The Peter Attia Drive - #206 - Exercising for longevity： strength, stability, zone 2, zone 5, and more

00:00:00.000 Hey everyone, welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

00:00:15.480 my website and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:19.800 into something accessible for everyone. Our goal is to provide the best content in health

00:00:24.600 and wellness full stop. And we've assembled a great team of analysts to make this happen.

00:00:28.880 If you enjoy this podcast, we've created a membership program that brings you far more

00:00:33.280 in-depth content. If you want to take your knowledge of the space to the next level at

00:00:37.320 the end of this episode, I'll explain what those benefits are. Or if you want to learn more now,

00:00:41.740 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.760 here's today's episode. Welcome to a special episode of the drive. Now that we've released

00:00:54.760 over 200 episodes, we realized we've covered a lot of stuff across various topics and in a lot

00:01:00.500 of detail that I think frankly for people can be very difficult if you're not someone who started

00:01:06.420 listening four years ago. I think even if you were listening from the very beginning, it can be really

00:01:11.860 hard at times to kind of piece together all of the information. So we thought about trying an

00:01:18.740 experiment for today's episode. We've decided to pull a variety of clips from previous podcasts,

00:01:25.120 but around a given theme. And in this episode, we're going to focus on clips that discuss exercise

00:01:31.160 and my framework for it. So we put these clips in order of what we think is the best way to listen

00:01:36.320 from top to bottom. So think of this as kind of a mashup of a whole bunch of things on exercise,

00:01:41.480 but they're organized in a way that I think should make frankly a lot of sense and hopefully

00:01:46.200 provide even more value than if you were to listen to each of these podcasts in their completeness.

00:01:51.780 So the hope here of course, is that this is going to allow you to understand this topic better,

00:01:54.680 but also to identify some previous episodes. If you now want to go back and dive really deep into

00:01:59.820 those first set of clips, we're going to look at is what I'm optimizing for with my exercise and why

00:02:06.260 I think training for the centenarian Olympics or centenarian decathlon, as I more commonly refer to it

00:02:11.540 these days is so important. The last thing to note here is that some of these clips are actually from

00:02:15.180 AMAs. And so if you're not a subscriber, hopefully this gives you a sense of what lives behind that

00:02:19.540 paywall and why we think there's a lot of value there. Additionally, for the stability and DNS

00:02:23.160 content clips in our episode with Beth Lewis and Michael Rontala, we actually filmed a lot of

00:02:27.180 instructional videos of them showing us how to do these exercises. I recommend you spend the time to

00:02:32.280 go and look at those videos because I think seeing here is probably better than just hearing.

00:02:39.180 So this is the first time we're doing this. So we'd love your feedback. So tell us what you think

00:02:42.780 about this and tell us if this is the kind of thing you'd like to see more of and tell us if

00:02:47.520 you think it sucks because it's a lot of work to do this. And if you think it sucks, I'd be happy to

00:02:51.300 not do this anymore. So without further delay, I hope you enjoy this special episode of The Drive.

00:03:01.500 Everything we're talking about, Bob, right now is based on longevity. And that's very different than

00:03:06.240 if you were asking this question through the lens of performance. Does that point kind of make sense

00:03:11.280 or should I expand on that a bit? Yeah, I think you should expand a little bit,

00:03:14.360 maybe on the performance, health and longevity, particularly performance and longevity and the

00:03:18.700 possible trade-off between the two. If someone said to me, Peter, my goal is to break two hours

00:03:25.080 and 40 minutes on the Chicago marathon next year, I would be talking about this in a totally different

00:03:30.660 manner. That is a very difficult performance goal. And that requires training at an energy system that

00:03:40.620 I'm not even really going to talk about in the context of longevity. If someone says, I want to

00:03:46.420 break 10 hours on the Ironman. If someone says, I want to deadlift three and a half times my body weight.

00:03:53.300 If you start to really look into the far recesses of amazing physical performance,

00:04:00.060 everything I'm saying needs to be modified. And I'm not going to talk about what those things look

00:04:05.260 like. What I will say is they are generally not co-linear with longevity. And at times they can be

00:04:13.000 outright orthogonal. And I realize as that's coming out of my mouth, it sounds pretty freaking stupid if 0.99

00:04:18.520 you're not a math person. So let me explain what that means in English. Something is co-linear when 0.98

00:04:23.820 it's directly in line with something is orthogonal when it is completely at odds with or at 90 degrees

00:04:29.000 to. So trying to run the fastest 10 K is training at an energy system that is very demanding of the

00:04:41.000 cardiovascular system. It is pretty much maximum cardiac output just beneath VO two max above functional

00:04:50.040 threshold. It puts an amazing strain on the body. And frankly, while doing that is better than sitting

00:04:58.080 on a couch all day, that is generally past the point of optimizing longevity returns. And it actually

00:05:06.800 comes at some longevity cost relative to something more at a slightly lower energy system.

00:05:14.980 So everything I'm talking about is geared towards this centenarian Olympics, which we've talked about

00:05:21.780 in the past, this idea of being the most kick-ass 90 year old possible. And that's really based on

00:05:29.940 two energy systems. So it's got the stability and the strength piece we talked about. And then it's got

00:05:35.180 this low end aerobic energy system, which is zone two that we'll talk about in a second. And then I

00:05:40.740 think it's punctuated with brief bursts of generally zone five. And the reason I think those two matter is

00:05:47.460 that's generally where life takes place. Life is zone one, zone two, and zone five. And so by training

00:05:54.320 zone two and zone five, obviously much more in zone two than zone five, we're really teeing ourselves up

00:06:01.380 metabolically and also structurally to do these things.

00:06:10.760 Based on what you know today, what do you wish you would have implemented when it comes to physical

00:06:16.040 conditioning slash training when you were at the age of 25? To make the question more general,

00:06:22.680 what do you believe is typically overlooked in this realm among very active 25 year olds who wish to be

00:06:28.180 in the race for the gold medals in the centenarian Olympics?

00:06:33.900 Well, that's a question from my heart. Have I spoken publicly about the centenarian decathlon in

00:06:39.900 the centenarian Olympics? I didn't realize I had, but obviously I have given this question.

00:06:43.280 There's a number of questions that talk about the centenarian Olympics. Unless there's a centenarian

00:06:47.080 Olympics, I don't.

00:06:48.300 I honestly don't remember talking about this. So, but I did. Let me restate what I'm talking about. And

00:06:53.860 that will put this question in context. About, I don't know, nine months ago, maybe a year ago,

00:07:00.200 I just sort of had this epiphany, which was that the system's going to fail first in body for most

00:07:09.040 people, which isn't to say always, right? So some people just die suddenly, you know, their mind and

00:07:13.480 their body are fine, but they get struck with a disease and they die. For another subset of people,

00:07:17.680 unfortunately, not that small. Their mind is taken from them first. So cognition gets robbed of them

00:07:23.580 and then eventually, you know, either they die or their body also breaks down and away they go.

00:07:28.920 But, but as I really reflected on what's going on, I think that for most people, the decline of mind,

00:07:37.780 body, and then the burden of disease seems to be one by one in the wrong way, meaning body seems to

00:07:43.980 fail first. So it got me thinking that at least for me, how would I mitigate that? So I came up with

00:07:51.240 this idea of backcasting instead of forecasting what I want to do in the end. And I borrow that

00:07:56.920 term backcasting from Annie Duke, who wrote Thinking in Bets, a book that I love. And Annie

00:08:01.460 will also be a guest on the podcast soon, I hope. So the idea of backcasting is instead of trying to

00:08:07.380 say, well, if I'm 25, what do I need to be doing tomorrow when I'm 26? And then what do I need to be

00:08:13.160 doing when I'm 30? And what am I doing before? An easier way to do it is say, what do I need to be

00:08:17.060 doing when I'm a hundred? And then how do I work backwards from that? And so for me as a ripe old

00:08:21.720 46 year old, 45 year old, when I started thinking about this, the question was, okay, well, if I want

00:08:27.460 to live to a hundred and again, genetically speaking, I probably won't because I don't have the genes to

00:08:32.020 get there, but let's assume that I can eek my way out to a hundred that's 55 years away. What do I have to

00:08:39.240 physically be able to do to be satisfied with my life? So as I went through that exercise, the way I did it

00:08:45.680 was doing it through the lens of my kids. So I took the ages of my kids and I projected them forward

00:08:53.500 to how old will they be when I'm a hundred? And that's an easy calculation to do. Obviously anybody

00:08:58.120 can do that for themselves. And then I said, well, probabilistically, how old will their kids be?

00:09:04.700 So I said, well, you know, my kids are this, this, this, their kids will be approximately this range.

