You may have noticed that for a blog that is called “Evidence-Based Fitness”, that there is not one single mention or reference to the “Hierarchy of Evidence” pyramid. This is entirely intentional. I can’t count the number of blog drafts that I’ve tried to write and then scrapped on how much I hated the old “hierarchy of evidence”. But this week, the Evidence-Based Medicine “pyramid” has finally been reworked. It’s not as graphically pretty. It does, however, better reflect the reality of the “this is not actually how it works” pyramid of old. The new infographic was revealed and can be found here (it’s even open access!) So what does this new infographic mean?
In a nutshell, it means there are no more simple answers and no more simple classifications. It means you can’t skip steps. It hopefully means an end to the blind application of a clearly dysfunctional classification system to interpret and compare studies to one another.
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Evidence helps me make decisions when the cost of intervention is high and immediate. Once I make the cut, I can never take it back. There are no do-overs and the damage I personally inflict on a patient is instant. Surgery is a calculated intentional harm for the chance at a net gain. This is in contrast to exercise and nutrition where change is more gradual and where the cost of intervention is perceived (rightly or wrongly) as mostly time and this vague thing we call effort. But the immediacy of time should not be overlooked as a high cost. Perhaps therein lies the rub: fitness “professionals” fail to see the costs of their own interventions; because if you could see that high cost, you would use EVERY resource available to you to make the right decision.
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