Sedentary Behavior In Older Adults Research Articles

Physical activity intensity classification during activities of daily living in older adults using accelerometers: Is the ear the new wrist?

Introduction
 Accurate measurement of physical activity (PA) in older adults is important, both in health research and personalized prevention. Accelerometers, used to overcome the limitations of self-reporting, were initially worn on the hips, but are increasingly worn on the non-dominant wrist. While this can improve wear compliance, the accuracy of PA intensity classification can be compromised. Given the high prevalence of mild to severe hearing loss in the older population, this study explores a novel approach: integrating an accelerometer into a hearing aid (ear sensor). We aimed to assess its accuracy and compare it to research-grade sensors worn at different locations.
 Methods 60 middle-aged to older adults (64.0 ± 8.0 years, 48% women) were included in this study. Each subject performed 12-13 different activities, which were pseudo-randomly selected from a list of 33 activities of daily living. Each activity lasted 8 min and included sedentary activities (e.g., lying, playing cards) low-intensity activities (e.g., hanging laundry), activities of changing intensity or without physical displacement (e.g., yoga, squats), indoor activities related to locomotion (e.g., walking, running), outdoor activities (e.g., walking uphill, cycling), and activities with aids (e.g., walking with a stroller). Oxygen consumption was measured via indirect calorimetry and used to classify activity intensity into sedentary behavior (SB, metabolic equivalent of task [MET] < 1.5), light intensity PA (LPA, 1.5 ≤ MET < 3.0), or moderate to vigorous intensity PA (MVPA, MET ≥ 3.0). The ear sensor was placed behind the left ear, while the research-grade sensors were placed on both wrists and ankles, on the hip, chest, and forehead. Estimation of PA intensity classes was done using mean amplitude deviations and ROC analyses. Contingency tables were used to determine classification accuracy.
 Results
 Overall accuracy of the ear sensor was 82.6%, performing better than both wrists (left 81.1%, right 76.0%) and both ankles (left 81.1%, right 81.9%), but worse than the forehead (83.6%), hip (85.6%) and the chest (85.9%). ROC analyses show that all sensors can effectively discriminate between sedentary vs. non-sedentary activities (AUC 0.97-0.98, exception ankles: AUC 0.95-0.96) and between MVPA vs. other (AUC 0.96-0.97, exception wrists: AUC 0.89-0.92).
 Discussion/Conclusion
 This study is the first to show that an accelerometer integrated into a hearing aid can accurately classify PA intensity and differentiate MVPA and sedentary behavior in older adults. It also confirms previous investigations showing that wrist-worn sensors – although increasingly being used to monitor PA – are less effective in capturing MVPA compared to sensors worn closer to the center of mass (including the head/ear in our study). Although the optimal wear site in older adults is a subject of ongoing debate, our data shows that a sensor integrated into a hearing aid offers a promising balance of classification accuracy and (possibly) user compliance. Further studies should explore integrating in-ear heart rate monitoring to enhance accuracy even further.

Sleep quality is associated with sedentary behavior in older adults: a quantile regression analysis

Sleep quality is associated with sedentary behavior in older adults: a quantile regression analysis

Association between accelerometry measured patterns of sedentary behaviors and functional status in older adults

BackgroundOlder adults are highly sedentary, and too much sedentary behavior (SB) is associated with negative health effects, but little is known about SB patterns and their associations with functional status.AimsTo examine the association between objectively measured sedentary behavior time (SBT) and sedentary behavior fragmentation (SBF) and functional status in older adults using the National Health Aging Trends Study (NHATS) dataset, a nationally representative sample from 2021.MethodsData from NHATS were analyzed using weighted linear regressions to examine the association between objective measures of SBT (mean hours spent in SB/day during waking hours) and SBF, and six functional variables (difficulties with activities of daily living [ADL], short physical performance battery, hand grip strength, immediate word recall, delayed word recall, and mental health), accounting for sociodemographic, body mass index, and the number of chronic conditions.ResultsA total of 738 individuals from the NHATS were included. Higher SBT was associated with greater difficulties with ADL, poorer short physical performance battery and hand grip strength, lower scores in both immediate and delayed word recall, and poorer mental health. Higher SBF was associated with fewer difficulties with ADL, better short physical performance battery and hand grip strength, a higher score in immediate word recall, and better mental health.Discussionand conclusionsGreater fragmentation of SB was associated with better function, and increasing SBF may be a useful strategy for mitigating the effects of SB in older adults, but prospective research is needed to support this approach.

