Invent!
Underwear Solutions
Technology is a part of the cause of lethal sitting, but it is an inevitable part of the solution as well. How can technology help reverse lethal sitting?
As I mentioned in chapter 2, we used magic underwear to track sitting and NEAT (nonexercise activity thermogenesis) activity in our research studies. Each set of underwear cost $7,000; disseminating the underwear nationwide would be cost prohibitive. To expand our work, we needed a physical activity measuring device that was inexpensive and could be used by potentially thousands of people. I began to look in the scientific literature.
In 1999, long before cell phones were commonplace, I found a device called the Tracmor. The Tracmor was a technology that allowed daily movement to be accurately measured minute-by-minute for days on end.1 A decade later, a host of devices would come onto the market to do the same thing (the Fitbit®, Gruve®, Nike+ FuelBand® and Kam® devices are examples), but the Tracmor was not only far ahead of its time, it also had been scientifically validated.
The only scientific group that used the Tracmor was in the Netherlands. I wrote to one of the lead professors, whom I’ll call Professor Fartoobusy. I sent a batch of emails—no response. I tried to telephone—he seemed to be perpetually unavailable. Becoming progressively more frustrated, I sent a FedEx letter. No response. After a total of nine FedExes, it was time for action, time to get up.
Without an appointment but in a torrent of passion, I headed off to a small town in the Netherlands where Professor Fartoobusy worked. It was amusing to enter his office unannounced. I walked in pulling my suitcase behind me. His secretary looked me up and down and asked in perfect, clipped English who I was. I explained that I was Dr. Levine from Mayo Clinic. She said, “You have to have an appointment—the professor doesn’t just see anyone.” I answered, “Please just tell the professor that I have flown from the United States to visit him.” She called through my request; then a heated exchange in Dutch occurred. Fartoobusy, long legged and gaunt, bounded out of his office. His cheeks were red, and he was flustered as he said, “Dr. Levine, I was just about to reply to your letters. What are you doing here?”
I explained that I urgently needed to get a device that would help crush the chair sentence. Fartoobusy smiled and offered me coffee. We walked together, and he explained that he was not in charge of this technology; Professor Klaus Westerterp was. He was in Maastricht, several hours’ drive away. I thanked Fartoobusy and asked him to call Professor Westerterp and tell him that I was on my way.
It was a long but fast drive to Maastricht. Physically, Professor Klaus Westerterp was almost the opposite of Fartoobusy. He was five foot six and had shoulder-length, sandy brown hair, a gentle smile and was dressed in jeans and an open-necked shirt. He had heard of my coming—the impassioned scientist who had flown from America unannounced to meet Fartoobusy. I liked Klaus immediately. He grasped my hand. “What an unexpected pleasure,” he said. It was the beginning of a decade-long friendship. I left Maastricht with five of his Tracmor units.
The Tracmor units looked as if they had been built in a laboratory. They were clumsily put together, each consisting of a large gray box about the size of a soda can connected via a wire to a small, 2-inch brown resin square. The gray box contained the electronics that stored the data, but the innovation was inside the brown resin square. Hidden inside the resin square were three acceleration sensors (accelerometers) pointing in different directions. Each of the three accelerometers captured movement in one direction (forward/backward, left/right or up/down). When the resin square was taped to a person’s back, the Tracmor could detect if a person was walking or motionless. The Tracmor unit allowed us for the first time to measure how free-living people went about their daily lives, whether burning calories while moving (NEAT) or being sedentary.
The scientific community had proven that chair addiction caused obesity and a host of medical problems; the Tracmor was a technology that measured motion and sedentariness while people went about their normal daily lives far away from the laboratory. This breakthrough was critical because it enabled me to better understand how sedentary people behave in the real world and to assess what interventions are best to reverse lethal sitting. The Tracmor was excellent for scientific studies in free-living people but it was not ready for the mass market. I needed a technological approach that could reach millions.
