#223 - AMA #39: The Centenarian Decathlon, zone 2, VO2 max, and more

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Welcome to a Sneak Peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com subscribe so without further delay, here's today's sneak peek of the Ask Me Anything episode.

Welcome to another Ask Me Anything episode. Here we are at number 39 and I'm joined once again by Nick Stenson. In today's episode, we answer a lot of questions that have come in from subscribers based on all of our recent exercise content. Given all those questions that we've been saving and coming off our last ama, which looked at the J curve data and the question around if you can exercise too much, we decided to do an AMA with more of a rapid fire style question follow up on those topics. So in this discussion I answer a lot of questions around the Centenarian Decathlon, which many of you have heard me discuss, and exercising with the goal of longevity, meaning lengthening your life and improving your health span. In addition to how I'm personally thinking about that, we talk a lot about the follow up questions around various types of cardiovascular training. This gets into everything from partitioning to methods to comparing different ways in which one might go about trying to get that cardiorespiratory benefit. We then get into nuances around VO2 max training versus zone 2 training, the ideal breakdown in terms of time and intensity for each and specific follow up questions around VO2 max in general. So if you're a subscriber and you want to watch the full video of this podcast, you can find it on the Show Notes page. If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy AMA number 39.

Peter, welcome to another ama. How you doing?

Feeling good man.

How's the heat out there?

I don't mean to sound like that guy who's like just too cool for school, but it's just not phasing me and people just can't stop complaining and I don't know why. And it's interesting because I'm normally my nickname in one phase of my life. Maybe it was residency or medical school. My nickname was Bubble Boy. If it was below 72 or above 76, it must have been med school. I was like, yeah, it's just too cold or too hot.

California does that to you though. Just getting those bubbles and anything outside of that feels good. You saw it in San Diego. 60 degrees and people would be in north faces walking around.

My thermostats definitely clicked to the much higher end again. We'll probably talk about rucking, but rucking. I always pick the hottest time of day to do it, so usually about somewhere between 4, 5pm and it's just moved my thermostat higher. So it's been 106, 107 every day for as far back as I can remember. And it's looking like it's going to be that as far forward as I can see. But I was in California three, four weeks ago and I had dinner with a friend. We ate outside. I was in a T shirt and I was freezing and it was about 65. I thought I was going to die. It wasn't that bad. But I was amazed at how cold I felt. So clearly I've lost my comfort level at the extreme low end of temperature.

The Canadian in you is just sad to hear that. Just the freezing cold at 65.

Well, so be it.

All right, so I think what we're going to do for this AMA is the last ama. What we did is we took a lot of questions and answered looking at the various literature to understand some of the confusion around if there's such a thing as too much exercise. But what we weren't able to do is with all the exercise content we've been putting out lately, we've gotten so many just follow up questions. And so coming off the last ama, what we thought is it'd be a good time to just do a little more rapid fire style of those questions, not necessarily a heavy deep dive, and just really look at answering all these different questions around exercise. That's what we're going to do today. If all goes well, we'll cover all four pillars of questions that have come in. And so it should be good, well rounded AMA on all things exercise. There should be something for everybody. So before we get to the first question, anything you want to add to that?

Nope. I think that's a great framework.

Perfect. So I think the first question is just to set the stage. It may be again, talking about what you view as your goal with exercise, which you've mentioned before, is training for the centenarian decathlon. So maybe just give people a really brief rundown of what that is and why you think it's so important for you as you look at your longevity journey.

So the centenarian decathlon, which I think many people listening will have heard me talk about, is simply a mental model for how I think about training. In all of my years of training, which have basically been my entire life, since I've been 12 or 13 years old, a couple of things appear clear to me. And by the way, this is true of not just my own training, but the training I've been involved with for other people, athletes, and this includes professional athletes, Olympians, things like that. Specificity matters and people confuse specificity with narrow. That's not the case. So I want to elaborate on these two things. You can be broadly trained and broadly conditioned, but with specificity and focus. And as we'll see in a moment, that's really what the centenarian decathlon is all about. You can be narrowly focused with great specificity. That's what certain types of athletes are doing. If you're a golfer, if you're the best golfer in the world, there are some really, really specific things that you need to be doing. By the way, they're highly asymmetric, depending if you're right or left handed. And your training is basically focused on enhancing those very, very specific movements and probably some training to counterbalance the asymmetry there. In my experience, it's very difficult to be successful in a physical endeavor if you are not pursuing some sort of objective. I'm just going to work out. Strategy doesn't really produce great results over the long haul and it certainly doesn't when you're trying to solve a complicated problem. So even if you could convince me that. No, no, no, no, the just work out for the sake of working out is better than sitting on a couch. I would say you're absolutely correct. But now we're going after a really hard problem which is to be in the last decade of your life, what we call the marginal decade, and be incredibly robust physically. What does that look like? Well, I think it means Imagine a 90 year old who's functioning like a 70 year old. I think that's attainable. So I'm not talking about 90 year olds functioning like 20 year olds. I think that's science fiction. But I am talking about 90 year olds functioning like 70 year olds or 85 year olds functioning like 65 year olds. But that is going to require a lot of preparation as we'll talk about later. When you think about the inevitability of decline of muscle mass, strength, cardiorespiratory fitness, you have to be training for that with the same degree of focus and specificity. That a person is training for to be an exceptional athlete in their 30s or 40s. So the centenarian Decathlon basically forces us to be specific in what our metrics are in that last decade of life. And it allows us to backcast from there. Because forecasting from wherever you are today will, almost without exception, fail to get you where you need to go, because you'll end up missing the mark by slipping underneath it. Instead, you want to start with where you need to be at the very end and work your way backwards. And almost everybody, myself included, is unpleasantly surprised with how far they are today from where they need to be to allow the decline that's going to take place to take them to their resting spot at the end.

