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Assessment of Sedentary Behavior With the International Physical Activity Questionnaire

Dori E. Rosenberg, Fiona C. Bull, Alison L. Marshall, James F. Sallis, and Adrian E. Bauman

Purpose:

This study explored definitions of sedentary behavior and examined the relationship between sitting time and physical inactivity using the sitting items from the International Physical Activity Questionnaire (IPAQ).

Methods:

Participants (N = 289, 44.6% male, mean age = 35.93) from 3 countries completed self-administered long- and short-IPAQ sitting items. Participants wore accelero-meters; were classified as inactive (no leisure-time activity), insufficiently active, or meeting recommendations; and were classified into tertiles of sitting behavior.

Results:

Reliability of sitting time was acceptable for men and women. Correlations between total sitting and accelerometer counts/min <100 were significant for both long (r = .33) and short (r = .34) forms. There was no agreement between tertiles of sitting and the inactivity category (kappa = .02, P = .68).

Conclusion:

Sedentary behavior should be explicitly measured in population surveillance and research instead of being defined by lack of physical activity.

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Promoting Walking Among Older Adults Living in Retirement Communities

Dori E. Rosenberg, Jacqueline Kerr, James F. Sallis, Gregory J. Norman, Karen Calfas, and Kevin Patrick

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.

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Associations of Cognitively Active Versus Passive Sedentary Behaviors and Cognition in Older Adults

Mariana Wingood, Nancy M. Gell, Dori E. Rosenberg, Gregory J. Stoddard, and Erin D. Bouldin

Background: Cognitively stimulating sedentary behavior (SB) may positively impact cognition. This study aimed to (1) describe participation across types of SB among older adults with and without cognitive impairment and (2) examine how baseline SB participation impacts cognition, longitudinally. Methods: We used National Health and Aging Trends Study data from rounds 6 to 11 for cross-sectional and longitudinal analyses. Participants were 2244 community-dwelling older adults who were selected for the SB module in round 6. The SBs were categorized as active (eg, hobbies) and passive (eg, television). Participants were also categorized as having intact or impaired orientation, memory, and executive function based on tests of orientation, recall, and the clock-drawing test. We calculated descriptive statistics characterizing SB by cognitive status. Aim 2 involved competing risks proportional hazard models of participants with intact cognition (n = 1574) to identify associations between baseline SB and changes in cognition, moves to institutional care, and death over 6 years. Results: Participants (40% ≥ 80 years, 55% female, 77% White non-Hispanic) averaged 8.75 (SD = 4.42) hours of daily SB, including 4.05 (SD = 2.32) hours of passive SB and 4.75 (SD = 3.13) hours of active SB. Active SB >3 hours per day was associated with a lower risk of impaired orientation (subdistribution hazard models = 0.60; P = .048) and memory (subdistribution hazard models = 0.62; P = .02). Baseline participation in passive SB did not impact the risk of having a change in cognition during rounds 7 to 11. Conclusion: Cognitive decline was lower among older adults who participated in more active SB. Thus, type of SB should be considered in examining the impact on cognition.

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Individual, Social, and Neighborhood Associations With Sitting Time Among Veterans

Rachel A. Millstein, Katherine D. Hoerster, Dori E. Rosenberg, Karin M. Nelson, Gayle Reiber, and Brian E. Saelens

Background:

Sedentary behavior is an increasingly recognized health risk factor, independent of physical activity. Although several correlates of sedentary behavior are known, little research has identified them among U.S. veterans, a population that faces disproportionate chronic disease burden.

Methods:

A survey was mailed to 1997 randomly selected veterans at a large urban Veterans Affairs medical center in 2012 and remailed in 2013 to nonresponders, resulting in a 40% response rate. We examined individual-, social-, and neighborhood-level factors in association with self-reported sitting time. Factors correlated with sitting time at P < .05 were included in a multiple linear regression model.

Results:

In the multivariate model, higher depression (B = 7.8), body mass index (B = 5.1), functional impairment (B = 4.2), and self-rated health (B = 68.5) were significantly associated with higher sitting time, and leisure time physical activity (B = –0.10) and being employed (B = –71.3) were significantly associated with lower sitting time.