At that time, 15 years ago, the music industry was being reinvented. Every other word was “iPod.” I recognized that the best way to make moving cool was to integrate our ideas into the iPod. I wrote to Tony Fadell, the president at Apple in charge of the iPod division. In a brief telephone conversation, I explained to him that I wanted to adapt the magic underwear technology for the iPod. I expected him to laugh and hang up. He laughed but he didn’t hang up; the NEAT lab was invited to Apple. I realized that we were not being invited to Apple to make a scientific presentation. This was business. This was our chance to get the chair sentence message out, to begin a mass campaign against The Chairman.
Since the NEAT lab was going to visit one of the greatest self-marketing companies in the world, I decided that we needed to meet power with power. I needed to hire a media consultant. I needed Adam Taub. Like the Monty Python actors and Sacha Baron Cohen, Adam wrote for the Cambridge University comedy troupe called Footlights.2 Adam had started off at Cambridge as a science major and then switched to law. After graduation, he became a production manager at Intel and then a prominent patent attorney. Finally, he opened his own marketing company. Within a year, he was scripting for television and running international corporate media events. Adam could help me script my pitch to Apple.
A week later, Adam had flown from London to the NEAT lab at Mayo. He needed to understand the science. He bought a bottle of wine and took me out at midnight on a remote lake in a canoe. When the bottle was empty, he asked me what I wanted from him. I told him I needed to wake up America and then the world. The chair is killing us. In the middle of the lake with the sun rising, I stood up in the canoe and shouted, “I need a revolution.”
Adam wrote scripts for the Apple presentation. We rehearsed as if we were actors; he corrected gestures, body postures and delivery. After a week we were ready, and three of us flew to Cupertino for the Apple presentation: Adam Taub, Paul (the master engineer) and me.
At Apple, we were ushered into a small conference room, and several of their technical and businesspeople entered. We prepared our stage. I sweated profusely in my suit—as if I were about to go live on Broadway! Tony Fadell entered last. This man was head of the whole iPod program. He had a giant smile and emanated “cool” like cologne. “Doctor, it’s such a pleasure to have you at Apple,” he said. He was a man you instantly liked. “So what have you got to show us?”
Adam was master of ceremonies; he gave the introduction. Next came Paul, who explained the technology, its capabilities and why we needed millions of people to engage in monitoring their daily NEAT levels. Then it was my turn. I began to explain the magic underwear technology and started a striptease, removing my suit jacket, tie, shirt, shoes, socks and suit pants. I was wearing the technology under my business clothes. At this point, Tony stopped smiling and looked as if he had entered a new reality. By this time I had stripped down to the magic underwear complete with wires and flashing lights, wearing only swimming trunks beneath it. The room was utterly silent. Everyone looked at Tony, who said, “You really are Dr. Levine from the Mayo Clinic, right?” I nodded.
Tony walked over to me, shook my hand and said, “If this is what all of our meetings are going to be like, we’ve got to work together. I have never quite seen a presentation like this before!”
A year later, the first mass movement sensing system was launched collaboratively between Apple and Nike (Nikeplus: http://www.apple.com/ipod/nike/). Shoe sensors synced with iPods, and soon millions of people had begun to measure their daily activity levels. For the first time, people could self-monitor their daily activity.
The NEAT lab had changed. We no longer worked in a laboratory focused on Ivory Tower research. We had morphed into something different. We had a mission: to free the chair-sentenced masses from their sedentary servitude. The measurement revolution had begun.
MEMS: Micro Machines Smaller than a Period
MEMS (micro electro-mechanical systems) technology consists of microchips the size of pencil erasers. MEMS accelerometer microchips cost only cents and can directly measure human movement.3 Inside the chips are microscopic teeth that slide back and forth depending on the amount of movement a person makes; the amount of movement is converted into an electrical signal. MEMS accelerometer chips have been incorporated into devices such as the Fitbit®, Gruve® device, LUMOback®, Nike+ FuelBand® and Adidas miCoach® system. They’ve enabled millions of people to measure their sedentariness and track their chair escape.
I’m often asked which of the various activity-tracking devices is best. MEMS chips are valid and reliable. What is more important is how well the device attaches to the body. Research studies demonstrate that the most reliable data are obtained when MEMS accelerometers are placed against the skin on a part of the body connected to the trunk, such as the base of the spine.4 Although wrist and shoe devices can deliver crude data, they cannot detect when your bottom is on the chair.
