The Peter Attia Drive - #206 - Exercising for longevity: strength, stability, zone 2, zone 5, and more

Episode Date: May 9, 2022

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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: What is Peter optimizing for with his exercise? [3:00]; Preparing for a good life at age 100: Training for the “Centenarian Olympics” [6:00]; The importance of preserving strength and muscle mass as we age [21:45]; The value of deadlifts for stability and longevity when done properly [27:30]; The importance of zone 2 aerobic training [35:45]; The most effective ways to engage in zone 2 exercise [40:00]; Zone 5 training and VO2 max [44:15]; A primer on VO2 max [52:00]; Stability—the cornerstone upon which all exercise and movement relies [1:03:00]; Peter’s current exercise routine [1:07:45]; More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Atia. This podcast, my website, and my weekly newsletter, I'll focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn more now,

head over to peteratia MD dot com forward slash subscribe. Now without further delay, here's today's episode. Welcome to a special episode of The Drive. Now that we've released over 200 episodes, we realized we've covered a lot of stuff across various topics and in a lot of detail that I think frankly for people can be very difficult if you're not someone who started listening four years ago. I think even if you were listening from the very beginning, it can be really hard at times to kind of piece together all of the information. So we thought about trying an experiment for today's episode. We've decided to pull a variety of clips from previous podcasts, but around a given theme.

And in this episode, we're going to focus on clips that discuss exercise and my framework for it. So 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 of a whole bunch of things on exercise, but they're organized in a way that I think should make frankly a lot of sense and hopefully provide even more value than if you were to listen to each of these podcasts in their completeness. So the hope here of course is that this is gonna allow you to understand this topic better,

but also to identify some previous episodes if you now wanna go back and dive really deep into those. First set of clips we're going to look at is what I'm optimizing for with my exercise and why I think training for the Centenary and Olympics or Centenary and the Catholic as I more commonly referred to with these days is so important. The last thing to note here is that some of these clips are actually from AMAs and so if you're not a subscriber, hopefully this gives you a sense of what lives behind that pay well and why we think there's a lot of value there. Additionally, for the stability and DNS

content clips in our episode with Beth Lewis and Michael Rintala, we there's a lot of value there. Additionally, for the stability and DNS content clips, in our episode with Beth Lewis and Michael Rintala, we actually filmed a lot of instructional videos of them showing us how to do these exercises. I recommend you spend the time to go and look at those videos, because I think seeing here is probably better than just hearing. So this is the first time we're doing this. So we'd love your feedback.

So tell us what you think about this, and tell us if this is the kind of thing you'd like to see more of. And tell us if you think it's sucks because it's a lot of work to do this and if you think it's sucks, I'd be happy to not do this anymore. So without further delay, I hope you enjoy this special episode of the drive. Everything we're talking about Bob right now is based on longevity and that's very different than if you were asking this question through the lens of performance. Does that point kind of make sense or should I expand on that a bit?

Yeah, I think you should expand a little bit maybe on the performance health and longevity, particularly performance and longevity and the possible trade-off between the two. 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. That is a very difficult performance goal. And that requires training at an energy system that I'm not even really going to talk about in the context of longevity. If someone says I want to break 10 hours on the Iron Man, if someone says I want a dead lift, three and a half times my body weight.

If you start to really look into the far recesses of amazing physical performance, everything I'm saying needs to be modified and I'm not going to talk about what those things look like. What I will say is they are generally not co-linear with longevity. And at times they can be outright orthogonal. And I realize as that's coming out of my mouth, it sounds pretty freaking stupid if you're not a math person. So let me explain what that means in English. Something is co-linear when it's directly in line with. Something is orthogonal when it is completely at odds with

or at 90 degrees to. So trying to run the fastest 10K is training at an energy system that is very demanding if the cardiovascular system, it is pretty much maximum cardiac output just beneath VO2 max above functional threshold. It puts an amazing strain on the body. And frankly, while doing that is better than sitting on a couch all day, that is generally past the point of Optimizing longevity returns and it actually comes at some longevity cost Relative to something more at a slightly lower energy system

So Everything I'm talking about is geared towards this Centenarian Olympics which we've talked about in the past This idea of being the most kick-ass 90-year-old possible. And that's really based on two energy systems. So it's got the stability and the strength piece we talked about. And then it's got this low end aerobic energy system, which is zone two that we'll talk about in a second. And then I think it's punctuated with brief bursts of generally zone five. And the reason I think those two matter is that's generally where life takes place. Life is zone one, zone two, and zone five.

And so by training zone two and zone five, obviously much more in zone two than zone five, we're really teeing ourselves up metabolically and also structurally to do these things. Based on what you know today, what do you wish you would have implemented when it comes to physical conditioning slash training when you were at the age of 25. To make the question more general, what do you believe is typically overlooked in this realm among very active 25 year olds who wish to be in the race for the gold medals in the Centenary and Olympics? Well, that's a question from my heart.

Have I spoken publicly about the Centenary and the Catholic on the Centenary and Olympics? I didn't realize I had, but obviously I had to give a question. I think he must have given a question. There's a number of questions that talk about the Centenary and Olympics, unless there's a Centenary and Olympics. I didn't realize I had, but obviously I had to give a question. There's a number of questions that talk about the Centenary Olympics. Unless there's a Centenary Olympics, I don't. I honestly don't remember talking about this, so, but I did. Let me restate what I'm talking about, and that will put this question in context. About, I don't know, nine months ago, maybe a year ago, I just sort of had this epiphany, which was that the system is going to fail first

in body for most people, which isn't to say always, right? So some people just die suddenly, you know, their mind and their body are fine, but they get struck with the disease and they die. For another subset of people, unfortunately, not that small, their mind is taken from them first. So cognition gets robbed of them, and then eventually, you know, either they die or their body also breaks down in a way they go. But but 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 one by one in the wrong way, meaning body seems to fail first. So it got me thinking that at least for me, how would I mitigate that? So I came up with this idea of backcasting instead of forecasting what I want to do in the end. And I borrowed that term backcasting from Annie Duke who wrote Thinking in Betts, a book that I love, and Annie will also be a guest on the podcast soon. I hope. So the idea of backcasting is instead of trying to say, well, if I'm 25, what do I need to be doing tomorrow when I'm 26? And then what do I need to be doing when I'm 30 and when I'm doing

40? 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? And so for me as a ripe old 46-year-old, 45-year-old when I started thinking about this, the question was, okay, well, if I want to live to 100, and again, genetically speaking, I probably won't, because I don't have the genes to get there. But let's assume that I can eke my way out to 100. That's 55 years away. What do I have to physically be able to do to be satisfied with my life?

