Fitness
MAHA Commission promotes fitness as a vital sign for children. What does that mean?
Nobody’s against fitness for children. But health secretary Robert F. Kennedy Jr.’s proposal to make physical activity a “vital sign” akin to blood pressure or growth is raising questions among physiology experts.
Physical fitness for all and children’s health are two tentpoles of Kennedy’s Make America Healthy Again mission, articulated in the MAHA Commission’s initial meeting in May, outlined in a draft Make Our Children Healthy Again report in August, and solidified in the full report Tuesday. The report promotes “physical activity as a vital sign,” a concept that usually defines a healthy level as 150 minutes of movement per week.
The commission, though, urges states to establish specific metrics of fitness, for example, a “predicted VO₂ Max” as a baseline for evaluating Medicaid managed care organizations on how much they were improving health. Other factors would include sleep, nutrition, and potentially “select high-quality supplements.”
And decades after President John F. Kennedy introduced it, the Presidential Fitness Test will return to gauge the speed and strength of America’s schoolchildren, the report says.
When the test was introduced in the 1960s, people worried that kids were spending too much time indoors, sitting around and watching television. To jump-start their fitness, physical activity at school was encouraged with routines from running to rope climbing, culminating in an annual test.
STAT has requested comment from the Department of Health and Human Services, which directed inquiries to the White House, asking about the basis for these ideas and what might come next.
What is VO₂ max, anyway?
Experts told STAT they were puzzled by the mention of VO₂ max as a metric. VO₂ max stands for the maximum volume of oxygen the body can take in and use in a single minute during intense physical activity. It’s determined by a standard exercise stress test that measures breathing with a mask to calculate oxygen consumption to define fitness.
As a measure of cardiorespiratory fitness, higher is better. It’s less clear whether it makes sense to apply an adult athlete’s numbers, aka VO₂ max, to children at play.
“It’s a really great test. It’s not really something you can do in someone under 9, 10 years old in a really good way,” Jared Hershenson, a pediatric cardiologist who directs cardiac exercise and rehabilitation at Children’s National Hospital, told STAT. “If you’re talking about trying to measure someone’s fitness who’s younger than that, there really is not any objective test that can do that, or quantitative test that can be done.”
VO₂ max is difficult to measure, even for adults, I-Min Lee, a professor of epidemiology at the Harvard T.H. Chan School of Public Health who studies the role of physical activity in preventing chronic diseases, also told STAT. You need lab equipment and you need participants to exercise to the point of exhaustion. Picture people on an exercise bike or a treadmill, going full out while wearing a mask to track their oxygen levels. Many people won’t or can’t do that, she said.
There are predictive equations that do not rely on lab tests, but instead use age, sex, body mass index, or other numbers. With varying degrees of accuracy, they are more feasible in large numbers of people to advance health.
Lee underscored that physical fitness and physical activity are related, but not identical constructs. Activity is something we do; fitness is a physiological construct.
There’s this catch: Fitness can be improved by regular activity, but it’s also partially genetically determined, she said. “I could exercise to death, but I will never be as fit as Lance Armstrong, since I don’t have his genes.”
Outside the lab, VO₂ max is familiar to weekend warriors who upload their runs, swims, rides, and hikes to sports/social media sites like Strava to track training and add up kudos from their friends. That less-than-lab-quality number is derived from heart rate and other data collected by the watches on their wrists, made by Garmin or Apple or Coros, among others in the burgeoning market for wearables.
In June, Kennedy predicted wearables for all in the next four years, but later pulled back, saying in a statement to Axios that “they are not for everyone because of concerns like cost and personal privacy.”
Eric Topol, a cardiologist and geneticist at Scripps Research Institute, scoffed at measuring VO₂ max in kids when for adults, studies have shown there are more practical ways to measure fitness that don’t involve lab testing or expensive wearables.
“To do that in children? Are you kidding me?” he said in an interview. “That is just absurd. But that’s just the anti-science movement that keeps spewing out things that are not substantiated or possible or likely.”
