The Peter Attia Drive - #261 ‒ Training for The Centenarian Decathlon： zone 2, VO2 max, stability, and strength ｜ Peter Attia, M.D.

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

00:00:15.500 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:19.820 into something accessible for everyone. Our goal is to provide the best content in health and

00:00:24.780 wellness, full stop. And we've assembled a great team of analysts to make this happen.

00:00:28.900 If you enjoy this podcast, we've created a membership program that brings you far more

00:00:33.320 in-depth content. If you want to take your knowledge of the space to the next level at

00:00:37.340 the end of this episode, I'll explain what those benefits are. Or if you want to learn more now,

00:00:41.760 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.800 here's today's episode. Welcome to a special episode of the drive for this week's episode.

00:00:54.540 We're going to release the live AMA that we recorded celebrating the release of Outlive,

00:00:59.680 which was recorded in April. We received a good bit of feedback from those who were invited and

00:01:04.840 able to attend this episode live. So we decided to make it more widely available. Our AMAs, of course,

00:01:11.200 are typically reserved only for our subscribers. So if you're not a subscriber, this might give you

00:01:15.140 a bit of an idea what our AMAs are like. Although this is not the typical format. Usually our AMAs go a

00:01:20.680 little bit deeper into content than this one. But nevertheless, hopefully this gives you a sense

00:01:24.440 of what we're up to. In this episode, we really focus the entire conversation around the centenarian

00:01:29.520 decathlon. We speak about the events in my centenarian decathlon and how I decided on them

00:01:33.780 and how I work with patients to create their own list. We then talk about how people can know if

00:01:39.360 they're on track for their centenarian decathlon across a variety of ages and the various fitness tests

00:01:45.040 that can help determine that. We focus the rest of the discussion around training for the

00:01:50.040 centenarian decathlon, including what that training should look like, whether you're older, younger,

00:01:55.320 new to exercise, or a veteran. And we talk about some questions that came up around zone two and

00:02:00.920 VO2 max training. So without further delay, I hope you enjoy this special episode of The Drive.

00:02:11.380 Never done a live event, never done a live AMA. Everything has been recorded. So how do you feel?

00:02:16.900 Ready.

00:02:17.200 You feel like there's more pressure on this because there is, you can't screw up. Everything you say

00:02:23.200 is officially written in stone.

00:02:25.140 Yeah.

00:02:25.600 That's good. We'll see how it goes. So what we're doing tonight, today, depending on where you're at,

00:02:32.440 is kind of an AMA that's all focused on one thing, which is the centenarian decathlon.

00:02:38.260 And so what we did is for everyone who pre-ordered, they could sign up for the event.

00:02:42.540 They submitted a bunch of questions. We went through, I mean, there was thousands of questions.

00:02:47.620 So right off the bat, we'll apologize to anybody who we can't answer the question, but we tried to

00:02:52.940 group them together, kind of organize them a bit, really to try and get through as much as we can.

00:02:58.320 So if anyone has heard our AMAs before, they'll probably know. Sometimes we can go into a little

00:03:04.820 bit of detail and sometimes one question can take a while, but the goal for this one is more of that

00:03:10.300 rapid fire. Let's see how many we can get out and it should be good. So anything you want to add or

00:03:17.840 say before we get rolling? No, but feel free to interrupt me if I'm being too long-winded.

00:03:22.980 All right. We'll just point at the watch and say, we got to speed it up. So I think what would be

00:03:28.420 helpful is because we did get a lot of questions around, Hey, what's the best thing you can do

00:03:33.960 for longevity? Like if there's only one thing, you know, you have five tactics in the toolkit,

00:03:39.340 but if there's one thing people should focus on, what would that be? And maybe it'd be worth

00:03:43.780 just kind of giving a little piece on that, just as we set the stage on why we decided to focus on

00:03:49.180 the centenarian decathlon and kind of why you think that's so important for people's longevity journey.

00:03:54.960 Yeah. I mean, look, it's an impossible question to answer because if you've got a person who's

00:03:59.660 sleeping four hours a night, if you don't fix that, nothing else will matter. If you have a person

00:04:04.520 who's malnourished, you know, you sort of have to address these issues, but generally speaking,

00:04:10.040 if everything in your life is a six or seven out of 10, taking your exercise to a 10 out of 10

00:04:16.680 is going to have a greater impact on both the length and quality of your life than any of the

00:04:21.540 other domains that I can think of, perhaps with the exception of emotional health. That's one that

00:04:26.600 can be such a binary thing. If you take a person who, you know, for example, like me, where that

00:04:32.620 house is not in order, you know, until that's addressed, all the exercise in the world wouldn't

00:04:36.180 fix that either. So it's a tough question. I get asked that question all the time. I wish

00:04:40.020 I had a slick answer for it, but that's really the best I can say.

00:04:43.100 Yeah. If anyone's read the book and has a really quick 30 second answer, they want to email to us

00:04:48.520 that Peter can steal, feel free to do that because we'll take it. So I think it'd be helpful. Maybe

00:04:54.060 let's just quickly define centenary decathlon marginal decade, two terms that we use quite a bit.

00:05:01.660 Obviously people will have read the book, but I think it's still good to just get a quick

00:05:05.420 definition of that because it will set the stone for everything we're going to cover.

00:05:08.580 Yeah. Marginal decade is the last decade of your life. So everyone will have a marginal

00:05:13.540 decade. Most people certainly don't know the day they enter it. Sometimes you know when you're in

00:05:18.960 it, especially if you're nearing the end of it, a person probably has a sense of that appreciation,

00:05:22.460 but it is an important model because I think that the marginal decade for most people is

00:05:28.940 really a period of poor life quality. Physical health has usually declined significantly.

00:05:35.420 cognitive health potentially has declined as well. As I have sort of observed many people in their

00:05:40.700 marginal decades, including people I've been close to, I noticed that there can be a great

00:05:45.060 sense of withdrawal because of these things, right? You're not participating in life. So the idea here

00:05:51.500 is quite simple, which is if you plan to have a remarkable marginal decade, by definition, it means

00:05:58.600 that all the decades that came before it also had to be pretty remarkable. And the analogy I use

00:06:03.720 in the book is that of an archer, probably because that's what I am. But if you really want to be

00:06:09.800 proficient at 50 yards with a bow and arrow, practice at a hundred and you'll be amazed at how

00:06:15.940 simple 50 becomes and 60 and 70 and 80. It's a very nonlinear relationship in terms of accuracy with a

00:06:22.920 bow and arrow. The centenarian decathlon becomes the scaffolding upon which I actually think of

00:06:29.040 this. So this, again, came from an idea or an observation, I suppose, I had in my own life, which was

00:06:34.340 from age 13 to about 42, I was constantly involved in something very specific that I was training for. So I

00:06:43.220 never exercised. I trained. I trained for boxing. I trained for cycling. I trained for swimming. I had

00:06:49.860 competitions. I had meets. And everything I did vis-a-vis exercise was in service of a goal.

00:06:56.700 And that made it very easy. There was real specificity to what I did. And then when I sort

00:07:01.660 of hung up my bike, I realized, oh my God, like, I don't know what I'm doing. I mean, I'm still

00:07:06.280 exercising, but it didn't feel like it had a purpose. And I sort of realized that's actually how

00:07:10.440 most people exercise. And when compared to the alternative, which is not exercising, that's okay.

00:07:15.460 But I realized as I thought more about this marginal decade, I needed to be very specific

00:07:21.740 in my training to make sure I didn't arrive there and sort of leave it to chance. Would

00:07:27.280 I be strong enough, healthy enough, have enough balance, all of those things. And so what I

00:07:33.200 realized is I had to, you know, to borrow the phrase from Annie Duke, I had to backcast from

00:07:37.920 that marginal decade around a set of very specific events. And that set of events we would call the

00:07:45.520 centenarian decathlon. And everybody's going to pick different events. These can be activities of

00:07:50.140 daily living. These could be very specific recreational activities. I think it's a good

00:07:55.200 idea to have both in there. And the more specifically you train for those, the more directed your training

00:08:01.400 is.

