Exploring adults' experiences of sedentary behaviour and participation in non-workplace interventions designed to reduce sedentary behaviour: a thematic synthesis of qualitative studies

Exploring sedentary behavior during neo- or adjuvant treatment in patients with cancer: A phenomenological study

PURPOSE

Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment.

METHODS

Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior.

RESULTS

The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image.

CONCLUSIONS

Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

Effect of wearing surgical mask during controlled aerobic training on functional capacity and perceived stress in inactive men: a randomized trial

The study aims to assess the impact of wearing a surgical mask during training on inactive men's functional capacity and perceived stress. Seventy non-smoker males with body mass index of 25-30 kg/m2 and moderate-intensity activity of fewer than 150 min/week were allocated randomly into two equal groups. The surgical mask group performed a controlled endurance exercise while wearing a surgical mask of three protection layers. The mask-less group performed a controlled endurance exercise without wearing any mask. Functional capacity and Perceived Stress were evaluated before and after the intervention. A significant improvement was observed within groups post-intervention in favor of the mask group regarding the Time Up and Go test (P < 0.05), with a 15.1% percentage improvement. Post-intervention, there was a significant change in the perceived stress score for the mask and mask-less groups (P < 0.05). The improvement in PSS was in favor of mask-less group participants as they changed from being categorized as moderate to mild stress on the PSS, with a 27.1% percentage improvement. Exercising while wearing a surgical mask Positive impacts functional capacity and negatively impacts Perceived Stress in inactive adults. An additional study evaluating the physiological effects of masks on continuous exercise is necessary.

The Quiet Epidemic: An Overview of Emerging Qualitative Research Trends on Sedentary Behavior in Aging Populations

Sedentary behavior poses a significant health risk to older adults. The purpose of this scoping review is to summarize key findings from qualitative research (since 2012), with a focus on explaining prevailing research trends and patterns within the field. This review included 25 studies that met the strict inclusion criteria. Five key research themes have emerged: (1) defining and shaping perspectives of sedentary behavior, (2) understanding the dynamics of daily routines and contexts, (3) raising awareness of older adults' perceived advantages and disadvantages of sedentary behavior, (4) identifying its determinants and discouraging factors, and (5) exploring interventions to promote active behaviors and reduce sedentary behavior. These themes highlight the multifaceted nature of SB and underscore the importance of tailoring interventions to address individual, social, and environmental issues. A comprehensive understanding of SB is critical to developing effective strategies to promote active lifestyles and reduce SB in older adults. Further qualitative research is needed to deepen our understanding and develop targeted interventions and strategies.

The meaning of sedentary behavior among older adults: a phenomenological hermeneutic study

BACKGROUND

A sedentary lifestyle has implications for health and well-being. For healthy ageing, it is recommended to interrupt prolonged sitting; however, little is known about the meaning of sedentary behavior among older adults. The aim of this study was to understand the meaning of sedentary behavior among older adults with initial support from community care.

METHODS

A phenomenological hermeneutics approach was used, and individual interviews were conducted with sixteen older adults aged 70 to 97 years, by phone and face to face. The older adults lived in ordinary housing in southern Sweden and received initial support from community care.

RESULTS

The interviews yielded three key themes: Being sedentary is an unnatural part of life, having an ageing body means unwanted frailty, and having a sedentary lifestyle is based on conscious choices.

CONCLUSION

Being sedentary means having a lack of physical activity and social interactions, resulting in wanting to be more physically active than sometimes possible. Clinical practitioners should bear in mind that becoming more sedentary is inevitable with an ageing body, but that older adults may have an innate desire to be as physically active as possible. A lifelong exposure to physical activity, the possibility of well-being found in sedentary activities and the impact of social networks should not be overlooked when creating clinical interventions to break unhealthy sedentary behavior among older adults. To increase the understanding of sedentary behavior among older adults, future research could focus on the impact of physical impairment on sedentary behavior and the relationship between sedentary behavior and physical activity throughout life.

