How to thrive beyond fifty

Physiotherapist Will Harlow, below, specialises in treating the over-50s - and has nearly a million subscribers to his YouTube videos. We asked him for his top tips for staying fit and flexible in later life

Getting older almost always means suffering more and more aches and pains, but physiotherapist Will Harlow says that doesn't have to be the case. He is the founder of HT Physio in Farnham, Surrey, which specialises in treating the over- 50s. He also makes short YouTube videos about common problems that are hugely popular.
Now Will has written a book, Thriving Beyond Fifty, which is full of great tips about how to make the most of your second half-century. We asked him for his advice about some of the most common concerns he encounters in his patients.

Which problems do you see most often?
The three most common things we treat at our clinic are mechanical back pain (which is pain without any obvious structural damage), hip or knee arthritis and injuries to the tendons that fix muscles to bones.
We also see lots of people with general mobility problems, such as issues with balance, poor confidence when walking, and difficulty getting up and out of a chair. Many of these problems are caused by sarcopenia, which is the scientific term for the v loss of muscle and strength due to age or immobility.

Is it inevitable that we'll get more aches and pains once we're over 50?
While arthritis and soft tissue problems become more likely with age, it is not necessarily inevitable that we must suffer daily pain and stiffness once over 50. I have long believed that many of the common aches and pains people suffer with can be resolved by fixing mechanical problems in their joints.
Weakness, stiffness and tightness of joints and muscles can set in over time and lead to pain, but these issues can often be resolved with the right treatment. We have hundreds of success stories of patients who came in thinking their knees were worn out, when in fact it was just a certain muscle not supporting the joint properly, and once it was strengthened the pain disappeared.

What do you recommend for lower back pain?
I like using resistance bands to add difficulty to movements, thus helping you to improve your strength. But you can strengthen the muscles important for preventing back pain (like the glutes and core) with just your bodyweight. Exercises such as leg lifts and bridges all work well. Stretching the muscles of the legs is also important for minimising back pain.

How long should you wait before having a hip or knee replacement if the pain starts to worsen?
There are a few key signs I look for that suggest a hip or knee replacement might be worth considering. The first is if there is no improvement in knee pain despite physiotherapy. This is the big one, and I would never refer someone on for a surgical opinion without at least trying to achieve an improvement in their symptoms.
Being unable to walk more than 100 yards is another sign that the joint is lacking integrity and may need replacing, and if you can't get through your day without painkillers it might be time to consider surgery.

How can you prepare in your 40s to be healthier and fitter in your 50s and beyond?
Research shows that the stronger and more mobile you are in your earlier years, the more likely you are to be healthy as you age past 50. Try to develop an exercise habit as early as you can. The best way to do this is to find something you enjoy! Getting into a sport or activity and sticking to it often ticks many of the boxes we need to stay healthy.
The research shows that strength training is one of the best ways to boost longevity and 'healthspan' - a measure of how healthy you are throughout your life.
My top recommendation would be to exercise at least three times a week. A combination of walking and resistance training is a great starting point.

Plantar fasciitis [pain in the arch and heel of the foot] is common in the over-50s. What do you recommend to treat it?
Plantar fasciitis is often caused by a combination of poor footwear, tight calves and mechanical problems in the foot. If you already have it, find footwear that reduces the pain and protects the heel. Comfy trainers with a soft, thick sole work best. Ideally make sure they also have some kind of arch support. Calf stretches are also key. Tight calves cause stress on the plantar fascia [the band of tissue that runs from the heel to the toes] and stretching them can reduce this.
Finally, strengthening the entire calf and foot is important. I have a video giving suggestions on how to do this on my YouTube channel.

