Generation 100 - CERG
Generation 100: Does exercise make you live longer?
Generation 100: Does exercise make older adults live longer?
The Generation 100 exercise study followed more than 1500 women and men in their 70s for five years. The aim was to find out if exercise gives older adults a longer and healthier life, and we also compare the effect of moderate and high-intensity exercise. The study is the largest of its kind, and the five-year testing of the participants was completed in 2018.
The main results were published in The BMJ on October 8, 2020, and are summarized in the animated video at the top of this page. A more thorough summary of the main results follows below.
Demographic data indicate a tripling of the population aged 60 years and older by the year 2050. Thus, research on how to achieve healthy aging is needed and required.
Generation 100 is the largest randomized clinical study that evaluates the effect of regular exercise training on morbidity and mortality in older adults. Inclusion of the participants in Generation 100 started in 2012.
Since then, a total of 1567 participants have been randomized to either five years of supervised exercise training, or to a control group. The exercise group was further randomized to either two weekly sessions of high intensity training or to moderate intensity training. The participant could perform most of the exercise sessions by them self if they wanted to, but all had to attend at least one supervised session every sixth week. The control group was instructed to follow national physical activity guidelines.
Thorough clinical examinations and fitness tests, as well as questionnaires, were administered to all participants at baseline, at one year (2013/2014), three year (2015/2016), and five year follow up (2017/2018).
The results from the Generation 100 Study contribute to improved understanding on how older adults can stay at good health for as long as possible. Exercise as medicine is a relatively cheap, accessible and available treatment that can benefit a large proportion of the population.
Read the full research article describing the study protocol for the Generation 100 study in BMJ Open:
A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study
Generation 100 smacktop
High-intensity interval training improves health in older adults
High-intensity interval training for five years increases quality of life and improves cardiorespiratory fitness more than moderate exercise. However, we can still not be completely certain that it's more effective to improve longevity in the elderly.
Among 70-77-year-olds in Norway in general, 90% survive the next five years. In the Generation 100 study population, an impressive 95.4% of the participants survived.
The high survival is likely to some extent caused by the exercise performed by the participants in all the three groups in the study. Our data shows that even the control group maintained a high level of physical activity throughout the period. Although this group was not offered organized exercise, the participants may have been motivated by the regular fitness and health check-ups throughout the study.
However, our findings can not make us completely sure that exercise prolongs life for older adults. The high survival in all groups is probably partly explained by a "healthy participant bias". Those who signed up to participate in the Generation 100 study had relatively good health, were relatively physically active and probably had high motivation for exercise in the first place.
Trend towards lower risk of early death with high intensity
In the high-intensity interval training group, 3% died during the study period. In the moderate intensity exercise group, 5.9% of the participants died. The difference between the groups is not statistically significant. However, the trend is so clear that we would encourage health authorities worldwide to recommend high-intensity exercise for older adults – at least as supplement to other types of exercise.
In the control group, 4.7% of the participants died during the five-year period. We found no difference when we compared the survival in the two exercise groups combined and the survival in the control group. Furthermore, the risk of dying from cardiovascular diseases or cancer did not differ between the three groups.
Active control group
The participants in the control group exercised more than we thought they would, which makes it challenging to interpret our results. Actually, 20% of the participants in this group exercised regularly with high intensity. Thus, they performed more high-intensity training than the moderate group but less than the high-intensity group. This may explain why they ended up in the middle also in terms of mortality.
Another possible reason why the study does not give us completely clear answers, could be that not all participants in the two exercise groups exercised according to the study protocol. Only half of the participants in the high-intensity group actually performed regular high-intensity interval training, whereas more than 10% of the participants in the moderate group exercised frequently with high intensity.
More health effects with high-intensity training
Both physical and mental quality of life were better in the high-intensity group after five years than in the other two groups.
High-intensity interval training also had a greater effect on cardiorespiratory fitness after one, three and five years, compared to the other two groups. Higher fitness is closely linked to a lower risk of premature death, so this improvement may possibly be a reason why the high-intensity group apparently had the highest survival.
