It’s easy to lose weight. The hard part is keeping the weight off.

About 1 in 5 overweight or obese Americans successfully loses weight and keeps the weight off. What if you could survey thousands of these successful losers to determine what habits they have in common — essentially crowdsourcing their top tips for weight loss success?

This is exactly what the National Weight Control Registry (NWCR) is doing. The NWCR is a database founded in 1994 by Rena Wing, Ph.D., of Brown University, and Jim Hill, Ph.D., of the University of Colorado. The NWCR was established to answer two key questions:

• Are there people who have successfully maintained a substantial weight loss? (Yes!)
• What common characteristics and strategies have helped these people achieve and maintain weight loss?

To be eligible for the NWCR, participants have to be 18 years of age or older, and have lost a minimum of 30 pounds and kept the weight off for at least 1 year. The registry now has more than 6,000 ‘losers’ who have lost an average of more than 60 pounds, and have kept off the weight for more than 5 years! (Almost 20% of NWCR participants have lost 100 pounds or more.)

These volunteers have answered questions about their eating behaviors, physical activity, and other habits. Thus most of the information is based on self-reports. About 90% had lost weight before, but had regained it (the average lifetime weight loss was 270 pounds over several previous attempts).

What’s different this time? The participants cite medical, emotional and/or social reasons or triggers for their successful loss and maintenance. They are committed to making — and keeping — behavioral changes that influence both the calories they consume and the calories they burn off.

7 Habits of Highly Successful Weight Loss Maintainers

1. Engage in regular physical activity. More than half of the NWCR members burn more than 2,000 kcal week. This is about 200 minutes a week (30 minutes/day) of moderate-intensity exercise. Popular activities include walking, stationary and/or road cycling, aerobics, walking or running on a treadmill, jogging, and strength training.

200 minutes a week is not a lot, and is just a bit more than the 150 minutes a week recommended in the U.S. Physical Activity Guidelines for Americans.
How many minutes of physical activity do you engage in each day? Can you add in 5–10 minutes a few days a week?

2. Limit television watching. About 63% of NWCR members report watching less than 10 hours a week of television (less than 1.5 hours a day on average).

According to the Bureau of Labor Statistics, Americans watched TV ~19 hours/week (2.7 hours a day) on average in 2010, while Nielsen pegs the number at ~32 hours/week (more than 4.5 hours a day) across ages 2 and up. How many hours a day do you spend watching TV?

3. Eat a low-calorie, low-fat diet. NWCR members report consuming 1,380 kcal/day, with less than 30% of the calories coming from fat.  When shopping, they often reach for foods (such as salad dressings, dairy, and soft drinks) that have been modified to contain less sugar and fat.

A typical diet is assumed to be around 2,000 calories a day, but when it comes to calories, it’s definitely not ‘one size fits all.’ You can calculate the estimated calories you need each day, plus receive a daily food plan at Choose My Plate, from the USDA.

4. Eat a consistent diet and don’t splurge. NWCR members tend to eat the same foods regularly. They prepare most of their meals at home and typically have less than one fast food meal a week. They don’t splurge on high-calorie foods on weekends, holidays, or other special occasions.

5. Eat breakfast. Almost 80% of NWCR members report eating breakfast every day. This habit may help control hunger and prevent them from overeating later in the day.

6. High dietary restraint and awareness. NWCR members maintain control over what they eat. They don’t eat something in response to their emotions, or just because it’s there.

7. Self-track. More than half of NWCR members weigh themselves at least weekly and track their daily food intake. They also tend to monitor their calories and/or fat grams.

Do you track? What method do you use? Have you tried an app, or the online USDA SuperTracker?

The successful losers combine physical activity and diet. They use their leisure time wisely, engaging in physical activity instead of sedentary activities, such as TV watching. They exhibit restraint. And they stay on track with self-tracking.

What works (or doesn’t work) for you?
If you are a successful loser, you are invited to join the study:  http://www.nwcr.ws/

Related posts

• Childhood Obesity By The (Big) Numbers 
• Twelve Everyday Health Rules–From 1908
• Kids and Media Use: Letting their fingers do the walking?
• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• 12 real foods for real results: Insider tips from top sports nutritionists
• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes

Photos

• Two women: istockphoto
• V a u h d i k a s [bike] courtesy of Pörrö at Flickr
• Remote courtesy of kevinthoule at Flickr
• Banana courtesy of the USDA Fruit Food Gallery
• Zero Gravity [scale] courtesy of mrjorgen at Flickr

Reference
Graham, T.J., Bond, D.S., Hill, J.O., Wing, Rena R. The National Weight Control Registry: A Study of “Successful Losers.” ACSM’S Health & Fitness Journal, 15 (2) pgs 8-12, 2011.
doi: 10.1249/FIT.0b013e31820b72b5

©2012 Kinetics. All Rights Reserved.

A Light Shining in the Darkness: Kevin Ado's Jacket (Senegal). Painted by Regina Holliday at the mHealth Summit, as part of The Walking Gallery.

This year’s mHealth Summit was very, very large (more than 3,600 people from 50 countries), and very, very diverse (researchers, policy makers, health care providers, developers, entrepreneurs).  There was a bit of something for everyone, and numerous outstanding summaries have been written from several perspectives (see list below).  Here’s a quick snapshot of what stood out.

5 Great Quotes

• “There’s 5.6 billion people using wireless today in the world. To put that in a health care context, that’s more people using cell phones than toothbrushes.” – Paul Jacobs, Ph.D., CEO, Qualcomm

• “A smart phone is a cognitive prosthetic.”  – Anthony Sterns, Ph.D., iRx Reminder LLC

• “If you’re an entrepreneur or venture capitalist, I would look at how you begin to prepare for an infrastructure-independent health care world, and focus on basically three questions:  What problem am I solving? Who is going to pay for that? What is unique?” – Don Casey, CEO, West Wireless Health Institute

• “There’s more pilots in mHealth than in the Navy.” – Jay Bernhardt, Ph.D., MPH, University of Florida

• “My hospital parking garage has better technology than my hospital.” – Unknown panelist

5 Major Themes (or most overused words, depending on your perspective)

• Ecosystem
• Disruptive
• Personalized
• Dashboard
• Immersive

5 User-Centric Companies / Projects to Watch

These five ‘Get’ the context angle. They understand their specific audience’s needs, wants, nightmares, and dreams. As a result, they are going to greatly impact their health and/or healthcare by harnessing the power of mobile technologies. (Summaries are abbreviated versions of what appears on the company sites.)

• Asthmapolis Dedicated to improving the management of asthma for patients and healthcare professionals. Asthmapolis is using medication sensors, mobile applications, advanced analytics and feedback to help physicians identify those patients who need more help controlling the disease before they suffer a severe and costly exacerbation.

• BodiMojo  Short for Body + Motivation + Journey, this research-based platform for teens, ages 13-18, offers a personalized, judgment-free zone that promotes healthy body image, fitness, nutrition and wellness through powerful, inspirational teen-driven content.*

• Chronology.MD  A PHR application for patients with Crohn’s disease. This project, funded by the Robert Wood Johnson Foundation, seeks to help patients create and communicate an effective patient narrative that can be used to increase the quality of the patient’s life and health over time.

• Eyenetra.com A combination of a mobile phone and a clip-on eyepiece that allows anyone to quickly measure their own eyes for glasses. Through mobile connectivity, the system allows users to easily access back end service providers and caregivers for consultation and treatment, enabling a complete solution from awareness to treatment.

• Sotera Wireless A wireless platform for continuous vital signs monitoring that keeps clinicians connected to their patients, whether in transport, in the emergency room or in general inpatient units.

5 Great Resources

• Health.data.gov
• Health Games Research
• hub: Health Unbound
• mHIMSS
• The Walking Gallery

What words, quotes, or companies caught your attention at the 2011 mHealth Summit?

What others are saying about the 2011 mHealth Summit

• Digital Meets Health, Paul Sonnier, @wirelesshealth1 (guest blogger), Popper and Co.
• Impressions from my first mHealth Summit, New Health Rock, The PrescribableApps Blog, @RxApps
• mHealth: Seemingly Stuck in Neutral, John Moore, @john_chilmark, Chilmark Research
• mHealth Summit Conference 2011: Thoughts and Takeaways, Joan Justice, HealthWorks Collective, @HealthCollectiv
• mHealth Summit 2011: A 30,000 Foot View 12/7/11, Travis Good, histalkmobile
• Mobiles Phones for Health Worldwide: Moving From Hype to Context and Benefit, Anne-Ryan Heatwole, @arheatwole   MobileActive.org
• My mHealth Summit Summary, Jennifer Shine Dyer MD, MPH, EndoGoddess Musings, @EndoGoddess
• Recapping the 2011 mHealth Conference, Aisha Moore, Communications Director, AIDS.gov, Blog AIDS.gov
• Successful examples of mHealth applications in Africa…from the mHealth Summit, Dr. Zohray Talib, @ZohrayTalib Global Health MD
• 3 Key Takeaways from 2011 mHealth Summit, Guest post by Charles Huang, @1CharlesH, HealthWorks Collective, @HealthCollectiv
• 5 mobile trends for 2012, Healthcare IT News
• Video Library of mHealth Summit talks 

Related posts

• mHealth Summit 2010: A context check list
• mHealth: Health where you live, work, and play
• Health 2.0 goes to Washington: Aretha Franklin would be proud
• The mHealth Summit: Local & Global Converge (2009 Summit and World Bank Day)

• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
• Self-tracking: Checking under the hood

* Disclosure:  I’m a consultant on a grant to BodiMojo.

