I recently discussed Dr. Peter Attia’s book Outlive, about healthy living practices. I promised to go into more detail about his ideas on exercising for longevity, which he calls the “Centenarian Decathlon”. He emphasized three aspects of training specifically to stay healthy in the long term in his book: stability, strength, and cardiovascular training.
He feels strongly about stability, which includes balance, core strength, proper alignment, and movement patterns. I have talked about balance training and gait training previously. But Dr. Attia also discussed the importance of proper alignment for safety during strength training. It is a good idea to work with a physical therapist or equivalent if you are concerned you may be deficient in any of these areas. For strength training, he concentrated on movements that help prevent loss of muscle as we age (sarcopenia) and also to prevent loss of bone density. Large compound movements are recommended such as deadlifts, presses, and pulling movements like pulldowns or rows. For beginners, it is suggested to work with a strength trainer to do these correctly for injury prevention.
I was especially intrigued by his ideas on cardiovascular training for longevity. A couple of things were emphasized: maintaining or improving mitochondrial density is crucial for healthy aging, and maximum aerobic capacity (VO2Max) corresponds strongly with longevity. The mitochondria are the powerhouses in our cells that allow our muscles to use oxygen to obtain energy from fuel such as fat or glycogen (the form in which glucose is stored in muscles). Aerobic exercise helps keep them healthy and expand their numbers. Dr. Attia feels the best type of exercise for this purpose is long steady-state sessions at a brisk pace. Technically, this is a pace that challenges the working muscles to produce a bit of lactate but is not enough to make excess lactate accumulate (it is near or just at the “lactate threshold” but not above it). The easiest way to achieve this is to monitor your breathing via the “talk test”: You should not be so out of breath that you are not able to speak complete sentences. But your breathing should be challenged a little (if you can sing you need to go a little faster). This is popularly referred to as “zone 2” training.
For maximum aerobic capacity, Dr. Attia recommends longer intervals. A classic example is four repeat efforts of 4 minutes at a fast pace, with enough easy pace in between to let your heart rate recover. Four minutes of easy pace between the fast pace efforts is suggested as a starting point, but this varies among individuals. The idea is that you can recover enough so that your last hard effort is as fast as your first one.
I had been doing the long steady training Dr. Attia recommends, but now try to do even more of it since I’ve learned more about its health value. My interval training had been exclusively shorter intervals, which I still enjoy. But now I also throw in the longer “4×4” intervals. They are challenging but I like them. Check back in 20 years and I’ll let you know how this worked out for longevity 😊