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Alessy SA, Malkin JD, Finkelstein EA, AlAhmed R, Baattaiah BA, Evenson KR, Rakic S, Cetinkaya V, Herbst CH, Al-Hazzaa HM, Alqahtani SA. Effectiveness of Interventions Promoting Physical Activity and Reducing Sedentary Behavior in Community-Dwelling Older Adults: An Umbrella Review With Application to Saudi Arabia. J Epidemiol Glob Health 2023; 13:361-373. [PMID: 37199911 PMCID: PMC10193325 DOI: 10.1007/s44197-023-00111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
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.
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Affiliation(s)
- Saleh A. Alessy
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Centre for Cancer, Society and Public Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Eric A. Finkelstein
- Duke-NUS Medical School, Health Services and System Research Program, Singapore, Singapore
| | - Reem AlAhmed
- King Faisal Specialist Hospital & Research Center, Liver Transplant Center, Riyadh, Saudi Arabia
| | - Baian A. Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina USA
| | | | | | | | - Hazzaa M. Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- King Faisal Specialist Hospital & Research Center, Liver Transplant Center, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD USA
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Lu F, Wong CKH, Tse ETY, Ng APP, Li L, Lam JSM, Bedford L, Fong DYT, Ip P, Lam CLK. The Impact of a Health Empowerment Program on Self-Care Enablement and Mental Health among Low-Income Families: Evidence from a 5 Year Cohort Study in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5168. [PMID: 36982089 PMCID: PMC10049337 DOI: 10.3390/ijerph20065168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Health empowerment can be an effective way to reduce health inequities. This prospective cohort study evaluated the 5 year impact of a health empowerment program (HEP) on health outcomes among adults from low-income families. The Patient Enablement Instrument version 2 (PEI-2), Depression, Anxiety and Stress Scale 21 (DASS-21), and 12 item Short-Form Health Survey version 2 (SF-12v2) were administered at baseline and follow-up for both intervention and comparison groups. A total of 289 participants (n = 162 for intervention group, n = 127 for comparison group) were included in the analysis. Most of the participants were female (72.32%), and aged from 26 to 66 years old (M = 41.63, SD = 6.91). Linear regressions weighted by inverse probability weighting using the propensity score showed that, after follow-up of 5 years, the intervention group demonstrated significantly greater increases in all items and total scores for the PEI-2 (all B > 0.59, p < 0.001), greater decreases in the DASS depression score (B = -1.98 p = 0.001), and greater increases in the Mental Component Summary score of the SF-12v2 (B = 2.99, p = 0.027) than the comparison group. The HEP may be an effective intervention enabling adults from low-income families to manage their health-related issues and improve their mental health, as evidenced by our study.
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Affiliation(s)
- Fangcao Lu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong 999077, China
| | - Emily Tsui Yee Tse
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
| | - Lanlan Li
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Joyce Sau Mei Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Laura Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong 999077, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
- Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518000, China
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Wadsworth DP, Tulloch K, Wright H, Linton C, Baker J, Fien S, Szabo H, Askew CD, Schaumberg MA. Learning from the lived experience of functionally healthy older adults: What does it mean to be “healthy”? Collegian 2023. [DOI: 10.1016/j.colegn.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Chastin S, Gardiner PA, Harvey JA, Leask CF, Jerez-Roig J, Rosenberg D, Ashe MC, Helbostad JL, Skelton DA. Interventions for reducing sedentary behaviour in community-dwelling older adults. Cochrane Database Syst Rev 2021; 6:CD012784. [PMID: 34169503 PMCID: PMC8225503 DOI: 10.1002/14651858.cd012784.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Older adults are the most sedentary segment of society, often spending in excess of 8.5 hours a day sitting. Large amounts of time spent sedentary, defined as time spend sitting or in a reclining posture without spending energy, has been linked to an increased risk of chronic diseases, frailty, loss of function, disablement, social isolation, and premature death. OBJECTIVES To evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, EPPI-Centre databases (Trials Register of Promoting Health Interventions (TRoPHI) and the Obesity and Sedentary behaviour Database), WHO ICTRP, and ClinicalTrials.gov up to 18 January 2021. We also screened the reference lists of included articles and contacted authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. We included interventions purposefully designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We included studies if some of the participants had multiple comorbidities, but excluded interventions that recruited clinical populations specifically (e.g. stroke survivors). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and full-text articles to determine study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. Any disagreements in study screening or data extraction were settled by a third review author. MAIN RESULTS We included seven studies in the review, six RCTs and one cluster-RCT, with a total of 397 participants. The majority of participants were female (n = 284), white, and highly educated. All trials were conducted in high-income countries. All studies evaluated individually based behaviour change interventions using a combination of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Four of the seven studies also measured secondary outcomes. The main sources of bias were related to selection bias (N = 2), performance bias (N = 6), blinding of outcome assessment (N = 2), and incomplete outcome data (N = 2) and selective reporting (N=1). The overall risk of bias was judged as unclear. Primary outcomes The evidence suggests that interventions to change sedentary behaviour in community-dwelling older adults may reduce sedentary time (mean difference (MD) -44.91 min/day, 95% confidence interval (CI) -93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low-certainty evidence). We could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes. Secondary outcomes We are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community-dwelling older adults. We were able to pool change data for the following outcomes. • Physical function (MD 0.14 Short Physical Performance Battery (SPPB) score, 95% CI -0.38 to 0.66; higher score is favourable; 98 participants; 2 studies; I2 = 26%; low-certainty evidence). • Waist circumference (MD 1.14 cm, 95% CI -1.64 to 3.93; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). • Fitness (MD -5.16 m in the 6-minute walk test, 95% CI -36.49 to 26.17; higher score is favourable; 80 participants; 2 studies; I2 = 29%; low-certainty evidence). • Blood pressure: systolic (MD -3.91 mmHg, 95% CI -10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low-certainty evidence) and diastolic (MD -0.06 mmHg, 95% CI -5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low-certainty evidence). • Glucose blood levels (MD 2.20 mg/dL, 95% CI -6.46 to 10.86; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). No data were available on cognitive function, cost-effectiveness or adverse effects. AUTHORS' CONCLUSIONS It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community-dwelling older adults. We are uncertain if these interventions have any impact on the physical or mental health of community-dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision. Future studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device-based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost-effectiveness, and adverse event data.
