#307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.
#307 ‒ 老年人的锻炼：从哪里开始，如何最大限度地减少风险，同时最大化潜力 | Peter Attia, M.D.

Hey, everyone. Welcome to The Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone.
大家好，欢迎收听《The Drive Podcast》。我是您的主持人 Peter Attia。这个播客、我的网站以及我的每周通讯都致力于将长寿科学转化为适合每个人理解的内容。

Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads.
我们的目标是提供健康和健康领域最优质的内容，我们已经建立了一支优秀的分析团队来实现这一目标。对我来说，非常重要的是提供所有这些内容，而不依赖付费广告。

To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free.
为了做到这一点，我们的工作完全依靠我们的会员，作为回报，我们提供独家会员专享内容和超出免费内容范围的福利。

If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription.
如果您想将对这一领域的了解提升到更高水平，我们的目标是确保会员获得的远远超过订阅费的价值。

If you want to learn more about the benefits of our premium membership, head over to PeterAttiaMD.com forward slash subscribe. Welcome to a special episode of The Drive.
如果您想了解更多关于我们高级会员的好处，请访问 PeterAttiaMD.com/subscribe。欢迎收听《The Drive》的特别节目。

This is an episode that is like an AMA where I'm the one answering the questions. However, it is an episode that will be available to all.
这是一个类似于 AMA 的节目，我将回答问题。然而，这是一个所有人都可以观看的节目。

One of the most common questions that we receive through the site is from people who are quote-unquote older, we'll define that as my cohort and up, 50 and up,
我们网站经常收到的一个最常见的问题是来自所谓的年长人士，我们将其定义为我的同龄人及以上，50 岁及以上

who realize the importance of exercise but are wondering if it's too late for them to start. This could be because they've never trained or they're worried about injury,
意识到锻炼的重要性，但担心是否为时已晚的人。这可能是因为他们从未接受过训练，或者担心受伤。

they have no idea how or where to start or they used to exercise when they were young but they've kind of got away from it and they're just trying to figure out what to do.
他们不知道该如何开始，也不知道从哪里开始，或者他们年轻时曾经锻炼过，但现在已经慢慢放弃了，他们只是试图弄清楚该怎么做。

As such, we wanted to create an episode for these people, people above 50 who haven't been exercising at least recently, want to start, but don't know where to begin. In this episode,
因此，我们希望为这些人创作一集节目，这些人年龄在 50 岁以上，最近没有锻炼过，想要开始锻炼，但不知道从哪里开始。在这一集中，

we speak about exercising in that age range as it relates to all four pillars of exercise and dive into not only why it is not too late, but what one can do to start exercising, minimize injury risk, and maximize potential.
我们谈论在这个年龄段进行锻炼与锻炼的四大支柱有关，并深入探讨不仅为什么现在还不算太晚，还有一个人可以做些什么来开始锻炼，减少受伤风险，并最大限度地发挥潜力。

This conversation will be a little less technical than some of our AMAs.
这次对话会比我们一些 AMA 的技术性稍低一些。

I wanted to try to keep it a bit more conversational and what we've done to accommodate that is included many of the studies that support the observations and points that are being made in the show notes.
我想尝试保持更多的对话性，为此我们所做的是在节目笔记中包含了支持观察和观点的许多研究。

Even if you're not in this quote older slash 50 and up age category, most of you likely know someone who is like a parent and you may find this hopefully something that you can share with them and help them to start exercising.
即使您不在这个引用的 50 岁及以上年龄段内，您大多数可能认识像父母一样的人，您可能会发现这是一件希望您能与他们分享并帮助他们开始锻炼的事情。

So without further delay, I hope you enjoy this special episode of The Drive.
所以，不再拖延，希望您喜欢这期《The Drive》的特别节目。

Peter, welcome to a special episode. How are you doing?
彼得，欢迎来到这个特别的一集。你好吗？

Very well. Thank you. 非常好。谢谢。

So today's episode is special in that it's kind of shot like an AMA, but it's going to be available to everyone. And what we're going to cover is one of the most common questions that we see come through day in,
所以今天的节目很特别，因为它有点像一个 AMA 拍摄，但是它将对所有人开放。我们要讨论的是我们经常看到的最常见的问题之一，每天都会出现的。

day out to the website is whether people who are quote unquote older, let's say just for general purposes for this conversation, 50 plus, Who realize the importance of exercise but are wondering if it's too late for them to start.
日出到网站的人是否是所谓的老年人，就这次谈话的一般目的而言，50 岁以上的人，他们意识到锻炼的重要性，但不确定是否为他们开始太晚。

And this could be whether they've never trained or worry about injury, they don't know what to do or how to do it, or they just think, you know what, it's too late for them to really make a difference.
这可能是因为他们从未接受过训练或担心受伤，他们不知道该怎么做或如何做，或者他们只是觉得，你知道，现在为他们真正产生影响已经太晚了。

And so we wanted to create an episode for that group, 50 plus who have not been exercising but want to start.
因此，我们希望为那些 50 岁以上的人群创作一集节目，他们虽然没有进行锻炼，但却想开始。

And although much of what we'll talk about applies to anyone in that age category, it also can apply to anyone of any age who is deconditioned and looking to start slow.
尽管我们将讨论的内容大部分适用于该年龄段的任何人，但也适用于任何年龄的体能下降者，希望缓慢开始的人。

With that said too, anyone who's younger most likely has parents who might be in this position and this could be a good episode to send to them to encourage them to start.
话虽如此，年轻人很可能有处于这种境地的父母，这可能是一个鼓励他们开始的好时机。

And so how we're going to structure it is a little less technical than some of our AMAs and much more conversational as to how you would speak to these people if they were your patients and came to you and were asking you these questions.
因此，我们将构建的方式比一些我们的 AMA 技术性要低一些，更多地是像与这些人交谈一样，如果他们是你的患者来找你，并向你提出这些问题。

And the show notes will have the studies that you talk about. We'll link to them. We'll link to other content that goes much deeper, but this will be a little bit more on that conversational side.
展示说明中将包含您谈论的研究。我们会提供链接。我们会链接到更深入的其他内容，但这将更多地偏向对话。

So with all that said, anything you want to add as someone who is now in the quote unquote older category as well?
所以说了这么多，作为一个现在被称为老年人群的人，你还有什么想补充的吗？

Yeah. My wife likes to refer to me as an older gentleman now. So that's right. I'm in the over 50 category, not just 50, but over 50. So a couple of things.
是的。我妻子现在喜欢称呼我为一个年长的绅士。没错。我已经进入了 50 岁以上的范畴，不只是 50 岁，而是 50 岁以上。所以有几件事情。

One, as we thought about putting this together, the goal initially was to have no figures, no studies, just really put all of that in the show notes, but let us talk.
一、当我们考虑整理这个内容时，最初的目标是不使用任何数字、研究，只是把所有这些都放在节目笔记中，但让我们来谈谈。

And I've sort of begged to have a few figures because I do think that there are times when a picture just says a lot.
我有点恳求要一些数字，因为我认为有时候一幅图片能说很多话。

So for folks who are listening to us, there's going to be a few times when I'm going to reference some figures from studies that I think really do a lot.
所以对于听众来说，接下来会有几次我会提到一些研究中的数据，我认为这些数据非常重要。

A couple of things to state is that we'll talk about this in detail, but we talk about 50 being a turning point. I think another really big turning point is 65 plus.
有几件事情要说明的是，我们将会详细讨论这一点，但我们谈论的是 50 岁是一个转折点。我认为另一个非常重要的转折点是 65 岁及以上。

And again, we'll get to some of these things, but we really start to notice reduction in strength at about that age.
再次，我们将会谈到一些这些事情，但我们真的开始注意到在那个年龄力量的减弱。

We start to see vestibular changes that occur around that age, and that probably contributes significantly to something we will talk about, which is the risk of falling.
我们开始看到在那个年龄发生的前庭变化，这可能对我们将要谈论的某事产生重大影响，即摔倒风险。

So, while I think everything we're going to talk about is going to be relevant to anybody who's over 50 and untrained, I will probably call out specifically areas where when we get into that 60 to 65-year-old camp,
所以，虽然我认为我们要讨论的一切对于任何超过 50 岁且未受过训练的人都是相关的，但当我们进入 60 到 65 岁年龄段时，我可能会特别指出一些领域，

we want to be even more mindful of things.
我们希望更加留心事物。

And so I think to start, you've spoken at length about the importance of exercise for longevity, so I don't think we need to start there, but let's say someone heard that message,
所以我认为首先，您已经详细谈到了运动对长寿的重要性，所以我认为我们不需要从那里开始，但假设有人听到了那个信息，

is in that 50 plus, 65 plus category, hasn't been exercising and they come to you and say, is it too late for me to start doing this? Is it too late for me to worry about this and start making changes?
在那个 50 多岁、65 岁以上的年龄段，长期不锻炼的人来找你，问：“我现在开始做这个还来得及吗？我现在开始担心并做出改变还来得及吗？”

I think it'd be helpful for people first to hear, how would you even respond to that?
我认为让人们首先听到会有帮助，你会如何回应这个问题？

I've had the same response largely for many years now, so I realize that some people will have already heard me say this, whether it's on another podcast, but truthfully, I haven't come up with a better analogy yet.
多年来，我基本上得到了相同的回应，所以我意识到一些人可能已经听过我说过这个观点，无论是在另一个播客上，但实话说，我还没有想出一个更好的类比。

It's really the analogy of saving for retirement. So, if you could be talking to somebody who's in high school or college and you were talking to them through the lens of being a financial advisor, their fiduciary, what would you say?
这实际上就是为退休存钱的类比。所以，如果你能和一个高中生或大学生谈话，并通过作为财务顾问、他们的受托人的视角与他们交谈，你会说些什么？

Well, you would say, listen, there's this really magical thing called compounding that Einstein basically said was the eighth wonder of the world and you want to use it to maximum advantage and to do that,
嗯，你可能会说，听着，有一种非常神奇的东西叫做复利，爱因斯坦基本上说它是世界上的第八大奇迹，你想要充分利用它，为了做到这一点，

you should start saving immediately. When you get your first job, you should be saving. If not, certainly by the time you get out of college, you should be saving. And if you do that, you don't really have to be that brilliant about it.
你应该立即开始储蓄。当你第一份工作时，你应该开始储蓄。如果没有，那么在你大学毕业之前，你应该开始储蓄。如果你这样做了，其实并不需要太聪明。

If you put all of your savings into an index fund at the age of 22, the probability that you are not going to be set when you retire is so low. So that's great.
如果你在 22 岁时把所有的积蓄投入到指数基金中，那么你退休时不会有困难的可能性非常低。所以这很棒。

But what happens if you're talking to somebody who's 45 and due to life circumstances, like they just haven't been able to save.
但如果你在和一个 45 岁的人交谈，由于生活环境的原因，比如他们根本无法存钱，会发生什么呢？

They haven't made enough money to even have some disposable saving income or they've saved and lost or invested badly or something like that. Would you say, well, too bad? No, of course you wouldn't.
他们甚至没有赚到足够的钱来有一些可支配的储蓄收入，或者他们存钱然后亏损了，或者投资不当，诸如此类。你会说，哎呀，太糟糕了吗？当然不会。

I guess the point here is it is never too late to start saving for retirement, but you must understand something, which is the longer you wait to start, The more you're likely going to have to save,
我想关键在于开始为退休储蓄永远不会太晚，但你必须明白一点，就是你等待开始的时间越长，你可能需要储蓄的金额就会越多

the greater return you're going to need, and therefore probably the greater risk you're going to take. So it's never too late to start saving and it's never too late to start exercising.
你需要更大的回报，因此可能需要承担更大的风险。所以现在开始储蓄和锻炼永远不会太迟。

But I want the message to be, don't wait because of some reason and say, well, I'm going to wait till I'm older because. So anyway, to me, that's the best way to think about this.
但我希望传达的信息是，不要因为某些原因而等待，然后说，嗯，我要等到我年纪大一点再说。总之，对我来说，这是考虑这个问题的最佳方式。

I think it will be helpful for this conversation because we'll touch on these various aspects as it relates to exercise in this age population.
我认为这将有助于这次对话，因为我们将涉及与这个年龄群体的锻炼相关的各个方面。

But can you just remind people of your four pillars and kind of how you think about each of those pillars individually as someone is aging?
但您能否简要提醒人们您的四大支柱，以及您如何单独考虑每个支柱，作为一个人在变老的过程中？

Yeah, and sometimes I think of it as three or four, but I think I'd write about it as four, so I'll stick with that. But it's basically stability, strength, aerobic efficiency, and peak aerobic output.
是的，有时我会把它看作是三个或四个，但我觉得我会把它写成四个，所以我会坚持这样做。但基本上是稳定性、力量、有氧效率和最高有氧输出。

And you could argue, well, those are just kind of a continuum. And so I would say, sure. But let's not get lost in the semantics. Those things, if you define them the way I do, kind of constitute everything.
你可以说，嗯，这些只是一种连续体。所以我会说，当然。但让我们不要陷入语义的纠缠。如果你按照我的定义来界定这些事物，它们几乎构成了一切。

Again, stability is kind of a broad term, but embedded within stability is everything that enables you to dissipate force safely, everything that enables you to have balance and flexibility because believe it or not,
再次，稳定性是一个相对宽泛的术语，但在稳定性之内包含了一切使您能够安全地消散力量的因素，一切使您能够保持平衡和灵活性的因素，因为不管您信不信，

those come from stability. If you have balance, by definition, you have stability. You can't have balance without stability. You can't actually have flexibility without stability.
那些来自稳定。如果你有平衡，根据定义，你就有稳定。没有稳定就不可能有平衡。实际上，没有稳定就不可能有灵活性。

We think of training as having a purpose and, of course, different types of training factor in to these different activities. So there are some types of training that really kind of myopically hit one of these things.
我们认为培训是有目的的，当然，不同类型的培训会影响到这些不同的活动。因此，有一些类型的培训确实会过分专注于其中一种事情。

So if you're riding a bike like I do for your zone 2 training, well, first of all, riding a bike is a very one-dimensional activity. There are basically no degrees of freedom outside of you pedaling the crank.
所以，如果你像我一样骑自行车进行你的 2 区训练，首先，骑自行车是一种非常单一维度的活动。基本上除了你踩踏板之外，没有其他自由度。

And if you do it at a fixed power output that meets the criteria for zone 2, then you're very narrowly targeting that. You're doing very little for any of the other systems. And then conversely,
如果您以符合第 2 区域标准的固定功率输出进行训练，那么您的训练目标非常狭窄。对其他系统的训练效果非常有限。相反地，

there are other types of training like rucking with a heavy weight on hills where actually you're targeting All four of those elements that requires tremendous stability,
有其他类型的训练，比如在山丘上负重行军，实际上你是在针对需要极大稳定性的这四个要素

moments of strength, large segments of aerobic base or aerobic efficiency and moments of peak aerobic output and even anaerobic output. So that's just something to keep in mind.
力量瞬间，大段有氧基础或有氧效率以及有氧输出高峰瞬间，甚至无氧输出。所以这只是需要记住的一点。

You mentioned at the outset there's a few graphs that you think will be important. I think it'd be a good spot for us to pull them up, which is one looking at the decline of muscle as we age so people can visually see what that looks like,
您一开始提到有几张图表可能很重要。我认为这是一个很好的机会让我们展示它们，其中一张是关于随着年龄增长肌肉减少的情况，这样人们可以直观地看到它的变化。

and then one looking at VO2 max across different age brackets. And so I'll share my screen here and pull them up,
然后看一下不同年龄段的最大摄氧量。所以我会在这里分享我的屏幕并拉出它们。

but I think it will be helpful for people if you kind of talk through them and how you look at it through the lens of this conversation.
但我认为如果你能够通过谈话的方式来解释并从这次对话的角度来看待它，这将对人们有所帮助。

So this is a figure that I fought like crazy to include in Outlive and I got overruled and just kicked in the groin. No way this figure was going in the book so it really makes me happy to be able to show this figure here.
所以这个数字是我拼命争取要包括在《Outlive》中的，但最终被否决了，只能黯然失色。这个数字绝对不可能出现在书中，所以能在这里展示这个数字真的让我很开心。

The figure for those who are not watching, it's basically four graphs and two of them are for men, two of them are for women, two of them demonstrate fat-free mass, which is a great proxy for muscle mass,
那些没有在观看的人，基本上是四个图表，其中两个是男性的，两个是女性的，其中两个展示了无脂肪质量，这是肌肉质量的一个很好的代理

and two of them show spontaneous or deliberate physical activity. In that sense, you can think of it as a two-by-two male-by-female versus activity and fat-free mass. Has kind of an X axis that shows age.
其中两者显示出自发或故意的身体活动。从这个意义上讲，你可以把它看作是一个男性与女性对活动和无脂肪体重的二对二。有一种 X 轴显示年龄的感觉。

OK, so what one notices when they look at this is that fat free mass rises up, so IE lean mass kind of rises. Pretty significantly from birth till about the age of 25 and then it slowly starts to go down.
好的，所以当人们看到这一点时，他们会注意到无脂肪质量在增加，也就是说瘦体重在增加。从出生到大约 25 岁之间，瘦体重显著增加，然后慢慢开始下降。

By the way, this is true for males and females. Males are on the right, females are on the left. So you'll notice that from age 25 to 75, there is indeed a gradual reduction of lean mass.
顺便说一下，这对男性和女性都适用。男性在右边，女性在左边。因此，您会注意到从 25 岁到 75 岁，瘦体重确实逐渐减少。

