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In this special episode filmed live in front of readers of Outlive, Peter answers questions revolving around his concept of the centenarian decathlon. He starts by defining the “marginal decade” and how that shapes his training for the events and activities that make up his personal centenarian decathlon. Peter explains how he coaches patients through the challenges of customizing their own list and building out a training plan, including how to set fitness goals early in life in preparation for the marginal decade. From there, he dives into training within the four pillars (zone 2, VO2 max, stability, and strength), including the minimum effective dose, how to split your time, his personal protocols, and other considerations. Additionally, he touches on bone mineral density, female-specific considerations, working through injuries, and the profound impact training can have on the overall quality of life.

We discuss:
0:00:00 - Intro
0:02:10 - The best interventions for longevity
0:03:45 - The marginal decade and the centenarian decathlon
0:07:14 - Peter’s personal list of events for his “centenarian decathlon” and how he helps patients create their own list
0:15:00 - Determining your fitness goals early in life in preparation for the marginal decade, metrics to track, and more
0:25:27 - How does playing sports like tennis, basketball, or golf fit into training for the centenarian decathlon?
0:29:15 - Training within the four pillars: minimum effect dose, how to split your time, and other considerations
0:35:57 - Advice for the older person and why it’s never too late to start
0:39:08 - Bone mineral density and other female-specific concerns and considerations
0:42:24 - Training advice for those with minimal access to a gym or equipment
0:44:14 - Injuries: prevention and working through existing conditions
0:48:07 - Cardiorespiratory training: how to split time between zone 2 and VO2 max training, and different modalities for a true zone 2 workout
0:54:33 - VO2 max training: modalities, Peter’s protocol, and how to monitor progress
1:04:28 - The profound impact training can have on the overall quality of life

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About:

The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. 

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If I knew that all this training I was doing, everything I'm doing, if I knew that it was going to shorten my life by a year, I would still do it purely for the improvement in quality of life between now and the end of my life.

The fact that it's not shortening my life by a year, the fact that it's probably adding 5 to 7 years to my life and improving the quality of my life means day in and day out, I just think it's about the most important thing, that I can do vis-a-vis my physical health.

You feel like there's more pressure on this because there is, you can't screw up.

Everything you say is officially written in stone.

So what we're doing tonight, today, depending on where you're at is kind of an AMA that's all focused on 1 thing, which is the centenarian decathlon.

And so what we did is for everyone who pre-ordered, they could sign up for the event.

We went through – I mean, there was thousands of questions.

So right off the bat, we'll apologize to anybody who we can't answer the question, but we tried to group them together, kind of organize them a bit, really to try and get through as much as we can.

So if anyone has heard our AMAs before, they'll probably know sometimes we can go into a little bit of detail and sometimes 1 question can take a while.

But the goal for this 1 is more of that rapid fire.

Anything you want to add or say before we get rolling?

No, but feel free to interrupt me if I'm being too long-winded.

We'll just point at the watch and say we got to speed it up.

be helpful is – because we did get a lot of questions around, hey, what's the best thing you can do for longevity?

You have 5 tactics in the toolkit, but if there's 1 thing people should focus on, what would that be?

Maybe it'd be worth just giving a little piece on that just as we set the stage on why we decided to focus on the centenarian decathlon and kind of why you think that's so important for people's longevity journey.

I mean, look, it's an impossible question to answer because if you got a person who's sleeping 4 hours a night, if you don't fix that, nothing else will matter.

If you have a person who's malnourished, you sort of have to address these issues.

But generally speaking, if everything in your life is a 6 or 7 out of 10, taking your exercise to a 10 out of 10 is going to have a greater impact on both the length and quality of your life than any of the other domains that I can think of, perhaps with the exception of emotional health.

That's 1 that can be such a binary thing that if you take a person, for example, like me, where that house is not in order, until that's addressed, all the exercise in the world wouldn't fix that either.

I wish I had a slick answer for it, but that's really the best I can say.

If anyone's read the book and has a really quick 30-second answer they want to email to us that Peter can steal, feel free to do that because we'll take it.

I think it'd be helpful, maybe let's just quickly define centenary and decathlon, marginal decade.

Obviously people will have read the book, but I think it's still good to just get a quick definition of that because it will set the stone for everything we're going to cover.

Marginal decade is the last decade of your life.

Most people certainly don't know the day they enter it.

You know, if you're, especially if you're nearing the end of it, a person probably has a sense of that appreciation.

But it is an important model because I think that the marginal decade for most people is really a period of poor life quality.

Physical health has usually declined significantly.

Cognitive health potentially has declined as well.

