09. Exercise as Medicine VO2 Max, Zone 2, and the Future of Longevity with Cooper Paul

Welcome back to the Functional Medicine Reality Podcast. I'm Dr. Mark Su, and today we're pivoting from the chronic inflammation world into the longevity space. I'm here with Cooper Paul, a pulmonary hypertension specialist at a major academic hospital in Boston and a true longevity medicine enthusiast who's taught me an incredible amount over the last few years.

Here's the thing. We all know exercise is good for us. But what if I told you there's data showing that going from a low VO2 max to an elite VO2 max can decrease your risk of dying in a given year by 400%? There is no medication in the world that can do that. And that's what we're unpacking today.

What We Cover in This Episode:

Cooper shares his family's story with the New England Parkinson's Ride, a fundraising event for the Michael J. Fox Foundation that's raised well over $12 million. That personal connection through his father sparked his passion for longevity medicine.

We break down the three pillars of exercise science within longevity medicine: VO2 max (your anaerobic power), zone two training (your aerobic base), and muscle mass and strength training. Cooper explains why VO2 max is the single best predictor we have for both healthspan and lifespan, and why even small improvements can make a drastic difference.

Cooper introduces predictive programming and back casting. You can actually project what your physical capacity will look like at 75 or 80 based on where you are now. Then ask yourself, is that the future I want? If not, build a plan to change it.

Zone two training is where things get counterintuitive. This isn't about grinding yourself into the ground. It's low intensity, sustainable, and it builds the aerobic base that supports everything else. Cooper explains the pyramid concept: VO2 max is the peak, but you can't build a tall peak without a wide base.

We also cover strength training for longevity. If you want to pick up your grandkid at 80 and that toddler weighs 35 pounds, you probably need to handle 45 to 50 pounds now to account for the scheduled decline we all experience.

Key Takeaways:

Low to elite VO2 max decreases your risk of dying in a given year by approximately 400%, far exceeding any medication.

You don't have to reach elite status. Even moving from low to below average makes a meaningful difference.

Zone two training is the foundation. It's the "I'm a little bored on the treadmill" kind of workout, and it works.

Strength training for longevity is about functional independence, picking yourself up if you fall, opening a jar, playing with your grandkids.

Progress over perfection. This is a lifelong endeavor, but it doesn't have to be an internal battle.

Connect with us:

Root Seek Health: https://rootseekhealth.com/

Dr. Mark Su's Podcast: Functional Medicine Reality Podcast

True Wellness Clinic (for VO2 max testing, DEXA scans, and more): truwellnessclinic.com

📊 Got Lab Results But No Real Answers? Download your free guide: https://rootseekhealth.com/podcast/

Transcript

Welcome And Purpose Of The Show

Dr. Mark Su 0:09

I'm Dr. Mark Su and welcome to the Functional Medicine Reality Podcast. Join me and our community weekly as we bring you unfiltered health from inflammation to longevity, real stories, real people, real solutions. Experience real life health changes from both patients and practitioners, and learn how to turn cutting-edge information into real results in your own life so you can feel better, live longer, live healthier, and be confident and clear in your healthcare choices. Let's get real and get results. I'm your host, Dr. Mark Su. I'm here today with longevity expert Cooper Paul. We are here, as usual, to help create clarity amidst all the noise out there in the internet and social media space and the ever-expanding healthcare space. We want to help you make better decisions so you can filter through all the noise, be able to make some better decisions with your time, money, and your effort so that you can be better and healthier with more efficiency. So today we're going to jump right into the topic of exercise science and longevity. All right, we're going to get really funneled into a specific lane within the longevity medicine world. We've been talking a lot in the previous episodes about a lot of chronic health, like chronic inflammation problems. And today we're making a kind of a hard pivot into the longevity space, and we're going to be talking about how we can optimize our longevity specifically in the realm of exercise. So with me today is Cooper Paul. He is a pulmonary hypertension specialist. He's employed at a major academic hospital in Boston. We've known each other for I think you said recently, maybe close to four years, Cooper? Yeah, I think I think right around four years. Which kind of surprised me. I didn't think it was that long yet.

Cooper Paul 2:06

Maybe three. I'm bad at that. I also thought my dog was three, and turns out she's almost five. So time moves weird in my brain.

Cooper’s Backstory And Parkinson’s Ride

Dr. Mark Su 2:14

You're just trying to make me feel better because I'm always off by at least a year. Yeah. Hopefully I don't do that with my own kids, and I don't know, we'll see. But um but uh Cooper is also a longevity medicine enthusiast and expert. I've learned an awful lot from you, Cooper. You already know that. Um, but let's go ahead and jump right in. Is that cool? Absolutely. Sounds great. First things first, I want to just uh quickly say, like, um, hey, what's what's some of your maybe background origin of interest and why you are into longevity space? And this may not may or may not be part of the answer, but um, I just think it's such a cool story about your family's fundraising activity in the state of Maine for a very high-profile um fundraising organization. Um, tell us a little bit about that.

Cooper Paul 3:06

Yeah, absolutely. Um, I have an awesome family. So my my father has Parkinson's and um my grandmother started a charity, I I shouldn't know how long ago, close to 20 years ago, and there was about 15 to 30 people that did this bike ride the first year and raised an a non-insignificant amount of money, but small. And it has grown tremendously over the years, and now there's about 1,500 riders that do this ride every year. They've raised well over 12 million dollars at this point. It's it's pretty remarkable. I think I'm I'm even selling them short on the number, but I don't want to exaggerate off the top of my head. But um, I come from a a group of people that really, when they put their mind towards something, they they get they get obsessed. And I think that's exactly what happened to me here with longevity medicine. Um, I think obviously we see it all around us in terms of people aging, especially working in the hospital, and we see the the negative side of aging. Um, and it's hard to find that focus on some of the really fun positive parts of aging in the time of life where we might not have as much work to do and get to spend more time with family and doing more of the things we like. And I like thinking about my future that way more than looking at the sickness and the ways that getting older can be difficult. And so in that I I got pretty obsessed with the idea of how to make that time as enjoyable as possible and and what can we actually do about it rather than waiting and hoping that it doesn't happen to us.

Dr. Mark Su 4:43

Yeah, no, that's great uh that's a great segue. And um, maybe you're being modest and humble, and it's kind of it's just kind of fun name-dropping, but so you guys, your your family has raised, you said, at least $12 million over the years for the Michael J. Fox Foundation. Yep. Uh, you know, relative to obviously relevant uh obviously to Parkinson's disease. Yes, with the New England's Parkinson's ride, shameless plug.

Cooper Paul 5:06

I probably should have thrown that in beforehand. I was gonna say, like, yes, let's feel free. I'll freeze it. It's a fantastic let's call it again. The New England's Parkinson's ride, and it's a really great resource for people that are newly diagnosed or been diagnosed for a while. Um, a lot of great people that come and do the ride and volunteer and and have met a lot of um a lot of people that have helped them throughout that. So I can always recommend that for anyone listening that you're here for a different reason, but hey, you know someone with Parkinson's or you at Parkinson's, it's it's a fantastic place to start.

