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How Much Exercise Prolongs Healthy Life?

I bought a new mountain bike this summer. I already had two perfectly good bicycles in the garage, but there’s nothing like a new toy to get you motivated. Hitting the trails these days involves monitoring my data. I’m interested to test myself using Personalized Activity Intelligence (PAI), a health score that measures cardiorespiratory fitness (CRF).

PAI draws heart rate activity from wearables, such as Fitbit and Apple Watch. It uses that information, along with self-reported data, to guide me toward the most beneficial amount of exercise for my body. Using all that data, the weekly effort I put into physical activity is translated into a single PAI score. Maintaining 100 PAI reduces my risk of cardiovascular disease and early death. I might like to live longer now that I’ve spent EUR2,500 on this new bike….

PAI takes account of my resting and maximum heart rate over a seven-day rolling period, adjusted for exercise intensity to reflect my VO2 max, a measure of CRF. Cycling should increase my heart rate above a threshold, and into the CRF training zone, generating PAI points. Consistently maintaining 100 PAI will derive the health benefits.

PAI requires several weeks of activity data to properly attune to my VO2 max, but my first five rides provide an indication of what’s to come (see Figure below). PAI uses the first ride data to begin calibrating the algorithm to me — the score is irrelevant. My second ride ends abruptly with a puncture and a fall, but by ride four I’m back in the zone, and by ride five back in the woods.

My average heart rate dropped over the first four rides, which suggests that my fitness reserve was decent and that I’ve quickly added some heart health to the equation. Although my average speed was consistent, the effort involved measured by heart rate and, ultimately, the points earned, trend downward.

See also: How to Link Heart Health to Insurance  

It’s clear that longer duration coupled with higher attained heart rate scores more points. I must up my game because the algorithm calibrates to my personal heart effort. With PAI, very low-intensity exercise doesn’t contribute to increased levels of CRF, while fitter people with higher heart rate reserve face a tougher threshold to accumulate PAI points.

Now the PAI algorithm is adjusting to my profile, and I’m discovering the effort required to earn a protective score. I go back out on the bike for ride five and earn 75 points; the maximum possible in one day. This isn’t a surprise. The route is longer and more challenging, and I ride harder because I’m already feeling fitter (see Figure below).

The algorithm will continue to adjust to my exercise behavior over the next few months. As my CRF increases, I will discover that running on a treadmill for 30 minutes is less fun and nets me fewer points. I will find that my daily brisk walking and average of 6,000 steps contribute but do not raise my heart effort enough to strongly influence my CRF. Running and walking will supplement my PAI score, but to score 100 — enough to affect my long-term health and get good value out of this bike — well, that simply requires greater effort.

For further background. read my blog Heart Health – Why Linking It to Insurance Is a Winning Formula.

How to Link Heart Health to Insurance

Cardiorespiratory fitness (CRF) is a measure of the body’s ability to supply oxygen to muscles, including the heart, during sustained levels of exercise. Whether you believe the hype that just sitting around poses a significant health risk, the truth is that most people could do with exercising more.

An inverse association between CRF and mortality is well-established. A recent study of the long-term mortality of physically active adults found the benefit of increased CRF is independent of age, sex, race/ethnicity and comorbidities. Exercise provides numerous health benefits, including reduction in coronary artery disease, hypertension, diabetes, stroke and cancer.

The same study confirms that the greatest chance for survival is associated with the highest aerobic fitness, debunking the notion that exercise benefits plateau quickly or even result in harm. So there really is no excuse for running a bath instead of a mile, or indeed for avoiding any exercise you fancy that increases resting heart rate. This is good news.

But as everyone’s level of cardio-fitness is different, the correct dose of exercise needed to confer any real benefit is less obvious.

That gap in accessible knowledge is why it’s also good news that there has been such progress with Personalized Activity Intelligence (PAI), a health score that measures cardiorespiratory fitness (CRF). PAI helps add years of healthy life through personalized activity engagement and has been scientifically proven to reduce the risk of cardiovascular disease and early death. PAI provides individual guidance on the most beneficial exercise dose by measuring heart beat data and translating it to a PAI Score.

See also: New Efficiencies in Life Insurance  

PAI takes account of resting and maximum heart rates adjusted for exercise intensity and collected over a seven-day rolling period to encourage consistent exercise behavior. Any activity that increases the heart rate above a threshold and into the CRF training zone may generate points, meaning people of all fitness levels can score points from activities they enjoy; whether that’s kayaking down rapids, mowing the lawn or running after the grandkids.