©2012 Kinetics. All Rights Reserved.

Your LBD (little black dress) is about to be joined in your closet by a SWD (smart wearable device). The worlds of electronics and textiles are becoming interwoven and the results are going to profoundly impact your health. Here’s what you need to know about e-textiles and smart fabrics and a preview of the clothes, shoes, and accessories  that may soon find their way into your closet.

E-Fashionista Vocabulary
Just when you thought you’d finally gotten a handle on terms like ruching, GORE-TEX, and tulle, along comes a whole new fashion lexicon. Forget about SmartWool. We now have smart fabrics and smart clothes. And intelligent textiles, interactive textiles, interactive clothing, and wearable computing. And e-fabrics, e-textiles, e-fibers, and e-broidery.

E-textile is short for electronic- or electro-  textile. E-textiles are essentially fabrics with electronics and other components that are embedded in, or intrinsic to, the fabric such that the fabric maintains its key properties, like draping. (Shown, conductive silver plated nylon thread)

Smart fabrics are generally defined as, well, smart. This means a fabric can not only sense the environment, but also react to it. Scenarios include a fabric that warms you when you’re cold, cleans itself when it’s dirty (hooray!), lights up to ensure you’re visible when it’s dark, and automatically stiffens to protect you when you’re falling. Smart clothes could monitor your fitness parameters as you train and give you advice to modify your workout, during your workout. And of course smart clothes would recharge your mobile device while it was tucked in your pocket.

Smart clothes and e-textiles offer a second skin to help you understand what goes on under your real skin. They enable you to wear sensors comfortably and unobtrusively to track your physiological signals and your surrounding environmental conditions in real time – anytime, anywhere. They are going to influence the health of patients, the training of athletes, and the safety of fire fighters. And perhaps most significantly, they are going to create an entirely new paradigm of wear, share, and compare.

Form follows function and function follows form
Sensors that detect physiological signals may be embedded or integrated directly into a textile (such as part of a yarn that is woven or knitted into the fabric) or they may be applied on top of the fabric, such as in an ink. Since the sensors are part of the garment, they are usually in direct contact with your skin.

The sensors can detect an amazing range of physiological stimuli from you and your surrounding environment. These include mechanical, thermal, chemical, electrical, optical, and magnetic signals. Once the sensors detect the signal, it’s collected, processed, stored and transmitted.

The potential of e-textiles and smart clothes is best demonstrated by applications in two key areas: health/medical and sports/professional performance and safety. These niches tend to be where cutting-edge development occurs and thus are good indicators of products and technology that may move mainstream (for further discussion on this, see Self-tracking, Sensors, and mHealth: Trends and Opportunities). Here are examples of just a few of the many really cool products that are in various stages of commercialization and development.

Under pressure: Under Armour E39 electronic compression shirt
The Under Armour E39 shirt, developed through a partnership with Zephyr Technology  (which makes the BioHarness), features a removable electronic monitor, or “bug.” The bug is a combined sensor pack, processor, and hard drive that plugs into the shirt. The sensor measures heart rate, breathing rate, skin surface temperature, and triaxial (3 axes – X, Y, Z – thus three dimensional) accelerometry. Sensor data can be sent via Bluetooth to smart phones and laptops for viewing by coaches and friends. The E39 shirt debuted at the NFL Scouting Combine in February, 2011 and is expected to be available to the public in 2012. (photo from Under Armour)

A real kick: The adidas adizero f50 powered by miCoach
Marketed as the “football boot with a brain,” the adidas adizero f50 soccer shoe contains a space in the outsole (bottom) to tuck a miCoach Speed Cell. This tracking device captures performance metrics such as speed, maximum speed, number of sprints, distance, steps and stride rates. The data are stored and can be wirelessly uploaded to a PC, Mac or  smart phone so you can share and compare your stats with friends or adidas professional players. The shoes and speed cell/USB adaptor are sold separately or as a bundle (available in November [ADDED NOTE: became available Nov 11]). The sensor device has been designed to be compatible with other adidas footwear. Expect a related miCoach online football (soccer) video game in 2012. (photo courtesy of adidas)

Reebok and mc10: Flexible electronics
Reebok is collaborating with mc10 to create intelligent sports equipment and apparel. Based on research by John Rogers of UIUC and George Whitesides of Harvard, mc10 develops thin “conformal” electronics that can bend and stretch and that can be imbedded into materials such as paper, fabric, latex, and leather. This is definitely a partnership that bears close, um, tracking.

Smarty pants: Printing biometric sensors on underwear
What better place to put sensors than the elastic band of your underwear? This location enables sensors to be in direct and continuous contact with the skin. Researchers have screen-printed amperometric carbon sensor arrays directly onto the elastic band of underwear. The sensors survive repetitive stretching, pulling, and folding. The sensors can measure hydrogen peroxide and NADH, and could potentially monitor chemicals found in sweat through dehydrogenase- and oxidase-based enzyme sensors (for example, ethanol and lactate). Applications include healthcare, sport, and military monitoring. (Image from the Royal Society of Chemistry)

PSYCHE Project: Updating the mood ring
The PSYCHE (Personalized monitoring SYstems for Care in mental HEalth) project aims to develop a cost-effective, continuous portable monitoring system for patients affected by mood disorders, such as bipolar illness. The goals of the project are to empower patients to proactively monitor their mood status in order to predict, detect and manage critical events and health issues; to improve patient-physician interaction; and to alert physicians in case of depressive or manic episodes. This system is currently being implemented and validated technically, functionally, and clinically.

Potential measurements include:

• Physiological: heart rate (electrocardiogram, ECG), respiratory rate, movement, galvanic skin resistance, brain wave activity (electroencephalogram, EEG), eye activity (electrooculogram, EOG), blood pressure, body temperature
• Biochemical: levels of prescribed drugs such as lithium; glucose, cholesterol, triglycerides and other indicators of metabolic disorders that can develop as a side effect of medication use
• Behavioral: obtained from correlating biochemical measures, voice analysis, and a behavioral index

Potential features include data that are collected along with “subjective annotations” and then integrated into an electronic health record (EHR) with information such as medication; measurement of both thoracic and abdominal respiration through textile sensors, thus potentially offering a mechanism for biofeedback training exercises; and night monitoring of heart rate, breathing rate and ambient conditions (temperature, light, noise) to deduce sleep status, which could be combined with sensorized bed sheets.

Sensors that fit like a glove
How do you measure hand function in individuals that have a neurological disorder?  With an instrumented glove. Researchers have developed a glove that measures finger and wrist flexion based on bend sensors that contain a carbon/polymer-based ink whose resistance increases with bending. Finger movements can be measured while the user is performing specific tasks, and even slight changes in fine motor skills can be detected.

Several commercialized, instrumented gloves are already available, mainly for virtual reality and computer gaming:

• CyberGlove II (shown)
• P5 Glove
• The Peregrine glove
• Nintendo Power Glove (vintage video commercial)

A vested interest in congestive heart failure patients and Mount Everest climbers
Leave it to a group of Italian researchers to develop a vest that perfectly marries form and function. The MagIC (Maglietta Interattiva Computerizzata) is a vest with embedded sensors made of conductive fibers to measure heart rate and breathing rate, and an electronic module with a triaxial accelerometer, data storage, and signal transmission. The washable vest comes in several sizes, is specifically tailored to minimize artifacts, and has a front or side opening with Velcro or a zipper so it can be worn by people with impaired movement.

The garment has been validated in several diverse telemedicine applications. In one scenario, patients with congestive heart failure who had recently been discharged from the hospital wore the vest in their homes for a few minutes each day for a month. The data were viewed remotely by a cardiologist. Patients reported that the garment was comfortable and that they felt “safely supervised.” The patients actually requested to continue the monitoring period!

In a more extreme scenario, climbers wore the vest on a Mount Everest expedition. The vest was made of polypropylene instead of cotton, and the position of the electronic module was moved higher up so it didn’t interfere with the climber’s backpack belts. Measurements were collected during the day and during sleep. Again, the vest was comfortable and provided accurate real-life telemonitoring.  (Image from Istituto Auxologico Italiano)

The ProeTEX Project: Fighting fire with wire
The ProeTEX project is a tour de force of sensor technology and usability. The goal is to develop e-textiles for emergency disaster personnel in order to improve their safety.  End-users, such as fire fighters, are part of the project team, and specific operative scenarios were deployed as part of the process to develop several garment prototypes.

