Push Harder, Live Longer

The Longevity Potency of Exercise

For every disciplined effort there is a multiple reward.

– Jim Rohn

Nothing worth having was ever achieved without effort.

– Theodore Roosevelt

What does not kill me makes me stronger.

–  Freddy Nietzsche

Only the most foolish people sign up for biostasis and then assume that they need do nothing else. Wiser people – surely the vast majority – understand that plenty remains to be done to maximize their chances of a long life, including the probability that they will live further after revival from biostasis. They know they can improve their odds by measures such as living in an area where their biostasis organization can get to them quickly, keeping their funding in place, and other actions.

An obvious but challenging way to improve your odds is to optimize your health. Having emotional support and good sleep are two of the most effective approaches. Diet and exercise are the other two. Optimal diet remains extremely controversial. Experts cannot even agree on the best mixes of fats, proteins, and carbohydrates. Experts also disagree over exercise but less so.

My goal in this essay is to highlight the powerful role of exercise in reducing your risk of death. While many may agree with this, they often do less than what is optimal. By vividly illustrating the benefits, I hope to encourage more consistent and effective exercise habits. The right types and amounts of exercise obviously improve your odds of living in good health and maintaining function as you age. That makes sense whether or not you have biostasis arrangements. For those of us committed to biostasis, exercise has two other crucial benefits.

First, regular exercise is likely to extend your lifespan by several years. During that time biostasis may well improve – whether in technical capabilities such as cryoprotectant effectiveness and toxicity reduction – meaning that you may go into biostasis in better condition – or in organizational capabilities affecting response time.

Second, when the time comes for biostasis your body and brain will be in better shape and so are likely to be better preserved. With a well-conditioned cardiovascular system, you will probably be perfused better. You will also be less likely to suffer identity-damaging events such as strokes, aneurysms, and unexpected and sudden cardiac arrest.

Keep in mind that exercise is natural for human beings. By “natural” I mean it is something we have evolved to do. Our bodies “expect” to be exercised. Over many thousands of years our bodies have been shaped into biological machines that respond to exercise and the decline without it.

Benefits of exercise

There are too many to cover in any detail. A simple listing makes evident the pro-health and pro-longevity power of exercise.

• reduces all-cause mortality

• reduces cancer risk

• reduces risk of heart attacks

• reduces risk of strokes

• spurs neuronal growth

• improves brain oxygenation

• improves memory

• improves mood and fights depression

• reduces risk of diabetes

• reduces blood pressure

• reduces obesity

• reduces risk of Alzheimer's

• destroys the most dangerous fats

• increases VLDL particle size, easing breakdown

• improves insulin sensitivity

• reduces triglyceride levels

• increase high-density lipoproteins

• increases tissue plasminogen activator activity

• reduces coronary artery calcium

• reduces cardiac stiffness

• activates AS160 which helps absorb glucose

• helps replenish ATP

• activates AMPK which helps burn fat and sugar and boosts disposal of harmful DNA

• reduces fat deposits which reduces inflammation

• increases BDNF, supporting growth of new neurons

• makes tissues sensitive to endogenous GLP-1

A 2009 study of more than 50,000 men and women by exercise researcher Steven Blair found that a lack of cardiorespiratory fitness was the most important risk factor for early death. Blair reported that lack of exercise accounted for about 16 percent of all deaths in men and women over the period of study. That is more than the combined contributions of obesity, diabetes and high cholesterol, and double the contribution of smoking. Lack of exercise has contributed to a massive increase in diabetes, from 15 million people in 1935 to 300 million expected in 2025.

The official recommendation is for 150 to 300 minutes per week of moderate-intensity aerobic activity, such as brisk walking, ballroom dancing or gardening, or 75 minutes of more vigorous activity such as cycling, running or swimming. According to the Exercise is Medicine initiative of the American College of Sports Medicine this modest amount of exercise reduces the risk of premature death through heart disease by 40 percent, approximately the same as taking statins – but with none of the side effects.

