- Welcome back team to the Building Lifelong Athletes podcast. Thanks so much for stopping by. If we haven't had a chance to meet yet, my name is Jordan Renneke and I'm a dual board certified physician in family and sports medicine. And the goal of this podcast is to keep you healthy and active for life through actionable evidence informed education. Thanks so much for stopping by. This week we've got three pretty cool articles we're gonna talk about and kind of recent articles and kind of thought provoking. So I just wanna go through and kind of take my thoughts and run you through the literature. So the idea is that we're kind of getting some research up to date stuff, learning some new things. So let's really dive into it. So the first article is titled Supercenturions and Clerical Errors in Longevity Records. This is by Newman et al in 2024, so very recent. And this was a absolutely fascinating article. We've all heard of blue zones, right? So blue zones are these magic areas where these people live to be 110, 114 years old, whatever these magical areas where there's something going on there, right? That makes these people live longer. And this paper kind of calls that into question and really just questions everything we think we know about blue zone. So let's look into a little bit here. The background, like we talked about, blue zones have been celebrated in the homes of these supercentenarians. So they've been celebrated for their extreme longevity, attributed to a combination of lifestyle, genetics and community factors. And so supercentenarians, so centenarians is 100 and supercentenarians is getting above that, above 110. And so these blue zone areas saying, "Hey, for some reason, genetically or lifestyle or whatnot, there are a higher percentage of people who get really, really old and who live to be supercentenarians." And so that's what we're looking at here. And what this study found was, is super interesting. The core finding was that it questions the validity of many supercentenarian records and suggests that a large proportion are clerical errors or even worse, pension fraud. And so you have to think like, what the heck? What does that mean? How is it impossible? Well, they found that in regions with incomplete vital registration, they had crazy high records, right? So the most places that had the most supercentenarians were associated with poverty, illiteracy and poor documentation. And they're trying to make the argument here that why would it be that in these areas that have such poor, they're so socioeconomically disadvantaged, they have poor literacy, they have poverty everywhere, why are there so many people living longer there? It's just kind of interesting. And one point they made to take this was, in the introduction of birth certificates in the US led to a sharp decline, about 69 to 82% in the number of supercentenarian records, supporting the theory of erroneous records prior to proper registration systems. So what they're saying is, once we actually started implementing birth certificates in America, the number of people who lived to be 110 unsurprisingly became a lot less 'cause they're saying they just weren't accurate. So where they're saying a lot of these things, a lot of these people who lived to 110 aren't even there. And they found similar findings as well in Italy and France where remarkable ages were associated with low socioeconomic status, once again, short lifespan and remote geographic location. And so the one thing they kind of think about here is why are we finding this? And they had a bunch of reasons. They say it could be because of poor records. They also said they could be literally fraud, but people continue to collect pensions. If they're not dead, they keep getting money for their family and so it doesn't make sense. For everything that we know, that's why we step back here, for everything that we know, right? People who tend to have a higher socioeconomic status tend to have better health outcomes. So why do we see the extreme opposite here? Extreme opposite, right? So people who are poor or have poor socioeconomic status, why are they living so long? That just doesn't make sense. So that's why this author here is kind of calling on a question. I think it's absolutely fascinating. And there's definitely some implications for everybody who are in physicians specifically. And I think we should be skeptical when interpreting the studies based on extreme longevity, right? And this kind of impacts the validity of Blue Zone studies and calls for a closer look at data accuracy. And it puts a new lens on public health efforts to focus on longevity. And my take is this, I like legitimately don't know if I can take any Blue Zone study seriously now. I mean, not ever again, but it just kind of questions the scheme of my brain. It makes you question everything. And it may also kind of call the entire longevity space into question, which the longevity space are now just a cesspool of terribleness anyways. But this might add to that and make it even worse. But I love it. I love this 'cause we have so many people obsessed with living to be 110, right? And all these things. And the idea that we may be basing our life on things that aren't even real and are just fraud and