A longitudinal exploration of self-reported TV behaviours as a surrogate for sedentary behaviour in older adults with an intellectual disability from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) study.

This study presents the findings of an investigation into the self-reported TV habits of adults with an intellectual disability, where time watching TV was used as a proxy for sedentary behaviour (SB). Risk factors identified for the general and intellectual disability populations and standard covariates of age, sex, level of intellectual disability, living circumstances and BMI were explored to determine their viability as contributors to increased TV viewing and SB. Missing data was imputed using Multiple Imputation Chained Equation (MICE). Multinomial logistic regression and Chi-squared Automatic Interaction Detector Analysis (CHAID) analyses of risk factors for increased TV viewing were explored and compared. The Systems of Sedentary Behaviour (SOS) framework was used to structure results. Novel risk factors for increased TV viewing were identified.

Mapping sedentary behaviour (MAPS-B) in winter and spring using wearable sensors, indoor positioning systems, and diaries in older adults who are pre-frail and frail: A feasibility longitudinal study.

Older adults who are frail are likely to be sedentary. Prior interventions to reduce sedentary time in older adults have not been effective as there is little research about the context of sedentary behaviour (posture, location, purpose, social environment). Moreover, there is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. The aim of our study was to determine the feasibility of measuring context of sedentary behaviour in older adults with pre-frailty or frailty using a combination of objective and self-report measures. We defined "feasibility process" using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and "feasibility resource" if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone) and are all participants willing to use the measures. Context was assessed using a wearable sensor to assess posture, a smart home monitoring system for location, and an electronic or hard-copy diary for purpose and social context over three days in winter and spring. We approached 80 potential individuals, and 58 expressed interest; of the 58 individuals, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts due to medical mistrust or worsening health (90% retention). The wearable sensor, indoor positioning system, and electronic diary accurately captured one domain of context, but the hard copy was often not completed with enough detail, so it was challenging to link it to the other devices. Although not all participants were willing to use the wearable sensor, indoor positioning system, or electronic diary, we were able to triage the measures of those who did. The use of wearable sensors and electronic diaries may be a feasible method to assess context of sedentary behaviour, but more research is needed with device-based measures in diverse groups.

Movement Patterns in Older Adults Recovering From Hip Fracture.

The aim of this study was to quantify physical activity and sedentary behavior in older adults recovering from hip fracture and to identify groups based on movement patterns. In this cross-sectional cohort study, older adults (≥70years) were included 3 months after surgery for proximal femoral fracture. Patients received an accelerometer for 7days. Demographics and outcomes related to physical function, mobility, cognitive functions, quality of life, and hip fracture were assessed. In total, 43 patients with sufficient accelerometer wear time were included. Across all groups, participants engaged in very low levels of physical activity, spending an average of 11hr/day in prolonged sedentary behavior. Based on the extracted components from a principal component analysis, three groups with substantial differences in levels of physical activity and sedentary behavior could be distinguished.

