Early in my training as a family physician, I learned that being proactive was the best way to avoid most health problems. In medical practice, this typically takes the form of preventive care, also known as “checkups.”. We look for “silent” diseases such as hypertension, cancers, or diabetes before a patient has symptoms. While early disease detection is important, it is a form of secondary prevention… finding a disease after it exists.

In the case of cardiometabolic diseases--the leading cause of death in most of the world--waiting for and reacting is misguided. In the modern world, this approach alone will fail many patients. Despite religiously doing annual “checkups,” people slowly acquire a long list of ailments and medications. Despite attempting to manage diseases, they suffer, confined mostly to a chair, decades before death.

This is a sad process to watch. And unfortunately, increasingly common among Americans.

Thus, like most primary care doctors, I heavily emphasize primary prevention through lifestyle efforts. In addition to reducing the chances of early death, I want people to thrive until the end. Health is not merely the absence of disease. Research has proven a person’s functional capacity (aka. fitness level!) is a far predictor of healthspan–the number of disease-free or fully functional years lived--than a person’s LDL or BMI.

All of this has left me pondering: what role should doctors play in improving fitness?

My understanding and views of exercise, nutrition, and other wellness topics have evolved through a scientific lens. Over the past decade, I have given more detailed exercise recommendations while recognizing everyone has different likes and limitations. Regardless of how a person gets in better shape, I want to support their efforts by showing them progress.

When managing a chronic disease like diabetes, objective measurements of decline or improvements are critical. Without lab work, a person and their doctor would fly in the dark. Yet, we rarely define a status or goal for patients when prescribing exercise. We routinely check body weight, vital signs, and cholesterol during a preventive visit. However, these are myopic views of a person’s fitness, detecting diseases due to being unfit for many years!

I have often joked I should walk patients up the hill near my office during yearly check-ups rather than recheck their cholesterol. Over the years, this jest has turned into an idea… we should diagnose a person’s fitness level!

An Olympian is an example of peak fitness. Their cardiorespiratory system, skeletal muscles, and mitochondrial functions have reached the limits of what is physiologically possible. The average Joe may not have an aspiration for a gold medal. However, the process of aging and most cardiometabolic diseases lie at the opposite end of the spectrum of fitness.

Running a marathon in under 3 hours requires different skills than lifting a 300-pound barbell off the floor. How should we categorize the vast array of athletic abilities?

CrossFit describes ten categories of general skill: cardiovascular/respiratory endurance, stamina, strength, flexibility, power, speed, coordination, agility, balance, and accuracy. For general fitness, a balance of these abilities is ideal. With respect to healthy aging and avoiding diseases, “endurance” (aerobic capacity) and “strength” are probably the most crucial.

You may have taken the Presidential Fitness Test (PFS) as a child or heard of your kids doing a “PACER” test in PE class. These are attempts to grade a child’s fitness level. Although not perfect, these assessments are far more objective yardsticks than most adults use.

Functional fitness tests are good predictors of general health, disease risk, and death. For example, a 2019 study showed the number of push-ups a 40-year-old man can do in one minute is strongly associated with future heart disease. In addition, a treadmill test performance (VO2 max) and quadriceps strength are good predictors of mortality in people over 50.

Looking deeper at the tissues and physiology that enable fitness can be done in many ways. A person’s “percent body fat” or “resting heart rate” are common examples. This scratches the surface of what enables performance and longevity. Using modern technology, we can gain deep insights into the function of your cardiorespiratory, neuromuscular, and metabolic systems.

How does physical activity or exercise change us for the better?

While we often think of “stress” as harmful, it is necessary for physiologic adaptation. In the case of exercise, we place demands on various organ systems and metabolism. In response, they grow or adapt. A stronger heart or skeletal muscle is built slowly, cell by cell. That biological progress can often be slow and difficult to perceive. This is especially true if the goal is weight loss or an improved physique.

A novice runner can likely get a new PR in a 5K every few months with consistent training. Losing the first 20 pounds is easier than the last 20 pounds. Unfortunately, progress isn’t always a straight line. Improvements can often be elusive or frustrating. This is especially true for someone who is obese or already struggling with chronic disease. However, advanced athletes deal with the same when they hit a “wall” in their performance.

When progress stalls, we are often left wondering, “Why am I not improving?” or “Is this the best I can ever do?”. Whether just starting a program or struggling to see progress, identifying your functional and physiologic weaknesses is essential. Improvements are often delayed due to misguided activities or even overtraining.

If you want to optimize performance or health, intelligent programming is critical. With FitnessDx, you can train smarter rather than just trying “harder.”

Through optimizing health & fitness, we may be able to prolong our lifespan (number of years lived) slightly. However, death is inevitable—it comes to us all eventually. Increasingly, I ask my patients an important question, “What will the last decade of your life look like?”

We have much more control over how functional we remain in the latter part of our lives. Our fitness level will largely dictate this. FitnessDx was designed to help people expand their healthspan; to continue enjoying their life’s passions for as long as possible.

W. Ryan Neuhofel, DO, MPH (Dr. Neu)

Introducing FitnessDx