Physical activity, fitness, and longevity

Area of Science:

• Cardiovascular disease research
• Exercise physiology
• Longevity studies

Background:

• Longevity is a key cardiovascular endpoint, influenced by cardiovascular disease (CVD), non-CVD risks, and physiological resilience.
• Physical activity (PA) and cardiorespiratory fitness (CRF) are consistently linked to reduced all-cause and CVD mortality.
• CRF integrates habitual PA, genetics, cardiopulmonary function, and comorbidity.

Purpose of the Study:

• Synthesize evidence on the link between PA and CRF and longevity.
• Highlight dose-response relationships and the impact of activity domain/intensity.
• Explain why CRF is a superior predictor of risk compared to self-reported PA.

Main Methods:

• Narrative review of existing evidence.
• Discussion of challenges in causal inference (confounding, bias, reverse causation).
• Emphasis on device-based PA assessment, repeated measures, and mechanistic/trial evidence.

Main Results:

• PA and CRF confer longevity benefits through multiple mechanistic pathways.
• These pathways include improved blood pressure, insulin sensitivity, body composition, vascular function, and reduced inflammation.
• CRF generally outperforms self-reported PA in predicting mortality risk.

Conclusions:

• PA and CRF are crucial for longevity, impacting various physiological systems.
• Clinicians should prescribe exercise using FITT principles and consider resistance training.
• Treating CRF as a vital sign and addressing implementation barriers are recommended.