Elevate Labs Bali

Comprehensive Longevity
Testing Protocol

A comprehensive new-client assessment battery covering body composition, cardiovascular fitness, musculoskeletal strength, neuromotor function, metabolic health, and cognitive baseline. Every test includes evidence-backed scoring rubrics stratified by sex and decade of life.

Protocol v1.0 — March 2026  ·  90–120 min  ·  14 Tests  ·  9 Domains
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Protocol Index

01 Body Composition & Anthropometrics 02 Cardiovascular Fitness 03 Strength & Musculoskeletal 04 Balance & Neuromotor 05 Flexibility & Mobility 06 Cardiovascular Health Markers 07 Autonomic & Nervous System 08 Respiratory Function 09 Cognitive & Reaction Time
Section 01

Body Composition & Anthropometrics

Body composition is a foundational longevity marker. Visceral adiposity is independently predictive of cardiovascular disease, metabolic syndrome, and all-cause mortality. Lean mass preservation is the single strongest hedge against sarcopenia and frailty.

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Visbody 3D Body Scanner
Full-body 3D composition scan — circumferences, posture, body fat estimate, segmental lean mass
Why It Matters

The Visbody scanner provides a non-invasive, radiation-free body composition estimate with 3D postural analysis. While not as precise as DEXA for body fat quantification, it delivers circumference measurements, body fat percentage estimates, posture deviation analysis, and segmental body shape data — all within 60 seconds. Peter Attia emphasizes in Outlive that body composition — not BMI — is what matters. Excess visceral fat drives insulin resistance, systemic inflammation, and dramatically increases cardiovascular and cancer risk. Tracking body composition over time reveals whether a person is losing lean mass (the hallmark of aging) or gaining metabolically dangerous visceral fat.

Key Sources
Peter Attia — Outlive (2023) Jayedi et al. 2020 — Body Fat & All-Cause Mortality (Obesity Reviews) Huberman x Attia — Exercises for Health & Longevity
Measurement Protocol
  1. Client removes all outer clothing; wears form-fitting underwear or provided scan shorts only. Remove jewelry, watches, hair ties.
  2. Client stands barefoot on the scanner platform in a neutral anatomical position: arms slightly abducted (~15°), feet shoulder-width on marked positions, eyes forward.
  3. Scanner performs a 35-second 360° infrared scan. Client remains motionless.
  4. System generates: body fat % estimate, lean mass estimate, waist/hip/chest/thigh circumferences, waist-to-hip ratio, posture deviation report, and 3D avatar.
  5. Record all metrics in client profile. Flag posture deviations for mobility assessment.
Body Fat Percentage Rubric
AgeExcellentGoodAverageBelow AvgPoor
▸ MALE
18–298–13%14–17%18–22%23–27%28%+
30–3910–15%16–19%20–24%25–28%29%+
40–4912–17%18–21%22–25%26–29%30%+
50–5914–19%20–23%24–27%28–31%32%+
60–6916–21%22–25%26–29%30–33%34%+
▸ FEMALE
18–2916–21%22–25%26–29%30–34%35%+
30–3917–22%23–26%27–31%32–35%36%+
40–4919–24%25–28%29–33%34–37%38%+
50–5921–26%27–31%32–35%36–39%40%+
60–6922–28%29–33%34–37%38–41%42%+
Waist-to-Hip Ratio Targets: Male < 0.90 | Female < 0.80. Ratios above 0.95 (M) or 0.85 (F) indicate elevated cardiometabolic risk regardless of overall body fat percentage. Based on WHO thresholds.
Section 02

Cardiovascular Fitness

VO₂ max is the single strongest predictor of all-cause mortality — stronger than smoking, hypertension, or diabetes as a risk factor. Peter Attia calls it "the most powerful longevity biomarker we have." Moving from the bottom 25th percentile to above the 75th percentile is associated with a 5x reduction in mortality risk.

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VO₂ Max Test
Cardiopulmonary exercise test — maximal oxygen uptake (mL/kg/min)
Why It Matters

VO₂ max measures the maximum volume of oxygen your body can utilize during intense exercise — the gold standard of cardiorespiratory fitness. A 2018 JAMA study by Mandsager et al. analyzing 122,007 patients found that low cardiorespiratory fitness was a stronger predictor of mortality than smoking, diabetes, or coronary artery disease. Moving from the lowest fitness quintile to just above average was associated with a 50% reduction in mortality. Peter Attia recommends all patients target at minimum the 75th percentile for their age/sex, with an aspirational goal of the 90th+ percentile — which functionally "makes you a decade younger." The American Heart Association published a 2016 scientific statement recommending VO₂ max be assessed as a clinical vital sign.

