Stay Young Forever: The #1 Thing For Overall Health & Longevity Is This... | Peter Attia

so the starting point is exercise is the number one factor for our longevity recently you were asked I think it was in the Q a you guys published on your show that a chap who's playing tennis twice a week and basketball twice a week um is that okay and I think your answer was it's probably not optimal to the person on the street I believe if they heard that someone was playing tennis twice a week and basketball twice a week they would be thinking wow that guy's crushing it so I wonder if that's a good way of explaining your model for exercise and why we need this broad approach to movement so maybe I'll explain what the centenarian because and then I'll come back and your questions are an interesting one so the centenarian decathlon is a model that we use to Anchor the marginal decade so again the marginal decade last decade of your life so what we want our patients to be able to do is identify again in great specificity physically what they want to be able to do and the physical manifestation of your marginal decade we just describe as your centenarian decathlon so you might have lots of goals in that marginal decade they might you know you should hopefully have some cognitive goals uh hopefully you have some emotional goals goals vis-a-vis relationships um but when it comes to the physical goals we we want you to be very specific and we start by saying look we we have a menu of options and we want you to at least be able to identify 10 that you want to be able to do and again these are very very specific um and I think there are some of these that many people would have on their list and there are others that are unique to individuals so there are some that are on my list that most people wouldn't care for like what would you say I'm sure most people wouldn't care that you know I want to be able to pull a 50 pound bow back I love archery so you know and currently I draw like a 75 pound bow but I want to be able to still draw a 50 pound compound bow I still want to be able to drive a race car to within about five percent of how fast I can drive it today you know Paul Newman up until a few months before his death was still driving at this you know almost at his best times so you know those are some really kind of weird esoteric goals for me um but then I also have much more genericals that I think make sense like I still would want to be able to walk up five flights of stairs uninterrupted I want to be able to walk down five flights of stairs those are different those are require very different types of strength and um Integrity of of the musculature um I want to be able to get up off the floor I want to be able to send on the floor for 20 minutes and I want to be able to get up on my own power again how often do you see somebody in their 80s that can do that it's very very unusual um you know I want to be able to pick a child up out of a crib I want to be able to pick a child up off the floor so there are many of these other goals that I have now um how does one go about doing that well again I think if you are listening to this scratching your head a bit thinking those sound really really easy how can those be goals you probably haven't spent enough time around people in their 80s or 90s those are staggering physical feats so let's think about what decathletes do a decathlete is an athlete who performs 10 different activities and the decathlete is not the best at any one of those activities right like when it comes to the 110 meter hurdles or the 200 you know yard meter dash you know they're not the fastest but no one is faster at doing all 10 of the things that they do which Encompass both the track and field events and um they're generally regarded as the best athlete in the Olympics and they train as a generalist but with great specificity yeah and so I think we have to apply the exact same model to ourselves as we prepare for those events we have to be great generalists so we have to have high peak cardiorespiratory Fitness wide aerobic base high levels of strength great amount of stability all of these things and we also you know have to be able to train very specifically to achieve those things so now let's go back to the question that you asked at the outset so is playing tennis twice a week and basketball twice a week sufficient to prepare you to be the most robust 85 year old and I said believe it or not I don't think the answer is yes yeah because as wonderful as those sports are they don't cover all the bases that I just described they're not building a very wide aerobic base nor are they building a very high cardiorespiratory Peak those are both very intermittent Sports start stop start stop they're interval training and that's great interval training is a very efficient way if you had no other time to get bits of both the aerobic base the anaerobic Peak but it it's no substitute for having a really wide base and a really high peak also they're not doing a lot for your strength directly they're not doing a lot for your stability in fact they're challenging your stability so if a person says I love doing those things I say great keep doing them if a person says I want to be able to do those things in my 80s I say great I think that's doable but you will need to train to ensure that you have the strength stability and the endurance to do those things well yeah it's such a wonderful framework to look at aging and I I like this idea that you specifically get your patience to write down what are 10 things I want to be able to do in my marginal decades now I've heard you say once that a couple of people will say I want to be heavily skiing does that person in their forces that say really want to hear this ski when they're 95 or is heavily skiing a way of saying I want to be independent and being able to enjoy the mountains and nature whether they do or not the point is by you knowing that by them articulating it it means they can develop a specific program with you and your team to help them meet that oh yeah completely and the other thing is these things can be malleable I mean there's if you'd ask me this question 10 years ago I I don't know that there there might not be many things that overlapped 10 years ago because 10 years ago I probably would have taken for granted so many things that I don't understand today and wouldn't it wouldn't have even made the list and there would have been other activities in the list that aren't as high a priority to me today so for example now in my marginal decade I would be happy to swim you know half a mile I think that's one of my things is to be able to swim half a mile in 20 minutes um how have you where have you got that from well you know swimming used to be very important to me yeah so so you know again if you'd asked me this a decade ago I probably would have wanted to have swung 10 miles and I would have really over indexed swimming and being able to swim really really long distances whereas now swimming is much less important to me so it's mostly just about being able to still enjoy the water yeah and you know if it's swimming half a mile now that would be sufficient it's you know can I tread water you know one of the things I have now is can I get out of the pool on my own like again without a ladder could I push myself up on a pool deck and get out of a pool so it's it's just less focused on the time in the water but you're you're right um if you if you if you go after hella skiing and when we have patients that say things like that I mean I'm not going to discourage somebody from that but I'm also going to say like that's going to require an astronomical amount of strength um and you're going to have to be a lot stronger in five years than you are now to appropriately catch the Glide rate down to where you're going to be at that point in time and by the way if you miss if you fall short you're still going to be able to do a lot of great things yeah but let's go for it yeah now I I love the approach you bring a specificity to something that is otherwise vague I just want to be well while I'm older what does well mean like well for what yeah that's the thing that that I we really try to get people to understand is no one no athlete and you have to think of yourself as an athlete here no athlete has ever achieved anything great without specificity I mean like pick any athlete doing anything today that's exceptional do you think they're just out there willy-nilly going yeah you think Djokovic is like yeah it would be great to win Wimbledon I'll just played Santa I'll just play a little bit of tennis each week I mean no chance yeah I mean no chance that the and again like we live in a world where Sports Science has made it really clear as to what it takes to achieve these physical things so so there's real there shouldn't be any difference when you're thinking about the activities you want to be able to do in the final years of your life that's a real irony about that Sport Science because on if I think about Humanity as a whole on one hand we're now seeing just incredible Feats that we've never seen before let's say Kip chougie running a marathon in under two hours something that was deemed physiologically impossible maybe 10 15 years ago by by certain people it's not possible the human body will self-employed or whatever right so he's shown that that's possible we're seeing World Records left right and Center going down we're seeing you know Premier League footballers playing into their 40s you know things that we didn't think was possible yet at the same time so the elites it seems are getting the benefits of all the latest sports science and are you know pushing new limits what humans can do you get it feels like the Baseline of what the population is able to do is going down and I don't know if you saw this there was a a study recently I think it was 25 million kids in 28 different countries they basically observed that I think it's compared to maybe 30 years ago the average speed it takes a child and this is between the ages 7 and 17 the average speed it takes to do a mile has gone a bit slower they're 90 seconds slower so there's a there's a certain irony there isn't there that's a great point two things you said Peter which think are really important number one is the point you made about if you think you're gonna be okay you probably haven't spent much time with people in their 70s 80s or 90s or if you're going to be okay without doing anything and unfortunately in my own life there's been a a Stark realization this year um I won't go into all the details but my mum who lives five minutes away from me Christmas Day evening she'd had a fall she got admitted to hospital she was in for three weeks there wasn't enough staff to take it out of bed I'd go in and do my own rehab I know how quickly one can decondition unfortunately since mum came home three weeks after being in hospital she has not been the same she has not recovered to anywhere near her Baseline so first point I wanted to address was um if you haven't seen it you may not take it as seriously as it needs to be taken and then the other point related to that and I kept this page open in your book it's in the chapter on training 101. but the graph that you have pulled from the um Jason Clifford and Brigham Young University I spend so much time looking at that graph I think everyone should look at it this is figure 11 figure 11. yeah this is the VO2 max decline it is utterly remarkable the central point I get from you is that decline is inevitable in your physicality it's gonna happen you've said before that we we understand at what rate it is likely to happen and I think it's genius this way that you go if you want to do that in your 90s or your 80s whatever that point is you have to account for the decline and therefore you have to be able to do some specific things in your 40s now many people who listen to this show Peter do park run community events every Saturday where you run or walk 5K um right so I don't know if you're up for a little um experiment here but this graph basically has well maybe do you want to explain the graph because you're probably better at doing it than me sure yeah so the the graph uh it shows I could probably do it from memory but it it shows three three lines so these lines are placed on uh against an X and Y axis so the x-axis is your age and it's obviously increasing to the right and the y-axis shows the VO2 max now I can't remember how much we discussed VO2 max on the first we didn't let me explain this first so um VO2 max stands for maximum ventilation of oxygen so what is ventilation uh ventilation rate or minute ventilation rate of oxygen it it means how much oxygen you're using at any point in time so ventilation rate is defined in liters per minute and um you and I sitting here right now having this discussion are probably at 0.3.4 liters per minute uh maybe 0.5 liters per minute because we're a little animated in how we're speaking right so we're at 500 CC per minute of oxygen consumption if we were to stand up and walk around this room that would maybe increase to one liter per minute if we were to go outside there and jog back and forth you know that would increase to two and a half liters per minute and eventually if we kept forcing ourselves to exercise at ever increasing pace and demand we would reach a maximum and that can be tested for in a laboratory so it's done either on a bicycle or on a treadmill stationary because you have to have a mask put over your face and the mask is what is able to measure the amount of oxygen you're consuming and this is one of the more important tests that's done by Elite endurance athletes and so if you talk about the most elite endurance athletes