But then something happens at the age of 75, which is the fall off in lean mass becomes much more significant. It's actually even more noticeable. In men, presumably because they're starting from a higher baseline.
但是在 75 岁时发生了一些事情，也就是瘦体重的减少变得更加显著。实际上，这甚至更加明显。在男性中，可能是因为他们的起点更高。

But this is clearly a curve that has three segments. Birth to 25, where you're gaining, gaining, gaining. 25 to 75, where you're slowly losing. And by the way, we know the numbers. We know that that's actually happening at 8 to 10% per year.
但这显然是一个有三个阶段的曲线。从出生到 25 岁，你在不断增长。25 岁到 75 岁，你在慢慢减少。顺便说一句，我们知道这些数字。我们知道实际上每年以 8 到 10%的速度发生着这种情况。

And then 75 and on, where you fall off a cliff. So, now let's look at the lower figures. The lower figures show physical activity level, and you can see that a very similar trend occurs.
然后是 75 岁，你会从悬崖上掉下去。现在让我们看看更低的数字。更低的数字显示了身体活动水平，你可以看到发生了非常相似的趋势。

It tends to peak a little bit earlier, so it's probably peaking in late teens and early 20s. And interestingly, it doesn't have a huge fall off between the ages of roughly 20 and 75. It actually stays relatively constant.
它往往在较早的阶段达到高峰，所以可能在十几岁末和二十岁初达到高峰。有趣的是，在大约 20 岁到 75 岁之间，它并没有出现明显的下降。实际上，它保持相对稳定。

If anything, it probably dips a touch in middle age. That might have to do when we're at sort of peak work and therefore not as busy physically.
如果有什么的话，可能是在中年时稍微下降了一点。这可能是因为我们在工作的巅峰期，因此在身体上并不那么忙碌。

But again, you notice what happens at the age of 75, which is physical activity level drops like a stone. And of course, this begs the age-old question, which is, which is the chicken and which is the egg?
但再次，你会注意到在 75 岁时发生了什么，即身体活动水平急剧下降。当然，这引发了一个古老的问题，即哪个是先有的，鸡还是蛋？

Because again, there is an unmistakable relationship here between physical activity and muscle mass and age, and something very noticeable happens at the age of 75. Of course, data like these cannot give us causality.
因为再次强调，体力活动、肌肉量和年龄之间存在着明显的关系，在 75 岁这个年龄发生了非常明显的变化。当然，这样的数据不能为我们提供因果关系。

In other words, can't tell us which one's causing the other. But I think anybody who's observed people at this age would come to the conclusion that there is bidirectional causality here.
换句话说，我们无法确定哪一个导致了另一个。但我认为任何观察过这个年龄段的人都会得出结论，这里存在双向因果关系。

In other words, as we lose muscle mass, we become less active, and as we become less active, we lose muscle mass.
换句话说，随着我们失去肌肉质量，我们变得不那么活跃，而当我们变得不那么活跃时，我们失去肌肉质量。

And there's one point that I will make in addition to this, which actually came from a very recent interview I did with Luke Van Loon.
除此之外，我还想补充一点，这实际上是我最近与卢克·范·卢恩进行的一次访谈中得出的。

So that's an episode that you can go back and listen to in great detail if you haven't But Luke made a very interesting point, so interesting that I was scribbling it down as he said it.
所以这是一个你可以回头仔细倾听的剧集，如果你还没有听过的话。但卢克提出了一个非常有趣的观点，有趣到我在他说的时候匆匆记下来。

Which was that data like these were replete with these sorts of data that show population-based reductions in activity of aging individuals always make it look like it's kind of a gradual, continuous curve.
这些数据显示，随着年龄增长，人群活动量逐渐减少，总是让人觉得这是一种渐进的连续曲线。

Even if it happens precipitously, it's still a continuous curve. And what Luke pointed out is, well, actually, that's true at the population level. It's not true at the individual level.
即使它突然发生，它仍然是一个连续的曲线。而卢克指出的是，实际上，在人口层面上是正确的。在个体层面上并不正确。

At the individual level, it is a series of Big, discrete drops. And so when you smooth out thousands of people with big, discrete drops, it looks like a smooth drop.
在个人层面上，这是一系列大的、离散的下降。因此，当你用大的、离散的下降来平滑成千上万的人时，看起来就像是一个平滑的下降。

And what it really comes down to is once you reach a certain age, Even minor setbacks become permanent setbacks. And that's the thing we're going to talk about, but we have to be able to avoid that situation. So I'll give you one example.
事实上，问题的关键在于一旦你到了一定年龄，即使是小小的挫折也会变成永久性的挫折。这就是我们要讨论的问题，但我们必须能够避免这种情况。所以我会给你一个例子。

People have long heard me talk about the idea that once you reach a certain age, like 65, and if you fall and break your hip or femur, the probability of death is really high. I mean, it's in the order of 15% to 30%.
人们长期以来一直听我谈论这样一个观念，即一旦你达到某个年龄，比如 65 岁，如果摔倒摔断了髋部或股骨，死亡的概率就非常高。我的意思是，大约在 15%到 30%之间。

What often gets forgotten there, even though I try to always mention it, is of the survivors, meaning the people who don't go on to die within 12 months, 50% of those people never reach the same level of function again.
在那里经常被遗忘的是，即使我尽力提及，幸存者，也就是那些在 12 个月内没有去世的人，其中 50%的人再也无法恢复到相同的功能水平。

That's an example of why these curves are probably not smooth, but in fact, have these discrete step-offs.
这就是为什么这些曲线可能不是平滑的一个例子，而实际上具有这些离散的阶梯。

And now, do you want to talk in the same way about how you talked with the muscle and activity decline by looking at VO2 max?
现在，您是否想以同样的方式谈论您是如何通过查看最大摄氧量来谈论肌肉和活动下降的？

Yes, so again, apologies for those not watching but rather listening. Again, please take a look at the show notes. But here you can see a table that shows exactly what is happening to VO2 max as we age.
是的，再次为那些没有观看而是在倾听的人道歉。请再次查看节目笔记。但在这里，您可以看到一张表，清楚地显示了随着年龄增长，VO2 max 发生的变化。

Now, the purpose of this table, of course, is to show you something else. The purpose of this table is to show you basically the quartiles of VO2 max by age.
现在，这张表的目的当然是向您展示另一些内容。这张表的目的基本上是按年龄显示最大摄氧量的四分位数。

So the way this table is broken up, is that low, below average, above average, and then high and elite combined represent the four quartiles of VO2 max. The difference is that elite peels off the top 2.3% for each respective age and sex.
因此，这张表的划分方式是低、低于平均、高于平均，然后高和精英结合代表 VO2 max 的四分位数。不同之处在于，精英剥离了每个相应年龄和性别的顶部 2.3%。

And so we could talk about what that looks like, but I think a more important point and the purpose of, I think, showing it here is to give you a sense of how every one of these categories falls.
所以我们可以谈论这是什么样子，但我认为更重要的一点，我认为在这里展示它的目的是让你感受到每一个类别是如何归类的。

In fact, What I think is most illustrative is to just look at the elite category. So again, these are the top 2.3% of the population.
事实上，我认为最具说明性的是仅仅看一下精英类别。因此，这些人口占比仅为顶尖的 2.3%。

So for example, if you look at a woman in her late teens, the top 2.3% would have a VO2 max greater than 53 milliliters of oxygen per kilogram per minute.
因此，例如，如果你看一个十几岁的女性，最顶尖的 2.3%的人的最大摄氧量会超过 53 毫升/千克/分钟。

And you can see that that will fall such that by the time a woman is 80, to be in the top 2.3%, she would have to be greater than 30 milliliters per kilogram per minute.
你可以看到，到一个女人 80 岁时，要成为顶尖的 2.3%，她的数值必须大于每千克每分钟 30 毫升。

But what's interesting is 30 places her in the bottom quartile for the late teens. It would place her at about the 25th percentile for someone in her 20s.
但有趣的是，30 岁的她在晚期青少年中排名倒数第一四分位数。这将使她在 20 多岁的人群中大约处于第 25 百分位数。

So the implication here is that regardless of how fit you are, You can still expect to see a precipitous drop here. And as I've talked about many times, and certainly my patients are probably very sick of hearing this,
因此，这里的含义是，无论您有多健康，您仍然可以预期在这里看到急剧下降。正如我多次提到的那样，我的病人们可能已经听腻了这一点，

the reason we want to see people, if they want to live a completely uncumbered life into the final decade of their life, and that's a big if, not everybody necessarily has that type of an aspiration,
我们想要看到人们的原因是，如果他们想要在生命的最后十年过上完全无拘无束的生活，这是一个很大的假设，不是每个人都一定有这种愿望

but if your aspiration is indeed to basically be able to do what you want, Without limitation, climb a flight of stairs, carry a luggage up a broken escalator, go for a hike,
但是如果你的愿望确实是基本上能够做你想做的事情，没有限制，爬楼梯，把行李拿上坏了的自动扶梯，去远足，

you pretty much need to be two decades younger at the elite level if you're thinking you're going to live to be about 90. So anyway, this hopefully provides some illustration of why that's the case.
如果你认为自己会活到 90 岁，那么在精英层面，你基本上需要年轻二十岁左右。总之，希望这能解释为什么会这样。

Yeah, Peter, I think that's really helpful for people to kind of see and hear and it's almost the why.
是的，彼得，我认为这对人们来说真的很有帮助，他们可以看到、听到，这几乎就是为什么。

So the why you should care about this and why no matter what age you are, no matter how quote-unquote old you are, you really do want to continue to think about this.
所以为什么你应该关心这个问题，无论你多大年龄，无论你被称为多老，你真的应该继续思考这个问题。

And so now we'll get into a lot of what people are probably really curious on is the how. So you've convinced me I need to care about this and I should do it. But, how?
所以现在我们将深入讨论许多人可能真正感兴趣的问题，那就是如何。所以你已经说服我我需要关心这个问题，我应该这样做。但是，怎么做呢？

And so, I think the first question that would be helpful here is, you know, what are the most important aspects of training if you're starting or even returning to exercise in later life? So,
所以，我认为这里会有帮助的第一个问题是，你知道，如果你开始或者在晚年重新开始锻炼，训练中最重要的方面是什么？所以，

this could be people who have never exercised or this could be people who exercise all the way until they were 40, family, life got busy, they took 10, 15, 20 years off and now they want to get back into it.
这些人可能是从未进行过锻炼的人，也可能是一直锻炼到 40 岁的人，家庭、生活变得忙碌，他们休息了 10、15、20 年，现在想重新开始锻炼。

I mean, I think there's a lot that one could say here, but I think you would want to start from the principles of exercise variability and movement quality will always trump volume, load, and intensity.
我的意思是，我认为这里有很多可以说的，但我认为你会想要从锻炼多样性和动作质量的原则开始，这总是比量、负荷和强度更重要。

So I would say that I think most people listening would agree that that's an obvious statement to make for someone who's new to the game. But this is an example of something where I would say that's even true for someone like me.
所以我想说，我认为大多数听众会同意，对于一个新手来说，这是一个显而易见的陈述。但这是一个例子，我会说，即使对于像我这样的人来说，这也是真实的。

I mean, I have a very high training age. That's the term that we use when we're assessing patients to understand how much volume they've done and over what period of time.
我的意思是，我有非常高的训练年龄。这是我们在评估患者时使用的术语，以了解他们已经完成了多少量的训练，以及在多长时间内完成的。

So basically, with the exception of one very bad injury, zero interruption in very high volume of training since the age of 13.
所以基本上，除了一次非常严重的受伤，自 13 岁以来，训练量非常大，没有任何中断。

And yet, as I'm now in my 50s, I realize I need to be much more attentive to these principles of exercise variability and movement quality. The reason is quite simply, I'm much more prone to injury today than I was before. And so,
然而，由于我现在已经 50 多岁了，我意识到我需要更加关注运动多样性和动作质量这些原则。原因很简单，我现在比以前更容易受伤。因此，

I have to think of ways to challenge myself that are not just And that doesn't mean that I don't still push load in complex movements like a deadlift I do, but I'm clearly not going to do nearly as much load or volume in those regards.
我必须想出一些挑战自己的方法，不仅仅是这样。这并不意味着我不再在像硬拉这样的复杂动作中努力，我确实在做，但在这方面我显然不会负担那么多的重量或体积。

And I am going to want to challenge myself, and by saying this of myself, what I'm really saying is everybody should be thinking about this, especially at this age,
我将要挑战自己，通过这样说我自己，我真正想表达的是每个人都应该考虑这一点，尤其是在这个年龄

in terms of, you know, circuit training, exercises where you're doing More than one thing at a time.
就是说，你知道的，循环训练，就是一次做多件事情的练习。

So, an example of this might be that if someone were just starting out, I would want to see them doing more body weight exercises that are slightly more complex movements.
所以，一个例子可能是，如果有人刚开始，我希望看到他们做更多稍微复杂的身体重量锻炼动作。

So, for example, a step back lunge is an important thing for them to be doing even if it's just body weight versus just working on a leg press with heavy weight. So, again,
因此，例如，对于他们来说，后退蹲起是一件重要的事情，即使只是自身体重，而不是只是用重物进行腿部推举。所以，再次，

there's a time and a place for using machines and I think we'll talk about why I think machines are a very good thing for someone starting out because they control the range of motion.
使用机器的时间和地点是有限的，我认为我们会讨论为什么我认为机器对于初学者来说是一件非常好的事情，因为它们控制着运动的范围。

But we must be able to mix that in with more complex movements that are variable in more than one plane. And for those movements, we obviously want to deload them so that we just begin to do the neuromuscular training.
但我们必须能够将这些与更复杂、在多个平面上变化的动作结合起来。对于这些动作，我们显然希望减载它们，这样我们就可以开始进行神经肌肉训练。

With that, let's say a potential patient over 50 coming to you and saying, I want to start exercising. How are you going to start to think about the structure of the programming that you give them?
那么，假设一个 50 岁以上的潜在患者来找你，说我想开始锻炼。你会如何开始考虑给他们的训练计划结构？

Because again, you mentioned like the four pillars and there's different areas you could start. So how do you think about that person just taking that first step to exercise?
因为你提到了四大支柱，可以从不同的方面入手。那么你认为一个人如何才能迈出锻炼的第一步呢？

You know, it always starts with a question that is obvious, but it sometimes is overlooked. And I have to be honest with you, this is something that Even I think I overlooked a lot years ago.
你知道，一切总是从一个显而易见的问题开始，但有时会被忽视。老实说，这是一件连我自己多年前也经常忽视的事情。

And that is you have to come up with something that is realistic for a person because the most important goal when you're returning someone to exercise or when you're starting someone from scratch is you want them to be able to look back in three months and view this as a positive experience.
这就是你必须提出一些对个人来说现实的东西，因为当你让某人重新开始锻炼或者从零开始时，最重要的目标是希望他们能够在三个月后回头看，将这视为一次积极的经历。

Nothing else matters if that is not true. If in three months you've improved them by every objective metric and they hated it or they're injured, well, I just don't know how to view that as a success.
如果这不是真的，那么其他任何事情都无关紧要。如果在三个月内，你通过每一个客观指标都让他们有所进步，但他们却讨厌这一切或者受伤了，那么我真的不知道如何将这看作是成功。

So, people are going to be very different in terms of what their appetite for beginning is, but because we're focusing this discussion on people who are not like me, they aren't lifelong exercisers and therefore,
所以，人们在开始运动方面的胃口会有很大不同，但因为我们把讨论重点放在那些不像我这样一直坚持锻炼的人身上，他们不是终身运动者，因此，

by definition, they're either starting from scratch or maybe coming back to it after a long hiatus, you have to assume that their appetite for training is not going to be 7 days a week, 2 hours a day.
根据定义，他们要么从零开始，要么可能在长时间的休假后回归，你必须假设他们对训练的热情不会是每周 7 天，每天 2 小时。

And therefore, what I really want to focus on is the habit of doing something active daily. And that doesn't mean training every day, but it means at least walking or doing something active.
因此，我真正想要关注的是每天都做一些积极的事情的习惯。这并不意味着每天训练，而是至少要走路或做一些积极的事情。

So you're going to evaluate them based on Their fitness level,
所以你将根据他们的健康水平来评估他们，

their level of conditioning and again at the most extreme level if it's a person who's never done anything and is completely deconditioned it's really going to be about walking and that's about it and it could be as little as 5,000 steps per day every day on relatively flat ground.
他们的训练水平，再次在最极端的水平上，如果是一个从未做过任何事情且完全没有训练的人，那么实际上只能是走路，仅此而已，每天在相对平坦的地面上可能只有 5000 步。

And of course, there's so many ways to progress this. If a person is a little bit more conditioned, I do like to put weight on them out of the gate. I'd like to have them do some rocking.
当然，有许多方法可以进步。如果一个人的体能稍微好一点，我会让他们一开始就加重量。我会让他们做一些摇晃。

We're not talking about putting 60 pounds on their back. It could be 20 pounds on their back, but getting them moving under a little bit of load. Again, there's lots of other things to consider here.
我们不是在讨论让他们背负 60 磅的重量。可能只是让他们背负 20 磅的重量，但让他们在一点负荷下移动。再次强调，这里有很多其他因素需要考虑。

So again, if a person is open to starting with some body weight exercises, That's a very helpful way to begin doing things. It doesn't have to be complicated, right? It could be box squats, wall sits.
所以，如果一个人愿意从一些体重练习开始，那是一个非常有帮助的开始方式。不必复杂，对吧？可以是箱子深蹲，靠墙坐。

Isometric things are much safer for individuals who haven't done conditioning in the past than isotonic movement-based, meaning strength movements where the muscle is changing length.
等长事物对于过去没有进行过调理的人来说要比等张力基础的事物更安全，这意味着肌肉长度在改变的力量运动。

