Health and fitness has long been a passion of mine, and I particularly enjoy understanding how to improve my fitness and learning how to live longer. I want to be around for as long as possible, but I also want to have a healthspan that lasts as long as my lifespan. I want to spend as little time in hospital as possible. The idea to move away from “Medicine 2.0” (relying on the healthcare system) towards “Medicine 3.0” (pre-emptive, focussed training and self-care) is the key philosophy behind Peter Attia’s book, Outlive, which I strongly recommend you read and is fast becoming one of the pre-requisites of Slow Down and Save.
As we strive to become the best physical versions of ourselves, the next logical step is to assess whether that hard work is really making a difference. Will I really live for longer if I keep lifting weights and going running 3 times per week? This is the question this blog will attempt to answer. I’m by no means an expert in this area – just someone who’s curious and willing to spend the time finding an answer. We can discuss the impact of training in terms of the relative reduction of all-cause mortality (a measure of the probability of death from all sources in any given year).
The Big Three
The biggest three indicators of longevity are strength, muscle mass, and VO2 Max. Let’s focus on these first.
Strength
Grip strength is increasingly considered to be an excellent predictor of mortality (ironic I think, in a world increasingly dominated by high-tech longevity clinics with sophisticated scans and expensive consultancy). The study in the Lancet, linked above, found that there was around a 16% increased risk of dying from any cause for every 5kg decrease in grip strength.
Among a large group of around 3 million people, one meta-analysis found a 41% increase in all-cause mortality for those in the bottom 20-25% grip strength vs those in the top 20-25%.
Specifically looking at older adults (aged 65 and older), this study found that men in the bottom 20% for grip strength had an ~240% increased risk of death vs men in the top 20%. And for women, it was an ~184% increase.
- Overall strength is important as it reduces the risk of falls while stronger bones also develop as strength is improved – this reduces the risk of broken bones or fractures (which are strongly correlated with decreasing mobility and increased mortality in the years that follow).
- Higher strength levels improve resilience to illness and injury, and reduce recovery times.
Muscle mass
Just having muscle – regardless of strength – is important for longevity and can help you live longer. Muscle acts as a metabolic reserve that reduces the risk of type 2 diabetes (by improving glucose metabolism) and reduces the risk of chronic inflammation (a slow immune response which can damage tissue and organs).
Studies looking specifically at muscle mass often don’t make a clear distinction between all-cause mortality risks from people with low muscle mass to those with high muscle mass. But we can say, from this study of 81,000 people, that those in the bottom 20-25% for muscle mass had an ~ 57% increased risk of all-cause mortality vs everyone else.
VO2 max
VO2 max is a measure of the maximum rate of oxygen your body can consume and utilise during intense exercise. It is the gold standard for measuring cardiovascular fitness. It is the single strongest predictor of longevity we know of. Nothing beats it. It effectively measures how efficient your body is at being alive. It reflects a harmony between the lungs, heart, blood vessels and muscles, and represents the entire oxygen chain within your body.
This study, of ~122,000 people, found an ~400% reduction in all-cause mortality for someone in the bottom 25th percentile of VO2 max for their age and sex vs someone in the top 2.3%.
Beyond the Big Three, other lifestyle factors play a critical role in how to live longer and maintain a healthy lifespan.
Other predictors of longevity
Smoking
According to this study of 333,000 adults followed for 12 years, people who smoke increase their risk of dying by 140-165% vs non-smokers. Former smokers have an increased risk of ~35%, but this risk decreases the longer someone has quit.
Diet
Like it or loath it, the Mediterranean diet is the most replicated “healthy diet” in longevity research. It focusses on daily consumption of vegetables, fruits, whole grains, nuts, extra virgin olive oil, weekly fish/seafood consumption, moderate dairy/ poultry and limited red meat/ ultra-processed food. People eating this diet have an ~25-30% reduced risk of mortality vs those eating the least Mediterranean-style diet.
Blood pressure
In a survey of around 214,000 people, this study found that people with high blood pressure had an ~25% increased risk of mortality vs those without.
Diabetes
A meta analysis of more than 2.3 million people found that diabetes was associated with a 90% increase in mortality in men, and a 100% increase in women.
Sleep duration
This is an interesting one. An analysis of 16 different studies, representing almost 1.4 million people, suggested that both long and short sleep duration was bad for you. They found a U-shaped association with mortality:
- Short sleep duration (<6-7hrs) was linked to a ~12% higher mortality risk.
- Long sleep duration (>9hrs) was linked to a ~30% higher mortality risk.
(Read my blog on how to get a good night’s sleep.)
Alcohol
A huge meta-analysis of 107 studies involving over 4.8 million people found:
- Low/modest alcohol consumption was not significantly linked with lower mortality vs lifetime non-drinkers.
- People who drank 45-64 g/day alcohol (~3-4 drinks) had a ~19% increased risk of mortality vs non-drinkers.
- People who drank 65+ g/day (~5+ drinks) had a 35% increased risk of mortality.
- The increased risk of mortality was generally larger among female drinkers.
Depression
An analysis of 25 cohort studies with more than 106,000 people found that people suffering from depression had an ~ 80% higher risk of mortality compared to people without depression. Another study of ~ 23,700 adults in the US found that those with mild depression had ~35% increasing risk of mortality, while those with moderate to severe symptoms had ~62% increased risk.
Correlation is not causation
Note that these predictors are not necessarily independent of one another. For example, frequent excessive sleep can be a marker of chronic illness, inflammation or early disease; eating a Mediterranean-style diet is often associated with lower blood pressure and a reduced risk of chronic disease. In this sense, you cannot ‘stack’ these risk factors together; they are all correlated with mortality, but not necessarily directly causated.
By focussing on the “Big Three” indicators, you’ll be able to control blood pressure, diabetes and depression more easily. Sleep quality and duration will probably improve too, and if you’re focussing on being active and living a healthy lifestyle as all good Slow Down and Savers should do, then your diet will improve and not smoking and reducing alcohol consumption will come naturally.
So there you have it! I hope this blend between scientific research and my colloquial blog-writing style has made the science of longevity more accessible to you. Primarily focussing on strength, muscle mass, VO2 max, and healthy lifestyle choices is the science-backed way to live longer.
If you enjoyed this article, here are some others that you may also like:
The unexpected benefits of lifting heavy weights
A no-nonsense guide on how to live a healthy life
The state of the UK’s electric charging network in 2025
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