MAPPING SEDENTARY BEHAVIOUR USING WEARABLE DEVICES AND DIARIES IN OLDER ADULTS WITH FRAILTY: A FEASIBILITY STUDY

Abstract Older adults with frailty are sedentary. Prior interventions to reduce sedentary time in older adults have not been successful as there is little research about context (posture, location, purpose, social environment). There is limited evidence on feasible measures to assess context of sedentary behaviour in older adults. Our aim was to determine feasibility of measuring context of sedentary behaviour in older adults with frailty using objective and self-report measures. We defined “feasibility process” using recruitment (20 participants within two-months), retention (85%), and refusal (20%) rates and “feasibility resource” if the measures capture context and can be linked (e.g., sitting-kitchen-eating-alone), and are all participants willing to use the measures. Context was assessed using a wearable sensor for posture, indoor positioning system [IPS] for location, and electronic or hard-copy diary for purpose and social-context over three days in winter and spring. We approached 80 individuals, and 58 expressed interest; of the 58, 37 did not enroll due to lack of interest or medical mistrust (64% refusal). We recruited 21 older adults (72±7.3 years, 13 females, 13 frail) within two months and experienced two dropouts (90% retention). The measures captured one domain of context, but the hard copy was not completed with detail making it challenging to link with the other devices. Not all participants were willing to use the wearable devices or electronic diary; but we linked the measures of those who did. Future studies will need to determine the most feasible and valid method to assess the context of sedentary behaviour.

Is education level, as a proxy for socio-economic position, related to device-measured and self-reported sedentary behavior in European older adults? A cross-sectional study from the SITLESS project.

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.

Sedentary Behavior and Physical Frailty Among Rural Older Adults in China: The Moderating Effect of Social Isolation

ObjectivesFew studies have explored the mechanisms underlying the relationship between sedentary behavior and physical frailty. The aim of this study was to investigate the moderating effect of social isolation on the association between sedentary behavior and physical frailty among older adults in rural China. DesignCross-sectional study. Setting and ParticipantsData were from 3238 individuals aged ≥60 years from rural areas in China. MethodsBinary logistic regression was used to explore the association between sedentary behavior and physical frailty and the moderating effect of social isolation. ResultsThe prevalence of physical frailty was 18.7% among the older adults, and 17.0% of them were sedentary for ≥8 h/d. Compared with older adults with sedentary behavior for <4 h/d, participants with sedentary behavior for ≥8 h/d were more likely to suffer from physical frailty [odds ratio (OR), 2.26; 95% CI, 1.57–3.27]. We found that social isolation may aggravate this relationship (OR, 3.31; 95% CI, 2.06–5.32), especially for rural older adults who were sedentary for ≥8 h/day. Conclusion and ImplicationsMore sedentary behavior was associated with higher risk of physical frailty, which was especially apparent among older adults with social isolation, suggesting that sedentary older people who experienced social isolation were more vulnerable to physical frailty. Decreasing sedentary behavior in older adults and encouraging them to participate in interactive social activities could help prevent physical frailty.

Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study

BackgroundGiven the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults.MethodsData from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes.ResultsAmong the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time.ConclusionsRegardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.

Effectiveness of Interventions for Reducing Sedentary Behaviour in Older Adults Living in Long-Term Care Facilities: A Protocol for a Systematic Review.

Background. Sedentary behaviour (SB) is an important risk factor for several health-related outcomes. The prevalence of SB is alarmingly high in older adults, who spend on average 9.4 h being sedentary each day, making them the most sedentary of all age groups. Objectives. The primary objective of this review is to assess the impact of interventions aimed at reducing SB in older adults (aged 60 years and older) living in long-term care facilities (LTCFs). The research question for this systematic review is as follows: in older people living in LTCFs, do interventions aimed at reducing SB, compared to usual care, result in a decrease in SB daily time or a reduction in the length of prolonged and uninterrupted sitting bouts? Data sources. Only peer-reviewed articles will be included in this systematic review, articles will be identified using the PICO method in seven different databases. Participants and interventions. Any primary intervention study (including randomized controlled trials, non-randomized controlled trials, and cohort studies) with the aim to reduce SB daily time or shorten the length of prolonged and uninterrupted sitting bouts in older adults living in LTCFs will be included. After searching databases, abstracts of the studies will be screened, and, after retrieving full text articles, data extraction will be conducted by two independent reviewers. Study appraisal and synthesis methods. The review will adhere to PRISMA reporting guidelines. Risk of bias (RoB) will be assessed using ROBINS-I or the RoB 2.0 tool and will be discussed with a third reviewer. The data will be grouped according to study design, with separate analysis for randomised and non-randomised designs. Results. The primary outcomes will be SB or time spent sedentary, assessed before and after the intervention. For the outcomes with the same measurement units, the pooled mean differences will be calculated. Standardised mean differences will be calculated for the outcomes with different measurement units. The data not suitable in numbers will be synthesised narratively. The strength of evidence of the outcomes will be assessed using GRADE assessment. If the data are suitable for quantitative analysis, we plan to use the Revman software to conduct a meta-analysis. Conclusions and implications of key findings. This protocol can serve as a valuable resource for other researchers interested in conducting similar systematic reviews or meta-analyses in the field of SB and older adult health.

