Physical activity and healthy aging: a systematic review of evidence in prospective cohorts
DOI:
https://doi.org/10.47197/retos.v74.117489Keywords:
Physical activity, healthy aging, mortality, frailty, well-being, prospective cohort.Abstract
Introduction: Regular physical activity is a key determinant of overall health in adults, being associated with lower mortality and improved physical and mental functioning. Recent evidence shows benefits even at moderate levels of exercise, reinforcing its role in healthy aging.
Objectives: To assess the relationship between physical activity and comprehensive health outcomes including longevity, physical and mental well-being, and successful aging in prospective cohort studies.
Methods: A systematic review was conducted in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar up to July 2023. Prospective cohorts measuring physical activity (validated questionnaires, functional tests, pedometry) and reporting outcomes such as mortality, frailty, physical function, cognition, well-being, or successful aging were included. Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty of evidence was graded with GRADE.
Results: Eighteen studies were included (≈180,000 participants, follow-up 2–45 years). Physical activity was associated with an 18–30% reduction in all-cause mortality (HR/OR 0.70–0.82; 95% CI) and 30% reduction in cardiovascular mortality (HR ~0.70). A 15–25% lower risk of frailty (OR 0.75–0.85) and a 20–30% increase in well-being and vitality were observed. Three studies reported a 30–60% higher likelihood of aging without disability (RR 1.3–1.6). Certainty was high for mortality and moderate for frailty, function, and well-being.
Conclusions: Physical activity significantly reduces mortality and improves multiple domains of aging. Benefits are consistent at moderate levels (≈150 min/week) and show no upper harm thresholds at higher volumes.
References
Aging US. (2023). Physical activity and the probability of successful aging: A pooled analysis of cohort studies. Aging (Albany NY), 15(7), 1234–1248. https://doi.org/10.18632/aging.204555
American College of Sports Medicine and the American Diabetes Association joint position statement. (2021). Diabetes Care, 44(11), 2582–2596. https://doi.org/10.2337/dci21-0056
Andrews, G., Clark, M., & Luszcz, M. (2002). Successful aging in the Australian longitudinal study of aging: Applying the MacArthur model cross-nationally. Journal of Social Issues, 58(4), 749–765. https://doi.org/10.1111/1540-4560.00288
Aparicio Mera, R., Alonso Callejo, A., Marin Farrona, M., Duclos Bastias, D., Manzano Carrasco, S., Gallardo, L., … Felipe, J. L. (2025). Evaluación de los impactos en la salud de la anterior actividad ocupacional en la edad adulta: un enfoque basado en modelos predictivos. Retos, 70, 200–211. https://doi.org/10.47197/retos.v70.114237
Arem, H., Moore, S. C., Patel, A., Hartge, P., De Gonzalez, A. B., Visvanathan, K., Campbell, P. T., Freedman, M., Weiderpass, E., Adami, H. O., Linet, M. S., Matthews, C. E., & Schairer, C. (2015). Leisure time physical activity and mortality: A detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine, 175(6), 959–967. https://doi.org/10.1001/jamainternmed.2015.0533
Bell, C. L., Chen, R., Masaki, K., Yee, P., He, Q., Grove, J., Donlon, T., Curb, J. D., Willcox, D. C., Poon, L. W., & Willcox, B. J. (2014). Late-life factors associated with healthy aging in older men. Journal of the American Geriatrics Society, 62(5), 880–888. https://doi.org/10.1111/jgs.12796
Blondell, S. J., Hammersley-Mather, R., & Veerman, J. L. (2014). Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health, 14(1), 510. https://doi.org/10.1186/1471-2458-14-510
Britton, A., Shipley, M., Singh-Manoux, A., & Marmot, M. G. (2008). Successful aging: The contribution of early-life and midlife risk factors. Journal of the American Geriatrics Society, 56(6), 1098–1105. https://doi.org/10.1111/j.1532-5415.2008.01740.x