I don't know if you want to talk about more now versus later, but again, I have strong thoughts on how to begin cardio training. We've spent a lot of time talking about the importance of VO2 max.
我不知道你是想现在还是以后谈论更多的事情，但我对如何开始心肺训练有着坚定的看法。我们已经花了很多时间讨论最大摄氧量的重要性。

When we're working with a patient who hasn't done training, we do not do VO2 max workouts. I do not believe in starting people with interval training without building an aerobic base.
当我们与一个没有进行训练的患者合作时，我们不会进行 VO2 max 的训练。我不相信在没有建立有氧基础的情况下就让人们开始间歇训练。

And the aerobic base, of course, that zone 2, you want to start building that in a manner that's consistent with where they're coming from.
当然，有氧基础，也就是那个第二心率区，你希望开始建立它，以符合他们的起点。

So that might just be, again, walking, that could be incline walking, that could be riding a bike, and then even within riding a bike, how do you do that?
这可能只是再次散步，可能是爬坡，可能是骑自行车，甚至在骑自行车时，你要怎么做呢？

Well, if a person doesn't have the lower back flexibility and strength, it might even be on a recumbent bike. As opposed to just a regular stationary bike.
嗯，如果一个人没有足够的下背部柔韧性和力量，甚至可能会选择躺式自行车。而不是普通的固定自行车。

So all of these things are considerations, but again, if you forget everything else, remember the following.
所以所有这些都是需要考虑的因素，但是再次强调，如果你忘记了其他一切，请记住以下内容。

You want to make sure that in three months, they feel better, they notice that they are fitter, and their appetite to exercise has grown. That's the most important thing if you're viewing this both as a participant or as a trainer.
你要确保在三个月内，他们感觉更好，他们注意到自己更健康，他们对锻炼的欲望增加了。如果你把这个当作参与者或教练来看，这是最重要的事情。

Let's continue down that aerobic path that you kind of mentioned there. And so I think the first thing people are curious about is what do we know about the ability to improve aerobic capacity?
让我们继续沿着你提到的有氧运动的道路前行。我认为人们最感兴趣的第一件事是我们对提高有氧能力的了解有多少？

Is that something that can be improved in someone who is older and untrained?
那是可以在年长且未经训练的人身上改善的吗？

Yeah, and that's to me the most amazing part of this is how malleable that system is. In fact, I think you could make the case that the physical system, so aerobic capacity, strength, is even more malleable than our cognitive systems.
是的，对我来说，这个系统最令人惊讶的部分是它的可塑性。事实上，我认为你可以提出这样的观点，即身体系统，如有氧能力、力量，甚至比我们的认知系统更具可塑性。

And we know that our cognitive systems are quite malleable.
我们知道我们的认知系统是非常具有可塑性的。

Again, I didn't want to load this With too many stats and studies, but I think this one is worth mentioning and obviously we can, in the show notes, give you all the granular detail.
再次强调，我不想在这里加载太多的统计数据和研究，但我认为这个值得一提，显然我们可以在节目注释中为您提供所有细节。

But one study that really jumped out to our team here was looking at percent improvement in healthy older people and healthy younger people. So, there was a study that did a 6-week aerobic exercise.
但是，有一项研究引起了我们团队的极大关注，该研究着眼于健康老年人和健康年轻人的改善百分比。因此，有一项进行了为期 6 周的有氧运动的研究。

They used cycling training program to assess changes in VO2 max, oxygen consumption, of course, workload and endurance. Now, in the older group, these people averaged 80 years of age.
他们使用骑行训练计划来评估 VO2 max、氧气消耗、工作量和耐力的变化。现在，在年长的群体中，这些人的平均年龄为 80 岁。

In the younger group, the people averaged 24 years of age. Couldn't be further apart.
在年轻群体中，人们的平均年龄为 24 岁。无法再远了。

And yet, in both groups, there was about a 13% improvement in VO2 max, a 34% improvement in maximal workload, so that's basically how many watts could you hit, and then a 2.4 fold improvement in endurance capacity.
然而，在两组中，最大摄氧量均提高了约 13％，最大工作量提高了 34％，这基本上是你能达到多少瓦特，耐力容量提高了 2.4 倍。

I found this staggering and I would not have predicted this prior to seeing this study. Now, of course, I want people to understand that the absolute levels of all of these things were significantly higher in the 24-year-olds.
我发现这令人震惊，之前看到这项研究之前我无法预测到这一点。现在，当然，我希望人们明白，所有这些事物的绝对水平在 24 岁的人中显著更高。

That's a given. They put out more watts, they have a higher VO2 max, etc. What we're talking about here is the malleability of the system.
这是理所当然的。它们输出更多瓦特，拥有更高的最大氧耗量等等。我们在这里讨论的是系统的可塑性。

What we're talking about here is how much could individuals improve in 6 weeks and the answer is they both improved dramatically. And I should point out something else.
我们讨论的是个人在 6 周内能够取得多大进步，答案是他们都有显著的进步。我还应该指出另一点。

This particular study followed the six-week training cycle that I just described with an eight-week deconditioning period. And what's worth pointing out here is that the older group declined much faster than the younger group.
这项研究遵循了我刚刚描述的为期六周的训练周期，接着是为期八周的脱适应期。这里值得指出的是，老年组的下降速度比年轻组快得多。

So both groups were able to see significant gains, but the older you were, the quicker you lost those gains with inactivity.
因此，两组都能够看到显著的收益，但年龄越大，不活动时失去这些收益的速度就越快。

Yeah. And so that speaks to what you mentioned earlier, which is the consistency.
是的。这就涉及到你之前提到的一致性。

So if someone starts and they do something for three months and they don't enjoy it, and so they drop off again, it's not like they're just going to stay at that level. That level is going to drop back down.
所以如果有人开始做某事，坚持了三个月却并不喜欢，于是再次放弃，那并不意味着他们会一直停留在那个水平。那个水平会再次下降。

And so being consistent is almost more important than how high you start.
因此，保持一贯性几乎比你起点有多高更重要。

That's right. You can't overstate this analogy of compounding. If anybody really just wants to understand how compounding works,
这是正确的。你无法过分强调复利的这个类比。如果有人真的想要理解复利是如何运作的，

just pull open Excel and build a very simple formula that shows what happens if something compounds at 2% per month or 1% per month or something like that. I mean, it becomes so nonlinear, our brains can't comprehend that.
只需打开 Excel 并构建一个非常简单的公式，显示如果某物以每月 2%或每月 1%的速率复利会发生什么。我的意思是，它变得如此非线性，我们的大脑无法理解。

And of course, I'm not suggesting that the gains in exercise will compound at that intensity, but the idea of how much fitter you can be after years of doing something. This is another point I want to make,
当然，我并不是在暗示运动的收益会以那种强度复利增长，但是想象一下多年坚持做某件事后你可以变得更加健康的想法。这是我想表达的另一个观点。

which is if you look at a lot of the literature in VO2 max training, you know, it suggests that people are capable of improving their VO2 max by 13%, like that study I just quoted.
如果你看一下很多关于最大摄氧量训练的文献，你会发现，它表明人们有能力通过提高他们的最大摄氧量来提高 13%，就像我刚引用的那个研究。

And so a lot of people hear that and they look at the table that I showed earlier and they say, well, I just had my VO2 max tested and I was at the 50th percentile. There's no way I'm gonna get to the top 2% of someone two decades younger.
因此，很多人听到这个消息后看了我之前展示的表格，他们说，我刚刚测试了我的最大摄氧量，结果在 50%的百分位。我怎么可能达到比自己小两十年的人群中顶尖 2%的水平呢。

That would require literally increasing my VO2 max by 80%. And this study showed that it could only happen 13%. To which I say, yeah, that study was six weeks long.
这需要将我的最大摄氧量实际上提高 80%。这项研究显示只能提高 13%。我想说，是的，那项研究只持续了六周。

When we give our patients these audacious goals, We talk about these as two and three-year goals. So it's very important to understand that whatever we're talking about here, we're talking about over a very long period of time.
当我们向患者设定这些大胆的目标时，我们将这些目标定为两到三年的目标。因此，非常重要的是要理解，无论我们在这里谈论什么，我们都是在讨论一个非常长的时间段。

What I was going to say too, with that long game on VO2 max, as we saw earlier, that elite category also drops. So if you're 40, it's not like your elite category is the same when you're 70.
我也要说的是，随着我们早些时候看到的那种长时间的 VO2 max 游戏，精英类别也会下降。所以，如果你已经 40 岁了，你的精英类别并不会和你 70 岁时一样。

So if you are making that progress and you are increasing, just as you age, the categories are also going to decrease. So you're just naturally going to move up as long as you're maintaining. So it's an interesting way to think about it.
所以，如果你正在取得进步并且在增长，就像你的年龄一样，类别也会减少。只要你保持下去，你就会自然而然地向前迈进。这是一个有趣的思考方式。

I have all of these crazy goals as you know and one of them is like what's the oldest I can be such that my VO2 max in milliliters per kilogram per minute exceeds my age. Clearly at some point that will cease to be true.
我有很多疯狂的目标，你知道的，其中之一就是，我能活到多大岁数，以至于我的每公斤每分钟的最大摄氧量（VO2 max）超过我的年龄。显然，在某个时候，这个说法将不再成立。

There's no 80-year-old whose VO2 max is 80. So the question is like where does that happen? And I think that's a really great heuristic for the health of a person is, does that happen when you're 30? You hope not.
没有 80 岁的人的最大摄氧量是 80。所以问题就像是在哪里会发生呢？我认为这是一个非常好的健康启发法则，一个人的健康状况是否会在 30 岁时发生这种情况？希望不会。

If a 30-year-old's VO2 max falls below 30, there's a huge problem. Does it happen when you're 40? That's probably where it happens for most people.
如果一个 30 岁的人的最大摄氧量低于 30，那就有很大问题了。你 40 岁时会发生吗？这可能是大多数人发生的年龄。

Can you push that to 50? Can you push that to 60? So again, the only way to start to play that game is to basically get in shape and stay in shape.
你能把它推到 50 吗？你能把它推到 60 吗？所以，再次，开始玩这个游戏的唯一方法就是保持身体健康并保持身体健康。

So on that, let's look at cardio training first and say, how would you put someone on a program to help on the cardio side?
那么，让我们首先看看有氧训练，问一下，你会如何制定一个有助于有氧训练的计划？

Once we've established that a person has the basics, they're not immediately injured, they've got the ability to start doing some cardio training, I like to really start with base building.
一旦我们确定一个人掌握了基本知识，没有立即受伤，有能力开始进行一些有氧训练，我喜欢真正从基础打好基础开始。

Even for someone like me who trains a lot, remember, 80% of my training volume is at zone 2. Only 20% of my training volume is in that VO2 max range.
即使对于像我这样经常训练的人来说，要记住，我的 80%训练量是在 2 区。只有 20%的训练量在 VO2 max 范围内。

And again, I've said this before, but it's always worth reiterating, understand that I am not training for anything other than the sport of life.
再次强调一下，我以前说过这句话，但值得重申的是，要明白我训练的目的不是为了别的，而是为了生活的运动。

If I were still training to be an athlete, if I were still training to be a cyclist, I would have to do something very different than what I'm stating.
如果我还在训练成为一名运动员，如果我还在训练成为一名骑行者，我将不得不做一些与我现在所说的非常不同的事情。

What I'm stating is far less intensive than someone who's trying to be a master's level athlete in pick your endurance sport. So now we're talking about a person who's new to this. What are we going to do?
我所说的远不及那些试图成为某项耐力运动的大师级运动员的人那么强烈。所以现在我们谈论的是一个新手。我们要怎么做呢？

I would be really happy if I could get them to start two days a week, 30 minutes a time. If I took a person who is relatively fit and we did two times a week at 30 minutes per session, they're not going to improve enough.
如果我能让他们每周开始两天，每次 30 分钟，我会感到非常高兴。如果我找一个相对健康的人，我们每周做两次，每次 30 分钟，他们不会有足够的改善。

They're going to experience no improvement. If I reduced my training volume to that level, I would probably go backwards.
他们不会有任何进步。如果我把训练量减少到那个水平，我可能会倒退。

But you have to remember, when you're starting with a person who's very deconditioned, they will actually see a training benefit at such low volume. So, I'm not going to throw them in 3-hour, 4-hour a week training.
但你必须记住，当你开始与一个非常不适应的人合作时，他们实际上会在如此低的强度下看到训练效果。因此，我不会让他们进行每周 3 小时、4 小时的训练。

We're going to start them much lower. Now, the question I get asked all the time is how do you help that individual calculate where their zone 2 is? And this is worth spending some time on.
我们将从更低的水平开始。现在，我经常被问到的问题是，你如何帮助个人计算他们的第 2 心率区在哪里？这值得花一些时间来解释。

Again, for folks who want a bit of a primer, when we talk about zone 2, we are not talking about the same zone 2 that shows up on your Polar Heart Rate or your Apple Watch or whatever other device you're talking about.
再次，对于想要一点入门知识的人来说，当我们谈论第 2 区时，我们并不是在谈论出现在您的极地心率监测仪、苹果手表或其他任何您提到的设备上的相同第 2 区。

We're talking about a very specific mitochondrial level of zone 2 and it's referring to the highest level of work that you can do while keeping lactate at effectively an indefinite steady state,
我们正在谈论的是非常具体的线粒体第 2 区的水平，它指的是在保持乳酸处于有效无限稳定状态的情况下，您可以做的最高水平的工作，

which for most people tends to be below 2 millimeters. So, once you're exercising and lactate gets above 2, you're probably not going to be able to sustain that for a couple of hours, which is effectively what we're talking about here.
对大多数人来说，这个数值往往低于 2 毫米。所以，一旦你开始运动，乳酸浓度超过 2 毫米，你可能无法持续几个小时，这实际上就是我们在这里讨论的内容。

Because metabolically, you are going to move to an area where you're generating too much hydrogen along with too much lactate and the muscles are going to be compromised.
因为在代谢上，你将会进入一个区域，产生了过多的氢气和过多的乳酸，肌肉将会受到损害。

So, if you really want the gold standard for measuring zone 2, you got to be kind of checking lactate levels, and I don't really advocate that for people, especially if they're starting out.
所以，如果你真的想要衡量第二心率区的黄金标准，你必须要检查乳酸水平，但我并不推荐这样做，特别是对于刚开始运动的人。

I do it, but I'm probably an outlier here because I enjoy that level of precision. So, what I do recommend is two ways to be thinking about this.
我这样做，但我可能是一个离群值，因为我喜欢那种精确度。所以，我建议的两种思考方式是这样的。

The first is on the rate of perceived exertion, which I've talked about at length in the past, and that is the talk test. So,
第一个是关于感知努力率的问题，我过去已经详细讨论过了，那就是谈话测试。所以，

and I've even posted a video I think somewhere that we can probably link to in the show notes showing people what I look like when I'm in zone 2 and what my difficulty in speaking is. We'll link to that so people understand.
我甚至已经发布了一个视频，我认为我们可能可以在节目注释中链接到，展示了我在 2 区时的样子以及我说话困难的情况。我们会链接到那个视频，让人们了解。

But because I know that people really like a little more guidance than that, I think using Phil Maffetone's MAP formula, Maximum Aerobic Performance, I think is what MAP stands for, but it's 180 minus your age.
但是因为我知道人们确实喜欢比那更多的指导，我认为使用菲尔·马菲通的 MAP 公式，最大有氧性能，我认为 MAP 代表什么，但是是 180 减去你的年龄。

It's a target heart rate and then if you're really new to the thing, which again is the audience we're now talking about, you might even subtract 10 from that. is gonna potentially be as low as 110 beats per minute at a target.
这是一个目标心率，如果你是真正的新手，也就是我们现在谈论的受众，你甚至可以从中减去 10。目标心率可能会低至每分钟 110 下。

And as they get fitter, that's probably gonna go a little bit higher. Now, I wanna point out that you don't wanna be too wed to this as you get more and more involved in your training.
随着他们变得更加健康，这个数字可能会略微上升。现在，我想指出的是，随着你在训练中变得越来越投入，你不想对此过于执着。

Because the fitter you get, I think the more variability you'll experience based on recovery. So my Maffetone formula would have my heart rate be 129, okay? Well, I can tell you, 129 is never in zone 2 for me except on the worst day,
因为你变得更加适应，我认为你会根据恢复情况经历更多的变化。所以根据我的马菲通公式，我的心率应该是 129，好吗？嗯，我可以告诉你，对我来说，除非是最糟糕的一天，129 从来不是我的 2 区心率。

maybe once Every two months, I might have a zone 2 based on lactate where my actual heart rate ends up being 129. It's almost always going to be in the high 130s and sometimes in the low 140s. So as you get more conditioned,
也许每两个月一次，我可能会有一个基于乳酸的 2 区，我的实际心率最终会达到 129。它几乎总是会在 130 多一点，有时会降到 140 多一点。所以随着你变得更有条件。

the formula may be less and less valuable and you will rely more and more on RPE or if you really want to take it to the next level, you might even start using lactate.
这个公式可能会变得越来越不那么有价值，你会越来越依赖于 RPE，或者如果你真的想把它提升到下一个水平，甚至可能开始使用乳酸。

Final point I say on this, even if a person is deconditioned, we will not use lactate on them. Because an individual that's coming in who's metabolically unhealthy tends to have very high resting lactates.
最后一点我要说的是，即使一个人失去适应性，我们也不会给他们使用乳酸。因为一个新来的代谢不健康的个体往往有非常高的静息乳酸。

