January 22, 2017

Exercise & Physical Health

How you move defines how you live

Read Time 8 minutes

My clinical interest is longevity, which is a function of lifespan and healthspan; In math parlance, longevity = (lifespan, healthspan). Lifespan is pretty easy to define. It’s the number of years you live. Healthspan is intuitively obvious, but a bit harder to define. For simplicity, let’s agree that healthspan is a measure of how well, not necessarily long, you live. Further, let’s agree that one without the other—long lifespan with poor healthspan or short lifespan with rich healthspan—isn’t what most people want. This has the makings of a complex, nonlinear, multivariate optimization problem.

The figure below is from my office whiteboard last week. I was explaining the relationship between lifespan (x-axis) and healthspan (y-axis) to one of my patients. My goal is to move the black line to the blue one.  Live longer (more x-axis) and live better (altered shape of decline curve).

I’m in the (very slow and time consuming) process of writing a book on this topic, which is really two books in one—the science of longevity and the “art” of it, the latter being a nuanced discussion about how one applies said science (most of it in animals) to the species of interest—people. If you don’t spend much time in the longevity literature, this distinction may not seem warranted. If you do spend time in said literature, it will be obvious why such a distinction is necessary.

Lifespan, at the first order, is driven by how long one can delay the onset of atherosclerotic disease (CHD, CVA), cancer, and neurodegenerative disease. Delay the onset of these, and you live longer. It’s a probabilistic truism. Obviously, I will explain this in great detail at the appropriate time, but I don’t want to focus on this topic today.

Healthspan, in its most distilled form, is about preserving three elements of life as long as possible:

  1. Brain—namely, how long can you preserve cognition (i.e., executive function, processing speed, short-term memory)
  2. Body—specifically, how long can you maintain muscle mass, functional movement and strength, flexibility, and freedom from pain
  3. “Spirit”—how robust is your social support network and your sense of purpose

In this post, I’d like to focus on one subset of healthspan: item #2—movement. But before I do, a brief digression will be helpful.

The hack—Darwin meets MacGyver

Evolutionary biology can, at times, provide a helpful framework for longevity. Our need for sleep and our resilience to short-term food deprivation are just two examples of traits that served our interests tens of thousands of years ago and continue to do so today.  Some of the interventions that can make you live longer and live better will find their foundation in understanding evolutionary biology. But many won’t. That is, many things I (and others) argue are necessary for longevity don’t really have an obvious foundation in evolutionary biology. Why?

Enter “the hack.”

A hack is something we do that gets around a problem, even if it’s not especially elegant. A patch might be an easier way for some to understand what I mean (cf. software patch). The hack can be elegant, the hack can be cumbersome, but its purpose is the same—something is getting in the way of a desired outcome and we need a workaround.

When I talk with my patients I try to differentiate interventions I propose as “evolutionary sound” or as “hacks.” Inasmuch as this framework is helpful, let me expand.

Our evolutionary ancestors were primarily concerned with survival. There was no survival more important than reproductive survival—ensuring you lived long enough to reproduce. Natural selection would prioritize short-term survival over long-term survival or quality of life. [As a very interesting, but too-nuanced-for-now aside, the evolution of APOE genes from the E4 to E3 to E2 variants may be great examples of this…yes, this will be discussed in the book, space permitted.]

Take stress response as an example. The stress response was an essential part of evolution. Without it, fending off an animal trying to attack you, or hunting for food in a state of starvation would not have been possible. Nothing about our evolutionary development selected for, or rewarded, equanimity. Our ancestors probably did not have the luxury of inner peace. It’s also not clear if it would have been necessary, or even helpful. But I argue that our current environment places sufficient non-evolutionary stress on us, and, as such, a hack that separates us from this stress is, indeed, helpful.  Furthermore, we now have the luxury of aspiring to things our ancestors could never dream of. They were preoccupied with reproducing and not dying; we aspire to play with our great grandchildren, we machinate on our legacies, we argue about if the Oscars are really inclusive enough.

