The Peter Attia Drive - #285 - AMA #55： Exercise： longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more

00:00:00.000 hey everyone welcome to a sneak peek ask me anything or ama episode of the drive podcast

00:00:16.400 i'm your host peter atia at the end of this short episode i'll explain how you can access

00:00:20.840 the ama episodes in full along with a ton of other membership benefits we've created

00:00:25.460 or you can learn more now by going to peter atia md.com forward slash subscribe so without

00:00:31.820 further delay here's today's sneak peek of the ask me anything episode

00:00:35.840 welcome to ask me anything episode number 55 i'm once again joined by my colleague nick stenson

00:00:46.340 given that it is now officially the new year today's ama is focused all around exercise this

00:00:53.400 is a topic we speak about a lot and it's not only because of how important it is but also because

00:00:58.500 of how many questions we see come through from our audience around it and the majority of these

00:01:03.440 questions revolve in one way or another around how someone can improve their cardiorespiratory fitness

00:01:09.220 increase their muscle mass increase their strength or all of the above as such in today's ama we cover

00:01:15.800 the importance of having a goal in your training and why for myself and a lot of my patients it's

00:01:21.660 training for the centenarian decathlon that provides the structure how can we help identify

00:01:27.340 the pillars of exercise where people are most efficient and from there how can people use

00:01:32.460 periodization training to not only make the most improvements in those areas but also create some

00:01:38.720 variety in training through this we look at case studies of different phenotypes and what a typical

00:01:44.940 workout might look like for different types of people for example those who come to exercise

00:01:50.780 with a strong background in one area but not in another or people who show up without any exercise

00:01:56.240 training at all we then focus on how stress can impact training and by that i mean emotional stress

00:02:02.880 and this is something i think we can all relate to that we go through periods of our life when we're

00:02:07.000 under great emotional stress and the question is how should that factor into the decisions we make

00:02:11.880 around training if you're a subscriber and want to watch the full video of this podcast you can find

00:02:16.700 it on the show notes page if you're not a subscriber you can watch a sneak peek of the video on our

00:02:21.880 youtube page so without further delay i hope you enjoy ama number 55

00:02:26.540 beer welcome to another ama how you doing very well i think we're gonna get right into it because we got

00:02:38.600 kind of a big one today so with it being the new year we know a lot of people are gonna start to

00:02:45.460 either take their exercise more seriously start to exercise thinking of switching up their exercise

00:02:49.720 routines and we see so many questions around exercise come through we thought this would be a

00:02:55.020 good time to make it kind of an all exercise ama and some of the questions we see from people are

00:03:01.500 they're wondering how to improve their cardiorespiratory fitness how to increase their muscle mass their

00:03:07.620 strength oftentimes how to do both and so we pulled questions that are going to look at how you solve

00:03:13.760 these problems with clients in your practice and this includes first really identifying and clearly

00:03:20.220 defining what the goal of training is because as you often talk about if you don't clearly identify

00:03:26.020 the goal you don't really know what to do and then from there helping people understand how they can

00:03:31.720 identify the area in their life that they need the most help in when it comes to exercise and then we'll

00:03:37.440 start to get into more tactical questions on how people can use periodization training how they can make

00:03:43.380 improvements in areas that are most needed and we're even going to look at some case studies of what

00:03:47.920 a different weekly workout could look like for a few different types of people from there we're then

00:03:53.640 going to step back and also look at some training questions that apply to everyone no matter what

00:03:59.180 level of expertise they're at this includes how stress can impact a workout and also how people should

00:04:05.180 look at wearables and the data from wearables as it relates to making decisions on training so we got

00:04:12.520 a lot so with all that said anything you want to add before we get into it no i like your ambition man

00:04:18.720 we'll see what we can do i think we first need to start a reminder before people on how you look at

00:04:26.440 training and the goal of training because for you you're not training to run a marathon be a power lifter

00:04:32.420 instead you're training for something else and you've talked about this before but i think it is

