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

Prevalence and Correlates of Sarcopenia among Elderly CKD Outpatients on Tertiary Care

Background: Sarcopenia is a widespread concern in chronic kidney disease (CKD) as well in elderly patients and is one of the main reasons why low-protein diets for this population are controversial. The aim of this study was to assess the prevalence and correlates of sarcopenia among elderly male patients affected by CKD followed up in an outpatient nephrology clinic, where moderate protein restriction (0.6–0.8 g/Kg/day) is routinely recommended to patients in CKD stage 3b-5 not on dialysis. Methods: This observational study included 80 clinically-stable male out-patients aged >60, affected by stage 3b-4 CKD. Forty patients aged ≥75 (older seniors) were compared to the other forty patients aged 60–74 (younger seniors). All patients underwent a comprehensive nutritional and functional assessment. Results: Older seniors showed lower serum albumin, hand-grip strength, body mass index (BMI), skeletal muscle mass, and resting energy expenditure. Protein intake was significantly lower in older seniors whereas energy intake was similar. Average daily physical activity was lower in the older seniors than in the younger ones. Sarcopenia was more prevalent in older than in younger seniors. Among older seniors, sarcopenic and non-sarcopenic ones differed in age and performance on the Six-Minute Walk test, whereas the estimated glomerular filtration rate (eGFR), biochemistry, dietary protein, and energy intakes were similar. Conclusions: Older senior CKD male patients have lower muscle mass, muscle strength, and physical capacity and activity levels, with a higher prevalence of sarcopenia than younger patients. This occurs at the same residual renal function and metabolic profile and protein intake. Energy intake was at the target in both subgroups. In this CKD cohort, sarcopenia was associated with age and physical capacity, but not with eGFR or dietary intakes.

Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: A systematic review of observational studies and an updated review of interventional studies

OBJECTIVES

We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews.

METHODS

We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates.

RESULTS

For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention.

CONCLUSION

Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551.

Validity of objective methods for measuring sedentary behaviour in older adults: a systematic review

Background

The evidence showing the ill health effects of prolonged sedentary behaviour (SB) is growing. Most studies of SB in older adults have relied on self-report measures of SB. However, SB is difficult for older adults to recall and objective measures that combine accelerometry with inclinometry are now available for more accurately assessing SB. The aim of this systematic review was to assess the validity and reliability of these accelerometers for the assessment of SB in older adults.

Methods

EMBASE, PubMed and EBSCOhost databases were searched for articles published up to December 13, 2017. Articles were eligible if they: a) described reliability, calibration or validation studies of SB measurement in healthy, community-dwelling individuals, b) were published in English, Portuguese or Spanish, and c) were published or in press as journal articles in peer-reviewed journals.

Results

The review identified 15 studies in 17 papers. Of the included studies, 11 assessed the ActiGraph accelerometer. Of these, three examined reliability only, seven (in eight papers) examined validity only and one (in two papers) examined both. The strongest evidence from the studies reviewed is from studies that assessed the validity of the ActiGraph. These studies indicate that analysis of the data using 60-s epochs and a vertical magnitude cut-point < 200 cpm or using 30- or 60-s epochs with a machine learning algorithm provides the most valid estimates of SB. Non-wear algorithms of 90+ consecutive zeros is also suggested for the ActiGraph.

Conclusions

Few studies have examined the reliability and validity of accelerometers for measuring SB in older adults. Studies to date suggest that the criteria researchers use for classifying an epoch as sedentary instead of as non-wear time (e.g., the non-wear algorithm used) may need to be different for older adults than for younger adults. The required number of hours and days of wear for valid estimates of SB in older adults was not clear from studies to date. More older-adult-specific validation studies of accelerometers are needed, to inform future guidelines on the appropriate criteria to use for analysis of data from different accelerometer brands.

Trial registration

PROSPERO ID# CRD42017080754 registered December 12, 2017.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0749-2) contains supplementary material, which is available to authorized users.

