Systematic literature review of determinants of sedentary behaviour in older adults: a DEDIPAC study.

Associations of perceived role of exercise in cancer prevention with physical activity and sedentary behavior in older adults

Accurate measurement of sedentary behaviour in older adults is informative and relevant. Yet, activities such as sitting are not accurately distinguished from non-sedentary activities (e.g., upright activities), especially in real-world conditions. This study examines the accuracy of a novel algorithm to identify sitting, lying, and upright activities in community-dwelling older people in real-world conditions. Eighteen older adults wore a single triaxial accelerometer with an onboard triaxial gyroscope on their lower back and performed a range of scripted and non-scripted activities in their homes/retirement villages whilst being videoed. A novel algorithm was developed to identify sitting, lying, and upright activities. The algorithm's sensitivity, specificity, positive predictive value, and negative predictive value for identifying scripted sitting activities ranged from 76.9% to 94.8%. For scripted lying activities: 70.4% to 95.7%. For scripted upright activities: 75.9% to 93.1%. For non-scripted sitting activities: 92.3% to 99.5%. No non-scripted lying activities were captured. For non-scripted upright activities: 94.3% to 99.5%. The algorithm could, at worst, overestimate or underestimate sedentary behaviour bouts by ±40 s, which is within a 5% error for sedentary behaviour bouts. These results indicate good to excellent agreement for the novel algorithm, providing a valid measure of sedentary behaviour in community-dwelling older adults.

BackgroundIn the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age.MethodsWe searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study.ResultsWe included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions.ConclusionThis systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

Background: In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. Purpose: We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age. Methods: We searched the Medline, Embase, Web of Science, SportsDiscus, PsycInfo, Cinahl, LILACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study. Results: We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health and renal cancer cells remain insufficient to draw conclusions. Conclusion: This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

The studies presented in this thesis highlight important issues relating to the measurement ofnphysical activity (PA) and sedentary behaviour (SB) in older adults, especially relating to thentransfer of these methods to free-living environments.Study One examined cut-points for ActiGraph GT3X+ (AG) for estimating time spent in SB innolder adults in free-living environments. ActivPAL3t (AP) was used as the reference standard.nMovement patterns were measured in 41 older adults over seven consecutive days with both AGnand AP. The results suggested that different cut-points must be used in older adults. In the case ofnolder adults when using 1-minute epochs, for example, 25 counts/minute must be considered whennusing the AG vertical axis only, or 200 counts/minute when using the three axes of thenaccelerometer.Study Two assessed the reliability and validity of a single question about sitting time on weekendnand weekdays and a 24-hour recall (MARCA) for the last two days (n=41) that provides contextualninformation about use of time. The single question showed poor validity, but fair agreement fornclassifying individuals into tertiles. The MARCA showed good validity and moderate agreement forncategorising participants into tertiles of time spent in SB. It is important to highlight that bothninstruments showed more accurate estimates for groups than for individuals.nStudy Three assessed MET values of common daily activities in middle age and older adults innfree-living environments and compared these with MET values listed in the Compendium ofnPhysical Activities (CPA). Sixty participants completed a semi-structured protocol of sitting, lying,nself-paced walking and four self-selected activities in their residences. 20 different activities werenmeasured among the participants, observing a wide range of movement patterns. Measured METsnwere significantly different from values in the CPA for several activities (sitting, walking,nsweeping, trimming, and laundry). It was concluded that using values from the CPA in older adultsnmay result in overestimation of total daily energy expenditure, particularly when considering thatnmost of the day is spent in sedentary activities.Study Four assessed the validity of four different AG equations for predicting energy expendituren(EE) in older adults; and assessed agreement between physical activity levels obtained from thesenequations and from four sets of published AG equations, with those from indirect calorimetry. Thenequations (Freedson, Crouter (refined equation), and Santos-Lozano (vertical axis [VT] and vectormagnituden[VM])) were compared with measured EE. 40 participants completed the study and 16ndifferent activities were assessed. It was concluded that when selecting an equation to estimate totalndaily EE from accelerometer data, equations with more accurate estimates of sedentary behaviournmight be preferred. However, when the main interest is to estimate total time spent in differentnphysical activity levels, a method with higher agreement for categorising activities may benpreferred.ConclusionThe work contained in this thesis will help researchers to 1) implement more accurate tools in thensurveillance of PA and SB in larger studies, 2) better understand the strengths and limitations ofncurrent predictive methods when applying them in free-living environments, and 3) improveninterpretation and translation of energy expenditure measures in older adults.n

