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Dr Monique Hope-Ross and Dr Paul ChellJohn Angerson<\/p>\nDo you feel drained? Less able to pick up a pace while walking, or struggling to open a jam jar? If you\u2019re otherwise well but noticing health niggles, a bit of weakness or brain fog, you could be \u201cpre-frail\u201d. The term describes the early stage of physical and mental decline, \u201cwhen your body has started to lose resilience\u201d, according to the GP and longevity specialist Dr Alka Patel, who adds: \u201cI often see it starting in midlife.\u201d<\/p>\n
According to new research by the Health Foundation think tank, our healthy life expectancy is declining, having fallen over a decade from 62.9 to 60.7 years for men and from 63.7 to 60.9 years for women. In other words, we are likely to spend a quarter of our lives with significant health issues. Meanwhile, a study in The Lancet Public Health found that 38 per cent of women aged 37 to 45 and 35 per cent of men in the same age group showed signs of pre-frailty which, according to landmark research by the American geriatrician Linda Fried, include self-reported exhaustion, slow walking, low physical activity and weak grip strength.<\/p>\n
The concept of pre-frailty is under the spotlight in the former neuroscientist and health journalist David Cox\u2019s new book, The Age Code, which examines the role our diet plays in ageing and how frailty is associated with reduced diversity in the gut microbiome.<\/p>\n
Ageing starts at a cellular level, with damage to mitochondria in each of the cells that \u201cgive us the energy to breathe, think, move\u201d, says the surgeon and metabolic specialist Dr Paul Chell. He and his wife, Dr Monique Hope-Ross, also a surgeon and expert in metabolic health, have co-founded Healthbuddi, an online provider of courses for weight loss and disease reversal. \u201cThere are two ageing peaks in life, one between 40 and 45, and one at 60,\u201d Hope-Ross says. \u201cThat\u2019s when mitochondrial dysfunction, among many other cellular problems, happens.\u201d<\/p>\n
Dr Monique Hope-Ross and Dr Paul ChellJohn Angerson<\/p>\n
Then there are senescent, or \u201czombie\u201d, cells, which are unable to divide like healthy cells or self-destruct via apoptosis. These increase in number as we get older \u201cand sit there, grossly non-functional, affecting all the other cells, and it leads to inflammation, a major part of ageing\u201d, Hope-Ross says.<\/p>\n
The shortening of telomeres, the protective caps on the end of chromosomes that protect our DNA when cells divide, is a \u201cbig factor\u201d driving senescent cell growth, Hope-Ross says. The resulting inflammation, where the body thinks it\u2019s under threat and attacks healthy tissue, \u201cbrings on the early signs of ageing\u201d, she says. \u201cYour muscles can become frail. You don\u2019t recover as well after exercise.\u201d Cognitive function is affected.<\/p>\n
However, as Patel says, \u201cthe more we understand these processes, the more we can address them\u201d. With the right lifestyle choices you have the ability to make your body robust again.<\/p>\n
Do half an hour of moderate exercise four times a week<\/p>\n
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All exercise is good for mitochondrial health, Chell says, but \u201cthe ultimate mitochondrial improvement exercise is zone two\u201d. This means exercising at moderate intensity so you \u201ccan talk but not sing\u201d and your heart rate is about 60 to 70 per cent of its maximum. \u201cMitochondria thrive when they are asked to work but not crushed,\u201d Chell says. \u201cSteady, sustainable exercise encourages the growth of healthier, more numerous mitochondria.\u201d Light jogging, cycling, rowing, swimming and walking all count. \u201cAim for 30 minutes of zone two, four times a week,\u201d he says.<\/p>\n
Try to add in at least one HIIT session a week<\/p>\n
Think of the mitochondria as a furnace, Hope-Ross says \u2014 zone two exercise increases its size while high-intensity exercise, such as spinning, sprint training and circuits, makes it burn stronger. \u201cIt\u2019s increasing the power from your mitochondria in slightly different ways,\u201d she says. Chell, meanwhile, says that one or two sessions of HIIT a week is enough to reap the benefits.<\/p>\n
Do these five strength training exercises every other day<\/p>\n
Grip strength is used as a marker of muscle loss because it\u2019s often where people first notice strength slip \u2014 when opening a jam jar, say. Decline in muscle, which is essential for posture, balance and bone health, comes with age. It can be compounded by inflammation, which causes anabolic resistance, meaning the body becomes less able to build muscle. The personal trainer Kate Rowe-Ham suggests a focus on five simple exercises: push-ups, squats, deadlifts, overhead presses and bent-over rows holding a 2-3kg weight in each hand.<\/p>\n
Limit your eating to a ten-hour window each day<\/p>\n
