Death is inevitable, but the rate of

decline is very much up to us. But the

drawback that young people have is they

only begin to realize the inevitability

of the decline when it besets them. So

your team that came in for testing that

are in their 20s, when I'm looking at

these results, there were issues that

were uncovered that were a concern. And

ignoring it doesn't lead to a good

outcome when you're 65. But a lot of

people have this issue. So it's okay to

speak freely about this. Yeah. The

biggest concern is that Dr. Dr. Peter

Aia is the go-to physician for high

performers, celebrities, and anyone

serious about unlocking the science

behind a longer, stronger, and healthier

life. I had a big epiphany at a funeral

of a friend of mine who I realized had

declined so much during their last

decade that when they couldn't do those

things that gave them pleasure because

of injuries, aches, and pains, they

weren't enjoying life. I call it the

marginal decade. Wow. Okay. So, what are

the most important parts of my health

that I should be thinking about for

longevity? So there's muscle mass,

muscle strength, but we don't have a

single metric that we can measure that

better predicts how long they will live

and how high their V2 max is, which is a

maximum amount of oxygen you can

consume. And if you compare somebody who

is in the top 2% to someone who is in

the bottom 25%, there is a 400%

difference in their all-c cause

mortality over the coming year. But how

do I know if it's an issue or not? We'll

go into much more detail around that,

but the way to avoid this is to train

specifically for that marginal decade.

And there's so many things that we just

do wrong. The sooner you start, the

better. So, rule number

one, this has always blown my mind a

little bit. 53% of you that listen to

the show regularly haven't yet

subscribed to the show. So, could I ask

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And my commitment to you is if you do

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power, me and my team, to make sure that

this show is better for you every single

week. We'll listen to your feedback.

We'll find the guests that you want me

to speak to and we'll continue to do

what we do. Thank you so

much. Dr. Peter, what is keeping you

busy at the moment in terms of the

subjects that you wrote about and

outlive, but the work that you do online

and the work you do in the variety of

businesses that you have? What is

keeping you fascinated at the moment?

Like what is what does one's mind focus

on? I wish I could say one thing.

There's probably a few things and maybe

that's um not good. Uh maybe the most

successful people in life only think

about one thing. I would say one of the

things I'm thinking a lot about is how

to translate outlive into a delivery

system uh obviously digitally that

basically operationalizes what is in

that book in a manner that allows people

to with as little friction as possible

implement the solutions for themselves.

So basically how do you live a longer

life? How do you age uh as gracefully as

possible and maximize your health span?

I think the other thing I'm focused on

that is related to that of course but

distinct um which I know your team got

to participate in a little bit this week

was kind of how to train people for

their marginal decade right so this idea

of we're all going to have a last decade

of life I call it the marginal decade

just so that we can get comfortable

talking about something that people

don't like to think about and um I'm

convinced that ignoring it and Not

thinking about it doesn't lead to a good

outcome. Instead, if you prepare for it

and train for it like an athlete trains

and prepares for their sport, uh you'll

have the best version of that possible.

Marginal decades and centurion

decathlon. Did I say that correctly?

Centinarian decathlon. Yep. Centinarian

decathlon. Can you explain these two

terms to me? Y. So, the marginal decade

is the last decade. Last decade of life.

Again, it's this weird thing where most

people don't know the day they've

entered it, but most people also realize

at some point when they're in it.

Um, I thought a lot about it. This was

sort of a big epiphany that I had in

2018 when I was sitting in the in the

church at a funeral of the parent of a

friend of mine who's who I realized had

declined so much during the last decade

of their life that even though they were

alive they weren't enjoying life. The

things that they loved to do in the case

of this individual play golf and tend to

the garden they couldn't do. they just

physically couldn't do it right. They

had injuries. They had aches and pains.

And when they couldn't do those things

that gave them pleasure, they retreated

from life. And I I I don't think there's

a person listening to us who can't

appreciate that because they they've

witnessed it, right? They've seen it in

a parent, a grandparent, a loved one.

And I don't know, there was just

something about that moment, which is

often the case, right? It's usually like

years and years of thinking about

something and it crystallizes in an

instant. But in that moment, I realized

aha the way to avoid this is to train

specifically for that decade. And the

best model for how to do that is to look

at athletes because every athlete trains

with specificity, right? So think think

of like all the different types of

athletes you would know. So if you think

about like a sprinter or a basketball

player or a football player, they are so

different and very little of their

training looks like the other guy. And

the reason for that is they're doing

something very specific, right? The

sprinter has a goal which is to move 100

meters as fast as possible. That's it.

And that requires a certain set of

skills. And the footballer has a totally

different goal. Yes, he has to be able

to run fast for short distances, but

just being able to run fast would not

produce in, you know, superior results.

And then the basketball player would be

different. And then the skier would have

a totally different set of skills. So I

said, "Well, who's the most well-rounded

athlete out there?" It's the decathlete

because that guy's got to do 10

different things really well. Now, he or

she doesn't have to be the best in the

world at those 10. In fact, they never

are. But overall they're considered the

best athlete because of the diversity

and breadth of what they can do. And so

I said that is our model. So what is the

centinarian decathlon then is I say to

you Stephen one day you are going to be

in your marginal

decade. What do you want to be able to

do physically athletically in that last

decade? It's the answer is so clear to

me because it's associated with all the

things that make me happy. So it would

be being able to explore the world still

with my partner, my romantic partner. It

would be But I would even dig further.

Tell me what that looks like. Okay. So I

went to Bali. Mhm. And me and my

girlfriend wanted to go white water

rafting. And to get down to the white

water rafts in Bali, we had to walk down

and then up again. Mhm. About a 100

meters of stairs. And as I went down

those stairs, I had one of those moments

that it sounds like you had at the

funeral where I realized that my dad

could not walk down these stairs. He

couldn't walk down them and he couldn't

walk up them. And by the way, it's a

different reason. I'm going to point

this out and I want to come back to your

story. Walking down is not about

endurance. Walking down is about

eccentric strength in the quads to be

able to uh decelerate the body as it's

moving down. Very important. Coming up

is about concentric strength in the

quads and glutes. and endurance. Okay.

All right. But continue. No, that's a

really good point because they're two

different training systems. And then the

reason why that was so important was

because of the great time I had in the

white water raft with my girlfriend. So

going down that lake through barley and

I thought, gosh,

it

hadn't if I'm not careful and I don't

think about this, I won't be able to

have these experiences when I'm 60. What

was involved in being in the raft? Yeah.

So, a lot of strength required to like

row um to keep us away from the rocks um

to push us off when we got stuck. Um

fall in the water, get it back in the

boat.

Absolutely. Think about the scapular

stability that's required. Think about

the upper body strength you need to lift

yourself back into a boat if you fall. I

mean, the list goes on and on and on.

And it was it was it took a long time.

We were out there for two hours going

through this lake. So, the other thing I

think about is Christmas. And I I think

about my nieces. So, my brother's a year

older than me and he has three kids

under the age of six. And you know what

that's like? These kids just sprint off

in every direction. And they'll say to

my dad, they'll say, "Come and play in

the garden." And my dad um wouldn't be

able to play with them in the garden the

way that they would want to play in the

garden, running around um being chased

around. So, my dad just watches them

from the kitchen. And so, these are just

obviously all the emotional things come

to mind first because those are the

things that stay with us. I'll give you

one more.

