“Your grip strength and VO2 max are better predictors of how long you’re going to live than whether you smoke, drink, family history of cancer - those things all matter, but it’s amazing how dwarfed they are by those two…”

I heard Dr. Peter Attia say this on a podcast and I couldn’t believe it. It turns out, it’s true. 

Extremely poor grip strength and aerobic fitness are better predictors of death than common risk factors like high blood pressure, heart disease, diabetes, and smoking.

Here’s a graph I made that illustrates the magnitude of the effect that grip strength and cardio fitness have on longevity:

*Risk of death measured over 8-10 years. The stats for grip strength and cardio fitness are the difference between the lowest (least fit) groups to the highest (most fit) groups in the research cited. Some more caveats about the statistics at the end of the article. 

Isn’t that mind blowing?

In a world where the quest for longevity often feels like a game of chance, understanding these two simple yet profound factors could be the key to unlocking a longer, healthier life. 

Here’s some more info on the impact cardio and grip strength have on your health, as well as ways to measure and improve them both.

The Impact of Cardio Fitness on Longevity 

Studies have shown that individuals with higher levels of cardio fitness tend to have lower rates of mortality from all causes, including heart disease, cancer, and even accidents. 

According to a study published in the Journal of the American Medical Association, extreme cardiorespiratory fitness (CRF) is associated with a significantly lower risk of all-cause mortality.  

The increase in all-cause mortality associated with reduced CRF (comparing low vs elite performers) had an adjusted HR of 5.04 (95% CI, 4.10-6.20; P < .001), emphasizing the detrimental impact of poor cardio fitness on survival rates.

Translation - compared to those in the “elite” group, the “low performers” had a 400% increased risk of dying over 8.4 years (the length of the study)!

How to test and improve your VO2 max

So, how can you assess your V02 max (cardio fitness)? One simple and widely used method is the exercise treadmill test (ETT), where you walk or run on a treadmill while your heart rate and oxygen consumption are monitored. 

You’d need to find a facility in your area and it would probably cost between $150-250. If you’re a fitness nut, it may be worth it to get a baseline once every few years. If you’re not a nut, we have two easier at home options to test.

1. The Cooper Run Test - Run as far as you can in 12 minutes. When you’re done, use the equation below to calculate your VO2max:

(35.97 x distance covered in 12 minutes in miles) - 11.29 = VO2max

1. The Rockport 1-Mile Walk Test - Walk 1 mile as fast as you can.When you’re done, use the equation below to calculate your VO2max:

132.853 - (0.0769 x weight in pounds) - (0.3877 x age) + (6.315 if male or 0 if female) - (3.2649 x walking time) - (0.1565 x heart rate)

If you’re young and able to run without dying, use the first one. If you’re older and/or afraid of snapping a hammy, use the second one. 

Improving your cardio fitness doesn't have to be complicated. Incorporating regular aerobic exercise into your routine – such as brisk walking, jogging, cycling, or swimming – can help boost your heart health and increase your longevity. 

The recommended guideline is at least 150 minutes of aerobic activity per week, spread out over several days. For best results, I’d suggest mixing in low-moderate intensity cardio (walks and steady state cycle/jog/row/etc) with high intensity intervals (protocols like going all out for 1 minute, resting for 1 minute, and repeating for 15-30 minutes), 

Don’t get stressed about being perfect here. In the study I referenced above, improving from “low” fitness to “below average” resulted in a 50% reduction in mortality over a decade. Even small changes in your activity levels make a big difference in your overall health. 

The Impact of Grip Strength on Longevity 

Your grip strength, the force you can exert with your hand muscles, might seem like just a measure of your ability to open a jar or carry groceries, but research suggests it's much more than that.

One study, published in the Journal of the American Medical Association, analyzed data from over 140,000 individuals and found that every 5-kilogram decrease in grip strength was associated with a 16% increase in all-cause mortality risk. That's right – your ability to grip could be a better predictor of your lifespan than some well-known risk factors.

According to the same study, comparing the weakest performers (0-25th percentile) to top performers (74th-100th percentile) in grip strength, the adjusted HR for all-cause mortality was 2.06.. Translation, the lowest grip group had double the risk of dying over the length of the study (10 years) compared to the strong grip group. 

Why is grip strength so important? Because it’s a key indicator of overall muscle mass and function, which are crucial for maintaining mobility and independence as you age. Weak grip strength has been linked to a higher risk of falls, fractures, and disability, all of which can significantly impact your quality of life and mortality risk.

How to test and improve your grip strength 

One simple way to measure your grip strength is with a hand dynamometer, a device that measures the force of your grip. 

If you have access to a pull up bar, you can also time how long you’re able to hang. 

To improve your grip strength, incorporate exercises that target your hand and forearm muscles into your workout routine. This could include exercises like:

• Farmer's walks

• Rows

• Deadlifts

• Pull downs

• Pull ups or dead hangs from a pull-up bar

• Bicep curls

Really, any strength training exercise that requires you to hold a dumbbell will improve your grip strength. So, prioritize resistance training with compound movements 2-5x/week. 

If you only have access to small weights (2.5 or 5 pounds), you can hold those while you walk to improve your grip endurance. 

Prioritizing Longevity Through Fitness - Focus On What You Can Control

The caveat I mentioned above - The precise extent to which cardio fitness and grip strength influence longevity is tricky. The complexities of research methodologies, including different study populations, control groups, and time horizons, make it impossible to get 100% accurate stats. 

So, it doesn’t really matter whether the negative impact of low cardio fitness is 2x, 3x, or 4x as bad as smoking. Or if poor grip strength is 1.5 or 2x as harmful as high blood pressure. We’ll never know the exact comparisons. 

That’s okay, because the research makes this abundantly clear - cardio fitness and grip strength are two factors within your direct control that have a profound impact our health outcomes and lifespan.

Three more takeaways that I can say with absolute certainty:

• Statistics are really confusing! I’ve taken undergraduate and doctorate courses in understanding this stuff. Even so, I have to check myself three times to make sure I interpret the research findings correctly. 

• Focus on factors you can control, like fitness and diet. This will always be more productive for improving longevity than fretting factors outside your control, like family history or getting hit by a bus. 

• Since cardio fitness and grip strength have a massive impact on your chances of living a long life, it may not be a bad idea to measure, train, and aim to maintain these qualities.

If you need a hand with making a training plan to improve your cardio and grip strength, have your people call my people.

And if you don’t have people that make calls for you, you can fill out this form:

Work with me 1 on 1

:-)

Best,

John

P.S. My right knee after leg day.

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