Overwhelming evidence indicates three lifestyle choices can help humans optimize wellness: increasing physical activity behaviors, decreasing sedentary behaviors, and consuming a well-balanced diet.
As director of the University Weight Control Center for more than 12 years, I supported the use of “structured lifestyle interventions” to increase participation in physical activities. This included group or individual counseling, introduction of behavior change and self-monitoring techniques, written information, and phone/online counseling.
Our program proved effective for changing behaviors, as long as people were enrolled. When the 12-week program concluded, nearly half of the participants did not maintain their newly learned exercise/nutrition behaviors during a one-year follow-up. Those participants reported it was too difficult to “do it on their own.” They needed continuous interaction, support, reminders, hints, and to-do lists. On a positive note, 50% of the participants (approximately) reported “success” at maintaining their new behaviors at the same one-year follow-up.
What are you wearing?
Most modern wearables can track vital signs, such as resting and activity pulse rate, and make comparisons with individuals of one’s same gender and age, reflecting changes (improvements) over time. (Image: iStock.)
Consumer-based health/fitness wearables can help one feel they are not doing this “on their own.” Wearables can monitor physical activity and specific health metrics and, when combined with a smartphone or computer, assist with a range of other motivational and health-monitoring tools. It’s just like the activities we performed in the clinic but with less expense. These tools include continuous heart monitoring with the diagnostic ability to detect rate and function abnormalities, blood oxygen saturation (PO2), sleep tracking, body temperature, blood pressure, and even blood glucose levels. These emerging technologies can provide ongoing support and motivation and interface with designated medical professionals.
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The health & fitness wearable marketplace will be worth an estimated $63.48 billion by 2027! Wow! Rising health awareness is a vital factor in increasing this market growth.
What can fitness/health wearables measure?
Step counter/exercise trackers Most wearable health/fitness devices include some sort of step counter that records how many steps and distances are covered for a given period. Prudent recommendations include a minimum of 7,000-10,000 steps daily to decrease sedentary risk syndrome (cardiovascular disease development). Most current wearable health/fitness devices also monitor acceleration, frequency, duration, intensity, and movement patterns. Some devices allow users to add running, cardio, dancing, cycling, and more. Summary information and recommendations data are available on request.
Vital sign monitor Most modern wearables can track vital signs, such as resting and activity pulse rate, and make comparisons with individuals of one’s same gender and age, reflecting changes (improvements) over time. Some devices offer selected body temperature readings, perspiration tracking, blood-oxygen saturation, and menstrual cycle data. By combining physical and workout data, the user can get a better picture of their overall health. Moreover, these data also can be stored and forwarded to an individual’s physician.
There are roughly 32,000 gyms in the U.S. with about 64 million people who regularly exercise in them. Of these, about 55% use a smartwatch to track their exercise duration, heart rate, steps, distance, and more. (Image: iStock.)
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Sleep recorder Keeping track of how much and how restful one sleeps is an important metric that offers important insight into health. Some trackers can discern and distinguish between sleep cycles, including REM sleep. Sleep quantity and quality represent an important indicator of health and wellness. In a previous column, I discussed different aspects of sleep and health.
Calorie tracking Most health & fitness wearables can track the number of calories expended during rest and physical activity; some allow the user to track calories consumed by entering the foods consumed.
Sync with other devices All health & fitness wearables can work with applications installed on a phone, tablet, or computer. Users can store data and compare progress with others (or just oneself) day-by-day or week-by-week. Some wearable devices are compatible with other tools, such as smart scales and clocks, or even specific exercise equipment. In some instances, one can instantaneously transfer data to a physician for review and evaluation. A growing number of devices can produce a medical-quality ECG (electrocardiogram) that offers a cursory evaluation of some heart anomalies and conditions like atrial fibrillation (AF), bradycardia, or tachycardia. These conditions may warrant further evaluation by a physician.
Expectations
Before you go out and buy a fitness/health tracker, make sure it’s worth it to you. Here are some of the pros and cons to consider.
Emerging technologies can provide ongoing support and motivation and interface with designated medical professionals. (Image credit: iStock.)
