#379 - AMA #79：适用于任何健身水平的心肺训练指南，以提升健康寿命、寿命和长期独立性

嘿，大家好。

Hey, everyone.

欢迎收听Drive播客的抢先版问答环节（AMA）。

Welcome to a sneak peek ask me anything or AMA episode of the drive podcast.

我是你们的主持人，彼得·阿蒂亚。

I'm your host, Peter Attia.

在本短片的结尾，我会解释如何完整收听AMA系列节目，以及我们为您准备的其他众多会员权益。

At the end of this short episode, I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits we've created.

或者现在就访问 peterattiamd.com/subscribe 了解更多信息。

Or you can learn more now by going to peterattiamd.com forward slash subscribe.

那么，不多说了，以下是今天Ask Me Anything节目的抢先版内容。

So without further delay, here's today's sneak peek of the Ask Me Anything episode.

欢迎来到Ask Me Anything第79期。

Welcome to Ask Me Anything, AMA episode 79.

在今天的AMA中，我们将全面探讨心肺耐力，这是听众最常提问的主题之一，当然也是延长寿命和健康寿命的核心领域。

In today's AMA, we take a comprehensive look at cardiorespiratory fitness, one of the most common topics we get questions about and of course an area that is central to not only lifespan but also health span.

请注意，我们已经制作了大量关于这个主题的内容，但这次我们想把所有相关信息整合到一个集中的 episode 中，同时加入我最新的思考——毕竟我对这些话题的看法一直在更新，也希望能不断精进。

Now look, we've done a lot of content on this topic but we wanted to put together an episode that brought it all together in one place and as always to include any of my updated thoughts, something which of course I'm constantly updating my thinking on topics and hopefully sharpening it.

因此，本集的目标是提供一份实用指南，帮助你合理安排训练，从而真正改善你的健康状况、功能能力，并在衰老过程中保持独立性。

So the goal of this episode is to provide a practical guide that allows you to structure your training in a way that meaningfully impacts your health, your functional capacity and maintains independence as you age.

我们将探讨为什么心肺耐力是健康寿命和寿命最强的可调节预测因子之一，什么是二区训练，它与高强度训练有何不同，目前仍存在一些混淆。

We'll discuss why cardiorespiratory fitness is one of the strongest modifiable predictors of health span and lifespan, What zone two training actually represents and why it's different from higher intensity work and there seems to be still some confusion about this.

如何思考运动的量、强度，以及在不同训练区间和采用不同方法时的可行性。

How to think about exercise volume, intensity and the practicality of training in different zones and using different approaches.

如何测量和追踪二区训练的具体进步。

How to measure and track improvements in zone two specifically.

VO2 max 的目标值、按年龄调整的目标，以及为‘边缘十年’做规划。

VO2 max targets, age adjusted goals and planning for the marginal decade.

围绕你的二区目标和 VO2 max 目标，构建有效的训练计划。

Structuring an effective workout routine around your zone two goals and your VO2 max goals.

如何在不同周训练量下，平衡二区训练与高强度训练。

How to balance zone two with higher intensity work across varying weekly training volumes.

再次强调，这是讨论中非常重要的部分，因为正如我所暗示的，有些听众根本就不应该进行二区训练。

Again, is a very important part of the discussion because as I allude to, there are going to be some of you listening to this that shouldn't be doing zone two at all.

我希望通过本播客的结束，你能成功识别出自己是否属于这类人群。

And my hope is that by the end of this podcast, you've been able to identify yourselves.

针对初学者、代谢不健康者、长期训练者、老年人等调整训练方式。

Adjusting training for beginners, metabolically unhealthy individuals, long time trainees, older adults, etcetera.

特别考虑女性群体，包括关于二区训练或其他有氧训练的一些误解。

Specific considerations for women specifically, including some misconceptions around zone two or other forms of cardio training.

常见的训练错误，以及如何避免平台期、过度疲劳和训练强度偏差，实用的可持续性、渐进性和长期适应策略。

Common training mistakes and how to avoid plateaus, burnout and missed targeted intensities, practical strategies for sustainability, progression and long term adaptation.

如果你是订阅者，想要观看本播客的完整视频，可以在节目说明页面找到；如果你不是订阅者，可以在我们的YouTube页面观看视频的抢先片段。

If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page and if you're not a subscriber you can watch a sneak peek of the video on our YouTube page.

那么，不多说了，希望你们喜欢AMA第七十九期。

So without further delay, I hope you enjoy AMA seventy nine.

彼得，欢迎来到又一期AMA。

Peter, welcome to another AMA.

你最近怎么样？

How are doing?

我非常好。

I'm doing very well.

谢谢你再次邀请我。

Thank you for having me back.

你随时来我们都欢迎。

Always welcome to have you.

我注意到，每次我们做这些访谈，你都会为每次录制带来更多的内容。

I see every time we do these, you bring something more and more to each recording.

这次我带来了什么？

What have I brought this time?

我不知道。

I don't know.

我甚至都没意识到。

I'm not even aware.

你想不到任何东西吗？

Nothing you can think of?

有什么突然冒出来的吗？

Nothing jumps out?

身体上有什么新的变化吗？

No new additions to the body?

没有。

No.

但既然我们现在在这些节目的结尾加入了‘ carve outs ’，这让我更加意识到，我简直就是YouTube和Instagram广告的完美目标，因为我完全可以做一个叫《Carve Out》的播客，专门讲那些被推给我、而我最终喜欢并购买的东西。

But given that we've now introduced carve outs at the end of these, it's made me that much more aware of how much I am the perfect target of YouTube and Instagram ads because I could create an entire podcast called The Carve Out, where I just talk about the things that I buy when they're served up to me as ads that I end up liking.

你今天买了一样东西吗？

Have you bought one thing today?

今天没有。

Not today.

但我两天前买了一件特别棒的东西。

But I did get something really awesome two days ago.

它两天前到了。

It arrived two days ago.

有什么想跟大家分享的吗？

Anything you'd like to share with the group?

绝对不。

Heck no.

我打算留着做个专属推荐。

I'm saving it for a carve out.

