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

1 hours 11 minutes 26 seconds

🇬🇧 English

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Speaker 1

00:00

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. Hey everyone. Welcome to the drive podcast.

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Speaker 1

00:42

I'm your host, Peter Attia.

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Speaker 2

00:48

Never done a live event. Never done a live AMA. Everything has been recorded.

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Speaker 2

00:53

So how do you feel?

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Speaker 1

00:54

Ready.

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Speaker 2

00:56

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. Yeah.

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Speaker 2

01:06

That's good. That's good. So we'll see, we'll see how it goes. 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.

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Speaker 2

01:20

And so what we did is for everyone who pre-ordered, they could sign up for the event. They submitted a bunch of questions. 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.

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Speaker 2

01:40

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. Let's see how many we can get out. I think it should be good.

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Speaker 2

01:59

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

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Speaker 1

02:03

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

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Speaker 2

02:06

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

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Speaker 1

02:11

So I think what would

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Speaker 2

02:12

be helpful is because we did get a lot of questions around, hey, what's the best thing you can do for longevity? There's only 1 thing. You have 5 tactics in the toolkit, but if there's 1 thing people should focus on, what would that be?

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Speaker 2

02:27

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.

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Speaker 1

02:39

Yeah. 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.

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Speaker 1

03:13

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. It's a tough question. I get asked that question all the time. I wish I had a slick answer for it, but that's really the best I can say.

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Speaker 2

03:34

Yeah. 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. 2 terms that we use quite a bit.

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Speaker 2

03:54

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.

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Speaker 1

04:01

Yeah. Marginal decade is the last decade of your life. So everyone will have a marginal decade. Most people certainly don't know the day they enter it.

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Speaker 1

04:11

Sometimes you know when you're in 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.

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Speaker 1

04:32

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? You're not participating in life. So the idea here is quite simple, right?

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Speaker 1

04:55

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.

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Speaker 1

05:29

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. So I never exercised. I trained.

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Speaker 1

05:51

I trained for boxing. I trained for cycling. I trained for swimming. I had competitions.

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Speaker 1

05:56

I had meets. And everything I did vis-a-vis exercise was in service of a goal. And that made it very easy. There was real specificity to what I did.

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Speaker 1

06:07

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.

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Speaker 1

06:24

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.

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Speaker 1

06:51

That set of events, we would call the centenarian decathlon. Everybody's going to pick different events. These can be activities of daily living. These could be very specific recreational activities.

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Speaker 1

07:04

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.

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Speaker 2

07:14

Yeah. 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?

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Speaker 1

07:39

Yeah. I will say this. It's organized in a way that's a bit confusing Because in my mind, I'm constantly thinking, okay, mobility and strength matter. Aerobic capacity matters.

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Speaker 1

07:53

So aerobic efficiency matters. Peak aerobic performance matters. 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.

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Speaker 1

08:10

I'll try to add a bit of color here.

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Speaker 2

08:12

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

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Speaker 1

08:23

a little bit? Yeah. So when I talk about aerobic efficiency, that's zone 2.

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Speaker 1

08:26

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. Those are 2 very difficult positions.

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Speaker 1

08:43

So that requires strength, stability, mobility. Get up off the floor with 1 point of support. That's stability and strength. Place a 30-pound suitcase overhead.

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Speaker 1

08:52

Strength, also mobility. Dead hang for 30 seconds. Strength and stability. Farmer walk for 1 minute with 25% of body weight in each hand.

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Speaker 1

09:03

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. Again, what is that really all about?

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Speaker 1

09:26

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. Single leg get up without support. So like getting up off a seat, for example.

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Speaker 1

10:11

Hex bar deadlift my body weight for 5 reps. Pretty aggressive, not now. A dumbbell lunge in perfect form with 15% of my body weight in each hand for 10 reps. Cover 3 miles in 1 hour by foot.

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Speaker 1

10:26

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.

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Speaker 1

10:57

Tread water for 10 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.

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Speaker 1

11:30

I have several of these lists. 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.

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Speaker 2

11:47

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.

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Speaker 2

12:03

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.

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Speaker 2

12:24

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.

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Speaker 2

12:46

And we did get a few questions on 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?

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Speaker 1

13:04

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.

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Speaker 2

13:21

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?

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Speaker 2

13:43

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

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Speaker 1

13:47

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.

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Speaker 1

14:03

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.

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Speaker 1

14:20

We say, pick 10. 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.

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Speaker 1

14:29

You have to really think about this. You have to prioritize. 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?

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Speaker 1

14:42

Do you know what's required to pick up a 30 pound child off the ground? What type of stability is required? What type of strength is required? How much will that require you to be able to do today based on the extrapolation of how much each of those parameters declines?

