Q&A With Rosemary Agostini, MD
By Virginia Smyth
Dr. Rosemary Agostini, medical chief for Activity, Sports, and Exercise Medicine, discusses her mission to help patients keep moving.
You recently started the Activity, Sports, and Exercise Medicine Department — the first of its kind in the nation. What's the main goal?
Sports medicine on its own seems very elitist — as if it's just for athletes. And it does often focus on orthopedics. In this new department, we work with everyone — from the very young to the very old, and people at all stages of their fitness journey. We want to focus on helping people get active and stay active.
Why is that?
All research is demonstrating that activity and exercise, and participating in sports, is part of being healthy and preventing and treating disease. If you have cardiovascular disease, you will benefit from a walking program; if you are depressed or anxious, activity and exercise can help. Across your lifespan and with different diseases, exercise makes a difference. It's not just about sports.
What type of patients should use this resource?
Whether the patient has an injury, or a different health issue, it should be related to activity, sports, or exercise. And people must have an interest in participating in their care. A patient might be someone with a knee injury who wants to start a walking program, or a high school athlete with a concussion. In the future, we hope to have the capacity to help facilitate exercise programs.
You're trained as a sports medicine primary care physician. What does that mean?
It means I have a fellowship in sports medicine — as do other physicians who are part of this new department. It means we view sports medicine with a holistic approach. We're going to look at all of you, not just at your injury. We're also going to ask you about the intensity, frequency, and duration of your exercise. And what surface you train on. We're going to ask about what you are doing at work and in your everyday life, and what your fitness goals are.
I've often heard you say that you will work with patients wherever they're at. What do you mean by that?
This is really about the art of medicine. It means working with the sullen high school football player who doesn't use more than two words to communicate, or helping someone with chronic pain learn to start moving, or advising someone else on which pair of walking shoes to buy. Small changes can make a big difference.
Is there anyone who shouldn't exercise or be active?
There's always an exception, but it's rare. Even if you have multiple health conditions, exercise should be an essential part of your treatment program and a component to helping you be functional in life.
How can someone tell if they're pushing themselves too hard?
Being sore is OK. Having pain during activity, sports, or exercise usually isn't. The exception is people with chronic pain — sometimes they need to just keep going. But otherwise, if something hurts when you exercise, you may need to learn to stop and get evaluated, and get treated. You need to be respectful of your body. I tell patients, "Our bodies are pretty smart — they tell us when we have pain; our brains are not so smart — they don't listen." No pain, no gain is incorrect.
Why is it necessary to check with your doctor before starting an exercise program?
People don't always exercise in the way they should. Sometimes they lack knowledge — they don’t know how much to exercise, or they don't know about equipment that is helpful. Sometimes there are cultural barriers. Or they may worry about safety — whether it's OK to walk in their neighborhood, for instance. We can help patients work through these barriers.
How do you work with patients who have an injury and keep exercising, even if it makes their injury worse?
Often these patients aren't listening to their body. I will discuss with them how they can get "active rest." That means helping them understand what they can still do, even with their injury. For example, if they are a runner and have injured their ankle, they may still be able to run in water, or go cycling, or use an elliptical trainer. I also want to share with them the tools they need to have fewer injuries.
You look pretty fit. What do you enjoy doing?
I competed in gymnastics and track and field in high school. I've been a downhill skier and a hiker all my life. I participate in exercise classes. This year I started working out one day a week with a trainer. We all can use a little help.