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Affiliation(s)
- Sebastien Chastin
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Sciences, Ghent University, Gent, Belgium
| | - Paul A Gardiner
- School of Health & Wellbeing, University of Southern Queensland, Ipswich, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Juliet A Harvey
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Calum F Leask
- Aberdeen City Health & Social Care Partnership, Aberdeen, UK
| | - Javier Jerez-Roig
- Department of Social Sciences and Community Health, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia, Vic, Spain
| | - Dori Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Jorunn L Helbostad
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dawn A Skelton
- School of Health & Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
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Aunger JA, Greaves CJ, Davis ET, Asamane EA, Whittaker AC, Greig CA. A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): results of a randomised-controlled feasibility study. Aging Clin Exp Res 2020; 32:2565-2585. [PMID: 31975288 PMCID: PMC7680324 DOI: 10.1007/s40520-020-01475-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Osteoarthritis is a prevalent condition in older adults that causes many patients to require a hip or knee replacement. Reducing patients' sedentariness prior to surgery may improve physical function and post-operative outcomes. METHODS We conducted a pragmatic randomised-controlled feasibility study with 2:1 allocation into intervention or usual care groups. The intervention, based on Self-Determination Theory, involved techniques to reduce sedentary behaviour, including motivational interviewing, setting of behavioural goals, and more. The primary outcome was feasibility, assessed using mixed methods. We included exploratory measures to inform a future definitive trial, such as ActivPal3 accelerometry to measure movement, the Short Physical Performance Battery (SPPB), Basic Psychological Needs, and cardiometabolic biomarkers. Assessments were at baseline, 1-week pre-surgery, and 6-week post-surgery. RESULTS We recruited 35 participants aged ≥ 60 years approximately 8 weeks before hip or knee arthroplasty. Participant uptake rate was 14.2%, and retention rate 85.7%. Participants were very satisfied with the study which was found to be feasible with some modifications. Exploratory within-group comparisons found that the intervention has potential to improve SPPB by 0.71 points from baseline to pre-surgery, a clinically significant increase, and reduce sedentary time by up to 66 min d-1. CONCLUSION In this older surgical population, it is feasible to use behavioural techniques to displace sedentary time to activity and to conduct a trial spanning the period of surgical intervention. This may improve physical function and surgical outcomes. The INTEREST intervention is now ready for evaluation in a full-scale randomised-controlled trial. REGISTRATION This trial was registered on Clinicaltrials.gov on 13/11/2018. ID: NCT03740412.
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Affiliation(s)
- Justin Avery Aunger
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK.
- Health Services Management Centre, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Colin J Greaves
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Edward T Davis
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Evans Atiah Asamane
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
- School of Primary, Community, and Social Care, Keele University, Staffordshire, ST5 5BG, UK
| | - Anna C Whittaker
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Carolyn Anne Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, UK
- MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
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Chase JAD, Otmanowski J, Rowland S, Cooper PS. A systematic review and meta-analysis of interventions to reduce sedentary behavior among older adults. Transl Behav Med 2020; 10:1078-1085. [DOI: 10.1093/tbm/ibz189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
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 < .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.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | | | - Sheri Rowland
- College of Nursing – Lincoln Division, University of Nebraska, Lincoln, NE, USA
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Voss ML, Pope JP, Larouche R, Copeland JL. Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living. BMC Geriatr 2020; 20:277. [PMID: 32762644 PMCID: PMC7409493 DOI: 10.1186/s12877-020-01647-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This “low movement” environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted. Methods “Stand When You Can” (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility. Results There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although device-measured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen’s d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical. Conclusion This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary. Trial registration Name of Clinical Trial Registry: clinicaltrials.gov Trial Registration number: NCT04458896. Date of registration: July 8, 2020. (Retrospectively registered).
