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When it comes to living longer and better, few voices carry as much weight as Peter Attia, M.D. The longevity medicine expert and author of Outlive: The Science of Art & Longevity has spent years translating complex research into actionable strategies for extending both lifespan and healthspan.
In a recent conversation on the mindbodygreen podcast, Attia shared the exact protocols he uses himself, from his Saturday morning VO2 max sessions to the cardiovascular biomarkers he believes should be on everyone’s radar. From how he trains to what he tracks, here’s how Attia applies the science of longevity in real life.
Why exercise remains the most powerful longevity tool
“Exercise is the single most powerful lever we have for both lifespan and healthspan,” explains Attia. Unlike any pill or therapy, it benefits nearly every system in the body—improving metabolic health, protecting the brain, strengthening the heart, and preserving muscle as we age.
While scientists are still uncovering the precise mechanisms behind exercise’s profound effects, Attia believes the takeaway is already clear: there’s no substitute. Even as researchers work on “exercise in a pill,” he suspects those efforts will never replicate the full spectrum of benefits that come from moving your body.
“ A well-structured exercise program can change your life,” he emphasizes.
The two metrics that matter most
When discussing the best predictors of longevity, Attia points to VO2 max and muscular strength—in that order. VO2 max, which measures your body’s ability to use oxygen during intense exercise, stands out as “the best predictor of lifespan” that we currently have.
For his own VO2 max training, Attia aims for 25 to 30 minutes of very hard effort weekly, typically doing intervals of four to eight minutes. He doesn’t rely on heart rate monitors, instead using rate of perceived exertion and power output on his bike.
For most people, he added, even imperfect execution delivers huge benefits. “You might not be operating at 100% efficiency—but 80% of the benefit is still fantastic.”
His 4-day strength training approach
Attia trains in the weight room four days per week, dedicating sessions to lower body, chest and back, arms and shoulders, plus a favorite Sunday workout focused entirely on carries and grip strength.
Since he’s hitting each body part only once weekly, volume matters. He aims for at least 12 sets per body part, working at an intensity of one to two reps in reserve. There’s some overlap built in: he does a set of 10 pull-ups between every exercise on leg day, effectively hitting back twice per week.
The cardiovascular biomarkers that actually matter
When it comes to preventing cardiovascular disease, the leading cause of death globally, Attia is unequivocal about which numbers deserve attention. At the top of his list: ApoB and Lp(a).
Looking into Lp(a)
Lp(a) is hereditary and only needs checking once, with levels below 30 mg/dL (or below 75 nmol/L, depending on units) considered low. While drugs in development can reduce Lp(a), we don’t yet know if lowering it pharmacologically improves outcomes.
A deep dive into ApoB
ApoB is different—it’s both measurable and treatable. ApoB is the protein that wraps around the lipoproteins responsible for plaque buildup in the arteries—including LDL, VLDL, and Lp(a). While most people only measure LDL cholesterol, Attia says ApoB provides a far more accurate picture of cardiovascular risk because it counts all the atherogenic particles circulating in your bloodstream.
Lifestyle interventions like reducing saturated fat, eating more fiber, and supporting metabolic health can all help lower ApoB. Still, most people can’t reach optimal levels through diet alone. That’s where pharmacological support comes in.
Beyond statins, Attia highlights several powerful options: ezetimibe, which blocks cholesterol reabsorption in the gut; PCSK9 inhibitors, which increase the liver’s ability to clear LDL particles; and bempedoic acid, which reduces cholesterol synthesis in the liver with fewer side effects. A newer drug class, CETP inhibitors like obicetrapib, is also showing promise—not only for cholesterol management but for reducing biomarkers of dementia as well.
According to Attia, combining smart lifestyle choices with the right medications could make heart disease a preventable condition in our lifetime.
The takeaway
Longevity, in Attia’s view, isn’t about chasing extremes—it’s about consistency, awareness, and intelligent effort. By prioritizing structured exercise, building and maintaining VO2 max and strength, and tracking key biomarkers, we can profoundly shift how we age.
We may not be able to control every variable of health, but as Attia reminds us, the most powerful tools are already within reach, and they start with how we move today.