Um, the other thing that comes to mind

as a man is just being able to protect

my family. And I don't necessarily mean

wrestle an intruder, but I mean like

lift things. And um, if something falls,

being able to pick it up and move it. So

those are the things that come come to

mind first and foremost. It's

protection, it's memories, it's

activities that create relationships and

connection. I mean, that's exactly the

exercise we do, right? we take people

through, give us the 10 most important

things you want to be able to do. So

like if you start with, I want to be

able to go back to Bali and I want to be

able to go down those hundred stairs,

get in the raft, go down the river, come

back up the stairs, that gets broken

down into very specific movement

patterns. Playing football with the kids

out back gets broken down into very

specific movement patterns. By the way,

they're very different, right? That one

comes down much more to foot reactivity,

lateral movement, things like that.

Being able to pick something up off the

floor is yet another set of movement

patterns. It turns out there are

approximately 27 physical requirements

that are necessary to do the sum total

of most things people want to do. Part

of the reason why I think people don't

care enough is because they see aging as

inevitable. Mhm. So they look at their

their parents, their grandparents, and

go they're immobile. They can't function

properly. That's my destiny. It's

genetic.

Obviously, I don't agree with that.

Although I have tremendous empathy for

people who might feel that way. It's uh

when you see something as ubiquitous as

the decline

of untold numbers of people as they age,

it would be very easy and tempting to

say that that is the inevitability of

our species. Death is inevitable despite

what some biohackers may tell you. Um

decline is inevitable but the rate of

decline is very much up to us and the

preservation of strength, stamina,

movement capacity, uh those things are

largely up to us. In fact, there are

actual data that demonstrate quite

clearly. In fact, I was just reading a

paper yesterday in in the journal Cell

that looked at the role of exercise in

aging individuals to preserve

mitochondrial function. So, this is a

study that looked at older individuals

and it randomized one group to a

significant amount of exercise and the

other group was just sort of business as

usual being largely sedentary. And then

using pretty elaborate techniques where

you biopsy the muscle, they look at the

mitochondria which are the kind of the

powerhouse of the cell in these

individuals. And it turned out that in

the people who were exercising, there

was very little decline in the

mitochondrial function compared to what

happened in the people who were not

exercising. Now, just because your

mitochondria continue to function well

doesn't mean all aspects of aging are

offset. But it's a very important one to

demonstrate. And this is also true by

the way of strength and endurance.

There's a big difference in the rate of

decline of muscle mass, muscle strength,

and cardiopulmonary fitness in people

who exercise versus who don't. So, it's

all kind of a long-winded way of saying

um you have as an individual so much

more under your control than you

realize, but you have to sort of begin

to compounding the gains. I'll do it

when I'm 50.

Well, look, the good news is 50 isn't

too old. And I've met many people who

don't begin to do this until they're 50.

But again, the analogy I would use here

is comparable to that of investing for

retirement. The longer you wait, uh, the

less money you're probably going to have

at the end.

Springs to mind this graph I saw the

other day which I'd sent to my friends

which shows that, um, the the decline, I

think it was in muscle mass from when

you're 30. And it makes the point that

there's this line which on this graph

called disability. And it shows that

people who didn't have enough muscle

mass when they were 30 cross the line of

disability when they're 70. Uh and those

that did have more muscle mass at 30

don't don't get close to that line. Um

so that for me was shocking because it

goes to show that what I do now is going

to determine whether

I'm, you know, by all intents of

measures disabled when I'm 70 or if I'm

able. The sooner you start, the better.

The drawback that young people have is I

mean, you've had a you've had a great

experience because you're you're

introspective about it and you've been

able to observe it in somebody older.

So, you've been able to gather

motivation without having to experience

the decline yourself. Um, so that's a

that's a wonderful position to be in.

For many people, that's not the case.

They only begin to realize the

inevitability of the decline when it

besets them. But the way to think about

this again is another analogy is that of

a glider. So gliders eventually all have

to come down, right? Our health span is

basically a glider, but we have a lot of

control about how long it stays in the

air based on how high we can start it.

So if you think about, you know, would

you rather take a glider off a really

high cliff or off a low cliff, that's

the that's the decision we get to make.

And and we sort of call that concept

physiologic headroom. So the example you

gave is a great one, right? So muscle

mass, muscle strength provide an

enormous amount of physiologic headroom

as does cardopulinary fitness. These are

huge variables that make all the

difference. and everyone's coming down,

but the fitter you are, the slower the

rate of decline and therefore the longer

it takes before you cross below a

threshold. And that threshold differs by

different metrics, but once you're below

that threshold, it's very difficult to

engage in activities of enjoyment.

Peter, you're 51 now. 52. 52. What do

you wish someone had told you when you

were 32? I'm 32 years old. What do you

wish um someone had screamed in your

face and told you when you were my age?

It wouldn't have been much about

exercise. It would have been more about

other aspects of life for sure. Um

because for whatever reason, I've always

gravitated towards exercise. That's

always been a very high priority for me.

So, I think my advice to 32-year-old

Peter would be much more about um

relationships and emotional health. But

if I could go back and speak

to 14-year-old

Peter, he a he wouldn't have listened,

but I would have begged him to go a

little bit easier on his body and back

off on certain things that probably have

led to injuries I have today that could

have been prevented.

Can I ask what they said things are?

Sure. Um, I think I I think I lifted far

too heavy far too often and probably

without enough coaching on technique.

And so, you know, I by the time I was

27, I had a devastating back injury, but

it's one of those things that happened

without any incident, which which is

often the case, by the way, for a back

injury. When you really blow out a disc

in your back, it's not necessarily

something you did in that moment. It's

usually something that's been built up

from the past. So, this injury I had at

the age of 27 really was the result of

years

of unnecessarily heavy axial loading uh

loading done with probably insufficient

technique, you know, or technique that

was at times sloppy and under fatigue

because I used to do a lot under

fatigue. You know, I sort of believed in

training under a lot of fatigue and and

I I think that that's a mistake. I think

that training under very heavy load

should not be done under great fatigue.

Interesting. We'll talk about that as

well. On that point of advice that you

gave me there about emotional health.

One of the things that's been very front

of mind for me at the moment is men's

health, specifically men's emotional

health because I read a report that came

out in March called Lost Boys and it

just details this pretty horrific

picture of men's emotional health in the

UK at the moment in particular, but the

trend holds around the world. and it

came out in the start of March. It's

been in all the newspapers in the UK and

it details a couple of sort of headline

stats. The reverse gender pay gap

amongst young men. So women are now

earning more. You know the stats

probably around um soon for every yeah

suicide and one in seven young men are

unemployed or out of work. All these

sort of horrific stats and then it

compounds with things like suicide

suicidal ideation etc

etc. I was thinking about this this

morning when I was listening to some of

your your work. I was thinking I wonder

what Peter's perspective is

on what it is to be a man. Actually, it

does kind of dovetail into some of your

work around testosterone and the decline

in testosterone. And because one of the

things I was thinking about is how

testosterone plays a role in what it is

to be a man, but if you look at the

stats around testosterone, um it appears

to be declining. Yes. And I say this in

part as well because testosterone causes

a certain set of behaviors

um in men

that define and shape what a man is and

what they want and how they show up. And

even when I said earlier on protection

as one of the three things I cared

about, that's probably in part because

of the testosterone in me. This debate

around testosterone, this conversation

around testosterone um and its

decline, is it declining? It is. It is.

