Kieran: When you look at the typical recommended daily recommendations of protein, it's for me not as high as it should be. I think as a population, I think that we are quite under-muscled. I think there's a lot of chatter around an obesity epidemic and people having higher levels of body fat, but truthfully, I think we're not technically over-body-fatted, we're just under-muscled.
Dr Rupy: Welcome to the Doctor's Kitchen podcast. The show about food, lifestyle, medicine, and how to improve your health today. I'm Dr Rupy, your host. I'm a medical doctor, I study nutrition, and I'm a firm believer in the power of food and lifestyle as medicine. Join me and my expert guests where we discuss the multiple determinants of what allows you to lead your best life.
I spend a ton of time exercising, but more recently, I've wondered if I can direct my training to be as efficient as possible. If I'm going to spend hours each week on this activity, I want to ensure that I'm extracting the maximum amount of value that I can from this time investment. Coupled with the new perspective of being a father, I'm also interested in staying as fit and as healthy and mentally sharp as I can. And that's why at the start of 2024, I actually decided to invest in a few investigations to determine my level of fitness and to direct my training for efficiency. On the podcast today is Mr Kieran Chopper. He's a highly skilled sports and exercise physiologist who actually performed my investigations that you'll be able to see on YouTube if you're interested in seeing me huff and puff and sweating away on a Wattbike with my top off. Kieran actually specialises in physiological testing, evaluation and strength, as well as reconditioning. He has expertise in working in both athletic and non-athletic populations and also has strong research interests in muscular physiology, environmental performance physiology and blood flow restriction training. Today, we're going to focus our conversation around three tests that he believes are just as useful as cholesterol testing and blood pressure monitoring. And honestly, after chatting to Kieran today, I'm of the same opinion. And these tests are resting metabolic rate, DEXA scanning and VO2 max testing. If you've never heard of these before, don't worry. We're going to break down exactly what they are and why they're useful as a guide to what you should be eating and how you should be exercising to keep you strong and fit into your later years. Now, of course, the first uphill battle is to make exercise a habit. I think if anyone is listening to this and doesn't have exercise as part of their weekly routine, that is the first hurdle, and none of these tests are going to get you to that habit. But, once you are there, I think that this next step of how to prioritise specific types of exercise to make your training as efficient as possible is a really good investment. I have no affiliation with any of these testing companies. I have no benefit at all if you choose to do any of these tests. I'm just giving the information to you to make your own choices. And I think from an interest point of view, particularly if you're interested in nutrition and longevity, I think these are really, really useful and certainly something that I personally invest in. These are expensive. We actually go through the costs of them. These are averages. You may be able to find it cheaper elsewhere if you do a bit of searching around your own area. We also talk about concepts such as protein synthesis and protein requirements as well, how training changes as we age, and we actually talk about what I would do if I was a teenager again or in my 20s. So, if you do have children who are young adults, this may be useful for them. We also talk about the effects of exercise on mitochondria, what those are, and what we should eat if we train late in the evening, how we should be thinking about dinner, and whether training fasted, particularly if you're doing fasted cardiovascular exercise, so aerobic exercise, is better for fat burning. I think Kieran is an incredible communicator. We haven't even touched on a number of different topics that I wanted to go into in a lot more detail like cancer and cancer metabolism and why exercise has a positive impact on that, whether that is during, post, or even as a preventative manner. And we didn't even talk too much about dementia and the mechanisms behind that. So there's so much more within the world of exercise physiology that we can explore. And if you are interested, please do give us feedback on the feedback form that's part of the podcast links. And we'd love to get your thoughts on this episode and what you want to listen to more of in 2025. As part of my own laboratory investigations, I was actually told that I needed to prioritise protein myself. And this actually sparked a lot more interest for me around the realisation that I was under-consuming this vital and critically important macronutrient. It's going to be synthesised in my next book, Healthy High Protein, that'll be coming out in March. And one of the recipes and recipe categories that we have, high protein, on the Doctor's Kitchen app. One of the recipes within that is the gado-gado style salad with tempeh, green beans and peanut lime dressing. If you just type in gado-gado or tempeh or peanut lime dressing, for example, it will pop up. It's one of the most amazing features that we have on our search criteria. You can actually search for high protein recipes if you wish. This is a recipe that I have all the time. It is packed full of nutrients, it is gut friendly, it is high protein, but it's also anti-inflammatory as well. And we've done so much research that explains why it meets all those different criteria. And the app has been absolutely game-changing for so many people because it subtly teaches you the science of nutrition whilst also leaning into the joy and the fun of cooking delicious recipes, which is what Doctor's Kitchen is all about. So, if you haven't yet tried the Doctor's Kitchen app, you can click the link in the in the caption, in the podcast player, or head to doctorskitchen.com for a free trial. People are absolutely loving it, and we are just so passionate about bringing recipes to you every single month, as well as the science behind the health goals. And we've added menopause as a health goal that is going down really well, and we're looking to add more health goals in 2025 as well. I'm also pleased to announce that the podcast is now going to be brought to you by Exhale Coffee, one of the most incredible companies that I'm now proud to say that I'm chief science officer for. I'm passionate about coffee if you don't know. I drink coffee every single day, and I'm currently drinking their decaf, which is decaffeinated using the mountain water method, which is a much, much less harsh way of extracting caffeine from coffee beans whilst maintaining the polyphenol count and the quality of flavour that you don't get in other decaffeinated coffees. And if you want to try a subscription to Exhale, then head to the podcast caption, click the link and just type in Dr50, that's D O C T O R 50, for 50% off a subscription. I highly recommend you check it out if you're a coffee drinker. I'm a big coffee snob. I've said no to so many coffee brands out there that are trying to put a health slant on it. This is by far the best coffee that I've tried, not just from a health point of view, but from a flavour point of view as well. So make sure you go check it out. On to my podcast with Mr Kieran Chopper. I'm sure you're going to absolutely love this one.
Dr Rupy: Kieran, we were chatting just before we started about the argument you make around VO2 max being as important, if not more important than some of the regular blood tests that I would do with a patient like blood pressure and lipoprotein monitoring. Let's talk about VO2 max and why you think this is something that everyone should get measured.
Kieran: I think when we try and understand what VO2 max represents, I think there's a bit of a step-by-step process as to how we take oxygen from our air and then convert it into the energy that we need to exercise. So from a very basic form, we've got air in our atmosphere, and what we do is we breathe it in. It goes to our lungs, it gets diffused into our bloodstream. It then gets shuttled away into our heart. Our heart pumps it down into our working muscles. Our muscles absorb it, and then it turns into energy that we use then to exercise. So it goes through so many different systems: our lungs, our circulation, our heart, our muscles, and our energy systems, that if one link along that chain isn't working too well, let's say somebody's got a respiratory problem like asthma or COPD, they're going to have a poor VO2 max. If somebody has a problem with cardiovascular disease or an arrhythmia, they're going to have a poor VO2 max. If somebody's got issues in terms of their circulation, in terms of, you know, high blood pressure or atherosclerosis or something like that, they're probably going to have a poor VO2 max. So it really is an all-encompassing biomarker that represents so many different systems that it's, for me, it just represents a marker that everybody should know.
