Peter Attia protocol and fitness measurement

[MXLeader]

Originally Posted by NHAero

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.

Excellent questions that I’ve struggled with, too. I have this article bookmarked for a couple of years now that answer most but not all of my similar questions.

My takeaways are that technique is everything when measuring your blood pressure; the right equipment, the right cuff size, the right position and the right time. Too often when I’ve gone to the doctor’s office (and dentist’s office over the last few years) the intake person seems to rush through the measurement and get an inaccurate reading because they took the measurement as soon as I sat down, or they took it over a shirt, or they used too small cuff. I’ve come to slow them down and help them get it right. The worst seems to be dentist offices where they use a wrist based cuff and where I’m practically lying down in the chair. I usually open up my Health App and show them my home readings from earlier that morning as I always self-monitor on the day of a doctor visit. Also, I happen to be very sensitive to caffeine in the morning, so I make sure I have none within 4 hours of my doctors visit.

My wife, in particular, has a pretty severe case of white coat syndrome where her systolic pressure is usually 20 points high and diastolic pressure is 10 points high if measured right at the beginning of the office visit. Her BP usually returns to a normal reading when taken again near the end of the visit when she’s more relaxed.

As far as BP medicine making your BP too low after exercise, I’m thinking that The proper dosage is the key. Since you’re already on top of your BP measurements. Report your measurements after your workouts back to your doctor if they seem to be too low or you feel faint when standing up.

[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 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

[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.

[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.

[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.

[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.