286. Dr. Jordan Metzl: Why Movement Is a First-Line Drug for Depression

Summary

Podcast Summary:

The Ultimate Human with Gary Brecka

Episode 286: Dr. Jordan Metzl – Why Movement Is a First-Line Drug for Depression
Date: July 14, 2026
Guest: Dr. Jordan Metzl (Sports Medicine Physician, Author)
Host: Gary Brecka

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Main Theme

This episode explores the transformative power of exercise and movement as a primary, “first-line” treatment for depression and chronic disease. Dr. Jordan Metzl, a sports medicine physician, discusses how the medical system can (and should) prescribe exercise as seriously as it does pharmaceuticals, the science behind exercise’s effects on healthspan and mental wellness, and strategies for long-term motivation and community engagement.

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Key Discussion Points & Insights

1. The Failings of Western Medicine: Treating vs. Preventing Disease

• [00:00, 15:55]
  • Traditional Western medicine excels at treating established diseases (e.g., diabetes) but neglects prevention.
  • A significant proportion of healthcare spending and tax revenue is funneled into managing preventable chronic diseases.
  • “We don’t spend nearly enough time thinking about preventing that from happening in the first place, and incentivizing it.” — Dr. Metzl [00:00]

2. Exercise as Medicine: Crafting Prescriptions for Movement

• [02:16, 07:13]

  • Dr. Metzl’s journey: Grew up in a family of physicians and athletes, recognized early the positive cognitive effects of exercise.

  • Ran his first marathon during residency in Boston—“That was the beginning of a love affair with the marathon. Now 40 marathons and counting.” — Dr. Metzl [04:33]

  • Developed a medical curriculum ("Prescribing the Medicine of Exercise") at Cornell, to teach future doctors how to prescribe exercise.

  • “If we had a drug … 100% effective for almost every chronic disease, zero side effects, and only positive effects—everybody should be prescribing this medicine ... And that obviously drug is movement.” — Dr. Metzl [05:41]

  • Prescription practicality:

    • Exercise regimens must be tailored to the patient’s age, physical condition, and comorbidities, just as with any pharmaceutical.

3. The Science: Clinical & Cellular Evidence for Exercise

• [08:50, 13:57]
  • Landmark studies (e.g., London Transport and Post Office study, 1950s) provided compelling evidence linking physical activity to reduced cardiac and metabolic disease.
  • Exercise impacts all organ systems, with proven benefits for heart, metabolic, pulmonary, muscular, cognitive, and neurodegenerative conditions.
  • At the cellular level, benefits stem from increased mitochondrial volume, anti-inflammatory myokines, and the reversal of “inflammaging.”
  • “Muscle is now recognized as an anti-inflammatory organ: myokines are anti-inflammatory, and that affects chronic disease expression.” — Dr. Metzl [13:02]

4. Motivation: The Missing Link in Lasting Behavior Change

• [17:09, 22:49]

  • Most people aren’t limited by lack of knowledge, but by lack of motivation.

  • “Knowledge, emotion, and belief: you have to know you should do it, feel like you should do it, and believe you can do it” — Dr. Metzl [20:53]

  • Community and fun are critical to forming consistent, sustainable movement habits.

  • “One of my superpowers was really to recognize that bringing people together was a way to harness motivation and to encourage motivation.” — Dr. Metzl [24:19]

  • Push—Dr. Metzl’s Motivation Philosophy:

    • Namesake of his book and group classes.
    • Quote: “Commit to getting off your ass.” [18:32]

5. Community as Medicine & the Power of Group Movement

• [24:19, 38:08]

  • Dr. Metzl organizes free, large-scale group exercise classes in NYC (e.g., 1,000+ people on the Intrepid).

  • “All my classes are free. … I want this to be a prescription that encourages people to go forth and to inspire others.” — Dr. Metzl [25:08]

  • Community-based movement increases compliance and motivation; social support is a recurring theme in health and longevity (e.g., Blue Zones).

  • Notable Moment:

    • Dr. Metzl describes the transition from solo athletes in his classes to intergenerational, multicultural crowds: “It’s so empowering … the energy from people of all different, multi-generational, multi-ethnic … is what motivation is.” [24:19]

  • Fun is the “holy grail” of exercise compliance.

    • German study: Exercise groups that had fun & choice stayed more compliant than the “serious” group.

6. Barriers, Incentives, and The Role of Policy

• [27:06, 47:39]
  • Most US healthcare incentives are designed around paying for disease treatment, not prevention.
  • Suggests we should incentivize healthy behaviors just as we do homeownership or having children (through taxes/other means).
  • “Either we’re going to pay some for prevention, or we’re going to pay a lot more for disease on the backside.” — Dr. Metzl [27:07]
  • The incentive system (procedures over outcomes) is flawed. “Our system incentivizes procedures, not outcomes.” — Dr. Metzl [45:01]

7. How to Build Lifelong Habits: Lower the Cost to Act

• [56:08, 61:05]
  • “Lowering the cost to act” is central to motivational success.
  • Strategies:
    • Men typically respond to financial triggers (prepaying for classes, trainers).
    • Women respond more to communal triggers (joining classes with friends).
    • Momentum is key: “If you can get that tire rolling, it gets its own speed and momentum.” [59:32]
  • “I don’t think there are motivated people and unmotivated people anymore — it’s about strategies to lower your cost to execute.” — Dr. Metzl [58:14]

8. Technology, Data, and the Future of Medical Prescriptions

• [42:26, 62:43]
  • Telemedicine and wearables are opening up ways to track and prescribe movement more precisely.
    • “In the future, how much you’re moving and what kind of activity … may be part of the medical visit.” — Dr. Metzl [43:18]
  • Dr. Metzl is experimenting with an AI assistant trained on all of his content to answer patient questions anytime [63:06].
  • Emerging AI can visually project “future you” based on your actions—a powerful motivational tool.

9. Exercise as a First-Line Drug for Depression

• [52:43, 54:06]
  • Robust clinical evidence now shows exercise can outperform or match SSRI medications for mild to moderate depression and anxiety.
  • “For garden-variety anxiety [and] depression … best treatment as a first-line treatment is exercise.” — Dr. Metzl [52:43]

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Notable Quotes & Memorable Moments

• On Motivation:
  “Commit to getting off your ass.” — Dr. Metzl [18:32]

• On Exercise as Universal Medicine:
  “If we had a drug that was 100% effective for almost every single chronic disease, zero side effects, only positive effects, everybody should be prescribing this medicine … and that obviously drug is movement.” — Dr. Metzl [05:41]

• On The Power of Community:
  “It’s so much better to have a community. … Bringing people together was a way to harness motivation and to encourage motivation.” — Dr. Metzl [24:19]

• On Western Medicine’s Limitations:
  “We incentivize procedures, not outcomes.” — Dr. Metzl [45:01]

• On Changing Medical Culture:
  “There was no curriculum on how to teach doctors how to prescribe exercise.” — Dr. Metzl [05:53]

• On Fun and Compliance:
  “The holy grail of compliance is fun.” — Dr. Metzl [32:07]

• On Shifting Identity:
  “I don’t think there are motivated people and unmotivated people anymore — it’s about strategies to lower your cost to execute.” — Dr. Metzl [58:14]

• On Transformation After Trauma (Case Study):
  “At age 70, she ran her first marathon. … By age 83, she started teaching a kettlebell class for people 80 and over.” — Dr. Metzl, describing his patient “Alice.” [65:48]

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Timestamps of Key Sections

• 00:00–02:52: Western medicine’s focus—prevention vs. treatment
• 04:33–06:58: Dr. Metzl’s personal journey from athlete to “prescribing” exercise
• 07:04–13:57: Exercise prescription as medical practice; the science from 1950s to present
• 17:09–22:49: Understanding motivation: knowledge, emotion, belief
• 24:05–25:35: Dr. Metzl’s free, massive group fitness classes—the power of exercise community
• 32:07–35:41: The science of fun: compliance, engagement, and plyometric class anecdotes
• 38:08–40:44: Impact of remote work on community and movement
• 56:08–61:05: Practical strategies for motivation & lowering “cost to act”
• 65:23–67:34: Inspirational patient story—recovering from loss and cancer through movement

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Actionable Takeaways for Listeners

• Prescribe Yourself Movement: Think of movement as a non-negotiable medicine for body, mind, and community health.
• Lower Your Cost to Act: Remove barriers—prepay for fitness, join a group, schedule fun, communal activities.
• Find Your Fun: Compliance comes from enjoying what you do—dance, walk, swim, play; the best exercise is the one that makes you smile.
• Community Matters: Surround yourself with active people—peer support is a force multiplier for motivation.
• If Struggling with Depression/Motivation: Start with small, consistent activity—build belief by joining others or setting up systems that make it easy to move.
• Advocate for Prevention: Push doctors and policymakers for prevention-first healthcare.

