Sedentary behavior, physical activity, and markers of health in older adults

Association Between Subjective Cognitive Decline and Twice-Weekly Muscle-Strengthening Activities in Middle-Aged and Older US Adults: An Analysis of the 2019 Behavioral Risk Factor Surveillance System

PURPOSE

Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD.

DESIGN

Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data.

SAMPLE

114 164 respondents, representing approximately 59 million US adults aged ≥45.

MEASURES

SCD was indicated if the respondent reported confusion or memory loss during the past 12 months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week).

ANALYSIS

Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C.

RESULTS

US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0).

CONCLUSION

Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities.

Associations of sedentary behavior and screen time with biomarkers of inflammation and insulin resistance

Sedentary behavior (SB) has been linked to risk factors of cardiometabolic disease, with inconsistent findings reported in the literature. We aimed to assess the associations of SB with multiple biomarkers of inflammation and insulin resistance in adults. Domain-specific SB, sitting time and moderate-to-vigorous physical activity (MVPA) were measured in 78 adults (mean ± SD 52.0 ± 10.8 y). Body fat percentage (BF%) was assessed using multi-frequency bioelectrical impedance. A blood draw assessed glucose, insulin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), leptin, and adiponectin. Adiponectin-leptin ratio (ALR), homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β) were calculated. Multivariable linear regression analyses, controlling for age, sex, MVPA, and BF%, were used to assess associations. After adjustment for age, sex and MVPA, total SB (7.5 ± 2.5 h/day) was positively associated with leptin, insulin, HOMA-IR, HOMA-β (Standardized Beta (β) range 0.21-0.32) and negatively associated with ALR (β = -0.24, p < 0.05 for all). Similarly, total sitting time (7.2 ± 2.9 h/day) was associated with TNF-α (β = 0.22) and ALR (β = -0.26). These associations were attenuated to non-significance after adjustment for BF%. Leisure screen time was detrimentally associated with IL-6 (β = 0.24), leptin (β = 0.21), insulin (β = 0.37), HOMA-IR (β = 0.37), and HOMA-β (β = 0.34), independent of age, sex and MVPA (p < 0.05 for all). Only the associations with insulin (β = 0.26), HOMA-IR (β = 0.26), and HOMA-β (β = 0.23) remained significant after further controlling BF% (p < 0.05). Self-reported SB is associated with biomarkers of inflammation and insulin resistance, independent of MVPA, and in some cases BF%.

Sedentary behavior patterns and bone health among overweight/obesity older women: a cross-sectional study

Background

Recent studies have indicated an association between sedentary behavior (SB), particularly patterns of SB, and bone health. However, it remains uncertain how different patterns of SB in overweight/obesity older women impact their bone health. This study aimed to investigate the association between objectively measured SB patterns and bone health in Chinese community-dwelling overweight/obesity older women.

Methods

Cross-sectional data were obtained from a baseline survey of Physical Activity and Health in Older Women Study. Quantitative ultrasound was used to measure speed of sound (SOS), broadband ultrasound attenuation (BUA), bone quality index (BQI) and T value to evaluate bone health. SB patterns were measured using triaxial accelerometers, including sedentary time in SB bouts of ≥ 10, 30, and 60 min, number of SB bouts ≥ 10, 30, and 60 min. Multiple linear regression was used to examine the associations of different SB patterns with bone health.

Results

After adjusting for confounders, sedentary time in SB bouts ≥ 60 min, number of SB bouts ≥ 60 min were significantly associated with bone health, with a lower SOS [β = -2.75, 95% confidence interval (CI): -4.96 to -0.53, P = 0.015], BUA (β = -1.20, 95% CI: -2.14 to -0.26, P = 0.013), BQI (β = -1.56, 95% CI: -2.63 to -0.49, P = 0.004), T value (β = -0.08, 95% CI: -0.14 to -0.03, P = 0.004) per 60 min increase of sedentary time in SB bouts ≥ 60 min, and a lower SOS (β = -3.97, 95% CI: -7.54 to -0.40, P = 0.029), BUA (β = -1.80, 95% CI: -3.44 to -0.16, P = 0.031), BQI (β = -2.28, 95% CI: -4.08 to -0.47, P = 0.014) and T value (β = -0.12, 95% CI: -0.22 to -0.03, P = 0.013) per bout increase of SB bouts ≥ 60 min, respectively.

Conclusion

Limiting the duration of prolonged sedentary bouts and minimizing the occurrence of number of SB bouts ≥ 60 min could be essential in bone health management, especially for those older people who are overweight/obesity.

A within-subject examination of grandparents' physical activity and sedentary behavior levels in the presence or absence of grandchild care provision

BACKGROUND

This study aimed to examine within-subject differences in levels of physical activity (PA) and sedentary behavior (SB) among Flemish grandparents aged 50 years and older during a day of providing versus not providing grandchild care. Additionally, grandparents' PA and SB levels of the specific caregiving moment within the included care day were also compared with those of the corresponding specific time frame on the matching non-care day.

METHODS

Data were obtained and pooled from three assessment time points of the Healthy Grandparenting Project. Objectively measured PA and SB levels were assessed through ActiGraphs wGT3x(+) worn during waking hours for seven consecutive days and expressed relative to the total wear time of the selected days or moments (i.e., percentage of time per day or per moment). Generalized linear mixed models were used to evaluate the within-subject differences in grandparents' light intensity PA (LIPA), moderate-to-vigorous intensity PA (MVPA) and SB levels between a care and non-care day as well as between the care and non-care moment of those respective days.

RESULTS

A total of 92 grandparents (64.6 ± 4.8 years, 67.4% women) were included in the analyses. During the care day and care moment, grandparents showed higher relative levels of LIPA (∆=4.0% and ∆=7.9%, respectively) and lower relative levels of SB (∆=3.7% and ∆=6.7%, respectively) as compared to their respective non-care day and non-care moment (all p < 0.001). While there was no significant difference in relative MVPA levels between a day of providing versus not providing grandchild care (∆=0.3%, p = 0.500), the grandparents showed significantly lower relative levels of MVPA during the specific care moment against the non-care moment (∆=1.3%, p = 0.029).

CONCLUSIONS

The higher percentage of time of LIPA and lower percentage of time spent on SB during a care day and care moment compared to a non-care day and non-care moment, highlight the positive impact of grandchild care provision on grandparents' activity levels, potentially improving other health-related outcomes. Furthermore, grandparents seem to compensate for their lower MVPA levels during the actual care moment since no differences in MVPA levels were found at day level when compared to a day without grandchild care.

TRIAL REGISTRATION

clinicaltrials.gov, Identifier: NTC04307589. Registered March 2020.

The association between sedentary behaviour and sarcopenia in older adults: a systematic review and meta-analysis

BACKGROUND

Sedentary behaviour is considered to contribute to sarcopenia when combined with physical inactivity. Whether sedentary behaviour is independently associated with sarcopenia remains controversial. The aim of this study is to explore the association between sedentary behaviour and sarcopenia in older adults in community and long-term care facility settings.

METHODS

Eight electronic databases including MEDLINE, PsycINFO, Wanfang were searched from inception until August 2023. The review included cross-sectional and longitudinal studies concerning the association between sedentary behaviour and sarcopenia among participants over 60 years old. Evidence was pooled by both random-effects meta-analysis and narrative synthesis. Subgroup analyses explored variation according to adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. Quality assessment for individual studies was performed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

RESULTS

Seventeen articles (16 cross-sectional studies and 1 longitudinal study) of 25,788 participants from community or long-term care facility settings were included. The overall quality of the included studies was rated high. Meta-analysis of 14 cross-sectional studies showed that sedentary behaviour was independently positively associated with sarcopenia: pooled odd ratio 1.36 (95% confidence interval, 1.18-1.58). The independent positive association remained in subgroup analyses by adjustment of physical activity, settings, and measurements of sedentary behaviour and sarcopenia. The narrative analysis corroborated the findings of the meta-analysis and provided additional evidence suggesting that interruptions in sedentary periods were linked to a decreased likelihood of developing sarcopenia.

CONCLUSIONS

The findings support the hypothesis that sedentary behaviour is independently positively associated with sarcopenia in older adults, providing vital indications for the development of strategies to prevent sarcopenia.