00:09:10.460 And then you realize, wow, their kids are going to have kids by the time I'm a hundred. So by the time I'm

00:09:14.880 a hundred, I'm going to have great grandchildren that will likely be between like one and seven

00:09:23.340 or eight. That's basically my calculation. Okay. So then I thought, okay, well, what are the things

00:09:28.500 I'm going to want to be able to do when I'm a hundred to just be happy? So it goes without saying,

00:09:33.160 I would love to not be, you know, bedridden with disease per se. It also goes without saying that I

00:09:39.860 would love to have the cognitive faculties that I have, or at least a high enough amount of them

00:09:45.840 that I'm able to sort of have the executive function processing speed and, you know, memory

00:09:50.960 that's necessary to sort of function. But then I really kind of double clicked on the physical part

00:09:55.260 of this. So there are a bunch of activities that I want to be able to do. I still want to be able to

00:09:59.800 shoot a bow and arrow. I still want to be able to actually exercise. Like I do enjoy, you know,

00:10:03.660 some people exercise because they have to, I think there are a number of us who exercise because we

00:10:07.320 actually enjoy it. And it's fortuitous that it provides benefit. But the one I really focused

00:10:11.880 on was the real simple stuff, the activities of daily living. And among them is like playing with

00:10:16.580 kids, right? So I started thinking about, well, what would I want to be able to do with great

00:10:19.640 grandkids when I'm a hundred and they're three, four, five. And in going through that, I made a list

00:10:26.300 and there were 18 things on my list. And I just began to refer to that as my centenarian decathlon,

00:10:32.460 which is problematic because the decathlon has 10 things and my list has 18 things,

00:10:36.460 but not within that tiny little detail. What's the Latin origin of 18? I assume DECA is Latin for

00:10:43.000 10 of something, right? Anyway, well, whatever. Okay. So we'll come up with a fancier term for it,

00:10:47.600 or I'll figure out a way to consolidate it. Let us know. So my centenarian decathlon has these 18

00:10:53.920 things that I want to be able to do when I'm a hundred. And some of them seem so trivial that

00:10:58.180 you'd be like, how is that even on your list? Like for example, I want to be able to get up off the

00:11:02.100 floor with a single point of support, which means I want to be able to using just one arm,

00:11:06.860 get up off the floor. Now it's not that it's the end of the world if I need to use two arms,

00:11:10.660 but like, I want to hold myself to that standard. I want to be able to drop into a squat position and

00:11:17.460 pick up a child that weighs 30 pounds. I want to be able to lift something that weighs 30 pounds over

00:11:22.720 my head. Cause that's about the weight of my little roller board suitcase. And I would really be bummed if

00:11:28.620 I couldn't put that in the overhead compartment of an airplane. Presumably I'll still be flying on

00:11:32.180 airplanes and you know, those will still exist. You'll be flying yourself probably.

00:11:36.840 Yeah. Yeah. Right. Well, we'll all have little jet packs or something. You know, I want to be able

00:11:40.420 to get myself out of a pool without a ladder. Simple, right? Again, how trivial is that to do today

00:11:46.340 where you have, you know, four inches between the concrete and the water and how, how easy is it for

00:11:51.340 us to just pull ourselves out today without the ladder? You're seeing the guys that can jump

00:11:54.760 without support. They can jump out of a pool, just jump out of a pool onto the platform.

00:12:01.900 No. Yeah. I think there's some videos for that. Yeah. So when I go through that whole thing,

00:12:07.800 I then say, okay, what are physical tasks that would approximate those things? So for example,

00:12:18.260 like picking up the 30 pound kid who comes running at you could be approximated by a 30 pound goblet squat,

00:12:24.040 lifting 30 pounds above your head in the form of a suitcase is also pretty easy to approximate with

00:12:28.360 these things. Goblet squat, just to, for the uninitiated, I usually think of it as like a

00:12:34.060 kettlebell, but almost like you're holding a goblet in front of you. It's like a front squat.

00:12:37.900 That's right. You're going down, coming up. That's right. Imagine picking up a child.

00:12:41.620 Then I've just been working backwards from there, which saying, well, if I want to be able to do these

00:12:45.300 things at a hundred, there's going to be a decline. I have to be able to do these things at 80.

00:12:50.440 I'm going to need to be able to do it at this level at 60. And I need to be able to do it at

00:12:54.980 this level today, again, given the inevitable decline. So most of my training today, in fact,

00:13:02.080 I would argue all of my training today centers around that. I no longer train for

00:13:09.860 anything that's not related to that. So I don't do any training that's related to racing or competing

00:13:18.880 in anything, which is not to say it's bad to do those things. I'm just saying that that's the

00:13:23.320 point I'm at in my life. So this is kind of a long-winded answer to what I think is a great

00:13:28.000 question, which is a 25-year-old who's frankly thinking of something that most 25-year-olds I

00:13:34.160 can't imagine would be thinking of. Certainly, I wasn't thinking of this at 25. I mean, at 25,

00:13:38.280 you're sort of immortal. But whoever asked this question is presumably realizing that, hey,

00:13:44.080 in 75 years, the world's going to look different and I want to be able to do X, Y, and Z. So I don't

00:13:48.280 know the answer because I don't know what that person's limitations are today. So rather, I would

00:13:52.260 just say, what is the framework? And my framework for thinking about this is four components of

00:13:57.040 exercise. One is stability. The second is strength. The third is aerobic performance. The fourth is

00:14:02.920 anaerobic output. And I didn't go through all of my 18, but each of my 18 touch at least one of

00:14:09.860 those. And many touch more than one. For example, the goblet squat requires both strength and

00:14:16.080 stability. Walking up, one of mine is being able to walk up three flights of stairs with 10 pounds

00:14:22.420 of groceries in each hand. Again, you and I could do that today, blindfolded and backwards. That starts

00:14:27.540 to become harder when you get older. Well, that's got a little bit of aerobic. That's on the threshold

00:14:33.220 of aerobic anaerobic, and it's also got strength. So what I would be looking to do is say, how well am I

00:14:39.020 doing on each of those things? Now, that said, in my experience, the one where most people start to

00:14:44.220 fail first is stability. Because as a species, we usually begin to fail that once we enter school.

00:14:51.660 And I think I've talked about this before, and I've certainly posted pictures of like

00:14:54.740 my youngest son squatting. It's just incredible. Like the way that they can do this is so beautiful.

00:15:01.500 You don't have to be a kinesiologist to look at them and go, wow, they're so natural when it comes

00:15:07.220 to these movements, everything they do. And the field of dynamic neuromuscular stabilization is,

00:15:12.180 in fact, built on this principle, which is, you know, there are about 13 or 14 movements

00:15:16.580 that are completely innate to us. And by the time we're a year and a half older, so we do them all

00:15:22.180 perfectly. And then it's basically all downhill from there. Accelerated significantly by school,

00:15:27.460 once you start sitting, that's when we lose so much of that stability. And we, you know,

00:15:32.180 lose the ability to maintain tension through our pelvic floor and throughout the entire,

00:15:36.420 I hate the term core, but core, of course, describing the diaphragm, the obliques,

00:15:42.180 the transversalus fascia, and the entire pelvic floor. So my two cents would be spend as much time

00:15:49.780 as possible working on dynamic stability, static stability, static first, then dynamic. And as long as

00:15:58.400 you incorporate those principles into what you are doing strength-wise, that's great. Because at the

00:16:05.360 age of 25, you can do a lot of dumb things and get away with it incorrectly. I think I've always 0.58

00:16:11.600 squatted and deadlifted somewhat incorrectly. I don't think I've ever fully engaged. In fact,

00:16:15.760 I know I've never fully engaged my pelvic floor doing those. And I think I got away with murder for

00:16:20.160 a long time, though I now realize the damage that's occurred as a result of it.

00:16:25.200 Do you want to talk about your, I think it was your squat routine? I think you mentioned this

00:16:29.040 to me one time way back when with your buddies. Oh, my high school. Yeah.

00:16:32.000 Yeah. The breathing squats? Yeah. Yeah. Amazing routine. I don't know that I recommend this,

00:16:38.120 but again, it was once a week. So we lifted six days a week in high school, three hours a day. I mean,

00:16:44.620 we just lived in the gym. And on Fridays, we would do this routine of breathing squats,

00:16:51.760 which was you took your best 10 rep weight. So a weight that you were going to absolutely fail at

00:16:58.740 10 reps with. You loaded it on your back and you do a rep. And so you go down and up at your normal

00:17:06.080 cadence. At the top, you took three of the deepest breaths you could take, each breath taking 10 seconds.

00:17:12.900 So that takes 30 seconds. So it's a five in, five out, three of those, and then do another rep and you

00:17:23.600 do 20 reps. So the set takes 10 minutes. And by the end, it's the only thing I've ever done since

00:17:33.280 that rivals that degree of discomfort is like an air bike Tabata. And this was like one of these

00:17:38.600 knucklehead things we got out of like our bodybuilding magazines for powerlifting magazines.