Topol himself gets his VO₂ max data on his iPhone, but acknowledges its limits compared to a physiology lab. For children, it would make more sense to give them a wristband with a pedometer to measure activity. “Let’s go with something simple and cheap like that, that everybody could have,” he said.
We’re not there yet for children’s wearables, Hershenson said, while acknowledging its potential if government and private sector entities work together. There are no reliable fitness data from wearables in pediatric patients, for the children Hershenson’s center sees who have significant challenges or for healthier kids. Companies on their own might have variations in how they measure fitness.
“In any of the technology, as far as I know, nothing’s been correlated with exercise tests. You’d have to have some sort of standard testing to compare it to,” he said. “I think it’s going to have to be some sort of surrogate,” maybe heart rate recovery, which tracks how fast the heart rate returns to its normal resting state after exercise.
Presidential Fitness Test, redux
Then there’s the metric President Trump wants to bring back to life: The Presidential Fitness Test. Started in the 1960s by President Kennedy and modified decades later by President Obama, it sent schoolchildren racing the mile and doing situps, pushups, pullups, and rope climbs. The new report says HHS and the Department of Education will partner with the President’s Council on Sports, Fitness, and Nutrition to help states and schools reintroduce it.
Hershenson isn’t sure measuring how many pullups a child can do is going to help gauge fitness, strength, or flexibility as they pertain to future health.
“I think it’s useful to have some sort of baseline. But you need to know what to do with that,” he said. “We’re not just gonna throw a ball around. Let’s find ways that we can improve this person’s strength and this person’s fitness by doing stuff that’s fun.”
That also means thinking about barriers to exercise.
“To me the best approach is always treating each person individually to figure out how I can help them be the best version of themselves,” Hershenson said. “That’s extraordinarily difficult when you’re making massive public policy for however many millions of people, but I think it’s going to be different for everybody.”
“Is it a questionnaire? Is it measuring heart rate recovery? Is it measuring how many steps you take?” he asked. “It’s probably not going to be perfect.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
The latest NHS exercise guidance reinforces what we’ve been preaching for years: hitting that 150-minute weekly movement target isn’t necessarily a get-out-of-jail-free card. It states that prolonged sedentary time is independently harmful, even for those of us who diligently carve out time for the gym. Verbatim, it says ‘prolonged sitting is harmful, even in people who achieve the recommended levels of moderate to vigorous physical activity’.
Chief Medical Officer Professor Sir Chris Whitty has been especially vocal about how detrimental it could be, highlighting hybrid working as a potential health hazard. ‘Without wanting to exaggerate, I think it’s important people think through, for example, hybrid working means quite a lot of people could very easily do very little other than leave their homes, where previously people would be routinely going to work, and that often meant at least some physical [activity],’ he said at a briefing.
I understand his logic, but it’s pretty reductive. Working from home isn’t the villain here – working from one chair is.
When we label remote work as “bad for your health”, we risk throwing the baby out with the bath water. In reality, for many – certainly the whole of the Women’s Health office, but also my less-fitness-conscious sister and stepdad, plus my entire friendship group – working from home often means being more active. It means more time to fit in a lunchtime run, to get some steps in before work, or to run some errands on a quick break.
On the other hand, plenty of office workers are more sedentary than they are at home. They sit at a desk for nine hours straight before driving home, whether to be seen to work tirelessly in front of their manager, or simply because they’re pulled from pillar to post in an office setting. For those who do have an office commute, eliminating that often stressful period of the day allows for better sleep, and more time for the movement breaks we need to break up the dreaded sedentary time. Not to mention that many commutes are almost entirely sedentary on a train/tube/bus.
The potential problem, the advice suggests, is the lack of incidental movement – the walk to the train, the stroll to a meeting room, or heading out for lunch – that’s naturally baked into your day when you’re in the “official” office. Without a commute or a day in the office, the onus is on you to manufacture movement in.
