So if you compare low muscle mass people to high muscle mass people as they age, the low muscle mass people have about 200% increase in all-cause mortality.

If you look at cardiorespiratory fitness, it's even more profound.

You're talking about 5x difference in all-cause mortality.

That's probably the single strongest association I've seen for any modifiable behavior.

So let's start with a couple of the things that you've already highlighted.

How much does smoking increase your risk of all-cause mortality?

Smoking is approximately a 40% increase in the risk of ACM.

It doesn't mean your lifespan is going to be 40% less.

It means at any point in time standing there, your risk of death is 40% higher.

So now the question is like, how do you improve?

So what are the things that improve those?

So now here we do this by comparing low to high achievers and other metrics.

So if you look at low muscle mass versus high muscle mass, what is the improvement?

And it's pretty significant.

It's about 3x.

So if you compare low muscle mass people to high muscle mass people as they age, the low muscle mass people have about a 3x hazard ratio or 200% increase in all-cause mortality.

Now, if you look at the data more carefully, you realize that it's probably less the muscle mass fully doing that.

And it's more the high association with strength.

And when you start to tease out strength, you can realize that strength could be probably 3.5x as a hazard ratio, meaning about 250% greater risk.

So they're usually using like grip strength, leg extensions, and like wall sits, squats, things like that.

So how long can you sit in a squatted position at 90 degrees without support would be a great demonstration of quad strength, a leg extension.

How much weight can you hold for how long relative to body weight, things like that.

You know, we have a whole strength program that we do with our patients.

We have something called the SMA.

So it's the Strength Metrics Assessment.

And we put them through 11 tests that are really difficult.

You know, like a dead hang is one of them.

Like how long can you dead hang your body weight, stuff like that.

So we're trying to be more granular in that insight, but tie it back to these principles.

If you look at cardiorespiratory fitness, it's even more profound.

So if you look at people who are in the bottom 25% for their age and sex in terms of VO2 max, and you compare them to the people that are just at the 50th to 75th percentile, you're talking about a 2x difference roughly in the risk of ACM.

If you compare the bottom 25% to the top 2.5%, so you're talking about, you know, bottom quarter to the elite for a given age, you're talking about 5x, 400% difference in all-cause mortality.

That's probably the single strongest association I've seen for any modifiable behavior.

So maybe we could talk a little bit about the specifics around the training to get into that, you know, top two tiers there.

Because it seems that those are enormous positive effects of cardiovascular exercise, far greater than the sorts of numbers that I see around, let's just say supplement A or supplement B.

And that's, you know, like this is my whole pet peeve in life, right?

It's like, I just can't get enough of the machinating and arguing about this supplement versus that supplement.

And I feel like you shouldn't be having those arguments until you have your exercise house in order.

You know, you shouldn't be arguing about this nuance of your carnivore diet versus this nuance of your paleo diet versus this nuance of your vegan diet, like until you can deadlift your body weight for 10 reps.

Like then you can come and talk about those things or something.

Like, let's just start with some metrics.

Until your VO2 max is at least to the 75th percentile and you're able to dead hang for at least a minute and you're able to wall sit for at least two, like we could rattle off a bunch of relatively low hanging fruit.

Dead hang for about a minute seems like a really good goal for a lot of people.

At least that's our goal.

I think we have a minute and a half is the goal for a 40 year old woman.

Two minutes is the goal for a 40 year old man.

So we adjust them up and down based on age and gender.

Great.

And then the wall sit, what are some?

We don't use a wall sit.

We do as just a straight squat, air squat at 90 degrees.

And I believe two minutes is the standard for both men and women at 40.

Great.

And then because for some people thinking in terms of VO2 max is a little more complicated, they might not have access to the equipment or to measure it, etc.

What can we talk about, think about in terms of cardiovascular?

So run a mile at seven minutes or less, eight minutes or less?

That's a good question.

So there are really good VO2 max estimators online and you can plug in your activity du jour.

So it would be at a bike run or rowing machine and it can give you a sense of that.

And I don't remember, I used to know all of those.

But now that I just actually do the testing, I don't recall them.

But it's exactly that line of thinking.

Like, can you run a mile in this time?

If you can, your VO2 max is approximately this.

And then you mentioned deadlifting body weight 10 times.

I just made that one up.

That's not one that we include, but something like that.

We use farmer carries.

So we'll say for a male, you should be able to farmer carry your body weight for, I think we have two minutes.

So that's half your body weight in each hand.

You should be able to walk with that for two minutes.

For women, I think we're doing 75% of body weight or something like that.

Yeah, it's basically grip strength.

It's mobility.

I mean, again, walking with that much weight for some people initially is really hard.

You know, we use different things like vertical jump, ground contact time, if you're jumping off a box, things like that.

It's really trying to capture...

And it's an evolution, right?

I think the test is going to get only more and more involved as we get involved.

Because it took us about a year.

Beth Lewis did the majority of the work to develop this.

Beth runs our strength and stability program in the practice.

And basically, I just tasked her with like, hey, go out to the literature and come up with all of the best movements that we think are proxies for what you need to be like the most kick-ass, you know, what we call centenarian decathlete, which is the person living in their marginal decade at the best.