Exercise for Longevity: Why It Matters To You
For all of us the reality is that there is a predictable and progressive decline in physical strength, muscle mass and cardiorespiratory fitness as we progress through each decade of life with a precipitous decline in our 7th and 8th decades. Medically termed sarcopenia, it is the loss of muscle tissue as a natural part of the aging process or with periods of immobility. It is characterized by the degenerative loss of skeletal muscle mass, quality and strength. The rate of muscle loss is dependent on exercise level, comorbidities, nutrition and other factors. For some of us, either through unexpected trauma or sickness, there can be a sudden, dramatic decline. The body suddenly breaks down leading to significant impairments in mobility and ability to perform normal activities of daily living. This decline of physical function often leads to other medical complications and undoubtedly a poor quality of life. A recent study of older British adults found that those with sarcopenia at baseline were nearly six times likelier to report having a low quality of life a decade later than those who had maintained more muscle mass.(1) Exercise for Longevity.
Now for the good news. The state of our Golden years is not inevitable or pre-determined.
We can alter the rate of this decline through exercise and proper nutrition. Exercise is one of the most effective interventions to extend our lifespan and improve quality of life. Study after study has found that regular exercisers live as much as a decade longer than sedentary people. Those who maintain higher activity levels lose much less muscle mass, about 50% less on average. And, the sooner we prepare, the better. If we make healthy lifestyle changes that endure into our later years, we are more likely to maintain good cardiorespiratory fitness, muscle mass and overall strength. These changes will help buffer the decline associated with any unforeseen future hospitalizations, reduce the onset of chronic disease and help us maintain a high quality of life that we desire. Preparation and implementation of a strategic exercise for longevity plan is essential. This strategic plan should be tailored around helping you to maintain enough strength and fitness to enjoy all activities in your elder years.
What are the most important activities of daily living that you want to maintain the ability to perform into your Golden Years? For example, do you value being able to pick up your three-year-old grandchild, getting up off the floor from a lying position without assistance, or perhaps climbing three flights of stairs carrying a bag of groceries? How about lifting a 25 lb carry-on bag into the overhead bin on an airplane, getting into or out of a pool or hot tub safely or walking a mile along a sunset beach? You can strategically plan to practice specific physical tasks that can approximate these activities. For example, lifting a 30 lb goblet squat is equivalent to lifting a 3 year old grandchild. Working on a stability program to improve your balance will help maintain your ability to traverse uneven terrain or climb stairs with reduced risk of falling. If you train to become stronger today you will be better able to live tomorrow. Train for the sport of Life. Exercise hard today, Live better tomorrow.
Exercise Plan for Tomorrow
An exercise training plan for tomorrow should incorporate three major disciplines or categories of exercise. These three main categories of exercise include the following:
Strength
Stability and Balance
Cardiorespiratory fitness
They all are very important and contribute in different ways that help you maintain health and physical fitness to endure life’s challenges. Let's see why.
Strength
Why is it so important to preserve strength and muscle mass as we age? Recent studies show that the lowest rate of muscle mass decline is about 1% to 2% per year after age 50 which amounts to about a 35% to 40% decline between age 20 and 80.(2) And, the strength losses might even be greater with some studies seeing 3% to 4% loss in overall strength per year. Given this sad statistic, the reality is that you can not expect to perform many physical tasks in your 80’s unless you begin to train yourself to be better than average when you are in your 40’s, 50’s and 60’s. This applies not only to your muscle mass and physical strength but also with cardiorespiratory fitness and balance. Furthermore, there is evidence that maintaining muscle mass and strength into our senior years affects mortality risk. A study in 2006 demonstrated that muscle strength was a better marker in estimating mortality risk.(3) The study looked at grip strength vs leg strength in both men and women in their 50’s followed prospectively for 6 years relative to all cause mortality. For every reduction in 0.2 unit of quadriceps strength there was a 26% increase in mortality. Reduced grip strength was similarly associated with a 23% increase in mortality.
Take home message: Having a strong body and exoskeleton can help reduce risk of serious injury in the event of accidental trauma. Maintaining a strong body as we age directly affects longevity.
