This article is based on my conversation with neuroscientist Julie Fratantoni, PhD, author of the Better Brain by Dr. Julie Substack, as part of the first-ever Brain Health Substack Summit hosted by The Habit Healers.

Click here to join tomorrow for Brain Health Substack Summit Day 2 with Annie Fenn, MD.

In the late 1990s, I was sitting in a pharmacology lecture during my first weeks of medical school, staring at a stack of handouts thick enough to be mistaken for a semester’s worth of reading. It was two weeks of material. I had three children at home. My youngest was ten months old.

So I started drawing cartoons.

I drew a Pepsi bottle to represent peptidoglycans, a class of molecules in bacterial cell walls. Then I drew a little van driving across the Pepsi bottle for vancomycin, the antibiotic that targets those molecules. I colored the van red, because vancomycin can cause a flushing reaction known as “Red Man Syndrome.” When test day came, I didn’t need to scramble for facts. I could see the picture in my head. The van. The Pepsi bottle. The red.

My classmates noticed. They started borrowing my cartoons, which forced me to explain the drawings out loud, which meant I had to think even harder about what the relationships between the drug classes actually were. Nearly thirty years later, I still remember pharmacology details I probably have no business remembering. My daughter later went to medical school and adopted the same method. We published books about it called Visual Mnemonics.

I did not know it at the time, but I had stumbled into something neuroscience now has a very clear explanation for. And it is not what most people think of when they hear the words “brain exercise.”

That is exactly what I wanted to explore when I sat down with Julie Fratantoni, PhD, for the opening conversation of our Brain Health Substack Summit. Julie is a neuroscientist, the author of the Better Brain Substack, and someone who works directly with clients on cognitive performance. I expected her to talk about brain-training apps and puzzles. Instead, she dismantled almost everything I thought I knew about what it means to exercise your brain.

The Basketball Problem

Julie likes to use basketball to explain two very different approaches to brain training.

Imagine you are coaching a youth basketball team. You run drills: dribbling, passing, shooting. Each skill gets practiced on its own. This is what researchers call bottom-up training. You are building individual abilities one at a time, rep by rep. My husband coached our youngest’s basketball team, so I know this routine well. You drill the fundamentals first, because no strategy in the world matters if you cannot get the basics right.

Now imagine game day. Suddenly your players need to decide when to pass, when to shoot, how to coordinate with teammates, how to adjust when the other team changes formation. That is top-down training. It requires the prefrontal cortex, the part of your brain right behind your forehead, which handles planning, problem-solving, decision-making, and the ability to pull separate pieces of information together into something useful.

The same split exists in cognitive training. Bottom-up brain exercises target single skills like working memory (the ability to hold information in mind temporarily), attention, or processing speed (how fast your brain takes in and responds to information). Top-down exercises challenge your prefrontal cortex to do the harder work of organizing, judging, and thinking critically.

Here is where things get interesting. Most commercial brain-training apps focus on bottom-up skills. And the majority of research shows that getting better at those games does not translate into real-life improvement. You get better at the game. That is about it.

Julie was blunt about this during our live conversation. The majority of research shows that these games do not generalize to real life, she said, and she wanted to say it loud and clear because it is the question she gets asked more than almost any other.

The 23-Hour Experiment

There is, however, one notable exception, and it comes from one of the largest cognitive training studies ever conducted.

The ACTIVE study enrolled about 3,000 adults aged 65 and older and assigned them to one of three types of cognitive training: speed training, memory training, or reasoning training. A fourth group served as a control and received no training at all. The participants trained over a period of three years and were then followed for two decades.

The result that caught everyone’s attention was this: the speed training group showed a 25 percent reduction in the risk of developing dementia, including Alzheimer’s disease. The memory and reasoning groups did not show that same protective effect.

But Julie pointed out something most people overlook when they read about this study. The speed training was adaptive, meaning it automatically adjusted its difficulty based on how each person performed. The other two types of training were not. That distinction matters, because it suggests the key ingredient may not have been speed itself, but the fact that the challenge was always calibrated to the right level for each person.

And then there is the dosage. Over three years, the total training time amounted to about 23 hours. Julie did the math. That is less than an hour a month.

Less than an hour a month, and it moved the needle on dementia risk by a quarter.

The Posture Problem

So should we all just download a speed-training app and call it a day? Not exactly. And this is where Julie’s thinking takes a turn that changes everything.

