Strava for Health

Absolutely. I guess we can start when I was at university. That's where I met Ayyoub, my co-founder. We connected around this shared passion for optimising our health — we trained in the gym together, and we started diving deeper into the whole space, trying every single wearable, reading the papers, reading all the books on optimising health and longevity. Over all those years we kind of knew we wanted to build a company together, and obviously we wanted to build it in this space, because we were spending all our time thinking about these topics.

When the time came, we actually started working on a slightly different project. We were exploring everything related to digital therapies for pre-diabetes. There are a lot of them in the US doing great work, helping people with pre-diabetes reverse the condition and get back to a healthy metabolism, but there was no significant solution in Europe at that time. While we were exploring that, we started seeing a lot of people with diabetes wearing continuous glucose monitors. We're both very curious, and we always love experimenting with these wearables, so we decided to give it a try and see what came out of those devices.

We both discovered that our glucose control was very poor. The diet we were eating really wasn't adapted to our individual metabolism — we had very high glucose levels on a daily basis. At first we were shocked; we didn't expect to see that. It was a real wake-up call. And we felt we needed to enable more people to access this kind of data, so they could understand how the food they eat is impacting their health and metabolism. So we built our first solution around that specific idea: giving people the data and helping them understand it.

After a few months, we felt there was potentially something even better to be built. Data is very helpful and it helps a lot of people understand what's happening — but there's also a psychological dimension. Data works very well for a specific group of people: athletes, biohackers, optimisers. But to reach a more mainstream audience, which was always our goal, you need something on top of that. And an app that was extremely interesting for us to study was Strava — the vertical social network for running, cycling and so on. We felt that the social dimension on a specific vertical was an extremely compelling strategy. So we decided to pivot a little out of the CGM world and build what we now call the Strava for Health. That's how we got to where we are today.

A hundred percent. I really believe data is extremely helpful, but I think it's quite wrong to think that only giving people data will necessarily improve a situation. Let me give you a couple of examples, from my own experience and from the hundreds of people we've talked to.

Very often the information you get from these wearables isn't good news. You might have metrics you need to improve, or metrics that are simply bad — poor sleep, poor glucose control. These things are part of life; for most people, you'll find something that isn't great. And that can easily create anxiety around the simple act of checking the metrics. You see a lot of people who don't want to check their sleep tracking when they know they didn't sleep well, or their glucose when they know they didn't do something positive for their metabolism. So there's a huge psychological dimension, and we think about it a lot when building the product, because right now it's a bit ignored in this space. I think that's a mistake, because you see it repeatedly. You see the same thing with weight tracking — a lot of people want to weigh themselves, but stepping on the scale every day is a stressful moment.

There are solutions on the product side. For example, only giving a seven-day trend — blurring the day-to-day variance and giving people an overall direction rather than raw numbers that are extremely anxiety-inducing. So that's something we think about a lot. There's no precise answer; it's more about acknowledging that this is a huge problem and keeping it in mind whenever we have a product dilemma.

Absolutely, that's one of the biggest challenges. We all have these goals of being healthy and staying engaged with them long term, but there are holiday weeks and different problems that come in and out of life. The key is to enable different things in the app — a lot of social features, a community, and features that aren't only performance-oriented. When everything is performance and perfection — you always want the green score, you always want to do better than last time — it works very well at first, but as soon as you fall out of it, you fear coming back.

The way to overcome that comes down to how you design things: what pop-up messages do you show? Is it "you've done something very bad", or is it something encouraging — for example, resurfacing the fact that 90-plus percent of people also have bad weeks or bad days? Really helping people understand that one week, or even one month, of something less than optimal isn't a big deal in the grand scheme of things. The big deal is: am I going to stick to something that's, say, 80% optimal for twenty, thirty, fifty years? Not did I get a perfect score for a week.

