← The Peter Attia Drive

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

Jun 24, 2024 1h 39m 31 insights
<p><a href="https://peterattiamd.com/exerciseforagingpeople/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=240624-pod-exerciseforagingpeople&amp;utm_content=240624-pod-exerciseforagingpeople-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=240624-pod-exerciseforagingpeople&amp;utm_content=240624-pod-exerciseforagingpeople-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=240624-pod-exerciseforagingpeople&amp;utm_content=240624-pod-exerciseforagingpeople-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>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.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Key points about starting exercise as an older adult [2:45];</li> <li>Why it's never too late to begin exercising and incorporating the four pillars of exercise [5:45];</li> <li>The gradual, then sharp, decline in muscle mass and activity level that occur with age [10:00];</li> <li>The decline of VO2 max that occurs with age [15:30];</li> <li>Starting a training program: exercise variability, movement quality, realistic goals, and more [18:30];</li> <li>Improving aerobic capacity: the malleability of the system, the importance of consistency, and setting long-term fitness goals [25:15];</li> <li>Starting cardio training: base building, starting with low volume, and zone 2 training [30:45];</li> <li>The critical role of VO2 max in longevity [36:45];</li> <li>How to introduce VO2 max training to older or deconditioned individuals [46:15];</li> <li>Options for performing zone 2 and VO2 max training [53:45];</li> <li>The ability to make gains in strength and muscle mass as we age [57:00];</li> <li>How to implement strength training for older individuals [1:01:00];</li> <li>Advice for avoiding injury when strength training [1:07:30];</li> <li>Risk of falls: the devastating consequences and the factors that increase fall risk [1:12:15];</li> <li>Mitigating fall risk: the importance of foot and lower leg strength, ankle mobility, and balance [1:19:45];</li> <li>Improving bone mineral density through resistance training [1:24:30];</li> <li>The importance of protein in stimulating muscle protein synthesis, especially in older adults [1:31:00];</li> <li>Parting advice from Peter [1:34:00]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Start Exercising Now, Don’t Delay

Begin exercising immediately, regardless of age, because the longer you wait, the more effort and “risk” (intensity) will be required to achieve significant benefits, similar to compounding in financial savings. This principle applies universally, but especially to those 50+.

2. Prioritize High VO2 Max

Strive for a high VO2 max throughout life, as it is the single most important biomarker for lifespan, significantly reducing all-cause mortality risk. A VO2 max of ~30 in your final decade is crucial for an unencumbered life, requiring consistent high fitness levels in midlife.

3. Engage in Strength Training

Incorporate resistance training into your routine regardless of age, as it can significantly increase muscle strength and hypertrophy, even in individuals over 80. This is crucial for offsetting age-related muscle loss and improving overall function.

4. Foster Positive Exercise Habits

When starting exercise, especially if deconditioned, prioritize making the experience positive and enjoyable for the first 2-3 months. The goal is to build a sustainable habit and an appetite for more activity, rather than focusing solely on objective metrics.

5. Progress Exercise Intensity Gradually

To minimize injury risk, especially as you age, prioritize increasing exercise frequency, then duration, and lastly intensity. Avoid rapid increases in load or difficulty, as progressing too quickly is a primary cause of injury.

6. Prioritize Movement Quality, Variability

For new or returning exercisers, especially those over 50, focus on exercise variability and high-quality movement rather than just increasing load or intensity. This minimizes injury risk and builds foundational neuromuscular control, which is critical as you age.

7. Begin Cardio with Zone 2

For individuals new to exercise, start with Zone 2 cardio training to build an aerobic base before incorporating high-intensity interval training. This can involve walking, incline walking, or cycling at a steady state that allows for conversation.

8. Gradually Introduce VO2 Max Training

Once a solid Zone 2 aerobic base is established, gradually introduce VO2 max training by adding short, intense intervals (e.g., 1-minute bursts) to existing Zone 2 workouts. This helps assess safety and form before progressing to dedicated VO2 max sessions.

9. Begin Strength Training Safely

When starting strength training, especially if new or deconditioned, prioritize muscular endurance by performing 15-20 repetitions per exercise with lighter weights. Begin with bodyweight exercises and machines before progressing to free weights to build foundational strength and stability safely.

10. Increase Protein Intake

Consume at least 1.6 grams of protein per kilogram of body weight daily, increasing this amount as you age due to anabolic resistance, which makes muscles less sensitive to amino acids. Aim for a minimum of 20 grams of protein per serving to stimulate muscle protein synthesis.

11. Address Fall Risk Factors

Actively mitigate fall risks by addressing lower limb weakness, balance issues, foot pain, and ensuring proper footwear. Be mindful of medication side effects like orthostatic hypotension, which can increase the likelihood of falls.