they're typically going to be cyclists cross-country skiers Runners and so whether it's kipchogee or Teddy pogachar you know I mean these people have astronomical VO2 Maxes yeah so the higher it is the fitter you are this is your Peak aerobic uh capacity it's normalized by weight so ultimately the numbers that you're used to seeing are reported as you know a number say 50 and it's converted into milliliters so 50 milliliters per minute per kilogram okay so the higher that number the fitter you are and so you know um we have tables that tell us and I think I put one of those in here that tell you by sex and by age where you rank by percentile now this graph is showing something different it's showing people in the top I think five percent yeah the middle of the pack so the median or the 50th percentile and the bottom five percent and it's showing over time how those three lines decline they all decline they all decline in fact the the rate of decline is actually steeper for the fittest people because they're starting at the highest point but even though it's stupid they still have they always remain higher they remain higher that's right so you always want to be on the top line what this graph also does that I find interesting and the reason I included it in the in the book is it shows various activity levels yeah and what they correspond to in terms of a given VO2 max so that you can observe when various people cross over so at this point I've lost my ability to memorize it so I'll just kind of turn to the graph so for example briskly climbing stairs requires a VO2 max of approximately 32 milliliters per kilogram per minute it doesn't matter your age right if you want to go briskly upstairs that's right whether you're at 30 or 90 you require you need to be at about 32 milliliters of oxygen per kilogram of body weight per minute okay now here's what's interesting people in the 50th percentile of the population at the age of 25 have a VO2 max of about 44 so they can do that pretty easily by the time they reach 50 they've descended to that level so a person who is my age who's 50 at the middle of the population's fitness level is just at the point where they're going to lose the ability to briskly climb a flight of stairs and it's only going to go down from there now interestingly someone in the bottom five percent even at the age of 25 is below that level wow okay now let's look at someone in the top five percent someone in the top five percent who by the way at the age of 25 is at about 62 in terms of that I'd say in terms of the VO2 max they don't hit that level of being right at their threshold until they're 75. so one of the things about this graph that I find interesting is it stops at 75. so one of the reasons we show this graph to our patients is to say oh and by the way the reason we hold you to a higher standard than this graph we hold our patients to a standard of being it's aspirational but this is what we want everyone to be at we want everyone to be at the top five percent for someone 10 to 20 years younger and the reason for that is we want you to actually be able to thrive into your final decade of life and you have said pizza before there is no reason that most people cannot be in the top 25 absolutely not there it's there is simply I mean you would have to have a mitochondrial disease to not be able to talk to 25 of your age so this is really empowering I think for people that no matter how old you are of course the earlier the better you want to give yourself buffer room so let me just summarize and make sure I've got it right make sure everyone's following along that essentially your VO2 max is a super important metric it is going to get worse as you age in a relatively predictable fashion therefore if you want to be doing something like briskly walking upstairs in your 80s we know what VO2 max you need in your 80s and therefore we can say what VO2 mats you need today and it's such a logical and beautifully simple way of looking at it and it makes it very very tangible the reason I brought it popcorn Pizza is because one of the things it talks about in this graph is joke six miles per hour on flat grounds right so six miles per hour is roughly 10 minute mile Pace yep right a 5k so a popcorn for anyone who does park run I appreciate some people walk but that is you know roughly a half an hour park run I think a lot of people I know a lot of people my age or 10 years older who aren't in great shape but they can do a 30 minute 5K right so what's really interesting to me is that I mean it's just it's brutal this graph it's utterly brutal right if you are about 37 years old right give or take a year I've got exact lines going down so if you're 37 years old and you can do a park run in half an hour like by the time you are 75 you can barely walk up a very gentle Hill at three miles per hour yeah if if at 37 your limit is just being able to run that 30 minute park run you at 75 you're gonna have a very difficult time getting around yeah so it's so in other words at 37 you need to be hammering through that park run you need to be running it in 21 or 22 minutes if you want to make sure that when you're 85 you have no physical impediment I mean the way I describe it to patients is I I'm not I'm not so deluded to think that at 80 I'm going to be doing what I am today but what I want to know that I can do when I'm 80 is take a train through Europe and take my own luggage with me and I pay attention to what that means now I pay attention to how quickly I sometimes need to move through a train station with my luggage and even now I know like like you have to hustle sometimes so like now it's not the limit of my ability today but I if I'm banking on that being the limit of my ability in when I'm 80 I know what level of Fitness I have to have when I'm 50. yeah it's way higher it's way higher the decline is inevitable so you need to give yourself buffer room and again just to be clear look I get no everyone's a runner right so it's not that you have to do a 30 minute 5K or be you know some equivalent version whether it's yeah I'm not I'm not a runner either so but it can be other things so I do most of my cardio training on a bike or on a treadmill or and if on a treadmill I do it on a steep incline or on a stair climber yeah um and I've just decided like and I still go back and forth sometimes I want to get back into running because I used to be a runner but I'm like you know what I'm not going to do it I'm going to save my joints I'm going to let it go but there are lots of things that I still need to be able to do on my feet I love being outdoors so I rock a lot and that's a great way for me to add the conditioning element and and for people who've never heard that term work would you mind explaining it yeah so it's it's walking uh with a very heavy weighted backpack so I I walk all over our neighborhood which because I live in Austin it's all Hills so it's okay up and down very steep hills with a weighted backpack and depending you know sometimes I will go with 60 pounds which is normally what I do and there are other days when I really want to push it I'll do a hundred pounds and um and and that you know I'm walking but it's still the most taxing thing you can imagine when you're carrying that much weight to walk you know up a hill that's 15 grade with more than half your body weight on your back so so there you don't have to be a runner I think is the point to test this system and the other thing that is important to understand is it does all at the end of the day come down to what you can do on your feet so being able to walk on an uneven surface being able to walk up a hill um those will become the rate limiting steps as you age I want to go back to something you said earlier and I'm sorry to hear this news about your mom but it actually is a sad illustration of a very important point now I write in the book about the fact that the mortality from a fall if you're over the age of 65 and break your hip or femur is as high as 30 percent at one year and most people myself included when I first learned of this literature because I did a whole AMA on this topic and initially when the analysts because I have a team of analysts that helps me with everything initially when they were pulling this literature I was like guys come on this is nonsense use your logic here there's no chance the mortality can be that high yeah and they kept showing me paper after paper after paper and this is often the case the analysts just keep showing me data and I'm not willing to believe it and I'm like guys come on you're being stupid here like yeah I love that you should watch it guys it's like wait a minute yeah yeah and it's like oh they're actually right you know so you know it's like I would say a very conservative bracket is 15 to 30 percent of people once they reach the age of 65 if they fall and break a femur or hip they're not going to be alive in a year but here's a stat that I didn't include in the book and I wish I did because it's just as important of the 70 to 85 percent who are not dead in a year 50 percent of them will have a complete reduction in level of function by one measure of unit so for example if they used to walk freely they will now require a cane for the rest of their life if they used to require a cane they will require a walker if they used to require a walker they will be in a wheelchair so in other words there there's a huge cost to this and there's actually another graph in there that I think is very sobering which shows the mortality associated with accidental death by decade and um appropriately so we in the U.S are very fixated on um accidental death due to opioid because this last year was the first year that that number of deaths eclipsed a hundred thousand in the U.S so it's a staggering number I believe it's 106 000 people died in the U.S last year due to opioid poisoning but at a population adjusted basis that's nothing compared to what Falls do to people over 75 and that's the graph I have in there which shows deaths normalized per population basis and all other forms of accidental deaths of which the other two big ones are overdose and auto death they're completely dwarfed by deaths associated with falling so yes the point here is most people in their 40s in their 50s I mean it just wouldn't even occur to us that you could fall let alone that a fall could be the end of your life either in that moment or more much more commonly in the coming year yeah it's it's incredibly sobering hearing that of course I've seen that first hand with my mum a demonstration of that this idea that well if that's what we've just been talking about even though we may be talking about strength per se now or a mixture of strength and stability I guess the principle of the VO2 mats declining it's the same kind of thing right we're going to decline and it is it's this it strength and its stability and it's um you know the point we're gonna decline you're going to need the buffer room so that if we do fall and break our hip when we're 65 we don't want to be in that 30 bucket we don't want to be in the other 50 bucket of the ones who yeah are not dead right we want to be in the other bucket where we are I don't know what percentage that is where you get back to your pre-4 Baseline that's what we want and to do that we need to build a buffer right so you have these four pillars of exercise or movement when it comes to being that generalist who's able to do the things that they want to do in their marginal decades so you have strength you have zone two cardio you have VO2 max and you have stability and I I really want to make sure we make this as practical as possible for people right but I wonder if it's worth just giving the broad Overview at the moment of these four pillars and I don't know if we can say this or not but what percentage of time perhaps about that you should Advocate to each one yeah so so so you've got it right those are the four pillars I will say that we have the most data the most Clarity around two of them strength and VO2 max um so the data for strength and VO2 max are undeniable meaning we just have so much epidemiology that is so uniform in its direction so strong in its signal um that you know and I go through this at Great length in the book because I want the reader to understand the difference between good epidemiology according to the criteria of Austin Bradford Hill and weak epidemiology for example what we see in nutrition where the epidemiology has a very difficult time parsing signal from noise but an exercise that's not the case and I go through all of the criteria why um so when the epidemiology says having a very high VO2 max leads to a longer life I mean it's Crystal Clear yeah and by the way we haven't mentioned that so it's worth mentioning that so everything we've talked about so far vis-a-vis VO2 max has been in the context of quality of life which for most people matters more than length of life but it should be noted that a high VO2 max is associated with a lower all-cause mortality to a greater extent than any other health metric including not smoking not having high blood pressure not having coronary artery disease not having end-stage renal disease none of those compare to the harm that they bring more than being unfit does so make sure you're taking action after watching this video I've created a free guide to help you build healthy habits we can all make short-term change but can those changes become a fundamental part of our life often they don't and that's why in this free guide I share with you the six crucial steps you need to take that really really effective if you want to get hold of that free guide right now all you have to do is click the link in the description box below so the