Module 4 · Foundational Certificate · Practitioner & Coach
Cells, Sleep, Stress & the Body in Motion
From the cell to the day-to-day. Telomeres, mitochondria and biological age; sleep; stress from eustress to distress; strength, movement and the brain; how to read the body's signals and red flags; and how ancestry and context change risk without stereotyping. Practitioner and Coach tracks.
Learning outcomes
- Explain, in plain language, what telomeres and mitochondria do and what the evidence does and does not show about influencing them.
- Describe how sleep affects metabolism, inflammation and ageing, and run a basic sleep assessment.
- Distinguish helpful stress from harmful stress and explain allostatic load.
- Explain sarcopenia, why strength and movement matter, and give age-appropriate low-barrier recommendations within scope.
- Recognise common warning signals and red flags, and decide when to refer.
- Explain how ancestry and context can change risk, and use it to personalise care without stereotyping.
Study time
Component | Time |
|---|---|
Taught content, 7 lessons (~12–15 min each) | ~1.75 h |
Short videos (6–8 min each) | ~0.7 h |
Lesson quizzes | ~0.75 h |
Mini cases and the worked case | ~1.5 h |
Required reading of selected cited papers, with a short written reflection each (checked) | ~2.0 h |
Own-habits log: one week of sleep, stress and movement notes, then a 30-minute write-up | ~0.75 h |
Signals and red-flag worksheet on a real or example case | ~0.6 h |
Ancestry lesson: family-history question card practice (2 role-plays) | ~0.4 h |
Module assignment (written case, ~800 words) | ~2.0 h |
Approx. total | ~10.4 h |
Estimates only.
Module Table of Contents
Seven lessons, from the cell to the day-to-day
Practical takeaways
- Tell people what a number is, what it is not, and what happens next, especially "biological age" results.
- Ask every person about sleep, stress and movement, and keep a record.
- Offer two or three sleep foundations and let the person pick one.
- Look for the signals of distress before deciding that stress is "good."
- Start strength and balance work early, and keep it gradual.
- Always ask the red-flag questions; refer promptly and document it.
Audit worksheet
Review three recent clients or patients (anonymised). For each: did I ask about sleep, stress and movement? Did I check for red flags? Did I record a next step and follow-up date? Did I stay within my scope? One improvement per case. (~30–40 minutes.)
Downloadables
- Sleep Diary (one week) and Sleep Foundations Card
- Family and Ancestry History Question Card
- Stress-Load Self-Check
- Movement Readiness Screen
- Symptom-Led Screening Template and Red-Flag Card
- Module 4 Self-Audit Worksheet
- Recommended Reading List (Lifespan and Disease Delusion as popular reads, flagged as popular-science, alongside the primary papers)
Downloadable files are in preparation.
Required reading
Learners choose any four of: Epel 2004; McEwen 1998; Watson 2015; Cappuccio 2010; Cruz-Jentoft 2019; Leong 2015; Northey 2018; Levy 2002; Joshi 2007; WHO Expert Consultation 2004. [Add links when final.]
Module quiz
What are telomeres, and why do they matter in ageing?
Show answer
Protective chromosome caps; shorten with cell division; a recognised hallmark.
True or false: Telomere length tests are recommended to guide individual treatment.
Show answer
False.
How much sleep does the AASM/SRS consensus recommend for most adults?
Show answer
Seven or more hours.
Why is the long-sleep association with mortality hard to interpret?
Show answer
Observational; may reflect illness.
Define allostatic load.
Show answer
Cumulative wear and tear from repeated or prolonged stress-system activation.
What is the difference between eustress and distress?
Show answer
Manageable challenge vs overwhelming load without recovery.
What is the primary criterion for sarcopenia in the European consensus?
Show answer
Low muscle strength.
What does WHO recommend for adults' muscle-strengthening?
Show answer
Two or more days a week.
A client mentions chest tightness on stairs. What do you do?
Show answer
Stop exercise advice, refer promptly.
What does "recognise, record, refer" mean for a coach?
Why is ancestry a "proxy" and not a cause of risk?
Show answer
It stands in for body composition, environment, access and more; assess the individual.
In INTERHEART, how did the average age at first heart attack differ in South Asian countries, and how did the authors explain it?
Show answer
53.0 vs 58.8 years; largely higher risk-factor levels at younger ages.
References
- López-Otín C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell 2013;153:1194–1217; and The hallmarks of aging: an expanding universe. Cell 2023;186:243–278. (As cited in Module 1.)
- Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM. Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA 2004;101(49):17312–17315.
- Telomere Research Network. Recommendations for the measurement of telomere length in population studies (precision and measurement error).
- Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11:591–592.
- Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 2010;33:585–592.
- McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med 1998;338:171–179.
- Levy BR, Slade MD, Kunkel SR, Kasl SV. Longevity increased by positive self-perceptions of aging. J Pers Soc Psychol 2002;83:261–270.
- Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16–31.
- WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157–163.
- Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA 2007;297:286–294.
- Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management. Lancet Diabetes Endocrinol 2015;3:1004–1016.
- Alshamsi MA, Fatima W, Al Teneiji MT, Srinivasamurthy SK. Vitamin D status among apparently healthy individuals in the UAE: a systematic review. Front Nutr 2025;12:1604819.
- Oppenheim A, Jury CL, Rund D, Vulliamy TJ, Luzzatto L. G6PD Mediterranean accounts for the high prevalence of G6PD deficiency in Kurdish Jews. Hum Genet 1993;91:293–294.
- Kling J. Race-, ethnicity-based clinical guidelines miss the mark: study (report of Siddique S, Digestive Disease Week 2022). MDedge Family Medicine, 27 May 2022.
- Kauff ND, Perez-Segura P, Robson ME, et al. Incidence of non-founder BRCA1 and BRCA2 mutations in high risk Ashkenazi breast and ovarian cancer families. J Med Genet 2002;39:611.
- El-Shanti H, Majeed HA, El-Khateeb M. Familial Mediterranean fever in Arabs. Lancet 2006;367:1016–1024.
- De Sanctis V, Kattamis C, Canatan D, Soliman AT, et al. β-Thalassemia distribution in the Old World: an ancient disease seen from a historical standpoint. Mediterr J Hematol Infect Dis 2017;9(1):e2017018.
- Ojo AO, et al. APOL1 kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2025;108:763–779.
- Emmett E, O'Connell M, et al. South London Stroke Register analysis of ethnic and socioeconomic inequalities in stroke (30-year data). eClinicalMedicine 2026 (as reported by King's College London, July 2026).
- Brooks PJ, et al. The alcohol flushing response: an unrecognized risk factor for esophageal cancer from acetaldehyde exposure. PLoS Med (as reported in press coverage).
- American Diabetes Association guidance lowering the diabetes screening BMI threshold for Asian Americans to 23 (2015), as summarised by diaTribe. Press coverage differs on the exact wording and later changes; confirm the current ADA position before relying on it.
- Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015;386:266–273.
- Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med 2018;52(3):154–160.
- World Health Organization. Guidelines on physical activity and sedentary behaviour. 2020.