#223 - AMA #39： The Centenarian Decathlon, zone 2, VO2 max, and more
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Summary
In this episode of the Ask Me Anything podcast, Dr. Nick Stenson is joined by Dr. Peter Atiyah to discuss the Centenary and the decathlon. In this AMA, we cover questions around the centenary and decathlon, as well as the question of whether or not too much exercise is too much.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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access the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to another ask me anything episode. Here we are at number 39 and I'm joined once again by
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Nick Stenson. In today's episode, we answer a lot of questions that have come in from subscribers
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based on all of our recent exercise content. Given all those questions that we've been saving and
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coming off our last AMA, which looked at the J curve data and the question around, if you can
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exercise too much, we decided to do an AMA with more of a rapid fire style question, follow up on
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those topics. So in this discussion, I answer a lot of questions around the centenary and decathlon,
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which many of you have heard me discuss and exercising with the goal of longevity, meaning
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lengthening your life and improving your health span. In addition to how I'm personally thinking
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about that, we talk a lot about the follow-up questions around various types of cardiovascular
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training. This gets into everything from partitioning to methods, to comparing different ways in which
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one might go about trying to get that cardiorespiratory benefit. We then get into nuances around VO2 max
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training versus zone two training, the ideal breakdown in terms of time and intensity for each and specific
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follow-up questions around VO2 max in general. So if you're a subscriber and you want to watch the full
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video of this podcast, you can find it on the show notes page. If you're not a subscriber,
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you can watch a sneak peek of the video on our YouTube page. So without further delay,
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I hope you enjoy AMA number 39. Peter, welcome to another AMA. How are you doing?
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Doing good, man. How's the heat out there? I don't mean to sound like that guy who's like
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just too cool for school, but it's just not phasing me and people just can't stop complaining and I don't
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know why. And it's interesting because I'm normally the, my nickname in one phase of my life, maybe it
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was residency or medical school. My nickname was bubble boy. If it was below 72 or above 76, it must
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have been med school. I was like, yeah, it's just too cold or too hot. California does that to you
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though. Just getting those bubbles and anything outside of that feels good. You mean you saw it in
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San Diego, 60 degrees and people would be in North faces walking around. My thermostats definitely clicked
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to the much higher end. Again, we'll probably talk about rucking, but rucking, I always pick the hottest
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time of day to do it. So usually about somewhere between four, 5 PM and it's just moved my thermostat
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higher. So it's been 106, 107 every day for as far back as I can remember. And it's looking like it's
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going to be that as far forward as I can see. But I was in California three, four weeks ago and I had
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dinner with a friend, we ate outside. I was in a t-shirt and I was freezing and it was about 65.
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I thought I was going to die. It wasn't that bad, but I was amazed at how cold I felt. So clearly I've
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lost my comfort level at the extreme low end of temperature. The Canadian in you is just sad to
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hear that. Just the freezing cold at 65. Well, so be it. All right. So I think what we're going to do
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for this AMA is the last AMA, what we did is we took a lot of questions and answered looking at the
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various literature to understand some of the confusion around if there's such a thing as too
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much exercise. But what we weren't able to do is with all the exercise content we've been putting out
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lately, we've gotten so many just follow-up questions. And so coming off the last AMA, what we
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thought is it'd be a good time to just do a little more rapid fire style of those questions, not
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necessarily a heavy deep dive and just really look at answering all these different questions
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around exercise. That's what we're going to do today. If all goes well, we'll cover all four
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pillars of questions that have come in. And so it should be good, well-rounded AMA on all things
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exercise. There should be something for everybody. So before we get to the first question, anything
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you want to add to that? Nope. I think that's a great framework. Perfect. So I think the first
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question is just to set the stage, it may be again, talking about what you view as your goal with
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exercise, which you mentioned before as training for the centenarian decathlon. So maybe just give
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people a really brief rundown of what that is and why you think it's so important for you as you look
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at your longevity journey. So the centenarian decathlon, which I think many people listening
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will have heard me talk about, is simply a mental model for how I think about training. In all of my
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years of training, which have basically been my entire life since I've been 12 or 13 years old,
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a couple of things appear clear to me. And by the way, this is true of not just my own training,
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but the training I've been involved with for other people, athletes, and this includes professional
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athletes, Olympians, things like that. Specificity matters. And people confuse specificity with narrow.
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That's not the case. So I want to elaborate on these two things. You can be broadly trained and broadly
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conditioned, but with specificity and focus. And as we'll see in a moment, that's really what the
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centenarian decathlon is all about. You can be narrowly focused with great specificity. That's
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what certain types of athletes are doing. If you're a golfer, if you're the best golfer in the world,
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there are some really, really specific things that you need to be doing. By the way, they're highly
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asymmetric, depending if you're right or left handed. And your training is basically focused on
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enhancing those very, very specific movements and probably some training to counterbalance the
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asymmetry there. In my experience, it's very difficult to be successful in a physical endeavor
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if you are not pursuing some sort of objective. I'm just going to work out strategy doesn't really
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produce great results over the long haul. And it certainly doesn't when you're trying to solve a
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complicated problem. So even if you could convince me that, no, no, no, no, the just work out for the
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sake of working out is better than sitting on a couch, I would say you're absolutely correct.