Key Sources
Mandsager et al. 2018 — JAMA Network Open Kaminsky et al. 2015 — FRIEND Database (Mayo Clinic) Peter Attia AMA #329 — Exercise & Longevity Huberman Lab — Attia on Exercise
Measurement Protocol
  1. Client fasts for 2+ hours prior. No caffeine for 4 hours. No intense exercise in the prior 24 hours.
  2. Fit metabolic cart mask (gas analyzer). Calibrate O₂ and CO₂ sensors. Apply heart rate chest strap.
  3. Graded treadmill protocol (modified Bruce protocol): Begin at 2.7 km/h, 0% grade. Increase speed and/or incline every 3 minutes.
  4. Client exercises to volitional exhaustion. Technician monitors for VO₂ plateau (increase <150 mL/min despite increasing workload), RER ≥ 1.10, and HR within 10 bpm of age-predicted max.
  5. Record peak VO₂ (mL/kg/min), max HR, RER, time to exhaustion, ventilatory thresholds (VT1 and VT2).
  6. 5-minute active cooldown. Monitor HR recovery at 1 min and 2 min post-test.
VO₂ Max Rubric (mL/kg/min)
AgeSuperior (90th)Excellent (75th)Good (50th)Fair (25th)Poor (<25th)
▸ MALE
18–29≥5549–5443–4837–42<37
30–39≥5247–5140–4634–39<34
40–49≥5044–4937–4331–36<31
50–59≥4539–4434–3828–33<28
60–69≥4135–4030–3424–29<24
▸ FEMALE
18–29≥4943–4837–4231–36<31
30–39≥4539–4434–3828–33<28
40–49≥4236–4131–3525–30<25
50–59≥3833–3728–3222–27<22
60–69≥3429–3324–2819–23<19
Attia's Framework: Minimum target = 75th percentile for your age/sex. Aspirational target = 90th+ percentile (equivalent to being a decade younger). Below the 25th percentile carries mortality risk comparable to end-stage kidney disease. Source: FRIEND Registry, Mayo Clinic Proceedings 2015.
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Heart Rate Recovery (HRR)
Post-exercise HR drop at 1 and 2 minutes — autonomic reflex marker
Why It Matters

Heart rate recovery measures how quickly the parasympathetic nervous system re-engages after peak exertion. A slow recovery signals autonomic dysfunction and is an independent predictor of mortality. A landmark study by Cole et al. (NEJM, 1999) found that a decline of ≤12 bpm in the first minute after peak exercise was associated with a 4x increase in mortality risk over 6 years, regardless of workload achieved. This is measured immediately after the VO₂ max test, making it cost-free to include.

Key Sources
Cole et al. 1999 — Heart Rate Recovery (NEJM) Nishime et al. 2000 — HRR & Mortality (JAMA)
Measurement Protocol
  1. Performed immediately following the VO₂ max test. Client transitions to active cooldown (slow walk, 2.0 km/h, 0% grade).
  2. Record HR at test cessation (peak HR). Record HR at exactly 60 seconds and 120 seconds post-cessation.
  3. Calculate HRR-1 = Peak HR − HR at 1 min. Calculate HRR-2 = Peak HR − HR at 2 min.
Heart Rate Recovery Rubric (1 minute, all ages, both sexes)
RatingHRR at 1 min (bpm drop)Clinical Significance
Excellent≥ 40 bpmSuperior parasympathetic tone
Good30–39 bpmStrong autonomic function
Normal18–29 bpmAdequate recovery
Below Average13–17 bpmReduced vagal reactivation
Abnormal≤ 12 bpm4x elevated mortality risk — further investigation warranted
Section 03

Strength & Musculoskeletal

Muscular strength is the most under-appreciated longevity biomarker. Grip strength alone is a stronger predictor of cardiovascular death than systolic blood pressure. Loss of lean mass after 30 accelerates at ~3–8% per decade, and by 80, most people have lost 30–40% of their peak muscle. Peter Attia calls strength training "the most important form of exercise for longevity."

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Grip Strength
Isometric hand dynamometry — dominant and non-dominant hand (kg)
Why It Matters

Grip strength is arguably the single most powerful proxy biomarker in the strength domain. A Lancet study (Leong et al., 2015) of 140,000 adults across 17 countries found that every 5 kg decrease in grip strength was associated with a 17% increased risk of cardiovascular death, a 16% increase in all-cause mortality, and a 9% increase in stroke risk. Peter Attia emphasizes that a strong grip reflects stability and strength through the entire upper kinetic chain — forearm, shoulder, scapula, and trunk. As he notes, "there's really no example where a person has a very strong grip but their forearm, deltoids, scapula, triceps are all weak."

