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So the minimum effective dose if you're doing nothing is not that much. You're going to get huge benefits when you go from nothing to probably three hours a week, and that would be an enormous improvement. Maybe that's the right way to think about it. Let's start there. Say someone starts at nothing, and you're saying, okay, start at three hours a week. How are you breaking that out?
I think you'd have to put probably an hour of that into steady-state aerobic training, Zone 2. I think you'd have to put an hour of that into strength training. I think you'd probably want to put 20 or 30 minutes of that, across one or two sessions, into high-intensity aerobic training. Not high-intensity intervals, by the way, but the longer intervals that are VO2 max appropriate. Then the remainder of that time, call it another 30 minutes or so, goes into some of the stability training. Again, it's important to understand that you're better off if you say, look, I'm only willing to devote 60 minutes a week to this stability work, which seems so boring, should I just blast it out in one one-hour session? The answer is no. You're better off doing 10 minutes a day, six days a week. There's really something to the neurologic pattern that comes from practicing your IAP, practicing your breathing, your scapular CARs, and your cat-cow exercises. Doing that for 10 minutes every day is better than trying to do it all in one shot.
So that's probably how I would structure a three-hour program. For the stability side, you mentioned a few exercises there, and what you and Beth did is record videos of you in the gym. Those are available at peterattiamd.com/outlive/videos. Anyone who wants to learn more about what those stability exercises are, and wants 10-minute, real short, real simple videos, can go check them out. We won't spend time on those here, because as you've said before, you really have to see it to understand it, as opposed to just hearing about it.
Let's say someone starts with three hours a week. How often do you ratchet that up? Does it get increased every week, every month, or when certain milestones are hit? It depends on what the limiting factor is. Usually, when a person starts at three hours per week, it's because that's the only time they're willing to put into it. Conversely, if a person has never lifted a finger and says, "Oh my God, I'm willing to do whatever it takes," and they only start at three hours a week because you don't want to injure them, then you're in a situation where you need to figure out how much you can ratchet it up. In a scenario like that, I'd probably ratchet a person up every six weeks. But the far more typical scenario is that the person says, "I'm willing to do three hours," does three hours a week, and then starts to habituate to that stress.
One of the important principles of training is progressive overload, which most people have heard of. In one way or another, the load, the ask, needs to get more complicated and more difficult. If you're talking about strength training, that could mean heavier weight, more reps, more sets, less rest, or other things that make it more demanding, such as using blood flow restriction training, or BFR. We're always looking for ways to make this more demanding. For example, at my stage now, I'm not adding time anymore. I am at the limit of how much I'm willing to spend on this. My kids are young, and every minute I spend in the gym is a minute I'm not spending with them, or working, or falling behind in some other area of my life. So I'm already spending about as much time as I'm willing to spend in the gym, which on the strength side is probably six hours a week. I have to find other ways to add that demand.
The other thing I would be doing is thinking about where the deficits are. Say you have a person at three hours per week whose VO2 max is already at the 70th percentile and who is reasonably strong, but whose aerobic training is an atrocity. Then I'm going to disproportionately add to the aerobic work, as opposed to building all of them equally. Conversely, we have a patient in our practice who, when he entered the practice, had a VO2 max probably above 60, and he is 60. He has been a lifelong runner, but he has never touched a weight in his life, so he has very little muscle mass. We're actually saying to him, look, we probably need you to run a little less. Your running is amazing, and you're very fortunate that you haven't been injured doing it. We want you to keep running as long as you can, but we also have to address some of these other issues, because you do have some of the really common issues of runners.