Physical inactivity is associated with increased incidence of obesity, diabetes mellitus, cardiovascular diseases, osteoporosis and cancer. Consequently, the American Heart Association, the American College of Sports Medicine and the US Department of Health and Human Services recommended that adults engage in at least 30 minutes of moderate physical activity preferably on all days of the week. In a study, published in 2007, by the National Institute of Health, involving 252, 925 individuals, adherence to the above physical activity guidelines resulted in a 50% reduction in the overall mortality risk (Arch Intern Med 2007; 167: 2453 – 2460). Having been stuck in a sedentary lifestyle in one’s younger days, will increased exercise level later in life reduce one’s mortality rate?

Researchers from Uppsala University and Karolinska Institutet studied 2322 men aged 49 – 51 years at baseline and followed them up for more than 35 years (BMJ 2009; 338: b688). These men were studied again at ages 60, 70, 77 and 82 years. At baseline almost half of the men reported a high level of physical activity (at least 3 hours of recreational sports or heavy gardening a week), 36% reported medium activity (walk or cycle for pleasure) and 15% were sedentary (spending most of the time reading, watching TV and going to the cinema). The study found that the relative mortality rates were highest among sedentary men and lowest among the most active men. When converted into differences in remaining life expectancies from age 50, high physical activity men were expected to live 3.8 years longer than sedentary men and 1.8 years longer than medium physical activity men. Men who increased their physical activity to a high level at 50 and maintained it till age 60 had the same mortality rate as the men who had been at high physical activity before entering the trial. In other words, if you adopt a high physical activity lifestyle at 50, by the time you reach 60 you will have ‘caught up’ and have the same mortality rate as someone who has embraced a high physical activity lifestyle before 50 years of age. After > 10 years of follow-up, the mortality rate in men who had increased their physical activity to a high level both from a medium or low level had halved. After > 10 years of follow-up, compared to current smokers, smoking cessation was associated with a 40% reduction of mortality rate. Men who never smoked had a 60% lower mortality rate than current smokers.

To those middle aged men who smokes and exercise little, the excuse that ‘The damage is done. It is too late for me to stop smoking and start exercising.’ may seem a bit flimsy now. You might wish to heed the saying ‘It is never too late to try’. 

As we age, we get more health issues. Some will kill, some incapacitate, while others merely cause inconvenience. The incidence of cardiovascular diseases increases as one gets older. Hypertension and irregular heart rhythm predispose to stroke. However, a significant portion of people who suffer a stroke do not have these predisposing conditions. A minor stroke can leave minimal disability but most of the time it will leave the victim with significant disabilities that requires chronic care. In the UK, a recent report from the National Audit Office estimated that the annual cost of caring for people with stroke was about 7 billion pounds. Thus, for healthy individuals, knowing which lifestyle habits are associated with increased stroke risk would certainly be beneficial.

A recent study from the University of East Anglia examined the potential combined impact of 4 health behaviours on stroke incidence in men and women living in the general community in Norfolk, England (BMJ 2009; 338: b349).  The participants were 20,040 men and women aged 40 – 79, drawn from the Norfolk component of the European Prospective Investigation of Cancer (EPIC-Norfolk), with no known stroke or myocardial infarction at baseline survey in 1993 – 1997. They were followed up till 2007. The 4 health behaviours were current non-smoking, moderate alcohol intake (< 14 units per week), physically not inactive (physically inactive means sedentary job and no recreational activity) and a plasma concentration of vitamin C ≥ 50 micromol/L (indicating the consumption of at least 5 servings of fruits and vegetables per day). The study found that the relative risk of developing a stroke is inversely related to the number of health behaviours. Compared to those with 4 health behaviours, the relative risk for stroke for both men and women in those with 3 health behaviours was increased by 15%. The increase was 58% for those with 2 health behaviours, 118% for 1 health behaviour and 131% for those without any health behaviours.

The most well known side effect of smoking is lung cancer. Not smoking at all certainly stops you from having an increased chance of developing lung cancer. Not smoking will also save you money and stop you from smelling like an ashtray when you walk near someone. Now, we know that not smoking would also reduce your risk of developing a stroke. Eating a healthy amount of fruits and vegetables daily coupled with daily exercise are part and parcel of a healthy lifestyle. Instead of taking the elevator to go up a couple of floors, take the stairs instead. You will be surprised how easy it is for you to get enough daily physical activity to put you into the physically active category. Finally, if you like your daily dose of wine, keep to less than 2 glasses per day.

See how easy it is to practice the 4 health behaviours. Don’t think about adopting the 4 health behaviours, just do it! This may just save you from developing a debilitating stroke or, worse still, a fatal one.