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I’m just about coming off what Barry’s Bootcamp calls “Hell Week”: seven classes in seven days. For those who haven’t experienced Barry’s, each 45-minute class is a carefully structured, instructor-led mix of run-sprint intervals on the treadmill followed by floor work with weights, heavily focused on core strength -- all set to music that feels more like a nightclub than a gym.
For anyone who has spent time in the "red room" at Barry's, you know it’s not just about the workout. It’s the structure, the instructors, the music, and perhaps most importantly, the tight knit community. There’s something about being surrounded by others pushing toward the same goal that changes the experience. It creates accountability. It builds momentum. And over time, it produces results.
Not long after, I’ll be jumping into another challenge -- this time at SoulCycle, riding as part of a team aiming to become the top “pack” in the country. We came in second last year. Close enough to be motivating.
Spending time in these boutique fitness environments -- and seeing the cumulative impact of consistent, HIIT exercise combined with diet, sleep, and routine -- has led me to reflect on something that feels increasingly relevant to us in the pharma industry.
Which raises a broader question: why does exercise remain something we recommend in the background, rather than something we intentionally design around?
For years, exercise has been positioned as something broadly beneficial but largely peripheral to medical treatment. It sits in the “lifestyle” category: important, yes, but often secondary to the primary therapeutic intervention.
But the more one looks at the emerging evidence, the harder that framing becomes to sustain.
The neurological and psychiatric literature, in particular, is beginning to paint a very different picture. Studies have shown that exercise can increase brain volume, including in areas like the hippocampus that are critical for memory formation. It appears to strengthen connectivity across key brain networks involved in attention, planning, and emotional regulation. There is growing evidence that it influences neurochemical pathways -- BDNF, IGF, and others -- that are directly tied to cognitive function and neurodegeneration.
And in the context of mental health, the findings are even more compelling. Large-scale analyses suggest that exercise can be as effective as psychotherapy or pharmacotherapy for certain forms of depression, with clear dose-response relationships tied to intensity.
At some point, it becomes difficult to view this as ancillary. It begins to look more like therapy. I’ve found myself joking with some of the riders at SoulCycle -- several of whom are training to become physicians at the Philadelphia College of Osteopathic Medicine (PCOM) -- that one day their prescription pads might include a formal “exercise” intervention. Given the mounting evidence, it may not be as far-fetched as it sounds.
Which raises an interesting -- and, perhaps, underexplored -- question for pharma:
Should we be thinking about exercise not as background advice, but as a co-therapy?
Not in the sense of replacing pharmacologic treatment, but in recognizing that for many conditions, especially neurological, psychiatric, and metabolic ones -- outcomes may be meaningfully shaped by what happens outside the prescription pad.
This is where things get more complex.
Because if exercise has measurable effects on cognition, mood, and brain structure, then it stands to reason that it could also influence clinical trial outcomes. It could affect baseline function, rate of progression, response to therapy, and even patient-reported outcomes.
And yet, in many cases, it remains loosely measured, if at all.
This is not a critique so much as an observation. Clinical development is necessarily controlled, and introducing behavioral variables adds complexity. But as therapies increasingly aim to reshape systems -- neurological, metabolic, behavioral -- the environment in which those therapies are used may matter more than we have historically acknowledged.
From a behavioral standpoint, this becomes even more interesting. Exercise is not a one-time intervention. It is a habit. (And I love to think about and write about habits.)
It requires initiation, repetition, reinforcement, and, often, social support. It is influenced by context, like time of day, environment, access; as well as by identity and motivation. It can be sustained, or it can fade, depending on the feedback it generates.
In other words, it operates according to many of the same principles we see in treatment adherence. This is where the concept of co-therapy becomes more than a clinical question. It becomes a behavioral one.
If a therapy is being used alongside exercise, then the patient’s experience of that therapy is shaped not just by the drug, but by the broader pattern of behavior in which it is embedded.
Does the therapy enable exercise? Does it enhance recovery, energy, or confidence? Or does it introduce barriers, like fatigue, discomfort, complexity, that make exercise less likely?
These are not trivial considerations. They influence how a therapy is experienced authentically in the real world.
What feels different today, and increasingly relevant, is the cultural shift around fitness itself. Boutique fitness is not a niche trend. It is growing rapidly, particularly among younger populations. In a world where many people work remotely and lack traditional points of daily interaction, fitness studios have become something more than places to exercise.
They are points of congregation.
Barry’s. SoulCycle. Solidcore. OrangeTheory. Lifetime. These are not just workout formats or "just a gym," they are communities. They create identity, routine, and social reinforcement. They give structure to the day and meaning to the effort.
There is, quite clearly, a movement underway -- one that blends physical health, social connection, and personal performance. And importantly, for many people, these routines are not occasional. They are increasingly woven into daily life.
If we take seriously the idea that pharma should “meet patients where they are,” then this shift has implications. Because increasingly, where patients are is not just in the clinic.
It is in these workout settings.
It is in the routines they build around fitness, recovery, sleep, and nutrition. It is in the communities that reinforce those behaviors. And it is in the expectations they form about what it means to feel healthy, energized, and in control.
In that context, therapies are not experienced in isolation. They are evaluated based on how well they fit into these routines.
These questions are becoming more relevant, not less.
This is where the conversation becomes strategic.
If exercise is acting as a meaningful co-factor in outcomes, and if it is increasingly embedded in the lives of patients, then there are several implications worth exploring.
Because if exercise is part of the therapeutic equation, then its variability becomes part of the story we are trying to understand.
All of this raises a more forward-looking question.
Pharma is already beginning to partner with emerging forces in the digital ecosystem, like AI, direct to patient companies like Hims, remote monitoring, and other connected health platforms. These partnerships are designed to meet patients in the environments where decisions are increasingly shaped.
So why not extend that thinking?
What would it look like to partner with the environments where health behaviors are actually being formed and reinforced?
It is not difficult to imagine this headline:
[PharmaCo] Announces Strategic Partnership with Barry’s to Support Patients on New Therapy in the Metabolics Space.
Hypothetical, of course. But not entirely far-fetched.
If we believe that behavior shapes outcomes, and that exercise is both a therapeutic input and an anchoring behavioral habit, then there is a case to be made for thinking more expansively about where and how pharma engages.