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Pros For many, tracking different fitness/health metrics can provide a better understanding of how you’re doing, not how you think you’re doing. This is important. Properly used, wearable data can provide the first indicator that something has gone haywire healthwise, and offers the opportunity to be proactive, not blindsided by an unwanted diagnosis.
Also, trackers can be very motivating, particularly to those who like numbers, notifications, digital rewards, comparisons, and reminders. When it’s cold outside, going for a winter walk may be a non-starter for many, but a simple reminder from a tracker may motivate one to produce enough steps to reach the day’s goal. The trackers feed into our competitive nature, pushing us toward the finish line, even when difficult.
Cons Not all fitness trackers are created equal. They have varying degrees of accuracy. Research indicates most trackers are reasonably accurate, but ‘reasonably’ isn’t perfect, which always leaves room for error. How much error depends on which device you choose. Inaccuracies can range from +/- 3% up to 20%. And another consideration is repeatability: Can the monitor accurately produce the same result on the same person on repeat use within a few minutes?
Any new gadget is fun for a while, and wearable trackers are no different. After some time, many individuals find themselves bored and over-stimulated with data, not to mention the need to constantly input and update data. The process can become anxiety-provoking, particularly for those who become obsessed with amassing the most data possible.
Another negative aspect is cost. There’s a tracker for every budget and style; you can spend $50, $1,000, or more. As with any technology, the more you spend, the more you get.
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Let’s talk about accuracy
Scientists have done numerous validation studies on most mainstream health & fitness trackers. The results indicate that accuracy is variable, depending on the technology used and what the tracker is trying to measure.
Any fitness tracker needs to accurately assess your activity level to be able to calculate it. A recent research review of the latest health & fitness trackers found that wrist- or arm-worn trackers for measuring energy expenditure varied in accuracy, depending on the task being performed. When the body’s movement was the only parameter being measured, they were less accurate than when the tracker also included a heart-rate monitor or body-heat sensor. In another study measuring aerobic workouts, caloric expenditure tended to be overestimated when working at a slower pace and underestimated when working at a faster pace.
Yet, in another study that compared 11 different trackers, researchers found that accuracy varied between them when counting steps. They tended to be better at correctly counting steps during brisk walking than day-to-day activities and intermittent walking when arm movements were frequently miscounted as steps.
Earlier-generation fitness trackers came with a chest band to measure heart rate by tracking the body’s electrical signals. These devices are very accurate. In contrast, modern fitness trackers worn on the wrist that measure heart rate using photoplethysmography (PPG) are less accurate, by varying degrees, depending on the tracker. These trackers contain LEDs (light-emitting diodes) that send light waves into your skin, and a photodetector captures the light that bounces off the wrist, which is then turned into information that the device’s inbuilt algorithms can analyze to determine heart rate. While these trackers have been shown to be accurate enough for measuring the heart rate of an average person, they are not suitable for research purposes and tend to produce erroneous, extreme readings, which might misinterpret the real-time exercise intensity.
Conclusions
Overall, the research on fitness & health trackers indicates that most people who use them tend to become more active, increase their step counts, and expend more energy at moderate and vigorous levels. They also found that trackers helped maintain good habits in the long term and could be helpful to medical professionals monitoring the health of their patients.
References
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ACSM. Wearable technology named top fitness trend for 2024.
Ash, G.I., et al. “Establishing a global standard for wearable devices in sport and exercise medicine: Perspectives from academic and industry stakeholders.” Sports Medicine. 2021;51(11):2237–50.
Chevance, G., et al. “Accuracy and precision of energy expenditure, heart rate, and steps measured by combined-sensing Fitbits against reference measures: Systematic review and meta-analysis.” JMIR mHealth and uHealth. 2022;10(4): e35626.
Fuller, D., et al. “Reliability and validity of commercially available wearable devices for measuring steps, energy expenditure, and heart rate: Systematic review. JMIR mHealth uHealth. 2020;8(9): e18694.
Gualtieri, L., et al. “Can a free wearable activity tracker change behavior? The impact of trackers on adults in a physician-led wellness group.” JMIR Research Protocols. 2016;5(4): e237.
Hickey, A.M., Freedson, P.S. “Utility of consumer physical activity trackers as an intervention tool in cardiovascular disease prevention and treatment.” Progress in Cardiovascular Diseases. 2016;58(6):613–9.
