Executive function in the context of chronic disease prevention: theory, research and practice

Abstract

Objective: To provide an overview of the nature, organization and measurement of executive function, and describe its significance for preventive medicine theory, research and practice.

Method: A conceptual and narrative review linking the operation of executive control systems to health behavior performance and health outcomes, within the context of chronic illness prevention.

Results: Stronger executive function is linked with more consistent performance of a variety of health protective behaviors, less performance of health risk behaviors, and greater longevity in the existing observational research literature. These effects are not fully explained by demographic factors such as education, income and socioeconomic status, but may in some cases interact with them, or mediate their effects on other outcomes. Experimental manipulations of executive control suggest that the effect of executive function is causal, particularly in relation to the modulation of appetitive craving responses that may compete with healthy behaviors (or facilitate unhealthy behaviors).

Conclusion: Executive function is a potentially important variable in explanatory frameworks for health behavior and health outcomes. The size of effect and its endurance remain uncertain, though the causal status of its influence on some behaviors is becoming increasingly clear. Additional understanding of the relation between executive control and demand imposed by ecological context is an important frontier for research on changing behavior to prevent disease, and may be an explanatory factor in social patterning of these same conditions.

Keywords: Chronic illness; Ecological factors; Executive function; Mortality; Prevention.