#261 ‒ Training for The Centenarian Decathlon: zone 2, VO2 max, stability, and strength | Peter Attia, M.D.

25:00Is that okay or how important is it to actually be really specific to train for this and to hit all of those pillars? Well, again, I think it depends on your objective. So everything has to be compared to the alternative. So the person says, look, I'm playing tennis twice a week, I'm playing basketball twice a week, and I'm lifting weights once a week. Am I doing great? The answer is, yeah, you are doing great, relative to most people, but I don't think that that's a recipe for success if you want to be in the best shape possible in your last decade. And the reason being is sports like any sport, whether it be basketball, tennis, swimming, any particular sport has so much repetitive stress in it that you're going to develop movement issues.

25:53You're going to have asymmetries in joints and muscles, and you want to kind of balance those things out as much as possible. So again, if you want to be able to play golf every week and you're going to walk five miles, that's great, but you have to acknowledge like every time you're swinging that club, it's asymmetric. So you have to think about what am I doing to counteract that? Same with tennis, same with basketball. And so again, it just depends on how much time a person is willing to put into this. I don't want to suggest that everybody needs to do this because I acknowledge it's really difficult.

26:24If it wasn't difficult, everybody would be doing it already. By definition, this is really a complicated idea. Maybe I just have the privilege of two things. One, I got to experience my marginal decade in my 20s. I had that back injury when I was 28 that left me unable to walk for three months. In so much pain, I didn't know my name for a year. And during that period of time, I would have given my life to have had everything back. So when I got it back, it's just, it's seared into my brain, what it feels like to be so immobile, so debilitated and in so much pain. And I think that's just the greatest gift I ever received was to have that time machine to basically go and experience the last decade of my life and then get zapped back to being 28 with a totally different mindset of, yeah, I never want that to happen again.

27:21And at least I'll do everything in my power to make sure it doesn't. So long answer to a short question, but the reality of it is you really do need to be training very specifically. And that means a lot of really silly looking, unsexy things that I do every day, sometimes as little as 10 minutes a day, sometimes as much as an hour a day, just on the stability stuff, just on the movement piece. but I wouldn't trade it for anything because the way my body feels, I'm thanked for it. So now let's talk about, so if someone's listening, they're like, okay, I want to train for this. And I'm willing to put in the work to the four pillars.

27:54So the strength, stability, zone two, VO2 max, just to keep it simple. What's the minimum effective dose where it's okay, how much per week does someone need to commit to be able to hit those four things? And then we can get into each of them in a little more detail, but just, you know, from a minimum effective dose if they have kids busy job families don't have a ton of time. What should they strive to set out for? Well, it depends where you're starting, right? So the minimum effective dose if you're doing nothing is not that much. You're going to get huge benefits when you go from nothing to probably three hours a week.

28:34That would be an enormous improvement. So I don't know that's the right way to think about it. Well, let's maybe let's just start there. So let's say someone starts at nothing. So you're saying, okay, start at three hours a week. How are you breaking that out? Well, if you only had three hours a week to commit to this, you know, I think you'd have to put probably an hour of that into steady state aerobic training zone two. I think you'd have to put an hour of that into strength training. I think you'd probably want to put 20 minutes of that or 30 minutes of that across one or two sessions into high intensity or aerobic training.

29:13So not hit intervals, by the way, but you know, sort of the longer intervals that are VO2 max appropriate. And then the remainder of that time, call it another, you know, 30 or 40 minutes, spread out at 10 minutes a day into some of the stability training. And again, I think it's important to understand. And if you say, look, I'm only willing to devote 60 minutes a week to this stability stuff, which seems so boring. Should I just blast it out in one one hour session? The answer is no. You're better off doing 10 minutes a day, six days a week. There's really something to the neurologic pattern that comes from practicing your IAP, practicing your breathing, your sick -apular cars, your cat cow exercises, doing that for 10 minutes every day is better off than just trying to do it all in one shot.

