Making the Connection

WE ALL KNOW that exercise makes us feel better, but most of us have no idea why. We assume it’s because we’re burning off stress or reducing muscle tension or boosting endorphins, and we leave it at that. But the real reason we feel so good when we get our blood pumping is that it makes the brain function at its best, and in my view, this benefit of physical activity is far more important — and fascinating — than what it does for the body. Building muscles and conditioning the heart and lungs are essentially side effects. I often tell my patients that the point of exercise is to build and condition the brain.

In today’s technology-driven, plasma-screened-in world, it’s easy to forget that we are born movers — animals, in fact — because we’ve engineered movement right out of our lives. Ironically, the human capacity to dream and plan and create the very society that shields us from our biological imperative to move is rooted in the areas of the brain that govern movement. As we adapted to an ever-changing environment over the past half million years, our thinking brain evolved from the need to hone motor skills. We envision our hunter-gatherer ancestors as brutes who relied primarily on physical prowess, but to survive over the long haul they had to use their smarts to find and store food. The relationship between food, physical activity, and learning is hardwired into the brain’s circuitry.

But we no longer hunt and gather, and that’s a problem. The sedentary character of modern life is a disruption of our nature, and it poses one of the biggest threats to our continued survival. Evidence of this is everywhere: 65 percent of our nation’s adults are overweight or obese, and 10 percent of the population has type 2 diabetes, a preventable and ruinous disease that stems from inactivity and poor nutrition. Once an affliction almost exclusively of the middle-aged, it’s now becoming an epidemic among children. We’re literally killing ourselves, and it’s a problem throughout the developed world, not merely a province of the supersize lifestyle in the United States. What’s even more disturbing, and what virtually no one recognizes, is that inactivity is killing our brains too — physically shriveling them.

Our culture treats the mind and body as if they are separate entities, and I want to reconnect the two. The mind-body connection has fascinated me for years. My very first lecture, to fellow medical professionals at Harvard, in 1984, was titled “The Body and Psychiatry.” It focused on a novel drug treatment, for aggression, that affected both the body and the brain, which I stumbled on as a resident working in the Massachusetts state hospital system. My experience working with the most complicated psychiatric patients set me on a path of investigation into the ways in which treating the body can transform the mind. It’s been an enthralling journey, and though it continues, it’s time to deliver that message to the public. What neuroscientists have discovered in the past five years alone paints a riveting picture of the biological relationship between the body, the brain, and the mind.

To keep our brains at peak performance, our bodies need to work hard. In Spark, I’ll demonstrate how and why physical activity is crucial to the way we think and feel. I’ll explain the science of how exercise cues the building blocks of learning in the brain; how it affects mood, anxiety, and attention; how it guards against stress and reverses some of the effects of aging in the brain; and how in women it can help stave off the sometimes tumultuous effects of hormonal changes. I’m not talking about the fuzzy notion of runner’s high. I’m not talking about a notion at all. These are tangible changes, measured in lab rats and identified in people.

It was already known that exercise increases levels of serotonin, norepinephrine, and dopamine — important neurotransmitters that traffic in thoughts and emotions. You’ve probably heard of serotonin, and maybe you know that a lack of it is associated with depression, but even many psychiatrists I meet don’t know the rest. They don’t know that toxic levels of stress erode the connections between the billions of nerve cells in the brain or that chronic depression shrinks certain areas of the brain. And they don’t know that, conversely, exercise unleashes a cascade of neurochemicals and growth factors that can reverse this process, physically bolstering the brain’s infrastructure. In fact, the brain responds like muscles do, growing with use, withering with inactivity. The neurons in the brain connect to one another through “leaves” on treelike branches, and exercise causes those branches to grow and bloom with new buds, thus enhancing brain function at a fundamental level.

Neuroscientists have just begun studying exercise’s impact within brain cells — at the genes themselves. Even there, in the roots of our biology, they’ve found signs of the body’s influence on the mind. It turns out that moving our muscles produces proteins that travel through the bloodstream and into the brain, where they play pivotal roles in the mechanisms of our highest thought processes. They bear names such as insulin-like growth factor (IGF-1) and vascular endothelial growth factor (VEGF), and they provide an unprecedented view of the mind-body connection. It’s only in the past few years that neuroscientists have begun to describe these factors and how they work, and each new discovery adds awe-inspiring depth to the picture. There’s still much we don’t understand about what happens in the microenvironment of the brain, but I think what we do know can change people’s lives. And maybe society itself.

