Q&A with Dr. Gladden: How Good Can We Be? Rethinking Human Performance After 50

Most people expect physical performance to decline with age. They accept slower recovery, lower energy, reduced strength, and the idea that getting older naturally means doing less.

In the second installment of our three-part monthly Q&A series, Dr. Jeffrey Gladden, a triple-board-certified cardiologist, longevity expert, and founder of Gladden Longevity, challenges that assumption. He explains why people can remain capable, resilient, and highly functional well beyond 50, and how mindset, daily habits, and the right approach to health all shape how well you perform as you age.

Q: When You Meet Someone in Their 50s or Beyond, What Tells You They're Capable of More Than They Realize?

Dr. Gladden: The fact that they're breathing. I really think that if someone is still with us on the planet, apart from some very dire situations where they are truly at the end of life or have a disorder bringing them very close to it, most people have the ability to improve.

A lot of it has to do with their mindset around what it takes to improve. Many people have very positive attitudes but simply don't have the knowledge of how to go about it. It can be very discouraging when they don't see improvement.

Nonetheless, when I meet someone who can walk through the door, I'm confident that there's a lot of room for improvement.

Q: What Misconceptions Prevent People From Performing at Their Highest Level After 50?

Dr. Gladden: I think there are two sides to this coin. One is the perception side, and one is what we might call the actual side.

What I’ve discovered is that form follows thought. We often say form follows function when talking about design, such as the way a house or car is built. But here, I think both form and function follow thought.

A lot of people come in focused on either their level of function or the shape they’re in, and they want to work on that. That is critical. If people can envision who they want to become and hold that image clearly in their minds, the power of that is almost unbelievable.

You’ve heard me say that I wake up 27 every day, even though I was born in 1954. The power of that is remarkable. I can even play with it while I’m exercising. This morning, I was on the elliptical, and I imagined myself at my chronological age. I felt a certain way. Then I reminded myself, “No, you’re 27.” Suddenly, it was, “Okay, let’s go faster. Let’s take off.”

It’s much more of a mental thing than people realize. The mind powers the body. It isn’t the body powering the body. I think that becomes really critical.

When people come in after suffering an injury, feeling physically worn down, struggling with their weight, blood sugar, brain health, or something else, we first ask them to paint a picture of who they want to be. We often connect that picture to claiming an age.

In my case, I claim 27. Other people might claim 42, 35, 18, or 50. All of those ages came up this week. It doesn’t matter which age someone chooses. It simply needs to be an age when they felt physically great. That becomes the starting point.

Once they have that picture, everything else can begin to come along. Otherwise, people sit back and say, “I’m 75,” “I’m 82,” “I’m 63,” or “I’m 59,” and they lock into that mindset along with all the social programming around it. They start thinking, “I’m older. I shouldn’t be doing this. I’ve had an injury. My knees hurt. I’m not going to run another marathon.” The point is that people will never get out of a hole they can’t see themselves getting out of.

Q: How Does Performance Differ From Health, and Why Do Both Matter?

Dr. Gladden: I think most people view health as something they want because it represents the absence of disease. It’s the idea that, “I’m not sick, so I’m healthy.” The medical profession has reinforced that. If you’re not sick, then you’re healthy, and wellness becomes a matter of keeping you healthy.

Performance, on the other hand, is health in action. It’s taking that health and utilizing those capabilities to train yourself to perform at a higher level, whether cognitively or physically. It could be golf, tennis, pickleball, running, biking, swimming, surfing, or anything else. It could even be playing the piano. The idea of performance is to take your health and leverage it into higher levels of performance in whatever you’re doing.

Performance has an element of expansion and excellence attached to it. If somebody is performing well, they played the song well, scored the goal, or whatever it is, that’s great performance.

You generally need health to support performance, although people can still perform when they’re less than perfectly healthy. The two also play off each other. If all you’re aiming for is health, you may be satisfied with simply being healthy. But to build true resilience and robustness, you need more than that. Robustness is the ability to withstand an unexpected challenge and experience minimal impact, while resilience is the ability to experience that impact and recover from it.

When you work on performance, you build greater resilience and robustness. In that sense, performance begins to transcend health itself. It takes health to another level.

That matters because resilience in biological organisms like us gets cut in half about every eight years. That’s an exponential decline. To fight back against it, having a target for health is important. But when you add a target for performance, you begin building a more exponential response to an exponential problem.

That’s why we place such a strong emphasis on performance. It’s one of the five key circles we focus on.

Q: Why Is Energy Often the First Thing People Lose as They Age?

Dr. Gladden: It has to do with the aging process itself. Many things contribute to that process. There are 12 underlying biological processes called the hallmarks of aging, and when people start to decline, it is typically because there has been movement in those 12.

They all play together. When one goes bad, it can drag down a couple of others, which then drag down a few more. That can circle back and pull the first one down even further. When you do not feel well, this is often the level we need to look at, but it is rarely examined. When we do look at it, we often find solutions.

The other level is health. Organ systems decline, and hormones start to drop off. Women go through menopause, and men go through andropause. Thyroid function can start to decline. Toxins can accumulate in the body, and detoxification pathways may not work as well.

Accumulated stress on the system can almost rust it from the inside out through oxidative stress. Then inflammation kicks in and continues to accelerate that slow burn of decline. Inflammation does its damage through oxidative stress.

There is a multifaceted set of reasons, and they may be prioritized differently in each person. For one person, thyroid function may be the main issue. For another, it may be hormones. For someone else, it could be detoxification, gut health, or something else.

Even when one issue leads, all the others are still in play because they are interrelated. To solve that problem, people need a different kind of medicine than they have usually been exposed to.

The medicine we have today tends to divide people into organ systems, assign a specialist to each one, and then have a family doctor oversee those specialists. But nobody is really looking at the entire system as an integrated system.