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Where to Find Dr. Metzl

• Instagram & LinkedIn: @jordanmetzl
• Book: "Push"
• NYC Group Classes: Open to all, free of charge (sign up via mailing list/social)
• AI/Knowledge Platform: Link in his Instagram’s link tree

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Closing Thought

“To me, an ultimate human is basically helping other people achieve their goals. I find that to be so gratifying.” — Dr. Jordan Metzl [63:47]

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This episode is an energizing call to action, showing how simple, social, and enjoyable movement is a transformative—yet underused—medicine for the challenges of modern life.

Transcript

[A]

In Western medicine, we do great at treating the problem after somebody has diabetes, where we can treat it, but why not think about preventing that from happening in the first place? And we don't spend nearly enough time thinking about that and incentivizing it.

[B]

When you look at the broad data on status of healthcare in America, we don't realize what portion of our tax revenue is just going to support preventable chronic disease.

[A]

Exercise is a first line drug. That's an exact example of the medicine of exercise. What we're really prescribing is community.

[B]

One of the first signs of early depressive symptoms is people become more and more and more reclusive. Less social interaction and less mobility.

[A]

It's really what motivation is, which is people want to connect and they want to help other people. It's so much better to have a community. And that's what I realized early on. Bringing people together was a way to harness motivation and to encourage motivation. That really made a big difference.

[B]

When people have gotten accustomed to this sedentary lifestyle, how do you get them off their ass?

[A]

That's the hundred thousand dollar question. And I'll give you two answers to that. Number one. Ultimate Human.

[B]

Hey, guys, welcome back to the Ultimate Human podcast. I'm your host, human biologist Gary Brecker, where we go down the road of everything, anti aging, biohacking, longevity, and everything in between. And today's podcast is going to be one of those really interesting podcasts about the intersection of all of those.

[A]

You.

[B]

It's rare that I get a guest on this podcast that has been so woke to what we consider mainstream for 30 years and is also an allopathic, classically trained physician. And so welcome to the podcast. Dr. Jordan Metzl.

[A]

Thank you so much. It's really an honor to be here. I'm thrilled to be here.

[B]

Yeah, yeah. It's an honor to have you. It really is. And two interesting stories that happened before the podcast. One, he showed it to my house, panting and sweating, soaking through his shirt, which was the first time a guest came in. I was like, well, maybe he's nervous to meet me. I'm kind of a celebrity. But he, he was out on a run and then realized midway through his run from my house, he didn't have the time to get here, so he just ran straight here.

[A]

I ran back to the hotel, but time to cool off, showered, got on a bike and biked over here. And I was like, oh man, I look like a mess when I.

[B]

What I love is you're practicing what you preach.

[A]

Absolutely.

[B]

But during my house tour, you know, we're sitting in the hyperbaric chamber, and you said something that really sparked my interest. You said that I've been writing people prescriptions for the medicine of exercise for years. And you're the first classically trained physician that I've heard refer to mobility and exercise as medicine.

[A]

Yeah.

[B]

And I think looking at your background, you also credit that recognition with what actually got you into medicine. So can you tell us a little bit about your journey?

[A]

Sure.

[B]

Into becoming a sports medicine.

[A]

Absolutely. So I come from a family of doctors. Both parents and three of the four brothers are doctor. The other guy's a doctor, too. So everybody, like dinner was, you know, everybody's Dr. Metzl. So my dad was the OG Dr. Metzl. Everyone else followed suit. And as I knew I was gonna be a doctor since the time I was quite young, when I was like, five, six, I used to go with my dad. He was a pediatrician. I had a little black plastic doctor bag. And that was. That was my destiny. I always really enjoyed that's the best, you know, that role. And I knew I was going to do that forever. So I was very. That was my path as I got into medicine, and I got in through medical school and then did residency, and I had this kind of whole life of being a doctor. And then simultaneously, I had a whole life of being an athlete. I played soccer in college and then in residency, where we really was a horrific type of schedule. You were awake, like, 36 hours in

[B]

a row doing the exact opposite of what we should be doing to our doctors.

[A]

I used to bring a jump rope to the on call and jump rope in the stairwell. People thought I was nuts, which maybe I was, but I really was recognized early on. In fact, even in med school, I recognized that my brain absorbed knowledge much better. After. I was working out throughout med school to study, really, my brain just worked better with exercise. But as I kind of got into my residency and then, interestingly, I'd never done a marathon, but. But the option in Boston, where I did my residency and internship, was that you could get the day off of internship, which was horrible. If you ran the Boston Marathon on Patriots Monday, I was like, that's the best deal in the world. Of course I'll run the marathon. So I ran my first marathon a hundred percent. So that was the beginning of a love affair with the marathon. And now 40 marathons and counting later,

[B]

and a lot of triathlons, too.

[A]

You're up triathlons.

[B]

You know, I got a 31. If you're a time marathon finisher and 12 time ironman.

[A]

Those are outdated now. It's like 40 and 15.

[B]

But.

[A]

But if your sports medicine doctor's a slug, no one's gonna listen to you. So you really have to, you know, it's part of the street cred, I guess, but anyhow. So as my career in medicine started to grow and I ended up in sports medicine, and I had this whole world of the idea of medicine was fix people when they are broken, if they're sick, if they're injured. And then I had my whole world of being an athlete, which was a lot about preventive health through movement. And if you go to a race, everybody's healthy, everybody's smiling, everybody's encouraging each other. And so these two separate circles of life, the doctor fix it when it's broken, and athlete preventive health through movement. And over time, those worlds started really coming together. So medicine and movement became one and the same. And over years, I have really morphed these into one. So if you come see me for a hurt knee, not only am I going to fix your knee, but I'm going to talk about how we use exercise as part of the medicinal part of your life. And that's led to really prescribing the medicine of exercise, which I see as a medicine. And what I tell all my patients, if we had a drug that was 100% effective for almost every single chronic disease, it was basically 100% efficacious, worked for every single person around the world, rich or poor, young or old, had zero side effects and only positive effects. Everybody should be prescribing this medicine. In my view, physicians and the medical system should be actively prescribing this to people as part of what we do. And that obviously drug is movement. And so much so that about 10 years ago, we started, as I mentioned before, when we were chatting, we started a course to prescribe teaching med students of the future, doctors of the future, how to prescribe exercise, called Prescribing the Medicine of Exercise, which is a seminar at Cornell Medical School. We've been doing this now for 10 years. When we started, we were looking for a curriculum for the med students. There was none. Despite medicine, in all the centuries of medicine and people knowing exercise is, quote, unquote, good for you, there was no curriculum on how to teach doctors how to prescribe exercise. So for me, the medicine of movement and prescribing the medicine movement is a huge piece of what I prescribe for health and for health span and for Healthy longevity. And I've been at that for a while and I'm really glad to see, you know, the tide changing in that, in that regard.

[B]

What is a prescription for, a medical prescription for exercise look like?

[A]

Well, it's different for everybody. So if you're, you know, 60 and overweight and have arthritic knees, that's different. If you're 25 and you want to do a triathlon and it's different than if you're, if you have Parkinson's disease.

[B]

But you're literally putting these, these protocols down and saying here's, here's what I want you to do. I want you to go home and I want you to 30 minutes on the treadmill, walking at this pace or this incline, or want you to do this kind of weight bearing exercise. I mean literally a descriptive set of functional movements.

[A]

I'm lucky that I work at hospital for Special Surgery. And so we are the world's biggest orthopedic specialty hospital in everything from orthopedic surgery to sports medicine, where I am to rheumatology to exercise and physical therapy. So we have a whole team of performance specialists, exercise physiologists, nutritionists, we, where I will say I see you as a patient and I want you to start thinking about these things. And then I will send a note out to our performance team and they will have that person come in for an evaluation. They'll look at his movement, they'll look at his metabolic health, they'll look at his nutrition, they'll look at all these things and they'll put together a program for him. And we're really working on standardizing that. But it's nice because each of these things is tailored. And it's not only me. I mean, I think I'm on the musculoskeletal side, but I definitely need help in order to help enact this in a, in a more holistic way for people. But that's the idea is that people should think about movement as part of their, their necessary medical intervention. And it means more coming from, from a physician. I think are different because I think people then really internalize that message and they realize this is not just because I feel good, but this is actually important for my health, which is what I'm really after.

