Exercise: longevity-focused training, goal setting, improving deficiencies (AMA 55 sneak peek)

hey everyone welcome to the drive podcast I'm your host Peter [Music] AA Peter welcome to another AMA how you doing very well I think we're g to get right into it because we got kind of a big one today so with it being the new year we know a lot of people are going to start to either take their exercise more seriously start to exercise thinking of switching up their exercise routines and we see so many questions around exercise come through we thought this would be a good time to make it kind of an all exercise AMA and some of the questions we see from people are you know they're wondering how to improve their cardiorespiratory Fitness how to increase their muscle mass their strength oftentimes how to do both and so we pulled questions that are going to look at how you solve these problems with clients in your practice and this includes first really identifying and clearly defining what what the goal of training is because as you often talk about if you don't clearly identify the goal you don't really know what to do and then from there helping people understand how they can identify the area in their life that they need the most help in when it comes to exercise and then we'll start to get into more technical questions on how people can use periodization training how they can make improvements in areas that are most needed and we're even going to look at some case studies of what a different weekly workout could look like for a few different types of people from there we're then going to step back and also look at some training questions that apply to everyone no matter what level of expertise they're at this includes how stress can impact a workout and also how people should look at wearables and the data from wearables as it relates to making decisions on training so we got a lot so with all that said anything you want to add before we get into it no I like your ambition man we'll see what we can do um I think we first need to start a reminder before people on how you look at training and the goal of training because for you you're not training to run a marathon be a powerlifter instead you're training for something else and you've talked about this before but I think it is important to just kind of lay that foundation for people so they know why you're making the recommendations why you're doing what you're doing so do you want to remind people quickly what the centinary in De cathlon is and why you use that as your training goal yeah so as you said a second ago I am no longer an athlete I don't train for anything specifically um in fact very recently you know how your phone will pop up pictures of something that occurred like you know this time five years ago or whatever well it popped up a picture of me from uh 2014 and it was after a training session this is back when I lived in San Diego you remember where Fiesta Island is Nick oh yeah awesome so fiest island is where we used to train for the time trials and it was a picture of me and Meb after a training session so Meb was running I was riding and I look at the picture there I'm in my my kit holding you know arm around Meb and it's like you know he probably weighs 138 lb I weigh like 168 lbs um you know 25 lbs or whatever less than I am today and um you know there's just no comparison to you know what I was then versus what I am today um and I I trained you know three times more than I train today in volume and it was very specific and um I've talked about this but again I think it's worth reiterating when I stopped competing when I was done with cycling done with swimming done with you know going you know being competitive at some level um I needed to find another goal because of what you said in the intro which is you it's very difficult to train without a purpose and um I I talk about this in the book but I really had an epiphany in the summer of 2018 so I I kind of had an aimless three years where I was exercising and I was reasonably fit but I there was no purpose it wasn't anchored to anything and it this all came sort of I don't know in a in a in a in a flash of inspiration as I was sitting at the funeral um of of the parent of a close friend of mine realizing that in the last decade of this person's life who had died uh they were you know largely debilitated physically um and that was tragic to me because I had seen them be healthy in their 60s and 70s so that's what gave me this idea of we need a goal and we need to treat life just as we would treat an athletic event and this idea of a centenarian DE cathlon came to my mind in part because decathletes are generally regarded as the best overall athletes despite not being the best in any one of the 10 things that they do now of course centenarian de cathlon is not an actual event maybe some people will do de cathlon when they're centenarians um but even becoming a centenarian is not necessarily the objective right we don't have that much control over how we stretch our genes that said what I imagine is in the last decade of my life what do I want to be able to do and how do I begin to train for that now and when you take that look at the future and you say look these are the things I want to be able to do you can apply metrics to those activities you can say hey if I want to be able to hike on uneven surfaces to the tune of you know two