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Expanded question: What are the best types of exercise for improving health span and longevity?

Answered on December 3, 2024
The best types of exercise for improving health span and longevity include a combination of aerobic and resistance training. According to the American College of Sports Medicine, a combination of aerobic exercise and resistance training is more effective than either form alone in counteracting the detrimental effects of a sedentary lifestyle on cardiovascular and skeletal muscle health.[1]
Aerobic exercises, such as walking, jogging, swimming, and cycling, are associated with significant longevity benefits. For instance, meeting the recommended 150 minutes of moderate-intensity aerobic activity per week provides substantial longevity benefits, with additional benefits seen at higher durations and intensities.[2] Specific activities like tennis, badminton, and soccer have been associated with significant life expectancy gains, likely due to their social interaction component.[3]
Resistance training is also crucial, as it helps maintain muscle mass and strength, which are critical for aging and disease prevention.[2] Regular physical activity, including both aerobic and resistance exercises, has been shown to modify the age-related decline in physical performance, with more intensive activities providing greater benefits.[4]
In summary, a combination of aerobic and resistance training is recommended for improving health span and longevity, with specific activities like walking, jogging, swimming, and sports that involve social interaction providing additional benefits.

1.
American College of Sports Medicine Position Stand. Exercise and Physical Activity for Older Adults.

Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al.

Medicine and Science in Sports and Exercise. 2009;41(7):1510-30. doi:10.1249/MSS.0b013e3181a0c95c.

Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for psychological and cognitive benefits accruing from regular exercise participation by older adults (Table 4). It is not yet possible to describe in detail exercise programs that will optimize physical functioning and health in all groups of older adults. New evidence also suggests that some of the adaptive responses to exercise training are genotype-sensitive, at least in animal studies (14). Nevertheless, several evidence-based conclusions can be drawn relative to exercise and physical activity in the older adult population: 1) A combination of AET and RET activities seems to be more effective than either form of training alone in counteracting the detrimental effects of a sedentary lifestyle on the health and functioning of the cardiovascular system and skeletal muscles. 2) Although there are clear fitness, metabolic, and performance benefits associated with higher-intensity exercise training programs in healthy older adults, it is now evident that such programs do not need to be of high intensity to reduce the risks of developing chronic cardiovascular and metabolic disease. However, the outcome of treatment of some established diseases and geriatric syndromes is more effective with higher-intensity exercise (e.g., type 2 diabetes, clinical depression, osteopenia, sarcopenia, muscle weakness). 3) The acute effects of a single session of aerobic exercise are relatively short-lived, and the chronic adaptations to repeated sessions of exercise are quickly lost upon cessation of training, even in regularly active older adults. 4) The onset and patterns of physiological decline with aging vary across physiological systems and between sexes, and some adaptive responses to training are age- and sex-dependent. Thus, the extent to which exercise can reverse age-associated physiological deterioration may depend, in part, on the hormonal status and age at which a specific intervention is initiated. 5) Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises.

2.
Which Type of Exercise Keeps You Young?.

Pedersen BK.

Current Opinion in Clinical Nutrition and Metabolic Care. 2019;22(2):167-173. doi:10.1097/MCO.0000000000000546.

Purpose Of Review: Robust epidemiological evidence exists that lifelong regular exercise contributes to longevity. The aim of this review is to discuss recent findings regarding, which dose and type of physical activity promotes a long healthy life, free of disease.

Recent Findings: Meeting the currently recommended amounts of leisure time physical aerobic activity of moderate intensity of at least 150 min/week provides most of the longevity benefit. However, a higher duration and intensity augments the beneficial effect on cardiovascular health and metabolism. Performing three to five times the recommended physical activity minimum reaches the maximal longevity benefit, that can be achieved. Although it is not dangerous to perform even higher amounts of exercise, the benefit may decrease. A high maximal oxygen uptake in mid-life is a strong marker of longevity, whereas muscle mass is a critical prognostic factor in aging and cancer.

Summary: Exercise training above the public health recommendations provides additional benefits regarding disease protection and longevity. Endurance exercise, including high-intensity training to improve cardiorespiratory fitness promotes longevity and slows down aging. Strength training should be added to slow down loss of muscle mass, associated with aging and disease.

3.
Various Leisure-Time Physical Activities Associated With Widely Divergent Life Expectancies: The Copenhagen City Heart Study.

Schnohr P, O'Keefe JH, Holtermann A, et al.

Mayo Clinic Proceedings. 2018;93(12):1775-1785. doi:10.1016/j.mayocp.2018.06.025.