Hsueh-Wen, C., et al. “Accuracy of optical heart rate sensing technology in wearable fitness trackers for young and older adults: Validation and comparison study.” JMIR mHealth uHealth 2020;8(4):e14707.
Huhn, S., et al. “The impact of wearable technologies in health research: Scoping review.” JMIR mHealth uHealth. 2022;10(1): e34384.
Keogh, A., et al. “Breaking down the digital fortress: The unseen challenges in healthcare technology — Lessons learned from 10 years of research.” Sensors. 2024;24(12):3780.
Lupton, D. “The quantified self: A sociology of self-tracking.” Sociology of Health and Illness. 2016;39:1557–71.
Molina-Garcia, P., et al. “Validity of estimating the maximal oxygen consumption by consumer wearables: A systematic review with meta-analysis and expert statement of the INTERLIVE network.” Sports Medicine. 2022;52(7):1577–97.
Perez, M.V., et al. “Large-scale assessment of a smartwatch to identify atrial fibrillation.” New England Journal of Medicine. 2019;381(20):1909–17.
Piwek, L., et al. “The rise of consumer health wearables: Promises and barriers.” PLOS Medicine. 2016;13(2): e1001953.
Shilaih, M., et al. “Modern fertility awareness methods: Wrist wearables capture the changes in temperature associated with the menstrual cycle.” Biosci Reports. 2018;38(6): BSR20171279.
Spaccarotella, C., et al. “Assessment of non-invasive measurements of oxygen saturation and heart rate with an Apple Smartwatch: C0mparison with a standard pulse oximeter.” Journal of Clinical Medicine. 2022;11(6):1467.
Swee Sun Tang, M., et al. “Effectiveness of wearable trackers on physical activity in healthy adults: Systematic review and meta-analysis of randomized controlled trials.” JMIR mHealth uHealth 2020;8(7);e15576.
To help you do this, we’ve tapped our Start TODAY experts for simple tips to lighten up meals, move in ways that boost metabolism and and refocus our mindset to get motivated to keep working toward your goals. Apply their strategies and finish the month feeling lighter, more energized and motivated to move forward. Here’s the plan to make it happen:
>>Download the 31-day calendar here
31-Day HIIT & Walking Challenge
This month’s workout plan is focused on short workouts that pack a punch. “HIIT workouts give you a bigger bang for your workout buck! They provide a more efficient workout because you’re alternating the pace and intensity rather than sticking to a steady, moderate pace,” says Mansour. “Changing things up with HIIT prevents boredom and keeps your muscles guessing. This is how we can get the body to change — whether that change is speeding up your metabolism, burning more calories, building muscle, losing weight, or just improving overall health — keeping your body guessing is the magic ticket to seeing results!”
Active recovery days include stretching to improve flexibility and walking for a cardiovascular workout that aids muscle recovery. When weather permits, Mansour encourages people to get outside on walking days. “Walking outdoors isn’t just a workout, it’s a chance to breathe in fresh air and get out of the house to change your environment,” she says. “Each time you go outside on a walk, even if you go on the same path, you’ll see or feel something different. Maybe it’s a change in weather, plants or flowers, people or things. Prioritizing taking your walk outside can hugely benefit your mental health. Getting out of your regular environment and into nature can be a form of meditation, too.”
Get the full 31-day workout plan with unique workouts sent to you daily — plus, walking podcasts, healthy spring recipes and mindfulness tools — in the Start TODAY app!
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Lighten up comfort food favorites by adding seasonal ingredients, like in this Spring Asparagus Pasta.
3 Simple Spring Diet Tips
In addition to mixing up your workout routine, use spring as an opportunity to start lightening up your meals by packing them with seasonal ingredients. Start TODAY dietitian Natalie Rizzo shares her top tips:
Incorporate more seasonal foods. After a long winter of eating the same foods, your palate is ready for a change! Aim to add at least one spring fruit or vegetable to your meals each day, like asparagus, peas, spinach, radishes, citrus or strawberries. This Spring Asparagus Pasta is a simple weeknight dinner that feels both light and comforting. Seasonal produce is fresher, more flavorful, and an easy way to naturally boost vitamins and fiber. Plus, seasonal produce is more affordable than other items in the produce section.
