by Dr. Lawrence Cheng, MD, and Dr. Ashley Riskin, MD
Exercise is one of the most important factors in extending life and reducing all-causes of mortality. It’s true. Some of the reasons why exercise is so beneficial is that it reduces cardiovascular risk factors.
Cardiovascular disease is still number one worldwide in terms of mortality. But we can fight it! Exercise decreases blood pressure, reduces risk of diabetes, improves lipid levels to a degree, and helps reduce stress.
Exercise also helps improve endothelial function and helps to balance autonomic nervous system by improving heart rate variability (HRV). Higher HRV has been associated with lower levels of many health conditions including cardiovascular disease.
Exercise decreases cancer risk likely through its beneficial metabolic effects. And exercise reduces inflammatory markers and decreases risk of Alzheimer’s.
The best drug for longevity – exercise/training
Our philosophy is that we want to be independent and strong 90-year-olds and we need to train aggressively for that today.
To achieve this, we need to be performing at an above average level of someone 10 years younger than us. It’s the same for you.
Try this: make a list of the things you want to be doing in the last decades of your life and work backwards from there. Are you exercising hard enough to get there?
There is a precipitous decline in physical fitness that occurs in our 70s. Without deliberate and consistent training, it is hard to avoid. The loss of bone, muscle mass and strength at this age significantly increases the risk of
fractures from falling with a mortality rate of approximately 50% in one year.
The exercise longevity prescription
The four components of exercise are stability, strength, aerobic and anaerobic performance. You need to work on all of these if you want health span (years alive in excellent health) and longevity. Exercising for longevity is different than exercising for performance.
For performance, athletes want to maximize cardiac output just below VO2max, which may in fact incur some costs in terms of longevity compared to training at lower energy system. But from a longevity standpoint, you want to spend more time training at a moderate intensity.
Aerobic Fitness and mortality
The research shows that there is a clear relationship between aerobic fitness and mortality. A study by Mandsager et al in 2018 showed that the more aerobically fit you were the lower your mortality. They looked at a group of 122,000, ranked them by VO2max and followed them for 10 years.
VO2max measures the maximum amount of oxygen your body can use during exercise. It is a marker of aerobic fitness.
The study showed if you just moved from the group that was categorized as low cardiorespiratory fitness (bottom 25 percentile) to below average (25th to 50 percentile), there is a 50% reduction in mortality over a decade.
This is equivalent to the risk reduction of quitting smoking. There continues to be a decrease in mortality as the aerobic performance improves to the elite category (top 5 percentile), but the but gains are more incremental.
Without exercise, VO2Max declines 10% by decade. If you maintain a high level of aerobic exercise, you decrease the rate of decline to about 5% per decade. You want to achieve a high peak Vo2max when you are younger so that you start at a higher baseline.
Moderate exercise (known as zone 2) helps to increase mitochondrial function (makes energy in our cells), improves metabolism, and increases BDNF (brain derived neurotrophic factor). Improved mitochondrial function correlates with longevity.
The general exercise recommendation is to spend ideally 3 – 4 hrs in zone 2 per week. Cycling, rowing, elliptical, brisk incline walking, and swimming are some forms of exercise where you can maintain a steady zone 2 level.
Advice for the average person who has never had serious training before:
Aim for 80% of the time for moderate intensity exercise (where you can talk but not easily) for 2- 3 hrs per week. Target heart rate is about 65% of your predicted heart rate maximum (220 – age).
After about 6 months, add interval training to improve Vo2Max. One protocol would be doing 4 minutes high intensity followed by 4 minutes of recovery. Repeat.
Zone 5 training (high intensity training) helps to improve VO2max. In terms of longevity benefit, we might not need to spend as much time here as we think. One or two 30-minute sessions of interval training is likely optimal.
In terms of whether you can do too much exercise, some studies do show a J shape curve in terms of the relationship between amount of exercise and mortality. Other studies have not shown an increase in mortality with very high levels of exercise.
