The Science & Art of Longevity, On Exercising for Longer Life8 min read
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 max, but a real test (e.g., the Cooper 12-Minute Run) is better and VO2-max charts are easy to find online.
The good news? You can improve VO2 max by as much as 17 percent per year. But you need to put in the work. Dr. Attia advises that patients do at least three 60-minute cardio sessions per week in zone 2 of their heart rate (70 to 85 percent of max heart rate, a gentle intensity during which you can say a complete sentence). They can involve running, cycling, rowing, even rucking. This is optimal for the health and efficiency of your mitochondria, the factories that burn fat and glucose to power your muscles and that decline as you age.
Along with cruising in zone 2, Dr. Attia recommends that patients do a weekly 30-minute VO2-max effort, such as high-intensity intervals of three to eight minutes. (Rest for the length of the interval.) For instance, you can run, ride, row, or ruck uphill for four rounds of four minutes, with four minutes of rest in between. “This is a much higher level of intensity—a hard, minutes-long effort,” he says. By testing your VO2 max and committing to cardio, you can nudge up your score and win in the long run.
Build Your Nest Egg of Muscle
Age-related muscle loss—which starts insidiously in your 40s and picks up the pace in your 50s—is called sarcopenia, from the Greek words for “poverty of the flesh,” says Dr. Attia. Think of strength training as a form of retirement saving, he says. Just as you want to retire with enough money saved up to sustain you for the rest of your life, you want to reach an older age with enough of a “reserve” of muscle to protect you from injury and allow you to continue to pursue the activities that you enjoy—in addition to acting as a buffer against the natural age-related decline in muscle mass. The larger the reserve you build up early on, the better off you will be over the long term. Dr. Attia structures his patients’ training around three 45- to 60-minute weekly total-body strength sessions, which emphasize the following key tenets.
Grip strength: New research reveals that American adults have far weaker grip strength—and thus less muscle mass—than they did even a generation ago. In 1985, men ages 20 to 24 had an average right-handed grip strength of 121 pounds, while in 2015, men of the same age averaged just 101 pounds. Dr. Attia notes that many studies suggest that grip strength predicts how long you are likely to live. In these studies, it’s acting as a proxy for overall strength, but it’s also a broader indicator of general robustness and your ability to protect yourself if you slip.
Best moves: Weighted carries, dead hangs, and plate pinches. Your goal: Do a farmer’s carry with half your bodyweight in each hand for one minute.
Concentric and eccentric loading: You need strength when your muscles are shortening (concentric) and lengthening (eccentric). In other words, you must be able to lift the weight up and put it back down, slowly and with control. In life, especially as you age, eccentric strength is where many people falter.
Eccentric strength in the quads is what gives us the brakes required when we are moving down an incline or walking down a set of stairs. It’s really important to keep us safe from falling.
Best moves: Focus on the “down” phase of lifts, whether rucking downhill or doing pullups, curls, or deadlifts. Practice slow stepdowns—can you step off an 18-inch box in three seconds or more?
Pulling motions: Dr. Attia says these anchor movements are how you exert your will on the world, whether you’re hoisting groceries or climbing El Cap.
Best moves: Practice pulling at all angles. Start with rows and deadlifts and progress to overhead moves like pullups.
Hip hingEing: You bend at the hips—not the spine—to harness your body’s largest muscles, the glutei maximi and the hamstrings. It is a very powerful move that is essential to life. If you are jumping, picking up a penny off the sidewalk, or simply getting out of a chair, you are hip hingeing.
Best moves: Deadlifts, hip thrusters, and countless single-leg variations.
Strengthen Your Foundation
Stability is often conflated with core strength, but it’s about more than just abs, says Dr. Attia. It is the foundation on which your twin pillars of cardiovascular fitness and strength must rest. His technical definition of stability: the subconscious ability to harness, decelerate, or stop force. It lets you create the most force in the safest manner possible, connecting your body’s muscle groups with much less risk of injury to your joints, your soft tissue, and especially your vulnerable spine. The goal is to be strong, fluid, flexible, and agile as you move through the world.
Dr. Attia recommends that patients do one hour of dedicated stability work weekly and five to ten minutes at the beginning of other workouts. He notes that there’s no one-size-fits-all approach and it’s about targeting your body’s weak areas. Often he practices exercises endorsed by the Postural Restoration Institute, such as breathing drills and exercises that create symmetrical range of motion for different limbs, and what’s called dynamic neuromuscular stabilization—moves babies learn, like squatting and crawling. He also does standard core training and foot and balance exercises. He likens stability work to a software upgrade for any movement you’re doing. Practices like yoga, tai chi, and dynamic stretching can help, too.
Dr. Attia’s exercise prescription may seem daunting, but it’s that important, he says. The key is finding exercises that you enjoy doing: “This isn’t an eight-week program—it’s a lifelong pursuit.”
Health Span Essentials
Dr. Attia practices what he calls medicine 3.0, an aggressive approach to preventive health care versus the main man-killers.
Metabolism: An annual DEXA scan for body-fat percentage and bone density. It’s critical because strong bones indicate robust health, and excess weight is a leading risk factor for cancer, second only to smoking, according to the American Cancer Society. Dr. Attia also recommends an annual oral glucose tolerance test to assess insulin resistance.
Heart: An apolipoprotein B (apoB) blood test, the best indicator of heart-attack risk. He also tests Lipoprotein(a), or Lp(a), the most prevalent hereditary risk factor for heart disease.
Brain: A test for the APOE4 genotype, which can increase the risk of Alzheimer’s disease.
Cancer: Early screening, including colonoscopies starting at 40.
Sleep: To prevent “social jet lag,” which can be damaging to your overall health, try to wake up and go to bed at the same time each day, even on weekends.
Supps: Dr. Attia takes eight milligrams of rapamycin once per week for its potential antiaging benefits, including reducing inflammation and improving the body’s cancer surveillance.
Alcohol: Limit alcohol to four to seven servings per week—ideally never more than two per day.
Driving: When at an intersection while driving, look left, right, then left again before entering. The most common way to be killed as a driver is to be hit by another car from the left at an intersection.
Outlive: The Science & Art of Longevity, by Peter Attia, M.D., with Bill Gifford, is out March 28 (Harmony Books).
This story appears in the March 2023 issue of Men’s Health.
Ben Court is the Executive Editor of Men’s Health. He has a decade of experience writing and editing stories about peak performance, as it relates to health, nutrition, fitness, weight loss, and sex and relationships. He enjoys yoga, cycling, running, swimming, lifting, grilling, and napping.