Best Exercises for Overall Health & Longevity | Dr. Peter Attia & Dr. Andrew Huberman

Summary

The conversation delves into the impact of lifestyle choices on longevity and risk of mortality. It highlights the detrimental effects of smoking, with a 40% increased risk of all-cause mortality, and contrasts it with healthier habits such as maintaining muscle mass and strength, which significantly reduce the risk. The importance of cardiorespiratory fitness is underscored, with a strong association between high VO2 max and reduced mortality risk. The discussion advocates for prioritizing physical fitness over debates on diet and supplements, proposing tangible goals for strength and endurance as markers of health.

Takeaways

• 🚭 Smoking increases the risk of all-cause mortality (ACM) by approximately 40%, meaning smokers have a higher risk of dying at any point compared to non-smokers.
• 💪 High muscle mass and strength are associated with lower ACM, with low muscle mass having a 200% increased risk and low strength having a 250% increased risk.
• 🏃‍♂️ Cardiorespiratory fitness has a profound impact on longevity, with the bottom 25% having a 2x risk of ACM compared to the 50th to 75th percentile, and a 5x risk compared to the top 2.5%.
• 🏋️‍♂️ Strength training is crucial, with specific metrics like grip strength, leg extensions, and squats being used to assess fitness levels.
• 🏃‍♀️ Running a mile within a certain time can serve as a VO2 max estimator, providing insights into cardiovascular health.
• 🥗 While diet and supplementation are often discussed, the script suggests prioritizing exercise and fitness before delving into these topics.
• 🏅 The concept of 'Attia's rule' is introduced, stating that one should not discuss diet nuances or supplements until they've achieved certain fitness milestones.
• 👨‍⚕️ The importance of a deliberate and consistent exercise program is emphasized, including strength and cardiorespiratory exercises.
• 📈 The discussion highlights the significance of modifiable behaviors like exercise over non-modifiable factors in determining longevity.
• 🎯 Specific fitness goals are suggested, such as dead hanging for a minute, air squats for two minutes, and farmer carries for two minutes, as markers of health and longevity.
• 🤸‍♀️ A variety of tests and metrics are used to assess overall fitness, aiming to capture a comprehensive view of an individual's health and potential longevity.

Q & A

What is the primary topic of discussion in the transcript?

The primary topic of discussion in the transcript is the impact of various lifestyle factors, such as smoking and exercise, on longevity and all-cause mortality (ACM).

Why is smoking considered harmful to longevity?

Smoking is considered harmful to longevity because it increases the risk of all-cause mortality by approximately 40%. This means that at any point in time, smokers have a 40% greater risk of dying compared to non-smokers.

How does high blood pressure affect all-cause mortality?

High blood pressure increases the risk of all-cause mortality by about 20 to 25%. It is a significant risk factor for various health issues, including heart disease and stroke.

What is the significance of muscle mass and strength in relation to longevity?

Having a high muscle mass and strength is significantly associated with lower all-cause mortality. Low muscle mass individuals have about a 3x hazard ratio, or a 200% increase in ACM compared to those with high muscle mass. Strength, particularly, is associated with about a 3.5x hazard ratio, indicating a 250% greater risk for those with low strength.

What is the impact of cardiorespiratory fitness on longevity?

Cardiorespiratory fitness has a profound impact on longevity. Individuals in the bottom 25% for their age and sex in terms of VO2 max have a 2x difference in the risk of ACM compared to those in the 50th to 75th percentile. When comparing the bottom 25% to the top 2.5%, there is a 5x, or 400% difference in ACM, making it one of the strongest associations for any modifiable behavior.

What are some of the specific exercises or tests mentioned to measure strength and fitness?

The transcript mentions grip strength, leg extensions, wall sits, squats, dead hangs, and farmer carries as specific exercises or tests to measure strength and fitness. There is also mention of a Strength Metrics Assessment (SMA) that includes 11 difficult tests.

What is 'Attia's rule' as discussed in the transcript?

Attia's rule, as discussed in the transcript, is a proposed guideline suggesting that individuals should not discuss topics like supplements, diets, or other health-related nuances until they have achieved certain fitness milestones, such as being able to dead hang for a minute, reach a VO2 max at the 75th percentile, and perform other strength-related exercises.

How can one estimate their VO2 max without specialized equipment?

