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Introduction: The Tale of Two Shoulders
1. UNC Gillings School of Global Public Health. Only 12 percent of American adults are metabolically healthy, Carolina study finds. UNC-Chapel Hill, November 28, 2018. https://www.unc.edu/posts/2018/11/28/only-12-percent-of-american-adults-are-metabolically-healthy-carolina-study-finds/
2. Greg Glassman first introduced this concept as a continuum of sickness, wellness, and fitness. See "What Is Fitness?" in the October 2002 CrossFit Journal: https://library.crossfit.com/free/pdf/CFJ-trial.pdf
3. Downey, C., Kelly, M., & Quinlan, J. F. (2019). Changing trends in the mortality rate at 1-year post hip fracture: a systematic review. World Journal of Orthopedics, 10(3), 166-175. https://doi.org/10.5312/wjo.v10.i3.166
4. Panula, J., Pihlajamaki, H., Mattila, V. M., Jaatinen, P., Vahlberg, T., Aarnio, P., & Kivela, S. L. (2011). Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskeletal Disorders, 12, 105. https://doi.org/10.1186/1471-2474-12-105
5. Davis, M. A., Onega, T., Weeks, W. B., & Lurie, J. D. (2012). Where the United States spends its spine dollars: expenditures on different ambulatory services for the management of back and neck conditions. Spine, 37(19), 1693-1701. https://doi.org/10.1097/BRS.0b013e3182541f45
6. Boutari, C., & Mantzoros, C. S. (2022). A 2022 update on the epidemiology of obesity and a call to action. Metabolism: Clinical and Experimental, 133, 155217. https://doi.org/10.1016/j.metabol.2022.155217
7. Feng, S., Xie, K., Zhang, Y., Yang, X., Guo, Y., & Xu, D. (2025). The relationship between skeletal muscle mass and cognitive impairment in older adults: a longitudinal study based on CLHLS. Frontiers in Public Health, 13, 1571510. https://doi.org/10.3389/fpubh.2025.1571510
8. de la Monte, S. M., & Wands, J. R. (2008). Alzheimer's disease is type 3 diabetes: evidence reviewed. Journal of Diabetes Science and Technology, 2(6), 1101-1113. https://doi.org/10.1177/193229680800200619
Chapter 2: Pain and the Metabolic Connection
9. Smart, K. M. (2023). The biopsychosocial model of pain in physiotherapy: past, present and future. Physical Therapy Reviews, 28(2), 61-70. https://doi.org/10.1080/10833196.2023.2177792
10. Latremoliere, A., & Woolf, C. J. (2009). Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), 895-926. https://doi.org/10.1016/j.jpain.2009.06.012
11. Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390. https://doi.org/10.2519/jospt.2017.7137
12. Messier, S. P., Gutekunst, D. J., Davis, C., & DeVita, P. (2005). Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis and Rheumatism, 52(7), 2026-2032. https://doi.org/10.1002/art.21139
13. Waddell, G., et al. (1997). Systematic reviews of bed rest and advice to stay active for acute low back pain. British Journal of General Practice, 47(423), 647-652.
14. Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology, 36(4), 811-816. https://doi.org/10.3174/ajnr.A4173
15. Waddell, G., Feder, G., & Lewis, M. (1997). Systematic reviews of bed rest and advice to stay active for acute low back pain. British Journal of General Practice, 47(423), 647-652.
Chapter 3: Your Power: Cellular Health and Energy
16. Storoschuk, K. L., Moran-MacDonald, A., Gibala, M. J., & Gurd, B. J. (2025). Much ado about Zone 2: a narrative review assessing the efficacy of Zone 2 training for improving mitochondrial capacity and cardiorespiratory fitness in the general population. Sports Medicine, 55(7), 1611-1624. https://doi.org/10.1007/s40279-025-02261-y
Chapter 4: Your Foundation: Muscles and Bone Density
17. Harvard Health Publishing. (2023, February 14). Age and muscle loss. https://www.health.harvard.edu/exercise-and-fitness/age-and-muscle-loss
18. Beckwee, D., Delaere, A., Aelbrecht, S., Baert, V., Beaudart, C., Bruyere, O., de Saint-Hubert, M., & Bautmans, I. (2019). Exercise interventions for the prevention and treatment of sarcopenia: a systematic umbrella review. The Journal of Nutrition, Health & Aging, 23(6), 494-502. https://doi.org/10.1007/s12603-019-1196-8
19. Srikanthan, P., & Karlamangla, A. S. (2014). Muscle mass index as a predictor of longevity in older adults. The American Journal of Medicine, 127(6), 547-553. https://doi.org/10.1016/j.amjmed.2014.02.007
20. Buckles, S. (2024, December 11). The global divide between longer life and good health. Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/the-global-divide-between-longer-life-and-good-health/
21. Simmons, B. B., & Liantonio, J. J. (2013, May). NSAIDs and the geriatric patient: a cautionary tale. Consultant360. https://www.consultant360.com/articles/nsaids-and-geriatric-patient-cautionary-tale
22. Starrett, K. (n.d.). Trigger warning: you've got to stop icing; a conversation with Gary Reinl. The Ready State. https://thereadystate.com/blogs/trigger-warning-youve-got-to-stop-icing/