A hundred percent agree. And this idea — maybe it wasn't formulated exactly like that in our minds — is one of the key reasons we wanted to pivot to a more social product. We're all social creatures and we all crave some immediate gratification; it's why so many people spend so much time on social media. I don't think we should see it as either good or bad — it just is. It can be leveraged in a bad way in some products, and in a good way in others.

When you think about biohackers, athletes, Ironman people — they have amazing performances and they're performance-driven. If you build a product with those people in mind, you might end up with something that doesn't work for the mainstream, because getting an Ironman guy to improve his performance by 10% is not the same as onboarding someone who has weight to lose and hasn't exercised in years. So I really believe in building a social app. You'll have many different communities, but the mechanism is the same: helping each other reach goals. The goals can be very small — walk 2,000 steps a day. But the mechanism is always about pushing and congratulating something positive, rather than telling someone, "oh, you have such a catastrophic metric." Even if it's true — they might have very poor metrics — if you log in and see everything in red, you see you're in the worst 1% of everything, you're not going to come back to that app. I speak from my own experience: I've tracked metrics that were very poor, and I just stopped tracking them after a while, because having a daily message that something is bad isn't productive. Yes, it's bad, you shouldn't hide it or forget it at all costs — but I believe data should be leveraged in the background. The front end, the contact with the person, needs to do far more in terms of psychology, to keep someone engaged for the very long term.

Many different things. You definitely have a little competition — again, neutral in itself, can be leveraged positively or negatively. It's very natural for people to want to do better when it's visible. Just the fact that something is visible pushes a lot of people to go the extra mile: "I'm in this group with my family — maybe I can go for a quick walk. We have this challenge, we're all in it together, it's visible, there's no way to lie about it." A lot of people find that very helpful as a nudge.

Then there's the fact that once people get interested in something, they love to talk about it. That's why you see so many of these communities pop up in external places, talking about health and performance. One of our ideas is to bring all those conversations onto Vital, where they'd be natively integrated with all the sources of data — so the conversation can happen in a more relevant way than when it's outside and it's hard to explain what you're even talking about.

And finally — why is it that when you open the app stores and look at the top 20 apps over the last five or ten years, you have social apps, some games, and occasionally a finance app? Because these are part of how we humans are. It's very rare, when people have five or ten minutes to kill, for them to open something other than a social app; we want to see what other people are doing. Health is something so many people say they want to improve, but there isn't currently a place where health is fun — where it's not only metrics and blog articles. Our idea is to make the whole process social and fun, somewhere people can spend time, and the byproduct is that they take care of their health and stay engaged in a long-term pursuit of optimisation.

Excellent question. You basically named the main metrics, and most of them have a specific use depending on your goals, your situation and your health status. If I had to point to the most important, I'd say HRV, glucose, and maybe sleep duration.

We can deep-dive on sleep tracking and its accuracy, but with those three: the trend of HRV helps you understand how recovered you are. Glucose I find very interesting specifically over four to six weeks, to understand how your usual diet is impacting your levels. In my case, I learned I was eating way too many carbs for my individual needs — I was constantly higher than I needed to be. I made the change I thought would work better, and I significantly improved my results. And sleep — I definitely think it's good to try to get enough. Tracking can have a detrimental effect, but for the most part it's positive: it makes you think about it. You go, "I should sleep now, because yesterday I only got five hours." It forces you to notice if something isn't trending in the right direction. It's not done perfectly right now, but directionally the data will be very helpful.

Here again I have a very strong opinion, and I fully agree with you. I never care whether I had bad sleep or good sleep. I wake up, I go train, I work — it doesn't change anything. I use it for longer-term trends. Obviously, if I feel exhausted, the sleep score in that case is genuinely catastrophic — not in the 50s or 60s, depending on the app.