Why is it declining and what and is this

does it matter? Well, I think the second

question is easier to answer than the

first. I do think it matters. Um the the

the why is probably multiffactorial and

the why is just as important as the fact

that it is. In other words, the fact

that it's declining is both relevant for

the fact that a very very important

hormone that has incredible benefit to

men uh and women by the way is going

down. And we have to come up with a an

answer to that, right? Like so how do we

address that? Do we address it medically

where we replace that hormone

exogenously, meaning we give you that

hormone directly or do we try to fix the

underlying problem? So if you want to do

the latter, you have to know what the

underlying problem is. Now at the

population level, the best answer as to

why testosterone levels are declining

and um unmistakably they are. So the

data here are unambiguous. There's no

debate on this fact. Um the debate is

around the why. I believe that the best

answer probably has to do with two

things. Uh one is uh increase in body

weight and fat, body fat specifically in

men. Um and uh some combination of uh

reduced quality of sleep and um and and

and sort of disruption to sleep. So so

why are those two things relevant? So

when you increase body fat, two things

are happening. One is you're increasing

inflammation and you are reducing the

amount of testosterone that gets to stay

in the form of testosterone because part

of the testosterone gets converted into

estrogen. So with body fat comes more of

this process called aromatization or

converting testosterone into estrogen.

So if you think about what those two

things are doing, if you have more

inflammation, that reduces your ability

to make testosterone and you have more

capacity to turn the less testosterone

you make into estrogen, the net result

of that is both of those things are

reducing your total pool of

testosterone.

If you couple that with less, you know,

lower quality sleep, and I'm not talking

about over the last three years, I'm

comparing like now to say 40 years ago.

And what are all the reasons that people

might have poorer quality of sleep? Now

I think there are many but obviously

phones and social media and uh just the

stimulation of the world we live in

probably plays a greater role in that.

Sleep is when we make these hormones,

right? So so so we we make follicle

stimulating hormone and luteinizing

hormone at their maximum amount during

sleep and those are the hormones that

are driving the production of

testosterone. So, what we've seen in

many of our patients when they have low

testosterone, because there's a test you

can do to see if their testosterone is

low because their body can't make it or

because their brain isn't receiving

enough of a signal to make it. This is a

very easy thing to determine medically.

Unfortunately, most people aren't

subjected to that level of testing

because they go to these testosterone

shops on street corners that are just

giving everybody testosterone. But if if

if a physician is curious enough to

understand that you can give a patient a

drug or a hormone called hCG. HCG is

luteinizing hormone which is one of the

hormones made by the brain. So if you

come in and you see a man who's got very

low testosterone and you can understand

why you give him luteinizing hormone. If

he still has low testosterone, you know

that he has what's called primary

hypogonatism, which means his

testosterone is low because his testes

can't make testosterone. Conversely, if

you give the man luteinizing hormone and

all of a sudden his testosterone goes

up, he has secondary hypogonadism or I

mean, you could mix the primary

secondary there, but really what it the

terminology doesn't mean anything. what

matters is he can make testosterone, but

for some reason his brain isn't giving

his body the signal to do it. And that's

that's a classic finding in a person

who's under high stress and or not

sleeping well. So that's a long-winded

answer to your question, but I think

that those are probably the greatest

contributors to this. Now, people have

talked a lot about what about

microplastics, what about other

environmental factors, what about other

factors in nutrition beyond just the

ones that would contribute to excess

body fat. The evidence there is less

compelling, but I don't think we should

discount it. But I I think I think that

that if those things are playing a role,

it is probably much smaller than than

what we just talked about. I was

thinking as you were speaking about

sleep and testosterone about how and

also the link there with bad diets, how

if I've not slept well, I wake up and

make worse food choices for sure. And I

was like, is that like dopamine

dysfunction?

Probably more due to insulin signaling.

So um we know from ex really good

experimental studies that when you

sleepdeprive people they become insulin

resistant and the more insulin resistant

a person is the less they're able to

access their stored uh energy. So higher

insulin resistance means greater

difficulty accessing stored energy. So,

if you're if you wake up and you're if

you know if you have successive days of

poor sleep and you're becoming somewhat

insulin resistant, um you're going to

want to eat more because you're not able

to access your own natural stores of

fat, which is where we want to go for

energy. So, if you look at one

experiment that was done out of the

University of Chicago, they they took uh

healthy subjects, young young subjects,

and sleepd deprived them for somewhere

between 10 and 14 days. So, not a huge

period of time. And they only let them

sleep four hours a night, which by the

way, I know a lot of people who were

doing that for years at a time. In in

that 10 to 14 day period of time, their

insulin resistance was worsened by 50%.

This is in other words they they do an

experiment called a uglycemic clamp

where they inject them with glucose to

see how effectively they can put glucose

into their cells which is that's the

that's the hallmark of insulin

sensitivity is how well you can put

glucose into your muscles when it's

infused in you and their capacity to do

that was reduced by 50%. after such a

short intervention. Um, so I think sleep

uh restriction and unhealthy sleep is a

is a very underappreciated cause of

metabolic health and weight gain and

then by extension these other things

we're talking about. It seems to me to

be the thing furthest upstream in my

life that then causes this cascading

effect to how I show up in sort of

cognitive performance. How well I can

articulate myself if I go to the gym,

how hard my workout is, if I choose

healthy options versus unhealthy

options. So it feels like the and mood

in general. Yeah. Yeah. I mean, look, I

I I've said this before and I'm not the

first to say this, so I'm paraphrasing

others, but if you really stop to think

about it, sleep doesn't make a lot of

sense from an evolutionary perspective.

Like, if you go back in time a few

hundred thousand years, why would we

have spent a third of our life

unconscious? It didn't serve our

purpose. You can't mate, you can't hunt,

and you can't defend yourself.

So you have to believe that if we could

have evolved out of it, we would have

done it and we didn't. So that means

that whatever it's doing, it must be

really important. I mean core essential

to our existence. While I will

completely acknowledge that different

people have a different necessity or

requirement for how much they sleep, I

still think that many people

underestimate how much they need. You

know, you asked me at the start, you

said, um, what are the things that you

want to do when you reach your marginal

decade? And I gave you my answer. What's

your answer to that now that you're a

father in heaven or in a different

season of life? Well, they're very

similar to the types of things you're

thinking about. And I love how you've

got specific examples. So, I really like

playing with my kids, right? So, I can

imagine that in my marginal decade, I'll

have grandkids that are the age of my

kids. Yeah. Right. And and you know,

maybe a bit older, but but as I'm even

getting towards that marginal decade.

Okay. So, playing sports is really,

really fun. I really like playing

especially because when I grew up like I

played hockey because I grew up in

Canada and then I immediately went into

kind of boxing and martial arts and

those became my life. So now playing

sports that I didn't play much as a kid

is really fun. Like I'm really enjoying

baseball. I'm really enjoying soccer.

And um and so when you play these

things, you realize this is not an easy

thing to do when you get old. Like to

sit in the, you know, to play to sit in

the goal and actually like stop a ball

when a kid is blasting at you full stop.

