The Peter Attia Drive - Building strength and muscle mass： how to optimize training, nutrition, and more for longevity (AMA #71 rebroadcast)

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

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00:01:04.260 Welcome to a special episode of The Drive. This week, we are rebroadcasting AMA 71,

00:01:10.720 which was on the topic of building strength and muscle mass. This is a topic that is

00:01:15.440 obviously central to both lifespan and healthspan, and is probably one of the topics I'm most

00:01:21.200 frequently asked about. This episode was released last year to our subscribers, but we think it's

00:01:27.840 important enough, and we do this occasionally with AMAs, that we re-release them to everyone.

00:01:33.240 It's also a great chance for those of you who are not subscribers to hear and experience what

00:01:37.340 the monthly AMAs are all about. While we've covered many aspects of this topic in the past

00:01:43.020 on different podcasts with multiple guests across many years, we find that AMAs like this that are

00:01:49.500 designed to bring all of that knowledge into one streamlined discussion are really helpful,

00:01:55.060 especially as you want to start to operationalize some of these things in your life. So consider

00:01:59.320 this sort of a long TLDR compared to what it would be like to gather all this information

00:02:04.460 everywhere. So in this episode, we're going to talk about why muscle matters for longevity,

00:02:08.940 metabolic health, and injury prevention from a data standpoint, the difference between muscle

00:02:12.380 mass and strength, because they're not the same, of course, although they travel together,

00:02:15.760 and which one matters more. Talk about things like why would grip strength predict mortality.

00:02:20.400 We discuss how to build muscle and strength effectively, including the important concepts

00:02:24.860 of progressive overload, rep ranges, training intensity, and safe ways to maximize results.

00:02:30.360 Talk about why power training and explosive movements become especially important with age

00:02:34.760 and how to add them into your routine. Talk about the nutrition needed to support muscle growth,

00:02:39.960 including protein intake, timing, and supplements such as creatine. Talk about training stages for

00:02:45.260 different people from beginners and older adults to younger athletes and people focused on

00:02:49.380 maintenance and including people like seasoned lifters. I'm going to talk about how to balance

00:02:54.260 recovery and injury prevention by managing fatigue, training consistency, and making

00:02:59.440 progress slowly over time. So without further delay, I hope you enjoy this special rebroadcast

00:03:03.920 of building strength and muscle mass as an AMA.

00:03:07.080 Peter, welcome to another Ask Me Anything episode with Dr. Peter Atiyah, Stanford-educated

00:03:20.280 physician. How are you doing? Thank you for that incredible introduction. I'm doing well,

00:03:27.620 and I appreciate you having me back. I just wanted to make sure you knew it was your show,

00:03:31.860 so I thought more of an introduction would make it feel more like home.

00:03:36.640 Before we start today's topic, how's your day going? Learn anything new today? Have you been

00:03:43.160 educated in any way? Well, you're always learning, Nick. That's the thing. At least I think we should

00:03:48.300 all try to be learning at all times. Today I had a particularly fun day. I went to my son's school

00:03:54.220 to take him lunch. This is something that I like to do once in a while is take lunch and

00:03:58.880 eat with my kids. He wasn't really in the mood to have lunch with me today, which happens from

00:04:04.000 time to time with seven-year-olds. So I ended up just in the cafeteria sitting at a table all by

00:04:09.780 myself eating lunch, which in and of itself was pretty funny because I really got a kick out of

00:04:15.080 watching all the kids doing their thing. But eventually a bunch of kids in his class I think

00:04:20.500 felt bad for me and they came up and just sat around me and they started asking me a bunch of

00:04:24.520 questions, which of course turned into me asking them more questions like, what are they doing in

00:04:29.400 PE? What are they learning in science? That kind of stuff. But the kid sitting right across from me

00:04:34.820 noticed I was drinking a diet soda. And truthfully, I don't really drink that many. I'm mostly a

00:04:40.700 Topo Chico Waterloo guy, but this was the first thing I grabbed. And he said, huh, I noticed

00:04:48.040 you're drinking whatever it was I was drinking, a Fresca actually. You know that that has a

00:04:52.740 sweetener in it that is 500 times sweeter than sugar? And I said, oh yeah, I think that's how

00:04:57.920 they get away with making it have no calories. He goes, you know, that causes cancer, right?

00:05:03.060 I just decided at that moment, probably not a good time to argue the abundance of the human

00:05:07.980 literature and the animal literature and all that. I let that one go, but I appreciated the

00:05:13.280 conviction and his concern for my health. He also pointed out afterwards that it wasn't going to

00:05:19.060 kill you quickly because you were only ingesting so little of it, which I thought was a very

00:05:24.580 astute comment for a seven-year-old. But anyway, needless to say, I had a lot of fun 0.98

00:05:30.020 doing second grade lunch today, and I would be interested in going back.

00:05:35.140 I do love it, especially because you've openly talked about how when you go to parties and

00:05:40.220 events where there are adults there, you usually don't explain what you do because you don't want

00:05:44.520 to have those conversations. And I love the fact you went to the local elementary school

00:05:49.700 and they roped you into that. We were talking briefly before this, and I think Jessica and

00:05:54.900 our team had a good idea. And people in the audience can let us know if they think this is

00:05:58.800 good, which is maybe we do get a panel of these seven-year-olds together and do a round table on

00:06:04.300 what elementary kids think about health, nutrition, exercise, protein, microplastics,

00:06:12.320 seed oils, you name it. Sounds like your local elementary school has a lot of insights on these

00:06:18.560 topics. Honestly, if our audience wants to hear the seven-year-old round table, I am totally game

00:06:26.140 to get, you know, a group of three or four or seven-year-olds around the table and really go

00:06:30.400 deep on the health issues that mean most to them. It's probably quite insightful. Yeah, it is. Let

00:06:37.740 us know if we should do it and we will make it happen. But for today's AMA, we are not talking

00:06:43.760 about that. We're actually going to talk about one topic and that is all things related to muscle

00:06:50.460 mass and muscle strength. So it's something that we've talked about on a lot of different podcasts.

00:06:55.300 You openly talk about the importance of it and we've gathered a lot of questions that have come

00:06:59.880 in. And these questions are going to deal with why is muscle mass and strength important? The

00:07:04.520 difference between muscle mass and strength? Which one matters more? How can you start to

00:07:08.700 increase your muscle mass and strength, whether you're old, young, male, female, the role of

00:07:14.340 nutrition and protein, one of your favorite topics in this. And then we'll end with some different

00:07:20.300 programming options for different types of people if they want to start applying this to their life

00:07:25.460 or if they want to start going further than their current exercise programming. So with all that

00:07:31.840 said, some people may say you have a lot of information on this already in episodes with

00:07:37.220 Lane Norton, Andy Galpin, Mike Isretel, and many more. So what would you say to someone who asked,

00:07:43.920 why are we now dedicating an AMA to this? It's a fair question and one that we internally kicked

00:07:50.060 around. And I think two things put us in the situation we're in. So one is we continue to

00:07:54.540 get asked more questions about this than almost anything. I would say it's among the three most

00:07:59.880 asked about topics. But I think the second thing is because we have so much content out there,

00:08:05.460 if you want to get the TLDR on this, you're going to be spending hours and hours and hours,

00:08:13.560 20 hours worth of digging. And so what we thought we could do was organize the content in a way that

00:08:19.080 would make it much easier for a person in what will undoubtedly be a much smaller aliquot of time

00:08:25.780 to get everything that they need to get out of this at the zeroth order and maybe first order

00:08:31.060 level. And then really through the show notes and supplemental material, go as deep as they want

00:08:36.380 if they need more content. I think we're going to deliver on this one. We've put a lot of work

00:08:40.200 into it. Well, you should, because it sounds like if you don't, next time you go to school,

00:08:44.160 pick up or drop off, you're going to hear an earful for some kids. So I'm half expecting the

00:08:48.620 next time I go in for someone to be like, dude, why are you so weak looking? Why do you have such

00:08:54.020 chicken arms. Do you not work out? I'm not saying it's a good idea. I'm just not saying it's a bad

00:08:58.600 idea if you roll up to the next one shirtless, maybe after a little dehydration and a little

00:09:03.680 pump prior to just to let those kids know who's in charge. On that, let's start with some

00:09:11.420 definitions. Muscle mass, muscle strength, two things that are kind of used intertwined, but

00:09:16.680 also a little different. We'll get into them here where I think it'd be helpful to start.

00:09:20.200 What is the definition of each of those and how we're going to talk about it?

00:09:24.020 I think most people understand that they are different. I think the confusion comes

00:09:27.340 from the fact that we will interchangeably talk about metrics of both of them. We're

00:09:32.020 going to clarify this. But of course, muscle mass is simply the total amount of skeletal

00:09:36.440 muscle in the body. There are three types of muscle in the body. We have cardiac muscle,

00:09:41.320 which looks and behaves a lot like skeletal muscle, but has properties that allow it to

00:09:45.860 basically run nonstop for the duration of your life. We have smooth muscle that is actually

00:09:51.480 quite distinct from skeletal muscle, but the bulk of muscle in the human body is indeed

00:09:57.620 skeletal. It has contractile properties that allow it to generate force. It has certain metabolic

00:10:03.860 requirements, but nevertheless, this is what we're referring to. I think of this as having

00:10:09.080 a structural function and a metabolic function. We're going to talk about both of these.

00:10:13.640 Of course, the related metric is strength, and that's the ability to exert force, to overcome

00:10:21.000 resistance. So again, I think that's very intuitively obvious to everybody,

00:10:25.560 but nevertheless, we could talk about those things. Two additional concepts just to introduce

00:10:30.220 is the idea of hypertrophy. So in addition to how strong a muscle is, how much force it can

00:10:35.940 overcome, we can talk about the size of the muscle. And then we can talk about power, which is

00:10:41.660 something that probably doesn't get talked about enough, although we certainly talk about it quite

00:10:44.920 a bit on the podcast. And power should not be confused with strength, although there's a strong

00:10:50.320 relationship between them. Power incorporates velocity. There's an inverted U shape that

00:10:56.400 describes the relationship where as resistance goes up, one is able to move with high enough

00:11:02.500 speed that they can continue to increase power. But as the resistance gets beyond a certain point,

00:11:07.960 speed will come down and actually power is coming down even while strength is going up. So

00:11:12.760 that kind of rounds out some of the semantics. Just hitting this right off the bat,

00:11:17.020 why is muscle mass and muscle strength important for someone to consider in the concept of

00:11:24.000 lifespan, a.k.a. why should everyone who's listening to this care about this topic?

00:11:29.640 I think what I want people to kind of fixate on now is while we will go back and forth between

00:11:34.660 them, that is simply an outcome of the data. We have to lean on what data are out there.

00:11:42.000 and sometimes the data are looking at muscle mass, sometimes they are looking at strength,

00:11:47.380 sometimes they're looking at both. What we really care about is strength, and therefore when we look

00:11:53.200 at measurements of lean muscle, which is very easy to measure, that's a big part of why we measure it.

00:11:58.520 It's objective, it's easy to measure, and it can be compared across studies much more easily than

00:12:03.240 strength can, for example. Although when you standardize metrics of strength, obviously it

00:12:06.980 can be pretty easy as well, but it's the strength that we care about. And it's strength that is

00:12:12.180 probably much more highly associated with, not just correlated with, but causally associated with

00:12:18.020 mortality, cardiovascular disease, neurologic disease, than muscle mass itself. What I would

00:12:23.340 say is we talk about muscle mass a lot. We care about muscle mass a lot. It plays an important

00:12:28.440 role in the metabolic function of muscle, but maybe above all else, just think of it as a great

00:12:33.800 proxy for strength, not a one-to-one proxy. I know everybody listening to this has met a really

00:12:39.180 wiry person who is insanely strong. And there are actually some people who have quite a bit of

00:12:43.960 muscle mass and yet they're not actually that strong. But if you exclude the extremes in the

00:12:48.740 bookends, there seems to be a reasonable mapping between muscle mass and strength.

00:12:54.040 Is there anything we know about how much of a difference muscle mass strength can make as it

00:12:59.620 relates to lifespan? Yes. I think this is a great way to think about all of the things that are

00:13:05.400 associated with mortality. So I sometimes will ask this question of people as just a way to

00:13:11.860 demonstrate, and not to be cheeky, but just to demonstrate the obvious as a way to reframe the

00:13:16.140 discussion. So if I say to a group of people, what factor is most associated with mortality?