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Affiliation(s)
- M L Voss
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - J P Pope
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - R Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Canada
| | - J L Copeland
- Department of Kinesiology & Physical Education, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
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Blackburn NE, Wilson JJ, McMullan II, Caserotti P, Giné-Garriga M, Wirth K, Coll-Planas L, Alias SB, Roqué M, Deidda M, Kunzmann AT, Dallmeier D, Tully MA. The effectiveness and complexity of interventions targeting sedentary behaviour across the lifespan: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2020; 17:53. [PMID: 32334631 PMCID: PMC7183680 DOI: 10.1186/s12966-020-00957-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence suggests that sedentary behaviour (SB) is associated with poor health outcomes. SB at any age may have significant consequences for health and well-being and interventions targeting SB are accumulating. Therefore, the need to review the effects of multicomponent, complex interventions that incorporate effective strategies to reduce SB are essential. METHODS A systematic review and meta-analysis were conducted investigating the impact of interventions targeting SB across the lifespan. Six databases were searched and two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias and complexity of each of the included studies. RESULTS A total of 77 adult studies (n=62, RCTs) and 84 studies (n=62, RCTs) in children were included. The findings demonstrated that interventions in adults when compared to active controls resulted in non-significant reductions in SB, although when compared to inactive controls significant reductions were found in both the short (MD -56.86; 95%CI -74.10, -39.63; n=4632; I2 83%) and medium-to-long term (MD -20.14; 95%CI -34.13, -6.16; n=4537; I2 65%). The findings demonstrated that interventions in children when compared to active controls may lead to relevant reductions in daily sedentary time in the short-term (MD -59.90; 95%CI -102.16, -17.65; n=267; I2 86%), while interventions in children when compared to inactive controls may lead to relevant reductions in the short-term (MD -25.86; 95%CI -40.77, -10.96; n=9480; I2 98%) and medium-to-long term (MD -14.02; 95%CI -19.49, -8.55; n=41,138; I2 98%). The assessment of complexity suggested that interventions may need to be suitably complex to address the challenges of a complex behaviour such as SB, but demonstrated that a higher complexity score is not necessarily associated with better outcomes in terms of sustained long-term changes. CONCLUSIONS Interventions targeting reductions in SB have been shown to be successful, especially environmental interventions in both children and adults. More needs to be known about how best to optimise intervention effects. Future intervention studies should apply more rigorous methods to improve research quality, considering larger sample sizes, randomised controlled designs and valid and reliable measures of SB.
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Affiliation(s)
- Nicole E Blackburn
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom.
| | - Jason J Wilson
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Ilona I McMullan
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), Syddansk Universitet, Odense, Denmark
| | - Maria Giné-Garriga
- Department of Sport Sciences, Faculty of Psychology, Education and Sport Sciences Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Katharina Wirth
- Agaplesion Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Laura Coll-Planas
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Sergi Blancafort Alias
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment-Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, United Kingdom
| | - Andrew T Kunzmann
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Mark A Tully
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, United Kingdom
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Matson TE, Anderson ML, Renz AD, Greenwood-Hickman MA, McClure JB, Rosenberg DE. Changes in Self-Reported Health and Psychosocial Outcomes in Older Adults Enrolled in Sedentary Behavior Intervention Study. Am J Health Promot 2019; 33:1053-1057. [PMID: 30957508 DOI: 10.1177/0890117119841405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To estimate changes in self-reported health and psychosocial factors associated with a 12-week sedentary behavior intervention for older adults. DESIGN Exploratory secondary analysis of pilot randomized controlled trial. SETTING Kaiser Permanente Washington. SUBJECTS Sixty adults aged 60 to 89 with body mass index ≥30 kg/m2. INTERVENTION Participants were randomized to the I-STAND intervention or control group. I-STAND involved 6 coaching sessions, a study workbook, Jawbone UP activity tracker to prompt breaks from sitting, and activPAL feedback on objective sitting time. MEASURES At baseline and 12-week follow-up, participants completed a survey with validated measures of self-reported health outcomes (depression, stress, memory/concentration, sleep, pain, ability to do daily activities, energy, and quality of life) and modified scales measuring psychosocial factors (perceived benefits/barriers, social support, self-efficacy, and sedentary habit strength) regarding sedentary behavior. ANALYSIS Generalized linear models assessed associations between group assignment and change in each self-reported health and psychosocial score, adjusting for baseline scores. RESULTS I-STAND participants demonstrated improvements in self-efficacy (β = 0.35, 95% confidence interval [CI]: 0.10 to 0.60) and reduced habit strength (β= -0.23, 95% CI: -0.42 to -0.04) compared to control participants. There were no significant differences in self-reported health outcomes, although power was limited in this exploratory analysis. CONCLUSION A sedentary behavior reduction intervention for older adults resulted in improvements for some psychosocial factors. Health outcomes may require longer than 12 weeks to observe improvements.
