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.
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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.
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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.”
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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.
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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.”
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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.
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.
