5 Things About the Impact of Health-Protective Behaviors

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Exercise and healthy eating can have substantial impacts on reducing the risk of or managing serious chronic health conditions. However, in order to see the benefits of these health-protective behaviors, patients need to perform them consistently.

Exercise and healthy eating can have substantial impacts on reducing the risk of or managing serious chronic health conditions. However, in order to see the benefits of these health-protective behaviors, patients need to perform them consistently.

In a new Viewpoint published in JAMA,1 Genevieve F. Dunton, PhD, MPH, highlighted the lack of evidence on interventions to maintain these behaviors over sustained periods of time.

“There is limited evidence on how to help individuals avoid temporary lapses in behavior,” she wrote. “Declines in healthy behaviors, even for short periods of time, can have negative health consequences and can increase vulnerability to permanent failure to reengage in the behavior (ie, relapse).”

Here are 5 things about health-protective behaviors and challenges to sustaining them.

1. The challenges with low-income populations and minorities

The stresses that low-income populations and minorities face throughout their lives lead to poorer health outcomes compared with wealthy, white individuals. These large inequalities in mental and physical health and hard to overcome as the stress these populations feel can lead to unhealthy behaviors.

A report from the American Psychological Association noted that the stress African Americans, US-born Hispanics, and low-income individuals feel is associated with lack of exercise, among other unhealthy behaviors, like smoking and drinking. The result is that men in the top 1% of income in the American population were living 15 years longer than the men in the bottom 1% in 2016. For women, there was a 10-year difference.


2. Benefits of diet and exercise for seniors

Exercise and diet can significantly impact aging and cognitive abilities. People over the age of 65 who were more active (exercising 3 or more times a week) had a 32% reduction in risk of dementia, according to results discussed at the 2017 Neuroscience Educational Institute Congress. Diets high in fruit, vegetables, legumes, and nuts, and low in red or processed meats were also associated with slower cognitive decline and better cognitive function.

A Gallup poll from 2017 found that older Americans who exercise more (3 days a week) were 42% less likely to be diagnosed with depression and 27% less likely to experience daily stress. The findings indicate that it’s important to encourage seniors to keep moving as they age.

3. Impact of diet and exercise on heart conditions

The evidence of the positive impact of diet and exercise on patients with heart conditions is well documented. Clinical guidelines suggest that physical activity after an acute coronary syndrome (ACS) event can help prevent a reoccurrence. However, research published2 in the Journal of the American College of Cardiology found that only 16% of patients discharged from the hospital after ACS had met guideline recommendations by the fifth week after discharge. More than half (56.5%) had no exercise by the fifth week.

Christi Deaton, PhD, RN, FAHA, FESC, of the University of Cambridge, explained that it’s important that physicians simply ask about physical activity and diet. She has found that patients often aren’t asked at all if they are being more active.

4. Exercise has a powerful impact on patients with cancer

Research has also shown that exercise can be effective for patients with cancer. For instance, a review3 of several treatments for cancer-related fatigue found that exercise was one of the more effective. Exercise and psychological interventions resulted in greater improvements than even pharmaceutical regimens.

A separate literature review4 found that of all lifestyle changes to reduce the risk of recurrence or death, exercise was the strongest protective factor for women diagnosed with breast cancer. The review assessed studies on the association between recurrence or mortality and factors like diet, exercise, weight loss, smoking, alcohol, and vitamin intake. The impact of exercise was even stronger for postmenopausal women, women with a body mass index above 25, and women who met the recommended levels of activity.

5. How to increase health-protective behaviors?

The use of gaming elements, called gamification, is becoming an increasingly popular way to increase the amount of physical activity among Americans. JAMA Internal Medicine published findings5 from a randomized clinical trial testing gamification as an intervention. The study found that patients in the gamification arm achieved step goals at a higher proportion than the control arm and that the gamification arm had a greater change in mean daily steps. The results support the notion social incentives can be successfully leveraged to change health behaviors.


1. Dunton GF. Sustaining health-protective behaviors such as physical activity and healthy eating. [published online May 31, 2018]. JAMA. doi:10.1001/jama.2018.6621.

2. Kronish IM, Diaz KM, Goldsmith J, Moise N, Schwartz J. Objectively measured adherence to physical activity guidelines after acute coronary syndrome. J Am Coll Cardiol. 2017;69(9):1205-1207. doi: 10.1016/j.jacc.2016.10.087.

3. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961-968. doi: 10.1001/jamaoncol.2016.6914.

4. Hamer J, Warner E. Lifestyle modifications for patients with breast cancer to improve prognosis and optimize overall health. CMAJ. 2017;189(7):e268-e274. doi: 10.1503/cmaj.160464.

5. Patel MS, Benjamin EJ, Volpp KG, et al. Effect of a game-based intervention designed to enhance social incentives to increase physical activity among families: the BE FIT randomized clinical trial. JAMA Intern Med. 2017;177(11):1586-1593. doi: 10.1001/jamainternmed.2017.3458.