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Affiliation(s)
- Theresa E Matson
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Melissa L Anderson
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Anne D Renz
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Jennifer B McClure
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dori E Rosenberg
- 1 Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Dickins KA, Buchholz SW, Rivero T, Miller C. A review of reviews: Sedentary behaviour and cardiovascular disease specific to older people. Int J Older People Nurs 2018; 13:e12211. [DOI: 10.1111/opn.12211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/15/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Tania Rivero
- Rush University Medical Center; Chicago Illinois
| | - Corinne Miller
- Feinberg School of Medicine; Northwestern University; Chicago Illinois
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11
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Deidda M, Coll-Planas L, Giné-Garriga M, Guerra-Balic M, Roqué i Figuls M, Tully MA, Caserotti P, Rothenbacher D, Salvà Casanovas A, Kee F, Blackburn NE, Wilson JJ, Skjødt M, Denkinger M, Wirth K, McIntosh E. Cost-effectiveness of exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: protocol for an economic evaluation alongside the SITLESS three-armed pragmatic randomised controlled trial. BMJ Open 2018; 8:e022266. [PMID: 30327403 PMCID: PMC6194476 DOI: 10.1136/bmjopen-2018-022266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Promoting physical activity (PA) and reducing sedentary behaviour (SB) may exert beneficial effects on the older adult population, improving behavioural, functional, health and psychosocial outcomes in addition to reducing health, social care and personal costs. This paper describes the planned economic evaluation of SITLESS, a multicountry three-armed pragmatic randomised controlled trial (RCT) which aims to assess the short-term and long-term effectiveness and cost-effectiveness of a complex intervention on SB and PA in community-dwelling older adults, based on exercise referral schemes enhanced by a group intervention providing self-management strategies to encourage lifestyle change. METHODS AND ANALYSIS A within-trial economic evaluation and long-term model from both a National Health Service/personal social services perspective and a broader societal perspective will be undertaken alongside the SITLESS multinational RCT. Healthcare costs (hospitalisations, accident and emergency visits, appointment with health professionals) and social care costs (eg, community care) will be included in the economic evaluation. For the cost-utility analysis, quality-adjusted life-years will be measured using the EQ-5D-5L and capability well-being measured using the ICEpop CAPability measure for Older people (ICECAP-O) questionnaire. Other effectiveness outcomes (health related, behavioural, functional) will be incorporated into a cost-effectiveness analysis and cost-consequence analysis.The multinational nature of this RCT implies a hierarchical structure of the data and unobserved heterogeneity between clusters that needs to be adequately modelled with appropriate statistical and econometric techniques. In addition, a long-term population health economic model will be developed and will synthesise and extrapolate within-trial data with additional data extracted from the literature linking PA and SB outcomes with longer term health states.Methods guidance for population health economic evaluation will be adopted including the use of a long-time horizon, 1.5% discount rate for costs and benefits, cost consequence analysis framework and a multisector perspective. ETHICS AND DISSEMINATION The study design was approved by the ethics and research committee of each intervention site: the Ethics and Research Committee of Ramon Llull University (reference number: 1314001P) (Fundació Blanquerna, Spain), the Regional Committees on Health Research Ethics for Southern Denmark (reference number: S-20150186) (University of Southern Denmark, Denmark), Office for Research Ethics Committees in Northern Ireland (ORECNI reference number: 16/NI/0185) (Queen's University of Belfast) and the Ethical Review Board of Ulm University (reference number: 354/15) (Ulm, Germany). Participation is voluntary and all participants will be asked to sign informed consent before the start of the study.This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement number 634 270. This article reflects only the authors' view and the Commission is not responsible for any use that may be made of the information it contains.The findings of the study will be disseminated to different target groups (academia, policymakers, end users) through different means following the national ethical guidelines and the dissemination regulation of the Horizon 2020 funding agency.Use of the EuroQol was registered with the EuroQol Group in 2016.Use of the ICECAP-O was registered with the University of Birmingham in March 2017. TRIAL REGISTRATION NUMBER NCT02629666; Pre-results.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
| | - Laura Coll-Planas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Míriam Guerra-Balic
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Catalonia, Spain
| | - Marta Roqué i Figuls
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Mark A Tully
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | | | - Antoni Salvà Casanovas
- Fundació Salut i Envelliment–Universitat Autònoma de Barcelona, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Frank Kee
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nicole E Blackburn
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Jason J Wilson
- Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Mathias Skjødt
- Department of Sports Science and Clinical Biomechanics, Center for Active and Healthy Ageing (CAHA), University of Southern Denmark, Odense, Denmark
| | - Michael Denkinger
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Katharina Wirth
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit, Agaplesion Bethesda Clinic, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Glasgow, UK
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Aunger JA, Doody P, Greig CA. Interventions targeting sedentary behavior in non-working older adults: a systematic review. Maturitas 2018; 116:89-99. [PMID: 30244786 DOI: 10.1016/j.maturitas.2018.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/10/2018] [Accepted: 08/03/2018] [Indexed: 01/16/2023]
Abstract
Sedentary behavior has been found to be associated with negative health outcomes independently of physical activity in older adults. This systematic review collates interventions to reduce sedentary behavior in non-working older adults, assessing whether they are effective, feasible, and safe. A systematic search identified 2560 studies across five databases. Studies were included where participants were ≥60 years on average with none younger than 45, and participants did not work >2 days per week. A total of six studies were identified, three of which included control groups, while the other three were repeated-measures pre-post designs. Only one study randomised participants. The overall level of quality of included studies was poor. A narrative synthesis was conducted, as the level of heterogeneity in outcomes and outcome reporting were too high for a meta-analysis to be performed. The narrative synthesis suggested that interventions have the potential to reduce sitting time in non-working older adults. Included studies reported feasible and safe implementations of their interventions in most samples, except for one subsample from a study of people in sheltered housing. Objectively measured reductions in sitting time were between 3.2% and 5.3% of waking time, or up to 53.9 min per day. Future studies should employ more rigorous designs to assess the effects of reducing sedentary behavior on health and physical function, and should include follow-ups to measure the duration of behavior change.
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Affiliation(s)
- Justin Avery Aunger
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, B15 2TT, United Kingdom.
| | - Paul Doody
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, B15 2TT, United Kingdom.
| | - Carolyn Anne Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, B15 2TT, United Kingdom.