That all makes sense. And we'll look at some graphs later on that. I know you show patience, which when I saw him, it did a really good job of explaining why when you look at that rate of decline, where you start at matters so much. And it kind of reminds me of the recent bone density episode we did too, when we looked at those graphs with if you didn't reach your full potential compared to if you did reach your full potential in bone density, your fall off looks very different. And we see the same with a lot of this exercise, which I think is going to be really interesting when we get to it. But I think what might be helpful is maybe just showing people how you're currently structuring your program to train for the Centenarian Decathlon. So in the last ama, we talked about met hours per week as a way to standardize looking at different literature. So do you want to walk people through your current structure and how you break that out to ensure you're not just focused on one piece, but focused on the broader picture?

You know, my exercise is not really geared towards the things it used to be geared towards. So if you look at how I exercise today and compare it to how I exercised, call it eight years ago, when I was very focused on one specific thing, which was time trialing, type of bike racing. If you compare it to where it was, I don't know, call it 15 years ago, where it was really very, very focused on marathon swimming. Again, pretty niche and specific thing. The training that I was doing 15 years ago versus 8 years ago had zero overlap. Similarly, if you look at what I'm doing today, it would not produce a good cyclist, it would not produce a good swimmer. That's just not the way it is. So it's really focused on something different. I think my training Kind of fits into four or five buckets. I have my zone two, my zone five strength, stability, and I kind of lump them together, even though they're very specific. And there are some very specific stability things I'm doing, and they're not necessarily strength related in the moment. And then I include rucking in there because it is so physical. Although truthfully, what drew me to rucking was actually more the psychological benefit of it. But as anybody who's done it knows it's quite demanding if you allow it to become demanding. And we talked about this. You've joined me on a ruck. You can see between the temperature, the elevation change and the weight, it's quite a lot of work. So that's how I kind of organize myself. And as you said, you can identify how many Mets are required for each activity, how much time you spend in each. The dot product of that gives you MET hours per week, and then you can get a sense of where your energy is going. That's probably the purest way to understand energy expenditure across those domains.

Peter, that makes sense. So what I'm going to do is I'm going to share a slide we put together of a table that you broke out of, what your current med hours per week are, if you want to walk people through what it is, and then also how you're thinking about it.

Yeah. So this is back of the envelope, but as I said, really straightforward zone two cycling. And my zone two is somewhere between 220 and 235 watts. So I took a slightly lower estimate and just said just let's average 225 watts. You can use a calculator to tell you how many Mets that is. So that's 11 mets. And if I spend four hours a week there, 11 times 4, 44. So that's 44 met hours per week. Zone 5 I do via cycling and stair climbing, and that's about 16 Mets. So now I'm really pushing the intensity, but I'm only spending half an hour a week at that intensity. So you can see that's only giving me eight MET hours per week. Lifting weights is about an average of 5 Mets. So some things are less, some things are more. It also depends greatly on other things that go in there. So all the time I'm on an air bike and doing more intense stuff in there would be at a much higher met, whereas doing a bicep curl is at a lower met. We've looked at a bunch of papers and I think our best estimate is I'M probably averaging about 5 Mets, which is really not that labor intensive. But you multiply that by six hours per week, there's 30 METs. And then the best data I could find was we're looking at military personnel rucking. It says £50 there. I do use about £60 or 55 to £60. So you can get a sense of if you're at 0% grade, it's 4.8 METs. If you're at 5% grade, 7.5. If you're at 10% grade 10 METs, I kind of look at my heart rate data when I do it, plus the elevation change, I think I'm probably averaging 6.5 Mets. I do three, usually closer to four hours per week. So maybe that's a bit of a conservative estimate of call it 20 met hours per week. So directionally you total that up and you can see, okay, it's about 100 met hours per week of activity. There's the breakdown by percent where they are and we'll come to this in a minute, but I want people to notice the relative amount of Zone 2 to Zone 5. My Zone 2 is slightly more than five times the not just the duration, but more importantly it's eight times the duration, but it's five times the MET hour, the aggregate intensity, the integral intensity. And that's going to become an important point when we start to talk about how you would partition your time between Zone two and Zone five.

That makes sense. And it kind of leads into a good question that we got, which is one of the things we see a lot is what do we know about whether moderate intensity exercise is as good as vigorous intensity exercise? So we do see a lot of questions that people are wondering how they should think about that moderate versus vigorous intensity as they look at their cardio work.

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Sam.