And as I observed many people in their marginal decades, including people I've been close to, I noticed that there can be a great sense of withdrawal because of these things, right?

Which is if you plan to have a remarkable marginal decade, by definition it means that all the decades that came before it also had to be pretty remarkable.

The analogy I use in the book is that of an archer, probably because that's what I am.

But if you really want to be proficient at 50 yards with a bow and arrow, practice at 100 and you'll be amazed at how simple 50 becomes and 60 and 70 and 80.

It's a very nonlinear relationship in terms of accuracy with a bow and arrow.

The centenarian decathlon becomes the scaffolding upon which I actually think of this.

So this again came from an idea or an observation I suppose I had in my own life, which was from age 13 to about 42, I was constantly involved in something very specific that I was training for.

And everything I did vis-a-vis exercise was in service of a goal.

There was real specificity to what I did.

And then when I sort of hung up my bike, I realized, oh my God, like I don't know what I'm doing.

I mean, I'm still exercising, but it didn't feel like it had a purpose.

And I sort of realized that's actually how most people exercise.

And when compared to the alternative, which is not exercising, that's okay.

But I realized, as I thought more about this marginal decade, I needed to be very specific in my training to make sure I didn't arrive there and sort of leave it to chance.

Would I be strong enough, healthy enough, have enough balance, all of those things.

And so what I realized is I had to borrow the phrase from Annie Duke.

I had to back cast from that marginal decade around a set of very specific events.

That set of events, we would call the centenarian decathlon.

Everybody's going to pick different events.

These could be very specific recreational activities.

I think it's a good idea to have both in there.

And the more specifically you train for those, the more directed your training is.

And I think what would be helpful right now is I know you have that list right next to you is maybe just reading through your list.

And again, as you kind of stated, your list doesn't mean it has to be everyone else's list, but a lot of times I think when there's newer concepts or people are trying to figure out how this works, it's helpful to hear like an example.

So do you kind of want to just burn through your list and let people know how you're thinking about this in your life?

It's organized in a way that's a bit confusing Because in my mind, I'm constantly thinking, okay, mobility and strength matter.

So in the back of my mind thinking, I have to make sure I can do all of those things well.

Then some of my centenarian decathlon Olympics are like exercises or metrics or feats and others are activities.

Real quick, you mentioned your 4 pillars of exercise, but people also know them by different things, which is zone 2 maybe or VO2 max.

So do you just kind of want to explain that

So when I talk about aerobic efficiency, that's zone 2.

When I talk about peak aerobic output, that's VO2 max.

Strength, stability, in with stability is mobility, balance, things like that.

Okay, so in no particular order, pick up a 30-pound child from a squatted position or from a crib.

So that requires strength, stability, mobility.

Get up off the floor with 1 point of support.

Farmer walk for 1 minute with 25% of body weight in each hand.

So again, it's something that today I could do for a day.

That's really pushing the bounds of what I would want to be able to do in my 80s for example, strength and anaerobic.

Pull or push a weighted sled 100 feet with, and I've put in here kind of a metric of resistance.

This is kind of 1 of those things if you're in a dangerous situation, a spouse has fallen, you have to pull somebody out of the way or something like that Walk up and down stairs with feet pointed perfectly forward So if your feet are pointed perfectly forward as you're walking up and down flights of stairs It means you still have the ankle mobility to do that So you can get an angle between your foot and your tibia, your shin, into an acute angle as opposed to having to turn your feet outward.

Single leg stand with eyes open for 30 seconds, with eyes closed for 15 seconds.

So like getting up off a seat, for example.

Hex bar deadlift my body weight for 5 reps.

A dumbbell lunge in perfect form with 15% of my body weight in each hand for 10 reps.

So again, that's 20 minute mile is pretty slow, but if you think about being able to do that in the last decade of your life, carry 20 pounds up 4 flights of stairs, produce a VO2 max above 30 milliliters per minute per kilogram.

If you can do that, that basically buys you a whole bunch of activities.

That means you could walk up a 6% grade at 3 miles an hour for a period of time.

Not necessarily for an hour, but perhaps for 20, 15 minutes.

Not that I have a plan to, but you can, you think about what's implied, like that's a very functionally aerobic thing to do.

Scale a ledge at shoulder height or pull myself out of a pool onto a deck 12 inches above the water surface.

Single leg glute bridge, 15 reps without loading my lumbar spine, and do a plank in perfect form with scapula retracted, no hip sag for 1 minute.

There are things that I would add to this that are – I have on a different list that get more into recreational activities.

I do want to be able to pull a 50 pound bow back, a compound bow that's 50 pounds.

A compound bow of course lets off as you get further but you still have to be able to pull 50 pounds at the outset.

