Ask anyone who exercises regularly whether it has any impact on their mood or cognition and almost all will say yes. But ask a scientist or physician to explain why this is, and you may get a lot of hand waving, stammering and medical jargon. When I tell people that my research interest is in how exercise impacts cognitive function and recovery in people with brain injuries, I get one of two responses. Some (usually people who themselves exercise regularly) are incredulous that medical science has not yet covered this ground. Others (typically non-exercisers) view this as an impossible-to-prove, unscientific waste of time. And herein lies part of the problem.
At least when it comes to the cardiovascular and systemic health benefits of exercise, the evidence is very clear. Large-scale epidemiological studies involving tens of thousands of people show that those who engage in moderate-to-intense physical exercise on a regular basis decrease their mortality from all causes (1), decrease cardiovascular morbidity (1), improve blood sugar control (2), improve bone density (3), suffer from less breast and colon cancer (4), experience less depression (5) and have better weight management (6, 7) than those who do not. Based on a wealth of medical research, the American College of Sports Medicine and the American Heart Association therefore recommend that all adults aged 18-65 engage in 30 minutes of moderate-intense aerobic (endurance) physical activity per day at least 5 days per week (8).
Evidence for exercise’s effect on the brain is also growing rapidly. In the time since I first became interested in this subject, the number of published studies has mushroomed from just a handful to literally hundreds. A few stand out as especially good. Two large observational studies [one from the Journal of the American Medical Association (9) and one from the New England Journal of Medicine (10)] showed a decreased incidence of cognitive decline in individuals who participate in physically and cognitively stimulating activities later in life. In 2008, an Australian group took things one step further, conducting a 6-month exercise intervention involving 170 people over 50 years of age who had complained of memory problems (11). Participants were randomly assigned either to a group that exercised 3x/week for 50 minute per day, or to one that received educational material about memory loss, nutrition, stress management and alcohol/smoking cessation. At the end of the study, those in the exercise group made modest gains on specific memory tasks, where those who did not exercise got worse over the same period of time. One year later, this trend persisted.
Within the last few months, a series of studies have been published that both observationally and experimentally connect exercise more tightly to brain health. In the January 2010 issue of the Archives of Internal Medicine, a group of German researchers reported following nearly 4000 elderly people over two years, and found that those who exercised three or more times per week had lower rates of cognitive decline than those who exercised less (12). In the Archives of Neurology, also January 2010, a relatively small (33 people), randomized controlled trial from Seattle subjected people with early signs of dementia to either a 6-month, monitored exercise program or a supervised stretching program of equal duration, then looked to see if there were changes to specific areas of cognitive function, as well as other factors such as hormone levels and blood sugar control. In this group, both men and women who exercised did better in an area of cognition called executive functioning; women who exercised saw more benefits to executive functioning than men who exercised (13). Finally, in an effort to clarify the temporal component of exercise and the brain, a Boston-based group published their findings from the Nurses’ Health Study, in which they showed that higher levels of physical activity in midlife were associated with less cognitive and mental health impairment among women who survived to old age (14).
In brain injury medicine, my area of clinical interest, there are a wide assortment of experimental studies looking at how exercise of different intensities and timing pre- and post-injury can impact brain recovery. In cases where strokes are experimentally simulated, those who did low-intensity cardiovascular exercise prior to the stroke had faster and more complete recoveries than those who did not (15). Furthermore, even for those who did not exercise before a stroke, low-intensity cardiovascular exercise started during the recovery and rehabilitation phase of the injury improved post-stroke recovery when compared to non-exercisers (16). Findings in experimental models of brain injury take this work one step further, showing that low intensity cardiovascular exercise in the recovery phase after brain injury is correlated with both improved performance on spatio-temporal memory tasks as well as new cell growth in specific regions of the brain. This same study showed that if the same intensity of exercise was started soon after injury, recovery was actually worse than if no exercise was done (17). Scientists are closer to understanding the molecular mechanisms behind this phenomenon, which appear to have everything to do with post-traumatic changes to energy metabolism.
