Forget lifespan: increasingly, healthspan – the years that we feel healthy and active – has become the holy grail among gerontologists. “You only need to watch the Veteran Games to understand the capacity of the human body to age well,” says physiotherapist Bhanu Ramaswamy.
While there’s no denying the fact of ageing, “It is important to distinguish between what is a natural part of the process, and less natural ageing, with increasing disability.” The slow change in our bodies won’t necessarily render us frail or immobile if we take care of ourselves, and there’s plenty we can do to help. Here’s where to start.
The importance of staying active
Deconditioning, caused by inactivity, is what we need to watch out for so we can nip it in the bud early. “Use it or lose it,” says Ramaswamy, who is a member of the Chartered Society of Physiotherapy’s Older People and Neurology networks. When people become less active, they grow more prone to metabolic conditions. “If you become overweight, that may lead to diabetes, a heart condition or high blood pressure, which puts you at risk of stroke,” she says. So if getting up from the sofa feels harder, rather than rely more on remote controls and riser chairs, see it as a call to action to build strength. As Ramaswamy says: “We’re adding to our decline by making things easier for ourselves.”
Physical changes are inevitable with age, but exercise and a healthy diet can minimise their impact. Muscles will naturally lose some of their bulk and there is a slowing of how bone and tissue are built or maintained, Ramaswamy says, adding, “A person may notice they are losing height or are more stooped.”
Where to start
There are easy ways to test how healthily your body is ageing in these respects, and learn what needs work. If you are relatively healthy, your late 50s is a good time to start. But if you notice change in physical ability at any age, Ramaswamy says, “You should test or seek advice when you become aware of the change, whether that is to your balance, strength or aerobic capacity.”
A top priority is leg strength. Sit in a chair with your arms folded, so you’re not tempted to use them for support, and stand and sit five times. “If you can’t do it in under 16 seconds, you need to build more strength,” Ramaswamy says. This could be because your life is too sedentary. If your legs have been weakened by an injury or you have severe arthritis, Ramaswamy suggests trying a seated exercise with a weight round your ankle. “Straighten and hold the leg straight for a count of five, let it rest, then repeat at least 10 times.”
Next, brace yourself for the “walk and talk test”. This involves timing yourself walking while reciting the months of the year back from December, or counting back in sevens from 100. “If you are around the 65-year mark, about four metres should be done in five seconds,” Ramaswamy says. If you’re too slow or grind to a halt, “this flags that your brain slows or stops you moving while thinking to finish the task without falling over”. In which case, see your GP to investigate whether there’s an underlying medical condition that needs resolving. Or you may simply need to practise dual tasking, “for example on exergaming consoles”, such as Wii Fit.
For shoulder flexibility, Ramaswamy uses the “back scratch test”, saying, “This provides information about the freedom in the shoulder girdles, so your arms can lift, and twist within the shoulder joint.” One arm is placed as if giving yourself a pat on the back, while the other elbow is bent low behind you, the aim being to clasp at least the middle fingers of the opposite hands.
For most people this works far better one way round than the other (for instance right elbow pointing up, left elbow pointing down), so this test will tell you which side needs the most work to restore flexibility.
Under-60s should be able to do this, but as you get older, there will be an ever-increasing gap between the fingers.
If you’re struggling with it, it’s time to see the physio or find some stretching exercises online or at a class (use caution trying it, Ramaswamy advises, as shoulders are prone to injury as people age). As for the lower half of your body, if you have trouble tying your shoelaces or cutting your toenails, your flexibility needs work.
Many of the aches and physical restrictions we experience are reversible, even if they’ve resulted from injuries, operations or a mild stroke. Physiotherapists can help identify problems, Ramaswamy says, then personal trainers and even the internet are excellent resources for remedies. “Think about what it is you’re finding hardest,” she adds. “There will be something on YouTube, or in the leisure centre, that will help.”
How much exercise should you do?
The government’s activity guidelines for adults aged 19 to 64 are, Ramaswamy says, “moderate exercise for a minimum of 150 minutes a week, or 75 minutes of vigorous exercise, as you’re getting blood coursing around your body. The blood brings nutrients, takes away toxins and waste products, and opens up areas of your brain that are starting to get sluggish.”
A two-hour walk every week with a friend easily eats up 120 minutes, but there’s a difference between leisure walking, “where you’re able to chat freely”, and moderate intensity, “which has to be at a pace that gets you a bit sweaty and out of breath”. Crucially, she says: “Try not to do the same thing over and over because your brain can become complacent and just go through the motions. For the exercise to have the most effect, you have to focus on it and engage your brain.”
What to eat …
When it comes to ageing healthily, says Valter Longo, professor of gerontology and biological sciences at the University of Southern California, “diet is much more powerful than anything else”. Take a 2022 review paper, he says, looking at a couple of million people in China, Europe and the US. It concluded that a healthy diet is associated with up to 13 years of increased life expectancy. That is if you start at age 20, but even starting at 60 could bag you an extra nine years.
