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Dr. Sara Grades Different Forms of Exercise for Women: CrossFit Gets a ??

crossfit-?When it comes to women and fitness, not all forms of exercises are equal. If you had a chance to read other parts of my series where I grade different forms of exercise, you know that I’m in favor of barre fitness (barre-liever all the way!), Tabata, and Chi Walking. But as a medical doctor and New York Times bestselling author of The Hormone Cure and more recently, The Hormone Reset Diet, I feel it is my responsibility as a professional to provide science regarding the pros and cons of other types of physical activity so that you can make your own informed choice about which forms are best for you. I had a few biases going into my review of CrossFit. A doctor/friend of mine loves it and teaches at a Box in Southern California. I’ve read, no . . . devoured, all books, podcasts, and videos by Kelly Starrett PhD, co-founder of San Francisco CrossFit and doctor of physical therapy. There’s a clear synergy between Paleo folks and CrossFit practitioners – you’ll see Paleo Mom Sarah Ballantyne PhD posting about her workouts on Instagram. I love the idea of functional fitness, even in a cult-like atmosphere. Bring on the squats and focus on the posterior chain (I’m sure I need it). I wanted to love it. If for some strange reason you haven’t yet heard of CrossFit, it’s a form of fitness that has taken this world by storm. You have probably seen sweaty muscular men and their firmly-toned female counterparts (think short shorts and knee-high socks) flipping large truck tires, jumping onto boxes, slamming down barbells, and tossing those funny looking kettlebells all over the “box,” which is code for a CrossFit gym. While it may look like a form of boot camp for Navy Seals, what you are actually witnessing is something called CrossFit. Yes, folks, this tire rolling, weight throwing, box-jumping craze is actually an exercise class open to the public – available for any and all who dare to try it. CrossFit isn’t just any old exercise class. It’s a growing tribe, a way of life, a way of eating (usually Paleo), a way of talking (they have their own parlance), a heart-thumping, muscle-pumping challenge that is going to give you a run for your money -- and then some. Swagger? Hells yes. You like variety? CrossFit is for you. How about intense competition? CrossFit lives for it. Accelerated fat burning? No sweat (well, actually lots of sweat!), CrossFit offers that too. Even the New York Times has commented: “What makes CrossFit appealing to members and confusing to outsiders is that it’s more than a workout — it’s a cultural identity.” ((http://well.blogs.nytimes.com/2014/08/18/CrossFit-book-breathe-fire/ )) In fact, CrossFit’s key physical qualities include improvements in cardiovascular endurance, strength, stamina, agility, balance, power, speed, coordination, accuracy, and flexibility. (("The Origins of CrossFit,” The Box Magazine, accessed February 19, 2015 )) What Is CrossFit Exactly? CrossFit is a total body workout that aims to increase functional capacity by drawing on a variety of high intensity movements which incorporate an assortment of equipment and body weight exercises. These movements integrate exercise modalities such as high intensity interval training (HIIT), Olympic lifting, power lifting, plyometrics (jumping), and gymnastics and are often performed to fatigue. The “equipment” (more like weapons of max fitness), may be anything from large truck tires, gymnastic rings, jump ropes, and plyo-boxes, to medicine balls, dumbbells, and resistance bands (to name a few). Workouts of the day (WOD) are posted on the CrossFit website (among others) and are open to anyone who wants to try the workouts at home or at one of CrossFit’s 10,000 affiliated gyms. Participants are invited to post their progress and accomplishments online, where they receive encouraging and positive feedback from a vast and active CrossFit community. ((“What is CrossFit?” Accessed February 19, 2015)) CrossFit founder, Greg Glassman, developed his earlier success as a coach and trainer teaching efficient, high-intensity workouts to celebrities and athletes in gyms all over Southern California. In 1995 he was hired to train the Santa Cruz Police Department where he found that combining traditional heavy lifting with sprints and high intensity exercises yielded best results. Glassman incorporates his training modalities and opens his first CrossFit gym in 1995 in Santa Cruz, California. By 2000 he founded CrossFit Inc. and in 2001 launched CrossFit.com which features his WOD of the day along with an extensive library of exercise videos, courses on how to become a certified CrossFit Coach along with a message board where members talk about all things CrossFit. In 2007 the CrossFit games were founded where athletes from all over the world come together to compete against one another once a year. The event became so popular that Reebok decided to sponsor it, with ESPN2 broadcasting it worldwide. ((“Greg Glassman Biography” Accessed 2/18/2015)) ((David Tao, “How CrossFit Embraced Fans and Built The Next Great Spectator Sport,” Forbes magazine. Accessed 2/17/2015 )) Curious? Watch the “Nasty Girl” WOD right here. The Pros CrossFit offers tremendous bang for your buck. The total body conditioning and emphasis on functional fitness prepares the body for nearly any physical challenge “unknown” and “unknowable.” ((“What is CrossFit?” Accessed February 19, 2015 )) It works the lateral part of the body, which is largely ignored in many fitness circles. Its high intensity workouts increase cardiovascular and fat burning capacity, which can lead to a fit and lean body. ((M.M. Smith, et al., “CrossFit-based High Intensity Power Training Improves Maximal Aerobic Fitness and body Composition. Journal of Strength and Conditioning 27 (2013): 3159-3172. doi: 10.1519/JSC.0b013e318289e59f)) The variety of exercises keeps the workouts interesting, which makes exercise fun rather than something you dread. Workouts are measured over time so participants can track their progress and see results quickly. Moreover, because of the high intensity nature of the sport, you needn’t spend as much time working out, which increases the desire continue. ((K.M. Heinrich, et al., “High-intensity Compared