00:13:22.220 Let me know what you think. And people will say smoking, high blood pressure, all sorts of things.

00:13:27.480 The answer is age. So nothing associates more with mortality than age, which by the way,

00:13:35.760 as a total aside, is why I still find aging clocks to be unhelpful because biologic age,

00:13:44.380 chronologic age, trying to suggest that those are different requires demonstrating that biologic

00:13:50.380 age as demonstrated through an aging clock is a superior predictor of mortality than chronologic

00:13:57.460 age. And nothing has come close to even being within the zip code of the zip code of the zip

00:14:04.560 code of the thing that I'm talking about. So when you look at Gompert's law for mortality,

00:14:09.940 you see an exponential increase in mortality with age. I'm going to pull up a figure here in a

00:14:15.540 second in which I tried to depict Gompert's law by decade. In other words, what was the relative

00:14:23.220 risk of mortality with each passing decade and it dwarfed all the other stuff on here so it didn't

00:14:29.340 make sense to put on. I'm only throwing all that out there Nick as an aside to say I am excluding

00:14:34.940 the elephant in the room with this figure that we put together by excluding age but if you take

00:14:42.540 that off the table what I'm showing you here is a collection of hazard ratios for all-cause

00:14:49.300 mortality. Again, not from head to head studies. These are from at least four, if not five

00:14:54.980 different studies, all of which will be referenced in the show notes. But what we're showing you is

00:15:01.120 what is the increase in all cause mortality for individuals across these various data points.

00:15:09.980 So if you consider the figure here, some of these will be completely familiar to people who have

00:15:15.700 heard me talk about this in the past. So if you look at the things on the left of this graph,

00:15:20.620 we're looking at markers of cardiorespiratory fitness. The easiest way to measure that by far,

00:15:25.180 of course, is VO2 max, which is why we talk about it so much. So if you're comparing

00:15:28.620 what's called above average to elite, that's basically someone who's in the third quartile.

00:15:34.640 So 50th to 75th percentile to someone who is in the top 2%. We're talking about a twofold

00:15:42.080 difference. By the way, the little bars on this thing, those are error bars, so 95% confidence

00:15:47.820 intervals. If you're looking at someone with low VO2 max, this would be somebody in the bottom 25

00:15:54.180 percentile to someone in the top two percentile. You're talking about a five-fold difference in

00:15:59.980 mortality, meaning there's a five times greater difference of dying in the subsequent year from

00:16:04.040 any and all causes. I'm going to skip some of the other VO2 max ones, but let's say you look at grip

00:16:08.960 strength. So you look at every reduction of grip strength by 10 kilos is about a 30% increase in

00:16:17.300 all-cause mortality. When you look at different metrics of muscle mass, if you compare bottom to,

00:16:24.820 say, middle quartile of muscle mass, you're talking about 2.3 hazard ratio, which means

00:16:32.340 130% increase in all-cause mortality. And again, at the right side of this figure,

00:16:38.120 I'm just showing you things that people would commonly and appreciate are driving mortality,

00:16:43.540 such as type 2 diabetes, which is about a 40% increase in all-cause mortality, uncontrolled

00:16:49.160 hypertension, high blood pressure, about a 60% increase in all-cause mortality, and of course,

00:16:53.640 smoking, which from a modifiable lifestyle behavior would be right near the top of the list

00:16:58.600 at about a 2.8 hazard ratio, at least in one study. I've seen other studies that has it as low as 1.4.

00:17:04.620 obviously the duration of tobacco use comes into that, but there's no mistaking the role on that.

00:17:09.620 So what do we take away from all of this? We take away from this that muscle mass,

00:17:13.460 strength, cardiorespiratory fitness play an enormous role in predicting how long you're

00:17:18.800 going to live. And while age is the king of kings when it comes to predicting how much longer you're

00:17:24.360 going to live, these things play a huge role as well. We talked about grip strength before,

00:17:28.700 but I think it'd be worth just quickly double clicking on grip strength. And can you talk about

00:17:33.300 how that is related to mortality? Grip strength is a very easy thing to test. A moment ago,

00:17:39.780 I said, hey, look, muscle mass is often used as a proxy for strength. Why? Well, it's because

00:17:44.600 DEXA is a ubiquitous test. It's very easy for researchers to use DEXA. It can be standardized

00:17:50.680 from one place to another, so it's easy to use. So then when you start to think about strength

00:17:54.620 metrics, one of the easiest things that we can do is test grip strength. It's also not just easy to

00:18:00.960 reproduce, but I would argue it's a great representation of upper body strength. So people

00:18:06.640 who have a very strong grip tend to have a very strong upper body. You can't do many things that

00:18:14.020 require a lot of upper body strength if your grip is very weak. So nevertheless, if we look at grip

00:18:19.680 strength, what do we know about it? So there was a study called the PURE study that measured grip

00:18:23.480 strength in somewhere in the ballpark of 140,000 people across 17 countries. And they found that

00:18:30.380 lower grip strength compared to higher grip strength was a significant predictor of all

00:18:34.980 cause mortality. So every five kilogram reduction in grip strength was associated with a 16%

00:18:43.560 increase in mortality, meaning every five kilos or 10 pounds of reduced grip strength

00:18:49.760 compared to someone who had more grip strength to that amount, there was a 16% chance of dying

00:18:56.540 in the subsequent year from any and all cause. Another very interesting study looked at people

00:19:03.260 in their eighth decade of life. So these were people age 70 to 79 at baseline, and they'd

00:19:10.100 followed them for seven years. And so these people were divided into quartiles based on muscle mass

00:19:17.720 and strength. So separate analysis. So DEXA was used to quantify muscle mass, and I believe they

00:19:25.820 use leg extension for quad strength. They might have used grip strength as well for upper body

00:19:32.400 strength. Okay. So basically you have quartiles of strength, quartiles of muscle mass in people

00:19:40.940 who were in their eighth decade of life, and they are prospectively followed. And what we're

00:19:46.080 looking for basically is what's called the Kaplan-Meier survival curve. So if you pull up

00:19:50.200 these curves here, Nick, you can see that, obviously, because it's a Kaplan-Meier curve,

00:19:56.320 it's cumulative, you can see a monotonic increase in mortality for all groups. But what you notice

00:20:01.600 is the strongest groups and the groups with the most muscle mass always have the highest survival.

00:20:10.200 Again, the mortality rates are pretty high in this figure. This is a seven-year follow-up in

00:20:16.320 people that are starting late in life. You wouldn't expect to see this steep mortality

00:20:20.040 drop if they were doing this in people aged 50 to 59, two decades younger. But the reason I suspect

00:20:27.200 that they chose to do this is because they wanted to actually see some separation. So another very

00:20:33.260 clear indication of at least a very strong association between muscle mass and muscle

00:20:40.200 strength in terms of all-cause mortality. What do we know about muscle strength and

00:20:47.120 muscle mass being causally related to mortality? Because I think sometimes you're going to hear

00:20:52.020 people say, well, is it just that people who are stronger tend to be healthier in other ways too,

00:20:58.540 and then live longer as a result? So how do you think about that?

00:21:01.960 Yeah, I think this is a very important question because I absolutely believe that there is

00:21:08.260 bi-directionality in this association. The healthier you are, the more easily you can

00:21:16.260 do the things that make you stronger and make you have more muscle. And that should be playing

00:21:22.680 a role in how long you live. In addition to the fact that doing those things allows you to live

00:21:29.200 longer. So that's my thesis. How would you get at that? Well, it's very difficult to do a randomized

00:21:33.500 experiment. But if we look at Mendelian randomization, which again, we've talked about

00:21:38.660 many times in the past, but this is basically looking at genetic scattering of traits that we

00:21:45.540 care about and asking the question, how does that impact the parameter of interest? So if we look

00:21:52.500 at Mendelian randomization studies that look at the relationship between muscle mass and mortality,

00:21:57.840 they do find at least partial causality rather than strength just being a proxy for general

00:22:04.460 health. So one study that looked at 300, 350,000 Finnish biobank participants used a polygenic

00:22:12.960 score as a proxy for grip strength. So in other words, a whole series of genes were associated

00:22:19.060 with grip strength. Again, this is not hard to imagine. Everybody knows that person who's just

00:22:24.180 stronger than everybody else. And when they looked at that polygenic marker for grip strength

00:22:31.080 and assessed the relationship to chronic disease and mortality, they found that each standard

00:22:36.100 deviation increase in grip strength from the polygenic score was linked to a reduction of

00:22:43.500 risk for vascular dementia by 7%, obesity by 6%, 5% for type 2 diabetes, 4% per mace,

00:22:51.340 and 3% for all-cause mortality. That's one way to look at this. But again, it suggests to me

00:22:58.120 bi-directionality here in that, yes, I think that the magnitude of the benefit that we see

00:23:04.280 in the pure observational cohorts clearly reflects the health of the user as well that enables them

00:23:11.600 to train. Peter, in the past, when we talked about VO2max, you've often spoke about how it

00:23:16.740 is such a good metric because it's an integrator of the work done. Meaning you can't just cram for

00:23:22.220 a VO2 max test the week before and greatly increase your VO2 max. Is that also kind of

00:23:28.560 similar to muscle strength, muscle mass? Yep. I think that's exactly why VO2 max,

00:23:35.200 muscle mass, and strength show up as such strong predictors is that they integrate

00:23:40.680 and aggregate years of work that go into producing high results. We say this all the time to our

00:23:48.320 patients when they show up and test very poorly. So when someone shows up and they're in the bottom

00:23:54.640 5% for muscle mass and their strength is poor and their fitness is poor, we explain to them that

00:24:01.360 this is not something that's going to turn around this year. This is not like fixing your ApoB,

00:24:06.860 even fixing your insulin resistance and things like that, which take a lot of work,

00:24:11.520 this is the longest part of your health journey if you're starting with a very low base.

00:24:16.220 And I think just understanding that and saying, look, it's going to be probably three years

00:24:20.520 before we get your VO2 max from 30 to 50, but it can be done provided you're able to and willing

00:24:27.040 to train. So far, we've talked about the benefits of lifespan as it relates to these metrics.

00:24:32.920 What do we know about the benefits of healthspan?

00:24:35.740 So not only living longer, but also living better.

00:24:38.620 Yeah, you've obviously heard me say this.

00:24:40.480 I think that exercise should still be viewed as the most, if not one of the most important

00:24:46.420 things that we can do to modify our behavior, even if it played no role in lifespan.

00:24:51.800 So even if you told me that all the exercise that I do was going to shorten my life by

00:24:56.940 a year related to being sedentary, what would I do?

00:25:00.080 And the answer is I would still do it because of the effects on healthspan. Now, of course,

00:25:04.160 that's a false choice. It's also increasing lifespan. But my point being is just the health

00:25:08.860 span benefits alone are important. So I think there's lots of ways to talk about healthspan,

00:25:15.840 but maybe we just put it all together and talk about all the benefits of muscle health.

00:25:20.800 So there are lots of ways I think that muscle impacts healthspan and lifespan. Maybe we just

00:25:25.180 take a minute and look at each. So let's start with metabolic health. So we've discussed this

00:25:29.060 on many previous podcasts, and I alluded to it earlier in our discussion, but muscle is the

00:25:34.660 predominant sink for insulin-mediated and even non-insulin-mediated glucose uptake. So the more

00:25:41.520 skeletal muscle you have, the more easily you can buffer blood sugar. And I would hope that I don't

00:25:48.920 need to spend much more time explaining why maintaining low blood sugar is an imperative

00:25:55.120 part of reducing not just the risk of type 2 diabetes, but more importantly, I would say heart

00:25:59.860 disease, dementia, and cancer. So anything that you have that aids in the shunting of glucose

00:26:06.640 easily into muscle is going to improve that. And therefore, we want muscle that has sufficient

00:26:14.280 size, say someone that can hold 300 to 500 grams of glucose in storage. And also we want insulin

00:26:21.600 sensitive muscles that allow the muscle to take that up with the least amount of insulin possible.

