Know Your Numbers, and Your Family History
Beyond the annual medical check-up
Do you know your physical fitness numbers? And what about your family medical and health history that may put you at increased risk of heart disease or diabetes or dementia?
Assessments of health and fitness indicators provide a lot of information about where you are at, what needs improvement, how things are trending, and can surely help with motivation and goal setting.
Your annual medical checkup that includes measures of height and weight (BMI), resting blood pressure, and standard blood work (lipids, glucose, etc.) should be just the start to your comprehensive physical fitness and health profile.
Most lifestyle and wellness experts agree that the following assessments should also be included:
Body composition. Ideally, a DXA scan to show regional and total body lean tissue, adipose tissue, and bone. Facilities in the U.S. can be found here and the cost usually ranges from $125-250. Determine the Appendicular Lean Mass Index (ALMI) or Fat Free Mass Index (FFMI) and the trunk or visceral fat levels. If you cannot get a DXA, determine % body fat and FFM (and FFMI) using bioelectrical impedance or BodPod and also measure waist circumference.
Aerobic fitness. Maximal aerobic fitness or VO2max (maximal oxygen consumption) is a robust predictor of several chronic diseases, and sets the ceiling for physical work capacity. It can be measured directly in an exercise physiology lab using expired gas analysis ($75-$200) or indirectly estimated using either a maximal or submaximal exercise test on a cycle ergometer (i.e., YMCA bike test) or treadmill (i.e., Bruce protocol). Several field tests are available with conversion equations and age- and sex-specific reference charts. Besides the classic 1-mile or 12-minute run, there is also a simple single stage treadmill walking or jogging protocol.
Muscular fitness. Testing for muscular strength can range from determining your 1-repetition max (or estimating it from a 3-5 rep test) to handgrip test to a muscular endurance tests of maximal pushups. If you have been lifting, it is easy to perform a 3-5 rep set during a regular training session and use the weight lifted and number of reps performed to estimate the 1RM (maximal strength) for squat, deadlift and/or bench press (equation here). Consider dividing it by body weight to determine your relative strength (i.e., 300 lb deadlift / 200 lb body weight = 1.5). The maximal pushup test is easy to perform (relatively speaking in terms of set up and equipment!). Muscular power should not be ignored as discussed in this blog, and can be measured simply with a long jump or using a VBT device.
Cardio-metabolic risk factors. Heart disease and type II diabetes continue to be leading causes of morbidity and mortality. Resting blood pressure is an important measure but sometimes it can read high during a medical visit (“white coat syndrome”). Several high quality electronic devices can be purchased at the local drug store so that you can measure in the comfort of your home. Again the routine blood markers received during a typical annual check-up are just the start. Total cholesterol, LDL, HDL, TC:HDL, TG, TG:HDL, etc. and fasting glucose give good insights but most cardiology and diabetes experts will also encourage the following biomarkers: for glucose metabolism and diabetes risk - HbA1c or even a oral glucose tolerance test (OGTT) or wearing a continuous glucose monitor for 14 days; for cardiovascular disease risk factors - Lp(a) (lipoprotein(a)) and ApoB (apolipoprotein B) along with a Coronary Artery Calcium (CAC) score scan ($75-300), which measures the measures the calcification of plaques in your heart arteries.
Brain health. Determine your Brain Care Score here. In terms of biomarkers, get an apolipoprotein E (APOE) test. This genetic biomarker identifies which variant of the APOE gene you have. The APOE gene has three common variants: 2, 3, and 4. While anyone can have a variety of these combinations (i.e., 4/3, 2/4, 3/3, etc), having two copies of the APOE4 variant (4/4) is the strongest known genetic risk factor for Alzheimer's disease (and cardiovascular disease).
Wellness and Quality of Life (QOL). Although several subjective paper-pencil surveys are available to measure wellness and/or QOL, let’s keep this really simple. On a sliding scale of 1 (really shit) to 10 (awesome), what is your QOL? 8? 6.5? 3.75? Sometimes this score does not match with the physical fitness and cardio-metabolic risk factor data. You can have great physical fitness but other things in life are impacting social and emotional health or something else.
Family medical and health history. You cannot run from your genes or family history of disease. Complete a Family Medical History Survey and know your risk. You can use the Surgeon General’s web-based tool called “My Family Health Portrait.” to keep track of the information or find standard forms elsewhere online.
“Genetics loads the cannon, but the environment pulls the trigger.” -Dr. Eliot Joslin, America’s first diabetes doctor
What’s Next
Ok, now you have your fitness and health profile. It is also important to take note of your current lifestyle including physical activity, nutrition, sleep and stress as all of these contribute to the physical fitness and cardio-metabolic risk factors. For some, this assessment may provide motivation to start or refine their lifestyle habits. Or maybe it’s adding more (or modifying) Zone 2 aerobic exercise or high-intensity intervals. Or including 1 power exercise in their resistance training program. Or maybe it’s focusing on sleep and stress management or some aspect of nutrition.
Regardless of how you use the data, periodic assessments and tracking of your comprehensive health and fitness profile will likely empower you to make informed decisions about your well-being, optimize your training, identify areas for improvement, and ultimately lead to better long-term health outcomes and a higher quality of life.
Explore the complete archive of Health and Fitness (aerobic fitness, brain health, lifestyle, etc.) blogs from IronMan Performance here
This looks expensive. Luckily, we get a free blood test/ health check every 5 years with the NHS. They don't do any fitness tests: but they are simple enough to do yourself.