Dr. Mark Su 5:37

Yeah, and I think you've um been aware, more aware than the a lot of typical healthcare practitioners, even in the functional or longevity space about Parkinson's, obviously, as a result of being so connected there. You guys have um been pri you know, had been privy to be at the gallas. I think you did you say you guys were the number one fundraising event of that organization for multiple years in a row, maybe for multiple years, yeah.

Cooper Paul 6:03

The the number one single-day event uh uh fundraiser for the Michael J.

Dr. Mark Su 6:09

Fox Foundation. Yeah, that's just crazy. I mean, beyond the name-dropping part, which is fun, but um that's like such an accomplishment for you guys.

Cooper Paul 6:18

Like, I I can't take any credit. It's I swear to God, it's my grandmother, my parents, my aunts, my my brother and his sister-in-law, the a lot of people working on it that do a tremendous job. I I tend to be one that gets to go and volunteer or ride a bike and and partake in it, but the hard work is all theirs.

Dr. Mark Su 6:37

Yeah, I mean, but it's it's just yeah, it's so fulfilling and has so much purpose behind it, right? Absolutely. Uh and you and then you recently shared with me that, well, we you can't do more, you can't have more participants in the 1500 because it's a town regulation law.

Cooper Paul 6:52

Exactly. Yeah, we're at the city limit. And and the town's been so good to us, I don't see us ever, ever going somewhere else for it. So that's kind of where we're just the crazy thing to me too.

Dr. Mark Su 7:03

You can't expand it, yet you're still like the top fundraising activity in the country. You think like there's somebody who's found a bigger venue or bigger something to be able to load in participants, but it's incredible. It's remarkable. Yeah, really, really good stuff. Um, so again, beyond the yeah, beyond the name drop, it's just it's just a really honorable and heartfelt um accomplishment and just um service to to humanity and and purpose. So that's it's it's good stuff. And again, as you just said, it's a real driver for you as motivation for health and wellness and uh longevity optimization.

Cooper Paul 7:38

Yeah. So absolutely.

Why VO2 Max Predicts Health And Lifespan

Dr. Mark Su 7:40

It's a great segue. Let's let's jump in, pivot here. So that's a great segue because we're talking it wasn't intentional, but we're talking about biking, okay, right there, a cycling event. And so we're gonna talk briefly here today about um a bit about exercise science. So through the long lens of longevity medicine, all right, you've taught me an awful lot about VO2 Max, zone two training, muscle mass conditioning. A lot of folks by this point have come across Dr. Gabrielle Lyon that talk about muscle, and muscle is your longevity organ. Shout out to Dr. Lyon. I've seen her present a couple times in conferences. So by now, also, a lot of people have seen that 60-minute segment back in December talking, you know, made big news social media talking about the the value of V2 VO2 Max. So start us off here, Cooper. For those who may not be yet be really aware of VO2 Max, maybe they've heard of it, they've seen something on the wearable, this or that. But why should anyone actually care what their VO2 Max score is? Like why is it, why is it such a big deal to you and other longevity experts?

Cooper Paul 8:43

Yeah, absolutely. I think it is as a test, the best predictor we have for both longevity, or I should say for both health span and lifespan. So it's the best predictor we have for how long you're going to live, but also how well you're going to live. And then to add on to that, I think as it comes from a treatment standpoint or from improving your VO2max, I think it's the most powerful tool we have to extend our lifespan and our health span. So as a medicine, of course, exercise is the best medicine, is what we love to say. But I think VO2max is where we can take that data and say, here's how good of a medicine it is, and here's how big of a difference it really can make in our lives.

Dr. Mark Su 9:28

No, a lot of a lot of personal trainers or exercise enthusiasts might have gotten a little cringy calling exercise medicine, but I think we we all get where we're coming from here, right? It's inner and if we want to say an intervention or a treatment, but yeah, nonetheless, um, you've shown me some really cool graphs uh comparing the power, let's say, the power of exercise as a treatment as measured by the VO2 max compared to other either disease states or other um interventions. Um you want to give us a little back on that?

Cooper Paul 10:02

I mean, if you think about um like if someone's a smoker, it's gonna increase your risk of dying in a given year by about 30%. Um if you have coronary artery disease, it'll probably it'll increase your risk of dying in a given year by about 40%. Going from a low VO2 max to an elite VO2 max will decrease your risk of dying in a given year by 400%. There isn't another medication in the world that can do that or another behavior that we can do that can do that. So I think that's why when we talk about this in health and longevity, you're not gonna have a long conversation with me about diet or we need to eat this food or that food, because it not that that stuff isn't important, but I think this stuff is the bare minimum. It's it, I shouldn't say the bare, it's the it's the best thing we can do, and I'd say step one. If if that's your goal, this is the place to start.

Dr. Mark Su 10:56

Yeah, those numbers you throw out, you know, 30, 40% risk of dying from smoking or coronary artery disease, and then 400% reduction in risk of dying any given year from a VO2 max. Not from it's not so generalized just to say from exercising, right? Because that's the key here that I've really you've really impressed upon me and really ingrained in my head and my soul is that we we all I think everyone would agree that exercise is good for our health. Yeah. The question now is how good and what kind of exercise, and how do we know how much benefit we're getting? Like, are we are we just talking about it's healthy for us uh categorically and sort of as a general concept, or can we actually get a little more uh quantified about it, right? Not to over-medicalize it, but hey, if we had the tools now to, with the data and the studies that you've pointed out to me, to say when you do whatever you like to do, but you actually accelerate and improve your VO2 max from, as you said, from what low to elite? Exactly. Right? I think low to from a low status uh again, graphs, we won't get technical as the definitions and all that stuff.

Cooper Paul 12:08

Yeah, absolutely.

Exercise As Medicine By The Numbers

Dr. Mark Su 12:09

But if we looked at the charts and you went from a low category for age to an elite category by age, 400 and I think it's 404%, which is it's almost like beyond belief. Yeah. Uh but not even elite, right? You've pointed out that you don't have to even get to the leak status.

Cooper Paul 12:26

Yeah, exactly. There's drastic improvements just moving from from low to below average or below average to average. And so I think that is something that we always impress upon our patients is our our starting point does not mean you come in day one and you're in the low category for your age, and we say, all right, we've got to get you to elite. It's it's showing, hey, any small benefits you start getting from this, any any amount of work you start putting towards this is gonna have drastic improvements on your health.

Dr. Mark Su 12:55

Yeah. Yeah. So, you know, speaking of that, so one one further step, next, next kind of uh extension thought here. Um, I believe the term you love is uh predictive predictive programming. Am I right? Absolutely. Because I I think the term I like is like prescriptive exercise, but I'm I remember a lot of P's in there, right? But yeah, I'm pretty sure it's predictive programming. So, you know, um so you love that term, predictive programming, the concept of backcasting, which is very much like a financial planning or other kind of planning where, okay, where do you want to be at this point or that point or that point? And so how do we get there? Right. And so um, but you know, again, like if I'm just thinking more historically or public health thinking, just in general, the uh a given Americans, general Americans uh thinking might be exercise is good for me. Okay, I'm gonna go exercise. What do I want to do? Uh maybe this, maybe that. But now we can say, well, that's kind of like saying, well, yeah, I want to be able to retire at 65. So maybe I'll go get a job doing this, or maybe I'll go do get a job doing that. But that's that's not very strategic. Yeah, exactly. Right? We kind of need a little more planning and a little more data involved, right? So tell us about the term predictive programming. How does it relate to VO2 max score?

