Extra Time: 10 Lessons for an Ageing Society - How to Live Longer and Live Better. Camilla Cavendish

capable in your seventies. Media editors should take a look at how they portray ‘pensioners’, and question whether they are falling for a narrow narrative about youth. Governments must raise retirement ages in line with life expectancy and make this explicit: as part of signalling that the average lifespan has changed. And all of us need to challenge our own attitudes. Prejudices we build up against the ‘old’ will only hurt us when we reach that stage ourselves.

      One vital question is what proportion of the over-60s will be ‘Young-Old’, thriving and capable like stewardess Bette Nash, and how many will be ‘Old-Old’, needing care, like her sister. On the answer to that question rests the future of our economies and the cohesion of our societies. If there are too many ‘Old-Old’, our welfare states and healthcare systems will be overloaded and younger generations will bear the burden. But if we can help people to stay healthy and productive, if we can abolish prejudice, we could see a new era of extended middle age, with most people staying vital almost to the end.

      Later in this book I describe breakthroughs in genetics and neuroscience which may transform the youthspan, elongating our ‘Young-Old’ period and limiting the ‘Old-Old’. But we don’t have to wait for those. We already hold two of the keys in our hands to improving our Extra Time: diet and exercise.

3

       Just Do It

       If exercise and diet was a pill, we’d all be taking it

      WHAT IF THE KIND of ageing we dread is not, in fact, normal? What if our modern accumulation of chronic diseases, followed by a prolonged twilight zone, are largely a consequence of Western habits, which have distorted the true path of biological ageing?

      It’s generally assumed that how we age is down to luck and genetic inheritance. But for most of us, genes write only 20 per cent of our fate. The other 80 per cent is down to environmental factors: what we eat and drink, how stressful our lives are, whether we live amid pollution, whether we exercise (and how often).

      This means that we already hold many of the keys to Extra Time in our own hands. Decades of research show that we don’t have to succumb to deterioration from the age of 50, our arteries and joints gradually stiffening, and puffing our way into chronic disease. We can fight to stay relatively youthful right up until 90, and even reduce our risk of dementia, by eating better and becoming far, far more active. A raft of studies around the world have, in fact, identified exercise as the single most powerful predictor of whether we will age well.¹

      ‘Miracle Cure’, a report from the Academy of Medical Royal Colleges, finds that the big four ‘proximate’ causes of preventable ill health are smoking, poor nutrition, lack of physical activity and alcohol excess. ‘Of these,’ the report says, ‘the importance of regular exercise is the least well-known. But relatively low levels of increased activity can make a huge difference’. The report concluded that 30 minutes of moderately intense exercise, five times a week, can reduce the risk of developing heart disease, stroke, type 2 diabetes, some cancers and even dementia.²

      This needs to be much, much better-known.

      If Life Is a Marathon, We Need to Sprint

      ‘If exercise was a pill, everyone would be taking it,’ says Norman Lazarus, 82, as we walk through a violent downpour outside his office at London Bridge. My feet are drenched even under my umbrella; he only has a jaunty red cap on his head, but he shrugs off the rain. A short, wiry man with a stubby white moustache, Lazarus is a long-distance cyclist who regularly covers distances of 60 miles. He has just come back from cycling 180 miles in Oxfordshire with his daughter at the weekend. ‘Exercise is great,’ he says, in his strong South African accent. ‘For the body, the mind, for muscles – you name it.’

      Lazarus is not just a biking fanatic, he is also emeritus professor at King’s College London, where he has co-authored a study into amateur endurance cyclists like himself. The older cyclists in the study – aged between 55 and 79 – were found to have similar immune systems, strength, muscle mass and cholesterol levels as those who were only in their twenties.³ On those criteria, the older cyclists had barely aged at all. The researchers could not tell how old they were by looking at their physiology on paper, only by meeting them and seeing their wrinkles.

      The King’s researchers believe that endurance sports, including cycling, swimming and running, may protect the immune system by boosting the number of T-cells in our blood. These protective white blood cells are thought to decline by about 2 per cent a year from our twenties onwards, making us gradually more susceptible to infections and conditions like rheumatoid arthritis. But the older endurance cyclists had almost as many T-cells as 20-year-olds – a protective effect that no medicine yet invented can provide.

      To qualify for the study, men had to be able to cycle 62 miles in under 6.5 hours and women had to be able to cycle 37 miles in 5.5 hours. That’s impressive. But all were amateurs, not professionals. Some, like Norman Lazarus, had only taken up cycling in their fifties. And they loved it. When interviewed, they reported not only managing the distances fine, but feeling fabulous as a result and wanting to do more.

      Lazarus cycles with an amateur group. He also goes to the gym three times a week and does what he calls ‘anti-gravity exercises’ – lifting weights. Many of his friends cycle, as does his wife, who is 85. ‘We’re all going to die, yes,’ he announces breezily, ‘but none of us are ill at the moment. One day we’ll get to the point where we can no longer fight infection. But then hopefully, it will be quick’ – he pulls his hands towards each other to demonstrate the narrowing period of illness, the mercifully brief end he anticipates when he and his friends eventually move from ‘Young-Old’ to ‘Old-Old’.

      Do the cyclists keep going because they are unusually healthy, or are they healthy because they cycle? Lazarus believes it’s the latter. What we see in the cyclists, he insists, ‘is true biological ageing, free from the problems caused by inactivity’.

      If you wanted to see what true biological ageing might look like, you could charter a boat. In Ikaria, a beautiful Greek island off the west coast of Turkey, one in three inhabitants live into their nineties and dementia is rare. Ikarian men don’t get cancer or heart disease very often, and when they do, it develops eight to ten years later than in Americans. Ikarians also report considerably less depression.⁴ Their life is very much an outdoor one – it’s said to be hard to get through a day in Ikaria without walking up 20 hills – and that might just have something to do with it.

      Ikaria is one of the Blue Zones (see here), where people live exceptionally long lives in good health. There doesn’t seem to be any genetic singularity; the secret is lifestyle. There has been much talk about the plant-based diets eaten in Blue Zones and far less focus on exercise. But whether in Sardinia, Okinawa or the other Blue Zones, it’s clear that these hearty, long-lived people lead very active outdoor lives.

      This is not ‘exercise’ in a gym, pumping iron to music videos. It’s movement built into daily life, to do tasks that the rest of us have replaced with cars, robot-vacuum cleaners and other devices. We have saved ourselves hours by not fetching water, chopping wood or tending our vegetables. But has it lost us our agility? Activity maintains muscle mass, reduces stress by connecting our primitive brain to its old hunter-gathering functions and improves immunity by triggering a cascade of chemical signals in the body. Whenever we take the lift rather than the stairs, or drive rather than walk, we may be losing more than we realise.

      Until now I’ve thought of endurance athletes as freakish, as having either a genetic predisposition or a crazy obsession to compete. But now I wonder. Stunning results have been seen in an otherwise normal group of American septuagenarians who started running when it became fashionable during the 1970s, and stayed hooked. Over