Why Aging Doesn't Mean Declining with Will Harlow

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Oh! Let's go! You don't even need a gym membership to get started. You can do resistance training just using the stuff you have lying around your home, even just with your own body weight. Balance is a skill, which is really good news because like any other skill, it can be improved. It improves with practice and repetition.

So someone comes to you and everything hurts.

Yeah.

What would be their first step?

I can think of a couple of patients who've come in to see me and they're in loads of pain. Any movement hurts. Even when you just touch them, they sort of jump and you think, well, that's not a normal response. So what we have to do for that person is prove that movement is not dangerous.

You've treated thousands of people. What truth do you know that you find that most experts out there are missing?

Pain does not mean you're broken or damaged.

Even when you're doing all the right things, your strength training, staying active, prioritizing protein, keeping the muscle you built over a lifetime gets harder with age. Now, our parents were told to accept that it's just getting older. I don't buy that. And that's why I use Timeline powered by MagnaPure. Here's the real story. Muscle isn't just about strength or looking good. Muscle runs your metabolism, protects your balance, preserves your independence, and determines how powerfully you age. And what most people don't realize is that muscle loss isn't only about hormones or workouts. It's about cellular energy. As we age, our mitochondria, those energy engines inside our muscle cells, become less efficient. Now, when your muscles can't produce energy well, it's harder to maintain strength, function, and resilience. That's where Mitopure comes in. It's the only clinically studied form of Urolithin A, a postbiotic shown in human clinical trials to support muscle strength and function by helping renew mitochondrial health at the cellular level. I love this because it works with your training, not instead of it. Now strength training is the signal, protein is the building block, and Mitopure supports the cellular energy that allows your muscles to actually respond and adapt. Mitopure gummies make it simple. 2 a day, sugar-free, vegan, non-GMO, and independently certified for quality. And let's not forget, absolutely delicious. So if staying strong is part of your longevity strategy, and I sure hope it is, visit timeline.com/JJVirgin and get 20% off your order. Hey, I'm JJ Virgin, PhD dropout— sorry, mom— turned 4-time New York Times bestselling author. As a certified nutrition specialist, Fitness Hall of Famer, and globally recognized leader in health, I'm driven to keep asking the tough questions and use my podcast to simplify the science of health into actionable strategies that help you thrive. I'd also love to hear your thoughts on the show. And here's the fun part. When you send me your review, I'll reply to you using my on-demand virtual me. That's right. My team and I created a virtual JJ packed with my books, speeches, and wisdom so I can personally connect with you. Here's how you do it. Subscribe and leave an honest review of the podcast. Take a screenshot of your review, text it to 813- 565-2627. That's 813-565-2627. My virtual JJ Virgin will reply directly, and trust me, this will make your day. So subscribe now at SubscribeToJJ.com and text me your review. Let's keep thriving together. What if everything you've been told about What if aging is wrong? What if stiff joints, bad balance, back pain, weakness, and losing independence after 50 are not normal aging, but the predictable result of doing the wrong things, or worse yet, doing nothing at all? Today's guest says most people are not aging out of movement, they're being deconditioned out of it. And if that's true, then strength can come back, balance can improve, pain can decrease, and confidence can return. Now, if you've ever wondered whether it's too late to rebuild your body, this conversation may completely change what you believe is possible. Welcome to Well Beyond 40. If there's one thing I want every woman to understand, it's that aging does not have to mean becoming weaker, frailer, or more limited. Too many people accept stiffness, pain, poor balance, and loss of confidence as inevitable after 50. But newsflash, they are not. They're warning signs, but more importantly, they are opportunities. And today I'm joined by Will Harlow, physiotherapist, bestselling author of Independence for Life, and creator of the H2 Physio YouTube channel with more than 1.5 million subscribers. He specializes in helping people over 50 rebuild strength, mobility, and independence. We're talking about what really causes decline, how to reverse it, the biggest mistakes people make, and exactly what to start doing today so you can stay strong, capable, and powerful for decades to come. Let's dive in. Will Harlow, welcome to the show.

Thank you, JJ Virgin. It's a pleasure to be here.

Well, this is a huge subject. I am glad you're tackling it. This, I think, is especially now with all this information out about lifting heavy. I feel like we're gonna get ourselves, like, I'm glad I'm glad that muscle and strength training is the forefront, but without the right mobility involved, could be really a problem. So let's dig in, 'cause the first thing I'd really like to talk about is the big lie about aging. Now you're about 12, so you're gonna have to dig deep here. But with your clients, 'cause I'm sure you've got some clients in their 40s, 50s, 60s, 70s, yes? Absolutely. What do you think the biggest myth people believe about aging aging bodies after 50 is?

Oh, I think by far the biggest myth is that age is just an inevitable decline and there's nothing you can do about it. And I think that myth has been believed for years and years and years. And yeah, people think that, oh, when you get older, you just get stiff, you get weak, you lose muscle mass, you get arthritis, and that's just how it has to be. And you're either lucky or you're not. And we don't have any influence over it, which of course we know now is a total lie. And there's a lot you can do to remain strong and healthy and mobile. And just because our cells are aging over time doesn't mean that our function has to go downhill. And the other thing that I think people get wrong is they think, well, even if we can do something about it, surely that's gonna take me, you know, 5 hours every week in the gym. I'm gonna have to like take up a new full-time job to maintain myself.

I'm gonna have to lift heavy stuff.

Absolutely. And again, none of that is true. You can do it with some really simple steps.

I'm glad you're saying this and everybody's gonna get these steps because I like to say challenge your muscles instead of lift heavy things. Yes. Because I feel like we are scaring people away from the very thing they need by showing grandma deadlifting her weight.

Yeah, I could not agree more. I think that's so, so important. And there was, I mean, if we go right back to the '80s, the craze was like cardio, cardio, cardio.

Oh honey, I know that was my, like, that's when I was in college and I was an aerobics instructor before I became a personal trainer. Exactly.

We know now that even though cardio's not bad, that's not the thing we should be doing to stay strong and mobile. But then I think the pendulum tipped really far the other way. It's like everyone needs to lift heavy. And we know that lifting heavy is good for us, but if you're just getting started, it's super intimidating. But there's research now showing that you don't actually have to pick up heavy weights as long as you are challenging your muscles. Mm-hmm. You can improve your strength, your muscle mass, and your bone density.