The key foods identified in the paper are “legumes, wholegrains and nuts, foods with low sugar, mostly vegan, a few weekly servings of fish and excluding red meat”. Red meat is consistently associated with health problems and morbidity. “We think it’s about the amino acid content, its role in accelerating the ageing process and its contribution to cancer risk,” Longo says. “But also, does it contain hormones, steroids, antibiotics?”
High protein diets are out. This might come as a shock to anyone who loves the low-carb paleo or Atkins diets, or protein bars and drinks. Protein may be an essential nutrient, but when Longo’s team looked into it, children in the US alone were consuming three to four times more protein than recommended. Longo says: “Children and adults are loaded with it and it’s clearly a problem.”
People up to 65 should have “0.8 grams of protein per kilogram of body weight a day – about 55g for someone weighing 68kg”. A 170g salmon fillet contains about 34 grams of protein, he adds, as do about 2.5 cups of beans. “Ideally people should have a mix of proteins from fish, beans, nuts and seeds as some are lower in certain amino acids.” We should also increase protein intake, to about 67g daily from our late 70s, because our bodies become less efficient as we age and need more nutrients.
… and when
It’s not just about what you eat, but when and how much. Longo has studied the effects of time-restricted eating (also referred to – misleadingly, he says – as intermittent fasting) for decades, along with fasting proper, and the upshot is that these periods of restricted eating trigger cellular repair and reboot the immune system.
Simply restricting calories has a broad impact, too, says Sebastian Grönke of the Max-Planck Institute for Biology of Ageing in Cologne. “It affects cardiovascular health, brain function, mental health and our immune system, with reports of higher sex drive and better sleep.”
Consistency is key. Human data so far concentrates on middle-aged people, but extensive mouse studies have shown results into old age work only if done long term. “If we keep mice up to two years on dietary restriction, then switch them back to the normal diet, when it comes to life expectancy, they lose almost all the protection they had gained,” Grönke says. But consuming no calories outside a set window is a big lifestyle change, for which he admits he doesn’t have the discipline, though he does avoid snacking. “The idea that you consume food more or less constantly, keeping your insulin levels high, is probably not the best for your health,” he says. “It’s better if you eat less often in general, but if you want to go further, you can try time-restricted feeding.”
Longo recommends eating only between 8am and 8pm, or a 12-hour window that suits you. Again, the earlier in life you start, the greater the rewards later, but don’t be tempted to go beyond this in the hope of eternal youth: “The 16 hours overnight fast is probably not a good idea for reasons such as gallstone formation,” he says. “Twelve is safer.” There’s also less chance of adherents skipping breakfast: “Even in younger people the meta analyses are suggesting if you do that, you’ll live less long and have more cardiovascular disease.”
Focus on what you gain, not lose
Living in a society driven by expectations of youth and beauty sets us up for a psychological fall, says Rebecca Poz, a consultant clinical psychologist and clinical neuropsychologist. The focus is often on what we’re losing – our memories, our looks – rather than what we gain. Despite a slow mental decline from our 30s, she says, “There are capacities that do increase with age: wisdom, connectedness and insights into deeper meanings. One of the things we need to be thinking about is how we start to look forward and see our future self as a positive self, when it’s not the same as it is now.”
Acceptance is key, she says, adding, “When we’re seeing those who are older starting to decline, it’s sad, so we need to have the ability to sit with things that are not necessarily pleasant.”
She suggests learning “‘distress tolerance’ – the ability to face something we’d rather not see, but without fearing we’ll be overwhelmed by the grief of it”. Noticing the distress is the first step, followed by “using compassionate reasoning to decide what to do next. For example, we might notice our mum is no longer well enough to walk round town and often forgets we’ve spent the day together, so we might think there’s no point visiting. A more compassionate way to reason out the dilemma might be to visit her at home, with take-away coffee and cake, sit in the garden and reminisce about old times for half an hour. It is more important to enjoy that moment than to remember it.”
Ageist societies can exacerbate problems with cognition as well as mood. Research has compared perceptions of ageing across different cultures. Typically, Poz says, “Westerners will associate ageing with words such as decrepit or deterioration, whereas in Chinese culture, they’ll bring words like wisdom or insight.” Older Americans’ memory skills, for example, are worse, under formal testing, than those of people living within positive age beliefs.
Finding role models for positive ageing – from Judi Dench to the subjects of the Guardian’s New Start after 60 series – can help, as can deciding to ignore ageist ideas. And there’s strength in numbers, Poz says: “Connecting with something bigger than ourselves can help us to resist societal opinion. This could be connecting with groups of peers, spirituality, religion or with nature to put society back into perspective.”
Learning how to zoom into moments of joy and zoom out in more challenging situations is another useful tool, Poz adds. “Sometimes we can get overwhelmed by the bigger issues, such as world news or the enormity of climate crises. At these times it can be helpful to focus on something smaller and more manageable, such as cooking a special meal for yourself, or inviting a friend round for a cuppa. Let the moment absorb you.”