Cognitive activity in a sitting position is protectively associated with cognitive impairment among older adults

AIM

Previous studies have obtained inconsistent results regarding the association between sedentary behavior and cognitive impairment. The present study aimed to examine the association between cognitive activity in a sitting position (CAS) and cognitive impairment among older adults.

METHODS

Community-dwelling older adults, from Obu or Nagoya in Japan, participated in a survey in 2013. A total of 5300 participants (mean age 75.0 ± 5.1 years; women 52.9%) met the criteria for the present study. We assessed the frequency and variety of CAS composed of six activities, including reading books or newspapers, writing a diary or letters, solving crossword puzzles, playing board games, using a computer and maintaining housekeeping records. The frequency of engagement in CAS was one or more time(s)/week. The variety of CAS was assessed by the number of engagements in CAS. Cognitive impairment was defined by two or more tests at least 1.5 standard deviations below the reference threshold in four neuropsychological tests. Logistic regression analysis was carried out to examine the associations between the frequency and variety of CAS and cognitive impairment, adjusted for covariates.

RESULTS

The proportion of participants engaging in each CAS varied from 12.3% (playing board games) to 93.6% (reading books or newspaper). After adjustment, five CAS were significantly associated with cognitive impairment (OR 0.33-0.65, all P < 0.001). The variety of CAS was significantly associated with the reduced OR of cognitive impairment (OR 0.61, 95% confidence interval 0.55-0.68).

CONCLUSIONS

Almost every CAS and a greater variety of CAS are associated with cognitive impairment among older people. Geriatr Gerontol Int 2019; 19: 98-102.

Interventions targeting sedentary behavior in non-working older adults: a systematic review

Sedentary behavior has been found to be associated with negative health outcomes independently of physical activity in older adults. This systematic review collates interventions to reduce sedentary behavior in non-working older adults, assessing whether they are effective, feasible, and safe. A systematic search identified 2560 studies across five databases. Studies were included where participants were ≥60 years on average with none younger than 45, and participants did not work >2 days per week. A total of six studies were identified, three of which included control groups, while the other three were repeated-measures pre-post designs. Only one study randomised participants. The overall level of quality of included studies was poor. A narrative synthesis was conducted, as the level of heterogeneity in outcomes and outcome reporting were too high for a meta-analysis to be performed. The narrative synthesis suggested that interventions have the potential to reduce sitting time in non-working older adults. Included studies reported feasible and safe implementations of their interventions in most samples, except for one subsample from a study of people in sheltered housing. Objectively measured reductions in sitting time were between 3.2% and 5.3% of waking time, or up to 53.9 min per day. Future studies should employ more rigorous designs to assess the effects of reducing sedentary behavior on health and physical function, and should include follow-ups to measure the duration of behavior change.

Sedentary behaviour is associated with diabetes mellitus in adults: findings of a cross-sectional analysis from the Brazilian National Health System

Background

Sedentary behaviour (SB) may contribute to the development of several chronic diseases, such as hypertension, diabetes mellitus (DM) and all-cause mortality. The aim of this study is to investigate the association between different domains of SB with diabetes among adult users of the Brazilian National Health System (NHS).

Methods

Cross-sectional study from the primary care system of the Brazilian NHS in the city of Bauru, Brazil. SB, physical activity (PA), DM and other chronic diseases were assessed by face-to-face interviews and medical records. As potential confounders in the adjusted model, we used gender, age, economic status, smoking status, hypertension, hypercholesterolaemia and PA.

Results

The study was composed of 147 men and 410 women. The fully adjusted model showed that Brazilian adults spending ≥3 h per day in television viewing (OR = 1.61 [95% CI: 1.11–2.33]) and overall SB (OR = 1.60 [95% CI: 1.09–2.36]) had increased prevalence of DM compared to those spending &lt;3 h per day.

Conclusions

TV viewing and overall SB was associated with higher prevalence of DM in Brazilian adults from the NHS, even after controlling for potential confounders including PA.