Use fresh herbs to brighten up your dishes. Fresh herbs like basil, cilantro, parsley, mint, or dill can instantly upgrade simple meals without extra salt or heavy sauces. Sprinkle them on salads, roasted veggies, eggs, soups, or grain bowls for a burst of spring flavor. Cilantro is the perfect finish to this Mexican Stuffed Sweet Potato, while herbs are blended into cottage cheese in this Herby Cottage Cheese Toast with Tomato recipe for a pop of fresh flavor.
Shift from heavy comfort meals to balanced plates. As the weather warms up, it’s time to move away from heavy comfort foods and embrace lightened up spring dishes. Build plates with a mix of lean protein, whole grains or starchy veggies, and plenty of colorful produce. Think roasted veggie grain bowls, hearty salads like this BBQ Chicken Quinoa Salad, or simple stir-fries instead of creamy casseroles or heavy stews.
A sprinkle of fresh cilantro is the perfect finish to this Mexican Stuffed Sweet Potato.
Spring Clean Your Mindset with This Mental Health Exercise
Yes, we are working to propel ourselves forward toward our health goals, but an important part of that process is slowing down and reflecting.
Getting permission not to rush in a world that feels like it’s moving faster than we can keep up is a reminder that most of us need.
Yasmine Cheyenne, start TODAY mindfulness expert
“Getting permission not to rush in a world that feels like it’s moving faster than we can keep up is a reminder that most of us need, but how often would we admit that?” says Cheyenne. “ When the to-do list feels long, and we’re trying to get everything done, we often say the opposite, disregarding how we feel, and push ourselves. Yes, we all have deadlines and things that need to be done. But we also need the reminder to take care while handling our responsibilities.”
This can be easier said than done. So Cheyenne offers up a simple exercise to help: Write down the words you need to hear each day to make yourself a priority and work toward your goals. Put them somewhere you see often, like your fridge or bathroom mirror, and recite them out loud daily.
“This is a perfect example of a reminder that seems small, but can come at the perfect time and help us care for ourselves,” she explains. “One of my favorite examples is: Take it slow and don’t rush, your nervous system deserves peace.”
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“When you tell yourself the thing you’ve been needing to hear, it allows you to admit the quiet rumbling within you and take the steps you need. It might be admitting ‘I’m tired and will give myself an early night this week.’ Or you’re saying ‘I’m so proud of the way I’ve committed to moving my body everyday.’ Whether you’re cheering yourself on or reminding yourself of what you need, we don’t always slow down enough to hear what we need from ourselves, and this practice is a great way to start.”
Talking out loud to yourself may feel strange at first, but Cheyenne says over time it will help shift your mindset and translate those words into action. “When we hear ourselves recite these words, it’s like we’re planting positive seeds within us. The more we say what we need, the more we remember it, and we’re more likely to follow through and care for ourselves,” she says. “Our actions really start with the words we say to ourselves. Reading them out loud helps us rewire the way we talk to ourselves and that inner shift is exactly what opens the door to transformation.”
Join our live “Spring Reset Workshop” on March 22 to get one-on-one coaching from Yasmine Cheyenne and connect with other Start TODAY members. Sign up here!
If you’ve ever wanted to lose weight, you’ve probably heard the phrase ‘calories in versus calories out’. While it’s true to a degree, losing weight in menopause isn’t about eating less, but rather eating differently.
Speaking to fitness coach Loretta Hogg, Dr Stacy Sims says: “One of the first things that women often do, because we grew up in an era of calories in, calories out, less calories means fat loss. That is not true because if you are not eating enough, your body holds on to fat.”
This is called the ‘starvation response’, and it’s the body’s way of protecting itself when food is restricted. Metabolism slows down, hunger hormones increase, and fat stores are preserved for survival.
“Staying adequately fuelled” and strength training regularly is what’s actually needed to lose weight while managing our hormone levels in menopause. “When we’re looking at how we’re going to budge some of the meno-pot, we really want to focus on getting strong and building that muscle because if we are working on muscle and our whole focus is muscle and bone, then we end up eating accordingly.”