00:04:36.540 important to just kind of lay that foundation for people so they know why you're making the

00:04:41.860 recommendations why you're doing what you're doing so do you want to remind people quickly what the

00:04:47.140 centenarian decathlon is and why you use that as your training goal yeah as you said a second ago i am

00:04:55.100 no longer an athlete i don't train for anything specifically in fact very recently you know how your phone

00:05:01.500 will pop up pictures of something that occurred like this time five years ago or whatever well

00:05:06.700 it popped up a picture of me from 2014 and it was after a training session this is back when i lived

00:05:13.420 in san diego you remember where fiesta island is nick oh yeah awesome so fiesta island is where we used

00:05:18.940 to train for the time trials and it was a picture of me and meb after a training session so meb was

00:05:26.260 running i was riding i look at the picture there i'm in my kit arm around meb and it's like he probably

00:05:33.260 weighs 138 pounds i weigh like 168 pounds 25 pounds or whatever less than i am today and there's just no

00:05:42.500 comparison to what i was then versus what i am today i trained three times more than i train today in

00:05:50.520 volume and it was very specific and i've talked about this but again i think it's worth reiterating

00:05:55.140 when i stopped competing when i was done with cycling done with swimming done with being competitive

00:06:01.440 at some level i needed to find another goal because of what you said in the intro which is

00:06:08.680 it's very difficult to train without a purpose i talk about this in the book but i really had an

00:06:15.200 epiphany in the summer of 2018 so i kind of had an aimless three years where i was exercising and i

00:06:22.080 was reasonably fit there was no purpose it wasn't anchored to anything this all came in a flash of

00:06:28.880 inspiration as i was sitting at the funeral of the parent of a close friend of mine realizing that

00:06:35.200 in the last decade of this person's life who had died they were largely debilitated physically and that

00:06:42.120 was tragic to me because i had seen them be healthy in their 60s and 70s so that's what gave me this idea

00:06:49.760 of we need a goal and we need to treat life just as we would treat an athletic event and this idea of

00:06:57.520 a centenarian decathlon came to my mind in part because decathletes are generally regarded as the

00:07:04.320 best overall athletes despite not being the best in any one of the 10 things that they do now of course

00:07:11.600 centenarian decathlon is not an actual event maybe some people will do decathlons when they're

00:07:16.960 centenarians but even becoming a centenarian is not necessarily the objective we don't have

00:07:21.520 that much control over how we stretch our genes that said what i imagine is in the last decade of

00:07:27.760 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

00:07:35.760 that look at the future and you say look these are the things i want to be able to do you can apply

00:07:41.280 metrics to those activities you can say hey if i want to be able to hike on uneven surfaces to the

00:07:49.520 tune of two mile round trip in an hour that requires this much cardiorespiratory fitness this much

00:07:56.400 strength this much balance and i know how much each of those things will decline over the next decades

00:08:02.960 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

00:08:09.120 pulled here if you could pull it up nick i think it's a bit of a messy figure and the message is

00:08:13.360 very clear perfect this is a figure that shows on the left it shows women and on the right it shows 0.78

00:08:22.400 men the bottom two figures show physical activity level over time so age is always shown on the x-axis

00:08:31.520 and the upper figure shows fat free mass in kilograms on the y-axis versus again age on the x-axis

00:08:40.160 so fat free mass of course is a very good proxy for lean mass or muscle mass and you can see that

00:08:45.600 these have data collected all the way from when people are teenagers up until the end of life and

00:08:53.440 again you don't really have to be a statistician to see the remarkable trends here so there's some

00:09:00.480 obvious differences between men and women the most notable one of just the difference in lean mass

00:09:05.280 men have significantly more lean mass than women but if you put that aside you'll realize two things 0.83

00:09:11.760 the first is that we have a steady increase in muscle mass and lean mass both for men and women

00:09:17.120 that occurs from birth right up until about the age of 25 and then you have a relatively minor decline

