EVERYONE—DOCTORS, SCIENTISTS, BIG PHARMA, ME, YOU– looking for a longevity hack, drug or supplement or superfood that will help us live a healthier and longer life. Turns out we already have one. “Exercise is by far the most powerful ‘longevity drug,'” says Peter Attia, MD, a surgeon-turned-physician who focuses on extending health — extending the portion of life when you’re able to do so. what you want to do vs. be. fragile and weak. “The data is unequivocal: exercise not only delays actual death, but also prevents cognitive and physical decline better than any other intervention. It is the single most powerful tool we have in the health-enhancing toolkit – and that includes nutrition, sleep and medication.”
Dr. Attia presents his approach in a new 496-page book called Outlive: The Science and Art of Longevity. The 50-year-old is a former boxer, long-distance swimmer and endurance cyclist; ate keto before that was a thing; and followed Formula 1 in the 1990s. Now it’s all about rucking, archery, rowing and strength training – and it’s still cycling and F1. The Austin-based doctor practices what he calls medicine 3.0, aggressively treating the causes of early disease and emphasizing prevention instead of waiting for symptoms to manifest. In Viva, goes deep into the four primary causes of slow death: heart disease/stroke, metabolic dysfunction, neurodegenerative disease and cancer. But delve deeper into exercise, specifically what strength and fitness levels are associated with a longer and happier life. Spoiler alert: He recommends much more exercise than government guidelines, ideally 10 to 12 hours a week. We adapted the fitness chapters in Survive and interviewed Dr. Attia to give a concise version of his exercise prescription.
Forge True Functional Fitness
Peak aerobics Cardiorespiratory fitness, measured in terms of your VO2 max (the maximum amount of oxygen your body can use during intense exercise), is perhaps the most powerful marker for longevity, says Dr. Attia. A 2018 study in JAMA who followed more than 120,000 people found that higher VO2 max was associated with significantly lower mortality. The study also determined that someone with VO2 max below the average for their age and gender (ie, between the 25th and 50th percentile) is at double the risk of all-cause mortality compared to someone in the top quartile.
Peter Attia, MD, working out in his home gym in Austin.
Dr. Attia says your VO2 max is a good proxy measure of physical ability: It indicates what you can—and can’t—do. Studies suggest that VO2 max will decrease by about 10 percent per decade after age 20 and up to 15 percent per decade after age 50. So having an 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 his age. Many smartwatches can estimate VO2 max, but a real test (for example, 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 recommends that patients do at least three 60-minute cardio sessions a week in zone 2 of their heart rate (70 to 85 percent of their maximum heart rate, a gentle intensity during which you can say a complete sentence). They can be running, cycling, rowing, even rucking. This is optimal for the health and efficiency of your mitochondria, the factories that burn fat and glucose to fuel your muscles and that decline with age.
Along with cruising in zone 2, Dr. Attia recommends that patients do a VO2-max effort of 30 minutes a week, as high-intensity intervals of three to eight minutes. (Rest for the length of the interval.) For example, 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 — hard, minute effort,” he says. By testing your VO2 max and committing to cardio, you can boost your score and win in the long run.
Build Your Nest Egg of Muscle
Regarding age The loss of muscle—which begins insidiously in your 40s and picks up 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 savings, he says. Just as you want to retire with enough money saved to support you for the rest of your life, you want to reach an older age with enough of a muscle “reserve” to protect you from injury and allow you to continue to pursue the activity you you like-in addition to acting as a buffer against the natural age-related decline in muscle mass. The bigger the reserve you build first, the better off you will be in the long run. Dr. Attia structures his patients’ training around three weekly 45- to 60-minute total-body strength sessions that emphasize the following key principles.
Dr. Attia has her own podcast, The Drive, and recently spoke with Andrew Huberman, Ph.D., host of the Huberman Lab podcast.
Grip strength: New research reveals that American adults have much weaker grip strength—and therefore less muscle mass—than they did even a generation ago. In 1985, men aged 20 to 24 had an average right hand 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 will live. In these studies, it acts as a proxy for overall strength, but is also a broader indicator of overall robustness. and your ability to protect yourself if you slip.
Best moves: Weighted carts, dead hangs and plate pinches. Your goal: Do a farmer’s carry with half of your body in each hand for one minute.
Concentric and eccentric load: You need strength when your muscles are shortened (concentric) and lengthened (eccentric). In other words, you must be able to lift the weight and cool down, slowly and with control. In life, especially in old age, eccentric strength is where many people fall short.
The eccentric force in the quads is what gives us the brakes we need when moving up an incline or walking up a set of stairs. It is really important to keep us from falling.
Best moves: Focus on the “down” phase of the lifts, whether rucking downhill or doing pullups, curls, or deadlifts. Practice slow stepdowns – can you drop an 18-inch box in three seconds or more?
Pulling movements: Dr. Attia says that these movements of the anchor are how you exercise your will on the world, whether you stretch the food or climb El Cap.
Best moves: Practice pulling in all angles. Start with rows and deadlifts and progress to overhead movements like pullups.
Hip zipper: You bend at the hips –no the spine – to exploit the largest muscles of your body, the glutes and hamstrings. It is a very powerful movement that is essential for life. If you’re jumping, picking up a penny from the sidewalk, or simply getting out of a chair, you’re hip.
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 upon which your twin pillars of fitness and cardiovascular strength should rest. His technical definition of stability: the subconscious ability to harness, slow down, or stop force. It allows you to create the most force in the safest way possible, connecting the muscle groups of your body with much less risk of injury to your joints, your soft tissues, 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 per week and five to ten minutes at the beginning of other workouts. He notes that there is no one-size-fits-all approach and it is about targeting the weak areas of your body. He often practices the exercises approved by the Postural Restoration Institute, such as breathing exercises and exercises that create a symmetrical range of motion for the different limbs, and what is called dynamic neuromuscular stabilization – it moves the children to learn, as and squatting and crawling. He also does standard core training and foot and balance exercises. He compares stability work to a software update for every move you make. Practices such as yoga, tai chi and dynamic stretching can also help.
Dr. Attia’s exercise prescription may seem scary, but it is what you do important, he says. The key is to find exercises you enjoy doing: “This is not an eight-week program – it’s a lifelong quest.”
Health care Essentials
Dr. Attia practices what he calls medicine 3.0, an aggressive approach to preventive health care versus the main killers of humans.
Metabolism: An annual DEXA scan for body fat percentage and bone density. It is critical because strong bones indicate robust health, and excess weight is a major 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.
Chorus: A blood test for apolipoprotein B (apoB), the best indicator of heart attack risk. It also tests for Lipoprotein (a), or Lp (a), the most prevalent hereditary risk factor for heart disease.
Brain: A test for the APOE4 genotype, which may increase the risk of Alzheimer’s disease.
Cancer: Early screening, including colonoscopies starting at age 40.
Sleep: To prevent “social jet lag”, which can be harmful to your overall health, try to wake up and go to bed at the same time every day, even on weekends.
Sup: : Dr. Attia takes eight milligrams of rapamycin once a week for its possible anti-aging 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 you are 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 and Art of Longevity, by Peter Attia, MD, with Bill Gifford, 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 on top performance, health, nutrition, fitness, weight loss, and sex and relationships. She enjoys yoga, cycling, running, swimming, lifting, grilling and napping.