Nivell d'activitat física i comportament sedentari en gent gran: instruments de mesura i intervencions

Els nivells d’activitat física (AF) i de comportament sedentari (CS) han esdevingut marcadors importants de la salut de les persones grans (65 anys). Tot i que ambdós comportaments estan molt relacionats entre ells, no s’associen de la mateixa manera amb l’estat de salut d’aquest col·lectiu. Aquest segment de població està augmentant molt ràpidament i és el menys físicament actiu i més sedentari. L’objectiu principal d’aquesta tesi doctoral és investigar la relació entre l’AF i el CS, així com també les intervencions per modificar ambdós comportaments, en l’estat de salut de les persones grans. Aquest objectiu s’ha dividit en tres estudis: (1) avaluar els efectes de les intervencions d’AF en un seguiment mínim de sis mesos, i descriure les estratègies específiques implementades per millorar l’adherència a l’AF; (2) avaluar la validesa del Sedentary Behaviour Questionnaire (SBQ) per mesurar el CS de les persones grans mitjançant l’accelerometria com a criteri de validesa; (3) avaluar la relació entre l’AF i el CS auto-reportat i mesurat mitjançant accelerometria amb la qualitat de vida relacionada amb la salut (QVRS) de les persones grans. L’estudi I mostra que les intervencions basades en AF tenen un efecte significatiu sobre els nivells d’AF a l’acabar les intervencions respecte el grup control (GC) no actiu (diferència de mitjanes estandarditzada (DME) = 0.18); i passats sis mesos de seguiment (DME= 0.30). L’educació, la monitorització i la planificació d’accions son les estratègies identificades més utilitzades. L’estudi II mostra un acord dèbil entre mesures (Correlació intraclasse (CIC) = 0.32) i una infravaloració de temps sedentari de 72.90 mins/dia de l’SBQ respecte l’accelerometria. L’estudi III mostra una relació estadísticament significativa però dèbil entre l’AF i el CS auto-reportada i mesurada mitjançant accelerometria amb la QVRS (p 0.05), essent positiva amb l’AF i negativa amb el CS, especialment amb el physical component score (PCS) de l’SF-12. Respecte a l’estudi I, podem concloure que tot i mostrar uns resultats bastant heterogenis, les intervencions basades en AF tenen uns efectes estadísticament significatius sobre els nivells d’AF a l’acabar les intervencions amb una tendència a minvar a partir dels 12 mesos. Les estratègies més utilitzades han estat l’educació, l’auto-monitorització i la planificació d’accions, totes tres basades amb la Teoria Social Cognitiva (TSC). L’estudi II mostra que l’SBQ tendeix a infravalorar el temps en CS de la gent gran. Per tant, l’SBQ és una eina vàlida però poc fiable. Amb els resultats de l’estudi III, concloem que l’AF i el CS auto-reportat i avaluat mitjançant l’accelerometria s’associen significativament però dèbil amb la QVRS, diferenciant entre la PCS i la mental component score (MCS).Los niveles de actividad física (AF) y de comportamiento sedentario (CS) han pasado a considerarse marcadores importantes de la salud de las personas mayores (65 años). A pesar de que ambos comportamientos están muy relacionados entre sí, no se asocian del mismo modo con el estado de salud de la gente mayor. Este segmento de población es el que está aumentando muy rápidamente y es el menos físicamente activo y más sedentario. El objetivo principal de esta tesis doctoral es investigar la relación entre la AF y del CS, así como también de las intervenciones para modificar ambos comportamientos, en la salud de las personas mayores. Este objetivo se ha dividido en tres estudios: (1) evaluar el efecto de las intervenciones de AF con un seguimiento mínimo de seis meses, y describir las estrategias específicas implementadas para mejorar la adherencia a la AF; (2) evaluar la validez del Sedentary Behaviour Questionnaire (SBQ) para medir el CS de las personas mayores mediante la acelerometría como criterio de validez; (3) evaluar la relación entre la AF y el CS auto-reportado y medido mediante acelerometría con la calidad de vida relacionada con la salud (CVRS) de las personas mayores. El estudio I muestra que las intervenciones basadas