mile round trip in an hour um that requires this much cardiorespiratory Fitness this much strength this much balance and I know how much each of those things will decline over the next decades so how much stronger do I need to be at 50 than I would expect to be at 85 or 90 um there's a there's a figure I pulled here if you could pull it up Nick I think it's um it's a bit of a messy figure and but but the message is very clear this is a figure that shows um on the on the left it shows uh women and on the right it shows men the bottom two figures show physical activity level over time so age is always shown on the x-axis and the upper figure shows fat-free mass in kilograms on the Y AIS versus again age on the x- axis so fat-free mass of course is a very good proxy for lean mass or muscle mass and you can see that these have data collected all the way from when people are teenagers up until the end of life and again you don't really have to be a statistician to see the remarkable Trends here so there's some obvious differences between men and women the most notable one of just the difference in lean mass men have significantly more lean mass than women but if you put that aside you'll realize two things the first is that we have a steady increase in muscle mass and lean mass both for men and women that occurs from birth right up until about the age of 25 and then you have a relatively minor decline in lean mass from 25 to 75 but then what happens at 75 Nick yeah it's off a cliff it literally falls off a cliff now we do the same exercise for um physical activity by the exercise no pun intended meaning you do the same uh visual exercise you watch that from the ages of uh 25 to 75 physical activity level is even more consistent and conserved than lean mass in both men and women and yet what happens at the age of 75 for both men and women yeah same thing yeah it just falls off a cliff now of course this figure cannot give us causality I can't look at this figure and tell you that the reason physical activity level falls off a cliff at 75 is because muscle mass does the same nor can I tell you that muscle mass is declining because physical activity goes down but it's hard for me to imagine that What's Happening Here is not um bidirectional in other words I suspect that what's happening is that at 75 or thereabouts for the average person activity declines and as activity declines muscle mass declines and as muscle mass declines activity declines further and these things spiral out of control and remember the you know average life expectancy is about 80 so that means that you know for people who are living to average life expectancy and slightly Beyond they're basically going to spend the last 5 to 10 years of their life in a very poor physical state and if there's anything that I hope people take away from the stuff that you know we've been talking about it's that you must focus on health span at least as much as you focus on lifespan and if there's an enormous failure in medicine 2.0 it's the myopic focus on lifespan at the complete exclusion of Health span so with that rant sort of over um therein lies kind of the why it it really doesn't matter you know what you know what your athletic background is maybe you were a stud athlete growing up maybe you've never played a sport SP in your life and you've never done so much as run a local 5K doesn't matter everyone needs to be an athlete for life and therefore everyone needs to think about becoming the best version of their centenarian decathlete and remind me what was the furthest you've ever swam furthest in one shot I've ever swam is about 28 miles so looking back at that picture of you and Meb you know would you say you were the better athlete and had more athletic achievements than Meb or do you think it's not quite that clear Meb having won the Boston Marathon uh having won the New York Marathon probably the most decorated uh American marathoner I'm gonna give the slight nod to Meb on that you did bike around Fiesta Island a lot though so you have that gone for you I I I was probably a better swimmer than Meb that maybe I can take that I'm sure if you put Meb on a bike he would have ridden circles around me oh yeah dude's just a machine um so with that said I think then we also need to quickly remind people of what you call the four pillars of exercise which is if you agree that this is what you're going to train for which is ultimately life and life as you age and being able to do what you want to do and sometimes people I think can get lost in the very specifics of like okay I need to be able to exactly this or exactly this but even stepping back for most people just acknowledging if I'm going to focus on when I'm 80 90 I want to be able to move freely take care of myself you know just the large things that can sometimes people give give people the goal they need and so with that said do you want to quickly remind people on what those four pillars of exercise are that anyone who has that goal is going to need to have all four yeah and again I I just want to make sure people understand for the centenarian de cathlon we're really thinking about things that are activities of daily living and activities of of leisure and pleasure and Sport and you know beyond activities of daily living so we kind of encourage people in our practice to go through this exercise and make sure they have both of those in there um