We can find plenty of information about reduction of specific disease risks from exercise in “Does Physical Activity Increase Life Expectancy? A Review of the Literature” by Reimers, Knapp, and Reimers in the Journal of Aging Research. Physically active persons can expect 3.5 to 4.0 years higher life expectancy. In one of the 13 studies, the gain was 6.9 years. The NIH puts the benefit at 4.5 years. This means exercise can prevent more premature deaths than any particular medical treatment and with no medication side effects.

Adequate exercise reduces the risk of breast cancer by 20% to 50%, colon cancer by 30% to 40%, bowel cancer by 60%, diabetes mellitus type 2 by 28% to 59%, stroke by 27% to 40%, and perhaps also reduces the risk of endometrial, lung, and pancreatic cancer. Being physically active reduces the relative risk of death by 20% to 35%. That implies approximately 3.5 to 4.0-year higher life expectancy.

What if you are already sick? Will exercise help then? The same study also found that exercise had a more powerful effect on those with a history of cancer or heart disease than among those without those diseases.

The number of extra years of life expectancy vary depending on the study but they are always positive and most find multiple extra years. These numbers may understate the potential effect you could expect from an optimal exercise routine. If you can gain 4 or 5 years by doing moderate exercise in line with the guidelines, could you gain more by doing more exercise? Also, these studies mostly seem to look only at one type of exercise. If you do aerobic exercise and resistance exercise, might you gain even more years?

How exercise wards off disease

Everyone knows that exercise is good for your health and function. Much less well known is the wide range of ways that exercise benefits us. After a bit of thought most people might come up with a few factors – exercise helps with blood pressure, improve blood fats, and strengthens bones. My above (incomplete) list of 26 ways in which exercise benefits us shows that there is much more to the exercise effect.

Aside from obvious functional improvements, probably the most well-known benefit is the cardioprotective effect. This matters plenty for those of us planning to go into biostasis. We really, really do not want to have unexpected cardiac failure, nor a massive stroke, nor a ruptured aneurysm blowing a hole in our brain. For the exercise-resistant let me therefore point out all the ways in which exercise helps you to avoid that ugly fate.

Those bothersome blood fats

Exercise improves your lipid profile – the kinds and amount of fats in your blood – by changing seven things: HDL cholesterol, LDL cholesterol, triglycerides, total cholesterol, particle size, lipoprotein lipase activity, and insulin sensitivity.

For decades both medical authorities and laypeople have focused on total cholesterol. It turns out that total cholesterol alone tells us little about cardiovascular risk. Lipids do not harm you unless they cause lesions in your blood vessels. Total cholesterol tells us nothing about that. The focus shifted to the amounts and ratio of high and low-density lipoproteins (HDL and LDL). Those who paid attention to the research soon realized that other factors mattered too. These include triglycerides, VLDL particle size, degree of oxidation of VLDL, LDL-C to HDL-C ratio, and Apolipoprotein B (ApoB).

Do not expect your general practitioner to be current on these risk factors. Some are stuck several decades in the past. Others learned certain things that turned out to be wrong but have not updated. For instance, my wife recently went to a new personal care physician (PCP) and asked for several blood tests. The doctor said there was no point checking VLDL particle size because it is fixed. In fact exercise can increase VLDL particle size by something like 25%. Larger, more buoyant LDL particles are less atherogenic than smaller, denser LDL particles. The bigger the VLDL particles are, the easier it is for enzymes to break them down. Exercise may also increase the size of HDL particles, making them more effective in their job of removing cholesterol from the bloodstream.

Vigorous exercise improves levels of HDL and LDL. It can increase HDL levels by 5 to 20% and reduce LDL by a more modest 5 to 10%. Physical activity improves clearance of LDL from the bloodstream and reduces the production of new LDL particles by the liver.

You want to keep your triglyceride level under control because triglycerides can contribute to plaque formation (atherosclerosis). Plaques narrow the arteries and stiffen them, restricting blood flow and increasing the risk of blockages, which can lead to heart attacks or strokes. High triglyceride levels are linked to increased inflammation in the blood vessels. Inflammation can weaken the plaque, making it more prone to rupture. A rupture can lead to the formation of a blood clot, further obstructing blood flow and potentially causing a heart attack or stroke.

