Freia: Science Backed Wellness
This paper synthesises existing scientific literature to explore the concept of Healthspan—the duration of life spent in optimal health and functionality. It focuses on five foundational lifestyle factors: physical activity, nutrition, sleep, stress management, and social and emotional wellbeing, assessing their contributions to chronic disease prevention, longevity, and overall quality of life. Extensive evidence highlights the substantial impact each factor individually holds, as well as the synergistic benefits gained from adopting multiple healthy behaviors concurrently. Findings from global health studies underscore that a comprehensive approach, addressing all lifestyle pillars together, is crucial for extending Healthspan and minimising the global burden of chronic diseases. This integrated perspective emphasizes the importance of promoting holistic lifestyle interventions to enhance individual and population health outcomes.
Healthspan
Healthspan refers to the length of life spent in optimal health and function (Rivera-Tavarez, 2017).
It emphasises not just longevity but the quality of those years. A growing body of research shows that modifiable lifestyle factors—particularly regular exercise, sound nutrition, adequate sleep, effective stress management, and robust social/emotional well-being—play a pivotal role in preventing chronic disease and extending both lifespan and healthspan. In fact, much of the global burden of heart disease, diabetes, cancer, and other chronic conditions is attributable to these lifestyle behaviours.
This review summarises scientific evidence for each of these five pillars of a healthy lifestyle, highlighting their effects on chronic disease prevention, longevity, and quality of life. Where available, we note the relative impact of each factor compared to others and discuss variations in the literature by population or methodology. We also provide general evidence that a comprehensive lifestyle-based approach can dramatically extend healthspan, citing findings from longitudinal studies, global burden of disease data, and health organisations. Finally, we highlight how Freia can help individuals optimise these lifestyle factors to improve their health and well-being.
Physical Activity and Exercise
Regular physical activity is one of the most well-documented contributors to disease prevention and extended longevity. A wealth of epidemiological studies and randomised trials demonstrate that people who are physically active have substantially lower risk of developing major chronic diseases—including cardiovascular disease, type 2 diabetes, and several cancers—compared to inactive individuals.
Long-term cohort studies consistently show that higher levels of exercise or cardiorespiratory fitness are associated with lower incidence of coronary heart disease, stroke, type 2 diabetes, colon and breast cancer, and even neurodegenerative conditions (Reimers et al., 2012).
Being physically active leads to a statistically signficant reudction in all-cause mortality risk. A meta-review concluded that the relative risk of death is about 20-35% lower in active or fit individuals than in their sedentary counterparts (Warburton et al., 2006).
Similarly, other large studies have found dose-dependent benefits of exercise where achieving at least the recommended ~150 minutes per week of moderate-intensity activity was found to significantly improve longevity gains, while even lower doses confer some benefit. Notably, Wen et al. (2011) showed that as little as 15 minutes of daily exercise (about 90 min per week) was associated with a 14% reduction in all-cause mortality risk and an increase in life expectancy by ~3 years, compared to no exercise. Additional gains were observed with greater activity—each extra 15 minutes per day further reduced mortality by about 4% in that study. These benefits appeared across all age groups and for individuals with risk factors, underscoring that it's never too late (or too early) to improve health through exercise (Wen et al., 2011).
Relative Impact: Physical inactivity is recognised as a major independent risk factor for mortality—often cited as on par with or just behind smoking and poor diet in its impact. By some estimates, inactivity contributes to around 9-10% of all deaths. A landmark analysis in The Lancet found that physical inactivity accounted for 6-10% of the global burden of major non-communicable diseases and roughly 9% of premature mortality worldwide (Lee et al., 2012).
The World Health Organisation has labeled physical inactivity as the fourth leading risk factor for global mortality, reflecting its widespread contribution to chronic illness. Globally, diet and high blood pressure tend to outrank inactivity in attributable deaths (as diet affects a broader range of diseases), but in many high-income settings sedentariness is among the top modifiable killers. For instance, in Europe physical inactivity has been estimated to account for about 10% of deaths (Warburton et al., 2006), and in the U.S. it is a key contributor to cardiovascular and diabetes mortality.
