206 - Exercising for longevity: strength, stability, zone 2, zone 5, and more | Peter Attia, M.D.

Intro (00:00:00)

• Peter Attia introduces 'The Drive' podcast, which aims to make the science of longevity accessible.
• The podcast is part of a broader content offering, which includes a website and a newsletter.
• A membership program offers in-depth content for those wanting to deepen their longevity knowledge.
• This special podcast episode compiles various exercise-related clips from previous episodes, providing a thematic overview to help listeners better understand Attia's exercise framework.
• The focus is on exercising for the 'centenarian olympics'—a concept promoting longevity.
• Feedback on this episode format is encouraged, as future episodes may be affected by listener input.

What is Peter optimizing for with his exercise? (00:03:00)

• Peter distinguishes between optimizing for longevity and performance in exercise.
• Exercises aimed at exceptional performance in competitive sports are not usually aligned with longevity.
• Performance goals such as marathon or Ironman times, or maximum weightlifting, may even be counter to longevity.
• Peter's exercise approach is tailored toward the 'centenarian olympics,' intending to be a robust 90-year-old.
• The focus is primarily on two energy systems: stability and strength, and low-end aerobic capacity (zone two), with occasional high-intensity (zone five) bursts.
• Real-life activities generally occur in zone one, zone two, and zone five, making training in these zones metabolically and structurally supportive for longevity.

Preparing for a good life at age 100: Training for the “Centenarian Olympics” (00:06:10)

• The concept of the “Centenarian Olympics” involves preparing the body and mind for health and functionality at the age of 100.
• Peter Attia discusses backcasting, a method of planning from age 100 backwards to current age to align physical training with desired future capabilities.
• Attia, influenced by the idea of backcasting from Annie Duke's book "Thinking in Bets", contemplates the physical tasks he wants to be able to perform at 100, as well as cognitive functions he wishes to maintain.
• He focuses on activities of daily living and devised an "18-event centenarian decathlon" list to ensure he can play with future great-grandchildren and perform ordinary tasks like getting out of a pool or lifting 30 pounds.
• The preparation involves approximating physical tasks to aging milestones and the decline in abilities that come with age.
• Attia emphasizes he trains exclusively for these functional tasks, disregarding competitive or racing aspects of exercise, and he structures his exercise regime around four components: stability, strength, aerobic performance, and anaerobic output.
• Most centenarians today likely owe their longevity to exceptional genetics rather than lifestyle, whereas Attia's approach is a more deliberate method to extend lifespan and maintain physical and cognitive function.

The importance of preserving strength and muscle mass as we age (00:21:48)

• Muscle mass and strength decline with age, with research indicating losses up to 1-2% per year after 50.
• Strength loss is associated with increased all-cause mortality, highlighting the importance of maintaining muscle mass and strength.
• Studies have shown a significant link between reduced strength (normalized for muscle size) and higher mortality rates in both men and women.
• The decline in muscle strength and mass emphasizes the need for focusing on physical conditioning for longevity.

The value of deadlifts for stability and longevity when done properly (00:27:39)

• The speaker has a long history with deadlifting, which he now practices with a focus on technique and form rather than heavy weights.
• An injury led to a reevaluation of deadlifts in terms of their role and utility in a longevity-focused exercise regimen.
• The adoption of Dynamic Neuromuscular Stabilization (DNS) reintroduced deadlifting for its ability to serve as an audit for perfect biomechanical function.
• Deadlifting with the right technique can enhance day-to-day functional activities and strengthen the spine, even under axial load.
• Pre-deadlift preparation exercises are also valuable, and deadlifting may offer benefits similar to the metabolic conditions associated with ketosis.
• The speaker plans to share more about deadlift preparation and its biomechanical benefits in future content.

The importance of zone 2 aerobic training (00:35:44)

• Zone 2 aerobic training is a key component of overall exercise.
• Peter Attia used to spend 10-12 hours a week in zone 2 as a cyclist, but now allocates 3-4 hours weekly.
• Swimming casually is mentioned, but likely doesn't reach the intensity of zone 2.
• Attia views zone 2 exercise as a mental governor, providing a type of stillness.
• He initially moved away from low-intensity aerobic training but realized its importance through literature and consultation with inugo San Milan.
• Benefits of zone 2 training include metabolic advantages, mitochondrial health, and neurotrophic factor secretion.
• Zone 2 training is enjoyable because it's not overly strenuous and can be combined with activities like reading.
• It's a lifelong, safe practice with significant health dividends.

