The Influence of Neighbourhoods and the Social Environment on Sedentary Behaviour in Older Adults in Three Prospective Cohorts

Social cohesion and associations with sedentary time, physical activity and dietary quality in The Maastricht Study

INTRO

We aim to investigate the relationship between social cohesion and sedentary behavior (SB), total physical activity (PA), moderate-to-vigorous PA (MVPA), and dietary quality. Additionally, we assess whether these associations are independent of neighborhood walkability and the food environment.

METHODS

A total of 7641 participants from The Maastricht Study in the Netherlands between the ages of 40 and 75 years were analyzed. Neighborhood social cohesion was obtained by participant questionnaire completed at baseline and measured by the Dutch Livability meter. Home addresses were linked to geographic information system (GIS) data from the Geoscience and Health Cohort Consortium (GECCO) to create neighborhood exposures of walkability and food environment. A thigh worn accelerometer collected data to measure sedentary time, total daily PA, and MVPA. Dietary quality was measured with a food frequency questionnaire. Multivariate linear regression analyses were adjusted for age, sex, socioeconomic position, neighborhood walkability, and food environment.

RESULTS

Those living in the highest quartile area of perceived social cohesion had statistically significant lower levels of SB (Q4 B: -13.04; 95% CI = -20.23, -5.85), higher total PA (Q4 B: 4.39; 95% CI = 1.69, 7.10), and higher MVPA (Q4 B: 2.57; 95% CI = 0.83, 4.31) and better diet quality (Q4 B: 1.12; 95% CI = 0.24, 2.01) compared to the lowest quartile independent of walkability and food environment. Similar results were found using the Livability meter.

CONCLUSION

We discovered neighborhood social cohesion as an important obesogenic determinant that should be considered in policymaking to encourage higher levels of PA and higher diet quality.

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.

Sitting as a moral practice: Older adults' accounts from qualitative interviews on sedentary behaviours

Amidst public health campaigns urging people to sit less as well as being more physically active, this paper investigates how older adults make sense of their sedentary behaviour. Using an accounts framework focusing on how people rationalise their sitting practices, we analysed data from 44 qualitative interviews with older adults. All interviewees had received information about sedentary behaviour and health, visual feedback on their own objectively measured sitting over a week and guidance on sitting less. Participants used accounts to position sitting as a moral practice, distinguishing between 'good' (active/'busy') and 'bad' (passive/'not busy') sitting. This allowed them to align themselves with acceptable (worthwhile) forms of sitting and distance themselves from other people whose sitting they viewed as less worthwhile. However, some participants also described needing to sit more as they got older. The findings suggest that some public health messaging may lead to stigmatisation around sitting. Future sedentary behaviour guidelines and public health campaigns should consider more relatable guidelines that consider the lived realities of ageing, and the individual and social factors that shape them. They should advocate finding a balance between sitting and moving that is appropriate for each person.

Device-measured sedentary behavior in oldest old adults: A systematic review and meta-analysis

Sedentary behavior contributes to health decline and frailty in older adults, especially the oldest old. The purpose of this systematic review was to synthesize evidence describing the volume of device-measured sedentary behavior and factors that influence sedentary behavior in community-dwelling adults aged 80 and older. Four electronic databases were searched in August 2018; the search was updated in September 2019 and December 2020. Twenty-one articles representing 16 unique datasets from six countries met inclusion criteria. Various devices and data processing methods were used to measure sedentary behavior; the most common device was the ActiGraph accelerometer. Sedentary time during the waking day ranged from 7.6 to 13.4 h/day. Studies using similar measurement methods (hip-worn ActiGraph with uniaxial cut-point <100 counts per minute) had a weighted mean of 10.6 h/day. Subgroup analyses revealed that male gender and age ≥85 may contribute to increased sedentary behavior. Only seven individual articles examined factors that influence sedentary behavior in the 80 and older age group; older age, male gender, non-Hispanic white race/ethnicity, social disadvantage, and declining cognitive function (in men) were associated with increased sedentary behavior. In conclusion, the oldest old are highly sedentary and little is known about factors that influence their sedentary behavior.

