Peter Attia protocol and fitness measurement

[XXtwindad]

Originally Posted by Likes2ridefar

Is yoga sufficient for strength training?

I’m in my 40s and have access to a gym but don’t go. I prefer yoga 4 or so days a week at home for 30 minutes and usually ride the same days as well (I ride at least an hour close to 7 days a week)

I find it easy to shed weight and add muscle mass still at 46 but have horrible flexibility and many aches and pains which are especially obvious if I stop yoga.

No. It's a great adjunct to a strength regimen, though.

If Attia's program could be summarized succinctly (and it really should be) it would be "have the strength to push yourself off the floor if you fall, the balance to prevent it, and the flexibility to avoid a lot of injuries."

So many of these gurus are about branding. The same with "The Longevity King." https://www.nytimes.com/2024/01/12/b...blueprint.html

You can buy his snake oil shakes and add years to your life!

Edit: This article just came into my inbox: https://www.nytimes.com/2024/01/04/w...5394951a47629a

Much more common sensical than Attia’s number-crunching word salad.

[MXLeader]

Originally Posted by Alan

Curious to hear others opinions on this and if you have a better way to measure fitness than FTP or VO2 max etc.

Originally Posted by XXtwindad

If Attia's program could be summarized succinctly (and it really should be) it would be "have the strength to push yourself off the floor if you fall, the balance to prevent it, and the flexibility to avoid a lot of injuries."

Attia somewhat awkwardly summarizes his program as preparing yourself for your own centurian decathalon; What are the 10 things you want to be able to do in your tenth decade? My goals are a work in progress but include…

- Remain living in my home without burdening others
- Remain prescription medication free
- Continue active volunteer work as a midcoast steward
- Travel comfortably while toting my own bags
- Cycle 90 kms on my 90th birthday with friends and family
- Ski with my great-grandkids
- Be near the top of erg rowers for 5000 meters for my age group
- Continue to ocean/lake kayak
- Continue hiking on trails that I’ve helped cut and maintain
- Actively maintain friendships/relationships and expand that circle

Sure, some are stretch goals but I think the list gets to the core of healthy aging. And the goals are just dreams unless there are objective steps that can be taken to achieve them. Lots of things can go wrong between now and then but without taking those steps now it is a pipedream.

Circling back to the importance of VO2 Max at the start of this thread, will I still be doing VO2 Max intervals on August 24th of 2050?

[Rabaja]

My 2 cents:
- Attia is not a guru or snake oil salesman. He mostly summarizes common sense and established science. Yes, he’s a little out there on a few things (e.g. rapamycin) but that is <10% of the book and he is open about his biases.
- He’s pretty level headed and a step above other popular audience longevity writers because he understands the scientific method, causal inference, basic statistics, etc. That cuts out a lot of the cra* that’s out there.
- There is nothing revolutionary here. It’s not even a “program”. It’s a fairly elementary set of prescriptions based on a reasonably comprehensive read of the scientific literature. The science is not settled on everything but the broad contours are pretty clear.
- My one paragraph summary of the book: keep your blood pressure below 120/80, LDL below 70 (check correlation with apoB), and BMI <25, take meds to meet these numbers if needed, use a CGM if you think your blood sugar is erratic, exercise regularly (it is the most powerful medicine by far) - mostly in Zone 2, lift heavy weights (particularly if you’re older), eat healthily (but don’t stress about it - eat mostly unprocessed food with enough protein and fiber and you will be fine), limit your drinking, make sure you get enough sleep, track your key metrics.
- None of this is controversial. It is mostly common sense. Of course the above is a simplification. He provides a lot more detail and explanation. But much of this is first year medical school stuff and if it is not he’s pretty open about it.
- Yes, he wants to sell subscriptions and the book is part of a marketing effort. So what. Read the book and don’t buy the subscription. Do the above and you will be ahead of 90+% of the population. Congratulations if you knew all of this. Most people don’t and the book is for them.
As always: YMMV.