One can estimate their VO2 max without specialized equipment by using online estimators that plug in data from various activities like running, cycling, or rowing. These estimators provide an approximation of one's VO2 max based on the activity and the time taken to complete it.

What are the recommended goals for dead hangs and wall sits based on age and gender?

For a 40-year-old woman, the goal is to dead hang for at least one and a half minutes, and for a 40-year-old man, the goal is two minutes. These goals are adjusted based on age and gender. For wall sits, two minutes is the standard for both men and women at 40.

How does the concept of a 'Centenary decathlete' relate to the discussion?

The concept of a 'Centenary decathlete' refers to an individual who is living in their marginal decade (the last decade of life) at the best possible level of health and fitness. The goal is to develop tests and measures that identify such individuals, focusing on the most essential movements and fitness components for overall health and longevity.

What is the significance of the farmer carry test in measuring overall health?

The farmer carry test is significant in measuring overall health as it assesses an individual's ability to carry a significant weight (half their body weight for men, 75% of body weight for women) for a set duration (two minutes). This test serves as an indirect measure of strength, endurance, and overall physical capability, which are important indicators of health and longevity.

Outlines

00:00

🚭 Smoking and Longevity: Risk Factors and Healthy Habits

This paragraph discusses the impact of smoking, particularly nicotine and cannabis, on longevity and all-cause mortality (ACM). It emphasizes the importance of understanding ACM as a risk factor agnostic of the cause of death. The conversation highlights that smoking increases the risk of ACM by approximately 40%, but this does not directly translate to a 40% reduction in lifespan. Other health risks such as high blood pressure and end-stage kidney disease are also discussed, with the latter showing a significant 175% increase in ACM. The paragraph stresses the importance of muscle mass and strength in reducing ACM, with low muscle mass individuals facing a 200% higher risk compared to those with high muscle mass. It also touches on the significance of cardiorespiratory fitness, with a profound 5x difference in ACM risk between the lowest and highest performers in terms of VO2 max.

05:01

🏃‍♂️ Elite Fitness and Cardiovascular Health

The focus of this paragraph is on the profound impact of elite fitness levels, particularly cardiovascular health, on reducing all-cause mortality. It highlights the significant difference in ACM risk between individuals with low and high VO2 max, with the top 2.5% having 5 times lower risk compared to the bottom 25%. The conversation emphasizes that achieving elite fitness does not require being a world-class athlete but maintaining a high VO2 max relative to one's age group. The importance of having a structured exercise routine and setting specific fitness goals, such as dead hangs and air squats, is discussed. The paragraph also mentions the concept of 'Attia's rule,' which suggests that one should not discuss supplements or diet nuances until they have achieved certain basic fitness milestones.

10:03

🏋️‍♀️ Developing a Strength and Stability Program

This paragraph introduces Beth Lewis's role in developing a strength and stability program aimed at enhancing longevity and overall health. The goal of the program is to identify and incorporate movements that serve as proxies for the abilities needed to excel as a 'Centenary decathlete,' or someone living optimally in their marginal decade. The paragraph underscores the importance of an evolved and comprehensive approach to fitness testing, which is expected to become more intricate over time.

Keywords

💡Longevity

Longevity refers to the quality or state of living for a long time, often used in the context of human life span. In the video, it is discussed in relation to various lifestyle factors and health conditions that can influence a person's potential to live a longer life. The conversation revolves around identifying prime movers for longevity and understanding how certain behaviors and conditions can either positively or negatively impact one's life expectancy.

💡All-Cause Mortality (ACM)

All-Cause Mortality (ACM) is a term used to describe the rate at which people in a population die from any cause. It is an important metric in public health and epidemiology because it is agnostic to the specific cause of death, providing a broad view of mortality risk. In the context of the video, ACM is used to discuss the impact of smoking and other health factors on the risk of death.

💡Muscle Mass

Muscle mass refers to the amount of muscle tissue in the body. It is an important indicator of physical health and strength, and it plays a significant role in overall well-being and longevity. The video emphasizes the importance of maintaining high muscle mass as we age, as it is associated with a lower risk of all-cause mortality.

💡Strength

Strength, in the context of the video, refers to physical strength or the ability of a person to exert force against resistance. It is a critical component of overall health and is closely related to muscle mass. The video discusses how strength is a significant factor in determining longevity, with low strength being associated with a higher risk of all-cause mortality.