Mitochondria, just like everything else, \u201cneed rest\u201d and intermittent fasting is \u201csupremely powerful at creating new, healthier mitochondria\u201d, Chell says. Unfed cells, when we\u2019re fasting, are much less likely to get cancer, she says. Hope-Ross suggests an eating window of ten hours a day, with \u201cno snacking and two meals, if possible\u201d.<\/p>\n
Eat salmon and chia seeds to support healthier telomeres<\/p>\n
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A 2022 meta analysis found consumption of omega-3 fatty acids \u2014 healthy fats found in fatty fish and plant sources such as chia seeds \u2014 may \u201cpositively affect\u201d telomere length. Cox reveals in The Age Code that increased omega-3 consumption may help to rejuvenate muscle as well as protecting heart health because they lower the levels of triglycerides, \u201ca type of blood fat that is linked to heart attack and stroke risk\u201d.<\/p>\n
Keep stress levels in hand by doing six slow breaths every hour<\/p>\n
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Patel describes stress as the biggest driver in pre-frailty \u201cbecause it\u2019s acting on every hallmark that decides how fast you age\u201d. To combat stress she suggests slowing your breathing down every 60 minutes to six breaths a minute. This helps to switch off your sympathetic nervous system, which is your stress-activating system. Breathe in for four and out for six.<\/p>\n
Add as much movement as possible to your day<\/p>\n
\u201cA person can go to the gym and still age poorly if the rest of the day is motionless,\u201d Chell says. \u201cIf you have a desk job, get off the bus to work a stop early, use stairs instead of escalators, stand up to take phone calls.\u201d Gardening and housework are also beneficial. While researching her new book, The Longevity Solution, Rowe-Ham found that Blue Zones \u2014 global regions where people tend to live the longest \u2014 broadly coincide with populations where overall activity levels are higher.<\/p>\n
Walk more<\/p>\n
Slower walking is a sign of pre-frailty because walking requires mobility, stability and balance, Rowe-Ham says. She suggests aiming for 4,000 steps a day. Research in the European Journal of Preventive Cardiology showed this is enough to start reducing all causes of death. To improve your walking Rowe-Ham recommends ankle circles, \u201cwhich can be done at your desk and help mobility as well as strengthening the front of your foot to better support your body\u201d.<\/p>\n
Do your shopping from memory, not a list<\/p>\n
Inflammation and incessant midlife juggling, compounded by the ease of ChatGPT and endless scrolling, mean we\u2019re no longer absorbing information as well as we did, according to the cognitive rehabilitation specialist Natalie Mackenzie. We need to do something with it, \u201cto read it, repeat it, recall it\u201d, to remember it. Write a list, which helps with memory consolidation, but when you get to the supermarket try to remember what you want to buy without looking at it. Functional exercises like this are usually more beneficial than memory-boosting games on brain-training apps. Mackenzie says these have their place but adds: \u201cYou tend to get better at what you\u2019re doing on the app rather than impacting day-to-day life.\u201d<\/p>\n
Prepare for sleep 80 minutes before bed<\/p>\n
Poor sleep is a key driver of cellular damage and inflammation. Patel teaches the 8\/80. She explains: \u201cTo preserve eight hours of sleep, get into relaxation 80 minutes before you go to bed.\u201d This can involve, for example, slowing your breathing, turning off laptops, journalling or stretching. It will help cortisol levels to lower and the sleep hormone melatonin to rise, as well as reducing the risk of other unhealthy behaviours.<\/p>\n
Eat leafy greens and drink full-fat milk to aid mobility<\/p>\n
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Vitamin K is important in preventing calcium accumulation in arteries and joints, which can lead to osteoarthritis and loss of mobility, Cox says. It is also crucial to maintaining bone and muscle quality and even supporting the immune system and brain health. One Spanish study found that those who increased their consumption of the vitamin had a 48 per cent lower risk of dying prematurely from cardiovascular disease. He suggests eating an \u201cabundance\u201d of leafy greens and cruciferous vegetables such as spinach, kale and broccoli (steaming is better than boiling) for the main form, vitamin K1, for healthy blood and bones. And consume dairy products such as full-fat milk and blue cheese for vitamin K2, which directs calcium to the right places.<\/p>\n
Make sure you are getting enough vitamin D<\/p>\n
Cox reveals there are receptors for calcitriol, the active form of vitamin D, \u201cin almost every single tissue of the body and, being a hormone, it influences the expression of innumerable genes, making the immune system more efficient at spotting pathogens or tumours, and preventing it from attacking healthy cells\u201d. In addition to getting outside for 15 to 20 minutes every day between April and September, he recommends whole foods rich in vitamin D, such as oily fish.<\/p>\n