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

"It's Good. It's Really Good.": Perspectives of Older Adults, Exercise/Recreation Professionals, and Primary Care Providers on Designing a Movement Behavior Intervention Using the Staircase Approach

BACKGROUND/OBJECTIVES

Interventions targeting sedentary behavior in older adults have reported mixed success for behavior change. The previously proposed Staircase Approach offers a novel strategy to support long-term behavior change by targeting a reduction in sedentary time before progressing to increasing physical activity levels. The current study aimed to understand the perceptions of older adults, exercise/recreation professionals, and primary care providers (PCPs) about the critical components of a new intervention based on the Staircase Approach.

METHODS

Participants (older adults, 65+ years; PCPs; and exercise/recreation professionals) from three Canadian provinces (Alberta, Ontario, and New Brunswick), participated in semistructured focus groups. Transcripts from the sessions were analyzed using reflexive thematic analysis in the context of a previously conducted review by our team.

RESULTS

There were 17 focus groups (n = 50): four in older adults (n = 14), five with PCPs (n = 14), and eight with exercise/recreation professionals (n = 22). Participants expressed varying opinions on the components necessary for a relevant intervention. The need to embed options within the intervention, and to promote and deliver the intervention, was clear. Some themes were consistent across and within groups (e.g., simple, motivational messaging), whereas others differed (e.g., education, delivery mode, and contact). PCPs added insights about the needs of older adults who typically do not participate in research.

CONCLUSION

Older adults have varied requirements, preferences, and skill levels that necessitate providing many options in any newly designed intervention. Significance/Implications: The intervention for the new Staircase Approach will require collaboration between multiple sectors to be successful.

Inactivity is isolation: insights from a sedentary time intervention in assisted living

BACKGROUND

As Canada's aging population continues to grow, a larger number of older adults will be residing in assisted living (residences with some on-site care and services). Research is needed to understand how to support active aging - defined as a combination of movement and social behaviours-in this unique living environment. In this study, we explored insights generated about active aging from older residents of assisted living who participated in an intervention designed to encourage standing breaks.

METHODS

This was a multi-method exploratory study. Residents of three assisted living facilities participated in a 12-week intervention called Stand When You Can. The Keele Assessment of Participation (KAP) was used to assess perceived levels of participation in various domains of assisted living at pre- and post-intervention. Focus group sessions were conducted to explore insights on active aging. Transcripts were thematically analyzed to generate themes and sub-themes.

RESULTS

A total of 18 residents (84.4 ± 6.8 years, 72% female), participated in the focus groups. KAP scores at pre-intervention were indicative of a high level of social participation within the residences. Five primary themes emerged from the focus group sessions: 1) intervention effectiveness, 2) physical and social engagement go hand in hand, 3) the congregate living environment can influence movement behaviour, 4) congregate living supports interpersonal relationships, and 5) personal preferences for solitary activity.

CONCLUSIONS

The natural communal setting of assisted living, along with supportive staff, presents a valuable opportunity to promote active aging, which is a complex interplay of social and movement behaviour. Our preliminary findings suggest that in addition to supporting individual behaviour change, a comprehensive approach that addresses the environment, social engagement, and staff engagement is needed in this setting. Future interventions should consider addressing each of these components to facilitate successful behaviour change related to active aging.

Exercise interventions for older adults with advanced cancer: A scoping review

INTRODUCTION

The feasibility, safety, acceptability, and perceptions of exercise in older adults with advanced disease are not well understood due to the scarcity of evidence. This scoping review aimed to (1) summarize evidence on the feasibility, acceptability, and safety of exercise interventions for older adults with advanced cancer and (2) explore this population's perceptions on participating in exercise programs.

MATERIALS AND METHODS

A systematic search was conducted by an expert research librarian in Medline, CINAHL, EMBASE, Cochrane CENTRAL, and SPORTDiscus (inception through November 2023). Eligible studies included older adults with advanced (stage IV or receiving treatment with non-curative intent) solid cancers and intervention or qualitative studies on physical activity/exercise in older adults pertaining to our objectives.

RESULTS

A total of 36 studies were included: 28 (78 %) intervention studies, seven (19 %) qualitative studies, and one (3 %) cross-sectional study. The Frequency/Intensity/Time/Type (FITT) principle was described in 18 studies (64 %). Feasibility was examined in 15 of the 28 intervention studies (54 %) using various definitions. Four studies had predetermined feasibility thresholds, yielding mixed results. One intervention study reported on two intervention-related severe adverse events. Nineteen of the 28 intervention studies (68 %) examined acceptability, reporting high levels of participant satisfaction. Qualitative data revealed several barriers and facilitators to exercise.

DISCUSSION

Exercise appears to be feasible, acceptable, and safe in older adults with advanced cancer. Consistent reporting on the FITT principle and feasibility operationalization are areas of improvement in exercise studies in older adults with advanced disease.

Relationship Between Sedentary Lifestyle and Handgrip Strength Among Korean Workers

OBJECTIVE

This study examined the relationship between sedentary time and handgrip strength with age-group stratification.

METHODS

This study used 11,295 Korean workers. Participants were divided into two age groups: ≤39 and ≥40 years. Handgrip strength was measured, and sedentary time was self-reported. Multiple logistic and linear regression models were used to examine the association between sedentary time and handgrip strength.

RESULTS

Those with ≥6 hours of daily sedentary time had slightly higher odds of low handgrip strength, though not significant overall (odds ratio 1.09, 95% confidence interval 0.95-1.26). However, younger adults with high sedentary time showed significantly higher odds (odds ratio 1.55, 95% confidence interval 1.13-2.12). Linear regression also indicated a stronger negative association in younger adults.

CONCLUSIONS

Interventions to reduce sedentary time could help maintain muscle strength, especially in younger populations.

Associations of objectively measured physical activity and sedentary time with all-cause mortality in Japanese older adults: a 10-year prospective study

OBJECTIVE

To examine the associations of accelerometer-measured physical activity and sedentary time with all-cause mortality in older Japanese adults.

METHODS

A total of 1723 independent Japanese adults aged ≥65 years were followed from 2011 to 2021. Moderate-to-vigorous physical activity (MVPA), light physical activity (LPA) and sedentary time were measured using a triaxial accelerometer secured to participants' waists.

RESULTS

Over a median follow-up of 9.9 years, 336 deaths were recorded. When examined as tertiles, higher MVPA (both ≥10 and <10 min bouts) and LPA were associated with a lower mortality risk. Additional adjustment for MVPA attenuated the associations of LPA, but the HRs in the highest tertile remained significant. Longer sedentary time was significantly associated with an increased mortality risk, but not after adjusting for MVPA. In spline analyses, a linear dose-response association with all-cause mortality was observed for LPA, while the HRs declined progressively with higher levels of MVPA until approximately 80 min/day, beyond which they levelled out. Replacing 10 min/day of sedentary time with MVPA but not LPA was associated with a 12% lower risk of morality (HR 0.88; 95% CI 0.83 to 0.93); the HR for replacing 10 min/day LPA with MVPA was 0.89 (95% CI 0.84 to 0.95). These results were materially unchanged when excluding deaths within the first 5 years of follow-up.

CONCLUSION

Physical activity, regardless of intensity, was associated with a lower all-cause mortality risk among older Japanese adults. Replacing sedentary time or LPA with MVPA was associated with a lower mortality risk. The mortality benefit started from a low MVPA dose and additional benefits were associated with higher doses.

Leisure activity and subjective well-being of older adults in Australia and Thailand: The impact of affiliation, restoration and meaning

OBJECTIVES

To explore leisure activity types among older adults in Australia and Thailand and how psychological mechanisms of restoration, affiliation and meaning in leisure activities impact subjective well-being (SWB).

METHODS

A survey was administered to 125 older adults aged 60 and above (65 from Australia and 60 from Thailand). The survey collected demographic information, self-rated health and SWB. Participants were also asked to manually list their top three leisure activities and provide details on each activity's frequency, duration and ratings of restoration, affiliation and meaning. Statistical analyses included correlation analysis and standard multiple regression.

RESULTS

'Meaning' significantly predicts well-being for Thai participants, while 'restoration' predicts well-being for Australians. Cultural differences were evident in preferred leisure activities. For example, 'TV and internet uses' was higher among Thai participants, and 'Creative' activities were higher among Australian participants. 'Exercise' was the top leisure activity in both countries, with many comments suggesting that health benefits are the primary reason for leisure.

CONCLUSIONS

Encouraging culturally relevant leisure activities with health benefits that also promote meaning and restoration may enhance well-being among older adults.

Is leisure sedentary time associated with mental health issues? Evidence from China Health and Nutrition Survey

Background

The relationship between leisure sedentary behaviors and mental health remains inconclusive. This study aims to provide evidence on leisure sedentary behaviors on mental health using longitudinal data, along with its moderating and mediating roles.

Methods

We utilized data from four waves (2006-2015) of the China Health and Nutrition Survey (CHNS), focusing on adults who completed their education, with a total sample of 23,693 observations. Leisure sedentary time, the independent variable, was measured based on self-reported data, while mental health issues were the dependent variables based on the Simplified Symptom Self-Rating Scale (SCL) and the Perceived Stress Scale (PSS-14). The primary analysis employed ordinary least squares (OLS) regression. Potential endogeneity was addressed by instrumental variable (IV) method via two-stage least squares (2SLS) regression and a continuous difference-in-differences (DID) design.