Years ago, when I read Jared Diamond’s magnum opus, “Guns, Germs, and Steel,” I remember thinking to myself how horrible it must have been to have lived even as recently as just a few hundred years ago, let alone a few thousand years ago. It really had a profound impact on me, though it was not the central thesis of his book at all. I realized that on my “worst” day—lost my cell phone, got a speeding ticket or had a fender bender, missed my flight, got food poisoning from some bad sushi—it didn’t really matter. Technology and civilization took a bunch of really acute problems—lethal infections, starvation, trauma, war, for example—and traded them for more chronic ones—lower back pain, heart attacks, type 2 diabetes, and Alzheimer’s disease. I’m not minimizing the latter. These problems matter, but evolution didn’t confront them and therefore we can’t readily turn to evolutionary insights for solutions. Parenthetically, it might not have been as miserable as I imagine, namely because our ancestors didn’t know any better. It’s not like they would have “missed” Tweeting on their smartphones or racing around on their carbon fiber bikes, lamented the loss of their favorite sports team, or missed the pleasure of sipping neat Don Julio 1942.

Think about what Peter Parker’s uncle said to him shortly before he was killed, “Remember, with great power comes great responsibility.” I think of our modern lives as a great power, or a great privilege, to be more accurate, I suppose. I would never want to go back and live as my ancestors did tens of thousands of years ago (or even a hundred years ago, though it might make for a nice vacation) and so I should pause for a moment and acknowledge the complete privilege of living today in this incredibly narrow sliver of time.  I love the internet. I love that agriculture and crop domestication have allowed me to live in civil society with dense populations and no fear of starvation. I love that a simple antibiotic can save my life from a formerly lethal infection. I love being able to sit down in a car or airplane, and I love the freedom those machines have brought me.

So if these examples of things I love are some of my great privileges, what are my great responsibilities? This is where hacks come in. We need hacks to prevent these great privileges from killing us—slowly—which they will do if we’re not deliberate. What are my hacks? A bunch of things that make virtually zero evolutionary sense but, if bolted onto my modern life, can give me—if I can thread the needle correctly—the best of both words.

Meditation, intermittent fasting, heavy compound joint and hip-hinge training, intense interval training, body work, supplements, drugs, introspection, sleep hygiene. These are my hacks. Let’s focus on one hack, in particular—movement preparation.

The savant of movement

I met Jesse Schwartzman through a mutual friend. After our first workout together I was blown away, but it wasn’t the workout that impressed me, it was the preparation routine Jesse put me through, prior to making me puke, that impressed me. I’d never felt more ready to move. Jesse’s formal bio is at the bottom of this page, but I just call him the savant of movement. One day Jesse and I were having coffee and he commented at how annoyed he was by the endless stream of “heroic” tweets and IGs of super-humans doing one-armed acrobatics or whatever the stunt of the day is. He commented, astutely, I noted, that the world needs another super-human trying to convince the rest of us we should be like him/her like it needs another dictator.

What we actually need are examples of how real people can be empowered to preserve muscle mass, move functionally, maintain freedom from pain, and be the best athletes of their lives. An “athlete-of-life” can hip-hinge, squat, carry, shift, push, pull, rotate, and anti-rotate with confidence and fluidity. On a deeper level, one should also re-connect to their childhood movement patterns, before the toll of life and technology wreaked havoc. We need to re-learn how to roll, crawl, and hang, which are patterns that can release the “brakes” from our everyday movement that sabotage strength and lead to pain and injury.

Watch a 2-year-old squat and you’ll know what I mean. They look like perfect little power lifters. By the time they are in grade school, and they’ve been sitting for hours a day, the first thing I see is tight hips. [Picture below courtesy my friend Pat Jak, also obsessed with correct movement.]

To that end, we decided to make a video of the exact warm-up sequence Jesse put me through so I could share it with my patients. If they (and you) find this video helpful, we’d like to produce more of these covering more specific topics, such as how to protect/ build/ rehab knees/ shoulders/ lower back, etc.

Before diving into the videos, I know at least one person is reading this and thinking, “What the hell is Attia talking about? He’s the king of doing stupid stuff like flipping 450-pound tires, swimming 12 hours, doing Tabata deadlifts…” And you’d be right. I do/did a lot of stupid stuff. But I always differentiate the stupid (“super-human”) stuff I do from the longevity drivers. My pet peeve, and that of Jesse, is that good people are misled by the heroics of big-personality super-humans who lead them to believe they need to do these things to live better. In reality, it’s almost always the opposite. You don’t have to do super-human feats to have great healthspan and, by extension, longevity. But you do have to do some very deliberate things to overcome our civilized environment. So while I call Jesse the savant of movement, he prefers to call himself the anti-super-human teacher.

