#176 - AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity
Peter Attia, MD, and Bob Kaplan discuss the profound impact of cardiorespiratory fitness (CRF), muscle mass, and strength on longevity and mortality risk. They delve into data showing how improving CRF, especially from low levels, offers significant health benefits comparable to or exceeding avoiding major health risks.
Deep Dive Analysis
7 Topic Outline
Introduction to AMA #27: Exercise Outputs and Longevity
Starting Point: Cardiorespiratory Fitness and Mortality
Explaining Metrics: VO2 Max and Metabolic Equivalents (METs)
Detailed Process of VO2 Max Testing
Monotonic Relationship Between Fitness and All-Cause Mortality
Quantifying Mortality Risk Reduction by Improving Fitness Levels
Comparing Fitness Benefits to Other Major Mortality Risk Factors
5 Key Concepts
VO2 max
VO2 max is an objective metric for cardiorespiratory fitness, representing the maximum rate at which an individual can utilize oxygen during intense exercise. It is measured in milliliters of oxygen per kilogram of body weight per minute, indicating the body's peak capacity for aerobic energy production.
METs (Metabolic Equivalents)
METs are another objective metric for cardiorespiratory fitness, often used interchangeably with VO2 max in literature. They quantify the energy cost of physical activities relative to resting metabolic rate.
Indirect Calorimeter
This device is used to measure VO2 max by providing complete occlusion around the mouth and nose to measure the concentration of oxygen expelled and carbon dioxide produced. By knowing the gas concentrations on the way in and out, it determines how much oxygen was consumed and CO2 produced.
Fick Equation
The Fick equation is mentioned as a method to calculate total energy consumption based on the measured flow rates of oxygen (VO2) and carbon dioxide (VCO2). It allows for the determination of kilocalories utilized per minute at any given point during exercise.
Hazard Ratio
A hazard ratio is a statistical measure used to compare the risk of an event (like mortality) between two groups over time. A hazard ratio less than one indicates a reduced risk in the exposed group, while a ratio greater than one indicates an increased risk.
4 Questions Answered
The most common metrics seen in the literature are METs (metabolic equivalents) or VO2 max, both of which are objective measures of cardiorespiratory fitness.
VO2 max is measured using an indirect calorimeter, a device that provides complete occlusion around the mouth and nose to quantify oxygen consumed and carbon dioxide expelled while a person works at increasing intensity on a bike or treadmill.
There is a clear monotonic relationship between cardiorespiratory fitness and all-cause mortality, with the greatest reduction in mortality risk observed when moving from low fitness levels to even below-average fitness.
Improving cardiorespiratory fitness from low to above-average levels can reduce mortality risk by an amount comparable to or greater than the risk associated with smoking, coronary artery disease, type 2 diabetes, or hypertension.
6 Actionable Insights
1. Optimize Fitness for Longevity
Prioritize improving cardiorespiratory fitness, muscle mass, and muscle strength, as these factors are strongly associated with reduced mortality and increased longevity.
2. Measure VO2 Max Annually
Undergo a VO2 max test to objectively measure your maximum oxygen utilization and benchmark your cardiorespiratory fitness for long-term health goals.
3. Elevate Low Fitness
Aim to improve your cardiorespiratory fitness from the lowest quartile to at least the ‘below average’ category, as this can result in a 50% reduction in mortality over a decade, especially if starting in your fifties.
4. Achieve Above-Average Fitness
Strive to achieve at least ‘above average’ cardiorespiratory fitness (50th to 75th percentile) from a low baseline, as this can lead to a 60-70% reduction in mortality.
5. Understand Elite Fitness Impact
Recognize that achieving elite cardiorespiratory fitness can lead to a five-fold reduction in mortality over a decade compared to having low fitness, highlighting its profound impact on longevity.
6. Watch Podcast Video
For a better understanding of the data presented in this episode, especially the figures, watch the full video version available on the show notes page if you are a subscriber.
4 Key Quotes
by far the biggest gap is between the people in the bottom 25%, which are categorized as low fitness and basically everyone above them.
Peter Atiyah
going from just being low to being below average is a 50% reduction in mortality over a decade.
Peter Atiyah
If any team deserves a Stanley Cup, it's Toronto.
Bob Kaplan
If you compare someone of low fitness to elite, it is a five fold difference in mortality over a decade, which is pretty remarkable.
Peter Atiyah