Physical activity and mortality: towards healthspan-oriented metrics and outcomes. A Scientific Statement from the European Association of Preventive Cardiology (EAPC) of the ESC

The current guidelines for cardiovascular disease prevention by the European Society of Cardiology highlight the undisputable benefits of exercise and a physically active lifestyle for cardiovascular risk reduction. In addition to the health benefits of physical activity, observational data suggest that regular physical activity lowers all-cause mortality. However, this was not confirmed by Mendelian randomization studies and randomized controlled trials. We argue that limitations of observational data (e.g. recall and recruitment bias, Hawthorne effects, and/or potentially reverse causation) and controlled trials (e.g. healthy volunteer bias and short follow-up) may compromise effects for exercise and physical activity on mortality. In addition, medical care in modern countries guarantees longer survival despite a high incidence for cardiovascular disease, which further reduces the potential impact of exercise and physical activity on lifespan. Healthspan, as a concept, focuses on life years in good health, as opposed to mere lifespan or mortality, which focuses solely on longevity. We propose using different measures of healthspan as an outcome to quantify the effects of exercise and physical activity. We outline the different dimensions of healthspan and how these could be measured at the population level using scalable, reliable, valid, and non-invasive assessments. Specifically, we propose physical function, mental and cognitive health, chronic disease prevention, and quality of life as appropriate measures. These measures may help to better understand physical activity and exercise-related benefits that contribute to a healthier life and to implement interventions that have the potential to increase healthspan across populations.