Association Between Healthy Lifestyle Practices And Life .

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Hirooka et al. BMC Public Health(2021) SEARCHOpen AccessAssociation between healthy lifestylepractices and life purpose among a highlyhealth-literate cohort: a cross-sectionalstudyNobutaka Hirooka*, Takeru Kusano, Shunsuke Kinoshita, Ryutaro Aoyagi and Nakamoto HidetomoAbstractBackground: The national health promotion program in the twenty-first century Japan (HJ21) correlates lifepurpose with disease prevention, facilitating the adoption of healthy lifestyles. However, the influence of clusteredhealthy lifestyle practices on life purpose, within the context of this national health campaign remains uninvestigated.This study assessed the association between such practices and life purpose, in line with the HJ21.Methods: We performed a nationwide cross-sectional survey on certified specialists in health management.Participants’ demographic information, lifestyle, and purpose in life were measured using a validated tool. The cohortwas median-split into two groups based on their clustered health-related lifestyle score. The values for health-relatedlifestyle and purpose were compared between the two groups and the correlation between health-related lifestyle andpurpose in life was measured.Results: Data from 4820 participants were analyzed. The higher-scoring health-related lifestyle group showed asignificantly higher life purpose than the lower group (35.3 vs 31.4; t 23.6, p 0.001). There was a significantassociation between the scores of clustered healthy lifestyle practices and life purpose (r 0.401, p 0.001). The higherscoring health-related lifestyle group achieved a higher life purpose than the lower-scoring group. This associationbetween healthy lifestyle practices and life purpose denotes a positive and linear relationship.Conclusions: Our results suggest that individuals who have a better health-related lifestyle gain a higher sense of lifepurpose. In other words, a healthy lifestyle predicts a purpose in life. Our findings posit that examining the causalrelationship between healthy lifestyle and purpose in life may be a more efficient approach toward health promotion.Keywords: Lifestyle, Health-related lifestyle, Purpose in life, Health literacyBackgroundSeveral studies have investigated the implications of lifepurpose, and literature has shown that a strong sense ofpurpose in life was positively associated with positivehealth outcomes [1–6]. Thus, having a sense of purposein life is a vital component of human life. Due to a* Correspondence: nkaorohi@saitama-med.ac.jpDepartment of General Internal Medicine, Saitama Medical University,Morohongo 38, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japanrapidly aging society in Japan, a national health promotion program in the twenty-first century—Health Japantwenty-first century (HJ21)—considers purpose in life asone of the major target goals of health promotion [7].Purpose in life is defined as “a self-organizing life aimthat stimulates goals” [1] and is known to promotehealthy behaviors and give life meaning [8, 9]. Ikigai is aJapanese word for what is considered an important factor for achieving better health and a fulfilling life [10]. The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver ) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.