💡Cardiorespiratory Fitness

Cardiorespiratory fitness refers to the ability of the circulatory and respiratory systems to supply oxygen to the muscles during sustained physical activity. It is a key measure of overall health and is directly related to the efficiency of the heart, lungs, and blood vessels. The video emphasizes that having high cardiorespiratory fitness can significantly reduce the risk of all-cause mortality.

💡VO2 Max

VO2 Max is the maximum amount of oxygen the body can utilize during intense exercise and is a measure of an individual's cardiorespiratory fitness. It is an important indicator of athletic performance and overall health. In the video, VO2 Max is discussed as a significant modifiable behavior that can greatly impact all-cause mortality and, by extension, longevity.

💡Supplements

Supplements are products taken by mouth to add nutrients to the diet, enhance health, or prevent diseases. In the context of the video, the speaker expresses a pet peeve about the excessive focus on debating the merits of different supplements without first ensuring that one's basic exercise and fitness routines are optimal. The speaker suggests that discussions about supplements should come after establishing a solid foundation of physical fitness.

💡Dead Hang

A dead hang is an exercise where one hangs from a pull-up bar or similar apparatus with arms fully extended, supporting their body weight without using any additional support from the arms or legs. It is a measure of upper body strength and endurance, and is used as a test of physical fitness. In the video, the dead hang is mentioned as a goal for individuals to achieve as part of their strength assessment.

💡Farmer's Carry

The farmer's carry is a strength training exercise where a person carries a heavy load in each hand, typically by walking a certain distance. It is used to build overall strength and endurance, particularly in the muscles of the arms, shoulders, and core. In the video, the farmer's carry is mentioned as a test of strength and a measure of health and longevity.

💡Centenary Decathlete

The term 'Centenary Decathlete' is used metaphorically in the video to describe an individual who is in their marginal decade (the last decade of life) and is living at their best, embodying the principles of health and fitness that contribute to longevity. It is a concept that combines the idea of a decathlete, who competes in multiple athletic events, with the goal of achieving optimal health across various domains.

💡Attia's Rule

Attia's Rule, as humorously proposed in the video, is a guideline that suggests individuals should not discuss topics like supplements and nutrition until they have achieved certain basic fitness milestones. It is a call to prioritize physical fitness and practical health measures over theoretical debates about diet and supplementation.

Highlights

The discussion revolves around prime movers for longevity and risk mortality.

Smoking nicotine is associated with a higher risk of dying earlier.

The distinction between cannabis and nicotine smoking in terms of impact on longevity is explored.

The desire for living to be between 90 and 100 years old is mentioned.

All-cause mortality (ACM) is introduced as a measure agnostic to the cause of death.

Smoking increases the risk of ACM by approximately 40%.

High blood pressure increases the risk of ACM by 20 to 25%.

Endstage kidney disease can lead to a 175% increase in ACM.

The importance of muscle mass and strength for longevity is emphasized.

Low muscle mass increases the risk of ACM by 200% compared to high muscle mass.

Strength, rather than just muscle mass, is more closely associated with lower ACM.

The Strength Metrics Assessment (SMA) is introduced as a comprehensive strength evaluation.

Cardiorespiratory fitness has a profound impact on reducing ACM.

Being in the top 2.5% for VO2 max can reduce ACM risk by 400% compared to the bottom 25%.

Exercise and fitness should be prioritized over debates about diet and supplements.

Attia's rule is proposed, which suggests not discussing supplements or nutrition until certain fitness milestones are reached.

Dead hanging for a minute is suggested as a goal for fitness.

Air squats at 90 degrees for two minutes is suggested as a standard fitness goal.

VO2 max can be estimated through online tools based on various activities.

Farmer carries are recommended as a measure of strength and endurance.

The Centenary decathlete concept is introduced, aiming for optimal health and longevity in the marginal decade.

Transcripts

- I've heard you talk before about some of the prime movers

for longevity and all risk mortality.

And I'd love for you to review a little bit of that for us.

I think we all know that we shouldn't smoke

because it's very likely that we'll die earlier,

if we smoke nicotine.

I'm neither a marijuana nor a nicotine smoker,

So I feel on stable ground there.

But anytime we say smoking nowadays,

people really want to distinguish between

cannabis and nicotine.

So I am curious about any differences there,

in terms of impact on longevity.

But in that context,

what are the things that anyone and everyone

can do, should do, to live longer, basically?

- How long you got?

- Well, you tell me, [people laughing]

you tell me, I'd like to live to be,

I'd like my final decade to be between 90 and a 100.

