Will We Ever Accept that Exercise is Often the Best Medicine?

Pills vs ExerciseFor years, experts have known that in mild to moderate cases of depression exercise is as effective (or more effective) a treatment as prescription drugs. Yet, here we are in 2014, with still climbing obesity rates and higher than ever numbers of people taking anti-depressants – a 400% jump in the last 20 years.  This past week, exercise as medical therapy got another round of press after The Atlantic highlighted the issue in their thought provoking feature “For Depression, Prescribing Exercise Before Medication.” Let me add, however, that we aren’t just missing the boat in terms of depression therapy. Research has shown time and again that exercise offers just as good if not better results for an array of medical conditions. I might be preaching to the choir with the general theme, but let’s go beyond the basic assumptions and home in on the critical underlying messages reflecting why exercise isn’t just the safest and often most effective choice but why it so often remains the least accessed therapy.

Yes, the whole picture is profoundly intuitive to any Primal type (or maybe anyone not sold on the pharmaceutical solution to living). Isn’t it a funny, head-scratching coincidence that basic exercise can prevent – and treat – psychological and physical decline? Who would’ve thought that movement was useful to our bodies – that offering our physical forms the activity they were designed to perform for eons would confer some actual benefit? Still, the actual results themselves are fun if not impressive to read. Consider this…

  • Regular exercise resulted in a 30% remission rate for those with depression who didn’t respond to SSRI medication.
  • Study participants with heart disease who exercised had the same risk of dying as those who took popular drugs such as statins, antiplatelet drugs or ACE Inhibitors.
  • Research subjects with prediabetes who took the array of common prescription medications had the same mortality risk as those who simply exercised.
  • Among study subjects who had experienced stroke, those who exercised had a significantly lower mortality risk than those who took medications such as anticoagulants and antiplatelets.

On the flip side of this coin, of course, are the negatives. We’ve established that exercise confers physical, cognitive and emotional advantages for the prevention and/or treatment of many medical conditions. Add to this equation the question of drawbacks. Does exercise have disadvantages? In all fairness, your hair gets messed up. You’ll likely sweat. You perhaps need to take an extra shower or time the day’s toilette to match your workout schedule. You need to buy a pair of shoes (but then again you can just go barefoot). You’ll need to invest a little time for heavier workouts but perhaps can try to get some of the low level movement in while using a handy-dandy treadmill desk (or, more old school, work a job with heavy manual labor or lots of activity). Then we come upon the whole inertia argument, but in response there are even effective exercise options for the motivationally challenged.

While I’m not trying to minimize the nuisance of smelly armpits or losing an hour on the sofa, let’s take a look now at the potential downsides of pharmaceutical solutions.

  • Side Effects for SSRIs: gastrointestinal disturbances, anxiety, agitation, insomnia, sleep disturbance, weight gain, sexual dysfunction
  • Side Effects for Statins: memory loss, forgetfulness, confusion, muscle damage, increased risk of diabetes, liver injury
  • Side Effects for Anti-coagulants: excessive bleeding, severe bruising, bloody urine or stool, headache, back pain, chest pain, difficulty breathing
  • Side Effects for ACE-inhibitors: dizziness, headache, fatigue, loss of appetite, gastrointestinal problems, diarrhea, numbness, fever, joint pain
  • Side Effects for Beta-blockers: diarrhea, stomach cramps, nausea, vomiting, rash, blurred vision, muscle cramps, fatigue, headache, depression, confusion, dizziness, sexual dysfunction, low or high blood glucose

The final kicker? A study out just last month showed that more than 20% of older adults being treated for multiple medical conditions are prescribed medications that worsen the symptoms of another condition. In other words, their medications work at odds or in “therapeutic competition” with each other. The more we dig ourselves into the pharmaceutical hole, it appears, the worse (and more ironic) it all gets.

Knowing all of this, why does the obvious solution feel so impossible? Why won’t people accept exercise as a genuine medical option? Why do we tend to go with a pill (at times, an awfully expensive one) rather than a simple, natural behavior change? Why are we individually invested in this choice? Why are we as a culture – or medical establishment – so invested in this approach?

We’ll spend billions of dollars researching which gene “lights up” or which protein levels rise all in the name of better understanding the physiological mechanisms of disease while the solution itself is staring us in the face. Let me back up for a moment and suggest that I’m not arguing that exercise covers any and all medical need. I’m not saying it has the absolute power to cure or prevent any particular person from developing illness in his/her lifetime. Our physiology is inherently complex. People should avail themselves of the broad medical options that allow them to lead the fullest and healthiest lives possible. That said, there’s rarely an instance in which lifestyle choices can’t make a powerful difference either unto themselves or in conjunction with conventional or complementary medical treatments.

The million dollar question in all this, of course, is how do we get people to accept exercise as a treatment? How do we convince doctors to literally prescribe exercise (understanding, of course, that some already do)? How can patients be convinced to avail themselves of the safest, perhaps most effective treatment option? The Atlantic feature chose to address this question from the perspective of psychiatrists. Their answer? To treat it “like real medicine.” For one psychiatrist interviewed, that means addressing it in his appointments with patients as he would a prescription for medication, discussing the details of studies that support the effectiveness of exercise, talking about effective “doses” and intensity levels, emphasizing the importance of consistency by comparing it to a diabetic’s occasional versus regular use of insulin.

It’s a provocative thought. What if doctors talked about exercise as medicine in their sessions? Would it be convincing to the majority of people who walk through their doors? (Would it win you over?) The results, according to doctors in The Atlantic piece, seem mixed. The most difficult factor is the obvious elephant in the living room – that the pill is there ready to be prescribed, whether it’s called “a last resort” or not. Nonetheless, can the rhetoric sway at least some people to take exercise to heart? Will homing in on the technical details of dosage and variety get people to take the usually friendly advice as medical law – and personal treatment plan?

There’s an interesting wrinkle to this that I don’t often see discussed with how we tend to downplay the value of lifestyle interventions. Research into the placebo effect demonstrates that the more costly we believe a certain placebo “medication” is, the higher we rate its “effectiveness” in treating our symptoms. The value we attach to a treatment influences the actual results we think we experience.

This point, in turn, brings up another dimension. While we (rightly) exalt the everyday accessibility of exercise, are we simultaneously downgrading its appeal to those who need it most? Let’s just brainstorm for a minute. What would happen if doctors could prescribe personal training and/or fitness center/class use as they do physical therapy? People often skip physical therapy or bow out before they’ve met their goals, but generally people take advantage of it when a doctor orders it. Would it boost people’s buy-in if we promoted general fitness training and support the same way? Are we kidding ourselves to think we can put the onus solely on the individual when the system so clearly supports the opposite choices?

There’s an interesting cultural dichotomy at work here. I think a lot of ordinary people would bristle at the suggestion that they need a trainer or that this person’s service should cost them in treating their illness. Yet, they think nothing of spending as much or considerably more on medications than they would the guidance (and motivation) of a personal trainer. Simultaneously, there’s an odd fascination with the most extreme representation of the trainer figure as millions watch Jillian Michaels et al. every week in the disturbing entertainment of televised panopticon meets “fat camp.” We’re a confounding, nonsensical populace (collectively speaking)….