High triglycerides are often linked to the presence of the more atherogenic small, dense LDL particles. As if that were not enough, elevated triglycerides are a component of metabolic syndrome and are often associated with lower levels of high-density lipoprotein (HDL) cholesterol. High triglycerides can increase the viscosity (thickness) of the blood, making it more difficult for the heart to pump blood efficiently. Thicker blood can also promote clot formation, further increasing the risk of heart attacks and strokes. Another bad effect: an imbalance in blood lipids, leading to endothelial dysfunction. This reduces the ability of blood vessels to dilate, increases blood pressure, and promotes the development of plaques.

Vigorous exercise enhances the activity of enzymes that break down triglycerides and improves the utilization of fatty acids for energy. It can also reduce triglycerides by 20-30%. Changes in blood indicators often take considerable time to show themselves. But exercise can reduce triglycerides within 24 to 48 hours after a single intense session. This happens because of increased lipoprotein lipase activity and improved insulin sensitivity.

Insulin sensitivity, diabetes, cancer, and neurodegeneration

Exercise improves insulin sensitivity which indirectly improves lipid metabolism. Exercise increases the activity of enzymes such as lipoprotein lipase which helps break down fats in the blood. It also enhances insulin sensitivity, which can further improve lipid profiles by reducing the liver's production of harmful lipids. By altering the structure of fatty triglyceride particles in the bloodstream exercise helps enzymes destroy them before they cause trouble. The improvement in insulin sensitivity means that exercise reduces the risk of metabolic syndrome – a cluster of dangerous conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

The Exercise is Medicine initiative found that even a modest amount of regular exercise lowers the chances of developing type 2 diabetes by 58 per cent. That is twice the effect of taking metformin, the most widely used anti-diabetes medicine. The improved response of cells to insulin causes excess glucose to be removed from circulation. Each bout of exercise produces that effect for up to two days.

Cancer, dementia, and neurodegeneration are all warded off by exercise. Exercise stimulates AMPK which helps burn fat and sugar and boosts burning of rubbish, faulty, or mutated DNA that can trigger cancer. The same process in brain cells suggests that exercise may help prevent dementias and neurodegeneration. Brain imaging studies of older adults found that exercise increased hippocampus volume by around 2 per cent – making up for two years of age-related decrease – and improved memory by 15% to 20%.

Heard enough? Sorry, there is more.

Power up your immune system

Most people would probably agree that exercise improves the immune system. But how does it do this? In many ways. Exercise enhances immune surveillance by increasing the circulation of immune cells, such as natural killer cells, T cells, and macrophages which identify and neutralize pathogens, such as viruses and bacteria. Exercise promotes the flow of lymph which contains white blood cells and filters out harmful substances.

In recent years science has come to recognize a major role of chronic inflammation in weakening the immune system and in causing heart disease, diabetes, and cancer. Regular exercise reduces chronic inflammation by decreasing the production of pro-inflammatory cytokines and increasing the release of anti-inflammatory molecules, such as cytokines and myokines from muscle tissue. Exercise helps regulate the levels of stress hormones, such as cortisol, which, when elevated, can suppress immune function. It can slow down or even partially reverse aspects of immunosenescence – especially the function of T-cells – helping older adults maintain a more robust immune system.

If you have the means, you can maximize the immune system-boosting effects of exercise by undergoing thymus-regenerating treatment with human growth hormone. I was fortunate to be able to do that almost ten years ago in the first clinical trial to rejuvenate the immune system. Not only did it succeed in regrowing the cortical cells of the thymus, analysis by aging clock expert Steve Horvath suggested a substantial reduction in overall biological age.

Another way exercise helps you to stand up to pathogens is by stimulating the production of antioxidants in the body, which help neutralize free radicals and reduce oxidative stress. Oxidative stress can damage immune cells and impair immune function. Not too surprisingly, regular exercise has also been found to improve the effectiveness of vaccines by enhancing the body's ability to generate a strong immune response to vaccination – an effect especially important in older adults.

Exercise further improves immune function by promoting better sleep. Exercise modulates the immune system, helping it to respond appropriately to challenges – meeting the challenge of infection while preventing overreactions, such as autoimmune responses or excessive inflammation.