So you say many people aren't aging. They're actually deconditioning. Yeah. Okay. Explain what you mean by that.

So I think it's important to define what deconditioning means. And deconditioning is basically just taking away the stimulus that your body needs to stay strong and mobile because our bodies are ruthlessly adaptive in both directions. Okay? If you strength train, you'll get stronger, your body responds. But the opposite also applies. If you don't do very much, you'll get weaker and stiffer. Very quickly. Now, these symptoms of weakness and stiffness, people just blame them on age.

Mm-hmm.

But really what's happening is they've just taken away that stimulus that was keeping them strong and keeping them well muscled. And that's the reason they're suffering with these, in inverted commas, age-related symptoms, not just because of their birthday.

Now, what do you think about the medical system and how they handle these things like, you know, joint pain, osteoarthritis, et cetera? I mean, do you feel like they could be normalizing some of this problem?

100%. And I mean, I've been through probably 150 consultations where patients come in and said, my doctor told me this was just due to my age. Everyone's got arthritis. There's nothing I can do. I just have to learn to live with it now. But then of those 150, probably about 130 of those, we've been right through the process, strengthened the person up, and hey presto, their symptoms have improved or in fact disappeared. So it wasn't age, and it's actually a damaging and harmful myth to tell someone that this is just what you've got to expect now and that it's hopeless, basically, because it takes away their hope. Yeah. So I'm not blaming the, the practitioners themselves because they're under a heck of a lot of pressure. They often don't have the time in the consultation to actually fully address the mechanics of that person, and maybe they're not even the right person to do that.

I mean, think about, you know how they always talk about, uh, Physicians having 1 hour of nutrition.

Yeah, yeah.

Okay, how many hours of exercise physiology did they have?

Probably even less.

No, they had none. There is none. So you look at it and go, and then you're supposed to be able to prescribe exercise? And then you prescribe exercise and you say, do gentle movement, which no one knows what that means anyway. So I see that as a big issue is it's just knowing who to refer to.

Yeah, definitely.

That's important.

Yeah, and you touched on a really important thing there, which is that People don't know what gentle movement means. This is why I think specifics are really important. So it's why whenever I try and give a recommendation, I'll always put specifics on it as well if I can. So to tell people, this is an example, this is exactly what you should do step by step. This is how long it's gonna take and this is what it should feel like. And I feel like that is one of the reasons that the content I make resonated cuz it's actionable.

Yeah, I love that because here's what I'm seeing out in the world that I think is problematic. I understand why it is and I understand that science is nuanced, you know, I spent years in graduate school in exercise science. However, I also know that people can't do anything with nuance. And that if you don't give them specific things to do, if you say, "Hey, you can do this, this, or this," they will do none. And so if you just say, "This is where you start. Just do this," they can actually do that. Then you can build on it. So I love that you're giving them super actionable. So if the joint pain and the osteoarthritis, all these things aren't due to aging, what are they due to?

Yeah, it's a great question. One of the reasons we can say that osteoarthritis or the pain from it is not just because the joint is wearing away is because we have these wonderful studies now where they take big populations of pain-free people. So people with no pain at all, they put them through MRI scanners and you see exactly the same changes inside their joints as you see inside the joints of the people who do have pain. So if you put the scan side by side, you can't tell which person has pain and which person doesn't quite often, because we see all the same, you know, loss of cartilage, bony spurs, that kind of thing is in both scans. Well, we know from that that it must be something other than just the deterioration in the joint that's causing the pain. So in my practice, we refer to most problems as mechanical, okay? And what mechanical means is that there are funny forces acting on the joint that's putting too much stress through it, and that's contributing to pain. So those funny forces could be due to weakness in the surrounding muscle. It could be due to stiffness somewhere that hasn't been corrected and has been allowed to be there for a long time. It could be a joint above or below the problem area that's forcing stress on the problem area. So most of the time, I would say 80%, there's a mechanical issue at play in someone who's got these arthritic pains. And once you solve it, you can often really improve those symptoms.

Well, and just having stronger muscles and tendons around the joint to support it.

Yeah.

You know, and then the movement, getting all the fluids moving. So, all right. You call strength the most important insurance policy after 50.

Yes.

Why?

So strength is just a wonderful proxy for independence. If you're strong, you can pick up heavy shopping bags, you can open and close heavy doors, you can get up and down from the floor, you can do all the things you want to do. And the other thing that's tied to strength is your muscle mass. And you know this, JJ, like, muscle mass is so closely linked to just about every health outcome. The more muscle mass you have on your body, the less likely you are to suffer with things like diabetes or arthritis or even brain issues like dementia. So strength and muscle go hand in hand and they basically back up every other system in the body. And your muscle mass is a completely independent organ. It's got the abilities to communicate with all the other parts of the body. And the more muscle you have, the better all the systems work.

Yeah, I like to say muscle changes everything.

Yeah.

I'm the chief metabolic health officer for a string of clinics. And we have looked at not just fat-free mass, because again, unless it's very hard to look at actual skeletal muscle mass, but we've been not just looking at fat-free mass, but also looking at quality muscle by doing a grip strength test. Yes. What are you doing to assess in your clinic for both predicting skeletal muscle and testing quality muscle?

Yeah, we have a few functional tests. And one of the things I love about coming to the US is that you guys are like 10 years ahead of us when it comes to the technology. But in my clinic, we don't have any of the scans or any of the fancy machines, but we do functional tests.

So you guys don't have bioimpedance yet?

No. Well, we do have it. We just don't have it in the practice because we run off— everything is based on functional tests. We care more about what a person can do rather than the results of a scan, to be honest. So in terms of what we test in the clinic, so grip strength is massive. So grip strength is well established as possibly the strongest biomarker of health we have.

Isn't that crazy? And it's so cheap and so easy to do. Yeah. Why isn't it done everywhere?

I know. And I honestly think that doctors should be testing grip strength as often as they test blood pressure.

I agree. Like, You look at it and go, I understand why everyone's not doing a VO2 max test. Sure.

I get it. They suck. Yeah.

Horrible. I haven't done it since I had to do it in grad school.

Literally.

I'm like, you guys should do it. I haven't done it. But grip strength, come on. Yeah. It's fun. Yeah.