00:26:26.820 We talk about inflammation. So muscle is an endocrine organ. This is not necessarily intuitive

00:26:32.180 to people. We don't really think of it this way, but it is indeed an endocrine organ,

00:26:37.040 which means it secretes signaling molecules called myokines, such as interleukin-6,

00:26:42.980 which has an anti-inflammatory role. Most of the interleukins we think of are actually

00:26:47.540 pro-inflammatory, but that's not the case with all of them. And so indeed, irisin, IL-6 can actually

00:26:54.160 reduce inflammation and improve metabolism. By the way, it's worth noting, Nick, many people have

00:26:59.480 looked at these interleukins and myokines as ways to biologically mirror the effects of exercise

00:27:09.020 without actually exercising. So for what it's worth, I don't know, 14 years ago or so, I remember

00:27:14.840 irisin was all the rage when it was discovered as a myokine. And of course, people immediately

00:27:20.800 said, listen, we just need to figure out a way to inject people with irisin and we will produce the

00:27:26.680 effects of exercise without doing it. And of course, these things have never panned out. Now, I'm not

00:27:30.800 going to give up on this approach. I know one of our previous podcast guests, Mike Isretel, really

00:27:35.980 was convinced that within a decade, no one will need to exercise. We'll just inject people with

00:27:41.540 myokines. I'm not nearly as bullish as he is on that, nor do I think I would even find that

00:27:47.240 interesting. I actually enjoy the act of exercise, but at least his view was, look, we will be able

00:27:52.160 to produce all of the metabolic benefits of exercise by doing this. The fact that we haven't,

00:27:57.040 by the way, suggests to me the vastness of what exercise does. It's not going to come down to two

00:28:03.280 or three myokines. It's going to be an entire cascade of things that probably affects why this

00:28:08.460 is happening. In the show notes, we're just going to link to all of the places where these things

00:28:13.840 have been discussed in great detail. The other thing to consider, which again, I think is

00:28:17.920 something we fortunately don't have to think of under normal circumstances, but it really does

00:28:23.980 matter when a person gets sick, is that muscle is indeed the reservoir for protein. So we don't

00:28:31.140 store protein the way we store glucose and the way we store fat. So I think everybody's familiar

00:28:35.140 with the idea that we store infinite amounts of fat. As much as our fat cells will get fat,

00:28:39.300 we can store fat, and that can provide us with months and months of energy. We don't store that

00:28:44.180 much carbohydrate, so we're kind of stuck there with our glycogen supplies. Of course, anything

00:28:48.640 excess we'll store is fat, and we don't store protein in the traditional sense outside of the

00:28:53.960 muscle itself. And so what that means is the more muscle you have, the less muscle you will end up

00:29:02.340 losing in a period of illness or stress like surgery, infection, hospitalization, burns,

00:29:07.640 things of that nature. So I think this is a big part of why people with more muscle mass

00:29:11.720 consistently have lower mortality. They're more likely to survive hospitalizations,

00:29:16.860 infections, car accidents, you name it. Put stress on the body, more muscle is better.

00:29:22.420 Then we kind of just get into the obvious stuff, which I don't think I need to spend much time on,

00:29:26.620 which is movement and activity in life. The more you move, the more you're alive,

00:29:31.140 the less you move, the less you're alive. I don't think too many people are going to disagree with

00:29:34.620 that. And I don't think we need to spend much more time talking about the centenarian decathlon

00:29:38.820 as the mental model I think about for how to prepare for the marginal decade. But there's

00:29:45.000 really no scenario under which you're going to have an optimal marginal decade if you are not

00:29:51.080 physically able to move and do as much of what your heart desires. We talk a lot about falls.

00:29:58.700 I actually just sent the team an email earlier today about a study that I was looking at that

00:30:03.740 very nicely summarized just the significance of the fall literature. Again, 300,000 hospitalizations

00:30:10.840 a year in the United States alone. Apologies for those not in the U.S. listening. I don't have the

00:30:15.300 stats, but you can extend them by proxy. 10 to 30 percent one-year mortality for those above 60,

00:30:22.820 and very few of these individuals, if they suffer a femur fracture, are going to return

00:30:27.960 to their state of previous health and mobility. So I think all of these things taken together

00:30:34.620 should really remind people of why this matters. If you just want to look at how mortality is

00:30:40.240 driven in falls, I'm going to rattle off by decade what the death rate per 100,000 is from a fall.

00:30:49.180 So if you're 25 to 35, it's 1.1 deaths per 100,000. 35 to 45, it's 1.7 deaths per 100,000.

00:30:57.400 45 to 55, 3.2 deaths. 55 to 65, 5.7 deaths. 65 to 75, 13.2 deaths. 75 to 85, 50 deaths.

00:31:10.860 And by the time you reach 85 and up, it's nearly 200 deaths. So anybody plotting that will realize

00:31:18.020 it is the true definition of an exponential growth curve. Double clicking on that before we move to

00:31:23.760 how does someone start to increase their muscle mass and strength? Can we just talk a little bit

00:31:28.420 more about what we know about how we gain and lose muscle as we age and why muscle is so important

00:31:36.640 when we're older and why that means that you can't wait until you're at a certain age to

00:31:43.160 start caring about it? So muscle strength peaks in the 30s typically, maybe even the early 40s.

00:31:51.420 again, notice I'm not talking about power, power peaks sooner than that. So that incorporation of

00:31:56.740 speed, but strength is going to peak in the fourth or early part of the fifth decade, but it will

00:32:02.880 decline with age at a rate of about one to 2% per year. This rate continues largely uninterrupted

00:32:12.980 unless there is a significant change to health status. But once you hit about the age of 70,

00:32:19.000 this acceleration continues. And one of our previous guests, Luke Van Loon, really made a

00:32:25.100 point that I thought was so interesting, which is when you look at these curves that represent

00:32:29.840 a decline in muscle mass, a decline in strength, and a decline in activity level, they look

00:32:35.300 physiologic, which means they look beautiful and smooth. But he said that's just because you're

00:32:39.960 looking at population-based averages. When you look at this at the individual level,

00:32:43.780 for most people, it's relatively slow decline punctuated by rapid periods of decline with

00:32:48.820 inactivity. So the key here is avoiding inactivity, avoiding time without training.

00:32:55.660 One of the greatest things that leads to that inactivity is injury. So that's why,

00:33:00.180 as far as I'm concerned, once you reach my age in your 50s, rule number one of training is don't

00:33:07.080 get injured. Do not miss workouts because you are injured. And I think that just only increases

00:33:13.960 as you age. And that's why I do worry when I see someone who's in their 60s and 70s having a

00:33:19.860 significant injury, which is going to take them out of training for months at a time. We'll kind

00:33:25.320 of link to much of the details around here. I don't really want to just rattle off all the

00:33:29.920 numbers. It gets a little overwhelming, but we'll kind of go to some of the more granular data of

00:33:35.260 what this looks like. I think we can summarize it by pulling up kind of a schematic. So there's a

00:33:39.960 schematic here that talks about how, look, age on the x-axis, relative function, muscle mass,

00:33:47.740 put whatever proxy you want on the y-axis, it's going to peak at about the age of 30. And you'll

00:33:53.960 see in this figure basically three levels of decline. And the levels of decline are going to

00:34:00.400 be dependent on the level of activity. So a very active individual, lower level of decline, still

00:34:07.100 declining. A population average, quicker level of decline, and a sedentary individual, much quicker

00:34:13.140 level of decline. And where does it become relevant? It probably becomes relevant in the

00:34:19.040 70s. So in the eighth decade of life is where you really start to see the difference. And the problem

00:34:25.260 is you don't want to be on that red curve in this figure that I'm showing and figure it out when all

00:34:31.540 of a sudden everything is taken away from you. If you're on the red curve today, get to that blue,

00:34:36.480 get to that green curve by increasing activity. Yeah. And on that graph, I think it's interesting

00:34:41.980 because there's almost two components too, which is if you've already passed your peak,

00:34:46.760 you really want to make sure you decline at the slowest rate possible. But if you're of the age

00:34:52.300 and listening or watching this and you haven't passed your peak yet, you really want to make

00:34:57.220 sure your peak is as high as you can go. Cause that's the other aspect that affects your decline.

00:35:02.460 correct? Yeah, that's a great point. It's very true with something like VO2 max, very true with

00:35:08.120 something like bone density. I'm very grateful for those formative years of my life, age probably

00:35:15.480 13 to 18, 19, when I was training absurdly hard. On the one hand, the drawback of that, Nick, is I

00:35:23.020 have awful scars to show for some of the stupid injuries, especially to my back. On the positive 0.99

00:35:28.900 side, I like knowing that my VO2 max was in the seventies or I think at one point, even the low

00:35:35.360 eighties. And so even though I'm much lower now, I'm still relatively high because I started from

00:35:41.320 such a high base. So yeah, you're right. I don't think our audience particularly skews on the

00:35:46.120 younger side of 30, but for those listening or for those who have kids, you want to really encourage

00:35:51.300 your kids or yourself to reach your maximum genetic potential, because it's going to get

00:35:56.620 that glider a lot higher and give you even more room to stay on that green curve as you age. 0.99

00:36:02.980 If you can do it without injuring yourself like I did as an idiot, then you've really won the game 0.99

00:36:07.560 because it wasn't necessary for me to do the stuff I did to injure myself. It was just due 0.99

00:36:11.540 to sheer ignorance. That's another topic we could talk about with the seven-year-olds at the round

00:36:15.860 table so we can park stupid ideas that you do when you're young. But moving on to now the crux of 0.99

00:36:21.580 this and what most people care about is getting into the nitty-gritty around how to increase

00:36:26.260 muscle mass and strength. So I think starting with just a general question of what do you think is

00:36:31.380 the most effective approach when you look at resistance training for someone to put on muscle

00:36:37.600 size, strength, mass? So I think one has to align around what it is that they're trying to optimize.

00:36:46.240 So optimizing for strength and optimizing for hypertrophy will require different types of

00:36:51.620 training. So to take two extremes of this, if you're talking to Lane Norton and he's preparing

00:36:58.540 for a powerlifting competition, which even though the word power is associated with it,

00:37:04.520 is the purest demonstration of strength, his training looks nothing, nothing like Mike

00:37:11.040 Isretel's training as a bodybuilder where he is training maximally for hypertrophy. I say nothing

00:37:17.620 like. They're both in the gym. They are both lifting a lot of weight, but a closer examination

00:37:23.620 will reveal pretty quickly that they're doing very different things. Now, most of us are not doing

00:37:30.320 either of these things. Most of us are going to be kind of in the middle. We're training for strength,

00:37:37.740 but not maximum strength. I have not deliberately done a one rep max in 15 years, and I'm very

00:37:47.260 confident saying, I will never deliberately do another one rep max in my life. Meaning I'm never

00:37:53.200 going to be training for maximum strength. At the other end of that spectrum, strength is still very

00:37:57.720 important to me. And that means I do need to be in a slightly lower rep range than just the other

00:38:04.140 end of the spectrum where I'd be training pure muscular endurance. And I'm still doing things

00:38:07.760 that are strength-based principles that I wouldn't necessarily be doing if I were purely optimized

00:38:12.280 around hypertrophy. Okay. We're going to talk about this in much more detail, but I just throw

00:38:15.920 that out, there's a couple of extremes. The principal underlying resistance training,

00:38:20.500 regardless of whether we're talking about hypertrophy or strength, is one of progressive

00:38:25.840 overload. And the idea here is that you constantly challenge the muscle with increasing demands

00:38:31.360 to force adaptation. Now, how this works has been discussed. And I want to say, I think probably the

00:38:37.740 podcast with Andy Gelpin might be the one where we went into most detail here. So obviously we're

00:38:42.540 going to link to all of that. But the reason all of this happens is basically a function of muscle

00:38:47.540 fiber recruitment. So people might remember from those episodes that we have type 1 and type 2

00:38:52.080 fibers. The fiber type refers to many differences in these muscles. It refers to the force with which

00:38:58.500 they can contract. It refers to their metabolism, whether they are more glycolytic or oxidative.

00:39:05.300 but basically we want to increase load and volume over time to recruit higher threshold motor units.