Conclusions:

Individual-level, but not social- and neighborhood-level, variables were associated with sitting time in this population. This study identified individual-level targets for reducing sitting time and improving overall health among veterans.

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Building Community: Stakeholder Perspectives on Walking in Malls and Other Venues

Basia Belza, Christina E. Miyawaki, Peg Allen, Diane K. King, David X. Marquez, Dina L. Jones, Sarah Janicek, Dori Rosenberg, and David R. Brown

Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.

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Reliability and Validity of the Sedentary Behavior Questionnaire (SBQ) for Adults

Dori E. Rosenberg, Gregory J. Norman, Nicole Wagner, Kevin Patrick, Karen J. Calfas, and James F. Sallis

Background:

Sedentary behavior is related to obesity, but measures of sedentary behaviors are lacking for adults. The purpose of this study was to examine the reliability and validity of the Sedentary Behavior Questionnaire (SBQ) among overweight adults.

Methods:

Participants were 49 adults for the 2 week test-retest reliability study (67% female, 53% white, mean age = 20) and 401 overweight women (mean age = 41, 61% white) and 441 overweight men (mean age = 44, 81% white) for the validity study. The SBQ consisted of reports of time spent in 9 sedentary behaviors. Outcomes for validity included accelerometer measured inactivity, sitting time (International Physical Activity Questionnaire), and BMI. Intraclass correlation coefficients (ICCs) assessed reliability and partial correlations assessed validity.

Results:

ICCs were acceptable for all items and the total scale (range = .51–.93). For men, there were significant relationships of SBQ items with IPAQ sitting time and BMI. For women, there were relationships between the SBQ and accelerometer inactivity minutes, IPAQ sitting time, and BMI.

Conclusions:

The SBQ has acceptable measurement properties for use among overweight adults. Specific measures of sedentary behavior should be included in studies and population surveillance.

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Reducing Sitting Time in Obese Older Adults: The I-STAND Randomized Controlled Trial

Dori E. Rosenberg, Melissa L. Anderson, Anne Renz, Theresa E. Matson, Amy K. Lee, Mikael Anne Greenwood-Hickman, David E. Arterburn, Paul A. Gardiner, Jacqueline Kerr, and Jennifer B. McClure

Background: The authors tested the efficacy of the “I-STAND” intervention for reducing sitting time, a novel and potentially health-promoting approach, in older adults with obesity. Methods: The authors recruited 60 people (mean age = 68 ± 4.9 years, 68% female, 86% White; mean body mass index = 35.4). The participants were randomized to receive the I-STAND sitting reduction intervention (n = 29) or healthy living control group (n = 31) for 12 weeks. At baseline and at 12 weeks, the participants wore activPAL devices to assess sitting time (primary outcome). Secondary outcomes included fasting glucose, blood pressure, and weight. Linear regression models assessed between-group differences in the outcomes. Results: The I-STAND participants significantly reduced their sitting time compared with the controls (–58 min per day; 95% confidence interval [–100.3, –15.6]; p = .007). There were no statistically significant changes in the secondary outcomes. Conclusion: I-STAND was efficacious in reducing sitting time, but not in changing health outcomes in older adults with obesity.

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Comparison of Questionnaire and Device Measures of Physical Activity and Sedentary Behavior in a Multi-Ethnic Cohort of Older Women

Michael J. LaMonte, I-Min Lee, Eileen Rillamas-Sun, John Bellettiere, Kelly R. Evenson, David M. Buchner, Chongzhi Di, Cora E. Lewis, Dori E. Rosenberg, Marcia L. Stefanick, and Andrea Z. LaCroix

