Why Exercise Is the Most Important Pillar of Brain Health
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I want to talk to you about the single most important thing you can do for your brain.
In my work as a neurologist, I describe five pillars of brain health: fitness, sleep, nutrition, mindset, and brain training. Each of them matters. Each of them, done well, makes your brain measurably stronger. But they are not equal, and by far the most important pillar of brain health is exercise and fitness.
I know that “exercise is good for you” sounds like advice you have heard a thousand times. What most people have never heard is why, what actually happens inside your brain and your cells when you move your body. Once you understand the biology, exercise stops being a chore on your to-do list and becomes more like a superpower.
Let me walk you through it.
Tiny Factories Power Your Cells, and You Can Build More of Them
Inside every one of your cells are small structures called mitochondria. Think of them as tiny factories that generate ATP, the energy currency of your body. Everything you do requires ATP. Your brain runs on it. So does your heart, your kidneys, your muscles, your skin. Nothing in your body works without the energy these little factories produce.
Here is the part that should concern you: with aging, both the number and the function of your mitochondria decline with every decade of life. It is one of the quiet engines of aging, operating silently in the background, long before you feel any difference.
And here is the part that should excite you: exercise reverses that decline.
When you exercise, you increase the number of mitochondria inside your cells. More factories. More energy. More capacity in every organ of your body, including your brain. If you want to rejuvenate every cell in your body at the most fundamental level, this is how you do it. And the best way to build more mitochondria is to build your fitness stamina.
More Blood Vessels, More Oxygen, More Nutrition
The second thing exercise does is expand your brain’s supply lines.
Physical activity increases the number of capillaries, the small blood vessels that deliver blood throughout your brain, your retina, your skin, and every other organ. More vessels mean more blood flow. More blood flow means more oxygen and more nutrition reaching every cell in your body.
Your brain is one of the most metabolically demanding organs you have. It depends, moment to moment, on a rich and steady supply of oxygen and nutrients. When you exercise regularly, you are literally upgrading the infrastructure that feeds it.
Exercise Grows the Part of Your Brain That Remembers
The third effect is, to me, the most remarkable of all.
Deep inside your temporal lobe sits a structure roughly the size of your thumb called the hippocampus. It is the ground zero for learning and memory in your brain. And when you exercise, you increase the number of neurons and synapses inside your hippocampus.
Let that sink in. Physical movement, walking, swimming, dancing, and playing tennis, causes new brain cells and new connections to form in the exact region that determines how well you learn and remember.
The downstream benefits are exactly what you would expect. People who exercise have a larger hippocampus and a larger cortex. They have better memory. They sleep better and enjoy a better mood. They are far less likely to develop Alzheimer’s disease decades later and less likely to suffer heart attacks and strokes along the way.
There are very few things in medicine I would call a no-brainer. Exercise is one of them.
The One Number That Predicts Your Brain’s Future
So what does it actually mean to be “fit”?
Fitness means stamina and endurance. How many flights of stairs can you climb? How far can you walk without stopping? These everyday questions point to something we can measure precisely, a number called VO2 max.
VO2 max is the total amount of oxygen your body can consume at peak exercise, usually measured in milliliters of oxygen per minute per kilogram of body weight. It is the gold-standard measure of cardiovascular fitness and endurance.
And it turns out to be far more than a fitness statistic. People with a higher VO2 max have more mitochondria in their cells, a bigger hippocampus, and a far lower likelihood of developing Alzheimer’s disease. It is a remarkable measurement, a single number that can tell you, today, what is likely to happen to your brain in the future.
You can measure your VO2 max precisely at a gym or a doctor’s office. But there are also simple ways to estimate it: walk one or two miles, then record your time, your heart rate, and your weight, and calculate your approximate VO2 max. I strongly recommend that you measure it and use that number as your baseline. What gets measured gets improved.
How to Build Your Fitness: The Right Way
If you have not been active, the path forward is simpler than you think. Here is what I tell my patients:
Start slowly. Do not go from nothing to a lot in one week. Begin with walking, and increase the amount of exercise you do on a weekly basis. Gradual, consistent progress is what builds mitochondria and what prevents injury and burnout.
