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Juliet A. Harvey, Sebastien F.M. Chastin and Dawn A. Skelton

Background/objectives:

Sedentary behavior (SB), defined as sitting (nonexercising), reclining, and lying down (posture), or by low energy expenditure, is a public health risk independent to physical activity. The objective of this systematic literature review was to synthesize the available evidence on amount of SB reported by and measured in older adults.

Data source:

Studies published between 1981 and 2014 were identified from electronic databases and manual searching. Large-scale population studies/surveys reporting the amount of SB (objective/subjective) in older adults aged ≥ 60 years of age were included. Appraisal and synthesis was completed using MOOSE guidelines.

Results:

349,698 adults aged ≥ 60 within 22 studies (10 countries and 1 EU-wide) were included. Objective measurement of SB shows that older adults spend an average of 9.4 hr a day sedentary, equating to 65–80% of their waking day. Self-report of SB is lower, with average weighted self-reports being 5.3 hr daily. Within specific domains of SB, older adults report 3.3 hr in leisure sitting time and 3.3 hr watching TV. There is an association with more time spent in SB as age advances and a trend for older men to spend more time in SB than women.

Conclusion/implications:

Time spent sedentary ranges from 5.3–9.4 hr per waking day in older adults. With recent studies suggesting a link between SB, health, and well-being, independent of physical activity, this is an area important for successful aging.

Limitations:

Different methodologies of measurement and different reporting methods of SB made synthesis difficult. Estimated SB time from self-report is half of that measured objectively; suggesting that most self-report surveys of SB will vastly underestimate the actual time spent in SB.

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Helen Hawley, Dawn A. Skelton, Malcolm Campbell and Chris Todd

Little is known about the relationship between attitudes and characteristics of instructors and uptake and adherence of older people to exercise classes. This article explores these issues.

Methods:

The authors surveyed 731 UK exercise instructors with specialist older adult exercise qualifications. A questionnaire investigated instructors’ characteristics and attitudes toward older adults’ participation in exercise.

Results:

For mostly seated classes, EXTEND qualification (B = 0.36, p = .005) had a positive effect on instructors’ attitudes. Later Life Training qualification (B = −2.80, p = .003), clinical background (B = −3.99, p = .005), and delivering classes in National Health Services (B = −3.12, p < .001), leisure centers (B = −2.75, p = .002), or nursing homes (B = −2.29, p = .005) had a negative effect on attitudes. For mostly standing classes, experience (B = 0.20, p = .003) and delivering in leisure centers (B = 0.46, p = .032) had a positive and clinical background (B = −1.78, p = .018) had a negative effect on instructors’ attitudes.

Conclusions:

Most instructors have positive attitudes, but training and work context can influence attitudes toward older people’s participation in exercise classes both positively and negatively.

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Helen Hawley-Hague, Maria Horne, Dawn A. Skelton and Chris Todd

Exercise classes provide a range of benefits for older adults, but adherence levels are poor. We know little of instructors’ experiences of delivering exercise classes to older adults. Semistructured interviews, informed by the Theory of Planned Behavior (TPB), were conducted with instructors (n = 19) delivering multicomponent exercise classes to establish their perspectives on older adults’ uptake and adherence to exercise classes. Analysis revealed ‘barriers’ to uptake related to identity, choice/control, cost, and venue, and ‘solutions’ included providing choice/control, relating exercise to identity, a personal touch, and social support. Barriers to adherence included unrealistic expectations and social influences, and solutions identified were encouraging commitment, creating social cohesion, and an emphasis on achieving outcomes. Older adults’ attitudes were an underlying theme, which related to all barriers and solutions. The instructor plays an important, but not isolated, role in older adults’ uptake and adherence to classes. Instructors’ perspectives help us to further understand how we can design successful exercise classes.

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Therese Brovold, Dawn A. Skelton, Hilde Sylliaas, Morten Mowe and Astrid Bergland

The purpose of this study was to determine the relationship among health-related quality of life (HRQOL), physical fitness, and physical activity in older patients after recent discharge from hospital. One hundred fifteen independent-living older adults (ages 70–92 years) were included. HRQOL (Medical Outcomes Study 36-item Short Form Health Survey), physical activity (Physical Activity Scale for the Elderly), and physical fitness (Senior Fitness Test) were measured 2–4 weeks after discharge. Higher levels of physical activity and physical fitness were correlated with higher self-reported HRQOL. Although cause and effect cannot be determined from this study, the results suggest that a particular focus on the value of physical activity and physical fitness while in hospital and when discharged from hospital may be important to encourage patients to actively preserve independence and HRQOL. It may be especially important to target those with lower levels of physical activity, poorer physical fitness, and multiple comorbidities.