00:39:14.240 So another important principle here is muscle protein synthesis. So we have to be able to

00:39:19.820 provide the substrate for these muscle fibers to repair and grow. And then of course you have to

00:39:27.940 have neurologic adaptation. So this is something that has taken me a while to sort of explain

00:39:34.880 to my daughter, who really, really has taken a huge enjoyment for going into the gym. And she's

00:39:41.760 at that age where she's running track and wants to work out all the time. And I kind of have to

00:39:45.920 explain to her that she needs to recover a little bit. Her neurologic system is actually fatiguing 0.98

00:39:52.340 when she keeps trying to do all these things at all the times. But we have to basically be able

00:39:56.460 to train the motor units to fire correctly, to sync correctly, how to control them. And again,

00:40:02.400 all of these things factor in. So broadly speaking, I just want people to understand

00:40:06.980 you have this overall idea of progressive overload and you have to be able to tap into

00:40:13.760 different motor units. You have to be able to provide amino acids for muscle protein synthesis

00:40:18.760 and you need time for neurologic adaptation. Let's talk a little bit more about how would

00:40:24.380 someone implement progressive overload? I think it's kind of a term that people may have heard,

00:40:29.660 but I think walking people through how they would actually go about that in the gym would

00:40:34.200 be helpful. Yeah, there are many ways to do this. One of them is maybe the most obvious way that

00:40:40.180 people would naturally think of, which is you can increase the load or the weight, but you can also

00:40:44.000 do it by increasing the reps that you do in a given set or the number of sets or the time under

00:40:49.280 tension, which is one of my personal favorites, or decrease the time between sets. Let's talk

00:40:54.800 about each. And within each, I would encourage everyone to think about which ones might be

00:41:01.060 safer, which ones might make more sense if you're lifting alone versus lifting with others,

00:41:05.520 which one might make sense under certain types of exercises versus others. I'm going to use myself

00:41:10.260 as an example here, but I would like people to sort of think about this for themselves.

00:41:13.700 Okay. So increasing weights directly. It's obvious. I don't need to say it anymore about

00:41:17.720 this, but I will call out places where this might not make sense. So for me, I just know that there

00:41:25.360 are certain parts of my body that I don't want to add more and more weight to, so I'm not going to

00:41:32.060 add weight. Where's an area where I feel very comfortable just adding weight because the risk

00:41:37.720 of increased loading doesn't seem to matter? Doing a bicep curl. Great way for me to increase

00:41:44.260 overload. Would I do this on something that has some degree of axially loading? Not anymore.

00:41:51.360 I would in the past. I won't today. Increasing reps. This is great. But again, we want to go

00:41:56.560 back to the principle here. If you are exceeding reps, it might imply that you weren't doing

00:42:04.620 enough in the first place at a given weight. So remember, we're always trying to target

00:42:09.460 1 to 2 RIR. So I guess we could say here if you're in the 2 rep in reserve and you want to move to

00:42:17.780 0 to 1 without increasing the weight, that would be a manner of progressive overload. But the truth

00:42:23.520 of the matter is here, once you start exceeding 12 to 15 reps, you are shifting more stimulus

00:42:28.460 towards muscular endurance. That's not a bad thing at all. You just have to be aware of what your

00:42:32.860 goals are. Extra sets and volume to me is a great way to increase overload without necessarily

00:42:40.200 increasing weight. Again, another part of that is decreasing time between sets or supersetting.

00:42:46.160 I also enjoy that a lot. Again, as I said a second ago, one of my favorite ways to increase

00:42:52.460 the overload or to progressively overload is time under tension. So my shoulders don't love

00:43:00.160 bench press anymore. So one of the things I really enjoy doing is very slow sets because I can use

00:43:07.300 much less weight. I have a little bit of arthritis in my AC joint on the right side. All the muscles

00:43:13.120 are fine, but I just don't want to aggravate that AC joint. So A, I'm using dumbbells because I can

00:43:19.120 put them in a position that's a little easier on the shoulder. Also, I don't have to use super

00:43:23.100 heavy dumbbells. If I told people how much I bench press, they'd be like, that guy's a chicken

00:43:26.960 chest. But if I'm bringing it down slowly, if I'm doing pauses at the bottom, if I'm increasing time

00:43:32.680 under tension, I'm still getting the stimulus for growth and strength without having to rely

00:43:39.060 on enormous amounts of weight. So I think it's just helpful for people to think about these things

00:43:44.660 in the context of themselves and within the exercises they do, because you might adapt

00:43:49.880 a different one of these for a different type of exercise.

00:43:54.040 Would have been really great if you would have told that seven-year-old today when you were

00:43:56.740 being lectured about your diet soda, how much you bench press, because I would love to hear what his

00:44:02.380 reaction to how strong you were as well, because maybe he had some tips for you. Yeah. There's no

00:44:08.080 way I would have fessed up to that kid, how bad my bench press is because he wouldn't have let me

00:44:13.160 out of the cafeteria. He would have called the other kids over to just mock. I love it. So for

00:44:19.000 people thinking about this and how to apply it, how often do you recommend patients work on

00:44:24.600 increasing those different levers in their day-to-day, week-to-week, month-to-month training.

00:44:31.320 I mean, the truth of the matter is you always need to be kind of trying to push this. Of course,

00:44:37.860 as we age, it's going to get harder and harder. And of course, at some point we are going to be

00:44:41.940 taking steps backwards, but the goal is you just don't want to get to the point where

00:44:45.800 you're not pushing the envelope of what you're capable of. Now, again, someone who's just

00:44:50.540 starting out, it's their first few months of ever doing resistance training. They're going to be

00:44:56.040 able to increase what I'm calling total load, which is a function of load, reps, rest, volume,

00:45:05.040 the overall metric that encapsulates everything by 5 to 10% per week. Whereas an advanced lifter

00:45:12.000 might be at 1% increased load per week. It's just really a function of what your experience is,

00:45:19.440 but think of it through the lens of always try to push forward. And then of course, just to be

00:45:23.880 clear, we talk about having a deload week. We talk about periods of backing off, but I'm talking

00:45:29.200 about not including those periods. Can we double click on the phases of a movement? So concentric,

00:45:36.240 eccentric movements and how one just define them again for people. And then also how people can

00:45:42.940 utilize those both different movements as they think about getting stronger.

00:45:47.840 So a concentric contraction occurs when a muscle is getting shorter while producing force.

00:45:55.600 This is what most people think of when they think about lifting a weight. A bicep is the

00:46:00.880 easiest way to think about this, but of course it's true for any muscle. So if my arm is straight

00:46:05.860 and I'm curling a dumbbell up using my bicep, the concentric phase of that is while the bicep

00:46:13.880 is getting shorter and I'm lifting it up. So training the concentric phase is where we build

00:46:21.600 power and force output. So the faster you do the concentric phase, the more power you generate.

00:46:30.140 Is there a time and a place for that? Absolutely. One of my favorite exercises is on the Kaiser

00:46:35.700 leg press machine, which is a pneumatic machine doing explosive single leg leg presses.

00:46:42.560 obviously something you do after a big warm-up you don't want to put an old guy like me into an

00:46:48.240 explosive movement but i'm usually doing this two-thirds of the way through my exercise which

00:46:53.300 means i'm leaving a little bit on the table because i'm coming into a little bit of pre-fatigue

00:46:56.700 that's a trade-off i'm willing to make at my age to reduce the risk of injury and i'm going to

00:47:03.320 not a maximum weight because remember maximum weight is not going to drive maximum power i'm

00:47:07.900 optimizing for power so I'm taking kind of a weight that's maybe two-thirds towards what I

00:47:14.020 would really do for a high strength set and I'm doing the most explosive movements I can do with

00:47:19.520 each leg and again the reason I like this Kaiser machine I have no affiliation with these guys

00:47:23.700 is it's measuring speed and force and power and so I'm just doing a power max optimize

00:47:31.380 By the way, once I fall below 92% of peak power, the set is over. So I'm really optimizing around

00:47:39.600 peak power there. So again, that's all focus on concentric movement. Now, conversely,

00:47:45.920 eccentric contraction is what happens when a muscle is lengthening under tension. Sometimes

00:47:53.960 when we lift, we are ignoring that eccentric phase. When I'm doing that explosive movement,

00:47:59.280 my leg is blasting out under maximum power of the concentric phase when i'm bringing that leg back

00:48:06.360 i'm not making any effort to do so slowly i'm not trying to put any stress in the eccentric phase

00:48:12.980 the slower you're bringing that weight back the more eccentric tension you are under so again

00:48:20.820 going back to the bicep curl i curl this thing up the slower i let that thing come down the more

00:48:27.260 eccentric tension I have. And by the way, that's what places the mechanical stress on the muscle

00:48:32.600 fibers, which creates more micro tears and damage within the fiber. And that's what's actually

00:48:38.360 driving hypertrophy. So whenever you're watching bodybuilders train, because again, bodybuilders

00:48:43.200 primarily concerned with hypertrophy, you'll be amazed at the eccentric control that they

00:48:49.980 demonstrate. Now, this is very important for minimizing injury. One of the things that I

00:48:54.900 think maybe sometimes people do wrong is they're not paying enough attention to their eccentric

00:49:00.020 phase. And for example, like if you're doing a leg curl, so you're sitting on a machine and

00:49:05.480 you're curling back under the concentric phase, you're shortening the hamstring and you just let

00:49:10.300 that thing go back very easy to injure these muscles. So I think we should almost always

00:49:15.340 be in control under the eccentric phase. The question is how much emphasis do you want to put

00:49:19.840 on each. So to give you just one more final extreme example, when I was cycling a lot,

00:49:27.680 so this is more than 10 years ago, anybody who knows anything about cycling knows two things

00:49:32.600 are true. You want very strong legs and you want to be as light as possible. So what role would

00:49:38.500 weights play in a cyclist's training? Well, one of my favorite exercises to do was very heavy.

00:49:47.380 and by very heavy, I mean typically five reps, very heavy hex bar deadlifts with drop sets.

00:49:56.480 By drop sets, I mean literally not dropping weights. I mean dropping the weight itself at

00:50:01.020 the top. So in other words, heavy pickup with good explosion on the concentric phase.

00:50:08.120 And you have to do this with a trap bar, not a straight bar, because then you, from a standing

00:50:12.140 position, drop the bar. So the whole hex bar just drops. And then you drop yourself down with no

00:50:18.860 tension and you pick it up and you do it again. So why would I do that? Well, I wanted maximum

00:50:23.520 strength and power with zero size because size is weight. Cyclist doesn't want any weight. He just

00:50:29.900 wants to have the strength. So that was a very powerful exercise. And by the way, I could do

00:50:35.400 that three times a week, sometimes four times a week, because without the eccentric phase and

00:50:41.200 without the tearing under tension of those muscle fibers, the recovery is very quick.

00:50:46.980 There's a lot of other things I did around those workouts. I was doing a lot of plyometrics,

00:50:50.840 what's called a post-activation potentiation type workout. So there's lots of really cool

00:50:54.700 things you can do, but maybe that's more than you wanted, Nick. I just think that

00:50:57.560 understanding concentric eccentric is a very important tool for training.

00:51:01.880 You mentioned this when you were talking about the Andy Galpin episode where you talked about

00:51:06.340 muscle fibers. Can you kind of give a brief summary of muscle fiber types and how they

00:51:12.400 change with age again? So whether you're talking strength, power, hypertrophy, they all have an

00:51:17.520 association with a type of muscle fiber. So strength and power are associated with the type

00:51:23.080 two fibers, the fast twitch fibers, and the endurance type stuff is the type one fiber

00:51:29.380 association. So slow twitch fibers. So again, type one fibers, less contractile force, contract

00:51:36.700 slower, less power, metabolically more fat dependent. They are more metabolically flexible.

00:51:45.260 They're the red fibers, by the way. They're red because there are lots of mitochondria,

00:51:50.840 lots of capillaries. Type two fibers, these ones have more contractile force, metabolically

00:51:57.440 glycolytic. And I think one of the most interesting things that Andy talked about in the podcast that

00:52:03.620 always stuck with me and has stuck with me since is that one of the most, and I don't remember if

00:52:08.780 he even described as the synquanon of aging, but certainly one of the hallmarks of aging

00:52:13.640 is the atrophy of the type 2A muscle fiber. So the fibers that are most responsible for power,

00:52:22.300 explosiveness are the ones that start to atrophy when we are already quite young in our 30s and

00:52:29.020 40s so power is the first thing we're going to lose then we lose strength then we lose size

00:52:37.060 that's kind of the order in which things go and therefore we think it's very important for people

00:52:43.560 of any age to always incorporate power training in what they do there's a use it or lose it

00:52:49.700 aspect to this. And we just think that it's imperative that we keep it.

00:52:54.160 That makes sense. And so if someone's thinking, okay, how do I improve my power in the gym?

