Will Harlow: The Mobility Test That Predicts How Long You’ll Live | TUH #280

We almost look at people who've got these age-related problems and say, well, what do you expect? You know, you're 60, you're 70, everyone's suffering with this. And the worst part is when people are told that so many times, they believe it.

It normalizes this culture of group suffrage. And when it seems normal in your peer group, you just accept it as a consequence of aging.

We think that people only lose independence in their 80s and 90s, and we just don't think about it. It's one of those things we take for granted that we start to lose a lot earlier than we realize.

Independence truly is freedom. As we get older, one of the measures of independence is, do you need help with the activities of daily living?

The 4 pillars of independence, as I call them, are mobility, strength— so how strong you are, but also how much muscle mass you have on your body— balance, and then the 4th pillar is skeletal health.

The age-related muscle wasting is more rapid, I think, than people realize.

Muscle mass throughout the entire body is an independent predictor of longevity.

How important is it for people that are trying to build strength, but in older ages, to return that strength? Do you have them draw their attention to those muscles. Do you find that that helps?

So what I tend to do with people now, and this is something people can do at home, is—

Hey guys, welcome back to the Ultimate Human Podcast. I'm your host, human biologist Gary Brecka, where we go down the road of everything anti-aging, biohacking, longevity, and everything in between. And today's guest all the way from the United Kingdom, physiotherapist that I'm actually greatly interested in running this podcast with, decided at one point in his life that the patients that he was caring for that were leaving his clinic without pain were going home and the pain was starting to return. And he wanted to find a solution to how people could care for themselves outside of the clinic and make a material difference on the trajectory of their life. And this has to do with musculoskeletal pain and movement and your posture and so many things that are overlooked by modern medicine, and we're starting to treat those symptoms that actually have a chronic underlying condition that can be fixed so you can put them permanently in your rearview mirror. So welcome to the podcast, Will Harlow.

Thank you, Gary. That's very kind.

Yeah, I'm super, uh, super excited about today. And, um, as always, we usually start running a podcast before the podcast starts, but, you know, so we, we had a great conversation before the podcast started. But I wonder if you might just give a little context to my um, listeners, because you're working at NHS as a physiotherapist, um, and having a great deal of success with the patients that you were hands-on with that could come into the clinic and, and actually receive treatment and guidance. But at some point you noticed that when they would leave, those gains would go away, and, and it was, and it was the chronic condition was coming back.

Yes.

And I believe that the people that are the most driven purpose purposeful, like passionate and impactful are the people that are solving problems. And so that seems to be the problem that you solved.

100%.

So give us a little context around that.

Yeah. So I was in the NHS at one point, but I actually started in professional sport and it was a funny trajectory for me really, because I spent my whole childhood growing up thinking I want to work in professional sport. I don't care what I do, I just want to be in and around the clubs and the players. And I was also really interested in the human body as well, like yourself. So when I heard about this thing called physiotherapy, I thought, great, this is going to tick both boxes. I'm going to be able to help people with their bodies whilst also working in professional sport. So I was locked on this idea of working in professional football, soccer as you guys say.

Yeah.

And I went right through university with this goal, came out the other side,, and, um, I got an in with a local football club which just so happened to be the club that I supported my whole childhood.

Oh man.

Yeah, so dream come true. Um, got an interview, got the job, got in there, and within about 3 to 6 months I was looking around thinking, this is not what I want to do at all. I'm in the wrong place. It just was a bad character fit for me, a bad fit for, you know, the environment. I didn't really like the culture.

Mm-hmm.

And it was almost like the world was coming crashing down for me because I thought, I've trained my whole life for this, I've got no plan B. Yeah, what on earth am I going to do now? But I took the chance and left. And while I was trying to figure things out, that's when I went into the NHS.

Ah, okay.

And when I was in the NHS, we were in this big kind of corporate mill-like clinic. I was seeing 15 patients a day. They were all referred from their primary care physician. And about 90% of them were people over 50. I never really worked with this pocket of people before, so I've seen people with—

careful, I'm over 50, dude, so don't, don't, don't come at us too hard.

I would never dream of it. All right, um, people with knee pain, people with back pain, sciatica, all of these things. And from my training, I knew I could help these people, and I started to see these wonderful transformations. I was just giving people basic advice, telling them what they needed to do, coaching them through it, and then watching the outcomes. And I look back about 3 months into the process and thought, this is the most fun I've ever had.

Yeah.

So it was at that moment I knew this is what I was destined to do. And I don't know about in the US, but in the UK, there's a huge problem in terms of the attitude we have towards aging.

Oh, no question.

We, we almost look at people who've got these age-related problems in inverted commas and say, well, what do you expect? You know, you're 60, you're 70, everyone's suffering with this. Yeah.. And I knew from my training, normalize it. Yeah, I know. And the worst part is when people are told that so many times, they believe it and they go, well, the doctor said this is it, so I guess this is just life now.

Yeah.

But seeing people improve, I knew that there was something here and I knew the demand for it was massive. The NHS wasn't the right environment for me to take it further. We were very much constrained by how often we could see people. And what we could do. I remember being given a, a 2.5 session average cap. That's how many times you're allowed to see people before you have to get rid of them and bring someone else.

2.5?

Yeah, we were marked only on our session average.

Oh my gosh.

Yeah.

Wow.

Because you've got to make room for someone else.

