The Peter Attia Drive - #223 - AMA #39： The Centenarian Decathlon, zone 2, VO2 max, and more

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.140 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.280 Welcome to another ask me anything episode. Here we are at number 39 and I'm joined once again by

00:00:44.860 Nick Stenson. In today's episode, we answer a lot of questions that have come in from subscribers

00:00:49.140 based on all of our recent exercise content. Given all those questions that we've been saving and

00:00:53.900 coming off our last AMA, which looked at the J curve data and the question around, if you can

00:00:58.080 exercise too much, we decided to do an AMA with more of a rapid fire style question, follow up on

00:01:04.620 those topics. So in this discussion, I answer a lot of questions around the centenary and decathlon,

00:01:10.640 which many of you have heard me discuss and exercising with the goal of longevity, meaning

00:01:15.460 lengthening your life and improving your health span. In addition to how I'm personally thinking

00:01:20.060 about that, we talk a lot about the follow-up questions around various types of cardiovascular

00:01:24.980 training. This gets into everything from partitioning to methods, to comparing different ways in which

00:01:31.640 one might go about trying to get that cardiorespiratory benefit. We then get into nuances around VO2 max

00:01:38.020 training versus zone two training, the ideal breakdown in terms of time and intensity for each and specific

00:01:42.980 follow-up questions around VO2 max in general. So if you're a subscriber and you want to watch the full

00:01:47.240 video of this podcast, you can find it on the show notes page. If you're not a subscriber,

00:01:51.080 you can watch a sneak peek of the video on our YouTube page. So without further delay,

00:01:55.400 I hope you enjoy AMA number 39. Peter, welcome to another AMA. How are you doing?

00:02:06.380 Doing good, man. How's the heat out there? I don't mean to sound like that guy who's like

00:02:10.640 just too cool for school, but it's just not phasing me and people just can't stop complaining and I don't

00:02:16.640 know why. And it's interesting because I'm normally the, my nickname in one phase of my life, maybe it

00:02:22.660 was residency or medical school. My nickname was bubble boy. If it was below 72 or above 76, it must

00:02:28.340 have been med school. I was like, yeah, it's just too cold or too hot. California does that to you

00:02:32.540 though. Just getting those bubbles and anything outside of that feels good. You mean you saw it in

00:02:37.320 San Diego, 60 degrees and people would be in North faces walking around. My thermostats definitely clicked 0.92

00:02:43.240 to the much higher end. Again, we'll probably talk about rucking, but rucking, I always pick the hottest

00:02:48.880 time of day to do it. So usually about somewhere between four, 5 PM and it's just moved my thermostat

00:02:54.020 higher. So it's been 106, 107 every day for as far back as I can remember. And it's looking like it's

00:03:01.320 going to be that as far forward as I can see. But I was in California three, four weeks ago and I had

00:03:07.460 dinner with a friend, we ate outside. I was in a t-shirt and I was freezing and it was about 65.

00:03:15.880 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

00:03:21.460 lost my comfort level at the extreme low end of temperature. The Canadian in you is just sad to 0.94

00:03:27.140 hear that. Just the freezing cold at 65. Well, so be it. All right. So I think what we're going to do

00:03:33.420 for this AMA is the last AMA, what we did is we took a lot of questions and answered looking at the

00:03:39.040 various literature to understand some of the confusion around if there's such a thing as too

00:03:43.580 much exercise. But what we weren't able to do is with all the exercise content we've been putting out

00:03:49.400 lately, we've gotten so many just follow-up questions. And so coming off the last AMA, what we

00:03:55.580 thought is it'd be a good time to just do a little more rapid fire style of those questions, not

00:04:01.840 necessarily a heavy deep dive and just really look at answering all these different questions

00:04:06.720 around exercise. That's what we're going to do today. If all goes well, we'll cover all four

00:04:11.280 pillars of questions that have come in. And so it should be good, well-rounded AMA on all things

00:04:16.240 exercise. There should be something for everybody. So before we get to the first question, anything

00:04:21.940 you want to add to that? Nope. I think that's a great framework. Perfect. So I think the first

