Lifestyle components of the global oldest old assessed as effective nonpharmacologic strategies to maintain lifelong cognitive and functional health

Cécil J.W. Meulenberg

DOI: 10.31382/eqol.190605


Longevity and high quality of life are amongst the most desired traits of humanity. However, the incidences of non-communicable diseases are rising, while sedentary lifestyles and malnutrition are more common than ever, and in general both functional and cognitive health is declining. Besides the concurrent costs to provide healthcare for such an aging population are dramatically increasing and depend on pharmacological treatment. There is an urgent need to raise awareness for cost-saving healthier customs and to adjust lifestyles. From specific geographic areas around the globe, where its citizens tend to grow (very) old, that is over 100 years of age (indicated as ‘oldest old’), without the obvious health-deficits, the so-called blue zones, lifestyle factors have been identified, or will be proposed, and taken as candidate for nonpharmacologic approaches to improve general health. This paper will summarize scientific studies focussing on cardiovascular and cognitive health benefits induced by: Physical activity through exercise, light to moderate intensity, and nonexercise outdoors activities; Nutrition through the Mediterranean diet and the incidence of neurodegeneration; Cognitive engagement through cognitive-motor exercises, language usage, and meditation; and finally: Sleep. The identified denominators are reviewed through various scientific studies regarding substantiated healthinducing effects. Adherence to such nonpharmacologic lifestyles is eventually a personal choice, and for governments to take notice of, and to include in policies.

Keywords: bilingualism • cognition • dementia • sleep • vitamin D • yoga.


Agarwal, A., Wang, Y., Buchman, A.S., Holland, T.M., Bennett, D.A., & Morris, M.C. (2018). MIND diet associated with reduced incidence and delayed progression of Parkinsonism in old age. Journal of Nutrition, Health & Aging, 22(10), 1211-1215.

Alladi, S., Bak, T.H., Duggirala, V., Surampudi, B., Shailaja, M., Shukla, A.K., … & Kaul. S. (2013). Bilingualism delays age at onset of dementia, independent of education and immigration status. Neurology, 81(22), 1938-1944.

Alladi, S., Bak, T.H., Mekala, S., Rajan, A., Chaudhuri, J.R., Mioshi, E., … & Kaul. S. (2016). Impact of bilingualism on cognitive outcome after stroke. Stroke, 14(1), 258-261.

Alladi, S., Bak, T.H., Shailaja, M., Gollahalli, D., Rajan, A., Surampudi, B., … & Kaul. S. (2017). Bilingualism delays the onset of behavioral but not aphasic forms of frontotemporal dementia. Neuropsychologia, 99, 207-212.

Anderson, J.A.E., Grundy, J.G., de Frutos, J., Barker, R.M., Grady, C., & Bialystok, E. (2018). Effects of bilingualism on white matter integrity in older adults. Neuroimage, 167, 143-150.

Ansaldo, A.I., Ghazi-Saidi, L., & Adrover-Roig, D. (2015). Interference control in elderly bilinguals: Appearances can be misleading. Journal of Clinical and Experimental Neuropsychology, 37(5), 455-470.

Asai, Y., Obayashi K., Oume, M., Ogura, M., Takeuchi, K., Yamagami, Y., … & Saeki, K. (2018). Farming habit, light exposure, physical activity, and depressive symptoms. Journal of Affective Disorders, 241, 235-240.

Bherer, L. (2015). Cognitive plasticity in older adults: Effects of cognitive training and physical exercise. Annals of the New York Academy of Sciences, 1337, 1-6.

Bialystok, E., Craik, F.I.M., & Freedman. M. (2007). Bilingualism as a protection against the onset of symptoms of dementia. Neuropsychologia, 45(2), 459-464.

Bialystok, E., Craik, F.I.M., Binns, M.A., Ossher, L., & Freedman, M. (2014). Effects of bilingualism on the age of onset and progression of MCI and AD: evidence from executive function tests. Neuropsychology, 28(2), 290-304.