This can be vastly improved by product decisions. How about, when you wake up, you don't see anything before you enter how you feel, or rate your recovery? Or you have an option so you don't see the score in the morning at all — you only see it in a weekly report, to understand how your recent habits are affecting your sleep. Because focusing too much on a single metric creates the problem you named. Wearables are relatively new. Who's to say that a 50 or 60% recovery isn't sometimes what leads to your best days? On a personal level, I've noticed I sometimes perform way better in the gym with average recovery, and a lot of people have experienced the same. It's very tempting to say "this metric should be trending there, and if it's low today you should perform worse today" — but I think that jump might not be true. It's way more complicated than that. So directionally this tracking will be helpful, but not necessarily the way it's currently implemented in the most popular apps. Personally, I care about recovery more on a monthly level than a daily one.

Well, that's the trillion-dollar question. I'll go back to some of what we mentioned, approached slightly differently. The general idea is that knowing what to do has nothing to do with getting people to actually do it. Knowledge is the main focus of science and a lot of recent technological effort — and that's great, it's an important part of progress. But as we see, it doesn't push people to do what they need to do. So the whole point is: how do we bring the long-term outcome into the short term?

You see a similar situation with saving money. Finance apps have a bit of a head start here — a lot of them try to push people to save, to not spend now and build up money for the future. For health it's similar. You can see your overall health score — granted it's calculated in a smart way — but the moment you reap the rewards is twenty, thirty, forty years away. So it's really about having short-term dopamine and a feel-good moment attached to things that will be helpful long term. That's the reason we didn't want to be a data-only solution. We want to be a social app that provides people with dopamine, granted they do things that are good for the long term.

The idea is to create a platform where doing healthy things is rewarded by the community, creating an ever-growing group of people helping themselves stick to those habits and getting the reward in the present as well as the long term. Leveraging the fact that we're social animals will end up being very beneficial. You see it already: the apps that have a community at the centre — same for weight loss, weight-loss groups where people share their progress — are the ones that outperform. The ingredients are fairly simple; the execution isn't. But it's all about bringing some celebration of the future into the present.

I know what you mean — excellent question. On a personal level, I agree with the article's conclusion. But I can also see the other side. Take a wearable: it helps you develop an understanding of your body and good habits around that understanding, and that might be enough for a lot of people. But for some people, the continuous tracking is what helps them stick to the habit they created. When you wear a continuous glucose monitor, many times you don't want to eat that donut — you know what it'll do, you don't want to see the spike. If you're disciplined enough that you'll actually look at the reading rather than skip it, that might stop you eating the donut on another day. So it works differently for different people, but for the vast majority it's fair to say there won't be a need to wear it all the time.

And in terms of the business case, I think it's still very positive for these companies, because we're only in the early days. Even the most popular wearable company has only sold a few million devices — Oura just sold one million rings. That's a lot, but there are almost 7.5 billion people on earth, so there are still a lot of rings to sell. Even if people use it for just a few years or a few months, the use case can be positive for them. I agree it's hard to imagine everyone using these devices and subscribing forever. That's exactly why we're building Vital the way we are. We know that even we, personally, use these tools on and off. What we don't do on and off is being engaged in this long-term pursuit of health. So we're trying to be the place where those conversations and self-experiments happen — whether you're tracking sleep or glucose, or just want to be in a challenge with your family or friends. We want the app to stay in your life for the very long term. And overall, pretty much all of these approaches will find a fair amount of success, because we're still so far from the mainstream really being involved in their health.

I think the assessment is correct. You named some of the best companies in the space — I'm a big fan and admirer of them. A lot of people want to take care of their health, but for a long time it was a bit boring, not so cool, not aspirational — not something you wanted to be in the conversation about. The first generation of wearables did an amazing job of gathering the right people to talk on behalf of the whole space, and marketing did a big part of the job too, because now it's cool to take care of your health.

I think that's great. Obviously we need to make it more affordable, and we need to include everyone in this pursuit — but it has to start somewhere, and as always it starts with a specific niche of people who are super into it and help spread the word about these practices. I think we're now at a shifting moment where we're starting to enter the mainstream — not really, really mainstream, but you see these conversations in many groups of people now, even people who aren't hardcore biohackers. Over the last two years we're entering a wider and wider group of people.

