Sedentary time in older adults: a critical review of measurement, associations with health, and interventions

Cognitive impairment and sedentary behavior predict health-related attrition in a prospective longitudinal Parkinson's disease study

INTRODUCTION

In Parkinson's disease (PD), the high burden of motor and non-motor symptoms, such as cognitive impairment or falls, is associated with rapid disease progression and mortality. This is often reflected by an increased drop-out rate of PD patients in longitudinal studies. Active physical behavior can impact the disease course beneficially and has an overall positive effect on health. Contrarily, sedentary behavior is associated with cognitive impairment in PD. The aim of this study was to investigate whether sedentary physical behavior assessed in the home environment and cognitive impairment can predict health-related study attrition due to sickness and death in PD.

METHODS

Data of 45 PD patients, longitudinally assessed, were analyzed. Of those, 20 patients completed six yearly visits, 16 dropped out due to sickness or death, and nine for other reasons. All patients wore a mobile device to assess physical behavior and completed cognitive testing.

RESULTS

Logistic regression revealed global cognition was the primary predictor for health-related drop-out in varying models (p ≤ .04). In the survival analysis, cognitive impairment (p = .005) and longer sedentary mean bout length (p = .02) were associated with drop-out due to sickness and death. The occurrence of health-related study drop-out or death was highest in patients with both impaired cognition and longer sedentary bouts.

CONCLUSIONS

Cognition was the primary predictor for study drop-out due to sickness and death. However, it seems that sedentary behavior might have a potential negative influence on PD patients' health, especially those with cognitive impairment.

The association between sedentary behavior and cognitive ability in older adults

Executive functions (EF) are a grouping of cognitive abilities essential for daily life. Previous research has shown that physical activity (PA) may in fact preserve EF in older adults, but the link between sedentary behavior (SB) and cognitive ability has been less explored. The purpose of this study was to examine the relationship between SB and cognition (executive function and memory) in older adults. Seventy five older adults (74.6 ± 9 years) self-reported their sedentary time (ST) and PA, as well as EF ability (paper-based measure of EF). Participants also completed several performance-based measures of EF and a memory task. Older adults who were less sedentary had superior EF and memory (e.g., Stroop time was significantly faster in less sedentary adults (34.7 s ± 1.9) compared to more sedentary adults (39.6 s ± 1.8), p = .02). Regression analysis showed that total ST was associated with several measures of EF after adjusting for age, and physical activity (e.g., Stroop time β =  .005 (.002, .009). Less cognitively demanding SB (TV viewing and napping) was associated with worse performance on most EF and in the memory task. Performing a hobby was also associated with lower levels of EF and memory. For example, the building times for the Lego task were positively related to napping (r² = .34), watching TV (r² = .27), and performing a hobby (r² = .46). Associations of ST with cognitive abilities were more pronounced in older adults who engaged in less PA. These results suggest that SB may play an important role in cognitive abilities of older adults. Longitudinal studies using performance-based assessments of EF are needed. Lara Coelho and Kayla Hauck contributed equally to the manuscript.

Engagement, Acceptability, Usability, and Preliminary Efficacy of a Self-Monitoring Mobile Health Intervention to Reduce Sedentary Behavior in Belgian Older Adults: Mixed Methods Study

Background

Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior. However, little is known about older adults’ experiences with a self-monitoring–based intervention aimed at the reduction of sedentary behavior.

Objective

The aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring–based mHealth intervention developed to reduce older adults’ sedentary behavior.

Methods

A mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants’ sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles.

Results

Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time.

Conclusions

Although the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change.

Trial Registration

ClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx

The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak

Diabetes is the second most prevalent non-communicable chronic diseases (NCDs) in patients with coronavirus disease 2019 (COVID-19) and is highly associated with increased incidence of disease severity and mortality. Individuals with diabetes and poor glycemic control have an even worse prognosis. Despite of the need/effectiveness of social distancing measures (i.e.: home confinement, quarantine and/or lockdown) during COVID-19 outbreak, preliminary findings showed an increase in negative behaviors during COVID-19 home confinement (i.e.: ~33.5% reduction in physical activity, ~28.6% (~3.10h) increase in sedentary behavior (i.e.: daily sitting, reclining and lying down time), and more unhealthy food consumption and meal pattern), which may have important clinical implications. For example, we estimated that this reduction in physical activity can increase the cases of type 2 diabetes (from ~7.2% to ~9.6%; ~11.1 million cases per year) and all-cause mortality (from ~9.4% to ~12.5%; ~1.7 million deaths per year) worldwide. Few weeks of reduction in physical activity levels result in deleterious effects on several cardiometabolic (i.e.: glycemic control, body composition, inflammatory cytokines, blood pressure, vascular function…) and functional parameters (i.e.: cardiorespiratory/muscle fitness, balance, agility…). In contrast, physical activity and exercise are important tools for preventing and treating diabetes and others NCDs. Home-based exercise programs are useful, safe and effective for the management of diabetes, and could be widely used during COVID-19 outbreak. In this context, there is an urgent need for recommending physical activity/exercise, during and beyond COVID-19 outbreak, for improving the management of diabetes, as well as to prevent the increase in global burden of COVID-19, diabetes and others NCDs.

A systematic review and meta-analysis of interventions to reduce sedentary behavior among older adults

Sedentary behavior (SB) is associated with numerous negative health outcomes, independent of physical activity behavior. Older adults are the most sedentary population in the United States. Understanding the effects and characteristics of existing interventions to reduce SB can inform practice, future research, and public health initiatives to improve older adults’ health. We conducted a systematic review and meta-analysis to examine existing SB intervention research among older adults and quantitatively synthesize intervention effects. Comprehensive searches were conducted to identify studies testing interventions to reduce SB time among adults at least 60 years old. Data on study design, intervention content and delivery, and participant characteristics were extracted from eligible studies. Standardized mean difference effect sizes (Cohen’s d) were synthesized using a random-effects model for two-group pretest–posttest design studies. Twenty-two reports describing 17 distinct studies were included in the narrative synthesis, with eight studies included in the meta-analysis (k = 8; n = 1,024). Most interventions were theory-driven and employed multiple strategies, including education, self-monitoring, and goal setting. Although SB interventions significantly reduced total sedentary time, the overall effect was small (d = −0.25, 95% confidence interval [−0.50, 0.00], p = .05). Studies were significantly heterogeneous (Q = 22.34, p < .01); however, the small number of comparisons prevented moderator analyses. Practitioners should employ diverse SB-specific strategies to encourage older adults to reduce time spent sedentary. To develop public health programs targeting SB in older adults, future research should include measures of time spent in specific SB and duration/number of breaks in sedentary time and investigate SB intervention effects on health outcomes.

The Potential Mediation of the Effects of Physical Activity on Cognitive Function by the Gut Microbiome

The population of older adults is growing dramatically worldwide. As older adults are at greater risk of developing disorders associated with cognitive dysfunction (i.e., dementia), healthcare costs are expected to double by 2040. Evidence suggests dementia may be slowed or prevented by lifestyle interventions, including physical activity (PA). PA is associated with improved cognitive function and may reduce risk for dementia by mitigating known risk factors (i.e., cardiovascular diseases) and/or by enhancing neurochemical processes. An emerging area of research suggests the gut microbiome may have similar neuroprotective effects. Altering the gut microbiome has been found to target physiological processes associated with dementia risk, and it influences gut-brain-microbiome axis signaling, impacting cognitive functioning. The gut microbiome can be altered by several means (i.e., disease, diet, prebiotics, probiotics), including PA. As PA and the gut microbiome independently influence cognitive function and PA changes the composition of the gut microbiome, cognitive improvement due to PA may be partially mediated by the gut microbiome. The present article provides an overview of the literature regarding the complex associations among PA, cognitive function, and the gut microbiome, as well as their underlying biological mechanisms. A comprehensive, theoretical model integrating evidence for the potential mediation is proposed.

