Best Exercises for Overall Health & Longevity | Dr. Peter Attia & Dr. Andrew Huberman
00:00:00.000 | I've heard you talk before about some of the prime movers for longevity and all-risk
00:00:09.440 | mortality.
00:00:11.920 | And I'd love for you to review a little bit of that for us.
00:00:15.600 | I think we all know that we shouldn't smoke because it's very likely that we'll die earlier
00:00:19.840 | if we smoke nicotine.
00:00:21.800 | I'm neither a marijuana nor a nicotine smoker, so I feel on stable ground there.
00:00:26.400 | But anytime we see smoking nowadays, people really want to distinguish between cannabis
00:00:30.640 | and nicotine.
00:00:31.640 | So I am curious about any differences there in terms of impact on longevity.
00:00:38.060 | But in that context, what are the things that anyone and everyone can do, should do to live
00:00:45.200 | longer basically?
00:00:46.200 | How long you got?
00:00:48.600 | Well, you tell me.
00:00:51.560 | You tell me.
00:00:52.560 | I'd like to live to be, I'd like my final decade to be between 90 and 100.
00:00:56.640 | Oh, no.
00:00:57.640 | I meant how long do you-
00:00:58.640 | No, no.
00:00:59.640 | I'm just kidding.
00:01:00.640 | I'm just kidding.
00:01:01.640 | And will we spend from now until you're 90 talking about this?
00:01:02.640 | Well, there's a risk of that.
00:01:03.640 | So let's start with a couple of the things that you've already highlighted.
00:01:05.560 | So smoking, how much does smoking increase your risk of all-cause mortality?
00:01:09.920 | And the reason we like to talk about what's called ACM or all-cause mortality is it's
00:01:14.040 | really agnostic to how you die.
00:01:16.920 | And that doesn't always make sense.
00:01:18.440 | I mean, if you're talking about a very specific intervention, like a anti-cancer therapeutic,
00:01:23.680 | you really care about cancer-specific mortality or heart-specific mortality.
00:01:27.780 | But when we talk about these sort of broad things, we like to talk about ACM.
00:01:30.760 | So using smoking, smoking is approximately a 40% increase in the risk of ACM.
00:01:37.240 | What does that translate to?
00:01:39.600 | That means I'm shortening my life by 40%?
00:01:42.920 | No.
00:01:43.920 | It means at any point in time, there's a 40% greater risk that you're going to die relative
00:01:47.920 | to a non-smoker and a never-smoker.
00:01:50.400 | So it's important to distinguish.
00:01:51.400 | It doesn't mean your lifespan is going to be 40% less.
00:01:54.040 | It means at any point in time standing there, your risk of death is 40% higher.
00:01:58.800 | And by the way, that'll catch up with you, right?
00:02:00.200 | At some point, that catches up.
00:02:02.680 | High blood pressure.
00:02:03.680 | It's about a 20% to 25% increase in all-cause mortality.
00:02:09.040 | You take something really extreme, like end-stage kidney disease.
00:02:12.100 | So these are patients that are on dialysis waiting for an organ.
00:02:15.520 | And again, there's a confounder there, because what's the underlying condition that leads
00:02:19.960 | you to that?
00:02:20.960 | It's profound hypertension, significant type 2 diabetes that's been uncontrolled.
00:02:25.800 | That's enormous.
00:02:26.800 | That's about a 175% increase in ACM.
00:02:30.960 | So the hazard ratio is like 2.75.
00:02:34.800 | Type 2 diabetes is probably about a 1.25 as well, so a 25% increase.
00:02:40.160 | So now the question is, how do you improve?
00:02:41.560 | So what are the things that improve those?
00:02:43.540 | So now here we do this by comparing low to high achievers and other metrics.
00:02:48.480 | So if you look at low muscle mass versus high muscle mass, what is the improvement?
00:02:56.000 | And it's pretty significant.
00:02:57.000 | It's about 3x.
00:02:58.440 | So if you compare low muscle mass people to high muscle mass people as they age, the low
00:03:02.840 | muscle mass people have about a 3x hazard ratio, or a 200% increase in all-cause mortality.
00:03:09.040 | Now if you look at the data more carefully, you realize that it's probably less the muscle
00:03:14.940 | mass fully doing that, and it's more the high association with strength.
00:03:20.140 | And when you start to tease out strength, you can realize that strength could be probably
00:03:25.420 | 3.5x as a hazard ratio, meaning about 250% greater risk if you have low strength to high
00:03:33.300 | strength.
00:03:34.300 | And high strength is the ability to move loads at 80% to 90% at one repetition.