The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review

BackgroundInactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities.MethodsArksey and O’Malley’s Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis.ResultsSixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), ‘exergames’ (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress.ConclusionsPopulation demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common—even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.

An intervention to decrease sedentary behavior in older adults: A secondary analysis of a randomized controlled trial.

Sedentary behaviors are associated with adverse health outcomes in older adults. The feasibility of behavioral interventions in this population is unclear. In the Sit Less, Interact, Move More (SLIMM) trial of 106 participants who had obesity, those randomized to the SLIMM intervention (N=54) were instructed to replace sedentary activities with stepping. An accelerometer was used to measure physical activity. In this secondary analysis, mixed effect models were used to examine the effects of the SLIMM intervention on sedentary and stepping durations and steps/day by age (<70 and≥70years). Mean ages in the <70years (N=47) and ≥70years (N=59) groups were 58±11 and 78±5. In the older subgroup, compared to standard-of-care (N=29), the SLIMM intervention (N=30) significantly increased stepping duration (13, 95%CI 1-24min/d, p=0.038) and steps per day (1330, 95% CI 322-2338, p=0.01) and non-significantly decreased sedentary duration by (28,95% CI -61-5min/d, p=0.09). In the age <70 subgroup, there was no separation between the standard of care (N=23) and SLIMM (N=24) groups. In older adults who had obesity, SLIMM intervention significantly increased stepping duration and steps per day. Interventions targeting sedentary behaviors by promoting low intensity physical activity may be feasible in this population.

Validation of an Algorithm for Measurement of Sedentary Behaviour in Community-Dwelling 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.

Inflammatory and Cardiovascular Correlates of Physical Activity and Sedentary Behavior in Older Adults Living With HIV.

Inflammation is an indicator of oxidative stress that may contribute to cardiovascular diseases in older people living with HIV (OPWH). Physical activity (PA) may reduce these biomarkers in OPWH, but little is known about the association of PA with inflammatory and cardiovascular biomarkers. We sought to examine the inflammatory and cardiovascular biomarker correlates of PA and sedentary behavior in OPWH. We included 101 OPWH with complete assessments of PA, sedentary behavior, and biomarker data to examine the association between the volume of PA and inflammatory and cardiovascular biomarkers. In this cohort of OPWH (mean age 55.9y), 68% were male and 83% were African American/Black. Among OPWH, greater volume of PA (ie,walking, moderate, vigorous, and/or total) was associated with lower systolic (P < .05) and diastolic blood pressure (P < .05), pulse pressure (P < .05), and tumor necrosis factor-alpha (P < .05). Greater duration of sitting was associated with greater triglycerides, interleukin-6, and tumor necrosis factor-alpha (P < .05). Although adherence to regular PA among OPWH is low and sedentary behavior is high, the associations between biomarkers and PA suggest a greater volume of PA could attenuate the inflammatory and cardiovascular derangements experienced by OPWH.

