Introducing the Hacker’s Guide to Fitness

Since the time I started this blog, I’ve used it to write about a variety of topics. Increasingly what excites me most is the idea of sharing the insight & learning I’ve had in finding smarter & more sustainable ways to improve my fitness & health. Much of this knowledge is not commonplace and even perhaps counter-intuitive. So I recently started a new blog with this purpose, called the Hacker’s Guide to Fitness. A hack is basically a smart way to solve a tough problem.

Follow this if you’d like to stay informed on topics related to fitness.


Is Counting Steps A Waste of Time?

Everyday I see a new ‘wearable’ product being launched with the promise that it would motivate me to be more active, lose weight, improve health & prevent all the potential ill effects of inactivity. Yet as a father of two kids there is never enough time to be active and certainly not the two hours it takes to complete the daily recommended activity goal of 10,000 steps!

So what’s the solution ? In a seminal piece of work, Paul T. Williams from the Lawrence Berkeley National Lab analyzed over 30 different studies covering over 2 million person years of follow-up to conclusively demonstrate that being fit is much more beneficial (i.e. lower risk of heart disease) than being active. In fact even a moderate improvement in fitness is more beneficial than being the most active person on the planet!

Fitness here is specifically defined as ‘cardio-respiratory fitness’ i.e. the ability of your heart & lungs to supply oxygen to your muscles when engaged in sustained physical activity.

As a result, the American Heart Association in 2013 issued a policy statement stating that “Cardio-respiratory fitness is the most important correlate of overall health status … and perhaps the strongest predictor for CVD and total mortality”. So if you have time to focus on improving one thing, that should be your fitness level not your activity.

Not to suggest that counting steps (or calories) is not beneficial at all … but it doesn’t seem like a smart way to improve your health. Fitness on the other hand is best improved through short bursts of high intensity training … so you actually spend less time yet can be healthier!


1. Paul T. Williams, Lawrence Berkeley National Laboratory, Med Sci Sports Exerc. 2001 May ; 33(5): 754–761
2. Donatello, Rebeka J. (2005). Health, The Basics. San Francisco: Pearson Education, Inc. (
3. Kaminsky et al A National Registry for Cardiorespiratory Fitness. Circulation. 2013;127:652-662

How to Sell : 3 Insights from Neuroscience

Dilbert on Sales.Selling is an art they say… you have to be born a salesman. But neuroscience is now throwing light on how selling actually works so we can all perhaps learn to be better salespeople.

Over the last year working with Kadence International, I’ve had the opportunity to measure response to different sales pitches using a neurometric method called Visceral (Disclosure : I helped develop the technology) that passively measures the reaction of the sales prospect during a simulated sales call. Here’s what we are learning:

1/ Keep it Short

The single most consistent finding is that everyone’s engagement declines during the course of a sales call. And by the end of a 15-minute pitch, engagement levels could be up to 20% lower than at start. So if you haven’t got their attention up front its all downhill from there.

2/ Ask, Don’t Tell

So when do you think people are more engaged – when they are talking or when you are talking ? Its remarkable how much engagement increases when the salesperson is having a conversation and how much it falls when it turns into a monologue. So equip your sales people with questions they can ask, at every step.

3/ Don’t Rely on Body Language

Research suggests that 80% of communication is from body language – what neuroscience is now revealing is that body language could be misleading. We’re learning that body language is reflective of personality type – so an extrovert is likely to appear interested in your product and an introvert could appear disinterested whereas their emotional engagement could be exactly the opposite. And many typical sales prospects (doctors, IT managers) are likely to be cerebral / introverted personalities so it makes it difficult to read who you’re winning with. The better approach is to set-up tangible follow-on actions that you can measure all your prospects against.

Interested in learning more? Feel free to reach me at : sraj(at)kadence(dot)com.

Kadence’s Neurometric Technology shortlisted for MRS Health Innovation Award!

Yippee!!! MRS is the world’s largest research organization with a presence in over 60 countries. Great to see that they’ve shortlisted us in their annual healthcare research innovation category. Congrats and best wishes to the other two contestants!