Results

Our findings indicate that high levels of sedentary time are associated adversely with mental health issues. Moderating roles show that improving health literacy and reducing sedentary time were effective in alleviating this adverse impact. Among older adults, social engagement and support from female caregivers showed greater potential to reduce the detrimental mental health impact of leisure sedentary time. Furthermore, obesity serve as its mediating role.

Conclusion

This study highlights the potential adverse impact of increased leisure sedentary time on mental health among Chinese population. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with mental health issues.

A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30% of older cancer survivors meet the recommended guidelines for physical activity.

OBJECTIVE

This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing.

METHODS

The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life.

RESULTS

Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing.

CONCLUSIONS

The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59504.

Impact of Sedentary Behaviors on Blood Pressure and Cardiovascular Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses

BACKGROUND

Cardiovascular diseases (CVD) are among the leading causes of mortality in the western world, and high blood pressure is among the greatest risk factors for CVD. Given that most of a person's waking hours are spent in sedentary behaviors, understanding the cardiovascular impact of a sedentary lifestyle is imperative. Although limiting sedentary time is encouraged in public health messaging, individual reviews analyzing its impact on clinically relevant cardiovascular outcomes such as blood pressure and CVD exhibit conflicting results.

OBJECTIVE

We conducted an umbrella review of systematic reviews and meta-analyses synthesizing the effects of sedentary time/behaviors on blood pressure or CVD.

METHODS

To be included, studies had to be a systematic review and/or meta-analysis that studied the impact of sedentary time or a sedentary posture on blood pressure or CVD incidence/mortality. The review was preregistered in PROSPERO (CRD4202342568) and conducted in May 2023. The Joanna Briggs Institute and Risk of Bias in Systematic Reviews tools assessed study quality. PRISMA reporting was followed.

RESULTS

Our umbrella review screened 2215 citations with 40 review studies meeting our inclusion criteria (n = 22 meta-analyses) that included 234 unique individual studies of 3,769,755 unique participants. The average study quality was high (9.2 ± 1.7 out of 11). A minority of studies (n = 7/20) supported that less sedentary time was associated with lower blood pressure, with reviews of interventional studies typically not observing a consistent effect (n = 9/12), whereas reviews of cross-sectional studies observed a positive effect (n = 5/7). When hypertension rates were used as the outcome, most (n = 3/4) studies observed a deleterious impact of sedentary time. For CVD incidence/mortality, less sedentary time or screen time was consistently associated with a lower CVD incidence/mortality (n = 17/23), with studies exhibiting a null effect generally including small sample sizes and being of a lower study quality. Total sedentary time and specific behaviors (i.e., television and screen time) exhibited similar findings.

CONCLUSIONS

Based on a high quality of evidence and large sample size, existing systematic reviews and meta-analyses demonstrate the negative impact of sedentary behaviors on CVD incidence/mortality, with conflicting reports for blood pressure that vary based on the study design.

Digital Behavior Change Interventions to Reduce Sedentary Behavior and Promote Physical Activity in Adults with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Technological advancements and ease of Internet access have increased the number of digital behavior change interventions (DBCIs). This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in reducing sedentary behavior (SB) and promoting physical activity (PA) in adults with diabetes.

METHODS

A comprehensive search of seven databases-PubMed, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, and Sedentary Behavior Research Database-was performed. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. Meta-analyses were performed where feasible; otherwise, narrative summaries were performed.

RESULTS

A total of 13 randomized controlled trials with 980 participants met the inclusion criteria. Overall, DBCIs could significantly increase steps and the number of breaks in sedentary time. The subgroup analyses exhibited significant effects in DBCIs with over 10 behavior change techniques (BCTs) in improving steps, the time spent in light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The subgroup analyses showed a significant step increment in DBCIs of moderate and long durations, with over 4 BCT clusters, or in conjunction with a face-to-face component. The subgroup analyses also indicated significant effects in studies with ≥ 2 DBCI components in improving steps, the time spent in LPA and MVPA, and reducing sedentary time.

CONCLUSION

There is some evidence that DBCI may increase PA and reduce SB in adults with type 2 diabetes. However, more high-quality studies are required. Future studies are needed to examine the potential of DBCIs in adults with type 1 diabetes.

Mapping context of sedentary behaviour in older adults who are prefrail and frail: an analysis of secondary outcomes from a longitudinal study (MAPS-B)

OBJECTIVES

To map the context of sedentary behaviour in older adults who are prefrail and frail during the winter and spring over 3 days (2 weekdays and 1 weekend) and to determine if certain types of sedentary behaviours are associated with health outcomes.

DESIGN

Mixed methods, prospective longitudinal cohort study.

SETTING

Community-dwelling older adults living in southern Ontario, Canada.

PARTICIPANTS

We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) and experienced two dropouts.

RESULTS

Participants accumulated a total of 18.4±2.6 hours/day of sedentary time in winter and 17.7±3.1 hours/day in spring. When considering daily indoor sedentary time (excluding sleep), participants accumulated 7.6±4.0 hours/day in winter and 6.3±2.7 hours/day in spring. In the spring, 68% of participants accumulated <8 hours/day of ≥15 min bouts of indoor sedentary time compared with 63% in the winter. Although there were no differences in sedentary time between seasons, we found a significant decrease in step count in winter (1190 fewer steps, 95% CI -2228 to -153 steps). There were no differences in sedentary time or step count between the weekday and weekend or between individuals who were prefrail and frail. There were no seasonal variations in participants' sedentary activities; the most common activities were watching television (TV), eating, napping, browsing the internet and socialising. We also found there may be gender differences in time and activities. Individuals who identified as female were more sedentary than individuals who were male. Almost all indoor behaviours occurred in the living/family room. Sedentary time was evenly spread throughout the day; however, prolonged sedentary behaviours ≥60 min mainly occurred in the evening regardless of the season. Step count in both winter and spring was positively associated with the Nottingham Activity of Daily Living assessment. There was an inverse association between sedentary behaviours ≥60 min (not including sleeping) and the 5×sit-to-stand and grip strength.

CONCLUSION

The current definition of sedentary behaviour requires modification to capture total sedentary time, continuous bouts >60 min, the types of behaviours, time of day and season.

TRIAL REGISTRATION NUMBER

NCT05661058.

Focusing on Sedentary Behavior in Comprehensive Cardiac Rehabilitation

In recent years, the adverse effects of prolonged sedentary behavior in daily life, so-called 'sitting too much', on health have been pointed out. Sedentary behavior is defined as 'all waking behavior in which the energy expenditure in a sitting, semi-recumbent, or recumbent position is 1.5 metabolic equivalents or less'. Even if a person engages in the level of physical activity recommended in the guidelines, sitting for too long at other times may increase the risk of developing various diseases and death. For patients with cardiovascular disease, a comprehensive cardiac rehabilitation program that systematically includes not only medical treatment but also exercise therapy, patient education, and disease management is extremely important. Also, differences in sedentary behavior during the acute and recovery phases are known to affect physical function and activities of daily living at the time of hospital discharge. Here, we discuss cardiac rehabilitation that addresses sedentary behavior and review the previous related research.

A multi-method feasibility trial of a multi-component behaviour change intervention to reduce sedentary behaviour and increase physical activity among ethnically diverse older adults

INTRODUCTION

Evidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and highly sedentary of all the age groups. The present study intends to examine the feasibility of a wearable gadget to remind users to break sitting time (by standing up and moving more), coupled with a brief health coaching session, pamphlet and reminder messages to decrease SB and improve PA.

METHODS AND ANALYSIS

This study will employ a multi-methods approach that generates quantitative data from questionnaires and qualitative data from semi-structured interviews following OAs' involvement in the study. This intervention will be informed by the socio-ecological model (SEM) and the habit formation model. The quantitative and qualitative data will be analysed separately and then integrated for interpretation and reporting, which will assist our knowledge of the feasibility of the programme.

ETHICS AND DISSEMINATION

Ethical approval for this study has been obtained from Swansea University (NM_ 2023 6667 6123). Informed consent will be obtained from participants. The findings of the study will be disseminated to the scientific community through conference presentations and scientific publications. The findings of the current study will determine the suitability of a future effectiveness trial.

TRIAL REGISTRATION NUMBER

NCT06407557.

Dose-Response Independent and Joint Associations of Physical Activity and Sedentary Behavior With Mortality Risk in 40 156 Australian Adults With Coronary Heart Disease

BACKGROUND

Little is known about the relationship between physical activity (PA) and sedentary behavior (SB) with death in people with coronary heart disease. The aim was to examine the independent and joint associations of PA and SB with death.