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13
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Results of the Sedentary Intervention Trial in Cardiac Rehabilitation (SIT-CR Study): A pilot randomized controlled trial. Int J Cardiol 2018; 269:317-324. [DOI: 10.1016/j.ijcard.2018.07.082] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022]
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14
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Matson TE, Renz AD, Takemoto ML, McClure JB, Rosenberg DE. Acceptability of a sitting reduction intervention for older adults with obesity. BMC Public Health 2018; 18:706. [PMID: 29879948 PMCID: PMC5992825 DOI: 10.1186/s12889-018-5616-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Older adults spend more time sitting than any other age group, contributing to poor health outcomes. Effective behavioral interventions are needed to encourage less sitting among older adults, specifically those with obesity, but these programs must be acceptable to the target population. We explored participant acceptance of a theory-based and technology-enhanced sitting reduction intervention designed for older adults (I-STAND). METHODS The 12-week I-STAND intervention consisted of 6 health coaching contacts, a study workbook, a Jawbone UP band to remind participants to take breaks from sitting, and feedback on sitting behaviors (generated from wearing an activPAL device for 7 days at the beginning and mid-point of the study). Semi-structured interviews were conducted with 22 participants after they completed the intervention. Interview transcripts were iteratively coded by a team, and thematic analysis was used to identify and refine emerging themes. RESULTS Overall, participants were satisfied with the I-STAND intervention, thought the sedentary behavior goals of the intervention were easy to incorporate, and found the technologies to be helpful additions to (but not substitutes for) health coaching. Barriers to standing more included poor health, ingrained sedentary habits, lack of motivation to change sedentary behavior, and social norms that dictate when it is appropriate to sit/stand. Facilitators to standing more included increased awareness of sitting, a sense of accountability, daily activities that involved standing, social support, and changing ways of interacting in the home environment. Participants reported that the intervention improved physical health, increased energy, increased readiness to engage in physical activity, improved mood, and reduced stress. CONCLUSIONS The technology-enhanced sedentary behavior reduction intervention was acceptable, easy to incorporate, and had a positive perceived health impact on older adults with obesity. TRIAL REGISTRATION The I-STAND study was registered at clinicaltrials.gov (ID: NCT02692560 ) February 2016.
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Affiliation(s)
- Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Anne D. Renz
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
| | - Michelle L. Takemoto
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA USA
| | | | - Dori E. Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, WA USA
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15
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Swartz AM, Cho CC, Welch WA, Widlansky ME, Maeda H, Strath SJ. Pattern Analysis of Sedentary Behavior Change after a Walking Intervention. Am J Health Behav 2018; 42:90-101. [PMID: 29663984 PMCID: PMC6123016 DOI: 10.5993/ajhb.42.3.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Ann M Swartz
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Chi C Cho
- Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Whitney A Welch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael E Widlansky
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hotaka Maeda
- Center for Aging and Translational Research, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Scott J Strath
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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16
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Gorely T, Ryde G. Sedentary Behaviour and the Social and Physical Environment. SEDENTARY BEHAVIOUR EPIDEMIOLOGY 2018. [DOI: 10.1007/978-3-319-61552-3_24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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17
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Maher JP, Sliwinski MJ, Conroy DE. Feasibility and preliminary efficacy of an intervention to reduce older adults' sedentary behavior. Transl Behav Med 2017; 7:52-61. [PMID: 27734281 DOI: 10.1007/s13142-016-0394-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Older adults represent the segment of the population that sits the most. This study evaluated the feasibility, acceptability, safety, and preliminary efficacy of an intervention to reduce sedentary behavior (SB) in older adults that can be disseminated broadly for limited cost and delivered by paraprofessionals with limited training. Senior centers in Central Pennsylvania were randomized to receive one of two healthy aging programs (i.e., intervention or comparison). Participants in both groups attended three 90-min meetings over 2 weeks. Behavior change content was delivered at the second session (i.e., day 7). Forty-two participants (n intervention = 25, n comparison = 17) were recruited from five senior centers. Content for the intervention group focused on reducing SB while comparison group content focused on reducing social isolation. Self-reported SB was assessed on days 7 and 14. Repeated-measures ANOVA revealed a significant group × time interaction for total and weekday, but not weekend, SB. In the week following the delivery of group content, participants in the intervention group reported an average decrease in total SB of 837.8 min/week; however, the comparison group reported a nonsignificant average decrease of 263.0 min/week of total SB. Participants in the intervention group also reported an average decrease in weekday SB of 132.6 min/weekday (d = -0.83) in the week following the delivery of group content; however, the comparison group reported a nonsignificant decrease of 24.0 min/weekday (d = -0.16). There were no significant changes in weekend SB in either group in the week following the delivery of group content. Participants' attendance, measurement completion, and program ratings were high. Safety issues were minimal. This intervention was feasible to implement and evaluate, acceptable to older adults, and showed promise for reducing older adults' SB.
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Affiliation(s)
- Jaclyn P Maher
- The Pennsylvania State University, University Park, PA, USA.
- University of Southern California, Los Angeles, CA, USA.
| | | | - David E Conroy
- The Pennsylvania State University, University Park, PA, USA
- Northwestern University, Chicago, IL, USA
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18
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Copeland JL, Ashe MC, Biddle SJ, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Dogra S. Sedentary time in older adults: a critical review of measurement, associations with health, and interventions. Br J Sports Med 2017; 51:1539. [PMID: 28724714 DOI: 10.1136/bjsports-2016-097210] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022]
Abstract
Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults. METHODS A trained librarian created a search strategy that was peer reviewed for completeness. RESULTS Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.
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Affiliation(s)
| | - Maureen C Ashe
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia
| | - Luís B Sardinha
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal
| | | | | | - Shilpa Dogra
- University of Ontario Institute of Technology, Oshawa, Ontario, Canada
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19
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Dogra S, Ashe MC, Biddle SJH, Brown WJ, Buman MP, Chastin S, Gardiner PA, Inoue S, Jefferis BJ, Oka K, Owen N, Sardinha LB, Skelton DA, Sugiyama T, Copeland JL. Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med 2017; 51:1526-1532. [PMID: 28724710 PMCID: PMC5738599 DOI: 10.1136/bjsports-2016-097209] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 01/12/2023]
Abstract
Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose–response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies. This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.
