For me, this situation is personal. My state of West Virginia ranks at the top in obesity, and the bottom in health programs for children. Close to 40 percent of West Virginia elementary school children are overweight or obese. And these obese children have high odds of becoming obese adults—with an 80 percent correlation in the case of obese teenagers. Insulin resistance, lifestyle, the external environment (including diet)—all tend to become more difficult to reverse as teenagers advance into their twenties and thirties. Complicating this is the role played, it is now believed, by the body’s internal environment—the intestinal microbiome—which works to “defend” and perpetuate an obese state.
More than a third of those who were born in 2000 will be afflicted by type 2 diabetes. The current generation of youth is likely to be the first that will die at a younger age than their parents did. It’s simple: children and youth of all ages need to start moving, running, and playing—especially while enjoying the outdoors. Eating well (and avoiding sugar-sweetened beverages and juices!) is essential, too, as discussed in chapter 10.
Health care providers shouldn’t try to shame children into reducing body fat. Doing so can cause eating disorders and psychological damage, and generally doesn’t work anyway. Exercise, healthy food, and a positive attitude—taken together in healthy doses, daily—is the best prescription for achieving a healthier body composition.
It has been understood for some time that physical activity is a key component of healthy brain development, by inducing cascades of growth factors that instruct downstream structural and functional change in the brain. A large study by Hans-Georg Kuhn and colleagues of the University of Gothenburg found that cardiovascular fitness among eighteen-year-old boys is positively associated with intelligence and educational achievements later in life, as well as with disease prevention. Exercise is fertilizer for the brain and body, and kids need more of it than do adults for optimal growth and development. Even if you disregard the physical health benefits of regular exercise, the boost that it gives to the brain alone should establish it as a public health priority.
We can’t afford to not change the way people approach movement and exercise. Numerous studies show that exercise-focused public health initiatives pay substantial dividends in terms of health care savings and worker productivity. I’m working on jumpstarting our state health leaders so that they can head out on this path—at a good, healthy jog.
NURTURING A PANDEMIC OF HEALTH
Speaking of paths, and in the spirit of getting kids out into nature, our nonprofit, the Eastern Area Health Education Center, is collaborating with private and public partners in our West Virginia counties to promote farmers’ markets and build fitness trails at schools and parks. This is a small, local effort, and the permitting process and bureaucracy is daunting, but we’re gaining ground.
First Lady Michelle Obama took one laudable step with her campaign Let’s Move!, which was dedicated to eliminating obesity within one generation. The program has raised awareness, but unfortunately the youth exercise and health needle has barely budged. (In my opinion, Let’s Move! didn’t sufficiently focus on cutting processed and sugar-sweetened food and beverages from our diets.)
In a nationwide program I am involved in called Park Rx America, parks and medical clinics are helping reduce obesity by providing opportunities for physical activity by making it easy to search for and print out maps for local parks at clinic visits. And in our rural county, I joined a small band of citizens and school administrators to start a middle school cross-country program that took off running, so to speak, during the very first year it was offered.
The beauty of running is its simplicity. In the United Kingdom, a free, informal school program known as The Daily Mile continues to gain traction, such that half a million schoolkids are now running a mile each day during school hours. Studies have shown dramatic fitness benefits from The Daily Mile (it takes only fifteen minutes), yet when pupils were measured for academic achievement, they found scores of up to 25 percent higher in reading, writing, and math. The United States and other countries are adopting similar programs, though at a disappointingly slow pace, thus far.
The start of the inaugural Berkeley County Middle School Cross Country Championships in West virginia, with two hundred children participating
A friend and lifelong exercise physiologist, Mick Grant, describes “Fun First” as his abiding principle, and he may be on to something. In summary: if it isn’t fun, don’t do it. The corollary to this is: stay healthy. (If you’re not healthy, it won’t be fun in any case.) Whether the athlete is ten years old and runs three days a week, or eighteen years old and runs seven days a week, the goal should be zero days missed due to injury or illness.
A group of middle schoolers crosses the Potomac on a run, then prepares a canvas that illustrates why they run.
Mick also encourages kids to try different sports and activities in addition to running. Running relieves stress, and kids can talk to their friends during training runs. Proper training for running, Mick points out, demands less commitment of time than any other sport. Endurance and speed factor into most sports, and running supplements most of these, too.
The trick is to get kids to enjoy coming to practice. Athletes need to push themselves, but the process of accepting a challenge and rising to it needs to be fun. This is the philosophy that guides Mick’s and my youth running initiatives.
BAREFOOT IN THE PARK
Running is one of the most accessible activities there is, and it’s a superb cross-training activity for almost any competitive sport. When a child’s sport isn’t available to them (for instance if no field is available, if there’s no team practice that day, or if they’re out of town), they can always run. Throughout, it should be enjoyable, because we want kids to come back for more.
