Most people who visit physiotherapist Will Harlow’s clinic in Surrey are experiencing joint pain in their back, knees and hips. He has been a physio for eight years, specialising in the over-fifties, and has recently been seeing more patients wanting help for decreased muscle mass, or getting out of breath – key signs that they could be ageing badly.
“Ageing well is maintaining the ability to do what you want when you want for as long as you want without needing help from someone else. That really is the premise of independence,” says Harlow, the author of Independence for Life. “Everyone is talking about longevity and trying to live longer but what’s the point in living longer if the last decade is painful and you’re reliant on people?”
Through his clinic and YouTube videos, which are subscribed to by 1.7 million people, he’s helped thousands of retirees maintain their independence. “I’ve seen people over 50 served badly by the NHS. So many come to me and say they’ve been told their pain is due to age and there’s nothing that can be done. I knew that if they had the right strategies, they can often get better, stronger and move easier.”
Here, he shares his ultimate tips for ageing well, the signs to look out for, and the habits to avoid that have seen his clients come off their crutches and gain strength and mobility.
The early warning signs
The most obvious early warning sign of bad ageing is pain. “Typically, it starts off mild, it’s more of an ache or stiffness, but then it doesn’t go away after a month, and it feels like it’s getting worse. That’s one of the first signs,” says Harlow.
Another is losing confidence, which can lead to a lack of independence, too. If you find yourself using handrails, using the arms of the chair to stand up or holding a partner while walking, it could be a sign of going downhill. “Without realising it, people start losing their balance, their strength and feel they need support.”
Will Harlow, who has over 1.7 million subscribers, says that with the right strategy, the over-fifties can get strongerHarlow says many patients come into the clinic and use support to stand up without noticing. “We ask them how long they’ve been using their arms to help them up and they don’t even realise they’ve done it. It just happens slowly over time.” One call Harlow receives often is people calling after struggling to get up from the ground.
Ageing well is possible, he says. Here are his tips to get started:
Don’t treat retirement as the end
“I have a joke that retirement is a scam. When people retire, they think they’re done now, put their feet up and stop. It’s the worst thing they could possibly do. Your body really is use it or lose it.”
Harlow explains that when you stop using your muscles, they start to “waste away”. In his experience, the first five years after retiring are when there’s the biggest decline in strength and mobility. “It’s the mentality. People think they need to slow down because they’re getting older and then they do get older very quickly. Those that take up golf, football or walking end up healthier in 10 years time than when they were working. It depends on what mindset they chose.”
Strength training doesn’t have to take much effort
A mix of exercise is best, according to the physiotherapist, but the most important is building up strength. “It really is the proxy for overall independence. If you’re not strong, you can’t lift things, you can’t open heavy doors and you lose muscle mass. The more muscle mass you have, the less chance of heart disease, diabetes, falls and even anxiety, depression and dementia. The brain can be linked to muscle mass and we can’t afford to lose it. It’s not just about being able to lift things. It gives you more energy, better sleep and you’ll look and feel better.”
This doesn’t have to be built in the gym, though. Compound movements, which work multiple muscles and joints, are time-efficient. He recommends his 20-minute 3-2-1 method. It’s three exercises, twice a week, and one progression each time you do it, like an extra repetition or a heavier weight.
The exercises are the goblet squat (holding a weight in front of your chest and squatting down to chair level and standing back up again), the farmer’s carry (holding a weight in each hand and walking for between 30 and 60 seconds at a time) and a press up, which can be done on the knees or toes.
The goblet squat is one of the exercises Harlow recommends to clients to try at homeFor these, you don’t need a gym, as Harlow finds many people feel intimidated. He admits that gyms can have good equipment, and machines are great for those over 50, but a good workout can be cheap and stress-free at home, too. Many of his clients use watering cans to hold while walking up and down their garden, or fill a bag with books in their home to squat with.
Don’t underestimate sleep
“There’s a myth that the older you get, the less sleep you need, but that’s not actually true.” Throughout our entire lives, Harlow says we need between seven and nine hours of sleep. “The problem as we get older is that sleep can become disturbed and people tend to wake more in the night so getting those hours in can be tricky.
“If people do go from not sleeping well to suddenly getting the required hours, you see a difference in how well they recover, how quickly they bounce back from exercise and heal, and how much muscle they can rebuild.”
