206 - Exercising for longevity: strength, stability, zone 2, zone 5, and more | Peter Attia, M.D.
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In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts about exercise to help listeners understand this topic more deeply, as well as to identify previous episodes which may be of interest. In this episode, Peter discusses his framework for exercise, what he’s really optimizing for, and how to train today to be prepared for a good life at age 100. He describes the importance of strength and stability, and why deadlifting is an important tool to consider for longevity. Additionally, he details why training in zone 2 and zone 5 is important, gives a primer on VO2 max, and describes the most effective ways to engage in those types of exercise. Finally, Peter reveals his current exercise routine.
We discuss: 0:00:00 - Intro 0:03:00 - What is Peter optimizing for with his exercise? 0:06:10 - Preparing for a good life at age 100: Training for the “Centenarian Olympics” 0:21:48 - The importance of preserving strength and muscle mass as we age 0:27:39 - The value of deadlifts for stability and longevity when done properly 0:35:44 - The importance of zone 2 aerobic training 0:40:00 - The most effective ways to engage in zone 2 exercise 0:44:21 - Zone 5 training and VO2 max 0:51:58 - A primer on VO2 max 1:03:09 - Stability—the cornerstone upon which all exercise and movement relies 1:07:55 - Peter’s current exercise routine
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The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 40 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.
Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).
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Etia presents a framework for exercise optimization centered on longevity and the 'centenarian olympics'—a set of functional capacities to maintain into old age—comprising four pillars (stability, strength, zone 2 aerobic, and zone 5 anaerobic) that should be pursued deliberately rather than for competitive performance, with specific protocols and training structures designed to preserve functional capacity rather than maximize athletic output.
- Performance goals (breaking 2:40 marathon, 10-hour Ironman) are orthogonal or opposed to longevity optimization, requiring fundamentally different training approaches
- The centenarian olympics framework identifies 18 functional tasks (getting off floor with one arm, lifting 30 lbs overhead, squatting to pick up a child) that should guide training prescription across the lifespan
- Stability is the foundational pillar that enables safe force transmission; strength and aerobic capacity decline 1-4% annually after age 50, requiring superthreshold maintenance; zone 2 builds mitochondrial health and metabolic flexibility while zone 5 preserves VO2 max and anaerobic capacity
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Backcasting from desired end-state capabilities (determining what you want to be able to do at age 100 and working backward) is a more effective planning framework than forecasting forward from current age.
“the idea of back casting is instead of trying to say well if i'm 25 what do i need to be doing tomorrow when i'm 26... an easier way to do it is say what do i need to be doing when i'm 100 and then how do i work backwards from that”
Stability is the fundamental pillar of exercise because it enables safe force transmission from muscles to the ground and vice versa across joints designed for load bearing, preventing force leakage through joints (scapula, elbow, knee, back, hips) that are not designed to dissipate force.
“stability is the cornerstone upon which you do everything it is the cornerstone upon which your strength is delivered your aerobic performance is delivered and your anaerobic performance is delivered and it's the way that you do so safely so stability is a way that we transmit force from the body to the outside world and vice versa from the outside world to the body in the safest manner possible across the muscles which are designed to carry that load as opposed to seeing the dissipation of force across joints that are not fit to do so”
A person cannot truly go 'all out' for more than 10 seconds; beyond that point, even elite athletes are pacing themselves consciously or subconsciously, as demonstrated by Usain Bolt slowing in the second 100m of the 200m sprint despite having a flying start.
“the limits of human performance in terms of quote unquote going all out is about 10 seconds so really no human has the potential to go all out for 10 seconds... even by the time usain bolt is running the 200 he is slowing down in the second half of that race the force with which he's able to hit the ground in the second half of that race is slower”
Zone 2 training benefits include metabolic benefits (glucose insulin-dependent and insulin-independent glucose-mediated disposal), mitochondrial function and density improvements, and BDNF secretion from this type of low-intensity aerobic activity.
“the benefits that it could have both from the standpoint of metabolic benefits such as glucose insulin dependent and insulin independent glucose mediated disposal looking at just sort of mitochondrial function mitochondrial health density and then looking at sort of the the sort of neurotrophic factors that bdnf secretion that can come from this type of activity”
The 20/10 Tabata protocol (20 seconds work, 10 seconds rest) is favored by researchers because it prevents conscious or unconscious pacing, whereas the 10/20 variant allows people to complete all rounds by pacing themselves, meaning the 10/20 can be performed at higher absolute intensity but the 20/10 forces confrontation with true maximal effort.