也许下个月。

Maybe next month.

我会对这些东西进行测试。

I put these things to the test.

让我告诉你。

Let me tell you.

我是个认真的产品测试者。

I am a serious tester of product.

到目前为止，我拿到的这个东西，已经测试过一次了。

So the thing that I got so far, I've already tested it once.

效果好得离谱。

It was insanely good.

我还需要多用几次。

I need a few more reps with it.

如果一个月后我仍然觉得它很棒，它可能会被列入‘ carve out ’清单。

And if I'm still digging it in a month, it might make it to the carve out list.

这太棒了。

That's great.

这令人兴奋，因为我觉得人们没有意识到你所说的这些东西，可能真的对健康和长寿有益。

It's exciting because I don't think people realize what you're talking about could be a legitimate thing that is actually beneficial to health and longevity.

但也可能只是个最蠢的20美元小玩意儿。

And it could be the dumbest $20 gadget that has ever existed.

对于这个范围内的产品，我们根本无法知道它到底是哪一种。

And we have no way of knowing which one it is when it comes to that spectrum.

好吧，我给你个提示。

Well, I'll give you a hint.

它是在一个YouTube广告上看到的。

It was served up on a YouTube ad.

所以它肯定不是前者，但我也要说它也不是后者。

So it's definitely not the former, but I will say it's also not the latter.

让人悬着心。

Leaving people hanging.

这两者之间有很大的区别。

There's a lot of daylight between those two.

是的。

Yes.

但你通常只是生活在这些光谱之间。

You just tend to live on the spectrums though.

对吧？

Right?

你总是非此即彼。

Like you kinda go one or the other.

这很公平。

That's fair.

你唯一适度做的事情就是适度本身，这其实和参与YouTube与Instagram广告的情况一样。

The only thing you do in moderation is moderation which turns out is the same with engaging in YouTube and Instagram ads.

你喜欢全力以赴。

You like to go all in.

那么，今天我们要讨论的主题是：心肺功能，用更简单的术语来说就是Zone Two和VO2 max。

So with that said, what we're covering today, one topic cardiorespiratory, fitness in simpler terms for people zone two v o two max.

多年来，我们曾在不同的播客、不同的嘉宾和不同的文章中讨论过这个话题，但这也是我们被问得最多的问题之一，部分是因为大家对它的兴趣，也因为我一直坦诚地指出，它是影响健康寿命和整体寿命最强有力的可改变因素。

This is a topic we have talked about over the years on different podcasts, different guests, different articles, but it's also a topic that we get asked about by far the most partly because of the interest in it and also I think because of how open you are on how it is the biggest and strongest modifiable predictor of both health span and lifespan.

也就是说，这是一个人能对其产生最大影响的事情。

Meaning it's the biggest impact that someone can do something about it.

因此，我们决定专门安排这次问答环节，收集所有相关问题，力求打造一个关于如何测量、追踪和通过训练提升Zone Two与VO2 max的全方位指南。

So that's why we decided to kind of dedicate this AMA, gather all the questions, and try to make it a one stop shop for everything relating to how to measure, track, improve zone two, v o two max through training.

我们会讨论这与那些有大量时间锻炼的人以及时间较少的人的关系。

We'll cover how this relates to people who have a lot of time to work out, people who have a little time to work out.

我们会分析这与刚开始锻炼的人、长期锻炼的人、老年人的关系，以及女性是否有特别的不同之处等等。

We'll look at how it relates to people who are just starting training, people who have been training for a long time, older adults, if anything changes for women in particular and more.

我们还会探讨，对于最近关于无氧阈值和乳酸的一些争论，你的观点是否有所变化，以及如何平衡训练量和强度，目标不是追求有史以来最好的一个月锻炼后就停止，而是着眼于长期效果。

We'll also look at if your opinion has evolved around some recent debates and discussions around zone two lactate, how to balance volume and intensity with the goal of not having your best exercise month ever and then stopping but more so long term.

那么，说了这么多，在我们开始之前，你还有什么想补充的吗？

So with all that said, anything else you want to add before we get started?

有。

Yes.

当团队向我提出这个想法时，我最初的反应是，我觉得这不值得。

This was an idea that when the team pitched it to me, my initial response was, I don't think this is worth it.

我们已经就这个话题生成了大量内容。

We've already generated plenty of content on this.

这肯定是我谈论的前五件事之一。

It certainly would be within the top five things that I talk about.

团队成功地说服了我，而且我认为他们是对的，他们说：‘彼得，这正是关键所在——如果有人想出去搜集你所有关于这个话题的言论，那简直是一项全职工作。’

And the team, I think, was able to get me convinced, and I believe rightly so, by saying, Yeah, Peter, that's kind of the point is if someone were to try to go out there and aggregate everything you've said on this topic, it would be a full time job.

有人甚至告诉我，这需要耗费数百小时的内容，确实是三位数的小时数。

And I think someone even shared with me how many hours and hours of content it would be, and it was triple digit hours.

他们说，这对那些拥有百科全书式记忆力、终身热衷且没有工作的人很有帮助，但大多数人并不属于这一类，因此拥有一份实用指南，而不仅仅是理论指南，将非常有帮助。

And they said that's great for the person with an encyclopedic memory who is a lifelong devotee who doesn't have a job, but most people aren't going to fit into that category and it would be really helpful to have a practical guide, not just a theoretical guide to this.

这让我改变了主意。

That kinda won me over.

所以我想说，要给团队点赞，是他们说服了我，这是正确的做法。

And so I guess I would just say kudos to the team for convincing me that this was the way to do it.

我对他们围绕这个主题构建的故事感到非常满意。

I'm really happy with the way they've crafted a story around this.

我们开始吧。

Let's dive in.

在开始之前，我有个小问题。

Before we do, quick question.

你觉得，如果团队把他们的论点制作成视频，作为Instagram或YouTube广告投放，你会更愿意听吗？

Do you think if the team started to put their arguments in forms of videos that we ran as Instagram or YouTube ads, you'd be more willing to listen?

如果你能做得足够好，但你必须在广告的前十秒内抓住我，否则我就会跳过。

If you could be good enough, but you have have to catch me within the first ten seconds of the ad or I'm skipping it.