Key Sources
Leong et al. 2015 — Grip Strength & Mortality (The Lancet) Bohannon 2018 — US Normative Values (JOSPT) Peter Attia AMA #329 — Grip Strength Discussion
Measurement Protocol
  1. Use a calibrated Jamar hydraulic hand dynamometer (or equivalent). Set handle to position II (standard).
  2. Client seated, back straight, feet flat. Shoulder adducted, neutrally rotated. Elbow flexed at 90°. Forearm neutral. Wrist 0–15° ulnar deviation. Arm unsupported.
  3. Instruct: "Squeeze as hard as you can for 3–5 seconds." Provide verbal encouragement.
  4. Perform 3 trials per hand, alternating hands. Rest 30 seconds between trials. Record best of 3 trials for each hand.
  5. Record: dominant hand max (kg), non-dominant hand max (kg), and note if difference exceeds 10% (potential asymmetry flag).
Grip Strength Rubric — Dominant Hand (kg)
AgeExcellent (90th)Good (75th)Average (50th)Below Avg (25th)Poor (<10th)
▸ MALE
18–29≥5650–5544–4938–43<35
30–39≥5549–5443–4837–42<34
40–49≥5246–5140–4534–39<31
50–59≥4842–4736–4130–35<28
60–69≥4438–4332–3726–31<24
▸ FEMALE
18–29≥3833–3728–3223–27<20
30–39≥3732–3627–3122–26<19
40–49≥3530–3425–2920–24<18
50–59≥3127–3022–2618–21<16
60–69≥2824–2720–2316–19<14
Clinical Cut-Offs (Sarcopenia Screening per EWGSOP2): Male < 27 kg | Female < 16 kg on dominant hand triggers sarcopenia risk assessment. Source: Cruz-Jentoft et al. 2019, Age and Ageing.
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Dead Hang Time
Maximum passive hang from pull-up bar — grip endurance, shoulder health, spinal decompression
Why It Matters

Peter Attia uses the dead hang as one of his primary functional longevity tests. It integrates grip endurance, shoulder stability, lat engagement, and upper-body muscular endurance into a single assessment. Attia sets the bar at 2 minutes for men and 90 seconds for women at age 40, decreasing slightly per decade thereafter. Beyond being a test, the dead hang is therapeutic — decompressing the spine, improving shoulder mobility, and strengthening the connective tissue of the hands and forearms. As a test, it correlates strongly with the capacity to perform daily tasks requiring upper-body engagement well into old age — carrying groceries, lifting luggage, rising from a chair using armrests.

Key Sources
Peter Attia AMA #329 — Dead Hang Standards Huberman Lab — Attia on Grip & Hanging AGEIST — 10 Science-Backed Longevity Benchmarks
Measurement Protocol
  1. Use a standard pull-up bar at sufficient height that feet clear the floor with arms fully extended.
  2. Client grips bar with overhand (pronated) grip, slightly wider than shoulder width. No gloves or straps.
  3. Lift feet off floor. Arms fully extended. Slight shoulder engagement (not fully passive/relaxed into sockets). Body straight, no swinging or kipping.
  4. Start timer when feet leave ground. Stop when any part of body touches ground, grip fails, or client voluntarily releases.
  5. One attempt. Record time in seconds.
Dead Hang Rubric (seconds)
AgeExcellentGoodAverageBelow AvgPoor
▸ MALE
18–29≥150s120–149s80–119s40–79s<40s
30–39≥135s110–134s70–109s35–69s<35s
40–49≥120s90–119s60–89s30–59s<30s
50–59≥100s75–99s45–74s20–44s<20s
60–69≥80s60–79s30–59s15–29s<15s
▸ FEMALE
18–29≥110s90–109s55–89s25–54s<25s
30–39≥100s80–99s45–79s20–44s<20s
40–49≥90s70–89s40–69s15–39s<15s
50–59≥75s55–74s30–54s10–29s<10s
60–69≥60s40–59s20–39s8–19s<8s
Attia's Benchmark (age 40): Male ≥ 120 seconds | Female ≥ 90 seconds. Reduce by ~15s per decade after 40. These are aspirational "longevity-fit" targets, not population averages. Most untrained adults will fail these initially.
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Farmer's Carry
Loaded carry for time — functional strength, grip endurance, core stability
Why It Matters

Attia describes the farmer's carry as one of the two best at-home functional strength tests alongside the dead hang. It combines grip strength, core stability, postural control, and total-body muscular endurance under load. The target he sets for a 40-year-old man is to carry total bodyweight (split across both hands) for 90 seconds. For women, 75% of bodyweight. This simulates real-world demands — carrying groceries, luggage, children — that directly predict independence in older age.