Below are four videos, a brief introduction, and one video for each of the three stages of the warm-up:

  1. Tissue preparation
  2. Muscle activation
  3. Dynamic preparation

In addition, we’ve put together a “tear sheet” for each of the three stages in case you want take them with you to the gym until you commit to memory.

I should point something out, since I know it will come up. With the recent publication of Tim’s book, Tools of Titans, I’ve been getting a lot of requests to make a video of my so-called “Jane Fonda” routine. In Part II of the videos, below, I do a glute med activation exercise, but it is not the full sequence I describe in Tools. That’s ok…the form that Jesse and I demonstrate, coupled with the description in the book, should be sufficient to get you through the full routine of seven movements. For the purpose of movement preparation, one only needs a bit of activation (hence the vertical plane, only). What I describe in Tools is a therapeutic routine I perform once or twice each week.

Lastly, and most importantly, I want to thank Elliot Stern and Kelly Choi for shooting, producing and editing these videos from start to finish. If you could only see the outtakes…


Here is direct link: https://youtu.be/ZVUQb2G_Mvw

Here is link to tear sheet, summarizing all three parts

Part I: Soft tissue preparation

Here is direct link: https://youtu.be/zdRgJpxifqA

Part II: Muscle activation

Here is direct link: https://youtu.be/JElEpnVH35Q

Part III: Dynamic preparation

Here is direct link: https://youtu.be/BGrw5z1SjtA


Jesse Schwartzman, MS, RD, ACSM CPT, holds a Master’s Degree in Nutrition and Applied Exercise Physiology from Columbia University, and is a Registered Dietician. Jesse, along with his wife Patty, currently owns and operates Fit4ward in NYC and the greater Fairfield County, CT, where he manages and engages in deeply personalized work with his clientele in all aspects of health.

Early on in his career, the importance of adopting lifestyle behaviors to support exercise and nutrition goals became a fundamental focus of his work. Joint mobility and tissue health, proper fascia and nervous system regeneration, fueling techniques, sleep and recovery, identifying asymmetries, and proper neuromuscular motor patterns are incorporated with every individual.

Jesse now has over 10 years of experience in the health and wellness industry in one on one personal training, nutritional counseling, health coaching, group workshops, and the corporate setting. Jesse previously trained clients at the highest certification level at Equinox Fitness Clubs, and managed Equinox’s most elite trainers and exclusive clientele in the Tier 4 Program at the “E” club.

Photo by Hidde Rensink on Unsplash

Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user's own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.


  1. Peter,

    I’m a 44 year old male that has a fake hip.(surgery was in 2006) Right now, my workout consists of lifting(not much cardio). I use machines and go somewhat light on legs. Are there movements I should avoid? I keep hearing squats are important…can I do them?

    • Brian, squats are an important movement. In a normal hip replacement surgery there are no contraindications to squatting after the operation has fully healed, and most would encourage the exercise. You may want to limit your range of motion, and not squat below thighs parallel to the ground. Also do not overload the move with weight resistancebur focus on balance and instability challenges like wobble boards or bosu balls instead.

    • Hello Peter. I discovered you from Tim’s podcast and have been researching diets for a long time and think the concepts you cover are the right path. I have a couple of questions as I havent found these on the blog yet and I know it is hard to comment. I am a recovering addict with anxiety and ADHD (yes, I have been diagnosed and had treament)

      1) Do you have any research, info, or imput about how a ketogenic diet impacts mental health such as the ailments I deal with?

      2) Do you think intermittant fasting is useful and would it be good provided you receive a clean bill of health from your doctor and his support that a few day fast would be useful before switching to a more keto diet?

  2. Peter,

    Often your comments here (and those of your readers) offer as much value to your posts as the posts themselves. This comment will not fall into the “value add” category, I’m afraid.

    I just want to say thank you for producing such high quality, high value information. I am a fellow member of the blogging world, specific to my business (nut nutrition or lifestyle. Actually closely related to the work you hated…fundraising and revenue generation), and I know first hand how intense and time consuming it can be (blogging…not fundraising, though that too). So as someone in the blogging space, I am always amazed by your posts and admire the effort and detail you put into every post.