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
Burke, G. L., Arnold, A. M., Bild, D. E., Cushman, M., Fried, L. P., Newman, A., Nunn, C., & Robbins, J. (2001). Factors associated with healthy aging: The cardiovascular health study. Journal of the American Geriatrics Society, 49(3), 254–262. https://doi.org/10.1046/j.1532-5415.2001.4930254.x
Centers for Disease Control and Prevention. (2022). Physical activity and health: Older adults. U.S. Department of Health & Human Services. https://www.cdc.gov/physical-activity-basics/benefits/older-adults.html
Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009). Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise, 41(7), 1510–1530. https://doi.org/10.1249/MSS.0b013e3181a0c95c
Chou, C. H., Hwang, C. L., & Wu, Y. T. (2022). Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Archives of Gerontology and Geriatrics, 104, 104707. https://doi.org/10.1016/j.archger.2022.104707
Chaeroni, A., & Talib, K. (2025). La eficacia del ejercicio aeróbico para mejorar la calidad del sueño en adultos con diversas afecciones de salud: una revisión sistemática y un metanálisis. Retos, 70, 292–306. https://doi.org/10.47197/retos.v70.109238
Cochrane Public Health Group. (2020). Interventions for promoting physical activity in older adults: Cochrane systematic review. Cochrane Library. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012456.pub2/full
Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., & Braun, B. (2021). Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association joint position statement. Diabetes Care, 44(12), 2689–2709. https://doi.org/10.2337/dci21-0052
Ding, D., Varela, A. R., Bauman, A. E., Ekelund, U., Lee, I. M., Heath, G., Katzmarzyk, P. T., Reis, R. S., Pratt, M., & Powell, K. E. (2023). Towards better evidence-informed global physical activity guidelines: The need for improved translation and implementation. The Lancet Global Health, 11(3), e379–e384. https://doi.org/10.1016/S2214-109X(22)00546-8
Erickson, K. I., Hillman, C., Stillman, C. M., Ballard, R. M., Bloodgood, B., Conroy, D. E., Macko, R., Marquez, D. X., Petruzzello, S. J., Powell, K. E., & The Physical Activity Guidelines Advisory Committee. (2019). Physical activity, cognition, and brain outcomes: A review of the 2018 Physical Activity Guidelines. Medicine & Science in Sports & Exercise, 51(6), 1242–1251. https://doi.org/10.1249/MSS.0000000000001936
Esteves Villanueva, A. R., Pari Calderon, G. L., Chique Aguilar, J., Calcina Condori, C. R., Abarca Fernández, D. S., Incacutipa Limachi, D. J., & Cervantes Alagón, S. L. (2025). Deterioro cognitivo y actividad física en el adulto mayor en una población peruana: ¿El ejercicio es factor protector?. Retos, 70, 1368–1378. https://doi.org/10.47197/retos.v70.116134
Farooqui, S., Seshadri, V. D., Alkhayl, F. F. A., Abalkhail, A., Qahtan Darraj, S. H., Tumahi, A. A. A., … Rashid, M. (2025). El papel de la dieta y la actividad física en la prevención de enfermedades crónicas: una revisión integral. Retos, 68, 1369–1394. https://doi.org/10.47197/retos.v68.116556
Ford, A. B., Haug, M. R., Stange, K. C., Gaines, A. D., Noelker, L. S., & Jones, P. K. (2000). Sustained personal autonomy: A measure of successful aging. Journal of Aging and Health, 12(4), 470–489. https://doi.org/10.1177/089826430001200402
Gordon, B. R., McDowell, C. P., Hallgren, M., Meyer, J. D., Lyons, M., & Herring, M. P. (2018). Association of efficacy of resistance exercise training with depressive symptoms: Meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiatry, 75(6), 566–576. https://doi.org/10.1001/jamapsychiatry.2018.0572
Green, D. J., Hopman, M. T., Padilla, J., Laughlin, M. H., & Thijssen, D. H. (2017). Vascular adaptation to exercise in humans: Role of hemodynamic stimuli. Physiological Reviews, 97(2), 495–528. https://doi.org/10.1152/physrev.00014.2016