00:08:02.320 And I think what would be helpful right now is, I know you have that list right next to you,

00:08:06.480 is maybe just reading through your list. And again, as you kind of stated, your list doesn't

00:08:11.820 mean it has to be everyone else's list. But a lot of times, I think when there's newer concepts or

00:08:16.600 people are trying to figure out how this works, it's helpful to hear an example. So do you kind

00:08:20.800 of want to just burn through your list and let people know how you're thinking about this in your

00:08:25.020 life?

00:08:25.720 I will say this. It's organized in a way that's a bit confusing because in my mind, I'm constantly

00:08:31.440 thinking, okay, mobility and strength matter. Aerobic capacity matters. So sort of aerobic

00:08:37.200 efficiency matters. Peak aerobic performance matters. I'm in the back of my mind thinking,

00:08:41.720 I have to make sure I can do all of those things well. And then some of my centenarian decathlon

00:08:46.640 Olympics are like exercises or metrics or feats and others are activities. So I'll try to add a bit

00:08:53.000 of color here.

00:08:53.520 Real quick, you kind of mentioned your four pillars of exercise, but people are also known

00:08:58.900 by different things, which is zone two maybe or VO2 max. So do you just kind of want to

00:09:03.900 explain that a little bit?

00:09:04.500 Yeah. So when I talk about aerobic efficiency, that's zone two. When I talk about peak aerobic

00:09:08.940 output, that's VO2 max. Strength, stability, in with stability is mobility, balance, things like

00:09:14.780 that. Okay. So in no particular order, pick up a 30-pound child from a squatted position or

00:09:21.020 from a crib. Those are two very difficult positions. So that requires strength, stability,

00:09:25.180 mobility. Get up off the floor with one point of support. That's stability and strength.

00:09:30.820 Place a 30-pound suitcase overhead. Strength, also mobility. Dead hang for 30 seconds. Strength

00:09:37.280 and stability. Farmer walk for one minute with 25% of body weight in each hand. So again, it's

00:09:44.640 something that today I could do for a day. That's really pushing the bounds of what I would

00:09:48.580 want to be able to do in my 80s, for example. Strength and anaerobic. Pull or push a weighted

00:09:54.840 sled 100 feet with, and I've put in here kind of a metric of resistance. Again, what is that

00:10:02.840 really all about? This is kind of one of those things. If you're in a dangerous situation,

00:10:06.820 a spouse has fallen, you have to pull somebody out of the way or something like that. Walk up

00:10:11.720 and down stairs with feet pointed perfectly forward. So if your feet are pointed perfectly forward

00:10:17.480 as you're walking up and down flights of stairs, it means you still have the ankle mobility to do

00:10:21.600 that. So you can get an angle between your foot and your tibia, your shin, into an acute angle as

00:10:26.820 opposed to having to turn your feet outward. Single leg stand with eyes open for 30 seconds,

00:10:32.700 with eyes closed for 15 seconds. Single leg get up without support. So like getting up off a seat,

00:10:40.840 for example, hex bar deadlift my body weight for five reps. Again, pretty aggressive, not now.

00:10:48.000 A dumbbell lunge in perfect form with 15% of my body weight in each hand for 10 reps. Cover three

00:10:55.000 miles in one hour by foot. So again, that's 20 minute mile is pretty slow. But if you think about

00:11:01.280 being able to do that in the last decade of your life, carry 20 pounds up four flights of stairs,

00:11:06.100 produce a VO2 max above 30 milliliters per minute per kilogram. And if you can do that,

00:11:13.160 that basically buys you a whole bunch of activities. That means you could walk

00:11:16.740 up a 6% grade at three miles an hour for a period of time, not necessarily for an hour,

00:11:22.300 but perhaps for 20, 15 minutes. Tread water for 10 minutes. Not that I have a plan to,

00:11:28.380 but again, you think about what's implied. Like that's a very functionally aerobic thing to do.

00:11:32.440 Scale a ledge at shoulder height or pull myself out of a pool onto a deck 12 inches above the water

00:11:40.380 surface. Single leg glute bridge, 15 reps without loading my lumbar spine and do a plank in perfect

00:11:49.540 form with scapula retracted, no hip sag for one minute. So I have several of these lists. There

00:11:55.900 are things that I would add to this that are, you know, or I have on a different list that get more

00:11:59.740 into recreational activities. I do want to be able to pull a 50 pound bow back, a compound bow that's

00:12:04.560 50 pounds and a compound bow of course lets off as you get further, but you still have to be able to

00:12:08.440 pull 50 pounds at the outset. So. I think it's helpful for people because if you think about

00:12:12.680 the list you made, the very specific things, but you kind of hinted at there's a reason behind

00:12:18.680 everything. The dumbbell being able to lift it is grandkids, great grandkids. You want to be able to

00:12:23.880 play with them. Being able to get off the ground is you want to be able to live by yourself or with a

00:12:28.480 spouse and be able to like fully move, not worry about falling. And so if anyone's having trouble

00:12:34.400 kind of thinking about how they do it, it's sometimes helpful to just take a step back and

00:12:38.260 be like, you know, do you want to live in a city area where you can walk to get groceries and bring

00:12:42.860 them back and then you can get specific from there too. So for anyone who's kind of thinking, okay,

00:12:48.100 what specifically should they think about for that? Always feel free to take a step back and then get

00:12:53.420 detailed going forward. Now you mentioned earlier kind of emotional health. There wasn't anything on

00:13:01.320 there on your list as it relates to that. And we did get a few questions on that. And also, you know,

00:13:07.500 you kind of talked about how physical and cognitive as you get older is always going to decline,

00:13:12.040 but emotional health on the other end, that's only piece of health span that can actually go up.

00:13:17.780 And so is it purposeful you don't have that on your centenarian decathlon list?

00:13:23.040 Yeah. The centenarian decathlon is focusing purely on that physical piece that is invariably going to

00:13:28.840 decline. So it doesn't really get into the cognitive or as you said, the emotional part,

00:13:33.220 which, you know, if we're really doing that right, it should be getting better as we age.

00:13:37.560 When you talk to your patients about this, because I know you work with every patient,

00:13:41.560 you want them to be able to create this list and kind of anchor back to it. Because like you said,

00:13:46.740 you're not training for a marathon, you're not training for a triathlon, you're really training

00:13:51.020 for this. What advice, what encouragement do you give them as they're starting to kind of think

00:13:55.860 through, okay, how do I create this list? How do I start to build this process in my mind?

00:14:01.340 We've gone through several iterations on this. Initially, we asked patients to do what I did,

00:14:06.320 which is just sit down and come up with the list. That didn't produce as much fruit, perhaps because

00:14:11.340 people weren't putting as much thought into it as I was. You know, it just wasn't something they were

00:14:15.660 spending all of their time thinking about. So what we do now is we give them a list

00:14:20.020 of about 50 items. About half of them are activities of daily living. About half of them

00:14:26.880 are sort of feats of fitness or strength. And we say, pick 10. And we've gone through multiple

00:14:33.460 iterations of this. We used to say, pick as many as you want. That turned out to be. So now it's like,

00:14:37.440 pick 10. So you have to really think about this. You have to prioritize. What are the 10 most

00:14:40.880 important things to you on this list? And then we ask the question, okay, to do those things,

00:14:47.900 do you know what is required? Do you know what's required to pick up a 30 pound child off the ground?

00:14:55.160 What type of stability is required? What type of strength is required? And how much will that

00:15:00.260 require you to be able to do today based on the extrapolation of how much those,

00:15:04.800 each of those parameters declines? And one of the questions we got come through a ton was,

00:15:11.540 those are the things you want to do at a hundred. To be clear, I don't expect to live to a hundred.

00:15:17.280 You know, if you look at my wall chart, it says 88. So call it in my eighties was probably,

00:15:21.800 you know, where I hope to be. In your marginal. In my marginal decade. Yeah.