Healthcare Research

Building sales aids that sell: Via neurometric measurement of a sales simulation by Kieron Mathews, Kadence International USA and Siva Raj, Bausch & Lomb

Dealing with busy Teens: ‘PKU and you’, how understanding patients with a rare metabolic disorder helped Nutricia to engage with young teens using anoOnline market research community by Robert Dossin, InSites Consulting and Sarah Manley, Nutricia

LEO Pharma NPD: How research innovation, with early patient input, directly influenced a product development decision by Janet Gunner, James Hindhaugh & Kevin Savage, Trufflenet Health

VisceralVisceral is a really cool product that I had the opportunity to work on in partnership with Kadence International while I was at Bausch + Lomb and I’m now helping develop further while at Kadence. Its a radically different approach to building sales aids & results in a sales pitch that is very tight and impactful.

Traditionally sales aids have been developed by showing the sales prospect (e.g. a doctor) the material in a research setting (typically by a specialist moderator) – by asking them to provide feedback / critical response to the material presented. This tends to have many issues – the response tends to be over-rational, secondly there is no effective way of determining if the prospect has been ‘sold’ by the material since you typically see most people give a positive response. Also I’ve personally found that this tends to result in sales aids that are ‘information heavy’ – perhaps as a result of the critical / review approach. Importantly, this completely ignores the fact that in the real world, the sales call is rarely about reading or showing the sales aid – the most effective sales calls are about asking the right questions and establishing a relationship – then using the sales aid (if you absolutely must) to visually illustrate a point or provide supporting data.

So how is Visceral different – firstly it uses a live sales simulation where a real sales rep pitches a prospect (say a doctor) who is invited to a central facility, while all of us watch secretly from the backroom! During the sales pitch we observe & record the doctor’s reaction but also measure the intensity of their emotional response by using a wrist worn heart rate monitor that transmits data via bluetooth smart to an ipad, allowing us to see real-time their reaction to specific pitch. In addition, we also measure the nature of their emotional reaction (valence in technical terms) by using facial coding to determine if its a positive or negative reaction – also streaming real-time.

Below is an example output – as you’ll see with this data it becomes really easy to determine if the respondent had a strong reaction to the material and which parts of the material evoked a reaction. The reality is that our brains remember the stuff that is emotionally meaningful to us and decision-making is mostly an emotional affair – so from both perspectives this is hugely insightful. All of this is very non-invasive – all that the user does is wear a watch which they pretty much forget about within a few minutes of starting to talk.


BTW negative emotion is not a bad thing – a lot of times you see initial negative reaction when the prospect is confronted with information that may go against their accepted beliefs. No emotion is the really bad thing – it means your entire sales call has been an utter waste of time.

For those of you doing qualitative market research it would be a surprise to see such quantified results – this is one of the biggest benefits of the approach. It makes a hitherto subjective methodology much more objective that both clients and creative agencies can use with confidence and hopefully result in sales aids that not just inform but actually sell.

If you’re interested in learning how this technology could help you develop better sales & marketing material drop me a note at sraj (at) kadence (dot) com.

(Lean) Startup Lessons from my 11-month old baby! (UPDATED)

Ryan B&W

(UPDATED 10/06 WITH LESSON #3 : Einstein was wrong!)

Bringing up a baby is like working in a startup – lots of late nights, you have no choice but to deal with crap and often your only reward is a gurgle and a charming smile!

Not a surprise therefore that some of the most valuable lessons I’ve learnt have been watching my baby boy grow up alongside my startup (this is actually quite literal as he spends most of his time playing in my basement office).

Lesson 1: Learn to fall before you learn to walk

In the last few weeks my baby has gone from exclusively crawling to standing while holding onto his playpen to taking a few unaided steps. Eventually he falls – mostly, but not always, he’s ready to try again. His willingness to immediately walk again has been a function of how well he fell! If he managed to fall on his bottom, it’s usually painless and he’s up within a few minutes. If he falls on his knees , it’s a bit painful and you can see him take longer to try again.

This feels like the #1 maxim for startup success … if your cost of failure is minimal to non-existent (i.e. you’ve learnt to fall on your bottom) then you can keep trying until you succeed (as all babies eventually learn to walk) – it’s that simple. And the cost of failure can be a multitude of things – some of it is time and money spent but much of it is emotional (what you’ve vested in the idea). The real challenge is to keep this minimal so you can try again and again – this is the basic principle of the lean startup idea. So what’s the most effective way of keeping costs to the minimum – to quote Eric Ries, lean startup guru : “Sell it, then build it”.

