Question & context

Longevity: Where do I start?

In short

Start with the levers that large studies most strongly link to a long, healthy life: endurance fitness, muscle strength, good blood pressure, not smoking, little alcohol, enough sleep and a high-fiber diet. After that, it is worth knowing a few values, such as blood pressure, blood lipids, blood sugar and, once in your life, lipoprotein(a). The well-known longevity substances such as rapamycin or NMN are exciting, but there is not yet a study in healthy people with hard endpoints such as lifespan or heart attacks. In large observational studies, multivitamins did not extend life.

What counts first

Build endurance

In a cohort of 122,007 people who had taken an exercise test, the least fit had a hazard ratio of 5.04 for mortality compared with the fittest. A meta-analysis of 33 cohorts found a hazard ratio of 0.87 for each additional level of exercise capacity. The WHO recommends that adults get 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous aerobic activity per week.

Train for strength

Muscle strength is a strong predictor: in the PURE cohort of 139,691 people, every 5 kilograms of lower grip strength was associated with a 16 percent higher risk of death. The WHO advises muscle-strengthening exercises on 2 or more days per week.

Know your blood pressure and lower it

In the SPRINT trial of 9,361 people with elevated cardiovascular risk, a strict target of below 120 instead of below 140 mmHg reduced all-cause mortality, with a hazard ratio of 0.73. Measure regularly at home and discuss the values with a physician, because the target applies to a standardized measurement and not to everyone.

Sleep, quitting smoking, less alcohol

Adults should regularly sleep 7 or more hours. In the fitness cohort mentioned above, smoking was about as strongly associated with mortality as below-average fitness, both with a hazard ratio of 1.41. Drinking less alcohol is among the measures with the best evidence in this database.

Dietary fiber as the foundation of your diet

A large analysis of 185 prospective studies and 58 clinical trials found 15 to 30 percent lower all-cause and cardiovascular mortality in people with the highest fiber intake. The greatest benefit appeared at 25 to 29 grams per day, meaning plenty of vegetables, legumes, whole grains and nuts.

When you should have this checked by a physician

Before you start intensive training, get a medical checkup if you have pre-existing conditions, have been inactive for a long time or notice symptoms such as chest pain, shortness of breath or heart palpitations during exertion. The screenings covered by statutory health insurance, such as the general health check-up and cancer screening, are a good, free starting point. Anyone considering drugs such as rapamycin or metformin for longevity purposes should do so only under medical supervision, because a benefit in healthy people has not been shown and the side effects are real. Elevated blood pressure, abnormal blood lipids or elevated blood sugar need medical treatment, not just optimization.

Why the basics are so powerful

The big longevity levers are boring but powerful. Fitness, strength, blood pressure, smoking, alcohol, sleep and diet act simultaneously on the heart, blood vessels, metabolism, brain and muscles. For some of them there are randomized trials with hard endpoints, for example on blood pressure; for others there are very large cohorts.

Context matters: the fitness and strength data come from observational studies. They show that fit and strong people live longer, not necessarily that every additional workout extends life by a specific amount. The Generation 100 intervention study with 1,567 older people found no difference in mortality after 5 years of supervised training compared with a control group that was also very active on its own. Even so, everything speaks for getting fit, because training improves almost every risk factor and quality of life.

Which values you should know

A sensible start is manageable: blood pressure, blood lipids with LDL or ApoB, the long-term blood sugar marker HbA1c and, once in your life, lipoprotein(a), because it is genetically determined and missing from the standard check-up. In addition, waist circumference, grip strength or training weights as simple values to track over time.

Large biomarker panels and annual full-body checkups are tempting. For general health checks, however, large studies found no reduction in mortality, and for large panels in healthy people there is no study showing a benefit. The best number is the one you draw a conclusion from.

Supplements and longevity substances: where things stand

Multivitamins are the prime example: in three large US cohorts with 390,124 adults, daily use was not associated with a longer life. Vitamin D and omega-3 missed their primary endpoints in the large VITAL trial with 25,871 participants from the general population. That does not mean they are useless, but that they have their place in cases of confirmed deficiency or certain diseases.