Hirooka et al. BMC Public Health(2021) 21:820Ikigai is defined as something to live for, exemplifyingthe joy and the goal of living [11]. Although Ikigai maynot be fully comparable to purpose in life, it does contain the respective concept and plays a cardinal role inyielding positive health-related outcomes [12].Notably, health outcomes associated with life purposeor Ikigai include physical [1, 12, 13] and mental health[3, 13], quality of life [4], disease mortality [1, 12], andlongevity [12]. Possessing a strong sense of purpose inlife has been associated with a lower risk of mortalityand cardiovascular diseases [1] (relative risk: 0.83 and0.83, respectively). The study concluded that purpose inlife tends to yield health benefits. One of the mechanisms considered in the literature was the benefits associated with a healthy lifestyle. People who have adopteda higher purpose in life tend to follow healthier lifestylepractices, which may decrease the incidence of noncommunicable chronic diseases, such as cardiovasculardiseases or cancer.Healthcare personnel are responsible for the health oftheir patients. Studies have shown that healthcarepersonnel are more likely to encourage healthy lifestylebehaviors among their patients if they engage in suchbehaviors themselves. Our study population comprisescertified specialists in health management who routinelyprovide advice on health to individuals in their community. Investigating the relationship between lifestyle andpurpose in life among healthcare personnel, our targetpopulation, is therefore of great scientific interest.There is a hierarchy of causality among chronic diseases. Non-communicable diseases, such as diabetes,stroke, cancer, and coronary artery disease, have risk factors. In the case of risk factors, such as hypertension,smoking, dyslipidemia, hyperglycemia, studies typicallysignified proximal causes [14, 15]. A healthy lifestyle is acentral causality for these risk factors and thus basic lifestyle should be considered a fundamental and proximalrisk factor for the aforementioned non-communicablediseases. Studies also highlight that healthy lifestyle practices prevent many similar chronic diseases [16, 17], andthat intervening to promote healthier lifestyle decreasesmortality due to non-communicable diseases [18, 19].Hence, the notion that health benefits are broughtthrough a healthy lifestyle may be supported if the lifestyle strongly correlates with purpose in life.In this context, however, research exploring the association between purpose in life and healthy lifestyle practices remain scarce. Moreover, existing literature usuallyconsiders a single health behavior in relation to purposein life. To determine the relationship between purposein life and clustered health-related lifestyle—the fundamental and proximal cause of many health outcomes—the potential benefits of purpose in life towards diseaseprevention and health must be deciphered.Page 2 of 8This study aimed to investigate the association between health-related lifestyles, in line with the HJ21, andpurpose in life, measured with a validated tool to betterunderstand the relational mechanisms.MethodStudy designThe design was a cross-sectional study on a cohort ofnationwide certified specialists in health management.We surveyed health-related lifestyles similar to those inthe questionnaire used for the HJ21. Our questionnaireis based on the one of the oldest national health surveysaround the world, the National Health and NutritionSurvey conducted by Japanese Government [20]. Thissurvey is the oldest of all national health examinationsurveys currently conducted worldwide and serves as acomprehensive database for risk factors related to noncommunicable diseases in Japan. The survey includesquestions on demographic data and health-relatedhabits, such as physical activity and exercise, nutritionand diet, smoking, stress, and alcohol intake. Purpose inlife was measured with a validated tool in Japanese usingthe purposeful life scale (Ikigai-9) [21]. The ethics committee of the Saitama Medical University approved thestudy (ID: 896, 2018).ParticipantsStudy participants were certified specialists in healthmanagement who actively pursued professional growthprovided by the Japanese Association of PreventiveMedicine for Adult Disease [22]. This certification issponsored by the Ministry of Education, Culture, Sports,Science and Technology, Japan. We excluded specialistswho did not actively engage in continuing education orhealth promotion activities. These specialists are expected to engage the community and the society theylive in to promote health and wellbeing. Specialists inhealth management are certified in multiple processes ofstudy. Candidates study various aspects within thecourse, including health promotion, lifestyle-related diseases, mental health, nutrition, environment and health,physical activity and exercise, emergency medicine, lifesupport, and health care system. To register, candidatesmust pass the final written examination. The JapaneseAssociation of Preventive Medicine for Adult Diseaseencourages specialists to participate in numerous activitiesby facilitating health promotion workshops, speeches, andactivities after registration. Among these individuals whomet our inclusion criteria (N 9149), 4820 agreed to participate in the survey.Variables and measurementsVariables measured in this study were demographiccharacteristics; health-related habits, including physical