In fact, there were people walking around with a lactate of two millimole at rest. Clearly, in that person, using lactate provides no value and you should rely on heart rate and RPE.
事实上，实际上有人在休息时乳酸浓度为 2 毫摩尔。显然，在这种情况下，使用乳酸没有任何价值，您应依靠心率和 RPE。

In that person, let's say they're doing two days a week, 30 minutes a day, how long do you like to see that consistency before you slowly increase either the duration or the number of days?
在那个人身上，假设他们每周做两天，每天 30 分钟，您希望看到持续多长时间后，才会逐渐增加持续时间或天数？

In part, it comes down to what we talked about, which is how do they feel? You know, I almost want to inspire within them an appetite to do a little bit more. I mean, this sounds silly, but when you're starting out some of this stuff,
在某种程度上，这取决于我们谈论的内容，也就是他们的感受如何？你知道，我几乎想激发他们内心的渴望多做一点。我的意思是，这听起来有点傻，但当你刚开始接触一些东西时，

a lot of it is just the growing pains of being able to sit on a bike and your butt doesn't hurt or being able to walk on a treadmill and making sure that their knees aren't aching or things like that.
很多时候只是在适应骑自行车时屁股不疼，或者在跑步机上行走时确保膝盖不疼痛之类的成长阵痛。

I would say within 8 weeks to 12 weeks I would want to start pushing frequency and or duration and I don't think there's a right answer here and if there is I'm sure someone will comment.
我会说在 8 到 12 周内，我想开始增加频率或持续时间，我认为这里没有一个正确的答案，如果有的话，我相信会有人评论。

I like to push frequency before I push duration so I'd almost rather go from 2 to 3 to 4 sessions at 30 minutes before we start going to 45 but eventually I'm going to want the sessions to be at least 45 minutes each.
我喜欢先增加频率，然后再增加持续时间，所以我宁愿从 30 分钟的 2 次到 3 次再到 4 次，而不是直接从 30 分钟增加到 45 分钟，但最终我希望每次训练至少持续 45 分钟。

On the other side of cardiorespiratory, VO2 max. Before we get into how you start to build that in for people, we do have a few other graphs here that I think are insanely helpful in looking at why VO2 max is so important as people age.
在心肺功能的另一方面，最大摄氧量。在我们开始为人们建立这一能力之前，我们有几张其他图表，我认为这些图表在看待随着年龄增长最大摄氧量为何如此重要方面非常有帮助。

And so I'll pull them up here, but do you want to kind of talk viewers and listeners through this side of it as well?
所以我会把它们拉到这里，但你想要通过这一方面与观众和听众进行交流吗？

Yeah, this was a graph that I was able to get into the book. I fought hard for this one because, boy, nobody wanted this one in a book and I can understand why. It requires some explanation.
是的，这是一张我设法放进书里的图表。我为这个图表奋战良久，因为，天哪，没有人想把这个放进书里，我能理解为什么。这需要一些解释。

So, this is a figure that shows the hazard ratio of various comorbidities and performance subgroups. So, again, what's a hazard ratio? Well, it gives you an estimate of relative Risk.
这是一个显示各种合并症和表现亚组的危险比的图表。那么，危险比是什么呢？它给出了相对风险的估计。

So let's start with the comorbidities because I think that's easier to understand. So if a person is a smoker, are they at increased risk? And in this case, the risk is all-cause mortality.
所以让我们先从合并症开始，因为我认为这更容易理解。所以如果一个人是吸烟者，他们是否面临增加的风险？在这种情况下，风险是全因死亡率。

Are they at an increased risk of death from all causes? I think anybody would understand the answer. That question is obviously yes. The question is how much?
他们是否面临更高的死亡风险？我想任何人都会明白答案。这个问题显然是肯定的。问题是有多大？

And in this analysis, if you compare a smoker to a non-smoker and ask the question, what is the probability of that smoker dying? In the coming 12 months from any and all causes, the answer is it's 41% greater than the non-smoker.
在这项分析中，如果你将吸烟者与非吸烟者进行比较，并提出这样一个问题：这位吸烟者在接下来的 12 个月内死亡的概率是多少？从任何原因来看，答案是比非吸烟者高出 41%。

Kind of makes sense. What if you take two people, one with coronary artery disease, known CAD, and the other without? Well, it's about a 29% difference in all-cause mortality. 29% greater risk, I should say, if I'm going to be more accurate.
有点说得通。如果你拿两个人，一个患有冠状动脉疾病，即已知的 CAD，另一个没有？嗯，总体死亡率相差大约 29%。如果我要更准确的话，应该说是 29%更高的风险。

What about somebody with type 2 diabetes? Well, again, it's a 40% greater risk of all-cause mortality in the coming year. High blood pressure, 21%.
患有 2 型糖尿病的人怎么样呢？再次提醒，未来一年内所有原因死亡的风险增加了 40%。高血压为 21%。

End stage renal disease, so somebody who's on dialysis awaiting kidney transplant, a whopping 178% increase in all-cause mortality.
晚期肾病，即正在透析等待肾移植的患者，所有原因死亡率激增 178%。

So now what we do is we do the same mortality analysis on that massive cohort of people for whom we have VO2 max data. So these are the data that we showed earlier where we looked at people in those quartiles.
现在我们要做的是对那些我们拥有最大摄氧量数据的大量人群进行相同的死亡率分析。这些是我们之前展示的数据，我们在那些四分位数中观察了人群。

And so what I do every time I run a patient through their VO2 max the first time is I figure out where they are, say somebody shows up in the below average camp. So that means they're in the 25th to 50th percentile for their age.
所以每次我第一次测试一个患者的最大摄氧量时，我都会弄清楚他们的水平，比如有人的水平处于低于平均水平的范围。这意味着他们的水平在同龄人中处于 25%到 50%的百分位数。

I say, look, if you just go from below average to above average, right, if I were just to compare you from your level at the 25th to 50th percentile to someone who's in the 50th to 75th percentile,
我说，看，如果你只是从低于平均水平提升到高于平均水平，对吧，如果我只是把你从第 25 到 50 百分位的水平与处于第 50 到 75 百分位的人进行比较，

the hazard ratio is 1.41. In other words, you are 41% more likely to die in the coming year than somebody who is that much fitter than you.
危险比为 1.41。换句话说，您明年死亡的可能性比比您健康得多的人高出 41%。

And by the way, it's not lost on anybody that that's the exact same hazard ratio of a smoker to a non-smoker. That's how big the difference is.
顺便说一句，任何人都不会忽视这一点，这正是吸烟者与非吸烟者的准确危险比率。这就是差距有多大。

And if you want to go from below average to high, so now you're going from, say, the second quartile to the third quartile, it's a 100% difference in risk. It's a doubling of the risk of death for that coming decade.
如果你想从低于平均水平提升到高水平，比如说，从第二四分位数提升到第三四分位数，风险就会增加 100%。这意味着在接下来的十年里，死亡风险会翻倍。

I won't go through the rest of these numbers here, but they're all staggering. And by the way, even just going high to elite, 29% difference in relative risk.
我不会在这里详细介绍其余的数字，但它们都令人震惊。顺便说一句，即使只是从高到精英，相对风险有 29%的差异。

When I talk about how VO2 max is the single most important biomarker we have for lifespan, these are the data from which I make that claim. There are obviously other data that are identical to this on different cohorts.
当我谈论 VO2 max 是我们寿命中最重要的生物标志时，这些数据就是我提出这一说法的依据。显然，不同群体的其他数据也与此相同。

But the point is, there aren't other biomarkers that will give you hazard ratios of this magnitude. Now, people often ask, why is that the case? And I think the answer is that VO2max is probably a remarkable integrator of work.
但关键是，没有其他生物标志物会给出这种程度的危险比率。现在，人们经常问，为什么会这样？我认为答案是最大摄氧量可能是一种非凡的工作整合者。

So it is Not a biomarker that changes quickly and easily to the magnitudes required to do this. You're not going to take your VO2 max from low to elite in a year. You can do it.
因此，这不是一个可以迅速轻易改变到所需的程度的生物标志物。你不可能在一年内将你的最大摄氧量从低水平提升到精英水平。你可以做到。

I would argue you absolutely can do it, but it's not going to happen in a year. And therefore, when it happens, it's going to reflect an astronomical volume of work that has been done.
我认为你绝对可以做到，但这不会在一年内发生。因此，当它发生时，将反映出已经完成的大量工作。

And the benefits of that work are what are being captured in the VO2 max number.
那项工作的好处就体现在 VO2 max 数值中。

That's kind of the lifespan side. I'm going to pull up the other graph here, which is more so on the health span side. And I think this was also in your book, but when you kind of combine all three of these VO2 max figures,
这有点是寿命方面。我要在这里展示另一个图表，更多地涉及健康寿命方面。我认为这也在你的书中提到过，但当你将这三个最大摄氧量数据结合起来时，

the first one we looked at, which is the bracket and the breakdown, how it compares to different diseases. And then this one kind of paints a really good holistic picture. And so do you want to walk listeners, viewers through this as well?
我们看的第一个是括号和分解，它与不同疾病的比较。然后这个有点像描绘了一个非常全面的画面。那么你想要向听众、观众解释一下这个吗？

Yeah, this is another figure that we show our patients all the time. Actually, we're probably building another one of this because there's a couple issues I have with this figure.
是的，这是我们经常向患者展示的另一个图表。实际上，我们可能会再建立一个这样的图表，因为我对这个图表有一些问题。

Namely, it stops at the age of 75. So I want to see this data extended to another two decades. And I realize that it's harder and harder to get those data, but I think we can estimate them.
也就是说，它停留在 75 岁。所以我希望看到这些数据延长到另外两个十年。我意识到越来越难获取这些数据，但我认为我们可以估算它们。

What this figure shows is really the other bookend of why we want a high VO2 max. So the figure above and the discussion I just had a moment ago makes it abundantly clear that if you want to live a long life, You better have a high VO2 max.
这个数字显示的实际上是我们为什么想要高 VO2 最大值的另一端。所以上面的图表和我刚才讨论的内容清楚地表明，如果你想活得长久，你最好有一个高的 VO2 最大值。

This figure says if you want to live a good life, you better have a high VO2 max because this gives you a very clear all-in-one view of what actually happens as your VO2 max declines. You lose capacity.
这个数字表示，如果你想过上美好的生活，最好拥有较高的最大摄氧量，因为这将为你提供一个非常清晰的全方位视角，展示了随着你的最大摄氧量下降实际发生的情况。你会失去能力。

So, the graph has a lot of information on here, but it can basically be distilled down into the following. You have three curves for the purpose of illustration.
因此，这张图上有很多信息，但基本上可以归纳为以下内容。为了说明，您有三条曲线。

You have people in the top 5%, people right at the middle of the pack, and people in the bottom 5%, so those are the green, black, and red curves respectively.
你有处于前 5%的人，处于中间水平的人，以及处于最低 5%的人，分别对应绿色、黑色和红色曲线。

By the way, for anybody paying attention, these data are pulled from a different data source than the previous data. I don't think this is as rigorous a data set and therefore the numbers don't line up completely.
顺便说一句，对于任何留意的人来说，这些数据是从不同的数据源提取的，而不是之前的数据。我认为这不是一个严谨的数据集，因此数字并不完全吻合。

So the 50th percentile here is not the 50th percentile elsewhere, but for the purpose of illustration, not important. The x-axis is time, of course.
因此，这里的 50th 百分位数并非其他地方的 50th 百分位数，但为了说明，这并不重要。当然，x 轴是时间。

So as age marches along, You are watching a reduction in VO2 max, which is the y-axis, for all curbs. So again, observation number one is, it doesn't matter how fit you are, your VO2 max is going down, down, down.
随着年龄的增长，您会看到所有曲线的最大氧耗量（VO2 max，y 轴）在减少。因此，第一个观察结果是，无论您有多健康，您的最大氧耗量都在不断下降。

Again, as I said, the problem with this graph, at least one of the problems is stops at the age of 75. And unfortunately, that deprives a patient from seeing that the curve doesn't continue along the trajectory of what came before it,
再次，正如我所说，这张图的问题之一是停在了 75 岁。不幸的是，这使患者无法看到曲线并没有沿着之前的轨迹继续下去。

it actually gets steeper. And so what you realize pretty quickly is that depending on where you want to be, and that's demonstrated by the activities on the right, You're gonna need to be pretty high to avoid the fall.
事实上，它实际上变得更陡峭。因此，您很快意识到，取决于您想要去哪里，这是由右侧的活动所证明的，您需要相当高的位置才能避免摔倒。

So what it's showing you is, hey, if you wanna be able to run 10 miles an hour on flat ground, you need a VO2 max in the mid to high 50s. If you wanna be able to run six miles an hour, which is a 10 minute mile,
所以它向你展示的是，嘿，如果你想在平地上跑 10 英里每小时，你需要一个在中到高 50 的 VO2 最大值。如果你想跑 6 英里每小时，也就是每英里 10 分钟，

up a very steep hill, you need to have a VO2 max of 50. And as you walk down this list, you see that the VO2 max requirement goes down as the aspiration goes down.
爬一个非常陡峭的山坡，你需要有 50 的最大摄氧量。当你走下这个清单时，你会发现最大摄氧量的要求随着愿望的降低而降低。

The point that isn't really clear on this curve is at what point does the VO2 max become sort of rate limiting for activities of daily living and that's in the high teens approximately.
这条曲线上并不太清晰的一点是，VO2 max 何时成为日常生活活动的一种速率限制，大约在高十几岁左右。

So once the VO2 max is into the high teens, we would say that you are now going to be limited in what you can do from an activity of daily living standpoint.
所以一旦最大摄氧量达到高十几岁，我们会说你现在在日常活动方面的能力将受到限制。

Having studied these types of data for a very long time, I know that for myself personally, and by the way, this tends to be true for most of our patients when we put them through the centenarian decathlon exercise, most people,
研究了这些类型的数据很长一段时间后，我知道对于我个人来说，顺便说一句，当我们让大多数患者参加百岁老人十项全能运动时，大多数人都会发现，

at least based on what they're telling you they want to be able to do in the last decade of their life, are going to require a VO2 max of about 30, so high 20s to 30 in the final decade of their life.
根据他们告诉你的，他们希望在生命的最后十年能够做到的事情，将需要达到大约 30 的最大摄氧量，所以在生命的最后十年中应保持在高 20 到 30 之间。

And I mean, Nick, when you look at that, what's your takeaway if I'm telling you you need a VO2 max of 30 if you're 90?
我是说，尼克，当你看到这个时，如果我告诉你，如果你是 90 岁，你需要一个 VO2 最大值为 30，你的理解是什么？

Yeah, you better be in the 95th percentile and above along the way.
是的，你最好在路上保持在 95 分位数及以上。

You have to be higher, right? Because the people on this graph who have a VO2 max of 30 at age 75 are gonna be lower than that at the age of 90. So yeah, you have to be way above the top of the green curve at the outset.
你必须要更高，对吧？因为在这张图上，那些在 75 岁时 VO2 max 为 30 的人，在 90 岁时会比这个更低。所以是的，你必须要远远高于绿色曲线的顶端。

So again, like I know people hear me say, and you've alluded to this, that, oh, Peter, he's just being kind of extreme, blah, blah, blah, blah, blah. No, no, no, I'm not being extreme. The data are right in front of us here.
所以，就像我知道人们听到我说的那样，你也提到过，哦，彼得，他只是有点极端，啦啦啦，不，不，不，我并不是在极端。这里的数据就在我们面前。

If you wanna be able to be completely unencumbered in the last decade of your life, You need to have a very high level of fitness when you're in midlife. And if you don't, that's okay. You have time to do it, but don't wait too long.
如果你想在生命的最后十年完全没有负担，你需要在中年时拥有非常高的健康水平。如果没有，也没关系。你还有时间去做，但不要等太久。

Yeah, it kind of is one of those things where it's like we often joke, does everyone need to measure their lactate two times every workout? Probably not. That might be you on like the heavy data side.
是的，有点像是那种我们经常开玩笑的事情，每次锻炼都需要测量乳酸吗？可能不需要。这可能是你在数据方面比较严谨的一面。

But looking at VO2 max, if you want to be able to do those things, that's not like you're measuring lactate every day. That's just a black and white fact kind of written in stone.
但是从最大摄氧量来看，如果你想要做到那些事情，那并不像每天都在测量乳酸一样。那只是一种黑白分明、铁板钉钉的事实。

Yep. You should talk about how you can train for VO2 max, but yeah, you don't need the devices to do this, even though I like using devices.
是的。你应该谈论如何训练 VO2 max，但是是的，你不需要设备来做到这一点，尽管我喜欢使用设备。

Well, that's actually where we're going next, which is when do you start when someone is starting to train or getting back into it? You mentioned you'll start them in the zone 2 a few days a week.
好的，这实际上是我们接下来要讨论的内容，也就是当有人开始训练或重新开始训练时应该从何时开始？你提到你会让他们每周进行几天的 2 区训练。

Obviously, zone 2, two days a week, 30 minutes is a lot different than a VO2 max exercise, which can take a lot more. So how do you have Your patients in that age bracket 50 and plus, when do you have them start training for VO2 max?
显然，区域 2，每周两天，30 分钟与最大摄氧量锻炼有很大不同，后者可能需要更多时间。那么，您如何让 50 岁及以上年龄段的患者开始进行最大摄氧量的训练呢？

How do you have them start training? How do you think about that?
你是如何让他们开始训练的？你对此有什么想法？

So a couple of things. One, the wider the base, the higher the peak. So I want to build a reasonable aerobic base before I start pushing VO2 max. And by the way, you do experience increases in VO2 max just from base building aerobic activity.
所以有几件事情。首先，基础越宽，峰值就越高。所以在开始推动最大摄氧量之前，我想先建立一个合理的有氧基础。顺便说一句，通过建立有氧基础活动，你确实会经历最大摄氧量的增加。