While there isn’t enough data at this point in humans to establish a role for physical exercise in the brain injury recovery process, there are a few interesting and promising early findings. At the crossroads of brain injury and sports medicine is where one finds the clinical problem of sports concussions. And at this crossroads, a group of researchers in Pittsburgh made a very interesting observation. Patients in the pediatric clinic who had sustained sports concussions appeared to return more quickly to baseline on neuropsychological testing if they performed moderate, regular physical activity than if they did not exercise at all. Those who did the worst on repeat neuropsychological testing were those who returned to high-intensity physical activity and sports competition immediately after their injuries (18). Researchers studying stroke recovery conducted a a small but compelling randomized study comparing the neuropsychological outcomes of chronic stroke survivors who performed moderate-to-intense aerobic exercise three times weekly to those who partook in a stretching program for an equal amount of time. This team found that the aerobic exercisers made gains in specific areas of memory, whereas the stretching group stayed the same (19)
Researchers often lament that association is not causation. Since we do not yet know the mechanism by which exercise acts on the brain, there is legitimate debate as to whether it is really the exercise that is responsible for what we see. People who exercise are physically capable of engaging in and experiencing a more stimulus-rich life, which in turn may help preserve brain function. Additionally, better overall health may confer brain health simply by improving cerebral blood flow and glucose regulation. Finally, it is likely that the same people who exercise regularly are also more pro-active in other health-related areas of life, and may therefore be more likely to seek out things that help them maintain brain health. Simply put, are people whose personalities or character cause them to seek out things that improve brain function actually wired differently from those who do not approach life in this way, and might this actually account for what is seen in these large observational studies?
But the biggest impediment in our ability to answer this question lies in how we are asking it. Medical science cannot draw conclusions about the effects of exercise on brain function because we are stuck comparing apples to oranges. Whereas studies involving drugs or discrete, uniform interventions can be compared rather easily, the problem with studying exercise is that everyone defines it differently, and few groups ever look at the same outcomes. Is being physically active throughout the day the same as working out briefly for some set period of time? Who defines what “light”, “moderate” and “strenuous” exercise is? And does it matter when in your life you do the exercise, where you do it or what kind of activity you’re actually doing?
Studies designed to help answer these questions are underway. In the interim, I am often asked to interpret the science and make recommendations for patients and friends. For now, what we can say is that exercise decreases your chances of having heart disease, high blood pressure, diabetes, osteoporosis, depression and certain forms of cancer, and that at some as-yet unclear frequency, intensity and duration, appears to decrease the chances of cognitive decline and may even improve cognition after brain injury. Is it the cure for all that ails you, an iron-clad insurance policy against dementia, stroke or brain injury? Absolutely not. But think what might happen if everyone followed the ACSM recommendations and partook in 30 minutes of "moderate-to-intense" exercise each day? Less heart disease, less diabetes, less cancer and less depression… more people living healthier lives instead of fighting preventable illnesses… less need for expensive medical care. As we work to reform the system of health care delivery in this country, perhaps we should also reform our views of what health is, and how each of us creates and maintains it. In my opinion, one of the easiest and best first steps is to promote access not just to cures for the sick, but to activities that can help us all stay well.
If you find this blog interesting, relevant or entertaining, please forward it to other interested parties, and consider expressing your support with a donation to AccesSport America.
1. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109-16.
2. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. PMCID: 1370926.
3. Vuori IM. Health benefits of physical activity with special reference to interaction with diet. Public Health Nutr. 2001;4(2B):517-28.
4. Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and site-specific. Med Sci Sports Exerc. 2001;33(6 Suppl):S530-50; discussion S609-10.
5. Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med. 2002;32(12):741-60.
6. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-41.
7. Shaw K, Gennat H, O'Rourke P, Del Mar C. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006(4):CD003817.
8. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-34.
9. Wilson RS, Mendes De Leon CF, Barnes LL, Schneider JA, Bienias JL, Evans DA, et al. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA. 2002;287(6):742-8.
10. Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348(25):2508-16.
11. Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008;300(9):1027-37.
12. Etgen T, Sander D, Huntgeburth U, Poppert H, Forstl H, Bickel H. Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med.170(2):186-93.
13. Baker LD, Frank LL, Foster-Schubert K, Green PS, Wilkinson CW, McTiernan A, et al. Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Arch Neurol.67(1):71-9.
14. Sun Q, Townsend MK, Okereke OI, Franco OH, Hu FB, Grodstein F. Physical activity at midlife in relation to successful survival in women at age 70 years or older. Arch Intern Med.170(2):194-201.
15. Lee HH, Shin MS, Kim YS, Yang HY, Chang HK, Lee TH, et al. Early treadmill exercise decreases intrastriatal hemorrhage-induced neuronal cell death and increases cell proliferation in the dentate gyrus of streptozotocin-induced hyperglycemic rats. J Diabetes Complications. 2005;19(6):339-46.
16. Luo CX, Jiang J, Zhou QG, Zhu XJ, Wang W, Zhang ZJ, et al. Voluntary exercise-induced neurogenesis in the postischemic dentate gyrus is associated with spatial memory recovery from stroke. J Neurosci Res. 2007;85(8):1637-46.