[5oakterrace]

Originally Posted by Rabaja

My 2 cents:
- Attia is not a guru or snake oil salesman. He mostly summarizes common sense and established science. Yes, he’s a little out there on a few things (e.g. rapamycin) but that is <10% of the book and he is open about his biases.
- He’s pretty level headed and a step above other popular audience longevity writers because he understands the scientific method, causal inference, basic statistics, etc. That cuts out a lot of the cra* that’s out there.
- There is nothing revolutionary here. It’s not even a “program”. It’s a fairly elementary set of prescriptions based on a reasonably comprehensive read of the scientific literature. The science is not settled on everything but the broad contours are pretty clear.
- My one paragraph summary of the book: keep your blood pressure below 120/80, LDL below 70 (check correlation with apoB), and BMI <25, take meds to meet these numbers if needed, use a CGM if you think your blood sugar is erratic, exercise regularly (it is the most powerful medicine by far) - mostly in Zone 2, lift heavy weights (particularly if you’re older), eat healthily (but don’t stress about it - eat mostly unprocessed food with enough protein and fiber and you will be fine), limit your drinking, make sure you get enough sleep, track your key metrics.
- None of this is controversial. It is mostly common sense. Of course the above is a simplification. He provides a lot more detail and explanation. But much of this is first year medical school stuff and if it is not he’s pretty open about it.
- Yes, he wants to sell subscriptions and the book is part of a marketing effort. So what. Read the book and don’t buy the subscription. Do the above and you will be ahead of 90+% of the population. Congratulations if you knew all of this. Most people don’t and the book is for them.
As always: YMMV.

Excellent summary. I would add - deal with your emotional stuff such as anger, anxiety, depression. It will haunt you and affect you.

You suggest - do this and you are ahead of 90 percent of folks. I would offer you do the strength stuff, 4 zone 2s of 45 minutes a week, some HIITs, follow the sleep and food stuff - you are in the 1 percent. Drs. know better than I do - but how many folks do you know who are 80 and have any kind of physical pop and ginger. A lot die by then, most are hanging on, precious, precious few are that active.

That is why I wrote this is really a lifestyle change. My cynical side says very few people will make such a change. Too much for most. Those already active might ramp it up ( like some on this forum). Others might dabble with this, which will help and is better than nothing. And that is why we see so very few at 80 with lots of pop and ginger. We gravitate to easy and comfort. Take a pill. See Easter's book The Comfort Crisis. Great read and more accessible than Attia in that it does not have all the medical stuff.

[Rabaja]

Originally Posted by 5oakterrace

Excellent summary. I would add - deal with your emotional stuff such as anger, anxiety, depression. It will haunt you and affect you.

Fully agree. Should definitely add that to the summary.


*****


The primary value of Attia’s book imho is the summary of basic medial facts in an easily digestible format. He incorporates the findings of relevant research that modify some of established views in the field.

I give you two examples, one general and one particularly relevant for endurance athletes such as many on this board:

(1) Blood Pressure

While a blood pressure of 120/80 is universally regarded as the gold standard, it had long been assumed that medical intervention is only warranted above 130/90.

I’ve had a BP of around 127/85 for many years and my primary care doctors over the past 15 years all said “We got to watch your BP but you don’t need to take any meds” (there was little in terms of nutrition or lifestyle that I could have done better).

Attia reports the results of the 2015 SPRINT trial, a large randomized, controlled study comparing two strategies for treating hypertension (the study only looked at systolic BP). One group was held to a BP <140 (“standard” BP control), the other to <120 (“intensive” BP control). The study had to be terminated prematurely because the health outcomes (reduction in cardiovascular and all cause mortality in particular) were so much better for the “intensive” group that it was ethically not defensible to deny the “standard” group the benefits of more aggressive intervention.

Bottom line: 120/80 is not just the gold standard, you want to intervene (with lifestyle changes and, if needed, meds) if your BP is >120/80.

This was not some random study (many of which have issues), but a properly designed, large-N trial that - at least for me who is notoriously critical of the quality of medical research - established facts that let me to change my view re meds. I now take 5 mg Lisinopril and my BP is sitting nicely at 115/75.

This example is not about some esoteric micro-lever you could manipulate with some experimental drug. No, it is about one of the major drivers of negative health outcomes that can be easily addressed.

(2) Strength Training

I’ve been an endurance guy for most of my adult life and never considered weight lifting. Yes, I’ve done pilates and functional strength training regularly, but otherwise I focus on getting in miles on the bike and in the pool.

What made me change my mind about weight lifting is the following example Attia gives in one of his podcasts (episode #239):

His guest, a professor of kinesiology, reports a study of two identical twins: one is a couch potato who doesn’t exercise at all (and never has), the other an endurance junkie who has been competing in Ironmans for 35 years and documented every workout for 30 years.