Lesson 2 : Eat your baby’s food

Feeding the baby is a whole other learning experience & the fun started when he graduated to solid food. Initially he would try anything (he clearly didn’t know any better), so we managed to get him to eat veggies we wouldn’t eat ourselves (I’m vegetarian btw so I can eat a variety of veggies but it surprises me how awful some of the babyfood veggies can be).

But it didn’t take him long to figure out that green peas suck (you should try the baby food variety), rice and oat cereal were acceptable when he’s really hungry but given a choice he would prefer to eat fruit and yoghurt (i.e. the sweet stuff).

Predicting what he would like was actually quite easy – if we liked it he liked it too! This kind of brings me to fundamental startup maxim #2 – if you can’t / don’t use your own product no one else is going to – the best way to build a product that others might use is to ‘eat your own baby food’!  Many successful products (Facebook, iPhone) were creations that essentially were designed to please their creators. Of course if your tastes are very unique, you are in real trouble … but if you can find something about yourself that is universally applicable (like a love of sweet things) – you’ll also find it easy to build a great product by just building stuff you like.

Lesson 3 : Einstein was wrong! 

I just realized that my baby might be insane – at least according to Einstein’s famous definition of insanity, i.e “Doing the same thing over and over again and expecting different results”. Ever since he learnt to crawl he’s been curious about what’s inside the fridge. So every time any of us open the fridge door he rushes to it (regardless of where he is) and tries to get his hands on the cold and interesting stuff inside. And when we see him doing that we being good parents shut the fridge door on him before he can get his paws on the stuff inside. And he keeps trying again and again regardless of outcome!

Recently though I’ve noticed a curious thing — there are a few occasions when he actually manages to get inside. I’ve either got a lot of things in my hands from a shopping trip or I’m cooking and rushing back to the stove from the fridge with stuff. These are usually rare (I don’t cook or shop very often!) but it does happen and in seconds the lower layer of the fridge is on the floor and he’s sitting there with a wicked smile having proven Einstein wrong!

Maxim #3 is therefore really simple – just keep trying. Stop worrying about how well you’re doing or wasting time trying to figure out the perfect strategy –  in an uncertain world where you are handicapped by being a startup trying repeatedly is a much better approach to success. And for a startup a single act of success is often all that’s necessary to survive for a bit longer.

Are you / have you worked in a startup while bringing up a baby … did you learn anything valuable? Don’t be shy to share your experiences in the comments section below.

[This is Week 2 of participating in Lean Startup Challenge Boston 2013 and I’m beginning to see Lean Startup Lessons everywhere!. You can read about my Week 1 experience here.]

How to Measure Your Metabolic Health (with some help from Apple)

From the poll I ran last week it looks like people really want to understand their “metabolic health” Below are the first set of wireframes that show you how the app could look.

So what is Metabolic Health?

In simple terms its the efficiency with which your body is able to supply the necessary fuel for your energy needs.


MetabolicFitness_UI_v9_ActivityProfile_Update MetabolicFitness_UI_v9_7Low metabolic health puts you at increased risk for heart disease or diabetes. High metabolic health has a protective effect that to some extent can compensate for higher body weight.

The screen on the left shows you the 5 different levels of Metabolic Health – the lower your level, the higher your risk of getting diabetes or heart disease.

How will the app measure my Metabolic Health?

The first step is to enter a few basic details (height, weight, etc.). Next the app runs an analysis of your last week’s activity with the help of the iPhone 5s’ motion sensor to calculate your metabolic profile. (The middle screen shows your activity profile including how intensely you are moving).

This is based on pretty cool work done by NASA & UMass – we’ve modified this to accept the kind of data that the iPhone can provide. Accuracy is about 82% compared to going to a lab – which is useful if you’re trying to get a broad sense of where you stand and want to have a tool that can help you assess if you’re making improvements.

You can also see how active you’ve been versus clinical guidelines & use that as a tool to drive your metabolic health higher (screen on the right). Interestingly, increasing intensity of your activity is likely to have a bigger impact on your metabolic health than increasing the amount of time you spend being active.