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Affiliation(s)
- Shilpa Dogra
- University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Maureen C Ashe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart J H Biddle
- Victoria University, Melbourne, Australia.,University of Southern Queensland, Springfield, Australia
| | | | | | - Sebastien Chastin
- Glasgow Caledonian University, Glasgow, UK.,Ghent University, Ghent, Belgium
| | | | | | | | | | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia
| | - Luís B Sardinha
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Giné-Garriga M, Coll-Planas L, Guerra M, Domingo À, Roqué M, Caserotti P, Denkinger M, Rothenbacher D, Tully MA, Kee F, McIntosh E, Martín-Borràs C, Oviedo GR, Jerez-Roig J, Santiago M, Sansano O, Varela G, Skjødt M, Wirth K, Dallmeier D, Klenk J, Wilson JJ, Blackburn NE, Deidda M, Lefebvre G, González D, Salvà A. The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial. Trials 2017; 18:221. [PMID: 28521831 PMCID: PMC5437412 DOI: 10.1186/s13063-017-1956-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/26/2017] [Indexed: 11/26/2022] Open
Abstract
Background Older adults are the fastest growing segment of the world‘s population. Recent evidence indicates that excessive sitting time is harmful to health, independent of meeting the recommended moderate to vigorous physical activity (PA) guidelines. The SITLESS project aims to determine whether exercise referral schemes (ERS) can be enhanced by self-management strategies (SMSs) to reduce sedentary behaviour (SB), increase PA and improve health, quality of life and function in the long term, as well as psychosocial outcomes in community-dwelling older European citizens from four countries, within a three-armed pragmatic randomised controlled trial, compared with ERS alone and also with general recommendations about PA. Methods A total of 1338 older adults will be included in this study, recruited from four European countries through different existing primary prevention pathways. Participants will be randomly allocated into an ERS of 16 weeks (32 sessions, 45–60 min per session), ERS enhanced by seven sessions of SMSs and four telephone prompts, or a control group. Outcomes will be assessed at baseline, month 4 (end of ERS intervention), month 16 (12 months post intervention) and month 22 (18 months post intervention). Primary outcomes will include measures of SB (time spent sedentary) and PA (counts per minute). Secondary outcomes will include muscle and physical function, health economics’ related outcomes, anthropometry, quality of life, social networks, anxiety and depressive symptoms, disability, fear of falling, executive function and fatigue. A process evaluation will be conducted throughout the trial. The full analysis set will follow an intention-to-treat principle and will include all randomised participants for whom a baseline assessment is conducted. The study hypothesis will be tested with mixed linear models with repeated measures, to assess changes in the main outcomes (SB and PA) over time (baseline to month 22) and between study arms. Discussion The findings of this study may help inform the design and implementation of more effective interventions to reduce SB and increase PA levels, and hence improve long-term health outcomes in the older adult population. SITLESS aims to support policy-makers in deciding how or whether ERS should be further implemented or restructured in order to increase its adherence, impact and cost-effectiveness. Trial registration ClinicalTrials.gov, NCT02629666. Registered 19 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1956-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain.
| | - Laura Coll-Planas
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | - Míriam Guerra
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Àlex Domingo
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
| | | | - Michael Denkinger
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany
| | | | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Lilibank Gardens, Glasgow, G12 8RZ, UK
| | - Carme Martín-Borràs
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Guillermo R Oviedo
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Javier Jerez-Roig
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Marta Santiago
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Oriol Sansano
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Guillermo Varela
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna (Universitat Ramon Llull), C/ Císter 34, 08022, Barcelona, Spain
| | - Mathias Skjødt
- Syddansk Universitet, Campusvej 55, 5230, Odense M, Denmark
| | - Katharina Wirth
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University and Geriatric Center Ulm Alb-Donau, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081, Ulm, Germany
| | - Jason J Wilson
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nicole E Blackburn
- UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing (IHW), University of Glasgow, Lilibank Gardens, Glasgow, G12 8RZ, UK
| | - Guillaume Lefebvre
- Sport Initiative et Loisir Bleu Association, BP 18104, 67038, Strasbourg, Cedex, France
| | - Denise González
- Sport Initiative et Loisir Bleu Association, C/ Bailén 5 bajos, 08010, Barcelona, Spain
| | - Antoni Salvà
- Fundació Salut i Envelliment UAB, Casa Convalescència UAB, C/ Sant Antoni Maria Claret 171, 4a planta, 08041, Barcelona, Spain
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21
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Wellburn S, Ryan CG, Azevedo LB, Ells L, Martin DJ, Atkinson G, Batterham AM. Displacing Sedentary Time: Association with Cardiovascular Disease Prevalence. Med Sci Sports Exerc 2016; 48:641-7. [PMID: 26559454 DOI: 10.1249/mss.0000000000000816] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Isotemporal substitution analysis offers new insights for public health but has only recently been applied to sedentary behavior research. We aimed to quantify associations between the substitution of 10 min of sedentary behavior with 10 min of light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) and the prevalence of cardiovascular disease (CVD). Age was also explored as a potential effect modifier. METHODS We completed a secondary analysis of data from 1477 adults from the Health Survey for England (2008). Sedentary time, LPA, and MVPA were measured using accelerometry. We applied isotemporal models to quantify the relationship with CVD prevalence of replacing 10 min of sedentary time with equivalent amounts of LPA or MVPA. Prevalence risk ratios (RR) with 95% confidence intervals (CI) are presented, adjusted for covariates. The role of age as an effect modifier was explored via age-MVPA and age-LPA interactions. CVD was defined as per the International Classification of Diseases. RESULTS The prevalence of CVD was 24%. The RR was 0.97 (95% CI, 0.96-0.99) for LPA and 0.88 (0.81-0.96) for MVPA. Substitution of approximately 50 min of LPA would be required for an association equivalent to 10 min of MVPA. The beneficial association of MVPA was attenuated with age, with a decrease in the relative risk reduction of approximately 7% per decade. CONCLUSIONS Isotemporal substitution of sedentary time with LPA was associated with a trivial relative risk reduction for CVD, whereas the equivalent replacement with MVPA had a small beneficial relationship. With respect to CVD prevalence, MVPA might become decreasingly important in older individuals. Prospective studies are needed to investigate causality.