The participants in the other two groups in the Generation 100 study also managed to maintain their cardiorespiratory fitness throughout the five-year period. This is quite unique for people in this age group, with an expected drop in fitness of 20% over a ten-year period. This indicates that the participants in all three groups of the Generation 100 Study have been more physically active than what is usual for men and women in their 70s.
Other results from the Generation 100 project
Follow the links below to read easy-to-understand summaries of all the published results from the Generation 100 Study. Those particularly interested can read the research articles in the scientific journals where they are published.
- Who are most physically active: Norwegian or Brazilian older adults?
- New fitness genes link to cardiovascular health
- What kind of exercise is most likely to increase fitness?
- What kind of exercise does older adults prefer?
- Which older adults are more likely to drop out of an exercise program?
- Does weather influence physical activity in the elderly?
- How fit is the average 70-year-old?
- Obesity and low fitness linked to higher cardiovascular risk
- More metabolic syndrome among inactive older adults
- Is lung function important for fitness in older adults?
- The faster walk, the more steps during a day
- Are older adults active enough?
- Is a lot of sitting OK for the fittest?
- How does fatigue impact activity level?
- What time of year is the activity level highest?
- New threshold for pshyical activity intensity in the elderly
Equally active seniors in Norway and Brazil
Older adults in Norway are slimmer than older adults in Brazil, and also have better grip strength and less triglycerides in the blood. Most seniors in both countries report being physically active at least two days each week. Norwegian older adults in general have higher cholesterol levels and blood pressure than Brazilians, but the proportion who use blood pressure medication is more than twice as high among Brazil's elderly. According to the study, an equally high proportion in both countries have the metabolic syndrome, which is an accumulation of risk factors for cardiovascular disease.
The differences in BMI and waist circumference seem to be explained by the fact that older people in Norway have a higher level of education than older people in Brazil. There was no difference when we repeated the analyzes without including the Brazilians who had no secondary education. 310 participants from our Generation 100 study and 255 seniors from Ribeirao Preto in Brazil are included in the study. 80% are women.
Six new fitness genes found
We have found six new genetic variants that link closely to having high or low cardiorespiratory fitness. Having a higher number of the favourable genetic variants – and a lower number of the bad ones – is linked to lower waist circumference, fat percentage, BMI and blood lipid levels. Furthermore, to have good fitness genes is associated with a lower likelihood of using blood pressure medication. We know that genes are quite important for maximum oxygen uptake, and this is the first major study to look for genetic variants associated with directly measured cardiorespiratory fitness.
In the study, we analyzed more than 120,000 unique genetic variants in 3470 healthy women and men who measured their maximum oxygen uptake during the HUNT3 Fitness study. We found that 41 of the genetic variants were closely related to the fitness of these participants, even after adjusting for gender, age and self-reported activity level. Six of the same genetic variants were also significantly associated with high fitness in the validation cohort of 718 elderly who participated in the Generation 100 study. Further experiments indicated that the genetic variants in question affect gene expression in adipose tissue, skeletal muscle and heart.
More people respond to high-intensity interval training
High-volume high-intensity interval training is more likely to improve cardiorespiratory fitness than continuous exercise at moderate intensity. One third of those who performed regular interval training with at least 15 minutes of high intensity per session increased their fitness, even when we used strict criteria to define a likely response. In comparison, one fifth of those who exercised at moderate intensity for at least 30 minutes per session were responders.
The article includes data from 18 trials and 677 participants from five countries. We have included studies with healthy adults of all ages, as well as higher risk populations and patients with coronary heart disease. A gain of at least 5 ml/kg/min was defined as response to exercise. The studies with the longest duration and highest exercise loads had the most significant number of responders, indicating that at least some of those who were deemed non-responders would respond with an increase in training duration, frequency or intensity.
Outdoor walking is popular among older adults
More than half of the self-reported activity among participants in the moderate intensity exercise group of the Generation 100 Study was performed as walking. Walking was also the most popular activity among the participants in the high intensity exercise group, but these participants did more cycling and jogging compared to the moderate group. Moreover, the findings show that older adults are able to perform high intensity exercise without strict supervision.