30:00So anyway, that's probably how I would structure a three -hour program. And for the, on the stability side, you kind of mentioned a few exercises there. And actually, what you and Beth did is we recorded those videos of you and the gym. And so those are available, peteratia -md .com slash outlive slash videos. And so anyone who wants to learn more about, okay, what are those stability exercises that I could do 10 minutes a day? Real short, real simple videos. you can go check them out so we won't spend time double clicking on those because as you've stated before it's you really have to see it to understand it as opposed to just hearing about it.

30:37And so let's say then someone is like okay I'll start with three hours a week. How often do you ratchet that up? Does that get increased every week? Does it get increased every month? Is it when certain milestones are hit? Well it depends what the limiting factor is. So usually when a person and starts at three hours per week, it's because that's the only time they're willing to put into it. Conversely, if a person's never lifted a finger and they say, oh my God, like I'm willing to do whatever it takes and they only start at three hours a week because you don't wanna injure them, then you're in that situation where how much can you ratchet it up?

31:13And I'd probably ratchet a person up every six weeks in a scenario like that. But I think the far more typical scenario is, okay, I'm willing to do three hours. I do three hours a week. Usually a person sort of starts to habituate to that stress. And one of the important principles of training is a principle that most people have heard have called progressive overload. So in one way or another, the training, the load, the ask needs to get more complicated, needs to get more difficult. So if you're talking about strength training, that could mean heavier weight. That could mean more reps, more sets, less rest between other things that make it more complicated such as using BFR.

31:55So we're always looking for ways to make this more demanding. For example, in my stage, now I'm not adding time anymore. I am at the limits of how much I'm willing to spend on this. My kids are young. Every minute I'm doing that, I'm not spending time with them or I'm not working or, you know, I'm just falling behind in some of the area of my life. So, you know, I'm already spending about as much time as I'm willing to spend in the gym. And it's probably on the strength side six hours a week. So I have to find other ways to add that demand. The other thing I would be doing is thinking about where the deficits are.

32:30So let's say you have that person that's at three hours per week. Maybe their ALMI is already at the 70th percentile, and they're actually reasonably strong, but their aerobic training is an atrocity. So then I'm going to disproportionately add to that as opposed to just equally build all of them. Conversely, you know, we have a patient in our practice upon entering the practice. I mean, this guy's VO2 max was probably above 60 and he is 60, but he's been a lifelong runner, but he never touched a weight in his life. So he has, you know, very little muscle mass. And this is a guy who we're actually saying, look, we're probably going to need your run a little bit less.

33:06And your running is amazing. And you're very fortunate that you haven't been injured doing it. We want you to keep running as long as you can, but we also have to address some of these other issues because you do have some of the really common issues of runners, some of the very common imbalances and things like that. So in his case, it was like, can we subtract a little bit of running time and start to get you doing strength training? So people almost need to take just an inventory of what they're doing and where their strengths are and that's where it's good to know, where is your VO2 max? How does your DEXA scan look?

33:39Can you farmer carry what percent of your weight? And if it's high and that piece is good, it's like, okay, keep training that but then film those deficits. You know, so we kind of hinted that the three hours per week really is for the people who are time limited. What about different ages? Because we dig it a lot of questions of, you know, I'm older. Is it too late for me to start training for this? And if the answer is no, how should I think about that? Because I'm not as young, I can't quite bounce back. I'm not as strong as when I'm younger, they might be coming into this with not as much strength.

34:15And so when you have a patient like that, do you think about how they should tackle this differently? Are they on kind of a different program than if someone was 30? How do you think about that from an age perspective? Everybody's different. An age is definitely one of the factors that calls for sort of nuance around programming. I'll say this. And I think I've talked about this on a previous podcast. I don't recall which one. There was a study that was done in Australia. I think we talked about on one of our podcasts actually where an investigator took a group of women with osteophenia or osteoporosis.

