Q&A on Zone 2 Exercise with Peter Attia, M.D.

Notes: min 0-19 (until live questions) Peter's Definition of Zone 2:  -Highest energy you can put out while keeping Lactate below 2 mM (milimole) -Higher than 2 mM makes you produce lactate at a rate faster than you can clear it. Equilibrium is thrown off. -Peter likes to be between 1.7-1.9 mM (previous video) -- Why is it important?  -"Most important place to be training your mitochondria."  -Mitochondrial degeneration contributes to aging, so slowing that process down helps. -- How often?  -Depends. If you're deconditioned = 30 minutes 3x/week, for example -- Where does Peter mainly do his zone 2 training? - Stationary Bike.  -Why? (1) Measures Wattage (2) Able to keep Wattage at a constant value (so he doesn't go into other zones) -Note: zone 2 can also be reached via swimming, treadmill, stair master, insert cardio machine -- Peter's Zone 2 Weekly Schedule: - 3-4 hours a week of zone 2. 3 hours is the target for his patients. -- How Long should i do it for?  -45 minutes per session should be the minimum.  -30 minutes if you're new -45 minutes if not.  -20 minute blocks or anything below 40 is not ideal. Short intervals < Long intervals -- Strength training before/after zone 2?  -Strength Training -> Zone 2 = Not good for hypertrophy.  -Zone 2 -> Strength = Less of an issue for hypertrophy.   -Peter only does strength training + zone 2 combined on one day, where he separates zone 2 in the morning and strength in the afternoon (separated by several hours). -- Slipping into z3,z4,z5 during workout, is it a problem?  -Yes. Once you get into z3,z4,, and z5 you start producing more lactate than your body can clear, which is counterproductive to that "sweetspot" of z2. -In order to prevent this, Peter does his training in-door on his wahoo kickr (stationary bike) so that he can keep his wattage at a constant value (barely changes). Outdoors makes it harder to do that. -- Most important benefits?  -Mostly physiologic. More zone 2 = better you are at insulin sensitive and insulin independent glucose uptake. Makes for very efficient mitochondria when it comes to glucose disposal, one of the hallmarks of metabolic health.  -Every day you age, you become less insulin sensitive so you want to push that boundary as much as possible. Also helps combat ROS (reactive oxygen species) & other processes involing inflammation. -- Beneficial at any age?  -Yes. However, younger aged individuals have a greater ability to explore other energy zones. -- Zone 2 vs High intensity interval training (HIIT)? - Long answer short, ask yourself "why cant I do both?" -- Can I use a Lactate meter sparingly?  -Absolutely. Peter has a lactate meter device to measure his lactate levels. Measures his lactate levels, HR, Watts, and Power after every single zone 2 session (this is optional). Pretty expensive, $4 per lactate strip + $150 Lactate device -- Don't want to use a Lactate Meter, how do I know if i'm in z2? -Measure via two things (1) HR (2) Perceived Exertion -Start off at 80% maximal HR. How to figure that number out? Need to really exert yourself via treadmill stress or some other way. -Perceived Exertion. He can mostly nasal breath, but he also breathes through his mouth although he's definitely not out of breath or breathing rapidly from his mouth. -Best strategy: measure your lactate periodically (i.e., once a month) and learn to rely on your HR + Perceived Exertion

It’s REALLY amazing to have access to this kind of knowledge so easily

My curiosity was peaked. I went to Duke Med School in the athletic facility where they test the Duke Cycling Team to have my zone 2 calculated. They first determined my max HR, 183. I’m 57. So the 180-age or the 220- age are way off if I used those for calculating Max HR. The med team put me on the ERG bike and worked me for 45 minutes bleeding and testing my blood continuously. They calculated my 2mmole HR at 157-160. If I used the 180-57 (age) as max hr I would undershoot my zone 2 by 34 beats per min. If I used (220-57) x .8 I would undershoot my zone 2 by 27 beats per minute. My point is to get your lactate tested to find YOUR zone 2. I would hate to think I wasted a workout outside of zone 2 based on a calculated number and not my biologically calculated number. I post this because like many of you I am genuinely interested in longevity and optimal health.

Only 3 minutes in and i already feel way smarter 🙏🙏🙏

Thank you Dr. Attia, you have a gift for making the complex easier for me to understand.

As an aspiring triathlete, this is absolute gold. Thank you Peter

Literally just searching youtube to learn more about this! Perfect! Thank you!

While it just seems like purely data driven science to you, having free access to this kind of information is among some of the most progressive and helpful work being done out there at the moment. The societal effects these resources have are phenomenal. You’re doing good work Doc P!

Tracking lactate with this level of precision looks expensive for someone on a budget, but it is good to understand these concepts. Another fascinating presentation.

Thank you so much for posting this, it really helped me and I truly appreciate it!

Awesome as always, Peter! You make Toronto proud!

Phenomenal information. Thanks Peter

Really nice for a brazilian to see so many things from Ayrton while you explain interesting things.

Dr. Attia, I feel like I am going back to college for free listening to your channel. THANK YOU SO MUCH

THis is the most informative and clear video I've seen about the topic. Thank you!

I was diagnosed with PACs and PVCs. that troubled me a fair amount throughout the day and often while working out. I started riding a stationary bike and maintained zone 2 for 30 to 45 minutes a day for weeks. My PACs and PVCs are rare now. I had no idea this would happen. Zone 2 felt safe, good for my heart, and this kept me going. Just thought I would share this.

Thanks for sharing on YouTube!

Peter’s whole book he compiled takes this video to another level, times 1000. Outlive, it is called. This video takes his book to another level as well! Thank you, Dr. Attia; I found a Doctor in Prescott, AZ, who read that same book, was four years out of medical school, and was on fire—helped me A LOT. Genetic testing, the whole nine. But.. he treated every patient that way - he was the facility's medical director and had to see patients from 9-6, then do his charts.. 6 days a week! It taught me two main things: one, it would be great for a second book to come out that is called ‘In Actual Practice ‘ or something for medical providers to implement medicine 3.0 on the day-to-day. Secondly, if a provider would do what was outlined in the book - finding the guy throwing the eggs - it would take about 45 minutes to 1 hour per patient. At least, that was my experience. Then again, I am 39y old, with three genetic clotting predispositions, one kidney, in phenomenal shape - and am SUPER interested in the information. I teach the local college Paramedic and EMT classes, work as medic FF, and am going back to school for advanced practices and degrees. Probably too old for medical school! Thank you, Peter, you rock, man! May the Lord bless you, your family, and your patients! ❤

Peter you are a brilliant “Experiment” that we all get to enjoy, bravo 🎉 Good Doctor

Great Q&A discussion, keep up the great videos and podcasts.