On the other end of the “medical speak,” when prescribing exercise is the self-care justification. You deserve to take care of yourself. You deserve to thrive. You deserve to not have to take insulin every day or deal with the complications of statins. Is this line of reasoning any more convincing for people than dosing out activity according to medical study suggestion? My own sense is it depends on the patient.

Either way, it always intrigues me how put out we are by our bodies’ needs. Are we naturally this lazy, or has the culture just gotten to us that we feel so put upon having to exercise ourselves – having to make the effort to pick up our 100 lb gym shoes and walk out that 1000 lb front door to go for a walk? That hour we have to “waste” on fitness could’ve been used for three dozen other, more pressing needs. Why not see a pill as the ultimate “easy button” that allows us to have it all. It’s hard to kick the collective faith in that assumption even if the research suggests a much different picture. Where does medical logic fit in a modern mindset? It’s hard to tell, but the simple Primal perspective as always holds – that we naturally live through our bodies and have the ability to physically and psychologically thrive when we offer ourselves the age-old inputs our genetic blueprints anticipate. Maybe Primal logic’s time has come.

Thanks for reading today, everyone. What thoughts does all this raise for you? Is there any clarity or direction to be found in how to prescribe movement over medicine?

TAGS:  prevention

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

If you'd like to add an avatar to all of your comments click here!

106 thoughts on “Will We Ever Accept that Exercise is Often the Best Medicine?”

Leave a Reply

Your email address will not be published. Required fields are marked *

  1. Mark,

    While I like the idea behind this article, the common denominator in much of this would seem to be blood sugar control. I think efforts to find the right carbohydrate level, and apply that using real food, will go a long way to making people feel like being more active.
    This is my opinion of course based on reading a bunch of different things.
    A typical diabetic, as laid out by Barry Groves starts with the t2 diagnosis, gets insulin, gets fatter, then needs statins, and blood pressure meds…….all while being told to eat a relatively high carbohydrate diet with “healthy” whole grains…….insane.

    Raise your blood sugar to exercise and then exercise to reduce it.

    I think a person gets much more mileage from their exercise, and is more motivated to do this when blood sugar is well controlled in the first place.

    1. Blood sugar control – alas, I’m struggling with it. My blood sugar level had been stable and fairly reasonable, around 115, for at least a year. I do about 90% primal. Carbs around 50 per day from healthy foods. Good exercise. IF most days. Taking Metformin, which seems to be one of the few really good medications. And my glucose level is now running as high as 300. Doc says wait and see.

    2. Right…is the lack of exercise the cause or the effect? In my case, I often have not felt up to exercising because of a fatigue problem caused by not meeting my nutritional needs through ignorance as well as following advice that didn’t work for me. After recently putting a big piece of the puzzle in place (i.e. resistant starch, one of many factors), I am walking almost every day, doing yard work, and even starting to jog a little. This will sound like nothing to many people, but for me it’s a drastic change. You can’t exercise if your blood sugar is whacked out and your energy level is low due to non-exercise factors.

      That being said, I’m 100% in agreement that nutrition and exercise can replace much of what is being done in the name of medicine/mental health these days.

    3. I can completely relate to this comment, and completely agree. I’ve said and written before that a lot of folks need to simply FEEL BETTER before embarking on an exercise regimen or before they even lose weight. And we start to feel better by eating the right kinds of food. It’s definitely the core of healing and the first step, before exercise, before pills, before anything.

      Our society, however, is so focused on results, particularly on weight loss, that most people feel like failures if they don’t shed pounds immediately, even if a change in behavior (ie. eating better) makes them FEEL better. We don’t care about health, per se, but about weight. It has been my experience, though, and thus my belief that we have to feel better, feel healthier, before we start to lose weight. Weight loss, then is secondary to health. It’s a nice side effect, but it’s not the main objective.

    4. Well-said. I agree completely. Blood sugar must be controlled with a low-carbohydrate diet. Once I became a ketone burner, my personal energy sky-rocketed and I exercise because I have the desire to get outside and enjoy the “high” that I get from the exercise, not because I feel exercise to be a “duty.” I believe most of the sedentary, over-weight folks don’t exercise because they feel lousy from high blood-sugar/insulin levels. Lose the carbs first, and the desire to exercise will follow. I also must say that I do feel the exercise adds another level to insulin control and after a brisk bike ride, I feel some sort of “endorphine-kick.” After around 15 miles of cycling, I also feel what I interpret to be a “keto-kick” when I really start burning fat. So, it is a happy cycle. My ketogenic diet gives me energy to want to exercise and the exercise gives me energy and mental clarity and a mood-lift to make me want to do more. (BTW, I am a 61-year-old female with serious familial insulin-resistant who has become a cycling maniac).

  2. When the doctor can write a prescription for a fitness center that your health insurance will cover is the day we will understand it is serious medicine. And second, doctors need to talk about it. I never had a doctor mention or ask about exercise until I got breast cancer. To her credit every appointment my breast surgeon emphasizes I am young and I can do more exercise to prevent recurrence. If I say I do 30 minutes a day she says do an hour.

    1. Yes, I’d like to see prescriptions for fitness centers and healthy foods, though I’m not sure if the general public would actually use them if prescribed…

      1. My father-in-law when he retired had a supplemental health insurance that pays for seniors to have a gym membership and he took advantage of it. I think if all our insurances did this for any age that the ones who took advantage of it would save them money in the long run.

      2. Most people would rather pop a pill than exercise. Sad but true.

    2. I actually did get a “prescription” to join a gym from my Dr – he had a deal with a local gym, and anyone who brought in a “prescription” from him got discounted membership for a year – I think it was 50% off from memory. no health insurance payments, but the discount wasn’t bad. This was 13 years ago, in the UK, when I was diagnosed with post-partum depression.

  3. Would love to see more cooperation between physicians and gyms. Just think of the progress that could be made if doctors sent many of their cases to a good nutritionist and fitness trainer instead of prescribing them drugs!

  4. Replacing being sedentary with regular exercise and movement = very good, and replacing pills with non-toxic lifestyle changes = very good, but some risk in this conversation of over-valuing strenuous exercise. And I am thinking of outliers rather than the norms of the studies described here – say, people whose stress regulation is already so off that significant exercise actually makes things worse. So, a caveat in my mind is the primary importance of healthy diet and healthy SLEEP – following which changes the exercise can come safely and naturally. Maybe this is already clear, but just wanted to add.

  5. I work with some chinese immigrants and they both tell me that in China Tai Chi is prescribed before drugs in many cases. The patient has to attend several times a week for 8 weeks or more. The instructor has to sign attendance sheets. Only then will they consider you for medication. Of course, that’s not for all conditions, but anecdotally they say it has helped their family and friends. I’d love to see something like this here. And real diets based on real foods. When will that stop being a “fad”.