Objective: To evaluate the differential improvements in life expectancy associated with participation in various sports.

Patients And Methods: The Copenhagen City Heart Study (CCHS) is a prospective population study that included detailed questionnaires regarding participation in different types of sports and leisure-time physical activity. The 8577 participants were followed for up to 25 years for all-cause mortality from their examination between October 10, 1991, and September 16, 1994, until March 22, 2017. Relative risks were calculated using Cox proportional hazards models with full adjustment for confounding variables.

Results: Multivariable-adjusted life expectancy gains compared with the sedentary group for different sports were as follows: tennis, 9.7 years; badminton, 6.2 years; soccer, 4.7 years; cycling, 3.7 years; swimming, 3.4 years; jogging, 3.2 years; calisthenics, 3.1 years; and health club activities, 1.5 years.

Conclusion: Various sports are associated with markedly different improvements in life expectancy. Because this is an observational study, it remains uncertain whether this relationship is causal. Interestingly, the leisure-time sports that inherently involve more social interaction were associated with the best longevity-a finding that warrants further investigation.

4.
Impact of Habitual Physical Activity and Type of Exercise on Physical Performance Across Ages in Community-Living People.

Landi F, Calvani R, Picca A, et al.

PloS One. 2018;13(1):e0191820. doi:10.1371/journal.pone.0191820.

The maintenance of muscle function into late life protects against various negative health outcomes. The present study was undertaken to evaluate the impact of habitual physical activity and exercise types on physical performance across ages in community-living adults. The Longevity check-up 7+ (Lookup 7+) project is an ongoing cross-sectional survey conducted in unconventional settings (e.g., exhibitions, malls, and health promotion campaigns across Italy) that began on June 1st 2015. The project was designed to raise awareness in the general population on major lifestyle behaviors and risk factors for chronic diseases. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Physical performance is evaluated through the 5-repetition chair stand test. Analyses were conducted in 6,242 community-living adults enrolled between June 1st 2015 and June 30th 2017, after excluding 81 participants for missing values of the variables of interest. The mean age of the 6,242 participants was 54.4 years (standard deviation 15.2, range 18-98 years), and 3552 (57%) were women. The time to complete the chair stand test was similar from 18 to 40-44 years, and declined progressively across subsequent age groups. Overall, the performance on the chair stand test was better in physically active participants, who completed the test with a mean of 0.5 s less than sedentary enrollees (p < .001). After adjusting for potential confounders, a different distribution of physical performance across exercise intensities was observed, with better performance being recorded in participants engaged in more vigorous activities. Our findings suggest that regular physical activity modifies the age-related pattern of decline in physical performance, with greater benefits observed for more intensive activities. Efforts are needed from health authorities and healthcare providers to promote the large-scale adoption of an active lifestyle throughout the life course.

Expanded question: What about High-Intensity Interval Training (HIIT) exercises in the context of improving health span and longevity?

Answered on December 3, 2024
High-Intensity Interval Training (HIIT) has been shown to offer significant benefits for improving health span and longevity. HIIT involves short bursts of intense exercise followed by periods of rest or low-intensity exercise. This form of training has been associated with various health benefits, particularly in older adults and sedentary individuals.
HIIT has been demonstrated to reduce biological age. A randomized controlled trial found that HIIT reduced transcriptomic age by 3.59 years in sedentary adults aged 40-65, while the control group saw an increase in transcriptomic age. This suggests that HIIT can positively influence age-related biological processes.[1]
Cardiorespiratory fitness improvements are another key benefit. A meta-analysis showed that HIIT significantly improves peak oxygen consumption (VO2max) compared to moderate-intensity continuous training (MICT), which is crucial for cardiovascular health and longevity. Enhanced cardiorespiratory fitness is linked to reduced mortality and morbidity.[2]
HIIT also improves metabolic health. Studies have shown that HIIT can enhance insulin sensitivity, reduce blood glucose levels, and improve lipid profiles, which are critical factors in preventing metabolic diseases such as type 2 diabetes and cardiovascular disease.[3]
Body composition and muscle strength are also positively affected by HIIT. Systematic reviews have found that HIIT can lead to reductions in body fat and increases in muscle strength, which are important for maintaining physical function and reducing the risk of sarcopenia in older adults.[4]
In summary, HIIT is an effective exercise modality for improving health span and longevity by enhancing cardiorespiratory fitness, metabolic health, and body composition. These benefits make HIIT a valuable component of exercise regimens aimed at promoting healthy aging and extending life expectancy.

