Vital 5 Clarifications

Medical Q&A [Moderated]
1

Hi Austin and Jordan,

I love the concept of the Vital 5, and I really appreciate the work you’ve done in putting this together. For many people, including me, outcome-oriented metrics provide much stronger motivation for improvement than purely process-oriented guidelines. I think I’m in decent shape, but I’m hoping to work on getting solidly into Zone 1 for these metrics over the next year. That being said, there are a number of areas where I’m somewhat unclear on how to use the guidelines. In no particular order:

  1. If my Non-HDL-C is in the optimal zone, should I be trying to get a direct ApoB test to confirm?
  2. How do you perform the cycling power field test? Is that something that can be done on a normal stationary bike at the gym, or does it require specific equipment?
  3. What are the “3.5 + (483 / Run Time)” and “(FTP W/kg ÷ 0.73 × 10.8) + 7” measurements in the aerobic capacity section? I don’t think I understand how to reconcile those with the standards in the chart.
  4. What kind of machine is intended for measuring the leg press numbers? I’m not an expert, but my understanding is that 300lbs on a leg press is not standardized in the way that it would be for a barbell squat. Anecdotally, my strength (or at least my numerical performance) on different leg press machines varies enormously.
  5. How do you measure hand grip strength? I’ve seen various grippers for sale, but I have no idea which one to get or how to accurately use it.
  6. Is there an “official” way to measure waist circumference? My measurement varies quite a bit based on food/water consumption, as well as posture and muscle/breath control when measuring. If I measure first thing in the morning while standing in an upright controlled posture, I’m at the edge of Zones 1 and 2. If I measure after a big dinner in a totally relaxed/slouched posture, I’m into Zone 3.
  7. I’m not clear on what the correct placement is for the measuring tape when measuring waist circumference. Your “Should BRI Replace BMI” article tells us to measure at the navel, while your “How to Measure Your Waist Correctly” article specifically mentions that the navel is not the correct location.

Any clarifications you can offer would be greatly appreciated. Thanks again!

2

Howdy,

A few thoughts here:

  1. If it were me, I would, yes. It’s relatively cheap and it’s a more accurate number.
  2. You can do it on a stationary bike. If choosing that test, the instructions are in the Max HR calculator article: "For increased accuracy and precision, an individual could perform a 20-minute maximum exercise test on a bike, treadmill, rower, or other modality they are familiar with. During this test, the goal would be to go as hard as possible at a sustained pace for the full 20-minutes. The average HR during this test would represent a “threshold heart rate”, which could be translated into custom heart rates for the 5-zone model."
  3. Those are formulae to translate other tests, a 1.5 mile run or cycling test, to VO2max.
  4. It’s not standardized, unfortunately. The numbers come from a Cooper Institute study, where they used a Universal Equipment leg press, which is horizontal (vs being on an angle). That said, I think if someone is below the cutoff on any type of leg press, they would likely benefit (health wise) from getting stronger.
  5. A grip dynamometer. Fortunately or unfortunately, depending on your perspective, the field has not decided on a particular brand, design, etc. If you’re wanting to test your grip, you could use nearly any device for this purpose.
    6 and 7. Yes, it should be done first thing in the morning after going to the bathroom. Unfortunately (again), the data sets regarding waist circumference and health risk use multiple different sites depending on the research group. For example, NHANES uses the waist measurement (and created the reference range used in American clinical practice) I mentioned in the how-to measure your waist article. That article probably needs to be updated. The WHO standard is the mid point between the last rib and top of the hip bone. The umbilicus is easy to measure on its own and seems to be more sensitive to changes in visceral adipose tissue, so, we decided to use it for that purpose here. That all being said, I haven’t seen a huge difference in numbers between the different sites in practice.

-Jordan

3

Hi Jordan,

Thanks for the quick response! I think I’m clear on most of the points, but there are two where I still have questions:

  • I’m still getting significant fluctuations in waist circumference based on how I hold myself. Measuring right now, I can get everything from 35" (standing upright, muscle tension in abs) to 39" (slouching with gut fully expanded). Do you have any recommendation there?
  • For the 20 minute bike test, I basically try to pace myself for maximum overall output over 20 minutes? Does the resistance level or the type of bike matter? Is there an alternative way to measure if the bike doesn’t record wattage? I tested a few of the bikes at the gym, and I couldn’t find one that that records wattage over a session.
4

That’s quite a bit of variance in the waist measurement. We recommend standing up straight, not flexing, and measuring with a spring-loaded tape measure.

The 20 minute bike test should mostly be about distance without having to slow down. Similar to a real bike, the resistance should be adjusted to maximize performance (distance). That said, if you don’t have a way to measure wattage, I have some concerns with the bikes you have access to. I would favor the run in that case.

5

To be clear, I have access to bikes that display wattage, but it’s just a point in time measure. If I could find a different type of machine (maybe a rower?) that recorded average wattage over a session, would that be comparable, or does it have to be a bike?

I’ll do the run if it’s the only option, but I’m a bit hesitant to do a max effort test in a high impact modality that I don’t train.

6

Unfortunately, we can’t really translate power during one activity to another and use the same formula. If you can’t get an average power reading, and you don’t run (which I agree would likely measure low as a result), and you wanted something very accurate, then I’d consider paying for access to a bike with wattage (any concept 2) or get your VO2max measured.

As far as whether or not this changes what you do, I’m not sure. I suspect you would likely agree you could benefit from more cardiorespiratory fitness (wouldn’t we all). In that case, you can get away without doing a super accurate measurement of it and just train it more like you would anyway.

7

Understood; thanks. I’m not really thinking of the measurement in terms of changing my action plan, but rather being a way to set goals and monitor my progress. I’ll see what I can do to get an average power measurement on a bike and go from there.

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