34:49These women had very low bone density. They'd never exercised in their life. If I'm not mistaken, no one was younger than in their mid -60s. They were probably, you know, in their 70s. These women were put on a pumping iron regimen. I mean, literally like old school in a gym picking up weights, walking around. This wasn't like some fancy posh Pilates class. This was pickup weights. And I think by the end of this study, one of the women may even got to the point where she was dead lifting her body weight. Imagine that 120 pound woman picking up on 20 pounds off the ground. Well, that was a great example because it was documented in a clinical trial.

35:30There are so many stories of these things that you just see that I just have to believe that people are far more resilient than they can imagine. And, you know, I write about one example of this in the case of Barry. Barry is someone who gets mentioned in, I think it's in the stability chapter actually. Here's a guy who traded his health for wealth, which is a pretty standard refrain, and then retired and had all the money in the world and realized, wait a minute, like I can't do anything. My body hurts so much. And if you look at Barry today, I mean, the guy's functioning better than he was 20 years ago.

36:04So, I think it really just comes down to being consistent and having a real sense of purpose around this stuff. And obviously, you have to be smart about it. I mean, you can injure yourself in the process of these things. So having someone who knows how to kind of guide that and using common sense is essential. But I would never want anybody to come away from this thinking, I'm too old to do anything about it. I think as long as you're breathing, you have a chance to do something about it. On that front, you kind of mentioned osteophenial osteoporosis. We did get a lot of other questions to outside of age, which is, is there anything female specific that they should be thinking about as it relates to sentinary into caflon?

36:40And I know Dexascan in addition to the muscle, it can also give bone mineral density, which is very important as we age. So maybe you don't want to talk a second about BMD and then also why that's something that maybe females specifically should be paying attention to thinking about. and then ultimately how that leads to how they should be training. Bounmineral density is very important for both sexes, but women are at a greater risk. The reason for that is the way bones work, and I'm oversimplifying a little bit, but bones effectively have strain gauges in them, and they respond to tensile stress.

37:19So when a muscle is contracting, the muscle via the tendon is attached to the bone, and as the muscle contracts, the bone is compressing. So imagine a strain gauge inside the bone that senses that, that's a mechanical signal that gets converted into a chemical signal, so mechanical to chemical via estrogen. Estrogen is the hormone that does the signal transduction, and that tells osteoblasts and osteoclasts, which are the bone -building, bone -reabsorbing cells to make the bone stronger, not weaker. So in other words, the use that are lose it, philosophy is at play here, and estrogen is the key link.

38:05Now, men and women have estrogen, and it's very important for both sexes. The difference is women lose estrogen precipitously in midlife, and therefore, women are more at risk for osteophenia and osteoporosis. Now, for men and women alike, it's very difficult to add bone density after you reach the critical period of maturation typically in the early 20s. So unfortunately, most of our audience has passed that point. I'm not sitting here having a discussion with teenagers, but of course, if I am, the answer is load -bearing, load -bearing, load -bearing. Reach your genetic potential while you have a chance.

38:45But for those of us who are past that point, the key is how much can you slow the rate of decline? And nothing is more important for that than load bearing activity. And in fact, it needs to be heavy load bearing activity. Walking does not count as load bearing activity. Running certainly better than swimming or cycling, where you're not bearing load. But none of those compare to strength training. So strength training is really the most important piece of maintaining bone mineral density. and it must be supported from an endocrine perspective with the appropriate amount of estrogen and potentially testosterone and certainly with the correct nutrition and supplementation such as vitamin D and the right amount of protein and things like that.

39:27One of the other questions we received is people were saying, hey, like what if you can't afford a trainer, maybe don't have a gym to go to, how much of this can you do kind of without fancy equipment, maybe with body weight? How do you think about that in terms of as people are wanting to train for this? You can definitely do quite a bit of stuff with body weight, but I would also encourage people to say like, if I don't have a lot of room, can I at least get some dumbbells and kettlebells? And you know, they do make these dumbbells. They're not cheap, but they're efficient, and they're cheaper than buying all the sets, where, you know, one dumbbell has multiple links in it, so it could be 70 pounds, 60 pounds, 50 pounds, etc., depending on where you click it.