1.
High-Intensity Interval Training Reduces Transcriptomic Age: A randomized Controlled Trial.

Lohman T, Bains G, Cole S, et al.

Aging Cell. 2023;22(6):e13841. doi:10.1111/acel.13841.

Leading Journal

While the relationship between exercise and life span is well-documented, little is known about the effects of specific exercise protocols on modern measures of biological age. Transcriptomic age (TA) predictors provide an opportunity to test the effects of high-intensity interval training (HIIT) on biological age utilizing whole-genome expression data. A single-site, single-blinded, randomized controlled clinical trial design was utilized. Thirty sedentary participants (aged 40-65) were assigned to either a HIIT group or a no-exercise control group. After collecting baseline measures, HIIT participants performed three 10 × 1 HIIT sessions per week for 4 weeks. Each session lasted 23 min, and total exercise duration was 276 min over the course of the 1-month exercise protocol. TA, PSS-10 score, PSQI score, PHQ-9 score, and various measures of body composition were all measured at baseline and again following the conclusion of exercise/control protocols. Transcriptomic age reduction of 3.59 years was observed in the exercise group while a 3.29-years increase was observed in the control group. Also, PHQ-9, PSQI, BMI, body fat mass, and visceral fat measures were all improved in the exercise group. A hypothesis-generation gene expression analysis suggested exercise may modify autophagy, mTOR, AMPK, PI3K, neurotrophin signaling, insulin signaling, and other age-related pathways. A low dose of HIIT can reduce an mRNA-based measure of biological age in sedentary adults between the ages of 40 and 65 years old. Other changes in gene expression were relatively modest, which may indicate a focal effect of exercise on age-related biological processes.

2.

High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its impact in the older population remains highly debated. This review and meta-analysis aimed to evaluate the effects of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and health-related outcomes in older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until July 2020) for randomized trials comparing the effect of HIIT on physical fitness, metabolic parameters, and cardiorespiratory fitness in older adults. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies; Stata 14.0 software was used for statistical analysis. HIIT significantly improved the maximum rate of oxygen consumption (VO) as compared to a moderate-intensity continuous training (MICT) protocol (HIIT vs.

Mict: weighted mean difference = 1.74, 95% confidence interval: 0.80-2.69, p < 0.001). Additional subgroup analyses determined that training periods >12 weeks, training frequencies of 2 sessions/week, session lengths of 40 min, 6 sets and repetitions, training times per repetition of >60 s, and rest times of <90 s were more effective for VO. This systematic review and meta-analysis showed that HIIT induces favorable adaptions in cardiorespiratory fitness, physical fitness, muscle power, cardiac contractile function, mitochondrial citrate synthase activity, and reduced blood triglyceride and glucose levels in older individuals, which may help to maintain aerobic fitness and slow down the process of sarcopenia.

3.
Low-Volume High-Intensity Interval Training for Cardiometabolic Health.

Sabag A, Little JP, Johnson NA.

The Journal of Physiology. 2022;600(5):1013-1026. doi:10.1113/JP281210.

High-intensity interval training (HIIT) is characterised by short bouts of high-intensity submaximal exercise interspersed with rest periods. Low-volume HIIT, typically involving less than 15 min of high-intensity exercise per session, is being increasingly investigated in healthy and clinical populations due to its time-efficient nature and purported health benefits. The findings from recent trials suggest that low-volume HIIT can induce similar, and at times greater, improvements in cardiorespiratory fitness, glucose control, blood pressure, and cardiac function when compared to more traditional forms of aerobic exercise training including high-volume HIIT and moderate intensity continuous training, despite requiring less time commitment and lower energy expenditure. Although further studies are required to elucidate the precise mechanisms of action, metabolic improvements appear to be driven, in part, by enhanced mitochondrial function and insulin sensitivity, whereas certain cardiovascular improvements are linked to increased left ventricular function as well as greater central and peripheral arterial compliance. Beyond the purported health benefits, low-volume HIIT appears to be safe and well-tolerated in adults, with high rates of reported exercise adherence and low adverse effects.

4.
High-Intensity Interval Training Among Middle-Aged and Older Adults for Body Composition and Muscle Strength: A Systematic Review.

Alzar-Teruel M, Aibar-Almazán A, Hita-Contreras F, et al.

Frontiers in Public Health. 2022;10:992706. doi:10.3389/fpubh.2022.992706.

