Peter Attia on The Best Exercises for Longevity

I think exercise is the single most important longevity drug we have, bar none. Like if you said like I wanna go deep down the rabbit hole of living longer, what do I need to do? It's like a super well crafted exercise program that is geared towards strength, muscle mass and cardiorespiratory fitness. So it's all of the above, it's not just one. Right, so I mean the hazard ratios for each of these are pretty interesting. This has become like each year I try to bring one new focus into our practice and the past 12 months the focus has been entirely around taking exercise to a new level in terms of our understanding of how to fine tune it. And the data are unbelievable, right? So if you, everybody knows that if you smoke or have diabetes, your risk of death goes up a lot. But your risk of death from having high cardiorespiratory fitness goes down by much more than your risk of death goes up from smoking or diabetes. So smoking and diabetes will double or triple your risk of death depending on the timeframe you're looking at. Having very high cardiorespiratory fitness. So having a VO2 max that is elite, we would define that as the top 2.5% of the population compared to below average is a five fold reduction in all cause mortality, death from any kind. Whoa. I mean, we don't have drugs that have a 5x reduction in mortality. That's incredible and that's just elite cardiovascular health. Right, and then when you layer in strength and muscle mass, we actually now have pretty good data as to the fact that strength is more important than muscle mass. We just use muscle mass as a good proxy for strength but if you just focus on strength, that's the metric that matters. It's about a three fold reduction in all cause mortality when you compare high strength to low strength. And the tests are, we're talking, it's not like how much you can squat and deadlift. It's like grip strength, dead hang, how long can you do an air squat? What's your quad strength? How quickly can you do five reps up and down from a chair? I mean, it's relatively simple stuff but when you stratify people by those metrics and you compare the highest to the lowest performers, there's just no comparison. Is there a point of diminishing returns though where you just get really, really strong but it's not helping you any more than being fairly strong? On the strength data, we don't see it because the data have only been parsed out as high to low. On the cardio respiratory, there is a point of diminishing return. So remember I said elite is the top 2.5% and then you, so it's, we break them into five categories but they're not equal in bucket size. You get most of the benefit honestly by going from not fit at all to average fit. That gives you three of the five X. Now that said, I hold myself and my patients to a way higher standard, which is we have a chart that shows all the data by age, by gender and by VO2 max. And I would say, if you're a 52 year old male, I'm asking you to have the VO2 max of an elite 42 year old male. So I want you to be a decade younger elite. And then we do the same thing with strength metrics. And when you prescribe that, like say if you take a 52 year old male that doesn't have a history of cardiovascular activity, you know, maybe they, you know, lightly work out the gym or something like that. What particular exercises do you think are the best to achieve that result? So we'd start with a base of zone two. So this zone two is that lactate thing I was talking about. So your zone two is defined as the highest level of aerobic output that you can generate while keeping lactate below two millimole. So I think a bike is the easiest way to do this because- Stationary or? Stationary just because it's, you can keep it steady state. You know, when you're on the road, it's all, you're all over the place. But so if you're on like a, you know, a stationary bike and so you, and also wattage is such an easy metric for people to understand. So how many watts are you putting out, right? So the first thing we would do is say, you probably need to be doing at least three hours a week of that zone two, which is building an aerobic base. So four 45 minute sessions at zone two, constantly driving it up. And honestly one session of the O2 max training per week and the best protocol for that is the four by four protocol. So that's four minutes at the highest output you can sustain. So here you could do it on an air bike or something, right? So you could do what's the highest wattage you can hold for four minutes and then four minute recovery and do five of those sets once a week. So when you're doing that, do you think that the best is like an air dine that works the arms and the legs? Or do you think just a regular bike that just works the legs? Like what is? For zone two, I mean, it really just matters that you're consistent, but I think most people find you can do a higher output when you're on an air bike in terms of absolute wattage because you are leveraging upper and lower body. It really doesn't matter that much. I mean, you can do this on a treadmill, you can do this on a stair climber, you can do this on any kind of cardiovascular activity, but you need 45 minutes, four times a week. That seems to be the minimum effective dose on zone two. Now, if someone's super deconditioned, it can probably be three 30 minute sessions to start and they'll see benefit. Interesting. And then as far as a strength program, do you recommend specific exercises? Is it like squat, deadlift? Well, it depends on, this is where it gets very dependent on the person. We have a test that we put our patients through that's 10 exercises and they're all basically normalized to your body weight and gender, so like a dead hang. So how long can you hang from a bar dead? So for male- How long should you be able to hold? Well, we hold males to the standard of two minutes and females to a minute and a half at the age of 40. So then it gets discounted by decade. Watch the entire episode for free only on Spotify.