So, if you take a person who's completely deconditioned and you put them into just a zone 2 program and you slowly add duration and frequency to that and then you retest their VO2 max,
所以，如果你把一个完全失去适应能力的人放入一个仅仅是第 2 心率区的训练计划中，然后慢慢增加持续时间和频率，然后重新测试他们的最大摄氧量，

it'll be higher even if they have never done a single interval. But ultimately, to really start to boost VO2 max, you are going to need to add more intense movement.
即使他们从未进行过任何间隔训练，这个数值也会更高。但最终，要真正开始提高最大摄氧量，你需要增加更强烈的运动。

I think that the easiest way to do that and the way we typically do it with our patients in a really detrained individual or untrained individual is just to add a little bit of interval training to the zone 2 workout. So for example,
我认为最简单的方法，也是我们通常与患者一起做的方法，对于一个真正训练有素或未经训练的个体来说，就是在第 2 心率区训练中加入一点间歇训练。例如，

if a person is doing their zone 2 on a treadmill and let's say you've got them walking 3 miles an hour and after a few months, they can handle 3 miles an hour at 4% or 5% incline, you say, great,
如果一个人在跑步机上进行他们的第 2 心率区训练，假设你让他们以每小时 3 英里的速度行走，几个月后，他们可以在 4%或 5%的坡度上应对每小时 3 英里的速度，你会说，太棒了，

I want you to finish the workout doing five one-minute quote-unquote bursts where you increase the slope from 5% to 10%. And you're just going to do it for a minute. It's going to really tire them out.
我希望你在锻炼结束时做五次一分钟的所谓“爆发”，在这期间你将坡度从 5%增加到 10%。你只需要坚持一分钟。这将让他们真正筋疲力尽。

You do a minute on and take a minute off, a minute on, take a minute off. So you start to get them used to increasing the intensity.
你做一分钟，休息一分钟，一分钟工作，一分钟休息。这样你开始让他们逐渐适应增加强度。

This also becomes a chance to assess, is this going to be something they can do safely or are they going to completely deteriorate in form? I'll give you an example of something I used to do.
这也成为评估的机会，他们是否能够安全地做这件事，还是会完全失去形态？我会举一个我过去常做的例子。

So I used to do What I think is looking back, I'm lucky I never got injured, but I used to do some really stupid things for VO2 max training that I think put me at two greater risk for injury. Deadlift Tabatas.
所以我过去做过我认为回头看很幸运我从未受伤，但我过去为了提高最大摄氧量而做了一些真的很愚蠢的事情，我认为这让我面临更大的受伤风险。硬拉塔巴塔。

So, you know, I would put 225 pounds on a bar and see how many reps I could do in 20 seconds, take 10 seconds off and repeat that 8 times. Now, did that do a lot for my VO2 max? Oh, you can bet it did.
所以，你知道，我会在杠铃上放上 225 磅，看看我在 20 秒内能做多少次重复，休息 10 秒，然后重复 8 次。那么，这对我的最大摄氧量有很大帮助吗？哦，你可以肯定。

But when I think about the risk I was putting myself under from a movement perspective, being under that much fatigue in the 7th and 8th round of that where you're trying to push harder and harder, I just don't think that makes any sense.
但是当我考虑到从运动角度我置身于风险之中时，当你在第 7 和第 8 轮比赛中感到疲劳不堪，却还要不断加大力度时，我觉得这根本没有任何意义。

I mean, that doesn't make sense in someone like me who has a lot of training background. So what do I want to do?
我的意思是，对于像我这样有很多训练背景的人来说，这是没有意义的。那么我想做什么呢？

I want to make sure that they're doing these intervals, which we'll talk about in a second, in an activity where the form isn't going to deteriorate to the point of injury. Now, let's talk about the gold standard for how to train VO2 max.
我想确保他们在进行这些间歇训练时，我们稍后会谈到，所处的活动形式不会恶化到受伤的程度。现在，让我们谈谈如何训练最大摄氧量的黄金标准。

And this is something we've discussed at length in at least two or three other podcasts that we'll link to. The sweet spot for that energy system is three to eight minutes of work. What defines that?
这是我们在至少两到三个其他播客中长时间讨论过的内容，我们将提供链接。该能量系统的最佳时长是三到八分钟的工作时间。是什么定义了这一点？

What defines that is you do as much work as you can at a steady state in that period of time. So at the low end of that is 3 minutes, so meaning how hard can you push for 3 minutes such that it's roughly the same level of work output,
这是由你在那段时间内尽可能保持稳定状态进行尽可能多的工作来定义的。因此，在这个范围的最低端是 3 分钟，意味着你在 3 分钟内可以多努力地推动自己，以便工作输出大致相同。

so watts if you're on a bike for example, but by the end of 3 minutes you're truly spent. And then at the upper end of that, it would be up to 8 minutes long,
如果你骑自行车，举例来说，但在 3 分钟结束时你真的筋疲力尽了。然后在那个范围的上限，可能会长达 8 分钟。

which obviously means it's going to be far less wattage, but the same physiologic response, which is by the end of it, you are truly gassed. I've talked about this.
这显然意味着功率要低得多，但生理反应相同，到最后，你真的筋疲力尽。我谈过这个。

Again, I personally just tend to gravitate to 4 minutes, 4 to 5 minutes is where I like to do the work, but I think it's great to mix it up. And I'll use four minutes as an example, just so folks understand what this should feel like.
再次强调，我个人倾向于将时间控制在 4 分钟，4 到 5 分钟是我喜欢工作的时间，但我认为变换一下也是很好的。我会以四分钟为例，这样大家就能明白应该是什么感觉。

When I'm doing a four minute interval, I barely notice the first minute. So if at the end of the first minute of a four minute interval, you're dying, you went out way too hard. It's okay. Try it the next time.
当我进行四分钟的间隔训练时，我几乎不会注意到第一分钟。所以如果在四分钟间隔训练的第一分钟结束时，你感觉筋疲力尽，那么你开始时的速度太快了。没关系，下次再试试看。

At two minutes, I'm still feeling pretty darn good. And believe it or not, sometimes I'm wondering if I shouldn't be pushing a little bit harder.
在两分钟的时候，我仍然感觉非常不错。信不信由你，有时候我在想我是不是应该再努力一点。

At 3 minutes I'm truly wearing it and that last minute is brutal and that's again assuming I'm largely holding power constant for the 4 minutes. So that's a general rule.
在 3 分钟时，我确实穿上了它，最后一分钟很残酷，这还是假设我在 4 分钟内基本上保持功率恒定的情况下。所以这是一个一般规则。

The way I describe it is 3 quarters of the way into the interval, so 6 minutes if it's an 8-minute interval, 3 minutes if it's a 4-minute interval. Three quarters of the way into the interval, you should be at the 50% level of your pain.
我描述的方式是在间隔的 3/4 处，所以如果是 8 分钟的间隔，那就是 6 分钟，如果是 4 分钟的间隔，那就是 3 分钟。在间隔的 3/4 处，你应该达到疼痛的 50%水平。

So once a person is ready to graduate into a dedicated VO2 max session, that's what I want to do and I want to see them doing that once a week.
所以一旦一个人准备毕业进入专门的 VO2 max 训练，那就是我想做的，我希望看到他们每周做一次。

Again, if you're training to be an elite level cyclist, you're going to have to do it more than that. But if you're training to just minimize risk and maximize gain,
再次强调，如果你正在训练成为一名顶尖水平的自行车手，你需要做的远不止这些。但如果你只是在训练中试图最小化风险并最大化收益，

I want to see people start to push those and maybe the first time they do it, they can only do four rounds of that. But eventually you'll get up to 5, 6, 7, 8 rounds of that. Again, if we're talking about 4 minutes.
我希望看到人们开始推动这些，也许第一次他们只能做四轮。但最终你会做到 5、6、7、8 轮。再次强调，如果我们谈论的是 4 分钟。

And when you put in a warm up and a cool down, and obviously I should say you're doing that at a 1 to 1 work to recovery ratio. I should have mentioned that earlier.
当你进行热身和放松运动时，显然我应该说你要保持 1 比 1 的工作与恢复比例。我应该早点提到这一点。

So if it's 4 minutes of work, it's 4 minutes of very, very passive recovery. Not a hardcore active recovery. It's a true rest and recovery. We're talking about 60 to 75 minute workouts here.
所以如果是 4 分钟的工作，那就是 4 分钟非常 passively 的恢复。不是 hardcore 的积极恢复。这是真正的休息和恢复。我们在这里谈论的是 60 到 75 分钟的锻炼。

Yeah, and so I think what I'm hearing you say is correct. It's one of those as it relates to VO2 max, even though it's so important and we just looked at all the numbers of why it's so important.
是的，我觉得我听到你说的是正确的。就像与最大摄氧量有关的那样，尽管它非常重要，我们刚刚看了所有相关数据，说明它为什么如此重要。

It's also one of those, in an older population who maybe is deconditioned, you're not pushing them to start VO2 max training right away.
这也是其中之一，在年长的人群中，也许是体能下降的人，你不会立即让他们开始 VO2 max 训练。

Like, it's important to get the base and it's also important to take, even when they start VO2 max training, take it slow and it's more important to build that over time than it is to just try to rush into it and either not enjoy it or,
就像，重要的是建立基础，也很重要的是，即使开始进行 VO2 max 训练，也要慢慢来，更重要的是随着时间的推移逐步建立，而不是匆忙尝试，要么不喜欢，要么

worst case, get hurt. 最坏情况下，受伤。

That's right. And the older and less conditioned you are, the less I want you to hurt during those VO2 max intervals. I bring it back to me because I can speak from my own experience with much more clarity.
没错。而且你年龄越大、身体适应程度越低，我就越不希望你在进行 VO2 max 间歇训练时感到疼痛。我把话题转回到我自己身上，因为我可以更清晰地从自己的经验中谈起。

The level of pain I am in today when I do my VO2 max sets is nothing compared to what it was 10 years ago, Nick. 10 years ago, it was truly pushing to the point of vomiting. I do not push that hard anymore.
我今天做最大摄氧量训练时所感受到的痛苦程度，与 10 年前相比微不足道，尼克。10 年前，那种程度简直让人快要呕吐。我不再那么拼命了。

I still push hard, probably harder than most people would expect. But it's not that level. And in 10 years, when I'm in my early 60s, it will be even less of a push than it is today.
我仍然努力拼搏，可能比大多数人预期的要更加努力。但并不是那种程度。而在 10 年后，当我进入 60 多岁的早期时，这种努力将比今天更少。

So the name of the game is play the game and stay in the game forever. And so we are really looking to minimize injury here and we're looking to minimize burnout.
所以游戏的名字就是玩游戏并永远留在游戏中。因此，我们真的希望在这里尽量减少受伤，我们也希望尽量减少疲劳。

And the first few times a person even experiments and dabbles with these four-minute intervals, I actually want them to come away thinking, that wasn't too bad. Great. Try a little bit harder the next time.
第一次尝试和涉足这种四分钟间隔的人，我希望他们能够觉得，这并不太糟糕。很好。下次再努力一点。

But we're not here to sort of wipe you out after the first session or even the first couple of rounds.
但我们并不是来在第一次课程甚至前几轮比赛后就把你淘汰的。

Anything else you want to say on the cardio side before we move to the strength side?
在我们转向力量训练之前，您还想在有氧训练方面补充什么吗？

We could talk about how to go about doing it. The good news is for VO2 max, I think you have many more options. For zone 2, believe it or not, you're kind of limited because of the steady state nature of it.
我们可以讨论如何去做。好消息是，对于最大摄氧量，我认为你有更多选择。对于第 2 区域，信不信由你，由于其稳态性质，你的选择有点有限。

So, again, for me, zone 2, if I'm not traveling, is always on my bike, which is on a stationary bike, so on a trainer, and that's it, full stop. If I'm traveling, I will usually do it on an incline treadmill.
所以，对我来说，如果我不出行，第二个区域总是在我的自行车上，这是一个静止的自行车，所以在一个训练器上，就是这样，完全停止。如果我出行，我通常会在一个倾斜的跑步机上做。

So I go to what I consider a normal brisk walking speed, which is 3.4 to 3.5 miles per hour. And then I just take the incline up. So I might warm up at 10 degrees or 10% grade, but usually I wind up at about 15% grade.
所以我走的是我认为正常的快步走速度，大约是每小时 3.4 到 3.5 英里。然后我就开始爬坡。所以我可能会在 10 度或 10%的坡度上热身，但通常我最终会到 15%的坡度。

So three and a half miles an hour, 15% grade, that's my zone 2. So, outside of that, you can do it on a rowing machine if you're a really good rower, but for most people,
所以每小时三英里半，15%的坡度，那就是我的第二心率区。所以，在这之外，如果你是一个非常优秀的划船手，你可以在划船机上做，但对于大多数人来说，

they're not efficient enough on a rowing machine so that you typically end up blowing up and through their zone 2 ceiling. I can do it on a StairMaster, but, you know, you just have to be sort of By the way,
他们在划船机上的效率不够高，通常最终会超过他们的第 2 心率区上限。我可以在踏步机上做到，但是，你知道的，你只需要有点……顺便说一句，

when you're using stairmasters and treadmills and all these things, remember, you probably don't want to have your hands on the device because there's too much variability in how much of the stress you're taking away. Does that make sense?
当你使用楼梯机、跑步机和所有这些设备时，请记住，你可能不想把手放在设备上，因为你消除的压力量可能会有太大的变化。这样说你明白了吗？

Like if you're in a treadmill and you're holding onto it, there's so much variability in how much of the load you're alleviating that I prefer to just go hands off the machine and settle in at a steady state that's going to be consistent.
如果你在跑步机上，抓住它，你会发现你减轻多少负荷有很大的变化，我更喜欢不握住机器，保持一个稳定的状态，这样会更加一致。

When it comes to VO2 max, you have way more optionality. That's where I ride my bike outside, but you could be doing almost anything provided that there's a constant enough space for you to do it for at least three minutes.
当涉及到最大摄氧量时，你有更多的选择。这就是我在户外骑自行车的地方，但只要有足够持续的空间，你几乎可以做任何事情，至少要持续三分钟。

Swimming, great way to do VO2 max training because you don't have the impact, all those other things.
游泳是进行 VO2 max 训练的绝佳方式，因为它没有冲击力，也没有其他那些因素。

So you could do it on a treadmill if you wanted to and you could run or you could, again, just walk at a steeper incline if your zones permit it. So I guess that's the only other point I would make about this.
所以如果你想的话，你可以在跑步机上做，你可以跑步，或者，如果你的区域允许的话，你也可以在更陡的坡度上走路。所以我想这是我关于这个问题要提出的唯一其他观点。

And if someone is older, let's say 65 plus, so they're in the older side of what we're talking about and they haven't done zone 2 before and they say, hey, do you have a preference on is it better to start on a treadmill versus a bike?
如果有人年纪较大，比如 65 岁以上，那么他们就属于我们讨论的较老年龄段，而且他们以前没有做过 2 区训练，然后他们问，嘿，你有偏好吗？是在跑步机上开始好还是在自行车上开始好？

Have you noticed anything as it relates to those two words? We talked early on about the importance of even just walking, getting like 5,000 steps, 7,000 steps.
你有注意到这两个词有什么关联吗？我们早先谈到过即使只是散步，走个 5000 步、7000 步的重要性。

Would you want to see people or encourage them to start on a treadmill or do you think a bike is just as safe, just as effective?
你想看到人们在跑步机上开始还是鼓励他们，或者你认为骑自行车同样安全、同样有效？

Yeah, I mean, look, I think all things equal, if this is the only exercise a person is going to be doing, I might lean a little bit towards the treadmill if they were truly agnostic, just because at the end of the day,
是的，我的意思是，看，我认为一切条件相同的话，如果这是一个人唯一要做的运动，我可能会稍微倾向于跑步机，如果他们真的是不偏不倚的话，因为说到底，

walking is a more valuable skill than cycling. Cycling has no application beyond cycling, whereas walking is a very important part of who we are. It's our superpower to be bipedal. So the more time you can spend doing it, the better you are.
走路是比骑自行车更有价值的技能。骑自行车除了骑自行车之外没有其他应用，而走路是我们身份的重要组成部分。成为两足动物是我们的超能力。因此，你花在走路上的时间越多，你就越好。

Again, for someone like me, it's kind of moot because I walk a lot anyway, I'm rucking, I'm forcing that system to work elsewhere. So, you know, I might as well do something I enjoy the most, which is probably riding a bike.
对于像我这样的人来说，这有点无关紧要，因为无论如何我都走很多路，我背着行囊，我在强迫那个系统在其他地方运转。所以，你知道，我倒不如做我最喜欢的事情，也许就是骑自行车。

Moving on now from the cardio side to the strength side, we already kind of looked at how muscle mass can drop as we age. What do we know about the possibility to gain muscle mass as we age?
现在我们从有氧运动转向力量训练，我们已经有点了解随着年龄增长肌肉量会减少。那么我们了解到关于随着年龄增长是否有可能增加肌肉量呢？

You know, it's really interesting. It's not that dissimilar from what we've talked about on the cardio front.
你知道，这真的很有趣。这与我们在心血管方面讨论的内容并没有太大不同。