  6. I don’t visit doctors often. My experience so far…fat doctors, pill pushers. How can an overweight, flabby endocrinologist give serious advice to diabetics? My gp was appalled that I was exercising when my body basically locked up…and told me diet wouldn’t change things…but prednisone would make mr better. People don’t question their doctors and many doctors take affront when questioned. It’s our screwed up medical care system. Besides, drugs make money …LOTS of money…how can they justify, in a bottom line society, pulling the scrip? Plus…people just don’t want to work that hard. It’s more fun to watch others suffer on TV while enjoying a beer and pizza. Plus who wants to go through the torture it appears to be. Gyms are humiliating…ads prove that. People don’t imagine they can look like THAT…they feel they will be embarrassed…it’s all basd avkwards. Just sayin’.

  7. Unfortunately when depression hits, its very hard to claw out of the soup and walk/run/play. Maybe support networks could encourage activity rather then the standard acceptance of inactivity as a symptom of depression. It helps to have a connection with even one other person who will encourage activity.

    1. Yep. Depression is not laziness or lack of motivation and it can be SO hard to crawl out of. An activity that stimulates your body and mind through socializing or because you’re engaged in learning (like a dance class or frisbee golf or something) will probably be a lot more successful than spending an hour on the treadmill at a gym – even thinking about that is depressing!

      1. An hour on the treadmill is depressing to think about even when you’re not depressed! I can’t do it without a tv AND a magazine.

    2. It can be difficult as well if the person encouraging activity does not understand how depression is affecting an individual. I have one friend whose answer for everything is “Go for a walk! You’ll feel better!” without being able to accept that, no, today, going for a walk is NOT going to make me feel better.

    3. What about walking therapy appointments? Wonder if many therapists do this…. seems like a win win.

    4. Yes, sometimes it’s hard to get out of bed in the morning, let alone excersize. I eat almost perfectly primal and take the recommended supplements and still feel like just breathing is too much effort sometimes. I know excersize would likely help me and the timing on this article is perfect. I think the problem for me is Mark’s last paragraph, where there are so many things I try to fit into my day. Spending time excersizing seems like a waste. I’ll try to start thinking of it as an essential like eating and drinking. >.>

  8. You might check out some of the rules and regs set out by our government that allows doctors to get paid….in many cases medicare/medicaid will not reimburse a doc if the pt has not been prescribed certain drugs. I know shocking! but true.

    1. It’s not just Medicare/Medicaid, the health insurance companies are in on it as well. They call it “Pay for Performance” or “best practices” or “Ambulatory Quality Outcomes”.

      They use a very mechanistic model of human physiology, where everyone has to have their measurable numbers fall into the correct range — LDL <130mg/dL or <100mg/dL if you have cardiac symptoms or are a diabetic. BP <120/80 (which used to be average for a healthy 20-something male, not the gold standard). Diabetics have to get their HbA1c < 8.0.

      While the BP and LDL rates are generally too low, the HbA1c is way too high as it equates to an *average* blood glucose of 205mg/dL. Complications for diabetics set in at around 140mg/dL (and HbA1c of about 6.0) so they should be aiming for that instead. But you can't get there, even on insulin, if you're eating to the ADA meal plan with approximately 300gm carb/day. And very few diabetics actually eat to that plan. Most eat more, either because they're hungry, or because they're on a blood glucose rollercoaster.

      On a personal note, I'm 63, a type 2 diabetic and have been doing OK on a (mostly) primal diet — i've got my HbA1c down from 7.7 to 5.5. I've had both my knees replaced and have osteoartrhitis in my left shoulder, fingers and toes (don't laugh — it makes walking painful). So exercise has not been something I've done much of for the past 20 years or so.

      In September 2013 I started walking more. Then it got cold and dark. At Thanksgiving I decided to join a gym so I could carry on walking. At that point I was walking about a mile a day. The gym had an introductory offer of 3 sessions with a personal trainer, so I tried it out. It was fun. I liked the trainer and so I signed up to work with him twice a week. It's now the beginning of April I'm seeing a slow but steady decrease in my blood glucose. I'm noticeably stronger, a little more agile. The balance issues I had following knee surgery are going away and I haven't needed to take a single painkiller since I started this.

      Last week I was able to swap out the 5-gallon (40lb) water bottle on the office water cooler, with no noticeable effort. Monday I made it to 200lb on the seated leg press, I started at 50lb in December.

      I've got a FitBit Flex and if my day doesn't include enough activity as it measures it, then I go to the gym and walk on the treadmill, or cycle. I aim to meet my goal 6 days a week, with one rest day. When I find I'm consistently beating my Flex goal, I up it a little. Right now I'm at 2 1/2 miles/day, and with the better weather (yay! spring!) I expect that will increase a good bit .

      I'm also sleeping better, and my mood is very much improved — a good thing as I've been dancing with clinical depression since my late teens.

      1. You may want to try Dr. Paul Lam’s Tai Chi for arthritis. You’ll find samples on line on YouTube. It’s gentle, relaxing and makes you stronger without strain. It’s worth a shot and doesn’t tax your joints.

  9. Yes, I think we are naturally that lazy. I think play and physical activity comes more naturally to children, but most adults don’t want to create extra work for themselves. I think this is a systems problem. With our clever modern engineering we have removed the need for the routine physical activity that our bodies need to maintain themselves and thrive. In order to get that physically activity we have to exercise. And I think that just goes against most peoples nature. I think exercise works best when there is some synergy, it accomplishes more than just one task, or you have more than one motivation for doing it e.g., walking, running or biking as a means of transportation that gets you from point A to point B, rather than just going around in circles or even worse on a tread mill. I think that we mostly don’t want to take on short term discomfort for more medium to long term health benefits. I personally believe that sloth is the mother of invention just as much as necessity is. Unfortunately, while there are so many upsides to our inventions they have made our naturally needed physical activity optional, and most of us want to opt out.

    1. I think you’re right on. I absolutely loathe going to the gym. For me, gym = obligation and I start to resent it almost immediately. Sometimes I like the classes, but I honestly do not want to do any one thing for a full hour. I think if gyms offered more structured group and individual opportunities offered in 20-30-40 minute increments, I would be more interested. Plus – most classes will easily push me to over my ideal heart rate zone, leading to burnout fast. No matter what, “going to the gym” is putting exercise in this partitioned off place in your life – unless you can make it your community/socialization experience, in which case I think it can become more synergistic, but that’s not the design for most places.

      Anyway, what you say about synergy with daily activities is a great point. I’d much rather get my activity from cleaning, yardwork, etc. I love taking walks with my partner – catching up on our day and becoming closer while being active. I do enjoy jog-walking in the nicer weather by myself, but even that is double-dipping – getting some sun, breathing fresh air, processing my thoughts – none of that will happen in a gym.

      1. If the hour-long class is too long for your attention span (as it is for mine), just leave whenever you decide. No one will track you down or ask you why you left, and if they do you can just be honest: say that you were bored or tired of doing the same thing. I used to be worried that people would think I was lazy or weak, but then I remembered that I don’t care what other people think. Because I’m doing this for myself, I can do whatever I want.