40:11So I feel like if you're going to think about, okay, what's the most efficient way to do this? I would say you do want to splurge on a few pieces of equipment. And certainly heavy enough dumbbells that you can get into carrying would be important. I think resistance bands are also really important. I've had a couple periods in my life where I haven't had access to a gym for three or four weeks. and during those periods of time, traveling with heavy resistance bands was essential. And if I could have added to that, having some dumbbells makes a big difference. So it's definitely easier if you have access to a gym, or you can go to a gym, like a TRX is probably another really great piece of device for people who don't know what that is.

40:53That's kind of this strap device that you either hang around a rack or something, or you can even put it behind a door. You just make sure the door, you're on the right side of the door, so the door can't open. and you can do a lot of exercises with that as well. What about injury? So you kind of mentioned there earlier, being conscious of if you're starting out just to not get injured. How should people think about this if they're either coming into it with previous injuries if they're worried about injury, especially kind of in the older population? Is that where the stability work can be much more effective?

41:30Is it, if you haven't lifted much weight, start lower and work on positioning and how the movement works or how should people think about the injury piece? You know, this is something where I think you just have to be careful and I don't think it would be reasonable for me to represent that I can offer an answer that would cover that in a Broadway. For example, we did a podcast with Alton Baron looking at injuries of the shoulder, neck elbow hand. Was that like a six -hour podcast? It was very long. It was like definitely one of our three longest podcasts up with maybe Tom Day's bringing Matt Walker.

42:04And that didn't even really get into the rehabilitation. That just talked about like what's at the root of it. You know, I've certainly done a number of videos with Kyler Brown where we've gone over some of my rehab post -shoulder surgery. So I think the truth of it is you're just, unfortunately, I hate to say this, it sounds like, but you've got to be able to align with people who understand how to not paint by numbers in their approach to rehabilitation. So maybe one way to help screen for that is basically when you meet a practitioner, just spending some time talking to them about their philosophy around your particular injury.

42:38For example, before I had my shoulder surgery, I wanted to understand all the details of early versus late mobilization, the trade -off between range of motion and stability. These are trade -offs when you're repairing a joint as flexible as the shoulder. You can make it really stable again if you're willing to give up all range of motion and vice versa. I hate to say it, but I think you just have to become a more involved consumer of your care in that regard. But unfortunately, I just can't offer some blanket piece of advice around injury. But for the most part, even if someone's dealing with an injury, you would highly encourage them to not let them just give up on working out because of that injury.

43:16No, I mean, if anything, that should be motivation to get better. In injuries, it depends where you are in your life cycle. But for most people who I think are listening to us right now, if you have a nagging injury and you take the approach of, I'm just going to sort of ignore it and it's not necessarily getting better, you're on a very slippery slope. I know someone very well who's had a shoulder injury for the last six months and it's not getting better. It's clearly not getting better, but more importantly, she's beginning to atrophy around She's becoming so weak and her pain is so significant around it that she's altered all of her movement patterns in response to this.

43:55You know, she's younger than I am. Sorry, I sort of had a heart to heart with her recently and said, what do you think the natural history of this is? Like, do you just think this is magically gonna get better when you're 70? No chance. You need to do X, Y and Z right now. And yeah, that means you're gonna have to invest like at least three hours a week in doing this kind of rehab to see if you can get this better without surgery. And maybe it will require surgery. I don't think it will actually in this particular case. But it's the alternative is worse. Let's touch on VO2 max again. So a lot of people reached out and said, how should I train for VO2 max?