Regardless of whether you buy an activity tracker for yourself or your dog, most Americans are carrying a MEMS accelerometer chip without realizing. There is a MEMS chip inside your smartphone. Here, the MEMS accelerometer is used to change the screen from portrait to landscape when you turn the phone.
When the first iPhone came out in 2007, I brought one to the laboratory and hacked into the signal from its MEMS chip. The accuracy was comparable to our research-grade magic underwear. At the time, apps were new. I needed an activity app. To create one, I telephoned Professor Ioannis Pavlidis.
Ioannis comes from Greece. Not only does he run the Computational Physiology Lab at the University of Houston, but he also spontaneously recites philosophy and poetry. My call found him in a coffee shop. I explained that I needed an app that detected the chair sentence. He listened, quoted a South American poet and hung up.
In six weeks, Ioannis had written the first app that enabled people to track their daily NEAT activity using their iPhone without buying any special equipment. He called it Walk n’ Play. He validated the app in our lab and released it at a national conference.5 The press picked it up, and Business Week selected it as one of its favorite apps. Two days later the University of Houston servers were under siege. Twenty-eight thousand users were measuring their sedentariness ten times each second.
If, during my PhD work, I had said to my mentor, Marsha Morgan, that one day I could measure human calorie burn in 28,000 people every tenth of a second for weeks at a time, she would have said I was delusional. But it happened; the app with 28,000 users had cost us nothing. Technologies driven by MEMS accelerometer chips enable potentially millions of people to self-monitor their daily activity.6
Today there are numerous apps for measuring physical activity, sitting and sedentariness. These types of MEMS-monitoring tools render it feasible to assess and ultimately prompt the reversal of chair addiction.
You Ain’t Seen Nothing Yet
More technologies are coming that have the potential to profoundly impact sitting disease.7 Wearable technologies are coming to the fore. For example, several designs for bras containing multiple health sensors exist. New types of band-aids will inform wearers via a transmitted text message when they have been sitting for too long and need to get up. Other skin-worn sensors can sense your level of dehydration, stress and sleep so that you are best informed on how to win your tech-savvy quest for active health.
But don’t think that these technologies are just for you; your pooch can have his or her sitting measured as well, and you will be informed via a downloadable app if you are ignoring your dog’s walking needs. There is even a system where you can see how active your pet fish has been!
Tremendous technology developments are afoot in the medical space. I foresee that every home will have a medical hub that will sync medical data, such as blood pressure, weight, blood sugar, electrocardiogram and sweat concentrations, to your remote medical center so that instead of your health being assessed a few times a year, it will be sensed and acted on almost continuously.
The cell phone will become a portable health hub; daily life will become more game-ified so that actively moving around your city becomes more fun. Also, I anticipate that social media will integrate body sensors so that you can “Like” the activity level of a friend and nudge another friend who is sitting too much. “Health nets” will connect millions of people who want to escape their chair sentences—together.
Friendly Technology?
Labor-saving technologies of various types impact us every hour we are awake. From the moment we wake up, we look at the electronic clock that, 50 years ago, would have been wound by hand. We move from our beds, press the TV remote control to switch on the morning news, access our tablets to check our mail (rather than walk to the mailbox), grind coffee in a machine and then brew it in another machine. We can switch on our lights without touching them. Our homes are heated by touching a switch rather than cutting wood or shoveling coal. Water comes from a tap—not hand pulled by a well. From our heated homes we might jump in our cars, grab breakfast at a drive-through and take an elevator up to our offices. Just a generation ago, people did every single one of these activities by hand or on foot. Today, on a given morning, we can utilize more than 70 labor-saving devices without breaking a sweat!
I was recently taunted in a National Institutes of Health conference as being the godfather of the anti-chair mafia. You might think that the godfather of the anti-chair mafia would seek the extermination of all labor-saving devices; you would be wrong. I do not advocate reversing progress. Labor-saving devices are here to stay. But we need to think about these tools of convenience differently. What these tools actually do is free up our minds, arms and legs to do useful things, like go for a walk with a friend, take an art class, volunteer, play piano or learn tai chi. Ultimately it comes down to how we use these technologies, for evil or good.