How do you keep an entire enterprise fit? With Mark White and Timothy Clark

September 29, 2020 Daniel Serfaty Season 1 Episode 3
How do you keep an entire enterprise fit? With Mark White and Timothy Clark
How do you keep an entire enterprise fit? With Mark White and Timothy Clark
Sep 29, 2020 Season 1 Episode 3
Daniel Serfaty

In the age of digital hyperconnectivity, we’re able to track, monitor, and measure human physical performance and fitness as never before. This week, occupational physiologist and physical trainer, Mark White, and Senior Scientist, Dr. Tim Clark of Aptima, discuss how for the first time in history, by combining data analytics, AI, and measurement technology, we have the potential to provide individualized, precision physical training—to improve not only health and wellness, but aid in recovery from injury—for entire populations but tailored to each individual. Mark and Tim address what can be done today to improve fitness on the individual, the team, and the enterprise levels, and share their visions of what could be done in the future by discovering the right balance between common sense experience and human performance science and technology. 

Show Notes Transcript

In the age of digital hyperconnectivity, we’re able to track, monitor, and measure human physical performance and fitness as never before. This week, occupational physiologist and physical trainer, Mark White, and Senior Scientist, Dr. Tim Clark of Aptima, discuss how for the first time in history, by combining data analytics, AI, and measurement technology, we have the potential to provide individualized, precision physical training—to improve not only health and wellness, but aid in recovery from injury—for entire populations but tailored to each individual. Mark and Tim address what can be done today to improve fitness on the individual, the team, and the enterprise levels, and share their visions of what could be done in the future by discovering the right balance between common sense experience and human performance science and technology. 

Tim Clark: There are a very limited number of Mark Whites and other individuals like him in the services, and this is just practical, you can't have a one-to-one relationship between strength and conditioning coaches and all Marines or soldiers. And that's a foundational piece for why we're building FitForce in the first place is to allow that sort of knowledge to scale and for the technology to allow the expert knowledge to flow through it, and so that we can actually have things where an individual has recommended plans, whether they be for recovery or improvement or some sort of objective that is built on the knowledge, but doesn't necessarily have to be built in a personal way by Mark or by somebody like him.

Daniel Serfaty: Welcome to MINDWORKS. This is your host, Daniel Serfaty. In the age of digital hyper-connectivity, we're able to track, monitor and measure human physical performance and fitness as never before. For the first time in history, by combining data analytics, artificial intelligence and measurement technology, we have the potential to provide individualized precision physical training to improve the health, the wellness, and also the recovery from injury for the entire populations. In this episode of MINDWORKS, my two special guests we'll address what can be done today to improve fitness in the individual, the team, and the enterprise levels, but also share a vision of what could be done in the future by discovering the right balance between common sense experience and human performance science and technology. 

Mr. Mark White is an occupational physiologist who has not only spent many years studying human fitness academically, but also practiced it on the ground with constituencies in both the military and the civilian populations. Mr. Tim Clark, a senior scientist at Aptima, who is looking at the analytics and the measures of human performance in different domains, and more specifically for today in the domain that we will discuss, which is physical fitness. Mark, Tim, welcome to MINDWORKS.

Tim Clark: Great to be with you. 

Mark White: Thank you. 

Daniel Serfaty: So perhaps you can introduce yourself and tell us what made you choose this domain of human performance and training. Tim, you want to start?

Tim Clark: I didn't choose this domain. I'd say the domain chose me. My background is in geographic information systems and more recently biomedical informatics and epidemiology. So I've been dancing around this area for a while, mostly from the technical side, but a number of years ago, we had a chance to really instantiate some of the technology with some populations that are working on physical training and really some of the problems in that domain that need to be solved. So that's kind of the way I became more involved in the research side of this, which led to some of the operational projects and capabilities that we've been working on for a couple of years now.

Daniel Serfaty: Great. Thank you. And Mark, what was your journey?

Mark White: It's a long journey, Daniel, truly the advice of a well-intended parent, my mother once told me as I was getting into college, "Choose something that you love to do, and you'll find a way to make a living at doing it." I've been involved in physical fitness since I was 13, and so I was the standard guy working out with sand filled weights, looking at Steve Reeves and Arnold Schwarzenegger in the magazines hoping to have that narcissistic influence in your life about looking good. And over the years, it's morphed into the practice of human performance and how we can take normal physiology, normal biology, and the function of a human being and make it better. Now, initially it was towards sports, but then it transitioned into occupation where I was able to help firefighters, police officers, and military service members do their job better. So you take normal physiology, you want to optimize the performance, maybe it's a robot capacity for the component that we're discussing. And in the end, it was truly coming full circle to teaching the human being about their body. That's the tool that we have, and a lot of times we don't know how to use it well.

Daniel Serfaty: Thank you for sharing that to both of you, because I found out that in this field, the field we focus on, we call this podcast MINDWORKS, but it's really about the mind, the body, the new way we think and we act, that people get to this field from very different angles, and that's what makes this field so fascinating. It's truly an interdisciplinary field. Here we are, the three of us, a geographer, a fitness buff who became a physiologist and an aerospace engineer talking about human performance. I think that makes it fascinating because we're all bringing our own techniques and practices into the field to study and improve the way we train human bodies, human brains, human teams to work better. Maybe for our audience, can you share with us, what is it that you do in your day job? What's a typical day? Because it's not always obvious for folks who come from the engineering or the sciences or other place. How do we work in this human performance field? What's a typical day for you?

