions, or other company information currently available on Bloomberg, it’s not fully clear whether WayBetter’s disruptive innovation will become a sustained innovation.

But I believe it will become a sustained innovation because the value of its ability to change behaviour pales in its ability to change in mindset about exercise not (only) as a game but as a financial investment. WayBetter’s legacy may very well be how it and other services like it will change the very meaning of exercise by casting it (explicitly or implicitly) in market terms.

And, whether consumers win, recover, or lose their money, WayBetter still comes out Way Ahead.

Photo by Filip Mroz on Unsplash