Both groups preferred to exercise outdoors, and only one third of the sessions were performed indoors. We also found that women more often than men exercised together with others. The information is gathered from exercise diaries from the first year of the Generation 100 Study, and includes almost 70 000 exercise logs in total.
Elderly with low education and fitness more often quit exercise programs
Less than 15 % of the 1500 participants dropped out of the Generation 100 study during the first three years. Low education, low grip strenght, low cardiorespiratory fitness and low levels of physical activity were significant predictors of dropping out. Participants with reduced memory status were also more likely to drop out. The results give important information about potential factors that increase the risk for dropping out of long-term exercise programs in older adults..
The Generation 100 study aims to find out if exercise can give older adults longer and healthier lives. The participants are randomized to three group, of which two are exercise groups. Our results also show that participants randomized to exercise – and thus more regular follow-up appointments – aslo were more likely to drop out than those randomized to the control group.
Does weather influence physical activity levels in the elderly?
Unfit older adults are less physically active during rain or snow, whereas fit older adults don't seem to let precipitation influence activity levels. Moreover, older adults are more physically active with increasing temperatures. The findings suggest that bad weather might be a barrier towards physical activity in unfit older adults.
To find these results, we studied accelerometer data from 1291 participants in the Generation 100 study. Hour-to-hour data on temperature and precipitation were collected from the Norwegian Meteorological Institute.
How fit is the average 70-year-old?
At baseline testing in the Generation 100 Study, we measured the maximum oxygen uptake of 1537 men and women from Trondheim born between 1936 and 1942. The results are by far the largest data material in the world that says something about expected physical capacity among older women and men.
The men achieved an average maximum oxygen uptake of 31.3 ml/kg/min. The women had lower values: 26.2 ml/kg/min. Women and men who had cardiovascular disease had 14% and 19% lower physical capacity, respectively, than those who were healthy. The ability to lower the heart rate quickly after maximum exertion was also reduced among heart patients.
Obesity and poor fitness: A risky combination
It can be useful to include both physical fitness and body composition when assessing the risk of cardiovascular disease in elderly and motivating them to lead a health-promoting lifestyle. The Generation 100 study shows that participants who have both low maximum oxygen uptake and unfavorable body composition probably have an extra high risk of cardiovascular disease.
The probability of having an accumulation of several risk factors was six times higher among older adults who had poor fitness and a body mass index (BMI) indicative of overweight or obesity, compared with slimmer participants with higher fitness. Men and women with poor cardiorespiratory and high fat percentage or high waist circumference also had a fivefold increased likelihood of high cardiovascular risk.
Read the full research article in Mayo Clinic Proceedings: Innovations, Quality & Outcomes:
Combined Association of Cardiorespiratory Fitness and Body Fatness With Cardiometabolic Risk Factors in Older Norwegian Adults: The Generation 100 Study
Less metabolic syndrome among physically active elderly
We have previously developed a new method for measuring physical activity in the elderly. Our results now confirm that using this method can tell us something about health. Data from the activity measurements of more than 1000 Generation 100 participants showed a higher incidence of metabolic syndrome among those who did not satisfy the minimum recommendations for physical activity based on relative intensity. Metabolic syndrome means that you have at least three of the common risk factors for cardiovascular disease.
The commonly used absolute intensity model, on the other hand, was not associated with metabolic syndrome. The results may therefore indicate that our new threshold values for moderate and intensive physical activity measured with an accelerometer provide a more accurate description of the amount of activity sufficient to provide good health in the elderly.
Read the full research article in BMC Geriatrics
Absolute and relative accelerometer thresholds for determining the association between physical activity and metabolic syndrome in the older adults: The Generation-100 study
Simple measures of lung function can reveal poor fitness
Our Fitness Calculator is even more accurate for older adults if you add measurements of lung function. In the Generation 100 Study, we tested how much air the participants managed to exhale during the first second after filling their lungs to the maximum. We also measured the capacity to transport oxygen from the alveoli to the blood, and also the levels of hemoglobin, which transports oxygen in the blood.