Differences in Context-Specific Sedentary Behaviors According to Weight Status in Adolescents, Adults and Seniors: A Compositional Data Analysis

To develop effective sedentary behavior interventions aimed at people who are overweight/obese, detailed insight is needed into the contexts of sedentary behavior of these people. Therefore, the aims of this study were to describe the composition of sedentary behavior and to compare context-specific sedentary behaviors between different weight groups. Cross-sectional data were used from a study conducted in 2013⁻2014 among a Flemish sample of adolescents (n = 513), adults (n = 301), and seniors (n = 258). Sixteen context-specific sedentary behaviors were assessed using a validated questionnaire during the week and weekend. Compositional descriptive statistics were performed to determine the relative contribution of context-specific sedentary behaviors in the three age groups. Compositional multivariate analysis of covariance and pairwise comparisons were conducted to examine weight group differences in context-specific sedentary behaviors. The compositional means indicated that the highest proportion of sedentary time was spent at school, at work, and while watching television. Statistically significant differences were found in the composition of sedentary behaviors between healthy weight and overweight/obese participants. In all age groups, socially engaging sedentary behaviors were more prevalent in healthy weight people, whereas socially disengaging behaviors were more prevalent in overweight/obese people. Consequently, the findings of this study suggest that future overweight/obesity interventions should no longer focus on total sedentary time, as not all context-specific sedentary behaviors are associated with overweight/obesity. Instead, it might be better to target specific contexts of sedentary behaviors-preferably those less socially engaging-when aiming to reduce overweight/obesity.

Sedentary behaviors, physical activity, and changes in depression and psychological distress symptoms in older adults

BACKGROUND

Television (TV) viewing and computer use have been associated with higher risk of depression, but studies specifically assessing the impact of these and other types of sedentary behaviors (SBs) on the mental health of older adults are scarce and their results are inconclusive. Similarly, the association between specific types of recreational physical activity (rPA) and mental health in older adults is poorly understood.

METHODS

In 2012, information on SBs, rPA, and other health behaviors was collected with validated questionnaires from community-dwelling older adults participating in the Seniors-ENRICA cohort. In 2012 and 2015, symptoms of depression and mental distress were assessed using the GDS-10 and the General Health Questionnaire-12 (GHQ-12), respectively.

RESULTS

Time spent watching TV was prospectively associated with higher (worse) GDS-10 scores in women (β [95% confidence interval (CI)] comparing the second and third tertiles of TV viewing to the first: 0.21 [-0.04 to 0.46] and 0.37 [0.13-0.62], respectively; P-trend: < 0.01), but not in men (-0.11 [-0.35 to 0.13] and -0.18 [-0.44 to 0.08]; P-trend: 0.16). Women, but not men, who spent more time in other SBs, including reading, using the computer and commuting, showed a lower number of depressive symptoms (-0.19 [-0.44 to 0.06] and -0.34 [-0.60 to -0.08]; P-trend: 0.01) and lower (better) GHQ-12 scores (-0.33 [-0.67 to -0.00] and -0.35 [-0.69 to -0.00]; P-trend: 0.05) at follow-up. Both in men and women, higher levels of rPA, such as walking, practicing sports, and do-it-yourself activities, were associated with lower GDS-10 scores (-0.07 [-0.25 to 0.11] and -0.19 [-0.36 to -0.01]; P-trend: 0.04) and with lower GHQ-12 scores (-0.02 [-0.26 to 0.22] and -0.23 [-0.47 to -0.00]; P-trend: 0.06).

CONCLUSIONS

Older women who spent more time watching TV and less time in other SBs showed a higher number of depressive symptoms. Data suggest that increasing rPA may improve mental health in older adults, particularly among women.

