Healthy longevity approaches as a potential for progressive health and fitness professionals

Highlights:

• There are 4 aging scenarios: prolonged senescence, compressed morbidity, decelerated aging, and arrested aging
• Statistics show that the population worldwide is rapidly aging which causes a plethora of problems 
• Longevity approaches should be included in the portfolio of health and fitness professionals to prevent the aging-related problems
  

Introduction

Over the past decades, the implementation of vaccination, antibiotics, and disinfectants resulted in a significant reduction of infectious diseases as a leading cause of death. Continuing decline in mortality throughout the last decades among the elderly is most likely due to the widespread implementation of healthy lifestyle behaviors such as proper diets, exercise, and reduction in tobacco smoking. The longer average lifespan of society gives new opportunities as well as new challenges. Population aging imposes a significant strain on economies, health systems, and social structures at the current pace. However, we are also in the middle of the so-called 'longevity boom'.

The aging scenarios

Based on the ability of science to improve the human organism's capacity to preserve and repair itself, scientists and demographers now predict a few scenarios for the future of human aging. These perspectives from the most pessimistic to most optimistic (and unrealistic) are:

• Prolonged senescence is the most pessimistic prediction where no increase in maximum life expectancy or quality of life would be present. Society would age over a longer time and live longer but not necessarily in good health. 
• Compressed morbidity when delaying the start of chronic diseases associated with old age would increase average healthspan but not lifespan. People would live a relatively similar lifespan as they do currently but with a much healthier and active lifestyle late into their 80s and 90s and the result would be a society with more older adults who are healthy and active, building a longevity economy.
• Decelerated aging targets the fundamental processes of aging to increase both average and maximum lifespan. The aging process would be a more extended period, giving people more active years before the evident decline. It is suggested that a mean life expectancy of  112 years could be standard, and  90-year older adults would be as healthy and active as those currently in their fifties.
• Arrested aging where the aging would be halted by continuous repair of damage in cells. The result would be allowing people to grow several thousand years old (1).

At the moment, we are the closest to the first scenario.

Statistics first 

The global demography is visibly shifting. Today 8.5 % of people worldwide are aged 65 and over. By 2050, this percentage is estimated to more than double and reach 1.6 billion, representing around 20 % of the global population. The population of people of age 80 and older is expected to more than triple between 2015 and 2050, growing to 447 million. It means that soon the world will have more older people than children (2).

Bloom et al. projected in 2015 that the proportion of people aged 60 years and above increased from 8 to 10 % during the last 60 years. In the next 40 years, however, faster growth of the total world population is expected, and this group should increase to 22 % up to 2 billion people. Nevertheless, the rise of life expectancy is not followed by the same increase in healthspan (3). The future, then, might be associated with a higher burden of illness, disability, and dependence on others; all of which the research field of gerontology aims to prevent (2).

The problems of an aging population

Rapidly changing demographics will visibly affect all aspects of society. The report prepared by Pew Research Center in 2014 states that citizens of the fastest aging countries are the most worried about the outcome.  An increasingly older population might lead to a health and social care services crisis. Aging brings a range of diseases, and caring for the elderly is a burden that many societies cannot deal with due to resource shortages. Beyond health and care, an inverted population pyramid where there is more elders than young adults and children has other disadvantages for society, affecting everything from pensions to housing (2). Aging is the main factor for most chronic pathologies. The prevalence of age-related diseases rises significantly, increasing the average lifespan, representing a socio-economic problem in developed societies. 

Recently it was estimated that more than 30 million people aged over 80 years will be residing in the United States by 2050; about half of these subjects would suffer from dementia, and about 3 million would be diagnosed with Parkinson's disease. The expected increase in the prevalence of aging-related pathological conditions will significantly impact economic productivity in many countries during the coming years, including enhancing psychological and financial burden for families and considerable pressure on the government healthcare programs and budgets (3). Older people are less likely to work due to deteriorating health while still needing physical and economic support. These securities will be the responsibility of a smaller portion of the population. Pension and retirement systems will be overwhelmed, and new retirement policies will be needed. If still based on treating age-related diseases instead of prevention and healthy longevity approaches, health systems would face staff and financial shortages. With the aging trend that we face now, a quick reaction is needed (4). 

The future is not necessarily grim

Each day we are bombarded by promising results of medical and technology research. New preventive and social strategies are developed to change the way we age and provide better health, function, and productivity for the elderly, but numerous solutions are still needed. It is common to believe that growing old and losing vitality is inevitable.  However, aging is a flexible trait that can be influenced both by genetic predispositions and environmental factors. We do not age the same way, and even identical twins could have very different aging patterns (5). 