You have to be able to move around. So

again, like I would love to be able to

play soccer, throw a football, throw and

hit a baseball as long as possible. you

can get into movements that are much

simpler. Uh, but if I can do all of

those things, I'm in great shape. Now,

of course, to be able to do that, I also

need to be able to do a lot of things

that many people also can't do in their

marginal decade, like sit on the floor,

get up off the floor under their own

power, um, you know, walk up x number of

flights of stairs, having the strength

to do that. I like doing certain things

like I like archery a lot. So it's, you

know, I want to be able to pull a bow

back. Obviously not at the same poundage

as the current bow that I pull back, but

I would still like to be able to pull a

50 lb bow back in the final decade of my

life. And when you think about all those

things you want to accomplish, if we

were then to sort of codify them into a

bunch of exercises or areas of your

health that you had to now be thinking

about that I needed to be thinking

about, what are the most important

things? So, I'm a 32-year-old. What are

what are the most important parts of my

health that I should be thinking about

if I want to achieve all the things that

I said to you in my final decade? No one

in the final decade of their life ever

said, "I wish I had less strength and I

wish I I wish I had less endurance." So,

you cannot be too strong and you cannot

be too fit. The only time that one would

throttle back on the pursuit of those is

a if doing so is come at the expense of

something else either with respect to

your health or your life and two if the

pursuit of that at such an extreme level

produces risk of injury. Okay. So in

other words, could I be stronger than I

am today? Yes. Uh I'll give you an

example. We know that in resistance

training, the sweet spot for pure

strength is one to five

reps. When your goal is to maximize

strength, you need to be pushing 1 2 3 4

five reps. Once you start thinking about

hypertrophy, muscle size, we're starting

to think about 7 8 9 10 11 12 reps. Once

we start thinking about muscular

endurance, we start thinking about north

of 15, right? Those are the general

patterns of resistance training. So, if

I want to build my muscles because I'm

going for aesthetic goals, then I need

to be aiming above five reps. I need to

be 10 or 12. But if I'm just purely

thinking about strength, bigger weights,

but lower reps. That's exactly right.

Okay. And then if I got muscular

endurance, which be even higher reps.

Okay. Lower weight. Yep. Okay. So,

again, we could go into much more detail

around that, but just to finish the

point here, why do I not do much

training at one to five reps? In fact,

these days I don't do any training at 1

to five reps anymore.

Why? Because to train at 1 to five reps

comes at a risk. Okay? Especially for

heavy compound movements. So

like I'm, you know, I'm okay getting a

little bit less of a strength benefit

while still of course getting stronger,

but training at a higher rep load. So

I'm typically so I'm targeting 8 to 12

reps with one to two reps in reserve is

basically how I'm doing my resistance

training. That means every set I'm doing

I would expect to get to within about

one rep of failure somewhere. So today

when I lifted I don't think I did less

than seven. I didn't do more than 12.

And the weight was always titrated so

that I was either failing, almost

failing, or one rep away from failing

somewhere in there. And I was adjusting

the weight constantly on every exercise

to get there with the exception of one

exercise. I did. Push-ups was one of the

things I did. Push-ups are kind of more

in the muscle endurance. Obviously, I'm

doing more reps when I was doing

push-ups, but pretty much everything

else was in that range. So again, I'm

not fully maximizing strength anymore

because the cost of it might be a little

bit high in terms of injury risk.

Similarly, I'm not strength training

24/7 because I need to make time to do

my endurance training and other types of

training. How often do you train uh

resistance training? I resistance

training three times a week. And how

often do you train generally? And I

train every day. Every day. Yeah. Why?

Because, you know, again, the the

intensity of my training is not that

high. At least three days a week. So the

three resistance days are pretty hard

because I'm really only doing each body

part once a week. So when I'm doing it,

I'm really I'll spend that 90 minutes

really kind of hammering those body

parts. Three of those days are just zone

two. So, my three three of my four

cardio days are zone two days where I'm

doing, you know, I'm on a bike and I am

riding at a level of intensity that

actually allows me to still talk some,

you know, not not talk like I am now,

but talking in a sort of a strained way.

So, for me, that's about a heart rate of

140 beats per minute. And that's just

not that's just not taking a huge toll

on me. like that. Those are almost like

recovery days for me. And then one day a

week I do a a really really hard V2 max

day and that's that's a really hard day.

That burns a lot of matches. That's

tomorrow. Not looking forward to it

already. Do you do cardio on your

resistance training days as well? No, I

don't. So, it's the seven day. It's four

days of cardio, three days of uh of

resistance. Now, that's going to change

in the summer when I'm going to add 3

days of swimming. Um, and I will end up

doing some swims on some resistance

days. So, before you do your resistance

workout, you don't go on the stepper for

20 minutes or cycle for 20 minutes or

something. I don't. Is there a

particular reason why? It wouldn't

really serve a purpose. Um, I So, I I

know a lot of people do that. I know a

lot of people will say, "Hey, I'm going

to do a little bit of a warm up on this

treadmill or the stepmaster before I

lift." But I actually have a pretty

strong point of view on how we should

warm up to lift. And I don't think

walking on the treadmill or running on

the treadmill or being on the

stairmaster or on the bike is a great

prep for the lift. I think it's better

to warm up for a lift doing movements

that prepare you to lift. So for

example, like if it's a leg day, so

Monday's leg day, right? So what am I

going to do? I'm going to start by doing

a bunch of core stabilizing stuff. So,

I'm going to do a whole bunch of this

dynamic neuromuscular stabilization

stuff. So, you get into basically these

baby positions and you really learn to

activate your core as you move around in

a six-month position and stuff like

that. I then do a whole bunch of um like

do you know what a 9090 is or a shinbox

exercise is um where you're you're kind

of on the ground in a position where

you're really is you know uh you can

start out doing it isometrically but

ultimately going through uh a slow

eccentric and concentric phase of

movement that's kind of activating

glutes. So I go through basically a

whole DNS sequence. Then I get into a

dynamic movement prep. So then I get

into a bunch of bouncing, a bunch of

footwork. Um, and then I start with

really light weights. So I'll go to a

leg extension machine and do very, very

light leg extensions, very, very light

leg curls. Come back and do more jumping

and moving and lunging and go back and

forth. So I'll spend 20 minutes doing a

warm-up, but the warm-up is geared for

me to lift. Whereas if I had just sat on

a bike and pedal around, that doesn't

actually replicate any of the movements

I'm going to do when I start loading

myself. I've got particularly concerned

about injury. Yeah. Now that I'm 32,

because when I was bloody 20, I could do

almost anything, it seemed, and nothing

would break. But I had a couple of

injuries when doing like shoulder

presses and things like that. And one of

my friends had a similar injury recently

which took him out for three or four

months where he did a shoulder press,

pulled something in his back or

something, his like neck. Yeah. And then

he couldn't like turn his head anymore.

In terms of

injury, if I wanted to get injured, am I

right in thinking that the the thing

that leads to injury is basically just

walking straight in and trying to lift

something heavy? Or is there things

further upstream that cause injury in

the gym? No, there's I mean that's one

way to increase your risk of injury for

sure. Uh but but yes, there are other

ways that it can happen and I think

about it a lot. I mean one of the

injuries I think a lot about are calf

injuries, Achilles injuries, sort of

tendon injuries. This is, I think, one

of the things that becomes a real

problem for people as they age. You

know, you you often hear about people my

age, uh, tearing an Achilles. It's a

devastating injury. Now, again, it's not

devastating in that you won't recover

from it, but boy, it's going to take you

out of commission for 6 months. So, a

lot of these injuries happen because the

individual still has strength, um, but

they've they've kind of lost some of the

pliability in the tendon because they've

kind of lost some of the jumping. That's

why I always start these workouts with

low level of jumping and I'll progress

to higher levels of jumping. But jumping

is actually a very important part of

training and it's one of the things that

we take for granted. But boy, when your

ability to jump is gone, and jumping, by

the way, can mean like just initiating a

jump. But it can also mean jumping off

something and stopping yourself. Those

are really important skills. And so like

something like jumping rope is really

important, right? Your feet are just

kind of moving like that. They're

they're acting as shock absorbers. Calfs

and Achilles have to constantly change

in length. And that accommodation is a

really important part of resilience. And

I think that should that should be an

important part of everybody's warm-up at

a minimum, if not part of their workout.

