Movement Is Medicine: Why How You Move Matters as Much as How Often

Most of us think of exercise as something separate from "real" healthcare, a nice-to-have for people who enjoy the gym or run marathons, distinct from the blood tests, scans and check-ups that make up medical care.

In Episode 34 of the Innersight Podcast, we sat down with Dr. Cuan Coetzee, a South African-trained chiropractor now practicing in London and author of Why Movement is Medicine to make the case that this separation is exactly backwards. Movement isn't an accessory to health. It's one of its foundations.

A Chiropractor's Unlikely Path to Writing a Book

Dr. Coetzee's journey into this topic wasn't a straight line. Trained as a chiropractor in Durban, he spent years in general practice in the Eastern Cape before relocating to the UK. Early in his career, he noticed a troubling pattern: he was treating people's pain without ever really addressing longevity - patients would come in hurting, get some relief, and leave with no broader plan for staying well.

The book itself was born, somewhat unexpectedly, out of the COVID lockdowns, a period when Dr. Coetzee, unable to physically treat patients, finally had time to compile years of notes, patient stories and explanations he'd found useful in practice. His stated goal wasn't just to inform people, but to create urgency: when a patient genuinely understands why they're being asked to do something, they're far more likely to actually follow through. It's the same principle Innersight builds into its own client programs - asking people to commit to concrete actions within a set timeframe, because without urgency, good intentions rarely translate into behavior change.

Movement Is Not Just Exercise

One of the central reframes in the conversation is that "movement" is a much bigger category than "exercise." Exercise is a deliberate, structured subset of movement, but movement itself, according to Dr. Coetzee, is fundamentally a neurological phenomenon. It's often described as the final output of a thought: nearly everything the brain does eventually expresses itself as some form of movement, and the brain only receives meaningful stimulation from movement and from education - there's no other physical pathway in.

This has a very practical implication: the brain is constantly trying to protect the body, and it does this partly by restricting movement it doesn't trust or doesn't use. If certain ranges of motion aren't used regularly, the brain effectively decides they're unnecessary and starts to physiologically limit them, which is why someone can go years without issue, then suddenly struggle (or get injured) attempting something as simple as lifting a heavy object, purely because the body was never conditioned for that movement pattern.

This "use it or lose it" principle also explains why so many people don't think of themselves as needing to move at all. Dr. Coetzee shared the example of his own wife, who grew up never associating exercise with health - it was simply something reserved for PE class or "people who do marathons." Reframing movement as a basic, daily necessity rather than an elective activity for athletes is, in his view, one of the most important shifts people can make.

The LENDS Framework: Five Levers for Brain and Body Health

Beyond movement specifically, Dr. Coetzee organizes his broader approach to longevity around a memorable framework: LENDS, adapted from a 2016 paper by researcher Joyce Shaffer. Picture a see-saw: without deliberate effort, health naturally tips toward decline through wear, tear and stress. LENDS represents the counterweights:

• L - Love: Joy, gratitude, genuine contentment and a real reason to want to get better. In his experience, sustained improvement rarely happens without this - patients need something (or someone) to get better for.

• E - Exercise: Movement as medicine, non-negotiable.

• N - Newness/Novelty: The brain needs ongoing novel stimulation to keep developing. Without it, cognitive function stagnates. Dr. Coetzee uses the koala as a memorable example: an animal that evolved a small brain relative to its body size because its lifestyle demands almost no novelty at all.

• D - Diet: What you do and don't put into your body.

• S - Sleep: Deep, quality sleep as a genuine biological essential, not a lifestyle luxury.

  
  

He considers these roughly equally weighted from a longevity standpoint, and notably, this framework places most of what conventional medicine focuses on (bloodwork, biomarkers, medication) inside just one small piece of "Diet," while everything else - love, exercise, novelty and sleep sits entirely outside the traditional medical model, despite arguably mattering just as much for how long and how well someone lives.

The Four Pillars of Movement

Returning to movement specifically, Dr. Coetzee structures his approach, and Innersight's own testing, around four pillars: stability, flexibility, endurance, and strength. Most people, he notes, are naturally strong in one or two of these and neglect the others. As a lifelong endurance athlete himself, he found cardiovascular training effortless but had to consciously build strength training and flexibility work into his own routine, and didn't take balance and proprioception seriously until injuries in his 30s forced the issue.

For strength specifically, his clinic uses a structured framework they call the "Move Med 8" -eight core movement patterns recommended for a resilient, long-term functional spine and body: push, pull, lift (the "big three"), calf raises and tibialis anterior raises, spinal flexion and extension, spinal rotation and lateral bending, and the split squat (hip flexion/extension).

Notably, he flags that many people actively avoid spinal flexion and rotation out of fear, and that avoidance itself often becomes a cause of pain, since unused movement patterns simply grow weaker over time.