en AF tienen un efecto significativo sobre los niveles de AF al terminar las intervenciones respecto a los grupos control (GC) no activos (diferencia de medias estandarizada (DME) = 0.18); y a los 6 meses de seguimiento (DME = 0.30). La educación, la auto-monitorización y la planificación de acciones son las estrategias identificadas más utilizadas. El estudio II muestra un acuerdo débil entre medidas (Correlación intraclase (CIC) = 0.32) y una infravaloración del SBQ del tiempo sedentario de 72.90 mins/día respecto a la acelerometría. El estudio III muestra una relación estadísticamente significativa pero débil entre la AF y el CS auto-reportado y medido mediante acelerometría con la CVRS (p 0.05) siendo positiva con la AF y negativa con el CS, especialmente con el physical component score (PCS). Respecto al estudio I, podemos concluir que, a pesar de mostrar unos resultados bastante heterogéneos, las intervenciones basadas en AF tienen unos efectos estadísticamente significativos sobre los niveles de AF al terminar las intervenciones, con una tendencia a menguar a partir de los 12 meses. Las estrategias más utilizadas han sido la educación, la monitorización y la planificación de acciones, basadas con la Teoría Social Cognitiva (TSC). El estudio II muestra que el SBQ tiende a infravalorar el tiempo en CS de la gente mayor. Por lo tanto, el SBQ es un instrumento válido, pero poco fiable. Con los resultados del estudio III, concluimos que la AF y el CS auto-reportado y medido mediante la acelerometría se asocian significativa pero débilmente con la CVRS, diferenciando entre el PCS y el mental component score (MCS).Physical activity (PA) levels and sedentary behaviour (SB) have become an important health marker for older adults (65 years old). Despite both behaviours are closely related, they are not equally associated with the older adults’ health status. In the last decades, older adults have been the fastest growing segment population, and they are the least active and most sedentary. The main aim of this doctoral thesis is to investigate the relation of PA and SB, as well as interventions to modify both behaviours, with older adults’ health. The main aim has been targeted with three studies: (1) to evaluate the effect of PA interventions with a minimum six months follow-up, and to describe specific strategies implemented to improve adherence to PA; (2) to evaluate the validity of the Sedentary Behaviour Questionnaire (SBQ) to measure older adults’ SB using accelerometry as a criterion validity; (3) to evaluate the relationship between PA and SB, self-reported and device-measured, with the health-related quality of life (HRQoL) among older adults. Study I shows that PA-based interventions have a significant effect on PA levels at the end of the interventions compared to non-active control groups (CG) (standardized mean difference (SMD) = 0.18); and at 6 months follow-up (SMD = 0.30). Education, self-monitoring and action planning are the most used identified strategies. Study II shows a weak agreement between measures (intraclass correlation coefficient (ICC) = 0.32) and an underestimation of the sedentary time with the SBQ of 72.90 mins/day against device-measured. Study III shows a statistically significant but weak relationship between PA and SB, self-reported and device-measured, with HRQoL (p 0.05), being positive with PA and negative with SB, in particular with physical component score (PCS). Regarding study I, although showing quite heterogeneous results, PA-based interventions have statistically significant effects on PA levels at the end of the interventions, with a decline after 12 months. The most widely used strategies have been educations, self-monitoring and action planning, based on the Social Cognitive Theory (SCT). Study II shows that SBQ tends to underestimate SB time among older adults. Therefore, the SBQ is a valid but unreliable instrument. Based on the study III results, we conclude that PA and SB, self-reported and device-measured, are significant but weakly associated with HRQoL, with a variance between PCS and mental component score (MCS)