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Speaker 2

15:01

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

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Speaker 1

15:10

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.

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Speaker 2

15:21

In your marginal decade.

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Speaker 1

15:22

In my marginal decade, yeah.

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Speaker 2

15:24

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?

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Speaker 1

15:53

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.

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Speaker 1

16:27

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.

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Speaker 1

17:01

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

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Speaker 2

17:10

You mentioned VO2 max there. 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?

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Speaker 1

17:23

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.

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Speaker 1

17:47

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.

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Speaker 1

18:00

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. We've talked about some of those things.

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Speaker 1

18:17

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. So half his body weight in each hand.

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Speaker 2

18:36

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

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Speaker 1

18:39

Yeah. 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.

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Speaker 1

18:55

So just do the math and adjust accordingly. I've talked about the dead hang. That's another great 1 for grip strength. Again, we have metrics that we would look at.

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Speaker 1

19:06

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. Can you do a wall sit for 2 minutes?

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Speaker 1

19:29

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. There are better ways to do it. 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.

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Speaker 1

20:04

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.

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Speaker 1

20:36

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.

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Speaker 2

20:57

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. Do you kind of.

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Speaker 1

21:13

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. I'm like, hey, yeah. Okay.

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Speaker 1

21:28

Yep. I got it. Yep. I'll pick them up.

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Speaker 1

21:32

You know, Do I want to sit there and talk? No, but I can. If I could talk like this, I'm in zone 1. If you and I went for a walk, we're in zone 1.

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Speaker 1

21:42

In fact, you've rucked with me. Most of rucking is below zone 2, except when you're going up the hills.

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Speaker 2

21:48

Which is brutal.

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Speaker 1

21:49

Then you're not talking. Then you're out of zone 2. So there's very little of a ruck that's actually in zone 2.

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Speaker 1

21:54

The closest I can get to zone 2 is doing that shuffle run. I can do sort of a light shuffle. 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.

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Speaker 2

22:08

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

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Speaker 1

22:08

it's too easy. If I'm walking up

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Speaker 2

22:09

a hill, it's too hard. And another important piece is muscle mass. I know you typically will look at muscle mass based on metrics from a DEXA scan.

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Speaker 2

22:21

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? Do I need to increase? Am I okay?

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Speaker 2

22:35

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. Maybe just talk about that for a second.

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Speaker 1

22:43

Yeah, I think everybody should have a DEXA scan. You just have to know this data. You have to know your bone mineral density.

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Speaker 1

22:51

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.

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Speaker 1

23:19

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. And then you'll get a number, right?

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Speaker 1

23:46

It could be 8, 9, 10. 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.

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Speaker 1

24:17

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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Speaker 1

24:46

They are integrators of the work that it takes to have a high VO2 max, to have high muscle mass, to have high strength. And the work that goes into that is the secret sauce. In other words, it's not so much the muscle mass, I think, that is the most important thing. It's what you had to do to get said muscle mass and what that muscle mass will then do vis-a-vis metabolic function and of course the implication with respect to the functional side of things.

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Speaker 1

25:14

Muscle mass and strength are not equivalent. When put head to head, strength beats muscle mass as a predictor of lifespan, but all of these things are important metrics to be tracking.

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Speaker 2

25:28

I think then the rest of the conversation will focus on the actual training piece of it, right? So that was the bulk of questions that we received, which is how much should I be training? How much in the different pillars?

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Speaker 2

25:42

How do you best train zone 2? How often, how many times a week, VO2 max. So I think we'll kind of now start getting into those pieces. But I think what would be helpful is, we also received a lot of questions from people who are like, hey, I play basketball 4 times a week.

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Speaker 2

25:57

Hey, I play tennis. I play golf. Hey, I do marathons. I maybe just I go to the gym and I lift.

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Speaker 2

26:06

Is that okay? How important is it to actually be really specific to train for this and to hit all of those pillars?

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Speaker 1

26:16

Well, again, I think it depends on your objective. Everything has to be compared to the alternative. If a person says, look, I'm playing tennis twice a week, I'm playing basketball twice a week, and I'm lifting weights once a week, am I doing great?

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Speaker 1

26:32

The answer is, yeah, you are doing great relative to most people. But I don't think that that's a recipe for success if you want to be in the best shape possible in your last decade. The reason being is sports like any sport, whether it be basketball, tennis, swimming, any particular sport has so much repetitive stress in it that you're going to develop movement issues. You're going to have asymmetries in joints and muscles and you want to balance those things out as much as possible.

