VO2 max
This is a measure of cardiorespiratory fitness. Having higher VO2 max correlates linearly with longer health-span and lifespan. Evidence continues to mount confirming that regular exercisers live an average of 10 years longer than sedentary people. They also tend to stay in better health, have lower health costs and better quality of life. VO2 max can be improved with exercise training at any age, so you are never too old to benefit. Get fit and stay fit as you age to stay healthier for longer.
An additional striking benefit of high cardiorespiratory fitness is a decreased risk of cognitive decline with ageing. Mild cognitive impairment or outright Alzheimer’s dementia have both been shown to be much less likely in very fit individuals. Exercising muscles produce chemicals that promote stronger bones, a more effective immune system and through increased release of brain-derived neurotropic factor (BDNF) help maintain brain volume and neuronal health.
There is no known medication which can impact your long-term health and longevity to the extent exercise does — it requires no prescription, causes precious few side effects (maybe the occasional minor injury) and can be done for free. All it takes is some effort. The life we are working on is yours… put in the work!!!
For more, see VO2 max.
Strength and muscle mass
Maintaining high muscle mass and strength has independent benefits from achieving high cardiorespiratory fitness. Multiple studies have shown that patients with low muscle strength have double the mortality of those with high muscle strength.
Grip strength, a reasonable marker of overall strength, has also been shown to correlate inversely with the risk of Alzheimer’s dementia. Higher muscular strength in older age correlates with a reduced risk of hypertension, improved glycemic control and less tendency for fat gain with ageing.
Muscle acts as protective “armour” against bony injury if a fall occurs. Having more muscle also correlates with greater stability and a decreased risk of falls — this is one of the major killers of the elderly. Injury from a fall often leads to prolonged immobility and during this time there is a rapid downward spiral in strength and overall health.
Preserving muscle mass and strength by doing regular resistance training and ensuring adequate daily protein can have almost as much of an impact on health and longevity as cardiorespiratory fitness. But this is not a matter of either-or; try to do some of both.
For more, see Resistance Training.
Sleep
The importance of adequate good quality sleep in maintaining optimal health and promoting longevity is gaining interest. Quality and length of sleep have been linked to the incidence of obesity, diabetes, heart disease, neurodegeneration and cancer. There are many proposed mechanisms for these associations — the conclusion, try to get at least 7 or 8 hours of good quality sleep every night.
Many people believe they function fine with only a few hours of sleep but chronic sleep debt is an insidious killer with objective evidence of long-term harm. Even a single night of bad sleep negatively affects performance in athletes — strength, endurance and accuracy all suffer. Consistently sleeping less than 7 hours a hight has been shown to increase the risk of dying of a heart attack, possibly due to increased cortisol and adrenalin levels causing sympathetic system over-activation, among other things. Increased cortisol raises blood pressure, stimulates glucose release from the liver and decreases glucose utilisation by muscle and fat, effectively causing insulin resistance. Poor sleep also suppresses leptin (the hormone which signals satiety and helps us stop eating) and increases ghrelin (the hunger hormone) which both contribute to overconsumption of calories and weight gain.
Perhaps one of the most important roles of sleep is marinating a healthy brain. Spending enough time in each of the stages of sleep, particularly deep sleep and REM sleep, is crucial for consolidation of memory, creativity and managing stressful experiences. During deep sleep neurones in the brain retract to encourage flow of cerebrospinal between them, a process thought to be crucial for clearance of amyloid-beta plaques and tau protein, both linked to neurodegeneration. Unsurprisingly, there is a strong correlation between Alzheimer’s disease and decreased total and deep sleep time.
Difficulty with sleep is extremely common and many patients request a “sleeping tablet”; some popular ones in Trinidad are Ambien (zolpidem), Lunesta, Valium (diazepam) and Xanax (alprazolam). These drugs help induce unconsciousness but they do not allow healthy sleep — they actually inhibit deep and REM sleep.
If there is no magic drug which can help with sleep how do we improve quality and duration? The non-prescription supplements melatonin (doses between 0.3mg and 5mg one hour before bedtime) and ashwagandha (typically 300mg – 600mg) have the best evidence of efficacy and safety.
Some other helpful tricks:
- Set the right environment — avoid bright lights and stimulating activities close to bedtime. Reading on a computer in night mode or better yet reading a book are fine, but try to avoid anything too stimulating. Watching News, spending time on Social Media and responding to stressful emails late at night are unwise. If possible make your bedroom dark and cold — eliminate as much light as possible (even LED clock screens) and aim for a room temperature around 19 C (not hard for those with air-conditioning!)
- Get your body ready — do not eat a large meal close to bed. Being either too full or too hungry will make restful sleep harder. Minimise liquid consumption near bedtime to avoid bathroom trips during the night. Minimise alcohol late in the afternoon and try not to exceed one drink per day — although alcohol initially has has sedative properties later in the night its metabolites negatively impact sleep quality (difficultly entering REM sleep). Drink caffeine with caution — some people metabolise caffeine faster than others but the average “half life” is 6 hours, which means that half the caffeine from a coffee is still in our system 6 hours after consumption. Some may need to stop all caffeine around noon while others can get away with it up to 2pm.
- Increase “sleep pressure” by getting early morning sunlight — bright light from the freshly risen sun hits our eyes and helps set our brain’s circadian clock so that in the afternoon melatonin release is optimal and sleepiness ensues. Daytime exercise helps promote night-time fatigue and can improve sleep quality and duration.
- Allow enough time for sleep — due to the hectic nature of life most of us have to wake early; allowing at least 8 hours for sleep (9 may be better) is essential if you want to get at least 7. Do the math and make sure you get to bed early enough. If necessary set a “bedtime alarm” and adhere to it as strictly as the morning wake-up alarm — stop everything, switch off all lights and get into bed when your bedtime alarm goes off.
If you try these and are still stuck, ask for help — other tactics can be discussed.
Stress control
Among other things chronic stress has been linked with cardiovascular mortality and cancer development. Finding ways of mitigating excess stress, including doing yoga, meditation, walking in nature or any other calming activity, are essential for those at risk. Although mitigating stress is highly complex and way beyond what can be written here addressing this risk factor is essential for anyone seeking happiness and health.
Guidance is available for those who wish to learn more about mindfulness meditation or who wish to start a structured yoga program.
Smoking, pollution, radiation
For anyone wishing to extend health-span and lifespan smoking cessation (and avoidance of second-hand smoke) is a must. There is robust evidence that smoking causes chromosomal telomere shortening, essentially ageing the smoker at their genetic level. The extent of damage correlates linearly with the quantity of cigarettes smoked, so there is little doubt this is happening.
Environmental pollution and radiation, including excessive sun exposure, have been shown to have adverse effects on biological age. At the very least try to avoid getting too much direct sun exposure on your skin — no more sun tans.