Bialystok, E., & Poarch, G.J. (2014). Language experience changes language and cognitive ability. Zeitschrift fur Erziehungswissenschaft, 17(3), 433-446.

Bialystok, E., & Viswanathan, M. (2009). Components of executive control with advantages for bilingual children in two cultures. Cognition, 112(3), 494-500.

Bonaccio, M., Di Castelnuovo, A., Costanzo, S., Gialluisi, A., Persichillo, M., Cerletti, C., … & Lacoviello, L. (2018). Mediterranean diet and mortality in the elderly: a prospective cohort study and a meta-analysis. British Journal Nutrition, 120(8), 841-854.

Bredensen, D.E., Amos, E.C., Canick, J., Ackerley, M., Raji, C, Fiala, M., & Ahdidan J. (2016). Reversal of cognitive decline in Alzheimer’s disease. Aging, 8(6), 1250-1258.

Buettner, D., & Skemp, S. (2016). Blue zones: Lessons from the world’s longest lived. American Journal of Lifestyle Medicine, 10(5), 318-321.

Calogiuri, G., Litleskare, S, Fagerheim, K.A., Rydgren, T.L., Brambilla, E., & Thurston, M. (2018). Experiencing nature through immersive virtual environments: Environmental perceptions, physical engagement, and affective responses during a simulated nature walk. Frontiers in Psychology, 8, 2312.

Charloux, A., Gronfier, C., Lonsdorfer-Wolf, E., Piquard, F., & Brandenberger, G. (1999). Aldosterone release during the sleep-wake cycle in humans. American Journal of Physiology, 276(1), E43-E49.

Chertkow, H., Whitehead, V., Phillips, N., Wolfson, C., Atherton, J., & Bergman, H. (2010). Multilingualism (but not always bilingualism) delays the onset of Alzheimer’s disease: evidence from a bilingual community. Alzheimer Disease and Associated Disorders, 24(2), 118125.

Choi, K.W., Chen, C.Y., Stein, M.B., Klimentidis, Y.C., Wang, M.J., Koenen, K.C., & Smoller, J.W. (2019 January 23). Assessment of bidirectional relationships between physical activity and depresseion among adults: A 2-sample Mendelian randomization study. JAMA Psychiatry, doi: 10.1001/jamapsychiatry.2018.4175.

Copinschi, G., Leproult, R., & Spiegel, K. (2014). Chapter The important role of sleep in metabolism: Chapter taken from How Gut and Brain Control Metabolism ISBN: 978-3-318-02638-2 Frontiers of Hormone Research, Karger (Vol. 42, pp. 59-72).

Cornelissen, V.A., & Smart, N.A. (2013). Exercise training for blood pressure: A systematic review and meta-analysis. Journal of the American Heart association, 2(1), e004473.

Craik, F.I.M., Bialystok, E., & Freedman, M. (2010). Delaying the onset of Alzheimer disease: bilingualism as a form of cognitive reserve. Neurology, 75(19), 1726-1729.

Cryan, J.F., & Dinan, T.G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature Reviews Neuroscience, 13(10), 701-712.

Davis, C., Bryan, J., Hodgson, J., & Murphy, K. (2015). Definition of the Mediterranean diet: A literature review. Nutrients, 7(11), 9139-9153.

Dash, S., Clarke, G., Berk, M., & Jacka, F.N. (2015). The gut microbiome and diet in psychiatry: focus on depression. Current Opinion in Psychiatry, 28(1), 1-6.

Duncan, H.D., Nikelski, J., Pilon, R., Steffener, J., Cherthow, H., & Phillips, N.A. (2018). Structural brain differences between monolingual and multilingual patients with mild cognitive impairment and Alzheimer disease: Evidence for cognitive reserve. Neuropsychologia, 109, 270-282.

Fastame, M.C., Hitchcott, P.K., Mulas I., Ruiu, M., & Penna, M.P. (2018). Resilience in elders of the Sardinian blue zone: An explorative study. Behavioral Sciences, 8(3), pii: E30.