00:09:25.040 in lean mass from 25 to 75 but then what happens at 75 nick yeah it's off a cliff it literally falls

00:09:34.800 off a cliff now we do the same exercise for physical activity exercise no pun intended meaning you do the

00:09:44.080 same visual exercise you watch that from the ages of 25 to 75 physical activity level is even more

00:09:53.840 consistent and conserved than lean mass in both men and women and yet what happens at the age of 75

00:10:00.800 for both men and women yeah same thing it just falls off a cliff now of course this figure cannot give us

00:10:09.520 causality i can't look at this figure and tell you that the reason physical activity level falls off a

00:10:17.040 cliff at 75 is because muscle mass does the same nor can i tell you that muscle mass is declining because

00:10:24.080 physical activity goes down but it's hard for me to imagine that what's happening here is not

00:10:30.720 bi-directional in other words i suspect that what's happening is that at 75 or thereabouts for the average person

00:10:39.360 activity declines and as activity declines muscle mass declines and as muscle mass declines activity declines further

00:10:46.000 and these things spiral out of control and remember the average life expectancy is about 80 so that

00:10:54.160 means that for people who are living to average life expectancy and slightly beyond they're basically

00:10:59.600 going to spend the last five to ten years of their life in a very poor physical state and if there's

00:11:06.080 anything that i hope people take away from the stuff that we've been talking about it's that you must focus

00:11:14.320 on health span at least as much as you focus on lifespan and if there's an enormous failure in medicine 2.0

00:11:22.640 it's the myopic focus on lifespan at the complete exclusion of health span with that rant sort of

00:11:31.040 over therein lies the why it really doesn't matter what your athletic background is maybe you were a stud

00:11:38.880 athlete growing up maybe you've never played a sport in your life and you've never done so much as run a

00:11:43.280 local 5k doesn't matter everyone needs to be an athlete for life and therefore everyone needs to think

00:11:50.960 about becoming the best version of their centenarian decathlete remind me what was the furthest you've ever

00:11:58.800 swam furthest in one shot i've ever swam is about 28 miles so looking back at that picture of you and meb

00:12:07.920 would you say you were the better athlete and had more athletic achievements than meb or do you think

00:12:13.600 it's not quite that clear

00:12:15.600 meb having won the boston marathon having won the new york marathon probably the most decorated american marathoner i'm gonna

00:12:24.640 give the slight nod to meb on that

00:12:26.640 you did bike around fiesta island a lot though so you have that going for you i was probably a better

00:12:32.640 swimmer than meb maybe i can take that i'm sure if you put meb on a bike he would have ridden circles

00:12:37.760 around me oh yeah dude's just a machine so with that said i think then we also need to quickly remind

00:12:44.880 people of what you call the four pillars of exercise which is if you agree that this is what you're going

00:12:51.360 to train for which is ultimately life and life as you age and being able to do what you want to do and

00:12:57.840 sometimes people i think can get lost in the very specifics of like okay i need to be able to do

00:13:02.800 exactly this or exactly this but even stepping back for most people just acknowledging if i'm going to

00:13:08.560 focus on when i'm 80 90 i want to be able to move freely take care of myself just the large things that

00:13:15.920 can sometimes give people the goal they need and so with that said do you want to quickly remind

00:13:20.880 people on what those four pillars of exercise are that anyone who has that goal is going to need to

00:13:28.160 have all four yeah i just want to make sure people understand for the centenarian decathlon we're really

00:13:34.160 thinking about things that are activities of daily living and activities of leisure and pleasure and

00:13:41.840 sport and beyond activities of daily living so we kind of encourage people in our practice to go

00:13:47.760 through this exercise and make sure they have both of those in there now to your point i think

00:13:53.680 broadly speaking the way internally we talk about this is four pillars and this is the way i wrote about

00:13:59.600 it in the book so it's two cardio pillars and two strengthy pillars cardio pillars are zone two

