Cheat Your Age - The Science of Staying Young and Fit - Part 2

In this podcast episode, I am once again chatting with one of my old mates Aaron Deere about the science of longevity. In particular in this episode we focus on how fitness, strength training, and cardiovascular health are critical to aging well. I always enjoy bringing Aaron on to the podcast and this conversation is certainly right up my street.

In this episode we talk about evidence-based strategies for maintaining health span, including VO2 max testing to bone density, muscle mass preservation, and practical exercise prescriptions. 

Our conversation challenges the notion of quick-fix supplements for longevity, emphasising instead the importance of consistent, personalised physical activity across every life stage. 

Listen in to discover actionable insights into how you can optimise your fitness and potentially extend your lifespan and improve your overall quality of life.

Links mentioned in this episode:

The LiftMor Trial 

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Transcript

SUMMARY KEYWORDS

Longevity, cardiovascular fitness, VO2 Max, muscle mass, bone density, strength training, power testing, flexibility, mobility, health span, lifespan, exercise prescription, injury risk, balance, nutritional strategy.

SPEAKERS

Peter Williams, Aaron Deere

00:00

Peter Williams  00:00

welcome everyone. Welcome to this new episode of functional medicine. Bite sized again, bringing back in one of my old buddies, former pupil, but probably say now the master. So I'm going to be listening to him rather than the other way around. Adam Deere welcome mate, how you doing? Just to redefine we've obviously done a couple of podcasts with with Aaron, because we want to get his clinical expertise, but also his practical expertise. He is the health and performance director at Hooke, andHooke really is one of the top end Real Deal longevity clinics in central London. And again, I mean that from, from, as I would look at this, from the sort of a facility that really is hot on utilizing evidence based research. Because, let's face it, the longevity market, which has massively exploded over the last five years has exploded on I think what we would both see is probably not a huge amount of research with regards to things to take particularly supplementally. It doesn't mean to say that there's some good stuff there, but I think the evidence is pretty slim at the moment. But what we are talking about today is we're going to be talking about the role, with regards to overall fitness in keeping us young and healthy, because there is lots of evidence on that, and that's really where we're going to get Aaron's expertise, particularly understanding science, but actually what they're doing at The facility, and of course, this is something that, myself, we do at our place as well. And I think we're sort of both on the on the on the same way that we look at this. So do you want to start off? Because I think probably the best place to start is, is to give us that summary with regards to just actually where the literature is and how much literature there is to say, if you get fit, and you've been fit all your life, then you are probably more likely to have a successful aging and probably live longer.

Aaron Deere  02:16

Yeah, exactly. I think it's the understated factor. At the moment, a lot of people seem to be looking for the supplements that are going to help improve their health span, improve their lifespan, their NAD boosters and spermidine and lithium things along these lines. But these are perhaps maybe the one or 2% needle movers. While, if we were looking at fitness, this has the potential to have literally the biggest effect on your your health span and your lifespan, that you know nothing else in terms of intervention wise, can can really touch for most people.

Peter Williams  02:57

Do you think that's simply, well, I look at this, I'm just hugely curious about, I think, how industries develop as well, and I think the longevity industry is developing on again, you can see how it's developing purely as a business, rather than, you know, and as a potential promise. But that promise, for me, looks like it's a promise based on quite, quite, I'm gonna say, dodgy theory. At the moment, there's some reasonable studies out there, but hardly anything. And I suppose maybe it's the allure of the of the of the of the magic pill that is going to solve the issue. But I think, as you absolutely alluded to, it might give you one or 2% on the bigger picture, and you'll pay for that 1 or 2% but come but it's very clear. I mean, I was just doing some stuff this morning. I looked at a paper in JACC, American College of Cardiology, 2018 I also looked at a BMJ, British Journal sports medicine, big meta analysis from 2019 and you know what? They both conclusively show that the cardiovascular, cardio, respiratory, cardiovascular fitness, is really a dose dependent relationship with regards to longevity. So can you delve into that a little bit more? And then if we can start breaking it down with regards to this is all well and good, but then it's a question of, how do we bring that into the reality of a week for busy people and busy professionals and parents, etc, and the stuff that you that you guys are looking at, and obviously it's the stuff that we do as well, but the way you look at that, and the way you structured that into into a program when someone comes in, and the importance that you give it as well. Because I think what me and you totally agree on is that when people come to see us, I mean, certainly, maybe not our clinic, but yours, it's a very high end clinic where people will be paying 1000s of 1000s of pounds to come in. And I just wonder whether they what are their responses when they are maybe looking for the magic bullet to some degree, and actually the magic bullet is in, or the magic bullets are in the exercise side. Are they disappointed? Are they? How do you go about