data errors, it's crazy to me. It's honestly like it's humorous just because it's so crazy. And obviously there's still many things to look at and learn from people who live long, even if it's not necessarily, you know, let's say they only live to 100 instead of 114. Like obviously they're still doing something, right? There might be something to that. But this article kind of questions that. It says, hey, maybe it's not as clear 'cause we thought, maybe it has to do with poor record keeping, just straight up fraud, who knows? But I thought it was a very insightful and thought provoking read and recommend you take a look at it. All right, and the next study we're gonna look at here is titled Cardio Respiratory Fitness and Long-Term Mortality. This is by Mansager et al. back from 2018. This one just kind of popped up in my feed. I thought it was really interesting. And this study design was a retrospective cohort study involving about 122,000 patients who underwent exercise treadmill testing with a medium follow-up of 8.4 years. So in English, what that means is 122,000 people did a stress test. So typically what a stress test is, they put you on a treadmill at some sort of incline and they start to increase the speed at which you're walking and make it progressively more hard. As you're doing that, that's challenging your heart. You're connected to a machine, an EKG, essentially you're looking at the EKG and looking for any sort of signs of ischemia or blockages, essentially is what we do. Other, you can do for other reasons for exercise testing as well, just to see what your tolerance is. But the majority of people here will look for referred because of reasons like looking for coronary artery disease. Other people who were for risk stratification, once again, understand that the higher you have a fitness, the less risky you are in terms of a cardiovascular perspective or early death. But what they're saying here is they're looking at most of those people who refer to cardiac reasons specifically, about 122,000 people. And what were the findings? The findings were that the cardiorespiratory fitness, it is inversely associated with all cause of mortality across all age groups and fitness levels. So not really surprising, right? We've known for a long time that the more fit you are, typically more healthy you are. That's not what we're looking at necessarily. But what they did was actually kind of interesting as well. The elite fitness, so top 2% provided the greatest reduction in mortality risk. So this created a hazard risk of 0.2 compared to the low performers with no observed plateau or negative impact at higher levels of fitness. And this is the big thing, right? So previously they've always talked about maybe this U shape in terms of, hey, if you don't exercise at all, nothing's going on there, you're at a higher risk. Whereas if you start exercising, things get better. And then if you exercise too much, your risk might actually go up again. So this U shape is what they've talked about. And this study is kind of challenging that. That's the whole idea, which is kind of interesting. And they found overall that the mortality benefit from a higher fitness level was greater than traditional risk factors, such as coronary artery disease, diabetes, and smoking. So let's take that again. The mortality benefit from a higher fitness level was greater than traditional risk factors, such as coronary artery disease, smoking, and diabetes. So what this is saying is that the more physically fit you are, it is arguably just as important as making sure you don't have diabetes, smoking, or anything like that, which is crazy. And that's one thing most people talk about, hey, control your risk factors, right? Make sure that your blood pressure is good, that you don't have diabetes, smoking, all those things. Well, fitness, maybe fitness should be one of those risk factors we talked about. If you have a higher cardiorespiratory fitness, it seems to decrease your risk of heart attacks or anything like that, which is crazy. And there are also some subgroup findings. And they found that the survival advantage is even more pronounced in older patients. So patients greater than 70 years and those with hypertension. And once again, the reiteration was there was no upper limit of benefit that was seen with increasing fitness, meaning that the more fit you get, the more benefit you got from it. We're not seeing that U shape curve or anything like that. And it's pretty crazy. So implications wise, clinicians should encourage patients to have a high level of fitness at all times. And it's as potent of a mild, pliable risk factor that we have for long-term survival, which is crazy. And so we actually may need to reconsider our physical activity goals. And particularly in older or hypertensive patients who have high blood pressure, elite fitness levels may yield substantial benefits. And my take from this is like, well, what's not new is like being fit is good for you. We've always known that. It was never like, oh, snap, like I didn't know I should work out. No, we always knew that obviously. But what is new is that there's possibly not that U shape. 