The Fitness Trap: Why Being Fit Isn't the Same as Being Healthy

Is Fitness Mandatory for Health?

Fitness seems to be helplessly intertwined with health. Health and fitness, fitness and health. You cannot have one without the other. Is that true? Is there a certain level of fitness that is mandatory to be considered healthy? And what aspects of fitness are important? Are we talking about running marathons or lifting heavy weights? Or perhaps something in between?

I agree with the general premise that, all things equal, a person with a higher fitness level defined by objective measures of strength, such as grip strength or quadriceps strength, or cardiorespiratory fitness and endurance, such as VO2max or maximum fat oxidation capacity, is likely going to be healthier.

The problem is that all things are not equal. Professional powerlifters and endurance athletes possess near superhuman ability in their particular trade, but the immense training volume and sacrifice required to compete at the highest level undoubtedly has some detrimental effects on their health status. Additionally, there are certain risk factors for chronic disease that just do not seem to be modulated by fitness level, with cholesterol being the best example. Likewise, there are bigger levers to pull to address certain risk factors, for example, using pharmacotherapy to manage chronically elevated blood pressure.

The Components of Physical Fitness

It is important to call out the general components of physical fitness so we are all thinking about this the same way:

1. Strength

2. Cardiorespiratory Fitness (CRF; as measured via Cardiopulmonary Exercise Testing (CPET) to obtain VO2max)

3. Mitochondrial Efficiency (i.e. endurance)

4. Body Composition

5. Power

To be clear, this is not an exhaustive list and each component listed probably requires a bit of a nuanced discussion around it, but that is outside the scope of this post. Additionally, I will make the argument in the biomarker post that most, if not all, of these components of fitness should actually serve as biomarkers as well.

One important caveat I must make before I piss off or confuse anyone; I am not arguing that being fit is not important. The evidence is overwhelming and it is quite clear. High levels of CRF are strongly associated with a mortality benefit, meaning the fitter you are, the longer you live. Being stronger confers the same mortality benefit and protection against a host of other negative health outcomes. The benefits don't really appear to have an upper limit, so the fitter and stronger you are, the more protected you will be against disease.

What is important to concede is that these extremely large population studies are not helpful down to the individual level. I already mentioned the possible issues around professional athletes who may be elite in various metrics of fitness, but that comes at a cost. Additionally, there is no consideration of biomarkers, and I am sure that if we looked at the fittest and strongest humans on earth but forced them to live with uncontrolled high blood pressure and cholesterol, they would succumb to cardiovascular disease well before they reaped any of the benefit of their otherworldly levels of fitness. Another important consideration is that being elite in one component, such as strength, can have an impact on the other components like VO2max. In other words, just being ridiculously strong doesn't give you a free pass in the other components. If you ace calculus but fail history, english and science, you have a pretty shitty GPA. The same goes here.

I suppose the take home point is that no single component of physical fitness is necessarily more important than the next, so each one requires attention. The other is that optimizing every component of fitness in the absence of health realated biomarkers is an incomplete assessment of health status.

A Personal Wake Up Call

Take me for example. I am fringe excellent for VO2max for my age and gender, I have above average grip strength, elite muscle mass per DEXA scan, and almost unmeasurable visceral fa (the bad fat around the organs). All of that would suggest I am a picture of health. However, I did an oral glucose tolerance test to assess my body's ability to handle a glucose challenge and found out that I was borderline diabetic.

So, no, I don't think fitness = health. I have a much more complex equation for health (as described here), but in order to fully explain it, I need to move into the other important consideration for the individual. Not just risk factors and biomarkers, but self-knowledge.

1. Why are you trying to be "healthy?"

2. What are you hoping a clean bill of health will enable you to do?

3. What are the things in your life that bring you the most joy and what level of fitness is required to do them? And for how long do you wish to continue doing those things?

4. How much do you enjoy the activities required (meaning the work) to improve the different components of fitness (i.e. strength training, zone 2 training, HIIT, etc.)?

Letting Fitness Serve Your Life

This is so incredibly key. Without a clear definition of what health looks like, or better said, what good health will enable you to do, it is really hard to know what is important. If you are going to add in a bunch of workouts you hate doing, eat food you hate eating and aim for fitness goals that have no tangible benefit tied to them, you are trading "health" for life. Our bodies and our health are in service to our mind and our soul. They are a means to an end, and that end is this moment. This moment where we are accomplishing a goal, supporting our community, enjoying time with friends and family, experiencing our life.

Sure, our body is going to breakdown. Our health is going to deteriorate. We are going to lose abilities and they will no longer serve us in the way we hoped. But that is why we have cultivated a resilient spirit. We can and will find joy and satisfaction in life even as our abilities no longer allow us to do the things we once loved. But we want to give ourselves a fighting chance to preserve those abilities for as long as we reasonably can, knowing that when they are taken from us (rather, when we give them back, as Epictetus said), we will be OK too. But to preserve ability requires us to know what abilities are important, why they are important and for how long we think they will be important. Now, you can set your personal goals related to each component of physical fitness. Otherwise, you will be looking at the norms for all of the components with the understanding that being "elite" in every one is the best possible formula for optimal "health" per population level data.

But guess what? To become elite in any, let alone all, components of physical fitness is going to take a whole hell of a lot of time and effort. And if that isn't something you want to do, or if it isn't something you'll enjoy doing, you've got a problem. You can set personal targets based on all the variables that make you uniquely you, from your family health history to your baseball practice with your son. Let your level of fitness serve you, don't live your life in service of it.

All of that said, I love exercising and I almost never miss a day. It brings joy to my life and makes me feel like a better person (meaning I feel like the best version of myself when I have exercised), even outside of any objective measures. Just make sure that on your journey to improved health and fitness, you never lose sight of who you are, who you love, and that you've only got one life to live.