“This is the best thing happening in the boxes. 14,000 gyms…each one is a lifeboat against this tsunami of chronic disease that’s going to take 70% of the people out there.”
—Greg Glassmann, CEO, CrossFit Inc.
The phone call came the night before Thanksgiving on November 20, 2018, at 7:00 p.m. A close friend of the family was likely going to die in the next few days, maybe even the next twenty-four hours—she is 95 years old. A couple weeks ago she had fallen and broken her hip and post-operative complications were possibly going to kill her. This news threw a shadow over our thanksgiving festivities but it also served to fan the flames on an issue that I have spent the last few years investigating: the role that physical exercise plays in aging versus early mortality due to physical inactivity and its relation to chronic disease.
You may ask, “What does this have to do with a 95 year old woman falling and breaking her hip?”
“Everything,” I would answer, because a full 1/4 of adults over 65 fall at least once a year and studies estimate that health care costs attributed to this issue were around 50 billion dollars in 2015 (1, 2). Small improvements in physical fitness can reduce the risk of falling and improve the chances of recovering if a fall should take place.
However, before we start in with the hard core data concerning exercise and health, I want to bring this back to a personal level. I grew up as an active person and spent my formative years rock climbing and mountaineering and practiced the sport until I was in my late forties. In those days I never had to worry about my weight or cardiorespiratory fitness because most of the time I was humping heavy loads over the mountains, working day-in and day-out to free climb some mighty piece of stone, or guiding clients up the Grand Teton.
Yet in my fifties I slowed down. I had a career that needed solidifying, a daughter to raise and put through college, and I didn’t think much about committing to a long term physical exercise program. Why should I? I still thought that I could just lift myself off the couch and do what I wanted. I saw fitness as this thing that would come back to me after a few weeks of activity. It didn’t occur to me that perhaps fitness and inactivity were different processes and had no idea that the majority of chronic diseases afflicting our population came from lack of physical exercise.
I was wrong to think that I could work out a little and get my fitness back and so my health declined even though I was active. In those years I became a cave diver (SCUBA) and traveled to Florida and Mexico and succeeded in some of the most advanced cave training and dived some of the most extreme caves in the world. But as I approached my sixties I saw my weight going up, my resting heart rate spiked into the seventies and my blood pressure in the high 140s. Fact is, getting off the couch to hike or to go cave diving had little or no effect on those numbers. My health and fitness were on a negative trajectory and I felt a sense of badness coming from my lifestyle if I didn’t do something about the situation.
And so it was that three years ago I began to cast around looking for a fitness solution. I sensed, on a deep intuitive level, that the activity had to be intense. I understood this because I had already seen that hiking, a gym membership, and long walks around the neighborhood didn’t work to change my numbers. I was also influenced by the fact that I had experienced a few years of fitness training with a young coach, Keats Snideman, whose methods involved intense workouts with diverse movements much like those found in a CrossFit gym, so I gravitated in that direction and started researching CrossFit programs.
During this time frame I also became acutely aware of others around me that were in the same age range but much worse off physically and I wondered about the prevalence of this condition in the population now aging out of the work force. And so we come to the numbers. It has to be done. We all must realize how serious this situation is so hold on to your hat and get ready for the ride.
By 2030 there will be over 71 million adults over 65 years old and their health care will cost 3-5 times more than someone younger (3). The majority of all health costs will be associated with chronic diseases that arise from the metabolic syndrome—a large cluster of conditions including cardiovascular fitness, obesity, hypertension, insulin resistance, arthritis and inflammation (4). According to the CDC, 90% of the 3.3 trillion dollar annual health care costs in 2016 were due to chronic and mental disorders (5).
A full 1/3 of the population of the USA and Europe are already expressing aspects of the metabolic syndrome that leads to cardiovascular disease, diabetes, osteoporosis, and dementia (4, 6). As our population ages the US health care system is going to be overwhelmed by the expense of treating chronic diseases and by the impact it has on the quality of life of the older population. We are living longer but we are less healthy. It is to our fiscal benefit to keep the aging out of the healthcare system and as a society we need to be abundantly clear about the cause of chronic conditions and what we can do to decrease their prevalence within our society.
There are two main interrelated reasons for the prevalence of chronic disease in our population: lack of exercise and diet. We are predominantly sedentary and eat processed foods that are high in sugar. Because of the lack of exercise the average person loses 1.2% and 3.5% of their strength and power each decade as they age (3). To clarify: strength is contractile ability like curling a milk jug and power is the capability to pick up the milk jug and deliver it to the dinning room table quickly. Moreover, the decline in cardiorespiratory fitness is approximately 10% per decade along with declines in balance, gait, and an increase in visceral fat (4, 7).
Adipose tissue is an active endocrine machine that produces factors that promote insulin resistance and systemic inflammation (4). In short, individuals with metabolic syndrome have 2-5 times more risk in acquiring type II diabetes and/or cardiovascular disease—usually these diseases appear together in the same individual.