Key Sources
Peter Attia AMA #329 — Farmer's Carry Standards Zest Science — Functional Longevity Tests
Measurement Protocol
  1. Use hex bar or two equally weighted dumbbells/kettlebells. Total load = client's bodyweight for males, 75% bodyweight for females.
  2. Client lifts weights from standing position. Walks at a controlled, steady pace on flat, clear 10m corridor (back-and-forth).
  3. Maintain upright posture — no forward lean, no shrugging. Arms straight at sides.
  4. Timer starts when client begins walking. Timer stops when weights are dropped, posture collapses, or client voluntarily stops.
  5. Record: total time in seconds, total distance covered, load carried.
Farmer's Carry Rubric (seconds at prescribed load)
AgeExcellentGoodAverageBelow AvgPoor
▸ MALE (load = bodyweight)
18–29≥120s90–119s60–89s30–59s<30s
30–39≥110s85–109s55–84s25–54s<25s
40–49≥90s70–89s45–69s20–44s<20s
50–59≥75s55–74s35–54s15–34s<15s
60–69≥60s45–59s25–44s10–24s<10s
▸ FEMALE (load = 75% bodyweight)
18–29≥110s85–109s55–84s25–54s<25s
30–39≥100s75–99s45–74s20–44s<20s
40–49≥90s65–89s40–64s15–39s<15s
50–59≥75s55–74s30–54s10–29s<10s
60–69≥60s40–59s20–39s8–19s<8s
Exceptional Strength Standard (Dan John): Carry 2x bodyweight for 30 seconds on a hex/trap bar. This is elite-level and not expected for most clients. The longevity target is 1x BW for 90 seconds (male, age 40).
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Wall Sit
Isometric quad endurance — lower body strength and muscular endurance
Why It Matters

Attia identifies the wall sit as a reliable test of isometric quadriceps strength when a formal leg extension or leg press is not available. Lower body strength is critical for fall prevention — the leading cause of injury-related death in adults over 65. Quadriceps strength specifically determines ability to rise from a chair, climb stairs, and decelerate during walking. Loss of quad strength is one of the earliest detectable declines in aging and a direct predictor of loss of independence.

Key Sources
Peter Attia AMA #329 — Wall Sit as Strength Test 5 Longevity Fitness Tests — Wall Sit Protocol
Measurement Protocol
  1. Client stands with back against smooth wall. Feet shoulder-width apart, approximately 2 feet from wall.
  2. Slide down until thighs are parallel to floor (knees at 90°). Back flat against wall. Arms crossed at chest or hands on hips (not on thighs).
  3. Timer starts in position. Timer stops when any form break: thighs rise above parallel, hands touch thighs, back leaves wall, or client stands.
  4. Record time in seconds. One attempt.
Wall Sit Rubric (seconds)
AgeExcellentGoodAverageBelow AvgPoor
▸ MALE
18–29≥150s120–149s75–119s40–74s<40s
30–39≥135s105–134s60–104s30–59s<30s
40–49≥120s90–119s50–89s25–49s<25s
50–59≥100s75–99s40–74s20–39s<20s
60–69≥80s60–79s30–59s15–29s<15s
▸ FEMALE
18–29≥120s90–119s60–89s30–59s<30s
30–39≥105s80–104s50–79s25–49s<25s
40–49≥90s65–89s40–64s20–39s<20s
50–59≥75s55–74s30–54s15–29s<15s
60–69≥60s45–59s20–44s10–19s<10s
Section 04

Balance & Neuromotor Function

Balance is the canary in the coal mine for aging. It integrates vision, vestibular function, proprioception, and muscular coordination. A 2022 British Journal of Sports Medicine study found that inability to stand on one leg for 10 seconds in adults aged 51–75 was associated with an 84% higher risk of all-cause death over 7 years.

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Single-Leg Stance — Eyes Open
Unipedal balance with visual input — baseline proprioceptive function
Why It Matters

The single-leg stance with eyes open tests the integration of all three balance systems (visual, vestibular, proprioceptive). A 2024 Mayo Clinic study found that one-legged balance — particularly on the non-dominant leg — showed the highest rate of decline with age of any physical measure tested, more than grip strength, knee strength, or gait speed. The inability to hold 10 seconds is associated with significantly elevated mortality risk (Araujo et al., BJSM 2022).