        One of the best things I’ve ever heard was from a 70 year old lady at the gym who used to say, “If you don’t like what I’m doing, you’re just gonna have to look the other way.”

    2. We probably all get a little TOO comfortable in the routine we’ve built for ourselves. But it doesn’t help that couches, chairs, and even mattresses have become much, much cushier over the years, making it ever more inviting to sit or lay back.

  10. Part of the problem is that we went about it so badly from the beginning. 97 percent of the people I know that are sedentary will tell you that they haven’t recovered from the horror that was grade school and high school gym class. Hell, I HAVEN’T recovered from that. Everyone thinks they’re going to have to start out doing 20 laps around the gym and master a one arm pull up right off the go. We’ve turned “exercise” into a dirty word. It implies suffering to a lot of people. It shouldn’t.

    Now, if we told everyone to go play fetch with their dog and soccer with their kids, we might get further.

  11. This is a huge subject, with so many complex layers. It’s one I’ve pondered for years and years and scratched my head at those around me who appear satisfied to follow whatever drug the Doctor prescribes even though they suffer side-effects and often doubtful improvement whilst seeing ‘success stories’ by following another way of living which improves conditions, negates medication and prevents problems in the first place!

    We appear to have lost (in very large part) a sense of personal responsibility for anything, most particularly our health.

    In the free market economies with massive (and powerful) vested interests I don’t see a way to free the populace without draconian change which provides the ‘stick’; humans are wired to find the short cuts it seems.

    It would take societal change on a scale so enormous I can’t see how it would be achieved because it affects every corner of living. We’d need to take a whole new generation and educate them differently (and in isolation), dismantle the current political systems, to a large extent provide the stick via much less social support …

    If Doctors were rewarded by results without using drugs, and drugs were very much more difficult to prescribe, we might make a small start, but who’d vote for that, and therein lies the ultimate the problem!

    1. We’d need to take a whole new generation and educate them differently

      Isn’t that what we’re doing (in a small way) by raising our kids with Paleo and Primal diets, and teaching them about different activity levels?

      1. Oh I hope so! I’ve been struggling recently keeping my whole family primal as it takes so much more effort on top of all the usual daily tasks and working etc (in a not very ironic way I think the extra pressure has contributed to a recent bout of depression). The thought that by at least educating my kids in this way of living I might be part of teaching the whole next generation that this is the way to go…well that might just be the spur to keep me going. Thanks for that little post Wenchypoo, and thanks Mark, as always.

  12. I also want to say, as a doctor, most of my patients are either on board with eating whole foods and having an active lifestyle or they are not. I find very few in the middle that are open to being influenced by me in the 20 minutes we spend together annually. I love to learn ways to be more persuasive, but ultimately people have to decide they want to do it for themselves. It’s not like the information isn’t out there for the public. I think it is common knowledge that humans need to exercise and eat really food to be healthy. I think for sure doctors should emphasize it more, but much of the time it is a low yield use of our effort to give that message again and again. Doctors can advise patients on their health ( and granted a lot of that advice could be allot better), but ultimately it is the patients responsibility to make it happen.

  13. A lot of HMOs, at least here in California, do cover gym memberships. If that is how you like to exercise, you might check with your insurance company to see if it’s a benefit. Employers sometimes have a deal with gyms, too, so check with HR.

    Trying to get non-exercisers to exercise is a major, up-hill battle. Everyone is quick to say that they don’t want to take pills, but actually making the lifestyle changes once they leave the doctor’s office is sadly unlikely. Even getting people enrolled in studies that look at exercise vs. other treatments is tough. One visit to the physical therapist didn’t result in a miracle cure? Then physical therapy doesn’t work!

    I like the idea of some gummint green eye-shade scrutinizing medical records for the “correct” drug prescriptions before doctors are paid! Where do these ideas come from?

    1. In my state (MN), most of the health plans offer a gym membership incentive, but it’s only for the mainstream or corporate gyms. You can rarely take advantage of it at smaller, specialized places (like yoga, cross-fit, or just an independently-owned outfit). I would absolutely take advantage of this benefit if I could use it wherever I wanted – some yoga here, some tai-chi there, some boot camp classes, with a personal trainer based out of her home, jog/walking on my own and tracking with an app, etc. If health plans could find a way of offering this cash incentive outside of corporate structures that have the resources to auto-track gym attendance, I think it would be way more useful and conducive to docs “prescribing” exercise.

    2. My insurer cover trips to Bally gyms…of which there are none in my area.

  14. Regarding medications, my Mom was very sick from Valley Fever (fungus in her lungs) which lead to other problems and was taking all the medication she was prescribed before. She wasn’t doing well, was on a breathing machine, doctors gave up and told us to put her on hospice, she was ok – ready to meet her maker. However, she asked the doctors if she was going to die anyway did she have to take all her meds, they said “no, you can go off them” so that’s what she did. Hmmmmm, shortly after that she started to get better and her appetite came back. That was last year. She finally got tired of waiting to die and started feeling stronger and slowly got her life back going. Now she walks around with a walker (she did before this) making dinner, going out to dinner, taking showers by herself – the only thing that really helped her was to stay off her meds and eat real food. I think that helped convince Dad to go off the statins that he was on as well. He’s doing much better, doesn’t have much forgetfull episodes (we worried he was going into dimentia territory) and pretty much takes care of the place on his own. They are going to drive the motorhome up to the Pacific Northwest for the summer. Almost back to normal.

    1. 2Rae: This is the first time I’ve ever heard about someone leaving hospice on their own two feet! That’s fantastic! Congratulations to your mom and your dad. It just goes to show us the tremendously powerful resilience of the human body given the right conditions and environment. I’m so impressed with your story. Thank you for sharing.

      1. Jen, we were told once people go on hospice and are unable to walk on their own it’s just a matter of time and they don’t leave on their own two feet. Needless to say we were grateful that she was “kicked off” hospice since she was getting better. I also encourage people to visit the hospital a LOT when their family/friends are there. The doctors told us that there was nothing more they could do for her, we all jumped into our cars and drove the 27 hours to her side, once we all showed up the doctors came up with two more things they could try. That worked out well enough for her to leave the hospital in a few days. Our bodies were designed well, if we feed them what they need they can repair the damage sometimes.

  15. I agree with most of the posts above. I’d say it’s covered all I was going to say, but I’ll say it anyway:

    People are lazy now a days

    People think their doctor is a God and never think to question them

    People are lazy…oops, I said that already ;O)

    People prefer the “quick fix” (bogus diets, “magic energy/diet pills, & prescriptions drugs)

    People are lazy…oops, said it again! ;O)

    People are not pro active in educating themselves

    1. Sure, people are lazy, but we’ve also normalized lazy.

      We normalize getting old and not being able to move like we used to. We normalize weight gain as we get older because we just don’t have that metabolism anymore. We normalize eating crap, we normalize taking pills, we normalize take out and watching movies.

