Aerobic exercise extends life: up to 40% lower risk of premature death

Want to live longer? Start walking. Or dancing. Or cycling . You don't need to become an athlete, just get some serious exercise. Even just half an hour a day can make the difference between a long life and a short one. This is the finding of a meta-analysis of 85 studies involving over 7 million people worldwide: those who engage in regular aerobic exercise have up to a 40% lower risk of premature death. These numbers are sobering. But more important than the data, what they tell us is: our heart, if we listen to it and keep it beating properly, can become our greatest ally in longevity.

Movement is good for all ages

“Physical activity may be even more important for long-term health than we thought,” said Gregore Mielke , co-author of the study and a senior lecturer in the School of Public Health at the University of Queensland in Brisbane, Australia.

Age doesn't appear to have a bearing: even those who start exercising late in life can increase their longevity, explained Ruyi Yu , a doctoral student in public health at the same university. In fact, the positive impact of physical activity is often greater in older adults, offering up to "an additional 10-15% risk reduction," as they are more likely to face multiple health problems. According to the researchers, exercise truly reduces mortality risk in a way that drugs cannot and should be considered an elixir of long life.

More exercise helps, but only up to a point.

The study, published recently in the British Journal of Sports Medicine , is "one of the most comprehensive analyses ever conducted" of physical activity starting in young adulthood, Mielke said. While exercise guidelines may vary from country to country, the meta-analysis followed the World Health Organization's recommendations: at least 150–300 minutes of moderate aerobic activity or 75–150 minutes of vigorous activity per week (or a combination of the two). "What makes this study different is that it analyzed research that tracked physical activity at multiple points in time," Mielke explained.

"This allowed us to examine long-term patterns, such as staying active, starting later, or quitting, and understand how these influence mortality risk. This allowed us to demonstrate that it's never too late to start being active, and starting at any point in adulthood can still lead to a longer, healthier life."

Stronger heart

Regular aerobic activity has been shown to be particularly effective in reducing the risk of heart disease, the leading cause of death worldwide. Compared to those who did little or no physical activity, those who exercised more had a roughly 40% lower risk of dying from cardiovascular causes. Their cancer risk was reduced by 25%.

The greatest longevity benefits were observed with at least 300 minutes of moderate exercise per week, while doing more didn't appear to add significant additional benefits in terms of lifespan. However, even sedentary people who started exercising regularly saw benefits, with a 22% reduction in the risk of premature death. Those who engaged in leisure-time physical activity showed a 27% reduction in risk.

Aerobic activity and chronic diseases

When it comes to recommending or prescribing physical exercise, the first fundamental question to ask is: who are we recommending it to? “There are at least two large categories of people to distinguish,” replies Patrizio Sarto , director of the Sports Medicine Unit at the USLL 2 of Marca Trevigiana in Veneto, the regional reference center for sport in young people with heart disease. “The Individuals with chronic conditions, often sedentary for years, and young people (or adults) with a history of exercise, diagnosed with heart disease, potentially at risk of arrhythmic events. In the first case, physical exercise has a disruptive potential: even starting a gradual program of aerobic activity can significantly alter the prognosis, reducing the risk of disease progression or recurrence, and in some cases preventing serious events. But this is also the group in which it is most difficult to implement change, because their personal history—we might say their 'behavioral DNA'—often lacks the habit of exercise. Here, our work is not only prescriptive, but educational and motivational: to help them rediscover the body as a resource.

Aerobic activity and heart disease

The situation is different for young people (or adults) with a history of sports, diagnosed with a heart condition that potentially poses a risk of arrhythmic events. "In these cases," explains the sports doctor, "paradoxically, the approach is the opposite: we shouldn't stimulate, but contain. People accustomed to living through sport suddenly find themselves faced with new and often frustrating limitations that have shattered their dreams. This is where a highly personalized clinical pathway is needed, to identify a safe level of exercise that is both physically and psychologically sustainable. This is why we have activated a clinical-psychological-sports pathway at our regional center."

How much exercise do cancer patients need?

Still with a view to personalizing physical activity prescriptions, specific clinical conditions requiring more targeted strategies should also be considered. "In women with breast cancer," explains the sports physician, "physical activity is one of the main non-pharmacological tools for reducing the risk of recurrence. Studies suggest that even three hours of moderate walking per week, combined with weight loss, can significantly improve prognosis: a 40-60% reduction in recurrence."

