The 10,000 Step Legend

March 18, 2019 / Thomas Cohn, MD

Most people have now heard of the daily 10,000 steps goal. It is the baseline average set for most fitness trackers on the market these days. This seems to be a magic number, but there is actually no scientific evidence behind it. The actual science pushes for 30-45 minutes a day of aerobic conditioning, which is recommended by the American Heart Association. There are numerous studies supporting aerobic conditioning for cardiovascular health and overall positive well-being. The 10,000 step goal was actually was just a marketing scheme for a Japanese pedometer first made in 1965. The pedometer had a Japanese name that translated to 10,000 steps, and the advertising campaign pushed that concept.

Walking To Better Health

The reality of walking a certain amount does have some merit. Monitoring your step count and standing every hour has the incentive to increase your overall activity level. A normal person will walk somewhere between 3,000 and 6,000 steps in a day with routine activity such as work, shopping, and moving about the home. Adding in 30 minutes of aerobic activity hopefully adds another 3,000-4,000 steps or more and pushes a person over 10,000 steps. Therefore the push to about 10,000 steps helps most people to get their extra aerobic workout as recommended for good cardiovascular fitness.

The overall goal of tracking activity is to motivate you to maintain a higher level of fitness. Being able to check your step count is feedback and accountability for being active. Some people can maintain activity levels without tracking themselves and others do group activities so they are accountable to more than just themselves. Many people unfortunately just do not care and let their physical fitness slide. Keeping active and exercising is one of the best ways to stay healthy. It is easier to be lazy, but to feel more healthy, exercise along with eating right and sleeping is essential. If you want to improve your health, it may pay to start tracking your habits, including activity, eating and sleeping. Using a fitness tracking device and the associated computer or phone app may greatly improve your success.

The benefit of exercise cannot be forgotten for anyone who has chronic pain. Keeping the body fit reduces pain in a number of ways. A good program will include stretching of the body to help maintain proper muscle length and function. Strengthening keeps the muscles strong and permits us to continue activity. Lastly, aerobic conditioning provides the endurance to tolerate activity as well as increasing the body’s own endorphins, which help reduce pain.

Becoming consistent with exercise is the aim of using a fitness tracker. If you are self motivated to exercise and are consistent that is wonderful. Using any tracker, from the one that is in any smart phone to those tied to a phone app like a smartwatch or a Fitbit may also be helpful. Find out what works for you and get moving.

Could Wearables Replace Opioids For Pain Management?

October 5, 2018 / Thomas Cohn, MD

Chronic pain affects roughly 100 million Americans, and the pain management market is estimated to be about $635 billion a year. With so many people to treat and money to be made by finding new, safer treatment options, a number of different technology companies are jumping into the world of pain management.

One area that is of particular interest to these companies is wearables and how they can be used to combat and treat chronic pain. A recent study involving more than 1,600 people with distal and proximal chronic pain focused on the Quell wearable device. The wearable allowed patients to track their pain in real time, including changes in pain intensity and pain interference with sleep, activity and mood on an 11-point scale. Patients tracked these changes over the course of two months, and researchers analyzed the findings at the conclusion of the study.

But tracking wasn’t the only feature available with the wearable. The unit actually provided high-frequency transcutaneous electric nerve stimulation. Many patients found that when they wore the device and it was emitting signals, that their pain levels decreased.

“[We found] statistically and clinically significant decreases in pain interference with activity and mood” and “a clinically significant decrease in pain intensity and less pain interference with sleep,” researchers wrote.

Wearables and the Future of Chronic Pain Management

The quell device was only helpful for a select number of people dealing with certain types of chronic pain, but the technology behind the device is exciting. It’s like a hybrid Fitbit and TENS unit, and as the technology continues to progress, we may soon see wearables that can work to drown out pain signals in all different areas of the body.

We understand the science, but because pain is such an individualized issue, there’s no one-size-fits-all wearable for chronic pain. Opioids do a better job of controlling a wider type of pain, but they come with their own potential drawbacks, including potential addiction and dependence. Wearables do not present the problem of dependence, but the tricky part is getting them to impact the specific nerve pathway that is causing pain.

We need to keep investing money in these alternative treatment options and in pain management as a whole. It seems like we’re nearing a breakthrough, not just with wearables, but as a whole. Pain is a huge industry affecting tens of millions of people, so it’s going to draw attention and investments. The first company to develop a wearable or another opioid alternative that can reliably control certain types of widespread pain will set the bar and enjoy the spoils that come with it. This will lead to more investments, better technology, and hopefully, better non-opioid patient care options for chronic pain. We’re excited to see what the future holds.

Fitness Trackers and Weight Loss

November 4, 2016November 4, 2016 / Thomas Cohn, MD

Fitness trackers like the Fitbit have been part of the health craze for several years now. Two claims are common for these devices:

That they will improve fitness levels, and;
Help people lose weight.

Recent studies have shown that these devices may improve the number of steps taken but fall short on helping patients lose weight or improve health. The study was performed at Duke-NUS Singapore Medical School. In general, knowing how many steps one takes has not translated to improved overall health.