I'm 59 and broke my wrist six weeks ago and the cast has now been removed. What will help speed up my recovery?
Recovering from a wrist fracture at your age requires a well-planned approach, with a focus on movement to regain strength, flexibility and function. Now that your cast is off, targeted exercises are crucial.
When you've had the all-clear from your doctor, start by gently moving the wrist in all directions to reduce the stiffness. You can use your opposite hand to gently assist each movement, gradually pushing a little further each session as the pain decreases.
If the fracture affected your hand function, simple activities like squeezing a stress ball can enhance grip strength and dexterity.
Resume activities slowly, avoiding heavy lifting or high-impact exercises that could strain your wrist. Low-impact activities such as swimming can help maintain overall fitness while protecting your wrist.
Sticking to your exercise plan is key. Recovery takes time, so be patient and follow your therapist's advice closely. Regular hands-on therapy from a physio combined with careful exercise will significantly speed up your wrist's recovery, helping you regain strength and mobility.

How long will it take me to regain full use of my wrist?
That depends on what 'full use' means to you. I once saw a lady in her 70s who was a yoga teacher and needed to be able to do handstands! For her, getting back to full use took a lot longer than it would for someone who just wants to carry a bag of shopping. Typically, your wrist should be fully functional between three and six months following the injury.

Should I wear a wrist splint?
Only if you've been told to wear one by your specialist. As a general rule, the more you can use it, the quicker it will get better, but a splint can sometimes prevent proper use.
However, if you have a lot of pain or are struggling to sleep, a wrist splint can be useful in protecting it and allowing some relief.

Breaking my wrist really knocked my confidence. What can I do to boost it?
If your confidence is low, the best way to restore it is to prove to yourself you are strong and stable through practice and repetition.
One of the first things I recommend to patients who have injured themselves after a fall is balancing exercises. Practicing things like standing on one leg or the tandem stand (demonstrated in my book) can boost your confidence.

How many steps should over-50s walk each day?
There is a myth that everyone should aim for 10,000 steps a day, but this target is arbitrary and only became popular because of a marketing campaign in Japan in the 1960s.
There is some evidence that says people who walk more than 6,000 steps a day tend to live longer than those who don't. This equates to roughly three miles of walking. I would recommend using the step tracker on your phone to record how many you do on average, then try to increase that daily number by 10% each month until you are somewhere in the 6-10k range each day.
Interestingly, recent research shows that shorter bouts of faster walking might be better for our health than long, slow walks. Getting a little out of breath is a good thing as it strengthens the heart and lungs.

What activities can I do with my adult children or grandchildren that we can all enjoy? Walking, playing in the garden and swimming are all great activities that can be enjoyed by the whole family. My family always used to play French cricket when we got together, which my grandparents can still join in with even though they are 88 and 91!

Is there a particular time of the day when it's better for over-50s to exercise?
I would recommend avoiding a hard workout just before bed, as it takes time for the heart rate to return to a normal level and this might interrupt sleep. You might find a harder workout is better in the morning, as this can invigorate you before you start your day. Otherwise, there is no evidence to suggest there is a best time of day to exercise. Do it when it suits you.

Are supplements worth taking and, if so, what are the best ones?
Everyone secretly wishes there was a magic pill to help them improve their health! There is some evidence for vitamin D, omega-3 and magnesium when it comes to improving the health of your muscles, bones and joints. Of course, check with your GP first before taking any.
However, I like to see supplements as the cherry on top of an enormous cake. Realistically, it is unlikely that any supplement will give you more than a 5% improvement in any aspect of your health. The main part of the cake is made up of diet, exercise, sleep and good habits.

Are there any exercises the over-50s should avoid?
There is no specific activity I would not recommend, except perhaps obvious things like sitting down all day or smoking.
Exercise-wise, make sure whatever you do is not painful but still challenges. If you take up a new exercise it is important to ease yourself in slowly. Over the age of 50 your soft tissues are not as resilient to change as they were when you were much younger, so easing in gradually will help you avoid injury.


◆ Thriving Beyond Fifty: 111 Natural Strategies to Restore Your Mobility, Avoid Surgery and Stay Off Pain Pills for Good by Will Harlow is published by Hay House, price £19.99. Will's videos can be seen at youtube.com/@HT- Physio Facebook: facebook.com/DementiaUK Picture: Adobe Stock