to Moderate-intensity Training for Exercise Initiation, Adherence, and Intentions: An Intervention Study. BMC Public Health 14 (2014): 789 doi: 10.1186/1471-2458-14-789)) Last, but definitely not least, CrossFit offers a sense of community to any and all who join them. Whether a veteran or a newbie, all participants are welcome with (well developed, big gunned) open arms and cheered on for their achievements and accomplishments. ((Sherri McMillan, “What You Can Learn From CrossFit,” Idea Fitness Manager 27, Issue 1.)) Accountability and community matter a ton when it comes to fitness, and conventional medicine is just beginning to catch on to its importance—CrossFit has embedded this crucial piece of fitness brilliantly in their gyms and philosophy. Another advantage to CrossFit is the calorie burn. In my first WOD, I burned 475 calories. Damn! My usual barre class nets me 250 to 275 calories, and that’s when I’m all in, shakin’ and quakin’ for the duration. But during that same class, I saw a number of people with poor form performing squats and deadlifts, and instructors who didn’t seem to notice or care to correct their form. That worries me. So if you want to try CrossFit, make sure it’s under the watchful eyes of a powerful instructor who truly knows and sees your form, especially when you’re fatigued. Someone like Kelly.
… with intelligence and swagger, Kelly Starrett is carpet-bombing the tired notions of what for years has stranded stretching and recovery thought in a ditch. With fresh vision harnessed to an exceptional background as an elite athlete, coach and physical therapist, he is pioneering a new era of sports performance as it relates to movement, mechanics and the actualization of athletic potential. Athletes and coaches from the entire spectrum of sport will benefit by following his lead. —T.J. Murphy, Competitor Magazine
The Cons While CrossFit is taking the world by storm, there are some things that you should be aware of before you join the CrossFit craze.
  1. Injury. Because CrossFit is a high intensity workout, you’re more likely to hurt yourself than with lower impact movements. While coaches are there to guide you, the fast paced, heavy weight baring, competitive nature of the sport can lead to poor technique and improper form. And when you lift heavy objects, quickly, and with bad form, it’s a recipe for disaster. According to one study, 73.5% of participant sustained some type of injury during CrossFit training ((P.T. Hack, et al., “The Nature and Prevalence of Injury During CrossFit Training." Journal of Strength and Conditioning Research (2013). doi: 10.1519/JSC.0000000000000318)) with shoulder, low back and knee injures being the most common. ((M. Benjamin, et al., “Injury Rate and Patterns Amongst CrossFit Athletes.” Orthopaedic Journal of Sports Medicine 2 (2014). doi:10.1177/2325967114531177)) Additionally, the smaller stabilizing muscles are often neglected, which may result in muscle imbalances and (you guessed it) increased injury. Of course, common sense is that you find a coach who onboards you with great scrutiny and vigilance about your form. And the corollary: some boxes are better than others at this task, as not all coaches are equally trained and talented.
  2. Excess stress/hormesis? High-intensity exercise induces a powerful and potentially healing stress response in the body, which can head you toward greater stress resilience or imbalance. Ideally, you want your workouts to push you toward resilience – and maybe your goal is enhanced performance, maybe not. I’ve seen CrossFit refugees in my office with imbalances of homeostasis, or the tendency of a system to maintain internal stability, owing to the coordinated response of its parts to any stimulus that would tend to disturb normal condition of function. ((Homeostasis, Dictionary.com accessed 2/19/2015)) In other words, your body strives for balance and, when you push it to physical extremes or overtrain, it’s not so balanced. Nor are we.As I explain in detail in my New York Times bestseller, The Hormone Cure, this lack of balance can wreak all kinds of havoc on one’s biology. Your body may react to the stressor of CrossFit by adjusting its hormone levels as it strives to get back to the “comfort zone,” causing additional imbalances to occur. Or you may become more stress resilience. Anecdotally, I see women in their twenties respond more favorably than older women, but that’s not a scientifically-based opinion and I’m sure there are loads of exceptions.Cortisol levels are particularly affected with HIIT and can become chronically high (and subsequently low) which can lead to symptoms of overtraining such as fatigue, sleeplessness, injury and  weight loss or gain. ((Mary Black Johnson and Steven M. Thiese “A Review of Overtraining Syndrome-Recognizing the Signs and Symptoms,” Journal of Athletic Training 27 (1992): 352-354. Accessed 2/20/2015)) ((“Mistakes for CrossFit beginners to Avoid” The Box Magazine Accessed 2/20/2015 )) This is simply fair warning that if you tend to be an overachiever, an “all-or-nothing” type of gal, be aware because CrossFit may just push you to the over-training zone. This is yet another opportunity to be in conversation with your body, rather than meeting some population-based goal (i.e., WOD when you’re tired) or pleasing your coach.
  3. Uncle Rhabdo? There have been reports of CrossFit participants developing rhabdomyolysis, a serious and possibly life-threatening condition that occurs when broken-down muscle cells fill the bloodstream. “It can kill you,” Mr. Glassman sats. “I’ve always been completely honest about that.” ((http://www.CrossFit.com/journal/library/38_05_cf_rhabdo.pdf; http://www.huffingtonpost.com/eric-robertson/CrossFit-rhabdomyolysis_b_3977598.html))
  4. Age faster? While I know folks who are 110% committed to their CrossFit and look amazing (Dr. Holly Lucille, my doctor/friend, comes to mind ((http://drhollylucille.com/tag/CrossFit/)), I know many more women who join CrossFit,  don’t lose weight, and get injured. They age faster, and don’t get lean as hoped. I think CrossFit suits younger people more than older for the reasons previously mentioned—as you age, often the emphasis deservedly gets placed less on performance and more on longevity, and I don’t think of CrossFit as the best form of longevity fitness.