So as I went through that exercise, the way I did it was doing it through the lens of my kids. So I took the ages of my kids and I projected them forward to how old will they be when I'm a hundred. And that's an easy calculation to do. I'd be saying anybody can do that for themselves. And then I said, well, probably, holistically, how old will their kids be? So I said, well, you well, my kids are this, this, this, their kids will be approximately this range. And then you realize, wow, their kids are gonna have kids by the time I'm 100.

So by the time I'm 100, I'm going to have great grandchildren that will likely be between like one and seven or eight. That's basically my calculation. Okay, so then I thought, okay, well, what are the things I'm gonna wanna be able to do when I'm a hundred to just be happy? So it goes without saying,

I would love to not be, you know, bedridden with disease per se. It also goes without saying that I would love to have the cognitive faculties that I have, or at least a high enough amount of them that I'm able to have the cognitive faculties that I have, or at least a high enough amount of them that I'm able to have the executive function processing speed and memory that's necessary to function. But then I really kind of double clicked on the physical part of this.

So, there are a bunch of activities that I want to be able to do. I still want to be able to shoot a bow and arrow. I still want to be able to actually exercise. Like, I do enjoy, you know, some people exercise because they have to. I think there are a number of us who exercise because we actually enjoy it. And it's fortuitous that it provides benefit. But the one I really focused on was the real simple stuff, the activities of daily living and among them is like playing with kids, right?

So I started thinking about, well, what would I want to be able to do with great-grandkids when I'm a hundred and they're three, four, five? And in going through that, I made a list and there were 18 things on my list. And I just began to refer to that as my centenary in de-Cathlon, which is problematic because de-Cathlon has 10 things and my list has 18 things.

But not with thinning that tiny little detail. What's the Latin origin of 18? I assume Deca is Latin for 10 of something, right? Anyway, well, whatever. Okay, so we'll come up with a fancier term for it, or I'll figure out a way to consolidate. Make it, let us know. So my centenary into Cafflon has these 18 things that I want to be able to do when I'm 100. And some of them seem so trivial that you'd be like, how is that even on your list? Like, for example, I want to be able to get up off the floor with a single

point of support, which means I want to be able to using just one arm get up off the floor. Now, it's not that it's the end of the world if I need to use two arms, but like I want to hold myself to that standard. 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 because that's about the weight of I want to be able to lift something that weighs 30 pounds over my head because that's about the weight of my little roller board suitcase and I would really be bummed if I couldn't put that in the overhead compartment of an airplane. Presumably, I'll still be flying on airplanes.

And, you know, those will still exist. You'll be flying yourself all the way. Yeah, yeah, right. Well, I'll have a little jet packs or something. You know, I want to be able to get myself out of a pool without a ladder. Simple, right? Again, how trivial is that to do today? Where you have four inches between the concrete and the water and how easy is it for us to

just pull ourselves out today without the ladder? You're seeing the guys that can jump without support, they can jump out of a pool. Just jump out of a pool onto the platform. No. I think there's some videos. Nice. For that. Yeah. So when I go through that whole thing, I then say, okay, what are physical tasks that would approximate those things?

So for example, like picking up the 30 pound kid who comes running at you could be approximated by a 30 pound goblet squat, lifting 30 pounds above your head in the form of a suitcase is also pretty easy to approximate with these things. Goblet squat just for the uninitiated. I usually think of it as like a kettlebell, but almost like you're holding a goblet in front of you, it's like a front squat, if you're going down coming up. That's right. Imagine you're getting a child up. Yeah, so pick him up a child. Then I've just been working backwards from there, which saying, well, if I want to be able to do these things at 100, there's going to be a decline.

I have to be able to do these things at 80. I'm going to need to be able to do it at this level at 60, and I need to be able to do it at this level today. Again, given the inevitable decline. So most of my training today, in fact, I would argue all of my training today, centers around fat. I no longer train for anything that's not related to that.

So I don't do any training that's related to racing or competing in anything, which is not to say it's bad to do those things. I'm just saying that that's the point I'm at in my life. So this is kind of a long-winded answer to what I think is a great question, which is not to say it's bad to do those things. I'm just saying that that's the point I'm at in my life. So this is kind of a long-winded answer to what I think is a great question, which is a 25-year-old who's frankly thinking of something that I, most 25-year-olds, I can't imagine would be thinking of,

certainly I wasn't thinking of this at 25. I mean, at 25, you're sort of immortal. But whoever asks this question is presumably realizing that hey, in 75 years, the world's going to look different, and I want to be able to do X, Y, and Z. So I don't know the answer because I don't know what that person's limitations are today. So rather, I would just say, what is the framework? And my framework for thinking about this is four components of exercise. One is stability, the second to 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. For example, the goblet squat requires both strength and stability. Walking up, one of mine is being able to walk up three flights of stairs with 10 pounds of groceries in each hand. up three flights of stairs with 10 pounds of groceries in each hand. Again, you and I could do that today blindfolded and backwards. That starts to become harder when you get older. Well that's got a little bit of aerobic. That's on the threshold of aerobic anaerobic and it's also got strength.

So what I would be looking to do is say, how well am I doing on each of those things? Now that said, 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. And I think I've talked about this before, and I've certainly posted pictures of like my youngest son squatting. It's just incredible.

The way that they can do this is so beautiful. You don't have to be a kinesiologist to look at them and go, wow, they're so natural when it comes to these movements, everything they do. And the field of dynamic neuromuscular stabilization is in fact built on this principle, which is, you know, there are about 13 or 14 movements that are completely innate to us. And by the time we're a year and a half older, so we do them all perfectly. And then it's basically all downhill from there. Accelerated significantly by school, once you start sitting, that's when we lose so much

of that stability. And we lose the ability to maintain tension through our pelvic floor and throughout the entire, I hate the term core, but core, of course, describing the diaphragm, the obliques, the transversalus fascia, and the entire pelvic floor. So my two cents would be spend as much time as possible working on dynamic stability, static stability, static first, then dynamic. And as long as you incorporate those principles into what you were doing strengthwise, that's great. Because at the age of 25,

you can do a lot of dumb things and get away with it incorrectly. I think I've always squatted and deadlifted somewhat incorrectly. I don't think I've ever fully engaged my pelvic floor doing those. And I think I got away with murder for a long time, though I now realize the damage that's occurred as a result of it. Do you want to talk about your, I think it was your squat routine? I think you mentioned this to me one time way back when with your legs. Oh, my high school, yeah. Yeah. The breathing squats? Yeah. Yeah. Amazing routine. I don't know that I recommend this, but again, it was once a week. So we lifted six days a week in high school three hours a day. I mean, we just lived in the gym.