Dr Rupy: Okay.
Kieran: And if you've got a good VO2 max, probably all of those other systems are going to be working and operating in a good state as well.
Dr Rupy: Got you.
Kieran: So for me, that's why it's, it's important for us to know.
Dr Rupy: Okay, so what I'm hearing is, as a measure of overall general health, VO2 max can be something that we use as a benchmarking exercise for where you're at in your health and your, and your health journey because of its relationship to respiratory health, heart health, and metabolic health in general. Why don't we talk about what VO2 max actually is, how we measure it, and people can make their own minds up as to whether they actually want to do the VO2 max test that I've done with you.
Kieran: Yeah, it's, so essentially VO2 max is the maximum rate at which we can uptake and utilise oxygen when we're exercising at maximal intensity. So, when we're exercising, as I said, that oxygen needs to be shuttled into our system and then be converted into energy, and the more oxygen that we can get into our system, the better, because we need oxygen to support essentially every system that we need in our body. And there's loads of different, you know, tools that are starting to show where or what represents VO2 max. It's starting to come up on our watches now that tell us what your VO2 max is. Is it accurate? It's not as accurate as what typically is the gold standard, which is an exercise test, where you get yourself on a bike or a treadmill, you hook up a mask that measures the amount of oxygen that you're breathing in and out when you're exercising. And this will tell you exactly what your maximal oxygen consumption is. So, typically you do it on a modality of exercise that you're most used to, whether that's a bike or a treadmill. If you're a rower, try and do it on a rower. Not every, you know, organisation will have a setup that will be able to support that. Most places will have a treadmill or a bike. And you would start off at a very low intensity, just gradually getting yourself into exercise, and it will start to increase in intensity every single minute, and you keep yourself pushing until you hit that point of exhaustion where you can't physically move your legs any further. And then during that point, you know, those kind of systems will then tell you how much oxygen that you're consuming.
Dr Rupy: Got you. So if I just replay that back to you, just for the listener here. So if I'm trying to hit my maximal exertion, right? So let's say I'm on a bike and I'm pedalling as hard and as fast as I can, my respiratory rate will respond appropriately by going up. My heart rate will respond appropriately by going up, and my blood pressure will also go up as well. All these things coalesce to essentially deliver oxygen maximally to my tissues around the body. And when you're measuring that, that is essentially the maximum oxygen uptake by my body. So this is why it is a measure of not just your heart function, but also the efficiency of your lungs, the efficiency of your circulatory system, etc, etc. As we're chatting right now, how does this compare to our sort of oxygen uptake? Like how, how much roughly are we, are we delivering to our tissues at this moment in time?
Kieran: Yeah, so at, at rest, we're probably in the ballpark of, let's say, 6, 700 millilitres of oxygen per minute while we're sitting here. And obviously it depends on the individual. If you're slightly, you know, larger body mass, if you're male, female, obviously depends on your frame. It will be on the slightly lower side than as we gradually increase our activities, that demand for oxygen increase because we need to supply that energy to, to keep us going. And there's ranges in terms of what we could then expect to get to. And there are charts that tell you exactly whether what age you're in and what whether you're, again, what sex you are, to tell you exactly what normative values those should be. For men, typically you want it in the kind of mid 40s, upper 50s. And when I say this number, I should say that it's the millilitres of oxygen per kilogram of body weight every minute of maximal exertion activity. So you have the litres of oxygen per minute typically, but what we do is divide it by your body weight because you will have some people who have slightly more body mass who could get to higher litres. But relative, we want to kind of go as we say pound for pound, then that gives you that score. So you'll hear the term let's say 40 millilitres of oxygen per kilogram of body weight every minute of exercise. That represents how much oxygen I can uptake relative to my body when I'm pushing myself at the highest intensity I can for exercise.
Dr Rupy: So it's titrated or measured according to one's body weight per kilogram. And so if you use the same calculation for how much we're currently utilising right now, if you put it into that format per kilogram per minute, what would like a at rest look like per kilogram per body?
Kieran: So yeah, you're probably looking in the 12 to 15, nothing massive in the early stages and then as I said, the exercise intensity gradually increases every minute, we'll start to ramp up and ramp up and then we'll hit that peak score, which is going to be the most that I can uptake. Now, this is what we call your maximal aerobic capacity. There is this what we call anaerobic state, which is going to be sprinting, which you can, let's say, run faster and use higher levels of energy, but that's not using what we call our aerobic system. We're tipping in then more to our primary anaerobic system then as well.
Dr Rupy: Got you. Yeah, we'll talk about aerobic versus anaerobic in a second actually, because I think those are really important points to to, uh, contextualise and to clarify for the listeners. So you mentioned there's something really important, um, age. When we age, what happens to our maximal oxygen uptake? What, what is and this informs the charts and how one would essentially benchmark themselves in terms of their longevity or their, and their, their general health?
Kieran: So once we get into our 30s, unfortunately, our VO2 max gradually starts to decline.
Dr Rupy: 30s?
Kieran: Into our 30s, yeah. Um, so it decreases at roughly around 10% a decade, or just 1% a year, but typically people say around 10% a decade. So the goal really is to try and get it as high as possible in those early stages. And truthfully, if you do the right type of exercise and can maintain your cardiovascular fitness as you get a little bit older, you can maintain your VO2 max. I've known people from, you know, the tests that I've done to improve their VO2 max even in their 60s.
Dr Rupy: Oh, really?
Kieran: Um, and it's really just giving you a dedicated program that you're consistent with to gradually improve those, you know, systems that deliver that oxygen. Um, but the typical rate of decline is roughly around 10% a decade in terms of our VO2 max decline.
Dr Rupy: Okay. And why, why does that happen? Is that because of, I mean, yeah, I'll let you explain.
Kieran: Yeah, so as I mentioned, you know, there's so many different systems at play. So we look at the primary one probably being our heart rate or our heart function. Just that's our primary delivery system of oxygen. Uh, and over time, our heart gradually reduces in size or atrophies. Um, so the amount of what we call cardiac output, which is the heart rate times your stroke volume, so how many beats per minute am I doing and how much blood am I pushing out every single beat, gradually declines over time. So the amount of oxygen that I can deliver to my system decreases, which also dictates how my VO2 max declines over time as well.
Dr Rupy: Okay. So and this is again why this is such a good sort of general marker for overall cardiac health, metabolic health. Um, when you do this test, perhaps you can explain, I'll put up a video of me actually doing this with you in the lab. Yeah, bring us up some bad memories because it sounds great. Probably at this point, people are like, sold, okay, great. I should get my VO2 max tested.