SYSTEMATIC REVIEW REGISTRATION

The systematic review protocol has been registered with the PROSPERO database (CRD42022311399).

Enhancing health outcomes for Māori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study

Background

The study offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumātua (Māori elders) and kaumātua service providers. The study aims to identify the baseline characteristics, along with correlates of five key outcomes.

Methods

The study design is a cross-sectional survey. A total of 75 kaumātua from six providers completed two physical functioning tests and a survey that included dependent variables based in a holistic model of health: health-related quality of life (HRQOL), self-rated health, spirituality, life satisfaction, and loneliness.

Results

The findings indicate that there was good reliability and moderate scores on most variables. Specific correlates included the following: (a) HRQOL: emotional support (β = 0.31), and frequent interaction with a co-participant (β = 0.25); (b) self-rated health: frequency of moderate exercise (β = 0.32) and sense of purpose (β = 0.27); (c) spirituality: sense of purpose (β = 0.46), not needing additional help with daily tasks (β = 0.28), and level of confidence with cultural practices (β = 0.20); (d) life satisfaction: sense of purpose (β = 0.57), frequency of interaction with a co-participant (β = -0.30), emotional support (β = 0.25), and quality of relationship with a co-participant (β = 0.16); and (e) lower loneliness: emotional support (β = 0.27), enjoyment interacting with a co-participant (β = 0.25), sense of purpose (β = 0.24), not needing additional help with daily tasks (β = 0.28), and frequency of moderate exercise (β = 0.18).

Conclusion

This study provides the baseline scores and correlates of important social and health outcomes for the He Huarahi Tautoko (Avenue of Support) programme, a strengths-based approach for enhancing cultural connection and physical activity.

Longitudinal associations of physical activity with inflammatory markers in US adults with and without type 1 diabetes

AIMS

To investigate the longitudinal associations of different levels of moderate-to-vigorous physical activity (MVPA) with C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen.

METHODS

We conducted longitudinal analyses with data from the Coronary Artery Calcification in T1D (CACTI) cohort, which included individuals with type 1 diabetes (T1D, n = 563) and without diabetes mellitus (non-DM, n = 692) with ∼ 3 years follow-up. Individuals were divided into groups to perform two analyses: 1) those who performed any MVPA and those who were sedentary (0 mins/week) and 2) those who performed 1-149 mins/week, ≥150 mins/week, or who were sedentary. Mixed effect models with an unstructured covariance structure were applied.

RESULTS

Compared to sedentary individuals, any MVPA was associated with a -2.96 % decrease in fibrinogen (p-value = 0.0043) and a -11.23 % decrease in PAI-1 (p-value = 0.0007) in combined analyses. Stratified analyses found 1-149 mins/week and ≥ 150 mins/week were associated with significant decreases in fibrinogen, -5.31 % and -3.44 %, respectively, in those with T1D. Both the non-DM and T1D groups had significant decreases in PAI-1 associated with ≥ 150 mins/week (-9.11 % and -16.96 %, respectively).

CONCLUSIONS

Our findings highlight that meeting ≥ 150 mins/week of MVPA is inversely associated with inflammatory markers linked with increased CVD risk.

Role of leisure sedentary behavior on type 2 diabetes and glycemic homeostasis: a Mendelian randomization analysis

Purpose

Utilize Mendelian randomization (MR) to examine the impact of leisure sedentary behavior (LSB) on the prevalence of type 2 diabetes mellitus (T2D) and glycemic homeostasis impairment, as well as to identify potential mediating pathways involved in these associations.

Methods

We chose genetic variants linked to LSB from a large genome-wide association study (GWAS) to use as instrumental variables (IVs). Then, we used a two-sample MR study to investigate the link between LSB and T2D and glycemic homeostasis. Multivariate MR (MVMR) and mediation analysis were also used to look at possible mediating paths.

Results

MR analysis showed a genetical link between leisure TV watching and T2D (OR 1.64, 95% CI 1.39-1.93, P< 0.001) and impaired Glycemic Homeostasis, while leisure computer use seemed to protect against T2D prevalence (OR 0.65, 95% CI 0.50-0.84, P< 0.001). It was found that leisure TV watching increases the risk of T2D through higher BMI (mediation effect 0.23, 95% CI 0.11-0.35, P< 0.001), higher triglycerides (mediation effect 0.07, 95% CI 0.04-0.11, P< 0.001), and less education (mediation effect 0.16, 95% CI 0.08-0.24, P< 0.001). Sensitivity and heterogeneity analyses further substantiated the robustness of these findings. Reverse MR analysis did not yield significant results.

Conclusion

This study shows LSB is linked to a higher rate of T2D and impaired glycemic homeostasis through obesity, lipid metabolism disorders, and reduced educational attainment.

[Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?]

BACKGROUND

The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes.

OBJECTIVE

The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6‑month follow-up and to determine which factors are associated with these changes.

MATERIAL AND METHODS

This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6‑month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression.

RESULTS

The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance.

CONCLUSION

The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).

Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study

BACKGROUND

Given the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults.

METHODS

Data from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes.

RESULTS

Among the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time.

CONCLUSIONS

Regardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.

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.

Associations of Mutually Exclusive Categories of Physical Activity and Sedentary Behavior with Body Composition and Fall Risk in Older Women: A Cross-Sectional Study

The individual effects of physical activity (PA) and sedentary behavior (SB) on health are well-recognized. However, little is known about the extent to which different combinations of these behaviors are associated with body composition and fall risk in older adults. This cross-sectional study examined the associations of mutually exclusive categories of PA and SB with body composition and fall risk in older women. Accelerometer-measured PA, body composition and fall risk (static and dynamic balance) parameters were assessed among 94 community-dwelling older women. The participants were categorized into four groups: active-low sedentary, active-high sedentary, inactive-low sedentary and inactive-high sedentary (active: ≥150 min/week moderate-to-vigorous PA (MVPA); low sedentary: lowest tertile of SB and light PA ratio). Compared to the inactive-high sedentary group, more favorable body composition and dynamic balance results were found in the active-low sedentary (body fat mass index (BFMI): β = -4.37, p = 0.002; skeletal muscle mass index (SMI): β = 1.23, p = 0.017; appendicular lean mass index (ALMI): β = 1.89, p = 0.003; appendicular fat mass index (AFMI): β = -2.19, p = 0.003; sit-to-stand: β = 4.52, p = 0.014) and inactive-low sedentary (BFMI: β = -3.14, p = 0.007; SMI: β = 1.05, p = 0.014; AFMI: β = -1.74, p = 0.005, sit-to-stand: β = 3.28, p = 0.034) groups. Our results suggest that PA programs focusing on concurrently achieving sufficient MVPA and reduced SB might promote a healthy body composition and reduced fall risk among older adults.

Daily step volume and intensity moderate the association of sedentary time and cardiometabolic disease risk in community-dwelling older adults: A cross-sectional study

OBJECTIVE

To investigate the moderating effect of step count and peak cadence on the relationship of sedentary time and cardiometabolic disease risk in community-dwelling older adults.

METHODS

This cross-sectional study included 248 older adults aged 60-80 years without cardiovascular disease (66.0 ± 4.6 years of age; 78 % females). Sedentary time, step count and peak cadence were measured by a hip-worn accelerometer for seven days. Peak cadence was defined as the average of 30 min of the day (but not necessarily consecutive) with the highest cadence (steps per minute) for all valid days. Cardiometabolic disease risk was defined using a sex-specific continuous metabolic syndrome score (cMetS). Sedentary time was used as an explanatory variable for cMetS and step count and peak cadence as moderators. The analyses were adjusted for known cardiometabolic disease risk factors and accelerometer wear time. The Johnson-Neyman technique was used to specify the value of moderator variables at which the significant relationship between sedentary time and cMetS disappears.

RESULTS

Both step count (β = -0.186, P = 0.032) and peak cadence (β = -0.003, P = 0.007) showed a moderating effect on the relationship of sedentary time and cMetS. The association of sedentary time and cMetS was not statistically significant (p > 0.05) when step count or peak cadence exceed 5715 steps per day and 57 steps per minute, respectively.