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Affiliation(s)
- Shaun Wellburn
- Health and Social Care Institute, Teesside University, Middlesbrough, UNITED KINGDOM
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22
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Tam-Seto L, Weir P, Dogra S. Factors Influencing Sedentary Behaviour in Older Adults: An Ecological Approach. AIMS Public Health 2016; 3:555-572. [PMID: 29546182 PMCID: PMC5689816 DOI: 10.3934/publichealth.2016.3.555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/08/2016] [Indexed: 12/18/2022] Open
Abstract
Sedentary behaviour is negatively associated with several health outcomes and is particularly problematic among older adults. Knowledge translation tools and public health promotion strategies are needed; however, little evidence is available to inform framing of such tools or development of intervention programs. The aim of the present study was to use data on the perceptions of sedentary time and the programs or supports older adults identify as important for reducing their sedentary time, to inform knowledge translation strategies targeting this population. Focus groups were conducted with four groups of older adults (n = 26) at local seniors' centres (Ontario, Canada). Participants were 74 ± 8.5 years old and were engaging in both sedentary and physical activities in a social environment. Using the Ecological Model for sedentary time in adults, we categorized data into leisure time, household, transport and occupation domains. Intrinsic and extrinsic factors that worked to either discourage or promote sedentary behaviour were identified. Drawing on both groupings of data, results were synthesized to inform public health strategies on appropriate messaging and better uptake of programming and guidelines. For example, successful programs developed on the topic will need to include a social component and a mentally stimulating component, as these were identified as critical for enjoyment and motivation. It was clear from this analysis that sedentary time reduction strategies will need to consider the different domains in which older adults accumulate sedentary time.
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Affiliation(s)
- Linna Tam-Seto
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Patricia Weir
- Faculty of Human Kinetics, University of Windsor, Windsor, ON, Canada
| | - Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, ON, Canada
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23
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Ashe MC, Winters M, Hoppmann CA, Dawes MG, Gardiner PA, Giangregorio LM, Madden KM, McAllister MM, Wong G, Puyat JH, Singer J, Sims-Gould J, McKay HA. "Not just another walking program": Everyday Activity Supports You (EASY) model-a randomized pilot study for a parallel randomized controlled trial. Pilot Feasibility Stud 2015; 1:4. [PMID: 27175291 PMCID: PMC4862805 DOI: 10.1186/2055-5784-1-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Maintaining physical activity is an important goal with positive health benefits, yet many people spend most of their day sitting. Our Everyday Activity Supports You (EASY) model aims to encourage movement through daily activities and utilitarian walking. The primary objective of this phase was to test study feasibility (recruitment and retention rates) for the EASY model. METHODS This 6-month study took place in Vancouver, Canada, from May to December 2013, with data analyses in February 2014. Participants were healthy, inactive, community-dwelling women aged 55-70 years. We recruited through advertisements in local community newspapers and randomized participants using a remote web service. The model included the following: group-based education and social support, individualized physical activity prescription (called Activity 4-1-1), and use of a Fitbit activity monitor. The control group received health-related information only. The main outcome measures were descriptions of study feasibility (recruitment and retention rates). We also collected information on activity patterns (ActiGraph GT3X+ accelerometers) and health-related outcomes such as body composition (height and weight using standard techniques), blood pressure (automatic blood pressure monitor), and psychosocial variables (questionnaires). RESULTS We advertised in local community newspapers to recruit participants. Over 3 weeks, 82 participants telephoned; following screening, 68% (56/82) met the inclusion criteria and 45% (25/56) were randomized by remote web-based allocation. This included 13 participants in the intervention group and 12 participants in the control group (education). At 6 months, 12/13 (92%) intervention and 8/12 (67%) control participants completed the final assessment. Controlling for baseline values, the intervention group had an average of 2,080 [95% confidence intervals (CIs) 704, 4,918] more steps/day at 6 months compared with the control group. There was an average between group difference in weight loss of -4.3 [95% CI -6.22, -2.40] kg and reduction in diastolic blood pressure of -8.54 [95% CI -16.89, -0.198] mmHg, in favor of EASY. CONCLUSIONS The EASY pilot study was feasible to deliver; there was an increase in physical activity and reduction in weight and blood pressure for intervention participants at 6 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01842061.