Thigh-worn accelerometry for measuring movement and posture across the 24-hour cycle: a scoping review and expert statement

Introduction

The Prospective Physical Activity Sitting and Sleep consortium (ProPASS) is an international collaboration platform committed to harmonise thigh-worn accelerometry data. The aim of this paper is to (1) outline observational thigh-worn accelerometry studies and (2) summarise key strategic directions arising from the inaugural ProPASS meeting.

Methods

(1) We performed a systematic scoping review for observational studies of thigh-worn triaxial accelerometers in free-living adults (n≥100, 24 hours monitoring protocols). (2)Attendees of the inaugural ProPASS meeting were sent a survey focused on areas related to developing ProPASS: important terminology (Q1); accelerometry constructs (Q2); advantages and distinct contribution of the consortium (Q3); data pooling and harmonisation (Q4); data access and sharing (Q5 and Q6).

Results

(1) Eighty eligible articles were identified (22 primary studies; n~17 685). The accelerometers used most often were the ActivPAL3 and ActiGraph GT3X. The most commonly collected health outcomes were cardiometabolic and musculoskeletal. (2) None of the survey questions elicited the predefined 60% agreement. Survey responses recommended that ProPASS: use the term physical behaviour or movement behaviour rather than 'physical activity' for the data we are collecting (Q1); make only minor changes to ProPASS's accelerometry construct (Q2); prioritise developing standardised protocols/tools (Q4); facilitate flexible methods of data sharing and access (Q5 and Q6).

Conclusions

Thigh-worn accelerometry is an emerging method of capturing movement and posture across the 24 hours cycle. In 2020, the literature is limited to 22 primary studies from high-income western countries. This work identified ProPASS's strategic directions-indicating areas where ProPASS can most benefit the field of research: use of clear terminology, refinement of the measured construct, standardised protocols/tools and flexible data sharing.

Long-Term Exposure to Residential Greenspace and Healthy Ageing: a Systematic Review

PURPOSE OF REVIEW

We systematically reviewed the available observational evidence on the association between long-term exposure to residential outdoor greenspace and health at older age and rated the evidence as sufficient, limited, or inadequate.

RECENT FINDINGS

We identified 59 studies, ranging from poor to very good quality. The health outcomes included mental health (N = 12, of which three were longitudinal studies and eight were rated to be of good quality), cognitive function (N = 6; two longitudinal studies, five of good/very good quality), physical capability (N = 22; five longitudinal studies, six of good/very good quality), cardiometabolic risk (N = 9; one longitudinal study, five of good/very good quality), morbidity (N = 11; three longitudinal studies, six of good/very good quality) and perceived wellbeing (N = 9; all cross-sectional, two of good quality). The evidence for a beneficial association with greenspace was rated limited for morbidity and inadequate for mental health, cognitive function, physical capability, cardiometabolic risk and perceived wellbeing. The reviewed studies provided inadequate/limited but suggestive evidence for a beneficial association between greater long-term greenspace exposure and healthy ageing. This review highlights the need of longitudinal studies that assess the association between long-term greenspace exposure and the trajectory of objective indicators of ageing.

The Built Environment and Socio-Demographic Correlates of Partial and Absolute Sedentary Behaviours in Community-Dwelling Older Adults in Accra, Ghana

This study examined built environmental and socio-demographic variables as correlates of sedentary behaviour in a population of older adults, and attempted to introduce the idea of measuring sedentary behaviour with two domains, namely 'partial sedentary behaviour' and 'absolute sedentary behaviour'. The study's population was community-dwelling older adults aged 60 years or more in Accra, Ghana. A self-reported questionnaire was used to gather data from 504 older people. Multiple linear regression analysis was used to present findings, with all nominal categorical variables incorporated in this analysis dummy-coded. The overall (third) regression model accounted for a variance of 55.9% and a significant F-test [F (25,454) = 22.99; p < 0.001)]. Gender was positively associated with sedentary behaviour - the sedentary behaviour of women was 28 min in excess of that of men. Sedentary behaviour decreased as the social network size and supporting social network of older people increased. Sedentary behaviour decreased as availability of spacious road pavements, secure social recreational centres for older people, and health services in the community increased. The improvement of road safety conditions at the community level and design of the built environment to support social integration of older people are major recommendations of this study.