association the hazard ratio for being in the top two percent of VO2 max compared to the bottom 25 is a hazard ratio of over five it's just it's a it's a staggering yeah it's almost as staggering when you consider having high strength high strength to low strength is almost as potent it's a hazard ratio of over three and for people who don't know Hazard ratio Pizza explained it in depth in our first conversation yeah yeah so so okay so let's talk about these things um why is strength so important why is stability so important instability by the way there's a whole chapter on it because it is the most foreign concept of those four so it warranted the exercise component there's a section of this book is three chapters but stability is by itself one of them stability basically is the capacity to transmit force from the body to the outside world and vice versa stably and uh without without injury would be the easiest way to explain that so every time you're taking a step you're transmitting a force to the ground that's what that's what propels you forward but a force is being transmitted in the equal and opposite direction back to you so what prevents your knee and hip and back from hurting it's stability what allows you to do that efficiently is stability so typically when an elderly person falls it's due to a lack of strength and stability stability is for example you know what allows the the foot to maintain balance if you think about it and watch yourself in the mirror if you're doing an exercise standing on one leg yeah let's say you're doing a single leg RDL or something like that you'll notice that that foot is is twitching like crazy to to try to preserve balance an audio Romanian deathlet for anyone who's not familiar with that yeah but but look stand in front of a mirror and stand on one leg and watch your foot Watch what it needs to do and we think of that as balance but balance is kind of like the readout state for stability yeah um most people probably have heard of different types of muscle fibers fast twitch muscle fibers and slow twitch muscle fibers well the fast twitch muscle fiber is the type 2 muscle fibers are the muscle fibers that give us power the slow twitch muscle fibers are the ones and I'm oversimplifying a little bit but they're the ones that kind of give us more endurance so you can have strength in both of these fibers but the explosive power comes in the type 2 muscle fiber well that is the Hallmark of Aging is the atrophy of that type 2 muscle fiber so hold on please I just so when we hear about fast twitch some of us will go and say yeah if I want to be 100 meter Sprinter that's what I need what's the relevance of that to when I'm 80 years old because when you're 80 years old if you lose your footing slightly and you let's just say you're you're stepping off a curb and you lose your footing you need to be able to react with enormous force and that's those fast twitch the term fast twitch and slow twitch is unfortunately a little bit misleading while it is completely true that fast twitch fibers twitch faster it really means and the real reason we use the terminology is they are fast to fatigue because they are much more powerful so a better way to think about it is you have high power fast fatiguing fibers and you have lower power very slow to fatigue fibers and unfortunately as we age we lose the former and so much of the injury we see in people as they age is the direct result of the atrophy of that powerful fast to fatigue muscle fiber now if you train it you can maintain it now you'll never maintain no 80 year old is going to walk around with the volume of fast twitch muscle fibers that a fit 30 year old has that's not going to happen but a well-trained 80 year old can still have the fast twitch muscle fibers of a 60 year old and that's what we want to have we want to know that we still maintain some power in those muscle fibers and that's why for example lifting heavy weights is essential for everyone at every age be it man or woman so again one of the big misconceptions is women don't need to lift weights you know that's completely incorrect one of the misconceptions is you know as you get older you shouldn't be lifting weights I mean this is a complete misconception so strength training is imperative for people as they age and not only does it have an enormous impact on bone mineral density but it has this enormous impact on these type 2 muscle fibers we were talking about fast twitch and sprinters I just want to clarify when you're lifting weights does it need to be done with speed in order to really help that fast twitch fiber or just simply lifting a heavy weight slowly also count as a stimulus for that particular it still does it doesn't have to be lifted quickly so it really comes down to the weight so you have to lift a heavy enough weight that the type 2 muscle fiber gets recruited and if the weight isn't heavy enough the muscle will the muscle will simply recruit the slow twitch fibers to do the work yeah zoom out for a moment and think about a lot of the centenarians that we see being interviewed and of course that's not a scientific study this is just observations of humans in blue zones or wherever it might be what strikes me is very interesting is that very few of them were trying to work on their longevity from what I can tell right it doesn't mean we shouldn't be it also is pretty obvious that most of those people are living in environments whereby a lot of the things that you write about were being automatically covered let's say I don't know a farmer in Sardinia still herding goats in his 80s right well it's kind of going uphills a lot walking VO2 max probably lifting things around I I just I think it's always good to zoom out and go okay these guys weren't measuring every metric they weren't looking at these decline graphs I feel and I wonder what you feel about this is that because of the way many of us now live we kind of need these Frameworks to help us achieve what these guys are doing naturally yeah would you see it differently no I see it exactly that way do you remember uh in in like the original Spider-Man Story You've Got Peter Parker when you know when he when his Uncle Ben gets shot yeah and um you know right before that his uncle says to him something which is you know Peter with great power comes great responsibility and I kind of always have that in the back of my mind when I think about modernity um do I like the fact that it's 2023 right now uh or is there any reason I'd want to go back to 1923 or 1823 if you gave me a time machine the answer is zero chance there's no chance I'd want to go back to 1923 or 1823 or 1723. so in other words I fully buy the beauty of the modern world we live in it's not perfect but it's better than the world 100 years ago 200 years ago and 300 years ago but it comes at a cost like everything and we have to be very mindful of that cost and by the way I think that exercise and nutrition are probably the two greatest examples of where we pay that price so you know we spent hundreds of millions of years evolving depending on which form of ours you're considering but even if you consider just Homo sapiens right like just think of the last hundreds of thousands of years of evolution what really gave us our superpower to LeapFrog ahead of all these other species was our brain and what enabled us to have a brain that was so energy demanding was the capacity to store energy yeah so in some ways the human superpower from an energetic standpoint is the capacity for energy storage we are very efficient at energy storage that served us incredibly well until relatively recently when energy became so abundant energy of course in the form of food that superpower became a detriment and now most people certainly in the developed world are overnourished and we're on the wrong side of the energetic curve yeah does that mean that we should all aspire to be hunter-gatherers again where we don't know where our next meal is going to come from no it just means we have to understand that with this great privilege came a responsibility the same is true with movement our ancestors didn't deliberately exercise if they saw that there were things like gyms and treadmills they wouldn't fathom what we were doing but all of this is a construct we've had to create yeah to compensate for the fact that the modern world has taken the need for all movement out of our lives so we have to go above and beyond so so maybe if if you know if you're listening to this and you're a person who doesn't like exercising that's fine but just understand that there's a huge responsibility that comes with living in the modern world to yourself yeah and even though you know your ancestors five generations back wouldn't exercise um they didn't need to because of what they were doing yeah and also I mean I love that line of thinking because it also means I think yes we need to take responsibility as much as we can within our means within our you know what's possible in our environments but I often say to patients if your great-grandparents we're here today in this food environment you know we'd probably find 78 of them would also be overweight and obese it's not a moral failing no not at all it's it was your superpower in a different environment now it's your Achilles heel um so it's definitely worth considering and even this laziness to exercise we've always kind of been lazy we've always tried to conserve energy I I I one of my dreams is to go to a tribe I would say it's a dream thought experiment with a treadmill I just wonder what they would think about what you're you're on a treadmill for an hour you're not even going anywhere what what are you doing it's actually a ridiculous and it's been done I mean anthropologists today there are still a handful of remaining and um of hunter-gatherer tribes out there and everything I have read says that they are in Prime energy conserving mode so when they are not hunting or gathering or moving with deliberate purpose they're conserving energy as much as possible they're not they're enter you know in fact I think Herman ponzer I was going to write about it and he writes about it yeah and they're they're total body energy expenditure is quite low yeah it's really fascinating so let's go back to these four pillars then okay so if we want to be well in our marginal decades and we're thinking about exercise we need to think about four components VO2 max strength Zone 2 cardio and stability we've touched on VO2 mats we've touched on strength before we move on from strength you're talking about lifting heavy weights so I guess I have two questions one is what qualifies as strength right the reason I asked that question is because let's say you're a runner right and I personally think Runnings fantastic it's a very innate human movement it's you're loading your um you know you're interacting with the ground you're putting load through your joints through your tendons if you're doing Hills that is a form of strength training for your legs right so if you're a runner and yes this is lower body not upper body if you do hill repeats regularly does that qualify as strength training probably not because it's still a high enough number of reps that it's not hitting the type 2 muscle fibers okay um as evidence and by the way even when I'm walking up a hill with a hundred pounds on my back up a 15 grade I'm still doing so many reps that I'm mostly fatiguing my type 1 fibers okay so even though it's you moving your body weight Against Gravity which is a form of weight yep it doesn't quite meet the threshold for working on that particular tattoo fiber that we are going to need one with 70 or 80s stepping off a curb right so a better example would be doing a box step up with weight in your hands you know they like if if it's getting a box getting a box setting up stepping up onto it up and down up and down holding weight in your hands and if you did that such that you could you were literally you know so we typically talk about doing these sets until you're at one to two reps in reserve so you don't have to go to failure when you're lifting but you want to go until you could only do one or two more reps at and that would be failure and if you're loaded to the point where you're getting eight to twenty reps in but meeting that criteria your one to two reps in Reserve at them at the most by definition you're now recruiting type 2 muscle fibers okay you've fatigued all the way through the type one in your type two so you'll and as a runner you'll appreciate the difference and what that burn feels like versus the burn of of running hill repeats again there's a lot of benefit in running Hillary um and you're taxing your VO2 max and you're doing a whole bunch of other things um and by the way as a runner you'll benefit from the strength that comes from those box climbs okay fascinating so that was one component so hill repeats doesn't count you're looking at something that's just one or two short of your maximum which I think is very helpful very very specific for people and again in terms of making this accessible to people that's a relatively you know a box Step Up you know it's kind of most people have access to that right yeah that when it comes to lifting weights especially if you're just starting out I mean the amount of equipment you need you can do this at any hotel you can do this at any it doesn't have to be a super fancy gym um you know carrying dumbbells doing what's called a farmer's carry such an important form of activity um both for your grip so most people will find when they initially do this and we have standards for our patients when it comes to these types of exercises whether it be box step UPS um if Farmers carry you know for example for a woman we