# Exercise as it relates to Disease/Lifestyle factors effecting people developing multiple chronic diseases

This is an analysis of the journal article "Lifestyle factors & multi morbidity: a cross sectional study" by Fortin et al. (2014).

## What is the background to this research?

The Australia Institute of Health & Welfare have defined chronic disease as "a physical or mental disturbance involving symptoms, dysfunction or tissue damage that may lead to ill health." Chronic diseases are the leading cause of disability and was accountable for 90% of all deaths in Australia in 2011. With changing lifestyles, ageing population and an increased likelihood of an individual having more than 1 chronic illness at the same time, chronic diseases are a health concern for all nations.
As a result of global concern over chronic diseases, the importance of lifestyle factors in health and disease has been the subject of many studies. A overwhelming size of the studies undertaken in this subject, have reported that lifestyle factors are correlated to many chronic diseases. Previous studies have analysed individual lifestyle factors in individual chronic disease and the morbidity and mortality risks associated with each chronic disease. But the association of multiple unhealthy lifestyle factors in an individual and multi-morbidity has not been researched.

## Where is the research from?

Fortin et al from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) conducted this research through Quebec, Canada supported but he Canadian Institute of Health & Research (CHR).

## What kind of research was this?

This is a cross sectional analysis, which is a type of observational study. The research used self-reporting questionnaires to collect the data.

## What did the research involve?

A random sample of 2000 males and females telephone numbers were provided by a survey firm. Surveyors selected the adult in the household with the most recent birthday to ensure random selection. Written & oral questions were provided to participants in English or French who were aged between 25 and 75 years of age. Following a socio-demographic survey, participants completed a self administered questionnaire regarding illness burden and lifestyle factors. Socio-economic status, chronic conditions and lifestyle factors were all defined and scaled using a Disease Burden Morbidity Assessment by self report and a Behavioural Risk Factor Surveillance System Questionnaire.
| Questionnaires | Information Collected |
| Socio-demographic | Age, gender, family income, education |
| Socio-economic | Elite group, middle-high, middle-low, low |
| Chronic conditions | Hypertension, elevated cholesterol, asthma, chronic obstructive pulmonary disease, diabetes, thyroid disorder, osteoarthritis, rheumatoid arthritis, osteoporosis, colon problem, angina/coronary artery disease, stroke, congestive heart failure, and cancer |
| Lifestyle factors | Smoking habit, alcohol consumption, fruit and vegetable consumption, physical activity and body mass index (BMI) |

## What were the basic results?

Fortin et al received 1,718 questionnaires back, and of those 1,196 questionnaires were submitted by adults 45 or older. 46.7% of men & 52.7% of females have multiple chronic diseases. Males and Females returned different results for lifestyle factors that were significantly different, except for physical activity.
Both physical activity and alcohol consumption were found to have no association with multi-morbidity in either males or females, as was fruit and vegetable consumption. However a low or high BMI was found to have an association with and increased probability of multi-morbidity in both genders. Smoking now or in the past was found to have an association with multi-morbidity in males but not in females.
This study found that the combination of multiple unhealthy lifestyle factors significantly increases the likelihood of multi-morbidity dramatically. Females who have a minimum of two unhealthy lifestyle factors were linked to increased risk of multi-morbidity. Where as males chances of multi-morbidity were only significantly increased when four or five unhealthy lifestyle factors were present.

## Practical Advice

It is clear that the extent of unhealthy risk factors in individuals may alter, depending on each specific individuals situation. The research supports the promotion and integration of positive healthy lifestyle factors in minimising the occurrence of multiple chronic diseases. Although unable to provide any interventions due to the study being of an observational nature, researchers highly recommend individuals with unhealthy lifestyle factors to their doctor or a qualified health professional. Individuals will be provided with the intervention strategies that will aid them in developing healthy lifestyle factors and in turn minimising the risk of developing multiple chronic diseases.

## What conclusions should be taken away from this research?

Unhealthy lifestyle factors are associated with multi-morbidity, however a combination of unhealthy lifestyle factors can significantly increase an individuals likelihood of contracting multiple chronic diseases.
With a variety of studies in this field supporting similar results, indicating that a combination of lifestyle factors leads to multi-morbidity. Although interventions and preventions have not been studied in-depth in this field, the similar results across studies may be used to hypothesis that the promotion of healthy lifestyle factors could be an intervention in minimising the likelihood multi-morbidity in individuals.

## What are the implications of this research?

Given the cross-sectional design of the study researchers were unable to make a causal inference. With the results of this study being specific to the Canadian population and due to its self reporting nature, it has been suggested that more studies in other regions would need to be undertaken to identify if the findings are similar or different depending on population.
However it is clear that although risk factors for individuals may have been identified, the prevention and intervention strategies for each individual is likely to be different and so may the extent of each risk factor. Individuals concerned with unhealthy lifestyle factors that may be attributed to them and prevention methods should contact their doctor or qualified health professional.

## Further reading

For further information regarding the association between unhealthy lifestyle factors and multi-morbidity; click on the links below.
* Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases: http://onlinelibrary.wiley.com/doi/10.1111/sms.12581/abstract;jsessionid=0554CCA9EAEAAEC74F67105512735852.f01t02
* Australia's health 2014: http://www.aihw.gov.au/publication-detail/?id=60129547205
* Risk factors contributing to chronic disease: http://www.aihw.gov.au/publication-detail/?id=10737421466

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 Fortin M, Haggerty J, Almirall J, Bouhali T, Sasseville M, Lemieux M, (2014) Lifestyle factors and multi-morbidity: a cross sectional study. Biomedcentral Public Health 1(1):1-8
* ↑ Australian Institute of Health & Welfare (AIHW). (2014) About chronic diseases. Available from: http://www.aihw.gov.au/chronic-diseases/about/
* 1 2 Australian Institute of Health & Welfare (AIHW) (2010). Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians. Cat. no. IHW 48. Canberra: AIHW.
* ↑ World Health Report 2002: reducing risks, promoting healthy life. Available: http://www.who.int/whr/2002/en/Overview_Epdf
* ↑ Bayliss E, Ellis J, Steiner J (2009). Seniors' self reported multi morbidity captured biopsychosocial factors not incorporate into two other data-based morbidity measures. J Clin Epidemiol. 62: 550-557
* ↑ Poitras M, Fortin M, Hudon C, Haggerty J, Almirall J (2012). Validation of the disease burden morbidity assessment by self-report in a French-speaking population. BMC Health Serv Res. 12:35