Effect of Sex on Anterior Cruciate Ligament Injury-Related Biomechanics During the Cutting Maneuver in Preadolescent Athletes

Background:

There are 2 movement patterns associated with an anterior cruciate ligament (ACL) injury: dynamic valgus and stiff landing. Although sex-dependent differences have been identified for adults, less is known for preadolescent athletes regarding movement patterns known to load the ACL.

Hypothesis:

We hypothesized that girls would demonstrate greater vertical ground reaction forces and knee valgus angles. We further hypothesized that the exercise intervention would affect girls more than boys and that this would primarily be demonstrated in less sagittal plane excursions, increased vertical ground reaction forces and knee valgus moments for girls than for boys.

Study Design:

Controlled laboratory study.

Methods:

Male and female soccer and handball players (n = 288; age range, 9-12 years) were recruited. A motion capture system synchronized to a force platform was used to record 5 trials of a cutting maneuver before and after a 5-minute fatigue intervention. Linear mixed models were constructed, and analysis of variance was used to analyze differences in outcomes associated with the sex of the athletes.

Results:

Boys showed greater peak knee valgus moment (0.26 vs 0.22 N·m/kg, respectively; P = .048), peak knee internal rotation moment (–0.13 vs –0.10 N·m/kg, respectively; P = .021), knee rotation excursion (–7.9° vs –6.9°, respectively; P = .014), and knee extension excursion (2.7° vs 1.4°, respectively; P < .001) compared with that in girls. A significant sex × fatigue intervention interaction (F = 7.6; P = .006) was found, which was caused by a greater increase in first peak vertical ground-reaction force (vGRF) from before to after the fatigue intervention for girls (15.3 to 16.0 N/kg) compared with boys (16.4 to 16.5 N/kg).

Conclusion:

Differences detected for biomechanical factors during the cutting maneuver do not point to a greater ACL injury risk for prepubescent or early pubescent girls than for boys. Nonetheless, girls go on to develop more detrimental movement patterns in adolescence than those in boys in terms of biomechanical risk factors.

Clinical Relevance:

Early adolescence is a good target age to learn and develop muscular control; balance, strength; flexibility; and jumping, running, and landing control. This time of physical and athletic growth may therefore be an appropriate period to influence biomechanical factors and thereby task execution and the injury risk.

Long-Term Follow-up of Skeletally Immature Patients With Physeal-Sparing Combined Extra-/Intra-articular Iliotibial Band Anterior Cruciate Ligament Reconstruction: A 3-Dimensional Motion Analysis

BACKGROUND

The physeal-sparing iliotibial band (ITB) anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established technique for treating skeletally immature patients with ACL rupture. However, the long-term implications of the procedure on the intricacies of kinetic and kinematic function of the knee have not been comprehensively investigated.

PURPOSE

To assess the short-, mid-, and long-term effects of ITB ACLR on kinetic and kinematic parameters of knee functions.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 38 patients who had undergone an ITB ACLR as a skeletally immature child were recruited to participate in a 3-dimensional (3D) motion analysis testing protocol at an institutional injury prevention center between 1 and 20 years after reconstruction. Exclusion criteria were congenital ACL deficiency and any other major knee injury (defined as an injury requiring surgery or rehabilitation >3 months) on either knee. 3D and force plate parameters included in the analysis were knee moment, ground-reaction force, and vertical jump height measured during drop vertical jump and vertical single-limb hop. Paired t tests and equivalency analyses were used to compare the parameters between cases (ITB ACLR limb) and controls (contralateral/nonsurgical limbs).