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Simone Nicolai, Petra Benzinger, Dawn A. Skelton, Kamiar Aminian, Clemens Becker and Ulrich Lindemann

The purpose of the study was to investigate whether a 24-hr recording period is sufficient to describe physical activity (PA) of 1 week for intraindividual comparison in older adults. Furthermore, the authors analyzed whether physical performance can be used as a surrogate marker of PA. PA was captured on 7 consecutive days by a body-fixed sensor in 44 community-dwelling older adults (80.75 ± 4.05 yr). Mean times of walking and of “time on feet” of the group were 10.2 hr (± 3.5) and 35.1 hr (± 9.43), respectively. Intraindividual variabilities of walking and of time on feet were 31.9% ± 10.79% and 19.4% ± 8.76%, respectively. Accumulated time of variables of PA showed no differences between weekdays, with variabilities of 3.8% and 1.8% for walking and time on feet, respectively. Association between Short Physical Performance Battery and PA was limited (walking r = .397, time on feet r = .41).

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Manon L. Dontje, Calum F. Leask, Juliet Harvey, Dawn A. Skelton and Sebastien F.M. Chastin

Older adults are recommended to reduce their sedentary time to promote healthy ageing. To develop effective interventions identifying when, why, and how older adults are able to change their sitting habits is important. The aim of this mixed-method study was to improve our understanding of reasons for (breaking) sedentary behavior in older adults. Thirty older adults (74.0 [±5.3] years old, 73% women) were asked about their believed reasons for (breaking) sedentary behavior, and about their actual reasons when looking at a personal storyboard with objective records of activPAL monitor data and time-lapse camera pictures showing all their periods of sedentary time in a day. The most often mentioned believed reason for remaining sedentary was television/radio (mentioned by 48.3%), while eating/drinking was most often mentioned as actual reason (96.6%). Only 17.2% believed that food/tea preparation was a reason to break up sitting, while this was an actual reason for 82.8% of the study sample. Results of this study show that there is a discrepancy between believed and actual reasons for (breaking) sedentary behavior. These findings suggest developing interventions utilizing the actual reasons for breaking sedentary behavior to reduce sedentary time in older adults.

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Ellen C. Jørstad-Stein, Klaus Hauer, Clemens Becker, Marc Bonnefoy, Rachel A. Nakash, Dawn A. Skelton and Sarah E. Lamb

The purpose of the study was to identify physical activity questionnaires for older adults that might be suitable outcome measures in clinical trials of fall-injury-prevention intervention and to undertake a systematic quality assessment of their measurement properties. PubMed, CINAHL, and PsycINFO were systematically searched to identify measurements and articles reporting the methodological quality of relevant measures. Quality extraction relating to content, population, reliability, validity, responsiveness, acceptability, practicality, and feasibility was undertaken. Twelve outcome measures met the inclusion criteria. There is limited evidence about the measures’ properties. None of the measures is entirely satisfactory for use in a large-scale trial at present. There is a need to develop suitable measures. The Stanford 7-day Physical Activity Recall Questionnaire and the Community Health Activities Model Program for Seniors questionnaire might be appropriate for further development. The results have implications for the designs of large-scale trials investigating many different geriatric syndromes.

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Philippa M. Dall, Dawn A. Skelton, Manon L. Dontje, Elaine H. Coulter, Sally Stewart, Simon R. Cox, Richard J. Shaw, Iva Čukić, Claire F. Fitzsimons, Carolyn A. Greig, Malcolm H. Granat, Geoff Der, Ian J. Deary, Sebastien F.M. Chastin and On behalf of the Seniors USP Team

The Seniors USP (Understanding Sedentary Patterns) study measured sedentary behavior (activPAL3, 9-day wear) in older adults. The measurement protocol had three key characteristics: enabling 24-hour wear (monitor location, waterproofing), minimizing data loss (reducing monitor failure, staff training, communication), and quality assurance (removal by researcher, confidence about wear). Two monitors were not returned; 91% (n = 700) of returned monitors had seven valid days of data. Sources of data loss included monitor failure (n = 11), exclusion after quality assurance (n = 5), early removal for skin irritation (n = 8), or procedural errors (n = 10). Objective measurement of physical activity and sedentary behavior in large studies requires decisional trade-offs between data quantity (collecting representative data) and utility (derived outcomes that reflect actual behavior).