00:52:58.620 What advice would you have for them? It's a lot like what I've talked about. You want to be able

00:53:02.480 to move quickly through concentric phases. And that turns out to be superior to traditional

00:53:08.940 resistance training. So there have been a number of studies that have looked at this. We found one

00:53:13.220 review of 13 studies that found power training superior to traditional strength training for

00:53:19.440 power. In other words, when you took people and you had them lift a certain amount of weight versus

00:53:24.920 lift the same amount of weight, but doing it quickly, not surprisingly, the improvements in

00:53:29.560 power came in the individuals that were lifting quickly. And just for the sake of time, I've

00:53:35.280 taken a little longer than I intended to, to this part. I'm not going to go through all of the

00:53:39.120 studies. They're in the show notes, but they're actually quite remarkable, the differences in

00:53:44.420 power based on the training. Again, you will become better at whatever it is you train for.

00:53:49.440 You kind of hinted at this earlier, but I think it's worth explaining quickly in a question because it's one we get asked a lot, which is what quote unquote intensity should I be training at? So it's something that I think people hear a lot. And so how do you think about the word intensity when it comes to someone's training?

00:54:08.220 Well, first of all, it is a very important variable in this entire equation. I think

00:54:11.960 there are different ways that you can think about it. So you can think about muscular failure,

00:54:15.820 which is the point at which you can no longer perform another rep. Do you need to do that

00:54:20.820 very often? No, you don't. In fact, there are risks associated with doing that. I find myself

00:54:26.240 there once or twice during an entire workout, and I'm not usually designing myself to go there,

00:54:32.480 but it's going to happen, obviously. Then you have technical failure. Now,

00:54:35.840 this is a place where I do get to quite a bit in a workout. This is when I can't do another rep

00:54:41.300 without compromising my form or cheating. And again, I think this is maybe easier for people

00:54:47.080 who have been lifting weights a longer time. You have a little bit more of a sense of what

00:54:50.700 cheating looks like, and that can be something as little as just rocking a little bit on a curl

00:54:55.520 or not doing a full enough rep or bouncing on the bottom or something of that nature.

00:55:01.180 And by the way, I'm not here to say that you should always stick to perfect form.

00:55:05.160 I've heard people far more intelligent and informed about bodybuilding than I will ever be

00:55:10.820 talk about all sorts of reasons why sometimes progressing through technical failure and going

00:55:16.040 into cheat reps is a great thing to do. And again, I would just defer to the experts on that.

00:55:20.720 The way I think about this though, and I think the most helpful way is to go through the rep

00:55:24.420 and reserve analogy or not analogy, but framework really, right? Which is, I think this is where

00:55:29.260 most people ought to live is in the one to two RIR, rep in reserve area. It's a very safe place

00:55:36.760 to be. You're not going to get into trouble. And by the way, you're virtually getting the same

00:55:42.480 benefits as going to failure on every set, which truthfully is almost impossible anyway.

00:55:47.680 So that means I'm stopping at a point when I could only do one or two more reps. Now,

00:55:56.400 you're never going to know what that feels like if you don't fail a couple of times.

00:55:59.940 You got to accept the fact I'm going to have to fail. Maybe don't pick a bench press when

00:56:04.140 nobody's around as the time to figure out what that feels like, but you can definitely figure

00:56:08.820 that out when you've got a spotter and you can definitely figure that out on an exercise where

00:56:13.180 the consequence of failure is very low. And again, everybody can figure this out. And once you know

00:56:19.000 it, I would just encourage people to be in the one to two RIR range for virtually everything

00:56:24.940 they're doing unless, again, they have very specific goals around power or around extremes

00:56:30.720 of strength. Peter, another question we get asked is when I'm in the gym, should I be focusing on

00:56:36.360 specific muscle groups? Should I prioritize full body movements? How do you think about that for

00:56:42.080 yourself and your patients? Compound exercises, which I think people are familiar with that,

00:56:46.780 but they're exercises that would engage multiple muscle groups and joints. It's really the joints

00:56:51.340 that they're talking about, compound joint, simultaneously. So a squat, a deadlift, presses,

00:56:55.640 rows, these provide the foundation for overall strength and muscle mass. And so again, when we

00:57:00.580 talk about powerlifting, which again is such an awful name, it should be called strength lifting,

00:57:04.780 it only has three exercises, a squat, a deadlift, a bench press. So those are three of the most

00:57:09.300 important exercises there are, clearly the foundation for what they do. Similarly, when

00:57:13.760 you look at bodybuilders at the opposite end of the spectrum, trying to generate as much muscle

00:57:17.140 mass as possible, pretty rare that they're not doing some variations of those. Now, a lot of

00:57:23.040 times injuries will allow them to do other things. They might not do a perfect squat. They might end

00:57:27.920 up doing variations of squats, but they're basically all working in the same thing.

00:57:32.580 Isolation exercises are also totally helpful, valuable. We should be doing those as well.

00:57:39.480 It's really kind of a question of time and goals. So if I don't have much time in the gym,

00:57:46.380 I'm only doing compound exercises. I'm trying to make the time to do accessory movements as well,

00:57:53.400 but I typically start with my compound movements and then move to my accessory movements later.

00:57:58.540 Other things to think about is that compound movements, they're challenging. I mean,

00:58:01.980 there's a skill to doing a compound movement. Anybody listening who's gone down the rabbit

00:58:07.540 hole of powerlifting and learning how to do a deadlift correctly and learning how to do

00:58:11.420 a squat correctly understands that you can have all the strength in the world,

00:58:15.120 but if you don't have the control and if you don't have the coordination to do these exercises,

00:58:19.100 you're not going to be able to translate your strength accordingly and you're probably going

00:58:22.840 to get injured. So in many ways that becomes part of the enjoyment of doing those exercises is it's

00:58:28.640 a technique more than it is just kind of a mindless activity. Is resistance training the

00:58:34.380 only way to build muscle? A lot of times we'll get questions on how effective our body weight

00:58:40.060 exercises. Like I like calisthenics. I like yoga. Is that sufficient as we think about muscle

00:58:46.320 strength, muscle mass? Resistance training with weights is hands down the most effective way to

00:58:51.460 build muscle. It's not the only way. One could clearly with the right types of body weight

00:58:58.920 exercises build muscle. That's going to be especially true for beginners. But I think we

00:59:06.140 need to sort of acknowledge that it's going to be very difficult with many of the bodyweight

00:59:12.060 exercises to get to that one RIR phase. Now, of course, pull-ups and push-ups can get you there.

00:59:19.580 The advantage of a pull-up is most of us are going to get there in a rep range that is more

00:59:26.920 congruent with hypertrophy and strength. I'm sure there's data out there that say the average

00:59:31.500 male and the average female can do X number of pull-ups, it's a low number. Conversely,

00:59:37.700 push-ups for most people, I think certainly once they become fit, most people would be doing enough

00:59:43.720 push-ups that going to failure, they're really going to be out there in muscle endurance land,

00:59:49.840 and therefore they're really not going to be able to put on much size. So if size and strength

00:59:56.660 our priorities, body weight exercises are not going to be your most effective way to go.

01:00:02.220 Doesn't mean you're not going to get some benefit. You will, but you're probably going

01:00:05.460 to get more muscle endurance. How do women need to think about this compared to men? 1.00

01:00:11.200 So one question we often get is as a female, should I be thinking about resistance training

01:00:16.380 any differently as you continually talk about it? I think it's safe to say this is an area I'm

01:00:22.760 looking forward to exploring a little bit more on the podcast. At the surface level, the advice is

01:00:28.060 generally the same. So there's not like some wildly different magic principle that says,

01:00:34.240 oh, women need to only go to three reps in reserve or need a totally different amount of volume.

01:00:39.320 For the most part, it's generally the same in terms of these principles and protein requirements.

01:00:47.020 But obviously the strength to weight ratios are going to be a little bit different. Women tend 1.00

01:00:51.580 to have more joint laxity and they may be more susceptible to injury. So they might need to be 1.00

01:00:56.680 even more mindful of tempo work, maybe more focus on the eccentric phase. But again, we're still

01:01:03.560 thinking about the same rep ranges. The hormones create a totally different issue. So reduction of

01:01:09.140 estrogen and testosterone during menopause, if they're not on HRT, will lead to elevated rates

01:01:15.240 of sarcopenia. We're talking about women who are not professional athletes, but ordinary women.

01:01:19.780 And so if anything, to me, that just says women need to be at least as mindful, if not more mindful of this. Again, I go back to the podcast with Belinda Beck, which is one of the most enjoyable discussions I've ever had just about the sheer bliss of watching these women in their 60s doing a clinical trial where they're basically instructed to just walk around and lift heavy weights and see how that improved their strength, how that improved their bone density, how it just improved their quality of life overall.

01:01:48.560 So yeah, women need to be lifting weights as much as men is the big take home. And while there may 0.93

01:01:54.360 be third and fourth order differences, I wouldn't let any of those discourage anybody from jumping

01:01:59.740 on it now. What are some metrics that people can do in the gym to track their progress on strength

01:02:05.560 slash goals they should have? You've often talked about a few in the past in different spots,

01:02:10.560 but you just want to talk maybe about a handful of if someone's in the gym wants to test where

01:02:14.980 they're at? What are a few things they could do to see? Before doing that, I think we should

01:02:19.240 acknowledge that tracking one RMs as a metric, one rep max as a metric of what one can do is a

01:02:26.100 totally reasonable way to do it. And it's a way that I used to do it for many years, right? I used

01:02:29.900 to be very tuned into my one rep max of a squat, a deadlift, a bench. And by the way, I didn't

01:02:36.020 always do the one rep max. There are very predictable formulas that say, if this is your

01:02:41.080 5-rep failure, your 4-rep failure, your 3-rep failure, your 2-rep failure will link to the

01:02:46.360 table that shows what the formula is. It's pretty straightforward. So truthfully, I would do a lot

01:02:52.240 of 2s and 3s, max 2, max 3, and impute my 1-rep. I don't do any of that stuff anymore. And today,

01:03:00.140 what I tend to focus on are other metrics that I care about. Some are power-related, some are

01:03:06.340 strength related. So I still keep track of my long jump. So just a standing broad jump.

01:03:12.540 Why do I love that? I think Andy Galpin also talked about this amazing exercise. Once you're

01:03:18.140 warmed up, don't do that one cold. That is testing in one movement, your maximum power

01:03:24.760 and your eccentric strength. So I don't know if you've done many standing jumps anymore, Nick,

01:03:29.980 But the takeoff is a maximum concentric power movement. But to stick that landing, you have to have the brakes. That's a maximum eccentric movement. One of the metrics that I just maintain in my life as I think about aging is I want to go as long as I can in life, being able to do a broad jump that is taller than my height.

01:03:50.500 on my floor. I have slightly longer than my height. I have six feet marked out on the floor and every

01:03:56.580 day I'm like, Hey, I don't do it every day, but every day I want to be able to make sure I can

01:04:01.300 comfortably do that. And at some point it's not going to be easy, right? And maybe at some point

01:04:04.360 I won't be able to do it. Pull-ups I think are a great test for people, especially if done under

01:04:10.640 control with complete range of motion, maybe doing an exaggerated eccentric. So we would say for

01:04:17.600 males, five or more. For females, three or more. Complete pull-ups with a three-second eccentric. 0.67

01:04:24.380 People have heard me talk about a dead hang. We say a target for a male would be two minutes,

01:04:28.620 for a female, a minute and a half. A wall sit with thighs parallel to the floor, 1.00

01:04:33.340 two minutes for both men and women. A farmer's carry, we would say, can you carry 100% of your 0.89

01:04:39.260 body weight? So 50% in each hand for a minute. As a male, 75% of your body weight, half of that in

01:04:44.580 each hand. If you're a female, a box step up with 25% of your body weight in each hand, 0.88

01:04:50.520 five reps per side. That's a big, big ham glute test. And then a wall pushup. We do a wall pushup 1.00

01:04:58.700 just so that your feet, you don't rock back and forth. It basically prevents cheating. So we'd

01:05:03.180 say, you know, could a guy do 20 really well controlled pushups? Could a woman do 10? Those 1.00

01:05:09.040 would be amazing markers of strength. And I think that what's more important to me is not whether

01:05:14.780 you hit these targets, it's whether you're making progress. We've talked about this before, so I

01:05:19.240 think we can go through it quick, but just if people are doing DEXAs to measure their muscle

01:05:24.000 mass, do you just want to remind people what metrics they're looking at on a DEXA and what

01:05:28.780 percentile you like to see them at? Yeah. And some DEXAs just give you this information. Most don't.