[B]

And I wonder, you know, I come from a big data background and so what kind of data are you seeing coming out of results? Are you seeing coming out of it? I mean, what would, was there, number one, was there anything that surprised you about this? And the outcomes in these patients. And what kind of outcomes are you seeing?

[A]

Yeah, so I think you're fascinating on that and it's interesting. So for our course, we've looked at the history of exercise science and exercise as medicine. And you may think, like, for you and I, like, of course, why wouldn't we do that? And even for many of the people who are getting this information now, you know, many of people in this space already have kind of drunk the Kool Aid somewhat, and so they know that. But much of the data on exercise and the health effects of exercise comes from, actually, the 1950s is when we started getting the most information. There was a really interesting study set in London, the London Transport and Post Office study, where they took people in the bus industry and the post office industry in London postal. And they had two categories of people. One had active jobs walking up and down, collecting tickets and delivering mail. And others had sedentary jobs sorting mail and driving buses. And they looked at their cardiac and cardiac mobility outcomes based on if they had active versus sedentary jobs. And the people who were active basically had much less risk of cardiometabolic disease, even in the 1950s. So that was really the first birth of learning about the effect of exercise. And then over time, and when I give talks on this, I have a wonderful slide of a woman in her 70s doing a single leg squat.

[B]

Wow.

[A]

And on one side, I don't know if I could.

[B]

I used to do them in CrossFit because they were required in CrossFit. But let me tell you something, dude, those are no joke. They call them pistols.

[A]

Not all the way down. Yeah, exactly. Right. So on one side, we have all the body systems of exercise. So this slide looks at the body and the cellular effects of exercise. On the body side, the system side, metabolic and cardiac hypertension and coronary artery disease and pulmonary function and muscular mass and body compos and Alzheimer's and et cetera, et cetera, all the body system effects that we've known in the past 80, 90 years. We've seen a real growth and proliferation of research around the clinical effects of exercise. So you may have seen a big meta analysis came out a couple of weeks ago looking at the effects of exercise on mental health and depression, anxiety, really highlighting some of these important changes as exercise, as medicine. On the other side of her single leg squat are the cellular adaptations to exercise. Things like musc and myokines and telomeric length. And some of the things we're hearing more about now, the cellular responses, which basically are the Cellular manifestations of the clinical changes that we're seeing I think is really fascinating because we're getting a better understanding on a micro level. We were talking about mitochondria before I was telling you about the Mitochondrial Society.

[B]

I didn't even know there was a Mitochondrial Society of America. But I want to be a member. Whoever's watching and controls the membership, I

[A]

think it's actually interesting. Can you give me International Mitochondrial Society?

[B]

I want to be on that. Dude, I want a T shirt. I want some mitochondrial swag.

[A]

100%.

[B]

Let's unite the nerds.

[A]

Yeah, exactly. But anyway, so on the cellular advancements in understanding exercise really parallel the clinical changes that we've seen over time. So why do people have more muscle? It's related to mitochondrial volume. So as we see that on a cellular level, we're really understanding the clinical changes that we're seeing. And then more information on why muscle is important to health span and the importance of functionality, things like achy knees, but also, you know, metabolic control and anti inflammatory effects of muscle. All these things we're recognizing over this really from this early work in the 1950s has been really exciting to see.

[B]

Yeah, no, it's so exciting to see. I think people, we, we, I think, you know, Dr. Gabrielle Lyon and some of the other big influencers in the space have really started to reframe the way that people think about muscle. You know, it's truly our metabolic currency. It's a sponge for glucose and the downstream consequences of hyperglycemia and insulin hyperinsulinemia. Those are the genesis of so many pathologies down the road. It's sort of mind numbing. It's one of those dominoes that if it falls, the consequences are just so grave for I feel like the Bible should say it's not the love of money that's a root of all evil. Blood sugar is the root of all evil.

[A]

Well, it's interesting. So there's a term that we teach in our course that is kind of really gaining traction in medical circles for sure. And I actually have in my newest book, I have a whole section on this at the beginning called inflammaging or inflammaging, depending on who you read. Inflammaging, inflammaging or inflammaging, the inflammatory basis of chronic disease. And much of this is related to sedentary behavior versus active behavior. And so muscle we think of as important for storage, but also as an anti inflammatory vehicle. Myokines are anti inflammatory and that affects the expression of basically chronic disease. So all the major chronic diseases, you know, metabolic diseases, diabetes, neurodegenerative diseases, cardiopulmonary diseases, certain types of cancer, are very much related to this chronic inflammatory state reflected in this term inflammaging or inflammaging. And exercise is a direct counterbalance to that. That's why we feel so strongly about it.

[B]

Yeah. You know, I was asked a really interesting question about aging not too long ago, last year at a conference and somebody said to me, if you were to put all the leading experts in the world that you know of in a room and ask them to agree on one theory of aging, what would it be? I said, you know, I think we would agree on the theory of immuno fatigue. Slow, progressive overwhelming of the immune system, degradation of the immune system, whatever you want to call it. A lot of it has to do with these low grade fights that the immune system is in these low grade inflammatory cascades. Um, they really don't really belong anywhere in and, and, and they're not necessary and they're things that you can do something about just with lifestyle changes. Listen, there's what I share on this podcast, and then there's what I share with my inner circle. If you've been following me for a while, you know how I hold nothing back here but my VIP community. That's where the real magic happens. Picture this. You're struggling with energy crashes, brain fog, or just feeling like you're not operating at your peak and you don't know where to get real answers. But here's what really set apart. You're not just getting my insights. When I have incredible guests on the podcast, VIP members get to submit questions for a private podcast segment. So that world renowned expert we just interviewed, you get exclusive access to their knowledge tailored to your specific situation. This section is under the private podcast section in the Ultimate Human Community. And speaking of exclusive, you're getting my personal protocols, the exact tools I use for water fasting, gut optimization, and morning routines that have taken me decades to perfect. This isn't theory. This is what works in the real world. The community launches challenges throughout the year where you get direct access to me and my network of experts. It's like having a personal health advisory board for less than a hundred dollars a month. Your health is your wealth. And this investment pays dividends for Life. Join the VIP community at theultimatehuman.com VIP and step into your ultimate potential. Now let's get back to the ultimate human podcast. And so you're Doing this in mass.

[A]

Yeah, I think that's the point. And so even some of the earlier work done, CDC had published in the early 2000s an estimation of what affects human health. And at that point their comment was 20% was genetics, 20% was interface with the medical system, and 60% was lifestyle. Increasingly, some of the recent work, like Eric Topol and others, published a study looking at the welderly people that lived 80 years, 80 to 100 with disease, meaning they were well and they didn't have disease. The average person over 80 has two or more chronic diseases. So they were called welderly. And so welderly versus age matched controls. And the thought was, Listen, if you're 88 and you don't have chronic disease, there's something genetically different about you. But there was actually nothing. Their genomes were almost identical to people who had chronic disease. So the biggest change, the biggest modifying factor was their habits. And so the idea that we have such a powerful influence on people's habits and in western medicine we do great at treating the problem. After somebody has diabetes, we can treat it, but why not think about preventing that from happening in the first place? And we don't spend nearly enough time, you know, thinking about that and incentivizing it. And so one of the big pieces that I'm really talking about and thinking about is how we incentivize people for the behavior that we want to see, because I think that's the piece. Because people ultimately may not want to do it on their own.

[B]

That's so true. And I think that you, you argue that it's not discipline, it's not knowledge, but it's motivation that's missing. This is, we're going to gravitate into push now and, and your the genesis of push. And I'd really love for you to talk about that. But what do you mean by motivation is the missing component? And how do you def. And then how do you excite that in somebody?

[A]

Yeah, I mean, that's exactly right. So I've been thinking about and trying to give this message for decades, as many have, some people gravitate towards it, others just don't. And so what do we know about the people that do? Well, some people, it's just kind of built into their DNA. Like I was born moving and I can't not move every single day. I love moving. It's a big piece of what I do. But others really struggle for that yet. But one of the things I really have kind of noticed over time is that consistency over Time is really. It's not what you do day after day, but it's week after week, year after year. What can you do to kind of master your own motivational health? And at the beginning of Push, I have two quotes, one from Gandhi, which is, you must be the change you wish to see in the world. That's the beautiful idea, that to be what you want to be, you have to kind of enact your own change. And below that, I have a quote from me, commit to getting off your ass. That if you don't commit to do it every single day, it just doesn't end up happening. You can kind of think, think about it and theorize about it, but you have to really commit to making it happen. That's actually how I start, start the book is, is with those two quotes.