She asked me to think about posture. Say you spend twenty minutes at the gym working on your form and alignment. That is great. But then you go home, sit hunched over a desk for eight hours, and repeat that for months on end. What is your posture going to look like in five years? Probably not great, because the eight hours of slouching vastly outweigh the twenty minutes of effort. We both immediately sat up straighter when she brought this up during the live, which I think proves her point.

The brain works the same way. If you spend an hour a month on a brain-training app but the rest of your waking hours are filled with chronic stress, constant distraction, and information overload, your cognitive health is going to reflect those thousands of hours, not the handful of training minutes.

Your brain is on all the time, Julie said. We are in this age where a lot of us are information workers. You take your brain home with you at the end of the day and you are always thinking. It never turns off.

Her argument is that we need to stop thinking of brain exercise as a separate activity that gets scheduled into the calendar and start thinking of it as the way we use our brains all day long. The question changes from “What brain exercise should I do?” to “How am I using my brain during the sixteen or so hours I’m awake?”

And she has a specific four-step framework for doing exactly that.

Exercise One: Reinterpretation

The first exercise has nothing to do with puzzles or games. It has to do with stress.

Your prefrontal cortex, the part of the brain responsible for planning, judgment, critical thinking, and complex problem-solving, essentially goes offline when you are stressed. Not a little offline. Functionally offline. When your body shifts into a threat response, your amygdala (the brain’s alarm center, which processes fear and strong emotions) takes the wheel, and your higher-order thinking gets sidelined. You cannot exercise a brain region you cannot access.

Julie teaches a technique called reinterpretation, which is a form of cognitive reframing. The idea is simple. When something stressful happens, you deliberately look at it from a different angle.

Here is her example. You send a friend a heartfelt message and hear nothing back. The default emotional response might be hurt feelings, or offense, or the start of an anxious spiral about the state of the friendship. Reinterpretation asks you to pause and consider: maybe your friend had a terrible week. Maybe something happened in their life that has absolutely nothing to do with you.

I had to laugh when she gave this example, because I know exactly where my mind goes in that situation. My worried-mother brain skips right past “they’re ignoring me” and lands on “are they in a ditch somewhere?” But there is also a possibility people forget about entirely: maybe there was a plain old technical glitch and the text never arrived. That happens more often than any of us want to admit.

The shift in perspective is not just a feel-good trick. Brain imaging research shows that people who practice reinterpretation regularly show decreased activity in the amygdala and increased activity in the prefrontal cortex. The actual pattern of brain activation changes. You are, in a measurable sense, training your brain to stay in thinking mode rather than reacting mode.

This matters because chronic stress does not just feel bad. It damages the brain over time and increases risk factors for cognitive decline. Getting good at recovering from stress, at catching yourself before the spiral, is one of the most protective things you can do for your long-term brain health.

Exercise Two: Single-Tasking

Once your nervous system is regulated and your prefrontal cortex is back in business, the next exercise is deceptively simple. Do one thing at a time.

Julie is emphatic about this. Multitasking is not a productivity strategy. It is an added source of stress, and most people do not realize it. Every time you bounce between browser tabs, glance at your phone while someone is talking, or try to follow a podcast while answering emails, your brain has to work to suppress the distractions. That suppression burns through your cognitive resources the same way running too many programs slows down a computer.

But the real cost of distraction is this: your brain cannot encode what it never paid attention to.

This is the answer to the question people ask Julie more than almost any other: “How do I improve my memory?” Her answer does not involve mnemonics or supplements. It involves giving something your undivided attention in the first place. If you were only half-listening, there is nothing to remember, because the information never fully entered your brain.

There is also a compounding effect. Julie points out that neuroplasticity, the brain’s well-documented ability to rewire itself based on experience, works in both directions. Every time you practice sustained focus, you strengthen the neural pathways that support attention. But every time you toggle between tasks, you reinforce the pattern of distraction. The brain you have is a brain that you have built based on how you use it every day, she said. If your daily habit is fragmented attention, you are literally building a more distractible brain.

Starting small works. Even two minutes of genuine, undivided focus on a single task is a beginning. You build from there. The goal is not to be locked in every second of the day. The goal is to protect your attention for the things that actually matter. And as I mentioned during our conversation, that level of focused engagement is also how you get into a flow state, those stretches where hours pass and you barely notice because you are so absorbed in what you are doing.

