A marker of successful aging is physical functioning. Exercising benefits physical and mental health as well as longevity. It is important to understand the extent of exercising and to which different types of exercise are differentially associated with the risk of mortality.

 

    One study examined the physical activity and other lifestyle characteristics of 16,936 Harvard alumni, aged 35 to 74, for relation to rates of mortality from all causes and influences on length of life, a total of 1413 alumni died during 12 to 16 years of follow-up (1962 to 1978). Exercise reported as walking, stair climbing, and sports play related inversely to total mortality, primarily to death due to cardiovascular or respiratory causes (1).

 

    Death rates declined steadily as the energy expended on such activity increased from less than 500 to 3500 kcal per week, beyond which rates increased slightly. Death rates were one quarter to one third lower among alumni expending 2000 or more kcal during exercise per week than among less active men. With or without consideration of hypertension, cigarette smoking, extremes or gains in body weight, or early parental death, alumni mortality rates were significantly lower among the physically active. Relative risks of death for individuals were highest among cigarette smokers and men with hypertension, and attributable risks in the community were highest among smokers and sedentary men. By the age of 80, the amount of additional life attributable to adequate exercise, as compared with sedentariness, was one to more than two years (1).

 

    A later analysis on the longitudinal study of 16,936 Harvard alumni as related to cardiovascular disease and longevity, identified 572 first coronary heart disease attacks, 1962-1972, and 1,413 all-cause deaths, 1962-1978. Men expending 2,000+ kcal per week in walking, stair-climbing, and sports play were at 39% lower risk of developing coronary heart disease than less active classmates. Attributable risk estimates suggested: there might have been 16% fewer cardiovascular disease deaths in the alumni population if every man had exercised 2,000+ kcal per week; 25% fewer from total cigarette abstinence; 9% fewer from the abolition of hypertension; 6% fewer with less obesity; and 11% fewer cardiovascular disease deaths in the absence of parental coronary heart disease. Discounting the influence of blood pressure status, cigarette habit, net weight gain since college, and parental history of early death, the more active alumni (39% of the population) are estimated to have lived on average one and one-quarter years longer than less active men (2).

 

    A prospective study examined the association between specific leisure-time activity and mortality risk using data from 1999 to 2006 U.S. National Health and Nutrition Examination Surveys which included adults followed through December 31, 2015 (n = 17,938, representing 191,463,892 U.S. adults). Participants reported specific leisure-time activities performed at moderate-to-vigorous intensity. Walking, bicycling, running, dance, golf, stretching, and weightlifting were examined. Cox proportional hazards models (adjusted hazard ratios [aHRs]; 95% confidence intervals [CIs]) assessed the association of individual activities with the risk of all-cause mortality, CVD mortality, and cancer mortality (3).

 

    Over a median follow-up of 11.9 years, 3799 deaths occurred. Any leisure-time walking ([aHR], 0.73; 95% CI, 0.66-0.82), bicycling (aHR, 0.73, 95% CI, 0.59-0.91), and running (aHR, 0.70; 95% CI, 0.59-0.84) were associated with lower all-cause mortality compared with no participation in the specific activity. Dance, golf, stretching, and weightlifting were not associated with mortality. Comparable results were observed when activities were categorized as none, less than 60 min/wk, or 60 minutes or more/wk. Walking and running were similarly associated with the risk of CVD mortality. Participating in moderate-to-vigorous walking, bicycling, or running may be particularly beneficial for health and longevity (3).

 

    Another study examined whether 15 different types of exercise were uniquely associated with all-cause mortality in a nationally representative sample of noninstitutionalized American adults between 18 and 84 years old. A total of 26,727 American adults in the National Health Interview Survey who reported their exercise type(s) in 1998 were prospectively followed for all-cause mortality through the end of 2015 (4).

 

    During 17 years of follow-up, 4955 deaths occurred. After adjusting for the total volume of other exercises and confounders (demographic factors, socioeconomic status, and health behaviors and status), walking, aerobics, stretching, weight lifting, and stair climbing were related to lower risks of mortality (OR ranging from 0.78 to 0.93). When adjusting for engagement in all exercise types and confounders, stretching (OR = 0.90, 95% CI = 0.83-0.97) and playing volleyball (OR = 0.53, 95% CI = 0.31-0.93) were uniquely associated with lower risks of mortality. These findings suggest that some types of exercise have unique benefits for longevity, but most common activities such as walking are beneficial concerning longevity (4).