The foregoing summary of exercise benefits is not comprehensive. I have not talked about activation of AS160 which absorbs glucose, the effects of exercise on bone strength and (obviously) muscle strength, reducing blood pressure, and increase of BDNF which supports growth of new neurons.

How much exercise is best?

“I know exercise is good for me but I don’t have the time!” Such an assertion is rarely true and may result from an unrealistic view of the time commitment required for major benefits. There will be certain jobs and certain times in a career where finding time to exercise will be especially challenging. An optimal routine may be impractical. Some particularly challenging positions include medical students in residency and surgeons, nurses on back-to-back shifts, investment bankers sometimes working 80-100 hours per week, senior executives, some attorneys, small business owners (watch The Bear to see this in action), some truck drivers, flight personnel, agricultural workers during planting and harvesting season, and others.

Most of us do not have to work 80-100 hours per week. The average American reportedly averages almost 8 hours a day watching TV. Is that true? It seems crazy high. Anyway, you are not average. Those of us who do are not putting in those hours all the time and throughout our careers. Even those who are heavily booked can find ways to get some exercise… and some is vastly better than none. So let us ask: How much exercise should you get for maximum benefits? And: How little exercise can I do and still benefit?

To reap all or most of the benefits of exercise, you do not need to be able to qualify for the UK’s Special Air Services, India’s Para Special Forces, the US Delta Force, or – God forbid – the insanely tough test for the Russia Alpha Group Spetsnaz. Run 3000m in under 10:30 minutes? Perform at least 25 pull-ups? Do at least 90 push-ups in under 2 minutes? No thanks and no need.

It is a good idea to take a few fitness tests – not the military ones – and record the results. That gives you a baseline for comparison. Are you getting fitter or are you deteriorating? And it helps you figure out how much and what kind of exercise to focus on. How is your aerobic fitness? How is your strength? Flexibility and balance?

Even among those who I know exercise regularly, I rarely see another person with a workout logbook. I like to record how well or poorly I do (compared to the last couple of sessions) and improve on that—even just a tiny bit. With a couple of decades of these records I can look back and compare my current performance with previous years and ages. A regular workout logbook is not for everyone. If you feel competitive with yourself, you will probably like it. but is a useful information repository for those so inclined.

Tertiles, quartiles, and sextiles

As I mentioned in passing earlier, most studies simply survey exercise habits and do not focus on identifying the optimal amount and type of exercise for longevity. They may report exercise levels in groups of three tertiles or four (quartiles). Even the top quartile may average less than optimal exercise. So, you may get better results from a close to optimal exercise routine than reported by the studies.

One of the more informative studies was reported in 2012. The authors pooled data from six prospective cohort studies in the National Cancer Institute Cohort Consortium, comprising 654,827 individuals, 21–90 years of age. Rather than quartiles, this study grouped people into sextiles. These categories were chosen to reflect “cut points in the 2008 US federal physical activity guidelines and the 2010 World Health Organization (WHO) guidelines.” The categories are comparable to brisk walking during leisure time for 0, 1–74, 75–149, 150–299, 300–449, and 450+ minutes per week, respectively.

Both of those guidelines recommend a minimum of 150 minutes per week of moderate-intensity activity or 75 minutes per week of vigorous-intensity physical activity or an equivalent combination for health benefits, and twice that level for additional benefits. Even the lowest activity group improved their life expectancy by 1.8 years compared to the no leisure time activity group. That group did exercise equivalent to brisk walking for up to 75 minutes per week – less than 11 minutes per day.

Life expectancy improved further with more exercise. The highest activity level group – equivalent to brisk walking for 450+ minutes per week – gained 4.5 years. Major improvements were seen in each BMI group. Those who were reasonably active and normal weight gained 7.2 years of life compared to those who were inactive and obese. The authors note that “while regular physical activity increases life expectancy, it remains unclear if high-intensity sports activities further increase life expectancy.” In other words, do not overdo it although we are not going to be clear what that means.

