Peter Attia protocol and fitness measurement

[Alan]

I have read his book which is good. See link below:
https://www.amazon.com/Outlive-Scien...ede125eba48e19

Book is worth reading. Of course I liked it as being a 5000 mi per year rider I am doing well vs the rest of his followers. I also watch his youtube videos as well as Dr Rhonda Patrick who Peter has had on some of his videos.

In a recent video https://www.youtube.com/watch?v=KpCkJs6DKCw he reinforced that VO2max is extremely important. Now that a lot of people are on computerized trainers most know their FTP and there are conversions from FTP to VO2 max. I did mine and I am in the close to 40 range for VO2 max which per Peter's chart is good for 60+ so no worries there. I do really question VO2 max as the best way to measure fitness. I have friends who have much higher FTPs than me but not sure they are really in better shape as their potential is higher.

I am not a PHD scientist but it seems to me that we should be comparing ourselves to our potential not others. I never was the greatest cyclist and never really raced as not fast enough but my endurance was always great. HRV may be a better way to measure fitness achievement vs potential but I haven't looked at mine though it is not hard to calc if you have the right device.

The other thing that Peter and Rhonda do is take the fun out of being in good shape. They focus rightfully on people who train just a few hours a week and that they need HIIT workouts.

I think I do better with 7-10 hours of riding with hills and intervals mixed into the workout. I ride because it is fun and I like riding w friends and being in good shape. Am sure that we are the exception as we have the time and motivation vs 99% of the rest of people who don't care.

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

Alan

Link to Dr Rhonda Patrick's video is below. I liker hers as well
https://www.youtube.com/watch?v=IxYdkMmtjBs

[prototoast]

Health and fitness are multidimensional attributes. Mr. Attia seems to be making the claim that if you can only look at a single dimension, VO2 max has the best predictive power of lifespan. I haven't read his book, or analyzed the data, but if I take his claim at face value, that seems plausible. VO2 max represents the body's competency at a core vital function, but it doesn't capture everything. Body mass is in the denominator of VO2 max, and just as has been observed ad nauseum for BMI, not all body mass is created equal.

Still, while there are and will be individuals who clearly are less or more "fit" than you might expect from their VO2 max alone, that doesn't necessarily undercut his claim that there isn't a better single-dimensional predictor of lifespan. It just means there is more to health than VO2 max.

[adub]

Ride 3-4x week with some maximal (vo2) efforts sprinkled in, lift weights 2x week, eat a healthy balanced diet.

It does not have to be complicated.

[meyatt]

A challenge is calculations are approximations. So, unless VO2 is measured in a lab, it's subject to some variability. Your FTP is also subject to a kind of variability, since it's also a calculation based on a test.

When I initially encountered Attia, I was pretty critical and thought he was another internet doctor snake oil salesman (that opinion encouraged me to read his book to see if it changed my mind), but I tend to agree with some of his takes more with time. VO2 does seem like a pretty strong indicator, but without the benefit of consistent lab testing, I think looking at several data points that are approximations (VO2, FTP, HRV, Critical Power, resting heart rate) etc. can give a good sense of where underlying fitness is trending — as prototoast said fitness is multidimensional.

I guess this is kind of the "Nate Silver" approach to fitness for mortals, where if I take the average of all these datapoints I can tend to see where they're going overall, vs relying to heavily on one.

I'm not sure we should even be comparing ourselves to our potential, this mental limitation stops people at times from putting in their best work and then being able to actually analyze what their real potential was in retrospect. Some people clearly have a greater genetic gift or natural aptitude, but you never know where you're going to get with time and consistency.

Conceptually, I think there's a lot of smart takeaways from his book about how we should be thinking measuring the value of our twilight years, and what we can do earlier in life to improve them. This year I've committed a lot more time to Z2 training (partly because of a 1300 mile race in July, it's just a requirement), and I'll be interested six months from now what it feels like having invested that time vs constantly hitting intervals all the time because I find them to be more "fun". I'm going to do a before and after VO2 test so it'll be interesting to compare.

