#285 - AMA #55： Exercise： longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more
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Summary
In episode 55 of the Ask Me Anything podcast, Dr. Nick Stenson joins Dr. Atia to discuss the importance of having a goal in your training and why you should focus on the centenarian decathlon.
Transcript
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hey everyone welcome to a sneak peek ask me anything or ama episode of the drive podcast
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i'm your host peter atia at the end of this short episode i'll explain how you can access
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the ama episodes in full along with a ton of other membership benefits we've created
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or you can learn more now by going to peter atia md.com forward slash subscribe so without
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further delay here's today's sneak peek of the ask me anything episode
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welcome to ask me anything episode number 55 i'm once again joined by my colleague nick stenson
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given that it is now officially the new year today's ama is focused all around exercise this
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is a topic we speak about a lot and it's not only because of how important it is but also because
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of how many questions we see come through from our audience around it and the majority of these
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questions revolve in one way or another around how someone can improve their cardiorespiratory fitness
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increase their muscle mass increase their strength or all of the above as such in today's ama we cover
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the importance of having a goal in your training and why for myself and a lot of my patients it's
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training for the centenarian decathlon that provides the structure how can we help identify
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the pillars of exercise where people are most efficient and from there how can people use
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periodization training to not only make the most improvements in those areas but also create some
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variety in training through this we look at case studies of different phenotypes and what a typical
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workout might look like for different types of people for example those who come to exercise
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with a strong background in one area but not in another or people who show up without any exercise
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training at all we then focus on how stress can impact training and by that i mean emotional stress
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and this is something i think we can all relate to that we go through periods of our life when we're
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under great emotional stress and the question is how should that factor into the decisions we make
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around training if you're a subscriber and want to watch the full video of this podcast you can find
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it on the show notes page if you're not a subscriber you can watch a sneak peek of the video on our
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youtube page so without further delay i hope you enjoy ama number 55
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beer welcome to another ama how you doing very well i think we're gonna get right into it because we got
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kind of a big one today so with it being the new year we know a lot of people are gonna start to
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either take their exercise more seriously start to exercise thinking of switching up their exercise
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routines and we see so many questions around exercise come through we thought this would be a
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good time to make it kind of an all exercise ama and some of the questions we see from people are
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they're wondering how to improve their cardiorespiratory fitness how to increase their muscle mass their
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strength oftentimes how to do both and so we pulled questions that are going to look at how you solve
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these problems with clients in your practice and this includes first really identifying and clearly
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defining what the goal of training is because as you often talk about if you don't clearly identify
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the goal you don't really know what to do and then from there helping people understand how they can
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identify the area in their life that they need the most help in when it comes to exercise and then we'll
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start to get into more tactical questions on how people can use periodization training how they can make
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improvements in areas that are most needed and we're even going to look at some case studies of what
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a different weekly workout could look like for a few different types of people from there we're then
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going to step back and also look at some training questions that apply to everyone no matter what
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level of expertise they're at this includes how stress can impact a workout and also how people should
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look at wearables and the data from wearables as it relates to making decisions on training so we got
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a lot so with all that said anything you want to add before we get into it no i like your ambition man
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we'll see what we can do i think we first need to start a reminder before people on how you look at
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training and the goal of training because for you you're not training to run a marathon be a power lifter
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instead you're training for something else and you've talked about this before but i think it is
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important to just kind of lay that foundation for people so they know why you're making the
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recommendations why you're doing what you're doing so do you want to remind people quickly what the
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centenarian decathlon is and why you use that as your training goal yeah as you said a second ago i am
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no longer an athlete i don't train for anything specifically in fact very recently you know how your phone
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will pop up pictures of something that occurred like this time five years ago or whatever well
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it popped up a picture of me from 2014 and it was after a training session this is back when i lived
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in san diego you remember where fiesta island is nick oh yeah awesome so fiesta island is where we used
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to train for the time trials and it was a picture of me and meb after a training session so meb was
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running i was riding i look at the picture there i'm in my kit arm around meb and it's like he probably
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weighs 138 pounds i weigh like 168 pounds 25 pounds or whatever less than i am today and there's just no
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comparison to what i was then versus what i am today i trained three times more than i train today in
