Exercise & Training

Big Picture

Exercise is one of five main areas to focus on for long-term health; the others are nutrition, sleep, medications/supplements, and emotional health. Together these domains are the primary levers clinicians use when helping people live longer and feel better. Within that set, exercise is often described as the most powerful single lifestyle tool when it is used fully and sensibly.

A helpful way to think about exercise is to aim for better healthspan — that is, maintaining strength, stamina, balance, coordination, and cognitive and emotional function as you age. Improving these areas has value on its own; some experts also believe that much of the lifespan benefit you can achieve comes simply from relentlessly pursuing better function, although that specific estimate is uncertain.

One practical way to organize training is a goal-driven framework sometimes called the 'centenarian decathlon': decide which activities you most want to do late in life, identify the physical traits needed for those activities, and plan your training backward from those long-term goals so that your daily and weekly work builds toward lasting function.

How This Affects Your Body

Physical health is not one thing but several measurable domains: strength, aerobic fitness, flexibility or mobility, and being largely free from pain. These different qualities can age at different speeds, so a useful training plan treats them separately while also combining them in sensible ways.

Stability is a foundational element of movement: it includes balance, motor control, the ability to handle and absorb forces, core pressurization (so your trunk is stiff when you need it), good rib and foot mobility, and controlled isometric muscle contractions. Many people show stability problems by midlife, but the nervous system stays adaptable and these skills can be retrained even in older adults.

Strength is the next layer built on stability, and power is a speeded form of strength — the ability to make force quickly. Power falls faster with age than raw strength, so keeping both strength and stability strong is necessary if you want to preserve power for tasks like catching yourself during a trip.

Cardiorespiratory fitness is also a continuum: the base is aerobic efficiency (your 'all-day pace' and ability to burn fat for long activity), and the peak is VO2max (the size of your aerobic engine). Some real-world tasks can be mapped to VO2max numbers — for example, a specific task might require a VO2max of about 31 mL·kg⁻¹·min⁻¹ — so understanding where you sit on that continuum helps you plan training.

Exercise also helps reduce inflammation and is linked to lower risk of major diseases; experts note especially strong evidence that regular exercise lowers risk for neurodegenerative diseases (like dementia), and building cognitive and movement reserve makes your brain and body more resilient when disease is present.

What You Can Do

A clear, stepwise approach helps turn goals into a practical plan. Below are sequential steps you can discuss with a clinician or coach to design a program that targets long-term function rather than only short-term sport performance.

1. Choose the long-term activities you most want to keep doing (for example: gardening, playing with grandchildren, hiking, or traveling).

2. Break each activity down into the physical traits needed (balance, leg strength, VO2 requirement, ability to lift a certain load, etc.).

3. Measure where you are now (examples: body composition like DEXA to check muscle mass; basic labs if recommended).

4. Project whether your current level will remain sufficient as you age; if not, aim to raise that capacity now.

5. Build a weekly plan that puts stability first, then strength and power, and also develops aerobic base and peak as needed.

6. If you are starting in later life, begin more slowly than younger people and emphasize injury prevention and coached progressions.

7. Reassess periodically and adjust training and nutrition based on how your abilities change.

Some specific training elements to include in your weekly plan are listed below. Exact exercises, repetitions, and progression should be individualized and can require skilled coaching, especially for stability and power work.

• Stability skills to practice: core pressurization (controlled trunk stiffness), rib mobility, proper foot mechanics, balance drills, and controlled isometric holds.

• Strength training: regular resistance work to maintain or build muscle mass (guided by body-composition data when available).

• Power practice: safe, lower-load, faster movements built on a foundation of stability and strength.

• Aerobic base work: steady efforts that raise your sustainable 'all-day pace' and fat-burning efficiency.

• VO2max/peak sessions: targeted higher-intensity intervals if your goals require a larger aerobic engine.

• Nutrition and monitoring: if DEXA shows low muscle mass, prioritize resistance work and increase protein; use lab and body-composition data to guide energy and protein targets.

If your main goal is long-term function rather than a short-term race or tournament, avoid overly-specific event training that narrows your fitness. Event-focused training is appropriate when you have a clear competitive target, but it may not prepare you as well for broad, late-life tasks.

Risks & When to Be Careful

Starting exercise later in life is definitely worthwhile, but older starters should move more slowly than younger trainees and emphasize strategies to avoid injury. There is an available "playbook" of age‑tailored programming, and working with experienced coaches or clinicians can help reduce risk.

A common, serious problem is that people lose the ability to do daily activities many years before death — for example, losing shoulder, knee, or hip function — which leads to withdrawal from valued activities. Prioritizing stability, strength, and safe progression can help prevent a long period of diminished quality of life.

Finally, exercise is powerful but not a cure-all: severe emotional-health problems may require additional, targeted care beyond exercise alone. Always talk with your healthcare team before making big changes to exercise, especially if you have chronic medical conditions or pain.

Open Questions

Experts agree exercise is essential, but some questions remain. One example is the exact amount of lifespan benefit that comes from pursuing better functional health — one speaker suggested a large portion (roughly three quarters) might be captured by focusing on function, but this estimate is acknowledged as speculative.

Other practical uncertainties include the precise exercise 'doses' (exact loads, sets, reps, interval schedules) that best preserve each trait for every person, and the methods for projecting decline and assigning numeric targets. Clinical teams commonly use tools like DEXA and lab data to guide these choices, but specific thresholds and mappings can vary by individual.

If you want to apply these ideas, ask your clinician or a trained coach about: how to translate your personal tasks into measurable targets (for example, what VO2max you need), how to interpret body-composition measures like DEXA, and whether an age‑tailored program is recommended. There are dedicated resources and programs that expand on the high-level playbook described here.