The Longevity Prescription

The Longevity Prescription

Why Movement Is the Medicine—and How to Protect It This Fall

By Jeffrey A. Saal, MD

Every few months, a new longevity product arrives with a great deal of confidence: a supplement, a wearable, a cold plunge, a peptide, a “protocol.” Patients bring these to me, and I understand the appeal. The promise is that somewhere out there is a novel intervention that will add years to your life, if you can just find it and afford it.

I’ve spent more than four decades in spine and musculoskeletal medicine, and I want to tell you something the longevity industry won’t: the most powerful thing you can do for a longer, healthier life is exercise. It isn’t new, it costs next to nothing, and nobody can sell it to you. Study after study, over decades and across millions of people, points to the same unglamorous conclusion. At SOAR Spine and Orthopedics, we’ve built our practice on that message since 1981.

Consider the scale of the mismatch. Demographers have calculated that even if we eliminated cancer entirely, U.S. life expectancy would rise by only about three years; eliminating heart disease would add roughly four and a half. In one widely cited model or medical progress, a major breakthrough against cancer or heart disease would add only about one more year of life for a 51-year-old. That’s one year for curing the disease.

Compare that with what basic habits deliver, and much of the biohacking industry looks like money spent at the margins.

What the Evidence Shows

When researchers examine what actually affects lifespan, physical activity is at or near the top of every list, and it doesn’t take much. In one large study, researchers followed more than 416,000 adults for about eight years. People who did just 15 minutes of moderate exercise a day (about 92 minutes a week, half of the standard recommendation) had a 14% lower risk of dying from any cause and lived roughly three years longer than those who were inactive. Every additional 15 minutes a day lowered all-cause mortality by another 4%. Those doing 30 minutes daily added about four years of life. The benefits held across every age group and both sexes, including people already at cardiovascular risk. That’s 15 minutes a day. You don’t need a marathon, a boutique class, or expensive equipment. A walk on your lunch break gets you there.

Three Habits That Matter Most

If I could get a patient to do only three things, they’d be these: don’t smoke, keep alcohol to a minimum, and move your body regularly. The evidence for all three is overwhelming. Harvard researchers tracked more than 120,000 people for decades and scored them on five low-risk habits: never smoking, a healthy body weight, at least 30 minutes a day of moderate-to-vigorous activity, a good diet, and moderate alcohol intake. A 50-year-old who had adopted all five could expect to live about 14 years longer (women) or 12 years longer (men) than someone who had adopted none. Even a single one of these habits was associated with roughly two additional years of life. Compare that with the single year that curing cancer would add for someone the same age. These effects dwarf almost anything you can buy.

On smoking, the numbers are stark. Research following more than a million adults has found that lifelong smokers lose roughly a decade of life, and that quitting before age 40 cuts the excess risk of death from continued smoking by about 90%. There’s no supplement on earth with a track record like that.

The science on alcohol has shifted. For years, the “a glass of red wine a day is good foryour heart” story was repeated as settled fact. It may not be the final answer. Recent studies of alcohol and health concluded that the level of consumption that minimizes overall health loss is, in fact, zero; a more recent update added some age-specific nuance, but the direction of the evidence is clear. When it comes to alcohol and longevity, less is better. Common sense prevails: moderation is key.

The Part We Have Devoted Our Careers To

This is where my field comes in, and it’s the part I care about most. You can’t exercise your way to a long life if your body won’t let you move. Every one of the studies above assumes you’re able to be active. But a large share ofthe population isn’t, because their musculoskeletal system stops them. Low back pain is the single leading cause of disability on the planet. It affected 619 million people in 2020, a figure projected to reach 843 million by 2050. When your back, hip, knee, or shoulder hurts, you sit more, you walk less, and you gradually stop doing the very thing that protects your heart and brain. That makes musculoskeletal pain a whole-body problem: it takes away the one intervention that helps everything else.

Muscle strength itself is a longevity signal. One study that followed nearly 140,000 adults across 17 countries found that grip strength predicted death more accurately than bloodpressure. Each 5-kilogram drop in strength was associated with about a 16% higher risk of dying from any cause. Strength isn’t about vanity; it’s a vital sign.  This is the work we do at SOAR. We don’t just tell you to exercise and send you out the door with an injured spine. Our goal is to keep your body healthy enough that exercise stays possible for the rest of your life. Our exercise-based, non-operative approach (stabilization training, individualized instruction, and interventional procedures only when they’re truly needed) exists so that movement stays available to you at 55, 70, and 85.