So research is very consistent here in demonstrating that resistance training can increase muscle strength and muscle hypertrophy at any age. Again, you tend to get into very small studies here, but when you look at large pooled analyses,
因此，研究在这里非常一致地表明，抗阻训练可以增加肌肉力量和肌肉肥大，不受年龄限制。再次，您往往会涉及到非常小的研究，但当您查看大规模的汇总分析时，

you can see that even if you limit your analysis to people over the age of 80, Which are people who are clearly in that area of being on the downhill for strength and hypertrophy.
即使您将分析范围限制在 80 岁以上的人群，您也会发现这些人明显处于力量和肌肉增长下降阶段。

Training can offset losses and in a deconditioned individual can actually make gains.
训练可以弥补损失，在一个失去状态的个体中，实际上可以获得收益。

Just as I hopefully made a case for why you can't overstate the importance of cardio training both at low and high intensity, I don't think you can overstate the importance of strength training.
正如我希望为您阐明有氧训练在低强度和高强度下的重要性一样，我认为力量训练的重要性也无法言过其实。

I just don't think there's anybody out there who shouldn't be lifting weights. I can't think of a case. I mean, unless you're decidedly saying, I don't want to live the longest, healthiest life I can.
我只是认为没有人不应该举重。我想不出有哪种情况。我是说，除非你明确地表示，我不想过最长寿命、最健康的生活。

If that's the case, then by all means, don't lift weights. But if you're in the camp that says, I want to maximize how well I can live and maybe even how long I can live, what should I do?
如果是这样的话，那么尽管不要举重。但如果你属于那种说：“我想要最大程度地提高生活质量，甚至可能延长寿命”的人群，那我该怎么办呢？

You have to be lifting weights regardless of age, regardless of sex, regardless of injury. You have to work around all of those things.
无论年龄、性别、受伤与否，你都必须举重。你必须克服所有这些困难。

So again, there's a very similar study To the one I cited earlier, again, I don't want to go too study heavy, but this is just so illustrative of the point.
所以，再次，有一项非常类似的研究，就像我之前引用的那个，我不想让研究内容过于繁重，但这只是为了阐明这一点。

There was a study that looked at people in their late 70s and early 80s and people in their 20s and at the outset measured three rep max for leg extension and then put them on a six week resistance training program and the people in their late 70s and early 80s had a 78% increase In their strength,
有一项研究调查了 70 多岁末期和 80 多岁初期的人以及 20 多岁的人，最初测量了他们的腿部伸展三次最大重量，然后让他们进行为期六周的抗阻训练计划，结果显示 70 多岁末期和 80 多岁初期的人的力量增加了 78%

which is almost identical to the 83, 84% increase that was found in the younger individuals. Again, it's important to understand that, yes, these people were significantly difference in the absolute strength that they had.
这几乎与年轻人中发现的 83、84%增长完全相同。再次强调，重要的是要理解，是的，这些人在他们的绝对力量上有显著差异。

The average leg extension in the people who were in their late 70s and early 80s was only 22 kilograms versus 178 kilograms for the young participants.
那些七八十岁的人的平均腿部伸展力只有 22 公斤，而年轻参与者的伸展力为 178 公斤。

But nevertheless, this is an important point that is everybody has the capacity to improve and therefore everybody needs to be doing this.
但是，这是一个重要观点，即每个人都有提高的能力，因此每个人都需要这样做。

I think the other thing that we've talked about in previous podcasts, most notably, I think we've talked about this with Andy Galpin on a couple of occasions.
我认为我们在之前的播客中谈到的另一件事情，尤其是我认为我们在几次与安迪·加尔平（Andy Galpin）的谈话中谈到过这个问题。

One of the things that Andy said that has always stuck with me and I think it's just such a great way to think about this, he almost described it as a hallmark of aging is the atrophy of the type 2 muscle fibers.
安迪说过的一件事一直让我记忆犹新，我认为这是一个很好的思考方式，他几乎将其描述为衰老的标志是类型 2 肌纤维的萎缩。

So again, you have type 1 fibers, you have type 2 fibers, the type 2 fibers are the glycolytic fibers, they are the much more powerful fibers, they have more contractile They're the ones that are responsible for power,
所以，你有 1 型纤维，你有 2 型纤维，2 型纤维是糖酵解纤维，它们是更强大的纤维，它们有更多的收缩力，它们是负责力量的纤维

not just muscle size and not even just strength and clearly not muscular endurance. And these are the things that basically peak when we're in our 20s.
不仅仅是肌肉大小，甚至不仅仅是力量，显然也不是肌肉耐力。这些基本上是我们二十多岁时达到巅峰的事物。

And so every day I'm sort of thinking about what am I doing to preserve them and minimize their loss.
所以每天我都在思考，我在做些什么来保护它们，减少它们的损失。

And again, a study we'll link to demonstrates that type 2 muscle fiber cross-sectional area It was increased by 27% in men aged 60 to 73 with 13 weeks of resistance training.
再次，我们将链接到的一项研究表明，60 至 73 岁男性进行了 13 周的抗阻训练后，型 2 肌纤维横截面积增加了 27%。

Now, again, you have to train relatively heavy for your level of strength. You have to push to make those results happen. But again, this can be done very safely as we'll talk about.
现在，再次，你必须根据自己的力量水平进行相对较重的训练。你必须努力去实现那些结果。但同样，这可以非常安全地完成，我们将会谈论到这一点。

Yeah, and I think now's the time to kind of look at that a little bit, which is you have a patient who's older. They come to you and they have not been strength training.
是的，我认为现在是时候稍微看一下这个问题了，就是你遇到一个年长的患者。他们来找你，但他们没有进行过力量训练。

Maybe they even do a DEXA and they see their metrics are really low as it relates to muscle mass. How do you start to incorporate that strength and resistance training to that individual?
也许他们甚至会进行 DEXA 扫描，发现他们的肌肉量指标非常低。您如何开始为这个人引入力量训练和抗阻训练？

I mean, I think there's a real parallel here with what we talked about on the endurance side. So I always start from the same vantage point, which is if you're new to strength training, I want to make sure that in two to three months,
我的意思是，我认为这里与我们在耐力方面讨论的内容有着真正的相似之处。所以我总是从同样的角度出发，那就是如果你是新手力量训练者，我希望确保在两到三个月内，

you're looking back at the last two to three months thinking, A, I enjoyed that. It wasn't as bad as I thought it was because remember, if someone hasn't lifted weights before, there's a reason, right?
你回顾过去的两三个月，会想到，“A，我很享受那段时间。事情并没有我想象中的那么糟，因为要记住，如果有人以前没有举过重物，那是有原因的，对吧？”

Like there's something about it that they are either intimidated by, afraid of, or didn't think it was valuable enough. I mean, there's a reason for it. So A, I want to undo that reason. Secondly, I want them to feel something is different.
就好像有些东西让他们感到害怕、畏惧，或者觉得不够有价值。我是说，这其中肯定有原因。所以首先，我想要消除这个原因。其次，我希望他们能感受到一些不同。

I want them to feel like Well, you know, I remember when I started this, I could only do this many push-ups and now I can do that many push-ups or when I was doing leg extensions or leg presses,
我希望他们感觉就像嗯，你知道的，我记得当我开始时，我只能做这么多俯卧撑，现在我可以做那么多俯卧撑，或者当我在做腿部伸展或腿部推举时，

I had the pin on this weight and now it's like 50% higher. That's the first principle. Second principle is, again, similarly, we are going to start with volume more than we are going to start with load.
我之前在这个重量上插了销，现在它增加了大约 50%。这是第一个原则。第二个原则是，同样地，我们将从体积开始，而不是从负荷开始。

Muscular resistance matters more to me than strength at this point, so I'm not going to lead in with let's go after those type 2 fibers.
肌肉的抵抗力对我来说比力量更重要，所以我不打算首先去追求那些 II 型肌纤维。

It's going to be let's work on the type 1 fibers and I don't care if you need to do 15 to 20 reps on every exercise, so be it. I'm not even really at this point going to be concerned with all the nuances of RPE.
我们要专注于 1 型肌纤维，如果你需要在每个练习上做 15 到 20 次，那就这样吧。我甚至在这一点上并不会太担心 RPE 的所有细微差别。

We've talked about this on many podcasts, including not just the podcast with Andy, but with Lane Norton.
我们在许多播客节目中都谈到过这个问题，不仅包括与安迪一起的播客节目，还有与莱恩·诺顿的节目。

The data are that the number of reps you do for hypertrophy and strength, especially for hypertrophy, don't really matter provided you get to within one or two reps of failure. We're not even really going to push that out of the gate.
数据显示，对于肌肥大和力量训练，尤其是肌肥大训练，你做的重复次数并不重要，只要确保接近失败的一两次重复。我们甚至不会一开始就过度强调这一点。

We might prescribe, hey, pick a weight that you fail at about 12 to 15 reps. But again, less concerned as to whether that's an RPE2 or an RPE4.
我们可能会建议，嘿，选择一个你在做大约 12 到 15 次重复时失败的重量。但再次强调，不太关心这是 RPE2 还是 RPE4。

The other thing to keep in mind is in parallel to this, you've got to be working on some of the stability stuff, which is not necessarily weight-based.
另一点需要记住的是，与此同时，您必须着手处理一些稳定性方面的问题，这并不一定是基于重量的。

So this is where you're working on intra-abdominal pressure exercises, really making sure that they can kind of pressurize the cylinder as we say, breathing exercises. So a lot of the stuff we borrow from DNS and PRI.
这就是你在进行腹腔内压练习的地方，确保他们能够像我们说的那样给气缸增加压力，进行呼吸练习。我们从 DNS 和 PRI 借鉴了很多东西。

We want to make sure that they can move their ribs correctly. And obviously you want to make sure that they have The ability to even recruit muscles correctly and a lot of those things are kind of hard, but I'll never forget an example.
我们希望确保他们能够正确地移动肋骨。显然，您希望确保他们甚至能够正确地招募肌肉，很多这些事情都有点困难，但我永远不会忘记一个例子。

Beth Lewis had me do one of the early times when I met her, which was laying on a floor. So picture me laying on my back. My knees are up, but my feet are flat on the ground.
贝丝·刘易斯在我初次见到她时让我躺在地板上。所以想象一下我躺在背上。我的膝盖弯曲，但我的脚是平放在地面上的。

So I'm in a very relaxed position and it was an exercise around Being able to sequentially recruit hamstrings one leg at a time and put the foot down into the ground and pull it back, if that makes sense.
所以我处于非常放松的状态，这是一个关于能够依次招募大腿肌肉的练习，一次一个腿，将脚放在地面上并将其拉回，如果这样说有意义的话。

So again, that's a pure hamstring isolation exercise. And yet, despite having very strong hamstrings, I really struggled to do that exercise while keeping my pelvic floor stable.
所以，这是一个纯粹的腿后肌分离运动。尽管我腿后肌很强壮，但我在做这个练习时很难保持盆底稳定。

So again, those are the types of things where you're not going to get injured, but you're going to have to learn to start recruiting and controlling a muscle. And again, once you do that, you're much safer lifting.
所以，这些就是你不会受伤，但你需要学会招募和控制肌肉的类型。再次强调，一旦你做到这一点，举重就会更安全。

How do you think about resistance training for people who are in the even older category, which is let's say 65 plus?
您如何看待那些年龄更大的人进行抗阻训练，比如说 65 岁及以上的人群？

I know at the outset you kind of mentioned that at a certain point the muscle mass you're losing and the things you have to be aware of is even higher. So how do you talk to a patient about this who is even in that older category?
我知道一开始你有点提到在某个时候你正在失去的肌肉量和你需要注意的事情甚至更多。那么你如何与一个属于老年人群的患者谈论这个问题呢？

I think you just have to do everything a lot slower. So, for example, somebody at this age, you'll do TRX, but you want to be much more stable in the positions you're doing.
我认为你只需要做每件事慢一点。比如，这个年龄段的人，你会做 TRX，但你要在做动作时更加稳定。

I would almost without exception only have somebody at this age, if they've never lifted before, only using machines to start, I wouldn't really want them Mucking around too much with dumbbells outside of maybe doing carries.
我几乎可以肯定，只有在这个年龄，如果他们以前从未举过重物，我会让他们从使用器械开始，我不太希望他们在使用哑铃方面乱搞太多，也许只是做些搬运动作。

I wouldn't want them picking up dumbbells to do lunges or things like that. I would sort of save that for phase 2 of what they're doing.
我不希望他们拿哑铃做弓步或类似的动作。我会把这种训练留到他们进行的第二阶段。

And truthfully, even though DNS, dynamic neuromuscular stabilization, which people know I'm a big fan of, when people think about it, you sort of think of these baby positions.
事实上，即使是 DNS，动态神经肌肉稳定性，人们知道我是一个忠实的支持者，但当人们想到它时，你会想到这些婴儿姿势。

Well, the reality of it is those positions are very important for people of any age. And so teaching an older person, especially a person who's new to physical activity, some of those positions is very valuable because A,
嗯，事实上，这些姿势对任何年龄段的人都非常重要。因此，教导一个年长者，尤其是一个对体育活动感到陌生的人一些这些姿势是非常有价值的，因为……

it's doing all the stuff I talked about a second ago, but they're also getting comfortable with being on the floor and moving on the floor. Again, this is Something that you and I will take for granted, Nick, for some time,
它正在做我刚才谈到的所有事情，但它们也开始逐渐适应地面并在地面上移动。同样，这是尼克，你和我将长时间视为理所当然的事情。

but people 20 years older, 30 years older than us can't take it for granted that being on the floor, moving on the floor and getting up on the floor unassisted is something that they should be able to do easily.
但是比我们大 20 岁、30 岁的人不能认为站在地板上、在地板上移动和自己站起来是他们应该能够轻松做到的事情。

You kind of hinted at it there. So let's say someone is kind of in this older bracket, even 50 plus and they're like, okay, I'm going to start resistance training. They obviously don't have a home gym.
你有点暗示了。所以假设有人处于较大年龄段，甚至是 50 岁以上，他们想开始做抗阻训练。显然他们没有家庭健身房。

Most people in that category aren't going to have that. And so if they do walk into kind of their local gym fitness center,
那个类别的大多数人不会有那个。所以如果他们走进当地的健身中心，

you would encourage them to start on the machines at first and lower weights just to slowly work that up before grabbing free weights, grabbing dumbbells, anything like that.
你会鼓励他们一开始先使用机器，减轻重量，慢慢增加，然后再使用哑铃或其他器械。

At this level, it's difficult for me to provide very thorough analysis because everybody is different and clearly what you might say makes sense if this person also happens to have a trainer who's really good with them.
在这个层面上，对我来说很难提供非常彻底的分析，因为每个人都不同，显然如果这个人碰巧也有一个对他们非常擅长的教练，你可能说的话就有道理。

Yeah, you're gonna say look you're gonna push things a little bit quicker,
是的，你会说看，你会加快事情的推进速度，

but if we're really starting at hey This is a person who's gonna be doing a lot of this stuff alone in a gym where there's a ton of intimidating stuff going around I would say yeah,
但是如果我们真的从嘿开始，这是一个人将会在一个健身房里独自做很多这样的事情，周围有很多令人生畏的东西，我会说是的

let's stick with the machines and I wouldn't be trying to do dumbbell presses or kettlebell exercise or anything like that no,
让我们继续使用机器，我不会尝试哑铃推举、壶铃练习或类似的任何动作

I think you really want to build your strength and stability with body weight and And with machines before you progress.
我认为你真的想要通过自身重量和器械来增强你的力量和稳定性，然后再逐步进步。

Again, if you have the luxury of having a trainer and that trainer is very good, I think they'll be able to progress you more quickly to those other things.
如果你有幸拥有一位非常优秀的教练，我认为他们将能够更快地帮助你进步到其他方面。

So then, Peter, you kind of hinted at it there, but a lot of people who are in the older category, they may be concerned about resistance training due to potential injury.
所以，彼得，你有点暗示了，但很多年长的人可能会担心抗阻训练会导致潜在的受伤。

So when you have your patients who are older start to resistance train, start to build muscle, are you worried about injuries?
那么，当您让年长的患者开始进行抗阻训练，开始增肌时，您是否担心受伤？

Kind of how do you speak to them about how they should think about that aspect, especially starting out or if they've never started before?
你如何与他们谈论他们应该如何考虑这一方面，特别是在刚开始或者从未开始过的情况下？

I think anybody who's worked with people, be it athletes or people who are really deconditioned, you always have to think about this, right? Because you're always balancing providing enough training stimulus to get the benefit.
我认为任何与人打交道的人，无论是运动员还是身体状况很差的人，你都必须考虑到这一点，对吧？因为你总是在平衡提供足够的训练刺激以获得好处。

And remember, training is a hormetic activity. It has to create a stimulus, whether that be on the aerobic system, whether that be for the type 1 fiber,
记住，训练是一种荷尔蒙活动。它必须产生刺激，无论是对有氧系统，还是对 1 型纤维。

the type 2 fiber, like there has to be A stimulus that comes from pushing outside of a comfort zone. So we have to have that training stimulus, but we know that if we do too much, we're going to get injured.
2 型纤维，就像必须有一个来自超出舒适区域的刺激。因此，我们必须有训练刺激，但我们知道如果做得太多，我们会受伤。

And I hope that by now I've made the case for why injury must be avoided at all cost, because injury means time to decondition. And the older we get, the more problematic that gets.
我希望到现在为止我已经阐明了为什么必须尽一切努力避免受伤，因为受伤意味着需要时间去恢复。随着年龄的增长，这个问题会变得更加棘手。

Again, I think about the back injury I sustained when I was 27 years old that basically left me Unable to walk for 3 months and unable to do much of anything for 9 months.
再次，我想起了我 27 岁时遭受的背部受伤，基本上让我在 3 个月内无法行走，9 个月内无法做任何事情。

