Most annual exams tell you what disease a patient has. As longevity medicine grows in popularity, patients are increasingly interested in more than avoiding disease. They want to optimize their healthspan (the number of years they live without chronic disease or symptoms). These four assessments are a direct measure of it. Each one is measurable, trackable, and tied to hard outcomes. Together they give you a baseline that a standard physical misses entirely.
1. VO₂ Max: Aerobic Fitness
What to measure: VO₂ max, or estimated VO₂ max tracked over time.
Tool: Wearable estimate for ongoing tracking; confirm with a CPET when the result will change what you do.
VO₂ max is the gold standard measure of cardiorespiratory fitness, and it predicts death better than most things in the chart. In a cohort of 122,007 patients, Mandsager and colleagues found fitness inversely tied to mortality with no upper limit of benefit. People in the elite fitness group had roughly an 80 percent lower risk of death than the least fit group. The gap from low to high fitness rivaled or exceeded the risk from smoking, diabetes, and coronary disease.
VO₂ max is not a fixed trait. It responds to training at any age, which makes it a treatment target and not just a risk score. Structured aerobic programs raise fitness even in older adults with early cognitive impairment, and the research is now precise enough to tailor the dose to the response. An active randomized clinical trial, the FIT-AD SMART trial, is testing exactly that, adjusting aerobic exercise to each person's fitness gain in older adults with early Alzheimer's disease. The clinical move is simple. You prescribe fitness, measure the change, and adjust, the same loop you already run for blood pressure or A1c.
You can now estimate VO₂ max from a wrist wearable, but treat the number with care. A 2025 systematic review of consumer devices found accuracy varies by brand and context, and a single reading does not always match a laboratory test. What wearables do well is track the same person over time. For a careflow, the trend matters more than perfect agreement on any one day. Use the wearable to see who is climbing and who is sliding, then order a formal test when the result will change what you do. The value is that you finally have this signal for every patient, not just the few who book a metabolic cart.
This is where the athlete's dashboard becomes a brain health dashboard. A 2024 neuroimaging study linked higher VO₂ max in healthy older adults to better integrity of the locus coeruleus, a brain region tied to cognitive reserve and resilience against neurodegeneration. It is one small study and not proof of cause, but it fits a growing pattern. The same metrics the SuperAge Games use to score aging double as early signals for the brain. When you train a patient's aerobic capacity, you may be defending memory as much as the heart.
How to act on the number: Treat VO₂ max like blood pressure. Prescribe a dose, measure the change, and adjust. Zone 2 aerobic training (conversational pace, 150–180 minutes per week) is the most accessible starting point for most patients. Recheck every three to six months. The wearable trend matters more than agreement with a single lab value. Use it to flag who is climbing and who is sliding.
2. Grip Strength
What to measure: Grip strength, both hands, in kilograms.
Tool: Hand dynamometer. Two minutes. No other equipment needed.
Grip strength is the cheapest powerful test you own. A dynamometer takes two minutes. Across large cohorts, every 5 kilogram drop in grip carries about a 16 percent higher risk of death. A 2024 NHANES analysis found the weakest fifth of adults faced hazard ratios of 2.20 in men and 2.52 in women.
Grip is not only a readout. It moves when you train it. In a 2024 randomized controlled trial, postmenopausal women who lifted for 12 weeks gained meaningful grip strength and skeletal muscle mass, while the group given extra protein without training barely changed. That is the consistent pattern in the strength literature. Resistance training is the active ingredient, and the dynamometer lets you prove the program is working from one visit to the next.
At SpringFest this year I caught an excellent talk from Kiran Krishnan and Myles Spar on why joint health and endothelial health rise and fall together. Their point stuck with me. The endothelium that lines your vessels and the tissue that cushions your joints age on the same clock, and the gut influences both. Calroy Health Sciences, who framed the session, are thought leaders in supporting the endothelial glycocalyx, the crucial inner lining that drives vessel resilience. When you build aerobic fitness and strength, you protect vessels and joints at once. One careflow, several systems.
How to act on the number: Measure both hands at baseline. Flag anyone in the lowest quintile for their age and sex and build resistance training into the plan. Retest at three months. Use the number visit over visit to prove the program is working.
3. Mobility
What to measure: Sit to rise test, single leg balance, and gait speed.
Tool: No equipment. Under ten minutes with a medical assistant.
Mobility screens tell you whether fitness and strength translate into real-world independence. Add these three tests to the same visit as grip strength and you have a complete strength and movement baseline in under ten minutes.
The sit to rise test scores from 0 to 10. Brito and colleagues found scores below 8 in adults aged 51–80 were associated with 2–5 times higher mortality rates over 6 years, with a 1-point increment linked to a 21 percent reduction in mortality.
Single leg balance for 10 seconds is a strong predictor of mortality risk. A 2022 cohort study in the British Journal of Sports Medicine found inability to hold the stance for 10 seconds was associated with an 84 percent higher risk of death within ten years, independent of age, sex, BMI, and existing health conditions.
Gait speed is one of the most studied predictors of aging outcomes. Speeds below 0.8 meters per second are associated with significantly elevated risk of disability, hospitalization, and mortality. Above 1.0 meters per second is generally considered a marker of healthy aging.
How to act on the number: Run all three at baseline, then again at the annual performance physical. Flag anyone who fails the 10-second single leg balance, scores below 8 on sit to rise, or walks slower than 0.8 m/s. These patients need targeted mobility and balance work, and a fall risk conversation.
4. Nutrition And Body Composition
What to measure: Protein intake, lean mass, fat mass, and weight trend.
Tool: Diet recall or food log for protein; DEXA or bioimpedance for body composition.
Strength and recovery fail without fuel. Anchor nutrition on protein, around 1.6 grams per kilogram of body weight for anyone building or defending muscle. Protein works best next to training, not instead of it. A 2024 systematic review and meta-analysis in older adults with sarcopenia found that protein paired with resistance exercise improved muscle mass and strength, though the authors flagged that few trials and mixed designs limit how hard you can lean on the finding. Read alongside the training data, the order of operations is clear. Train first, then feed the training.
This matters more, not less, for patients on GLP-1 medications. Rapid weight loss strips muscle along with fat, so the target is not the number on the scale. It is preserving functional tissue. Resistance training is your strongest tool for protecting muscle quality during weight loss and through aging, and adequate protein supports it. Track lean mass and fat mass with body composition rather than weight alone. We covered that gap in detail in our GLP-1 newsletter issue.
How to act on the number: At baseline, get a diet recall focused on daily protein and run a body composition scan. Set a protein target and a lean mass target, not a weight target. For patients on GLP-1 medications, track lean mass at every visit. Revisit composition every three to six months.
Reading the Four Tests Together
No single number tells the full story. A patient with high VO₂ max but poor grip strength has an aerobic base without functional strength. A patient with good grip but low protein and declining lean mass is heading toward sarcopenia. The value of the four-assessment battery is the pattern across all of them. The ability to trend each marker visit over visit to see who is improving and who needs a different intervention.
Build the intake template once. Run it at every performance physical. The same battery serves the competitive masters athlete and the deconditioned 60-year-old. Only the numbers move.