Yeah, and I think it's helpful for people because if you think about the list you made, very specific things.

But you kind of hinted at there's a reason behind everything, right?

Like the dumbbell, being able to lift it is, grandkids, great-grandkids, you want to be able to play with them.

Being able to get off the ground is you want to be able to play with them.

Being able to get off the ground is you want to be able to live by yourself or with a spouse and be able to like fully move, not worry about falling.

And so if anyone's having trouble kind of thinking about how they do it, it's sometimes helpful to just take a step back and be like, you know, do you want to live in a city area where you can walk to get groceries and bring them back?

And then you can get specific from there too.

So you know, for anyone who's kind of thinking, okay, what specifically should they think about for that?

Always feel free to take a step back and then get detailed going forward.

Now you mentioned earlier kind of emotional health.

There wasn't anything on there on your list as it relates to that.

And also, you kind of talked about how physical and cognitive as you get older is always going to decline.

But emotional health on the other end, that's the only piece of healthspan that can actually go up.

And so is it purposeful you don't have that on your centenarian decathlon list?

Yeah, the centenarian decathlon is focusing purely on that physical piece that is invariably going to decline.

So it doesn't really get into the cognitive or as you said the emotional part, which, you know, if we're really doing that right, should be getting better as we age.

And when you talk to your patients about this, because I know you work with every patient, you want them to be able to create this list and kind of anchor back to it.

Because like you said, you're not training for a marathon, you're not training for a triathlon, you're really training for this.

What advice, what encouragement do you give them as they're starting to kind of think through, okay, how do I create this list?

How do I start to build this process in my mind?

So we've gone through several iterations on this.

Initially we asked patients to do what I did, which is just sit down and come up with the list.

That didn't produce as much fruit, perhaps because people weren't putting as much thought into it as I was.

It just wasn't something they were spending all of their time thinking about.

What we do now is we give them a list of about 50 items.

About half of them are activities of daily living.

About half of them are sort of feats of fitness or strength.

We've gone through multiple iterations of this.

We used to say, pick as many as you want.

That turned out to be So now it's like, pick 10.

What are the 10 most important things to you on this list?

Then we ask the question, okay, to do those things, do you know what is required?

Do you know what's required to pick up a 30 pound child off the ground?

How much will that require you to be able to do today based on the extrapolation of how much each of those parameters declines?

1 of the questions we got come through a ton was, those are the things you want to do at 100.

to be clear, I don't expect to live to 100.

If you look at my wall chart, it says 88.

Call it in my 80s is probably where I hope to be.

And so how are you thinking about, okay, so if in your marginal decade you want to be able to do that, there's people who are listening who are going to be in their 20s, 30s, 40s, 50s, 60s, 70s, 80s.

So the people who are on the younger spectrum of that were kind of wondering, you kind of mentioned you can do all those right now easy all day, every day.

So how do you think about how much you should be able to do in your 30s or 40s or 50s?

Kind of how do you talk to patients about how they kind of like back cast and figure out, okay, my goal at 40 should be X to be Y at 80.

We have a pretty good sense of how major parameters like strength and VO2 max decline with age.

And so even though I can do everything on that list blindfolded, It's going to take a lot of work to make sure that my VO2 max is 30 to 32 mils per minute per kilogram in 30 to 40 years, especially if it's closer to 40 years.

And truthfully, like right now, my VO2 max is not what I'd like it to be.

It's probably in the mid 50s, which is again, fine for somebody my age, but I really would like a bigger margin of error and maybe want it to be mid to high 50s as opposed to low to mid 50s.

So if you're 30, if you're 20 years younger than me, the bar is even higher.

So yeah, paradoxically, the youngest people aren't necessarily in the best shape here on a relative basis.

They might be in absolute terms, but they have longer to maintain that and therefore they have to be starting from a higher place.

Do you maybe want to talk about a few metrics or tests people could do so they can understand where they're at currently from a cardio perspective and let's say a strength perspective?

Well, I think VO2max is – I don't know that it's necessarily the single best metric of cardiorespiratory fitness, but it's certainly the 1 that's been studied the most and it's obviously the 1 that for which we have the most data.

It's also 1 that you can go out and get done on your own.

It's a $100 test, maybe $150 test you can go and find.

In most cities, they would be able to do this for you.

There are also free versions, you can estimate it.

You could run a Cooper's test or various versions of these tests, which we've talked about elsewhere.

You can just look that up if you want to know how to do that protocol.

You don't need to even spend a dollar to estimate your VO2 max if you're willing to go down to a track and run a mile or something.

So the question then becomes, what are some other metrics that go with it?