Fatores associados à elevada exposição ao comportamento sedentário em pessoas idosas: uma análise com dados da Pesquisa Nacional de Saúde, 2019

Abstract Objective To analyze the factors associated with sedentary behavior in older adults. Method A cross-sectional study of data from the 2019 National Health Survey involving 22,728 older Brazilian adults was conducted. The outcome was sedentary behavior and the exposures included sociodemographic characteristics, lifestyle, household characteristics and chronic diseases. Multiple logistic regression was used. with a significance level of 5%. Results The prevalence of sedentary behavior was 32.8% (95%CI: 31.8-33.8) There was a greater chance for the outcome in individuals that were female (OR=1.20; 95%CI: 1.08-1.34); aged 70-79 years (OR= 1.22; 95%CI: 1.09-1.36); aged ≥80 years (OR=1.18; 95% CI: 1.02-1, 36); had no partner (OR= 1.27; 95%CI: 1.14-1.41); were diabetic (OR =1.17; 95%CI: 1.06-1.30), had systemic arterial hypertension (OR =1.34; 95%CI: 1.18-1.51). previous stroke (OR = 1.61; 95%CI: 1.32-1.96), and no place to perform physical activity close to home (OR=1.16; 95%CI: 1.05-1.29). Older adults with low education (OR= 0.71; 95%CI: 0.61-0.82), and that resided in rural areas (OR=0.53; 95%CI: 0.47-0.61) were less likely to be sedentary. Conclusion Individuals that were female, older(ager &gt; 70 years), had diabetes, hypertension, previous stroke, and no place to perform physical activity close to home, were associated with high exposure to sedentary behavior. Living in rural areas and having less education were inversely associated with this risk behavior.

Factors associated with high exposure to sedentary behavior in older adults: analysis of data from the National Health Survey, 2019

Resumo Objetivo Analisar os fatores associados ao comportamento sedentário em pessoas idosas. Método Estudo transversal, com dados da Pesquisa Nacional de Saúde, 2019 com 22.728 pessoas idosas do Brasil. O desfecho foi o comportamento sedentário e as exposições: características sociodemográficas, estilo de vida, características do domicílio e doenças crônicas. Foi empregada a regressão logística múltipla e um nível de significância de 5%. Resultados A prevalência do comportamento sedentário foi 32,8% (IC95%: 31,8-33,8).Verificou-se maior chance para o desfecho no sexo feminino (OR =1,20; IC 95%: 1,08-1,34), entre as faixas etárias de 70 a 79 anos (OR = 1,22; IC 95%: 1,09-1,36) e 80 anos ou mais (OR=1,18; IC 95%: 1,02-1,36); entre pessoas idosas quem não tem companheiro (OR= 1,27; IC95%: 1,14-1,41); diabéticos (OR =1,17; IC 95%: 1,06-1,30), hipertensos (OR =1,34; IC 95%: 1,18-1,51), naqueles que tiveram Acidente Vascular Cerebral (OR = 1,61; IC 95%: 1,32-1,96) e naqueles que não têm lugar para praticar atividade física próximo do domicilio (OR =1,16; IC95%:1,05-1,29). Pessoas idosas com baixa escolaridade (OR = 0,71; IC 95%: 0,61- 0,82), e residentes em zona rural (OR = 0,53; IC 95%: 0,47-0,61) possuem menores chances de comportamento sedentário. Conclusão Mulheres, maiores faixas etárias (a partir dos 70 anos), pessoas com diabetes, hipertensão e que já tiveram AVE, e que não possuem locais para prática de atividade física próximo à residência foram associados à elevada exposição ao comportamento sedentário. Enquanto, viver em zonas rurais e possuir menor escolaridade apresentaram associação inversa a esse comportamento de risco.

