In his television broadcast on Sunday, Boris Johnson made three important points about the health effects of the next, more relaxed phase of lockdown.
The first was that the more we know about the virus, the more dangerous it appears to be; and the only step an individual can take is to keep their distance from other people, apart from members of their ‘household’, a term that is still not precisely defined. And from tomorrow, people will now be allowed to meet and sit down with another person from outside their household, but only outdoors, and provided they remain two metres apart at all times.
The Prime Minister’s second important point was that, in addition to being afraid of the “terrible disease”, people were “fearful about what this long period of enforced inactivity will do to their mental and physical wellbeing”. About which more later.
His third point was to praise “the fortitude of the elderly, whose isolation we all want to end as fast as we can”.
In fact, my only real annoyance with the Prime Minister’s oration was his sloppy use of metonymy; I am allergic to the phrase “the elderly”, as it lumps all people together who have one characteristic in common.
The key number “70” was not mentioned, however, because, at present, government advice relates to all ages. But when the general lockdown is finally lifted, we can doubtless expect a separate policy for those aged 70 and above, as well as those with certain long-term conditions.
For, as my studies have shown, there is a significant increase in risk that occurs with age. Sure, the age of 70 is artificially precise, little different from 69 or 71; and people aged 70, or indeed any chronological age, differ from one another in many more ways than they resemble one another. But age is still the single best simple risk factor.
Professor Sir David Spiegelhalter, leading statistician and chairman of the Winton Centre for Risk and Evidence Communication at the University of Cambridge – and, for my money, the best communicator on risk in Britain by miles – made it very clear on Andrew Marr’s show on Sunday: risk doubles every 6 or 7 years, so someone aged 70 is at double the risk of someone aged 63, and the risk of a person aged 77 is double the risk of the average 70 year old, and so on.
Now let’s celebrate the spotlight that the Prime Minister shone on the mental and physical consequences of what he called “enforced inactivity”, which the medical profession now calls the “deconditioning syndrome”. I do not know if Prof Spiegelhalter has studied this, but I would estimate that his seven-year rule would also apply, and that a 70-year-old will lose physical ability and fitness at double the rate of a 63-year-old, and recover the lost ability at half the rate. This assumes, of course, that people know about the risks of inactivity and take action. The evidence is that difficult though this may be, it is possible to recover all four aspects of physical fitness – stamina, skill, suppleness and strength.
Going out – now, at last, more than once a day – is one way to achieve this, certainly for stamina and the strength of leg muscles. But it is essential for the exercise to be of what is called moderate intensity; this is, enough to feel your breathing is a little more rapid but still being able to talk.
While brisk walking is enough – and the briskness of walking can easily measured by the NHS app (download at nhs.uk/oneyou) – it is the motivation that is important, as many people in middle-age have found when trying to influence parents or grandparents. They don’t want to be bossed about by their ‘know-all’ children telling them what is good for them.
But grandchildren are a different matter, however – and if it is grandchildren who ask a grandparent to take them to the park, a different response is often elicited. Only the grandchildren could give their grandparents a new pair of trainers, or a Frisbee, or one of those devices to hurl balls for dogs! Only grandchildren could recruit their grandparents to do a sponsored walk – daily strolls staggered over the course of a few week all add up – for a charity of the grandchildren’s choice (such as anthropologist Jane Goodall’s ‘Root and Shoots’, for example).
The Lancet Commission on dementia, along with other key reports, is clear that isolation is a major risk factor for dementia as well as for loneliness and depression. Of course, people who are isolated are usually isolated because of physical disability and, by definition, find it difficult or impossible to get 30, or even five minutes of moderate intensity in a park – so what can they do?
Well, the wonderful OneYou Active 10 app can detect and measure brisk walking, even when you are marching on the spot to the Grenadier Guards or the Beatles (holding on to the back a chair for safety).
Engaging in a fundraising effort for a cause gives what is now recognised by the scientific community as being of vital importance for living longer better – a sense of purpose, or ikigei, as the Japanese call it. If that fund-raising is part of a team, so much the better, and if that team is also competing with other teams, motivation is further strengthened. Talk to your grandchildren and come up with a suitable challenge that you can do together, remotely but as a team, and ideally against other competing families.
As this year’s London Marathon was cancelled, some families have taken on the 2.6 Challenge, coming up with a host of activities, from walking, running or cycling 2.6 miles, juggling for 2.6 minutes, to holding online workouts with 26 friends. Other families are raising money by stair-climbing the equivalent of Ben Nevis, Snowdon and Scafell Pike in competition against each other. If you’re stuck for ideas, take a look at the JustGiving website, which is full of families of all ages, inventing new ways to do their bit and keep themselves busy – and fit.
Although many parents and grandparents live miles, hundreds or even thousands of miles away from each other, that need not be an obstacle to stimulation and support. Video chat devices such as Amazon’s Echo Show or Facebook’s Portal – which use voice commands and sit easily on the kitchen countertop – can bring people much closer. Such technology has a very important contribution to make to the wellbeing of our elders in isolation. So instead of the nice new cardigan, why not give one of these presents instead?