Daily Physical Activity and Sedentary Time Assessed by Acceleration Based on Mean Amplitude Deviation among Older People

Accelerometer-derived estimates of physical activity (PA) and sedentary time have been an important methodological focus. However, little is known about the daily activities among older people during their normal lives. Furthermore, some older individuals would like to be more active, yet experience an unmet PA need, which is defined as the desire to engage in more PA but without the opportunity to act on the desire. This study examined the intensity of daily PA and sedentary behavior measured with accelerometers among older people, and whether PA differs between weekdays and weekends and those with and without the experience of unmet PA need, measured with self-reports. A total of 174 community-dwelling older people (64% female) aged 75 to 90 years used an accelerometer for 7 consecutive days during waking hours, and the results were classified for sedentary behavior (thresholds of 0.0167 g), light activity (0.091 g), and moderate-to-vigorous activity (MVPA, 0.414 g) based on mean amplitude deviation (g). We found that during weekdays, older people engaged slightly more in light activity and had less sedentary time than during weekends. In total, 7.6% of the participants perceived an unmet PA need. Accordingly, those with unmet PA needs spent less time in MVPA, especially during weekdays, and they might benefit from PA-enabling interventions.

Single question about total lying time for assessing physical inactivity in community-dwelling older adults: a study of reliability and discriminant validity from sleeping time

[Purpose] To investigate reliability and discriminant validity of a single question about total lying time for assessing physical inactivity in community-dwelling older people. [Participants and Methods] The participants were 54 healthy older individuals (mean age, 72.5 years), who were asked to recall retrospectively their mean total lying and sleep times per day in the previous week (7 days). The total lying and sleep times per day in the forthcoming week (7 days) were also investigated prospectively after confirming the mean total lying and sleep times per day in the previous week, and their mean values per day were calculated. [Results] Intraclass reliability of total lying and sleep times per day in the forthcoming week were acceptable [ICC (1, 1) for total lying time=0.835, ICC (1, 1) for sleep time=0.707]. No significant difference in average total lying time between the previous (8.4 ± 2.0 hours/day) and forthcoming (8.7 ± 1.7 hours/day) weeks was seen. In the forthcoming week, average total lying time was significantly higher than average sleep time (7.1 ± 1.3 hours/day). There was low significant correlation between total lying time and sleep time. [Conclusion] Total lying time can be measured with acceptable reliability and discriminant validity, and is a different outcome than sleep time in community-dwelling older adults.

Wearable Activity Trackers in the Management of Rheumatic Diseases: Where Are We in 2020?

In healthcare, physical activity can be monitored in two ways: self-monitoring by the patient himself or external monitoring by health professionals. Regarding self-monitoring, wearable activity trackers allow automated passive data collection that educate and motivate patients. Wearing an activity tracker can improve walking time by around 1500 steps per day. However, there are concerns about measurement accuracy (e.g., lack of a common validation protocol or measurement discrepancies between different devices). For external monitoring, many innovative electronic tools are currently used in rheumatology to help support physician time management, to reduce the burden on clinic time, and to prioritize patients who may need further attention. In inflammatory arthritis, such as rheumatoid arthritis, regular monitoring of patients to detect disease flares improves outcomes. In a pilot study applying machine learning to activity tracker steps, we showed that physical activity was strongly linked to disease flares and that patterns of physical activity could be used to predict flares with great accuracy, with a sensitivity and specificity above 95%. Thus, automatic monitoring of steps may lead to improved disease control through potential early identification of disease flares. However, activity trackers have some limitations when applied to rheumatic patients, such as tracker adherence, lack of clarity on long-term effectiveness, or the potential multiplicity of trackers.

The COVID-19 rehabilitation pandemic

The coronavirus disease 2019 (COVID-19) pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.

Device-assessed physical activity and sedentary behavior in a community-based cohort of older adults

BACKGROUND

Few studies characterize older adult physical activity and sitting patterns using accurate accelerometer and concurrent posture measures. In this descriptive paper, we report accelerometer data collection protocols, consent rates, and physical behavior measures from a population-based cohort study (Adult Changes in Thought, ACT).

METHODS

The ACT study holds enrollment steady at approximately 2000 members of Kaiser Permanente Washington aged 65+ without dementia undergoing detailed biennial assessments. In 2016 the ACT-Activity Monitor (ACT-AM) sub-study was initiated to obtain data from wearing activPAL and ActiGraph devices for 7 days following regular biennial visits. We describe the methods protocol of ACT-AM and present characteristics of people who did and did not consent to wear devices. We compute inverse probability of response weights and incorporate these weights in linear regression models to estimate means and 95% confidence intervals (CI) of device-based pattern metrics, adjusted for wear time and demographic factors, and weighted to account for potential selection bias due to device-wear consent.

RESULTS

Among 1885 eligible ACT participants, 56% agreed to wear both devices (mean age 77 years, 56% female, 89% non-Hispanic white, 91% with post-secondary education). On average, those who agreed to wear devices were younger and healthier. Estimated mean (95% CI) activPAL-derived sitting, standing, and stepping times were 10.2 h/day (603-618 min/day), 3.9 h/day (226-239 min/day), and 1.4 h/day (79-84 min/day), respectively. Estimated mean ActiGraph derived sedentary (Vector Magnitude [VM] < =18 counts/15 s), light intensity (VM 19-518 counts/15 s), and moderate-to-vigorous intensity (VM > 518 counts/15 s) physical activity durations were 9.5 h/day (565-577 min/day), 4.5 h/day (267-276 min/day), and 1.0 h/day (59-64 min/day). Participants who were older, had chronic conditions, and were unable to walk a half-mile had higher sedentary time and less physical activity.

CONCLUSIONS

Our recruitment rate demonstrates the feasibility of cohort participants to wear two devices that measure sedentary time and physical activity. Data indicate high levels of sitting time in older adults but also high levels of physical activity using cut-points developed for older adults. These data will help researchers test hypotheses related to physical behavior and health in older adults in the future.

Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living

Background

Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This “low movement” environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted.

Methods

“Stand When You Can” (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility.

Results

There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although device-measured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen’s d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical.

Conclusion

This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary.

Trial registration

Name of Clinical Trial Registry: clinicaltrials.gov

Trial Registration number: NCT04458896.

Date of registration: July 8, 2020. (Retrospectively registered).

A Cross-Sectional Examination of Patterns of Sedentary Behavior and Cardiometabolic Risk in Community-Dwelling Adults Aged 55 Years and Older

Introduction

Sedentary behavior (SB) is highly prevalent among older adults, with more than 25% engaging in 6 hours or more of SB daily. SB has been associated with several cardiometabolic biomarkers in younger adults; however, there is a paucity of research in older populations. This study examined associations between patterns of SB and cardiometabolic biomarkers in community-dwelling adults aged 55 years and older.

Methods

Data were drawn from a convenience sample of 54 community-dwelling individuals (12 males, 42 females; mean age = 72.6 ± 6.8 years, range = 56–89 years). Cardiometabolic biomarkers assessed included systolic (SBP) and diastolic blood pressure (DBP), body mass index, waist circumference, and fasting blood glucose and cholesterol parameters. SB was assessed via accelerometry over a 7-day period, and measures included daily time in SB, number and length of sedentary bouts, the number and length of breaks between sedentary bouts, moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA). Associations between the SB measures and each cardiometabolic risk factor were examined using separate stepwise multiple regression models, controlling for sex, MVPA, and accelerometer wear time. Isotemporal substitution models were used to examine the change in cardiometabolic outcomes when SB is replaced by an equal duration of either LPA or MVPA.