Regular stretching counts as a movement break
Without sounding evangelical, I’ve made this a non-negotiable part of my day. On WFH days, I work out or walk every single morning before I log on, and walk again every evening, even if just a lap around the block. During the day, I have a personal rule: if I’m downstairs, I use the upstairs toilet (and vice versa). Sounds excessive, but it forces me to activate my muscles and add to my step count every few hours.
Beyond that, the options are endless if you’re intentional. Use a standing desk or put your laptop on a kitchen worktop during calls. Take every phone meeting on foot, pacing your hallway if necessary. Set a timer to stand up every 30 mins to stretch, grab a glass of water, or do a quick load of laundry.
We don’t need to return to the office to be healthy; we need to bring movement back into our homes. The goal: to stop being professional sitters.
As Women’s Health UK’s fitness director and a qualified Pilates and yoga instructor, Bridie Wilkins has been passionately reporting on exercise, health and nutrition since the start of her decade-long career in journalism.
After earning a first-class degree in journalism and NCTJ accreditation, she secured her first role at Look Magazine, where she launched the magazine’s health and fitness column, Look Fit, before going on to become Health and Fitness writer at HELLO!
Since, she has written for Stylist, Glamour, Cosmopolitan, Marie Claire, Elle, The Metro, Runner’s World and Red. Today, she oversees all fitness content across Women’s Health online and in print, spearheading leading cross-platform franchises, such as ‘Fit At Any Age’, which showcases the women proving that age is no barrier to exercise.
She has also represented the brand on BBC Radio London, plus various podcasts and Substacks – all with the aim to encourage more women to exercise and show them how. Outside of work, find her trying the latest Pilates studio, testing her VO2 max for fun (TY, Oura), or posting workouts on Instagram.
If you ask anyone on the gym floor how to grow a bigger set of shoulders, you’ll probably find that no two answers are the same. In between front raises, upright rows, machine presses and cable raises, shoulder day can quickly become a long list of exercises.
However, fitness creator and coach Eric Evans, also known on social media as Average to Jacked, thinks most lifters are overcomplicating things. He says that if he had to start from scratch after over a decade of training, he’d strip his shoulder workouts back to just two simple moves.
‘If I had to start over today, I’d build my shoulders with just two movements: a lateral raise and also a rear delt fly,’ he explains.
According to Evans, the reason for this isn’t because those exact exercises are magic, but because they work the correct movement pattern for the muscle.
‘Your body doesn’t know the name of the exercise you’re doing,’ he argues. ‘It really only knows the fundamental movement pattern you’re asking it to perform and also the amount of tension you’re placing on the muscle.’
So, you don’t have to perform cable lateral raises if your gym only has dumbbells, or use a reverse pec deck if you’d rather do bent-over rear delt flyes. As long as you’re training the same movement pattern and progressing the move with intensity or volume, you’ll achieve a similar result.
According to the coach, lateral raises deserve a place in your programme because they primarily target the side delts, helping create broader-looking shoulders and a more pronounced ‘V-taper’. Rear delt flyes train the back of the shoulders to create a rounder, more 3D physique.
‘I’m not including anything for the front delts, and that’s intentional,’ he says. ‘Your front delts are already heavily involved every time you do pressing exercises for your chest.’
For most lifters already bench pressing, incline pressing or overhead pressing regularly, he argues the side and rear delts are more likely to be the limiting factor.
‘I don’t think the front delts are what’s holding their shoulders back. I think it’s the side and rear delts,’ he adds.
He recommends focusing on controlling every rep, and avoiding using momentum to swing the weight. He also suggests working in the 8-15 rep range, adding reps until you reach the top of the range before increasing the load and repeating the process – also known as progressive overload.
‘You definitely don’t need to hit your shoulders from 10 different angles,’ he says. ‘You just need to consistently train these two movement patterns, push them hard and then gradually get stronger over time.’
The Bottom Line
Research suggests muscle growth is driven more by sufficient training volume, progressive overload and proximity to failure than by constantly changing exercises and programme hopping. In fact, that could hinder it. So if your shoulder workouts have become jam-packed with unnecessary variations, simplifying your approach may be exactly what helps you make more consistent progress in the long term.
