Non-pharmacological interventions for lower limb rehabilitation after stroke: a systematic review and network meta-analysis

 With no provided protocols this was COMPLETELY FUCKING USELESS WORK!

I've never been able to figure out mirror therapy for legs, when a protocol could solve that issue! Alas, NO PROTOCOL!

Non-pharmacological interventions for lower limb rehabilitation after stroke: a systematic review and network meta-analysis

• Yueting Tan,
• Zhangcheng Feng,
• Jiaqi Peng,
• Kun He,
• Benyuan Cheng &
• Xiaobing Xie 

We’re sharing this article early to provide faster access to peer-reviewed, accepted research. It is citable and carries a permanent DOI. This version is subject to further edits and will be replaced automatically by the final Version of Record. All legal disclaimers apply.

Abstract

Objective

Stroke is a leading cause of long-term adult disability, and lower limb dysfunction substantially limits functional independence. This study aimed to systematically compare the effects of different non-pharmacological rehabilitation interventions on lower limb recovery after stroke using a network meta-analysis.

Methods

This systematic review was conducted in accordance with PRISMA guidelines. Randomized controlled trials evaluating non-pharmacological interventions for post-stroke lower limb rehabilitation were identified from MEDLINE, Embase, Web of Science, and PubMed. Outcomes included balance assessed by the Berg balance scale (BBS), motor function assessed by the Fugl-Meyer assessment (FMA), and gait speed assessed by the 10-meter walk test (10MWT). A random-effects network meta-analysis was performed using R software. Evidence certainty was evaluated using the CINeMA approach based on the GRADE framework.

Results

38 randomized controlled trials involving 1,932 participants were included. Compared with conventional rehabilitation, mirror therapy (MT) yielded the greatest improvement(NOT RECOVERY!) in balance (Berg Balance Scale, MD = 5.296, 95% CI 2.104–8.488); functional electrical stimulation (FES) achieved the optimal improvement(NOT RECOVERY!)in gait speed (10-meter walk test, MD = 0.118, 95% CI 0.056–0.180); and robot-assisted gait training (RAGT) showed the most significant benefit(NOT RECOVERY!)in overall lower limb motor function (Fugl-Meyer Assessment lower extremity subscale, MD = 4.608, 95% CI 0.922–8.294). Ranking probability analyses indicated that MT, FES, and RAGT had the highest likelihood of being the top-performing interventions for their respective outcome domains. The certainty of evidence ranged from very low to moderate per the CINeMA framework.

Since you're not measuring 100% recovery; you'll never get there! Survivors' only goal is 100% recovery and you blithering idiots are ignoring that!

“What's measured, improves.” So said management legend and author Peter F. Drucker !   

If you can't measure it you can't improve it and make it repeatable!

Conclusions

Non-pharmacological rehabilitation interventions exhibit domain-specific efficacy for post-stroke lower limb recovery: MT presents the optimal benefit for balance, FES for gait speed, and RAGT for global lower limb motor function. However, these findings should be interpreted with caution due to the overall low-to-moderate certainty of evidence. High-quality, adequately powered randomized controlled trials with standardized outcome assessment and long-term follow-up are warranted to validate these findings and clarify the long-term clinical effectiveness of these interventions.

My conclusion is that everything here is a failure, but you refuse to acknowledge that failure!

These 6 standing exercises restore balance after 60

 

If you can't do ALL of these immediately upon leaving the hospital, your doctor IS A FAILURE! The proper response would be to show them the door.

Pictures at link.

These 6 standing exercises restore balance after 60

Balance becomes one of the most important fitness qualities after 60. Strong balance helps prevent falls, improves confidence during movement, and supports independence during everyday activities. Walking across uneven ground, climbing stairs, reaching for objects, and changing direction all require the body to coordinate muscles, joints, vision, and core stability simultaneously. When balance declines, even simple daily tasks start feeling more challenging and less secure.

Many adults turn to yoga to improve stability, and while yoga offers benefits, some poses demand flexibility and floor mobility that can be difficult for older adults. Standing exercises often provide a more direct and practical approach because they train balance in positions that closely resemble real-life movement. These exercises strengthen the hips, core, ankles, and stabilizing muscles responsible for keeping the body upright and controlled throughout the day.