Well, today if you look at me, there's really no lasting effect of that. But imagine that had happened to me when I was 70. That's it. My life is over. I never get back to where I was.
嗯，今天如果你看着我，其实并没有什么持久的影响。但想象一下，如果那发生在我 70 岁时。那就完了。我的生活就结束了。我永远无法回到从前。

So, it's probably safe to say that the most common reason for injury when you're starting out is progressing along the intensity axis too soon.
因此，可以说，当你刚开始时受伤的最常见原因可能是过早沿着强度轴前进。

So remember we talked about how you push frequency, you can push duration, you could push intensity. I think you want to err on the side of my heuristic is move the frequency, then the duration, lastly, the intensity.
所以记住我们谈过的，你可以增加频率，增加持续时间，也可以增加强度。我认为你应该偏向于我的启发法则是先增加频率，然后是持续时间，最后是强度。

So that's clearly true on the cardio training side, but I think it's also true on the strength training side. Obviously, another very important part of Injury is just a lack of neuromuscular control.
这在有氧训练方面显然是正确的，但我认为在力量训练方面也是如此。显然，另一个非常重要的受伤部分就是缺乏神经肌肉控制。

So that accounts for many things from why people fall more frequently as they age to how people get injured. If we're just limiting it to talking about strength training, why are individuals getting hurt when they're lifting weights?
这就解释了许多问题，从人们年纪越大跌倒更频繁，到人们如何受伤。如果我们仅限于谈论力量训练，为什么有人在举重时受伤呢？

Well, a lot of it is maybe they're moving a weight that they can't control. We've talked a lot about the importance of being able to control the eccentric phase of a movement.
嗯，很多时候可能是因为他们在移动一个他们无法控制的重量。我们已经谈论了很多关于能够控制运动的离心阶段的重要性。

And I think we've all seen someone in the gym who's just throwing weights around and getting away with it, but you're going to stop getting away with that the older you get. So we want to really make sure that people have the coordination,
我认为我们都见过健身房里有人只是随意举重，但随着年龄增长，你将无法再这样轻松应付。因此，我们真的希望确保人们有协调性，

they're doing the types of drills like agility ladders, hand-eye coordination exercises, ball tosses, such that they're generating neuromuscular control in addition to strength.
他们正在进行各种训练，比如敏捷梯子训练、手眼协调练习、传球等，这样他们不仅在增强力量，还在培养神经肌肉控制。

Probably the other big area where we see injuries is due to a lack of movement variability. So people say, well, do I need to squat and deadlift and bench press? And I think the short answer is no.
可能另一个我们看到受伤的主要领域是由于缺乏运动多样性。所以人们会说，我需要深蹲、硬拉和卧推吗？我认为简短的答案是否定的。

I think a lot of those things can be done with, for example, squats and deadlifts. You can accomplish many of those goals using a single leg.
我认为很多这些事情可以通过举重和硬拉等方式完成。你可以用单腿完成许多这些目标。

Variants that are far less weight and even something like a bench press with a bar, I would much rather substitute in, once you're ready for that, floor presses and single arm floor presses.
变种，重量要轻得多，甚至像卧推这样的动作，我更愿意用地板推举和单臂地板推举来替代。

You'll be laying on the floor with knees up, feet flat on the ground, one arm straight up, the other arm doing the presses. And again, what's nice about that is on a floor press,
你会躺在地板上，膝盖弯曲，双脚平放在地面上，一只手伸直向上，另一只手进行推举。而且，地板推举的好处在于，

your range of motion is nowhere near what it is on a bench because you're obviously not going to be able to bring the elbow below your back, which you could on a bench, so you lose a bit of range.
你的活动范围远不及在凳子上的范围，因为显然你无法将肘部移到背后，而在凳子上是可以的，所以你会失去一些范围。

It's clearly not, quote unquote, as good a pec exercise, but there's also a very good margin of safety there. Think about how much harder it is to hurt yourself doing a floor press than a regular traditional bench press.
这显然不是所谓的一种很好的胸肌锻炼，但在安全方面也有很大的保障。想想做地板推肘比传统的卧推更难受伤的程度。

These are just some slight examples of ways that you can think about minimizing injury. By the way, just as an example, like when I was coming back from shoulder surgery,
这些只是一些可以考虑减少受伤的方式的轻微示例。顺便说一句，就像我从肩部手术回来时的一个例子，

I mean, it was probably a year of just doing floor presses before I proceeded to go back onto a bench.
我的意思是，在我重新回到卧推之前，可能有一年时间只是做卧推。

Yeah, it kind of reminded me, can't remember who it was, but someone once told us they used to do Tabata deadlifts and that could be a potential good example of a good way to get injured, correct?
是的，这让我想起来了，记不清是谁说的了，但有人曾告诉我们他们过去做过塔巴塔硬拉，这可能是一个潜在的受伤好例子，对吧？

I mean, anybody's stupid enough to do that, Nick. I mean, gosh, I just don't even know what I would say.
我是说，任何人都愚蠢到那种程度，尼克。我是说，天哪，我甚至不知道我会说什么。

Hey, if they're doing Tabata deadlifts, you have to question everything they say, right? Like, how can they be trusted on anything?
嘿，如果他们正在做塔巴塔硬拉，你就得质疑他们说的一切，对吧？比如，他们怎么能在任何事情上值得信任呢？

I think you would probably have to say there, you shouldn't listen to a word they say.
我认为你可能得说，你不应该听他们说的任何话。

Well, if I can remember who that is, I'll make sure to tune them out going forward.
好吧，如果我能记得是谁，我会确保以后屏蔽他们。

If you can remember, let us know.
如果你能记得的话，请告诉我们。

On that front, fall risk. You've talked about it before. You mentioned it earlier. Do you just want to speak about fall risk? We also have a few graphs here that Again,
在这方面，摔倒风险。你之前谈过这个问题。你之前提到过。你只想谈谈摔倒风险吗？我们这里还有一些图表。再次，

we wouldn't have pulled if they didn't tell such a story but I think it'd be really important here to talk about fall risk because I think this is important not only for people in this age category but also even anyone who's still listening that's even younger to see what this can look like and it's also to give them that motivation to even train at a younger age.
如果他们没有讲这样一个故事，我们就不会撤回，但我认为在这里谈论摔倒风险非常重要，因为我认为这不仅对这个年龄段的人很重要，甚至对那些还在听的年轻人也很重要，让他们看看这种情况可能是什么样子，也给他们动力，让他们在年轻时就开始训练。

Kind of what you hinted at earlier, it's like saving for retirement at a much early age. So what do you want to tell people about falls?
有点像你之前暗示的，就好像在很年轻的时候为退休存钱一样。那么你想告诉人们关于跌倒的事情是什么？

I just don't think we can say enough about it. I think back to all of the failures of our traditional medical training and there's so many, right?
我只是觉得我们无法对此多说。我回想起我们传统医学训练的所有失败，真的有很多，对吧？

In four years and $250,000 of education at Stanford, how many Hours of lecture that I have on exercise, zero. When was this discussion about falling presented to us as medical students? Never.
在斯坦福四年的教育和 25 万美元的投资中，我接受了多少关于运动的讲座？零。作为医学生，我们何时听说过有关跌倒的讨论？从未。

So in the United States, over 14 million or 25% of people over the age of 65 will fall each year. Now, to be clear, that's people who report it. We believe that that number is significantly higher. This risk goes up quite non-linearly.
因此，在美国，每年有超过 1400 万人，即 65 岁以上人口的 25%，会摔倒。现在，明确一下，这是报告的人数。我们相信这个数字实际上要高得多。这种风险呈非线性增长。

By the time we're talking about octogenarians and nonagenarians, the annual incidence of falling is at least 50%.
当我们谈论八九十岁的老人时，每年跌倒的发生率至少为 50%。

You'll recall that I said that the risk of death from that fall Depending on the series you look at, will be somewhere between 15 and 30% of those falls.
您会记得我说过，从那次跌落中死亡的风险取决于您查看的系列，将在 15%至 30%之间。

If they result in a broken hip, will result in fatality within the 12 months that ensue. Pull up this graph. This is a graph we had showed in a newsletter a couple of years ago.
如果导致髋部骨折，将在随后的 12 个月内导致死亡。拉起这张图表。这是几年前我们在通讯中展示过的一张图表。

Every once in a while, you don't really need any statistics to understand this. You just need to look at the graph. This is the normalized death rate per 100,000 people over the last basically 15 years.
每隔一段时间，你真的不需要任何统计数据来理解这一点。你只需要看一下图表。这是过去大约 15 年每 10 万人中的标准化死亡率。

These are data from the CDC and you can see that just from 2007 to 2016, we've seen a 30% increase in fall deaths.
这些是来自疾控中心的数据，你可以看到从 2007 年到 2016 年，我们看到坠落死亡人数增加了 30%。

To put it in perspective, the projection is that by 2030, we're going to expect to see seven fall deaths every hour in the US. Again, it's very difficult to wrap our minds around this, I think, and I think all of us as physicians,
换个角度来看，预测到 2030 年，我们预计在美国每小时会有七起跌倒死亡事件。再次强调，我认为这非常难以理解，我认为作为医生的我们都是如此。

certainly myself in this category, unless you're a physician who specifically has a geriatric practice, maybe where you would see more of this, I just don't think we can wrap our minds around this problem and the magnitude Again,
我肯定自己也属于这个类别，除非你是一个专门从事老年医学的医生，也许在那里你会看到更多这样的情况，我只是觉得我们无法完全理解这个问题及其规模。再次，

if you look at the data in 2018, we're talking about 36 million falls reported to 8 million injuries.
如果您看一下 2018 年的数据，我们谈论的是有 3600 万次跌倒报告导致了 800 万起受伤。

That looks like it's going to very quickly become 52 million falls with 12 million injuries in about 5 years for people over the age of 65. So, I think that it's safe to say that falls pose Not by magnitude,
看起来在未来 5 年内，65 岁以上的人群将迅速增加到 5200 万次跌倒，导致 1200 万次受伤。因此，我认为可以肯定地说，跌倒并非规模问题，

but certainly by severity, as significant a threat to an aging individual as the typical horseman that we've spoken about so often.
但是，严重程度上，对于一个年迈的个体来说，它是一个同样重要的威胁，就像我们经常谈论的典型骑士一样。

What do we know about the reasons for falls? What makes a fall worse than the others? Because as you mentioned, these are only reported falls.
我们对摔倒的原因了解多少？是什么让一次摔倒比其他摔倒更严重？因为正如你所提到的，这些只是被报告的摔倒。

So there's probably a lot of times where if someone falls and they get up and they're just a little banged up, they're not going to report it to anybody.
所以很可能有很多时候，如果有人摔倒了，起来后只是有点摔伤，他们不会向任何人报告。

And so if we want to double click on falling in particular, what do we know about more detail on that that make it more dangerous than others?
所以，如果我们想要更详细地了解特别是跌倒这一点，我们对此了解多少，使其比其他事故更危险？

Yeah, so I think there's two ways to kind of think about this. There's what is it that increases our susceptibility to fall? Why is that going up as we age?
是的，我认为有两种方式来思考这个问题。我们为什么更容易摔倒？随着年龄的增长，这种情况为什么会加剧？

And then there's another issue, which is not only does your probability of fall going up, but the severity of the fall. Is also going up as you age. So those two things are compounding and that's why if you look at the data,
然后还有另一个问题，不仅是你摔倒的概率增加了，而且摔倒的严重程度也随着年龄增长而增加。所以这两个因素是相互叠加的，这就是为什么如果你看数据，

and I actually do think I included this figure in Outlive, I have a figure that shows the death rate of falls by decade. And if you're trying to explain to somebody what exponential growth looks like, you just show them that graph.
我实际上认为我在《Outlive》中包含了这个数字，我有一个显示每十年跌落死亡率的数字。如果你试图向某人解释指数增长是什么样子，你只需向他们展示那张图表。

That's exponential growth and that's why. Two things are compounding non-linearly and you put them on top of each other. So let's talk about it. Like why is this happening?
这是指数增长，这就是原因。两件事以非线性方式相互作用，叠加在一起。所以让我们来谈谈。为什么会发生这种情况？

Well, I think if you're asking like why are there more falls, it's going to be lower limb weakness and we should double click on specifically like the role of the toe there. We had a recent podcast with Courtney Conley that discussed that.
嗯，我认为如果你问为什么会有更多的跌倒，那可能是下肢无力，我们应该特别关注脚趾的作用。我们最近与 Courtney Conley 进行了一期讨论这个问题的播客。

Difficulty with walking and balance. Remember I said vestibular changes kick in around the age of 65. So all of us become less visually capable and we have less just innate vestibular capacity.
行走和平衡困难。记得我说过，大约在 65 岁左右，前庭变化就会出现。因此，我们所有人在视觉能力上都会变弱，而且我们的前庭能力也会减弱。

Visual difficulties, foot pain, poorly fitting footwear as we age, and then of course there's medications that people take. So the older we get, the greater we see the incidence of hypertension. Hypertension does need to be treated.
视力困难、脚痛、随着年龄增长，鞋子不合脚，当然还有人们服用的药物。因此，随着年龄增长，高血压的发病率也越来越高。高血压确实需要治疗。

It's an enormous risk for stroke and heart attack. But sometimes we over-treat it and people become orthostatic and when they stand up, they get light-headed and fall.
这是中风和心脏病的巨大风险。但有时我们会过度治疗，导致人们出现直立性低血压，站起来时头晕眼花，摔倒。

I don't know if you know anybody that that's happened to, Nick, but that can also be kind of a devastating consequence of just being alive. You also talk about things that I don't think are necessarily age-related.
我不知道你是否认识任何人经历过这种情况，尼克，但这也可能是生活中的一种毁灭性后果。你还谈到了一些我认为并非与年龄相关的事情。

All of those things are age-related, but obviously, just having uneven steps around, clutter, all of those things play a role. So, the more of these factors you check off, the more likely you are to fall.
所有这些都与年龄有关，但显然，周围不平整的台阶、杂乱无章等因素都起着作用。因此，你勾选的这些因素越多，摔倒的可能性就越大。

Now, to the question of why is it more catastrophic, an amazing statistic is that the leading cause of traumatic brain injury in people over the age of 65 is falling. 95% of hip fractures are driven by falls.
现在，关于为什么更具灾难性的问题，一个惊人的统计数据是，65 岁以上人群中创伤性脑损伤的主要原因是跌倒。95%的髋部骨折是由跌倒引起的。

Clearly frailty is the leading cause of this. So frailty means poor muscle mass, poor reactivity, and low bone density.
显然，脆弱是这一现象的主要原因。因此，脆弱意味着肌肉质量差、反应迟钝和骨密度低。

Those are probably the things that are driving the severity of the fall, which are so much higher in a person who's older than, you know, a person who's younger.
这些可能是导致跌落严重程度加剧的因素，这种情况在年长者身上要比年轻人更为严重。

You recall I alluded back to the podcast with Andy Galpin where we talked about the atrophy of the type 2 muscle fiber. Well,
你还记得我提到过与安迪·加尔平一起做的播客，我们谈到了 2 型肌纤维的萎缩问题。嗯，

I think Andy used that as the great example of another reason why falls go up as people age is that If you or I step off a curb we weren't expecting to be there or you know when you're stepping from one level to another and the level is different than you expected,
我认为安迪将其用作另一个原因的绝佳例子，即为什么随着人们年龄增长，跌倒的次数会增加。如果你或我从一个我们没有预料到的路缘踏出，或者当你从一个高度走向另一个高度时，而高度与你预期的不同，

that immediately destabilizes you. Well, the ability to react to that very quickly and get a firm footing, that is a very power-driven movement.
那会立即使你失去平衡。嗯，能够迅速做出反应并稳住脚跟，这是一种非常有力量的动作。

That's not really about how strong you are, it's actually about how explosive and powerful you are. That is a type 2 muscle fiber phenomenon.
这并不完全取决于你有多强壮，实际上更关乎你有多爆发力和强大。这是一种 2 型肌肉纤维的现象。

And as you watch the atrophy of those two fibers, you have far less reactive speed in your feet and therefore you're more likely to fall in response to that.
当你看到这两根纤维的萎缩时，你的脚反应速度会大大降低，因此你更容易因此摔倒。

Again, the more we can train these systems, the better we are going to be able to resist falling.
再次，我们训练这些系统的次数越多，我们就越能抵抗摔倒。

You mentioned there Courtney's episode, which if anyone hasn't listened to her watch will be really good to go back to,
你提到了 Courtney 的那一集，如果有人还没有听过或者看过的话，回头再去看一定会很有意思

but can we double-click on the role that the foot plays in fall risks and even in particular one thing she talked about which was toe strength?
但我们能否深入探讨脚在摔倒风险中所扮演的角色，甚至是她谈到的一个特定问题，即脚趾力量？

Yeah, again, great episode, absolutely worth going back to if you haven't listened to it. Also, we'll talk about the videos that Courtney and I put together, but foot health matters.
是的，再次强调，这是一集很棒的节目，绝对值得回头听一听。此外，我们还将讨论考特尼和我制作的视频，但脚部健康也很重要。

I think one of the things I took away from the discussion with Courtney was that toe strength was the biggest predictor of falling in people over 65. In that podcast, Courtney ran me through a bunch of tests to determine toe strength.
我认为与 Courtney 讨论中我得出的一个结论是，脚趾力量是 65 岁以上人群摔倒的最大预测因素。在那期播客中，Courtney 让我做了一系列测试来测定脚趾力量。

One of those tests, my two favorite, right? So one of those tests was a little card that you put under your toes. And it's a dynamometer, so it measures the force that you can push each toe down as the card is trying to be pulled out.
其中一个测试，是我最喜欢的两个之一，对吧？所以其中一个测试是一个小卡片，你把它放在脚趾下面。这是一个动力计，它可以测量你在卡片试图被拉出时每个脚趾可以向下推的力量。