00:15:25.260 So how are you thinking about, okay, so if in your marginal decade, you want to be able to do that,

00:15:30.140 you know, there's people who are listening, who are going to be in their twenties, thirties,

00:15:34.380 forties, fifties, sixties, seventies, eighties, the people who are on the younger spectrum of that,

00:15:39.280 we're kind of wondering, you can do all those right now, easy all day, every day. So how do you

00:15:45.180 think about how much you should be able to do in your thirties or forties or fifties? Kind of,

00:15:51.280 how do you talk to patients about how they kind of like back cast and figure out, okay, my goal

00:15:56.120 at 40 should be X to be Y at 80. We have a pretty good sense of how major parameters like

00:16:04.420 strength and VO two max decline with age. And so even though I can do everything on that list

00:16:09.820 blindfolded, it's going to take a lot of work to make sure that my VO two max is 30 to 32 mils per

00:16:17.180 minute per kilogram in 30 to 40 years, especially if it's closer to 40 years. And truthfully, like

00:16:24.020 right now, my VO two max is not what I'd like it to be. It's probably in the mid fifties,

00:16:29.100 which is again, fine for somebody my age, but I really would like a bigger margin of error and

00:16:35.980 maybe want it to be mid to high fifties as opposed to low to mid fifties. So if you're 30, if you're

00:16:42.560 20 years younger than me, the bar is even higher. So paradoxically, the youngest people aren't

00:16:48.400 necessarily in the best shape here on a relative basis. They might be in absolute terms,

00:16:53.140 but they have longer to maintain that. And therefore they have to be starting from a higher

00:16:57.640 place. You mentioned VO two max there. Do you maybe want to talk about a few metrics or

00:17:02.600 tests people could do so they can understand where they're at currently from a cardio perspective and

00:17:08.840 let's say a strength perspective? VO two max is, I don't know that it's necessarily the single best

00:17:13.900 metric of cardiorespiratory fitness, but it's certainly the one that's been studied the most. And

00:17:18.000 it's obviously the one that for which we have the most data. It's also one that you can go out and

00:17:22.780 get done on your own. It's a hundred dollar test, maybe $150 test. You can go and find any,

00:17:29.300 in most cities, they would be able to do this for you. There are also free versions. You can estimate

00:17:34.160 it. You could run a Cooper's test or various versions of these tests, which we've talked

00:17:37.460 about elsewhere. And you can just look that up to, if you want to run, know how to do that protocol.

00:17:41.160 So you don't need to even spend a dollar to estimate your VO two max, if you're willing to go down

00:17:45.080 to a track and run a mile or something. So the question then becomes, what are some other metrics

00:17:50.580 that go with it? Well, I mean, certainly strength metrics matter. We've talked about some of those

00:17:55.280 things. A great metric for both upper body strength and grip strength and a bit of stamina

00:18:01.280 to boot is a farmer carry. And so, you know, for men, we'd like to say a guy in his forties

00:18:06.860 should be able to carry his body weight for a minute. So half his body weight in each hand.

00:18:12.260 Do you maybe want to explain what a farmer carry is for people who aren't familiar?

00:18:14.980 Yeah. It's literally just carrying and walking. So if a person weighs 180 pounds,

00:18:21.220 can they put 90 pounds in each hand and walk for a minute? For a woman who's 40, 1.00

00:18:25.800 we would want to see that at about 75% of her weight. So just do the math and adjust accordingly. 0.92

00:18:32.960 I've talked about the dead hang. That's another great one for grip strength. Again, we have sort

00:18:37.100 of metrics that we would look at. We would say a man in his forties, we'd want to see two minutes

00:18:41.620 of dead hang for a woman a minute and a half. And then of course that gets discounted by roughly 10 0.76

00:18:47.220 to 15 seconds per decade as you go from 40 to 50, et cetera. There are other great examples of

00:18:53.140 strength, a wall sit, for example. Can you do a wall sit for two minutes? So you're sitting with

00:18:58.580 your back against the wall, your thighs are parallel to the ground, you're not using your hands. And

00:19:03.240 basically this is a one way to test leg strength. There are better ways to do it. We typically do this

00:19:09.000 in a more free form where we have people do an air squat where they're hovering, but not using their

00:19:16.740 back for support. So now it's a little more stressful because you're not just using your

00:19:20.920 legs, but you have to stabilize. Whereas on the wall sit, you get all the stabilization for free

00:19:25.080 because you're pushing back into the wall. So there are no shortage of ways to do this kind of

00:19:29.760 thing and probably beyond the scope of our discussion now to go through all the different ways.

00:19:34.240 Zone two, of course, is another really important thing to do. So there's the technical way it's

00:19:39.180 defined based on lactate production. But again, the simplest way for most people is the RPE way,

00:19:44.200 right? Zone two is that threshold where you go from being able to speak while you're exercising,

00:19:52.800 but being uncomfortable to not being able to speak. And where most people cross that threshold is where

00:19:58.680 you will now start to net accumulate lactate with your activity. And so figuring out and

00:20:04.500 demonstrating that you can generate more and more work at that level, whether it be wattage or speed

00:20:09.580 or whatever your metric you're using, that becomes also just an enormous way to track your progress.

00:20:15.200 And do you, not to put you on the spot or make it awkward, but I think with RPE and zone two,

00:20:20.580 sometimes people don't know what that level is of like, if I'm talking like this, is that okay?

00:20:25.800 Should it be like, I can only get one word out every five seconds? Do you kind of...

00:20:30.140 No, for me, I mean, it feels like if I'm on my bike doing a zone two and my wife comes in or one

00:20:36.580 of my kids comes in to talk to me, I'm like, I can talk. I'm like, hey, yeah. Okay. Yep. I got it.

00:20:46.140 Yep. I'll pick them up. You know, do I want to sit there and talk? No, but I can. If I could talk like

00:20:52.520 this, I'm in zone one. If you and I went for a walk, we're in zone one. In fact, you've rucked

00:20:58.020 with me. Most of rucking is below zone two, except when you're going up the hills.

00:21:02.400 Which is brutal.

00:21:03.240 Then you're not talking. Then you're out of zone two. So there's very little of a ruck that's

00:21:07.100 actually in zone two. The closest I can get to zone two is doing that shuffle run. I can do sort

00:21:13.260 of a light shuffle. But if I'm walking, it's hard, but it's not hard enough. And if I'm walking flat,

00:21:18.560 it's too easy. If I'm walking up a hill, it's too hard. And another important piece

00:21:22.780 is muscle mass. And I know you typically will kind of look at muscle mass based on metrics from a DEXA

00:21:30.700 scan. And then there's also, you know, certain percentiles that you want to see patients in.

00:21:36.240 So maybe talk a little bit about that because that way anyone who's listening to this and is curious,

00:21:40.580 okay, how do I stack up from a muscle perspective? Do I need to increase? Am I okay? They can go out

00:21:46.020 and get one of these done relatively cheap. They're relatively easy to find. And there's a

00:21:50.340 few core metrics. So maybe just talk about that for a second.

00:21:52.800 Yeah. I think everybody should have a DEXA scan. You just have to know this data. You have to know

00:21:57.260 your bone mineral density. I think you have to know how much visceral fat you have. And I think

00:22:01.380 you have to know how much muscle mass you have. Obviously you're also getting body fat, which is

00:22:06.560 important, but it's not as important as those other three. A DEXA scan will either automatically

00:22:11.860 calculate for you, or at least give you the data to calculate for yourself, something called the ALMI

00:22:16.600 and the FFMI. So the ALMI stands for Appendicular Lean Mass Index. And again, sometimes it's just spit

00:22:23.920 out in the report. But if it's not, you would simply go to the report where it shows you lean mass for

00:22:30.940 left leg, right leg, left arm, right arm. And you add those three up, make sure they're in kilograms.