The six exercises below challenge balance from multiple angles while improving coordination, posture, and lower-body strength. Each movement trains stability in a way that carries directly into everyday life. Perform them consistently and you'll build stronger balance, better body control, and greater confidence during movement.

1. Single-Leg Stands

I've failed the one leg standing test of the Berg Balance Scale from the beginning, 20 years of failure so far and will never get better. My therapists DID NOTHING to get my one leg balance fixed!

Few exercises test and improve balance as effectively as standing on one leg. The movement forces the ankles, knees, hips, and core to work together continuously to maintain stability. Many adults over 60 discover that one side feels noticeably weaker than the other, highlighting imbalances that often go unnoticed during normal activity. This exercise strengthens the stabilizing muscles responsible for preventing falls while improving body awareness. The longer you maintain control without excessive wobbling, the stronger your balance foundation becomes. Consistent practice often leads to noticeable improvements in walking confidence and lower-body stability.

How to Do It

• Stand tall near a wall or chair
• Shift your weight onto one foot
• Lift the opposite foot slightly off the floor
• Keep your chest upright
• Focus on a fixed point ahead
• Maintain steady breathing
• Hold for 20 to 30 seconds
• Repeat on both sides.

RELATED: 4 Wall Exercises That Build Glute Strength Faster Than Squats After 60

2. Standing Marches

(Lack of hamstring ability and I can't get the left leg to hip height(unless I'm in a pool), failure of my doctor and therapists to notice and address that!.) 

Standing marches strengthen the hips, thighs, and core while improving dynamic balance. Every time one foot leaves the ground, the supporting leg must stabilize the entire body. Many adults lose this ability gradually because daily movement rarely challenges balance in a controlled way. The marching motion restores single-leg stability while reinforcing proper walking mechanics. It also improves coordination between the upper and lower body, creating smoother movement patterns. Performed regularly, standing marches help make everyday walking feel stronger and more controlled.

How to Do It

• Stand tall with feet hip-width apart
• Tighten your core gently
• Lift one knee toward hip height
• Lower slowly with control
• Alternate sides continuously
• Keep your chest lifted
• Avoid leaning backward
• Perform 20 total marches.

3. Heel-to-Toe Walks

(Partially doable, my doctor and therapists NEVER ADDRESSED my 

15 degree left angle of my left foot)

Heel-to-toe walks challenge balance by narrowing the base of support. This exercise forces the body to stay aligned while moving forward in a controlled manner. Many adults find it surprisingly difficult because it exposes weaknesses in core stability, hip strength, and coordination. The movement closely resembles the balance demands encountered during daily walking, making it highly functional. Practicing heel-to-toe walking improves body awareness and helps develop smoother, more confident movement patterns.

How to Do It

• Stand tall
• Place one foot directly in front of the other
• Touch heel to toe with each step
• Walk slowly and deliberately
• Keep your eyes forward
• Tighten your core gently
• Continue for 10 to 15 steps
• Turn around and repeat.

RELATED: 5 Bed Exercises That Firm Waist Thickening Faster Than Weight Training After 55

4. Side Leg Raises

(Doable but not very high. This one will be done since my gluteus medius 

complains at times and needs to be strengthened.)

Strong hip muscles play a major role in balance. Side leg raises target the glute medius, a key stabilizer that helps keep the pelvis level during walking and standing. Weakness in this muscle often contributes to instability and reduced confidence during movement. This exercise strengthens the outer hips while challenging balance on the supporting leg. Adults over 60 frequently notice improved walking mechanics and better lower-body control after adding side leg raises to their routines.

How to Do It

• Stand beside a chair or wall
• Hold lightly for support if needed
• Shift your weight onto one leg
• Lift the opposite leg outward
• Keep your torso upright
• Lower slowly with control
• Perform 10 to 12 repetitions
• Repeat on the opposite side

5. Clock Reaches

(Failure. I've failed the one leg standing test of the Berg Balance Scale from the 

beginning, now 20 years later(age 70) I still fail and will until the day I die.)

Clock reaches challenge balance through multiple directions while strengthening the hips and core. Unlike simple standing exercises, this movement requires the body to maintain stability while reaching outside its normal base of support. Many adults immediately notice weaknesses because the exercise combines balance, coordination, and mobility in a single movement. The reaching pattern closely resembles many daily activities that require bending and reaching safely. Strong performance demonstrates excellent lower-body control and balance awareness.