'Cause for a long time, it just didn't quite make sense. But we've seen data that, hey, when you work out a little bit, you get huge benefits. And then you kind of plateau out. And then more, it's like, oh no, do you get the risk of AFib or something like that? And never made like intuitive sense necessarily. And this is a piece of evidence. Obviously this isn't the whole story. This is a piece of evidence saying, hey, like the more you work out, the probably the better it is. Obviously it gets to the spot of, are you having yourself or getting injured, all those things. But it seems like the more fit you are, the better you are. And to me, it's really insane that fitness can be thought of as a risk factor. That's honestly a game changing and a practice changing thing for me. I don't think about that. I think of risk factors for someone for a cardiovascular risk score. I think about their blood sugar, their blood pressure, and I'm looking for insulin resistance and looking for cholesterol, all these things I'm thinking about. And then I always talk about exercise. I counsel on that all the time, but I don't necessarily think of it as a risk factor. This kind of changed that for me. So we think about, hey, should we be including your cardiovascular fitness as a marker for that? And I think that's a really cool thing to think about. And we have ways to test that in different, that's a whole different topic for a different podcast. So I thought that was very intriguing. All right, and the last article we're gonna talk about is titled "Occupational versus Leisure Time, Physical Activity and Mortality." This is Cohen et al. from 2024 here. And overall, what is happening here, well, this was a meta-analysis of over 590,000 participants from 22 studies that were looking at differential effects on occupational physical activity and leisure time physical activity on all-cause mortality. So what they were looking for here is occupational physical therapy is activity at work, right? The things you do moving around, doing your job, whereas leisure time is just that, and your leisure, going out and doing things. And they looked at various studies that were published in the literature already. So, and they had to have activity levels measured in some way, shape, or form, whether that was through activity monitors, which there weren't a lot of studies in there, or from just self-reported things. And overall, they looked at all-cause mortality, but they weren't specifically looking at those two. It was just kind of like grouping together, oh, this one had this and this, so we'll use that. But it wasn't a prospective study looking at physical activity and mortality. It was a retrospective, but a meta-analysis kind of bringing them all together. And how do they divide them? Well, here's essentially what they broke them down into. The occupational physical activity groups, they had sedentary, low, moderate, high. Sedentary is work that just involves sitting. So usually at a desk, so a lot of people, including physicians these days, a lot of times we're just sitting there doing things, but low levels, work that involves standing or walking around, maybe retail, hospitality, moderate, carrying lighter objects or walking upstairs, factory, warehouse, we're thinking of that. Whereas high is a physically demanding work involving frequent carrying or lifting heavy loads, construction, manual labor, like that. So that's how they broke down occupational. Whereas leisure time, sedentary is you just sit on the couch. You're not doing anything, you get home and you're just sedentary. Low level is occasionally getting in there, such as slow walking, maybe household activities. I never understand that as a side note when they say household activities. It's like what, so anyway, who's not a hoarder and just doesn't do anything? That doesn't mean anything. Everyone does household activities. Regardless, that's low level. Moderate level, engagement activities like brisk walking or dancing at high levels and regularly engaging in more strenuous activities like jogging, cycling, swimming, or just pretty much working out. And what were the main findings? Well, the main findings for leisure time physical activity, this was consistently associated with lower all-cause mortality in both men and women. And so once again, the more leisure time physical activity you had, the lower chance you had of dying is really what it came down to. And what was kind of interesting, I thought here was higher levels of leisure time physical activity, reduced mortality risk significant. Hazard ratios of 0.85 in low group, 0.78 in the moderate, 0.75 in the high compared to sedentary. So what this means, so we talk about hazard ratios. One second, hazard ratio measures the risk of death for different levels of physical activity compared to the reference group. So in this case, sedentary. So you'd be looking at low versus sedentary, moderate versus sedentary, high versus sedentary. And they found that they had 0.78, or I'm sorry, 0.85, 0.78, and 0.75. And what that means is, so even the lowest group just doing low, still at a 15% less in lower risk of death. Whereas the next group up at 22% and the highest group at a 25% lower risk of death. That's pretty substantial when compared to that. So for leisure time, even just doing something at two pre-substantial