44:31So if you take away the only three hours a week to do everything, if it's someone saying, okay, my muscle mass is good, but my VO2 max sucks. What program should I get on? So the first thing to remember is you've got to be spending If you're really committed to developing your cardiovascular respiratory fitness, you know, I think I talked about this in one of the podcasts. Maybe it was on Tim's podcast. You're trying to maximize the area of a triangle. So the triangle has a base and the triangle has a peak. And the goal is how big an area can I get? Not how wide, not how tall. You don't want one that's this wide and this tall.

45:08And you don't want one that's this tall and this wide. You want the max. The base is your zone two. The peak is your VO2 max. From a training perspective, the rule of thumb that is applicable for people like us, i .e. normal people, and the best athletes in the world is roughly 80 -20. 80 % of your volume is down here, 20 % of your volume up here. In fact, some of the really, really elites are probably closer to 90 -10. So you're saying no matter if you're just an ordinary athlete or you're the best of the best, it's still rough. the same. Tadi Bogacher, who's the greatest cyclist on this planet, two -time winner of the Tour de France, absolutely mopping up the field of cyclists like their children.

45:55That guy's doing 80 % to 90 % of his training at Zone 2. And I know that for a red fact because we know who his coaches. So then let's maybe talk about that pyramid. So maybe let's just step back and say, I didn't answer your question by the way about the Vio2max which we can come to. Yeah, so maybe I was just going to say maybe let's just cover the whole pyramid. So what's the training of the whole pyramid. If you know, it's kind of 80 % 20%. Let's break out. So I just start with how much time am I willing to put into this? Now, I got to be honest with you. I wish I could be putting 10 hours a week in Tacardio.

46:22I mean, historically, I've put in 14 to 20 hours a week in Tacardio up until 10 years ago. So like, I really miss those days. I miss being insanely fit. I'd miss that terribly. And I miss the joy of that much training. It's simply not possible today for all of the obligations that I have and I've done the math 10 ways to Sunday, I'd have to give up something I'm not willing to give up, I've had to give up archery or give up driving or give up my kids or something like that. I'm not willing to give any of these things up. So I basically start with what's the most amount of time I can put into dedicated cardio.

46:58And for me, it's like four to five hours a week, not including rocking. I sort of keep that in its own bucket. So then it's a very simple calculation. 80 % of that time is zone two and 20 % of that time is VO2 max. And how are you breaking out? Let's just start with zone two. How many I divided into four workouts a week Tuesday Thursday Saturday Sunday and Do you always recommend doing it over like let's say you could do Four hours and one day is there the same benefit of doing all your zone two and one day versus spreading it out? You know, I've talked about this within you go his view is if you can get at least 30 to 45 minutes you should spread them out.

47:38Again, if you're only able to commit an hour to it, it might be one hour once or 30 minutes twice, but I'm sort of doing 45 minutes to 60 minutes each time is what I do. Are you doing zone two V .O .2 max on the same day? One of those days. So, so Tuesday, Thursday is just zone two and then two long sessions of stability training called an hour of zone two and hour of stability. Actually, I want to just walk you through the whole week. That'll be easier. So Monday is just strength training. So that's about 90 minutes to two hours when you include the stability training that I do as well. So movement preps stability training, strength training, and that's all lower body.

48:17That's Monday. Tuesday is zone two, followed by dedicated hour of stability. Wednesday is upper body strength and stability. Again, 90 minutes to two hours. Thursday is a repeat of Tuesday. Friday is a repeat of Monday. Saturday is zone two in the morning, upper body strength, repeat of Wednesday in the afternoon. Sunday is zone two, followed by VO2 max. And what you ever do VO2 max before you do zone two? I generally don't, just because I like to have a lot of reps before I go for broke. So even when I was like a cyclist and doing two, Vio2 max workouts a week, they were always preceded by the metric we would use on a bike was kilojoules.

