Miss the webinar?

Access the Recording Here

In the pursuit of a longer and healthier life, it's essential to focus on both the quantity and quality of the years we live. Healthy longevity—free from chronic diseases—requires attention to both morbidity and mortality. This approach offers valuable insights for health professionals, the public, and policymakers alike, shifting the focus from merely treating illnesses to preventing them.

Physical activity plays a pivotal role in this shift, particularly as our population ages. Active adults not only live longer but also enjoy more years in good health. Meeting the recommended 150 to 300 minutes of moderate intensity of 75 to 150 minutes of vigorous intensity physical activity per week provides substantial benefits. Doubling this amount may yield even greater rewards. For the best results, combine aerobic exercises with 2 days of resistance training to maximize health benefits.

The advantages of higher physical activity levels extend well into older age, helping to prolong life and increase the years spent free of chronic diseases. It's important to encourage those who are inactive to start incorporating physical activity into their routines. Significant health benefits can be achieved without needing to reach the highest activity levels. Moreover, adults already engaging in high levels of activity should continue, as they may gain additional modest benefits beyond the recommended amounts.

Q: Is there a difference between strength training and cardiovascular training on life expectancy/longevity?

Studies show that both aerobic and strength training individually lower mortality risk compared to no exercise. However, combining both types of exercise offers the greatest longevity benefits. Aerobic and strength training provide distinct and complementary health benefits, making the combination of the two optimal for overall health.

Q: From your data it appears that the years with cardiovascular disease (CVD) are similar (6-7 years) regardless of physical activity level. Can you comment on this?

Research indicates that more active individuals tend to have a longer total life expectancy and a longer healthy life expectancy. And for an active person who develops cardiovascular disease their higher levels of fitness can result in a stronger, more resilient body that can help them live longer even with the disease. Therefore, the number of years with disease may be similar between active and inactive individuals. Importantly, those who are more active often experience less severe disease and fewer recurrent events once they are diagnosed with a disease. Thus, even if the duration of illness is comparable in active vs inactive adults, the overall burden and severity of the disease are generally lower in active individuals.

Q: Health is related to income, education, etc. How have these been excluded in your data?

Physical activity is just one factor in living a healthier, longer life. Variables such as income, education, genetics, age, sex, and lifestyle factors (e.g., smoking, sleep) also play significant roles. In observational studies on physical activity and longevity, we account for these variables in our analyses. However, it's impossible to fully control for every factor. Thus, while physical activity is crucial, it is only one component of overall health.

Q: Can engaging in light to moderate everyday activities suffice for being deemed physically healthy without fitness exercises?

For optimal health, it's recommended that healthy young to middle-aged adults engage in moderate to vigorous intensity physical activities. While light intensity activities are better than a sedentary lifestyle, incorporating moderate to vigorous intensity exercise provides greater benefits. For older adults or those with chronic conditions, moderate intensity activities, or the highest intensity they can manage, are advised. Particularly for older adults, research has shown that light intensity activities can still offer longevity benefits.

Q: How does physical activity before puberty influence longevity?

Most longevity research focuses on cohorts starting from young adulthood (18+ years old), so there's limited data on the impact of childhood physical activity. Importantly, one of the major determinants of being active as an adult, is your history of physical activity, including whether you were active as a child. Developing a joy and commitment to being active early can lead to lifelong activity as an adult and contribute to a healthier, longer life.

Q: What is the threshold of excessive resistance training for adults?

The association between resistance training and mortality risk follows a J-shaped curve, with maximum risk reduction at about 30–60 minutes per week of muscle-strengthening activities. Benefits extend up to approximately 130–140 minutes per week. There are no well-established physiological mechanisms explaining why higher doses of resistance exercise may not provide additional benefits for mortality. However, two possible mechanisms could be increased arterial stiffness and chronic inflammation. Due to the small number of individuals engaging in very high levels of resistance training, research has not been able to definitively conclude whether there are risks of excessive training and at what volume should be consider too high.

Q: Do high volumes of aerobic activity increase the risk of overuse injuries while aiming to increase lifespan?

The majority of longevity benefits do not require very high volumes of activity. Most of the benefits are achieved by meeting the physical activity guidelines of 150-300 minutes of moderate or 75-150 minutes of vigorous activity per week. Participation in exercise and physical activity increases the risk of musculoskeletal injuries, particularly during the activity itself. The intensity and type of exercise are important factors related to the incidence of injury. Walking and moderate-intensity physical activities are associated with a very low risk of injury, whereas jogging and competitive sports carry a higher risk of injury. Common methods to reduce injury can be helpful - such as stretching, warm-up, cool-down, and gradually increasing exercise intensity and volume.

Overall, being physically active across the lifespan may lower the risk of injury during daily living. For example, active older adults are less likely to experience serious falls, which are a leading cause of injury and disability in this age group.

Q: What are your guidelines for defining moderate and vigorous activity? Do you use heart rate, RPE, etc.?