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Affiliation(s)
- Maureen C Ashe
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Meghan Winters
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 11522, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Christiane A Hoppmann
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; UBC Department of Psychology, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Martin G Dawes
- Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Paul A Gardiner
- School of Public Health, The University of Queensland, Level 3, Public Health Building, Herston Rd, Herston, Queensland 4006, Australia; Translating Research Into Practice (TRIP) Centre, Mater Research Institute-The University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
| | - Lora M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario N1H 8 K4, Canada
| | - Kenneth M Madden
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; UBC Department of Medicine, Division of Geriatric Medicine, Room 7185, 2775 Laurel Street, Vancouver, BC N2L 3G1, Canada
| | - Megan M McAllister
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Gillian Wong
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Joseph H Puyat
- UBC School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Joel Singer
- UBC School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation and Outcomes Sciences, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Heather A McKay
- Centre for Hip Health and Mobility, 7F-2635 Laurel Street, Vancouver, BC V5Z 1 M9, Canada; Department of Family Practice, University of British Columbia (UBC), 320-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada; UBC Department of Orthopaedics, 3114-910 West 10th Avenue, Vancouver, BC V5Z 1 M9, Canada
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Prince SA, Saunders TJ, Gresty K, Reid RD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev 2014; 15:905-19. [PMID: 25112481 PMCID: PMC4233995 DOI: 10.1111/obr.12215] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 12/16/2022]
Abstract
UNLABELLED The objective of this study was to systematically review the literature and compare the effectiveness of controlled interventions with a focus on physical activity (PA) and/or sedentary behaviours (SBs) for reducing sedentary time in adults. Six electronic databases were searched to identify all studies that examined the effects of interventions that targeted PA and/or SBs and that reported on changes in SBs (sedentary, sitting or television time). A qualitative synthesis was performed for all studies, and meta-analyses conducted among studies with mean differences (min/d) of sedentary time. PROSPERO CRD42014006535. Sixty-five controlled studies met inclusion criteria; 33 were used in the meta-analyses. Interventions with a focus on PA or that included a PA and SB component produced less consistent findings and generally resulted in modest reductions in sedentary time (PA: standardized mean differences [SMD] = -0.22 [95% confidence interval {CI}: -0.35, -0.10], PA+SB: SMD= -0.37 [95% CI: -0.69, -0.05]). Moderate quality evidence from the randomized controlled trial meta-analysis coupled with the qualitative synthesis provides consistent evidence that large and clinically meaningful reductions in sedentary time can be expected from interventions with a focus on reducing SBs (SMD= -1.28 [95% CI: -1.68, -0.87] ). There is evidence to support the need for interventions to include a component focused on reducing SBs in order to generate clinically meaningful reductions in sedentary time.
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Affiliation(s)
- S A Prince
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
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25
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Gardner B, Thuné-Boyle I, Iliffe S, Fox KR, Jefferis BJ, Hamer M, Tyler N, Wardle J. 'On Your Feet to Earn Your Seat', a habit-based intervention to reduce sedentary behaviour in older adults: study protocol for a randomized controlled trial. Trials 2014; 15:368. [PMID: 25240737 PMCID: PMC4180306 DOI: 10.1186/1745-6215-15-368] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background Many older adults are both highly sedentary (that is, spend considerable amounts of time sitting) and physically inactive (that is, do little physical activity). This protocol describes an exploratory trial of a theory-based behaviour change intervention in the form of a booklet outlining simple activities (‘tips’) designed both to reduce sedentary behaviour and to increase physical activity in older adults. The intervention is based on the ‘habit formation’ model, which proposes that consistent repetition leads to behaviour becoming automatic, sustaining activity gains over time. Methods The intervention is being developed iteratively, in line with Medical Research Council complex intervention guidelines. Selection of activity tips was informed by semi-structured interviews and focus groups with older adults, and input from a multidisciplinary expert panel. An ongoing preliminary field test of acceptability among 25 older adults will inform further refinement. An exploratory randomized controlled trial will be conducted within a primary care setting, comparing the tips booklet with a control fact sheet. Retired, inactive and sedentary adults (n = 120) aged 60 to 74 years, with no physical impairments precluding light physical activity, will be recruited from general practices in north London, UK. The primary outcomes are recruitment and attrition rates. Secondary outcomes are changes in behaviour, habit, health and wellbeing over 12 weeks. Discussion Data will be used to inform study procedures for a future, larger-scale definitive randomized controlled trial. Trial registration Current Controlled Trials ISRCTN47901994. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-368) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Gardner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
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26
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Using an individualised consultation and activPAL™ feedback to reduce sedentary time in older Scottish adults: results of a feasibility and pilot study. Prev Med 2013; 57:718-20. [PMID: 23891853 DOI: 10.1016/j.ypmed.2013.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 07/03/2013] [Accepted: 07/17/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Sedentary behaviours have been linked to poor health, independent of physical activity levels. The objective of this study was to explore an individualised intervention strategy aimed at reducing sedentary behaviours in older Scottish adults. METHODS This feasibility and pilot study was a pre-experimental (one group pretest-posttest) study design. Participants were enrolled into the study in January-March 2012 and data analysis was completed April-October 2012. The study was based in Glasgow, Scotland. Participants received an individualised consultation targeting sedentary behaviour incorporating feedback from an activPAL activity monitor. Outcome measures were objectively (activPAL) and subjectively measured (Sedentary Behaviour Questionnaire) sedentary time. RESULTS Twenty four participants received the intervention. Objectively measured total time spent sitting/lying was reduced by 24 min/day (p=0.042), a reduction of 2.2%. Total time spent in stepping activities, such as walking increased by 13 min/day (p=0.044). Self-report data suggested participants achieved behaviour change by reducing time spent watching television and/or using motorised transport. CONCLUSION Interventions to reduce sedentary behaviours in older people are urgently needed. The results of this feasibility and pilot study suggest a consultation approach may help individuals reduce time spent in sedentary behaviours. A larger, controlled trial is warranted with a diverse sample to increase generalisability.
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