我不确定我们团队是否具备这种能力。

Like, I don't know that that's a skill set that exists on our team.

我们没有练习过在前十秒内抓住观众的技巧。

We don't practice that skill of catch you in the first ten seconds.

没有。

No.

我们更擅长的是，在经过两小时的严谨解释后，才让你理解。

We practice more of we will get you at the end of two hours after explaining in rigor.

因此，我想，我们最好先快速看一下，为什么心肺功能不仅是你关于寿命（活得多久）方法中的核心支柱，也是健康寿命的关键。

So with that said, I think what would be helpful to start is looking at real quick why is cardiorespiratory fitness a central pillar in not only your approach to lifespan, how long you live, but health span.

是的。

Yeah.

所以，如果你已经听我讲过多年这个话题，你完全可以打开你的播客播放器，快进几分钟。

So again, if you've been listening to me talk about this for years, you can literally go to your podcast player and hit forward for a couple of minutes.

你不需要再听这些内容。

You don't need to hear this.

但我还是想花至少一分钟谈谈这个观点：心肺耐力是最重要的、可改变的因素之一。

But I do want to spend at least a minute on this idea that cardiorespiratory fitness is one of the most important and modifiable.

我们必须强调，这里讨论的是影响你寿命和健康寿命的可改变预测因子。

Very important that we're talking about modifiable predictors of both how long you're going to live and how well you're going to live.

所以，如果你查看所有全因死亡率的预测因子——记住，这是长寿领域的金标准指标——心肺耐力的表现优于我们能测量的任何其他变量。

So if you look at all the predictors of all cause mortality, which remember that's the holy grail metric of longevity, cardiorespiratory fitness outperforms every other variable we can measure.

这包括血压、胆固醇、BMI、吸烟，甚至包括年龄，这简直让我震惊。

This includes blood pressure, this includes cholesterol, this includes BMI, smoking, it even includes age which just blows my mind.

因此，心肺耐力（CRF）代表了你的心脏、肺、血管和肌肉协同工作，输送和利用氧气的效率。

So cardiorespiratory fitness, CRF, represents how efficiently your heart and lungs and blood vessels and muscles can work together to deliver and utilize oxygen.

因此，这个系统越高效，你的身体就越有生理储备。

So the more efficient that system is, the more physiologic reserve your body has.

正是这种储备使你能够承受压力。

And it's this reserve that allows you to tolerate stress.

这种压力可能来自感染、手术，或者仅仅是日常生活的种种需求。

This stress can come in the form of an infection, surgery or just frankly the day to day demands of living.

这通常且反复地通过一种称为VO2最大值的测试来测量。

This has been most typically and most repeatedly measured using a test called VO2 max.

当然，你听过我谈论过这个，它已经成为人们热议的一个热门话题。

You've heard me talk about this, of course, and it's become a very popular thing that people talk about.

它是身体在最大努力下（需要运动）利用氧气的最高速率。

It's the maximum rate at which the body can utilize oxygen tested of course during maximal efforts which require exercise.

因此，这个数值以每公斤体重每分钟消耗的氧气毫升数来表示。

So this number is expressed in milliliters of oxygen per kilogram of body weight per minute.

但它也可以通过称为METs（代谢当量）的方法来估算，其中1 MET等于每公斤体重每分钟摄取或利用3.5毫升氧气。

But it can be estimated using something called mets or metabolic equivalence where one met is equal to 3.5 milliliters per kilogram per minute of oxygen uptake or utilization.

因此，我认为VO2最大值成为如此流行的测量方式，是因为它是一种标准化的测试。

So, I would say that the reason that VO2 max has become such a popular way to do this is because it is a standardized test.

但这并不意味着它总是被正确执行的。

That doesn't mean it's always done correctly.

我们有很多例子说明它可能被错误地执行，因此对于我们的患者，我们实际上会亲自进行这项测试。

And we've got plenty of examples of how this can be done incorrectly, which is why for our patients we actually do the test.

我们厌倦了依赖其他实验室来做这项测试。

We got tired of relying on other labs to do it.

但大多数情况下，经过良好训练的技术人员可以一致地完成这项测试。

But for the most part, a well trained technician can do this consistently.

这使得研究变得容易。

And that makes it easy to study.

因此，在文献中你会看到大量讨论，最终都归结为METs或VO2 max。

And that's why in the literature you're going to see so much discussion where it comes down to mets or VO2 max.

这两者可以互换使用。

The two can be used interchangeably.

但当你谈到二区训练时，就不会出现这种情况。

And you won't, for example, see that when it comes to zone two.

所以今天我们将会大量讨论这一点。

So we're going talk a lot about that today.

但我只想指出，二区训练是一个更难把握的领域，因为它不是最大努力，而是一种中间强度的努力。

But I just want to point out zone two is a much more difficult area to navigate because it's not a maximal effort, it's an in between effort.

VO2最大值是一种最大努力。

VO2 max is a maximal effort.

所以当你告诉某人全力冲刺直到他们撑不住为止时，这实际上更容易实现。

So when you tell somebody to basically floor it until they're going to keel over, that's actually much easier to achieve.

现在，为了说明VO2最大值在死亡率方面的重要性，由于它已被广泛研究，如果你的VO2最大值处于人群的最低四分位数或五分位数——即VO2最大值最低的20%到25%的人群——那么你每年因任何原因死亡的风险比前2%到3%的人高出四到五倍。

Now, to put some context around the importance of VO2 max in mortality, again because it's been studied, if you're in the bottom quartile or quintile, so bottom twenty to twenty five percent of the population with respect to your VO2 max, you've got a four to five fold higher risk of mortality, all cause mortality in any given year than those in the top three percent, two to three percent.

这是一个相当大的差距。

That's a pretty big jump.

但请记住，即使是很小的进步，比如从第二四分位数提升到第三四分位数，也能使全因死亡率显著改善50%到75%。

But keep in mind, even tiny little jumps, say moving from the second quartile to the third quartile, will still have easily a fifty to seventy five percent improvement in all cause mortality.

