Research Article: Combined Impact of Traditional and Non-Traditional Healthy Behaviors on Health-Related Quality of Life: A Prospective Study in Older Adults

Date Published: January 25, 2017

Publisher: Public Library of Science

Author(s): Ana Bayán-Bravo, Raúl F Pérez-Tasigchana, Carmen Sayón-Orea, David Martínez-Gómez, Esther López-García, Fernando Rodríguez-Artalejo, Pilar Guallar-Castillón, Hemachandra Reddy.


Combined exposure to several healthy behaviors (HB) is associated with reduced mortality in older adults but its impact on health-related quality of life (HRQL) is uncertain. This is a cohort study of 2,388 individuals aged ≥60 recruited in 2000–2001, whose data were updated in 2003 and 2009. At baseline, participants reported both traditional HB (non-smoking, being very or moderately active, healthy diet) and non-traditional HB (sleeping 7–8 h/d, being seated <8 h/d, and seeing friends every day). HRQL was measured with the SF-36 questionnaire at baseline, in 2003 (short-term) and in 2009 (long-term); a higher score on the SF-36 represents better HRQL. Linear regression models were used to assess the association between HB at baseline and HRQL in 2003 and 2009, with adjustment for the main confounders including baseline HRQL. In the short-term, being physically active, sleeping 7–8 h/d, and being seated <8 h/d was associated with better HRQL. Compared to having ≤1 of these HB, the β (95% confidence interval) for the score on the physical component summary of the SF-36 in 2003 was 1.42 (0.52–2.33) for 2 HB, and 2.06 (1.09–3.03) for 3 HB, p-trend <0.001. Corresponding figures for the mental component summary score were 1.89 (0.58–3.21) for 2 HB and 3.35 (1.95–4.76) for 3 HB, p-trend <0.001. Non-smoking, a healthy diet or seeing friends did not show an association with HRQL. In the long-term, being physically active was the only HB associated with better physical HRQL. As a conclusion, a greater number of HB, particularly more physical activity, adequate sleep duration, and sitting less, were associated with better short-term HRQL in older adults. However, in the long-term, being physically active was the only HB associated with better physical HRQL.

Partial Text

There is evidence of the benefits of a healthy lifestyle in old age. Specifically, several healthy behaviors (HB), including traditional factors (non-smoking, physical activity, and healthy diet) and non-traditional factors (adequate sleep duration, avoiding sedentariness, and a good social network) have been associated with reduced mortality in older adults; moreover, there is an inverse dose-response between the number of HB and mortality.[1]This approach, that considers the combined exposure to several HB, is relevant because it captures their synergistic impact; in fact, HB do not occur in isolation, but they aggregate in the population.[2–4]

Informed consent was given by each participant in the study. The research protocol was approved by the Clinical Research Ethics Committee of “La Paz” University Hospital in Madrid, Spain. All the participants gave written consent.

At baseline, men scored higher than women in all SF-36 scales and summaries. Higher education and higher alcohol intake were also associated with better HRQL. By contrast, individuals with extreme sleep duration, general or abdominal obesity, and the rest of morbidities had lower scores on HRQL (Table 1).

Among older adults in Spain, a greater number of traditional and non-traditional HB (being active, adequate sleep duration, and being non-sedentary) were linked to better short-term HRQL. Also, being physically active showed a long-term association with better HRQL. However, several HB that in previous studies were associated with lower mortality, such as non-smoking, a healthy diet, or frequent contact with friends and neighbors, did not show a relation to HRQL.




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