Rapamycin, NMN and related substances are fascinating in animal studies. In humans, there is so far no randomized trial with a hard endpoint in healthy people, and the largest studies in some cases already missed their primary outcome measures. If you are curious, follow the research, but invest first in training, sleep and blood pressure.

What the database says

Sorted by strength of evidence. The BK-Score rates the state of knowledge, not the substance.

Strength training 3× per week Evidence 9/10 · Well supportedStrength training is the best-supported single measure in this database, with effects on muscle mass, bone density and metabolism. The link to a longer life comes from cohorts.
Blood pressure target – 120 at home is not the same 120 Evidence 9/10 · Well supported, heavily overhypedThe strict target of below 120 mmHg comes from SPRINT, where it reduced mortality. The measurement method is decisive, because the value at home is not automatically the same as in the study.
Cutting back on alcohol Evidence 9/10 · Well supportedNot an active substance, but a lever of leaving something out, with very good evidence: less alcohol improves sleep and recovery and lowers cancer risk.
Dietary fiber – the best-supported component of food Evidence 9/10 · Well supported, heavily overhypedThe best-supported component of food, with large cohorts and randomized trials on risk factors. The links to mortality come from observational data.
Lipoprotein(a) Evidence 8/10 · Well studied – effect not confirmedA genetically determined risk factor that about one in five people has at elevated levels and that is missing from the standard cholesterol check. Measuring it once in your life is worthwhile; a drug with proven benefit does not yet exist.
Zone 2 & VO2max training Evidence 7/10 · Supported, with caveatsMaximal oxygen uptake is one of the strongest predictors of mortality. Whether Zone 2 training in particular is optimal for it has not been shown; higher intensities often do just as well.
Muscle as an organ (grip strength & myokines) Evidence 7/10 · Supported, with caveatsMuscle strength strongly predicts all-cause mortality in large cohorts. What is measured is strength, not mass, and a hand dynamometer is enough to track it over time.
Sleep & sleep hygiene Evidence 7/10 · Supported, with caveatsCohorts show a U-shaped association between sleep duration and mortality. Behavioral therapy for sleep disorders is well supported; life extension through sleep optimization in healthy people is not.
Adjusting protein to age Evidence 7/10 · Supported, with caveatsWith age, protein needs for maintaining muscle rise. Geriatric medical societies cite considerably lower amounts for this than the longevity scene does.
Micronutrient concentrates (LaVita & co.) Evidence 9/10 · Well studied – effect not confirmedMultivitamins and micronutrient concentrates are well studied but show no survival benefit in large studies. A counterexample to the idea that more always helps.

Frequently asked questions

What is the most important longevity factor?

There is no single one, but in large cohorts endurance fitness and muscle strength are among the strongest predictors of mortality. Add to that not smoking and good blood pressure. These levers act on many organs at once.

Which blood values should I know for longevity?

Useful ones are blood pressure, LDL or ApoB, HbA1c and, once in your life, lipoprotein(a). Add the values your primary care practice recommends in a check-up. Large panels without clear consequences usually raise more questions than they answer.

Is NMN or rapamycin worth it?

For neither is there a study in healthy people with hard endpoints such as lifespan, heart attack or dementia. The largest studies in some cases missed their primary endpoints. Rapamycin is a prescription drug with relevant side effects.

How much exercise do I need for a long life?

The WHO recommends 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous aerobic activity per week plus strength training on 2 or more days. The WHO stresses that some activity is better than none.

Does a multivitamin do anything for life expectancy?

In large observational studies, people taking a daily multivitamin did not live longer. The US Preventive Services Task Force considers the evidence insufficient to recommend multivitamins for prevention. With a confirmed deficiency, things look different.

At what age should I start with longevity?

The earlier the better, but it is never too late. Even in very old people, structured training reduced major mobility disability in a large study. The basics pay off at any age.