Be persistent and win the first step. Some mornings, you will wake up and not feel like going for a walk. Do not negotiate with that feeling. Just get up and go. Once you have put your shoes on and stepped outside, the rest is easy. The first step is the difficult part; everything after it takes care of itself.
Find the exercise you actually like. If you don’t enjoy the gym, don’t go to the gym, go for a walk. If you don’t like running, play tennis. If you don’t like tennis, take dancing lessons. Do something you genuinely enjoy, because the best exercise is the one you will still be doing three months from now. Remember: the more active you are, the more mitochondria you generate.
My Prescription
Exercise is the most important thing you can do for your brain, and you need to do it every day.
My recommendation is simple: remain active every single day. Walk 5,000 steps or more as much as you can. Get at least three hours of real exercise each week, and make sure it is something you enjoy.
Do this consistently, and you will be doing the best possible service for your brain and your body. You will live longer. And you will stay sharp well into your 80s and 90s.
Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.
📺 Watch the full video on Dr. Fotuhi’s YouTube Channel.
Keep up with Dr. Fotuhi on LinkedIn & Instagram.
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AI Is Changing Your Brain, Here's How.
How many days do you think it takes to start losing a skill you’ve had for decades?
For me, the answer was three.
A few weeks ago, I got into a self-driving car for the first time and let it take me around my town. It was smooth. It was relaxing. And honestly, it was a little bit magical. I sat there with my hands barely on the wheel, watching the car make its own decisions.
Three days later, I got behind the wheel of my own car again. This time with no assistance. Just me. And something felt off. It was slightly difficult to manage the heavy traffic on a busy highway. My sense of the road felt a little rusty.
It had only been three days, and I could already feel the difference.
That small moment stuck with me. Because as a neurologist who has spent forty years studying the brain, I knew exactly what was happening. My brain had not lost the skill of driving. But the parts of my brain responsible for it had quietly relaxed, because for three days they simply did not have to work that hard.
Negative Neuroplasticity: The Part Nobody Talks About
This is what I call negative neuroplasticity.
Your brain is not fixed. It is not a piece of hardware that stays the same your whole life. Your brain is living tissue, and it changes its shape, its structure, and its strength based on how you use it every single day.
Think of your brain like a muscle. If you work your biceps and triceps, they grow. If you stop using them, they shrink. Your brain grows and shrinks in the same way, in response to your lifestyle and your environment. The parts you use and challenge often get stronger. That is positive neuroplasticity. The parts you stop using quietly fade and shrink. That is negative neuroplasticity.
And we have seen this before, long before AI arrived.
When calculators became common, our collective ability to do math in our heads got weaker. When GPS became common, our sense of direction got weaker too. So here is the honest question all of us need to ask: if AI can now write our emails, solve our problems, remember our facts, and even drive our cars, what happens to the parts of our brains that used to do all of that work?
What the Research Is Starting to Show
There is new research beginning to answer that question, and the results are worth paying attention to.
In one study, researchers had people write essays in one of three ways: completely on their own, using a search engine, or using ChatGPT. The whole time, machines measured their brain activity. The group that used ChatGPT showed the weakest brain engagement of the three. And afterward, many of them could barely remember what they had just written, because in a very real sense, they had not actually written it themselves.
We are seeing the same pattern in medicine.
In one study, experienced doctors used an AI tool to help them spot polyps during colonoscopies. After they grew used to working alongside the AI, their detection rate without it actually dropped, compared to how they performed before they ever used the tool. These were skilled physicians, quietly losing a bit of their edge, simply because the tool had been doing that part of the thinking for them.
To me, this all makes perfect sense. The activity in the parts of our brain that we stop using and challenging gradually fades away.
This Is Not About Fearing AI
I want to be very clear about something, because this is not a message about fearing AI or rejecting it.