00:17:44.380 And the idea was like, nothing will stimulate more strength and growth than that activity. And the

00:17:49.960 reality of it is it worked. I mean, in the course of one year of doing that, I added over 100 pounds

00:17:57.760 to my squat. And that was starting at a level where I was already pretty strong and just, but you know,

00:18:04.880 what's so funny about it is like, it was so painful that on Thursdays I'd start getting up

00:18:10.720 tight, like knowing that we were going to do this the next day. It was just, you just dreaded this

00:18:16.380 pain so much.

00:18:17.220 Yeah. We might get into this too. There's slow, it's called super slow or slow training. Doug McGuff is

00:18:21.920 one of the guys, a body by science is one of the proponents. And he talks about lifting,

00:18:27.280 lifting slow and basically accumulating time under tension of maybe 90 seconds, which I don't think

00:18:32.840 people realize is like an eternity. And you're talking about what you're talking about, that if

00:18:37.220 you actually calculate when you, when you lift, if you're bench pressing or squatting or something

00:18:41.860 like that, if you ever timed yourself and realize when you're working out like that and you're

00:18:45.760 lifting weights, how actually, actually little the time is that is spent under tension. And then you

00:18:52.380 compare it to that, which is. Yeah. Because in that 10 minutes, I'm not under the same tension the

00:18:58.200 whole time. When you're standing, you're under much less tension. I mean, in many ways, my

00:19:03.080 recollection of that was your upper body hurt as much as your lower body. Again, fortunately it's

00:19:08.020 been so long since I've done it, but honestly, I think that your traps, your lats, because you know,

00:19:14.140 when you're squatting, you're really trying to wrap the bar around your neck. You have to engage

00:19:18.020 your lats to squat. So the fatigue here, the fatigue there, I mean, the whole thing's a mess,

00:19:22.460 but you know, your legs are getting a bit of a break during that period of time because you're

00:19:27.600 locked out. So yeah, I mean, 90 seconds of totally being under tension is an eternity if the weight

00:19:34.040 is heavy enough, which is the principle behind that whole lift. Yeah. And on that, on the note of

00:19:40.340 centenarian decathlon, we should call it the Olympics since there's 18 events. Yeah. Yeah. I was thinking

00:19:46.260 about it. And I think one thing too, is that if you're thinking about doing a goblet squat, it's almost

00:19:50.160 like a checklist of things that you want to be able to, to achieve. So it's not necessarily like

00:19:55.140 going to the CrossFit games and you're going to see how many goblet squats you can do for time

00:19:59.560 compared to other centenarians. You're basically checking something off that you would hope to do.

00:20:03.960 And one thing that I think like once this is refined down to maybe less than 18, or maybe it's 18 events

00:20:10.280 is maybe put it in front of, there's a lot of ongoing centenarian studies. There's the New York,

00:20:16.160 the Einstein one, which is the Ashkenazi Jews, a long-lived centenarian study. I got that wrong,

00:20:22.660 but there's the Thomas Pearls where I think they actually have like an aggregate Italian

00:20:28.680 centenarians, the Okinawans and things like that. And I wonder how many of those centenarians,

00:20:34.220 maybe you give the list to Nir Barzali or Tom Pearls. My guess is none of them. How many of them

00:20:38.060 could do it? None of them. That, yeah. And here's the reason. This is why I think this is

00:20:42.100 different. Anyone who's a centenarian today, I'm willing to make an extreme statement,

00:20:47.080 which I know is a dumb thing to do. Anybody who's a centenarian today is a centenarian

00:20:51.660 because of their exceptional genes. They haven't hacked their way there. What we're talking about,

00:20:58.160 people our age, is we're talking about hacking our way into being centenarians.

00:21:02.460 So that is going to be very deliberate. Now, again, I'm not taking away from the odd centenarian

00:21:08.120 who's also lived like a monk, but we know this really well because we've done all this research

00:21:13.060 on it for the book. Most centenarians, I mean, they haven't done anything necessarily better than

00:21:19.600 or worse than their peers. In fact, on average, they tend to smoke more, exercise less, and eat

00:21:24.300 worse. So what we're really talking about is a completely new model, which is actually forcing

00:21:31.980 your way to become a centenarian rather than just sort of gliding your way into it. And therefore,

00:21:36.820 I think it's going to require much more deliberate attention around what your mind and body are

00:21:42.360 doing at that point in time. Now that we've set the stage for what we're optimizing for with our

00:21:51.620 exercise, these next two clips are going to focus on strength. One of the pillars in my framework for

00:21:57.040 exercise. The first clip is from a recent AMA on the importance of preserving strength and muscle

00:22:00.860 mass as we age. And the second is from an older episode where I speak about the importance of deadlifts

00:22:05.500 and why I think they're so beneficial to our longevity if we're able to do them safely.

00:22:14.720 Let's kind of just put some numbers to this. So what does it mean? You know, how much lean mass

00:22:20.740 and strength are people losing by time? Because I think this is another thing I try to communicate

00:22:25.780 to patients a lot, which is it goes back to that idea of what I said about the gravity of aging.

00:22:31.780 You know, what is aging kind of robbing you of as time goes on? And you have got to fight like hell

00:22:38.600 to avoid it. But basically, you look at multiple studies, they're going to say the lowest rate of

00:22:46.700 decline that I could see is 1% per year. Another study, and we can post these studies in the show

00:22:52.440 notes, you know, 1.3% per year. Others are sort of putting it 1% to 2% per year after 50, 35 to 40%

00:23:02.380 between age 20 and 80. And the strength losses might even be greater, right? We're talking about 2% to

00:23:11.680 3%, some studies even showing 4% strength loss per year. I mean, it's very difficult to put that in

00:23:20.560 context, right? When you understand what compounding does. It gives you a sense of what it means to sort

00:23:27.860 of be average when you're 50. If you have the aspiration of kind of kicking ass when you're 85, 0.97

00:23:38.560 you can't afford to be average when you're 50. And that's just the bottom line. There's no other way 0.98

00:23:44.140 to describe that either through cardiorespiratory fitness, strength, or probably even muscle mass

00:23:50.640 to some extent given its association with strength. So I know it sounds like we're kind of harping on

00:23:55.600 this point, right? That like you've got to be strong. You've got to have muscle mass to accompany

00:24:01.540 that strength, probably because at some point when you lose enough of it, you lose the strength

00:24:06.040 and you've got to have the cardiorespiratory fitness. So there was another study that we looked

00:24:11.420 at, Bob, that had the, I think it went out 10 years on the Kaplan-Meier curves, didn't it?

00:24:16.140 Yes. Let me see if I can pull that up. Okay. Yeah, this is the one. I thought this was a very

00:24:20.400 interesting study. So you'll have to refresh my memory, but I'm pretty sure this is the one

00:24:25.220 where they looked at men and women, leg strength versus grip strength. They measured these in sort of

00:24:34.560 Newton meters doing, I think, a leg extension and a grip exercise, correct?

00:24:38.400 Correct. The leg strength they did in Newton meters, which I know that's, that's, those are

00:24:43.520 the units that you like to use in your workouts. And then the, um, the grip strength is in kilograms.

00:24:49.380 Okay. So men here, average age, about 54 women, about the same, I think 53. So you evaluate people

00:24:58.160 in their sixth decade of life, and then they were followed prospectively for five to six years.

00:25:04.440 Now, remember, this is all cause mortality. So looking at the men's strength, leg strength 0.99

00:25:12.880 specifically, it's definitely not subtle, right? So obviously with time, every Kaplan-Meier curve

00:25:19.860 moves down as you go to the right, but the weaker you are, the quicker it goes down. What this analysis

00:25:27.340 showed for the men, if you, if you look at quad strength, basically for every 0.2 unit reduction

00:25:36.220 in quad strength, and they normalize this for muscle size. It's important to point that out

00:25:41.980 here, I think, is that they, they took their strength metric and they normalized it by muscle

00:25:47.280 size. And they did it in two ways, which I think made this study a little more complicated than I would

00:25:52.120 like, because you get the same answer both ways, I think, but I guess it speaks to the rigor of it.

00:25:56.800 They used actually CT cross-sectional area, and then they use DEXA. But when you, when you take

00:26:01.800 that normalized unit of strength per CT area, and you reduce that by 0.2 units, which can seem

00:26:07.420 somewhat, you know, I think for the listener, that's not the important point or DEXA reduced

00:26:11.440 by 0.34 units, you're seeing this increase in mortality, a 26% or a 39% increase in mortality.

00:26:21.400 And with reduction in grip strength, which was normalized by DEXA arm measurement, it's a 23%.

