The body awareness that fades with age is not the body awareness that predicts function

A paper published on 20 August in The Journals of Gerontology reports that older adults tracked their own heartbeat less well under a breath holding challenge, while their ability to sense a load on their own breathing did not change with age at all. Alone it reads as a modest laboratory result. On the arc it belongs to, it is the fourth marker in eleven years pointing the same way, and that direction matters for how we prescribe body awareness work.

What the new study measured

The team, working across the University of Texas at Austin and UCLA with Sahib Khalsa as senior author, tested 78 healthy adults aged 18 to 79 in one session, mean age 49.1. Each went through three assessments: self reported sensibility on the Multidimensional Assessment of Interoceptive Awareness, a cardiac task tapping along to their own heartbeat at baseline and again during breath holding, and a respiratory task estimating inspiratory loads at varying resistance (The Journals of Gerontology, Series B, 2026).

The perturbation design is the part worth noticing. Most interoception work measures people at rest, which only reports what someone detects when nothing is happening. Breath holding and inspiratory loading push the signal around and ask whether the person tracks it.

Three findings came out. Older age was associated with reduced cardiac sensitivity during breath holding. Respiratory sensitivity stayed stable across the age range. Self reported sensibility increased with age. The authors describe task performance and self report as following divergent aging pathways.

The eleven year arc

That result only carries weight because of what came before it.

In 2015, Sarah Garfinkel and colleagues made the distinction possible at all, separating interoceptive accuracy on a task from interoceptive sensibility on a questionnaire and showing the two dissociate within the same person (Biological Psychology, 2015). Before that, one number stood in for the whole construct, and nobody could ask whether the pieces age differently.

In 2022, a study of 47 older adults compared with 18 younger ones found interoception reduced in old age, and that reduction mediated how strongly participants experienced their own emotional states (Brain Sciences, 2022). That was the high water mark for the simple story.

Then in February this year a group tested 60 adults aged 21 to 87 on a battery covering interoceptive accuracy, sensibility and awareness alongside body image, tactile acuity and peripersonal space, and asked which predicted daily functioning on the SF-36. The answer was sensibility, and within it the self regulation and body trust subscales in particular, which predicted limitations in physical health, emotional wellbeing and fatigue (Frontiers in Psychology, 2026).

Line those four up and the arc is hard to miss. The dimension that erodes with age is fine grained tracking of a fast internal signal under load. The dimension that predicts whether a person can do their week is body trust. In the newest data, that second dimension does not fall with age. It rises.

What I would take into practice

I am a Feldenkrais® practitioner, not a physiotherapist, so treat this as one practitioner reading the literature rather than a clinical recommendation. The Feldenkrais Method® works through attention to internal sensation, which puts it inside what this arc measures, so I have an interest in not overreading it.

A few things follow that seem worth holding in practice.

First, a low score on a heartbeat task is weak evidence about a person's capacity for body awareness work. Cardiac tracking is one modality, it is the one that declined here, and the respiratory channel in the same participants held steady. If you want to know whether someone can sense and use their own breath, the heartbeat literature is not answering it.

Second, breath is the channel with the best case for holding up, and it is also the easiest internal signal to bring into a home programme. Nobody needs equipment or a quiet hour to notice that one side of the ribs moves more than the other. For people whose breathing has narrowed under years of guarding, that noticing is often the first thing available, which is why chronic shallow breathing is a starting point rather than a problem to address directly. If you have not sent someone home with that kind of work before, our guide to feldenkrais lessons online shows what a beginner sequence actually asks of a person.

The one I would actually change practice on is body trust, which starts to look like a target rather than a soft outcome. If self regulation and body trust are what predict physical limitation and fatigue, then between session homework that rebuilds a person's confidence in their own signals is doing measurable work, not just making them feel supported. Doing less and noticing more is not a gentler substitute for the real thing. On this evidence it is aimed at the variable that carries.

What I see in the people who come to me matches that. Somebody arrives at seventy convinced they have lost the ability to feel what their body is doing. Usually they have not. What they have lost is the assumption that attention will report anything they can use, because for years the main thing it reported was discomfort. That is a trust problem wearing the costume of a sensory problem. The same distinction runs through proprioception decline with age, where the measured deficit and the lived hesitation are related but not the same thing.

Where I would hold back

These are small samples, seventy eight people in the new study and sixty in the Frontiers battery, and both are cross sectional, so cohort effects remain a live alternative to change within a person. The rising sensibility scores have an obvious second reading too, which is that older adults report more bodily awareness partly because there is more to report. Neither paper tested a movement intervention, so the step from these associations to what a session should contain is mine, not theirs. Feldenkrais work sits alongside what a physiotherapist provides rather than in place of it, and none of this changes that.

The useful piece is narrower and steadier. Body awareness is not one dial. Before writing off an older client's capacity to work with sensation, ask which dimension you are looking at.