When we included these three values in the Fitness Calculator, we were able to calculate the actual fitness of the participants even more accurately, especially for men. This suggests that the lungs may be a limiting factor for physical capacity in older men in particular.
Walking speed is important for the activity level
Older adults who walk fast achieve more steps in a day than older adults who walk slowly. In addition, walking slowly was the only gait pattern factor that could predict the Generation 100 participants most likely to reduce their activity level during the first year of the study.
Step frequency and step length also had an effect on the activity level: the shorter the length and the higher the frequency, the less physical activity.
Read the full research article in Journal of Aging and Physical Activity:
The Association Between Gait Characteristics and Ambulatory Physical Activity in Older People: A Cross-Sectional and Longitudinal Observational Study Using Generation 100 Data
Using gait patterns from 86 healthy Generation 100 participants, we have also compared two computer programs that analyze gait.
Are the elderly sufficiently physically active?
At the start of the Generation 100 study, only 29% of the participants were as physically active as the health authorities recommend – if the activity level is measured with the standard method for accelerometers. If, on the other hand, we use our method, which takes into account that older people usually have lower physical capacity than younger people, as many as 71% were physically active enough.
The study also shows that there were more women than men who reached the recommendations based on our new method, which uses age-relative rather than absolute training loads. The most common activity in both women and men was walking.
Fit older adults can sit a lot without having increased cardiovascular risk
70-77-year-olds with high cardiorespiratory fitness even though they sit a lot during the day, do not have higher risk of cardiovascular disease than equally fit older adults who sit less. The results indicate that having a high maximal oxygen uptake can offset the negative cardiovascular consequences of sitting still among the elderly. The study also shows that low fitness is closely linked to increased accumulation of risk factors no matter how little or how much an older person sits still during the day.
Data from the accelerometers showed that the Generation 100 participants on avarage were at rest 75% of their awake time. Just over a third of women and men complied with the health authorities' minimum recommendations for physical activity. But even among those who do not meet these recommendations, high fitness seems to protect against the accumulation of risk factors. On the other hand, those with low fitness are not protected even if they meet the activity recommendations. Thus, the results indicate that having high fitness is even more important for the health of the elderly than being as physically active as the authorities recommend.
Fatigued seniors are less physically active in the morning
Older adults who are fatigued walk on average 1000 fewer steps a day than other older adults. They also exercise less at moderate or higher intensity, and spend less calories during the day. The results may indicate that fatigue prevents elderly from being physically active, but physical inactivity likely also leads to more fatigue.
We also found that overweight participants, those with low fitness, and participants who had several other health problems were more exhausted and less physically active than others. In total, 9% of the participants reported fatigue.
Another paper shows that it's the activity level in the morning that is reduced among elderly with fatigue. By looking at hour-by-hour data from accelerometers, we found that the activity level for the rest of the day is not different between persons with and without fatigue.
Read the full research article in Journal of aging and physical activity:
Fatigue Alters the Pattern of Physical Activity Behavior in Older Adults: Observational Analysis of Data from the Generation 100 Study
Most physically active in summer
The higher fitness, the higher is the level of physical activity in older adults. Moreover, the women in the Generation 100 study had a higher activity level than the men, and the activity level turned out to be higher in the summer than in the winter.
Maximum oxygen uptake, gender and season were the three most important factors that could tell us something about the physical activity level of the participants. This cross-sectional study is based on baseline accelerometer data from 850 Generation 100 participants.
Lung function could impact fitness in healthy older adults
In Generation 100 participants with worse lung function than a certain threshold, we found a clear association with fitness level: The worse the lung function, the worse the cardiorespiratory fitness. For participants who had better lung function than this threshold, however, maximum oxygen uptake was not limited by lung function.
In healthy people, it is the heart, not the lungs, that is usually considered the limiting factor for cardiorespiratory fitness. The lungs actually have a reserve capacity to transport oxygen to the blood even at maximum exercise. However, the threshold level we found for lung function to be important for fitness was well within what is considered normal lung function in persons aged between 70 and 77 years. The results may therefore indicate that age impairs lung function to such an extent that it affects the physical capacity of many healthy older adults.