Background: The aging of population is leading to the investigation of new options to achieve healthy aging. One of these options is high-intensity interval training (HIIT), although its effects on body composition and muscle strength are currently unclear. The objective of this systematic review is to examine the scientific publications on the effects of HIIT on the body composition and muscle strength of middle-aged and older adults. Methods: The search was carried out in the PubMed, Cochrane Plus, Web of Science, CINAHL and SciELO databases without limitation of publication dates. The literature search, data extraction and systematic review were performed following the PRISMA standards and the risk of bias of the selected studies was assessed using the Cochrane Collaboration Risk-of-Bias. Results: Initially 520 publications were identified, out of which a total of 8 articles were finally selected to be included in this systematic review. Improvements in body composition were seen in six of the selected items and an increase in muscle strength in seven of the eight. Regarding physical function, improvements were found in both gait speed and balance. Conclusions: This systematic review found that HIIT is effective in improving body composition and increasing muscle strength. However, when comparing HIIT to moderate-intensity continuous training, it is not clear that HIIT is more beneficial; a firm conclusion cannot be drawn due to the scarcity of published studies, their variety in methodology and the ambiguity of their results, so it is suggested to carry out more research in this area.

Expanded question: So of the types of exercises, aerobic, resistance training, and High-Intensity Interval Training (HIIT), rank them from highest significant impact on health span and longevity. Give detailed recommended protocols of each as a scheduled routine to follow.

Answered on December 3, 2024
1. High-Intensity Interval Training (HIIT): HIIT has the highest significant impact on health span and longevity. It improves cardiorespiratory fitness, insulin sensitivity, and mitochondrial function, which are critical for longevity. [1-3]
Recommended Protocol:
Frequency: 3 times per week
Duration: 20-30 minutes per session
Intensity: 85-95% of maximum heart rate
Structure: 4-6 intervals of 1-4 minutes of high-intensity exercise (e.g., sprinting, cycling) with 1-3 minutes of active recovery (e.g., walking).[2-4]
2. Aerobic Exercise: Aerobic exercise is highly effective for improving cardiovascular health and longevity. It is associated with reduced mortality and morbidity.[5-6]
Recommended Protocol:
Frequency: 5 times per week
Duration: 30-60 minutes per session
Intensity: Moderate (50-70% of maximum heart rate) to vigorous (70-85% of maximum heart rate)
Activities: Walking, jogging, swimming, cycling.[5-6]
3. Resistance Training: Resistance training is essential for maintaining muscle mass and strength, which are crucial for aging and disease prevention.[5][7]
Recommended Protocol:
Frequency: 2-3 times per week
Duration: 30-45 minutes per session
Intensity: 60-80% of 1-repetition maximum (1-RM)
Structure: 8-10 exercises targeting major muscle groups, 2-3 sets of 8-12 repetitions per exercise.[7]
Combining these exercise modalities can provide comprehensive benefits for health span and longevity.

1.
High-Intensity Aerobic, but Not Resistance or Combined, Exercise Training Improves Both Cardiometabolic Health and Skeletal Muscle Mitochondrial Dynamics.

Ruegsegger GN, Pataky MW, Simha S, et al.

Journal of Applied Physiology (Bethesda, Md. : 1985). 2023;135(4):763-774. doi:10.1152/japplphysiol.00405.2023.

This study investigated how different exercise training modalities influence skeletal muscle mitochondrial dynamics. Healthy [average body mass index (BMI): 25.8 kg/m2], sedentary younger and older participants underwent 12 wk of supervised high-intensity aerobic interval training (HIIT; n = 13), resistance training (RT; n = 14), or combined training (CT; n = 11). Mitochondrial structure was assessed using transmission electron microscopy (TEM). Regulators of mitochondrial fission and fusion, cardiorespiratory fitness (V̇o2peak), insulin sensitivity via a hyperinsulinemic-euglycemic clamp, and muscle mitochondrial respiration were assessed. TEM showed increased mitochondrial volume, number, and perimeter following HIIT (P < 0.01), increased mitochondrial number following CT (P < 0.05), and no change in mitochondrial abundance after RT. Increased mitochondrial volume associated with increased mitochondrial respiration and insulin sensitivity following HIIT (P < 0.05). Increased mitochondrial perimeter associated with increased mitochondrial respiration, insulin sensitivity, and V̇o2peak following HIIT (P < 0.05). No such relationships were observed following CT or RT. OPA1, a regulator of fusion, was increased following HIIT (P < 0.05), whereas FIS1, a regulator of fission, was decreased following HIIT and CT (P < 0.05). HIIT also increased the ratio of OPA1/FIS1 (P < 0.01), indicative of the balance between fission and fusion, which positively correlated with improvements in respiration, insulin sensitivity, and V̇o2peak (P < 0.05). In conclusion, HIIT induces a larger, more fused mitochondrial tubular network. Changes indicative of increased fusion following HIIT associate with improvements in mitochondrial respiration, insulin sensitivity, and V̇o2peak supporting the idea that enhanced mitochondrial fusion accompanies notable health benefits of HIIT.NEW & NOTEWORTHY We assessed the effects of 12 wk of supervised high-intensity interval training (HIIT), resistance training, and combined training (CT) on skeletal muscle mitochondrial abundance and markers of fission and fusion. HIIT increased mitochondrial area and size and promoted protein changes indicative of increased mitochondrial fusion, whereas lessor effects were observed after CT and no changes were observed after RT. Furthermore, increased mitochondrial area and size after HIIT associated with improved mitochondrial respiration, cardiorespiratory fitness, and insulin sensitivity.