I use AI every single day. I think of it almost like one of my staff members. I let it handle the tedious, minor parts of my work, the things that do not require my judgment or my creativity. But I still do the hard thinking myself. The writing. The decisions. The real work. Because I know that “use it or lose it” applies to my brain just as much as it applies to my muscles.
Here is the strange thing. We already understand this instinct perfectly well when it comes to our bodies. We just have not caught up yet when it comes to our brains.
Think about how life used to require constant movement. People walked to work. They rolled their windows up with their own hands. They pushed in a clutch and changed gears with their own feet, over and over, every time they drove. All of that built-in movement quietly kept our bodies strong, without anyone ever thinking of it as exercise.
Today, machines do almost all of that work for us. We press a button, and the window rolls up. We slide into an automatic car and never touch a gear again. And what did we do as a society, once daily life stopped giving us that movement for free? We built gyms. We started going to Zumba classes, yoga classes, and Pilates. We began taking long walks on purpose, specifically to give our muscles the workout that daily life no longer provided automatically.
This is exactly the position we are now in with our brains.
AI is quietly becoming the automatic window button and the automatic transmission for our minds. It removes the friction, and it feels wonderful in the moment. But if we are not careful, we are quietly losing the mental exercise that daily life used to give us for free, when we had to remember phone numbers, do math, navigate our own cities, and write our own thoughts from a blank page.
Six Ways I Build a Gym for My Own Brain
So, just as we built gyms for our bodies once our environment stopped providing free exercise, we now need to build a gym for our brains. These are small, deliberate exercises we choose on purpose, precisely because daily life no longer forces us to do them.
Here are six exercises I personally do. Not because I read them in a textbook, but because I know they are important for keeping my own brain sharp.
1. I minimize using GPS on purpose: When I am driving somewhere I have been before, I make myself recall the way, even if it takes an extra moment of thinking. That small effort keeps my hippocampus and other memory areas active and engaged.
2. I memorize names: I work to remember the names of all my students and every person I meet, every single day. Holding a name in my mind and pulling it back later sounds almost too simple to matter. But that daily repetition is exactly what keeps my memory strong, the same way a short walk keeps my heart healthy.
3. I protect at least one block of deep, unassisted thinking: No AI, no shortcuts. Just my own mind, working hard on a project from beginning to end.
4. I keep authorship of anything that truly matters. I let AI carry the tedious, minor parts of my work, but the real writing, the real decisions, and the real thinking stay mine.
5. I take up hobbies that challenge my mind: Learning new dance steps is at the top of my list, and this one is for pure joy as much as it is for my brain. I am willing to bet you already have a small wish list in the back of your mind, something you have always wanted to learn from scratch or finally get better at. The science is clear that a new, challenging skill grows your brain in a matter of weeks. So pick the one hobby that sounds the most fun, and enjoy practicing it until you get really good at it.
6. I use AI to challenge me, not replace me: After I write an essay or prepare a presentation, I ask AI to critique my work and push back on it. I also use AI as a tutor when I need to understand something complex. In other words, I use AI to stimulate my brain, not to replace it.
The Brain You Have Is the Result of Your Daily Choices
So here is what I want to leave you with.
AI is not going to make you stupid. But how you use it will absolutely shape whether your brain stays sharp or slowly grows weaker.
Your brain, like your body, becomes what you ask of it every single day. The brain you have, sharp or dull, strong or weak, is the result of your daily choices. Just as the shape of your body is in your hands, so is the shape of your brain.
Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.
📺 Watch on Dr. Fotuhi’s YouTube Channel.
How Ai is slowly destroying your brain health – Dr. Fotuhi
What Is a Brain Portfolio?
Let me start with a simple question.
If you were managing a $10 million investment portfolio, would you put all of it into a single stock?
Of course not. You would diversify. You would spread your money across different types of assets. You would manage your risk, monitor your performance, and make adjustments over time. That is simply what anyone serious about money does.
Now I want you to think about your brain the same way.
Your Brain Is an Asset
Your brain is an asset too. In fact, it may be the single most important asset you have. It allows you to think, make decisions, solve problems, lead your organization, manage your finances, and maintain your relationships.