METHODS AND RESULTS

This is a prospective cohort study including Australian participants aged ≥45 years with self-reported coronary heart disease (2006-2020). Self-reported PA (min/wk) and SB (h/d) were the exposures. Cardiac and all-cause death were the main outcomes. The cohort included 40 156 participants (mean age, 70.3 (SD, 10.3) years; 15 278 women [38%]). During a median follow-up of 11.1 (interquartile range, 6.2-14.4) years, 2497 cardiac and 12 240 all-cause deaths were recorded. Compared with no PA, a 20% to 30% lower risk of cardiac and all-cause death was associated with any level of PA. Walking and moderate to vigorous PA at 150 to 300 min/wk was associated with a 43% to 44% lower risk of cardiac death and 35% to 40% lower risk of all-cause death. Compared with ≥10.5 h/d of SB, participants who were sedentary for 7 to 10.4 h/d experienced an ≈25% reduced associated risk of cardiac and all-cause death. A 56% associated reduction in all-cause mortality risk was found if SB was limited to <3.4 h/d. If participants completed >150 min/wk moderate to vigorous PA and spent <7 h/d in SB, the associated risk of cardiac and all-cause death was reduced by ≈70%.

CONCLUSIONS

All people with coronary heart disease should be encouraged to meet the PA guidelines and limit SB to <7 h/d, noting any increase in physical activity and decrease in SB is better than none to prevent premature death.

Leisure sedentary time and elevated blood pressure: evidence from the statutory retirement policy

Objectives

The relationship between sedentary behaviors and elevated blood pressure remains inconclusive, and the socioeconomic mechanisms underlying the linkage are rarely discussed. Since retirement is often associated with behavioral changes that impact health, this study aims to provide evidence on changes in leisure sedentary time after the statutory retirement age on elevated blood pressure, along with the socioeconomic mechanisms.

Methods

We utilized data from five waves (2004-2015) of the China Health and Nutrition Survey (CHNS), focusing on males aged 55-65 employed in the formal sector. Leisure sedentary time, the independent variable, was measured based on self-reported data, while diastolic (DBP) and systolic (SBP) blood pressure were the dependent variables. Using statutory retirement policy as an exogenous variation, we employed a continuous difference-in-differences (DID) framework and a propensity score matching difference-in-differences (PSM-DID) approach to examine the relationship between changes in leisure sedentary time after the statutory retirement age and elevated blood pressure. The analysis was conducted using ordinary least squares (OLS). To address potential endogeneity, we applied the instrumental variable (IV) method via two-stage least squares (2SLS).

Results

Our findings indicate an increase in diastolic blood pressure after statutory retirement, attributed to increased leisure sedentary time. However, there was no significant increase in systolic blood pressure. Moreover, physical activity did not appear to offset this rise in blood pressure, while higher educational attainment and having family members employed in the medical field helped mitigate its negative effects.

Conclusion

This study highlights the potential adverse impact of increased leisure sedentary time on diastolic blood pressure among middle-aged men in the formal sector, while also exploring the socioeconomic factors that may alleviate these effects. These results provide a foundation for public health initiatives aimed at addressing the rising prevalence of sedentary behavior and its association with blood pressure issues.

Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure

The gradual deterioration of physiological systems with ageing makes it difficult to maintain skeletal muscle mass (sarcopenia), at least partly due to the presence of 'anabolic resistance', resulting in muscle loss. Sarcopenia can be transiently but markedly accelerated through periods of muscle disuse-induced (i.e., unloading) atrophy due to reduced physical activity, sickness, immobilisation or hospitalisation. Periods of disuse are detrimental to older adults' overall quality of life and substantially increase their risk of falls, physical and social dependence, and early mortality. Disuse events induce skeletal muscle atrophy through various mechanisms, including anabolic resistance, inflammation, disturbed proteostasis and mitochondrial dysfunction, all of which tip the scales in favour of a negative net protein balance and subsequent muscle loss. Concerningly, recovery from disuse atrophy is more difficult for older adults than their younger counterparts. Resistance training (RT) is a potent anabolic stimulus that can robustly stimulate muscle protein synthesis and mitigate muscle losses in older adults when implemented before, during and following unloading. RT may take the form of traditional weightlifting-focused RT, bodyweight training and lower- and higher-load RT. When combined with sufficient dietary protein, RT can accelerate older adults' recovery from a disuse event, mitigate frailty and improve mobility; however, few older adults regularly participate in RT. A feasible and practical approach to improving the accessibility and acceptability of RT is through the use of resistance bands. Moving forward, RT must be prescribed to older adults to mitigate the negative consequences of disuse atrophy.

Understanding resilience: Lifestyle-based behavioral predictors of mental health and well-being in community-dwelling older adults during the COVID-19 pandemic

BACKGROUND

Changes in sleep, physical activity and mental health were observed in older adults during early stages of the COVID-19 pandemic. Here we describe effects of the COVID-19 pandemic on older adult mental health, wellbeing, and lifestyle behaviors and explore predictors of better mid-pandemic mental health and wellbeing.

METHODS

Participants in the Adult Changes in Thought study completed measures of lifestyle behaviors (e.g., sleep, physical activity) and mental health and wellbeing both pre-pandemic during regular study visits and mid-pandemic via a one-time survey. We used paired t-tests to compare differences in these measures pre- vs. mid-pandemic. Using multivariate linear regression, we further explored demographic, health, and lifestyle predictors of pandemic depressive symptoms, social support, and fatigue. We additionally qualitatively coded free text data from the mid-pandemic survey for related comments.

RESULTS

Participants (N = 896) reported significant changes in mental health and lifestyle behaviors at pre-pandemic vs. mid-pandemic measurements (p < 0.0001). Qualitative findings supported these behavioral and wellbeing changes. Being male, never smoking, and lower pre-pandemic computer time and sleep disturbance were significantly associated with lower pandemic depressive symptoms. Being partnered, female, never smoking, and lower pre-pandemic sleep disturbance were associated with higher pandemic social support. Pre-pandemic employment, more walking, less computer time, and less sleep disturbance were associated with less pandemic fatigue. Participant comments supported these quantitative findings, highlighting gender differences in pandemic mental health, changes in computer usage and physical activity during the pandemic, the value of spousal social support, and links between sleep disturbance and mental health and wellbeing. Qualitative findings also revealed additional factors, such as stresses from personal and family health situations and the country's concurrent political environment, that impacted mental health and wellbeing.

CONCLUSIONS

Several demographic, health, and lifestyle behaviors appeared to buffer the effects of the COVID-19 pandemic and may be key sources of resilience. Interventions and public health measures targeting men and unpartnered individuals could promote social support resilience, and intervening on modifiable behaviors like sleep quality, physical activity and sedentary activities like computer time may promote resilience to fatigue and depressive symptoms during future community stressor events. Further research into these relationships is warranted.

The work Lifestyle-integrated Functional Exercise program for preventing functional decline in employees aged 55 years and older: development and initial evaluation

BACKGROUND

Despite the global increase in older employees, workplace physical activity interventions (WPAIs) for this target group have not yet been sufficiently developed. The major drawback of existing WPAIs is low adherence due to lack of time or limited motivation. A novel approach could be to integrate tailored neuromotor and strength exercises into everyday working tasks to prevent the functional decline of older employees at the workplace without needing much additional time for training. This approach was tested in the present study by evaluating the proof-of-concept of a novel WPAI based on the Lifestyle-integrated Functional Exercise (LiFE) program integrated into a working environment (wLiFE55 +).

METHODS

The proof-of-concept of wLiFE55 + was quantified within a 4-week pre-post exercise intervention study by measuring (1) feasibility including adherence, activity frequency, adverse events and acceptance (integrability of wLiFE55 + activities, perceived improvement and safety, satisfaction, physical demand, personal trainer session, intervention content) and (2) pre-to-post changes in neuromotor function (12-Level Balance Scale, 12-LBS; Community Balance and Mobility Scale, CBM), strength (60sec Chair Stand Test), and PA (1-week activity monitoring). For statistical analysis, the median and interquartile range (IQR) were computed. For pre-to-post changes, Wilcoxon signed-rank tests with effect size (r) were also performed.

RESULTS

Seventeen older employees (mean age 59 years, 8 female) were included of which fifteen completed the study. The intervention adherence was 100%, and the activity adherence was 58% (9 out of 12 maximum possible wLiFE55 + activities implemented). Depending on the specific activity, the frequency of practice ranged between 25-75% of the days of the intervention period, and single wLiFE55 + activities were practiced between one and three times per day. No adverse events occurred, and acceptance was high. Pre-to-post increases with medium effect sizes were found for neuromotor function (CBM, 12-LBS) and specific PA variables (total sedentary time, sedentary bouts > 30 min).

CONCLUSION

The results of the study highlight the feasibility of wLiFE55 + in a work setting with older employees. The pre-to-post increases observed in neuromotor measures and reductions in sedentary time suggest that wLiFE55 + may counteract the age-related functional decline in older employees and justifies future studies in this field. The next steps are program adjustments to boost exercise frequency and evaluating wLiFE55 + in a randomized controlled trial.

The relationship between accelerometer-based physical activity, sedentary behavior, and seven common geriatric syndromes: a two-sample Mendelian randomization study

Introduction

To investigate the causal associations between accelerometer-based physical activity (PA), sedentary behavior (SB), and seven common geriatric syndromes (GSs) (frailty, falls, delirium, urinary incontinence, dysphagia, hearing loss, and visual impairment) by Mendelian randomization (MR) analysis.

