Jun 106 min read

The 6F's: Fitness

As I sit here writing, I have just returned from an early morning run. For the past decade I have made an increasing effort to engage in regular, physical exercise. For anyone who has followed the blog or my social media pages, it might surprise you to know that I have not always been “into” fitness. In fact, for most of my childhood, high-school, and college years I was not just un-athletic, but I hated working out. I blamed it on “Sport induced asthma” (which I have never had). But in reality, I didn’t like the feeling of hard work.

However, over the years, several key events have subsequently changed my perspective causing me to go from one who preferred comfort to one who intentionally attempts to engage in exercise based “suffering” on a daily basis.

The first event happened early in my career. As I was finishing residency, I noticed that my weight had gone up. The early mornings, late nights, long days and consequent poor nutrition and non-existent exercise habits had left me heavy in a way that was beginning to be uncomfortable. Things jiggled when I walked. I had difficulty talking while climbing stairs. And though I was not yet a dad, I was well on my way to developing my “Dad-bod.”

Then on one particular shift I had a patient – not much older than myself. I walked into the room as my team was finishing up the ECG. They handed me a tracing that was a classic example of an ST-elevation myocardial infarction (STEMI). This patient was having a heart attack. Suddenly, I saw myself laying in that bed. Without changes, that would be my future.

Furthermore, as I look across the landscape of my patients, I see a common story played out in the lives of each of them. The modern, urban lifestyle of comfort and convenience combined with over-indulgence, a lack of physical exertion and a calorie packed, carbohydrate-based diet has left many with a string of debilitating comorbid diseases, overweight, and challenged when it comes to performing activities of daily living (ADL). Tasks like climbing stairs or bending over to tie shoes become a major chore. And for some, the prospect of standing unassisted let alone walking is nothing more than a memory of previous days. I didn’t want this to be my story.

This brings us to the third priority in our series… Fitness. When I mention the word fitness, I am sure that the first thing that comes to your mind is someone laboriously running or lifting heavy weights. While these activities are certainly the visible manifestation of fitness, the idea of fitness to which I am referring here is broader.

Fitness does not mean simply how far you can run or how much weight you can lift? If that were the case it may seem odd to make these the priority over other things. It would be hard to make the argument that we should prioritize rep and sets over things like our friends or finding fulfillment in the experiences that life brings. But there is a reason that I place fitness just below family and above other thing on the priority ladder. The reason is that fitness is the predicate for the priorities that are to come.

Let’s begin by defining fitness. The dictionary defines it as, “the quality of being suitable to fulfill a particular role or task.”[i] So, more than just miles per minute or reps per set, when I refer here to fitness and the reason that it takes this priority slot, I am thinking of the broader understanding, one's physical ability to do the things that make life full and meaningful.

This may sound a bit vague and abstract. And from the perspective of someone who is young, the margin between one’s abilities and what one is expected to do is quite large. But if the emergency department is any representation of the natural trajectory of life, time and comorbid disease can rapidly degrade that margin. Suddenly, that which was previously easy is now hard. And that which was hard is now impossible.

So, as we begin to focus on the idea of fitness, the reason for pursuing a lifestyle of fitness can be condensed down into three main reasons:

1. So I can do what I need to do

2. So I can do what I want to do

3. So that I am not a burden on others

As we walk through life we are faced with a number of responsibilities, opportunities, and challenges. Some of these things we are obligated to do. Others are options for us. In a given day, I may need to perform the duties of my job. I need to climb and descend stairs. I need to be able to get up from a chair. I may need to mow my lawn. I want to pick up and hold my children or play with them. I may want to go with my family on a scenic hike. All of these things require a degree of fitness – the ability to squat, stand, push, pull, etc.

One of the duties that has increasingly fallen on the emergency department is to seek and find placement in skilled nursing facilities for patients who need an extra degree of care, beyond the capabilities that are available to them at home. For some, this is to administer medicines or perform wound care. But unfortunately for many it is because they no longer have the strength to rise from bed and stability walk. Their physical deconditioning makes them a risk for falling, precipitating a downward spiral of health and vitality.

As we compare our abilities, we may be tempted to argue that they we capable of accomplishing all of that life requires of us at the moment. Walking has never been in question. Rising from bed or a chair is something that we can accomplish with relative ease. But what if we need to do more? Do we have a fitness margin that we can draw upon if life demands more of us? The idea of fitness is expressed not just by my ability to accomplish the minimum activities of daily living but also summed up in the question, can I do the things that allows me to live life to the fullest?

In addition to the benefits to strength, stamina and stability, regular physical fitness has profound impacts on the physical health of our bodies. Mark Rippetoe, author of Starting Strength writes that even though strength and endurance isn't mandatory for our subsistence, "Our strength, more than any other thing we possess, still determines the quality and quantity of our time here in these bodies."[ii] Enter the need for regular physical exercise.

The CDC reports that 80% of Americans are insufficiently active and recommend 150-300 minutes per week of moderate-intensity activity[iii]. There a large amount of data showing that regular physical fitness is linked to improved blood pressure, cholesterol, insulin sensitivity and much more. Fitness is of significant importance. It is not just the means by which we develop bodies that enable a sense of pride over shame, but as the means by which we maintain the physical integrity and proper functioning of our bodies.

Finally, there is a virtue to the pursuit of fitness. On April 10, 1899, then New York Governor Theodore Roosevelt gave a speech before a group of men in Chicago entitled "The Strenuous Life."[iv] In this speech, he addresses the need for and virtue of strenuous living:

I wish to preach, not the doctrine of ignoble ease, but the doctrine of the strenuous life, the life of toil and effort, of labor and strife; to preach that highest form of success which comes, not to the man who desires mere easy peace, but to the man who does not shrink from danger, from hardship, or from bitter toil, and who out of these wins the splendid ultimate triumph.

A life of ignoble ease, a life of that peace which springs merely from lack either of desire or of power to strive after great things, is as little worthy of a nation as of an individual.

Fitness helps us build and maintain dignity. It is the vehicle by which we develop resilience. Disciplining ourselves on a daily basis to engage in exercise is a means of putting ourselves in the path of imposed suffering. This in turn helps us develop the resilience to stand strong when we are faced with actual, involuntary suffering.

Roosevelt continues:

We do not admire the man of timid peace. We admire the man who embodies victorious effort; the man who never wrongs his neighbor, who is prompt to help a friend, but who has those virile qualities necessary to win in the stern strife of actual life. It is hard to fail, but it is worse never to have tried to succeed. In this life we get nothing save by effort… A mere life of ease is not in the end a very satisfactory life, and, above all, it is a life which ultimately unfits those who follow it for serious work in the world.

Fitness prepares us to meet and overcome the physical challenges that we face in life. Get after it!