A qualitative investigation of physical activity compensation among older adults

Compensatory behavior of physical activity in adolescents - a qualitative analysis of the underlying mechanisms and influencing factors

INTRODUCTION

Compensatory behavior of physical activity (PA) based on the ActivityStat hypothesis in adolescents is scarcely investigated, and existing studies showed inconclusive results. Understanding the compensatory behavior in a holistic way is important as this can help to improve intervention outcomes and thus, increase the PA levels in adolescents. Thus, the aim of the present study is to investigate the occurrence, direction, timeframe, and ratio of habitual activity compensation in adolescents. Furthermore, we want to identify the awareness of compensation and factors that influence compensatory behavior.

METHODS

The present qualitative study used a mixed methods crossover analysis design. Participants (N = 15, 8 boys and 7 girls) were adolescents aged 11-15 years (mean age 13.04 ± 1.28). They provided a habitual weekly schedule with habitual/regular activities and their intensity. Participants then kept an activity diary over one week to capture their actual behavior. After that, data were compared and deviations > ±20% were considered as compensation opportunities. On this basis, deviations were descriptively analyzed for compensatory behavior and were coded as positive and negative compensatory behavior. Further, for each compensation, the ratio of compensation (MET-minutes of the compensating activity/MET-minutes of the activity that was compensated) was calculated. Additionally, interviews were conducted to explore perceptions and influencing factors for (no) compensation.

RESULTS

Overall, 198 compensation opportunities were identified with deviations greater ± 20%. Of these, 109 opportunities were compensated overall (69 within-day, 40 between-day). Negative compensation took place in 57 opportunities and 52 opportunities were compensated positively. Most of the deviations were overcompensated (compensation/deviation > 100%). About half of the adolescents (N = 8) were not aware about their compensatory behavior, and only one boy was aware of all his compensatory behavior. The most mentioned influence for positive compensation were social support by friends and good weather. As influencing factors for negative compensation, tiredness as well as no need for movement were mentioned predominantly. No negative compensation occurred because adolescents wanted to stick to their routines or participated in hedonistic activities.

DISCUSSION

Summarizing the findings, the present study delivered new insights into the field of compensatory behavior in adolescents. Nevertheless, compensatory behavior was not consistently observed regarding the occurrence of compensation, direction, timeframe and ratio. However, social support appears to be an important factor to compensate positively or to avoid a negative compensatory behavior. Further, it seems to be helpful to support individuals in their search for hedonistic activities as well as in the establishment of routines.

Effects of a supervised exercise training on body composition after bariatric surgery: a randomized controlled trial

OBJECTIVE

This study aimed to determine the effects of a multicomponent exercise intervention during the first year post-bariatric surgery (BS) on body composition, weight loss (WL), energy expenditure, and nutrient intake.

METHODS

A total of 84 patients were included in this study and were randomly assigned to either an exercise group (n = 41) or a control group (n = 20). The exercise group participated in a multicomponent exercise program that began 1-month post-BS, whereas the control group received only standard medical care post-BS. Body composition was assessed by dual-energy x-ray absorptiometry, and physical activity energy expenditure was assessed by accelerometers. Nutritional intake was assessed through a 4-day food diary.

RESULTS

A total of 6-months post-BS, exercise was found to be effective in mitigating the loss of lower-limb and appendicular lean mass (LM), as well as favoring trunk fat mass (FM) loss. Moreover, it further decreased percent FM and promoted additional excess WL. After 12 months, exercise not only reduced waist circumference but also helped to lessen the loss of total, trunk, and appendicular LM.

CONCLUSIONS

Exercise further induced trunk fat mass, percent FM, excess WL, and waist circumference reductions. Moreover, exercise attenuated the loss of total and regional LM.

Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies

Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

Changes in Muscle Mass and Strength During Follow-Up After One-Year Resistance Training Interventions in Older Adults

ABSTRACT

Mertz, KH, Reitelseder, S, Rasmussen, MA, Bülow, J, Højfeldt, G, Jensen, M, Hjulmand, M, Lindberg, J, Kramer, MU, Bechshøft, R, and Holm, L. Changes in muscle mass and strength during follow-up after one-year resistance training interventions in older adults. J Strength Cond Res 37(10): 2064-2070, 2023-The aim of this study was to investigate if home-based resistance training compared with center-based resistance training was associated with better preservation of muscle mass and strength in older individuals, 6 months after the interventions ended. One hundred four healthy older individuals (>65 years) who had completed 1 year of either home-based light-intensity training with daily whey protein supplementation (LITW), center-based heavy resistance training with whey protein supplementation (HRTW), or daily whey protein supplementation alone (WHEY) returned for follow-up measurement 6 months after the interventions. Measures of muscle mass, strength, and power were assessed at the end of intervention as well as at follow-up. Furthermore, we compared changes in these parameters between subjects who continued resistance training (≥1 weekly training session) during follow-up (CONT) with those who stopped (STOP). Resistance training continuation during follow-up did not differ between HRTW and LITW (41 vs. 41%, P = 1.0) but was higher for both groups compared with WHEY (18%, P = 0.04-0.05). However, no between-group differences were observed between LITW/HRTW/WHEY in changes in muscle mass, strength, or power during follow-up. STOP was associated with a poorer preservation of quadriceps cross-sectional area compared with CONT (-1.7 cm 2 [-0.4 to -3.0], P = 0.01, effect size: 0.79). No effect of training continuation was observed on changes in muscle strength and power. In conclusion, maintenance of muscle mass and strength is not superior after home-based resistance training compared with center-based training. However, training continuation seems crucial for the maintenance of muscle mass, irrespective of the training intervention.

Exploring Children's Self-Reported Activity Compensation: The REACT Study

PURPOSE

Previous research has focused on device-based measures of activity compensation, with little understanding of how children perceive potential compensatory responses to activity or inactivity, or whether these change after periods of activity or inactivity. The aim of this study was (a) to explore the alignment between children's self-reported usual compensation and compensation recall after experimental conditions and (b) to examine sex differences.

METHODS

In total, 360 children (47% boys) participated in at least one of three experimental conditions over 6 wk: (a) restricted physical activity (PA; indoor play), (b) imposed moderate- to vigorous-intensity PA (MVPA; sports class), and (c) imposed light-intensity PA (LPA; standing lesson). Before the first condition, children reported their "usual compensation" behavior to examples of restricted/imposed PA, and 2-3 d after each experimental condition, they completed a recall measure of their compensation after the condition. Multilevel regression models were conducted to determine whether children's perceptions of "usual compensation" score were associated with recalled compensation score after imposed or restricted PA. Additional models were fitted for sex-specific associations.

RESULTS

Overall and among girls, the usual compensation score was positively associated with the compensatory recall score for the additional MVPA and LPA conditions ( P < 0.0005; e.g., they thought they would usually compensate for additional MVPA and then perceived that they compensated after additional MVPA). A negative association was seen in the restricted activity condition among girls ( P = 0.03). All associations in the boys' analyses were statistically nonsignificant.

CONCLUSIONS

These findings suggest some alignment between children's self-reported usual compensation and compensation recall after imposed changes to routine activity. Future research should consider device-measured comparisons and identify characteristics of children at risk of activity compensation in future interventions.

The Effects of an Acute Bout of Aerobic or Resistance Exercise on Nonexercise Physical Activity

Introduction/Purpose

A reduction in nonexercise physical activity (NEPA) after exercise may reduce the effectiveness of exercise interventions on weight loss in adults with overweight or obesity. Aerobic exercise (AEx) and resistance exercise (REx) may have different effects on NEPA. The purpose of this secondary analysis was to examine the effect of a single bout of AEx or REx on NEPA and sedentary behavior in inactive adults with overweight or obesity.

Methods

Adults with overweight or obesity (n = 24; 50% male; age, 34.5 ± 1.5 yr; body mass index, 28.5 ± 0.9 kg·m-2) not meeting current physical activity guidelines completed a single 45-min bout of AEx, REx, or a sedentary control on different days in random order. After each condition, participants' NEPA was recorded for 84 h by accelerometer. Time spent sedentary and in light, moderate, and vigorous physical activity; steps; metabolic equivalent of task (MET)-hours; and sit-to-stand transitions were calculated using activity count data.

