After her experiences, Jacalyn Robert-McComb has dedicated her life to helping others through physical activity.
As a young woman, Jacalyn Robert-McComb was on a dangerous trajectory. She had symptoms suggesting an eating disorder, but not many people really talked about eating disorders 50 years ago. She could have had undiagnosed mental illness, she said, but such disorders are frequently accompanied by anxiety and depression, which are much easier to diagnose and treat. For her, the pendulum swung back and forth between anorexia nervosa and bulimia nervosa.
"I had the more easily diagnosed disorder, depression," she said. "Being a perfectionist or growing up as a first child in a family where you think they're placing demands on you, which is usually not true, can lead to high levels of anxiety if you think you may not be able to live up to those demands.
"Eating disorders are closet disorders; no one wants to admit they are in the terrible cycle of eating and purging, especially someone who has achieved so much. I just couldn't overcome the recurring cycle of binging and purging. I couldn't make myself stop the bulimia patterns, which is just a terrible feeling, a feeling of helplessness and hopelessness."
She admits she hit rock bottom – then came a turning point.
"I was sitting in a class in college, and they started talking about exercise," she remembers. "I don't know exactly what they said, but I started running every day, and I started getting healthier and stronger. I realized that I started feeling better when I started exercising, and exercise actually helped me with the bulimia symptoms.
"It was a pivotal point in who I am today, because that's what helped me survive."
It's not exactly accurate to say Robert-McComb discovered exercise in college – after all, she was an athlete for much of her life. As a child, she even wanted to host a TV fitness show, like the popular Jack LaLanne or Debbie Drake.
Growing up in Cape Girardeau, Missouri, her extended family spent nearly every summer weekend at the lake. She had always been a gifted skier and took ballet classes. In college at Southeast Missouri State University, she was a long-distance runner and a gymnast – as she points out, all sports in which leanness is considered advantageous.
But because physical education (PE) was frowned upon as a career field, she chose to study nursing in college.
"I really didn't like nursing," she admitted, "but no one wanted to go into PE because people thought you weren't smart if you were in PE, so I avoided it."
After deciding she couldn't commit her life to a field she didn't like, she dropped out of the nursing program and graduated with a bachelor's degree in general studies in 1977. She was left with the question of what to do with her life.
Robert-McComb grew up with the images from Cypress Gardens, a theme park in Florida known for its water ski shows and opulent gardens. The filming site for multiple movies and TV specials in the 1950s and '60s, it was made more famous by visiting celebrities like Elvis Presley, King Hussein of Jordan and Johnny Carson. Cypress Gardens became known as the "Water Ski Capital of the World" because many of the sport's landmark firsts – and the breaking of more than 50 world records – happened there.
"They had pictures of women on the water skis, sitting on top of men's shoulders, and there were flowers all over their heads," Robert-McComb remembered. "I just said, 'I want to do that,' so I pursued it."
The first time she auditioned, she wasn't selected. After taking additional ballet classes, she tried again. On her second audition, she made it.
"It was a pretty big deal to be selected as a skier there," she said. "I competed in water-skiing and barefooting tournaments. Most of the women there didn't have periods because we were all really thin, and we had to be thin because we would do four-level pyramids. It was kind of considered normal not to have a menstrual cycle."
As much as she enjoyed her job at Cypress Gardens, Robert-McComb eventually began to ask herself what her next step should be. She decided to go back to school to teach PE.
"Of course, I never did teach it," she laughed.
She earned her bachelor's degree in physical education from Florida Southern University in 1982, her master's degree in teaching physical education from Southeast Missouri State in 1984 and her doctorate in exercise science from the University of Mississippi in 1989. Along the way, she personally discovered what many others already knew, the concept of exercise as medicine.
"I'm certified by the American College of Sports Medicine as a clinical exercise physiologist," she said. "We prescribe exercise as a pharmaceutical, so to speak. I really believe that exercise is medicine; the change that exercise has on the body is amazing."
Within academia, Robert-McComb became interested in researching a phenomenon with which she had personal experience: disruption in the female menstrual cycle. These disruptions – specifically infrequent, irregular or a total lack of menstrual periods – originally were believed to be a direct result of exercising.
"Newer research, when I was coming up the ranks, suggested it was really all about energy availability," Robert-McComb said. "It's not the exercise itself that causes the disruption of the menstrual cycle, but it's not taking in enough calories to meet those exercise demands."
Anne B. Loucks, one of the most renowned scientists in the field of energy availability, found that luteinizing hormone (LH), which triggers ovulation, was disrupted when individuals consumed too few calories – somewhere in the ballpark of 30 kilocalories per kilogram of fat-free mass – per day. Below that threshold, menstruation stops.
"We are created for survival," Robert-McComb explained. "Your body basically says, 'You're not going to have a baby, because if you're not even feeding me enough to survive, how are you going to feed that baby?'"
She notes that many women who don't have periods are in sports where thinness is an advantage for them, but the fact that they don't take in enough calories doesn't necessarily mean they have eating disorders.
