Chapter 1What Is Movement?If you asked me what movement means to me, to describe it so even a child could understand, I would start by saying this: Movement means to me exactly the same things it means to you.
There is no difference between me, a sports medicine physician who competes in triathlons and leads fitness classes, and you. Movement is the same for every human being.
This chapter, part science, part emotion, part experience, is the best explanation of movement I know.
Movement Is LifeIt would be easy for me to say something glib like “If you ain’t movin’, you ain’t livin’,” but there’s truth in that cheesy statement, both literally and metaphorically.
How does a medical professional determine a human being is alive? Movement. Chest up and down from respiration. Vibrations in the chest and wrist and throat from a pumping heart and flowing blood. Pupillary response when light hits the eyes. In a hospital setting, numbers on monitors rise and fall, ECGs illustrate cardiac activity (activity being movement), EEGs measure brain activity, and those old-school blood pressure cuffs have a hand pump and a needle jumping all around a circular gauge.
What do doctors say in certain situations when a patient is unconscious? Squeeze my hand or wiggle your toes. And what’s one of the first things those wonderful hospital pros will have you do as soon as possible after a surgery or trauma or enough healing has happened?
Get up and move. Stand. Go to the toilet on your own. Walk down the hall and back. Bathe.
In my own practice, I often ask patients to move their limbs in a variety of ways, depending on their injury, so I can assess how severe the problem may be.
Movement is foundational to everything human beings do, to who and what we are.
Movement is the ordinary—taking laundry upstairs, chasing a toddler, pushing a mower—intertwining with the extraordinary—giving birth, crossing a finish line, a heart beating for more than ninety years straight.
It’s foundational: the very bedrock of our lives, on the same level as eating, sleeping, and breathing. And it’s perhaps even more foundational than those three things, since moving with purpose each day makes all your eating, sleeping, and breathing more efficient and healthier.
When you abandon movement, your life’s foundation deteriorates. It is as inevitable as water seeping into cracks in concrete.
Think back to the three-year-old. The time when movement meant joy.
When we stop moving, the joy dies. We die.
Movement Is MedicineI’m a doctor who regularly prescribes physical activity to my patients. Movement is by far the best medicine I know—so much so that I joined forces with colleagues from the Hospital for Special Surgery to create one of the first seminars to teach medical students, physicians of the future, how to prescribe exercise for their patients. Our seminar, “Prescribing the Medicine of Movement,” is now required curriculum for second-year medical students at Cornell Medical School.
Why not say “Movement is health”? Because not everyone is healthy, but they can still move. People with injuries, limitations, and disabilities can move in different ways to make themselves stronger. Movement itself is not health—it is a sign of health and can be the path to better health. That’s what I prescribe, that’s what I aid and abet, that’s what I see every day.
This medicine is also free, requires no trip to the pharmacy and no insurance company sign-off, has no negative side effects (sore muscles don’t count, sorry), and can be taken as often as you like (infinite refills!). Oh, and if you take this medicine regularly, you eventually may be able to decrease or stop taking other medications for health issues that improve. That’s right: More of this medicine can sometimes lead to less of other medicines.
How many health problems can movement help address? The actual number may not be known, but here’s a sampling: heart disease, dementia/Alzheimer’s, certain cancers, osteoarthritis, depression (exercise has long been known as “nature’s antidepressant”), type 2 diabetes, prediabetes/metabolic syndrome, fatty liver, hypertension, high cholesterol, autoimmune disorders, osteopenia/osteoporosis, ADHD, sleep apnea, anxiety, asthma, menopause symptoms, low back pain, erectile dysfunction, stress, and more. We are now learning that these changes in body systems described above correlate to cellular changes: maintaining telomeric length, improving mitochondrial volume and function, even reducing genomic instability. These types of cellular changes provide an even-greater appreciation of the major health benefits from moving every day. The changes that we can see, and the changes happening inside our cells, are profound.
Let’s simplify this further. The biggest health threat we face isn’t cancer or heart disease. It’s low fitness. A sedentary life—the life more and more of us are living—promotes all diseases. A growing pile of research shows that low fitness causes more premature deaths than smoking, obesity, and high blood pressure. And very little exercise is required to achieve benefits. In one study of 334,000 Europeans, the people who enjoyed the greatest benefits of exercise—a 16 to 30 percent drop in mortality risk—were the ones who went from inactive to moderately inactive. This doesn’t mean you’re running a marathon; it means you’re getting out and doing something active for about half an hour a day.
Exercise Is Medicine for High Blood PressureA 2023 meta-analysis of 270 studies covering sixteen thousand people in the British Journal of Sports Medicine found that physical activity had a significant improvement on blood pressure.
• People with normal blood pressure saw benefits, but those with hypertension saw the largest improvement in blood pressure.
• All forms of exercise tested were effective: aerobic, strength training, combined aerobic/strength training, high-intensity interval training (HIIT), and isometric training (grip strength, leg extensions, wall squats).
• Isometric exercises were most effective. Why? Researchers suggest that movements like wall squats, where you hold in the seated position for an extended period, involve longer muscle contraction, which can reduce blood flow in the muscles. When the muscles relax, blood rushes back in causing a process called “reactive hyperemia,” which produces nitric oxide in the body and relaxes blood vessels. Over time, this can improve blood pressure.
• One last pretty important detail: Exercise has been shown to be comparable to medication in reducing blood pressure.
Why is inactivity so destructive? Many reasons, all bad. The pandemic ripped away the curtains on a number of societal problems we haven’t addressed, and one of the biggest is our low fitness and poor physical condition in general. The most damaging comorbidities of the pandemic are obesity and its associated health problems, plus a lethal attraction to our lungs. People with deconditioned lungs and unmanaged weight-related health issues had more severe infections and higher death rates. People who were in better physical condition fared better.
Copyright © 2026 by Jordan D. Metzl, MD. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