want her ultimately uh and we Index this by decade but say a woman in her 40s should be able to carry 75 of her body weight in her hands for a minute so if she weighs a hundred pounds she should be able to carry 75 pounds 37 and a half in each hand for a minute and if she can do that if she can if she can then what it means that we are very confident that by the time she's in her last decade she will have the strength to open a jar for example do the types of things that we think really matter to people yeah I love that it's really specific because anyone any female listening to the show right now can actually go and check that themselves see what am I able to carry now if they cannot let's say they go okay this sounds great oh wow I can only do 20 or 30 percent or I can only carry it for 20 seconds and then my grip Fades out yeah so what's the advice then it means drop the weight so say go to half your body weight until you can get to a minute go find a weight that you can get to a minute and then slowly Advance the weight that's brilliant really really practical and for a man it's your body weight for a minute so at what age again in your in your fifth decade so between the age of 40 and 50. so for example if the man weighs 180 pounds he should be able to hold 90 pounds in each hand and walk for a minute yeah I love that and again a lot of people will not be able to do that out of the gate that's fine drop it down go to 70 of your body weight go to 50 of your body weight um it's interesting a lot of people get put off strength training they think it's a they may never have done it as a kids they they may be intimidated by gyms they may not know what to do and think ah man I can't afford a personal trainer I don't know what I'm doing the farmers carry is is kind of something you know I guess you've got to be mindful that you're not sticking your head out right that you've got a decent decent alignment and yes you probably need some body awareness but it's it's quite accessible thing that people could try themselves I think yeah for sure and we've we've um I can't remember if we included the farmers carry in the video for the book but there are there's a there are a series of videos we made to go with the book it's on your website right yeah yeah um so so it's we there's probably less than the show notes yeah there's at least half a dozen of the exercises including the step up where we show the correct form because you're right you can you can cheat you can do these things incorrectly there's a lot of ways to to do this and we always have people start these things with just body weight for example in the step up you know before they move to anyway staying on strength let's talk about grip strength and foot strength the extremities of our body why are they so important maybe there's a lot of data on grip strength yes but what's fascinating for me and you'll explain the data I'm sure on grip strength but that might indicate to someone I need to get my grip stronger so I'm going to buy buy those little grip scripts and just get really really strong critics which I I'm not entirely convinced it's going to do what we want it to do so maybe expand out on that if you can yeah so I think the same reason that VO2 max is such a remarkable proxy for lifespan and health span is why grip strength always seems to be a remarkable proxy for both as well and it comes down to what they are indicators of or what I like to describe as integrals of so you know how a hemoglobin A1c is at least in theory supposed to be an integral or summation of what your blood glucose has been like over the past three months similarly a very high VO2 max is an integral of very hard training for a long period of time yeah if you took an unfit person and said I want you to train really hard for a week they're not going to have a high VO2 max in a week in fact if you took a person at the bottom fifth percentile and had them exercise for three months they're not going to get to the top fifth percentile that's why a person at the top five percent of VO2 max you can tell has years of training that's what it's telling you so it's such a good predictor of lifespan because it's reflecting so much more than we can ever get out of a questionnaire tell me how much you exercise a week and how strenuous it is who cares like all those inputs are reflected and it can't be hidden it can't be masked it can't be cheated yeah the same is true with grip strength grip strength is an integral for overall strength you can't be very strong without having a strong grip right so I mean think about being in a gym and lifting weights you're always using your hands um I'm here in London right now we're at a hotel I was dead lifting yesterday and I sometimes bring liquid chalk with me because you know if you're at a gym and they don't like you to use chalk you have this liquid chalk and I forgot to bring my liquid chalk and so I had to deadlift without chalk yesterday and it's just a stark reminder of how I become grip limited when I'm dead lifting in other words like I was failing because I couldn't even hold the bar anymore so I actually ended up dropping the bar at some point not because my glutes and my quads and my legs were because I was limited by my grip and you start to realize so much of what I'm doing in the gym is driven by my grip strength yeah when I'm doing a pull-up if my grip is failing I'm failing and that's why farmers carry of course is such a good functional exercise that's right yeah you're using your grip so often when you are strength training and so it's true that it's an easy thing to measure and that's also true of VO2 max it's objective scientifically measurable reproducible you can measure it here in London you can measure it in San Francisco you can measure it in Delhi it doesn't matter where you are you can always measure this same is true with grip strength leg extension chest press I mean these are the things that they typically measure but it's you'll you know it's you're always going to see the studies talk about grip strength and I agree with you completely it it's it's a bit misleading yeah because people think great I just need to go get a little squeezer thing and it's like no definitely don't get a little squeezer thing go pick heavy things up and walk around yeah there's something about that the extremacies isn't it that's how we interact and carry things but our feet to how we interact and that's the that these are the the hands and the feet are the Force transmission to the outside yeah and my I was going to say bias but yeah I was trying to be aware of my own biases I personally have been wearing Minimalist Shoes for over 10 years now they've been transformative for me I've recommended them to so many patients over the years not everyone but many of them and I've heard and seen so many improvements now again you've got to be careful I'm not talking about going from wearing cushion shoes you're in thailite to suddenly trying to run marathons in minimal issues no no let's let's be logical let's be rational about this but I wonder what your perspective is on foot strength how it relates to what you just said about grip strength and potentially where minimalist and barefoot shoes may fit into this part of the conversation yeah I mean I have the luxury of kind of because I work out at home I work out Barefoot so I I do really enjoy being Barefoot as much as possible um and I think that um look the feet are very similar to the hands um in terms of musculature what I think most people would appreciate is we have much more dexterity with our hands than we do with our feet and um a part of that is the fact that our hands are never really restricted the way our feet are so when we're in tight-fitting shoes constantly uh so in other words it's not just being in a minimalist versus a non-minimalist shoe it's kind of like having your toes jammed together yeah you know 12 hours a day that creates for a difficulty in using the foot the way it was kind of meant to be used so for people who have kids look at your kids feet yeah you see what happens yeah so so um anyway along the way of saying I I completely agree I do think that the the the shoe industry has kind of um probably gone uh to a place where we've we're not making healthy feet and many people myself included have had to spend a lot of time undoing uh the damage of of wearing shoes too often and very tight shoes and you know interesting there was a study done at the University of Liverpool a couple of years ago and to be fair the study was done wearing fever Beth that she isn't to be completely transparent they all wanted the supporters of this show um and it was making it clear that I was buying them with my own money for seven years before they started sponsoring the show that being said that study showed that um adults who were wearing these Minimalist Shoes over four to six months for just regular activities going to work going to the shops going for a walk not for running or not for going to the gym just for getting on with their day I think from recollection the foot strength went up by over 60 percent which I found remarkable because you're not actively trying to get a foot workout in you're just wearing something that allows your feet that that results in your feet having to do more work than when they're completely cushioned yeah which is which is pretty incredible just taking a quick break to give a shout out to Vivo barefoot shoes now I've been a huge fan of Vivo barefoots for over 10 years now well before they started supporting my podcast they are the only shoes that I wear then they really have had a huge impact on my own life and the lives of many of my patients you see when people start wearing Minimalist Shoes like vivos you can see improvements in things like back pain hip pain knee pain foot pain even things like plantar fasciitis can often get better and scientific research shows us that just wearing vivos for about four months or so improves the strength in your feet by over 60 which is absolutely absolutely incredible one thing people don't realize about these shoes is just how flexible they are which allows your feet to do what your feet naturally want to do rather than the shoe dictating your foot's movements Vivo Barefoot are giving my audience a 15 off one-time code when you make your first order and they make it really easy for you to give them a try they give a 100 day trial for new customers so if you don't like them you just send them back for a full refund I'm a huge fan I really hope you take advantage of this offer to get your 15 off codes all you need to do is go to Vivo barefoot.com forward slash live more or click on the link in the description box below so strength I just wanted to before we move on from strength just touch on females there are some unique uh pressures on women especially post menopausally and so I just wanted to speak to that when we're talking about strength training yes it's very important for both men and women but are there particular reasons and your view why women need to pay special attention in part I mean there are several but in part I think uh on average women come in for example to our practice or you know in Middle adult uh middle age they've done less strength training than men um of course we use nomograms that are sex specific so we when we're looking at metrics of muscle mass we use something called appendicular lean mass index and fat-free mass index so those are going to be normalized to age and sex um but uh you know women are often coming in having done less strength training so they're going to have less muscle mass is that a problem yes yeah sure strength and muscle mass are positively associated with lifespan and health span for men and women equally and [Music] um there's a big step up once you're at the 75th percentile so in other words the top 25 compared to the bottom 25 for muscle mass is a pretty significant difference uh in terms of risk of all cause mortality okay so let's just imagine see scenarios here teenage girl or there's a parent listening and they're concerned about their their daughter let's say maybe their son as well who's a teenager we've spoken all about the decline that happens in your 30s and your 40s are there things we can and should be doing with our children with teenagers to insulate them even more oh if you if from this decline absolutely and I'm glad you brought that up because um bone mineral density has a strong genetic component um however you achieve your genetic ceiling or your genetic potential by your early 20s and so if you if you think about the implications of that it means that people who are not doing the types of activities and again strength training is the most important activity on the list if you're not lifting weights as a teenager into your 20s you're not going to achieve your genetic ceiling and everybody both men and women are in a state of decline for bone mineral density from your early to mid 20s on for the rest of your life so if you're before that if you're listing right now and you're a teenager or if it's a parent we should be doing whatever we can to encourage our children or yourself if you're that teenager to be lifting heavy weights until at least 22-23 well beyond but beyond but there's this beautiful window in which you can capture your your your genetic potential okay and again everybody male and female will start to decline from about the mid-20s onward women have a much more precipitous decline at menopause if they don't go on hormone replacement therapy so estrogen is the most important hormone in bone health for both men and women and women lose their estrogen precipitously at about the age of 50 if they don't go on HRT so in that sense women are more susceptible and