The most effective ways to engage in zone 2 exercise (00:40:00)

• There is no best device for zone 2 exercise, but consistent outputs are important.
• Peter Attia prefers the bicycle due to the clear wattage metric; he uses a Wahoo KICKR ergometer.
• Treadmill brisk incline walking is recommended for most patients as it’s easier to stay in zone 2.
• Attia knows his zone 2 metrics well, adjusts based on heart rate, and checks lactate levels routinely.
• His wife favors the Peloton for cycling and the rowing machine for zone 2, which shows personal preferences vary.
• Rowing is typically used for zone 5 efforts due to higher intensity.
• Ellipticals can be effective if they meet the individual's heart rate and speed needs.
• The goal is to maintain a consistent effort without fluctuation in intensity.
• Erg mode on a bike is favored by Attia as it doesn't require much attention, allowing for multitasking, such as listening to podcasts.

Zone 5 training and VO2 max (00:44:21)

• Zone 5 training encompasses upper-end aerobic and verging on anaerobic exercise.
• Attia describes it as VO2 max training, which many might not allocate the appropriate amount of time to.
• The degree of difference in VO2 max between the bottom 25% and top 2.5% of people is about five-fold.
• Attia emphasizes the importance of VO2 max training but suggests that it doesn't require excessive time investment.
• He performs Zone 5 training on a StairMaster, which he prefers over an elliptical.
• Zone 5 workouts consist of a combination of three minutes in Zone 2 with one minute at VO2 max, repeated for 20-30 minutes.
• On bike rides, Attia engages in a different pattern of VO2 max intervals.
• Most people might focus too much on Zone 5, neglecting Zone 2.

Anaerobic Training Protocols & Human Performance Limits [Music]

• The StairMaster used resembles an escalator with rolling steps.
• Attia sets the machine to a high METs rate for running stairs during VO2 max intervals.
• Human performance at 'all out' effort is sustainable for approximately 10 seconds; anything more requires submaximal effort.
• The difference in sprint speed between 100m and 200m events exemplifies the limitation in sustaining 'all-out' effort.
• Attia mentions a preference for Zone 5 workouts over Tabata these days, despite having done both.
• Original Tabata protocol (20 seconds of work/10 seconds of rest) often leads to pacing to complete the set rather than truly working at maximum effort.

A primer on VO2 max (00:51:58)

• VO2 max is a physiologically significant rate measuring oxygen processing from air to muscles during peak exertion.
• It was first identified in the 1920s by A.V. Hill through progressive intensity exercises revealing a consistent consumption plateau.
• VO2 max measures the aerobic system's upper limits but doesn't singularly predict athletic performance.
• VO2 max is expressed in both absolute terms (liters per minute) and relative terms (milliliters per kilogram of body weight per minute).
• Relative VO2 max considers body weight but does not account for lean mass versus adipose tissue.
• The utility of VO2 max differs when comparing athletes versus monitoring individual progress.
• The "plateau" in oxygen use is multifactorial, with potential bottlenecks at any point from lung capacity to muscle cellular respiration.
• The respiratory system may have limitations among highly trained athletes that go against earlier assumptions of lung overcapacity.
• Alternate theories suggest factors other than oxygen delivery to muscles, such as brain oxygen levels, may regulate endurance performance limits.
• Experiments altering the fractional inhalation of oxygen (FIO2) could help isolate variables within the VO2 max cascade, though complex interactions may still obscure a clear understanding.

Stability—the cornerstone upon which all exercise and movement relies (01:03:09)

• Stability is a fundamental aspect that influences strength, aerobic, and anaerobic performance.
• It ensures safe force transmission through muscles rather than joints unfit for bearing loads.
• Many people lose natural movement efficiency early in life due to inactivity and excessive sitting.
• Correct stability techniques can prevent force leakage and chronic injuries seen in inefficient movements.
• Dynamic neuromuscular stabilization (DNS) and similar principles are incorporated in various disciplines like Pilates.
• The effectiveness of stability training relies on the proficiency of both the practitioner and the student.
• Different approaches to stability and posture, such as Pilates, DNS, and postural restoration, can all be beneficial.
• Finding the right practitioner and approach to stability may require experimentation and iteration.
• Digital curricula on stability exercises are being developed for broader accessibility.