Some comparative risk models (using disability-adjusted life years, DALYs) find that poor diet contributes more to disease burden than lack of exercise, yet exercise often rivals other factors in specific outcomes (like preventing cardiac events). In a recent analysis of U.S. veterans, low physical activity was one of the strongest predictors of earlier death, associated with about a 30-45% higher risk of mortality (similar to the impact of smoking) (Nguyen et al., 2024).
In summary, while the exact rankings differ, there is unanimous agreement that regular exercise is a foundational pillar of health and that insufficient activity incurs a heavy toll on longevity and healthspan.
Nutrition and Diet
Dietary habits are equally crucial in determining chronic disease risk, longevity, and day-to-day wellness. Decades of nutrition science have established that a healthy diet—rich in vegetables, fruits, whole grains, legumes, nuts, and healthy fats, and limited in processed foods, refined carbohydrates, red/processed meats, and added sugars/salt—can dramatically reduce the risk of many chronic diseases (Sofi et al., 2008). An unhealthy diet, conversely, is a leading driver of obesity, hypertension, dyslipidemia, type 2 diabetes, and systemic inflammation, which are underlying causes of cardiovascular disease, stroke, certain cancers, and other conditions.
The protective effects of good nutrition are evident in numerous prospective cohort studies and clinical trials. For example, adherence to a Mediterranean diet pattern (characterised by high intake of plant foods, olive oil, and fish, with moderate wine and low red meat) has been associated with lower total mortality and incidence of heart disease, cancer, and neurodegenerative diseases. In a meta-analysis of cohort studies covering over 1.5 million people, Sofi et al. (2008) found that individuals with high adherence to a Mediterranean diet had a significant reduction in overall mortality (approximately 9% lower risk per 2-point increase in a diet adherence score), as well as lower cardiovascular mortality (by ~9%), lower cancer incidence/mortality (~6% reduction), and a 13% reduced risk of neurodegenerative diseases, compared to those with low adherence. This, and similar evidence, suggests that diet quality has broad, multi-system benefits for long-term health.
Beyond disease prevention, nutrition profoundly influences quality of life. Proper nutrition supports immune function, energy levels, cognitive function, and emotional well-being. Malnutrition or diets heavy in ultra-processed foods can lead to fatigue, poorer mental health, and lower daily functioning even in the absence of overt disease. On the other hand, diets rich in antioxidants and anti-inflammatory compounds may contribute to better mood and cognitive aging. Thus, nutrition is integral not only to preventing disease but also to maintaining vitality across the lifespan.
Relative Impact: Poor diet is often identified as the leading modifiable risk factor for death and disability worldwide. According to the Global Burden of Disease analyses, suboptimal diet contributes more to mortality than any other behavioural risk factor, including physical inactivity and smoking. In 2017, dietary risks were estimated to be responsible for approximately 11 million deaths globally, representing about 22% of all adult deaths (GBD 2017 Diet Collaborators, 2019).
This study highlights that one in every five deaths worldwide is associated with poor dietary habits—primarily via cardiovascular disease, cancers, and diabetes related to high salt, sugar, and processed meat intake and insufficient intake of fruits, vegetables, whole grains, and healthy fats. In terms of disability-adjusted life years, diet accounted for 255 million DALYs globally in 2017 (GBD 2017 Diet Collaborators, 2019), underscoring nutrition's massive role in shaping population health.
However, it is important to note that diet and exercise often interact (and poor diet can cause conditions like obesity that magnify inactivity's harms), so they are both critical. Some studies have tried to rank lifestyle factors' impact on specific outcomes: for instance, a 2019 analysis of U.S. health data found that diet quality had the single greatest impact on cardiometabolic mortality, above other factors like exercise or smoking (Murray et al., 2019).