Yeah, yeah, because it's just a mill.

Exactly.

Yeah.

So I knew that wasn't the right setting, so I didn't know anywhere else that was offering this kind of help for older people, so I decided to start it myself. So I left and I set up my own clinic, and it just, it really took off because I think the message just resonated straight away that, you know, you're not just destined to suffer like this forever. There's a lot we can do. You just haven't had the right guidance yet.

Yeah.

So that's how it started.

You know, I think too, you know, with aging just in general, what happens is as we move through life, right, like my, my kids are in their 20s, um, early 20s to late 20s. All their friends are getting married, right? So like every weekend there's another marriage, and then, you know, as they're emerging from that, it's like now everybody's having babies. Um, and in my age demographic, and then I look at my parents, it's like everybody has similar ailments and, and issues going on. So it's very normal. It's like, well, you're on blood pressure medication, so am I. What do you take? Oh, I take Enderol, I take a beta blocker. Um, hey, we all take it, you know. And, and, uh, you know, my knees hurt all the time. So does my back. I wake up, I can barely move. Yeah, neither can I. It's like it normalizes this. It's, it's sort of this culture of group suffrage, right? And, and when it seems normal in your peer group, you just accept it as a consequence of aging.

Yeah.

And I would argue the same thing that you're arguing. They're not consequences of aging. At all. It's just not having the tools to put these things in your rearview mirror.

Absolutely.

And, um, and so you, you, you started your own clinic, but at some point you started to notice that people were also, um, you were making these major strides in the clinic, but afterwards, their, their sort of post-care, you know, where, where they were left to their own devices, they, they started to slip backwards.

Yeah, 100%.

Which led to you doing this online.

Yes, right, definitely.

And, um, so talk a little bit about that transition.

Yeah, like, for sure. So I think looking back, um, and bearing in mind I was very early in my career here, so when I just started, I was very much still focused on pain. Like, what's the problem this person's got that's causing pain? Great, once you figured it out, let's fix it. Once the pain's gone, we'll send them on their way. As you say, they were coming back and I was like, well, why is this person's knee pain come back? You know, I've fixed the problem, but I hadn't fixed it because there were deeper rooted things that we hadn't yet addressed. Now, through seeing this many times, I decided that one of the better ways I could help people to avoid this cycle of almost boom, bust, get better, then get worse again was to give them things to do in between their sessions and after they leave me. And one of the best ways to deliver that was via video, right? So I started putting these videos out initially just to help my patients.

And I've seen a lot of your videos, you like your rotary videos, you know, your glute strength videos, your, your, your, your shoulder mobility videos.

Yeah.

Um, and, and they're very easy to follow. I mean, they're, they're simple routines and you're very specific about different ailments. Um, and, and having gone to chiropractic college and having a pretty fundamental understanding of, of anatomy you know, they make extraordinarily good sense, you know, because when the biomechanics get off, um, the pain shows up.

Yeah.

And we think the pain is, you know, the shoulder pain is because something happened to my shoulder, but it's, you know, the biomechanics sort of led to that repetitive use issue.

Yeah, definitely. And I always try and strip things back to the most fundamental basics of movement because I never think of myself as a smart guy. I'm like, I have to see something work for me to understand it.

Yeah.

And I figure that a lot of people like that approach as well. They just want something very simple, like a really simple explanation, and then one thing they can do to fix that problem. And I think that was probably the approach that really, you know, propelled the channel to getting so many millions of views. Um, but really the mission hasn't changed from there. It's still like give people something very easy that they can do and don't overcomplicate it, strip it back to basics, figure out what has gone wrong, and then a simple strategy to try and improve it.

I, I love that you, you talk about the fear of movement sometimes being as bad as the injury itself.

Yes.

What do you mean by that, the fear of movement?

Yeah, so let's go back to pain science for a minute, okay? Because this is really, really important. We used to think that when someone was in pain that was because there was a tissue that was damaged, and the only reason someone can have pain is because there's some element of damage there, right? We now know that's not true. We now know that there are many things that can cause pain, and there are studies showing that people who have been through an MRI scanner without pain are just as likely to have some of these injuries, in inverted commas, as people who do have pain. So there must be some missing, missing pieces to the puzzle. That we hadn't figured out. Now, one of these is a fear of movement, and fear of movement is something that triggers muscle spasms. It tightens everything up, it restricts the movements of your joints, and it's primarily driven by what's going on in the neural circuitry.

So like neural inhibition.

Exactly. And that drives pain up even more. So I had many people come into the practice who didn't have any obvious injury, but they still had a lot of pain. And a lot of that was because they were so afraid to move from something having gone wrong a while ago that that was now the primary driver of pain. Ah, so figuring out what's causing that fear of movement and then slowly unpicking it can have dramatic effects for people that have suffered with this kind of mechanical pain for a very long time.

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Yes.

And the brain subconsciously will guard through this process called neural inhibition, different limbs from engaging in certain movement planes because doesn't realize that the injury is over. That's safe to move again. And so very often he was like, you know, would it— would throw their biomechanics off even though there was anatomically nothing wrong with them. They had healed from surgery, trauma, uh, you know, whatever it was.

Yeah.

And, uh, you talk about these four pillars of independence, um, and I wonder if you'd lay those out because, you know, that seems to me a good foundation from for us to start with. You know, independence truly is freedom. You know, as we get older, one of the measures of independence is do you need help with the activities of daily living? Yeah. And starting early is the cure for that.

