Exercise - Training For Longevity
Key Points:
Fitness is the best predictor for risk of dying
Fitness has three main components: Aerobic Fitness, Strength and Stability. All three are necessary to age well
The best way to improve your aerobic fitness is steady, moderate (Zone 2) activity. This is the bulk of training done by even the most elite athletes
Lifting weights isn’t a vain pursuit. It is necessary for well-rounded fitness
Fractures from a fall are a major cause of death as you age
I’ll start by changing the typical paradigm. I don’t advocate for “exercise.” I think that word has largely lost it’s meaning. Instead, I recommend focusing in on a specific idea: Training. And more specifically, Training for Longevity.
I’ve always been an active person. I played sports as a kid, through high school and at a high level in college. I have a moderate level of innate ability, to the point that I could stay competitive in the small athletic ponds I swam in. Fast forward a couple of decades (circa 2022): I have four young kids at home, lots of responsibilities, 12-hour shifts and a few more injuries under my belt. If I don’t make a plan for exercise it’s unlikely to happen. How do I maximize my time? How do I avoid injuries? How do I set goals?
Here I’ll put in another plug for Peter Attia - who has disseminated a huge amount of information on this subject:
Where do you start? Going back to the Goals/Objectives/Strategies/Tactics Frameworks, the first thing is to define what you are working towards. The truth is, there is not an upper limit of fitness. Conversely, there is such a thing as "overtraining,” and this can result in injury and ultimately stymie your fitness efforts. Here are some important questions:
Do you have nagging injuries that haven’t been addressed?
Physical therapy may be the right first stop, so the regimen you eventually adopt isn’t interrupted
Are there things you would like to do now, but can’t?
What are the physical goals on your centenarian decathlon?
Aerobic Fitness
Aerobic or cardiovascular fitness deals with how well your body can translate oxygen and nutrients to your heart and muscles to complete different activities. This process is necessary to do things like running a marathon, walking up a hill or flight of stairs or surviving an illness like pneumonia. The gold standard for measuring this is called VO2 max - which is a literal measure of how much oxygen your body is able to use. This test is completed similar to a stress test and formal testing is available in the high country. Most people will never undergo this type of testing, so here are some equivalencies. Your apple watch can also take a stab at where your level lies.
When I was in medical school we touched on the concept of VO2 max in pulmonary physiology, but I don’t recall it being addressed at any point after that first year. It’s unfortunate, because that number is the single best predictor of mortality: more than smoking or heart disease, cancer or kidney failure. While this number is partly innate, it can be improved with training - particularly Zone 2 training, which is a moderate intensity exercise that maximizes your body’s aerobic pathway.
VO2 max is typically measured in a sports physiology lab, but your apple watch can give you an estimate if it has enough data from your exercise
VO2 max is partly innate, but can be improved with targeted exercise
Resistance Training
I’ve never been a gym guy. As a kid I’d rather be in the woods chopping down trees for forts. As an adolescent and young adult I just wanted to play sports, not lift weights. I recently realized that I equated weightlifting with bodybuilding, a consequence of growing up in the heyday of Arnold Schwarzenegger. They are different. Strength and muscle mass are both strongly correlated with longevity. Some people have an innate ability to accrue muscle mass without targeted resistance training. Some people have very active jobs that allow them to steadily build strength and muscles. Most people need a dedicated regimen provide the necessary stimulus to build muscle and every person needs some training to ensure proper technique to avoid injury.
My introduction to resistance training started in 2023 with the surprising recommendation from an orthopedist colleague to give Crossfit a try. I have a lot of friends who’ve suffered serious injuries in that world and I never imagined myself at that type of gym. I’ll give the same advice I received: leave your ego at the door. Don’t try to keep up with anybody else. Start light and focus on your form. That advice has kept me relatively injury-free thus far. The crossfit-style model incorporates aerobic and strength training into an ~hour-long workout, with a “coach” present to guide your technique. The biggest downside with this type of workout is injury: lifting heavy weights when you are aerobically fatigued greatly increases your risk of injury - so tread lightly. While this still works for me in this season, I do anticipate I will phase into separate aerobic and resistance workouts in the future. At Valle Health I often recommend a course of physical therapy (PT) or work with a personal trainer to both address any pre-existing problems and get acquainted with the basic functional movements of resistance training: lifting, squatting, pressing.
What are the benefits of resistance training?
The foundational movements in resistance training are foundational movements for life:
Lifting and squatting: The same movement required to pick up a grandchild or your groceries
Overhead press: The same movement required to put your luggage in an overhead bin on a plane or train
Muscle mass improves your metabolic health, both being a reservoir for excess nutrition and feeding back other signals for growth and repair
Increased muscle mass provides stability to your joints and can improve both pain and loss of function associated with osteoarthritis or joint instability
Muscle mass will decline at a predictable rate starting in your 30’s and will accelerate - unless you take steps to stop or reverse the process. Contrary to the old paradigm, you can build muscle at any age. If you’re reading this as a young(er) person the smart goal is to build your muscle mass as early as possible, when the process is easier. If you’re starting this process later in life, today is the best time to start, but you’ll need to ramp up slowly to avoid injury.
At Valle Health we use Bioimpedance Analysis (Inbody) to establish a baseline of muscle mass and track the response to your exercise regimen. This is a simple and noninvasive way to give you objective data to guide your training.
Stability
Stability is your ability to move through the world in a controlled fashion. This is more important in the High Country than most locales. Uneven ground is hard to come by. You have to navigate hills and stairs - and trails if you want to enjoy all the beauty our area has to offer. Winter is long, and you just can’t avoid snow and ice all the time.
Training for stability pairs very well with the activities you’ll do for the first two facets: aerobic training and resistance training - and is honestly the foundation for doing the other facets safely.
Lifting weights safely requires stability. Running requires stability. Even walking requires stability - especially on uneven ground!
