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ADDING LIFE TO YOUR YEARS: THE HEALTHSPAN
Lifespan is how long you live.
Healthspan is how well you live.
The concept of the healthspan refers to living as many of your years as possible with the energy, strength and capacity to engage in the activities that are meangingful to you.
While average life expectancy has increased, it does not necessarily mean we’re living longer in better health. Current data (2026) published by the Office for National Statistics shows the average years lived vs total years lived in good health.
Life Expectancy
Healthy Years Lived
Years Lived With Poor Health
79 years
61 years
18 years
Men
83 years
61 years
22 years
Women
This means, on average, UK men live 23% and women 27% of their lives in poor health.
Poor health = chronic disease, frailty and reduced physical capacity.
Without targeted intervention, starting around age 30:
-
Cardiorespiratory fitness declines by approximately 10% per decade—accelerating up to 15–20% after age 65
-
Muscle mass is lost at 3% to 8% per decade, culminating in a 30% to 50% loss by age 80
-
Muscle strength is lost at a faster rate than muscle mass, decreasing by 5%-10% in our 30s and 40s, up to 20% - 35%+ per decade from the age of 65.
Physical activity consistently emerges as the most important factor influencing both absolute physical capacity and the rate of age-related decline
High functional physical capacity compresses the period of sickness, disability, and frailty toward the very end of life. Termed compression of morbidity, this strategy enables individuals to live vibrant, self-sufficient lives for longer, limiting severe ill-health to a brief period at the end of the lifespan
Individuals who maintain higher levels of muscle strength and cardiorespiratory fitness generally retain greater physical reserve, allowing them to maintain function, independence and health for longer as they age.
Everybody’s line on the graph below will look different. The starting point of the line will be determined by the peak physical capacity achieved in our 20s and 30s, with the trajectory determined by the maintenance of physical strength and fitness throughout subsequent years.
Health, function & independence
Threshold of frailty and physical dependence
20 30 40 50 60 70 80 90 100
Age (years)
The Two Pillars: Cardiorespiratory Fitness & Skeletal Muscle Strength
Pillar 1: Cardiorespiratory fitness (CRF)
Definition
Cardiorespiratory fitness is the capacity of your heart, lungs, and blood vessels to deliver oxygen to working muscles, and the efficiency of your cells in converting that oxygen into energy for sustained physical activity.
How do we measure it?
It is measured through oxygen uptake (VO₂). VO₂ is the volume of oxygen your body consumes at any given moment during exercise or at rest, reflecting your current energy demand and effort level.
It is expressed as milliliters of oxygen per kilogram of body mass per minute (ml / kg / min).
VO₂ max (maximal oxygen uptake) is the size of your engine. It measures the maximum amount of oxygen your body can take in, pump through your bloodstream, and turn into usable energy when you are working at peak effort.
VO₂ max testing is unrealistic and unnecessary for most individuals. Therefore, sub-maximal tests (performed at a reduced intensity and/or for a shorter duration) can be used to gather data which can be extrapolated to a predicted VO₂ max.
Additionally, METs can be used to describe exercise intensity.
A MET is a ‘metabolic equivalent’
- 1 MET represents our resting oxygen consumption. In volume of oxygen terms, this equates to 3.5 ml / kg / min
METs
Activity Example
1 MET (3.5 ml / kg / min)
Sitting quietly
3 - 3.5 METs (10.5 - 12 ml / kg / min)
Walking at 2-3 mph
5 - 7 METs (17.5 - 24.5 ml / kg / min)
Playing recreational tennis
10 METs (35 ml / kg / min)
Jogging at 6 mph
or vigorous swimming
15 METs (52.5 ml / kg / min)
Running at 8mph or vigorous skipping rope
20 METs (70 ml / kg / min)
Competitive cross
country skiiing
Why is cardiorespiratory fitness important?
CRF is considered one of the strongest indicators of overall health and longevity. The American Heart Association has called for CRF to be considered a vital sign due to its predictive value for health outcomes.
This is because CRF reflects the performance of several interconnected systems including the heart, lungs, circulation, blood vessels and skeletal muscle cells.
