Background  Physical activity is associated with reduced risks of chronic diseases and premature death. Whether physical activity is also associated with improved overall health among those who survive to older ages is unclear.

Methods  A total of 13 535 Nurses' Health Study participants who were free of major chronic diseases at baseline in 1986 and had survived to age 70 years or older as of the 1995-2001 period made up the study population. We defined successful survival as no history of 10 major chronic diseases or coronary artery bypass graft surgery and no cognitive impairment, physical impairment, or mental health limitations.

Results  After multivariate adjustment for covariates, higher physical activity levels at midlife, as measured by metabolic-equivalent tasks, were significantly associated with better odds of successful survival. Significant increases in successful survival were observed beginning at the third quintile of activity: odds ratios (ORs) (95% confidence intervals [CIs]) in the lowest to highest quintiles were 1 [Reference], 0.98 (0.80-1.20), 1.37 (1.13-1.65), 1.34 (1.11-1.61), and 1.99 (1.66-2.38) (P < .001 for trend). Increasing energy expenditure from walking was associated with a similar elevation in odds of successful survival: the ORs (95% CIs) of successful survival across quintiles of walking were 1 [Reference], 0.99 (0.80-1.21), 1.19 (0.97-1.45), 1.50 (1.24-1.82), and 1.47 (1.22-1.79) (P < .001 for trend).

Conclusion  These data provide evidence that higher levels of midlife physical activity are associated with exceptional health status among women who survive to older ages and corroborate the potential role of physical activity in improving overall health.

Author Affiliations: Departments of Nutrition (Drs Sun and Hu) and Epidemiology (Drs Townsend, Hu, and Grodstein), Harvard School of Public Health, Boston, Massachusetts; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (Drs Okereke, Hu, and Grodstein); and Health Sciences Research Institute, University of Warwick, Coventry, England (Dr Franco).