Exercise is the most powerful drug for longevity and has the greatest effect on how well you live out the rest of your life.

While many of us recognize the benefits of exercise, not everyone realizes how profound its effects really are. 

In his book “Outlive,” Peter Attia emphasizes the importance of physical activity for health and longevity. He notes that regular exercise has been shown to improve a wide range of health outcomes, from reducing the risk of chronic diseases to improving cognitive function.

This post is a summary of the evidence-based links between exercise and longevity, and exercise programming advice to optimize for a healthy and longer life, from the book.

Effects of Exercise on Longevity

There are numerous studies that show that even a minimal amount of exercise can have a significant positive impact on your physical and cognitive health.

Below are some key takeaways on the benefits of exercise for longevity and healthspan.

• Exercise can lengthen your life by several years
• Exercise delays the onset of chronic diseases and improves healthspan
• Exercise reverses physical and cognitive decline and has benefits for emotional health
• Even a little bit of daily activity is much better than nothing
• Habitual runners and cyclists live longer and have less morbidity from metabolic dysfunction
• Exercise-based interventions can perform as well as or better than pharmaceutical drugs in reducing mortality from certain diseases
• Seniors with the least muscle mass are at the greatest risk of dying from all causes and maintaining higher activity levels can reduce muscle loss in old age
• Having more muscle mass can protect against adverse outcomes following surgery and lower the risk of falling in the elderly
• Exercise is effective against diseases of aging and has often been compared to medicine.

Exercise Programming for Longevity

To optimize our fitness for longevity, it’s important to consider not only how much exercise we do, but also what types of exercise we do.

Cardio, Strength, and Stability are the three dimensions based on which one should structure their exercise regimen. All three of them are equally important for longevity. Cardio can be achieved through a combination of long, steady endurance work (Zone 2) and maximal aerobic efforts (VO2 max).

Here is a breakdown of each of these dimensions

Zone 2 Training

Zone 2, one of five intensity levels used in endurance sports training, is a fundamental base-building exercise that professional athletes believe is even more important for non-athletes, as it helps improve the health and efficiency of our mitochondria and prevents chronic diseases.

Zone 2 training is performed at a moderate pace, slow enough to maintain a conversation but fast enough to strain it, and corresponds to 70-85% of your maximum heart rate.

Going too hard during Zone 2 training creates more lactate than we can eliminate, so it’s crucial to maintain the correct pace.

It’s easy to fit Zone 2 training into our lifestyles, such as brisk walks, stationary cycling, jogging, running, or swimming and can be an opportunity to listen to podcasts or audiobooks.

Three hours of Zone 2 training per week is the minimum for most people to derive benefits and make improvements, while even two 30-minute sessions can have enormous benefits.

Zone 2 is like building a foundation for a house, supporting virtually everything we do in our exercise regimen and daily lives.

VO2 Max

Peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is the single most powerful marker for longevity, representing the maximum rate at which a person can utilize oxygen while exercising.

The effects of improving VO2 max are so profound with someone in the bottom quartile of VO2 max being nearly four times likelier to die than someone in the top quartile, and even climbing from the bottom 25 percent to the 25th to 50th percentile of VO2 max cuts the risk of death nearly in half.

.Having a higher VO2 max is vital for overall health and longevity, and it can be increased through training. 

The elite range for one’s age and sex should be the target, and pushing even further to the elite level for their sex, but two decades younger, is an ambitious yet achievable goal. 

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Measuring VO2 Max

VO2 Max test is usually done on a treadmill or stationary bike, and it can be performed in a laboratory or clinical setting under the supervision of a trained professional. 

There are also various wearable devices and apps that claim to estimate VO2 max. Even though these might not be as accurate as laboratory tests, you can still use them to track improvements in your number

How to train VO2 Max

The way to train VO2 max is similar for both athletes and non-athletes i.e with one or two VO2 max workouts per week.

The interval formula for VO2 max workouts is to go four minutes at maximum pace followed by four minutes of easy riding or jogging. Repeat this four to six times and cool down

These workouts can be done on a bike, rowing machine, treadmill, or track. Ensure that you are fully recovered between sets to reach peak effort. Failing to recover sufficiently between sets can lead to missed adaptations.Allow enough time for a warm-up and cool down from this intense effort.

Strength

A ten-year observational study found that low muscle mass and strength increased the risk of mortality, with those having both low muscle mass and low strength plus metabolic syndrome having the highest risk, emphasizing the importance of strength training regardless of age.

Muscle mass starts to decline from the thirties, with a 40% reduction by old age, while strength and power decline even more quickly. Hence building a reserve of strength is crucial for long-term benefits.

The following should be the foundational elements of your strength training routine

Grip strength – Target carrying half your body weight in each hand for one minute as a standard for males and 75% of that weight for females.

Pulling motions – Get stronger at Pull ups and Rows.

Hip-hinging movements – Get stronger at Dead lifts, Squats, Step ups, Hip Thrusters, etc.

Attention to concentric and eccentric loading – Ability to lift the weight up and put it back down slowly in all exercises

The ideal frequency is to do at least 2 strength training sessions in a week along with your Zone 2 and VO2 max workouts

Stability

In discussing exercise, stability is just as important as aerobic fitness and strength in preventing injury. It provides a solid foundation that enables us to do everything else we do without getting hurt, making us bulletproof.

Injury is a common reason why older people tend to exercise less, or not at all. Pushing oneself too hard without adequate stability leads to injury and potentially dangerous movement patterns.

There is no one-size-fits-all prescription for everyone when it comes to improving stability.

You have to design a custom plan based on how you breathe, feet placement, and spine health.

I’d suggest you buy the book or visit websites like www.rehabps.com and www.posturalrestoration.com for an in-depth understanding of stability training.

Summary

To summarize, here’s how your exercise regimen should look like for a longer and healthier life

• At least 3 sessions per week of 1 hour each in zone 2 training (70-85% of your maximum heart rate)
• 1 to 2 VO2 max sessions, intervals of 4 min hard and 4 min easy efforts repeated for 4 to 6 times
• At least 2 strength training sessions focussing on grip strength, pulling, and hip-hinge movements with attention to concentric and eccentric loading.
• Stability training at least twice a week

Overall, “Outlive” is a must-read for anyone interested in living a long and healthy life. 

Attia’s insights into the science and art of longevity are both fascinating and practical, offering readers a roadmap for optimizing their health span and living their best lives. Whether you are in your 20s or your 80s, this book has something valuable to offer you.

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