Is My Workout Doing Anything for My Brain?

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For most of my life, exercise was about the scale.

How many calories I burned. What size I’d fit into. How I’d look on camera the next morning.

I never once asked what my workouts were doing for my brain.

That changed in perimenopause.

The first thing I noticed was my short-term memory. I spent decades in news relying on my memory for everything, long before our phones could remember things for us. And suddenly, it felt like it was slipping away. Then came the fog, which I didn’t even have a name for at the time.

It was one of the scariest parts of this entire transition for me.

A few weeks ago, I was giving a speech in Philadelphia and mentioned brain fog. When I looked out at the audience, every woman in the room was nodding. They knew exactly what I meant. And I think a lot of them knew the fear underneath it, too.

Then there’s something Dr. Lisa Mosconi told me that I still can’t shake: Alzheimer’s isn’t necessarily something that suddenly starts at 70 or 80. The changes can begin in midlife, decades before a diagnosis.

Since then, brain health is something I think about all the time. As I build this next chapter, I want to be strong enough to live it. But I also want my brain to come with me.

So when I sat down with clinical neurophysiologist and Alzheimer’s researcher Louisa Nicola, I asked her the question so many of you have asked me: How should we actually be working out for our brains?

Exercise is medicine for the brain

Louisa has spent more than a decade studying the brain, and her focus is Alzheimer’s disease. When she looks at what it takes to lower our risk, outside of medication, “the best intervention is exercise.”

She walked me through what happens in the brain when we move. Steady cardio like walking boosts blood flow to the brain and helps produce BDNF, a growth factor that supports new brain cells in the hippocampus, the part of the brain tied to short-term memory. (Hello, perimenopause.) Harder efforts produce lactate, which she called “an absolute beautiful fuel source for the brain,” at a time in midlife when the brain may not use glucose as efficiently as it once did.

And when we contract our muscles, they release myokines that travel to the brain. She described them as little worker bees that help repair and protect our neurons.

I wish someone had explained all of this to me 20 years ago.

Larger legs, larger brain

The moment that really got me was when she started talking about our legs.

She pointed to research on older female twins showing that leg power predicted how well their brains aged over ten years. “The larger the legs, the larger the brain,” she said.

I told her thick thighs save lives. She didn’t argue.

Our leg muscles are some of the biggest muscles we have. Louisa explained that more muscle gives the body more places to store glucose, squeezing those muscles helps push blood back up through the body, and more muscle means more of those myokines reaching the brain.

How heavy is heavy?

This is where she got specific, and where I got a little uncomfortable.

If you’re training for your brain, Louisa says the bare minimum is two days a week of strength training, and it needs to be heavy: around 80% of your one-rep max. She recommends compound movements like squats and deadlifts that work many muscle groups at once.

That doesn’t mean walking into the gym tomorrow and loading up the bar. She doesn’t think anyone should start at 80%. Start with what you can do, even bodyweight exercises, and build from there. “You have to fall in love with strength training,” she told me.

Then I asked about Pilates. I love Pilates.

“I’m sorry to offend you,” she said. Pilates is wonderful, but you’re “probably not getting the biggest bang for your buck.” It’s a great add-on, not the whole plan.

I promise you, I’m strength training.

The workout plan for your brain

So I asked her to build out my week. I exercise about five or six hours a week, and here’s how she told me to use them:

Two hours of heavy strength training
One session of the Norwegian 4x4 to build VO2 max: four minutes at a near-max effort, three minutes of rest, repeated four times
The rest in zone 2, which is about 65% of your max heart rate: brisk walking, light jogging or biking
And on top of all of it, 10,000 steps a day

She also told me not to rely on my wearable for VO2 max. If you don’t want to do a lab test, she suggested the 12-minute Cooper test as a simple way to estimate it.

It starts in midlife, and so can the work

The thing Louisa said that stayed with me most was this: Alzheimer’s is “a midlife disease with late-stage symptoms.”

That could sound frightening. But she meant it as the opposite. There are 14 modifiable risk factors for dementia, including high blood pressure, diabetes, high cholesterol, hearing loss, social isolation and physical inactivity. These are things we can actually work on.

We also talked about creatine and why she’d call it her one “golden supplement,” the p-tau217 blood test you can ask your doctor about, and why she wants women to take their symptoms seriously and advocate for themselves.

I’m not going to pretend I have it all figured out. But I walked away from this conversation looking at my workouts completely differently.

They’re not about the scale anymore. Or the size on the tag.

They’re about the woman I want to be at 75 and 85. Still working. Still traveling. Still learning. Still remembering.

What if the most important workout you do this week is the one you’re doing for your brain?

My full conversation with Louisa Nicola is out now on The Tamsen Show. Listen to it here or watch it here.

Frequently asked questions

What is the best exercise for brain health?

Louisa Nicola recommends heavy strength training at least twice a week, compound lifts like squats and deadlifts, one Norwegian 4x4 interval session, zone 2 cardio and 10,000 steps a day.

What is the Norwegian 4x4?

Four minutes at a near-max effort, three minutes of rest, repeated four times. Nicola uses it to build VO2 max.

Why do strong legs matter for the brain?

Nicola pointed to research on older female twins in which leg power predicted brain aging over ten years. Larger leg muscles store glucose, help push blood through the body and release myokines that reach the brain.

Is Pilates enough for brain health?

Nicola says Pilates is wonderful but probably not the biggest bang for your buck. Treat it as an add-on to strength training.

When does Alzheimer's start?

Nicola calls it a midlife disease with late-stage symptoms, which is why midlife is the time to work on modifiable risk factors such as blood pressure, physical inactivity and social isolation.

About the guest

Louisa Nicola is a clinical neurophysiologist and Alzheimer's researcher who has spent more than a decade studying the brain. Listen to the full conversation with Tamsen Fadal on The Tamsen Show.

This article summarizes a conversation on The Tamsen Show for general education and is not medical advice. Talk with a qualified healthcare professional about your own situation.

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