“the problem with a quote unquote 2010 tabata is whether consciously or subconsciously you're actually pacing yourself to complete it... anybody who's tried both knows you can go so much harder for the 10 20 than the 2010. the 2010 is generally favored because that's the one that was studied by ursawa”
Etia had a cycling peer with lower VO2 max (55-60 ml/kg/min vs his 70 ml/kg/min) who was consistently faster on the bike, suggesting efficiency and other factors beyond VO2 max determine performance, meaning VO2 max is useful for self-comparison over time but not for predicting outcomes between different athletes.
“my number was just like yours except i was heavier so i was about 5.1 to 5.2 liters but i weighed more so that worked out to about 70 mils... his was 55 to 60... there was never a day that i could ride faster than him... he may well have been and he may have simply been a far more efficient athlete”
Zone 2 training is characterized by being easy enough that it never feels like a workout one wants to skip, sustainable for entire lifespan without high injury risk, and yields enormous dividends when practiced consistently, making it possible to combine with other activities like listening to podcasts and audiobooks.
“one of the things about zone two that i really enjoy is it's just not that hard... there's never been a day when i've been like i don't feel like doing this i just i always look forward to it... we can do zone two our entire lives we can do it safely and it just yields enormous dividends”
Performance optimization and longevity optimization are often orthogonal or opposed—pursuing elite athletic goals like breaking 2:40 in a marathon, completing a 10-hour Ironman, or deadlifting 3.5x body weight requires training at energy systems that are past the point of optimizing longevity returns and actually comes at longevity cost relative to lower-intensity training.
“if someone said to me peter my goal is to break two hours and 40 minutes on the chicago marathon next year i would be talking about this in a totally different manner... everything i'm saying needs to be modified... they are generally not co-linear with longevity and at times they can be outright orthogonal... trying to run the fastest 10k is training at an energy system that is very demanding of the cardiovascular system... that is generally past the point of optimizing longevity returns and it actually comes at some longevity cost”
Muscle mass declines at a minimum rate of 0.3-1% per year, with other studies showing 1-2% annual decline after age 50, and total lean mass decline between age 20 and 80 reaches 35-40%, while strength losses are even greater at 2-4% per year, making average performance at age 50 incompatible with high functional capacity at age 85.
“the lowest rate of decline that i could see is one percent per year another study you know point three percent per year others are sort of putting it one to two percent per year after 50 35 to 40 percent between age 20 and 80. and the strength losses might even be greater right we're talking about two to three some studies even showing four percent strength loss per year”
At age 25, young active people pursuing longevity should prioritize static stability followed by dynamic stability integrated into all strength training, as stability is where most people fail first after entering school due to sitting and reduced activity, which accelerates loss of diaphragm engagement, pelvic floor tension, and overall movement patterns learned innately in the first 18 months of life.
“spend as much time as possible working on dynamic stability static stability static first then dynamic... at the age of 25 you can do a lot of dumb things and get away with it... in my experience the one where most people start to fail first is stability because as a species we usually begin to fail that once we enter school... there are about 13 or 14 movements that are completely innate to us and by the time we're a year and a half old or so we do them all perfectly and then it's basically all downhill from there accelerated significantly by school once you start sitting”
VO2 max can be reproducibly maintained on a stationary bike using wattage as the metric because watts are easily trackable and reproducible, or on a treadmill using brisk incline walking (10-15 degree incline, 2.5-3 mph) for runners who are inefficient, and the key is choosing a device that reproducibly produces the same output with minimal mental effort to sustain target intensity.
“i would say it's one where it's very easy to reproducibly produce the same output so i am hugely fond of a bicycle because it has a very clear metric that i can adjust which is the wattage... treadmills are also a great way to do this in my experience unless you are a really good runner... we generally start people between 10 and 15 degrees somewhere between two and a half and three miles per hour”
Most people fail to realize how little actual time under tension occurs during typical weight training sessions; for example, a 90-second continuous time-under-tension protocol (as advocated by Doug McGuff's 'Body by Science' approach) represents an eternity of sustained muscular load compared to traditional lifting.
