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PaperclipPerfector  10mo ago (text post)   3018 thread views

Wellness Wednesday for December 27, 2023

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New Swedish twin study just dropped[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10274991/

Maybe exercising doesn't matter all that much?

Results

We identified four classes of long-term LTPA: sedentary, moderately active, active and highly active. Although biological ageing was accelerated in sedentary and highly active classes, after adjusting for other lifestyle-related factors, the associations mainly attenuated. Physically active classes had a maximum 7% lower risk of total mortality over the sedentary class, but this association was consistent only in the short term and could largely be accounted for by familial factors. LTPA exhibited less favourable associations when prevalent diseases were exclusion criteria rather than covariate.

Conclusion

Being active may reflect a healthy phenotype instead of causally reducing mortality.

I both want this to be true (because it would be a relief, in a way) but also don't (because it means your mortality isn't really modifiable by exercise). Any good analyses/critiques available?

  1. On Jun 5th 2023. So not that new.

I once looked into animal studies on exercise and I remember there were papers showing a similar result. Mouses that exercised did not live longer, but they were healthier: https://link.springer.com/article/10.1186/2046-2395-2-14

It’s not impossible IMO that exercise is a consequence of a healthy organism, whose energy is so abundant that it wants to get rid of the excess through physical expenditure. Anyone who has experienced childhood or owned a young dog should be familiar with the phenomenon. Exercise intervention studies would have been compromised by the fact that the already-healthier people would have been more keen to sign up, or if it were randomized more keen to accept, and more keen to remain in the study. When I was young, randomly running required about 5% of the willpower it does for me now — because I was a well-trained athlete as a child? No, just an organism with a lot of health energy to spare.

One obvious confounder I just thought of: if a twin dies isn't the other twin going to feel, like, super bummed and like their life isn't worth living anymore?

According to ChatGPT4

Twins, particularly identical ones, often have a very close emotional and social bond. The loss of a twin can lead to significant emotional stress and grief, which might impact the surviving twin's health. This phenomenon is sometimes referred to as the "twinless twin syndrome," where the death of one twin can lead to deteriorating health in the other.

An alternate title for this study could perhaps be: Twinless twin syndrome kills more than good lifestyle habits protect

The same thing keeps being suggested:

  • Propensity to live an extremely long life (longer than 90, certainly than 100) is almost entirely genetic. If your family mostly checks out at 80 it’s unlikely going full Bryan Johnson is going to get you to 100.
  • Regular checkups can help avoid unexpected but curable conditions that can lead to not reaching your genetic life expectancy (most historic examples of these like appendicitis and pregnancy are no longer major issues in developed countries, and others like diabetes and breast cancer can usually be managed/treated to allow for many additional years of life).
  • Healthy lifestyles do nothing to raise your genetic ‘cap’, although they might improve your quality of life (range of movement, ability to play with the grandkids, to go on walks, to attract the opposite sex etc).
  • Extremely unhealthy lifestyles can lower your life expectancy because of eg. medical complications of morbid obesity.

Regular checkups can help avoid unexpected but curable conditions that can lead to not reaching your genetic life expectancy (most historic examples of these like appendicitis and pregnancy are no longer major issues in developed countries, and others like diabetes and breast cancer can usually be managed/treated to allow for many additional years of life).

colon cancer screening is a big one. lots of middle-aged ppl dying from this now.

What are latest thoughts on when the begin screening and how frequently to repeat? My physician thinks we shouldn't start earlier than 45 and I feel like he'd laugh if I suggested every 5 years.

I have used Cologuard even few years, at my doctor's recommendation.

Depends heavily on family history and other risks, but 45 is the new standard.

Propensity to live an extremely long life (longer than 90, certainly than 100) is almost entirely genetic. If your family mostly checks out at 80 it’s unlikely going full Bryan Johnson is going to get you to 100.

I'll admit a fairly huge part of my skepticism of study results like this is because I assume the world is full of haters who don't want Bryan Johnson (and other longevity types who rub like 50% of the population the wrong way) to succeed in living longer: https://twitter.com/bryan_johnson/status/1727742379522949433

The guy just reads like a fitness influencer for nerds

One thing that I don't understand how to deal with is

Alcohol use was based on average alcohol consumption (g/day) in 1981 of beer, wine and spirits[25] and classified as never, former, occasional (>0.1 and <1.3 g), low (≥1.3 and <25 g), medium (≥25 and <45 g), high (≥45 and <65 g) and very high (≥65 g)[26].

Body mass index (BMI) (kg/m2) was calculated based on self-reported height and weight in 1981. BMI based on self-reports has been shown to agree well with BMI based on measured values[23].

They assessed these in 1981 and maybe tried to control for them? But the study ran through 2020? Why only check these once? What's the impact either way? I flip between "maybe this doesn't matter at all" and "doesn't this render the study findings highly suspect enough that you should feel bad for submitting it for print at all?"

Being active may reflect a healthy phenotype instead of causally reducing mortality.

Not surprising. Munger and Kissinger lived to 100, neither were 'active'. No '10k steps/day' for either of them. Same for Warren Buffett: at 93 he plays bridge all day when not counting his money and still fully healthy. These wealthy sedentary guys live forever. My granddads died at 78 and 80; the sedentary one lived longer. I think it's almost all genes. That is not to say excercise doesn't help, it does to some degree when controlling for genes, but genes do most of the heavy lifting, and also just dumb luck like not getting in a car accident or murdered. Also, helps to avoid drugs , smoking, and alcohol .

Makes sense. Can't smoke, drink alcohol and do drugs if you're too busy exercising.

(Unless you start running with the Hash House Harriers)

I assure you that runners and cyclists are generally not a light-drinking group.

As per https://en.wikipedia.org/wiki/Hash_House_Harriers

The Hash is humorously known as A Drinking Club With A Running Problem, with the preferred beverage of consumption being beer.

But I just meant that if you gave the population 30-60 minutes of busywork a day, like exercise, that made it really hard to do self-destructive things like drugs, drinking or smoking at the same time, that might be a significant health gain even if there was no direct benefit from the exercise itself.

after adjusting for other lifestyle-related factors

Same problem as ever. Controlling away things that are mediated by exercise ensures that they aren't actually testing what the headline says they're testing.

In any case, the main reason to be fit isn't to maximize the length of life, but to improve quality-of-life. Even if I became convinced that a sedentary individual, flabby and skinny-fat though they may be, does not suffer a reduced length of life, I would still suggest that being fit improves quality-of-life significantly.

I don't fully understand all of the lingo being used in the paper, but it looks like the lifestyle factors they controlled for are smoking and alcohol use. Isn't that the right thing to do to here?

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