The identification of strategies that can promote health and productivity into old age is one of the most important challenges facing public health.1 In a linked research paper (doi:10.1136/bmj.e5568), Rizzuto and colleagues present welcome evidence that can help inform such strategies.2 The authors found that several modifiable factors—including smoking, being part of a social network, and participating in leisure time activities—predicted survival in respondents in a cohort of more than 1800 people aged 75 years or over from the Swedish town of Kungsholmen. The estimated effects were large. Participation in leisure activities categorised as “productive,” “social,” or “physical” predicted 0.9-1.4 additional years of survival. These results are largely consistent with findings in other populations,3 4 5 6 which suggests that the associations are generalisable beyond the current study’s population. How can these findings be interpreted and what do they mean in terms of real health benefits? There are clinical and policy responses that are potentially justified by the current evidence base. However, acknowledging the study’s limitations will help to identify the crucial next steps in this research agenda.

The greatest challenge is to …