    I have been implementing many of your ideas as I experienced much of what you experienced. Training for a marathon, I got fat. Really fat. Blood pressure was hypertensive, 44″ stomach…well on my way to metabolic syndrome (if not suffering from it outright) while running hours and hours and hours every week.

    Since going ketogenic, my weight has dropped, my strength is up (hitting PRs in deadlifts, squats, chin ups, cleans all the time). Blood pressure is down. No cravings, no hunger and my prescription reflux medicine is collecting dust after years of needing it daily.

    What is most amazing is this, my wife said to me last week:

    “Even if you weren’t losing weight at all, your mood is so positive and energy is so off the charts that I would never want you to change your diet.”

    My clients, staff and colleagues have asked me what Im doing based purely on my energy levels and positive moods.

    Focusing on physical health is important but those other measures, like the happiness of those we love and how we interact with the world is an essential marker in quality of living.

    Look at that…maybe I did tie my comment into your post after all.

    Your stuff is hugely valuable on so many levels, for the lay person and for the person who wants to really geek out on this stuff. When I visit my GP I often bring questions based on what you’ve written and feel like a participant in my health care vs a passive consumer.

    Thanks again Peter,


  3. I’m curious what you think of rebounding – on a high quality rebounder, with respect to lymphatic activation.

    I like to do 15 minutes or so of a “health bounce” before my kettlebell swings (I’m doing the Simple & Sinsister Pavlov program. I also jump back on during swing sets to keep my HR slightly elevated.

    I’m going to incorporate your exact 3 step program above and wonder if I should do my 15 min bounce before or after or at all? I will say I’m a big fan of this little tramp!



    • Hi Sheila. I would suggest bouncing after you do the full 3 part sequence to make sure you are mobile and have the right muscle firing sequence for such a dynamic and reactive exercise. But if nothing else, do the soft tissue sequence beforehand, as the lower body soft tissue foam rolling will help your tissue be more elastic on the bounce. I have not used the rebounder personally but I would probably not do it every day as the repetitive motion without enough recovery may cause stress to the soleus, achilles, and knees. But in general it sounds like a fun incorporation into exercise.

  4. Peter, I just got through watching the videos. They are very well done.

    I have a few questions.

    I’m curious as to how you incorporate the movement sequence that you go through in the video into your workout regimen.

    Do you do this entire sequence before you engage in your weightlifting routine? Or do you do the movement sequence independent of your weightlifting workout?

    Likewise, do you do the movement sequence before you engage in an aerobic workout, such as sprinting or biking?

    Generally, how many times a week do you do the movement sequence?

    It occurred to me after watching the videos that every golfer on the PGA Tour ought to watch this.

    • I will Jesse chime in, but I do the entire sequence (which I can do in 10-12 min) before my workouts. I also occasionally do the shin box drill in between dead lift sets.

    • Good questions Tom. This warmup is designed as a catch all for almost any type of sport or activity you want to accomplish. Counteracting sitting and technology was also a focus. I do this routine before lifting and running, but also on “off” days to keep my body limber and to make tight muscles more elastic.

      Down the line, we may create some more sport specific content that would have more plyometrics, or extra dynamic stretching depending on the skill. So you can consider this a possible every day activity, it’s like brushing your teeth for your body.

  5. Dr T:
    Below is really common sense, but a brilliant insight and in this media age is so overlooked and misunderstood in every facet of modern life. Thanks for your caring.

    My pet peeve, and that of Jesse, is that good people are misled by the heroics of big-personality super-humans who lead them to believe they need to do these things to live better. In reality, it’s almost always the opposite. You don’t have to do super-human feats to have great healthspan and, by extension, longevity

    • You have us given a true gift, Peter and Jesse. Thank you so much for your generosity. This will help many folks, including me. I can’t wait to start putting these routines into practice.

  6. Jesse, along with his wife Patty, currently owns and operates Fit4ward in NYC

    Is there contact info for them?