00:04:27.320 question is just to set the stage, it may be again, talking about what you view as your goal with

00:04:31.800 exercise, which you mentioned before as training for the centenarian decathlon. So maybe just give

00:04:37.060 people a really brief rundown of what that is and why you think it's so important for you as you look

00:04:43.880 at your longevity journey. So the centenarian decathlon, which I think many people listening

00:04:48.120 will have heard me talk about, is simply a mental model for how I think about training. In all of my

00:04:54.720 years of training, which have basically been my entire life since I've been 12 or 13 years old,

00:05:00.900 a couple of things appear clear to me. And by the way, this is true of not just my own training,

00:05:06.640 but the training I've been involved with for other people, athletes, and this includes professional

00:05:13.020 athletes, Olympians, things like that. Specificity matters. And people confuse specificity with narrow.

00:05:21.560 That's not the case. So I want to elaborate on these two things. You can be broadly trained and broadly

00:05:28.880 conditioned, but with specificity and focus. And as we'll see in a moment, that's really what the

00:05:34.620 centenarian decathlon is all about. You can be narrowly focused with great specificity. That's

00:05:41.620 what certain types of athletes are doing. If you're a golfer, if you're the best golfer in the world,

00:05:47.620 there are some really, really specific things that you need to be doing. By the way, they're highly

00:05:53.820 asymmetric, depending if you're right or left handed. And your training is basically focused on

00:06:00.100 enhancing those very, very specific movements and probably some training to counterbalance the

00:06:06.680 asymmetry there. In my experience, it's very difficult to be successful in a physical endeavor

00:06:13.580 if you are not pursuing some sort of objective. I'm just going to work out strategy doesn't really

00:06:20.180 produce great results over the long haul. And it certainly doesn't when you're trying to solve a

00:06:26.180 complicated problem. So even if you could convince me that, no, no, no, no, the just work out for the

00:06:32.100 sake of working out is better than sitting on a couch, I would say you're absolutely correct.

00:06:36.180 But now we're going after a really hard problem, which is to be in the last decade of your life,

00:06:42.060 what we call the marginal decade, and be incredibly robust physically. What does that look like? Well,

00:06:48.280 I think it means imagine a 90-year-old who's functioning like a 70-year-old. I think that's

00:06:54.420 attainable. So I'm not talking about 90-year-olds functioning like 20-year-olds. I think that's

00:06:59.120 science fiction. But I am talking about 90-year-olds functioning like 70-year-olds or 85-year-olds

00:07:05.040 functioning like 65-year-olds. But that is going to require a lot of preparation, as we'll talk about

00:07:12.440 later. When you think about the inevitability of decline of muscle mass strength, cardiorespiratory

00:07:17.460 fitness, you have to be training for that with the same degree of focus and specificity that a

00:07:24.020 person is training for to be an exceptional athlete in their 30s or 40s. So the centenarian

00:07:29.500 decathlon basically forces us to be specific in what our metrics are in that last decade of life,

00:07:36.440 and it allows us to backcast from there. Because forecasting from wherever you are today

00:07:41.960 will almost without exception fail to get you where you need to go, because you'll end up missing

00:07:49.500 the mark by slipping underneath it. Instead, you want to start with where you need to be at the very

00:07:55.880 end and work your way backwards. And almost everybody, myself included, is unpleasantly surprised with how

00:08:03.720 far they are today from where they need to be to allow the decline that's going to take place to

00:08:12.640 take them to their resting spot at the end. That all makes sense. And we'll look at some graphs later

00:08:18.980 on that I know you show patients, which when I saw them, it did a really good job of explaining why

00:08:24.460 when you look at that rate of decline, where you start at matters so much. And it kind of reminds me of

00:08:30.300 the recent bone density episode we did too, when we looked at those graphs with if you didn't reach

00:08:36.000 your full potential compared to if you did reach your full potential in bone density, your fall off

00:08:41.480 looks very different. And we see the same with a lot of this exercise, which I think is going to be

00:08:46.800 really interesting when we get to it. But I think what might be helpful is maybe just showing people

00:08:51.940 how you're currently structuring your program to train for the centenarian decathlon. So in the last

00:08:58.180 AMA, we talked about med hours per week as a way to standardize looking at different literature.

