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How five simple lifestyle habits can extend life expectancy

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Data from two large prospective cohort studies on American adults has led to a new study published in Circulation quantifying the effect of five very simple lifestyle habits on life expectancy, largely due to reductions in cancer and cardiovascular disease mortality. 
 
This isn’t rocket science. GPs already emphasise these habits to our patients, and they are embedded in the RACGP’s Guidelines for preventive activities in general practice (Red Book).
 
It is interesting, however, to see exactly how much these five habits add to our lives. They are: 

• never smoking 
• body mass index of 18.5–24.9 kg/m² 
• ≥ 30 minutes of moderate to vigorous physical activity per day
• moderate alcohol intake
• high diet quality score (upper 40%).

According to the study, each habit adds 2–3 years of life expectancy, while the collective increased life expectancy if a person meets all five criteria is 14 years for women and 12.2 for men (compared with someone who did not meet any of the criteria). 
 
But is this easier said than done? Two out of three of our patients are likely to be overweight or obese, 70% are mostly sedentary, four out of five do not eat enough fruit and vegetables to meet dietary guidelines, alcohol permeates our society. And so on. 
 
So what can we do?
 
As GPs, we can model good lifestyle habits, and help our patients with behaviour change. The RACGP’s Smoking, alcohol, nutrition, physical exercise (SNAP) guide advises using the ‘5As framework’:

• Ask – a systematic approach to asking all patients about their SNAP, which may occur opportunistically as they present for other conditions and/or by recall for health checks
• Assess – assess readiness to change, and dependence (for smoking and alcohol)
• Advise – provide brief, non-judgemental advice with patient education materials
• Assist/agree – work with the patient to set agreed goals for behaviour change; provide motivational interviewing; refer to telephone support services, group lifestyle programs or individual providers (eg dietitian or exercise physiologist); consider pharmacotherapy
• Arrange – regular follow-up visits to monitor maintenance and prevent relapse

Brief motivational interviewing has been shown to be effective in changing a number of health-related behaviours, including smoking cessation and alcohol use, and is a valuable tool for GPs.
 
Motivational interviewing is intended to create a positive and collaborative therapeutic relationship. This is in contrast to a paternalistic relationship, which can create more resistance to change.
 
I am encouraged by the fact these habits do not appear to be extreme. They will have additional benefits to quality of life, such as improved mental health from a better diet and increase in exercise, and reduction in risk of many other chronic conditions.
 
We can also encourage our patients by observing that any change towards a better lifestyle – no matter how small it seems – will be beneficial. 
 
It can be easy to feel discouraged when patients continue to smoke, drink heavily, eat poorly and remain inactive. But our patients do listen to us, especially if we empower them through techniques such as motivational interviewing.

After using motivational interviewing techniques with a long-term patient who smoked – an approach taking all of five minutes – I was pleasantly surprised when he came to see me a few months later announcing he had quit for good.
 
When I asked what caused him to quit, he said, ‘Because you told me it was ruining my health’.  
 
We should never underestimate the important role we can play in helping to improve patients’ lifestyles, and to extend their life expectancy.

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life-expectancy lifestyle-habits motivational-interviewing snap-guide

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