Tim Clark: A lot of my day involves talking to our Marine Corps counterparts and understanding really what their problems are, is the thing that we've been working on, the software solution that we've been building, is it really meeting the need that you all have in the field? So that's how I spent a lot of my days really kind of making sure the project and the effort kind of moves forward. But at the same time, there are a lot of things that we need to do to make sure that this doesn't just turn into a research project that goes away after the funding goes away. So we focused a lot on, how does this become a sustainable capability? How does this get fielded? How does this get trained? How does this pass through? What's called the accreditation side of a technical solution? So how does the Marine Corps own this solution and how do they sustain it long term? That's what I spend a lot of my time doing on this particular project. But another project it's typically understanding where all of this is going both from a theoretical side and also from a technical side.

Daniel Serfaty: So in fact, and in interest of full disclosure, Tim Clark is a colleague of mine at Aptima and is leading one of our key capabilities, you're a translator, you're an interpreter, you go from the needs in the field to the technical side of the equation that is there with a mission of developing technologies and other ways to help basically those folks. You just make sure that the supply of technology and the demand for satisfying those needs are aligned.

Tim Clark: I think that's a great way to describe it. We're in the business of listening for the most part, but continuing to listen because the situation isn't static, there's always a change from the operational side and priorities change. We work primarily in adverse space and adversaries change and the ways of thinking about the next battles change. And even on the fitness side, we still need to be attuned to that because that's going to change the way our stakeholders and our partners conduct their daily activities. It really does involve a whole lot of listening, but yes, being able to translate that into working capability that itself adapts to the next week, the next month.

Daniel Serfaty: Mark, in fact, you're not only a student of the field, you're true practitioner since the age of 13, you told me you were practicing basically this, so today you're not 13 anymore, I say that for our audience, they don't know, what are your typical activities during the job?

Mark White: At this point in my career, after 20 some odd plus years of practicing and then continuing my education, I act as an advisor. If I were going to give it an analogy it would be, how do I inform people to take the scientific aspect of the knowledge that we currently have about what human performance is, what it can be to an individual, but practice this science in an artful way. So I advise people, Tim calls me a lot, during one of our projects we would chat at least two or three times a week, and I would ask him certain questions too as we would banter back and forth, and the advisory role that I try and play at this point in my career is how do we get what our current knowledge base is? And when I say that, I'm spanning, let's assume hundreds of years of peer reviewed journal articles from qualitative to quantitative research, how do we get that knowledge out there to the people that are most needing it? So I'd love to continue to be a practitioner, but sadly Daniel, at this point I am now just talking most of the time.

Daniel Serfaty: I'm sure you're practicing from the way you look on the screen. So let me follow up maybe with a question Mark, in order to bring that science to the practitioner, whether the practitioner, as you say, is an athlete or a firefighter, the first condition is our ability to measure, to assess in a sense how humans attend their physical fitness. Can you talk to me a little more about, why is that important to be able to measure the right things?

Mark White: So I'll ask an overhead question. How do we know 12 inches is equal to 12 inches? There's a unit of measurement, we have to validate it, it then becomes a standard and all human beings on the face of the planet agree upon it. We use scientific method to assess that measurement and apply it properly, and we assume based on frequentist statistics probability, that that occurrence is going to continue forward. What we're then doing is taking those measurements and we apply them to an individual, and we're teaching them about that measurement. How is this important to you? How is your aerobic capacity important to you? We understand the importance of it, relatively superficially speaking that is, for a long distance runner, a marathon runner, we understand that, but how's that important to a firefighter? And then more specifically, and I would speak to the US at this point, how's that important to your general health? Because human performance has a spectrum, and it's not just for the 1% on the right hand side of that bell shaped curve, it should include everybody.

Daniel Serfaty: That's a very good example, the one that you bring that we need some standards, but you make another point that is really fundamental, I haven't thought about it, that it's not important just to measure the right thing according to what science tells us, but it's also important to communicate that to the practitioner so that eventually they can improve that thing. There's a notion that cannot sustain whether if they're a good level or improve it. Tim, can you pick up on that? How do we move from this notion of measuring the right thing to improving that thing?

Tim Clark: This is something that we've struggled with from the technology side is, how can we measure that thing, and really, how can we make it not a burden to measure that thing? Because what we find with our populations that we work with, and this goes with our military populations, but really just anyone, is it's hard to, and it's not realistic to expect people to be active participants in data creation. I think you get your individuals who are willing to submit to those sorts of measurements, but most of us, and sheepishly I include myself in this, it doesn't happen all the time. And if you don't create the data, if you're not measuring and creating those data, you really don't have anything to work with when it comes to modeling the types of things that you want to model, which include human behavior, how you respond to certain types of physical training and all of that.