T-shirt or inner garment: This assesses the health status of the emergency worker through measurement of physiological parameters. An elastic region contains textile electrodes for measurement of heart rate, as well as a body temperature sensor. Sensors for blood oxygen saturation (SpO2) and sodium (Na+) can also be integrated. A detachable band contains a piezoelectric breathing rate sensor and the electronic modules. Since this garment is in contact with the user’s skin, comfort is considered a key design feature.

Jacket or outer garment (shown): This monitors the user’s activity state and the surrounding environment. There are two triaxial accelerometers. One at the collar detects inactivity and falls to the ground and one at the wrist also detects inactivity. Together they provide a estimation of body inclination. A textile motion sensor located in the elbow region provides redundancy in measuring user movement. A carbon oxide sensor is located in the lapel area, near the user’s mouth and nose. There’s also an external temperature sensor, a heat flux sensor, and a GPS antenna, as well as a visual alarm and acoustic alarm to warn the user of detected dangers. The jacket contains electronics for data storage and transmission.

Boots: At the request of the end users, the boots contain sensors to measure the concentration of toxic gases, like carbon dioxide (CO2), that are heavier than air and accumulate at ground level. The boots also monitor the contact of the foot with the ground, thus tracking the activity of the user.

The data from all the sensors are recorded in a device located in the jacket and transmitted wirelessly to a remote post where all the parameters of the emergency personnel can be monitored in real time.
(Image from ProeTEX)

ProeTEX is one of many Smart Fabrics, Interactive Textile (SFIT) projects funded by the European Commission and conducted by a large consortium of European partners that includes universities, research centers, medical hospitals, and industry. Other projects include MyHeart, BIOTEX, STELLA, and OFSETH.

Sensor Accessories = Sencessories
While there are amazing e-textile garments commercially available and in development, what any true-blue fashionista knows is that accessorizing is what really matters. Forget about watches that resemble a car dashboard duct-taped to your wrist. Companies are now developing sleek sencessories, such as the Jawbone UP (shown), a motion sensing band that tracks your movement  (or your lack of movement) using technology from MotionX.

Imagine sencessories such as cuff links, earrings, a brooch, belt, bracelet, tie bar, pendant, finger ring or toe ring that you can mix and match to monitor your heart rate, breathing rate, blood glucose, calories burned, and ambient air quality.  What sencessory would you most like to sport?

DIY e-textile Fashion
Do you love hardware stores and Project Runway? There are a number of Do-It-Yourself sites where you can create your own sartorial sensor splendor.

• LilyPad Arduino (shown): a set of sewable electronic components (see the LilyPad Arduino Flickr group for ideas)
• Plug and Wear: tutorials and supplies
• Textronics developers kit
• Lynne Bruning on the e-Textile Lounge and wearable computing (video)
• KOBAKANT DIY Wearable Technology

Wear, Share, Compare
E-textiles and smart clothes are going to revolutionize virtual data sharing communities. In the sports world, you’ll be able to compare your data against the data of your drinking buddies and your favorite pro athletes. Polar provided live race data during the Tour de France and Guinness Rugby has put RFID chips into rugby balls and player jerseys. Expect to see more live tracking of pro athletes during major sporting events (see STATS SportVU video for examples), as well as integration and gamification with fantasy sports leagues and video games.

On the medical side of the spectrum, you’ll be able to share your data in real time with your PHR and with health care providers, giving you the ability to leave a hospital early, or even to just leave a hospital room. E-textile data will be shared in existing online communities such as Patients Like Me and Cure Together, and will provide the base for new communities. The data are going to drive new research paradigms and help us better understand the connection between our health and our environment.

Dress for Success
As you can imagine, there are numerous challenges to overcome when designing e-textiles:

• The sensors need to be accurate, reliable, sensitive, specific, low cost, reproducible, have a short analysis time, a high signal to noise ratio (low motion artifacts), and work over a wide range of temperatures.
• The clothes need to maintain their key properties, such as bending, stretching and drapability. They should also be washable, long lasting, light weight, and should be easy to put on and off if they are going to be worn by people with disabilities.

When it comes to health applications, it’s especially important to pause and consider user context. Life is not ‘one-size-fits-all’ and smart clothes shouldn’t be, either. To be successful, e-textile garments will need to:

• be based on need, not driven by technology
• be comfortable and affordable
• be intuitive to use
• be integrated with health care providers and systems as appropriate
• improve the wearer’s quality of life.

This is a very hot field and there will be incredible developments in the future. Watch for:

• sensors that detect not only what goes on under your skin, but also on your skin. Imagine tracking your skin microbiome to better gauge your health status and disease risks
• advances in data analytics to identify trends and anticipate critical events (imagine being able to predict an epileptic seizure or migraine)
• sensor tattoos
• utilizing data for real-time personal biofeedback training, such as stress reduction
• harvesting or scavenging energy from your body to power your smart clothes. Energy sources include your breath, blood flow, body heat, and foot strike during walking.

Research in e-textiles may also lead to new insights in clothing design for individuals with various medical needs that have not yet been recognized, let alone addressed. There is customized clothing for women who have undergone mastectomies, people with an ostomy or stoma, and individuals with Down’s Syndrome. What’s missing? What would you like to see redesigned? And how can we best reinvent the hospital gown?

Clothes are our second skin. They let us express who we are. Our relationship with our clothes will grow even more personal in the future as they not only track our physiological and environmental status, but also react to protect us and serve to connect us.

What smart garment would you most like to have hanging in your closet?

More e-textiles:

• Georgia Tech Wearable Motherboard™ (GTWM) This is one of the first smart shirts. It was developed in the 1990s with funding from  the U.S. Department of Navy.
• The LifeShirt System (no longer available for sale)
• Somnus Sleep Shirt Night shirt that analyzes breathing patterns
• “Intelligent” t- shirt Washable garment monitors ECG, body temperature and position. Developed by researchers at Carlos III University in Madrid.
• e-textile pants assess stability in the elderly
• Body suit for fetal monitoring during pregnancy
• Le Chal: A haptic feedback based shoe for the blind

Smart reads on Smart textiles

• Smart Textiles Blend LEDs, Circuits and Sensors (Priya Ganapati, Gadget Lab)
• Fashioningtech.com Syuzi Pakhchyan (blog, forum, resources)
• Innovation In Textiles (news and technical resource for the global technical textiles industry)
• International Symposium on Wearable Computers  (ISWC)

Related posts

• Self-tracking, Sensors, and mHealth: Trends and Opportunities (big list of resources)
• mHealth Summit 2010: A context check list
• The mHealth Summit: Local & Global Converge
• mHealth: Health where you live, work, and play
• Self-tracking: Checking under the hood
• 7 Health 2.0 Trends for 2011

©2012 Kinetics. All Rights Reserved.

“Research reveals new secret weapon for Le Tour,” read the press release headline, referring to the Tour de France. “Now there could be a new, completely legal and rather surprising weapon for riders aiming to shave vital seconds off their time – beetroot juice.”

Beetroot juice? Within 24 hours my local bike club forum was buzzing about the news. The research, published in Medicine & Science in Sports & Exercise (June 2011), is the latest in a series of studies on beetroot juice and exercise conducted by Dr. Andy Jones and crew at the University of Exeter (the University put out the press release).

The study found that men who consumed 0.5 liters (~17 ounces) of beetroot juice improved simulated 4 km and 16.1 km cycling time trial performance by 2.8 percent (11 seconds) and 2.7 percent (45 seconds), respectively, as compared to when they completed the rides after drinking a placebo. Power output increased while oxygen consumption was not changed, indicating cycling economy was improved. The participants drank the juice 2.5 hours before completing the rides, which were conducted on stationary bikes.

The nine competitive male cyclists (average age 21 years) who participated in this study were asked to avoid strenuous activity and refrain from caffeine and alcohol consumption prior to coming to the lab to ride. This is standard. But a subsequent step in the protocol is not standard:

“The subjects also abstained from using antibacterial mouthwash and chewing gum during the supplementation periods because these are known to eradicate the oral bacteria that are necessary for the conversion of nitrate to nitrite.”

Huh? It turns out beetroot juice is just the tip of the iceberg for an exciting and rather amazing area of research that also involves bacteria and spit. You’ll be hearing a lot more about this work and its implications for sports performance and health, so it’s worth a closer look.

Why beetroot juice?
Beetroot juice is chock full of inorganic nitrate. The nitrate (NO₃^-) gets converted to nitrite (NO₂^-), which is then converted to nitrogen oxides, such as nitric oxide (NO). Nitric oxide is a powerful signaling molecule that is thought to be responsible for the majority of the physiological benefits. [Nitrate is not the same as nitrite. See  the section on risks below.]

Beetroot juice contains lots of nutrients, including antioxidants and polyphenols. To make sure the effects were due to nitrate, the researchers selectively removed  just the nitrate from the juice. When participants were given this altered juice, they exhibited no improvements in cycling performance. (Thus the nitrate-depleted juice served as the perfect placebo for comparison against the regular juice.)