Background: Limited data are available regarding the correlation between questionnaire and device-measured physical activity (PA) and sedentary behavior (SB) in older women. Methods: We evaluated these correlations in 5,992 women, aged 63 and older, who completed the Women’s Health Initiative (WHI) and Community Healthy Activities Model Program for Seniors (CHAMPS) PA questionnaires and the CARDIA SB questionnaire prior to wearing a hip-worn accelerometer for 7 consecutive days. Accelerometer-measured total, light, and moderate-to-vigorous PA (MVPA), and total SB time were defined according to cutpoints established in a calibration study. Spearman coefficients were used to evaluate correlations between questionnaire and device measures. Results: Mean time spent in PA and SB was lower for questionnaire than accelerometer measures, with variation in means according to age, race/ethnicity, body mass index, and functional status. Overall, correlations between questionnaires and accelerometer measures were moderate for total PA, MVPA, and SB (r ≈ 0.20–0.40). Light intensity PA correlated weakly for WHI (r ≈ 0.01–0.06) and was variable for CHAMPS (r ≈ 0.07–0.22). Conclusion: Questionnaire and accelerometer estimates of total PA, MVPA, and SB have at best moderate correlations in older women and should not be assumed to be measuring the same behaviors or quantity of behavior. Light intensity PA is poorly measured by questionnaire. Because light intensity activities account for the largest proportion of daily activity time in older adults, and likely contribute to its health benefits, further research should investigate how to improve measurement of light intensity PA by questionnaires.

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Associations Between Perceived Neighborhood Walkability and Device-Based Physical Activity and Sedentary Behavior Patterns in Older Adults

Mikael Anne Greenwood-Hickman, Rod Walker, John Bellettiere, Andrea Z. LaCroix, Boeun Kim, David Wing, KatieRose Richmire, Paul K. Crane, Eric B. Larson, and Dori E. Rosenberg

Neighborhood walkability has been associated with self-reported sedentary behavior (SB) and self-reported and objective physical activity. However, self-reported measures of SB are inaccurate and can lead to biased estimates, and few studies have examined how associations differ by gender and age. The authors examined the relationships between perceived neighborhood walkability measured with the Physical Activity Neighborhood Environment Scale (scored 1.0–4.0) and device-based SB and physical activity in a cohort of community-dwelling older adults (N = 1,077). The authors fit linear regression models adjusting for device wear time, demographics, self-rated health, and accounting for probability of participation. The Higher Physical Activity Neighborhood Environment Scale was associated with higher steps (+676 steps/point on the Physical Activity Neighborhood Environment Scale, p = .001) and sit-to-stand transitions (+2.4 transitions/point, p = .018). Though not statistically significant, stratified analyses suggest an attenuation of effect for those aged 85 years and older and for women. Consistent with previous literature, neighborhood walkability was associated with more steps, though not with physical activity time. The neighborhood environment may also influence SB.

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Validity of Two Awake Wear-Time Classification Algorithms for activPAL in Youth, Adults, and Older Adults

Jordan A. Carlson, Fatima Tuz-Zahra, John Bellettiere, Nicola D. Ridgers, Chelsea Steel, Carolina Bejarano, Andrea Z. LaCroix, Dori E. Rosenberg, Mikael Anne Greenwood-Hickman, Marta M. Jankowska, and Loki Natarajan

Background: The authors assessed agreement between participant diaries and two automated algorithms applied to activPAL (PAL Technologies Ltd, Glasgow, United Kingdom) data for classifying awake wear time in three age groups. Methods: Study 1 involved 20 youth and 23 adults who, by protocol, removed the activPAL occasionally to create nonwear periods. Study 2 involved 744 older adults who wore the activPAL continuously. Both studies involved multiple assessment days. In-bed, out-of-bed, and nonwear times were recorded in the participant diaries. The CREA (in PAL processing suite) and ProcessingPAL (secondary application) algorithms estimated out-of-bed wear time. Second- and day-level agreement between the algorithms and diary was investigated, as were associations of sedentary variables with self-rated health. Results: The overall accuracy for classifying out-of-bed wear time as compared with the diary was 89.7% (Study 1) to 95% (Study 2) for CREA and 89.4% (Study 1) to 93% (Study 2) for ProcessingPAL. Over 90% of the nonwear time occurring in nonwear periods >165 min was detected by both algorithms, while <11% occurring in periods ≤165 min was detected. For the daily variables, the mean absolute errors for each algorithm were generally within 0–15% of the diary mean. Most Spearman correlations were very large (≥.81). The mean absolute errors and correlations were less favorable for days on which any nonwear time had occurred. The associations between sedentary variables and self-rated health were similar across processing methods. Conclusion: The automated awake wear-time classification algorithms performed similarly to the diary information on days without short (≤2.5–2.75 hr) nonwear periods. Because both diary and algorithm data can have inaccuracies, best practices likely involve integrating diary and algorithm output.