And on Fridays, we would do this routine of breathing squats, which was you took your best 10 rep weight. So a weight that you were going to absolutely fail at 10 reps with. You loaded it on your back, and you do a rep. And that 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. So that takes 30 seconds.

So it's a five in, five out, three of those, and then do another rep and you do 20 reps. So the set takes 10 minutes. And by the end, it's the only thing I've ever done since that rivals that degree of discomfort is like an air bike tabata. And this was like one of these knucklehead things we got out of like our bodybuilding magazines for powerlifting magazines. And the idea was nothing will stimulate more strength and growth than that activity. And the reality of it is it worked. I mean, in the course of one year of doing that,

I added over 100 pounds to my squat. And that was starting at a level where I was already pretty strong. And just, but it's so funny about it. Like, it was so painful that on Thursdays, I'd start getting uptight, like knowing that we were gonna do this the next day. It was just, you just dreaded this pain so much.

Yeah, we might get into this too. There's a slope, it's called super slow or slow training. Doug McGuff is one of the guys, a body by science, is one of the proponents. And he talks about lifting, lifting slow and basically accumulating time under tension of maybe 90 seconds, which I don't think people realize is like an eternity. And you're talking about what you're talking about, that if you actually calculate when you lift, if you're bench pressing or squatting or something like that, if you ever timed

yourself and realize when you're working out like that and you're lifting weights, how actually little the time is that is spent under tension and then you compare it to that, which is pretty darn. Yeah, because in that 10 minutes, I'm not under the same tension the whole time. When you're standing, you're under much less tension. I mean, in many ways, my recollection of that was your upper body hurt as much as your lower body.

Again, fortunately it's been so long since I've done it, but honestly, I think that your traps, your lasts, because when you're squatting, you're really trying to wrap the bar around your neck. You have to engage your lats to squat. So the fatigue here, the fatigue there, I mean, the whole thing's a mess, but your legs are getting

a bit of a break during that period of time because you're locked out. So yeah, I mean, 90 seconds of totally being under tension is an eternity if the weight is heavy enough, which is the principle behind that whole lift. Yeah, and on that, on the note of a centenarian to Cathalon. We should call it the Olympics since there's 18 events, yeah. Yeah. I was thinking about it. And I think one thing too is that if you're thinking about doing a goblet squad, it's

almost like a checklist of things that you want to be able to achieve. So it's not necessarily like going to the CrossFit Games and you're going to see how many goblet squads you can do for time compared to other centenarians, you're basically checking something off that you would hope to do. And one thing that I think, like once this is refined down to maybe less than 18 or maybe it's 18 events, is maybe put in front of there's a lot of ongoing centenarian studies. There's the New York, the Einstein one, which is the Ashkenazi Jews long lived centenarian study.

I got that wrong. But there's the Thomas Pearls where I think they actually have like an aggregate, Italian centenarians, the Okinawins and things like that. And I wonder how many of those centenarians, maybe you give the list to near Barcelay or Tom. My guess is how many of them could do it? None of them. Yeah. And here's the reason. This is why I think this is different. Anyone who's a centenarian today, I'm willing to make an extreme statement, which I know is a dumb thing to do. Anybody who's a centenarian today is a centenarian because of their exceptional genes. They haven't hacked their way there. What we're talking about, people are ages. We're talking about hacking our way

into being centenarians. So that is going to be very deliberate. Now again, I'm not taking away from the odd centenarian who's also lived like a monk, but you know, we know this really well because we've done all this research on it for the book. 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. So what we're really talking about is a completely new model, which is actually forcing your way to become a centenary, and rather than just sort of gliding your way into it. And therefore, I think

it's going to require much more deliberate attention around what your mind and body are doing at that point in time. around what your mind and body are doing at that point in time. Now that we've set this age for what we're optimizing for with our exercise, these next two clips are going to focus on strength. One of the pillars in my framework for exercise. The first clip is from a recent AMA on the importance of preserving strength and muscle mass as we age. And the second is from an older episode where I speak about the importance of deadlifts and why I think they're so beneficial to our longevity

if we're able to do them safely. mass and strength are people losing by time. Because I think this is another thing I try to communicate to patients a lot, which is, it goes back to that idea of what I said about the gravity of aging. You know, what is aging kind of robbing you of as time goes on. And you have got to fight like hell to avoid it. But basically, you look at multiple studies, they're going to say, So, basically, you look at multiple studies, they're going to say, the lowest rate of the client that I could see is 1% per year, another study, and we'll be posting these studies in the show notes, 1.3% per year, others are sort of putting it 1 to 2% per year after 50, 35 to 40% between age 20 and 80, and the strength loss might even be greater, right? We're talking about two to three, some studies even showing 4% strength loss per year.

I mean, it's very difficult to put that in context, right, when you understand what compounding does. It gives you a sense of what it means to sort of be average when you're 50. If you have the aspiration of kind of kicking ass when you're 85, you can't afford to be average when you're 50. And that's just the bottom line. There's no other way to describe that, either through cardio respiratory fitness, strength, or probably even muscle mass to some extent, given its association with strength. So I know it sounds like we're kind of harping on this point, right? That like you've got to be strong, you've got to have muscle mass to accompany that strength,

probably because at some point when you lose it enough enough of it, you lose the strength and you've got to have the cardiovascular fitness. So there was another study that we looked at, Bob, that had the, I think it went out 10 years on the cap on my occurs, didn't it? Yes, let me see if I can pull that up. Okay, yeah, this is the one. I thought this was a very interesting study. So you have to refresh my memory, but I'm pretty sure this is the one where they looked at men and women, leg strength versus grip strength.

They measured these in sort of Newton meters doing, I think, a leg extension in a grip exercise, correct? Correct. The leg strength they didn't do in meters, which I know that's those are the units that you like to use in your workouts. The grip strength they didn't do in meters, which I know that's those are the units that you like to use in your workouts. And then the grips strength is in kilograms. Okay. So men here average age, about 54 women about the same, I think 53.