00:22:37.200 So if they're in pounds, you have to convert them to kilograms, divide by 2.204, and then divide that

00:22:42.420 by your height in meters squared. And if that's given in inches or feet, you have to make the

00:22:46.320 conversion. So, and then you'll get a number, right? It could be eight, nine, 10, if you're a male,

00:22:51.640 five, six, seven, eight, if you're a female. And then there are nomograms that will tell you for your

00:22:57.040 age and for your sex, what percentile you are in. And we want all of our patients to be at or above

00:23:03.260 the 75th percentile for ALMI. And again, it's associative data, but it's very strong associative

00:23:09.660 data, which is look, muscle mass is a great integrator of exercise and strength. So hemoglobin

00:23:18.220 A1C is a metric that is effectively an integral function for glucose. So you get this number,

00:23:25.580 6.5, and it tells you directionally over the last three months, your average blood glucose has been

00:23:31.600 140 milligrams per deciliter. So the hemoglobin A1C integrated the area under the curve and spit

00:23:37.080 out that number. And similarly, that's effectively what VO2 max muscle mass and strength are doing.

00:23:44.000 They are integrators of the work that it takes to have a high VO2 max, to have high muscle mass,

00:23:50.420 to have high strength. And the work that goes into that is the secret sauce. In other words,

00:23:55.880 it's not so much the muscle mass, I think that is the most important thing. It's what you had to do

00:24:01.580 to get said muscle mass and what that muscle mass will then do vis-a-vis metabolic function.

00:24:07.600 And of course, the implication with respect to the functional side of things. So muscle mass and

00:24:12.280 strength are not equivalent. And when put head-to-head, strength beats muscle mass as a predictor of

00:24:19.300 lifespan. But all of these things are important metrics to be tracking. So I think then the rest of

00:24:25.860 the conversation will kind of focus on the actual training piece of it, right? So that was the bulk

00:24:30.940 of questions that we received, which is how much should I be training? How much in the different

00:24:37.040 pillars? How do you best train zone two? How often? How many times a week? VO2 max. So I think we'll kind

00:24:43.620 of now start getting into those pieces. But I think what would be helpful is we also received a lot of

00:24:49.480 questions from people who are like, hey, I play basketball four times a week. Hey, I play tennis.

00:24:54.160 I play golf. Hey, I do marathons. I maybe just go to the gym and I lift. Is that okay? Or how

00:25:02.780 important is it to actually be really specific to train for this and to hit all of those pillars?

00:25:09.920 Well, again, I think it depends on your objective. So everything has to be compared to the alternative.

00:25:15.660 So if a person says, look, I'm playing tennis twice a week, I'm playing basketball twice a week,

00:25:20.160 and I'm lifting weights once a week. Am I doing great? The answer is, yeah, you are doing great

00:25:26.100 relative to most people. But I don't think that that's a recipe for success if you want to be in

00:25:34.580 the best shape possible in your last decade. And the reason being is sports like any sport, whether it

00:25:41.900 be basketball, tennis, swimming, any particular sport has so much repetitive stress in it that

00:25:50.580 you're going to develop movement issues. You're going to have asymmetries in joints and muscles,

00:25:56.260 and you want to kind of balance those things out as much as possible. So again, if you want to be

00:26:01.500 able to play golf every week and you're going to walk five miles, that's great. But you have to

00:26:07.160 acknowledge every time you're swinging that club, it's asymmetric. So you have to think about what

00:26:11.460 am I doing to counteract that? Same with tennis, same with basketball. And so again, it just depends

00:26:17.440 on how much time a person is willing to put into this. I don't want to suggest that everybody needs

00:26:21.980 to do this because I acknowledge it's really difficult. If it wasn't difficult, everybody

00:26:25.500 would be doing it already. By definition, this is really a complicated idea. And maybe I just have

00:26:32.800 the privilege of two things, right? One, I got to experience my marginal decade in my 20s, right?

00:26:39.300 I had that back injury when I was 28 that left me unable to walk for three months. And in so much

00:26:46.580 pain, I didn't know my name for a year. And during that period of time, I would have given my life to

00:26:53.480 have had everything back. So when I got it back, it's just, it's seared into my brain what it feels like

00:27:00.540 to be so immobile, so debilitated, and in so much pain. And I think that's just the greatest gift I

00:27:07.440 ever received was to have that time machine to basically go and experience the last decade of

00:27:13.200 my life and then get zapped back to being 28 with a totally different mindset of, yeah, I never want

00:27:19.880 that to happen again. And at least I'll do everything in my power to make sure it doesn't.

00:27:23.560 So long answer to a short question, but the reality of it is you really do need to be training very

00:27:29.020 specifically. And that means a lot of really silly looking, unsexy things that I do every day,

00:27:36.000 sometimes as little as 10 minutes a day, sometimes as much as an hour a day, just on the stability

00:27:40.420 stuff, just on the movement piece. But I wouldn't trade it for anything because the way my body feels,

00:27:45.640 I'm thanked for it. So now let's talk about, so if someone's listening, they're like, okay,

00:27:50.520 I want to train for this and I'm willing to put in the work to the four pillars. So the strength,

00:27:55.340 stability, zone two VO2 max, just to keep it simple, what's the minimum effective dose where

00:28:02.200 it's, okay, how much per week does someone need to commit to be able to hit those four things?

00:28:08.960 And then we can get into each of them in a little more detail, but just from a minimum effective

00:28:14.340 dose, if they have kids, busy job, families don't have a ton of time, what should they strive to set

00:28:21.320 out for? Well, it depends where you're starting, right? So the minimum effective dose, if you're

00:28:25.120 doing nothing is not that much, you're going to get huge benefits when you go from nothing to

00:28:31.720 probably three hours a week, that would be an enormous improvement. So I don't know if that's

00:28:38.960 the right way to think about it. Well, let's, maybe let's just start there. So let's say someone

00:28:42.460 starts at nothing. So you're saying, okay, start at three hours a week. How are you breaking that out?

00:28:48.120 Well, if you only had three hours a week to commit to this, you know, I think you'd have to

00:28:53.620 put probably an hour of that into steady state aerobic training zone two. I think you'd have to put

00:29:01.440 an hour of that into strength training. I think you'd probably want to put 20 minutes of that or 30

00:29:07.080 minutes of that across one or two sessions into high intensity aerobic training. So not hit intervals

00:29:15.200 by the way, but you know, sort of the longer intervals that are VO2 max appropriate. And

00:29:20.720 then the remainder of that time, call it another, you know, 30 or 40 minutes spread out at 10 minutes

00:29:26.600 a day into some of the stability training. And again, I think it's important to understand

00:29:31.280 if you say, look, I'm only willing to devote 60 minutes a week to this stability stuff, which seems

00:29:37.200 so boring. Should I just blast it out in one, one hour session? The answer is no, you're better

00:29:42.740 off doing 10 minutes a day, six days a week. There's really something to the neurologic pattern

00:29:47.800 that comes from practicing your IAP, practicing your breathing, your saccapular cars, your cat-cow

00:29:54.560 exercises. Doing that for 10 minutes every day is better off than just trying to do it all in one

00:29:59.780 shot. So anyway, that's probably how I would structure a three-hour program.

00:30:03.620 And for the, on the stability side, you kind of mentioned a few exercises there. And actually

00:30:09.420 what you and Beth did is we recorded those videos of you in the gym. And so those are available

00:30:14.720 peteratiamd.com slash outlive slash videos. And so anyone who wants to learn more about,

00:30:22.100 okay, what are those stability exercises that I could do 10 minutes a day, real short, real simple

00:30:27.260 videos, you can go check them out. So we won't spend time double clicking on those because as you've

00:30:32.900 stated before, it's, you really have to see it to understand it as opposed to just hearing about

00:30:36.980 it. And so let's say then someone is like, okay, I'll start with three hours a week. How often do

00:30:45.240 you ratchet that up? Does that get increased every week? Does it get increased every month? Is it when

00:30:50.620 certain milestones are hit? Well, it depends what the limiting factor is. So usually when a person

00:30:56.200 starts at three hours per week, it's because that's the only time they're willing to put into it.