Physical activity and protein intake are associated with ageing-related outcomes, including loss of muscle strength and functional decline, so may contribute to strategies to improve healthy ageing. We investigated the cross-sectional associations between physical activity or sedentary behaviour and protein intake patterns in community-dwelling older adults across five countries. Self-reported physical activity and dietary intake data were obtained from two cohort studies (Newcastle 85+ Study, UK; LiLACS, New Zealand Māori and Non-Māori) and three national food consumption surveys (DNFCS, The Netherlands; FINDIET, Finland; INRAN-SCAI, Italy). Associations between physical activity and total protein intake, number of eating occasions providing protein, number of meals with specified protein thresholds, and protein intake distribution over the day (calculated as a coefficient of variance) were assessed by regression and repeated measures ANOVA models adjusting for covariates. Greater physical activity was associated with higher total protein intake and more eating occasions containing protein, although associations were mostly explained by higher energy intake. Comparable associations were observed for sedentary behaviour in older adults in Italy. Evidence for older people with higher physical activity or less sedentary behaviour achieving more meals with specified protein levels was mixed across the five countries. A skewed protein distribution was observed, with most protein consumed at midday and evening meals without significant differences between physical activity or sedentary behaviour levels. Findings from this multi-study analysis indicate there is little evidence that total protein and protein intake patterns, irrespective of energy intake, differ by physical activity or sedentary behaviour levels in older adults.

ObjectivesReducing sedentary behaviour (SB) in older adults is a promising strategy to promote healthy ageing. However, to develop more effective interventions, more in-depth information is needed on how existing interventions work. The present realist review aims to identify the working mechanisms and contextual preconditions to guide the development of future interventions.DesignA realist review was conducted following the iterative process of Pawson and Tilley and reported following the RAMESES publication standards.Data sourcesEvidence was searched in four databases: EMBASE, PubMed, Web of Science and Scopus, and in the grey literature.Eligibility criteriaAll study types and designs were included. Studies conducted in older adults with a mean age of 60 years or older, providing information on the context, mechanisms and/or outcomes of interventions aimed at the reduction of SB were eligible for inclusion and appraised for relevance and rigour.Data extraction and synthesisAll data were coded by two independent reviewers. Sections that contained relevant information to refine, refute or confirm the initial programme theory were given a code. Based on these codes, context-mechanism-outcome configurations were made, and a final programme theory was developed.ResultsIn total, 58 studies, from 61 articles, were eligible. The review revealed three important contexts for changes in SB: the (1) motivation, (2) opportunities and (3) capabilities of older adults. Depending on the context, other behaviour change techniques should be used to trigger specific mechanisms and, in turn, reduce SB. Especially, the impact of the underlying automatic processes of SB on the effectiveness of SB interventions became clear. Existing interventions primarily focus on the reflective processes guiding SB, without taking into account that SB is often an automatic response that occurs unconsciously, with little reasoning.ConclusionsThe effectiveness of SB interventions in older adults highly depends on the context in which the interventions occur. In particular, the context of automatic motivation should receive more attention to break the ingrained habit of SB in older adults.

Sedentary behavior (SB) is a determinant of health in older adult people. Educational level is a primary driver of health disparities and is demonstrated to be a reliable measure of socioeconomic position. We aimed to examine the associations between educational level and self-reported along with device-measured SB in older adults living in Europe and the association of mentally active and passive SB domains with the educational level and gender in these associations. The design is cross-sectional. One thousand three hundred and sixty participants aged 65 and over (75.3±6.3 years old, 61.8% women) participated. Inclusion criteria were scored with the Short Physical Performance Battery. Variables that describe the sample were assessed with an interview, and device-measured SB was assessed with an accelerometer. SB was assessed with the Sedentary Behavior Questionnaire and an accelerometer. Multiple linear regression models were used to study the association between the level of education and SB. Participants self-reported an average of 7.82 (SD: 3.02) daily waking hours of SB during weekend days, and the average of device-measured SB was 11.39 (1.23) h. Total mentally active SB (weekdays and weekends) was associated with the education level (p < 0.000). Participants were more sedentary during the week than during weekends, regardless of level of education (p < 0.000). Education level was significantly associated with self-reported mean hours per day in 46SB (p = 0.000; R=0.026; 95%CI). Low education level in older adults is associated with self-reported SB but not with objective SB measures.