"If you're thinner, you have less weight to carry around or you look nicer on the balance beam," she said. "There may be disordered eating associated with it and there may not be, because it's also thought whenever you're just really fatigued, you don't feel like eating."
A question of stress
To determine what angle to pursue in her own research, Robert-McComb traveled to Loucks' laboratory at Ohio State University. Loucks told her that one of the biggest remaining questions was how stress affects the female menstrual cycle.
As someone with higher-than-normal levels of anxiety, it seemed like the perfect angle for Robert-McComb. She began a series of studies to determine the biological response to stress. Another researcher, Reid Norman, had been doing similar research on primates called macaques at the Texas Tech University Health Sciences Center (TTUHSC).
"He had found that when these macaques were restrained – they weren't hurt, they just sat in a cage, but they couldn't move their arms up and down, and, in essence, they felt like they lost control – there was a disruption in LH," Robert-McComb said. "So our first study examined women with menstrual patterns termed oligomenorrheic. Menses usually occurs every 21 to 35 days. The diagnosis changes to oligomenorrhea after more than 90 days without a period. So we compared the group of women with oligomenorrhea to women who had healthy, normal menstrual cycles, termed eumenorrhea. We exposed both groups to a 60-minute psychological stressor to see if there was a difference in LH pulsatility between the two groups."
They predicted the stressor would have a greater effect on the oligomenorrheic group's LH pulsatility pattern. That, they reasoned, would indicate LH pulsatility was interrupted in the brain, at the level of the hypothalamus.
"However, in our laboratory, we found that we really could not elicit a stressor strong enough to cause disruption," Robert-McComb said. "We knew it did happen in real-life situations, like in times of war, but we couldn't stimulate that response."
Robert-McComb's next idea was to see what type of interventions could augment or decrease a stress response.
"We didn't use stress just from a psychological perspective, using a survey; we measured a physiological response to a stressor," she said. "We measured cortisol every 10 minutes, beginning with a 20-minute baseline, a 20-minute stressor and a 40-minute recovery period, because many times the peak in cortisol is after the stressor. We found out that we could alter the stress response for individuals who went through a mindfulness walking program, but we needed a larger result."
While Robert-McComb admits there's nothing she likes to do more than exercise, exercising for stress relief can become complicated because exercising increases cortisol, the body's main stress hormone.
"It's a treacherous slope, so to speak, because exercise is, in itself, a stressor," she explained.
Exercise and stress
In collaboration with then-master's student Kembra Albracht-Schulte, a thesis project was modeled after a 2013 study published in the journal Medicine and Science in Sports and Exercise. In the original study, the participants were exposed to images from the International Affective Picture System – a database that provides a standardized set of pictures for psychological research on emotion and attention – designed to elicit a stress response. After a 20-minute baseline measurement came 20 minutes of exercise – half the participants rode a stationary bicycle and half simply sat on the bicycle seat as the control group – followed by a 20-minute exposure to a stressor and a 20-minute recovery period.
"They found that those participants who rode the bicycle had a lower perception of stress, as evaluated by Spielberger's State Anxiety Test, following exposure to the stressor," Robert-McComb said. "So we thought, let's do it with yoga instead of cycling."
Albracht-Schulte and Robert-McComb used the same protocol, with a few exceptions. They collected more physiological data, and they tested only women in a certain phase of their menstrual cycles, since menses has been shown to affect the stress response. Each participant served as their own control, counterbalancing sessions of yoga or sitting on the mat quietly for the same length of time.
"We found some interesting results," Robert-McComb said. "Both had an effect on the stress response, and just sitting on the mat was probably more effective than the yoga."
Their findings supported the previously known "Time-Out Hypothesis," the idea that time away from a source of stress is effective in reducing state anxiety.
Robert-McComb, Albracht-Schulte and colleague Joaquin Gonzales had planned to replicate the study this fall, substituting high-intensity interval training on a spin bike instead of yoga, but COVID-19 has changed their immediate plans.
"Because I'm a person who has high anxiety naturally, exercising and going to daily
Mass, or meditating, are some of the best things I can do to decrease my levels of
anxiety," Robert-McComb said. "So throughout my research career, I have been examining
the stress response and evaluating the effectiveness of interventions that help
people deal with anxiety and showing that from a data standpoint."
Helping people deal with their anxiety and stress may be even more important now, due to the coronavirus pandemic, but while increasing levels of anxiety, it also has limited the opportunities for Robert-McComb to interact with those who need help.
"Until COVID-19, I taught yoga and water exercise at Covenant Hospital," she said. "It is an older population, and the exercise and social aspects are so important to them."
In her faculty role, she relishes the opportunities to interact with students and researchers in whom she can see glimpses of her younger self. While it can be difficult sometimes to share the details of her personal journey, she has found it often helps others to share theirs as well.
"At my stage in my life, I find pleasure out of helping people, especially young female scientists and students who experience anxiety and stress – and admit it," she said. "I'd say 95% of students feel stress, especially in today's time. If I am open about my own experiences that are similar to the experiences a student is feeling, they feel much more comfortable talking about it with me."