The effects of exercise on longevity

Highlights:

• Every exercise brings benefits, even a light one
• The best is to spend more than half of your exercise time on aerobic exercise and combine it with strength training
• It is recommended to move a bit every 30 minutes or 1 hour, changing from sitting to a standing position
  

Introduction

With increasing average age, it is becoming more and more essential to improve the quality of life of the elderly. Lifestyle may play a crucial role in this, and exercise presents a natural and available tool to improve health and overall outlook. Both physical exercise and moving around bring many benefits. Let's take a look at how both physical and non-physical activity affects the longevity and health of your patients.

Physical exercise: improve your health in many aspects

In the coming 40 years, the number of adults aged 65 years and older in Europe, as an example, is expected to be more than double. In conjunction, the number of elders with chronic diseases related to age is growing. What is needed for our aging population now are effective and affordable therapeutic interventions to prevent these chronic conditions. The few most promising ones are the simplest ones: vitamin D and marine omega-3 fatty acids supplementation and physical exercise, the latter of which we would discuss. (1)

Exercise is one of the most critical health factors, regardless of age, with diet and sleep. The positive effects of exercise for your patients are numerous. They involve almost every aspect of the body and brain by decreasing risk, treating, and preventing at least 35 diseases, including non-communicable and, in particular, cardiovascular diseases (CVD) (2).

Benefits of exercise

Let us take a look at the effect of exercise on longevity. A study of 102 healthy seniors showed that 4-7 exercise sessions per week resulted that left ventricles functioned as in younger individuals, thus contributing to the prevention of cardiovascular diseases (3). Lifelong aerobic exercise is associated with reducing arterial stiffness in the elderly (5 sessions per week) and reducing ventricular afterload (2 to 3 sessions per week). But not only lifelong exercise brings benefits - it is never too late to start. Research on a group of men in their mid-fifties had shown that when they began an exercise regime that they kept for two years, it improved their maximum oxygen uptake and cardiac stiffness (4).

What other benefits can physical activity bring? Hypertension prevention has a positive effect on blood pressure and coronary heart disease, reducing the risk of cardiovascular mortality. It is also as efficient as glucose-lowering medication when treating type 2 diabetes. 56% of patients undergoing 5-6 weekly aerobic sessions lasting 30 - 60 minutes (half of them combined with resistance training) could safely stop taking glucose-lowering medication (4).

Exercise also has an anti-cancer effect, decreasing the risk of contracting 13 cancers (esophageal, liver, or stomach cancer (5)) and improving the chances of surviving when already sick, impacting tumor growth. Active people also have a 40% decrease in risk of Alzheimer's disease, reducing the symptoms and helping in preserving the cognition with patients with a mild version of the disease (6). And what type of exercise can bring all those benefits? 150 minutes per week of moderate aerobic activities, such as walking, jogging, or cycling) or 75 minutes per week of more intense aerobic exercise. It is also recommended to add strength training to aerobic exercise to improve muscle mass (2).

How much should you exercise?

World Health Organization recommends (7) for adults between 18 - 64 years of age to do at least 150–300 minutes of moderate-intensity aerobic physical activity, or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week. When it comes to the benefits of the exercise program, the experts are still debating if the more is the merrier. The recommended amounts of exercise may be surpassed three to five times to provide the most longevity benefits (2). Still, there are growing concerns about a highly active population that engage in an exercise program five or ten times more than recommended. Over three million individuals were observed in extensive studies (8) that all concluded that dose-benefits of physical exercise create a reverse J-curve. It means that the most unhealthy behavior is not exercising at all. The risk decreases (and benefits steeply increase) till they reach optimal levels in around several hours per week and increase again as the volume of exercise increases. In a nutshell, too low and too high volumes of physical activity present increased health risks, especially for the cardiovascular system. What are the possible risks of overdoing exercise? It may be a high risk of arrhythmias such as atrial fibrillation (AF). It is documented in endurance athletes that presented 5-times more incidence of AF than the sedentary control group (9). Increased risk of ventricular tachycardia (one of the symptoms of the athlete heart syndrome) was described within former Swiss professional cyclists (10). Myocardial fibrosis, detected by late gadolinium enhancement (LGE), correlates with the number of training years and the number of completed competitions (11). 

Coronary artery calcification is twice likely to be found in athletes; nevertheless, the plaque composition is more stable and benign (8).

The risks associated with overdoing exercise are not always chronic. There is an increased risk for acute myocardial infarction during or soon after exercise, with the risk varying between 2- and 17-fold according to different studies and rising for the most sedentary individuals.

To summarize, there is a "sweet spot" of the optimal amount of exercise that brings the most benefits to health and longevity. Increasing the exercise volume up to this point is always beneficial; exceeding this number of hours may be detrimental, as shown in many studies done on professional athletes.

Non-physical exercise: prevention of sedentary problems‍

We have concluded that for health and longevity, it is essential to undergo a regimen of cardiovascular exercise for 5 hours a week/0.75 hours a day in the optimal case. Again, WHO recommends (7) that adults between 18 -64 years of age limit the amount of time spent sedentary. Replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits. But what happens in the rest of the day and week? Would this physical exercise offset the dangers of a sedentary lifestyle?