Aaron Deere  05:03

that? Okay, so a few Yeah, a few bits there. So yeah, cardiovascular fitness is really kind of turning out to be one of the key areas to address. If we're looking at lifespan and health span, we assess it through a vo two max test, and what we do is, once we have your VO two max score, we compare that against where you sit in terms of your population data for your age group and your gender. Now what we know is that we can put that into percentile groups. So we're looking at excellent, above average, average, below average and poor. And there's a lot of good research coming out now in terms of where you sit in terms of that score as a population percentile, and the effect it will have, or the potential implications it'll have on your lifespan and health span. So you know, again, this is just broad associations drawn, but you know, there's data there saying that going from below average to above average in your VO two Max equates to 2.1 additional years in your lifespan, and then having a below average vo two Max can equate to 2.9 year decrease in your lifespan. Now the people there in the excellent are the elite. So we're going kind of, you know, two and a half top two and a half percent, this can equate to almost five year increase in life expectancy. So, you know, this is all just associative data, but paints quite a clear picture in terms of the role of this cardiovascular fitness. Now, in terms of, you know, the question you asked about, you know, how we using this at the hook clinic, we are taking a real 360 approach in terms of what we're doing between fitness, nutrition, medical, musculoskeletal and cognitive and that method or that idea, we are really embedding in our whole messaging. So you know, we might see that there's some glycemic markers that are out of range. We might see that the cognitive assessment test scores are quite low, and we might see the VO two Max is quite low. So that is one of the key areas that we need to work on. For that, for each client, we have a strategy for each part of it, so it's never in isolation. But the reality is, to improve, improve your VO two Max, you have to do the work. So it's about really educating our clients to understand about right right now, this is the biggest intervention you can make to improve your lifespan, health span, outcomes. It's not in a supplement. It is in doing the work to improve your cardiovascular fitness. Now, most people's mind go to, right? I'm going to have to be on a treadmill or a bike, and then I'm going to have to be in there four or five times a week until I'm exhausted, you know, basically fall off the bike. But that isn't the case, because with a lot of clients, the start point is just doing that low intensity zone two work 60 to 70% of their max heart rate for 30 to 45 minutes, and doing that two to three times per week, we see improvements in their vo two maxes when we retest. Now it's about trying to understand about how they can do that. So if they don't have access to a gym to do some incline treadmill walking or, you know, cycling, it'll be going out and walking. But what we found is that a normal walk often isn't enough to get people into zone two. So we would normally give them, ask them to put on a backpack and then put, like, a five kilo or a 10 kilo weight in their backpack, and that extra load that they give them normally gets them into their zone two. So it's just about trying to figure out for each client what is the best way forward to get them started. Because once they get going and they see the improvement in their vo two, Max, everything else becomes so much easier related to exercise.

Peter Williams  09:19

So I just want to go over a couple of things on that. Is that we've there are always some sort of national guidelines, aren't they? That I think for us, I think most of our patients don't hit and we think somewhere around about 150 minutes a week, with regards to mixed cardiovascular work, is where I like to think your minimum baseline is. That's the way I look. I mean humans by a species that they're literally designed for movement, and that movement has to occur every day. And as you said, for most people there, I've got there's got to be stages through the week where you're out of breath. And there's two ways which, I think what you're alluding to on there is that a lot of people, they need to feel as though I'm. I was trying to explain what you were saying with regards to maybe they're not working hard enough. And I tried to say, you'll be able to have a conversation, but you may have to catch yourself because you're breathing reasonably heavy, not not crazily. So you could still have a conversation, but you're just, you know, there's a little bit of strain in a conversation is where I would probably think, if I was trying to give someone a really practical example of where zone two is, and can we, can we just go back? Because what I'd like to do is this, can you define what we're doing with when we do a vo two, Max? Can you define what that test is actually showing? And it's not easy to do. You need to do it properly, which is a, which is a maximum VO, two, you need some very specialized pieces of kit. Not a lot of people use it. I mean, I know you guys have got it, but can explain what that is actually doing, and how we can, how you take that, that exacting data, and apply that to sort of real time, to someone who maybe doesn't have access to a gym, so we can just explain what, what, what that test is actually showing us, and why that's so important from an overall health perspective.

Aaron Deere  11:10

So you know, you've got different types of vO two Max. You can do a sub maximal, where you're going off your RPE and then using an equation to then kind of estimate what your VO two Max is. I mean, relatively accurate if you don't have the kit, but, you know, we want to really find out what it is. So we use a product called the cardio coach. It's gas analysis. We're looking at CO two levels, etc, and what we're looking for is your maximum level of oxygen uptake, because that's how much oxygen you can get in, in liters per kilo to your body to move that oxygen around your body. So, you know, the more oxygen you're able to get in, the more efficient you will be able to be in exercise. You know, if we look at the I was looking at this the other day, but I think the highest ever recorded via vo two Max was 93 or something like that, from a biathlon or a track or a no

Peter Williams  12:12

Nordic cross country skiier if I remember

Aaron Deere  12:13

remember, yeah, that's right, yeah. And, you know, our, I think our highest that we've tested in, in, in hook. I think we had a 63 come in. But you know, most of them we're looking at, kind of the excellent range for most people, around 50, as their maximum oxygen uptake,

Peter Williams  12:36

just scrape in desperately to hold on to that one. And really what you're suggesting, though, is that, for me, when people say, what is VO two Max, because there's a huge, huge industry growing up with regards to mitochondria, and what we've learned about mitochondria, and they are, they, if you like, the power plants of each cell. And really for me, VO two, VO two Max, and your ability to take an oxygen is all about the efficiency of those mitochondria. And that means that, you know, mitochondria, every cell of the body, every cell of bodies. That's correct, isn't it? Yeah, I think so yeah. And therefore the higher your VO two Max, the better that cells should be able to do work. And, you know, I think, as I said to you, this is, I think a lot of times scientists who, who maybe aren't sport scientists or exercise guys, you know, it's like, Well, surely mitochondria is mitochondrial efficiency is best looked at through through vo two max or, you know, simple stuff, like, you know, more like a cooper 1.5 mile test as a field test. You know, how quickly can you run a you know, run a mile. And, you know, these are all examples of understanding how efficient your body is in utilizing oxygen and providing you energy to do work. So what? So can we just so there is, how do you prescribe and what would be an example? Because, obviously one of the key things I was interested in what you're doing is that telling people to go out and run and run three or four times a week is not as simple as that, particularly once you get sort of into your 40s, because you've got biomechanical things to think about, you've got loading things to think about, and you've got the risk of injury aspects to think about, which is, again, which was quite interesting. Why you were saying we sometimes will start people on incline treadmills, which makes complete sense, because you're not loading them as much from a point of view of ground reaction give me an idea how you, how you move this forward, because I think one of the, one of the, the, I suppose, the difficulty with listening to people on social media is that I think there's a lot of good stuff out there, but you and I know that there's a real skill in how do we put all of this together, particularly to make sure that people don't get injured. So can you again, go into all of that and the other the other things that you're thinking about regards to strength, with regards to bone efficiency, with regards to mobility, how they all fit in, and how you build that program.

