Evidence
Alert

Healthy lifestyles increase life expectancy in people with multiple conditions (multimorbidity) by as much as in other groups

Regular exercise and a balanced diet can help overcome the negative impact of long-term diseases on life expectancy. A major new study found that middle-aged people who have multiple long-term conditions (multimorbidity) can expect to live an extra 6-7 years if they adopt a healthy lifestyle. 

The research includes data on almost half a million people. It is the first study to show that the well-known benefits of a healthy lifestyle extend to people with multiple conditions. Having two or more long-term conditions such as diabetes, depression, and high blood pressure, is known to reduce life expectancy. The new results show a healthy lifestyle can offset that effect.

The results are drawn from the UK Biobank project – an ongoing effort to track the health of some 500,000 people. The study estimated the years a healthy lifestyle could add to life expectancy overall. It also looked at the contribution of individual healthy behaviours, such as taking regular exercise.

What’s the issue?

People who engage in a healthy lifestyle, such as eating a balanced diet, taking regular exercise, and avoiding smoking and excess alcohol consumption, incur many health benefits, including a longer lifespan. 

It was not previously known if this benefit was also seen in people living with multiple conditions. Multimorbidity is the presence of two or more long-term conditions, ranging from anxiety and eczema to cancer and schizophrenia. It has become a major worldwide epidemic. People with multiple conditions have poorer health and a higher risk of death compared with others in the population. 

Researchers compared the impact of a healthy lifestyle on life expectancy in people with and without multiple conditions. It was the first study to be able to look at the impact of different lifestyle factors.

What’s new?

The study used the UK Biobank to collect data on participants’ health and lifestyle factors. The Biobank includes information on 480,940 adults, average age 58 years, and in this study, they were followed for an average of seven years. 

The most common condition was high blood pressure, affecting almost one in three men (29.6%) and slightly fewer (22.7%) women. Asthma, cancer, diabetes, angina, depression and migraine were also common. One in five people, or 93,746 in all, had at least two long-term conditions, and were classed as having multiple conditions. 

The study considered four lifestyle factors: physical activity, smoking, diet (fruit and vegetables) and alcohol consumption. The authors estimated the life expectancy of participants and adjusted the results for factors such as deprivation, body mass index and ethnicity. They compared the life expectancy of people with and without multiple conditions.

The researchers found that healthy lifestyles led to similar increases in life expectancy, whether or not someone had multiple conditions. The healthier the lifestyle, the greater the increase in life expectancy.  

The study found that:

    • for those without multiple conditions, a very healthy lifestyle increased average life expectancy at age 45 by 7.6 years in men and 6.5 years in women - compared with the unhealthiest lifestyles
    • for those with multiple conditions, the same lifestyle brought a similar gain in life expectancy: 6.3 years in men and 7.6 years in women 
    • smoking was the most influential lifestyle factor: at 45 years old, smokers would be expected to live 5-6 years less than non-smokers
    • regular physical activity boosted life expectancy by between 0.9 years (in women without multiple conditions) and 2.5 years (for men with multiple conditions)
    • healthy diet and alcohol intake showed less certain effects on life expectancy. 

Overall, the researchers concluded that a healthy lifestyle can reduce the impact of multiple conditions on life expectancy.

Why is this important?

The key finding is that a healthy lifestyle is equally important for everyone, whether they have multiple conditions or not. Age is a strong risk factor; even so, young and middle-aged adults who live in deprived areas are the most likely to have multiple conditions. Engaging in a healthy lifestyle could be more difficult for people in this group. 

The study also found that certain lifestyle factors, such as smoking and physical activity, were more damaging than others. Public health policies and healthcare professionals could therefore focus on these lifestyle habits. This study suggests this approach would have more impact than costly strategies to address multiple risk factors.

What’s next?

Reporting the number of years of life that could be gained through healthy living, provides a strong and clear message. It could motivate people with multiple conditions to make changes to their lifestyle. Public health campaigns could use the numbers from this study to help communicate the importance of not smoking, and of taking regular exercise.

Future research could look at clusters of conditions: lifestyle factors could have a different impact on someone with heart disease and diabetes, compared to someone with depression and migraine. 

Most participants in this study (94.8%) were White British, who have a longer life expectancy than the whole population. Further work could look at lifestyles among more diverse groups, in which more years are likely to be gained by healthy living.

Other lifestyle factors that could have an independent impact on life expectancy should be considered. They include sleep, time spent being inactive, and the consumption of red and processed meat, sodium and sugary drinks. Prioritising research on lifestyle behaviours among people with multiple conditions could improve the health of the population and decrease pressure on the NHS. 

You may be interested to read

The full paper: Chudasama Y, and others. Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: a longitudinal cohort study. PLOS Medicine 2020;17:9  

A call for action on multimorbidity by UK Governments and Royal Colleges: Whitty C, and others. Rising to the challenge of multimorbidity. BMJ 2020;368:l6964 

A report by the Academy of Medical Sciences on multimorbidity, which summarises the existing evidence about the burden, determinants, prevention, and treatment of multimorbidity, as well as identifying areas of weakness in which further research is required

Funding

This project was supported by NIHR Applied Research Collaboration (ARC) East Midlands. 

Commentaries

Study author

The findings were surprising, as we found that even though participants had multimorbidity, those adhering to a healthier lifestyle had very similar benefits on their predicted longevity to those without multimorbidity. Reflecting that it’s always worthwhile making healthy lifestyle changes. As a result of this study, we found that it is important to prioritise research on multimorbidity and modifiable lifestyle behaviours as this would positively impact the population’s health and wellbeing.

Yogini Chudasama, Epidemiologist, University of Leicester 

The Richmond Group 

This study’s findings demonstrate how it’s possible to improve life – and life expectancy – for people living with multiple conditions. This is good news but it throws down the gauntlet as Integrated Care Systems develop their plans to improve population health and primary care networks embed new ways of working.

As the study notes, economic and other circumstances can have a big impact on people’s ability to change the way they eat and move. People need to be able to afford to eat healthily, so income and employment will be key ingredients in enabling people with multiple conditions to improve their health in these ways.

It’s also important that professionals and services don’t respond to this research by lecturing people. We know from the insight work that has driven our We Are Undefeatable campaign, inspiring and supporting physical activity for people with health conditions, that people with long-term conditions understand how and why activity can help them but they need personalised support and motivation as they begin to be active or to increase their activity levels.

The voluntary sector will have a key role to play in making use of this study’s findings, including by acting in partnership with social prescribers.” 

Neil Tester, Director, The Richmond Group of Charities 

Lived experience 

I have several conditions and I found this research encouraging. It is never too late to improve your life chances! These results could potentially encourage people to take more care of themselves and make healthy choices. There is a clear message to pass on to smokers in particular about the real difference that quitting makes.

Public health campaigns at local and national level could help ensure that the evidence is put out as simple but effective messages to patients and professionals.

Helen McGregor, Canterbury 

Researcher 

Based on the large and enriched UK biobank data, this paper provides good evidence that a healthier lifestyle is consistently associated with a longer life expectancy. The association holds across various individual risks and irrespective of the presence of multiple long-term medical conditions. 

The robust estimates will help policy makers develop guidelines and implement strategies for health promotion and the management of multiple conditions. They will also inform a wider range of the public of the benefits of adopting healthier habits in daily life.

Ling Yang, Senior Research Fellow, University of Oxford 

Conflicts of Interest

Several authors have received funds from pharmaceutical companies.