Exploring the content of the STAND-VR intervention: A qualitative interview study

Prolonged sedentary behaviour has been identified as a potential independent contributor to a number of chronic conditions as well as mortality. The integration of digital technology into health behaviour change interventions has been shown to contribute to increases in physical activity levels, reductions in time spent sedentary, reductions in systolic blood pressure and improvements physical functioning. Recent evidence suggests that older adults could be motivated to adopt a technology such as immersive virtual reality (IVR) due to the added agency it can potentially afford them in their lives through physical and social activities offered in IVR. To date, little research has attempted to integrate health behaviour change content into an immersive virtual environment. This study aimed to qualitatively explore older adults' perspectives on the content of a novel intervention, STAND-VR, and how it could be integrated into an immersive virtual environment. This study was reported using the COREQ guidelines. Twelve participants aged between 60 and 91 years took part. Semi-structured interviews were conducted and analysed. Reflexive thematic analysis was the chosen method of analysis. Three themes were developed, "Immersive Virtual Reality: The Cover versus the Contents", "Ironing Out the (Behavioural) Details" and, "When Two Worlds Collide". These themes offer insights into how retired and non-working adults perceived IVR before and after use, how they would like to learn how to use IVR, the content and people they would like to interact with and finally, their beliefs about their sedentary activity and using IVR. These findings will contribute to future work which aims to design IVR experiences that are more accessible to retired and non-working adults, offering greater agency to take part in activities that reduce sedentary behaviour and improve associated health outcomes and, importantly, offer further opportunity to take part in activities they can ascribe greater meaning to.

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

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

Evolution led humans to bipedalism, but we live in a sedentary society: Will "Sunday running" protect us from NCDs at no cost?

Evolution led humans to bipedal stance and movement. However, we live in a sedentary society that strongly challenges our willingness to be physically active. We (mis)understand that being at least a Sunday runner could protect us from sedentary-related diseases, but what if this compromises the healthier life expectancy anyway? Citing Paul Gauguin, we know where we come from and what we are, the question arises about where we are going. And also, how.

Effect of Weight Goals on Sitting and Moving During a Worksite Sedentary Time Reduction Intervention

Introduction/Purpose

Although many US adults report trying to lose weight, little research has examined weight loss goals as a motivator for reducing workplace sitting and increasing physical activity. This exploratory analysis examined weight goals and the association with changes in workplace sitting, physical activity, and weight.

Methods

Employees (N = 605) were drawn from worksites participating in Stand and Move at Work. Worksites (N = 24) were randomized to a multilevel behavioral intervention with (STAND+) or without (MOVE+) sit-stand workstations for 12 months; MOVE+ worksites received sit-stand workstations from 12 to 24 months. At each assessment (baseline and 3, 12, and 24 months), participants were weighed and wore activPAL monitors. Participants self-reported baseline weight goals and were categorized into the "Lose Weight Goal" (LWG) group if they reported trying to lose weight or into the "Other Weight Goal" (OWG) group if they did not.

Results

Generalized linear mixed models revealed that within STAND+, LWG and OWG had similar sitting time through 12 months. However, LWG sat significantly more than OWG at 24 months. Within MOVE+, sitting time decreased after introduction of sit-stand workstations for LWG and OWG, although LWG sat more than OWG. Change in physical activity was minimal and weight remained stable in all groups.

Conclusions

Patterns of change in workplace sitting were more favorable in OWG relative to LWG, even in the absence of notable weight change. Expectations of weight loss might be detrimental for reductions in workplace sitting. Interventionists may want to emphasize non-weight health benefits of reducing workplace sitting.

I Sit but I Don't Know Why: Investigating the Multiple Precursors of Leisure-Time Sedentary Behaviors

Background: Precursors driving leisure-time sedentary behaviors remain poorly investigated, despite their detrimental consequences. This study aimed to investigate the predictive validity of controlled and automatic motivational precursors toward reducing sedentary behaviors and being physically active on leisure-time sedentary behaviors. The influence of demographic, physical, socio-professional, interpersonal, and environmental variables was also examined and compared with the associations of motivational precursors. Methods: 125 adults completed questionnaires measuring controlled motivational precursors (i.e., intentions, perceived competence), demographical (i.e., sex and age), physical (i.e., body mass index), and interpersonal (i.e., number of children) variables. Regarding automatic motivational precursors, habit strength and approach-avoidance tendencies were captured using the Self-Report Behavioral Automaticity Index and a manikin task. Time at work was computed as a socio-professional variable, days of the week and weather conditions were recorded as environmental precursors. Participants wore an accelerometer for 7 days and leisure time was identified using notebooks. Associations between the different precursors and the leisure-time sedentary behaviors were examined in linear mixed effect models. Results: Intention to be physically active and habit strength toward physical activity were negatively associated with leisure-time sedentary behaviors. Sex, body mass index, time at work, number of children, day of the week, and weather conditions were more strongly associated with leisure-time sedentary behaviors. Conclusion: Our findings show that, in comparison with other variables, the influence of motivational precursors on leisure-time sedentary behaviors is limited. This study supports the adoption of a broad-spectrum of precursors when predicting sedentary behaviors.

