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Dr. Michael Joyner on Exercise and Longevity
- Lifelong interest in exercise and exercise physiology
- Exercise is a major factor in longevity, along with sleep, nutrition, emotional health, and exogenous molecules
- Exercise has the most impact on lifespan and health span
Why Exercise Helps You Live Longer
- Risk factors that contribute to cardiovascular disease and all-cause mortality are influenced by exercise and physical activity
- Blood pressure
- Diabetes
- Lipids and cholesterol
- Stress management
- Endothelial function (lining of blood vessels)
- Autonomic nervous system (vagal tone, heart rate variability)
- Exercise has a synergistic effect on these risk factors, providing a greater benefit than the sum of the individual improvements
- Epidemiological studies consistently show a 50% reduction in cardiovascular and all-cause mortality among physically active individuals
- Examples: London bus driver/bus conductor study, longshoremen studies, Harvard alumni studies, Vasa Lopet cross-country ski race finishers
Natural Experiments in Epidemiology
- Comparing two groups of people exposed to different factors
- Consistent findings of a 50% reduction in cardiovascular and all-cause mortality among physically active individuals
- Exercise and physical activity lead to increased life expectancy
Exercise and Aging - Consistent small risk reductions in mortality for vegetarians
- Likely due to health-conscious choices in other areas of life
- Exercise has a more profound impact on health and longevity
- Hazard ratio of 0.5 (50% reduction in all-cause mortality)
- Translates to a 3–5 year increase in life expectancy
- 6–8 years of improved healthspan (disability-free years)
Natural Experiments in Exercise
- Bus conductor vs. bus driver study
- Conductors had more physical activity, less likely to make poor health choices
- Exercise can offset declines in physical ability more than sleep, nutrition, or medication
Centenarian Decathlon
- Model for measuring healthspan
- Focuses on athletic events and activities of daily living in the last decade of life
- Examples: walking 3 miles in 1 hour, climbing 60 stairs in 1 minute, carrying 20 pounds of groceries, getting up off the floor with one hand of support
Decline in Performance with Age
- Decline can start at age 30 without training, pushed back to age 40 with training
- Steeper decline in the mid-70s, shifting from cardiopulmonary limitation to skeletal muscle strength and frailty
- 70% of 70-year-olds can’t get off the floor
- Importance of strength, circuit, and agility training in the 40s and 50s
Maintaining Activity and Strength in Aging
- At age 75, there is a steep decline in physical activity, muscle mass, and strength
- Loss of strength likely contributes to loss of activity, creating a feedback loop
- Importance of exercising relatively hard a few days a week to slow decline
- Avoiding inactivity is crucial for maintaining physiological function
Dangers of Falls in Later Life
- High mortality rate for 65+ year-olds who suffer a fall resulting in hip or femur fracture
- 25–60% mortality rate at one year, depending on the study
- Exercise can help prevent falls and maintain bone mineral density
Impact of Exercise on Health and Autonomic Nervous System
- Major health events, like a broken hip, can significantly impact the survival and quality of life of older individuals
- Epidemiologist Lester Breslow identified factors in people who lived to 90:
- Non-smokers
- Not obese
- Physically active
- Ate modestly
- Stayed engaged in life
- Exercise can help maintain a healthy weight and counteract a bad diet
- However, it is difficult to outrun a bad diet in a modern, high-calorie, low-physical activity world
Autonomic Nervous System
- Controls the internal environment (homeostasis)
- Two branches: sympathetic nerves and parasympathetic nerves
- Sympathetic nerves: increase heart rate, constrict blood vessels, help muscles contract harder, make you sweat
- Parasympathetic nerves (e.g., vagus nerve): slow heart rate, lower blood pressure, critical for digestion
- Exercise helps tune up the autonomic nervous system, improving its ability to regulate the internal environment
Exercise and Recovery
- During exercise, blood pressure and heart rate increase to meet the demands of the skeletal muscles
- This is a normal response to generate a large cardiac output
- After exercise, heart rate and blood pressure fall, often to better levels than in untrained individuals
Heart Rate Recovery (HRR) and Heart Rate Variability (HRV)
- HRR: how quickly heart rate returns to baseline after exercise
- Faster HRR indicates better vagal nerve function, which is protective against arrhythmias and sudden cardiac events
- HRV: variation in time between heartbeats
- Indirect marker of vagal tone or activity
- Can be quite genetic and less modifiable than other factors
Training and Mortality Risk - Training and physical fitness can be measured in met hours per week
- Met: metabolic expenditure of sitting at rest (3.5 oxygen ventilation)
- Example: Running 6 miles in an hour = 10 met hours
- Epidemiology suggests a J‑curve relationship between training and mortality risk
- Sedentary individuals have the highest risk
- Moderate exercise reduces risk
- Extremely high levels of exercise (e.g., 100 met hours per week) may increase risk
Vo2 Max Test and Mortality
- Vo2 max test measures oxygen consumption during exercise