12. Strengthen Toes to Reduce Falls

Prioritize strengthening your toes, as toe strength is the biggest predictor of falling in individuals over 65. Perform specific exercises to ensure your great toe can push down with at least 10% of your body weight and toes 2-5 with 7%.

13. Improve Calf Strength, Ankle Mobility

Enhance lower leg strength by training both gastroc and soleus muscles, often underdeveloped in many individuals. Improve ankle mobility, particularly dorsiflexion, by practicing exercises like walking downstairs with toes pointed perfectly forward, which is crucial for balance and preventing falls.

14. Heavy Resistance Training for Bone

To improve bone mineral density (BMD), particularly in older adults and postmenopausal women, engage in heavy resistance training. Studies show that even twice-weekly, 30-minute sessions with 5 sets of 5 reps at over 85% of one-rep max can significantly increase lumbar spine and femoral neck BMD.

15. Develop Neuromuscular Control

Focus on developing neuromuscular control, including the ability to control the eccentric (lowering) phase of movements, rather than just lifting heavy weights. Incorporate coordination drills like agility ladders and ball tosses to enhance control and reduce injury risk.

16. Integrate Stability Exercises

Alongside strength training, incorporate exercises that improve intra-abdominal pressure, breathing mechanics, and muscle recruitment (e.g., DNS principles). This enhances overall stability and control, making subsequent lifting safer and more effective.

17. Practice Getting On/Off Floor

Regularly practice movements that involve getting on and off the floor unassisted, such as DNS baby positions. This is a crucial functional skill for older individuals, improving mobility and confidence.

18. Assess Zone 2 with Talk Test

To determine your Zone 2 heart rate, use the talk test (you can speak full sentences but not sing) or the Maffetone formula (180 minus your age, subtracting 10 if you’re very new to exercise). This helps ensure you’re training at the correct intensity for aerobic base building.

19. Maintain Exercise Consistency

While older individuals can achieve significant aerobic gains, they lose these gains much faster with inactivity compared to younger individuals. Therefore, consistent exercise is paramount to sustain improvements in VO2 max and endurance.

20. Progress Cardio Frequency First

After 8-12 weeks of consistent Zone 2 training, gradually increase the frequency of sessions (e.g., from two to three or four days a week) before significantly extending the duration of each session. Eventually, aim for sessions of at least 45 minutes.

21. Perform VO2 Max Intervals

For dedicated VO2 max training, aim for intervals lasting 3 to 8 minutes at a steady, high intensity that leaves you truly exhausted by the end. This targets the specific energy system most effectively for peak aerobic output.

22. Avoid Holding Cardio Machine Handles

When using incline treadmills or StairMasters for Zone 2 training, avoid holding onto the handles. This ensures you are not inadvertently reducing the load and allows for a more consistent and effective workout.

23. Prioritize Walking for Cardio

If you are a beginner over 65 and have no strong preference, consider starting Zone 2 cardio with walking on a treadmill or outdoors. Walking is a fundamental bipedal skill that offers broader benefits than cycling alone.

24. Preserve Type 2 Muscle Fibers

Focus on training that preserves Type 2 muscle fibers, which are responsible for power and reactive speed, as their atrophy is a hallmark of aging. This is critical for maintaining functional independence and reducing fall risk.

25. Utilize Safer Strength Substitutions

Instead of high-risk exercises like traditional barbell bench presses or heavy deadlifts for beginners, opt for safer alternatives such as single-leg variants for lower body or floor presses for upper body. These options reduce range of motion and weight, minimizing injury potential.

26. Incorporate Daily Light Activity

Aim to do something active daily, even if it’s just a 15-minute walk after dinner or 5,000 steps on flat ground. This builds consistency and a foundational habit for further exercise progression.

27. Utilize Isometric Exercises Safely

For individuals new to conditioning, incorporate isometric exercises (e.g., wall sits) as they are generally safer than isotonic (movement-based) strength movements. This helps build strength without the higher injury risk of dynamic movements.

28. Consider Light Rucking

If slightly more conditioned, introduce light rucking (e.g., 20 pounds on your back) to move under a bit of load. This can challenge multiple pillars of exercise simultaneously.

29. Adopt Diverse Exercise Portfolio

Develop a varied exercise routine that includes resistance training (progressing beyond bodyweight) and challenges different cardio energy systems (e.g., modest pace, brisk walking, uphill walking). This holistic approach, combined with enjoyment and injury prevention, ensures long-term success.

30. Avoid High-Risk Exercises

Steer clear of extremely high-intensity, high-risk exercises such as Tabata deadlifts, especially if you are older or less conditioned. Prioritize safety and sustainable training methods to minimize injury and ensure long-term participation in exercise.

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