Until recently research into the causal factors behind the metabolic syndrome have been isolated and the definition of fitness has also varied from one study to another. For example a study might focus on the effect of endurance training on hypertension or strength training as it relates to gait and balance. Only recently have studies taken into consideration diet and exercise together as it relates to the global cluster of metabolic issues. These studies have shown that exercise and diet both reduce the metabolic cluster that leads to chronic diseases like type II diabetes (4, 8).
The positive effect of exercise is greatest when functional exercise is utilized at high intensity coupled to a diet that is composed mostly of fish, nuts and seeds, fruit and complex carbohydrates and no sugar (4). Finally, recent studies at the National Institutes of Health have concluded a direct link between physical activity, diet and metabolic diseases—there is no argument about this—we are talking about hundreds of studies (8). The findings are indisputable and denying the findings are like saying that the earth doesn’t revolve around the sun.
Let me emphasize: Physical inactivity is the primary event that causes chronic disease. Physical exercise prevents chronic disease. The data is straightforward and conclusive.
Furthermore, these studies show that exercise should be functional with components that are aerobic and strength oriented and performed in a variety of different ways with high intensity. This program should be coupled to a diet that is balanced with protein, fat, complex carbohydrates, and no sugar. Enter CrossFit Inc., CEO, Greg Glassman, who said, “We sit collectively in unique possession of an elegant solution to the world’s most vexing problem [chronic disease]. And it may be so elegant that it’s optimal.”
The first CrossFit gym was opened in Santa Cruz, California, in 2000 by Greg Glassman and Lauren Jenai (9). I think it’s fair to say that Greg Glassman began to understand the relationship between exercise and prevention of chronic disease long before there were so many conclusive studies. Certainly there were other influencers as well, like my coach and friend, Keats Snideman, who trained me one day a week back in the early-2000’s and many other coaches who understand the connection between exercise and chronic disease scattered all around us and throughout US cities. But I think that CrossFit, with over 14,000 gyms worldwide (and growing), has the infrastructure to make an impact in the fight against chronic disease in general, and perhaps most importantly, with those of us that are over sixty and aging out of the work force.
In the CrossFit model the workouts are highly varied multifunctional movements completed at high intensity (10). Typical workouts called WODs (workout of the day) involve the combination of gymnastics, weightlifting, and cardiovascular movements. From a personal perspective I started CrossFit three years ago and have seen extraordinary results in terms of my fitness: a resting heart rate in the low to mid-fifties, blood pressure down ten points into the low 130s and quite often in the mid-120s, and my metabolic numbers such as cholesterol are down in the healthy range and body weight down to a normal BMI. I should note that I have not altered my diet except for taking fish oil and I should point out that my diet has never included the overt consumption of sugar or sugary drinks. Lastly, I am not on any prescription drugs though my doctor wanted to medicate me for my prehypertension three years ago.
However, if CrossFit is going to be a driving force in the cure of chronic disease then I think there are some things that the organization needs to do in order to become a mainstream solution to the problem:
The public face of CrossFit seems too intense and out of reach to the masses and especially to older adults. Although many YouTube videos are circulated that showcase older people benefiting from CrossFit, most of the media features athletes throwing around massive weights by men and women who are young, fully ripped, and look like they could squeeze water out of granite.
When I first researched CrossFit I was intimidated by the movements that I had seen in the videos and spoke about my concern to the affiliate owner of the gym that I eventually joined. The main thing was, could I do the movements and stay uninjured? The last thing old people want is to land in the hospital where the care is uneven, the costs can bankrupt a meager retirement account and you can die from the hospital experience (11).
More needs to be done to make CrossFit seem accessible on its public face. One thing that might bring national recognition would be a research study carried out across the country at qualified affiliates using CrossFit programming to analyze the conditioning of senior participants and how that relates to their chronic disease status—take a bunch of these people with chronic diseases and reverse their cluster of conditions in a controlled study and publish the data. There are few unbiased research studies that can be found in the literature that analyze CrossFit and its effect on fitness (12). Moreover, there are no controlled studies that show the effect of CrossFit on resting heart rate or blood pressure. There are also no studies that focus on the best combination of exercise volume with respect to injury rate over time in contrast to the health benefits of the exercise combined with diet.
There are major universities everywhere there are CrossFit boxes and CrossFit has already made significant connections with doctors. I know of at least one anecdote that happened in our box where an individual with type II diabetes had his status reversed based on dietary changes (no sugar) and CrossFit programming under the care of a doctor and our coaches. Anecdotes are anecdotes, but a research study with controls and publishable results? That would be very good for CrossFit Inc.
Many CrossFit affiliates have masters programs but many do not. A corollary to this is the low number of masters coaches. This matters because many of the young coaches may lack the understanding regarding the aged athlete. We come in all shapes and sizes with a daunting number of range of motion issues in addition to other physiological issues.
As an example, after a forty years of rock climbing, I have significant mobility issues in my shoulders that cause limits in range of motion. I may never do the Fran with a ninety-five pound barbell because of the overhead since I can’t lock my arms out—believe me when I tell you that I am working on this.
Masters coaches understand these issues and are less likely to shake their head and simply suggest a stretching regime before class. They know that particular movements might not be possible for a given older individual and they are more likely to be ready with an appropriate scale option. A masters coach will also understand that these clients are likely to never be pain free in the WODS due to the ingrained mobility issues in their joints.