In practical terms, diet and exercise are synergistic: a healthy diet provides the necessary nutrients and weight control that enable physical activity, while exercise can help regulate appetite and metabolic health. Successful lifestyle interventions, such as intensive cardiac rehab programs or diabetes prevention programs, almost always include a dietary component, reinforcing that nutrition is integral to any healthspan extension strategy.
Sleep
Sleep is increasingly recognised as a vital component of a healthy lifestyle, on par with diet and exercise in its impact on long-term health. Adequate sleep is essential for physiological restoration, metabolic regulation, cognitive function, and emotional well-being. Chronic sleep insufficiency or poor-quality sleep has been linked to a host of adverse health outcomes. Epidemiological studies have found that people who habitually get too little sleep (typically defined as under 7 hours per night for adults) have higher risks of obesity, type 2 diabetes, hypertension, heart disease, stroke, and depression (Cappuccio et al., 2010). Possible mechanisms include hormonal and metabolic dysregulation: short sleep can alter appetite hormones (increasing ghrelin and decreasing leptin), promoting weight gain; it can induce insulin resistance and elevate blood pressure and systemic inflammation, thereby accelerating arterial disease. Immune function is also impaired by lack of sleep, contributing to greater infection risk and possibly cancer susceptibility. In addition, insufficient sleep impairs cognitive performance, mood stability, and productivity, diminishing quality of life and potentially increasing injury risk (e.g., from accidents). Conversely, healthy sleep (generally 7-9 hours/night for most adults, with good sleep continuity and timing) supports memory consolidation, tissue repair, and cardiometabolic health, thereby aiding prevention of chronic disease and maintenance of daily well-being.
Individuals who regularly slept much less than 7 hours had a significantly higher risk of all-cause mortality—about a 12% increase in risk for short sleepers (<6 hours) compared to those sleeping 7-8 hours.
Interestingly, habitually long sleep (>8-9 hours) was also associated with an even greater increase in mortality risk (~30% higher risk) Cappuccio et al. (2010). While the reasons for the long-sleep finding are not fully clear (it may partly reflect underlying illness causing fatigue), the evidence firmly indicates that consistently getting ~7-8 hours of sleep is optimal for longevity.
Adequate sleep duration and quality have been linked with a lower incidence of fatal and non-fatal cardiovascular events and possibly some cancers.
Relative Impact: Compared to factors like diet and exercise, sleep's contribution to population-level mortality is harder to quantify and has not been traditionally included in global risk rankings. The Global Burden of Disease studies do not yet list “insufficient sleep” as a formal risk factor, partly due to complexities in measurement and causal attribution. However, emerging research suggests that poor sleep may contribute meaningfully to chronic disease burden (Huang et al., 2022).
One framework comes from studies of allostatic load (the cumulative physiological “wear and tear” from chronic stress and inadequate recovery, which includes poor sleep): individuals with high allostatic load have about a 22% higher all-cause mortality risk, illustrating how chronic sleep deficits (a contributor to allostatic load) can shorten lifespan (Guidi et al., 2020). Moreover, sleep influences other risk factors—insufficient sleep can worsen obesity and diabetes, thereby amplifying diet-related and activity-related risks.
In terms of self-reported impact, adults who sleep <7 hours are much more likely to report chronic health conditions; the CDC reports, for instance, that short sleepers have greater odds of heart attack, asthma, and depression than those who get enough sleep (7-9 hours).
In summary, while sleep may not historically have been ranked alongside diet or smoking in epidemiological analyses, it is now understood to be a foundational pillar of wellness—sufficient sleep greatly amplifies the benefits of other healthy behaviours and directly contributes to a longer, healthier life.