00:26:27.900 All of these were statistically significant. Now for women, it's worth noting that they were

00:26:34.400 statistically significant, but they had a basically a higher confidence interval or a larger confidence

00:26:39.940 interval, meaning they came close to crossing unity. In fact, Bob, I think it's probably worth

00:26:46.300 including table four in the show notes, because frankly, I find the table to be an easier way to

00:26:52.440 appreciate the statistical relevance of this. So I think the figure is great because the figure

00:26:57.520 shows you the magnitude of the gaps between it, but it's, you know, nobody can look at these figures

00:27:03.560 and tell what's statistically significant and what is not. But again, I think the point of this is

00:27:08.920 using a pretty rigorous way to quantify strength, normalizing strength by size of muscle and

00:27:18.180 prospectively following people, we again see this trend. And I think that this goes hand in hand with

00:27:24.420 the previous analysis, which showed us that strength is the more important parameter, which again,

00:27:32.160 I don't think we're going to be able to say that enough today.

00:27:39.680 The importance of deadlifts as an adult. How has your thinking changed on this? I like your history

00:27:45.400 on this one. So maybe even take it back to in school when you were doing powerlifting before it

00:27:51.100 might've been in vogue. Yeah. Yeah. Long before it was in vogue, one of my best friends in high school

00:27:55.660 who was also involved in boxing and martial arts, we would go to the Scarborough campus of the

00:28:02.580 university of Toronto every day and lift weights. And it was, it's still one of the fondest memories

00:28:09.540 I have of what a gym could be like. It would certainly be the, it was certainly not the sunny,

00:28:16.400 warm golds in Venice, but it had some of those features, which was old school, lots of iron,

00:28:23.260 nothing fancy. Of course, unlike a nice gym, this was like two stories below ground. So there were

00:28:29.580 no windows, poorly ventilated. So in the summer, it was staggeringly hot in the winter. It was so cold.

00:28:37.260 You felt like you were getting frost bitten by touching the iron. And aside from me and my friend,

00:28:43.180 there were no kids there. We were 14, 15, 16 years old. And it was this group of men who to this day,

00:28:51.240 I think back and like, can't believe how strong they were. And most of them competed in power

00:28:56.780 lifting. And so that sort of got us interested in power lifting. And that's how we sort of started

00:29:01.240 putzing around with it. And as most people know who are listening, or I guess people might know who

00:29:06.100 are listening, power lifting is different from Olympic lifting. Power lifting is three lifts, 0.84

00:29:11.220 the deadlift, the squat and the bench press. And so, yeah, make a long story short, grew up doing a lot

00:29:16.660 deadlifting, a lot of squatting, a lot of bench pressing. It was always very horrible at bench

00:29:20.740 press, much better at squatting and deadlifting. Fast forward to, I don't know, a few years ago,

00:29:28.040 maybe three years ago, I had an injury where I kind of tore or partially tore one of my obliques.

00:29:38.300 I don't even remember how I did it. I remember it was very stupid, whatever I did. 0.96

00:29:42.140 And everything went- Tearing a phone book? 0.99

00:29:47.040 That would be great. Possible.

00:29:48.780 But everything went kind of sideways after that. And I really was never able to fully

00:29:54.260 deadlift again without some discomfort. And so again, this is now take it back to maybe 2016.

00:30:03.400 I sort of decided, you know what, maybe the deadlift has reached its point of futility.

00:30:11.660 And maybe I've extracted all I'm going to out of that. And there's no denying what a wonderful

00:30:17.740 movement it is in terms of being a total hip hinge compound movement. But I was like, look,

00:30:22.840 I can probably get most of the benefits of a deadlift doing things that place me under less

00:30:28.540 load. And also, again, in the spirit of thinking about longevity, I thought, why does one need to

00:30:33.820 subject themselves to twice their body weight or more in an axial load? So I sort of got away from it.

00:30:39.760 And then I think all that kind of changed when I started DNS, dynamic neuromuscular stabilization,

00:30:45.820 which I started about 18 months ago. And we're going to have a podcast on this topic because it's

00:30:51.700 just, there's so much I want to talk about here. And so actually, I think today we got an email about

00:30:56.620 how we're trying to make some time for this podcast. So we'll definitely, if you're listening

00:31:01.000 to this and you don't know what DNS is, dynamic neuromuscular stabilization, by all means,

00:31:05.040 you should go read about it. But we're going to have at least one solid podcast on this.

00:31:09.300 But it was through that process that I realized, actually, the deadlift for me was going to be

00:31:15.960 beneficial, not because of the metabolic benefits. I was not going to be doing Tabata deadlifts like I

00:31:22.140 used to, or even by trying to set records for how much I could lift or anything like that, but rather

00:31:28.220 because it becomes a beautiful audit for everything working perfectly. So I deadlifted this morning.

00:31:35.140 So today's a Monday. I deadlifted on Saturday. I deadlifted a few days before that. Like I deadlift

00:31:40.400 at least twice a week, often three times a week, both straight bar and trap bar. And Bob, I don't go

00:31:47.300 that heavy. I don't know the last time, maybe I've had 400 pounds on one of those on the trap bar

00:31:53.020 in the past year, but I usually sort of stop at about 350 to 375 on the straight bar. I'm even

00:32:01.640 lighter, maybe 185. I do a lot of slow eccentrics. I film every single rep of every single set and I

00:32:13.520 study it. And I send it to Beth Lewis, who is my coach. And we do so much around making this

00:32:23.940 deadlift perfect. And I'd rather take a lightweight and deadlift it perfectly several times a week.

00:32:31.120 And I'm not doing like killing crusher sets. Like, I mean, it's today was four sets of 10,

00:32:36.680 five sets of 10, maybe. And at no point was I like past my limit. So again, I can push myself harder

00:32:43.240 doing other things. But what I could get out of doing that deadlift perfectly is do I have just

00:32:49.620 the right amount of thoracic extension? Do I have just the right curvature in the lumbar spine?

00:32:55.600 Am I activating my glutes? Am I activating my hamstrings? Am I pulling back instead of pulling

00:33:03.140 up? Am I wedging correctly? Like all of this little stuff translates biomechanically to the activities of

00:33:10.860 daily living that matter to me, like getting up off the floor, picking up one of my kids,

00:33:16.840 lifting a piece of luggage or something like that. And so if I can do the deadlift and it feels right,

00:33:23.180 then I know I'm ready to do everything correctly. And when I'm deadlifting and I feel like, hey,

00:33:27.880 this isn't correct, this doesn't feel right. Well, first of all, now I've really learned what that

00:33:31.980 feeling is. And secondly, I've now learned the steps that I can go back and reconstruct what needs

00:33:38.460 to be done. And so one of the things I definitely want to do is actually put together kind of a video

00:33:43.380 on deadlift and deadlift preparation, because I think that there are probably 10 exercises that I

00:33:50.280 do as a way to get ready to deadlift. And they don't take long. Like this, my deadlift checklist

00:33:55.100 is like 10 to 15 minutes. So it's not so onerous. It's almost like ketosis the way we were talking

00:34:01.120 about it in the past, right? Which is, it's not even clear if it's the ketones themselves that can

00:34:07.020 sometimes be the benefit versus the metabolic conditions that allow you to make them, right?

00:34:12.200 In other words, I'm not even sure how much of the benefit is the actual deadlift versus all of the

00:34:17.820 things you have to do to do the deadlift correctly. And one of the most exciting things, just on this,

00:34:22.400 the last thing I say on this is it never occurred to me up until a year and a half ago that you could

00:34:28.900 actually deadlift in a way that puts your spine under traction. That's very counterintuitive. You would

00:34:34.720 think that anytime you're lifting under an axial load, your spine is under compression, but it turns

00:34:40.380 out when you learn the right positioning and you understand how to create intra-abdominal pressure

00:34:45.980 and you know how to elongate your spine, you can actually deadlift and create traction in the spine

00:34:52.520 actively. And that's why deadlifting is the most important thing I do before I get on an airplane.

00:34:59.220 Because when you're on an airplane and you're sitting there for five or six hours,

00:35:02.380 what you really want to do is not let your spine be compressed. And the deadlift primes me to then

00:35:09.200 go and sort of maintain that activated form of traction.

00:35:14.140 Yeah. It's a significant investment, but I would say it's worth it that you'll bring your hex bar

00:35:18.380 to the gate before your flight and pump yourself up and bang out a few sets.

00:35:24.040 I mean, I don't know what it is about the TSA guys. They get so wigged out when you have your

00:35:27.980 hex bar there at the gate. Putting that overhead? Yeah. Yeah. If you're TSA pre, they don't mind as

00:35:33.040 much, but if you're not TSA pre, they just lose it. Sticklers. They're sticklers.

00:35:44.700 The next set of clips is from a topic that we've covered on a lot of episodes and of course is a

00:35:49.720 very important pillar in this framework of exercise. This is aerobic training and specifically looking at

00:35:54.120 low end aerobic efficiency or zone two training. This was most recently covered again in our second

00:35:59.400 episode with Inigo San Milan. This is a training zone. I spend a reasonable amount of time in it,

00:36:05.240 not as much as I used to when I was a cyclist. And I probably spent, I don't know, 10 to 12 hours a

00:36:10.340 week in this zone today. I spend three or four hours a week in this zone, but I still believe this

00:36:16.160 is incredibly important. And I want to make sure that you understand this. All I'm doing is swimming.

