We all want to live longer. But what good is living longer if you’re too frail and weak to enjoy it? That sentiment is the underscore of longevity physician Peter Attia, M.D.’s aggressive approach to preventing the symptoms of aging in order to live a longer, healthier life.
“Exercise is by far the most potent longevity ‘drug,’” says Attia in his book Outlive. “The data are unambiguous: Exercise not only delays actual death but also prevents both cognitive and physical decline better than any other intervention. It is the single most potent tool we have in the health-span-enhancing toolkit—and that includes nutrition, sleep, and meds.”
According to Attia, the benefits of fitness extend far beyond general health. His approach involves training intentionally to be able to do the things you want to do 30, 40, or 50 years from now—a practice he promises has a huge payoff now, too.
Peter Attia’s Workout Routine
In order to become, as Attia puts it, a “kick-ass 100-year-old,” you have to train as if you’ll actually get there. In his book, Outlive, he encourages you to consider the ten most important physical tasks you want to be able to do for the rest of your life and then train to do those things—a concept he’s coined the “Centenarian Decathlon.”
Attia’s list is fifteen items long and includes being able to hop over a three-foot fence, and pull himself up and over the edge of a pool. Here’s his example list:
- Hike 1.5 miles on a hilly trail
- Get up off the floor under your own power, using a maximum of one arm for support
- Pick up a young child off the floor
- Carry two five-pound bags of groceries for five blocks
- Lift a twenty-pound suitcase into the overhead compartment of a plane
- Balance on one leg for thirty seconds, eyes open (bonus points: eyes closed, fifteen seconds)
- Have sex
- Climb four flights of stairs in three minutes
- Open a jar
- Do thirty consecutive jump-rope skips
Attia’s clear that the items on his list are personal, and yours should be, too. Consider what you want to be able to do, and what you’re willing to give up. For example, maybe you don’t care if you can hike a mile and a half, but you want to be able to play tennis.
That said, Attia argues the methods needed to train for life can be broken down into four key pillars: Stability, strength, aerobic efficiency, and anaerobic performance. You need to be aerobically fit enough to go far at slow speeds and anaerobically fit enough to go not so far at fast speeds; strong enough to carry groceries, kids, a suitcase, or laundry; and have the stability to avoid falling (or be strong enough to brush it off when you do).
Attia’s workout recommendations
To hit all four fitness pillars, Attia recommends the following each week:
- Stability: one hour, split into 5 to 10 minute blocks done before your other workouts
- Strength: three 45 to 60 minute full body workouts targeting all major muscle groups
- Aerobic Efficiency: four 45 to 60 minute zone 2 cardio workouts
- Anaerobic Performance: one 30 minute VO2 max workout
Attia’s workout schedule
On an episode of The Drive, Attia shares how he fills all four buckets throughout the week:
- Monday: 10 minutes stability, 60 minutes lower body strength
- Tuesday: 10 minutes stability, 60 minutes zone 2
- Wednesday: 10 minutes stability, 60 minutes upper body strength
- Thursday: 10 minutes stability, 60 minutes zone 2
- Friday: 10 minutes stability, 60 minutes lower body strength
- Saturday: 10 minutes stability, 60 minutes zone 2, 30 minutes zone 5
- Sunday: 10 minutes stability, 60 minutes zone 2, 60 minute upper body strength
Train Like Attia
According to Attia, copying and pasting his above workout schedule is a good place to start, but it isn’t enough. “This isn’t an eight-week program—it’s a lifelong pursuit,” he writes in Outlive. For the highest impact, he encourages you to become your own coach by giving your full attention to every rep. He’s convinced this practice will help you get better, smarter, and learn the proprioceptive clues to become functionally strong.
“We need to change our approach so that we are focused on doing things right, cultivating safe, ideal movement patterns that allow our bodies to work as designed and reduce our risk of injury,” he writes. “Better to work smart than too hard.” With that in mind, here’s the Cliffs Notes version.
Build stability first
Attia argues strength is important, but stability training should come first (like, six months of it before ever picking up a weight). Why? Stability is the secret sauce that allows you to create the most force in the safest manner possible.
By slowing down to focus on stability, you’ll learn how to control your body. That control means once you add load to your strength workouts, you’ll be able to move better and lift heavier, faster (if that’s your goal). You’ll also reduce the risk of injury to your joints, especially your vulnerable spine.
There’s no one-size-fits-all approach to stability training because it’s about targeting your body’s individual areas of weakness, Attia notes. He opts for dynamic neuromuscular stabilization (DNS). “The point of DNS is to retrain our bodies—and our brains—in the patterns of perfect movement we learned as little kids,” he says.
DNS is like a software update for the basics: the ability to breathe correctly (which directly affects how you move), create intra-abdominal pressure (which is essential for stabilizing the spine), and control your fingers, toes, and spine.