00:31:00.280 And conversely, if a person's never lifted a finger and they say, oh my God, like I'm willing

00:31:06.000 to do whatever it takes. And they only started three hours a week because you don't want to injure

00:31:10.600 them. Then you're in that situation where how much can you ratchet it up? And I'd probably ratchet a

00:31:14.840 person up every six weeks in a scenario like that. But I think the far more typical scenario is,

00:31:21.160 okay, I'm willing to do three hours. I do three hours a week. Usually a person sort of starts to

00:31:27.400 habituate to that stress. And one of the important principles of training is a principle that most

00:31:32.900 people have heard of called progressive overload. So in one way or another, the training, the load,

00:31:39.340 the ask needs to get more complicated, needs to get more difficult. So if you're talking about

00:31:44.280 strength training, that could mean heavier weight. That could mean more reps, more sets, less rest

00:31:51.080 between other things that make it more complicated, such as using BFR. So we're always looking for ways

00:31:57.500 to make this more demanding. For example, in my stage now, I'm not adding time anymore.

00:32:03.020 I am at the limits of how much I'm willing to spend on this. My kids are young. Every minute I'm doing

00:32:09.220 that, I'm not spending time with them or I'm not working or, you know, I'm just falling behind in

00:32:14.120 some other area of my life. So, you know, I'm already spending about as much time as I'm willing to

00:32:18.220 spend in the gym. And it's probably on the strength side, six hours a week. So I have to find other

00:32:23.100 ways to add that demand. The other thing I would be doing is thinking about where the deficits are.

00:32:29.840 So let's say you have that person that's at three hours per week. Maybe their ALMI is already at the

00:32:35.380 70th percentile and they're actually reasonably strong, but their aerobic training is an atrocity.

00:32:40.760 So then I'm going to disproportionately add to that as opposed to just equally build all of them.

00:32:47.280 But conversely, you know, we have a patient in our practice upon entering the practice. I mean,

00:32:51.940 this guy's VO2 max was probably above 60 and he is 60, but he's been a lifelong runner,

00:32:57.040 but he never touched a weight in his life. So he has, you know, very little muscle mass.

00:33:01.420 And this is a guy who we're actually saying, look, we're probably going to need you to run a little

00:33:05.520 bit less. And your running is amazing. And you're very fortunate that you haven't been injured doing

00:33:10.420 it. We want you to keep running as long as you can, but we also have to address some of these

00:33:14.740 other issues. Cause you do have some of the really common issues of runners, some of the very common

00:33:19.960 imbalances and things like that. So in his case, it was like, can we subtract a little bit of running

00:33:25.180 time and start to get you doing strength training? So people almost need to take just an inventory of

00:33:31.320 what they're doing and where their strengths are. And that's where it's good to know. Where is your VO2

00:33:36.280 max? How does your DEXA scan look? Can you farm or carry what percent of your weight? And if it's high

00:33:42.160 and that piece is good, it's like, okay, keep training that, but then fill in those deficits.

00:33:47.540 You know, so we kind of hinted that the three hours per week really is for the people who are

00:33:51.540 time limited. What about different ages? Because we did get a lot of questions of, you know, I'm older.

00:33:58.860 Is it too late for me to start training for this? And if the answer is no, how should I think about

00:34:06.320 that? Because I'm not as young. I can't quite bounce back. I'm not as strong as when I'm younger.

00:34:11.440 They might be coming into this with not as much strength. And so when you have a patient like

00:34:17.240 that, do you think about how they should tackle this differently? Are they on kind of a different

00:34:24.240 program than if someone was 30? Kind of, how do you think about that from an age perspective?

00:34:28.880 Everybody's different and age is definitely one of the factors that, you know, calls for

00:34:32.820 sort of nuance around programming. I'll say this, and I think I've talked about this on a previous

00:34:37.580 podcast. I don't recall which one. There was a study that was done in Australia. I think we

00:34:42.680 talked about on one of our podcasts, actually, where an investigator took a group of women with

00:34:47.360 osteopenia or osteoporosis. So these women had very low bone density. They'd never exercised in 0.99

00:34:52.620 their life. They were, if I'm not mistaken, no one was younger than in their mid sixties. They were

00:34:57.600 probably, you know, in their seventies. And these women were put on a pumping iron regimen. I mean, 1.00

00:35:04.280 literally like old school in a gym, picking up weights, walking around. This wasn't like some

00:35:10.300 fancy posh Pilates class. This was pickup weights. And I think by the end of this study, one of the

00:35:17.880 women may even got to the point where she was deadlifting her body weight. Imagine that 120 1.00

00:35:22.160 pound woman picking up 120 pounds off the ground. While that was a great example, because it was 1.00

00:35:27.900 documented in a clinical trial. There are so many stories of these things that you just see that

00:35:32.680 I just have to believe that people are far more resilient than they can imagine. And, you know,

00:35:38.200 I write about one example of this in the case of Barry. Barry is someone who gets mentioned in,

00:35:43.440 I think it's in the stability chapter, actually. Here's a guy who traded his health for wealth,

00:35:49.000 which is a pretty standard refrain, and then retired and had all the money in the world and

00:35:53.800 realized, wait a minute, like I can't do anything. My body hurts so much. And if you look at Barry today,

00:36:00.040 I mean, the guy's functioning better than he was 20 years ago. So I think it really just comes down

00:36:05.960 to being consistent and having a real sense of purpose around this stuff. And obviously you have

00:36:10.420 to be smart about it. I mean, you can injure yourself in the process of these things. So

00:36:14.400 having someone who knows how to kind of guide that and using common sense is essential. But I would

00:36:19.580 never want anybody to come away from this thinking I'm too old to do anything about it. I think as long

00:36:24.520 as you're breathing, you have a chance to do something about it. On that front, you kind of

00:36:29.220 mentioned osteopenia, osteoporosis. We did get a lot of other questions too, outside of age, which is,

00:36:35.520 is there anything female specific that they should be thinking about as it relates to centenary

00:36:40.020 decathlon? And I know DEXA scan, in addition to the muscle, it can also give bone mineral density,

00:36:45.140 which is very important as we age. So maybe do you want to talk a second about BMD and then also

00:36:51.760 why that's something that maybe female specifically should be paying attention to thinking about, 1.00

00:36:56.800 and then ultimately how that leads to how they should be training.

00:37:01.160 Bone mineral density is very important for both sexes, but women are at a greater risk. And the

00:37:08.100 reason for that is the way bones work, and I'm oversimplifying a little bit, but bones effectively

00:37:13.700 have strain gauges in them and they respond to tensile stress. So when a muscle,

00:37:21.760 is contracting, the muscle via the tendon is attached to the bone, and as the muscle contracts,

00:37:29.080 the bone is compressing. So imagine a strain gauge inside the bone that senses that. That's a

00:37:36.160 mechanical signal. That gets converted into a chemical signal, so mechanical to chemical via estrogen.

00:37:43.900 Estrogen is the hormone that does the signal transduction, and that tells osteoblasts and

00:37:51.360 osteoclasts, which are the bone-building, bone-reabsorbing cells to make the bone stronger, not weaker. So in other

00:37:58.220 words, the use it or lose it philosophy is at play here, and estrogen is the key link. Now, men and women

00:38:06.460 have estrogen, and it's very important for both sexes. The difference is women lose estrogen precipitously 0.97

00:38:14.000 in midlife, and therefore women are more at risk for osteopenia and osteoporosis.

00:38:20.860 Now, for men and women alike, it's very difficult to add bone density after you reach the critical

00:38:28.000 period of maturation, typically in the early 20s. So unfortunately, most of our audience is past that

00:38:35.460 point. I'm not sitting here having a discussion with teenagers, but of course, if I am, the answer is

00:38:40.640 load-bearing, load-bearing, load-bearing. Reach your genetic potential while you have a chance.

00:38:46.280 But for those of us who are past that point, the key is how much can you slow the rate of decline?

00:38:51.600 And nothing is more important for that than load-bearing activity. And in fact, it needs to be

00:38:56.840 heavy load-bearing activity. Walking does not count as load-bearing activity. Running, certainly better

00:39:02.260 than swimming or cycling where you're not bearing load, but none of those compare to strength training.