Stress Management
Chronic psychological stress can take a profound toll on the body and is a significant, though sometimes underappreciated, factor in chronic disease and longevity. The mind-body connection means that stress—whether from work, caregiving, financial strain, or other sources—can manifest in physiological changes that promote disease (Richardson et al., 2012).
Chronic stress leads to repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, resulting in elevated cortisol and adrenaline levels, higher blood pressure, increased blood glucose, pro-inflammatory cytokine release, and other alterations (known collectively as allostatic load). Over time, this can damage the cardiovascular system, impair immune function, and contribute to metabolic disorders.
In one meta-analysis of six large cohorts, people with high perceived stress had a 27% higher risk of incident coronary heart disease compared to those with low stress levels (Richardson et al., 2012). Similarly, job strain (a combination of high demands and low control at work) has been associated with increased risk of myocardial infarction and stroke in several studies, and chronic stress in personal relationships has been linked to poorer prognosis in cardiac patients. Chronic stress is also a known risk factor for mental health disorders like anxiety and depression, which themselves carry increased mortality risk and diminish life quality.
Relative Impact: Quantifying the direct contribution of stress to mortality and morbidity is complex, as stress often acts through other risk pathways. However, research has attempted to estimate its impact. One approach is via allostatic load, the cumulative burden of chronic stress on multiple physiological systems. A recent systematic review and meta-analysis found that individuals with high allostatic load had a 22% higher risk of all-cause mortality and a 31% higher risk of cardiovascular mortality compared to those with low allostatic load (Guidi et al., 2020). This underscores that the physiological imprint of chronic stress significantly shortens life and especially impacts cardiovascular outcomes.
Another study by Rosengren et al. (2004) highlighted how people with significant psychologicalstress had roughly twice the risk of an MI compared to those with no stress, suggesting stress might account for ~10-20% of population risk of heart attacks.
Yet, when ranking lifestyle factors, stress is not always explicitly included, partly because it is harder to measure and modify than, say, diet or smoking. Some models that do include “psychosocial factors” find they contribute a smaller fraction of DALYs than behaviours like diet, but this can depend on the population; in societies with high social stress or trauma prevalence, the impact is larger. For example, in certain veteran populations, post-traumatic stress disorder (PTSD) has been linked to a ~50% increase in mortality risk (Ahmadi et al., 2011). A recent analysis of U.S. veterans (mentioned earlier) found that poor stress management was associated with a ~20-30% increase in mortality risk during follow-up, indicating stress habits have a measurable effect (Nguyen et al., 2024).
In summary, while stress may not always be quantified in the same way as diet or exercise in epidemiological models, it clearly plays a role in chronic disease risk. Effective stress management is associated with better health outcomes and should be considered a key component of extending healthspan. As research evolves, we may see stress indices included more in health risk calculators, especially as societies grapple with rising mental health challenges. Reducing chronic stress, whether at the individual or community level, holds promise for preventing disease and improving the quality of extended lifespan.
Social and Emotional Wellbeing
Social and emotional well-being encompasses the quality of an individual's relationships, their sense of connection or isolation, and their overall psychological state (including happiness, optimism, and absence of chronic depression or anxiety). These factors might seem intangible compared to diet or exercise, but a robust body of evidence indicates that social and emotional well-being has a profound influence on health outcomes and longevity. Humans are inherently social creatures; supportive social networks and positive emotional health provide meaning, reduce chronic stress, and encourage healthy behaviours, all of which contribute to a longer, healthier life. Conversely, social isolation, loneliness, and persistent negative emotional states (like depression or chronic anxiety) have been linked to higher risks of mortality and morbidity, rivaling or exceeding the effects of more traditional medical risk factors.