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volume and it was very specific and i've talked about this but again i think it's worth reiterating
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when i stopped competing when i was done with cycling done with swimming done with being competitive
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at some level i needed to find another goal because of what you said in the intro which is
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it's very difficult to train without a purpose i talk about this in the book but i really had an
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epiphany in the summer of 2018 so i kind of had an aimless three years where i was exercising and i
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was reasonably fit there was no purpose it wasn't anchored to anything this all came in a flash of
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inspiration as i was sitting at the funeral of the parent of a close friend of mine realizing that
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in the last decade of this person's life who had died they were largely debilitated physically and that
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was tragic to me because i had seen them be healthy in their 60s and 70s so that's what gave me this idea
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of we need a goal and we need to treat life just as we would treat an athletic event and this idea of
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a centenarian decathlon came to my mind in part because decathletes are generally regarded as the
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best overall athletes despite not being the best in any one of the 10 things that they do now of course
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centenarian decathlon is not an actual event maybe some people will do decathlons when they're
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centenarians but even becoming a centenarian is not necessarily the objective we don't have
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that much control over how we stretch our genes that said what i imagine is in the last decade of
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my life what do i want to be able to do and how do i begin to train for that now and when you take
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that look at the future and you say look these are the things i want to be able to do you can apply
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metrics to those activities you can say hey if i want to be able to hike on uneven surfaces to the
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tune of two mile round trip in an hour that requires this much cardiorespiratory fitness this much
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strength this much balance and i know how much each of those things will decline over the next decades
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so how much stronger do i need to be at 50 than i would expect to be at 85 or 90. there's a figure i
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pulled here if you could pull it up nick i think it's a bit of a messy figure and the message is
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very clear perfect this is a figure that shows on the left it shows women and on the right it shows
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men the bottom two figures show physical activity level over time so age is always shown on the x-axis
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and the upper figure shows fat free mass in kilograms on the y-axis versus again age on the x-axis
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so fat free mass of course is a very good proxy for lean mass or muscle mass and you can see that
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these have data collected all the way from when people are teenagers up until the end of life and
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again you don't really have to be a statistician to see the remarkable trends here so there's some
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obvious differences between men and women the most notable one of just the difference in lean mass
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men have significantly more lean mass than women but if you put that aside you'll realize two things
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the first is that we have a steady increase in muscle mass and lean mass both for men and women
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that occurs from birth right up until about the age of 25 and then you have a relatively minor decline
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in lean mass from 25 to 75 but then what happens at 75 nick yeah it's off a cliff it literally falls
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off a cliff now we do the same exercise for physical activity exercise no pun intended meaning you do the
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same visual exercise you watch that from the ages of 25 to 75 physical activity level is even more
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consistent and conserved than lean mass in both men and women and yet what happens at the age of 75
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for both men and women yeah same thing it just falls off a cliff now of course this figure cannot give us
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causality i can't look at this figure and tell you that the reason physical activity level falls off a
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cliff at 75 is because muscle mass does the same nor can i tell you that muscle mass is declining because
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physical activity goes down but it's hard for me to imagine that what's happening here is not
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bi-directional in other words i suspect that what's happening is that at 75 or thereabouts for the average person
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activity declines and as activity declines muscle mass declines and as muscle mass declines activity declines further
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and these things spiral out of control and remember the average life expectancy is about 80 so that
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means that for people who are living to average life expectancy and slightly beyond they're basically
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going to spend the last five to ten years of their life in a very poor physical state and if there's
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anything that i hope people take away from the stuff that we've been talking about it's that you must focus
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on health span at least as much as you focus on lifespan and if there's an enormous failure in medicine 2.0
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it's the myopic focus on lifespan at the complete exclusion of health span with that rant sort of
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over therein lies the why it really doesn't matter what your athletic background is maybe you were a stud
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athlete growing up maybe you've never played a sport in your life and you've never done so much as run a
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local 5k doesn't matter everyone needs to be an athlete for life and therefore everyone needs to think
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about becoming the best version of their centenarian decathlete remind me what was the furthest you've ever
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swam furthest in one shot i've ever swam is about 28 miles so looking back at that picture of you and meb
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would you say you were the better athlete and had more athletic achievements than meb or do you think
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meb having won the boston marathon having won the new york marathon probably the most decorated american marathoner i'm gonna
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you did bike around fiesta island a lot though so you have that going for you i was probably a better