Key Sources
Araujo et al. 2022 — 10s Balance & Survival (BJSM) Mayo Clinic 2024 — One-Leg Balance & Aging Springer et al. 2007 — UPST Normative Values (JGPT)
Measurement Protocol
  1. Client barefoot on flat, hard surface. Hands on hips.
  2. Lift one foot off ground (client chooses leg). Non-standing foot may rest against standing ankle or calf. Do not hook behind knee.
  3. Timer starts when foot leaves ground. Timer stops when: standing foot shifts, raised foot touches ground, hands leave hips, or 60 seconds reached.
  4. Perform 3 trials per leg. Record best of 3 for each leg. Test both dominant and non-dominant.
Rubric — Eyes Open (seconds, best of 3, both sexes)
AgeExcellentGoodAverageBelow AvgPoor
18–2960s (max)50–59s40–49s25–39s<25s
30–3955–60s45–54s35–44s20–34s<20s
40–4950–60s42–49s30–41s15–29s<15s
50–5945–60s35–44s25–34s10–24s<10s
60–69≥32s22–31s10–21s5–9s<5s
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Single-Leg Stance — Eyes Closed
Proprioceptive-vestibular challenge — removes visual compensation
Why It Matters

Closing the eyes removes visual input and forces the body to rely exclusively on vestibular and proprioceptive systems — dramatically harder and far more sensitive to aging. A 2014 BMJ study found that individuals aged 53 who could not balance on one leg with eyes closed for more than 2 seconds were three times more likely to die over the subsequent 13 years. This test declines rapidly beginning in the late 20s and is often the first detectable deficit in neuromotor aging.

Key Sources
Dr. Michael Mosley — Balance & Longevity MAT Assessment — Eyes Closed Norms Shimizu et al. 2012 — One-Leg Stance Across Lifespan (PMC)
Measurement Protocol
  1. Same setup as eyes-open test. Hands on hips, barefoot, flat surface.
  2. Client closes eyes first, then lifts one foot off ground.
  3. Timer starts when foot leaves ground. Timer stops on any of: foot touches down, eyes open, hands leave hips, standing foot shifts.
  4. Perform 3 trials per leg. Record best of 3. Test both legs.
Rubric — Eyes Closed (seconds, best of 3, both sexes)
AgeExcellentGoodAverageBelow AvgConcern
18–29≥28s20–27s12–19s6–11s<6s
30–39≥22s15–21s10–14s5–9s<5s
40–49≥18s13–17s8–12s4–7s<4s
50–59≥12s8–11s5–7s3–4s<3s
60–69≥8s5–7s3–4s2s<2s
Red Flag: Any adult under 60 who cannot hold 5 seconds eyes-closed warrants further vestibular/neurological screening. For adults 50+, inability to hold 10 seconds eyes-open is associated with 84% higher all-cause mortality (Araujo et al., 2022).
Section 05

Flexibility & Mobility

Mobility is the prerequisite for all other physical capacities. Loss of range of motion precedes loss of strength, which precedes loss of function. Attia uses the deep squat as a fundamental screen — if you can't get your hips below your knees, your movement system is compromised.

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Deep Squat Assessment
Overhead squat pattern — hip, ankle, thoracic mobility & motor control
Why It Matters

The ability to achieve a full-depth squat (hips below knees, heels on ground, torso upright) is fundamental to human movement. It requires adequate ankle dorsiflexion, hip flexion/rotation, thoracic extension, and coordinated motor control. Attia frames this as a non-negotiable for longevity — being unable to get on and off the floor independently is one of the strongest predictors of care dependency and mortality. The sit-to-stand and sit-to-rise test (Brito et al., European Journal of Preventive Cardiology, 2012) found that adults who could not sit and rise from the floor without using hands had 5–6x higher mortality.

Key Sources
Brito et al. 2012 — Sit-Rising Test & Mortality Huberman x Attia — Mobility for Longevity
Measurement Protocol
  1. Client stands barefoot, feet shoulder-width apart. Raises arms overhead, elbows extended.
  2. Descends into a full squat: hips below knees, heels remain flat on floor, arms remain overhead, torso as upright as possible.
  3. Hold bottom position for 3 seconds. Return to standing.
  4. Score on 0–3 scale: 3 = full depth, heels down, arms overhead, upright torso. 2 = full depth with minor compensations (slight heel rise, forward lean, or arms drift forward). 1 = cannot reach full depth OR major compensations (heels significantly elevated, torso collapses forward). 0 = cannot attempt / falls / pain.
  5. Note specific limitations: ankle dorsiflexion, hip impingement, thoracic kyphosis, knee valgus.
Scoring (all ages, both sexes)
ScoreRatingInterpretation
3OptimalFull range, no compensations. Adequate mobility for all movement patterns.
2AcceptableMinor limitations. Targeted mobility work recommended.
1LimitedSignificant restriction. Priority mobility intervention needed before loaded training.
0Severely LimitedCannot perform. Requires assessment for structural limitation, injury history, or pain.
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Sit-and-Reach
Hamstring and lower back flexibility — posterior chain extensibility
Why It Matters

Posterior chain flexibility (hamstrings, lower back, calves) is a consistent correlate of lower back pain prevalence and functional mobility. Research published in the American Journal of Physiology (Yamamoto et al., 2009) found that trunk flexibility in middle-aged and older adults was associated with arterial stiffness — less flexible individuals had stiffer arteries, independent of other fitness markers. While not a direct mortality predictor, it is a reliable functional screen for musculoskeletal risk.