- Higher Vo2 max = greater physical fitness
- Strongly linked to all-cause mortality
- Fitter individuals have lower mortality risk
- Hazard ratio of 5.4 between fittest 2.5% and least fit 25%
- Fitness is a more significant risk factor than smoking or end-stage renal disease
- Exercise is not a complete vaccine against health issues
- Can still have plaque buildup in coronary arteries
- Blood vessels can be larger and healthier with exercise
- Protective effect on lipids and blood vessel linings
Met Hours and Exercise Intensity
- Walking 3 miles in an hour: 3–4 met hours
- Running 6 miles in an hour: 10 met hours
- Example: Running 6 miles in an hour, 4 times a week = 40 met hours per week
- Extremely high levels of exercise (e.g., 100 met hours per week) may increase mortality risk according to some literature
- However, this is still debated and not universally agreed upon
J Curve in Exercise and Mortality
- However, this is still debated and not universally agreed upon
- Mortality decreases with increased exercise up to a certain point, then increases again
- Some studies show a J curve, others do not
- Large NCI study with 650,000 subjects did not show a J curve
- Cross country ski paper from Scandinavia supports high levels of exercise without increased mortality
Atrial Fibrillation and Exercise
- Heavy exercisers may have a slightly increased risk of atrial fibrillation
- No increased risk of fatal arrhythmias
- Ventricular arrhythmias, which can be fatal, are not seen more in heavy exercisers
- Atrial fibrillation risk still lower than sedentary, hypertensive, obese, diabetic individuals
- Good treatments available for atrial fibrillation
Myocardial Fibrosis and Exercise
- No compelling evidence to suggest myocardial fibrosis in heavy exercisers
- Flexible, compliant heart muscles seen in fit young people and master athletes
- Training helps maintain ventricular compliance and flexibility
VO2 Max and Exercise
- VO2 max declines about 10% per decade starting in the 30s
- Decline driven by age-related decline in heart rate and reduced heart pumping capacity
- Training can reduce the rate of decline by about half up to the 70s
- Maintaining high VO2 max in youth can help offset the decline in later years
Training for High VO2 Max
- High-intensity training necessary to achieve high VO2 max
- Longer intervals three or four times a week can provide significant benefits
- Maintaining high VO2 max can extend life and improve quality of life in later years
VO2 Max and Aging
- VO2 Max: measure of maximum oxygen consumption during exercise
- Important for maintaining independence and physical abilities as we age
VO2 Max in Older Adults
- A VO2 Max in the 20s or lower 30s is considered good for someone in their 80s
- Scandinavian elite skiers in their 80s had VO2 Max values in the high 30s or low 40s
- Likely due to genetic gifts and lifelong physical activity
- Aiming for a VO2 Max of 30 is a reasonable goal for older adults
Strength and Stability Training
- Important to train strength and stability alongside cardiovascular fitness
- Being able to perform daily activities and maintain independence is key
- Examples: playing with grandchildren, navigating stairs or escalators
Factors Affecting VO2 Max
- Gas exchange in the lung
- Pump efficiency (heart rate, stroke volume, contractility, etc.)
- Gas exchange in the muscle bed
- Majority of reduction in VO2 Max as we age comes from reduced cardiac output
- Mainly due to reduction in peak heart rate
- Can be buffered to some extent with a compliant ventricle
Training for VO2 Max
- Elite athletes often have lower peak heart rates due to high stroke volume
- Training can help maintain or improve VO2 Max as we age
- Important to find a balance between cardiovascular, strength, and stability training
High Output Endurance Athletes - Low-end aerobic efficiency is important for peak performance
- Example: Tadej Pogačar’s ability to maintain 4 watts per kilo for 4 hours
- Wider base of aerobic efficiency allows for a higher peak
Training Intensity Levels
- Elite athletes typically follow a 60–70–20–30–10 model
- 60–70% of time spent in medium-fast intensity (Zone 2/3)
- 20% of time spent in slightly higher intensity (Zone 3)
- 10% of time spent in high intensity (Zone 4/5)
- Training has converged on this model over the past 20 years
Benefits of Different Training Zones
- Zone 1 (recovery pace) has health benefits and is used for recovery between intervals
- Examples: slow walking, walking the dog, parking farther away in a parking lot
- Zone 2/3 (medium-fast intensity) is where most elite athletes spend their time
- Builds mitochondrial efficiency
- Zone 4/5 (high intensity) is used for pushing limits and improving peak performance
Training Volume for Elite Athletes
- Example: Eliud Kipchoge runs 14–18 hours per week
- 60–70% of time spent in medium-fast intensity (Zone 2/3)
- 20% of time spent in slightly higher intensity (Zone 3)
- 10% of time spent in high intensity (Zone 4/5)
- Training volume has not changed much for elite athletes over the past 50–60 years
- Improvements in performance mostly due to better equipment, races, sports medicine, and longer careers
Health Benefits of Light Exercise
- Improvements in performance mostly due to better equipment, races, sports medicine, and longer careers
- Substantial health benefits from light physical activity
- Biggest benefit comes from the first 10–15 minutes a day
- Improves insulin sensitivity, fights against diabetes