Aaron Deere  15:08

So, yeah, that first bit about, you know, where, where do we start them? How do we start them? So, number one, they're given a heart rate monitor. Because, you know, how hard did you work? Oh, I think it was, we're not interested in that. We want to see the data, and also that will help with compliance, because, you know, we're we're linked up to their heart rate monitor so we can actually physically see what they've done or they haven't done. So, you know, you can't lie to us about that one, but then it's about understanding the client. So, you know, someone may already be training. But, you know, not training in an efficient way, or not training to their requirements, much easier to then, you know, move their sessions around and get them on. You know, what the testing has shown us, that they need somebody who's not exercising is a bigger challenge. It might literally start with one session per week, and that might be the start point. So, you know, there might be 130, 45, minute zone two session, and then we're going to slowly build from there, once they become accustomed to it. Now, most people, vast majority of people we're seeing, have musculoskeletal issues. And these are things that, you know, oh, my knees always done that, or my hips always been sore, and these are fixable issues, but we have to go back a few steps in order to do that involve the musculoskeletal physio massage practitioners that we have. So that may mean that they're unable to load and do any higher intensity activity. So we've got to pitch it at the right level. So it might be indoor cycling on a bike because they can't have too much load, or it might be uphill walking, etc. So it's, again, just about building the client, building the program for each specific client and their needs. Then it's about layering in the next levels of information. So you know you mentioned two things there, muscle mass and bone health. These are two massively important areas, because we know with muscle mass that the more muscle mass you have, the more likely you are to live longer. Now I will put a caveat. I'll put an asterisk on that, because there is that U shaped curve, because that would mean body builders would be the ones that would be living to 150 but most of them barely make it past 50. But that might be an account of all the drugs they take. So in normal populations, we see the more muscle mass you have, the better off you are, because you know, we know we're going to undergo sarcopenic muscle loss. We know the more muscle mass you have, the better metabolic outcomes that you have, because that muscle mass is a storage for glucose. So that's going to help us so much in later life. So a big part of our strategy is people that are in their late 40s, early 50s, trying to increase their muscle mass. And a lot of people that come to us are under muscled, and it's not an area that they have focused on, and we really want them to focus on it now as a primary goal, because it's going to it's never going to be easier than it is now for them to put on muscle mass as they get older, it's going to get harder. So just adding a kilo or two and focusing the training nutritional strategy around that now will have a huge effect further down the line.

Peter Williams  18:32

So let me just reiterate a few points on there. Again, obviously a load of stuff that that we do as well, and I've got a couple of points I'd want to talk about on that, totally agree as to say, muscle is this incredibly secretory organ that sends all of these molecules around the body that do really good things for health, but you've got to stimulate it to do it. The more muscle mass you tend to have in, as you said, general populations, the healthier you tend to be. But what I would also say on that and again, bit of a bit of a plug for my Instagram. It is a question of not so much just the muscle that you have, but the capacity for the nervous system to communicate with that muscle quickly, particularly with regards to fall reduction. So I'm interested in not just how much muscle mass you have, but what you can do with it. I think you would agree with that, wouldn't you that? Again, the capacity to the nervous system to communicate quickly and explosively with the muscles is super important, particularly as you get over 60, and falls become a massive component of real trouble as you age. Again, one of the one of the big comorbidities as we get over 60. But also, as you're saying, is that this muscle is also this brilliant reservoir for particularly storing sugars. So it has this massive metabolic effect as we age. And again, you're really looking for muscle quality, aren't you, you're looking at how well it works, how much it's infiltrated by fat over the year. Is, again, you want to keep it as clean as possible. And I think, Aaron, this brings us back to Everything is that you really, you know to ultimately, there's no part in your life where you can't, where you you shouldn't have been active, because in your 50s, if you didn't do it in your in your teens and your 20s and 30s, you will pay for it at those stages. And I think what's also what you're saying is that the older you get, the more difficult it is to gain a load of muscle. It's not that you can't, but it's much more difficult. And actually, as you say, you're in a situation where, I mean, let's say, probably once we get to 40, the increasing loss of muscle if we didn't do anything is quite profound. So if you're gaining, as you said, one or two kilos of muscle in a year, that's very substantial gains.

Peter Williams  18:41

Yeah, exactly. So average rate of muscle loss is around about 8% per decade, once we head past 40, and then that will increase up to about 15% after 70. So who the more we have, the better off we are. And then we also need to consider that strength also declines very quickly as well. So you know that can be up to three or 4% per decade with men, and two and a half to 3% with women. Now we know that strength loss will lead to issues like poor balance, increased fall risk, etc. So these two are very closely interlinked.

Peter Williams  19:27

And I think when you come back to and I want to bring that back into the again, the practical picture, because this is all well and good, but as I said to you, I think what we've been our experience tells us that you've got to mitigate everything. And you know, and I can think about me now coming up, coming up 56 you know, my knees aren't as good as they they were before. So you've got a you've got to sort of coach them and I think about my mom, who's had two knee replacements, who's just a rock solid individual, probably will live to over 100 but she's her knees are shot and she has poor mobility, and her risk is her falls and I know it's going to kill her, because she's lost that capacity to be able to move quickly because of these sort of musculoskeletal issues that have come on just because she's getting old. So can you give us some, maybe some examples of people with that, and how you've got to think about that, and how you amalgamate that into a strength or cardiovascular program? Knowing quite well, if I go back to beginning is that, as again, one of the most high end places that you can go to do really good longevity, your exercise prescription is going to be your probably the biggest component of what you do in most people. So can you sort of give us that indication, maybe some examples of where you've had to think laterally with regards to not just the cardiovascular fitness, it's the strength training, and it's doing that on someone who's got dodgy hips, dodgy knees, etc. Can you amalgamate all of that in? To give us an