So you evaluate people in their sixth decade of life. And then they were followed prospectively for five to six years. Now remember, this is all cosmortality. So looking at the men's strength, leg strength specifically, it's definitely not subtle, right? So obviously with time, every coplin' my recurve moves down as you go to the right, but the weaker you are, the quicker it goes down. What this analysis showed for the men, if you look at quad strength, basically for every

point two unit reduction in quad strength, and they normalize this for muscle size. It's important to point that out here, I think, is that they took their strength metric and they normalized it by muscle size. And they did it in two ways, which I think made this study a little more complicated than I would like, because you get the same answer both ways, I think, but I guess it speaks to the rigor of it. They used actually CT cross-sectional area, and then they used DEXA. But when you take that normalized unit of strength per CT area and you reduce that by 0.2 units, which can seem somewhat, you know, I think for the listener, that's not the important point, or DEXA reduced by 0.34 units, you're seeing this increase in mortality,

a 26% or a 39% increase in mortality. And with reduction in grip strength, which was normalized by DEXA arm measurement. It's at 23 percent. All of these were statistically significant. Now, for women, it's worth noting that they were statistically significant, but they had basically a higher confidence interval or a larger confidence interval, meaning they came close to crossing unity. In fact, Bob, I think it's probably

worth including table four in the show notes because frankly, I find the table to be an easier way to appreciate these statistical relevance of this. So I think the figure is great because the figure shows you the magnitude of the gaps between it, but it's, you know, nobody can look at these figures and tell what's statistically significant and what is not. But again, I think the point of this is using a pretty rigorous way to quantify strength, normalizing strength by size of muscle and prospectively following people. We again see this trend. And I think that this goes hand in hand with the previous analysis,

which showed us that strength is the more important parameter, which again, I don't think we're going to be able to say that enough today. The importance of deadlifts as an adult, how is your thinking changed on this? I like your history on this one, so maybe even take it back to in school when you were doing powerlifting before it might have been invoked. Yeah, yeah, long before it was invoked, one of my best friends in high school who was also involved in boxing and martial arts,

we would go to the Scarborough campus of the University of Toronto every day in lift weights. And it was, it's still one of the fondest memories I have of what a gym could be like. It would certainly be the, it was certainly not the sunny, warm golds and Venice, but it had some of those features which was old school, lots of iron, nothing fancy. Of course, unlike a nice gym, this was like two stories below ground, so there were no windows poorly ventilated. So in the summer, it was staggeringly hot, and the winter it was so cold, you felt like you were getting frostbitten by touching the iron. And aside from me and my friend, there were no kids there. We were 14, 15, 16 years old, and it was this group of men who, to this day, I think back

and I can't believe how strong they were. And most of them competed in powerlifting, and so that sort of got us interested in power lifting, and that's how we sort of started putsing around with it. And as most people know who are listening, or I guess people who might know who are listening, powerlifting is different from Olympic lifting. Powerlifting is three lifts, the deadlift, the squat, and the bench press. And so yeah, make a long story short,

grew up doing a lot of deadlifting, a lot of squatting, a lot of bench pressing. It was always very horrible at bench press, much better at squatting and deadlifting. Fast forward to, I don't know a few years ago, maybe three years ago, I had an injury where I kind of tore or partially tore one of my obliques. I don't even remember how I did it. I remember it was very stupid, whatever I did. And everything went... Taring a phone book. That would be great.

It's possible. But everything went kind of sideways after that. And I really was never able to fully deadlift again without some discomfort. And so again, this is now take it back to maybe 2016. I sort of decided, you know what, maybe the deadlift has reached its point of futility and maybe I've extracted all I'm going to out of that

and there's no denying what a wonderful movement it is in terms of being a total hip hinge compound movement. But I was like, look, I could probably get most of the benefits of a deadlift doing things that place me under less load. And also, again, in this period of thinking about longevity, I thought, why does one need to subject themselves to twice their body weight or more in an axial load? So I sort of got away from it. And then I think all that kind of changed when I started DNS dynamic neuromuscular stabilization, which I started about 18 months ago. And we're going to have a podcast on this topic because it's just there's so much I want to talk about here. And so actually I think today we got an email about how we're

trying to make some time for this podcast. So we'll definitely, if you're listening to this and you don't know what DNS is dynamic neuromuscular stabilization, by all means, you should go read about it, but we're going to have at least a one solid podcast on this. But it was through that process that I realized actually the deadlift for me was going to be beneficial, not because of the metabolic benefits. I was not going to be doing tabata deadlifts like I used to or even by trying to set records for how much I could lift or anything like that, but rather because it becomes a beautiful audit for everything working perfectly.

So I did lift it this morning. So today's a Monday. I did lift it on Saturday. I did lifted a few days before that. I did lift at least twice a week, often three times a week, both straight bar and trap bar. And Bob, I don't go that heavy. I don't know the last time. Maybe I've had 400 pounds on one of those on the trap bar in the past year, but I usually

sort of stop at about 350 to 375. On the straight bar, I'm even lighter, maybe 185. I do a lot of slow eccentric, I film every single rap of every single set. And I study it, and I send it to Beth Lewis, who is my coach. And we do so much around making this deadlift perfect. And I'd rather take a lightweight and deadlifted Perfectly several times a week and I'm not doing like killing crusher sets like I mean it's today was four sets of 10 Five sets of 10 maybe and at no point was I like passed my limit So again, I can push myself harder doing other things

But what I could get out harder doing other things, but what I could get out of doing that deadlift perfectly is, do I have just the right amount of thoracic extension? Do I have just the right curvature in the lumbar spine? Am I activating my glutes? Am I activating my hamstrings? Am I pulling back instead of pulling up and my wedging correctly, like all of this little stuff translates biomechanically to the activities of daily living that matter to me, like getting up off the floor, picking up one of my kids, lifting a piece of luggage or something like that. And so if I can do the deadlift and it feels right, then I know I'm ready to do everything

correctly. And when I'm deadlifting and I feel like, then I know I'm ready to do everything correctly. And when I'm deadlifting and I feel like, hey, this isn't correct, this doesn't feel right. Well, first of all, now I've really learned what that feeling is. And secondly, I've now learned the steps that I can go back and reconstruct what needs to be done. And so 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, so it's not so onerous. 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, right? In other words, 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. And one of the most exciting things, just on this last thing I say on this, is 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 counterintuitive. You would think that anytime you're lifting under an axial load, your spine is under compression. But it turns out when you learn the right positioning and you understand how to create intra-addominal pressure and you know how to elongate your spine, you can actually deadlift and create

traction in the spine actively. And that's why deadlifting is the most important thing I do before I get on an airplane. Because when you're on an airplane and you're sitting there for five or six hours, what you really want to do is not let your spine be compressed. And the deadlift primes me to then go and sort of maintain that activated form of traction. Yeah, it's a significant investment, but I would say it's worth it. That you'll bring your hex bar to the gate before your flight, yourself up and bang out a few sets.