Results

Adjusted regression analyses showed that daily sedentary time was positively associated with DBP (β = 0.052, ∆R² = 0.112, p = 0.022) and inversely associated with HDL cholesterol (β = −0.111, ∆R² = 0.121, p = 0.039). Sedentary bout length was also associated with DBP and HDL cholesterol (β = 0.575, ∆R² = 0.152, p = 0.007; β = −1.529, ∆R² = 0.196, p = 0.007, respectively). Replacement of 10 minutes of SB a day with LPA was associated with improved DBP and HDL cholesterol (p ≤ 0.05). No other significant associations (p ≤ 0.05) were found.

Conclusion

Sitting for prolonged periods of time without interruption is unfavorably associated with DBP and HDL cholesterol. Prospective studies should identify causal relationships and observe specific changes in cardiometabolic profiles in older populations.

Transition and factors associated with the level of physical activity combined with sedentary behavior of the elderly: A longitudinal study

Introduction:

Physical activity and sedentary behavior are emerging issues in public health, especially in developing countries.

Objective:

To verify transition and factors related to physical activity combined with sedentary behavior among the elderly followed for 24 months.

Materials and methods:

We conducted a longitudinal observational study with people aged 60 years or over living in the urban area of Uberaba, Brazil. We collected the data from sociodemographic, health, and physical tests in 2014 and 2016 using the Mini-Mental State Examination (MMSE), the Katz Index, the Lawton and Brody Scale, the Short Physical Performance Battery (SPPB), and the International Physical Activity Questionnaire (IPAQ). For the combined evaluation we considered a cutoff point of 150 minutes of physical activity per week and the percentile 75 (420 minutes/day) for sedentary behavior constituting the groups: Unsatisfactory (insufficient sum of physical activity and sedentary behavior), intermediate (loss of only one of the two components) and satisfactory (sufficient sum of physical activity and sedentary behavior). The statistical descriptive and inferential analysis was performed using the Statistical Package for Social Sciences^™, version 21.0, considering p<0.05.

Results:

Of the 374 elderly, 61 (16.3%) improved their physical activity and sedentary behavior condition, 226 (60.4%) remained in the same category and 87 (23.3%) got worse. Unsatisfactory levels of physical activity and sedentary behavior were related to the eldest group (p=0.031), the absence of professional activity (p<0.001), the dependence for instrumental activities of daily living (p=0.013), and a worse physical performance (p<0.001).

Conclusion:

Our results showed a relationship between sociodemographic and health factors with physical activity and sedentary behavior, reiterating the need for further research on the subject.

Association between physical function and various patterns of physical activity in older adults: a cross-sectional analysis

BACKGROUND

To improve physical function, physical activity (PA) guidelines for older adults recommend completing PA in bouts of 10 min or more. Spontaneous PA (< 10 min) can also benefit older adults. However, a paucity of research exists examining if shorter bouts of PA are associated with greater physical function.

AIM

To determine the association between various patterns of PA and the likelihood of greater physical function in older adults.

METHODS

Older adults from the 2003-2004 and 2005-2006 cycles of the National Health and Nutrition Examination Survey were included for analysis. PA lasting 1, 5, 10, 30, and 60 min was quantified using accelerometers. Physical function was assessed using a Likert scale reflecting the self-reported capability to complete 11 tasks. A single function score was then computed using factor analysis. Logistic regression analyses calculated the association between PA bout length and the likelihood of above average function.

RESULTS

PA performed in 1-min (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.01-1.03), 5-min (OR 1.02; CI 1.01-1.03), or 10-min bouts (OR 1.02; CI 1.01-1.03) was associated with greater physical function following adjustment for confounders. When scaled to represent an accumulation of 10 min of MVPA, likelihoods increased for both 1-min ([OR] 1.25; 95% [CI] 1.11-1.39) and 5-min (OR 1.22; 95% CI 1.08-1.37) bouts.

DISCUSSION/CONCLUSIONS

Our findings suggest bouts of PA lasting 10 min or shorter in duration are associated with greater physical function in older adults.

Impact of dopamine-related genetic variants on physical activity in old age - a cohort study

OBJECTIVES

The beneficial effects of a physically active lifestyle in aging are well documented. Understanding the factors of importance for physical activity in older adults are therefore essential. Informed by animal and human data linking the dopamine system to motivation and reward processes, we investigated the associations between variations in dopamine genes and objectively measured physical activity and sedentary behaviour. Further, we aimed to verify whether higher age may exacerbate the impact of dopamine genes on physical activity.

METHODS

We analyzed data from 504 older adults, 66-87 years, from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Physical activity was measured with activPAL accelerometers and DNA was extracted from blood samples for genotyping. We assessed the effects of three dopamine relevant genetic variations (DRD1, DRD2, and DRD3) on daily time in sedentary behavior, light-intensity physical activity and moderate-to-vigorous physical activity using analyses of covariance, adjusting for sex, age and physical function.

RESULTS

Higher dopamine receptor efficacy was related to moderate-to-vigorous physical activity, but not to light-intensity physical activity or sedentary time. DRD1 explained 2.7% of variance in moderate-to-vigorous physical activity, with more pronounced effect in people aged ≥80 years, about 10% of explained variance.

CONCLUSION

Stronger genetic effects in older adults are in line with the well-established nonlinear effects of dopamine signaling on performance, expected to be exacerbated with aging. Individuals over 80 years, genetically predisposed to lower dopamine receptor efficacy, engaged on average 100 min/week in moderate-to-high physical activity, below the recommended levels beneficial for healthy aging. Our findings highlight that some individuals might need extra support to maintain a physically active lifestyle.

Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People?

Pneumonia-related mortality is expected to increase in aging societies. This prospective cohort study examined whether daily walking (1 hour/day) could reduce pneumonia-related mortality among older people who lacked other exercise habits. We analysed data from Japanese Specific Health Checkup across 82 municipalities in 7 prefectures among participants aged ≥65 years who participated in daily walking but did not regularly engage in other forms of exercise (n = 132,448). Information on walking habits and health-related indicators was assessed at a baseline survey conducted between 2008 and 2014. Pneumonia-related and all-cause mortality were followed for a median of 3.4 years. We performed a competing risk model with propensity score matching to evaluate the association between daily walking habits and pneumonia-related mortality. Our propensity-matched analysis revealed a significant association between daily walking and pneumonia-related mortality among older people who lacked other exercise habits, such that the sub-hazard ratio and 95% confidence intervals were 0.58 (0.39, 0.86). This study extends the findings of previous research on the effects of exercise on pneumonia by demonstrating that daily walking alone is sufficient to reduce pneumonia-related mortality among older people who do not regularly engage in other exercise habits.