49:11So as how many kilojoules of work would you do before you would do the super hard sets? And it had to be at least 1 ,000 kilojoules, which it translates to at least 1 ,000 calories of work. like four zone two, I know you said you kind of like to break it up. If someone is like, hey, you know, I can do four days a week of zone two, but I can only do 15 minutes a day. Would you say - Then I'd compress it. I would say do two thirties. So in your zone two sessions you like to do at least thirty. At a minimum, yeah. When you're in those zone twos, are you like when you hit the bike and the clock starts?

49:46I do it all mine on a bike. sometimes on a treadmill, but what I do is the computer is programming to the Wahoo kicker, which is the device I'm sitting on. So it's taking 10 minutes to ramp me up. Maybe just walk through what modalities can people do zone two on? treadmill, bike. Anything that is steady state. So swimming is a great way to do it because you can really swim in a pool at a steady state. Running is a great way to do it because you can pretty much run at a steady state. Cycling outdoors is is generally hard unless you have specific, like fiesta island was a great place to train. I used to train at fiesta island because for people who don't know where that is in San Diego, it's where all with a time trial bike races were and it's just a seven kilometer loop that you can ride on without lights or any like there's no traffic or anything that gets in your way.

50:33But for the most, I wouldn't be able to do zone two outside here in Austin. It's too hilly and there's too much traffic. It fits in starts. I can do my VO2 max here because I go to a hill and that's my favorite way to do VO2 max is on a hill That's about a mile long and just do very hard up the hill and then easy down the hill a treadmill is another great way to do it Just front of a walking incline typically Rowing machine if you're really a good rower you have to be efficient enough most people are not efficient enough And they don't have the strength they don't have the stability to row really well for 45 minutes it's, stair climber is another really good one.

51:12Depends again, if you're starting out, brisk walking is probably good enough too. We don't have to get into all the reasons of the benefits of zone two because we have so many podcasts with InUgo, San Milan, people can listen to, but you kind of hinted at another thing there, which is when you start your zone two workouts, you'll ramp up, but also a lot of times we get questions where, you know, hey, I did a 90 minute workout out and I was in zone two for 45 minutes of it. Am I good? I think what you mean in that question is, you know, like I went out for a three hour bike ride today when I got back, my computer told me I was in, I did 44 minutes of zone two.

51:49So two issues there. One is that's just a zone two based on heart rate. That's generally the worst approximation of zone two. So zone two really is more based on lactate if we're going to be purely accurate or at a minimum RPE. But even if you pass it that 45 minutes of zone two from your heart rate is roughly accurate, it's not the same physiologically because usually you're passing in and out of zone two in that situation. And so you're not getting kind of that constant steady state churn, which you're looking for. What we're really kind of looking for is the harnessing of mitochondrial efficiency.

52:23And to do that, you have to be able to push oxidative phosphorylation right to its limit before you trip into glycolysis. And you're just at the limit of that glycolysis being the dominant energy source. Whereas if you're on that ride, you're going into and out of glycolysis constantly. So it's not that you're so much in zone two for 45 minutes, as that you passed through zone two for a sum total of 45 minutes. Which again, there's still value in that, but not for what we're talking about. And what about VO2 max? What modalities can you do VO2 max training on? You know, here I think it's probably the easier in a way, right?

53:00Because it's pretty much anything that gets your heart rate up and gets you very tired. So, you know, look, it could be an air bike, it could be a regular bike, it could be a stationary bike, stair climber, treadmill, running outside, you know, the sky's almost the limit. Something like burpees is probably pretty tough once you get into something that that intense like jumping because the sweet spot for VO2 max is kind of 3 -8 minute intervals. So you don't want to be doing things that are so intense that you can't do them for at least 3 minutes. And so that's why I'd kind of hold off on that stuff.

53:34I mean, when I was young and I was really fit, I did a lot of it with jumping, but I can't jump for 3 minutes anymore. Like, I'm not that fit anymore. So I have to rely on easier things. What's your current VO2 max workout? out. So you mentioned kind of three to eight minutes on. Is it typically I do four on four off is sort of where I spend most of my time. Sometimes three on three off on a rowing machine. I got into that quite a bit last summer, but these days, and sometimes by the way, I just I'm in a bit of a rush and I'll just do one minute on two minute off at a much higher intensity on the stair climbers.