17. Griesbach GS, Hovda DA, Molteni R, Wu A, Gomez-Pinilla F. Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function. Neuroscience. 2004;125(1):129-39.
18. Majerske CW, Mihalik JP, Ren D, Collins MW, Reddy CC, Lovell MR, et al. Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. J Athl Train. 2008;43(3):265-74. PMCID: 2386420.
19. Quaney BM, Boyd LA, McDowd JM, Zahner LH, He J, Mayo MS, et al. Aerobic exercise improves cognition and motor function poststroke. Neurorehabil Neural Repair. 2009;23(9):879-85.
Thursday, March 25, 2010
Tuesday, March 16, 2010
Two Minutes
In rowing, before the start of each race, a two-minute warning is issued. At this point all competitors are expected to lock their boats into the starting platform and prepare for the race to begin. For me, these two minutes were sometimes moments of great clarity and reflection. At other times, they were filled with feelings of impending doom, when I questioned what I was doing, whether it was all really worth it, and whether I was crazy putting myself through such anguish. Those questions never went away, but as I taught myself how to race, I slowly learned to focus my attention, even if just for a short few minutes, exclusively on the course ahead. While some say the Zen moments in high-intensity sports are the ones where competitors persist through great pain or adversity, I feel that the real moments of enlightenment come when you are cognizant of the adversity you are about to inflict upon yourself, yet deliberately and even enthusiastically move from your position of comfort to one of inevitable pain and uncertainty. Not being ready to end your quiet two minutes isn’t always a sign of fear, or even weakness. It may just be your subconscious mind’s way of telling you that it’s not completely confident you will make it out the other side. So just as the start of each rowing race is preceded by its two minute period of reflection, I think it’s fitting that the first real post to this blog reflect a bit about the events and experiences in my life that brought me to this particular starting line, and gave me my passion for AccesSport and its beneficiaries.
Sports were not always a part of my life, though they now are integral to it – socially, professionally and personally. A late-in-life athlete who was much more geek than jock, I competed in my first of two Olympics at age 27, and spent more than a decade of my life training and competing as a rower. The path by which I came to the sport was not unusual, but it was by no means the path from which a typical recruit advances to the rarefied athletic strata of the US Olympic Team. And as the girl who flunked all her PE skills tests in high school, an undiagnosed asthmatic who had not exactly lit the world on fire with performances on the two “no-cut” policy sports teams I’d graced in the past, I was probably the last person anyone would have imagined attempting, let alone succeeding via the route I took. My first exposure to rowing was as a college freshman, from the edge of Montlake Cut in Seattle. Something about watching those eight people moving and pulling in synchrony captured my imagination. Without skills, all of my earlier attempts at team sports were characterized by long periods standing, arms up or down depending on the sport, waiting for someone to pass me a ball. But because I lacked skills, understandably, this almost never happened. And because no one ever passed me the ball, I never had the chance to practice what I might do if I had the ball. So I never improved. Looking out at that boat, I thought how the best person and the worst person in it both took the same number of strokes each day, and that both therefore had a chance to become better. When I decided I wanted to row, it was because I hoped that somehow, surrounded by water and beautiful scenery, I might get the chance I was looking for to improve myself and finally be part of a team.
Groucho Marx is famous for saying that he would never want to join a club that would have him as a member. Fortunately for me, at least in the sport of rowing, this was a problem I rarely had to face. From the start, it seemed there was always some reason I just wasn’t right for the job. My college rowing team had strict height standards that I did not meet. So I did what every aspiring Olympic athlete doesn’t do: I gave up. Four years later, in the spring of my senior year, I signed up for a 5-week intramural rowing class. In wide fiberglass boats that resembled in no way that graceful eight I saw, I bobbed around Lake Washington with an art major, a mathematician and a couple of graduate students. We were all different shapes and sizes. We were slow. And we laughed a lot. I was hooked from the minute we pushed off of the dock. I spent the following year looking for a place and a group where I could continue in the sport. In Portland, Oregon, I joined the only club that returned my phone call. Since most rowers trained to compete, and races catered to either collegiate or masters’-aged (>27 years) competitors, I was stuck in a 6-year-wide no-man’s land in which I was neither old enough to row with masters nor young enough to still be in college. With no one else my age, and desperate for any opportunity to be on the water, I drove to the boathouse each morning at 5:15, hoping someone might be sick or oversleep, and that their seat might be open for the day. Over a year passed and I was becoming antsy and frustrated at my lack of opportunity, when one afternoon, a club member took me aside and offered to let me use his one-person shell. Though I felt this would take me further away from that synchronous eight I’d seen in the Cut, I saw it as the only opportunity I had to stay in a sport I had come to really enjoy. And so I reluctantly formed a team of one.