00:36:27.060 I'm not doing workouts. I'm not looking at the pace clock. I'm not doing intervals. I literally

00:36:33.940 just get in the water with no agenda other than to get wet and hear the sound of water going by my ears.

00:36:40.860 Probably I'm not even swimming hard enough to get into zone two, truthfully. I doubt my heart rates

00:36:45.280 above 120. That's the next topic. That's where I think this is a good segue. If you think about it,

00:36:52.180 you can talk about it, but I think that's one of the things is like a governor putting a rate

00:36:56.080 limiter on your performance when you do zone two, that it's almost like for a lot of people, it is

00:37:01.360 for me doing this reminds me kind of of stillness, although I might read on the bike or things like

00:37:06.800 that. But can you talk about zone two importance and how your thinking has changed on that?

00:37:10.820 Yeah. When I stopped riding a bike with a purpose, which was for me a time trial, so that would have

00:37:17.500 been late 2014, early 2015, I kind of really just stopped doing any low intensity aerobic training. So

00:37:27.260 anyone who does ride a bike or swims a lot has plenty of that activity in them. So even if you're

00:37:33.460 training for the 200 meter individual medley, which is a race that's very short, very quick, and very

00:37:40.480 painful, you still put in hours and hours a week of aerobic-based training. Similarly, if you're

00:37:46.520 training for a one-hour all-out time trial, you still put in hours a week of low-end aerobic-based

00:37:53.440 training. But when I stopped doing that, I was like, well, I don't need to do this anymore. And I

00:37:58.800 went from cycling to rowing and running. And I was sort of obsessed with just being as efficient

00:38:08.280 as possible. So everything was all out. I mean, if I was running, it was going to be a six-minute

00:38:13.420 mile. It wasn't going to be a nine-minute mile. I think especially through the interactions that I

00:38:21.120 had with Inigo, who I met about a year before I had him on the podcast, which was just recently,

00:38:26.520 it was sort of meeting him and kind of going back through the literature on that type of training

00:38:34.600 and the benefits that it could have, both from the standpoint of metabolic benefits, such as glucose,

00:38:41.860 insulin-dependent and insulin-independent glucose-mediated disposal, looking at just sort

00:38:47.120 of mitochondrial function, mitochondrial health density, and then looking at sort of the sort of

00:38:52.840 neurotropic factors, the BDNF secretion that can come from this type of activity.

00:38:56.520 I mean, all of these things were just pointing towards this was a glaring hole in my training

00:39:02.800 that I needed to get back. And so that has been great. And like you said, I mean, one of the things

00:39:07.760 about Zone 2 that I really enjoy is it's just not that hard, you know? Like, frankly, sometimes it's

00:39:15.180 just nice to get on the bike. And I probably spend three or four hours a week doing it. And that is my

00:39:20.260 time to listen to podcasts and audiobooks. And I really enjoy it. I can't wait to get on that bike.

00:39:25.800 As sort of boring as it seems to be sitting on a stationary bike for that long, there's never been

00:39:31.360 a day when I've been like, I don't feel like doing this. I just, I always look forward to it. And I

00:39:34.740 think in large part, it's because I also get to combine it with learning, which you wouldn't be

00:39:40.160 doing if you're out there crushing intervals. And not that there's something wrong with that. I think

00:39:43.880 each of these things has this time and a place, but I think that we can do Zone 2 our entire lives.

00:39:49.920 We can do it safely and it just yields enormous dividends.

00:40:00.040 Your question, if I recall, was if you want to do your Zone 2 training at home, what's the best

00:40:04.300 type of device to do it on? I don't think there's a best device, but I would say it's one where it's

00:40:10.260 very easy to reproducibly produce the same output. So I am hugely fond of a bicycle because it has a

00:40:20.340 very clear metric that I can adjust, which is the wattage. Watts are super easy to track. I'm riding

00:40:28.840 on a bike that is an ergometer. So I put my road bike on a device called a Wahoo kicker,

00:40:34.440 and it is hooked up to a computer where I'm telling it the numbers of watts that I want,

00:40:41.200 and it's putting that resistance into me, and I generate it. Now, my wife, conversely,

00:40:46.580 likes to ride a Peloton. I don't know why. I think it's the worst bike on the face of the earth,

00:40:52.320 but on the Peloton, it works a little bit different, which is she goes into a mode where

00:40:58.740 she's not doing a class, but she basically sets the resistance with a little knob, and then the 0.87

00:41:06.360 amount of RPMs that she can put to it spits out a wattage. But it's actually, in my mind,

00:41:11.760 a little harder because she has to kind of control, like she has to be titrating her cadence to stay

00:41:17.860 the same so that she can hit a wattage number. So it's the difference between being in erg mode and

00:41:22.660 spin mode. But the point is, regardless of how you do it on a bike, wattage becomes the metric that

00:41:28.600 matters. We, of course, are always measuring heart rate as well, and we'll talk about this in a

00:41:33.560 second in terms of how you tweak it. Treadmills are also a great way to do this. In my experience,

00:41:39.620 unless you are a really good runner, which is to say you're very efficient at running,

00:41:45.320 for most people, running gets them out of zone two a little too quickly. So for treadmill with our

00:41:52.540 patients, we prefer brisk, incline walking. Most treadmills will go up to 15 degrees, and we

00:42:01.760 generally start people between 10 and 15 degrees, somewhere between two and a half and three miles

00:42:07.300 per hour, maybe less. And again, it's very empirical. It's sort of how quickly can you figure out where

00:42:12.700 somebody is. By those two metrics, I have a very clear sense of my zone two. I know exactly how many

00:42:18.200 watts my zone two is. I also know what heart rate I should expect to see. And if I'm vastly outside of

00:42:25.140 that, there's usually a physiologic reason, and I have to make an adjustment on the wattage. So if my

00:42:29.940 heart rate is significantly higher than that, it might mean I'm a little bit sick, dehydrated,

00:42:36.920 something else is going on, and I might have to back off to get the heart rate down, even if it means

00:42:41.440 bringing the wattage a little bit below. And I'm checking my lactate every single time I do this, and I do it

00:42:46.440 four times a week. We'll discuss frequency. Same thing on treadmill. I know on a treadmill exactly

00:42:51.020 what incline, exactly what speed, and what heart rate. And it's a comparable heart rate too on the

00:42:55.860 bike. That's an easy way to sort of make that happen. The other thing my wife loves is a rowing 1.00

00:43:01.260 machine. Now, I'm not fond of the rowing machine for zone two. I like the rowing machine for zone five,

00:43:08.320 but that's because I'm not a very good rower. So again, my wife's a better rower than me, 0.61

00:43:13.120 and she has better form than me. Someone like Beth Lewis, who we've had on the podcast,

00:43:18.920 who's an amazing rower, she's more efficient. She can get a zone two workout on the rowing machine. 1.00

00:43:25.180 I love rowing, but it's just cycling for me a second nature. Cycling is a very efficient thing

00:43:30.680 for me to do. I'm not hugely fond of ellipticals personally, but again, if you have one that works

00:43:37.720 for you where you're able to get your heart rate high enough and you're able to move quick enough,

00:43:43.320 then great. The key is how much energy do you have to put into maintaining a sustained dose?

00:43:51.020 That's the biggest challenge, Bob, with zone two is you don't want it to be vacillating.

00:43:55.420 That's why ultimately I love being on an erg mode of a bike, which is I don't actually have to think

00:44:00.480 about it. It's putting 200 watts to my wheel no matter what I do. Even if I slow down or speed up,

00:44:06.780 it's just always keeping the watts the same. Frankly, I can just tune out and listen to

00:44:11.500 podcasts and audio books, which is what zone two is for in my book.

