Dr. Benjamin Levine: How Exercise Prevents & Reverses Heart Aging

Everyone has to get old sometime, but what if, at least for some aspects of aging, we didn't have to? Imagine if the loss of heart size and the stiffness that often comes with aging could be reversed, even well into late middle-age.

And not by a little - by a lot. Today's guest, Dr. Benjamin Levine, has shown that with the right exercise protocol, people who were sedentary most of their lives could reverse up to 20 years of heart aging. Dr. Levine is one of the world's leading experts in understanding how the heart adapts under a variety of conditions, whether that's exercise, elite athleticism, or hospital bedrest. Or even highly exotic conditions, like prolonged exposure to microgravity. He is the founding director of the Institute for Exercise and Environmental Medicine at UT Southwestern in Dallas, a leading facility renowned for its research in cardiovascular physiology.

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EPISODE LINKS:

CHAPTERS:
(00:01:31) Are 3 weeks of bed rest worse for fitness than 30 years of aging?
(00:05:18) Why untrained individuals recover fitness faster than athletes following bed rest
(00:06:49) Does exercise protect against long COVID?
(00:09:41) "COVID triad testing" guidelines for evaluating heart health in athletes
(00:11:27) Why strict bed rest is a model for space flight
(00:12:24) How 12 weeks of bed rest affects heart size
(00:13:52) Why a brand-new rubber band mimics a lifetime of endurance training
(00:17:23) The exercise dose that preserves youthful cardiovascular structure
(00:19:32) The exercise regimen that reversed 20 years of heart aging
(00:23:14) What it takes to reverse vascular age by 15 years in 70-year-olds
(00:28:38) Benefits of starting an exercise regimen in your 70s [benefits that don't involve cardiac remodeling]
(00:34:26) Considering the risks of high-intensity exercise
(00:37:51) Balancing high-intensity & moderate-intensity training
(00:42:49) Training for health vs. training for performance
(00:43:57) Why muscle mass & cardiorespiratory fitness are like retirement funds
(00:45:12) Make exercise a part of your personal hygiene
(00:46:16) Why does VO2 max correlate with longevity?
(00:53:43) The 2018 JAMA study on cardiorespiratory fitness & mortality
(00:59:21) How does change in fitness over time affect mortality?
(01:01:34) Why exercise non-responders should consider "increasing the dose"
(01:05:23) The 2 limiting factors for improving VO2 max in competitive athletes
(01:08:20) How marathon training affects heart size in sedentary young people
(01:12:34) Heart adaptations in purely strength-trained vs. endurance athletes
(01:18:23) Why pure strength-trainers should incorporate endurance training
(01:22:07) How strength training affects blood pressure (exercise pressor reflex)
(01:26:41) How exercise influences cardiac output in mitochondrial myopathy patients
(01:28:39) Does CrossFit count as endurance training?
(01:31:04) What's the best exercise for improving blood pressure?
(01:36:11) Lifestyle strategies for treating hypertension
(01:38:40) Why recovery is key to reaping the benefits of a training stimulus
(01:42:36) The best indicator of being overtrained
(01:43:36) Heart rate brackets & running pace estimates for training zones 2-5
(01:50:00) Why heart rate variability is a poor indicator of recovery
(01:55:16) Why do men tend to be faster runners than women?
(01:58:49) Can women achieve similar aerobic exercise benefits doing 2x less than men?
(02:00:21) Are there cardiovascular benefits of HRT in women?
(02:02:12) How Dr. Benjamin Levine defines "extreme exercise"
(02:04:00) How does exercise volume affect coronary plaque calcification?
(02:10:50) How exercise duration & intensity affect coronary calcium levels
(02:14:03) Why high exercise duration & intensity increases risk of Afib
(02:16:33) What exercise dose increases Afib risk?
(02:17:59) Managing stroke risk in athletes prone to Afib with anticoagulants
(02:21:14) Why you shouldn't become an endurance athlete to "live longer"

PODCAST INFO:

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[FoundMyFitness]

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Timestamps:
(00:01:31) Are 3 weeks of bed rest worse for fitness than 30 years of aging?
(00:05:18) Why untrained individuals recover fitness faster than athletes following bed rest
(00:06:49) Does exercise protect against long COVID?
(00:09:41) "COVID triad testing" guidelines for evaluating heart health in athletes
(00:11:27) Why strict bed rest is a model for space flight
(00:12:24) How 12 weeks of bed rest affects heart size
(00:13:52) Why a brand-new rubber band mimics a lifetime of endurance training
(00:17:23) The exercise dose that preserves youthful cardiovascular structure
(00:19:32) The exercise regimen that reversed 20 years of heart aging
(00:23:14) What it takes to reverse vascular age by 15 years in 70-year-olds
(00:28:38) Benefits of starting an exercise regimen in your 70s [benefits that don't involve cardiac remodeling]
(00:34:26) Considering the risks of high-intensity exercise
(00:37:51) Balancing high-intensity & moderate-intensity training
(00:42:49) Training for health vs. training for performance
(00:43:57) Why muscle mass & cardiorespiratory fitness are like retirement funds
(00:45:12) Make exercise a part of your personal hygiene
(00:46:16) Why does VO2 max correlate with longevity?
(00:53:43) The 2018 JAMA study on cardiorespiratory fitness & mortality
(00:59:21) How does change in fitness over time affect mortality?
(01:01:34) Why exercise non-responders should consider "increasing the dose"
(01:05:23) The 2 limiting factors for improving VO2 max in competitive athletes
(01:08:20) How marathon training affects heart size in sedentary young people
(01:12:34) Heart adaptations in purely strength-trained vs. endurance athletes
(01:18:23) Why pure strength-trainers should incorporate endurance training
(01:22:07) How strength training affects blood pressure (exercise pressor reflex)
(01:26:41) How exercise influences cardiac output in mitochondrial myopathy patients
(01:28:39) Does CrossFit count as endurance training?
(01:31:04) What's the best exercise for improving blood pressure?
(01:36:11) Lifestyle strategies for treating hypertension
(01:38:40) Why recovery is key to reaping the benefits of a training stimulus
(01:42:36) The best indicator of being overtrained
(01:43:36) Heart rate brackets & running pace estimates for training zones 2-5
(01:50:00) Why heart rate variability is a poor indicator of recovery
(01:55:16) Why do men tend to be faster runners than women?
(01:58:49) Can women achieve similar aerobic exercise benefits doing 2x less than men?
(02:00:21) Are there cardiovascular benefits of HRT in women?
(02:02:12) How Dr. Benjamin Levine defines "extreme exercise"
(02:04:00) How does exercise volume affect coronary plaque calcification?
(02:10:50) How exercise duration & intensity affect coronary calcium levels
(02:14:03) Why high exercise duration & intensity increases risk of Afib
(02:16:33) What exercise dose increases Afib risk?
(02:17:59) Managing stroke risk in athletes prone to Afib with anticoagulants
(02:21:14) Why you shouldn't become an endurance athlete to "live longer"