Cooper Paul 14:11

Yeah, absolutely. So I mean, I it's it's tough because like you said, thinking of your exercise routine as medicine is is sometimes a little bit of something that might turn off some patients to exercise, and that's not how they shape it in their heads. But for this perspective of, hey, we're specifically looking here at how long can I live, how healthy can I be. Thinking of it from a predictive programming point of view is saying, all right, if I do a VO2 max test and I get my result and it shows me that at the age of 75, I'm gonna have a pretty difficult time walking up a hill at three miles an hour. And so the things that I like to do are gonna start becoming difficult at the age of 75. And so some someone might see that and say, great, I'm happy with that. But I think for us it's it's allowing someone to look to be able to predict out what their future is going to look like, then make a second list of saying, hey, here's what I want it to look like, and then we can develop a plan for patients based on exactly what that what that goal is in mind. And I think as the same idea as backcasting, it's we want to think of the future and get an idea of what it's going to look like and or what we'd like it to look like and make a plan based off of it. Because, like you said, if you go to a doctor's office and you say, Hey, nice to meet you, how have you been? I've been great. All right, we're gonna prescribe you a bunch of medication just that you have you have no need for yet, but you might. It doesn't really work that way. But in this in this field for for health, it's kind of the opposite. This is this is a field where I think the earlier you get started, the better. There's always going to be improvements that can be made. But I think uh for me, and why I get so passionate about this is for my age group in particular, for the younger person, medicine can seem a little bit like, ah, I go to the doctor, they tell me they do my normal labs, my blood pressure, everything looks good. They tell me to come back in a year. And so they think I'm healthy. But I want people to think about it from a perspective of, well, how healthy am I? And how healthy am I going to be? And am I doing the things right now that are actually going to make a difference in my life as I get older? Or am I just a ticking time bomb? And I think that's really important for patients to think of, not just from the perspective of, am I a ticking time bomb to develop diabetes or heart disease, but just to go do the things you like to do? Because you might be on a great track from uh your your cholesterol might be great your whole life and you're not going to get heart disease, but it doesn't really matter if you can't go and take a walk with your grandkids if if that's something that matters to you.

Predictive Programming And Backcasting

Dr. Mark Su 16:54

Yeah, that's really cool. It's kind of like the difference between um talking about uh yeah, d um what's on paper and disease versus actual thriving. Yeah, exactly. Um yeah, so I think um, you know, and I'm just thinking through, you know, who might be listening and someone who say someone who doesn't like to exercise, right? Um I don't know. There might be somebody who's they historically don't like to exercise, but this actually is motivating them. Yeah. Maybe, right? There's some people who um, like you said, there might be some folks who they don't want to kind of create a, they don't want to over-medicalize their exercise. Hey, that's cool. That might be right just where they are, where you are right now, but things change. And as and again, the the point here that I think about is just that the data is there to give us that opportunity. It avails itself and avails to us the opportunity to be empowered with knowledge. Yeah, absolutely. And be able to, as you say, be able to be more uh intentional for those of us who want to be about our course of our our life and our our quality of life and or length of life.

Cooper Paul 18:03

Absolutely. And I think to feed off of that, I would say a majority of the people that that we've interacted with, I think a lot of them really enjoy exercise, but may not know exactly what their in specific goal is outside of, hey, I like to exercise, I take care of myself, but I need a little bit more um goal in mind. And so you have someone that's training for a marathon, and it's a pretty specific way to train for a marathon. But that's once you're done with that goal, you've run the marathon, now what? And I promise you, if if your goal is living to be a a really healthy 95-year-old, you're not gonna train for a marathon every day. That's that's not gonna be the answer of how to do it. So I think for some people it's having being really healthy and doing the things they want to do at 95 years old, if that's your if that's the plan you have in mind, then there is a really specific way to exercise for it. And I think that's it can be um exciting for patients because sp they can look at that and say, all right, this is now how I'm going to to tailor my workout and have a plan.

Dr. Mark Su 19:11

So two two kind of uh slight side rail questions I think about. One is I don't know, let's say, let's say um, so I I know I can be a little bit person I can be a person whereby I start creating some real higher expectations for myself in the form of if I'm gonna start doing this, I really need to commit to it. I need to be able to keep it up long term. Okay. Let's say we're talking to someone like that who's like, you need excise, maybe they don't, okay, but they're motivated by this kind of information and to find out the Rio2 Max and go, oh wow, like, okay, I this actually it sparks something in me, and I'm gonna go do something. Okay, I'm gonna do something about it. But let's say they then have the thought, man, I'm gonna have to do that like forever. Or do that for like what kind of commitment for how long? Do we have any info at all? Here's the question Do we have any info at all as to like I don't know that we've never talked about in those studies? How long were people doing that for, or was that not known? It's just like a spot on the um spot check on what their VO2 max is. You know, is there what I'm really getting at is can we say any what can we say to people about, hey, per progress over perfection doesn't need to be perfection, doesn't need to be forever, and think and and if you kind of fall out of routine, you go on vacation, you get hurt, whatever else, like it's okay. You can climb back in the wagon, get in back in the saddle. You can still, even if you don't get back to where you were exactly, some is better than none.

Cooper Paul 20:37

Yeah. I think that's a great question. And I'm I might have a little bit of a cop out of an answer, but I think what you're saying is exactly right. I mean, this is a lifelong endeavor. And when we think about the fitness of our bodies, um, I think it's we've all seen it. You can lose it way faster than you can gain it. And so with that, we do have to keep in mind that this is a lifelong endeavor. And I think it's a struggle for some people who come in, get their VO2 max tested, and it's not where they want it to be. And you see that early first two-month push, they want to make that big change right away. And it's just this is something that does take time and takes it's it's a lifelong work. You're never gonna be able to say, I've done it. Now it's time to take a break. It's it just doesn't work that way, and it's it's gonna be a life of a passion of your entire life of I've I've got to take care of myself. And what better reward than being able to live independently and pick up your grandkid and go play golf with your friends? And I think that's there's of course the rewards are daily. The the rewards and the the benefits you're gonna feel from it are going to be right away, but the work that it's going to take isn't gonna end once you hit a hit your goal.

