You can do everything you want to when you’re old—if you train for it.
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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.
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:
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).
To hit all four fitness pillars, Attia recommends the following each week:
On an episode of The Drive, Attia shares how he fills all four buckets throughout the week:
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.
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.
When it comes to building core stability, Attia is a fan of going back to the basics. In an Instagram post, he stresses the importance of being able to create concentric intra-abdominal pressure. You’ll see him practicing this through exercises —like this anti-extension core exercise—that are much harder to do correctly than they look.
Once you build a base of stability Attia recommends moving on to more complex balance exercises, and building mobility through moves cat cows and scapular CARS (controlled articular rotations). For most of his stability exercises you won’t need fancy equipment—just patience. The one exception: He swears by the MOBO board for building foot strength and stability.
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:
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.
“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.
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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