那么，为什么这种关系如此强大？

So why is this such a powerful relationship?

我认为这不仅关乎这个数字所代表的含义，也就是我之前谈到的关于氧气输送和利用的所有内容。

And I think it comes down to not just what the number represents, which is everything I've talked about vis a vis oxygen delivery and utilization.

我以前说过，但我觉得有必要再重复一遍。

I've said this before but I think it bears repeating.

像VO2最大值这样的指标，就像力量一样，实际上是所做工作的综合体现。

Measures like VO2 max, just like strength, they're actually integrators of work done.

所以，如果一个人的VO2最大值很低，而他的目标是达到很高的VO2最大值，他当然可以做到，但这可能需要数年时间和无数小时的训练。

So, if a person has a VO2 max that is low and their aspiration is to have a very high VO2 max, they can but it will take potentially years and countless hours of work done.

这些训练将在心血管系统、呼吸系统、血液系统、肌肉系统和代谢系统等多个层面进行。

And that work will be done at the level of their cardiovascular system, their pulmonary system, their hematologic system, muscular system, metabolic system.

所有这些系统都必须持续工作数百小时，才能实现预期的效果。

And all of those things will have to work and work and work for hundreds of hours to get a desired outcome.

如果你仔细想想，从生理学角度来看，这比吃一颗降低胆固醇的药要令人印象深刻得多。

And if you think about that, that's much more frankly impressive from a physiologic perspective than taking a pill that lowers your cholesterol.

这并不是说吃降低胆固醇的药不能改善健康结果，但平均而言，它无法像这种方式那样显著改善健康结果。

It's not to say that taking a pill that lowers your cholesterol doesn't improve outcomes, but it's not going to come close to improving outcomes as much as this does on average.

存在一些特殊情况。

There are edge cases.

有一些患有家族性高胆固醇血症的个体，这种降低胆固醇的药物对他们会有显著的益处。

There are some individuals with familial hypercholesterolemia where that pill that lowers their cholesterol will have an outsized benefit.

但总体而言，这就是为什么改善心肺耐力或力量的事物往往对死亡率产生如此重大影响的原因。

But by and large, this is why things that improve cardiorespiratory fitness or strength tend to have such an impact on mortality.

除了死亡率之外，您还能谈谈健康寿命方面的益处吗？

Beyond mortality, can you also talk about the health span benefits?

所以，您所说的不仅是它能帮助你活多久，还有它能帮助你活得多好。

So, what you refer to as not only how long it can help you live but how well it can help you live.

是的。

Yeah.

我认为这里的论点同样有力。

I think the argument here is just as strong.

当然，数据不如死亡率那么客观，因为健康寿命不是一个那么客观的指标。

Of course, the data are not quite as objective because health span is not as objective.

因此，我所向往的、能定义我良好健康寿命的目标，可能和你，尼克，不同，也不同于正在听我们讲话的每一个人。

So what I might aspire to be able to do that would define good health span for me might not be the same as you, Nick, and is not going to be the same as every person that is listening to us right now.

但我们知道，而且今天至少会展示一张图表来说明这一点，即VO2 max会随着年龄增长而稳定下降，大约每十年下降10%。

But what we do know, and I think we'll show at least one figure to that effect today, is that VO2 max declines quite predictably with age at about 10% per decade.

但完成各种活动所需的氧气消耗量并不会改变。

But the oxygen cost of doing things doesn't change.

无论是爬楼梯、举起重物、追逐孩子还是运动，这些活动的氧气需求都不会改变。

So, whether it be climbing stairs or lifting something up or chasing your kids around or playing a sport, those things don't change.

因此，当你的氧气输送和利用能力持续下降，而需求却保持不变时，这两条曲线终将相交。

So, if you have a declining capacity to deliver and utilize oxygen in the presence of constant demand, at some point those curves cross.

这实际上意味着，你开始丧失完成这些活动的能力。

And what that effectively means is you start losing the ability to do these things.

我们稍后在谈到这一点时会更详细地讨论。

Again, we'll talk about this in much more detail when we get there.

但正如一张图表可能比我的表述更能说明问题，我们的目标是尽可能长久地保持身体活动的可行性。

But as I think a figure can represent better than what I'm saying necessarily, our objective is to be able to maintain optionality around being physical for as long as possible.

而这相当于尽可能提高你的VO2最大值，同时尽可能增强力量。

And that is tantamount to having as high a VO2 max as possible in addition to being as strong as possible.

过去在谈论心肺耐力时，为了帮助人们更简单地理解，你经常提到基础与峰值模型。

When talking about cardiorespiratory fitness in the past to kind of help people understand it in a simpler way, you've often talked about the base and peak model.

你能再详细解释一下这个框架吗？以及不同类型的运动和强度如何影响这个模型的各个组成部分？

Can you just walk through a little bit more about that framework and how different exercise and intensities can contribute to each component of that?

我谈到这个心肺耐力三角模型，但这个模型完全不是我发明的。

I talk about this cardiorespiratory fitness triangle and I can't take credit for this at all.

这是我的一位自行车教练提出的。

It was one of my cycling coaches that came up with this.

这个模型的思路是，想象一个带有底边和顶点的三角形。

So the idea was that you picture a triangle with a base and a peak.

底边代表我们所说的长时间持续进行次最大强度运动的能力。

And the base is what we think of as your capacity to do sustained sub maximal effort over a long period of time.

想想那些你可以持续数小时做的事情。

So think of something you could do for hours.

而峰值则代表你的最大有氧输出能力。

And then the peak represents your maximum aerobic output.

也就是你能维持五到十分钟的强度。

So what you could sustain for five to ten minutes.

显然，这里存在许多不同的梯度。

Obviously, there are so many gradations here.

你的功能阈值功率——即你能维持一小时的强度——显然比峰值低，也比基础值持续时间短。

Your functional threshold power, which is what you could obtain for an hour, is obviously smaller number than the peak and a shorter number than the base.

所以，无论如何，如果你的目标是最大化你的整体有氧能力，那就是要最大化这个心肺三角形的面积。

So anyway, the goal here, if you're trying to maximize your total aerobic capacity, is to maximize the area of this cardiorespiratory triangle.