Physical activity can be measured simplistically but without much insight into the physical workload achieved. PAI, however, measures heart rate and uses an algorithm that calibrates to an individual’s heart effort and is helpful in creating personalized programs for sustained physical activity. PAI has shown the positive impact that sustained physical activity has on heart health and represents a more effective and realistic approach than setting daily step or exercise targets.

The guidance indicates when the intensity of exercise does not contribute to increased levels of CRF or when fitter people with higher heart rate reserve (the difference between resting heart rate and maximum heart rate, which is used to calculate the optimal cardiorespiratory fitness level in aerobic exercise) need to challenge themselves more.

Life and critical illness products do an amazing job protecting policyholders from financial loss but until now have provided little practical help in safeguarding customers’ health. We believe PAI has the potential to motivate behavioral change, helping policyholders to become more physically active and stick to it, while reducing their risk of disease and premature death. As insurance seeks to shift its emphasis from protection to prevention, this winning formula is possibly some of the best news yet.

See also: Intersection of Tech and Holistic Health  

Hear more about the science behind PAI from inventor Ulrik Wisløff, professor at NTNU and head of the Cardiac Exercise Research Group, in this short interview:

To find out more, contact Ross Campbell.

Putting Digital Health to Work

The U.K. spends £97 billion treating diseases but just £8 billion preventing them. This imbalance is set to change according to government proposals. Under a social prevention model, health advice would be tailored to an individual based on several criteria, including personal data, lifestyle and demographics.

There are parallels to insurance. The Association of British Insurers has reported that U.K. life insurers paid out £5 billion in income protection, critical illness and life assurance claims in 2017. These claims payments represent amounts paid when people’s health has failed. While not every diagnosis or early death can be avoided, providers could offer more to help customers mitigate risk and stay healthy.

This predicament is fueling interest in matching insurance programs to fitness data. There are multiple digital-based solutions available to help with engagement post-underwriting — a white space for insurers to move into. Gen Re is active in researching technology of this type, which has led us to collaborations with a network of established companies and startups in an effort to create a prevention model.

One such company is PAI Health. It offers a proprietary, science-based algorithm that uses cardiorespiratory fitness (CRF) to provide personalized guidance on how much exercise is needed for optimal health.

See also: New Health Metrics in Life Insurance  

In a 2018 article, Mandsager et al. confirmed CRF is a modifiable risk indicator of long-term mortality that is quite independent of age, sex and comorbidities. CRF is also associated with cardiovascular and other health benefits, including reductions in coronary artery disease, hypertension, diabetes, stroke and even cancer. CRF is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival.

That said, taking the right dose of physical exercise is very important. Too much exercise means a risk of adverse outcomes leading to the idea of a U-shaped dose-response association between exercise and cardiovascular events. PAI Health works by linking the individual to the dose.

This personalized approach is critically important to ensure an insurance program is built around physical activity that appeals to the broadest range of people, and not just those who live in Lycra. In other words, an insurance program that provides benefit to everyman based on achievable yet therapeutic levels of everyday physical activity.

It can be challenging to untangle large amounts of data and turn it into meaningful health insights. It’s important that there is evidence to validate the algorithms and “health scores” promoted in apps. All exercise is beneficial to health, but it’s well-known that steps lack scientific reasoning. A daily target of 10,000 steps is daunting, even unrealistic, and lacks any calibration to the individual and to physical capability.

PAI Health avoids these problems. The Physical Activity Intelligence (PAI) algorithm was invented by Ulrik Wisløff, head of the Cardiac Exercise Research Group and professor at the Norwegian University of Science and Technology. External evidence supports the conclusion that meeting a personal PAI target cuts cardiovascular risk, significantly reduces other lifestyle-related diseases in men and women of all ages and increases life expectancy. This has been shown to also be true in patients with established cardiovascular disease.

Preventative medicine is about ensuring people take greater responsibility for their health and well-being. Most insurers could do more to engage policyholders in this way. Research suggests consumers increasingly value experiences above physical things. Can a new breed of protection products offer people more of an experience? A policy that actively involves them in protecting their own health could offer that.

See also: More Opportunities for Reinsurers in Health  

For any national health service to link care to personal data requires the highest standards of data privacy, and insurance is no different. While a prevention approach to healthcare is unlikely to be without controversy, the major barrier to a social prevention model is diverting funds away from treatment. For insurers, the problems may be less knotty. Elegant solutions like PAI Health are ready to be utilized.

