April 17, 2026, 8:30 am | Read time: 6 minutes
We no longer die suddenly. We die slowly. That’s according to someone who sees daily what happens when prevention comes too late: Prof. Dr. Thomas Kälicke, chief physician of orthopedics and trauma surgery at GFO Clinics Bonn, longevity expert, and bestselling author. He is convinced that we are fighting the wrong battles—because the most effective “pill” against the biggest health threats of our time isn’t found in a pharmacy—it’s right outside our door.
People Used to Die Suddenly, Now We Die Slowly
Life expectancy in Germany has more than doubled over the past 150 years.1 A medical triumph—with a blind spot. People used to die suddenly—from infections, injuries, workplace accidents. Now we die slowly. From chronic diseases.* The problem is no longer a sudden misfortune. The problem is silent killers. I call them the “deadly sextet” in my book “LNGVTY: Longer – Better – Live“.
Scientists calculated that in 2017 alone, about 11.6 million years of life were lost due to diseases.2 Statistically, each affected person could have lived an average of eleven to twelve years longer. Eleven to twelve years!
We Only Intervene When It’s Too Late
And this is precisely the core problem of our healthcare system: We often start treatment only when the disease is already present. We are excellent at treating a heart attack in the catheter lab. We place stents, repair vessels, and stabilize patients. But we usually intervene only when it’s too late. What we need is medicine that starts earlier.
The Deadly Sextet Develops Quietly
Because the deadly sextet doesn’t develop overnight. It usually evolves quietly over decades and includes:
- Metabolic disorders like fatty liver and insulin resistance
- Cardiovascular diseases
- Cancer
- Neurodegenerative diseases like dementia
- Muscle, bone, and cartilage degeneration
- Microbiome disorders
When these diseases encounter an organism weakened by immunosenescence and cellular aging in old age, a so-called “no-win situation” often arises: We are too late! But there is a lever—and it’s surprisingly simple.
The One Pill Everyone Would Take
I’m sure: If there were a pill that worked against all the instruments of the deadly sextet and could significantly extend our lives, we would all take it.
The good news: This pill exists. It’s called exercise. And it works—proven—against all six silent killers.
1. Exercise Against Metabolic Disorders
Exercise directly impacts our energy metabolism. Under physical stress, we burn glucose, mobilize fat reserves, and improve insulin sensitivity. Our metabolic flexibility—the ability to switch between fat and carbohydrate burning—increases continuously. Regular training can reduce insulin resistance and counteract fatty liver. Metabolic disorders are often the starting point for cardiovascular diseases and cancer. Early intervention here interrupts a dangerous cascade.
2. Exercise Strengthens Heart and Vessels
Cardiovascular diseases are the leading cause of death in Germany. Exercise strengthens the heart muscle, improves vascular elasticity, and regulates blood pressure. Increased blood flow functionally “trains” vessels. Small damages can be repaired more quickly.
Many patients with high blood pressure can reduce their medication under regular endurance training—some even stop it entirely (of course, under medical supervision). Exercise acts here like a multifunctional heart medication—only without a package insert.
3. Exercise Reduces Cancer Risk
According to the German Cancer Research Center, regular physical activity lowers the risk of numerous cancers.3 The effect is particularly well-documented for colon cancer. Women also reduce their risk of breast and cervical cancer through exercise. There are indications for kidney, bladder, stomach, and esophageal cancer as well.
The mechanisms are complex: strengthening the body’s defense mechanisms, reducing chronic inflammation, decreasing visceral fat, improving insulin sensitivity, and hormonal regulation. Exercise is not a guarantee—but a significant protective factor.
4. Exercise Protects Against Dementia
Numerous studies show: Regular exercise reduces the risk of neurodegenerative diseases like dementia.
A central mechanism is the increased production of BDNF (Brain-Derived Neurotrophic Factor). This growth factor promotes the formation and stabilization of synapses and is particularly active in the hippocampus, cerebral cortex, and forebrain—regions crucial for memory and abstract thinking.
The good news: BDNF production measurably increases with exercise and promotes neuronal plasticity. You could say: Exercise is fertilizer for the brain.
5. Muscles, Bones, and Cartilage
As we age, we continuously lose muscle mass without training. This process—sarcopenia—dramatically increases the risk of falls. An osteoporosis-related hip fracture is not a harmless event: 20 to 30 percent of those affected die within a year. Strength training directly counteracts this!
Even in old age, muscle strength can be significantly increased. Strong muscles stabilize joints, protect bones, and maintain independence. In practice, I often see the opposite: muscle loss as a ticket to needing care. Yet it is preventable.
6. Exercise Changes Our Microbiome
Our gut houses up to 70 percent of our immune cells. It is a central control organ of our immune system. Studies show that exercise changes the composition of the microbiome and increases the production of short-chain fatty acids—independent of diet. These fatty acids have anti-inflammatory effects, strengthen the intestinal lining, improve energy yield, and promote satiety regulation. Exercise is thus also immune training. A healthy gut means a resilient organism.
The 6 “Silent Killers” in the Body and How to Control Them for as Long as Possible
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Prevention Instead of Repair Medicine
Our medicine is excellent at repairing damage. But it often intervenes only when diseases are manifest. The deadly sextet, however, develops long before its final stage.
If we want to extend healthy life—not just lifespan—we must act earlier. Exercise is not a lifestyle recommendation. It is a biological necessity.
Conclusion: The Pill Isn’t in the Pharmacy
Of course, there remains a residual risk in life. You can still be hit by a truck on a crosswalk despite training. There are no absolute guarantees.
But within the biological rules of our bodies, exercise is the most effective, broadest, and best-researched measure against the major killers of our time.
A pill against metabolic disorders, heart attack, cancer, dementia, muscle, bone, and cartilage degeneration, and microbiome disorders?
We already have it! It’s called exercise.
And it’s not waiting in the medicine cabinet. It’s right outside your door.
About the Author: Prof. Dr. Thomas Kälicke is a specialist in surgery, orthopedics, and trauma surgery with additional qualifications in special trauma surgery, hand surgery, and physical therapy. In early 2011, at the age of 38, he became chief physician at GFO Clinics Bonn. Since 2025, he has also been chief physician of general surgery at CURA Hospital in Bad Honnef. In addition to his clinical work, he has been advising and accompanying people for many years who want to change their lifestyle and stay healthy long-term. As a sought-after speaker, he conveys scientifically sound insights into longevity in an understandable and practical way.
*In 2023, about 1.03 million people died in Germany. In contrast, there were only 2,839 traffic fatalities—but 348,300 deaths from cardiovascular diseases and about 250,000 from cancer.