Why Exercise Is a Miracle Drug

82 zdw 69 8/2/2025, 4:02:16 PM derekthompson.org ↗

Comments (69)

bob1029 · 31m ago
> The author Daniel Lieberman has put it well: Exercise is healthy and rewarding even though it’s something we never evolved to do.

We have ostensibly spent much of our evolutionary budget on the ability to run ~indefinitely no matter what. Compared to virtually any other animal, we can vastly outperform them in the most arduous environments. Our bodies are mechanically optimized for running at every level. We have connective tissue that stores and releases energy. Our bodies can reject on the order of 1kW+ of heat steady-state through the magic of evaporative cooling.

jb1991 · 17m ago
Ask anyone in the army how all those years of running drills have affected them as they got older. It’s not so rosy. Lots of knee problems in that group. Above average practice of running throughout life also increases likelihood of requiring pacemakers later in life.
doytch · 7m ago
This is a gross simplification on both accounts.

US Army veterans do have a higher rate of arthritis but their days are quite different from the "run 3-5 days a week" that most people think of when talking about recreational runners.

And the pacemaker comment stood out so I did a bit of digging and found a study [1] you might be referring to. Again, the effects were strong only in the heavy-duty-exercisers/pro/semi-pro cross-country skiier group. Additionally, this didn't offset the gains to cardiovascular or mortality risk - that group was still "healthier."

[1] https://pubmed.ncbi.nlm.nih.gov/39101218/

derektank · 11m ago
People in the army are also regularly carrying an extra 50 pound ruck, 25 pounds of body armor, and enough other various and sundry items to add up to about 100+ lbs of total kit. That's probably what's destroying people's knees more than the running by itself
Phlebsy · 5m ago
Coupled with weeks if not more of regularly scheduled sleep deprivation so you never actually recover from any of those hard days.
afthonos · 4m ago
I can’t be sure, but my impression is that army drills (1) push uniformly (rather than let you improve at your own pace) and (2) often involve carrying your kit, which is 20-40lbs. Neither of these is similar to the kind of running GP describes, namely unburdened, at a comfortable speed, over ~arbitrary distances.
alecst · 4m ago
Hm, I'm skeptical. I think the data might be a little equivocal on that one.

I'm also part of the barefoot running army and tend to think that the braking forces from shoes have a role to play in knee problems (I personally stopped having them when I started running barefoot so that's where my bias comes from.)

polio · 10m ago
It's more that the military's goal isn't to produce adults that are indefinitely healthy, but rather a robust geopolitical deterrent that only requires its employees to be physical capable for about twenty years, after which their service life is over. Running is not the issue. Even a car designed for driving can be driven irresponsibly.
quora · 8m ago
I guess there are a lot of confounding variables in there, having taken up running a few years ago my resting heart rate is very low, and I'm far more aware of it than a non-runner. I suppose folks with a family history of heart problems may take up exercise to try and get ahead of it too.
fmbb · 11m ago
Army personnel in general is unnaturally beefy and I'm sure these running drills often are done carrying load, no?

Humans are evolved to run, but not to have heavy frames and not carrying material for fighting wars.

wslh · 3m ago
Older soccer players, and other professional sport players have physical issues BUT they train at extremes.
thrance · 8m ago
Just because our ancestors did something doesn't mean it's automatically good for your health. After all, prehistoric men weren't known for their long life expectancy.
lukan · 2m ago
"After all, prehistoric men weren't known for their long life expectancy."

After surviving early years, people still used to get old. Infant mortality was just way higher bringing the average down. (And that those metrics often compare to poor peasants and our paleo ancestors were not peasants)

_Algernon_ · 1m ago
What data are you basing this on? My understanding is that historical life expectancy is only as low as it is because of the immense infant mortality rates. People who survived through childhood tended to live long.
closewith · 9m ago
To be fair, it was the weight not the distance that destroyed my knees and ankles. But still, I've aged a lot better than many of my friends and family who were more sedentary, so who knows.
pmarreck · 22m ago
> Our bodies are mechanically optimized for running at every level

My flat feet (and those of my mom, and those of one of her parents, ad infinitum) would beg to differ lol