So I think getting the measures right is really important, and there's a scientific consensus about what measurement looks like in physical training. There's always some arguments about it, but at the same time, I mean, there are things that we can measure, but really our challenge is, how do we make this measurements as unobtrusive as we possibly can, and getting back to the communication piece, how do we help the users understand that their doing this is valuable to them, to their enterprise and will contribute to something, whether it be their job performance, their overall health, their ability to be around for their children into old age, these are all important things that start with measurement and evaluation.

Daniel Serfaty: What you both seem to say is that, in order even on the path to improvement, not only do you need to measure the right thing, but also you need to communicate that, and the person, because we're talking about in this case fitness that has to do with the person exercising or going through some steps, need to understand the relationship between measuring that measure, and you mentioned, Mark, aerobic capacity, for example, and the need to improve it, and then eventually the past to improve it. It takes quite a bit for compliance, doesn't it?

Tim Clark: I think there's a really good example of a slow movement toward that sort of acceptance on a broad level. So 10 years ago, not very many of us were counting our steps and there's still a lot of debate about how useful step counts are, but at the same time, these products evolved pretty rapidly into the marketplace, encouraging people to increase their step counts, setting it to 10,000 steps per day. And that has changed a lot of people's behavior, even just that one measurement, that's relatively easy to capture, has changed the way people move throughout the day. I think what we're talking about here is being able to extend that to some more complex measures that influence your health and health outcomes.

Daniel Serfaty: They need to be complex, but they need to be understood.

Tim Clark: Correct, and that's the big challenge here is how do we take innately complex calculations and concepts and boil those down to where people don't have to have a PhD to really understand those, or can understand those with a readiness score or a health score of some sorts. That's really our big challenge.

Mark White: I had a professor years ago tell me, "Mark, we can write all the information that we have down in books, we call them textbooks, but if I can't convey them to people and make a greater impact to all of us, to a greater population, then having all the book smarts and knowledge, it's relatively meaningless because I need to be able to convey to those that don't have access to that information." And I've used it in my practice. At this point I no longer do personal training, but years ago when I was training individuals, I would ask the question, "How long do you think you're going to need me as your trainer?" And most often it was, "Well, indefinitely." And my response was, "No, if I'm a good personal trainer, I need you to gain independence. Therefore, is a learning process, not only from the biological physiological perspective where your muscles are growing, you're understanding how they're changing in aerobic capacity and all those other physical traits of your body are improving, but you also have to know how to control them and to maintain them. And if I've done a good job, I've done education and training, and now you have independence."

Daniel Serfaty: So your measure of success for you is to lose a customer basically.

Mark White: Absolutely.

Daniel Serfaty: But obviously not because word travels fast for, it's not easy to find a true trainer, many people understand the motions, et cetera, but that combination of coaching and making people more independent, in charge of their own health, as you said, is more difficult. I know you continue to study, Mark, you were telling me that you are working currently on a PhD. Can you tell us a little bit about that, what you're studying in particular there?

Mark White: The topic is load carriage, and the physiological measurement that I'm interested in deals with the respiratory system. The actual measurement is called work of breathing, and there's a unit of measure it's measured in joules per minute or kilojoules per minute. Basically it's how the diaphragm and the intercostal muscles work relative to the whole bodywork. And at some point, the diaphragm and the inspiratory muscles can become fatigued prior to what we term the local motors or the musculoskeletal system that's actually doing the work. And there's a negative feedback loop system that works within the brain, and it's tying in the respiratory muscle feedback plus group III and IV afferents from the muscles.

Ultimately at the end, work of breathing becomes so high and the physical activity that the brain is telling the body to do, can no longer be sustained by the respiratory system and the respiratory systems says, "Hey brain, why don't you go tell the arterials in the legs and in the arms to face a constrict and minimize." So all of a sudden during load carriage, my arms and my legs start feeling heavy. Is it because the actual legs and arms are fatigued because of the work was too much for the legs and the arms? Or is it because the blood flow to the legs and the arms have minimized because the respiratory system said I'm fatigued and I can't keep up with you. 

Daniel Serfaty: That's fascinating. That shows, again, this notion of connectivity, that those systems are not independent, the physical, the nervous system, the locomotion system, as well as we'll explore later in our chat, the connection to the mental if the nervous system is involved here. I can't imagine that there is a connection to the cognitive and perhaps even to the emotional.

Mark White: Absolutely.

Daniel Serfaty: Now, switch gears a bit and move towards one particular technology set that both of you have been collaborating on that you've been involved, and I want to take our audience through that journey. We call it technology FitForce. I would ask Tim to describe, to tell us a little bit the story, how he led a team that took research and development idea and turned it into a field solution that is just in the process of going through that transformation. We know fit is one of the most difficult thing to do, is moving from the realm of research to the realm of the practical in the field. So tell us that story. How did you take FitForce? How did it start as an even an idea, and eventually now it's turning into technology or a solution that has some legs?

