for 15 miles – that wouldn’t be worth it, just to get, say, a pound of steak. You’d stop after a mile and keep tracking.’
That’s a relief. I don’t enjoy running – I can only sustain it with friends, shuffling through corny hits on my headphones. But Lazarus does make me wonder how many of us modern office workers would have the stamina to track our prey for miles, if we were suddenly transported to a desert plain. Nervously, I ask whether he thinks I am doing enough. I do British Military Fitness twice a week in my local park, cycle to meetings if I can and play a slow game of tennis once a week. I don’t mention that I achieve this only on good weeks. ‘Perfect,’ he beams, as if I have made it into a club. ‘Do what you enjoy.’ He pauses. ‘But’ – he fixes me with a glare – ‘your goals do need to be sufficiently ambitious.’
Ambition is frankly what most of us lack. When I started researching this book, I thought I was pretty fit. Now, I realise with horror that I’ve slumped into a rather comfy regime. My tennis game is doubles, not singles, and includes gossip and cappuccino. I’ve dropped into the slow group at Military Fitness. I don’t work up a sweat as often as I used to. And what many experts seem to believe, though few dare to put it so crudely, is that sweat is the measure which really matters.
Ambitious is also what our health systems are not. Older people are so often told: ‘don’t overdo it’. Yet from the age of 50, muscle and bone mass start to decline by around 2 per cent a year.9 We should be doubling down on strength training and aerobic fitness from that age. Instead, we spend an awful lot of time sitting down: something we are now told is as dangerous as smoking.
Don’t Just Sit There – Do Something
The idea that sitting is as dangerous as smoking sounds absurd, but evidence from all over the world, from Norway to Canada, suggests a lack of low-level physical activity is cumulatively crippling. It puts us at much greater risk of getting the same nasty diseases which exercise can help to prevent.10 That doesn’t mean it’s your fault if you get cancer: I abhor the invidious trend which implies that people who fall sick didn’t do enough sit-ups or eat enough broccoli. But so compelling is the evidence, I predict that in 20 years’ time it will seem as foolish not to exercise every day as it does now to keep smoking.
We’ve known that sedentary occupations were dangerous since 1953, when J. N. Norris and colleagues reported in The Lancet that London bus drivers were more likely to suffer heart disease than London bus conductors.11 This was a brilliantly elegant piece of research. The two groups of staff worked the same hours, breathed the same air and hailed from similar backgrounds. The main difference was that the drivers were sitting down all day, the conductors were moving around taking tickets and chatting to people. Without knowing it, the conductors had chosen a far healthier job.
Sitting down for more than an hour at a time sharply decreases the enzyme LPL, which burns body fat and produces good cholesterol.12 It can also weaken leg and hip muscles, which makes older people more likely to fall. A weekend workout will not erase the effect of prolonged hours sitting in our cars, at our desks or at a screen. In the US and UK, only a quarter of us are apparently moving around enough during the working day, and in Australia, only a third. Older adults have the lowest levels of physical activity, with only 7 per cent of Brits achieving the recommended minimum of five times a week.13
It’s not easy to improve, especially if you earn your living driving a truck or typing. Fitbits may help: people who take 10,000 steps a day apparently have lower blood pressure, more stable glucose levels and better moods than those who don’t.14 There’s no special magic to the 10,000 target – it apparently derives from the first pedometers sold by a Japanese company in the 1960s, which were called manpo-kei, or ‘10,000-step meter’. Some people think 15,000 steps better resemble the daily distances covered by the average Ikarian or Okinawan, but the point is to keep trying, every day.
Could What We Think of as ‘Ageing’ Actually Be Lack of Fitness?
‘We have a muddled concept of ageing,’ says Sir Muir Gray, Clinical Advisor to Public Health England, former Chief of Knowledge for the NHS, and author of the wonderfully named book Sod 70! ‘Society perceives disease, loss of fitness, dependency, dementia and frailty as inevitable,’ he says. ‘But they are not.’
With a shock of white hair at 73, and a wiry energy, Gray clearly has no intention of slowing down. He arrives sporting a pair of black Nike trainers and announces in his rasping Scottish brogue that he has walked to our meeting – I dare not ask how far since it may put me to shame. Gray is passionately convinced that we confuse the effects of true ageing with what is mainly a loss of fitness, caused by far too little activity. ‘People with long-term conditions and those who experience pain,’ he says, ‘often mistakenly believe that exercise will make things worse, rather than understanding that the more conditions you have, the more you need to improve the four aspects of fitness: strength, stamina, suppleness and skill.’ Some doctors prescribe exercise – for osteoarthritis, for example – but not for many other conditions.
Gray believes we could save billions if we made it normal to expect people of all ages to be active. ‘Almost every week, there are headlines about the rising cost of health and social care,’ he explains. ‘The blame is usually placed on the rising numbers of older people, as if the requirement for social care was an unavoidable consequence of ageing. But exercise can reduce the need for social care.’ In 2017, he and colleagues calculated that the UK could save several billions a year from ‘even modest improvements in fitness’ to stop older people crossing the line from independence to dependence: needing carers or going into a home.15
Unless we are rigorous about keeping active, natural decline will be accelerated by unnatural stiffness, extra loss of muscle tone and immunity, and hardening of the arteries. Gray calls this the ‘fitness gap’, which opens up between how able we are and how able we could be. This starts, imperceptibly, in our thirties. By our sixties, we may find we cannot do the basic things we want to do: run for a bus or climb the stairs, for example. If we don’t heed the warnings, we may end up crossing the line into dependency.
The fitness gap can be narrowed, Gray argues, from any age. Even 90-year-olds can improve their strength with relatively small amounts of exercise.16 Three months of balance and gait training, and mild weight-bearing exercises, can reduce falls – which are responsible for five times as many hospitalisations among the over-65s as any other injury. They can make the difference between whether someone remains independent, or crosses the line into dependency on others.
In the UK, 10 per cent of ambulances are called out for older people who have fallen over.17 Half of those who fracture a hip subsequently become reliant on others. Yet physical activity can halve the risk of falls.18 It also strengthens muscle and bone density, making fractures less likely.19 From a cost–benefit point of view, let alone a humanitarian standpoint, we should be investing in such programmes in every community.
A little bit of imagination would go a long way here. One company, MIRA Rehab, is using gaming software to improve balance in people aged 3 to 102. In one game, you play a piano by sitting down or standing up: each movement sounds a different key. One stroke victim was so keen to play the whole tune, says MIRA’s founder Cosmin Mihaiu, that he managed to sit down and stand up more times than his therapist had imagined possible. A trial has found statistically significant improvements in balance and pain among people who played the games 3 times a week for 12 weeks.20
Yet many 90-year-olds who want to exercise come up against the prevailing attitude that exercise is for young people and that older people should relax. We give people pills to stave off pain rather than prescribe exercise which might resolve
