Movement is Medicine
Movement and mobility are so much a part of everyday life that we tend to take them completely for granted, until something happens to make it harder. Like when you accidentally roll your ankle or develop stiffness in your shoulder. Even then, we do our best to “walk it off” or ignore the discomfort, hoping it’ll go away on its own. And most of the time it does, thanks to the self-healing resilience of the body.
Our musculoskeletal system usually bounces back quickly, because the muscles and connective tissue are able to activate intrinsic repair mechanisms. The body is in constant dialogue with the brain during movement, in order to avoid danger and navigate terrain. When injury is detected, defensive mechanisms like inflammation are triggered to bring in more oxygen and fuel, and to begin the necessary repair work.
At rest, our organs, musculoskeletal system, and brain maintain a dialogue which gets kicked into high gear during exercise. It’s analogous to a car’s engine and computer that go from idling to being driven in gear. Additional resources and coordination are required for speed. But this is where the metaphor breaks down, because exercise also triggers the body to tune itself up, switch on preventive maintenance mechanisms, and even grow additional capacity to meet demand.
Movement is medicine
Regular exercise has been consistently shown to extend longevity, reduce the risk of heart disease, regulate blood sugars, and lower blood pressure. We also know that physical activity improves mood and sleep, helping to reduce stress. Exercise has even been linked to reduced risk for common cancers like lung, colon, breast, stomach, and esophageal cancers.
Exercise allows your body to drive and tune itself up at the same time
Since brain health is the sum of our overall health, it makes sense that exercise must also be good for brain health. Physical activity is hands-down the best validated lifestyle habit for improving cognitive outcomes. Population studies show that exercise reduces the risk for dementia by up to 25%, when maintained consistently over a decade.
Clinical trials prove that exercise improves brain function most effectively when combined with nutrition, cognitive stimulation, social connection, and management of heart health risk factors. Apart from these indirect effects on brain health, physical activity has also been shown to reduce inflammation, improve blood flow, and promote growth of brain cells and blood vessels. The newest research in exercise physiology has illuminated cellular and molecular mechanisms that help to connect the dots between movement and brain health. Turns out our musculoskeletal system isn’t just for carrying and getting around.
Muscles also serve vital functions by promoting body-brain communication through neurochemicals called myokines. Myokines are also known as “hope molecules” because some act on the brain like antidepressants. Others modulate inflammation and maintain neural connections in brain networks. Additionally, myokines engage organs like the liver and pancreas in “muscle-organ crosstalk,” to facilitate coordination of synthetic and metabolic processes (see Fig 2),
Exercise not only allows the body to access healing mechanisms within our muscles, but it also enlists a type of connective tissue called fascia which is embedded with nerves that hardwire directly into the brain. I like to think of fascia as being like the brain’s secret service, because it’s constantly whispering intel on the body back to the brain. Our fascia is a web-like connective tissue onesie that encases your whole body and extends deeply inward to wrap around vital structures like muscles and organs.
The most recognizable bits of fascia in the body are the IT (iliotibial band) that runs down the outside of your thigh, and the plantar fascia on the bottom of your foot. If you’ve ever tried to roll or stretch these structures, you might have been surprised at how sensitive they feel. That’s because fascia is embedded with nerves that transmit all kinds of signals (like pain, stretch, and position) to the spinal cord and brain.
In addition to providing intel to the brain, fascia is also responsible for producing collagen, which is needed for remodeling and wound healing. It can also engage connective tissues to recruit immune cells, deliver nutrients, and remove waste and debris. In other words, fascia mobilizes fix-it and clean-up functions—just like when the CIA needs to cover up a crime scene in the movies. 😊
Regenerative properties of muscle and connective tissues are best triggered through movement, but our body’s resilience also depends on our ability to maintain an adequate reserve of lean muscle mass over time. Our musculoskeletal health is highly dependent on our relationship with movement. So the good news is that we build the body and brain’s resilience through physical activity, while the bad news is that they can be undermined through inactivity.
Meeting yourself where you are
Even though I know that movement is powerful medicine for the body, it’s still a constant struggle to prioritize exercise and movement. And it’s even harder to convince my inner critic that whatever I’m doing is enough. Whether you consider yourself to be an athletic type or less active than you’d like to be, it’s easy to get confused about what kind of movement counts or how much we should be doing.
Our modern work lives require us to sit for long periods of time. We are either attached to our screens or commuting for much of the day. And we often feel too tired or stressed to move, even when we know we’d feel better if we did.
We know that exercising at moderate or vigorous intensity for a minimum of 150 minutes per week (or 22 minutes per day) reduces risk for dementia. But what if you also have to sit for most of the day to get work done and pay the bills?