100%. And I define independence as being able to do what you want, when you want, for as long as you want, without needing help from someone else unless you want it. And independence is one of those funny things where we think that people only lose independence in their 80s and 90s, and we just don't think about it. But it's one of those things we take for granted that we start to lose a lot earlier than we realize.

Mm-hmm.

So when I was thinking about what actually influences independence, I looked back at the patients I've treated and tried to think, well, what were the reasons that those people had lost independence to begin with?

Mm-hmm.

And it came down to these 4 things. And the 4 pillars of independence, as I call them, are mobility— so how well you can move your joints— strength— so how strong you are, but also how much muscle mass you have on your body. I'm sure we can talk about muscle later, but it's one of the most important things for your health.

I would agree with that. Yeah.

Uh, balance— so how well you can stay on your feet— is the 3rd pillar. And then the 4th pillar is skeletal health. So I define that as the health of your joints, so what's going on inside the joints. And the health of your bones as well. So avoiding things like osteoporosis and osteopenia, because those lead to a big loss in independence for many of the people that I've treated, even if the other pillars are intact. So I see these 4 pillars almost like the 4 legs of a table.

Yeah.

So you need all 4 to have a sturdy table. If you knock one away, the table's wobbly at best. If you lose 2, the table's on the floor. Right. So that's how I see it.

Yeah, and, and some of your solutions I, I find really fascinatingly simple if they're done, you know, consistently, right? Um, like brushing your teeth on one foot, you know, and, and so standing barefoot and brushing your teeth on one foot just to get that one minute of extra foot stability and like, you know, calling your attention to your balance while you're doing something else, you know, things that I feel like everybody could incorporate into their lifestyle relatively easily.

Yeah.

And so how much of it is under our control?

So much of it. And the thing you're referring to, Gary, there is something I call exercise snacks.

Yeah.

Now, exercise snacks, I think it's just worth bringing this to everyone.

Yeah.

It's short bursts of movement or exercise, typically 30 to 60 seconds, that you do in otherwise dead time throughout the day.

Mm.

So the classic time to do it, as you say, is standing on one leg whilst brushing your teeth to work on your balance. Mm-hmm. You don't need to work on your balance in an exercise snack. You could work on your strength, you could work on your mobility, you can even work on your bone health. Mm. So what I tell people to do is to pick the one thing they want to improve and then build almost an exercise snack regime around that one attribute.

That's cool.

And you can rotate the exercises you choose, but if you have a clear goal, Like, let's say you wanted to build up some strength in your upper body.

Mm-hmm.

You might do a 30-second exercise snack of wall press-ups, and then you might have a resistance band looped around a door. So next time you walk past it, you do 30 seconds of rows. Mm. And before long, you are gonna start building up that attribute. And the research really supports this as well. This is not just like some, you know, little thing that you can do that might or might not work. This is really evidence-based.

You know, it's fascinating to me too, because I think we've been trained to think that exercise happens in one duration burst, you know, 45 minutes or an hour every day at the same time, and then it's done. Yeah. Where, you know, you're saying, hey, even if you have a really busy lifestyle and you have a lot going on, you have these moments throughout the day where you could just draw attention to whatever it is that you want to focus on.

Yeah.

I've got to ask you about, um, sciatica. Sure. Because, uh, you know, growing up and, you know, having graduated from chiropractic college, you know, there's so many people suffer from this, and it can be— excuse me— debilitating and get progressively worse.

Yeah.

And it's one of those things that draws people's attention away from everything else. It's sort of subconsciously on your mind if you have it. Um, by the grace of God, I've never, never suffered from it, but I know people that have had really chronic sciatica, and it's debilitating.

Yeah.

And eventually it can even lead to, like, atrophy and, you know, other things. Yeah. But what would be some of your go-tos people could do at home, let's say, for sciatica?

Sciatica is such an interesting one. It's actually one of my special interest areas.

Really? Oh, awesome, dude. I'm glad I asked then.

And in a real cruel twist of irony, a couple of years ago I had it myself. I picked up a nasty bout of it from a deadlift where I just wasn't concentrating. I, um, I rounded my spine too much picking up this heavy weight. I just got back from a long holiday without any weight training and was anxious to get back into it. Yeah. So it was a typical case, you know, rushing in, no warm-up, bad technique, bang. I felt this pain down the back of my leg, and like any good physio, I thought I've pulled my hamstring.

Yeah.

But of course I hadn't. Yeah, it was a probably a disc injury.

Yeah.

And, um, that really brought it home for me because I've been helping people with this problem for so long without ever having suffered myself. Mm. And then having that pain for 3, 4 months, having the numb foot, worrying if it was ever going to get better, that really brought it home as to how debilitating this can be. So it kind of renewed my interest in helping people with it. Mm. So there are lots of different ways to treat sciatica because there are lots of different things that can cause it. The most common cause is an issue with one of the discs in the spine, so a disc bulge or a herniation.— but really anything that presses on one of the nerve roots or irritates one of the nerve roots in the lower part of the spine can cause sciatica. Okay, so it could be a disc, it could be a joint, it could be a muscle that traps it, it could just be general inflammation. And sometimes there's sciatica and we have no idea what's caused it. There's no diagnosis there, the person just has the pain. So once upon a time, I used to try and treat sciatica based on what the tissue was that was causing it.. But then I realized that was an oversimplification.