now to your point um I think broadly speaking the way in internally we talk about this is four pillars and this is the way I wrote about it in in the book right so it's kind of two cardio pillars and two sort of strengthyou effic efficiency or maximum aerobic efficiency and then Peak aerobic output so that's measured by V2 Max whereas aerobic efficiency is measured measured by Zone 2 output and then on the other side we have strength and within strength there's a lot so we'll go into some more detail about what that means because strength involves both you know muscle quality and motor control and you have Ecentric strength and you have concentric strength and all those things and then you have this other idea that wraps around strength called stability and of course stability speaks about the safety with which you can apply that strength I.E exert force on the outside world uh and the safety with which the outside world can exert force on you and of course inherent with instability are other issues that we think about especially things that decline as we age such as Mobility balance flexibility looking deeper into those four what are people able to track and kind of identify further to know where they're at which one of those are do people have the ability to kind of as you said you know on strength there's different aspects of it maybe just touch on what those aspects are so people know how they can start to measure in their own life where they're at and where they need help yeah there are so many right so so let's take strength as an example um So within strength we want to think about you know Peak strength we want to think so so that would be kind of Maximum um strength um again to be clear that would be what is your maximum one rep max for something we would want to think about muscular endurance so the ability to move something that's much lighter but for many many reps um it's important to point out by the way that you don't have to train at a one rep max to increase your strength and you don't have to actually measure at that level in other words you could you could see how much you could do something for five reps and that would allow you to impute or estimate what you could do for one rep and if you're a powerlifter who's competing in a sport where you have to do that that of course that would be insufficient but for for those of us that are not powerlifters you know knowing what we could do for you know our best five reps is a good enough proxy for then you know calculating what our one rep max would look like we then talk about various things like motor control so um again I think this is sort of a hybrid of the strength stability piece but this is a really important uh you know I I gave the example of hiking over an uneven surface you know I just got back from you know hunting trip a little while ago and boy you're you know you're walking around in the dark carrying heavy stuff on obviously uneven surfaces um and that's a much more complicated and dynamic situation than you know riding a stationary bike for example so we want to be able to train in both of those ranges you want to be able to train um under perfect conditions such as you know using a machine or you know being on a bike or something like that and then you also want to be able to train on variable surfaces and in situations where you have less control and again when we talked about cardiorespiratory Fitness lots of things that we measure here but again you know thinking of these in the two extremes W which is what is the maximum output you can sustain while still exclusively utilizing uh your Aerobic System so therefore you're not at all accumulating lactate um and again I'm being a little a little bit um uh sloppy in my terminology there and we can maybe clear that up a bit a bit later but but basically you know what's the maximum output you can sustain without accumulating net lactate um and at the other end of that Spectrum what is the maximum utilization you have of oxygen which corresponds of course not to your maximum output but more importantly your maximum aerobic output again these are very quantifiable um and as you know these are numbers that we know for all of our patients and I think they're numbers that everybody should know for themselves yeah and I think that's a great lead into kind of the next place which is you have the cardiorespiratory side you have the strength side A lot of people are going to be wondering okay how do I know where exactly I'm at in each of those so I can help identify if one or the other needs help or if they both need help so maybe walk through how people can understand their current state as it relates to those two things thank you for listening to today's sneak peek AMA episode of the drive if you're interested in hearing the complete version of this AMA you'll want to become a premium member it's extremely important to me to provide all of this content without relying on paid ads to do this our work is made entirely possible by our members and in return we offer exclusive member only content and benefits above and beyond what is available for free so if 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Channel: Peter Attia MD

Views: 81,007

Keywords: Peter Attia MD, Dr. Peter Attia, Early Medical, The Drive Podcast, The Drive, Longevity, Zone 2

Id: ffWJIWEAHyo

Length: 20min 36sec (1236 seconds)

Published: Mon Jan 15 2024