- Oh no, I meant how long do you, yeah, yeah.

- I'm just kidding, I'm just kidding.

- And will we spend from now until you're 90

talking about this? - Well there's a risk of that.

- So, let's start with a couple of the things

that you've already highlighted.

So smoking, how much does smoking increase your risk

of all-cause mortality?

And the reason we like to talk about what's called ACM,

or all-cause mortality, is it's really agnostic

to how you die.

And that doesn't always make sense,

I mean, if you're talking about,

a very specific intervention like a anti-cancer therapeutic

you really care about cancer-specific mortality,

or heart-specific mortality.

But when we talk about these broad things

we like to talk about ACM.

So, using smoking.

Smoking is approximately a 40% increase in the risk of ACM.

- What does that translate to in,

that means I'm shortening my life by 40%?

- No, it means at any point in time,

there's a 40% greater risk that you're going to die

relative to a non-smoker - Got it.

- and a never-smoker.

Yeah, yeah, so it's important to distinguish.

It doesn't mean your lifespan is going to be 40% less,

it means at any point in time, standing there,

your risk of death is 40% higher.

And by the way, that'll catch up with you, right?

At some point that that catches up.

High blood pressure, it's about a 20 to 25% increase

in all-cause mortality.

You take something really extreme

like endstage kidney disease,

so these are patients that are on dialysis,

waiting for an organ.

And again, there's a confounder there

because what's the underlying condition

that leads you to that?

It's profound hypertension, significant type 2 diabetes

that's been uncontrolled.

That's enormous, that's about 175% increase in ACM.

So the hazard ratio is 2.75. - Mm-hmm.

- Type two diabetes is probably about a 1.25 as well,

so 25% increase.

So now the question is like, how do you improve?

So what are the things that improve those?

So now here we do this by comparing low to high achievers

and other metrics.

So if you look at low muscle mass versus high muscle mass,

what is the improvement?

And it's pretty significant, it's about 3x.

So if you compare low muscle mass people

to high muscle mass people, as they age,

the low muscle mass people have about a 3x hazard ratio

or 200% increase in all-cause mortality.

Now, if you look at the data more carefully,

you realize that it's probably less the muscle mass fully

doing that, and it's more the high association

with strength.

And when you start to tease out strength

you can realize that strength could be

probably 3.5x as a hazard ratio,

meaning about 250% greater risk

if you have low strength to high strength.

- And high strength is the ability to move loads

at 80 to 90- - So it's all defined

by given studies.

So the most common things that are used

are actually, they're used for the purposes of experiments

that make it easy to do.

And I don't even think they're the best metrics.

So they're usually using grip strength, leg extensions,

and wall sits, squats, things like that.

- Okay. - So how long can you sit

in a squatted position at 90 degrees without support,

would be a great demonstration of quad strength,

a leg extension, how much weight can you hold,

for how long, relative to body weight?

Things like that.

We have a whole strength program

that we do with our patients,

we have something called the SMA.

So it's the Strength Metrics Assessment,

and we put them through 11 tests that are really difficult,

like a dead hang is one of them,

how long can you dead hang your body weight,

stuff like that.

So, we're trying to be more granular in that insight

but tie it back to these principles.

If you look at cardiorespiratory fitness,

it's even more profound.

So, if you look at people who are in the bottom 25%

for their age and sex,

in terms of VO2 max, and you compare them

to the people that are just at the 50th to 75th percentile,

you're talking about a 2x difference, roughly,

in the risk of ACM.

If you compare the bottom 25% to the top 2.5%,

so you're talking about, bottom quarter to the elite

for a given age, you're talking about 5x.

- Wow, yeah. - 400% difference

in all-cause mortality.

That's probably the single strongest association I've seen

for any modifiable behavior.

- Incredible, so when you say elite these are people

that are running marathons at a pretty rapid clip.

- Not necessarily, it's just what the Vo2 max is for that,

my Vo2 max would be in the elite for my age group.

My Vo2 max, but then again, I'm training very deliberately

to make sure that it's in that.

So, I wouldn't consider myself elite at anything anymore,

but I still maintain a Vo2 max that is elite for my age.

- I'd consider you an elite physician and podcaster

[Peter laughing] and guy, all around,

but, true.

But in terms of, okay so for- - But the point is

you don't have to be a world class athlete

to be elite here, yeah. - Got it.