A Pilot Randomised Clinical Trial of a Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: Feasibility and Preliminary Effects of the GET READY Study

Care-home residents are among the most sedentary and least active of the population. We aimed to assess the feasibility, acceptability, safety, and preliminary effects of an intervention to reduce sedentary behaviour (SB) co-created with care home residents, staff, family members, and policymakers within a pilot two-armed pragmatic cluster randomized clinical trial (RCT). Four care homes from two European countries participated, and were randomly assigned to control (usual care, CG) or the Get Ready intervention (GR), delivered by a staff champion one-to-one with the care home resident and a family member. A total of thirty-one residents participated (51.6% female, 82.9 (13.6) years old). GR involves six face to face sessions over a 12-week period with goal-oriented prompts for movement throughout. The feasibility and acceptability of the intervention were assessed and adverse events (AEs) were collected. The preliminary effects of the GR on SB, quality of life, fear of falling, and physical function were assessed. Means and standard deviations are presented, with the mean change from baseline to post-intervention calculated along with 95% confidence intervals. The CG smoked more, sat more, and had more functional movement difficulties than the GR at baseline. The GR intervention was feasible and acceptable to residents and staff. No AEs occurred during the intervention. GR participants showed a decrease in daily hours spent sitting/lying (Cohen’s d = 0.36) and an increase in daily hours stepping, and improvements in health-related quality of life, fear of falling, and habitual gait speed compared to usual care, but these effects need confirmation in a definitive RCT. The co-created GR was shown to be feasible and acceptable, with no AEs.

Sedentary Time is Associated with Cardiometabolic Diseases in A Large Japanese Population: A Cross-Sectional Study

Aim: Accumulating evidence reveals that sedentary behavior is associated with mortality and cardiometabolic disease; however, there are potential age and sex differences in sedentary behavior and health outcomes that have not been adequately addressed. This study aimed to determine the association of sedentary behavior with cardiometabolic diseases such as hypertension, dyslipidemia, diabetes mellitus, and its risk factors in a large Japanese population according to age and sex.

Methods: Using data from the Japan Multi-Institutional Collaborative Cohort Study obtained from baseline surveys, data of 62,754 participants (27,930 males, 34,824 females) were analyzed. This study uses a cross-sectional design and self-administered questionnaires to evaluate sedentary time and anamnesis. For the logistic regression analysis, sedentary time < 5 h/day was used as the reference and then adjusted for age, research areas, leisure-time metabolic equivalents, and alcohol and smoking status. From the analysis of anthropometric and blood examinations, 35,973 participants (17,109 males, 18,864 females) were analyzed.

Results: For hypertension and diabetes, sedentary time was associated with a significantly higher proportion of male participants. Both sexes were associated with a significantly higher proportion of participants with dyslipidemia. Participants who had longer sedentary time tended to have increased levels of blood pressure, triglycerides, and non-high-density lipoprotein cholesterol (HDL-C), and decreased levels of HDL-C, especially in the 60–69 years group.

Conclusions: Independent of leisure-time physical activity, sedentary time was associated with cardiometabolic diseases in a large Japanese population classified by age and sex. Our findings indicate that regularly interrupting and replacing sedentary time may contribute to better physical health-related quality of life.

Older adults' construal of sedentary behaviour: Implications for reducing sedentary behaviour in older adult populations

Older adults are the most sedentary age group, with sedentary behaviour having negative health-related consequences. There is currently limited understanding of how older adults view sedentary behaviour. This study investigated older adults' understanding of the concept of sedentary behaviour. Semi-structured interviews were conducted with 22 community-dwelling older adults in urban North-West England, selected to be diverse in socio-economic background and activity levels. Interviews were recorded and transcribed verbatim. An inductive thematic analysis was conducted. Participants often construed sedentary behaviour as synonymous with a lack of physical activity, and many perceived reducing sedentary behaviour and increasing moderate-to-vigorous physical activity to be the same thing. Participants perceived the term 'sedentary' to have negative connotations and were often judgemental of people who engaged in high levels of sedentary behaviour. Most participants considered reducing sedentary behaviour to be of value, though more active individuals were unconvinced that reducing sedentary behaviour has value beyond the benefits of being physically active. Interventions may wish to provide education to address the misconception that increasing moderate-to-vigorous physical activity is necessary in order to reduce sedentary behaviour. Educating older adults on the independent health consequences of sedentary behaviour may also prove beneficial.

Sedentary behaviour in hospitalised older people: a scoping review protocol

BACKGROUND

Older adults spend up to 23 h daily sitting or lying while in hospital. Sedentary behaviour (SB) within a hospital setting is often associated with poor health outcomes including physical and cognitive decline, reduced quality of life and death as well as hospital readmissions. Conversely, replacing SB with mild to moderate levels of physical activity such as walking can significantly reduce hospital readmission risk by 30 days. Given the potentially harmful effects of SB in hospitalised older adults, it is vital to identify current literature by broadly exploring different aspects of SB among older people in hospital. The overall aim of this scoping review is to produce a literature map of current evidence on key domains of sedentary behaviour in hospitalised older people.

METHOD

A search for relevant publications will be undertaken in Pedro, MEDLINE Ovid, Cochrane, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, Embase, Ageline, Joanna Briggs Institute (JBI) and clinical trials registries. Publications in English and those where the author can provide the full text in English will be included. Studies conducted in hospitals (including in-patient rehabilitation facilities) or acute and subacute care settings and in people aged ≥ 65 will be included. A three-stage method will be used to identify relevant articles, consisting of database search using keywords, keywords and index words across all databases, and reference searching. Articles will be selected following screening of titles/abstracts succeeded by a full-text appraisal utilising a standardised selection form. Two independent reviewers will extract data using the standardised form that will be tested on two articles. A narrative summary will accompany results presented in tables and figures.

Show cards of the Global Physical Activity Questionnaire (GPAQ) - do they impact validity? A crossover study

Background

The Global Physical Activity Questionnaire (GPAQ) is applied internationally as a tool to assess the level of physical activity. The GPAQ was designed as an interview, including the use of show cards, which visualise activities of moderate and intensive physical activity and support the distinction between these intensities. The self-administered version of the GPAQ is used in the application-oriented research for reasons of economy and practicality. However, the use of show cards often remains unknown.

The aim of the present study was to examine differences in validity between two self-administered versions of the GPAQ with and without show cards.

Methods

In this crossover study, two groups (n = 54; 57.4% female; 28.3 ± 12.2 years) received the GPAQ with or without show cards after 7 days and the respective other version after additional 7 days. For validation, all participants wore an accelerometer (ActiGraph GT3X+) on all 14 days.

Differences between GPAQ versions and accelerometer data were compared by Wilcoxon signed rank test. Additionally, Spearman analyses and Bland-Altman plots were calculated.

Results

No statistically significant difference between the GPAQ versions could be found in regard to the accuracy of physical activity assessment (p > 0.05).

Both GPAQ versions show similar correlation coefficients for vigorous physical activity (rho = 0.31–0.42) and sedentary behaviour (rho = 0.29–0.32). No statistically significant correlation was found for physical activity of moderate intensity. The Bland-Altman plots support these results, as both GPAQ versions have the same trends in terms of overestimation and underestimation of physical activity.

Conclusion

The use of show cards had no significant impact on questionnaire validity. Therefore, both GPAQ versions can be applied interchangeably. Nevertheless the exact description of application of the GPAQ is desirable in terms of reproducibility and transparent scientific research.

Is urinary incontinence associated with sedentary behaviour in older women? Analysis of data from the National Health and Nutrition Examination Survey

BACKGROUND

Urinary incontinence (UI) is a common geriatric syndrome associated with physical and cognitive impairments. The association between type of UI and sedentary behaviour (SB) has not been explored.

AIM

To determine association between moderate-severe UI, or any stress UI (SUI) or any urgency UI (UUI) and SB in community-dwelling older women.

METHODS

Women aged 60 and over from the 2005-2006 cycle of the National Health and Nutrition Examination Survey (NHANES) with objectively measured (accelerometer) and self-reported SB and UI data were selected. Multivariate models exploring association between moderate-severe UI and SB, or SUI and SB, or UUI and SB were analysed using logistic regression adjusted for factors associated with UI.