“if you actually calculate when you when you lift if you're bench pressing or squatting or something like that have you ever timed yourself and realize when you're working out like that and you're lifting weights how actually actually little the time is that is spent under tension”
Exercise regulation involves not just oxygen delivery to muscles but also central factors like brain oxygen levels, with the brain using oxygen thresholds as 'circuit breakers' that reduce muscular output to maintain adequate cerebral oxygenation even when muscles could theoretically work harder.
“you're getting these other circuit breakers that are starting to come down that aren't even on this path from mouth to lungs to blood to muscle there's other factors that are saying whoa wait a second oxygen's getting a little low so we're gonna actually cut off the supply to the muscles or reduce it in order to make sure that we don't get stupid”
Conventional wisdom has been that lungs are not a limiting factor for VO2 max because they are 'overbuilt', but recent research suggests that in highly trained endurance athletes, the lungs can be a limitation, and elite athletes can experience exercise-induced arterial hypoxemia even at sea level due to insufficient oxygen diffusion time as blood passes through the pulmonary capillaries.
“for decades it's been conventional wisdom that the lungs don't respond to training because they're overbuilt... there was just a paper published a big review in the last month or two arguing that you know in some cases the lungs aren't overbuilt and one of the situations is highly trained endurance athletes... you can also run into situations where an athlete is so fit their heart is so strong it pumps blood past your lungs so quickly that it doesn't have time to fully stock up on oxygen... exercise induced arterial hypoxemia... in elite endurance athletes is actually about half of them”
VO2 max is the maximal amount of oxygen per unit time that a person can process—the rate at which oxygen is taken from air into lungs, into blood, pumped to muscles, and used metabolically—and was first formally described in the 1920s by A.V. Hill who observed a plateau in oxygen consumption at maximum workload intensity.
“vo2 max is the one physiological parameter... physiologically vo2 max is telling you how quickly you can take oxygen from the air into your lungs get it into your blood pump it to your muscles and then have your muscles use it in the metabolic processes... it was first sort of discussed or measured in the 1920s by a guy named av hill”
VO2 max is reported in two metrics: absolute liters per minute (which scales with body size and doesn't allow fair comparison between athletes of different sizes) and relative milliliters per minute per kilogram of body weight (which normalizes for body size), though both metrics have limitations because whole body weight includes non-metabolic tissues like skeleton and adipose tissue that don't scale with oxygen utilization.
“rather than liters of oxygen per minute it's milliliters of oxygen per minute per kilogram of body weight... if you want to compare apples to apples between athletes of different sizes you divide at least for a crude approximation you just divide by weight... there's a whole rabbit hole to go into is to say well why are we dividing by whole body weight because you know there's a bunch of things like skeleton and organs and stuff that don't scale the adipose tissue doesn't matter”
The majority of centenarians alive today are centenarians because of exceptional genes, not lifestyle optimization, and on average they tend to smoke more, exercise less, and eat worse than their peers, meaning the deliberate approach to becoming a centenarian through training and lifestyle hacking is a completely new model distinct from existing centenarian populations.
“anybody who's a centenarian today is a centenarian because of their exceptional genes they haven't hacked their way there... most centenarians i mean they haven't done anything necessarily better than or worse than their peers they're in fact on average they tend to smoke more exercise less and eat worse”
The centenarian olympics/decathlon is an 18-item list of functional tasks that an individual wants to be able to perform at age 100, including activities like getting up off the floor with single-arm support, dropping into a squat to pick up a 30-pound child, lifting 30 pounds overhead, and getting out of a pool without a ladder.
“my centenary in decathlon has these 18 things that i want to be able to do when i'm 100... i want to be able to get up off the floor with a single point of support... i want to be able to drop into a squat position and pick up a child that weighs 30 pounds... i want to be able to lift something that weighs 30 pounds over my head... i want to be able to get myself out of a pool without a ladder”
The deadlift, when performed with correct positioning and intra-abdominal pressure, can actually place the spine under traction despite axial loading, which is counterintuitive but biomechanically possible when spine elongation is maintained, and this spinal traction benefit is why deadlifting is the most important pre-flight activity because it primes spinal activation that prevents compression during prolonged sitting.
