Is there a single substance that can lower blood pressure, regulate cholesterol, protect against diabetes, and dramatically reduce the risk of dementia and cancer at the same time? In this conversation, we explore why movement is more powerful than any medication, how to wisely build your own “health insurance policy” for later life, and what the legendary VO2 max metric reveals about longevity.
I speak with Professor Łukasz Małek, a distinguished sports cardiologist and ELEVATE speaker. He explains why longevity medicine becomes little more than a marketing bubble without solid foundations, and how to train intelligently so that instead of achieving the best shape of your life, you do not end up with chronic overtraining.
Michał Wieczorek: Łukasz, we both work in the field of building longevity. As a cardiologist and scientist, you look at the human body through the lens of the heart. What does that actually mean in practice, and what role does a sports cardiologist play in the Polish medical system?
Professor Łukasz Małek: In the Polish system, sports cardiology does not formally exist as a separate specialty. There is general cardiology and sports medicine, which takes a holistic approach to caring for athletes. After completing my training in conventional cardiology, I decided to pursue a two year postgraduate program at the University of London at the renowned St. George’s center. I wanted to fill a gap and focus on the hearts of athletes, both professionals and the steadily growing group of amateurs. In sports cardiology, diagnostics are crucial. Cardiac magnetic resonance imaging, for example, allows us to distinguish the so called “athlete’s heart,” which becomes naturally enlarged as a result of training, from serious conditions such as dilated cardiomyopathy. The goal is to avoid unnecessarily excluding anyone from sports while also making sure we do not miss a genuine life threatening risk.
Cardiovascular disease is still the world’s leading killer, accounting for nearly 30% of deaths globally, and unfortunately Poland remains among the high risk countries. At ELEVATE, you will explain why movement is the best medicine. Why do you call it a “polypill”?
Because conventional medications usually work in one direction. If a patient has hypertension, they receive a pill to lower blood pressure. If they have high cholesterol, they receive another one. Insulin resistance or heart rhythm disorders may require additional medications. At some point, an older person wakes up with a handful of pills on the nightstand. Physical activity is remarkable because it works in many directions at once. It naturally normalizes blood pressure, improves the lipid profile, regulates glucose metabolism, reduces the risk of atherosclerosis, and also protects against depression and cognitive decline. One stimulus can reduce the need for many different treatments. That is why movement is the cheapest and most effective polypill in the world.
In the longevity world, there is currently enormous interest in measuring aerobic capacity, or VO2 max. People often cite the famous Cleveland study involving 122,000 participants, which showed a linear relationship: the higher the VO2 max, the lower the risk of death from any cause. Is a high aerobic capacity really the best insurance policy for a long life?
Yes, that is true, and numerous scientific observations confirm it, including long term studies in which patients were followed for more than 40 years. People in the highest VO2 max category may have a five to six times lower risk of death. Physical activity also strongly reduces the risk of some of the most common cancers, including colorectal and breast cancer. We even studied the histories of Polish Olympic medalists from the previous century and found that they lived an average of 7 to 8 years longer than the general population. VO2 max is an excellent metric because it evaluates the performance of the entire body at once: lung function, the heart’s ability to pump blood, and cellular metabolism in the muscles. It measures how much oxygen the body can take in and actually use during exercise.
Does that mean we should all train like Olympic athletes and push our VO2 max as high as possible?
Absolutely not. This is one of the traps of the modern longevity trend, which can become a bubble for people trying to optimize minor details while neglecting the basics. I see people searching for expensive innovations while starting their vacation mornings with red meat and alcohol. It is like buying designer furniture for a house that does not yet have floors or plastered walls.
When it comes to VO2 max, we need to remember one thing: genetics sets a fixed ceiling that we cannot break through, and training can improve the metric by approximately 20%. Exhausting the body with brutal workouts just to force the number higher creates a risk of chronic fatigue, injury, and damage to health. The most important finding from these studies is that the greatest health benefit does not come from reaching an elite level, but from moving from complete inactivity to moderate activity. We should treat movement like an insurance policy. Fitness naturally declines with age. When we build it from a young age, then if illness, infection, or a fracture occurs, we fall from a much higher starting point. This is what allows an 80 year old to remain independent, mentally capable, and protected against muscle loss.
What training protocol would you recommend, then, for someone who simply wants to live a long and healthy life?
The World Health Organization recommends an absolute minimum of 150 minutes of moderate activity per week. An optimal, evidence based protocol for cardiovascular prevention involves 150 to 300 minutes of moderate intensity exercise each week. The simplest and safest approach is the 80/20 rule. Around 80% of all weekly movement should be moderate intensity activity, meaning the level at which you are slightly sweating but can still speak comfortably in full sentences. The remaining 20% can be devoted to intense exercise, such as HIIT or zone five training, provided that we are healthy and have undergone appropriate medical evaluation. We should also remember strength training, which protects against sarcopenia, as well as stability exercises and stretching.
Age is not an excuse. My oldest patient is a competitive track and field athlete who is 90 years old and is now moving into the “90+” competition category, winning medals in the shot put and javelin. People can and should remain active at every stage of life, adjusting intensity to their own abilities rather than to fashionable charts found online.
A beautiful and deeply inspiring conclusion. Thank you very much for this conversation, and see you at ELEVATE!
Thank you very much, Michał. See you there!