One thing I'd love you to do is to

persuade people listening that muscle

mass matters for longevity because

um and also if you can within that that

leg day matters because we all avoid leg

day including me and sometimes I need to

be told again why why it matters for me

to add it. Well, I mean, I think look,

muscle mass

um is is probably the second most highly

uh correlated finding uh or third most

to longevity after strength and

cardiorespiratory fitness V2 max. So,

why is that? Um so, first of all, I

think that muscle mass is both directly

a proxy for strength in general. The

more muscle you have, the stronger you

are. We all know exceptions to that. We

know wiry little people who are insanely

strong. And I have patients like that.

They're just naturally, you know, thin

people. But when we put them through the

testing

protocols, you know, they're remarkable

in terms of their strength. And I tend

to not worry about the fact that they're

slight in build when when I see that

they're strong across the board. There

is another benefit of muscle mass which

is it's the place where you dispose of

glucose. So from a metabolic

perspective, the more muscle mass you

have, the more glucose buffering

capacity you have. And why does that

matter as I age? Because you know, one

of the hallmarks of aging is a reduction

in the capacity to metabolize and buffer

glucose. And so as as glucose levels

become less and less regulated, all

sorts of bad things happen. uh bad

things happen to micro vessels in the

body. So we if you think of the most

extreme example of this is type two

diabetes. So once a person has type two

diabetes, what are they at risk for?

They're at the risk of reduced vision

and ultimately blindness, amputations of

their digits, impetence, right? The

penis has tons of tiny blood vessels in

it and the more that you know

glycosillated proteins accumulate there,

the less they get blood flow and

obviously damage to the small blood

vessels of the brain as well. So all of

these things are hugely problematic when

glucose is disregulated. And again, the

most important thing that you can do to

regulate glucose in addition to the

obvious, which is eating energy balance,

not eating too much, is making sure you

have large insulin sensitive muscles,

which means large muscles in the context

of an individual who's sleeping well and

exercising. And you're going to

basically have a great place to put all

of that glucose when you consume it. And

is that going to save off me getting

belly fat because my glucose is going to

be stored in the muscles as opposed to

somewhere else or again it all depends

on the total energy balance. But yes,

it's clearly going to make a difference,

right? So one of the shest ways to um

reduce your capacity to store fat is to

add more muscle. Okay. Um I I did the

grip strength test. I've done it twice

now. And meaning you did one of the like

grip meters or you did a hanging test.

The uh one of the grip grip meters.

actually did it at Brian Johnson's house

and then I but I also did it with Andy

Galpin and people tell me it's a

indicator of longevity but I've never

really understood why is it just testing

my strength. Yeah. Um grip strength of

all the strength metrics it's one of the

most highly correlated with longevity.

We actually prefer to do it like at 10

squared where your colleagues tested

yesterday. We prefer to do it on a dead

hang. So, we make them hang from a bar.

Um, and we just time how long they can

hang. So, that that's a really good

metric of your grip strength because

it's also normalized to your weight.

Okay. So, uh, so we we want to see that

people can hang for at least two minutes

on a bar. And so, the question is why is

that so highly correlated with

longevity? And it's what you said. It's

it's it's strength. Uh, and the reason

for it is it's really hard to be strong

anywhere in the upper body if your grip

is weak. Like if you think about being

able to push, especially being able to

pull, like all of the real metrics of

upper body strength require a strong

grip. And if you have a strong grip, you

have a strong hand, you have a strong

forearm, you have a strong scapula that

is connected to your rib cage, like it

goes up the whole chain. That's another

reason why we like the dead hang as a

way to test it because the dead hang is

testing everything. It's testing your

actual grip. It's testing your scapular

stabilization, the stability of your

shoulder. It's basically testing that

entire chain. And then I also think

there's a practical side of this, right?

when when you know it's very

underappreciated what frailty does to an

aging individual and what sarcopenia

loss of muscle mass does to an aging

person and and what it is about falling

that is so devastating to an older

person and the stronger your grip the

easier you're able to navigate a lot of

those things right it just seems

unthinkable that falling is something I

should be thinking about at 32 in the

future like cuz my seems ridiculous it

seems ridiculous yeah and yet it is

devastating. So once you reach the age

of

65, which that ain't that far. I mean,

if you you know 65 year olds all day

long, that does that's not a that's not

a very old person. Yeah. Once you reach

the age of 65, your mortality from a

fall that results in a broken hip or

femur is 15 to 30%. Think just think

that is such a staggering number. So,

you're over 65, you fall, and that fall

results in the break of a femur or hip.

There's a 15 to 30% chance you'll be

dead within a year. What kills me? It

could be something very acute like you

bang, you know, the fall that's

significant enough to do that also bangs

your head. It could be that you get a

fat embolism, you get a blood clot. It

could be that, you know, during the

recovery process of this, you just never

really get better. You never thrive

again. I think a more disturbing

statistic is that of all the people who

survive, 50% will never again regain the

level of function they had before the

injury. Wow. So they will require a cane

for the rest of their life or something

like that. Um now there are lots of

things that account for that. Andy

Galpin, who you mentioned a moment ago,

talks a lot about this, but it's a lot

of it comes down to foot explosiveness,

power. So the reason you're not really

afraid of falling like when was the last

time you were walking and you your your

foot caught something and you you

slipped like yesterday. Yeah, quite

often. Yeah, exactly. Why don't you fall

when that happens? Because I can quickly

readjust, right? That's power. Okay, so

you have the power in your foot to

readjust when you lose your step. You

step off a curb not realizing it, it

doesn't matter. You readjust. Okay,

those are a very very specific muscle

fiber that is responsible for that. It's

called the type 2B muscle fiber. That is

the first fiber that atrophies when you

age. In fact, you're already at your

peak. It's all downhill from where you

are now. Thank you so much. Yes. So, I'm

I'm already 20 years past you and my

power is a fraction of what it was 20

years ago. Now, I fight like hell based

on the exercises I do to try to make to

try to keep it as high as possible. So

the reason that these, you know, people

who are in their 70s are falling all the

time is people think it's a balance

thing. It's not just a balance thing,

right? It's that they're undergoing the

same insult you and I undergo on a daily

basis. But the difference is their

probability of being able to catch it

either through the explosiveness of

their foot or their lower leg coupled

with maybe not being able to grab onto

something as quickly and adjust. Uh it's

a power deficit problem. So, what do I

have to train now at 32 to ensure that

specifically the example of hitting

something and quickly being able to

adjust? Um, I'm able to do that when I'm

70. I think jumping is a great way to do

this, right? So, so I mean I use certain

specialized pieces of equipment that

actually have power built into it

because power is different from

strength, right? So, strength is really

the ability to is is just the ability to

move a force independent of the speed at

which you move it. Power is the maximum

combination of force and speed. Okay? So

if you on the on the on the um x axis if

you were to put force and on the y-axis

if you were to put power the curve is an

inverted u. So as the force or the

weight that you're moving goes up and

you're trying to move it as fast as you

can, you're getting more and more and

more and more power. But then at some

point the weight gets so heavy that even

as you continue to move it, it's going

slower and slower and slower. So your

power is going down. So there's a sweet

spot there. So one of the things I do is

there's certain specialized pieces of

equipment that allow you to train in

that way. So I definitely rely on a lot

of those. But even if you don't have

access to that machine, jumping is a

really important way to generate power.