2.
Low-Volume High-Intensity Interval Training for Cardiometabolic Health.

Sabag A, Little JP, Johnson NA.

The Journal of Physiology. 2022;600(5):1013-1026. doi:10.1113/JP281210.

High-intensity interval training (HIIT) is characterised by short bouts of high-intensity submaximal exercise interspersed with rest periods. Low-volume HIIT, typically involving less than 15 min of high-intensity exercise per session, is being increasingly investigated in healthy and clinical populations due to its time-efficient nature and purported health benefits. The findings from recent trials suggest that low-volume HIIT can induce similar, and at times greater, improvements in cardiorespiratory fitness, glucose control, blood pressure, and cardiac function when compared to more traditional forms of aerobic exercise training including high-volume HIIT and moderate intensity continuous training, despite requiring less time commitment and lower energy expenditure. Although further studies are required to elucidate the precise mechanisms of action, metabolic improvements appear to be driven, in part, by enhanced mitochondrial function and insulin sensitivity, whereas certain cardiovascular improvements are linked to increased left ventricular function as well as greater central and peripheral arterial compliance. Beyond the purported health benefits, low-volume HIIT appears to be safe and well-tolerated in adults, with high rates of reported exercise adherence and low adverse effects.

3.

High-intensity interval training (HIIT) can effectively increase peak oxygen consumption, body composition, physical fitness, and health-related characteristics of adults; however, its impact in the older population remains highly debated. This review and meta-analysis aimed to evaluate the effects of high-intensity interval training on cardiorespiratory fitness, body composition, physical fitness, and health-related outcomes in older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until July 2020) for randomized trials comparing the effect of HIIT on physical fitness, metabolic parameters, and cardiorespiratory fitness in older adults. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies; Stata 14.0 software was used for statistical analysis. HIIT significantly improved the maximum rate of oxygen consumption (VO) as compared to a moderate-intensity continuous training (MICT) protocol (HIIT vs.

Mict: weighted mean difference = 1.74, 95% confidence interval: 0.80-2.69, p < 0.001). Additional subgroup analyses determined that training periods >12 weeks, training frequencies of 2 sessions/week, session lengths of 40 min, 6 sets and repetitions, training times per repetition of >60 s, and rest times of <90 s were more effective for VO. This systematic review and meta-analysis showed that HIIT induces favorable adaptions in cardiorespiratory fitness, physical fitness, muscle power, cardiac contractile function, mitochondrial citrate synthase activity, and reduced blood triglyceride and glucose levels in older individuals, which may help to maintain aerobic fitness and slow down the process of sarcopenia.

4.
High-Intensity Interval Training and Cardiometabolic Health in the General Population: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Edwards JJ, Griffiths M, Deenmamode AHP, O'Driscoll JM.

Sports Medicine (Auckland, N.Z.). 2023;53(9):1753-1763. doi:10.1007/s40279-023-01863-8.

Leading Journal

Background: High-intensity interval training (HIIT) remains a promising exercise mode in managing cardiometabolic health. Large-scale analyses are necessary to understand its magnitude of effect on important cardiometabolic risk factors and inform guideline recommendations.

Objective: We aimed to perform a novel large-scale meta-analysis on the effects of HIIT on cardiometabolic health in the general population.

Methods: PubMed (MEDLINE), the Cochrane library and Web of Science were systematically searched. Randomised controlled trials (RCTs) published between 1990 and March 2023 were eligible. Research trials reporting the effects of a HIIT intervention on at least one cardiometabolic health parameter with a non-intervention control group were considered.

