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Movement Medicine

BY ALAN OLDHAM
VIDEO BY ADAM REIST

It is probably safe to assume that rowers, in general, know that keeping fit is an excellent way to prevent many of the chronic ill-health conditions that come along with a sedentary lifestyle. You may even have heard the saying “prevention is better than cure.”

But what if the thing that works for prevention could also be an effective cure? It turns out that physical activity—including rowing—is being used more and more, not simply as prevention, but as treatment for many chronic conditions. In some cases, it can even outperform taking a pill.

Beyond the simple message that exercise is good for you, the connections between this “movement for movement” and the sport of rowing are deep. Physician Jane Thornton, a Canadian Olympian world pairs champion, is a global leading voice in the field. We spoke to her about her own journey from elite rower into research and advocacy; how “movement as medicine” is changing the way doctors prescribe treatments; and what current and future rowers should know about the way training affects their health.


From Boat to White Coat

In hindsight, Thornton’s involvement in the world of physical activity in health care looks like a natural fit, but taking a lead on the issue both at home and internationally wasn’t exactly what Thornton had planned when she started medical school.

“Helping patients become more active was definitely an area of interest for me,” recalls Thornton. “Coming from the world of elite sport, I had expected there to be more of a focus in medicine on the health benefits of movement. I was attending one of the best medical schools in the world, yet it was never discussed in the classroom or clinical experiences I had during those four years. I came to realize this was the norm nationwide, and in many international settings as well.”

It was good timing in many ways that Thornton embarked on her medical career with a wealth of experience behind her; during her time with Canada’s national team, she had been working hard on more than just rowing. While training and racing to worlds gold in the pair in 2006 and stroking the Canadian women’s eight at the Beijing 2008 Olympics, Thornton earned a PhD in the field of sport medicine and women’s health at the University of Western Ontario.

“I knew that research on prescribing physical activity to patients was already happening internationally,” she says. “I realized early on in my training that I would have to take the initiative, so I sought out guidance from these experts and wanted to see firsthand what the best practices are around the world.”

By the time Thornton had finished medical school and started her residency in family medicine, she had trained in several different countries, from South Africa to Switzerland, alongside many of the top experts in the field of integrating physical activity into health care.

Only a few months after graduation, Thornton found herself back at her alma mater, this time delivering the medical school’s first lecture on physical activity to the next graduating class of medical students. That was six years ago.

In the time since, Thornton has sought to share what she has learned; she works with colleagues in Canada and abroad to advance research in the field. One major breakthrough came in 2016 when Thornton led the creation of international guidelines on the prescription of physical activity for chronic conditions. 

In true rowing fashion, however, Thornton is quick to acknowledge the work of others. “I have inspiring colleagues,” she says pointing in particular to Ann Gates, founder of United Kingdom-based exercise-works.org, a valuable resource for integrating health-promoting movement into people’s lives and teaching doctors how to prescribe it.

“There are big initiatives around the world to bring physical activity into the conversation about effective health care,” says Thornton. “Interest is growing among doctors and patients to seek out better and sustainable health solutions. Including physical activity is a good option and one increasingly supported by evidence.”


Movement as Prevention

While the ideas of movement as prevention and movement as cure have their roots early in human history, from ancient China to India to Greece, the so-called “walking cure” has taken a back seat in modern times to demands for state-of-the-art medications and costlier interventions. 

Yet movement is as important as ever, argues Thornton and a growing number of her colleagues.

“To start,” she points out, “there is almost worldwide consensus on physical activity guidelines, recommending that adults aged 18-64 should accumulate at least 150 minutes of moderate to vigorous intensity aerobic physical activity per week. It is also beneficial to add muscle- and bone-strengthening activities using major muscle groups at least two days a week. More physical activity provides greater health benefits.”

“The U.S. came out with updated guidelines last year,” adds Thornton. “These further emphasize that even doing five minutes of physical activity has real health benefits. They also clarify that 150 minutes of moderate activity could be replaced with 75 minutes of physical activity at a vigorous intensity.”

As a preventive measure, regular physical activity is proven to significantly cut the risk of colon cancer, depression, and dementia (by up to 30 percent); cardiovascular disease (by up to 35 percent); Type 2 diabetes (by up to 40 percent); hip fractures (by up to 68 percent); and what doctors call “all-cause mortality”—namely all conditions that result in premature death (by 30 percent).


Movement as Cure

“Traditionally, physical activity research and policy has focused on these preventative aspects of maintaining an active lifestyle,” says Thornton. “But more and more studies are looking into the benefits of physical activity as a treatment option.”