01:05:34.880 you usually have to calculate it on your own. So we look at appendicular lean mass index and fat

01:05:40.140 free mass index. So assuming you have a DEXA scan that's not showing this to you, you want to go to

01:05:46.080 the section where it says it shows you lean mass by extremity. So you would literally add up how

01:05:53.120 much lean mass in left arm, right arm, left leg, right leg, put that in kilos. So if it's done in

01:05:59.080 pounds, you got to convert it to kilos and then divide it by your height, which has to be in meters

01:06:03.760 squared, and then that number you put on a nomogram, which we'll include in the show notes,

01:06:08.300 and then you'll see your percentile. You do the exact same exercise with fat-free mass,

01:06:12.460 although there it's easier because you're just looking at total mass, subtracting out fat mass,

01:06:17.760 and dividing that by the height in meters squared. And again, you'll see these things are often,

01:06:22.600 I would say, concordant, but they can be discordant. We like to see people above or at

01:06:28.180 the 75th percentile for each of those metrics. But again, not everybody's going to get there.

01:06:32.900 There are some people whose genetics, like my wife, will never, ever, ever get above the 75th percentile. She's just not built that way. She has a tiny build and it's fine. We focus on her strength goals, not her size goals. She's not going to put that weight on. We're not going to spend much more time on it because I don't think it's nearly as important as the strength side of things. 0.99

01:06:54.480 That seven-year-old earlier today, what percent do you think he was in ALMI, FFMI? Was he above

01:07:01.020 75? Was he a strong kid? You know, it's funny. I've never seen the kid nomograms. They're going

01:07:05.480 to be different because they're so short, but I'm pretty confident he's going to be 97th percentile

01:07:11.680 by the time he's in high school. Oof. Okay. So he's strong. He's got potential.

01:07:16.620 As long as he stays away from diet soda. Yeah. Well, how do you think he got so strong to date?

01:07:21.060 he's not sitting there sipping diet cokes like a chump okay moving on from how-to questions to now 1.00

01:07:28.900 how often questions how can someone balance rest and recovery with intensity of workouts 0.98

01:07:35.680 common question we get asked is how frequently should someone work out and obviously that's

01:07:40.500 going to matter on how much time they have but also how do you think of that with balancing that

01:07:45.700 rest recovery with also needing to push to failure often, like we've talked about before.

01:07:52.680 Your training age, experience, age, genetics, other stressors, nutrition, sleep play such a

01:08:03.960 role in this. And because it's all so obvious which direction these things go into, again,

01:08:09.760 I'm not going to go down the rabbit hole of each of these. It should be apparent that if you're

01:08:14.060 young, if you're focusing on nothing but training, if you don't have any other responsibilities or

01:08:19.360 stressors in your life, if you're sleeping eight or nine hours a night, eating nonstop, there's a

01:08:25.380 scenario where you can just train all day, every day. And then there's a scenario where you're

01:08:29.740 like the rest of us and you got to pick and choose. I've experienced all sides of this and

01:08:35.400 I'll probably just come at this through the lens of what I do and what I recommend my patients do

01:08:40.380 because my patients, like me, have time as their bottleneck. And I think that's probably true for

01:08:46.300 most people listening, is we don't have infinite amounts of time, so how do we make the best use

01:08:51.320 of the time we have? I think it is abundantly clear that if you train with the right exercise

01:08:57.200 selection, with the correct intensity, the right volume, you might only need to train each body

01:09:03.980 part once a week. In fact, some of the most serious bodybuilders of all time have got away

01:09:09.080 with training each body part once a week. And if they can do it, certainly the rest of us schleps

01:09:13.300 can do it. Now, of course, you can do full body workouts two to three times per week and rotate

01:09:20.240 the types of exercises that go into it. I find that approach to be better for people who are

01:09:25.960 early to strength training. Whereas I find the more experienced you get, the more you want to

01:09:30.840 go deeper on a set of muscle groups for a given day. So I've played with all of these. I really

01:09:37.840 like what I've been doing for the past year or so, which is three resistance workouts a week.

01:09:43.640 A body part is done once a week and that's it. It's done very hard. It takes me a couple of days

01:09:49.420 for that body part to recover. So for example, when I do legs on Monday, which I do my Tuesday

01:09:55.780 zone two ride, that would be the most I could muster up. I would not even attempt to do a VO2

01:10:01.960 max workout the next day. And sometimes I'm sore from the lift for a day or two, not uncommon.

01:10:07.840 Of course, we also talk about deloading. I referred to this earlier. Mike Istratel on a previous podcast recommended one week every eight to be either a significant deload or even potentially a full off week. And then a two week, don't even go to the gym, maybe just do some other exercises once a year. I think that's part physical. I also think it's part mental.

01:10:31.620 Now, again, part of that is when you're training at the level that somebody Mike is at, it's probably an important thing to consider. At my level and for my patients, I typically am not recommending it because none of us are training quite hard enough where we really need that full deload. Life tends to offer us deloads through vacations and things of that nature anyway, where you might just use your trip away where you can only use the hotel gym as your time to deload.

01:10:58.880 Is there a way for someone to tell maybe if they are overtraining?

01:11:01.880 Or another way to think about it is someone who's newer to training and they're starting

01:11:05.680 to train, is there a way or something that they can pay attention to to say, okay, maybe

01:11:10.960 it is worth dialing it back for a few days to rest?

01:11:15.100 I know this is going to sound very unscientific, but I have not found anything to be a better

01:11:19.980 predictor of this than willingness to train.

01:11:22.400 Now, I do look at other factors.

01:11:24.240 So especially on the cardio front, I'm very attuned to my resting heart rate and my heart

01:11:29.180 rate variability and my sleep quality. Those things tend to be far less predictive of my

01:11:35.100 performance in the weight room. I think it's important that people learn to differentiate

01:11:39.280 the reluctance to train because I'm really busy and I don't want to get up from my desk or

01:11:44.560 leave what I'm doing now to go in the gym versus, okay, now that I've gotten to the gym and I'm

01:11:48.960 warmed up, I still don't want to train. Those are two different things. I often experience the

01:11:53.180 former. I'm too busy. I'm in a good groove. I don't really want to go and do this thing

01:11:57.420 versus, okay, no, no, I'm here in the gym. I've got through my warmup sets. I actually feel like

01:12:02.000 crushing it. When I'm in that second set and I still don't want to be in there, that's usually

01:12:07.740 a sign I shouldn't be in there. Or if I'm going to be in there, I should totally mix it up and

01:12:11.840 do something that is totally unrelated. Just work on a whole bunch of movement things and just sort

01:12:16.740 of get out of it and come back for another day. That to me is, I think, very important. I will

01:12:21.280 add a caveat to that, which is that technique tends to be more applicable, the more experienced

01:12:27.500 you are. So, you know, if I took a person who's never exercised and said, Hey, just use your

01:12:32.560 interest in exercising as a metric, they might never exercise. So unfortunately you have to sort

01:12:38.340 of develop enough experience to be able to use that. One question we get commonly asked, which

01:12:43.260 I think is just due to the rise of wearables that people have is where does HRV fit into

01:12:49.340 understanding where someone's at and if they should be training intensity, day off, etc.

01:12:56.680 Yeah, we've certainly talked a lot about heart rate variability. And I do think that the absolute

01:13:01.740 number comparing yours to your friends is not relevant, but comparing yours to yourself,

01:13:07.160 provided you have an accurate way to measure it. Again, I've talked a lot about how I like using

01:13:11.400 a device called Morpheus, no affiliation with Morpheus, but I like it because you use either

01:13:17.120 a chest strap or an armband where the optical sensor is in the antecubital fossa. So you're

01:13:23.720 actually getting a very accurate measurement. Things on the wrist and hand are not nearly as

01:13:28.000 accurate. So for that setting, seeing your HRV consistently low, especially if accompanied by

01:13:34.200 high resting heart rate, that usually tells you you're fatigued. Low parasympathetic flow,

01:13:39.400 high sympathetic flow doesn't mean you're going to have a bad workout, by the way. I've actually

01:13:44.160 paradoxically had some insanely good workouts, waking up on the heels of high sympathetic drive.

01:13:51.420 Why? Because that at least transiently gives me a big boost. But chronically, that's problematic.

01:13:58.200 And so chronically, one has to be mindful of how you meter that experience and finding.

01:14:04.400 Let's say outside of kind of what we talked about, HRV and willingness to train, are there any other,

01:14:10.960 let's call them warning signs that if someone's in the gym, they're very willing to train excited

01:14:15.940 about it. But if they're seeing certain things, feeling certain things, they should kind of think

01:14:20.500 to themselves, okay, maybe today is not a day to push. I would say persistent muscle soreness.

01:14:26.940 You're not recovering. You're getting the good quote unquote burn that normally accompanies

01:14:32.480 maybe a workout a day or two after, but it's never going away. It might be that you really

01:14:36.700 need to take a rest, at least from those body parts. Another one that I'm pretty mindful of

01:14:41.160 is just decreased performance. Because I log a lot of my data, especially on the bike,

01:14:46.660 I'm very cognizant to the meta cycles I go through in the year. And I sort of have a sense of like,

01:14:53.320 for example, because I live in Austin, this is not going to be surprising to anybody who's been

01:14:57.140 here in the summer. My performance on the bike actually goes down in the summer, probably by

01:15:02.060 5-7%. I've been here five years now, so it's a pretty reproducible finding. I believe it is

01:15:07.960 solely just due to the heat. Even though I'm still going to go out early in the morning to do a ride,

01:15:12.160 like, it doesn't matter. The difference between riding at 85 degrees and riding in the winter,

01:15:17.020 if it's 55 degrees, is huge in terms of VO2 max performance. But knowing in addition to those

01:15:23.980 changes, are there other decreases in performance? And again, here we're talking about being in the

01:15:28.380 gym, I think that's important. I think you also have to be very mindful of pain that is indicative

01:15:34.380 of potential injury. So joints that are hurting, things that hurt more with use, those would be

01:15:41.120 things I'd care a lot about. There are probably other things. The problem is other changes like

01:15:45.760 mood and irritability, which can certainly indicate overtraining. They are so nonspecific

01:15:51.240 that it's very difficult. I think you have to just try to gestalt through thinking about these

01:15:55.860 things. A question that we get asked a lot about, especially when it relates to newer people to

01:16:01.340 exercise. So if someone's listening and they're like, look, I haven't been resistance training.

01:16:05.920 I want to start. I'm really worried about getting injured because you often talk a lot about the

01:16:12.060 benefits of healthspan, not being injured and the ramifications I can have. You have a patient come

01:16:18.040 to you and say, Hey, I'm willing to do this. What are some ways that I can start this in hopes of

01:16:24.340 not getting injured and doing this for a long time, what advice are you giving them?

01:16:29.040 It's in line with what we're saying here, which is I think everybody, but certainly a beginner

01:16:34.100 or somebody coming back to it after a significant period of time off. So someone who might've been

01:16:38.900 the high school football star who lived in the weight room, but now they're 40 and they're kind

01:16:43.280 of coming back to it. Act as though you've never done this before. Focus on injury prevention,

01:16:47.620 work on gradual progression learn foundational movements learn correct form joint injuries often

01:16:56.080 result from high load fatigue both of these so you want to have controlled movements both on the

01:17:03.500 eccentric and concentric side so even if you're not exaggerating concentric if you're just doing

01:17:08.440 one-to-one tempo or one-to-two tempo still controlling it i think that assisted movements

01:17:14.940 are really really helpful so even on pull-ups and things of that nature there's enormous value

01:17:21.440 in doing pull-ups with bands so that you can get into a complete rep range use proper scapular

01:17:28.880 control and not injure your shoulder or your elbow because you have to cheat because it's

01:17:35.920 just such a heavy movement doing lots of things with body weight until you figure out the right

01:17:41.860 position to be in. Again, I've talked about some of these before, but relying more on eccentric

01:17:46.800 load to keep the weight down. And I think another very important principle for everybody, certainly

01:17:52.440 something I spend a lot of time adhering to, is using unilateral things. So, so much of what I do

01:17:58.140 for my legs, I'm just trying to think. One, I would say 50% of everything I'm doing on a leg day

01:18:05.340 is single leg. My left and right leg are doing separate things, which is allowing me to actually

01:18:10.900 use a fraction of the weight, but I'm still obviously getting the same amount of work.