As expected, the endurance junkie had much better V02 max, lipid profile, and blood pressure. But there was no difference between the two in terms of muscle mass, muscle quality (intramuscular lipid), or strength. In fact, on a number of metrics, the couch potato was stronger, a better jumper, with higher quality muscle.

This result made be consider weight lifting for the first time in my life. We all lose muscle mass with age and the rate of deterioration increases north of 50. I was just at that age and had noticed a significant loss in strength when going back to the gym for functional training after Covid.

The example suggested that high volume endurance exercise does nothing to slow down the loss of muscle mass and strength. And we all know that loss of strength is a key factor driving falls and injuries in old age, which can have dramatic effects on health outcomes.

So I started weight lifting with a trainer, 3x week. I’m a very slow gainer but after 3 months improvements in strength begun to kick in. I feel much better and, for the first time in years, I actually got faster on the bike.

Attia is a big proponent of weight lifting and imho it is worth reading that section of book to understand why.

These are just two examples. Both are on fundamental health drivers, not quack science. This is basic stuff and if you are not aware of it (I wasn’t) I think you could do worse than reading the book.

[NHAero]

Originally Posted by Rabaja

Fully agree. Should definitely add that to the summary.


*****


The primary value of Attia’s book imho is the summary of basic medial facts in an easily digestible format. He incorporates the findings of relevant research that modify some of established views in the field.

I give you two examples, one general and one particularly relevant for endurance athletes such as many on this board:

(1) Blood Pressure

While a blood pressure of 120/80 is universally regarded as the gold standard, it had long been assumed that medical intervention is only warranted above 130/90.

I’ve had a BP of around 127/85 for many years and my primary care doctors over the past 15 years all said “We got to watch your BP but you don’t need to take any meds” (there was little in terms of nutrition or lifestyle that I could have done better).

Attia reports the results of the 2015 SPRINT trial, a large randomized, controlled study comparing two strategies for treating hypertension (the study only looked at systolic BP). One group was held to a BP <140 (“standard” BP control), the other to <120 (“intensive” BP control). The study had to be terminated prematurely because the health outcomes (reduction in cardiovascular and all cause mortality in particular) were so much better for the “intensive” group that it was ethically not defensible to deny the “standard” group the benefits of more aggressive intervention.

Bottom line: 120/80 is not just the gold standard, you want to intervene (with lifestyle changes and, if needed, meds) if your BP is >120/80.

This was not some random study (many of which have issues), but a properly designed, large-N trial that - at least for me who is notoriously critical of the quality of medical research - established facts that let me to change my view re meds. I now take 5 mg Lisinopril and my BP is sitting nicely at 115/75.

This example is not about some esoteric micro-lever you could manipulate with some experimental drug. No, it is about one of the major drivers of negative health outcomes that can be easily addressed.

(2) Strength Training

I’ve been an endurance guy for most of my adult life and never considered weight lifting. Yes, I’ve done pilates and functional strength training regularly, but otherwise I focus on getting in miles on the bike and in the pool.

What made me change my mind about weight lifting is the following example Attia gives in one of his podcasts (episode #239):

His guest, a professor of kinesiology, reports a study of two identical twins: one is a couch potato who doesn’t exercise at all (and never has), the other an endurance junkie who has been competing in Ironmans for 35 years and documented every workout for 30 years.

As expected, the endurance junkie had much better V02 max, lipid profile, and blood pressure. But there was no difference between the two in terms of muscle mass, muscle quality (intramuscular lipid), or strength. In fact, on a number of metrics, the couch potato was stronger, a better jumper, with higher quality muscle.

This result made be consider weight lifting for the first time in my life. We all lose muscle mass with age and the rate of deterioration increases north of 50. I was just at that age and had noticed a significant loss in strength when going back to the gym for functional training after Covid.

The example suggested that high volume endurance exercise does nothing to slow down the loss of muscle mass and strength. And we all know that loss of strength is a key factor driving falls and injuries in old age, which can have dramatic effects on health outcomes.

So I started weight lifting with a trainer, 3x week. I’m a very slow gainer but after 3 months improvements in strength begun to kick in. I feel much better and, for the first time in years, I actually got faster on the bike.

Attia is a big proponent of weight lifting and imho it is worth reading that section of book to understand why.