Yeah.

So the person needs treating as a whole, not as an injury, if that makes sense. So what I tend to do with people now who have it, and this is something people can do at home, is most sciatica is linked to movements of the spine. Okay, about 90%. If you move your spine in a certain direction, it's either going to make it better or it's going to make it worse, or it's going to do nothing. So the first thing I would recommend people do is find out what those movements are for them.. So it might be that if you bend forwards, that sciatica gets worse. So now you know, okay, so when I flex, that aggravates it. So what you need to do then is for a moment until it starts to improve, try and avoid doing lots of those flexed positions. Because with any nerve pain, this is not a no pain, no gain thing. It's the total opposite. You have to avoid the thing that's causing the pain, otherwise it increases the inflammation., and the problem goes on for longer, right? So once you've found the thing to avoid, you make sure you take note of that. Now you're going to test the other movements, and chances are you'll find one that makes it feel maybe slightly better. And that is your almost golden movement. You're going to keep coming back to that almost as an exercise snack. Again, going back to that concept, keep repeating it. And what people often find is the pain starts to reduce when they do that. Mm. So this really helps in the early phases. Once that pain is under control, we then want to start rebuilding strength around the area because it doesn't take long after having an injury like sciatica or that pain in your leg for strength to start to reduce.

So true.

And with it, mobility, and with it, confidence.

Yeah.

So strengthening the glutes up, strengthening the core, strengthening the spine itself, absolutely vital for anyone who's been through this. But you have to start by knocking that pain down a few notches first because otherwise everything aggravates it. Another good evidence-based thing is walking. Walking can really help to reduce and control the pain of sciatica, so as much of that as you can, and just avoiding things that cause pain. And sometimes those things are unusual. I know for me that when I had that pain, if I slightly lent one way, it really hurt, but if I lent right the way down, no problems. So I avoided any exercises where I was slightly leaning forward. So anything with weight on my back that caused me to come forward slightly, avoid.

Mhm.

But then other exercises, even things like the leg press, which people typically think you should avoid with sciatica, that was fine for me. So it's very individual.

Okay.

So avoid what hurts, do more of what doesn't, keep moving, and rebuild that strength.

Do you find that most sciatica um, even chronic sciatica goes away over time if, if you do that?

Yeah, most of the time. If you're following a good plan and it's, it's designed to help you reduce pain, restore mobility, and rebuild strength, 90% of cases get better. Wow. And I think people's perception of it is skewed because we all hear about the awful cases that are there all the time and didn't get better.

Mm-hmm.

That's probably only about 10% of cases.

Mm.

And then there are people who have recurrent sciatica, which is quite common. But again, I would argue that most people where it's recurrent, they haven't fully regained mobility or rebuilt strength. They often wait until the pain goes away, then they just jump straight back into doing what they were doing before. And there's still that underlying problem that might not be causing pain now, but it's leaving them vulnerable to a re-injury later.

So for— I'm sure that when you were at NHS and a lot in your clinic, you were seeing a lot of post-surgical or post-traumatic recovery, like where people had some kind of specific incident and then it led to the need for rehabilitation. But what percentage of people, or how, how often did you see like repetitive use injuries, or people that had prolonged poor posture over time.

Yeah.

Um, and now it's just starting to manifest, and you have to correct that. Because I think, you know, that too little attention is paid to biomechanics.

100%.

You know, um, I've talked about this before, you know, every, every professional golf coach would rather start somebody swinging a golf club from day one rather than unlearn somebody who's been swinging a golf club wrong for 20 years.

Takes twice as long, right?

It's like as long because those neural patterns are ingrained. And I think, you know, um, the, the way that those neural patterns get ingrained, you know, when your posture is off or your gait is off, and now it's starting to manifest pain. And people think, oh man, my hip is starting to go. And it's like, well, you're just starting to feel it. It's really been going for a long time.

Yeah.

So how do you restore— like, like, what is good biomechanics and how do we restore that overall?

It's a really good question, and as I've moved through my career, I've come to the conclusion that probably 80% of the cases that I treat in the clinic are what I would call mechanical problems. So mechanical pain. We used to think, as I said, everything that caused pain is an injury, right? Now we know that you can have pain in the absence of injury, and you can have an injury in the absence of pain. So the actual injury itself is a poor predictor of how much a person is going to suffer.

Yeah.

We even see this with people with almost no cartilage left in their joints.

Yeah.

You put them through an X-ray machine for another reason. You say, how's your knee? Does it hurt? And they're like, no, it's fine. You know, you've got no cartilage, you're bone on bone.

Yeah.

But they don't have pain.

Yeah.

And the reason they don't have pain, I would argue, is that their mechanics were still pretty good around that knee. So there wasn't stress going through the joint as much as someone else who did have the pain.

Right.

So in answer to your question, biomechanics are so important. And when I look at someone's joint and I'm looking at the biomechanics and how to fix it, it often starts with the muscles. So I'll look at what those muscles are doing to protect that joint, because your muscles are like your joint's bodyguards. Yeah, that's their job. Their, their job is to reduce stress and strain on the joint tissue itself. Okay, because we've got cartilage in our joints and it does a pretty damn good job, but it's not designed to take the entire weight of the body every time you move. You need the muscles to take some of that weight as well.