To CrossFit or Not To CrossFit?

CrossFit is an efficient total body workout that allows participants to get many of the positive benefits of exercise, but in a shorter amount of time. If you have been an athlete or are involved in regular physical activity, you may want to give CrossFit a try, but please keep in mind the following guidelines.
  • Try not to do too much too soon. Because of the high intensity nature of the exercises, your muscles will need time to recover. I know this is obvious – the voice of reason – but I see it neglected regularly by well-meaning folks.
  • Give yourself a couple of days to rest in between CrossFit workouts so your body can acclimate accordingly. Can’t tell intuitively? Use heart rate variability to determine if you’re adequately rested. (Let me know in the comments section if you want to hear more about this topic!)
  • CrossFit has trained coaches on hand. Ask them about the proper technique for the exercises about which you are unsure. It is more important to get your form right than to kill yourself keeping up with Melanie Muscle to your left.
  • Finally, don’t show off! You may have a solid background in physical activity, but don’t assume that “you got this.” Take your time as you try new exercises out, and make sure you maintain proper form-even if that means you need to go slower. Check your ego at the door.

Who Should Cross Out CrossFit

If you are someone who has had a recent injury or a history of injuries, you may want to think twice about trying CrossFit. Due to the high intensity, heavy weight baring, fast paced series of exercises, people with injuries are more at risk for hurting themselves. If you are new to physical activity and are just getting started on your fitness regime, you may want to wait before you try CrossFit. While it’s a fast and effective way to get into shape, CrossFit requires a solid grasp of good technique and proper form, so it may be best to hire a personal trainer for a session or two, or observe a few classes, so you can establish a base of knowledge first. Finally, if you don’t like extremely high intensity workouts, then CrossFit is probably not right for you. While the coaches may offer modifications to reduce exercise intensity, the very nature of CrossFit is competitive, which makes slower, lower impact versions difficult to follow. crossfitbplusWith all of this information in mind, I give CrossFit a B+. While I find myself drawn to the cult-like quality, the ever-changing variety, and the potential fat burning capacity that it seems to offer, the risk for injuries limits CrossFits suitability for those with injuries and/or reduced fitness capacities. If you are a Type A personality with a hearty exercise foundation, this highly rigorous workout may be exactly what you are looking for, but if you are of the free-spirit, yoga type, CrossFit may push you beyond your OM and into your OMG as you scurry to keep up with the fast paced workouts, leaving good form and Sivasana at the door. I’d love to hear from you about your thoughts about CrossFit, why it’s so popular, what I’ve forgotten to mention, and if you’ve tried it. Please leave a comment below and let us know your story with CrossFit or other extreme fitness. [sc:Crossfit]


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