So if you're just doing a vertical jump,

that's a that's power. What about

balance? I I was at Brian Johnson's

house and as he was cooking his I don't

know breakfast or lunch or whatever, he

was balancing on a half

ball. You've seen one of those things.

Yeah. Yeah. I I don't think I asked him

why he was balancing on it, but I assume

it was to do with balance and the

certain muscles in the in the leg. There

are lots of exercises that are great for

balance. Um, anything that produces

instability is great because it's uh,

you know, for lack of a better term,

I've heard it described as problem

solving for your foot. Okay? Right? So,

so if you think about being on any

unstable surface, even if you're just

walking on an unstable surface, so if

you if you were to look at a person's

foot, their lower leg actually, as

they're walking on a surface that's

constantly changing, so like a gravel

path or something like that, you're

going to see like if this were my lower

leg, you would see the musculature of

the lower leg constantly adjusting to

it. And so, yeah, I'm I really enjoy

things that force that type of training.

Do you do flexibility stuff? Yeah. So,

I'm actually naturally a pretty lax

person. So, I don't do any stretching if

that's what you're asking. But all of

the sort of stability and dynamic stuff

I do incorporates movement at end

ranges. So,

um I I'll give you an example of why I

think the notion of flexibility might be

a little bit misunderstood. If you ask a

person to stand up and with their legs

straight touch their toes, most people

would say that's a great test of

flexibility in the hamstring, right? And

most people can't do that. What they

don't realize is everybody's hamstrings

are long enough to allow them to do

that. The reason they can't do it is

their central nervous system will not

release them to do it. Does that make

sense? Interesting. The central nervous

system won't release them to do it.

That's right. It doesn't feel safe for

them to do it. Now, how do I know this?

Because if you take a person under

general

anesthesia, you can put them into almost

any position possible. So, if you took a

person under general anesthesia, laid

them on the operating room table, you

could lift their leg up to

here. When they're awake, you couldn't

get it past here. When they wake up from

surgery, will they have a torn

hamstring? Not at all. They won't even

know their leg was moved. The difference

is when they're under general

anesthesia, their brain is not sending a

signal to the leg that says don't lift.

So why is the why is the leg why is the

brain doing that to the individual? This

is how I learned it on a personal level.

So about six years ago, I had tweaked my

back and had just done a, you know,

unnecessarily heavy set of deadlifts and

just pushed it a little too far. And I

was kind of nursing this this sort of,

you know, just very very tight QL. I was

completely jammed up. And I came in to

to do some training with a friend of

mine who's one of the guys that actually

he is really the guy that introduced me

to this thing called DNS, dynamic

neuromuscular stabilization. And I mean,

I was stiff as a board. I couldn't, you

know, get past my knees bending forward

and I'd been hurting for like three

days. And we went through a series of

exercises

for 40 minutes, which included me laying

on my back with my legs up, him leaning

on top of me, so my feet are here on his

chest and doing isomemmetric pushes

while working on uh generating

intraabdominal pressure. And after an

yeah maybe 40 minutes of this type of

exercises, I was palms on the

floor. Now, how do I go from not being

able to get to my knees to palms on the

floor in 40 minutes with three days of

horrible back pain? The difference is

when I my back was hurting, it was my

body was not going to let me go down,

right? The body was saying, "No way.

your back. I'm protecting you because

you were you are not stable. You're not

going to go any further. And what we

went through with this exercise and a

series of exercises was basically I mean

I'm oversimplifying this and sort of

anthropomorphizing it, but letting my

brain know it's okay. You're stable.

You're stable. You're stable. The back

is safe. The back is safe. Let him go.

And then ah I'm palms on the floor. So I

love testing this. Sometimes I'll just

wake up in the morning and do five

minutes of breathing exercises when I'm

stiff as a board and just get into a you

know position on the floor. Why the

breathing breathing exercises? Because

that's really how it's the it's the the

breathing is how I kind of create this

cylinder in my abdomen to sort of push

the you know push the the the floor of

the cylinder down as the pelvic wall.

The diaphragm is the se cylinder uh the

top and then the the entire you know

entirety of my abdomen is the wall of

the cylinder. And so I kind of go

through these exercises every single

day, usually on my back actually. That's

kind of like part of my warm-up and and

it's just a way to kind of ground myself

around creating uh concentric pressure

in the abdomen. Just to get some tips

from you around your your strength

training regime. Um how many exercises

do you do? What does I'm really curious.

So you train three days a week doing

strength and resistance stuff.

Do you do like shoulders and back and um

as like a pet like you know people it's

just totally Yeah. Yeah. Exactly. So on

Monday Monday is uh is pure lower body.

Okay. And uh uh Wednesday is arms and

shoulders and Friday is uh chest and

back. Okay. Super simple like nothing

nothing no rocket science. An hour uh I

mean it's it's a like an hour and a half

of lifting play plus maybe 20 minutes of

the warm-up stuff. So on the chest and

back day, how many chest exercises are

you doing? Four. Four. Okay. And then

four on back. Yeah. Okay. And I just I'm

just super setting them. And I'm going

to do maybe five sets of each. So five

working sets. So there's a lot of

warm-up in there, too. Um and I'll also

do some other stuff like some medball

slams or things like that as well.

There's been this huge rise in people

doing these um high roxes and sort of

elite endurance events and and such.

really interesting that it's become so

popular. Even things like running clubs,

I know, but the fact that people are

more people are doing marathons now than

ever before. Why do you think this is

happening? I don't know. I mean, I think

it's a very net positive thing, though.

I mean, I I I I do think that there's um

more and more people that are taking up

things like rucking and running and and

you know, finding camaraderie in these

things. The only thing I hope is that

that people are doing it in a manner

that's sustainable and safe and allows

them to do it indefinitely. So I, you

know, I just I'm always hopeful that

whatever thing that people are doing,

they're not injuring themselves cuz

again, rule number one is don't get

injured. So So you're, you know, you're

you're you're playing uh you're playing,

you want the game, the name of the game

is to play the game as long as possible.

In front of me, I have a bunch of

different graphs and images. Um, and

they some of them relate to a word you

said earlier on, which is V2 max. And

this is something I've heard you talk

about previously, but for anyone that

doesn't understand what V2 max is or why

it's important, um, can you explain what

it is and why it's so critical to

longevity and health span? I think most

people will be familiar with the idea

that we are obligate anorobes, which in

English means we cannot survive without

oxygen.

Okay. So why is that?

So oxygen is absolutely essential to

catalyze the chemical reaction that

turns food into a currency for energy

called

ATP. So everybody's probably heard of

ATP. ATP is the money, the currency of

energy in our body. Anything that

interrupts the production of ATP is

fatal. So an extreme example of that is

cyanide. Everyone's heard of cyanide as

a poison. If you take cyanide, you'll be

dead within seconds because cyanide

blocks one of the transporters in the

production of ATP. So that just gives

you a sense of how critical it is to

have an infinite and abundant supply of

ATP. Oxygen is also essential for that.