00:09:04.440 So do you want to walk people through your current structure and how you break that out to ensure

00:09:10.440 you're not just focused on one piece, but focused on the broader picture?

00:09:14.740 You know, my exercise is not really geared towards the things that used to be geared towards. So if you

00:09:20.900 look at how I exercise today and compare it to how I exercised, call it eight years ago, when I was

00:09:25.860 very focused on one specific thing, which was time trialing, type of bike racing. If you compare it

00:09:32.620 to where it was, I don't know, call it 15 years ago, where it was really very, very focused on

00:09:38.220 marathon swimming. Again, pretty niche and specific thing. The training that I was doing 15 years ago

00:09:44.300 versus eight years ago had zero overlap. Similarly, if you look at what I'm doing today, it would not

00:09:50.040 produce a good cyclist. It would not produce a good swimmer. That's just not the way it is. So it's

00:09:54.300 really focused on something different. I think my training kind of fits into four or five buckets.

00:09:59.100 I have my zone two, my zone five, strength, stability, and I kind of lump them together,

00:10:04.500 even though they're very specific and there are some very specific stability things I'm doing.

00:10:09.180 They're not necessarily strength related in the moment. And then I include rucking in there because

00:10:14.040 it is so physical. Although truthfully, what drew me to rucking was actually more the psychological

00:10:19.940 benefit of it. But as anybody who's done it knows, it's quite demanding. If you allow it to become

00:10:26.240 demanding, and we talked about this, you've joined me on a rock. You can see between the temperature,

00:10:30.480 the elevation change, and the weight, it's quite a lot of work. So that's how I kind of organized

00:10:34.660 myself. And as you said, you can identify how many mets are required for each activity, how much time

00:10:40.620 you spend in each. The dot product of that gives you met hours per week, and then you can get a sense of

00:10:45.260 where your energy is going. That's probably the purest way to understand energy expenditure

00:10:50.280 across those domains. Peter, that makes sense. What I'm going to do is I'm going to share a slide

00:10:55.680 we put together of a table that you broke out of what your current met hours per week are,

00:11:01.680 if you want to walk people through what it is, and then also how you're thinking about it.

00:11:06.080 Yeah. So this is back of the envelope, but as I said, really straightforward. Zone two cycling.

00:11:11.220 And my zone two is somewhere between 220 and 235 watts. So I took a slightly lower estimate and

00:11:19.400 just said, just let's average 225 watts. You can use a calculator to tell you how many mets that is.

00:11:25.540 So that's 11 mets. And if I spend four hours a week there, 11 times four, 44. So that's 44

00:11:31.720 met hours per week. Zone five, I do via cycling and stair climbing, and that's about 16 mets. So now I'm

00:11:39.880 really pushing the intensity, but I'm only spending half an hour a week at that intensity. So you can

00:11:45.220 see that's only giving me eight met hours per week. Lifting weights is about an average of five

00:11:53.280 mets. So some things are less, some things are more. It also depends greatly on other things that go

00:11:59.900 in there. So all the time I'm on an air bike and doing more intense stuff in there would be at a much

00:12:05.820 higher met, whereas doing a bicep curl is at a lower met. We've looked at a bunch of papers and

00:12:11.220 I think our best estimate is I'm probably averaging about five mets, which is really not that labor

00:12:16.960 intensive. But you multiply that by six hours per week, there's 30 mets. And then the best data I

00:12:21.660 could find was we're looking at military personnel rucking. It says 50 pounds there. I do use about 60

00:12:28.120 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

00:12:36.940 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

00:12:43.240 plus the elevation change. I think I'm probably averaging 6.5 mets. I do three usually closer to

00:12:49.340 four hours per week. So maybe that's a bit of a conservative estimate of call it 20 met hours per

00:12:54.180 week. So directionally, you total that up and you can see, okay, it's about 100 met hours per week

