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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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How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

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How the 3-3-3 Rule Helped Me Stick to an Exercise Routine

If you’ve ever started a new workout routine with the best intentions only to find yourself skipping sessions by week two, you’re not alone. I’m the type to get trapped in the same cycle of burnout, where I go hard for a couple of weeks, feel exhausted, feel guilty, and repeat. For me, what finally broke that cycle wasn’t a new gym membership or a fancy fitness app, but a simple scheduling hack: the “3-3-3 rule.” I’d seen this rule applied it to general productivity, and all the same principles can apply to your fitness habits, too. Here’s how you can use the 3-3-3 rules to structure your workouts and create a habit that sticks.

What is the 3-3-3 rule?

The 3-3-3 “rule” (or “method,” or “gentle suggestion”) is essentially a weekly workout framework built around three types of movement, each done three times per week:

  • Three strength training sessions. This includes lifting weights, bodyweight circuits, resistance bands, whatever builds muscle and challenges your body.

  • Three cardio sessions. This includes running, cycling, swimming, jump rope, a dance class—what counts as “cardio” is up for debate, but here, I think of it as anything that gets your heart pumping.

  • Three active recovery days. This includes light walking, yoga, stretching, foam rolling, and so on.

And yes, I realize this math adds up to nine intentional days of movement across a seven-day week. Here’s the thing: You do double duty some days, or skip workouts here and there, or adjust to a nine-day cycle, because the point isn’t rigid scheduling. The point is rhythm over a strict structure. For me, the 3-3-3 rule provides a sense of momentum that’s flexible enough to fit into real life, but consistent enough to actually stick to.

Why the 3-3-3 rule works for me

Before I get into how the 3-3-3 rule helped me specifically, let’s talk about why so many workout plans fall apart in the first place. I believe most of them make two classic mistakes. The first is doing too much, too soon. You go from zero to six days a week at the gym, you get burnt out, and the whole thing unravels. The second mistake is having no real structure at all—just vague intentions, like “I’ll work out when I can,” which never materializes into anything real for a lot of people.

For me, the 3-3-3 rule solves both of those problems. It gives me enough structure to build habit and momentum, but not so much intensity that my body and brain feel overwhelmed. I personally adore running, but I struggle to motivate myself to lift weights; the 3-3-3 rhythm here helped me find a middle ground between those two workouts. When I know I have three strength sessions to hit in a week (or nine-ish day cycle), I can look at my calendar and find three slots without too much drama or dread.

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There’s also plenty of breathing room built into the plan, which was the biggest game changer for me. I used to have the (toxic) thought that my rest days were wasted days, which is a mentality that led to either overtraining or complete inactivity with pretty much no middle ground.

Plus, there’s something psychologically satisfying about the number three. I know and love the rule of threes in photography, comedy, survival tips, and all over the place.

How to make a 3-3-3 workout schedule work for you

The 3-3-3 rule has a ton of wiggle room for customization. Here are some ideas for how you can approach it:


What do you think so far?

For strength days, pick a format you actually enjoy. That might be a full-body circuit, a push/pull/legs split, or a class at your gym. (Boxing, anyone?) Your focus on these days should be a progressive challenge—push yourself, yes, but don’t obliterate yourself.

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For cardio days, variety helps. Mix a longer, easier effort with a shorter, more intense session (like a 20-minute interval run). I know I’m biased, but cardio really shouldn’t feel like punishment.

For recovery days, resist the urge to “make them count” by sneaking in extra work. The whole point is to let your body consolidate the gains from your harder days. Walk, stretch, breathe, and trust the process.

Another practical tip: Pick a night to map out your 3-3-3 week ahead of time. You’ll probably find that the week arranges itself pretty naturally once you’re looking for those nine windows.

The bottom line

As always, consistency should always be your priority in fitness. If you’ve been struggling to find a rhythm, if your past workout plans have always fizzled out around week three, give the 3-3-3 rule an honest four-week try. Maybe start with a 1-1-1 month! After all, the 3-3-3 rule isn’t a hack to totally transform your physique, but I do think it can provide something way more valuable. Finding a routine that works for you—like the 3-3-3 rule works for me—is the first step to make exercise a reliable, sustainable part of your life.

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

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I’m a running coach — I’ve just tested shoes actually designed for women’s feet, and they’re a total game changer

Why you can trust TechRadar


We spend hours testing every product or service we review, so you can be sure you’re buying the best. Find out more about how we test.

QLVR ENDVR: Two minute review

Most running shoes feel familiar for a reason: the formula has barely changed in millennia. We have archaeological evidence of shoes being fastened with “shoelaces” as far back as around 3,500 BC, yet the basic lace-up running trainer remains the default.

QLVR (pronounced “clever”) set out to challenge that. Its debut shoe, the ENDVR, is a laceless “running slipper” built around a women-specific mechanical structure, with a slip-on Wing Fit system inspired by the way a bird’s wing opens and closes around movement.

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

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Mere minutes of daily vigorous exercise can cut your risk of 8 diseases | CNN

Move more. Sit less. For many years, that’s been accepted guidance for people wanting to get healthier.

Now that message is getting refined, with a growing body of research suggesting that certain types of movements may be more beneficial than others when it comes to health benefits.

The intensity of your exercise may matter as well. A new study published in the European Heart Journal found that a small amount of vigorous activity may be linked to lower risk of eight different chronic diseases.

The findings raise questions about why intensity matters and how people can incorporate more intense exercise routines into everyday life. To better understand the study’s implications, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.