it's not uncommon to see women at the transition to menopause who haven't been lifting weights even if they've been very fit and they've been exercising um they show up with osteopenia uh wow and I mean we see this too often two things to to comment on there one is that makes me feel better about some of the uh disagreements my wife and I often have if they're if a new kettlebell delivery has come at home and I have them lying around and the kids are picking them up and playing with them and my wife's like no no put it down you'll hurt yourself I'm like hey let him let them pick it up right of course there's injuries to considerate you've got to be safe but I just think you know what kind of let them do it it's funny you say that I mean my um my two boys who are uh one just turned six the other is eight they've really become interested in coming in the gym with me in the past year and um I've just started them doing kettlebell lifts so it's a deadlift basically with a kettlebell so they're standing over a kettlebell and you know at first I just had them doing it with the lightest kettlebells and they were really getting annoyed and they really wanted to start lifting heavy things so I said okay guys on the condition that you can listen to me and you can do this properly and actually it turned out to be really challenging to cue a five and six year old to do a deadlift because I can't cue him the way I would cue you yeah I can't tell him about intra-abdominal pressure and thoracic extension and stuff it has to be much more simple so the first thing I realized when I was watching him pick it up is he was doing it incorrectly and I was surprised I thought a kid will always pick something up correctly but he didn't he was using his back and not his legs and I was like why is he doing that and I realized oh immediately like his arms are bent if you don't have tension in the arms if you don't have profound tension in your arms you can't use your legs if you have any laxity of tension in the upper body and he was bending down so much that he was like grabbing the thing this close and then trying to pick it up with his back so anyway it was a great exercise for me to learn to cue him correctly but then to watch how perfectly they can lift things um and now it's like okay so he just comes in the gym and all he wants to do is pick up that kettlebell up and down up and down up and I want to see he just turned six a couple weeks I love that yeah I love that and obviously he wants to do what Daddy's doing and Daddy's lifting stuff I want to do that as well so we can harness that potentially yeah um but the point is this is so important for for teenagers and um again you you may you mentioned something earlier that I think is a is a troubling and upsetting statistic which is you know that over whatever period of time I can't remember 30 years I think you said there was a 90 92nd loss in one mile time you know unfortunately I'm sure there is a a comparable statistic for loss of strength as well um so yeah basically with kids teenagers we want to be encouraging this early now of course the same is true with Fitness in other words you like I I feel very fortunate that you know even though I don't train at a fraction of the level that I used to I think the part of the reason I can maintain a relatively high level of Fitness is I maintained an absurd level of Fitness as a teenager into my 20s so in other words I reached a genetic ceiling then that I think makes it easier for me to stay in shape now and again that shouldn't mean that anyone who arrives at 50 who's not in shape should be discouraged you in many ways they have more potential they have a potential to be higher than they were before I don't I'll never be as high as I once was um but I'll probably be higher than that person on account of the fact that I had that capacity so young so we you know again to your point if you're listening to this and you're a parent or a teenager you really want to make sure um your kids are fit yeah when I think about your work pizza and when I think about the things that you're talking about in outlive a lot of what your asking or I guess suggesting people consider doing in their lives requires them to make some quite significant changes sometimes now over the course of my career as a medical doctor I've changed my perspective on what really causes a patient to change I used to believe that knowledge was all that was required knowledge is power and I've realized that I don't think that's the full story even with the knowledge I look there's a lot of knowledge out there and podcasts books if knowledge was the answer we wouldn't have a health care crisis so my question to you is in your experience what are the common obstacles you find for people who are trying to make changes I think it depends on the changes but but if so put that Nuance aside for the moment um I think in some cases the impediment to change is just inertia I mean sometimes it is difficult to say you know this is the way I kind of live my life these are my habits I want to create a new set of habits that requires sort of a willingness to to do something different which for some people they don't want to break a habit so so I'll give you an example um because I think they realize that doesn't sound very clear um if you tell a person um look you've got to go to bed an hour earlier and it would really be great if you didn't fall asleep on the couch watching TV because that hour of sleep that you're getting on the couch then you have to wake up and go into bed like that that's just lousy quality sleep well that the impediment to change isn't that they don't understand as you said that sleep is important but it's that they have a real habit around sitting on the couch to watch TV after you know to unwind and you're now basically saying well you're going to come up with a new way to unwind so it's the introduction of you know we're gonna make one change but it actually requires several changes and I I think that sort of underlies a lot of things I also think there are you know certain things that people have to do that are not that Pleasant initially so for a person who's never exercised I think it's actually quite intimidating and initially unpleasant to exercise and you can tell them until you're blue in the face that once you get over kind of the initial challenge of this it's actually going to feel quite good you're actually going to appreciate the fact that it's not just beneficial for you in the long run which it is but even in the short run but they do have to take a bit of a leap of faith sometimes to do that um I think when it comes to changing behaviors for example such as food um sometimes realizing that changing the default environment of your food is very important requires a big leap forward so it's one thing to say look I want you to you know stop eating this way and start eating this way isn't as simple as saying that it's well your pantry needs to change and the types of places you go for lunch need to change because you know you want the changes to be requiring less willpower yeah and more automated Behavior yeah so I don't think I'm being very articulate when I'm saying this but I guess what I'm trying to say is it's usually not one change yeah it's usually multiple changes that have to be set up to make the behavior of Interest be more automatic yeah I would say that very much Echoes my own experience I guess what I've been thinking about with patients very very similar to you I think is that all behaviors are therefore a reason they serve a role in our lives and I think often we try and change the behavior without understanding what was driving that so is the sugar you're craving at 9 00 pm on the sofa really physical hunger or is it emotional hunger you know is it that you've had a crap day is it that you've fallen out with your partner and that that bit of sugar is gonna help you because if it is then you might need a different strategy is it that you're you feel lonely and instead of the sugar maybe you want uh a phone call with your friends is it stress maybe you want a relaxing bath rather than that Sugar whatever it might be and so I would say that's one of the key things I've I've learned over my career is yeah you can change the behavior without addressing that but it tends to be short-lived classically New Year New You you know for I'm spinning four times a week every week for the whole year don't you do it for two weeks when your motivation's high and then suddenly you've had that bad day at work and you need to pick the kids up and whatever ah you know what that's too hard so it's not something you spend time within your practice trying to understand because look the behaviors are great I want to talk about more of these behaviors that we want people to do but it's often not the behavior it's it's the impediment to that behavior that I find I spend a lot of time with with patients I I think we do as well and um I think that that is the I think that is the the biggest challenge and and certainly within a year of being in our practice there's no patient who's at a loss for what they should be doing right that's um you know that's there's not much of a mystery it'll be it might be a mystery when they come in there might truly be some confusion about you know the optimal strategy around exercise or whatever um you know one of the things that um we try to remind folks I just think of it with the example you gave is um try not to have too back to back misses yeah right so the the example you gave thereof so you for for two weeks you're doing your four spin classes a week and it's all going well and then you have that bad day I think that a lot of people get into a negative spiral when they punish themselves for that bad day and they feel ashamed that they've missed their workout something that they said they were set themselves set theirselves you know set themselves to do and sort of that shame becomes the more dominant emotion as they are getting ready to have that next workout and it becomes easier to miss that next workout and instead what I think you want to try is say look you have that bad meal that you said you weren't going to have you missed that workout you do something that is kind of off your path um just give yourself a total pass with no judgment and just say yeah it's really hard like if this was easy you would have done it last year or the year before or the year before but just get it right the next one just make sure the next meal is right make sure the next workout happens um and I I even find this as important myself I mean I I and I tend to you know people would look at me and assume I'm sort of a a beacon of willpower um but it's not always true and I I still have to be very uh non-judgmental and sort of remind myself when I slip that it's okay and let's just try not to slip tomorrow is that a new thing you've had to learn in general absolutely um it's become more relevant as I've become older so um you know I think when I was younger and even more selfish there were never reasons for me to deviate but now with a family with other responsibilities there are plenty of reasons for me to deviate and I deem those better uses of my time sometimes and as a result of that I I do sometimes battle myself thinking what's happened to you like yeah look at how much you're slacking off and and you know whatever regard you're talking about but but yeah I think I'm much more compassionate with myself today than I used to be yeah snap I mean I I would very much berate myself in the past if I said I was going to do something and I didn't uh there was quite a lot of negative self-taught going on and you realize it's just never that helpful if shame or guilt is that underlying emotion I just don't think it's sustainable in the long term it will always catch you out at some points certainly that's what I felt by the way that's a whole other so so so going back to the what are the impediments to the behavior change I find that there's another phenotype that I see in my practice which is um um another manifestation of of of trauma right which is uh basically the individual who's completely incapable of taking care of themselves or putting themselves ahead of others yeah so I see this phenotype more commonly in females um and I see this as often you know um a mother who's you know doing a lot of heroic stuff so probably working really hard in a job uh probably puts her husband and kids needs ahead of her own but she does so at such a detriment to her own health yeah and she keeps you know she you know it's like so she sort of understands that her health is suffering but almost feels like it's her place to suffer and she can't make that exception and you know you'll sort of say look like you've got to carve out an hour a day for yourself to do these things and she says yeah I know I should but and then there's a string of excuses but you realize that deep down what's going on is like there's a form of self-punishment happening and I'm not saying that that's true of every mother who's out there working busting her butt but I'm just saying in the in the examples that I've seen in my practice I really attribute this to kind of a maladaptive Behavior around trauma and um and that's another example of where you know I I would describe that as sort of an emotional health failure that's cascading into physical health failure yeah I would say that one of the things I've learned and it plays into what you just said about this trauma Pace a lot of people these days have I would call them low-grade addictions whether it be sugar or social media or online shopping or scrolling online whatever which which gets in the way of other behaviors because there's a lot of behaviors that people