Gender and Age Differences in Hourly and Daily Patterns of Sedentary Time in Older Adults Living in Retirement Communities

A Novel Approach to Reduce Sedentary Behaviour in Care Home Residents: The GET READY Study Utilising Service-Learning and Co-Creation

The GET READY study aimed to integrate service-learning methodology into University degrees by offering students individual service opportunities with residential care homes, to co-create the best suited intervention to reduce the sedentary behaviour (SB) of residents throughout the day, with researchers, end-users, care staff, family members and policymakers. Eight workshops with care home residents and four workshops with care staff, relatives and policymakers, led by undergraduate students, were audiotaped, transcribed verbatim and analysed with inductive thematic analysis to understand views and preferences for sustainable strategies to reduce SB and increase movement of residents. Perspectives about SB and movement in care homes highlighted four subthemes. Assets for decreasing SB included three subthemes, and suggestions and strategies encapsulated four subthemes. There is a need to include end-users in decision making, and involve care staff and relatives in enhancing strategies to reduce SB among residents if we want sustainable changes in behaviour. A change in the culture at a policymaker and care staff's level could provide opportunities to open care homes to the community with regular activities outside the care home premises, and offer household chores and opportunities to give residents a role in maintaining their home environment.

Objectively-Assessed Patterns and Reported Domains of Sedentary Behavior Among Japanese Older Adults

BACKGROUND

Prolonged periods of sitting time can be adversely associated with older adults' well-being and functional capacities. Understanding patterns and contexts of sedentary behaviors (SB) can inform approaches to prevention. This study examined Japanese older adults' objectively-assessed patterns and reported domains of SB and their interrelationships.

METHODS

Participants (n = 297; aged 65-84 years) of this cross-sectional study wore an accelerometer for 7 days and completed a survey. Five measures related to SB patterns were identified from the accelerometer data. SB from six domains, socio-demographics, and chronic conditions were identified from the survey data. Relative contributions of six domains to objectively-measured prolonged sedentary time (≥30 minutes) and the number of breaks were examined in a series of multivariate linear regressions. Covariates were socio-demographics, chronic conditions, and accelerometer wear time.

RESULTS

On average, participants spent 8.8 hours a day sedentary (58% of accelerometer wear time), with 7.6 breaks per sedentary hour, and 3.7 hours a day through prolonged sedentary bouts (4.4 time/day). The proportions of time in the SB domains were 9.4% for car, 4.0% for public transport, 6.1% for work, 45.5% for television (TV) viewing, 9.8% for computer use, and 25.1% for other leisure. Domains of SB that contributed significantly to longer sedentary time through prolonged bouts were TV viewing and computer use. TV viewing was also associated with a lesser number of breaks.

CONCLUSIONS

For Japanese older adults, initiatives to address SB could focus on breaking-up prolonged periods of SB by encouraging more frequent breaks, especially during TV viewing.

Accelerometer-Measured Physical Activity and Sedentary Behavior: A Cross-Sectional Study of Brazilian Older Adults

BACKGROUND

To examine the level of physical activity and sedentary behavior (SB), measured with accelerometers, in older adults from a city in southern Brazil according to sociodemographic and health characteristics.

METHODS

The sample consisted of 425 older adults (≥63 y) from the EpiFloripa Aging Study. Light physical activity (LPA), moderate to vigorous physical activity (MVPA), and SB were measured with accelerometers over a period of 7 days.

RESULTS

The older adults spent two-thirds of the time of use in SB, one-third in LPA, and only 2.1% (95% confidence interval, 1.8-2.2) in MVPA. In the final adjusted model, lower levels of MVPA were observed for women, as well as higher SB and lower LPA and MVPA for those with higher age. There were also trends toward prolonged SB and lower LPA when participants had a higher educational level and toward lower MVPA with higher body mass index.

CONCLUSIONS

Constant monitoring of physical activity levels and SB using objective measures is recommended and interventions should be directed at the groups most exposed to excessive SB and low levels of MVPA.