CONCLUSION

Steps per day and peak cadence moderate the association of sedentary time and cardiometabolic disease risk in older adults. Therefore, steps per day and peak cadence seem to offset the deleterious effects of sedentary time on cardiometabolic health in this population.

Sedentary Behavior and Lower-Extremity Physical Function across the Lifespan of Adults with Multiple Sclerosis

One outcome of aging with multiple sclerosis (MS) involves the decline in physical function, including compromised balance, reduced walking speed, and lower-extremity strength. Sedentary behavior, the other end of the activity continuum, may be targeted for improvements in physical function among adults with MS, but less is known about the relationship between sedentary behavior and physical function with increasing age in MS. This study examined the associations between device-measured volume and pattern of sedentary behavior and physical function based on SPPB (Short Physical Performance Battery) of ambulatory persons with MS across the lifespan. We categorized participants (N = 216) into young (20-39 years), middle-aged (40-59 years), and older (60-79 years) age groups. Participants completed the SPPB during a single visit to the laboratory and wore an accelerometer for a 7-day period. The one-way analysis of variance indicated no differences in volume and pattern of sedentary behavior among the three age groups, except for average sedentary bout length. Spearman bivariate correlations indicated that pattern, but not volume, of sedentary behavior was associated with physical function in young, middle-aged, and older adults, and the magnitude of these associations varied by age group. Future interventions may reduce and break up prolonged periods of sedentary behavior for improvements in physical function and possibly other consequences in persons with MS.

Preliminary User Evaluation of a Physical Activity Smartphone App for Older Adults

Objectives

Mobile health (mHealth) delivered through smartphone apps is a viable means of improving health behaviors. Technologies can be strengthened and made more age-inclusive by involving older adults as co-designers, resulting in more accessible and effective products. This study's purpose is to describe preliminary acceptability and feasibility of a physical activity (PA) app tailored to underactive older people.

Methods

Moving Up is a multi-feature app designed to increase PA and reduce sedentary behaviors in underactive older adults. The suite houses a core activity tracker and three add-on features that target correlates of inactivity: sedentary behavior, stereotypes about aging, and PA knowledge and routines. Three groups of 4-5 older adult smartphone owners were provided with and oriented to the Moving Up app activity tracker and one add-on feature. Participants beta-tested the app for two weeks, after which each cohort reconvened to discuss experiences, make recommendations for app improvements, and complete a usability questionnaire on their assigned feature.

Results

Thirteen participants (median age, 71 years; iOS users, n=8; females, n=12) completed the beta-testing period and returned for follow-up. Reported usability was moderate across the features. Sentiments about app content and general impressions were mainly positive, although users made several recommendations for app improvements such as more individualized messaging and timely notifications.

Conclusions

A PA app for older adults demonstrated generally good usability and acceptability. Integrating the impressions and recommendations from older adults into the design of mHealth tools will enhance overall usability and likelihood to positively influence PA behaviors long-term.

Symptoms of depression are related to sedentary behavior and sleep duration in elderly individuals: A cross-sectional study of 49,317 older Chinese adults

OBJECTIVE

Depression is a common mental disorder in older adults. This study aimed to determine the incidence of depression and the relationship between sedentary behavior and sleep duration in elderly individuals.

METHOD

A total of 49,317 elderly adults from eight health centers in six Chinese provinces completed an online self-reported health questionnaire. Logistic regression was used to explore the association between sedentary behavior, sleep duration, and depression symptoms.

RESULTS

Symptoms of depression were present in 20.1% of older adults. Sedentary behaviors for >6 h/day (OR = 3.16; 95% CI: 2.90-3.44; p < 0.001) were a greater risk factor for depressive symptoms in older adults than sedentary behaviors for less than 3 h/day. Elderly individuals with short sleep durations (<7 h/day) were more likely to experience depression (OR = 2.20; 95% CI: 2.07-2.34; p < 0.001).

CONCLUSION

This study suggested that sedentary behavior and short sleep duration in older Chinese adults are associated with depressive symptoms. In China, further improvement of the mental health and lifestyle of elderly individuals may be warranted.

Role of Cardiovascular Risk Factors on the Association Between Physical Activity and Brain Integrity Markers in Older Adults

BACKGROUND AND OBJECTIVES

Physical activity has been associated with a decreased risk for dementia, but the mechanisms underlying this association remain to be determined. Our objective was to assess whether cardiovascular risk factors mediate the association between physical activity and brain integrity markers in older adults.

METHODS

At baseline, participants from the Age-Well study completed a physical activity questionnaire and underwent cardiovascular risk factors collection (systolic blood pressure, body mass index [BMI], current smoker status, and high-density lipoprotein cholesterol, total cholesterol, and insulin levels) and multimodal neuroimaging (structural MRI, diffusion MRI, FDG-PET, and florbetapir PET). Multiple regressions were conducted to assess the association among physical activity, cardiovascular risk factors, and neuroimaging. Mediation analyses were performed to test whether cardiovascular risk factors mediated the associations between physical activity and neuroimaging.

RESULTS

A total of 134 cognitively unimpaired older adults (≥65 years) were included. Higher physical activity was associated with higher gray matter (GM) volume (β = 0.174, p = 0.030) and cerebral glucose metabolism (β = 0.247, p = 0.019) but not with amyloid deposition or white matter integrity. Higher physical activity was associated with lower insulin level and BMI but not with the other cardiovascular risk factors. Lower insulin level and BMI were related to higher GM volume but not to cerebral glucose metabolism. When controlling for insulin level and BMI, the association between physical activity and cerebral glucose metabolism remained unchanged, while the association with GM volume was lost. When insulin level and BMI were entered in the same model, only BMI remained a significant predictor of GM volume. Mediation analyses confirmed that insulin level and BMI mediated the association between physical activity and GM volume. Analyses were replicated within Alzheimer disease-sensitive regions and results remained overall similar.

DISCUSSION

The association between physical activity and GM volume is mediated by changes in insulin level and BMI. In contrast, the association with cerebral glucose metabolism seems to be independent from cardiovascular risk factors. Older adults engaging in physical activity experience cardiovascular benefits through the maintenance of a lower BMI and insulin level, resulting in greater structural brain integrity. This study has implications for understanding how physical activity affects brain health and may help in developing strategies to prevent or delay age-related decline.

TRIAL REGISTRATION INFORMATION

EudraCT: 2016-002,441-36; IDRCB: 2016-A01767-44; ClinicalTrials.gov Identifier: NCT02977819.

The impact of lockdown caused by the COVID-19 pandemic on glycemic control in patients with diabetes

PURPOSE

The aim the study was to assess the impact of the lockdown due to COVID-19 on diabetes control.

METHODS

The HbA1c value from a pre-lockdown visit (V1) from patients with diabetes was compared to the lockdown visit one (V2) after 3-5 months of its duration. Additional information on how the HbA1c changed and which variables can modify HbA1c during lockdown was also studied.

RESULTS

Records from 65 patients (type 2 diabetes -96,9%) were eligible and revealed that: HbA1c was at the target in 60% of the patients at V2 compared to 40% at V1; HbA1c decreased and normalized in 19, but worsened in 4 participants during the lockdown. No impact on HbA1c of: sex, age, diabetes duration, therapy type and modification before the pandemic, abandonment of the treatment, previous problems with glycemic control, or change in body weight and physical activity during the lockdown, was found. The previous macrovascular complications were the only variable that affected the increase in HbA1c (p = 0.0072), OR = 5.33.

CONCLUSIONS

The COVID-19 pandemic has not revealed worsened glycemic control in patients with type 2 diabetes, in general. The patients with macrovascular complications turned out to be at risk of the harmful impact of the restrictions on the HbA1c.

mHealth-Supported Interventions With Potential to Address Sedentary Behavior in Older Adults: A Scoping Review

Sedentary behavior (SB) is an independent risk for negative health outcomes in older adults. Mobile health (mHealth) technology has potential to address SB in this population. This scoping review aimed to describe, synthesize, and identify gaps in literature on mHealth-supported interventions with potential to reduce sedentariness in older people. Following an iterative search of five major databases, 13 studies were included in the final review. Only three papers described SB-related factors as the primary target of intervention. mHealth-Driven components were frequently paired with nonmobile approaches and aided self-regulation of physical activity as opposed to SB. Most SB-related outcomes were not statistically significant or were inconclusive. This scoping review revealed a paucity of research applying mHealth-supported approaches to directly overcome sedentariness in older people. Protocol studies included in the review provide evidence that efforts to address this research gap continue to be made, but the need for additional high-quality research remains.