It takes like 5 seconds to do. Yeah. And it's super predictive of health. And it's, to be clear, grip strength, we are not just testing grip, we're testing overall body strength. Because grip is a wonderful proxy for how strong you are everywhere. And if the weaker your legs are, the weaker your grip is usually. And once people understand this, they say, oh, I see the relevance now. Yeah. So grip strength is a better predictor of longevity than blood pressure. It is, which just blows my mind every time. But it's super easy to test. So we do that. We also do something called the 30-second chair stand test.

Oh, I love that.

Which I really like, which is how many times you can get up and down from a chair in 30 seconds. And then another really big thing we do is a, um, a 10-meter walking test. All right. And we do that to test someone's walking speed. And there's some really scary data around walking speed being a predictor of how long a person will live. And one of the best studies I've seen on this took a, a group of older men. They were, uh, in their 70s and they tracked them over 10 years. At the start of the 10-year period, they took a walking speed test, and then at the end of the 10 years, they had a look to see who was still alive. All right. They found that the slowest walkers, only 18% of them were still alive 10 years later. Wow. The fastest walkers, 86% of them were still alive 10 years later. So again, walking speed doesn't necessarily keep you alive on its own, but it's just a great proxy for your overall strength, your overall mobility, and how well we can move.

Since I've been in the airport, pretty much every week, I just watch how slow people are moving now.

Yeah.

And it is frightening. And what you just indicated were all the different ways we could really look for sarcopenia. Yes. That no one's looking for, which is also crazy to me.

Yeah.

So my belief is that a lot of what happens to us in midlife, you know, we talk about like our metabolism slowing down, yet we see the studies that say it really doesn't, that most of what's happening is because we're not moving as much.

Yeah.

What happens when someone, and for a lot of women especially, they were always cardio or Pilates or barre, you know, or yoga, and no shade on those as accessories. That's like the frosting on the cake, not the cake. What happens when someone stops building muscle in midlife?

On a cellular level, you start to lose these muscle fibers called type 2 fibers. And type 2 fibers are your big powerful fibers that generate the most force. And you might think, well, surely that's just for athletes, but it's not cuz those are the fibers we use to get out of a chair, to get on and off the toilet. And if we trip, those are the fibers we use to take a step to stop ourselves from falling. So when we start to lose those fibers, obviously we lose strength really quickly. And the research shows that after the age of 30, the default trajectory if you do nothing about it is to lose between 3 and 8% of your muscle mass each decade. But the thing that most people miss is along with that 3 to 8% of muscle strength loss happens 2 to 3 times faster. So you could quite literally be losing, you know, 20, 30% of your overall strength each decade if you don't do anything about it. And the difference between having 100% strength and only 70% strength might be the difference between being able to get up and off the floor and not. Being able to open a heavy door or not. And I've had patients who come in to see me and they aren't there because of pain. They're there because they were out in the garden, they were pulling up weeds, they tried to get up and they realised they couldn't. And the only thing they could do, cuz no one was in the house, was crawl back to the bottom of the garden where they'd left their mobile phone and call a neighbour to help them to get back up again, which is terrifying.

Yeah.

And they were scared because they didn't think they were the kind of person who had declined. They always thought of themselves as healthy. They were walking, they were doing their yoga, Pilates, but they had lost enough muscle mass that it was not possible for them to do that very simple task. So a lot can go wrong if you lose that strength and muscle mass. Obviously as well, you've got the metabolic aspect as well. So less muscle on your body means that your insulin sensitivity drops, you have worse blood sugar control, you probably burn less calories at rest than someone with more muscle mass. So body composition changes will accelerate for the negative with less muscle mass as well.

Of course, they're not checking their body comp, they're just weighing themselves. Sure. You'll hear people say, "I weigh the same as I did in high school." Yeah, but that composition's changing. It's not the same weight though.

Yeah, yeah, yeah, exactly.

The other piece of that too, so we're losing muscle size and strength and power. And one of the things that I see out there is a trend, and I'd love to hear what you think of it, 'cause I can't stand it. And it started years ago in LA. You know, I was in LA for years, and that's where kind of like every fitness trend seems to start, and then go die. Yes, it's the hub. Anyhow, it was super slow training. And I go, this is the dumbest thing I've ever seen. If you train slow, you go slow. Why do we want— and I understood the time under tension goal that they were doing, but I'm like, why wouldn't we just do, fast and do more time under tension that's also training power. Yes. What's your thought on that? 'Cause I think I saw it coming back again and I'm like, oh my gosh, really?

So I don't hate super slow because it's a great way to build strength, but I think we need to differentiate between strength and power, as you said.

And power you lose the most of. Definitely. So—

Yeah, yeah, absolutely.

So strength is just— I'm making my case here.

Absolutely, and I'm gonna circle around and totally agree with you.

You don't have to agree with me, but I'd love you to.

I actually do because strength, Strength is just how much force you can generate. Power is how much force you can generate times speed. Okay, now if you were to stumble, what do you think saves you? Is it strength or is it power? It's power, because you have to move quickly to correct it. So if we're only doing the super slow training, we'll stay strong, which is great, and it will definitely maintain your muscles. So it's 100% better than nothing, but if you haven't got power then you don't have that safeguard for those moments where you need to quickly stick out an arm or you need to quickly correct yourself. So I 100% agree with you. If people are only doing super slow, I would encourage them to at least get some faster movements in there as well. Yeah, because the body's so relevant to what you train. Like, as you say, if you, if you train slow, you're going to move slow outside of the, the gym and the, the workout environment. So we adapt to what we practice over and over again. So if we're practicing those faster moves, you're gonna be ready for it when you need it.

This reminds me of something one of my team members just sent me to respond to an Instagram video, and it was a girl jumping up and down on a rebounder. I'm like, okay, well, I like rebounders for lymph movement. You know, no, you're not burning tons of calories on. We used to think in college that we could eat a bunch of cookies and jump up and down on a rebounder and we'd be back to zero. Doesn't work that way. But this gal was jumping up and down and the caption on this little video was how I get, how I keep get shredded arms or something like that. Okay, now she's like maybe 25. And she's on this video and she's doing this.

Okay.