The next time you are in a park, watch a child run barefoot. Notice the relaxed movement and foot placement, and the springy body, with legs trailing out behind. When barefoot, kids don’t land hard on their heels. They can change direction on a dime and never roll an ankle.
Then watch children wearing highly cushioned or supportive shoes. They look as if they’ve been shoehorned into hobbling prosthetic devices in order to compensate for a structural problem. All too commonly, they sprain an ankle.
Kids are naturals. Neuromuscular pathways that control form and coordination get “wired in” during childhood, and we have a tendency to develop bad habits if good ones aren’t reinforced. Adults often place their kids in cushioned, confining footwear from day one. The single best intervention that parents can make on behalf of their children is to get them out of restrictive shoes and let their feet feel the earth. Free the feet!
Unfortunately, the shoe industry has succeeded at convincing parents, educators, and health care professionals that a child should wear miniature versions of traditional adult shoes—almost all of which have elevated heels, extreme cushioning, and some form of motion control technology. Cushioned shoes do not reduce injury rates among youth (and may even increase them). In the window of time before kids’ feet are deformed by shoes, they still have an opportunity to walk and run naturally.
Foot specialists, too, are victims of conventional wisdom. The American Podiatric Medical Association’s position paper on children’s shoes cautions that the shoe should be rigid in the middle, and not twist. It goes on to add, “[This] does not apply to toddlers’ shoes. For toddlers, shoes should be as flexible as possible.” I wonder: at what point does a toddler become a child, and why do they suddenly need to begin binding and restricting and distorting their feet?
Let’s get our kids started on the right foot. Given what we know about child development and the elements of natural running gait, here are a few things to consider before you shop for kids’ shoes:
Ultra-thin soles with no (or low) heel drop are best, especially for kids. This allows for
good proprioception, or feel for the ground, and for neuromuscular activation throughout the entire kinetic chain. Kids learn movement and balance through proprioception, and the foot is the foundation and the messenger for that. A single-piece midsole/outsole (not two-piece) offers protection on unnatural and rough surfaces, while allowing natural dissipation of ground reaction forces.
The shoe should be flat but bend easily at the toe joints—where the foot is designed to bend—and not impede the forming and stiffening of the arch of the foot on toe-off. The toe box should be wide enough to provide for natural outward toe spread, because the foot produces the greatest leverage when the toes are straight and aligned with the metatarsals. And look for a soft, breathable upper material that is good for repeated cycles through a washing machine, or for soaking in sports detergent (we use SweatX), with air drying. The smell comes from bacteria (not from the dirt), and the SweatX kills it without destroying the fabric.
Kids’ shoes don’t need a lot of tread or traction. Shoes with stickiness and grip produce more heat and have higher braking moments (and increased torque) when running and playing, which increases the risk of sprains and tears. (This is one reason not to outfit a small child with cleated shoes.) Removing the sockliner insole (if the shoe has one) can improve the foot-to-ground interface, and heavy socks aren’t needed, either.
Be aware of how scale affects shoe geometry and function. A 4-millimeter “drop” (differential in the elevation of the sole from heel to the ball of the foot) in a size 1 shoe has the same gradient as a 12-millimeter drop in a larger, cushioned adult shoe. Also, a 40-pound child cannot bend the midsole of a shoe that might be considered relatively flexible for a 165-pound man. The lighter the child, the more important it is that the shoe rolls up and flexes easily.
KIDS WON’T ALWAYS BE SO
Kids (and their parents) should be aware of the unsettling changes that can occur during adolescence. For natural hormonal reasons, girls’ running times may be slowing. The rail-thin, springy eleven-year-old is gone in a blur, yet she often brings with her into womanhood a different body combined with an intense pressure to win. This can make her more prone to depression, injuries, and disordered eating. Healthy females lay on essential body fat during adolescence—which is a bit of a mismatch for elite distance running.
During puberty, both genders of children become susceptible to traction injuries at tendon insertion sites (and a variety of musculoskeletal syndromes) when soft tissue growth doesn’t keep up with rapid lengthening of the bones. For instance, when getting into a squat, they may feel discomfort because the bones have lengthened yet the Achilles tendon hasn’t kept up. Injuries can develop where the major tendons and ligaments are inserted into the bone. Sever’s and Osgood-Schlatter diseases (I prefer to call them syndromes), for instance, are typical tendinopathies at the Achilles and patellar tendon insertions that almost always resolve by the end of adolescence.
LEARN FROM THE CHILDREN
The start of the Freedom’s Run kids’ fun run in Shepherdstown, West Virginia
Running with a jump rope. Embrace your inner child and rediscover movement and play!
More adults—and this includes doctors, medical researchers, and educators—need to climb into the sandbox with children. Instead, they busy themselves with crafting guidelines that no one follows. For all of us, running and movement should be approached as a form of play—the way it is for kids, who are living, fully aware, in the present moment. Running and healthy movement become sustainable for all of us only when we give ourselves permission—as kids do—to have fun.