What’s with the mouthwash?
Humans lack the necessary enzyme to convert nitrate to nitrite and get the whole chain of events going. But it turns out there are bacteria that lounge in the back of our mouths that are pros at this. The nitrate we eat goes through a rather strange and wonderful journey:

1. When we consume a source of nitrate, such as beetroot juice, the nitrate is rapidly absorbed by our small intestine. Nitrate levels subsequently rise in our blood stream and remain elevated for hours.
2. Our salivary glands suck up about 25 percent of this circulating nitrate, concentrating it in our saliva (the balance of the nitrate ends up in our urine). Saliva levels of nitrate become 10-20 fold higher than blood levels, and can peak 30 minutes after ingesting nitrate.
3. This salivary nitrate is then converted to nitrite by bacteria that hang out on the back of our tongues.
4. When we swallow, our saliva, now full of nitrite, goes to our stomach, where the nitrite is converted to nitric oxide and other nitrogen oxides. Some of the nitrite also makes its way from our stomach back into our circulation.

If we use an antiseptic mouthwash, we stop the bacteria from working. If we spit (or don’t swallow), we deny our gut the nitrite-enriched saliva.

Bacteria? Seriously?
Yes, bacteria. Communities of bacteria reside in our mouths, our nasal passages, on our skin, in our gastrointestinal tract, in our urogenital tract, and in many other places where light doesn’t shine. For each single human cell we have, we have ten (10!) microbial cells.

We have a symbiotic relationship with these microbes. As the beetroot juice research illustrates, bacteria possess enzymes we don’t have but that we need in order to digest certain foods.

We each possess a unique set of bacteria; the lint in our belly button, the dirt under our fingernails, and the bacteria in our gut help define who we are, and may affect our health. If you’ve ever consumed foods that contain probiotics, such as yogurt or tempeh, than you’ve influenced your microbial community. This is a very hot field of research and product development.

How big of a boost to athletic performance does beetroot juice/nitrate cause?
Surprisingly big. In this study average power output was increased by 5 percent during the 4 km time trial and  6 percent during the 16.1 km time trial. There were no changes in oxygen consumption, indicating cycling economy was improved.

Several studies have now shown that dietary nitrate supplementation causes an improvement in exercise efficiency and an improved tolerance for high-intensity exercise. In essence, your muscles are getting better gas mileage from oxygen.

Bear in mind this research was conducted on very small numbers (usually less than 12 participants in each study) of mostly male, college-age participants. All the research was carried out in laboratory settings. Whether the benefits extend to real-world settings has not been examined.

Geek speak:

To date, dietary nitrate supplementation has been shown to improve a number of exercise performance variables in several small studies:

• reduce the oxygen cost of submaximal cycling
• reduce the oxygen cost of low and high intensity knee extensor exercise
• reduce the oxygen cost of treadmill walking and running
• extend time-to-exhaustion during high intensity exercise

How does it work? Dietary nitrate supplementation appears to reduce the metabolic perturbation in contracting muscle cells (muscles at rest are not affected). There is a reduced rate of muscle ATP turnover at a given work rate. The mechanisms responsible for this reduced oxygen cost include increased mitochondrial efficiency (Larsen, 2011), and perhaps increased energetic efficiency of calcium transport by the sarcoplasmic reticulum Ca2+ ATPases (SERCA) (Ferreira, 2011).

The effects of dietary nitrate are not limited to athletic performance. Nitric oxide can widen (dilate) blood vessels, reducing blood pressure and increasing blood flow. Much of the current research on dietary nitrate supplementation is focusing on the prevention and treatment of conditions such as heart attacks and peripheral arterial disease (PAD). Scientists are also starting to examine the effects of nitrate on brain health.

Beetroot juice? Yuck. What other foods have high levels of nitrate?
Beetroot juice was used for the experiments because it offers a quick and easy way for research participants to consume a substantial amount of nitrate. But beetroot juice is something of an acquired taste, and it can, ahem, result in red urine and red stools.

Luckily, beetroots are just one of many vegetables and herbs that are high in nitrate. Leafy green vegetables tend to be the top sources of nitrate:

• Very high nitrate levels (> 250 mg/100 g*): arugula (rocket or rucola), bok choy, celery, chervil, collard greens, cress, lettuce, radish, red beetroot, rhubarb, spinach, Swiss chard.
• High nitrate levels (~100-250 mg/100 g): basil, celeriac, Chinese cabbage, chard, coriander, endive, fennel, kohlrabi, leek, mustard greens, parsley.

*Numbers are nitrate content, expressed as milligrams per 100 grams fresh weight, and are compiled from a variety of U.S. and European sources. Nitrate levels in vegetables can vary considerably depending on many factors, such as growing conditions.

The amount of nitrate utilized in the research studies to reduce the oxygen cost of exercise ranges from about 300-500 mg. These are levels that are readily obtained by eating a diet rich in fruits and vegetables. Here’s how some of the numbers compare:

500 ml (~17 ounces) beetroot juice          500 mg nitrate*
1 cup raw spinach                                              926 mg nitrate**
1/2 cup cooked collard greens                    198 mg nitrate**
1 cup raw leaf lettuce                                       103 mg nitrate**

* The beetroot juice used in several of the experiments was supplied by James White Drinks Ltd (Ipswich, U.K.). According to the company website, approximately 2.5 beetroots are in each 250 ml serving and the juice contains 0.1 g of nitrate per 100 ml.

** These numbers are adapted from Hord, 2009. Remember that nitrate concentrations in vegetables can vary considerably.

Participants in almost all the research studies were asked to avoid foods high in nitrate, and/or performed the exercise tests after a 3 hour (or overnight) fast. Thus they started off with low levels of plasma nitrate in their systems.

What would happen if you conducted the research on participants who consumed a diet of nitrate-rich vegetables and thus would presumably have high plasma nitrate levels to begin with? Would you see improvements in athletic performance following additional dietary supplementation? It seems unlikely as there is no evidence that higher doses of dietary nitrate increase the beneficial effects (no dose-response studies have been published).

What about hot dogs?
Nitrate and nitrite are also present in very low levels (too low to impact athletic performance) in cured and processed meats such as hot dogs, bologna, corned beef, luncheon meats, sausages and ham. They are added to enhance flavor, stabilize color, and serve as antimicrobial and antioxidant agents.

Nitrate and nitrite are considered potentially harmful at high concentrations, and their levels are regulated in food and drinking water. This regulation is the source of much debate. Researchers note that the traditional Japanese diet, the heart-healthy Mediterranean diet, and the research-based Dietary Approaches to Stopping Hypertension (DASH) eating plan all emphasize fruits and vegetables, and thus are abundant in nitrate. This has led to speculation that these diets might help protect against heart disease, high blood pressure, and type 2 diabetes in part because of their high nitrate levels. For a good discussion of the dietary issues, as well as lists of nitrate levels in foods, see Hord, 2009.

What are the risks?
The nitrate-nitrite-nitric oxide pathways can be confusing. There is a big difference between the biological effects and toxicity of nitrate and nitrite. And there is a big difference between the biological effects of inorganic nitrate, found in dietary sources such as beetroot juice and vegetables, and organic nitrate, found in drugs such as nitroglycerin.

Nitrate supplementation to enhance sports performance has become a hot topic in online forums, but unfortunately there are some misconceptions. This has raised concern among leading researchers in the field, prompting them to address potential hazards (see the Journal of Applied Physiology, August 2011 ‘Letters to the Editor’ section). Recommendations include:

• Don’t use nitrate salts and nitrite salts as dietary supplements to enhance sports performance.
• Be aware that nitrite, used intentionally or unintentionally, can have harmful effects.
• Nitrate-containing vegetable juice presents a potential risk if stored incorrectly. If the juice gets contaminated by bacteria that can convert nitrate to nitrite, high levels of nitrite could accumulate over time which could potentially be harmful.
• Nitrate ingestion from dietary sources, such as vegetables, is safe.

In addition, several medications may adversely interact with a high nitrate diet. These include nitroglycerin or nitrate preparations used for angina, and PDE-5 inhibitors such as Viagra, Cialis and Levitra. Anyone with risk factors for or diagnosed with heart disease, or with low blood pressure (hypotension), may wish to consult their healthcare professional before starting a high nitrate diet. Individuals with kidney stones should bear in mind that several vegetables that are high in nitrate are also high in oxalate (rhubarb, beetroot, Swiss chard, spinach).

The bottom line: You are what you – and your microbes – eat
It’s tempting to interpret this exciting research as suggesting that a particular substance, such as beetroot juice, provides a “new secret weapon” akin to an ergogenic aid. But all the evidence points to the slightly less sexy conclusion that the true ‘secret weapon’ to sports performance resides in your vegetable crisper. (Popeye was right all along!)

Eating a diet abundant in nitrate-rich vegetables may improve your athletic performance (as well as your cardiovascular health). Conversely, consuming a diet low in nitrate-rich vegetables may adversely affect your athletic performance (and your cardiovascular health).

