Quick Dive: Physical activity – healthspan vs. mortality outcomes

What is the reason for and aim of the publication?

The paper was motivated by the observation that although physical activity is recommended and observational data are promising with regards to reducing all-cause mortality, the results from randomized controlled trials have been less successful. However, we believe that the “hard endpoint” of death does not fully capture what really matters for individuals and public health in light of changing demographics, medical care, and the complexity of aging. Hence, we aimed to propose “healthspan” rather than lifespan as an appropriate endpoint for studies assessing the effects of exercise and physical activity.

What are the most important take-home messages?

• Physical activity is very important for maintaining health, but may not help to improve longevity. While many observational studies link higher physical activity to lower all-cause mortality, more rigorous genetic studies (Mendelian randomization) and randomized controlled trials have failed to consistently reproduce a strong “more physical activity equals longer life” effect.
• “Healthspan”, which is life lived in good health may be a more meaningful outcome than simply lifespan. We argue that measuring how long people remain healthy, functional, independent, cognitively intact, and with good quality of life is more relevant than all-cause mortality.
• Physical activity likely extends healthspan across many domains. Even when mortality benefits are uncertain, physical activity consistently shows beneficial associations with improved cardiovascular and metabolic risk factors (blood pressure, lipids, insulin sensitivity, inflammation), musculoskeletal health (muscle mass/strength, bone density), functional capacity, mental/cognitive health, and a lower risk of chronic diseases.

What are challenges in practical implementation – and possible solutions?

We need better, multidimensional, scalable measures of healthspan. Because healthspan is complex (physical, cognitive, mental, disease burden, quality of life), in this statement we propose a suite of measures ranging from objective tests of physical function (e.g. walking tests, handgrip strength) to chronic-disease markers (blood pressure, lipids, vascular health), mental/cognitive assessments, quality-of-life questionnaires, and possibly wearable-device data of real-life activity. 

Which issues still need to be tackled, that are not yet addressed by the paper?

Our statement exemplifies the need to shift from lifespan to healthspan but, of course was unable to address all open questions: currently there is no single, validated definition of healthspan or a standardized composite metric. Further, methods for integrating wearable-derived digital data, which are scientifically validated are yet to be developed. Also, population-specific adaptations (age, sex, disease, socioeconomic factors) should be considered when developing metrics as well as potential interventions.

What further developments on the topic are emerging?

We believe that there will be a shift with regards to digital biomarkers given they allow large-scale, low-cost, longitudinal monitoring of healthspan in the real world. In addition, multi-dimensional approaches which go beyond the “Yes” or “No” for the presence of a disease towards identifying “healthspan trajectories”. This will allow to monitor individuals and patients over time to hopefully improve public health.

Scientific statement: Physical activity and mortality: towards healthspan-oriented metrics and outcomes

Document types published by the ESC, Associations, Councils, Working Groups, and ESC Committees (according to the ESC Scientific Documents Policy):