Influence of individual and combined healthy behaviours on successful aging

Abstract

Background: Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging.

Methods: We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes).

Results: At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis.

Interpretation: Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.

Figure 1:

Selection of participants for the study. MI = myocardial infarction.

Figure 2:

Association between the number of healthy behaviours participants showed at baseline and (A) successful aging or (B) survival. In model 1, each number of healthy behaviours is included in the model as a category, and ORs are calculated with “0 healthy behaviours” as the reference group. In model 2, the category 1–4 includes all participants with 1–4 healthy behaviours, and the ORs are calculated with “0 healthy behaviours” as the reference group. The binary outcomes are successful aging versus death or normal aging, and survival to the end of follow-up versus death. OR = odds ratio. Error bars indicate 95% confidence intervals. *Models were adjusted for age, sex, level of education and marital status, and were mutually adjusted for all health behaviours. †Reference.