Getting patients to perform prescribed exercises is probably a physical therapist’s biggest challenge. We know this first hand from the therapists employed at our pain management clinics. This reluctance and indeed, apathy about exercise is predictable but still troubling. After all, patients in pain should be more strongly motivated to perform therapeutic exercises than the average individual.

In fact, despite a mountain of research that has emerged in recent decades on the miracle drug that is regular physical activity, 80 percent of Americans aren’t exercising enough to take advantage of its health benefits.

This is why this isn’t going to be another article extolling the cardiovascular or musculoskeletal benefits of exercise. For decades, national health authorities in the U.S., U.K, and other countries have issued guidelines for physical activity but haven’t successfully persuaded enough of us to get up and move.

In an attempt to convince more of our readers to start a regular exercise routine, we will speak to exercise’s other benefits — specifically, life extension and youthful looks.

Can exercise really help us to live longer?

Let’s start with claims that exercise can extend life spans. If exercise is a powerful anti-aging supplement, then we would expect Olympic athletes to live longer than any of us. Simone Biles started gymnastics at age 6 and trains for 4 to 5 hours a day. Michael Phelps spends an average of 4 hours in the pool, not including the workouts he does outside the pool.

This is, at minimum, 14 times more physical activity than the average American, and 7.5 times more than the CDC’s recommended exercise guidelines.

There is actually evidence that Olympians do outlive the average person. One study found that they live 2.8 years longer than the general population of the same age, gender, and nationality. Interestingly, endurance-based athletes seem to live longer than power-based ones like weight lifters. Tour de France cyclists, for example, live 8 years longer.

However, if elite athletes are only motivated to improve their life spans, they will be disappointed at the return on their sweat investment. Given that the athlete is working 1,300 percent more than the average American, an increase of 2.8 years produces only a measly 4 percent increase over the average lifespan. It is a good thing then that living longer isn’t what motivates them to compete.

This seemingly unrewarding tradeoff is actually good news for those of us not aspiring to be professional athletes but who do want to live longer. Studies of another group of “elite” humans recommend steps that are much more achievable for the average person.

The world’s aging elites

This other elite group is the residents of the Earth’s “blue zones”. Blue zones are areas with clusters of the longest-living humans. The term was coined by demographers Gianni Pes and Michel Poulain after they used a blue felt-tip pen to highlight such zones on their map.

Sardinia, Italy, is an island of pristine waters and beautiful coastlines, and it has nearly 10 times more centenarians than the United States. Okinawa, Japan boasts the world’s longest-lived women, while the Seventh-day Adventists in Loma Linda, California, live a decade longer than the rest of America. These are a few examples of blue zone regions around the world.

Surprisingly, the absence of exercise is a common factor across blue zones. In other words, the world’s supercentenarians (those who live over 110 years) have never stepped foot in a gym before.

When most of us think of exercise today, we imagine engaging in short, intense bursts of activity like running or lifting weights at the gym. The Sardinians, and other blue zone residents, on the other hand, expend their energy not in 30 or 60-minute bursts, but throughout the day. They are rarely seated at a desk. Instead, many walk several miles each day. Even the one group of women that spent their working lives seated in Seulo, Sardinia were pedalling sewing machine treadles and burning calories every day.

Sustained, low-level activity, not short bursts of exercise, is the common denominator in blue zones.

While it is true that many other factors, such as a primarily plant-based diet, an active social life, and daily living that is close to nature have been identified as contributing to the long lifespans of blue zone residents, what they all have in common is a distaste for staying sedentary.

All this is the good news of course. However, unless the scientists at Google’s Calico or Life Biosciences crack the immortality code, the life-enhancing benefits of exercise will hit a limit. And most scientists agree that the current upper limit for human life is around 123 years.

A real-life youth elixir

In the movie Death Becomes Her, Meryl Streep plays a narcissistic and aging actress who drinks an exotic potion to gain eternal life and youthful looks. Modern research increasingly shows that regular exercise is the real-life version of this potion. And while eternal life is a double-edged sword wielded to comical effect in the film, exercise offers no such equivocation about its benefits.

Visible aging leads to a discussion about the health of our skin. As we get older, we begin to notice changes to the quality of our skin. Our skin starts to feel thinner, saggier and wrinkles begin to cut lines into our face. These changes happen because our skin doesn’t renew itself as quickly anymore, leading to a thicker stratum corneum, which is the outermost layer of the epidermis. In the deeper layers, collagen production starts slowing down, resulting in wrinkles and skin that feels less elastic.

It will come as no surprise to you by now that scientists have established exercise’s anti-aging bonafides. More remarkably, they found that exercise can actually reverse aging.