Definitions, measurement and prevalence of sedentary behaviour in adults with intellectual disabilities – a systematic review

Supporting positive change in lifestyle behaviours is a priority in tackling the health inequalities experienced by adults with intellectual disabilities. In this systematic review, we examine the evidence on the definition, measurement and epidemiology of sedentary behaviour of adults with intellectual disabilities. A systematic literature search of PUBMED, EMBASE, MEDLINE and Google Scholar was performed to identify studies published from 1990 up to October 2015. Nineteen papers met the criteria for inclusion in the systematic review. Many researchers do not distinguish between insufficient physical activity and sedentary behaviour. None of the studies reported the reliability and validity of the methods used to measure sedentary behaviour. Sedentary time, assessed objectively, ranged from 522 to 643 min/day: higher than in adults without intellectual disabilities. This first-ever review of sedentary behaviour and intellectual disabilities found that at present the evidence base is weak. Studies calibrating accelerometer data with criterion measures for sedentary behaviour are needed to determine specific cut-off points to measure sedentary behaviour in adults with intellectual disabilities. Researchers should also examine the reliability and validity of using proxy-report questionnaires to measure sedentary behaviour in this group. A better understanding of sedentary behaviour will inform the design of novel interventions to change lifestyle behaviours of adults with intellectual disabilities

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

BackgroundSedentary 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.MethodsThe 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.ResultsParticipants 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).ConclusionLow education level in older adults is associated with self-reported SB but not with objective SB measures

Relationship of the SITLESS intervention on medication use in community-dwelling older adults: an exploratory study

BackgroundSedentary behavior (SB) and physical activity (PA) interventions in older adults can improve health outcomes. Problems related with aging include prevalent comorbidity, multiple non-communicable diseases, complaints, and resulting polypharmacy. This manuscript examines the relationship between an intervention aiming at reducing SB on medication patterns.MethodThis manuscript presents a local sub-analysis of the SITLESS trial data on medication use. SITLESS was an exercise referral scheme (ERS) enhanced by self-management strategies (SMS) to reduce SB in community-dwelling older adults. We analyzed data from the ERS + SMS, ERS and usual care (UC) groups. Patient medication records were available at baseline and at the end of the intervention (4-month period) and were analyzed to explore the effect of SITLESS on medication patterns of use.ResultA sample of 75 participants was analyzed, mostly older overweight women with poor body composition scores and mobility limitations. There was a significant reduction of 1.6 medicines (SD = 2.7) in the ERS group (p < 0.01), but not in the UC or ERS + SMS groups. Differences were more evident in medicines used for short periods of time.ConclusionThe findings suggest that an exercise-based program enhanced by SMS to reduce SB might influence medication use for acute conditions but there is a need to further investigate effects on long-term medicine use in older adults

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Older adults; Physical activity; AdherenceAdultos mayores; Actividad física; AdherenciaAdults majors; Activitat física; AdherènciaExercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.The present study was funded by United States Department of Health & Human Services National Institutes of Health (NIH), USA, and NIH National Institute on Aging (NIA), USA, (K24 AG057728)

Association of Self-Reported and Device-Measured Sedentary Behaviour and Physical Activity with Health-Related Quality of Life among European Older Adults

Human movement behaviours such as physical activity (PA) and sedentary behaviour (SB) during waking time have a significant impact on health-related quality of life (HRQoL) in older adults. In this study, we aimed to analyse the association between self-reported and device-measured SB and PA with HRQoL in a cohort of community-dwelling older adults from four European countries. A subsample of 1193 participants from the SITLESS trial (61% women and 75.1 ± 6.2 years old) were included in the analysis. The association between self-reported and objective measures of SB and PA with HRQoL were quantified using Spearman’s Rho coefficients. The strength of the associations between self-reported and device-measured PA and SB with self-rated HRQoL (mental composite score, MCS; physical composite score, PCS) were assessed through multivariate multiple regression analysis. Self-reported and device-measured PA and SB levels showed significant but poor associations with PCS (p < 0.05). The association with MCS was only significant but poor with self-reported light PA (LPA) and moderate-to-vigorous PA (MVPA). In conclusion, the findings of this study suggest that both self-reported and device-measured PA of all intensities were positively and significantly associated, while SB was negatively and significantly associated with the PCS of the SF-12

Validity of the Sedentary Behaviour Questionnaire in European Older Adults using English, Spanish, German and Danish versions