New activity level thresholds for the elderly
When using accelerometers, one must reach a certain intensity level for it to be considered moderate or intense physical activity. The same absolute intensity threshold is used to make objective measurements of physical activity levels in women and men of all ages. However, many older adults have too low physical capacity to achieve these absolute intensity threshold, and will therefore end up in the category of physically inactive even if they exercise regularly at an intensity that is sufficiently high based on their own fitness level.
Therefore, we have established new threshold levels to describe moderate and intense physical activity with accelerometers in older women and men. Our threshold values are based on relative intensity, and take into account both that the average fitness of the elderly is lower than in younger people and that older women have lower fitness levels than older men.
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NTNU, Fakultet for medisin og helsevitenskap
Institutt for sirkulasjon og bildediagnostikk
St. Olavs Hospital
Prinsesse Kristinas gt. 3
Akutten og Hjerte-lunge-senteret, 3. etg.
Contacts, Generation 100
Publications from Generation 100
Stensvold, D., Viken, H., Steinshamn, S. L., Dalen, H., Støylen, A., Loennechen, J. P., Reitlo, L. S., Zisko, N., Bækkerud, F. H., Tari, A., Sandbakk, S. B., Carlsen, T., Ingebrigtsen, J. E., Lydersen, S., Mattsson, E., Anderssen, S. A., Singh, M. A. F., Coombes, J. S., Skogvoll, E., Vatten, L. J., Helbostad, J. L., Rognmo, Ø., & Wisløff, U. (2020) Effect of exercise training for five years on all cause mortality in older adults—the Generation 100 study: randomised controlled trial. The BMJ.
Rodrigues, J. A. L., Stenvold, D., Almeida, M. L., Sobrinho, A. C. S., Rodrigues, G. S., & Júnior, C. R. (2020). Cardiometabolic risk factors associated with educational level in older people: comparison between Norway and Brazil. Journal of Public Health.
Bye, A., Klevjer, M., Ryeng, E., Silva, G. J., Moreira, J. B. N., Stensvold, D., & Wisløff, U. (2020). Identification of novel genetic variants associated with cardiorespiratory fitness. Progress in Cardiovascular Diseases.
Williams, C. J., Gurd, B. J., Bonafiglia, J. T., Voisin, S. A. C., Li, Z., Harvey, N., Croci, I., Taylor, J. L., Gajanand, T., Ramos, J. S., Fassett, R. G., Little, J. P., Francois, M. E., Hearon Jr., C. M., Sarma, S., Janssen, S. L. J. E., Caenenbroeck, E. M. V., Beckers, P., Cornelissen, V. A., Pattyn, N., Howden, E. K., Keating, S. E., Bye, A., Stensvold, D., Wisløff, U., Papadimitriou, I., Yan, X., Bishop, D. J., Eynon, N., & Coombes, J., (2019). A multi-centre comparison of V̇O2peak trainability between interval training and moderate intensity continuous training. Frontiers in Physiology, 10, 19.
Reitlo, L. S., Sandbakk, S. B., Viken, H., Aspvik, N. P., Ingebrigtsen, J. E., Tan, X., Wisløff, U., & Stensvold, D. (2018). Exercise patterns in older adults instructed to follow moderate-or high-intensity exercise protocol–the generation 100 study. BMC Geriatrics, 18(1), 208.
Viken, H., Reitlo, L. S., Zisko, N., Nauman, J., Aspvik, N. P., Ingebrigtsen, J. E., Wisløff, D., & Stensvold, D. (2018). Predictors of Dropout in Exercise Trials in Older Adults. Medicine and science in sports and exercise.
Aspvik, N. P., Viken, H., Ingebrigtsen, J. E., Zisko, N., Mehus, I., Wisløff, U., & Stensvold, D. (2018). Do weather changes influence physical activity level among older adults?–The Generation 100 study. PloS one, 13(7), e0199463.