Okay, and she goes, this is all I do. I do it like every day. And I'm like, oh no. And for those of you who are not watching, what I was doing was pretend I'm jumping up and down on a rebounder and I'm just moving my arms up and down and back and forth. And this is how I'm gonna get shredded arms. Why wouldn't that work to build muscle?

Well, I'll say first is at least she's moving. At least she's moving. It's better than nothing.

Hey, and that's what I said on the, 'cause I go, listen, on the reaction, any movement's better than the couch. 100%. Right? So yay, we're moving. But if we're gonna move, like we could take this up a notch.

100%. And you mentioned something earlier, which is time under tension. And that word tension is really, really important, right? So you're not gonna build stronger or bigger muscles if you aren't challenging them with force or tension. And the way we do that is by moving against resistance. So just flapping them up and down against gravity, unless you're super weak, you're not gonna build strength muscle.

At the very beginning, if you could build muscle from that, then there's a bigger problem.

For sure. So that, that's really the long and short of it.

Yeah.

You have to put your muscles under some kind of challenge for them to change. 'Cause as I said, the body's adaptive, but only when we challenge it.

And you have to continue to challenge it. That's the other piece that I think people forget is like, if you're still doing the same workout over and over and over again, you will not continue to get bigger results. You'll just do a downhill slide.

Yeah, you'll just plateau or go downhill if you keep doing the same thing. We need that progressive aspect.

That was my very first company in the exercise world was called Progressive Exercise.

Was it really?

It was, way back in the '80s. Yes. So someone listening, I always like to say forgot to work out, but the reality is a lot of people, women especially in their 50s, 60s, 70s, I mean, when I was growing up, I literally worked out in high school with the football team in their weight room.

Oh, wow.

Because I'd always done boys' sports 'cause I was always the tallest girl. So it always made me be on the boys' team. So I was used to that. Yeah. And the girls had a ballet bar and a mat. Okay. And the boys had a squat rack and a bench press and a leg press. I'm like, I'm going over there.

Yeah.

But that was typical. And the reality is, Even today, you go into the gym and the weight room is still predominantly men, you know, doing some of the craziest stuff, right? And you go, and I do a lot of hotel gyms and it's everybody's on the cardio equipment. And so for a lot of women, especially, I'm still hearing, I'm afraid to get bulky, which blows my mind. But, you know, 50 plus, I think part of it too is they're intimidated. I mean, and I understand that 'cause you don't wanna get hurt. The worst thing you could do. But for someone who's 50+, who's done a lot of cardio, maybe they've been doing a yoga class or Pilates or barre. The first thing I'd love to talk about is why Pilates or barre or yoga may initially be enough, but won't be enough over time to really build strength and power. And then where can they begin as they move into really challenging their muscle?

So with the yoga and the Pilates and the barre, like great forms of exercise, but as you said, they should be, layered on top of some kind of solid resistance training regime if your goal is to stay as healthy and as strong as possible. Now, I do actually really like them as exercise modalities for people that are trying to improve their mobility or their flexibility.

That's why I do it.

Yeah, absolutely. And that is a big chunk of my audience. And sometimes I'll have people who come in and they say, you know, I'm pretty strong, I, I work out a lot, but I've got this really stiff knee and my muscles are tight and I'm almost like bound up.. And for that person, if they're already doing resistance training, adding in yoga or Pilates on top can be transformative. And I remember when I worked in pro sport, we used to sometimes get the, the footballers who were pretty strong, we'd get them doing yoga and Pilates and the injury rates did come down for the ones who started doing that. So it certainly works.

Did they like doing it?

Do you know what? They grew to love it.

They grew.

That's the important word. Not at the start. It was like, I don't know, why am I doing this? I feel stupid. But When we start to get a bit better at things, I think we enjoy them more.

Yeah, boy, that's hard at first when you do a yoga class.

For sure. Awful. But typically these classes don't provide enough mechanical tension on the muscles to keep them strong or indeed to actually build muscle mass. So if your goal is to be strong, it's not enough. If you just wanna improve mobility, great, keep doing it.

What's great is if you have been doing yoga or Pilates, you've got great body awareness.

Yes.

You've got good mobility, good flexibility. Likely you're a little bit more in balance.

Yes. And now we can say, start the resistance training.

For sure. So especially for a lot of people who are intimidated to go to the gym and now they're seeing people lifting heavy, like literally the 80-year-old lifting her body weight as a deadlift. Where would we start with someone like that?

Yeah. So first of all, I hear this all the time. So a load of my audience will say to me, "Will, I would love to get involved in this, but I'm too scared to go in the gym. There's all these big guys in there." Do I have to just walk in front of them, pick up the heaviest weight I can and pretend I know what I'm doing? And the answer is no. In fact, you don't even need a gym membership to get started. You can do resistance training just using the stuff you have lying around your home, even just with your own body weight. And the other misconception I think people have is it's gonna take me, you know, 5, 6, 7 hours a week of dedicated time to actually make progress. And again, that's false.. And there's research showing that we can build muscle and strength in people who haven't done much resistance training in as little as one session per week. Now that isn't the optimal dosage. I actually like people to start off with two. Me too. And I like, um, two 20-minute sessions as a minimum effective dose for people just getting started. And for the people who are very intimidated, I usually give them something called my 3-2-1 method. And the 3-2-1 method's very simple. The 3-part is you're gonna choose 3 exercises, and these are gonna be compound movements that work you through multiple joints and multiple muscle groups, and you're gonna learn these movements really, really well. The 2-part is you're gonna do it twice a week, and the 1-part is each week that you do it, you're gonna try and progress one variable. Now, the variable could be you add one extra rep, or you add a tiny bit of weight. Or resistance each time you do it. And when you're just getting started, body weight is enough. So for one of those compound moves, you might choose a sit to stand from a chair. When that gets easy and you can do 10, 15, 20 of those before the muscles feel tired, get a bag, fill it up with some books, and hold it into your chest to add some resistance. Each week you do it, add another book in that bag or add one extra rep. And just like that, you're adding progressive overload, and over time you're going to get stronger.

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To be honest, the best way to know is by trying to fix the mechanical problems first. Before you undergo any investigations, right? So I always go from a fix the mechanics first before we start sending people for scans or surgical opinions. Always start with the mechanics first, and 99% of people who have a painful problem have some issue with their mechanics.