Hirooka et al. BMC Public Health(2021) 21:820activity and exercise, nutrition and diet, smoking, stress,and alcohol intake; and purpose in life. There wereeleven health-related lifestyle questions, of which fivewere two-scaled (“Intention to maintain ideal weight,”“Exercise,” “Alcohol intake,” “Manage lifestyle to preventdisease,” and “Smoking”). For these items, a score of “1”was assigned for an unhealthy lifestyle and a score of “4”was assigned for a healthy lifestyle. The rest of the sixhealth-related habits (“Reading nutritional informationlabels,” “Maintaining a balanced diet in daily life,”“Intention for exercise,” “Stress,” “Rest,” and “Sleep”)were to be answered on a four-point scale, from “4”(most favorable) to “1” (least favorable). Finally, weadded the values of each answer to the questions on thehealth-related lifestyle of the participants as their clusteredhealth-related lifestyle scores. To measure purpose in life,we used the Ikigai-9 scale, a validated tool to quantify purpose in life. The Ikigai-9 is a psychometric tool that measures across the dimensions of (1) optimistic and positiveemotions toward life, (2) active and positive attitudes towards one’s life, and (3) acknowledgement of the meaningof one’s existence [23]. The Ikigai-9 scale consists of ninequestions on various aspects of life purpose and eachquestion must be answered on a five-point scale, from “1”(Strongly disagree) to “5” (Strongly agree). These variablesand measurements were previously described elsewhere[24]. Considering the variables, age, weight, height, BMI,volume of alcohol intake, and purpose in life scores werenumeric. Sex, healthy lifestyle, smoking, alcohol intake,and stress comprised either binary or ordinal data.AnalysisDescriptive statistics (i.e., mean, standard deviation,range) were used to describe participants’ characteristics.The cohort was divided into two groups (i.e., a higherand lower group, with a cut-off using the median score)based on the clustered health-related lifestyle scores.The correlations between age and lifestyle score and between age and purpose in life score were analyzed. Thedifference in the Ikigai-9 score between the two clustered health-related lifestyle score groups was investigated. Further, the effect size of the difference in Ikigai-9score between the two groups was calculated with usingCohen’s d. The association between the clusteredhealth-related lifestyle score and the Ikigai-9 score wasalso analyzed as a bivariate correlation and a correlationcoefficient was calculated to see whether the healthrelated lifestyles accounted for life purpose. A multipleregression analysis was performed to determine the association between the clustered health-related lifestylescore and the purpose in life score, after controlling forage. All statistical tests were two-tailed and the softwareIBM SPSS Statistics (Version 26.0. Armonk, NY) wasused for the analysis.Page 3 of 8ResultsThe demographic and health-related lifestyle characteristics of the study participants are shown in Table 1. Intotal, 4820 certified specialists in health managementwere included in the analysis. There were 3190 women(66.2%) and 1630 men (33.8%). The mean (SD) age of allstudy participants was 55.4 ( 12.2) years. The majorityof the participants (85.0%) were non-obese and“intended to keep ideal weight” and “maintain a healthylifestyle (82.6% and 89.2%, respectively) to preventlifestyle-related disease,” such as obesity, metabolic syndrome, and cardiovascular disease. We also found thatmore than 80% of the study participants “read nutritional information labels” and more than 90% “maintained a balanced diet in daily life.” Regarding exerciseand physical activity, more than 80% of the study participants “intended to exercise” and approximately 64% ofthem achieved the recommended levels. These findingsreflected a low rate of obesity among the participants,which was 15.0% in the study. While most of the participants reported resting and sleeping adequately, the rateof taking on stress was high (74.4%). The descriptiveanalysis of the Ikigai-9 scores confirmed that it was normally distributed, based on the histogram and P-P plot.Table 2 shows the demographics and healthy lifestylepractices for both the higher and lower clustered healthrelated lifestyle score groups. We found consistent favorable results in all measured health-related habits in thehigher clustered health-related lifestyle score group.There was a significant difference in the scores of purpose in life between the higher group and the lowerclustered health-related lifestyle score group (t 23.6,p .0001). In the higher group, the average score of purpose in life was 35.3 (95% CI; [35.1–35.5]), while for thelower group, the average score for purpose in life was31.4 (95% CI; [31.2–31.7]). The differences in the Ikigai9 purpose in life scores of the two groups and its effectsizes (Cohen’s d) were 3.8 (95% CI; [3.5–4.2]) and 0.68,respectively. Moreover, there was a significant association between the clustered health-related lifestyle scoreand purpose in life score, r .401, p .001. The significance remained after controlling for age. Correlation between age and both lifestyle and purpose in life weresignificant (Pearson r 0.29 and 0.15, respectively; bothp .05).DiscussionWe found that the higher-scoring clustered healthrelated lifestyle group showed a statistically significanthigher purpose in life than the lower-scoring clusteredhealth-related lifestyle group. The study also highlighteda significant positive association between the clusteredhealth-related lifestyle score and the Ikigai-9 score. Tothe best of our knowledge, this study was the first to

