I’ve been following Eric Topol since the pandemic and find him to be a very level headed thinker about medicine, so I was surprised when he strongly recommended a book on medicine by bestselling author and YouTube celebrity, Petter Attia. (Simply because such books are usually junk.) Having now read most of Outlive, I can see why. Topol is not without his criticisms, but he still recommends the book, and so do I. I really wish I could make everyone I care about read it!

Most importantly, the book makes a very strong argument for the importance of exercise. Yeah, you already knew that, but Attia wants you to do much more exercise than you are probably doing right now. More importantly, he makes a strong case for exactly why you need to be exercising, as well as offering very specific recommendations for the types of exercise you should be doing and how you should be doing them.

To be honest, most of us are never going to do all the things Attia recommends - but even if you only do a fraction of them the benefits are still quite considerable, and understanding the reasons for his recommendations can help inform your own practice.

Attia’s argument is based on both his experience as a medical doctor as well as his work in the field of financial risk analysis. He focuses on what he calls the Four Horsemen”—heart disease, cancer, Alzheimer’s (and related neurodegenerative diseases) and metabolic dysfunction (insulin resistance, Type 2 diabetes). He does an exceptional job of weaving all the common threads together for these four chronic conditions, such as how metabolic dysfunction is a key underpinning across the board.”

In particular, he argues that because exercise is key to addressing metabolic dysfunction, it is also key to helping prevent the other three horsemen. And the reverse is true as well, people who are unfit are at much higher risk of these diseases.

One notable study he cites is from over 750,000 U.S. veterans ages 30 to 95. The least fit 20% group had 4-fold higher risk of dying than a person in the top 2% of their age and sex category (Figure below, JACC, 2022). He reiterates the paper’s conclusion: Being unfit carried a greater risk than any of the cardiac risk factors examined.””

He talks about healthspan” rather than lifespan” because even though these interventions might slightly prolong your life, that is not his focus. Rather it is on trying to ensure that the last decades of your life are not spent treating these debilitating conditions.

What got me especially excited are some of the specific recommendations he makes about exercise. The section on stability” is probably the least scientific of his chapters, since it is not based on published research. Nonetheless, it happens to be the one that fits best with what I’ve discovered via my own fitness journey these past four years. The specific recommendations he makes in that chapter are very close to what I am already doing and he explains this approach very well. I might try to summarize some of this later on, but really the best thing you can do is to just read the book yourself!