Tim Clark: This is kind of a torturous path, but I have to say, this is really professionally and personally validating to have that kind of experience where one has an idea where they're sitting in a room with colleagues and tossing things around, and to see it progress into something that could potentially impact tens to hundreds of thousands of service members lives, and potentially more than that, that's an incredibly validating experience that is still in progress and quite difficult, but we're happy to be doing it. The origin of FitForce actually started when there was a, what's called a Small Business Innovation Research opportunity. The research topic was really not related to fitness at all initially, it was related to medical informatics and decision support. I had just had a really bad wrist injury where I had to have surgery, and I was actually going through occupational therapy at the time.

I got a sheet of paper that said, this is what you should do for your recovery. And I thought, surely there's a better way to understand how I am recovering from this surgery that I had to have and talk in my progress be tracked. How can I make decisions about my health and how can my care team make decisions about my health? So we wrote a proposal in 2015 and it was accepted. Then on day one, we talked to the technical point of contact and he said, "Very clearly, you are now focused on something else. You're going to look at musculoskeletal injury," which is a very large problem within the services, number of duty days are lost every year to what are largely preventable musculoskeletal injuries, overuse injuries, injuries due to bad form, those types of things. So that's kind of how the project originated is, how can we start to track those kinds of things? And most importantly, how can we model whether an individual or whether a set of individuals is potentially at risk for musculoskeletal injury?

Daniel Serfaty: So from the get go, even the fact that it started from a totally different angle, you had a partner, what you call the technical point of contact. You are basically with a senior scientist who is a US Navy, that together you came up basically with, okay, this is a problem, we'll solve it.

Tim Clark: Absolutely. I think the difference maker from transitioning from research into operations was having access to the operational community from essentially day two. So we started talking to the Marines who were having these issues with their ability to plan physical training programs. They were doing relatively heroic things, they were building Excel spreadsheets with, this is the plan over the course of a day, over the course of several weeks, and they're very specific ways to do this, and these are trained individuals, but the challenge there is that it doesn't scale. It's difficult to do things through Excel and emailing things around. So again, very heroic in the way that they did these, but there was an opportunity for us to support their workflows with technology and with some of these algorithms that we're able to write and operationalize. That's really been our goal for the past several years is to work very closely with them to understand their workflows and get the relationship between physical training and musculoskeletal injury.

Daniel Serfaty: Before we talk about that, because I would like you to describe really what that tool is aiming at when it's in use by the Marines, I have a question for Mark. Mark, I mean, you study these high performance organization where fitness is essential, not just to their health, but also to their mission. Don't they know how to do that without all the new digital technology? What is it that science can bring them? I mean, at the end of Marine, whether you watch the movies or you have a family member in the Marines, you know that they are fit, you know that they train all the time. If you're a firefighter, you know the importance of staying fit for your own, not just effectiveness, but even survival. What is it that we can bring them?

Mark White: That's an excellent question, Daniel, and I'll bring it to a crescendo when I come back to the brain analogy I'm going to provide you with. Over the years in practice and education, I've come up with this analogy, everything is an energy problem. I want to go down that rabbit hole of the laws of physics and everything else, but as we exist in this three-dimensional space in time, we're also part of it, our biological systems, and that means as scientists, we can quantify those things. And if we don't know how to quantify those things, we can find a way to do it. In the physical fitness realm over the past, I'd say 20 years, we have done an exponentially improved job of tracking that information, and as Tim alluded to, most of the time as a strength and conditioning professional, we build spreadsheets.

I say, okay, here's your volume load, and this is how much tonnage Mark lifted over this workout, and I have this accumulated process of gathering that information, the concept as a strength and conditioning coach that we apply to change that volume load and tonnage to make sure that individual doesn't over train and become overstressed. How much stress do I apply? How much energy is too much energy for that person? It's called periodization. And we've known this for quite some time. Hans Selye was the forefather for the general adaptation syndrome. It's kind of like the Goldie locks of energy. How much is too much? How much isn't enough? And then I've got my sweet spot. I've got my warm porridge. It's perfect. That's what I'm looking for. 

But there is no magic number that then I can say, okay, Mark's beautiful sweet spot for training load is this number, and I'm going to apply it to the rest of the people on the planet, and they're all going to adapt the same way to that energy. Now, and spring it back to the operator, don't they know, and aren't they fit? Yes and no. Sadly, information is commonly passed down within the confines of that occupation, and so you're only as good or you're as limited as your predecessor. And what ends up happening is that, to make the information simple, we dilute the content and therefore generation after generation, after generation, that content then just boils down to, well, this is the way it's always been done, that's how I'm going to do it. 

The crescendo in this though, is if I do this properly and I have the training and education, just like I applied to my personal training clients, but I do it to the operators, I give them autonomy, and quite honestly, that autonomy is based on rate of perceived exertion. And you can teach the individual how to perceive the body through our five senses, they then have this much greater understanding of how they, as an individual, are interacting in the environment that they're in with any machines. So it really then becomes that classic human factors or human system integration model, where I've got man, machine and environment, but that takes time, but they can perceive it and they can understand it.

