Of the dozens of books I read each year, Outlive: The Science and Art of Longevity by Dr. Peter Attia, as I shared in my last post, ranks as one of my all-time favorites in terms of its life-altering content.

Described as a manifesto on living better and longer, the book challenges much of the conventional medical thinking on aging, including life span. One of these challenges I unpacked in my last post was my surprising discovery that, if you subtract deaths from major infectious diseases like typhoid, yellow fever, cholera, diphtheria, and others, nearly all of which were eradicated by public sanitation and antibiotics in the 1920s and 30s, life expectancy has barely budged since the turn of the 20th century.

The reason: Despite the many achievements of our modern medical system, it has failed miserably in managing the chronic “slow death” pathologies that end the lives of the majority of Americans over age 70.

Nicknamed the “Four Horsemen” in the book, they include heart disease, cancer, Alzheimer’s, and Type 2 Diabetes.

As Dr. Attia explains in Outlive, a new standard of care is needed, an integrative, lifestyle-based approach to preventing the premature physical decline that leads to chronic disease. Firmly grounded in research and real-life conditions, the book is a call to action for a course correction in living a long, healthy, and meaningful life.

This post will summarize my three biggest takeaways from the book. (I have deliberately avoided too much detail since my goal is for you to read it for yourselves!)

1. Understand that physical decline is non-linear.
Skeletal muscle mass, the driving factor in stemming the onset of physical frailty, actually begins to decline in our 30s, but for most of us, it’s fairly imperceptible and mostly controllable up until our mid-forties, 50s, and even into our 60s.

But the vast majority of us are unprepared for the steep acceleration in muscle mass loss and related physical decline as we enter our 70s. Dr. Attia writes:

We lose muscle mass and strength, along with bone density, stamina, stability, and balance, until it becomes almost impossible to carry a bag of groceries into the house. Chronic pains prevent us from doing things we once did with ease. At the same time, the inexorable progression of atherosclerotic disease (hardening of the arteries) might leave us gasping for breath when we walk to the end of the driveway to fetch the newspaper. Or we could be living a relatively active and healthy life until we fall or suffer some unexpected injury that tips us into a downward spiral from which we never recover.

Dr. Mike Joyner is an anesthesiologist and exercise physiologist at the Mayo Clinic whose extensive research has been influential in Dr. Attia’s work.

In a recent interview on Dr. Attia’s podcast, Dr. Joyner points out that as many as 70% of people over age 70 either cannot or have great difficulty getting up off the floor by themselves.

Even more alarming, one finding from Dr. Joyner’s research on physical decline shows that this same population (70 and older) who suffer a debilitating fall such as a hip or femur fracture, have an average mortality rate of 50% within 12 months.

In both examples, consider the negative impact of these conditions on quality of life. How eager, for example, would you be to sit on the floor and play with your grandchildren if you were worried you couldn’t get back up by yourself? Or what are the chances of approaching each day with a positive and purposeful attitude while confined to a wheelchair due to an injury from a preventable fall?

And as Dr. Attia’s research shows, cognitive decline and physical decline are closely linked which is why, as millions of baby boomers enter their 70s, we are seeing a massive increase in dementia, Alzheimer’s, and related neurological pathologies.

The bottom line: Most Americans are wholly unprepared for the rapid progression of physical and mental decline as we age.

2. Take responsibility for your own health.
Traditional medical care assumes you are a passive patient. But aging well requires a paradigm shift in your approach to your health care. You must become an active participant. As Dr. Attia writes:

In Medicine 2.0*, you are a passenger on the ship, being carried along somewhat passively. Medicine 3.0 demands much more from you, the patient: You must be well-informed, medically literate to a reasonable degree, clear-eyed about your goals, and cognizant of the true nature of risk. You must be willing to change ingrained habits, accept new challenges, and venture outside of your comfort zone if necessary.

In addition to swimming upstream against the cultural currents of sedentarism, processed foods, and comfort addiction, as healthcare consumers, we must also embrace a shift from the passive acceptance of virtually every medical decision from our providers to fully participating in the process, being willing to challenge at times, seek second opinions, and do our own research.

As Dr. Attia puts it:

You are always participating, never passive.

