For adults over 65, staying active may involve much more than simply reaching a daily step target. New research suggests that balance, agility, lower-body strength and cardiovascular fitness may all provide important clues about healthy aging and longevity.
A large study published in JAMA Network Open on August 10, 2026, followed 13,423 adults aged 65 and older and found that better objectively measured physical fitness was associated with a lower risk of death from any cause over a median follow-up of seven years.
Researchers Tested More Than Daily Activity
Rather than relying solely on questionnaires or step counts, researchers directly tested participants across four major areas of fitness: cardiorespiratory fitness, muscular strength, flexibility, and balance and agility.
Assessments included a two-minute step test, chair stands, arm curls, a single-leg balance test, flexibility exercises and an eight-foot “up-and-go” test measuring how quickly participants could rise from a chair, walk around a marker and sit down again.
This approach measured what older adults could physically do—not simply how much activity they reported.
Balance and Agility Showed Strong Association
Some of the strongest results involved balance and agility.
Compared with adults in the lowest-performing group, those in the highest-performing group on the eight-foot up-and-go test had an adjusted 59% lower risk of all-cause mortality during follow-up.
For the single-leg standing test, the highest-performing group had an adjusted 50% lower mortality risk than the lowest-performing group.
These are associations and do not prove that improving a balance-test score itself will extend someone’s lifespan.
Leg Strength Could Be Especially Important
Lower-body strength also emerged as a significant marker.
Participants performing best on the 30-second chair-stand test had an adjusted 45% lower mortality risk compared with those in the lowest performance group.
Leg strength becomes particularly important with age because it contributes to walking, climbing stairs, getting out of a chair, maintaining balance and recovering from a stumble.
Separate 2026 research involving more than 5,000 women aged 63 to 99 has also linked greater muscular strength with lower all-cause mortality.
Cardio Fitness Remains a Powerful Marker
Cardiorespiratory fitness shouldn’t be overlooked.
Adults performing best on the study’s two-minute step test had an adjusted 42% lower mortality risk than those in the lowest-performing group.
A recent review of physical activity, fitness and longevity similarly concluded that cardiorespiratory fitness is consistently associated with lower cardiovascular and overall mortality, with particularly large benefits when inactive people become even moderately more active.
Overall Fitness Produced the Strongest Result
Perhaps the most interesting finding came when researchers stopped looking at individual abilities and considered overall fitness.
A composite score combining all seven fitness assessments produced the strongest association. Participants in the highest overall-fitness group had an adjusted 61% lower all-cause mortality risk compared with those in the lowest group.
That supports a broader message for healthy aging: being reasonably capable across several physical domains may matter more than excelling at just one.
You Don’t Need to Become an Athlete at 65
The study does not establish specific workout prescriptions, and observational research cannot prove that fitness differences directly caused the differences in mortality.
It does, however, suggest that functional fitness deserves attention alongside traditional measures of health.
For older adults, a balanced programme can include aerobic activities such as walking, cycling or swimming; resistance exercises targeting major muscle groups; and appropriate balance and mobility work.
The researchers also found that much of the mortality difference was concentrated between people with the lowest fitness and everyone performing better, suggesting that moving out of very low fitness may be particularly meaningful.
The takeaway is encouraging: fitness after 65 isn’t just about counting steps. Maintaining the ability to move efficiently, stay balanced, remain strong and sustain aerobic activity may collectively provide a better picture of healthy aging—and could help preserve independence as well as longevity.
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