Social isolation is one of the worst things for your health
One study Harlow quotes is the US Surgeon General’s report that equates the health risk of chronic social isolation to smoking up to 15 cigarettes per day. The lack of connection can increase the risk of premature death by 29 per cent. An older study by Harvard Health also showed that loneliness was associated with a 32 per cent greater risk of stroke, similar to that of obesity.
“This isn’t just saying don’t get lonely, it’s saying that this will have a genuine impact on your health and quality of life. People who are more socially connected tend to be more active, keep their brains healthier for longer and tend to be more mobile. It’s vital.”
Don’t wait until pain is urgent
Harlow finds that many patients put off making a change to their lifestyle until their lives are consumed by pain. “If you’re able to get into a habit of daily movement as soon as possible, you start from a higher level if you do decline. The goal should be to have as much muscle mass as possible when you hit 60.”
One study, published by the National Library of Medicine, found that muscle mass decreases approximately between three and eight per cent per decade after the age of 30. This rate of decline is higher after the age of 60 and can increase the risk of falls and injury.
Daily habits stack up
Walking maintains your strength, bone density and mobility, he says, but one thing he recommends is balance exercise snacking, which are “very short bursts of exercise, typically between 30 and 60 seconds, that you do in otherwise dead time during the day”.
While waiting for the kettle to boil or you’re on hold to the bank, practice standing on one leg or pretend to walk a tightrope to test your balance. Harlow believes doing this will improve balance in eight to 12 weeks without requiring any extra time.
Stretch in bed
Joint pain in the knees and hips is common and if you experience it, try “taking the joint through a full range of motion” repeatedly for five minutes to loosen it before getting out of bed and starting the day.
For the knees, “you can just practice bending the knee as much as you can, until the point of stiffness but not into pain, and straightening it and flattening it back down on the mattress”. Building up strength in the legs and quad muscles is also essential for the knees.
For hips, you’ll need to stretch it through your glutes by “lying on your side, lifting up your leg towards the air while still on your side”.
Don’t do excessive cardio or crash diet
Being in a harsh calorie deficit, which Harlow is seeing more with the rise of GLP-1s, can increase the decline of muscle mass and bone density, which needs to be avoided. “Cardio is great for your health, but past a certain point, it’s not doing anything for the body. Through that and a rapid crash in weight, people can lose up to 40 per cent of muscle mass, which is difficult to regain.”
Eat more than the recommended protein
The Government recommendation for standard protein intake is 0.75 grams per kilogram of body weight, which Harlow says is too low. He advises people to follow the US guidelines of 1.6 grams per kilogram of body weight to stop muscle loss alongside resistance training. “There’s a myth that increasing protein intake is bad for your health, but that’s been busted; it’s not true. As we get older, we need more protein, not less.”
He recommends non-processed foods to patients to avoid inflammation. “Inflammation is a big problem and gets worse as we age; it accelerates strength loss. Processed foods increase it dramatically. Whole foods are more nutritious and often anti-inflammatory.”
You don’t need to use saunas
The evidence for hot baths and saunas helping recovery is limited, according to Harlow, and he doesn’t think it speeds up the recovery process.
“The biggest thing for people over 50 is to realise that your recovery demands change as we age. Where it might have taken you 48 hours to recover from a workout at 30, it might take you 72 hours now in your sixties.
“For most people, it’s about reducing the number of times per week you’re exercising, not reducing intensity. I don’t tell people to go to the gym and take it easy because that’s when they get weaker. You’re better off doing two workouts per week, going pretty hard, rather than going five days a week, even if you could do that in your twenties. Leave more time between your workouts and more time between working the same muscles and make sure your protein intake is high to drive recovery.”
Test yourself regularly
There are three tests that Harlow gives his patients that indicate if somebody is ageing well, or what they need to improve on. The first is lying completely flat on the floor and getting back up to standing again using any technique. This should take less than 10 seconds. If it takes longer, or you cannot do it without holding onto a wall or chair, you could be lacking strength or mobility.
The second is the 30-second chair test, which requires a timer and chair. In half a minute, test how many times you can sit on the chair and stand back up again. Men should be aiming for a number higher than 14 and women 12. If you’re less than that, it suggests a lack of strength in the legs.
The last is the single-leg stand, which involves standing on one leg and balancing for 10 seconds. “Everyone should be able to do that and if you can’t, the research shows you are at a higher risk of falls within the next year and your balance needs work.” For those under the age of 65, Harlow asks them to do it with their eyes closed.
The paperback version of Will Harlow’s ‘Independence for Life’ is out now
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