Feriani, J.D., Coelho, H.J. Junior, Scapini, K.B., de Moraes, O.A., Mostarda, C., … & Rodrigues, B. (2017). Effects of inspiratory muscle exercise in the pulmonary function, autonomic modulation, and hemodynamic variables in older women with metabolic syndrome. Journal of Exercise Rehabilitation, 13(2), 218-226.

Flowers, E., Freeman, P., & Gladwell, V.F. (2016). A cross-sectional study examining predictors of visist frequency to local green space and the impact this has on physical activity levels. BMC Public Health, 16, 420.

Gamaiunova, L., Brandt, P.Y., Bondolfi, G., & Kliegel, M. (2019 February 26). Exploration of psychological mechanisms of the reduced stress response in long-term meditation practitioners. Psychoneuroendocrinology, 104, 143-151. doi: 10.1016/j.psyneuen.2019.02.026

Ghai, S., Ghai, I., & Effenberg, A.O. (2017). Effects of dual tasks and dual-task training on postural stability: A systematic review and meta-analysis. Clinical Interventions in Aging, 12, 557-577.

Gold, B.T., Johnson, N.F., & Powell, D.K. (2013a). Lifelong bilingualism contributes to cognitive reserve against white matter integrity declines in aging. Neuropsychologia, 51(13), 2841-2846.

Gold, B.T., Kim, C., Johnson, N.F., Kryscio, R.J. & Smith C.D. (2013b). Lifelong bilingualism maintains neural efficiency for cognitive control in aging. Journal of Neuroscience, 33(2), 387-396.

Gollan, T.H., Salmon, D.P., Montoya, R.I., & Galasko, D.R. (2011). Degree of bilingualism predicts age of diagnosis of Alzheimer’s disease in low-education but not in highly educated Hispanics. Neuropsychologia, 49(14), 38263830.

Greer, S.M., Goldstein, A.N., & Walker, M.P. (2013). The impact of sleep deprivation on food desire in the human brain. Nature Communications, 4, 2259.

Heinbockel, T.C., Rossman, M.J., Jankowski, L.R., Jackman, R.A., Bailey, E.F., Chonchol, M.B., … & Graighead, D.H. (2019). Effects of inspiratory muscle strength training on cardiorespiratory fitness in middle-aged to older adults. FASEB Journal, 33(1_supplement), 695.4. Retrieved April 10, from

Hoge, E.A., Bui, E., Palitz, S.A., Schwarz, N.R., Owens, M.E., Johnston, J.M., … & Simon, N. M. (2018). The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 262, 328-332.

Hounsome, B., Edwards, R.T., Hounsome, N., & Edwards-Jones, G. (2012). Psychological morbidity of farmers and non-farming population: Results from a UK survey. Community Mental Health Journal, 48(4), 503-510.

Hunter, M.C., Gillespsie, B.G., & Chen, S.Y.P. (2019 April 4). Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Frontiers in Psychology, 10, 722. doi: 10.3389/fpsyg.2019.00722.

Jacka, F.N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., … & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Medicine, 15(23), 1-13.

Johnson, K.V., & Foster K.R. (2018). Why does the microbiome affect behaviour? Nature Reviews Microbiology, 16(10), 647-655.

Katz, D.L., & Meller, S. (2014). Can we say what diet is best for health? Annual Review of Public Health, 35: 83-103.

Kelly, J.R., Minuto, C., Cryan, J.F., Clarke, G., & Dinan, T.D. (2017). Cross-talk: The microbiota and neurodevelopmental disorders. Frontiers in Neuroscience, 11, 490.

Kodama, S., Tanaka, S., Saito, K., Shu, M., Sone, Y., Onitake, F., … & Sone, H. (2007). Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: A meta-analysis. Archives of Internal Medicine, 167(10), 999-1008.

Kondo, M.C., Jacoby, S.F., & South, E.C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & Place, 51, 136-150.