Movement Is Brain Medicine, Too

The benefit doesn’t stop at the neck. A major 2024 review identified 14 modifiable risk factors that together account for nearly 45% of dementia cases worldwide. Physical inactivity is one of them, and the review highlights midlife as the time when changing it matters most. Regular exercise builds cognitive and physical reserve, protects the blood vessels that feed the brain, and appears to delay the onset of decline. When I tell patients that the same walk protecting their heart is also protecting their memory, it usually gets their attention. Exercise is the closest thing we have to a whole-system drug, and it happens to be free.

Next: Calming the Nervous System

Once you’re moving and your foundation is sound, there’s real value in adding what I’d call quality-of-life practices, especially learning to calm the nervous system. Meditation and related mind-body practices aren’t mysticism; they produce measurable physiological changes. One analysis pooling 45 clinical trials found that meditationlowered cortisol, blood pressure, and heart rate compared with active controls. Subsequent reviews of mindfulness-based stress reduction have shown meaningful reductions in blood pressure. Chronic stress is corrosive to the cardiovascular and musculoskeletal systems alike, and teaching the nervous system to down-regulate is a legitimate longevity tool.

The order matters, though. Calming the nervous system builds on a body that moves. It doesn’t replace it.

Fall Is a Great Time to Get Moving, So Prepare First

I’m writing this in the fall for a reason. The heat has broken, routines are resetting after summer, and cooler weather makes this one of the best times of year to be activeoutdoors: hiking, walking, cycling, working in the yard. This is the season to build the habit that carries you through the winter and the holidays. But clinics fill every autumnwith people who go from a week at a desk straight into a full Saturday of raking and yard cleanup, a long trail, or a new fall sports league. Enthusiasm isn’t the same as being ready.

A few ways to stay active and avoid injury:

Build up gradually. Tissues adapt to stress over time. Before a big hike or a round of holiday travel, spend two to three weeks building walking volume and doing basic hip, hamstring, and thoracic mobility work. Increase your activity by no more than about 10% per week.

Lift with your hips. Raking, yard cleanup, and lifting luggage are back injurieswaiting to happen when you bend from the spine instead of the hips. Hinge at the hips, keep loads close, and let your legs do the work.

Add strength training. Because strength predicts survival, don’t rely on cardio alone. A twice-weekly routine of basic resistance work (squats, carries, rows) protects your joints as you age.

Move a little, most days. Remember the 15-minute threshold. Consistency beatsintensity. A daily walk outdoors, while the weather is still on your side, does more for you than one big workout a week.

Address pain early. Ordinary next-day soreness is fine. Sharp, radiating, orpersistent pain, especially with numbness, tingling, or weakness, is a warning  sign.  Don’t push through it. Early evaluation is how we keep a small problem from derailing your active season.

What We Have Always Said

There’s no secret here. The longevity strategy with the strongest evidence is movement, supported by a healthy musculoskeletal system, not smoking, minimal alcohol, and a nervous system you’ve learned to calm.

Don’t look for miracles outside yourself. You alone are the driver of your success and happiness. (The Dalai Lama has said much the same!)

That’s the medicine we’ve been prescribing for more than forty years. The season ahead is an invitation to take it. If pain is standing between you and an active life, that’s exactly the problem we help solve, so the years you add are years you can enjoy.

Keep Moving, and Stay Tuned

Don’t let an injury or a painful problem slow you down. Pain is common, but it rarely has to be permanent. Most musculoskeletal problems respond well to the right diagnosis and the right plan, and getting people back to the activities they love is what we do every day.

We also want to address the newer therapies you may be hearing about. We aren’t naysayers. Our advice reflects a careful reading of what the evidence shows at this moment, and that evidence keeps changing. We’re following the research on peptides and other emerging treatments closely and evaluating it as it develops. As the science evolves, our recommendations will evolve with it.

In an upcoming article, we’ll take a closer look at peptides and other breakthrough therapies, including what the data support, what remains unproven, and where they fit within our treatment philosophy. Until then, keep moving. Your most active years may still be ahead of you.

The physicians of SOAR Spine and Orthopedics have pioneered non-operative, exercise-based musculoskeletal care in the San Francisco Bay Area since 1981. To discuss keeping yourself active and pain-free this fall, request an appointment at our Redwood City or Santa Clara offices.