Former President Jimmy Carter is just days away from turning 99, having defied the odds of dying from a brain cancer with an 80 percent mortality rate.
The almost-centenarian was diagnosed with stage 4 melanoma in 2015 that had spread to his brain and liver. He was 91 at the time.
But a lifetime of exercise, healthy eating, a passion for the outdoors, and companionship with his wife has helped him defy expectations for his deadly diagnosis.
Jason Carter, the 39th president's grandson said the former leader was an avid runner until his 80s and he played tennis every day, he was a swimmer, a hunter, and a cyclist. He also had love, companionship and a sense of purpose, all necessary for living a long healthy life.
The 39th president attributes his longevity to his great love, Rosalynn Carter. Marrying her, the former president said, was the ‘pinnacle’ of his life and helped get him through trying times.
Jimmy Carter, 99, was last seen publicly at his wife Rosalynn's funeral in November 2023 (pictured) – and he has been receiving hospice care since February 2023 at his home in Plains, Georgia
Experts who have studied centenarians agree - physical activity, faith, love, companionship, and a sense of purpose make up the backbone of so-called 'Blue Zones,' or areas of the world where people typically live to 100 and beyond.
Maintaining an active lifestyle, even simply walking around town every day, has been shown to improve longevity.
Companionship has been shown to have a similarly positive effect on a person’s lifespan, with studies consistently showing loneliness is toxic.
In recent years, Mr Carter has said despite the date on his grandfather's birth certificate, he feels more like a 60- or 70-year-old.
Mr Carter, a former Georgia state senator, told TIME: ‘If he got to a new city that he had never been to before, whether there was Secret Service or not, he would say, “Hey, is there a bike?”’
Carter also stayed mentally and intellectually engaged well into his senior years, writing books, teaching Sunday school, and leading humanitarian efforts around the world.
Faith has always played a central role in the former President's life, which he has credited for his positive outlook and resilience through hard times, such as radiation therapy for the metastatic melanoma in his brain.
The former President was also proactive about his health. He saw a doctor for a bad cold in 2015, which led to a thorough physical, allowing doctors to find the cancer on his skin.
Further testing from there confirmed the cancer had spread to his brain.
This allowed the doctors to start a treatment regimen immediately, which greatly improved his prognosis.
Only around 22 percent of people diagnosed with stage 4 metastatic melanoma survive after five years.
Fortunately he was eligible for a new type of immunotherapy, Keytruda, which had only been approved a year before.
He underwent four rounds of radiation therapy to treat the spots on his brain, followed by at least four rounds of the immunotherapy Keytruda.
Typically, cancer cells use specific proteins to shield themselves from the immune system, making it hard for the body to confront and eliminate.
But Keytruda blocks these protein shields so the immune system can see and destroy them more effectively.
Unlike traditional chemotherapy, which attacks rapidly dividing cells – even healthy ones – Keytruda specifically targets the immune system's ability to recognize and fight cancer, leading to more effective treatment with fewer side effects.
Historically, the median survival time for people with melanoma that had spread to their brains was between four and six months.
But the advent of new therapies like Keytruda and others that use lab-modified cells from the patient's own body to fight the cancer has bumped that up to about 13 months.
The former President was cancer-free just four months later.
And exercise can go a long way in fighting off illness or disease. It reduces the risk of dying by any cause, also called all-cause mortality. A 2022 study published in the journal Circulation found that individuals engaging in vigorous physical activity for 75 to 149 minutes per week had a 19 percent lower risk of dying from any cause.
Those who exercised for 150 to 299 minutes per week experienced a 21 percent to 23 percent reduction in risk.
Jimmy Carter is pictured jogging around the South Lawn of the White House in 1978. The former president has been an avid jogger for decades. When he turned 80 and needed to give his knees a break, he switched to cycling
Jimmy Carter's grandson Jason gave another health update on the ailing former president with just a few weeks until he turns 100
For moderate physical activity, individuals who exercised for 150 to 299 minutes weekly saw a 20 percent to 21 percent decrease in all-cause mortality. Those who engaged in moderate exercise for 300 to 599 minutes per week had a 26 percent to 31 percent lower risk of death.