Methods

Instrumental variables from a genome-wide association study were used for MR analysis. The exposure factors were three PA phenotypes (average acceleration, overall activity, and moderate-intensity activity) and one SB phenotype (SB). The outcome variables were seven common GSs. The inverse variance weighted (IVW) method was utilized for the primary MR analysis. Additionally, sensitivity, pleiotropy, and heterogeneity analyses were subsequently conducted to assess the robustness of the present study's findings.

Results

According to the primary MR results obtained using the IVW method, genetically predicted PA (average acceleration) decreased the risk of two GSs (frailty, p = 0.01; dysphagia, p = 0.03). Similarly, overall activity decreased the risk of two GSs (frailty, p = 0.01; delirium, p = 0.03), and moderate-intensity activity reduced the risk of three GSs (urinary incontinence, p = 0.04; hearing loss, p = 0.02; visual impairment, p = 0.01). Furthermore, SB was causally correlated with a greater risk for three GSs (frailty, p = 0.03; fall, p = 0.01; dysphagia, p = 0.04).

Conclusion

This study provided evidence that accelerometer-based PA may be causally associated with a lower risk of GSs, while SB may increase the risk of GSs.

Sedentary patterns and health outcomes in the oldest-old: a latent profile analysis

Background

Sedentary behavior is most prevalent among those aged 80 years and above, referred to as the oldest-old. Current literature emphasizes the significance of sedentary behavior patterns, but further evidence is required to understand how these patterns relate to specific health outcomes and to identify at-risk profiles for tailored interventions in the oldest-old. Therefore, the aim of this study was to identify profiles of adults aged 80+ years based on their sedentary patterns and health outcomes, and to examine associations between profiles and socio-demographics.

Methods

A cross-sectional study was conducted in Flanders (Belgium) from February 2021 to December 2022 recruiting 90 older adults (80+) through convenience sampling, employing word of mouth, social media and local service centers. Latent profile analysis identified device-based sedentary patterns and assessed their associations with physical and cognitive functioning, mental health-related quality of life (QoL), and social isolation. Associations of these profiles with socio-demographic factors were analyzed.

Results

Three distinct profiles were identified: (1) the 'cognitively and physically frail' profile, (2) the 'healthy' profile and (3) the 'lower mental health-related QoL' profile. Those in the 'cognitively and physically frail' profile exhibited the least favorable sedentary pattern, and had a higher likelihood of residing in a nursing home. No significant differences were found for the other socio-demographic variables, being age, sex, educational degree and family situation.

Conclusions

Three distinct profiles in the oldest-old population, based on cognitive and physical functioning, mental health-related QoL, and sedentary behavior patterns, were identified. Lower physical and cognitive functioning was associated with unhealthy sedentary patterns. Further research with larger samples is crucial to uncover potential links between socio-demographics and at-risk subgroups, enhancing our understanding of sedentary behavior and geriatric health outcomes in this population.

Exploring the perspectives of older adults who are pre-frail and frail to identify interventions to reduce sedentary behaviour and improve mobility: a thematic content analysis

Older adults who are frail are one of the most sedentary and the least physically active age groups. Prolonged sedentary time is associated with increased risk of negative health outcomes. To help design effective and sustainable content and optimize the uptake of sedentary behaviour interventions, an in-depth understanding of older adults' perceptions of sedentary behaviour is needed; however, most qualitative studies have been conducted in healthy older adults. The aim of this study was to explore perspectives of sedentary behaviour within the context of older adults who are pre-frail and frail after the winter and spring. We included participants if they: (1) spoke English or attended with a translator or caregiver, (2) were ≥ 60 years, and (3) were frail on the Morley Frail Scale. We utilized a qualitative description methodology including a semi-structured in-depth interview and thematic content analysis. Concepts from the COM-B (Capability Opportunity Motivation-Behaviour) model were used to guide the semi-structured interviews and analysis. To ensure credibility of the data, we used an audit trail and analyst triangulation. We recruited 21 older adults (72 ± 7.3 years, 13 females, 13 frail) from southwestern Ontario, Canada. Two individuals were lost to follow-up due to medical mistrust and worse health. We transcribed 39 audio recordings. We identified three salient themes: (1) older adults rationalize their sedentary behaviours through cognitive dissonance (reflective motivation), (2) urban cities in southwestern Ontario may not be "age-friendly" (physical opportunity), and (3) exercise is something people "have to do", but hobbies are for enjoyment despite medical conditions (psychological capability). Perspectives of sedentary behaviour were different in the winter versus spring, with participants perceiving themselves to be less active in winter. Incorporating dissonance-based interventions as part of an educational program could be used to target the reflective motivation and psychological capability components. Future research should consider interdisciplinary collaborations with environmental gerontology to develop age-friendly communities that promote meaningful mobility to target physical opportunity.

Assessing the association between a sedentary lifestyle and prevalence of primary osteoporosis: a community-based cross-sectional study among Chinese population

OBJECTIVES

To reveal the association between a sedentary lifestyle and the prevalence of primary osteoporosis (POP).

DESIGN

A community-based cross-sectional study was conducted.

SETTING

This study was conducted in communities in Hefei city, Anhui province, China.

PARTICIPANTS

A total of 1346 residents aged 40 and above underwent POP screening via calcaneus ultrasound bone mineral density (BMD) testing and completed a questionnaire survey.

OUTCOME MEASURES

The average daily sitting time was included in the study variable and used to assess sedentary behaviour. The 15 control variables included general information, dietary information and life behaviour information. Logistic regression was used to analyse the association between the POP prevalence and study or control variables in different models.

RESULTS

1346 participants were finally included in the study. According to the 15 control variables, the crude model and 4 models were established. The analysis revealed that the average daily sitting time showed a significant correlation with the prevalence of POP in the crude model (OR=2.02, 95% CI=1.74 to 2.36, p<0.001), Model 1 (OR=2.65, 95% CI=2.21 to 3.17, p<0.001), Model 2 (OR=2.63, 95% CI=2.19 to 3.15, p<0.001), Model 3 (OR=2.62, 95% CI=2.18 to 3.15, p<0.001) and Model 4 (OR=2.58, 95% CI=2.14 to 3.11, p<0.001). Besides, gender, age and body mass index showed a significant correlation with the POP prevalence in all models.

CONCLUSIONS

This study suggests a potential association between a sedentary lifestyle and the prevalence of POP within the Chinese population. Modifying sedentary behaviours could contribute to a reduction in POP risk. However, longitudinal cohort studies are necessary to confirm this hypothesis in the future.

Move your feet and sleep: A longitudinal dynamic analysis of self-reported exercise, sedentary behavior, and insomnia symptoms

INTRODUCTION

Insomnia symptoms are associated with poor physical and mental health. Exercise is associated with good sleep while sedentary behavior is associated with poor sleep. This study investigated the longitudinal, dynamic associations among exercise, sedentary behavior, and insomnia symptoms.

METHODS

Seven hundred and fifty-six adults (Mage=47.2years, 54.9% female) took part in an online longitudinal study investigating sleep and health across the lifespan. Participants reported duration of moderate-to-strenuous exercise, percentage of day spent sitting, and insomnia symptoms (Insomnia Severity Index [ISI]). The ISI was scored as a total score and two-factor scores: (1) Sleep Disturbance (items 1, 2, 3) and (2) Daytime Dysfunction (items 4, 5, 6, 7). Multilevel modeling was used to examine the typical (i.e., between-persons) and individual (i.e., within-persons) associations among sedentary behavior, exercise, and insomnia symptoms.

RESULTS

Sedentary behavior was significantly associated with total ISI scores at both the between-person and within-person levels (β = 0.036, t = 3.23, p = .001; β = 0.014, t = 1.99, p = .048). Both between-persons and within-person levels of sedentary behavior were associated with Daytime Dysfunction (β = 0.028, t = 3.79, p < .001; β = 0.009, t = 2.08, p = .039). Exercise was associated with total ISI and Daytime Dysfunction scores at the between-persons level but not at the within-persons level (β = 0.028, t = 2.57, p = .01; β = -0.002, t = -3.02, p = .003).

CONCLUSIONS

Sedentary behavior was a more consistent and robust predictor of insomnia symptoms than exercise. The association between sedentary behavior and insomnia symptoms was dynamic in that when an individual reported being more sedentary than their norm, they also reported more insomnia symptoms. Future analyses should examine potential moderator variables and comorbid conditions.

Dose-response associations between physical activity and sedentary time with functional disability in older adults with or without frailty: a prospective cohort study

Purpose

Evidence regarding the dose-response curve shapes of physical activity (PA) and sedentary time (ST) in older adults with functional disability (FD) is extremely limited. Moreover, these associations may differ depending on with/without frailty. We examined the dose-response associations between moderate-to-vigorous PA (MVPA) and ST with FD among older adults with/without frailty.

Methods

We included 7,480 initially nondisabled adults (3,795 men and 3,685 women) aged 65-84 years in Ota City, Tokyo, Japan. MVPA and ST were evaluated using the International Physical Activity Questionnaire-Short Form. FD was prospectively identified using a nationally unified database of the long-term care insurance system. Frailty was determined using Check-List 15, validated against Fried's frailty criteria. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and ST for FD were calculated, and dose-response curves were examined using restricted cubic splines.