How to Do It

• Stand on one leg
• Imagine a clock surrounding you
• Reach the free foot toward 12 o'clock
• Return to center
• Reach toward 3 o'clock
• Return to center
• Continue around the clock pattern
• Repeat on both sides.

RELATED: If You Can Walk This Many Steps in 60 Seconds After 60, You're in Great Shape

6. Standing Knee-to-Elbow Crunches

I've failed the one leg standing test of the Berg Balance Scale from the beginning, 20 years of failure so far and will never get better. My therapists DID NOTHING to get my one leg balance fixed!

This exercise strengthens the core while challenging balance and coordination simultaneously. Many adults focus only on leg strength when trying to improve stability, but strong abdominal muscles play a major role in maintaining balance during movement. The crossing motion forces the body to stabilize while rotating, creating a greater challenge than simple standing exercises. It also improves coordination between the upper and lower body, helping everyday movements feel smoother and more controlled. Consistent practice builds balance, core strength, and body awareness at the same time.

How to Do It

• Stand tall with feet shoulder-width apart
• Place your hands behind your head
• Lift one knee upward
• Rotate the opposite elbow toward the knee
• Squeeze your core muscles
• Return slowly to the starting position
• Alternate sides continuously
• Perform 20 total repetitions.

Read the original article on Eat This Not That.

If you can complete these 3 standing exercises after 60, your functional fitness is stronger than 90% of peers

 

I think I'm good on these at age 70.

If you can complete these 3 standing exercises after 60, your functional fitness is stronger than 90% of peers

Fitness after 60 isn't measured by how much weight you can lift or how many miles you can run. Instead, it shows up in the movements you perform every day without thinking twice. Standing from a chair, balancing on one leg, reaching overhead, and walking confidently all depend on strength, stability, and coordination working together. As a trainer, I've found that a few simple standing exercises reveal far more about someone's overall fitness than most gym workouts.

Many adults judge themselves against unrealistic standards or compare their abilities to people decades younger. I prefer using functional movements because they measure the qualities that matter most for healthy aging. These exercises challenge your legs, core, balance, and cardiovascular fitness simultaneously while closely resembling everyday activities. If you perform them with good control, you're likely in better shape than you realize.

I've used these assessments with hundreds of adults over 60, and they consistently separate those who simply exercise from those who move exceptionally well. Don't worry about perfection or speed. Focus on maintaining good form from beginning to end. Your results will tell you a great deal about your current level of functional fitness.

RELATED: 5 Standing Exercises That Restore Hip Strength This Week, No Gym Needed After 60

Exercise 1: Sit-to-Stand Test

I can do this from a standard kitchen chair, couches and Adirondack chairs, not!

The sit-to-stand remains one of my favorite indicators of lower-body strength because it mirrors one of the most common movements you'll perform every day. Strong quadriceps, glutes, hamstrings, and core muscles all contribute to completing this exercise with control. Clients who perform it easily usually walk farther, climb stairs more comfortably, and maintain greater independence as they age. The challenge isn't simply standing up. It's doing so repeatedly without using momentum or your hands.

How to Perform It

• Sit near the front of a sturdy chair.
• Cross your arms over your chest.
• Stand completely.
• Sit back down under control.
• Repeat continuously for 30 seconds.
• Count your completed repetitions.

Benchmark: Completing 12 to 17 controlled repetitions without using your hands indicates excellent lower-body strength for most adults over 60.

RELATED: 4 Standing Exercises That Flatten Apron Belly Faster Than Gym Sessions After 60

Exercise 2: Single-Leg Balance Hold

I've failed the one leg standing test of the Berg Balance Scale from the beginning, 20 years of failure so far and will never get better. My therapists DID NOTHING to get my one leg balance fixed!

Balance often becomes the first physical quality to decline with age, making this one of the most valuable assessments I use. Standing on one leg requires the ankles, hips, core, and nervous system to communicate continuously while making tiny adjustments. Clients who hold this position comfortably usually demonstrate excellent coordination and lower-body stability. Strong balance also reduces fall risk while improving confidence during everyday movement.

How to Perform It

• Stand next to a chair for safety.
• Shift your weight onto one leg.
• Lift the opposite foot slightly.
• Keep your eyes focused ahead.
• Avoid grabbing the chair unless necessary.
• Time your longest hold.