当然，要做到这一点，你需要尽可能拓宽基底并提高峰值。

And of course, to do that you want to have the widest base and the highest peak possible.

而这两者需要不同的训练方式。

And these require different forms of training.

所以，如果你一直只以单一强度训练，也会同时提升这两方面。

So if you just trained at one intensity level the whole time, you would increase both of these things.

我想明确这一点，因为它造成了很多混淆。

I want to be clear on that point because it creates so much confusion.

如果你只停留在一个训练强度水平，通过足够的训练量，你确实能提升这两者。

If you only parked yourself at one level of training, you would, through enough volume, increase both of these.

但这并不是最大化效果的方法，当然也不是最省时的方式，甚至不一定是最优的方式。

But that's not the way to maximize the problem and it's certainly not the most time efficient way to do it nor is it necessarily the best way to do it.

事实上，鉴于没有任何高水平运动员会这样训练，这几乎肯定不是正确的方法。

In fact, it's almost assuredly not given the fact that no high level athlete trains that way.

基础训练 ideally 是通过提高身体更高效利用氧气、将燃料（主要是脂肪）转化为ATP的适应性来建立的。

The base is ideally built through adaptations that help you utilize oxygen more efficiently to convert fuel, but mostly fat, into ATP.

这实际上旨在提高线粒体的密度和效率，优化脂肪氧化和乳酸利用。

What this is really geared towards is improving mitochondrial density and efficiency and optimizing fat oxidation and lactate utilization.

相反，峰值——也就是VO2最大值——代表了氧气输送（主要是）和利用的上限。

Conversely, the peak, which again is that VO2 max, represents the ceiling for oxygen delivery primarily but utilization.

而它取决于这一系统将氧气输送给线粒体的能力。

And it's driven by how well this system can deliver oxygen to the mitochondria.

这主要是瓶颈所在。

That's primarily the bottleneck.

它关乎你能向线粒体输送多少氧气，而基础则关乎你能多高效地利用底物。

It's how much oxygen can you deliver to mitochondria versus the base which is how much can you utilize substrate efficiently.

因此，在向线粒体输送氧气方面，主要有四大驱动因素。

So, when it comes to delivering oxygen to the mitochondria, there are really four big drivers.

首先是氧气从肺部扩散到血液中。

There's the diffusion of oxygen from the lungs into the blood.

其次是心输出量，也就是心率和每搏输出量。

There's cardiac output, so that's heart rate and stroke volume.

然后是血液的携氧能力，即血红蛋白。

Then there's the oxygen carrying capacity of the blood, namely hemoglobin.

最后是肌肉提取氧气的能力。

And then there's the muscle's ability to extract this.

但正如我刚才所说，心输出量才是这里的主因，也是我们在减少时最敏感的因素。

But as I said a moment ago, it's the cardiac output that is the main driver here and it is the one we are most sensitive to in reduction.

因此，驱动心输出量的主要因素是每搏输出量，即每次心跳泵出的血量，以及心率。

So again, what drives cardiac output primarily is stroke volume, how much blood comes out of the heart with each pump and heart rate.

当然，当你达到最大摄氧量强度时，心率也会达到最大值。

And of course when you're at a VO2 max effort you're getting to maximum heart rate.

因此，最大摄氧量变异性的70%到85%仅仅由这一项因素决定。

So, somewhere between 7085% of the variability in VO2 max is accounted for just by this one variable.

在节目笔记中，我们会提供更多关于这方面的详细内容，如果你对这些内容感兴趣，想深入研究的话。

In the show notes, we'll include a whole bunch more detail on this if anybody kind of wants to nerd out on this stuff.

我非常喜欢这些内容，但此刻我不想再花更多时间讨论了。

I love this stuff but I don't want to spend any more time on it right here.

所以，正如我之前暗示的，很容易产生这样的误解——如果我曾经给你造成过这种印象或过度简化了这一点，我在此表示歉意，这确实有可能发生。

So, as I kind of alluded to, it's very tempting to and I want to apologize if I've ever created the impression or oversimplified this and it's possible that I have.

二区训练是你唯一用来打基础的训练方式，而高强度训练是你唯一用来提升峰值表现的方式。

Zone two is what you do exclusively to build your base and high intensity workouts is the only thing you do to build your peak.

正如我所说，这些系统是相互协同的，如果你只做二区训练，你绝对能获得更宽广的基础。

As I said, these systems work together and if all you did was zone two, you would absolutely get a wider base.

你也会提高你的峰值。

You would also raise your peak.

同样，如果你进行高强度训练，你会提高峰值，但也会稍微拓宽你的基础。

Similarly, if you did higher intensity training, you would increase your peak but you would also widen your base a little bit.

关键在于，正如我们将在细节中探讨的，如何优化不同训练量和强度需求下的时间分配。

The key, as we'll get into in the nuance, is what is the optimized way to utilize time around different volume and intensity requirements.

那么，你能完成多少总训练量？

So how much total work can you do?

你能进行多少心肺耐力训练？

How much cardiorespiratory fitness training can you do?

这可能是最重要的决定因素。

That's probably the single biggest determinant.

但这涉及一个最小-最大问题，这也是我们今天要讨论的重要内容。

But that involves a min max problem which is a big part of what we're going to talk about today.

这就是我对这个三角形的理解。

So that's how I think about the triangle.

谈到二区训练时，你经常提到脂肪氧化、线粒体和乳酸。

When talking about zone two, you've often talked about fat oxidation, mitochondria, lactate.

我经常觉得这些术语对人们来说可能有点令人困惑，因此重新审视并解释它们总是有帮助的。

Oftentimes I think these terms can be a little confusing for people and so I think it's always helpful to kind of relook at them and explain it.

你介意花几分钟详细讲解一下与心肺耐力相关的细胞机制吗？这样大家就能熟悉你在这里可能会用到的那些术语了。

So do you mind just spending a few minutes walking through the cellular mechanisms that are involved in cardiorespiratory fitness just so everyone is kind of familiar with the terms you may or may not use throughout here?