Right.

And if they're not doing their job, that's often the first place I would start. And then we also want to look beyond that joint itself. So this is absolutely classic, and we were speaking about this before we came in.

Yeah.

You mentioned having a foot problem, and then before long your back starts to hurt.

Yeah.

Well, there probably wasn't an injury in your spine causing the pain. But the mechanics lower down were having an influence on the mechanics higher up.

Yeah.

Is that making sense?

Making so much sense. I mean, because I, I have flat feet, um, and on the— my left foot I have a really collapsed arch. I mean, it's flat on the ground. And I noticed, you know, as that arch collapsed, I would get a little medial knee pain, then I would get some lateral hip pain and low back pain.

So common.

And eventually it worked its way up to my shoulder. Um, and finally, I've gone through corrective, uh, I had a really good physio that you just met, by the way, happened to be here working with my wife, uh, Dr. Evan. And, um, uh, doing all the like boring stuff that I didn't want to do, like band rotations and holding a, you know, a 5-pound and then a 10-pound weight and externally rotating and, you know, um, just restrengthening the rotator cuff and, and really What he attempted to convince me of in the beginning, and what I'm now convinced of, is just I was anatomically just not in the right position. You know, in my case, my shoulder just come forward and, yeah, and, uh, posture was terrible. And so that anterior bicep just never healed.

Yeah.

And as soon as I strengthen the rotator cuff through just time and consistency with these exercises, I'm back to no pain. Pull-ups, overhead exercises, you know, everything.

You've just demonstrated the magic of fixing those mechanics. Yeah, so you've taken the stress off that bicep tendon by strengthening presumably the muscles at the back of the shoulder girdle, and that's allowed it to move in the way it was designed. And then hey presto, the body starts to heal.

Yeah, so this is how we kick off healing, by fixing those mechanics, putting the right biomechanics back in place so the body can do what was meant to do.

The body wants to heal. Yeah, it wants to work with you. It's not trying to work against you. Yeah, but it needs the right conditions to do so and the right inputs.

One of my favorite biohacks outside of breathwork by far is mineral salts. Baja Gold Sea Salt. It's got all of the trace minerals that the body needs. You know, most of us are not just protein deficient, meaning amino acid deficient, or fatty acid deficient. We are mineral deficient. So a quarter teaspoon of this in water first thing in the morning will make sure that you get all of the essential minerals that you need. It tastes amazing. In fact, I made a steak today. I actually made a grass-fed steak with grass-fed butter, and I put just mushrooms and a little bit of rosemary, and I sprinkled Baja Gold sea salt all over the top. Try it, it'll be your new favorite for cooking too. It's the cheapest and one of my favorite biohacks. I don't know, a $15 or $20 bag of this will probably last you 5 years. This is literally the world's best biohacking secret. Now let's get back to the Ultimate Human Podcast. So you also have, which I'm really curious about, um, a great predictor of longevity, uh, the, the, the simple, uh, sit-stand test.

Yes.

I want to, I want to do it. I'm hoping that I don't embarrass myself, but, um, uh, and it's basically in a 30-second time frame.

Yeah.

Um, what the number of times you can sit and stand and sit and stand to a full standing position. Yes. And you cross your arms, right?

That's right. No arms allowed.

Yeah, arms allowed. So you sort of rock forward, stand up, sit down, rock forward, stand up. And there's evidence that the number of times that you can do that in 30 seconds is a predictor for, you know, mortality and longevity. I would actually heavily agree with you on that. Can we do that during the pod? Can we fire it up? Can I, can we do it? Okay. Hopefully this goes well or we'll just have to cut this right out of the podcast. Um, all right, and I have a weighted vest on, so I'm going to take the weighted vest off, right? I'm wearing a 7-pound ion weighted vest. Let me give myself every possible advantage here. Um, is this chair good for it?

To be honest, you would want a nice firm chair normally, but we can make do. We can make two. Let's, let's bring the firm chair up here. Yeah.

Um, pull this bad actor back right there.

That one would be perfect.

Okay. 'Cause then I could always blame it on the chair if I—

Yeah. We need a scapegoat in case this goes wrong.

Yeah, yeah, dude, I should have actually left the chair.

That would be good, actually.

Okay, so I'm just gonna—

Yeah, yeah, no, no, so we'll practice first, so—

Okay.

So you want to be sat on the edge of the chair.

Okay.

So you're going to come up, all the way up, that's it, and then all the way down to a full sit, and then straight back up again, but there's no pauses. So we're going to do it as many times as you can.

Okay.

In 30 seconds.

Many times I can.

Yeah. Yeah. So we're going for rapid movement. Okay.

Okay.

And should I start? Should I time it?

I'll tell you. You got a timer?

Yeah, I got a timer.

Okay, so I'd start sitting.

Yeah. So we start sitting and the first number one is when your bum touches the seat again and then you just keep going.

Okay.

I'll tell you when to stop.

I don't get one for standing up?

No.

Oh dude, that's—

it's got an up and down is one.

Okay.

All right. Okay. All right, ready? I'll give you a countdown. So you're gonna go on go. All right. 3, 2, 1, go! Keep going, Gary! This is phenomenal. And stop. I'll give you that last one as well.

29?

Yeah. Amazing.

Is that good?

