Attia-O’Keefe, M.D.: Preventing CVD and the risk of too much exercise

Hi all. I can’t help but be very interested in Barbell Medicine’s response to Peter Attia’s most recent podcast on “too much exercise”. Granted their examples of training pertain to endurance, where do your views differ on training “hard” as you get older? Are the problems they discuss relevant to powerlifting?

They basically state that past a certain point in life, you’re either serving the master of longevity or the master of performance. Clearly there can be balance here. What is the nuanced POV from your perspective?

Maybe this makes for a topic on a podcast of your own. Or even better, a podcast with Attia covering the differences in your philosophies overall would be really interesting if you could get him on or vice versa.

They did not argue against training “hard”. Rather, they were discussing the potential downsides of extremely high volumes of high intensity exercise, performed over a long period of time, like the kind an elite endurance athlete or ultramarathoner might perform.

We have described our recommendations on exercise for health purposes; specifically, that there is no minimum threshold for benefit (i.e., any amount helps), that we see a dose-response effect of increasing exercise volume (albeit with diminishing returns) on health-related benefits, all of which are supported by the evidence base used to design the current physical activity guidelines.

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Thanks, Austin. That is clarifying. However, they mentioned if you’re over 30 (!) and you’re running more than 15 miles a week, you aren’t doing it for health/longevity. A, that’s young and B that’s not much exercise at all as compared to your description "extremely high volumes of high intensity exercise". I thought their statement was striking and would seem to imply there are common equivalents in lifting weights in terms of exertion and why/why not.

I think Attia’s thoughts on this extend to lifting weights as well. e.g. I remember him saying the appropriate time to max out on a deadlift is never. And of course being here, I personally think that is silly based on what I have learned from you guys, but I do wonder the rationale from his perspective (not heard the detail) and why it’s not a concern from your pov.

I believe you guys have it right, I’m able to stay in a sweet spot on your programs that involves more vol than I previously thought possible. But equally, I’m mid 30s now, I’m not competing, and I don’t have elite level capacity, so am I right to continue pushing. Just interesting to consider.

We would simply not agree with this assertion, although may be partially due to where we would arbitrarily place our “cutoffs” on the diminishing returns curve. We still have evidence of decreasing morality risk up to very high levels of cardiorespiratory endurance.

There are also no established equivalents for lifting weights.

I would agree that no one “needs” to max out a deadlift for health purposes.

However, I am unconcerned with our recommendations causing people to lift weights “too much”, given the enormously greater global problem of physical inactivity.

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Thank you once again. You guys are invaluable.

So we have no evidence of longevity trade-offs in weight lifting (absence of evidence is not evidence of absence acknowledged)? Or do you see your regulation methods (RPE/load management) being the mechanism by which you’re managing inflammation, for example, over the course of a lifetime of lifting and thereby managing longevity trade-offs?

For the purposes of my questions I’m assuming a guy who’s like you, training like you do, running near lifetime PRs and setting new PRs. I know you have to account for the majority in your recommendations. How do you see yourself changing the way you train as you age? When do you anticipate you’ll set your final PRs and decide to adjust your training? E.g. Tuscherer has pretty much called the competition game off for himself right?

I know you’ve somewhat covered this in various places as it pertains to new lifters. But what about guys like you? (the challenge with instagram, podcasts, articles, forums, etc is your knowledge base is very difficult to keep track of and track down)