And yet most of us do not manage our brain the way we manage a financial portfolio. Instead, we wait. We wait until there is a problem. We wait until our memory starts to slip, or until we are exhausted, stressed, and burned out. And only then do we ask, “What can I do about it now? Do I have early signs of Alzheimer’s disease?”
I believe we should approach brain health very differently. We should look at the brain the way we look at a financial portfolio. I call it your brain portfolio.
Just as a financial portfolio has different asset classes, your brain portfolio has five major assets: exercise, sleep, diet, stress management, and brain training.
And the key idea, the one I want you to hold onto, is diversification. You do not want to pour all of your brain health investment into a single area. Exercise is extremely important, but exercise alone is not enough. A good night’s sleep is important, but sleep alone is not enough. Eating well is important, but diet alone is not enough. You need to invest across all five. Each one contributes something different, and together they build a far stronger brain.
Let me walk you through each asset.
Asset One: Exercise
Think of exercise as one of the highest-performing assets you have.
When you exercise, you are not simply strengthening your muscles and your heart. You are increasing blood flow to the brain, supporting the growth and maintenance of brain connections, and helping to regulate blood pressure, glucose, and inflammation, all of which matter for optimal brain health.
Exercise also helps grow new neurons in the hippocampus, the memory center of your brain. And it strengthens the frontal lobes, the regions critical for emotional regulation and decision-making.
So exercise is not just a fitness investment. It is an important investment in your brain capital.
Asset Two: Sleep
Sleep is your brain’s maintenance department.
While you sleep, your brain is not shutting down. During deep sleep, your brain clears out the metabolic waste that accumulates throughout the day. This remarkable cleaning and rinsing process is your brain’s waste management system. At the same time, the parts of your brain responsible for consolidating memories, regulating emotions, and making decisions are refreshed and restored.
If you consistently under-invest in sleep, eventually you pay the price. The waste that does not get rinsed out accumulates night after night, week after week, year after year. Over time, that buildup contributes to significant brain shrinkage.
Regularly sleeping fewer than six hours a night carries serious long-term consequences, including an accelerated risk of developing Alzheimer’s disease.
Asset Three: Diet
I think of diet as the raw material your brain uses every single day.
Your brain requires energy, essential fats, vitamins, minerals, and other nutrients to function properly. A good diet provides the building blocks for your brain cells and blood vessels.
So when you choose what to eat, you are not simply deciding what goes into your stomach. You are deciding what resources you are providing to one of the most valuable organs in your body. You are supplying the raw material your brain needs to function at its peak.
Asset Four: Stress Management
Your fourth asset is stress management, and I think of it as risk management for the brain.
Some stress is normal and even healthy. But chronic, unmanaged stress can become a major risk factor for both mental and physical health.
You do not need to eliminate every stressful situation, which is neither possible nor the goal. What you need is to reduce stress where you can and learn to manage the rest effectively. That means learning how to recover from stress: creating periods of calm, maintaining meaningful relationships, and making sure your brain has enough time to recharge.
Asset Five: Brain Training
The fifth asset is brain training, and here the rule is simple: your brain is a use-it-or-lose-it organ.
When you learn something new, you challenge your attention and stimulate the parts of your brain responsible for problem-solving. When you play music or take on intellectually demanding activities, you give your brain the chance to build new neural networks.
The regions you stimulate with new hobbies and new learning, such as picking up a new language, literally grow larger. It works just like your muscles, which grow in proportion to how much you challenge them with exercise.
Your brain remains an active, adaptable asset throughout your entire life, not just in childhood. You can expand and grow your brain at any age.
The Real Power Is in the Portfolio
Here is the part that matters most. These five assets do not operate independently. They interact.
Exercise can improve your sleep. Better sleep improves your attention and emotional regulation. A healthy diet supplies the energy and nutrients your brain needs to function well. Stress management improves both your sleep and your decision-making. And brain training gives your brain the stimulation it needs to stay adaptable.
The real power comes from the portfolio as a whole.