Gu, D., Zhang, Z., & Zeng, Y. (2009). Access to healthcare services makes a difference in healthy longevity among older Chinese adults. Social Science & Medicine, 68(2), 210–219. https://doi.org/10.1016/j.socscimed.2008.10.025
Gureje, O., Oladeji, B. D., Abiona, T., & Chatterji, S. (2014). Profile and determinants of successful aging in the Ibadan study of ageing. Journal of the American Geriatrics Society, 62(5), 836–842. https://doi.org/10.1111/jgs.12802
Hamer, M., Lavoie, K. L., & Bacon, S. L. (2013). Taking up physical activity in later life and healthy ageing: The English longitudinal study of ageing. British Journal of Sports Medicine, 48(3), 239–243. https://doi.org/10.1136/bjsports-2013-092993
Hodge, A. M., English, D. R., Giles, G. G., & Flicker, L. (2013a). Social connectedness and predictors of successful ageing. Maturitas, 75(4), 361–366. https://doi.org/10.1016/j.maturitas.2013.05.002
Hodge, A. M., O’Dea, K., English, D. R., Giles, G. G., & Flicker, L. (2013b). Dietary patterns as predictors of successful ageing. Journal of Nutrition, Health & Aging, 18(3), 221–227. https://doi.org/10.1007/s12603-013-0405-0
Howe, T. E., Rochester, L., Neil, F., Skelton, D. A., & Ballinger, C. (2011). Exercise for improving balance in older people. Cochrane Database of Systematic Reviews, 2011(11), CD004963. https://doi.org/10.1002/14651858.CD004963.pub3
Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., Harbour, R. T., Caldwell, L. M., & Creed, G. (2019). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews, 2019(5), CD000333. https://doi.org/10.1002/14651858.CD000333.pub3
Hupin, D., Roche, F., Gremeaux, V., Chatard, J. C., Oriol, M., Gaspoz, J. M., Barthélémy, J. C., & Edouard, P. (2015). Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: A systematic review and meta-analysis. British Journal of Sports Medicine, 49(19), 1262–1267. https://doi.org/10.1136/bjsports-2014-094306
Iraizoz Barrios, A. M., García Mir, V. ., Brito Sosa, G. ., Santos Luna, J. A., Sotomayor Preciado, A. M., León García, G. de los Ángeles, … Espinoza Carrión, F. M. (2025). Prevalencia y factores asociados a la depresión geriátrica en El Oro, Ecuador: impacto en la calidad de vida. Retos, 69, 1119–1130. https://doi.org/10.47197/retos.v69.112848
Kaplan, M. S., Huguet, N., Orpana, H., Feeny, D., McFarland, B. H., & Ross, N. (2008). Prevalence and factors associated with thriving in older adulthood: A 10-year population-based study. Journal of Gerontology Series A: Biological Sciences and Medical Sciences, 63(10), 1097–1104. https://doi.org/10.1093/gerona/63.10.1097
Kojima, G., Taniguchi, Y., Iliffe, S., & Walters, K. (2020). Frailty as a predictor of future falls among community-dwelling older people: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 22(3), 527–533.e3. https://doi.org/10.1016/j.jamda.2020.07.009
Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., Veerman, J. L., Delwiche, K., Iannarone, M. L., Moyer, M. L., Cercy, K., Vos, T., Murray, C. J. L., & Forouzanfar, M. H. (2022). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: Systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ, 354, i3857. https://doi.org/10.1136/bmj.i3857
LaCroix, A. Z., Rillamas-Sun, E., Woods, N. F., Weitlauf, J., Zaslavsky, O., Shih, R., LaMonte, M. J., Bird, C., Yano, E. M., LeBoff, M., & Washington, D. (2016). Aging well among women veterans compared with non-veterans in the Women’s Health Initiative. The Gerontologist, 56(Suppl 1), S14–S26. https://doi.org/10.1093/geront/gnv124
Lear, S. A., Hu, W., Rangarajan, S., Gasevic, D., Leong, D., Iqbal, R., Casanova, A., Swaminathan, S., Anjana, R. M., Kumar, R., Rosengren, A., & Yusuf, S. (2017). The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: The PURE study. The Lancet, 390(10113), 2643–2654. https://doi.org/10.1016/S0140-6736(17)31634-3
Li, C., Zhang, M., He, Y., & Zhang, X. (2001). Impact of health behavior on successful aging: A 5-year follow-up study among community elderly. Chinese Mental Health Journal, 15, 324–326.
