Exercise as Medicine for Successful Aging

Aging is an inevitable process, but functional decline doesn’t need to be. One widely accepted truth in rehabilitation and exercise medicine, is that exercise can in fact be a therapy, a prescription and an effective medicine for those with and without disease. As a sports specialist chiropractor, I see how structured physical activity can transform a patient’s quality of life – whether it’s preserving independence as we approach our later decades, working towards a new physical goal, re-engaging in activities after a hiatus or looking to optimize sports performance as an athlete.

In 2025, the evidence supporting exercise as a cornerstone of health and longevity is stronger than ever and continues to get stronger. It is well-known that exercise is a multi-system intervention, touching on cardiovascular, brain, mental, and musculoskeletal health. A recent review by Ara et al. 2025, titled Exercise as a Therapy for Successful Aging, highlights how exercise targets the biological hallmarks of aging and helps extend not only lifespan but also health span – the years lived in good health. This week I wanted to dive into some of the information presented in this article, and convince you why exercise, when prescribed appropriately, may be our most powerful medicine for successful aging. That is, if you need further convincing…

How Exercise Targets the Biology of Aging

The biology of aging is complex and involves changes at the cellular level including mitochondrial dysfunction, loss of proteostasis, telomere attrition, dysregulated nutrient sensing and chronic inflammation. These, along with other cellular processes, gradually impair organ function and decrease our ability to utilize energy and repair tissue. In the paper mentioned above, the authors group these changes into primary, antagonistic, and integrative hallmarks, all of which are influenced by exercise.

Exercise protects against primary hallmarks of aging by reducing oxidative stress, improving metabolic flexibility and efficiency and stimulating mitochondrial biogenesis. It also influences antagonistic hallmarks by improving insulin sensitivity, enhancing protein turnover, and reducing the accumulation of senescent cells that contribute to chronic inflammation. At the integrative level, which manifests as frailty, sarcopenia, and loss of regenerative capacity, exercise demonstrates some of its most powerful effects that we can actually see. Strength, power, cardiovascular health, and neuromuscular function can all be preserved or restored through various forms of training. This means that rather than passively accepting functional decline as a part of the aging process, individuals can actively neutralize – and in some cases reverse – the progression of age-related functional loss with strategic exercise interventions.

What Types of Exercise Work Best?

Not all exercises are created equal, and one of the strongest messages from Ara et al. is that programs should be personalized. A “one size fits all” approach ignores the variability in health status, age, psychological readiness and personal goals across individuals. That said, certain modalities consistently stand out.

Resistance and power training are critical for maintaining muscle mass and strength. Unlike aerobic training alone, which primarily benefits cardiovascular and metabolic health, resistance training directly addresses sarcopenia, bone mineral density and frailty, which are leading predictors of disability and mortality in older populations. High-intensity interval training (HIIT), may complement strength work by enhancing aerobic capacity and metabolic function in a time-efficient manner while also often providing some of the benefits seen in resistance training and weight bearing exercise.

The balance between these exercise types should of course reflect individual needs and personal goals. For example, a frail older adult may begin with supervised resistance training using body weight or light loads and gradually progress, while a previously active senior athlete may benefit from power training and higher-intensity intervals if they already have a higher baseline level of fitness. What’s important to note, is that the presence of disease (e.g., hypertension, type 2 diabetes, previous history of heart attack) is not a reason to avoid vigorous exercise. Actually, quite the contrary. Read that again.

In a previous edition of my newsletter, I reflected on how Dr. Paul Angaran (a St. Michael’s Hospital Sports Cardiologist and Electrophysiologist), suggests that those with known disease or past history of an event remain at greater risk by doing nothing, than the risk of an adverse event during vigorous exercise. This is such an important point for us all to know, as folks with disease are often instilled by the fear of activity from past assumptions, mainstream media or even erroneous past medical advice.

The Measurable Outcomes of Exercise

The benefits of regular exercise are measurable and clinically significant. Prevention and treatment of frailty and sarcopenia are among the most striking. Both conditions are associated with falls, higher rates of hospitalization, disability, and mortality, but targeted exercise interventions can neutralize their progression or even reverse them.

We know that exercise enhances cardiovascular and metabolic health by improving endothelial function, lowering blood pressure, enhancing insulin sensitivity, and reducing systemic inflammation. All of these things are measurable and can be monitored, some even at home. Influencing these functions becomes so important when it comes to prevention of the diseases that they may eventually lead to (e.g., type 2 diabetes, Alzheimer’s disease, heart attack, stroke), thereby also reducing all-cause mortality.