      In summary, a good majority of us (and by us, I mean “them”) honestly believe that we are supposed to get fat, feel bad, and hurt as we grow older. They don’t know any different or any better.

      Doesn’t excuse it and doesn’t make it okay. But if you’ve never seen the light how do you know it’s dark?

  16. It seems like every solution to health must be complicated and then monetized. Confuse and then make people pay doctors, pharmaceutical companies, dietitians, physical therapists, nutritional supplement companies, gyms and personal trainers, and sports apparel companies. Of course, these professionals are sometimes needed, but too often health is seen as a big “problem” that needs to have money, professional expertise, and “stuff” thrown at it.
    Because people like to avoid problems, (like money worries, money troubles) and the complexity brought on by contradictory guidelines in every aspect of human health, it is not surprising so many choose to just forget it, watch TV, surf the Internet, play video games, eat junk food and/or party, and then try and go to sleep.
    Simple movements like walking, running, swimming, cycling, (ok, throw in some planks, pull ups, and push ups) and sensible eating of real food (ok, preferably primal), and sunshine, and adequate sleep, is all most people need for physical and mental health. But who is going to get rich promoting simple, common sense (ok, Sisson is). In our dumbed-down 21st century society, common sense now requires an expert; home-cooked meals are sacrificed to the convenience of cheap, fast food; and physical education has been reduced in schools from a daily, necessary and usually enjoyable activity, to an inconvenient and often uncomfortable, bi-weekly nod to tradition.
    It would be much easier to establish the habits of fitness and exercise in people when they are still young. This would put less pressure on obesity, diabetes, addiction and depression as motivating factors to exercise in later life. But the world of unregulated, free-ranging play once available to young children has been replaced by the expensive, highly regulated world of car-pooled, parentally supervised, results-oriented pursuits of athletic or academic (ok, I live in Asia) perfection. GIven those psychic and economic burdens, it is perhaps not surprising that so many of our young are put in a place where their only option is to watch TV, surf the internet, play video games and eat junk food.
    Habits so formed make the shoes feel that much heavier, and the door to the world of simple exercise ten times heavier still.

  17. “You’ll likely sweat” as a downside? Who doesn’t love the mega-drop from the eyebrow?

    1. I take pride in the many little drops that surround the stationary bike after a good sprint work out!

  18. Here’s the best thing about exercise, as it relates to heart health: Exercise can create new coronary arteries! You can effectively give yourself a “bypass operation.”


    “When there is increasing traffic volume on a highway, it may make sense to make the highway into a larger freeway to allow a higher traffic volume. In short, the same happens to the coronary arteries: When blood flow is increased, the inner layer of vessel cells (endothelial cells) sense this necessity and start the process of enlarging from capillaries into genuine collateral vessels. In response to endurance exercise training (such as running, bicycling, swimming, and hiking), blood flow is increased, which leads to a conversion from capillaries into collaterals. This is a very elegant treatment everybody can accomplish. It reduces the chances of the occurrence of angina pectoris, myocardial infarctions, and death. Beyond the interventional, surgical, and medical treatments against coronary artery disease, this collateral training is a natural and valuable therapy that many patients can apply by themselves, for themselves, if only they are aware of it. ”

    I have no idea why this isn’t more widely known. 🙁

  19. As a young adult who went through a phase of mood swings and depression I’m glad to see this because in all honesty, exercise is what saved my life.
    I know cardio gets a bad rep sometimes here, but registering for a few events and endurance training worked wonders.

    In spring 2012 [eating primal but way too low calorie] I started getting mood swings and minor depressive states that came and went. In summer 2012 [not eating primal or running] I started getting more depressed. By Fall 2013[semi primal/ED behavior] I was having suicidal ideas. I went to a doc, prescribed SSRI in about two seconds. So here I was mid-semester college, 20 years old, not sure how I was going to make it through the year. 3 Months later, it got worse, switched SSRIs. I made the person decision in Dec of 2012[back to primal] to stop all meds. Then decided to try birth control, maybe it was PMDD? No. Bad idea but I gave it till March and stopped that too.

    The shift came when I started running/rowing again. Then, I found out I was b12 deficient. Holy crap, the shots made a difference too. No more anxiety and mood swings. Between daily exercise and b12 shots I was so much better. Eating a balanced paleo diet, lots of protein with moderate carbs. It took time but I’m thankful to have survived that period of my life.

  20. A woman I know always says, “I’m just a big girl,” when referring to her poor dietary choices or lack of exercise. It seems like an excuse to me, but I’m sure there’s a lot more to it than that.
    In the end, for her, and a lot of other people, it just seems to be laziness. They don’t want to have to change anything about what they are doing, even if that could mean feeling better. On a recent trip to Europe, where it is much easier to walk everywhere, my dad bitterly complained, even when we only had to walk a mile. By the end of the trip, he was feeling a lot better, less leg and back pain, yet he vowed never to walk as much ever again. I don’t understand why you wouldn’t choose to do something you know makes you feel good, just because you are too lazy…not really an answer, because I’m just as baffled about it!

    1. That’s someone who’s too comfortable with who (or what) she is.

      1. Unfortunately, she is a deeply unhappy person. Very happy on the outside and wonderful to be around, but I sense a profound dissatisfaction with who she is, just from the other things she’s said.

  21. I’m tired of seeing smiling, happy people on these drug ads while they read out these side effects. They should show how it really feels to have…diarrhea, stomach cramps, nausea, vomiting, rash, blurred vision, muscle cramps, fatigue, headache, depression, confusion, dizziness, sexual dysfunction, low or high blood glucose… instead of having someone laughing and running through a field of flowers!

  22. Let’s be careful about implying that no one ever needs antidepressants. I’ve always been active but there was a period of time I needed meds just to get by.

    1. Thank you. I love this website, but this thread was making me feel profoundly uncomfortable. If I hadn’t started on a regimen of antidepressants and therapy, I likely wouldn’t be here at the moment. I’m only just starting to get a grip on my health because I accepted that I needed some chemical assistance.

      Maybe one day I will have reached the point where exercise alone is all I need, but until then I will take my (relatively small number of) pills and count my blessings.

  23. Having experienced recurrent depression throughout my life, I will say that anti-depressants have not been a cure-all but they have been a godsend. Depression is not about a lack of motivation. It’s like being stuck in a deep hole. Anti-depressants, for me, have been a ladder – a way to get out of that hole. Once I’m back on level ground, I can start utilizing other interventions to get well and stay well. Exercise can absolutely help me evade depression without medication and sometimes it can help me out of a shallower hole. But if that hole is very deep, gimme that ladder please. The real trick (for me) has been learning how to avoid future deep holes – using nutrition, activity, and coping skills picked up in therapy. Sometimes I flit and dance right around those holes with gusto, sometimes I crawl very very carefully and get a bit scraped up, and sometimes I fall back in. Meds are a wonderful, modern tool that have absolutely saved lives – they won’t help you thrive, but they will get you to a baseline of surviving.

