EVERYONE—DOCTORS, SCIENTISTS, BIG PHARMA, ME, YOU—is looking for a longevity hack, a drug or supplement or superfood that will help us live healthier, longer lives. It turns out we already have one. “Exercise is by far the most potent longevity ‘drug,’ ” says Peter Attia, M.D., a surgeon turned physician who focuses on extending health span—stretching the portion of life when you’re able to do what you want to do versus being frail and weak. “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.”
Dr. Attia presents his approach in a new 496-page book called Outlive: The Science & Art of Longevity. The 50-year-old is a former boxer, long-distance swimmer, and endurance cyclist; ate keto before it was a thing; and followed Formula 1 in the 1990s. Now he’s all about rucking, archery, rowing, and strength training—and he’s still into cycling and F1. The Austin-based doctor practices what he calls medicine 3.0, aggressively treating the causes of diseases early and emphasizing prevention rather than waiting for symptoms to manifest. In Outlive, he goes deep on the four primary causes of slow death: heart disease/stroke, metabolic dysfunction, neurodegenerative disease, and cancer. But he goes deepest on exercise, specifically what strength and fitness levels are associated with longer, happier lives. Spoiler alert: He recommends way more exercise than the government guidelines, ideally ten to 12 hours a week. We adapted the fitness chapters in Outlive and interviewed Dr. Attia to give you a concise version of his exercise prescription.
Forge True Functional Fitness
Peak aerobic cardiorespiratory fitness, measured in terms of your VO2 max (the maximum amount of oxygen your body can utilize during intense exercise), is perhaps the most powerful marker for longevity, says Dr. Attia. A 2018 study in JAMA that followed more than 120,000 people found that higher VO2 max was associated with significantly lower mortality. The study also determined that someone of below-average VO2 max for their age and sex (that is, between the 25th and 50th percentiles) is at double the risk of all-cause mortality compared with someone in the top quartile.
Dr. Attia says your VO2 max is a good proxy measure of physical capability: It indicates what you can—and cannot—do. Studies suggest that VO2 max will decline by roughly 10 percent per decade after your 20s and up to 15 percent per decade after age 50. Increasing your VO2 max makes you functionally younger. So having average or even above-average VO2 max has long-term ramifications. Dr. Attia’s goal for his patients is to be at an excellent level for the decade (or two) below their age. Many smartwatches can estimate VO2