Results

No differences were observed in the percent of waking time spent sedentary and in light, moderate, and vigorous activity between conditions (P > 0.05). No differences were observed in steps, MET-hours, or sit-to-stand transitions between conditions (P > 0.05). NEPA responses were variable among individuals, with approximately half of participants reducing and half increasing NEPA over the 84 h after each exercise condition.

Conclusion

NEPA was not reduced after an acute bout of AEx or REx in a sample of inactive adults with overweight or obesity.

Test-retest reliability of a measure of perceived activity compensation in primary school children and their parents: a mixed methods study

There is a lack of specific tools for assessing children's activity compensatory responses. This study 1) determined test-retest reliability and internal consistency of survey items assessing children's self-reported and parents' proxy-reported perceived compensatory responses; and 2) described children's and parents' views of potential compensatory mechanisms. Children (n = 55; mean age 10.2 ± 0.9) and their parents (n = 60) completed a survey twice, seven days apart. A sub-sample (17 parents; 13 children) participated in a short, semi-structured interview. Intraclass Correlation Coefficients (ICCs) and Cronbach's alpha assessed absolute agreement and internal consistency. Interviews were analysed via thematic analysis. Seven self- and proxy-reported survey sub-scales had excellent test-retest reliability (ICC ≥ 0.75), three had good (ICC ≥ 0.56) and one fair (ICC = 0.44). All survey items and sub-scales had acceptable internal consistency (alpha >0.67). Thematic analysis identified two overarching themes: awareness of compensation and mechanisms of compensation. After an active day at school, most participants perceived that compensation occurred later that day. Mechanisms of compensation included psychological, physiological, environmental, and interpersonal mechanisms. This reliable survey provides a new tool for assessing children's and their parents' perceptions of activity compensation and may inform future intervention designs. Future research is needed to establish concordance between perceived and device-assessed compensation.

Investigation of movement-related behaviors and energy compensation in people living with liver disease: A scoping review

The importance of integrated movement behaviours (MB, i.e., physical activity [PA], sedentary behaviour, and sleep) and their interdependence for health has been recently discussed in the literature. The proposition that the amount of time spent in any one of these behaviours may impact the amount of time spent in another is supported by the ActivityStat hypothesis. The aim of this review is to (1) to assess whether individuals with liver disease display MB and/or energy (i.e., total energy expenditure [EE], basal EE, resting EE, and activity EE) compensation throughout the day and/or days; and (2) to examine whether a prescribed PA intervention triggers compensatory responses. Documents were included if they focused on people living with liver disease; analysed MB and/or EE components; were data-based; and were published in English. Fifteen documents were included in the final synthesis. The one finding that addressed research question 1 showed no compensatory response. As for research question 2, most of the findings suggest no compensation effects in response to a PA intervention. There is insufficient evidence to support the ActivityStat hypothesis in people living with liver disease. Further research should be conducted to test this hypothesis using standardized methodological procedures.

Exploring activity compensation amongst youth and adults: a systematic review

BACKGROUND

Globally, significant efforts have focused on increasing physical activity and reducing sedentary behaviour in youth and adults across a range of settings (e.g., schools, workplaces, community, and home). Despite this, interventions have had varied efficacy and typically have failed to sustain changes in behaviours over time. One explanation that has been put forth to explain the mixed success of interventions is activity compensation. However, little is known about activity compensation, including whether compensation occurs, and perceptions and potential mechanisms of activity compensation. Understanding activity compensation would assist in tailoring and targeting of potential intervention strategies. The primary aim of this review was to synthesise research that has investigated activity compensation in youth and adults. The secondary aim was to identify potential reasons for and/or awareness of compensatory changes that may have occurred.

METHODS

An electronic search of the EBSCOhost (via Academic Search Complete, CINAHL Complete, Education Source, Health Source: Nursing/Academic Edition, PsycINFO, SPORTdiscus with Full Text), MEDLINE Complete, Global Health, EMBASE, Scopus and Web of Science databases up to May 2021 was conducted. Quality assessment of included quantitative studies used a modified compensation-specific McMaster Quality Assessment Tool.