    Lastly, I would be curious to see some kind of study/survey that shows what keeps long-term gymgoers attending year after year consistently. My guess would be that it fulfills a social component. The vast majority of corporate gyms are not set up to accommodate that. They advertise themselves that way (especially the Y) but in reality it takes a very long time to develop relationships in that setting even if you attend classes. I’m not a cross-fitter, but I imagine that is a very big part of why those folks enjoy it so much. I practiced martial arts for three years (stopping to attend grad school) and it’s the only thing I have stuck with that long as an adult. It was hugely therapeutic and I’m sure part of it was that it was social.

    1. Amy, yes to all of the above! At one point in my life, antidepressants were they only thing that got me to where I could even imagine a better life, let alone make changes in that direction. I am eternally grateful that they were there when I most definitely need them. I’m off meds now and in a much better state, been eating primal for over three years, and adding exercise into the mix.

      Also, as one of those folks traumatized by school gym classes, I can attest to the huuuuge mental barrier there can be to exercising. And the seemingly common modern view that exercise must be a “warrior” activity a la Jillian & Co. or don’t bother doesn’t help either. I’m lucky enough to have found a small outdoor exercise group led by a wonderful trainer which meets all the criteria of sweat, fun, and community. I actually look forward to going!

      But unfortunately the modern medical system as I experienced it gave me absolutely no advice or encouragement about change of diet or exercise. I discovered the two vital key components of my current healthy life (this website plus my workout group) all on my own. I was motivated since I didn’t want to be on anti-depressants all my life, but where’s the motivation for so many other people–the ones who find it just easier to pop some pills and get on with the next twenty tasks on their overly long To Do lists….

    2. For me so far, that is absolutely the appeal of CrossFit – a social filler. Much easier than building up relationships at the gym or other classes; it’s a ready made community

  24. Doctor’s do prescribe exercise, but most people just don’t bother and want a quick fix pill instead. This isn’t going to change anytime soon.

  25. I’ve always thought that people MAKE the time for things that are most important to them. Obviously most people don’t want to be healthy or they would make time for it. They would rather tweet and twitter and twat and faceplant and twerk and god knows whatever most people do.

    1. Well said Nocona.

      Those who want to, will. Those don’t, won’t. Period.

    2. I’d prefer to “twitter and twat” about my latest work out. You can have both!

      Can twerking count as exercise?

  26. I hear everyone complaining about how unmotivating it is and how boring it is to go to the gym or how gyms should be subsidized by health insurers blah blah. People, wake up! All you need is to get off your butt and go for a walk. Get on your bike and go for a ride. Take the dog for a hike, play soccer with some friends. Don’t make it so damn complicated. My mom is 70 and fit as a fiddle, she does some form of exercise, either yoga or running (yes, she runs! Usually only 4 or 5 km but still) and she says if a day has passed without some form of activity she starts feeling sluggish and old.

    1. My 82 year old grandma mows her 72 year old neighbor’s yard. She doesn’t see the irony when she says that she feels sorry for him because “he’s so old and can’t do much for himself anymore.” She also plants a 1/4 acre garden and cans her vegetables. She walks 1.25 miles to church on Sunday and 3 nights a week for activities. She is on no medications and needs none.

      She doesn’t even know where a gym is, but she is very fit healthy.

    2. Agreed, Janna. Gyms are a commitment because they cost money. You feel you have to do it even if/when you don’t want to. Then it becomes a grind.

      A better idea for many people is an informal, noncommitment approach to exercise. Don’t run out and buy a load of equipment just because some guru thinks you should be doing HIIT or bench presses. Don’t overthink it. Just put your body in motion according to what you feel like doing at the moment. For some people this could mean a 50-mile bike ride, whereas for others it could be a 15-minute walk with the dog or an afternoon of tending the garden. Exercise shouldn’t be a one-size-fits-all endeavor, and it shouldn’t be regimented to the point that it’s dreaded.

      A doctor once told me that if there is such a thing as a magic bullet, it’s to just keep moving. That might have been the only intelligent thing she ever said to me, but as far as medical advice goes, it’s a real keeper.

    3. Yeah, really. People make exercise unnecessarily complicated. Maybe it should just be called movement. Or not sitting on your butt most of the day.

      For the first time ever I am in a cube farm a few days a week (working in health and fitness media ironically) and I feel like my head is going to explode from being so stationary. A whole bunch of people are working on producing information on how to make movement more complicated for the mainstream all while sitting on their butts in a windowless office building. Once I’ve done my piece there I’m hightailing it out. I don’t know how people do that for years on end. Yes, the money is good on paper. But you pay with your health so not really 🙁

  27. While certainly there is a place for “sickness management” or more commonly called conventional medicine, until the powerful marketing that barrages people in every facet of their daily life starts actually touting real benefits of exercise beyond the slick abs and firm behinds, it will be seen as nothing more than a task to be avoided in favor of “enjoying life” engaged with gadgets and technology and woeful “food choices.”

  28. Good stuff as always Mark. Thanks also for the RS post. you are still the classiest out there and love your never ending commitment to growth and learning. Ok, thats enough brown nosing for now.

    About 10 years ago I was at at breakfast for the chamber of commerce.
    The biggest hospital in the area was very influential and involved in local politics.
    The CEO of this hospital, (and I will never forget him) was an extremely well educated and well spoken physician (he has testified and made appeals before congress many a time).a lawyer and an mba, so he really understood both sides of the coin in regards to running the business.
    He spoke to a group of about 200. After the start of his slide show on the “future of medicine”, he got to a segment about being informed consumers.
    He than got quiet and said the following:
    ” if I told you that the research is in and we have developed a special medicine a protocol if you will, that would GUARANTEE an 85% REDUCED risk in the following conditions (and he rattled off a laundry list which included depression and hypertension)…. would you sign up? Would you take it?
    That new medicine folks is called………EXERCISE”. I share this with you today as friends he said. Because trust me when I tell you, if there is one thing you do for yourself it should be this.”

    my 2 cents and from experience, nothing seems to make more of an impact in my life than exercise, clear results for body, mind and soul.
    No need to go nuts… but we must move everyday.

    Just look at the typical day for the majority.

    Wake up from a soft mattress sleep.
    Stand and make coffee
    Sit with cup of coffee and breakfast.
    Stand in shower.
    Sit in car and drive to work.
    Leave work in car sitting and sit for lunch.
    Sit at the office all day.
    Get in car, sit down, drive home.
    Sit for dinner
    Sit on the couch watch tv
    Back in the cozy soft bed for sleep
    rinse – repeat.

    No not everyone of course but YES the majority has the above schedule.


    1. And isn’t it amazing that humans can even live to be 65 while doing this their whole lives? Of course, it’s debatable to call it living while on 7 drugs, insulin and trying to get the closest parking spot at Costco.