Association Between Occupational Sitting With High Sensitivity C-Reactive Protein: The Jackson Heart Study

Modifiable, behavioral risk factors like occupational sitting may contribute to inflammation, an important cardiovascular risk factor. This study evaluated the association of self-reported occupational sitting with changes in c-reactive protein (CRP) and the role of sex. We examined occupational sitting and baseline CRP levels for 2889 African American participants in the Jackson Heart Study. Four multivariable linear regression models were estimated to determine the association of occupational sitting and CRP. Analyses were conducted in 2020. The mean age was 50.8 years and 61% were female. Participants who reported occupational sitting as “often/always” had CRP levels of 4.9±6.8 mg/L, “sometimes” had levels of 4.8±8.1 mg/L, and “never/seldom” had levels of 4.3±6.8 mg/L. In the unadjusted model, “often/always” engaging in occupational sitting was significantly associated with higher levels of CRP when compared to “never/seldom” ( P < .05). This differed by sex with female participants who reported “often/always” occupational sitting had CRP levels of 6.0±7.6 mg/L compared to only 5.1±6.9 mg/L for “never/seldom.” Neither the overall association nor the female-specific association remained statistically significant in the adjusted models. We found an association between occupational sitting and inflammation, measured by CRP. This association varied by sex but did not remain significant after fully adjusting for covariates.

Association of Self-Reported and Device-Measured Sedentary Behaviour and Physical Activity with Health-Related Quality of Life among European Older Adults

Human movement behaviours such as physical activity (PA) and sedentary behaviour (SB) during waking time have a significant impact on health-related quality of life (HRQoL) in older adults. In this study, we aimed to analyse the association between self-reported and device-measured SB and PA with HRQoL in a cohort of community-dwelling older adults from four European countries. A subsample of 1193 participants from the SITLESS trial (61% women and 75.1 ± 6.2 years old) were included in the analysis. The association between self-reported and objective measures of SB and PA with HRQoL were quantified using Spearman’s Rho coefficients. The strength of the associations between self-reported and device-measured PA and SB with self-rated HRQoL (mental composite score, MCS; physical composite score, PCS) were assessed through multivariate multiple regression analysis. Self-reported and device-measured PA and SB levels showed significant but poor associations with PCS (p < 0.05). The association with MCS was only significant but poor with self-reported light PA (LPA) and moderate-to-vigorous PA (MVPA). In conclusion, the findings of this study suggest that both self-reported and device-measured PA of all intensities were positively and significantly associated, while SB was negatively and significantly associated with the PCS of the SF-12.

How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults?

Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.

An intervention to increase physical activity in care home residents: results of a cluster-randomised, controlled feasibility trial (the REACH trial)

BACKGROUND

Care home (CH) residents are mainly inactive, leading to increased dependency and low mood. Strategies to improve activity are required.

DESIGN AND SETTING

Cluster randomised controlled feasibility trial with embedded process and health economic evaluations. Twelve residential CHs in Yorkshire, United Kingdom, were randomised to the MoveMore intervention plus usual care (UC) (n = 5) or UC only (n = 7).

PARTICIPANTS

Permanent residents aged ≥65 years.

INTERVENTION

MoveMore: a whole home intervention involving all CH staff designed to encourage and support increase in movement of residents.

OBJECTIVES AND MEASUREMENTS

Feasibility objectives relating to recruitment, intervention delivery, data collection and follow-up and safety concerns informed the feasibility of progression to a definitive trial. Data collection at baseline, 3, 6 and 9 months included: participants' physical function and mobility, perceived health, mood, quality of life, cognitive impairment questionnaires; accelerometry; safety data; intervention implementation.

RESULTS

300 residents were screened; 153 were registered (62 MoveMore; 91 UC). Average cluster size: MoveMore: 12.4 CHs; UC: 13.0 CHs. There were no CH/resident withdrawals. Forty (26.1%) participants were unavailable for follow-up: 28 died (12 MoveMore; 16 UC); 12 moved from the CH. Staff informant/proxy data collection for participants was >80%; data collection from participants was <75%; at 9 months, 65.6% of residents provided valid accelerometer data; two CHs fully, two partially and one failed to implement the intervention. There were no safety concerns.

CONCLUSIONS

Recruiting CHs and residents was feasible. Intervention implementation and data collection methods need refinement before a definitive trial. There were no safety concerns.

Determinants of instrumented sedentary and physical activity behavior in geriatric rehabilitation inpatients: RESORT

BACKGROUND

Physical inactivity in hospitalized older adults is highly prevalent and associated with detrimental health outcomes. Understanding its determinants is important for prognosis and tailoring interventions in geriatric rehabilitation inpatients.

METHODS

Within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort, geriatric rehabilitation inpatients wore an inertial sensor (ActivPAL4) for one week to objectively assess instrumented sedentary behavior (i-SB) and physical activity (i-PA). Determinants were grouped in five geriatric domains: morbidity, cognition/psychology, physical performance, functional performance, and nutritional status. Their association with i-SB (mean sitting, lying, non-upright time) and i-PA (mean number of steps, sit-to-stand transitions and upright time) quintiles were examined using multivariate ordinal logistic regression analyses with Bonferroni correction (p < 0.006).

RESULTS

A total of 145 inpatients were included (mean age 83.0, SD 7.7 years; 55.9% females). More comorbidities were associated with a lower daily number of steps (OR:0.91, 95%CI: 0.86-0.96) and lower upright time (OR:0.93, 95%CI: 0.88-0.98). Depressive symptoms (higher Hospital Anxiety and Depression Scale score) were associated with higher non-upright time (OR: 1.12, 95%CI: 1.03-1.21) and lower upright time (OR: 0.89, 95%CI: 0.83-0.96). Better physical performance (higher Functional Ambulation Classification, gait speed, and Short Physical Performance Battery score) was associated with lower i-SB measures (OR range: 0.07-0.78, p < 0.0005) and higher i-PA measures (OR range: 1.35-19.50, p < 0.0005). Higher functional performance (Katz index of Activities of Daily Living score) was associated with lower i-SB measures (OR range: 0.61-0.69, p ≤ 0.003) and higher i-PA measures (OR range: 1.60-3.64, p < 0.0005). Being malnourished was associated with lower i-PA measures (OR range: 0.29-0.32, p ≤ 0.004).

CONCLUSIONS

Worse morbidity, depressive symptoms, worse physical and functional performance, and worse nutritional status were associated with higher i-SB and lower i-PA. These determinants should be taken into account while designing and promoting multidisciplinary physical activity interventions.

Balance in life as a prerequisite for community-dwelling older adults' sense of health and well-being after retirement: an interview-based study

Purpose

This study aimed to describe community-dwelling older adults’ perceptions of health and well-being in life after retirement.

Methods

This study is part of a larger project using a mixed-methods design to address lifestyles’ influence on community-dwelling older adults’ health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach.

Results

The results encompass four categories describing variations in community-dwelling older adults’ perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle.

Conclusions

The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for—and coached themselves to uphold—a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being.

Combined Physical Activity and Sitting Time Association on Older Adults' Body Mass Index: Cross-Sectional Findings From the Brazilian Longitudinal Study of Aging

This study examined isolated and combined associations of physical activity (PA) and sitting time (ST) with body mass index (BMI) among older Brazilian adults. We have analyzed baseline data of 8,177 participants aged 50 years and older from the Brazilian Longitudinal Study of Aging. Respondents were categorized into sufficient PA/low ST, sufficient PA/high ST, insufficient PA/low ST, or insufficient PA/high ST using the Short Version of International Physical Activity Questionnaire. Multinomial logistic regression analysis examined the associations of being underweight (BMI, <18 kg/m2), overweight (BMI, 25-29.9 kg/m2), and obese (BMI, ≥30 kg/m2) with PA and ST categories. High ST (≥165 min/day) was associated with overweight (odds ratio, 1.26; 95% confidence interval [1.11, 1.44]) and obesity (odds ratio, 1.43; 95% confidence interval [1.21, 1.70]). However, no association was observed between PA and BMI. Participants in the insufficient and sufficient PA/high ST categories were more likely to be obese after adjusting for sociodemographic and health condition. Our findings call for public health initiatives that consider reducing ST in older adults.

