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Increasing Exercise Linked with Attending Religious Services

Whether celebrating the festival of lights of Hanukkah or the light of Christ at Christmas or Kwanzaa this holiday season, frequently attending religious services adds spark to improving healthy behaviors and increasing chances for living longer by as much as 33%, found a 28-year- long study published in the American Journal of Public Health. 1

In this study funded in part by the Centers for Disease Control and Prevention, researchers looked at the links between religious attendance and health behaviors, including basic ones like smoking, exercise, and excessive alcohol consumption, and receiving annual medical check-ups, as well as relational ones like interactions with friends and relatives. The study followed more than 2,600 people randomly selected from Alameda County, California, a large urban area including the cities of Oakland and Berkeley.

"Over a nearly 30-year period those attending services weekly were more likely than those attending less or not at all to both establish good health behaviors not already being performed and to maintain ones already established," noted Dr. William Strawbridge and his research team.

" For both genders combined, weekly attendance was associated with a statistically significant improvement in quitting smoking, becoming [more] often physically active, becoming not depressed, increasing the number of individual personal relationships, and getting married," the researchers found. Women were more likely to stop heavy drinking, but not men.

A previously published study by the same research team regarding religious attendance and mortality followed 5,286 residents of this same county for 28-years and found that those who attended religious services weekly or more had a 33% greater chance of survival after controlling for age, gender, ethnicity, education and physical and mental health variables.23 Adjusting for social connections caused a slight reduction in effect to 31%. When adjusting for health practices including cigarette smoking, level of alcohol consumption, level of exercise, and body mass index, the effect was reduced to 23%, yet still remaining significant.

The researchers noted that health practices or social connections could act to "confound" the relationship between religious attendance and living longer by persons with good health practices and strong social connections also happening to be frequent attenders at religious services. However, frequent attendance may have some link with increasing healthy behaviors and social connections and thus these health and social factors would serve as "explanatory" or "intervening" variables on a causal pathway between attendance and reducing chances or earlier death.

To clarify these distinctions further in the present study, the researchers discovered that becoming frequent attenders indeed was linked with increasing healthy behaviors and social connections. For instance, at the study's start, frequent attenders were much less likely to smoke cigarettes or drink heavily. However, those frequent attenders that did smoke at baseline were twice as likely as infrequent attenders to stop. Also, frequent attenders who exercised never or only sometimes at the start of the study, were over a third more likely to increase frequency of exercise.

There were no differences in marital status at baseline for frequent attenders compared to less frequent or non-attenders. But those who were married were more likely to stay married to the same person over time if they were frequent attenders. Also frequent attenders increased in social memberships of non-religious organizations and increased close contacts.

Consequently, frequent attendance may be associated with lowered mortality rates partly because attendance over time facilitates the adoption of better health practices, increased social connections, and marital stability. Also, the fact that many frequent attenders at the start of the study did not drink heavily or smoke, might possibly be due to religious attendance influencing health practices before the study began, the researchers suggested.

Conversely, persons who either stopped going to religious services or infrequently attended were more at risk for 1) stopping medical check-ups, 2) decreasing social relationships, and 3) becoming divorced or separated.

The researchers stated:
"The analyses here indicate that attenders did not all start off with such good behaviors; to some extent, their good health behaviors and more extensive social relationships occurred in conjunction with their attendance. If this is so, the commonly employed strategy in analyses focusing on associations between religious attendance and mortality of adjusting for health behaviors and social relationships over the follow-up period may actually underestimate the impact of attendance."

Even baseline adjustments for these variables are subject to the same potential analytical error because attendance at religious services could have influenced health behaviors and social relationships before the analyses began, they added.

The researchers suggested further investigation is needed to learn what mechanisms might contribute to impacting health behaviors and social connections. These might include spiritual/religious/philosophical tenets, such as viewing one's body with respect; relational aspects, such as supportive friendships and community; cognitive aspects such as a stronger sense of coherence, meaning, or sense of control; and psychological, such as enhanced coping skills or potentially increased self-esteem stemming from religious beliefs or practices.

For instance, other mental health studies have revealed the role of positive religious coping in reducing psychological distress and reducing one's risk for depression.3 In addition, in more than 800 studies that have examined the relationship between religious involvement and some indicator of mental or social health, the large majority found that religious involvement is associated with lower rates of alcohol or drug abuse, less depression and anxiety, greater hope and optimism, more self-esteem, greater purpose and meaning in life, greater well-being and life-satisfaction, and more stable marriages.4

Dr. Strawbridge and his research team concluded: "Discovering exactly how attendance impacts adoption and maintenance of good health behaviors could thus aid in the design of… strategies to broadly promote the adoption of good health behaviors before illness strikes and provide effective self-care treatment strategies when it does."

1Strawbridge WJ, Shema SJ, Cohen RD, Kaplan GA. Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Annals of Behavioral Medicine 2001; 23(1): 68-74.
2 Strawbridge WJ, Cohen RD, Shema MS, Kaplan GA. Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health 1997; 87(6):957-961.
3 Koenig HG, Larson DB, Larson SS. Religion and coping with serious medical illness. The Annals of Pharmocotherapy 2001; 35:352-358.
4 Koenig HK, McCullough ME, Larson DB. Handbook of Religion and Health. Oxford: Oxford University Press; 2001.

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