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In the pursuit of a longer and healthier life, it's essential to focus on both the quantity and quality of the years we live. Healthy longevity—free from chronic diseases—requires attention to both morbidity and mortality. This approach offers valuable insights for health professionals, the public, and policymakers alike, shifting the focus from merely treating illnesses to preventing them.

Physical activity plays a pivotal role in this shift, particularly as our population ages. Active adults not only live longer but also enjoy more years in good health. Meeting the recommended 150 to 300 minutes of moderate intensity of 75 to 150 minutes of vigorous intensity physical activity per week provides substantial benefits. Doubling this amount may yield even greater rewards. For the best results, combine aerobic exercises with 2 days of resistance training to maximize health benefits.

The advantages of higher physical activity levels extend well into older age, helping to prolong life and increase the years spent free of chronic diseases. It's important to encourage those who are inactive to start incorporating physical activity into their routines. Significant health benefits can be achieved without needing to reach the highest activity levels. Moreover, adults already engaging in high levels of activity should continue, as they may gain additional modest benefits beyond the recommended amounts.

Q: Is there a difference between strength training and cardiovascular training on life expectancy/longevity?

Studies show that both aerobic and strength training individually lower mortality risk compared to no exercise. However, combining both types of exercise offers the greatest longevity benefits. Aerobic and strength training provide distinct and complementary health benefits, making the combination of the two optimal for overall health.

Q: From your data it appears that the years with cardiovascular disease (CVD) are similar (6-7 years) regardless of physical activity level. Can you comment on this?

Research indicates that more active individuals tend to have a longer total life expectancy and a longer healthy life expectancy. And for an active person who develops cardiovascular disease their higher levels of fitness can result in a stronger, more resilient body that can help them live longer even with the disease. Therefore, the number of years with disease may be similar between active and inactive individuals. Importantly, those who are more active often experience less severe disease and fewer recurrent events once they are diagnosed with a disease. Thus, even if the duration of illness is comparable in active vs inactive adults, the overall burden and severity of the disease are generally lower in active individuals.

Q: Health is related to income, education, etc. How have these been excluded in your data?

Physical activity is just one factor in living a healthier, longer life. Variables such as income, education, genetics, age, sex, and lifestyle factors (e.g., smoking, sleep) also play significant roles. In observational studies on physical activity and longevity, we account for these variables in our analyses. However, it's impossible to fully control for every factor. Thus, while physical activity is crucial, it is only one component of overall health.

Q: Can engaging in light to moderate everyday activities suffice for being deemed physically healthy without fitness exercises?

For optimal health, it's recommended that healthy young to middle-aged adults engage in moderate to vigorous intensity physical activities. While light intensity activities are better than a sedentary lifestyle, incorporating moderate to vigorous intensity exercise provides greater benefits. For older adults or those with chronic conditions, moderate intensity activities, or the highest intensity they can manage, are advised. Particularly for older adults, research has shown that light intensity activities can still offer longevity benefits.

Q: How does physical activity before puberty influence longevity?

Most longevity research focuses on cohorts starting from young adulthood (18+ years old), so there's limited data on the impact of childhood physical activity. Importantly, one of the major determinants of being active as an adult, is your history of physical activity, including whether you were active as a child. Developing a joy and commitment to being active early can lead to lifelong activity as an adult and contribute to a healthier, longer life.

Q: What is the threshold of excessive resistance training for adults?

The association between resistance training and mortality risk follows a J-shaped curve, with maximum risk reduction at about 30–60 minutes per week of muscle-strengthening activities. Benefits extend up to approximately 130–140 minutes per week. There are no well-established physiological mechanisms explaining why higher doses of resistance exercise may not provide additional benefits for mortality. However, two possible mechanisms could be increased arterial stiffness and chronic inflammation. Due to the small number of individuals engaging in very high levels of resistance training, research has not been able to definitively conclude whether there are risks of excessive training and at what volume should be consider too high.

Q: Do high volumes of aerobic activity increase the risk of overuse injuries while aiming to increase lifespan?

The majority of longevity benefits do not require very high volumes of activity. Most of the benefits are achieved by meeting the physical activity guidelines of 150-300 minutes of moderate or 75-150 minutes of vigorous activity per week. Participation in exercise and physical activity increases the risk of musculoskeletal injuries, particularly during the activity itself. The intensity and type of exercise are important factors related to the incidence of injury. Walking and moderate-intensity physical activities are associated with a very low risk of injury, whereas jogging and competitive sports carry a higher risk of injury. Common methods to reduce injury can be helpful - such as stretching, warm-up, cool-down, and gradually increasing exercise intensity and volume.

Overall, being physically active across the lifespan may lower the risk of injury during daily living. For example, active older adults are less likely to experience serious falls, which are a leading cause of injury and disability in this age group.

Q: What are your guidelines for defining moderate and vigorous activity? Do you use heart rate, RPE, etc.?

One simple method is the talk test: for moderate activity, you can hold a conversation but not sing; for vigorous activity, you can only speak a few words at a time. Using heart monitors like wrist worn devices or chest straps, moderate intensity is 65-75% of maximal heart rate (%HRmax) and vigorous intensity is 76-96% HRmax. Rate of perceived exertion (RPE) is another method where on a scale of 0 to 10, moderate intensity targets an RPE of 3-4, while vigorous exercise targets an RPE of 5-7.

Q: One of the major issues in society is that in the age of convenience, activities of daily living have become more sedentary. Examples include online shopping, Amazon orders, and DoorDash, which contribute to a spoiled lifestyle. Technology has deterred people from being more active. As a personal trainer, what is the best approach to advise clients to avoid using convenience as a deterrent to being active?

With the rapid growth of technology, various conveniences can limit our daily physical activity. Setting a step goal is an effective strategy to encourage more movement and less sitting. We have shown that taking more steps per day is associated with a lower risk of death. Instead of using delivery services, clients can be encouraged that by walking through the grocery store, there is an opportunity to take 1,000 more steps toward a step goal. Similarly, opting for manual tasks like vacuuming instead of using a robot can help increase daily steps and overall activity. These small changes toward making your everyday life more active and less sedentary can be meaningful for health and longevity.

In summary, embracing an active lifestyle is not an all-or-nothing proposition. By making consistent efforts to stay active, we can all enjoy the benefits of a healthier, longer life.