By Sophy Robinson
Sophy is a former trustee of Humanists UK and she has worked for many years as a performance coach in large global corporate and UK public sector organisations. In this article, she explains why she is a convert to Peter Attia’s “Training 101” programme.
“What in the world is a centenarian decathlon?” asks Peter Attia in his best-selling book Outlive (2023). The book’s subheading is The science and art of longevity, but the focus is really on the concept of “healthspan”. How can human beings live healthier, more active and fulfilling lives in the final 20-30 years before the grim reaper knocks on the door?
This topic was covered earlier this year in the April edition of Humanistically Speaking with features on the top 50 things to do to stay healthier for longer, and a delve into futuristic technological interventions which might slow down or reverse the ageing processes. So what extra can we learn from Peter Attia? I think his approach is congruent with the principles of humanism and it's helpful by being based on practical things we can do now, with very specific recommendations:
He uses science to question and cut through the noise in a world of the latest fads in diets and exercise programmes, and he always seem to be open to new data and willing to change his views.
His recommendations are based on evidence about causation rather than correlations.
We are encouraged to be aspirational and positive, and set goals around a vision of the life we would like to be living in our 90s.
He writes, “One of my core principles is that the only way to create a better future for yourself – to set yourself on a better trajectory – is to start thinking about it and taking action NOW”. This approach is enshrined in “the centenarian decathalon”: a framework we can all use to organise our physical aspirations for the later decades of our lives. Many of us stick our heads in the sand, but “not thinking about our decline won't make it any less inevitable”.
So, the question he asks is this: what are the ten most important physical tasks we want to do for the rest of our lives, in fact into our ninth decade? Attia has a list of 50 aspirational tasks, claiming that all are within the realm of possibility, and that we should not assume that we will inevitably become weak and incapable towards the end of our lives. This is a small sample of the items on his list:
Hike 1.5 miles on a hilly trail
Get up off the floor under your own power using maximum of one arm for support
Pick up a young child from the floor
Carry two 5lb bags groceries for 5 blocks
Lift a 20lb suitcase into an overhead locker on a plane
Balance on one leg for 30 seconds with your eyes open
Have sex
Climb four flights of stairs in three minutes
Open a jar
Do 30 consecutive jump rope skips
We are all encouraged to make our own list based on our own life situation, though there are general fitness goals that should probably underpin everyone’s healthspan aspirations. The idea is that this forms the basis of a training plan – Training 101 – which starts immediately, and continues for the rest of one’s life.
This is not just a random construct from a former fitness freak, which Peter Attia admits that he once was!It is based on five sources or types of data: studies of centenarians; human studies of the causes of the Four Horsemen (explanation to follow); research on ageing at the molecular level; animal studies; and, finally, a branch of epidemiology which focuses on causality rather than correlation.
He is very critical of current medical practice, which helps to keep us alive for longer but often as miserable slaves to the “Four Horsemen”: heart disease, cancer, neurodegenerative disease and, finally, type 2 diabetes and related metabolic dysfunction. He argues that healthcare needs a radical overhaul with money and resources principally devoted to prevention. And that while medicine fails to change, we have to take action for ourselves using the best data we have about disease prevention.
While we do now have a much better theoretical understanding of the causes of the main disease groups, we need tactics that are fully interwoven with the way that we eat, breathe and sleep. Attia prioritises five domains: exercise is his absolute number one, followed by nutrition, sleep, emotional health and, finally, drugs/hormones/supplements. Nothing much new there you might think, but within those domains are some very clear recommendations.
Exercise has emerged as the most powerful driver of healthy longevity, more so than diet or any supplements in the health food store. The data is said to be “unambiguous”, with exercise delaying both cognitive and physical decline more than any other intervention. But it also helps our emotional wellbeing. Many of us have experienced the emotional “high” after exercise.
So what? We all know we should do more exercise you might, understandably, harrumph. Well, without trying to summarise significant sections of the book, let me highlight a few of the things that made me take notice, and changed my approach to fitness work.
First of all, the concept of zone 2 training. This is getting your heart and lungs working to the extent that you would struggle to keep a conversation going. The aim is to do three hours per week of zone 2 training or four 45-minute sessions. If you are not very fit right now, then you have to build up to this minimum threshold. If a brisk walks gets you out of breath then start with that, and build it up. If brisk walks are a breeze, then walk up hills, and if there aren’t any hills where you live go “rucking”. This means putting weights in your rucksack to the extent that walking gets your heart racing. (My neighbour is diminutive, and can't walk at my brisk zone 2 pace, so I’ve loaded up my backpack with heavy books on our vigorous walks in the New Forest this year.)
The point is that this aerobic work improves your mitochondrial health and with age, the data proves, if you don't use them you lose them! And as mitochondria are the powerhouses in our cells, they are crucial. The scientific term is “mitochondrial biogenesis”: with zone 2 exercise you get new and more efficient ones reversing the normal effects of ageing.