RESULTS

A total of 44 studies met the inclusion criteria (22 = adult populations; 22 = youth populations) and were classified as (1) quantitative (n = 31); (2) combination of quantitative and behavioural (n = 11); (3) behavioural only (n = 1); and (4) qualitative (n = 1). Of the 42 studies that included a quantitative component, 11 (26%) reported compensation occurred. Within the 13 studies examining specific behaviours, 35 behaviours were assessed, and evidence of compensation was inconsistent. Compensation mechanisms included fatigue, time constraints, lack of motivation, drive to be inactive, fear of overexertion, and autonomous motivation.

CONCLUSION

Little evidence of compensation was reported in the included quantitative studies; however, inconsistencies between studies makes comparisons difficult. There was considerable variability in the types of behaviours assessed in quantitative studies, and few studies examined potential compensatory mechanisms. Future research, using compensation specific study designs, methods, and analytic techniques, within different population sub-groups, should address these evidence gaps.

Compensatory Belief in Health Behavior Management: A Concept Analysis

Purpose

This study aimed to identify the exact definition of the concept of compensatory belief (CB) and to help clinicians and caregivers to distinguish patients who tend to form such beliefs.

Methods

This study is a conceptual analysis based on the strategy of Walker and Avant (2014). We retrieved studies from existing literature using databases such as PubMed, CINAHL, Wiley, and Web of Science, and extracted information from the results. No date limitations were applied.

Results

A total of 35 articles were sourced for data extraction. The identified attributes of CB were as follows: cognitive coping strategy, pleasure without guilt, compensatory behaviors, automatic motivated self-regulatory process, and implicit cognition. The observed antecedents were: failure to resist desire, reluctance, a conflicting motivational state, seeking appropriate balance, and self-image maintenance. The consequences of CB were lower health-related intentions, justification of unhealthy choices, relief from cognitive dissonance, continued existence of conflict feeling, and poor long-term health.

Conclusion

Compensatory belief stems from motivational dissonance or confliction. Despite causing feelings of pleasure and relief, it can negatively impact long-term health. Although CB is crucial to establish healthy behaviors, it is easily ignored in medical work.

"Getting Used to It, but Still Unwelcome": A Grounded Theory Study of Physical Identity Development in Later Life

Given the global trends toward an aging society and the increased desire for healthy aging in late life, this study examines older adults' perceptions of aging and their physical identity through their engagement in physical activities. Adopting a grounded theory, we interviewed 15 individuals aged 65 years and older, who were involved in physical activities on a regular basis. This study provided a final model depicting (a) divergent and convergent modes of strategies and socioemotional aspects of physical identity development in later life and (b) different strategies employed between younger-old versus older-old age groups and between participants who have underlying health conditions and those who do not. These findings add a contextual explanation of identity development in later life and stress the recurring process of physical identity development.

"Think of It Like a Game": Older Adults' and Health Professionals' Perspectives on Interactive Exercise Technology Design

Purpose: Interactive exercise technology (IET) is an effective and practical way to support physiotherapy for older adults. The purpose of this study was to use design thinking to collect feedback on the first iteration of an IET prototype from older adults and health professionals and to use that feedback to gain an understanding of their needs and values, with the goal of developing recommendations to inform the second iteration of the IET prototype. Method: This study was conducted using three steps of design thinking: (1) test, in which four focus groups were conducted, asking older adults and health professionals about their perspectives on an IET prototype; (2) empathize, in which the focus group discussions were recorded and transcribed and thematic content analysis was conducted; and (3) define, in which the needs and values of the participants were identified. Results: The participants were 19 health professionals and four older adults. Four themes, which represented the values that these groups held regarding IET design, were revealed: instruction, safety, accessibility, and motivation. Conclusions: Older adults and health professionals have specific needs for the design of IET, which should be considered in the development of future IET.