Background“Push” components of mobile health interventions may be promising to create conscious awareness of habitual sedentary behavior; however, the effect of these components on the near-time, proximal outcome, being breaks in sedentary behavior immediately after receiving a push notification, is still unknown, especially in older adults.ObjectiveThe aims of this study are to examine if older adults break their sedentary behavior immediately after receiving personalized haptic feedback on prolonged sedentary behavior and if the percentage of breaks differs depending on the time of the day when the feedback is provided.MethodsA total of 26 Flemish older adults (mean age 64.4 years, SD 3.8) wore a triaxial accelerometer (Activator, PAL Technologies Ltd) for 3 weeks. The accelerometer generated personalized haptic feedback by means of vibrations each time a participant sat for 30 uninterrupted minutes. Accelerometer data on sedentary behavior were used to estimate the proximal outcome, which was sedentary behavior breaks immediately (within 1, 3, and 5 minutes) after receiving personalized haptic feedback. Generalized estimating equations were used to investigate whether or not participants broke up their sedentary behavior immediately after receiving haptic feedback. A time-related variable was added to the model to investigate if the sedentary behavior breaks differed depending on the time of day.ResultsA total of 2628 vibrations were provided to the participants during the 3-week intervention period. Of these 2628 vibrations, 379 (14.4%), 570 (21.7%), and 798 (30.4%) resulted in a sedentary behavior break within 1, 3 and 5 minutes, respectively. Although the 1-minute interval did not reveal significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided, the 3- and 5-minute intervals did show significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided. Concretely, the percentage of sedentary behavior breaks was significantly higher if personalized haptic feedback was provided between noon and 3 PM compared to if the feedback was provided between 6 and 9 AM (odds ratio 1.58, 95% CI 1.01-2.47, within 3 minutes; odds ratio 1.78, 95% CI 1.11-2.84, within 5 minutes).ConclusionsThe majority of haptic vibrations, especially those in the morning, did not result in a break in the sedentary behavior of older adults. As such, simply bringing habitual sedentary behavior into conscious awareness seems to be insufficient to target sedentary behavior. More research is needed to optimize push components in interventions aimed at the reduction of the sedentary behavior of older adults.Trial RegistrationClinicalTrials.gov NCT04003324; https://clinicaltrials.gov/ct2/show/NCT04003324

ObjectivesTo map the context of sedentary behaviour in older adults who are prefrail and frail during the winter and spring over 3 days (2 weekdays and 1 weekend) and to...

BackgroundOlder adults engage in increased amounts of sedentary behavior (SB), which can result in a significant decline in muscle function and overall health. An understanding of the motivational driving factors that lead older adults to engage in SB can help to create effective intervention programs.ObjectiveThis study aimed to determine the association between prevention and promotion focus with SB in older adults, as well as compare these associations with two factors (ie, age and BMI) that are commonly known to have an association with SB among older adults.MethodsA cross-sectional analysis was conducted among 93 community-dwelling older adults with a mean age of 74.98 (SD 6.68) years. Prevention and promotion focus were both assessed using the Regulatory Focus Questionnaire. Correlation analysis was performed to determine the associations between prevention focus, promotion focus, age, and BMI with SB. Anderson-Darling tests confirmed nonnormal data distributions for all factors (except age); therefore, Spearman rank correlation was used to determine correlations between factors. Comparative analysis of significant correlations was performed using Fisher Z transformation.ResultsPrevention focus had the greatest statistically significant correlation with SB (ρ=0.296; P=.004), followed by BMI (ρ=0.204; P=.049). Both age (ρ=0.116; P=.27) and promotion focus (ρ=0.002; P=.99) had statistically insignificant correlations with SB, indicating no associations. The correlation between prevention focus and SB did not significantly differ from the correlation between BMI and SB (P=.51).ConclusionsPrevention focus was found to have a weak, but significant positive association with SB in older adults. Although age and BMI have been found to have an association with SB in previous literature, age was not associated with SB in this study, while BMI had a significant but relatively weaker association with SB than that with prevention focus. However, the association found between BMI and SB did not statistically differ from the association found between prevention focus and SB. These findings suggest that older adults could be driven to engage in increased amounts of SB due to having a dominant prevention focus, which revolves around thoughts of safety and avoiding negative consequences. The recognition of this association has the potential to aid in developing intervention programs that could promote shifting from prevention to promotion focus, thereby reducing SB in older adults.