00:03:38.820 | And it's all defined by given studies.
00:03:40.800 | So the most common things that are used are actually-- they're used for the purposes of
00:03:46.400 | experiments that make it easy to do, and I don't even think they're the best metrics.
00:03:50.020 | So they're usually using grip strength, leg extensions, and wall sits, squats, things
00:03:57.380 | like that.
00:03:58.380 | So how long can you sit in a squatted position at 90 degrees without support would be a great
00:04:02.920 | demonstration of quad strength, a leg extension.
00:04:07.000 | How much weight can you hold for how long relative to body weight, things like that.
00:04:11.480 | We have a whole strength program that we do with our patients.
00:04:14.000 | We have something called the SMA, so it's the Strength Metrics Assessment.
00:04:16.440 | And we put them through 11 tests that are really difficult, like a dead hang is one
00:04:22.520 | of them, like how long can you dead hang your body weight, stuff like that.
00:04:25.540 | So we're trying to be more granular in that insight, but tie it back to these principles.
00:04:31.200 | If you look at cardiorespiratory fitness, it's even more profound.
00:04:34.780 | So if you look at people who are in the bottom 25% for their age and sex in terms of VO2
00:04:40.760 | max, and you compare them to the people that are just at the 50th to 75th percentile, you're
00:04:48.540 | talking about a 2x difference roughly in the risk of ACM.
00:04:53.760 | If you compare the bottom 25% to the top 2.5%, so you're talking about bottom quarter to
00:04:59.880 | the elite for a given age, you're talking about 5x, 400% difference in all cause mortality.
00:05:09.160 | That's probably the single strongest association I've seen for any modifiable behavior.
00:05:13.360 | Incredible.
00:05:14.360 | So when you say elite, these are people that are running marathons at a pretty rapid clip?
00:05:18.960 | Not necessarily.
00:05:19.960 | It's just like what the VO2 max is for that, like my VO2 max would be in the elite for
00:05:23.680 | my age group.
00:05:24.680 | My VO2 max, but again, I'm training very deliberately to make sure that it's in that.
00:05:29.520 | So I wouldn't consider myself elite at anything anymore, but I still maintain a VO2 max that
00:05:34.440 | is elite for my age.
00:05:36.280 | I consider you an elite physician and podcast and guy all around, but true.
00:05:44.400 | But in terms of, okay, so for the point is like, you don't have to be a world-class athlete
00:05:48.720 | to be elite here.
00:05:49.720 | Yeah.
00:05:50.720 | Got it.
00:05:51.720 | So maybe we can talk a little bit about the specifics around the training to get into
00:05:54.760 | that, um, you know, top two tiers there because it seems that those are enormous positive
00:06:00.060 | effects of cardiovascular exercise, uh, far greater than the sorts of numbers that I see
00:06:04.880 | around, let's just say supplement a or supplement b.
00:06:08.440 | And that's, you know, like this is my whole pet peeve in life, right?
00:06:11.800 | It's like, I just can't get enough of the machinating and arguing about this supplement
00:06:17.320 | versus that supplement.
00:06:19.600 | And I feel like you shouldn't be having those arguments until you have your exercise house
00:06:24.380 | in order.
00:06:25.380 | Um, you know, you shouldn't be arguing about your, this nuance of your carnivore diet versus
00:06:32.120 | this nuance of your paleo diet versus this nuance of your vegan diet.
00:06:36.320 | Like until you can deadlift your body weight for 10 reps, like then, then you can come
00:06:40.640 | and talk about those things or something like, let's just start with some metrics like until
00:06:43.920 | your VO2 max is at least to the 75th percentile and you're able to dead hang for at least
00:06:49.240 | a minute and you're able to wall sit for at least two, like we could rattle off a bunch
00:06:52.980 | of relatively low hanging fruit.
00:06:56.600 | I wish there was a rule that said like you couldn't talk about anything else health related.
00:07:00.400 | We can make that rule.
00:07:01.400 | No one will listen to it.
00:07:02.560 | I don't know about that.
00:07:03.560 | We can make whatever rules we want.
00:07:04.560 | We can call it a Tia's rule.
00:07:06.480 | One thing I've done before in this podcast on social media is just borrowing from the
00:07:09.960 | tradition in science, which is it's inappropriate to name something after yourself unless you
00:07:13.920 | were a scientist before 1950.
00:07:15.920 | Um, but it's totally appropriate to name things after other people.
00:07:18.680 | So I'm going to call it a Tia's rule until you can do the following things.
00:07:22.460 | Um, don't talk about.