Kuo, M., Barnes, M., & Jordan, C. (2019 February 19). Do experiences with nature promote learning? Converging evidence of a cause-and-effect relationship. Frontiers in Psychology, 10, 305. doi: 10.3389/fpsyg.2019.00305.

Lassale, C., Batty, G.D., Baghdadli, A., Jacka, F., Sánchez-Villegas, A., Kivimäki, M., & Akbaraly, T. (2018). Healthy dietary indices and risk of depressive outcomes: A systematic review and meta-analysis of observational studies. Molecular Psychiatry.

Lauenroth, A., Ioannidis, A.E., & Teichmann, B. (2016). Influence of combined physical and cognitive training on cognition: A systematic review. BMC Geriatrics, 16, 141.

Leproult, R., & Van Cauter, E. (2010). Role of sleep and sleep loss in hormonal release and metabolism. Endocrine Development, 17, 11-21.

Lin, X., Zhang, X., Guo, J., Roberts, C. K., McKenzie, S., Wu, W.C., … & Song, Y. (2015). Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association, 4(7), e002014.

Lourida, I., Soni, M., Thompson-Coon, J., Purandare, N., Lang, I.A., Ukoumunne, O.C., & Llewllyn, D.J. (2017). Mediterranean diet, cognitive function, and dementia: A systemic review. Epidemiology, 24(4), 479-489.

Marselle, M.R., Warber, S.L., & Irvine, K.N. (2019 March 19). Growing resilience through interaction with nature: Can group walks in nature buffer the effect of stressful life events on mental health? International Journal of Environmental Research and Public Health, 16(6), pii: E986. doi: 10.3390/ijerph16060986.

Martínez-Horta, S., Moreu, A., Perez-Perez, J., Sampedro, F., Horta-Barba, A., Pagonabarraga, J., … & Kulisevsky, J. (2018). The impact of bilingualism on brain structure and function in Huntington’s disease. Parkinsonism and related disorders, pii: S1353-8020(18)30405-X. doi: 10.1016/j.parkreldis.2018.09.017

Martinez-Lacoba, R., Pardo-Garcia, I., Amo-Saus, E., & Escribano-Sotos, F (2018). Mediterranean diet and health outcomes: a systematic meta-review. European Journal of Public Health, 28(5), 955-961.

Marušič, U., Kavčič, V., Giordani, B., Gerževič, M., Meeusen, R., & Pišot., R. (2015). Computerized spatial navigation training during 14 days of bed rest in healthy older adult men: Effect on gait performance. Psychology and Aging, 30(2), 334-340.

Marušič, U., Giordani, B., Moffat, S. D., Petrič, M., Dolenc, P., Pišot., R., & Kavčič, V. (2018a). Computerized cognitive training during physical inactivity improves executive functioning in older adults. Neuropsychology, Development and Cognition Section B, Aging Neuropsycholology and Cognition, 25(1), 49-69.

Marušič, U., Grospretre, S., Paravlić, A., Kovač, S., Pišot R., & Taube, W. (2018b). Motor imagery during action observation of locomotor tasks improves rehabilitation outcome in older adults after total hip arthroplasty. Neural Plasticity, 5651391.

Mayne, P.E., & Burne, T.H.J. (2019 April). Vitamin D in synaptic plasticity, cognitive function, and neuropsychiatric illness. Trends in Neurosciences, 42(4), 293-306. doi: 10.1016/j.tins.2019.01.003.

Mitchel, K.S., Dick, A.M., DiMartino, D.M., Smith, B.N., Niles, B., Koenen, K.C., & Street, A. (2014). A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. Journal of Traumatic Stress, 27(2), 121-128.

Naska, A., Oikonomou, E., Trichopoulou, A., Psaltopoulou, T., & Trichopoulos, D. (2007). Siesta in healthy adults and coronary mortality in the general population. Archives of Internal Medicine, 167(3), 296-301.

Nedeltcheva, A.V., Kilkus, J.M., Imperial, J., Schoeller, D.A., & Penev, P.D. (2010). Insufficient sleep undermines dietary efforts to reduce adoposity. Annals of internal Medicine, 153(7), 435-441.

