Dr Ray O’Connor takes a look at recent clinical articles on lifestyle and health, including the importance of exercise as an alternative to less effective or unsafe medications for many conditions
Although physical activity recommendations increasingly consider daily step counts, it remains unclear whether step accumulation patterns—short versus sustained longer bouts—affect associations with mortality and cardiovascular disease (CVD) among suboptimally active populations.
Dr Ray O’Connor
The objective of this prospective cohort study using data from the UK Biobank1 was to examine associations of step accumulation patterns with all-cause mortality and CVD incidence in persons with 8000 or fewer daily steps.
The participants were 33,560 persons (mean age, 62.0 years) who were engaging in 8,000 or fewer daily steps and were free of CVD or cancer at baseline. Participants were categorized as having activity bouts of shorter than five minutes, five to shorter than 10 minutes, 10 to shorter than 15 minutes, or 15 minutes or longer according to the bout in which they accumulated most of their steps.
Sedentary participants had fewer than 5,000 daily steps, and low active participants had 5,000 to 7,999 daily steps. The outcomes of interest were all-cause mortality and CVD incidence. The results were remarkable.
Cumulative all-cause mortality at 9.5 years decreased with bout length: For bouts shorter than five minutes, it was 4.36 per cent; for five to shorter than 10 minutes, 1.83 per cent; for 10 to shorter than 15 minutes, 0.84 per cent; and for 15 minutes or longer, 0.80 per cent. Cumulative CVD incidence at 9.5 years followed a similar pattern.
The authors’ conclusion was that suboptimally active adults who accumulated most of their daily steps in longer bouts had lower mortality and CVD risk than those who accumulated most daily steps in shorter bouts. The everyday practice implications are obvious.
Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (generally referring to those aged ≥60 years).
This personal view article2 recently published in the Lancet Healthy Longevity highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care.
The authors contend that exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is also an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease.
Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression.
They point out how targeted exercise programmes have also been shown to ameliorate drug-induced side effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications.
However few health care professionals have formal training in advising on exercise. Thus a good first step is to provide health-care professionals with additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature.
Speaking of incorporating exercise into a treatment regime, the purpose of this systematic review and network meta-analysis3 was to assess the efficacy and safety of various exercise modalities as therapeutic interventions for managing knee osteoarthritis.
The authors selected randomised controlled trials comparing different exercise modalities, including aerobic exercise, flexibility exercise, mind-body exercise, neuromotor exercise, strengthening exercise, mixed exercise, and control group for patients with knee osteoarthritis. The primary outcomes included pain, function, gait performance, and quality of life, assessed at short term (four weeks), mid-term (12 weeks), and long term (24 weeks) follow-up. The results were that 217 randomised controlled trials with 15,684 participants were found which evaluated the relative benefit of five exercise modalities for knee osteoarthritis. The authors concluded that aerobic exercise may be the most beneficial exercise modality for improving pain, function, gait performance, and quality of life in knee osteoarthritis.
Finally, how useful are lifestyle interventions for preventing cognitive decline in older adults who are cognitively unimpaired? This was the topic of a systematic review and network meta-analysis of randomised controlled trials (RCTs).4 The authors aimed to compare and rank the relative efficacy of single-domain and multidomain lifestyle interventions. The authors identified 109 eligible RCTs, including 23,010 participants (median age 70⋅1 years, 14,957 [65 per cent] female and 8,053 [35 per cent] male).
Compared with health education, significant improvements in global cognition were found for physical exercise and cognitive training combined, cognitive training alone, diet, physical exercise, cognitive training, and health education combined and physical exercise alone.
The strongest effect was found with combination of physical exercise and cognitive training. The authors conclude that their findings support lifestyle interventions as key components of prevention strategies; however, their optimal combination requires further investigation.
References:
- Del Pozo Cruz B et al. Step Accumulation Patterns and Risk for Cardiovascular Events and Mortality Among Suboptimally Active Adults. Ann Intern Med. 2025 DOI:10.7326/ANNALS-25-01547.
- Izquierdo M et al. Integrating exercise and medication management in geriatric care: a holistic strategy to enhance health outcomes and reduce polypharmacy. Lancet Healthy Longev 2025;6: 100763 Published Online September 25, 2025. https://doi.org/10.1016/j.lanhl.2025.100763.
- Yan L et al. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ 2025;391:e085242 http://dx.doi.org/10.1136/bmj-2025‑085242.
- Mendes A et al. Single-domain and multidomain lifestyle interventions for the prevention of cognitive decline in older adults who are cognitively unimpaired: a systematic review and network meta-analysis. Lancet Healthy Longev 2025;6: 100762. Published Online September 25, 2025. https://doi.org/10.1016/j.lanhl.2025.100762.
