On Friday 11/08/13 I did the following WOW supervised by all 3 trainers at UE (Joy!).

MedX Compound Row with SS retrofits (starting with entire stack, then 360, 240 then 140-part of my demo to Ed)

Nautilus Pullover with SS retrofits

SuperSlow Systems Pulldown

SuperSlow Systems Neck Extension

Lumbar Extension via Romanian Deadlift

Then today (111/13/13) I went to Fike and did “shoulders”.

Dumbell Front Raise

Dumbell Bent Fly

Dumbell Lateral Raise

Barbell Overhead Press

Dumbbell Shrug

I have really enjoyed reading over the last WOW’s comments.  People of opposing viewpoints have challenged each other in meaningful ways and the discussions have been enlightening for me.  There have also been several examples of logical fallacies/cognitive errors.  I am not going to name names, since we all do it.  I am especially guilty of many logical fallacies (the sunk costs fallacy and cognitive dissonance have cost me more time in my life than I care to admit).

One of the logical fallacies that keeps appearing in the threads is one that is rampant in the fields of fitness and success.  The fallacy in question is that of Survivorship Bias.  Survivorship bias is the marketing that underpins P90X, Crossfit, as well as magazines such as Fortune, Success, Forbes and biographies of successful businessmen and athletes.  A very popular fitness fad that I have lost clients to (who later came back) are Fitness Boot Camps. These camps fashion themselves after boot camps or Navy Seals physical training camps.  These programs actually accrue some impressive results that are then heavily advertised.  The assumption is that the training was clearly responsible for the results.  What the Navy understands that the lay public does not, is that BUDS Hell week is not done to produce a given degree of conditioning; it is done to weed out.  Those that cannot recover and perform, or who become injured, ring the bell and go home.  Those who can recover, adapt, or even thrive make the cut.  But the boot camp did not make them that way, it was just a way to separate the wheat from the chaff.  The same can be said for programs such as Gym Jones, Crossfit, Insanity or P90X, which is why such programs are so popular amongst Everest-summiting mountain climbers, ex-special forces soldiers or SWAT team members. The fact that they succeed in something so tough only seems to reinforce their sense of superiority and group identity.  This luster of superiority is also what attracts those who ultimately don’t survive.  They too hope that they can forge elite fitness in the crucible of a boot camp that they pay to attend.  These are the folks that are hospitalized with rhabdomyolysis, tear their rotator cuff, herniate a disc or simply get tired of tearing their skin off on a plyo box.  Those that survive are those with the physical attributes that we would all like to have, and they become great spokespersons for the movement.

In medicine survivorship bias drives the use of one of the most marketed therapies in the history of medicine:  the administration of Tissue Plasminogen Activator in ischemic strokes.  The trial that launched this therapy was the NINDS trial.  In the trial those given TPA for their strokes ended up showing better neurological outcomes at 3 months than those who received only aspirin and supportive care.  The thing that was not acknowledged in the conclusions of this study were that results could only be measured in survivors.  If you looked at all patients (including those that died), you found that those who were sicker and got TPA were much more likely to die of fatal brain hemorrhages.  Thus, in the TPA group the sicker patients died leaving on the less sick to be measured for function at three months whereas those in the control group had to include the more severe strokes along with the less severe ones which made their function at 3 months look worse.  Now we see every hospital vying to be a “Stroke Center” and advertising with billboards that say “Time is Brain”.  The survivorship bias that launched TPA for stroke was further reinforced by Confirmation Bias.  Many times a patient presenting with major stroke symptoms will have spontaneous resolution or migration of a clot, or collateral circulation will find an alternate pathway to the area of the brain being deprived of its blood supply.  It is not uncommon to see a patient who is completely paralyzed and aphasic return completely to normal in a matter of minutes to hours (in which case it is called a Transient Ischemic Attack or TIA).  Many a neurologist has recounted stories of pushing TPA and then seeing a miraculous return to normal causing them and the patient’s family to credit the miracle drug.  I cannot tell you how many times I have seen a patient return to normal just seconds before the order to give TPA was carried out.  Just a few seconds made the difference between a diagnosis of TIA versus the actions of a miracle drug.

When I was researching the topic of survivorship bias I came across a website devoted to the subject of cognitive errors (www.youarenotsosmart.com).  In its very lengthy article on survivorship bias it told the story of a group of mathematicians who worked for the DoD during WWII who were asked to evaluate how to decrease the losses of B-17 bombers.  On a given bombing mission up to 50% of the planes would not return.  Crew members called themselves “already ghosts”.  Commanders of the Army Air Force had surveyed the damage of returning bombers and found that most of the bullet holes were in the wings, around the gun turret, and along the center underbelly.  Army Air Force officials had suggested that extra armor be installed at these locations.  Since weight was a critical issue, armor had to be used where it counted.  The DoD mathematicians intervened however and pointed out that these locations are exactly where you did not want to place the extra armor because you were analyzing the planes that survived.  These bullet holes represented where a plane could be shot and expect to survive.  Fortunately, the mathematicians prevailed and bomber crew mortality dropped significantly throughout the rest of the war.

In a similar vein, it is all too easy to observe Ken Hutchins (or other such personal training center) train clients over the years and note how few impressive physiques have been produced.  However, one must consider what kind of client has been serviced.  How might survivorship bias and selection bias skew our point of view.  A personal training center that offers a protocol with an emphasis on safety, in a clinical and private environment is very likely to draw from the very population that did not survive (or would never attend) a boot camp or hard-core bodybuilding gym, or crossfit “box”.  Further if the proprietor was famous for his involvement in The Osteoporosis Study, what kind of client do you think might show up at the door and how selection bias may have more to do with perceived physique outcomes than any protocol or approach itself.  Perhaps this is why a studio in Ohio, using exactly the same protocol, but is owned by a bodybuilder has a whole stable of successful bodybuilders and fitness competitors to point to.

For anyone new to BBS coming to read this blog, a 400+ comment thread may seem overwhelming and may suggest that BBS principles may be in question.  What must be realized is that exercise investigation is actually quite primitive, and those that have access to funding and resources do not understand the issues as well as some of the commenters on this blog.  What we are therefore stuck with is trying to make sense of our observations through the fog of cognitive bias that is part and parcel of the human brain.  Like any field, this one is filled with history.  Some of that history is good and grand.  Some of that history includes people that may have been (or felt that they were) betrayed or somehow thrown under the bus.  Once those lost opportunity costs are factor in, these cognitive biases can be put on steroids.  However, open discussions that get heated and run 400 posts are how refinement and discovery get made, and as long as everyone remains respectful, perhaps we can shore up the plane where it counts.  Like the Beastie Boys say about New York: “On the number 10 bus we fight and fuss, you know we’re thorough in the buroughs because that’s a must.”

A video called the Texas Sharpshooter illustrates Jeffrey’s points on bias