Associations of total amount and patterns of objectively measured sedentary behavior with performance-based physical function

Although greater sedentary time has been found to be associated with negative health impacts, little is known whether the specific pattern of sedentary behavior (i.e. sedentary bouts, breaks and durations) are associated with physical function among older adults. The present study examined the associations between objectively measured sedentary behavior and physical function among older Japanese adults. A total of 174 male and 107 female community-dwelling older Japanese adults aged 65–84 years (mean age: 74.5 ± 5.2 years) were recruited. Sedentary behavior and physical activity were assessed using a triaxial accelerometer. Physical function was measured through hand grip strength, eye-open one leg standing, 5-m walking, and timed up and go tests. Forced-entry multiple linear regression models adjusted for potential confounders were performed. After adjustment, total daily sedentary time and duration of prolonged sedentary bouts (both ≥ 30 min) were positively associated with time spent on the 5-m walking stage and timed up and go tests in older women; however, no significant associations were observed in older men or the whole sample. This paper highlights the importance of developing sedentary behavior change strategies for interventions aiming to improve mobility in in older women. Further evidence from a prospective study is required to establish directions of causality between sedentary behavior and mobility.

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This study used triaxial accelerometers and standardized physical fitness tests.

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Total daily sedentary time was negatively associated with mobility in older women.

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Duration of prolonged sedentary bouts was negatively related to mobility in older women.

A co-created intervention with care home residents and university students following a service-learning methodology to reduce sedentary behaviour: The GET READY project protocol

BACKGROUND

There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents' complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate service-learning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers.

METHODS

Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

The descriptive epidemiology of the diurnal profile of bouts and breaks in sedentary time in older English adults

Background

High sedentary time is associated with adverse metabolic health outcomes and mortality in older adults. It has been suggested that breaking up sedentary time may be beneficial for metabolic health; however, population prevalence data are lacking on the patterns of sedentary behaviour which would identify opportunities for intervention.

Methods

We used data of adults aged ≥ 60 years (n = 3705) from the population-based EPIC-Norfolk cohort, to characterize the patterns of total sedentary time, breaks in sedentary time and sedentary bouts across the day and assess their associations with participant characteristics, using multi-level regression. Sedentary time was measured objectively by a hip-mounted accelerometer (ActigraphTM GT1M) worn for 7 days during waking time.

Results

More than 50% of every waking hour was spent sedentary, increasing to a peak of 83% in the evening. On average fewer breaks were accrued in the evenings compared with earlier in the day. Marginally more sedentary time was accrued on weekend days compared with weekdays (difference 7.4 min, 95% confidence interval 5.0-9.7). Large proportions of this sedentary time appear to be accrued in short bouts (bouts of < 10 min for 32% of the time). Older age, being male, being retired, not being in paid employment and having a higher body mass index were associated with greater sedentary time and fewer breaks.

Conclusion

Sedentary time is common throughout the day but peaks in the evenings with fewer breaks and longer bouts. We identified a number of characteristics associated with sedentary time and additionally inversely associated with sedentary breaks, which should inform the development and targeting of strategies to reduce sedentary time among older adults.

Pattern Analysis of Sedentary Behavior Change after a Walking Intervention

OBJECTIVES

We examined the pattern of change in sedentary behavior (SB) resulting from a physical activity (PA) intervention in older adults, and the influence of sex on changes in SB.

METHODS

One hundred twenty (N = 120) inactive older adults from 2 12-week step/day-target interventions were included in this pooled reanalysis. Participants were randomly assigned to an intervention (STEP) or control group (CON). A Hip-worn accelerometer (Actigraph) was used to assess SB and PA.

RESULTS

Significant decreases in SB (-25 minutes) were largely accounted for by the increase in moderate- to vigorous-intensity PA (MVPA; +17.3 minutes). More broadly, data showed that for every 1% increase in proportion of time spent in MVPA, SB decreased by 1.21%. Results of the pattern analysis showed significant pre-post decreases in the number of daily sedentary bouts lasting 10, 20, and 30 minutes and the number of sit-to-stand transitions in the STEP group. Males tended to decrease time spent in longer bouts and females tended to decrease the number of sit-to-stand transitions to achieve lower SB.

CONCLUSIONS

Decreases in SB were accomplished through reductions in shorter bouts of SB and likely through a variety of small changes that differed between individual participants and sexes.

