I want to start today's newsletter off with a joke that I found to be absolutely hilarious! I heard in the doctor's lounge this week. This one is too much.

Okay, so this endocrinologist is walking through the MICU on his way to the SICU and he's stopped by this rather attractive nurse taking care of Mr. Smith.

"Dr. Jones. So glad you're here! Mr. Smith is crashing. He's just developed atrial fib with RVR! I ordered a 12-lead, CK-MBs, a TSH, gave a 150 mg amiodarone bolus, and checked a BNP. Anything else you want me to do?!"

"Why don't you give 40 of K-Riders and Lactated Ringers with D.45 over 45 minutes Stat!. Check an Ebola titer and draw a sample for C Dificile. Transport the patient to a reverse ventilation room with respiratory droplet precautions then place the bed in negative Trendelenburg position...whoa...wait just a minute nurse, did you say amiodarone??  

I thought you said PRO-PAF-enone!!!

Oh my g-d, my side hurts so bad!!

Anyway, in addition to the joke we have some medically important news to share from Research and Development branch of Walk with a Doc. We hope in time, it will be proven to be revolutionary.  

You'll see from the great NY Times article below, movement is extremely important from the moment we get out of bed.  

That got us thinking - where can we fill in the gaps and advance. Whenever that spirit hits us, we go straight to the brains behind WWAD - our R&D crew over at the Oedison Complex on West Campus.  

Our charge to them? Create something that adds steps to our day. Their reply - Shower Pedometers. So simple, it's genious. 

Hard to believe no one else had trademarked the concept before us.  Let me walk you through our thought process:

Everybody knows we shoot for 10,000 steps/day - and not all of us are getting there everyday. Or are we? 

How many times are we turning around in the shower? You may have never thought about that. Answer: Probably dozens.

How many times are we taking steps to reach up and adjust the nozzle? So many!

How many times are we reaching down the pick up the soap? (Let's pass on this one, Dr. Happy Pants) 

Point being - we may be getting hundreds of "steps" each day, before we even set a wet foot on the dry bathroom floor mat.

So, our staff quickly identified the essential characteristic of this innovative step forward - It's gotta be water-proof. Of course. Okay, next!  

Hmmmm, we need to have somewhere to attach it. Right. How do we do that? Most other companies' R&D folks would have struggled for weeks with this one - not our boys (and you too Melinda).  

Our engineers developed a 1/4" thick rubber wet suit and within it incorporated a polyethylene glycol rubber tubing apparatus that will support 97% of pedometers on the market today. Our Marketing division has dubbed this the:

HydroWalker Party Suit (TM pending). 

I know, I know. Isn't this thing incredible. It gets better. The HydroWalker Party Suit, being built so perfectly, is 100% impermeable to soap and water. A matter of fact, most of our test subjects reported sweating inside the suit profusely. (While all the data is not back yet, we view this as an additional feature lending itself to even more health benefits.) Sorry, I digress. So because our skin is not seeing the soap and water "first hand" - the pedometers emit your choice of 3 scents: Irish Rose, Electric Rain, and Funky Cold Madina (If given a choice, pick one of the first two).

Anyway, while the HydroWalker was released to the public this Wednesday, it is not without its' faults. There has been a low incidence of moderate voltage shocks reported (32.2% of all testers). But leave it to Melinda and our boys to go the extra yard in solving the problem. Wait until you hear this.  

They've developed a state-of-the-art alert system on all WWAD pedometers. When activated, the shower-ee will be on 'automatic pilot' (in the case of loss of consciousness). The pedometer itself will directly contact the 9-1-1 and say,

"Help! I've been electrocuted by the HydroWalker Party Suit Pedometer! (For added effect, our Audio & Visual Core Group recorded Mrs. Oprah Winfrey's voice, and tediously spliced excerpts from her show, as we felt this would garner more immediate attention from the EMS Dispatcher).  

For an extra $17.50 the alert will say,

"Help! This is Oprah! I've been electrocuted by the ...."

One issue here is that the HydroWalker Party Suit Alert Button has shocked just over 87% of the testers. So, a majority of our testers that sustained an initial firing are actually receiving dual shocks.