Research by Holt-Lunstad et al. (2010) synthesised data from 148 prospective studies to examine the link between social relationships and mortality and found that individuals with strong social ties had a 50% increased likelihood of survival over the study follow-up periods compared to those with insufficient or poor social relationships. In other words, loneliness and weak social integration were associated with significantly higher mortality risk (the effect size was an odds ratio of ~1.5 for mortality when comparing low vs. high social support) (Holt-Lunstad et al., 2010). This magnitude of effect is comparable to, or greater than, many established risk factors. In fact, the authors noted that lacking social connections can be as detrimental to lifespan as smoking 15 cigarettes a day or having alcohol use disorder, and is riskier than inactivity or obesity in some analyses.
Emotional well-being, including positive affect and optimism, has also been linked to better health and longevity.
Positive emotional states are thought to strengthen immune function and reduce harmful inflammation, whereas chronic negative emotions do the opposite (Holt-Lunstad et al., 2010; Nguyen et al., 2024). Depression and chronic anxiety, in particular, are associated with increased incidence of heart attacks, strokes, and poorer survival from cancer.
It's telling that in the recent Veterans study noted earlier, living with anxiety or depression was associated with about 8% of premature deaths (Nguyen et al., 2024) - a significant portion, highlighting the toll of mental illness on physical health. Moreover, emotional well-being often dictates one's capacity to maintain other healthy behaviours: someone who is socially isolated or depressed may be less likely to eat properly, exercise, or adhere to medications, creating a cascade of health risks.
Relative Impact: When considering relative impact, social and emotional factors often work behind the scenes, influencing and amplifying other risk factors. They may not always appear in “top 5 causes of death” lists because their effects are partly indirect. However, some researchers have attempted to rank these factors. The meta-analysis by Holt-Lunstad et al. (2010) implies that low social integration's effect on mortality is comparable to well-known biomedical risk factors. Another analysis projected that social isolation could be as potent a risk factor for mortality as smoking and obesity, especially among older adults (Holt-Lunstad et al., 2010). In terms of population attributable fractions, one study estimated that insufficient social support accounted for about as many deaths as sedentary lifestyle in a U.S. population (Pantell et al., 2013). The Global Burden of Disease studies do not explicitly include “loneliness” or “social support” as risk factors, which some experts argue is a limitation. Nonetheless, there is increasing recognition: for example, the UK appointed a “Minister of Loneliness” in recent years in response to data on health impacts of social isolation, and healthcare systems are exploring “social prescribing” (connecting patients with community groups or social activities) as a way to improve health outcomes.
It's worth noting that in the veteran cohort study presented presented by Nguyen et al. (2024), the lack of positive social relationships was associated with a relatively smaller increase in mortality risk (~5% increase) compared to other factors like smoking or inactivity (Nguyen et al., 2024). This might suggest that in that specific analysis, social factors appeared less impactful. However, this likely reflects differences in how the factor was quantified or the unique aspects of that cohort (e.g., veterans have certain social structures). Other studies in more general populations have found larger effects for social isolation. For instance, among elderly individuals, being socially isolated has been linked to a markedly higher 5-year mortality risk; one cohort found a 45% increase in mortality for those socially isolated, independent of health status (Steptoe et al., 2013). Such discrepancies underscore that context matters: in societies or subgroups where social connectedness is generally high, only the most isolated are at risk; in contexts where loneliness is more pervasive, it can have a broader population impact.
In terms of emotional well-being, meta-analyses have found that high levels of life satisfaction and positive affect are associated with lower mortality risk (some showing ~10-15% reduction in risk) after adjusting for other factors (Chida & Steptoe, 2008). Chronic depression, on the other hand, is associated with a significantly elevated risk of mortality; for heart disease patients, depression can double the risk of death post-heart attack. These statistics indicate that addressing mental health is crucial for improving healthspan.