In my experience, high-level athletes come in two basic types. The first is someone for whom athletics are merely a canvas on which they display their ambition, competitive drive, discipline and persistence. For these athletes, being the best at their chosen sport is an extension of who they are; victory is mastery, defeat is incompletion. The degree to which they achieve domination in their chosen sport is directly related to the magnitude of their drive. And though their own anthropomorphic characteristics may steer them towards one sport over another, if all factors were equal, it would not matter to them whether they played basketball, lifted weights or ran marathons – the goal would remain the same. The other type of athlete is someone who may also be ambitious and driven, but the key to his or her success lies within the sport itself. “I just love to swim,” Wendy Boglioli, the 1976 US gold medal-winning swimmer, often says in her talks, describing how she got her start in the sport not in a pool, but swimming in a pond near her house in Wisconsin, with her father coaching her from a nearby rowboat. Periodically one hears a high-level athlete like Wendy attribute success in their sport to their passion for that particular sport, although this seems to be the far less common, if even accidental route to the top. In fact, more often, you hear the opposite. In his recent autobiography, tennis great Andre Agassi wrote about his near-lifetime hatred of the sport of tennis, and on how surprised he was when he revealed this secret hatred to another tennis great, only to be reassured that he was by no means alone, and that nearly everyone at the top hated their sport.
Being an athlete was never part of who I was. Not only did I not view rowing as a platform for demonstrating prowess, I did not view any sport as a platform for self-expression in this way. I was not out to prove anything; I simply loved to row. In the process of enjoying the world from the waterline, becoming aware of how my actions affected the motion of the boat and water around me, and because I learned how to affect change to that experience through my training, I became fast. A breakthrough moment came when I realized that sports were not something I was destined to always be bad at, but rather, were something at which I could improve with effort and practice, like spelling or math. As time went on, there were many workouts I would dread, but the distinction between not wanting to row and not wanting to do some particular training exercise was always clear. Even in my last year of competition, training three times daily by myself, the former rarely happened. With training, my speed and skills grew, but my size continued to be a barrier to my inclusion on many teams and training groups I aspired to join. Equally as often, it was my untraditional background, lack of formal training, age and professional ambitions that rendered me unsuitable for entry to the higher eschelons of the sport. Speed earned me the right to compete at the top, but beating others on the water proved much easier a task than gaining acceptance.
Improvements were rapid. Within two years of my first voyage in a single, I had won several National titles as a sculler. A year later, I represented the US at the World Championships for the first time. Two years after that came the Olympics. But despite all the things I learned in competition, I feel the most important lessons I learned from my experience in the sport had little to do with winning, racing or even rowing. Over the course of my career, I spent over 15,000 hours – the equivalent of a toddler’s life span – training alone, giving me ample opportunity to reflect on what I hoped ultimately to gain from my practice. I learned to focus when there was no tangible goal, or when I knew that my chances of reaching my goal were vanishingly small. I learned to find pleasure less in the outcome and more in the performance, and in the process that prepared me for that performance. Finally, I had to learn to cheer for myself, even when every voice from the sidelines was screaming for my competition. Immersed in a sport for which I was never quite right, I had to make peace and be right with myself. Though I spent most of my time as a high-level athlete being judged on my speed and size, at the end of the day, the most important lessons that sports practice taught me are ones that are relevant to anyone at any age or level. It is these lessons that I think are so critical to the athletic experience, and so important to make available to everyone.
Eventually, like many Olympic athletes, my competitive path influenced my professional one. At the time I was sure that taking a non-traditional route to the top of my sport hampered me competitively. But years later, there is no question that the skills I acquired in negotiating that route laid the groundwork for what would become my career in rehabilitation medicine and my research interest in exercise and brain recovery. During long stretches when I was without a coach, I watched videos, read books and articles and taught myself about exercise physiology and biomechanics. Without comprehensive health insurance, little injuries grew into big ones. So when physical therapy and preventive medicine were financially untenable, I read everything I could about injury prevention and sports medicine. The more I learned, the more I wanted to know, and the more interested I became in using that knowledge to help others resolve their injuries and return to doing what mattered most to them. As a physician, the more I saw the many ways in which the body could go wrong, the more grateful I was for the healthy body I was lucky enough to have.
