Abstract
Introduction: Sedentary behaviour (SB) has a deleterious effect on health and physical function in older adults (OA). Yet, there is little known about how to change SB patterns in OA. This thesis aimed to: 1) define the extent and context of SB in older adults; 2) develop an intervention to help reduce SB in OA using known physical activity behaviour change motivational techniques; 3) pilot this intervention, using activity monitoring and real time or follow-up feedback, to motivate frailer OA to reduce their SB.Methods: 1) Systematic Review: Eighteen studies (23 papers) were included to define prevalence of SB and 22 studies (31 papers) were included to define amount of SB in OA; 2) Mixed Methods: Exploration of context of SB, to develop the intervention, was undertaken in two lifelogging studies. Six OA reported in-depth description of context alongside camera images and objective SB monitoring; Thirty six OA used a standard classification system to report context; 3) Pilot Randomised Controlled Trial (RCT): The Stomp Out (prolonged) Sitting (SOS) Intervention recruited OA living in sheltered housing complexes (N=23) and consisted of face-to-face discussions, including visual feedback, about their SB on weeks 2, 6 and 10. They were monitored continuously over 14 weeks with an activPAL. One group had the addition of real-time feedback, via a vibrational feedback function (VTaP). The primary outcomes were SB parameters and secondary outcomes were physical function and self-reported wellness, analyzed with mixed model analysis. The participants also reported effects of the intervention and behaviour changes made via a self-report questionnaire, analyzed thematically.
Results: Approximately 60% of older adult’s report sitting for more than 4 h per day and on average report sitting for more than 5.3 h per day. When objectively measured, 2/3 of the OA populations are sedentary for more than 8.5 hours in their waking day. Self-report of SB greatly underestimates the actual SB measured objectively.
When examining the context of OA SB, screen-based activities were responsible for 62% of total sedentary bouts. They tend to be in their own home, on their own or with a family member. Social activities, eating and a variety of hobbies/leisure pursuits keep OA sitting for long periods, the most common reasons given for prolonged sitting was rest and relaxation. Within the RCT, there was no change to total SB time, however, those in the VTaP group broke their sitting more readily into shorter bouts. They also improved functional ability, suggesting this intervention had positive effects for the OA. The strategies used by the OA suggest useful ways of tailoring the interventions to individual’s circumstance and perceptions. The majority of self-reported benefits were physical in nature, but there were also numerous psychological and social benefits. To achieve a reduction in SB, the older adults reported that they made changes to the way they perceived their environment and daily routines.
Conclusion & Recommendations: It is hard to change total sedentary time in frailer OA. However, even in this frailer group of OA, with a large health related drop-out, patterns in SB can be changed, particularly when a real time prompt is used. For OA living in sheltered accommodation, it is appropriate to recommend reducing SB as this will improve their sit to stand ability and potentially improve their timed up and go, a marker of frailty and falls. This recommendation may not be appropriate for healthier older adults and further work is needed to clarify this.
| Date of Award | 2016 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Dawn Skelton (Supervisor) & Sebastien Chastin (Supervisor) |