Benchmark: Holding the position for 30 seconds or longer on each leg reflects top-tier stability for most adults over 60.

RELATED: The 10-Minute Chair Routine That Restores Leg Strength Faster Than Gym Sessions After 60

Exercise 3: Standing March Endurance

Impossible to lift the left knee to hip height unless in a pool. It has nothing to do with my endurance or balance. 

 Walking depends on far more than simply putting one foot in front of the other. Strong hip flexors, stable core muscles, good balance, and cardiovascular endurance all contribute to maintaining a smooth, confident stride. The standing march combines each of these qualities into one practical assessment. I often use it because it closely reflects the stamina needed for shopping, traveling, hiking, and enjoying an active lifestyle.

How to Perform It

• Stand tall.
• Lift one knee to hip height.
• Lower with control.
• Alternate legs continuously.
• Maintain an upright posture.
• Continue for one minute.

Benchmark: Completing the full 60 seconds without losing posture, shortening your stride, or needing extra support places you above average for functional endurance after 60.

Read the original article on Eat This Not That.

These 2 Fitness Tests Take Less Than a Minute and Can Reveal How Well You're Aging

 Did your competent? medical staff get you recovered enough to pass these? 

NO? SO INCOMPETENCE EVERYWHERE!

These 2 Fitness Tests Take Less Than a Minute and Can Reveal How Well You're Aging

What if a few simple movements could offer a glimpse into how well you're aging? It turns out standing on one leg or getting up from a chair and walking a few feet may tell you more than you'd expect.

We already know that regular physical activity is one of the foundations of healthy aging. But fitness is about more than your exercise frequency or how many miles you walk. Your ability to balance, move quickly, get up from a chair, and keep your body in motion may also offer important clues about your physical health as you age.

A new study published in JAMA Network Open adds to that evidence, finding that several measures of physical fitness were associated with lower risk of death in older adults.

As a dietitian and personal trainer, I find this particularly interesting. I've also worked in a hospital, where I saw firsthand just how devastating a bad fall can be. It can lead to a fracture, hospitalization, loss of mobility and, in some cases, a major loss of independence.

But the encouraging part is that physical fitness isn't a fixed trait, and it's never too late to start working on it.

What the study found

Researchers looked at 13,423 adults ages 65 and older in Taiwan who completed standardized fitness assessments between 2015 and 2016. They then linked those results to health records and followed participants for a median of seven years.

The researchers assessed fitness across four areas: cardiorespiratory fitness, muscular strength, flexibility, and balance and agility. Overall, higher levels of objectively measured fitness were associated with progressively lower all-cause mortality. The strongest associations were seen with balance and agility, followed by lower-body strength and cardiorespiratory fitness.

Compared with people in the lowest-performing group, those in the highest-performing group had:

• 59% lower mortality risk on the 8-foot up-and-go test

• 50% lower mortality risk on the 1-leg stance

• 45% lower mortality risk on the 30-second chair stand

• 42% lower mortality risk on the 2-minute step test

The researchers also created a composite fitness score incorporating all seven assessments. The highest-performing group had a 61% lower risk of death compared with the lowest-performing group.

It's important to note this was an observational study, and fitness was only measured at one point in time. But the findings offer an interesting way to think about healthy aging not simply in terms of how much exercise you do, but what your body is actually capable of doing.

The fitness tests that stood out

Two of the tests in the study are especially interesting because they're simple movements you can easily picture yourself doing: getting up and walking a short distance, and standing on one leg. Here's what each test involves, what it measures, and why these everyday abilities matter as we age.

The 8-Foot Up-and-Go

• How to do it: Start seated in a sturdy chair. When ready, stand up, walk eight feet, turn around, walk back and sit down. The study measured how quickly participants could complete the movement.

• What it shows: This isn't just about walking speed. It challenges balance, agility, coordination, lower-body strength, and functional mobility (the ability to get up, move, turn and sit down with control). Those are skills we use all day without really thinking about them.

I could easily do this while still in the hospital. 

The 1-Leg Stance

• How to do it: Stand near a sturdy surface for support if needed. Lift one foot off the floor and see how long you can maintain your balance. In the study, participants had up to 30 seconds and two attempts.

