Education reviews Br J Sports Med: first published as 10.1136/bjsports-2017-098170 on 13 September 2017. Downloaded from Circulating hormones like testosterone, Fight, flight or finished: forced fitness cortisol, growth hormone, insulin-like growth factors and catecholamines are behaviours in Game of Thrones very important for responses in muscle to exercise and injury. They are a crucial Ryan E Rhodes,1,2 E Paul Zehr1,3,4,5,6,7,8 part of the stress response experienced by pretty much every character inhab- iting GRR Martin’s fantasy world. Even purpose and thrumming with the epineph- the word ‘stress’—with its Latin root Spoiler alert! This paper deals with plot rine rush of combat. ‘stringere’ meaning to draw tight, strain, points found in the GRR Martin books in That thundering of blood, racing heart exert or tax—seems to come right out of the ‘Song of Ice and Fire’ series and the rate, sweating and sense of power are the an episode of ‘Game of Thrones’. ‘Game of Thrones’ television production hallmarks of the fight or flight response— seasons 1–6. If you haven’t yet caught up the ability our nervous and hormonal (and why haven’t you?), please proceed systems have to energise us—briefly—for AWASH IN A SEA OF HORMONES… at your own risk. You have been warned! feats of courage, strength and power in Thriving and surviving in our world and the name of self-preservation. Call it the Martin’s hinge on the concept of homeo- ‘epinephrine rush’, the ‘thrill of the chase’, stasis in our physiological systems. The ‘If you know others and know yourself, it is all part of the acute stress response we concept of homeostasis relates to adaptive you will not be imperilled in a hundred have when faced with scenarios and situa- responses to change that all serve to drive battles; if you do not know others but tions that demand our complete focus and the body back to its comfortable oper- know yourself, you win one and lose one; attention. And there is no shortage of such ating range (see figure 1). These include if you do not know others and do not scenarios in Game of Thrones. responses to extreme cold, haemorrhaging know yourself, you will be imperilled in every single battle’ Both the response to fighting and the blood loss, traumatic pain and emotional ―From ‘The Art of War’ by Sun Tzu training for learning to fight rely heavily distress—basically daily life in pretty (544–496 BC)1 on the ‘fight or flight’ response. This acti- much any scene in Game of Thrones from vation of the sympathetic nervous system just about every season. ‘Storms come and go, the big fish eat the is the ability you have to respond to exer- The stress response concept is part little fish, and I keep on paddling.’ cise stresses, which is a function of the of something pioneering physiologist ―Varys ‘the Spider’ in the second season ‘Game of Thrones’ episode level of regulating hormones in your body. Hans Selye called the ‘general adaptation ‘The Night Lands’ that premiered on Your state of balance—your physiological syndrome’ and which has three stages. The 8 April 2012. homeostasis—revolves around this. first is an ‘alarm reaction’ which mimics Blood thundering in his ears, Jon Snow raises his broadsword Longclaw in a smooth arc of Valyrian steel that abruptly stops over his head only to then reverse http://bjsm.bmj.com/ course in a deadly slash downward onto the head of the Other and cleaving it in two. All his senses blazing with clarity, the bastard son of the late Eddard Stark, now himself leader of Castle Black, turns to face his next adversary full of power and 1Department of Exercise Science, Physical and Health on October 1, 2021 by guest. Protected copyright. Education, University of Victoria, Victoria, British Columbia, Canada 2Behavioural Medicine Laboratory, University of Victoria, Victoria, British Columbia, Canada 3Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada 4Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada 5Island Medical Program, University of Victoria, Victoria, British Columbia, Canada 6Centre for Biomedical Research, British Columbia, University of Victoria, Victoria, British Columbia, Canada 7Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Victoria, British Columbia, Canada 8Department of Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada Correspondence to Dr E Paul Zehr, University of Victoria, Centre for Biomedical Research,Victoria, V8P 5C2, British Columbia, Canada; pzehr@ uvic. ca Figure 1 Regulating bodily balance at King’s Landing. 