Who should they go to for that?

Being biased, I would say going to a physical therapist or a PT is one of the best places you can start, but you want someone who is familiar with the problems that people of your age get. Okay, because many of these kind of sports injury clinics and things like that, they are specialists in the, the younger athletic population. They don't see arthritic changes, they don't see these kind of tendon problems that develop over time, so they don't know what's normal in terms of timelines sometimes. So you want someone who's experienced in dealing with people like you, I always say.

Okay, and so that's the step one is really to get an assessment, which I would hope, you know, before you really do any type of an exercise program, it'd be great to do that. I mean, that would be the perfect world. I don't like to put up constraints and barriers to stop people from moving, but in the perfect world, that would be the best thing to do. I would assume that most of the issues are happening in people's knees or their hips or their lower back. Actually, when I was in grad school, my whole work was around low back pain, 'cause I was like, "I'll have work forever." Yeah, yeah, that's not going away anytime soon. Yeah, no, it's what, 90% of people have low back pain at some point?

For sure.

What's going on with all of that? What are people getting wrong there? 'Cause I'm assuming a lot of this must be biomechanics.

Yeah, definitely. So I think the first thing people are getting wrong is they assume that pain equals damage. And we know now for a fact that that's not the case. Now pain is associated sometimes with damage, but you can have pain in the absence of damage and you can have damage in the absence of pain. Now we go back to that study we spoke about earlier. We've got these MRI scans. You can't tell from a scan who's in pain and who's not. It just, that's not how it works. It's just one piece of the puzzle. So I think people are getting that wrong and they say, oh, my doctor says that I've got, I hate this by the way. My doctor says I've got the spine of an 80-year-old and I should be careful with exercise and I shouldn't move.

Yeah. Why would you, first of all, like find another doctor? Like why would you ever say this?

It's so bad. And it cripples people because they, they take that with them forever, and that just becomes a permanent fear of movement then. 'Cause it's like, well, my doctor says that I need to watch out because of how bad my spine looks on a scan. But what the doctor didn't tell them is that their neighbor who's the same age and doesn't have back pain probably has the same looking scan.

Yeah.

So I'm sorry, it's a bugbear of mine when they, when people are told that.

It's a what?

A bugbear.

A bugbear.

Is that a British saying?

That is definitely a British thing. I'm like, what is a bugbear? I just embarrassed myself now.

Yeah, okay, definitely a bugbear.

Okay, a bugbear. Yes. I'm okay.

What I would say is another issue that people have, another mistake, and it's not necessarily the mistake of the person who has the pain, so I'm not blaming them, is thinking that the only area that's the problem is the area where the symptoms are. So quite often when someone comes to us with knee pain, we will definitely look at the knee, but we might spend more time looking at their hip or their ankle. Because the joints above and below the painful area are often, have often got more mechanical problems than the actual painful area itself. So typically in someone with knee pain, we might look at the glutes because weak glutes are a big cause of knee pain. We might look at how well that hip extends and how well the hip rotates. We need to look at how well the ankle can dorsiflex, where you bring your toes up to your shin, because again, all of these things are associated with knee pain. So the knee might be the victim, not the cause. So if you've got a practitioner who's just treating your knee and you've got knee pain, then you should give them a nudge to have a look above and below if they haven't done that yet, because that can really get some people out of a hole.

I still remember I had a client who came to me because the doctor had told him to strengthen his knee.

Yeah.

I was like, okay. And we're working a couple weeks in, I'm like, this is not a knee problem. You can't abduct, adduct from your hip whatsoever. Like, this is a huge problem. Yeah. But They just missed it. They were like, "This is a knee problem. Like nothing's, this, we're not getting anywhere. Your knee's fine." So glad you said that. So someone comes to you and let's say they can't see you in person there, 'cause I know you have this big YouTube presence, but they're like, "Everything hurts." What would be their first step to getting back to life here?

I have a lot of people like that who, they are what I would call centrally sensitized, and that means that their pain is far outweighing the stimulus that's causing it. And let me unpack that a little bit. Now, we know that damage is not the only thing that can cause pain. Your central nervous system is a massive driver of pain, and your central nervous system can almost act like an alarm system.. It can be turned really high up on the sensitivity gauge or right down. Now we want that alarm system to be functioning, but can you imagine if you had a house alarm that triggered every time a mosquito flew into the house? It would be a horrible place to live because there'd be the alarm going all the time. And for some people, that alarm is the pain, and that's what their internal system has become like. It's hypersensitive, so they're always in pain. And this is one of the big causes of chronic pain. Now, it's a difficult problem to unpack, but what you have to do is take things right back to basics and start with that person where they are right now. Now, I can think of a couple of patients who've come in to see me and they're in loads of pain. Any movement hurts. Even when you just touch them, they sort of jump and you think, well, that's not a normal response. So that's the central nervous system driving the pain up. So what we have to do for that person is prove that movement is not dangerous. And once their brain starts to learn that, then the pain usually starts to come down. So you have to find some kind of movement that maybe doesn't hurt as much as the other movements. It might be something as simple as just lifting an arm up and then putting it down, or straightening a knee and then putting it back down. Find that movement, stick to it repeatedly. Over time, the sensitivity of the pain starts to drop. That alarm system is dampened down., and then you can start to expand movement over time. Now this takes a long time for, for people when they've been stuck in it for a long time, but it's such a worthwhile process because that kind of chronic pain doesn't tend to just go away on its own. This is the process that gets rid of it.

Do some people just genetically have higher pain thresholds? Women especially, I would think.

I think probably women come out just on top of men. And we obviously don't have to deal with the, uh, the childbirth.

We, we all, the big joke, you know, if you guys had to have babies, we'd have like We'd be gone.

The human civilization would've died out a long time ago. Yeah. I don't know. I don't know what the answer is to that.

I think, or is it a trigger and almost like a PTSD thing where now you're in hypersensitivity and it's all the above.

I think some people do have a genetic set point, but definitely we are creatures that are conditioned by our experiences. So if you have something that is very painful, that can almost leave like a traumatic imprint. And that can increase the sensitivity of the central nervous system. So that's definitely a thing as well. There's so many factors though.