00:12:58.960 of activity. There's the breakdown by percent where they are. And we'll come to this in a minute,

00:13:04.440 but I want people to notice the relative amount of zone two to zone five. My zone two is slightly more

00:13:12.580 than five times the, not just the duration, but more importantly, it's eight times the duration,

00:13:19.260 but it's five times the met hour, the aggregate intensity, the integral intensity. And that's

00:13:24.840 going to become an important point when we start to talk about how you would partition your time

00:13:28.900 between zone two and zone five. That makes sense. And it kind of leads into a good question that we

00:13:35.500 got, which is one of the things we see a lot is what do we know about whether moderate intensity

00:13:40.500 exercise is as good as vigorous intensity exercise? So we do see a lot of questions that people are

00:13:46.720 wondering how they should think about that moderate versus vigorous intensity as they look at their

00:13:51.820 cardio work. Thank you for listening to today's sneak peek AMA episode of the drive. If you're

00:13:57.360 interested in hearing the complete version of this AMA, you'll want to become a member. We created

00:14:02.180 the membership program to bring you more in-depth exclusive content without relying on paid ads.

00:14:08.620 Membership benefits are many and beyond the complete episodes of the AMA each month,

00:14:13.180 they include the following ridiculously comprehensive podcast show notes that detail

00:14:18.000 every topic, paper, person, and thing we discuss on each episode of the drive access to our private

00:14:24.440 podcast feed, the qualies, which were a super short podcast, typically less than five minutes

00:14:29.820 released every Tuesday through Friday, which highlight the best questions, topics, and tactics

00:14:34.640 discussed on previous episodes of the drive. This is particularly important for those of you who

00:14:40.140 haven't heard all of the backup episodes. It becomes a great way to go back and filter and decide which

00:14:45.320 ones you want to listen to in detail, really steep discount codes for products I use and believe in,

00:14:50.600 but for which I don't get paid to endorse, and benefits that we continue to add over time. If you want to

00:14:56.680 learn more and access these member-only benefits, head over to peteratiamd.com forward slash subscribe.

00:15:03.620 Lastly, if you're already a member, but you're hearing this, it means you haven't downloaded our member-only

00:15:08.620 podcast feed where you can get the full access to the AMA, and you don't have to listen to this.

00:15:13.600 You can download that at peteratiamd.com forward slash members.

00:15:19.380 You can find me on Twitter, Instagram, and Facebook, all with the ID peteratiamd.

00:15:25.160 You can also leave us a review on Apple Podcasts or whatever podcast player you listen on.

00:15:30.080 This podcast is for general informational purposes only and does not constitute the practice of medicine,

00:15:35.580 nursing, or other professional healthcare services, including the giving of medical advice.

00:15:41.400 No doctor-patient relationship is formed. The use of this information and the materials linked to this

00:15:46.660 podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for

00:15:53.080 professional medical advice, diagnosis, or treatment. Users should not disregard or delay in

00:15:59.740 obtaining medical advice from any medical condition they have, and they should seek the assistance of

00:16:05.120 their healthcare professionals for any such conditions. Finally, I take conflicts of interest very

00:16:10.960 seriously. For all of my disclosures and the companies I invest in or advise, please visit

00:16:16.560 peteratiamd.com forward slash about where I keep an up-to-date and active list of such companies.

00:16:35.120 Basically, I know.

00:16:37.120 I'll see you next time.

00:16:37.900 Bye.

00:16:38.160 Bye.

00:16:38.280 Bye.

00:16:39.360 Bye.

00:16:40.480 Bye.

00:16:41.920 Bye.

00:16:42.340 Bye.

00:16:42.760 Bye.

00:16:43.580 Bye.

00:16:43.920 Bye.

00:16:44.180 Bye.

00:16:58.620 Bye.

00:16:59.180 Bye.

00:17:00.240 Bye.

00:17:03.280 Bye.

The Peter Attia Drive - September 19, 2022

#223 - AMA #39： The Centenarian Decathlon, zone 2, VO2 max, and more

Episode Stats

Summary

Transcript