Kieran: And as soon as they watch it.
Dr Rupy: And as soon as they watch it. They're not going to want to do it. I don't know about this. So if for folks who are listening, how would you describe a VO2 max test, the timing, the intensity and all that kind of jazz?
Kieran: Yeah, so typically we want to hit our VO2 max within an 8 to 12 minute period. So you typically do a warm-up, maybe kind of two, three minutes just to get your heart rate to a kind of a regulated place, your oxygen consumption gets going. And then what we would typically do is a is a traditional ramp protocol or a gradually inclined protocol where your intensity is increasing every single minute. On a treadmill, it might be increasing at a rate of 1 kilometre an hour per minute. On a bike, you might be pedalling at an increased wattage, which is 10 to 15 watts per minute, and that gradually increases over time. And you want to try and hit your VO2 max somewhere within that 8 to 12 minute period. So anything less than eight minutes, we probably don't get enough data to give you a very reputable result. Anything longer than 12 minutes, which does happen, you know, what we don't want is somebody's legs getting a little bit too tired before we fully tax their cardio-respiratory system. So that's kind of the sweet spot in between that we'd like to try and aim for. Um, so it's just means we start off very easy to start off with. Let's say walking at 5 kilometres an hour, and then it goes to 6, 7, 8, 9, 10, all the way up until you hit that VO2 max point, essentially.
Dr Rupy: Okay. So it starts off very easy. Um, like you say, if you're doing it on the treadmill, um, you're just walking pace. I'm doing it on a bike. I'm just pedalling along, there's barely any resistance. You're just getting an idea of like how my breath rate is and me getting used to the machinery as well. And then it generally gets more intense. So in my case, the resistance was being increased gradually up and up and up. And I can tell that or the viewer can tell that because my respiratory rate will increase and increase. You're also wearing a mask as well. What are we measuring with this, with this mask? And what are you seeing on your screen when you're doing the test?
Kieran: So the mask essentially just captures what you're breathing in and kind of stops any atmospheric kind of air being measured. So there's a little sensor attached to the mask which measures the volume of air going in and out of your lungs and also the ratio of that being how much oxygen that I'm consuming when I'm exercising. So you'll have kind of two small little sensors attached to the mask and it's measuring directly what you're breathing in during exercise. It is unfortunately a little bit of an uncomfortable piece of kit because it's it's kind of captured around your face. Um, but yeah, it's going to just measure, like I said, the air that's going in and out of your lungs and that'll just be measured in terms of litres of of air per minute. And then it'll convert that how much of that air that I'm breathing in and out is oxygen, essentially. So that's how the mask measure measures it essentially.
Dr Rupy: Okay, fine. So at the end of that, I get my VO2 max, which is a number that's expressed per kilogram per minute. And I can use that number to put myself on a benchmark against age. And that's, you know, below average, average, good, excellent. Unfortunately, I'm not in the excellent category yet. Um, how do, how does one improve this metric? And and this is outside of, let's say you do have asthma or some sort of obstructive respiratory condition, outside of better management of a medical problem. So optimising drugs for your heart failure if you're if you've got heart failure or optimising medications to ensure that you don't have as much bronchoconstriction. Outside of that, how do we improve VO2 max?
Kieran: So there's three things that we can primarily dictate when we're exercising. And this is something that I always want to make sure when I'm speaking with clients as to tell me what's going to work best for you. There's the frequency at which we train, so how regularly am I doing my exercise, what's the intensity then of that exercise, and what's the volume, i.e. how many sets and repetitions I can do of that exercise. So, that's traditionally, let's say, in something like weight training, you say you train twice a week and you can do x amount of weight for a certain number of reps and sets. Similarly with cardiovascular exercise, we can really only pull on two out of those three levers at any given point when we're training. We can't train really hard for long periods of time every single day of the week, but we could do it once or twice a week, meaning that we can do two out of those three things. I could train not super high intensity, but I can do it for long periods for regular, for kind of regular periods of or regular times in the week. And then the other one is then I can do really high intensity exercise and I can do that kind of regularly, but it has to be quite short in terms of its volume. So you only do it for a couple of minutes, um, you know, let's say 15, 20 minutes of high intensity interval training, for example. So those are the three kind of primary levers that I'll see, okay, which one do you think you'll be able to primarily use? Do you think you'll be able to train regularly enough? And for most people they say, look, I can probably do this twice a week at at max. Then I'll say fine, let's focus on intensity and volume and not so much on the frequency. And we'll still get the benefits that we'd like to in terms of improving our VO2 max. Um, within that, then you've obviously got your long steady state cardio exercise and you've got your high intensity interval style exercise. Um, both aren't very, obviously depends in terms of your cardiovascular or kind of, you know, running enthusiast or cycling enthusiast. Um, but it's it's finding the modality that works best for you. Uh, and if you're somebody who feels like I can commit the time to it, then long steady state cardio is going to be the thing for you.
Dr Rupy: What's, what's long steady cardio?
Kieran: So long steady state cardio is going to be exercising at a low enough intensity. So what we call just below your aerobic threshold or you there's a lot of terms we hear in science which is aerobic threshold, ventilatory threshold, lactate threshold, for example. So training below that level for extended periods of time will provide a lot of adaptation in terms of improving our VO2 max. The other thing then is what we call high intensity interval training, which is training at pretty close to what we call our velocity of VO2 max. So, to break it down simply, if you did a a Wattbike VO2 max test or a an exercise test on a bike and if you get to 200 watts in terms of your maximal output, we would want to do intervals at roughly around 90% of that velocity of VO2 max. So that'd be 180 watts. But we do that for something like two minutes on and two minutes off. And we do those for repeated bouts. And that's probably a good starting point in terms of improving that VO2 max. It starts off then with doing that quite consistently. And then over time, it's about what we call progressively overloading that over time. So okay, I can do two minutes on, two minutes off, and I might do that for, let's say, five to six repetitions. After a week or two, I might then go to seven repetitions. I might then go to eight repetitions. Once I can do something like eight repetitions of two minutes on, two minutes off, I'll say, okay, let's try go three minutes on, two minutes off for four repetitions, five repetitions. And that's a way of me progressively overloading my training plan or my client's training plan. Um, and that's how we'll improve their VO2 max gradually over time.
Dr Rupy: Got you. Okay. So, let's say I'm one of the listeners and I want to improve my VO2 max. Um, I might not even want to get it measured, it sounds pretty intense, but I do want to increase the reserve that I have for my spiritual system and my cardiovascular system because I know this has longevity benefits. But here are the, uh, frequency restrictions I have. I can only train twice a week. So, if I'm training twice a week, what should I, what should I do if I'm looking to improve my VO2 max?