[B]

Wow. Well, if it's a compliment to you, I like your quote better than Gandhi.

[A]

They compliment each other.

[B]

I'd rather have Euros on my walls than Gandhi's. But so, so, you know, this, this concept around motivation, I want to drill into that a little bit because I think what happens to most people is, you know, I have, I have a quote that I derive to, called. That says that aging is the aggressive pursuit of comfort. Because the more aggressively we pursue comfort, I believe, the faster we age, which I think very much speaks to what you've been doing. And you're writing scripts in the 90s for exercise. You must have been like, way out there. Like, your colleagues are like, oh, there he is. He's, you know, he's a granola, tree hugger, whatever, you know, no science behind that. But, but, you know, you, you were cognizant enough to know how it impacted your life and your brother's lives and like your role as an athlete and what it did for you in your capacity to pract, practice medicine, be present for lectures, take in information, regurgitate information. It became what it sounds like to me, like a superpower for you. Like this sort of secret superpower, which was just that you were fit. Right. It's not, not, not rocket science, but. And I think there's a lot more widestream, you know, mainstream acceptance for it. But when you have people that have had habitual patterns for so long, like, I listen to my parents, I kid you not. My mom has the same argument with my dad every single night. And she's like, john, you don't eat onions and you're not eating enough vegetables. I'm like, mom, he's 82. You've been married 60 years. He's never put one in his mouth. What makes you think exactly. It's gonna change?

[A]

Exactly.

[B]

He's not changing. Just let the man eat right. I mean, at this point, he's made it eight, you know, decades. He's. He's gonna get however many more decades out of it he's gonna get. But it ain't gonna include onions, and there ain't going to be bell peppers. Just accept it is what it is. But. But when people have gotten accustomed to this sedentary lifestyle and they've gotten comfortable. Right. And they really just want you to fix what's wrong, Doc. Like, listen, my knee just bothering. Could just fix the knee and just. I don't want to do all this other stuff. Like, how do you get them off their ass?

[A]

Yeah, it's. That's the. That's the $100,000 question. And I'll give you two answers to that. Number one is that for me and what I write about is there are really three components to a motivational strategy. Knowledge, emotion, and belief.

[B]

Knowledge, knowledge, emotion, and belief.

[A]

So knowledge. Knowledge, I know I should be doing this. And most people know in this day and age, when I started talking about this, people knew it, but I think they know it more now. And you can't go anywhere without knowing that. And there's really a stigma around people who are inactive, you know, much like people that are. You know, smoking has a stigma. Inactivity has a stigma now, too. So I think we've done. I don't feel badly about that. Actually. I don't, because I feel like activity promotes health for all the reasons we've talked about. So I think Knowledge. I know I should be doing this. Emotion, I feel like I should be doing this. And so there needs to be an emotional response from I know I should be doing this to I feel like I should be doing this. And that piece is a step around what makes people enjoy what they're doing. And I'll get back to that in a second. And then belief. I believe I can do this. And going from somebody that knows they should be doing it to somebody that emotionally feels like they should be doing it, somebody believes they can do it is really the steps I've seen. And one of the things I've been lucky enough to do in addition to my role as a doctor and athlete is about 50, 15 years ago, I recognized that one of my powers was influencing people. I think I was an influencer in activity before there were influencers per se. And I started teaching exercise classes, and I started 15 years ago I had one of my patients was a general manager at one of the gyms near my office in New York. And she said, hey, listen, Sunday afternoon about 3 o', clock, our place is empty. Because I asked her about, can I borrow a studio to start teaching exercise? Interestingly, one of my brothers and I were very competitive in triathlon. And I walked into a plyometrics class at a gym I was going to and I took it. And the next day I was like, oh my God, I'm sore as hell and my muscles feel great. And I started generating more power.

[B]

Plyometrics. That's body weight.

[A]

Body weight? Yeah. Little small jump training, a lot of the kind of modern day crossfit hyrox type stuff and burpee broad jump being one. And so I was like, oh my God, I feel great. And so I started learning about this and then I said, I want to start teaching this to my patients. And, and plus I realized that when I had a community doing this horrific stuff together with me, it was fun, as you've noticed as well. And I wanted to go do it. And so I started running these classes. My first class was like 15 people in the basement of gym. Had to be one of the worst fitness classes. I had no idea how to put together.

[B]

Like if you could go pull that video now, you'd be so embarrassed.

[A]

Terrible, terrible, terrible. But I started learning about teaching fitness. Fast forward to today. We have like about 55, 60,000 people on our listserv for these fitness classes and we run these massive classes. Last year we got about almost 14,000 people up moving.

[B]

Wow.

[A]

And it's so empowering. And when I started, it was just people like me, runners and triathletes in Central park doing hill sprints and jump squats. Over time, people brought their kids and their parents and their grandparents and multi ethnic, multi size. Now we run everything from yoga to Zumba to strengthening.

[B]

And where are these run? Are these run in your facility?

[A]

I do them both. No, they're out in central, all in public places. And we have different kind of grants from different companies to put them on. We get the flight deck of the Intrepid, which is a huge aircraft carrier in New York City.

[B]

That's cool.

[A]

Thousand people at once.

[B]

I've driven by that.

[A]

Yes. Thousand people at once three times a summer. You'd love to have you come. And it's so empowering because not only has the vibe change, but the energy from people of all different, multi generational, multi ethnic from all over the place, people come in and it's just so it's really what motivation is, which is people, people want to connect and they want to help other people. And so, yes, you can do some workout on your own in your room, but it's so much better to have a community. And that's what I realized early on. And so I think one of my superpowers was really to recognize that bringing people together was a way to harness motivation and to encourage motivation. That really made a big difference.

[B]

That's so cool. And I love that you have a philanthropic side to you too. You say every fourth class should be free.

[A]

They're all free. Everything's free. So everything I do is free. And they get subsidized. I mean, I'm lucky that as a physician I do fine. And I really want this to be a prescription that encourages people to go forth and to inspire others. And to me, everything I do in that space is all free. And I want it that way because I want people to be able to come and to bring people from different communities. And it really is people all, all working together.

[B]

Yeah. So I mean, as a sports medicine physician, obviously you're seeing the whole gamut, right? You're seeing people that have sports related industries, but injuries, but they're not, they're not a professional athlete. And then you're seeing the really, really high performers, you know, the people that are functioning at the highest level of performance in their, their careers or athleticism. And what have you seen in the data coming from using exercises of prescription, some medical prescription, which I love. What have you seen in the data? Like what, what biomarkers do you see shift and what are the consequences of those? Because when you look at the broad data on the status of healthcare in America and the number of people with metabolic syndrome, the number of people that have chronic, chronic disease, the, the cost of chronic disease to the average American, we don't realize what portion of our tax revenue is just going to support preventable chronic disease.

[A]

100%.

[B]

Can we get a little granular maybe on some of the biomarkers that you're seeing?

[A]

Sure. So I think there's, it's kind of a, it's a broad question. I think first of all, there's no question that people are healthier when they move. And you know, the pillars of functional medicine, you know, healthy activity, healthy community, healthy movement, healthy diet, healthy sleep, you know, these are some of the things that are, you know, you've accomplished. And then when you look at, you know, some of the work done in blue zones where people are not necessarily wealthy, but they live to 90 years plus routinely. They're communal. They eat. Not huge.

[B]

Communal is a big one too.