New Health Metrics in Life Insurance

A new measure of fitness and health, called Personal Activity Intelligence (PAI), has important implications for both life insurers and their policyholders.

It’s now possible to predict, using new technology, the chances that consumers of all ages will develop heart disease. Even better, if the data from the new technology shows improvement, there is also an opportunity to reduce the potential health risk.

Digital technology applications offer life insurers the chance to engage customers with personalized health data that is both easy to provide and simple to understand. And, of course, this is a win for life insurers, too – customers with personalized health data receive more value from the relationship. After all, enabling healthier, longer lives means a longer lifetime value to the benefit of the policyholder and the insurer.

The secret to personalized health data

There is a secret to this personalized health data, and it is based on cardiorespiratory fitness (CRF). CRF is one of the best predictors of health and mortality, with a direct correlation between cardiorespiratory fitness and lifestyle diseases.

Until now, CRF has been the missing link to quantify the level of physical activity required to reduce the risk of lifestyle diseases. In England, healthcare costs related to physical inactivity are five times more than smoking, and in the U.S. $117 billion health care expenditures per year were associated with inadequate levels of physical activity.

Health data analytic companies, such as PAI Health, offer solutions to make CRF data accessible and relevant to insurers and consumers alike. Customers’ activity levels and CRF data are tracked using a personalized baseline risk assessment. Dynamic, real-time risk monitoring improves customer engagement and reduces risk. Insurers are therefore able to determine the level of risk and understand the health profile for individual customers.

Shifting the conversation from payer to partner

Think of how providers currently handle the customer relationship. Once a customer purchases an insurance policy, the communications typically become almost entirely transaction-based, focused on renewals and claims. What if an insurer had access to data insights that assess customers’ health and risk levels dynamically over time? This now opens the door to a personalized health dialogue.

See also: Making Life Insurance Personal  

One of the largest life insurance companies saw this opportunity when it just entered into an agreement to provide its policyholders with wearable digital devices and gain their customers’ health and fitness data. The insurer will offer rate discounts and other incentives to its policyholders, creating a conversation between the company and its customers about fitness and health.

By using CRF metrics and personalized health data, software tools present complicated data in a comprehensible format for the first time. Here is exactly why tracking this valuable CRF data is not only the best approach for insurers, but also is extremely important in the future of health:

  1. It takes the guesswork out of health: Innovations in biometric algorithms help make big data simple enough for anyone to understand. The data that comes from these algorithms is also personalized for anyone of any health level. It offers the chance to meet people where they are, in a more open and understanding environment, to get them started on the path to a longer, healthier life.
  2. It’s educational and accessible: For most customers, the idea of changing their lifestyle can be daunting. CRF metrics can be a conversation starter opening the door to educational content that naturally supports the transition to a healthier lifestyle, making the entire process less intimidating for customers. What’s more – it’s extremely accessible and convenient, because all a customer needs to do is take a minute out of the day and get started via smartphone.
  3. It’s universal and trusted: Health isn’t one size fits all, but the beauty in CRF metrics such as the Personalized Activity Intelligence (PAI) is that they work for customers at any health level and with whatever type of exercise they prefer. And what many customers don’t realize is that they are becoming healthier through daily habits, such as mowing the lawn, washing the car or doing housework. By using an activity metric underpinned by CRF, you are providing customers with data that is trusted by the AHA, NHS and sports science experts as a proven measure of health.
  4. It fits real life: CRF activity metrics take a holistic look at improving activity, rather than looking day by day. This means if a customer misses a day or needs a break, it isn’t the end of the world. The activity prescription provided to the person readjusts and the risk models update, so the person can stay motivated on the journey to his or her best self. Improving CRF is a physiological adaptation that requires continual work, which is exactly what the data molds to.
  5. It doubles as a measure of health: As an insurer, it’s important to know the health levels of individual customers. A simple score tells the insurer and its customers exactly where they are, to achieve optimal health. The information might be incorporated into rates and underwriting.

The time is now to start engaging customers in a dialogue using personalized health metrics that can lower risk and costs, while adding more to the relationship.

See also: This Is Not Your Father’s Life Insurance  

Through this data, insurers and policyholders alike have a new opportunity to advance the way we monitor and act on health, to help customers enjoy happier, longer lives.