This is exactly how we think about financial diversification. We do not ask, “Which single stock will make me rich?” We ask, “How can I build a diversified portfolio that performs well and manages risk over time?”
We should ask the same question about our brains: How can I build a diversified brain portfolio that helps me maintain my memory, focus, creativity, resilience, and independence as I grow older?
Monitor, Rebalance, and Start Now
There is one more principle from finance worth borrowing. You need to monitor your portfolio.
You do not invest once and forget about it. You review your performance, identify your weaknesses, rebalance, and make adjustments when your circumstances change. The same should be true for your brain health.
Maybe your exercise is strong, but your sleep is weak. Maybe your diet is excellent, but you are carrying too much chronic stress. Maybe you are physically active but intellectually under-stimulated.
The goal is not perfection. The goal is balance.
And you may be wondering when the best time is to start paying attention to your brain portfolio. The answer is now. When it comes to your brain, prevention is a far better strategy than waiting for a major problem to appear.
A Note for Executives and Leaders
For executives, business leaders, and CEOs, I think this concept is especially important.
You spend your professional life managing financial assets, human capital, operational risk, and long-term growth. But none of those assets matter very much if your own brain is not functioning at its peak. Your brain is the executive system behind every single decision you make.
So I encourage you to think about your brain the same way you think about your financial portfolio. Diversify. Invest consistently. Manage your risk. Monitor your performance. And rebalance when necessary.
Your brain is not simply another organ in your body. It is the most important asset you have, and it is built to grow and expand throughout your life.
Look into the five pillars of your brain health and build a brain portfolio that will last you a lifetime. The earlier you start, the more likely you are to enjoy strong cognitive returns for many years to come.
That is how you become not just a successful executive, but a brain super ager.
Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.
📺 Watch the full video on Dr. Fotuhi’s YouTube channel
Falling in Love Is a Brain Function
“I love you from the bottom of my heart.”
We have all said it, or heard it. It is one of the oldest ways we express love, and most of us never stop to question it. We imagine that love lives deep in our heart.
But here is the surprising truth: your heart is made up of muscle, and it is not capable of experiencing emotions. Love does not begin in your heart. Love begins in your brain.
Let me explain what actually happens.
The Message Starts in Your Brain and Ends in Your Chest
The feeling of love emerges from the interactions of several brain areas the regions that handle emotion, motivation, reward, and social bonding. When you fall in love with someone, these areas glow with activity. They, in turn, stimulate the part of your brain that regulates hormones in your blood, such as adrenaline.
The adrenaline then makes your heart beat faster. That is why, when you see someone you love, your heart pounds.
The message begins in your brain and ends up in your heart. You cannot feel the glowing of activity in your brain, but you can feel the pounding of your heart in your chest. And so, understandably, we have spent centuries believing it is the heart that sparks with love.
Every Emotion You Feel Is Built by Your Brain
I am a neurologist, and I have spent much of my career studying the brain, mostly at Johns Hopkins and Harvard Medical School. One thing that never stops amazing me is this: every emotion we experience fear, joy, excitement, pride, sadness is created by the brain.
Different emotions involve different groups of brain regions working together as a network. Love is no exception. In fact, love gives us a beautiful window into how the human brain works when it comes to bonding and forming lasting relationships.
Feelings of love also engage the dopamine reward and motivation system. It is the activity of dopamine pathways in the brain that leads to the pleasure, joy, excitement, and motivation that make you want to keep seeing the person you love, over and over again.
What Scientists Saw Inside the Brain of Someone in Love
The research that uncovered this is fascinating.
Helen Fisher and her colleagues studied people who were intensely in love. While these volunteers lay inside a brain MRI scanner, the researchers showed them photographs of the person they loved. Something remarkable happened. The dopamine-rich areas deep inside the brain, including a region called the ventral tegmental area, or VTA, became intensely more active.
That surge of dopamine is what gives you the intense sense of pleasure about the person you love, and it is what motivates you to want to be near them at all times.
