Executive Health Over 40: 5 Numbers That Predict Performance

If you are over 40 and run a company or a team, five numbers tell you more about how long you will keep performing than most of what shows up on a standard physical: your cardiorespiratory fitness, your grip strength, how much strength training you do each week, how much you sleep, and how many hours you work. Each one is linked in large studies to how long people live or how well they function, and each one can be measured this week without a lab.

Key takeaways

Key takeaways

1. In 122,007 adults, the least fit group had about five times the risk of death of the fittest, and being below average for your age carried the same hazard ratio as smoking (1.41). These are associations, not proof of cause.
2. Every 5 kg lower grip strength was linked to a 16% higher risk of death from any cause in 139,691 adults across 17 countries.
3. The biggest mortality benefit from strength training appeared at about 30 to 60 minutes a week; combined with aerobic work, risk was 40% lower than doing neither.
4. Six hours of sleep a night for two weeks produced deficits comparable to up to two nights without sleep, and people did not notice.
5. Working 55+ hours a week is associated with a 35% higher stroke risk, and output in historical factory data flattened at around 63 hours.
6. Test all five this month, retest quarterly, and work on the worst number first.

I have spent nearly 30 years in fitness, and I now coach founders and executives one to one. Most leaders track revenue, burn and pipeline weekly, then go a year or more between looking at the numbers that decide whether they will be around, and sharp, to enjoy any of it. This page gives you the five, the best evidence behind each, what that evidence does and does not prove, a test you can run yourself, and the habit that moves it.

A note before you start. This is coaching information, not medical care. Two of the tests below involve hard effort. Talk to your doctor before starting any of them, especially if you have heart disease, high blood pressure, diabetes, joint problems, or you have been inactive for a while.

What are the most important health metrics for executives over 40?

I picked these five for three reasons. Each has strong, large-sample research behind it. Each is something you can test cheaply and retest every quarter. And each responds to small, repeatable changes in behaviour, which is the whole premise of the 2% Solution I have taught since 2015: 30 minutes a day, 15 of them moving, 5 still, and 10 reading.

Blood pressure, lipids, blood sugar and body composition matter too. Your physician should be tracking those, and if you have just come out of a clinic assessment, read what to do after your executive health assessment. The five below are the ones that rarely show up in that report, and the ones you control most directly.

1. Cardiorespiratory fitness (VO2 max): how strong is your engine?

Cardiorespiratory fitness (CRF) is how well your heart, lungs and muscles use oxygen during hard effort. Labs measure it as VO2 max, in millilitres of oxygen per kilogram per minute, or in METs. One MET is the oxygen cost of sitting quietly, about 3.5 mL/kg/min, according to the 2024 Adult Compendium of Physical Activities.

What the research found

The study that put this number on the map is Mandsager and colleagues, published in JAMA Network Open in 2018. Cleveland Clinic researchers followed 122,007 adults (mean age 53) who did a treadmill test between 1991 and 2014, for a median of 8.4 years. There were 13,637 deaths. People were sorted into five groups by their peak METs compared with others of the same age and sex.

The gap between the bottom and the top was large. After adjusting for other risk factors, people in the lowest fitness group (below the 25th percentile) had about five times the risk of death of the elite group (HR 5.04). Just being below average rather than above average carried a hazard ratio of 1.41, the same figure the study found for smoking.

In 2024 a team led by Justin Lang published an overview in the British Journal of Sports Medicine that pulled together 26 systematic reviews covering 199 cohort studies and more than 20.9 million observations. High fitness, compared with low, was associated with a 53% lower risk of death from any cause (HR 0.47). Each 1-MET increase in fitness was associated with an 11% to 17% lower risk of all-cause death.

I go through the Mandsager numbers properly, including why you have to be careful comparing them with smoking, in why low fitness may be riskier than smoking.

What it does and does not prove

Both studies are observational. They show strong, consistent associations. They cannot prove that raising your fitness, by itself, will add a set number of years. Healthier people may simply be fitter, and Mandsager used a single treadmill test, in a population referred for testing at one US hospital. Lang's team rated the certainty of the evidence from very low to moderate. What makes this metric hard to ignore is the consistency: the same direction shows up across millions of people, many countries and decades of follow-up.

How to test your VO2 max this week

You have three options without a lab.

1. A non-exercise estimate. The Norwegian University of Science and Technology (NTNU) runs a free online calculator built from the HUNT fitness study. It uses your age, sex, resting heart rate, waist or BMI and activity level. Zero exertion, so start here.
2. A 1.5-mile (2.4 km) run for time, if you already run or train regularly. The Cooper Institute gives this formula: VO2 max = (483 ÷ time in minutes) + 3.5. Divide the result by 3.5 to get METs. A 12-minute 1.5-mile works out to about 43.8 mL/kg/min, or roughly 12.5 METs.
3. A walking test, if you are not running fit. The Cooper Institute recommends a walking test such as the Rockport one-mile walk for anyone who is inactive, carrying extra weight, or gets joint pain from running.