Stability and Balance
Stability is the cornerstone upon which your strength and aerobic performance is delivered. Stability is a way to transmit force from your body to the environment without unnecessary dissipation of energy across joints. You want all of the force exerted by your body to be applied efficiently and not to be lost through unstable joints or movements. More importantly, stability teaches you how to exercise with proper form thus helping to prevent future injuries while simultaneously strengthening your spinal stabilizers that will reduce the occurrence of chronic neck and back pain. Furthermore, it inherently will improve your balance and greatly reduce risk of falling. Falls are by far the leading cause of accidental death and disability in those ages sixty-five and older and more than 800,000 older people are hospitalized for falls each year, according to the CDC. Many older patients suffer hip fractures as the result of a ground level fall. A 2015 study showed that the mortality rate of 65 year-olds within the first year after hip fracture can be as high as 35% and 40% for those 75 year-old or older.(4)
Stability is somewhat discipline agnostic but heavily dependent on the teacher and student. A good stability program should be individualized to the student’s needs and integrate exercises that train your proprioception and vestibular systems to improve balance. Stability can be successfully taught through a number of different disciplines: Pilates, DNS (Dynamic Neuromuscular Stabilization), PRI (Postural Restoration Institute), FRC (Functional Range Conditioning), Yoga and martial arts to name a few. Many of these disciplines not only incorporate important principles of stability but also incorporate flexibility, balance, and breathing techniques that teach one to exercise safely and will assist in preventing future injury.
One important exercise discipline that emphasizes stability is dynamic neuromuscular stabilization. Dynamic neuromuscular stabilization or “DNS” is a manual and rehabilitative approach to optimize the movement system based upon the scientific principles of developmental kinesiology.(5) It is based on innate movement patterns that we automatically develop as young children. They activate intrinsic spinal stabilizers in order to optimize key movement patterns that control human posture, movement and gait. Unfortunately they are gradually lost over time through inactivity as we become accustomed to our modern sedentary lifestyle. We lose the ability to maintain stability not only through our abdominal muscles but also through our spine, shoulders, hips, obliques and pelvic floor. However, it’s possible to reacquire this ability through deliberate practice of these movements. The goal is to first learn how to activate and maintain motor control of these “core” stability muscles. Eventually you improve upon your “static stability” and then progress to develop “dynamic stability”, i.e. maintain core strength while in movement. Over time, you will automatically incorporate these core stability movement patterns into your everyday activities leading to improved posture (less neck and back pain), improved balance (less falling) and improved mobility (improved quality of life).
Take home message: Working an exercise program that incorporates stability, flexibility and balance will teach you how to exercise in a more efficient and safe manner which will lower your risk of suffering acute injuries. It will strengthen key intrinsic spinal stabilizers that will optimize important movement patterns that control posture, movement and gait thus helping to improve mobility while reducing the occurrence of chronic neck and back pain.
Cardiorespiratory Fitness VO2 Max
The strong association between cardiorespiratory fitness and longevity has been long known. Exercise helps the human “machine” perform far better for longer. John Ioannidis, a Stanford researcher, has conducted multiple randomized clinical trials showing that exercise-based interventions performed as well as or better than multiple classes of pharmaceutical drugs at reducing mortality from coronary artery disease, diabetes and stroke.(6) On a deeper biochemical level, exercise is medicine. Exercise stimulates production of endogenous drug-like chemicals called cytokines that help to stimulate growth of musculoskeletal tissue and strengthen our immune system. Endurance exercise helps generate a cytokine called brain-derived neurotrophic factor, “BDNF”, that improves the health and function of our brain, helping to reduce the risk of developing dementia and Alzheimer’s disease.(7)
Cardiorespiratory or aerobic fitness measures how efficiently your body can deliver oxygen to your muscles. It measures your physical stamina. The more aerobically fit you are, the more energy you will have for life’s activities. Cardiorespiratory exercise can be subdivided into categories or “zones” based on your heart rate: Zone 1 through Zone 5, with Zone 1 being the least intense exercise and Zone 5 at maximal intensity. Most activities of daily living require energy levels between Zone 1 and Zone 2 with infrequent quick bursts of maximal energy, such as running through the airport terminal to catch a flight. For the purposes of improving your cardiorespiratory fitness, training to improve your “Zone 2 fitness” (low intensity aerobic energy) and “Zone 5 fitness” (very intense maximal energy, VO2 max) are most important. Let’s take a brief look at why these energy systems are so important.
Peak aerobic cardiorespiratory fitness, measured in terms of VO2 max, is perhaps the single most powerful marker for longevity. VO2 max represents the maximum rate at which a person can take oxygen from the air and deliver it to your muscles to do work. The more oxygen your body consumes, the higher your VO2 max. It is typically expressed in terms of the volume of oxygen a person can use per kilogram of body weight. An average physically fit forty-five-year-old man will have a VO2 max of 40 mL/kg/min, while an elite endurance athlete will score in the 60’s and above. A physically unfit adult will typically score in the 20’s. Essentially having a higher VO2 max allows you to do more work; to exercise harder and for longer.
