Exercise for healthspan optimisation

If exercise were a drug it would be a blockbuster without any peers. Improved cardiovascular health. Better insulin sensitivity. Improved cognition and neuroprotection. Reduced all-cause mortality. Vitality now and long-term health and functionality later.

The following are often written, and are definitely good advice:

• walk more
• walk in nature
• find something you enjoy doing
• the best exercise is the exercise you can enjoy and perform consistently
• exercise with others, for example, in group classes

However, if you want to fully exploit exercise as a powerful tool for healthspan optimisation, referring to the time of life you spend in a healthy, functional state, what would that exercise look like?.

Exercising for healthspan is also not the same as exercising for sports performance. Sports, including team sports, are a terrific way to be active and get a lot of the benefits from exercise. Yet they differ from healthspan-focused exercise in distinct ways:

• Sports sometimes prioritise performance over health, for example, via rapid weight-reduction to make weight classes and through repetitive motions that exert shearing and impact forces on connective tissues and bone.
• Sports training applies the principle of ‘specific adaptations to imposed demands’ (SAID), which reduces the time and recovery capacity available for practices that do not directly contribute to the sport.

If you are not a competitive athlete but are interested in leveraging exercise for your maximum possible health benefit, these are the five types of exercise you should consider.

Five exercise modalities for optimising healthspan

1. Balance, mobility and stability

Why is it helpful?

Balance, mobility and stability are foundational, preventing injury, supporting good posture, enabling graceful, confident movement during exercise and everyday activity [1]. Avoiding injury is the most effective enabler for exercise consistency and avoiding periods of inactivity, which contribute significantly to loss of muscle and bone density [2].

How do you improve it?

Yoga, Pilates and callisthenics all incorporate balance, mobility and stability. Alternately, one can build a five to 10 minute daily practice of specific exercises that can be performed at home, such as:

• single-leg stands, progressing to perform the stand with eyes closed
• Turkish get-ups, performed with a very light weight
• single-leg Romanian deadlifts, also performed with a very light weight
• world’s greatest stretch

Whilst not necessary, balance boards, wobble boards and bosu balls can add variety and fun to a routine. 

2. Strength, muscle size and bone density

Why is it helpful?

One of the biggest positive health interventions for most people is retaining or developing stronger muscles and muscle mass [3]. Muscle is an active endocrine organ, secreting health-supporting myokines. It also acts as a huge sink for blood glucose and fats, thus helping you avoid insulin resistance and diabetes [4]. It enables you to remain highly functional as you age and reduces injury risk. You are less likely to fall and less likely to break something if you do.

How do you improve it?

Through two to four sessions per week of resistance exercise, including upper and lower body movements. For maximum benefit within a modest workout time, focus on:

• Safety first, which means if you are inexperienced, engage a certified personal trainer who can teach you how to lift properly.
• Large, compound movements, such as Romanian deadlifts, squats and lunges, bench press, pullups and pulldowns.
• Progressive overload, meaning increasing the load, or the repetitions, in order to continue providing a growth stimulus
• Using the equipment in a commercial gym is ideal, but home-gym options exist too, such as bodyweight exercises, TRX band systems and resistance bands.

3. Peak aerobic capacity (VO2 max)

Why is it helpful?

Peak aerobic capacity represents your ability to use oxygen for energy during brief bursts of intense exercise. This is strongly associated with VO2 max, which is a literal measure of oxygen in ml per kg of body weight per minute, which can also be easily estimated and tracked.

Higher VO2 max improves heart muscle efficiency through greater stroke volume, delivering more oxygen to working muscles and directly supporting athletic performance of any kind. It is strongly associated with reduced all-cause mortality and cardiovascular disease risk, meaning the higher your VO2 max, the less likely you are to die or suffer an adverse cardiac event [5]. VO2 max also has a neuroprotective, cognition-enhancing benefit [6].

How do you improve it?

VO2 is highly trainable, meaning it can be improved significantly through dedicated exercise. The protocol found to deliver the greatest improvements in VO2 max is the Norwegian 4x4 [7]. This consists of four intervals of four minutes each performed at around 85-95% of your maximum heart rate, followed by a three minute active rest period. Hence a total session, excluding warm up and cool down is 28 minutes. Running, cycling, elliptical trainers, rowing and climbing are all well suited.