Accelerometer-measured physical activity and sedentary time are associated with maximal fat oxidation in young adults

The present work aimed to examine the association between physical activity (PA) and sedentary behaviour with maximal fat oxidation (MFO) in young individuals. A total of 77 active adults (30 women; 22.8 ± 4.5 years) were included in this cross-sectional study in which PA and sedentary behaviour were measured using accelerometers for 7 consecutive days. PA was classified into different intensities (i.e. light, moderate, vigorous, and moderate-to-vigorous) and sedentary behaviour into sedentary time (i.e. time, number of bouts, and length of bouts) and sedentary breaks (i.e. time, number of breaks, and length of breaks). MFO was determined using a graded cycloergometer test through indirect calorimetry and relativized to lean mass (MFO_LM) and lean leg mass (MFO_LL). Positive associations were found for light and vigorous PA in relation with MFO, MFO_LM and MFO_LL, independently of cofounders (P ≤ 0.01). Moreover, a negative association was found between MFO and MFO_LM and the length of sedentary bouts which was accentuated after adjusting by cardiorespiratory fitness (P ≤ 0.05). These results suggest that light and vigorous PA and sedentary behaviour are related to MFO during exercise. Despite this, further interventional studies are needed to clarify if increments of light and vigorous PA could enhance MFO in different populations.

Strategies to enhance routine physical activity in care home residents: the REACH research programme including a cluster feasibility RCT

Background

Care home residents are mainly inactive, leading to increased dependency and low mood. Although exercise classes may increase activity, a more sustainable model is to engage staff and residents in increasing routine activity.

Objectives

The objectives were to develop and preliminarily test strategies to enhance the routine physical activity of care home residents to improve their physical, psychological and social well-being through five overlapping workstreams.

Design

This trial had a mixed-methods research design to develop and test the feasibility of undertaking an evaluative study consisting of gaining an understanding of the opportunities for and barriers to enhancing physical activity in care homes (workstream 1); testing physical activity assessment instruments (workstream 2); developing an intervention through a process of intervention mapping (workstream 3); refining the provisional intervention in the care home setting and clarifying outcome measurement (workstream 4); and undertaking a cluster randomised feasibility trial of the intervention [introduced via three facilitated workshops at baseline (with physiotherapist input), 2 weeks (with artist input) and 2 months], with embedded process and health economic evaluations (workstream 5).

Setting

The trial was set in 12 residential care homes differing in size, location, ownership and provision in Yorkshire, UK.

Participants

The participants were elderly residents, carers, managers and staff of care homes.

Intervention

The intervention was MoveMore, designed for the whole home, to encourage and support the movement of residents in their daily routines.

Main outcome measures

The main outcome measures related to the feasibility and acceptability of implementing a full-scale trial in terms of recruitment and retention of care homes and residents, intervention delivery, completion and reporting of baseline data and outcomes (including hours of accelerometer wear, hours of sedentary behaviour and hours and type of physical activity), and safety and cost data (workstream 5).

Results

Workstream 1 – through a detailed understanding of life in a care home, a needs assessment was produced, and barriers to and facilitators of activity were identified. Key factors included ethos of care; organisation, management and delivery of care; use of space; and the residents’ daily routines. Workstream 2 – 22 (73.3%) out of 30 residents who wore a hip accelerometer had valid data (≥ 8 hours on ≥ 4 days of the week). Workstream 3 – practical mechanisms for increasing physical activity were developed, informed by an advisory group of stakeholders and outputs from workstreams 1 and 2, framed by the process of intervention mapping. Workstream 4 – action groups were convened in four care homes to refine the intervention, leading to further development of implementation strategies. The intervention, MoveMore, is a whole-home intervention involving engagement with a stakeholder group to implement a cyclical process of change to encourage and support the movement of residents in their daily routines. Workstream 5 – 12 care homes and 153 residents were recruited to the cluster randomised feasibility trial. Recruitment in the care homes varied (40–89%). Five care homes were randomised to the intervention and seven were randomised to usual care. Predetermined progression criteria were recruitment of care homes and residents (green); intervention delivery (amber); and data collection and follow-up – 52% of residents provided usable accelerometer data at 9 months (red), > 75% of residents had reported outcomes at 9 months (green, but self-reported resident outcomes were red), 26% loss of residents to follow-up at 9 months [just missing green criterion (no greater than 25%)] and safety concerns (green).

Limitations

Observations of residents’ movements were not conducted in private spaces. Working with care home residents to identify appropriate outcome measures was challenging. Take-up of the intervention was suboptimal in some sites. It was not possible to make a reliably informed decision on the most appropriate physical activity end point(s) for future use in a definitive trial.

Conclusions

A whole-home intervention was developed that was owned and delivered by staff and was informed by residents and staff. The feasibility of conducting a cluster randomised controlled trial was successfully tested: the target numbers of care homes and residents were recruited, demonstrating that it is possible to recruit care home residents to a cluster randomised trial, although this process was time-consuming and resource heavy. A large data set was collected, which provided a comprehensive picture of the environment, residents and staff in care homes. Extensive quantitative and qualitative work comprehensively explored a neglected area of health and social care research. Completion of ethnographic work in a range of settings enabled the production of an in-depth picture of life in care homes that will be helpful for other researchers considering organisational change in this setting.

Future work

The content and delivery of the intervention requires optimisation and the outcome measurement requires further refinement prior to undertaking a full trial evaluation. Consideration could be given to a recommended, simplified, core outcome set, which would facilitate data collection in this population.

Trial registration

Current Controlled Trials ISRCTN16076575.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grant for Applied Research programme and will be published in full in Programme Grant for Applied Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Association between accelerometer-measured physical activity, glucose metabolism, and waist circumference in older adults

AIMS

To examine the association of physical activity (PA) and sedentary time (ST) with glucose metabolism according to waist circumference (WC) in older people.

METHODS

A population-based sample of 702 individuals (aged 67-70 years) wore wrist-worn accelerometers for two weeks and underwent an oral glucose tolerance test. The associations between moderate-to-vigorous (MVPA) and light (LPA) PA, ST, and glucose metabolism across the tertiles of WC were analysed using general linear regression.

RESULTS

Among highest WC tertile, LPA negatively associated with fasting insulin (β =  - 0.047, 95% CI - 0.082 to - 0.012), HOMA-IR (β =  - 0.098, 95% CI - 0.184 to - 0.012), and HOMA-β (β =  - 3.367, CI - 6.570 to - 0.783). ST associated with 120 min glucose (β = 0.140, CI 0.021 to 0.260). Among lowest WC tertile, MVPA negatively associated with 30 min insulin (β =  - 0.086, 95% CI - 0.168 to - 0.004) and 120 min insulin (β =  - 0.160, 95% CI - 0.257 to - 0.063) and positively associated with Matsuda index (β = 0.076, 95% CI 0.014 to 0.139). Light PA negatively associated with 120 min insulin (β =  - 0.054, 95% CI - 0.104 to - 0.005).

CONCLUSION

With the limitation of the cross-sectional study, reducing ST and increasing LPA may be beneficial for glucose metabolism among abdominally obese older adults. Lean older adults could benefit more from increasing MVPA.

Recent Trends in Sedentary Time: A Systematic Literature Review

This paper systematically reviews and synthesizes the relevant literature on sedentary time research. A bibliometric analysis was conducted to evaluate the publications from 2010 to 2020 in the Web of Science (WoS) core collection database. Derwent Data Analyzer software was used for the cleaning, mining, and visualization of the data. Historical trends of the topics, main contributors, leading countries, leading institutions, leading research areas, and journals were explored. A total of 3020 publications were studied. The United States, the United Kingdom, and Australia are the three most productive countries. The Australian institution Baker Heart and Diabetes Institute led the list of productive institutions, and Ekelund U published the most papers. Sedentary time raised the concerns of scholars from 106 research areas, and public health was the dominant field. Physical activity, accelerometer, children, and obesity were the most frequently used keywords. The findings suggest that sedentary time is rapidly emerging as a global issue that has detrimental effects on public health. The hotspots shifted in the past 10 years, and COVID-19 was the most popular topic of sedentary time research.

