Exercise, don't smoke, and consume five fruit or vegetable servings and only one or two drinks daily and you'll live 14 years longer than smoking, hard-drinking, burger-popping couch potatoes. That's the result of new research on the combined effect of these four healthy behaviors on longevity, detailed in the journal PLoS Medicine. Most people know that individual lifestyle choices affect long-term health, but this is the first study to look at these four together. To arrive at the findings, Kay-Tee Khaw and colleagues from the University of Cambridge and the Medical Research Council in England studied 20,000 UK men and women between the ages of 45 and 79, none of whom had known heart disease, circulatory disease or cancer. Between 1993 and 1997, the subjects filled out a questionnaire that gave them a health score ranging from 0 to 4, with a low score being "bad" and a high score being "good." A point was awarded for each of the following: not currently smoking; physical activity (physical inactivity was defined as having a sedentary job and not doing any recreational exercise); a moderate alcohol intake of one to 14 units a week (a unit is half a pint of beer or a glass of wine); and a blood vitamin C level consistent with eating five servings of fruit or vegetables a day. Deaths among the participants were recorded until 2006. After factoring in age, the results showed that over an average period of 11 years people with a score of 0, that is, those with a bad score for not undertaking any of these healthy forms of behavior, were four times more likely to have died than those who had scored 4 (a high or good score) on the questionnaire. Furthermore, the researchers calculated that a person with a health score of 0 (a bad score, for not engaging in healthy behaviors) has the same risk of dying as someone 14 years older who had scored 4 in the questionnaire (i.e. someone engaging in all four healthy forms of behavior). This was independent of social class and body mass index. The study is part of the European Prospective Investigation into Cancer and Nutrition, conducted across 10 European countries, the largest study of diet and health ever undertaken. It's tougher for people living in isolation to make these lifestyle changes, according to a related editorial in the same issue of PLoS Medicine.

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