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CNN: What did this study examine about exercise and its relationship to chronic disease?

Dr. Leana Wen: This investigation looked at how the intensity of physical activity is related to the risk of developing a range of chronic diseases. Researchers analyzed data from two very large groups in the UK Biobank, which is a long-term health study in the United Kingdom that tracks medical and lifestyle information from hundreds of thousands of participants. One group included about 96,000 people who wore wrist activity trackers that objectively measured their movement, and the other included more than 375,000 people who self-reported their activity.

The researchers followed participants over an average of about nine years and examined the development of eight conditions: major cardiovascular events, atrial fibrillation, type 2 diabetes, immune-related inflammatory diseases, fatty liver disease, chronic respiratory disease, chronic kidney disease and dementia, as well as overall mortality.

The key finding was that the proportion of activity done at vigorous intensity mattered. People who had more than about 4% of their total activity classified as vigorous had substantially lower risks of developing these conditions compared with people who had no vigorous activity at all. The numbers were stunning, with the participants having the following results:


  • 63% lower risk of dementia,

  • 60% lower risk of type 2 diabetes,

  • 48% lower risk of fatty liver disease,

  • 44% lower risk of chronic respiratory disease,

  • 41% lower risk of chronic kidney disease,

  • 39% lower risk of immune-mediated inflammatory diseases,

  • 31% lower risk of major cardiovascular events,

  • 29% lower risk of atrial fibrillation, and

  • 46% lower risk of death from any cause.

These results are amazing. Imagine if someone invented a medication that could reduce the risks of all these diseases at once — it would be very popular! Crucially, even people who exercised a lot still benefited if the proportion of time they spent doing vigorous physical activity was increased. Conversely, people who were relatively inactive also benefited from adding just a little bit of higher-intensity exercise to their daily routines.

CNN: What counts as “vigorous” physical activity?

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Wen: Vigorous activity is generally defined as exercise that substantially raises your heart rate and breathing. A simple way to gauge it is the “talk test.” If you can speak comfortably in full sentences while exercising, you are likely in the low to moderate range. If you are so out of breath that you can only say a few words at a time, that is vigorous.

Running, cycling, lap swimming or climbing stairs quickly could count. But this also depends on people’s baseline fitness. For some individuals, taking longer strides with walking can be vigorous exercise. Others who are already fairly fit would need to do more. It’s also important to remember that vigorous activity doesn’t have to be in the context of a structured exercise plan. Short bursts of effort in daily life, such as rushing to catch a bus or carrying heavy groceries upstairs, can also qualify if they raise your heart rate and make you breathless.

CNN: Why might higher intensity exercise provide additional health benefits?

Wen: Higher intensity activity places greater demands on the body in a shorter period. This type of movement can improve cardiovascular fitness, increase insulin sensitivity and support metabolic health more efficiently than lower-intensity activity alone. Some studies have also linked vigorous activity with cognitive benefits.

Greater intensity may have distinct benefits across different organ systems. The researchers found that some conditions, such as immune-mediated inflammatory diseases, appeared to be more strongly linked to the intensity of activity than to the total amount. On the other hand, type 2 diabetes and kidney disease were influenced by both how much activity people did and how intense it was. Why this is the case is not yet known, but intensity appears to have a significant impact across diseases affecting multiple organs.

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CNN: How much vigorous activity do people need?

Wen: The threshold for people seeing a benefit appears to be relatively low. The researchers found that once people reached more than about 4% of their total activity as vigorous, their risk of developing chronic diseases dropped substantially.

To put that into practical terms, we are not talking about professional athletes dedicating their lives to hours of high-intensity training. Everyday people may see benefits from just doing a few minutes of vigorous effort daily.

CNN: How can people realistically incorporate vigorous activity into their daily routines?

Wen: One helpful way to think practically is that vigorous activity does not have to happen all at once. It can be accumulated in short bursts throughout the day.

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People can take the stairs instead of the elevator and do so at a faster pace than usual. When they are heading to work, they can add some speed walking. They can park farther away when grocery shopping and walk briskly while carrying groceries.

Structured exercise also can incorporate intervals where people alternate between moderate and more intense effort. If you’re swimming laps, you can warm up at a more leisurely pace, then do a few laps at a faster pace, then again at a leisurely pace and repeat. This suggestion applies to any other aerobic exercise: Aim for multiple intervals of at least 30 seconds to a minute each where your body is working hard enough that you feel noticeably out of breath.

CNN: What about someone who is older or has mobility issues?

Wen: Not everyone can or should engage in high-intensity activity in the same way. Vigorous activity is relative to that person’s baseline. For someone who is not used to exercise, even a short period of slightly faster walking or standing up repeatedly from a chair could be considered high intensity. And not everyone may be able to walk. In that case, some exercises from the chair can have aerobic benefits.

Individuals who have specific medical conditions should consult with their primary care clinicians before embarking on a new exercise routine. People with mobility issues also may benefit from working with a physical therapist who can help to tailor exercises appropriate to their specific situation.

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CNN: What is the key takeaway for people trying to improve their health?

Wen: To me, the main takeaway from this study is that it’s not only how much total exercise you get but also how hard you push yourself that matters. And you don’t have to have a lot of high-intensity exercise: Adding just a little has substantial health benefits across a wide range of chronic health conditions.

At the same time, exercise needs be practical. People should look for opportunities to safely increase intensity in ways that fit their daily lives. The most effective approach to physical activity is a balanced one: Exercise regularly, incorporate more challenging activities when you can and build habits that are sustainable over time.

Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.

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