Exercise Three: The Heavy Lifting

This is the one Julie calls the strength training for the brain, and it is the step most people skip.

After you have calmed down (step one) and focused in (step two), the real exercise is engaging deeply with whatever information is in front of you. Julie calls it integrating information. It means taking what you just read, watched, or heard and doing something active with it in your mind, rather than letting it wash over you.

Think about the last book you read. If someone brought it up at dinner next week, could you say something meaningful about it? Or would you find yourself saying, “Oh yeah, I read that, but I don’t really remember what it was about.” Julie says that experience is completely normal, and also completely avoidable. Forgetting is actually a protective feature of the brain. We do not need to store every single thing. But for the things that matter to you, the things you invested your time in, there is a way to make them stick.

Her approach is to ask yourself a few questions after you engage with something that matters. What is one thing I learned that updates my thinking? How does this apply to my life? What would I tell a friend about this, and why should they care? These do not need to be formal. You do not need a journal or a worksheet. A minute or two of honest reflection is enough.

What you are doing, at the neurological level, is creating hooks. New information that just passes through your brain has nothing to attach to. But when you actively connect it to something you already know or care about, you give it anchor points. The more connections you make, the more likely you are to remember it later and to use it when it counts.

Julie takes this a step further and recommends adding a social component. If you saw a great film, went to an exhibit, or listened to a conversation that struck you, challenge yourself to share the core takeaway with someone. Not a blow-by-blow summary, but the essence: what was meaningful, and why. This forces you to distill, which is itself a high-level cognitive skill. And it gives you a reason to do the thinking in the first place. One of her clients, a woman with grown children in their twenties, uses this as motivation. She processes what she learns so she can pass it along to her kids. The purpose drives the practice.

Julie also made a point that I think matters for everyone reading this on Substack. When you share an article or a podcast with someone, tell them why. “Oh, you should read this” is easy to ignore. But “this changed the way I think about how I learn” gives the other person a reason to engage, and the act of putting that into words forces you to figure out what the takeaway actually was.

And here is the part that connects back to that pharmacology lecture in the 1990s. I was not just memorizing drug classes. I was drawing cartoons, which forced me to identify the key relationships. Then I was teaching classmates, which forced me to explain those relationships out loud. Years later, sitting with a patient who mentioned a medication, the red van on the Pepsi bottle appeared in my mind and helped me recall a critical side effect. The information had hooks in every direction. It had been used, shared, applied, and reapplied. That is why it stuck.

Julie explained the neuroscience behind it perfectly. Memory is not about perfectly freezing and preserving the past, she said. Memory is about what you need for the future. Your brain remembers things you are going to use again. So if you can create a connection to how something is relevant to your life, how it helps you, how it helps someone else, those are the things that get remembered.

Exercise Four: Do Nothing

The fourth and final step is the one that surprises people most. After all that effort, after calming down, focusing in, and thinking hard, the most important thing you can do is rest.

Not rest as in watch Netflix. Not rest as in scroll through your phone. Real rest. No new input at all.

Neuroplasticity, the process by which your brain forms new connections, requires rest to complete. Exposure to new information starts the process, but the actual rewiring happens during downtime, when your brain is not being asked to take in anything else. Think of it like concrete. You can pour it and shape it, but it needs time to set. If you keep pouring new concrete before the first batch hardens, you end up with a mess.

Julie recommends short, strategic breaks throughout the day, particularly after periods of focused learning or engagement. They do not need to be long. Even 30 seconds to two minutes of sitting with no input, no phone, no podcast, no music, can make a difference.

She also pointed to something called ultradian rhythms, which are natural cycles your body runs through during the day, roughly 60 to 120 minutes of focused capacity followed by a 20-minute period when your brain needs to recover. I recognize this pattern in my own work. After about 45 minutes of reading and writing for my Substack, I start losing the thread. When I find myself going back and trying to re-read the same paragraph, I know it is time to get up. I keep kettlebells nearby and usually head outside and walk around for a bit. I come back sharper, with better ideas, and ready for the next session.

The reason for this is not just physical refreshment. When you stop focusing on a task, your brain activates what neuroscientists call the default mode network. This network, sometimes called the creativity network, is responsible for making unexpected connections between ideas. It is the reason you often have your best insights in the shower, on a walk, or in the middle of doing something completely unrelated. By resting, you are not wasting time. You are giving your brain the space to do work it literally cannot do while you are focused.

