The Importance of Reducing The Importance of Reducing Sedentary Behavior in Older Sedentary Behavior in Older AdultsAdults

Lisa H. Colbert, PhD, MPHDept. of Kinesiology

University of Wisconsin-Madison

What is Sedentary What is Sedentary Behavior?Behavior?

◦Participation in activities that do not substantially increase energy expenditure above resting levels

◦A behavior that we often have a choice about

(Credit: Science Daily/Gary Martin)

What isn’t Sedentary What isn’t Sedentary Behavior?Behavior?◦A lack of physical activity or exercise

◦Current physical activity recommendations for older adults are 150 min/wk of moderate intensity activity as tolerated

◦So…you could still do adequate PA but have substantial sedentary time

Major contexts for sedentary behaviour and their distribution over a typical adult’s waking hours. (From Dunstan et al. 2010a, reproduced with permission of Touch Briefings, European Endocrinology, Vol. 6, p. 20, © 2010.)

2

Light activity throughout the day

The Evolving Definition of "Sedentary". Pate, Russell; ONeill, Jennifer; Lobelo, Felipe

Exercise & Sport Sciences Reviews. 36(4):173-178, October 2008. DOI: 10.1097/JES.0b013e3181877d1a

2

Active Couch Potato

The Evolving Definition of "Sedentary". Pate, Russell; ONeill, Jennifer; Lobelo, Felipe

Exercise & Sport Sciences Reviews. 36(4):173-178, October 2008. DOI: 10.1097/JES.0b013e3181877d1a

(From Dunstan et al. 2010a, reproduced with permission of Touch Briefings, European Endocrinology, Vol. 6, p. 21, © 2010.)

Why should we care?Why should we care?

Time Spent SedentaryTime Spent Sedentary

Matthews et al., 2008

Sitting Time and All-Cause Mortality - Women

Patel A V et al. Am. J. Epidemiol. 2010;172:419-429

Patel A V et al. Am. J. Epidemiol. 2010;172:419-429

Sitting Time and All-Cause Mortality - Men

2KATZMARZYK, PETER; CHURCH, TIMOTHY; CRAIG, CORA; BOUCHARD, CLAUDE, Medicine & Science in Sports & Exercise. 41(5):998-1005, May 2009., DOI: 10.1249/MSS.0b013e3181930355

Sitting Time and All-Cause Mortality

•Total mortality

•Cancers (ovarian, colon, endometrial)

•Diabetes

•Obesity & Weight Gain

*even among those who do adequate PA

Health and Disease Outcomes Associated with SB

How can we decrease How can we decrease sedentary time?sedentary time?

•Stand up at each TV commercial

•Fold laundry while watching TV

•Stand/walk while on phone

•Modify environment…..

Decreasing Sedentary Time/Increasing Breaks

What do we still need to What do we still need to figure out?figure out?

•Confirm relationships with disease outcomes

•Relationships with important outcomes in older adults•Physical Function•Balance•Strength

•How older adults accumulate SB

•Feasible ways to reduce sedentary time in older adults

Work we are planning to Work we are planning to do….do….To compare the relationship between SB

and physical function in older adults

To determine the relevant domains in which SB is accumulated most frequently

To test an intervention to reduce SB

Madison Rock County

SB & physical function

X X

SB & balance testing

X

Pilot test“Sit Less, Live

Better”X

ParticipantsParticipants30-60 adults aged ≥ 65 years

◦ Community-dwelling and able to walk unaided

ProtocolProtocolVisit 1

◦ Health history and demographics◦ SB domain questionnaire◦ Sent home with activity monitors

Visit 2◦ SB domain questionnaire◦ Physical function measurements◦ Balance testing (in Madison)

Measures: Sedentary Measures: Sedentary Behavior and Physical Behavior and Physical ActivityActivity

Actigraph GT1M◦Uniaxial accelerometer◦Time spent in PA

ActivPal◦Time spent in SB andPattern of SB (breaks)

0 2 4 6 8 10 12 14

< 3 hrs

3-5.9 hrs

6-7.9 hrs

8+ hrs

Inactive time (hrs/day 0-99 cts/min)

Sel

f-re

po

rted

sit

tim

e (h

rs/d

ay)

How well do older adults report daily sitting time?

ActivPAL information

Measures: self-reported Measures: self-reported SBSBSB domain questionnaire

◦Adapted from Gardiner et al. 2011◦Assesses time spent sitting while:

Watching TV Using the computer Reading Socializing Driving or in public transportation Doing hobbies At work or volunteer Other activities

Measures: Physical Measures: Physical FunctionFunction

Modified Short Physical Performance Battery ◦Standing Balance

side-by-side, semi-tandem, & full-tandem stands

◦Walking balance walk a narrow path

◦Chair Rise Ability stand-up and sit-down 5 times

◦Gait Speed 6 meter course: usual pace

Measures: Physical Measures: Physical FunctionFunctionHand grip strength

◦Upper body physical function

Long Distance Corridor Walk◦2 minute walk◦400 meter walk

The SF-36 –self report◦Physical function subscale

““Sit Less, Live Better” Sit Less, Live Better” interventionintervention◦Participants 2 groups of 10 adults from the cross-

sectional study – Rock County

◦Protocol Four small group sessions held

weekly 1.5-2 hours in length Booster session at 8 weeks

Facilitating behavior change by applying concepts of the self-determination theory

Session 2 (1.5 hrs)• Session overview• In-depth info on benefits of sitting less / breaking up sedentary time• Individual brainstorming: what are my reasons for choosing to sit less?• Group discussion: how could sitting less benefit me personally?• Review action plans & problem solve as group• Write new action plan

Session 4 (1.5 hrs)• Session overview• Review information about the benefits of sitting less• Review action plans / goals• Group discussion: how has this been difficult? How has it been rewarding? How can we sustain the changes?• Worksheet: Setting long-term goals• Action plan

Session 5 – “Booster” (2 hrs)• Brief overview of program and session• Individual updates, review action plans / barriers / motivators• Reiteration of health benefits and group sharing of personal benefits experienced• Create long term action plan for future

Week 1 Week 2 Week 3 Week 4 Week 8

Session 1 (2 hrs)• Program overview• What is sitting less vs. exercising more• Group brainstorming: why are we Sedentary? Benefits of sitting less?• Worksheet: how much time do I spend Sitting?• Action plan / goal setting

Session 3 (1.5 hrs)• Session overview• Share example stories and ask group to discuss barriers and problem-solve solutions• Group discussion: personal barriers / solutions / motivators• Action plans

PA/SB –Pre Intervention; At week 4; at week 12 (one-month post-booster)

Thanks to…..Thanks to…..

Jane MahoneyRachel SmedleyJill BallardJoyce LubbenDiane LauverKeith Gennuso

Thoughts or Thoughts or Questions????Questions????