Key Sources
Yamamoto et al. 2009 — Flexibility & Arterial Stiffness ACE Fitness — Sit-and-Reach Norms
Measurement Protocol
  1. Use a standard sit-and-reach box (26 cm at the feet). Client removes shoes.
  2. Client sits on floor, legs fully extended, feet flat against box. Knees must remain straight (assistant may gently hold knees).
  3. Hands together, palms down. Slowly reach forward as far as possible along the ruler. No bouncing.
  4. Hold farthest position for 2 seconds. Measure to nearest 0.5 cm.
  5. Perform 3 trials. Record the best.
Sit-and-Reach Rubric (cm)
AgeExcellentGoodAverageBelow AvgPoor
▸ MALE
18–29≥4034–3929–3324–28<24
30–39≥3833–3728–3223–27<23
40–49≥3529–3424–2818–23<18
50–59≥3528–3424–2716–23<16
60–69≥3325–3220–2415–19<15
▸ FEMALE
18–29≥4137–4033–3628–32<28
30–39≥4136–4032–3527–31<27
40–49≥3834–3730–3325–29<25
50–59≥3933–3830–3225–29<25
60–69≥3531–3427–3023–26<23
Section 06

Cardiovascular Health Markers

Resting blood pressure and heart rate are the most accessible windows into cardiovascular health. Hypertension is the number one modifiable risk factor for death globally (GBD Study, The Lancet). Every 20/10 mmHg increase above 115/75 doubles cardiovascular disease risk.

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Resting Blood Pressure
Seated brachial BP — systolic and diastolic (mmHg)
Why It Matters

Hypertension is the single largest contributor to cardiovascular mortality worldwide. The landmark SPRINT trial (2015) demonstrated that intensive BP control (target <120 systolic) reduced cardiovascular events by 25% and all-cause mortality by 27% compared to standard treatment (<140). Bryan Johnson targets systolic BP in the 110–120 range as part of his Blueprint protocol. Attia emphasizes that blood pressure is one of the few directly actionable, high-leverage longevity interventions.

Key Sources
SPRINT Research Group 2015 — Intensive BP Control (NEJM) American Heart Association — BP Guidelines Bryan Johnson Blueprint — BP Targets
Measurement Protocol
  1. Client seated quietly for 5 minutes. Feet flat on floor, back supported, legs uncrossed. Arm resting on table at heart level.
  2. Use validated automatic oscillometric cuff. Correct cuff size (bladder encircles ≥80% of arm circumference).
  3. No talking during measurement. Take 3 readings, 1 minute apart. Record the average of readings 2 and 3.
  4. Measure both arms on first visit. If difference >10 mmHg systolic between arms, use the higher arm for all future readings.
Blood Pressure Classification (all ages, both sexes — AHA/ACC 2017)
CategorySystolic (mmHg)Diastolic (mmHg)Clinical Action
Optimal<110<70No action — ideal longevity range
Normal110–11970–79Maintain with lifestyle
Elevated120–129<80Lifestyle modification, retest in 3 months
Stage 1 HTN130–13980–89Lifestyle + consider pharmacotherapy
Stage 2 HTN≥140≥90Medical referral required
Longevity Target (Attia/Johnson): Systolic 110–120 mmHg. This is the range associated with the lowest cardiovascular risk in epidemiological data. Not to be confused with hypotension — symptomatic BP <90/60 requires evaluation.
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Resting Heart Rate
Seated resting pulse — cardiovascular efficiency marker
Why It Matters

Resting heart rate reflects cardiovascular efficiency and autonomic balance. A meta-analysis by Zhang et al. (CMAJ, 2016) of over 1.2 million participants found that every 10 bpm increase in resting HR was associated with a 9% increase in cardiovascular mortality and a 16% increase in sudden cardiac death. Resting HR >90 bpm is consistently associated with elevated all-cause mortality. Elite aerobic fitness drives resting HR into the low 50s or below.

Key Sources
Zhang et al. 2016 — RHR & Mortality Meta-Analysis (CMAJ) Huberman Lab — Heart Health Newsletter
Measurement Protocol
  1. Taken during BP measurement rest period. Client seated quietly for 5 minutes.
  2. Record from validated pulse oximeter or BP cuff readout. Average of 3 readings.
Resting Heart Rate Classification (all ages, both sexes)
CategoryRHR (bpm)Interpretation
Athlete/Excellent<55Superior cardiovascular efficiency
Good55–64Well-conditioned
Average65–74Normal range
Below Average75–84Reduced conditioning
Poor/Elevated Risk≥85Associated with elevated mortality — lifestyle intervention or medical review
Section 07

Autonomic & Nervous System

Heart rate variability (HRV) is a non-invasive window into autonomic nervous system function. Low HRV is associated with elevated inflammation, poor stress resilience, cardiovascular disease, and all-cause mortality. It is the most personal of all biomarkers — individual baselines vary enormously.