Well, I mean, certainly strength metrics matter.

Good metrics for – a great metric for both upper body strength and grip strength and a bit of stamina to boot is a farmer carry.

For men, we'd like to say a guy in his 40s should be able to carry his body weight for a minute.

Do you maybe want to explain what a farmer carry is for people who aren't familiar?

It's literally just carrying and walking.

So if a person weighs 180 pounds, can they put 90 pounds in each hand and walk for a minute?

For a woman who's 40, we would want to see that at about 75% of her weight.

So just do the math and adjust accordingly.

That's another great 1 for grip strength.

Again, we have metrics that we would look at.

We would say a man in his 40s, we'd want to see 2 minutes of dead hang for a woman, a minute and a half.

Then of course that gets discounted by roughly 10 cents, roughly 10 to 15 seconds per decade as you go from 40 to 50, et cetera.

There are other great examples of strength, a wall sit, for example.

So You're sitting with your back against the wall, your thighs are parallel to the ground, you're not using your hands and basically this is 1 way to test leg strength.

We typically do this in a more free form where we have people do an air squat where they're hovering but not using their back for support.

Now, it's a little more stressful because you're not just using your legs, but you have to stabilize whereas on the wall sit, you get all the stabilization for free because you're pushing back into the wall.

There are no shortage of ways to do this kind of thing and probably beyond the scope of our discussion now to go through all the different ways.

Zone 2, of course, is another really important thing to do.

There's the technical way it's defined based on lactate production, but again, the simplest way for most people is the RPE way, right?

Zone 2 is that threshold where you go from being able to speak while you're exercising, but being uncomfortable to not being able to speak.

Where most people cross that threshold is where you will now start to net accumulate lactate with your activity.

Figuring out and demonstrating that you can generate more and more work at that level, whether it be wattage or speed or whatever your metric you're using, that becomes also just an enormous way to track your progress.

And do you, not to put you on the spot or make it awkward, but I think with RPE and zone 2, sometimes people don't know what that level is of like, if I'm talking like this, is that okay?

Should it be like, I can only get 1 word out every 5 seconds.

No, for me, I mean, it's, it, it feels like, you know, if I, if I'm on my bike doing a zone 2 and my wife comes in or 1 of my kids comes in to talk to me, I'm like, I can talk.

You know, Do I want to sit there and talk?

If I could talk like this, I'm in zone 1.

If you and I went for a walk, we're in zone 1.

Most of rucking is below zone 2, except when you're going up the hills.

So there's very little of a ruck that's actually in zone 2.

The closest I can get to zone 2 is doing that shuffle run.

But if I'm walking, it's hard, but it's not hard enough.

And if I'm walking up a hill, if I'm walking flat, it's too easy.

If I'm walking up a hill, if I'm walking flat,

And another important piece is muscle mass.

I know you typically will look at muscle mass based on metrics from a DEXA scan.

Then there's also certain percentiles that you want to see patients in.

Maybe talk a little bit about that because that way anyone who's listening to this and is curious, okay, how do I stack up from a muscle perspective?

They can go out and get 1 of these done relatively cheap.

They're relatively easy to find and there's a few core metrics.

Yeah, I think everybody should have a DEXA scan.

You have to know your bone mineral density.

I think you have to know how much visceral fat you have and I think you have to know how much muscle mass you have.

Obviously, you're also getting body fat, which is important, but it's not as important as those other 3.

A DEXA scan will either automatically calculate for you or at least give you the data to calculate for yourself, something called the ALMI and the FFMI.

The ALMI stands for appendicular lean mass index.

And again, sometimes it's just spit out in the report, but if it's not, you would simply go to the report where it shows you lean mass for left leg, right leg, left arm, right arm, and you add those 3 up, make sure they're in kilograms.

So if they're in pounds, you have to convert them to kilograms, divide by 2.204, and then divide that by your height in meters squared.

And if that's given in inches or feet, you have to make the conversion.

If you're a male, you know, 5678, if you're a female, and then there are nomograms that will tell you for your age and for your sex, what percentile you are in.

And we want all of our patients to be at or above the 75th percentile for ALMI.

And again, it's associative data, but it's very strong associative data, which is, look, muscle mass is a great integrator of exercise and strength.

So hemoglobin A1C is a metric that is effectively an integral function for glucose.

So you get this number, 6.5, and it tells you directionally over the last 3 months, your average blood glucose has been 140 milligrams per deciliter.

So the hemoglobin A1c integrated the area under the curve and spit out that number.

And similarly, that's effectively what VO2max muscle mass and strength are doing.

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261 ‒ Training for The Centenarian Decathlon: zone 2, VO2 max, stability, and strength