A qualitative study of sedentary behaviours in stroke survivors: non-participant observations and interviews with stroke service staff in stroke units and community services

PURPOSE

Sedentary behaviour (SB) is associated with negative health outcomes and is prevalent post-stroke. This study explored SB after stroke from the perspective of stroke service staff.

METHODS

Qualitative mixed-methods study. Non-participant observations in two stroke services (England/Scotland) and semi-structured interviews with staff underpinned by the COM-B model of behaviour change. Observations were analysed thematically; interviews were analysed using the Framework approach.

RESULTS

One hundred and thirty-two observation hours (October - December 2017), and 31 staff interviewed (January -June 2018). Four themes were identified: (1) Opportunities for staff to support stroke survivors to reduce SB; (2) Physical and psychological capability of staff to support stroke survivors to reduce SB; (3) Motivating factors influencing staff behaviour to support stroke survivors to reduce SB; (4) Staff suggestions for a future intervention to support stroke survivors to reduce SB.

CONCLUSIONS

Staff are aware of the consequences of prolonged sitting but did not relate to SB. Explicit knowledge of SB was limited. Staff need training to support stroke survivors to reduce SB. Sedentary behaviour in the community was not reported to change markedly, highlighting the need to engage stroke survivors in movement from when capable in hospital, following through to home.Implications for rehabilitationStroke survivor sedentary behaviour is influenced, directly and indirectly, by the actions and instructions of stroke service staff in the inpatient and community setting.The built and social environment, both in the inpatient and community settings, may limit opportunities for safe movement and can result in stroke survivors spending more time sedentary.Stroke service staff appreciate the benefit of encouraging stroke survivors to stand and move more, if it is safe for them to do so.Staff would be amenable to encourage stroke survivors to reduce sedentary behaviour, provided they have the knowledge and resources to equip them to support this.

Stationary Behavior and the Step-Defined Sedentary Lifestyle Index in Older Adults After Total Knee Arthroplasty

OBJECTIVES

To measure stationary behavior in a cohort of older adults after total knee arthroplasty (TKA) and determine the clinical utility of the step-defined sedentary lifestyle index (SLI) as a measure of stationary behavior after TKA.

DESIGN

Cross-sectional measurement study.

SETTING

Participants were recruited from a community intake clinic for hip and knee surgeries.

PARTICIPANTS

Sixty-five older adults 3 months after TKA (N=65).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Stationary behaviors, including stationary time, stationary bouts, breaks from stationary time, and the proportion of participants meeting the SLI, were measured in older adults 3 months post TKA using accelerometry. A 2-way analysis of variance test (α=0.05) was conducted to determine the effects of SLI (<5000 or ≥5000 daily steps) and possible interactions with sex on stationary behavior.

RESULTS

Participants spent 80% (13.17±2.3h) of their waking time in stationary time and had an average of 6.06 bouts of stationary time >30 minutes per day. Forty (61.5%) of the participants fell below the SLI of 5000 steps/d. SLI had significant effects on both waking stationary time (P<.001) and number of breaks in stationary time (P<.001), with participants taking <5000 daily steps having longer stationary times and fewer breaks in stationary time. Sex had a significant effect on the number of breaks in stationary time (P=.04), with men (n=23, 35%) reporting more breaks than women (n=42, 65%) (mean difference 13.36; 95% confidence interval, -2.67 to 18.69). No interactions were found between SLI and sex.

CONCLUSIONS

Both women and men had high levels of stationary behavior 3 months post TKA. The SLI discriminated waking stationary time and breaks in stationary time and may have clinical utility in measurement of stationary behavior.

Enhancing oxygenation of patients with coronavirus disease 2019: Effects on immunity and other health-related conditions

Coronavirus disease 2019 (COVID-19) distresses the pulmonary system causing acute respiratory distress syndrome, which might lead to death. There is no cure for COVID-19 infection. COVID-19 is a self-limited infection, and the methods that can enhance immunity are strongly required. Enhancing oxygenation is one safe and effective intervention to enhance immunity and pulmonary functions. This review deliberates the probable influences of enhancing oxygenation on immunity and other health-connected conditions in patients with COVID-19. An extensive search was conducted through Web of Science, Scopus, Medline databases, and EBSCO for the influence of enhancing oxygenation on immunity, pulmonary functions, psycho-immune hormones, and COVID-19 risk factors. This search included clinical trials and literature and systematic reviews. This search revealed that enhancing oxygenation has a strong effect on improving immunity and pulmonary functions and psycho-immune hormones. Also, enhancing oxygenation has a self-protective role counter to COVID-19 risk factors. Lastly, this search revealed the recommended safe and effective exercise protocol to enhance oxygenation in patients with COVID-19. Enhancing oxygenation should be involved in managing patients with COVID-19 because of its significant effects on immunity, pulmonary functions, and COVID-19 risk factors. A mild to moderate cycling or walking with 60%-80% Vo2max for 20-60 min performed 2-3 times per week could be a safe and effective aerobic exercise program in patients with COVID-19 to enhance their immunity and pulmonary functions.

Saving lives through life-threatening measures? The COVID-19 paradox of infection prevention in long-term care facilities

The current SARS Cov-2 infection control measures have paradoxical effects. On the one hand, the lockdown measures help to protect vulnerable populations in particular. On the other hand, these measures inevitably have the effect that those who are to be protected not only become socially isolated and are exposed to enormous psychological stress, but also break down physically due to inactivity. Thus, the activation that is omitted in the lockdown is not compensated by external reference groups, which also indicates that important conditions for healthy ageing are not given in long-term care facilities.

Residential Street Block Disorder and Biological Markers of Aging in Older Adults: The National Health and Aging Trends Study

BACKGROUND

Residential environments are associated with older adult health, but underlying physiologic causal mechanisms are not well understood. As adults age, street blocks are likely more relevant to their health than the larger neighborhood environment. This study examined the effects of adverse street block conditions on aging biomarkers among older adults.

METHODS

We included community-dwelling Medicare beneficiaries aged 67 and older with 2017 biomarker data from the nationally representative National Health and Aging Trends Study (n=4,357). Street block disorder in 2016 was measured using interviewer report of any trash/glass/litter, graffiti, or vacant buildings on participants' blocks. Propensity score models were used to create balanced groups with regard to multiple 2015 participant characteristics, including demographic, socioeconomic, residence, and early life characteristics. Linear regressions modeled street block disorder as a predictor of four aging biomarkers, hemoglobin A1C, high-sensitivity C-reactive protein, interleukin-6, and cytomegalovirus antibodies, before and after applying propensity score weighting.

RESULTS

Adjusting for participant sociodemographic characteristics and applying propensity score weights, living on a block with any disorder was associated with 2% higher mean hemoglobin A1C levels (95% CI: 0.002-0.03), 13% higher C-reactive protein (95% CI: 0.03-0.23), 10% higher interleukin-6 (95% CI: 0.02-0.19), and 19% more cytomegalovirus antibodies (95% CI: 0.09-0.29) compared to living on a block with no disorder.

CONCLUSIONS

Street block disorder predicted subsequent aging biomarkers after applying a propensity score approach to account for confounding among a national sample of older adults. Targeting street-level residential contexts for intervention may reduce risk for poor health in older adults.

Associations of Sedentary Patterns with Cardiometabolic Biomarkers in Physically Active Young Males

PURPOSE

Sitting time (ST) is a serious global health issue and positively associated with cardiometabolic disease. The present study investigated associations between objectively measured ST, sedentary patterns, and cardiometabolic biomarkers in physically active young males.

METHODS

Cross-sectional analysis was completed in 94 males 18-35 yr of age. Total ST, prolonged sedentary bouts (≥30 min with no interruption), and sedentary breaks (transitions from sitting/lying to standing/stepping) were assessed using activPAL. Lipids, insulin, C-peptide, C-reactive protein (CRP), vascular cellular adhesion molecule-1, intercellular adhesion molecule 1, E-selectin, P-selectin, leptin, resistin, and adiponectin were measured using assay kits. The expression of specific proteins related to endothelial dysfunction was determined using quantitative real-time polymerase chain reaction. Associations between total ST, prolonged sedentary bouts, and sedentary breaks with cardiometabolic biomarkers and total ST and levels of gene expression were assessed using generalized linear models.