Effects of Providing High-Fat versus High-Carbohydrate Meals on Daily and Postprandial Physical Activity and Glucose Patterns: a Randomised Controlled Trial

We determined the effects of altering meal timing and diet composition on temporal glucose homeostasis and physical activity measures. Eight sedentary, overweight/obese men (mean ± SD, age: 36 ± 4 years; BMI: 29.8 ± 1.8 kg/m²) completed two × 12-day (12-d) measurement periods, including a 7-d habitual period, and then 5 d of each diet (high-fat diet [HFD]: 67:15:18% fat:carbohydrate:protein versus high-carbohydrate diet [HCD]: 67:15:18% carbohydrate:fat:protein) of three meals/d at ±30 min of 0800 h, 1230 h, and 1800 h, in a randomised order with an 8-d washout. Energy intake (EI), the timing of meal consumption, blood glucose regulation (continuous glucose monitor system (CGMS)), and activity patterns (accelerometer and inclinometer) were assessed across each 12-d period. Meal provision did not alter the patterns of reduced physical activity, and increased sedentary behaviour following dinner, compared with following breakfast and lunch. The HCD increased peak (+1.6 mmol/L, p < 0.001), mean (+0.5 mmol/L, p = 0.001), and total area under the curve (+670 mmol/L/min, p = 0.001), as well as 3-h postprandial meal glucose concentrations (all p < 0.001) compared with the HFD. In overweight/obese males, the provision of meals did not alter physical activity patterns, but did affect glycaemic control. Greater emphasis on meal timing and composition is required in diet and/or behaviour intervention studies to ensure relevance to real-world behaviours.

Using a Smartphone-Based Ecological Momentary Assessment Protocol With Community Dwelling Older African Americans

OBJECTIVES

Little is known about the feasibility of smartphone-based Ecological Momentary Assessment (EMA) approaches to collect psychosocial data from older populations, especially disadvantaged older populations. In response to this gap, this report provides evidence of the feasibility and utility of a smartphone-based EMA approach for real-time assessment with older African Americans. In addition, we share lessons learned about how to improve utility.

METHODS

Ninety-seven older African Americans ages 55 and older (range: 55-95 years) used an Android smartphone loaded with an EMA application to provide data about their everyday activities and stress four times per day for seven consecutive days.

RESULTS

Exit interviews early in the study suggested enhancements to the EMA interface. Adherence was demonstrated with response completion rates of 92-98% on EMA measures and no participant attrition based on the EMA protocol.

DISCUSSION

Our findings suggest using a smartphone-based EMA approach for data collection is feasible and has utility with older African Americans. We most likely enhanced adherence by testing, training, monitoring, and adapting the EMA protocol using input from older adults early in the EMA design process.

Association between Sedentary Behaviour and Physical, Cognitive, and Psychosocial Status among Older Adults in Assisted Living

Objective

Identification of the factors that influence sedentary behaviour in older adults is important for the design of appropriate intervention strategies. In this study, we determined the prevalence of sedentary behaviour and its association with physical, cognitive, and psychosocial status among older adults residing in Assisted Living (AL).

Methods

Participants (n = 114, mean age = 86.7) from AL sites in British Columbia wore waist-mounted activity monitors for 7 consecutive days, after being assessed with the Timed Up and Go (TUG), Montreal Cognitive Assessment (MoCA), Short Geriatric Depression Scale (GDS), and Modified Fall Efficacy Scale (MFES).

Results

On average, participants spent 87% of their waking hours in sedentary behaviour, which accumulated in 52 bouts per day with each bout lasting an average of 13 minutes. Increased sedentary behaviour associated significantly with scores on the TUG (r = 0.373, p < 0.001) and MFES (r = −0.261, p = 0.005), but not with the MoCA or GDS. Sedentary behaviour also associated with male gender, use of mobility aid, and multiple regression with increased age.

Conclusion

We found that sedentary behaviour among older adults in AL associated with TUG scores and falls-related self-efficacy, which are modifiable targets for interventions to decrease sedentary behaviour in this population.

An Evaluation of Accelerometer-derived Metrics to Assess Daily Behavioral Patterns

INTRODUCTION

The way physical activity (PA) and sedentary behavior (SB) are accumulated throughout the day (i.e., patterns) may be important for health, but identifying measurable and meaningful metrics of behavioral patterns is challenging. This study evaluated accelerometer-derived metrics to determine whether they predicted PA and SB patterns and were reliably measured.