Follow-up surveys of our volunteers have been so important. One stated they "did not enjoy starting their morning with 45-50 Joules sent through their body twice, and for that matter - even once." Some others commented they felt the suit was "unsafe". A couple of, what I would call 'non-risk takers' shared they felt the "risks outweighed the benefits."

One person even took the time to mention that they were "surprised and quite honestly disappointed when they discovered a physician was heading the study."

So, why? Why, do we do it. It's a lot easier to walk away and say, "Let someone else deal with it." Well, you know what. That's not me.  

That's not you.  

And THAT'S NOT WALK WITH A DOC!

And if in the process we happen to subject ourselves to what will likely be a class action lawsuit for tens of millions of dollars, so be it.  

Please remember, we are many yet we stand as one.

The HydroWalker Party Suit retails $624.99.

I hope you read on as I really enjoyed this article from NY Times Magazine and thought you might like it as well.

Great title right! So seriously, all the little movements add up. That's what Magic Underwear is all about. I see it as we have macro-exercise - (e.g. Walk with a Doc, 45 minute bike ride, swimming a bunch of laps, etc.) and we have micro-exercise (e.g. taking the stairs, frequents walks to the water cooler, parking far away, etc.)

Micro-exercise is HUGE. It is why we encourage 10K steps a day and give away 1000's of pedometers. We agree with the concept that sitting is dangerous.  Dr. Miriam Nelson shared an interesting thought at a meeting last month. She wondered wondered if that instead of doctors having to give patients permission to exercise, doctors should be the ones to have grant permission not to exercise, because it's a heck of a lot more dangerous that staying active. 

DR. LEVINE'S MAGIC UNDERWEAR resembled bicycle shorts, black and skintight, but with sensors mounted on the thighs and wires running to a fanny pack. The look was part Euro tourist, part cyborg. Twice a second, 24 hours a day, the magic underwear's accelerometers and inclinometers would assess every movement I made, however small, and whether I was lying, walking, standing or sitting.

A weakness of traditional activity and obesity research is that it relies on self-reporting - people's flawed recollections of how much they ate or exercised. But the participants in a series of studies that Dr. Levine did beginning in 2005 were assessed and wired up the way I was; they consumed all of their food in the lab for two months and were told not to exercise. With nary a snack nor workout left to chance, Dr. Levine was able to plumb the mysteries of a closed metabolic universe in which every calorie, consumed as food or expended for energy, could be accounted for.

His initial question - which he first posed in a 1999 study - was simple: Why do some people who consume the same amount of food as others gain more weight? After assessing how much food each of his subjects needed to maintain their current weight, Dr. Levine then began to ply them with an extra 1,000 calories per day. Sure enough, some of his subjects packed on the pounds, while others gained little to no weight.

"We measured everything, thinking we were going to find some magic metabolic factor that would explain why some people didn't gain weight," explains Dr. Michael Jensen, a Mayo Clinic researcher who collaborated with Dr. Levine on the studies. But that wasn't the case. Then six years later, with the help of the motion-tracking underwear, they discovered the answer. "The people who didn't gain weight were unconsciously moving around more," Dr. Jensen says. They hadn't started exercising more - that was prohibited by the study. Their bodies simply responded naturally by making more little movements than they had before the overfeeding began, like taking the stairs, trotting down the hall to the office water cooler, bustling about with chores at home or simply fidgeting. On average, the subjects who gained weight sat two hours more per day than those who hadn't.

People don't need the experts to tell them that sitting around too much could give them a sore back or a spare tire. The conventional wisdom, though, is that if you watch your diet and get aerobic exercise at least a few times a week, you'll effectively offset your sedentary time. A growing body of inactivity research, however, suggests that this advice makes scarcely more sense than the notion that you could counter a pack-a-day smoking habit by jogging. "Exercise is not a perfect antidote for sitting," says Marc Hamilton, an inactivity researcher at the Pennington Biomedical Research Center.