Julie described the same thing from her own experience. She will be writing something, go take a walk, and then come back with all these ways to make it better and new ideas she would not have had if she had just kept pushing through.

The uncomfortable truth is that most of us have almost no real rest in our day. When we take a “break,” we reach for our phones. Scrolling through social media feels like a break, but it is actually flooding your brain with new visual and emotional stimulation. Julie mentioned someone she spoke with recently who had a significant realization about this: scrolling is not rest. Netflix is not rest. Only true absence of new input qualifies.

Driving in silence is one of Julie’s favorite recommendations. She says people hate it at first. Then they start to crave it.

The Four-Step Framework

To recap Julie’s four brain exercises:

Reinterpretation. When stress hits, practice looking at the situation from a different angle. This calms your amygdala (your brain’s emotional alarm center) and brings your prefrontal cortex (the thinking part of your brain) back online. This is a brain exercise.

Single-tasking. Do one thing at a time. Give important tasks your full attention. Your brain cannot form memories of things it never properly noticed in the first place. This is a brain exercise.

Deep integration. After engaging with something that matters, pause and ask yourself: what is one takeaway? How does this apply to my life? What would I tell someone about this? This creates the mental hooks that make information stick. This is a brain exercise.

Rest. Take short breaks with no new input. Let your brain consolidate what it just learned. Allow the default mode network, your brain’s creativity system, to come online. This is a brain exercise.

None of these require an app. None of them cost money. None of them need to be scheduled into a separate block of time. They are ways of using the brain you already have, all day long, in a slightly different and much healthier way.

Your Brain Health Action Guide

Based on my conversation with Julie, here are practical ways to start putting these four exercises into your daily life:

Start with stress recovery. The next time you feel a stress reaction building, pause before reacting. Ask yourself: what is one other way to look at this situation? Practice this once a day. Over time, you will get faster at it, and your brain’s stress response will literally become less reactive.

Protect your attention. Pick one activity each day, a conversation, a chapter, a work task, and commit to giving it your complete focus with no phone and no other screens. Start with five minutes if that is all you can manage. Build from there. Notice how much more you remember afterward.

Reflect after learning. After you read an article, listen to a podcast, or finish a meeting, take 60 seconds and ask yourself: what is the one thing I want to take from this? Even better, tell someone about it and explain why it mattered to you.

Schedule real rest. Build at least two or three short breaks into your day where you have zero new input. No phone. No music. No screens. Just your own thoughts. Try it after a focused work session, or even during your commute by driving in silence. If you find your mind wandering to new ideas and connections, that is not a failure of focus. That is your default mode network doing its job.

Adapt your challenge level. Remember the ACTIVE study: the training that actually reduced dementia risk was adaptive. It met people where they were. Whatever you are working on, whether it is a new skill, a puzzle, or a demanding project, make sure the difficulty is appropriate. Too easy and your brain coasts. Too hard and stress shuts down the very systems you are trying to strengthen.

Want to go deeper? Check out Dr. Julie Fratantoni’s article on this topic, How to Exercise Your Brain, on her Substack, Better Brain.

Read Dr. Julie’s article here.

Brain-Healthy Recipe from Chef Martin Oswald

As part of the Brain Health Substack Summit, Chef Martin Oswald created a special brain-healthy recipe inspired by Dr. Julie’s work. Good nutrition is one of the foundations of cognitive health, and this recipe was designed with that in mind.

See Chef Martin Oswald’s recipe here.

Want to train your brain with games backed by science? I recently launched a free weekly Substack called Train the Brain Games where I share cognitive challenges focused on processing speed and other skills the research actually supports. It grew out of my own curiosity about whether the puzzles I love are actually doing anything for my brain. Turns out, some of them are. Subscribe for free and give your brain a real workout each week.

This article is part of the Brain Health Substack Summit, the first-ever summit of its kind on the Substack platform. All week long, I am sitting down with leading experts in neuroscience and cognitive health for live conversations and in-depth articles. The summit is hosted by The Habit Healers. Subscribe to both The Habit Healers and Better Brain so you do not miss a single conversation.

References:1. Coe NB, Miller KEM, Sun C, et al. Impact of cognitive training on claims-based diagnosed dementia over 20 years: evidence from the ACTIVE study. Alzheimers Dement (N Y). 2026;12(1):e70197. Published 2026 Feb 9. doi:10.1002/trc2.70197

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