That's a very strong score. Yes! Yeah.

How old am I, human?

How old are you, Gary?

55.

Okay, you're in elite territory of that. Yes, dude!

Elite territory!

You smashed it.

Clip that, put it everywhere.

So, for your age, anything above 20 is really strong.

Really?

And that might surprise you, right? Because you did that quite easily.

Anything about— yeah, all right, hold on, let me get the other chair back, catch my breath. All right, cool. All right, good, good.

Yeah, yeah, that went well. You smashed it.

Yeah, elite territory. You got that right, man. Audio was clear. Smashed it. Oh, that's awesome.

Yeah, so anything above 20 um, for people between 50 and 60 is very strong.

Wow.

Um, but this is on like population average, right? So obviously this is tens of thousands of people, so that gives you an idea of how low probably the real average is, right? So anything below 15 at your age would be a little bit concerned. Anything below 12 is deeply concerning.

Okay.

Now the numbers that you should hit are different for each age group. So each age group's got its own and each gender as well. Right. Okay. But I would say, I would argue that any age below 12 is problematic. And there's some pretty robust data to show that anyone who can't hit more than 12 of those in 30 seconds have about a 2x risk of falls.

Wow.

In the next year, which is the greatest risk, which is the greatest risk.

So in older ages.

Yeah, absolutely. So with falls, they cost your healthcare system $50 billion a year. Really? It's massive.

Falls?

Yeah, just falls. So in the elderly, falls in the elderly. And many people who fall who are over 65 will fracture their hip. And the scary stat there is that 1 in 3 of those people will die within the next 12 months. Wow. So it's terrifying.

We actually used to call that in the mortality space, the triad of death. Yeah, we had a nickname for it, you know, these hip fractures. And yeah, what was super interesting was Um, when we really look deep into the data, very often, um, the hip breaks and then they fall. Oh, the fall wasn't always causing the fracture. Like, they'd be so osteoporotic or osteopenic that the femoral neck would break and that would cause the fall. So instead of the fall causing the fracture, the fracture caused the fall.

I've never come across that. I mean, that's probably happened very much times without me realizing.

Yeah, grandma's standing there at the sink, you know, washing dishes, and crack, the hip breaks and she just falls. Um, and sometimes the family member will say, well, why did she fall? You know, I was watching her, she was just standing at the sink washing dishes and she just bang hit the floor. And then they would realize, yeah, the femoral neck broke because this skeletal system had gotten so weak they couldn't even support itself. That's a great— so, so let's talk about First of all, everybody needs to do this.

Yeah, try it. Such a good test.

See if you can beat 20. What did I get? 29. You got to beat 29. But if someone is in that 12 or under category or 12 to 15 category, what's that a wake-up call to say you got to start doing?

Yes. So it is primarily a measure of your leg strength and specifically quads and glutes. And I call these your independence muscles. 'Cause if you've got strong quads and strong glutes, you're just much better overall in terms of your mobility. You've got less chance of an injury when you step down from a height, which is one of the key risk points as we age. Ah, not being able to hold your own weight and just stepping down from a curb, stepping off a bus, stepping downstairs is a double risk there because A, your muscle's lengthening as you control, so you're more likely to lose that control, but also you're on an elevated height. So if you do lose control and you fall, the stakes are higher, right? So having strong quads and glutes prevents some of that risk.

Okay.

Now, it also means if you got less than 12, chances are you've also got poor muscle mass in your legs. And we know that muscle mass throughout the entire body is an independent predictor of longevity. And the more muscle mass we have, the healthier we are, the longer we live. It's just as simple as that. And for every 10% decrease in a mark of muscle mass index, so how much muscle you have on your body, there's an 11% increase in your all-cause mortality risk. Wow. So for every 10% you lose, it's an 11% increased risk.

Wow.

So not good.

And, and, but the thing that's fascinating is this is within our control.

100%.

So like, if, if you are one of those people that hit 12 or less or 15 or less, that's your wake-up call to change it. Not— yeah, you're not stuck.

No, absolutely not. And there's so much you can do.

Yeah.

Um, so many simple exercises will help you build up the strength in those key muscles. But what I want to just address really quickly is there's probably some people who tried that test and they're feeling pretty hopeless. The research shows that you can make incredible improvements at any age. And on the flight on the way over here I read a new paper that came out just the other day which said that a group of nursing home residents— so these were people in their 90s and older—

wow—

were put through an 8-week quad strengthening program. And in that 8 weeks, they improved their strength by 175%.

Oh my gosh, 175% more than 75% in a 90-plus-year-old in 8 weeks. Wow.

Which is not long at all. Now, for those people, I have no doubt that was life-changing because they can start walking around again. They can probably get in and out of chairs again independently. Can make a huge difference to them. So what this proves is that it's not too late at any age. I love to make improvements. And another bit of great news is that when you first start working on your strength, we typically see improvements within as little as 2 weeks.

Wow.

It's not because you can build muscle mass in that time, because you can't, but you build up those neural connections again, and that happens fast. So your body learns these movement patterns quickly. So within 2 weeks, there's a meaningful change in what you can functionally do, but you just have to get started and you just have to stick to it.

