top of page

Outlive: Key Takeaways for Strength Athletes Part 1 - Exercise

Updated: Dec 10, 2023

I've read, or rather listened, to Outlive: The Science and Art of Longevity by Peter Attia, MD with Bill Gifford, multiple times over several months now. The intent of this post is not to provide a full review of the book, which I highly recommend, but rather to pull out some key takeaways that Strength athletes and enthusiasts should consider for improving not only your training, but also your quality of life and health span. Part 1 of this series is specifically focused on exercise and concludes with 2 takeaways for you to consider in your training. Part 2 does a DEEP dive into conditioning, while Part 3 touches on stability concepts for your consideration.


  1. I am not a Doctor or Medical Professional. The information provided here is for educational purposes only and does not replace medical or healthcare professional advice. Consult your Primary Care Physician or other healthcare professional before implementing any recommendations into your life style.

  2. Any views and opinions expressed are my own and are not affiliated with USA Powerlifting or the authors of this book.

  3. This post contains advertisements. Any views and opinions are my own and not affiliated with VIVOBAREFOOT.


"cardio vascular disease, cancer, and neurodegenerative diseases" are all "fueled in some way by metabolic disfunction."  Use exercise as a tool to avoid these icebergs.

In this book, the author likens life to a voyage at sea. He states that the longer we live, the more likely we are to encounter icebergs. These icebergs represent the four diseases of aging which he also calls the four horsemen:

  1. Heart Disease

  2. Cancer

  3. Neurodegenerative Disease

  4. Metabolic Disease or Insulin Resistance

Our goal is to avoid the four horsemen, and cruise into our 10th decade of life or further, while still being able to do the things we love. We don't want to end up like a passenger on the Titanic, unknowingly headed towards an iceberg, in our 4th, 5th, or 6th decade of life, then end up on a ship that is slowly sinking. The author asserts we can use "radar" during our voyage to avoid these icebergs for as long as possible, and that the best long range radar we have to detect these icebergs is insulin resistance. He states and shows readers how "cardio vascular disease, cancer, and neurodegenerative diseases" are all "fueled in some way by metabolic disfunction." Attia believes the first logical step in improving health span is getting your "metabolic house in order," by "changing how we exercise, what we eat, and how we sleep." Again, in this post we will be primarily focused on exercise, but you will be well served to consider his recommendations on sleep and nutrition.

"cardio vascular disease, cancer, and neurodegenerative diseases" are all "fueled in some way by metabolic disfunction"

In Chapter 11, Attia asserts that exercise is the best tool we have to combat the four horsemen. If you are reading this blog post, then you likely already exercise, and that's great news! If you don't already exercise, then NOW is the time to start! The question is, are you and I doing enough? If not, what can we do to improve our exercise regimen?


According to the Physical Activity Guidelines for Americans 2nd edition [1], "Today, about half of all American adults—117 million people—have one or more preventable chronic diseases. Seven of the ten most common chronic diseases are favorably influenced by regular physical activity. Yet nearly 80 percent of adults are not meeting the key guidelines for both aerobic and muscle-strengthening activity, while only about half meet the key guidelines for aerobic physical activity. This lack of physical activity is linked to approximately $117 billion in annual health care costs and about 10 percent of premature mortality." This echoes Attia's sentiments that exercise is one of the best tools we have to increase life span and health span.

"Yet nearly 80 percent of adults are not meeting the key guidelines for both aerobic and muscle-strengthening activity"

In Chapter 11 of Outlive, Attia reinforces the importance of exercise to extend and improve health span. Exercise is so important that he says if you can only take away one thing from his book and apply to your life, it has to be in the realm of exercise. Attia notes that "Going from zero weekly exercise, to just 90 minutes per week, can reduce your risk of dying from all causes by 14%. It's very hard to find any drug that can do that."

Cardio Respiratory Fitness (Conditioning)

Attia also states in Chapter 11 that peak cardio respiratory fitness, measured in terms of VO2 max, may be the single most powerful indicator for living a long and healthy life. He notes someone of below average VO2 max is at double the risk of all cause mortality compared to someone in the top 25%. Attia further adds that someone in the bottom 25% is 4 times more likely to die than someone in the top 25%.

