Ageing well does not depend only on genes or on luck, but largely on our daily habits. At the 2026 Healthy Longevity course in Singapore, Professor Mark H.H. Kramer (Amsterdam UMC) presented longevity from a societal angle and set out the eight pillars of lifestyle medicine. Here is how they shape our years in good health.
Ageing well: aiming for health, not only for duration
The key concept is not life expectancy but "health expectancy", meaning the years lived in good health. The data from Amsterdam's multi-ethnic HELIUS cohort are a warning signal: only 6.2 % of people are classified as ageing healthily, against 24.8 % in a moderate state and 69 % in a poor state.
This multidomain ageing score covers chronic diseases, mental health, cognitive function, physical function, pain, social support and quality of life. Ageing well therefore means acting on several dimensions at once.
The 8 pillars of lifestyle medicine
Lifestyle medicine rests on eight concrete pillars, within everyone's reach:
1. Balanced nutrition. 2. Regular physical activity. 3. Stress management. 4. Restorative sleep. 5. Social connections. 6. Avoiding tobacco. 7. Limiting alcohol. 8. Avoiding opioids.
These pillars are not worked on in isolation. Restorative sleep influences stress and appetite; physical activity supports mood and social ties. It is their combination that helps us age well.
Why lifestyle weighs so heavily on longevity
The weight of lifestyle is confirmed by the AHA's Life's Simple 7, which defines ideal cardiovascular health: not smoking, a healthy diet, 150 minutes of physical activity a week, a BMI below 25, systolic pressure below 120 mmHg, total cholesterol under 5.2 and fasting glucose under 5.5.
The benefit is striking: meeting all 7 criteria out of 7 is associated with a 45 % reduction in mortality. Yet only one person in five meets at least five of them. There is therefore wide room for progress in ageing well, through accessible changes.
Ageing well begins in the very first days
Professor Kramer stresses the role of social determinants: around 25 % of health differences are linked to social factors such as education, income, housing or working conditions. Accelerated ageing affects disadvantaged groups more heavily.
History sheds light on this point. The Dutch "hunger winter" of 1944-1945 showed how early nutritional stress leaves a lasting mark on health. Hence the importance of the "first 1000 days" of life: investing early in a child's development offers the best returns for future longevity.
From individual care to prevention for all
Ageing well also requires a reorganisation of care. Professor Kramer proposes shifting care from hospital towards the home and the community, reinventing primary care around long-term coaching rather than occasional visits, and mobilising digital health, AI and connected devices to identify risk before disease appears.
The guiding idea is to anchor lifestyle interventions in the "biotopes" of society: early childhood, schools, the workplace, community centres, senior residences. Health is built where we live.
In practice, these principles meet concrete preventive work. Strengthening physical activity, preserving restorative sleep, maintaining social ties and managing stress are all levers available day to day, often supported by movement professionals.
In conclusion, ageing well is not a matter of chance but the fruit of habits cultivated early and regularly. The eight pillars of lifestyle medicine offer a clear road map for turning the years gained into years truly lived in good health.