But of all the skills I picked up along the way, the one that has the most bearing on this particular effort is that of fundraising – and the enduring impact of having to depend on private donations to reach my goals. Training unsupported by the national team, I was left with debts that the majority of my Olympic teammates never experienced. I faced a choice: give up trying, or swallow my pride and beg people for money. In the year leading up to the 2004 Olympics, I lived almost exclusively off of private donations and the generosity of others. Without prescription drug coverage, I depended on a pulmonologist in Alaska to send me boxes of samples of my asthma medication, which I rationed so they would last through important races. A sympathetic former employer donated to my cause after my training and competition demands precluded continuing in my job. Friends donated frequent flyer miles so that I could attend Olympic Trials. And when the Olympics was over, and the United States Rowing Association sent me a bill, I paid them with cash that friends, supporters and fellow rowers gave me. Though I concluded my competitive experience never really knowing what I might have accomplished if I’d been adequeately supported, there was an unexpected benefit to taking this path. As one whose competitive career was financed primarily through private donations, I will always remember how it feels to have my destiny linked directly to the generosity of individuals. Because people who knew and supported me were willing to give me the chance to realize my dream, it is now my job to pay this gift forward and help other unconventional athletes who might not otherwise have access to the equipment and opportunities they need to realize their potential.
From these experiences – personal and athletic – comes my passion for sharing sports with others, and belief in their ability to change lives in so many ways. The barriers I encountered in my sport were utterly trivial in comparison to those experienced by the athletes in AccesSport’s programs. Today I challenge you to reflect for a few minutes on what sports have brought you or someone you know. If this, or anything you’ve read here, resonates with you, please consider making a donation to AccesSport America.
Jennifer
Sports were not always a part of my life, though they now are integral to it – socially, professionally and personally. A late-in-life athlete who was much more geek than jock, I competed in my first of two Olympics at age 27, and spent more than a decade of my life training and competing as a rower. The path by which I came to the sport was not unusual, but it was by no means the path from which a typical recruit advances to the rarefied athletic strata of the US Olympic Team. And as the girl who flunked all her PE skills tests in high school, an undiagnosed asthmatic who had not exactly lit the world on fire with performances on the two “no-cut” policy sports teams I’d graced in the past, I was probably the last person anyone would have imagined attempting, let alone succeeding via the route I took. My first exposure to rowing was as a college freshman, from the edge of Montlake Cut in Seattle. Something about watching those eight people moving and pulling in synchrony captured my imagination. Without skills, all of my earlier attempts at team sports were characterized by long periods standing, arms up or down depending on the sport, waiting for someone to pass me a ball. But because I lacked skills, understandably, this almost never happened. And because no one ever passed me the ball, I never had the chance to practice what I might do if I had the ball. So I never improved. Looking out at that boat, I thought how the best person and the worst person in it both took the same number of strokes each day, and that both therefore had a chance to become better. When I decided I wanted to row, it was because I hoped that somehow, surrounded by water and beautiful scenery, I might get the chance I was looking for to improve myself and finally be part of a team.
Groucho Marx is famous for saying that he would never want to join a club that would have him as a member. Fortunately for me, at least in the sport of rowing, this was a problem I rarely had to face. From the start, it seemed there was always some reason I just wasn’t right for the job. My college rowing team had strict height standards that I did not meet. So I did what every aspiring Olympic athlete doesn’t do: I gave up. Four years later, in the spring of my senior year, I signed up for a 5-week intramural rowing class. In wide fiberglass boats that resembled in no way that graceful eight I saw, I bobbed around Lake Washington with an art major, a mathematician and a couple of graduate students. We were all different shapes and sizes. We were slow. And we laughed a lot. I was hooked from the minute we pushed off of the dock. I spent the following year looking for a place and a group where I could continue in the sport. In Portland, Oregon, I joined the only club that returned my phone call. Since most rowers trained to compete, and races catered to either collegiate or masters’-aged (>27 years) competitors, I was stuck in a 6-year-wide no-man’s land in which I was neither old enough to row with masters nor young enough to still be in college. With no one else my age, and desperate for any opportunity to be on the water, I drove to the boathouse each morning at 5:15, hoping someone might be sick or oversleep, and that their seat might be open for the day. Over a year passed and I was becoming antsy and frustrated at my lack of opportunity, when one afternoon, a club member took me aside and offered to let me use his one-person shell. Though I felt this would take me further away from that synchronous eight I’d seen in the Cut, I saw it as the only opportunity I had to stay in a sport I had come to really enjoy. And so I reluctantly formed a team of one.