Ageism in the Fitness and Health Industry: A Review of the Literature

This review aims to understand how age-related stereotypes against older adults' physical capabilities influence their ability to engage in regular physical activity. The authors wanted to know how people construe ageism in the fitness and health arena, how ageism manifests in this field, and how ageism influences older adults' learning and practicing physical activity. Data was extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Twenty-two empirical studies met the selection criteria. The findings revealed that the attributes of ageism fell into either self-imposed or other-directed ageism categories and manifested as implicit or explicit ageism. The study also identified the following four themes: (a) perceptions of aging and exercise, (b) exercise motivation, (c) opportunities for older adults, and (d) ambiguous positionality as older exercisers. The research provides evidence for the existence of ageism against older exercisers. Further research considering the implication of ageism within the exercising industry is necessary.

Physical Activity Intervention Effects on Sedentary Time in Spanish-Speaking Latinas

BACKGROUND

Latinas have high rates of sedentary behavior and related health disparities, but it is unknown if interventions to increase physical activity will also reduce sedentary time. The current study examined changes in objectively measured sedentary time among Latinas in a randomized controlled trial of a physical activity intervention.

METHODS

Spanish-speaking Latinas (N = 202) were randomized to an exercise or wellness group and wore an accelerometer at baseline, 6 months, and 12 months.

RESULTS

Participants were sedentary on an average of 8.86 hours per day (SD = 2.60) at baseline. The intervention group had significantly greater increases in sedentary time compared with the control group, with the intervention group engaging in 146 more minutes per week of sedentary time at 6 months and 254 minutes per week of sedentary time at 12 months than the control group (P = .02). The intervention effect on sedentary behavior remained after controlling for moderate to vigorous physical activity. Additionally, time spent in moderate to vigorous physical activity was positively associated with more sedentary time (P = .04).

CONCLUSION

An intervention to increase moderate to vigorous physical activity resulted in greater sedentary time, raising concerns regarding compensation and highlighting the need for interventions to address both physical activity and sedentary behavior to improve public health.

Do older English adults exhibit day-to-day compensation in sedentary time and in prolonged sedentary bouts? An EPIC-Norfolk cohort analysis

INTRODUCTION

Compensatory behaviours may be one of the reasons for the limited success of sedentary time interventions in older adults, but this possibility remains unexplored. Activity compensation is the idea that if we change activity levels at one time we compensate for them at a later time to maintain a set point. We aimed to assess, among adults aged ≥60 years, whether sedentary time and time spent in prolonged sedentary bouts (≥30 mins) on one day were associated with sedentary time and time spent in prolonged sedentary bouts (≥30 mins) on the following day. We also sought to determine whether these associations varied by sociodemographic and comorbid factors.

METHODS

Sedentary time was assessed for seven days using hip-worn accelerometers (ActiGraph GT1M) for 3459 adults who participated in the EPIC-Norfolk Study between 2004 and 2011. We assessed day-to-day associations in total and prolonged bouts of sedentary time using multi-level regressions. We included interaction terms to determine whether associations varied by age, sex, smoking, body mass index, social class, retirement, education and comorbid factors (stroke, diabetes, myocardial infarction and cancer).

RESULTS

Participants (mean age = 70.3, SD = 6.8 years) accumulated 540 sedentary mins/day (SD = 80.1). On any given day, every 60 minutes spent in sedentary time was associated with 9.9 extra sedentary minutes on the following day (95% CI 9.0, 10.2). This association was greater in non-retired compared to retired participants (non-retired 2.57 extra minutes, p = 0.024) and in current compared to former and never-smokers (5.26 extra mins for current vs former; 5.52 extra mins for current vs never, p = 0.023 and 0.017, respectively). On any given day, every 60 minutes spent in prolonged bouts was associated with 7.8 extra minutes in these bouts the following day (95% CI 7.6, 8.4). This association was greater in older individuals (0.18 extra minutes/year of age, 95% CI 0.061, 0.29), and for retired versus non-retired (retired 2.74 extra minutes, 95% CI 0.21, 5.74).

CONCLUSION

Older adults did not display day-to-day compensation. Instead, individuals demonstrate a large stable component of day-to-day time spent sedentary and in prolonged bouts with a small but important capacity for positive variation. Therefore older adults appear to be largely habitual in their sedentary behaviour. Strategies to augment these patterns may be possible, given they may differ by age, smoking, and working status.