A quest for clearer thinking on ageing

In the latest in the series of blogs curated by the Clinical Policy Unit, the Consultant in Public Health at Oxford University Hospitals Trust discusses professional perceptions of ageing, growing older, loss of fitness, disease and the role of activity in preserving health:

Most people, including most clinicians, have a muddled concept which they may refer to as ‘ageing’ or ‘growing older’ and which they perceive as inevitable.

For me, the core mission is to help people see there are four inter-related processes:

Ageing is a normal process, starting as the dominant theme from about 30 (but not necessarily – Bradley Wiggins set a new 1 hour record at 35!). The effects of ageing are a loss of maximal ability, for example pulse rate, and a loss of reserve or resilience, that is ability to respond to challenges. The rate of ageing is influenced by genetic and epigenetic factors but is not a cause of major problems until the age of 90.

Disease is an abnormal process, sometimes related to ageing but more often due to long term exposure to lifestyle and environmental risk factors, most of which are modifiable.

Loss of fitness resulting from inactivity has an impact from the age of the first car or the first sedentary job which often occur together – usually in the early twenties. The effects of loss of fitness are a loss of maximal ability, for example muscle strength and a loss of reserve or resilience; that is again ability to respond to challenges. These are very similar to the effects of ageing which is one reason these two processes are often confused. Loss of fitness often occurs after the onset of disease as a consequence of the loss of activity due to either physical or social factors.

Growing older is a social process – one which is influenced by personal beliefs and attitudes – which in turn are strongly influenced by the prevailing culture of a society.

Professionals need to lead the propaganda campaign to change beliefs and attitudes with three big slogans:

  • Ageing in itself is not a cause of problems
  • Not only can many diseases be prevented or delayed so too can disability, dementia and frailty
  • People need to increase their activity levels with every year and with every diagnosis.
Sir Muir Gray

Sir Muir Gray is a Consultant in Public Health in Oxford University Hospital NHS Trust and a professor in the University of Oxford’s department of Primary Care Health Sciences.

He is also a Consultant in Public Health for

He is the author of Sod70! And with Diana Moran the joint Author of Sod Sitting, Get Moving.

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  1. Edna Petzen says:

    Great article and helpful advice! Like the use of plain English to get the message across.

  2. Scarlett McNally says:

    Great blog! Our BMJ article (written by me, Muir Gray and 4 others) expands on this: ‘Focus on physical activity can reduce the need for social care’. Full text is on

  3. Clive Hart says:

    Great article!

    To my mind this is what’s missing from all the STP work taking place. The prevention agenda is being ignored and is simply paid lip service to.

    For me, preventative actions and education offer the biggest possible ‘game changer’ and should be an absolute priority to relieve pressure on our NHS.

  4. Peter J Gordon says:

    You might be interested in this perspective on the “Edinburgh Consensus” which wishes to operationalize in the NHS a changed system of classification making MCI (Mild Cognitive Impairment) redundant and replacing all diagnoses of MCI with a diagnosis of “preclinical dementia” or “prodromal dementia”.

    I have many concerns about this “Consensus” and have summarised them here:


    Dr Peter J Gordon
    NHS Scotland