RESULTS

Paired t tests showed no statistically significant differences between limbs, and equivalency analyses confirmed equivalency between limbs for all tested outcome variables.

CONCLUSION

The ITB ACLR appears to restore normal, symmetric, physiologic kinetic and kinematic function in the growing knee by 1 year after reconstruction, with maintenance of normal parameters for up to 20 years.

Urban environments and objectively-assessed physical activity and sedentary time in older Belgian and Chinese community dwellers: potential pathways of influence and the moderating role of physical function

BACKGROUND

Many studies have examined neighbourhood environmental correlates of older adults' physical activity (PA) but only a few focused on sedentary time (ST). Only a small proportion of these studies used objective measures of PA/ST, such as accelerometer-assessed PA/ST, and only a couple employed accelerometer cut-points appropriate for older adults. Furthermore, although older adults experience declines in physical function as they age, there is a dearth of information on the impact of the neighbourhood environment on PA/ST in individuals with different levels of physical function.

METHODS

We used data from two extant cross-sectional studies conducted in Hong Kong (China) and Ghent (Belgium) (N = 829). Participants were recruited from pre-selected administrative units stratified by socio-economic status and walkability. Moderate-to-vigorous PA (MVPA) and ST were assessed for 7 days using accelerometers and cut-points developed for older adults. Objective neighbourhood environmental attributes within 400 m and 1 km buffers surrounding participants' homes were quantified using Geographic Information Systems data. Lower extremity physical function was objectively assessed. Socio-demographic information was collected via interviews. Total, direct and indirect (mediated) effects of environmental attributes on MVPA and ST were estimated using generalised additive mixed models and the joint-significant test.

RESULTS

Commercial/civic destination density and number of parks within 1 km from home showed positive total and direct effects on MVPA, and public transport density showed negative total and direct effects on ST, which were consistent across cities and physical function levels. The total and direct effects of residential density on MVPA depended on physical function, and those of residential density on ST differed by city. A complex network of potential inconsistent pathways linking all environmental attributes to MVPA and ST in the whole sample or in subgroups of participants was revealed.

DISCUSSION

Access to parks and commercial/civic destinations appear to support older adults' MVPA in different geographical and cultural contexts and irrespective of their physical function level. By supporting MVPA, these characteristics also contribute to a reduction in ST. The potential effects of public transport, recreational facilities and residential density are less straightforward and point at inconsistent effects that may depend on the geographical context and level of physical function.

Assessing Neighborhood Satisfaction and Social Capital in a Multi-Cultural Setting of an Abu Dhabi Neighborhood

Behavioral research studies propose that urban open spaces contribute to enhance sociability in urban areas. The urban areas in the city of Abu Dhabi are less appealing to attract vibrant activity and social life. This study investigates the role of the built environment in the enhancement of neighborhood satisfaction and social capital in a residential neighborhood of Abu Dhabi. A total of 145 residents were surveyed for their perception, attitude, and behavior. Regression analyses to predict the role of the built environment of the open space, as well as the ethnicity of respondents, on measures of neighborhood satisfaction and social capital were performed. Spatial data and audit tools were used to assess the lack of suitable built-environment in the study area. Results indicate that improvements to the built environment can improve both the social capital and neighborhood satisfaction of the urban residents of Abu Dhabi. Implications of this study include recommendations to enhance the experience of urban spaces in arid regions like Abu Dhabi. Recommendations include adding landscape elements, providing a comfortable walking environment, adding attractive locations and destinations, and a clean and safe environment with attractive buildings or homes.