01:18:15.500 It also develops, I think, a better coordination for many things. So I think those are kind of

01:18:19.960 some of the principles that are helpful here. Moving on to now things outside of the gym,

01:18:25.460 specifically nutrition. So obviously you've talked in the past, nutrition is an important

01:18:30.820 factor as it relates to muscle growth. So how do you think about protein, which is something

01:18:38.720 you've talked about before for a variety of reasons as it relates to growing muscle and

01:18:45.160 how much protein should people get? So again, the recommended dietary allowance, the RDA is 0.8

01:18:54.060 grams per kilogram per day. That's sort of the lower threshold to prevent malnutrition. It's

01:19:01.820 generally very inadequate for trying to build muscle or even preserve muscle once you age.

01:19:08.720 So if you're trying to do what we're talking about here, you're going to want to be in the

01:19:14.060 1.6 to 2.4 grams per kilogram per day, kind of call that 0.8 to 1 gram per pound of body weight.

01:19:23.740 People who are less active and older might even need to be higher due to anabolic resistance.

01:19:28.960 So easy rule of thumb, roughly a gram per pound of body weight. If you're older than 60, you might

01:19:37.200 even need a little bit more than that. Again, if you're a little bit less than that, it's not the

01:19:41.920 end of the world. But you don't want to see somebody at 0.4 grams per pound or 0.5 grams

01:19:48.160 per pound of body weight. I think that's almost certainly insufficient to meet the demands of

01:19:53.460 aging. Another question we get often asked, types of protein. Are there types of protein that matter

01:19:59.060 more than others? Proteins are made up of 20 amino acids. Nine of them are essential, so the body

01:20:04.920 can't synthesize them. So those are the highest priority is getting essential amino acids.

01:20:10.360 Leucine being one of them also turns out to be a very important amino acid at triggering

01:20:15.440 muscle protein synthesis, or MPS as we call it. And so we're really looking at the completeness

01:20:22.660 of a protein source, so how many of the essential amino acids does it have, what's the digestibility,

01:20:29.260 and when it comes to those metrics, animal proteins generally, if not completely, outdo

01:20:36.540 animal proteins for completeness and digestibility. So really the big three that we think of are dairy,

01:20:43.420 eggs, and beef. So if you have a diet that's giving you sufficient servings of dairy and beef

01:20:50.240 and eggs, you can be 100% sure you are getting sufficient amounts of protein just by hitting

01:20:58.500 your volume numbers. Now, I realize that many people listening to us either don't fancy those

01:21:05.180 foods or, for other reasons, might choose to abstain from them altogether. The good news is

01:21:10.100 it's okay. You don't have to consume animal products to meet your goals. You can indeed

01:21:16.120 achieve these goals with plant-based proteins, it will just require two things. It will require

01:21:22.580 probably eating more protein and probably cooking the protein whenever you can to increase the

01:21:29.840 digestibility and absorption of it. We often recommend with patients who heavily favor

01:21:37.340 plant-based proteins, and by the way, as you can appreciate, there's variability in here.

01:21:41.700 So there's people who don't want beef protein, but they're still happy to consume eggs or dairy

01:21:47.020 protein and vice versa. So there's lots of ways around this. But if we're talking about somebody

01:21:50.620 who's really only going to be interested in plant proteins, we tend to get them to try to really

01:21:56.340 focus on hitting the right amounts of some of the essentials. And I'm not going to lie, it's not easy.

01:22:01.820 It's not the optimal way to do it. But if you're willing to make the choice, then I think you have

01:22:06.300 to put a little bit of effort into that. What about protein timing? How do you think about

01:22:10.840 the timing of protein throughout a day as someone is thinking about optimizing their protein intake?

01:22:16.620 I think the data on this are still evolving. And I think the way I would have answered this

01:22:21.060 question two years ago is probably different than the way I would answer it today. And I honestly

01:22:24.640 think it depends a lot on the protein source. So a lot of times studies that are looking at this,

01:22:30.480 they're using radiolabeled isotopes of amino acids in liquid form, and they're measuring

01:22:37.620 muscle protein synthesis. And those studies tend to find that you want multiple small protein meals.

01:22:46.060 You certainly want to get your first bolus of protein right after working out, but you can only

01:22:51.560 incorporate 30 or 40 of those grams. And so you need to be continually reactivating over time.

01:22:57.780 Again, that might be true for the situation in which that's done, but we've also seen that

01:23:02.460 casein versus whey, which is also a dairy protein, produces a much longer and slower delivery of the

01:23:09.800 amino acids. And so I tend to think a lot less about this than I used to. I used to really

01:23:15.460 worry about exactly when I was consuming protein. Now that I don't consume whey protein shakes that

01:23:22.500 much, if at all, and I tend to eat more of my protein, I'm just trying to get 50, 40 to 50

01:23:29.360 grams of protein four times a day through a meal or snack. And I'm not thinking that much more

01:23:36.640 about it. What I try to do is avoid lower doses. So I'm not just going to be out there eating 10

01:23:43.320 grams of protein in a sitting and nothing else. Now, again, we've covered this so much in one of

01:23:48.580 our previous newsletters that I think just as everything that we're talking about here,

01:23:51.980 the show notes will have a lot more detail on this. One question we get asked a lot about,

01:23:56.400 I think, as you kind of mentioned, this field is evolving, but I think one thing that sticks

01:24:00.180 with people is the importance of post-workout protein. How necessary is that? Again, I think

01:24:08.660 it's less important than we used to think. I am going to consume protein pretty much right after

01:24:14.380 a workout, but that's also because I'm not consuming protein typically before the workout

01:24:18.680 because I'm working out in the morning. But that window, that anabolic window is pretty broad.

01:24:24.160 I mean, four to six hours. So I don't think it's something one needs to lose sleep over.

01:24:30.720 Your hunger will probably dictate it anyway, because you're going to be hungry within an

01:24:34.760 hour or two after a workout, although probably not right after. So I don't think you need to

01:24:40.060 stop the press. I don't think you need to stop for breakfast right after the workout, be late for

01:24:46.380 work or whatever. I think you can certainly wait an hour or two, especially with what we understand

01:24:51.720 today based on that anabolic window. Another piece of this that we get asked a lot about is,

01:24:58.000 let's say someone is time-restricted eating or fasting, quote-unquote, throughout a given day.

01:25:05.020 So they're only consuming food for a few hours throughout the day. And then we also have people

01:25:09.840 who are fasting for multiple days. So how does fasting caloric restriction, whether within a day

01:25:17.380 or multiple days impact muscle mass? And how should people who are using those tools think

01:25:23.800 about that so they don't potentially lose too much muscle? Some of these things are going to

01:25:29.400 be less relevant if you're using high amounts of anabolic steroids, where you can fight the

01:25:34.060 inertia of this more. But if we limit this to people who are either not taking anabolic steroids

01:25:38.940 or who, if they are, they're doing it under physiologic replacement levels, it's very

01:25:45.160 difficult to maintain muscle mass as you are losing weight. So if you create enough of a caloric

01:25:51.380 deficit, regardless of how you do it, fasting, intermittent fasting, time-restricted feeding,

01:25:57.880 whatever you want to call it, anything that creates a caloric deficit sufficient enough

01:26:02.800 to induce weight loss is going to put muscle mass at risk. Now, what can you do to minimize that?

01:26:09.420 you can meet your protein needs of approximately one gram per pound of body weight and maintain

01:26:15.460 high levels of resistance training. Now, when I was doing a lot of fasting, obviously I was

01:26:21.360 creating an enormous caloric deficit. I was not eating a thing, so I was not getting any protein.

01:26:26.380 I did resistance train, but all the resistance training in the world wouldn't have mattered.

01:26:30.500 By the way, had I still consumed 200 grams of protein for a whopping total of 800 calories per

01:26:37.240 day, I'm not convinced I would have been able to have fought off much of the muscle mass loss

01:26:43.600 because that is still such a low calorie amount that, you know, I'm in such a caloric deficit

01:26:48.820 that I was going to lose weight. Most of that protein would have been converted into glucose,

01:26:52.880 I suspect. I don't think I would have had enough anabolic stimulus to maintain muscle mass. So

01:26:58.200 I would say that when you look at bodybuilders who, again, are the masters of this, they're not

01:27:04.080 going through enormously rapid periods of weight loss. And that's generally what's allowing them

01:27:10.100 to preserve lean mass. In addition to, of course, the use, as is often the case in untested body

01:27:16.400 building, the use of anabolic steroids. But even if you look at people who are in tested categories

01:27:20.640 of bodybuilding where they're drug-free, I still think their fastidious attention to diet and how

01:27:25.520 they're doing it is what allows them to do this. Now, there are data that suggests that protein

01:27:29.720 intake by itself can be proactive. And we know this, right? So again, I think it was Luke Van

01:27:36.340 Loon who had this great analogy of the bricks are the brick layers. So protein by itself is able to

01:27:44.700 induce muscle protein synthesis in the context of modest calories. There are some studies we'll

01:27:51.320 link to that will show that even with significant caloric restriction, not as extreme as I just

01:27:56.640 described, but say a 30 to 40% caloric restriction, sufficient enough protein and resistance training

01:28:03.800 is able to maintain some amount of muscle mass and maintain some levels of muscle protein

01:28:11.400 synthesis. So again, it can be done. It's a needle that is not trivial to thread. And for most people

01:28:18.940 losing weight, especially if you're losing a lot and or losing it quickly, you're going to

01:28:23.580 probably give up some lean mass. Beyond protein, any other aspects of nutrition that someone

01:28:30.380 should be aware of as they're using to think about supporting muscle gain?

01:28:35.440 Obviously, hydration matters. It sounds silly, but given that muscles themselves are made up

01:28:39.520 of 70% water, which explains why creatine plays a role here. So I'd say hydration, creatine use,

01:28:46.860 and recovery. So failure to recover is going to make it very difficult to grow.

01:28:52.380 that's one of the things that people who are overtraining are sort of missing on. So dehydration,

01:28:58.220 of course, reduces the function of muscle. Creatine, again, we've talked about it a bunch,

01:29:03.300 but it's just worth remembering what it is. Creatine is a phosphate donor. So it's kind of

01:29:07.780 the fastest way to generate ATP. Multiple clinical trials, meta-analyses nonstop demonstrate that

01:29:16.700 creatine is favorable in terms of strength, power, and muscle mass. So I always tell people it's

01:29:23.260 really one of the few supplements that I almost universally recommend. There aren't many things

01:29:27.900 that I just think universally make sense to people who are exercising, or anybody for that matter,

01:29:33.560 and creatine's probably the closest we have to that list for me. Beyond nutrition, any other

01:29:39.440 quote-unquote lifestyle factors that people should be aware of that can affect their ability to gain

01:29:46.280 muscle, focus on muscle mass resistance training. Besides things you can't change like genes,

01:29:51.240 we've talked about the training itself. We've talked about the nutrition itself, recovery,

01:29:57.820 hormones, sleep, stress, huge, huge role here. So let's take the most obvious of these,

01:30:04.260 which is hormones. The more testosterone you have, the easier it is to put on muscle mass,

01:30:09.840 full stop. This is true if you're a man. This is true if you're a woman. This is true if you're in

01:30:13.640 menopause. As it's true, if you're not in menopause, more testosterone, all things equal,

01:30:17.660 more muscle, especially when compounded with a training effect. But what's a lot more difficult

01:30:23.140 to appreciate is more cortisol, less muscle. Chronically elevated levels of cortisol are

01:30:28.600 actually catabolic to muscle. We see the most extreme example of this when we look at a patient

01:30:32.880 with Cushing's disease or Cushing's syndrome, where they actually experience muscle wasting

01:30:36.620 due to the hypercortisolemia. But for many of us listening who don't have Cushing's disease,

01:30:41.000 but who still probably walk around with too much cortisol, it's definitely hurting us. And

01:30:45.260 unfortunately, you don't have a pill you can take that makes your cortisol levels go down. You've

01:30:49.500 got to do all of these challenging things that we all are working very hard to do to reduce

01:30:54.200 our level of perceived stress. If you're not sleeping enough, you're not recovering enough.

01:30:59.000 This is when the body is mostly going through its rebuilding and resilience phase. We joke about it.

01:31:04.680 You see bodybuilders, they're like sleeping nine, 10 hours a day. They're putting their bodies under

01:31:10.000 so much stress that they need that maximum time to recover. So the harder you're training,

01:31:14.540 the more you need to sleep for sure. Consistency, of course, plays such a big role in this.