Planning for a Healthy Aging Program to Reduce Sedentary Behavior: Perceptions among Diverse Older Adults

Reducing prolonged engagement in sedentary behavior is increasingly considered a viable pathway to older-adult health and continued functional ability. Community-based programs that aim to increase physical activity can improve programs' acceptability by integrating older adults' perspectives on sedentary behavior and healthy aging into their design. The purpose of this study was to better understand the perceptions of a diverse group of community-dwelling older adults regarding sedentary behavior and its influence on healthy aging. Six focus group discussions with forty-six participants took place across two senior centers in New York City. Self-report questionnaires about daily activity patterns, general health status, and typical sedentary behaviors were also completed by the participants and analyzed using descriptive statistics. The focus group discussions were audio-recorded, transcribed, and analyzed using inductive and deductive approaches and an ecological framework to identify salient themes. A qualitative analysis revealed that the participants were aware of the physical costs of engaging in prolonged sedentary behavior. However, many routine sedentary activities were perceived to be health-promoting and of psychological, cognitive, or social value. The insights gained can inform the development of senior-center programs and health-promotion messaging strategies that aim to reduce older adults' sedentary behavior.

Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults

OBJECTIVES

To systematically review and synthesise findings from process evaluations of interventions in trials which measured sedentary behaviour as an outcome in adults to explore: (1) how intervention content, implementation, mechanisms of impact and context influence outcomes and (2) how these interventions are experienced from different perspectives (participants, carers, staff).

DESIGN

Systematic review and narrative synthesis underpinned by the Medical Research Council process evaluation framework.

DATA SOURCES

Databases searches were conducted in March 2019 then updated in May 2020 and October 2021 in: CINAHL, SPORTDiscus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, AMED; EMBASE, PsycINFO, MEDLINE, Web of Science and ProQuest Dissertations & Theses.

ELIGIBILITY CRITERIA

We included: Process evaluations of trials including interventions where sedentary behaviour was measured as an outcome in adults aged 16 or over from clinical or non-clinical populations. We excluded studies if interventions were delivered in educational or workplace settings, or if they were laboratory studies focused on immediate effects of breaking sitting.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted and coded data into a framework and assessed the quality of studies using the Mixed Methods Appraisal Tool. We synthesised findings using a narrative approach.

RESULTS

17 process evaluations were included. Five interventions focused on reducing sedentary behaviour or sitting time, 12 aimed to increase physical activity or promote healthier lifestyles. Process evaluations indicated changes in sedentary behaviour outcomes were shaped by numerous factors including: barriers (eg, staffing difficulties and scheduling problems) and facilitators (eg, allowing for flexibility) to intervention delivery; contextual factors (eg, usual lifestyle and religious events) and individual factors (eg, pain, tiredness, illness, age and individual preferences).

DISCUSSION

Intervention requires careful consideration of different factors that could influence changes in sedentary behaviour outcomes to ensure that interventions can be tailored to suit different individuals and groups.

PROSPERO REGISTRATION NUMBER

CRD42018087403.

Measurement of Barriers, Attitudes, and Expectations for Sitting Less in Pregnancy

OBJECTIVE

Our objective was to develop, validate, and describe findings from an instrument to measure barriers, attitudes, and outcome expectations of sitting less in pregnant women.

METHODS

This validation (sub-study 1) and descriptive study (sub-study 2) evaluated a new questionnaire measuring sedentary time in pregnant women (N=131) in each trimester.

RESULTS

In sub-study 1, construct validity was supported by associations between device-measured sedentary time and questionnaire scores. An optimized questionnaire removed infrequently reported and non-correlated items. The original and optimized questionnaires with scoring instructions are provided. In sub-study 2, physical symptoms and work were most commonly reported as major reasons for sitting in pregnancy, followed by leisure, family, and social activities. Some women reported limiting sitting due to boredom/restlessness, to improve energy or health, and to control weight. In the third trimester, some women reported sitting more/less due to pain and encouragement from family, friends, and co-workers. Few women reported household chores or pregnancy risks as reasons to sit, felt sitting was healthy or necessary during pregnancy, or were encouraged to sit by healthcare providers.

