Staying Younger for Longer

Many of us hope to stay active, independent and healthy for as long as possible. But while genetics play a part, the choices we make throughout our lives can have a significant impact on how we age.

Here, Dr Vicky Carre reflects on twenty years in general practice and explores why some people seem to stay fitter and stronger for longer than others. She shares the latest thinking on healthy ageing, along with some advice on how to maximise not just your lifespan, but your healthspan.

Last week, my daughter turned eighteen, and next week my son turns twenty-one. These landmarks naturally lead to reflection, and they also made me realise that I have now been a general practitioner for twenty years.

I started my GP training after returning to work following maternity leave for my son. Before that, I had been training in medical oncology but decided that general practice would be the better life decision for me.

Thinking about twenty years in general practice makes me feel incredibly old, but also incredibly privileged.

I am now at the stage in my career where I see teenagers in my consulting room and can still remember doing their newborn baby check. I congratulate people on their retirement when I have seen them through much of their working lives. And, of course, I also see people make the transition from being healthy, functioning adults to increasing frailty and, ultimately, end-of-life care.

It makes me wonder why that latter transition seems remarkably rapid in some people, while others remain strong and independent for many years. Why do I have some sixty-year-old patients who seem so much older, while some eighty-year-olds appear decades younger?

The concept of frailty and “prefrailty” is a hot topic now. I have discussed in previous columns the distinction between lifespan and “health-span” – not simply how long we live, but how long we remain healthy and independent. Sadly, we spend a substantial proportion of our lives living with illness or disability.

Even more sobering is the finding that signs of decline can appear much earlier than we might imagine. Research has demonstrated that frailty and prefrailty are not confined to older people, with a substantial proportion of middle-aged adults already showing some features of prefrailty.

This concern is particularly topical currently, given the huge rise in the numbers of people taking GLP-1 medications like Wegovy and Mounjaro. GLP-1 medicines can help achieve substantial weight loss and important improvements in metabolic health for many people with obesity. But with significant weight loss, it isn’t just fat that is lost – it is also lean tissue and muscle – and there is a concern that we are building towards an epidemic of frailty.

The measures used in frailty studies are surprisingly tangible: self-reported exhaustion, lower levels of physical activity, slower walking speed, reduced muscle mass and weaker grip strength, for example. These may sound like simple physical measurements, but they provide a window into much more complex processes occurring within our bodies. Ageing begins at a cellular level long before we would consider ourselves “old”.

Telomeres are protective structures at the ends of our chromosomes. They help protect our DNA as cells divide, and they tend to become shorter with repeated cell division and ageing. Our mitochondria – the tiny powerhouses within our cells – also become less efficient at producing energy. And then there are so-called senescent cells, sometimes rather ominously described as “zombie cells”. These are cells that have stopped dividing and are no longer functioning normally, but instead of being cleared away through a process called apoptosis, they persist and release inflammatory substances that affect neighbouring cells and contribute to the chronic, low-grade inflammation associated with ageing.

The obvious question, therefore, is whether there is anything we can do to slow these processes.

Genetics, of course, plays an important role, and we all inherit different starting points and different susceptibilities to disease. But genes are not destiny. Lifestyle, environment and the accumulation of our everyday choices over the years have a major influence on how we age.

Not smoking, keeping alcohol consumption low, maintaining a healthy weight, eating a nutritious diet, getting enough sleep, staying physically active and managing conditions such as high blood pressure, diabetes and high cholesterol are the foundations on which everything else is built.

So, once you have these basics covered, what can you do to further power up the longevity-enhancing benefits of your daily habits?

Build some muscle

We tend to think about exercise in terms of burning calories and improving cardiovascular fitness. But as we get older, maintaining muscle strength becomes increasingly important. Muscle is not simply about looking toned. It allows us to get out of a chair, climb stairs, carry shopping, get up from the floor and remain independent.

Muscle mass naturally declines with age, but strength and function can be maintained and improved through resistance training. Recommendations are for muscle-strengthening activities at least twice a week, alongside aerobic activity and exercises that improve balance and flexibility.

And you don't need an expensive gym membership. Squats, lunges, wall push-ups, resistance bands, weights or using your own body weight can all count. The key is that the muscles have to work against resistance and that the challenge gradually increases.

Eat enough protein

Muscles need protein to repair and maintain themselves. This becomes particularly important as we get older because our muscles become somewhat less responsive to the stimulus of dietary protein and exercise. A useful general target for most healthy older adults is around 1.0–1.2 grams of protein per kilogram of body weight per day.

And this doesn't mean that everyone needs protein shakes. It means making sure that protein is deliberately included in meals rather than allowing our diets to become dominated by bread, pasta, biscuits and other carbohydrate-rich foods. Fish, eggs, Greek yoghurt, dairy products, beans, lentils, tofu and nuts are all useful sources, as are meat and poultry for those who eat them.

If you have significant kidney disease or another medical condition affecting your diet, protein requirements should be discussed with your doctor or dietitian rather than simply increased.

Maintain cardiovascular fitness

Strength is key, but we also need cardiovascular fitness.

The current UK guidance recommends that adults aim for around 150 minutes of moderate-intensity activity each week, or 75 minutes of vigorous activity, alongside strengthening activities.

Cardiovascular fitness gives us physiological reserve. It means that when illness, surgery or another physical challenge comes along, we have more capacity to cope with it and recover.

Brisk walking, cycling, swimming, running and other aerobic activities all count. The important thing is to raise your heart rate regularly and, ideally, include some periods of higher intensity if your health allows.

Keep balanced

Balance is another component of physical resilience that becomes increasingly important as we age. Balance is a critical marker of healthy ageing because it relies on several systems working together: strong legs, good vision, coordination, a functioning nervous system and healthy inner ears. The ability to bring all these systems together effectively is a surprisingly good marker of how well we are ageing.

Fortunately, it is something we can practise. Test yourself by standing on one leg while you brush your teeth, walk heel-to-toe along a straight line, and practise sit-to-stands (getting up from a chair without using your arms to help you). Yoga, Pilates and tai chi classes can help you train your balance and coordination.

Eat a rainbow

I have focused on protein, but there are two other key components for a healthy-ageing diet that must not be forgotten – fibre and antioxidants.

Fruit and vegetables provide fibre, vitamins, minerals and a huge range of naturally occurring compounds called polyphenols and other antioxidants. The different colours in plant foods reflect some of this chemical diversity. Red tomatoes, purple berries, orange peppers, green leafy vegetables, yellow peppers and brightly coloured herbs all contain different combinations of potentially beneficial compounds.

Oxidative stress is one of the mechanisms implicated in cellular ageing, and our antioxidant systems help to protect cells from this damage. There is good reason, therefore, to eat a wide variety of plant foods.

At the same time, try to minimise red meat and ultra-processed foods, particularly those that are easy to overeat and high in calories, salt, saturated fat and added sugar.

And finally, keep living

There is one aspect of healthy ageing that doesn't fit neatly into a blood test or fitness tracker – people!

Remaining socially connected, giving back to the community, continuing to learn, keeping up with current affairs, and travelling are all important for ageing well.

After twenty years in general practice, I have come to realise that the patients who impress me most and who seem to age the best are the people who are curious, active, engaged, positive and independent, and those who continue to have a sense of purpose and keep engaging in activities that bring pleasure.

So perhaps we should stop thinking about ageing as something that suddenly happens to us when we reach sixty or seventy. The foundations are being laid much earlier. Telomeres will shorten, mitochondria will change and eventually our cells will age. But if we can build big reserves of muscle, strength, fitness, balance, metabolic health and social connection throughout our lives, then it will help us to stay younger for longer.