Cross-sectional associations between personality traits and device-based measures of step count and sedentary behaviour in older age: the Lothian Birth Cohort 1936

Background

While the associations between personality traits and self-reported physical activity are well replicated, few studies have examined the associations between personality and device-based measures of both physical activity and sedentary behaviour. Low levels of physical activity and high levels of sedentary behaviour are known risk factors for poorer health outcomes in older age.

Methods

We used device-based measures of physical activity and sedentary behaviour recorded over 7 days in 271 79-year-old participants of the Lothian Birth Cohort 1936. Linear regression models were used to assess whether personality traits were cross-sectionally associated with step count, sedentary time, and the number of sit-to-stand transitions. Personality traits were entered one at a time, and all-together, controlling for age and sex in Model 1 and additionally for BMI and limiting long-term illness in Model 2.

Results

None of the associations between personality traits and measures of physical activity and sedentary behaviours remained significant after controlling for multiple-comparisons using the False Discovery Rate test (all ps > .07).

Conclusions

We found no evidence that personality traits are associated with device-based measures of physical activity or sedentary behaviour in older age. More studies are needed to replicate and examine the nature of these relationships.

Understanding the neighbourhood environment and the health and wellbeing of older Chinese immigrants: a systematic literature review

Neighbourhood environment has a significant impact on the health and wellbeing of older people. In recent years, the increase in older Chinese immigrants globally has attracted a growing amount of research which has investigated the health and wellbeing of these elderly residents. The aim of this study is to provide a systematic literature review of empirical findings on the health and wellbeing of older Chinese immigrants and the ways in which the neighbourhood environment impacts them. A systematic search was conducted using online databases where 52 articles met specific criteria and were subsequently reviewed critically. An inductive approach was undertaken to analyse the data extracted from the selected articles. The review was categorised according to the following themes: neighbourhood social environment, neighbourhood physical environment and place attachment. The findings show that the majority of research has investigated the health status of older immigrants, and in particular, the impacts related to the social environments in which they live. The literature review indicated that there is scope for future studies to investigate the impact of the physical neighbourhood environment on this group of people.

Cross-Sectional Associations of Neighborhood Perception, Physical Activity, and Sedentary Time in Community-Dwelling, Socioeconomically Diverse Adults

Background: Little is known about the role of perceived neighborhood environment as a determinant of physical activity (PA) and sedentary time (ST) in understanding obesity-related health behaviors. We focus on a biracial, socioeconomically diverse population using objectively measured ST, which is under-represented in the literature.

Methods: We examined the association between self-reported neighborhood perception (Likert-scale questions), PA using the Baecke questionnaire, and both non-sedentary time and ST using accelerometry from wave 4 of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 2,167). After applying exclusion criteria, the sample size was n = 1,359 for analyses of self-reported PA and n = 404 for analyses of accelerometry data. Factor analysis identified key neighborhood characteristics to develop a total neighborhood perception score (NPS). Higher NPS indicated less favorable neighborhood perception. Linear regression was used to determine the relationship between NPS, PA, non-sedentary time, and ST.

Results: Complete data were available for n = 1,359 [age 56.6(9.0) years, 59.5% female, 62.2% African American] for whom we identified four neighborhood perception factors: (1) concern about crime, (2) physical environment, (3) location of violent crime, and (4) social environment. Worsening perception of the overall neighborhood [β = −0.13 (SE = 0.03); p = 0.001], the physical environment [−0.11 (0.05); p = 0.03], and the social environment [−0.46 (0.07); p < 0.0001] were associated with decreased PA. Worsening perception of the overall neighborhood [1.14 (0.49); p = 0.02] and neighborhood social environment [3.59 (1.18); p = 0.003] were associated with increased ST over the day. There were no interactions for race, sex, poverty status, or economic index.

Conclusion: Poor overall neighborhood perception, perceived social environment, and perceived neighborhood physical environment are associated with PA and ST in a multi-racial, socioeconomically diverse cohort of urban adults.

Clinical Trial Registration: The HANDLS study is registered at ClinicalTrials.gov as NCT01323322.

