I am a fan of Dr. Peter Attia who is a physician focused on the science of longevity.  He strives to help his patients simultaneously improving lifespan (delay the onset of chronic disease) and healthspan (quality of life). He has a podcast call The Drive where he interviews people whose work can inform anyone interested in promoting long term health and fitness. Some of my fondness likely comes from confirmation bias. Attia’s material is very close to many of the conclusions I reached when I was trying to understand what leads to a healthy life. I captured my preliminary conclusions in Health and Fitness in One Post.

I appreciate that Attia is science oriented and he is willing to re-think his positions when data contradicts his beliefs. He isn’t overly certain, saying he has “strong opinions which are loosely held.” He has written a nice series on studying studies which discusses how to read and evaluation the quality of published research which often has flaws.

Attia notes that the biggest threat to longevity are chronic diseases (CDC). He groups these into four catagories of chronic diseases:

• Metabolic Disease (a spectrum of everything from hyperinsulinemia to insulin resistance to fatty liver disease to type 2 diabetes). These are arguably the most preventable diseases through diet and exercise are also contributes to atherosclerotic disease.
• Atherosclerotic Disease (comprised of cardiovascular disease and cerebrovascular disease). I haven’t personally studied this group of diseases. It’s the next thing I want to study. Number one on all cause mortality.
• Cancer: until there are major breakthroughs early detection is key. Survival once the cancer has metastasized is poor and hasn’t significant improved in 50 years, though there are some promising approaches that might finally result in breakthrough treatments
• Neurodegenerative Disease (Alzheimer’s disease being the most common). As far as I can tell, there are no effective treatments. While there are some theories and ideas of how to prevent, there are not strong causal links. 

Attia has identified what he believes are the  Five Tactics for Longevity which are:

• Exercise physiology: the most “powerful drug” in our arsenal 
• Nutritional Biochemistry: Diet, fasting
• Sleep
• Increase distress tolerance: Constance, chronic stress has negative consequences to health and wellness. Controlled, acute stress is helpful.
• Exogenous Molecules: medications, supplements, hormones

At this time, I have mostly focused and benefited from Attia’s material on exercise.

Exercise

Attia encourages most people to train for the centenarian olympics (additional details in AMA 39). Identify what you want to be able to do when you are 100. Backcast what fitness needs to be achieved earlier in life in view of the typical loss of strength due to aging. Your training program should strive to improve your fitness so that your fitness level bisect the backcast projection.

Attia has a framework of exercise includes four areas which provide unique benefits:

• Stability: Balance, efficient movement. This is particularly important as people age because it reduces the likelihood of injuries due to  falling. Some forms of yoga, Pilates, and Dynamic Neuromuscular Stabilization (DNS)  are examples.
• Strength: Developing muscle strength. The more strength you have the easier it is for you to engage in heavy work. It is easier to build strength when we are young, and we have a tendency to lose strength as we age. BUT there are a numbers of studies that show people who are in their 60s (and older) can gain strength with training.
• Aerobic Efficiency which focuses on metabolic “base” (zone 2): improving mitochondrial function which is key to your ability to burn fat, reduce the risk of diabetes, and be able to sustain endurance. Cycling, running. and rowing are some of the best options for zone 2 workouts.
• Anaerobic peak: High Intensity (zone 5): Builds your metabolic systems ability to handle peak exertion. Often part of an high intensity interval (HIIT) protocol.