Research suggests that anywhere from 30 to 60 mins of exercise per day are needed to offset the risk of sitting for more than 8 hours a day. In other words, it’s best to get up and move around for 5-10 mins at least every 2-3 hrs of sitting, and ideally those “move breaks” would add up to at least 30 mins a day. That way, you are moving throughout the day to break up longer periods of sitting.
Fascia is constantly whispering intel on the body back to the brain
Muscle atrophy or shrinkage happens when muscles don’t get used. This used to be an age-related problem, but musculoskeletal health problems are showing up increasingly even in youth. Prolonged periods of fixed posture and repetitive hand movements are showing up as neck, shoulder, and wrist pain—even in school-aged children! More importantly, screen time displaces time that would otherwise be spent in live social interactions, walking, active play, sports, and strength-building. Over the longer term, screen time has been implicated in increased risk for anxiety, depression, social stress, and sleep disturbance.
Young adults who are physically inactive may fail to reach optimal peak muscle mass, but even active individuals need to be intentional about maintaining lean muscle. That’s because our muscles and bones naturally begin to shrink like glaciers at a virtually imperceptible rate after the age of 30. This process accelerates by age 50, when we begin losing up to 2-3% of our muscle strength per year.
The good news:
Our muscles respond fairly quickly and reliably in midlife, so it’s important to take advantage of this critical window to preserve muscle strength. Muscles have a tendency to become less sensitive to training in elderhood when the same amount of training may not yield the same results—a phenomenon known as anabolic resistance.
Enough is enough
I’ve been using the terms movement, physical activity, exercise, and training somewhat interchangeably, even though they are different.
Movement is the broadest umbrella, describing any kind of movement we engage in.
Physical activity is a type of daily movement like commuting to work (by walking or cycling), domestic chores (like cleaning and gardening), or leisure activities (like dancing or playing tennis).
Exercise is a kind of physical activity that’s typically done on a regular, structured basis, often including goals (like improving fitness and reducing stress).
Training usually means exercise that’s focused on performance based metrics over time (like getting ready for a race, event, or competition).
So what’s the best kind of movement for preserving brain health?
The simple answer is: No one knows for sure. Taking a deep dive into the science of movement can get confusing. Because while we’ve seen that population studies consistently link higher physical activity to lower rates of dementia, there are no studies definitively proving that exercise protects against brain degenerative conditions. Nor is it likely that that research would be done any time soon, because it would be a Herculean task taking decades of control and monitoring to track such outcomes.
For now we are left with advice that seems bland and nonspecific, because it’s where experts can mostly find common ground:
Get up! Try to avoid sitting for longer than 30-45 minutes at a time. Go fill your water bottle. Take the long way to the bathroom. Walk outside to take a call. Any amount of movement is better than sitting.
Maintain or build your muscle reserve and cardio fitness, by doing at least 150 minutes of moderately intense exercise per week.
We want advice that’s actionable at the individual level, but the reality is that the level of certainty we want simply doesn’t exist. And it’s probably a good thing there’s no one-size-fits-all solution, because we are all unique and different in our needs and preferences. We each need to figure out for ourselves what works best for our body and our lifestyle.
I’ve long been in the habit of thinking that I’m not doing enough exercise or movement, but a research paper published in 2017 by a team from Stanford University has given me pause. Investigators showed that people lived longer when they believed that they were doing an adequate amount of exercise, even if their actual physical activity was the same.
In other words, how we think about the adequacy of our self-care may be just as important as what we do to take care of ourselves.
Since then, I’ve come to see that it’s just not helpful to feel inadequate about exercising. What’s more empowering is to remind myself that I’m on the right path to being of sound mind and body at age 100, as long as I’m moving as much of my body as possible, as often as I can.
Dr Em coaching tips
These exercises are about meeting ourselves where we are. When we engage the mind to protect the brain, we need to acknowledge our level of readiness for change before jumping in with habit change tools.
Movement audit worksheet (here)
This worksheet is about developing awareness of how we feel about the current situation, practicing feelings fluency by checking in with body sensations and emotions. Please note that:
There’s no right or wrong answer
Don’t overthink this. Whatever is top of mind works best
Be aware of any judgmental or critical thoughts coming from your ”peanut gallery” or inner critic. Write them down on a separate sheet of paper, if needed.
Check the score.
Awareness helps us to inform us about our readiness for change. It allows us to meet ourselves where we are, so we aren’t setting ourselves up to fail when we aren’t ready, or whipping ourselves up to take action when it’s not the right time.
It’s okay whether or not you feel ready for change. Scientists called the not-quite-ready stage “precontemplative.”
Remember that these tools are providing data at this moment. This is simply a snapshot in time. Perhaps that will change over time, when you get through whatever you’re going through right now. That’s okay.
The most important thing is to trust what your body is telling you now. Your brain is already changing by having awareness and building trust with your body’s signals.
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