We know that drinking alcohol is probably not the best thing you can do to extend your lifespan. And research has shown that activities like strength training and improving your V02 max can help add years to your life. But if you had to focus your energy on just one of these—in other words, saying goodbye to the bar or getting underneath one a few times a week—which would do the most to extend your longevity?
That’s what a new study aimed to uncover—and the results may surprise you. In a good way! That is, if you’re not ready to give up drinking. No, alcohol is not suddenly healthy. And fitness is still the best investment you can make in your health. But the relationship between the two isn’t as simple as previously thought. And, depending on your current fitness level, hitting the gym might be a better new year’s resolution for improving your longevity than attempting to give up or cut down on your drinking.
What the study found
The Trøndelag Health Study, also known as the HUNT study, is one of the largest ongoing health studies ever conducted. Established to analyze the health and wellbeing of a large population—including the impact of various lifestyle factors like, including diet and exercise—over an extended period of time, the study began in 1984 in the Norwegian county of Trøndelag with a sample size of about 75,000 people.
Since then, researchers have reconvened every 10 years to record new data—gathered from a range of inputs, including biological samples, questionnaires, and interviews—and enlist new participants. Four decades in, the study has collected data from well over 100,000 subjects, serving as the basis for hundreds of independent research papers.
This latest study, published last month in the journal Sports Medicine, sought to investigate how changes to a person’s fitness level and alcohol consumption might increase or decrease their risk of dying from various causes. Using data from two rounds of the HUNT study, collected a decade apart, the researchers focused on a sample of about 25,000 healthy adults, which they segmented by fitness level and alcohol usage, allowing them to observe changes to both variables over the 10-year span.
While the analysis produced some expected results (namely, that subjects who increased their alcohol intake, or started drinking, raised their mortality risk, as did those who reported a decrease in fitness level), the most notable insights emerged when these behaviors were viewed together, rather than in isolation. For instance, subjects with a fitness level in the bottom 20 percent had a considerably higher risk of dying—regardless of the amount of alcohol they reported drinking. And among participants who increased or even just maintained their fitness, mortality risk was much lower, even when they increased the amount of alcohol they drank. In other words, fitness noticeably attenuated the risk of mortality associated with drinking alcohol.
Improving fitness is better for longevity than drinking less
The study shows, unequivocally, that, if improving longevity is your goal, then improving your fitness will give you more bang for your buck than reducing your alcohol consumption. “And it's not even close,” says Jordan Weiss, PhD, assistant professor in the Division of Precision Medicine and Optimal Aging Institute at NYU Grossman School of Medicine.
“The HUNT study shows us that being in the bottom 20 percent for fitness is more dangerous than moderate drinking, and a fit person who drinks moderately will likely outlive an unfit non-drinker,” he says. “If the average person can walk 30 minutes a day and cut drinking from five nights to two, then both are achievable. But if I had to pick one to move the mortality needle, I would always pick exercise.”
Of course, on paper, the best thing you could do for your health would be to stay fit and abstain from alcohol altogether. But that’s not realistic for most people—a fact that was not lost on the study’s authors.
“Personally, I think that, as humans, we will keep drinking. I don't see a future where everyone is abstaining from alcohol—I don't think that will ever happen,” says Javaid Nauman, PhD, associate professor at the Norwegian University of Science and Technology, associate professor at the College of Medicine at United Arab Emirates University, and the study’s lead author. “So how can we counter some of the negative impacts of alcohol? Through improvements in fitness, or the maintenance of fitness.”
Fitness does not completely cancel out the risks of drinking alcohol
An important point to highlight is that, while improving fitness is a more powerful longevity strategy than reducing alcohol consumption, and may even blunt some of alcohol’s negative effects on your health, the walls of the weight room won’t shield you from all of the risks associated with drinking.
"Some people interpret attenuation as permission, but I would interpret it more along the lines of, your fitness gives you some resilience, but you're still better off minimizing alcohol consumption for optimal health,” says Dr. Weiss. "Fitness primarily protects against cardiovascular mortality, while alcohol has a cancer risk,” he says. “They operate through completely different mechanisms, in terms of DNA damage and hormone disruption, so fitness likely can't protect against that.”
"I would say, don't feel like you're offsetting drinking,” says Pablo Prichard, MD, board-certified reconstructive surgeon, longevity expert, and host of NBC’s Forever Young. “You should always consider those two as separate, because there are very, very different risks with alcohol and fitness. Your cardiorespiratory fitness affects a lot of different things, including your heart and your lungs. But when you're talking about your cancer risk mitigation, that's a totally separate area of longevity that you're affecting.”
That said, according to Dr. Nauman, while the two behaviors each come with their own unique risks, there is some common ground at the center of the Venn diagram. “In terms of the mechanisms through which fitness [and drinking less] improve overall health, there are many shared or overlapping mechanisms,” he says. Hence physical activity’s ability to attenuate some of the mortality risk associated with drinking. Just don’t expect the benefits of one behavior to completely eclipse the risks of the other.
The higher your fitness, the lower your risk—up to a point
If you’d rather not give up drinking, the study’s message is clear: Improve your fitness to dull alcohol’s impact on your health—especially if you’re not already exercising regularly. “If you're in that bottom 20 percent of cardiorespiratory fitness, the best thing you can do—by far—is to get out of that,” says Dr. Prichard. “That's going to be better than not drinking.”
“And even better—although this data doesn't show it, because they didn't look at it—if your fitness level is in the top 20 percent, that's going to be even better for your longevity than being somewhere in the middle,” he says.
However, beyond that point, the protective benefits of hitting the gym start to top out. “Once you're moderately fit, you get diminishing returns as you start pushing towards elite performance,” says Dr. Weiss. “If you're already competing in Hyrox, cutting alcohol is going to be more beneficial than adding an extra six miles to your run every week.”
“I think the main takeaway is it totally depends on your starting point,” Dr. Weiss says. “If you're sedentary and drinking one to two drinks a day or per week, then fix the sedentary part first; being in the bottom 20 percent for fitness carries around a 65 percent higher mortality risk, which overwhelms moderate drinking. But if you're already fit and drinking heavily, then alcohol is probably your primary target.”