In my experience, high-level athletes come in two basic types. The first is someone for whom athletics are merely a canvas on which they display their ambition, competitive drive, discipline and persistence. For these athletes, being the best at their chosen sport is an extension of who they are; victory is mastery, defeat is incompletion. The degree to which they achieve domination in their chosen sport is directly related to the magnitude of their drive. And though their own anthropomorphic characteristics may steer them towards one sport over another, if all factors were equal, it would not matter to them whether they played basketball, lifted weights or ran marathons – the goal would remain the same. The other type of athlete is someone who may also be ambitious and driven, but the key to his or her success lies within the sport itself. “I just love to swim,” Wendy Boglioli, the 1976 US gold medal-winning swimmer, often says in her talks, describing how she got her start in the sport not in a pool, but swimming in a pond near her house in Wisconsin, with her father coaching her from a nearby rowboat. Periodically one hears a high-level athlete like Wendy attribute success in their sport to their passion for that particular sport, although this seems to be the far less common, if even accidental route to the top. In fact, more often, you hear the opposite. In his recent autobiography, tennis great Andre Agassi wrote about his near-lifetime hatred of the sport of tennis, and on how surprised he was when he revealed this secret hatred to another tennis great, only to be reassured that he was by no means alone, and that nearly everyone at the top hated their sport.
Being an athlete was never part of who I was. Not only did I not view rowing as a platform for demonstrating prowess, I did not view any sport as a platform for self-expression in this way. I was not out to prove anything; I simply loved to row. In the process of enjoying the world from the waterline, becoming aware of how my actions affected the motion of the boat and water around me, and because I learned how to affect change to that experience through my training, I became fast. A breakthrough moment came when I realized that sports were not something I was destined to always be bad at, but rather, were something at which I could improve with effort and practice, like spelling or math. As time went on, there were many workouts I would dread, but the distinction between not wanting to row and not wanting to do some particular training exercise was always clear. Even in my last year of competition, training three times daily by myself, the former rarely happened. With training, my speed and skills grew, but my size continued to be a barrier to my inclusion on many teams and training groups I aspired to join. Equally as often, it was my untraditional background, lack of formal training, age and professional ambitions that rendered me unsuitable for entry to the higher eschelons of the sport. Speed earned me the right to compete at the top, but beating others on the water proved much easier a task than gaining acceptance.
Improvements were rapid. Within two years of my first voyage in a single, I had won several National titles as a sculler. A year later, I represented the US at the World Championships for the first time. Two years after that came the Olympics. But despite all the things I learned in competition, I feel the most important lessons I learned from my experience in the sport had little to do with winning, racing or even rowing. Over the course of my career, I spent over 15,000 hours – the equivalent of a toddler’s life span – training alone, giving me ample opportunity to reflect on what I hoped ultimately to gain from my practice. I learned to focus when there was no tangible goal, or when I knew that my chances of reaching my goal were vanishingly small. I learned to find pleasure less in the outcome and more in the performance, and in the process that prepared me for that performance. Finally, I had to learn to cheer for myself, even when every voice from the sidelines was screaming for my competition. Immersed in a sport for which I was never quite right, I had to make peace and be right with myself. Though I spent most of my time as a high-level athlete being judged on my speed and size, at the end of the day, the most important lessons that sports practice taught me are ones that are relevant to anyone at any age or level. It is these lessons that I think are so critical to the athletic experience, and so important to make available to everyone.
Eventually, like many Olympic athletes, my competitive path influenced my professional one. At the time I was sure that taking a non-traditional route to the top of my sport hampered me competitively. But years later, there is no question that the skills I acquired in negotiating that route laid the groundwork for what would become my career in rehabilitation medicine and my research interest in exercise and brain recovery. During long stretches when I was without a coach, I watched videos, read books and articles and taught myself about exercise physiology and biomechanics. Without comprehensive health insurance, little injuries grew into big ones. So when physical therapy and preventive medicine were financially untenable, I read everything I could about injury prevention and sports medicine. The more I learned, the more I wanted to know, and the more interested I became in using that knowledge to help others resolve their injuries and return to doing what mattered most to them. As a physician, the more I saw the many ways in which the body could go wrong, the more grateful I was for the healthy body I was lucky enough to have.
