Lessons from the Blue Zones: steps for living a happier, healthier life for longer

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It is estimated that between 2015 and 2050, the proportion of the world’s population over 60 years old will double;1 however, while people are living longer, their health isn’t keeping pace. A report from the World Health Organization (WHO) found that despite global life expectancy sitting at 73.4 years,2 healthy life expectancy (the number of years a person can expect to live in “full health”) lagged behind at 63.7 years.3  Largely driven by an increase in chronic, age-related diseases affecting the older generations, the healthspan–lifespan gap means that approximately one-fifth of the average person’s life will be impacted by morbidity.4

Closing the healthspan–lifespan gap is an appealing target that has been adopted by numerous public health organizations,4,5 with the United Nations naming the period from Jan 2021 to Dec 2030 the “Decade of Healthy Aging”.6 But the standard approach to healthcare could in fact be widening the gap. Twenty-first-century medicine is largely reactive in nature, treating diseases and managing symptoms once they arise. With each new clinical development, disease management strategies help to further prolong lifespan. Yet, while cures for the most damning of chronic diseases remain elusive, healthspan remains stagnant. Reducing the lifespan–healthspan gap requires a preventive approach to medicine, focused on reducing the risk of developing the age-related diseases that are propagating the disparity.4

Exploring the impact of lifestyle on aging health

Results from an 18-year-long twin study published in 1999 first demonstrated the association between genetics, lifestyle, and the way in which we age. The research group found that, above the age of 60, only 25% of variation in health status could be explained by genetics; the remaining variation is due to lifestyle and environmental factors, which can enhance or reduce the risk of disease development.7 To determine which factors contribute to optimal aging, individual longevity studies have aimed to identify specific traits or life trajectories of long-lived persons.8 Expanding on this, population longevity studies have identified regions of the world in which a large proportion of the inhabitants demonstrate exceptional longevity – the so-called ‘Blue Zones’.8

In 2004, the Barbagia Region of Sardinia was identified as the first longevity Blue Zone due to its high population of centenarians.9 Later additions to the Blue Zone roster were Okinawa (Japan), Nicoya (Costa Rica), Ikaria (Greece), and Loma Linda (California, USA).10,11 In addition to their long lifespan, the populations of these regions typically remain physically active well into their later years and do not suffer the degenerative diseases common to their age group elsewhere in the world.11

Insights from the Blue Zones

By examining features shared by each of the Blue Zone regions, researchers identified key lifestyle factors that are common denominators for longevity. These factors, referred to as the ‘Power 9’, are:11

  1. Moving naturally throughout the day, focusing on consistent regular movement rather than bursts of high intensity exercise
  2. Having a sense of purpose, a reason to wake up in the morning
  3. Building stress-relieving rituals into one’s day-to-day routine
  4. Stopping eating when 80% full and eating the smallest meal in the evening
  5. Adopting a plant-based approach to food, with beans, vegetables, fruits, and whole grains forming the core of one’s diet
  6. Consuming moderate but regular amounts of wine, preferably limited to social settings with friends
  7. Being part of a community and forging a sense of belonging
  8. Developing close and strong family connections
  9. Forming strong social networks with close friends

Looking at these factors, it is of little surprise that the lifespan–healthspan gap is widening in the western world: for many, the ability to move naturally is constrained by hours sat at a desk and life in pedestrian-unfriendly cities;12 diets tend to be heavy on ultra-processed foods;13 and despite the connections afforded by social media, as a society we are lonelier and more isolated than ever.14,15

However, there is still time to change. And the Blue Zones research team has demonstrated that applying the Power 9 principles can change the health trajectory of a community.11 In the city of Albert Lea (Minnesota, USA), Blue Zone experts set forth to update the city in line with their longevity values. Working with the local government they set to improve outside spaces, increase access to healthy foods, and instill a sense of community across the city. In just one year, the average lifespan increased by 2.9 years, healthcare claims decreased by 49%, and workplace absenteeism reduced by 21%.11

The science to back it up

The concept of a true longevity Blue Zone is controversial, with skeptics saying that the exceptional longevity demonstrated in the regions is more likely due to record-keeping errors or pension fraud.16 Indeed, living in such a place, or even living your life as if you do, is no guarantee of making it to 100. Genetic factors and predispositions can outweigh the healthiest of lifestyles; however, the Power 9 principles taken from Blue Zone research largely align with the core pillars of lifestyle medicine, and results from Blue Zone studies – such as the one in Albert Lea – are in line with recent results coming from the wider longevity research community.10