Results: This meta-analysis included 97 RCTs with a pooled sample size of 3399 participants. HIIT produced significant improvements in 14 clinically relevant cardiometabolic health parameters, including peak aerobic capacity (VO) [weighted mean difference (WMD): 3.895 ml min kg, P < 0.001), left ventricular ejection fraction (

Wmd: 3.505%, P < 0.001), systolic (WMD: - 3.203 mmHg, P < 0.001) and diastolic (WMD: - 2.409 mmHg, P < 0.001) blood pressure, resting heart rate (WMD: - 3.902 bpm, P < 0.001) and stroke volume (

Wmd: 9.516 mL, P < 0.001). Body composition also significantly improved through reductions in body mass index (WMD: - 0.565 kg m, P < 0.001), waist circumference (WMD: - 2.843 cm, P < 0.001) and percentage body fat (WMD: - 0.972%, P < 0.001). Furthermore, there were significant reductions in fasting insulin (WMD: - 13.684 pmol L, P = 0.004), high-sensitivity C-reactive protein (WMD: - 0.445 mg dL, P = 0.043), triglycerides (WMD: - 0.090 mmol L, P = 0.011) and low-density lipoprotein (WMD: - 0.063 mmol L, P = 0.050), concurrent to a significant increase in high-density lipoprotein (

Wmd: 0.036 mmol L, P = 0.046).

Conclusion: These results provide further support for HIIT in the clinical management of important cardiometabolic health risk factors, which may have implications for physical activity guideline recommendations.

5.
Which Type of Exercise Keeps You Young?.

Pedersen BK.

Current Opinion in Clinical Nutrition and Metabolic Care. 2019;22(2):167-173. doi:10.1097/MCO.0000000000000546.

Purpose Of Review: Robust epidemiological evidence exists that lifelong regular exercise contributes to longevity. The aim of this review is to discuss recent findings regarding, which dose and type of physical activity promotes a long healthy life, free of disease.

Recent Findings: Meeting the currently recommended amounts of leisure time physical aerobic activity of moderate intensity of at least 150 min/week provides most of the longevity benefit. However, a higher duration and intensity augments the beneficial effect on cardiovascular health and metabolism. Performing three to five times the recommended physical activity minimum reaches the maximal longevity benefit, that can be achieved. Although it is not dangerous to perform even higher amounts of exercise, the benefit may decrease. A high maximal oxygen uptake in mid-life is a strong marker of longevity, whereas muscle mass is a critical prognostic factor in aging and cancer.

Summary: Exercise training above the public health recommendations provides additional benefits regarding disease protection and longevity. Endurance exercise, including high-intensity training to improve cardiorespiratory fitness promotes longevity and slows down aging. Strength training should be added to slow down loss of muscle mass, associated with aging and disease.

6.
Effectiveness of Aerobic Exercise Programs for Health Promotion in Metabolic Syndrome.

Morales-Palomo F, Ramirez-Jimenez M, Ortega JF, Mora-Rodriguez R.

Medicine and Science in Sports and Exercise. 2019;51(9):1876-1883. doi:10.1249/MSS.0000000000001983.

Purpose: Continuous and interval are the two types of aerobic exercise training commonly used for health promotion. We sought to determine which aerobic exercise training program results in larger health improvements in metabolic syndrome (MetS) individuals.

Methods: One hundred twenty-one MetS patients (age, 57 ± 8 yr; weight, 92 ± 15 kg; and MetS factors, 3.8 ± 0.8 components) with low initial cardiorespiratory fitness (CRF) (V˙O2peak, 24.0 ± 5.5 mL·kg·min) were randomized to undergo one of the following 16-wk exercise program: (a) 4 × 4-min high-intensity interval training at 90% of HRMAX (4HIIT group; n = 32), (b) 50-min moderate-intensity continuous training at 70% of HRMAX (MICT group; n = 35), (c) 10 × 1-min HIIT at 100% of HRMAX (1HIIT group; n = 32), or (d) no exercise control group (CONT; n = 22). We measured the evolution of all five MetS components (i.e., MetS Z Score) and CRF (assessed by V˙O2peak) before and after intervention.

Results: MetS Z score decreased 41% after 4HIIT (95% confidence interval [CI], 0.25-0.06; P < 0.01) and 52% in MICT (95% CI, 0.24-0.06; P < 0.01), whereas it did not change in 1HIIT (decreased 24%; 95% CI, -0.16 to 0.03; P = 0.21) and CONT (increased 20%; 95% CI, -0.19 to 0.04; P = 0.22). However, the three exercise groups improved similarly their V˙O2peak (4HIIT, 11%; 95% CI, 0.14-0.33; MICT, 12%; 95% CI, 0.18-0.36; and 1HIIT, 14%; 95% CI, 0.21-0.40 L·min; all P < 0.001).