DRILLS
Some favorite calisthenics for kids are linked on the videos page of the book’s website, including:
Jump rope and jumping jacks build rhythm and aerobic fitness.
Burpees. Kids are good at these.
Stair hops build strength and spring, especially in the feet, Achilles tendon, and lower leg.
The grapevine drill is a simple lateral movement exercise that improves agility. This can even be done during a run.
Parkour. The ultimate running play. Obstacles emerge from the terrain, and the point is to creatively navigate and utilize them, while developing your own style of smooth, efficient movement.
CHAPTER 17
Healthy at Any Age
Once, when I was a young physician, I said that the man is of the age of their arteries. Later I enjoyed writing the age of his endothelium. Today, as a retired, 84-year-old GP, I say that the age of a man is that of his mitochondria.
—SERGIO STAGNARO of Genoa, Italy, in a comment on a New York Times article
Healthy life expectancy—our healthspan—is not keeping pace with the average lifespan, and the years we spend with poor health and disabilities in old age are growing.
—DR. ROSS POLLOCK, King’s College London
MYTH: Frailty is what happens when the body wears out, and there is little that you can do to delay this natural aging process.
FACT: Frailty results from not continuing to use and move and stress your body as you grow older.
With age, we tend to lose the habit of natural, fluid movement that came to us automatically as children. But this is not an inevitable loss. Indeed, relaxed, efficient movement has been trained out of us by work (sitting), by our environment (cars and mechanical aids), and by the downright dangerous myth that we should “take it easy” when we grow old.
My dream is to see elderly people rediscover the fluid movement and biomechanics of the bodies that we were all born with. It’s still there—waiting to be jump-started, revved up, and taken out on the highway. Considering that older folks come with an approaching expiration date, there’s no time to lose!
EXERCISE INTELLIGENCE
It’s well known that physical activity and cardiorespiratory fitness are associated with higher cognitive functioning. A study led by Agnieszka Burzynska and colleagues at the University of Illinois suggests that high-intensity physical activity has a protective effect on neural processing in aging, too. This is because exercise triggers the production of BDNF, which stimulates the growth and differentiation of new synapses and neurons, especially in areas vital to learning, memory, and higher thinking. In other words, physically fit older adults are more flexible—cognitively and in terms of brain function—than their more sedentary peers.
Diet is an actor in the aging process, too. A Stanford study found that in basically healthy people, the presence of insulin resistance is a strong predictor for a variety of age-related diseases, and for Alzheimer’s in particular. (“Alzheimer’s” is used generally to describe a spectrum of dementias.)
One tragic, underrecognized dimension of Alzheimer’s treatment is that many patients are prescribed heavy sedatives. No wonder they often have blank stares. The new psychiatric medications (and a barrage of other designer drugs to address pain in Alzheimer’s) that are hitting the market will do little or nothing to reverse dementia.
Movement and exercise, on the other hand, can improve it, noticeably if not significantly. Dementia specialist Dr. Dale Bredesen and colleagues have demonstrated success with a novel, personalized therapeutic protocol originally known as MEND (metabolic enhancement for neurodegeneration), and now called ReCODE (Reversal of Cognitive Decline). His model for “patching 30 holes in the roof” combines exercise with an anti-inflammatory and low-glycemic diet, good sleep, hormone and micronutrient optimization, MCT oils, and even a touch of red wine. The ReCODE protocol, when followed, has helped patients recover enough to return to work.
The good news is that more people will live into their eighties than ever before. The bad news is that the odds of dementia at age eighty-five are 50 percent. Plaques and tangles in the brain are presumed to be the primary indicators of Alzheimer’s, although half of patients who present with the clinical spectrum of Alzheimer’s
don’t have them. Healthy elderly people can exhibit substantial plaque and tangles, which to some extent are present in normal aging.
There’s more to the Alzheimer’s story. Our brains are remarkably neuroplastic, and we are wired to develop work-arounds. The more we use a movement, the more that movement becomes available to us. PET scans are one encouraging diagnostic tool: they are superior to MRIs for illuminating brain activity, and for assessing the variety of pathologies that can appear as Alzheimer’s.
Insulin resistance that occurs in the brain itself is referred to as type 3 diabetes. This happens when high glucose levels (and corresponding hyperinsulinemia) trigger “glycation” of brain proteins, along with inflammatory responses that damage nerves. Neuropathy is an expected complication of poorly controlled diabetes. Central neuropathy (dementia) is the worst kind. Faulty aging might suitably be termed “inflamaging.”
RUNNING INTO OLD AGE
So, will running help you to live longer? Despite some scares in the media that running is dangerous, the answer is yes—at least the majority of the evidence points that way. As sports medicine pioneer Dr. Gabe Mirkin says, “The only mechanism ever found to prolong life and delay aging is exercise. There is no data whatever to show that antioxidants, vitamins, or anything else prolongs life.” This is partly because when you take supplements and antioxidants, you don’t get the “training effect”—meaning your body isn’t stimulated to produce these substances on its own.
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