00:39:07.180 So strength training is really the most important piece of maintaining bone mineral density. And it

00:39:15.040 must be supported from an endocrine perspective with the appropriate amount of estrogen and

00:39:19.740 potentially testosterone, and certainly with the correct nutrition and supplementation, such as

00:39:24.580 vitamin D and the right amount of protein and things like that. One of the other questions we

00:39:28.840 received is people were saying, hey, like, what if you can't afford a trainer, maybe don't have a gym to

00:39:35.960 go to? How much of this can you do kind of without fancy equipment, maybe with body weight? How do

00:39:43.200 you think about that in terms of as people are wanting to train for this? You can definitely do

00:39:48.340 quite a bit of stuff with body weight, but I would also encourage people to say, like, if I don't have

00:39:52.400 a lot of room, can I at least get some dumbbells and kettlebells? And, you know, they do make these

00:39:56.720 dumbbells. They're not cheap, but they're efficient and they're cheaper than buying all the sets where,

00:40:02.380 as you know, one dumbbell has multiple links in it. So it could be 70 pounds, 60 pounds, 50 pounds,

00:40:09.200 et cetera, depending on where you click it. So I feel like if you're going to think about, okay,

00:40:13.340 what's the most efficient way to do this? I would say you do want to splurge on a few pieces of

00:40:19.440 equipment and certainly heavy enough dumbbells that you can get into carrying would be important.

00:40:26.240 I think resistance bands are also really important. I've had a couple periods in my life where I

00:40:31.940 haven't had access to a gym for, you know, three or four weeks. And during those periods of time,

00:40:37.160 traveling with heavy resistance bands was essential. And if I could have added to that,

00:40:41.860 having some dumbbells makes a big difference. So it's definitely easier if you have access to a gym

00:40:47.260 or you can go to a gym, like a TRX is probably another really great piece of device for people

00:40:52.520 who don't know what that is. That's kind of this strap device that you either hang around

00:40:57.180 a rack or something, or you can even put it behind a door. You just make sure the door is

00:41:01.680 that you're on the right side of the door. So the door can't open and you can do a lot of exercises

00:41:06.380 with that as well. What about injury? So you kind of mentioned there earlier being conscious of if

00:41:14.020 you're starting out just to not get injured, how should people think about this? If they're either

00:41:18.660 coming into it with previous injuries, if they're worried about injury, especially kind of in the

00:41:24.980 older population is, you know, is that where the stability work can be much more effective? Is it

00:41:30.780 if you haven't lifted much weight, start lower and work on positioning and how the movement works or

00:41:37.560 how should people think about the injury piece? You know, this is something where I think you just

00:41:41.280 have to be careful. And I don't think it would be reasonable for me to represent that I can offer an

00:41:45.320 answer that would cover that in a broad way. For example, we did a podcast with Alton Barron

00:41:50.740 looking at injuries of the shoulder, neck, elbow, hand. Was that like a six-hour podcast?

00:41:57.400 It was very long.

00:41:58.520 It was like definitely one of our three longest podcasts up with maybe Tom Dayspring and Matt

00:42:03.220 Walker. And that didn't even really get into the rehabilitation. That just talked about like what's

00:42:08.840 at the root of it. You know, I've certainly done a number of videos with Kyler Brown where we've gone

00:42:13.120 over some of my rehab post-shoulder surgery. So I think the truth of it is you're just,

00:42:18.560 unfortunately, I hate to say this, it sounds like, but you've got to be able to align with people

00:42:22.880 who understand how to not paint by numbers in their approach to rehabilitation. So maybe one

00:42:29.540 way to help screen for that is basically when you meet a practitioner, just spending some time

00:42:35.060 talking to them about their philosophy around your particular injury. For example, before I had my

00:42:39.620 shoulder surgery, I wanted to understand all the details of early versus late mobilization,

00:42:45.260 the trade-off between range of motion and stability. These are trade-offs when you're

00:42:49.480 repairing a joint as flexible as the shoulder. You can make it really stable again if you're

00:42:53.560 willing to give up all range of motion and vice versa. I hate to say it, but I think you just have to

00:42:57.560 become a more involved consumer of your care in that regard. But unfortunately, I just can't offer

00:43:03.680 some blanket piece of advice around injury.

00:43:06.120 But for the most part, even if someone's dealing with an injury, you would highly encourage them to

00:43:11.540 not let them just give up on working out because of that injury.

00:43:16.200 No. I mean, if anything, that should be motivation to get better. I mean, injuries,

00:43:19.780 it depends where you are in your life cycle. But for most people who I think are listening to us

00:43:24.440 right now, if you have a nagging injury and you take the approach of, I'm just going to sort of

00:43:30.840 ignore it and it's not necessarily getting better, you're on a very slippery slope. I know someone very

00:43:37.140 well who's had a shoulder injury for the last six months and it's not getting better. It's clearly

00:43:42.240 not getting better, but more importantly, she's beginning to atrophy around it. She's becoming

00:43:47.120 so weak and her pain is so significant around it that she's altered all of her movement patterns

00:43:53.680 in response to this. You know, she's younger than I am. So I sort of had a heart to heart with her

00:43:58.100 recently and said, what do you think the natural history of this is? Like, do you just think this is

00:44:02.840 magically going to get better when you're 70? No chance. You need to do X, Y, and Z right now.

00:44:09.620 And yeah, that means you're going to have to invest like at least three hours a week in doing

00:44:13.980 this kind of rehab to see if you can get this better without surgery. And maybe it will require

00:44:19.100 surgery. I don't think it will actually in this particular case, but it's the alternative is worse.

00:44:24.860 Let's touch on VO2 max again. So a lot of people reached out and said, how should I train for VO2 max?

00:44:31.120 So if you take away the only three hours a week to do everything, if it's someone saying, okay,

00:44:36.880 my muscle mass is good, but my VO2 max sucks, what program should I get on?

00:44:42.480 So the first thing to remember is you've got to be spending, if you're really committed to

00:44:46.480 developing your cardiorespiratory fitness, you know, I think I talked about this on one of the

00:44:51.040 podcasts, maybe it was on Tim's podcast. You're trying to maximize the area of a triangle.

00:44:55.960 So the triangle has a base and the triangle has a peak. And the goal is how big an area can I get?

00:45:03.720 Not how wide, not how tall. You don't want one that's this wide and this tall, and you don't

00:45:08.640 want one that's this tall and this wide. You want the max. The base is your zone two. The peak is your

00:45:15.420 VO2 max. From a training perspective, the rule of thumb that is applicable for people like us,

00:45:21.960 i.e. normal people, and the best athletes in the world is roughly 80-20. 80% of your volume is down

00:45:30.400 here, 20% of your volume up here. In fact, some of the really, really elites are probably closer to 90-10.

00:45:37.660 So you're saying no matter if you're just an ordinary athlete or you're the best of the best,

00:45:43.140 it's still roughly the same?

00:45:45.120 Tadi Pogacar, who's the greatest cyclist on this planet, two-time winner of the Tour de France,

00:45:50.840 absolutely mopping up the field of cyclists like they're children. That guy's doing 80-90% of his

00:45:58.460 training at zone two. And I know that for a red fact because we know who his coach is.

00:46:03.100 So then let's maybe talk about that pyramid. So maybe let's just step back and say-

00:46:06.200 I didn't answer your question, by the way, about VO2 max, which we can come to.

00:46:08.720 Yeah. So maybe I was just going to say, maybe let's just cover the whole pyramid. So what's the

00:46:12.260 training of the whole pyramid? If you know it's kind of 80%, 20%, let's break out what that looks like.

00:46:16.620 So I just start with how much time am I willing to put into this? Now, I got to be honest with you.

00:46:19.840 I wish I could be putting 10 hours a week into cardio. I mean, historically, I've put in 14 to

00:46:25.480 20 hours a week into cardio up until 10 years ago. So I really miss those days. I miss being insanely

00:46:32.800 fit. I miss that terribly. And I miss the joy of that much training. It's simply not possible today

00:46:39.360 for all of the obligations that I have. And I've done the math 10 ways to Sunday. I'd have to give up

00:46:45.280 something I'm not willing to give up. I've had to give up archery or give up driving or give up

00:46:50.600 my kids or something like that. I'm just, I'm not willing to give any of these things up. So

00:46:53.580 I basically start with what's the most amount of time I can put into dedicated cardio. And for me,

00:46:58.660 it's like four to five hours a week, not including rucking. I sort of keep that in its own bucket.