That's why without oxygen, you can only

survive for a couple of minutes. Longer

than you can without cyanide, but not

much longer. So how does it work?

So we breathe in air and that air goes

into our lungs and that air goes through

our lungs into these distal things

called capillaries where hemoglobin is

bringing the waste product called carbon

dioxide back to the lungs. And there's a

gradient of of partial pressure between

oxygen and carbon dioxide such that a

switch takes place. The air that we

breathe in delivers some of its oxygen

to the hemoglobin molecules and the

carbon dioxide diffuses off that into

the air and we breathe out air that is

lower in oxygen and higher in carbon

dioxide than what we breathed in. Mhm.

So if I go that was high oxygen, low

carbon

dioxide, that was low oxygen, high

carbon dioxide. And that's the that's

happening every second of every day.

That oxygen, that hemoglobin molecule

that's carrying oxygen is carrying it to

every cell in my body because every cell

in my body needs

oxygen. And that cell in the body is

taking the oxygen to run that chemical

reaction to make ATP. and it's shuttling

back carbon dioxide. And it's just the

most incredible thing in the world to

imagine how frequently this is

happening. And the more you exercise,

the more you consume oxygen. So oxygen

consumption is a proxy for energy

demand. So we can measure this. Now to

do so, you have to put a mask on because

I have to be able to measure very

precisely two things.

I have to be able to measure exactly the

flow rate of air going in and out of

your mouth and I have to be able to

measure very precisely the concentration

of oxygen coming out. If I know those

two things, I can calculate how many

lers per minute of oxygen you are

consuming.

So you and I sitting here right now are

probably

consuming less than half a liter a

minute. So call it 500 cc a minute of

oxygen right now because you have to

consume some to be alive. And look, I'm

moving my arms around and you're nodding

and taking notes. So, you know, if

you're sleeping, you might be consuming

300 milliliters of oxygen per minute.

That's that's the lowest level.

If you were to get up and we were to

walk around here, that number might go

up to 800 milliliters uh per minute. If

we were to walk a little more briskly,

we might be at a liter per minute of

oxygen. If I said, "Let's go out in the

parking lot and jog." Well, we might get

up to like 1.5 L per minute. we pick up

the pace a little bit, we'll get to two

liters per minute. If I start really,

really running us hard, we're going to

get to three and a half, four liters per

minute. Well, at some point, I am going

to push you so hard that you will

achieve your maximum level of oxygen

consumption. And if I push you any

harder and faster, you won't extract

more oxygen from the air. You may go

faster but you will do so through a

process that does not involve the

consumption of oxygen. You will do do so

through an anorobic glycolytic pathway

but you will have achieved your maximum

consumption of oxygen. And that number

has a very special name. It's called V2

max. So V2 max measured in liters per

minute is the maximum amount of oxygen

you can consume. And the only way you

can measure that again is to have this

mask with very very fancy apparatus that

measures both of those things I said.

And you have to be stressed hard. So we

typically do this on a treadmill or on a

bike. So your your your colleagues that

came into 10 squared yesterday, they did

it on treadmills. They ran and they ran

them and ran them and they ran them

until they couldn't go any faster. And

then we measured how many liters per

minute of oxygen they were consuming.

Now that answers what V2 max is. So the

next question is does this matter? Well

the short answer is we don't have a

single metric of humans that we can

measure that better predicts how long

they will live than how high their V2

max

is.

And it's not even close to be completely

clear. So if you compare somebody who is

in the top 2% to someone who is in the

bottom 25% for their age uh the

difference in mortality is 5x 500%. Yes.

400% technically because with hazard

ratios you you you go two two a 2x

hazard ratio is 100% I guess. Yeah. So

let's look at you. So I see you've

pulled this chart out which is one of my

favorite charts. Okay. So you Oh, by the

way, there's one other thing I should

state. We normalize this by weight.

Okay. Okay. So, we always divide that

number of liters per minute by how many

kilograms you are. So, the number is

actually reported as milliliters per

kilogram per minute. Okay.

Okay. All right. So if we look at

somebody who is your age, male 30 to

39, if their V2 max is below 35

milliliters per kilogram per minute,

they are in the bottom

25%. Conversely, if they are at 53

milliliters per kilogram per minute,

they are in the top two and a half

percent.

So to be clear, if you take a

35-year-old man and one of them has a V2

max of 53 and the other one has a V2 max

of

35, there is a

400% difference in their all-c cause

mortality over the coming year. Wow.

Okay. So all cause mortality, anything

killing them over the coming year.

That's right. Now, this becomes more and

more profound as you age because

the all cause mortality ratio for a

35-year-old is incredibly low. Yeah,

it's like 1%. So, that means you're

comparing 1% to 4%. It's not that big a

deal. But when you get up to my age, so

I'm two decades older than you. So now

the low bar, the bottom quartile is less

than

29. The high bar is more than 50.

Well, my relative mortality in the next

decade is probably 2 to 3%. So now

multiply that by four. Okay. When I get

into my marginal decade, the low bar is

18. The high bar is

36. That's a 2x difference in V2 max. A

4x difference in mortality is huge. when

the all-c cause mortality for an 85y old

is going to

be, you know, the one-year annual, you

know, the one-year mortality for that

person is, you know, more than 10%.

Yeah. So, one of the things that we do

is we sort of think through this not

just through the lens of mortality,

which is what I just walked you through

here, but also health span, which is

kind of what you were talking about

earlier with the graph of strength and

disability. So we have another figure

that we show people that um on the x

axis shows age. Yeah. And on the y ais

shows

V2. And it has a whole bunch of lines

that come across that show various

activities. You know, if you want to be

able to run a six-minute mile, you have

to have a V2 that's very high. If you

want to be able to run an 8-minute mile,

a 10-minute mile. If you want to be able

to climb a flight of stairs without

getting out of breath, like it shows all

of these different things. And you see

what the required V2 is. Mhm. I think in

fact we might even have these graphs in

here.

Yeah. Right there. So we put your dot on

the graph and we say if you stay where

you are, you're meaning right at that

green curve, you're in for a great life.

Why? Because even when you're in your

80s, you're still going to be able to do

all of those things. So the results

you're looking at here are Jack's

results. Yep. Who runs the production

here. He came to your center. Yep. Came

to 10 squared in Austin. He did the

test. I think he was on the treadmill

for like an hour or something like that.

And can you explain to me exactly what

his results say as it relates to what

you were just describing? Yeah. So he

did both a zone 2 and a V2 max test. So

Jack got on the treadmill and you know

there's a protocol for how you warm

somebody up. really want them to be able

to get to a maximum effort. You don't

just put them on a treadmill and crank

it up. You take you take your time

getting them up there. And he had an

amazing result. So, his V2 max was 4.1

lers per minute. And he achieved that at

a heart rate of 204 beats per minute,

which is higher than what was predicted

for his age. If you normalize it by his

weight, he was at

56.5 milliliters per kilogram per

minute. So when you look at his age,

because he's in his 20s, he was at about

the 97th percentile for his age, meaning

his V2 max was higher than 97% of people

his age.

And uh so out of the gate that just

tells us from a longevity standpoint,

our goal is to keep him there as long as

possible. I mean, we're so ambitious

with our patients and clients that we

actually want them to be as as an

aspiration to be two decades younger at

the top 2%.