Muscle & Strength

Later in Chapter 11, Attia references interesting studies indicating that muscle may be just as important, maybe even more important, than cardio respiratory fitness. He references a 10 year observational study of about 4,500 people ages 50 and older which found those with low muscle mass were at 40% to 50% increased risk of mortality when compared to controls. Attia adds that upon further analysis that it was not the mere muscle mass that matters, but also the strength and ability to generate force. Subjects in the study with low muscle strength were at double the risk of death, while those with low muscle mass and/or strength combined with metabolic syndrome were at 3 or more times greater risk of all-cause mortality.

Attia references another study that suggests that strength may even be more important than cardio respiratory fitness for longevity. This study found that even if someone was in the bottom half of cardio respiratory fitness, their risk of all-cause mortality was 48% lower if they were in the top third of the group in strength when compared to the bottom third.

Whether you are new to exercise, or a highly trained athlete, there are useful takeaways that we can all benefit from in his book. Attia asserts whether you are looking at it from cardio respiratory or muscle & strength perspective, the fitter you are, the lower your risk of death. He notes there is no other intervention that can rival the magnitude of benefit of exercise when it comes to increasing life span and health span.

In Chapter 13 of Outlive, Attia discusses the importance of stability. He notes many older people tend to exercise less, if at all, because of some chronic condition or injury. Attia asserts stability is essential to movement, especially if we want to repeat that movement for decades. He believes most acute injuries are likely the culmination of a chronic weakness and/or lack of stability that was the root cause of the injury. Just like we are trying to avoid the four major icebergs on our voyage of life, Attia believes stability is the key to avoiding other ice bergs along our fitness journey.


Are you convinced now that we should all be exercising, regardless of age? If not, re-read the previous section above. If so, then how much exercise do you need? The Physical Activity Guidelines for Americans make the following recommendations for Adults and Older Adults:


  • 150 minutes to 300 minutes a week of moderate-intensity aerobic activity, or 75 to 150 minutes a week of vigorous aerobic activity.

  • Additional benefits are gained by engaging beyond 300 minutes a week of moderate-intensity aerobic activity.

  • 2 or more days a week of muscle-strengthening activities of moderate or greater intensity involving all major muscle groups for additional health benefits.

Older Adults

  • Multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.

  • If unable to do 150 minutes of moderate-intensity physical activity a week due to chronic conditions, do as much as their abilities allow.

Note, the guidelines provide recommendations for optimal health outcomes. That is, if you are seeking improvements in sport performance, you will likely need to go beyond the guidelines depending on the specific sport and your goals. The guidelines also have recommendations for preschoolers, as well as children and adolescents ages 6 to 17. However, I am assuming most children will not be running into this blog.


2 people doing conditioning work

Since the name of this blog is "Crafted Strength," I am making the assumption most folks who read this already meet or exceed the 2 or more days a week of muscle-strengthening activities. The key takeaways here will be focused on how strength enthusiasts can augment their training so that they can continue to train and enjoy life well into their later decades.


If you typically skip cardio, I hope I have given you enough reason to reconsider this, as increased metabolic conditioning is not only important for continued strength development, but also for continued longevity and quality of life. Conditioning doesn't have to be hard, and it can be anything from running or cycling to swimming depending on your interests. Take a look at your current exercise regimen and ask yourself, "am I meeting the recommended guidelines for aerobic activity per week?" If not, how can you add more? If yes, would it benefit you to add more? Defining what "moderate" and "vigorous" intensity even is, and how to augment and progress your conditioning work will be covered in Part 2 of this series.

Stability Work

If you currently do not do any stability work, there is a case to be made that doing so will not only improve your athletic performance, but it will also help you avoid injury that can not only stop you from training, but could potentially knock you out of the game of life entirely. We don't need to do single legged squats on a BOSU ball here, but some sort of stability work that challenges your balance and develops your proprioception will make you a well-rounded athlete and likely more resilient.

Stability is not limited to balance, although balance can be a key component. Stability also includes the effective transmission of force and power through your body's moving parts. Just like a machine, the most likely points of failure are usually a moving part or it's electronics. Unlike a machine, the human body can strengthen it's moving parts through appropriate movements and progressions. Stability work can be anything from core work, to unilateral movements, joint resiliency exercises to barefoot training. Stability concepts will be discussed in Part 3 of this series.



  2. Outlive: The Science and Art of Longevity by Peter Attia MD with Bill Gifford


Sign Up Here for Newsletter, Updates, and More!

Thanks for subscribing!

bottom of page