Importantly, the biggest health benefits don’t come from striving for the highest possible VO₂ max, they come from avoiding the lower ends of the scale.
Low cardiorespiratory fitness carries a mortality risk comparable to traditional risk factors like smoking, hypertension, and diabetes, and is strongly associated with an increased risk of all cause mortality.
Every additional 1 MET increase in fitness is associated with an 11-17% lower risk of all-cause mortality, coronary heart disease or cardiovascular events. Moving from low to moderate levels of cardiorespiratory fitness is associated with a lower risk of developing:
Cardiovascular disease
Type 2 diabetes
Hypertension
Certain cancers including colon and breast cancer
Chronic respiratory conditions
Metabolic syndrome
Cognitive decline
Depression/anxiety symptoms
Pillar 2: Muscle Strength
Definition
Muscle strength: the maximal force your muscles and nervous system can generate against resistance.
Muscle mass: the total amount of skeletal muscle tissue in the body.
How do we measure it?
To test muscle strength we can perform clinical tests such as a hand grip test using a dynamometer, repetition maximum tests (how much you can maximally lift for a predetermined number of repetitions e.g., 1, 5, 10), and manual muscle testing. Muscle mass can be measured with a DEXA scan or bioelectrical impedance analysis.
Why is muscle strength important?
Muscle strength and mass are both inversely associated with all-cause mortality. While maintaining muscle mass is vital for metabolic health, muscular strength is even more predictive of longevity: every 5 kg decline in grip strength (a clinical marker for overall strength) is associated with a 16% higher risk of all-cause mortality.
Skeletal muscle acts like a big metabolic sponge. It disposes of approximately 80% of circulating blood glucose, making it a key defence against type 2 diabetes, insulin resistance, and metabolic syndrome.
Higher levels of strength acts as a form of physical "armour", being associated with reduced risk of:
Frailty and falls
Poor bone health, including osteoporosis
Sarcopenia, characterised by low muscle strength and confirmed by low muscle mass
Muscle is an active endocrine organ that regulates physiological processes and maintains health.
When your muscles contract during exercise, they release substances called myokines into circulation. These are proteins that communicate with other tissues and organs, including the brain, the vascular system, the liver and pancreas, body fat and the immune system. Think of it as your own internal pharmacy delivered by your own internal postal service. Muscle tissue and myokines help to:
Reduce systemic inflammation
Increase fat oxidation
Support tissue repair and remodelling
Improve cognitive function and neuroplasticity (the brain’s ability to adapt and change)
Increasingly, evidence points towards the importance of maintaining muscular power as we age. Power is the ability to generate force with speed, determining how quickly you can react, push off the ground, or catch yourself to prevent a fall. Power declines at a faster rate than strength due to the loss of type 2 (fast twitch) muscle fibres and a reduction in nerve supply to muscles.
Can we do anything about this?
YES! :)
Cardiorespiratory fitness and muscle strength are key modifiable factors influencing our current health and the number of healthy years (the healthspan) that we will live.
Exercising across the lifespan has the potential to offer us our greatest physical reserve in later years, but the good news is we can benefit regardless of the age we begin.
Research demonstrates that progressive resistance training significantly improves muscle strength in older adults, including adults aged 80–90+. In one landmark trial, frail older adults with a mean age of 87.1 years increased muscle strength by approximately 113% after 10 weeks of high-intensity resistance training. Walking speed and stair climbing power also improved. Subsequent research has confirmed that meaningful strength gains remain possible even in individuals aged 90 and above.
Similarly, strong clinical evidence confirms that cardiorespiratory fitness remains adaptable well into later life. Multiple randomised controlled trials in adults aged 70 and older demonstrate significant, measurable improvements in aerobic capacity following structured conditioning.
What To Do Next
Knowing that physical reserve protects your long-term independence is empowering. Understanding the evidence is the first step; translating it into a safe, sustainable plan is where a clinical exercise physiologist can help.
Because exercise acts like medicine, achieving specific physiological adaptations requires specific dosing. Different longevity goals require different training stimulus. Muscular strength, fast reaction power, metabolic muscle mass, and cardiorespiratory fitness all require specific tweaks around type of exercises, load, frequency, volume and time.