01:31:19.480 So many things in health come down to compounding and you are not going to make great gains if you

01:31:25.060 are inconsistent in what you're trying to do in the gym. So if you could have the best month of

01:31:29.340 your life, but if the next month you're inconsistent and you repeat that cycle over

01:31:33.560 and over again, it's not going to really matter. So Peter, I think what would be helpful as we

01:31:38.220 kind of think about wrapping this AMA is picking a few different types of people. Let's say someone

01:31:45.260 who's newer to exercise and newer to resistance training and is younger. What does some programming

01:31:52.040 look like for them and how could they take that information to a gym and start to execute against

01:31:58.380 it? We can look at someone who is newer to exercise but older and look at how that maybe

01:32:03.880 differs than the younger person. And then I think we can look at someone who's seasoned at resistance

01:32:09.500 training and has been doing it. Is there anything they should do to modify their workouts to really

01:32:14.680 have maximal achievement here based on what we talked about? So I think let's start with someone

01:32:20.480 who hasn't been resistance training is quote unquote younger patient comes to you and says,

01:32:25.800 hey, I'm willing to do this. What do you want my programming to be? What should it look like

01:32:30.120 when I get to the gym. So first off, many ways to do this. There are going to be trainers listening

01:32:35.440 to this who say, I wouldn't do this. I would do that. Look, I think there's lots of ways to do

01:32:38.720 it. This is one way to do it. And by the way, this is a really, really fun demographic of people to

01:32:44.800 work with. Why? Because if they adhere to this type of routine, they are going to see pretty

01:32:52.200 remarkable gains. So one way to skin this cat is to actually do the exact opposite of say what I'm

01:32:58.160 doing where you do a three-day full body program. On each day, you will do each body part to some

01:33:05.960 effect. I don't recommend this for someone who's more advanced and wants to use more intensity and

01:33:12.080 things of that nature. But for this person, it can be great. So I would say, look, do a Monday,

01:33:16.700 Wednesday, Friday, or a Tuesday, Thursday, Saturday split. We're going to do time in gym,

01:33:21.840 one hour each workout. So again, this is exactly what we're going to do with a patient in this

01:33:27.100 situation who we're just introducing to the gym. So let's just say, Nick, we've got a person who's

01:33:31.880 been long on cardio. So more typically, this, by the way, might be a female, not to stereotype,

01:33:37.520 but that's more often the way it shows up. They're super long on cardio, in great shape, 0.58

01:33:42.900 very low muscle mass though. They've never lifted weights before. But then I'm going to say to them,

01:33:47.340 how much are you willing to exercise a week? They say they're willing to give me six hours

01:33:51.520 a week of training. We're going to take them to very high levels on their cardio front in three

01:33:55.960 hours a week, but I'm going to have them spend these three one-hour sessions in the gym.

01:34:01.160 So one hour in the gym, we would target a minimum of 10 and maybe as many as 20 sets per body part 0.88

01:34:09.380 per week. So again, they're going to spread that out over the three workouts. They might do three

01:34:15.340 to four sets per exercise, anywhere from six to 15 reps per exercise, anywhere from 90 to 120

01:34:25.000 20 seconds per exercise. I'm often going to have them supersetting on this because we have the

01:34:30.940 luxury of them doing whole body. They're getting rest from a given exercise, but while they're

01:34:35.740 doing something for their back, I might have them rest, quote unquote, by doing something for their

01:34:41.000 chest. So you're using opposing muscles. Start them out at a very low intensity of three to four

01:34:47.220 RIR, working them up to one to two RIR. And this is a person who's not going to stop moving.

01:34:53.340 We're either going to pair up hosing muscles like chest and back or completely different. As recently as two years ago, I was doing a whole body workout every maybe three days a week where I was alternating lower body, upper body, lower body, upper body supersets all the way through. Lots of ways to do this, but that would be one way to do it.

01:35:13.620 You kind of hinted there, but just, I think superset sometimes is a new term for people.

01:35:19.040 So do you just want to give like a really quick, clean definition in case people

01:35:22.560 didn't pick it up from what you just said? Let's say you're doing a bicep and a tricep superset.

01:35:29.700 Instead of just doing bicep, curl, rest, bicep, curl, rest, bicep, curl, rest, you would do a

01:35:36.040 bicep curl and then a tricep extension or something like that. And then a bicep curl

01:35:40.380 and the tricep extension. So you're resting one muscle while you're working an opposing muscle

01:35:45.000 or a completely different part of the body. It's much more time efficient. To be clear,

01:35:49.660 you wouldn't typically, you could, there's a totally different reason for doing this,

01:35:54.060 but for this person, I would not superset chest and tricep or back and bicep because those are

01:36:01.660 not really opposing muscles and you're now getting into fatiguing supporting muscles.

01:36:07.560 There's a time and a place for that

01:36:08.780 if you're trying to make improvements.

01:36:10.680 So for example, if you're trying to improve your pull-ups,

01:36:13.120 you will superset them with bicep curls

01:36:15.420 because you're pre-fatiguing the bicep.

01:36:18.380 And so you're trying to double up on failure

01:36:20.600 and break through plateaus and things of that nature.

01:36:22.500 Not what we're doing with this person.

01:36:24.180 Perfect.

01:36:25.020 So now let's take same person, new to training,

01:36:29.160 haven't been resistance training,

01:36:30.800 but they're older in age.

01:36:32.180 How does the programming you gave

01:36:34.460 the younger person differ here?

01:36:36.060 the principles are the same because they're new to this but we want to probably start with lower

01:36:40.960 volume lower intensity and maybe increase a little more gradually big form here big focus is on form

01:36:48.040 of course and probably slower tempos looks very similar to the other person but the intensity is

01:36:56.680 going to be considerably lower that other person by the way is going to really feel smoked in the

01:37:02.080 hour because they're not going to stop moving. This person, depending on their age, I might even

01:37:07.720 not do the supersets by the way. And therefore they have fewer exercises that they're going to

01:37:13.120 get done if they're allocating the same amount of time. For these newer people, one of the questions

01:37:18.260 we can get asked is if I'm going to the gym, I have two options. I have free weights, which could

01:37:23.380 be dumbbells, kettlebells, et cetera. And I have machines. So based on the comment you just made

01:37:28.800 about form, if someone's newer to the gym and has that optionality, do you traditionally like to

01:37:35.000 encourage them to start with machines because there's less risk in the form variation than

01:37:41.360 free weights? I think it depends on their setup. So sometimes they'll have a trainer and if the

01:37:46.440 trainer's really good, I think it's fine to do anything. Look, I mean, again, go back to the

01:37:50.600 Belinda Beck discussion of the Liftmore study. They were deadlifting. 65-year-old women who'd

01:37:58.320 never touched a weight in their life, we're deadlifting. This is one of the most complicated

01:38:03.280 movements you could ever try to teach somebody. What does it tell me? It tells me if you know

01:38:07.660 how to teach somebody how to do an exercise, they can do it. So I don't think it has to be that,

01:38:12.860 oh, if you're a novice, you have to do machines. I think machines are great. It's a great way to

01:38:17.100 start. And then sometimes it's a less intimidating way to start, especially for a person who doesn't

01:38:21.040 have a trainer and is kind of going to go and figure this out at their gym, which by the way,

01:38:24.580 might seem really intimidating if they have to go to the section of the gym where there's just

01:38:28.380 benches and sweaty dudes and dumbbells, but maybe it's less intimidating, you know, to be where the

01:38:32.820 machines are. So I don't want to make too much hay out of it. I just kind of want that person in the

01:38:37.460 gym and moving stuff around and developing a little bit of confidence without hurting themselves.

01:38:41.680 And machines are a great way to accomplish that. So let's now take a person who's been resistance

01:38:47.440 training. Anything specifically you recommend to them for their programming, should they modify

01:38:53.500 in any ways, what type of advice are you giving a patient who's resistance training, some in the

01:38:59.460 gym, but comes to you and says, hey, I want to maximize this for lifespan, healthspan benefits?

01:39:05.380 What would you say? Honestly, at this level, Nick, it's totally different. I mean, if you take the

01:39:10.580 seasoned person who's saying, I love doing this, but this is kind of like me talking to me. Now,

01:39:16.260 what am I thinking about? And I have many patients who are in this boat as well. They love lifting

01:39:21.060 weights. They've been doing it for a long time, but they need a direction to go in. And I think

01:39:26.000 this is where the centenarian decathlon becomes very, very helpful, which is, okay, you have to

01:39:31.440 define your sport. What is it you want to be able to do in the last decade of your life?

01:39:36.200 I want to be able to swim a mile. I want to be able to ride a bike. I want to be able to hike.

01:39:41.760 I want to be able to play soccer with a kid. I need to be training in ways that allow my muscles

01:39:47.900 to be able to do that. So a lot of it actually comes down to taking things away that were

01:39:54.620 increasing risk. I haven't deadlifted in over a year. Truthfully, most of the times I deadlifted,

01:40:00.500 I felt pretty good. But once a month, I didn't. I was just too fatigued, was too distracted. I just

01:40:07.640 did something where my back would get a little irritated, was never a big problem. It's not like

01:40:13.460 it ever resulted in sciatica or any of these cataclysmic outcomes. But it just occurred to

01:40:18.460 me. I was like, well, I don't need to take this risk anymore. Now, again, there's going to be

01:40:21.520 somebody listening to me that says, this guy's horrible. How could he stop deadlifting? What an

01:40:25.660 idiot? Okay, fill your boots. You want to deadlift all day? Knock yourself out. And I hope you do it 1.00

01:40:30.320 safely for the rest of your life. I can just tell you that for me, the risk reward trade-off wasn't

01:40:35.380 there when there are so many other exercises that I can do. I can do Hetfield lunges and squats. I

01:40:41.220 can do belt squats. I can do so many things that are producing virtually no axial load on my spine

01:40:48.220 and I never ever have even the slightest irritation. So that's an adjustment that I've

01:40:54.840 made. Is that making me bigger or stronger? No, it's not. It's de-risking. So de-risking is

01:40:59.740 becoming a component of taking myself towards my goals. It's also focusing on things where I see

01:41:05.660 deficits. It's also focusing on areas where I say, hey man, I'll give you an example. I am

01:41:11.600 constantly worried, as I think every middle-aged person is, about tearing their Achilles. We all

01:41:18.240 have a friend who's done it. I'm sure somebody listening to us has done it. I'm very paranoid

01:41:22.600 about this. It's such a devastating injury. It sets you back so far. And it always seems to happen

01:41:28.920 when a person's muscles exceed the capacity of their connective tissue. It's often someone who's

01:41:36.880 pretty athletic or who was formerly very athletic, who tries to go back to do something and they

01:41:41.880 engage in an explosive movement, but then they tear the connective tissue. So it sounds silly,

01:41:47.580 spend a lot of time bouncing, spend a lot of time doing exercises like calf raises that are

01:41:55.220 seemingly quite boring, but that just work on strengthening that connective tissue between

01:42:02.160 the muscle and the bone. So I can't give a generic answer here other than to say this is finishing

01:42:09.580 school. This is why we created 10 squared. I haven't talked too much, I guess, about 10 squared,

01:42:14.320 but this is why we created an entire company around taking people, regardless of their level

01:42:21.500 of athleticism or experience and training them for the marginal decade, because the level of

01:42:27.560 precision that you need to train for this is as important and as nuanced as if you were training

01:42:33.800 for a very specific sport at a young age, like a decathlon or a triathlon or something like that.

01:42:40.180 I think that covers everything we wanted to cover in this AMA. So that said, anything you want to

01:42:46.420 ad, anything randomly in your head, any advice on life that you have for anyone out there still

01:42:53.620 listening? Still listening. God, that sounds depressing. I don't think so. I think I've

01:42:58.320 spilled all my advice for a month. There we go. Well, good thing we'll see you next month then,

01:43:02.760 and we'll get more of that life-spilling advice. I think that's all we got. Peter,

01:43:06.680 thank you very much for showing up again. Thank you.

01:43:10.060 Thank you for listening to this week's episode of The Drive. Head over to PeterAttiaMD.com

01:43:16.400 forward slash show notes. If you want to dig deeper into this episode, you can also find me

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The Peter Attia Drive - July 06, 2026

Building strength and muscle mass： how to optimize training, nutrition, and more for longevity (AMA #71 rebroadcast)

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