[XXtwindad]

Originally Posted by Alan

I have read his book which is good. See link below:
https://www.amazon.com/Outlive-Scien...ede125eba48e19

Book is worth reading. Of course I liked it as being a 5000 mi per year rider I am doing well vs the rest of his followers. I also watch his youtube videos as well as Dr Rhonda Patrick who Peter has had on some of his videos.

In a recent video https://www.youtube.com/watch?v=KpCkJs6DKCw he reinforced that VO2max is extremely important. Now that a lot of people are on computerized trainers most know their FTP and there are conversions from FTP to VO2 max. I did mine and I am in the close to 40 range for VO2 max which per Peter's chart is good for 60+ so no worries there. I do really question VO2 max as the best way to measure fitness. I have friends who have much higher FTPs than me but not sure they are really in better shape as their potential is higher.

I am not a PHD scientist but it seems to me that we should be comparing ourselves to our potential not others. I never was the greatest cyclist and never really raced as not fast enough but my endurance was always great. HRV may be a better way to measure fitness achievement vs potential but I haven't looked at mine though it is not hard to calc if you have the right device.

The other thing that Peter and Rhonda do is take the fun out of being in good shape. They focus rightfully on people who train just a few hours a week and that they need HIIT workouts.

I think I do better with 7-10 hours of riding with hills and intervals mixed into the workout. I ride because it is fun and I like riding w friends and being in good shape. Am sure that we are the exception as we have the time and motivation vs 99% of the rest of people who don't care.

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

Alan

Link to Dr Rhonda Patrick's video is below. I liker hers as well
https://www.youtube.com/watch?v=IxYdkMmtjBs

I agree with much of your assessment. As a personal trainer, too much fitness advice is oriented toward the outliers. For example (I guess I’m quibbling with your opinion here) people who are deconditioned are NOT going to do well with a HIIT program because it’s just too arduous and they won’t stick with it.

I’ve highlighted some snippets from a recent NYT interview I read with Attia. The financial and time resources (and the two are inevitably intertwined) make his suggestions unattainable.

OTH, I agree with his assessment of functional strength training and think many more cyclists need to do it.

https://www.nytimes.com/interactive/...interview.html

When I read your book, I was thinking, this guy is advising me to pursue a fair bit of medical testing, which I doubt my insurance covers. There’s equipment he thinks I should probably buy. He’s suggesting psychotherapy. This stuff all costs money. So to put it crassly, is your method just for the rich?

The biggest asset class a person needs is not financial; it’s time. It would be delusional of me to say that a single working mom with five kids in the inner city has the same amount of time that the wealthy mom in Beverly Hills has. Of course not. Unfortunately, the truth of it is that health is not fully democratized. There’s a certain income level and disposable time requirement that’s probably necessary. You don’t have to be wealthy, but you have to be above a certain threshold in terms of disposable time and income to spend on good food, gym memberships or exercise equipment at home and those things. I don’t know that dollar amount. I don’t think it’s that high. But it’s certainly higher than where many people are, unfortunately.

All right, we can leave it at that. If you were to say to someone, “If you don’t do anything else to increase your health span,8 at least start doing X,” what would X be?

For most people, the answer is exercise more. Then within that, you can get into the weeds. Many people, I think, are underemphasizing strength training. There’s the sense that, Yep, I’m out there, I’m hiking, I’m walking. Those things are great, but the sine qua non of aging is the shrinkage or atrophy of Type 2 muscle fiber.9 That’s the thing we probably have to guard most against, and you can’t do that without resistance training. Count the number of times in human history when someone in the last decade of their lives said: “I wish I had less muscle mass. I wish I was less strong.” The answer is zero.

[adub]

If you test your FTP a few times a year (20 min road test), wear a hr strap,and have your correct metrics entered, the Garmin vo2 on the newer watches is within a few % of a metabolic cart vo2 test.

And most people (even who are kinda active) will fail at raising their vo2 max by any meaningful value because it's really hard! Doing maximal efforts at your vo2 will make you question your life decisions!

