I’m wondering if some trying to push away frailty are really targeting something else, namely reducing the true aging speed, and it’s youth they’re after, not strength. There are those that want strength, but I wonder what people are really after.
For example take Deborah, 46 years old, comes into the anti-aging clinic and doesn’t know what she wants. You could get her VO2 Max to 50 and being able to do 60 kg squat, for instance. Targeting the brain and internal organs might actually be a preference of her, rather than lifting small things or moving freely, hiking, rock climbing.
A hierarchy of preferences of aging phenotypes is probably a better idea rather than equalizing all phenotypes. She might prefer to sit in a wheelchair feeling good, and with a quick mind, rather than having focused on being strong but with mild cognitive impairment.
It also shows which phenotypes should be prioritized, in this case e.g dementia prevention, sometimes they overlap but sometimes they don’t. She probably also would like longevity research, as strength would be somewhat solved. Advice on social media tends to be general rather than specific.
I think the overlap is so substantial that any emphasis in the differential strategies is going to be pretty minimal. Keeing your brain healthy means keeping your CV system healthy, your kidneys healthy, liver and most other organs, metabolic health etc. Exercise will be a part of it, because it impacts all of the above. There may be some subtle emphasis in exercise on some muscle groups vs cardiopulmonary conditioning, but it overlaps substantially. More useful would be identifying specific vulnerabilities. If you have shit kidneys or weak knees, you tailor treatments for the weakest links. You also do so preventatively, if you have a family history of poor renal function, then you will take extra care of those even without current symptoms, avoid NSAIDs, getting on an SGLT2i etc. I think we all do this regardless. Of course it’s bound up to some degree with your preferences beyond strict longevity. You may like sports or very physically challenging activities, and that may lead you to exercise more than is strictly necessary for functional health and longevity. Or you want to preserve your looks because you want to, say, work the streets into old age, so you’ll do more to keep your hair and skin glowing beyond strict health concerns or needed in the rough trade end of things versus more exclusive services etc.
Otherwise, in general you keep in mind the interaction between QOL, healthspan and lifespan.
I agree with @CronosTempi that people should work on the weakest aspect, but also often there is the reverse of a trade off " Mens sana in corpore sano"
I resonate with the premise underlying this discussion: that we should understand our own phenotypes, or strengths weaknesses, and prioritize those interventions that match our individual makeup.
I ordered rapamycin, had it here, but never started taking it. The more I read and thought about it the more I came to feel (with great reluctance) that rapamycin is not a good match for my phenotype: petite, ectomorphic, more worried about frailty and sarcopenia based on myself, my test results, (eg quite low insulin) my family history (long lived, frail women who eventually succumb to neurodegeneration). I do take metformin for glucose reduction with potential cancer prevention as a bonus. But I also take a little leucine, as I do not eat red meat nor sufficient protein, and do need to instigate muscle synthesis, especially since taking metformin. (Perhaps it goes without saying: exercise is a key priority).
There is so much encouraging research on rapamycin, and I am bummed that it does not seem to be the right intervention for me. Welcome thoughts on this.
“Eveyone needs better mitochondria.” So true. So will just need to push the levers that we all know about: exercise, diet, sleep, hot tub (with hot/cold hormesis), some time restricted eating.