00:44:21.260 The next set of clips look at another pillar in my framework of exercise, which is now that

00:44:26.080 upper end aerobic verging on anaerobic exercise. We sometimes talk about this as zone five, but again,

00:44:33.700 I would be less concerned with the terminology. The zones really are a function of the underlying

00:44:38.440 system that you're referring to, whether you're talking about a heart rate based training or a

00:44:42.820 power based training. I think of zone five as basically your VO two max training. And I think

00:44:50.400 a lot of people sometimes spend too little or too much time in this zone. And we want to kind of help

00:44:55.840 you understand what that sweet spot might look like. Assuming that you're not training specifically

00:45:01.360 for athletic events that require unusual levels of fitness around that energy system. But again,

00:45:07.620 if you're really just talking about being the fittest, healthiest person you need to be

00:45:11.260 to be kind of a kick-ass 90 year old, then I think we don't need to be spending quite as much time there

00:45:17.080 as you might think to harness the benefits. So in these clips, I'm going to talk about how I train

00:45:21.980 there and how I think about VO two max. Now we talk about VO two max in AMA 27, and that's where

00:45:28.380 we're going to talk about how the benefits appear to comparing someone of low fitness to elite fitness

00:45:34.760 with respect to these metrics. And it's kind of staggering. The difference between someone at the

00:45:40.260 bottom 25% of VO two max versus someone at the top two and a half percent is about a five fold

00:45:45.760 difference. So this shows the importance of VO two max and why I think you ought to be spending

00:45:50.060 more time there. We've got a zone, zone, wait for it. Five question, not two. What is Peter's

00:46:03.800 approach to zone five training? What about other anaerobic training protocols? I love this. So my

00:46:10.000 zone five is mostly done on my Stairmaster, which is my absolute favorite piece of equipment. That's

00:46:16.420 not a bicycle. Other than the elliptical. Yeah. I can't stand the elliptical. So basically my zone

00:46:23.300 five workout, which I really only do once a week is three minutes of zone two with one minute at VO two

00:46:31.520 max, because I know what my VO two max is. I know how to convert it into Mets, which is VO two max

00:46:37.860 divided by 3.5. And the Stairmaster allows you to work in Watts and Mets. So basically I'm doing three

00:46:44.500 minutes at my zone two. And then I go one minute at what my VO two max is, which truthfully is quite

00:46:52.460 difficult to hold your VO two max for one minute. And then right back to three, my recovery is then

00:46:58.240 the three minutes at zone two. And so that four minute pattern, I just repeat for 20 to 30 minutes.

00:47:06.780 And I usually do that on the tail end of a zone two workout. So that's kind of my longer aerobic day.

00:47:12.740 Other workouts that I liked when I'm outdoors on my bike, I also like doing kind of a more VO two max

00:47:20.520 training type ride, which would be kind of like a four minutes at call it 125% of FTP functional

00:47:28.400 threshold power followed by four minutes recovery. So one to one work rest, but obviously at a lower

00:47:35.040 intensity than the three to one rest to work that I just described. So yeah, there's lots of ways to

00:47:41.580 hit zone five and it's a very important zone as well. My view is most people spend too much time

00:47:48.240 there and not enough time in zone two though. I've got a few follow-up questions, which it'll

00:47:52.920 give you more time too on this. I went almost to my two minutes on that one. I was like staring at my

00:47:57.960 clock. One's I think simple. So the Stairmaster, is it a Stairmaster? I don't know if it's called a

00:48:03.720 Stairclimber. Do you have the one where it's like literally you're going up steps or is it the one where

00:48:08.420 you just have like two levers and you're pushing them back and forth? Oh, sorry. No, mine is like

00:48:13.860 the fancy gym one where it's like an escalator of steps. Is that what it's called? No, no, no, no,

00:48:17.920 it's not a Jacob's ladder. It's a series of eight inch steps that roll up and down a machine. So

00:48:23.900 the higher the intensity you set it, the less resistance is in those steps and the faster you

00:48:30.700 have to go to not fall off the back. So if I set it to like eight Mets, it's moving quite,

00:48:37.020 there's actually quite a bit of resistance. So I can step quite slowly without falling off.

00:48:41.560 When I set it to like 20 Mets, it feels like there's no resistance and I'm running up the

00:48:48.300 stairs to not get thrown off the back. I think we could do a podcast on a lot of this stuff,

00:48:53.620 VO2 and all that other stuff. But one of the things that sticks out to me, because

00:48:56.800 you know, when you got like a coach or anybody and they want you to give 110% and you think like,

00:49:02.400 what the hell is this? You know, I can give a hundred percent maybe, but when you're talking

00:49:06.460 about your VO2 max and you're saying, you know, I'm going at a hundred percent, I think some people

00:49:09.580 might just think like, oh, this person, you must be going all like balls to the wall, all out.

00:49:16.720 However, when you're looking at like, what's my workload to my VO2 max, you can actually,

00:49:21.340 you can exceed a hundred percent of your VO2 max in terms of the work you're doing. Right.

00:49:25.620 Right. And Alex Hutchinson, who is going to be on the podcast very soon, writes about this very

00:49:31.400 elegantly in his book, Endure. Basically the limits of human performance in terms of quote unquote,

00:49:37.440 going all out is about 10 seconds. So really no human has the potential to go all out for 10

00:49:43.680 seconds. You might think you are, but you're not. Wait, wait, wait. I take spin class. I've taken spin

00:49:48.940 classes before and I'm going all out for like 80% of it, you know, or at least the instructor wants me to

00:49:54.920 go all out. Sure. Sure. Yeah. The instructor is playing games with your mind and if that helps

00:49:59.740 you, so be it. But look, you only need to look at the difference between a hundred meter and a 200

00:50:04.700 meter sprint. So take the best explosive athletes on the planet. And even by the time Usain Bolt is

00:50:12.840 running the 200, he is slowing down in the second half of that race. The force with which he's able

00:50:19.380 to hit the ground in the second half of that race is slower. He can go faster in the second half

00:50:24.020 because he gets a flying start, but the hundred meter, which is basically a 10 second race is

00:50:30.020 about the true limit of what all out means. So I even find this interesting when you consider two

00:50:36.040 variants of Tabata, as you know, there's the 2010 Tabata and the 10, 20 Tabata. And you and I both

00:50:43.080 have air bikes, which have, you know, which are great tools for doing that. When I go through cycles

00:50:49.940 of Tabata, which these days I'm not, I'm focusing much more on zone five workouts on both the rowing

00:50:56.060 machine, which I didn't get into and also in the stair machine. But sometimes I just do like a couple

00:51:00.660 Tabatas a week. I mean, anybody who's tried both knows you can go so much harder for the 10, 20 than

00:51:07.620 the 2010. The 2010 is generally favored because that's the one that was studied by Ursawa and Tabata.

00:51:14.560 Fun fact, by the way, Tabatas are not named after the guy who developed the protocol. He was the guy

00:51:20.120 that wrote the paper. Ursawa developed the protocol. They should be called Ursawas.

00:51:24.660 So the problem with a quote unquote 2010 Tabata is whether consciously or subconsciously,

00:51:29.840 you're actually pacing yourself to complete it, which is what it is, but I think it actually poses

00:51:35.340 a little bit of difficulty. Okay. I'm surprised you don't actually just say I do Ursawas and then

00:51:41.760 have people- Have people look it up? Look at you. Yeah. Dude, Mondays and Fridays,

00:51:47.580 Mondays and Fridays, I just do Ursawas. Yeah. See people nodding their head.

00:51:58.360 So with that, let's just start with sort of something you've already alluded to.

00:52:02.240 Let's explain what it is, talk about how much it matters, and then kind of get into some examples.

00:52:06.840 So let's start with a term that many people have heard before, but I don't think most people

00:52:10.960 understand what VO2 max really means. And eventually we're going to talk about running

00:52:14.920 efficiency and lactate threshold, and we're going to get into all of this stuff, but let's make sure

00:52:19.060 people understand what VO2 max is, both in an absolute term and then in a manner that we normalize

00:52:24.400 it by weight and what it is and what it isn't, how it's measured, how it matters, and maybe we'll

00:52:30.760 even talk about some notable exceptions. So VO2 max is the one physiological parameter that anyone

00:52:36.940 who's involved in endurance has heard of and has some sense of. The first order analogy is it's

00:52:42.280 kind of the size of your engine. Physiologically, VO2 max is telling you how quickly you can take

00:52:49.400 oxygen from the air into your lungs, get it into your blood, pump it to your muscles, and then have

00:52:54.600 your muscles use it in the metabolic processes that will provide energy to move you to do whatever you

00:53:00.520 want to do. So it's a rate. It's how much oxygen per unit time can you process absolutely flat out.

00:53:08.380 Now, the sort of backstory here is it was first sort of discussed or measured in the 1920s by a guy

00:53:15.600 named A.V. Hill, who was actually a very good runner. The observation that he made is if you have

00:53:20.440 someone, you ask someone to go out and run at a gentle pace, they'll consume, let's say, two liters

00:53:26.420 of oxygen per minute. Then you tell them to speed up. Now they're doing three liters of oxygen per

00:53:31.360 minute. Tell them to speed up again. And now they're going pretty much, maybe not as fast as

00:53:36.000 they can, but they're going fast. And they're using four liters of oxygen per minute. So you tell them

00:53:39.920 to speed up again, and you measure it, and they're like, oh, they're only using four liters of oxygen a

00:53:44.960 minute, just like last time. Speed up again. And they're still just using four liters of oxygen a

00:53:48.860 minute. There's a plateau. There's a point at which even though you're working harder, you're not using

00:53:53.200 any more oxygen. And so this plateau looks like it's a physiological limitation. And it probably is

00:53:59.340 in some sense. It's a controversial thing. But basically, you've reached a point where no matter

00:54:04.060 how hard you push yourself, you can't get more oxygen. And so you can still go faster because

00:54:08.380 you're starting to use other forms of energy. But this is the limits of your aerobic system.