Sedentary behavior is associated with disability and multimorbidity in older adults during the COVID-19 pandemic: a cross-sectional survey

Objective: We described sedentary behavior during the COVID-19 pandemic in Brazilian older adults and explored whether highly sedentary behavior was associated with multimorbidity, physical activity levels, adoption of physical distancing, perceived social isolation, disability, and depressive symptoms. Methods: We surveyed 184 older adults and gathered information on sedentary behavior, multimorbidity, physical activity, adoption of social distancing, perceived social isolation, disability, and depressive symptoms. Then, we investigated the association between highly sedentary behavior and these factors. Results: 26% of participants reported high levels of sedentary behavior, spending 5 hours per day in sitting (median). Highly sedentary behavior during COVID-19 pandemic was associated with multimorbidity (OR: 2.78, 95% CI 1.12-6.89) and disability (OR: 1.08, 95% CI 1.02-1.16). Conclusion: The prevalence of highly sedentary behavior in older adults during the pandemic was 26%. High sedentary behavior was associated with disability and multimorbidity in them. These findings can be used to guide the academia, the public sector, and health professionals to develop integrated initiatives to monitor and to decrease sedentary behavior especially in older adults with disability and multimorbidity during and beyond the COVID-19 pandemic.

Daily and hourly patterns of physical activity and sedentary behavior of older adults: Atherosclerosis risk in communities (ARIC) study

This cross-sectional study of older adults ≥ 65 years describes daily and hourly patterns of accelerometer-derived steps, sedentary, and physical activity behaviors and examines differences by day of the week and sociodemographic and health-related factors to identify time-use patterns. Data were from 459 Atherosclerosis Risk in Communities (ARIC) study participants (60% female; mean ± SD age = 78.3 ± 4.6 years; 20% Black) who wore a hip accelerometer ≥ 4 of 7 days, for ≥ 10 h/day in 2016. We used linear mixed models to examine daily patterns of steps, sedentary, low light, high light, and moderate-to-vigorous intensity physical activity (MVPA). Differences by sex, median age (</≥ 78 years), body mass index, self-rated health, depressive symptoms, and performance in a two-minute walk test were explored. Men (vs women), and those with overweight and obesity (vs normal weight), had significantly higher sedentary minutes and lower minutes of low light per day. For each additional meter walked during the two-minute walk test, sedentary behavior was lower while high light, MVPA, and daily steps were higher. No significant differences in time-use behaviors were found by self-reported race, age, education, self-rated health, or depressive symptoms. Participants were least active (22.5 min MVPA, 95% CI: 11.5, 33.5) and most sedentary (453.9 min, 95% CI: 417.7, 490.2) on Sunday. Most activity was accrued in the morning (before 12 PM) while the evening hours (3–11 PM) were spent ≥ 50% sedentary. Movement patterns suggest opportunities for promotion of activity and reduction in sedentary time on Sundays, in the evening hours, and for those with overweight or obesity.

Cost-effectiveness of a programme to address sedentary behaviour in older adults: results from the SITLESS RCT.

BackgroundThis study details the within-trial economic evaluation and long-term economic model of SITLESS, a multi-country, three-armed randomized controlled trial comparing a combined intervention of exercise referral schemes (ERS) enhanced by self-management strategies (SMS) against ERS alone and usual care (UC).MethodsA cost-utility analysis, conducted from the base-case perspective of the National Health Service and personal and social services, estimated the incremental cost per incremental quality-adjusted life year (QALY) and years in full capability (YFC). A secondary analysis combined the costs with a broad set of outcomes within a cost-consequence framework, from a societal perspective. A Markov-type decision-analytic model was developed to project short-term changes in physical activity to long-term outcomes and costs, over a 5- and 15-year time horizon.ResultsThe results of the within-trial analysis show that SMS+ERS is highly likely to be cost-effective compared to ERS alone (ICER €4270/QALY), but not compared to UC. Participants allocated to the SMS+ERS group also showed an improvement in YFC compared to ERS alone and UC. The long-term analysis revealed that SMS+ERS is likely to be a cost-effective option compared to ERS and UC over a 5-year, but not with a 15-year horizon, being then dominated by ERS alone.ConclusionThis research provides new evidence that SMS is a cost-effective add-on to ERS strategies. This economic evaluation informs the case for further, cost-effective, refinement of lifestyle change programmes targeted to older adults, with the aim of ultimately reducing the impact of non-communicable diseases in this population.