[richardthomas]

Maybe the best of Rhonda's interviews. 86-year old habitual exerciser here, trying to figure out how to best live the rest of my life.

[wmp]

Just finished a 40 minute workout with HIIT exercises. 59 active minutes and 191 max heartbeat. 63 years young and exercise daily. My joints and back feel fine 💙

[honeyclover]

No hyperbole, nuanced discussion that clarifies and debunks so many hypes. A true scientist🙏🏼 Would love to hear more from him on this topic!

[davidjohnbunnell]

Dr. Patrick, This is a brilliant, gold standard example of a responsible podcast. As a clinician who has spent a great deal of time around cardiovascular medicine and surgery, I feel like I should document 2.5 hours of continuing medical education. Keep up the good work.
DJB PA-C

[nicki]

Dr. Ben Levine's "prescription for life" weekly routine

• One hour of fun, moderate-intensity aerobic activity (e.g., dancing, walking, biking)

• One 30-minute high-intensity session (e.g., Norwegian 4x4)

• Two or three 30-minute sessions at moderate intensity (able to talk but not sing)

• One or two days of strength training

[jayeshpatel]

I was privileged enough to see Dr. Levine as a patient. A genuine doctor who is on another level when it comes to research and knowledge.

[AnthonyRosbottom]

As a 52 year old, this was a great wake-up call. Thanks for the video Rhonda and Dr Levine.

[yaslh]

Remarkable interview. I am absolutely blown away by the brilliance, sensitivity, and articulate nature of the guest. His ability to convey complex ideas with such clarity is truly remarkable. I feel incredibly grateful for the crystal clear information he provided. Pure gold! Dr. Levine, thank you for sharing your expertise and enlightening us all.

[gtkona]

RE: Coronary calcium and 'soft' plaque. At 64, after 35 years of endurance training at about 8 hours per week average, with a definite trend to high intensity training and racing, running, XC skiing, and triathlon, my calcium score was 164 and had increased from about 100 in two years. My coronary artery CT scan demonstrated that I had large coronary arteries and virtually no 'soft' plaque.

[HSLSFirst]

This was the best interview I've watched on social media. First time I was able to watch a 2+ hours interview. Dr. Levine is extremely knowledgeable, interesting to listen. Very moderate, nuanced and measured. No extremist statements.

[LuminairPrime]

One point I like: people of different fitness levels will crash into weakness in the same amount of time, but getting their strength back takes longer in the people who were stronger because you don't get special credit for being strong in the past. Being strong takes time and hard work for everyone no matter what. This means fitness is not a state you achieve, rather a lifelong war you fight. This means "use it or lose it" is SO TRUE, and it means being sedentary is poisonous to EVERYONE.

[Donald-Putin]

This is why I listen to you Rhonda, nothing but high quality, technical information that is deep and non-pedestrian. Appreciate what you do and PS - I started using the sauna per your videos. Feeling great because of it, and randomly overheard two guys striking up a conversation while in the sauna about your and Andrew Heuberman's sauna videos the other day; thought you might like to know that! This also happened to me once before while striking up a conversation about your videos in my customers office. An engineer in the back of the room spoke up and said "are you talking about THEEEE Rhonda Patrick?"

[StephenLeeman-nm]

I’ve been exercising for 40 years and reading and listening to many podcasts and this by far is the best and most informative information I’ve have ever heard ❤

[AndrewKos-br]

The key phrase of the whole interview happens at 46:23 when Dr. Patrick asks Dr. Levine about the relationship between MaxVO2 and longevity. He states “that correlation is relatively weak”. You wouldn’t know that by listening to Dr. Attila, Huberman et. al. On YouTube. Most experts talk as if the relationship between MaxVO2 and longevity is a given. So great to hear a real expert give a more nuanced answer. Very refreshing.

[jnchacon]

OMG ... I love how he explains everything so clearly and simply so people that are not educated in medicine, like me, can understand the ideas well enough to gain a practical helpful insight.
Thank you both.

[f-xdemers]

A man who understands what science is and can express it's workings, limitations and conclusions. A pleasure to the mind.

[MichelleDantas]

I can spend the entire day listening to him! Brilliant, so passionate, and caring ❤

[climacus]

Dr. Levine comes across as a man with a big heart and a burning interest in his profession. Great interview with tons of information.

[samuele.marcora]

Ben Levine is a legend in the field of exercise science. Not these pseudo experts on YouTube these days. Well done for having him on your show