00:54:13.980 This tells you what it tells you, we can get into. It's not clear what it tells you. It tells you

00:54:19.480 exactly what I just said. It tells you how much oxygen you can use. Does that tell you exactly how

00:54:23.080 fast you can run? No, there are a lot of other factors. But that tells you what sort of aerobic

00:54:28.500 engine you have to play with. I remember in high school, I mean, we would sort of talk about, well,

00:54:33.840 which athletes have the highest VO2 max? Is it the Norwegian cross-country skiers? Is it the

00:54:38.640 professional runners and cyclists and things like that? But people are usually used to hearing these

00:54:43.820 numbers reported not in liters per minute, but in milliliters per minute per kilogram. So give an

00:54:51.860 example so people understand those differences. Because we usually talk about the outliers as a

00:54:57.880 number that's a bigger number than two liters or five liters. It would be sort of 75, 80 milliliters

00:55:04.180 per, just explain to people how those are different. Sure. So I'll use my own numbers.

00:55:08.840 Typically when I was tested, I could get about a little bit more than five liters per minute. So 5.1,

00:55:14.380 5.2, if I remember correctly. Now, if you compared me to a rower, the road would make me look pathetic 0.94

00:55:21.180 because the rower would be using seven liters a minute or more. But the rower is also huge,

00:55:29.440 twice my size or whatever. And so that doesn't necessarily mean that that rower is better at

00:55:35.180 using oxygen for me because the rower has way more muscle. And so the rower is the amount of oxygen

00:55:40.060 reaching any given muscle cell may be lower. So if you want to compare apples to apples between

00:55:46.980 athletes of different sizes, you divide, at least for a crude approximation, you just divide by weight.

00:55:53.480 And so the numbers we usually hear are rather than liters of oxygen per minute, it's milliliters of

00:55:59.600 oxygen per minute per kilogram of body weight. So for me, five liters of oxygen per minute works out

00:56:07.520 to something like 80 milliliters of oxygen per minute per kilogram of body weight.

00:56:15.380 There's a whole rabbit hole to go into is to say, well, why are we dividing by whole body weight?

00:56:19.720 Because there's a bunch of things like skeleton and organs and stuff that don't scale.

00:56:24.940 The adipose tissue doesn't matter. I mean, you could argue a better comparison would be

00:56:28.620 total liters per minute divided by lean mass divided by time or normalized to time. And then you're

00:56:35.260 you're at least getting the metabolically active tissue, presumably.

00:56:39.440 Yeah. And there's papers where they do things like let's divide by weight to the power of 0.68

00:56:45.560 or 0.7, which is another way of getting effectively. It's a way of approximating

00:56:49.860 just the lean mass, the metabolically active tissue. And you can go down that rabbit hole,

00:56:54.820 but I suspect you'll want to get to it. It's like at a certain point, it doesn't matter that much

00:56:58.700 anyway. So we don't need to, you can't just measure someone's VO2 max and know how fast they're going to

00:57:03.900 race. So it's, it's, it's useful, but it's not, it really, especially for comparing between people

00:57:09.200 now comparing within yourself, it tells you something if you've increased or if your VO2

00:57:14.200 max has decreased, but in that sense, it doesn't matter what you're dividing by.

00:57:18.040 I remember there was a guy that I used to ride with, and this was not that long ago,

00:57:22.320 maybe five or six years ago when I was still, you know, somewhat competitive, at least with myself.

00:57:27.940 Actually, it's funny. My number was just like yours, except I was heavier. So I was about 5.1 to 5.2

00:57:32.740 liters, but I weighed more. So that worked out to about 70 mils per mig per kig was my VO2 max.

00:57:39.440 His was 55 to 60, but there was never a day that I could ride faster than him. Not one.

00:57:47.740 There's simply, and I always felt like, although we did the test so many times, I kept feeling like

00:57:52.340 the machine must've been broken on him. Like I knew my 70 was about right because I'd been tested

00:57:58.420 so much and that was lower than it had been when I was younger. So it seemed appropriate, but

00:58:02.960 I was always convinced that that there's no way he's only 55. The reality of it is he may well have

00:58:08.360 been, and he may have simply been a far more efficient athlete, which we're going to get into.

00:58:14.640 Before we get to the story of Oscar Svensson, let's talk a little bit about historically what

00:58:20.080 people have believed the limits are of VO2 max. We don't even have to go very far historically to get

00:58:25.160 into a whole mudslide of confusion and debate and disagreement. There's a lot of places along

00:58:32.060 the way that could in some circumstances be the bottleneck. Normally people tend to assume that

00:58:37.380 what is it that causes VO2 max to plateau is essentially what I think what we're talking about.

00:58:42.780 And just one thing I should add here, it's like, why is that interesting? It's because you think,

00:58:46.860 well, if you want to measure endurance, just have someone run a mile or whatever, you know,

00:58:50.460 as hard as they can. But any test like that depends on motivation, depends on whether you

00:58:55.380 pace it right. There's all these factors that come into it. The nice thing about VO2 max is that in

00:59:00.220 theory, it's independent of motivation. That's why scientists like it, because it doesn't matter

00:59:05.280 if the subject doesn't really care about the study. If you see a plateau, you know that's a property of

00:59:11.120 their body and not a product of whether they were excited about the study. So the question is,

00:59:16.500 this plateau, what is it that causes it? And it could be in the lungs, it could be the heart,

00:59:23.060 it could be the circulation, it could be the muscles ability to extract it. I don't want to

00:59:27.580 pretend that I know the answer because it's still controversial. The picture that emerges is that

00:59:31.260 almost every part along this cascade is engineered more or less to what it needs to be. And so if you

00:59:39.360 perturb any of those elements, you can get limitations. So for example, the conventional wisdom is that

00:59:45.520 your lungs are not a limitation. You can always breathe enough in. And so then the question is,

00:59:49.760 can you diffuse enough oxygen from your lungs into your bloodstream and so on and so forth?

00:59:55.180 There are situations where, and it's been for decades, it's been conventional wisdom that the

00:59:58.820 lungs don't respond to training because they're overbuilt. There was just a paper published a big

01:00:03.220 review in the last month or two arguing that, you know, in some cases the lungs aren't overbuilt.

01:00:08.600 And one of the situations is highly trained endurance athletes. They can be limited by their

01:00:13.860 ability to get enough oxygen in. And you can also run into situations where

01:00:17.700 an athlete is so fit, their heart is so strong, it pumps blood past your lungs so quickly that it

01:00:24.260 doesn't have time to fully stock up on oxygen. You get something called exercise-induced arterial

01:00:28.260 hypoxemia. So this is usually an issue at altitude, but in elite endurance athletes is actually about half

01:00:35.340 of them exhibited even at sea level. So they're already running into a limitation just in getting

01:00:39.980 oxygen from their lungs to their bloodstream. And then at every stage of the way, there can be

01:00:44.720 limitations if anything is knocked off kilter. And certainly right down to the ability of the

01:00:49.380 muscles to first extract the oxygen from the bloodstream and then to make use of it metabolically

01:00:54.140 in the mitochondria. So there isn't one single answer, which is why you get these debates because

01:00:59.100 everyone is concerned. I have evidence that this is the limit. It's like, yeah, but I have evidence

01:01:02.860 that this is the limit and that's the limit and they're all the limit.

01:01:05.880 Yeah. I've always wanted to see the experiment where you took a group of athletes,

01:01:08.440 maybe this has been done. You run them all to max and then you reduce the FiO2 of the incoming

01:01:15.340 oxygen. So normally we do it with room air. So you're getting a fractional inhalation of oxygen

01:01:20.080 is 21%. And the way, of course, just for the listener, the way these things work is the way

01:01:24.740 they're calculating how much oxygen is being consumed is they're measuring the concentration

01:01:29.260 of oxygen on the way out. So you're calculating the delta. And so I've always thought, well, wouldn't

01:01:33.940 it be interesting to start selectively dropping FiO2 21%, 20%, 19%, 18%. Now, presumably if the lungs

01:01:43.840 aren't the limitation, you should still see the same absolute delta and you could at least start to

01:01:49.540 eliminate one of those variables, which would be FiO2 and capillary exchange. And then you start pointing

01:01:57.480 to some of these other variables. Again, I'm sure somebody has done this experiment, but I don't know

01:02:02.100 what it yielded. Probably not with the fine tooth comb that you're suggesting. People have compared

01:02:06.420 21% to 10% or whatever, and 15%. I mean, it's interesting when you go to altitude or the

01:02:13.600 equivalent, when you reduce the amount of oxygen, funny things happen. Like the first thing you would

01:02:17.500 think would happen is like, you can't get enough oxygen. So you're going to go anaerobic sooner.