BackgroundThe distribution of time across physical activity, sedentary behaviors, and sleep appears to be essential for the management of obesity. However, the impact of reallocating time among these behaviors, collectively known as 24-h movement behaviors, remains underexplored.ObjectiveThis study examines the theoretical effects of reallocating time between 24-h movement behaviors on obesity indicators across different age groups.MethodsWe performed a pooled data meta-analysis of 9818 participants from 11 observational and experimental studies. To estimate the time spent in movement behaviors, we reprocessed and harmonized individual-level raw accelerometer-derived data. Isotemporal substitution models estimated theoretical changes in body mass index (BMI) and waist circumference (WC) associated with time reallocation between movement behaviors. We performed the analysis separately for children, adolescents, adults, and older adults.ResultsEven minor reallocations of 10 min led to significant changes in obesity indicators, with pronounced effects observed when 30 min were reallocated. The most substantial adverse effects on BMI and WC occurred when moderate-to-vigorous physical activity (MVPA) was reallocated to other movement behaviors. For 30-min reallocations, the largest increase in BMI (or BMI z-score for children) occurred when MVPA was reallocated to light-intensity physical activity (LPA) in children (0.26 units, 95% confidence interval [CI] 0.15, 0.37) and to sedentary behavior (SB) in adults (0.72 kg/m2, 95% CI 0.47, 0.96) and older adults (0.73 kg/m2, 95% CI 0.59, 0.87). The largest increase in WC was observed when MVPA was substituted with LPA in adults (2.66 cm, 95% CI 1.42, 3.90) and with SB in older adults (2.43 cm, 95% CI 2.07, 2.79). Conversely, the highest magnitude of the decrease in obesity indicators was observed when SB was substituted with MVPA. Specifically, substituting 30 min of SB with MVPA was associated with a decrease in BMI z-score by − 0.15 units (95% CI − 0.21, − 0.10) in children and lower BMI by − 0.56 kg/m2 (95% CI − 0.74, − 0.39) in adults and by − 0.52 kg/m2 (95% CI − 0.61, − 0.43) in older adults. Reallocating time away from sleep and LPA showed several significant changes but lacked a consistent pattern. While the predicted changes in obesity indicators were generally consistent across age groups, inconsistent findings were observed in adolescents, particularly for reallocations between MVPA and other behaviors.ConclusionsThis investigation emphasizes the crucial role of MVPA in mitigating obesity risk across the lifespan, and the benefit of substituting SB with low-intensity movement behaviors. The distinct patterns observed in adolescents suggest a need for age-specific lifestyle interventions to effectively address obesity. Emphasizing manageable shifts, such as 10-min reallocations, could have significant public health implications, promoting sustainable lifestyle changes that accommodate individuals with diverse needs, including those with severe obesity.

Biomarkers associated with sedentary behaviour in older adults: A systematic review

The chondroectodermal dysplasia--Ellis-Van Creveld Syndrome--is an unusual form of congenital disease, genetically transmitted with a recessive autosomal pattern, which involves the skeletal system, nails and teeth. In about 50 to 60 percent of cases, the affected individuals show cardiac abnormalities, and the most common are single atrium, large atrial septal defect, ostium primum type. Other abnormalities may accompany these lesions, such as aortic atresia, hypoplasia of the ascending aorta or of the left ventricle. About half of the patients die in the childhood due to cardiorespiratory complications. Two cases are described with this syndrome, a male and a female, with 54 and 45 years old respectively; they were followed in our Departments and showed congestive heart failure and single atrium. These cases led us to review the subject; we believe that the unusual longevity of these patients can be related to their relatively benign cardiac disease.

How are combinations of physical activity, sedentary behaviour and sleep related to cognitive function in older adults? A systematic review.