benefits, it's about 15%. If you can go more than that, then that's great. And kind of like our last paper we talked about, it also had substantial effects. So the more you do, probably the better. Whereas occupational physical activity is kind of interesting. In contrast, higher levels of occupational physical activity were associated with increased mortality risk in men, but not necessarily women. This is weird, we're gonna talk about it. But higher levels of this physical activity in the occupation showed an increased risk of mortality in men with a hazard ratio of 1.12, suggesting a paradox somehow where physically demanding work may not confer the same health benefits as leisure time physical activity. So once again, these people who had high occupational physical activity were 12% more likely to die. And why is that? Well, they kind of coined it the physical activity paradox where they're kind of guessing what it is. Really, we don't know why. These are observational, we have no idea, but they're kind of guessing. One theory they place is that occupational physical activity is often associated with repetitive, non-rewarding tasks may contribute to repetitive injuries in the body or wear and tear, quote unquote, rather than rejuvenating effects, which voluntary engaging leisure time activity has. So when you go exercise, you feel better. If you do it all day, everyday repetitive tasks, it may wear you down, that's one thing. But I think what a big thing is, probably one of the biggest things is the socioeconomic factors, right? So things like lower education income may also play a big role. And so a lot of times, more physically demanding jobs, people who do that are typically in lower socioeconomic classes and statuses, and so that may play a huge factor that it's not even anything they do with their jobs, it's just the rest of their life, the other risk factors that they have. And so that's something we need to consider. And I think just taking this for face value, what the take on point would be for physicians is, hey, we need to talk about public health messages, promoting physical activity, and differentiate between leisure time and occupational physical activity. And tailored device might be beneficial for workers and physically demanding jobs saying, hey, we should try to do some leisure time activity, may be important, and it's hard to. But at the end of the day, it's really hard to definitively say what's going on here. But I think it kind of helps clarify things in general that like leisure time may be the key, right? We need to counsel patients intentionally about physical activity that need to be intentional about that, and that may be helpful. However, this study did definitely have limitations in terms of mostly Western affluent societies, and that's just that study population. And the biggest thing for me, like if I had to take away from this, it's not actually like, oh, you get no benefit from physical activity because your body won't know, like if you take 10,000 steps working versus leisure time, I don't think there's a physiologic way of knowing that, unless, like I said, their proposed mechanism is like, well, you're already at work, you're incurring much more stress, you know, this movement is with stress and it's not rejuvenating. So once again, that's a theory. Definitely not saying that's definitive yet. And so if that is true, then I could see why we see that discordance here. But overall, it's kind of a tricky one. But if I had to guess, I'm just betting, completely random conjecture by me, but I think socioeconomic status probably has more to play in this than we think in terms of the people who are more physically active at their jobs, maybe lower socioeconomic status. And what does that entail? Well, that entails less money for quality healthcare, for activities, for leisure time itself, for they might live in food deserts. There's just so many reasons, you know, pollution. You literally name it and you're at a worse outcome by having lower socioeconomic status. And so that's a big, big confounder. But either way, I thought it was very interesting. And I really hope you enjoy this. This was three thought-provoking articles I thought were kind of cool. Overall, just stepping back saying that, hey, maybe we should think twice about the blue zones. We should probably be as fit as possible. And we should try to, you know, really emphasize the leisure time physical activity. Those are the big three takeaway points from these articles. But I hope you enjoy it. And if you did enjoy it, it would mean the world if you liked, commented on this or shared with a friend. Really, I think that's the best thing and the highest compliment you could ever pay if you share this with a friend or give us a five star review, that would mean a lot. But thanks so much for stopping by today. I really appreciate it. Now get off your phone and get outside. Have a good rest of your day. We'll see you next time. Disclaimer, this podcast is for entertainment, education and informational purposes only. The topics discussed should not solely be used to diagnose, treat or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing. And at the time of listing this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