[prototoast]

Originally Posted by adub

And most people (even who are kinda active) will fail at raising their vo2 max by any meaningful value because it's really hard! Doing maximal efforts at your vo2 will make you question your life decisions!

I thought that was his point--that VO2 max is not an easy number to alter (probably the easiest way is to lose weight), and therefore it is a better predictor of overall health than metrics that are more responsive to training.

[flying]

I like him & most of what he say's. Of course I do not agree on everything but then again as you said he is targeting a group of averages.

What I do like about his video is you learn so much about many markers I previously had no idea about. Things like ApoB, LP(a), hs-CRP things like that which I now chart & follow.

Although I am not sure I 100% agree with his methods to reduce things like ApoB. For instance he himself is taking Repatha the 2x a month PSK9 injection even if he doesn't need it as well as Bempedoic Acid & Ezetimibe in the form of Nexlizet.

In his opinion he would rather just take that whole risk off the table. Even before actually needed. His thinking is for instance none would say cigarettes don't cause cancer & no doctor would say a little bit of cigarettes are ok. So he looks at ApoB the same & rather plunge it.

I am personally not sure about that approach & it reminds me a bit of Angelina Jolie getting a prophylactic double mastectomy even though she hadn't been diagnosed with breast cancer.

[commandcomm]

Never mind.

[John H.]

I love watching, reading and listening to Peter Attia.
But you have to realize that his ideas and therefore measurements reflect what he is currently into for himself and his clients.
His bent is health/longevity. Not athletic performance for one sport. So for the person trying to be as fit as they can be without too much time commitment, his ideas may make sense.
For someone who is trying to ride their bike faster, not so much.
I think that many would find that his "zone 2" pace is more like tempo. Not a bad thing if you are riding 60-90 minutes 3-4x per week with no speed goals.
But too hard if you are trying to hold that pace for long rides and also integrate in harder interval sessions.
In terms of measurements of fitness? What are you goals? Find measurements that align with your goals. Might be a power number for a certain duration, might be an amount of vertical, might be hours, might be power to weight. Might even be smiles per mile.

[adub]

When you watch the info that guys (and gals) like Attia pump out it's hard to imagine someone who has the time to keep up with all the protocols they recommend. You gotta remember these dudes are in the business of clicks, there is only so much that they can talk about multiple time a week.

All of them including Attia have jumped on to the bandwagon of Z2, sauna, cold plunge, light therapy and now vo2.

If you're a cyclist or runner you've known about Z2 (going easy) and vo2 (going hard) for 30 years, nothing new here. Combine an active lifestyle with eating basic whole foods and you don't have to pay attention to this noise.

And in regard to using vo2 max as a measure of fitness & subsequent longevity you could use a myriad of other measurements as well that are easier for someone without a degree to figure out- running 5km PB time, bike- 30min PB time up your favorite climb, etc.. Any cardiovascular fitness marker that you choose to measure if you're getting quicker (and then likely losing weight) you're getting fitter and your vo2 max is likely going up

[Mark McM]

Originally Posted by prototoast

Mr. Attia seems to be making the claim that if you can only look at a single dimension, VO2 max has the best predictive power of lifespan.

Hmmm... On average, women have smaller VO2 max but longer lifespans then men. There's got to be more to it.

[adub]

Originally Posted by Mark McM

Hmmm... On average, women have smaller VO2 max but longer lifespans then men. There's got to be more to it.

vo2 has a different reference range for males and females.

[prototoast]

Originally Posted by Mark McM

Hmmm... On average, women have smaller VO2 max but longer lifespans then men. There's got to be more to it.

Right. I certainly wasn't independently validating his claims. As is so often the case, while factually accurate, these types of claims often take the implicit form of "this is the best predictor (controlling for all the other obviously better predictors I won't list out)."

My only point was that something being a good predictor on average does not mean it accurately characterizes each individual, nor should a predictor be treated as a target.

[homagesilkhope]

Originally Posted by john h.

might even be smiles per mile.

Now you're talking!