- Provides a buffer against weight gain
- Improves blood vessel lining and autonomic function
Using Metrics to Track Exercise Progress
- Heart rate recovery and heart rate variability can be useful metrics
- Rating of perceived exertion (RPE) can also be helpful
- Helps individuals learn to read their own body
- Focus on big picture aspects of exercise
- Total minutes of activity per day
- Balance of high-intensity and moderate-intensity exercise
- Incorporating other forms of activity (e.g., taking stairs)
Example Exercise Regimen
- Hard day: Circuit training, stationary bike intervals, drop sets for major muscle groups
- Easy day: 30–40 minutes of light cycling or rowing, active rest
- Alternating hard and easy days for optimal recovery and progress
Boosting VO2 Max
- 4x4 or 4‑on‑4 protocol: 4 minutes of high-intensity exercise followed by 4 minutes of rest
- Can be done on a bike, on an incline, or with other forms of exercise
- Focus on maintaining steady power output and heart rate
- Aim to push through dips in performance during the third minute
Interval Training and VO2 Max
- Interval training can help boost VO2 max
- For beginners, start with 80% of their time at a conversational but not enjoyable pace
- After building a reserve, introduce four hard intervals once a week (four minutes on, four minutes off)
- Eventually, increase to two hard sessions per week
- More than five or six hard sessions every two weeks can lead to load management issues
Training to Train
- Some individuals need to train before they can train hard
- Pretraining for 3–6 months may be necessary for older individuals or those new to exercise
Elite Athletes and Exceptional Performances
- Elite athletes used to have a finite number of exceptional performances
- Sports medicine advancements and professionalization have extended athletes’ careers
- Age of Olympians has increased, allowing for longer careers and more exceptional performances
Performance Enhancing Drugs in Sports - Athletes can monetize their careers, leading to longer participation in sports
- Tom Brady’s career would have been over in 2009 without advancements in orthopedic surgery
- NBA, NFL, and MLB salary scales motivate athletes to play longer for millions of dollars
Doping in Sports
- Industrial strength doping era is over
- Testing has improved in frequency and chemistry
- Micro-dosing still possible
- Novel compounds, small peptides, and difficult-to-detect substances still a concern
- Industrial strength doping has been replaced by low-dose doping and manipulation
Growth Hormone in Sports
- Growth hormone may still be used in sports
- Athletes may use low-dose, short-acting androgens and EPO-related compounds
Exercise Mimetics
- Pharmaceutical companies are researching exercise mimetics
- Current efforts focus on increasing mitochondrial biosynthesis
- Exercise mimetics may have limited benefits compared to actual exercise
- Polypill (low-dose statins, blood pressure meds, etc.) may provide some benefits similar to exercise
Polypill for Lifestyle Diseases - Polypill: a combination of medications that address multiple health issues
- Example: statin for cholesterol, metformin for glucose tolerance, beta blockers for heart rate
- Polypill could be a potential public health strategy for lifestyle diseases
- Encourages exercise and healthy habits
- Understudied area
Sex Differences in Blood Pressure Regulation
- Research with Sarah Baker on sex differences in blood pressure regulation
- Interest in human performance
Hemoglobin Dissociation Curve
- Right shift: hemoglobin releases oxygen to tissues, harder to get oxygen from lungs
- Good for hypoxic situations
- Left shift: hemoglobin picks up oxygen from lungs at high altitude
- Found in animals adapted to high altitude (llamas, bar-headed goose)
- Some humans have rare left-shifted hemoglobins
Convalescent Plasma Program
- Antibody-rich plasma from recovered COVID patients given to those with the disease
- Evidence of effectiveness when given early in the course of the disease
- Helpful for immune-suppressed individuals
- Over 100,000 patients treated
- Plasma donors typically available 2–3 weeks after recovery, up to 6 months
- “Super donors” have both infection and vaccination, providing broader spectrum antibodies
Future of Physical Activity in America
- Need for increased physical activity and access to resources
- Disparity in access to coaching, facilities, and programs
- Decline in unstructured play and opportunities for physical activity
- Importance of addressing societal issues to improve overall health and physical activity levels
Open Gym and Physical Activity - Open gym in Tucson provided a safe space for high-energy kids
- Police knew where they were, making their job easier
- Beneficial for athletes and community
- Lack of open gym in Rochester, Minnesota
- Rich community, but limited access to facilities
- Suggestion for a national open gym movement
- Winter and summer, making use of existing facilities
Mandatory Physical Activity
- Idea of mandatory 1‑hour activity for everyone
- Could be exercise, gym, or just walking
- Example of secretaries walking during lunch break
- Social event, problem-solving, and increased productivity
Future Plans and Connections
- Attia plans to continue reading Mike’s work
- Hopes to meet in person and work out together
- Mention of Eddie Coyle at the University of Texas
- Potential future podcast guest
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