576 Rhodes RE, Zehr EP. Br J Sports Med May 2019 Vol 53 No 9 Education reviews Br J Sports Med: first published as 10.1136/bjsports-2017-098170 on 13 September 2017. Downloaded from Figure 2 Some characters who show adaptability to fight (or not so much) to the finish. the ‘fight or flight’ response. The second either spell continued existence or certain Jaime Lannister, eldest son of Lord stage is one where adaptation occurs, and death in Game of Thrones. George R R Tywin, the powerful Lord of Casterly Rock there is an adjustment and resistance to the Martin’s world is a brutal survival of the and patriarch to the House Lannister, is stressor so that the effect of the stressor is fittest landscape, where characters have to generally considered the best swordsman reduced. If adaptation is insufficient or if possess keen senses or they are dispatched and one of the bravest men in the Seven the stressor is too large, we enter the third to their deaths. Those characters who Kingdoms. Due to these skills, he became stage which is one of exhaustion and cell adapt can thrive, but those who fail to the youngest member of the Kingsguard in death. adapt are finished. history. While his martial prowess has kept A lot of how the bodies of the charac- Of course, like any theatre of war and him alive in many battles throughout West- ters in Martins’ Game of Thrones respond politics, victory requires good luck and the eros, his murder of the Mad King Aerys to daily exercise stress, stress response and support of background teammates. It also branded him the notorious Kingslayer. various hormones. Tiny formations at the does not hurt to be on the winning side This has served to further fuel his lethal or base of your brain called the pituitary and of magical forces in the Seven Kingdoms treacherous reputation depending on how the pineal gland are important in all this. or across the seas in Essos, Qarth and one views the act. http://bjsm.bmj.com/ So is testosterone and is likely one of the Dothrak. Nevertheless, many of the very Gregor Clegane is the elder brother of hormones that you think of immediately. best and most decisive moments in Game Sandor Clegane (the Hound) and a landed Testosterone is a very important medi- of Thrones come down to individual char- knight who serves Lord Tywin Lannister ator for how the body responds and adapts acter actions that follow fight, flight or on retainer. He is considered the largest to exercise stress, and levels of circulating finished consequences. While Game of man in Westeros and called ‘the Moun- testosterone are elevated during and Thrones features a vast number of these tain’ based on his enormous bulk and after exercise. As with growth hormone, through its pages and on screen, below height. This size is also complemented on October 1, 2021 by guest. Protected copyright. the effects are largest with more stren- we highlight exemplars of each (see by a ferocity and savagery that has made uous and prolonged exercise. Central in figure 1 and 2). him the most feared individual in the all of this are the catecholamines—those Seven Kingdoms. Gregor is suspected (and substances like epinephrine—that give us observed) in several murders and torture such a rush and the power to perform in Fight throughout the Westerlands. In combat, fight or flight. They also have the power Physical ability and fighting prowess are his strength gives him a huge advantage to make us want more and more of them generally essential characteristics for over almost any opponent, able to over- in our bodies. survival in the ever warring Seven King- power his enemies with brute force rather doms of Westeros and beyond. While than rely on his skill. The combination of FIGHT, Flight or FINISHED AS IT Varys ‘The Spider’ and Petyr ‘Littlefinger’ these battle tactics and his fearsome repu- APPLIES TO SOME ‘GAME OF THRONES’ Baelish do show that there are other ways tation has allowed him to ‘survive’ thus far CHARacTERS to survive in this world with almost no in Game of Thrones. While the fight or flight response physical ability, skill in combat is a massive Brienne of Tarth begins the Game of describes the energy systems provided by advantage to survival. Three characters Thrones series as a Kingsguard of Renly our nervous and hormone systems, we epitomise the use of fighting skills as a Baratheon after winning a tournament. She can extend this to an analogy of survival means of survival in combat and future possesses similar attributes to both Gregor conduct in Westeros. The fight or flight intimidation, thus reducing the need to Clegane and Jaime Lannister in that her system guides behaviour in ways that prove oneself at every possible conflict. height and size are well above normal, Rhodes RE, Zehr EP. Br J Sports Med May 2019 Vol 53 No 9 577 Education reviews Br J Sports Med: first published as 10.1136/bjsports-2017-098170 on 13 September 2017.