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Speaker 1

27:13

Again, If you want to be able to play golf every week and you're going to walk 5 miles, that's great, but you have to acknowledge every time you're swinging that club, it's asymmetric. So you have to think about, what am I doing to counteract that? Same with tennis, same with basketball. And so, again, it just depends on how much time a person is willing to put into this.

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Speaker 1

27:38

I don't want to suggest that everybody needs to do this because I acknowledge it's really difficult. If it wasn't difficult, everybody would be doing it already. By definition, this is really a complicated idea and maybe I just have the privilege of 2 things, right? 1, I got to experience my marginal decade in my 20s, right?

S1

Speaker 1

27:58

I had that back injury when I was 28 that left me unable to walk for 3 months and in so much pain, I didn't know my name for a year. And during that period of time, I would have given my life to have had everything back. So when I got it back, it's seared into my brain what it feels like to be so immobile, so debilitated and in so much pain. I think that's just the greatest gift I ever received was to have that time machine to basically go and experience the last decade of my life and then get zapped back to being 28 with a totally different mindset of, yeah, I never want that to happen again.

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Speaker 1

28:42

At least I'll do everything in my power to make sure it doesn't. Long answer to a short question, but the reality of it is, you really do need to be training very specifically. That means a lot of really silly looking unsexy things that I do every day. Sometimes as little as 10 minutes a day, sometimes as much as an hour a day, just on the stability stuff, just on the movement piece.

S1

Speaker 1

29:08

But I wouldn't trade it for anything because the way my body feels, I'm thanked for it.

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Speaker 2

29:15

Now let's talk about if someone's listening, they're like, okay, I want to train for this and I'm willing to put in the work to the 4 pillars. So the strength, stability, zone 2, VO2 max, just to keep it simple. What's the minimum effective dose where it's, okay, how much per week does someone need to commit to be able to hit those 4 things?

S2

Speaker 2

29:36

And then we can get into each of them in a little more detail, but just, you know, from a minimum effective dose, if they have kids, busy job, families don't have a ton of time, what should they strive to set out for?

S1

Speaker 1

29:49

Well, it depends where you're starting, right? So the minimum effective dose, if you're doing nothing, is not that much. You're going to get huge benefits when you, you know, go from nothing to probably 3 hours a week.

S1

Speaker 1

30:03

That would be an enormous improvement. Maybe that's I don't know if that's the right way to think about it. Maybe let's just start there. Let's say someone starts at nothing.

S1

Speaker 1

30:18

So you're saying, okay, start at 3 hours a week. How are you breaking that out? Well, if you only had 3 hours a week to commit to this, you know, I think you'd have to put probably an hour of that into steady state aerobic training zone 2.

S2

Speaker 2

30:37

I think you'd have to put

S1

Speaker 1

30:37

probably an hour of that into steady state aerobic training, zone 2. I think you'd have to put an hour of that into strength training. I think you'd probably want to put 20 minutes of that or 30 minutes of that across 1 or 2 sessions into high intensity aerobic training.

S1

Speaker 1

30:53

So not hit intervals, by the way, but sort of the longer intervals that are VO2 max appropriate. And Then the remainder of that time, call it another 30 or 40 minutes, spread out at 10 minutes a day into some of the stability training. Again, I think it's important to understand, you're better off If you say, look, I'm only willing to devote 60 minutes a week to this stability stuff, which seems so boring. Should I just blast it out in 1, 1 hour session?

S1

Speaker 1

31:22

The answer is no, you're better off doing 10 minutes a day, 6 days a week. There's really something to the neurologic pattern that comes from practicing your IAP, practicing your breathing, your scapular CARs, your cat-cow exercises. Doing that for 10 minutes every day is better off than just trying to do it all in 1 shot. So anyway, that's probably how I would structure a three-hour program.

S2

Speaker 2

31:48

And for the, on the stability side, you kind of mentioned a few exercises there. And actually, what you and Beth did is we recorded those videos of you in the gym. And so those are available, peterottmd.com slash outlive slash videos.

S2

Speaker 2

32:04

And so anyone who wants to learn more about, okay, what are those stability exercises that I could do 10 minutes a day? Real short, real simple videos. You can go check them out. So we won't spend time double clicking on those because as you've said it before, you really have to see it to understand it as opposed to just hearing about it.

S2

Speaker 2

32:25

Let's say then someone is like, okay, I'll start with 3 hours a week. How often do you ratchet that up? Does that get increased every week? Does it get increased every month?

S2

Speaker 2

32:37

Is it when certain milestones are hit?

S1

Speaker 1

32:40

Well, it depends what the limiting factor is. Usually, when a person starts at 3 hours per week, it's because that's the only time they're willing to put into it. Now, conversely, if a person's never lifted a finger and they say, oh my God, I'm willing to do whatever it takes, and they only started 3 hours a week because you don't want to injure them, Then you're in that situation where how much can you ratchet it up?

