This study examines the multifactorial determinants of exceptional longevity in a Japanese urban district that achieved the highest life expectancy nationally according to the 2020 Municipal Life Tables. Through a comprehensive analysis of geographical, environmental, social, and behavioral factors, we identify the complex interactions between topographical features, particularly hillside terrain, urban planning, community engagement, and health behaviors that contribute to superior longevity outcomes. Our findings reveal that the synergistic effects of daily physical activity induced by hilly terrain, well-developed healthcare infrastructure, and robust social networks create an environment uniquely conducive to healthy aging. This case study challenges conventional assumptions about age-friendly environments and suggests that certain physical challenges in the built environment may paradoxically promote better health outcomes when combined with strong social support systems. The implications extend beyond the immediate geographical context, offering insights for urban planning and public health policy in aging societies worldwide.
Buettner, D. (2016). Blue Zones: Lessons from the world's longest lived. American Journal of Lifestyle Medicine, 10(5), 318-321. https://doi.org/10.1177/1559827616637066
Cerin, E., Nathan, A., van Cauwenberg, J., Barnett, D. W., & Barnett, A. (2017). The neighbourhood physical environment and active travel in older adults: A systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 15. https://doi.org/10.1186/s12966-017-0471-5
Daskalopoulou, C., Stubbs, B., Kralj, C., Koukounari, A., Prince, M., & Prina, A. M. (2017). Physical activity and healthy ageing: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 38, 6-17. https://doi.org/10.1016/j.arr.2017.06.003
Dominguez, L. J., Veronese, N., & Barbagallo, M. (2021). A commentary on Blue Zones®: A critical review of age-friendly environments in the 21st century and beyond. International Journal of Environmental Research and Public Health, 18(2), 837. https://doi.org/10.3390/ijerph18020837
Franceschi, C., Garagnani, P., Morsiani, C., Conte, M., Santoro, A., Grignolio, A., Monti, D., Capri, M., & Salvioli, S. (2018). The continuum of aging and age-related diseases: Common mechanisms but different rates. Frontiers in Medicine, 5, 61. https://doi.org/10.3389/fmed.2018.00061
Herbert, J., Schumacher, L. M., Brown, R., Battaglia, C., & Barreira, T. V. (2022). Blue Zones: Centenarian modes of physical activity: A scoping review. Journal of Population Ageing, 1-25. https://doi.org/10.1007/s12062-022-09396-0
Kreouzi, M., Theodorakis, N., & Constantinou, C. (2022). Lessons learned from Blue Zones, lifestyle medicine pillars and beyond: An update on the contributions of behavior and genetics to wellbeing and longevity. American Journal of Lifestyle Medicine, 16(5), 652-662. https://doi.org/10.1177/15598276221118494
Lissner, L., Bengtsson, C., Björkelund, C., & Wedel, H. (1996). Physical activity levels and changes in relation to longevity: A prospective study of Swedish women. American Journal of Epidemiology, 143(1), 54-62. https://doi.org/10.1093/oxfordjournals.aje.a008657
Michel, J. P., Dreux, C., & Vacheron, A. (2016). Healthy ageing: Evidence that improvement is possible at every age. European Geriatric Medicine, 7(4), 298-305. https://doi.org/10.1016/j.eurger.2016.04.014
National Academies of Sciences, Engineering, and Medicine. (2015). Lessons from the Blue Zones. In Business engagement in building healthy communities: Workshop summary (pp. 11-24). The National Academies Press. https://doi.org/10.17226/21721
Nature Aging. (2021). Rethinking the urban physical environment for century-long lives: From age-friendly to longevity-ready cities. Nature Aging, 1(12), 1088-1095. https://doi.org/10.1038/s43587-021-00140-5
Oe, H. (2025a). The art of aging gracefully: Japan's blue zones revealed [Kindle edition], Liliana Planning, Japan
Oe, H. (2025b). The harmony of ikigai: Embracing wellness through Japanese wisdom [Kindle edition], Liliana Planning, Japan.
Oe, H. (2025c). The art of living: Secrets from Japan's blue zones [Kindle edition], Liliana Planning, Japan
Oe, H. (2025d). Blue islands beautiful country: Preserving Japan's legacy of longevity [Japanese edition] [Kindle edition]. Suzaku Yuri Press.
Pes, G. M., Dore, M. P., Tsofliou, F., & Poulain, M. (2022). Diet and longevity in the Blue Zones: A set-and-forget issue? Maturitas, 164, 31-37. https://doi.org/10.1016/j.maturitas.2022.06.004
Poulain, M., Pes, G. M., Grasland, C., Carru, C., Ferrucci, L., Baggio, G., Franceschi, C., & Deiana, L. (2004). Identification of a geographic area characterized by extreme longevity in the Sardinia island: The AKEA study. Experimental Gerontology, 39(9), 1423-1429. https://doi.org/10.1016/j.exger.2004.06.016
Reimers, C. D., Knapp, G., & Reimers, A. K. (2012). Does physical activity increase life expectancy? A review of the literature. Journal of Aging Research, 2012, 243958. https://doi.org/10.1155/2012/243958
Rosero-Bixby, L., Dow, W. H., & Rehkopf, D. H. (2013). The Nicoya region of Costa Rica: A high longevity island for elderly males. Vienna Yearbook of Population Research, 11, 109-136. https://doi.org/10.1553/populationyearbook2013s109
Sallis, J. F., Cerin, E., Conway, T. L., Adams, M. A., Frank, L. D., Pratt, M., Salvo, D., Schipperijn, J., Smith, G., Cain, K. L., Davey, R., Kerr, J., Lai, P. C., Mitáš, J., Reis, R., Sarmiento, O. L., Schofield, G., Troelsen, J., Van Dyck, D., ... Owen, N. (2016). Physical activity in relation to urban environments in 14 cities worldwide: A cross-sectional study. The Lancet, 387(10034), 2207-2217. https://doi.org/10.1016/S0140-6736(15)01284-2
Schwendinger, F., Infanger, D., Lichtenstein, E., Hinrichs, T., Knaier, R., Rowlands, A. V., & Schmidt-Trucksäss, A. (2025). Intensity or volume: The role of physical activity in longevity. European Journal of Preventive Cardiology, 32(1), 10-19. https://doi.org/10.1093/eurjpc/zwae295
Takano, T., Nakamura, K., & Watanabe, M. (2002). Urban residential environments and senior citizens' longevity in megacity areas: The importance of walkable green spaces. Journal of Epidemiology and Community Health, 56(12), 913-918. https://doi.org/10.1136/jech.56.12.913
Willcox, D. C., Willcox, B. J., Wang, N. C., He, Q., Rosenbaum, M., & Suzuki, M. (2008). Life at the extreme limit: Phenotypic characteristics of supercentenarians in Okinawa. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(11), 1201-1208. https://doi.org/10.1093/gerona/63.11.1201
Zhong, J., Liu, W., Niu, B., Lin, X., & Deng, Y. (2022). Role of built environments on physical activity and health promotion: A review and policy insights. Frontiers in Public Health, 10, 950348. https://doi.org/10.3389/fpubh.2022.950348
Oe, H. (2025). The Longevity Paradox of Hillside Living: How Urban Topography and Community Networks Promote Healthy Aging. International Journal of Academic Research in Business and Social Sciences, 15(6), 457-468.
Copyright: © 2025 The Author(s)
Published by Knowledge Words Publications (www.kwpublications.com)
This article is published under the Creative Commons Attribution (CC BY 4.0) license. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this license may be seen at: http://creativecommons.org/licences/by/4.0/legalcode