To improve your performance during day-to-day training and competition:

• Aim for a serving of fruits and a serving of vegetables at each meal (If you don’t know where to start, take a look at ChooseMyPlate.gov, the DASH Eating Plan and the Mediterranean diet)
• To up your odds of improving performance for a specific event, try consuming nitrate-rich foods approximately 3 hours before the event
• Ditch the mouthwash (and don’t obsess over belly button lint or dirt under your fingernails – they probably harbor friendly, helpful microbes)
• Don’t forget the big picture. Stay well hydrated and get plenty of sleep (see Twelve Everyday Health Rules from 1908)
• Consider keeping a training log so you can look for patterns among these variables and determine what works best for you.

Recipes
See how easy it is to incorporate greens into your diet with these awesome recipes (and stunning photos) from around the food blogosphere:

• From Smitten Kitchen: Spinach Quiche (freezer friendly) and Arugula, Potato and Green Bean Salad
• From Kiss My Spatula: Wild Arugula-Quinoa Salad with Cherries and Thyme Roasted Baby Beets with Mint Vinaigrette
• From Love & Olive Oil: Fig, Prosciutto, and Arugula Pizza and Pizza Bianca with Goat Cheese and Greens
• From Food Blogga: Spinach and Apple Salad with Warm Cranberry-Maple Dressing and Arugula, Baby Spinach and Blueberry Summertime Salad
• From 5 Second Rule: Creamy Spinach Cashew Spread and Roasted Beet Salad with Goat Cheese and Walnuts

Also try:

• Start with Dr. Allen Lim’s Rice Cakes (a favorite snack of pro cyclists) and add in chopped spinach or other greens (fresh or frozen)
• Do your own riff on the classic Joe’s Special (try rolling in tortillas and freezing) or add spinach to Freezer Breakfast Burritos (my standby is to omit the sausage, add frozen hash browns, make several dozen and freeze)

What’s your favorite recipe that uses leafy green vegetables?

Hungry for more information?

• L F Ferreira, BJ Behnke. A toast to health and performance! Beetroot juice lowers blood pressure and the O2 cost of exercise. Journal of Applied Physiology, 110:585-586, 2011. doi: 10.1152/japplphysiol.01457.2010
• NG Hord, Y Tang, NS Bryan. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. American Journal of Clinical Nutrition, 90 (1):1-10, July 2009. doi: 10.3945/ajcn.2008.27131
• KE Lansley, et al. Acute dietary nitrate supplementation improves cycling time trial performance. Medicine & Science in Sports & Exercise, 43(6):1125-1131, June 2011. doi: 10.1249/MSS.0b013e31821597b4
• FJ Larsen, et al., Dietary inorganic nitrate improves mitochondrial efficiency in humans, Cell Metabolism, 13(2):149-159, February 2011. doi: 10.1016/j.cmet.2011.01.004
• JO Lundberg, et al. Roles of dietary inorganic nitrate in cardiovascular health and disease.  Cardiovascular Research, 89 (3):525-532, 2011. doi: 10.1093/cvr/cvq325
• A A Kenjale, et al. Dietary nitrate supplementation enhances exercise performance in peripheral arterial disease. Journal of Applied Physiology, 110(6):1582-1591, 2011. doi: 10.1152/japplphysiol.00071.2011

The Human Microbiome Project seeks to characterize the various microbes and their DNA that reside in and on our bodies. The project is examining the connections among these microbial communities, our health, and various conditions including psoriasis, Crohn’s Disease, acne, asthma, and obesity.  Also check out Belly Button Biodiversity.

Related posts

• Carbohydrates and sports performance: rinse, repeat, win?
• 12 real foods for real results: Insider tips from top sports nutritionists
• Are humans designed to be endurance runners?
• What can pro cyclists teach us about pain?

Photos
Shorewood Criterium courtesy of Michael Newman at Flickr
1k-7649 spinach courtesy of Creativity+ Timothy K Hamilton at Flickr

©2012 Kinetics. All Rights Reserved.

How do you know what’s normal?  How do you win? How do you know when to stop?

These were just a few of the wonderful, offbeat questions that popped up during a session on self-tracking I facilitated at HealthCampDC 2011.

Bring together a group of thought leaders with wide-ranging expertise. Let them debate and question the concept of self-tracking. Suddenly data and tracking take on entirely new identities.

HealthCampDC was one event of many during DC Health Innovation Week. Our discussion on self-tracking highlighted the theme of the week: how do we better utilize data to weave together stories to improve health outcomes?

Issues:

• People are lazy. Tracking systems need to be simple and intuitive.
• Diseases and conditions aren’t siloed. Tracking systems for them shouldn’t be, either.
• Community, sharing, friends, competition – these are all very important components of self-tracking.
• Community, sharing, friends, competition – there are times when these are detrimental in tracking communities and encourage negative health outcomes. Example given: anorexics who compete to see who can eat the least amount each day.
• Tracking sensors are rather worthless if they aren’t reliable and accurate.
• The Quantified Self is important, but so is the Qualified Self. Self-tracking data are not just numbers. Data can also be in the form of images and sound.
• A great example of a successful (trusted, confidential) self-tracking community? Alcoholics Anonymous.
• For many individuals who self-track, privacy is key, and sharing is the last thing they want to do. Example given: people who are HIV positive.
• Self-tracking is not  ‘one size fits all.’
• Just the act of tracking is valuable. Putting down a number or taking a photo raises awareness, which is a key step in behavior change.

Questions:

• How can SMS be better utilized for self-tracking in underserved communities?
• What are the barriers to tracking?
• How do you better incentivize or incorporate motivators into tracking devices?
• Under what conditions would it be helpful to have a tracking ‘trajectory’ to illustrate the path you’re on (good or bad)?
• How do you make tracking data actionable?
• How do you cross the self-tracking chasm from ‘work’ to ‘fun’?

Self-tracking session gurus included Marilyn Langfeld (@MarilynsView), Alan Viars (@aviars), Gregg Masters (@2healthguru), Sandra Paredes, Andrew Rainey (@breadforthecity), Greg Bloom (@breadforthecity), Richard Layman, Rebecca Frank (@frankrebecca), Andre Blackman (@mindofandre), Dave Haft (@davehaft), Eden Shiferaw (Community Education Group), Mark Scrimshire (@ekivemark), Stephen Murphy (@IQSolutions), Joe Lyons (Lyons Advisors, LLC), Baabi Das (Zansors, LLC), Jessica Sachs, Peter Speyer (@PeterSpeyer), Lindsey Hoggle (@lindseybh), Lanny Hartmann (@Lanny). Apologies to anyone I missed – let me know and I’ll add you.

What do you view as key issues and questions in the realm of self-tracking?

Thanks to Kaiser Permanente Center for Total Health for hosting the event in their stunning new space.

DC Health Innovation Week Events  (Twitter tag: #dchealth):

• The Walking Gallery #Thewalkinggallery
• HealthCa.mp/dc #hcdc
• The Health Data Initiative #healthapps
• Health Innovation Summit #futurehealth
• Health 2.0 Code-a-Thon #health2dev
• DC Health Innovation Week Proclamation (pdf)

Great posts by others on Health Innovation Week events:

• “Walkers” keep on walkin’, Talkers get to talkin’ and Mover’s & Shakers- yep, you guessed it- Get to Movin’ and Shakin’!, Matthew Browning, Your Nurse Is On
• 8 key takeaways from health data-palooza, Peter Speyer, Data Development
• #HealthApps insightful @TimOReilly hits the spot, again. This time on Privacy and how it relates to the Rainbow button initiative. #hcdc, Mark Scrimshire, HealthCa.mp
• Human being trumps human doing : DC Health Innovation Week recap, Ted Eytan, M.D.
• The Health Data Initiative Forum, Brain Ahier, Healthcare, Technology & Government 2.0
• Health Digital Check-Up: Washington, DC Health Innovation Week, David Barton, Edelman Digital
• 5 Things That Caught My Attention at the Health Data Initiative Forum, Chris Hall, SoHealth
• How a Health 2.0 code-a-thon works, Andy Oram,  O’Reilly Radar
• A New Hope? (…but what about that pesky death star?), Mike Painter, Pioneering Ideas

Related posts

• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• Self-tracking: Checking under the hood
• What I did during my summer vacation: HealthCamp
• mHealth Summit 2010: A context check list

©2012 Kinetics. All Rights Reserved.

“Pretty awesome. RT @ageekmom: @NASATweetup How’s it feel making dreams come true with every tweetup? #burningquestion : -) ”    – Tweet from @NASATweetup, April 19, 2011.

When it comes to utilizing social media to extend a brand and engage, educate and excite an audience, NASA has the right stuff.  That was clearly demonstrated during a NASA Tweetup I attended at the NASA Headquarters in downtown Washington, DC.  NASA defines a Tweetup as “an informal meeting of people who use the social messaging medium Twitter.”

NASA provides a case study of how to successfully showcase science, or any other topic, product, or event, 140 characters at a time. Here are nine tips for out-of-this-world social media, based on NASA’s extensive media expertise.