Kieran: So, if you don't have the specific numbers, so let's say if you haven't done a VO2 max, a nice starting point is to say, okay, let's do one longer steady state cardio session. So it's a bike or a Yeah, a bike or a treadmill, it can be kind of a brisk walk, anything like that. And you want to get yourself from an exercise perspective to a point where you can hold a conversation still while you're exercising, but your respiratory rate has gradually increased a little bit. When you're getting to a stage where you can't maintain a conversation because you're finding that you need to get air in and out a bit more, you're probably going a little bit too hard, so probably dial it back a just a tiny bit. Um, so we'd do one of those sessions and we might just do that for 30 minutes. And that's a good place to start building our, what we call our aerobic base and start improving that kind of long steady state cardio.
Dr Rupy: Okay, so, so when I used to, um, train with a buddy of mine, we used to go for a run around the park. And because he's one of my closest mates, we would love to chat during our, our run, right? The state that you're describing here, this sort of perceived exertion is where I can have, I can't have a conversation like we're having right now, but I can sort of speak in like three or four word sentences maybe and just sort of like get the point, but it takes me twice, three times the, the time versus if we were just sat down having a conversation. Is that sort of the exertion level?
Kieran: Yeah, there's essentially, think of it almost as four gear sticks. You've got your first gear stick, which is when you're exercising, you can talk. You're primarily can go nose to nose breathing because you don't need as much air when you're exercising. Um, then we go into another gear where we're probably going nose to mouth breathing. So breathing in and out through the mouth. Yeah, and then the kind of later stages, we say, okay, I'm not getting in as much air or oxygen through my nose, so it's kind of mouth-to-mouth breathing. Okay. And that's really when you're struggling to maintain that conversation. And then finally, you've got that, again, much quicker, higher levels of mouth-to-mouth breathing where you're just trying to get as much oxygen in, but also as much of that carbon dioxide out that you're producing as well.
Dr Rupy: Okay, great. So if I'm in this sort of steady state, what is the ideal amount of time I should be looking at to sort of get the maximum benefits of this, this training?
Kieran: Yeah, so it, it truthfully depends on your time commitment levels. A very basic level is something like 30 minutes is a good starting point. If you can do longer, great. It's going to provide additional benefit, but if you can just start off doing 30 minutes of that intensity of exercise where, like I said, it's challenging enough where you're starting to get that respiratory rate up, but not too much so that you're not able to maintain a conversation. So start off with 30 minutes and then as the weeks progress, try and do 35, 40, 45. And then once you feel like, okay, I can do 45 minutes of this intensity, drop it back down to 30, but let's just turn it up a tiny bit. So whether you walk a little bit quicker, you cycle a little bit harder, that's that progressive overload that tells our body, I'm not used to this and I need to do something to improve my body to tolerate this a little bit better. So our body's adapt and that's how we kind of gradually see the adaptations that we need to.
Dr Rupy: Great. So I love this. So if your time commitment is only 30 minutes and you're able to do this, and I like this measure as well because it contextualises it for the individual. So some people, if they're on a bike, for example, and I like doing the bike because I can see the wattage and I'm, I'm sort of data-driven in that respect. If I can maintain a wattage of 120 watts, um, that gives me an idea of like where I'm at. Um, if I can maintain that wattage for 35, 40 minutes, great. Before going into past 60 minutes, your suggestion would be to drop back down to 30 minutes and then increase the wattage ever so slightly, all the while being conscious that I should be able to breathe in that gear two that in through the nose, out through the mouth, and maintain a somewhat of a broken conversation if I was to try and chat with someone.
Kieran: Yeah, exactly that. So I mean you can, you can go when I'm programming for people it would be let's say 30 minutes up to 45 minutes. If you feel like I can dedicate a bit more time, we'd go from 45 minutes to 60 minutes. If you feel like you could do even more time you could go from 60 to 75. It really doesn't matter, but once you find that range that you say from a time commitment perspective, the max I can commit to this is maximum let's say 45 minutes. Cool. We'll start off with 30, work our way up to 45, drop back down to 30, but increase the exercise intensity. Work our way back up to 45 minutes. Drop back down to 30, increase the exercise intensity. And that's my way then to progressively overload somebody in terms of their cardiovascular activity.
Dr Rupy: Great. Okay, and this is great because, you know, this could be brisk walking for some people, or it could be like a a real sort of intense cycle on a white bike. So, again, choose your modality of steady-state exercise and try and commit at least 30 minutes. If you've only got two exercise periods in the week, which is very uh relevant for me right now because I've got an eight-week-old. So this is, this is great. Um, okay, so that's one of my exercise appointments for the week. Uh, what would be the other thing that you would recommend if I've only got two exercise opportunities to improve my VO2 max?
Kieran: So that's going to be your long steady state cardio. The other one then is going to be doing some form of high intensity interval style training. Um, this is going to be the one that is much tougher. You're pushing your body to higher levels of intensity. Um, but it's something that really drives a significant amount of adaptation in quite short periods of time. So, as I mentioned, it's really helpful when we do do a VO2 max because we can then dictate exactly what that intensity is. If you're not able to know what that is, again, get yourself on a bike or a treadmill and get yourself to a point where you're doing primarily mouth-to-mouth breathing, really pushing yourself, but not to a level where you feel like, okay, if I do this for longer than 30 seconds, I just can't maintain it. You should be able to do this exercise intensity for at least two to four minutes maximum. Um, but it should be pushing yourself to a level that that is as far as I could go from a duration perspective. Um, so again, we'd start off with something like two minutes on at this exercise intensity, then two minutes off. And that two minutes off, we'd like to be active recovery. So you could be, let's say, if you're doing it on a bike, you'd cycle at a quite a high intensity, and then we'd drop it back down, but still keep our legs moving to keep that kind of blood flow going and try and start getting rid of that lactate that we might have produced um during that exercise. But we then do that for multiple repetitions. So we might do that for two minutes on, two minutes off, and we might do that for six repetitions. So it's 12 minutes of really hard work and then 12 minutes of of essentially active rest. And that means that once a week, if I can do 12 minutes of exercise of really hard exercise, I can get phenomenal benefits from it. So.
Dr Rupy: You make it sound so easy. Those 12 minutes are pretty intense. So, okay, so if you're starting out at this, let's say you haven't done hit training before, and let's say actually, this again could be brisk, uh, maybe uphill walking that gets you to this level of exertion where you feel that you could only do this for two minutes, starting right in the bottom here. A starting point in terms of uh, a routine would be two minutes on, two minutes off and repetitions would you still aim for six or would you go for like three or four?