And so the rule of thumb, if I recall, was your great toe should be able to push down with at least 10% of your body weight. And if it can't, it's too weak.
据我记得，一个经验法则是，你的大脚趾应该能够用至少 10%的体重向下推压。如果不能，那就太弱了。

Toes 2 through 5 collectively should be able to push down about 7% of your body weight. Another great test was the kind of lean forward test. So this was when you're standing up straight, we have this little laser device.
第 2 到第 5 脚趾总体应该能够承受大约 7%的体重。另一个很好的测试是前倾测试。所以当你站直时，我们有这个小激光设备。

It sounds more complicated than it is. I've obviously already gone out and bought said laser on Amazon. Link to all that, but you shoot it against a wall and you get a distance and then you lean forward and without catching yourself,
这听起来比实际情况更复杂。显然，我已经在亚马逊购买了所说的激光器。链接到所有这些，但你把它对着墙壁射击，你会得到一个距离，然后你向前倾斜，而不会摔倒。

just letting your toes basically do the work to see how far they support you. And you should be able to, I believe, be able to move at least five inches or maybe it's four and a half inches there. So those are some great ways to test.
只需让你的脚趾基本上来完成工作，看看它们能支撑你走多远。我相信，你应该能够至少移动五英寸，或者可能是四英寸半。这些都是一些很好的测试方法。

And again, it's just added so much more to how I think About the importance of this stuff. Cause I have to be honest with you. I've always thought of foot as an important thing. Not always, but you know, in the past five years,
再次，这让我对这些事情的重要性有了更多的思考。因为我必须诚实地告诉你。我一直认为脚是一件重要的事情。不是一直，但你知道，在过去的五年里，

the importance of toe strength and feet has been relevant to me for other reasons, but I never appreciated what a role it played in falling. So I'll leave it at that.
脚趾力量和脚部对我来说有其他重要性，但我从未意识到它在摔倒中扮演的角色。所以就说到这里吧。

But just to say, we'll link here to a whole bunch of exercises that go to explain how to strengthen your toes. Next thing you want to talk about here is really calf strength.
但是要说的是，我们将在这里链接到一系列解释如何加强脚趾的锻炼。接下来你想要讨论的是小腿力量。

And again, in the videos, Courtney goes through the benchmark tests for both gastroc and soleus test. I would say the following, virtually nobody I've ever seen has been able to pass these tests out of the gate.
在视频中，Courtney 再次进行了关于 gastroc 和 soleus 测试的基准测试。我想说的是，我从未见过有人能够一次通过这些测试。

These are very difficult tests and that tells us that most of us are heading into older age with underdeveloped strength in our lower leg.
这些是非常困难的测试，这告诉我们，大多数人在步入老年时下肢力量发育不足。

And so again, it's actually changed my training and I have added Much more soleus and gastroc training. And frankly, it's been at a much heavier weight than I've trained in the past because of my understanding of how those fibers work.
所以，我的训练实际上发生了变化，我增加了更多的比目鱼肌和腓肠肌训练。坦率地说，这是因为我对这些纤维如何工作的理解，所以我训练的重量比过去要重得多。

The other thing here is around ankle mobility. So another set of tests that Courtney put me through were around dorsiflexion and tibial rotation. And again, I was surprised that I did not pass these with flying colors.
这里的另一件事是脚踝活动性。Courtney 让我做的另一组测试是关于背屈和胫骨旋转。而且，我很惊讶地发现我在这些测试中表现并不完美。

And I think I passed on one side, but not the other. We showed the side that I failed on, if my memory serves me correctly. I'll also always remember something that someone told me many years ago,
我想我通过了一边，但另一边没有。如果我记得正确的话，我们展示了我失败的那一边。我也会永远记得多年前有人告诉我的一件事。

which was if you can't walk down a flight of normal height stairs, so call it a 7 or 8 inch step, whatever normal is, and keep your toes perfectly pointed forward, you don't have enough dorsiflexion.
如果你无法走下一个普通高度的楼梯，比如 7 或 8 英寸的台阶，无论普通是什么，而且你的脚趾要完全指向前方，那就说明你的胫骨屈肌不够。

So if you think about it, a lot of people when they're walking downstairs have to turn their toes somewhat out to accommodate the tibial or the shin angle with the foot.
所以如果你仔细想想，很多人在下楼梯时不得不稍微向外转脚尖，以适应胫骨或脚部的角度。

And so I would encourage everybody the next time they're walking down stairs to actually see if they can walk with feet perfectly parallel and pointing forward.
所以我鼓励每个人，在下次走楼梯时，实际上看看他们是否可以双脚完全平行且向前。

And if that's difficult on your lower shin and upper foot, You probably don't have enough dorsiflexion. And so again, we'll link here to a whole bunch of exercises that you can use to train that.
如果这对你的小腿和脚背上部很困难，那可能是因为你的胫骨屈肌不够。因此，我们将再次提供一系列锻炼的链接，供你训练。

And there are a handful of devices here that I use, and I really like these devices. Don't have any affiliation with all of them, so not promoting something that I'm a part of, but definitely something that I'm a big fan of.
这里有几款设备我经常使用，我真的很喜欢这些设备。我与它们没有任何关联，所以并非在推广我参与的项目，但绝对是我非常喜欢的东西。

The last few questions we wanted to hit are just kind of on a few different variables that relate to exercise.
我们想要谈论的最后几个问题涉及到与运动相关的几个不同变量。

The first is bone mineral density and you kind of talked about it with falls and frailty and we had a whole AMA that people can look at on bone mineral density,
第一是骨密度，你在谈到跌倒和脆弱时提到了它，我们还有一个关于骨密度的完整 AMA，人们可以查看

but what do we know about resistance training for bone mineral density in older adults because I do know this is something that As people get older, they're much more worried about and looking at, even compared to people in their 20s,
但是我们对老年人骨密度抵抗训练了解多少呢？因为我知道这是老年人非常担心和关注的事情，甚至与 20 多岁的人相比

30s. And also, I think this allows you to talk about, which I think is one of your favorite news stories on this subject. So do you want to speak to that?
30 秒。而且，我认为这让你可以谈论，我认为这是你在这个主题上最喜欢的新闻故事之一。那么你想谈谈吗？

Yeah. BMD or bone mineral density, which is one of the kind of four pieces of data you get from a DEXA scan is typically reported as both a Z-score and a T-score.
是的。BMD 或骨矿物密度是从 DEXA 扫描中获得的四种数据之一，通常报告为 Z 分数和 T 分数。

Now it's really important if you are getting a DEXA scan because you want this information, you need to make sure that it's reported segmentally. So a lot of places that do a DEXA scan don't give you the hip and lumbar spine Readings,
现在，如果您正在接受 DEXA 扫描，这是非常重要的，因为您想要这些信息，您需要确保它是分段报告的。因此，许多进行 DEXA 扫描的地方并不提供髋部和腰椎的读数。

they'll just give you total body T-score and Z-score and unfortunately that is not sufficient to understand your risk. So you need a T-score for the lumbar spine and you need a T-score for at least one if not both of the hips.
他们只会给你总体身体 T 分数和 Z 分数，不幸的是这并不足以了解你的风险。因此，你需要腰椎的 T 分数，至少需要一个髋部的 T 分数，如果可能的话最好是两个。

We'd like to see it for both hips but some places we'll just do one because the concordance between hips is pretty high. I'll take a moment just to explain what a T-score is.
我们想要看到两侧的情况，但有些地方我们只会检查一侧，因为两侧之间的一致性非常高。我稍微解释一下 T 分数是什么。

A T-score is the difference between your bone mineral density and the mean level for a 30-year-old of your sex divided by the standard deviation. If the T-score is below minus 1, that is defined as osteopenia.
T 分数是您的骨密度与同性别 30 岁人群平均水平之间的差异除以标准差。如果 T 分数低于负 1，那被定义为骨质疏松。

If the T-score is below minus 2.5, that is defined as osteoporosis. So that's sort of one thing to understand. Another thing to understand is how bones work from a density standpoint.
如果 T 分数低于-2.5，那就被定义为骨质疏松症。这是需要理解的一点。另一个需要理解的是骨骼从密度角度是如何工作的。

A lot of this is already covered in that AMA that we did and we should absolutely link to that for long listening, but I'm just kind of giving the TLDR here. We basically are in a bone building, net bone building phase until our early 20s.
很多内容已经在我们进行的那次 AMA 中涵盖了，我们应该绝对链接到那里以供长时间收听，但我在这里只是简要概括一下。基本上，直到我们 20 多岁之前，我们基本上处于骨骼建设、净骨建设阶段。

We sort of hit bone peak And then it's mostly a decline from that point on. For women, the decline becomes quite precipitous once they hit menopause if they are not placed on estrogen therapy. You might ask why.
我们在某种程度上达到了骨峰，然后从那一点开始大部分时间都是下降。对于女性来说，一旦她们进入更年期，如果没有接受雌激素治疗，下降就会变得相当陡峭。你可能会问为什么。

Well, it has to do with the fact that estrogen is potentially the single most important hormone when it comes to regulating bone health. And the reason for it is that bones respond to load.
嗯，这与雌激素可能是调节骨骼健康最重要的激素有关。原因在于骨骼对负荷作出反应。

So that gets to your question, Nick, which is why does strength training matter so much? It's because it is a load.
这就回答了你的问题，尼克，为什么力量训练如此重要？因为这是一种负荷。

The bones need a compressive force on them to grow and the compressive force comes typically when the muscles around them are contracting.
骨骼需要受到压缩力才能生长，而这种压缩力通常是由周围肌肉收缩时产生的。

By the way, the one thing that I recall from that podcast that stood out as even a greater impact on bone strength was wrestling and jiu-jitsu. Take that for what it's worth. I know that both of those are near and dear to your heart.
顺便说一下，我记得那个播客中最引人注目的一点是摔跤和柔术对骨骼强度的影响甚至更大。你可以考虑一下这一点。我知道这两样对你来说都是非常重要的。

But what happens is when the bone is placed under load, think of it as a strain gauge that measures the deflection of the bone and that strain gauge has to communicate through a chemical signal to the osteoblasts and osteoclasts,
但是当骨骼受到负荷时会发生什么呢，可以将其想象成应变计，用来测量骨骼的挠曲，并且这个应变计必须通过化学信号与成骨细胞和破骨细胞进行沟通，

which are the bone building and bone decaying cells respectively. And that chemical signal, so the mechanical signal is transduced into a chemical signal that's done via estrogen.
它们分别是促进骨骼生长和促进骨骼衰退的细胞。而那种化学信号，所以机械信号通过雌激素转化为化学信号。

And so that's why estrogen is so important because it's the chemical messenger that says, hey, I'm under load. I'm being deformed. Please give me more bone building material here. What else can I say about that?
所以这就是为什么雌激素如此重要，因为它是一种化学信使，它告诉身体：“嘿，我承受着负荷。我正在变形。请给我更多的骨骼建造材料。”关于这个问题，我还能说什么呢？

Well, look, unfortunately, this is another one of those things that declines precipitously with age and it's non-linear, meaning the rate of decline goes up by decade. It's not a constant rate of decline.
嗯，看，不幸的是，这又是一个随着年龄急剧下降的事情，而且是非线性的，也就是说下降速度会随着十年增加。它不是一个恒定的下降速度。

You referred to a study that was done by Belinda Beck at, I believe, Griffith University in Australia. We'll link to that, but it was called the Lift-More Trial. It was published in 2015.
您提到了一项由贝琳达·贝克在澳大利亚格里菲斯大学进行的研究。我们将提供链接，但它被称为“Lift-More 试验”，发表于 2015 年。

I've linked many times before to a great YouTube video where she kind of talks about the high level of this. This is a study that recruited healthy postmenopausal women with low bone mass.
我之前多次链接过一个很棒的 YouTube 视频，她在视频中谈到了这个问题的高水平。这是一项招募了骨量低的健康绝经后妇女的研究。

So these were women that all had at least osteopenia, T-scores below minus one. And the intervention group was given eight months of just twice weekly, 30 minutes at a time, so 60 minutes total, supervised strength training.
所以这些女性至少都患有骨质疏松症，T 分数低于负一。干预组接受了为期八个月的每周两次、每次 30 分钟的监督力量训练，总计 60 分钟。

Where they were doing 5 sets of 5 reps at more than 85% of their 1 rep max. The reason this study always caught my attention is these were women who didn't have a background in strength training and yet they were doing 5 by 5s.
她们进行了 5 组 5 次重量超过其 1 次最大重量 85%的训练。这项研究总是吸引我的注意，因为这些女性没有力量训练背景，却能做 5 组 5 次的训练。

And so we want to also kind of dismiss the idea that you can't take somebody who's new and get them strong. 5x5s are real set. Those are big workouts and these are being pushed to 85%, beyond 85% of their 1RM. So that was the intervention.
所以我们也想要摒弃这样的观念，即你不能让一个新手变强壮。5x5 是真正的训练组。这些是很大的训练量，它们被推到了 85%以上，超过了他们的 1RM 的 85%。所以这就是干预措施。

The control group was just given low-intensity exercise. And after eight months,
对照组只进行了低强度运动。八个月后，

the BMD of the lumbar spine in the treatment group had gone up by almost 3% at the same time that the controls had lost over 1% of the BMD in their lumbar spine. And basically the same thing was true in the femoral neck.
在治疗组，腰椎骨密度增加了近 3％，而对照组腰椎骨密度下降了超过 1％。而股骨颈的情况基本相同。

You saw an increase in the women who had been training versus a significant, it was almost a 2% decrease in the control group.
你看到接受训练的女性增加了，而对照组则出现了近 2%的显著下降。

So again, to me, it's just one of my favorite studies because of the population that it's using and the simplicity of the intervention. So I just can't say enough about the importance of this.
所以对我来说，这是我最喜欢的研究之一，因为它使用的人群和干预的简单性。所以我无法说出这一点的重要性。

I didn't realize it either, but how awesome of a name for a study is Lift More, M-O-R. Like, it's an A-plus name.
我也没有意识到，但“Lift More, M-O-R”是一个多棒的研究名称。就像，这是一个 A+级的名字。

You gotta do it. 你必须这样做。

Yeah, I just gotta do it. That should be a license plate for you. I feel like every now and then you're looking for license plates. Lift More is an A-plus one, although people might be expecting someone insanely jacked, bodybuilder.
是的，我只是得去做。这应该是你的车牌。我觉得你时不时在寻找车牌。举重更多是 A+级别的，尽管人们可能期待着一个疯狂壮硕的健美运动员。

That's true, yeah. 那是真的，是的。

Like Arnold style to walk out of that.
像阿诺德风格走出去。

Yeah, I would not do justice to that license plate.
是的，我不会对那个车牌做出合理的解释。

Yeah, that's probably true. Just need to do more Tabata deadlifts to get that muscle size up. Okay, what about protein? Another subject that you've talked heavily about, tons of places, we can link to all of them,
是的，这可能是真的。只需要做更多的塔巴塔硬拉来增加肌肉量。好的，蛋白质呢？这是你大谈特谈的另一个话题，有很多地方可以链接到它们。

but how does protein relate to muscle building, especially in people 15 plus, and how do you talk to your patients about it?
但蛋白质如何与肌肉建设相关，尤其是在 15 岁及以上的人群中，您又如何与患者谈论这个问题呢？

Oh boy, they're sick of it, I'm sure. Because we talk about it a lot. Protein by itself. Stimulates muscle protein synthesis. Ingested protein by itself stimulates muscle protein synthesis.
哦，他们一定听腻了。因为我们经常谈论这个。蛋白质本身。刺激肌肉蛋白质合成。单独摄入的蛋白质刺激肌肉蛋白质合成。

So in English, what that means is simply eating protein even without a training stimulus promotes the building of muscle. Of course, that effect is dwarfed by the effect of a training stimulus plus protein.
所以用英语来说，这意味着即使没有训练刺激，摄入蛋白质也会促进肌肉生长。当然，训练刺激加上蛋白质的效果要远远大于单独摄入蛋白质的效果。

Look, I think at the high level, this is relatively straightforward. You probably want at least 1.6 grams of protein per kilogram of body weight.
看，我认为在高水平上，这相对比较简单。你可能至少想要每公斤体重至少 1.6 克的蛋白质。

And as you get older, you should start to move that number higher and higher because of what's called anabolic resistance. So as we get older, the muscles become less sensitive to the effects of the amino acids. By the way,
随着年龄的增长，您应该开始提高这个数字，因为所谓的“合成抵抗”。随着年龄的增长，肌肉对氨基酸的作用变得不那么敏感。顺便说一句，

I won't get into it here because we covered it in great depth On the podcast recently with Luke Von Loon, but it was actually the first time I had a really good explanation,
我不会在这里详细讨论，因为最近在播客中与卢克·冯·卢恩进行了深入探讨，但这实际上是我第一次得到了一个非常好的解释

at least speculation as to why anabolic resistance is taking place. So I've never actually really known why. I mean, it turns out that maybe that's because nobody knows,
至少有关为什么会发生肌代谢抵抗的猜测。所以我实际上从来没有真正知道为什么。我的意思是，可能是因为没有人知道。

but Luke offered a list of several very interesting and plausible physiologic reasons for why the aging individual is less and less sensitive to amino acids. So again, we've done so much on protein. I don't think I need to say more here.
但卢克提出了几个非常有趣和合理的生理原因，解释为什么老年人对氨基酸的敏感性越来越低。所以，我们在蛋白质方面已经做了很多工作。我想我在这里不需要多说。