One simple method is the talk test: for moderate activity, you can hold a conversation but not sing; for vigorous activity, you can only speak a few words at a time. Using heart monitors like wrist worn devices or chest straps, moderate intensity is 65-75% of maximal heart rate (%HRmax) and vigorous intensity is 76-96% HRmax. Rate of perceived exertion (RPE) is another method where on a scale of 0 to 10, moderate intensity targets an RPE of 3-4, while vigorous exercise targets an RPE of 5-7.

Q: One of the major issues in society is that in the age of convenience, activities of daily living have become more sedentary. Examples include online shopping, Amazon orders, and DoorDash, which contribute to a spoiled lifestyle. Technology has deterred people from being more active. As a personal trainer, what is the best approach to advise clients to avoid using convenience as a deterrent to being active?

With the rapid growth of technology, various conveniences can limit our daily physical activity. Setting a step goal is an effective strategy to encourage more movement and less sitting. We have shown that taking more steps per day is associated with a lower risk of death. Instead of using delivery services, clients can be encouraged that by walking through the grocery store, there is an opportunity to take 1,000 more steps toward a step goal. Similarly, opting for manual tasks like vacuuming instead of using a robot can help increase daily steps and overall activity. These small changes toward making your everyday life more active and less sedentary can be meaningful for health and longevity.

In summary, embracing an active lifestyle is not an all-or-nothing proposition. By making consistent efforts to stay active, we can all enjoy the benefits of a healthier, longer life.

Alexis Bhagat fought her way into sports medicine.

The 32-year-old clinical exercise physiologist is a true Millennial: like many of us, she went to the mat, so to speak, on an extracurricular activity. Specifically karate, which blossomed into an impressive athletic career. And it was no surprise: Both of her older brothers were also fiercely competitive karate athletes, the elder of whom owns his own dojo in Chicago, where Bhagat (née Ocampo) originally hails from.

But back to karate for the moment. How’d that happen?

Bhagat: “I have two older brothers, and they were doing it at that time. And I sat in a karate class, and I just looked at my dad, and I was like, ‘Hey, I wanna do this too.’ And so he signed me up for karate class. Immediately it just became a family thing.”

By the time she was six years old, Bhagat was putting in two-a-day training sessions. At 11 or 12, she was competing internationally with the U.S. team, primarily via AAU Karate. (Its philosophy of “Sports For All, Forever” dovetails nicely with ACSM’s mission to “extend and enrich lives through the power of movement.”)

Bhagat trained with coaches all over the globe, competed in world championships, learned how to attack an exercise program with tenacity and gusto — learned, too, how to deal with and recover from injuries. It was an education about getting in touch with her own body in the way only a high-level athlete can.

Here’s her resume and trophy room, translated into text:

• 3x Ozawa Cup International Champion
• 3x Most Outstanding Female Competitor of the Year
• 3x US Open Champion
• 10x NKF National Champion
• 16x AAU National Champion
• 2x Hawaii International Champion
• 2x JKA Champion
• 1x Jr. Pan American Games Champion
• 2x WKC Jr World Champion
• 1x WKC Sr World Champion
• WUKF European Champion
• WUKF World Champion
• Former AAU-USA Assistant Coach

Karate was the reason she pursued a pre-physical therapy degree at Benedictine University in Lisle, Illinois, before moving on to a master’s in clinical exercise physiology from the same school in the fall of 2016. It drove almost everything in her life.

Then came the COVD-19 pandemic.

The COVID-19 disjunct, as much we all desperately want to get past it, shows up as a crucial turning point in the lives of many I interview for ACSM. For Bhagat, the pause in her training and competition schedule hit just as she was beginning to feel like karate was something her “old self” had done. It seems the pause allowed her to take stock of who she’d become while she wasn’t looking. Her last competition was the 2019 European championships in Romania.

“When the pandemic hit, that kind of took a toll,” she says. “And that’s when my priorities shifted. I got older. And of course, I really wanted to focus on my career and start a family.”

At the time of our interview, Bhagat is 17 weeks pregnant.

* * *

By the time COVID-19 reared its head, Bhagat was immersed not only in karate but in a career as an exercise physiologist at Northwestern Memorial Hospital in Chicago.

But she felt she was stagnating. She and her husband, Kevin, a UX designer, were itching for a fresh start somewhere outside the Windy City. The couple decided they wanted to move West.

Initially, the goal was California, but it wasn’t to be. Instead, Colorado beckoned. And though she had plenty of work experience and a master’s degree, most of the jobs Bhagat applied to required a certification as well, which she hadn’t yet earned. Fortunately, she found her current role at Kaiser Permanente, and Kaiser provided a six-month grace period in which she could work to get certified. She chose ACSM.

“When I got hired in April (2021), I studied immediately,” she says. “I studied really hard for three months, like even during work and after work. And then I took the test in July and passed on the first try, thank God, because I’m not a good test-taker.”

Two years later, ACSM held its 2023 annual meeting in Denver. She took the opportunity to attend, finding herself particularly interested in sessions about cardiac arrest.