Alternative protocols, also very effective, include forms of High Intensity Interval Training (HIIT), Reduced Exertion High Intensity Interval Training (REHIT), Sprint Interval Training (SIT) and classic circuit training. 

4. Aerobic endurance

Why is it helpful?

Aerobic endurance exercise involves sustained, rhythmic physical activity that elevates heart rate and breathing at a low to moderate intensity. It enhances cardiovascular health through strengthening the heart, improves metabolic function via encouraging mitochondrial health, fat oxidation and insulin sensitivity, and has significant science-based benefits for mental and cognitive health.

Having greater aerobic endurance also simply equips you to enjoy life, helping you do more of whatever activity you like for fun, be it hiking, sailing, riding, climbing, or team sports. These can also be used to improve aerobic endurance!

How do you improve it?

For 30-60 minutes, engage in a form of exercise at an intensity you can maintain for the duration. Examples are outdoor or indoor running, cycling, swimming, elliptical training, rowing, rollerblading, skating, skiing and dancing. If you have a heart rate monitor, aim for 60-75% of your heart rate maximum.

5. Breathwork

Why is it helpful?

Breathwork refers to intentional regulation of breathing, with significant effect upon physical, mental and emotional states [8]. Developing breath control can enhance capacity for all forms of exercise by enabling greater tolerance of CO2 during exertion, alignment of breathing with the rhythm of activity and delaying fatigue. 

Breathwork can also be a fantastic aid for recovery when used to activate the rest and recovery focused parasympathetic nervous system.

How do you do it?

Box breathing, 4-7-8 breathing, alternate nostril breathing and breath holds are highly accessible practices easily incorporated into a brief daily practice. Apps like Breathe: Relax and Focus, available on iOS and Android, provide simple guided breathwork sessions. For something more sophisticated, Oxygen Advantage and Buteyko Clinic have video instructions, apps and coaches available. 

Putting the five together

Within a week, your exercise for healthspan approach could look like this:

• Balance, mobility and stability: Five to 10 minutes daily practice.
• Resistance exercise: Two to four sessions per week of 30-40 minutes each.
• VO2 max: Two sessions per week of 16-30 minutes each.
• Aerobic endurance: Two sessions per week of 30+ minutes.
• Breathwork: Three to five minutes daily practice.

Or, like this:

• Monday: Resistance exercise 
• Tuesday: VO2 max
• Wednesday: Resistance exercise
• Thursday: Endurance
• Friday: Resistance exercise
• Saturday: VO2 max
• Sunday: Endurance

Every day: Balance, mobility and stability and breathwork.

Three bonus tips

Progress vs perfection

Even if you are strongly motivated to get the best value from exercise, progress and consistency are preferable to punishing yourself for not reaching perfection. Do what you can, as often as you can. Accept that sometimes other things must take priority, and be kind to yourself when they do. 

Rest and recovery

Treat your recovery as equally important as the exercise itself. This includes:

• Enjoying a diverse, nutritionally dense diet with sufficient calories to fuel your activities.
• Getting plenty of high-quality sleep.
• Including rest and relaxation practices such as meditation, massage, sauna, hot baths and walks in nature.
• Being mindful about how you feel and when you may need to take a rest day, or rest week.

Plan, track or gamify

You might like to plan, track or gamify your approach, using an app like Strava, Apple Fitness or Google Fit. Try it if this appeals and you welcome the structure. Continue it if it feels helpful. Discontinue if it feels like more of a burden. It can be motivational to observe your consistency and progress, or to simply capture your routine so you know what you intend to do, but these tools are not essential.

References

1. Associations Between Measures of Balance and Lower-Extremity Muscle Strength/Power in Healthy Individuals Across the Lifespan: A Systematic Review and Meta-Analysis.

2. Inactivity and Skeletal Muscle Metabolism: A Vicious Cycle in Old Age.

3. Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. 

4. Lower skeletal muscle mass is associated with diabetes and insulin resistance: A cross-sectional study. 

5. Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009. 

6. Cardiorespiratory fitness and risk of dementia: a prospective population-based cohort study.

7. Effects of different protocols of high intensity interval training for VO2max improvements in adults: A meta-analysis of randomised controlled trials.

8. Brief structured respiration practices enhance mood and reduce physiological arousal.