Aaron Deere  23:11

example, yeah, really, really good question about you know what we've done for this? So we like to reverse engineer the programs. So you might be 55 now we want to know what you want to be able to do at 80. Okay, so at 80 I still want to be able to bend down, pick up my grandkids off the floor. I want to be able to get off the floor unassisted. So, right? What do we need to be able to do in order to achieve so we've got to be flexible enough in order to do almost like a Turkish get up type position to get off the floor. You want to be able to lift your grandkid? Okay? Your grandkids gonna, well, they're gonna weigh 10/15, kilos. So you basically might need to be able to do a Kettlewell swing or something, you know, of that type of movement. And then we will reverse engineer that. So if you're doing that at 80, that means at 70 you still need to be able to do a Romanian deadlift. You still need to be able to do a squat where you're going to at least three quarter range, etc. And then we'll keep, keep on bringing it back.

Peter Williams  24:23

Hold that. Because I think what is really important thing that you're talking about here and and what you're trying to say is that you're engineering specificity of movement, aren't you? So can you clarify why that's so important and what specificity means, because of the great example I think about here is that you know fit people who go skiing and wonder why their legs are absolutely shot after the day. So can you give us what specificity of Exercise and Movement means and why it's so important? What you're alluding to? The.

Aaron Deere  25:00

Yeah, so maybe, like, if we swung it round and we, we thought about elite level athletes, so someone like a high jumper or a long jumper, right? They have to train in a certain way. They need to be massively explosive, but there is no point for them to be able to dead lift  400 kilos, because that's not going to be a benefit for them in their sport. Maybe their deadlift needs to be 180/200 but then they need to have a vertical jump of, you know, 30 inch, whatever it is, right? So they need to have specific elements to be successful in what they do. So if we think about that for a normal population situation, we know that they will need to be able to squat, they will need to be able to hip hinge, they will need to be able to balance on one leg. So these are the patterns that are the equivalent of their movements that they carry out on a day to day basis. So therefore we structure the gym training around becoming more efficient in these patterns, so utilizing things, as I said, kettlebell swings, deadlift movements, squat patterns, goblet squats, split squats, etc, because these are the ones that are going to carry over and then help them in their day to day activities, and allow them to build strength through their movements, these movements that they're going to use for the rest of their life.

Peter Williams  26:30

The great thing about that and apologies, because obviously I'm at home and the kids are out for lunch, so you might hear them screaming, what I love about this again, it comes back to, you know, for someone who's been in in the sort of exercise world for literally, you know, 3030, years, it really comes back to the sort of fundamental movements of of human movement, isn't it on a lot of these,

Aaron Deere  26:58

yeah, Exactly, being able to move in different planes, different directions, being able to balance under different stresses, single leg, being able to land on one leg, things like this, all that really basic formative movement stuff, turns out to be so important further down the line. 

Peter Williams  27:22

Because, again, that comes into then you can build in the sort of the progressive. And I'm going to use the progressive, the term progressive overload of exercise where, but particularly if I talk about balance. And again, some of the work that I do on balance is that, for some people, even just taking one foot off the floor is enough, and once they get used to that, you can start bringing in more and more complexity. Second layer, where you know they've they've maybe got to  mover move an upper limb while they're trying to keep the balance. So there's a complexity and a layering that you can build in to make these exercises more and more complex. So not only are you getting this greater balance aspect to it, you're getting this progressive overload where your brain's gotta do more. And then, you know, you start throwing balls at them, they've gotta catch them. And again, on one leg, you're increasing the layers and layers of complexity that you can do. Mate, have you got a really good example? Give us these were always really nice to hear the example of, you know, a problem patient that came in, as I say, it might have been their knees or their hips, and you've had to work around that, to just give everyone an idea of just how you you work through work. You free that because, because there's, you know, when I look at this, I think sometimes the problem is just pure time, you know, because you've got to do, you know, a minimum. For me, I like to say to people, we hit 150 minutes on the CV, and then we gotta have two minimum of two strength training programs in their week. And that's a lot for most people, and that's where I find, you know, that's your baseline. That's where we've got to get you through before we can think about the next steps. And for most people, I see, they're not doing that.

Aaron Deere  29:04

Most people are time poor, you know. And it's about, I guess, working around, I guess, what the initial assessment of time that they can commit and then, you know, a bit of, a bit of a bargaining, or a meeting in the middle to be able to say, well, you know, you want to achieve this. In order to achieve this, you need to commit this. I understand you're here at the moment. So we need to try to figure out, how can we get another session? How can we, you know, free up another another hour, another extra 30 minutes at the minimum.

Peter Williams  29:38

And Aaron, how does that go? Because I think we're, it seems really weird, isn't it. It's sort of almost like I could drop us back 20 years ago, when we were literally at the beginning with our early conversations, and now we're sort of, we're sort of on a coming on the other side of our career, and you can look back and your conversation with your patients is a little bit different, I think now, because. Is it's almost like, here's what we're going to need to achieve, and you've got to be okay, though, if you can't do that, you're you're not going to get what we think we would like you to get. So this is what the middle ground looks like, and what you put in is what you're going to get out. So how do your conversations go with with patients? Are they usually pretty good with that?

Aaron Deere  30:19

Yeah. I mean, I'm in a fortunate situation that the clients that have come to hook, they're really looking to make change. So, you know, they've come to us, they want to go through the full health investigation, and you know we've come to you to kind of program and progress all aspects of this. So, you know, I've been very open to changing things around, making more time. You know, we've, we've had people where we've had to take them right back on rehab protocols from from what that had been doing, and, you know, they're bought into it right from the start, because it's kind of like it. I'm handing the keys to you because, you know, I know you guys know what you're doing, and I'm prepared to do what, what it is that you are going to lay out for me. So you know, you asked me about examples, and we're very lucky to be able to have a full MSK team to support us. So people that have knee injuries, hip injuries, shoulder injuries. The start point will be with the MSK team. They will then lay out what the program needs to be moving forward then we have a full team of very skilled personal trainers within Hooke in Hooke fitness, so we're able to use our in house team and very closely monitor the progress of the each client, and then they come back for reassessment with the MSK team. So we're really fortunate that we've got that loop kind of within the building, because we can closely monitor each client and then be able to progress them at the right rate. Interesting.