It’s easy to get overly drawn into the minutiae of a single problem, she says. “For example, developing arthritis and focusing on how it is stopping you doing your usual activities. At these times it can be helpful to take a step back and notice things that are still going well, for example being able to complete the crossword, or sing the words to a favourite song on the radio.”
Be flexible mentally
“The more flexible somebody can be in their mindset, generally, the more mentally well they are across time,” Poz says. If you can’t play tennis competitively any more, for example, think about what the hobby gave you and find an equivalent you can still do. If things change, we need to figure out new ways to get our needs met. “Having a sense of control and choice is extremely important,” Poz says, “along with fun, and connecting with other people in a joyful way.”
Feeling down or stressed is not a natural part of ageing: “If you start to experience a low mood, it’s important to go to your GP.” While doctors are less likely to refer older people for talking therapy, “research shows if given access, their outcomes are better than younger adults,” Poz adds. “People need to know it’s not OK to suffer.”
All the lifestyle choices that are good for your heart, and systemic health in general, are also good for the brain. A recent study that followed thousands of women for 20 years confirmed that seven heart-healthy habits reduced dementia risk: being a non-smoker; having a normal body mass index; eating a healthy diet (with a high intake of fruits and vegetables, fish, fibre-rich wholegrains, low sodium and low intake of sugar-sweetened beverages); being physically active; and not having diabetes, hypertension or high cholesterol.
What was interesting, says Pamela Rist, associate epidemiologist at Brigham and Women’s hospital in Boston, and a member of the American Academy of Neurology, “was that women who were the healthiest in middle age had the lowest risk of dementia later”.
While there’s limited evidence that doing puzzles and brain training reduces dementia risk, says Amy Pepper, of Dementia UK, anything that keeps our brains active is going to be useful. Other ways of stimulating the brain, she says, include “socialising, talking to people, meeting people in groups as well as one to one and things that will stimulate different areas of the brain such as creative hobbies, learning a language and listening to music”. We don’t know exactly why those things reduce risk, Pepper adds, “because we don’t know what the process is that causes dementia – that’s still under investigation. But we do know that people who live alone, or who have less social interaction, have a higher risk of developing dementia.”
Stress can be a factor in increasing risk, she says, although worrying about stress levels would be counterproductive. “The advice would be to focus on the things that you can change, modifiable risk factors, so keeping healthy and socially active.”
If you notice memory or cognition changes in yourself or a loved one, the sooner you see a doctor, the better. “It could be a blocked artery that can be treated,” Pepper says, pointing out that if this goes undiagnosed, there is an increased risk of stroke or developing vascular dementia. “Things like vitamin deficiencies, thyroid problems and depression can all mimic the symptoms of dementia,” she says, but even if it is that, there are benefits to finding out earlier, when the symptoms are still subtle. “There are some types of dementia medications that can help to slow the progression and tend to be more effective earlier on. And there are other positives such as being able to plan for the future while you are still able to, making the course of the disease easier to live with for both the person with dementia and their family.”
Learn how to balance
The ability to stand on one leg for 10 seconds is a predictor of longevity, according to a study published last year. Balance doesn’t seem to decline significantly for most of us until our 60s; over half of those in their early 70s are unable to reach 10 seconds. After controlling for other factors, the study found an 86% increased risk of death in the next 10 years if you can’t do this.
Good vision is key to balance. “The recommendation is people get their eyes tested at least every year after 65,” says Carrie-Ann Wood, a physiotherapist for older adults at Guy’s and St Thomas’ hospital in London. “The input from your eyes tells your body where you are and spots obstacles and depth differences in steps or curbs.”
Not only do falls cost the NHS an estimated £2.3bn a year, they come, Wood says, “at a massive personal and emotional cost for people. If someone has a fall and becomes fearful, they’re less likely to do things. And when they do less, they become weaker, so they’re more at risk of falls. So it’s to try to stop that cycle, or prevent it from happening in the first place, so that people can live as active and independent a life as they can.”
Balance exercises are recommended by government guidelines at least twice a week for older people. These can be “as simple as standing on one leg, or standing with your feet together and your eyes closed”, says Wood, who also recommends tai chi as having “really promising results” for improving balance.
Wood has various tests up her sleeve to let you know if it’s time to start beefing up the balance training. One of those is the old drink-driving test: “You should be able to walk as if you are on a tightrope, one foot in front of the other with your heel touching the toes of the foot behind. And you want to be able to hold any balance position for at least 30 seconds, so standing with your feet together and then lifting one foot.”
This should be easy for anyone able-bodied under 60, and there’s a case for becoming an expert at yoga balances – or any other form – in middle age. “The use it or lose it law applies to balance function, so we should be doing what we can for it,” Wood says.
Another challenge is “standing while moving, which helps you rehabilitate your balance. Keep your feet still but move your centre of gravity by lifting weights to the side or up and down or doing squats. This is to maintain dynamic balance, as opposed to static balance.”
It’s worth testing all these elements as we age, because we’re all different, Wood says. “Some people who come into my clinic who are 60 are not in good shape from a strength and balance point of view. Some people who come in are 95 and in brilliant shape.”