When it comes to self-improvement 'All or Nothing' might be the optimal strategy

According to a new study being reported in the June 11 issue of Archives of Internal Medicine, addressing multiple unhealthy behaviors at once may be more effective than sequential approach." This means that those thinking of quitting smoking, going on a diet, starting to exercise, etc., are better off plunging in and doing it all at once rather than phasing them slowly in.

David J. Hyman, M.D., M.P.H., of Baylor College of Medicine, Houston, and colleagues randomly assigned 289 African-American patients who had hypertension and were smokers to one of three groups that encouraged them to stop smoking, reduce their sodium intake to less than 100 milliequivalents per liter per day, and increase physical activity by at least 10,000 pedometer steps per week.

The first group received one in-clinic counseling session on all three behaviors every six months, plus motivational telephone calls for 18 months; the second group followed a similar protocol, but addressed a different behavior every six months; and the third group received usual care, consisting of a one-time referral to existing group classes. After six, 12 and 18 months, urine and blood samples were obtained, blood pressure was taken and behavioral changes were assessed.

...after six months, 29.6 percent in the simultaneous, 16.5 percent in the sequential and 13.4 percent in the usual-care groups had reached the urine sodium goal. After 18 months, 20.3 percent in the simultaneous, 16.9 percent in the sequential and 10.1 percent in the usual-care groups tested negative for urine cotinine, which the body produces when it metabolizes nicotine, indicating they had stopped smoking.

"Long-term multiple behavior change is difficult in primary care," the authors conclude. "This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach."

While the results go against the grain of some conventional wisdom (about tackling too much at one time) they make intuitive sense when you think about how health goals work together. You don't typically see people smoking on the StairMaster at the gym and the food available at gyms is generally more healthy than other places you might eat. By just going to the gym 3x a week, you are putting yourself in the position of better nutrition (at least some of the time) and not smoking (at least while you are there). You'll also benefit from being around other people trying to be healthy. Similarly, it's hard to want to go for a run if smoking has made it so that you get winded just walking up stairs. So quitting smoking will help on your exercise goals.

In short, if you are going to tackle unhealthy behaviors (like diet and smoking), do it all at once. While the results show that over 70% of participants will fail to fully accomplish their goals, you still have a significantly greater chance of accomplishing them than via a sequential process.