 

    The lifestyle factors in the elderly that affected longevity were examined in 440 men and 625 women aged 60 to 74 living in a rural Japanese community. The baseline data such as age, sex, present illness, walking hours per day, sleeping hours per day, alcohol consumption, a history of smoking, and "ikigai" (meaningfulness of life) were collected in July 1990. During 90 months of follow-up from July 1990 to December 1997, there were 123 deaths. By Cox's multivariate hazard model adjusted age, sex, and medical histories, walking > or = 1 hour/day (HR = 0.63, 95% CI 0.44-0.91) and an "ikigai" (HR = 0.66, 95% CI 0.44-0.99) lowered the risk for all-cause mortality for 37% and 34%, respectively. Regarding hours of sleep, the cumulative survival curve showed that 7 hours/day was the border, and sleeping > or = 7 hours/day lowered the risk 51%(HR = 0.49 95% CI 0.33-0.74). Based on the findings in this study, walking > or = 1 hour/day, sleeping > or = 7 hours/day, and "ikigai" are important factors for longevity in the elderly (5).

 

    A study was conducted in the Prefecture of Longevity, Okinawa, on the elderly living in the village of Ogimi. It was revealed that those in the good sleep health group took short naps, a significantly fewer number fell into dozes, and a significantly greater number exercised regularly or walked. A significantly greater number of this group maintained regular eating habits over 10 years and consumed more seaweed and fish. Participation in senior citizens' clubs was higher, reflecting high emotional adaptability. The study's results indicate a relationship between lifestyle and sleep health among the elderly, and suggest that deterioration of sleep health is related to physical and mental health (6).

 

    O'Keefe et al. made a good summary toward the question regarding how much exercise is good for well-being and longevity. They believe that humans are evolutionarily adapted to be very physically active throughout life, and thus habitual physical activity is essential for well-being and longevity. Nevertheless, middle-aged and older individuals engaging in excessive strenuous endurance exercise appear to be at increased risk for a variety of adverse cardiovascular effects including atrial fibrillation, myocardial fibrosis, and coronary atherosclerosis. An emerging body of evidence indicates U-shaped or reverse J-shaped curves whereby low doses and moderate doses of physical activity significantly reduce long-term risks for both total mortality and cardiovascular mortality, however, at very high doses of chronic strenuous exercise much of the protection against early mortality and cardiovascular disease is lost. The optimal dose, or what we term 'Goldilocks Zone,' of physical activity may be: at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous-intensity aerobic activity, but not more than four to five cumulative hours per week of vigorous (heart-pounding, sweat producing) exercise, especially for those over 45 years of age. It is also important to take at least one day per week off from vigorous exercise. There appear to be no concerns about an upper threshold for safety for leisure-time low-to-moderate intensity activities such as walking at a comfortable pace, housework, gardening, etc. After every 30 consecutive minutes spent sitting, stand up and move, ideally walking briskly for about five minutes (7).

 

    Maintaining or increasing physical activity in late-middle age is associated with a reduction in mortality. Expending 2000 or more kcal during exercise per week, or walking > or = 1 hour/day sounds an achievable goal for people who want to have successful healthy aging.

 

Reference List:

1. Paffenbarger, R. S., Hyde, R., Wing, A. L., & Hsieh, C. (1986). Physical Activity, All-Cause Mortality, and Longevity of College Alumni. New England Journal of Medicine, 314(10), 605–613.

2. PAFFENBARGER, R. S., HYDE, R. T., HSIEH, C.-C., & WING, A. L. (2009). Physical Activity, Other Life-style Patterns, Cardiovascular Disease and Longevity. Acta Medica Scandinavica, 220(S711), 85–91.

3. Porter, A. K., Cuthbertson, C. C., & Evenson, K. R. (2020). Participation in specific leisure-time activities and mortality risk among US adults. Annals of Epidemiology. Oct;50:27-34.e1.

4. SHEEHAN, C. M., & LI, L. (2020). Associations of Exercise Types with All-Cause Mortality among U.S. Adults. Medicine & Science in Sports & Exercise, 52(12), 2554–2562.

5. SEKI, N. (2001). Relationships between Walking Hours, Sleeping Hours, Meaningfulness of Life (Ikigai) and Mortality in the Elderly: Prospective Cohort Study. Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene), 56(2), 535–540.

6. TAIRA, K., TANAKA, H., ARAKAWA, M., NAGAHAMA, N., UZA, M., & SHIRAKAWA, S. (2002). Sleep health and lifestyle of elderly people in Ogimi, a village of longevity. Psychiatry and Clinical Neurosciences, 56(3), 243–244.

7. James H O'Keefe, Evan L O'Keefe , Carl J Lavie . (2018). The Goldilocks Zone for Exercise: Not Too Little, Not Too Much. Mo Med, 115(2):98-105.