But of all the skills I picked up along the way, the one that has the most bearing on this particular effort is that of fundraising – and the enduring impact of having to depend on private donations to reach my goals. Training unsupported by the national team, I was left with debts that the majority of my Olympic teammates never experienced. I faced a choice: give up trying, or swallow my pride and beg people for money. In the year leading up to the 2004 Olympics, I lived almost exclusively off of private donations and the generosity of others. Without prescription drug coverage, I depended on a pulmonologist in Alaska to send me boxes of samples of my asthma medication, which I rationed so they would last through important races. A sympathetic former employer donated to my cause after my training and competition demands precluded continuing in my job. Friends donated frequent flyer miles so that I could attend Olympic Trials. And when the Olympics was over, and the United States Rowing Association sent me a bill, I paid them with cash that friends, supporters and fellow rowers gave me. Though I concluded my competitive experience never really knowing what I might have accomplished if I’d been adequeately supported, there was an unexpected benefit to taking this path. As one whose competitive career was financed primarily through private donations, I will always remember how it feels to have my destiny linked directly to the generosity of individuals. Because people who knew and supported me were willing to give me the chance to realize my dream, it is now my job to pay this gift forward and help other unconventional athletes who might not otherwise have access to the equipment and opportunities they need to realize their potential.
From these experiences – personal and athletic – comes my passion for sharing sports with others, and belief in their ability to change lives in so many ways. The barriers I encountered in my sport were utterly trivial in comparison to those experienced by the athletes in AccesSport’s programs. Today I challenge you to reflect for a few minutes on what sports have brought you or someone you know. If this, or anything you’ve read here, resonates with you, please consider making a donation to AccesSport America.
Jennifer
Thursday, March 11, 2010
The Starting Line
Blogs have always seemed painfully self-indulgent to me, so it is with some trepidation that I even take this on. But with a fantastic cause and a good message to convey, I hope you will forgive me long enough to give this page a read.
Though a formal introduction might be overkill, I would like to kick off with an overview of who I am and what I hope to accomplish with this blog. Many of you know me, some know only of me. If you’ve read this far, hopefully you’ve gleaned that my name is Jennifer Devine, that I am a Boston-area physician and researcher interested in brain injury rehabilitation, and that I’m a former Olympic athlete training for the 2010 Boston Marathon while fundraising for an organization near and dear to my heart – AccesSport America. AccesSport is a national group that brings opportunities for high-challenge sports to children and adults with disabilities. They dissolve barriers and provide access to sports experiences that many of us take for granted, and in the process, give athletes a chance to discover, grow and learn many of the same lessons that sports give able-bodied people of all ages every day.
This organization and its mission are important to me because they bring athletic experiences to people who might not otherwise have the chance to have them, and because they have had an enormous impact on many of my current and former patients. As a resident in rehabilitation medicine, I first met the AccesSport team on a warm October afternoon, when I accompanied a young spinal cord injured patient on a canoeing trip on the Charles River. Injured outdoors, doing a sport that he loved, he was trapped inside the hospital for most of his recovery, in a room overlooking the river. As his rehab stretched out over months, and the full impact of his injury wore slowly down on him, we all began to understand the huge role that sports had played in his pre-injury life. Each day, he seemed to lose heart that he would ever really experience the exhilaration of sports again, and as that part of his identity withered, he resembled a little less the person he was before the injury. But the minute he got into that canoe, put a paddle in his hand and felt the boat move along the water, a piece of who he used to be came back into his life. I believe that piece made a huge difference in his recovery, return home and happiness as he moved from rehabilitation to the rest of his life. I saw this happen over and over, with patients, kids and adults I met through AccesSport. Whether lifetime athletes affected by injuries or kids who’d never participated in sports before this program, all seemed to leave with a similar sense of accomplishment. Empirically, the challenge of nearly all sports is learning to perform some specific motion faster, more efficiently or with greater acuity or force than either your opponent or you have done in the past. But the real challenge in this task is believing in your mind that you are capable of doing this even before you’ve started. Whether you are a professional athlete or a newly tetraplegic teenager, this challenge is the same. The transformative power of meeting that challenge is equal opportunity. Equipment and coaches notwithstanding, this is what allows AccesSport to change lives.
My goal in creating this page is to raise at least $5000 for AccesSport America. To increase traffic to this (and thus the AccesSport) webpage, and to encourage, enhance and stimulate discussion about the role of sports and exercise in our lives, I plan to share with you a variety of entries over the next 6 weeks. By uniting my personal, professional and athletic experiences, I hope to post some unique stories and perspectives that might resonate with others and inspire people to give. Want to know what it’s like to train for and compete in a marathon while working a full-time job? Gory details to follow. Wondering how to get yourself moving, or having trouble staying motivated to continue your own exercise program? I think I can help with that. Curious what the research shows when it comes to exercise and brain function? I’ll share what I know on that subject, too.
Though my main goal is to get people to give to Team AccesSport, my secondary motives with this page are to help everyone realize the importance and value of exercise in their lives, to give those who exercise a new appreciation for the good they do their bodies and minds, and to move those who might be on the fence (for whatever reason) closer to including sports and exercise in their lives.
