# Outlive ## Metadata * Author: [Peter Attia MD](https://www.amazon.comundefined) * ASIN: B0B1BTJLJN * ISBN: B0BZTCPLP6 * Reference: https://www.amazon.com/dp/B0B1BTJLJN * [Kindle link](kindle://book?action=open&asin=B0B1BTJLJN) ## Highlights while I am working out this way, using a small handheld lactate monitor, to make sure my pacing is correct. The goal is to keep lactate levels constant, ideally between 1.7 and 2.0 millimoles. This is the zone 2 threshold for most people. If I’m working too hard, lactate levels will rise, so I’ll slow down. — location: [3952](kindle://book?action=open&asin=B0B1BTJLJN&location=3952) ^ref-17492 --- you know your maximum heart rate—not estimated, but your actual maximum, the highest number you’ve ever seen on a heart rate monitor—your zone 2 will correspond to between approximately 70 and 85 percent of that peak number, depending on your fitness levels. — location: [3958](kindle://book?action=open&asin=B0B1BTJLJN&location=3958) ^ref-39574 --- Even when we are at rest, our lactate levels tell us much about our metabolic health. People with obesity or other metabolic problems will tend to have much higher resting lactate levels, a clear sign that their mitochondria are not functioning optimally, because they are already working too hard just to maintain baseline energy levels. — location: [3974](kindle://book?action=open&asin=B0B1BTJLJN&location=3974) ^ref-52329 --- Millán and other exercise physiologists, it seems that about three hours per week of zone 2, or four 45-minute sessions, is — location: [4006](kindle://book?action=open&asin=B0B1BTJLJN&location=4006) ^ref-47324 --- Four times a week, I will spend about an hour riding my stationary bike at my zone 2 threshold. — location: [4009](kindle://book?action=open&asin=B0B1BTJLJN&location=4009) ^ref-17228 --- measure your output in watts at this level of intensity. (Many stationary bikes can measure your wattage as you ride.) You take your average wattage output for a zone 2 session and divide it by your weight to get your watts per kilogram, which is the number we care about. So if you weigh 60 kilos (about 132 pounds) and can generate 125 watts in zone 2, that works out to a bit more than 2 watts/kg, which is about what one would expect from a reasonably fit person. These are rough benchmarks, but someone who is very fit will be able to produce 3 watts/kg, while professional cyclists put out 4 watts/kg and up. — location: [4011](kindle://book?action=open&asin=B0B1BTJLJN&location=4011) ^ref-14271 --- Typically, for patients who are new to exercising, we introduce — location: [4029](kindle://book?action=open&asin=B0B1BTJLJN&location=4029) ^ref-40358 --- VO2 max training after about five or six months of steady zone 2 work. — location: [4030](kindle://book?action=open&asin=B0B1BTJLJN&location=4030) ^ref-12117 --- have all my patients undergo VO2 max testing and then train to improve their score. — location: [4032](kindle://book?action=open&asin=B0B1BTJLJN&location=4032) ^ref-40611 --- by supplementing our zone 2 work with one or two VO2 max workouts per week. — location: [4106](kindle://book?action=open&asin=B0B1BTJLJN&location=4106) ^ref-12685 --- VO2 max intervals are a bit longer, ranging from three to eight minutes—and a notch less intense. I do these workouts on my road bike, mounted — location: [4108](kindle://book?action=open&asin=B0B1BTJLJN&location=4108) ^ref-39760 --- The tried-and-true formula for these intervals is to go four minutes at the maximum pace you can sustain for this amount of — location: [4110](kindle://book?action=open&asin=B0B1BTJLJN&location=4110) ^ref-23202 --- time—not an all-out sprint, but still a very hard effort. Then ride or jog four minutes easy, which should be enough time for your heart rate to come back down to below about one hundred beats per minute. — location: [4111](kindle://book?action=open&asin=B0B1BTJLJN&location=4111) ^ref-36823 --- Repeat this four to six times and cool down. — location: [4112](kindle://book?action=open&asin=B0B1BTJLJN&location=4112) ^ref-44580 --- single workout per week in this zone will generally suffice. — location: [4123](kindle://book?action=open&asin=B0B1BTJLJN&location=4123) ^ref-45983 --- We measure BMD in every patient, every year, looking at both of their hips and their lumbar spine using DEXA. — location: [4171](kindle://book?action=open&asin=B0B1BTJLJN&location=4171) ^ref-40884 --- there is an enormous body of literature linking better grip strength in midlife and beyond to decreased risk of overall mortality.[*5] The data are as robust as for VO2 max and muscle mass, in fact. Many studies suggest that grip strength—literally, how hard you can squeeze something with one hand—predicts how long you are likely to live, while low grip strength in the elderly is considered to be a symptom of sarcopenia, the age-related muscle atrophy we just discussed. In these studies, grip strength is likely acting as a proxy for overall muscle strength, but it is also a broader indicator of general robustness and the ability to protect yourself if you slip or lose balance. If you have the strength to grab a railing, or a branch, and hold on, you might avoid a fall. Surprisingly, given the extent to which fitness and gym-going have become so commonplace in our culture in the last few decades, American adults actually seem to have far weaker grip strength—and thus less muscle mass—than they did even a generation ago. In 1985, men ages twenty to twenty-four had an average right-handed grip strength of 121 pounds, while in 2015, men of the same age averaged just 101 pounds. This suggests that people now in their thirties are entering midlife with much less strength — location: [4242](kindle://book?action=open&asin=B0B1BTJLJN&location=4242) ^ref-50591 --- Training grip strength is not overly complicated. One of my favorite ways to do it is the classic farmer’s carry, where you walk for a minute or so with a loaded hex bar or a dumbbell or kettlebell in each hand. (Bonus points: Hold the kettlebell up vertically, keeping your wrist perfectly straight and elbow cocked at ninety degrees, as though you were carrying it through a crowded room.) — location: [4256](kindle://book?action=open&asin=B0B1BTJLJN&location=4256) ^ref-11966 --- One of the standards we ask of our male patients is that they can carry half their body weight in each hand (so full body weight in total) for at least one minute, and for our female patients we push for 75 percent of that weight. This is, obviously, a lofty goal—please don’t try to do it on your next visit to the gym. Some of our patients need as much as a year of training before they can even attempt this test. In general, we urge our new patients to begin with far less weight than they have lifted in the past, sometimes even dropping down to body weight exercises at first. As we will see in the next chapter, on stability, it is far more important to learn and practice ideal movement patterns than to be pounding heavy weights all the time. That said, a farmer’s carry is pretty straightforward (weight in each hand, arms at sides, walk). The most important tip is to keep your shoulder blades down and back, not pulled up or hunched forward. If you are new to strength training, start with light weights, even as low as ten to fifteen pounds, and work up from there. Another way to test your grip is by dead-hanging from a pull-up bar for as — location: [4259](kindle://book?action=open&asin=B0B1BTJLJN&location=4259) ^ref-63140 --- Here we like to see men hang for at least two minutes and women for at least ninety seconds at the age of forty. (We reduce the goal slightly for each decade past forty.) — location: [4270](kindle://book?action=open&asin=B0B1BTJLJN&location=4270) ^ref-8162 --- the websites for DNS (www.rehabps.com) and the Postural Restoration Institute (PRI) (www.posturalrestoration.com), the two leading exponents of what I’m talking about here. Stability is an integral part of my training program. Twice a week, I spend an hour doing dedicated stability training, based on the principles of DNS, PRI, and other practices, with ten to fifteen minutes per day on the other days. — location: [4472](kindle://book?action=open&asin=B0B1BTJLJN&location=4472) ^ref-47127 ---