Medical Director Message November 2022

Mark Cominsky, Paramedic

Health - November 7, 2022

Mark Cominsky is an EMS coordinator for the UH Elyria

Good morning,

If I gave you the winning lottery numbers, what would you do? What would be going through your mind? Would it be what to buy? Would you feel your financial future is set?

We all know that you need a certain amount of money to cover your future financial needs for retirement. One way we prepare is by investing in retirement and other deferred compensation programs. Sometimes a pension or just showing up to work is not enough to cover all costs. What if I told you to look into the future, but this time for your health and fitness? Some of us may look at our parents and think their condition is what is destined for us. Can you see your future retired life? We see different potential versions of our future almost every day – at work, talking to patients, and with our own families. Every time we get dispatched to an elderly patient unable to get up, too weak to stand, or recently suffered a stroke or heart attack, all possible futures for each of us. I encourage you to ask yourself each time, “knowing what you know now, would you do anything different in your life?”

We’ve seen our future. And I want everyone to enjoy their retirement and not spend their savings on medical costs that could have been prevented or, at the very least, decreased. You prepare financially by using deferred compensation programs and maybe even putting some additional money aside. Some people put 20 dollars a check away, and others make the maximum sacrifice possible. I am looking for the same sacrifice in fitness, to contribute to your own future. It doesn’t have to be hours; it can be something as little as 15 minutes 6 days a week – the same length as a coffee break or a phone conversation. And it’s still an investment for your future. 

It’s not easy. It’s easier to start, like a New Year’s resolution. The hard part is maintaining it. We may not see the changes we want as fast as we would like to see them. Remember that this is an investment, and investments take time to see a return. I’ve heard that “comparison is the thief of joy.” Remember that you are doing it for yourself. Don’t let someone else steal the joy that you’re working towards. 

For me, I find joy that I am doing this for me so I can enjoy my vacations when I retire, play with my grandkids, or just being active.  


Mark Cominsky

EMS Coordinator

Exercise - November 14, 2022

Good morning,

Do you exercise? Do you exercise intensely?

In just a few weeks (seven weeks, to be exact), we’ll all be setting New Year’s Resolutions. A common resolution every year is to exercise more. How do you know how much to exercise? A quick Google search will say that one should exercise at a moderate intensity of 150 minutes per week or 75 minutes of vigorous activity at the same time. If you want to lose weight, you must double those amounts. While those numbers are clear, what’s not clear is what “intensity” means and how you can gauge intensity minutes.

The most accepted definition has been around since 1970. You take the number 220 and subtract your age, and that’s your maximum heart rate or a heart rate you shouldn’t reach. Once you’ve found your maximum heart rate, multiply it by 50 – 70% to achieve a moderate intensity, and 71-85% to reach a vigorous activity level. 

As a novice or just starting out, this is a great formula to get you moving. However, as you progress and set fitness goals, you might wonder if there are better ways to assess your intensity levels. There are signs of this everywhere: treadmills, ellipticals, stationary bikes, or any exercise machine. Each requests weight and other personal metric input to find your MET (metabolic equivalent of task). A MET is an energy requirement for basal homeostasis or a state of balance among all the body systems needed for the body to survive and function correctly. 1 MET equates to 1 calorie for every weight in kilograms (165 lb. / 2.2 = 75 kg). A 165-pound person would need 75 calories an hour to sleep to maintain basal metabolism, or the number of calories you burn as your body performs basic (basal) life-sustaining function.  There is also a math aspect to the formula. 

Intensity level using METs is defined as 3 – 6 METs for moderate intensity and greater than 6 METs for vigorous activity level. The easiest method to figure out METs/calories burned is to put in your weight on the treadmill; if you do not, it could be calculating fewer calories that you are burning for that workout.

To make this more tactical, let’s take a specific example: someone runs a 10-minute mile (6mph) on a level, flat surface. A 200- pound person would burn 156 calories, and a 150-pound person would burn 117 calories at this pace. To determine the METs used:

From this example, you can see that it is important to put your weight in the machine to accurately understand the intensity level you are exercising. The same formula can be used from your smartwatch if you choose.

It will help in achieving your fitness goals of 150 minutes of moderate (3 – 6 METs) or 75 vigorous (> 6 METs) intensity for the week. 

Thanks for your time and interest. Until next week,

Mark Cominsky

EMS Coordinator

Routine - November 21, 2022

Good morning,

How long does it take to form a habit?

