Here is a breakdown of the elite group for you. The trend still holds.
Also quoting from results, and this is really important for all the longevity seekers on this forum:
There was a statistically significant reduction in mortality between elite and high performers 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04).
Remember, this is study is coming from Cleveland Clinic and it was published in JAMA - one most of reputable journals in medicine.
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L_H
#122
Sorry but the new chart also has large error bars with large overlap.
The conclusion you quote is correct, I’m merely pointing out that:
the “High” performance group is broadly defined (top 75th to 97.7th centiles)
And so we can’t know where the optimum VO2 max falls, based on this data. It may be above the 97.7% cut off, or below.
That’s why they restricted their conclusion to merely saying that:
“cardiorespiratory fitness (≥2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups.”
That’s different to saying that it is optimum to be above the 97.7% mark.
And my point still stands: “Those graphs look impressive until you realise the x axis is based on categories not vo2 max.”
This chart is, i think, revealing, it shows a pretty minimal difference
On a different point, I’m shocked at how low the bar is for being “elite”. The mean maximum METs achieved at the elite level was 13.8 +/- 1.5.
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Table is just one representation of the data. The authors look at the data in many different ways.
When analyzed by age group, the difference in survival between elite and high performers was only maintained in older patients. There was a statistically significant reduction in mortality between elite and high performers 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04). In younger age groups, there was no difference in survival between elite and high performers.
That explains your error bars, you can’t eke out much more longevity in healthy young people who already very fit.
Statistics is just science of probability, There is no study with 100% confidence interval.
L_H
#125
I think you’ve misunderstood what im saying. There can be a statistically significant reduction in mortality between elite and high performers, and it still doesn’t tell you whether the optimum performance ability falls within the high performing range, or the elite performing range… Because the high performing ranges is so large.
The chart i picked out was to demonstrate just how small the difference in survival is between the two groups.
And we haven’t even got to the question of reverse causality…
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For all ages, not 70+ only.
Now, that we established correlation we can discuss causation.
When you start looking at multiple studies that correlate longevity/healthspan with:
- Vo2 Max
- Amount of exercise
- Being an elite Athlete
the causation becomes elucidated.
L_H
#127
Except we haven’t established correlation across the fitness range.
The only correlation established is when comparing two discrete performance groups high vs elite. And the “high” performance group is really broadly defined. So we don’t know which centile of fitness correlates with the lowest all cause mortality risk.
As a thought experiment: imagine if we split the population into 2 groups (instead of 4). Say, the top 1% and the rest. We could easily find that the least fit 99% of the population correlates with higher death rates when compared to the top 1%. However that wouldn’t tell us whether it is better to be in the top 1% or the centile below.
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I think a book of interest to anyone, whatever their view on high performance exercise, is Bill McKibben’s “Long Distance” See Long Distance by Bill McKibben | Goodreads
Bill is well known, deservedly as a environmental activist. But this book is his account of training at an Olympic level for a year at x-country skiing (at the age of 39 - a sort of last gasp on getting to his maximum training peak). During that year he also finds out his father is dying of cancer. Some nice reviews at the Goodreads link above.
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However that wouldn’t tell us whether it is better to be in the top 1% or the centile below
Blockquote
Statistics ! There was a statistically significant reduction in mortality between elite and high performers 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04) .
THERE YOU GO ! Look at the CI, Look at the P-value !
The only correlation established is when comparing two discrete performance groups high vs elite. And the “high” performance group is really broadly defined. So we don’t know which centile of fitness correlates with the lowest all cause mortality risk.
As a thought experiment: imagine if we split the population into 2 groups (instead of 4). Say, the top 1% and the rest. We could easily find that the least fit 99% of the population correlates with higher death rates when compared to the top 1%. .
How would you even do a study without GROUPING subjects???
Medical studies put patients in groups ALL THE TIME.
Group with drug A vs group with PLACEBO, group with diet A vs. group with diet B, group with intervention A vs No intervention. And so on.
So basically what you are saying that pretty much every medical study ever done is NOT HELPFUL.
I think you are just trolling at this point. I’m done with this discussion.
Challenge accepted.
You’re not concerned that it’s not an RCT? These are either patients referred for an exercise treadmill test or elite athletes. The fact that their baseline fitness predicts mortality doesn’t really tell us what would happen if individuals from the general population worked to change their fitness. I’d be especially reluctant to make conclusions about the shape of the fitness vs mortality risk function at the top / right side of the curve.