“it never occurred to me up until a year and a half ago that you could actually deadlift in a way that puts your spine under traction that's very counter-intuitive... when you learn the right positioning and you understand how to create intra-abdominal pressure and you know how to elongate your spine you can actually dead lift and create traction in the spine actively and that's why dead lifting is the most important thing i do before i get on an airplane”
A healthy 2.5-year-old moving naturally provides a clinical demonstration of perfect force transmission and efficiency, while adult movement patterns typically show inefficient force dissipation around the scapula, elbow, knee, back, and hips.
“when i look at my two and a half year old move it's a perfect clinic in force transmission safely across the body when you look at me move prior to sort of becoming obsessed with and schooled in these disciplines... it's always a little bit of an inefficient way to get things done and it results in a lot of force leakage or seeping out around my scapula my elbow my knee my back my hips”
Peter performs a 10-15 minute deadlift preparation checklist of approximately 10 exercises before deadlifting that may provide benefits equivalent to or greater than the deadlift itself in terms of stabilization and movement preparation.
“one of the things i definitely want to do is actually put together kind of a video on deadlift and deadlift preparation because i think that there are probably 10 exercises that i do as a way to get ready to deadlift and they don't take long like this my deadlift checklist is like 10 to 15 minutes”
Peter abandoned deadlifting around 2016 after a partial oblique tear made loading the spine uncomfortable, but resumed deadlifting after learning dynamic neuromuscular stabilization (DNS) techniques, now deadlifting 2-3 times per week at lighter loads (185-375 lbs) with perfect form as a movement audit rather than for strength or metabolic gains.
“i had an injury where i kind of tore or partially tore one of my obliques... everything went kind of sideways after that and i really was never able to fully deadlift again without some discomfort... i sort of decided you know what maybe the deadlift has reached its point of futility”
The benefit of deadlifting with correct form and technique may not come primarily from the deadlift itself but from all the preparatory exercises and movement patterns required to execute the deadlift correctly, similar to how ketosis benefits might come from the metabolic conditions that enable ketone production rather than the ketones themselves.
“i'm not even sure how much of the benefit is the actual deadlift versus all the things you have to do to do the deadlift correctly... it's almost like ketosis the way we were talking about it in the past right which is it's not even clear if it's the ketones themselves that can sometimes be the benefit versus the metabolic conditions that allow you to make them”
High-quality Pilates teachers often teach the same stability and force transmission principles as DNS practitioners despite using different terminology, making the choice of discipline less important than the quality of the teacher and student understanding, with other valid approaches including Postural Restoration Institute (PRI) and dynamic neuromuscular stabilization (DNS).
“i think a great pilates teacher is already teaching many of these principles... a great pilates teacher who even though they're using a very different vocabulary than the one that i use or that the dns practitioners use the results speak for themselves... postural restoration pri dns pilates these are all different ways that one can come about trying to learn these principles”
Etia checks lactate levels four times per week during zone 2 training to verify intensity maintenance, knowing his exact zone 2 wattage, heart rate, and corresponding lactate level, and will reduce wattage to achieve target heart rate if it is significantly elevated (signaling illness, dehydration, or other physiological stress).
“i have a very clear sense of my zone two i know exactly how many watts my zone two is i also know what heart rate i should expect to see and if i'm vastly outside of that there's usually a physiologic reason... i'm checking my lactate every single time i do this and i do it four times a week... if my heart rate is significantly higher than that it might mean i'm a little bit sick dehydrated something else is going on and i might have to back off”
The four pillars of exercise for longevity are: stability, strength, aerobic performance (zone 2), and anaerobic output (zone 5), with each of the centenarian decathlon activities requiring at least one and many requiring more than one of these components.
“my framework for thinking about this is four components of exercise one is stability the second is strength the third is aerobic performance the fourth is anaerobic output and i didn't go through all of my 18 but each of my 18 touch at least one of those and many touch more than one”
The body typically fails first (before mind and before major disease burden), making physical capacity preservation the critical longevity target for most people, though some suffer cognitive decline first and a smaller subset suffer sudden death without physical decline.
“the system's gonna fail first in body for most people which isn't to say always right so some people just die suddenly... for another subset of people unfortunately not that small their mind is taken from them first... as i really reflected on what's going on i think that for most people the decline of mind body and then the burden of disease seems to be won by one in the wrong way meaning body seems to fail first”
Etia's current weekly exercise macro structure (unchanged over past year despite changing micro-structure in specific exercises) consists of: Tuesday, Thursday, Sunday as zone 2 cardio days (45 minutes each); Saturday as either dual zone 2 + zone 5 workout or single longer anaerobic bike ride; and Monday, Wednesday, Friday, Sunday as lifting days split into upper body (Wednesday, Sunday) and lower body (Monday, Friday), with lifting always done after cardio.