There are many ways to help the cause. If you read something that resonates with you, let that be motivation to donate as much as you are able to give (the link is RIGHT AT THE TOP OF THE PAGE). And if you know of others for whom a particular post might be relevant, please feel free to forward a link to this blog. If you want to take it a step further and feel comfortable posting a link to AccesSport or my blog on your own Facebook page, blog or website, please do so!! Whatever I can do to increase traffic and thus improve the chances of getting donations for this fantastic cause, the happier I will be.
Six weeks left and many miles to run. I can cover the distance alone, but I will need a lot of help if I’m to reach my goal. Please donate, and check back regularly for new posts and updates.
Thanks for reading!
Jennifer
Though a formal introduction might be overkill, I would like to kick off with an overview of who I am and what I hope to accomplish with this blog. Many of you know me, some know only of me. If you’ve read this far, hopefully you’ve gleaned that my name is Jennifer Devine, that I am a Boston-area physician and researcher interested in brain injury rehabilitation, and that I’m a former Olympic athlete training for the 2010 Boston Marathon while fundraising for an organization near and dear to my heart – AccesSport America. AccesSport is a national group that brings opportunities for high-challenge sports to children and adults with disabilities. They dissolve barriers and provide access to sports experiences that many of us take for granted, and in the process, give athletes a chance to discover, grow and learn many of the same lessons that sports give able-bodied people of all ages every day.
This organization and its mission are important to me because they bring athletic experiences to people who might not otherwise have the chance to have them, and because they have had an enormous impact on many of my current and former patients. As a resident in rehabilitation medicine, I first met the AccesSport team on a warm October afternoon, when I accompanied a young spinal cord injured patient on a canoeing trip on the Charles River. Injured outdoors, doing a sport that he loved, he was trapped inside the hospital for most of his recovery, in a room overlooking the river. As his rehab stretched out over months, and the full impact of his injury wore slowly down on him, we all began to understand the huge role that sports had played in his pre-injury life. Each day, he seemed to lose heart that he would ever really experience the exhilaration of sports again, and as that part of his identity withered, he resembled a little less the person he was before the injury. But the minute he got into that canoe, put a paddle in his hand and felt the boat move along the water, a piece of who he used to be came back into his life. I believe that piece made a huge difference in his recovery, return home and happiness as he moved from rehabilitation to the rest of his life. I saw this happen over and over, with patients, kids and adults I met through AccesSport. Whether lifetime athletes affected by injuries or kids who’d never participated in sports before this program, all seemed to leave with a similar sense of accomplishment. Empirically, the challenge of nearly all sports is learning to perform some specific motion faster, more efficiently or with greater acuity or force than either your opponent or you have done in the past. But the real challenge in this task is believing in your mind that you are capable of doing this even before you’ve started. Whether you are a professional athlete or a newly tetraplegic teenager, this challenge is the same. The transformative power of meeting that challenge is equal opportunity. Equipment and coaches notwithstanding, this is what allows AccesSport to change lives.
My goal in creating this page is to raise at least $5000 for AccesSport America. To increase traffic to this (and thus the AccesSport) webpage, and to encourage, enhance and stimulate discussion about the role of sports and exercise in our lives, I plan to share with you a variety of entries over the next 6 weeks. By uniting my personal, professional and athletic experiences, I hope to post some unique stories and perspectives that might resonate with others and inspire people to give. Want to know what it’s like to train for and compete in a marathon while working a full-time job? Gory details to follow. Wondering how to get yourself moving, or having trouble staying motivated to continue your own exercise program? I think I can help with that. Curious what the research shows when it comes to exercise and brain function? I’ll share what I know on that subject, too.
Though my main goal is to get people to give to Team AccesSport, my secondary motives with this page are to help everyone realize the importance and value of exercise in their lives, to give those who exercise a new appreciation for the good they do their bodies and minds, and to move those who might be on the fence (for whatever reason) closer to including sports and exercise in their lives.
There are many ways to help the cause. If you read something that resonates with you, let that be motivation to donate as much as you are able to give (the link is RIGHT AT THE TOP OF THE PAGE). And if you know of others for whom a particular post might be relevant, please feel free to forward a link to this blog. If you want to take it a step further and feel comfortable posting a link to AccesSport or my blog on your own Facebook page, blog or website, please do so!! Whatever I can do to increase traffic and thus improve the chances of getting donations for this fantastic cause, the happier I will be.
Six weeks left and many miles to run. I can cover the distance alone, but I will need a lot of help if I’m to reach my goal. Please donate, and check back regularly for new posts and updates.
Thanks for reading!
Jennifer
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