Peter Williams  32:04

It's almost the perfect model, really, isn't it, which has got nice as a you know, from your perspective, because people are ready, and when they're ready, it's so much easier to do. Mate, can I? Can I move on? I want to move on to obviously, we've talked about, we've talked about, and I'm going to put these in sort of the same thing, strength and power. I know they are slightly different, but you know, what we're trying to look at is that we want to get you stronger. We want to get you more powerful. We want more muscle mass. Give us an idea of some of the ways that you would test that. I mean, because, again, these are some simple ways that you can test, like grip strength, but gives an give us an indication of how you're doing that and what could be the simple things that we could we could look at on a daily basis, yeah.

Aaron Deere  32:47

So what we there's a million tests we could do for strength and for power, right? But what we want to do is first understand what the research was in terms of robust tests that have a large volume of population data, because there's no point us doing a strength test if we then can't relate it back to where you sit in terms of the population percentile and the potential outcomes On lifespan from that. So we wanted to pick tests that have that information. So grip strength, you mentioned that's, you know, probably one of the most used, and it's a proxy measure for, you know, total strength. And there's a lot of research around grip strength and lifespan outcomes, so we use that one isometric mid thigh pull. So to describe that one, it's like if you did a dead lift where you pulled against the guards on the the squat rack, almost at the top of your deadlift range. And what you're looking at, there is your posterior chain strength, and there's good data we've we've got from mid type pool as well about your total strength level from that and population percentiles and lifespan outcome. Then we look at upper body endurance in the form of a press up test. So what's your maximum number of press ups that you can do? Now, what was initially surprising to me was that there is a very strong association between the number of press ups you can do and your cardiovascular health and cardiovascular disease risk, and that's very well established for what it is.

Peter Williams  34:47

So interesting, isn't it? I think this was, this was the fireman study, wasn't it? Yeah, exactly, yeah, okay, and yeah. Again, as a as guys who understand strength conditioning, the. Push ups, and there's push ups,

Aaron Deere  35:01

yeah. So ours, we're very strict. It's at a set tempo. There's a metronome that you have to stay to. It has to be full range at the moment you fail on it. You know, you're you're out, and that's your that's your score. So those are the big three in terms of of what we're what we're looking at for our initial strength

Peter Williams  35:26

tests. But what I love about this brings it back to what we were saying. Ultimately, without blowing anyone's trumpet, we're talking to two people here who really understand this, because this is basically what we've done all our lives. You're at one of the most renowned longevity clinics that is, that is solid, and that's where I look at, I mean, you wouldn't be there if it wasn't a solid place. And yet, you're looking at a push up, which, you know, for me, is just one of the most fundamental best strength exercises that you can do if you do it properly. And then you're looking at grip strength again, 30 pound hand grip dynamometer, that's going to give you a really good indication of longevity. These are things that don't cost anything, and yet are have huge amounts of population data consistently over the years. And I think that's again, is that this is the key about longevity doesn't have to be expensive. You know, these are fundamental basics that you can be doing. So you can take away if you can't do a slow and smooth push up and get past, you know, depending on your age, you can't, you know, you can progressively see if you're getting better as a marker by doing push ups over time. You know, in a certain way, you don't need to spend 1000s of 1000s of pounds, but you can have a really good guide on that. And this is what I love about how you've gone and looked at the literature, and we're trying to make longevity not this sort of situation where it's only for the rich, only for the rich. This is the question of anyone can do this. Anyone can go out and walk. You just need the time. And you know you need the time to be able to put it to your to be able to go out and do it and do it consistently. So pal, continue where you are, where are you with the flexibility and mobility side, because I try to build that into just general movement anyway. But is there anything specific that you do? Is there anythn anything specific that you test?

Aaron Deere  37:29

That's a important one. There was one other bit as well. So in addition to the strength we have the power testing, so we're using vertical jump for that. So we're using VALD force plates to not only measure jump height, but we're looking at the weight distribution between left and right on the takeoff and landing, looking for asymmetries. Because once we start to see anything an asymmetry over kind of five or 10% that really increases your pre predisposition of injury, or really highlights to us that there is something going on at perhaps, you know, knee, hip level, you know, you see a 30% asymmetry in terms of weight distribution from left to right. And you know, there's going to be huge compensations going on there in terms of, you know, muscle and joint, etc. So I

Peter Williams  38:24

just want to confirm it as when you talk about power testing, power is about the capacity to apply force in a short period of time. And obviously, the the more force over a shorter time, the more powerful you are. That's amazing. You're doing force plate

Aaron Deere  38:38

work. Yes. So we use them for our balance tests. We use them a lot. You know, it's very valuable tool. It's very precise measurement. The most important thing can we get your scores, but we're going to have a reliable method of remeasuring you to quantify the improvements that you've made. And you know, where, you know, just doing a vertical jump test without using the force plates, you know, we might not be able to quantify, you know, your exact jump height that you've improved. And then with the VALD the level of data that you can extract from there is just mind blowing. So we're able to really do deep analysis. And now this might be data that's not that important to the client. But for us, it's, it's, it's really valuable on rate of force development, etc. So it's, it's a really, really useful tool. And you know, we've got some very skilled fitness specialists that are then able to progress each client's testing to start to look at hip to knee strength, ratios, ankle capacity and things along these lines, to then further, go down the pipeline, down the rabbit hole with each client to really personalize their fitness program and what they need. So your question about flexibility, range of movement, do. Have we do assess these metrics now, we don't have the same level of robust data like we do with these strength tests, but we do know how important it is in the kind of health span lifespan equation. So we will use things like hip hinge test. We'll use things like overhead squat tests, and then the MSK team will use their specific measurement test, their favor tests and things like this, within their assessment to be able to look at their range of movement for what they're doing.