Positive and negative well-being and objectively measured sedentary behaviour in older adults: evidence from three cohorts

Background

Sedentary behaviour is related to poorer health independently of time spent in moderate to vigorous physical activity. The aim of this study was to investigate whether wellbeing or symptoms of anxiety or depression predict sedentary behaviour in older adults.

Method

Participants were drawn from the Lothian Birth Cohort 1936 (LBC1936) (n = 271), and the West of Scotland Twenty-07 1950s (n = 309) and 1930s (n = 118) cohorts. Sedentary outcomes, sedentary time, and number of sit-to-stand transitions, were measured with a three-dimensional accelerometer (activPAL activity monitor) worn for 7 days. In the Twenty-07 cohorts, symptoms of anxiety and depression were assessed in 2008 and sedentary outcomes were assessed ~ 8 years later in 2015 and 2016. In the LBC1936 cohort, wellbeing and symptoms of anxiety and depression were assessed concurrently with sedentary behaviour in 2015 and 2016. We tested for an association between wellbeing, anxiety or depression and the sedentary outcomes using multivariate regression analysis.

Results

We observed no association between wellbeing or symptoms of anxiety and the sedentary outcomes. Symptoms of depression were positively associated with sedentary time in the LBC1936 and Twenty-07 1950s cohort, and negatively associated with number of sit-to-stand transitions in the LBC1936. Meta-analytic estimates of the association between depressive symptoms and sedentary time or number of sit-to-stand transitions, adjusted for age, sex, BMI, long-standing illness, and education, were β = 0.11 (95% CI = 0.03, 0.18) and β = − 0.11 (95% CI = − 0.19, −0.03) respectively.

Conclusion

Our findings indicate that depressive symptoms are positively associated with sedentary behavior. Future studies should investigate the causal direction of this association.

The Influence of Social Capital on Farm Household’s Borrowing Behavior in Rural China

This paper evaluates whether social capital affects the ability of farm households to obtain formal and informal loans. We test for the impact of two measures of social capital. The first measure, kinship, captures the traditional aspects of bonding social capital in rural areas that might affect the probability of getting informal loans. As the economic reforms in China have changed the traditional rural way of life and weakened the role of kinship, more mobile farmers are likely to develop a different kind of social capital also based in the Chinese tradition but not focused exclusively on kin. This friendship social capital is hypothesized to affect farmers’ ability to get both formal and informal loans. We use the Chinese Household Finance Survey data from 2013 and estimate the probability of obtaining credit, while also accounting for the reverse causality. In addition, we use the Heckman selection model to establish how social capital affects not only the probability of getting loans but also the size of the loan. Empirical results suggest that social capital affects borrowing by farm households. In particular, the friendship social capital has a positive effect on farm household’s ability to get formal loans, and has a substitution effect on informal borrowing, while kinship has a positive effect on farm households’ ability to get informal loans. Friendship and kinship are positively associated with the amount of a farm household’s formal and informal loans, respectively.

Characteristics of a protocol to collect objective physical activity/sedentary behaviour data in a large study: Seniors USP (understanding sedentary patterns)

The Seniors USP study measured sedentary behaviour (activPAL3, 9 day wear) in older adults. The measurement protocol had three key characteristics: enabling 24-hour wear (monitor location, waterproofing); minimising data loss (reducing monitor failure, staff training, communication); and quality assurance (removal by researcher, confidence about wear). Two monitors were not returned; 91% (n=700) of returned monitors had 7 valid days of data. Sources of data loss included monitor failure (n=11), exclusion after quality assurance (n=5), early removal for skin irritation (n=8) or procedural errors (n=10). Objective measurement of physical activity and sedentary behaviour in large studies requires decisional trade-offs between data quantity (collecting representative data) and utility (derived outcomes that reflect actual behaviour).

What If Healthy Aging Is the 'New Normal'?

We dedicate this special issue to our colleague, Dr. Lucinda Bryant (1941-2016).[...].