Attia also suggests starting with a routine his trainer, Beth Lewis, calls toe yoga—a series of exercises designed to enhance toe agility. According to Lewis, building toe dexterity protects against falls, which become more common as you age. Try it by lifting only your big toe for ten reps, or all of your toes except your big toes, or ‘play the piano’ with your toes, and so on. He’s also a fan of classic core training, balance exercises, and building mobility through moves cat cows and scapular CARS (controlled articular rotations).
Hammer strength training
After the age of 30, sarcopenia (or muscle loss) kicks in. Without regular strength training, you can lose as much as three to eight percent of your muscle mass per decade (1). This slows down your metabolism and decreases your strength and functional ability to complete daily tasks with ease.
Think of strength training as a form of retirement savings. “Just as you want to retire with enough money saved up to sustain you for the rest of your life, you want to reach older age with enough of a “reserve” of muscle to protect you from injury and allow you to continue to pursue the activities you enjoy,” says Attia. The larger reserve you build now, the better off you’ll be for the long haul.
To build his reserve, Attia structures his sessions around four major tenets:
- Grip strength, or how hard you can grip with your hands. Attia pegs grip strength as a proxy for overall strength and robustness. Increase it with weighted carries, dead hangs, or pull-ups. “One of the standards we ask of our male patients is that they can carry half their body weight in each hand (so their full body weight in total) for at least one minute,” says Attia.
- Concentric and eccentric loading—emphasizing the ability to both lift and lower weight with control. Eccentric strength is the ability to put on the brakes when walking downhill or down the stairs, for example. Per Attia, it’s where most people lose their touch with age. To build eccentric control, Attia practices rucking (walking or hiking with a weighted pack on your back) downhill, and slow step-ups, taking three seconds to control his descent.
- “Pulling motions are how we exert our will on the world, whether we are hoisting a bag of groceries out of the car trunk or climbing El Capitan,” says Attia. In the gym, aim to pull from all angles from overhead like pull-ups, and in front of you like rows.
- Hip-hinging movements like deadlifts, squats, hip thrusts, and their single-leg variations. Attia approaches the major two hip-hinging moves—deadlifts and squats—with care. He notes these moves aren’t right for everyone, since the heavy axial load increases the risk of injury to the spine. Start with single-leg moves like lunges and step-ups with lighter loads.
Attia polishes off every strength workout with blood flow restriction (BFR) training—a practice that involves putting a cuff on a target muscle to reduce blood flow out of the area. BFR allows you to work at a lower intensity (less weight) while building comparable strength and muscle mass to higher-intensity strength training. You can use basic BFR bands to get the job done, but Attia prefers SmartCuff a device that directly adjusts the tension in BFR bands while you’re working out to ensure you’re restricting blood flow enough to see adaptations.
Push your anaerobic limits
“Peak cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity,” says Attia. “The payoff of increasing your VO2 max is that it makes you functionally younger.”
After the age of 25, your VO2 max drops by 10 percent per decade—and by as much as 15 percent after the age of 50 (2). He recommends one to two thirty-minute VO2 max sessions per week for benefits (if you aren’t training for a triathlon or a specific sport just one is plenty). Anything that works a large number of muscles, and can quickly send your heart rate through the roof is ideal. Think rowing, running, or cycling.
VO2 max efforts are a bit longer, and a notch less intense than sprints. His favorite VO2 max workout involves four-minute intervals at the maximum pace you can maintain, followed by four minutes of complete recovery. Rinse and repeat four to six times.
Build your aerobic efficiency
According to Attia, zone 2 training is just as important as speed work. “Zone 2 training builds a foundation for anything else you do in life,” he says. “It also plays a crucial role in preventing chronic disease by improving the health, efficiency, and flexibility of your mitochondria—which decline with age.”
Poor mitochondrial function is linked to heart disease (3), dementia (4), type 2 diabetes (5), metabolic syndrome (6), cancer (7), and insulin resistance (8). A study published in Oxidative Medicine and Cellular Longevity found that zone 2 training increases mitochondrial size, number, and function (9). Which means more efficient workouts, and better metabolic health.
Zone 2 training is cardio performed at a low intensity—somewhere between 65 to 75 percent of your maximum heart rate—for an extended period of time. “I sometimes do this on a treadmill. Usually, a 15 percent incline at 3 to 3.4 miles per hour will get me there,” Attia said on The Drive. “Some people choose to do this on an elliptical, I’m not a fan of that personally, but there are multiple ways to skin this cat.” Cycling, swimming, running, rowing, or rucking all qualify—so long as it’s an activity you can maintain for well over 45 minutes.
For benefits, Attia suggests a total of three hours per week—or four 45-minute sessions—is the minimum dose; but, more is better.
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