54:11So I have one of those like industrial grade strength climbers, And sometimes I'll just go sprint for a minute up the stairs and then takes me two minutes to get my heart rate back down to about a hundred and then repeat that for 20 to 30 minutes. So that's kind of like my poor man's cheating VO2 max workout. But what I really like to do is four minute repeats, four minutes on, four minutes off. And on the four minutes on, are you going 100 % for the full? Like how should someone think about you have to play with this? This is years and years of practice to know what that feels like. So again, I'm doing this on a bike, so I'm looking at wattage.

54:49And my watts are so low now I'm embarrassed. So I'm not going to tell you what the watts are because there's so much lower than they used to be. But I know I have a sense of what I need to average my wattage over those four minutes. So I might go out at 105 % of that wattage. And it feels pretty easy for the first minute. If it doesn't, I've gone too hard. By three minutes, I'm very uncomfortable. In that last minute, IE, at four minutes, I don't have much left. If you go out, all out, in that first minute, you're not going to get to four minutes. You're just going to crash and you're sort of not in that zone.

55:26There's no question, I positive split the thing, meaning I do more work in the first half than the second, but I don't want it to be more than about 10%. How much of this can it improve for people, right? So if people are saying, okay, I'm willing to put in the work for zone two. I'm willing to put in the work to increase my VO2 max. Is this something, if it's been two weeks, a month, two months, and they're not seeing maybe huge increases, like they should get discouraged? I mean, I don't think you're going to get in your VO2 max tested every three months, you know? So it's, how should people think about just monitoring progress in order to see if improvements are happening, just to keep people motivated?

56:04Well, again, it depends on what modality you're using, but yeah, I don't think you need to test your VO2 max more than once a year. What you're looking for is you pick a modality and I'll give you an answer. So let's take bike. Okay, so again, most stationary bikes have a power meter. If you're riding outdoors, you'd probably want to have a power meter. I do think it's the great equalizer. So speed can be misleading because of wind and stuff like that. So you'll know how much water you can do. So when you start out, you might only be able to put out 150 watts for the four minutes. But if in six months you're putting out 175 watts for those four minutes, assuming that your weight has an increased significantly, your VO2 max has gone up.

56:48Again, the other thing to keep in mind with VO2 max is weight plays an important role in it because it is VO2 max in liters per minute divided by your weight in kilograms. So if the name of the game for you is how do I maximize my VO2 max in total absolute terms, you can really game the system. My VO2 max when I was cycling was high because I was very light and I was disproportionately light in my upper body and your upper body is contributing nothing to the VO2 max for most tests because it's basically tested on a bike or on a treadmill. So you get punished for any upper body mass and you're only rewarded for lower body mass.

57:30So the lighter your upper body is, the better you are. It can also be good motivation to people who, let's say on the 2x2 nutrition framework, if you maybe are overnourished and you do lose weight while you're starting to get the cardio, you can see a good jump in your VO2 max if you're losing excess weight. Yeah, it just comes down to how long you're willing to put into this. The literature on this suggests you can only improve your VO2 max by 50%, but the literature is typically looking at eight week studies. So what we're interested in is a lifetime of training. And in a lifetime of training, you can increase your VO2 max by 50%.

58:05So there is a strong genetic component to it. You know, when you see these people who have freakishly high VO2 maxes in the 80s, there's unquestionably a strong genetic component to that, but they're also training like crazy. Well, and you kind of hinted, right, which is the goal for people who are wanting to start training for the Centenary and the Cathlon for them is thinking about it based on their lifetime horizon. It's not something that's going to play out as I can train for this for six months. Like, it's not like I'm going to train for a marathon after I train for the marathon, I'm going to go back to doing what I was doing.

