Minimum combined sleep, physical activity, and nutrition variations associated with lifeSPAN and healthSPAN improvements: a population cohort study.

<h4>Background</h4>Sleep, physical activity, and nutrition (SPAN) are key determinants of both life expectancy (lifespan) and disease-free life expectancy (healthspan(definition)), yet are often studied in isolation. This study aimed to determine the minimum combined SPAN improvements needed for a longer lifespan and healthspan.<h4>Methods</h4>This prospective cohort comprised 59,078 participants from the UK Biobank, recruited between 2006 and 2010 (median age: 64.0 years; 45.4% male). Between 2013 and 2015, a subsample of participants was invited to wear a wrist worn accelerometer for 7 days. Moderate to vigorous physical activity (MVPA; mins/day) and sleep (hours/day) were calculated using a validated wearables-based algorithm. Diet was assessed using a 10-item diet quality score (DQS), including intake of vegetables, fruits, grains, meats, fish, dairy, oils, and sugar-sweetened beverages (ranging 0-100; higher indicates better quality). Lifespan and healthspan (free of cardiovascular disease (CVD), cancer, type II diabetes, chronic obstructive pulmonary disease (COPD), and dementia) were estimated across 27 joint tertile SPAN combinations and a composite SPAN score using life tables.<h4>Findings</h4>Over an 8.1-year median follow-up, 2458 deaths, 9996 CVD, 7681 cancers, 2971 type II diabetes, 1540 COPD, and 508 dementia events occurred. Compared to the least favourable tertiles, the optimal tertiles (7.2-8.0 h/day of sleep; >42 min/day of MVPA; DQS of 57.5-72.5) had 9.35 additional years of lifespan (95% CI: 6.67, 11.63) and 9.45 years of healthspan (95% CI: 5.45, 13.61). Compared to the 5th percentile, a minimum combined improvement of 5 min/day of sleep, 1.9 min/day MVPA, and a 5-point increase in DQS (e.g., additional ½ serving of vegetables/day or additional 1.5 servings of whole grains per day) was associated with 1 additional year of lifespan (95% CI: 0.69, 1.15). For healthspan, a combined improvement of 24 min/day of sleep, 3.7 min/day of MVPA, and a 23-point DQS increase was associated with 4.0 additional years (95% CI: 0.50, 8.61).<h4>Interpretation</h4>Modest concurrent improvements in sleep, physical activity, and diet were associated with meaningful gains in lifespan and healthspan.<h4>Funding</h4>Australian National Health and Medical Research Council.