Diabetes or heart failure

Even for patients with diabetes, walking is a true therapy, but even then, great care is needed: "Foot care, wearing comfortable shoes, always checking blood sugar before starting (never start if blood sugar is below 140 mg/dL), knowing how to recognize the symptoms of hypoglycemia, and always carrying what you need to combat it (simple sugars)," recommends Sarto, who adds: "In patients post-myocardial infarction or with heart failure, walking may not be sufficient, although it represents a crucial first step. In these cases, intensity and personalized exercise are crucial: it is necessary to establish a supervised exercise program, preceded by a comprehensive clinical evaluation, stress testing, optimization of drug therapy, and rigorous risk factor management."

One hundred and fifty minutes of aerobic activity per week

It's well known that exercise is the key to a long and healthy life, but what, in practical terms, is the minimum recommended activity to achieve the protective effect revealed by this new study? "The general recommendation, shared by the WHO, the American College of Sports Medicine, and European Guidelines," Sarto responds, "is 150–300 minutes per week of moderate aerobic activity (e.g., brisk walking, light cycling, dancing) or 75–150 minutes per week of vigorous activity (e.g., running, swimming, intense cycling), or a combination of the two. Strength training should also be added at least twice a week. But the true value of these recommendations emerges only when tailored to the individual, with attention to their medical history, functional condition, and sustainability over time. Even more than quantity, what matters is consistency. A little but regular activity is better than a lot and sporadic."

The benefits of walking

Many people, especially over 65, are content to engage in physical activity by walking every day, preferably at a brisk pace. Is this type of exercise enough to achieve concrete health benefits? "In the general population who are sedentary or have a low level of activity," Sarto responds, "walking every day at a brisk pace—that is, at a pace that increases the heart rate and induces slight shortness of breath, but still allows for conversation—can already represent a significant change. Epidemiological data show that this mode of exercise is associated with a reduction in total mortality risk of up to 30–40%, especially if maintained over time. In sedentary individuals, even smaller amounts (e.g., 15–20 minutes a day) can already produce measurable benefits."

Start moving after your 40s

For those starting late, even after age 65, what are the safest and most effective exercises? "For those who are sedentary or are just starting out in physical activity at a later age," Sarto responds, "it's advisable to start with low-intensity, long-duration aerobic exercise. Brisk walking, cycling on flat paths, swimming, or gentle gymnastics are excellent activities for exercising the heart, lungs, and metabolism, reducing blood pressure, and improving mood. Regularity is key: even 30 minutes a day, at least three to five days a week, can make a difference."

The importance of muscle strengthening

As we age, it's natural to lose muscle mass (sarcopenia), resulting in a deterioration in balance and an increased risk of falls. For this reason, muscle-strengthening exercises are also recommended. "Carrying weights, using a loaded backpack, increasing resistance on a stationary bike or pedaling uphill, or wearing fins to increase resistance in the water: anything that combines cardio with muscle strengthening is excellent," the researchers suggest in the study. Sarto adds: "Targeted strength exercises—even just bodyweight exercises or small equipment—are essential to counteract this process. Two sessions a week are enough to achieve preventative and functional effects."

How to avoid injuries

Therefore, even after 60—indeed, especially after 60—it's possible (and recommended) to begin a physical activity program. The important thing is not to improvise, not to be pressured by rushing, and to choose an activity you can enjoy and do consistently. Exercise, at this stage of life, is one of the most powerful tools for maintaining independence, health, and quality of life. How can you avoid injury? "It's essential to listen to your body," Sarto replies: "If you experience persistent muscle pain, excessive fatigue, unexplained shortness of breath, or chest pain, it's best to slow down and consult your doctor. Furthermore, increase the intensity, duration, or frequency of your exercise only once your body has adjusted to your previous level. Technique is also important: even simple exercises, if performed poorly, can cause overload or joint pain. For this reason, it's best to rely on qualified instructors, physiotherapists, or graduates in physical education with experience in prevention or rehabilitation."

What happens to those who stop moving?

Returning to the study in the British Journal of Sports Medicine , it raises an important question: do the benefits of past physical activity last even if you stop being active? Unfortunately, the researchers observed that those who stopped exercising seemed to lose the benefits gained over time, with a similar risk of death as those who had always been inactive. Therefore, never stop completely, but rather reduce or change your activity. “Even people who didn't reach the levels recommended by the Guidelines but maintained a minimum level of activity still had a lower risk of early death than those who remained sedentary,” added Mielke. “We encourage people to move however they like. The important thing is to get your body moving and find enjoyable ways to be active.”