Successful aging implies a low risk of disease
and disability, high mental and physical
functioning and an active engagement with life
(Rowe and Khan, 1997). As the world's
population ages, lifestyle factors that lead to
successful aging will become increasingly important
for improving the health and functional
capacity of the elderly without significantly
increasing health care costs. The Japanese, and
older Okinawans in particular, offer a good
example of successful aging. Despite spending
among the lowest % GDP on health care among
nations Japan has achieved the world's longest
disability-adjusted life expectancy (WHO, 2000).
The Okinawans have been recognized as the
healthiest and longest-lived of the Japanese
and this is particularly evident among
Okinawan centenarians, who have delayed or
sometimes avoided entirely the chronic
diseases of aging, such as coronary heart
disease, cancer, stroke, diabetes and dementia.
We hypothesize that the successful aging of
the Japanese and in particular the Okinawan-
Japanese is largely lifestyle based. In order to
generate further hypotheses for studies of specific
lifestyle interventions we made cross-sectional
comparisons between Okinawan-Japanese,
Japanese and Americans including life expectancy,

mortality and morbidity data, traditional
and emerging risk factors for the main chronic
diseases, and physical function at older ages.
The data were drawn mainly from the 25-year
Okinawa Centenarian Study, the Okinawa
Prefectural government, the Japan Ministry of
Health and Welfare and the U.S. National
Health and Nutrition Examination Survey
databases. Physical functioning was highest in
the older Okinawan-Japanese who also
presented the most favorable chronic disease
risk factor profile. Potential promising areas of
lifestyle intervention include: cholesterol and
dementia; homocysteine, flavonoids and
cardiovascular health; exercise and fall risk;
and adult day care programs. Cross-national
studies, using culturally sensitive research
tools, are needed to further refine and test
lifestyle means for successful aging.

The authors thank the Japan Ministry of
Health and Welfare, the Medical Research
Council of Canada, the Japan Foundation for
Aging and Health, and the Warren, Whitman,
Richardson Fellowship of Harvard Medical
School for research support. BJW is a Men's
Associates Fellow of the Hebrew Rehabilitation
Center for Aged and the Division on Aging,
Harvard Medical School.