could do to what someone said longevity but I think this is a really important piece you know why is it that people can't do those behaviors why do a lot of people perceive themselves to not have time and I mean I very much like Gable mates um definition of addiction which is again if I butcher it slightly please forgive me but something it's got these three components uh any Behavior or substance that you crave that either relieves pain or gives you pleasure that you are unable to stop doing or give up despite negative consequences right so through that lens of looking at addiction I would say many of us most of us all of us have some level of addiction and I'm interested do you do you find that a relevant area to go into with your patients do you see these low-grade addictions as getting in the way of them making potentially more helpful changes when it comes to their longevity yes but I would take a step even further back from that and say forget about the impact of these Addictions on their capacity to exercise or eat correctly or sleep correctly I would say just talk about the impact of those Addictions on their relationships um and and and I think that's kind of the interesting thing about trauma which usually on some level underpins some of these behaviors and by the way I think that that term is so loaded and people think trauma has to be Big T trauma but but really little T trauma can be just as just as impactful um but but not kind of dealing with those things and not understanding that most of those things produce really wonderful adaptations but as collateral they sometimes have maladaptive behaviors yeah and failing to deal with those things can have the impact on the physical side which we talk about right it's usually going to come in the form of failing to engage in self-care through those behaviors those positive behaviors but it can also be pretty disruptive to your interpersonal relations and and I think if your interpersonal relationships are compromised your quality of life is compromised your your happiness is compromised your joy is compromised and um you know honestly I think that's just as as problematic so to your question I think the way to approach that with patients is probably to find out where they're sensing the discomfort the most yeah and I I think that varies by individuals so I think there's some people who are sensing that discomfort the most vis-a-vis the behaviors that they're not engaging in correctly I.E I'm not eating well enough I'm not exercising I'm not taking care of myself in the physical sense whereas I think for others the the the way in which they're going to um face up to that is is going to come through the the destruction or damage on their relationships with their spouse their kids their friends co-workers it's when you when you really delve into this area and I know you've been on a personal Journey yourself with this as have I it's more and more about emotional health I think it's not that physical health doesn't matter of course it doesn't you know being physically healthier of course helps us with our emotional health as well but I kind of feel that the emotional health piece yes it drives better self-care yes it helps your relationships but you know there's quite a lot of research now showing that I've got to be very careful how I word this because I'm absolutely not putting blame on people but there are strong associations now between people who hold on to negative emotions who hold on to anger and resentment who are unable to forgive and the risk of autoimmune disease and again I'm not putting blame on people there are associations in the literature if I look at my own practice my non-nhs practice was largely filled with people with autoimmune disease a lot of women I would see these kind of personality traits a lot I don't know if you're familiar with Fred luskin's work at Stanford about um forgiveness and the ability to forgive on blood pressure really really interesting and I guess I followed you for years Peter and so you strike me as someone who you you've openly shared things that you measure in your own life right for many years I often think about that that phrase that you know not everything that we measure matters and not not everything that matters can be measured exactly so yes we can measure key metrics and we spoke about some of them uh first time you came on my show but there were kind of some other sort of unmeasurables which I find more and more are impactful for health I'm thinking about specifically to one patient I think she was 48 she had mildly elevated blood pressure I can't remember exact numbers but I'm going to guess it was in the region of 135 to 140 over 90 something like that and we for six months we're trying to make changes with the lysashi transformed her diets she started exercising you know she started to prioritize her sleep yeah I couldn't get it to budge I couldn't help her get it to budge and I was and we mentioned it properly we did 24-hour monitoring and I I thought what am I missing here now of course some people are going to be resistant maybe it needs pharmacies of course but I just felt from talking to her that she was holding on to a lot of anger and it turns out as I got to know him more that she actually was she has split up with her ex-husband who had cheated on her and she couldn't let go right she absolutely just could not let go and we spoke a bit about forgiveness and the importance of doing that and letting go and I won't go into everything that we did but essentially over the next few months she basically learned the skill of forgiveness she uh managed to let go of the anger she felt and her blood pressure normalized now that's an N equals one I'm aware of that but I'm sharing that with you because these things really teach me that there are all kinds of inputs into a human that manifests in their physical health and I didn't learn that stuff at Medical School I've just kind of picked it up through just observing and then it goes to the literature and see well that there is supportive research now do we have the same quality of evidence for that as we might do for a particular form of exercise for lowering blood pressure no probably not but on an individual level when I have someone in front of me I'm always trying to think which inputs here can I manipulate what could I be missing here I and you're someone I respect incredibly and so this feels like the softer side to Medicine but I feel it's just as important as the harder side and I I guess I just love your thoughts and perspective on areas like that oh I I I would agree with that completely uh in every regard right meaning that do I think that that matters absolutely do I think that it's very difficult to quantify if not impossible absolutely um to me the biggest question is um you know how do you teach it right so so how how did you get that patient uh who I think most people wouldn't fault her if she basically said I'm going to carry this you know ax to grind for the rest of my life most people would say understood yeah get it um so how how did you work with her to first of all convince her that it was worth trying to to uh to to forgive her her ex and then secondly how did how did she actually go about doing that yeah so firstly I believe in informed consent so I explains her the situation I explained the risks of not treating that blood pressure in terms of her long-term health and I explain what the options were I also had built up a really good rapport with her I got to know her this is one of the abuses that hard these days to be fair but certainly a few years ago there was still that continuity in primary care where you were in the NHS here where you would get to know someone you would get to know their family you would actually get to see who they were in in their lives in a way that you don't always get with Hospital medicine so I had built a really good rapport with her she trusted me so I don't go there with every patient I just got a sense what am I so you know when the time was right in a consultation when I felt she was open to it I said listen you've done incredible work with all the changes you made to your lifestyle I would have expected to see some change here not always but usually my feeling is I I picked up a couple of things from me that I think maybe at play hair would it be okay if I go through some of them with you are you interested and I approached it and the first time I broached it you know brick wall she wasn't willing to go there but I would like to see patients regularly even though it's just 10 minutes I would often get them back every few weeks I like to follow them up and talk to them and it got to the point where she was open she goes I said look we can put your medication and or we can try this because I think this may help your blood pressure but frankly I think it's going to help many other aspects in your life as well like if you hold on to this I understand and I explain to her that forgiveness would be not for her ex-husband it would be for her and I can't remember the exact exercise I think I I wrote this out on my third book but it was a forgiveness exercise it just a four-step process of asking her you know what exactly what was the emotion she was holding on to what benefit that gave her is there a possibility that you can see it um from your ex-husband's perspective you know what might have been going on in their minds and are you willing to carry this for the rest of your life because you essentially and I can't remember the language I used said actually that means your husband still has power over you today your ex-husband an act that he did it still affects you in your day today so again I don't want to I don't want to sort of derail the entire podcast onto this case but it wasn't just a quick fix it took time it took trust it took her trying it a little bit coming back I think our offers refer to uh psychotherapists I don't think she wanted to she builds up trust with me but the point is is that yes it was difficult but my belief is that not only did that help her with her blood pressure that's going to reap dividends in multiple aspects of her life emotionally and physically for years to come I'm convinced of that and I agree with you I think there's a subtle point there which is I think it's a better health outcome than just pharmacologically addressing it so if you had just given her an Ace inhibitor or an ARB you would have fixed her blood pressure but you probably wouldn't have fixed the underlying sympathetic tone the hypercortisolemia that was still going to have negative Health consequences and I've done that for many patients right I've I've done what you did I put them on the ice right so I'm not trying to say I do that every time no no but I'm saying in her case what I think is a win is uh it's it's the blood pressure got fixed but that's almost a biomarker of the actual problem getting fixed and with it her risk of many things is going down that are you know accounted for by the hypercortisolemia and that increased sympathetic tone and the increased blood pressure yeah I just find that so fascinating and then what I was thinking this morning you know I'm going to talk to Peter about you know one thing that fascinates me deeply is your practice it sounds like very few other practices that exist maybe globally now we touch on this briefly last time about our different experiences you know you in the US in a private system me in the UK in a publicly funded system and how that would affect are experience and potentially our viewpoints as doctors and I'm fascinated as to what people coming to see you with because typically in the NHS we acknowledged last time that we're pretty bad at real prevention in medicine the current way it's practice medicine 2.0 compared to Medicine 3.0 as you outline in your book right but people in the UK I would say Anna in America I'm sure typically go to see their doctor with a problem right doctor I've got pain here this hurts you know that they're coming in with a problem that they want you to solve are your patients coming in to see you and your team with a problem or are they coming in to say Hey listen I want to make sure my marginal decades is as good as it can be Peter can you help me yeah so if you if you compare I think maybe a note that you would write when you see your patient it probably starts with a chief complaint yeah right it would probably start with Mrs Smith came to see me today with a chief complaint of bloating or reflux or pain here or there on our first meeting with a patient the um the the note actually begins with their goals and there we break the goals into two brackets so it's marginal decade goals and goals for the next 12 months yeah I love it I think it's just just a wonderful exploration of what might be possible what might Health Care real preventive Healthcare look like and yes you say it's a luxury but I guess you've created that you've created the opportunity for people to go and experience that and I guess you've learned so much through doing that and creating that because often we don't have the luxury certainly in the National Health Service of doing a lot of the tests you do having access to that data what do you say because I was thinking okay I don't think the testing is the biggest limitation really I don't um and we actually talk about this with our patients early on like in the first month or so um in fact the first time we do a blood test review with a patient we review their bloods I sort of give a soliloquy that every patient gets the first time and the gist of it is something like this look um there are there are several metrics that we're going to be paying attention to in in the duration of your time in this practice so you