• What it shows: The test gives you a simple look at balance and neuromuscular control, your ability to keep your body stable while standing on one leg. Balance becomes particularly important as we age.

On my good leg I can do this, my bad leg not even close. Since I haven't been able to do this since my stroke at age 50 I guess I should have died sometime in the ensuing 20 years. I thought the Berg Balance Scale testing  that was common, was totally worthless since there never was any specific therapy given to address the failure points I had in that test. 

However, these aren't the only pieces of the puzzle. Lower-body strength and cardiorespiratory fitness matter, too. The chair-stand and two-minute step tests in the study speak to those abilities, and they reinforce that healthy aging isn't about being good at one thing but rather keeping your body strong, agile, and capable.

What these findings mean for you

The takeaway isn't to choose balance over strength or cardio. These abilities work together. You want enough cardiovascular fitness to sustain activity, enough strength to move and support your body, and enough balance and agility to stay steady and react when your environment changes. Regular cardio still matters, but so does resistance training, balance work, and maintaining mobility.

The good news is you don't have to wait until you're older to start, or assume it's too late if you haven't focused on fitness before. It's never too late to improve your physical fitness. The goal isn't to just pass a longevity test; it's to keep building the strength, stability, endurance, and confidence you need to stay active and independent for as long as possible.

Seven lifestyle changes that are more effective than longevity treatments

 With all this research on longevity, healthspan and lifespan; SHOULDN'T YOUR COMPETENT? DOCTOR ALREADY HAVE PROTOCOLS PREPARED? NO? So, PURE INCOMPETENCE! 

And your board of directors is so incompetent they don't recognize incompetence in their hospital! YOU better start running that hospital!

• longevity (129 posts to October 2013)
• longevity diet (19 posts to July 2021)
• longevity exercises (6 posts to November 2020)
• healthspan (31 posts to December 2024)
• lifespan (17 posts to September 2016)
• lifestyle interventions (3 posts to August 2017)

Seven lifestyle changes that are more effective than longevity treatments

Dr Clare Nieland, 51, is a general practitioner with more than 20 years of experience working in the NHS and private sector at Hooke Clinic in London and the Windsor Wellness Clinic. She believes strongly in the power of nutrition and healthy lifestyle choices for achieving optimum wellbeing.

Longevity is a real buzzword nowadays. It is particularly rife on social media, where numerous brands and influencers claim they hold the secret to living past 100.

Whilst it is great that many of us are striving to live longer, the obsession with longevity misses a crucial point – we need to ensure those extra years are spent in good health. I help my patients improve their “healthspans”, to keep them independent, mobile and mentally sharp for as long as possible.

There is no use in buying “anti-ageing” supplements or spending thousands of pounds on therapies that claim to reverse biological ageing if you are not mastering the basics of a healthy lifestyle – nutrition, physical activity, sleep and stress management. You cannot out-run a bad diet or cure chronic stress with a single supplement.

In my NHS and private practices, I apply a combination of conventional and lifestyle medicine as both methods are important. Conventional medicine trains doctors to treat the disease, whilst the world of lifestyle medicine is markedly different – we are taught the fundamentals of good health and how to prevent issues from occurring in the first place.

A larger focus on preventative medicine is in the NHS 10-year-plan, and I would love to see this become a reality. When I trained as a doctor, we were not taught about the power of nutrition or physical activity in creating good health and preventing disease. Nowadays, though, it is encouraging to see some medical schools introducing lifestyle medicine into the curriculum. Hopefully this momentum continues.

Related video: Research reveals the habits scientifically proven to add a decade to your lifespan (Talking With Docs)

AtHooke Clinic, we offer extensive health testing and strive to prevent lifestyle-related diseases such as type 2 diabetes, fatty liver disease and obesity. Our tests investigate over 120 biomarkers, and include nutritional and physical assessments, a three-part MRI scan and investigating electrical activity in the brain. Our patients are empowered with a panel of results, goals and experts to help them make informed choices about their health.

However, it goes without saying that not everyone can afford such testing. Luckily, there are all sorts of habits you can adopt in your daily life to improve your healthspan. As a proponent of the lifestyle-first approach, I try my best to practise what I preach – these are my top tips for ageing well.