Kieran: Yeah, I'd I'd I'd traditionally just try and start for anywhere from five to six. I think, you know, 12 minutes of work, 12 minutes of rest is probably a good starting point. And then we'd gradually increase those repetitions from six reps, seven reps, eight reps. Once we get to eight repetitions, we could probably dial it back down but increase the amount of time that we're working at that intensity. So something like three minutes on, two minutes off. Uh, we could then work our way up to four minutes max. You might then increase your rest period just slightly, instead of doing two minutes rest, do three minutes of rest just to kind of give your body enough time to recover between each session or between each exercise bout. Um, because what's more important is maximising that exercise intensity and spending as much time as you can in that intensity within that two to four minute period, essentially.
Dr Rupy: Okay, fine. So if I just to bring us back to the differences between aerobic and anaerobic, um, is this what dictates that transition from aerobic to anaerobic training?
Kieran: Yeah, so it's it's how much oxygen that I'm actually able to get into those cells. For some people who do this long steady state cardio, they'll be quite efficient at getting that oxygen in and turning it into, um, into the energy we need to exercise. But as soon as they get up to those higher levels of intensity, they might not be great at buffering out that lactate and removing it. So maybe a little bit more interval style training might be more beneficial for them to start producing it, flushing it out, producing it and flushing it out and becoming more efficient that way. For some people, like let's say you're, you know, intermittent sport athletes, like football players, basketball players that do a lot of high intensity exercise but not too much low steady state work. They might be able to, you know, buffer out that lactate quite efficiently, but they can't exercise for those longer periods of time. So maybe more long steady state cardio might be better for them. So it depends on your modality as well as what happens during let's say your VO2 max test. We can see when those periods happen. If it happens way too early where your lactate starts to accumulate, maybe we need to again, get a bit more efficient at that pathway. If it happens a little bit later on, then it just changes how we then need to decide our training essentially.
Dr Rupy: Got you. Yeah. We'll we'll talk about aerobic versus anaerobic in a second actually, because I think those are really important points to to, uh, contextualise and to clarify for the listeners. So you mentioned there's something really important. Um, lactate. I don't think people may understand, remember from GCSE biology about lactate and lactic acid. Yeah. So when we're exercising, in our bodies, in our cells, we go through these varying different systems and one that's called glycolysis. Glycolysis basically takes a glucose molecule and then converts it into another substrate that allows us to turn that into the ATP or energy that we need. It's adenosine triphosphate it's called. And in glycolysis, in the presence of oxygen, that goes into our mitochondrion and then turns into energy. Without the presence of oxygen, it then converts into something we call lactate or lactic acid. Um, and that's going to be the thing that starts to accumulate when we can't provide enough oxygen to the working muscles to maintain that level of exercise intensity, essentially. So as soon as that lactate starts to accumulate, and it's not specifically that lactate that causes that burning sensation when you're exercising. It's something called these H+ ions that primarily drive that. Um, but it's a byproduct of when our bodies are not producing or not delivering enough oxygen to to exercise, we start to accumulate a lot of this lactic acid.
Dr Rupy: Yeah, because I remember when I was at PE and as a kid, I was always told that the lactic acid building up was the reason why I had, you know, fatigue muscles and soreness and burn and all that kind of stuff. But that that thinking on that has changed completely. So it's more the H+.
Kieran: H+ ions is is what kind of causes that sensation essentially. And now lactate is going to be the main biomarker that we measure but it's the the the actual H+ ions is what causes that sensation. And you can do something that's called a lactate threshold test where when you're exercising, you can take a very small blood sample. Some people take it on the finger when they're exercising, some people take it on the ear, for example. And that will tell you how much lactate or lactic acid is in our bloodstream while we're exercising at a certain intensity. And it can be a a very, a I guess blockade in terms of how long that we can exercise for. There's three primary things that dictate endurance performance. There's your VO2 max. There's your efficiency, which is how much oxygen is required to maintain this exercise intensity that I'm working at. And also, am I moving efficient, um, effectively as well? So from a biomechanical perspective, are my joints and muscles working in synchronization to be more efficient? And then the third thing is then your lactate threshold or your lactate production essentially. So if you've got a great VO2 max and you're running with the correct biomechanics and you are then not producing as much lactate, your endurance performance is going to be fantastic. Some people who might have a great VO2 max, but they'll have a poor lactate threshold. So they've got a massive engine essentially, but the lactate just accumulates potentially a little bit earlier on into that process. Eventually, that's going to start to weigh on the system and then your body's going to start to feel that burning sensation and not be able to maintain that exercise intensity for that longer extended period of time.
Dr Rupy: Got you. And so, if we want to be really data-driven about the steady-state exercise, I understand there are some people actually testing their lactate levels to ensure that it's sub a certain threshold. Can we talk a little bit about.
Kieran: Yeah, so when we're exercising, lactate gradually accumulates over time. In the early stages, when we're able to deliver enough oxygen to our body to sustain the energy requirements when we're exercising, lactate is not produced. A very little might be produced, but um, it'll be mostly just going into our mitochondria and turning into energy.
Dr Rupy: Got you. So we're really efficient at utilising any excess lactate as a result of metabolism, goes back into the mitochondria. So it's if we were to measure it, just be like nice and flat.
Kieran: Yeah, exactly. And then there comes a point in exercise where it's gradually starting to increase. What I always tell people is that there's a period in exercise which is what we call that aerobic threshold or that lactate threshold where it's starting to accumulate, but we're able to flush it out of the body quick enough where it's not really becoming a problem. I tell people like there's a fire in the room, but we have enough water to put it out before it starts to spread.
Dr Rupy: That's a good analogy. I like that.
Kieran: As soon as then that exercise intensity starts to increase further and further and that lactate starts to accumulate faster and faster and we don't have enough water to put those fires out, that's when it starts to become a problem. And that's when we say, okay, I can't maintain this exercise intensity quick enough because it's really starting to affect my body, essentially.
Dr Rupy: Okay, fine. And so, just to bring us back to the differences between aerobic and anaerobic, um, is this what dictates that transition from aerobic to anaerobic training?
Kieran: Yeah, so it's it's how much oxygen that I'm actually able to get into those cells. For some people who do this long steady state cardio, they'll be quite efficient at getting that oxygen in and turning it into, um, into the energy we need to exercise. But as soon as they get up to those higher levels of intensity, they might not be great at buffering out that lactate and removing it. So maybe a little bit more interval style training might be more beneficial for them to start producing it, flushing it out, producing it and flushing it out and becoming more efficient that way. For some people, like let's say you're, you know, intermittent sport athletes, like football players, basketball players that do a lot of high intensity exercise but not too much low steady state work. They might be able to, you know, buffer out that lactate quite efficiently, but they can't exercise for those longer periods of time. So maybe more long steady state cardio might be better for them. So it depends on your modality as well as what happens during let's say your VO2 max test. We can see when those periods happen. If it happens way too early where your lactate starts to accumulate, maybe we need to again, get a bit more efficient at that pathway. If it happens a little bit later on, then it just changes how we then need to decide our training essentially.
