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People with bad health habits that they will not or cannot abandon often make excuses: "What's the point of living longer -- you'll only spend more years in a nursing home?" or "A healthy life really isn't any longer, it just seems that way."

Perhaps the saddest excuse of all dates back to 1964 when the Surgeon General issued the first report on smoking and health. Diehard smokers told me, "By the time I get lung cancer, they'll know how to cure it." If only that had happened. But 34 years later we are hardly closer to curing lung cancer than we were then.

The fact is none of these excuses hold up under the scrutiny of sound medical research, and a recently published study of more than 1,700 men and women followed for 32 years puts the lie to them all.

The study, published in April in The New England Journal of Medicine, clearly showed that people with healthier habits not only live longer, they live better, experiencing only half as much chronic disability as their less-prudent age mates.

The findings strongly suggest that vitality into one's later years is less a matter of genes and more a question of how a person chooses to live. Those who smoked the least, stayed trim and exercised regularly not only lived longer but were less likely to develop disabilities. Even among participants who died, the low-risk people had shorter periods of disability before dying.

Changing Mortality Curve

In 1980, Dr. James Fries, professor of medicine at Stanford University, published a provocative article suggesting that preventive health practices would keep Americans healthier longer and change the shape of the nation's disability and death curve from one that resembles a water slide to one that looks more like a cliff.

According to his "compression of morbidity" hypothesis, most Americans, instead of experiencing a more-or-less steady rate of increasing disability and deaths starting at mid-life, could live reasonably well into their 80's, before they begin to die at an accelerated rate.

To put it another way, if people could be persuaded to choose more prudent health habits, the majority would reach their ninth decade in good health and then die after, at most, a relatively brief period of illness.

But some skeptics challenged Fries, suggesting instead that practicing good health habits, while likely to add years to life, would also swell the number of years during which people are beset by chronic illness and disability. If true, critics said, this would further overwhelm an already overburdened system struggling to care for millions of elderly Americans with costly, debilitating, lingering health problems.

Healthy Habits Do Pay

Now, nearly two decades after Fries's proposal, he and his colleagues have data that dispute the naysayers. According to their new findings, living healthfully would not only add years to life, it would also add life to years, keeping people well and able to enjoy life far longer than they otherwise might have.

Although the participants' average age was only 75 at the last assessment, there is every indication that those with healthy habits will on average remain in better health however long they live. Those whose habits put them at lowest risk for health problems delayed the average age at which they developed even minimal disability by nearly seven years -- to age 73 as against age 66 for those at highest risk.

The researchers tracked 1,741 men and women who graduated from the University of Pennsylvania in 1939 and 1940. These alumni were surveyed by other researchers at the time of graduation and again in 1962, 1976 and 1980 before the Stanford team took over and reassessed their health habits and health status annually for seven years starting in 1986.

Participants were classified as being at high, moderate or low risk based on three modifiable factors known to contribute to poor health: cigarette smoking, excess weight and inactivity. At every assessment -- even when the participants were only about 43 years old -- those at highest risk were more likely to report disabilities than those at moderate risk, who in turn had more disabilities than those at low risk.

The authors emphasize that for the overwhelming majority these risk factors are matters of personal choice. But it is all too obvious that a growing number are making the wrong choices.

Although tens of millions of adults have quit smoking in the last 34 years, we now face the chilling fact that as many as 40 percent of students in some high schools are smoking. The tobacco industry has been particularly successful in hooking teen-age girls and young blacks on this noxious weed. And if you think young Americans smoke too much, in many European countries it is hard to find any young person without a cigarette.

Obesity, too, is a growing concern. Americans on the whole are fatter now than at any time in our history. People tend to blame the ready availability of high-calorie foods and the constant temptation to eat too much, especially too much fatty, sugary foods. Few seem to have the will to resist overindulging.

But the food supply and eating habits are not the only culprits. Inactivity has a major, deleterious influence on the weight of Americans. Having created a society replete with labor-saving devices, we failed to compensate adequately for our relative inactivity by building more exercise into our daily routines and leisure time.

Only about one American in five gets enough exercise to keep weight down and health up. And there is virtually no physical activity in the lives of 60 percent of Americans, whose exercise consists of little more than pressing a finger to the television remote.

Yet, those who exercise regularly weigh less and are better able to achieve and maintain weight loss. Thus, in addition to its direct health benefits, for example, in preventing cardiovascular diseases and cancer, exercise can help control weight.

Other factors not assessed in the Fries study also influence health. But the people who stayed trim and exercised, in all likelihood, regularly ate more healthfully as well. I think you get the point: at any stage of life, it pays to pay attention to preventive health practices. Good health and longevity are largely in your hands.

LIVING LONGER, LIVING BETTER

A study of University of Pennsylvania graduates, classes of 1939 and 1940, indicates that those who practice healthy habits stay free of disabilities longer. Class members were divided into low, moderate and high risk groups based on weight, exercise and use of tobacco.

Those groups then were rated on a disability index based on eight basic tasks: dressing and grooming, arising, eating, walking, bathing and other hygiene, reaching, gripping and executing basic chores. A score of 0.1 indicates some difficulty in performing one of the tasks. A score of 1.0 means some difficulty performing all eight tasks. And the maximum score of 3.0 indicates inability to perform all eight tasks.

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Sources: Dr. Anthony J. Vita and Dr. Raymond R. Balise

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