I mean, I don't know what it is about the TSA guys. They get so wigged out when you have your hex bar there at the gate. Put that overhead. Yeah. If your TSA pre they don't mind as much, but if you're not TSA pre they just lose it. Sticklers, they're sticklers. The next set of clips is from a topic that we've covered on a lot of episodes. And of course, is a very important pillar in this framework of exercise.

This is a aerobic training and specifically looking at low end aerobic efficiency or zone two training. This was most recently covered again in our second episode with In You Go Son Malon. This is a training zone I spend a reasonable amount of time in it, not as much as I used to when I was a cyclist, and I probably spent, I don't know, 10 to 12 hours a week in this zone. Today, I spend three or four hours a week in this zone,

but I still believe this is incredibly important, and I wanna make sure 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 rates above 120. That's the next topic. Yeah. That's where I think this is a good segway. All right. Very well. If you think about it, you can talk about it, but I think that's one of the things is like a governor putting a rate limiter on your performance when you do zone two, that it's almost like for a lot of people, it is for me doing this reminds

me kind of of stillness, although I might read on the bike or things like that, but can you talk about zone two importance and how you're thinking has changed on that? Yeah, 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. So anyone who does ride a bike or swims a lot has plenty of that activity in them. So even if you're training for the 200 meter individual medley, which is a race that's very short, very quick and very painful, you still put in hours and hours a week of aerobic based training.

Similarly, if you're training for a one hour all-out time trial, you still put in hours a week of low-end aerobic based training. But 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. I think, especially through the interactions that I had with Inigo, who I met about a year before I had him on the podcast, which was just recently, it was sort of meeting him and kind of going back through the literature on that type of training and the benefits that it could have, both from the standpoint of metabolic benefits such as glucose, insulin-, and insulin dependent glucose mediated disposal,

looking at just sort of mitochondrial function, mitochondrial health density, and then looking at sort of the sort of neurotropic factors, the BDNF secretion that can come from this type of activity. I mean, all of these things were just pointing towards, this was a glaring hole in my training that I needed to get back. And so that has been great.

And like you said, I mean, one of the things about Zone 2 that I really enjoy is, it's just not that hard. You know, like, frankly, sometimes it's just nice to get on the bike. And I probably spend three or four hours a week doing it. And that is my time to listen to podcasts and audiobooks. And I really enjoy it. I can't wait to get on that bike. As sort of boring as it seems to be sitting on a stationary bike for that long, 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.

And I think in large parts, it's because I also get to combine it with learning, which you wouldn't be doing if you're out there crushing intervals. And not that there's something wrong with that. I think each of these things has this time and a place, but I think that we can do zone to our entire lives, we can do it safely, and it just yields enormous dividends. Your question, if I recall, was if you wanted to do your zone to training at home, what's the best type of device to do it on? I don't think there's a best device, but 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. Wots are super easy to track. I'm riding on a bike that is an ergometer. So I put my road bike on a device called a Wahoo Kicker and it is hooked up to a computer where I'm telling it the numbers of watts that I want and it's putting that resistance into me and I generate it. Now my wife conversely likes to ride a peloton.

I don't know why. I think it's the worst bike on the face of the earth, but on the peloton it works a little bit different, which is she goes into like a mode where she's not doing a class, but she basically sets the resistance with a little knob and then the amount of RPM's that she can put to it spits out a wattage. But it's actually, in my mind, a little harder because she has to kind of control, like she has to be titrating her cadence to stay the same so that she can hit a wattage number. So it's the difference between being an ERG mode and spin mode. But the point is, regardless of how you do it on a bike, wattage becomes the metric that matters. We, of course, are always measuring heart rate as well, and we'll talk about this in a second.

It was a how you tweak it. Treadmills are also a great way to do this. In my experience, unless you are a really good runner, which is to say you're very efficient at running. For most people running gets them out of zone two a little too quickly. So for treadmill with our patients, we prefer brisk incline walking. Most treadmills will go up to 15 degrees and we generally start people between 10 and 15 degrees, somewhere between two and a half and three miles per hour, maybe less. And again, it's very empirical. It's sort of how quickly can you figure out where somebody is.

By those two metrics, 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 and I have to make an adjustment on the wattage. So 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 to get the heart rate down even if it means bringing the wattage a little bit below. And I'm checking my lactate every single time I do this and I do it four times a week with this guest frequency. Same thing on treadmill. I know on a treadmill exactly what incline exactly what speed and what heart rate. And it's a comparable heart rate too on the bike. That's an easy way to sort of make that happen. The other thing my wife loves is a rowing machine. Now I'm not fond of the rowing machine for zone two. I like the

rowing machine for zone five, but that's because I'm not a very good rower. So, again, my wife's a better rower than me, and she has better form than me. Someone like Beth Lewis, who we've had on the podcast, who's an amazing rower, she's more efficient. She can get his own to work out on the rowing machine. I love rowing, but it's just cycling for me a second nature. Cycling is a very efficient thing for me to do. I'm not hugely fond of ellipticals personally, but again, if you have one that works for you where you're able to get your heart rate high enough and you're able to move quick enough,

then great. The key is how much energy do you have to put into maintaining a sustained dose. And that's the biggest challenge Bob would zone two is you don't want it to be vacillating. And that's why ultimately, I love being on an erg mode of a bike, which is I don't actually have to think about it. It's putting 200 watts to my wheel, no matter what I do. Even if I slow down or speed up, it's just always keeping the watts the same. Frankly, I can just tune out and listen to podcasts and audiobooks, which is what zone two is for in my book.