In terms of tracking, I've tested pretty much everything — it's my job, so there's always the excuse of testing something "for work". The things I really stick to now: sleep tracking, which I find useful for noticing trends; HRV trends, to make sure I'm improving those metrics over a long enough period; and my steps — the OG metric. Simple step tracking I honestly find very useful. I'm a big proponent of walking. I'm lucky to live in a very walkable city, so I try to hit at least 15,000 steps a day. It's quite an amount, but it helps me think better and digest better; for me it solves 99% of problems. I also like to keep my calorie expenditure high — I have quite a huge appetite, so it's essential that I exercise enough.

One thing that's also very helpful is finding a physical activity you deeply enjoy and try to get better at. Maybe it's not for everyone, but it's a great way to unplug from work and building a company. It's fun, you find a community around the practice, and you try to improve — and, like all these pursuits, it's a slow process; you have to learn to accept that. For me it's been weight training, strength training specifically. I really enjoy it, and it helps me with everything else in my life — and it's excellent for longevity to maintain enough muscle mass and strength.

Finally: don't obsess. This goes back to the flip side of tracking. It's very easy to become obsessed with these metrics. Part of that comes from the products, but part of the responsibility is on the user. The goal is to optimise our healthspan — to live as long and as healthily as possible — not to obsess over the fact that we might have some poor metrics. In most cases things are reversible, and even when they're not, they're manageable. Adopting the mindset of not being overly obsessed is really helpful.

I'd say playing the long game — which is why I named the newsletter The Long Game. Right now, society as a whole is really obsessed with the short term. We constantly see people's massive success on Instagram and other platforms, and I think it's very detrimental, especially for younger people. We need to understand that getting anywhere worth celebrating is a matter of decades. It's not something you get to by working a little here and there.

The best way to do that — this sounds cheesy, but there's a lot of truth to it — is to simply learn to enjoy the process and understand it'll take a while. Find a lifestyle and a day-to-day that you enjoy and that's aligned with your long-term goals. For me that was the game changer. Obviously we have big goals at Vital, and personally, like everyone — but you still need to love your day-to-day, because that will be 99.999% of your life. It doesn't mean every day has to be perfect, but there's a way to work on your perceptions and find something that works for you, and that can be extremely game-changing. Nothing crazy — just being aligned with yourself. For me, that's the only thing that helps you keep high energy for a sustained period.

And finally: things like nutrition, exercise and sleep are the basics. Maybe I didn't talk about them as much because I've been in this niche of optimising health for seven or eight years, so those are things I fixed in the early years — but they're still the most important. All this advanced tracking might be useful in the future, but we all need to understand: if you're walking enough, getting your minutes of exercise, sleeping a fair amount and eating fairly clean, that's most of it. I know there are nutrition wars right now, so I won't get into that — but if you remove processed food, which I think everyone agrees isn't good, you'll feel very good. The rest is a mindset game.

If we can help a huge number of people really love the process of taking care of their health and find a community to do it with — whether that's a family or a community created within Vital — I'd call that a huge success. I tend not to define success by specific metrics. If you want to talk about company success you can find metrics to argue either way, but I try to be obsessed over the mission of Vital.

So many people right now die too young, or age very poorly. You see very few 18- or 19-year-olds out walking or hiking, and whenever I do, I'm very happy. I want that to be more and more common. Hopefully we'll have new therapies that help people live even longer in good health, but for the time being I think we can do far better than we do. If we could create a product that pushes a significant number of people to stay engaged in practices that are, honestly, fairly simple — and those simple practices, executed diligently, would massively improve healthspan. Data will help a lot, but there's also low-hanging fruit that could add maybe 10 or 15 years of global healthspan. Most people die from lifestyle diseases. Yes, ageing is still a big thing, and even if you removed those you wouldn't live to 200 — but I think we can get a lot of people close to 90 or even 100 in a fairly good state. At least, that's what we're going to try to create.