That is what we are doing at Gladden Longevity. We are creating an AI-assisted systems biology approach to the individual, and that includes all five circles.

Q: Can Peak Performance Continue Into a Person's 70s, 80s, and Beyond?

Dr. Gladden: Yes. Let’s say we go back 10 years and only have the technologies that were available then, with no further improvements. A person could still perform at a high level, but that level would gradually decline as they moved through the aging process.

Even 10 years ago, we had quite a few tools. We had thyroid and hormone therapies, peptides, and other treatments that could support muscle function and muscle mass. Peptides have been around for some time, although they are only now beginning to reach the mainstream.

Those tools could have given someone a very different trajectory than they might have had 25 years ago. Even then, there were people skiing black diamond runs in their 80s. They were rare, but they existed. They took care of themselves, ate well, slept, avoided alcohol, prioritized what they could control, and usually had some genetic gifts as well.

What is different today is that people can function at a higher level than they could have if progress had stopped 10 years ago. We now have deeper insights into the hallmarks of aging, along with new tools that allow us to measure those processes and, in some cases, begin turning back the clock. We are gaining ground rapidly.

This September, we will have access to a new tool that may be more powerful than anything we have used before for turning back DNA methylation and biological age. We will see how that translates into organ performance and other outcomes. But the larger point is that cartilage regeneration and many other advances are beginning to come online.

Let’s say an athlete has declined 10% or 15% from where they were three years ago. The good news is that they may still have the right mindset. They still identify as an athlete and with the version of themselves who performed at their peak.

Because of that mindset, they are more likely to ask, “I don’t feel the way I did at my peak, but I want that back.” When they ask that question, they may find that the answers are getting very close to fulfilling that promise.

Again, it comes back to mindset. What questions are you asking? What do you relate to? What do you want to do? What picture are you painting of yourself?

That is where athletes and other high performers often have an advantage. They understand that if they take care of their bodies and continue to imagine themselves performing at a high level, they may still be able to do it.

In many respects, we are the luckiest generation of all time. If you are starting to feel some decline and ask, “I want to nip this in the bud. What do I need to do?” We can deconstruct the situation and begin figuring it out.

We have had people come to us saying, “I’m 68. I’ve competed for a long time and usually rank near the top nationally, but I feel like I’m starting to lose my edge. I think I may need to retire next year.”

We told them, “You don’t need to retire. Let’s take a look at some things.” Years later, they are still competing and still finishing near the top.

I think we are most limited by what we imagine to be possible. That is the interesting thing.

Q: What Habits Consistently Separate High Performers From Those Who Experience Accelerated Decline?

Dr. Gladden: That’s a really good question. I would divide it into two broad areas: the mental and the physical. There are habits that develop in each.

When I wake up every morning, I take a gauge of myself. Am I feeling 27 this morning? Yes, no, maybe. For me, I’m on thyroid medication, so I take my thyroid medication and then a couple of supplements about 30 minutes later.

After that, I sit down and journal. In that journaling, I imagine myself as the very best version of myself, and I write about everything I’m grateful for, even the things that haven’t happened yet. I think that sense of gratitude and the joy of being here are profoundly helpful.

Then I write down three things that would make the day great. Those could be very specific or more expansive. From there, I ask myself, "How am I going to show up today?" What affirmation am I making about myself? Again, it can be something very concrete or something more spiritual.

By starting the day with gratitude, thinking about what would make the day meaningful, and deciding who I’m going to be that day, then repeating that process day after day and reflecting on what happened the next morning, you really start to grow. It’s like putting in the laps. The insights begin to come faster and faster.

After that, I meditate for 10 minutes, put on my sneakers, and exercise. Today I spent some time on the elliptical before coming into the office. The important thing is that I’m building more than a habit. I’m building an identity.

People say it takes 21 or 28 days to develop a habit. You start with an intention, then you build the habit by doing it consistently. But after three or four months, or in my case several years, it becomes part of your identity. It’s no longer something you do. It’s who you are.

I’m someone who practices gratitude. I’m someone who believes I can do the impossible. That identity carries you a long way because setbacks are going to happen. I’ve also learned there really are no setbacks. Everything is a gift. It’s another opportunity that arrives in a different form.

The same principle applies on the physical side. I put on my sneakers every day. I miss occasionally because life happens, but I do something every day. That creates the identity of, "I’m someone who exercises."

It doesn’t matter whether it’s a 10-minute workout in a hotel room with resistance bands or a 90-minute bike ride. The important thing is showing up consistently.

Ultimately, I’m not just training my muscles. I’m training my nervous system. People tend to think exercise is about muscles and joints, but it’s really about the nervous system. It’s your coordination, the speed your legs can turn over when you run, your balance, your agility. All of those things depend on the nervous system.

So I think about training the nervous system in two ways: mentally through my thoughts, intentions, and mindset, and physically through the way I move, build cardiovascular fitness, develop strength, and maintain those abilities over time. That’s pretty much how I approach it.

Q: What Do You Think the Future of Human Performance Will Look Like Over the Next 20 Years?

Dr. Gladden: I think it’s hard to imagine how good it’s going to get. I believe we’re going to see elite athletes competing at the highest levels for another 20 years beyond what we think is possible today. 

When you have the ability to regenerate the body while the mind continues to expand through insight, wisdom, growth, perspective, and a deeper understanding of the “game” you’re playing, I think people can become more formidable at 60 than they were at 40.

A great athlete today may not be quite as fast as they were 15 years ago, but they often make up for it with experience and precision. If you ask almost any elite athlete whether they were better in the last few years of their career than in the first few, many would probably say, “Absolutely.” They understand the game at a much deeper level.

I think that’s where we’re headed. I think we’re going to have a lot of fun.