Cycling Across the Andes, Falling into the Longevity Medicine Wormhole, and Somehow Ending Up in Perioperative Care

Dr Douglas R Tunney Anaesthetic Consultant University Hospitals Dorset NHS Foundation Trust

Training to cycle across the Andes led to many questionable decisions, including "altitude acclimation" in Dorset and an unexpected plunge into the longevity medicine wormhole. Along the way, it became uncomfortably clear that the principles used to survive multi-day cycling in extreme environments are remarkably similar to those required to survive major surgery.

Longevity medicine, championed by clinicians such as Peter Attia, emphasises aerobic fitness, muscle mass, metabolic health, and stability, framed by the concept of the Centenarian Decathlon—the physical tasks required to remain independent in later life. These same capabilities strongly influence perioperative outcomes, where surgery functions as a rather unforgiving physiological stress test. Poor fitness and sarcopenia predict complications, prolonged recovery, and loss of independence—outcomes familiar to anyone who has watched a patient attempt their first post-operative sit-to-stand.

This talk explores how longevity principles can be rapidly repurposed for perioperative care through prehabilitation, early mobilisation, and nutritional strategies. Evidence supporting protein supplementation and creatine to limit surgery-induced muscle loss is reviewed, alongside clinical examples—including an 82-year-old post–hip fracture patient who now consumes more protein than his anaesthetist.