00:47:02.640 So then it's a very simple calculation. 80% of that time is zone two and 20% of that time is VO2 max.

00:47:11.000 And how are you breaking out? Let's just start with zone two. How many?

00:47:15.080 I divide it into four workouts a week, Tuesday, Thursday, Saturday, Sunday.

00:47:19.340 And do you always recommend doing it over? Like, let's say you could do four hours in one day.

00:47:26.720 Is there the same benefit of doing all your zone two in one day versus spreading it out?

00:47:31.840 You know, I've talked about this with Inigo. His view is if you can get at least 30 to 45 minutes,

00:47:36.720 you should spread them out. Again, if you're only able to commit an hour to it, it might be

00:47:40.940 one hour once or 30 minutes twice, but I'm sort of doing 45 minutes to 60 minutes each time is what I do.

00:47:48.140 Are you doing zone two VO2 max on the same day?

00:47:52.160 One of those days. So Tuesday, Thursday is just zone two, and then two long sessions of

00:48:00.100 stability training. Call it an hour of zone two, an hour of stability. Actually, why don't I just

00:48:05.220 walk you through the whole week? That'll be easier. So Monday is just strength training. So that's about

00:48:10.120 90 minutes to two hours when you include the stability training that I do as well. So movement prep,

00:48:15.100 stability training, strength training, and that's all lower body. That's Monday.

00:48:18.080 Tuesday is zone two followed by dedicated hour of stability. Wednesday is upper body strength and

00:48:27.280 stability. Again, 90 minutes to two hours. Thursday is a repeat of Tuesday. Friday is a repeat of

00:48:34.600 Monday. Saturday is zone two in the morning, upper body strength repeat of Wednesday in the afternoon.

00:48:43.680 Sunday is zone two followed by VO2 max.

00:48:49.560 And will you ever do VO2 max before you do zone two?

00:48:53.440 I generally don't just because I like to have a lot of reps before I go for broke. So even when I was like a

00:49:02.700 cyclist and doing two VO2 max workouts a week, they were always preceded by the metric we would use on a

00:49:10.740 bike was kilojoules. So it was how many kilojoules of work would you do before you would do the super

00:49:15.780 hard sets? And it had to be at least a thousand kilojoules, which would translate to at least a

00:49:20.420 thousand calories of work.

00:49:22.420 For zone two, I know you said you kind of like to break it up. If someone is like, hey, you know,

00:49:27.920 I can do four days a week of zone two, but I can only do 15 minutes a day. Would you say-

00:49:33.620 Then I'd compress it. I would say do two thirties.

00:49:35.920 So in your zone two sessions, you like to do at least 30.

00:49:40.000 At a minimum. Yeah.

00:49:40.960 When you're in those zone twos, are you like when you hit the bike and the clock starts?

00:49:46.000 I do it all mine on a bike, sometimes on a treadmill. But what I do is the computer is

00:49:50.700 programming to the Wahoo kicker, which is the device I'm sitting on. So it's taking 10 minutes

00:49:54.980 to ramp me up.

00:49:56.020 Maybe just walk through what modalities can people do zone two on? Treadmill, bike?

00:50:01.400 Anything that is steady state. So swimming is a great way to do it because you can really swim

00:50:06.120 in a pool at a steady state. Running is a great way to do it because you can pretty much run at

00:50:10.480 a steady state. Cycling outdoors is generally hard unless you have specific, like Fiesta Island was

00:50:17.860 a great place to train. I used to train at Fiesta Island because for people who don't know where that

00:50:21.800 is in San Diego, it's where all the time trial bike races were. And it's just a seven kilometer loop

00:50:27.480 that you can ride on without lights or any, like there's no traffic or anything that gets in your

00:50:32.220 way. But for the most part, I wouldn't be able to do zone two outside here in Austin. It's too hilly

00:50:37.440 and there's too much traffic. It's fits and starts. I can do my VO2 max here because I go to a hill

00:50:43.760 and that's my favorite way to do VO2 max is on a hill that's about a mile long and just do very hard

00:50:50.780 up the hill and then easy down the hill. A treadmill is another great way to do it. Just kind of a

00:50:55.320 walking incline typically. Rowing machine, if you're really a good rower, you have to be efficient

00:51:01.740 enough. Most people are not efficient enough and they don't have the strength. They don't have the

00:51:06.460 stability to row really well for 45 minutes. Stair climber is another really good one. Depends.

00:51:12.980 Again, if you're starting out, brisk walking is probably good enough too. We don't have to get

00:51:17.700 into all the reasons or the benefits of zone two because we have so many podcasts with Inigo,

00:51:23.080 San Milan people can listen to, but you kind of hinted at another thing there, which is

00:51:27.480 when you start your zone two workouts, you'll ramp up. But also a lot of times we get questions where,

00:51:33.340 you know, Hey, I did a 90 minute workout and I was in zone two for 45 minutes of it. Am I good?

00:51:41.080 I think what you mean in that question is, you know, like I went out for a three hour bike ride today.

00:51:45.980 When I got back, my computer told me I was in, I did 44 minutes of zone two. So two issues there. One is

00:51:51.420 that's just a zone two based on heart rate. That's generally the worst approximation of zone two.

00:51:56.160 So zone two really is more based on lactate. If we're going to be purely accurate or at a minimum

00:52:00.740 RPE. But even if you posit that that 45 minutes of zone two from your heart rate is roughly accurate,

00:52:08.560 it's not the same physiologically because usually you're passing in and out of zone two in that

00:52:12.900 situation. And so you're not getting kind of that constant steady state churn, which you're looking

00:52:18.700 for. What we're really kind of looking for is the harnessing of mitochondrial efficiency.

00:52:23.440 And to do that, you have to be able to push oxidative phosphorylation right to its limit

00:52:28.600 before you trip into glycolysis. And you're just at the limit of that glycolysis being the dominant

00:52:36.380 energy source. Whereas if you're on that ride, you're going into and out of glycolysis constantly.

00:52:42.120 So it's not that you're so much in zone two for 45 minutes as that you passed through zone two

00:52:46.520 for a sum total of 45 minutes, which again, there's still value in that, but not for what

00:52:51.740 we're talking about. And what about VO2 max? What modalities can you do VO2 max training on?

00:52:57.880 You know, here, I think it's probably easier in a way, right? Because it's pretty much anything

00:53:01.680 that gets your heart rate up and gets you very tired. So, you know, look, it could be an air bike.

00:53:07.660 It could be a regular bike. It could be a stationary bike, stair climber, treadmill, running outside.

00:53:13.540 You know, the sky's almost the limit. Something like burpees is probably pretty tough once you 1.00

00:53:18.560 get into something that intense, like jumping, because the sweet spot for VO2 max is kind of

00:53:24.800 three to eight minute intervals. So you don't want to be doing things that are so intense that you

00:53:30.120 can't do them for at least three minutes. And so that's why I'd kind of hold off on that stuff.

00:53:34.720 I mean, when I was young and I was really fit, I did a lot of it with jumping, but I can't jump

00:53:40.560 for three minutes anymore. Like I'm not that fit anymore. So I have to rely on easier things.

00:53:45.280 What's your current VO2 max workout? So you mentioned kind of three to eight minutes on,

00:53:49.760 is it?

00:53:50.160 Typically I do four on four off is sort of where I spend most of my time. Sometimes three on three

00:53:55.740 off on a rowing machine. I got into that quite a bit last summer, but these days, and sometimes by

00:54:01.520 the way, I just am in a bit of a rush and I'll just do one minute on two minute off at a much higher

00:54:09.600 intensity on the stair climber. So I have one of those like industrial grade strength climbers.