“What the research shows is that there is a benefit to physical activity in at least 30 chronic conditions,” she explains. “From anxiety and depression to arthritis and Type 2 diabetes, physical activity can be an effective treatment—even some types of cancer respond well to exercise. That number is rising as new studies investigate the role of physical activity as more than simple prevention of ill-health.”

From both a prevention and treatment standpoint, physical activity is becoming an increasingly important aspect of health care, especially in an ever-aging population—something many masters rowers in particular surely know intuitively.

“Engaging in physical activity can be especially important for older adults,” Thornton adds. “It is crucial to help prevent falls—a leading cause of injury for older adults—while helping maintain independence and reduce loneliness.”

“There is a growing movement among doctors for ‘social prescribing,’” she continues. “Doctors and other health care providers are seeing firsthand the benefits of ‘prescribing’ time spent outdoors, in nature, and with others as being integral to overall health.”

These last points are particularly significant when it comes to community-oriented sports such as rowing, where participants become members of a larger group. The strong social bonds formed through rowing—or even erging—regularly with friends provide benefits that are not only life-enhancing, but potentially life-lengthening. Add to this the part about time spent outdoors and the benefits multiply.

“What rowing adds is manifold,” says Thornton. “Teamwork is a huge benefit, from the act of carrying the boat down to the water together to trying to keep the stroke in sync. We know the perception of pain is lessened when rowers work together, and attention and focus are being trained in ever-evolving conditions from the tilt of the boat, a change in the wind, a new stroke rate or rhythm, or a call from the coxswain to direct our attention to the catches for 10 strokes.”

“The fact that you can take up the sport later in life, either for pleasure or competition, is another great aspect of rowing,” Thornton continues. “You don’t need to know what you’re doing from the age of four or five. The other part that seems intuitive to rowers, but something we teach doctors on when they are counselling, is goal-setting. Common goals are an almost daily conversation in rowing; goal-setting helps motivate participants and reduces barriers to participation.”

“Then there’s the accountability part,” adds Thornton. “You need to show up or the boat doesn’t go out. Most rowers do their training first thing in the morning. That is a generally a good strategy to fit in physical activity since for many people, by the end of a workday they have so little energy that they lose their motivation for training.”


Prescribing Physical Activity

For Thornton, a prescription for physical activity is exactly what health care providers (and patients) should be mindful of when considering treatment options. 

As for the actual dose, “it depends,” says Thornton. “Physical activity can complement—and sometimes replace— medications or medical procedures to manage a range of chronic conditions. It is not a question of pills versus exercise in all instances; it is important to look at the research and find the most effective treatment, or treatments on a case by case basis.”

To illustrate her point, Thornton uses the case of a fictitious patient named Nancy, who makes regular appearances in Thornton’s lessons on this topic to medical students.

“Nancy is 68 years old,” begins Thornton. “She’s single, she is now sedentary because her knee hurts from an old knee injury that has come back to haunt her. She used to love walking trails near her home with her dog, but she’s also worried about falling. She’s recently been diagnosed with high blood pressure. Her family history is not on her side—before they passed away, her mom had suffered from osteoporosis and a broken hip, her dad had a heart attack.”

“Embedded in this not-uncommon story are a lot of fears and common chronic conditions,” continues Thornton. “Many doctors would be most comfortable in prescribing pills or other interventions. On this visit, however, Nancy and I talk through the risks, the safety issues, the way to overcome those and build back slowly to meet the guideline levels of physical activity. We have to debunk some myths—for example, that exercise will be worse for her knee pain, or that her fall risk will increase.”

“In fact, if Nancy were to take up rowing,” adds Thornton with a smile, “that would actually ease many of these concerns.”


Informing Doctors, Empowering Patients

The push to get more doctors putting pen to prescription pad for a dose of physical activity has inspired Thornton to raise awareness and put the latest research into the hands of both doctors and patients.

Even though the practice of prescribing physical activity is not yet universal, Thornton is encouraged by what she’s seeing. 

“More and more doctors grasp its value as part of most treatment regimens,” she says. “They are understanding that physical activity can augment existing therapies and sometimes replace medication. For the patient, it is important to be able to ask about it and feel comfortable when talking with their physician and know how to find out what is safe for them given any existing conditions. It is about shared decision-making to achieve the best health outcomes.” 

