By Alexandra Sifferlin
December 14, 2015
TIME Health
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Presidential hopeful Donald Trump has “extraordinary” physical strength and stamina, according to his doctor.

The candidate on Monday released a short statement about his health, in which his physician wrote that if elected, Trump would “be the healthiest individual ever elected to the presidency.”

That’s pretty bold assurance considering the men previously elected to the job have lived a remarkably long time. If elected, Trump, 69, would become the oldest person elected to the presidency. Could his own “astonishingly excellent” blood pressure—according to his doctor—offer a similar longevity benefit?

As TIME editors Nancy Gibbs and Michael Duffy wrote earlier this year, there appears to be something special about people holding the position. Former Presidents Jimmy Carter and George H. W. Bush are both currently 91, and Ronald Reagan lived to 93. “Here is a Classic Conundrum of cause and effect: the men who survive the crushing pace (not to mention lethal diet) of multiple U.S. presidential campaigns and go on to hold one of the most stressful jobs in the world also have a habit of outliving the rest of us,” Gibbs and Duffy write.

But why? The duo reports:

—For starters, there is constant vigilance.

Ignoring troubling symptoms is not an option for someone who has a doctor following him virtually everywhere he goes; medical teams are steps away at all times. Even when Presidents return to private life, they are shadowed by Secret Service details, albeit smaller ones. Among those agents, an EMT is always on duty. Think of it as a retirement benefit.

At least since the mid-1970s, nearly every President has been devoted to some kind of regular exercise. Ford swam and skied. Carter jogged almost daily. Reagan chopped brush and lifted weights. Bush the younger took to biking when his knees put a halt to running. If some of that recreation was done for public relations purposes, most Presidents have come to rely on it for private sustenance. (Not everyone got the memo: as President, Bill Clinton may have been conspicuously photographed in his jogging shorts, but he typically relaxed in the office by reading, doing crosswords and chewing on cigars, a pattern that probably helped land him in New York–Presbyterian Hospital for bypass surgery in 2004 and another surgery six years later. He is now a part-time vegan.)

—There’s also a mental stamina that might give former U.S. leaders an edge:

We all may know we need to manage our stress, but for a sitting President this is imperative, a consistent part of the advice they give one another. Be sure to rest. Take your vacations. Use Camp David. After the hard-fought 1960 election, Richard Nixon and John F. Kennedy met in Key Biscayne, Fla., where Nixon made an unsolicited promise. I may criticize your policies, he told Kennedy, but “of one thing I can assure you: I shall never join in any criticism of you, expressed or implied, for taking time off for relaxation. There is nothing more important than that a President be physically, mentally and emotionally in the best possible shape to confront the immensely difficult decisions he has to make.”

For many Presidents, stress acts as a force multiplier. The toll stress takes, research has shown, depends on how it is viewed. What is normally harmful becomes helpful when it is treated as a fact of life or a chance to learn. The more powerful a person is, the more in control, the better the odds he has learned to use stress to his advantage. Clinton aides flaunted his mantra like a bumper sticker: “That which doesn’t kill him only makes him stronger.” For people with that kind of resilience–sometimes called adaptive competence–stress can correlate with a longer life.

—Finding meaningful work after leaving the White House and the pressure to solidify a legacy might also keep leaders young. There are also a few current presidential candidates who share close familial ties with prior U.S. top dogs, which may provide the latter another benefit:

And so as 2015 unfolds, it’s important to note that three of the four current ex-Presidents may have something else to live for now. Clinton’s wife Hillary is trying to become the 45th President, and so is Bush son and brother Jeb. Aides to the elder Bush privately admit that the prospect of seeing a second son run for the White House helps keep him going.

And nothing gets the blood pumping like a little competition among friends.

So while Trump may be healthy at 69, he’s not peerless where history is concerned.

Read more: Why do Presidents Live so Long?

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