8/21/2026
This is the eighth piece in my series about Eric Topol's book, Super Agers: An Evidence-Based Approach to Longevity.
So far, I've been focusing on Chapter 3, “Lifestyle+.” Today, I'll cover the section on exercise.
First, exercise may be the most powerful “medicine” we have.
Topol makes a very strong claim: regular physical activity may be the single most effective intervention we know for healthy aging.
Exercise benefits the cardiovascular system, brain, muscles, pancreas, liver, immune system, blood vessels, and gut microbiome. It also improves insulin sensitivity and mitochondrial function.
Second, exercise is strongly associated with longer life and better health.
Large studies consistently associate physical activity with lower mortality from all causes, cardiovascular disease, and cancer, as well as better sleep.
One analysis of 196 studies involving more than 30 million people found about a 31% reduction in all-cause mortality associated with physical activity.
But Topol also points out an important nuance: more isn't necessarily infinitely better. Some evidence suggests that the benefits may plateau around:
Moderate exercise: 300–600 minutes per week
Vigorous exercise: 150–300 minutes per week
The goal, therefore, isn't to exercise as much as possible, but to exercise regularly and consistently.
Third, you don't need to hit 10,000 steps every day.
The famous 10,000-step-a-day target was not originally based on scientific evidence. Studies show meaningful benefits beginning at much lower levels.
For example, among older women, reduced mortality was associated with walking as few as 2,700 steps per day, with benefits increasing and then leveling off at around 7,500 steps.
So move more, walk regularly, and increase your pace or intensity when you can.
Fourth, aerobic exercise alone isn't enough as we age.
Topol considers exercise to have two essential dimensions: aerobic conditioning and strength/resistance training.
Muscle mass and strength begin declining around age 50. Between ages 60 and 90, men lose roughly 33% of their muscle mass, while women lose about 26%.
Strength training helps preserve muscle mass and strength, as well as bone density, balance, mobility, posture, and independence.
For older adults, maintaining muscle isn't simply about looking fit. It is about maintaining the ability to live independently.
Fifth, grip strength is a useful marker of overall strength.
Topol emphasizes hand-grip strength. Across 48 studies involving more than 1.1 million people, stronger grip strength was associated with lower all-cause mortality.
Grip strength also declines by more than 2% per year after age 50, on average.
Although this association does not prove that increasing grip strength itself will make someone live longer, grip strength is still a useful measure of functional strength—and it matters for many everyday activities.
Sixth, balance becomes increasingly important.
Topol recommends the one-leg stand as a simple measure of balance.
For seniors, he suggests being able to stand on one leg for at least 30 seconds. Inability to stand for 10 seconds was associated with roughly twice the risk of all-cause mortality.
Balance can be improved through simple exercises such as standing on one leg or practicing heel-to-toe walking. Yoga and Pilates can also help with balance and flexibility.
Seventh, sitting for long periods is itself a problem.
Topol said, "There’s one thing you don’t want to do for any prolonged period: sit." Because exercise doesn't erase the consequences of prolonged sitting.
A large study found that people who mostly sat at work had 16% higher all-cause mortality and 34% higher cardiovascular mortality, even after adjustment for other factors.
The key is to break up prolonged periods of sitting.
Eighth, and perhaps most encouraging: it's never too late to start.
You don't have to have been an athletic person when you were young. Starting later in life can still make a meaningful difference.
Topol gave an example of "Richard Morgan, 93-year-old man, who took up regular exercise for the first time in his life in his 70s using a rowing machine in his backyard shed, with an average 40-miniute workout each day."
For healthy aging, think of exercise as a lifelong investment in your heart, brain, muscles, bones, metabolism, immune system, balance, and independence.
For older adults, Topol's practical formula is:
Move regularly + walk briskly + do aerobic exercise + build muscle + train balance + strengthen your grip + avoid prolonged sitting.
And there's no better ending than Topol's own words:
“If I’m going to be old, I’d rather be strong and old!”