S1

Speaker 1

33:02

I'd probably ratchet a person up every 6 weeks in a scenario like that. But I think the far more typical scenario is, okay, I'm willing to do 3 hours. I do 3 hours a week. Usually a person sort of starts to habituate to that stress.

S1

Speaker 1

33:21

1 of the important principles of training is a principle that most people have heard of called progressive overload. In 1 way or another, the training, the load, the ask needs to get more complicated, needs to get more difficult. So if you're talking about strength training, that could mean heavier weight, that could mean more reps, more sets, less rest between, other things that make it more complicated, such as using BFR. So we're always looking for ways to make this more demanding.

S1

Speaker 1

33:55

For example, in my stage now, I'm not adding time anymore. I am at the limits of how much I'm willing to spend on this. My kids are young. Every minute I'm doing that, I'm not spending time with them or I'm not working or I'm just falling behind in some other area of my life.

S1

Speaker 1

34:12

I'm already spending about as much time as I'm willing to spend in the gym and it's probably on the strength side, 6 hours a week. I have to find other ways to add that demand. The other thing I would be doing is thinking about where the deficits are. Let's say you have that person that's at 3 hours per week, maybe their ALMI is already at the 70th percentile and they're actually reasonably strong, but their aerobic training is an atrocity.

S1

Speaker 1

34:41

So then I'm going to disproportionately add to that as opposed to just equally build all of them. Conversely, we have a patient in our practice who's upon entering the practice, I mean this guy's VO2 max was probably above 60 and he is 60, but he's been a lifelong runner. But he never touched a weight in his life. So he has very little muscle mass and this is a guy who we're actually saying, look, we're probably going to need you to run a little bit less.

S1

Speaker 1

35:13

You're running is amazing and you're very fortunate that you haven't been injured doing it. We want you to keep running as long as you can, but we also have to address some of these other issues because you do have some of the really common issues of runners. Some of the very common imbalances and things like that. So In his case, it was like, can we subtract a little bit of running time and start to get you doing strength training?

S2

Speaker 2

35:35

Yeah. It really is. People almost need to take just an inventory of what they're doing and where their strengths are. That's kind of where it's good to know Where is your VO2 max?

S2

Speaker 2

35:46

How does your DEXA scan look? You know, can you farm or carry? What percent of your weight? And if it's high and that piece is good, it's like, OK, keep training that, but then fill in those deficits.

S2

Speaker 2

35:57

What about, you know, so we kind of hinted that the 3 hours per week really is for the people who are time limited. What about different ages? Because we did get a lot of questions of, you know, I'm older, is it too late for me to start training for this? And if the answer is no, how should I think about that?

S2

Speaker 2

36:19

Because I'm not as young, I can't quite bounce back, I'm not as strong as when I'm younger. You know, they might be coming into this with not as much strength. And so when you have a patient like that, do you think about how they should tackle this differently? Are they on kind of a different program than if someone was 30?

S2

Speaker 2

36:39

How do you think about that from an age perspective?

S1

Speaker 1

36:42

I mean, everybody's different and age is definitely 1 of the factors that calls for nuance around programming. But I'll say this, and I think I've talked about this on a previous podcast, I don't recall which 1. There was a study that was done in Australia that I think we talked about on 1 of our podcasts actually where an investigator took a group of women with osteopenia or osteoporosis.

S1

Speaker 1

37:10

These women had very low bone density. They'd never exercised in their life. They were, if I'm not mistaken, no 1 was younger than in their mid-60s. They were probably in their 70s.

S1

Speaker 1

37:22

And these women were put on a pumping iron regimen. I mean, literally, old school, in a gym, picking up weights, walking around. This wasn't like some fancy posh Pilates class. This was like pick up weights.

S1

Speaker 1

37:40

I think by the end of this study, 1 of the women may even got to the point where she was dead lifting her body weight. Imagine that, 120 pound woman picking up 120 pounds off the ground. So while that was a great example because it was documented in a clinical trial, there are so many stories of these things that you just see that I just have to believe that people are far more resilient than they can imagine. I write about 1 example of this in the case of Barry.

S1

Speaker 1

38:10

Barry is someone who gets mentioned in I think it's in the stability chapter actually. Here's a guy who traded his health for wealth, right? Which is a pretty standard refrain. And then retired and had all the money in the world and realized, wait a minute, I can't do anything.

S1

Speaker 1

38:28

My body hurts so much. And If you look at Barry today, I mean, the guy's functioning better than he was 20 years ago. So I think it really just comes down to being consistent and having a real sense of purpose around this stuff. Obviously, you have to be smart about it.