Olson, R.K., Pangelinan, M.M., Bogulski, C., Chakravarty, M.M., Luk, G., Grady, C., & Bialystok, E. (2015). The effect of lifelong bilingualism on regional grey and white matter volumes. Brain Research, 1612, 128-139.

Owen, N., Sparling, P.B., Healy, G.N., Dunstan, D.W., & Matthews, C. (2010). Sedentary behavior: Emerging evidence for a new health risk. Mayo Clinic Proceedings, 85(12), 1138-1141.

Pacanowski, C.R., Diers, L., Crosby, R.D., & Neumark-Sztainer, D. (2017). Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial. Eating Disorders 25(1), 37-51.

Panagiotakos, D.B., Chrysohoou, C., Siasos, G., Zisimos, K, Skoumas, J., Pitsavos, C., & Stefanadis, C. (2011). Sociodemographic and lifestyle statistics of oldest old people (>80 years) living in Ikaria island: The Ikaria study. Cardiology Research and Practice, 2011, 679187.

Paravlić, A., Marušič, U., Gerževič, M., Urzi, F., & Šimunič, B. (2016). The effects of different exercise-based interventions on functional fitness of older adults. Annales Kinesiologiae, 7(2), 117-137.

Pes, G.M., Dore, M.P., Errigo, A., & Poulain, M. (2018). Analysis of physical activity among free-living nonagenarians from a Sardinian longevous population. Journal of Aging and Physical Activity, 26(2), 254-258.

Petersson, S.D., & Philippou, E. (2016). Mediterranean diet, cognitive function, and dementia: A systemic review of the evidence. Advances in Nutrition, 7(5), 889-904.

Pires, G.N., Bezerra, A.G., Tufik, S., & Andersen, M.L. (2016). Effects of acute sleep deprivation on state anxiety levels: A systematic review and meta-analysis. Sleep Medicine, 24, 109-118.

Poulin, M., Pes, G.M., Grasland, C., Carru, C., Ferrucci, L., Baggio, G., … & Deiana, L. (2004). Identification of a geographic area characterized by extreme longevity in the Sardinia island: The AKEA study. Experimental Gerontology, 39(9), 1423-1429.

Robbins, R., Grandner, M.A., Buxton, O.M., Hale, L., Buysse, D.J., Knutson, K.L., … & Jean-Louis, G. (2019). Sleep myths: An expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep Health, pii: S2352-7218(19)30025-7. doi: 10.1016/j.sleh.2019.02.002.

Sarris, J., Logan, A.C., Akbaraly, T.N., Amminger, G.P., Balanzá-Martínez, V., Freeman, M.P., … & Jacka, F.N. (2015). Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2(3), 271-274.

Schweizer, T.A., Ware, J., Fisher, C.E., Craik, F.I.M., & Bialystok, E. (2012). Bilingualism as a contributor to cognitive reserve: Evidence from brain atrophy in Alzheimer’s disease. Cortex, 48(8), 991-996.

Serra-Majem, L., Roman, B., & Estruch, R. (2006). Scientific evidence of interventions using the Mediterranean diet: A systematic review. Nutrition Reviews, 64(2), S27-S47.

Sharma, A., Barrett, M.S., Cucchiara, A.J., Nalaka, S., Gooneratne, M.D., & Thase M.E. (2017). A breathing-based meditation intervention for patients with major depressive disorder following inadequate response to antidepressants: A randomized pilot study. Journal of Clinical Psychiatry, 78(1), e59-e63.

Shen, X., Wu, Y., & Zhang, D. (2016). Nighttime sleep duration, 24-hour sleep duration and risk of all-cause mortality among adults: A meta-analysis of prospective cohort studies. Scientific Reports, 6, 21480.

Sofi, F., Cesari, F., Abbate, R., Gensini, G. F., & Casini, A. (2008). Adherence to Mediterranean diet and health status: meta-analysis. BMJ, 337, a1344.