Peter Williams  40:40

Yeah, and I think on a practical measure, you would be thinking about, you know, how easy is it for me to get up and down from the floor? I think would be a really good example. There's, I don't think there's any data on that. I don't think there's any tests on that, but it's the it's a practical thing that you can look at. You know, once in your 40s and 50s, is that difficult to do? You know, are you finding crossing your legs, crossing the leg, cross the other one, a bit more difficult to do. And these are just giving you little primers that, you know, maybe I should sort of think about, thinking about some of the aspects of flexibility. But it comes back to, you know, for me, flexibility comes in the movement patterns that you do, and you know, it should be completely interdispersed into the training. So can we move on to that? Because, you know, how do you build the program? How do you build the program? Are there some specifics, from a point of view of not just a random program, but you know, you've built something specifically. It's got, it's got specific time frames that you want to achieve. Give us an indication of how you're doing that and and try and do it from a way that, you know, maybe the the people listening to this who, who don't, maybe understand this world so well Can, can take some tips.

Aaron Deere  41:54

So it's about joining the dots from what the data tells us. So, you know, we go through this fitness test that is an hour and a half long, and then we get all your data. So let's give an example that you're above average in your VO two Max and your vertical jump was also above average, but your grip strength, your mid thigh pull were both below average, and your balance, likewise, was below average. So we know that we need to structure your program about around getting stronger and improving your balance as the the big areas of focus now we're not going to completely neglect vo two, Max and power, because we still need to continue to train these, but these will not get the the bulk of the attention in the program. So we saw from your your your hip hinge movement test that you didn't, you weren't able to hip hinge very well, and we know that would have been affecting your isometric mid thigh pull test. So we need to take you all the way back to start to understand how to hip hinge. So this is how to use your posterior chain. So we're talking about calves, hamstring, glutes, lower back, and then rhomboids, etc, in upper back as an effective unit to be able to produce force. So this might be going back to doing body weight exercises, you know, things like Cobra cobras, hip thrusts, and then progressing forward to standing Good morning, seated good mornings, RDLs, etc, to be able to really start to learn to recruit that posterior chain. And once we're then able to use this chain as we're as we're supposed to, we can then start to add load. Now, if someone was to come in and we said your mid thigh pull wasn't very good, and you need strength, we put them straight onto deadlift, you know that is going to potentially, one, be injurious, and then two, we're going to hit a ceiling in what we're going to be able to do here, because we're not able to execute the movement in the correct way. So it's about putting that time in to the areas that the testing has told us you need to focus on in order to progress it forward. And now, in terms of balance, you know, this is more, a bit more of a trickier one, because it's not something you would normally associate with a strength and conditioning program. So we need to think about, kind of, how we we hide the broccoli with this one, right? Because getting people to come in to stand on one leg is not, you know, very stimulating, and it's been difficult. So we think about our exercise choices. So we think about doing things like single legged Romanian deadlifts or single leg balance on Bosu balls, what not. And what I will say is what I've seen from clients working on balance, it is a slower process. We will see bigger improve. Improvements in strength lifts quicker then we will see balance improvements. But it does happen, but it just takes time. So it is something that you know, you probably took it looking at kind of nine month, 12 month outcomes to see improvements in your balance scores, as opposed to you might see improvement in your strength in three to six months.

Peter Williams  45:25

So, and I think what you're saying is that you know this sort of strength training program, the CV, this needs to be it. This is, there's no I'm going to do this for a year. This is, this is the rest of your life process. So again, when you describe it like that, then it's okay to take your time, because most people overcook it too quickly. And sometimes, I have to say, sometimes get a little bit frustrated because you're not pushing them on. They feel as though you're not pushing them on quick enough. But you know, if you push them on too much, they're going to get injured. Which leads me into sort of, can we get an idea of how you have to structure different training and what are the what are the issues that you look at from a point of view of what you're giving someone in their 40s as opposed to what you would give someone in their 60s or 70s? Can you give us an idea of how the full training program will likely look different.

Aaron Deere  46:22

Yeah, so this is an important one, and it's something I'm trying to wrap my head around at the moment, and I'm still in denial of myself. So tell me. Tell me, you know, in my 30s, I was trying to lift every single weight that there was in the gym, and, you know, could manage to attack every every session like it was the last session I was ever going to do, and I had no problem lifting six times a week and feeling still felt great. And that's certainly not the case now, at 46 years old, and you know, my sessions are now 45 minutes, with half of that basically being prehab work. So, you know, it took me a long time to be able to accept that that's where I that's where I am, and that's what I need to be able to progress. So, you know, if we're building that strength in, you know, the 30s and the early 40s, that's going to kind of carry us over into our 50s and 60s, and then we're moving into a phase of of maintenance, really. You know, that might be a bit sad to say it, but we the goal is about hanging on to what we have, yeah, and trying to reduce injury risk. So, you know, there's no point at kind of 55/60 year old. For most people thinking you're going to go in there and do deadlift, you know, PRs, because the injury risk rate of that is very high, so we have to think about this risk first reward. So, you know, it's about really structuring and understanding this reverse engineering that we were talking about previously, and then utilizing our gym exercises to be able to do that, but then hitting those kind of key pillars in terms of cardiovascular strength, balance as the and mobility as the kind of key four that We want to make sure we're incorporating.

