A woman I trained years ago, an older therapist and a practicing artist with shoulder trouble, told me one afternoon that I should be a therapist. She said I should use exercise as my modality. What she had noticed was the way I got people to talk while they moved. I knew it was true when she said it. I did not know how to make a living from it, and I was a single father of two boys.
She was describing a fact about performance that I have been circling ever since. Movement is a vehicle. It is a way into the person. The exercise was never the point, and the person on the other side of it is not an athlete in any special sense. They are someone who has to function under strain, and who is carrying more than the strain shows. This piece asks how far that idea travels: whether what I have learned from sport about regulation and recovery belongs only to sport, or to anyone who performs when it matters.
§ 1 · The operating room
Whatsoever thy hand findeth to do, do it with thy might.
At a Harvard-affiliated VA hospital, researchers once clipped sensors to a cardiac surgeon and put a near-infrared headband on her forehead to follow blood oxygenation in her prefrontal cortex. Lauren Kennedy-Metz and colleagues, in a 2020 feasibility study, found they could track her cognitive workload through live valve surgery, and that the peaks lined up with the most demanding phases of the procedure. The study showed that it could be done. It did not show that doing it improves outcomes, and the idea of game film for surgeons is still an idea.
Mihaly Csikszentmihalyi, in Flow, used surgery as one of his examples. Surgeons who loved their work, he found, described the activity itself in terms close to those athletes use: absorption, no wasted movement, the sense of the work carrying them. I recognize that from the boat. What I take from the two together is a plausible principle and not a finding. The things that help a rower reach that state, enough sleep, a settled body, a mind not braced against itself, probably matter in an operating room too.
§ 2 · The fire academy
Firefighters may feel pressure to suppress emotion in service of the job, and the cost of that is a worry in the profession. A trial now under way, known as PEER UP, is testing whether recruits who learn emotion regulation skills during the academy have fewer symptoms later. The skills are based on the Unified Protocol, a treatment developed for emotional disorders, and they are taught by peers, not by clinicians. Cohorts are randomized to that training or to peer-delivered mental health education, and the main outcome is PTSD symptoms over the first two years of service. No results have been reported, so I can tell you what it is testing and not what it found.
The design reflects an older idea from James Gross and Oliver John's work on emotion regulation: people who habitually suppress their feelings tend to report worse wellbeing than people who reappraise them, though most of that evidence comes from questionnaires. It is a useful hint about a job that rewards silence. I would not claim more for it. And on the question of whether wearable sensors might someday help flag burnout risk, I will say only that the early studies I know of are small and mixed, and none I have seen shows that sensors detect it earlier than a person can say so.
§ 3 · The classroom
Teachers are the setting I would watch most closely. Reviews of the research on teachers' emotions, such as Sutton and Wheatley's from 2003 and Mei-Lin Chang's on burnout from 2009, link how teachers manage their feelings to their wellbeing and to the climate of their classrooms. Most of that work relies on self-report and on correlation, so I can't say which way the arrows run. But the connection is plausible and it points somewhere uncomfortable. A school that cares whether children can direct their attention might begin with the adult at the front of the room.
§ 4 · Between appointments
Clinicians learn a great deal through ongoing assessment, and a good therapist sees more in an hour than a questionnaire does. What most therapists have less of is a view of how a client's body is doing between appointments: sleep, resting heart rate, the slow drift of heart rate variability. Wearable data can supply a second, partial view. Researchers are exploring whether combining sensor data with clinical assessment helps anticipate symptoms, and the results so far are early.
I would offer anything I build here as one more thing to look at. It should never be a verdict on a client. The idea I would hold on to is a simple one. A person may accurately describe how they feel while wearable data suggests strain worth discussing. Neither account automatically overrides the other, and the conversation between them is the useful part.
§ 5 · What I have not earned
The capacities seem to travel more readily than my measurements of them. How a person regulates emotion, how their body recovers, how aroused they are, and how early hardship shaped all of it are not specific to athletes, and sport is a good place to watch them because it compresses time and gives fast feedback. But I can't say that the scores I built for athletes apply unchanged to surgeons, firefighters or teachers. That is a claim about the validity of specific instruments in specific populations, and it would have to be tested in each. A psychometric battery earns that standing through studies in independent samples, and a provisional patent filing establishes a date and not validity. The way to deserve a wider audience is to do the testing before the talking.
§ 6 · What travels
If I pull back from the settings, the claim I'm left with is simple, and I'm more confident of it than of any instrument. People who perform under pressure, in a boat, an operating room, a fire tower or a classroom, run on some of the same human machinery. They seem to do better when their bodies are rested, when their feelings are named and not only suppressed, when they have someone to be steady with, and when the load matches the control they have over it. Sport is a good place to learn this because it shows its results fast. It is not the only place it applies.
The woman with the shoulder trouble was right about the thing underneath all of it. The exercise was the vehicle. What I was actually doing was talking with people while they moved, and the movement made it possible to talk. That doesn't need a score. It needs someone willing to move beside a person and listen. I would like what I build to make that easier, and never to replace it.
Sources and further reading
Kennedy-Metz, L. R., Dias, R. D., Srey, R., Rance, G. C., Furlanello, C. & Zenati, M. A. (2020). Sensors for continuous monitoring of surgeon's cognitive workload in the cardiac operating room. Sensors, 20(22), 6616.
Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New York: Harper & Row.
Peer delivered, emotion regulation-focused mental health prevention training for fire fighter trainees: design and methodology of a randomized controlled trial (2025). Contemporary Clinical Trials Communications, 47, 101537; corrigendum, 48, 101568. Trial registration NCT06290778 (PEER UP). Authors not listed here; results not yet reported.
Gross, J. J. & John, O. P. (2003). Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348 to 362. Gross, J. J. (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology, 39(3), 281 to 291.
Sutton, R. E. & Wheatley, K. F. (2003). Teachers' emotions and teaching: a review of the literature and directions for future research. Educational Psychology Review, 15(4), 327 to 358. Chang, M.-L. (2009). An appraisal perspective of teacher burnout: examining the emotional work of teachers. Educational Psychology Review, 21(3), 193 to 218.