Overall, while social and emotional well-being factors are harder to rank in a hierarchy of risk factors, their influence is profound and multi-dimensional. Health authorities now increasingly talk about “the social determinants of health” which include social support and community context as key determinants of outcomes. Interventions like community-building, mental health care access, and fostering social connections (especially for the elderly or those living alone) are seen as important public health strategies. A holistic view of healthspan thus firmly includes nurturing positive relationships and emotional resilience. In practical terms, maintaining close relationships, engaging in community or group activities, practicing gratitude or mindfulness, and seeking help for mental health challenges are all investments in one's long-term health. These factors often interact with the other pillars—e.g., exercising in groups provides both fitness and social connection; eating meals with family can improve diet and emotional bonding; stress management techniques often overlap with building social support. Such synergies mean that improving one pillar can have spillover benefits on others, collectively enhancing one's healthspan.
Freia: Translating Research into Optimising Health
Each of the lifestyle pillars discussed—exercise, nutrition, sleep, stress management, and social/emotional well-being—individually contributes to healthier and longer life. However, they rarely operate in isolation in the real world. A person's overall health trajectory is the combined result of all these behaviours (and others such as avoiding tobacco and excess alcohol). One of the most compelling findings in preventive medicine is that adopting a cluster of healthy lifestyle practices has an impressive, multiplicative effect on extending life expectancy and healthspan.
In one study, they found that a 50-year-old woman who practiced all five habits would, on average, live 14 years longer than her counterpart who practiced none of those habits; for men, the difference was about 12 additional years of life (Li et al., 2018).
Moreover, those with all five habits had an 82% lower risk of dying from cardiovascular disease and a 65% lower risk of dying from cancer over ~30 years of follow-up compared to those with none Li et al. (2018). These dramatic differences underscore how powerful a comprehensive healthy lifestyle can be in preventing the leading killers. Similarly, Li et al. (2020) showed that people who sustained a combination of four or five healthy lifestyle factors lived significantly more years free of major chronic diseases (such as heart disease, cancer, and diabetes).
Essentially, not only do healthy behaviours add years to life, but importantly, they add life to years by compressing the period of illness and disability typically experienced at end-of-life.
Global data confirm that most chronic disease deaths are preventable through lifestyle modifications. The World Health Organisation estimates that approximately 80% of heart disease, stroke, and type 2 diabetes cases, along with 40% of cancers, could be prevented by addressing common risks such as poor diet, physical inactivity, and tobacco and alcohol use (World Health Organization, 2011). The Global Burden of Disease study similarly attributes a substantial portion of global morbidity and premature mortality to lifestyle factors like diet, physical inactivity, obesity, and substance use, highlighting how these risks often cluster within individuals (Global Burden of Disease Collaborative Network, 2019). Consequently, optimising multiple lifestyle pillars simultaneously—rather than focusing on isolated behaviours—is essential for extending healthspan.
Moreover, the literature indicates that adopting several healthy behaviours together provides synergistic benefits greater than their individual effects. Cohort studies consistently find that individuals practicing multiple healthy behaviours experience the lowest disease risks, underscoring the interrelated nature of diet, physical activity, sleep, stress management, and social wellbeing. This interconnectedness underpins the growing field of Lifestyle Medicine, which emphasises a comprehensive approach to preventing chronic diseases and promoting optimal health.
Freia recognises the interrelated nature of these pillars and leverages this understanding to facilitate habit formation and behvarioural changes. By fostering balanced health practices, the app empowers users to build resilience, enhance quality of life, and reduce chronic disease risks over the long term.
Conclusion: The scientific evidence is clear that exercise, nutrition, sleep, stress management, and social/emotional wellness are foundational determinants of our healthspan. Each factor independently supports chronic disease prevention, longevity, and better quality of life, and together they form a powerful synergy for healthy aging. While literature may differ on which factor is “most important”, the variations usually stem from context and methods; ultimately, all pillars are important, and neglecting any one can undermine the benefits of others. A balanced focus on all five—moving more, eating wisely, sleeping sufficiently, managing stress, and cultivating positive relationships—offers the best prospect for not only a long life, but a life lived with vitality and purpose.
Using sound scientific research, Freia helps its users make daily choices that favours good health and well-being to extend their healthspan.