Other researchers have confirmed that even small increases in daily exercise improve longevity. 4,800 adults, ages 40 to 85, wore fitness trackers for a week and were then tracked by the researchers for ten years. They calculated death rates based on activity level and used the results to estimate the effects of adding 10, 20, or 30 more minutes to their daily exercise routines.

A 10-minute increase in daily exercise was associated with a 7% drop in the number of deaths per year. Adding 20 minutes per day led to a 13% drop and adding 30 minutes produced a 17% decrease. If everyone in the USA increased their activity level, the number of deaths prevented would be between 110,000 and 272,000 per year. At least 56 per cent of US adults do not meet the government's exercise guidelines.

A 2022 study looked at the life expectancy effects of higher levels of long-term vigorous physical activity (VPA) – 75 to 150 minutes weekly – and moderate physical activity (MPA) – 150 to 300 minutes per week. They found the greatest prolongevity effects at exercise levels two to four times the levels recommended by government agencies such as HHS. The higher exercise group had 26% to 31% lower all-cause mortality and 28% to 38% lower risk of cardiovascular disease mortality. Non-cardiovascular disease mortality fell by 25% to 27%.

You can choose your mix of moderate and vigorous. The researchers report that any combination of medium to high amounts of moderate and vigorous exercise produce close to the maximum mortality reduction – about 35% to 42%.

Do it! (And some humble suggestions)

If you are obese you may be asking yourself: “Should I dive into an exercise program or lose weight first?” The answer is: definitely start exercising. Even if you are fat, get fit!

People who are fat but fit are only half as likely to die prematurely as unfit lean people. Exercise can aid in weight loss, although its effectiveness is somewhat debated. It may depend on the kind of exercise and the composition of your diet – a high carbohydrate diet may lead to rebound eating to cover the calories burned. Even if exercise does not help weight loss directly it will make you healthier and may indirectly help with weight loss due to improved self-image.

Obligatory warning: If you have not exercised significantly for months or years, you should get a health checkup before engaging in vigorous exercise.

Build up gradually. If you push yourself too hard initially, not only might you actually reduce your gains and possibly injure yourself, you may dislike the feeling so much that you will not do it again. (A CrossFit gym did this to me when I was not in great shape. I left feeling sick and did not return.) Do not be easy on yourself but do not push your limits until you are clearly in better condition.

Equip yourself: Roads are there to run on, with treadmills or rowing machines for bad weather. Gyms are great! You do not need to pay a hefty monthly fee for facilities you will not use. I pay about $20/month for a well-equipped gym. If you are unable or unwilling to take the time to drive to a gym and back, consider getting some exercise equipment at home. If space is an issue, try resistance bands. They work well (if you are not really strong) and take up almost zero space. They are also good for traveling.

Track progress: If you are reading this blog, you probably like data-tracking technologies. You should consider getting one of the numerous fitness trackers. What I track, I record. By keeping a record of my running times and weights over time, I compete with myself to do better. If solo exercise does not motivate you, try group sports – even pickleball if you must!

Comparing yourself to others is natural and probably unavoidable. But keep your comparisons in perspective. If you compare yourself to the best runners or biggest bodybuilders or strongest powerlifters, you are going to come up short. Your motivation may shrivel. Acknowledge the top performers by all means but mostly look at regular people otherwise similar to you – people your age with a full-time job and priorities other than maximizing performance. So far as you can manage it, avoid comparing yourself to anyone else. Instead, use your exercise log book to compare yourself to yourself in the past.

Fight the decline. Finally, you will read in many places that both aerobic capability and strength decline. That is true but refuse to take it too seriously. Some of the decline is a self-fulfilling prophecy. Those who maintain exercise throughout their lives can – barring major injury – greatly slow down and even stop the loss of performance.

If you are a sprinter, you will see a decline quite early on. Distance runners can maintain most of their performance for longer. You can also retain and build strength even as a “senior.” I am in my 61^st year and am currently almost as strong as I have ever been. Two years ago, when I was training more often, I was my strongest ever. My senior colleague here is his fittest ever in his sixth decade (barely).

If you want to live longer and eventually go into biostasis in good shape, push yourself to exercise regularly. Find something you enjoy. Challenge yourself. Do not leave everything to future technologies to fix!