Don't you think? So I look at resistance training and challenging your muscles and all the good things it does for you. But I think one of the things that it does for you that no one talks about is it teaches you how to handle pain. Like it's gonna hurt a bit. Yeah. You know? And it's like knowing what's the right amount of pain or not the right amount of pain. But also you get used to like, okay, I'm gonna have a little pain. Yeah. And that's gonna go away. Yeah. And you learn to tolerate higher levels of pain.

Definitely. And I think age is accelerated when we start to take away discomfort too much. Like we need some discomfort in our lives.

What are some of the early warning signs that someone could become more prone to falling?

I mean, falls are a massive problem and it's one of the—

Talk about how massive it is just so people get this. 'Cause I feel like it's one of those things, especially for women, like the first sign a woman has heart disease is 50% of them die from a heart attack. Yeah. Like I think we don't take this as seriously as we should.

No, 100%. I mean, from a, um, from an economic point of view first, the US spends $50 billion a year on the impact from falls. It's crazy, isn't it? Right across the healthcare system. Wow. But on an individual level, it's catastrophic for health. It's often the thing that leads to a decline that leads to someone passing away. Yeah, 50% of people over 50 will fall in any given year, which is a stat people— wow— often are super shocked with. But that's true, and that's obviously because we have some, uh, repeat fallers and some people who don't fall at all. But across an average population, 50% will fall once in a year. Many of those falls will lead to a fracture, particularly a hip fracture. And of those who fracture their hip who are over the age of 70, 1 in 3 will die within the next year. So this is a huge problem. Yeah. Okay. So we've got lots of falls, lots of not just people passing away, but the ones who survive, they often never get back to their baseline level of mobility and independence. So their life is changed forever. And you know, this is just a problem that's running away with us. It's not getting better, it's getting worse because people are living longer. Right. So falls are a massive issue. Now, there are a few signs that someone might fall before the actual fall happens and a few tests that we do. So the signs are people who are just starting to have to rely on handrails where they didn't before, or having to use their hands to do things where they didn't, or maybe feeling a little bit more unsteady than they did. Those are the things people often report to us. Less muscle mass is another risk. Less strength in any part of the body is another risk. But there's one great test people can do at home, which very accurately screens for fall risk. And this is whether you can stand on one leg for longer than 10 seconds.

And this is so much harder than it sounds. Well, we do the stand on one leg and close your eyes and then you're like, whoa. Yes. 100%.

So for people over 65, it's one of the strongest predictors of a fall in the next year.

Wow.

If you can't stand on one leg for longer than 10 seconds with your eyes open, you're statistically 2 or 3x more likely to fall in the next year. If you're under 65, I like people to do it with their eyes closed, 'cause I think that's a better test.

Yeah.

Under 65, you should be able to stand on one leg with your eyes closed for 10 seconds.

Now, does it matter which leg, or you have to do both legs and you have to be able to stand 10 seconds on each leg, or does it not matter as long as it's one leg?

Super question. And I would like people to be able to do it on both. We always test both sides whenever we do anything in the practice. I don't know what the research says about that, but I'm sure they tested both sides.

I would bet, 'cause I don't know if you've seen this, I need to find this study, but the research where if your grip strength is 10% different between right and left, and it's not something like osteoporosis, although then you'd even wonder, like, does it matter that you have a higher risk of cognitive decline? It would seem like it would be the same if there's this big imbalance.

I'm sure it is because an imbalance anywhere in the body is not good. Not gonna be a good thing. We wanna be as symmetrical as we can in terms of strength and function.

Yeah, which leads me back to, and just even in my own life, here I am, I'm an exercise physiologist by training. And still I built up all these imbalances over the year, just doing my thing. Yeah, doing my thing. And it's like, we all do it unless you have someone else go in and look at you and do an assessment. So this is just one of those things. I think of the things we do when we go to the doctors, we should all be going and getting a physical therapy assessment.

Yeah, I always say to my clients, clients, like you go to your dentist every 6 months, even when you don't have toothache. Why don't we do that with a physio as well?

Yeah, why aren't we doing this? Yeah. It's crazy. Okay, so someone does the test and they don't make it to 10 seconds, or even if they do, still, what could they be doing to start to improve their balance?

Yeah, so balance is a skill, which is really good news because like any other skill, it can be improved. So balance is less like building muscle mass and more like practicing a golf swing or striking a football or whatever skill you prefer to do, knitting or crocheting, whatever it is, it improves with practice and repetition. So there's a really effective way to improve your balance called exercise snacks.

And we love the exercise snacks, which I think are brilliant. Yeah.

And they're super easy to do. They fit into times of the day when you otherwise which would not be doing anything productive, and they're very, very effective. So an exercise snack is a short burst of exercise, typically 30 to 60 seconds long, and you do it when you are on hold to the bank, when you're waiting for the kettle to boil, or when you're waiting for something to cook on the stove. These are perfect opportune times to do them. And there's some lovely research to show that practicing balanced exercise snacks for 12 weeks So typically kind of 3 to 5 times per day led to a 31% increase in balance in a group of older people.

In 12 weeks.

Just 12 weeks. Wow. And that 31% improvement sounds kind of academic, but that led to one less fall per person per year on average. So that's a massive difference.

Oh, that's huge. And so when you say practicing balance, yeah, I'm thinking of what we did to, because Friday is yoga day when we are in town. Nice. And we both suffer through it. In fact, Tim for a while was like, "I'm not going anymore." I go, "You can't do this to me." "Don't leave me." Like, "Don't leave me at the yoga class." What are they doing to you there?

Is it brutal?

Well, and one of the things, I have an old broken foot from when I was 21. So I'm like, I'm on my broken foot with all this arthritis, like on the foot balancing. But, you know, it forces you to balance. So what can you do at home? Like when you said, do these exercise snacks to balance, like what?