00:54:15.020 And sometimes I'll just go sprint for a minute up the stairs and then takes me two minutes to get

00:54:20.560 my heart rate back down to about a hundred and then repeat that for 20 to 30 minutes. So that's

00:54:27.060 kind of like my poor man's cheating VO2 max workout. But what I really like to do is four minute repeats,

00:54:33.800 four minutes on, four minutes off.

00:54:35.220 And on the four minutes on, are you going a hundred percent for the full? Like how should

00:54:40.240 someone think about you have to play with this? This is years and years of practice to know what

00:54:45.360 that feels like. So again, I'm doing this on a bike. So I'm looking at wattage and my watts are

00:54:49.980 so low now I'm embarrassed. So I'm not going to tell you what the watts are because there's so much

00:54:53.280 lower than they used to be. But I know I have a sense of what I need to average my wattage over

00:54:59.180 those four minutes. So I might go out at 105% of that wattage and it feels pretty easy for the

00:55:08.420 first minute. If it doesn't, I've gone too hard. By three minutes, I'm very uncomfortable. In that

00:55:15.720 last minute, i.e. at four minutes, I don't have much left. You know, if you go out all out in that

00:55:21.720 first minute, you're not going to get to four minutes. You're just going to crash and you're

00:55:24.940 sort of not in that zone. There's no question I positive split the thing, meaning I do more work

00:55:30.200 in the first half than the second, but I don't want it to be more than about 10%. How much of this

00:55:34.320 can it improve for people, right? So if people are saying, okay, I'm willing to put in the work

00:55:38.840 for zone two, I'm willing to put in the work to increase my VO2 max. Is this something if it's been

00:55:44.840 two weeks, a month, two months, and they're not seeing maybe huge increases, like they should get

00:55:51.280 discouraged? I mean, I don't think you're going to get in your VO2 max tested every three months,

00:55:56.020 you know? So it's, how should people think about just monitoring progress in order to see if

00:56:00.960 improvements are happening just to keep people motivated? Well, again, it depends on what

00:56:05.160 modality you're using, but yeah, I don't think you need to test your VO2 max more than once a year.

00:56:09.840 What you're looking for is you pick a modality and I'll give you an answer.

00:56:14.120 So let's take bike.

00:56:16.020 Okay. So again, most stationary bikes have a power meter. If you're riding outdoors,

00:56:21.380 you'd probably want to have a power meter. I do think it's the great equalizer. So speed can be

00:56:25.240 misleading because of wind and stuff like that. So you'll know how much wattage you can do. So when

00:56:30.840 you start out, you might only be able to put out 150 watts for the four minutes. But if in six months

00:56:38.820 you're putting out 175 watts for those four minutes, assuming that your weight has an increased

00:56:45.280 significantly, your VO2 max has gone up. Again, the other thing to keep in mind with VO2 max is

00:56:50.520 weight plays an important role in it because it is VO2 max in liters per minute divided by your weight

00:56:57.400 in kilograms. So if the name of the game for you is how do I maximize my VO2 max in total absolute

00:57:05.080 terms, you can really game the system. My VO2 max when I was cycling was high because I was very light

00:57:11.460 and I was disproportionately light in my upper body and your upper body is contributing nothing to

00:57:17.720 the VO2 max for most tests because it's basically tested on a bike or on a treadmill. So you get

00:57:25.380 punished for any upper body mass and you're only rewarded for lower body mass. So the lighter your

00:57:31.180 upper body is, the better you are. It can also be good motivation to people who, let's say on the

00:57:37.880 two-by-two nutrition framework, if you maybe are overnourished and you do lose weight while you're

00:57:43.180 starting to get the cardio, you can see a good jump in your VO2 max if you're losing excess weight.

00:57:48.820 Yeah, it just comes down to how long you're willing to put into this. The literature on this suggests

00:57:52.120 you can only improve your VO2 max by 50%, but the literature is typically looking at eight-week

00:57:57.860 studies. So what we're interested in is a lifetime of training. And in a lifetime of training,

00:58:03.540 you can increase your VO2 max by 50%. So there is a strong genetic component to it. You know,

00:58:08.360 when you see these people who have freakishly high VO2 maxes in the eighties, there's unquestionably

00:58:13.760 a strong genetic component to that, but they're also training like crazy.

00:58:17.580 Well, and you kind of hinted, right? Which is the goal for people who are wanting to start training for

00:58:23.040 the centenarian decathlon for them is thinking about it based on their lifetime horizon. It's not

00:58:29.360 something that's going to play out as I can train for this for six months. Like, it's not like I'm

00:58:34.180 going to train for a marathon after I train for the marathon, I'm going to go back to doing what I

00:58:37.860 was doing. It's, you really do want to create a program that you can keep up with for years and

00:58:43.700 decades. And also you keep that timeline perspective of, okay, I don't need to increase in a sane amount

00:58:50.860 because what I want to do is not get injured, be able to do something that I can do, find enjoyment

00:58:56.480 out of it and find value. Well, that kind of took us that time. This was a little bit of a shorter AMA

00:59:04.020 for us. We also just kind of speed around those questions, but hopefully people found some value out of

00:59:10.380 it and just kind of to build off what they learned. But any last piece of advice that you would want to give

00:59:16.300 people as they think about centenary decathlon, as I think about their longevity journey, again, kind of

00:59:21.900 assuming people read the book, you know, what advice would you give them? Advice, maybe not, but

00:59:27.820 certainly incentive would be the following. We talk so much about the benefits of exercise in terms of

00:59:33.860 how much it reduces the risk of chronic disease, how much it reduces all cause mortality. You've probably

00:59:39.460 heard me say this before, but it's worth repeating. If I knew that all this training I was doing,

00:59:44.560 everything I'm doing, if I knew that it was going to shorten my life by a year, I would still do it

00:59:49.900 purely for the improvement in quality of life between now and the end of my life. The fact that

00:59:57.600 it's not shortening my life by a year, the fact that it's probably adding five to seven years to my

01:00:02.560 life and improving the quality of my life means day in and day out. I just think it's about the most

01:00:12.320 important thing that I can do vis-a-vis my physical health. There's other elements of health that we

01:00:17.940 didn't get to. That would be sort of my parting thought. And of course, my parting comment would

01:00:22.300 be a thanks to everyone who's listening to this. Because by definition, if you're listening to this,

01:00:26.780 you were an early purchaser of Outlive. So I really want to thank you for that. It means a lot to me.

01:00:33.760 I think I mentioned this once before on our podcast, but it's probably worth repeating.

01:00:38.380 I never thought that a book would mean as much as it has in terms of how personal it feels and how

01:00:46.640 attached to the thing that I feel as it's out there. And there's no other piece of content I've

01:00:52.700 ever created. There's no blog post I ever felt this attached to or newsletter or podcast. There's

01:00:59.160 just nothing. And this feels oddly personal. And therefore, whenever I go somewhere and I run into

01:01:05.540 someone and they send me a message about it and they say, hey, I got your book. I read it. I really

01:01:09.080 liked it. It means more to me than I thought I would. I'm sorry that I can't be thanking each and

01:01:13.220 every one of you in person for purchasing the book as early as you did. Hopefully, this is the next

01:01:17.960 best thing. And so thank you very much. And I should say, too, the one thing I forgot to mention

01:01:22.960 earlier is for anyone who has a physical copy of the book, if you haven't popped the jacket cover

01:01:28.300 off yet and seen the actual cover, there is something on the actual cover to itself that

01:01:33.960 was a special design. And again, shout out to... No one's mentioned that yet.

01:01:38.060 Not a lot. We got in a few, but again, Rodrigo Corral and that whole crew, just awesome. Not

01:01:45.000 only on the jacket cover, but the physical... What's that called? The board? What are they

01:01:50.180 called? The hard cover of the thing? There's a name for that and I forgot. I just call it the book.

01:01:54.500 The book. It's a different question, but it's a little Easter egg out there for people, but

01:01:57.500 awesome. All right, Peter. Thank you very much. Thank you very much.

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The Peter Attia Drive - July 10, 2023

#261 ‒ Training for The Centenarian Decathlon： zone 2, VO2 max, stability, and strength ｜ Peter Attia, M.D.

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