S1

Speaker 1

38:47

I mean, you can injure yourself in the process of these things. So having someone who knows how to guide that and using common sense is essential. But I would never want anybody to come away from this thinking, I'm too old to do anything about it. I think as long as you're breathing, you have a chance to do something about it.

S2

Speaker 2

39:08

Yeah. And on that front, you kind of mentioned osteopenia, osteoporosis. We did get a lot of other questions too outside of age, which is, is there anything female-specific that they should be thinking about as it relates to centenarian decathlon? And I know dexascan, in addition to the muscle, it can also give bone mineral density, which is very important as we age.

S2

Speaker 2

39:30

So maybe do you want to talk a second about BMD and then also why that's something that maybe females specifically should be paying attention to thinking about and then ultimately how that leads to how they should be training.

S1

Speaker 1

39:44

Yeah. Bone mineral density is very important for both sexes, but women are at a greater risk. And the reason for that is, the way bones work and I'm oversimplifying a little bit, but you know, bones effectively have strain gauges in them and they respond to tensile stress. So when a muscle is contracting, the muscle via the tendon is attached to the bone and as the muscle contracts, the bone is compressing.

S1

Speaker 1

40:17

So imagine a strain gauge inside the bone that senses that. Well, that's a mechanical signal. That gets converted into a chemical signal. So mechanical to chemical via estrogen.

S1

Speaker 1

40:33

Estrogen is the hormone that does the signal transduction. And that tells osteoblasts and osteoclasts, which are the bone building, bone reabsorbing cells, to make the bone stronger, not weaker. So in other words, the use it or lose it philosophy is at play here. And estrogen is the key link.

S1

Speaker 1

40:55

Now men and women have estrogen and it's very important for both sexes. The difference is women lose estrogen precipitously in midlife. And therefore, women are more at risk for osteopenia and osteoporosis. Now for men and women alike, it's very difficult to add bone density after you reach the critical period of maturation, typically in the early 20s.

S1

Speaker 1

41:24

So unfortunately, most of our audience is past that point, right? I'm not sitting here having a discussion with teenagers. But of course, if I am, the answer is load bearing, load bearing, load bearing. Reach your genetic potential while you have a chance.

S1

Speaker 1

41:41

But for those of us who are past that point, the key is, how much can you slow the rate of decline? And nothing is more important for that than load bearing activity. And in fact, it needs to be heavy load bearing activity. Walking does not count as load bearing activity.

S1

Speaker 1

41:57

Running certainly better than swimming or cycling where you're not bearing load, but none of those compared to strength training. Strength training is really the most important piece of maintaining bone mineral density, and it must be supported from an endocrine perspective with the appropriate amount of estrogen and potentially testosterone, and certainly with the correct nutrition and supplementation such as vitamin D and the right amount of protein and things like

S2

Speaker 2

42:23

that. And 1 of the other questions we received is people were saying, hey, what if you can't afford a trainer, maybe don't have a gym to go to, how much of this can you do kind of without fancy equipment, maybe with body weight? How do you think about that in terms of as people are wanting to train for this?

S1

Speaker 1

42:47

You can definitely do quite a bit of stuff with body weight, but I would also encourage people to say, like, if I don't have a lot of room, can I at least get some dumbbells and kettlebells? And, you know, they do make these dumbbells. They're not cheap, but they're efficient and they're cheaper than buying all the sets where as you know, 1 dumbbell has multiple links in it.

S1

Speaker 1

43:06

So it could be, you know, 70 pounds, 60 pounds, 50 pounds, et cetera, depending on where you click it. So I feel like if you're going to think about, okay, what's the, What's the most efficient way to do this? I would say you do want to splurge on a few pieces of equipment and certainly heavy enough dumbbells that you can get into carrying would be important. I think resistance bands are also really important.

S1

Speaker 1

43:31

I've had a couple periods in my life where I haven't had access to a gym for, you know, 3 or 4 weeks. And during those periods of time, traveling with heavy resistance bands, was, was essential. And if I could have added to that, having some dumbbells makes a big difference. So yeah, it's, it's definitely easier if you have access to a gym or you can go to a gym, like a TRX is probably another really great piece of device for people who don't know what that is.

S1

Speaker 1

43:57

That's kind of this strap device that you either hang around a rack or something, or you can even put it behind a door. You just make sure the door is, you're on the right side of the door, so the door can't open. And you can do a lot of exercises with that as well.

S2

Speaker 2

44:13

And What about injury? So you kind of mentioned there earlier, you know, just being conscious of if you're starting out just to not get injured. How should people think about this if they're either coming into it with previous injuries, if they're worried about injury, especially in the older population, is that where the stability work can be much more effective?