Navigating how to effectively and efficiently approach this if you have a painful joint, osteoporosis, diabetes, a recent fall and reduced balance or a busy schedule can be daunting. Yet these conditions aren't reasons to avoid exercise—they are the exact reasons to seek it out.
This is where an exercise physiologist bridges that gap.
How We Work Together
Consultation and assessment:
We review your medical history, previous injuries, musculoskeletal conditions, and current physical ability to identify which elements of physical capacity and reserve needs reinforcement.
Targeted exercise prescription:
Using the current evidence-base and clinical guidelines, we match the exercise to your specific needs, whether that is increased muscular strength, tendon capacity, bone mineral density, balance, or aerobic capacity etc.
Integrated into Your Life:
The most effective longevity plan is the one you can consistently maintain. We collaborate with you to build a realistic, achievable routine that fits around your work, family, and daily commitments.
The best exercise program is the one you actually do
Vitruvian Exercise Physiology
References
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Lang et al. British Journal of Sports Medicine. 2024
Cardiorespiratory fitness and mortality from all causes, cardiovascular disease and cancer: dose–response meta-analysis of cohort studies
Han et al. British Journal of Sports Medicine. 2022
Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association
Ross et al. (AHA Writing Group). Circulation. 2016
Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Sports Medicine. 2020
Sarcopenia: revised European consensus on definition and diagnosis
Alfonso J. Cruz-Jentoft et al. (EWGSOP2) Age and Ageing. 2019
Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study
Leong et al. The Lancet. 2015
Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing
Mandsager et al. JAMA network open. 2018
Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men
Blair et al. Journal of the American Medical Association. 1995
Long-Term Effects of Changes in Cardiorespiratory Fitness and Body Mass Index on All-Cause and Cardiovascular Disease Mortality in Men: The Aerobics Center Longitudinal Study
Duck-chul et al. Circulation. 2011
Accelerated longitudinal decline of aerobic capacity in healthy older adults
Fleg et al. Circulation. 2005
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Hawkins and Wiswell. Sports Medicine. 2003
Muscle tissue changes with aging
Volpi et al. Current Opinion in Clinical Nutrition and Metabolic Care. 2004
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Goodpaster et al. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006
Dynapenia and sarcopenia: different faces of the same coin
Manini and Clark. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2012
The InCHIANTI Study
Ferrucci et al. / Lauretani et al. Journal of the American Geriatrics Society. 2002
The Health ABC Study
Goodpaster et al. / Newman et al. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006
Baltimore Longitudinal Study of Aging (BLSA)
Metter et al. / Fleg and Lakatta. Journals of Gerontology. 1997
Low- and High-Volume of Intensive Endurance Training Significantly Improves Maximal Oxygen Uptake after 10-Weeks of Training in Healthy Men
Tjønna et al. PLOS One. 2013
Strength, but not muscle mass, is associated with mortality in the Health, Aging and Body Composition Study cohort
Newman et al. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006
Aerobic training in the 'oldest old': the effect of 10 weeks of low-intensity aerobic training on the cardiorespiratory fitness of frail elderly people
Malbut et al. Age and Ageing. 2002
High-intensity strength training in nonagenarians: effects on skeletal muscle
Fiatarone et al. The New England Journal of Medicine. 1990
Exercise training and nutritional supplementation for physical frailty in very elderly people
Fiatarone et al. JAMA. 1994
Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial
Binder et al. Journal of the American Geriatrics Society. 2002
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Garber et al. Medicine & Science in Sports & Exercise. 2011
Power vs strength training in older adults
Balachandran et al. Journal of Frailty, Sarcopenia and Falls. 2022
High speed power training in older adults
Fielding et al. Journals of Gerontology. 2014
Benefits of Resistance Training in Physically Frail Elderly: A Systematic Review
Chou et al. Archives of Gerontology and Geriatrics. 2012
Age-related muscle anabolic resistance: inevitable or preventable?
Breen and Phillips. Essays in Biochemistry. 2022
Consequences of physical inactivity in older adults
Cunningham et al. Scandinavian Journal of Medicine & Science in Sports. 2020