Why should you care about how your brain works? For one thing, it’s running the show. Right now the front of your brain is firing signals about what you’re reading, and how much of it you soak up has a lot to do with whether there is a proper balance of neurochemicals and growth factors to bind neurons together. Exercise has a documented, dramatic effect on these essential ingredients. It sets the stage, and when you sit down to learn something new, that stimulation strengthens the relevant connections; with practice, the circuit develops definition, as if you’re wearing down a path through a forest. The importance of making these connections carries over to all of the issues I deal with in this book. In order to cope with anxiousness, for instance, you need to let certain well-worn paths grow over while you blaze alternate trails. By understanding such interactions between your body and your brain, you can manage the process, handle problems, and get your mind humming along smoothly. If you had half an hour of exercise this morning, you’re in the right frame of mind to sit still and focus on this paragraph, and your brain is far more equipped to remember it.

Everything I have written over the past fifteen years has been aimed at educating people about their brains. Your life changes when you have a working knowledge of your brain. It takes guilt out of the equation when you recognize that there’s a biological basis for certain emotional issues. On the other hand, you won’t be left feeling helpless when you see how you can influence that biology. This is a point that I keep coming back to with my patients, because people tend to picture the brain as a commander mysteriously issuing orders from an ivory tower, untouchable from the outside. Not at all. Exercise breaks down those barriers. My hope is that if you understand how physical activity improves brain function, you’ll be motivated to include it in your life in a positive way, rather than think of it as something you should do. Of course you should exercise, but I won’t be preaching here. (It probably wouldn’t help: experiments with lab rats suggest that forced exercise doesn’t do the trick quite like voluntary exercise.) If you can get to the point where you’re consistently saying to yourself exercise is something you want to do, then you’re charting a course to a different future — one that’s less about surviving and more about thriving.

In October of 2000 researchers from Duke University made the New York Times with a study showing that exercise is better than sertraline (Zoloft) at treating depression. What great news! Unfortunately, it was buried on page fourteen of the Health and Fitness section. If exercise came in pill form, it would be plastered across the front page, hailed as the blockbuster drug of the century.

Other fragments of the story I’m presenting bubble to the surface, only to sink back down. ABC World News reports that exercise might stave off Alzheimer’s disease in rats; CNN flashes stats on the ever-expanding obesity crisis; the New York Times investigates the practice of treating bipolar kids with costly drugs that are only marginally effective yet carry horrendous side effects. What gets lost is that these seemingly unrelated threads are tied together at a fundamental level of biology. I’ll explain how, by exploring volumes of new research that hasn’t yet appeared anywhere for the general public.

What I aim to do here is to deliver in plain English the inspiring science connecting exercise and the brain and to demonstrate how it plays out in the lives of real people. I want to cement the idea that exercise has a profound impact on cognitive abilities and mental health. It is simply one of the best treatments we have for most psychiatric problems.

I’ve witnessed this among my patients and my friends, a number of whom have given me permission to tell their stories here. Yet it was far beyond the walls of my office that I discovered the exemplar case study, in a suburban school district outside Chicago. The implications of the most exciting new research merge in this tale of a revolutionary physical education program. In Naperville, Illinois, gym class has transformed the student body of nineteen thousand into perhaps the fittest in the nation. Among one entire class of sophomores, only 3 percent were overweight, versus the national average of 30 percent. What’s more surprising — stunning — is that the program has also turned those students into some of the smartest in the nation. In 1999 Naperville’s eighth graders were among some 230,000 students from around the world who took an international standards test called TIMSS (Trends in International Mathematics and Science Study), which evaluates knowledge of math and science. In recent years, students in China, Japan, and Singapore have outpaced American kids in these crucial subjects, but Naperville is the conspicuous exception: when its students took the TIMSS, they finished sixth in math and first in the world in science. As politicians and pundits sound the alarm about faltering education in the United States, and about our students being ill-equipped to succeed in today’s technology-driven economy, Naperville stands out as an extraordinary bit of good news.

I haven’t seen anything as uplifting and inspiring as Naperville’s program in decades. At a time when we’re bombarded with sad news about overweight, unmotivated, and underachieving adolescents, this example offers real hope. In the first chapter, I’ll take you to Naperville. It is the spark that inspired me to write this book.