Can Exercise Be Unhealthy?

It’s Time to Decouple Exercise from Weight Loss & Worthiness

Today is all about exercise—the why, the how, and the SO WHAT?

• My newsletter (below) includes practical tips on how to *ditch* the guilt and turn up the JOY around exercise.

• This week on my podcast, fitness expert Prof. Natalia Petrzela joins me to discuss America’s obsession with exercise—and where physical fitness *actually* fits into health.

In December, I saw a female patient in her mid-50s for her annual physical. She was trying to lose weight and improve her health habits and reported feeling frustrated and tired. Despite getting up at the crack of dawn three times a week to hit the gym before work, she was not losing weight. Worse, she felt exhausted from trying her best and not seeing results.

What am I doing wrong? she asked me.

Before I answered her question, we reviewed her routines around sleeping, eating, and consuming substances like caffeine and alcohol. We talked about stress and stress management tools and her support systems at home and at work. We discussed what she likes about physical activity, beyond simply getting it done.

It turned out that she had a number of forces working against her:

• In an attempt to lose weight, she was pairing exercise with intermittent fasting. Artificially suppressing normal daytime hunger cues with 3-4 cups of coffee at work, she felt wired and tired most afternoons. And by not eating until late in the day, she ended up overeating in the evenings when hunger inevitably overcame her. 

• She hated gyms. She grew up in the American West where, as a child, she had loved hiking and outdoor cycling. Gyms, she said, felt like “exercise as a chore.”

• She disliked getting up early in the morning to exercise—so much so that she would lie in bed at night, tossing and turning and worrying about not getting enough sleep, and then dragging around the next day in a fog.

I told her she was a member of an nationwide club!

Unfortunately there are two common, false narratives about exercise that loom large in people’s minds:

• That exercise is inevitably associated with weight loss.

• That exercising is a moral virtue. 

Most people agree that exercise is healthy. But the pervasiveness of diet culture plus the multi-billion-dollar fitness industry (think: sneakers on fashion runways, compression fabric blends as our second skin, the booming industry of fitness instructors as life coaches) can easily confuse us about the reasons why we need to exercise.

But more than that, I believe these exercise-narratives can do harm to a person’s self esteem. How do I know? I hear it from patients all the time. For example, my patients who struggle with obesity can easily view the absence of weight loss, despite their best efforts to exercise, as a personal failure, a reflection of weak willpower, or a poor ability to care about their health. The moralization of exercise (and its association with thinness) can hold people back from feeling—and actually being—healthy.

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Numerous studies show that exercise alone generally doesn’t promote weight loss. It makes sense. Brisk walking for 30 minutes burns, on average, around 140 calories, approximately the same number of calories in a 12-ounce latte with 2% milk. Yet, we might assume it’s more.

I have some patients who are so wedded to their exercise routine that they feel guilty taking a day off or are fearful of gaining weight without it. This can be a sign of a purportedly healthy routine inadvertently controlling the person, instead of the person being in charge of the routine. It turns out that there is sometimes too much of a good thing.

I think we can also agree that person A who exercises every day of the week is no more worthy than person B who exercises once in a blue moon. In fact, attaching morality to a fitness routine is basically equating discretionary time (and income) with worthiness, something that is not at all accurate!

I'm not suggesting that exercise isn't good for you or that it shouldn’t be part of a weight loss program. I’m simply saying that decoupling exercise from weight loss and worthiness opens the door to more positive movement and a more authentic definition of health. 

So, given that exercise is generally good for us and given that our relationship with it can be inherently fraught, here is what I suggest to my patients who are trying to improve their mental and physical health, without falling prey to diet culture and their own unrealistic expectations:

Make it fun.

When exercise feels like a chore, people are unlikely to stick to it. Of course, most people don't have the luxury of taking a joyful hour out of their busy schedule to break a sweat. But if you have the choice between an activity that provides pleasure over something that feels like a burden, I’d pick the former. Even a glimmer of fun can make it all seem worthwhile.

Make it social.

We're much more likely to stick with an exercise routine if we do it with a friend. Not only are we less likely to cancel on another person than we are on ourselves, getting simultaneous doses of physical activity and social connection checks two important health “boxes.” 

Mix it up.

So many of the skeletal complaints I see in my office are from overuse. Runners tend to get more knee and back pain if they don’t offset the pavement pounding with good stretching and core work. Swimmers risk burning out their shoulders if they don’t diversify their routines. Yoga enthusiasts often lack cardiovascular fitness without adding bursts of high-intensity cardiovascular exercise as part of their exercise “kit.” As I explained in my recent newsletter about our “infrastructure” (i.e., our skeletal integrity), the combination of cardiovascular activity, strength exercises, and stretching forms the Golden Triangle of fitness.

Make it sustainable. 

Set yourself up for success by starting slow and setting realistic goals. It’s probably unrealistic, for example, for someone with two toddlers and a traveling spouse to train for a marathon. It doesn’t make sense for someone who hates gyms to drag themselves out of bed to use an elliptical machine inside one. Building more movement into your existing lifestyle is more likely to pay off in the long run than retrofitting your life around aspirational exercise goals. 

Don't beat yourself up for taking days off.

There's no medical mandate for exercising every single day of the week. Rest is an essential ingredient in any fitness routine. Moreover, you’re human! So, despite what your Apple watch may be telling you, give yourself a break when you can't get to the gym or you take more days off than you’d like. Park shame in your mental garage, and instead be sure to celebrate the days you hit the hiking trail, bike, or pool. Fitness is a process, not an outcome. Many of the rewards of exercise are intangible. Be sure to notice them!

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For another perspective on America’s obsession with exercise, Natalia Petrzela joins me on the podcast this week! Here, Natalia and I discuss our often complicated relationship with exercise; why it’s so important for our overall health; and how to become healthier from the inside out.

Natalia is a leading political and intellectual historian and certified fitness instructor. She firmly believes that exercise matters not only for our physical health, but mental health as well. Natalia is the author of Fit Nation – The Gains and Pains of America’s Exercise Obsession, which shows how fitness in America is about more physical health—it’s a means for equity, inclusivity, and community-building.

I hope you enjoy the show!

Natalia Petrzela on America's Fitness Obsession

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Housekeeping and final notes:

• Hello, paid subscribers! Join me on for our next Zoom hangout! This time it’s about Menopause & Women's Health: A Discussion about Risks & Benefits of Hormone Therapy. You can register right here.

• Hello, subscribers in the DVM area! I hope you will consider joining me on February 28 at 5 pm ET when I’ll be delivering an in-person talk about menstrual & mental health for a terrific organization called My 28 Days. I’d love to see you there! To learn more about the event and to sign up, click here.

• Ready for a dose of sanity about COVID? My friend

  Emily Oster
  must be reading my mind. Her evidence-based and clear-headed post about the current COVID situation is here.