23. Reid, R. (2025, August 28). R.I.C.E. is outdated: why ice delays healing and what to do instead. MoveU. https://moveu.com/blogs/news/r-i-c-e-outdated-why-ice-delays-healing-what-to-do-instead
24. Courties, A., Gualillo, O., Berenbaum, F., & Sellam, J. (2015). Metabolic stress-induced joint inflammation and osteoarthritis. Osteoarthritis and Cartilage, 23(11), 1955-1965. https://doi.org/10.1016/j.joca.2015.05.016
Chapter 5: Your Foundation: Muscles and Bone Density
25. Teraguchi, M., Yoshimura, N., Hashizume, H., et al. (2016). Metabolic syndrome components are associated with intervertebral disc degeneration: the Wakayama Spine Study. PLoS One, 11(2), e0147565. https://doi.org/10.1371/journal.pone.0147565
Chapter 6: The Spine
25. Teraguchi, M., Yoshimura, N., Hashizume, H., et al. (2016). Metabolic syndrome components are associated with intervertebral disc degeneration: the Wakayama Spine Study. PLoS One, 11(2), e0147565. https://doi.org/10.1371/journal.pone.0147565
Chapter 7: Establishing Your Baseline
26. Vaishya, R., Misra, A., Vaish, A., Ursino, N., & D'Ambrosi, R. (2024). Hand grip strength as a proposed new vital sign of health: a narrative review of evidences. Journal of Health, Population and Nutrition, 43(1), 7. https://doi.org/10.1186/s41043-024-00500-y
Chapter 8: Track Your Progress
27. Centers for Disease Control and Prevention. Prediabetes statistics. https://www.cdc.gov/diabetes/communication-resources/prediabetes-statistics.html
Chapter 9: Building Blocks: Eat Better
28. Buchanan, L., et al. (2025, February 14). Toward, a metabolic health intervention, demonstrates robust 1-year weight loss and cost-savings through deprescription. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1548609
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29. CrossFit, LLC. (2020). Level 1 Training Guide. https://library.crossfit.com/free/pdf/CFJ_English_Level1_TrainingGuide.pdf
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30. Johnson, D., & Kim, J. (2023). The simplicity of lower back pain. Journal of Orthopaedic Research and Therapy, 8.
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31. Glassman, G. (2002-2020). The CrossFit Level 1 Training Guide. CrossFit, LLC.
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32. Gibala, M. J., et al. (2012). Physiological adaptations to low-volume, high-intensity interval training in health and disease. The Journal of Physiology, 590(5), 1077-1084. https://doi.org/10.1113/jphysiol.2011.224725
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33. Altulea, A., Rutten, M. G. S., Verdijk, L. B., & Demaria, M. (2025). Sport and longevity: an observational study of international athletes. GeroScience, 47(2), 1397-1409. https://doi.org/10.1007/s11357-024-01307-9
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34. Faigenbaum, A. D. (2000). Strength training for children and adolescents. Clinics in Sports Medicine, 19(4), 593-619. https://doi.org/10.1016/s0278-5919(05)70228-3. See also Myer, G. D., et al. (2013). How young is "too young" to start training? ACSM's Health & Fitness Journal, 17(5), 14-23. https://doi.org/10.1249/FIT.0b013e3182a06c59
Chapter 12: Building Blocks: Recovery as You Train
35. Huang, T. (2025, August 15). Sleep irregularity, circadian disruption, and cardiometabolic disease risk. Circulation Research, 137(5), 709-726. https://doi.org/10.1161/circresaha.125.325613
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36. Zhang, Y., Chen, C., Lu, L., Knutson, K. L., Carnethon, M. R., Fly, A. D., Luo, J., Haas, D. M., Shikany, J. M., & Kahe, K. (2022). Association of magnesium intake with sleep duration and sleep quality: findings from the CARDIA study. Sleep, 45(4), zsab276. https://doi.org/10.1093/sleep/zsab276
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37. de Menezes-Junior, L. A. A., Sabiao, T. D. S., Carraro, J. C. C., Machado-Coelho, G. L. L., & Meireles, A. L. (2025). The role of sunlight in sleep regulation: analysis of morning, evening and late exposure. BMC Public Health, 25(1), 3362. https://doi.org/10.1186/s12889-025-24618-8
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38. Palomar-Cros, A., Srour, B., Andreeva, V. A., Fezeu, L. K., Bellicha, A., Kesse-Guyot, E., Hercberg, S., Romaguera, D., Kogevinas, M., & Touvier, M. (2023). Associations of meal timing, number of eating occasions and night-time fasting duration with incidence of type 2 diabetes in the NutriNet-Sante cohort. International Journal of Epidemiology, 52(5), 1486-1497. https://doi.org/10.1093/ije/dyad081
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39. Merz, B. (2015, February 25). Sauna use linked to longer life, fewer fatal heart problems. Harvard Health. https://www.health.harvard.edu/blog/sauna-use-linked-longer-life-fewer-fatal-heart-problems-201502257755
40. Anderson, B. O., et al. Health and cancer risks associated with low levels of alcohol consumption. The Lancet Public Health, 8(1), e6-e7.