Wearables vs Lab Testing Accuracy

Dr. Mark Su 21:59

And I and uh right off the bat I'll say preview it it doesn't have to be a grinded out internal conflict um you know I'm I'm expending beyond I'm fighting myself about it. We'll talk about um we'll we'll definitely get to zone two and uh it's almost a little contrary to a lot of people's opinions as we've talked about a lot uh or people's expectations about how much effort you have to put out and all that so we'll get to that in a second but um just preview like it doesn't have to be an internal conflict okay um but yeah I'm thinking about how um yeah some people uh just aren't that exercise oriented right and so that that's where I'm coming from you know I'm just thinking about some people listening may not be they're not they're not the fitness junkies they're not the the gym rat right um but there is something to be said about like the contrary to that to me I'm just um reflecting on you know we have a lot of patients who look I think in in the functional medicine world right we have a lot of patients who they may not be against a seven-day course of antibiotics okay I'm sick as crap or have pneumonia or whatever I'm not against the antibiotics there. What they're against is having to take a statin forever or take blood pressure medicine for the rest of their life or whatever it is, right? And I'm not being anti-pharma. I'm just saying people don't like having to take a medication for the rest of their life. So in this case it's kind of like well yeah it's a lifelong endeavor but if we can find something that the activity, because it's all about the metrics, not about the actual activity, which is what you taught me when I first when we first started talking about this years ago, I kept asking like what is the exact exercise? And you're like, yeah, it's not like that. Yeah. Yeah. Right? There's a lot of different paths to Rome, if you will, absolutely to get that V2 max up the zone too, whatever. And ultimately um if you can if you can nail dial in, lock into what you can enjoy and sustain, um that's much more enjoyable to people and embraceable and sustainable and it has many more benefits, 400% more 400 plus more percent benefit um than say, you know, con um in parallel with that statistic you threw out earlier than say uh people's usual disgruntlement about having to take a medication for the rest of their life.

Cooper Paul 24:13

Yeah absolutely I never thought about that but fair?

Dr. Mark Su 24:18

No I think you're spot on. So let's let's flip it back over. Okay to you so let's go back to the the VO2 max you've given us a lot of um like some pretty solid and compelling data. And these this is not these are this is these are studies. Like we can, you know somebody wanted to find out they can message us one way or the other we'll uh through the podcast, through the through the rootseekhealth.com website we can get them the the studies, et cetera let's talk a minute about the differences in VO2 Max testing and the accuracy of those results, right? There are people no doubt listening going like, oh yeah I've got whatever an ordering a whoop watch or whatever the case may be many different wearables talking uh that measure VO2 max. Um tell us about those differences um as far as we know anyway we don't always know the algorithms but um there's ways people know that they can measure just um walking running et cetera and kind of timing themselves et cetera et cetera yeah tell us about the differences in accuracy and the ramifications of those results.

Cooper Paul 25:12

Yeah absolutely um I think I think the most important thing I would say is because of how how we've prefaced this that this is a really important data point and it's a really important test for you to know where you stand and to project out your future for me I always want to get the most accurate data. And so does that mean that every three months you want to go and pay money to go get your VO2 Max tested with a a mask on I don't necessarily think that that's the case but I think it's important to get for one a baseline and then schedule check-ins. That being said the Aura ring the Apple Watch or the Whoop or whatever these wearables are there is something to be said that they are there's some accuracy to them. I don't think they're extremely far off. I think they are based on algorithms and the heart rate zones that they give you for for where you're at during exercise tend to be again they're based off an algorithm. So for some patients that might be higher and when we talk again later or in a few minutes about zone two you might see that people are actually not spending as much time in zone two as they think they their heart rates actually or I should say their their heart rate zones are a stage higher than they should be and really they're spending the majority of their time in zone three and so I think there is benefit to be had from using them.

Dr. Mark Su 26:41

But that being said I think there is there's a real reason and and uh a pressing nature to why I think it's important to to get a validated uh a validated test and get your actual results before relying on the wearables it makes me think about um I I I don't know I don't know how much I worry so greatly these days about blood pressure cuffs that people grab at you know a local pharmacy this and that online but um it's pretty common we'll still suggest to people if certainly if you have any question at all, bring it in to the office we'll check you you know on our manual professional cuffs and check your home cuff and then get a comparison, right? So at least they have a sense of it. I mean this happens all the time with scales. Yep. Right? Absolutely hey at home I'm measuring like six pounds more all the time and I'm not wearing clothes compared to when I'm in the in the office, right? So hey if you get a comparison. So that that seems like a very reasonable thing to do say hey like as like you said as at least as a baseline and then so if you've got some other kind of wearable then okay at least you have a sense of the um you know the proportion or ratios of or the yeah the comparison contrast and just get a sense of where you're at with whatever wearable you're using. And I think you would I'm guessing you would agree that we've because I think we've probably talked about this to say, hey like um whatever whatever wearable the person might have, uh it's very it's for me it's much more arguable that the the value there is you can use that, even if it's not like the most accurate, it's still going to be pretty consistent or precise in that if I'm at this score now and then I'm working out my exercise in this way and then three months later I'm getting you know whatever change on my wearable, whatever algorithm that is, it's consistent to three months ago as to how it's measuring that. So I can at least gauge my direction of change.

Cooper Paul 28:27

Absolutely completely agree.

What A VO2 Max Test Feels Like

Dr. Mark Su 28:30

So just for a second here we talked um you know at at the local longevity clinic here close to where we are right True Wellness and New Report, so we um we use the Panoe machine right so this is we have no financial affiliation with Panoe. This is not an ad for Panoe but uh we use that to test the VO2 Max and many, many other metrics, right? But um if someone's listening and or watching they don't know uh they're completely unaware of what that's about.

Cooper Paul 28:59

Um can you describe what what that test looks like right what it what what does a person experience if they're gonna walk into doing a let's say a Panoe test because there is let's let's just say that's an exemplary of other kinds of gas mask testing if you will absolutely so it's it's a pretty fun test for everyone um and so you come in you you do put on a mask um that is pretty air sealed to your face um you have a little battery pack attached to your back for it um and you get on a bike the test takes usually somewhere between eight to twelve sometimes 15 minutes um and you push yourself pretty hard it is a an all-out exercise test so it ramps up as you go it gets more difficult as time goes on um with a short cooldown period at the end and you push yourself and it's it's a little uncomfortable depending on where you're doing it but you do get a ton of really really useful data for a 15 minute test. So I think all things considered for some of the things that I think some people can get a little nervous oh am I going to be able to exercise with this with this mask on it might feel a little bit uncomfortable and I think that's that's totally normal but I think it's a relatively short test.

Dr. Mark Su 30:17

Obviously it's non-invasive and it's it's pretty uh pretty painless yeah so I was just getting ready to ask you so when you say it's it it's a little uncomfortable but then at the end you said it's pretty painless. So yeah um like you know my observations of of it and seeing you know um seeing you having tested multiple people I don't know that I think of it as um uncomfortable I certainly don't think of it as anywhere near painful but um yeah what what can someone expect especially someone who's like I I'm not I don't consider myself in shape right um I mean there's a ton of people who are like well I don't want to test my cholesterol yet let's wait till after the holidays or let's wait till I lose five pounds, seven pounds, whatever, and then let me check my cholesterol. So I'm sure the same thing applies here. I'm sure there's plenty of people who are like uh I'm not really in shape. Let me I'm just started or I'm intending to get in the gym give me two months and then I'll test like what do you say to that kind of person?