The next set of clips look at another pillar in my framework of exercise, which is now that upper end aerobic, verging on anaerobic exercise. So we sometimes talk about this as zone 5, but again, I would be less concerned with the terminology. The zones really are a function of the underlying system that you're referring to, whether you're talking about a heart rate, base training, or a power base training. I think of zone 5 as basically your VO2 max training. And I think a lot of people sometimes spend too little or too much time in this zone,

and we want to kind of help you understand what that sweet spot might look like, assuming that you're not training specifically for athletic events that require unusual levels of fitness around that energy system. But again, if you're really just talking about being the fittest, healthiest person you need to be kind of a kick ass, 90-year-old, then I think we don't need to be spending quite as much time there as you might think to harness the benefits. So in these clips, I'm going to talk about how I train there and how I think about VO2 max. Now we talk about VO2 max in AMA27 and that's where we're going to talk about how the

benefits appear to comparing someone of low fitness to elite fitness with respect to these metrics. And it's kind of staggering. The difference between someone at the bottom, 25% of VO2 max versus someone at the top 2.5% is about a five-fold difference. So this shows the importance of VO2 max and why I think you ought to be spending more time there. We've got a zone, zone, wait for it, five question, not two.

What is Peter's approach to zone five training? What about other anaerobic training protocols? I love this. So my zone five is mostly done on my stairmaster, which is my absolute favorite piece of equipment that's not a bicycle. Other than the elliptical? Yeah, yeah, it's damn the elliptical. So basically my zone five workout, which I really only do once a week, is three minutes of zone two with one minute at VO2 max. Because I know what my VO2 max is, I know how to convert it into Mets, which is VO2 max divided by 3.5, and the stairmaster allows you to work in watts and mats. Basically, I'm doing three minutes at my zone two. Then I go one minute at what my VO2 max is, which truthfully is quite difficult to hold your VO2 max for one minute. Then right back to my recovery is then the three minutes at zone two.

That four minute pattern, I just repeat for 20 to 30 minutes. And I usually do that on the tail end of a zone two workout. So that's kind of my longer aerobic day. Other workouts that I liked when I'm outdoors on my bike, I also like doing kind of a more VO2 max training type ride, which should be kind of like a four minutes at, call it a hundred and twenty five percent of FTP functional threshold power, followed by four minutes recovery. So one to one work rest, but obviously at a lower intensity than the three to one rest to work that I just described. So yeah, there's lots of ways to hit zone five and it's a very important zone as well.

My view is most people spend too much time there and not enough time in zone two though. I've got a few follow-up questions which it'll give you more time to on this. I went almost to my two minutes on that one. I was like staring at my clock. One's I think simple. So the stairmaster, is it a stairmaster? I don't know if it's called a stair climber. Do you have the one where it's like literally you're going up steps or is it the one where you just have like two levers and you're pushing them back and forth? Oh, sorry, no.

Mine is like the fancy gym one where it's like an escalator. Is that what it's called? No, no, no, no, it's not a Jacob's ladder. It's a series of eight inch steps that roll up and down a machine. So the higher the intensity you set it, the less resistance is in those steps. And the faster you have to go to not fall off the back.

So if I set it to like eight mets, it's moving quite, if there's actually quite a bit of resistance, so I can step quite slowly without falling off. When I set it to like 20 mets, it feels like there's no resistance. And I'm running up the stairs to not get thrown off the back. I think we could do a podcast on a lot of this stuff, VO2 and all that other stuff. But one of the things that sticks out to me, because you know, when you got like a coach or anybody, and they want you to give 110 percent, and you think like, what the hell is this? You know,

I can give 100 percent, maybe. But when you're talking about your VO2 max% and you think like what the hell is you know, I can give a hundred percent maybe But when you're talking about your VO2 max and you're saying I'm you know, I'm going at a hundred percent I think some people might just think like oh this person you must be going all Like balls to the wall all out No, definitely like what's my workload to my VO2 max? You can actually you can exceed a hundred percent of your VO to max in terms of the work you're doing, right? Right. And Alex Hutchinson, who is going to be on the podcast very soon, writes about this

very elegantly in his book, Endure, basically 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. You might think you are, but you're not. Wait, wait, wait, wait, wait, I take spin class. I've taken spin classes before and I'm going all out for like 80% of it, you know, or at least the instructor wants me to go all out. Sure, sure. Yeah, instructor is playing games with your mind and if that helps you so be it, but look, you only need to look at the difference between a hundred meter and a two hundred meter sprint. So take the best explosive athletes on the planet, and even by the time you say in bolt is running the two hundred, 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.

He can go faster in the second half because he gets a flying start. But the hundred meter, which is basically a 10-second race, is about the true limit of what all-out means. So I even find this interesting when you consider two variants of Tabata. As you know, there's the 2010 Tabata and the 10-20 Tabata. And you and I both have airb bikes which are great tools for doing that. When I go through cycles of Tabata, which these days I'm not, I'm focusing much more on zone five workouts on both the rowing machine which I didn't get into and also in the stair machine.

But sometimes I just do like a couple Tabata's a week. I mean, 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 Ersawa and Tabata. Fun fact, by the way, Tabata's are not named after the guy who developed the protocol. He was the guy that wrote the paper. Ersawa developed the protocol. They should be called Ersawa's. So the problem with a quote unquote 2010 Tabata is whether consciously or subconsciously, you're actually pacing yourself to complete it, which is what it is. But I think it actually

poses a little bit of difficulty. Okay. I'm surprised you don't actually just say I do Ersawa's and then have people look at it. Look at you. Yeah. Yeah. Dude, Mondays and Fridays Mondays and Fridays is a I just do or saw was. Yeah. People nodding their head. So with that, let's just start with sort of something you've already alluded to. Let's explain

what it is, talk about how much it matters, and then kind of get into some examples. So let's start with a term that many people have heard before, but I don't think most people understand what VO2 max really means. And eventually we're gonna talk about running efficiency and lactate threshold, and we're gonna get into all this stuff.

But let's make sure people understand what VO2 max is, both in an absolute term, and then in a manner that we normalize it by weight. And what it is and what it isn't, how it's measured, how it matters, and maybe we'll even talk about some notable exceptions. So VO2 max is the one physiological parameter that anyone who's involved in endurance has heard of and has some sense of the first order analogy is it's kind of the size of your engine. 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 that will provide energy to move you to do whatever you want to do. So it's a rate. It's how much oxygen per unit time can you process absolutely flat out. Now, the sort of backstory here is it was first sort of disgust or measured in the 1920s by a guy named A.V. Hill, who was actually a very good runner. The observation that he made is if you have someone, you ask someone to go out and run at a gentle pace,

though consume, let's say, two liters of oxygen per minute. Then you tell someone to go out and run at a gentle pace, though consume, let's say, two liters of oxygen per minute. Then you tell them to speed up. Now they're doing three liters of oxygen per minute. You tell them to speed up again. Now they're going pretty much, maybe not as fast as they can, but they're going fast. They're using four liters of oxygen per minute. So you tell them to speed up again, and you measure it and you're like, oh, they're only using

four liters of oxygen a minute, just like last time. Speed up again. oh, they're only using four liters of oxygen a minute, just like last time. So speed up again. And they're still just using four liters of oxygen a minute. There's a plateau. There's a point at which, even though you're working harder, you're not using any more oxygen. And so this plateau looks like it's a physiological limitation. And it probably is, in some sense, you know, it's a controversial thing.