Single leg stand is the easy one that everyone's heard. Off. So the typical one is like stand on one leg while you're brushing your teeth. Works really, really well. But that's only training your static balance. We've got another type of balance called dynamic balance, which is how well you can balance while you are moving. So I like to give people moving balance snacks. My favorite one's something called the tightrope walk, where you just imagine you've got a tightrope on the floor in front of you and you're gonna walk along it heel to toe as slowly as you can. Now your feet are going to be going like this to try and correct you. That's totally normal. It's actually what we want. So I'm sure when you were in your yoga class, JJ, when you were standing on one leg, did you notice your foot moving? Yes. That's a really good sign. It means you're challenging the balance enough for it to improve. So if someone's standing on one leg and that foot is not moving at all, it means that exercise is too easy for you. You need to make it a bit tougher. So the tightrope walk works really well. For other people, you can stand on one leg and then try reaching, so moving your center of gravity. So it's almost like trying to knock you off balance. Any way you can challenge yourself so that that foot starts to move is gonna improve your balance over time. Yes.

We just had an amazing foot expert on, and that was the big thing was like, your foot needs to move. I'm like, okay. Definitely. Now I'm really focusing on foot movement. Nice. Which again, when you look at osteoarthritis, I always think the most important thing you can do is move.

Yes, definitely.

Like move, move, move.

Yeah. That foot stuff will pay off over time. 'Cause when the joints get a bit more mobile and the muscles get stronger, it'll have knock-on effects all the way up. It'll have what? Knock-on effects. My accent is—

Knock-on effects. Yes. Okay. Let's talk about the, like someone has 10 minutes a day.

Yeah.

All right, someone has 10 minutes a day, how would you have them use that each day?

Great question. I would give them one compound exercise which works multiple joints, multiple muscle groups, and have them do 2 or 3 sets of it as close to failure as they comfortably can. So ideally something like the goblet squat would be one of my number one choices. That's gonna take you 5 minutes. And then for the remaining 5, I would have you split those minutes up and do balance exercise snacks a couple of times a day. That's how I'd spend those 10.

And if you were gonna pick one exercise, yeah, would it be that the goblet squat?

It would be either that or the farmer carry. I love the farmer carry because it works the whole body, not just the legs.

Describe what it is for everybody.

Yeah, so it's picking up two heavy weights and walking with them. Simple as that. You want to keep good upright posture, so chest out, shoulders back. Grip those weights tight and just walk. You get to the end of your hallway, turn around and walk back, and you just keep going, ideally for 30 to 60 seconds. So it works really well as a snack, and it builds up strength in your legs in your back and in your grip as well, which is not just important for your longevity, of course, but you need grip to open jars, to open, uh, to pick up heavy things, to lift, uh, shopping out of your trunk. I was gonna say boot, but that's another Englishism.

Well, and I mean, everybody's now Instacarting, so it's like you look at this and go, comfort crisis.

Yeah, 100%.

Like we no longer have to carry these bags in. I mean, all the stuff. So now we have to do the exercise. Like again, being in the Amazon, All the things that we do, they don't have to do because they actually carry water. Exactly. You know?

Their life is resistance training.

Yeah, their life is all involved in resistance and power and all the things that we now have to fake because our life has gotten them out, which leads me to daily habits that people do that are aging them faster.

Yeah, I would say prolonged sitting is the worst and not because sitting is bad, Because sitting itself, there's nothing wrong with it. What we are doing right now, there's nothing harmful about sitting in a chair for an hour as long as you get up again. So it's this prolonged part, which is the problem. And the problem is people are just not moving. They're sat for 8 hours, 10 hours a day. Now that sounds like a lot, but the average retiree sits for between 6 and 8 hours a day. It's a long time.

They just need to get a dog.

Yeah, 100%. Well, it's one of the best things people can do for their, for their health is getting a dog. Not just because you're out walking, but you've got the accountability.

Yeah.

Yeah. Because Fido's staring at you with puppy dog eyes and you don't wanna go for a walk. You haven't got a choice. You've gotta go. So it gets people out. So there's a great thing to do, but this prolonged inactivity is the problem. When some research came out to show how harmful prolonged sitting was, people got the wrong end of the stick. They said, oh, sitting's really bad. So we're all gonna get those standing desks. Well, they're still inactive. They're just doing it while stood up. So the health outcomes for those people were exactly the same as the ones who were sitting all the time.

It's like get the treadmill under the standing desk and then we got something.

So that would would solve the problem. So this prolonged sitting is a bad thing.

You've treated thousands of people. What truth do you know that you find that most experts out there are missing?

Pain does not mean you're broken or damaged. And I think that when people have pain, many experts go straight for the overmedicalized approach. So let's x-ray it, let's scan it. Oh look, that's shown up on the scan. That's your problem. That's why you've got pain. We need to cut you open, fix that thing, and then hopefully you'll be all right. And that's such an outdated approach. We know now that those tiny little changes on the scan are only a very small part of the picture, and fixing the mechanics around that area is gonna serve you much better. And best of all, it's totally natural. You're not having to cut yourself open and disrupt the body's natural healing.

Why do smart people wait until pain forces change?

Mm, this is such a common one, isn't it? And I think we're all guilty of it. Human nature is such that we tend to act on the things that feel the most urgent, right? So it's like, the car needs a service, the car needs a service, I haven't booked it, it will be all right. Oh, the engine light's come on, now I've got to book it. Do you know what I mean? So yeah, when there's a sign that we need to take action, that's when we act. And it's very difficult to motivate yourself to take action before it feels like a problem. But this is an issue because muscle loss is painless. Strength loss initially is painless. Balance loss is painless.

And it's slow, so you don't even notice it.

It slips away quietly. Osteoporosis, when we start to lose bone density, we don't feel that at all.

Well, and we're not even looking for it till it's too late.

Exactly. So these things don't feel urgent, but it doesn't mean they're not happening underneath the surface. So I think realizing that can hopefully get people to, to take action earlier. But the other thing I'd say to people who think, well, I'll just wait until something goes wrong until I start to, you know, build strength and muscle, I'll wait until I feel like it's got so bad that I have to take action. The things that help you protect your independence at the age of 70 and 80 are the same things that help you feel better in terms of your energy, in terms of your vitality, in terms of your mood, and your sleep today. So if you start something in your 40s now, you're not only waiting to get the benefit when you're 70 and 80, you're going to get the benefit today as well. You're going to feel better, you're going to have more energy, you're going to feel sharper, you're going to feel like you're, you're the best version of you today. And those benefits start very quickly. So I think if we can push people towards the benefits they're going to get, not just what they'll avoid in the future, hopefully get some people started who might otherwise not have.

Yeah. Although we seem to always be motivated more by getting out of pain.