“The important part about prescribing physical activity,” says Thornton, “is that once a few simple parameters are set out by the physician such as safety, intensity, and duration, it really is up to the patient to choose something enjoyable—the activity or sport that is the best fit for them. Group activities and not-for-profit sports clubs within communities are ideal points of access.”

Regardless of whether someone is engaging in physical activity to keep fit and healthy or as a treatment strategy for an existing condition, creating opportunities for people to get active in our communities is essential. This is where rowing and other sports have the opportunity to play an active role in sustaining and promoting community health, opening doors to physical activity.

“I think of examples in dragon boating where they have set up breast cancer teams to raise money and awareness,” adds Thornton. “Patients love those. You have camaraderie and solidarity as you go through an illness (and recovery) experience together. That’s huge.”

“For me, a learn-to-row class in my teens was my entry point into physical activity,” recalls Thornton of her own introduction to rowing while attending high school in Fredericton, New Brunswick. “I was terrible at other sports and physical activity wasn’t emphasized while I was growing up. I fell in love with rowing, the teamwork, being on the water; it really did change my life, my career path, and health.”

Whatever someone’s path into the sport, for most rowers, that same love of the sport is what keeps them showing up each practice. A good question, however, is whether rowing is a helpful choice when it comes to treatment of health issues and not just prevention?

“Rowing is an exceptional sport,” says Thornton. “In many ways those same things that make it good for prevention also make it a good choice of activity to use as part of the treatment of many chronic conditions. Having a conversation with your doctor is important if there is any health concern, or any new or poorly controlled medical condition. Rowing is one of the few sports that engages the entire body during physical activity; any time you can do that, there is a huge health benefit.” 

“Some of the strongest health benefits of physical activity affect the cardiovascular system,” she adds. “Rowing is an excellent way to do this. It has sweeping effects, including on oxygen utilization, the health of blood vessels, effects on blood pressure, and it strengthens the heart muscle and its ability to pump.”

“That said, I would advise people to check with their doctor if they have any symptoms during exercises like chest pain, pain in the neck, jaw, and arms, shortness of breath at rest or mild exertion, dizziness or fainting, heart palpitations, a racing heart or unusual fatigue.”

“Rowing may be something that has to be introduced gradually for some,” says Thornton. “The important thing for anyone, whether using physical activity as prevention or treatment, is to get moving in a safe way. The majority of health benefits can be derived simply by putting on a pair of shoes and going for a brisk walk or run.”

The financial burden of taking up an organized activity like rowing is another concern, especially for socio-economically marginalized populations, but Thornton sees this as an opportunity for clubs to get creative.

“When I teach doctors about physical activity,” she says, “I emphasize social determinants of health and the need for doctors to avoid prescribing expensive treatments, especially when they’re no more effective,” she says. “This is one potential barrier to participation in the spot of rowing for those who can’t afford it.”

“Good practices might include a sliding scale of membership fees based on income,” she suggests. “Trying to provide some opportunities that are free or very low cost can also encourage participation by exposing new people to the sport. Being creative is important and can really help engage the larger community and be a positive influencer on community health.”


Pushing the Limits

Taken as a whole, the pace of change in our understanding of what movement can do is staggering.

“For many years there was a belief that exercise is bad for joints,” says Thornton. “The thinking was ‘the more you do, the worse they get.’ Researchers are turning that idea on its head; it seems that even though the joint surfaces of elite athletes look worse on imaging, in fact that has nothing to do with pain or function.”

“Mental health is another fast-evolving field,” she points out. “For those with mental health conditions, engaging in physical activity has been shown to decrease symptoms such as fatigue, pain, low mood, anxiety, bipolar disorder, and schizophrenia. It improves self-esteem and also sleep quality, which has a direct impact on reducing symptoms.”

“There is so much we still don’t know about the limits of what the human body can do and the full extent of what movement does to the human body.”

While all on its own, physical activity cannot cure every condition, it is likely the closest thing to a cure-all we have. As research keeps pushing the boundaries of what we think movement can do, a prescription for physical activity might just become one of the most potent doses of medicine your doctor can provide.

In a sport like rowing, those out there pulling on an oar or erg handle are already setting themselves up for a healthier, longer life. But, as Thornton points out, being a late-entry sport and one that provides a community of support to its members, rowing is an ideal way for anyone to engage in physical activity, even for the first time in their lives.

“Physical activity isn’t just for people who are already fit and work out every day,” stresses Thornton. “Taking up moderate to vigorous exercise at any age can have significant benefits for your physical and mental health. Rowing is an excellent sport for this.”

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