But basically, you've reached a point where no matter how hard you push yourself, you can't get more oxygen. And so you can still go faster because you're starting to use other forms of energy, but this is the limits of your aerobic system. This tells you what it tells you we can get into. It's not clear what it tells you. It tells you exactly what I just said. It tells you how much oxygen you can use. Does that tell you exactly how fast you can run?

No, there are a lot of other factors, but that tells you what sort of aerobic engine you have to play with. I remember in high school, I mean, we would sort of talk about, well, which athletes have the highest VO2 max is at the Norwegian cross-country skiers, is the professional runners and cyclists and things like that.

But people are usually used to hearing these numbers reported not in leaders per minute, but in milliliters per minute per kilogram. So, give an example so people understand those differences, because we usually talk about the outliers as a number that's a bigger number than two leaders or five leaders. It would be, you know, sort of 75, 80 milliliters, pretty just explain people how those are different. Sure. So, 80 milliliters per minute. Explain people how those are different. Sure. So I'll use my own numbers. Typically, when I was tested, I could get about a little bit more than five liters per minute, so 5.15.2 if I remember correctly. Now, if you compared me to a rower, the rower would make me look pathetic, because the rower

would be using seven liters a minute or more. But the roeer is also huge, twice my size or whatever. And so that doesn't necessarily mean that that roeer is better at using oxygen for me because the roeer has way more muscle. And so the roeer is the amount of oxygen reaching any given muscle cell may be lower. So 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. And so the numbers we usually hear

are rather than leaders of oxygen per minute, it's milliliters of oxygen per minute, per kilogram of body weight. So for me, five liters of oxygen per minute, per kilogram of body weight. So for me, five liters of oxygen per minute works out to something like 80 milliliters of oxygen per minute, per kilogram of body 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, an organ and stuff that don't scale. The adipose tissue doesn't matter. I mean, you could argue a better comparison would be total leaders per minute divided by lean mass divided by time, or normalize the time. And then you're at least getting the metabolically active tissue presumably.

Yeah. And there's papers where they do things like, let's divide by weight to the power of 0.68 or 0.7, which is another way of getting it effectively. It's a way of approximating just the lean mass, the metabolically active tissue. And you can go down that rabbit hole, but I suspect you'll want to get to you. It's like at a certain point, it doesn't matter that much anyway. So we don't need to, you can't just measure someone's VO2 max and know how fast they're

going to race. So it's useful, but it's not. Especially for comparing between people. Now comparing within yourself, it tells you something if you've increased or if your VO2 max has decreased. But in that sense, it doesn't matter what you're dividing by. I remember there was a guy that I used to ride with. And this was not that long ago, maybe five or six years ago when I was still,

you know, somewhat competitive at least with myself. Actually, it's funny. 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 mills per mig per gig with my VO2 max. His was 55 to 60, but there was never a day that I could ride faster than him, not one. There's simply, and I always felt like, although we did the test so many times, I kept feeling like the machine must have been broken on him. Like, I knew my 70 was about right because I'd

been tested so much, and that was lower than it had been when I was younger, so it seemed appropriate. But I was always convinced that that there's no way he's only 55. The reality of it is he may well have been, and he may have simply been a far more efficient athlete, which we're going to get into. Before we get to the story of Oscar, Svensson, let's talk a little bit about historically what people have believed the limits are of VO2 max. We don't even have to go very far historically to get into a whole mudslide of confusion and debate and disagreement. There's a lot of places along the way that could in some circumstances be the bottleneck.

Normally, people tend to assume that what is it that causes VO2 max to plateau? Is essentially what I think what we're talking about. And just one thing I should add here, it's like, why is that interesting? It's because you think, well, if you want to measure endurance, just have someone run a mile or whatever,

as hard as they can. But any test like that depends on motivation, depends on whether you pace it right. There's all these factors that come into it. The nice thing about VO2MAX is that in theory, it's independent of motivation. That's why scientists like it, because it doesn't matter if the subject

doesn't really care about the study. If you see a plateau, you know, that's a property of their body and not a product of whether they were excited about the study. So the question is, this plateau, what is it that causes it? And it could be in the lungs, it could be the heart,

it could be the circulation, it could be the muscle's ability to extract it. I don't want to pretend that I know the answer because it's still controversial. The picture that emerges is that almost every part along this cascade is engineered more less to what it needs to be. And so if you perturb any of those elements, you can get limitations. So for example, the conventional wisdom is that your lungs are not a limitation.

You can always breathe enough in. And so then the question is, can you diffuse enough oxygen from your lungs into your bloodstream and so on and so forth? There are situations where, and it's been, 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. There was just a paper published a big review in the last month or two, arguing that, in some cases, the lungs aren't overbuilt, and one of the situations is highly trained endurance athletes. They can be limited by their ability to get enough oxygen in, and 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. You get something called exercise-induced arterial

hypoxemia. So this is usually an issue at altitude, but in elite endurance athletes is actually about half of them exhibited even at sea level. So they're already running into a limitation just in getting oxygen from their lungs to their bloodstream. And then at every stage of the way, there can be limitations if anything is knocked off-kilter. And certainly right down to the ability of the muscles to first extract the oxygen from the bloodstream and then to make use of it metabolically in the mitochondria. So it's there isn't one single answer, which is why you get these debates because everyone is comes, I have evidence that this is the limit. It's like, yeah, but I have evidence that this is the limit and that's the limit and

they're all the limit. Yeah, I've always wanted to see the experiment. It's like, yeah, but I have evidence that this is the limit and that's the limit and they're all the limit. Yeah, I've always wanted to see the experiment where you took a group of athletes. Maybe this has been done. You run them all to max and then you reduce the FIO2 of the incoming oxygen. So normally we do it with room air. So you're getting a fractional inhalation of oxygen is 21%. And the way, of course, just for the listener, the way these things work is the way they're calculating how much oxygen is being consumed is they're measuring the concentration

of oxygen on the way out. So you're calculating the delta. And so I've always thought, well, wouldn't it be interesting to start selectively dropping FIO2, 21%, 20%, 19%, 18%, now presumably if the lungs aren't the limitation, you should still see the same absolute delta, and you could at least start to eliminate one of those variables, which would be FIO2 and capillary exchange. And then you start pointing to some of these other variables. Again, I'm sure somebody has done this experiment, but I don't know what it yielded. Probably not with the fine tooth comb that you're suggesting.