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Heart Rate Variability (HRV)
5-minute resting RMSSD — parasympathetic tone & autonomic resilience
Why It Matters

HRV measures the beat-to-beat variation in heart rhythm, reflecting the dynamic interplay of sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) nervous systems. Higher HRV indicates greater autonomic flexibility — the body's ability to adapt to stress. Andrew Huberman has extensively discussed HRV as a tool for tracking recovery, stress resilience, and overall nervous system health. A 24-hour SDNN below 50ms has been linked to significantly increased all-cause mortality (AHA Scientific Statement, 2022). RMSSD is the most commonly tracked metric via wearables and the most reliable short-term measure of vagal tone.

Key Sources
Shaffer & Ginsberg 2017 — HRV Metrics Overview (Frontiers) Tegegne et al. 2020 — HRV Reference Values (Lifelines Cohort) Huberman Lab — HRV & Nervous System Kubios — HRV Normal Ranges
Measurement Protocol
  1. Client lies supine in a quiet, dimly lit room. Room temperature 22–24°C. No caffeine in prior 4 hours. No intense exercise in prior 12 hours.
  2. Apply chest-strap ECG sensor (Polar H10 or equivalent — gold standard over wrist PPG for accuracy).
  3. Allow 3-minute stabilization period. Then record 5 minutes of continuous R-R interval data.
  4. Software analysis: calculate RMSSD (primary metric), SDNN, pNN50, and LF/HF ratio.
  5. Report RMSSD in milliseconds. Compare to age-sex norms and note as baseline for longitudinal tracking.
HRV (RMSSD) Reference Values — 5-minute Supine (ms)
AgeHigh (90th)Above Avg (75th)Median (50th)Below Avg (25th)Low (10th)
▸ MALE
18–29≥8055–7938–5424–37<20
30–39≥6544–6430–4320–29<16
40–49≥5536–5424–3516–23<13
50–59≥4530–4420–2914–19<11
60–69≥3824–3716–2311–15<9
▸ FEMALE
18–29≥8558–8442–5728–41<22
30–39≥7048–6934–4722–33<18
40–49≥5538–5426–3718–25<14
50–59≥4530–4421–2914–20<11
60–69≥3825–3717–2411–16<9
Important: HRV is the most individually variable biomarker in this protocol. Population norms provide context, but the primary value is longitudinal tracking of each client's personal baseline. A 20%+ sustained drop from personal average is clinically meaningful regardless of absolute number. Source: Tegegne et al. 2020 (Lifelines), Welltory 2023 meta-analysis.
Section 08

Respiratory Function

Pulmonary function declines ~1–2% per year after age 25. Reduced lung capacity is independently associated with cardiovascular disease, cognitive decline, and all-cause mortality. A simple breath-hold test provides a low-cost screen for CO₂ tolerance, which reflects respiratory efficiency and autonomic control.

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BOLT Score (Body Oxygen Level Test)
CO₂ tolerance & respiratory efficiency — breath-hold after normal exhale
Why It Matters

The BOLT score, popularized by Patrick McKeown (author of The Oxygen Advantage) and frequently referenced by Andrew Huberman, measures carbon dioxide tolerance — how efficiently the body handles CO₂. Low BOLT scores (<20s) correlate with chronic over-breathing, mouth breathing, poor sleep quality, exercise-induced asthma, and anxiety. A higher BOLT score indicates better respiratory efficiency, improved oxygen delivery to tissues via the Bohr effect, and greater exercise tolerance. Huberman recommends nasal breathing and CO₂ tolerance training as foundational health practices.

Key Sources
Patrick McKeown — BOLT Score Protocol Huberman Lab — Breathing for Health & Performance
Measurement Protocol
  1. Client seated comfortably, breathing normally through nose for 2 minutes prior to test.
  2. After a NORMAL exhale (not forced), client pinches nose and starts timer.
  3. Timer stops at the FIRST distinct urge to breathe (diaphragmatic contraction, swallowing reflex, or involuntary breath). This is NOT a max breath-hold — it measures CO₂ sensitivity threshold.
  4. The first breath after the test should be calm and controlled through the nose. If client gasps, the hold was too long — retest after 5 minutes.
  5. Perform 2 trials with 5-minute rest between. Record the average.
BOLT Score Rubric (seconds, all ages, both sexes)
ScoreRatingInterpretation
≥40sExcellentOptimal CO₂ tolerance. Efficient breathing pattern. Likely nasal breather.
30–39sGoodGood respiratory efficiency. Minor room for improvement.
20–29sAverageModerate CO₂ tolerance. May benefit from breathing retraining.
10–19sBelow AverageLow tolerance. Likely chronic over-breather. Breathing intervention recommended.
<10sPoorDysfunctional breathing pattern. Priority intervention — assess for mouth breathing, sleep-disordered breathing, anxiety-related hyperventilation.
Target: All clients should work toward BOLT ≥ 25 seconds as a minimum. An improvement of 5–10 seconds typically correlates with noticeably better sleep, exercise tolerance, and stress resilience. McKeown recommends a target of 40 seconds as optimal.
Section 09