These are just two examples. Both are on fundamental health drivers, not quack science. This is basic stuff and if you are not aware of it (I wasn’t) I think you could do worse than reading the book.

Thanks for all you've added to this discussion.
I know I need to start weight training (better late than never) because it's noticeably more effort at age 70 to lift my heavier bikes up onto the ceiling hooks. The NYT had an article this week about a sit-and-stand test for assessing power, and of course a cyclist, even an old slow one, can do well on that. If it used arms instead of legs I know I'd score more poorly.

I have a check-up with a new PCP next month and I will pay more attention to BP (I've been around 120/80 or so) and also ask for some other tests like ApoB. I don't take any meds now and would like to continue that, but I can be persuaded by data.

[5oakterrace]

Originally Posted by Rabaja

Fully agree. Should definitely add that to the summary.


*****


The primary value of Attia’s book imho is the summary of basic medial facts in an easily digestible format. He incorporates the findings of relevant research that modify some of established views in the field.

I give you two examples, one general and one particularly relevant for endurance athletes such as many on this board:

(1) Blood Pressure

While a blood pressure of 120/80 is universally regarded as the gold standard, it had long been assumed that medical intervention is only warranted above 130/90.

I’ve had a BP of around 127/85 for many years and my primary care doctors over the past 15 years all said “We got to watch your BP but you don’t need to take any meds” (there was little in terms of nutrition or lifestyle that I could have done better).

Attia reports the results of the 2015 SPRINT trial, a large randomized, controlled study comparing two strategies for treating hypertension (the study only looked at systolic BP). One group was held to a BP <140 (“standard” BP control), the other to <120 (“intensive” BP control). The study had to be terminated prematurely because the health outcomes (reduction in cardiovascular and all cause mortality in particular) were so much better for the “intensive” group that it was ethically not defensible to deny the “standard” group the benefits of more aggressive intervention.

Bottom line: 120/80 is not just the gold standard, you want to intervene (with lifestyle changes and, if needed, meds) if your BP is >120/80.

This was not some random study (many of which have issues), but a properly designed, large-N trial that - at least for me who is notoriously critical of the quality of medical research - established facts that let me to change my view re meds. I now take 5 mg Lisinopril and my BP is sitting nicely at 115/75.

This example is not about some esoteric micro-lever you could manipulate with some experimental drug. No, it is about one of the major drivers of negative health outcomes that can be easily addressed.

(2) Strength Training

I’ve been an endurance guy for most of my adult life and never considered weight lifting. Yes, I’ve done pilates and functional strength training regularly, but otherwise I focus on getting in miles on the bike and in the pool.

What made me change my mind about weight lifting is the following example Attia gives in one of his podcasts (episode #239):

His guest, a professor of kinesiology, reports a study of two identical twins: one is a couch potato who doesn’t exercise at all (and never has), the other an endurance junkie who has been competing in Ironmans for 35 years and documented every workout for 30 years.

As expected, the endurance junkie had much better V02 max, lipid profile, and blood pressure. But there was no difference between the two in terms of muscle mass, muscle quality (intramuscular lipid), or strength. In fact, on a number of metrics, the couch potato was stronger, a better jumper, with higher quality muscle.

This result made be consider weight lifting for the first time in my life. We all lose muscle mass with age and the rate of deterioration increases north of 50. I was just at that age and had noticed a significant loss in strength when going back to the gym for functional training after Covid.

The example suggested that high volume endurance exercise does nothing to slow down the loss of muscle mass and strength. And we all know that loss of strength is a key factor driving falls and injuries in old age, which can have dramatic effects on health outcomes.

So I started weight lifting with a trainer, 3x week. I’m a very slow gainer but after 3 months improvements in strength begun to kick in. I feel much better and, for the first time in years, I actually got faster on the bike.

Attia is a big proponent of weight lifting and imho it is worth reading that section of book to understand why.

These are just two examples. Both are on fundamental health drivers, not quack science. This is basic stuff and if you are not aware of it (I wasn’t) I think you could do worse than reading the book.

On this strength training. I was a rower for eons, concept 2 erg, chop wood, outdoor painting yada yada. Reasonably strong. Last winter, age 67, I carry 2 bags of wood pellets up the stairs from the basement for the wood stove. We heat this way and go through hundreds of bags. One bag in each hand. This fall - it was an effort to carry one bag with two arms. After 6 weeks I am back to 2 bags again. The POINT - I lost strength real quick from last spring to this past fall. 2nd year I have gone through this.