Recent dietary studies have found high intake of fruits, high-fiber vegetables, and lean meat is associated with decelerated aging, whereas consumption of red meat, cheese, and starchy vegetables has the opposite effect.17 Numerous studies have also demonstrated health benefits associated with plant-based diets.18,19 Regarding exercise, one study with over 62,000 participants showed that regular vigorous intermittent lifestyle physical activity – i.e., exercise that is part of daily
life rather than a structured workout – results in a reduction in all-cause, cancer, and CVD mortality risk.20 Increased social isolation has long been shown to be associated with assorted chronic illnesses and an increased risk for mortality,21 and a recent study added to the existing literature by demonstrating that those with more social connections experience slower biological aging and have
a lower mortality rate.22

Steps for a (hopefully) longer life

We’ve all had days where it feels like we are chained to the desk, but making time for your health is key for both your short-term mood and long-term health trajectory. Every few hours, why not take a walk around the room, stretch out the day with a quick yoga practice, or drop into a set of squats to get the blood flowing and the body moving. Walking challenges – such as the ones run by the Scientific Group Mental Health team – can be great for promoting daily movement, giving you a target number of steps to aim for. For lunch, find healthy, plant-focused recipes that are quick to whip up, provide energy for the rest of the day, and make for a sustainable choice. Connect with friends and colleagues, through meetings or in the pub after a long day, for support navigating stressful scenarios and for an altogether more enjoyable work environment. And make time for stress-relieving practices in your day to avoid burnout.

While we may not live to be 100 or remain disease free into our final decades, by applying the principles of the Blue Zones, we could have the best chance of realizing this goal.  

References

  1. World Health Organization. Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Last accessed May 2024.
  2. Life expectancy of the world population. https://www.worldometers.info/demographics/life-expectancy/. Last accessed May 2024.
  3. World Health Organization. GHE: Life expectancy and healthy life expectancy. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy. Last accessed May 2024.
  4. Garmany A et al. NPJ Regen Med. 2021;6(1):57.
  5. Angell SY et al. Circulation. 2020;141(9):e120–38.
  6. United Nations. Decade of healthy ageing: 2021–2030. https://social.desa.un.org/sdn/decade-of-healthy-ageing-2021-2030. Last accessed May 2024.
  7. Christensen K et al. J Aging Health. 1999;11(1):49–64.
  8. Poulain M et al. Mech Ageing Dev. 2021;198:111543.
  9. Poulain M et al. Exp Gerontol. 2004;39:1423–9.
  10. Kreouzi M et al. Am J Lifestyle Med. 2022;0(0).
  11. World Economic Forum. 9 lessons from the world’s Blue Zones on living a long, healthy life. https://www.weforum.org/agenda/2017/06/changing-the-way-america-eats-moves-and-connects-one-town-at-a-time/. Last accessed May 2024.
  12. Park JH et al. Korean J Fam Med. 2020;41:365–73.
  13. Juul F et al. Am J Clin Nutr. 2022;115(1):211–21.
  14. Surkalim DL et al. BMJ. 2022:376:e067068.
  15. US loneliness index. https://www.cigna.com/static/www-cigna-com/docs/about-us/newsroom/studies-and-reports/combatting-loneliness/loneliness-survey-2018-full-report.pdf. Last accessed May 2024.
  16. Financial Times. The surprising data behind supercentenarians. https://www.ft.com/content/912c2b53-65eb-4c5c-96d3-605f8872dbbe. Last accessed June 2024 .
  17. Biemans Y et al. Age Ageing. 2024;53(Suppl. 2):ii20–9.
  18. Babalola F et al. Cureus. 2022;14(10):e29843.
  19. Capodici A et al. PLoS One. 2024;19(5):e0300711.
  20. Stamatakis E et al. Nat Med. 2022;28:2521–9.
  21. Holt-Lunstad J et al. Perspect Psychol Sci. 2015;10(2):227–37.
  22. Rajai N et al. JACC Adv. 2024;0(0).

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