Results

During 3.6 years of follow-up, 1,001 (13.4%) participants had FD. Among all participants, compared with no MVPA, the HRs for FD reduced linearly up to approximately 2000 metabolic equivalents (METs)■min/week of MVPA, and the lowest HR (HR: 0.61, 95% CI: 0.51-0.74) was reached at around 3,000-4,000 METs■min/week. Although the shape of this association was consistent regardless of with/without frailty, the magnitude of the association tended to be stronger in frail older adults than in non-frail older adults. Compared with those for the median (300 min/day) of ST, the HRs for FD increased linearly as ST reached approximately 600 min/day or more, independent of MVPA, with a maximum HR of 1.31 (95% CI: 1.01-1.71) for 1,080 min/day among all participants. This association was more pronounced among non-frail older adults but not statistically significant among frail older adults.

Conclusion

Higher MVPA levels consistently reduced the incidence of FD regardless of frailty in a significant inverse nonlinear dose-response manner. A significant positive nonlinear dose-response association between ST and FD risk was identified among non-frail older adults but not among frail older adults. Increasing MVPA and reducing prolonged ST are important for preventing FD among non-frail older adults. However, reducing ST alone may be insufficient; increasing MVPA, even if by only small increments, is highly recommended for frail older adults.

Association between leisure sedentary behaviors and hypertension risk: A prospective cohort study and two-sample Mendelian randomization analysis in Europeans

OBJECTIVE

This study aimed to investigate the potential causal relationship between domain-specific sedentary behaviors (including television watching, computer use, and driving) and hypertension risk in European populations.

METHODS

Initially, we conducted a multivariable Cox regression analysis to evaluate the associations between domain-specific sedentary behaviors and the risk of developing hypertension using data from 261,829 hypertension-free participants in the UK Biobank. To validate the findings of observational analysis, we employed two-sample univariable mendelian randomization (UVMR) analysis utilizing summary statistics from genome-wide association study conducted on European populations. We then performed multivariable mendelian randomization (MVMR) analysis to account for the influence of the risk factors for hypertension.

RESULTS

In this prospective observational analysis, individuals who spent >3 h per day watching television had significantly higher risk of developing hypertension (HR = 1.24, 95% CI: 1.20-1.29, P < 0.001) compared to those who watched television for 0-1 h per day. The mendelian randomization analysis provided consistent evidence for a causal relationship between prolonged television watching time and hypertension risk (OR = 1.45, 95% CI: 1.25-1.69, P < 0.001; all PMVMR < 0.05) in both UVMR and MVMR results. No significant associations were found between computer use, driving behaviors and the risk of hypertension in either the observational or UVMR/MVMR analyses.

CONCLUSIONS

These findings provide evidence for a causal effect specifically linking higher television watching time to an increased risk of hypertension and indicate the potential effectiveness of reducing television viewing time as a preventive measure to mitigate the risk of hypertension.

Isotemporal substitution analysis of time between sleep, sedentary behavior, and physical activity on depressive symptoms in older adults: a cross-sectional study

BACKGROUND

Compared to young individuals, older adults participate more in sedentary behavior (SB) and less in physical activity (PA). These behaviors are associated with numerous adverse health factors.

OBJECTIVE

The purpose of the study was to examine the hypothetical effects of substituting time spent sleeping, performing SB, and performing moderate-to-vigorous physical activity (MVPA) on depressive symptomatology in older adults.

DESIGN AND SETTING

An analytical cross-sectional study employing exploratory survey methods was conducted in the city of Alcobaça in the state of Bahia, Brazil.

METHODS

The study included 473 older adults who answered a structured questionnaire during an interview. Exposure time to SB and PA level were assessed using the International Physical Activity Questionnaire, and depressive symptoms were analyzed using the short version of the Geriatric Depression Scale. An isotemporal replacement model was used to evaluate the effects of different SB sessions on depressive symptomatology.

RESULTS

An increase in the risk of depressive symptoms was observed when MVPA and sleep time were substituted for the same SB time at all times tested, with maximum values of 40% and 20%, respectively. Opposite substitution of MVPA and sleep time increments reduced the risk of depressive symptomatology by 28% and 17%, respectively.

CONCLUSIONS

The results of the present study indicate that replacing SB with the same amount of sleep or MVPA may reduce depressive symptoms. The longer the reallocation time, the greater are the benefits.

Association between accelerometry measured patterns of sedentary behaviors and functional status in older adults

BACKGROUND

Older adults are highly sedentary, and too much sedentary behavior (SB) is associated with negative health effects, but little is known about SB patterns and their associations with functional status.

AIMS

To examine the association between objectively measured sedentary behavior time (SBT) and sedentary behavior fragmentation (SBF) and functional status in older adults using the National Health Aging Trends Study (NHATS) dataset, a nationally representative sample from 2021.

METHODS

Data from NHATS were analyzed using weighted linear regressions to examine the association between objective measures of SBT (mean hours spent in SB/day during waking hours) and SBF, and six functional variables (difficulties with activities of daily living [ADL], short physical performance battery, hand grip strength, immediate word recall, delayed word recall, and mental health), accounting for sociodemographic, body mass index, and the number of chronic conditions.

RESULTS

A total of 738 individuals from the NHATS were included. Higher SBT was associated with greater difficulties with ADL, poorer short physical performance battery and hand grip strength, lower scores in both immediate and delayed word recall, and poorer mental health. Higher SBF was associated with fewer difficulties with ADL, better short physical performance battery and hand grip strength, a higher score in immediate word recall, and better mental health.

DISCUSSIONAND CONCLUSIONS

Greater fragmentation of SB was associated with better function, and increasing SBF may be a useful strategy for mitigating the effects of SB in older adults, but prospective research is needed to support this approach.

Dose-response Associations of Physical Activity and Sitting Time With All-cause Mortality in Older Japanese Adults

PURPOSE

Although examining the dose-response curves of physical activity (PA) and sitting time with health-related outcomes is an important research agenda, the results for older Japanese adults are extremely limited. We examined the dose-response associations of PA and sitting time with all-cause mortality among older Japanese.

METHODS

Initially, 8,069 non-disabled residents (4,073 men; 3,996 women) aged 65-84 years of Ota City, Japan, were analyzed. Moderate-to-vigorous PA (MVPA) and sitting time were evaluated using the International Physical Activity Questionnaire-Short Form. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA and sitting time for all-cause mortality were calculated, and the dose-response curves were examined using restricted cubic splines (RCS).

RESULTS

During 4.1 years of follow-up, 458 participants (5.7%; 331 men and 127 women) died. Compared with the low MVPA (<600 metabolic equivalents [METs]·minutes/week) group, HR for mortality gradually reduced in moderate (600-3,000 METs·minutes/week) and high (>3,000 METs·minutes/week) MVPA groups (moderate: HR 0.66; 95% CI, 0.54-0.82; high: HR 0.58; 95% CI, 0.45-0.75; P < 0.001 for trend). RCS showed that the HR for mortality reduced linearly up to approximately 2,000 METs·minutes/week of MVPA, and maximal risk reduction was seen at approximately 3,000-4,500 METs·minutes/week of MVPA. No significant dose-response association of sitting time with mortality was observed.

CONCLUSION

Higher MVPA levels reduced all-cause mortality risk, in a significant inverse non-linear dose-response manner. Sitting time was not significantly associated with all-cause mortality. It is important to disseminate the significance of even a slight increase in the MVPA for reducing mortality risk.

Monitoring mobility in older adults using a Global Positioning System (GPS) smartwatch and accelerometer: A validation study

There is growing interest in identifying valid and reliable methods for detecting early mobility limitations in aging populations. A multi-sensor approach that combines accelerometry with Global Positioning System (GPS) devices could provide valuable insights into late-life mobility decline; however, this innovative approach requires more investigation. We conducted a series of two experiments with 25 older participants (66.2±8.5 years) to determine the validity of a GPS enabled smartwatch (TicWatch S2 and Pro 3 Ultra GPS) and separate accelerometer (ActiGraph wGT3X-BT) to collect movement, navigation and body posture data relevant to mobility. In experiment 1, participants wore the TicWatchS2 and ActiGraph simultaneously on the wrist for 3 days. In experiment 2, participants wore the TicWatch Pro 2 Ultra GPS on the wrist and ActiGraph on the thigh for 3 days. In both experiments participants also carried a Qstarz data logger for trips outside the home. The TicWatch Pro 3 Ultra GPS performed better than the S2 model and was similar to the Qstarz in all tested trip-related measures, and it was able to estimate both passive and active trip modes. Both models showed similar results to the gold standard Qstarz in life-space-related measures. The TicWatch S2 demonstrated good to excellent overall agreement with the ActiGraph algorithms for the time spent in sedentary and non-sedentary activities, with 84% and 87% agreement rates, respectively. Under controlled conditions, the TicWatch Pro 3 Ultra GPS consistently measured step count in line with the participants' self-reported data, with a bias of 0.4 steps. The thigh-worn ActiGraph algorithm accurately classified sitting and lying postures (97%) and standing postures (90%). Our multi-sensor approach to monitoring mobility has the potential to capture both accelerometer-derived movement data and trip/life-space data only available through GPS. In this study, we found that the TicWatch models were valid devices for capturing GPS and raw accelerometer data, making them useful tools for assessing real-life mobility in older adults.