might be in this practice for two years you might be in this practice for 10 years we don't know but you're going to get used to a drill and a Cadence with which we pay attention to things and most patients are coming into this practice with an over indexing on blood test because that's kind of you know in their previous relationships with doctors that's the thing that doctors are most paying attention to and we say look that's fine like you know we're going to do blood tests and we're going to talk about that here today that's what we're here to talk about but you should understand that your blood test is only about I don't know one of 30 to 40 inputs that we put into our risk assessment model so your family history which we talked about last week and we you know the reason we sent you home with a 10 page packet to fill out is because we really want to know your family history um and you know you're gonna we're gonna do a movement assessment that's going to take two hours and eventually a strength assessment that'll take a couple of hours in a VO2 max test and a zone two test and a dexa scan and a liquid biopsy like there's a lot of things and yes we want to know your APO B and your you know you glycemic you know we'll do an ogtt et cetera so the labs are only one of again 30 things we look at and by the way the labs have huge blind spots like the labs are really good at helping us predict your risk of cardiovascular disease when coupled with understanding your blood pressure and a few other things um they're not really good at helping us understand your long-term risk of cancer even your immediate risk of cancer I mean there's just a stochastic process to that that outside of measuring metabolic Health this doesn't really tell us if you have cancer or not um so we sort of almost de-emphasize the labs and I think the biggest impediment um from a Time perspective is is actually on the is on the movement stuff is on the exercise stuff is on nutrition we'll be back to the conversation in just a moment now many of us struggle to find time to eat all of these incredible Whole Foods that's why I'm a big fan of good quality Whole Food supplements like this one that's been in my own life for over three years now it contains over 75 Whole Food Source ingredients vitamins minerals pre and probiotics and can help us support our energy focused digestion and our immune system 81 are giving my audience a fantastic offer one year supply of vitamin D and five free travel packs with your first order you can see all details at drink81.com forward slash live more or just click on the link below and now back to the conversation sleep it's it's that's the challenge you'd have in 10 minutes right that's why yeah 10 minutes can't simply make that happen and and and people say to me you know Peter why aren't you you know scaling this like why aren't there a hundred other practices doing this and I think that's the challenge it's how do you scale those other pieces that do require the bespoke nature of of interaction with with a with an expert in that area and we're doing some things I mean we're building courses and and video stuff along that line but um it it it's it's it's just going to take other doctors saying I want to learn this stuff well enough that I can then be the conduit of this information um but I'll tell you there's I mean in the UK you guys are further ahead of the U.S and that you already consider APO B for example to be uh an appropriate metric for measuring risk for cardiovascular dise you consider APO B in the UK to be superior to ldlc the the US is still backwards on that one I think also what your model is showing is true prevention and actually without getting into policy and why the Healthcare System assess it the way it is big picture if every patient had access to that let's say let's take the UK a government-funded system a tax-funded system if you actually were able to do this with everyone despite The Upfront cost it's very clear or I guess without running numbers how can I say this it would appear to be very clear that you will save a ton of money at the back end like if you watches Why by the way people always ask me can we Institute a system like this in the U.S and I actually say it's much easier to Institute this in a single-payer system um can you just expand what that term single-payer means if someone doesn't yeah so a single-payer system would be like the NHS where you have the government as the only payer the government is the insurer yeah and why is that the case so a single-payer system by definition implies the government is PL is paying we don't have that in the United States for everyone we have we have something called the center of Medicaid services CMS that provides um services to people over 65 and something called Medicaid for people who have you know qualify for very low income but the majority of people in the United States who have health insurance have it through a private insurance carrier and that private insurance carrier will only be insuring them for a short period of time and it's actually it's even more complicated in the US because depending on the size of your employer sometimes the employer is the insurance uh risk Bearer but it's done through the administrative Services of an insurance company all of this is to say they don't really have the incentive to pay money today when you're 25 and 30 to prevent complications when you're 60 or 65 because they won't be the ones insuring you then you'll have a different employer or a different Insurance Company so if you think about the NHS though or any single-payer system um there really is an incentive to invest wisely when people are young and healthy to spend a little bit more because you still as the Single Payer in this case the government own the risk of that life down the line yeah so it's in many ways much more logical to consider medicine 3.0 in the context of a single-payer system than it is in a multi-payer system now that makes complete sense I guess one of the obstacles to that um is that the National Health Service is such a political Hot Potato that really there doesn't appear to be this 20 30-year Vision more there's an election in two years so what do I need to do with the NHS to make sure that I get re-elected which is fundamentally going to be problematic because decisions are always going to have a bias to short-term as opposed to long term and of course these things require an upfront investment that is more painful in the short term you reap the benefits in the long term just to finish up on your practice given that it is private given that um there's a cost element to it presumably and please correct me if I've got this wrong presumably it's only going to be people with a certain amount of resource who can actually access that and then in a capitalist system a lot of the people who end up with that resource in my experience are kind of type A personalities who have worked hard often not always often felt that there was something to prove right which drives them to get incredible success in this system which can reap rewards I don't know if that's fair to say or not of course every patient is different but then if that is the case are there certain patterns you see in those individuals and then I guess what can we learn from that if because a lot of people like Yorkshire listen to this show who may not have those resources so I'm always interested this is a great model of a practice what can we learn from that yeah I mean I think I think as a as a generalization that's probably a fair characterization um of course there are many exceptions to it so it's you know it's one has to take that with a grain of salt um and what's interesting is something that you alluded to earlier right I think that sometimes the most high achieving hyper-performing people are doing it because they have something to prove and sometimes that need to have something to prove comes with other baggage that can undermine your health both directly and indirectly and so I realized that statistically speaking more affluence translates to more Health yeah but that's not true Beyond a certain point in other words it's true that having you know an income of 50 000 pounds a year will produce a better health outcome than having an income of ten thousand pounds per year um and maybe having an income of a hundred thousand pounds per year will give you a better health outcome than having an income of fifty thousand pounds per year possibly I'm not sure but what's absolutely not true in my experience is having an income of 50 million pounds per year versus a hundred thousand pounds per year I don't see any difference in health outcomes at that level and in fact the person with the you know multi-multi uh million pound income often comes with other problems yeah um and so you know one needs to be careful what one wish is for and I say that just as much to myself as two others um and I think one just has to accept the fact that um you only have really responsibility and accountability for your own choices and your own behaviors and I I really think that time is the most important parameter in this game it's really not about resources as Financial Resources as much as it is about time yeah and that's an example of where yeah that person who's barely making it can often be in a situation where they don't have time either you know they're they're scrounging so many things together to make it work but um but you know you brought up exercise a moment ago I mean if a person could spend an hour a day exercising I mean they're going to be healthier than the richest person on the planet who isn't doing that yeah yeah who has all the fancy doctors who has all the fancy clinics who does all the executive physicals I mean none of that stuff will matter if they're not taking care of themselves and I've seen people across the Spectrum and the the correlation is very loose yeah just to finish off them Pizza you touched and maybe we're not trying to really go into this in detail but given that women have lower Eastern levels post menopause I know this this is quite a contentious area in terms of does every woman need hormones after menopause for brain protection cognitive protection muscles are you able to go to such a nuanced topic it's sort of quick over overview summary does every woman need it in your view well um it is a very complicated topic and it's one I've devoted a couple of podcasts and a lot of writing to um it is contentious very contentious certainly I found it to be it is contentious unfortunately it's contentious for the wrong reasons meaning it's all predicated on bad information right so all of this controversy around hormone replacement therapy stems from a trial called The Women's Health Initiative that was published 21 years ago that you know very erroneously um sort of permitted the media to misunderstand and misinterpret and and propagate um and basically the conclusion of that study was that estrogen caused breast cancer when in fact the the experiment showed the exact opposite so the Women's Health Initiative actually showed that estrogen was protective Against Breast Cancer but estrogen combined with synthetic progesterone did slightly increase the risk of breast cancer but not mortality from breast cancer when I say slightly increase the risk I mean one case per thousand one there was one additional case per thousand of breast cancer zero additional breast cancer deaths associated with that in the estrogen group alone meaning women who didn't take estrogen with MPA the synthetic progesterone there was a reduction in breast cancer that was both true when the trial was halted at five years and subsequently when the data were evaluated 15 16 17 years later so again just a grotesque misunderstanding of the literature um there are many reasons to consider estrogen some of those have to do with symptoms so vasomotor symptoms um and I would argue that any woman who is experiencing vasomotor symptoms such as hot flashes and night sweats um shouldn't have to suffer through those and therefore I think hormone replacement therapy completely makes sense in that context where I think it gets a bit more nuanced is what about women who are not experiencing vasomotor symptoms and what about women who are through the period of vasomotor symptoms so let's say they went through menopause at 50 and they're now 60 if they stop the hormone replacement therapy presumably they would stop they would not have symptoms anymore but they would also lose the protective benefits of estrogen on their bones the truth of it is we don't have great data on that and we never will no one will repeat the experiment to find out the answer to that but at least in our system I believe that it's much easier to screen for breast cancer than it is to treat osteoporosis and um I think each woman has to be sort of I mean I hate to say it it's such an obvious cliche but each woman needs to be treated individually and you you basically have to look at what are the symptoms of estrogen withdrawal and if they're trivial if a woman experiences no issues with estrogen withdrawal and she's really afraid of the consequences of Lifetime estrogen then that's probably the choice for her yeah I appreciate your your brief overview in a very complex topic um I spoke to Professor any smokerjee a few months ago about menopause and issues like this I hope to cover it against I think it is such an important issue and I think we're going to see I would imagine we'd see more research on this particularly to do with cognitive health and what what it means what that Eastern deficiency May mean for the brain going forwards but again that needs a proper nuanced discussion in and of itself yeah the Women's Health Initiative didn't