From a brain perspective, physical activity is known to support cerebral blood flow, increase neurotropic factors such as BDNF which can enhance neuronal integrity and neuroplasticity, and has been associated with reduced risk of cognitive decline and dementia. In addition to preserving memory and executive function, exercise contributes to improved mood and resilience, counteracting the psychological challenges that often accompany aging and being a reliable option for the treatment of anxiety and depression.

The multi-system effects of exercise are undeniable and the beauty of the majority of these effects is that they can be measured and felt in real time. Blood pressure? Check it. Strength? Measure it, and then re-measure it. Endurance? See how you feel on your go-to walking route.

Goal setting is a major component to an effective exercise plan. Specific goals lead to specific interventions which lead to specific outcomes.

Overcoming Barriers to Movement

While the science is clear, implementing exercise prescriptions in real life is often challenging. Barriers to exercise are multifactorial and can include psychological barriers, such as low self-confidence or fear of injury, or socioeconomic, including limited access to safe environments or financial resources. Other barriers may also be truly medical, such as chronic pain or co-morbidities that restrict movement.

Addressing these barriers requires a multifaceted approach and some flexibility on both the practitioner and the patient’s end. For some individuals, supervised programs may be preferred as they provide the necessary safety and confidence to get started, while for some they may be undesirable.

Healthcare providers play a critical role by providing exercise prescriptions that meet the patient where they are. Some questions that should be asked are:

What are your goals? What is your purpose? What has been your biggest challenge that is preventing you from getting physically active? Do you feel safe exercising?

We should consider these questions for all that are looking to engage in a structured exercise plan. These individualized questions can lead us towards not only a more meaningful and effective program that is likely to be followed, but also behavioural strategies that may augment the program such as motivational interviewing or seeking social supports that can further improve adherence, enjoyment and motivation.

At the community level, infrastructure like safe walking paths, accessible gyms, or group exercise classes can make movement more attainable for broader populations.

Practical Takeaways for Aging Actively

For individuals and clinicians alike, the guiding principle is to treat exercise with the same seriousness as medication. The research suggests several key takeaways:

First, the bare minimum should include both aerobic and resistance training. Aerobic exercise improves cardiovascular and metabolic health, while resistance and power training protect muscle mass and functional independence. Second, make additional modalities such as balance and mobility training part of the routine, especially in later years as balance and independence often decline. These components may not demand as much attention early in life but become essential for fall prevention and daily function. Third, personalize the prescription. Let’s not forget that we’re all human. If we don’t see a purpose or value in what we’re doing or if we have difficulty connecting the dots between intentional exercise and the outcome of interest, we’re far less likely to do the work. So, keep it fun, keep it novel, and be sure it’s meaningful for you.

Don’t forget that the benefits of exercise are absolutely possible at any age. I have seen countless folks in their 70s, 80s and even 90s begin exercise programs and make meaningful functional change. Heck, my grandfather is turning 101 years old next week and he continues to attribute his health to going to the gym 3 times per week. For him, the combination of exercise and the social stimulation that going to the gym affords seems to be the recipe for keeping him sharp and mobile.

The take home message is simple: it is never too late to start.

Implications for Healthcare Providers

Exercise should be prescribed with the same precision as pharmacological treatments, including dose (frequency, intensity, time, and type), progression, and monitoring. Beyond simply recommending “more activity,” clinicians should provide specific, actionable guidance that is meaningful for their patients. Follow-up and outcome tracking are essential to ensure that patients are achieving measurable improvements.

Moreover, healthcare systems should view exercise as a central therapeutic tool. Collaborative care involving physicians, chiropractors, physiotherapists, and strength and conditioning specialists ensures that patients receive comprehensive, individualized support. When exercise is integrated into standard practice, it shifts the paradigm from reactively managing decline to proactively promoting health and longevity.

Conclusion

At the end of the day the aging process cannot be stopped, but the way we age is highly modifiable. Exercise is the most effective, evidence-based intervention for preserving physical, cognitive, and metabolic health across the lifespan. As highlighted by Ara et al. 2025, exercise directly addresses the biological hallmarks of aging, delays or prevents frailty, enhances neurological function, and extends health span. By embedding exercise into our daily lives and promoting it in our healthcare systems, we not only add years to our lives but we also give ourselves the capacity to add life to our years.

Yours in good health,

Andrew

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