Peter Attia's 4 Horsemen of Chronic Disease (and How to Avoid Them)

Tips for a Happier and Longer Life...

A couple of years ago there was a great series on Disney Plus called Limitless. It featured the Aussie actor Chris Hemsworth who's the absolute beefcake of a guy who played Thor in the movie. It was a fascinating series in which Chris took on various challenges to teach him certain tips to help him extend his life (the premise of the film was that a scan had found certain genes that indicated a far higher likelihood of Alzheimer’s when he gets older, so he was looking at ways to combat this).

Anyway, I highly recommend the show but that’s not the reason for mentioning it to you today. The reason is that a variety of experts feature on the show, one of whom is Dr. Peter Attia. Dr. Attia is a trained medical doctor who now specializes in the world of longevity – living a longer and healthier life. And when I watched the show in my late 40s, with various family health challenges you may have read about on my About Me page, this guy intrigued me. So I had a dig online and found some great podcast interviews with Dr. Attia and read articles on his website. Then back in 2023 he released ‘Outlive’ which is an astonishing book about living longer and healthier. I highly recommend it and would like to share a few of the basic principles here, namely:

The Four Horseman of Chronic Disease

Dr. Attia has found by studying the available research that there are 4 main “Horsemen” when it comes to death over 65. They are responsible, at least in the USA, for at least 80% of deaths for non smokers aged 65 and over:

HORSEMAN 1: Atherosclerotic disease (comprised of cardiovascular disease and cerebrovascular disease)

HORSEMAN 2: Cancer

HORSEMAN 3: Neurodegenerative disease (Alzheimer’s disease being the most common)

HORSEMAN 4: “Foundational disease” a spectrum of everything from hyperinsulinemia to insulin resistance to fatty liver disease to type 2 diabetes.

The #1 Method to Avoid The Horsemen

And to avoid these deadly horsemen the BIGGEST and MOST IMPACTFUL thing that you can do is regularly exercise. Yep in the esteemed doctor’s view excercise tops nutrition, medication, therapy and pretty much everything else. Now all the above play their part but Dr. Attia states that all the research points to exercise as being the biggest “bang for your buck” when you want to ward off these diseases. Now whilst any exercise is good; he is specific in describing 4 distinct types of exercise as essential to this. And I’ll give you a short summary on this now so that you have a working formula you can use (and if this interests you I strongly suggest buying his book as the insights go way deeper there).

The 4 Types of Exercise

EXERCISE TYPE ONE: Zone 2/ Aerobic Efficiency

This type of exercise is anything that is done at a level where you can just about talk, but you can’t really hold a conversation. Any less, or more, intense does not hit the sweet spot required.. This sweet spot of fairly vigorous, but not full out, exercise has been found to improve the health of our mitochondria which are essential for brain health and metabolic health, thus reducing risks of the 4 horsemen. The good doctor prescribes a minimum of 3 hours per week of this type of exercise and typically it can be swimming, rowing on a machine, or cycling. Walking tends not to hit the required level of intensity, and running tends to get too high to quickly. However, walking uphill and/or carrying a weighted backpack (doesn’t need to be crazy heavy, depending on your frame) can get walking much closer to the level needed. Zone 2 is the exercise where we need to spend the most time per week to build our Mitochondrial health.

EXERCISE TYPE TWO: Zone 5/ Aerobic Efficiency

This is a much more intense level of exercise that you only need to do once per week. The aim of this is to improve your VO2 Max (which is the maximum rate your heart, lungs, and muscles can use oxygen when exercising). Research shows correlation between people with higher VO2 Max and living longer. It will also allow you to be more physically fitter and active as you age. His formula to train in this way is 4 x 4 x 4. So, you cycle, run, or row at the maximum pace you can manage for 4 minutes. Then take 4 minutes very slow doing the cycle, row, or run to rest. Then back to the “all out” 4 minutes again followed by the slow 4 minutes. Do these sets of 4 on and 4 off for 4 times total. Voila you’re done.

EXERCISE TYPE 3: Strength

We all lose strength and muscle mass as we age. So, it’s really important to do regular forms of strength training to combat this, as weakened muscles lead to frailty. This means we can do less things and also it can lead to an earlier death in many ways (research shows us that up to 1/3 of people who are over 65 who go into hospital after falling and breaking their hip are dead within a year). So, strength is key to stop falling and other vulnerabilities. One simple way is to carry a weighted backpack (as mentioned earlier) - this is called rucking. You can do this when walking the dog, walking with friends, even around the house doing chores (I do all 3 and it helps build muscle without too much additional effort). On top of this you probably need to hit the gym once or twice per week. Get someone to put you on a program (I am not going into the details here but ask them to give you exercises that work on grip strength, concentric and eccentric loading, pulling, and hip hinging). Do this a minimum of once per week, more if possible.

EXERCISE TYPE 4: Stability This involves work like Pilates, yoga, and tai chi. Look for a good DVD or streaming program or find a class in your local town. Stability helps you avoid injury and falls meaning you can maintain your exercise and activity levels.

I know this may be a LOT to take in, and the sheer thought of doing all these different exercises may be daunting. Plus I don’t know your current health and fitness; so a trip to the doctor may be in line first to check if you have any existing concerns about your health or fitness. Then just break it down to what you can do. If you can only spare 1-2 hours then get going with some aerobic work and strength work, they will give you the best returns on health and fitness. Over time you may be able to squeeze more in, but for now do what you can.

In addition, try to use existing time to exercise.

Do things like:

1. Park you car further away from home, so getting more steps in.

2. Carry a weighted ruck pack in daily activities (this also burns 2-3 times more calories than normal walking).

3. Take regular walk or stretch breaks during the work day.

4. Plan family activities that involve exercise.

5. Consider getting a standing desk or, even better, a treadmill desk.

I really hope this has been helpful, rather than overwhelming. And again I’d emphasize do what you can and try to build it up. Most people don’t have 6+ hours spare per week for this but over time you may build up to it.

Move to Live,

JFT Beach