Daniel Serfaty: That's really fascinating. What you're pointing out here is that there is no cookie cutter solution, we're all different individuals, we learn differently, we work differently, we perform differently and we certainly should exercise differently, and finding that sweet spot, that Goldilocks, is really about high personalization, and a lot of our technologies now go to that precision sweet spot, whether it's a student who is learning algebra or whether it's an athlete trying to exercise and develop more capacity for their core. So I would love to go back to that idea a little later, but first perhaps, Tim, can you describe what FitForce is for our audience?

Tim Clark: So FitForce on the surface is very similar to what you would see with other fitness apps that are available on the market. There's the ability for individuals like Mark, or even individuals who have learned from individuals like Mark to create these periodized plans. And there's some guidance that goes into how those plans are created. So there's a limited set of individuals who are responsible for creating plans that will improve unit health or improve the readiness permissions. But then there's also the execution side, how does that plan get pushed out? And there's a lot of considerations when determining the best way to push out plans at scale, who to share those with. But on the surface, the goal is to understand whether individuals or units are completing the workouts as prescribed, whether there are any deviations from that and really tracking that over time so that we can enable some of those population level and individual level analytics. 

So that's where FitForce is today, and we've spent a lot of effort and time getting FitForce to the state where it can reasonably produce those plans, but also understand how individuals are executing against those. And that's the data foundation that we are offering to the military community is, once you have the data, you can do a whole host of things related to modeling against those data. But data are often the things that don't come very easily.

Daniel Serfaty: Thanks for the description, but maybe I wonder if you can help me and our audience here, we have an app that has quite a bit of science behind it, not just in term of data analytics, but also some knowledge of physiology and exercise, et cetera. But at the end of the day, I can see a couple of users, I can see the Marine, the person who is training, checking his or her data, looking over time saying, okay, I need to go more here, less here, et cetera. But there is also the trainer, the professional trainer who train those Marines. And eventually there is a Marine Corps who wants to know, as an enterprise, how is FitForce? So which one are we serving here with this particular technology?

Tim Clark: The intent has always been to serve all three but capture all of the behavior and the data creation. And then those primarily happened at the planning level and the execution level. So you can imagine a scenario where, as somebody who's evaluating the fitness of the Marine Corps, which plans are leading to injury? And what's the type of knowledge that's going into those plans? And can those plans be adapted to have better outcomes? And all of that involves, again, building the plans in a digital way that's scalable, but also being able to track the usage of those plans and the execution of those plans.

So we can answer the question, this particular plan instantiated this time of year at this location results in X number of musculoskeletal injuries or pre indicators of injury, or over-training, or whatever the metric is we're looking at, versus this other type of plan that might be both planned and executed in different conditions. And that's really, I think, where the high level analysts will want to understand, well, what's the context? Why did this work over here But it didn't work over here? What are those conditions? And are those conditions adaptable and changeable?

Daniel Serfaty: So Mark, if you take off your scientist cap for a second and put back your trainer's cap, if you had such an app and you're training firefighters, how would you use FitForce as a trainer who has deep, deep knowledge about the physiology and the training and the exercises to train 20 firefighters? How can that help your job?

Mark White: If you don't mind, I'll carry on the Marine Corps analogy that Tim had. Organizationally, you need to have a program that will allow all practitioners the umbrella to practice under, this overriding philosophy of how we're going to practice this. So if I'm a strength and conditioning coach within the Marine Corps for a battalion, this software application FitForce allows me to track that energy that I was talking about earlier and apply different aspects of strength and conditioning towards individual Marines, units and companies. I am not a healthcare provider, I care about human performance, and so I take people that are normal in physiology and biology, and I try to improve them. I want to maintain a certain fitness level for larger groups of people, but with FitForce Planner, I can also drill down to the individual level and look to see that, Tim is a bit weak in upper body strength, and I know that that's going to impede his load carriage performance. 

So I can start to change his strength and conditioning plan to add in one or two different exercises, or change the way that that exercise is performed in sets and reps, where everybody else is doing standard muscular endurance type work, and Tim we're going to actually work on basic strengths. So I'm going to take your sets and increase them by two or three, and then I'm going to drop the repetitions within that set and we're going to add an extra 10 pounds on to what I expect you to be doing. So it allows for wonderful customization prescription, I would use, application of that stress to [inaudible].

Daniel Serfaty: I like that because you're making the link between the fact that it's fitness and strength and conditioning, but there is also the clear injury prevention idea there that you're trying through that exercise to go there, because you don't want to go to the other side of the equation, to the medical care that comes with its own complication, but there is a third part to that is also the recovery part. So somebody has been injured because those injuries are going to happen, how can FitForce help us bring somebody on the path to recovery back to, say, a normal activity? Tim, is that something that's within the scope of the design right now?

Tim Clark: It's a future capability, but the technical foundation would allow for that sort of activity. So you can imagine, Mark, instead of being a strength and conditioning coach, he's somebody who works in recovery as a-

Mark White: An athletic trainer.