  29. Here in the UK the NHS do have exercise referral scheme, which I believe will set you up on a heavily subsidised exercise programme

  30. Kudos to you Mark for continuing to educate and inspire so many of us on a daily basis! I think it is clear you are more motivated and less lazy than the average human. I think this topic of exercise as medicine is so important and something we need to be constantly reminded of lest it drops from our consciousness. Where is the ad budget for this? I’d love to see a corollary article summarizing what we know about diet and depression/mental health. (see, I’m lazy and I want you to synthesize the information for me). What evidence is there that having abnormal fats in diet and our lipid heavy brain leads to mental illness, neurodegenitive disorders such as dementia, parkinson’s, and MS and neurodevelopmental disorders such as ADHD and Autism? What is the deal with free glutamine and that Unblind Your Mind lady who can cure her daughters autism by removing it from her diet?

  31. Some of not exercising is overcoming inertia. There is a point where you get overweight enough and sick enough and any exercise is just plain hard and progress is snails pace slow and it hurts. It is easy to get discouraged and quit. When I started at 255 lbs I walked. I promptly blistered my feet despite good shoes within a mile and a half. I talked my dad who is still a runner in his 70’s about it and got some recommendations that included wicking socks which really helped. I exercise to be able to play harder but I started with lifelong asthma, diabetes(10 years), Hashimoto’s(5 years) and blood pressure(4 years) issues-in my early 40’s. I had the fortune of growing up going camping around 60 days a year and miss it terribly when I don’t go. Hiking was part of the camping. When I was an adult I got connected to a re-enactment group and camped up to 21 weekends a year in all weather. Currently I trail walk(because I can’t stand being cooped up indoors) or bicycle for exercise. My current goal is to be able to go backpacking in the Cascade Mountains near my home. Another goal is to go ocean kayaking. I’ve never been a team sports person and it doesn’t interest me in the slightest. My love is exploring the out of doors and fishing and camping. I figure if I am going to exercise I will do what I love. I garden and do yard work, I play with my kids and for weight lifting I pack and unpack historical camping gear(canvas pavillion and wooden take down furniture). Lately we have gotten a dog and that also gives me an excuse to walk more in the interest of taking the dog out. I haven’t lost great amounts of weight yet(only about 25 lbs), but the endo said with both the diabetes and the Hashimoto’s progress was going to be a lot slower than for a normal person. I do find I can walk further, that my strength is gradually improving, and I ache less. Even when I was my sickest and heaviest I never completely stopped walking. I needed the fresh air and time alone to think.

  32. SSRI side effects can be even worse…and they seem to run in my family. My mother shot her house while taking Wellbutrin. With a gun. Seriously. When I was in college I took Paxil briefly. Flat affect, no sex drive, no sense of humor, exhaustion- no big surprises. But then one night I heard my brain telling me how wonderful it would be to sleep out under the stars on such a clear night, completely ignoring the fact that it was below freezing and so would likely kill me. I would rather deal with anxiety attacks than be semi-suicidal!

  33. At one point in my life I was clinically depressed. The sunlight outside literally hurt to be in. I felt like everyone waiting for me in the cross-walk was thinking horrible things about me. I didn’t want to be anywhere where someone could see me. I just wanted to crawl into a little ball and wait for sleep or worse. I did force myself to take a walk every day, hurrying from patch of shade to patch of shade and avoiding busy streets. But it was not a time in my life when I was eager to take on a lot of challenges. So I don’t know how well exercise will actually work for serious depression. Even though I got some exercise it didn’t fix me.

  34. In general, I think if someone’s condition can be managed by prescription medication, some doctors will tell that person they are “healthy.” A relative is on three heart/cholesterol medications, is overweight (I would say borderline obese), and eats one of the worst diets I’ve ever encountered: zero (I mean ZERO) vegetables, mostly bread, meat, potatoes, chips, maybe an apple. He has no interest in changing his diet, claiming his taste buds are more refined. (Counterintuitive, I know – high salt, high sugar instead of “refined” taste in food).

    Yet, his doctor tells him he is healthy in spite of his diet, then hands him the scripts for his heart meds…

  35. Based on my own experiences and those of many people I know, I think that exercise can help with mild depression, but is unlikely to help with major depression.

    I can also tell you that, at least in my own life, EVERYONE tells you to exercise for depression. But motivation disappears during depression, particularly for anything that involves leaving the house or moving, and it becomes yet another obligation to feel guilty about, another way to fail. And though people were well-meaning, the unsaid message I heard when people told me to exercise was, “you’re just not trying hard enough, it’s your fault your depressed.” That’s not true, because as it turns out, what I really had was a thyroid condition.

    I absolutely love being active when I’m healthy. And I think keeping exercise in mind as part of the depression mix is a good thing to do. For those people that can keep depression at bay through maintaining an exercise routine, that is really wonderful. It’s important to be aware of the limits though, because in my experience there *are* downsides to pushing exercise too hard as a solution to depression.

    1. Yes, this! For me, in the worst of my depression, I *had* joined a gym, but every time I couldn’t manage to pry myself out of bed, that *failure* made the depression worse.

      I like that I’m starting to want to dance again, to take the long way home when I’m walking.

  36. I don’t think people are lazy. I think it’s more because we eat the wrong foods. High carb load makes us lethargic. I think Gary Taubes is absolutely correct with his assessment of laziness and overeating. I was “thin” but always lethargic and had no energy when I did show up at the gym as much as I liked working out. Since going primal, I can’t wait to go for a walk or to the gym and I hit it hard in the gym. It comes back to what we put in our bodies is the key, what we do follows it.

    We are like cars; some of us are meant to race, others are meant to haul stuff but no matter what, until we put in the right fuel, we will never be able to reach our optimal performance.

  37. I used to love being physically active. Until I developed first a knee problem, and now a back/disc problem that really limits my mobility. What do you do in such instances? I go to physical therapy but I don’t get the same rush, doing those slow, IMO boring exercises. I really miss biking, walking, skiing, etc. I can’t even engage in challenging weight training. Frustrating.

    1. Hang in there. I jogged for 30 years. I was a child athlete, racquet ball competitor, race walker, biker…strong as an ox. Suddenly I lost my strength, my flexibility and my ability to move. I can no longer run but I walk whenever I can as far as I can. It’s frustrating to be sure. Just do what you can…boring or not. It doesn’t happen over night…but don’t stop trying. Any movement is better than none.

  38. If physicians read patients ALL the side effects of the pills (like the commercials) and then presented exercise as an alternative, some might just go for a walk instead! Seriously, though, i think we put out by our body’s needs because we are no longer able to understand what it is trying to tell us.

  39. For us older women (I will be 60 this year), I think one of the problems is that when we were young we were told NOT to exercise. I graduated high school before Title IX, which guaranteed equal access to sports for women. In high school we had no sports teams for girls. Cheerleader or majorette, that was it. I would have loved to run cross country, but there was no girls team and heaven forbid a girl would be on the boys team. I remember Kathrine Switzer was pulled off the Boston Marathon route because she was a woman. A common remark back then was if you did heavy exercise or running your uterus would fall out. So no wonder older women don’t want to exercise! After college I just couldn’t stand it anymore, I had to run. They didn’t make running shoes for women so I had to buy men’s shoes. I ran for probably 20+ years until my knees started hurting. Since I thought it would be a good idea to try to preserve them for future use, I started cycling. I ride my bike to work 2-3 times per week (28 miles round trip) and go to a weight training class twice a week. The hardest part is getting out the door. I’m always glad I did it. Inertia is the enemy. It’s easier to watch TV and eat a bag of chips, but you sure don’t feel as good.