Peter Williams  48:22

Can we just briefly touch on because obviously there is a there is a bone density aspect, particularly, particularly for women, that is needs to be built into the construction a lot of their training programs once they are 45 and above, can, can we just mention that? And I'm assuming you've got probably quite a few, and what are the things that you need to think about on that side, and also, just if you could go into the testing aspect of how you look at that as well.

Aaron Deere  48:55

I'm so glad you brought that up. Bone density, bone health, I think is going to be the next big thing that is going to begin to be focused on, because I feel it's really under appreciated at this point in time. And the implications of low bone mineral density on health span and lifespan outcomes is absolutely massive. So, you know, we've seen these figures around low bone density and lifespan and what happens if you have a hip fracture, yeah, so it's quite mind blowing, really, like within the within 30 days of a hip fracture, five to 10% of older adults will die, yeah, perfectly healthy hip fracture, five to 10% will be dead in a month. By 24 months, that mortality risk climbs to 30% Yeah. So I. That's mind blowing figure, and even those who recover, the long term outcome is also not great. The risk of death remains elevated for up to a decade, and many never return to independent living. So doing everything you can to avoid a hip fracture is a primary longevity strategy. So what we need to understand is what we need to do for that. Now, step number one is assessment. Where are you with your bone mineral density? So again, we're very lucky that DEXA scanning is part of the compulsory part of our health screening at hook. So I've seen hundreds of DEXA scans, and this is not low bone mineral density. Osteopenia is not an issue that is isolated to post menopausal women. You would not believe the number of healthy young when I say young, I'm kind of saying 35 to 45 year old males that have osteopenia. It was shocking like the first few that we saw. We thought the calibration and the machine must have been wrong. So we've tested them in in other places, same thing, and it keeps coming up for these healthy young males that strength train, eat reasonably well, and they're largely osteopenic in their lumbar spine. So this is a this issue isn't gender specific,

Peter Williams  51:41

yeah. And what are your, what are your sort of assumptions about why, you know, I would think about again, I think one of the things, because I've done quite a lot of them over the years, that continues to surprise me is the amount of gene variations around particularly the vitamin D, both it's metabolism, it's transport, and then the VDR receptor. It's still beggars belief that I see it literally time and time again, which is huge surprise.

Aaron Deere  52:12

Yeah, that's definitely a key moderator. And calcium intake as well, which is a huge one. You know, more and more people kind of steering away from dairy, are not meeting the nutritional requirements for calcium. And you know, when you do your blood work and your calcium markers within range, you know, but it's a poor measure of calcium status, because the body's going to do everything it can to maintain that calcium level, it will take it from its storage depot, which is the bone, yeah. So that's also been a key variable, you know, really trying to dig into what the calcium intake is, and then increasing that. Because a lot of people are under the RNI for for calcium.

Peter Williams  53:00

Interesting on that side,

Aaron Deere  53:02

yeah. So now we're we have these people that are osteopenic. Now we can't just straight away throw them into a high intensity lifting program, because we know that alongside those nutritional interventions, exercise is the key, one of the key moderators of bone mineralal density. And we know resistance training that loads the skeleton is very, very important, with ballistic slash plyometric exercises being very important in this bone remodeling equation. Because what we want to do is we want to be able to increase the rate of these cells called osteoblasts that help us create more bone and help in the bone remodeling process. So there was a study done by an Australian group, and it was called the lift more trial, yeah, and they took a whole group of post menopausal women that were osteopenic and osteoporotic, and this is the first study to ever show this, that they saw an increase in spinal density of two to 3% within eight months in this group of females, hip density, bone room density also improved significantly, especially the femoral neck, where a lot of the breaks happened, muscle mass and strength and balance also all increased, and then their posture improved, so reduced kyphosis, which then is associated with reduced fall risk. Now what they did was a special resistance training program that when I say special, it didn't reinvent the wheel, right? And it's quite simple, very simple in what it did. It uses very specific exercises that were a combination of strength and basic ballistic exercises. And it was just about being repetitive that they were doing it two to three sessions per week. They was fully supervised every session, so they made sure they were doing the right exercises in the right volume, at the right load, so and like this was in within eight months. So this is something that is actually reversible, and this was really the first study to be able to show that,

Peter Williams  55:37

I suppose the I suppose the key for that on me is it's just the comes back to the consistency and the capacity to understand. So let me take that back. I suppose what I'm trying to say on that one is that they've got you lifting pretty hard on that intervention, and you've got to start people off steadily over time and make sure that you don't overcook them. But I think what it does prove again comes back to the importance of being able to apply force to your body, and what that is capable of doing, which is pretty substantial, particularly on the on the bone aspects. And look, the other thing about that again, it comes back to my Instagram, hop skips. All of those are just super simple, you know, dropping yourself off the bottom step. You know, all of these are really important for for bone loading that you can do at home. Don't particularly need to to have a gym from that mate. How would you summarize all of this up? You know, because what we're trying to do here is that we're trying to bring, we're trying to bring the sort of longevity market and bring it back to good science and the practicalities and the big hitters in the good science. How do we how do we summarize this? How are you summarising this to your patients? But how do we summarize this to the general public who are listening to this, to this conversation?