Animal studies help us understand the biology of love and lasting relationships even further. Prairie voles are small, monogamous rodents that form long-lasting pair bonds. Researchers have found that the dopamine system in their brains surges when these animals have to climb over a fence to seek out and reach their partner.
In other words, it appears that even the act of seeking the one you love can give you some of the same joy you feel when you are with them. The dopamine pathways in the brain, along with a hormone called oxytocin, help people who love each other bond and stay together.
Love Is Bigger Than Romance
As we research the biology of love, we have discovered something profound: our brains have evolved to connect with other human beings. Love and connection are part of what makes us human.
And this is where I want to expand the meaning of love. When we hear the word “love,” we often think about romance. But the human brain does not reserve something as important as love for romance alone. There is also the love between parents and children.
A few years ago, I saw something in the news that I will never forget. After the tsunami in Japan, photographs surfaced of mothers who had been found still holding their children, having used the last moments of their lives shielding them from the water. These women, in the most extreme situation imaginable, sacrificed their own lives for their children. Their love for their child outlived their instinct to save themselves.
I remember looking at those images and thinking, “I would do that too.” As I am sure almost every parent would. That is the power of love in the brain.
These relationships may look different from one another. But they all involve the same dopamine and oxytocin network in the brain that helps us connect, care, trust, and protect one another.
Why Heartbreak Physically Hurts
There is another side to this.
When an important relationship is lost, the pain can be very real. Research on social rejection and loss has shown that social pain can engage some of the same brain regions involved in physical pain.
So if you have ever experienced heartbreak and thought, “Why does this hurt so much?” there is a neurological reason for it. Some of the same brain areas that light up with physical pain also light up with the emotional pain of losing someone you love.
Your brain takes social connection seriously. From an evolutionary point of view, belonging to a group was essential for survival.
The Lesson From the Longest Study of Human Life
This brings me to something I believe is even more important than romantic love: human connection is a genuine part of brain health.
One of the longest-running studies of human life is the Harvard Study of Adult Development, which has followed people for more than eight decades. One of its most important lessons is remarkably simple: the quality of our relationships matters enormously for our health and happiness. People who have stronger, more supportive relationships tend to be healthier and live longer.
And this is not just one study. Large studies and meta-analyses involving hundreds of thousands of people have found associations between loneliness and a higher risk of dementia, and between social isolation and a higher risk of premature death.
I want to be careful here. That does not mean loneliness automatically causes dementia, or that one loving relationship guarantees a longer life. But the message from decades of research is remarkably consistent: we are social creatures. Our brains and bodies do better when we have meaningful connections.
Don’t Let Technology Replace What Makes Us Human
So as AI becomes more present in our lives, I think we have a responsibility: do not let technology replace the relationships that make us human.
Protect the connections you already have. Call your parents. Check on your friends. Make time for the people who matter. And be willing to let new people into your life.
Every time you reach out to someone, listen deeply, share a laugh, offer comfort, or allow someone to help you, you are participating in the life of another human being. You are also giving your own brain an experience it was designed to have. Connection. Belonging. Love.
A Challenge for You This Week
So now, I have a challenge for you.
Think of three people who matter to you. Not three people you follow. Not three people you text with an emoji. Three people who truly matter.
And sometime this week, reach out to them. Call them. Meet them. Tell them what they mean to you. Tell them you love them from the bottom of your heart, even though you now know your love for them actually resides in your brain, not your heart.
And know this: the connection you share with them will contribute to your own brain vitality and longevity for years to come.
Dr. Majid Fotuhi is a Harvard- and Johns Hopkins-trained neurologist, bestselling author of The Invincible Brain (USA TODAY Bestseller), and one of the world’s leading experts on brain health and cognitive performance. He has spent more than three decades studying the brain’s capacity for growth and repair. To discover your brain health score and receive a personalized 10-page report, take the free Invincible Brain Assessment at invincible.drfotuhi.com.
📺 Watch https://youtu.be/OwfFXOhhBKY on Dr. Fotuhi’s YouTube Channel.
Keep up with Dr. Fotuhi on LinkedIn & Instagram.
References
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