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Fibre and protein are the food groups to focus on, she says. They are filling, aid muscle growth (and so help maintain a healthy metabolism), help reduce food cravings, and provide us with the key nutrients our body needs when oestrogen levels fall.
We know there’s a huge market for protein powders, bars and other supplements, but actually, most of us can get what we need from eating high-protein foods.
The amount of protein you need in menopause depends on your weight. “The recommended protein intake for women over 45 is approximately 1 to 1.5g of protein per kilogram of body weight per day, which is higher than the general recommendation for younger adults,” Dr Nadira Awal, a Doctify-rated GP who specialises in women’s health and menopause, previously told woman&home. You can work out your personal recommendation using menopause specialist Dr Mary Claire Haver’s perimenopause protein calculator.
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Dr Sims says many women are “afraid of abundance” when it comes to eating, but emphasises that “without abundance we can’t lose fat”. “Let’s change the focus on not what we want to lose, but what we want to gain. We want to gain bone, we want to gain muscle. We want to fuel for that, so then the body fat comes off,” she tells Loretta.
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Dr Sims says the best way for us to gain this muscle and bone growth is through strength training. “We need to focus on heavy lifting,” she explains in another video on her Instagram account. “The caveat here is that most perimenopausal women haven’t had a long history in strength training, and it’s a learned skill.” She says consistency is key, and starting off small, even just focusing on movement without weights, before you start adding some load. “But the goal is to get into heavy resistance training, where we have low reps with a heavy weight,” she says.
Dr Sims says it’s “absolutely safe” for women to lift heavy during perimenopause and menopause – and it’s something we should all be doing. She is keen to emphasise that it’s never too late to start, and that “what matters is your form and your function”.
If you’re new to lifting weights, try a simple dumbbell workout at home and work your way up from there. If you have the means, consult a personal trainer for guidance on developing a workout plan.
Sleep is another lifestyle aspect that Dr Sims says says may affect how you lose weight. She says poor sleep “creates metabolic disturbance and dysfunction and increases fat gain”. Improving our sleep quality can lead to body composition improvements in as little as two to three weeks. High levels of cortisol, caused by poor sleep and ongoing stress, also makes fat loss harder as our bodies hold onto energy rather than using it.
Some key ways to improve sleep include going to bed and waking up at the same time every day, limiting blue light exposure at bedtime, and cutting down on your alcohol and caffeine intake.
Editor’s note: This article is the seventh in an eight-part series led by retired General James Mingus, the thirty-ninth vice chief of staff of the Army, on transforming the Army to meet the challenges of tomorrow’s battlefield. You can read other articles in the series here.
The battlefield in America’s next war will offer no sanctuary. The war won’t be fought from forward operating bases equipped with elaborate gyms, contractor-provided dining facilities, or coffee shops. The battlefield will be austere, harsh, and unrelentingly violent, with victory only possible by combining physical strength, endurance, and a will to prepare.
The Army’s Holistic Health and Fitness (H2F) program is the bedrock upon which this preparation begins. Winning America’s next war requires an Army that can get to the fight, win the fight, and get home from the fight—a mission profile that demands not just fit soldiers built for endurance, but warrior athletes built for endurance and able to leverage strength, speed, and power, and grounded in sound sleep and nutrition.
Culture Shift Begins with Mindset Shift
For the last several decades, the Army took pride in fielding formations rooted in a physical fitness culture relying heavily on push-ups, sit-ups, and miles of running and ruck marching. Physical training began predictably after saluting the flag at 0630 and ended promptly when the basic exercises, calisthenics, and formation run were complete. It was one-dimensional, unimaginative, boring, and, ironically, lazy. Army fitness during this period was solely focused on physical endurance.
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In the early 2000s, however, Army fitness began to change, led by special operations units like the 75th Ranger Regiment, which began experimenting with trending fitness regimens like Gym Jones, CrossFit, and Mountain Athlete. By combining emerging principles from several of these programs, special operations units began designing their own programs, such as the Ranger Athlete Warrior program. The rest of the active Army quickly started to model these programs, and the first H2F pilot kicked off in 2018.