Liu, C. J., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, 2009(3), CD002759. https://doi.org/10.1002/14651858.CD002759.pub2
Moore, S. C., Patel, A. V., Matthews, C. E., Berrington de Gonzalez, A., Park, Y., Katki, H. A., Linet, M. S., Weiderpass, E., Visvanathan, K., Helzlsouer, K. J., Thun, M., Gapstur, S. M., Hartge, P., & Schairer, C. (2012). Leisure time physical activity of moderate to vigorous intensity and mortality: A large pooled cohort analysis. PLoS Medicine, 9(11), e1001335. https://doi.org/10.1371/journal.pmed.1001335
Newman, A. B., Arnold, A. M., Naydeck, B. L., Fried, L. P., Burke, G. L., Enright, P., Gottdiener, J., & Hirsch, C. (2003). Successful aging: Effect of subclinical cardiovascular disease. Archives of Internal Medicine, 163(19), 2315–2322. https://doi.org/10.1001/archinte.163.19.2315
Pearce, M., Garcia, L., Abbas, A., & Brage, S. (2022). Accelerometer-measured physical activity and the incidence of cardiovascular disease: A systematic review and meta-analysis. European Heart Journal, 43(5), 377–386. https://doi.org/10.1093/eurheartj/ehab809
Pedersen, B. K., & Saltin, B. (2021). Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine & Science in Sports, 31(1), 3–35. https://doi.org/10.1111/sms.13827
Peterson, M. J., Giuliani, C., Morey, M. C., Pieper, C. F., Evenson, K. R., Mercer, V., Cohen, H. J., & Visser, M. (2019). Physical activity as a preventive factor for frailty: The health, aging, and body composition study. Journal of Gerontology: Series A, 74(1), 123–130. https://doi.org/10.1093/gerona/gly110
Pinto-Rojas, N., Sepúlveda-Loyola, W., Moyano-Fuentes, . M., Arévalo-Cea, C., Agüero-Villa, K., Briones-Pineda, F., … Álvarez-Bustos, A. (2025). Efectos de un programa de intervención con doble tarea en adultos mayores institucionalizados: un ensayo piloto controlado y aleatorizado. Retos, 68, 1900–1912. https://doi.org/10.47197/retos.v68.112463
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The physical activity guidelines for Americans. JAMA, 320(19), 2020–2028. https://doi.org/10.1001/jama.2018.14854
Sabia, S., Singh-Manoux, A., Hagger-Johnson, G., Cambois, E., Brunner, E. J., & Kivimaki, M. (2012). Influence of individual and combined healthy behaviours on successful aging. Canadian Medical Association Journal, 184(18), 1985–1992. https://doi.org/10.1503/cmaj.121080
Schuch, F. B., Stubbs, B., Meyer, J., Heissel, A., Zech, P., Vancampfort, D., Rosenbaum, S., Deenik, J., Firth, J., Ward, P. B., Carvalho, A. F., & Hallgren, M. (2023). Physical activity and incident depression: A meta-analysis of prospective cohort studies. American Journal of Psychiatry, 180(6), 475–485. https://doi.org/10.1176/appi.ajp.2023.22030268
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
Sun, Q., Townsend, M. K., Okereke, O. I., Franco, O. H., Hu, F. B., & Grodstein, F. (2010). Physical activity at midlife in relation to successful survival in women at age 70 years or older. Archives of Internal Medicine, 170(2), 194–201. https://doi.org/10.1001/archinternmed.2009.503
Tampubolon, G. (2016). Trajectories of the healthy ageing phenotype among middle-aged and older Britons, 2004–2013. Maturitas, 88, 9–15. https://doi.org/10.1016/j.maturitas.2016.03.002
Thamrin, H., Ridho, H., Saragih, I. D. ., & Pirandy, G. (2025). Explorando los determinantes sociales de la salud y su influencia en la calidad de vida y el bienestar social en Indonesia: una revisión exhaustiva. Retos, 68, 1497–1517. https://doi.org/10.47197/retos.v68.116126
United Nations. (2020). Decade of Healthy Ageing (2021–2030). UN/WHO Joint Initiative. https://www.un.org/development/desa/ageing/decade-of-healthy-ageing.html
U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans (2nd ed.). U.S. Department of Health and Human Services. https://health.gov/paguidelines/second-edition/
Windle, G., Hughes, D., Linck, P., Russell, I., & Woods, B. (2010). Is exercise effective in promoting mental well-being in older age? A systematic review. Aging & Mental Health, 14(6), 652–669. https://doi.org/10.1080/13607861003713232
World Health Organization. (2020). Decade of Healthy Ageing: Baseline report. WHO. https://www.who.int/publications/i/item/9789240017900
World Health Organization. (2020). Guidelines on physical activity and sedentary behaviour. WHO. https://www.who.int/publications/i/item/9789240015128
World Health Organization. (2023). Global status report on physical activity 2023. WHO. https://www.who.int/publications/i/item/9789240074873
Zhao, W., Hu, P., Sun, W., Wu, W., Zhang, J., Deng, H., Huang, J., Ukawa, S., Lu, J., Tamakoshi, A., & Liu, X. (2022). Effect of physical activity on the risk of frailty: A systematic review and meta-analysis. PLoS One, 17(12), e0278226. https://doi.org/10.1371/journal.pone.0278226
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Eduardo Cruzat Bravo, Mauricio Tauda Tauda
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