S2

Speaker 2

44:38

Is it if you haven't lifted much weight, start lower and work on positioning and how the movement works? How should people think about the injury piece?

S1

Speaker 1

44:48

You know, this is something where I think you just have to be careful and I don't think it would be reasonable for me to represent that I can offer an answer that would cover that in a broad way. For example, we did a podcast with Alton Baron looking at injuries of the shoulder, neck, elbow, hand. Was that like a six-hour podcast?

S1

Speaker 1

45:08

It

S2

Speaker 2

45:08

was very long.

S1

Speaker 1

45:09

It was definitely 1 of our 3 longest podcasts, up with maybe Tom Dayspring and Matt Walker. That didn't even really get into the rehabilitation. That just talked about like what's at the root of it.

S1

Speaker 1

45:21

I've certainly done a number of videos with Kyler Brown where we've gone over some of my rehab foot post shoulder surgery. I think The truth of it is you're just, unfortunately, I hate to say this, it sounds like, but you've got to be able to align with people who understand how to not paint by numbers in their approach to rehabilitation. Maybe 1 way to help screen for that is basically when you meet a practitioner, just spending some time talking to them about their philosophy around your particular injury, right? So how, you know, for example, before I had my shoulder surgery, I wanted to understand all the details of early versus late mobilization.

S1

Speaker 1

46:07

Range of motion, the trade-off between range of motion and stability. These are trade-offs when you're repairing a joint as flexible as the shoulder. You can make it really stable again if you're willing to give up all range of motion and vice versa. I hate to say it, but I think you just have to become a more involved consumer of your care in that regard.

S1

Speaker 1

46:29

But Unfortunately, I just can't offer some blanket piece of advice around injury.

S2

Speaker 2

46:34

Is there but for the most part, even if someone is dealing with an injury, you would highly encourage them to not let them just give up on working out because of that injury?

S1

Speaker 1

46:45

No. I mean, if anything, that should be motivation to get better. I mean, injuries, it depends where you are in your life cycle, right? But for most people who I think are listening to us right now, if you have a nagging injury and you take the approach of, I'm just going to sort of ignore it and it's not necessarily getting better, you're on a very slippery slope.

S1

Speaker 1

47:11

I know someone very well who's had a shoulder injury for the last 6 months and it's not getting better. It's clearly not getting better, but more importantly, she's beginning to atrophy around it. She's becoming so weak and her pain is so significant around it that she's altered all of her movement patterns in response to this. She's younger than I am.

S1

Speaker 1

47:35

I sort of had a heart to heart with her recently and said, what do you think the natural history of this is? Like, do you just think this is magically going to get better when you're 70? No chance. You need to do X, Y, and Z right now.

S1

Speaker 1

47:49

And yeah, that means you're going to have to invest like at least 3 hours a week in doing this kind of rehab to see if you can get this better without surgery. And maybe it will require surgery. I don't think it will actually in this particular case, but it's, you know, the alternative is worse.

S2

Speaker 2

48:07

Yeah. And let's touch on VO2 max again. So a lot of people reached out and said, how should I train for VO2 max?

S1

Speaker 1

48:15

So If you take away the only 3 hours a week to do everything, if it's someone saying, okay, my muscle mass is good, but my VO2 max sucks, what program should I get on? The first thing to remember is you've got to be spending if you're really committed to developing your cardiorespiratory fitness. I think I talked about this on 1 of the podcasts, maybe it was on Tim's podcast.

S1

Speaker 1

48:39

You're trying to maximize the area of a triangle, right? So the triangle has a base and the triangle has a peak. The goal is how big an area can I get? Not how wide, not how tall.

S1

Speaker 1

48:51

You don't want 1 that's this wide and this tall, and you don't want 1 that's this tall and this wide. You want the max. The base is your zone 2. The peak is your VO2 max.

S1

Speaker 1

49:02

From a training perspective, the rule of thumb that is applicable for people like us, i.e. Normal people and the best athletes in the world, is roughly 80-20. 80% of your volume is down here, 20% of your volume is up here. In fact, some of the really, really elites are probably closer to 90, 10.

S2

Speaker 2

49:24

You're saying no matter if you're just an ordinary athlete or you're the best of the best, it's still roughly the same.

S1

Speaker 1

49:32

Taddei Bogachev, who's the greatest cyclist on this planet, two-time winner of the Tour de France, absolutely mopping up the field of cyclists like their children. That guy is doing 80% to 90% of his training at zone 2. I know that for a red fact because we know who his coach is.

S2

Speaker 2

49:52

Then let's maybe talk about that pyramid. Maybe let's just step back and say I

S1

Speaker 1

49:55

didn't answer your question by the way about VO2max which we can come to. Yeah.