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swimmer than meb maybe i can take that i'm sure if you put meb on a bike he would have ridden circles
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around me oh yeah dude's just a machine so with that said i think then we also need to quickly remind
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people of what you call the four pillars of exercise which is if you agree that this is what you're going
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to train for which is ultimately life and life as you age and being able to do what you want to do and
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sometimes people i think can get lost in the very specifics of like okay i need to be able to do
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exactly this or exactly this but even stepping back for most people just acknowledging if i'm going to
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focus on when i'm 80 90 i want to be able to move freely take care of myself just the large things that
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can sometimes give people the goal they need and so with that said do you want to quickly remind
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people on what those four pillars of exercise are that anyone who has that goal is going to need to
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have all four yeah i just want to make sure people understand for the centenarian decathlon we're really
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thinking about things that are activities of daily living and activities of leisure and pleasure and
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sport and beyond activities of daily living so we kind of encourage people in our practice to go
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through this exercise and make sure they have both of those in there now to your point i think
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broadly speaking the way internally we talk about this is four pillars and this is the way i wrote about
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it in the book so it's two cardio pillars and two strengthy pillars cardio pillars are zone two
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efficiency so this is aerobic efficiency or maximum aerobic efficiency and then peak aerobic output so
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that's measured by vo2 max whereas aerobic efficiency is measured by zone two output and then on the other
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side we have strength and within strength there's a lot so we'll go into some more detail about what
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that means because strength involves both muscle quality and motor control and you have eccentric strength
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and you have concentric strength and all those things and then you have this other idea that wraps
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around strength called stability and of course stability speaks about the safety with which you can apply
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that strength i.e exert force on the outside world and the safety with which the outside world can exert
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force on you and of course inherent within stability are other issues that we think about especially
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things that decline as we age such as mobility balance flexibility looking deeper into those four
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what are people able to track and kind of identify further to know where they're at you know in
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strength there's different aspects of it maybe just touch on what those aspects are so people know how
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they can start to measure in their own life where they're at where they need help there are so many so
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let's take strength as an example within strength we want to think about peak strength so that would be
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kind of maximum strength again to be clear that would be what is your maximum one rep max for
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something we would want to think about muscular endurance so the ability to move something that's
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much lighter but for many many reps it's important to point out by the way that you don't have to train
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at a one rep max to increase your strength and you don't have to actually measure at that level in
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other words you could see how much you could do something for five reps and that would allow you
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to impute or estimate what you could do for one rep and if you're a power lifter who's competing in
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a sport where you have to do that of course that would be insufficient for those of us that are not
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power lifters knowing what we could do for our best five reps is a good enough proxy for then calculating
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what our one rep max would look like we then talk about various things like motor control so again i think
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this is sort of a hybrid of the strength stability piece but i gave the example of hiking over an
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uneven surface you know i just got back from a hunting trip a little while ago and you're walking
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around in the dark carrying heavy stuff on obviously uneven surfaces and that's a much more complicated
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and dynamic situation than riding a stationary bike for example so we want to be able to train in both of
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those ranges you want to be able to train under perfect conditions such as using a machine or
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being on a bike or something like that and then you also want to be able to train on variable surfaces
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and in situations where you have less control and again when we talked about cardiorespiratory fitness
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lots of things that we measure here but again thinking of these in the two extremes which is what is the
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maximum output you can sustain while still exclusively utilizing your aerobic system so
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therefore you're not at all accumulating lactate and again i'm being a little bit sloppy in my
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terminology there and we can maybe clear that up a bit later but basically what's the maximum
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output you can sustain without accumulating net lactate and at the other end of that spectrum
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what is the maximum utilization you have of oxygen which corresponds of course not to your maximum
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output but more importantly your maximum aerobic output again these are very quantifiable and as
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you know these are numbers that we know for all of our patients and i think they're numbers that
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everybody should know for themselves yeah and i think that's a great lead into the next place which is
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you have the cardiorespiratory side you have the strength side a lot of people are going to be
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wondering okay how do i know where exactly i'm at in each of those so i can help identify
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if one or the other needs help or if they both need help maybe walk through how people can understand
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their current state as it relates to those two things thank you for listening to today's sneak peek
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