With increasing life expectancy, a key question arises: how can we live longer without losing quality of life? The Global Consensus on Optimal Exercise Recommendations to Enhance Healthy Longevity in Older Adults offers a resounding answer: physical exercise is not a supplement, but a pillar of treatment.

Backed by decades of research and the collaboration of experts from 40 countries, the document proposes a paradigm shift: personalized exercise programs should be as essential as drug treatment at all ages, but especially in the care of older adults. The goal is not to add years to life, but rather to ensure that those years are lived with autonomy, energy, and overall well-being. Furthermore, it proposes concrete strategies to combat frailty, maintain independence, and reduce costs for the healthcare system.

From walking to strength training: Why recommendations need to evolve

The relationship between exercise and healthy aging is not a new idea. Since the 1970s, epidemiological studies have shown that regular exercise reduces the risk of chronic diseases such as cardiovascular disease , diabetes, and osteoporosis . However, generic recommendations, such as “walk 30 minutes” or “take 10,000 steps daily,” have become obsolete for older adults with complex health conditions.

Recent studies reveal that progressive strength training —with weights or machines—is key to preserving muscle function, the loss of which accelerates fragility. The problem, experts warn, is that many current programs fail due to insufficient dosage. “Just as with drugs: if the dose is low, the effect is null. In some cases, the prescribed exercise is so mild that it’s equivalent to a placebo,” the report explains. This would be unacceptable in the pharmaceutical field.

The solution, according to the global consensus , is to treat exercise as a “precision medical prescription,” individualized, supervised, and tailored to each patient’s needs. Rather than as a secondary option within medical care.

Compression of morbidity: more healthy years

One of the key messages of the consensus is the concept of morbidity compression: minimizing the number of years of disability in old age and maximizing the number of years of healthy life. According to evidence, structured exercise programs can add up to ten years of healthy life, surpassing the benefits of many pharmacological interventions.

The consensus abandons universal recommendations and emphasizes the importance of individualized plans, which include:

▪ Comprehensive assessment: Determine individual health status, capabilities, and risks.

▪ Structured programs: Include aerobic exercises for cardiovascular health, strength and muscle power training to strengthen muscles, and balance training to prevent falls.

▪ Patient-centered goals: Design plans tailored to individual preferences to increase motivation and adherence.

▪ Multi-component programs: Integrate physical and cognitive tasks to strengthen mental acuity and resilience.

It’s not just prevention: exercise as treatment

One of the most notable points of the consensus is that exercise not only prevents disease, but can also treat it. In older adults with frailty or sarcopenia (severe muscle loss), progressive strength training and high-intensity interval training (HIIT) have been shown to be highly effective in preserving muscle strength and cardiovascular endurance.

It is also highlighted that strength training can complement drug treatments for conditions such as Parkinson’s and cardiometabolic disorders, enhancing their effectiveness and reducing adverse effects. In cases of mild hypertension, cardiovascular training programs can reduce the need for medication by up to 30%.

Replacing medications with exercise

Polypharmacy—the use of multiple medications—is a common problem in the older population, increasing the risk of harmful interactions. This consensus emphasizes that exercise can, in certain cases, replace or reduce the need for medications for conditions such as hypertension and depression, thus reducing medication burden and associated risks.

Despite such overwhelming evidence, exercise prescription remains poorly integrated into healthcare systems. Although more and more hospitals have incorporated exercise programs for cardiac, cancer, and geriatric patients, these programs typically focus on the initial phase of treatment, with access to specialized gyms and limited follow-up in the first few months.

However, infrastructure remains a challenge, and in practice, prescribing medication is easier than developing and implementing an exercise program, despite its proven benefits.

Health professionals need training

Another key obstacle is the lack of training in exercise prescription among healthcare professionals. Many primary care physicians, among others, lack specific knowledge on how to prescribe exercise programs tailored to each patient. For these programs to be effective, specialists within the healthcare system are needed to guide patients through a progressive process of improvement.

Although the initial investment in infrastructure and personnel may seem high, the long-term economic impact would be positive. Reducing the burden of chronic diseases through exercise would reduce the costs associated with hospitalizations and prolonged treatment, representing an efficient strategy for the sustainability of health systems.

The consensus advocates for initiatives such as Exercise is Medicine , which promotes the assessment and prescription of exercise as a “vital sign,” on par with blood pressure or heart rate. Successful examples, such as the WHO-backed VIVIFRAIL program , demonstrate that community exercise groups improve functional capacity and reduce the risk of falls in older adults.

Beyond the individual benefits, the economic benefits of regular exercise programs for older adults are unquestionable. Preventing hospitalizations and reducing the need for long-term care can significantly ease the burden on healthcare systems. Furthermore, group exercise programs promote emotional and social well-being, combating loneliness and strengthening support networks.

A call to action

The Global Consensus is not just a guide: it’s a manifesto for rethinking disease management in older adults. “Frailty is not an excuse to avoid exercise: it is the ultimate reason to prescribe it,” the document states.

The goal is ambitious but achievable: train and include exercise prescription specialists within the health system, create partnerships with community centers, and normalize exercise prescription as part of medical treatments. As the report concludes, “Living longer is not enough if we can’t wake up every morning wanting to live them.”