First off, thank you for the amazing content you’ve been putting out over the past few weeks. I’ve been studying your Vital 5 Action Plan for Longevity and really appreciate the clarity and practicality of the framework.
I had a few questions to better understand your approach:
Muscular Function – Leg Press vs. Barbell Squat:
How would you translate the 2.5× bodyweight leg press standard to a regular barbell back squat? Most plate-loaded leg presses are set at roughly a 30° angle, which reduces the effective gravitational component to half (since sin(30°) = 0.5). At the same time, there’s some friction involved, while a free-weight squat has higher stability demands. Would it be reasonable to estimate that a 2.5× bodyweight leg press corresponds roughly to a 1.25× bodyweight squat—or perhaps even slightly less?
Aerobic Capacity vs. Muscular Function Standards:
The aerobic capacity field test standards seem noticeably more demanding than those for muscular function. Is that intentional, or could that simply reflect my own bias, given that I focus on strength training?
Insulin Resistance:
I was curious why insulin resistance didn’t make the final “Vital 5” list. Is the assumption that if someone performs well across the five categories, insulin sensitivity is very unlikely to be suboptimal?
Thanks again for the outstanding work—I’m really enjoying diving deeper into your material.
Thanks for the post and the kind words. To your questions about the Vital 5:
The leg press wasn’t really our choice, but rather the Cooper Institute did when the performed one of the only prospective studies on strength and health outcomes. I don’t know that a squat would be better/more discriminatory re: risk, given the higher skill component of the movement. I’d just do a leg press for this purpose if you’re concerned. If someone can squat ~ 1.5 BW I have no doubt they can leg press 2.5x BW, but the skill component of the squat makes it hard to know how much “lower” the squat can be proportionally.
I think it reflects bias across the board, e.g. Western society’s focus in exercise science, our own bias as more strength focused, and the findings that there is continued risk reduction with more aerobic fitness, which does not yet appear to be the case with strength.
We acknowledge that and felt similarly, which is why we included insulin resistance as the “beyond the vital 5” test. That said, insulin resistance is reflected in blood pressure, lipids, and waist circumference (see ATP 3 criteria). It is unlikely someone could be elite in all 5 categories and have insulin resistance.
I’m not sure if I should open another thread, but I also have a question about the latest podcast and the Vital 5 Action Plan.
You mentioned that if someone consistently has a blood pressure of 120/80, you would treat it aggressively for longevity. Does that include medication?which cases for someone with 120/80~ you would consider medication?
I said if someone has a BP of greater than 120/80 I would treat it with both lifestyle and medications. While there are some exceptions, I think most people’s resting blood pressure should be at or below 120/80.
Oh, I am ESL so I probably did not explain this well. What I mean is a slightly high reading around 120/80 in the elevated range. If a person is already following cardio and strength training guidelines, has good body composition and overall health, would you be aggressive about treating this with medication, referring to the blood pressure categories in the Barbell Medicine table?