Cooper Paul 31:10

Yeah I actually think that's a fantastic uh thought process from that person. And this might be the one field of medicine where they're right. And so actually with a with a VO2 max test, if you haven't done any exercise in the last month, you're probably actually not going to get a very accurate test because to some degree it you just haven't um you haven't really pushed yourself like that in a long time. And so you might fail for reasons outside of just are you I shouldn't say fail, but you're gonna get a low score for reasons that may be related to muscle weakness or really you just for lack of better terms poop out sooner than you really would have if you had a month of just a little bit more exercise um in your schedule. And so I do like to say to people that haven't really been exercising at all to give yourself three to four weeks of add in one day a week where you just do a little bit of exercise coming just come in from a place of this is now a part of my routine so that when you get on the test it isn't the first time you've trained in a little while because obviously you're coming in you're going to push yourself pretty hard.

Dr. Mark Su 32:20

Now you've so just to I mean not to like reassure I guess but just to flesh that out a little bit more that that hard push it doesn't it doesn't start out like that right away it's absolutely not at the beginning it's really pretty low key.

Cooper Paul 32:34

Yep. It's called it is called the ramp study. So it starts at a very low resistance and it increases about every minute as you're going um until it gets to a point where you you you again lack of better term it's what I use with the patients I want you to go until you poop out. And so I think that's that's the best way to describe it is you really do push yourself until you you really can't push yourself any further.

Clinical CPET vs Longevity Testing

Dr. Mark Su 33:00

Yeah so it's intended right I mean that's it's not a sign on someone's like deconditioning or whatever because no matter who you are no matter how fit you are or aren't everyone's going to hit that point of um of uh what our you know you've met Christian our our son with uh with bodybuilding what they call like um failure yeah I mean you said you said you kind of backed off on the word failure but the workout guys they they use that term purposely yes absolutely you max out you max out your reps and you max out the weight until you you hit like failure and you like I cannot do anymore. Exactly. Right? They do it on purpose. Most of us as most of us as Americans as humans in in America we're not so motivated to do that. But I can't I I look back on reports um by the way I was looking back on our results you know um last night just across the the table of results and holy cow his his VO2 max score was so high I know he was a lot younger but oh my oh my God. Okay. So maybe there's a maybe he's done really well to max himself out. But everyone's gonna max out no matter who you are. Yes. Exactly. And I would I I've thought uh you've you've definitely pointed out that you know if if someone's older especially right um I don't know let's say 60, 65, certainly 70 and above, those folks definitely you want to be a little more mindful about what their conditioning level is before they go into the test. But at the same time no matter what uh conditioning level or fitness level the person might have, you as a tester have full control about how slow you might want to ramp up or not.

Cooper Paul 34:28

Absolutely. Yeah so you you change it based on to some degree it's an expectation for the patient. And so if if you have someone that comes in and they're in the gym every day, you're like, all right, if I set too low of a ramp here and I make the resistance really low and increase slowly, they're gonna be on this bike for 35 minutes because this is what they do. Versus if I have someone that comes in and really never goes to the gym very much and I set them at a much higher resistance level their leg muscles are going to tire out before they ever hit their VO2 max and they're not going to be able to push the bike any further. And so there is some art to it of trying to say yeah this this is probably a good place to start. And that's why you get the variability between you know eight to twelve minutes because every once in a while you might make it a little bit too easy on someone and it's not that they're not going to hit that point eventually it's just it'll take a couple minutes longer.

Dr. Mark Su 35:28

Yeah. So speaking of um as a little bit more of a I don't want to say well interesting comparison so you you had told me years ago when we first met that you said uh something along the lines of uh yeah this is what I do for a living down at Tufts. Okay, so and then over the time as I saw you testing folks and uh being so so matter of fact with it because it was it was just kind of like I think I I don't know if you said this but I interpret it as like kind of child's play for you. Comparatively, what's the comparison for what you do with this kind of gas testing in in the pulmonary hypertension department in an academic center in Boston?

Defining Zone Two And Why It Matters

Cooper Paul 36:10

Yeah absolutely so in in uh not just pulmonary hypertension but pulmonary in general we do um CPET testing or cardiopulmonary exercise testing which is very similar to what we're doing just obviously looking for very different things than what we're looking for. I think I should say a lot more things because they also get a VO2 max result on their test but they get a lot more data than we do. And so and that's obviously looking for pathologic reasons why patients might be short of breath. For for those patients that may not have anything seen on that initial CPET or have an unknown cause or cannot find why they're short of breath, we do what's called an invasive CPET which was when we do it with a a swan catheter or a catheter that's measuring pressures inside of their heart as well as an arterial catheter in their in their wrist and we get a lot of data during that test and it's it's a bit more invasive and that's not something I would recommend for everyone here to go do for fun and and get a baseline for their health. That's that's something a little bit more extreme. But I think yeah again because of that um there is some a a level of familiarity and comfort with doing these and also just some excitement because in that world we're we're always looking for for something wrong. We're trying trying to help someone and help them feel better and and it's it's hard to put someone through a test like that who is having a really hard time breathing and is really struggling with something. And in this world we're doing the opposite we're we're taking a healthy person and putting them through a test to try and map out an awesome future for them. And so I think that's um it it makes this this version of the test very rewarding.

Dr. Mark Su 38:00

Yeah yeah or a healthier person at least absolutely yeah maybe on paper they've got some issues but um the the intention here is to pursue wellness and longevity certainly and as opposed to trying to climb out of a really deep dark sick hole. Yeah. I picture I've never I don't know if I've seen it you've never shown me any or I've never seen anything online but uh or otherwise but I sort of picture uh I the six billion dollar man six million dollar man like when they were revving him up uh in those at the beginning of that show or Ivan Drago I think his name was from uh from Rocky III yeah exactly Rocky II is Rocky IV Rocky IV uh yeah they I I can imagine they they're just hooked up to all kinds of machines with what you're doing for work.

Cooper Paul 38:47

So it's it's uh it is funny to see but it's it's really cool and people push themselves really hard and it's um again that that's a rewarding test as well for other reasons but it's it is very different.

Dr. Mark Su 39:03

Yeah so let's make a hard shift um shift over to the zone two training right we've we've mentioned it several times but really haven't even defined it yet so we just keep alluding to it. So whereas VO2 max is um I think of it sometimes or might have worded to is worded it to some patients as sort of like a measure of your um it's certainly anaerobic capacity so we could think maybe I might think of it as power but zone two then zone two training is kind of like your aerobic capacity, right? More the sort of like the more um yeah why don't you define it for us and tell us a little bit about like what what is this and why is it important?

