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"Good to Go" - A Book Review

What is recovery? It comes across as a vague, all-encompassing, and slightly non-specific term, at least as it pertains to exercise and other forms of physical activity. The Webster dictionary defines recovery (in this context) as, "The process of becoming healthy after illness or injury." In an athletic or exercise sense, we could go a little further and say that it's the body's way of compensating after dealing with a stressor (a single bout) and improving upon its previous levels of strength and/or conditioning; it's not just a return to the status quo. Award-winning journalist and former professional cyclist Christie Aschwanden published the best-selling book "Good to Go" in 2019, which discusses the science of recovery. The book also takes a close examination of many of the popular modalities currently being used by elite athletes and weekend warriors alike, ostensibly to promote healing and optimize performance.

Before becoming a science journalist, Aschwanden studied biology at the University of Colorado and worked as a research assistant in a lab. In addition to being a professional cyclist in the early 1990s, she has participated in a variety of other sporting endeavors at a high level, such as skiing and running, well into her 40s. I think that all of those things come through in her writing and give her a unique perspective to share. The author examines some of the practices of professional athletes such as Tampa Bay Buccaneers quarterback Tom Brady, high level triathletes, and also participates in a study with several other weekend runners to see if beer is a suitable post-run recovery drink. One theme that resonates throughout the book is the idea that whether you're talking about weekend warriors, average Joes, or elite athletes at the top of their game, everybody wants a magic bullet. People who have a competitive nature want to get an edge, whether it's real or perceived. This is why the "recovery industry" has become so lucrative, and it's the reason that people are willing to invest a significant amount of time and money in the pursuit of performance optimization.

Aschwanden examines the use of ice and cryotherapy as a recovery modality. RICE protocol (rest, ice, compression, and elevation) has been standard operating procedure in athletic and sports training since the late 1970s, and is especially popular in the treatment of injuries. The thinking is that ice slows blood flow and reduces inflammation in the injured area, in addition to relieving pain. The problem is that this may actually delay the healing process, as inflammation is a necessary component for the body to mobilize resources to repair injured tissue. As Gabe Mirkin, MD, who was once a proponent of icing but has recently reversed course, says, "Anything that reduces your immune response will also delay muscle healing. The message is that the cytokines of inflammation are blocked by icing-that's been shown in several studies." Indeed, Gary Reinl, a rehabilitation specialist who has consulted for several professional sports teams echoes Mirkin's sentiment. According to the author, Reinl believes that "...Icing merely slows blood flow to the area, it doesn't halt it indefinitely. Once the icing stops and the blood flow returns to normal, whatever process you were trying to hinder will proceed again. The swelling will continue and the inflammation will start. The only thing you did was delay things." This is a far cry from what has become the accepted mainstream viewpoint. Cryotherapy, in which the participant enters a chamber filled with refrigerated air or liquid nitrogen that can reach temperatures as low as -250℉, has also become popular of late. While many athletes swear by it, cryotherapy has not been shown to be very effective at treating the conditions for which it is being promoted. The existing studies were all of low quality and there was no convincing placebo to meet the gold standard of a randomized, double-blind study. Keep those thoughts in mind the next time you see an athlete jump into a cold tub or a cryogenic chamber after a rigorous practice.

Sports drink commercials, particularly for Gatorade, are ubiquitous during any televised sporting event. Most people are aware of how Gatorade was invented, which was during the mid-1960's at the University of Florida. It was a rather simple beverage composed of sodium, sugar, monopotassium phosphate, and water. Since the original concoction was not particularly tasty, some lemon flavoring was added. The Gator football team figured it now had a secret weapon, and they believed that consumption of the drink contributed to their 1967 Orange Bowl win over Georgia Tech. Other teams took notice, and soon thereafter Gatorade became available commercially. Gatorade was acquired by the Quaker Oats company in 1983, and then the NFL signed a deal to make it the league's official sports drink. Does that mean that Gatorade (or any of its competitors) helps to improve performance or recovery? According to Carl Heneghan of the University of Oxford's Centre for Evidence-Based Medicine, the answer is no. Heneghan says, "Worryingly, most performance tests used to assess sports drinks have never been validated." Author Aschwanden elaborates: "When Heneghan's team gathered and examined all of the available evidence on sports drinks (they even consulted sports drink manufacturers to ask them for their supporting studies, though not all complied), they found what amounted to a bunch of preliminary or inconclusive evidence packaged as more definitive proof." The so-called research being performed at the Gatorade Sports Science Institute appears to be little more than clever marketing, and can hardly be considered objective science, since the sample sizes are typically very small. It doesn't exactly make you want to "Be Like Mike", a reference to the old Michael Jordan Gatorade ad campaign of the 1990s.

Aschwanden also examines the concept of a so-called "anabolic window" that exists after exercise or sports performance, something that has become an accepted tenet in fitness lore. We often hear that following exercise there is a certain period of time when the body is most receptive to nutrients, in order to facilitate recovery and stimulate growth, and that if we miss this opportunity to replenish the resources that we have used during exercise, our progress can be negatively impacted. Does such a window exist? According to Brad Schoenfeld, the director of the Human Performance Lab at CUNY Lehman College in the Bronx, "...It's not so much an anabolic window, it's an anabolic barn door." Aschwanden continues: "As long as you eat breakfast, lunch, and dinner, it's almost impossible not to get through. The barn door doesn't slam shut 45 minutes after exercise. Instead, it stays open for four or five hours, maybe more." This means that what we've been programmed to believe is, at best, misleading, and at worst, outright false. It's important to understand how efficient the human body is at maintaining homeostasis (a state of equilibrium), and to not worry about every minute detail. Instead, the author says, "...It's important to get the big picture right."

Now that we know that several of the accepted modalities provide negligible benefit, what are some recovery strategies that do work? One thing that is proven to work, costs no money, and requires only a little effort to do correctly is to focus on getting a proper amount of sleep. This is something that I have talked about in previous blog posts, but it certainly bears repeating. Most adults require between 7 and 9 hours of sleep per night, in order to feel refreshed. Keep the temperature in the bedroom around 65℉, with dark enough curtains to block out morning light; ear plugs can block out ambient sounds that make it difficult to fall asleep. Try to establish a consistent bedtime and wake-up time, and minimize your exposure to artificial light in the 30 to 60 minutes prior to sleep. Find ways to relax when you are able. Practicing meditation regularly, or simply being mindful from time to time, can go a long way toward not only helping you sleep better, but being in a better frame of mind and less stressed. While I believe the human body was designed to move and should not be sedentary, it's very easy to overdo it with various types of activities that can tax your body's immune system. This can lead to illness, injury, and a decrease in both exercise and sports performance. Listen to your body; nobody knows it better than you do. If you start to see a dip in performance or are feeling tired or sluggish frequently, it might be time to slow things down and rest.

The placebo effect is very powerful. Even if a modality provides no real benefit, the power of the mind can make one believe it is effective. If you think a ritual or practice is doing something for you, it can provide psychological benefits and relieve anxiety. The science of recovery is inexact and still evolving, and we are learning all the time. The last point I will make is a quote from Nobel Laureate physicist Richard Feynman: "The first principle is that you must not fool yourself-and you are the easiest person to fool."

Posted September 16, 2021 by Matthew Romans