Meeting People Where They Are

A recurring, practical theme throughout the conversation is that most behavior-change advice fails because it aims too high, too fast. Dr. Coetzee's approach with new patients isn't to prescribe an ideal program, it's to find the smallest realistic commitment someone will actually stick to, even if that's just a 10-minute walk, twice a week. From there, patients "habit stack": adding a third weekly session, or extending the walk slightly, gradually building tolerance without triggering the brain's natural resistance to sudden, large changes.

He references a concept called graded exposure - increasing physical load incrementally enough that the nervous system doesn't perceive it as threatening. A commonly cited sweet spot is roughly 10-15% novelty at a time: enough to create adaptation, not so much that the brain "protects" the body by pulling back. This connects directly to a statistic often cited on the podcast: increasing daily step count from around 2,000 to 7,000 has been associated with a 43% reduction in all-cause mortality, a striking result from what, on paper, looks like a fairly modest change.

Zone 2 Training: The Case for Going Slower

Both Dr. Coetzee and ourselves are strong advocates for zone 2 training - low-intensity, "conversational pace" exercise where you can still comfortably talk. Unlike higher-intensity training, zone 2 work is generally safe even in the presence of minor niggles or old injuries, and can often be genuinely therapeutic rather than aggravating.

Interestingly, this connects to mental health as well. Dr. Coetzee referenced the SMILE study, which found exercise (across a fairly wide range, from 12 minutes to 180 minutes weekly) to be roughly as effective as antidepressant medication for chronic depression. His personal target is around 180 minutes of zone 2 activity weekly, but he's careful to frame even the lower end of that range, as little as 12 minutes a week, as a meaningful baseline worth starting from, not a token gesture.

A common pattern in Innersight's own client base reinforces this: many people, particularly in the 35-55 age range, spend most of their training time in "zone 3" - too hard to be easy, not hard enough to be a true high-intensity effort, which often shows up as elevated inflammatory markers on bloodwork (like CRP) without the corresponding fitness benefits of properly structured hard or easy sessions. The fix generally isn't more effort, it's redistributing effort toward the two ends of the spectrum: genuinely easy, and genuinely hard.

Feet: The Overlooked Foundation

One of the more unexpected topics covered was the importance of foot health and mechanics. Dr. Coetzee assesses feet in every patient and has personally transitioned to minimalist, barefoot-style footwear (zero-drop, wide toe box), though he's careful to stress that transitions like this must happen gradually, since sudden changes in footwear can overload the Achilles tendon.

His broader point: footwear, raised heels and excessive arch support fundamentally alter gait, and while supportive shoes can be genuinely useful short-term, they ideally need an "exit strategy" toward restoring natural foot function where possible. Since the foot is the very first point of contact in any movement pattern, weakness or dysfunction there can produce compensatory issues that travel all the way up the chain, frequently showing up, somewhat counterintuitively, as knee, hip or lower back pain that actually originates at the foot and ankle.

This ties directly back to fall prevention and balance, a topic we at Innersight also emphasize in our own testing. A hip or femur fracture from a fall, particularly after age 60, can meaningfully shorten both lifespan and quality of life, making foot strength and balance training a much higher-leverage intervention than it might initially seem.

The Biggest Myth: Pain Equals Damage

Asked about the most common misconception he encounters, Dr. Coetzee didn't hesitate: the belief that pain intensity is directly proportional to tissue damage. In his experience, this is emphatically not the case - he's seen patients in genuine agony from little more than a minor muscle spasm their brain has reacted strongly to, and at the other extreme, patients with only mild, dull discomfort who turned out to have serious underlying pathology, including cancer.

The practical takeaway: don't wait for pain to become severe before seeking help, and don't assume mild symptoms are automatically benign. He references a widely cited 2017 imaging study which found that by age 40, roughly 50% of completely pain-free, asymptomatic people already show disc abnormalities on MRI, a striking reminder that structural findings and symptoms often don't line up the way people assume.

The Bigger Picture

What ties this whole conversation together is a simple, recurring idea across nearly every Innersight episode: the most powerful health interventions are rarely exotic. They're consistent movement, adequate sleep, real human connection and a body that's regularly, but not excessively challenged.

Dr. Coetzee's core message, distilled to its simplest form, is one worth remembering: get yourself tested and understood before problems appear, find a realistic starting point wherever you currently are, and build from there. Life genuinely is short, and movement, in his words, is medicine.

Watch this episode on our Youtube channel: https://youtu.be/ekT7xRPOr1s

For more infomation, visit: https://www.movemed.co.uk/

Visit Cuan's Youtube channel: @movemeduk

#MovementIsMedicine #MobilityTraining #Longevity #Mobility #FunctionalMovement #HealthyAging #PainRelief #PostureCorrection #Chiropractic #MusculoskeletalHealth #InjuryPrevention #MoveBetter

This blog post is not intended as a substitute for the advice of your healthcare provider. No doctor-patient relationship is formed through this content - it is provided for general informational purposes only.