The Best Longevity Exercises with Peter Attia

The Joe Rogan Experience I think exercise is the single most important longevity drug we have Bar None like if you if you were if you said like I want to go deep down the rabbit hole of living longer what do I need to do it's it's like a super well crafted exercise program that is geared towards strength muscle mass and cardiorespiratory Fitness so it's all the above it's not just one right so I mean the hazard ratios for each of these are pretty interesting we've 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 time frame 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 percent of the population compared to below average is a five-fold reduction in all-cause mortality death from any kind whoa I mean there 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 is 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 you know 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 like an air squat you know like 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 cardiorespiratory there is a point of diminishing return so remember I said Elite is the top 2.5 percent and then you so it's it's it's it's um 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 5x now that said you know I 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 know 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 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 what particular exercises do you think are the best to achieve that result so we 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 the 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 um so if you're on like a you know a stationary bike and um so you and also wattage is such an easy metric for people to understand so how many watts are you putting out right so um 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 2 constantly driving it up and honestly one session of VO2 max training per week and the best protocol for that is the 4x4 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 would 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 um interesting and then as far as a strength program like do you recommend specific exercises is it like squat deadlift well it depends on this is where it gets very dependent on the person so we have a test that we put our patients through that's um 10 exercises um 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 me should you be able to hold well we hold males to the standard of two minutes and a long time yeah and females to a minute and a half 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