好的。

Yeah.

这其实挺有趣的，因为我注意到Instagram上有些特别棒的梗图，人们在嘲笑任何使用‘线粒体’这个词的人。

So it's really funny because I've noticed some amazing memes on Instagram where you basically have people that are making fun of anybody that uses the word mitochondria.

所以，由于我平时不太关注健康网红圈，我才知道‘线粒体’这个词现在居然成了一个必须频繁使用的流行词。

So somehow, because I don't really pay attention to the wellness influencer health space, apparently the word mitochondria is now just one of those buzzwords that you should throw around as much as possible.

如果你在玩健康网红术语 bingo 游戏，提到‘线粒体’就能得很多分。

And so if you're playing sort of wellness influencer bingo, you're gonna get a lot of points for mitochondria.

我记不太清其他那些明显是傻气标志的词了。

Can't remember some of the other awesome words that are just basically pathognomonic for buffoonery.

你看过这些梗图吗？

Have you seen any of these memes?

它们太棒了。

They're amazing.

就像线粒体、炎症、肠道菌群，他们把所有流行词都用上了。

It's like mitochondria, inflammation, gut biome, like they've got all the buzzwords.

蛋白质，还有一个。

Protein, another one.

蛋白质，我肯定。

Protein, I'm sure.

你现在已经让我触发了 bingo 卡了。

You've set me up now to trigger a bingo card.

但我想你说得对，没有这些术语，这个讨论是没法进行的。

But I guess you're right, you can't have this discussion without doing this.

所以希望我在这里使用‘线粒体’这个词能获得豁免。

So hopefully I'm going get an exemption for my use of the word mitochondria here.

在你的心肺系统基础中，存在着一种名为线粒体的细胞器，当然，所有上过高中生物课的人都记得，它们被称为细胞的‘微型能量工厂’，我们体内大部分的ATP都是由它们产生的。

At the foundation of your cardiorespiratory system are these organelles called mitochondria and of course all of you who took a high school class in biology will remember that they're referred to as sort of the little power units of the cell and the majority of our ATP is produced by them.

再次强调，ATP是能量的货币。

And again, ATP is the currency for energy.

因为我实在忍不住想再深入一点细节，ATP的工作原理是：ATP含有三个磷酸基团，它会捐赠出其中一个磷酸基团，正是这种化学键断裂释放的能量产生了能量。

Just because I can't resist giving one more level of detail, the way ATP work is they donate, ATP has three phosphates, they donate one of those phosphates and it's that liberation of energy that comes from that chemical bond that creates energy.

线粒体可以通过脂肪酸或丙酮酸来生成ATP。

The mitochondria can generate ATP from either fatty acids or pyruvate.

丙酮酸是葡萄糖通过一种称为糖酵解的过程分解而产生的中间产物。

Pyruvate is an intermediary breakdown product of glucose via a process called glycolysis.

这两种过程都在持续不断地进行。

And both of these processes are constantly occurring.

关键问题是，它们发生的比例是多少？

It's just the question is what's the balance in which they're occurring?

当然，这两种过程是否相等？

And of course, are these both equal?

不，它们并不相等。

No, they're not.

每个过程都有其权衡。

Each process has a trade off.

这种权衡可以简单地表述为：

The trade off would simply be stated this way.

如果你追求效率，而不那么在意ATP产生的速度，你希望采用更偏向有氧的途径。

If you are optimizing for efficiency and you don't care as much about the speed with which you can deliver ATP, you want to take that more aerobic pathway.

也就是说，利用氧气，将脂肪酸或葡萄糖的分解产物（无论是丙酮酸还是乙酰辅酶A）送入线粒体，通过氧化途径，每单位碳输入产生大量ATP。

Meaning utilizing oxygen and shuttling the breakdown product of fatty acid or glucose, either in the form of pyruvate or acetyl CoA, into the mitochondria to use an oxidative pathway to generate lots of ATP per units of carbon that go in.

但问题是，当ATP需求加速时，你必须做出权衡。

The problem with that is as the demand for ATP accelerates, you have to make a trade off.

你必须做出牺牲。

You have to make a sacrifice.

身体会说：对不起，我再也无法继续了。

The body says, I'm sorry, I can't do this anymore.

我必须走这条更快的路径，通过糖酵解将葡萄糖转化为丙酮酸，最终转化为乳酸。

I have to go down this quicker path using glycolysis where I turn glucose into pyruvate, ultimately into lactate.

虽然我从中获得的ATP要少得多，但我能向肌肉输送更多的ATP。

I don't get nearly as many ATP for it but I can deliver much more ATP to the muscle.

但我不能无限期地这样做。

Now I can't do this indefinitely.

这背后有一系列问题，我们稍后会讨论。

There's a whole problem associated with that which we'll talk about.

但这就是高效能权衡的大致情况。

But that's effectively at the high level of the trade off.

所以，另一种思考方式是通过涉及的肌纤维来理解。

So, another way to think about this is through the lens of the fibers that are involved.

这些术语我们之前在播客中提到过，但本播客的目标是将这一切串联起来。

And again, these are terms we've used on the podcast before but the goal of this podcast is to kind of tie this all together.

在较低强度下，你会用到I型或慢肌纤维。

So at lower intensities, you have these type one or slow twitch muscle fibers.

而且我认为，‘慢肌’这个术语在某种程度上确实反映了它们收缩的速度，但我认为更关键的是，它们不易疲劳，属于更偏向耐力的肌纤维。

And again, I think the term slow twitch, it does to some extent reflect the speed with which they twitch, but I think a more important way to think about them is they're slow to fatigue and they're more endurance based fibers.

因此，在低强度下，正是这些肌纤维在承担全部工作，它们富含线粒体，呈深红色，擅长氧化脂肪，效率极高。

So again, lower intensities, they're the ones that are doing all the work, very rich in mitochondria, deep red, they excel at oxidizing fat and they're very, very efficient.

随着强度增加，我们必须开始招募更多的II型肌纤维。

As the intensity increases, we have to start recruiting more of the type two fibers.