People have compared 21% to 10% or whatever, and 15%. I mean, it's interesting when you go to altitude or the equivalent, when you reduce the amount of oxygen, funny things happen. The first thing you would think would happen is you can't get enough oxygen, so you're going to go anaerobic sooner, you're going to produce more lactate. And yet, the opposite happens. There's something called the lactate paradox. If you try and exercise to exhaustion at lower levels of altitude, you're going to produce more lactate. And yet the opposite happens. There's something called the lactate paradox. If you try and exercise to exhaustion

at lower levels of altitude, you actually give up when your lactate levels are lower than you would at sea level. And there's debate about what causes this and even whether it's a real thing. But the picture that makes sense to me is that these things are not just about how much oxygen is making it to the muscle.

It's also like, what is your brain oxygen level? And so you're getting these other circuit breakers that are starting to come down. They're not 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 going to actually cut off the supply to the muscles. So reduce it in order to make sure that we don't get stupid. This next clip is going to focus on stability. As I mentioned at the outset, with Beth Lewis and Michael Rintalos, we filmed a bunch

of instructional videos to go with this. I can't recommend them enough. It's one thing to hear us talk about these things. It's quite another thing to see the exercises and be able to do them yourself. 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. So for example, when you're picking something up, let's say you have to pick up something in it weighs 60 pounds. Well, you have to exert 60 pounds of force on the world around you. That's Newton's laws tell us that that's what it means to pick up 60 pounds. The idea is you want all of that 60 pounds to be transmitted from your muscles to the ground, lifting this thing up, and you don't want anything dissipating out your back, out your knees, out your hips. And while most of us are born with the ability to do that naturally, it generally gets lost by the time we're in grade school in response to many things, but probably chief among them is a relative lack of activity and a relative abundance of sitting.

And 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 of, as you mentioned, one of them, dynamic neuromuscular stabilization or DNS. 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. And this is sort of one of the root causes of a lot of the chronic injuries a lot of us have. So stability then is probably what I think of as the foundation upon which everything should be done

vis-a-vis exercise. Just yesterday I was actually talking to a patient and she was asking me if she needed to do DNS or if she could continue to work on the Pilates that she has been doing for many years. And my response was that I think a great Pilates teacher is already teaching many of these principles. So I think this is somewhat discipline agnostic, but it's heavily dependent on the practitioner and the student. So I've seen really good Pilates teachers who even though they're using a very different vocabulary than

the one that I use or that the DNS practitioner is used, the results speak for themselves, and those patients do have the correct patterns of movement. They are able to get air fully into their lungs. They're able to get their diaphragm low into their abdomen. They're able to flatten out their pelvic floor, generate concentric robust intra-abdominal pressure that stabilizes every aspect of them. There are other people who either the teacher doesn't have the skill to do that or the teacher does, but it's just not being presented in a way that the student can understand it.

So, this is also one of those things that's iterative. I think one should always be searching for this. Postural Restoration, PRI, DNS, Pilates, these are all different ways that one can come about trying to learn these principles. 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. 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.

Currently, all of the work we do on this front, we've put together many video courses. Those are exclusively for our patients at this point, but as our knowledge expands and our footprint in this space expands, my hope is that we are able to start to create digital curriculum on this type of stuff that can help people who, again, don't have access to somebody. I'm going to be a little bit more focused. I'm going to be a little bit more focused.

We'll end this week's episode with a clip from one of our recent AMAs. I believe episode 32, where I talk about the macro structure of my current training routine. As we come to this end, I want to mention in the intro, it's the first time we've done this, so we'd really like to hear your feedback. Positive and negative, is this something you want to see us do again with other topics?

If so, maybe even suggest some of the topics you'd like to hear. And if not, please be honest with us and tell us not. As I said, it's a lot of work to do this, and we only want to do this if people find this valuable. So thanks so much. I thought it might be helpful for people before we get into some of those specifics. Just what does your current exercise routine look like each week? I know it's always changing, but if you can give people a rough overview, I think that

will be helpful as we get into some of these other questions. Yeah, I mean, the actual macro structure of what I do has not changed much in the last year. The micro structure has changed a lot, meaning the exercises have changed a lot. But the macro structure is that on, let's see, Tuesday, Thursday, Saturday, Sunday, are cardio days.

So Tuesday, Thursday, Sunday are zone two. Saturday is either a zone two, followed by a zone five, it's kind of a separate workout. So each of those are 45 minute zone twos and then kind of like a 30 minute zone five is a separate workout that's done almost immediately after. So basically getting out of bike clothes and putting on stair climbing clothes. Alternatively, I might just do a longer bike ride on Saturday and make

it more of an anaerobic workout. Then from a lifting standpoint, it's Monday, Wednesday, Friday, Sunday is lifting. And about, I don't know, nine months ago, I switched to an upper body lower body split. I used to lift three days a week and do upper body lower body every day. So each day I was doing kind of pushing, pulling and hip-hinging. And now the lower body component, I think, is Monday, Friday, the upper body is Wednesday, Sunday.

And I always lift after doing cardio because I think the reverse has been demonstrated to a road strength training gains. Peter, what happens if you miss a day? Because I noticed you didn't say day one, day two, day three, you were very distinct on the days of the week. I know you typically don't miss a day, but if you miss Wednesday, do you just scrap those exercises and then just continue with your program or are you trying to make up in the interim? No, like yesterday, Sunday would have been a ride followed by a lift day, but I was on the track the whole day and I knew that in advance. So I just ended up doing that lift on Saturday, but obviously was short changed on the zone two for yesterday. was short-changed on the zone two for yesterday. So 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. And what about timing? Do you have a preference morning, afternoon, evening? Is that flexible as well within kind of your schedule? A little more flexible on weekends, but 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,

around 7.15, 7.30, that's one I'll typically live. Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth, exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now, for that end, membership benefits include a bunch of things.

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