Also, most of the energy our bodies burn to run just turns into heat, it's all very inefficient... even if sweating itself works pretty well, and even if our heat tolerance is high assuming we have a source of fresh water

janderson215 · 18m ago
I’ve read in a few places that the flat feet comes from wearing shoes that don’t allow your toes to splay, which causes the muscles that create the arch to atrophy. Not a scientist and have never had flat feet, so can’t confirm, but I recently started wearing zero drop shoes and definitely feel a healthy soreness as my feet get stronger.
tristanMatthias · 19m ago
My friend has fixed his flat feet by focusing on yoga poses that engage the “knife edge” of his feet (ie: the outside). It took some time but he reckons it’s very noticeable. Maybe worth a try?
federiconafria · 13m ago
It worked for me, it's not even about specific poses, you need to consciously keep your ankle from collapsing and yoga helps with that.
kstrauser · 8m ago
My wife's a podiatrist. I can conjure what I've heard her tell a thousand people over the years: invest in arch supports. Shoot for the ones that run about $50 and are rigid. Don't start with the $500 custom ones, and skip the $10 soft ones you see at the pharmacy. Go to REI or a running shop or a sporting goods store and get those instead.

My knees freaking killed me when I was running. I started using the supports my wife bought for me and it instantly improved, and far beyond any placebo effect. Before: my knees ached after I ran 100% of the time. Now: they never ache anymore.

fmbb · 9m ago
Nobody claimed we are intelligently designed.

Evolution is not perfect. We are still better at running long distances for long stretches of time than any other animal.

Invictus0 · 20m ago
I mean, would you prefer we add in some evolutionary pressure?

Note also that there are numerous champion runners with flat feet.

pmarreck · 9m ago
One contributing factor to human weight gain when given a non-limited supply of food is apparently the knocking-out of the gene that produces uricase, which pretty much every other animal has (and they usually don't get fat, even when given unlimited food supply). Not a single human has a working uricase gene. It has been hypothesized that famines throughout human history (there's your "evolutionary pressure") have contributed to this.

My point is that selection pressures do not always lead to optimal outcomes...

https://chatgpt.com/share/688e4822-4e44-8004-9625-21a254fa02...

Xenoamorphous · 18m ago
How much of that is due to only using two limbs? Which also makes us slower I guess.
begueradj · 5m ago
> Compared to virtually any other animal, we can vastly outperform them in the most arduous environments. Our bodies are mechanically optimized for running at every level.

I'm not sure from where you get this because any documentary/book/article and simply real life experiences related to this subject states the opposite.

sharkweek · 30m ago
I can directly tie my mood to how much exercise I’ve had in a given week. It’s also easy, given how busy life feels, to let the proverbial frog boil in water when it comes to this.

My partner often comments when I’ve been a little grumpier than usual by saying, “you should go on a bike ride.”

It really works wonders on the soul (and the more physical heart and lungs) getting out for a spin in the fresh air.

quora · 6m ago
Absolutely, as much as everyone says eating right, exercising and sleeping well are the answer I totally neglected myself. Boosting cardio and dropping some weight has been an absolute lifechanger
LeftHandPath · 35m ago
The best way to make a happy, healthy person into an unhappy, unhealthy person is to keep them lonely and keep them still. It should come as no surprise that the inverse also tends to hold true.

On a tangent, I think that's part of why volunteering can be so rewarding.

siva7 · 28m ago
> The best way to make a happy, healthy person into an unhappy, unhealthy person is to keep them lonely and keep them still.

So becoming a software developer?

LeftHandPath · 15m ago
Or taking up any white collar job! There's a reason I spend a lot of my free time swimming and hiking.
psyclobe · 4m ago
Haha.. ouch.
otterpro · 17m ago
Exercise "simulate the arduous tasks that were once necessary to make it through a life" makes sense, as most of our ancestors were blue-collar workers and farmers. I try to integrate more physical activity in my life, which seemed like labor before, but now feels like life-saving activity. For example, I am intentionally trying to fix/diy things with my house like painting my garage, mowing my lawn instead of hiring someone else to do it, and even learning woodworking and gardening. Even in the heat of the summer, I feel more invigorated working outdoor whenever I can, and helps offset the sluggishness I feel after a day of sitting, coding, and staring at the monitors at work.
thrance · 4m ago
The human body didn't evolve to do farm work, or mow lawns, or more generally to do "blue collar" work. Also, our ancestors weren't known for their exceptional lifespans.
stavros · 12m ago
Ah yes, the evolutionary pressure of being a blue-collar worker.
datameta · 24m ago
Walking is exercise. Never forget that.