Because I notice, you know, in older ages, uh, the first sign is people will start pressing on their knees, or they'll start grabbing the chair to get up, or they'll pull themselves up somehow. Hence the crossed arms, right? So you're fully independent and with no, uh, assistance. Both of my parents are at that stage now, and I have them working with a physio actually to try to improve, improve that strength. Because, you know, the— once you're in bed and the bed's up high and there's not much that you need to do, and, you know, to stand up and you kind of shuffle around all day and then go back into bed, you're not really— that strength is leaving fast. Sarcopenia in older ages is more rapid than age-related muscle wasting. It's more rapid, I think, than people realize.

Definitely. And we used to define sarcopenia just as a loss of muscle mass. Mm-hmm. But now we define it as well as a loss of strength and function.

Mm.

So it's multiple things happening at the same time.

Yeah.

And even though muscle mass and strength are very closely linked, they're not the same thing. So you lose muscle mass over the age of 30 at about a rate of 3 to 8% per decade. If you do nothing about it. Right.

So if you're just not strength training, you're going through your normal daily life, even walking to work, right? You're still declining in muscle mass. What was really astounding to me was looking at some of these sagittal plane views through the quads.

Yeah.

You know, where they— looks like they just chop straight through a quad. You can see the femur in the center and then the muscle, you know, going out almost looks like it's touching the skin. And then 5 years later, you see more fat on the border, and 10 years later, more fat, 20 years later, 30 years later, and, and the muscle almost seems to be like melting into the bone. And, and sometimes it looked like their circumference shrank a little bit, but not that much. It was just replaced with fatty tissue.

Yeah, yeah. And you can see the fatty infiltrates inside the quads themselves as well. Yeah, inside the muscle. But have you seen the same cross-sectional studies with masters athletes now still going into their 60s, 70s, 80s. These guys have got muscle that looks very similar to many people in their 30s and 40s.

Right.

It's because they're using them all the time.

Right.

So they avoided these changes that we used to think were inevitable because they're using it, not losing it.

Yeah. So let's say that someone is at home and tries this sit-stand exercise, doesn't have the wherewithal to go to a physio. Where would you start? Would you start by just repeating that? Exercise, or where would you start?

The simplest place would be to repeat it. But if they're, you know, very— if they're in pain or they got a really low score, they just couldn't do it, they had to use their hands, we might need to even wind it back a step further. So from that position, which by the way is where I find many of my patients when they first meet me, they often can't get out of a chair without help. We might start with some seated exercises. So just getting the quads going, add some weight to the ankle so you're getting the quads going like that. You might get them in bed and doing a straight leg raise against a resistance band. So non-weight-bearing exercises, but still building up the quads.

Okay.

Once you can get to that position where you can get in and out of a chair, that's a great thing to practice. But then we want to progress that pretty quickly as well. So then we start to add a weight in. So a goblet squat from a sit-to-stand position here. Exactly.

I hate those. I do them, but I hate them. They're savage. My trainer has me do them.

Yeah, yeah, they're great. And then you get rid of the chair and you have them doing squats without the chair if they can handle that as well.

Right.

And there's just so many ways to progress and make things tougher over time. I like to keep things simple. I have a rule of just one progression at a time. You either increase the reps, you increase the weight, or you change the technique, but not at the same time.

Right.

And then over time, that's how we get that progressive overload that actually rebuilds the muscle.

And it really helps them focus on those nerve pathways. You know, I, I've had, uh, like Chris Bumstead, you know, uh, was a 6 or maybe even 8-time Mr. Olympian.

Incredible.

I think 8-time Mr. Olympian, I think.

Amazing.

And, and he talks a lot about the, the muscle-mind connection, um, and the difference between sort of mindlessly working out and pushing weight and, and thinking about the muscle contraction, being very present for that muscle contraction, you know, just having your brain and your muscle seemingly connected during that, that exercise. How important is it for people that are trying to build strength outside of somebody who's trying to get super athleticism or, you know, become a bodybuilder, but in older ages to return that strength, do you, do you, do you have them draw their attention to those muscles? Do you find that that helps?

Oh, 100%. And what I would say is it's fascinating how many of the techniques we use now with the older population originated in the bodybuilding world.

Oh really?

Yeah, it's amazing. And this is one of them. So the mind-muscle connection we used to think of is just for guys that are trying to get huge, um, but it works just as well for older people that are trying to build some strength back up in their quads, right?

Yeah.

And there's, there's evidence to show that it isn't just what your muscle itself can do that produces the contraction, it's how well neurally you can connect to it. Yeah, that's very well established. And just concentrating on it is a way to improve it 20-30% just like that.

Yeah. Wow.

Just having that presence of mind to do it. Definitely. So I try and avoid telling people to do exercises absent-mindedly while watching TV.

Right.

I think they deserve the full attention, especially if we're just doing, you know, a minute to 2 minutes worth of work at a time.

Right.

Everyone can put down what they're doing and just focus on that thing because you'll get so much out of it.

Yeah. You know, I noticed that, uh, the, the chiro physio that's working with my father will have him do it in front of a mirror sometimes.

Oh, it works so well.

Right. Um, so he can see like what side he's leaning to and, and, you know, visually corrected. And I think probably at the same time, that visualization going back into the muscle in real time, in that real-time feedback. Yeah, and Chris talks about that too, you know, working out in the mirror. Um, and people think, oh, you're just trying to be vain, you just want to watch your muscles flex. But, you know, just to make sure that they're symmetric in there. And, and also it just has your mind lock into, okay, we're working on our shoulders now. And yeah, really drawing your attention to that.