- Yeah, - Got it.

So maybe we could talk a little bit about

the specifics around the training

to get into the top two tiers there,

because it seems that those are enormous positive effects

of cardiovascular exercise,

far greater than the sorts of numbers that I see around,

let's just say, supplement A, or supplement B.

- Well, and that's, you know

this is my whole pet peeve in life, right?

It's like, I just can't get enough

of the machinating and arguing

about this supplement versus that supplement.

And I feel like you shouldn't be having those arguments

until you have your exercise house in order.

You shouldn't be arguing about your,

this nuance of your carnivore diet,

versus this nuance of your paleo diet,

versus this nuance of your vegan diet,

until you can deadlift your body weight for 10 reps,

then you can come and talk about those things

- let's just come up with some - You're right.

metrics, - Yeah.

- until your Vo2 max is at least to the 75th percentile,

and you're able to dead hang for at least a minute,

and you're able to wall sit for at least two,

we could rattle off a bunch of relatively low hanging fruit,

I wish there was a rule that said

you couldn't talk about anything else, health related.

- We can make that rule.

- [laughs] No one will listen to it.

- Well, I don't know about that,

we can make whatever rules we want.

We can call it Attia's rule.

One thing I've done before on this podcast

and on social media is just borrowing

from the tradition in science, which is,

it's inappropriate to name something after yourself,

unless you were a scientist before 1950.

But it's totally appropriate to name things

after other people, so I'm going to call it Attia's rule,

until you can do the following things,

don't talk about supplements. - Please refrain

from talking about supplements and nutrition.

- There it is, hereafter,

thought of, referred to, and referenced

as Attia's rule.

I coined the phrase, not him,

so there's no ego involved, but it is now Attia's rule.

Watch out! #attia'srule.

- Oh God.

- Wikipedia entry, Attia's rule.

In all seriousness, and I am serious about that.

Dead hang for about a minute,

seems like a really good goal for a lot of people.

At least- - That's our goal,

I think we have a minute and a half is the goal

for a 40 year old woman,

two minutes is the goal for 40 year old man.

So we adjust them up and down based on age and gender.

- Great, and then the wall sit?

What are some numbers? - We don't use the wall sit.

We do just a straight squat, air squat, at 90 degrees,

and I believe two minutes is the standard

for both men and women at 40.

- Great, and then,

because for some people thinking in terms of VO2 max

is a little more complicated,

they might not have access to the equipment

or to measure it, et cetera.

What can we talk about, think about

in terms of cardiovascular?

So run a mile at seven minutes or less,

eight minutes or less? - That's a good question.

So there are Vo2, there are really good Vo2 max

estimators online, and you can plug in your activity d'Azur,

so, be it a bike, run, or rowing machine,

and it can give you a sense of that.

And I don't, I used to know all of those,

- Oh, that's okay. - But now that I just

actually do the testing, I don't recall them.

But it's exactly that line of thinking,

can you run a mile in this time?

If you can, your Vo2 max is approximately this.

- Great. - And I think

somewhere in my podcast realm

I've got all those charts posted of like,

this is by age, by sex,

this is what the Vo2 max is in each of those buckets.

- Terrific, we'll provide links to those,

we'll have our people find those links.

And then you mentioned dead lifting body weight 10 times.

- I just made that one up.

We don't, that's not one that we include, but-

- [Andrew] Something like that?

- We we use farmer carries,

so we'll say for a male you should be able to farmer carry

your body weight for, I think we have two minutes.

So that's half your body weight in each hand,

you should be able to walk with that for for two minutes.

For women, I think we're doing 75% of body weight,

or something like that, yeah.

- Great, I love it.

As indirect measures of how healthy and,

- Yeah, huge. - we are, and how long

we're going to live. - Yeah, it's basically

grip strength, it's mobility,

I mean, again, walking with that much weight

for some people initially is really hard.

We use different things like vertical jump,

ground contact time if you're jumping off a box,

things like that, so it's really trying to capture,

and it's it's an evolution, right?

I think the test is going to get

only more and more involved as we get evolved,

'cause it took us about a year,

Beth Lewis did the majority of the work to develop this.

Beth runs our strength and stability program

in the practice.

And basically I just tasked her with like,

"Hey go out to the literature and come up with

all of the best movements that we think are proxies

for what you need to be the most kick-ass,

what we call Centenary decathlete."

Which is the person living in their marginal decade,

at the best.

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