3. Your biggest weapon in fighting chronic disease isn’t the latest diet fad, supplement, or drug.
One of the core themes of the book is an unambiguous conclusion that the author deduces from decades of research: The most effective tool in our toolbox to stay healthy and vital as we age is…physical exercise. As Dr. Attia attests:

I used to prioritize nutrition over everything else, but I now consider exercise to be the most potent longevity ‘drug’ in our arsenal, in terms of lifespan and health span. The data are unambiguous: Exercise not only delays actual death but also prevents both cognitive and physical decline, better than any other intervention.

As Dr. Joyner points out in their interview, among its many obvious benefits, exercise expands our blood vessels, a condition known as “vascular elasticity” that positively impacts cardiac health, lowers blood pressure, reduces harmful cholesterol, and increases heart rate variability (HRV), a key component of lowering stress and building immunity.

The problem: Despite these enormous and life-enhancing benefits, exercise is the most challenging for people of all ages to initiate and sustain.

Indeed, surveys consistently show that approximately 70% of Americans get less than 2 hours per week of exercise while those same surveys reveal that we watch 4-6 hours/day of TV and streaming video.

Sadly, the normalization of sedentaryism has taken a massive toll on Americans’ wellness.

Dr. Attia likens it to casting a broken leg for 3 months: The physical atrophy revealed in the immobilized leg closely resembles the deleterious effects of a lack of exercise on every aspect of our physical well-being.

In a 1966 Texas University study, for example, examinations of cardio-respiratory fitness in a group of college athletes who were given three weeks of bed rest revealed the equivalent of 30 years of aging.

Indeed, as Dr. Joyner concludes from his decades of research, the more physically active you are, the less the negative impact of everything else–poor nutrition, high cholesterol, smoking, etc. Dr Attia agrees:

There is nothing that is as negative in terms of its impact on your health than exercise is positive.

The Prescription: A Prevention Strategy

Have you ever signed up for an athletic challenge like a 10K, marathon, or Spartan race?

Chances are you didn’t just show up on race day and hope for the best; you probably trained for months, fortifying yourself to endure the intense physical insult to your body and perform at your peak.

That’s the unifying message from Outlive. If we want to thrive and not just survive as we age, we need this same approach: a robust preparation strategy incorporating strength, stability, and cardio training that begins as early as possible after age 30 (although it’s never, ever too late to start), and continues until the end of our lives.

In a culture like ours, more accustomed to seeking a prescription for the latest drug than pursuing significant lifestyle changes, this prevention strategy is neither easy nor will it be embraced by the majority of Americans. But for those willing to put in the work, this is their best bet to not only live longer but thrive in the process.

Finally, if, after reading the book, you’re looking for ways to get started, here are four excellent resources. (Note: While the first three are physically located in northwestern Michigan where I live, all offer virtual options.)

1. StrengthRx is on a mission to empower its clients to discover their strengths in movement, nutrition, and mindset. They offer a broad range of health and longevity resources beyond personal training. These include corrective exercise for chronic pain and movement limitations, nutrition planning, strength balance testing, and joint mobility assessment. I have personally trained here for over two years with great results. (strengthrxgym.com)

2. Aevitas Longevity Clinic is scheduled to open in early 2024 and is based on the “medicine 3.0” approach outlined in Outlive. Founded by three physicians with athletic backgrounds, Aevetis’ goal is to offer a personalized, evidenced-based package of services designed to enhance longevity and health span. (aevitasmedical.com)

3. Table Health has positioned itself as the primary resource in northern Michigan for “holistic” primary care, functional medicine, and wellness services, offering both in-person and virtual plans. (tablehealth.com)

4. Wild Health is one of the nation’s leading practices in the emerging field of precision medicine. They take a deep dive into blood work, genetic testing, and other tools to create a personalized plan based on your individual needs. (I have been a patient for 2+ years). They offer a variety of plans and although they don’t replace your primary care physician (everything’s done via Zoom), the comprehensiveness they provide in genomics, biometrics, microbiome assessment, etc. exemplifies the new standard of care described in Outlive. (wildhealth.com)

How prepared do you feel for the aging process?

Did the information in this post feel new to you or did it validate a mindset you already had?

Has it sparked any new inspiration for you to take a more active role in your health care in specific ways?

I’d love to hear your feedback.

*Medicine 2.0 is Dr. Attia’s term for the traditional standard of care.