Love to hear your comments / thoughts / suggestions below on what you personally find useful and how we could improve this app.

Want to be the first to test it or download it ? Sign up below :

[This is Week 2 of my involvement in the Lean Startup Challenge, Boston – applying lean principles to health technology product development You can read about my Week 1 experience here].

Lean Startup Challenge Boston 2013!

Hurrah! We got accepted into the Lean Startup Challenge Boston as one of ~25 teams selected to participate in the contest. The goal of the Lean Startup Movement is to help you quickly & cost-effectively identify your ‘Minimum Viable Product’ through repeated hypothesis testing until you’re reached the point where you know your idea is actually going to work!



Last Friday was the kick-off at the Boston Globe HQ and we had a great crowd. As a Rochester based startup I find its really helpful to get out & meet people whenever you can in Boston and other cities – gives you a broader perspective. Also given our relationship with UMass Amherst and other emerging partnerships in the Boston area, we’ve begun to feel part of the Boston community & there’s no better place to incubate a health tech startup.

Within a few minutes of arriving there we were all busy being fed and getting to know the other teams. Admit I don’t remember every startup but some ideas stood out – particularly those from teams I had the chance to meet.

Artistbomb : which is trying to make it easier for event locations to host a band Smart360Biz : which is trying to improve organizational efficiency

Runparty : helping runners real-time sync music with their friends

We finished the evening with a 60-second pitch including one I did for Revvo (yes that’s the name of the startup I’m working on!) – exercise therapy for diabetes patients that could potentially help stop or reverse the progression of the condition.

The next couple of days were busy with grounding in the foundations of the lean startup idea – useful even for someone who had read Eric Ries’ book on the topic and applied it to product development in a big healthcare organisation.

I’ve shared a couple of the presentations here and here. In fact what I personally found most useful (& practical to boot) was the 1-page Lean Canvas that you can use to define your idea across a number of dimensions. Its simple, easy to do & really a living / working document that you can share with others in your startup + potentially use for investor discussions etc.


So over the next few weeks I’m hoping to use the lean startup challenge as an opportunity to test if we can actually find a group of people who have lower than average levels of metabolic health, who are concerned about their metabolic health and are willing to take action to address that. I’m going to test this via an iphone app (the iPhone 5s’ new M7 co-processor creates the capability to actually measure metabolic health simply & easily).

Last week’s poll was a great starting point (thanks to all of you who participated) – to my slight (but pleasant) surprise – out of the app ideas listed, people were in fact most interested in measuring their metabolic health (45% picked this as their top idea) – so at least we have a strong foundation to build on.

Next step is to get a bit more granular on what kind of info (within the constraints of an iPhone screen size & measurement capability) is going to be most relevant & interesting – so you should shortly see a few draft wireframes on this blog! Look out for that and don’t forget to give me your feedback.

Cool Ideas to Leverage the iPhone’s New M7 Processor

20130910_134447-L1-580x326Apple launched the iPhone 5s earlier this week and one of the interesting new capabilities it revealed was the M7 chip that continuously tracks data from the accelerometer, gyroscope and compass. All 3 sensors have been previously available but until now could not be run in the background (something I would have really liked to have had 3 years ago when I buit Fitaide which used the accelerometer).

There’s already been speculation on the potential impact this could have on wearables like Fitbit & Nike Fuelband, which pretty much offer the same benefit today in a dedicated device. On the plus side this could also end up helping wearables by giving them a user base to upgrade from a ‘lite’ experience, so its not a surprise that Nike was amongst the first to launch an app, called Nike+ Moves.

The core technology however has many potential applications and got me thinking about doing an experimental app that could demonstrate some cool new features. Here are a few ideas, pick the one you would personally like to use. Also let me know, via comments or other means, any other suggestions you have.

UPDATE (09/25) : The poll is now closed, thanks to everyone who participated. You can see the results below. And now comes the fun stuff … we’re going to build out an app that will have the top 2 features that won in the poll. Look out for the wireframes in the blog post below!


3 Predictions for the Future of Medicine (Part 1)

Given the dramatic decline in R&D productivity (70% according to one analysis), and the spiraling costs of healthcare globally, the first question to ask is does medical innovation have a future ?