[A]

Hugely important. They eat kind of a diet, not with many pre processed foods. Everything's relatively healthy. They move every day. Doesn't have to. They're not doing hiit workouts, but they're moving every day. And those things are all really important to kind of think about health and the, the financial burden of chronic disease, as you say, is really incredible. And people don't realize how much money we are spending as a country on treating disease. Now, some of that I think is important, but I think the piece that I want to really think about is how can we incentivize paying for and encouraging prevention rather than paying for disease treatment. And so we encourage all kinds of things in our country already. So we encourage people to buy houses by making tax deductions for houses. We encourage people to get married and have kids by making tax deductions. The things we want people to do, we incentivize that behavior. And so, you know, thinking about incentivizing movement is a great concept to me. You know, when, when Mike Bloomberg talked about taxing sugary sodas in New York City, he almost got, you know, I remember, but. But he was right to start thinking about incentivizing the b. We tax cigarettes, you know, incentivizing things that we want people to do. Because left to our own devices, either we're going to pay some for prevention or we're going to pay a lot more for disease on the backside. So I love the idea of thinking about what are the things we can do to incentivize the changes that we want to see. And then on the biomarker question, I think that we are learning more about that as we go. I will say I feel like there's a little bit of. When people hear the kind of concept of longevity and I want to live as long as possible, I always get a little bit uncomfortable in that space. Because the truth of the matter is, as we talked about, we've done a great job in longevity in modern science with the things that got us from our life expectancy of sanitation exactly 41 years old in the 1800s to now almost 80, 150, 200 years later, sanitation and antibiotics and vaccines and all the things that have made a huge difference in health. So I think that is a bit of a misnomer. I know the movement has kind of taken on, quote, unquote, longevity, but I think what we're really talking about is kind of healthy longevity, health span. And unfortunately, I agree with you. Unfortunately, in the United States, we have the widest gap between what's called the lifespan healthspan gap, meaning our average expectancy is about 81 years old, but we have an almost 10 year, almost 11 years now lifespan healthspan gap. So the last 10 to 11 years, on average, people live in poor health. And so that is very expensive. And that is really burdensome, not only on the people, but on their families. I mean, think about how many people are. You know, it's agonizing to see a parent go through all that. Now, that does not mean if you move every day, you will not get. I mean, Lance Armstrong was the fittest guy on the planet and he had testicular cancer.

[B]

Right.

[A]

So it's not a one to one correlation, but it's on average, you know, can we affect people's health through some of these preventive measures? And the answer is, I definitely think we can. We have to start thinking about how we incentivize people to do the things we want them to do.

[B]

So without, like governmental incentives and state incentives and tax incentives, how have you, in your practice, running all of these exercise classes, prescribing medicine, prescribing the medicine of exercise, how have you kept people's motivation over a prolonged period of time? Because I'm very interested in that too. When I look at professional careers, I'm always fascinated not by the athletes that was great once, but why by the athlete that was great over a long period of time. Lance Armstrong's a perfect example. I mean, yeah, I think 7 Tour de France says, I mean, look, I'll give you all the performance enhancing drugs you want. Go win seven back to back.

[A]

He was a beast before he was doing, I mean, in a field where everybody was doing the same stuff, right? He was the best. Yeah.

[B]

I mean, and, and there was. Yeah, there was a. A cohort of people whose lives were dedicated to beating him. Right.

[A]

I mean, doing the same kind of stuff.

[B]

I mean, it's always fascinating to me that they can maintain that level of intensity over a prolonged period of time and bring that down to the masses, which is what you're working with and prescribing exercise for. One of my favorite biohacks outside of breath work by far is mineral salts, Baja gold, sea salt. It's got all of the trace minerals that the body needs.

[A]

You know, most of us are not

[B]

just protein deficient, meaning amino acid deficient, or fatty acid deficient. We are mineral deficient So a quarter teaspoon of this in water first thing in the morning will make sure that you get all of the essential minerals you that that you need. It tastes amazing. In fact, I made a steak today. I actually made a grass fed steak with grass fed butter. And I put just mushrooms and a little bit of rosemary and I sprinkled Baja gold sea salt all over the top. Try it. It'll be your new favorite for cooking too. It's the cheapest and one of my favorite biohacks. I don't know, a 15 or $20 bag of this will probably last you five years. This is literally the world's best biohacking secret. Now let's get back to the ultimate human podcast. Is there anything that you've noticed helps people stay motivated?

[A]

It's a great question and it may be surprising to you. And so there was an interesting study done in Germany where they took two groups of people over. It was only an eight week study, but I use it in a lot of my talks looking at exercise compliance. And they looked at what can we do over an eight week period of time. They took two groups, they randomized them and they had one group who did exercise that was fun and the fun group got to choose their workouts, they had music, they got a lot of positive reinforcement from the instructor. And the not fun group did basically many of the same exercises with basically a Germanic non smiling trainer and no music and no input on what was happening. And over eight weeks they looked at their exercise frequency and their self reported exercise enjoyment and there was a statistically significant difference between the fun group. And the fun group wanted to go more, they wanted to go longer and they have self reported better experience than the non fun group. And so, so the answer to me, the holy grail of compliance. If the holy grail of fitness is compliance, the holy grail of compliance is fun. And I think that's one of the biggest lessons we can learn. If you come to any group event, people are smiling like my classes, but the end of a triathlon, end of a running event, and that's one of the things that I worry about in our fitness influencer world. So many of these people look jacked and they have great muscles and they look awesome and they just don't look happy. They look like they need a good Mac and cheese. Like they just do not look happy. I just feel like the importance of fun and smiling is a big piece of compliance. Not over maybe a week or a month, but over a lifetime smiling. What makes you smile? And I have people that love yoga, people love dance, people love strength training, people. But what makes you tick is what I found when I interviewed. So for my book, I interviewed to my patients from all different generations, even people in their 90s who are still very active.

[B]

Wow.

[A]

And fun. Was the. And fun. I think it's a great question. The answer is fun. What makes you smile? If you smile, you're likely to keep doing it. And I think it's great. Last piece on this is that a challenging exercise is essentially holding in a crab or reverse plank where you have your hands and feet off the. Your butt off the ground. Hands and feet on the ground. And I was trying to get people in one of my outdoor classes to hold a reverse plank for about a minute and people hated it. And like, yeah, we can do a forward plank. We hate this reverse. And so then I had this idea where I brought a whole bag of balloons and everybody blew up a balloon. And like 6:30 in the morning in Central park, everybody had a balloon. And I get these ugly hats from Chinatown in New York that bright gold that say king. And you can get a king hat if you are basically the last person to keep your balloon off the ground while keeping your butt in the air. And so basically they're doing a reverse plank crab position with one hand, the other with these.

[B]

Oh, so you're in a squat position.

[A]

Yeah, you're kind of hands in and you have to keep one arm just basically balancing, keeping your balloon in the air. And people are just laughing out there and having a great time. It's like two, two and a half minutes. You don't even notice you're doing it because you're just laughing and smiling. Having a great kind of isometric plank type exercise. So the idea is fun is a huge. I want people to think about, you know, so many of your listeners are in the fitness world and I think, yes, we're all teaching fitness. And what we're really prescribing is community in the veneer fitness.

[B]

That's a big.

[A]

That's where it is.

[B]

I think you're so good to hear you say that because meta analyses, big data studies, blue zone studies, all, you know, link back, back to this sense of community, connection, purpose, like life's got to have meaning. Things have to have, have, have meaning. You know, the, in these blue zones, these are, they are, they are some of the most connected and surrounded by love and connection of anywhere else in the world. And, and I don't think that you could delete that and still have, you

[A]

know, couldn't agree more. And I guess one of the challenges in our Western society, interestingly, I forget which one of the blue zones it's in is one of them. Where there's a term where it's a multi generational experience, kind of equivalent to like a bar mitzvah in Judaism, where you go, the younger people go, and they present life's problems to the elders and they talk through. And there's a whole built in, multi generational experience built into one of these blue zones. There's a specific term for it. But I totally agree with you that this. In Western society, we have kind of increasingly put our older generations out in different places. We're encouraged to kind of segment ourselves. I feel like the pandemic and remote work was one of the worst things that happened to people's mental health.

[B]

I think so too.

[A]

I wrote a actually interesting. When the pandemic started happening in medicine, our life didn't change. A lot of people's lives changed around us. They started doing remote work and doing whatever and working from home. And we were still going in, doing our jobs. But I wrote an op ed for the New York Times probably two years after the pandemic started. Tyler, working from home may not be as healthy as you think. And I talked about the science isolation, the science of technology. So it's interesting. So I looked at basically with every evolutionary invention, from the wheel to the bicycle, to the car, to the airplane, to the computer to the smartphone, people could basically move less because they could do more at home. And so this remote work was the pinnacle of that. You could work from home, eat from home, socialize from home, and people got used to doing that. And yet people's imperative to move is the same from way back when. And so the title was People Working From Home May Not Be as Healthy as yous Think. I thought I was gonna get 10 to 1 love letters in the comments. Dude, thank you so much for pointing this out. It was like ten to one, like, screw you. Don't touch my work from home.

