#196 – AMA #32: Exercise, squats, deadlifts, BFR, and TRT

In this “Ask Me Anything” (AMA) episode, Peter shares his current workout regimen and how he incorporates blood flow restriction (BFR). He walks through the mechanics and fundamentals of some of his favorite lifts including squats, deadlifts, and hip thrusters and stresses the relative importance of each in the context of longevity. He touches on the relative importance of muscle size vs. muscle strength and discusses the impact of fasting on muscle mass and the potential tradeoffs during aging. Peter then dives into the topic of testosterone replacement therapy (TRT) for both men and women, starting with a clinical discussion around how he actually replaces testosterone in patients. He explains the targets of this therapy as well as the risks and benefits, and he gives his interpretation of current data on the association between TRT and heart disease. 

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We discuss:

• Peter’s current exercise routine [2:25];
• How Peter incorporates blood flow restriction (BFR) into his workouts [5:45];
• Relative importance of muscle size vs. muscle strength [16:45];
• Comparing squats to deadlifts and why both are important [22:00];
• Squatting technique and fundamentals [31:15];
• Important cues to look for while lifting weights [38:30];
• Proper mechanics of a deadlift [42:00];
• Hip thrusters as an alternative to the squat or deadlift [44:00];
• Split-leg work for simulating activities of daily living [47:00];
• The impact of fasting/calorie restriction on muscle mass and the potential tradeoffs to consider [49:45];
• Testosterone replacement therapy: Considerations when contemplating TRT and Peter’s approach with patents [54:30];
• Data on the association between TRT and heart disease [1:04:15];
• TRT for women—risks and benefits [1:06:45];
• Impact of fasting on testosterone levels [1:13:45]; and
• More.

Peter’s current exercise routine [2:25]

A few previous podcasts on exercise:

• Jeremy Loenneke episode
• AMA #19
• AMA #21
• AMA #26
• AMA #27

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Peter’s current exercise routine

Cardio – Tuesday, Thursday, Saturday, Sunday are cardio days

• Tuesday, Thursday, & Sunday are zone 2 on a bike (for 45 minutes)
• Saturday is either:
  • A) Zone 2 followed by Zone 5 (separate workouts)
    • So a 45 minute zone 2 and then a 30 minute zone 5 done immediately after zone 2
  • B) Alternatively is just a longer bike ride on Saturday and make it more of an anaerobic workout

Lifting – Monday, Wednesday, Friday, Sunday 

• About 9 months ago he switched to an upper body, lower body split (Previously he was lifting three days a week and would do upper body, lower body every day)
• Nowadays, lower body is Mon and Fri
• Upper body is Wed and Sun

What happens if you miss a day? 

• He will never miss a lifting day
• Sometimes he’ll have to miss a cardio day

“I will always get those four lifts in during the week, no matter what. And sometimes it just means moving the days around or doubling up on a different day.” —Peter Attia

Time of day

• Little more flexible on weekends, but Monday through Friday, pretty much no flexibility
• He always lifts weights in the morning around 7:15 or 7:30 AM

How Peter incorporates blood flow restriction (BFR) into his workouts [5:45]

*See Jeremy Loenneke episode for more on BFR

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How Peter incorporates blood flow restriction (BFR) into his workouts

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