Consistency over sporadic herculean efforts always wins out.

endoblast · 26m ago
I go for a decent walk most days and it doesn't require effort or get boring. It goes well with listening to headphones and relaxing the eyes on the horizon plus seeing a bit of nature and humanity in action.

This does me a lot of good however the only upper body exercise I get is playing the piano! I can't see myself joining a gym or doing press-ups reliably in the long-term. I need to find a suitable hobby which has upper body + other benefits while being fun/interesting and low-risk. Carrying logs has helped but we have enough firewood now.

SonOfLilit · 1m ago
Consider rock climbing
fsiefken · 9m ago
VR boxing, sword fights or tennis. Synthriders is very nice
socalgal2 · 34m ago
I find it interesting that the article is about exercise and the title picture is yoga. In fact near the top

> To a best approximation, aerobic fitness and weight-training seem to increase our metabolism, improve mitochondrial function, fortify our immune system, reduce inflammation, improve tissue-specific adaptations, and protect against disease.

Yoga is neither aerobic fitness nor weight training

note: I do yoga probably about twice a month (should do more) so I'm not dissing yoga. I'm only noting that the picture of yoga seems to have nothing to do with the article.

jcynix · 4m ago
>Like someone already said: what if you get an injury going to hard at it?

There's no need to go hard, even steady walking for 20 minutes a day is healthy. And recent studies show that you don't need to jog or run, walking is almost as efficient and less stressful for your joints.

One of the best ways to exercise as long as you aren't a brain in a jar is to use an indoor rowing machine. Rowing will engage about 80% of your muscles.

dusanh · 2m ago
Any recommendations on a rowing machine?
voat · 42m ago
Maybe not a drug. But if the improvements in health come from bio chemical signals, it should be possible to activate those signals without engaging in exercise. Eventually?
vmg12 · 18m ago
It would take a lot of different drugs to simulate what exercise does.

- Impact and stress strengthening the muscles, bones and tendons / ligaments

- energy use that leads to better sleep

- increased blood flow, development of new capillaries, stretching of blood vessels

- if you exercise outside, exposure to sunlight

- the release of all the associated neurochemicals

I have a suspicion that anything designed to mimic exercise would hurt as much as the actual thing given that so many of the benefits of exercise involve damaging bone and tissue then repairing it

sctb · 37m ago
Strictly speaking, any intervention other than exercise is going to give you a subset of the total stimulation. A drug acting on the tissues directly would bypass the neurological component, for example.

If the idea is to avoid the effort of exercise, perhaps it would be worth considering the possibility that the effort itself is essential.

tomalaci · 29m ago
Steroids. You will be growing muscle while sitting on a couch, even better than someone that naturally trains. However, you very likely will develop asymetries or other weird complications because you didnt properly work out.

My point is that, even though we might find even more ways to improve/modify our bodies, they will come with slew of risks that are just not worth it if you can achieve it naturally.

On another note, I feel like there is severe muscle inflation in media which would distort how fit a person should be. You really do not need to kill yourself in the gym or hop on a some reddit-approved juices to get very fit. Just gotta experiment and find a comfortable full body workout that you can do consistently, like you brush your teeth every day.

Fire-Dragon-DoL · 25m ago
You get plenty of asymmetries working out too, it's natural. Don't think just weight lifting, think of: tennis, boxing, baseball
socalgal2 · 33m ago
The article has an opinion on this

> When I asked Ashley if it was possible to design a drug that mimicked the observed effects of exercise, he was emphatic that, no, this was not possible.

stuckinhell · 32m ago
sooner than later glp + myostatin inhibitors seems to be a big winner.

https://diabetesjournals.org/diabetes/article/72/Supplement_...

DaveZale · 39m ago
yes and no. A couple thousand myokines at work here.

Even lactate, formerly regarded as simply a waste product, is one.

But sure, a cocktail may be possible at some point, beyond getting a blood transfusion from someone fitter and maybe younger.

mythrwy · 23m ago
Yes we could also in potentially in the future manage to block pain signals when we stick our hand on hot stoves and that should be super!
gonzo41 · 33m ago
This is so bleak. Go for a walk.
toomuchtodo · 24m ago
Time is short, I’ll take the walk and lift the weights but if I can get the results faster using biological engineering, I’m willing to spend and accept greater risk to make it happen (both for metabolic profile management a la GLP-1RAs and muscle growth). There is no extra credit for making life harder than it has to be, and we’re all dead eventually.
Loughla · 31m ago
Why? My best friend uses a wheelchair and has dexterity issues in his hands due to a stroke.