这些是快肌纤维，它们在力量收缩方面更强，但也更容易疲劳。

These are fast twitch fibers which again are more contractile in their force but they are also fast to fatigue.

它们的线粒体较少，会更多地依赖糖酵解途径。

They have less mitochondria and they're going to recruit and rely more heavily on glycolysis.

这一过程发生在细胞质中，而非线粒体内。

That's happening outside the mitochondria.

因此，最初产生的乳酸——虽然常被误解，但我们之前已经做过一期完整的节目讨论这个话题，我们会提供相关节目链接。

So initially lactate, which again kind of gets a bit of a bad rap but again we've done an entire podcast on this and we'll link to the podcasts on this topic.

但其中最重要的一期，无疑是与乔治·布鲁克斯的那期。

But the most important of these is definitely the one with George Brooks.

最初，乳酸会在局部被回收。

Initially, the lactate gets recycled locally.

因此，它被转运到邻近的I型纤维中。

So it's shuttled to neighboring type one fibers.

它在II型纤维中产生，然后被转运到I型纤维，重新转化为丙酮酸，接着丙酮酸进入线粒体以产生更多ATP。

It gets generated in a type two fiber, gets shuttled to a type one fiber, gets converted back into pyruvate and then the pyruvate goes into the mitochondria to produce more ATP.

这被称为乳酸穿梭。

That's called the lactate shuttle.

但这些过程受需求限制，因此随着输出和需求增加，II型纤维中的乳酸生成量开始超过相邻线粒体的处理能力。

But again, these things are constrained by demand and therefore as output increases and demand increases, lactate production in the type two fibers begins to exceed the capacity for what can be done locally in the mitochondria adjacent.

此时，乳酸就会溢入血液中。

And at that point, lactate spills into the bloodstream.

所以，如果你用连续乳酸监测仪测量血液中的乳酸水平——顺便说一下，这类设备已经处于原型阶段，市场上也有一些产品。

So if you were measuring lactate in the bloodstream with a continuous lactate monitor, which by the way, these things are easily in prototype and there's some that are in the market.

因此，未来你将能够更好地理解这一点。

So this will be something you can appreciate in the future.

你可能在开始锻炼时，乳酸水平处于0.5毫摩尔的静息状态。

You might start out an exercise session where your lactate is resting at 0.5 millimole.

直到目前为止我所描述的所有情况，都不会使这一数值上升，尽管局部乳酸水平正在升高。

Everything I just described up until this point would not increase that even though locally lactate levels are rising.

但一旦乳酸开始溢入血液，你就必须依赖身体其他组织来清除它，比如心脏，以及其他此时未被使用的肌肉。

But once it starts spilling into the bloodstream, now you actually have to rely on other tissues in the body, the heart, other muscles that are not being utilized at this point in time.

它们必须开始利用乳酸作为燃料来清除它，正如我们从乔治·布鲁克斯那里学到的，大脑也会这样做。

They have to start clearing it using lactate as fuel, as we've even learned from George Brooks, the brain will do this as well.

肝脏也可以通过糖异生作用将乳酸转化回葡萄糖。

The liver also can convert that lactate back into glucose via gluconeogenesis.

这基本上使身体能够将乳酸水平维持在一个高于原始基线的新基准上。

This basically allows the body to maintain certain levels of lactate at a new baseline that is above the original baseline.

这通常被称为第一个乳酸阈值。

This is usually referred to as the first lactate threshold.

对于代谢健康且代谢灵活的人而言，即能够自由切换利用葡萄糖和脂肪酸的人，这一阈值大约出现在2毫摩尔的乳酸水平。

And again, for a metabolically healthy individual and someone who's metabolically flexible, meaning they can go back and forth between utilizing glucose and fatty acids, this falls at about two millimole of lactate.

这就是我们所说的二区。

That is what we refer to as zone two.

同样，如果这些条件不满足，如果你不是代谢灵活的人，那么以两毫摩尔作为第一个阈值是不会实现的。

Again, if some of those conditions aren't met, if you're not a metabolically flexible person, using that first threshold of lactate at two millimole is not going happen.

有些人静息时的乳酸水平就已经高于两毫摩尔。

There are people who walk around at rest with a lactate level above two.

好的。

Okay.

但重点是，你现在达到了一个新的稳态，如果你还记得，第一个稳态是局部组织能够以与产生速率相等的速度清除乳酸，局部的产生和消耗达到平衡。

But the point here is you can maintain, you're now at a new steady state where if you remember the first steady state is where the local tissues are able to offset lactate production at the rate that it's being produced, consumption and production are equal locally.

然后你进入第二个层次，我们称之为第一个乳酸阈值，因为这是我们在血浆中测量到的第一个阈值。

Then you have this second level, which we refer to as the first lactate threshold because it's the first one we're measuring in the plasma.

在这个层次上，全身组织现在能够平衡乳酸水平。

And that's where now the systemic tissues are able to balance it.

但我们现在进入第三个乳酸水平，这被称为第二个乳酸阈值，其数值更高。

But now we get to a third level of lactate, which is really called the second lactate threshold, and that's at higher and higher levels.

在这一点上，一旦身体超过这个水平，而这个水平因人而异很大，如果我们有时间，我可以详细讲讲如何测量它。

And at this point, once the body gets above that level, and this level varies quite a bit by individual, maybe if we have time I'll go into how you can measure that.

我曾在与奥拉夫、亚历山大、布的第一次播客中详细讨论过这个问题，但我们可以回头再谈。

I talked about this at length in the first podcast with Olaf, Alexander, Boo, but we can come back to that.

但无论如何，这些更高的输出水平，即工作肌肉中的糖酵解乳酸生成，完全超过了身体清除它的能力。

But anyway, these higher levels of output, glycolytic lactate production in the working muscles completely surpasses the body's ability to clear it.

此时，血液中的乳酸开始急剧上升。

At this point, blood lactate starts to rise much more sharply.

这伴随着氢离子的产生，因为乳酸带负电荷。

It's accompanied by hydrogen ion because the lactate is negatively charged.

氢离子带正电荷，因此它们大致呈一对一的平衡关系。

The hydrogen is positively charged, so they're balanced kind of one to one.