The main aim of this study was to assess the criterion validity of the Sedentary Behavior Questionnaire (SBQ) to measure SB in community-dwelling older adults using thigh-measured accelerometry as the criterion method. 801 participants (75.6 ± 6.1 years old, 57.6% females) provided valid thigh-based accelerometer data (activPAL/Axivity) and completed the SBQ. Criterion validity was assessed using Spearman’s Rho coefficients. Bland–Altman plots, including 95% limits of agreement and Intraclass Correlation Coefficient (ICC), were used to assess the agreement between self-report and device-measured daily SB time. Strength of the association was examined using multiple linear regression. There was a weak correlation (Rho = 0.25, p &lt; .001) between self-reported and device-based SB measures. The SBQ under-estimated daily SB time compared to accelerometry. Our results highlighted an overall weak-to-moderate correlation between measures, with significant differences between each country’s version. Researchers should be cautious when using the SBQ to provide an estimation of SB time in older adults

Exercise referral schemes enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity among community-dwelling older adults from four European countries: protocol for the process evaluation of the SITLESS randomised controlled trial

Introduction: SITLESS is a randomised controlled trial determining whether exercise referral schemes can be enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity in the long term, in community-dwelling older citizens. The intervention is complex and requires a process evaluation to understand how implementation, causal mechanisms and context shape outcomes. The specific aims are to assess fidelity and reach of the implementation, understand the contextual aspects of each intervention site, evaluate the mechanisms of impact, and explore perceived effects. Methods and analysis: Following the Medical Research Council guidance on complex interventions, a combination of qualitative and quantitative procedures is applied, including observational checklists and attendance registries, standardised scales (ie, Marcus’s Self-Efficacy Questionnaire, Physical Activity Self-Regulation Scale and the Lubben Social Network Scale) at baseline, postintervention and follow-up assessments, semistructured questionnaires gathering contextual characteristics, and participant observations of the sessions. Semistructured interviews and focus groups with the participants and trainers are conducted at postintervention and during the follow-up to explore their experiences. Outcomes from the standardised scales are analysed as moderators within the impact evaluation. Descriptive results on context and perceived effects complement results on impact. The qualitative and quantitative findings will help to refine the logic model to finally support the interpretation of the results on the effectiveness of the intervention. Ethics and dissemination: The study design was approved by the respective Ethical Committee of Ramon Llull University, Southern Denmark, Northern Ireland and Ulm University. Participation is voluntary, and all participants are asked to sign informed consent before starting the study. A dissemination plan operationalises how to achieve a social impact by reaching academic and non-academic stakeholders. A data management plan describes the specific data sets and regulates its deposition and curation. All publications will be open access

Correlates of Sedentary Behaviour in Adults with Intellectual Disabilities-A Systematic Review

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach

Accelerometer-measured sedentary and physical activity time and their correlates in European older adults: The SITLESS study

Background: Sedentary behavior (SB) and physical activity (PA) are important determinants of health in older adults. This study aimed to describe the composition of accelerometer-measured SB and PA in older adults, to explore self-reported context-specific SB, and to assess socio-demographic and functional correlates of engaging in higher levels of SB in participants of a multi-center study including four European countries. Methods: 1360 community-dwelling older adults from the SITLESS study (61.8% women; 75.3±6.3 years) completed a self-reported SB questionnaire and wore an ActiGraph accelerometer for seven days. Accelerometer-determined compositional descriptive statistics were calculated. A fixed effects regression analysis was conducted to assess the socio-demographic (country, age, sex, civil status, education and medications) and functional (BMI and gait speed) correlates. Results: Older adults spent 78.8% of waking time in SB, 18.6% in light-intensity PA (LPA), and 2.6% in moderate to vigorous PA (MVPA). Accelerometry showed that women engaged in more LPA and walking and men engaged in higher amounts of MVPA. Watching television and reading accounted for 47.2% of waking time. Older age, being a man, single, taking more medications, being obese and overweight, and having a slower gait speed were statistically significant correlates of more sedentary time. Conclusions: The high amount of SB of our participants justifies the need to develop and evaluate interventions to reduce sitting time. A clinically relevant change in gait speed can decrease almost 0.45 percentage points of sedentary time. The distribution of context-specific sedentary activities by country and sex showed minor differences, albeit worth noting