Exercise for him is (a) expensive and (b) really really really painful.

If he could take a pill that simulated this it would be amazing for his life.

raddan · 22m ago
I was struck this past week to the extent that even a mild physical impairment can cause. I overdid it last week on a run and I spent this week nursing a swollen knee. What kind of exercise to do without involving my knee? I lift weights sometimes, but I can’t do that every day, and it also does not give me the mood altering effect that a good run does. I was drawing a blank glumly in an armchair when my wife suggested swimming at the local pool with pull buoys (so that I can keep my knee immobilized).

After a few experiments that felt more like drowning than swimming I finally got the hang of it. But it left me seriously worried about exercise in my future. After all, joint problems are likely going to happen again in my future. And I started to wonder: how do disabled folks do this? It must be incredibly difficult (and expensive!). I really am incredibly lucky across multiple fronts to have the life that I have.

AtlasBarfed · 3m ago
GLP-1 is a rare opportunity for our overweight nation to "get back on the treadmill" in both a literal and figurative way.

If you have been sedentary for a long time and are overweight, you obviously have too much weight for your muscular strength and connective tissues, which have concurrently atrophied with inactivity, in addition to reduced neuro-biomechanic maps in your brain since you haven't used the circuitry.

This all adds up to a high initial injury risk in starting exercise even if you have the mentally focus.

But GLP-1, if it is the miracle it purports, should be able to drop overweight people, even if it is temporarily, to the point where you can being exercise much more safely, and/or with more intensity and duration to get more benefits sooner.

On a macro level a universal health care system that is cheap and effective is really a generation or two away with heavily incentivized exercise, and not without precedent, if I am to understand what Iceland did.

We will live longer, live far better, feel better, look better, be happier, more connected, less anxious, more adventurous, smarter, more productive. These aren't 1-2% improvements at macro levels. 10% improvements, which in pharma land are considered exceptionally effective drugs, and a minimum, and 30-50% miracle drug levels of outcomes are on the table.

But our medical establishment is either drugs or surgery. The extent of insurance company inducements are "silver sneakers".

The perverse accounting involved in extreme obesity may demand a national level program of "Biggest Loser" (although, not to that insanity) for financial inducements to get people to lose weight, because the loss of "caring" for the obese (FORTY PERCENT of Americans are obese and it keeps getting worse each decade).

LiquidPolymer · 12m ago
I hate exercise. The only thing I hate more is not exercising.
DaveZale · 42m ago
for those who are biochemically inclined:

Myokines aka exerkines

chickenzzzzu · 41m ago
Until you injure something particularly nasty, like a joint, tendon, muscle tear, etc...
darth_avocado · 22m ago
I injured my knees by running more than my knees could handle. Instead of never exercising again, after a 2 month long break I started incorporating other forms of exercise in my run schedule. Now I run longer and have other parts of my body feel better.

There’s a hundred reasons to not exercise but you only need to focus on the one reason why you need to keep doing it.

raddan · 20m ago
Use it or lose it!
semicolon_storm · 12m ago
A proper training plan makes you more injury resistant and makes it easier to bounce back from injuries if you do happen to get hurt.

For example, just look at the data for sarcopenia: https://pmc.ncbi.nlm.nih.gov/articles/PMC9654071

serpix · 37m ago
Then we switch sports and start rehab. Aerobic exercise can be done in so many ways.
maccard · 17m ago
The vast vast majority of injuries are recoverable from and you will be able to return to what you did before. There are some bad ones, but even people with hip replacements, ACL tears and all sorts of nasty “career ending” injuries will be able to run/bike/play tennis/golf/weightlift.

It’s pretty well understood that stopping moving is incredibly bad for your body, and modern recoveries focus on pain management, pain avoidance and getting you moving again as quickly as possible.

NeutralForest · 37m ago
You can also walk and bike, it doesn't need to be crazy intensive.
dfee · 35m ago
It will happen. But, that’s part of the game. The alternative? A mind in a useless body.
darth_avocado · 21m ago
There will be mind but not a healthy one.
zoover2020 · 34m ago
Love the description!
olddustytrail · 33m ago
Lack of exercise is vastly more likely to cause injury to your body than exercise is.

Unless you're an elite athlete pushing your body beyond what is reasonable, but that really doesn't apply to most people.

maccard · 2m ago
Exercising wrong is more likely to cause you injury than either of those things. Do a bit, and do it carefully