Joy . . . or Pain?

How to further reduce disability and morbidity -- especially as they apply to you? Below are nine simple (if difficult) suggestions you can adopt, starting in the next half-hour, that science has linked to a longer, healthier life, or to a reduced risk for deadly disease. If you feel you've heard some of them before, don't blame us: Facts are stubborn things.

Exercise Daily

Reams of research suggest regular physical activity retards bodily decline, though the precise mechanism by which it might do that remains a mystery. Rigorous activity helps circulate blood throughout the body's tissues and organs, delivering nourishment and removing impurities. Exercise also helps maintain weight in a healthy range. Epidemiological studies associate a body mass index of 27 or greater (27.8 for men and 27.3 for women) with increased sickness and death.

Some good research connects aerobic capacity with living longer. A 2002 study in the New England Journal of Medicine looked at 6,213 men with and without coronary artery disease. It showed a 12 percent improvement in survival for every unit of metabolic capacity increased through endurance training.

In a 1999 study in the Journal of the American Medical Association (JAMA), low levels of fitness increased men's risk of death from cardiovascular disease by about five times; overall risk of death from all causes increased about three times.

Experts also know muscle strength and balance can help protect against falls and related injuries that can compromise independence and, in the very old, lead to death.

More definitive data on fitness's protective benefits on life span is expected. NIA is developing a randomized trial to study how exercise affects people's risk for disabilities. This will be the first direct test of its kind to show "whether we can actually prevent decline in the living community," said Hodes.

Until that study's findings appear, make sure you get the Surgeon General's recommended 30 minutes of vigorous exercise daily. And read today's Lean Plate Club column for thoughts about incorporating strength training into your life.

Refine Your Fuel

Fifty years ago, 10 percent of Americans were obese. By 2000, 33 percent were. The increase, most of it in the last 10 years, translates into hundreds of thousands of deaths a year. Obesity is linked to type 2 diabetes, heart disease and 20 percent of all cancers.

The key to fighting obesity? Increase intake of fresh fruit, vegetables and whole grains, dump the junk foods and sugary sodas, watch your body mass index and cut portion sizes, say nutrition researchers. Of course, the most important factor in weight control is balancing calories in and calories out. (See "Exercise Daily," above.)

Additionally, studies associate diets high in fiber and low in saturated fat with longer, healthier lives. A recent UCLA study, presented July 13 at the International Research Conference on Food, Nutrition, and Cancer, showed that such diets also lower breast cancer risk and slow tumor cell growth. Last fall a study in JAMA offered strong support for the Mediterranean diet, based on grains, olive oil, vegetables, fruits and fish. The study followed more than 2,300 healthy men and women ages 70 to 90 for 10 years; those who combined such a diet with about 30 minutes of daily exercise, moderate drinking and not smoking were more than 50 percent less likely to die from any cause.

Can you go further? You've probably heard about promising research, in animals and to some early degree in humans, about benefits of severe caloric restriction -- say, cutting daily calories by about a third. Case Western Reserve's Whitehouse said the results on smaller caloric-restriction studies in humans have been stunning: Cholesterol levels, blood pressure and other major risk factors for heart disease plummeted, along with risk factors for diabetes. But this kind of diet is very hard to sustain, may compromise nutrition and isn't proven yet.

Supplementing some vitamins and minerals is also critical as you age and lose some of your ability to produce them or absorb them from foods, according to the National Academy of Sciences (NAS). Vitamin B-12 helps protect against anemia and neurological disorders; it's also been shown to lower levels of the amino acid homocysteine, associated with risk of heart disease, stroke, Alzheimer's disease, Parkinson's disease and osteoporosis. Calcium helps protect against osteoporosis, colorectal cancer and cardiovascular disease. It also helps lower blood pressure and cholesterol levels. Recent evidence suggests that Vitamin D, a preserver of bone health, may also help protect against breast, colon and prostate cancer.