A 2018 study in JAMA that followed more than 120,000 people found that higher VO2 max was associated with lower mortality.(8) Those in the bottom quartile of VO2 max for their age group (the least physically fit 25%) were almost four times likelier to die than someone in the top quartile; and five times likelier to die than a person in the elite level VO2 max (top 2.5%). As the authors of the JAMA study concluded, “Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival.” Most importantly, they found that improving your VO2 max from the 25% into the 25 to 50th percentile reduced your risk of death almost in half.
Take home message: at any age and at any physical fitness level you will see a significant reduction in mortality risk when you increase your peak aerobic cardiorespiratory fitness.
Cardiorespiratory Fitness: Aerobic Efficiency Zone 2
Aerobic exercise can not only improve our cardiorespiratory fitness but it can also greatly impact our metabolic health and how our bodies utilize glucose and fat as fuel. Training to be more fit in this Zone 2 energy system will greatly improve our mitochondrial function which will ultimately assist with weight loss and provide our bodies with the energy it needs to perform at its best. Mitochondria are the little intracellular organelles that produce energy for our cells. They are the cellular engines that burn glucose and fat, and thus they are not only fundamental to our metabolic health but also can greatly impact our athletic performance.
Mitochondrial health becomes especially important as we age since the number of mitochondria substantially decreases as we get older. However, mitochondria are fantastically plastic and with aerobic exercise they will grow to become more efficient through a process of mitochondrial biogenesis (increases the number of mitochondria) and mitophagy (recycles or reduces the number of dysfunctional mitochondria). A person who routinely exercises in Zone 2 is improving not only their mitochondria density but also their mitochondrial function. Zone 2 training, defined as continuous exercise at 70% to 80% of maximal heart rate, builds the foundation for intense training and is the cornerstone to building a strong cardiorespiratory fitness. Studies have shown that zone 2 exercise can double your mitochondria density leading to a more efficient use of energy. This improved mitochondrial function will lead to a more efficient utilization of energy called “metabolic flexibility” where the cells gain the ability to metabolize not just glucose but fatty acids and lactate, significantly increasing your capacity to exercise longer and harder without fatigue. Furthermore, studies have found that when we exercise, our overall glucose uptake increases as much as one-hundred fold compared to when we are at rest. This promotes non-insulin-mediated glucose uptake from our blood helping to reduce insulin resistance and other metabolic diseases.
Take home message: Increasing your mitochondrial density and function through Zone 2 exercise will not only help you to lose weight and improve your capacity to exercise harder with less fatigue, it will significantly lower your risk of developing cancer, diabetes, heart disease and dementia.(9)
For all of us there is a predictable decline in physical strength, muscle mass and cardiorespiratory fitness as we age. This decline of physical function often leads not only to impairments of mobility, but further medical complications, progression of chronic disease and undoubtedly a poor quality of life. The good news is that we can alter the rate of this decline through exercise and proper nutrition. Exercise is one of the most effective interventions to extend our lifespan and improve quality of life. Exercise is medicine. Implementing these healthy lifestyle changes will make us physically stronger and healthier, reduce the onset of chronic disease and help us maintain a high quality of life that we desire. Preparation and implementation of a strategic exercise for longevity plan is essential. If you train to become stronger today you will be better able to live tomorrow. So Get Mooving! Train for the sport of Life.
Get the latest news about exercise, nutrition and lifestyle sent right to your email.
Exercise for Longevity - Moov Better. Live Longer, Healthier.
Veronese, N., Koyanagi, A., Cereda, E. et al. Sarcopenia reduces quality of life in the long-term: longitudinal analyses from the English longitudinal study of aging. Eur Geriatr Med13, 633–639 (2022).
Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2014 Feb 24;3(4):346-50.
A. B. Newman et al., on Behalf of the Health, Aging and Body Composition Study Investigators, Strength, But Not Muscle Mass, Is Associated With Mortality in the Health, Aging and Body Composition Study Cohort, The Journals of Gerontology: Series A, Volume 61, Issue 1, January 2006, Pages 72–77.
Karademir et al. Hip fractures in patients older than 75 years old: Retrospective analysis for prognostic factors. International Journal of Surgery. Dec 2015. Vol 24. p 101-04.
Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013 Feb;8(1):62-73.
Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. Br J Sports Med. 2015 Nov;49(21):1414-22.
Gao, L., Zhang, Y., Sterling, K. et al. Brain-derived neurotrophic factor in Alzheimer’s disease and its pharmaceutical potential. Transl Neurodegener 11, 4 (2022).
Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open.2018;1(6):e183605.
San-Millán I. The Key Role of Mitochondrial Function in Health and Disease. Antioxidants (Basel). 2023 Mar 23;12(4):782.
