Forever Strong: A New, Science-Based Strategy for Aging Well

by Gabrielle Lyon D.O.

risk increases further with a waist size that is greater than 35 inches (88 centimeters) for women or greater than 40 inches (102 centimeters) for men.2

in adults, waist-to-height ratio may be better than both BMI and waist circumference

To determine your WHtR, divide your waist circumference by your height, both measured in the same units. For example, if you stand 5 feet 7 inches tall, that equals 67 inches. If your waist is 36 inches around, you would divide 36 by 67 to get 0.53.

your goal should be to keep your waist circumference to less than half of your height, ideally a WHtR of less than 0.5.

taking measurements at the same time daily will provide the most accurate results.

I recommend an optimal fasting TG level of less than 100 mg/dL and an optimal nonfasting TG level of less than 150 mg/dL.

a genetic set point typically drives increased LDL cholesterol. Research suggests that heritability explains 40 to 50 percent of plasma LDL levels.

a good target level for your apo-B is less than 80 mg/dL, with an ideal level of 60 mg/dL. ACTION ITEM Test apo-B levels every three to six months—three months if you have elevated levels and less often if you’ve already hit the ideal range.

Alanine aminotransferase (ALT):18 Male: 29 to 33 units/L Female: 19 to 25 units/L Aspartate aminotransferase (AST): Male: 10 to 40 units/L Female: 9 to 32 units/L ACTION ITEM Test ALT and AST levels every three to six months.

studies suggest that serum levels of high-sensitivity C-reactive protein (hs-CRP) are a stronger predictor of cardiovascular trouble.

this number should be less than one.

Another effective way to regulate blood-glucose levels, as discussed, is through exercise, because muscle contractions use up glucose.

blood glucose should be 140 mg/dL or less, two hours after eating. Healthy fasting glucose levels run between 70 and 99 mg/dL.

patients who eat a higher-protein diet tend to run a higher HbA1C as well as higher glucose, which is still within the range of normal.

Normal hemoglobin A1C ranges between 4.0 and 5.6 percent.

Measurement of after-meal (postprandial) glucose response reveals your body’s reaction to a meal. Normal glucose tolerance should not exceed 140 mg/dL and should return to a normal fasting blood-sugar level after a two-hour period.

Using a continuous glucose monitor will allow you to gauge the effectiveness of your workouts.25 It will also allow you to see, in real time, if an after-meal walk is sufficient to keep blood glucose in check or if you require more rigorous activity such as air squats. The goal is to be able to leverage muscle as an organ to balance the glucose system. ACTION ITEM Test your glucose levels, specifically how often your blood sugar is elevated over a period of time, by performing a glucose tolerance test, wearing a glucose monitor, or doing a finger stick after meals.

While properly balancing micronutrients can go a long way toward minimizing hunger, the sensation itself, when it arises, can be reinterpreted as evidence that your body is utilizing stored fuel for energy. I typically tell my patients that hunger (not starvation) is something you can master. It is a cue that you are burning the excess adipose tissue keeping you from moving in the right direction.

when it comes to exercise, I tell my patients, “If you don’t want to quit at least once, you’re not working hard enough.”

If you don’t have time for fitness, how do you think you’re going to have time for sickness? You’re not ever going to find the time for health; you must make the time.

You can expect to lose roughly 12 percent of your strength with each week of inactivity.

Because of the muscle breakdown-and-repair process, training at least three times a week is essential.

Weekly Training Targets 150 minutes/week of moderate-intensity to vigorous exercise. Resistance training three to four days a week. 1 HIIT session each week.

Incorporate compound movements that involve more than one muscle group at a time.

Continuously track your workouts and progressions.

given that a reduced VO2 max is the strongest predictor of cardiovascular and all-cause mortality (aka your likelihood of dying), it’s an excellent measure for health.

Increasing strength-training output remains one of the most effective tools to move the body-composition needle—especially if you’ve been feeling stuck.

ADVANCED At least 150 minutes of vigorous aerobic training per week. Resistance training of high intensity that involves all major muscle groups four to six times per week,

After you have identified your one (or two, max) SMART goals, we need to identify any roadblocks that could impede your progress.

Next, we’re going to determine your goal timeline and your weekly training frequency.

Stabilization: The ability to provide dynamic joint support to maintain correct posture during all movements.

Muscular endurance: The ability to produce and maintain force over prolonged periods. Muscular hypertrophy: Increasing muscle size through enlargement of skeletal-muscle fibers. Muscular strength: The neuromuscular system’s ability to produce internal tension to overcome external force.

Muscular power: The neuromuscular system’s ability to produce the greatest possible force in the shortest amount of time possible. Think explosive movements.

A dynamic warm-up that includes movement rather than static stretches can start with five minutes of cardiovascular activity (treadmill, StairMaster, high knees in place) at low to moderate intensity followed by five to fifteen minutes of more specific movements based on the day’s exercises. Important areas to warm up are the ankle complex, the hip complex, and the thoracic spine in your mid-back.

Train each specific muscle group three to five times per week with 48 to 72 hours of recovery time in between.

Think of ways you can make your current exercise selection more challenging once you’re ready to progress.

For a higher payoff, do your conditioning and interval work as a separate morning session, then complete a resistance training session approximately six to eight hours later.

A well-rounded program requires balance between muscle groups and incorporates all our movement patterns. Your workout also needs to balance pulling motions (e.g., a row, bicep curl, lat pull-down) with pushing motions (e.g., push-up, chest press, overhead press). Leg exercises occupy their own category, beyond push or pull, because most incorporate both the anterior (front) and posterior (back) muscles synergistically, unless specific muscles are isolated on a machine.

Perform the most important exercises first, when you have the most energy, mental focus, and time.

studies show that muscle improvement increases when we visualize the target muscle and consciously direct activity and concentration there during exercise performance.

Alternating DB chest press.

DB underhand grip row.

DB split squat.

Bear crawls.

low-impact cardio. Examples: swimming, biking, rowing, elliptical, hiking, walking. Low-intensity exercise means working within 50 to 60 percent of your max heart rate. Any of the examples listed above will qualify. Or calculate it yourself with this equation: 220 – your age = general guideline for max heart rate. Then multiply that number times the percentage of the target heart-rate zone.

Squat prying.

T’s, Y’s, L’s, W’s.

Kickstand RDL.

Push-ups.

DB bridge pullover.