[B]

Yeah.

[A]

It was like I was slapping their grandma. I was like, I'm just pointing out,

[B]

you know, the other day.

[A]

Totally. They didn't want to hear it, but. But I think this remote work has been a real challenge for people's physical and psychological health. I think people need each other. And I feel like that's why the fitness community is so important, because I feel like it's a place where people, you know, can really interact. And that's why I think we've seen a real rise of these group fitness activations, and people don't want to be alone. It's not good for them.

[B]

Yeah, you know, I, I, in fact, I, for a period of time, I owned a CrossFit gym. I actually exited it because, because the combination of speed and heavy weight, I wasn't a big fan of.

[A]

Yeah, I agree.

[B]

But I didn't think we should be deadlifting for time. 400 meter sprint, deadlift for time complex, you know, compound Olympic lifts, you know, with soccer moms, you know, really, really kind of a difficult thing. But it was good for our business. Yes, correct. Great for your business. But conceptually, one of the things I, I loved about it, and there's data around this too. You know, your, your propensity to stick to a workout routine if you have a workout partner, you know, goes up precipitously, you know, if you have somebody holding you accountable. What I noticed was the 6am class became like the 6am class. The 7am class was the 7am class. The 8am class was the 8am class. And was all the same people, people. And they really sort of built this community and they almost be like, well, where's Janice today? Jan? What the heck? Thursday Janice isn't here. Somebody call her like. And these were not like tight friends. The only commonality they had was our fitness, you know, was our CrossFit class. But, you know, they were so regular and they supported each other so much. One of them didn't show up. They were calling them, texting me, okay, like, what happened? We are worried sick. Yeah. And, and then going through hard things as a group and emerging out the other side. Sometimes I would look around the gym and like, everybody's plastered on the floor, leaning up against the walls, you know, the wads over, laying on the weights. But there was a smile on everybody's face and everybody was like, you did a great job. You know, and, and there is so much to that community connection. Because you wake up, you're a little tired, but you're like, like, oh, I don't want to disappoint my glass.

[A]

Yeah, 100%.

[B]

And they get out of bed and then they move their ass.

[A]

Yeah, 100%. And that's in the idea of actually calling push. Push was I want people to learn how to push themselves mentally, physically, and physiologically. And you can push yourself mentally with other people, you can push yourself physically with other people, but I think physiologically you really need other people to help push your physiology.

[B]

And it feels good when you're Showing up for somebody else, too. Absolutely right. That sense of need is almost like. Like, you know, caregiver. Like, you know, like, I need to be there today because my partner's not gonna have a partner, kind of. And I think the more that we can weave that in, you know, it's. You know, when I go back and I think about my life as a young child on the playground. Recess. We had a long, long recess. I went to Montessori school, so we had to actually do recesses today. And. And I remember there wasn't a lot of structure to research, but they would throw balls out on the field and stuff. And then pretty soon, like, a group of boys and a group of girls, we'd line up, we'd pick teams, and next thing you know, there's a kickball game going on or a soccer game going on. And, like, we problem solved. And we problem solved around exercise. And. Yeah, I. Look, I didn't realize what was going on back then. Nine years old, and when it hit my friend with a stick. But. But, you know, and when I think about the intelligence of that, you know, it really made for a great learning environment. Right. Because after you. You blow the carbs out and you come back in, you can start to take in information again. So where do you see this convergence of modern allopathic medicine and exercise? Is medicine, even food as medicine. Where do you see these converging? Because I think one of the big problems is that a physician cannot make a living prescribing exercise. Let's be honest. There's no ICD 910 codes or ICD 10 codes or ICD 11 codes in there for reimbursement for that. So how do these worlds collide? I think you did it out of passion and personal interest. But a lot of physicians don't have the same orientation that you do. Correct.

[A]

So I think that this is a case where technology can really help us. I think one of the things that happened since the pandemic is that before the pandemic happened, I never had done what telemedicine, ever. I never did a virtual visit, ever. I didn't know what that was. I remember when our offices shut down and they said, we're gonna switch over to Zoom. We're like, what was that? We didn't know what that was like. We had no clue. There was no such thing as virtual visit. I think one of the things that's come out of that is people's increasing comfort with virtual health in some ways. And I think the ability to track movement on people's devices, upload that information to get. I think right now we have a bit of a TMI situation where people are getting all kinds of data, all kinds of blood tests, all kinds of move stats and sleep stats. I wore one of those rings for a couple weeks. It's like, you got a sleepwear? I'm like, yeah, dude, tell me something I don't know.

[B]

I already know. I feel like shit.

[A]

Exactly. But I think that the idea of getting information that can be synthesized very easily and quickly, I think that the old vital signs of temperature and respirations and blood pressure, pulse, they were really important and have been very important as a fundamental. Of seeing a doctor. But how much you're moving and what kind of activity, how much intensity. We're increasingly really recognizing the value of intensity throughout your day. So encouraging people to put in intensity into their lives. Not only their HIIT training, which you and I both love, but also just intense periods of getting people to take the stairs. It was a really interesting study that came out of the European Heart Journal about a month ago looking at what's called VPA or vigorous physical activity, and people putting two minutes of VPA into their day every single day, versus people that didn't. Just two minutes, two minutes of like, things like taking the stairs or air squats, things to get their heart rate up. And that made a difference in their health outcomes of heart disease and diabetes, et cetera. So encouraging people to think about intensity. But then more importantly, how many intense minutes have you been doing, Mr. Jones? How many intensity, how much activity you've been doing? That may be part of the medical visit of the future. And now if I want somebody to see a nutritionist, I can just refer them to a virtual nutritionist in some cases, and that's very easy to do. So I think that in the future there'll be hopefully places where people have a more holistic view of their health. And I think over time that will become part of what we do. We're not there yet, but I think we're further along than we used to be.

[B]

And doctors should be able to make a living doing things like this, not disincentivize or deincentivize to. To do things that they're not covered for, you know.

[A]

Yeah, I think our system in general is screwed up that way. I think, unfortunately, the system really encourages people's procedures. And so there's been a real shift towards procedural medicine. So if you have somebody with a meniscus tear in my office, and that may not Be a surgical meniscus tear and you manage them along and maybe they need an injection and some strengthening and they do a lot better from that and they're feeling a lot better versus if somebody gets an arthroscopic surgery for that, which may not be the right treatment for them. But it's a lot easier to do, it's quicker, it reimburses a lot better. And people used to do those a lot. These degenerative meniscus tears were treated surgically. There was just a 10 year study published looking at the outcomes of those and they did less well than the people treated non surgically with the same problems.

[B]

Wow.

[A]

But there was a real incentive towards the procedure. And so our system has incentivized procedures instead of outcomes. And I think one of the things to think about over time as we get more data is we'll be able to basically incentivize outcomes. They were trying to do that with some of the earlier generation Obamacare people, but I think they didn't get far enough down the road. And there were a lot of other things baked in there that people didn't like. But I think the messaging around this is encouraging. Outcomes is where we should be. Thinking about where we're going would be helpful because unfortunately we have a procedure based world.

[B]

Wow. I've never heard it framed that way. We incentivize procedures and not outcomes. And then if you look at the outcome data, you might actually change the procedure. Correct? Yeah. No, that's. This is one of the reasons why I'm, I'm excited about AI because I think what AI is going to do for us is, is bubble things to the surface, you know, and have it be the truth. I think we've done so many peer reviewed placebo controlled randomized clinical trials that, you know, and some of them directly contraindicate each other depending on the outcome, maybe the study design or faulty mechanics in the study or what have you. And so it's really easy to get super myopic and argue these finite points of why you should do something and why not. But what AI can do is take 700 trillion independent variables and create an actual result. Hey guys, here's the outcome. It's not debatable. Right. I use it this example all the time. We've never done a randomized placebo controlled study on parachutes, so we don't have any actual scientific data that they work. Right. It's never been proven nobody would jump out of an airplane without one. So because we know what the outcome would be Right. Because we look at the outcome and that's really an interesting vantage point to say if we actually started to focus on outcomes, not just these procedures, we might change the whole architecture of how.