Cooper Paul 39:38

Yeah absolutely so you you said it perfectly so VO2 max is your is getting past that anaerobic threshold it's it's really how far can you max yourself out. Zone two is how far how much work can you do without going into an anaerobic pathway. And so the best way that I I talk about its importance with with people is really is bringing up the pyramid that I've talked with you a bunch of times before and so if VO2 max is that top of your pyramid that's that's how high how tall you want to be and how hard you want to push yourself zone two is the base of that pyramid and with if if your pyramid's that triangle you're not going to get a very tall a very tall peak if you don't have a really wide base. And so zone two is somewhere where patients really develop that fat burning capacity and really get that um hell uh I should say um mitochondrial benefit. And so what I want people to think of with with zone two is specifically it's it's your ability to recover post a workout but also your ability to push yourself further. And so the more work you can do in that zone two and and you think about that as all right an easy way to think of what zone two is for people is what we've been told by our doctors you said this to me the other day and it's funny I've I've had the same conversation but also didn't put two and two together is when a doctor says to you exercise can look like a short walk where you're able to have a conversation with someone you're able to speak a sentence but you'd rather not you're you're a little short of breath but you're still able to to hold a conversation and that's really what zone two is and and what I want people to think of it's a low stress workout. It is yeah it's a consistent steady I'm spending time in this state I got a book in front of me because I'm a little bit bored because it is monotonous and I'm just really working on my body's ability for that fat burning capacity for that mitochondrial health and I'm building that base for VO2 max. So the wider we get that the more time I can spend there and increase how much work I can do. If at first I got to set the treadmill to one and a half miles an hour and that gets me to zone two, great. In six months maybe I'm at two miles an hour. Then I get up to three miles an hour and you can really increase how much work you can do you're gonna see that gain in your in your VO2 max test as well.

Dr. Mark Su 42:10

So zone two is like your cardio uh VO2 max is like when you're sprinting but if somebody's asked thinking um thinking it out there uh you know how do you so you mentioned zone two versus zone three the differences are are what and how does one know if they're in zone two or zone three?

Cooper Paul 42:25

Yeah so you did mention like you know how breathless are you when you're doing the activity if you're doing it with somebody that's one example but absolutely I mean I think the best way to tell is a lactate monitor which is similar to like a blood sugar monitor where you can do a a finger prick and take a little blood sample and test test your lactate and make sure you're under two are those ever commercially available like are those available just to the public? Absolutely I think there you could probably get one for like $100. Um oh I didn't know that.

Dr. Mark Su 42:54

Absolutely you know because now nowadays we got those you know like over the direct to the consumer CGM monitors that you know a lot of people are doing even if they're not diabetic. But I'm not sure I knew this was commercially available.

Finding Your True Zone Two

Cooper Paul 43:04

Yep absolutely yeah they're they're probably somewhere around $100 $150. That being said I I don't think that's the most practical way to test this for everyone. The breath test is is probably a better way to do it like what we were just talking about with exercise. But really um on the Panoe test when you when you're in zone two or I should say with um the breath analysis it's going to give you your zone based on uh the carbon dioxide that you're breathing out and it'll correlate it with the heart rate. And that heart rate zone is something that you can now take home and do whatever work out for a prolonged period of time that keeps you in that heart rate zone. And it it really is that simple.

Dr. Mark Su 43:49

So the the fitness enthusiasts here probably are they listening they know that you can calculate zone two or it's told you can calculate your zone two heart rate by taking Minus your age, uh, and then taking 60 to 70 percent of that number. Yeah, exactly. Right.

Cooper Paul 44:06

60 to 70 percent. And what you're thinking on that calculation versus um what you get, what one might get from like a Panoe testing, are they do you anticipate that they're pretty similar or I would anticipate they're pretty similar, but I think again, the other the heart rate uh calculation is it's it's similar to what say with the aura ring or the whoop watch. Is it's an algorithm, it's a it's a guess, but that doesn't really take into account the different fitness levels that people are at. So if I have someone that comes to me that's in really great shape, they've been pushing themselves for a really long time, their zone two heart rate might be much lower because they just or much higher, you know. You just you have no real way of knowing without doing an actual test. And and again, with something like this, there is benefit in being accurate. Yeah.

Dr. Mark Su 45:00

So now let's let's jump back and talk uh just for a second here. VO2 Max versus zone two results. Uh you've you've educated me on some of the difference between these. Um can you share that with you know everyone else? Is one more important than the other? Would you, if you have to pick one to prioritize, what would you pick? Does it depend on what kind of person you are, what kind of information you're looking for? Does it depend on what kind of fitness level you have or your goals or what kind of exercises you might do? What sort of challenges have you observed in patients in terms of um either, I don't know, interests or incentives or their abilities to improve, you know, VO2 Max versus zone two? I just have a lot of questions there.

Cooper Paul 45:42

But no, that's fine. I I think the easiest way to answer it is all of the data we have for longevity and for lifespan is VO2 Max. And so if I was to say there was one thing that matters the most, it's VO2 Max because you can't you aren't gonna be able to reach an extremely high VO2 max without having a pretty solid zone two capacity. And so in that, that's gonna be my gold standard, best way to tell where you're at. Zone two, I'd like to think of less as a test result and more of a process. That's it's part of how we get there, and it's part of the of the work. And that's that's like you had said earlier, you know, what is this workout plan? And do I get in and just push myself as hard as I can? And with zone two training, it really isn't. It's that monotonous, slow thing that you can do as a warm-up before you go do your resistance training. And it it's not something that you have to really push as hard as possible to try and maximize this thing. It's really just it's time. It really is time, which of course is not the easiest thing to come by.

Dr. Mark Su 46:50

Yeah. Yeah, you've told me several times that um you've you've had some a number of patients, uh mutual patients, uh even who they're used to exercising harder and it was not easy for them to in mindset to pull I don't want to say pull back, but to spend time in that lower heart rate zone because it just didn't feel like they were getting as much of a workout.

Cooper Paul 47:12

Yeah.

VO2 Max As The Gold Standard

Dr. Mark Su 47:13

But I know that I you know the the two or three people I'm thinking of, they came back later and said they feel better. Yeah. Kind of interestingly, it's it's like counterintuitive.

Cooper Paul 47:22

Absolutely. Yeah, and it's it's funny. I mean, it we have we all used to have those trackers for how many steps we've taken in a day. And I think that kind of left the ether where people don't really talk about that anymore. But I remember my mom always used to come and like 20,000 steps today, 20,000 steps today. And it was like that that kind of stopped. And but at the same time, I think that it kind of is that simple is how much can we keep our bodies moving and and keep keep the low amount of energy, but never really being stagnant. And the the most or the least we can sit around, the the better we're going to feel. Any solution to that in in mainstream America, corporate America? They have those little treadmills that can go under your desk now. So yeah, so I guess that's a solution, but I I don't know. I don't have a great answer. Maybe we should all start smoking again, so it's a reason to go outside and walk around.

Dr. Mark Su 48:23

Yeah, yeah. Um it does make me think about um, yeah. I mean, it's it's again, there's a lot of paradoxes here for me. You know, there's a there's so many people who they want to lose weight, right? And then they're walking, they're walking a lot, but it doesn't move the needle very much with weight. Yet we're talking about how being in that zone two, and presumably there's a lot of people who are walking who are in zone two on a pretty decent you know percentage of their time. And um, and we talk about that being your fat-burning zone, but they're like, I don't know, I'm not seeing the needle move, right? It there's a lot of interesting paradoxes here. And I don't know, is it just like time's gonna tell us to, you know, over time we'll learn more and narrow and laser this in better?