1. Cook from scratch with your friends and family

I live in Windsor with my husband Nick, a former Olympian, our three rugby-obsessed teenage boys, and our gorgeous black labrador Bella. Life is always busy, and certainly never boring, so I try my best to optimise the fundamentals of eating well, getting enough sleep, regularly moving, and connecting with others.

strong relationships as we age. In fact, a wealth of research links social isolation to a heightened risk of disease and early death.

It is important to me that my boys can cook, are self-sufficient and feel comfortable in the kitchen. Sadly, I think we are failing the future generation with our over-reliance on ultra-processed foods (UPFs) at the expense of cooking with fresh, healthy ingredients. We know that UPFs are incredibly bad for us, with a range of studies linking them to adverse health outcomes including obesity, type 2 diabetes and cardiovascular diseases.

(Not for me, cooking one-handed is just waiting for me to cut myself, I buy meal kits from Home Chef.)

2. Keep your cupboards stocked with beans and brown rice

I inherited good genes, but there is a mild family history of pre-diabetes and cardiovascular disease, so I try to stick to the Mediterranean diet pattern, as it is consistently linked with a reduced risk of chronic disease.

My cupboards are always stocked with lentils, tinned tomatoes, beans, chickpeas and brown rice, as well as onions and garlic, plus a full spice rack. These are great (and cheap) staple ingredients and have a range of powerful health benefits.

Research suggests that swapping white rice for brown rice improves blood sugar levels and can help with weight control. Meanwhile, lentils are a rich source of protein, fibre, essential amino acids and minerals. Plus, they are packed with polyphenols – anti-inflammatory and antioxidant compounds – which help to prevent chronic diseases like diabetes and obesity.

Each week, I stock my fridge with fresh meat from the local farm shop. As I live with four active men, I try to ensure our meals are high in quality protein, which is important for muscle growth, bone density and satiety. I love batch-cooking a rich and meaty ragu at the weekend, which keeps us going for a few days. Planning and batch-cooking for the week ahead, incorporating cheap cupboard staples with fresh sources of protein and vegetables – instead of stocking up on ready meals – is a great way to cut back on UPFs.

3. Practise balancing while brushing your teeth

As our balance naturally declines with age, our risk of falling increases, which also increases fracture risk. However, there are simple measures we can take to improve it. At my NHS practice, I work closely with a health coach who advises patients to incorporate balancing into their daily routine – whether that is standing on one leg while brushing your teeth or squatting as you wait for the kettle to boil. At Hooke, we measure your balance as a baseline and it is a trainable skill.

Improved balance means you are less susceptible to falls and hip fractures – both of which are linked to an increased risk of early mortality in older adults. It will also result in better co-ordination, increased stability and stronger muscles. Even if you do fall, the extra padding from your muscles and improved bone strength means you are less likely to have a fracture.

One study published in the British Journal of Sports Medicine found that people in middle to later life who could not stand on one leg for 10 seconds had almost double the risk of premature death.

On my good leg I can do this, my bad leg not even close. Since I haven't been able to do this since my stroke at age 50 I guess I should have died sometime in the ensuing 20 years. I thought the Berg Balance Scale testing  that was common, was totally worthless since there never was any specific therapy given to address the failure points I had in that test. So 20 years of failure already and my next 30 years will be no better, totally useless for me!

Balance is therefore a powerful predictor of ageing and longevity, as is grip strength. If your muscles are strong, so is your grip. One influential study, published in 2015, followed more than 140,000 adults across 17 countries and found that grip strength predicted mortality and cardiovascular events more strongly than systolic blood pressure.

You can test your grip strength simply by squeezing a foam ball in your hand. Squeeze it for as long as you can before your grip fatigues and continue to practise this regularly, whilst improving your overall body strength with resistance exercises. Over time, you should be able to grip the ball for a longer period, suggesting your muscles have strengthened.

My doctor and therapists COMPLETELY FAILED AT RECOVERING MY LEFT HAND! So this really has no basis for me, but my right hand is stronger than ever. 

4. Prioritise morning sunlight

I try to get outside for a walk with Bella within an hour of waking, even if it is just for 10 minutes. Morning sunlight improves sleep quality by stimulating the release of melatonin, the sleep hormone. It also supports long-term cardiometabolic health, by helping to regulate our circadian rhythm and promoting vitamin D synthesis.

the sunlight is a simple habit to reduce stress, with a wealth of research suggesting that it helps to reduce levels of cortisol, the stress hormone.