你会感受到由此产生的酸性环境。

You have this acidity that occurs.

事实证明，真正对肌肉造成毒害的是氢离子，而不是乳酸。

It turns out that it's the hydrogen ion and not the lactate that is effectively poisoning the muscle.

它实际上阻止了肌肉中的肌动蛋白和肌球蛋白丝放松。

It actually prevents the actin and myosin filaments in the muscle from being able to relax.

对大多数人来说，第二个乳酸阈值，或者按不同计数方式可能是第三个，通常出现在4到5毫摩尔乳酸之间。

Again, for most people, that second lactate threshold or really third one depending on how you're counting them occurs somewhere between four and five millimole of lactate.

这是一个变化性更大的数值。

That's a much more variable number.

好的。

Okay.

所以我就先说到这里。

So I'm going to stop there.

我们可以讨论的内容还有很多，但希望这已经奠定了基础。

There's a lot we could talk about there but hopefully that kind of sets the groundwork.

确实如此。

Very much so.

我认为在继续之前，或许值得稍微换个角度谈谈二区训练，因为最近关于它是否具有独特益处，或者是否只需专注于高强度训练，已经有很多讨论。

I think maybe worth clicking on to zone two before we get further in a little bit of a different way because it seems like there's been a lot of discussion lately on whether it has unique benefits, whether it's just better to focus on higher intensity work only.

那么你是如何看待这个问题的？

So how do you think about this question?

我认为这取决于具体情境。

I think it comes down to context.

我认为人们对这个问题存在很多困惑。

I think there's a lot of confusion around this.

所以我会尽力澄清这些误解。

So hopefully I'll do my best to dispel that.

有一些观点在挑战有氧二区（zone two）具有特殊性、神奇性或任何益处的说法。

There's ideas out there challenging the idea that zone two is special or magical or there's anything that's good about it.

当然，也有人坚称高强度训练能产生相同甚至更大的适应性效果。

And there are certainly people who would assert that high intensity work produces the same or even greater adaptations.

我认为，按照某些人提出的框架，这种说法确实是成立的。

And I think honestly in the framework that some people are proposing that it is true.

那么我们现在来仔细分析一下这个问题。

So let's now think through this.

对于高强度锻炼的支持者来说，那些说不要浪费时间做二区训练的人，当一个人的锻炼时间越少，这种观点就越成立。

For the proponents of high intensity exercise, people who say don't waste your time doing zone two, the shorter the amount of exercise time that a person has, the more true that is.

因为请记住我几分钟前说过的话：如果你真的想最大化你三角形的面积，没有什么能比得上训练量。

Because remember something I said a few minutes ago which is if you really want to maximize the area of your triangle, nothing beats volume.

但现在，我不会这么做。

Now, won't do it.

所以你必须达到二区，也就是你开始获得一些适应性的第一个阶段。

So you have to get to zone two, this first place where you have some adaptation.

但你在二区花费的时间越多，效果就越好。

But the more time you spend there, the better.

因此，如果我们谈论的是职业运动员，甚至是业余运动员，十年前我训练的方式——奇迹般地，我每周仍能骑自行车十四到十六小时——那么我们就可以深入探讨这段时间应该如何分配。

And so, if we're going to talk about a professional athlete or even a recreational athlete, you're going to talk about ten to fifteen years ago the way I trained where by some miracle I still was managing to spend fourteen to sixteen hours a week on a bike, then we can get into the nuance of how that time should be divided.

所以现在，让我们转向一个会遵循一般指南的人。

So now let's turn this over to someone who's going to adhere to the general guidelines.

一般指南建议，你每周最好锻炼一百五十分钟。

So the general guidelines says you should exercise ideally one hundred and fifty minutes per week.

所以每周是两个半小时。

So that's two and a half hours per week.

我确信如果你们做得更多，这些指南也会很高兴，但这是我们希望人们达到的目标。

And I'm sure the guidelines would be happy if you did more but that's what we're trying to get people to.

大多数人每周的锻炼时间并没有达到两个半小时。

Most people are not exercising two and a half hours per week.

坦率地说，如果你只能坚持这么长时间，那么进行二区训练就不是高效利用你时间的方式，因为它提供的训练刺激不足以推动身体适应，从而让三角形变大。

And truthfully, if that's all you can adhere to, then zone two is not going to be an efficient use of your time because it doesn't provide a sufficient enough training stimulates to drive the adaptations to make the triangle bigger.

请记住，这150分钟是总锻炼时间。

And remember that 150 is total exercise.

其中一部分必须是力量训练。

Well, part of that's going to have to be some resistance training.

所以即使你决定每周安排两次30分钟的力量训练，总共一小时，那么你只剩下一个半小时用于有氧运动。

So even if you said I'm going to carve out an hour for two thirty minute resistance training workouts in a week, then you've got an hour and a half for cardio.

坦率地说，我会说这所有的时间都应该用于高强度训练。

Truthfully, I would say then all of that time should be done at high intensity.

你最好安排两次每次四十五分钟的高强度训练。

You should probably have two forty five minute high intensity workouts.

但当我谈论训练时，也许我应该如此，但我通常不是针对那类人群说话。

But when I talk about training, and maybe I should be, but I'm generally not talking to that population.

当我与那类人群中的患者交谈时，情况就不同了。

When I'm talking to my patients in that population, it's a different story.

我们会这样做。

And we do.

我们非常明确地表示，如果你这一周只有两个半小时用于锻炼，我们会围绕这个时间来制定你的训练计划。

We're very clear that if you've only got two and a half hours this week to exercise, we're going to craft your program around that.

但我现在谈论的是那些真正思考如何在一生和健康寿命中长期优化并取得最佳效果的人。

But I'm talking to a person who is really thinking about how to optimize and achieve their best results over both lifespan and health span over decades.

如果是这种情况，那么你需要的训练量将超过每周一百五十分钟。

And if that's the case, then you're going to need more volume than one hundred and fifty minutes a week.

这意味着你必须利用不同强度的训练水平。

And then that means you're going to have to utilize different levels of intensity.