Cyclists often take a few months "off" after the season. Easy stuff. After age 60 I cannot take anything "off." I lost it too quickly, especially strength. Hence, this is why Attia points to falling as a big risk. 50 percent of folks die in a year after they fall (I am guessing they must be in their 70a or 80s). Fall and what happens - sedentary recovery and you are in trouble. Cannot stop training.

[reuben]

Originally Posted by Rabaja

- My one paragraph summary of the book: keep your blood pressure below 120/80, LDL below 70 (check correlation with apoB)

I'll just add that it's possible to go too low. Years ago, in the 1980s, I was a triathlete. To make a long story short I ended up in the hospital, where they discovered a few things, one of which was that my total cholesterol was 110. I don't remember the HDL/LDL numbers, but they were so low that my doctor told me that I actually needed more of the bad kind (can never remember which it is), ordered me to eat a Big Mac every day, and return every Monday for a blood test (my iron was also very low, and probably a few other things were out of whack as well).

[PurpleBikeChick]

I have come to appreciate his work. Two takeaways new to me from Peter Attia were the need for:

1) strength training - short term goal- will the Farmers carry help me fix a flat? I'm up 80% in my carry so when someone in my (women's) group has the next flat it's mine we have trouble with taking tires off/on. Long term goal - to be able to lift my e-bike onto the car rack in my terminal decade.

2) Stability - balance declines with aging. Time for exercise is limited so am just doing many activities of daily living on one foot.

I turn to his podcasts when exercising indoors (now often with a weighted backpack doing Zone 2 on the treadmill thanks to him)

[reuben]

Originally Posted by PurpleBikeChick

I have come to appreciate his work. Two takeaways new to me from Peter Attia were the need for:

1) strength training - short term goal- will the Farmers carry help me fix a flat? I'm up 80% in my carry so when someone in my (women's) group has the next flat it's mine we have trouble with taking tires off/on. Long term goal - to be able to lift my e-bike onto the car rack in my terminal decade.

2) Stability - balance declines with aging. Time for exercise is limited so am just doing many activities of daily living on one foot.

I turn to his podcasts when exercising indoors (now often with a weighted backpack doing Zone 2 on the treadmill thanks to him)

Soul sister. I'm absolutely tuned into this. I retired last year, and, not unexpectedly, I ain't what I used to be. Nothing can be totally discounted, but to me my creeping loss of strength and balance are the most notable. Moreso than my VO2max (I have no idea what it is), FTP (not sure what the acronym stands for) and that sort of stuff.

I'm incorporating more bodyweight exercises for strength, but dumbells and the like aren't completely out of the picture. Various balance widgets are in play, but just a simple one legged bent over whatever-it's-called is a good test, or just the ability to balance on one foot for 30-60 seconds.

I like simple things, and that includes my exercise equipment and routines.

Now that hunting season is almost over it's time to resume my day hikes in the local woods. I love the up and down, the birds, the turtles, the snakes, the mud, the heat, the cold, the roots and rocks. I call them my "mental health hikes", but they surely have physical benefits as well - like, um, balance. And they make me feel SO much better, not just during and immediately after, but throughout the rest of the day as well. Two hours, eight hours... it's all good.

And the multiweek backpacking trips are once again more firmly in focus. My last trip, which was far too long ago, was about four weeks long. New areas on my list are Yendegaia, Los Dientes, and the Darwin Range - basically "The Uttermost Part of the Earth", per E. Lucas Bridges' famous book. And the JOGT and up into the Orkney Islands in the land of my maternal ancestors...

It's been over 5 years since my last trip to Patagonia, and I've never yet been to Scotland, or Mongolia, "Land of the Eternal Blue Sky"...

And Yin Yoga. This isn't like the yin yoga you'll commonly find in studios. It's great for slowly (months) lengthening ligaments, tendons, and fascia. In more popular yang yoga poses/asanas are held for about 30 seconds. In yin yoga they're held for 2-10 minutes. I find this to be really, really beneficial.

Edit for typo:

Originally Posted by reuben

And Yin Yoga. This isn't like the yang yoga

[XXtwindad]

Originally Posted by PurpleBikeChick

I have come to appreciate his work. Two takeaways new to me from Peter Attia were the need for:

1) strength training - short term goal- will the Farmers carry help me fix a flat? I'm up 80% in my carry so when someone in my (women's) group has the next flat it's mine we have trouble with taking tires off/on. Long term goal - to be able to lift my e-bike onto the car rack in my terminal decade.