Aaron Deere  57:12

I think that the key, one of the key points, is you need to understand where you are, because that's then going to dictate how you're going to move forward in the most effective manner. You know, if you're just going to do bike intervals and zone two, and then you're going to do dead lifts, and then you're going to do jumps, and this might not be right for you. So it's worth investing the time to understand what your strengths are, what your weaknesses are, and you know where you sit in terms of that population data range. Are you above average at this? Below average of this? Because then you've got a clear understanding of the areas you need to work on. Then it's about, what do I need to put in place to improve this, okay, what exercises do I need to use to specifically improve my strength? What percentage of my one RM, do I need to lift that? You know? What do I need to do improve my press ups? You know? Is there other exercise I will use instead of only doing press ups? And then you start to build your program and put it in place. The next key bit is re evaluation. Okay? Because you will get stronger, your cardiovascular fitness will improve, this will alter the demands and requirements of your program. So that's why we always need to go in in training phases. So we've got a specific stimulus to work on, yeah, and then we need to reevaluate what the success of our program, our interventions have been. Now, you know, ultimate goal is, we obviously want to be above average, excellent at everything, and unless we're reevaluating, we will never know where we are in terms of that, that continuum. And I think that's a bit that gets missed that, you know, I might have done this test once, or something along those lines. If these are things that you need to go back to to further understand how to develop your strategy to move forward, you might see that your voc Max improves very quickly. You're a very fast adapter. And then, but your your strength is something that takes a lot longer. So you know, this helps you shape your program that right? I've got to above average for vo two Max, so I might only need to put 45 minutes or 60 minutes on my cardio training, and I can, I can put more of that time in that I have into my strength training, because that's the area that needs more focus,

Peter Williams  59:42

and so do you, because I'm a, I, you know, as a technophobe, I'm still a massive, massive fan of basic health trackers, whether that is aura ring, whether that is Garmin, I think the whoops, a little bit more complex. But, I mean, I'm assuming you're a massive fan of those, because they are giving you reasonable data that you can work from. Yeah.

Aaron Deere  1:00:10

I mean, I get bad news from my aura ring every morning when I wake up in terms of my sleep scores. But you know, they very accurate, and I guess it kind of reflects that I, you know, I didn't get eight hours, and it was interrupted sleep.

Peter Williams  1:00:30

And just, just on that, oh, it's your sleep, because we talk about this, don't, you'll see your sleep's never good, and my deep sleep is never as good, good enough.

Aaron Deere  1:00:38

No, I think that i i actually touched a sleep score of 80 the other day, which is the highest that I've ever got. I mean, that was probably about four weeks ago. I managed that. But, yeah, that was the highest score I've got. But now I've gone from a 25 HRV guy up to a 40/45 which I was quite proud of. But then when I had a conversation with a client of mine and saying that he's had dips from 80 to 60, it really kind of, you know, put it back into perspective for me. Yeah.

Peter Williams  1:01:15

But you know what? We're all just trying to we're all just trying to wade through the morning and try and get on top, you know. And I think anyone listening to this, you know, we might know all this stuff. We're all in the same boat, trying to work it out. As I said to you, I mean, my deep sleep, I don't know whether it is, I can never, I can never seem to get more than 45 minutes. And sometimes it says I haven't had any, which is hugely disturbing, but, but there you go. But you're a fan of the trackers aren't there? I think technology is good enough now, and I think anyone you know, there's maybe a couple of 100 quid, maybe a little bit more, but I'm a massive fan that there's just really good data you get from that that allows you to at least have some baselines that you can follow, rather than, you know, having to invest all the time. But I do think we are moving into the world where, you know, maybe a yearly by yearly blood test might be a good idea, you know. Or, as I say, you know, a bone mineral density scan. I mean, you don't need to go for your GP anymore. You can self refer. There's lots of independent places that will will run that for you. And I think these are incredibly important, because if you don't test, you don't know where you are. And this is what you were saying about we've got to have a baseline to start from, and then we've got to we've got to build the strategy work to that strategy, and then we evaluate what worked and what didn't. And we've also got to do that within the context that, you know, life can be rather stressful and a bit shitty most of the times. And, you know, understanding that maybe actually, although you haven't progressed much, given how how terrible life has been, you've actually done really well with it within within that context. And I think a lot of people forget that, and again, as experience, that's what we see all the time is that you know you've done amazingly well. I mean, even treading water in in the context of how your life's been so shitty at the moment, is a really good, good place to be. You know, it's not perfect, but you know it is how well you've done within the context of where you are, mate, it's an absolute pleasure. Again, we could be here for hours and hours, and again, I will think about another aspect, because in all of this, I do think these are how, however you want to address this, or whether it's cardiovascular health, whether it's whatever, whatever it's longevity, whether it's optimal aging, it still brings us back to understanding that the fundamentals that were talked about 50, 100 years ago are still the fundamentals of you know what a place like Hooke is doing, which is really reassuring, to be fair, because I think the longevity market is one that can be perpetuated with stuff that maybe isn't really that good, and maybe is sort of pulling the wool over your eyes, because, you know, you can earn and tell quite a lot of stuff. And so it's really reassuring that, again, when we understand the complexity of how you're layering all of this, and doing that off of good science, it makes it a really reassuring conversation. So until next time, old boy, and you get get some sleep, I would suggest as well, or try to leave, leave off the lager that might help.

Aaron Deere  1:04:38

No, I've cut that a lot now it's just a Friday, Saturday thing?

Peter Williams  1:04:42

And, you know, this is the sad thing, isn't it? Is that we've, we've been contact sport men for all our lives, and that goes through the martial arts to the rugby to the basketball. And also, I think with age, there's the mellowing, maybe, of the ego. But, well. Well, maybe he goes, What's going to kill us? Because actually, as we discussed before rolling with the young guys, it's, it's a hard thing to do. I gave that up years ago.

Aaron Deere  1:05:12

Yeah, I'm still I'm still not there yet. I've still got that, that Matt pride, that Matt ego, to still try and deal with. And you know, my son, he's, he's nine, and every day is a battle for the Alpha status in the house. So I can't, yeah, can't really push that one just yet.

Peter Williams  1:05:34

So I've got a 17 year old rugby playing scrum off who's, well, it's not, it's not that difficult to be much taller than I am, but I am. But unfortunately, I think the, I think the Crown has already been passed across, so yeah, the sort of Yeah, how things get passed on. And I think it's that mellowing, that Yeah, and if he hits me on a tackle, I'm going to be in trouble anyway. Mate, pleasure as always. Thanks a lot,

Aaron Deere  1:06:01

mate. Look forward to next time