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Physical biomarkers

The body, measured like blood.

Eleven tests across capacity, strength, composition and movement, re-run every quarter.

tests, four domains
11tests, four domains
the best-evidenced physical predictor
VO₂the best-evidenced physical predictor
re-measured rather than once
Quarterlyre-measured rather than once
The protocol

Eleven tests, across four domains.

Count them against whatever your last physical assessment covered. Each one is here because it predicts something about the next twenty years, and each is re-run every quarter.

A member running on a laboratory treadmill in a metabolic gas-exchange mask while a physiologist watches the analyser
01

Cardiorespiratory capacity

  • VO₂ max

    Graded exercise test to volitional exhaustion, gas exchange

    Cardiorespiratory fitness is among the best-evidenced predictors of all-cause mortality. Pooled across 33 studies of healthy adults, low fitness carried a relative risk of 1.70 against high fitness, and the gradient held across the whole measured range.[1][2]

  • Ventilatory thresholds

    The two breakpoints inside the same test

    Where your aerobic base ends and where you tip into unsustainable work, the two numbers that decide how your training week is actually written.

  • Heart rate recovery

    Fall in heart rate in the first minute after peak

    Autonomic function. A fall of 12 beats per minute or less in the first minute predicted death at twice the rate, after adjusting for the workload reached, so it is not simply restating your fitness.[3]

A hand squeezing a steel dynamometer at full effort, tendons raised across the back of the hand
02

Strength and power

  • Grip strength

    Hand dynamometry, both sides

    A proxy for whole-body strength. Pooled across roughly two million adults, higher grip strength carried a hazard ratio of 0.69 for death from any cause. It is also one of the few tests where the left-right difference is itself informative.[4]

  • Sit-to-stand

    Five-repetition and thirty-second protocols

    Lower-limb power, and the practical ability to get off a chair unaided. It is scored against your own previous result rather than a published cut-off.

  • Gait speed

    Timed walk over a fixed distance

    Sometimes called the sixth vital sign. Pooled across nine cohorts of older adults, survival rose with gait speed across the full range, at a hazard ratio of 0.88 for every 0.1 m/s.[5][6]

A hand gripping the steel electrode of a body-composition analyser, its coiled cable running back to the instrument
03

Composition and structure

  • Body composition

    Segmental bioelectrical impedance

    Lean mass, fat mass and where each sits. Two people at the same weight can have very different amounts of each, which a scale cannot show you.

  • Anthropometry

    Circumferences, skinfolds, segment lengths

    Distribution rather than total: visceral pattern, limb asymmetry, and the measurements a scan alone will not give you.

A physiotherapist assessing an overhead squat, with movement markers taped at the shoulder, hip and knee
04

Movement and control

  • Posture assessment

    Static and loaded, photographed and scored

    How you stand and load under your own weight, recorded so a change over the years is visible rather than remembered.

  • Muscle imbalance

    Left-right and agonist-antagonist comparison

    Where force is not shared evenly between sides or between opposing muscle groups. It stays invisible until both sides are measured.

  • Movement screen

    Loaded and unloaded patterns, range and control

    Whether you can get into the positions your training asks for. The programme is written from what this finds.

One functional score, and what it is not

The eleven results combine into a single functional longevity score across four domains, tracked every quarter so the direction is visible rather than remembered. It is a composite we build from tests that individually carry published predictive evidence: cardiorespiratory fitness, grip strength and gait speed each associate with all-cause mortality in large pooled analyses. The composite itself is ours. It is not a validated published instrument, and we will always say which of the two you are looking at.[1][4][6]

No normative targets are published here on purpose. A grip figure or a VO₂ number means nothing without your age, your sex and your own previous result, and a page that prints one is handing out medical advice to somebody it has never assessed.

About the tests.

Preparation, timing, and which ones you actually need.

References

  1. 1.Kodama, S., et al. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. PMID:19454641
  2. 2.Mandsager, K., et al. (2018). Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open. PMID:30646252
  3. 3.Cole, C. R., et al. (1999). Heart-rate recovery immediately after exercise as a predictor of mortality. New England Journal of Medicine. PMID:10536127
  4. 4.García-Hermoso, A., et al. (2018). Muscular strength as a predictor of all-cause mortality in an apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women. Archives of Physical Medicine and Rehabilitation. PMID:29425700
  5. 5.Fritz, S., & Lusardi, M. (2009). White paper: "walking speed: the sixth vital sign". Journal of Geriatric Physical Therapy. PMID:20039582
  6. 6.Studenski, S., et al. (2011). Gait speed and survival in older adults. JAMA. PMID:21205966
Start with the baseline

The method only works from a measurement.

Everything above starts at the same place: one visit that maps where you actually are. What follows is decided by what that visit finds.

See the full protocol

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