Older adults' perspectives on physical activity and sedentary behaviour within their home using socio-ecological model

BACKGROUND

There are few studies that focus explicitly on the impact of the home environment on older adults' sedentary behaviour (SB) and physical activity (PA) using the socio-ecological model (SEM). This study aims to investigate older adults' PA and SB within the home environment integrating the SEM as a theoretical framework.

METHODS

A qualitative exploratory research design was employed to conduct 33 in-depth interviews (IDIs) and five focus group (FGs; n = 16) with multi-diverse ethnic older adults (mean age 72±5 years). Using reflexive thematic analysis themes were generated from the data set and were interpreted using the SEM.

RESULTS

The findings indicate that different levels of the SEM had an impact on older adults' PA and SB. These include the 1) Individual level: Attitude, perception and motivation 2) Interpersonal level: Family and Friends: a motive to remain active 3) Organisational level: healthcare institutes, 4) Community level factors: Significance of social groups, 5) Physical Environment: Microenvironment and 6) Policy level factors (lockdown restrictions and healthcare system). This model can be utilised to foster activity within the home by focusing on the facilitators and barriers identified at each of these levels of influence.

CONCLUSION

The study findings suggest that modifying PA and SB in the home environment is complex and is influenced across different levels of the SEM. Therefore, a holistic approach is required that integrates these multiple influences. This understanding can inform the design of interventions that seek to optimize PA and minimize SB within the home environment.

Domains of Sedentary Behavior and Cognitive Function: The Health, Aging, and Body Composition Study, 1999/2000 to 2006/2007

BACKGROUND

This study examines the relationship between various domains of sedentary behavior and subsequent cognitive function to evaluate whether different sedentary activities have specific associations with future cognitive performance.

METHODS

Data were from 1 261 older adults participating in the Health, Aging, and Body Composition (Health ABC) Study between 1999/2000 and 2006/2007. Total sitting time (hours/day), reading time (hours/week), and TV time (≤27/≥28 h/wk) were self-reported at baseline and 3 years later. At follow-up, cognitive function was evaluated using the Teng Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST). Multivariable linear regression modeling examined the independent associations of baseline sedentary behaviors and 3-year change in those behaviors with cognitive function scores at follow-up, adjusting for important covariables.

RESULTS

Baseline total sitting time was positively associated with 3MS (β = 0.14 ± 0.07; p < .05) and DSST (β = 0.20 ± 0.10; p < .05) scores at follow-up, as was reading time (β = 0.09 ± 0.03; p < .05 for 3MS score and β = 0.14 ± 0.04; p < 0.01 for DSST score). Participants who increased their TV watching time over 3 years had a significantly lower 3MS score (β = -1.45 ± 0.71; p < .05) at follow-up, compared with those who maintained a low level of TV time (referent). These findings were independent of age, sex, race, education level, health status, depressive symptoms, and physical activity.

CONCLUSION

Some types of sedentary behavior may have benefits for cognitive function in older age, thus highlighting the importance of measuring different domains of sitting time.

Does the built environment influence location- and trip-based sedentary behaviors? Evidence from a GPS-based activity space approach of neighborhood effects on older adults

OBJECTIVE

Evidence on the influence of built environments on sedentary behaviors remains unclear and is often contradictory. The main limitations encompass the use of self-reported proxies of sedentary time (ST), the scarce consideration of the plurality of sedentary behaviors, and environmental exposures limited to the residential neighborhood. We investigated the relationships between GPS-based activity space measures of environmental exposures and accelerometer-based ST measured in total, at the place of residence, at all locations, and during trips.

METHODS

This study is part of the CURHA project, based on 471 older adults residing in Luxembourg, who wore a GPS receiver and a tri-axial accelerometer during 7 days. Daily ST was computed in total, at the residence, at all locations and during trips. Environmental exposures included exposure to green spaces, walking, biking, and motorized transportation infrastructures. Associations between environments and ST were examined using linear and negative binomial mixed models, adjusted for demographics, self-rated health, residential self-selection, weather conditions and wear time.

RESULTS

Participants accumulated, on average, 8 h and 14 min of ST per day excluding sleep time. ST spent at locations accounted for 83 % of the total ST. ST spent at the residence accounted for 87 % of the location-based ST and 71 % of the total ST. Trip-based ST represents 13 % of total ST, and 4 % remained unclassified. Higher street connectivity was negatively associated with total ST, while the density of parking areas correlated positively with total and location-based ST. Stronger associations were observed for sedentary bouts (uninterrupted ST over 20 and 30 min).

CONCLUSION

Improving street connectivity and controlling the construction of new parking, while avoiding the spatial segregation of populations with limited access to public transport, may contribute to limit ST. Such urban planning interventions may be especially efficient in limiting the harmful uninterrupted bouts of ST among older adults.

A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement

Patients with cardiovascular disease benefit from cardiac rehabilitation, which includes structured exercise and physical activity as core components. This position statement provides pragmatic, evidence-based guidance for the assessment and prescription of exercise and physical activity for cardiac rehabilitation clinicians, recognising the latest international guidelines, scientific evidence and the increasing use of technology and virtual delivery methods. The patient-centred assessment and prescription of aerobic exercise, resistance exercise and physical activity have been addressed, including progression and safety considerations.

Providing office workers with height-adjustable workstation to reduce and interrupt workplace sitting time: protocol for the Stand Up for Healthy Aging (SUFHA) cluster randomized controlled trial

BACKGROUND

Sedentary behavior (SB) has been linked to several negative health outcomes. Therefore, reducing SB or breaking up prolonged periods of SB improves functional fitness, food consumption, job satisfaction, and productivity. Reducing SB can be achieved by introducing a health-enhancing contextual modification promoted by a sit-stand desk in the workplace. The primary goal will be to test the effectiveness of this intervention in reducing and breaking up SB, while improving health outcomes in office-based workers during a 6-month intervention.

METHODS

A two-arm (1:1), superiority parallel-group cluster RCT will be conducted to evaluate the effectiveness of this intervention in a sample of office-based workers from a university in Portugal. The intervention will consist of a psychoeducation session, motivational prompts, and contextual modification promoted by a sit-stand desk in the workplace for 6 months. The control group will work as usual in their workplace, with no contextual change or prompts during the 6-month intervention. Three assessment points will be conducted in both groups, pre-intervention (baseline), post-intervention, and a 3-month follow-up. The primary outcomes include sedentary and physical activity-related variables, which will be objectively assessed with 24 h monitoring using the ActivPAL for 7 days. The secondary outcomes include (a) biometric indices as body composition, body mass index, waist circumference, and postural inequalities; and (b) psychosocial variables such as overall and work-related fatigue, overall discomfort, life/work satisfaction, quality of life, and eating behavior. Both the primary and secondary outcomes will be assessed at each assessment point.

DISCUSSION

This study will lean on the use of a sit-stand workstation for 6 months, prompted by an initial psychoeducational session and ongoing motivational prompts. We will aim to contribute to this topic by providing robust data on alternating sitting and standing postures in the workplace.

TRIAL REGISTRATION

The trial was prospectively registered, and the details are at: https://doi.org/10.17605/OSF.IO/JHGPW ; Registered 15 November 2022. OSF Preregistration.

Effectiveness of Interventions Promoting Physical Activity and Reducing Sedentary Behavior in Community-Dwelling Older Adults: An Umbrella Review With Application to Saudi Arabia

BACKGROUND

As Saudi Arabia is expected to face population aging in the future, the burden of diseases arising from inadequate physical activity (PA) and excess sedentary behavior (SB) may subsequently increase without successful interventions. The present study critically reviews the global literature on the effectiveness of PA interventions targeting community-dwelling older adults to draw on lessons and applications for future interventions in Saudi Arabia.

METHODS

This umbrella review of systematic reviews included interventions designed to increase PA and/or reduce SB in community-dwelling older adults. We conducted searches in July 2022 in two electronic databases-PubMed and Embase-and identified relevant peer-reviewed systematic reviews in English.

RESULTS

Fifteen systematic reviews focusing on community-dwelling older adults were included. Several reviews reported that PA- or SB-based interventions, including eHealth interventions (such as automated advice, tele-counseling, digital PA coaching, automated PA tracking and feedback, online resources, online social support, and video demonstrations), mHealth interventions, and non-eHealth interventions (such as goal setting, individualized feedback, motivational sessions, phone calls, face-to-face education, counseling, supervised exercise sessions, sending educational materials to participants' homes, music, and social marketing programs), were effective in the short term (e.g., ≤ 3 months) but with wide heterogeneity in findings and methodologies. There were limited studies on PA- and SB-based interventions that could be effective for one year or more after the intervention. Most reviews were heavily skewed toward studies carried out in Western communities, limiting their generalizability to Saudi Arabia and other parts of the world.