Cognitive & Reaction Time

Cognitive function and processing speed are often the last things tested — and among the first things that decline. Reaction time is a surprisingly powerful predictor of mortality, independent of fitness level. A study published in PLOS ONE found that slower reaction time increased mortality risk nearly as much as smoking over a 15-year follow-up.

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Visual Simple Reaction Time
Stimulus-response latency — processing speed & neurological integrity
Why It Matters

Simple reaction time measures the speed of the entire sensory-motor processing chain: visual perception → neural transmission → motor execution. Hagger-Johnson et al. (PLOS ONE, 2014) studied 5,134 adults and found that slower reaction time was associated with significantly elevated all-cause mortality over 15 years, including cardiovascular and respiratory death — with effect sizes comparable to smoking status. Reaction time declines approximately 1ms per year after age 25, and this decline accelerates after 60. It serves as a non-invasive proxy for overall CNS integrity.

Key Sources
Hagger-Johnson et al. 2014 — Reaction Time & Mortality (PLOS ONE) Human Benchmark — Visual Reaction Time Test
Measurement Protocol
  1. Use standardized digital reaction time test (computer-based or tablet). Client seated comfortably. Dominant hand on input device (mouse click or screen tap).
  2. Screen displays a visual stimulus (color change or shape appearance) at random intervals (2–10 seconds).
  3. Client responds as quickly as possible upon seeing the stimulus.
  4. Perform 20 trials. Discard fastest and slowest 2 (outlier removal). Record median of remaining 16 trials in milliseconds.
Visual Reaction Time Rubric (milliseconds, both sexes)
AgeExcellentGoodAverageBelow AvgSlow
18–29<200ms200–230ms231–270ms271–330ms>330ms
30–39<210ms210–245ms246–285ms286–345ms>345ms
40–49<220ms220–260ms261–305ms306–370ms>370ms
50–59<235ms235–280ms281–330ms331–400ms>400ms
60–69<255ms255–310ms311–370ms371–450ms>450ms
Note: Males typically test ~10–15ms faster than females on average due to differences in nerve conduction velocity and muscle fiber composition. However, the variance within each sex is far greater than the variance between sexes, so unified norms are appropriate for a wellness screening context. Source: Dane & Erzurumlouglu, 2003.
Protocol Summary

Assessment Flow & Duration

Recommended Test Order & Timing
#TestDurationNotes
1Intake & Consent10 minMedical history, contraindications screen, informed consent
2Visbody 3D Scan5 minBody composition, posture, circumferences
3Blood Pressure + RHR10 min5 min seated rest + 3 readings
4HRV (5-min supine)10 minQuiet room, ECG chest strap, 3-min stabilization + 5-min recording
5BOLT Score5 minCO₂ tolerance, 2 trials
6Visual Reaction Time5 min20-trial computerized test
7Sit-and-Reach5 minPosterior chain flexibility
8Deep Squat Assessment3 minMovement quality screen
9Single-Leg Balance (EO + EC)10 minBoth legs, both conditions, 3 trials each
10Grip Strength8 min3 trials each hand, alternating
11Dead Hang5 minSingle max-effort attempt
12Wall Sit5 minSingle max-effort attempt
13Farmer's Carry8 minSetup + single attempt at prescribed load
14VO₂ Max + HR Recovery25 minGraded treadmill test to exhaustion + cooldown + HRR measurement
Total Assessment Time: Approximately 90–120 minutes per client. VO₂ max test is placed last because it induces maximal fatigue. Order resting tests (HRV, BP, reaction time) before any physical exertion. Grip, hang, wall sit, and carry should precede VO₂ max but after balance/mobility to ensure neuromuscular tests are not confounded by cardiovascular fatigue.
Re-Testing Cadence

Full protocol repeat: every 90 days for active program participants. Abbreviated retest (VO₂ max, grip, body composition, HRV): every 45 days. Blood pressure and resting HR: every visit or on demand.

BOOK YOUR TEST

WhatsApp us to schedule your 90-minute longevity baseline. Available at both Uluwatu and Canggu locations.