Safety: the run is a maximal effort. The Cooper Institute describes its run tests as meant for people who are apparently healthy and regularly active. Talk to your doctor before attempting it, warm up for at least five minutes, and stop if you feel chest pain, dizziness or unusual breathlessness.

Then compare your result with the Mandsager thresholds for your age and sex. For men aged 50 to 59, for example, below 8.2 METs put you in the lowest group and 14 or more in the elite group. The full ranges for ages 40 to 69 are in the scorecard below.

The 2% habit that moves it

Use your 15 moving minutes every day, and make most of them steady and slightly uncomfortable: brisk walking, cycling, rowing, stairs. Brisk walking at 3.5 to 3.9 mph costs about 4.8 METs, according to the Compendium. Once a week, swap a steady session for short hard intervals. Canada's 24-hour movement guidelines (CSEP) call for at least 150 minutes a week of moderate to vigorous activity; 15 minutes a day gets you to 105, and two longer weekend sessions close the gap.

2. Grip strength: why does a handshake predict health?

What the research found

The Prospective Urban Rural Epidemiology (PURE) study, published in The Lancet in 2015 by Leong and colleagues, measured grip strength with a dynamometer in 139,691 adults aged 35 to 70 across 17 countries of different income levels, and followed them for a median of four years. Every 5 kg lower grip strength was associated with a 16% higher risk of death from any cause (HR 1.16, 95% CI 1.13 to 1.20) and a 17% higher risk of cardiovascular death (HR 1.17). It was also linked to a modestly higher risk of heart attack (HR 1.07) and stroke (HR 1.09). The authors reported that grip strength was a stronger predictor of all-cause and cardiovascular death than systolic blood pressure.

What it does and does not prove

Grip is a marker. It reflects your overall strength and, to a degree, your general health. The PURE authors called it "a simple, inexpensive risk-stratifying method" and said more research is needed to test whether improving strength reduces mortality. So the finding does not mean that squeezing a spring gripper at your desk will extend your life. Illness also lowers grip, so some of the link likely runs in that direction. Treat a low or falling number as a signal that your whole-body strength is slipping.

How to test your grip strength this week

You need a hand dynamometer. Many physiotherapy clinics and some gyms have one, and they are inexpensive to buy. Stand, keep your elbow by your side, squeeze as hard as you can for a few seconds, and record the best of two or three tries on each hand. The effort is brief; skip it if you have a hand, wrist or elbow injury.

For a reference point, the most useful open dataset I have found is Dodds and colleagues, PLOS ONE 2014: 49,964 people from 12 British studies, with centile curves from age 4 to 90. Grip peaks in the 30s at a median of about 51 kg for men and 31 kg for women. The authors set a "weak grip" cut-off at 27 kg for men and 16 kg for women. Note this is British data and dynamometers vary, so use it as a guide and track your own trend.

Source: Dodds et al., PLOS ONE 2014, Table 2.

The 2% habit that moves it

Put loaded carries and hangs into your moving minutes two or three times a week: carry a pair of heavy dumbbells or kettlebells for 30 to 40 metres, rest, repeat; hang from a bar for as long as you can hold good position. Heavy rows, deadlifts and pull-ups train grip as a side effect.

3. Muscle strength: what is the weekly strength dose?

What the research found

Momma and colleagues published a systematic review and meta-analysis of 16 prospective cohort studies in the British Journal of Sports Medicine in 2022. Compared with doing no muscle-strengthening activity, doing some was associated with a 15% lower risk of death from any cause, 17% lower for cardiovascular disease and 12% lower for total cancer, independent of aerobic exercise.

The dose is the part executives should note. The largest risk reductions, about 10% to 20%, sat at roughly 30 to 60 minutes a week. Lowest all-cause risk was at about 40 minutes a week. Above that the curves were J-shaped, meaning the benefit levelled off and the data on very high volumes is unclear. People who combined strength work with aerobic activity had the biggest reduction: a 40% lower risk of death from any cause compared with people who did neither.

There is also a simple field test with an eye-catching result. Yang and colleagues (JAMA Network Open, 2019) followed 1,104 male firefighters in Indiana, mean age 40, for about 10 years. Those who could do more than 40 push-ups at baseline had 96% fewer cardiovascular events than those who managed 10 or fewer (incidence rate ratio 0.04).

What it does and does not prove

Momma's review relied on self-reported strength activity, most studies were from the USA, and the authors rated certainty as very low for most outcomes. The firefighter study had only 37 cardiovascular events, studied active men only, and its authors said it did not support push-up capacity as an independent predictor of heart disease risk. Read both as strong reasons to train strength, not as precise forecasts.

How to test your strength this week

Do a push-up test. Warm up, then do as many full push-ups as you can with a straight body and chest close to the floor, at a steady pace (the firefighter study used a metronome at 80 beats per minute). Stop when your form breaks. Record the number. If a full push-up is not there yet, test from an incline (hands on a bench) and record that, then retest the same way each quarter. Talk to your doctor first if you have shoulder, wrist or heart problems.

Then count your actual weekly minutes of muscle-strengthening work over the last four weeks, from your calendar or training log rather than memory.