Cooper Paul 49:04

Yeah, I think that's a a great question. And I think the question with weight loss and obesity in and of itself is it's a multifactorial uh issue. And I think the question of how to solve that overnight is is not one that I have the answer to. All right, we'll give you we'll give you two nights. Yeah. All right, great. Perfect.

Dr. Mark Su 49:25

Maybe three if you're, you know, if you need a third night, we'll I appreciate it. Okay, so let's move to the last last topic, right? So um, you know, like at True Wellness and a lot of how you and I, and I think whether spoken or unspoken, a number of other longevity practic medicine practitioners, we think uh we can we can talk about um these three big area, subtopic area categories, subcategories of um of exercise medicine within the range realm of longevity medicine. So you got the VO2 max, anaerobic sprinting capacities, you have the power, you got the VO2 max, the cardio, the lower level um you know activity that everyone can do or does on some level, uh, just how much, right? And then you got this third piece about um muscle. Muscle, the longevity organ, Gabrielle Lyons mantra. Um, but let's talk about that. Strength training, right? Resistance training. Um, what are the biggest take-home messages for folks about strength training uh to build muscle mass? And what are some easy metrics people can use to say, hey, you know, well, where do I stand with that? You know, I've got this hand grip um measurement of sorts to as a quick and dirty way, but most people don't have that. What are some take-home messages on this subcategory?

Strength Training For Aging Well

Cooper Paul 50:38

Yeah, absolutely. Well, I think of I think of strength training the same way that I do as VO2 Max is it's something that is going to decline as we age. And so it's kind of scheduled decline and both are are relatively similar. It's about 10 to 15% every decade. And so the way that I think of strength is the same way that I or the same way I'm talking about VO2 Max is we want to predict out that future. So if someone says to me, hey, when I'm 80, it's really important to me that I'm able to bend down and pick up my grandkid off the ground and and walk around with it. It's like, okay, perfect. You're that baby is probably somewhere around 35 pounds. That's a pretty big baby. It's gonna be yeah. But if you're 60, you probably right now have to be able to pick up somewhere around 45 to 50 pounds if we're gonna schedule in that decline in strength as we age. And so I think that's that's the same type of mantra that we want to have here is we're always trying to plan out for what the future looks like and then increase what we're doing now. And I like to leave room for margin of error, and so I always want to aim higher, I want to, I want to make those same gains with strength and have people go into that time in life with that same level of confidence of like, hey, I know where I'm at right now is gonna lead to the future I'm looking for.

Dr. Mark Su 52:10

Yeah. Um, and so if somebody's asking, okay, so what what are the best ways to strength train specific to longevity? Do you have any advice?

Cooper Paul 52:21

Yeah, I think that's a fantastic question. And I I would say I don't have the right answer. I think everyone has to everyone has their own way they like to strength train. And the thing I would say is most important is to do so in a way with that is safe. And I always like finding someone to work with in that regard because a lot of these are big movements and things that we're taking on, and that someone that has never gone and lifted weights, if they go into a gym and start trying to deadlift, we're probably gonna have some injuries. And so I always say to start is to find someone to work with that can help show you the basic movements and increase as you go. Take your time, start really slow.

Dr. Mark Su 53:03

I know a lot of uh folks are are taught and recommended, you know, uh certainly just on a broad scale, focus on the big muscle groups. Yeah. Right? I think that's I think that's a pretty fair, still supportable, no doubt, for this purpose as well.

Cooper Paul 53:18

Sure.

Dr. Mark Su 53:20

Uh and then um because I'm thinking about um if somebody wanted to gauge where they're at, we've talked before about you know uh maybe a trio of activities they can just measure on their own at home. Um or or maybe not sometimes at home, sometimes not, but um uh and and I'm thinking about how you know the the phantom chair, the the dead hang and the farmer's carry, yeah. Right. And we we'd have to get out some charts to just to you know to individualize it for age group and all that stuff. But um but yeah, those are you know, as I'm thinking about those, yeah, those are largely about um the larger muscle groups, right? Yeah. The the phantom chair is like your your core, right? Your and then your your quads, let's say quads hands means your your upper legs, your core. Um dead hang is yeah, to me that's kind of like more about um arm arm strength, grip strength, no doubt. Um, but but that farmers carry is you might we might think of it like we're carrying all the stuff with our arms or carrying the weights with our hands and arms, but that's a lot of core strength too, no doubt. Absolutely.

Cooper Paul 54:25

And so I think what we like to think of with aging and with with strength is the what are some of the issues that happen with aging and strength. And so falls are a really big risk as we get older, and so we want to think of stability and and that's I think stability and balance are some of the things that are our biggest focus with aging because they're the biggest risks as we age. And so a lot of it, you're right, is quad strength, ankle strength, those big muscle groups that keep you on your feet. Things like like the dead hang where you're just hanging from a bar and doing that for a long period of time. And then similar with farmers carry and those grip strength markers, I think some of it is as silly as hey, I'm confident that if I live independently at 85 years old, I'm gonna be able to open it open a jar. And it sounds silly, but that's it's something that is difficult. And if you get stuck, you can't open your food, it's like, all right, now what do I toot for dinner? And so I think it's it's important. And then lastly, I think the other way I like to think of it something like a dead hang is if I fall, can I pick myself up? Do I actually have that upper body strength to get myself off the ground? And so it's it is a little bit morbid when we put things into this perspective, and that's why I always start with the picking your grandkid off the ground. But I do think there is this as other aspect of aging that is a little bit scarier, and I think if we take those things head on and know why we're doing them, there is quite a bit of benefit to be had.

Dr. Mark Su 55:58

Yeah, there's a lot more of a lovey-dovey feeling about picking up your grandkids from the ground than calling and not being able to get back up.

Cooper Paul 56:05

Absolutely.

Dr. Mark Su 56:06

On a total side note, um, I was just talking to a uh one of our staff today, and they were telling me about how an 80-year-old, he might be 81, um, when they were calling them that that that patient was, and I'm not saying, you know, there's safety issues. I don't know the the extent of the details of where they live, but he was apparently showing shoveling snow off his roof. That's pretty pretty uh that's thriving, man. That is thriving. I mean, honestly, that's that's thriving.

Cooper Paul 56:38

That's also a little bit of just risk-taking behavior.

Practical Metrics: Hang, Carry, Chair

Dr. Mark Su 56:41

Like I said, uh that aside, right? I I don't know the details. I don't know how I don't know how he got there. I don't I'm not gonna go down that road, but um, we were just both kind of like, what yeah, good for him. So, okay, last question here, looking at all these pieces, uh, or yeah, probably next to last one here. So, any do you have any uh any observations right now about the society trends with all these topics here, you know, VO2 max, um, zone two or uh the muscle mass topic? You know, there's a lot of stuff going on with the muscle stuff these days, right? Eat protein, protein, protein, protein, and then some more protein, and then some protein, right? You know, creatine, testosterone, I mean, for men or women, all kinds of ways of addressing muscle mass and the whole protein topic. But yeah, any kind of what top one or two reflection thoughts you might have on societal trends with this stuff and you know, whether it's among specifically the fitness and health enthusiasts or the general population segment, uh, anything come to mind?