2) Stability - balance declines with aging. Time for exercise is limited so am just doing many activities of daily living on one foot.

I turn to his podcasts when exercising indoors (now often with a weighted backpack doing Zone 2 on the treadmill thanks to him)

Absolutely agree with this. See post #31.

The two things that are imperative as you age. You’d better be able to pick your butt off the floor as you fall and minimize your chances of doing it.

I do 100 body weight push-ups 5X per week. As for the balance, a fun exercise is to get a rubber physioball (or tennis ball) and lift one knee up, thread the ball under and catch it off the wall. Great proprioception exercise. I do a set of 50 each side with clients.

Some books to read as ad adjunct (or in lieu of) the OP’s post: “Exercised” and “The Story of the Human Body” by Daniel Lieberman and “Why Zebras Don’t Get Ulcers,” by Robert Sapolsky.

[XXtwindad]

Originally Posted by reuben

Soul sister. I'm absolutely tuned into this. I retired last year, and, not unexpectedly, I ain't what I used to be. Nothing can be totally discounted, but to me my creeping loss of strength and balance are the most notable. Moreso than my VO2max (I have no idea what it is), FTP (not sure what the acronym stands for) and that sort of stuff.

I'm incorporating more bodyweight exercises for strength, but dumbells and the like aren't completely out of the picture. Various balance widgets are in play, but just a simple one legged bent over whatever-it's-called is a good test, or just the ability to balance on one foot for 30-60 seconds.

I like simple things, and that includes my exercise equipment and routines.

Now that hunting season is almost over it's time to resume my day hikes in the local woods. I love the up and down, the birds, the turtles, the snakes, the mud, the heat, the cold, the roots and rocks. I call them my "mental health hikes", but they surely have physical benefits as well - like, um, balance. And they make me feel SO much better, not just during and immediately after, but throughout the rest of the day as well. Two hours, eight hours... it's all good.

And the multiweek backpacking trips are once again more firmly in focus. My last trip, which was far too long ago, was about four weeks long. New areas on my list are Yendegaia, Los Dientes, and the Darwin Range - basically "The Uttermost Part of the Earth", per E. Lucas Bridges' famous book. And the JOGT and up into the Orkney Islands in the land of my maternal ancestors...

It's been over 5 years since my last trip to Patagonia, and I've never yet been to Scotland, or Mongolia, "Land of the Eternal Blue Sky"...

And Yin Yoga. This isn't like the yin yoga you'll commonly find in studios. It's great for slowly (months) lengthening ligaments, tendons, and fascia. In more popular yang yoga poses/asanas are held for about 30 seconds. In yin yoga they're held for 2-10 minutes. I find this to be really, really beneficial.

The Scottish Highlands are magical. Can’t wait to go back.

[Rabaja]

This is a very interesting and helpful discussion.

Originally Posted by NHAero

I have a check-up with a new PCP next month and I will … ask for some other tests like ApoB.

Attia favors ApoB over LDL because: (a) it is the protein wrapper rather than the amount of cholesterol it carries that creates plaque risk; (b) there are lipids other than LDL whose wrappers likewise create plaque risk (notably VLDL). This is a sound argument in principle.

I ran this by my PCP who has the kind of preventative mindset that Attia advocates. He replied that his colleagues in the cardiology department (one of the best in the world and a place Attia knows well) don’t use ApoB in most cases since (a) it is highly correlated with LDL, and (b) for the vast majority of patients, even if there is a divergence, doesn’t change the recommended course of action. In other words, it matters in theory but not in practice.

This is a good example to take everything you read with a grain of salt. I really like Attia’s book and find it very useful. But it doesn’t mean that everything he says is the last word. Imho the best way to use the book is as preparation for having an informed conversation with your health care provider. I had that conversation with my PCP, he ordered the ApoB test, we saw that it is highly correlated with my LDL score, and we moved on.

Originally Posted by 5oakterrace

Cyclists often take a few months "off" after the season. Easy stuff. After age 60 I cannot take anything "off."

Same here and I am 10 years younger than you. If I take two weeks off things start to fall apart. Three weeks and I have to dig myself out of a hole.