Dr Rupy: Got you. I think we we've talked a lot about this so far in the on the pod with the perspective of like, you know, athletes and uh training volume. I don't want to discount that this is super important for people in the older age group. So above the age of 50, particularly for women as well, in the who are postmenopausal, to ensure that they're getting not just protein content, but available protein as well. Is this something that you've seen in practice in in clinical?
Kieran: Um, yeah, I think, you know, one thing is that just diets change and people just don't have, you know, the their regular feeding processes, you know, that they would traditionally have in terms of a breakfast, lunch and a dinner. You know, people just, I think breakfast is a big area that's traditionally missed in our diets and it is, you know, as people say, one of the most important meals in the day. Um, so I think, yeah, I'm not, not too sure as to how much I probably expand on that. So I think.
Dr Rupy: No, that's cool. I think, um, in terms of the consumption of protein as we age, we need to probably consume more. I think a lot of older vulnerable adults under-consume. And whether that's because of lacking of appetite, the ability of their guts to break down proteins because of the gradual loss of microbial diversity. There's probably a whole other number of reasons as to why I think a high protein requirement is something to aim for.
Kieran: Yeah, and our, our muscle mass gradually atrophies over time. So by having higher levels of protein, we will be able to maintain it. Even if we're not doing traditional weight-based training or resistance exercise, even having a high protein diet can reduce the rate of that muscle mass decline. So for those who are slightly older, as you said, if we want to hang on to some of that muscle, but we just don't have the ability to lift weights in the same way, having a higher protein diet will retain that a little bit better.
Dr Rupy: Yeah, and it's probably something that I don't think I fully appreciated, particularly when I was working in, um, geriatric medicine and actually, you know, the, the, just how common sarcopenia is, particularly if you've had extended bouts of inactivity or immobilisation because of surgery, like typical neck of femur fractures that you have in older vulnerable patients and just the loss of muscle mass. If we were to optimise their protein intake, whether that is through shakes or ideally through a whole food diet, how much muscle can we preserve? It seems like from some of the research that you just mentioning, we could do a lot.
Kieran: Makes a big difference. Yeah. And I think it's, it's just getting enough so that you can maintain a consistent diet and not overly consuming proteins obviously that it's just not sustainable. But getting enough, even just to getting let's say 1 gram per kilogram of body weight for people in that older category, getting closer to maybe 1.2 will make a drastic difference in terms of retaining that muscle mass, for sure.
Dr Rupy: Got you. Um, so we've done two investigations that I think everyone should get done. Resting metabolic rate, VO2 max, DEXA. Uh, so I was quite surprised at my DEXA. So I was happy that my visceral fat was very low. Or perhaps we could talk a bit about what DEXA is. Like why would you recommend people get a DEXA scan? What information does it, what, what does it give you and how would that guide one's training?
Kieran: Yeah, so a DEXA machine essentially is a standalone machine that measures your body composition. You would lie down on a bed and you'll have a small kind of arm of the machine run over you that emits these very small radiation waves, not so much so that it's a kind of risk of kind of any major radiation. It's quite minimal. But what it does is measures your bone density, so I guess the, you know, the thickness of your bones, um, how much fat you're holding on your frame, and also what that muscle mass looks like as well. Um, so the DEXA scan is good. It's done in approximately let's say 20 minutes and you can get a good picture as to what your overall composition looks like because on the outside, you know, you might look a certain way in terms of your frame, but when you start to understand what's actually happening deep down in terms of your visceral fat and how much of your frame is actually made up of muscle mass, sometimes can dictate a very different story. So.
Dr Rupy: Yeah, yeah. And if someone's got a lot of fat on them, um, would the strategy, I know I've asked you this before, but would the strategy be over-indexing on steady state cardio?
Kieran: I think there's going to be nothing more powerful than being in a calorie deficit through diet truthfully. And I think the amount of calories that you burn throughout exercise versus how much easier it is just to limit that in your diet is going to be a much easier pathway to, to reduce that body fat percentage. If you were to do long steady state cardio for, let's say, 30 minutes, you might burn upwards of 2 to 300 calories throughout that period. But if I just didn't snack on that chocolate bar in the mid-afternoon, then I would have then, you know, been in a better position to reduce my, my calorie intake for that day. So, um, I think yes, long steady state cardio serves its purpose and it definitely helps in terms of reducing that person's body fat. Um, but I will always tell people that, you know, if your diet is not in check, then it's going to be much, much tougher to, to reduce that body fat over time.
Dr Rupy: Okay, and so you've convinced me on all these different tests, right? I'm someone who gets them regularly. So how often do you recommend a VO2 max test? So if you, if you were tsar of people's cardio-metabolic health and, you know, they got their blood pressure, they got their lipoproteins measured, how often would you suggest a VO2 max?
Kieran: Ideally, it's, it's somewhere in the ballpark of twice a year. I think from a, you could do it once a year and that's fine. I think twice a year, at least gives you a certain level of positive reinforcement that you're doing the right thing. So if you do all this hard work and you realise, gosh, I need to wait 12 months before I find out if it's actually caused any benefit. From a sustainability perspective, people are less likely to adhere to that training. Whereas if you know that you're able to test it, you know, in, you can do it every three months if you're really, really into your cardiovascular exercise. For some people that might be a little bit too much. Every six months is probably a good place to go in terms of allowing enough time to cause some adaptation, but then giving you that break-up point to know, okay, is this hard work resulting in the change that I want? So twice a year is probably a good place to be.
Dr Rupy: Okay, and it's 12 minutes, or so. Yeah. Uh, what's that going to set me back roughly?
Kieran: Yeah, so in terms of a VO2 max test, you're probably looking in the ballpark of roughly 200 to 250 pounds at a max. Um, different organisations will have different packages in terms of if you're doing a test, but um, but yeah, I think the big thing to get away from is, a, tell me what my VO2 max is, but then b, what then do I need to do to improve it? And if your physiologist tells you how to improve it, great. If not, you can work alongside your strength and conditioning coach or your personal trainer who might be able to inform you on that.
Dr Rupy: Yeah, I mean if you're dropping 200 quid, then you want to get a little bit of an exercise protocol as well in addition to that. Okay, uh, resting metabolic rate, the one where you basically just take a nap.
Kieran: Yeah, roughly in the ballpark of 150 pounds probably. Um, again, you probably would need to do that, you know, once every, you know, three months, once every six months is perfectly fine. If it's normal, it needs to be, or I guess if it's where it needs to be, then it doesn't have to be as regularly. If there are some issues in terms of let's say that carbohydrate fat utilisation issue, you know, rechecking it after three months to show have the changes I've made improved is probably a good thing to do.
Dr Rupy: Okay, and you're ideally you want that to show that you're in uh more of a fat burning mode, right?