RESULTS

Total ST was significantly associated with triglycerides (B = 1.814), insulin (B = 2.117), homeostasis model assessment of insulin resistance (B = 0.071), and E-selectin (B = 2.052). Leptin (B = 0.086), E-selectin (B = 1.623), and P-selectin (B = 2.519) were significantly associated with prolonged sedentary bouts, whereas leptin (B = -0.017) and CRP (B = -0.016) were associated with sedentary breaks. After adjustment for moderate to vigorous physical activity, the associations between triglycerides (B = 2.048) and total ST, and between CRP (B = -0.016) and sedentary breaks, remained significant. E-selectin mRNA levels (B = 0.0002) were positively associated with ST with or without adjustment for moderate to vigorous physical activity.

CONCLUSIONS

Total ST and prolonged sedentary bouts were positively associated with several cardiometabolic biomarkers, with interruptions in ST potentially contributing to reduced cardiometabolic risk in physically active young male adults.

Accelerometer-Measured Sedentary and Physical Activity Time and Their Correlates in European Older Adults: The SITLESS Study

Background

Sedentary behavior (SB) and physical activity (PA) are important determinants of health in older adults. This study aimed to describe the composition of accelerometer-measured SB and PA in older adults, to explore self-reported context-specific SB, and to assess sociodemographic and functional correlates of engaging in higher levels of SB in participants of a multicenter study including four European countries.

Method

One thousand three hundred and sixty community-dwelling older adults from the SITLESS study (61.8% women; 75.3 ± 6.3 years) completed a self-reported SB questionnaire and wore an ActiGraph accelerometer for 7 days. Accelerometer-determined compositional descriptive statistics were calculated. A fixed-effects regression analysis was conducted to assess the sociodemographic (country, age, sex, civil status, education, and medications) and functional (body mass index and gait speed) correlates.

Results

Older adults spent 78.8% of waking time in SB, 18.6% in light-intensity PA, and 2.6% in moderate-to-vigorous PA. Accelerometry showed that women engaged in more light-intensity PA and walking and men engaged in higher amounts of moderate-to-vigorous PA. Watching television and reading accounted for 47.2% of waking time. Older age, being a man, single, taking more medications, being obese and overweight, and having a slower gait speed were statistically significant correlates of more sedentary time.

Conclusions

The high amount of SB of our participants justifies the need to develop and evaluate interventions to reduce sitting time. A clinically relevant change in gait speed can decrease almost 0.45 percentage points of sedentary time. The distribution of context-specific sedentary activities by country and sex showed minor differences, albeit worth noting.

Sedentary Patterns and Systemic Inflammation: Sex-Specific Links in Older Adults

The study aimed to examine sex-specific associations between objectively measured sedentary patterns and pro- and anti-inflammatory biomarkers in older adults when considering the moderating impact of physical activity (PA). Accelerometer-based monitoring of sedentary patterns and PA was conducted in a population of older men (n = 83; age: 67.4 ± 1.5; height: 178.7 ± 6.6 cm; weight: 80.9 ± 10.6 kg) and women (n = 146; age: 67.4 ± 1.6; height: 164.2 ± 6.1 cm; weight: 64.6 ± 10.1 kg) aged 65-70. Blood samples were collected for the assessment of the inflammatory biomarkers C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), IL-10, IL-18, and monocyte chemoattractant protein-1 (MCP-1). Data were analyzed using multiple linear regression models. Total and bouts of ≥10 min of sedentary time were inversely associated with the anti-inflammatory marker IL-10 in older men (accumulated sedentary time: β = -0.116; bouts: β = -0.099; all p < 0.05). Associations were independent of moderate-to-vigorous physical activity (MVPA) and total PA volume. In women, total and bouts of ≥10 min of sedentary time were detrimentally associated with the pro-inflammatory marker fibrinogen (accumulated sedentary time: β = -0.130; bouts: β = -0.085; all p < 0.05). Associations remained between accumulated sedentary time and fibrinogen when adjusting for MVPA and total PA volume. This study highlights sex-specific routes by which sedentary patterns impact on pro- and anti-inflammatory biomarkers in older adults. The findings support efforts to promote accumulation of time spent in PA at the expense of time in sedentary pursuits on low-grade inflammation in older men and women.

Reliability of ActiGraph GT3X+ placement location in the estimation of energy expenditure during moderate and high-intensity physical activities in young and older adults

WHO defines physical activity (PA) as any bodily movement produced by skeletal muscles that requires energy expenditure (EE). The purpose of this study was to compare the EE estimations by ActiGraph GT3X+ with a gold standard measurement, the portable gas analyser in a set of 3 different PAs. This cross-sectional study involved 56 participants, age range (years, [min, max]: young people [20, 33], older adults [65, 83]). Participants completed a single session of three experimental PAs including biking, treadmill walking, and treadmill running. Each participant wore five GT3X+ triaxial accelerometers and a portable gas analyser used as the gold standard measurement. The GT3X+ were placed on the wrists, the waist (centred at the pelvis), and the ankles. ActiGraph GT3X+ and MetaMax3B records were investigated through intraclass correlation coefficient. Magnitude of measurement error was estimated using Effect Size. The GT3X+ wrist and GT3X+ waist underestimated EE regardless of the PA type. The GT3X+ ankles strongly overestimated EE during biking (mean bias = 489 ± 392%) and walking (mean bias = 106 ± 58%), while it underestimated EE during running (mean bias = -47 ± 27%). The ActiGraph GT3X+ does not provide accurate EE estimates across a range of placement locations during moderate and high-intensity PA.

Interactions Between Diet, Physical Activity, and the Sociocultural Environment for Older Adult Health in the Urban Subarctic

This study sought to examine the relationship between the sociocultural factors that shape diet, physical activity, and nutritional status outcomes among seniors in Anchorage, Alaska. Alaskan seniors are an ideal study population because the state has the fastest growing senior population in the United States. Since much health research in the circumpolar north focuses on the influence of the economic or rural environment on nutrition, there is a need to investigate the ways social relationships shape diet, physical activity patterns, and nutritional status in urban spaces. This cross-sectional study included 82 community-living men and women (mean age = 74 years) in Anchorage. Participants underwent anthropometric measurements and completed questionnaires on their dietary intake, physical activity, and the sociocultural influences on their diet and exercise practices. T-tests indicate that diet and physical activity practices in this sample do not meet national recommendations and that diet differs adversely from national reference samples. Mann-Whitney U tests indicate the media and friends are associated with increases in energy expenditure. Family influences increased fruit consumption, while participation in cultural and social events increased intake of fats and sweets. Reaching older adults through a variety of channels, including the media, social networks, and culturally responsive programs can alleviate some of the barriers to healthy diet and exercise patterns.

The Effects of Displacing Sedentary Behavior With Two Distinct Patterns of Light Activity on Health Outcomes in Older Adults (Implications for COVID-19 Quarantine)

Rationale: The COVID-19 pandemic is limiting outdoor and community-based activities, especially for older adults owing to the requirement for self-isolation, potentially increasing prolonged sedentary behavior (SB). Given a poor tolerance for intense exercise, SB displacement with light intensity physical activity (LIPA) is a promising health enhancing alternative. Therefore, the aims of this study were to investigate the effects of two different types of SB displacement on health outcomes in older adults and any differential impact of associated LIPA pattern.

Method: 28 older women (age: 73 ± 5 years, height: 1.60 ± 0.07 m, weight: 67 ± 10 kg, and BMI: 26.1 ± 3.6 kg/m²) underwent overnight fasted dual energy x-ray absorptiometry (DEXA) imaging, blood sampling, and functional assessments before being randomly allocated to one of two groups: (1) single continuous bout of 45–50 min LIPA daily (n = 14); or (2) SB fragmentation (SBF; ~48 min LIPA daily, 2 min LIPA for every 30 min of SB; n = 14). Compliance was systematically monitored using tri-axial accelerometery. All measures were taken at weeks 0 and 8.