An interesting anecdote bubbles up.

“Actually, my oldest brother cardiac arrested while fighting in the dojo,” Bhagat recalls. “He got kicked really hard in the ribs and arrested in front of me — I was only 10 or 11 — and someone did CPR. They said that if she’d stopped, he would have died.”

We chat about impact-related cardiac arrest (aka commotio cordis) and the sports in which it seems most likely to occur — football, baseball, etc. Then the connection:

“It’s crazy that my experience of that when I was little is now my field.”

It’s always possible to assign too much or too little significance to the events in our lives, but the striking moment Bhagat describes, in which her brother is roundhouse kicked in the chest, then walks to the side of the dojo before simply and suddenly collapsing, his life left entirely in the hands of a CPR-capable bystander, begs our attention.

Here we must remember that we’re viewing the scene through the eyes of a little girl who may or may not know that her brother is on a knife edge, for whom the concept of death might not yet be concrete but who feels the enormity and strangeness of life events far more than we as adults allow ourselves to. The poetic logic that Bhagat was destined to work in cardiac rehab seems inescapable.

Now, Bhagat is one of three clinical exercise physiologists in the Kaiser system. She provides remote supervision to cardiac rehabilitation patients who perform prescribed exercise while wearing Fitbits to track their vital signs.

In fact, Bhagat and her chief co-worker, a nurse, had no small part in building the remote program they now run. It’s asynchronous, meaning that Bhagat doesn’t lead exercise classes per se but rather works on exercise prescriptions for patients and monitors their vital signs from afar.

There are guardrails, of course.

“These patients are exercising independently,” she says. “So we have stricter criteria. A patient should be able to walk a hundred feet unassisted.”

Naturally, Bhagat’s role is to make sure they aren’t getting into dangerous territory during their routines, and she also meets with them for 30 minutes each week to see if they’re experiencing any concerning symptoms. And if someone shows a dangerously abnormal vital sign, she’ll receive an alert in real time. She provides care to roughly 100 patients at any on juncture; each month, about 28 enroll as others cycle out.

Crucially, Bhagat worked with her supervisors to ensure her CPT coding was at the same level as her nurse colleague’s, since she was providing the same level of care. (Promoting proper coding for certified professionals is an ACSM priority.)

* * *

What many ACSM members and cert pros might know Bhagat for, though, is her social media presence.

“It all started during pandemic,” she says. “I started posting exercise physiology study guides. I was gearing towards students needing help because I was at that stage. Like, I needed help.”

Having always been compelled to take meticulous notes — and to organize them in a visually appealing manner — Bhagat was unintentionally preparing herself to help other up-and-coming physiologists in their studies. During the pandemic, she saw nurses posting to TikTok but noticed that there was a dearth of clinical exercise physiology content. She decided to fill the niche.

At first, it was just for fun. But the momentum grew. Eventually, she added day-in-the-life content, providing needed visibility to the field of clinical exercise physiology — especially important for students wondering what they might be able to do with such a degree.

Her reach grew, as well as her impact.

“I’ve had, I would say, almost 15 or 20 interviews already from 2020 till now, just with different students,” she says. “I would have people messaging me like, ‘Hey, I’m in the field. Can I do an interview with you from my school, just so I can learn more from someone who’s actually in the field?’ and I’m like, yes, please let’s do it.”

Later, she says: “Our role is so diverse, but it’s also very specific as well. And so I wanted to shed light on that.”

You can check out her posts (@alexisobhagat) on Instagram and TikTok.

* * *

I ask what she does in her spare time.

“I love hiking,” she says. “That’s always fun. I haven’t tried it yet since getting pregnant, so I’ll have to try that, but hiking for sure.” She continues: “I love hanging out with my friends. I’m very faith based as well. So I’ve been with my small groups here in my church just hanging out with them and getting to know them.”

This leads to a discussion about the role of faith in her life and work. She outlines how athletes often harbor a powerful desire for control — diet, training, and overall routine being a mere handful of examples. She and her husband really wanted to end up in California, for one thing, but it just didn’t happen. The pandemic tested their faith as well. Yet, the solution was to loosen rather than tighten their grip.

“I had to surrender all of my control and just let God take the reins. And it actually led me to Colorado — still a really nice place. Friendly people and a job I love doing, although I am away form family. It just opened up so many doors for me, and I feel like I wouldn’t have done that if I didn’t surrender control of what, you know, I think should be done.”

What about the future?

“In my role right now, I love what I do. I love my co-worker; she’s awesome too. And then just working with Kaiser, it’s just been awesome. So I’m not sure right now, but I definitely want to stay in this virtual realm of exercise physiology.”

Like many of us, the name of the game right now is to soldier on. Comfortably situated in a rewarding role, and with a growing family to look forward to, Bhagat continues to share her story with up-and-coming physiologists on her social media platforms.

So, when the next big change does occur, we’re sure to hear about it.