The 2% habit that moves it

Three days a week, make your 15 moving minutes a strength session: a squat or lunge, a push, a pull and a carry, two or three hard sets each. That is 45 minutes a week, right inside the range Momma found, and it meets the CSEP guideline of at least two days a week of muscle strengthening. If your calendar allows two longer sessions instead, that works too. Strength is often the quickest of the five to move, which makes it a good place to start, and it is a common first focus in one-to-one coaching.

4. Sleep: how much sleep does an executive really need?

What the research found

The most useful study for anyone who thinks they run fine on six hours is Van Dongen and colleagues, published in Sleep in 2003. In a controlled lab study, 48 healthy adults aged 21 to 38 were restricted to 4, 6 or 8 hours in bed per night for 14 days, and others went three nights with no sleep at all. Those restricted to six hours or less a night for two weeks built up thinking deficits comparable to up to two nights of total sleep deprivation. Their sense of how sleepy they were levelled off after the first few days. In the authors' words, subjects were "largely unaware of these increasing cognitive deficits."

That is the executive problem in one line. Your judgment is degrading and your self-assessment says you are fine.

Canada's 24-hour movement guidelines recommend 7 to 9 hours of good-quality sleep for adults aged 18 to 64, with consistent bed and wake times. The US CDC says 7 or more hours for adults aged 18 to 60.

What it does and does not prove

Van Dongen tested young, healthy adults in a lab for two weeks, on attention and memory tasks. It does not measure boardroom decisions or long-term health, and it does not tell you exactly how a 50-year-old responds. It does show, under tight control, that chronic short sleep impairs performance and that people are poor judges of their own impairment.

How to test your sleep this week

Keep a seven-night sleep log. Each morning write down lights-out time, wake time, your best estimate of hours actually asleep, and your alertness from 1 to 10 at 10 a.m. A wearable can help, but treat its sleep stages as estimates. Your number is your average hours asleep across the seven nights.

Safety: if you snore loudly, someone has seen you stop breathing or gasp in your sleep, or you nod off while driving or in meetings, talk to your doctor. Those can be signs of a sleep disorder that a log will not fix.

For a fuller picture, take the sleep quiz, and read how sleep shapes leadership.

The 2% habit that moves it

Two parts of the 2% Solution do the work here. The 10 reading minutes go at the end of the day, from paper, in place of the phone. The 5 still minutes go right before that: breathing, stretching or just sitting with no input. Set a fixed wake time seven days a week and count back eight hours for your lights-out target.

5. Hours worked: when do long hours start costing you?

What the research found

In 2021 the WHO and International Labour Organization estimated that working 55 or more hours a week led to 745,000 deaths from stroke and ischemic heart disease in 2016, up 29% since 2000. The analysis, published in Environment International, concluded that working 55-plus hours a week is associated with a 35% higher risk of stroke and a 17% higher risk of dying from ischemic heart disease, compared with 35 to 40 hours. About 9% of the world's population works these hours. WHO's director-general put it bluntly: "No job is worth the risk of stroke or heart disease."

Productivity falls off too. Economist John Pencavel (IZA Discussion Paper, 2014) reanalysed British First World War munitions factory records. Output rose in proportion to hours up to about 49 hours a week, then rose more slowly, and flattened at around 63 hours. Output at 70 hours differed little from output at 56. Weeks with no day of rest produced about 10% less output for the same hours.

Closer to home, a BDC survey of 1,500 Canadian small business owners in early 2023 found 45% reported mental health challenges, up from 38% a year earlier, and 54% were concerned about work-life balance.

What it does and does not prove

The WHO/ILO figures are modelled estimates built on observational studies, so they show association and population-level burden, not that your next long week will cause a stroke. Pencavel's data comes from factory work in 1916, which is a long way from strategy work. But knowledge work depends even more on attention and judgment, which are exactly what fatigue erodes, so I would expect the curve to bend earlier, not later. That last point is my reasoning, not something the study measured.

How to test your hours this week

Log your real hours for two weeks, including evening email, weekend "quick checks" and travel time spent working. Note how many days in those two weeks had no work at all. If you are at 55 or more, or you have had no full day off in a fortnight, read the signs of founder burnout before you read anything else.

The 2% habit that moves it

Use your 5 still minutes as a shutdown ritual at a fixed time each evening: write down tomorrow's top three, close the laptop, and stop. Protect one full day a week with no work. And move one recurring hour of meetings into a walk or a training block, so the hour you take back pays you twice.

Your five-number scorecard

Run every test this month, write the results down, and retest once a quarter. The "watch" column uses thresholds from the studies above; it is a prompt to act, not a diagnosis.

How to use these numbers with your doctor and your coach

Bring the scorecard to your next physical. Your doctor has the blood work and the clinical history; you bring the five numbers that show how you actually live. If you have recently had a clinic assessment, here is how to turn that report into a plan.

Then pick one number, the worst one, and work on it for 12 weeks before adding another. That is where most people go wrong: they try to fix all five in January and fix none by March. If you want to know what working with a coach on this looks like, I explain it in executive health coaching: what it is and who it is for.

If you want a second set of eyes on your scorecard and a plan for the one number that matters most for you right now, book a free 20-minute call and we will go through it together.