RESULTS

In the overall sample of 459 older women, 23.5% reported moderate-severe UI, 50.5% reported any SUI and 41.4% reported any UUI. In bivariate analysis objectively measured proportion of time in SB was associated with moderate-severe UI and UUI (p = 0.014 and p = 0.047) but not SUI. Average duration of SB bouts in those with moderate-severe UI or any SUI was no longer than older women reporting no continence issues, but it was significantly (19%) longer in older women with any UUI (mean difference 3.2 minutes; p = 0.001). Self-reported SB variables were not associated with any type of UI. Multivariate analysis showed an association between UUI and a longer average duration of SB bouts (OR = 1.05, 95% CI = 1.01-1.09, p = 0.006) but no association with moderate-severe UI or SUI.

CONCLUSION

UUI was significantly associated with increased average duration of SB bouts in community-dwelling older women. The importance of objective measurement of SB is highlighted and suggests that decreasing time in prolonged sitting may be a target intervention to reduce UUI. Future studies are required to further explore the association between SB and incontinence.

Validity of the Past-day Adults' Sedentary Time Questionnaire in a Cardiac Rehabilitation Population

PURPOSE

Self-report measures of sedentary behavior are easier to use in a clinical setting; yet, no self-report measures of sedentary behavior appear to be validated in cardiac rehabilitation over time. The aim of this study was to assess the validity of the Past-day Adults' Sedentary Time (PAST) questionnaire in a cardiac rehabilitation population over 12 mo.

METHODS

Seventy-two cardiac rehabilitation participants were recruited to a prospective cohort study. Participants wore an ActiGraph ActiSleep accelerometer (sedentary time <100 counts/min) for 7 consecutive days and completed the self-administered PAST questionnaire at baseline, 6 wk, and 6 and 12 mo. Total daily sedentary time from both methods were compared using Bland-Altman plots and Spearman rank-order correlations.

RESULTS

Agreement between the 2 measures of sedentary time improved over 12 mo. At 6 and 12 mo, there was a good level of agreement between measures (mean difference between accelerometer and PAST 57 and -0.7 min, respectively), although the dispersion of the differences was wide (95% limits of agreement -428 to 541 and -500 to 498 min, respectively). There were weak correlations between the PAST questionnaire and average accelerometer measured sedentary time at all time points (α = -0.249 to 0.188).

CONCLUSIONS

Following repeated assessments, the PAST questionnaire may be useful to determine sedentary time in cardiac rehabilitation participants at a group level, with participants appearing to more accurately recall their time spent in sedentary behavior. Further research is indicated to assess the validity of sedentary behavior questionnaires in cardiac rehabilitation, with a combination of objective and self-reported measures currently recommended.

Reducing Sedentary Time among Older Adults in Assisted Living: Perceptions, Barriers, and Motivators

Older adults accumulate more sedentary time (ST) than any other age group, especially those in assisted living residences (ALRs). Reducing prolonged ST could help maintain function among older adults. However, to develop effective intervention strategies, it is important to understand the factors that influence sedentary behavior. The purpose of this study was to explore perceptions of ST as well as barriers and motivators to reducing ST among older adults in assisted living, in the context of the Social Ecological Model (SEM). Using a qualitative description approach, we sought to learn about participants’ perceptions of sedentary time in their daily lives. Semi-structured focus groups were held at six ALRs with 31 participants (84% women, 83.5 ± 6.5 years). Data were transcribed and coded using an inductive thematic approach. Themes were categorized based on four levels of the SEM: individual, social, physical environment, and organization. Many reported barriers were at the individual level (e.g., lack of motivation, pain, fatigue) while others were associated with the organization or social environment (e.g., safety concerns, lack of activities outside of business hours, and social norms). These findings suggest that there are unique challenges and opportunities to consider when designing ST interventions for assisted living.

Twenty four-hour activity cycle in older adults using wrist-worn accelerometers: The seniors-ENRICA-2 study

OBJECTIVES

This study aimed: (a) to provide a detailed description of sleep, sedentary behavior (SED), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) over the complete 24-hours period using raw acceleration data in older adults; and (b) to examine the differences in the 24-hours activity cycle by sex, age, education, and body mass index (BMI).

METHODS

Population-based cohort comprising 3273 community-dwelling individuals (1739 women), aged 71.8 ± 4.5 years, participating in the Seniors-ENRICA-2 study. Participants wore a wrist-worn ActiGraph GT9X accelerometer for 7 consecutive days, and the raw signal was processed using the R-package GGIR.

RESULTS

Participants reached 21.5 mg as mean acceleration over the whole day; 32.3% (7.7 h/d) of time was classified as sleep, 53.2% (12.7 h/d) as SED, 10.4% (148.6 min/d) as LPA, and 4.1% (59.0 min/d) as MVPA. No marked differences were found in sleep-related variables between socio-demographic and BMI groups. However, women showed higher LPA but lower SED and MVPA than men. Moreover, SED increased whereas LPA and MVPA decreased with age. Participants with obesity (BMI ≥ 30 kg/m² ) accumulated more SED and less LPA and MVPA than those without obesity. As expected, adherence to physical activity recommendations varied widely (9.2%-76.6%) depending on the criterion of MVPA accumulation.

CONCLUSION

Objective assessment of the 24-hour activity cycle provides extensive characterization of daily activities distribution in older adults and may inform health-promotion interventions in this population. Women, the oldest old, and those with obesity offer relevant targets of strategies to improve lifestyle patterns.

Criterion Validity of the Sedentary Behavior Question From the Global Physical Activity Questionnaire in Older Adults

BACKGROUND

To assess the validity of the single question to determine sedentary behavior (SB) by using the Global Physical Activity Questionnaire (GPAQ) in older adults.

METHODS

The sample included 163 participants (96 women) aged 65-92 years. Self-reported SB was obtained from the GPAQ. Objectively measured SB was assessed using the Intelligent Device for Energy Expenditure and Activity. Participants wore the Intelligent Device for Energy Expenditure and Activity continuously during 2 consecutive days while following their daily routine. The relative validity was assessed using the Spearman rank correlation coefficient (ρ), and the agreement was examined using mean bias and 95% limit of agreement with the Intelligent Device for Energy Expenditure and Activity as reference.

RESULTS

The results showed small correlations (ρ = .291, P < .001) between the SB from the GPAQ and the objective measures, and ranged from ρ = .217 to ρ = .491 depending on the potential moderator. Similarly, the GPAQ underestimates the SB for approximately 2 hours per day in older adults (limit of agreement = -7.3 to 3.4 h/d).

CONCLUSION

The GPAQ may not be the most suitable questionnaire for measuring SB in this population and should be used with caution because those studies that use this questionnaire in older adults may have an inaccurate measurement of SB levels.

Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits - a prospective cohort study with 15 years follow-up

Background

Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking.

Objective

To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days.

Methods

In total, 1220 women and men, 18–75 years, from the population-based Sweden Attitude Behaviour and Change study 2000–2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay.

Results

Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48–0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33–0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37–0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20–4.74).

Conclusion

This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message “sit less and move more”.

Effects of Vibrotactile Feedback on Sedentary Behaviors in Adults: A Pilot Randomized Controlled Trial

No effective and easily implemented intervention strategies for reducing sedentary behavior have been established. This pilot trial (UMIN000024372) investigated whether vibrotactile feedback reduces sedentary behavior. Twenty-six adults aged 30–69 years who were sedentary ≥8 h/day were randomly assigned to control (n = 13) or vibration (n = 13) groups. Participants wore a monitor 9 h daily for seven-day periods at baseline (week zero), during the intervention (weeks one, three, five, and seven), and after the intervention (week eight). During the eight-week intervention, vibration-group participants were notified by a vibration through the monitor whenever continuous sedentary time reached ≥30 min; they also received weekly reports of their sedentary patterns. Control-group participants did not receive feedback. The primary outcome was change in total sedentary time. Changes in longer bouts of sedentary time (≥35 min) were also assessed. No significant difference was found in the change in total sedentary time (control: −17.5 min/9 h, vibration: −9.1 min/9 h; p = 0.42). Although no significant differences were observed in sedentary time in longer bouts, vibration-group participants exhibited significantly lower sedentary time (–21.6 min/9 h, p = 0.045). Thus, vibration feedback does not appear to offer any advantages in reducing total sedentary time.