Not everyone can get outside first thing – plus, you might not want to during the dreary winter months. A good alternative is to buy a seasonal affective disorder (SAD) lamp, as they emit bright light that mimics natural sunlight, and can improve alertness, mood and sleep-wake timing. It may even reduce symptoms of SAD, but it is important to note that you don’t produce vitamin D this way.

Even having a brisk lunchtime walk helps, although be aware that the later you get outside, the later your brain will signal that it is time to sleep in the evening.

5. Give creatine a try – and have your vitamin D levels tested

In an ideal world, you would have a bespoke supplement created for you that addresses your various needs and deficiencies. Some people can afford such a luxury, that is not the reality for many. Whilst I am against wasting money on pills and potions that have no significant evidence base, I believe creatine and vitamin D are worth taking.

Creatine is one of the most extensively studied supplements. It is proven to boost strength and power in resistance training, while a meta-analysis by Oxford University found that creatine supplementation enhanced measures of memory performance in healthy individuals, especially in those aged 66-76.

The standard dose of creatine is 3-5g per day, although emerging evidence suggests 10-15g may be better to reap the cognitive benefits. This is safe for most healthy adults, but I would advise sticking to the 3-5g dose for now, as research continues to develop. When buying creatine, make sure it is pure, with nothing added (I use Bulk Powders “Pure Creatine”, which is very affordable).

The NHS recommends that everyone take a daily vitamin D tablet in the winter months, with recent data suggesting that almost half of UK adults have lower than “optimal” levels. The standard guidance is 400 international units (or 10 micrograms) of vitamin D per day, but in reality we need so much more.

I advise my patients to have their vitamin D levels tested on the NHS or privately, and then to start taking a daily supplement containing 2,000-3,000 international units, or a tailored amount according to results. Yes, that is a much higher dosage, but vitamin D is crucial for the immune system, bone health, muscle function and brain.

6. Get creative with resistance training

I lift heavy weights three times a week and take pride in having muscles – they are a longevity organ. Just two to three short resistance sessions a week can reduce frailty, insulin resistance and cognitive decline more than cardio alone.

Lots of women worry that strength training will make them bulky, but it simply won’t happen because there is not enough testosterone floating around in our bloodstreams. After 40, we start to experience muscle loss (sarcopenia), which means we actively need to build or maintain muscle mass. The same is true for bone density – as our hormones start to decline, our bones weaken and we are more likely to develop osteopenia or osteoporosis. This can lead to bone fractures, even from minor falls or strains.

Strength training can help you to avoid these fates. Whilst joining a gym is a great way to meet new people and strengthen social connections, you can also get creative at home. Start small – whether that is raising tins of beans above your head or practising chair squats. It is never too late to start!

7. Experiment with hot and cold therapy

There are plenty of fads and quick fixes in the world of biohacking (the process of implementing scientifically-backed lifestyle interventions to optimise health) that lack solid evidence and are not worth your money. I would urge you to master the basics before trying anything which claims to be the key to longevity – there is no use spending hundreds of pounds on cryotherapy, which uses extreme cold to enhance recovery and reduce inflammation, if you spend your weekends binge drinking alcohol and don’t exercise.

However, I would recommend hot and cold therapy. If you have access to a gym or spa, this involves alternating between a sauna and ice bath; or you could simply start with a cold shower.(I just bought a personal sauna, will use the cold shower instead of an ice bath. Not sure I could get out of an ice bath with only one useable arm/hand)

The alternate temperatures help to boost circulation by causing blood vessels to rapidly expand and restrict, creating a “vascular pump” that improves blood flow, oxygen delivery and nutrient transport. It also creates hormesis – the “good” type of stress, which helps your body to adapt and strengthen.

Evidence suggests that regular sauna use could reduce dementia risk and, now, there are lots of affordable options for in-home saunas. You don’t need to spend a fortune on a fancy spa membership!

Yeah, your FUCKINGLY INCOMPETENT? DOCTOR hasn't told you about heat and cold shock proteins, right?

• cold shock proteins (10 posts to October 2023)
• heat shock proteins (11 posts to April 2013)

As told to Ella Nunn. You can find Dr Clare on Instagram @windsorwellnessdoctor

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