Additionally, a 2004 study published in the American Journal of Preventive Medicine found that adults aged 65 and older who participated in physical activity had a 28 percent lower risk of dying from any cause compared to those who did not engage in exercise.
Longevity expert Dr Peter Attia previously told DailyMail.com that exercise can reduce the risk of dying by a staggering 50 percent.
If starting at zero when it comes to getting active, longevity expert Dr Peter Attia previously told DailyMail.com that exercising for just 30 minutes a day, six days a week can halve your death rate.
But the 'right' amount of exercise done weekly depends on a person's fitness level.
Cardiovascular exercise, a favorite of the former President, causes the heart to pump faster and the lungs to work harder to pump oxygenated blood throughout the body.
It reduces the risk of heart disease and stroke and improves circulation, which helps nutrients get into tissues throughout the body.
Cardio can also reduce inflammation in the body, a hallmark of aging.
An analysis of about a dozen studies in 2012 found that physically active people lived an extra 0.4 to 6.9 years. On average, men gained 2.9 years, while women gained nearly four years.
Dr Attia said: ‘What we know is exercise is the single biggest elixir for brain health. And it's amazing how much more powerful it appears to be than nutrition, even sleep. And those things are very important, but exercise is on a league of its own.’
While exercise is an important aspect of longevity, President Carter’s grandson said his grandfather attributes his long, healthy life to something else – his enduring love for his wife Rosalynn.
Wed in 1946, President and Mrs Carter were married for 77 years before Rosalyn's death in 2023 at the age of 96, leaving her husband without her for the first time since they were teenagers.
Strong relationships and close friendships are believed to underpin a long, healthy life.
Mr Carter said in 2015: ‘The best thing I ever did was marry Rosalynn. That's the pinnacle of my life.’
According to Brigham Young University researchers, social connections can help maintain a healthy weight, regulate blood sugar, boost cancer survival rates, reduce depression, and improve mental health.
In fact, lacking social connection posed a similar risk of death as smoking 15 cigarettes a day or excessive alcohol use. Additionally, poor social ties were found to be more harmful than physical inactivity and obesity.
Dr Julianne Holt-Lunstad, a psychologist at BYU and co-author of the study, said: 'I don't think a lot of people recognize that our relationships can have a physical impact as well as emotional.
'There's a pretty large literature linking social relationships to a variety of physiological processes that are linked to disease risk.'
The Carters volunteered for Habitat for Humanity together for more than three decades, which saw them travel all over the world.
This type of charitable work gave the couple a sense of purpose after leaving the White House, a sense of purpose that experts on longevity have said can prolong someone's life.
The photo made available by the Jimmy Carter Library shows Eleanor Rosalynn Carter (L) and Jimmy Carter when they were married, in Plains, Georgia in July 1946
Mr and Mrs Carter are pictured in 2019 during a press conference for a Habitat for Humanity project, a charity they worked on together for three decades
Mr and Mrs Carter were long considered a power couple before her death last year. He dispatched her to foreign countries as a diplomat, she sat in on cabinet meetings and had nightly phone calls with each other while she was traveling. And they always held hands.
After Mr Carter left office, he and Rosalynn established the Carter Center in 1982, a nonprofit focused on combatting global health threats such as malaria, promoting human rights reforms, advocating for mental health awareness, and engaging in research efforts to combat poverty and healthcare inequities.
They often read the Bible aloud to each other at night in Spanish to stay proficient in their older years.
He said on behalf of the Carter Center when Rosalynn died: ‘Rosalynn was my equal partner in everything I ever accomplished.
‘She gave me wise guidance and encouragement when I needed it. As long as Rosalynn was in the world, I always knew somebody loved and supported me.’
Mr Carter is 'doing okay,' according to his grandson, who gave an update on Mr Carter's health leading up to his birthday.
He said: 'I mean he's been in hospice for over 19 months now and he has really physically diminished and can't do much on his own, but he is emotionally engaged and still having experiences and laughing, loving.'