really answer that question for us there were a lot of flaws in that part of the study so we instead look at smaller experiments that have been done since that time um certainly some of which suggest the protective benefit of estrogen for cognition it's possible that might only be in a subset of women for example those with an APO E4 Gene exactly so it's still a TBD and the remaining time let's see we can uh cover cardio censor cardiac okay what is zinc Cartier for people who've never heard that term before right and I think there will be quite a few although I think we often get seduced into thinking that our section of the internet is what everyone also sees but we all consume highly curated feeds that feed us what we already know what what we like I'm pretty sure much my audience will not know the term so why is that a key pillar of longevity protection when it comes to exercise for you so um this is a complicated one because it requires understanding a little bit about metabolism and how we um how we make ATP out of nutrients so there are basically two Pathways that we have at our disposal to make ATP ATP being the energy currency that is necessary for every physiologic function um so to be clear ATP is a form of chemical energy but it is made from another form of chemical energy in the form of food so when we consume food and for the purpose of this discussion let's just talk about two things fat and glucose since those are the most abundant energy sources fat and glucose contain energy in their chemical bonds those chemical bonds have to get turned into electrical energy which then gets turned back into chemical energy there's two ways to do that there's a very very efficient way to do that and a very very inefficient way to do that you might ask why is there an inefficient way to do it why would you ever do it that way it has to do with speed it's the speed with which you need the ATP if you need the ATP really really quickly if I said I want you to stand up and give me 25 burpees you know or do some you know I want you to Sprint all out for 30 seconds or for a minute you are demanding ATP at such an accelerated rate that your body is going to take you down a very inefficient way of turning glucose into an intermediate molecule called pyruvate and then turning that into lactate and generating a little bit of this ATP if I gave you all the time in the world if I said I want you to go for a slow jog your body hopefully if you're reasonably fit will instead turn that glucose and and maybe even fat ideally fat into smaller molecules that go into the mitochondria and make a lot of electrons that then get turned into ATP down the line so again I'm really oversimplifying but I think the point I want to make is there's a slow efficient way to do it that has no byproduct except for carbon dioxide and water and then there's a inefficient way to do it when you when you're when there's a gun to your head and it doesn't make much ATP and it makes a lot of lactate and lactate gets attached to hydrogen in the hydrogen causes your muscles to get stiff okay zone two is a term that is used to describe the highest level of exertion you can sustain while keeping lactate below a certain threshold two millimole why well once lactate gets Beyond two millimole it begins to start accumulating two millimole for most people is the level at which you can sustainably clear it while creating more of it so the fitter an individual is the higher speed they can run or the higher wattage they can put out on a bike while still keeping their lactate at or below two millimole and the difference is quite staggering so you mentioned kipchogee earlier I don't know his numbers but I would bet that kipchogee could run a 4 minute 50 mile of 455 certainly a five minute mile while keeping lactate below two for many of us that will be beyond our Max if you I first of all I couldn't run a mile in five minutes any longer um but even when I could run a mile in five minutes you know that I would be lactate above too yeah right so maybe even saying five yeah yeah so so um the same is true in cycling they give you look at you know tadi pogachar he could make four watts per kilo on a bicycle and his lactate is below too I could make four watts per kilo for a few minutes before I'd be filling up with lactate so the point being that this is working out in this specific Zone is particularly working on a particular energy system that we need yeah it is your maximum aerobic efficiency so if VO2 max is your maximum aerobic output VO2 max produces lots of lactate but it is the maximum oxygen consumption you have it's your max aerobic output this is different this is Max aerobic efficiency the uh sort of metaphor I use with patients is a pyramid the VO2 max is the peak height of the pyramid the the zone two is the base of the pyramid and the goal of cardio training is to have the biggest area of your pyramid so you don't want a pyramid with a high peak narrow base and you don't want one with a wide base short Peak you want wide base big peak so you want a very high zone two threshold and a high VO2 max yeah thank you it is a complex area um I will make one more point because the person listening to this might be like what the hell is he talking about with lactate here's the good news a person who then says okay how do I put this into practice if Peter says hey we really ought to be trying to do three hours of zone two conditioning per week it's true that the gold standard is achieved by measuring lactate but the way that we can do this in real life is just on exertion under what we call rate of perceived exertion and this is the tell for when you're in zone two when you're in zone two you can speak but it's uncomfortable and you don't want to but you can still speak in full sentences if you can do if you can speak in full sentences easily you're in zone one and you're not achieving that training effect so in other words it's not hard enough so if you and I went for a walk right now we would not be in zone two because we in zone one could be in zone flat ground having a what we've been saying one that's right if we went out for a run right now well that would be a bad example because it would be easier for you than me but let's just assume for a moment we we did something where we're both kind of comparably fit and we couldn't speak to each other or if we did it was one word here and there we would be in zone three four or five yeah and that would there's benefit in doing that but not for this type of conditioning yeah you have to thread the needle to that sweet spot and that's what you're basically doing is enhancing your mitochondrial efficiency yeah now I love it and and I would say for me for much of my life I've neglected this massively I was always drawn to intensity for a variety of reasons not really because I like the feeling more because I've always felt quite time pressured I've had a lot of caring responsibilities for parents throughout my adult life but I was saying the last couple of years completely changing that and I'm spending a lot of time relative to the Past in zone two and what's real I think for me and there's a lot of content you've put out online about zone two that you've written it beautifully in your book if people want to learn more I'm going to cover it on the show shortly for sure as well the beautiful thing about zinc is it's it's quite easy it doesn't you know yes you know you're a bit out of breath as you say you can hold a conversation you don't want to a lot of people get put off exercise I think it's too hard and I find one of the great things about zones I really enjoy it because I think listen to a podcast listen to an album I haven't listened to it for ages or whatever it might be and the recovery time is negligible right so actually I feel it enhances my life and enhances my cognition and I know it's doing something called Longevity so I'm not sure how appreciated that is so for people who are scared of exercise and don't want that uncomfortable feeling of real high exertion certainty can become one of your very best friends very quickly and it's important even if you're the best in the world so yeah if you look at the kipchogees of the world they're still spending 80 percent of their training time in zone two yeah um and you asked earlier can you think about a way of what percentage of your time should you spend in each of these zones I mean that's really what it comes down to exactly it's about 80 20. so it's about 80 percent of your cardio time should be spent in zone two 20 of your cardio time should be spent at a much higher intensity but if you start to push that down you're going to risk over training burnout and injury yeah so if you if you say I'm going to do 50 of my time will be high intensity and 50 of my time will be low intensity or zone two um a you're not going to achieve as as good a result but more importantly I think you're going to run the risk of that injury and over training we don't have time to go into this in detail so let me just summarize and please correct me if you think I've misinterpreted any fits a VO2 max workouts so to really that twenty percent of time potentially where you're working on that part of your Fitness as opposed to the 80 zone two it's typically done with longer intervals I know you do four minutes on four minutes off so four minutes really intense four minutes off so full recovery so beyond kind of the typical sort of hits workouts again that's a really quick summary because I want to be respectful for your time yeah The Sweet Spot is actually three to eight minutes three ten minutes off work of work with one-to-one work to recover three so if you're if you're enter if you're exercising at such a level of intensity that you can only do it for a minute on and a minute off that's great there is VO2 max benefit in that um but just understand it's not optimized for VO2 max yeah you're not going long enough because you're going too intense so okay so then if that person is going okay you convinced me I need to get on my exercise train for my longevity I can give you five hours a week but that's all I got how would you break up those four pillars into those five hours um it would depend on what their current deficits are now so again it's different if this is a person that's coming in who's done a lot of strength training and never done cardio or vice versa but let's make it really hard and say it's a person who's never lifted a finger so if it's if that's the case if it's a person who's never lifted a finger I might do two hours of strength training three hours of cardio and in their first cycle that three hours of cardio would all be zoned two I wouldn't even throw in any VO2 max or stability no I would just say for for three hours a week I would do four 45 minute zone two training and maybe in the last five minutes of each I would pick up the intensity a little bit Yeah but not even to the just just to get them just to get them a little acclimated to a higher workload and then the two hours of strength training I might have them do probably two 60-minute sessions a week where each session is whole body strength training and it's really foundational fundamental movements there's nothing terribly fancy some of it's probably going to be with just body weight um and then I would sort of reevaluate them at three months and first question would be hey have you enjoyed this enough that you'd want to add a little more time they might say I've enjoyed it a lot but I don't have more time okay great so then we might say we're gonna go to two and a half hours of zone two and 30 minutes where there's now a dedicated VO2 max workout and we're gonna probably get more advanced on the strength training so it's hard for me to say it exactly but but that's that's the general I appreciate it it's very individual it was more just to give some sort of guidance a huge apologies that we sort of rushed through a lot of these really complex topics like zone two and vat maths of course people can read more in the book or on your podcast just to finish off them Pizza finer words if someone is asking you listen I'm inspired by what you do um there's so much info out there I don't know where to start what do you say to them oh wait that's tough um I guess I would say just sort of pick one thing I mean presumably the person asking this question has enough um awareness to know where they are most efficient whether it be hey I'm really overnourished I'm under muscled I'm sleeping four hours a night like I would say pick the one thing that you're confident you could chalk up to a win and just do that for the next 12 weeks and really fix that pattern again if it's your sleep really fix your sleep we haven't talked about that today but you know again there's lots to do there if it's nutrition just really get that because it's just as much about the confidence that comes from sort of addressing that pattern um and making incremental changes that stick as opposed to trying to make massive changes that are harder to stick um so that's probably what I would advise thank you Pizza thank you for the work you're doing I think you're inspiring many people around the world to believe that they can actually do something right now that's going to help them in their marginal decade that's coming on the show and enjoy your time in the UK If you enjoyed that conversation I think you are really going to enjoy this one about the simple things you can do to improve sleep energy and reduce fatigue the foundational practice that I truly believe every person should do every day is

Channel: Dr Rangan Chatterjee

Views: 863,677

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: MNyZPkK0Zos

Length: 126min 29sec (7589 seconds)

Published: Wed Oct 04 2023