Conclusions: Our findings suggest that in sedentary individuals with MetS and low initial CRF level any aerobic training program of 16 wk with a frequency of three times per week is sufficient stimulus to raise CRF. However, the more intense but shorter 1HIIT training program is not effective on improving MetS Z score, and thus we caution its recommendation for health promotion purposes in this population.

7.
Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association.

Fletcher GF, Ades PA, Kligfield P, et al.

Circulation. 2013;128(8):873-934. doi:10.1161/CIR.0b013e31829b5b44.

Leading Journal

Resistance exercise training, which involves activities that use low- or moderate-repetition movements against resistance, has been accepted as a primary component of a comprehensive exercise program, both for apparently healthy individuals and (with appropriate screening and precautions) for subjects with CVD. Although the effect of resistance exercise on CVD risk factor modification is less than traditional endurance exercise, the increase in strength and potential for increased muscle mass could improve the individual’s ability to become more physically active, raise the basal metabolic rate, and in older people, improve the ability to perform activities of daily living and decrease fall risk (Table 7). People initiating a resistance training program should be carefully screened for both cardiovascular limitations and preexisting orthopedic and musculoskeletal problems. In addition, individuals should be provided with careful recommendations with regard to the specific components of the resistance training program, including proper technique, number and types of exercises, and safety precautions.
Detailed guidelines for resistance training can be found elsewhere.,, An outline of progressive resistance training programming is presented in Table 7. Programs including a single set of 8 to 10 different exercises (eg, chest press, shoulder press, triceps extension, biceps curl, pull-down, lower back extension, abdominal crunch/curl-up, quadriceps extension or leg press, and leg curls/calf raise) that train the major muscle groups, when performed 2 to 3 days per week, will elicit favorable adaptations and improvement (or maintenance thereof). Intensity of training (training load) is prescribed relative to the 1-repetition maximum (1-RM), which is the highest weight or load an individual can lift for a specific exercise only once when using proper technique. To achieve a balanced increase in both muscular strength and endurance, a repetition range of 8 to 12 is recommended for healthy participants <50 to 60 years of age (60%–80% of 1-RM), and a range of 10 to 15 repetitions at a lower relative resistance (40%–60% of 1-RM) is recommended for cardiac patients and healthy older participants.

Expanded question: If one were to combine the three types of exercises, aerobic, resistance training, and High-Intensity Interval Training (HIIT), what is the recommended daily schedule? Considering that doing any of the above exercise routines one day would require sufficient rest for the remainder of the day, and even a lighter day of exercise or a different form of exercise the next day, right?

Answered on December 3, 2024
Combining aerobic exercise, resistance training, and High-Intensity Interval Training (HIIT) can optimize health span and longevity. The following is a recommended weekly schedule that balances these exercise modalities while allowing for adequate rest and recovery:
Monday:
Aerobic Exercise: 30-60 minutes of moderate-intensity aerobic activity (e.g., brisk walking, jogging, cycling).[1]
Tuesday:
Resistance Training: 30-45 minutes focusing on major muscle groups (e.g., free weights, machines, body weight exercises), 2-3 sets of 8-12 repetitions per exercise.[2]
Wednesday:
HIIT: 20-30 minutes, consisting of 4-6 intervals of 1-4 minutes of high-intensity exercise (85-95% of maximum heart rate) with 1-3 minutes of active recovery.[3]
Thursday:
Light Aerobic Exercise or Rest: 30 minutes of light activity (e.g., walking, yoga) or complete rest.
Friday:
Resistance Training: Similar to Tuesday, focusing on different muscle groups if using a split routine.[2]
Saturday:
Aerobic Exercise: 30-60 minutes of moderate to vigorous activity (e.g., swimming, dancing).[1]
Sunday:
HIIT: Similar to Wednesday, ensuring high-intensity intervals with adequate recovery periods.[3]
This schedule ensures a balanced approach, incorporating all three exercise types while allowing for sufficient rest and recovery. The American College of Sports Medicine recommends this combination to maximize health benefits and minimize the risk of overtraining.[1-2]

1.
Exercise/­Physical Activity in Individuals With Type 2 Diabetes: A Consensus Statement From the American College of Sports Medicine.

Kanaley JA, Colberg SR, Corcoran MH, et al.