00:07:23.820 | Please refrain from talking about supplements and nutrition.
00:07:25.900 | There it is.
00:07:26.900 | Hereafter thought of, referred to and referenced as a Tia's rule.
00:07:31.060 | I coined the phrase, not him, so there's no ego involved, but it is now a Tia's rule.
00:07:35.940 | Watch out.
00:07:36.940 | Hashtag a Tia's rule.
00:07:38.220 | Oh God.
00:07:39.220 | Um, Wikipedia entry, a Tia's rule in all seriousness, and I am serious about that.
00:07:43.660 | Um, dead hang for about a minute seems like a really good goal for a lot of people, at
00:07:48.260 | least.
00:07:49.260 | That's our, that's our goal.
00:07:50.260 | I think we have a minute and a half is the goal for a 40 year old woman.
00:07:52.860 | Two minutes is the goal for 40 year old man.
00:07:54.660 | So we adjust them up and down based on, uh, age and gender.
00:07:59.100 | Great.
00:08:00.100 | And then, uh, the wall sit.
00:08:01.100 | What's, what are some numbers?
00:08:02.100 | We don't use a wall sit.
00:08:03.100 | We do as, as just a straight squat, air squat at 90 degrees.
00:08:06.380 | Um, and I believe two minutes is the standard for both men and women at 40.
00:08:10.540 | Great.
00:08:11.540 | And then, uh, because for some people thinking in terms of, you know, two max is a little
00:08:14.300 | more complicated.
00:08:15.300 | They might not have access to the equipment or the, to measure it, et cetera.
00:08:18.900 | Um, what can we talk about, think about in terms of cardiovascular?
00:08:22.140 | So run a mile at, uh, seven minutes or less, eight minutes.
00:08:25.300 | That's a good question.
00:08:26.380 | So there are VO two, there are really good VO two max estimators online and you can plug
00:08:31.780 | in your activity du jour.
00:08:34.060 | So be at a bike run or rowing machine and it can give you a sense of, of that.
00:08:39.300 | And I, I don't remember.
00:08:40.620 | I used to know all of those, but now that I just actually do the testing, I don't recall
00:08:45.100 | them.
00:08:46.100 | But it's exactly that line of thinking, like, can you run a mile in this time?
00:08:49.180 | If you can, your VO two max is approximately this.
00:08:52.220 | Great.
00:08:53.220 | And, and, and I think somewhere in my podcast realm, I've got all those charts, charts posted
00:08:59.580 | of like, this is by age, by sex.
00:09:04.120 | This is what the VO two max is in each of those buckets.
00:09:06.620 | Terrific.
00:09:07.620 | We'll provide links to those.
00:09:08.620 | We'll have our people find those links.
00:09:10.740 | And then, um, you mentioned deadlifting body weight 10 times.
00:09:13.420 | I just made that one up.
00:09:14.420 | We don't, that's not one that we include, but, but something, something like that.
00:09:18.220 | Um, we use, we use farmer carries.
00:09:20.300 | So we'll say for a male, you should be able to farmer carry your body weight for, uh,
00:09:25.260 | I think we have two minutes.
00:09:27.180 | So that's half your body weight in each hand.
00:09:28.900 | Um, you should be able to walk with that for, for two minutes.
00:09:32.100 | Um, for women, I think we're doing 75% of body weight or something like that.
00:09:35.980 | Yeah.
00:09:36.980 | Great.
00:09:37.980 | I love it.
00:09:38.980 | Um, as indirect measures of how healthy and how long we're going to live.
00:09:42.820 | It's basically grip strength.
00:09:44.300 | It's mobility.
00:09:45.300 | I mean, again, walking with that much weight for, for some people initially is really hard.
00:09:49.340 | Um, you know, we use different things like vertical jump, ground contact time.
00:09:52.780 | If you're jumping off a box, things like that.
00:09:54.460 | So it's, it's really trying to capture and it's, it's an evolution, right?
00:09:57.740 | Like I think the, the test is going to get only more and more involved as we, as we,
00:10:01.900 | as we get involved.
00:10:02.900 | Cause it took us about a year.
00:10:04.460 | Beth Lewis did the majority of the work to develop this.
00:10:07.020 | Um, Beth runs our strength and stability program in the practice.
00:10:10.940 | And you know, basically I just tasked her with like, Hey, go out to the literature and
00:10:13.540 | come up with all of the best movements that we think are proxies for what you need to
00:10:18.820 | be like the most kick-ass, you know, what we call centenarian decathlete, which is the
00:10:22.580 | person living in their marginal decade at the best.
00:10:25.660 | [Music]