Sedentary Behavior at Work and Cognitive Functioning: A Systematic Review

Background: It is now well-established that sedentarity has a negative impact on the physiological functioning and health of humans, whereas very little is known about the psychological repercussions, especially in cognitive functioning. Yet, studying the cognitive effects of the sedentary lifestyle is particularly relevant in the short term for productivity and in the long term for cognitive health (accelerated aging). This systematic review therefore aims to make an inventory of the potential cognitive effects of sedentarity at the workplace. Methods: Pubmed, PsycINFO, Cochrane, Web of Science, and Scopus were searched for English-language peer-reviewed articles published between January 1, 2000 and December 31, 2017 to identify studies including sedentary behavior and objective measures from cognitive domains (cognitive inhibition, cognitive flexibility, working memory, etc.). To carry out this systematic review, the 3 keywords "Sedentary" and "Cognition" and "Work" (and their derivatives) had to appear in the title or in the summary of the paper. Results: Of the 13 papers that met the inclusion criteria, 9 were short-term interventions, 3 medium-term interventions, and 1 long-term intervention. Nine of them reported non-significant results. Two studies study reported deterioration in cognitive performance. Two reported an improvement in performance in cognitive tasks with one study with overweight adults and the only one study with a long-term intervention. However, these studies intend to reduce sedentary behavior, but do not allow answering the question of the potential cognitive effects of the sedentary lifestyle. Conclusion: These data suggest that sedentary behavior is not associated with changes in cognitive performance in interventions that intend to reduce sedentary behavior. Then, and given the trend toward increased time in sedentary behavior, long-term prospective studies of high methodological quality are recommended to clarify the relationships between sedentary behavior and the cognitive functioning. Our systematic review identifies also the need for retrospective, longitudinal, or epidemiologic studies. It also recognizes the need to standardize methodology for collecting, defining, and reporting sedentary behavior and the need to standardize the cognitive tests used. The relationship between sedentary behavior and cognitive functioning remaining uncertain, further studies are warranted for which 8 recommendations are proposed.

[Sedentary lifestyle and urinary incontinence in women: A literature review]

AIM

The sedentary lifestyle is defined by a lack of regular mobilizing activities in the activities of daily life. The purpose of this work was to gather data related to the potential link between urinary incontinence and sedentary lifestyle in women.

METHOD

A literature review (Pubmed/MEDLINE databases) based on keywords: women; urinary incontinence; sedentary; sedentary behavior; sedentary lifestyle; physical activity; exercise; sport, over the period 2008-2018 was carried out.

RESULTS

Five cross-sectional observational studies were analyzed. Overall, the data supported a link between sedentary behavior and urinary incontinence in women. Several potential confounding factors (age, body mass index, comorbidities, lower socio-familial support) have been identified in the literature. Pathophysiological mechanisms remain poorly established, potentially including metabolic factors, postural factors and muscle dysfunctions. Few articles respected the strict definition of sedentary lifestyle, and no prospective study investigating the causal link between meddle or long-term sedentary was highlighted.

CONCLUSION

The limited data available in the literature suggests that sedentary lifestyle is a risk factor for female urinary incontinence. Many confounding factors have been identified, justifying further studies evaluating more specifically the causal link between sedentary lifestyle and urinary incontinence in women.

Physical activity and sedentary time are related to clinically relevant health outcomes among adults with obstructive lung disease

Background

The purpose of the current study was to determine the association between sedentary time and physical activity with clinically relevant health outcomes among adults with impaired spirometry and those with or without self-reported obstructive lung disease (asthma or COPD).

Methods

Data from participants of the Canadian Longitudinal Study on Aging were used for analysis (n = 4156). Lung function was assessed using spirometry. Adults were said to have impaired spirometry if their Forced Expiratory Volume in 1 s was <5th percentile lower limit of normal (LLN). A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Healthcare use and quality of life outcomes were assessed using self report.