[Promotion of physical activity for older patients with rheumatism : Characteristics of inflammatory rheumatic diseases against the background of physical activity recommendations]

Due to the wide range of positive effects and the clear evidence of effectiveness, physical activity is one of the most important treatments for inflammatory rheumatic diseases. Because of the frequent overlap of disease and age-related aspects in older patients, the implementation of the German national physical activity recommendations has to be checked and accompanied by physicians. To get the older patients in motion, a patient-centered approach is required that takes the individual health problem(s) and the current context of life into account. This article provides an overview of the activity-related characteristics of older patients with inflammatory rheumatic diseases. Against this background a simple strategy is provided for promoting physical activity during medical consultation, which takes the characteristics of older patients with rheumatism into consideration. In this way, physicians can integrate a targeted, resource and time-saving economic strategy into consultations that is in concordance with the national physical activity recommendations.

How Acceptable is Reducing Sedentary Behavior to Older Adults? Perceptions and Experiences Across Diverse Socioeconomic Areas

Sedentary behavior is associated with negative health outcomes, and older adults represent the most sedentary age group. There is currently little qualitative evidence to inform the development of sedentary behavior interventions targeting older adults. This study explored factors affecting older adults’ sedentary behaviors and the acceptability of potential strategies to reduce sedentary time. Semistructured interviews with 22 older adults with diverse socioeconomic backgrounds in Manchester, England were conducted. An inductive thematic analysis was structured using the framework approach. Limited availability of community resources was identified in deprived areas. Local environments impacted sedentary behavior, including sense of community belonging, crime, and physical infrastructure. Enjoyment, socializing, and feeling a sense of achievement were key motivations to engage in nonsedentary activities. As older adults desire social interaction and enjoyment, community interventions in urban settings should try to reduce sedentary behavior by offering group-based activities, particularly in deprived areas where current provision is limited.

Dose-dependent association of accelerometer-measured physical activity and sedentary time with brain perfusion in aging

INTRODUCTION

Age-related decreases in cerebral blood flow (CBF) may lead to cognitive decline, while physical activity (PA) can maintain CBF and cognition in aging. The intensity of PA needed to affect CBF in aging, and the independent effects of sedentary time on CBF are currently unknown. Moreover, research conducted in free-living environments with objective measures of PA (e.g., accelerometry) is lacking.

METHODS

This cross-sectional study used accelerometry to objectively measure sedentary time, all light PA [AllLightPA], moderate-to-vigorous PA [MVPA], and total activity counts [TAC] in 52 cognitively healthy older adults. Robust linear regressions investigated the association of CBF (using arterial spin labeling magnetic resonance imaging) in frontal and medial temporal regions, with each PA intensity and sedentary time.

RESULTS

Greater sedentary time was significantly associated with lower CBF in lateral and medial frontal regions after adjusting for MVPA, while higher AllLightPA (adjusted for MVPA), MVPA (adjusted for AllLightPA), and TAC were associated with greater CBF in lateral and medial frontal regions.

DISCUSSION

Lighter activities, as well as MVPA, are beneficial to CBF in brain regions typically affected by the aging process and malleable to exercise interventions (i.e., the frontal lobes), whereas sedentary time is an independent risk factor for neurovascular dysregulation in normal aging.

Editor's Choice: Dual-process model of older adults' sedentary behavior: an ecological momentary assessment study

Objective: A 10-day ecological momentary assessment (EMA) study was conducted to test a dual-process model of older adults' sedentary behavior.Design: Older adults (n = 104, 60-98 years) answered 6 EMA questionnaires/day to assess conscious processes (i.e. momentary intentions, self-efficacy to limit sedentary behavior over the next two hours) and wore an activPAL accelerometer to measure sedentary behavior. Habit strength for sedentary behavior, a non-conscious process, was self-reported at an introductory session.Main outcome measure: Time spent sitting in the two hours after the EMA prompt.Results: Older adults engaged in less sedentary behavior on occasions when their intentions (b = -1.63, p = 0.02) and self-efficacy (b = -2.01, p = 0.003) to limit sedentary behavior were stronger than one's average level of intentions or self-efficacy, respectively; however, older adults' average level of intentions (b = -5.30, p = 0.05) or self-efficacy (b = 2.77, p = 0.27) to limit sedentary behavior were not associated with sedentary behavior. Older adults with stronger sedentary behavior habits engaged in greater sedentary behavior in the two hours following the EMA prompt (b = 2.04, p = 0.006).Conclusion: Sedentary behavior is regulated by conscious and non-conscious processes. Interventions targeting older adults' sedentary behavior should promote momentary intention formation and self-efficacy beliefs to limit sitting as well as content to disrupt habitual sedentary behavior.

Changes in Self-Reported Health and Psychosocial Outcomes in Older Adults Enrolled in Sedentary Behavior Intervention Study

PURPOSE

To estimate changes in self-reported health and psychosocial factors associated with a 12-week sedentary behavior intervention for older adults.

DESIGN

Exploratory secondary analysis of pilot randomized controlled trial.

SETTING

Kaiser Permanente Washington.

SUBJECTS

Sixty adults aged 60 to 89 with body mass index ≥30 kg/m2.

INTERVENTION

Participants were randomized to the I-STAND intervention or control group. I-STAND involved 6 coaching sessions, a study workbook, Jawbone UP activity tracker to prompt breaks from sitting, and activPAL feedback on objective sitting time.

MEASURES

At baseline and 12-week follow-up, participants completed a survey with validated measures of self-reported health outcomes (depression, stress, memory/concentration, sleep, pain, ability to do daily activities, energy, and quality of life) and modified scales measuring psychosocial factors (perceived benefits/barriers, social support, self-efficacy, and sedentary habit strength) regarding sedentary behavior.

ANALYSIS

Generalized linear models assessed associations between group assignment and change in each self-reported health and psychosocial score, adjusting for baseline scores.

RESULTS

I-STAND participants demonstrated improvements in self-efficacy (β = 0.35, 95% confidence interval [CI]: 0.10 to 0.60) and reduced habit strength (β= -0.23, 95% CI: -0.42 to -0.04) compared to control participants. There were no significant differences in self-reported health outcomes, although power was limited in this exploratory analysis.

CONCLUSION

A sedentary behavior reduction intervention for older adults resulted in improvements for some psychosocial factors. Health outcomes may require longer than 12 weeks to observe improvements.

Sedentary Time, Physical Activity, Fitness, and Physical Function in Older Adults: What Best Predicts Sleep Quality?

The aim of this study was to identify the best predictor of sleep quality (SQ) among physical behavior or capacity-related variables, namely physical activity, sedentary time, fitness, and physical function (activities of daily living) of independent elders using a representative sample of Portuguese aged 65 years and older (N = 437). SQ and activities of daily living were evaluated by a questionnaire, sedentary time, and physical activity through accelerometry, and physical fitness by means of the Senior Fitness Test. The logistic regression analysis revealed that activities of daily living measured by the Composite Physical Function was the only explanatory variable discriminating between poor SQ and good SQ. Receiver operating characteristic analysis showed that the best trade-off between sensitivity and specificity to discriminate older adults with poor SQ and good SQ was 20 points in the Composite Physical Function (sensitivity = 57.9%; specificity = 60.9%; area under the curve = 0.600, 95% confidence interval [0.536, 0.665], p = .003). Better physical function seems to be associated with better SQ in independent elders.

Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation?

OBJECTIVES

To understand how device-measured sedentary behaviour and physical activity are related to all-cause mortality in older men, an age group with high levels of inactivity and sedentary behaviour.

METHODS

Prospective population-based cohort study of men recruited from 24 UK General Practices in 1978-1980. In 2010-2012, 3137 surviving men were invited to a follow-up, 1655 (aged 71-92 years) agreed. Nurses measured height and weight, men completed health and demographic questionnaires and wore an ActiGraph GT3x accelerometer. All-cause mortality was collected through National Health Service central registers up to 1 June 2016.

RESULTS

After median 5.0 years' follow-up, 194 deaths occurred in 1181 men without pre-existing cardiovascular disease. For each additional 30 min in sedentary behaviour, or light physical activity (LIPA), or 10 min in moderate to vigorous physical activity (MVPA), HRs for mortality were 1.17 (95% CI 1.10 to 1.25), 0.83 (95% CI 0.77 to 0.90) and 0.90 (95% CI 0.84 to 0.96), respectively. Adjustments for confounders did not meaningfully change estimates. Only LIPA remained significant on mutual adjustment for all intensities. The HR for accumulating 150 min MVPA/week in sporadic minutes (achieved by 66% of men) was 0.59 (95% CI 0.43 to 0.81) and 0.58 (95% CI 0.33 to 1.00) for accumulating 150 min MVPA/week in bouts lasting ≥10 min (achieved by 16% of men). Sedentary breaks were not associated with mortality.

CONCLUSIONS

In older men, all activities (of light intensity upwards) were beneficial and accumulation of activity in bouts ≥10 min did not appear important beyond total volume of activity. Findings can inform physical activity guidelines for older adults.

Association between sitting time and orthopedic conditions in Korean older adults

This study aimed to identify the association between sitting time and orthopedic conditions in Korean older adults. Data from adults aged ≥65 years from the 6th Korea National Health and Nutrition Examination Survey (2014-2015) were used for analysis (n = 3,011). Sitting time ≥7.5 h/day was significantly associated with knee joint (OR = 1.41, 95% CI: 1.11, 1.79), hip joint (OR = 1.54, 95% CI: 1.17, 2.03), and low back pain (OR = 1.44, 95% CI: 1.19, 1.74) when adjusted for sex, age, obesity, housing type, family income, education, and marital status in multiple logistic regression analyses. These findings imply that appropriate pain management according to sociodemographic characteristics in orthopedic conditions are necessary to reduce excessive sitting time in Korean older adults.

Sedentary Behavior and Quality of Life in Individuals With Parkinson's Disease

Background. Sedentary behavior is a growing public health concern and may have particular relevance for the Parkinson disease (PD) population. However, the influence of sedentary time on factors associated with quality of life (QOL) in PD is unknown. The primary purpose of this study was to examine relationships between sedentary behaviors and markers of PD-specific QOL. A secondary purpose was to examine relationships between physical activity behaviors and QOL. Methods. We assessed sedentary and active behaviors using objective and interview measures and examined relationships between these behaviors and a measure of PD-specific QOL in individuals with PD. Results. Results demonstrated that sedentary time was significantly related to several aspects of QOL, including perceived deficits in the domains of mobility, cognitive processing, and communication. Additionally, results showed that time spent watching television was more strongly associated with lower levels of QOL than other more engaging sedentary activities. For physical activity, relationships between objective measures and QOL were weaker and only significantly associated with mobility. Time spent doing housework was associated with lower levels of QOL, whereas time spent in recreational activity was associated with lower levels of discomfort. Discussion. These results suggest that targeting decreases in sedentary behaviors (eg, reducing time spent watching television, breaking up prolonged bouts of sedentary time) may be effective for improving QOL in individuals with PD.

Measurement of physical activity in clinical practice and research: advances in cancer and chronic respiratory disease

PURPOSE OF REVIEW

Physical activity has emerged as an important health outcome and its assessment, in particular with objective monitors, has proliferated in recent years. This review considers recent advances in physical activity measurement and clinical trials in cancer and chronic respiratory diseases where physical activity was a primary or key secondary outcome focusing on methodological learning points.

RECENT FINDINGS

There is growing data on (i) the validity of commercial 'consumer' physical activity monitors, e.g. FitBit, and (ii) the role of hybrid physical activity assessments; combining objective and subjective measures to understand physical activity quantity and quality. In both cases, adherence is challenging and can be optimized using short monitoring protocols, e.g., 3-4 days, and by providing clear instructions and support materials to participants. Studies in cancer and chronic respiratory disease have found mixed effects from physical activity interventions based on pedometers, behavior change techniques, online resources, and/or therapeutic nutrition. The most responsive physical activity outcomes and minimum clinically important differences are still to be understood.

SUMMARY

Physical activity measures provide an opportunity to detect changes in health behavior. However, measuring physical activity as a trial endpoint is challenging and focusing effort to ensure optimal participant compliance is important.

Sedentary behaviors and anxiety among children, adolescents and adults: a systematic review and meta-analysis

Background

Although the number of studies examining the relationships between sedentary behaviors (SB) and anxiety is growing, an overarching evidence, taking into account children, adolescents, and adults as well as different types of SB and different categories of anxiety outcomes, is still missing. Thus, this systematic review and meta-analysis aimed at obtaining a comprehensive overview of existing evidence.

Methods

A search in the following databases: PsycINFO, PsycARTICLES, Academic Search Complete, ERIC, HealthSource: Nursing/Academic Edition and MEDLINE, resulted in k = 31 original studies included in the systematic review (total N = 99,192) and k = 17 (total N = 27,443) included in the meta-analysis. Main inclusion criteria referred to testing the SB--anxiety relationship, the quality score (above the threshold of 65%), and the language of publications (English). The study was following the PRISMA statement and was registered at PROSPERO (CRD42017068517).

Results

Both the systematic review and meta-analysis indicated that overall average effects were small: higher levels of symptoms of anxiety were associated with higher levels of SB (weighted r = .093, 95% CI [.055, .130], p < .001). Moderator analyses indicated that trends for stronger effects were observed among adults, compared to children/adolescents (p = .085).

Conclusions

Further longitudinal studies are necessary to elucidate the predictive direction of the anxiety—SB relationship and to clarify whether the effects depend on the type of anxiety indicators.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6715-3) contains supplementary material, which is available to authorized users.

A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): protocol for a randomised controlled feasibility study

BACKGROUND

Osteoarthritis is a highly prevalent condition in older adults, that causes many sufferers to require a hip or knee replacement in order to improve their quality of life and reduce pain. Individuals waiting for hip or knee replacements are often highly sedentary; thus, it is pertinent to assess whether reducing their sedentariness prior to surgery may aid in improving post-operative outcomes.

METHODS/DESIGN

The study will be a randomised controlled feasibility trial design, with 2:1 randomisation into an intervention and usual care group respectively. A target of 45 patients aged 60 years or older waiting for elective hip and knee replacements will be recruited from Russells Hall Hospital, Dudley, UK, approximately 8-10 weeks before surgery. The intervention, informed by Self-Determination Theory (SDT), will be composed of multiple behaviour change techniques, namely, motivational interviewing, feedback on current objectively measured sedentary behaviour and activity, goal-setting, environmental modification, self-monitoring, and social support. Assessments will occur at baseline, 1 week pre-surgery, and 6 weeks post-surgery. The primary outcome will be the feasibility of intervention delivery and of the trial procedures, assessed quantitatively based on rates of recruitment, retention, measures-completion, and intervention fidelity assessment, and with mixed-methods assessment of acceptability, practicality, adaption, satisfaction, and safety. Exploratory outcomes will include physical function, cardiometabolic biomarkers, measurement of SDT constructs, and both objective and subjective measurement of physical activity and sedentariness. The study will last up to 18 weeks per participant. No formal between-group comparisons are planned, but the variance in within-group changes and differences between groups in outcome measures will be explored and reported with 95% confidence intervals.

