#307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.

In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it’s too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.

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We discuss:

• Key points about starting exercise as an older adult [2:45];
• Why it’s never too late to begin exercising and incorporating the four pillars of pillars of exercise [5:45];
• The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];
• The decline of VO2 max that occurs with age [15:30];
• Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];
• Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];
• Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];
• The critical role of Vo2 max in longevity [36:45];
• How to introduce VO2 max training to older or deconditioned individuals [46:15];
• Options for performing zone 2 and VO2 max training [53:45];
• The ability to make gains in strength and muscle mass as we age [57:00];
• How to implement strength training for older individuals [1:01:00];
• Advice for avoiding injury when strength training [1:07:30];
• Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];
• Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];
• Improving bone mineral density through resistance training [1:24:30];
• The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];
• Parting advice from Peter [1:34:00]; and
• More.

Key points about starting exercise as an older adult [2:45] 

About this episode:

• This episode is designed like an AMA but available to everyone.
• It addresses common questions from people aged 50+ about starting exercise.
• Aimed at those who haven’t trained before, worry about injuries, or think it’s too late to make a difference.
• Although the focus is on people aged 50+, the advice applies to anyone deconditioned and looking to start exercising.
• Younger listeners can share this episode with their older parents to encourage them to start exercising.
• This conversation is intended to mimic how Peter would speak to his patients.

Key Points on starting exercise as an older adult:

• Peter is himself in the over 50 camp
• And 50 is a significant turning point for starting exercise, but another crucial point is 65+.
• At 65+, people typically experience noticeable reductions in strength and vestibular changes, which increase the risk of falling.
• The episode will address concerns specific to the 60-65 age group and emphasize the importance of being mindful of these changes.
• Recommendations will cater to the unique needs of older, untrained individuals to help them start exercising safely and effectively.

Why it’s never too late to begin exercising and incorporating the four pillars of pillars of exercise [5:45]

What do you say to the person who asks, “Is it too late for me to start doing this? Is it too late for me to worry about this and start making changes?”? 

• Peter has spoken at length about the importance of exercise for longevity
• He’s had the same response largely for many years now
  • Some people will have already heard him say this on another podcast, but truthfully I haven’t come up with a better analogy yet

The analogy of saving for retirement 

• So if you could be talking to somebody who’s in high school or college and you were talking to them through the lens of being a financial advisor, their fiduciary, what would you say? 
• You would say, “Listen, there’s this really magical thing called compounding that Einstein basically said was the 8th wonder of the world. And you want to use it to maximum advantage.”
• To do that, you should start saving immediately
• When you get your first job, you should be saving
• If not, certainly by the time you get out of college, you should be saving
• And if you do that, you don’t really have to be that brilliant about it
  • If you put all of your savings into an index fund at the age of 22, the probability that you are not going to be set when you retire is so low
• But what happens if you’re talking to somebody who’s 45 and due to life circumstances they just haven’t been able to save
  • They haven’t made enough money to even have some disposable saving income 
  • Or they’ve saved and lost or invested badly or something like that
• Would you say, “Well, too bad?” No, of course you wouldn’t

The point here is it is never too late to start saving for retirement, but you must understand something which is the longer you wait to start, the more you’re likely going to have to save, the greater return you’re going to need, and therefore probably the greater risk you’re going to take 

“It’s never too late to start saving and it’s never too late to start exercising. But I want the message to be ‘Don’t wait’”‒ Peter Attia  

• Peter wants the message to be: don’t wait because of some reason and say, “Well, I’m going to wait till I’m older because…”

Remind people of your 4 pillars and how you think about each of those pillars individually as someone is aging? 

• It’s basically stability, strength, aerobic efficiency [zone 2], and peak aerobic output [zone 5]
• You could argue, “Well, those are just kind of a continuum.”
  • Peter would say “Sure, but let’s not get lost in the semantics. Those things, if you define them the way I do, kind of constitute everything.”
•  Stability is kind of a broad term, but embedded within stability is everything that enables you to dissipate force safely
  • Everything that enables you to have balance and flexibility because believe it or not, those come from stability
  • If you have balance by definition, you have stability
  • You can’t have balance without stability, you can’t actually have flexibility without stability

We think of training as having a purpose, and different types of training factor into these different activities 

• There are some types of training that myopically hit 1 of these things
• If you’re riding a bike (like Peter does for zone 2 training), it is a very one-dimensional activity
  • There are no degrees of freedom outside of you pedaling the crank
  • And if you do it at a fixed power output that meets the criteria for zone 2, then you’re very narrowly targeting that
    • You’re doing very little for any of the other systems
• Conversely, there are other types of training like rucking with a heavy weight on hills, you’re actually targeting all 4 of those elements
  • That requires tremendous stability, moments of strength, large segments of aerobic base or aerobic efficiency, and moments of peak aerobic output and even anaerobic output
• That’s just something to keep in mind

The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00]

A few graphs Peter thinks are important 

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