  40. My mother is 75, and walks 3 miles (minimum) a day. She always has since I can remember. She was prescribed an osteoporosis (sp?) drug awhile back (it does run in our family), but didn’t like it so she chooses to lift weights and bounce on a mini trampoline instead. He doctor is happy with her test results.
    She does eat pretty healthfully (not primal, but close – and cooks primal meals when I come over!)
    She had some minor surgery a year ago and when asked what medication she took, she replied: a vitamin D supplement and sometimes a 1/2 a baby aspirin.

    My friends parents are the same age as my mother. They are both on at least 10 different (expensive) drugs, which constantly have to be re-adjusted because they counter act with each other. Both her parents have been in and out of the hospital for heart, kidney and liver issues, and both have type ii diabetes.
    They have always looked at exercise as a burden all their lives, and could see no pleasure in it. And the fat-free “healthy” cookies were always in the house. It hurts to see her Dad in the hospital eating munchkins and processed hot chocolate as his treat. She says its genetics.
    Ha, maybe an inclination for a primal lifestyle is in the genes? I guess I hope so…

  41. Good article Mark! I am wholeheartedly with you on your exercise viewpoint.One of the great things about exercise is it gets the oxygen into your lungs and promotes energy.People with anxiety and fear are generally breathing, in a very shallow manner and are not bringing positive energy into their body.

    Anti depressant medication doesn’t suddenly make people happy.Instead it just tends to make them numb. Sitting in neutral I guess.This is not how you want to live your life.

    Better off visiting a psychologist, starting an exercise program, and surrounding yourself with beautiful nature and positive people, in my opinion.

    Keep up with the great articles.

    1. I went through a traumatic experience in my life and ended up on antidepressants. Feeling numb was a distinct improvement. It enabled me to function to the point where I could dig myself out. After six months I felt better and ditched the antidepressants. In that time period I lost 55lbs from extreme stress and heartache.

    2. Respectfully, while my antidepressant did not “suddenly make me happy,” it did not leave me numb. That may have been your experience or the experience of someone you know, but until I started on a course of antidepressents *and* therapy, I hadn’t felt anything in years that wasn’t some version of self-loathing, misery, and despair.

  42. Maybe, just maybe the massive, lucrative pharmalogical industry and the benefits they can provide doctor’s practices help determine the doctor’s treatment.

  43. This is very interesting. I love your work, and strive to follow it every day. At 45, people don’t believe it when they see me eating dark chocolate, or when I deny the allegation that I exercise every day. Regrettably, however, I have suffered depression. Despite doing all the “right” things. for me, exercise was actually one of the stressors. You see, 50 triathlons, including a couple of ironmen (pre-primal lifestyle) affected me self-perception. Kids come along, work gets serious, sleep becomes a luxury, but you’re still getting up early to run/swim/bike…. until you can’t. And then, even when you’re advised to give it a rest you can’t. After all, exercise is a cure for depression….you get the picture.

    Like all medecine, look at the dosage…..

  44. I found your site when I decided to take control of my mental health as meds and hospitalization have not helped. What I heard from alot of posts is that lazy people and drs grab meds as a first. Most mental health symptoms, like mine, is feeling so low that death is welcomed. Not having the option to get out of bed let alone go for a walk. Meds can and do achieve relief. Minor relief, but relief. After that, nutrition and working up to exercise is what is important. This article is accurate but not understand the complexities of mental health disorders cause misconception.

  45. I haven’t read whole article yet…

    however some of the side effects of SSRIs included weight gain… weight LOSS or anorexia is a more common side effects…weight gain may actually be associated with well being returning and people gaining weight healthily due to a lifted mood and increased appetite…

    don’t forget serotonin syndrome, potential very dangerous… and QT interval prolongation too with some medications.

    so the combination of ‘strenuous exercise’ with SSRIs may be a risk… just my two penny.


  46. Good advice not followed is bad advice. The fact that exercise does all of this is irrelevant to the fact that most people don’t do it. So doctors can either give advice that they KNOW will not be followed. Or they can treat with drugs. So they do the latter.

    As well, when you’re really depressed, the LAST thing you want to do is exercise. So the fact that it might help is pretty much wholly irrelevant.


  47. I have tested this and confirmed!

    From age 8 to 14 I suffered from sinusitis and bronchitis, asthma. I weighed 210 lbs. Then lost 65lbs and suddenly I was cured of these respiratory problems I had for years. I eventually became more active and have been much stronger.

  48. In a nutshell,
    We have a food industry that doesn’t care about health. And a health industry that doesn’t care about food.

  49. As far as I’m concerned the diet is more important than exercising. There are so many things that can cause us not to exercise any given day which a proper paleo style diet will at the very least keep our weight down. I personally struggle to exercise on a consistent basis and it seems to go in cycles of a couple months on and a month off but at 56 years of age I believe I’m in better shape than most 36 year olds. I credit the paleo diet that will maintain my health long enough so when I do get back into my exercise regimen it doesn’t take long for me to sprint like a 20 year old or do 20 (real) pull ups. I do believe that exercise can do everything Mark mentions and that he and many of the people on this forum are a testament to exercise, but the one constant for me is the food I eat.

  50. yep. i do not exercise, i forgot to take my fish oil and i feel the depression coming back. if i am depressed i have no will to exercise . always on the line..

  51. Thanks for linking the Atlantic article. I couldn’t agree more that exercise beats any sort of antidepressant pill at least 90% of the cases. I haven’t had any good experiences to report from antidepressants, for me they only made things worse. But I guess that’s how we are as humans; we like to believe that we can replace the benefits of natural body movement with a pill we designed and engineered.
    Excellent post, I’ll make sure to share it with my friends

  52. what if you’re a regular exerciser, a lover of sports, and a primal eater and follower of the lifestyle and STILL suffer from regular bouts of depression, low energy and anxiety?

    1. Check to see if you need some probiotics. Too much yeast overgrowth will cause all three – depression, anxiety and low energy.

  53. it’s the medical model. This model also ‘serves’ many people. For example, the medical companies and their lobbyists and the politicians. It does not ‘serve’ the people. There is a lot of business in disease and the system supports it. When the system rewards health, then exercise will be used as a prescription for depression.

  54. I think the spiritual aspect of exercising is often neglected. It’s an activity that requires you to focus on the present moment to some extent. When that is the case, the mind stops wandering, something that is one of the chief reasons behind depression and anxiety. Whenever the mind wanders, we always think of situations which we “want’ to have, but are out of our hands at the moment. We are not one with reality. Exercise results in elimination of this chatter, even if it’s for a short while. It’s like a meditative experience, which is very relaxing for the mind.

    This is one of the reasons why we should do exercises that we like to do, because when you enjoy the activity, you’re likely to go deeper into the aforementioned meditative state.