  7. Dr. A—

    I’m a 49 year old concierge internist, lipidologist, hypertension specialist and share your passion for personalized biohacking (love Bulletproof, Ferris, Paleo literature, and of course Tom Dayspring who obviously got you excited as well) ……….most of my day is spent as a motivational speaker talking food, biochemistry, movement, etc with my patients. My question:

    I, my wife, and even my 20 year old daughter take metformin. Almost everything I’ve read looks good……almost everything…….the question is your belief in importance of mitochondrial uncoupling as an anti-aging tool……some of the literature strongly favors, but there is some dissonance on the topic. In addition to high healthy fat, LC, movement, metformin (or berberine with its PCSK9 properties)………any other quick biohacks to enhance mitochondrial uncoupling?
    Your stuff is terrific. Thanks so much!

  8. Is it possible to do a generalized 80/20 version (do the 20% that gives 80% of the return) of the full routine for those who can’t or won’t committ to the full ~30 min? And if, which movements would you pick?

    • Indeed; how would you recommend finding your personal 80/20?
      Going through the 26 movements and feeling it out/using common sense or would you need to see a professional?

      Surely individualizing is best, but I assumed people on average get more benefit from certain movements (e.g. rolling hamstrings vs calves?), hence why I asked for a generalized 80/20.

      Thanks for putting yourself on the mat and sharing such in depth programming pro-bono.

    • Agreed with Peter. It’s all personal. But any one of these three routines stands on its own as a sequence worth doing. Start with soft tissue and then start sprinkling in exercises from the second and third routines. Also, know the more often you do it, the faster it gets. If the full 3 phase routine takes longer than 10-15 minutes, you still need to practice.

    • Thanks Jesse, sounds good. One thing I would advise if you want to make your guide more awesome; turn it into a mobile friendly webpage with animated gifts of each movement accompanying the text. Actually just saw a reddit post hit the front page with a similar guide (guy looks a bit like Peter..) https://www.reddit.com/r/Fitness/comments/5pwxki/foam_rollers_and_lacrosse_balls_are_awesome/

      Got the roller you recommended, feels like a step up from your basic solid core roller.


    • I personally think that for most trainees, particularly older or low experience ones would benefit more from a HIT (slow rep cadence) type of resistance (weight lifting) routine, of short duration, than a yoga-ish body weight type routine like this. For building or retaining muscle mass and strength and the resultant positive myokinome/hormonal effects. The reason is the intensity of muscle stimulation is higher and/or across more muscle fiber types. Once sufficient strength is obtained perhaps graduate to a routine with more ballistic, higher rep speed, movements.

  9. Love this, spot on content and format. By the way, your writing has tightened up considerably since I started reading your blog. It was always enjoyable, but this is on a new level. Looking forward to the book.

  10. Thanks Peter and Jesse for this impressive stuff!

    Are there any talks/writings by Jesse on nutrition/weight loss? If any, where can we find them?


  11. Hello Peter,
    It is great to see that you’re blogging again. I miss reading your information on health and nutrition.
    Thanks old friend.

  12. Thanks Peter & Jesse for the workout and sharing.

    Born in the 1940’s I managed to get here (2017) with no medication (well one fungal infection about 12 years ago), no issues so far with lipids, BP, A1c, etc, and we will try to be in the blue curve as long as I can. Well I hope to read the book one day.

  13. I just recently have been learning about this line of thought through Katy Bowman and her writings. She’s especially helpful for women dealing with pelvic floor issues. It’s liberating to be able to think of movement and exercise in different terms than just “exercising” once a day, but instead whole body movement and daily activity in a functional and healthy pattern. Thank you for sharing!

    • You really “get it” Angela. It’s not about breaking workouts into sections and body parts, but mobilizing and stabilizing fundamental human movement patterns on a day to day basis. Then you can use your body freedom in any activity you choose. You will get much more out of this sequence doing it on a day to day basis than for 2 hours on Sunday.

  14. Hi Peter,

    In terms of hacks, do you have any experience incorporating EMS devices such as a Compex to improve or facilitate better recruitment of all muscle fibers during warms ups and during training? My interest is on the recruitment of deep muscle fibers which are hard to get to. Perhaps going heavy may not be the best for joint mechanics but maybe a combination of both EMS, and say a movement like a deadlift at slightly lower weight might be a better strategy. Love to hear your thoughts on this.

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