Sofi, F., Abbate, R., Gensini, G.F., & Casini, A. (2010). Accruing evidence on benefits of adherence to the Mediterranean diet on health: An updated systematic review and meta-analysis. American Journal of Clinical Nutrition, 92(5), 1189-1196.

Sofi, F., Macchi, C., Abbate, R., Gensini, G.F., & Casini, A. (2014). Mediterranean diet and health status: An updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutrition, 17(2), 2769-2782.

Spartano, N.L., Davis-Plourde, K.L., Himali, J.J., Andersson C., Pase, M.P., Maillard, P., … & Seshadri, S. (2019 April 5). Association of accelerometer-measured light-intensity physical activity with brain volume: The Framingham heart study. JAMA Network Open, 2(4), e192745. doi: 10.1001/jamanetworkopen.2019.2745.

Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet, 354(9188), 1435-1439.

Spiegel, K., Leproult, R., L’Hermite-Baleriaux, M., Copinschi, G., Penev, P.D. & Van Cauter, E. (2004). Leptin levels are dependent on sleep duration: Relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. Journal of Clinical Endocrinology and Metabolism, 89(11), 5762-5771.

Spiegel, K., Tasali, E., Penev, P., & Van Cauter, E. (2004). Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine, 141(11), 846-850.

Strasser, B., Siebert, U., & Schobersberger, W. (2010). Resistance training in the treatment of the metabolic syndrome: A systematic review and meta-analysis of the effect of resistance training on metabolic clustering in patients with abnormal glucose metabolism. Sports Medicine, 40(5), 397-415.

Tamm, S. (2019). A Neuroimaging perspective on the emotional sleepy brain. Doctoral Dissertation. Stockholm, Sweden: Karolinska Institute.

Tasali, E., Leproult, R., Ehrmann, D.A., & Van Cauter, E. (2008). Slow-wave sleep and the risk of type 2 diabetes in humans. Proceedings of the National Academy of Sciences of the United States of America, 105(3), 1044-1049.

Trichopoulou, A., Bamia, C., & Trichopoulos, D. (2009). Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ, 338, b2337.

van der Ploeg, H.P., Chey, T., Korda, R.J., Banks, E., & Bauman. A. (2012). Sitting time and all-cause mortality risk in 222,497 Australian adults. Archives Internal Medicine, 172(6), 494-500.

Van Cauter, E. & Spiegel, K. (1999). Chapter-Circadian and sleep control of endocrine secretions: Chapter taken from Circadian and Sleep Control of Endocrine Secretions ISBN: New York, Dekker (Vol. 13, pp. 43-61).

Verghese, J., Mahoney, J., Ambrose, A.F., Wang, C., & Holtzer, R. (2010). Effect of cognitive remediation on gait in sedentary seniors. Journals of Gerontology Series A, Biological Sciences and Medical Sciences, 2010, 65A(12), 1338-1243

Visceglia, E. & Lewis, S. (2011). Yoga therapy as an adjunctive treatment for schizophrenia: A randomized, controlled pilot study. Journal of Alternative and Complementary Medicine, 17(7), 601-607.

Vollbehr, N.K., Hoenders, R.H.J., Bartels-Velthuis, A.A., & Ostafin, B.D. (2017, August 4). The influence of yoga on chronic depression and potential cognitive mediators. Paper presented at the conference of the American Psychological Association, Washington D.C., U.S.A. Retrieved April 11, 2019, from

Wen, L., & Duffy, A. (2017). Factors influencing the gut microbiota, inflammation, and type 2 diabetes. Journal of Nutrition, 147(7), 1468S-1475S.

Woumans, E., Santens, P., Sieben, A., Versijpt, J., Stevens, M. & Duyck, W. (2015). Bilingualism delays clinical manifestation of Alzheimer’s disease. Bilingualism: Language and Cognition, 18(3), 568-574.

Zelenski, J.M., & Nisbet, E.K. (2014). Happiness and feeling conncected: The distinct role of nature relatedness. Environment and Behavior, 46(1), 3-23.