S2

Speaker 2

49:59

Maybe I was just going to say, maybe let's just cover the whole pyramid. What's the training of the whole pyramid? If you know it's 80%, 20%, let's break out what

S1

Speaker 1

50:06

that looks like. I just start with how much time am I willing to put into this? Now, I got to be honest with you, I wish I could be putting 10 hours a week into cardio.

S1

Speaker 1

50:13

I do. Historically, I've put in 14 to 20 hours a week into cardio up until 10 years ago. I really miss those days. I miss being insanely fit.

S1

Speaker 1

50:27

I miss that terribly and I miss the joy of that much training. It's simply not possible today. For all of the obligations that I have and there's I've done the math 10 ways to Sunday. I'd have to give up something I'm not willing to give up.

S1

Speaker 1

50:43

I've got to give up archery or give up driving or give up my kids or something like that. I'm not willing to give any of these things up. I basically start with what's the most amount of time I can put into dedicated cardio. For me, it's like 4 to 5 hours a week, not including rucking.

S1

Speaker 1

50:59

I keep that in its own bucket. Then it's a very simple calculation. 80% of that time is zone 2 and 20% of that time is VO2 max.

S2

Speaker 2

51:09

How are you breaking out? Let's just start with zone 2. How many

S1

Speaker 1

51:13

I divide it into 4 workouts a week. So 4 Tuesday, Thursday, Saturday, Sunday.

S2

Speaker 2

51:19

Do you always recommend doing it over? Let's say you could do 4 hours in 1 day. Is there the same benefit of doing all your zone 2 in 1 day versus spreading it out?

S1

Speaker 1

51:32

No, I think I've talked about this with Inigo. His view is if you can get at least 30 to 45 minutes, you should spread them out. Again, if you're only able to commit an hour to it, it might be 1 hour once or 30 minutes twice.

S1

Speaker 1

51:47

But I'm doing 45 minutes to 60 minutes each time is what I do.

S2

Speaker 2

51:57

Are you doing zone 2 VO2 max on the same day?

S1

Speaker 1

52:01

1 of those days. Tuesday, Thursday is just zone 2. Then 2 long sessions of stability training.

S1

Speaker 1

52:13

So it's like, call it an hour of zone 2, an hour of stability. Actually, why don't I just walk you through the whole week? That'll be easier. Monday is just strength training.

S1

Speaker 1

52:21

That's about 90 minutes to 2 hours when you include the stability training that I do as well. Movement prep, stability training, strength training, and that's all lower body. That's Monday. Tuesday is zone 2, followed by dedicated hour of stability.

S1

Speaker 1

52:38

Wednesday is upper body strength and stability. Again, 90 minutes to 2 hours. Thursday is a repeat of Tuesday. Friday is a repeat of Monday.

S1

Speaker 1

52:52

Saturday is zone 2 in the morning, upper body strength repeat of Wednesday in the afternoon. Sunday is zone 2 followed by VO2 max.

S2

Speaker 2

53:07

And will you ever do VO2 max before you do zone 2?

S1

Speaker 1

53:14

I generally don't just because I like to have a lot of reps before I go for broke. So even when I was like a cyclist and doing 2 zone VO2 max workouts a week, they were always preceded by a long, the metric we would use, on a bike was kilojoules. So it was how many kilojoules of work would you do before you would do the super hard sets and it had to be at least a thousand kilojoules, which is translate to at least a thousand calories of work.

S2

Speaker 2

53:45

And for zone 2, I know you said you like to break it up. If someone is like, hey, I can do 4 days a week of zone 2, but I can only do 15 minutes a day, would you say Then

S1

Speaker 1

53:59

I'd compress it. I would say do 2 30s.

S2

Speaker 2

54:02

In your zone 2 sessions, you like to do at least

S1

Speaker 1

54:05

30? At a minimum, yeah.

S2

Speaker 2

54:09

Now, when you're in those zone twos, are you like when you hit the bike and the clock starts? No,

S1

Speaker 1

54:15

I take 10 minutes. I do it all night on a bike, sometimes on a treadmill. But what I do is there's a, like a little, it's a, it's, it's the, the computer is programming to the Wahoo kicker, which is the device I'm sitting on.

S1

Speaker 1

54:29

So it's, It's taking 10 minutes to ramp me up.

S2

Speaker 2

54:33

Maybe just walk through what modalities can people do zone 2 on? Treadmill, bike?

S1

Speaker 1

54:39

Anything that is steady state. Swimming is a great way to do it because you can really swim in a pool at a steady state. Running is a great way to

S2

Speaker 2

54:49

do it because you can really swim in a

S1

Speaker 1

54:49

pool at a steady state. Running is a great way to do it because you can pretty much run at a steady state. Cycling outdoors is generally hard unless you have specific Fiesta Island was a great place to train.