The posture of sitting itself probably isn't worse than any other type of daytime physical inactivity, like lying on the couch watching "Wheel of Fortune." But for most of us, when we're awake and not moving, we're sitting. This is your body on chairs: Electrical activity in the muscles drops - "the muscles go as silent as those of a dead horse," Hamilton says - leading to a cascade of harmful metabolic effects. Your calorie-burning rate immediately plunges to about one per minute, a third of what it would be if you got up and walked. Insulin effectiveness drops within a single day, and the risk of developing Type 2 diabetes rises. So does the risk of being obese. The enzymes responsible for breaking down lipids and triglycerides - for "vacuuming up fat out of the bloodstream," as Hamilton puts it - plunge, which in turn causes the levels of good (HDL) cholesterol to fall.

Hamilton's most recent work has examined how rapidly inactivity can cause harm. In studies of rats who were forced to be inactive, for example, he discovered that the leg muscles responsible for standing almost immediately lost more than 75 percent of their ability to remove harmful lipo-proteins from the blood. To show that the ill effects of sitting could have a rapid onset in humans too, Hamilton recruited 14 young, fit and thin volunteers and recorded a 40 percent reduction in insulin's ability to uptake glucose in the subjects - after 24 hours of being sedentary.

Over a lifetime, the unhealthful effects of sitting add up. Alpa Patel, an epidemiologist at the American Cancer Society, tracked the health of 123,000 Americans between 1992 and 2006. The men in the study who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than the men who sat for three hours or less. The death rate for women who sat for more than six hours a day was about 40 percent higher. Patel estimates that on average, people who sit too much shave a few years off of their lives.

Another study, published last year in the journal Circulation, looked at nearly 9,000 Australians and found that for each additional hour of television a person sat and watched per day, the risk of dying rose by 11 percent. The study author David Dunstan wanted to analyze whether the people who sat watching television had other unhealthful habits that caused them to die sooner. But after crunching the numbers, he reported that "age, sex, education, smoking, hypertension, waist circumference, body-mass index, glucose tolerance status and leisure-time exercise did not significantly modify the associations between television viewing and all-cause . . . mortality."

Sitting, it would seem, is an independent pathology. Being sedentary for nine hours a day at the office is bad for your health whether you go home and watch television afterward or hit the gym. It is bad whether you are morbidly obese or marathon-runner thin. "Excessive sitting," Dr. Levine says, "is a lethal activity."

The good news is that inactivity's peril can be countered. Working late one night at 3 a.m., Dr. Levine coined a name for the concept of reaping major benefits through thousands of minor movements each day: NEAT, which stands for Non-Exercise Activity Thermogenesis. In the world of NEAT, even the littlest stuff matters. McCrady-Spitzer showed me a chart that tracked my calorie-burning rate with zigzagging lines, like those of a seismograph. "What's that?" I asked, pointing to one of the spikes, which indicated that the rate had shot up. "That's when you bent over to tie your shoes," she said. "It took your body more energy than just sitting still."

In a motion-tracking study, Dr. Levine found that obese subjects averaged only 1,500 daily movements and nearly 600 minutes sitting. In my trial with the magic underwear, I came out looking somewhat better - 2,234 individual movements and 367 minutes sitting. But I was still nowhere near the farm workers Dr. Levine has studied in Jamaica, who average 5,000 daily movements and only 300 minutes sitting.

Dr. Levine knows that we can't all be farmers, so instead he is exploring ways for people to redesign their environments so that they encourage more movement. We visited a chairless first-grade classroom where the students spent part of each day crawling along mats labeled with vocabulary words and jumping between platforms while reciting math problems. We stopped by a human-resources staffing agency where many of the employees worked on the move at treadmill desks - a creation of Dr. Levine's, later sold by a company called Steelcase.

Dr. Levine was in a philosophical mood as we left the temp agency. For all of the hard science against sitting, he admits that his campaign against what he calls "the chair-based lifestyle" is not limited to simply a quest for better physical health. His is a war against inertia itself, which he believes sickens more than just our body. "Go into cubeland in a tightly controlled corporate environment and you immediately sense that there is a malaise about being tied behind a computer screen seated all day," he said. "The soul of the nation is sapped, and now it's time for the soul of the nation to rise."