METHODS

We defined and measured 55 metrics that describe daily PA and SB using data collected by using the activPAL monitor in four studies. The first two studies were randomized crossover designs that included recreationally active participants. Study 1 experimentally manipulated time spent in moderate-to-vigorous-intensity PA and sedentary time, and study 2 held time in exercise constant and manipulated SB. Study 3 included inactive participants who increased exercise, decreased sedentary time, or both. The study conditions induced distinct behavioral patterns; thus, we tested whether the new metrics could improve the prediction of an individual's study condition after adjusting for the overall volume of PA or SB using conditional logistic regression. In study 4, we measured the 3-month reliability for the pattern metrics by calculating intraclass correlation coefficients in a community-dwelling sample who wore the activPAL monitor twice for 7 d.

RESULTS

In each of the experimental studies, we identified new metrics that could improve the accuracy for predicting condition beyond SB and moderate-to-vigorous-intensity PA volume. In study 1, 23 metrics were predictive of a highly active condition, and in study 2, 24 metrics were predictive of a highly sedentary condition. In study 4, the median intraclass correlation coefficients (25-75th percentiles) of the metrics were 0.59 (0.46-0.65).

CONCLUSIONS

Several new metrics were predictive of patterns of SB, exercise, and nonexercise behavior and are moderately reliable for a 3-month period. Applying these metrics to determine whether daily behavioral patterns are associated with health-outcomes is an important area of future research.

Intra-Individual Variability of Physical Activity in Older Adults With and Without Mild Alzheimer's Disease

Physical activity shows promise for protection against cognitive decline in older adults with and without Alzheimer's disease (AD). To better understand barriers to adoption of physical activity in this population, a clear understanding of daily and weekly activity patterns is needed. Most accelerometry studies report average physical activity over an entire wear period without considering the potential importance of the variability of physical activity. This study evaluated individual differences in the amount and intra-individual variability of physical activity and determined whether these differences could be predicted by AD status, day of wear, age, gender, education, and cardiorespiratory capacity. Physical activity was measured via accelerometry (Actigraph GT3X+) over one week in 86 older adults with and without AD (n = 33 and n = 53, respectively). Mixed-effects location-scale models were estimated to evaluate and predict individual differences in the amount and intra-individual variability of physical activity. Results indicated that compared to controls, participants with AD averaged 21% less activity, but averaged non-significantly greater intra-individual variability. Women and men averaged similar amounts of physical activity, but women were significantly less variable. The amount of physical activity differed significantly across days of wear. Increased cardiorespiratory capacity was associated with greater average amounts of physical activity. Investigation of individual differences in the amount and intra-individual variability of physical activity provided insight into differences by AD status, days of monitor wear, gender, and cardiovascular capacity. All individuals regardless of AD status were equally consistent in their physical activity, which may have been due to a highly sedentary sample and/or the early disease stage of those participants with AD. These results highlight the value of considering individual differences in both the amount and intra-individual variability of physical activity.

Breaking-up sedentary time is associated with impairment in activities of daily living

Identifying modifiable behaviors associated with prevention of activities of daily living (ADL) impairments is vital to implement preventive strategies for independent living in elderly. We aimed to examine the associations between objectively measured breaks in sedentary time with ADL impairments and physical independence. Cross-sectional assessments were carried out in 371 participants (131 male) aged 65-103 years from the Portuguese surveillance system of physical activity. Physical activity (PA) and sedentary time (ST) were assessed with accelerometry, and ADL impairments and physical independence with the self-reported 12-item composite physical function scale. Using ROC analyses a cut-off of 7 hourly breaks in sedentary time was identified which maximized the sensitivity and specificity in diagnosing physical dependence. Logistic regression analysis demonstrated that, independently of moderate-to-vigorous PA (MVPA), participants performing ≤ 7 hourly breaks in sedentary time had 2 to 7 fold increased odds for impairment in 10 of the 12 ADL. When stratifying ADL into basic, instrumental and advanced ADL we verified that less than 7 hourly breaks in sedentary time was associated with a 2 to 5 fold increased odds for impairments and physical dependence, independent of MVPA. No associations were observed between meeting PA guidelines and basic, instrumental, and advanced ADL impairment although time in MVPA was lower in participants showing impairments. In conclusion, the frequency of breaks in sedentary time in older ages is independently associated with lower risk for ADL impairments and physical dependence. Our findings support interventions to encourage older adults to increase overall PA by interrupting sedentary time.