1.  Treat your participants / followers / friends with respect.
Do you value your followers?  Do your actions show it? NASA sent a string of emails to Tweetup participants (who were chosen at random after registering online) that included a congratulatory welcome; details on the Tweetup (directions, the schedule, onsite tech availability); and a recommendation to swing by the nearby National Air and Space Museum to catch a special appearance of Robonaut 2 before the Tweetup.

At the Tweetup we received an official name badge and a swag bag full of goodies (pins, patches, stickers, fun pads and more). The event started on time and finished on time. From launch to landing, we were treated like space royalty.

What do you do for your followers to indicate how much you appreciate them?

2.  Don’t overlook the details.
There’s no point in having a Tweetup if people can’t tweet. We had Wi-Fi access with clear, written instructions on how to access the network. We were notified ahead of time that power outlets would not be available. The Tweetup, which was easily accessible by public transportation, took place in an auditorium outfitted with chairs that had desks and many folks set up laptops. Cameras were allowed. NASA created a Twitter list of participants (@nasatweetup/astro-wheels) and repeatedly provided its Twitter account and hashtag (@NASAtweetup, #NASATweetup).

How many times have you been to a social media-related event only to find you have no connectivity? If a tweet falls in the room and no one can send it, then no one can hear it and it doesn’t make a sound.

One very important, but often overlooked, detail during the Tweetup was that NASA showed the live Twitter stream, but made it small enough as to be unreadable (see left and right sides of the above photo). Tweetup participants could see that a very active conversation was going on based on the movement of the stream, but the chatter did not distract from the conversation going on among the participants in the room.

How many events have you attended where the virtual stream of tweets and retweets (RTs) overshadows the live event? When it comes to showing live Twitter streams, size matters.

3.  Provide exceptional value: Give people a reason to show up / like you / follow you.
Our Tweetup featured astronaut Doug Wheelock. “Wheels” spent six months on the International Space Station (ISS). He launched to the ISS on June 15, 2010 as part of the Expedition 24 crew. He assumed command of Expedition 25 on September 22 and returned to Earth on November 25, 2010. He worked on more than 100 microgravity experiments and conducted numerous space walks. He was known for sharing amazing twitpics from space and challenging his more than 100,000 followers to guess the locations.

“Okay…here’s one that you may need to dig out a World Atlas to find. Hint: These islands are small, remote, and i http://twitpic.com/2tiaa3“  – Tweet from @Astro_Wheels, from the ISS, Oct 1, 2010.

Other NASA Tweetups occur in tandem with shuttle launches. Granted, not everyone can offer launch pads or robotics demonstrations, but do you provide a compelling reason for people to follow you or ‘like’ you?  What do you offer that’s ‘out of this world’?

4.  Be clear about your brand and identity.
Look at the photo above. Is there any doubt who hosted the event and who is speaking? Take a look at some of NASA’s social media accounts: @NASAedu, @NASA_Technology, @ISS_NatLab, @AstroRobonaut, NASA Facebook and NASA YouTube.

Do you have a clear brand and brand strategy?  What’s your Twitter background? ‘Default’ should not be your answer.

5.  Do your social media homework and practice what you preach.
If you’re going to host a Tweetup, you should be facile on Twitter. NASA has a Twitter roster that includes astronauts, engineers, programs, projects, and yes, even robots.

“@cafferatajm I’m not awake yet, technically. But when I am awake, I can see great! I have five cameras in my head.” – Tweet from @AstroRobonaut, aboard the ISS, May 5, 2011

NASA uses a single hashtag for all Tweetups (#NASATweetup). This is extremely active and builds a sense of community. NASA creates Twitter lists for each event, and repeatedly tweets about the events.

Decide on your hashtag and key messaging well in advance. Promote them across multiple platforms so people can share news about your event before, during, and after.

6.  Repurpose your content and utilize various social media platforms.
The Tweetup event was streamed live over NASA television. You can view it on NASA’s YouTube Channel, NASA Tweetup Rolls with “Wheels”. During the Tweetup, a highlight film of Doug Wheelock’s shuttle trip aboard the ISS was shown. To sum up, NASA refilmed its own film during a Tweetup and posted it on YouTube.

Of course not everyone is on Twitter. Check out NASA’s list of social media accounts. In addition to Twitter, it includes Flickr, Facebook, MySpace, and YouTube. NASA also has created numerous apps, hosts regular online video chats, and has an extensive program of learning technologies.

7.  Be willing to make mistakes, learn from them, and move forward.
During the Tweetup, astronaut Doug Wheelock admitted that initially he didn’t know anything about Twitter, but was “highly encouraged” by NASA to tweet. “What I wasn’t realizing and picking up on, and what you guys all know, is the power and the transformation of this tweet once it hits the internet. And it’s what happens after you tweet that’s the real power in this type of media.”

Colonel Wheelock then confessed, “I had to be careful, because I actually got in trouble early on. You guys were getting these tweet pictures before NASA was getting the official photos from space. So I sorta got the cart before the horse. And I got politely scolded. I got a phone call on a private line on board the space station. ‘Hey, we don’t mind you doing this Twitter thing, but when you tweet a photo, make sure that we have it, … because we get a request coming in for the high resolution photo’ … I had to pull those back a bit and rein them in, and make sure I was downloading the photos so when you guys asked for the high resolution photos, then NASA could politely say, yes we have that for you, we’ll send it to you.”

Don’t be afraid to take one giant step forward into social media. Often times the best way to learn is by doing. (Just be sure you have social media policies in place first).

8.  Be nimble.
Go to where your audience is – or will be. What’s trendy now? Foursquare. Doug Wheelock was the first astronaut to ‘check in’ from space on Oct. 22, 2010 when he checked in to the ISS. Thanks to a NASA-Foursquare partnership, Foursquare users can earn a NASA Explorer badge (shown on Wheelock’s right arm, above) by following NASA on Foursquare and checking in to NASA-related venues. NASA was also ahead of the virtual world social media curve with two islands in Second Life back in 2007.

Where should you be that you aren’t?

9.  Connect, communicate, and most importantly, have a conversation.
Social media is not one-way communication. It’s not posting links to press releases. It’s listening and engaging in a conversation with your audience. NASA responds to questions and engages. NASA understands that people always come first and that social media is only a tool to further your dialog, educate your audience and spread your message.

NASA invests a lot of time and energy in social media. In return it gets loyal fans – lots and lots of them (over one million followers on Twitter, ~400,000 likes on Facebook). NASA’s messages go viral, and even its Tweetups garner press coverage (Los Angeles Times, NPR).

In return for its investment in social media, NASA is educating individuals about its space program, creating loyalty, inspiring dreams, and – based on the beaming faces at the Tweetup – creating future generations of astronauts who may one day share 3D twitvideos from Mars.

“‘Fly me to the Moon…let me dance among the Stars…’ I hope we never lose our sense of wonder. A passion for exploration and discovery is a noble legacy to leave to our children. I hope we set our sails and venture out one day. That will be one glorious day… ” – Twitpic from @Astro_Wheels, August 22, 2010, from aboard the ISS.

Some of the coverage of the Tweetup with Astro_Wheels

• NASA Tweetup: Rocket Star @Astro_Wheels, Beth Beck, Bethbeck’s Blog
• At the @NASATweetup, @Astro_Wheels shares the view from space, Alex Howard, gov20.govfresh
• Astronauta compartilha sua visão do Espaço no @NASATweetup, Claudia Beatriz, Aprendiz de viajante (translation available on the site)
• Science! Space! And NASA Tweetups, Alla Goldman, The Bivings Report
• An interview with Col. Doug Wheelock, the first person to check in from space, Ching Yu, About Foursquare

Related posts

• Utilizing mobile technology and new media to encourage mobile lifestyles
• 1960′s lab life with the Nobel Prize-winning decipherer of the genetic code
• 7 Health 2.0 trends for 2011

©2012 Kinetics. All Rights Reserved.

Do you weigh yourself regularly?  Do you make note of your  blood pressure or menstrual cycle? Do you note when your waist size or dress size changes? If so, you’re a self-tracker.

Self-tracking is extremely widespread. In addition to all the organized tracking communities, there’s a growing number of organic self-tracking communities. For examples, take a look at the diabetes made visible community on Flickr, or the more than 20,000 videos on YouTube tagged weight loss journey.

At the same time, sensor technology is advancing at an astounding pace. New materials and fabrication techniques, many at the nanoscale level, are leading to a host of amazing sensors that can be woven into clothes or permanently implanted into our bodies.

Mobile health (mHealth) offers the perfect platform to merge the tracking communities and sensor technologies. Toss in the power of social networking capabilities, and you’ve put the trifecta of instant ‘track, share, and compare’ at people’s fingertips.

This presentation was given by invitation at the 2011 mHealth Networking Conference to review the current status of self-tracking and sensors, and to highlight just a few of the many exciting opportunities that lay ahead.

Resources cited in the presentation are listed below.

