by Skeptical Scalpel

Pop quiz:

The physical activity associated with prolonging your life the longest is

  1. Aerobics
  2. Cycling
  3. Running/jogging
  4. Swimming
  5. Tennis

For the correct answer, read on.

A study in the Mayo Clinic Proceedings this month reported the results of a prospective population survey of more than 6700 citizens of Copenhagen, Denmark. The subjects were sent questionnaires about physical activity over the course of 25 years. Those with pre-existing coronary heart disease, stroke, cancer, or missing information about leisure time physical activity were excluded.

The investigators focused on eight types of exercise—tennis, badminton, soccer, jogging, cycling, low-intensity calisthenics, swimming, and health club activities such as treadmill, elliptical trainer, or lifting weights. They recorded demographic, socioeconomic, and health information. The study’s end point was all-cause mortality obtained from the National Central Person Register which tracks every Danish citizen.

Of those participating, 5674 (84.5%) reported involvement in one of the eight physical activities for an average of nearly 7 hours per week. The remaining 1042 (15.5%) said they were sedentary. The active group was younger and more likely to have a university degree than the sedentary cohort.

By the end of the study, 4448 of the subjects had died. The investigators adjusted for multiple variables, including age, sex, weekly amount of exercise, smoking, education, income, alcohol drinking, diabetes mellitus, social network, and education.

Compared to the sedentary participants, subjects who played tennis lived an average of 9.7 years longer. Jogging, swimming, and cycling resulted in 3.2, 3.4, and 3.7 extra years of life respectively. Even badminton at 6.2 added years of life was better than the more intense sports.

I know what you’re saying to yourself. That’s one study. Big deal.

Similar results were found in a 2016 paper published in the British Journal of Sports Medicine. Since the early 1990, over 80,000 British individuals with an average age of 52 have been surveyed periodically. About 45% of them satisfied national physical activity guidelines. Compared to those who did not exercise, the most significant reduction in risk of all-cause mortality (47%) was for those who participated in racket sports—tennis, badminton, or squash.

Other significant reductions in risk of all-cause mortality were seen with swimming 28%, aerobics 27%, and cycling 15%. Interestingly, running was not associated with a significant reduction in risk of all-cause mortality.

Why are racket sports associated with increased longevity? The authors of the 2016 paper speculated that the interval bursts of energy in racket sports may be better than continuous intense exercise. They also mentioned that racket sports are more social than the individual activities like cycling and jogging and cited previous research that found social isolation predicts shorter life expectancy.

Remember, correlation does not necessarily mean causation. However, a randomized trial about this subject will never happen.

Tennis anyone?

Disclosure: I play racket sports three to five times per week.


Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last 8 years, he has been blogging at and tweeting as @SkepticScalpel. His blog has had more than 3,000,000 page views, and he has over 18,000 followers on Twitter.