The simple answer is YES – global disease burden continues to grow at a dramatic pace. But the nature of disease has shifted – from infectious to lifestyle diseases, even in poor & middle-income countries. According to the WHO, non-communicable diseases, already the leading cause of death globally, are expected to account for 74% of deaths by 2030 with cardiovascular disease being the leading culprit. This change in the nature of disease is fundamentally changing the practice of medicine.

The current healthcare system arose in an era where infectious diseases were paramount & therefore was designed to be transactional – if you have a problem go to the doctor, get medicine (hopefully take medicine), solve problem and perhaps see the doctor again for a final check-up. If you have a serious problem, repeat the same process but now in a hospital setting. But this system of medicine struggles to cope with lifestyle diseases which are often chronic & require continuous care.

Drug therapy also reflects an infectious disease origin – in simple terms find the bug and kill it or improve the body’s resistance mechanism. With chronic disease however, where the root cause is often behavioral – not biological – its not a surprise that this approach fails to solve the issue. And perhaps explains why it is increasingly difficult to create drugs that offer significant benefit over the previous generation, while the burden of disease continues to grow unabated.

So given this context, how is the medicine of tomorrow going to be different from the medicine of today? In 3 important ways:

1/ The Future of Medicine is Networked

Highly specialized centers of excellence will reach out into the community to deliver care, often virtually.

2/ The Future of Medicine is Digital

Pretty soon your doctor will be prescribing a piece of software instead of a chemical or biological entity.

3/ The Future of Medicine is Frugal

The massive growth in disease burden in emerging markets combined with the growth of digital health is going to call for and result in frugal solutions.

Part 1 of this series explores the first of these predictions in greater detail.

1 / The Future of Medicine is Networked

The essential change in the healthcare system will be moving from a physical / single point of care to multiple care providers connected together, often virtually. We are already seeing significant consolidation in the American healthcare landscape – according to Accenture the number of independent primary care practices has dropped from 57% in 2000 to 39% in 2012 – driven by rising costs and increased documentation needs.

Hospital systems are also consolidating at a rapid pace. As the NYT recently pointed out, hospitals across the nation are being swept up in the biggest wave of mergers since the 1990s. The same article carries a prediction from Booz & Company, that 1,000 of the nation’s roughly 5,000 hospitals could seek out mergers in the next five to seven years. The Affordable Care Act is cited as a big cause … but also the rise in overall costs of healthcare.

Patients’ needs however haven’t changed – they still want high quality, cost-effective care that is convenient. So its not a surprise that many have rushed to fill this emerging void – from Walgreen’s Minute Clinics to Walmart’s Solo Health kiosks as well as phone based systems such as Aetna’s Teladoc. Many, if not most, of these emerging primary care options are connected to a local or regional healthcare system.

Parallel to this is the rising trend of super-specialized centers of excellence building links into the community to deliver their care. Joslin, one of the nation’s top diabetes centers with an excellent track record of research & innovation in the space, is expanding its affiliate program. Mayo Clinic, a top ranking institution, is rolling out a Mayo Clinic Care Network, and so is Cleveland Clinic in cardiovascular care. Affiliates are typically offered direct access to often world renowned researchers and physicians as well as the latest thinking on best in class care in that space.

Legacy EMR and Health IT systems will be under pressure to support this change (meaningful use provisions of the Affordable Care Act are slowly nudging them here). This change has created opportunities for targeted solutions, for example :

1/ Provider to provider connectivity : e.g. SupervisionMD which enables portable telepresence in medical situations

2/ Patient to provider connectivity : Welldoc a smartphone based technology that is targeting disease management, Glooko a seemingly simple piece of hardware that makes it easy for doctors to read data from the plethora of glucose meters in the market and  which is using big data to help providers (& patients) gain insight.

Yet, despite these promising ideas, the current reality is that of a healthcare system changing faster than technology has been able to support – creating huge opportunity for technology that can seamlessly bring together different stakeholders (often with different sets of incentives) into one care solution that effectively addresses a patient’s needs.

Do you agree with the above 3 … what would you predict for medicine? Comment below and stay tuned for a discussion on the next 2 predictions.