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MAHA Commission promotes fitness as a vital sign for children. What does that mean?

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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.

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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.

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Reward yourself by exercising regularly at One to One Fitness | CWRU Newsroom | Case Western Reserve University

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Reward yourself by exercising regularly at One to One Fitness | CWRU Newsroom | Case Western Reserve University

Now is the time to recommit to your health in time to feel your best for all your summer activities! One to One Fitness Center offers several ways to save in March.

Members of the Case Western Reserve University community can take advantage of sign-up specials designed to reward themselves for creating healthy habits.

Individuals can get 50% off the initiation fee (regularly $50 plus tax) and earn back what they do pay by exercising eight or more days in both April and May. Learn more online about this deal on initiation fees.

Students also can get additional savings:

  • Graduate students who are enrolled for the spring semester receive summer membership free.
  • With Spartan Shape Up memberships, affiliate students pay just $40 per month for membership from now through May, and no initiation fee or security deposit is required.
  • Students also can pay $44 plus tax per month with a month-to-month, ongoing plan. No initiation fee or security deposit required.

One to One Fitness Center, owned and operated by CWRU, is known for offering personal, professional, friendly and clean services. Memberships include full access to the 28,000-square-foot fitness center, group exercise classes, validated parking in Lot 53, towel and locker service, and member discounts on programs and services.

Members also can add their spouse or partner to their account for $30 plus tax per month. The center also offers personal training, Pilates Reformer, massage therapy and sound bath therapy, swim lessons, and more.

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Visit the One to One Fitness Center website, email onetoone@case.edu or call 216.368.1121 for more information.

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A 3-Step Plan to Give Your Diet, Fitness Routine and Mindset a Reset for Spring

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A 3-Step Plan to Give Your Diet, Fitness Routine and Mindset a Reset for Spring

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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Start TODAY Spring Asparagus Pasta recipe
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:

  1. 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.
  2. 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.
  3. 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.
Start TODAY Mexican Stuffed Sweet Potato
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!

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Exercise scientist says ‘eating more’ is key to losing weight in perimenopause – here’s why

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Exercise scientist says ‘eating more’ is key to losing weight in perimenopause – here’s why

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.”

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