00:14:09.360 efficiency so this is aerobic efficiency or maximum aerobic efficiency and then peak aerobic output so

00:14:16.080 that's measured by vo2 max whereas aerobic efficiency is measured by zone two output and then on the other

00:14:22.080 side we have strength and within strength there's a lot so we'll go into some more detail about what

00:14:29.600 that means because strength involves both muscle quality and motor control and you have eccentric strength

00:14:36.800 and you have concentric strength and all those things and then you have this other idea that wraps

00:14:42.000 around strength called stability and of course stability speaks about the safety with which you can apply

00:14:50.000 that strength i.e exert force on the outside world and the safety with which the outside world can exert

00:14:56.800 force on you and of course inherent within stability are other issues that we think about especially

00:15:02.880 things that decline as we age such as mobility balance flexibility looking deeper into those four

00:15:08.880 what are people able to track and kind of identify further to know where they're at you know in

00:15:14.240 strength there's different aspects of it maybe just touch on what those aspects are so people know how

00:15:19.360 they can start to measure in their own life where they're at where they need help there are so many so

00:15:25.840 let's take strength as an example within strength we want to think about peak strength so that would be

00:15:32.560 kind of maximum strength again to be clear that would be what is your maximum one rep max for

00:15:38.240 something we would want to think about muscular endurance so the ability to move something that's

00:15:43.520 much lighter but for many many reps it's important to point out by the way that you don't have to train

00:15:50.240 at a one rep max to increase your strength and you don't have to actually measure at that level in

00:15:58.880 other words you could see how much you could do something for five reps and that would allow you

00:16:03.280 to impute or estimate what you could do for one rep and if you're a power lifter who's competing in

00:16:09.440 a sport where you have to do that of course that would be insufficient for those of us that are not

00:16:14.080 power lifters knowing what we could do for our best five reps is a good enough proxy for then calculating

00:16:21.440 what our one rep max would look like we then talk about various things like motor control so again i think

00:16:27.520 this is sort of a hybrid of the strength stability piece but i gave the example of hiking over an

00:16:32.960 uneven surface you know i just got back from a hunting trip a little while ago and you're walking

00:16:37.920 around in the dark carrying heavy stuff on obviously uneven surfaces and that's a much more complicated

00:16:45.360 and dynamic situation than riding a stationary bike for example so we want to be able to train in both of

00:16:52.480 those ranges you want to be able to train under perfect conditions such as using a machine or

00:16:58.800 being on a bike or something like that and then you also want to be able to train on variable surfaces

00:17:03.040 and in situations where you have less control and again when we talked about cardiorespiratory fitness

00:17:08.240 lots of things that we measure here but again thinking of these in the two extremes which is what is the

00:17:15.360 maximum output you can sustain while still exclusively utilizing your aerobic system so

00:17:23.440 therefore you're not at all accumulating lactate and again i'm being a little bit sloppy in my

00:17:28.480 terminology there and we can maybe clear that up a bit later but basically what's the maximum

00:17:34.240 output you can sustain without accumulating net lactate and at the other end of that spectrum

00:17:41.280 what is the maximum utilization you have of oxygen which corresponds of course not to your maximum

00:17:47.040 output but more importantly your maximum aerobic output again these are very quantifiable and as

00:17:54.320 you know these are numbers that we know for all of our patients and i think they're numbers that

00:17:58.320 everybody should know for themselves yeah and i think that's a great lead into the next place which is

00:18:04.720 you have the cardiorespiratory side you have the strength side a lot of people are going to be

00:18:08.960 wondering okay how do i know where exactly i'm at in each of those so i can help identify

00:18:15.280 if one or the other needs help or if they both need help maybe walk through how people can understand

00:18:21.680 their current state as it relates to those two things thank you for listening to today's sneak peek

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The Peter Attia Drive - January 15, 2024

#285 - AMA #55： Exercise： longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more

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