CONCLUSION

There is evidence that some PA and SB interventions may be effective in the short term, but high-quality evidence regarding long-term effects is lacking. The cultural, climate, and environmental barriers related to PA and SB in Saudi Arabia require an innovative approach and research to evaluate such interventions in older individuals in the long term.

The Effect of a Standing Intervention on Falls in Long Term Care: a Secondary Analysis of a Randomized Controlled Trial

Background

Older adults in long term care (LTC) spend over 90% of their day engaging in sedentary behaviour. Sedentary behaviour may exacerbate functional decline and frailty, increasing the risk for falls. The purpose of this study is to explore the impact of a 22-week standing intervention on falls among LTC residents at 12-month follow-up.

Methods

This was a planned secondary analysis of the Stand if You Can randomized controlled trial. The original trial randomized 95 participants (n = 47 control; n = 48 intervention) to either a sitting control or a supervised standing intervention group (100 minutes/week) for 22 weeks. Falls data were available to be collected over 12 months post-intervention for 89 participants. The primary outcome was a hazard of fall (Yes/No) during the 12-month follow-up period.

Results

A total of 89 participants (average age 86 years ± 8.05; 71.9% female) were followed for 12-months post-intervention. Participants in the intervention group (n=44) had a significantly greater hazard ratio of falls (2.01; 95% CI = 1.11 to 3.63) than the control group (n=45) when accounting for the history of falls, frailty status, cognition level, and sex.

Conclusion

Participants who received a standing intervention over 22 weeks were twice as likely to fall 12 months after the intervention compared with the control group. However, the prevalence of falls did not surpass what would be typically observed in LTC facilities. It is imperative that future studies describe in detail the context in which falls happen and collect more characteristics of participants in the follow-up period to truly understand the association between standing more and the risk of falls.

Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital

Introduction

This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults.

Methods

The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects.

Results

The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together.

Discussion

Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.

Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?

Association between Sedentary Behavior during Leisure Time and Excessive Weight in Chinese Children, Adolescents, and Adults

(1) Background: Sedentary behavior is increasing in all age groups and is one of the most common lifestyles that is a risk factor for overweight and obesity; however, few studies have evaluated the impact of leisure-time sedentary behavior on overweight and obesity. This study aims to examine the distribution characteristics of different leisure-time sedentary behaviors and their effects on excessive weight in different age groups in the Chinese population to provide evidence for the development of behavioral interventions. (2) Methods: This study utilizes data from the 2004 to 2011 China Health and Nutrition Survey (CHNS). Participants ranged in age from 6 to 18 years or older and were from China. Weight and height were measured in the physical examination, and the sedentary behavior times during leisure periods were collected by using a questionnaire. Logistic regression models were performed for association analyses. (3) Results: A total of 36,169 participants were included in this study. The impact of screen-based sedentary leisure time on excessive weight is greater in middle-aged and older adults. For middle-aged adults, sedentary time periods spent on the Internet or video games were found to be significantly and positively associated with excessive weight (OR, 1.122, 95% CI, 1.005-1.253). In addition, for older adults, sedentary time periods spent watching television or videos were found to be significantly and positively associated with excessive weight (OR, 1.065, 95% CI, 1.035-1.095). (4) Conclusions: This study helps grasp the target population and provide evidence for the development of behavioral intervention guidelines.

The Frail-LESS (LEss Sitting and Sarcopenia in Frail older adults) intervention to improve sarcopenia and maintain independent living via reductions in prolonged sitting: a randomised controlled feasibility trial protocol

BACKGROUND

Sarcopenia is a progressive and generalised loss of muscle mass and function with advancing age and is a major contributor to frailty. These conditions lead to functional disability, loss of independence, and lower quality of life. Sedentary behaviour is adversely associated with sarcopenia and frailty. Reducing and breaking up sitting should thus be explored as an intervention target for their management. The primary aim of this study, therefore, is to examine the feasibility, safety, and acceptability of conducting a randomised controlled trial (RCT) that evaluates a remotely delivered intervention to improve sarcopenia and independent living via reducing and breaking up sitting in frail older adults.

METHODS

This mixed-methods randomised controlled feasibility trial will recruit 60 community-dwelling older adults aged ≥ 65 years with very mild or mild frailty. After baseline measures, participants will be randomised to receive the Frail-LESS (LEss Sitting and Sarcopenia in Frail older adults) intervention or serve as controls (usual care) for 6 months. Frail-LESS is a remotely delivered intervention comprising of tailored feedback on sitting, information on the health risks of excess sitting, supported goal setting and action planning, a wearable device that tracks inactive time and provides alerts to move, health coaching, and peer support. Feasibility will be assessed in terms of recruitment, retention and data completion rates. A process evaluation will assess intervention acceptability, safety, and fidelity of the trial. The following measures will be taken at baseline, 3 months, and 6 months: sitting, standing, and stepping using a thigh-worn activPAL4 device, sarcopenia (via hand grip strength, muscle mass, and physical function), mood, wellbeing, and quality of life.

DISCUSSION

This study will determine the feasibility, safety, and acceptability of evaluating a remote intervention to reduce and break up sitting to support improvements in sarcopenia and independent living in frail older adults. A future definitive RCT to determine intervention effectiveness will be informed by the study findings.

TRIAL REGISTRATION

ISRCTN, ISRCTN17158017; Registered 6 August 2021, https://www.isrctn.com/ISRCTN17158017.

Relationship between Empowerment and Functioning and Disability in Older Japanese Patients: A Covariance Structure Analysis

In the present study, 151 Japanese older adults aged over 65 years and admitted to recovery-phase rehabilitation facilities were enrolled to investigate the relationship between empowerment and contextual factors, functioning and disability, with structural equation modeling (SEM). The analysis included 151 patients aged 81.75 ± 7.15 years, including 54 males (35.76%) and 97 females (64.24%). The results of the SEM analysis showed that role presence (β = 0.45, p < 0.01) and family structure (β = 0.18, p = 0.02) significantly impacted empowerment. In addition, the results showed that patient empowerment positively impacted physical activity (β = 0.25, p < 0.01) and psychosomatic functions and abilities (β = 0.36, p < 0.01). Furthermore, the goodness-of-fit of the model hypothesized in this study was shown to have explanatory power. This study showed that empowerment contributed to the prevention of physical inactivity and confinement among Japanese older patients. In other words, the study provided evidence for the importance of empowerment-based program planning in the practice of person-centered care aimed at promoting the health and discharge of older patients in Japan.

Associations between everyday physical activity and morale in older adults

Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity-or even spending time in an upright position-and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.

Total Sedentary Time and Cognitive Function in Middle-Aged and Older Adults: A Systematic Review and Meta-analysis

Background

An estimated 47 million people have dementia globally, and around 10 million new cases are diagnosed each year. Many lifestyle factors have been linked to cognitive impairment; one emerging modifiable lifestyle factor is sedentary time.

Objective

To conduct a systematic review and meta-analysis of peer-reviewed literature examining the association between total sedentary time with cognitive function in middle-aged and older adults under the moderating conditions of (a) type of sedentary time measurement; (b) the cognitive domain being assessed; (c) looking at sedentary time using categorical variables (i.e., high versus low sedentary time); and (d) the pattern of sedentary time accumulation (e.g., longer versus shorter bouts). We also aimed to examine the prevalence of sedentary time in healthy versus cognitively impaired populations and to explore how experimental studies reducing or breaking up sedentary time affect cognitive function. Lastly, we aimed to conduct a quantitative pooled analysis of all individual studies through meta-analysis procedures to derive conclusions about these relationships.

Methods

Eight electronic databases (EMBASE; Web of Science; PsycINFO; CINAHL; SciELO; SPORTDiscus; PubMed; and Scopus) were searched from inception to February 2021. Our search included terms related to the exposure (i.e., sedentary time), the population (i.e., middle-aged and older adults), and the outcome of interest (i.e., cognitive function). PICOS framework used middle-aged and older adults where there was an intervention or exposure of any sedentary time compared to any or no comparison, where cognitive function and/or cognitive impairment was measured, and all types of quantitative, empirical, observational data published in any year were included that were published in English. Risk of bias was assessed using QualSyst.

Results

Fifty-three studies including 83,137 participants met the inclusion criteria of which 23 studies had appropriate data for inclusion in the main meta-analysis. The overall meta-analysis suggested that total sedentary time has no association with cognitive function (r = −0.012 [95% CI − 0.035, 0.011], p = 0.296) with marked heterogeneity (I² = 89%). Subgroup analyses demonstrated a significant negative association for studies using a device to capture sedentary time r = −0.035 [95% CI − 0.063, − 0.008], p = 0.012). Specifically, the domains of global cognitive function (r = −0.061 [95% CI − 0.100, − 0.022], p = 0.002) and processing speed (r = −0.067, [95% CI − 0.103, − 0.030], p < 0.001). A significant positive association was found for studies using self-report (r = 0.037 [95% CI − 0.019, 0.054], p < 0.001). Specifically, the domain of processing speed showed a significant positive association (r = 0.057 [95% CI 0.045, 0.069], p < 0.001). For prevalence, populations diagnosed with cognitive impairment spent significantly more time sedentary compared to populations with no known cognitive impairments (standard difference in mean = −0.219 [95% CI − 0.310, − 0.128], p < 0.001).