Results: Physical behavior significantly altered (decreased SB/increased LIPA; p < 0.05) and to a similar extent in both groups. We observed a significant reduction in serum triglycerides [p = 0.045, effect size (ɳ_p²) = 0.15; SBF: −0.26 ± 0.77 mmol/L, LIPA: −0.26 ± 0.51 mmol/L], improved 30 s sit-to-stand (STS) count (p = 0.002, ɳ_p² = 0.32, 2 ± 3 STS) and speed (p = 0.009, ɳ_p² = 0.35, −10 ± 33%), as well as increased average handgrip strength (p = 0.001, ɳ_p² = 0.45, 6 ± 12%), and gait speed (p = 0.005, ɳ_p² = 0.27, 0.09 ± 0.16 m/s) in both groups. Interestingly, SBF caused a greater increase in peak handgrip strength (8 ± 14%), compared to LIPA (2 ± 10%; p = 0.04, ɳ_p² = 0.38).

Conclusion: SB displacement induced significant improvements in fasting triglycerides, gait speed, as-well as STS endurance/speed in older women. Frequent vs. continuous SB displacement also caused greater increases in handgrip strength. While both SB displacement protocols display promise as efficacious home-based interventions for self-isolating older adults, our results would suggest a physical functioning advantage of the SBF protocol for certain outcomes.

The impact of non-residential grandchild care on physical activity and sedentary behavior in people aged 50 years and over: study protocol of the Healthy Grandparenting Project

Background

Finding effective ways to support people aged > 50 years to develop adequate levels of physical activity and sedentary behavior is necessary as these behaviors are positively related to the maintenance of functional independence and health-related quality of life. Given the widespread provision of grandparental child care, examining its impact on grandparents’ energy-expenditure related behavior in the broader context of health is imperative. Therefore, the Healthy Grandparenting Project will aim to investigate the levels of physical activity and sedentary behavior, body composition and health-related quality of life in grandparents caring for their grandchildren and to compare these outcomes with non-caregiving grandparents and older adults without grandchildren, both momentarily and over time. An additional purpose is to identify possible predictors of potential changes over time.

Methods

A prospective cohort study will run over a period of 2 years, including three test occasions with a one-year time interval in between (T0 = baseline, T1 = 12 months, T2 = 24 months). A total of 276 participants will be recruited in Flanders through non-probability quota sampling (50–50% men-women), of which 92 caregiving grandparents, 92 non-caregiving grandparents and 92 non-grandparents. All three subsamples will be matched for age and sex. At each test occasion, anthropometric and body composition measurements will be determined. Participants’ levels of physical activity and sedentary behavior will be assessed both objectively and subjectively by means of accelerometry and self-report questionnaires. Information about their grandchildren and the provided grandparental care (if applicable) as well as their health-related quality of life will also be assessed using self-report questionnaires. Mixed modelling will be used to identify differences in physical activity, sedentary behavior, body composition and health-related quality of life between the subsamples at baseline, as well as to evaluate and compare changes in energy-expenditure related behavior over time between subsamples and to identify predictors of the detected changes.

Discussion

The Healthy Grandparenting Project is an innovative study examining the levels of physical activity and sedentary behavior in caregiving grandparents, non-caregiving grandparents and non-grandparents. Obtained results will help in the development of campaigns to maintain/improve health in adults at a more advanced age.

Trial registration

clinicaltrials.gov, Identifier: NTC04307589. Registered March 2020.

Minimizing sedentary behavior (without increasing medium-to-vigorous exercise) associated functional improvement in older women is somewhat dependent on a measurable increase in muscle size

The optimal pattern of sedentarism displacement and mechanisms underlying its health effects are poorly understood. Therefore, the aim of this study was to quantify muscle-tendon adaptation in response to two different sedentarism displacement interventions and relate any adaptations to functional outcomes. Thirty-four older women (73±5yrs) underwent skeletal muscle-tendon size and functional assessments. Participants were randomly allocated to: Sedentary behavior fragmentation (SBF), Light intensity physical activity (LIPA), or Control groups. Measures were taken at weeks 0 and 8. Gait speed significantly increased (p=0.003), in both experimental groups (SBF: 0.06 ± 0.08m/s, 6±10%, LIPA: 0.06 ± 0.07m/s, 6±6%), but not control (-0.02 ± 0.12m/s, -2±9%). Accordingly, the relative change in Vastus Lateralis muscle volume, accounted for 30% (p=0.027), and 45% (p=0.0006) of the explained variance in the relative change in gait speed, for SBF and LIPA respectively. Gastrocnemius Medialis fascicle length changes were positively associated with gait speed changes, following LIPA exclusively (R²= 0.50, p=0.009). This is the first study to show SBF and LIPA are adequate loading in older women, with related muscle adaptation and clinically relevant gait speed improvements. Such adaptations appear similar irrespective of whether sedentarism displacement is prescribed in a single bout (LIPA) or in frequent micro-bouts (SBF).

Stand Up Now: A Sedentary Behavior Intervention in Older Adults of Moderate to Low Physical Function

OBJECTIVES

To examine the efficacy of an the intervention Stand Up Now (SUN) to reduce sedentary behavior (SB) and improve physical function and mobility.

METHODS

SUN included two groups: (a) focused on reducing total SB (SUNSL) and (b) focused on increasing sit-to-stand (STS) transitions (SUNSTS). The participants (N = 71; Mage = 87 ± 7 years) had 12 weekly health coaching sessions. SB, physical function, and mobility were measured at the baseline, 6, and 12 weeks via the activPAL, Short Physical Performance Battery, and the 8-foot up and go, respectively. Linear mixed models examined the outcome variables over time.

RESULTS

Both groups decreased sedentary time (1.3 ± 0.3 hr, p < .001), increased standing time (0.5 ± 0.2 hr, p < .02), and improved physical function (1.5 ± 0.4 points, p < .001) from the baseline to 6 weeks, and they maintained it at 12 weeks. SUNSTS increased STS transitions (5.4 ± 4.1, p < .001), while SUNSL had no changes (0.5 ± 3.1, p > .9). There were no changes in mobility for either group (0.5 ± 1.5 s, p > .05).

DISCUSSION

SUN demonstrates the efficacy to improve SB and physical function in older adults.

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

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

"I Trust in Staff's Creativity"-The Impact of COVID-19 Lockdowns on Physical Activity Promotion in Nursing Homes Through the Lenses of Organizational Sociology

Objectives: The health-enhancing benefits or regular physical activity (PA) reach into old age. With the emergence of the coronavirus disease of 2019 (COVID-19) pandemic and the associated national lockdowns and restrictions, nursing home residents were restrained from being physically active. In our study, we aimed to assess the impact of the COVID-19-related restrictions on PA promotion in nursing homes from an organizational-sociological lens. Methods: We collected data in eight nursing homes in Germany. Data collection included (i) semistructured interviews focusing on COVID-19-related restrictions and their effects on nursing homes from the home administrators' perspectives; (ii) open-ended surveys with nursing home staff and relatives focusing on daily routines and contact restrictions; and (iii) collection of documents such as care concepts, mission statements, and weekly activity plans. We analyzed all data with a reflexive thematic analysis approach. Results: We identified three stages of COVID-19-related changes in nursing homes that impacted PA promotion, as follows: (1) external closure and search for emergency control, (2) organizational adaptations to create a livable daily life in the internal environment, and (3) slow reintegration of interactions with the external organizational environment. Document analysis revealed that PA promotion was not part of decision programs or internal staff work descriptions. Rather, PA promotion was delegated to external service providers. The assignment of PA promotion to external providers was not structurally anchored in decision programs, which makes PA promotion not sustainable, particularly during unforeseen events that limit access to the organization. During the pandemic, executive staff believed in internal staff to buffer competencies with regard to PA promotion. Thus, executive staff often considered PA promotion relevant, even during the pandemic, but thought that PA promotion is a task that can be fulfilled by unqualified but motivated internal staff. Conclusion: While our study participants showed a high level of coping-capacity belief, it remains unclear which long-term impacts of COVID-19 on PA promotion in nursing homes are to be expected. At the practice level, executive staff in nursing homes that aim to promote PA within their organization should become aware that PA promotion needs to be incorporated into organizational structures to be implemented and continued in challenging times such as in a pandemic.