Yeah, so important.

Hey guys, let me tell you about one of my favorite new hydration drinks. Now this is for distance athletes, HIIT cardio exercisers, people that sweat a lot or exercise intensely. And A-Game is a hydration drink. It has 8 essential vitamins, it has all of the electrolytes, the entire suite of B vitamins. Before you freak out and read that it has 21 grams of sugar, which it does, the sugar is coming from natural cane sugar and honey, my preferred mechanisms for getting glucose into the blood during intense exercise. It also has natural flavors, but these natural flavors don't come from bacterial fermentation. They actually come from real citrus fruits, and the color is from vegetable juice, not artificial dyes. So next time you're looking for a great hydration drink and you're exercising intensely, A-Game is your choice. Now let's get back to the Ultimate Human Podcast. Um, so the, the main reason why people were coming to you was for pain, either post-surgical recovery or for pain that had become chronic. Um, on your site, do you have the exercises that we just talked about? Can somebody go to your— yeah, join your, uh, uh, join your membership program and actually get some of these exercises for them to do at home?

Yeah, the membership program is about putting it into structure for people, but you don't need to join the membership to get them. I've got it all on my YouTube channel. Okay, all broken down for people.

Yeah, I've watched— like I said, I watched— I've watched a bunch of them. They make makes perfectly good sense. So what was the impetus for now wanting to put this into a book?

It's a great question. And when I was thinking about how I could best help people, because this is where the motivation comes from, I want to reach 100 million people over 50 and actually impact their lives meaningfully in some way. And the first book I released—

well, you've impacted mine, so that's 99,999,000. You have to go back. Thank you.

I'll put your name. I'll give you one. Yeah. Yeah, um, so the first book, I got so many messages from people saying what an impact it had. So I knew that a book was a great vehicle for that, and I recognized that there were two types of people who were coming into my clinic who both needed help, and perhaps the way we were helping them was incomplete. So the first type of person was the person who was in a pretty bad way. They were in pain. They'd been told by a doctor or by friends that, you know, nothing can be done for you, this is just your age, what do you expect?

At some point we'll do surgery.

100%. They'd gone downhill, you know, they'd lost their strength, they'd lost their mobility, and they were just feeling hopeless and they didn't know where to start. It just felt like there was nothing they could do. I wanted to put in one place all of the strategies and the tactics that I've used with my clients that they could follow so that they wouldn't feel so overwhelmed and wouldn't feel like they were hopeless and they could actually see light at the end of the tunnel. So that was the first group of people. And then the second group of people are quite different. They're people who are very health-conscious. They're already doing a lot for their health, but they're listening to all the podcasts, they're watching all the YouTube videos, even all of mine, and it's like, where do I start now? Like, I want to do the right thing for my health, but I'm walking 10,000 steps. Now someone's telling me I shouldn't do that. And I'm doing this diet. And now someone else has said that's actually the worst thing you can do for your health. I've, I'm lost. So I wanted to give them the minimum effective dose, science-backed answer to this is what you actually need to do if you want to see progress. So I put— I kind of had both of those people held in my mind when I wrote this book. So that's who it's for.

And so you can meet somebody wherever they are on their journey. Right. That's the sub-12 on the stand to somebody that actually wants to go to the next level. And you know what I'm, I'm really encouraged by is it seems like the last 5 years we've really drawn attention to how much control we have over our destiny.

Yeah.

You know, I think until the pandemic, almost most people felt like their healthcare choices were in somebody else's hands. And healthcare wasn't something that you reached out for until you, you needed it. There was either a pain or an incident drove you to the ER, drove you to the urgent care, made you make a doctor's appointment. But we're realizing now that it's going to be so much easier, easier to keep people out of the system. Yeah, right. Than it will be to fix the system. Right. I mean, I'm a big part of that with Maha Action and some of the other organizations I give time to. So Independence for Life. I love it. I'm going to put them— it's out now, right?

It will be out when this airs. Yeah.

So I'll have a link, link in the show notes for the book. This has been amazing. My VIPs have a lot of questions for you. So my VIPs, the ones I tell before the podcast starts, you know, who's coming on the podcast.

Yeah.

If you're interested in becoming a VIP, just go over to theultimatehuman.com/vip and you can sign up. I'll see you in these podcasts and I'll see you on some of the live sessions. But I wind down all of my podcasts by asking my guests the same question. And there's no right or wrong answer to this question, but what does it mean to you to be an ultimate human? Because I feel like you're an ultimate human.

I would say no. There's a lot I'm still working towards, I would say, but I'm on the right path, I think. In answer to your question, the word I would keep coming back to is momentum. And momentum is obviously a movement word. And I think movement is obviously so important, it's what I've built my career around. But I think momentum also describes progress. And I know personally for me that when I felt at my best, it's been when I can actively feel like I'm making progress towards something. If I'm flatlined or if I'm declining, I'm a terrible version of myself. So I feel like everyone just needs to feel, or to get into a position where they feel like they are making progress and they do have some momentum. Because momentum is a privilege and it keeps you driving forward. Mm-hmm. So I would say that's my definition.

That's great, man. What a great answer. Well, guys, I know you're going to enjoy the book. I'm definitely going to read it. I'll put a link to it in the show notes. And until next time, that's just science.