Medicine and Science in Sports and Exercise. 2022;54(2):353-368. doi:10.1249/MSS.0000000000002800.

Type of Training,Type,Intensity,Frequency,Duration,Progression
Aerobic,"Walking, jogging, cycling, swimming, aquatic activities, rowing, dancing, interval training","40%-59% of VO2R or HRR (moderate), RPE 11-12; or 60%-89% of VO2R or HRR (vigorous), RPE 14-17","3-7 d/wk, with no more than 2 consecutive days between bouts of activity","Minimum of 150 to 300 min/wk of moderate activity or 75 to 150 min of vigorous activity, or an equivalent combination thereof","Rate of progression depends on baseline fitness, age, weight, health status, and individual goals; gradual progression of both intensity and volume is recommended"
Resistance,"Free weights, machines, elastic bands, or body weight as resistance; undertake 8-10 exercises involving the major muscle groups","Moderate at 50%-69% of 1-RM, or vigorous at 70%-85% of 1-RM","2-3 d/wk, but never on consecutive days","10-15 repetitions per set, 1-3 sets per type of specific exercise","As tolerated; increase resistance first, followed by a greater number of sets, and then increased training frequency"
Flexibility,"Static, dynamic, or PNF stretching; balance exercises; yoga and tai chi increase range of motion",Stretch to the point of tightness or slight discomfort,≥2-3 d/wk or more; usually done with when muscles and joints are warmed up,10-30 s per stretch (static or dynamic)group; 2-4 repetitions of each,As tolerated; may increase range of stretch as long as not painful
Balance,"Balance exercises: lower body and core resistance exercises, yoga, and tai chi also improve balance",No set intensity,≥2-3 d/wk or more,No set duration,As tolerated; balance training should be done carefully to minimize the risk of falls

2.

Meta-analyses show that optimal gains in muscle function and size can occur with training two to three times per week (285,306,386). This can be effectively achieved with "whole body" training sessions completed two to three times a week or by using a "split-body" routine where selected muscle groups are trained during one session and the remaining muscle groups in the next. A rest period of 48 to 72 h between sessions is needed to optimally promote the cellular/molecular adaptations that stimulate muscle hypertrophy and the associated gains in strength (36).

3.
Effect of Performing High-Intensity Interval Training and Resistance Training on the Same Day vs. Different Days in Women With Type 2 Diabetes.

Ghodrat L, Razeghian Jahromi I, Koushkie Jahromi M, Nemati J.

European Journal of Applied Physiology. 2022;122(9):2037-2047. doi:10.1007/s00421-022-04980-w.

Type 2 diabetes (T2D) is associated with chronic inflammation as a critical factor for muscle atrophy and disease progression. Although the combination of aerobic and resistance training leads to more significant improvements in health-related indices for T2D patients, the interference effect in concurrent training can decrease positive adaptations. The purpose of this study was to investigate the physiological adaptations in performing high-intensity interval training (HIIT) and resistance training on the same day vs. different days in T2D patients. Twenty-four non-athletic 45-65-year-old women with T2D participated in an 8-week intervention. They were randomly divided into three groups: same days (SD), different days (DD), and treatment as usual (control). SD group had resistance training followed by HIIT on Saturday, Monday, and Wednesday. In contrast, the DD group had the same volume of resistance training on Saturday, Monday, and Wednesday and HIIT on Sunday, Tuesday, and Thursday, with Friday as a resting day. Blood samples were collected 24 h before the first and 48 h after the last session in each group to measure glucose, insulin, glycosylated hemoglobin, IGF1, IL1β, CRP, lipid profile, miR-146a, and miR-29b. Three subjects dropped out during the study, and 21 participants (SD = 7, DD = 6, Control = 8) completed the 8-week intervention. MiR-146a changed significantly (P = 0.006) in both SD and DD groups compared to the control group. IGF1 (P = 0.001) and fat-free mass (P = 0.001) changed significantly in SD and DD groups compared to the control group, and also DD led to more significant increases in IGF1 and fat-free mass in comparison with SD. MiR-29 (P = 0.001) changed significantly in the DD group compared to the control group. The reduction of IL-1β, fat mass and insulin resistance was significant in SD and DD compared to the control group; DD showed more potent effects than the SD group on the fat mass (P = 0.001) and insulin resistance (P = 0.001). This study demonstrated that a combination of HIIT and resistance training could be practical for improving health-related outcomes in T2D. Our study indicated for the first time that training strength and HIIT on separate days appeared to be more effective to combat muscle atrophy and insulin resistance.