Stensvold, D., Sandbakk, S. B., Viken, H., Zisko, N., Reitlo, L. S., Nauman, J., Gaustad, S. E., Hassel, E., Moufack, M., Brønstad, E., Aspvik, N. P., Malmo, V., Steinshamn, S. L., Støylen, A., Anderssen, S. A., Helbostad, J. L., Rognmo, Ø, & Wisløff, U. (2017). Cardiorespiratory Reference Data in Older Adults: The Generation 100 Study. Medicine and science in sports and exercise, 49(11), 2206.
Sandbakk, S. B., Nauman, J., Lavie, C. J., Wisløff, U., & Stensvold, D. (2017). Combined Association of Cardiorespiratory Fitness and Body Fatness With Cardiometabolic Risk Factors in Older Norwegian Adults: The Generation 100 Study. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 1(1), 67-77.
Zisko, N., Nauman, J., Sandbakk, S. B., Aspvik, N. P., Salvesen, Ø., Carlsen, T., Viken, H., Ingebrigtsen, J. E., Wisløff, U., & Stensvold, D. (2017). Absolute and relative accelerometer thresholds for determining the association between physical activity and metabolic syndrome in the older adults: The Generation-100 study. BMC geriatrics, 17(1), 109.
Hassel, E., Stensvold, D., Halvorsen, T., Wisløff, U., Langhammer, A., & Steinshamn, S. (2017). Lung function parameters improve prediction of VO2peak in an elderly population: The Generation 100 study. PloS one, 12(3), e0174058.
Egerton, T., Paterson, K., & Helbostad, J. L. (2017). The association between gait characteristics and ambulatory physical activity in older people: a cross-sectional and longitudinal observational study using generation 100 data. Journal of aging and physical activity, 25(1), 10-19.
Aspvik, N. P., Viken, H., Zisko, N., Ingebrigtsen, J. E., Wisløff, U., & Stensvold, D. (2016). Are Older Adults Physically Active Enough–A Matter of Assessment Method? The Generation 100 Study. PloS one, 11(11), e0167012.
Sandbakk, S. B., Nauman, J., Zisko, N., Sandbakk, Ø., Aspvik, N. P., Stensvold, D., & Wisløff, U. (2016, November). Sedentary Time, Cardiorespiratory Fitness, and Cardiovascular Risk Factor Clustering in Older Adults--the Generation 100 Study. In Mayo Clinic Proceedings (Vol. 91, No. 11, pp. 1525-1534). Elsevier.
Egerton, T., Helbostad, J. L., Stensvold, D., & Chastin, S. F. (2016). Fatigue alters the pattern of physical activity behavior in older adults: observational analysis of data from the generation 100 study. Journal of aging and physical activity, 24(4), 633-641.
Viken, H., Aspvik, N. P., Ingebrigtsen, J. E., Zisko, N., Wisløff, U., & Stensvold, D. (2016). Correlates of objectively measured physical activity among Norwegian older adults: the Generation 100 Study. Journal of aging and physical activity, 24(3), 369-375.
Egerton, T., Chastin, S. F., Stensvold, D., & Helbostad, J. L. (2015). Fatigue may contribute to reduced physical activity among older people: An observational study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(5), 670-676.
Hassel, E., Stensvold, D., Halvorsen, T., Wisløff, U., Langhammer, A., & Steinshamn, S. (2015). Association between pulmonary function and peak oxygen uptake in elderly: the Generation 100 study. Respiratory research, 16(1), 156.
Zisko, N., Carlsen, T., Salvesen, Ø., Aspvik, N. P., Ingebrigtsen, J. E., Wisløff, U., & Stensvold, D. (2015). New relative intensity ambulatory accelerometer thresholds for elderly men and women: the Generation 100 study. BMC geriatrics, 15(1), 97.
Stensvold, D., Viken, H., Rognmo, Ø., Skogvoll, E., Steinshamn, S., Vatten, L. J., Coombes, J. S., Anderssen, S. A., Magnussen, J., Ingebrigtsen, J. E., Singh, M. A. F., Langhammer, A., Støylen, A., Helbostad, J-, K., & Wisløff, U. (2015). A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study. BMJ open, 5(2), e007519.
Egerton, T., Thingstad, P., & Helbostad, J. L. (2014). Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite. BMC research notes, 7(1), 542.