During the holiday I caught up on some books on my must read list. Outlive- The science and art of longevity, by Dr Peter Attia was at the front of the list. In this book, Dr Attia explains his strategic and science based approach to expending lifespan, while also improving our physical, mental and emotional health.
One of his key arguments is that our current medical model has been very effective at increasing lifespan over the last few hundred years, by better management of infection, pathogens and communicable diseases. However our healthspan is generally impacted in our last 20-30 years of life, where many in our community are afflicted with chronic disease that impact function and quality of life.
His rationale is that medicine needs to become more proactive in monitoring and early intervention of the “four horsemen” of chronic disease in ageing. The odds are you will die of one of the following:
Metabolic dysfunction- Insulin resistance & type 2 diabetes
Cardiovascular disease- Heart attack & stroke
Cancer- (colon, breast, prostate, lung, pancreatic, skin…)
Neurodegenerative disease. Think Alzheimer’s and dementia
In the book Dr Attia explores ways individuals can optimize their healthspan by focusing on metabolic health factors through evidence-based research and practical applications. It is his view that metabolic dysfunction proceeds and is a factor in the three other horsemen
Although there are genetic factors that influence and predispose us to certain disease, the field of epigenetics has confirmed how our environment can switch certain genes on and off. Our lifestyle, what we do and don’t do (day in day out), is one key factor that influences the expression and progression of these chronic diseases. Through the book, Peter Attia goes into great detail on the science and the current understanding of these “four horsemen” and then goes into practical tools to aid the reader in prevention. Besides explaining various pharmacological and procedural intervention, the second half of the book describes lifestyle and behavioural modifications.
In his view there are five tactical domains that can be addressed in order to alter someone’s health. The first is exercise which he believes to be the most potent domain in terms of someone’s health span. In my “Being Vital” program this is like my vital pillar Move. Next is diet or nutrition, or as he prefers to call it “nutritional biochemistry” (my vital pillar Nourish). The third domain is sleep, which until recent times has been underappreciated by medicine (my vital pillar Recover). The fourth domain encompasses tools and techniques to manage and improve emotional health (my vital pillar Connect and Psychological Flexibility). The fifth domain consist of “exogenous molecules”- think of the drugs, supplements and hormones that are prescribed by doctors. This is obviously out of my scope of service.
It was pleasing to read that a leading doctor in the longevity space reaffirmed my “Vital Pillars of Wellbeing”. Having prescribed exercise over the last 30 years, I was also excited to hear Dr Peter Attia refer to exercise as “the most powerful longevity drug.” Further he adds:
“More than any other tactical domain we discuss in this book, exercise has the greatest power to determine how you will live out the rest of your life. There are reams of data supporting the notion that even a fairly minimal amount of exercise can lengthen your life by several years. It delays the onset of chronic disease, pretty much across the board, but it is also amazingly effective at extending and improving healthspan. Not only does it reverse physical decline, which i suppose is somewhat obvious, but it can slow or reverse cognitive decline as well. It also has the benefits in terms of emotional health, although those are harder to quantify. So if you adopt only one new set of habits based on reading this book. It must be the realm of exercise.”
In regards to exercise, we can divide it into its various components of fitness: Cardiovascular (efficiency and maximal output), strength, stability, mobility and balance. All of these are referred to in the book, with evidence based research backing up the importance of all contributing to quality longevity. Higher Vo2 max, grip strength and muscle mass are associated with lower mortality risk across the board. They are all highly correlated with longevity!
This should all be no surprise. The higher your VO2 max, the stronger your heart and more efficient your cardio vascular system. This results from behaviours and habits that regularly place a demand on your heart, lungs and muscle cells, making them more efficient and reducing the risk of many of the four horsemen. Similarly, having stronger grip and more muscle mass indicates that you are regularly engaged in activities that put a demand on your muscles and bones to keep strong. We know that regular resistance training counteracts the usual steady decline of muscle mass with age. This not only improves metabolic health, but also allows you to have the strength to do the activities you want to do. It also prevents falls and possible fractures. Falls are by far the leading cause of accidental deaths in those aged sixty five and older (and this is without counting the people who die 3-12 months after a non-fatal, but still serious fall that pushes them into a long painful decline).
The science is clear. In order to experience “quality longevity” you need to be proactive in developing a routine of regular movement and cultivate the various components of fitness. Because there is normally (but not necessarily) a steady decline with age, we need to get busy in building redundancy so that we can function at our best in our later years. Enter the “Centenarian Decathlon”- a framework that Dr Attia uses to organise patients’ physical aspirations for the later decades of their lives. Think about this as the ten most important physical tasks you will want to be able to do for the rest of your life. They may reflect your personal interest or activities of daily living. This can be useful because it helps you visualise with great precision, exactly what kind of fitness you need to build and maintain as you get old and helps develop a template for your training.
1. Hike 3km on a hilly trail
2. Get up off the floor under your own power, using a maximum of one arm for support
3. Pick up a child from the floor
4. Carry two 3kg bags of groceries for five blocks
5. Lift a 7km suitcase into the overhead compartment of a plane
6. Balance on one leg for 30 seconds
7. Open a jar
8. Climb four flights of stairs in three minutes
9. Do thirty consecutive rope skips
10. Play 9 rounds of golf
One purpose of the "Centenarian Decathlon" is to help redefine what is possible in our later years and wipe away the assumption that most people will be weak and incapable at that point in their lives. I am keen to abolish this stereotype and create a new narrative- Are you?
Over the school holidays I took time to rest, reflect and reset. Not only was it a time to catch up on a few books, it enabled me to be flexible and creative with my exercise routine. Having escaped the Melbourne winter, I was lucky to enjoy some ocean swimming. This became part of my new holiday workout routine. A 1km swim from point to flags, exit the water and enjoy a warm down walk along the beach. Every second day I would also maintain my resistance workout, with a body weight exercise session with some gymnastic moves thrown in for good measure.
I forgot how much I enjoyed swimming in the open water. The sun filtering through the waves, the gentle rock of the swell beyond the wave zone, and the fish, turtles and other marine creatures keeping me company. Swimming was something I engaged in regularly 25 years earlier when training for triathlon, and is something I am keen to try again, now that my marathon days are behind me.
When swimming you cannot but become mindful of your movement and environment. The cyclical nature of stroke, glide, kick and breath helps centre your mind- a moving mediation in a glistening blue space. For me exercise is more than physical heath, it’s the vital fuel I need to maintain emotional health. Feel free to check out my short presentation on Moving for mental and cognitive and health. This is one of the modules in my Move pillar in the Being Vital Coaching Program.
On a final note, my relationship to exercise has developed and changed over the years. In my early years it was more about aesthetic. As I journeyed, I discovered how exercise helped with my anxiety and build emotional resilience. Now that I have entered my sixth decade, I am more mindful of how activity can help me maintain function and do the things I love. Walking up a mountain with a pack and skis in a natural setting being one such thing. What I have learnt is that bodies change. I now need to be more careful when moving heavy objects in the garden. I have mourned my ability to run long distance as my calfs have deteriorated. However, as one metaphorical door closes another opens. Reengaging with my swimming is one such example. Our bodies are designed to move. From my perspective, It's about being accepting, flexible and proactive to stay in motion. And, to be grateful for this gift that so many don't have the pleasure of experiencing. J.