[A]

Yeah. So I have a great example of a recent study that was published actually last year in the New England Journal of Medicine. It was one of the 10 best studies in our society last year looking at. So some of the most difficult patients to take care of are people that have kind of moderate to Morbid, moderate obesity, BMI greater than 30, with arthritis in their knees and knee pain. Because they come in and they're like, hey, my knee hurts. And we're like, well we want you to lose some weight, your knee will feel better. And like, yeah, I would, but I can't move because my knee hurts. And so there's not been a great way to think about those. So there was a really interesting study that was done, done in 61 sites in 11 countries where they took people who had, they had to be basically have a BMI over 30, they had to have arthritis grade 2 to 3, so moderate arthritis on an X ray and those symptoms correlating with that. So arthritic knees, overweight and reporting pain

[B]

or mobility or reduction of.

[A]

Yeah, and they were broken up into two groups. One group, which was one third of the group was injected with a placebo and the doctors and the patients didn't know which group they were and they signed up in the study. So one group was injected with the placebo and both groups got the same information on diet and exercise once a week. And so the placebo group was injected with saline. Two thirds were given one of the GLP1s. The study was funded by Novo Dornisk, but in any case it needed to be done. And so they were injected with GLP1 and they tracked them for 14 months. So what happened? So the study, the group that basically was given the placebo lost about 3% of weight. The group that basically was given the GLP one lost about 20% of their weight. Their knee pain reduced by about half and their self reported activity profile increased by about half compared to the placebo group. So the idea was that the GLP one was almost twice as effective at weight loss and knee score, pain and activity profile. So that problem was a lot better. Now the problem with that is that we don't know the long term effects of some of these peptides like GLP1s and so, so there's some question on that, but we do know the long term effects of chronic obesity. Which are really dangerous to people. So that study really is a great way of structuring. It was a double blind, placebo controlled study. It was scientifically really well done, looking at a specific problem that helped us look at what we do. And so now we're looking at. And actually I'm talking with some colleagues about putting together a survey study of sports medicine doctors, because in my view, five years from now, sports medicine doctors are going to be prescribing GLP1s for people in that category of overweight with arthritic knees because they're so challenging. And our old paradigm of just lose weight and your knee will feel better, like, dude, I would if I could, but my knee hurts too much. And so there's a lot in there about this shifting world we're in, which I'm really excited about.

[B]

I think we're going to have a

[A]

whole different framework and way of thinking about these problems that really blends together the different worlds. It's just we have to get there.

[B]

If you know me, you know, I don't recommend anything I haven't personally tested. That's not a marketing line. That's just how I operate. I've been on the road my entire career. Different time zones, brutal schedules, no margin for days off. And so I'm constantly testing what actually works in my own body. NAD was something I keep coming back to. It's the molecule your cells use to produce energy and repair, and it declines faster than most people realize. When I found Symbiotica's liposomal nad, the absorption technology is what got my attention. I tested it, I felt it, and it's been in my bag ever since. I'm always evolving what I put in my body, and this one has stayed on the list. I'm genuinely excited for you to experience it. This is the standard we hold every product to before it even reaches you. Now, let's get back to the ultimate human podcast. Yeah. So. So it was the weight loss coming off the knees, relieving the pain that

[A]

allowed the mobility a thousand percent. And, and it's a. It's a different way of thinking about it. We didn't have that option before.

[B]

Yeah. Now, I know you're not a psychologist or a psychiatrist, but I have been reading a lot of studies recently on comparing SSRIs and mobility. And one of the first things signs of early depressive symptoms is people become more and more and more reclusive. Right? Less social interaction and less mobility. So their, their level of time they spend sedentary increases dramatically. And it almost correlates with the, with the level of symptoms. At least there's a correlation there between being very, very sedentary or increasing the amount of time that you're sedentary and your grade on these different, different psychological scores of, of depression. And how were they were able to reverse a lot of these just with mobility as an intervention alone, using placebos, you know, sugar pill versus ssri. But in both cases, using mobility and showing that in some cases exercise significantly outperformed psychiatric medication.

[A]

Absolutely. And we have increasingly great evidence on that exact point. I think the problem is that people would rather take a pill. Sometimes they would rather take the easy route. But the problem with a number of these SSRIs is they have, you know, they're easy to go on, they're very difficult to get off, they have a lot of side effects, libido, et cetera. They're not perfect, and they affect everybody differently. So what we talk about a lot is exercise as a first line drug. And that's why that's an exact example of the medicine of exercise. Because in that case, yeah, it may feel good to go for a speed walk or a run or go to a, you know, a strength class. But I'm talking about this as your physician. You're depressed, and I want you to take this instead of taking those other things. And let's see how that works. Now, that doesn't mean there aren't people with schizophrenia that need medication or bipolar disorder that need medication. But what I'm talking about is garden variety anxiety, depressive symptoms, et cetera. Those kind of things can be the best treatment for those as a first line treatment is exercise. And so how do we teach doctors about that? When I talk to psychiatrists and psychologists, I did a grand rounds lecture recently to a group of psychiatrists at Cornell, and I asked them at the beginning, raise your hand if you prescribe exercise to your patients. And almost everybody raised their hand, but there's no standardized way to do it. They have no formula. They don't really know who to do it, how to do it.

[B]

Good for them, though.

[A]

Yeah, they do it, but they all recognize it. But there's no formal mechanic to do it. And so I think that's where this whole kind of field is, is that we want this to become. To think of exercise as a medicinal intervention.

[B]

Yeah, I mean, I mean, I'm of the mindset that some is better than none, absolutely, no matter what you're doing. And like you said, attach getting the fun component in there. I Mean, that's a really interesting way to look at motivation, is to draw people into doing what they love to do. My wife likes the ballroom dance, and dancing can be intense.

[A]

No, it's great. And if she loves doing it, do you do it with her or not?

[B]

No, she. She has a. A. She has a Russian dance partner that she's convinced me is gay. But I need to go check this guy out and make sure that he's, you know, playing for the. Playing for the same team and not, you know, circling my wife.

[A]

But it's interesting, though, that I think that the piece of that. By the way, the piece on that. That is. Is exactly what I was talking about before, is that everybody has a thing that makes them smile. And for her, if it's doing the. Because my mom was into that, doing the bronze. I mean, I remember we came home, and, you know, she had four boys, and she was, you know, she was an amazing mother, a psychoanalyst, and tons of energy. But came home, and mom had a fake tan. Like, dude, mom, what are you doing? Then mom had fake nails. Like, mom, what are you doing? Mom became a devoted. She would go in the middle of a ballroom dancer. She's, like, devoted. She would go to these different balls. She had a dance teacher of the same ilk, and it made her smile, and it really gave her a purpose. Purposeful. You know, to me, I suck at ballroom dancing, and fine, I would do

[B]

it for my wife.

[A]

For sure. It was fun. But anywho, my mom loved it, and I think your wife loves it. And so I think the idea here is that what is your why? What makes you feel a purpose? And if it's ballroom dancing or whatever it is, that's great.

[B]

So tell me where all this is going for you. What projects are you working on? What should my audience be excited about that you're endeavoring to do?

[A]

Well, first, I think the idea of studying motivation and talking about motivation. Push was worked for about five years on my book Push, about trying to understand the science of motivation. And when I looked at it, my other books have been a lot about taking care of your body or your achy knees or very hard things. Push is a lot about how do I assess my own motivation and how do I realize where I am on my own motivational spectrum, and then how do I make it better? What are the things standing in my way? What's limiting me? And so I've been talking and thinking a lot about lecturing about motivational health and basically trying to unchart, unlock Your own motivation, which I think people can really do. There's a term I've been really using which I love, called lowering the cost to act, which is basically taking what you want to do do and making it what you do. And so that means I know I should be strength training, I know I should be walking, I know I should be moving, I know I should be doing whatever thing. What are the concepts that are going to make me make what I want to do and what I do the same? When I started researching Push, I thought there were people that were motivated and then people that were unmotivated. I don't think that anymore. I think everybody's motivated. I think the people that are successful have learned how to lower their cost to execute act, meaning they pay for a trainer in advance. They join a walking community, they join a running community, they join a hyrox, they join a CrossFit gym, they join ballroom dancing. They join things that will make them want to go. And I've seen so many different instances of this. I had one guy who I write about who really wanted to go to the gym, but he couldn't get himself to do it. And he finance guy worked super early in the morning, and then the way home, he's like, I'm tired. So what he would do in the morning, he loved his workout clothes and his workout shoes. He would go to one of the local gyms that had day lockers. At 6 in the morning, he'd lock his stuff in the locker room. And then if you come back, the end of the day, if you're not there, they cut off your lock and put it in the lost and found. So he would have to go back to the gym to pick up his stuff. On the way home, he's like, as long as I'm here, I might as

[B]

well, oh, that's good.