CONCLUSIONS

The developed questionnaire demonstrated validity and identified barriers to and expectations of sitting less during pregnancy. Prenatal interventions to reduce sitting should address general and pregnancy-specific barriers.

Sedentary Behavior and Associated Factors Among Working Adults in Eastern Ethiopia

Background: Sedentary behavior is a major risk factor for non-communicable diseases. Due to changes in lifestyle, sedentary behavior is increasing in sub-Saharan Africa. However, information on the extent of sedentarism among various segments of the population is scant in low-income countries. The objective of this study was to assess the extent of high sedentary behavior and associated factors among working adults in eastern Ethiopia.

Methods: A crosssectional study was conducted among 1,164 working adults at Haramaya University from December 2018 to February 2019. Data were collected through face-to-face interviews using the WHO STEPS and sedentary behavior questionnaire. All reported sedentary activities were added to calculate the total number of hours spent on sedentary behavior, which was then dichotomized into two categories. Those who had ≥8 sedentary hours per day were categorized as having high sedentary behavior. The prevalence ratio (PR) with 95% confidence intervals (CIs) was calculated. Factors associated with outcome variables were identified using Poisson regression with a robust variance statistical model.

Results: The prevalence of high sedentary behavior was 20.3% (95% CI, 18.0–22.7%) among the study participants. The prevalence of high sedentary behavior was associated with age 45–54 years adjusted PR (APR: 2.00; 95% CI = 1.01–3.97) and 55–64 years (APR: 2.16; 95% CI = 1.03–4.57), being a non-manual worker (APR: 2.11; 95% CI = 1.46–3.05), frequent khat chewers (APR: 1.57; 95% CI = 1.22–2.01), with body mass index of ≥25 kg/m² (APR: 1.93; 95% CI = 1.53–2.44), and regular alcohol drinker (APR: 1.39; 95% CI = 1.11–1.76).

Conclusion: One-fifth of working adults had high sedentary behavior. Factors associated with high sedentary behaviors were older age, being a non-manual worker, substance-use behaviors, and having a high body mass index.

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.

Body weight perception outweighs body weight when predicting shame, criticism, depression and anxiety for lower BMI range and higher BMI range adults

This study examined the relationship between body weight shame, self-criticism and mental health for individuals across body weight ranges. In total 1695 participants completed a series of online measures and we used Structural Equation Modelling, to assess for the relationship between weight, perceived weight, social rank (social comparison, body weight shame, submissiveness) self-criticism (inadequate and self-hatred) and anxious and depressive symptoms. Results indicated that perceived body weight is more important than actual body weight in predicting body weight shame. Importantly, individuals classified in higher BMI ranges rely more on the self-hatred form of self-criticism which significantly predicts anxious and depressive symptoms.

A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain

Background

Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one’s ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants’ perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms.

Methods

Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants.

Results

Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED.

Conclusion

This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10238-5.

A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke

Background

Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke.

Methods

A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development.

Findings

Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience.

Conclusions

To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

Reducing Sedentary Time among Older Adults in Assisted Living: Perceptions, Barriers, and Motivators

Older adults accumulate more sedentary time (ST) than any other age group, especially those in assisted living residences (ALRs). Reducing prolonged ST could help maintain function among older adults. However, to develop effective intervention strategies, it is important to understand the factors that influence sedentary behavior. The purpose of this study was to explore perceptions of ST as well as barriers and motivators to reducing ST among older adults in assisted living, in the context of the Social Ecological Model (SEM). Using a qualitative description approach, we sought to learn about participants’ perceptions of sedentary time in their daily lives. Semi-structured focus groups were held at six ALRs with 31 participants (84% women, 83.5 ± 6.5 years). Data were transcribed and coded using an inductive thematic approach. Themes were categorized based on four levels of the SEM: individual, social, physical environment, and organization. Many reported barriers were at the individual level (e.g., lack of motivation, pain, fatigue) while others were associated with the organization or social environment (e.g., safety concerns, lack of activities outside of business hours, and social norms). These findings suggest that there are unique challenges and opportunities to consider when designing ST interventions for assisted living.