DISCUSSION

This is the first study assessing the feasibility of an intervention to reduce sedentary behaviour in older adults with mobility limitations, and the first to assess whether such a reduction could work in a prehabilitative context prior to surgery. The results of this study will help inform the design of a definitive randomised controlled trial.

TRIAL REGISTRATION

This trial is registered on Clinicaltrials.gov. Registration number: NCT03740412. Date of registration: 13/11/2018.

Even a Previous Light-Active Physical Activity at Work Still Reduces Late Myocardial Infarction and Stroke in Retired Adults Aged>65 Years by 32%: The PROOF Cohort Study

Background: Work may contribute significantly to daily physical activity (PA) and sedentary behavior (SB). Physical inactivity and SB at work might be two major risk factors for premature morbidity. Therefore, the aim of this research was to describe self-reported past PA and SB at work and during leisure time within the PROOF cohort subjects, and to determine consequences of PA and SB on late health of these now retired workers.

Material and Methods: The PROOF cohort study was used to prospectively allow assessment of the predictive value of PA and SB at work and during leisure time among a healthy retired French population, with regard to cardiovascular and cerebrovascular events. PA (MET-h/week) and SB (h/d) were assessed using the Population Physical Activity Questionnaire (POPAQ) and the modified Global Physical Activity Questionnaire (GPAQ). Odds ratios (ORs with 95% CIs) for cardiovascular and cerebrovascular events were associated with each level of PA at work: light (<3 METs), moderate (3–5.9 METs), vigorous (≥6 METs) and were compared to SB at work.

Results: Out of the 1011 65-year-old subjects initially included, the 15-year follow-up has been currently completed for 688 (68%) subjects; 89 deaths (all-cause mortality, 9%) and 91 fatal and non-fatal cardiovascular and cerebrovascular events (9%), were reported. An active work (light, moderate, or vigorous intensity) was associated with a 21% reduced risk of cardiovascular (myocardial infarction) and cerebrovascular events (stroke) (OR = 0.79, 95% CI: 0.32–0.91, p < 0.02) compared to sedentary work. This relationship was already significant for light intensity work (32%; i.e., OR = 0.68, 95% CI: 0.31–0.87, p < 0.02).

Conclusion: There is strong causal evidence linking PA and SB at work with late cardiovascular and cerebrovascular disease. All in all, the risk for onset of myocardial infarction and stroke was lower among those who had a previous active work compared to those with previous sedentary work. Even previous light active work produced substantial health benefits.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT00759304.

The impact of physical activity and sedentary behaviors on frailty levels

Heterogeneity in aging can be explained by frailty. Lifestyle behaviors such as physical activity can help manage frailty levels. Conversely, sedentary behaviours are associated with frailty independently of physical activity. Here, we summarize epidemiological and clinical trial evidence concerning the impact of physical activity and sedentary behaviors on frailty levels. We also analysed the National Health and Nutrition Examination Survey (NHANES) data to describe physical activity and sedentary behavior accumulation patterns across frailty levels and their impact on mortality risk. The few prospective and intervention studies demonstrate that higher physical activity levels are associated with a lower incidence of frailty. There are no interventions published which limit sedentary behaviors to manage frailty. Using the NHANES data we demonstrate that individuals are less likely to meet physical activity guidelines and are more likely to accumulate sedentary time in prolonged bouts. Prolonged sedentary bouts and total sedentary time were associated with a higher mortality risk in frail individuals but not in the fit group. Non-bouted sedentary time was not associated with mortality risk. Our review and novel data suggest that there is a need for more intervention studies which focus on increasing physical activity or minimizing sedentary time to manage frailty levels.

Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults: A systematic review and meta-analysis

BACKGROUND

Physical activity and sedentary behavior are modifiable risk factors for non-communicable disease and healthy ageing, however the majority of older adults remain insufficiently active. Digital behavior change interventions (DBCI) have the potential to reach many older adults to promote physical activity and reduce sedentary time. This study aims to assess the efficacy of DBCI interventions in older adults (≥50 years) on physical activity and sedentary behavior.

METHODS

A systematic review of major databases from inception to 03/2018 was undertaken. Randomized controlled trials (RCT) or pre-post interventions assessing effects of DBCI on physical activity and/or sedentary behavior in older adults (≥50 years) were included. Random effects meta-analyses were carried out.

RESULTS

Twenty-two studies were included, including 1757 older adults (mean age = 67 years, %male = 41), 68% showed moderate-high risk of bias. Meta-analyses suggested that DBCI increased total physical activity among RCT studies (n = 8) (SMD = 0.28; 95%CI 0.01, 0.56; p = 0.04) and pre-post studies (n = 6) (SMD = 0.25; 95%CI 0.09, 0.41; p = 0.002), increased moderate-to-vigorous physical activity (SMD = 0.47; 95%CI 0.32, 0.62, p < 0.001; MD = 52 min/week) and reduced sedentary time (SMD = -0.45; 95%CI -0.69, -0.19; p < 0.001; MD = 58 min/day). Reductions in systolic blood pressure (-11 bpm; p = 0.04) and improvements in physical functioning (p = 0.03) were also observed.

CONCLUSIONS

DBCI may increase physical activity and physical functioning, and reduce sedentary time and systolic blood pressure in older adults, however more high-quality studies are required.

A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation

The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.

Is Sitting Time Related with Physical Fitness in Spanishelderly Population? The EXERNET Multicenter Study

BACKGROUND

Older adults spend most of their waking hours performing sedentary activities. The influence of these lifestyle patterns on the physical fitness (PF) levels of this population has not yet been sufficiently investigated.

OBJECTIVE

The aim of the study was to examine whether sedentary behavior (SB) (h•d-1sitting) is associated with PF, and specifically to analyze whether sitting >4 h•d-1 is associated with higher risk of having lower levels of fitness in seniors.

DESIGN

EXERNET multi-center study.

PARTICIPANTS AND SETTINGS

A representative sample of 3136 non-institutionalized elderly (aged 72.2±5.3 years), from 6 Regions of Spain were included in the study.

MEASUREMENTS

PF was assessed using 8 different tests from the EXERNET battery. Lifestyle patterns were collected using a validated questionnaire. ANOVA was used to compare the groups according to the hours of sitting. Binary logistic regression was used to calculate the association between the SB and low levels of fitness.

RESULTS

For both genders, those who spent sitting >4 h•d-1 had lower levels of balance, agility, walking speed and aerobic endurance (p<0.001). Sedentary men also had less strength of lower extremities (p<0.05), whereas, sedentary women were less flexible in the lower extremities (p<0.001). More than 4 h•d-1 sitting was associated, in men, to higher odds for having low strength (lower extremities), agility, flexibility (lower extremities) and aerobic endurance (p<0.05); and in women, to higher risk of low balance, strength (lower and upper extremities), flexibility (lower extremities), agility, walking speed and aerobic endurance (p<0.05).

CONCLUSIONS

Seniors that sit >4 h•d-1 have lower levels of fitness and this behavior is related with an increased risk of having low levels of PF in this population.