Results

Among those with asthma, participating in strengthening activities was associated with lower odds of reporting poor perceived health (OR = 0.65, CI: 0.53, 0.79), poor perceived mental-health (OR = 0.73, CI: 0.60, 0.88), unhealthy aging (OR = 0.68, CI: 0.56, 0.83), and reporting an emergency department visit in the past 12 months (OR = 0.76, CI: 0.60, 0.95). Among those with COPD, those who reported highest weekly sedentary time had higher odds of reporting poor perceived health (OR = 2.70, CI: 1.72, 4.24), poor perceived mental-health (OR = 1.99, CI: 1.29, 3.06), and unhealthy aging (OR = 3.04, CI: 1.96, 4.72). Among those below the LLN, sitting time (OR = 2.57, CI: 1.40, 4.72) and moderate intensity physical activity (OR = 0.23, CI: 0.09, 0.63) were associated with overnight hospital stays.

Conclusions

Higher physical activity levels and lower sedentary time may be associated with lower healthcare use and better quality of life. This research may have implications related to the use of physical activity for improving health outcomes and quality of life among adults with obstructive lung disease or impaired spirometry.

Electronic supplementary material

The online version of this article (10.1186/s12890-018-0659-8) contains supplementary material, which is available to authorized users.

Effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults: a systematic review and meta-analysis

Background

No systematic reviews of the effectiveness of interventions for reducing non-occupational sedentary behaviour are available. Therefore, the aim of this systematic review was to assess the effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults.

Methods

An electronic search of nine databases was performed. Randomised controlled trials (RCT) and cluster RCTs among adults testing the effectiveness of interventions aimed to reduce non-occupational sedentary behaviour were considered for inclusion. Two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias.

Results

Nineteen studies that evaluated multicomponent lifestyle interventions, counselling or education, television (TV) control devices and workplace interventions were included. Evidence from the meta-analyses suggested that interventions can reduce leisure sitting time in adults in the medium term (−30 min/day; 95% CI −58 to –2), and TV viewing in the short term (−61 min/day; 95% CI −79 to –43) and medium term (−11 min/day; 95% CI −20 to –2). No significant pooled effects were found for transport sitting time, leisure-time computer use and longer term outcomes. No evidence was available on the effectiveness of interventions for reducing non-occupational sedentary time in older adults.

Conclusions

The findings of this systematic review suggest the interventions may be effective in reducing non-occupational sedentary behaviour in the short to medium term in adults. However, no significant effect was found on longer term outcomes. The quality of evidence was, however, low to very low. No evidence was available on the effectiveness of non-occupational interventions on reducing sedentary time in older adults. Further high-quality research with larger samples is warranted.

The epigenetic clock and objectively measured sedentary and walking behavior in older adults: the Lothian Birth Cohort 1936

Background

Estimates of biological age derived from DNA-methylation patterns-known as the epigenetic clock-are associated with mortality, physical and cognitive function, and frailty, but little is known about their relationship with sedentary behavior or physical activity. We investigated the cross-sectional relationship between two such estimates of biological age and objectively measured sedentary and walking behavior in older people.

Methods

Participants were 248 members of the Lothian Birth Cohort 1936. At age 79 years, sedentary behavior and physical activity were measured over 7 days using an activPAL activity monitor. Biological age was estimated using two measures of DNA methylation-based age acceleration-i.e., extrinsic and intrinsic epigenetic age acceleration. We used linear regression to assess the relationship between these two estimates of biological age and average daily time spent sedentary, number of sit-to-stand transitions, and step count.

Results

Of the six associations examined, only two were statistically significant in initial models adjusted for age and sex alone. Greater extrinsic age acceleration was associated with taking fewer steps (regression coefficient (95% CI) - 0.100 (- 0.008, - 0.001), and greater intrinsic age acceleration was associated with making more sit-to-stand transitions (regression coefficient (95% CI) 0.006 (0.0001, 0.012). When we controlled for multiple statistical testing, neither of these associations survived correction (both P ≥ 0.17).

Conclusion

In this cross-sectional study of 79-year-olds, we found no convincing evidence that biological age, as indexed by extrinsic or intrinsic epigenetic age acceleration, was associated with objectively measured sedentary or walking behavior.

Sedentary time in older men and women: an international consensus statement and research priorities

Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose–response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies.

This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.