Advances in exercise science and twenty years of war helped reframe the Army’s fitness mindset to encompass mental, physical, nutritional, and sleep dimensions. This mindset shift forms the basis of the H2F culture, changing how we train and care for soldiers. The focus is now on building strength and resilience like professional athletes—or more fittingly, warrior athletes. Where mission endurance was the goal before, tactical athleticism is now the goal, with an emphasis on strength, speed, power, and agility.
You Can’t Fake Results
A key part of any fitness program is the ability to measure its effectiveness, and in only a few short years, the return on investment for the H2F program has been profound. Currently sixty-six brigades have an H2F performance team, which consists of twenty-two professionals: a program director, dietitian, physical therapist, and occupational therapist; seven strength and conditioning coaches; four athletic trainers; one cognitive performance specialist; and six military personnel. By 2029, the program will expand to cover the entire active Army, as well as four states of Army National Guard and two Army Reserve commands.
According to analysis from the US Army Research Institute of Environmental Medicine, if H2F had been implemented across the entire Army, over a five-year period it would have added 1,080 deployable soldiers to the fighting force. If that’s not compelling enough, also consider these complementary H2F data points compiled by the Center for Initial Military Training Research and Analysis team after analyzing data from 2019 to 2023:
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61 percent decrease in musculoskeletal injury referrals
44 percent decrease in behavioral health profiles
79 percent decrease in substance abuse cases
22 percent decrease in fitness test failures
33 percent increase in expert rifle marksmanship qualification
Expanding the Tools
As part of continuous transformation, the Army is looking for unique ways to leverage technology to enhance the H2F program. Several units are experimenting with wearables like rings and watches that measure sleep efficiency, heart rate variability, and blood oxygen saturation—providing rich data to inform approaches to physical, nutritional, and sleep aspects of fitness. Today, entire Army divisions are turning physiological data into leader decision-making information. A company commander who knows his or her soldiers’ sleep scores, for example, is equipped with data to combine with other information to help select the most well-rested platoon to lead a dangerous mission. Individual soldiers will also learn the correlations that exist between their fueling, recovery, and performance habits, which will help in multiple facets of their personal lives.
The Army is also continually working to improve facilities and services that support H2F. Most units now have access to twenty-four-hour functional fitness gyms on post and many units utilize fitness containers—effectively, gyms in a box. Plans are also in place to build additional facilities to ensure soldiers at every post have adequate equipment to train. To improve nutrition, the Army is experimenting with campus-style dining facilities that will supplement, and in some cases replace, traditional dining facilities—affording soldiers a myriad of quick, 24/7 accessible healthy food options. A no excuse not to work out and no excuse not to eat healthy mentality now abounds across the Army.
Soldiering has no offseason and no time-outs, and wars wait on no one. When America calls, the Army responds. Unlike professional athletes who can vary training volume, intensity, and specific exercises over planned cycles or offseasons, a practice known as performance periodization, soldiers have no such luxury. Tactical athleticism via compound periodization is the goal for soldiers—ensuring peak performance at all times by developing key physical attributes (e.g., strength, endurance, and power) year-round to maximize efficiency, prevent burnout, and improve overall warfighting readiness. The H2F tools highlighted above aid in measuring and maximizing this readiness.
What’s Next?
Imagine two Army squads ascending Colorado’s Pikes Peak carrying fifty-pound fighting loads. Squad A trained to get to the top through push-ups, sit-ups, and miles of running. The soldiers of Squad B are warrior athletes who took the H2F approach. When Squad A’s soldiers finally struggle to the top, they’re just happy to be mission complete and they flop on the ground. The soldiers of Squad B assault the mountain, and when they get to the top, they still have enough juice to rip the arms off their adversaries and steamroll into the next mission. In their post-hike squad photo, they’re all standing tall—straight backs, satisfied smiles, and trap muscles extending inches above their shoulders so they almost appear to have no necks. For them the mission is just getting started, and their smirks seem to say, “Is that it? What’s next?”
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Welcome to the No Neck Army.
Retired General James Mingus served as the thirty-ninth vice chief of staff of the Army.
Colonel Graham White is an infantry officer and the executive officer to the vice chief of staff of the Army.
The views expressed are those of the authors and do not reflect the official position of the United States Military Academy, Department of the Army, or Department of Defense.