Kieran: Okay, great. And you can do that through the dietary interventions that we mentioned, increasing quality fats in your diet, because there was, I don't know if whether it was the same within the exercise physiology world, but particularly in the cardiology world and the metabolic health world, there was a real push against fats. And I think there's still a bit of a hangover of being anti-fat as well. Is that, is that something that has changed in your world since you trained? Yeah, I think people hear fat and hear is a very kind of scary word in the nutrition side of things. And they, it's there's the difference between saturated and unsaturated fats. We've got plenty of good fatty acids that make massive improvements in our cardiovascular health. And then there's the saturated fats that causes issues in terms of blood pressure and cholesterol levels that we don't want to see. So, you know, we've got our HDL and our LDL. LDL being our bad cholesterol, which we get from our saturated fats. HDL being the one that cleans up our bloodstream and you get that from our good fats. So, um, yeah, I think they're, they're probably needs to be a bit better of an education piece on people understanding the differences between them. Um, hopefully that happens where we start to integrate more nutrition learnings in curriculums in school, hopefully, but um, yeah, I think they're, fat can be a scary word, but it's, it does have massive benefits when used correctly.
Dr Rupy: Yeah, absolutely. I think the quality of fats is super important. Um, and a DEXA scan, how much is that going to cost?
Kieran: Yeah, DEXA scan, I think is roughly in the ballpark of again, 250 pounds at a maximum. Um, yeah, it's again, very quick test. It probably take no longer than 20 to 30 minutes. Um, again, if you've got issues with bone density or high levels of body fat, again, these assessments inform the next kind of your next lifestyle change and then you should get another test to show how much has improved. So, you know, this shouldn't be done once every couple of years. It should be done on a regular basis to make sure that you're heading and trending in the right direction, essentially.
Dr Rupy: Yeah, and look, some people might sort of balk at the price of these tests and I think, you know, collectively, if you're spending around 600 pounds every six months or so on these tests, it is a lot. But at the end of the day, and certainly for me, this has given me a lot more encouragement and confidence that I'm training in the correct way. And it gives me sort of those guardrails of, okay, I'm training in the right direction in terms of my cardio-metabolic health. You know, someone being of South Asian origin, I'm at greater risk of metabolic disease, unfortunately. My cholesterol is on the high side genetically. And so if I can do everything in my power to mitigate against that, and if these tests give me the sort of impetus to do better in terms of my exercise frequency, volume, all that kind of stuff, I think it's a really worthwhile investment.
Kieran: It is. And I think, you know, we, for those who do, do their exercise and go to the gym and do their runs, you know, making it a little bit more informed and making sure that you're maximising the benefits from all that time that you're putting into it would make a big difference. So, you know, if you go to the gym two or three days a week and you go for, you know, a run once or twice a week, but you're not fully monitoring it and progressing it the way that you should, it's not going to be a waste of time, but it's definitely a suboptimal way of approaching your training. Whereas having these tools to then inform specifically what you need to do, and you can get these generic training programs and generic training recommendations, but ideally you want something that's very tailored and bespoke to you. And that's what's going to inform that training and get you the results you want faster. And that's essentially what most of us want. We want those results as effectively and efficiently as possible, in as little time as possible. And these tools help kind of inform us a lot better.
Dr Rupy: Yeah, I couldn't agree more, because, you know, the amount of time that I invest in looking after my health and training as well, like I'm, I'm someone who, prior to having a kid, uh, would train five to six times a week. And so every time, if you count the amount of time it takes for me to get to the gym or work out at home, you know, we're looking at hours and hours every single month. And if I can do some things that tweak my training in a way that makes that time better and more efficiently spent, it's, it's 100 times, you know, the cost of this worth it.
Kieran: Yeah, absolutely. And also you could also potentially then reduce the amount of time that you need to do it and to dedicate towards training. So if I can train more effectively, I might not have to do five, six days a week. I could do three days a week really, really well and still get better results than I was previously getting through six days a week because it's more informed.
Dr Rupy: Yeah, yeah, absolutely. Okay, so we've talked about protein and the amount of protein that we should be consuming every single day. And I'm glad we've talked about it in the context of how it's a lot higher than the current recommended daily allowance. I think this is something that is very hot in the sort of protein research world, and it's going to be coming to the public domain very, very soon as well. Um, specifically, if someone trains late, right? So someone who can't fit the gym in in the morning for whatever reason, because of the commute. And then they have to train at like 6:00 or 7:00 p.m. If they have to then succumb to having a late dinner, is it preferential to eat a late dinner that may interfere with their sleep, let's say at like 10:00 or 11:00 p.m., which is quite an unnatural time and out of sync with your circadian rhythm. Is it better to take the hit and eat close to bedtime? Or should they wait until the next day? Or is there another?
Kieran: Yeah, I think it's, it's, it's going to be a little bit less ideal because what you want to do is throughout that recovery process is to send as much of that blood to those muscles while you're resting and not being sent to the gut to help break that food down. Um, do we need something after training? Probably. So something a little bit more light, something that's maybe a little bit higher in protein, not too dense in terms of its carbohydrates can be beneficial. Um, ideally, you know, if you could have a meal beforehand, then that might help as well before you go to the gym rather than doing it afterwards, not so much that you feel like you've got quite a heavy stomach and you can't train appropriately. Um, but ideally, recovery is really where you want to allow your body to rest and send as much of that kind of blood and as much of those systems to help that recovery process. So if we've got quite a heavy meal sitting in our gut, then it's going to be less blood that we can dictate towards recovery and more towards breaking that food down. So for me, I'd probably tell somebody have a kind of meal before we work out. And then when you come back, if you're needing something to refuel, have something a little bit lighter and then just focus on then getting a good meal the next day.
Dr Rupy: Okay, fine. So a light meal and potentially having sort of, um, something before training. And that was going to be my next question actually, in terms of pre-loading snacks. So, should I, particularly if I'm doing steady state exercise, so this, you know, long cycle below the lactate threshold, should I be having a snack before, like a carbohydrate-rich snack, or should I am I able to do it and am I suggested to do it in a faster state?
Kieran: You, you can do either. What I'll say is for something like, if you were a competitive and you're in competition, then having something like that will, you know, improve your performance. If you're doing it just to do as part of your training regime, it's probably a little less important. I think depending on the duration at which you're doing that long steady state cardio, you should have enough fuel to get you through. If you're doing it for two hours, two and a half, three hours, long steady state in terms of training for a marathon, let's say, then yes, probably something before it would help or maybe getting something in between, like again a a quick snack while you're exercising is perfectly fine as well. Um, but yeah.
Dr Rupy: I've seen a lot of athletes have these sort of like ultra-processed gels before they go and like do a marathon or a long run. Are those things advisable for the general population to have during training or that?
