Understanding the Impact of Lifestyle on Chronic Diseases

Dr Ray O’Connor takes a look at the latest clinical articles on the importance of lifestyle in general health, including the impact of sedentary behaviour

Lifestyle Update (Part 2)

There is a lot of new material appearing regarding the importance of lifestyle factors in both causing and treating ill-health. Hence the third update in two months.

Although individual risk factors have been linked to specific diseases, the cumulative effect of life-course factors on the accumulation of multiple chronic diseases is unclear. This longitudinal cohort study aimed to quantify the extent to which measured and unmeasured factors explain disease burden across eight major organ systems.

The authors carried out a longitudinal analysis of a population-based birth cohort of individuals born at Helsinki Finland between 1934 and 1944. They tracked chronic disease accumulation for 30 years from hospital inpatient and outpatient records. Measured life-course factors (including age, sex, early life factors, adult lifestyle, clinical characteristics, biomarkers, and socioeconomic status) were assessed from birth until late midlife.

They included data from 2003 people. Their findings were that although conventional, modifiable risk factors, particularly Body Mass Index (BMI), fasting blood glucose, and systolic blood pressure, emerged as key drivers of chronic disease across multiple systems, there was also substantial unexplained variance. This evidence underscores the importance of controlling established modifiable risk factors (ie, BMI, blood pressure, and glucose) across the life course to slow or prevent multimorbidity. However, the substantial contribution of unmeasured factors indicates that known risk factors alone cannot fully explain multimorbidity.

The authors recommend that future work should focus on uncovering additional, potentially modifiable drivers of chronic disease, ranging from biological to environmental and psychosocial domains. They suggest employing integrated prevention and intervention strategies, beginning early in life and continuing through adulthood, to reduce the global burden of multimorbidity.

Intrinsic capacity is a term that describes the composite of all the physical and mental capacities of an individual. It has been proposed by WHO as a marker of healthy ageing. However, the association of movement behaviours (physical activity and sedentary behaviour) with intrinsic capacity remains largely unexplored. The Seniors-ENRICA-2 prospective, population-based study included a cohort of male and female community-dwelling older adults aged 65–94 years living in Spain.

It’s aim was to analyse the association of movement behaviours with intrinsic capacity in older adults. Accelerometer-based levels of sedentary, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed at baseline. 3,273 participants were recruited. 2,477 (75⋅7 per cent) of 3,273 participants had complete data for movement behaviours and intrinsic capacity at baseline and were therefore included in the analyses. 1,314 (53⋅0 per cent) of 2,477 participants were female and 1,163 (47⋅0 per cent) were male. 1,463 (59⋅1 per cent) participants provided follow-up data over a median of 2⋅3 years and 940 over 5⋅5 years.

The findings were that, not surprisingly, sedentary behaviour was associated with a reduction of intrinsic capacity. MVPA improved intrinsic capacity. However light physical activity (LPA) led to no such improvement. These findings support the importance of promoting physical activity, especially MVPA and reducing sedentary behaviour for healthy ageing.

Sedentary behaviour may be a modifiable risk factor for Alzheimer’s disease (AD). The authors of this study examined how sedentary behaviour relates to longitudinal brain structure and cognitive changes in older adults. The study was part of the Vanderbilt Memory and Aging Project. 404 participants completed regular actigraphy, neuropsychological assessment, and brain MRI over a 7-year period.

Their findings were that greater sedentary time related to a smaller AD neuroimaging signature and worse episodic memory. The authors concluded that their findings support the importance of reducing sedentary time, particularly among aging adults at genetic risk for AD. Their findings also seem to establish sedentary behaviour as an independent risk factor for Alzheimer’s disease.

Preclinical and observational studies suggest that exercise may improve cancer outcomes.

In this phase 3, randomized trial conducted at 55 centres, the authors assigned patients with resected colon cancer who had completed adjuvant chemotherapy to participate in a structured exercise program (exercise group) or to receive health-education materials alone (health-education group) over a 3-year period. The primary end point was disease-free survival.

From 2009 through 2024, a total of 889 patients underwent randomization to the exercise group (445 patients) or the health-education group (444 patients). At a median follow-up of 7.9 years, disease-free survival was significantly longer in the exercise group than in the health-education group.

The hazard ratio for disease recurrence, new primary cancer, or death was 0.72. Also, the 8-year overall survival was 90.3 per cent in the exercise group and 83.2 per cent in the health-education group. The authors conclusions were that a 3-year structured exercise program initiated soon after adjuvant chemotherapy for colon cancer resulted in significantly longer disease-free survival and findings consistent with longer overall survival.

So having established how important PA is in older age groups, how challenging is it to get older adults to engage in the practice? This qualitative study aimed to explore the acceptability of a 12-week intervention to reduce sedentary behaviour (SB) for ethnically diverse sedentary older (aged >65 years) adults (OAs.

The intervention consisted of a 40–60 minute personalised one-to-one in-person health coaching session, a wearable activity tracker to remind participants to take breaks from prolonged sitting time, a pamphlet and weekly reminder messages via a mobile phone. The primary outcome was to assess the acceptability of the intervention.

The findings of this study support the acceptability of the intervention and therefore will inform a future effectiveness trial conducted by the same group of researchers.

References:

According to the source: Irish Medical Times.