There does seem to be an increased risk of atrial fibrillation, sudden cardiac death with extreme levels of exercise (associated with high volume endurance exercise), but the absolute risk is very small. The benefits of exercising far outweigh the risk of harms. We should be exercising more.
One key predictor of longevity is strength. This means, the stronger we are, the longer we will live. Both muscle mass and strength are correlated to improved lifespan.
There are many reasons for this. Increased muscle mass serves to protect us from falling as we age and if we do fall it protects our bones from breaking.
Lean body mass can be viewed as a metabolic sink that improves glucose and insulin regulation – a key factor in preventing age-related disease.
As we age, no one wants less muscle. We need to train today to have adequate muscle mass as we age as it is much easier to prevent muscle loss than it is to gain it.
And we lose approximately 1-2% of our muscle mass per year after age 50. During that same time, we lose 1.5-4% of our strength per year. That translates into a 35-40% loss in strength from our peak through our 80s. These losses compound and are profound.
In order to live well, be independent, fully mobile and a successful healthy 90-year-old, we must be strong.
And we can’t relax on this! Studies demonstrate that even a two-week period of bed rest can undo the benefits of six months of weight training in the elderly. In other words, it’s hard to put on muscle as we age but it’s easy to lose it.
Sarcopenia, the loss of muscle, is a challenging aspect of ageing that is paramount to preventing us from reaching our goals of longevity.
Strategies to combat muscle loss and maintain strength? Just lift and move heavy things. Resistance training is a must. However, so is injury prevention. Both form and stability help here.
If you aren’t used to lifting weights, then start slow but start. As you progress, you can work with a trainer or get instruction online. The key is to start if you aren’t working resistance. If you are, the key is to keep doing it and do it regularly and never stop. Ever.
Just like our own health goals, our goal for our patients is to be active and fit well into their 80s and 90s. To ensure they are able to workout then, we advise starting now, making it a habit and then never stopping.
Think of stability as your exercise foundation, the cornerstone upon which your strength, aerobic and anaerobic performance is delivered. And it’s the way that you do so safely. Unfortunately, it’s the one area most of us don’t do well enough.
It defines how we transmit forces from the body to the outside world. Stability allows for load to be carried across muscles without putting inappropriate force on joints. Less strain on those knees and backs!
We are born with great form and ability to transmit forces appropriately. Think of a two-year old squatting down to play with toys, their form is impeccable. Over time, our reliance on sitting and general lack of activity over the years results in loss in form and stability. We must work to maintain and preserve this as we train for our 8th decade and beyond.
Techniques such as dynamic neuromuscular stabilization (DNS) are modalities offering training in proper stabilization and movements.
Avoiding losing force in your joints is key to injury prevention. We are strong advocates of functional movement assessment to identify areas of need to avoid injury.
Working with a therapist to identify and correct issues can be impactful. Pilates and yoga can offer a focus on stability. The postural restoration institute is worth a review for those interested (posturalrestoration.com). Some exercises to consider: hip hinge, deadlifts, scapula stabilization and concentric intra-abdominal pressure exercises.
If anything, having stability at the forefront of your training will help bring awareness to form and serve you well on the injury prevention front, a key strategy to maintaining muscle mass and aging well.
Science has made it clear, longevity and healthspan can be manipulated through exercise. If you want to live a long and healthy life, maybe into your 9th decade and beyond, then we know the answer. It is exercise.
Make today the day you start exercising for your health and longevity. Focus on stability and strength and you’ll have the best chance of achieving your best, healthiest and longest life.
Dr. Lawrence Cheng, MD, CCFP(EM), MPH, is clinical co-director and co-founder of Connect Health Centre for Integrative and Functional Medicine.
Dr. Ashley Riskin, MD, is clinical co-director and co-founder of Connect Health Centre for Integrative and Functional Medicine.