To recap, “Longevity” is a function of lifespan and Healthspan. Healthspan is the number of years you can preserve the essential elements of good quality life. The good news is that the measures that lead to a longer healthspan which we want to achieve, typically result in a longer lifespan.
These are:
- Physical function. Delaying the decline in stability, strength, muscle mass and bone density, flexibility, aerobic efficiency and your maximum ability to utilise oxygen in the muscles measured as VO2 Max.
- Cognitive decline. Delaying the natural decline in memory, higher functioning, processing speed which can progress abnormally in dementia and mild cognitive dysfunction.
- Emotional wellbeing. It is said that our peak happiness is in your 40s. This can decline as we lose purpose, social standing and support and relationships with friends. It is important to address this.
I will cover all of these in detail future blogs. We will focus first on physical exercise, the most powerful drug in our armoury against Peter Attia’s four ‘horsemen’ (heart disease, cancer, neurodegenerative diseases including dementia and metabolic syndrome/ diabetes). No drug combination can match the preventative benefits of exercise.
Why Is Exercise Important to Longevity?
Exercise is important not only in building muscle bulk and strength. It also reduces the risk of dementia1, cancer2, heart disease3 and insulin resistance4, (which leads to diabetes as we will discuss in future blogs).
In deciding what you want to achieve, Peter Attia suggests we look at taking part in the Centenarian Decathlon. By this he means, what ten things would you like to be able to do in your old age?
Most people are very unrealistic in their expectations. They look at their elderly relatives decline but assume it will not happen to them. It certainly need not happen early but in order to ensure you achieve the aims of the decathlon you must start to prepare now. Our aim is to shift by one or more decades, the period of decline typically experienced in our last decade.
Some examples suggested by Peter are:
- Picking up a child from the ground
- Lifting your luggage and placing it in an overhead bin on an airplane
- Carrying your groceries up four flights of stairs
- Getting up off the ground, from your back, with the support of only one hand.
Some people will add, skiing, playing golf, running. In planning we need to be aware of where we are currently and where we can expect to be in 20 or 30 years from now.
What Are The Best Forms of Exercise for Longevity?
There are four categories of exercise that Peter believes provide the most value.
- Stability: Stability gives us the steady base from which to perform exercise and reduces the likelihood of falling. Hip fracture after the age of 65 has a huge impact on health Span and the risk of early death5. Bone density and stability are crucial to maintain. HRT is associated with reduced all-cause mortality (39%) and Ischaemic heart disease in women (32%) where it is started below the age of sixty and within 10 years of the menopause6. It is also associated with preservation of bone density7 and reduces the risk of bowel cancer8.
- Strength: Resistance training is important in maintaining muscle mass. There is a direct correlation between muscle mass and hand grip and all-cause mortality. The lowest 25% of the population in regard to strength and muscle mass have a four times greater risk of dying in the next year than the highest 5%9.
- Zone 2 training: As a guide, Zone 2 is the highest level of exercise you can perform and still be able to talk (it is defined scientifically as the level of exercise that can be sustained whilst still keeping lactate levels below 2mmol/litre). This is a measure of aerobic efficiency.
- VO2 max (maximum aerobic output): Your VO2 max mentioned above refers to the maximum rate at which your muscles can extract oxygen from your blood and put it to metabolic use to generate energy. It is the measure that is most highly associated with longevity.
If you have three hours a week available for training, you might spend an hour on Zone two training, 30 minutes on stability exercises, 30 minutes on VO2 max training (usually about 30% higher output as measured by watts on the bicycle with four-minute pulses) and an hour on building muscle with resistance training.
To support your muscle build up you should ensure you take enough protein in your diet, typically aim at 1 gram per kilo of body weight.
How Can I Improve My VO2 Max?
Peter calculates the VO2 Max of all his patients and monitors it annually for improvement or decline. VO2 max is usually performed on a bicycle with a mask over the mouth and nose. You cycle until you achieve your maximum level of exertion. We can then calculate the VO2 max to get an idea of the efficiency of the muscles in utilising oxygen.
The great news is we can improve our VO2 max with exercise rather than watch it steadily decline. Peter gives an example of a centurion who at the age of 103 continued to both improve his VO2 max by cycling but also to beat his previous records achieved a few years earlier. The University of Kent offer VO2 max testing.
Does Genetics Play A Role In Longevity?
People who achieve the age of 100 clearly have a leg up from their genes but when we look at their genes, there are rarely similarities between different centenarians. However, the brother of a man achieving the age of 100 has a 17 times higher chance of also achieving 100 than the general population. Women are more likely to reach this age, but siblings benefit slightly less than the case in men10. However, there are some genes that are known to be related to longevity. What we are aiming to do is mimic the benefit that these genes give centenarians, even when we do not inherit these genes ourselves.
If you know your VO2 max, you can predict the expected decline with age (if you do not take measures to maintain current levels). You can then predict which of your list of important activities will be achievable if you do nothing. This will, hopefully, incentivise you to do something about it now.
For more detail go to Peter Attias excellent book ‘Outlive’ and his podcasts, ‘The Drive’ from which this advice is taken.
Dr Allan Fox, Private GP Healthcare in Canterbury.
References
- Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging, J. Eric Ahlskog, PhD, MD, Yonas E. Geda, MD, MSc, Neill R. Graff-Radford, MBBCh, FRCP, and Ronald C. Petersen, PhD, MD ↩︎
- Does physical activity prevent cancer?, D.Batty ↩︎
- Exercise for Prevention and Relief of Cardiovascular Disease: Prognoses, Mechanisms, and Approaches, Danyang Tian and Jinqi Meng ↩︎
- Update on the effects of physical activity on insulin sensitivity in humans, Stephen R Bird and John A Hawley ↩︎
- Hip fracture as risk factor for mortality in patients over 65 years of age. Case-control study,J Negrete-Corona, J C Alvarado-Soriano, L A Reyes-Santiago ↩︎
- Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It’s About Time and Timing, Howard N. Hodis, MD and Wendy J Mack, PhD ↩︎
- Effect of hormone therapy on the risk of bone fractures: a systematic review and meta-analysis of randomized controlled trials, Linlin Zhu, Xinyan Jiang, Yuhong Sun, Wenhuan Shu ↩︎
- Hormone replacement therapy and the risk of colorectal cancer: a meta-analysis, K Nanda, L A Bastian, V Hasselblad, D L Simel ↩︎
- Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans, Eun-Jung Bae, Na-Jin Park, Hae-Sook Sohn, and Yun-Hee Kim ↩︎
- Life-long sustained mortality advantage of siblings of centenarians, Thomas T. Perls et al ↩︎
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