In another example, I have a colleague who became interested in trying CrossFit because of the changes he saw in me. Body transformation is an unavoidable positive aspect of CrossFit and my co-workers noticed and asked me about what I was doing and of course, I advocated for CrossFit. In this case, the co-worker in question is sixty-three years old and is overweight with a predisposition to cardiovascular disease.
He joined a CrossFit gym but only lasted three days after the on-ramp program before a squatting sequence took him out of the game. Of course his doctor told him to stop going to CrossFit because be believes the program is too intense. I suspect he was ramped up to fast which might have been avoided if the coach had been a masters coach who would have had him squatting to a box and completing less reps. This particular gym lost a client but created someone who will most likely say that CrossFit was too hard for him and that he got hurt by it. I want to stress the fact that there are no research studies that analyze CrossFit from the point of view of managing volume in a given WOD relative to different individuals (12). Data concerning injury rates in CrossFit suggest that the injury rate per hour of training is low but that most participants are injured if they participate in CrossFit longer than six months(12). It would be interesting to know how many people try CrossFit and leave after their first few sessions? In any case, scaling matters to the health and fitness of the participants in order to maximize the long term retention of the older athletes.
Scaling movement is an important aspect of the public perception of CrossFit because potential clients need to know that the workouts are within the realm of the possible and are safe. I think that the programming in CrossFit is brilliant but the intent of a particular workout needs to be understood on a deep level by the coaches in order to scale it properly. I also think that there is a high degree of variability in how different coaches see the intent of a programmed workout and therefore the scaling of the WOD.
In all the research that I did leading up to writing this article, I could not find any significant method that is used to determine the Rx of a WOD other than the assignment by the original inventor of the WOD which seems arbitrary to me. In a WOD with wall-balls, if a full 1/3 of the class is flat on their backs, chests pumping at the sky, in a sequence that is supposed to be unbroken, there is a problem with the scaling.
In climbing I used to say, “One man’s 5.8 is another man’s 5.11,” meaning that the upper limit in the ability to perform a certain task in a certain time frame is not the same for all people. That’s not to say that eventually one may rise through hard work to the level of 5.11. The key is to find the individual maximum and hold that line, at that intensity. In the wall-ball WOD, coming down in weight and/or reps would have done the trick.
In the recent L1 that I participated in there was only a few minutes devoted to the discussion of scaling and the example discussed was Fran. In the end, the coach suggested that our clients should eventually do Fran with a 95 pound barbell. I see this as a potential conflict because it makes common sense that older clients may never reach this weight but there is often a perception that this weight is the only legitimate Fran, and that perception can have negative consequences when it comes to making CrossFit a mainstream solution to curing chronic disease because we want these people to join the boxes and then we want them to stay with us for the longterm.
Having completed the L1 and the online scaling course I have a deeper appreciation for the scaling dilemma. Running a class with upwards of twenty people has to be hard enough let alone trying to sort out scaling options for the outliers. I feel challenged trying to figure out scaling options for myself let alone the other participants that I observe working around me during a WOD. However, this is precisely why the scaling issue should be studied on a deeper level by CrossFit if it wants to be a mainstream solution to chronic disease.
In finishing, I agree with coach Glassman that CrossFit is the “elegant” answer to the chronic disease epidemic and I feel fortunate that I have found a place in the “lifeboat” and that I am part of the solution to this “vexing problem”. When I hear the critics say that CrossFit is not for everyone, I disagree: CrossFit is for everyone, if it’s done right.
CF-Online Scaling Course (2018)
1. Take A Stand On Falls. (2017). CDC.gov.
2. Florence et. al. Medical Costs of Fatal and Nonfatal Falls in Older Adults. (2018). Journal of American Geriatrics Society. 10: 1111.
3. Gray, M. and Paulson, S., (2014). Developing a Measure of Muscular Power During Functional Tasks for Older Adults. BMC Geriatrics. 14. 145.
4. Reija, M., Diet and Cardiorespiratory Fitness in Older Adults With Special Reference to Metabolic Syndrome and Cognitive Function. (2015). Dissertation in Health Sciences. #300. The University of Eastern Finland.
5. Center for Medicare and Medicaid Services. National Health Expenditure Data for 2016.
6. Nolan, P.B., et al., (2017). Prevalence of Metabolic Syndrome and Metabolic Syndrome Components in Young Adults: A Pooled Analysis. Prev. Med. Rep., 7, 211-215.
7. Fleg, J. L. and Strait, J., (2012). Associated Changes in Cardiovascular Structure and Function: A Fertile Milieu For Future Disease. Heart Fail. Rev., 17, 545-554.
8. Booth, F. W., et. al., (2012). Lack of Exercise is the Major Cause of Chronic Disease. Compr. Physiol., 2(2), 1143-1211.
9. Wikipedia: CrossFit
10. CF-L1 Training Guide
11. Klevens, R.M., et. al., (2007). Estimating Health Care-Associated Infections in U.S. Hospitals. Public Health Rev. 122(2). 160-166.
12. Claudino, J. G., et. al., (2018). Sports Medicine-Open 4:11