What do you track? What opportunities do you envision?

Communities, organizations

• 23andMe
• Asthmapolis
• Cure Together
• MedHelp
• PatientsLikeMe
• Quantified Self
• TuDiabetes
• Tweetwhatyoueat!

Tracking tools

• MedHelp – Health tools
• Personal Informatics – tools
• iTunes app store, popular apps, Healthcare & Fitness, Medical

Sensors

• BodyMedia
• cardiomems
• Fitbit
• IDEAL LIFE
• iHealth
• Polar
• Sleeptracker
• Under Armour
• Withings
• Zeo

Reports & publications

• Healthcare unwired: New business models delivering care anywhere. PricewaterhouseCoopers, September, 2010
• Peer-to-peer healthcare, Susannah Fox, Pew Internet, Feb 28, 2011
• Ingestible thermometer pill aids athletes in beating the heat, NASA Spinoff, 2006
• Innovations in health literacy research, workshop summary. Institute of Medicine, The National Academies Press, 2011
• Boomers, technology & health: Consumers taking charge! MIT Enterprise Forum Northwest, January, 2011 (pdf)
• 2008-2013 Action plan for the global strategy for the prevention and control of noncommunicable diseases, World Health Organization, 2009
• Yang , Yang-Li et al., Thick-film textile-based amperometric sensors and biosensors . Analyst, 135:1230-1234, 2010
• Abraham, WT, et al., Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. The Lancet, 377:658-666, 2011
• Frost, J. et al., Patient-reported outcomes as a source of evidence in off-label prescribing: Analysis of data From PatientsLikeMe. Journal of Medical Internet Research, 13( 1), 2011
• Baicker, K. et al., Workplace wellness programs can generate savings, Health Affairs, 29(2): 304-311,2010

Miscellaneous

• Salt-o-meter, The Globe and Mail
• Finally: Self-tracking is cool enough for viral advertising. information aesthetics, Feb 15, 2011
• Push Snowboarding, Nokia x Burton

Related posts

• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
  
• Self-tracking: Checking under the hood
• mHealth: Health where you live, work, and play
• mHealth Summit 2010: A context check list
• Utilizing mobile technology and new media to encourage mobile lifestyles

©2012 Kinetics. All Rights Reserved.

The world of Health 2.0 has so many moving parts that are spinning so fast, that it’s tempting to gaze into a crystal ball and predict what will collide and where it will land. As we move from Health 2.0 to Health Squared, here are 7 trends I see on the horizon.

1.  Nutrigenomics & Nutrigenetics
We’re moving toward the $100 genome, and Direct-to-Consumer (DTC) genetic testing from companies such as 23andMe is on the rise. While we’re gradually learning more about the connection between our genes and our risk factors and our responses to drugs, there’s an intriguing area that has received little attention: the link between our genes and what we eat.

Nutrigenomics examines how what we eat affects our genes, proteins and metabolism. On the flip side, nutrigenetics looks at how our genetic sequence affects our responses to what we eat. Also to watch, nutraceuticals (nutrition + pharmaceuticals), which are foods and food products that provide health and medical benefits. It’s about linking the world of “-omics” with what we put in our mouths, and it will bring a whole new spin to “Eat this, not that!”

2.  Ready-to-Wear Biosensors
Advances in biosensor technology will result in clothing that monitors our every move  and mental state. The information will be automatically downloaded to our mobile devices. This advance will revolutionize health, as the ‘right place, right time’ biofeedback will lead a shift from reactive to proactive health care. Designers will compete to create self-tracking garments for pregnant women on Project Runway.

3.  Groupon Health for Baby Boomers
On January 1, 2011, ten thousand baby boomers turned 65. Each day 10,000 more will turn 65. This will continue for the next 19 years.

Groupon, Living Social, and numerous other sites that harness collective buying power will offer deals based on age, and will target the more than 75 million baby-boomers. This “silver tsunami” is concerned with healthy living and longevity, and they love getting and sharing deals. They already routinely hop online to access email, research health information, buy products, and make travel reservations (Pew Generations report, Dec 2010).

Groupon Health for boomers will focus on anti-aging options (yoga retreats, vitamin packs, golf packages, cholesterol screenings, brain exercise gadgets, pilates classes), and skip unhealthy deals (tanning salons). Boomers will be hired to find the deals for their classmates.

4.  Lies, Damned Lies, and Statistics
Given the exponential increase in biological data (take a spin around NCBI), we’ll need robust stats that help us separate the signal from the noise, tease out trends, and dissect potential cause and effect vs. random correlations.

Bioinformatics will become a trendy buzz word, number crunching will become a contact sport, and entirely new statistical models will be created.

5.  Infographics :: Data Visualization
What was once the domain of a small corner of the USA Today newspaper has gone mainstream. Daily newspapers now feature word clouds, and Hans Rosling’s talks on visualizations of global health have become TED and YouTube phenomenona.

We’re inundated with data that beg to be made into visual stories. The data stem from self-tracking (Quantified Self) and crowd sourcing (Cure Together), and from gene mapping and global mapping.

We will see even more data artfully displayed. Utilizing graphics to convey health information will increase health literacy and will consistently prove a picture is worth several thousand words.

6.  3D mHealth
New technologies are enabling 3D displays on mobile devices that don’t require the use of glasses. These are created by altering our sense of depth, using auto-stereoscopic 3D technology. This imaging will greatly enhance mobile health applications; visualize the possibilities of 3D for everything from anatomy textbooks to yoga poses. How about a 3D Pillbox?

7.  Transgenerational Social Networking
Many of our risks for diseases may be due to stretches of DNA that are not along our own chromosomes, but rather, are along the chromosomes of our parents or grandparents. This is the crux of the paradigm shifting field of  “transgenerational” genetics.

Research is mounting that suggests the genes our ancestors carried, but that were not passed down to us, can influence the traits and diseases we get. In addition, the foods that our mother ate while she was pregnant with us, and our parents environmental exposures (e.g., pesticides), may influence the traits we have, and that our children and grandchildren will have.

This throws a monkey wrench in classical genetics and merits close watch. While you don’t have to Friend your mom on Facebook, you will want to ‘friend’ her PHR – and your grandmothers – and learn everything you can about your parents health and habits.  And you’ll also want to closely track your own diet for the sake of your health (see #1), and for the health of your grandchildren.

When you look into your crystal ball, what trends do you see as we move from Health 2.0 to Health Squared?

Related posts

• Self-tracking: Checking under the hood
• mHealth Summit 2010: A context check list
• Health 2.0 goes to Washington: Aretha Franklin would be proud
• Utilizing Mobile Technology and New Media to Encourage Mobile Lifestyles

Photo credits

• Crystal ball:  Frozen Bubble, courtesy of sparkleice on Flickr
• Chocolate: Want one? courtesy of MarcelGermain on Flickr
• Yoga: yoga_signed courtesy of shunpikie on Flickr
• Hans Rosling: Courtesy of Gapfinder
• Pills: flickr pills – you should check how many you need … courtesy of eagleglide on Flickr
• Mother & Daughter: Silhouetted Mother & Daughter courtesy of Jerome Rothermund on Flickr

©2012 Kinetics. All Rights Reserved.

Der Mensch als Industriepalast (Man as Industrial Palace), Fritz Kahn, 1926. (See full description below.)

Our bodies are exquisite self-tracking machines. We’re artfully engineered with rheostats and feedback loops and switches. The number of times our heart beats in a minute, the temperature of our body, the pH of our blood, the sodium concentration inside our cells, and the turning on and off of our genes are all tightly regulated.

Unfortunately, we don’t come equipped with external tachometers. We don’t have a fuel gauge that points a needle to ‘full’ to signify when we should stop eating, or a temperature gauge to indicate when we are overheating. There is no factory-installed ‘check engine’ light.

In order to make sense of what’s going on under our hoods, we can turn to a variety of tracking tools. Sensors, probes and analyzers help us detect the electrical, chemical and mechanical signals emanating from within. We can measure, track and display with respect to time and space, episode and intervention. And best of all, we get to serve as our own control: N=1.

From lab bench to park bench
As a physiologist, my life has revolved around self-tracking. In grad school, we routinely used ourselves to calibrate equipment, develop techniques, and generally see ‘what would happen if….’  We documented our lives in lab notebooks and every day was ‘show and tell.’

Self-tracking is moving out of the lab and into living rooms and bedrooms, gyms and diners. There’s a rapidly growing community, Quantified Self, that is “a collaboration of users and tool makers who share an interest in self-knowledge through self-tracking.” The site originated with gurus Kevin Kelly and Gary Wolf, and an expanding community is overseen by them, along with Alexandra Carmichael, cofounder of CureTogether. There are more than a dozen meet-up groups around the world, as well as an active Twitter community (#quantifiedself).

Long the province of elite athletes and astronauts at one end of the spectrum, and individuals living with chronic diseases (and ICU patients) at the other end of the spectrum, tracking is moving from the fringes inward. Now the bright, shiny gadgets we ordered from scientific equipment catalogs (lactate analyzers, heart rate monitors, pulse oximeters) can be picked up on Amazon.