Conclusions

The association of total sedentary time with cognitive function is weak and varies based on measurement of sedentary time and domain being assessed. Future research is needed to better categorize domains of sedentary behaviour with both a validated self-report and device-based measure in order to improve the strength of this relationship. PROSPERO registration number: CRD42018082384.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-022-00507-x.

Reliability of the accelerometer to control the effects of physical activity in older adults

Background

Reliable physical activity measurements in community-dwelling older adults are important to determine effects of targeted health promotion interventions. Many exercise interventions aim to improve time spent sedentary (SED), in light-intensity-physical-activity (LPA) and moderate-to-vigorous-intensity-physical-activity (MVPA), since these parameters have independently proposed associations with health and longevity. However, many previous studies rely on self-reports which have lower validity compared to accelerometer measured physical activity patterns. In addition, separating intervention-effects from reactivity measurements requires sufficient test-retest reliability for accelerometer assessments, which is lacking in older adults.

Objectives

The study objective was to investigate the reliability of sensor-based PA-patterns in community-dwelling older adults. Furthermore, to investigate change over time of physical activity patterns and examine any compensatory-effect from the eight-week supervised exercise-intervention.

Methods

An exercise-group (n = 78, age-range:65-91yrs) performed two 1h-exercise sessions/week during eight-weeks. PA-pattern was assessed (using hip-worn accelerometers), twice before and once during the last-week of the intervention. A control-group (n = 43, age-range:65-88yrs) performed one pre-test and the end-test with no exercise-intervention. A dependent-t-test, mean-difference (95%-CI), limits-of-agreement and intraclass-correlation-coefficient-ICC were used between the two pre-tests. Repeated-measures-ANOVA were used to analyze any intervention-effects.

Results

The exercise-groups´ two pre-tests showed generally no systematic change in any PA- or SED-parameter (ICC ranged 0.75–0.90). Compared to the control group, the exercise intervention significantly (time x group-interaction, p<0.05) increased total-PA-cpm (exercise-group/control-group +17%/+7%) and MVPA-min/week (+41/-2min) and decreased %-of-wear-time for SED-total (-4.7%/-2.7%) and SED-bouts (-5.7%/-1.8%), and SED-bouts min/d (-46/-16min). At baseline level, no significant differences were found between the two groups for any parameter.

Conclusions

The current study presents a good test-retest-reliability of sensor-based-one-week-assessed-PA-pattern in older-adults. Participating in an 8-week supervised exercise intervention improved some physical activity and sedentary parameters compared to the control group. No compensatory-effect was noted in the intervention-group i.e., no decrease in any PA-parameter or increase in SED at End-test (in %-of-wear-time, min/day or total-PA).

Leisure-time sedentary behaviors are differentially associated with all-cause dementia regardless of engagement in physical activity

Sedentary behavior (SB) is associated with cardiometabolic disease and mortality, but its association with dementia is currently unclear. This study investigates whether SB is associated with incident dementia regardless of engagement in physical activity (PA). A total of 146,651 participants from the UK Biobank who were 60 years or older and did not have a diagnosis of dementia (mean [SD] age: 64.59 [2.84] years) were included. Self-reported leisure-time SBs were divided into two domains: time spent watching television (TV) or time spent using a computer. A total of 3,507 individuals were diagnosed with all-cause dementia over a mean follow-up of 11.87 (±1.17) years. In models adjusted for a wide range of covariates, including time spent in PA, time spent watching TV was associated with increased risk of incident dementia (HR [95% CI] = 1.24 [1.15 to 1.32]) and time spent using a computer was associated with decreased risk of incident dementia (HR [95% CI] = 0.85 [0.81 to 0.90]). In joint associations with PA, TV time and computer time remained significantly associated with dementia risk at all PA levels. Reducing time spent in cognitively passive SB (i.e., TV time) and increasing time spent in cognitively active SB (i.e., computer time) may be effective behavioral modification targets for reducing risk of dementia regardless of engagement in PA.

The Effectiveness of Interventions to Reduce Sedentary Time in Different Target Groups and Settings in Germany: Systematic Review, Meta-Analysis and Recommendations on Interventions

BACKGROUND

Sedentary behavior is an important risk factor for several chronic diseases and is associated with an increased risk of mortality. We assessed the effectiveness of interventions to reduce sedentary time in Germany and provide recommendations on interventions to reduce sedentary time in children and adults.

METHODS

We comprehensively searched PubMed, Web of Science and the German Clinical Trials Register up to April 2022 for intervention studies targeting sedentary behavior in Germany. We performed a systematic review and qualitative synthesis of the interventions and a meta-analysis in children.

RESULTS

We included 15 studies comprising data from 4588 participants. The results of included primary studies in adults and children showed inconsistent evidence regarding change in sedentary time, with a majority of studies reporting non-significant intervention effects. The meta-analysis in children showed an increase in sedentary time for children in the control and intervention groups.

CONCLUSION

We found inconsistent evidence regarding the effectiveness of interventions to reduce time spent sedentary and our meta-analysis showed an increase in sedentary time in children. For children, we recommend physical and social environment interventions with an active involvement of families. For adults, we recommend physical environment interventions, such as height-adjustable desks at work.

The ongoing effects of the COVID-19 pandemic on perceived physical activity, physical function and mood of older adults in the U.K: A follow-up study (March 2020-June 2021)

Coronavirus (COVID-19) and its variants, continue to spread globally more than two years after the discovery of the wild-type virus in Wuhan, China. Following the onset of COVID-19, fluctuating restrictions have likely impacted the daily lives of older adults living in the United Kingdom (UK). Subsequently, the longer term effects of COVID-19 on physical activity levels, perceived physical function and mood of older adults are unclear. Therefore, the present study aimed to follow a group of older adult's living in the UK for one year, to monitor physical activity levels, perceived physical function and mood. A longitudinal, mixed-methods, observational study was conducted using self-administered, online surveys at 3-month intervals between March 2020 and June 2021. A total of 100 participants (46 males [age: 76 ± 5 years] and 54 females [age:74 ± 4 years]) completed all surveys. Bayesian analysis allowed calculation of direct probabilities whilst incorporating our prior knowledge. Throughout this period, older adults maintained or increased their pre-lockdown physical activity levels despite a decrease in intensity of effort of physical activity tasks, whilst sitting time increased at two of the follow-up time-points. Furthermore, perceived physical function decreased (ps = 91.78%;>1.21 AU) and mood undulated in a pattern that reflected the tightening and easing of restrictions. Despite total physical activity being maintained, perceived physical function decreased by a small but clinically meaningful margin.

Dynamic performance-exposure algorithm for falling risk assessment and prevention of falls in community-dwelling older adults

This study aimed to design a dynamic performance-exposure algorithm for falling risk assessment and prevention of falls in community-dwelling older adults. It involved a cross-sectional and follow-up survey assessing retrospective and prospective falls and respective performance-related, exposure and performance-exposure risk factors. In total, 500 Portuguese community-dwelling adults participated. Data modelling showed significant (p<0.05) relationships between the above risk factors and selected nine key ordered outcomes explaining falls to include in the algorithm: previous falls; health conditions; balance; lower strength; perceiving action boundaries; fat mass; environmental hazards; rest periods; and physical activity. Respective high-, moderate- and low-risk cutoffs were established. The results demonstrated a dynamic relationship between older adults' performance capacity and the exposure to fall opportunity, counterbalanced by the action boundary perception, supporting the build algorithm's conceptual framework. Fall prevention measures should consider the factors contributing most to the individual risk of falling and their distance from low-risk safe values.

Linear and non-linear associations of device-measured sedentary time with older adults' skeletal muscle mass

BACKGROUND

Time spent sitting is associated adversely with health outcomes in older adults. Nevertheless, it is not clear how sedentary time may be related to appendicular skeletal muscle mass (ASM) - a key attribute of sarcopenia. This cross-sectional study examined associations of total sedentary time with ASM among community-dwelling older Japanese males and females.

METHODS

Participants (n = 281, 74.3 ± 5.2 yr) wore a tri-axial accelerometer for seven days. Body mass index-adjusted ASM (kg/BMI) was derived from bioimpedance measures. Multivariate linear and quadratic regression models examined the associations of ASM with total sedentary time, stratified by sex. Restricted cubic spline models were fitted to estimate non-linear associations. Isotemporal substitution (IS) models were used to estimate the impacts of replacing 30-minute of sedentary time with light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA).

RESULTS

After adjustment, total sedentary time had a significant linear and negative association with ASM among females (β = -0.014; p = 0.023). For males, total sedentary time had a significant quadratic association (p = 0.020). Spline models indicated a reverse U-shaped association (p < 0.001) with total sedentary time over 9.3 h/day being associated with lower ASM. The IS models indicated that replacing 30 min/day of sedentary time with LPA would be positively and significantly associated with older females' ASM (β = 0.007, p = 0.022).

CONCLUSIONS

In older Japanese adults, higher volumes of time spent sedentary were associated with lower ASM. For males, only very high volumes of sedentary time appeared to be detrimental. These adverse relationships may in part be offset by more time spent in either LPA or MVPA.