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What do you want to be doing in your later decades, and what is your plan for the rest of your life?
These are the two questions Dr Peter Attia asks all his patients.
The idea is twofold: to refocus their attention on their healthspan and to jolt them from the human tendency to choose immediate gratification over potential future gains, particularly when those gains take effort.
But then, as the Stanford-trained physician whose focus is the applied science of longevity says, many of us have witnessed the slow death of someone we love: alive but withered by illness in body, mind or both.
It doesn’t have to be like this, argues Attia in his new book, Outlive, which is currently number one on the New York Times non-fiction best-seller list. We have the potential to live longer and live better: to go to our deathbeds having lived fully to the end.
How we achieve that is the million-dollar question.
Of the various ways we can delay the deterioration of brain and body, many of which Attia explores in his book, he says the most potent longevity “drug” is exercise.
“I used to prioritise nutrition over everything else,” writes the 50-year-old father of three. But, he says: “The data are unambiguous: exercise not only delays actual death but also prevents both cognitive and physical decline, better than any other intervention.”
Exercise, however, and the guidelines of at least 30 minutes of moderate physical activity five days a week, are overly broad blanket terms, that annoy Attia.
Over a video call from his home in Austin, Texas, the doctor of Chris Hemsworth and Hugh Jackman clarifies that he does see merit in the physical activity guidelines, which only about 30 per cent of Australians meet.
“Going from zero exercise to about three hours per week probably [leads to] about a 40 to 50 per cent relative reduction in all cause mortality,” says Attia, who recently featured in the docuseries, Limitless. “And there’s a belief that you can get more compliance if you create the minimum standard as opposed to an optimal standard.”
He adds that if every one of us exercised for 30 minutes a day and maintained a healthy weight, we would be healthier and “probably add five years” to our life expectancy.
“But, I’m asking a question, which is what does [an extra] 10 to 15 years look like? And at an exceptionally higher quality of life. The metric for me is when I’m 80... I want to function like a healthy fit, 60-year-old.”
To function as a fit, healthy 60-year-old when we’re 80 and reach the limits of our health and lifespan, we have to break down “exercise” into its four most important parts, he argues: strength, stability, aerobic efficiency and peak aerobic capacity.
Strength
An 80-year-old man will have about 40 per cent less muscle mass than he had at 25, but what’s even more of a concern is that we lose muscle strength at about three times the rate we lose muscle mass.
Preventing these losses is vital for supporting and protecting our bodies as we age – helping us maintain function, stimulate bone growth and lower our risk of falling and becoming frail – but also for maintaining metabolic health.
On a practical level, if we want to be able to pick up and play with our grandchildren, carry shopping or travel and be able to lift our suitcase, for instance, we have to work on our strength now and account for the 8-17 per cent declines per decade. That means we need to be able to lift at least 25 kilograms comfortably today if we’re going to be able to comfortably pick up a 15-kilogram kid in the decades to come.
Stability
Strength, without stability, almost inevitably results in injury. Without stability, Attia says, “you are hosed”. But stability is not just strong core muscles. In fact, it begins with our breath. A calm breath can steady our nervous system and create mental equilibrium, and it has knock-on effects to our physical function too. “Poor or disordered breathing can affect our motor control and make us susceptible to injury,” Attia writes.
In real-world terms, he says, that means someone who is breathing poorly while shovelling in their garden, for instance, is putting themselves at increased risk of injury.
Breathing exercises, along with ones where we practice standing on one foot at a time, are crucial to balance, stability and our ability to move safely into older age.
Aerobic efficiency
Our aerobic fitness doesn’t just increase the likelihood of living an extra decade compared with someone who is sedentary, it enhances our ability to enjoy our lives, enabling us to walk, run, swim, hike, dance, travel, have sex, or go shopping – whatever our jam is.
Aerobic exercise also powers our mitochondria, the little cellular engines that burn glucose and fat to provide us with energy and are fundamental to our metabolic health. The best news is that healthy mitochondria are fostered by zone 2 training: that’s the type where we move at a moderate pace where we can still maintain a conversation, only for longer.
For someone with a low level of fitness that might mean two 30-minute sessions a week. For Attia, it involves four weekly one-hour-long sessions cruising on his bike while listening to an audiobook. “A side benefit of zone 2 is that it helps with cognition by increasing cerebral blood flow and by stimulating the production of BDNF, brain-derived neurotrophic factor,” he explains, noting that for this reason it is an important part of Alzheimer’s disease prevention.
VO2 Max
It’s the metric for our maximum rate of utilising oxygen and though we often hear of it relating to athletes, it’s relevant to all of us.
“VO2 max is astonishingly predictive of how long you live,” Attia says. According to one large study cited in the book, simply climbing from the least fit (bottom 25th percentile) to below-average fitness (the 50th percentile), as measured by Vo2 max, we nearly halve the risk of an early death.
“Increasing your Vo2 max by any amount is going to improve your life” Attia says, adding that the beauty is that we can always improve it through training.
Simply adding one or two VO2 max workouts a week when we push hard for several short (a few minutes at a time) bursts can help, though people starting out should consult their GP first.
Starting to add these pieces to the puzzle of our life can make a difference to whether we live the rest of our life in a way we might like, says Attia, whose book took nearly seven years to write.
“I think at the outset of this book, it was about a quest for immortality and I think at the end it is a quest for a better life.”
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