Another issue is that the statistical model isn’t causal and we should be cautious about interpreting the effects of variables. Basically, it’s really hard to control for comorbidities, especially when they are correlated. The effects of variables like smoking, diabetes, etc are handled with binary variables and their estimated influence seems, to me someone who doesn’t know the literature, small. This suggests to me that some of the effect of smoking, etc is being attributed to fitness. The smoking variable will capture the average effect of smoking while the fitness variable may capture the variable effects of different intensities of smoking. As a thought experiment: if someone is a smoker and a low performer on the treadmill test, and they have the choice of quitting smoking or doing more aerobic exercise, do we really believe they should increase their cardio? That’s what the paper seems to imply.
That being said, sure, let’s all do more cardio. But let’s not believe from this study that cardiorespiratory fitness is proven as the one variable to rule them.
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There is value in doing things – making yourself do things – that you do not love to do. Even that you do not want to do. There is an area in the brain called the anterior mid cingulate cortex. Its function and health improves when you succeed in making yourself do things you don’t want to do (assuming of course that those things are not themselves detrimental to your health.) I learned about this in a Huberman interview of David Goggins. I’m not sure if it was Goggins who said it, but nonetheless it struck a chord: “Everything worth having is on the other side of hard.”
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I love that but I do believe I can develop habits which make “hard to do” feel good.
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Are you for REAL ?
RCT with 122,000 subjects with group of Elite VO2 max? :LMFAO
OF course it’s no causal !
Clearly you haven’t read the thread, I am not going to rehash all my points over and over.
I agree and have been practicing all life long but I see the application more to things that require a lot of effort and getting out of my comfort zone to achieve but then I can have a “cigarette moment” so to speak, triumph with my arms akimbo at the top of the mountain looking down at the steep slope I had to climb. Basically hard at first but easy and fulfilling later, once you put in the work: like learning a new language. Working out hard for me never gets to that stage though where I’ve enjoyed my achievement. With HIIT the better I got the more the class trainer would challenge me, say with heavier weights — which makes sense, progressive overload and whatnot, but meant it never got any easier. I just hated every minute. So no I don’t see a point in engaging in something like that for longer than is absolutely needed, unless one is a masochist.
Very recently I’ve begun to wonder whether my apoE3/4 genetic makeup is what’s making hard exercise even less tolerable than it would be for someone else. Apoe4 females in particular seem to have really impaired mitochondrial respiration function so it does make me think, perhaps it’s why the stressor feels so unbearable. It could unfortunately mean I need even more of it 
— still trying to figure that out, but at 7 month pregnant, it’s all theoretical for the next year at the very minimum.
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There is a method to habit formation. In addition, I’ve read that testosterone makes hard efforts feel good.
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@约瑟夫_拉维尔 If you’ve got words of wisdom for me, I’m all ears—except transition “therapy” to get me on that sweet T… THAT would be a bridge too far 
.
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Atomic Habits is a very good resource. He has been on many podcasts if you prefer that format. I did have a habit episode on my podcast but I think James Clear is the best person to learn from.
It’s simple but not easy. Good luck.
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Hard efforts make the testosterone LOL
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OK, so my question is around the “marginal cost” vs. the “marginal benefit” of going from “high performer” to “elite” performer.
Does anyone have a sense for the investment in hours per week you think it would take to go from “high” to “elite”?
If I’m currently at 6 or 7 hours per week of exercise, and I eventually trend towards moderate or high fitness levels, what would it take to get to elite?
Ultimately this is the key issue I think; what return do we get for our “investment” of added exercise and training.
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Most wouldn’t even be able to get to the elite level anyway so it’s a moot question, that’s a full time job and there are probably some genetic traits that allow this sort of training.
The importance of this statement though is that the J or U curve occurs much higher than most people think as long as the exercise is performed in a PROPER MANNER. Most elites are trained by professional coaches and scientists.
The Circulation journal study where the benefits seem to max at 10 hours was SELF-REPORTED, so most of these people were not trained under any professional setting. When they started pushing beyond 10 hour level the benefit stopped. Most likely because they were either pushing too hard or under-recovering, guessing here of course.
This is consistent with my observation of a cohort comprising of hundreds of cyclist acquaintances. I follow them on Strava, and I am able to see their work outs, distance, heart rate, effort, power and there subjective descriptions. I see many pushing too hard, most of the time and burn out when they do.
Positive feedback loop. It’s a good thing.
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