58:38It's you really do want to create a program that you can keep up with for years and decades. and also you keep that timeline perspective of, okay, I don't need to increase in a same amount because what I wanna do is not get injured, be able to do something that I can do, find enjoyment out of it and find value. Well, that kinda took us that time. This was a little bit of a shorter AMA for us. We also just kinda speed around those questions, but hopefully people found some value out of it and just kinda to build off what they learned. but any last piece of advice that you would want to give people as they think about Centenary and the Catholic one, as I think about their longevity journey, again, kind of assuming people read the book, you know, what advice would you give them?

59:26Advice may be not, but certainly incentive would be the following. We talk so much about the benefits of exercise in terms of how much it reduces the risk of chronic disease, how much it reduces all cause mortality. You've probably heard me say this before, but it's worth repeating, if I knew that all this training I was doing, everything I'm doing, if I knew that it was going to shorten my life by a year, I would still do it purely for the improvement in quality of life between now and the end of my life. The fact that it's not shortening my life by a year, the fact that it's probably adding five to seven years to my life and improving the quality of my life means day in and day out, I just think it's about the most important thing that I can do vis -a -vis my physical health, so other elements of health that we didn't get to.

1:00:18That would be sort of my parting thought. And of course, my parting comment would be a thanks to everyone who's listening to this, because by definition, if you're listening to this, you were an early purchaser of outlive, so I really want to thank you for that. It means a lot to me. I think I mentioned this once before on our podcast, but it's probably worth repeating. I never thought that a book would mean as much as it has in terms of how personal it feels and how attached to the thing that I feel as it's out there. And there's no other piece of content I've ever created. There's no blog post I ever felt this attached to or newsletter or podcast.

1:00:59There's just nothing. And this feels oddly personal. And I run into someone and they send me a message about it and they say, Hey, I got your book. I read it. I really liked it. To me, it means more to me than I thought I would. I'm sorry that I can't be thanking each and every one of you in person for purchasing the book as early as you did. Hopefully, this is the next best thing. And so thank you very much. And I should say to the one thing I forgot to mention earlier is if anyone who has a physical copy of the book, if you haven't popped the jacket cover off yet and seen the actual cover, there is something on the actual cover too itself that was a special design and again, shout out to...

1:01:37No one's mentioned that yet. Not a lot. We got in a few but again, Rodrigo, Carral and that whole crew just awesome, not only on the jacket cover but the physical. What's that called? The board. What do they call the hard cover or the thing? There's a name for that and I forgot. I just called the book. The book. It's a different question but it's a little Easter egg out there for people but... Yep. Awesome. All right Peter, Thank you very much. Thank you very much. Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in -depth exclusive content without relying on paid ads.

1:02:13It's our goal to ensure members get back much more than the price of the subscription. Now, to that end, membership benefits include a bunch of things. 1. Totally kick -ass comprehensive podcast show notes that detail every topic paper person thing we discuss on each episode. The word on the street is nobody's show notes rival these. Monthly AMA episodes are asking me anything episodes hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spills like this. The qualities which are a super short podcast that we release every Tuesday through Friday highlighting the best questions topics and tactics discussed on previous episodes of the drive.

1:02:54This is a great way to catch up on previous episodes without having to go back and necessarily listen to everyone. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse. And a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member -only benefits, you can head over to peteratiamd .com forward slash subscribe. You can find me on Twitter, Instagram, Facebook, all with the ID, Peter Atia MD. You can also leave us a review on Apple podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only.

1:03:31It does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No doctor -patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay an obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously.

1:04:09For all of my disclosures in the companies I invest in or advise please visit peteratia md .com forward slash about where I keep an up -to -date and active list of such companies.

1:04:40I'm going to do a little bit of the same thing. I'm going to do a little bit of the same thing. I'm going to do a little bit of the same thing. I'm going to do a little bit of the same thing. I'm going to do a little bit of the same thing.