Harley Street Institute

    Anti-Ageing & Longevity Medicine

    Part of Module 4: Cells, Sleep, Stress & the Body in MotionReading · video · case work · reflection
    Curriculum contents

    Curriculum contents

    Worked Case: Richard, Putting the Foundations Together

    Before we begin
    “Richard has a sleep diary, a stress history, a below-average VO2 max and a new chest symptom. What do you do first, second and third?”

    The teaching

    One case worked end-to-end through the HSI Method with Module 4's tools: cell-level context (Lesson 4.1), sleep (4.2), stress (4.3), movement (4.4), and signal-led decisions including the red flag and referral (4.5). The chest symptom takes priority and changes the plan: Assess and refer before any training plan.

    Assessed activity

    Learners complete a written case (~800 words) applying the HSI Method to a new anonymised case: what they would assess, prioritise, refer, and measure.

    Patient Journey — Checkpoint 19

    Continuing case
    Richard Okafor46 yearsFinance director

    Cardiology review is normal. Richard asks: "So can I go back to my normal routine?" What do you say, and what do you set up for the next four weeks?

    How would you apply this lesson to Richard?

    Reflect before you move on

    What is the first thing you would change in your own practice or life after this module?

    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.

    Key Points

    • 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.
    Ancestry, Context & Risk: Personalising Without StereotypingNext lesson coming soon

    Flexible payment options

    We've made it easy to pay your way.

    Choose from trusted providers at checkout. Whether you prefer to pay in full, split across instalments, or pay later, the option is yours — secured by industry-standard providers.

    stripePayPalKlarna.

    Klarna availability subject to eligibility checks at checkout. Stripe and PayPal available for all major cards. Course fees may be split into instalments where supported.

    From Aesthetic Intelligence

    Further reading

    Continue with relevant clinical analysis and evidence reviews from the HSI journal.

    The HSI Mini Scale

    A proposed four-domain facial examination — skin quality, muscle and movement, volume and support, laxity and descent — scored 0–3 and reported as a phenotype (S–M–V–D) with a named dominant driver, rather than summed into a single ageing score.

    View page

    The Screen–Stress–Jaw–Neck Axis

    A narrative evidence review and hypothesis on screen exposure, awake bruxism, psychological load, neck pain, TMD and non-migraine headache; clinical observations are author-reported, not independently verified.

    View page

    Endolaser Power vs Energy (Jowl)

    A retrospective two-cohort case series (n=10) holding energy constant at 300 J per side and raising power from 3 W to 4 W — satisfaction rose from 7/10 to 9/10. The physics of thermal confinement explains why.

    View page
    AI