This question was answered by a study on a Stockholm-based 60-year old men and women cohort (12) that examined the association between NEPA (non-exercise physical activity) in their daily lives and cardiovascular health, risks of cardiovascular events, and total mortality. A total of 4232 individuals was followed for a decade to assess the cardiovascular events and mortality. The scientists concluded that - regardless of regular physical exercise - high amounts of NEPA brought several health benefits for both men and women. Those benefits included lower waist circumference, a preferable level of HDL cholesterol, and in men lower levels of insulin, glucose, and clotting protein fibrinogen (12). Those high levels were also correlated with a lower risk of a first cardiovascular event and all-cause mortality. 

Other authors reach the same finding: NEPA is key to health and longevity. They studied the criteria of NEPA for preventive and rehabilitative care, such as verticality (standing), frequency (once every 30 or 60 minutes), and duration of the exercise (at least one minute (13). Another example of the importance of movement can be found at the island of Ikaria, a longevity blue zone. Physical activity levels were moderate or high for 71.8% of participants. (14) 

Conclusion: An exercise is an excellent form of prevention and treatment

Exercise is one of the lifestyle factors that can significantly improve the life of everybody, including your older patients. From cardiovascular diseases to diabetes or Alzheimer's disease, aerobic exercise is one of the best prevention and treatment. The positive effects of exercise are numerous and involve almost every aspect of the body and brain, as was described by Juvenal in Mens sana in corpore sano. To achieve an optimal level of health, it is also essential to avoid a sedentary lifestyle and engage in regular, brief movements over the day. And like most medication and lifestyle measures, exercise should be performed in moderation - the benefits increase significantly up to the sweet spot and later on, plateauing or even decreasing.

References

1. Bischoff-Ferrari HA, de Godoi Rezende Costa Molino C, Rival S, Vellas B, Rizzoli R, Kressig RW, et al. DO-HEALTH: Vitamin D3 - Omega-3 - Home exercise - Healthy aging and longevity trial - Design of a multinational clinical trial on healthy aging among European seniors. Contemp Clin Trials. 2021;100:106124
2. Pedersen BK. Which type of exercise keeps you young? Curr Opin Clin Nutr Metab Care. 2019 Mar;22(2):167-173. doi: 10.1097/MCO.0000000000000546. PMID: 30640736.
3. Howden EJ, Sarma S, Lawley JS, Opondo M, Cornwell W, Stoller D, Urey MA, Adams-Huet B, Levine BD. Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial: Implications For Heart Failure Prevention. Circulation. 
4. Johansen MY, MacDonald CS, Hansen KB, Karstoft K, Christensen R, Pedersen M, Hansen LS, Zacho M, Wedell-Neergaard AS, Nielsen ST, Iepsen UW, Langberg H, Vaag AA, Pedersen BK, Ried-Larsen M. Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA. 2017 Aug 15;318(7):637-646. doi: 10.1001/jama.2017.10169. PMID: 28810024; PMCID: PMC5817591.
5. https://media.jamanetwork.com/news-item/physical-activity-associated-with-lower-risk-for-many-cancers/
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7.  Physical activity, https://www.who.int/news-room/fact-sheets/detail/physical-activity
8. O'Keefe EL, Torres-Acosta N, O'Keefe JH, Lavie CJ. Training for Longevity: The Reverse J-Curve for Exercise. Mo Med. 2020 Jul-Aug;117(4):355-361. PMID: 32848273; PMCID: PMC7431070.
9. Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study. BMJ. 1998 Jun 13;316(7147):1784-5. doi: 10.1136/bmj.316.7147.1784. PMID: 9624065; PMCID: PMC28577.
10. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008 Jan;29(1):71-8. doi: 10.1093/eurheartj/ehm555. Epub 2007 Dec 7. PMID: 18065754.
11. Wilson M, O'Hanlon R, Prasad S, Deighan A, Macmillan P, Oxborough D, Godfrey R, Smith G, Maceira A, Sharma S, George K, Whyte G. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol (1985). 2011 Jun;110(6):1622-6. doi: 10.1152/japplphysiol.01280.2010. Epub 2011 Feb 17. PMID: 21330616; PMCID: PMC3119133.
12. Ekblom-Bak E, Ekblom B, Vikström M, et al, The importance of non-exercise physical activity for cardiovascular health and longevity, British Journal of Sports Medicine 2014;48:233-238.
13.  Mobility-Non-Exercise Physical Activity (NEPA) is the key to health and longevity, https://www.peertechzpublications.com/articles/JNPPR-7-167.php
14.  Legrand R, Nuemi G, Poulain M, Manckoundia P. Description of Lifestyle, Including Social Life, Diet and Physical Activity, of People >/=90 years Living in Ikaria, a Longevity Blue Zone. Int J Environ Res Public Health. 2021;18(12).

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