[A]

It lowered his cost to act. And so this whole idea of learning to understand and unlock your own motivation, because I feel like we, many of us in this kind of healthy space talk about the same kind of things, but how do we get people to actually do it? And not only people like us, we're going to do it no matter what, but how do we get the other people to do it? And I think that whole idea of figuring out how to lower people's cost to act, I find to be very powerful. So working on that. And then I'm also lucky to be involved with our local running organization called the New York Roadrunners Club, which is a the world's biggest running club. Put on the New York Marathon and a whole bunch of events in New York, and we are starting a whole research collaboration around figuring out why runners get hurt and what we can do to keep them on the road. So I'm very interested in that as well.

[B]

Wow. So what are one. Some things that people can do to lower their cost to act? And for a listener right now who's, like, encouraged and motivated and excited about this, what could they get up and do today, you know, to sort of change the trajectory about how they've been viewing mobility in their life? I mean, how do you take something that hasn't been a priority for two decades, three decades in somebody's life and shift it to a priority without some kind of traumatic life event where they've come to see you for their yes or they're back no.

[A]

It's a great. I mean, that's. That's most people, and I think they have to. They have to figure out what motivational trigger they have. For many men, it's financial. Guys respond better. So this whole idea of lowering the cost act comes. There's a center for Behavioral economics at Penn. And University of Pennsylvania has a dual center between Wharton, the business school, and the med school, trying to figure out behavioral economics, what makes people change. And interestingly, they came to the conclusion it was like $1.30 a day. It's a little small number, but men respond better to financial triggers. So men who are listening should find a trainer and prepay 10 sessions. And so if you prepay, you're like, dude, I paid the money. They're charging me if my ass is there or not, I'm gonna go there and get my. Men respond very well to that trigger. Women respond very well in general to communal triggers. And so I'm gonna join a community. I'm gonna have a friend. I'm gonna sign up for a thing with a friend, do it with a girlfriend. Do with a girlfriend. I'm gonna start doing that. Those in generalities tend to be the two most effective triggers for people. And then you start. One thing I write about and think about a lot is what I call the exercise wheel. If you want to get a. From your old CrossFit days, if you want to get a tractor tire from here to across the room, the biggest energy is getting that damn thing up off the ground. Once it's rolling, it gets a momentum of its own. Not flipping, but rolling. And so if you can get that thing rolling, it starts to basically get its own speed and momentum. And that's what I want people to think about, how do I get my own tractor tire rolling? And that's by lowering my cost to act.

[B]

Wow, that's so great. I mean, you know, there's. There's some really interesting technology coming out. These predictive AIs. I was actually looking at one this morning. A group came over in the AI space and was demonstrating it to me, and I thought it was really fascinating because what it did was it painted a picture of exactly who you are now, based on the exact data of today. Right. Your BMI and all of these, all these other data scores. Your. Your hyperinsulinemic, you're insulin resistant, you have high triglycerides, you have all of this going on. If you took these actions, this is where you'll be in 10 weeks, this is where you'll be in 12 weeks, and this is where you'll be in 21 weeks. And it actually created photorealistic images of their body morphic. I love that. And I was like, wow, that's really cool. Now, the downside would be if it wasn't accurate, but they are assuring me that this is. With extraordinary accuracy because the amount of data that they were able to pull into this, which is another thing I'm encouraged, you know, with. By AI about.

[A]

Yeah.

[B]

So if you knew, you might look like that by this date. That's sort of something we can conceptualize. It's like, okay, Thanksgiving is three months out. The whole family's going to be here by Thanksgiving. I can look like this. Or my wedding date, my son's wedding, my. Yeah. By Buddy Spar mitzvah, whatever it is. I think those kinds of triggers for people, exactly what you were talking about, whether they're financial or communal, that's lowering their cost Act.

[A]

That's. And that's a great way to think about that. I'm lowering the cost act by basically, I want this outcome. And so this is where I'm now. I want to get to that outcome.

[B]

That's the first time that I'd seen be able to show it to you.

[A]

That's so cool.

[B]

It's like you're sitting here. You look like this. How about. You want to look like this? This is how long it's going to take.

[A]

Can I have biceps like you? That's what I'll take.

[B]

Thank you. No, you're making. You're making me feel great. Great. Dr. Metzl, this is. This has been amazing, man. Loved it.

[A]

Loved it.

[B]

For my audience that has enjoyed this as much as I am, where do they Find you.

[A]

So I'm on social media. Rjordanmetzel. That's kind of my main Instagram. LinkedIn. Not doing TikTok. I probably should, but I'm not.

[B]

You don't want the Chinese spying on you.

[A]

Exactly. They can spy, I don't care. And then I've actually been working, you'll see there. I've actually been working with an AI company about doing a. An AI of just my own information. So that's been really interesting. This company, it's in my link tree for my Instagram, but basically it's all the talks and lectures and podcasts and research papers, everything I've done over 25 years all loaded into one AI. So then they can ask me a question from wherever and I can answer them when I'm sleeping. So it's good.

[B]

Love that. So I'm going to put all of that in the show notes and I wind down all of my podcasts by asking my guests the same question. What does it mean to you to be an ultimate human?

[A]

To meet ultimate human is to me what meant to be a doctor, which is I got into medicine because I really loved helping people. There's just people have different jobs, they have different, you know, they're filled by different things. Some people want to be seen, some people want to be financially successful, some people want to be famous. To me, listen, I love being successful, I love all those things. But the most gratifying is when you can help somebody and they look at you and say, hey, Dr. Metzl, you really made a difference in my life. I did this thing, I get a picture from somebody finishing some event or something and said, I really am so thankful to you for helping me get to this piece. And it's that one on one human connection to me, an ultimate human is basically helping other people achieve their goals. I find that to be so gratifying.

[B]

That is so good, man. John Maxwell calls it about living a life of service, not a life of significance. And if you've ever had the benefit and the gratification of living a life of service and seeing that service come back to you in a very rewarding way, which is rarely monetary, it really is deeply gratifying. Before we close out, and I usually don't do this, but you just sparked my interest in something. Is there a patient of yours or story that really stands out to you? Like someone that came in to see you just battered, broken, desperate, desolate? Maybe not, but. And you did this prescription of medicine, maybe you had some other traditional medical interventions and that story sort of still sticks in your mind.

[A]

Not only do I have one, but I started push with it. So I start push with a narrative story about a woman that came in to see me in her late 60s, mid-60s, and she had simultaneously had a breast cancer diagnosis and lost her husband in the same two year span at 68. Now those two things together could put people to the point where they're like, listen, I just don't feel like doing this anymore.

[B]

I'm alone.

[A]

But she was a fighter. And she started going out for walks. And she started walking. And then she started slow jogging. And then she started slow jogging a bit more. And at age 70, she ran her first marathon. And I start my book with her. Then she did another marathon by age 82. By age 82, she'd run 15 marathons. And at age 83, she started teaching a kettlebell class for people 80 and over. No. Yes. Really? She's the first patient in my. She's the first story in my book that is amazing. And I find people like that. So I'm lucky because, you know, listen, being a doctor is not easy. It's tiring. You're there along, people see, like Instagram doctors, like, hey, it's not like that. Like, you're there early, you're there late, you got a lot of people, a lot of questions, a lot of energy, a lot of interaction. It's exhausting.

[B]

Yeah, yeah, yeah. A lot of withdrawals.

[A]

It's a lot of withdrawals. But it's so gratifying to have people like that. In the book. I call her Alice, and in Alice's story is exactly the story of basically overcoming sadness through activity. And not only herself, but she inspires so many people around her that I consider someone like that to be so gratifying.

[B]

That is an amazing story and there's so many layers to that story too, because she found her community and her connection. Losing a husband, I imagine, at mid-60s, probably married for a long time time, very isolated and then getting this community movement, all the things together. Yeah. Did she beat the breast cancer conventionally?

[A]

No, no, no. She did through chemo and everything. Yeah. Chemo, yeah. Then started using, then started using exercise just to help her feel better because she was so depressed and it really made a huge difference for her.

[B]

Amazing. Dr. Metzl, thank you so much for coming on the Ultimate Human podcast. This was amazing. I know my audience is really going to enjoy it. Your energy was very catchy. So I'm sure it went right through the camera and motivated my audience. Dance. So, guys, until next time, that's just science.