So if you're 50, you want to be V2 max

north of 53. And then the other thing we

do is we check on something called heart

rate recovery. So in 60 seconds post V2

max, how long does it take uh how many

beats does their heart rate come down in

one minute? This is also a very powerful

predictor of mortality because it's a

huge indication of what's called

parasympathetic sympathetic balance. So,

it's basically a question of how does

the how how much is their autonomic

nervous system in favor of sort of a

stress response versus a recovery

response. And so, the gold standard

here, we want to see people that can

recover at least 30 beats in the first

minute. He did pretty well. He recovered

28 beats. You know, if you're really,

really fit, you're going to be 40, 50

beats of recovery within the first um

one minute. It's incredible. Incredible.

Then we tested his um lactate levels and

we ran him for what we called zone 2

testing. Right? So zone 2 is his aerobic

base. This is where he should be

spending 80% of his training. 80% of his

cardio training time should be in this

energy system. So it's hard enough that

it's not just pure recovery, but not so

hard that it's, you know, uh pushing

energy systems that are that are higher.

This is this is a pace he should be able

to hold for an hour and he should

certainly feel like he's working but not

feel it too much. Technically it's also

a place where he's prod he's got maximum

fat oxidation. So we do this also in the

same measure on a treadmill. This is a

bit more of a complicated test because

you're titrating between how he feels

and what his blood lactate levels are.

Maybe not to get too complicated in the

weeds on that, but we're simultaneously

looking at the ratio of how much carbon

dioxide he produces to how much oxygen

he consumes. That tells us how much fat

he is using in his own body. And we look

at that number and he maxed out

at.77 grams per minute, which is very

good. One gram per minute of fat

oxidation is exceptional. So

7677 is pretty darn good. His lactate

hit about 2 mill and he achieved this

running at 7.3 miles hour. So So again,

that's there there's a lot to unpack in

there, but that gives us a pretty good

sense of his level of fitness. And for a

guy in his 20s, um that's that's really

good fitness. He does a lot of running.

Yes. Yeah. Yeah. Yeah. And and but even

this test is a body of work. We normally

would separate these two tests on two

separate days. Okay. So people, you

know, the the people who come to 10

squared are not from Austin. They're

from all over the place. So they come in

for two days of testing. And you got to

sort of figure out a way to take a

person who's not necessarily that fit

and and allow them to do these tests. So

it's kind of broken up over to a couple

days so they can mix it with the

strength testing and all the other

stuff. And if you were advising Jack on

how to improve some of these scores

here, what would you say? So the truth

of the matter is looking at his stuff

here I would say I think you've got the

endurance thing really covered in his

case there were other issues that were

uncovered during his intake that were of

more concern and this is a matter of

like now what we think of as portfolio

management right so when your V2 max is

in the top 2% when your fat oxidizing 7

you know almost8 grams per minute and

he's got a heart rate of 165 to 170 when

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for 10% off your first order. These are

Jack's results. So I've invited Jack in

because I feel like he might have some

questions and you might have some

questions. So you guys go ahead. All

right. Well, uh, first off, Jack, thanks

for being an awesome guinea pig

yesterday. You hit it out of the park,

um, as far as your cardio training. So,

tell me a little bit like what are you

what are you doing for cardio? How often

are you running? So, I actually stripped

it back quite a lot. I probably started

maybe maybe like two years ago going

really heavy on running and that's all I

did. And then I started getting a little

bit injured. So, now I've cut it back,

but I'd say I do like one long run a

week and that's like 20k. Outside of

that, I don't really do much other

cardio. Interesting. I I know that the

team talked to you about your left foot.

Yes. And did did they show you the

pictures on the treadmill? They did.

Yeah. That's super interesting. Super

interesting. I sprained my ankle really

badly like 6 months ago. Y said that

could have been something. I think it's

very likely that the ankle sprain has

not has changed your gate such that you

probably are going to develop an injury

over time with your running. if the if

your pattern is not corrected. So,

you're overcompensating on the left and

did I I assume that I assume you noticed

the difference in the height of your

shoulders and your head and everything

while you were running. So, even though

the engine is working insanely well,

this test only measures the performance

of your engine, your chassis, which is a

subjective assessment to use the car

analogy shows that the chassis is a bit

weak. Okay, I'll give a bit of context

on what that actually was. So, when I

was running on the treadmill, um I think

it was Kyler was it? He he showed me a

picture afterwards of me running and

basically my head was right in the

middle. When I went on my right side,

but then when I went on my left, my

whole body was like a bit lopsided. Y So

yeah, that's kind of what you're talking

about there. That's right. And again,

like the good news about running is each

step is very light. Mhm. But if you're

running 20k, that's a lot of steps. So

even something that's a light impact but

done thousands of times will produce a

problem. Okay, so let's shift from how

well the engine is, which is exceptional

at both ends. By the way, to be clear,

your peak engine output, which is V2

max, was awesome, and your engine

efficiency, which was your zone 2, your

fat oxidation, exceptional. We do have

this issue on the chassis that needs to

be addressed or you're going to get a

repetitive strain injury. Mhm. Um, so

then the next thing that the the team

did was just a very simple test called

the DEEXA scan, but we we do a more

comprehensive one. So we're looking at

all the bone density, left hip, right

hip, lumbar, spine, and then total body

fat, total muscle mass, and then

visceral fat, which is fat around the

organs. I think the most surprising

aspect of the test was your bone

density. So, um, a DEXA scan, uh,

measures bone density very accurately

and both, uh, sort of across the board

in terms of your your lumbar spine and

your right hip and your left hip, you

were in your in your lumbar spine two

standard deviations below the mean for

someone your age. So, that means

basically you're in the bottom 10

percentile of bone density for a guy

your age. And for your hips, you're not

much better. Both on the left and right

hip, you're about 1 and a half to 1.7

standard deviations below the

mean. So what does that mean? That means

that you're at you you already have

something called osteoporosis. So when

your T-core, which in your case is

almost the same as your zcore because of

your age, but the zcore compares you to

someone your age. The t-core compares

you to someone 30 years old. So when

your T-core is minus1 um you have

osteopenia and when it gets below minus

2.5 you have osteoporosis. Those are

just technical definitions of bone

density. The problem is your risk of

bone fracture goes up really

significantly. Now because of how young

you are. It's not like I'm worried

you're going to walk out of here and

something's going to go wrong. But the

risk of you sustaining an injury in

sport is is not trivial. Right? If you

were out skiing and Steven was out

skiing, assuming he had normal bone

density, and you guys both took a

tumble, I would be infinitely more

worried about your bone density. And we

have patients in our practice who do.

They're young, healthy people, and they

get these freakish fractures while

skiing or playing sports and things like

that and they have really low bone

density. So, so one, it's just something

we want to address. The bigger concern

is that what's what is the what is the

story of this going to be when you're 60

and 65 and 70? And that's that's the one

where we really want to mitigate it. So,

I know that the team talked to you about

making sure you follow up with an

endocrinologist. You want to make sure

that there's nothing here that is

medically obvious to be treated, such as

vitamin D deficiency, anything that has

to do with parathyroid hormone or

calcium and things that are, you know,

medically obvious to treat. Um the most

important behavioral thing that a person

can do with low bone density beyond

correcting all the nutritional

deficiencies that can lead to it is

applying heavy load to the bone. So

bones are active pieces of tissue even

though we don't think of them that way