01:02:20.740 You're going to produce more lactate. And yet the opposite happens. There's something called the

01:02:24.320 lactate paradox. If you try and exercise to exhaustion at lower levels of altitude, you actually give up

01:02:30.220 when your lactate levels are lower than you would at sea level. And there's debate about what causes

01:02:34.880 this and even whether it's a real thing. But the picture that makes sense to me is that these things

01:02:41.180 are not just about how much oxygen is making it to the muscle. It's also like, what is your brain

01:02:45.660 oxygen level? And so you're getting these other circuit breakers that are starting to come down

01:02:49.820 that aren't even on this path from mouth to lungs to blood to muscle. There's other factors that

01:02:56.420 are saying, whoa, wait a second, oxygen's getting a little low. So we're going to

01:02:59.540 actually cut off the supply to the muscles or reduce it in order to make sure that we don't get 1.00

01:03:03.500 stupid. This next clip is going to focus on stability. As I mentioned at the outset with 0.99

01:03:13.040 Beth Lewis and Michael Rentalis, we filmed a bunch of instructional videos to go with this.

01:03:16.900 I can't recommend them enough. It's one thing to hear us talk about these things. It's quite

01:03:21.200 another thing to see the exercises and be able to do them yourself.

01:03:29.520 Stability is the cornerstone upon which you do everything. It is the cornerstone upon which your

01:03:35.340 strength is delivered, your aerobic performance is delivered, and your anaerobic performance

01:03:40.480 is delivered. And it's the way that you do so safely. So stability is a way that we transmit force

01:03:47.380 from the body to the outside world and vice versa from the outside world to the body in the safest

01:03:53.620 manner possible across the muscles, which are designed to carry that load, as opposed to seeing

01:04:00.140 the dissipation of force across joints that are not fit to do so. So for example, when you're picking

01:04:08.480 something up, let's say you have to pick up something and it weighs 60 pounds. Well, you have to exert 60

01:04:14.360 pounds of force on the world around you. That's Newton's laws tell us that that's what it means to

01:04:18.420 pick up 60 pounds. The idea is you want all of that 60 pounds to be transmitted from your muscles to the

01:04:26.420 ground, lifting this thing up. And you don't want anything dissipating out your back, out your knees,

01:04:31.680 out your hips. And while we're, most of us are born with the ability to do that naturally, it generally

01:04:38.420 gets lost by the time we're in grade school in response to many things, but probably chief among

01:04:45.020 them is a relative lack of activity and a relative abundance of sitting. And when I look at my two and

01:04:54.100 a half year old move, it's a perfect clinic in force transmission safely across the body. When you look

01:05:04.240 at me move prior to sort of becoming obsessed with and schooled in these disciplines of, as you

01:05:11.560 mentioned, one of them, dynamic neuromuscular stabilization or DNS, it's always a little bit

01:05:16.620 of an inefficient way to get things done. And it results in a lot of force leakage or seeping out

01:05:24.080 around my scapula, my elbow, my knee, my back, my hips. And this is sort of one of the root causes

01:05:30.640 of a lot of the chronic injuries a lot of us have. So stability then is probably what I think of as

01:05:38.740 the foundation upon which everything should be done vis-a-vis exercise. Just yesterday, I was

01:05:44.380 actually talking to a patient and she was asking me if she needed to do DNS or if she could continue

01:05:52.920 to work on the Pilates that she has been doing for many years. And my response was that I think a

01:05:58.960 great Pilates teacher is already teaching many of these principles. So I think this is somewhat

01:06:04.780 discipline agnostic, but it's heavily dependent on the practitioner and the student. So I've seen

01:06:11.160 really good Pilates teachers who, even though they're using a very different vocabulary than the one that I

01:06:16.300 use or that the DNS practitioners use, the results speak for themselves. And those patients do have the

01:06:24.180 correct patterns of movement. They are able to get air fully into their lungs. They're able to

01:06:31.780 get their diaphragm low into their abdomen. They're able to flatten out their pelvic floor,

01:06:38.560 generate concentric, robust intra-abdominal pressure that stabilizes every aspect of them.

01:06:45.460 There are other people who either the teacher doesn't have the skill to do that or the teacher does,

01:06:50.380 but it's just not being presented in a way that the student can understand it. And so this is also

01:06:54.620 one of those things that's iterative. And I think one should always be searching for this. So

01:06:59.220 postural restoration, PRI, DNS, Pilates, these are all different ways that one can come about

01:07:06.580 trying to learn these principles. I think unfortunately of the four pieces of exercise we're

01:07:11.500 going to talk about, this is the one that probably will take the most tinkering for people to find the

01:07:17.520 right type of practitioners. Probably sometime next year, Bob, as you know, we are going to start

01:07:23.760 to put together some material on this for people outside of our practice. Currently, all of the work

01:07:30.520 we do on this front, we've put together many video courses. Those are exclusively for our patients at this

01:07:36.400 point. But as our knowledge expands and our footprint in this space expands, my hope is that we are able to

01:07:43.160 start to create digital curriculum on this type of stuff that can help people who, again, don't have

01:07:48.720 access to somebody. We'll end this week's episode with a clip from one of our recent AMAs, I believe

01:07:59.460 episode 32, where I talk about the macro structure of my current training routine. As we come to this end,

01:08:05.680 as I want to mention in the intro, it's the first time we've done this. So we'd really like to hear your

01:08:09.500 feedback, positive and negative. Is this something you want to see us do again with other topics? If so,

01:08:15.660 maybe even suggest some of the topics you'd like to hear. And if not, please be honest with us and tell us

01:08:19.720 not. As I said, it's a lot of work to do this. And we only want to do this if people find this valuable. So thanks

01:08:24.320 so much.

01:08:30.040 I thought it might be helpful for people before we get into some of those specifics. Just what is your current

01:08:35.640 exercise routine look like each week? I know it's always changing, but if you can give people a rough

01:08:41.240 overview, I think that will be helpful as we get into some of these other questions.

01:08:45.440 Yeah. I mean, the actual macro structure of what I do has not changed much in the last year. The

01:08:51.660 micro structure has changed a lot, meaning the exercises have changed a lot. But the macro structure

01:08:56.620 is that on, let's see, Tuesday, Thursday, Saturday, Sunday are cardio days. So Tuesday, Thursday,

01:09:04.640 Sunday are zone two. Saturday is either a zone two followed by a zone five as kind of a separate

01:09:14.740 workout. So each of those are 45 minutes zone twos, and then kind of like a 30 minute zone five as a

01:09:19.800 separate workout that's done almost immediately after. So basically getting out of bike clothes and

01:09:24.260 putting on stair climbing clothes. Alternatively, I might just do a longer bike ride on Saturday

01:09:29.880 and make it more of an anaerobic workout. Then from a lifting standpoint, it's Monday, Wednesday,

01:09:38.520 Friday, Sunday is lifting. And about, I don't know, nine months ago, I switched to an upper body,

01:09:46.620 lower body split. I used to lift three days a week and do upper body, lower body every day. So each day I

01:09:52.980 was doing kind of pushing, pulling and hip hinging. And now the lower body component I think is Monday,

01:09:59.340 Friday, the upper body is Wednesday, Sunday. And I always lift after doing cardio because I think

01:10:06.520 the reverse has been demonstrated to erode strength training gains. Peter, what happens if you miss a

01:10:12.500 day? Because I noticed you didn't say day one, day two, day three, you were very distinct on the days

01:10:17.000 of the week. I know you typically don't miss a day, but if you miss Wednesday, do you just scrap

01:10:22.160 those exercises and then just continue with your program? Or are you trying to make up in the interim?

01:10:27.900 No, like yesterday, Sunday would have been a ride followed by lift day, but I was on the track the

01:10:34.620 whole day and I knew that in advance. So I just ended up doing that lift on Saturday, but obviously

01:10:40.080 was shortchanged on the zone two for yesterday. So I will pretty much will never compromise a lift.

01:10:46.760 I will always get those four lifts in during the week, no matter what. And sometimes it just means

01:10:52.380 moving the days around or doubling up on a different day. And what about timing? Do you have

01:10:57.560 a preference morning, afternoon, evening? Is that flexible as well within kind of your schedule?

01:11:03.100 A little more flexible on weekends, but Monday through Friday and pretty much no flexibility.

01:11:07.060 Those lifts have to be done first thing in the morning and not first thing in the morning. So 0.90

01:11:09.960 morning routine is kind of more about the kids and stuff like that. But once they're out the door to

01:11:15.360 school, it's around 7.15, 7.30, that's when I'll typically lift.

01:11:19.980 Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper

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The Peter Attia Drive - May 09, 2022

#206 - Exercising for longevity： strength, stability, zone 2, zone 5, and more

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