“the actual macro structure of what i do has not changed much in the last year... tuesday thursday sunday are zone two... saturday is either a zone two followed by a zone five... then from a lifting standpoint it's monday wednesday friday sunday is lifting... the lower body component i think is monday friday the upper body is wednesday sunday and i always lift after doing cardio”
Attia stopped competing in cycling in late 2014/early 2015 after time-trial racing and subsequently eliminated all low-intensity aerobic training, believing it unnecessary without racing, and instead focused exclusively on high-intensity efforts (running at 6-minute-mile pace or rowing all-out), which represented a training hole that took approximately one year of interaction with Inigo San Millan and literature review to recognize and correct.
“when i stopped riding a bike with a purpose which was for me a time trial so that would have been late 2014 early 2015. i kind of really just stopped doing any low intensity aerobic training...when i stopped doing that i was like well i don't need to do this anymore and i went from cycling to rowing and running and i was sort of obsessed with just being as efficient as possible so everything was all out i mean i was if i was running it was going to be a six minute mile it wasn't going to be a nine minute mile”
Attia prioritizes lifting in the early morning (around 7:15-7:30 AM) after a morning routine with his children and maintains rigorous adherence to four lifts per week, rescheduling rather than skipping workouts even when scheduling conflicts occur.
“monday through friday and pretty much no flexibility those lifts have to be done first thing in the morning and not first thing in the morning so morning routine is kind of more about the kids and stuff like that but once they're out the door to school it's around 7 15 7 30 that's when i'll typically live...i will pretty much will never compromise a lift i will always get those four lifts in during the week no matter what and sometimes it just means moving the days around or doubling up on a different day”
The Tabata protocol was developed by Izumi Tabata under researcher Irsawa, but the protocol is incorrectly named after Tabata (the researcher who published it) rather than Irsawa (who developed it), and should properly be called 'Irsawa training'.
“tabatas are not named after the guy who developed the protocol he was the guy that wrote the paper ursawa developed the protocol they should be called ursawas”
Zone 2 training is characterized by effort below the level that would raise heart rate above 120 bpm while swimming, allowing Peter to exercise with no agenda other than aquatic immersion, without pushing intensity or measuring pace.
“all i'm doing is swimming i'm not doing workouts i'm not looking at the pace clock i'm not doing intervals i literally just get in the water with no agenda other than to get wet and hear the sound of water going by my ears probably i'm not even swimming hard enough to get into zone two truthfully i doubt my heart rate's above 120.”
Etia's older breathing squats routine in high school (once per week, 20 reps total with 3 deep 10-second breaths between reps, taking 10 minutes total) added over 100 pounds to his squat in one year despite being phenomenally uncomfortable, and remains one of the most intensely uncomfortable training methods he's experienced rivaled only by air bike Tabata.
“so you go down and up at your normal cadence at the top you took three of the deepest breaths you could take each breath taking 10 seconds... you do 20 reps so the set takes 10 minutes... in the course of one year of doing that i added over 100 pounds to my squat”
The episode is the first of a new format where previous podcast clips are curated around a theme (exercise and longevity framework) and arranged in what Etia believes is a logical pedagogical order, rather than presenting each full previous episode.
“we've decided to pull a variety of clips from previous podcasts but around a given theme... we put these clips in order of what we think is the best way to listen from top to bottom so think of this as kind of a mashup... the hope here of course is that this is going to allow you to understand this topic better but also to identify some previous episodes if you now want to go back and dive really deep”
Finding the right stability practitioner is the component of Attia's exercise framework requiring the most experimentation and tinkering due to the heavy dependence on practitioner skill and teaching ability; digital curriculum for stability training is planned but not yet available for non-patients.
“i think unfortunately of the four pieces of exercise we're going to talk about this is the one that probably will take the most tinkering for people to find the right type of practitioners...postural restoration pri dns pilates these are all different ways that one can come about trying to learn these principles i think unfortunately...probably sometime next year bob as you know we are going to start to put together some material on this for people outside of our practice”