How to increase your ‘healthspan’ by a decade

“Exercise has the greatest power to determine how you will live out the rest of your life," says longevity expert Dr Peter Attia.

We’re an ageing society, that’s indisputable, but our later years are increasingly lived in ill health, plagued by the “four horsemen”: diabetes, cancer, heart disease and dementia. This is the terminology used by Dr Peter Attia, cancer surgeon-turned-longevity expert, whose message is that we need to focus on our healthspan – the number of years we live in good health – rather than just our lifespan, the number of years we’re alive.

And it’s a message which has been inspiring his many thousands of social media followers.

While Silicon Valley scientists are working in labs pursuing everlasting life, Dr Attia asks in his new book, Outlive: The Science and Art of Longevity: “What’s the point of living longer if your life sucks? My patients insist they don’t want to linger on in a state of ever-declining health.”

The data backs him up. The King’s Fund reported last year that although a male in England could expect to live 79.4 years, his average healthy life expectancy was only 63.1 years – so he would have spent 16.3 of those years in “not good” health. For women, life expectancy is 83.1 years, of which 19.3 years would have been spent in “not good” health.

Last year the State of Ageing report from the Centre for Ageing Better showed that we are living an increasing number of years with a disability and that for the first time in many years life expectancy was actually decreasing, mainly as a result of the Covid pandemic.

While most of us will live to somewhere in our 70s and 80s, we will most likely die a “slow” death from a chronic condition, writes Dr Attia, which began many years before. By the time modern medicine steps in with a diagnosis and treatment, it is usually too late. “The logical conclusion is that we need to step in sooner to stop the horsemen in their tracks – or better yet, prevent them altogether,” writes Dr Attia.

While most of us will live to somewhere in our 70s and 80s, we will most likely die a “slow” death from a chronic condition that began many years before.

Years of ill health are not inevitable, he argues, and modern medicine is not delivering when it comes to prevention. He cites our treatment for type 2 diabetes. “It begins long before someone crosses that magical diagnostic threshold on a blood test. Type 2 diabetes is merely the last stop on the line. Yet, too often, the point of clinical diagnosis is where our interventions begin. Why is this OK?”

Leading campaigner and physician Sir Muir Gray, 78, director of the optimal ageing programme at Oxford, agrees.

“The NHS is great for diagnosis, treatment and acute care. When I had a heart attack, they put a stent in. “And yet,” he says, “of all the doctors I’ve seen over the years and the many drugs I’ve been prescribed, I’ve had very few words about the importance of diet and exercise.

“People have to understand that ageing by itself doesn’t have to be a cause of major problems until our 90s; think of the Queen working two days before her death. Yes, we need a bit of luck to avoid diseases that we can’t prevent like Parkinson’s and Alzheimer’s, but there are many other factors, and a major one is loss of mental and physical fitness.”

To this end, Sir Muir does 12 minutes of exercise in the morning to build strength, stands on one leg while brushing his teeth for balance and coordination, and does 30 minutes of brisk walking daily.

He is also soon to launch what he calls a new health service for people who are 60-plus, which will focus on helping people age well and learn from others with similar conditions. “My approach is PDSR – preventing, delaying, slowing down and reversing.”

Dr Richard Siow, director of ageing research at King’s College London, also sees the value of self-care: “When people think of healthcare they think of going to see a doctor, but I’m thinking about lifestyle interventions to maintain wellness. Not just taking care of our muscles and our heart and our brain, but also our psychological well-being, to reduce factors that quicken the onset of ageing conditions.”

For Attia, reducing our risks of chronic illness and increasing healthspan lies in five key pillars: exercise; “nutritional biochemistry” (ie what and how much we eat); sleep; emotional health; and drugs and supplements (where necessary).

This healthspan prescription will not be the same for everyone, as we all respond differently and have different needs. It’s also not enough to focus on just one element; we have to think of our health holistically as everything is connected. The message then is clear: ageing well is, to a large degree, up to us and it’s never too late to start. Or, as Dr Attia puts it: “You are no longer a passenger on this ship; you’re its captain.”

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Ways to be healthier for longer

Build your own Centurian Decathlon

“Exercise has the greatest power to determine how you will live out the rest of your life. It delays the onset of chronic diseases, pretty much across the board, but it is also amazingly effective at extending and improving healthspan,” writes Dr Attia. To this end, he asks clients to list the 10 most important physical tasks they want to do for the rest of their lives.

These include activities like hiking, picking up a grandchild, carrying groceries, and lifting a suitcase into a plane.

Inevitably, most people want to continue to do all 10 as they get older, but in order to do these things, it’s important to be specific about the exercise required, which will be a mix of cardiovascular fitness and strength training as muscle mass declines.

The key point here is that doing one exercise, even if you do it to excess, is not going to deliver results and may lead to injury. And you need to be doing much more exercise than you think to protect against the inevitable decline. Dr Attia’s decathlon includes archery, hiking for an hour with a 9kg backpack (known as rucking), five pull-ups and swimming half a mile (0.8 of a kilometre) in 20 minutes.

Practise standing up from sitting on the floor and grip strength

“Strength is such an important part of ageing,” says Dr Attia. “If you look at the majority of people over the age of 75 and 80, you’ll be struck by how many activities they can’t do because they lack strength.”

Many people of a certain age can’t stand up from sitting on the floor because they don’t have the strength in their hip muscles. Yet studies have shown not being able to do this can predict a greater likelihood of mortality.

Similarly, if you’re struggling to open a jar, carry shopping or do up buttons, you may need to work on your grip strength, which is strongly correlated with a risk of dementia. Attia recommends simply walking carrying weights, or even better carrying them out in front of you. “Being able to carry heavy things is a very important skill as we age, and speaks to lots of abilities: fitness, grip strength, stability,” he says.

Sir Muir Grey advises aiming for a plank for the same number of seconds as your age.

Strive to be healthy at work

We spend most of our time at work, and as the population ages and we retire later, more of us are working later in life. Dr Richard Siow of KCL says it becomes even more important that our workplace is not contributing to physical and emotional stress. “If you’re sitting in front of a computer for long hours, take regular breaks to avoid back pain. Choose healthy food from the canteen, walk outdoors in your lunch hour, find strategies to manage workplace stress, and consider a four-day week,” he says.

Work out what diet is best for you

Although Dr Attia has talked about favouring the keto diet for himself in his book, he does not recommend one particular diet. Yet clearly, most of us are eating too much of the wrong thing and the modern 24/7 availability of food makes it hard to stick to a regime.

“For a majority of patients, the goal is to reduce energy intake while adding lean mass. This means we need to find ways to get them to consume fewer calories, while also increasing their protein intake, and pair this with proper exercise,” he says.

Some people achieve this by cutting carbs, fasting, or calorie counting; the key message here is to monitor your weight closely, measure your fat and muscle mass and take action.

Take good care of your emotional and brain health

“Emotional health may represent the most important component of healthspan,” says Attia. “Nothing else about longevity is worth much without some degree of happiness, fulfilment, and connection to others.”

It is also closely linked to our physical health and mortality. Attia cites dialectical behaviour therapy (DBT), a type of talking, or cognitive behavioural therapy, as a technique that helped him.

Dr Siow points out that: “If we’re depressed we’re not going to be exercising or eating well. We will not be financially productive and it could be downhill from there.”

• Outlive: The Science and Art of Longevity, by Dr Peter Attia with Bill Gifford (Vermilion)