Tim Clark: Those words. So you can imagine that person creating a planner program for one or more individuals who really need to track the user's progress against those plans to have those users state assessments, to where you understand this individual is at this point and the prescription, do I need to adapt that prescription because he or she is not progressing the way I thought that they would? The thing I will say, and this kind of goes back to really the overarching case is, there are a very limited number of Mark Whites and other individuals like him in the services. And this is just practical. You can't have a one-to-one relationship between strength and conditioning coaches and all Marines or all soldiers, and that's a foundational piece for why we're building FitForce in the first place is to allow that sort of knowledge to scale and for the technology to allow the expert knowledge to flow through it. So that we can actually have things where an individual has recommended plans, whether they be for recovery or improvement or some sort of objective that is built on the knowledge, but doesn't necessarily have to be built in a personal way by Mark or by somebody like him.

Daniel Serfaty: That's a good point. It's almost to try to have Mark Whites wisdom and science and experience in a box basically, for the trainer in the field, and therefore perhaps change even the required ratio of trainers to trainees, because at that point you have the trainer who is augmented by this technology that is data driven.

Tim Clark: One of the things that we've learned working with the operational community is that, oftentimes those who are leading physical training execution are not practitioners, they're not experts. And even the folks who may be generated the plan are relatively new to the domain, have maybe received a little bit of training about how to create a plan, but are ultimately not 20 years into the field. And those are really our target users from the planning side to help enable them with the key knowledge that allows them to customize and personalize for their units.

Daniel Serfaty: So it's been already partially deployed with the Marine Corps, at least, I want to know how it was received.

Tim Clark: One should have thick skin when building technology, and I tell my team that a lot, and that thick skin I think has allowed us to really take the feedback that we received and to understand how our users perceive the product and the process. 

Daniel Serfaty: Can you give me examples? 

Tim Clark: We get asked a lot, when is the app coming out? FitForce is an offline capable web application. So we actually don't have a native application on iOS or Android yet. And the purpose for that was to build something quickly that we could quickly adapt as a military capability. So often when you transition something and it becomes an operational capability, it becomes more challenging from a technical perspective to make changes to that and to keep up with versions and things like that. We've done it as a web application that allows us to make those rapid changes. That is something that we hear from the users, just because of familiarity with other fitness offerings out there is, can I download this app? 

One of the key challenges we had upfront is to enable offline usage of these capabilities and a very specific reason for that is, there's not always great connectivity on military installations. And in fact, by design in a lot of cases, creating an offline capable web application became a really big challenge and users have asked us for the features that you would expect online capabilities to have like streaming video and things like that. We've made a lot of those types of accommodations based on the user feedback. I would say that kind of covers a lot of the more negative feedback we've received. But from a positive side, we've been told a lot about how easy this makes the planning process, and we made a lot of affordances for being able to template out daily activities, they're referred to as play cards in Marine Corp speak. So we've created a way to share those templates and to really make those templates easy to copy to other days, and to rapidly update the plan time from the Excel document was several hours, and now we're down to a couple of minutes. They need to be able to do this quickly and with confidence, and that's what we've tried to enable.

Daniel Serfaty: Good to hear. How about you, Mark? Did you give some tough feedback to Tim and his team? 

Mark White: When I provide feedback, I always try and keep it in a context that, [inaudible] the disclaimer that, I didn't call you ugly, and I didn't tell you that your mom dresses you funny. So don't take it personal, and Tim didn't, his team took that feedback. Now, from other perspectives like the front end user, I never actually received any of that information, but as a professional, what I was trying to do was help FitForce compete with what commercially currently exists off the shelf. And what was really interesting about the development of this application when I came into it about 2018, is that they had a unique set of business requirements, all commercial off the shelf products that are being produced in the strength and conditioning field for sports performance, have a bunch of Mark Whites. I'm a diamond dozen out there in the sports field.

I say that because kinesiology and strength and conditioning in the academic institutions, that's been going on for at least 30, 40, 50 years now, slightly different names over the decades, but there are a lot of people out there that have this knowledge. They just don't exist in the military. And the unique case setting that FitForce Planner was trying to address was, we have FitForce instructors and we have education and training, and we don't have the organizational infrastructure to have a hierarchy that sits high up in the Marine Corps, where one or two Mark Whites sit, and then we bleed down into these other professionals. We need a software application that will allow us to programmatically constrain the FitForce instructor that may not have that type of expertise for I don't hurt people, as a strength conditioning professional I haven't done my job if I hurt you. 

If you get hurt out in the field in operations, or on the football field or soccer field, that's part of the job, I can't prevent that. But if I hurt you in the training room, that's a 100% preventable. So that to me is the uniqueness that FitForce provides the Marine Corps, and programmatically as we were going through the iterations and versions of FitForce, Tim's team did a wonderful job taking any input that I would provide them with and trying to attempt to integrate it. You can imagine, Mark White's professional opinion versus the customer stakeholders opinion may not always align, and so in the end, there are features that I'm sure Tim wanted to have in there that will eventually get added, but time may not have permitted, but at this point it's a wonderful application that quite honestly we'll continue to live on.

Daniel Serfaty: Thank you for sharing that case study, the FitForce case study, and the fact that it is still work in progress while we're implementing and getting feedback from the field. I would like to take us to another direction, looking basically at the proliferation of wearable sensor that can send signals from our bodies, heart rate, temperature, stress sometimes, both in term of work and fitness, and there are many apps like that in the market that are connected to the sensors. What's good about them, but what are also their limitations? If you kind of think about the future where we're all going to wear clothes that are going to be sensors and those data being collected, and they're telling the story about our state, our physical, perhaps even emotional state, can you give me the pluses and the minuses of that? After all, you believe in data. So the more data, as long as this data is being processed in the right way, the better, but are there some limitations of what we should do with these data?