Cooper Paul 57:39

Absolutely. I mean, I think for me, my concern is always that these things become buzzwords. And I think for a lot of people, VO2 Max has become a buzzword. I I've the amount of people I've talked to said, oh, I'd love to get my VO2 Max checked. Why? I I just know it's important. I don't know what it is. And so my my hope in this world is that instead of just becoming a buzzword, it's actually in our having these conversations and and actually trying to explain to people why this is so important, that those that are actually listening might it might stick in their heads of like, no, this is another marker and and another way to test my health. And so I I I know that might not be exactly the answer you're looking for, but I do think in anything like this, things can feel like trends. And this is something where I think the data is it's actually pretty old. This has been around for a long time, and so I I really hope that this doesn't become a trend and then it becomes something that people actually see the value in because there are a lot of trends. Most of them do not, I should say most is the wrong answer. None of them have as much data as as this.

Dr. Mark Su 59:02

Yeah, and so you and you're thinking that um if I hear you right, that's where the bottom line is knowledge hopefully knowledge is the sustainer and to sort of prevent this from or or yeah, prevent this from being a trend.

Cooper Paul 59:20

Absolutely. Absolutely. I think.

Dr. Mark Su 59:23

Um Yeah, and and so do you think there are do as as of right now, are there any particular topics or or treatments within this exercise science, longevity, and medicine world that you you see as coming more to the forefront in the very near future, in the next half year year, or other uh other subtopics that you think kind of uh there's not so sure how well that's really gonna get be adopted, embraced by um the general public, and it eh that it might be a little bit more of a trend like a year or two from now. Anything stand out at all?

Trends, Access, And What Sticks

Cooper Paul 59:53

Yeah, I mean, I think even when we just if we're talking specifically about what we've talked about today, I think um it's the question is for me, access. Like I see the VO2 max testing becoming more and more available in different areas. And so in that, I I do have curiosity of whether you know this might really stick. And the same you can go get a DEXA scan for your for your muscle mass index, and you can you can you can do more testing now in all over the country for these things, and that that's where I'm I'm I'm very hopeful that I think this is something that might last, where clearly people are seeing or hearing the story more than just, hey, this is something I should go and do. I I think there's there is hope in there that this this is something that might be continuing to grow.

Dr. Mark Su 1:00:51

Well, I love um I love your th your thoughts, and I think that you know I I've been telling patients that uh, you know, I am I'm really curious to see what really does not only penetrate public America but stick certainly. But I I I don't see this longevity medicine field as a uh a passing fancy. There's there's too many there's um as you know, as you know from my wife Jessica and the research she does at Harvard, like the the slides I've seen her present in the research conferences on this stuff, there's way too much money at stake, right? Exactly how we get to that end point with where wherever we're going with longevity medicine, we'll see. But the the amount of um the amount of potential and therefore the amount of money involved, the powers that be, the players involved, um, the research, and there there's there's too much going on. There's too much, not just interest, but um reason for the interest. So I think I think you're spot on with, you know, when we have that kind of solid data. Like we wouldn't, the people who are who are in the in the field with, you know, at not just as researchers, but the funding of that research, they're not putting that money just willy-nilly just to see if they can live longer. It's not for fun, right? They're they got better things to do with their money if it's not gonna be worthwhile. So people know people know there's real value here. Absolutely. It's interesting to see who's gonna be able to execute, apply and execute you know what the tools we have in front of us.

Cooper Paul 1:02:16

Completely agree.

Dr. Mark Su 1:02:19

Um well, you know, you know how much I appreciate you, so thanks for doing this. Uh we kind of pulled this off a little bit on the uh little bit kind of on the fly for various reasons. But um I've learned so much from you over the last few years, and I'll continue to learn. I know there's a lot of other people out there. I'll continue to learn from you specifically. I know there's a lot of other people out there who are also like really enthusiastic about um about the stuff that uh the kind of with the kind of passion that you have as well. Um it's just it's just really cool to see you, someone like you, or you specifically be able to help people put more meat to the bones, if you will, beyond um, this is interesting, and I'm empowering myself because you've said it many times. I see that in the younger populations, right? The 30s and 40 year olds, they're they're the they're the ones who are out there already telling me, like, oh, I've already done that. I've already done that. Absolutely. The 50s and 60-year-olds, like, I I see the curiosity growing and I hear more people talking about it, but I, you know, we kind of spoke to some of those hesitancies, right? Like, I don't know if I really want to know. I don't know if I want to, I don't know if I'm ready. I'm not maybe I'm not in shape yet enough to do it, and blah, blah, blah, blah. So there's a lot of uh it's an interesting societal, you know, it's an interesting time right now in our society with these trends. And um, I'm very privileged and honored to know you and be able to have you in my life as a resource professionally and personally to to help make sense of a lot of this stuff for me. So thank you.

Cooper Paul 1:03:49

Yeah, absolutely. It's it's been a pleasure for me as well. And uh I I look forward to continue learning. And keep and we can keep geeking out.

Resources And How To Get Tested

Dr. Mark Su 1:03:59

Yeah, yeah, we didn't get into too much. I I meant to say it earlier, but yeah, you you love the data. A lot of people who I think are um fitness enthusiasts also love the data. So uh there's a kind of a nice inherent match there, a marriage of um two parties. Yes, agreed. Yeah. Well, thanks for yeah, look, Cooper, thanks for taking your time. Again, for those of you who um if you're looking for if you live in a radius of Newburyport, Massachusetts, and you would like a testing um or just an inquire more about this kind of testing, you can go to true wellnessclinic.com. That's T-R-U Wellnessclinic.com, and you'll be able to uh make an appointment or get testing done uh not just for Panoe testing, VO2 Max, zone two training, et cetera, but and the muscle mass testing uh, et cetera. But there's uh many other options. We're not gonna get into that today. Um it's not so much a shameless plug, it's a it's a valuable resource genuinely to help people with their health pursuits. Um in this case, we're not just for certainly first and foremost, we're here talking about longevity and pursuing wellness, but even for folk, we've we've seen a lot of benefit for people who have chronic inflammation become healthier through some of those tools at that clinic as well. Uh and if you are not within that geographic radius we um of 01950, still ad high highly advocate that you look around you, go online, find a place near you. There are multiple um fitness uh uh franchises that use the Panoi machine as well. It is by many people regarded as the top-of-the-line testing tool for this kind of data. And uh and for those who are interested in longevity pursuits outside of actual in person testing, then we'll talk about that another time. Um, you can still reach also our team at rootseekhealth.com, um, the sort of foundation and sponsor of this uh podcast. So again, thanks, Cooper. Really? For your time. And um yeah, best to you going forward in in every way. And um for the rest of you, we'll check you on the next podcast.

Cooper Paul 1:06:10

Thank you, Mark.