Originally Posted by 5oakterrace

[T]his is why Attia points to falling as a big risk. 50 percent of folks die in a year after they fall (I am guessing they must be in their 70a or 80s).

“If you are >65, and you fall and break your hip, there is a 30-40% chance you will be DEAD in 12 months.” (Peter Attia)

Originally Posted by reuben

I'll just add that it's possible to go too low. Years ago … I ended up in the hospital, where they discovered … that my total cholesterol was 110. I don't remember the HDL/LDL numbers, but they were so low that my doctor told me that I actually needed more of the bad kind.

Very interesting. My comment was in the spirit of Attia questioning the <100 threshold for LDL in the official guidelines (which a few years ago was lowered from <130). My PCP agrees with Attia and suggests <70 as target. This was in the context of someone who is above (i.e. doesn’t have a risk of going “too low”). If I look at my historical lipid data I see that LDL and HDL are negatively correlated. I.e. the lower LDL goes the higher HDL is, which provides some stability to total cholesterol.

[callmeishmael]

One reason why Attia and other use VO2 is that it's not cycling specific, and has been measured a lot in different populations.

One thing that Alan Couzens mentions is that those with a VO2 max >50 have a hugely reduced risk of all-cause mortality. Stay over that number and it's actually quite likely that your metabolic health will be very good.

The next thing he says is that it takes the average individual one hour of activity, per month, per year of age, to maintain such a number. In other words, by the time you're 70, that translates to not quite 2.5 hours a day. To clarify, activity can mean walking, gardening, even light housework etc as well as more intensive stuff, but you need to get up off your bum and move - a lot.

I have personal anecdotal evidence that this stuff works. My father - now 74 - fell on ice last winter and broke his hip. He was walking up and down the street within a week of hip replacement surgery, and jogging on the treadmill in 6 weeks. His surgeon was amazed at his recovery, but he has always walked miles and miles, jogged and swum once or twice a week, has never been overweight, eats well and drinks in moderation. I'm hoping to be in the same shape in due course!

It dawned on me a while ago that the best way to be in good shape at 70 is to be in good shape at 60. And the best way to be in good shape at 60 is... etc

[NHAero]

Originally Posted by Rabaja

Snip


(1) Blood Pressure

While a blood pressure of 120/80 is universally regarded as the gold standard, it had long been assumed that medical intervention is only warranted above 130/90.

I’ve had a BP of around 127/85 for many years and my primary care doctors over the past 15 years all said “We got to watch your BP but you don’t need to take any meds” (there was little in terms of nutrition or lifestyle that I could have done better).

Attia reports the results of the 2015 SPRINT trial, a large randomized, controlled study comparing two strategies for treating hypertension (the study only looked at systolic BP). One group was held to a BP <140 (“standard” BP control), the other to <120 (“intensive” BP control). The study had to be terminated prematurely because the health outcomes (reduction in cardiovascular and all cause mortality in particular) were so much better for the “intensive” group that it was ethically not defensible to deny the “standard” group the benefits of more aggressive intervention.

Bottom line: 120/80 is not just the gold standard, you want to intervene (with lifestyle changes and, if needed, meds) if your BP is >120/80.

This was not some random study (many of which have issues), but a properly designed, large-N trial that - at least for me who is notoriously critical of the quality of medical research - established facts that let me to change my view re meds. I now take 5 mg Lisinopril and my BP is sitting nicely at 115/75.

This example is not about some esoteric micro-lever you could manipulate with some experimental drug. No, it is about one of the major drivers of negative health outcomes that can be easily addressed.

I'm curious about what constitutes one's blood pressure. At the behest of my PCP, I've been tracking mine daily, usually with three successive measurements at 5 min intervals morning and afternoon. I take it while sitting at the desk working at the computer, after at least 5 minutes sitting down. It seems to me that this is +/- the lowest it might get (maybe lower when sleeping)? So when we speak about blood pressure, is it resting blood pressure, with the understanding that it's higher at other times of day?

Also - because (I think) peripheral capillaries expand during exercise, my BP is lower after a ride (not immediately but say within 1/2 hour). If I start taking BP meds, is there a chance that BP gets too low during/after exercise?

I'm using a machine that I think is measuring systolic a bit low, compared to my Doc's office measurement. So I add 7-8 to the systolic number. Over the past 5-1/2 weeks I've averaged 117/80, and if I add 7 to systolic that's 124/80.