Are Routines a Driver of Good Health?

Lilian White, MD
Posted on April 1, 2024

Routines are defined as behaviors performed repetitively and often daily. A slight distinction from routine problems: those that are commonplace. Although it’s often easy to see how a chaotic lifestyle may increase vulnerability to disease, how true is the opposite? Do routines contribute to good health?

On the macrolevel in health care, we have routines involving measuring vital signs and the structure of an office visit: history, exam, intervention. And often, standard screening recommendations are built into electronic medical records, requiring minimal intentional thought. Standardized note templates—subjective, objective, assessment and plan—are commonplace. This has become particularly true with the corporatization of medicine and managed care, where time, volume, and checkboxes are essential to delivering routines of care.

How is a routine distinct from a habit—and does it matter?

Although routines and habits tend to involve repetitive behaviors with little thought, some experts distinguish habits as those actions that require a cue to perform, whereas routines do not. However, because of their similarity, many of the recommendations for impacting routines are extrapolated from research on habit formation.

How does the concept of routine impact patient health at the individual level?

In children, the Structured Days Hypothesis (SDH) posits that more structure in a child’s day reduces obesogenic behaviors, including improvements in levels of physical activity, screen time, and sleep. 

In adults, a study reviewing the effect of the COVID-19 pandemic on sleep noted that those whose daily routines were not significantly disrupted (e.g., key workers such as medical staff, police officers, postal workers) did not experience significant disturbances in sleep compared with those whose routines were disrupted, offering support for routines as a subtle point of leverage for building and maintaining health. The review also noted those who fell out of healthy routines because of the pandemic were found to have poorer sleep, reduced levels of physical activity, mental health symptoms, and increased weight. Overall, routine appears to be a key building block of lifestyle change formation.

What makes routine so helpful in maintaining healthy behaviors?

In part, it may be because of the reduced burden of decision-making, resulting in healthy routines as the planned default. In theory, reduced decision-making may also reduce the need for willpower to maintain healthy choices.

How do we help our patients establish and maintain routines for health?

Compelling research is being performed on the effect of dissecting a behavior into a series of small actions to promote behavior change. As the theory goes, small, individual actions are easier to implement than starting with the expectation of completing a complex series of actions that may make up a routine or habit (i.e., setting out the running shoes vs. running 10 miles). The bar for achieving a small action is much lower, resulting in early success. This paves the way for building a desired routine. Additionally, depending on the routine, varying aspects of the routine from time to time may help to prevent boredom and injury, as detailed in this patient information handout in American Family Physician about implementing exercise.

Overall, routines appear to be essential health behaviors for children and adults. Family physicians may help patients form routines through encouraging small, early successes.