The 5 Minute Pill

The Book

The Book - Atmasvasth - A Guide to Ageing Healthfully

A 15-point guide to living long, healthy

AtmasvasthBhavin Jankharia

The Detailed 15-Point Guide to Live Long, Healthy

The 15-Point Guide - Detailed

The detailed 15-points guide to live long, healthy

AtmasvasthBhavin Jankharia

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A YouTube version of the audio is also now available here.

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In the 15-point atmasvasth guide to live long healthy, the first and foremost factor that helps us maintain our healthspan is physical activity, accounting for 30% of all the effort we need to put in to stay healthy. 

These are the points listed in the guide.

• At least 30-45 minutes of moderate to brisk walking every day, 6 days a week. Anything more is better. If you are able to, then running works wonders and is NOT associated with injury or harm. Being active over the weekends is equivalent to workout out evenly during the week.
• Add resistance training, including pull-ups.
• Add yoga or tai-chi or similar exercises to improve balance.
• Use stairs instead of lifts and add short bursts of brisk walking as part of your daily routine. 
• If you are already active, then improve your cardiorespiratory fitness (CRF) to the appropriate level for your age by increasing the level / amount of your physical activity. You can measure your CRF using your tracking device (Apple Watch, etc) or with a treadmill stress test.
• Remember, every move counts and any activity is better than none.

The two key takeaways are, “every move counts” and the popular saying by Dr. Butler, “If exercise could be packaged into a pill, it would be the single most widely, prescribed and beneficial medicine in the nation”.

Today, let’s focus on moderate to vigorous physical activity (MVPA). 30-45 minutes of brisk walking (4000 steps of brisk walking, not just 4000 overall steps per day) is the sweet spot where we get the best bang for the buck with significant reduction of mortality compared to minimal to no MVPA. The more the steps, the better, but the improvement in longevity starts leveling off, until there is minimal difference between 8000 and 10,000 steps, and no further benefit beyond 10,000 steps. 

For years, the data was based on what people wrote out in questionnaires, but in the last few years, the use of accelerometers (like the Apple Watch, Fitbit, Garmin, etc) have allowed researchers to obtain more accurate and objective data on the association of physical activity with healthspan and lifespan. One fundamental question has always been…what is the minimum amount of physical activity needed to live long, healthy?

A seminal paper was recently published in the Lancet, headed by Ekelund Ulf [1]. It analyzed 40327 people from 7 cohorts to answer this one question…and the answer is simple. It is a 5 minute pill. 5 minutes of MVPA results in a 30% drop in mortality for those who start from doing nothing.

If you are already active, then the advantage of an additional 5 minutes diminishes incrementally as the graph below shows.

How does this reconcile with our sweet spot of 30-45 minutes of MVPA (brisk walking) or 4000 steps? Should we now just reduce our brisk walking to 5 minutes or 10 or perhaps at best 15 minutes?

Any activity is better than none, so whatever you do is fine. However at 4000 steps or 30-45 minutes of brisk walking,  you optimize the mortality risk as I had shown in this graph in 2021. Beyond that, while the mortality risk keeps dropping, the further benefit also keeps reducing.  

Swallowing a 5 minute pill makes the biggest difference when you haven’t been physically active earlier, with a 30% reduction in mortality, reaching up to 50% with 4000 purposeful steps. Anything more adds to fitness levels, but not much to longevity, though these accelerometer studies don’t account for the additional benefits and improvement of longevity with resistance training and better cardiorespiratory fitness (CRF), though again the incremental advantage would not be as dramatic. 

So what does this mean for you and I?

If you are not active, then start today. 5 minutes of brisk walking will improve your longevity by 30%. If you are active, continue what you are doing, but the sweet spot remains 30-45 minutes of MVPA a day for 5-6 days a week, which is around 3 to 3.5 km or 4000 steps. Anything more is better but the effects will no longer be as dramatic.

Footnotes

1. Ekelund U, Tarp J, Ding D, Sanchez-Lastra MA, Dalene KE, Anderssen SA, et al. Deaths potentially averted by small changes in physical activity and sedentary time: an individual participant data meta-analysis of prospective cohort studies. The Lancet. 2026 Jan;S0140673625022196.