If there’s one thing Kori Sampson knows, it’s how to optimise your body composition for performance. To tap into his knowledge as an elite athlete and coach, we asked him to create a 4-week plan to help you move faster, recover quicker and keep pushing when the fatigue sets in – all while improving your muscle-to-fat ratio.
Ready to build muscle, burn fat and come out the other side looking, feeling and performing better? Click here to get 14 days of free access to the plan via the Men’s Health app.
Fitness
80-year-old fitness icon Joan MacDonald reveals her simple exercise for a stronger, more stable core
Joan MacDonald didn’t enter a gym until she was 70. Really. Since then, the 80-year-old has transformed her health by losing three stone and building significant muscle, and now coaches other women through her training platform, Train With Joan, which she launched to help others boost their fitness at any age.
The premise of her app is simple: minimal-equipment workouts built around no-fuss, effective exercises that can be done anywhere. One ‘powerful core and stability exercise’ she swears by is alternating bodyweight clock taps. ‘This movement helps strengthen the muscles that keep you stable, balanced and moving well as you age,’ Joan explains.
Bodyweight clock taps benefits
Think they look too simple? That’s the point. Joan is adamant that ‘You don’t need complicated workouts to start getting stronger. Sometimes the most effective movements are the simple ones you do consistently.’
According to Joan, regularly performing bodyweight clock taps help:
- ‘Strengthen your core which supports your spine and reduces strain on your lower back.
- ‘Improve balance and coordination, helping you stay steady on your feet.
- ‘Increase hip stability, which supports your knees and joints.
- ‘Build functional strength for everyday movements like stepping, turning and reaching.
- ‘Help reduce fall risk by improving control and body awareness’
How to do bodyweight clock taps
Find a demo from Joan above, along with instructions for how to do them with proper form below.
- Stand on one leg with a slight bend in your supporting knee and brace your core.
- Keeping your hips level, reach your free foot forward to lightly tap the floor in front of you (12 o’clock), then return to the centre.
- Continue tapping to different “clock” positions—such as 3, 6 and 9 o’clock—maintaining your balance and control throughout.
- Complete all reps on one leg before switching sides.
Form tip: Move slowly and focus on staying stable. The goal is controlled movement, not how far you can reach.
How many reps and sets to do
Joan shares her advice, according to your fitness level.
- Beginners: ‘3 taps per leg x 8-10 reps’
- Intermediate: ‘3 taps per leg x 10-12 reps’
- Advanced: ‘3 taps per leg x 12-15 reps’
One of our most frequently asked questions here at Women’s Health? How to build muscle and burn fat at the same time. So, we asked superstar trainer Oyinda Okunowo exactly how to do it. In this 4-week plan – created exclusively for Women’s Health COLLECTIVE members – you’ll get the workouts and nutrition guidance needed to help you on your way to better body composition. Tap the link below to unlock 14 days of free access to Oyinda’s plan and start training today.
Get the plan
As Women’s Health UK’s fitness director and a qualified Pilates and yoga instructor, Bridie Wilkins has been passionately reporting on exercise, health and nutrition since the start of her decade-long career in journalism.
After earning a first-class degree in journalism and NCTJ accreditation, she secured her first role at Look Magazine, where she launched the magazine’s health and fitness column, Look Fit, before going on to become Health and Fitness writer at HELLO!
Since, she has written for Stylist, Glamour, Cosmopolitan, Marie Claire, Elle, The Metro, Runner’s World and Red. Today, she oversees all fitness content across Women’s Health online and in print, spearheading leading cross-platform franchises, such as ‘Fit At Any Age’, which showcases the women proving that age is no barrier to exercise.
She has also represented the brand on BBC Radio London, plus various podcasts and Substacks – all with the aim to encourage more women to exercise and show them how. Outside of work, find her trying the latest Pilates studio, testing her VO2 max for fun (TY, Oura), or posting workouts on Instagram.
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