NYCU-Led Study Links Better Fitness to 61% Lower Mortality Risk in Older Adults
Maintaining strength, balance and mobility may help older adults preserve independence and age more healthily, an NYCU-led study suggests.
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Edited by Chance Lai
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A seven-year study of 13,423 adults aged 65 and older in Taiwan found that those in the top 20% of overall fitness had a 61% lower risk of death from any cause than those in the bottom 20%.
Researchers at National Yang Ming Chiao Tung University (NYCU) conducted the study in collaboration with colleagues from Chung Yuan Christian University, National Taiwan University of Sport and several other academic institutions. The study, titled “Physical Fitness and All-Cause Mortality in Older Adults,” was published on August 10 in JAMA Network.
The association remained significant after the researchers accounted for age, sex, socioeconomic status, physical activity, body mass index and chronic health conditions. The findings suggest that healthy aging depends not only on preventing disease but also on maintaining strength, balance and mobility.
Li-Lin Liang, an associate professor at NYCU’s Institute of Public Health, led the cross-university research team behind the seven-year study.
Simple Tests Offer a Broader Picture of Health
The researchers analyzed data from adults aged 65 and older who completed standardized fitness assessments in Taiwan between 2015 and 2016. Their health records were tracked through the end of 2022, with a median follow-up of seven years. During that period, 1,631 participants, or 12.2% of the study population, died.
Participants completed seven functional fitness tests covering four areas: cardiorespiratory endurance, muscular strength, flexibility, and balance and agility. The tests included stepping in place for two minutes, performing repeated arm curls and chair stands, reaching forward from a seated position, reaching behind the back, standing on one leg with the eyes open, and rising from a chair to walk around a marker before sitting down again.
Rather than measuring athletic performance, these exercises reflect abilities that older adults rely on in daily life, such as standing up without assistance, walking safely and maintaining balance.
Balance, Mobility and Leg Strength Stand Out
Balance and agility showed the strongest associations with survival, followed by lower-body strength and cardiorespiratory fitness. Compared with participants in the lowest-performing 20%, those in the highest-performing group on the 8-foot up-and-go test had a 59% lower risk of death. The test requires participants to rise from a chair, walk 8 feet, turn around, return and sit back down.
Top performers on the one-leg stance test had a 50% lower risk of death, while those who performed best on the chair-stand test had a 45% lower risk. Participants with the best results on the two-minute step test had a 42% lower risk.
The findings highlight the importance of maintaining the ability to stand, walk and respond to changes in balance. These abilities are central to independent living and may also help reduce the risk of falls, fractures and related complications.
Older Adults Do Not Need to Become Athletes
The relationship between fitness and mortality was not always linear. For several measures, mortality risk declined most sharply as participants moved beyond the lowest fitness levels, with the reduction leveling off at higher levels.
This suggests that older adults may not need to achieve exceptional fitness to see a meaningful difference. Moving from a low to a moderate level of fitness may offer the greatest potential benefit. “The findings are especially meaningful for older adults who may feel that it is too late to improve their health,” said Li-Lin Liang, an associate professor at NYCU’s Institute of Public Health and a co-corresponding author of the study.
“Even if someone starts with limited physical capacity, becoming more active and gradually improving strength, balance and mobility may bring meaningful health benefits.
Looking Beyond a List of Diseases
Liang said the findings support a more comprehensive view of healthy aging. Health assessments should consider not only which diseases an older person has but also how much “physiological reserve” that person retains. Physiological reserve refers to the body’s capacity to maintain function, respond to stress and recover from illness or injury. An older adult may have one or more chronic conditions yet remain physically capable and independent.
“An older adult may have a chronic disease but still be able to walk a considerable distance and maintain good balance and muscle strength,” Liang said. “That person has a very different level of physiological reserve from someone whose mobility has already declined substantially,” Liang added that physical fitness is a valuable indicator of overall health because it reflects the status of more than one organ or disease. Instead, it captures the combined effects of daily functioning, disease burden and physiological aging.
Rethinking What It Means to Age Well
Because the study was observational, it identified an association but could not prove that better fitness directly extends life. Fitness was also measured only once, and information on certain factors, including participants’ smoking history, was unavailable.
Despite these limitations, the consistency of the findings across multiple fitness measures underscores the value of looking beyond disease diagnoses when assessing the health of older adults. Liang said the results support continued efforts to promote fitness among older adults and incorporate simple functional assessments into routine care. Such tests could help health professionals detect declining mobility earlier and develop strategies to preserve strength, balance and independence.
The study offers a practical message: Healthy aging does not require becoming an athlete. For older adults, retaining the ability to rise from a chair, stand steadily and walk with confidence may be a more meaningful goal—and those starting at the lowest fitness levels may have the most to gain from taking the first step.
Better performance in balance, mobility, lower-body strength and cardiorespiratory fitness was associated with a substantially lower mortality risk among older adults.
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