S1

Speaker 1

55:00

I used to train at Fiesta Island because for people who don't know where that is in San Diego, it's where all the time trial bike races were. It's just a 7 kilometer loop that you can ride on without lights or any there's no traffic or anything that gets in your way. For the most part, I wouldn't be able to do zone 2 outside here in Austin. It's too hilly and there's too much traffic and it just fits and starts.

S1

Speaker 1

55:26

I can do my VO2 max here because I go to a hill and that's My favorite way to do VO2 max is on a hill that's about a mile long and just do very hard up the hill and then easy down the hill. But a treadmill is another great way to do it. Just kind of a walking incline typically. Rowing machine, if you're really a good rower,

S2

Speaker 2

55:49

you have

S1

Speaker 1

55:49

to be efficient enough. Most people are not efficient enough and they just, they don't have the strength. They don't have the stability to row really well for 45 minutes.

S1

Speaker 1

56:00

Stair climber is another really good 1. But it depends. Again, if you're starting out, brisk walking is probably good enough too.

S2

Speaker 2

56:12

Yeah, and we don't have to get into all the reasons or the benefits of zone 2 because we have so many podcasts with In You Go, San Milan, people can listen to. You kind of hinted at another thing there, which is when you start your zone 2 workouts, you'll ramp up. Also, a lot of times we get questions where, hey, I did a 90-minute workout and I was in zone 2 for 45 minutes of it.

S2

Speaker 2

56:36

Is that, am I good?

S1

Speaker 1

56:38

No. I mean, what I think what you mean in that question is, you know, like I went out for a 3 hour bike ride today. And, when I got back, my computer told me I was in, I did 44 minutes of zone 2. So 2 issues there.

S1

Speaker 1

56:51

1 is that's just a zone 2 based on heart rate. That's generally the worst approximation of zone 2. So zone 2 really is more based on lactate if we're going to be purely accurate or at a minimum RPE. But even if you posit that that 45 minutes of zone 2 from your heart rate is roughly accurate, it's not the same physiologically because usually you're passing in and out of zone 2 in that situation.

S1

Speaker 1

57:15

And so you're not getting kind of that constant steady state churn, which you're looking for. What we're really kind of looking for is the harnessing of mitochondrial efficiency. And to do that, you just, you have to be able to push oxidative phosphorylation right to its limit before you trip into glycolysis. And you're just, you're at the limit of that glycolysis being the dominant energy source.

S1

Speaker 1

57:40

Whereas if you're on that ride, you're going into and out of glycolysis constantly. So it's not that you're so much in zone 2 for 45 minutes as that you passed through zone 2 for a sum total of 45 minutes, which again, there's still value in that, but not for what we're talking about.

S2

Speaker 2

57:56

Yeah. And what about VO2 max? What modalities can you do VO2 max training on?

S1

Speaker 1

58:02

You know, Here I think it's probably easier in a way, right? Because it's pretty much anything that gets your heart rate up and gets you very tired. Look, it could be an air bike.

S1

Speaker 1

58:16

It could be a regular bike. It could be a stationary bike, stair climber, treadmill, running outside, the sky's almost the limit. It's hard to do it on, it would be hard to do it. I'm trying to think, I mean, heck, you could probably do it with something like burpees is probably pretty tough once you get into something that intense like jumping because the sweet spot for VO2 max is kind of 3 to 8 minute intervals.

S1

Speaker 1

58:45

So you don't want to be doing things that are so intense that you can't do them for at least 3 minutes. And so that's why I'd kind of hold off on that stuff. I mean, when I was young and I was really fit, I did a lot of it with jumping, but like those, I mean, I can't jump for 3 minutes anymore. I don't have it's just I'm not that fit anymore.

S1

Speaker 1

59:08

I have to rely on easier things.

S2

Speaker 2

59:11

What's your current VO2 max workout? You mentioned kind of 3 to 8 minutes on. Is it

S1

Speaker 1

59:16

Typically, I do 4 on, 4 off is sort of where I spend most of my time. Sometimes 3 on, 3 off on a rowing machine. I got into that quite a bit last summer, but these days, and sometimes by the way, I just am in a bit of a rush and I'll just do 1 minute on, 2 minute off at a much higher intensity on the stair climber.

S1

Speaker 1

59:41

So I have 1 of those like industrial grade strength climbers and Sometimes I'll just go sprint for a minute up the stairs and then it takes me 2 minutes to get my heart rate back down to about a hundred and then repeat that for 20 to 30 minutes. So that's kind of like my poor man's cheating VO2max.