Tim Clark: I think that we're at a point where we have just some tremendous capabilities that are coming out as products, and then also some of the science behind them is just really remarkable. It will give us the chance to evaluate user state over time in ways that we haven't been able to before. And from a health perspective, from an epidemiological perspective, these are critical things because if we don't have the data, it's difficult to understand where an individual is and where they might go. I think some of the bigger challenges are related to, when there are so many of these wearable technologies, some are really fantastic and are being validated by military research labs and then other organizations that seriously want to look at them for health and clinical cases. There's also a proliferation of some of these that are not very good or are easy to market, but are maybe less accurate. And you really have to be careful when considering these things, because if you're producing bad data, any sort of follow on analytic is also not going to be of quality.

Daniel Serfaty: Tim, you're worried that given that the data is being collected, say we have a ring, or we have a watch that collects basically heart rate and heart rate variability that can be a predictor sometime of stress for workload, and you worry that people are going to use those signals, process them wrongly, and then reach the wrong conclusion and suggest intervention that shouldn't be? Is that your worry?

Tim Clark: Yeah, that's a concern both from the modeling level. So if the model comes to the wrong conclusions, that's one thing. But if an individual potentially misinterprets those, or if the modeling is not expressed very well, that could lead an individual to change their behavior in a way that might not be beneficial to them. So full disclosure, I'm wearing a ring sensor right now which is quite fantastic, and in a way that it detects and has been validated by some military organizations, but also how it presents information to me about how I sleep, some of my activities throughout the day. And again, I think that can be a really valuable thing if you have confidence that what you're seeing is the truth. And that really is the big challenge that we have.

Daniel Serfaty: Tell me what you're worried about, Mark. You're listening to that and you say, oh, we are going in a dangerous direction here. If we can measure Tim's sleep, and those data are going to be somewhere for somebody maybe to learn from and for somebody to exploit. Are we worried about that? Should we worry about that?

Mark White: Yes. I think we should always worry about it. I think it's a two-sided coin. I use in my practice as an aerospace and operational physiologists in the air force, technologies within the chamber when it was allowed, to teach and it would teach air crew what hypoxic hypoxia felt like. And you just use a little finger probe, so as PO2 saturation. And the interesting thing in that setting is that I was teaching them about data that could be collected on an individual, whether we were going to do it or not in the cockpit at 26,000 feet during operations, was a different question, but I could teach to the signs, the objective change in a human person that I'm watching go through, also explain his symptoms, things that he is feeling. With that, I go back to this stoic aspect of experiential learning.

We have five senses that at least we know of right now that we experience this life. What I'm worried about is that we're going to use sensors to supersede the input that our biological organism was designed to use in this terrestrial based environment, and we're going to let the computer trump what really should just exist in the brain and our interpretation of it. And we're going to use it as a crutch. And the analogy I would use, Daniel, is people ask me, "Mark, should I use a weight belt when I do my back squats?" Well, not when you're learning to back squat, because you need to train your abdominal core muscles to stabilize that lower portion of your low back before you actually put the weight belt on. "Well, when should I eventually put the weight belt on?" And there's an art in the practice of that, it really should be at six, 800 pounds. 

I mean, when you're just way beyond what your low back should be doing, I'm worried that somebody would use a weight belt as a crutch at a much lower weight, and then they take the weight belt off, then they're going to rely on something that was not necessarily strong in foundation. That being their body. And then they're going to fold like a cheap chair and create an injury. And that can be said about data and the information. So it really supports what Tim was talking about and the potential risks quite honestly. And I've got to say some of our adversaries are reverse engineering our knowledge, and we have professional organizations that I belong to that have positions that are posted, that I could apply for as a strength and conditioning professional in our adversarial countries. They're taking our knowledge and they're trying to gain from it. And yes, that data that we're collecting can also be used against us too, we just don't know how.

Daniel Serfaty: So you're worrying about these data being public, and I think it's both for security purposes as well as for general privacy purposes, but you're also worried about raw information without the wisdom and the experience to use that information, to transform it into a prescriptive things, when you were talking about the belt and the weightlifting that can actually lead to the very injury it's supposed to prevent. And these are certainly things that concern all of us in this business is notion of, yes, human data is great to improve performance, but both the data itself and what we do with those data, the processing that science and technology brings on top of these data, plus the experience is really what makes those data useful.

Let me ask you again as we broaden the scope here about wellness, fitness, health recovery, we're in the midst of a pandemic, and both sick people in hospitals, as well as the healthcare workers and the educational workers, et cetera, are exposed to it. Can you imagine some of these applications of tracking and measuring, to go back to our initial questions, being useful maybe to track the workforce for signs of infection or for potential propagation of that infection for recovery from illness? Tim, are you imagining some solution there that are based on this notion of remote measurement of the human state?

