Benefits of physical activity in older adults.

Longevity

The association between physical activity and mortality and morbidity is well established. A 2023 meta-analysis of large prospective studies that examined dose–response found that physical activity levels equivalent to the recommended 150 minutes per week of moderate physical activity reduced all-cause mortality by 31% compared with no physical activity.12 The authors used metabolic equivalent of task (MET), the ratio of work metabolic rate to resting metabolic rate. One MET is equivalent to the energy cost of sitting quietly. A 2019 systematic review and meta-analysis found that, among middle-aged and older adults (aged ≥ 40 yr), higher levels of total physical activity were associated with reduced risk of death in a dose–response relation, such that the most, second-most, and third-most active quartiles were associated with 0.47, 0.35, and 0.28 hazard ratios, respectively, compared with the least active quartile.13 According to a large 2019 observational study, resistance exercise is also associated with reduced mortality independent of aerobic exercise.14 Two 2022 meta-analyses found, respectively, that 60 minutes of resistance exercise per week is associated with a risk reduction of 27% in all-cause mortality15 and that muscle-strengthening activities for 30–60 minutes per week is associated with a 10%–20% reduction.16

Cardiorespiratory fitness and peak exercise capacity are associated with mortality. Peak exercise capacity is a better indicator of risk of death than established cardiovascular risk factors such as smoking, hypertension, and diabetes mellitus.17 A study examining cardiorespiratory fitness in older adults found dose-dependent reductions in mortality across all age groups (including participants aged 60–69, 70–79, and 80–95 yr).18 Substantial improvements (approximately 16%) in VO_2max (an individual’s maximum rate of oxygen consumption, a strong indicator of mortality19) in older adults can occur with only 90 minutes of submaximal exercise per week over 16–20 weeks.20

Strength is also associated with reductions in all-cause mortality in older adults. A 2022 systematic review and meta-analysis found a linear inverse relation between handgrip strength and all-cause mortality up to sex-dependent thresholds (42 kg for men, 25 kg for women) in older adults.21 In their 2018 systematic review and meta-analysis, the authors found both handgrip and knee extension strength to be predictors of all-cause mortality in adults, with most of the studies examining adults older than 65 years.22 – Move more, age well: prescribing physical activity for older adults CMAJ January 27, 2025 197 (3) E59-E67; DOI: https://doi.org/10.1503/cmaj.231336