Should you check under your hood?
Suffering from insomnia? Want to get pregnant? Training for your first 10K? Measuring any number of parameters can reveal trends and provide clues as to what makes you tick. Self-tracking can help you make a connection between what you’re feeling or sensing and how your body is doing.

You can track physiological parameters such as heart rate, blood pressure, body temperature, and blood glucose. You can track mental health parameters such as mood and self-esteem. You can track behaviors such as foods eaten, hours spent sitting at a computer, songs listened to, minutes spent exercising, and hours spent sleeping. You can track environmental influences such as outside temperature and pollen count, commuting time, number of friends on Facebook, number of neighbors on your street you know by first name.

The data provide a glimpse of what’s going on under your hood. The measures are all exquisitely intertwined and although they might not represent true cause and effect, when grouped in combination they can reveal wonderful patterns. The patterns tell a story that can provide you with insights and awareness, which may in turn lead to behavior change, thus creating a feedback loop much like your internal circuits.

Self-tracking lets you build a personal dashboard to create a narrative of yourself. It can empower you to better understand how you are functioning, and thereby put you in better control of what’s going on under your hood. And as you self-track, at some point you will cross a threshold where you view your body not only as a machine full of data points, but as an engineered piece of living art.

Great self-tracking resources

• Quantified Self
• What if Self-Tracking Goes Mainstream?, Alexandra Carmichael, The Future Now Blog
• The data-driven life, Gary Wolf, The New York Times
• Know thyself: Tracking every facet of life, from sleep to mood to pain, 24/7/365, Gary Wolf, Wired

Related posts

• Self-tracking, Sensors, and mHealth: Trends and Opportunities
• Self-Tracking Meets Ready-To-Wear: Make Room in Your Closet for Smart Clothes
• mHealth: Health where you live, work, and play
• Twelve Everyday Health Rules–From 1908
• Are humans designed to be endurance runners?

The image
The image above is a cropped view of  Der Mensch als Industriepalast (Man as Industrial Palace) by Fritz Kahn (1888-1968). It is a chromolithograph frpm 1926, and is courtesy of the National Library of Medicine, as part of their amazing Dream Anatomy exhibit. “Kahn’s modernist visualization of the digestive and respiratory system as ‘industrial palace,’ really a chemical plant, was conceived in a period when the German chemical industry was the world’s most advanced.”

Inspired by the art, Henning M. Lederer created this video in 2009:

©2012 Kinetics. All Rights Reserved.

“Involve end users at the very beginning.” – Walter Curioso, MD, MPH, PhDc., Universidad Peruana Cayetano Heredia and University of Washington

At the second mHealth Summit, over 2,500 individuals from almost 50 countries converged in Washington, DC to discuss the mHealth (mobile health) ecosystem. Several themes surfaced, including scalability, profitability, sustainability, and data accessibility. But one theme continually stood out: context.

Programs that are successful  have several key features in common that are centered around user context. Conversely, interventions, apps, and programs that seem amazing on paper but don’t work, don’t get the context thing.

“It’s very easy to fool yourself that something works.” – Bill Gates, Bill  & Melinda Gates Foundation

Based on the wisdom of the speakers and attendees at the mHealth Summit, as well as at several recent mHealth-related meetings, here is a handy-dandy context check list. Depending on your perspective, your ‘user’ may be a customer, client, or consumer, and may be a parent, patient, doctor, nurse, or community health worker.

A context check list of 15 key questions you should ask:

1. For whom are you designing?
What are their values? Their wants and needs? Their fears? What empowers them?

2. What communities are your users part of? How do these communities influence their decisions, behaviors, values and beliefs?
Your users may be part of a community where they send and receive 100 text messages a day, or they may be part of a community that does not text. They may be part of community that relies on images and stories to communicate information. They may be part of a community where talking about sex is taboo.

3. Are you willing to let your users teach you what you really meant to do and how to do it?
Are you willing to be wrong? Are you willing to be wrong often? A key to success is to fail, and to fail frequently and quickly. Embrace failure and iterate – often and fast.

4. Are you correctly measuring how your users are using your program?
Are you collecting the right metrics that will allow you to iterate?

5. What is the literacy level of your users? What is their health literacy?
“SMS does no good if people can’t read.” – Nils Daulaire, MD, MPH, Director, Dept. of Health and Human Services Office of Global Health

Literacy involves reading, writing, speaking, doing basic math, and listening. Research shows that health materials consistently exceed the reading ability of the intended audiences. “We have the audacity to say people have low literacy skills when our material is poorly designed.” – Rima E. Rudd, ScdD, MSPH, in Improving Health Literacy for Older Adults, Expert Panel Report 2009 (CDC) (PDF)

Literacy rates vary by country, by sex, and by age. They vary by county within a state.
- State and county estimates of low literacy (U.S. Dept of Education)
- Adult literacy rates by country, Human Development Report 2009, United Nations Development Programme (see appendix H) (PDF)

6. Do you know what languages your users speak?
There’s English and Spanish and Chinese. And then there are the specialized languages. Think teen speak vs. senior speak.
Texting abbreviations for the elderly, courtesy of the Car Talk guys:
IMHO: Is My Hearing-aid On?
ROFL… CGU: Rolling On The Floor Laughing… And Can’t Get Up
FWIW: Forgot Where I Was

7. What is it you really want your users to understand or do?
Do they want to do it? What is their stage of readiness?

8. Do your users trust you?
(Have you asked them?)

9. Are you basing your mobile strategy on computer usage patterns or on mobile usage patterns?
The most popular search terms on the main MedlinePlus website (not including the mobile version) include words such as depression, diabetes, hypertension, and asthma (see search word cloud).
The most popular search terms from mobile platforms tend to be ‘incident driven.’ Think pregnancy, herpes, and STDs.

10. Do you know what incentivizes your users?
Is it a colorful flower on a screen saver, is it connecting with others, or is it cold hard cash?

11. Do you know the health status of your users?
Do your users have (or treat) a single disease or multiple conditions? If you are developing a program for a specific disease or condition, will it function in a silo? Should it?

One third of U.S. adults report living with at least one of five chronic conditions (high blood pressure, lung conditions, heart conditions, diabetes, and cancer), and 13% say they have two or more conditions, according to the Pew Internet report on Chronic Disease and the Internet.

Rethink scalability. It’s not just going from 10 users to 10,000. It’s enabling your user to go from managing one health concern to managing three, within a single program.

12. What disabilities do your users have?
Can your users hear a conversation, do their hands tremble, are they color blind, do they have impairments in cognitive function, do their fingers swell, do they use reading glasses, can they be understood when they speak?
About 49 million Americans have a disability, according to the U.S. Census Bureau.

13. Do your users have access to health care and health information?
Are your users isolated? Will you be functioning as their health lifeline? Do they have access to information and facilities?  If you provide them will actionable information, will they be able to do it?

14. Are you providing something that your users need to know or do, or that would be nice for them to know or do?
Are you trying to get your users to understand the difference?
Two word example: Medication adherence.

15. Are you engaging and empowering your users?
Are your users able to answer the question, “What’s in it for me?”

“It’s about the users.” – David Gustafson, PhD, Director, Center for Health Enhancement Systems Studies, University of Wisconsin, Madison

Examples of programs that work because they understand the context of their users

• Text4baby
• Jitterbug
• Project Masiluleke
• Community Health Information Tracking System (CHITS)

A few of the many mHealth Summit commentaries worth reading

• Bill Gates, @billgates, Cell Phone Science
• Tara Cousineau, Ph.D., @taracousphd, Bodimojo, Mobile Health and Teenagers
• Brannon Cullum, @brannonc, @aym, Movements.org blog, Recapping day two of the mhealth summit
• Brian Dolan, @mobilehealth, Mobihealthnews, Round-up: Reactions to the mHealth Summit
• Global Health Blog, @IntraHealth, mHealth: the Possibilities of the Personal
• John Moore, @john_chilmark, Chilmark Research, mHealth: Is it a Market?
• Elisheba Muturi, @ShebaMuturi, Social Health Matters, 2010 mHealth Summit: Show me the evidence
• mHealth Journal, @mhealthjournal, 40 video tech demos of mHealth devices, apps & software online
• Al Shar, @pioneerrwjf, Pioneering Ideas (RWJF), Time to Accelerate Innovation: Takeaways from this Year’s mHealth Summit
• Alex Bornkessel, @socialbttrfly, guest post on Pulse+Signal, In Review: The mHealth Attendee Gaining in Notoriety

Related posts

• The mHealth Summit: Local & Global Converge (Coverage of the 2009 Summit and World Bank Day)
• mHealth: Health where you live, work, and play
• Utilizing mobile technology and new media to encourage mobile lifestyles
• Kids and media use: Letting their fingers do the walking?

Photo credit: BlackMagic by John J. Jarvis on Flickr

©2012 Kinetics. All Rights Reserved.