This is human nature, isn't it?

Yes. What scares you most about how society thinks about aging?

I just think it's an absolute travesty that we are still willing to write people off because of their age. I think that just this whole attitude of, well, they're old, so, you know, this is just what happens. I think that's terrible. I see what damage it does to people who feel like they're left behind, because many of them find their way to my practice often after years of having given up, and then something speaks to them and they say, you know what, I shouldn't have to deal with this. Like, I— surely there's hope. And there usually is. But the fact that they've had 10 years where they've just been sat at home thinking there's no hope for me, there's nothing I can do, that's, that's a tragedy. This isn't just me saying it. There's so much research out there to show that you can build muscle, you can build strength, you can regain balance at any age. And I was reading a study on the plane over here which showed that a group of 90-year-old nursing home residents were put through an 8-week resistance training program by the people in their home, and in 8 weeks they increased their leg strength by 174%. And these people were over 90 years old. So to say that it's too late to build strength is just patently untrue. You can do it at any age. So to write people off just because of their age now is, um, so outdated. It's, it's harmful at best, and I would say it's criminal at worst.

There you go. Okay, speed round.

Ready? Go for it.

What exercise gives the most return after 50?

Any kind of squatting movement, I would say. So just getting started, sit to stands. If you're more advanced, you've got weight on your back, do a full squat.

Most overrated fitness trend?

Any kind of crash diet, because it leads to huge amounts of muscle mass loss as well as fat, of course. And then when people stop it, they put all the fat back on but not the muscle.

One household habit ruining mobility? Sitting for too Best predictor of independence at 80?

Whether you can stand on one leg for longer than 10 seconds.

If everyone did one thing daily, what would it be?

Try getting up and down from the floor at least once a day. And when it starts to feel harder to do that, that's when you know that something is slipping. So then you address it.

So you have a new book out. Yes. Yeah. Independence for Life.

Yeah, this guy here.

Yeah. This guy here. Yeah. Books are— is this your first book? Second book. Oh, second book. Yes.

Do you have kids?

I know. Yeah, well, so books are like kids. They are. I mean, it's like there's all this, you know, maybe it's because I'm a woman, 'cause we have to like, you know, give birth to them and then you have to raise them. Sure. So now you're in the process of raising it 'cause it's out May 26th, 28th?

May 26th.

May 26th. So what can someone, if they would like to learn more, 'cause I'm gonna put all of this at jjvirgin.com/independence. For Independence for Life. Thank you. Um, someone would like to learn more about what you do, the book. I know you have a really cool assessment. Yeah, talk us through all of that. Absolutely. You have a huge YouTube channel too.

Thank you. Yeah, so people can check me out on YouTube. So if they just type in Will Harlow, it will come up.

Cool. And we'll link to it.

Thank you. But the book Independence for Life, I wrote this for, for two people. It's the same two people I, I keep seeing coming in and out of the clinic. So the first person is like the one we just discussed. They've been told it's just your age, nothing can be done. They've been written off by other practitioners that they'd seen, but they know deep down that that's not true and there's something they can do, but they just don't know what to do.

This sounds like your favorite patient.

Yeah, I love these people because just the transformations are massive. So all of the strategies I use with those patients I put into here so that the people who, um, have been written off can start to take back control over their health. So that's the first type type. Then the second type of person, maybe there's more of these people, they watch the podcasts and the YouTube videos and they read all the blogs, they know all the fitness stuff, but they're super overwhelmed. They've been told to jump, they've been told to strength train, they've been told to walk, they've been told to run, they've been told to do yoga. And now it's like, well, how do I do this without making it a full-time job?

Yeah.

So I tried to distill down what you actually need to do to stay strong, mobile, and independent and give you kind of the minimum effective dose strategy. I put that in this book as well. So if you're either of those two people, You're who I wrote this book for, which I think is pretty much most people, hopefully. Yeah. All my other stuff you can find at willharlow.com. That's the easiest place. And I have a, a really cool, um, free thing that people can get called the Stronger for Life Roadmap, which is a, a quick quiz, 10 questions long. Based on your answers, we'll send you a tailored 7-day exercise plan to get you started. So it's perfect for people.

I love that. I'm so excited about that piece of it. And again, we'll put all of that at jjvirgin.com/roadmap. Independence. I love the fact that you will give them 7 days to get started. That's super cool. Thank you. And the— that must have been really hard to put together. It took me a very long time. I mean, I like just the— like how to really— all the nuance of— it's— people don't realize what it is.

Yeah, definitely. Because my audience is so diverse. We've got people that are like yourself, you know, super advanced. And then we've got people that can barely get out of a chair. So those two people do not need the same exercise program. To be able to create something different for everyone.

Right. That's fantastic. I appreciate your time. Thank you for coming by. And I know you're heading back to the UK. That's it.

So I'll be sad to leave, actually.

I bet. Well, I just can't believe you didn't have time to hang out in Florida.

I know.

Especially now. This is the best time of year to be in Florida and New York.

It's amazing. I mean, I'm so depressed to be going back to half the temperature that you guys have got here. We'll be back soon, I'm sure.

Hope so. And if you are, we'll do round 2.

Thank you.

Love it. And we'll go into the gym. Yes. Do some videos.

That would be awesome.

That would be fantastic.

Next time we'll do that.

Cool. All right. So again, JJVirgin.com/Independence. And thank you.

Thank you very much.

If this episode inspired you, send it to someone who thinks aging means slowing down, because it doesn't. The truth is simple. Capability can be trained, strength can be rebuilt, and independence can be protected. And remember, aging is a privilege, but aging powerfully is a choice. So choose wisely, and I'll see you next time. Be sure to join me next time for more tools, tips, and techniques you can use to look and feel your best and be built to last. Also, I'd love to connect with you and hear your thoughts on the podcast. Here's how. First, subscribe to the podcast and leave an honest review. Second, take a screenshot of your review. And third, text it to 813-565-2627. That's 813-565-2627. When you do, I'll reply using my brand new Virtual JJ. It's my on-demand virtual self built from my books, talks, and years of experience so I can interact with you directly. You'll make my day and I can't wait to hear from you. Thanks for tuning in and I'll catch you on the next episode. Hey, JJ Virgin here. And just a reminder that the Well Beyond 40 Podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.