Lesson number two for me was about muscles. I hate lifting weights in the gym, and associate it with boredom, discomfort and lycra-clad narcissism. But muscle mass is crucial to staving off the ravages of old age. We don't need bulging biceps, but we do need muscles that hold our skeletons together and stop us from falling over and getting injured. Loss of sufficient muscle mass is technically called sarcopenia, though we know it as frailty. And to avoid it, we all need to do some form of weight training, while also focusing on stability.
There isn't much in the book to make you laugh out loud, though I did when I read the section on the importance of toe exercise. Yes, in Training 101 you must NOT neglect your toes, as they are crucial to stability. Chapter 13 is called “The Gospel of Stability” but don't be put off by that.
Apparently, stability is “the subconscious ability to harness, decelerate or stop force”. And while Pilates is helpful, it’s not the magic bullet. There is indeed work to be done on our breath, then we must focus on our feet, which is where the toe work has to start. We ignore them at our peril because if toe strength is compromised “everything up the chain is more vulnerable - ankle, knee, hip, spine”.
I write this with some conviction as I had my first fall this summer. And I like to think I am quite strong, fit and in good shape for my 68 years. But one sunny evening on the way to a restaurant I was walking fast, talking fast, and missed the step up onto the pavement and crumpled onto the ground. Both my hands and wrists took a hammering, as did my shoulder. Three months later, and I'm still struggling with a rotator cuff injury and the tendons in my wrist are painful. Training 101 is derailed! I can't lift weights, and I can't do much in a yoga class. Hopefully the injuries will heal, but I need to rethink my exercise regime, and my work on stability has to get more attention.
Of course, nutrition, as the second priority, could be the subject of an entire article. But again, I will try to highlight Attia's main recommendations and how he navigates this complex, tribal and contentious topic. He states: “Low fat, vegan, paleo, low carb or Atkins – every diet has its zealous warriors who will proclaim the superiority of their way of eating over all others until their dying breath, despite a total lack of conclusive evidence.”
He prefers to focus on the science of “nutritional biochemistry” to escape the realms of ideology, religion and emotion; and on a few simple rules based on the little we know with complete certainty:
Don't eat too many calories, or too few
Consume protein and essential fats
Obtain the vitamins and minerals you need
Avoid pathogens such as e-coli, and toxins such as mercury or lead
The little we do know comes from epidemiology and clinical trials. And much of the click-bait news about diets is fed by misleading and incomplete findings from epidemiology, which fail to identify what is causation and what is correlation. What is clear though is that most people in developed countries need to eat less food, and specifically less calorie-dense food. So, most diets focus on at least one of three factors:
Calorie restriction: just eating less is the winning strategy.
Dietary restriction: eating less of particular foods is the most common strategy, but it won't work if your overall calories stay the same.
Time restriction: the latest dietary trend involves periods of fasting. UK authors Professor Tim Spector and the late Michael Mosley are great proponents of it. But Attia claims the scientific evidence is weak, and that it’s not a panacea because of its deleterious effect on muscle mass.
Sadly then, there is no magic bullet in the dietary world that will help us live in a healthier state throughout our lives. As the bon viveur film director Michael Winner said when he lost six stone in his late 60s: “My method was simple - EAT LESS. It’s the only rule you need. Have a little of what you fancy – just enough to keep you in touch with the tastes you love – but substantially less than you're used to.”
Nigel Lawson, a former Chancellor of the Exchequer and father of TV chef Nigella Lawson, said much the same when he lost five stones in weight and went on to live to age 91. To the consternation of those who disagreed with his views on politics and climate change, his mental faculties seemed to be in a good state to the end!
But beyond eating less, Attia is very clear about the importance of consuming more protein than is typically recommended as the Recommended Dietary Allowance by public health authorities. This is closely linked to his arguments about the need to retain/build lean muscle mass as we age. The amount you should eat depends on gender, body weight, activity level and age, with some evidence suggesting that as we age it’s harder to gain muscle so that means we need to load up on chicken, fish and meat. Plants will yield protein, but Attia claims the evidence is that its overall quality “is significantly lower than that from animal products”. Controversial, I know, but it’s apparently down to the distribution of amino acids in plant protein, which has less methionine, lysine and tryptophan, as well as the volume of indigestible fibre it contains, which means the all-important protein is less bioavailable. His message is clear: “don't ignore protein”. Carbohydates and fats are a much more moveable feast, but a person weighing 180 pounds (13 stone) needs 130-180 grams of protein per day, which is a lot to eat, even if spaced out over four servings! 180 grams of protein is equivalent to nearly six cooked chicken breasts.
There is, of course, much more to “digest” in the book, and I can't do justice here to the sections on sleep and emotional health. There are also very important caveats about the genetic determinants of disease and ageing, but despite all the work on mapping and editing genes with CRISPR technology, medicine doesn't yet offer many interventions to improve healthspan.
Inevitably, Outlive is one person’s perspective, analysis and recommendations. However, the book seems to have stood up to scrutiny since it was published last year. I am a certainly a convert and am trying the best I can to follow my version of Training 101, albeit with some serious setbacks over the summer!
Further reading and watching
Peter Attia podcasts
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