Geroscience is an interdisciplinary field of research that aims to understand the mechanistic links between aging and aging-associated diseases and is centered primarily on the extension of healthspan.'Geroscience hypothesis'states that aging could be manipulated in such a way that will, in parallel, allow delaying the start of all age-associated chronic disorders because these pathologies share age as the primary underlying risk factor. Healthspan extension is the main goal of interventions to achieve healthy longevity where patients will be living longer but with good health and quality of life, including improved productivity, functioning, and independence. Currently, the research attempted to enhance healthspan focuses primarily on slowing the hallmarks of aging, such as mitochondria dysfunctions or impaired proteostasis. These processes interact, influencing each other to maintain the normal cellular signaling pathways and support organismal homeostasis. However, the compensatory mechanisms mediating these processes became exhausted when reaching a certain age. Various aging aspects are manifested, enhancing the risk of functional declines and progression of age-associated chronic pathologies (3). One genetic mutation in evolutionarily conserved pathways across model organisms can sometimes increase lifespan significantly and prolong the healthspan. It means that the rate of aging is not rigid. Advancing age does not always go hand-in-hand with fragility and poor health. When the population is getting older, the understanding of how the healthspan can be prolonged is crucial. This knowledge might enable people to be productive and active social and economic life members for longer (2).

If aging is not an inadmissible component of life, then it might be manipulated. Gerontology proves that age-associated senescence is a complex pathophysiological process that could be prevented or even reversed. Currently, biotechnological innovations that potentially may slow down or postpone processes involved in aging are extensively implemented in anti-aging medicine. Achievements in this field are attributed mainly to the increasingly widespread implementation of 'omics' platforms such as genomics, transcriptomics, proteomics, and metabolomics. The broad implementation of such technologies gave a deeper understanding of the fundamental molecular and cellular processes underlying aging. This new knowledge develops novel therapeutic strategies to counteract age-associated pathological conditions. In the long run, the most promising among them is stem cell- and gene therapy-based approaches. Presently, however, due to insufficient knowledge regarding the potential side effects of these technologies, including cancer, uncertainties and concerns still prevail about their safety among the general public and medical professionals. Therefore, using more traditional pharmacological interventions can be considered a reasonable alternative (3).

‍

What is the most needed now?

Developing efficient health interventions, such as disease-prevention and health-promotion programs that target significant causes of morbidity in the elderly, might minimize the cost pressure related to population aging by helping the population to stays healthy until old age. The worldwide demographic trend of increasing the proportion of elderly persons in various countries could likely explain the dramatic rise in interest of both the general public and medical communities in biogerontology research. The research aimed to promote human longevity understandably raise concern among the general public, policymakers, and government regulators regarding the growth of the older population and, consequently, the higher prevalence of chronic diseases associated with aging. However, experimental studies conducted in various animal models have shown that artificial life extension is often accompanied by reduced or delayed morbidity, including neurodegeneration, CVD, and cancer. For example, a dietary restriction was shown to extend the lifespan, slow the functional decline rate, and delay the prevalence of age-related chronic diseases in different model organisms. There is also accumulating epidemiological evidence, which is consistent with findings from animal studies. For instance, centenarians, particularly those residing in so-called 'Blue Zones', have exceptional longevity and remain free from disabilities and chronic illness to very old age (6). These findings mean that the prevention and spreading the idea of a healthy, longevity lifestyle should be the first aims of every health and fitness professional.  

1.    Lucke JC, Hall W. Who wants to live forever? EMBO Rep. 2005;6(2):98-102.

2.    The Lancet Healthy L. The Lancet Healthy Longevity: Health For All, For Longer. Lancet Healthy Longev. 2020;1(1):e1-e.

3.    Vaiserman A, Lushchak O. Implementation of longevity-promoting supplements and medications in public health practice: achievements, challenges and future perspectives. J Transl Med. 2017;15(1):160.

4.    Bloom DE, Chatterji S, Kowal P, Lloyd-Sherlock P, McKee M, Rechel B, et al. Macroeconomic implications of population ageing and selected policy responses. Lancet. 2015;385(9968):649-57.

5.    Guyuron B, Rowe DJ, Weinfeld AB, Eshraghi Y, Fathi A, Iamphongsai S. Factors contributing to the facial aging of identical twins. Plast Reconstr Surg. 2009;123(4):1321-31.

6.    Buettner D, Skemp S. Blue Zones: Lessons From the World's Longest Lived. Am J Lifestyle Med. 2016;10(5):318-21.