Researchers at McMaster University in Ontario first noticed this in mice. Sedentary mice were compared to mice given running wheels. The results showed that the active mice maintained not only better internal health measures (healthier muscles, hearts, brains), but also looked “younger” since their fur never turned gray or became bald, unlike their more inactive labmates.

To see if this carried over to humans, the researchers biopsied the skin from the buttocks of 29 volunteers between the ages of 20 and 84. Taking skin from an area not exposed to the sun, which prematurely ages the skin, allowed them to isolate the effects of exercise. Half of these participants performed at least 3 hours of moderate or vigorous physical activity each week, while the other half remained sedentary.

When the skin samples were examined microscopically, the researchers found that the physically active men and women above age 40 had skin that was closer in composition to that of the 20- and 30-year-olds, even if they were past age 65.

Their stratum corneums were thinner and healthier, while the deeper dermis layer was thicker, indicating better collagen production.

To further isolate the effects of regular physical activity from environmental or genetic factors, the researchers got a group of sedentary volunteers aged 65 or older exercising. For 3 months, these volunteers worked out twice a week, either running or cycling at a moderately strenuous pace (equivalent to at least 65 percent of their maximum aerobic capacity for 30 minutes). Skin samples before and after the endurance training program were compared.

This is where the results become interesting enough for the mainstream press to report on. The skin of the previously sedentary but now active person actually began to look more like those of the 20- to 40- year olds. Before the training, these looked just like those of other sedentary volunteers in their age cohort.

Youth that is more than skin-deep

Studying blood drawn immediately after people exercised provided the researchers with some clues to explain these results. Contracting muscles during physical activity requires energy and this metabolic activity is regulated by certain enzymes, including one called AMPK. Exercise increases AMPK activity, which causes another type of molecule called IL-15 to be released. This was identified as an important link between exercise and skin health. IL-15 enters the bloodstream and catalyzes changes that regulate mitochondrial function in aging skin. The skin samples of volunteers who had engaged in endurance training had 50 percent more IL-15 than at the start of the study.

Youth that is more than skin-deep

It is quite remarkable that these researchers managed to identify a potentially novel mechanism through which exercise affects skin health at the cellular level. However, since our bodies are holistic systems, youthful skin is probably just one consequence of how exercise affects our biological age. Another way of saying this is that exercise helps our bodies get functionally younger, and one way this manifests itself is in younger skin.

So the youth-endowing benefits of regular physical activity are more than skin deep. In another study, scientists peered into the nuclei of our cells to measure the length of telomeres in people who engaged in vigorous exercise. Telomeres are the protective caps at the end of our chromosomes. They are highly correlated with age because each time our cells divide, they get a little shorter. Adults that engaged in high levels of physical activity were found to have telomeres that were up to nine years “longer” than those who were sedentary.

The catch is that this significant longevity bonus requires you to double the CDC recommendation for vigorous exercise — at least 30 minutes of an intense activity like jogging, for 5 days a week. No significant difference in telomere length was found between those who only engaged in low or moderate levels of physical activity and those who were sedentary.

Inflammaging

At this point, we need to talk about inflammation. Larry Tucker, the exercise science professor responsible for the study above believes that exercise preserves telomere length by suppressing inflammation and oxidative stress over time. Regular physical activity acts as a positive shock that interrupts the vicious cycle in our bodies caused by low-grade, chronic inflammation. This process, coined “inflammaging”, has been identified as a major factor to aging.

Exercise intervenes in the inflammaging process by improving the body’s immune responses. Instead of low grade, systemic inflammation that shortens telomeres and ages our bodies, more anti-inflammatory cytokines and T-cells are produced, slowing down the aging process and reducing the risk of age-related diseases. Damage and wounds within the body also heal faster because increased blood flow during exercise can improve immune cell activity and oxygen delivery.

The full picture of the intricate dance happening deep inside our cells when we exercise is still a mystery. But it is safe to say that exercise slows biological aging and more youthful-looking skin is just one of many positive by-products. The extra years gained will likely also be more functional years, marred less by age-related diseases.

The moral of this story is, exercise is the non-fictional, real-life elixir of youth and longevity. If we can overcome our body’s preference for rest, staying physically active on a regular basis becomes the most powerful medicine we can take for our bodies today.

We covered a lot in this article, so here is a quick summary:

Regular physical activity can extend life spans, but we needn’t work as hard as Olympic athletes to take advantage of this benefit. The residents of “blue zones” have shown us that the key is in sustaining low-level activity on a daily basis.

Since most of us live more sedentary lifestyles than blue zone residents, we should aim to get at least 20 minutes of daily exercise for life extension benefits.

Exercise is also a youth elixir, maintaining and even reversing skin aging with as little as 30 minutes of vigorous exercise, performed twice a week.

Younger skin is a byproduct of a biologically younger body, as exercise changes us at the cellular level by prolonging telomere length and improving our immune system’s response against inflammaging.