Roger Dickinson


The 4 Horsemen, the Body in your Mind and Peter Drucker

Posted by Roger Dickinson on 28 July 2023, 21:25 SAST
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In his book (which I’m currently finishing up) Outlive: The Science and Art of Longevity Dr Peter Attia point out that the odds are overwhelming that an average middle-class person will die as a result of one of the chronic diseases of aging he calls the Four Horsemen. These are heart disease, cancer, neurodegenerative disease, or type 2 diabetes and related metabolic dysfunction. For those who care about these things, the Four Horsemen imagery is taken from Revelation 6 in the New Testament of the Bible. I choose not to go into the Revelation 6 imagery's meaning and symbolism here but maybe suffice to say that it is intended to convey the coming of chaos, hardship and eventually death. How it also relates to Attia's point is that the Horsemen come in response to choices made by individuals and groups of people.

Attia’s view is that one of the Horsemen or a combination of them will eventually kill you and me, before out time.  This of course apart from the proverbial bus that could knock you over, another global pandemic or Vogons destroying the earth for an intergalactic highway (this is a nod to the The Hitchhikers Guide to the Galaxy -which I’m also rereading).

The Horsemen bring sickness, stress and depression before they bring death. Their cumulative effect puts incredible strain on individuals,  families, communities and countries.

Turns out however, that the Horsemen are mostly constructs of our lifestyle choices, modern middle class living and personal neglect.  We can choose to be taken by the Horsemen or not! And even if they get us eventually, we can choose how long the chase lasts and on who's terms it all ends.

We will all eventually die of something but an unhealthy, painful, unfit pathway need not be the way to go!


It is the world that has been pulled over your eyes to blind you from the truth - Morpheus (The Matrix)

My wife has said to me a few times that I am one person in my mind and another one in my body. Ouch!!! But true.

Photographic evidence to follow.

On the left is what I currently actually look like and on the right who my mind says I look like.

The right photo is the 1988 long jump on the way to that mythical Victor Laudorum and the left is 2 weeks ago at the  Bluebells FC Commemorative  match.

Only one is the current reality!

The only real positive of that photo on the left, is that I still seem to have my eye on the ball!

But not on other things clearly. Like my BMI and Body Fat percentage and the fact that according to all leading health research groups, abdominal fat is a sign of metabolic syndrome, a collection of disorders that include high blood pressure, obesity, high cholesterol and insulin resistance. Together, these increase the risk of stroke, heart disease and type 2 diabetes.

I am well on the way to meeting at least 2 of Attia’s horsemen! I have pulled an imaginary healthy world over my eyes!

Many of us do this, not only with our health, but also with our careers, finances, religions, relationships and supporting of sports team that have not won anything since the double in 1962!

But the Horsemen are not mythical, and pretending they are not there won’t make them go away.

According to everyone’s favourite AI Chatbot, some common leading causes of death for middle-aged males (roughly 35 to 64 years old) in many parts of the world include:

1.      Cardiovascular Diseases: This category includes heart attacks, stroke, and other conditions affecting the heart and blood vessels.

2.      Cancer: Various types of cancer, such as lung cancer, prostate cancer, colorectal cancer, and pancreatic cancer, can be significant causes of death among middle-aged men.

3.      Accidents and Injuries: Unintentional injuries resulting from accidents, such as motor vehicle accidents, falls, and poisoning, are a significant cause of death in this age group.

4.      Respiratory Diseases: Chronic respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and lung diseases related to smoking.

Accidents and injuries aside, Attia’s 4 Horsemen are getting the job done!

ChatGPT goes on to say (in the Terminator voice I imagine)

It is essential to note that these leading causes of death can be influenced by lifestyle choices, genetics, access to healthcare, and various socioeconomic factors.


So apart from genetics, which you can blame on your parents, and possible socioeconomic factors, which you can blames on the government – this is on us. The responsibility for what is killing me lies with me!

Only what is measured is managed.

Management guru Peter Drucker once said, “[only] what gets measured, gets managed.” I found this to be true in practically all walks of life, and the measure to manage thinking is at the centre of our literacy programming.

So with health and fitness what can we measure and what can be managed.

The standard measurements that most people manage is weight as measured by a scale. Or how I look in the mirror.

Road Runners seem to do better with have an established code of measurements from 10km time to 42 km time to ultramarathons. Runners 'know', for example, that to run a 3 hour marathon, they need to be training at 4.16 minutes per kilometre. To achieve times like this weekly mileage goals are set with training variations of short runs, long runs, time trials and hill sessions. 

 In a mainstream gym, the de factor measurements are much you can bench press, curl and (sometimes) squat. Oh yes, and how I look in the mirror!

These are actually all good and valuable. The ‘how I look in the mirror’ maybe not so much (The Influence of Exercise Environment and Gender on Mood and Exertion - PMC (

But please don’t be hating on the guy flexing in the gym bathroom! Each to his own I say!

However it turns out there are better indictors of overall health and fitness.

Crossfit which has led the fitness world over the last 2 decades or so, measures fitness by its 10 General Physical Skills

  1.   Cardiovascular/respiratory endurance,
  2. Stamina,
  3.  Strength,
  4. Flexibility,
  5.  Power,
  6. Speed,
  7. Coordination,
  8.  Agility,
  9.  Balance,
  10. And accuracy

Each of these has standardised tests and norms.

For the world renowed  Mayo Clinic  and others, health is assessed in the following areas:

  1. Body Mass Index (BMI)
  2. Blood Pressure
  3. Cholesterol Levels
  4. Blood Sugar Levels
  5. Waist Circumference
  6. Physical Activity
  7. Sleep Quality
  8. Mental Health
  9. Nutritional Habits
  10. Substance Use

Each of these also has age related benchmarks and limits.

  1. (Note the mirror is for some reason omitted in both these examples)

So the question (to me) is what am I measuring and what am  doing about it.

Well currently not a whole lot!

My default setting is to get engrossed in one part of my life and run that at full speed. Right now that is our impact education businesses!

This leads inevitably to the neglect of the other parts of my life, like health and fitness. I do try to get some kind of balance in my life but in the words of the Jedi master...

What to do then?

Measure and manage perhaps?

So in respect to Mr Drucker, I've decided to do a baseline on all key health and fitness norms for my age, see where we are at and then do somehting about the one's that are not looking good!

I have decided to do start this at the end of August and to do something about them in Phases of 3 months at a time over 24 months.

I'll use this blog to track and report on it! (If anyone is interested)

But why do it alone?

I have also invited my friends to join me. Males in the same age phase as me.

And surprise surprise 10 immediately signed up with more interested!

Seems most of us don't want to be meeting those Horsemen anytime soon.




africa, four horsemen of the apocalypse, health, male fitness, measure what you manage, peter drucker

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