The standard and most accepted answer is roughly three weeks. Though, that norm is more of a myth than a fact. In a book by Dr. Maxwell Waltz in 1960, he stated: “these, and many other commonly observed phenomena, tend to show that it requires a minimum of about 21 days for an old mental image to dissolve and a new one to gel.” Gel is the keyword here, meaning a habit has not formed. 

A study published in the European Journal of Social Psychology in 2009 states that it takes 18 to 254 days for a person to form a new habit. On average, the study concluded it takes 66 days for a behavior to become automatic. And even then, it depends on the actual habit one is trying to form. I feel that fitness will probably take longer to become automatic behavior. If you Google fitness challenges, you’ll typically find an achievable goal: for example, do 100 pushups every day for a month, row 2000 meters every day for two weeks, etc. However, the catch here is they limit the activity to a fixed time. Once that goal/challenge is over, it’s possible that a habit still has not formed or become automatic.

The challenge I propose is to do at least 15 minutes of vigorous activity (greater than 6 METs), 6 days a week for 1 year. It will equate to 90 minutes a week of vigorous intensity level to meet the American Heart Association recommendation for physical activity. No more, just 15 minutes, you can increase intensity, but the time minimum stays the same. The goal here is to form a habit, to form a behavior that becomes automatic, something where you’ll feel upset if you did not do it for that day. Do it until you want to do it.

To help, below is a list of simple exercises that vary in intensity level and circuit training in style. Most people have access to some type of aerobic machine, treadmill, rower, bike, or elliptical. To get to at least 6 METs (Metabolic Equivalents of Task), use the average weight of men and women to calibrate the list below. Using a treadmill and open floor space, here is an example circuit to hit 15 minutes of vigorous activity -

This workout is estimated at 15 minutes and will achieve a MET level between 6 – 8 METs, meeting your 15 minutes of vigorous intensity level. You can change any exercise to accommodate the equipment made available to you. Switch it up and have fun with it. If you want to increase the MET level, increase the speed/incline on the treadmill; you should be out of breath. 

Challenge yourself to a habit. 

Mark Cominsky

EMS Coordinator

Metabolism - November 28, 2022

Good morning,

As November comes to a close (and perhaps thankfully my fitness challenges), I want to take some time for us to review and understand METs, and more specifically, how you may see them in our day-to-day activities. MET stands for Metabolic Equivalent of Task, or, in layman's terms, the amount of energy needed to perform a task. Everything we do requires energy and can be defined in a MET. When you sleep, your body requires minimal energy, which equates to 1 MET. Most people do not see things or activities we do in METs, but often in the number of calories it burns. A lot of people count calories and in doing so are also using METs. To better relate these things together, you need to determine your weight in kilograms (kg). To calculate this, you take your weight in pounds (lbs) and divide it by 2.2 to get your weight in kilograms (kg). For example, a 220 lb person is a 100 kilogram (kg) individual because 220 divided by 2.2 equals 100.

How can I relate calories to METs? Let’s take a look at an easy example: sleep. When you are sleeping, you burn 1 calorie for every kilogram you have in weight, which is equivalent to 1 MET. For example, a 100-kilogram person would burn 100 calories every hour while sleeping. Remember, my challenge to you this month was to exercise a minimum of 150 minutes of moderate exercise (3 – 6 METs) or 75 minutes of vigorous (>6 METs) a week. The frequency was over 6 days with one day of rest. I proposed 15 minutes on 6 days of vigorous activity for one year until a habit is formed, which is achievable. If you do not think this is enough, you will be surprised by some of the daily activities we perform that are at a vigorous category.

It is often suggested that being active keeps you young, so behold a list of daily things we do that we consider routine, but really could be keeping us young and moderate to vigorous METs: 

The above is just a short list and probably answers those times when you wonder why you hate to help people with moving or roofing. Maintaining that activity for such a long day is why you are exhausted when you are done, but it keeps you young and active into your maturing age.

In addition, with a firefighter readership, I thought I would add some basic firefighting METs:

Thank you all for reading about fitness these last few weeks. I will leave with only one thing: a reminder of my original challenge for 15 minutes of vigorous activity, 6 days a week--and until it’s a habit you don’t want to break it. Happy Holidays all. Feel free to reach out to me with any questions. 

Mark Cominsky

EMS Coordinator