1: Question: “When was the last time your doctor tested your grip strength or asked you a detailed question about your strength training?” Dr. Peter Attia asks in his powerful book Outlive: The Science and Art of Longevity
Does our doctor know our VO2 max, the highest amount of oxygen we can use during intense exercise (a key measure of cardiovascular fitness)? Have they provided any training suggestions for how to improve it?
Peter’s guess? Precisely never.
Why? Because cardio, strength training, nutrition, and sleep are not considered part of “healthcare.”
“It’s only after we get injured or become so weak that we are in danger of losing our independence,” Peter notes, “that we are deemed eligible for physical therapy and rehabilitation.”
This approach to medicine is one of the key differences between Medicine 2.0 and an emerging new perspective called Medicine 3.0.
As a champion of Medicine 3.0, Peter sees all of these activities through the lens of longevity: How can we utilize them to “delay the onset of chronic disease and death, while simultaneously maintaining healthspan for as long as possible?”
2: So far, we’ve looked at maximum aerobic activity and endurance. Today, we turn our attention to strength training.
We begin losing muscle mass in our thirties. With each passing decade, we lose strength. “But both physical activity levels and muscle mass decline steeply after about age sixty-five,” Peter notes, “and than even more steeply after about seventy-five. It’s as if people just fall off a cliff sometime in their mid-seventies.”
What’s happening here? It turns out there are two types of muscle fibers. While “daily life and zone 2 endurance work may be enough to prevent atrophy of type 1 fibers,” he writes, “unless we are working safely against significant resistance, our type 2 muscle fibers will wither away.”
One important note: “The key word is safety,” he writes. Tomorrow, we will cover the details of why stability is so important.
We can exercise in such a way to “create the most force in the safest manner possible, connecting our body’s different muscle groups with much less risk of injury to our joints, our soft tissue, and especially our vulnerable spine,” Peter explains. “The goal is to be strong, fluid, flexible, and agile as you move through your world.”
3: Peter has four specific recommendations regarding strength training. Note: as we covered yesterday [hyperlink], our goal is not to have the biggest biceps in the gym.
“I focus on these four foundational elements of strength because they are the most relevant,” he observes, “to living a fulfilling and active life in our later decades.”
A: Grip strength: “Our grip is our primary point of contact in almost any physical task,” Peter writes. “from swinging a golf club to chopping wood; it is our interface with the world. If our grip is weak, then everything else is compromised.”
In practical terms, if we are strong enough to grab a railing or a branch and hold on, we may prevent a fall.
A large body of research links grip strength in midlife to a reduced risk of overall mortality. “The data,” he writes, “are as robust as for VO2 max and muscle mass.
“Many studies suggest that grip strength—literally, how hard you can squeeze something with one hand—predicts how long we are likely to live,” Peter explains, “while low grip strength in the elderly is considered to be a symptom of sarcopenia, age-related muscle atrophy.”
Training our grip strength is relatively straightforward: “One of my favorite ways to do it is the classic farmer’s carry, where we walk for a minute or so with a loaded hex bar or a dumbbell or kettlebell in each hand, he suggests. (Bonus points: Hold the kettlebell up vertically, keeping your wrist perfectly straight and elbow cocked at ninety degrees, as though you were carrying it through a crowded room.)
“The most important tip is to keep your shoulder blades down and back, not pulled up or hunched forward,” he explains.
What if we are new to strength training? We must start with light weights, even as low as ten to fifteen pounds.
Why? “In general, we urge our new patients to begin with far less weight than they have lifted in the past,” Peter suggests. “It is far more important to learn and practice ideal movement patterns than to be pounding heavy weights all the time.”
With time, we can add additional weight. “One of the standards we ask of our male patients is that they can carry half their body weight in each hand (so full body weight in total) for at least one minute, and for our female patients we push for 75 percent of that weight. This is, obviously, a lofty goal—please don’t try to do it on our next visit to the gym. Some of our patients need as much as a year of training before they can even attempt this test.”
Another exercise we can do to build our grip strength is to dead-hang from a pull-up bar for as long as possible. Peter emphasizes: “This is not an everyday exercise; rather, it’s a once-in-a-while test set.”
We simply grab the bar and hang. Peter writes: “Here we like to see men hang for at least two minutes and women for at least ninety seconds at the age of forty. (We reduce the goal slightly for each decade past forty.)”
B: “Eccentric strength: “Which provides us “the control we need when we are moving down an incline or walking down a set of stairs. It’s really important to keep us safe from falls and from orthopaedic injuries.”
As we get older, this is an area where many people falter. “Eccentric loading means loading the muscle as it is lengthening, such as when you lower a bicep curl,” he writes. “It’s more intuitive when lifting something to focus on the concentric phase, such as curling the dumbbell with our biceps.”
However, focusing on the eccentric phase is critical. Training for it is relatively easy: “It means focusing on the ‘down’ phase of lifts ranging from pull-ups or pull-downs to deadlifts to rows.”
“One of the tests we have our patients perform is stepping onto and off an eighteen-inch block and taking three full seconds to reach the ground (a forward step down, like descending a very tall step).
“The stepping up part is comparatively easy, but most people initially struggle with with a controlled three-second descent,” he observes. “That requires eccentric strength and control.”
What’s another way to train eccentric strength? Rucking, or carrying a weighted pack while walking downhill because it forces us to put on the “brakes.”
C: Pulling: “Pulling motions are how we exert our will on the world, whether we are hoisting a bag of groceries out of the car trunk or climbing El Capitan,” he writes. “It is an anchor movement. In the gym, it typically takes the form of rows, where you’re pulling the weight toward your body, or pull-ups.”
Working out on a rowing machine serves two purposes: Pulling and aerobic VO2 max training.
D: Hip-hinging movements: Such as the deadlifts, squats, step-ups, hip-thrusters, and countless single-leg variants of exercises that strengthen the legs, glutes, and lower back.”
Why are these types of exercises important?
“If we can pull, we can carry groceries and lift heavy objects. If we can do a hip-hinge correctly, we can get up out of a chair with no problem. We’re setting ourselves up to age well,” he says.
Remember, Peter recommends: “It’s not about how much weight we can deadlift now, but how well we will function in twenty or thirty or forty years.”
However, These types of exercise come with a warning: “Hip-hinging under high axial load, as with a heavy deadlift or squat, should be approached with care because of the risk of injury to the spine,” he writes. “This is why we have our patients work up to weighted hip-hinging very slowly, typically beginning with single-leg step-ups and split-stance Romanian deadlift, either without weights or with only very light weights held in the hands.”
Best to work with a trainer and/or seek out Peter’s exercise videos online.
But before we head to the gym to do some strength training, let’s take a few minutes to understand how we can train for what he calls: “The crucial and complex concept of stability.”
Which we will cover tomorrow!
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Reflection: How can I incorporate Dr. Attia’s four foundational strength exercises into my routine to enhance my longevity and maintain independence as I age?
Action: Start focusing on grip strength exercises, such as farmer’s carries and dead-hangs, and gradually incorporate eccentric strength, pulling motions, and hip-hinging movements into my workout regimen.
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