Hirooka et al. BMC Public Health(2021) 21:820Page 4 of 8Table 1 Demographic Characteristics of the CohortCharacteristicsTable 1 Demographic Characteristics of the Cohort e1630Stress (%)Female3190High20.44820Moderate54Age range 30 years129 (2.7)Low21.830–39 years372 (7.7)None3.740–49 years930 (19.3)50–59 years1541 (32.0)Satisfactory20.560–69 years1291 (26.8)Adequate54.070–79 years489 (10.1)Not adequate21.8 80 years68 (1.4)Not satisfactory3.7Age (Ave years, SD)55.4 (12.2)Rest (%)Sleep (%)Height (Ave cm, SD)161.3 (8.0)Satisfactory21.3Weight (Ave kg, SD)57.5 (10.8)Adequate57.4BMI (Ave kg/m , SD)21.9 (3.3)Not adequate20.3Obesity (%)15.0Not satisfactory1.02Intention to keep ideal weight (%)Yes82.6No17.4Managing Lifestyle for disease prevention (%)Yes89.2No10.8Reading nutritional information labels (%)Always34.3Often47.9Rarely13.4Very rarely4.3Maintaining a balanced diet in daily life (%)Always52.8Often38.0Rarely8.0Very rarely1.2Intention for exercise (%)Always42.3Sometimes41.3In the past13.2Never3.1Adequate Exercise (%)Yes63.9No36.1Excessive alcohol intake (%)5.8Smoking (%)Current6.1Past18.0show that a strong sense of purpose in life correlateswith clustered health-related lifestyles in the context of anational health campaign. Several studies indicate a positive relationship between purpose in life and healthrelated lifestyles [1, 25–27]. Furthermore, many publications reveal a correlation between a single healthy habitand purpose in life. Therefore, our findings—that affirma positive relationship between purpose in life and clustered health-related lifestyle—are consistent with previously reported results and help broaden the evidence ofthis association.Exploring the mechanistic link of purpose in life witha healthy lifestyle may help us understand this relationship. While studies highlight the positive relationship between purpose in life and health-related lifestyle, a fewstudies’ results are inconsistent with our findings. Forexample, an existing prospective study did not observe apositive association between purpose in life and healthysleep patterns [28]. In other studies, the purpose of lifewas not associated with smoking [29, 30]. Notably, themechanistic link between health-related lifestyle andpurpose in life has not been well examined. Hookeret al. proposed a hypothesized model linking purpose inlife with health [31]. They summarized the relationshipbetween life purpose and health outcomes by utilizingthe concept of self-regulation. In the model, they proposed that life purpose influenced health through threeself-regulatory processes and skills: stress-buffering,adaptive coping, and health behaviors. Health-relatedlifestyle, one of the self-regulatory processes, is the resultof individuals setting goals, monitoring their progress,and using feedback to modify their lifestyle [31]. Thus, a

Hirooka et al. BMC Public Health(2021) 21:820Page 5 of 8Table 2 Comparison between Lower and Higher Health-relatedLifestyle GroupsTable 2 Comparison between Lower and Higher Health-relatedLifestyle Groups Female17011489Not adequate11.130.958.2 (12.0)52.1 (11.5)Not satisfactory0.12.135.3 (35.1–35.5)31.4 (31.2–31.7)SexAge (Ave years, SD)2BMI (Ave kg/m , SD)21.8 (3.0)22.0 (3.7)Obesity (%)12.218.3Intention to keep ideal weight (%)Yes92.870.3Managing Lifestyle for disease prevention (%)Yes94.482.7Reading nutritional information labels (%)Always44.722.2Often45.450.8Rarely7.819.9Very rarely1.97.0Maintaining a balanced diet in daily life (%)Always68.334.9Often29.647.6Rarely2.014.9Very rarely0.12.5Always63.617.6Sometimes33.650.3In the 5Past1.211.6None81.069.110.831.6Intention for exercise (%)Adequate Exercise (%)YesExcessive alcohol intake (%)Smoking (%)Stress (%)HighModerate54.453.6Low28.613.9None6.30.8Rest (%)Satisfactory32.58.5Adequate55.153.0Not adequate11.832.0Not satisfactory0.56.5Sleep (%)Purpose in life score ([95% CI])purpose provides the foundation and motivation for engaging in a healthy lifestyle. Kim et al. also suggestedthat sense of purpose in life enhances the likelihood forengagement in restorative health-related lifestyle practices (e.g., physical activity, healthy sleep quality, use ofpreventive health care services) from cardiovascular disease to the indirect effect of behavior [32].There is an alternative explanation for

15 hours ago · related lifestyle group showed a statistically significant higher purpose in life than the lower-scoring clustered health-related lifestyle group. The study also highlighted a significant positive association between the clustered health-related lifestyle score and the Ikigai-9 score.

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