Fitness Tracker Study

The study involved 800 adults, divided into four groups, and the interventions with the trackers lasted for six months. The goal was to boost activity to 50,000 to 70,000 steps a week. Three groups received trackers, and incentives to use the trackers varied and one group was a control group without the trackers. The control group was just given information on the benefit of exercise. The study lasted six months, and the groups given the trackers were successful at boosting their physical activity and maintained their activity the best at one year out. However, 90 percent of those with a tracker stopped using them by a year after the conclusion of the study. The most telling outcome was increased activity did not cause any improvements in blood pressure or weight loss.

The reality is that improved cardiovascular health and weight loss is more complex than just increasing the number of steps taken. Cardiovascular health has several components, to lower blood pressure one must have a degree of higher intensity aerobic conditioning. The heart rate must get to a high level to be effective at possibly lowering your blood pressure. Weight loss is extremely complex, and goes well beyond exercise. Fitness trackers like the Fitbit are best to be considered motivational devices. Everyone has a different reason for exercising. Some people are self motivated and just exercise because they want to and may have personal goals to achieve. Some people like to go to health clubs and find exercising a social pursuit. Others exercise for health reasons, such as controlling cardiac disease or diabetes. A fitness tracker allows some to maintain personal goals. Checking the amount of steps may keep a person going to meet their goals. However if your goal is better cardiovascular fitness or weight loss, it will take more than just walking a certain number of steps. If weight loss is a concern or cardiovascular fitness is your need, working with a physician or other professional may be beneficial for more guidance.

Being Accountable For Your Health

September 21, 2015 / Thomas Cohn, MD

Taking control of your health requires daily management, and it’s not always easy to do on your own. Sometimes help comes in the form of a gym buddy, but recently we’ve seen a rise in the number of people who wear a fitness tracker to help them track their activity, which is a great start towards a healthy lifestyle. That’s because people who wear some sort of fitness tracker tend to exercise more regularly and they are more accurate in reporting the time and amount of exercise. In the end, it all comes down to holding ourselves responsible for our health, but if these devices can help you stick to a schedule, it seems well worth the investment.

The boom in activity trackers hopefully will lead to higher rates of compliance with fitness. For my patients with pain, those who have included the use of a fitness tracker to monitor activity have been more consistent in exercise. They have also tended to be more motivated in performing an exercise routine, use less medication and have better control of symptoms.

One of the most important actions necessary to control pain is exercise. One needs to perform muscle strengthening and aerobic conditioning on a regular basis to control symptoms. Working with a physical therapist to learn how to perform the correct exercise is a good start, and after learning how to exercise appropriately, consistently being active is critical. The use of an activity tracker can significantly help a person stay the course of appropriate exercise.

The cost of a good fitness tracker runs about $100. As medicine goes, this is a relatively cheap investment into your own health. If pain is a factor in your health, get a fitness tracker, use it and get active.

Exercise Accountability and Pain

September 2, 2015 / Thomas Cohn, MD

A recent study in Medicine and Science in Sports and Exercise points out whether we are reliable in reporting our exercise. The answer is that most of us tend to over report our activity level. When using an objective measure of activity, such as a monitoring device of steps and pulse, the record is much more accurate. The best way to keep healthy and reduce pain is to stick to a regular exercise routine. If you are not being accountable, the activity is usually not being done. Very few people have the self-discipline to be consistent with exercise on their own.

Up until recently, the best way to be accountable is to have an exercise partner. Whether it be a yoga classmate or a running partner, if you had to meet someone else, it was much harder to skip the exercise.

Currently, the electronic age can become out partner, as most people now own a smartphone. Both the Android and the Apple phones have fitness apps built into the phone and have electronics that can monitor motion. As long as one has the phone in hand (or pocket), the phone will record your steps. Most people should be aiming at obtaining at least 10,000 steps a day to maintain general cardiac aerobic fitness.

Fitness Trackers and Exercise

A fitness tracker, such as a Fitbit, Vivofit (by Garmin) or Jawbone can be of great benefit. There are now multiple brands of trackers, those at about $100 dollars tend to monitor:

Steps

Distance

Calories burned

Steps climbed

Sleep patterns

The more expensive ones will add in heart rate monitoring, sometimes blood oxygen levels, and may connect to smartphone notifications. All the fitness trackers have apps that chart your daily, weekly and monthly statistics. Keeping a record of your activity tends to make one more responsible toward meeting fitness goals.

The importance of maintaining physical activity is very evident in the pain patient. My patients who are the most active have the best control of their symptoms and tend to use the least amount of drugs and other interventions. For myself, the fitness tracker keeps me more active, maintaining my aerobic conditioning goals. The more intense aerobic exercise, even for just 15 minutes every day, definitely increases my endorphins (the body’s own pain killers) and decreases my back and leg pain. Without the tracker, I know I would be lazy, and definitely would think I am doing more activity than I actually perform.

Aerobic activity does need to be combined with strengthening and stretching for most pain patients. The areas that are causing pain often need more physical muscle support to prevent symptoms, and strengthening and keeping these muscles healthy is another priority.