Kieran: Yeah, no, primarily not. Um, you know, they, they, they serve their purpose in terms of providing a quick fix of energy, you know, when we're doing this exercise, but, you know, the general public isn't really working at intensities that are at a competitive standard that requires this also for longer periods of time. If you are a person who does, you know, a recreational marathon or do a parkrun or something like that, you know, that's, that's fine. It's probably not the go-to thing. It's just making sure you've got a good overall diet, rather than needing any of these specific gels.
Dr Rupy: Okay. And I know you work in a clinical environment, uh, at the moment or alongside clinical colleagues. Are there particular different training modalities that you would recommend for someone who, uh, has osteoporosis, uh, or is frail, or has just had a coronary event, for example? Or is the goal still to optimise for VO2 max improvement within the sort of framework of the exercise types that you've already gone through?
Kieran: So for somebody who's kind of more osteoporosis, resistance training is going to be much more powerful in terms of improving our bone density than compared to, you know, typical cardiovascular activity. So doing some form of weight-bearing exercise, um, loading ourselves with, you know, it could be machine-based, it can be kind of free-weight based, but something that's causing some muscular tension that drives kind of that adaptation that's required to improve bone density is going to be stronger than doing your traditional cardiovascular exercise. So I do doing something that's a bit more weight bearing. Um, something that might be a slightly more impact, you know, you could do some light levels of jumps, not too much so when it's somebody's got let's say a very low bone density, you don't want to cause any issues. But those kind of small jumps or what we call mini kind of ballistic or plyometric exercises do drive a lot of adaptation in terms of improving our bone density. Um, so doing that type of exercise is definitely going to be more beneficial.
Dr Rupy: Okay, and if someone's, uh, recently had a heart attack, um, and so they've obviously experienced some death of the myocardial tissue, are there adaptations that we have to make? Obviously, within the realms of how frail an individual is. Or is the the goal still, again, to increase VO2 max?
Kieran: Yeah, I, like I said, there's, there's so many different systems at play. And obviously, a person's VO2 max is isn't probably not going to be as good as it was previously, but we can make the other adaptations in other systems. I.e. we can improve the capillarization around our muscles that can help diffuse that into the blood, into the muscles more efficiently. The muscles themselves could be a bit more effective at turning that glucose and fuel source into energy. So we can still improve our VO2 max and that can still be done in some form of long steady state cardio and sometimes some more higher intensity interval training once it's monitored appropriately by your, you know, your professional person who would look after that for you, whether that's your cardiac physiologist or your physician, for example. But yeah, you could still get those improvements. Um, but it's probably not going to be the same, obviously, as beforehand. So.
Dr Rupy: Okay, and in some cases, like you were saying, VO2 max has been stabilised or even increased as well, right? So this is something to.
Kieran: Yeah, so for some people, again, we've I've, you know, I've had people who've improved their VO2 max by, you know, 15 to 20% even in their 60s because previously they're probably weren't doing as much exercise. We've had some people who were doing plenty of exercise, but they're now actually progressively overloading. Whereas most people who might just say, okay, I've jumped on the treadmill, I've jumped on the bike, I've done my 30 minutes, that's my cardiovascular activity done. But you, you don't, you're not progressing it on a week-to-week basis. And when you do progress it, it makes such a difference in terms of driving that adaptation. Our body's really smart. It'll listen to us constantly and say, okay, is this enough of a stimulus that makes me say I need to do something to improve this? If it's not, we're going to stay the same. So if you always go on the bike at 100 watts and cycle for 30 minutes, you're not going to improve your health. If you get up to a level where our body's saying, ooh, I'm not used to this, I need to do something to improve my system, then you'll start to see that adaptation.
Dr Rupy: Yeah, and I think for a lot of people that might be quite hard to hear, and I just want to reiterate, you know, obviously any form of exercise is obviously brilliant. But if you're trying to be as efficient with your time as much as possible, then you want to, I think the theme of this episode is progressive overload, you know, and driving that adaptation. These are the things that we've come back to quite a bit. And in terms of, um, just to round this off, you know, a lot of our listeners might have children in their teens and and 20s. And you said right at the start of this podcast, you know, our broke my heart, our VO2 max tends to decline, even though there are obviously instances where it can plateau or even increase, but it generally, it tends to decline over time. Does that stand to reason that we should be encouraging our, our youth, our kids, you know, even into our 20s, to instead of focusing on resistance training and muscle building and bulking, which is all the rage on Instagram and TikTok, we should be really trying to encourage them to think about VO2 max training at that early age so they, they get a a lovely strong foundation which will provide a lot more reserve as as they age?
Kieran: Of course. Yeah, I think the, the goal is to primarily get their VO2 max as high as possible, no matter the age category, but definitely in those early years. Um, because getting it up to that higher level then gives you a, I guess, a higher ceiling to work from, and that means the decline isn't going to be as rapid. So, for somebody, I think there was a research study that came out that if you can do a park run in your, you know, late 20s, early 30s, in 30 minutes, by the time you then get to 70, you'll barely be able to walk uphill at a 3 kilometre an hour pace because that's how quickly it declines. If you have a much higher VO2 max, then you can obviously do much more brisk walking, activities as you'd like to do with your grandchildren, for example, where you can walk up and down stairs, you can carry the groceries in without feeling like it's too much of a physical burden. So, getting that VO2 max up in those early stages in your early 20s to, you know, late 20s, early 30s is definitely going to be much more powerful than obviously trying to do it a little bit later on in the game. It will definitely be important to do it. There's never a point in our lives where we shouldn't focus on improving our VO2 max, but getting it as high as possible in the early stages will definitely be much more powerful.
Dr Rupy: Yeah, and I think you know what, that was the unlock for me when I found out that we were having our first child, that I want to be around for as long as possible, and I want to be in a state of fitness where I can be there for hopefully their kids if they choose to have them, or just being around in a state where I'm able to, uh, act with them and and, you know, hang out and still like play football and all the rest of it. I still want to be as mobile as I as I want to be in my in my later years. So for me, like that's really reframed the way I train and the modalities in which I train in and also just being as efficient as possible. So I I, you know, the investment in investigations is one thing, but just being a lot more intentional about the training, I think is something.
Kieran: Yeah, that's it. I think, you know, walking into the gym and kind of going through the motions, it's for me, like I said, it will have its benefits, it just won't be as powerful as kind of as you said, going into the gym with some level of intent, tracking, monitoring, making sure what I'm doing is a little bit tougher than what I did yesterday is really what's going to say, okay, I'm getting to a stage where I'm progressing and that's what's going to help that kind of I guess sustainability and longevity of our health for the long term. So.
Dr Rupy: Yeah, absolutely. Gosh, Kieran, this has been so good. So super educational, but there's so many other things I'd love to ask you about, including HRV and heart rate recovery and muscle fibres and all that kind of stuff. So in 2025, if you're if you're up for it, we'd love to love to do this again.
Kieran: We'll pick it up again for sure then.
Dr Rupy: I would love that.