Tim Clark: Absolutely. And I know there are a number of efforts that are looking at wearables as a way to predict COVID-19 maybe a couple of days before the symptoms present themselves, and those things will continue to proliferate, I think, as the pandemic goes on for a while. I think the challenge will remain to make sure that we're not making the problem worse. So the belt analogy is really great. I mean, you can have a technology that provides some information to you or allows you to feel like you're doing the right thing, but those really need to be validated and lab tested, and a lot of the things that are really challenging during a pandemic where speed is of the essence, but science doesn't typically respond well to speed and those types of constraints.

I am optimistic about the scale of data collection, because ultimately a lot of the problems in epidemiology are related to not having the data about where an individual is or where a population is at a certain point, wearables have the opportunity to change that calculus quite a bit, but there needs to be a baseline level of confidence in both the measurements and then also the recommendations that might come out of these. So I'm hopeful, and I think that there are going to be some good things that come out of this, but also need to be very cautious about how quickly those come out and make sure we're not making the problem worse.

Daniel Serfaty: Certainly the warning articulated by Mark earlier, certainly I can see how they can scale out in the case of trying to track a pandemic or to track the contact that a particular person has and the temperature of people and reach their own conclusion. I think we shouldn't rush to those solution immediately only because there is a time pressure, but we should also understand the consequences of not doing it right, especially on that scale.

Tim Clark: Absolutely. And I do want to add just the level of trust in these capabilities needs to be very high because you can imagine a scenario where if you're using a contact tracing app and it tells you something incorrect, your trust in that technology is now gone and these technologies require public participation and trust in the results to be effective. And we kind of have to get that right now before the trust dissipates.

Daniel Serfaty: Yes. I want to conclude with asking each one of you the same question, actually, I'd like you to envision success of those technologies, including FitForce, but not limiting to FitForce, in which we are able to sense at the population level, the health, the state, the fitness, the recovery, in general, the worker state, whether it's a factory worker or an office worker, et cetera, in order to enhance eventually their health, to improve their level of stress, et cetera. And I want you to tell me, how does it look like, especially if we have a system like FitForce, but beyond FitForce, how does it look like in three years given the advancement of technology? And how does it look like in 10 years? It's easy to imagine about the future because nobody is going to argue with you today, but I'll come back in three and 10 years and challenge again those predictions. Just a one minute answer about the shorter term and how does it look like really if we push our imagination in 10 years? Who wants to start?

Tim Clark: I'll take that one first. I think in three years if we're successful, we will have ability system where individuals feel confident enough to contribute their data about them, and these are often very sensitive because they find value in it. The 10 year timeline is a little bit different, and this tracks back to what Mark was talking about earlier, if we do our job as well, then maybe FitForce doesn't need to exist as much as it does today, that people understand all of these health and wellness factors and are really conscious of them in all of their daily activities and really take measures to feel good and to perform well, and this is just a taught and inherited knowledge. So I don't want to talk myself out of a job, but I think that would be fantastic.

Daniel Serfaty: I don't think you're in any danger of talking yourself out of a job, Tim. Mark, what's your predictive cap on, what do you say?

Mark White: Altruistically, when I have always envisioned, when I say always it was probably after the age of 30, as a society, a culture that is ingrained in fitness, now, the fitness is the modality towards healthiness. Not everybody has to be an Olympic athlete, but the idea that this information could be used, could create a paradigm shift, and I kid you not, a paradigm shift in how we practice healthcare in this country. I asked a woman once, "Who's responsible for your health?" Now, this is when I owned a gym, I was doing a health history questionnaire with her and she said, "My physician." And I thought immediately, oh my God, no. However, contemplating on that, weeks, months, my guess is most people think that.

I truly then started to glean the idea, God, if I could give you your health, I give you independence away from a medical care system that is profit oriented. Now, the medical care system shouldn't go away, it's needed for those acute extreme conditions. We need those responders, but I'd love to see a society where we're not going to our physician once a month, maybe it's once a year at best. And our preventable diseases, those rates start to drop from an epidemiological level. And it's not because we hate the healthcare system, it's because we don't rely on it. We don't need it. We only need it under those acute conditions. And so 10 years from now, I'd love to see a society that was envisioned where people were exercising and you saw people exercising, every minute of every day, somebody was out there doing something and you didn't see chronic obesity and other preventable conditions that lead to complications. I believe that that's possible, but I don't know how to get my philosophy out there, Daniel.

Daniel Serfaty: This is a very hopeful and wise note here, Mark. Thank you. I'd like to thank you, Mark White, and thank you, Tim Clark, for the wonderful interview. You've enlightened us about, not only what is being done today to improve the population's fitness, but also in your vision of what could be done in the future by relying on the right balance between common sense experience and technology.

Thank you for listening. This is Daniel Serfaty, please join me again next week for the MINDWORKS Podcast, and tweet us @mindworkspodcast, or email us at [email protected] MINDWORKS is a production of Aptima Incorporated. My executive producer is Miss Debra McNeely and my audio editor is Mr. Connor Simmons. To learn more or to find links mentioned during this episode, please visit aptima.com/mindworks. Thank you.