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But now we're going after a really hard problem, which is to be in the last decade of your life,
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what we call the marginal decade, and be incredibly robust physically. What does that look like? Well,
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I think it means imagine a 90-year-old who's functioning like a 70-year-old. I think that's
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attainable. So I'm not talking about 90-year-olds functioning like 20-year-olds. I think that's
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science fiction. But I am talking about 90-year-olds functioning like 70-year-olds or 85-year-olds
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functioning like 65-year-olds. But that is going to require a lot of preparation, as we'll talk about
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later. When you think about the inevitability of decline of muscle mass strength, cardiorespiratory
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fitness, you have to be training for that with the same degree of focus and specificity that a
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person is training for to be an exceptional athlete in their 30s or 40s. So the centenarian
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decathlon basically forces us to be specific in what our metrics are in that last decade of life,
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and it allows us to backcast from there. Because forecasting from wherever you are today
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will almost without exception fail to get you where you need to go, because you'll end up missing
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the mark by slipping underneath it. Instead, you want to start with where you need to be at the very
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end and work your way backwards. And almost everybody, myself included, is unpleasantly surprised with how
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far they are today from where they need to be to allow the decline that's going to take place to
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take them to their resting spot at the end. That all makes sense. And we'll look at some graphs later
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on that I know you show patients, which when I saw them, it did a really good job of explaining why
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when you look at that rate of decline, where you start at matters so much. And it kind of reminds me of
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the recent bone density episode we did too, when we looked at those graphs with if you didn't reach
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your full potential compared to if you did reach your full potential in bone density, your fall off
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looks very different. And we see the same with a lot of this exercise, which I think is going to be
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really interesting when we get to it. But I think what might be helpful is maybe just showing people
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how you're currently structuring your program to train for the centenarian decathlon. So in the last
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AMA, we talked about med hours per week as a way to standardize looking at different literature.
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So do you want to walk people through your current structure and how you break that out to ensure
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you're not just focused on one piece, but focused on the broader picture?
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You know, my exercise is not really geared towards the things that used to be geared towards. So if you
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look at how I exercise today and compare it to how I exercised, call it eight years ago, when I was
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very focused on one specific thing, which was time trialing, type of bike racing. If you compare it
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to where it was, I don't know, call it 15 years ago, where it was really very, very focused on
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marathon swimming. Again, pretty niche and specific thing. The training that I was doing 15 years ago
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versus eight years ago had zero overlap. Similarly, if you look at what I'm doing today, it would not
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produce a good cyclist. It would not produce a good swimmer. That's just not the way it is. So it's
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really focused on something different. I think my training kind of fits into four or five buckets.
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I have my zone two, my zone five, strength, stability, and I kind of lump them together,
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even though they're very specific and there are some very specific stability things I'm doing.
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They're not necessarily strength related in the moment. And then I include rucking in there because
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it is so physical. Although truthfully, what drew me to rucking was actually more the psychological
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benefit of it. But as anybody who's done it knows, it's quite demanding. If you allow it to become
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demanding, and we talked about this, you've joined me on a rock. You can see between the temperature,
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the elevation change, and the weight, it's quite a lot of work. So that's how I kind of organized
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myself. And as you said, you can identify how many mets are required for each activity, how much time
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you spend in each. The dot product of that gives you met hours per week, and then you can get a sense of
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where your energy is going. That's probably the purest way to understand energy expenditure
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across those domains. Peter, that makes sense. What I'm going to do is I'm going to share a slide
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we put together of a table that you broke out of what your current met hours per week are,
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if you want to walk people through what it is, and then also how you're thinking about it.
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Yeah. So this is back of the envelope, but as I said, really straightforward. Zone two cycling.
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And my zone two is somewhere between 220 and 235 watts. So I took a slightly lower estimate and
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just said, just let's average 225 watts. You can use a calculator to tell you how many mets that is.
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So that's 11 mets. And if I spend four hours a week there, 11 times four, 44. So that's 44
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met hours per week. Zone five, I do via cycling and stair climbing, and that's about 16 mets. So now I'm
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really pushing the intensity, but I'm only spending half an hour a week at that intensity. So you can
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see that's only giving me eight met hours per week. Lifting weights is about an average of five
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mets. So some things are less, some things are more. It also depends greatly on other things that go
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in there. So all the time I'm on an air bike and doing more intense stuff in there would be at a much
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higher met, whereas doing a bicep curl is at a lower met. We've looked at a bunch of papers and
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I think our best estimate is I'm probably averaging about five mets, which is really not that labor
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intensive. But you multiply that by six hours per week, there's 30 mets. And then the best data I
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could find was we're looking at military personnel rucking. It says 50 pounds there. I do use about 60
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pounds or 55 to 60 pounds. So you can get a sense of if you're at 0% grade, it's 4.8 mets. If you're
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at 5% grade, 7.5. If you're at 10% grade, 10 mets. I kind of look at my heart rate data when I do it
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plus the elevation change. I think I'm probably averaging 6.5 mets. I do three usually closer to
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four hours per week. So maybe that's a bit of a conservative estimate of call it 20 met hours per
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week. So directionally, you total that up and you can see, okay, it's about 100 met hours per week
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of activity. There's the breakdown by percent where they are. And we'll come to this in a minute,
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but I want people to notice the relative amount of zone two to zone five. My zone two is slightly more
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than five times the, not just the duration, but more importantly, it's eight times the duration,
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but it's five times the met hour, the aggregate intensity, the integral intensity. And that's
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going to become an important point when we start to talk about how you would partition your time
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between zone two and zone five. That makes sense. And it kind of leads into a good question that we
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got, which is one of the things we see a lot is what do we know about whether moderate intensity
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exercise is as good as vigorous intensity exercise? So we do see a lot of questions that people are
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wondering how they should think about that moderate versus vigorous intensity as they look at their
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