Built Environment, Physical Activity, and Frailty Among Older Persons

Stimulating physical activity is a promising strategy to prevent frailty and disabilities in daily life. Besides offering facilitated physical activity (such as via sport clubs), it is also possible to be physically active in an unorganized setting such as walking in the built environment. This thesis provides insights and recommendations for research, policy, and practice with regard to the frailty development process and the role of the built environment and physical activity programs for physical activity and disability among older persons

Move more:Combining gamification and physical nudges to promote walking breaks and reduce sedentary behavior of office workers. A randomized controlled trial

Background: Sedentary behaviour (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations, such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote health behaviour change. However, most studies of effectiveness so far lacked active controls, and few studies have tested interventions combining these two strategies. Objective: This study investigated the effectiveness of an intervention combining a gamified digital intervention with physical nudges to increase PA and reduce SB in Dutch office workers. Methods: Employees of the municipality of Rotterdam (N = 298) from two office locations were randomized at the location-level to either a 10-week intervention, combining a five-week gamification phase encompassing a gamified digital intervention with social support features and a five-week physical nudges phase, or to an active control (i.e. limited digital application with self-monitoring and goal-setting). The primary outcome was daily step count objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB. Mixed-effects models were used to analyse the effects of the intervention on the primary and secondary outcome measures of participants up to one month after the intervention. Results: A total of 234 participants completed the study and provided accelerometer data. During the gamification phase, participants in the intervention condition significantly increased their number of daily steps (from 10138 to 10901; 763.5 increase) compared to those in the active control (from 10403 to 10619; 215.6 increase) (p = 0.01). These improvements were not sustained during the physical nudges phase (p = 0.76) or follow-up (p = 0.88). Conclusions: A digital intervention with gamification and social support features significantly increased the step count of office workers, compared to an active control encompassing self-monitoring and goal-setting. Physical nudges in the workplace were insufficient to promote maintanence of behaviour change achieved in the gamification phase. Future research should explore how to improve the long-term effectiveness of gamified digital interventions

Relaties van de fysieke omgeving met leefstijl, redzaamheid en sociale verbindingen

Onderzoeknaar de rol van de leefomgeving voor gezondheid en leefstijl is een relatief jong onderzoeksterrein. Ondanks een exponentiele toename in het aantal studies op dit terrein in de laatste twee decennia bestaat er

The BeHealthyR Study: A randomized trial of a multicomponent intervention to reduce stress, smoking and improve financial health of low-income residents in Rotterdam

Background: Compared to higher socioeconomic status (SES) groups, those in lower SES groups are financially strained, experience higher rates of smoking-related morbidity, are in poorer health and have reduced life expectancy. This is especially true for the city of Rotterdam, where a large inequality in health is observed between low and high SES groups. The BeHealthyR study (Dutch: Grip en Gezondheid) is a randomized controlled trial (RCT) which will evaluate the impact of a theory-based multicomponent behavior intervention aiming to reduce stress, smoking, and improve financial health by means of a group-based stress management program combining cognitive and behavioral techniques, and nudges in low-SES residents living in Rotterdam. Methods: The BeHealthyR study is a three-arm RCT. Between February 2018 and July 2019, low-SES participants who perceive stress, smoke, are financially strained and reside in Rotterdam (one of the four largest cities in The Netherlands) are recruited. Subsequently, participants are randomly assigned to either a stress management condition (SM), stress management with a buddy condition (SM-B) or a control condition (CC). Participants in the SM and SM-B conditions will attend four weekly group sessions (1.5 h/session) and a follow-up session eight weeks later. The SM condition includes psychoeducation and exercises, and cognitive and behavioral intervention techniques. Demographic data and objective measures will be collected at baseline (T0), four weeks post-baseline (T1), and twelve weeks post-baseline (T2). Primary outcome measures are to reduce stress, smoking and improve financial health. We hypothesize that low-SES participants in the intervention conditions, compared with those in the control condition, will experience less stress, smoke less and have improved financial health. Discussion: This study is a group-based intervention which aims to investigate the effects of a theory-based behavioral change intervention employing several components on reducing stress, smoking, and improving financial health in low-SES residents living in Rotterdam. If effective, the findings from the present study will serve to inform future directions of research and clinical practice with regard to behavioral change interventions for low-SES groups. Trial registration: ClinicalTrials.gov (ID: NCT03553979). Registered on January 1 2018

The role of high-intensity physical exercise in the prevention of disability among community-dwelling older people

Background: Moderate to vigorous physical activity (MVPA) is considered important to prevent disability among community-dwelling older people. To develop MVPA programs aimed at reducing or preventing disability more insight is needed in the contributions of exercise duration and intensity and the interplay between the two. Methods: Longitudinal data of 276 Dutch community-dwelling persons aged 65 years and older participating in the Elderly And their Neighbourhood (ELANE) study were used. MVPA exercise (yes/no), duration (hours per two weeks), intensit

Characteristics of residential areas and transportational walking among frail and non-frail Dutch elderly: Does the size of the area matter?

Background: A residential area supportive for walking may facilitate elderly to live longer independently. However, current evidence on area characteristics potentially important for walking among older persons is mixed. This study hypothesized that the importance of area characteristics for transportational walking depends on the size of the area characteristics measured, and older person's frailty level.Methods: The study population consisted of 408 Dutch community-dwelling persons aged 65 years and older participating in the Elderly And their Neighborhood (ELANE) study in 2011-2012. Characteristics (aesthetics, functional features, safety, and destinations) of areas surrounding participants' residences ranging from a buffer of 400 meters up to 1600 meters (based on walking path networks) were linked with self-reported transportational walking using linear regression analyses. In addition, interaction effects between frailty level and area characteristics were tested.Results:

How many walking and cycling trips made by elderly are beyond commonly used buffer sizes: Results from a GPS study

In choosing appropriate buffer sizes to study environmental influences on physical activity, studies are hampered by insufficient insight into the distance elderly travel actively. This study aims at getting insight into the number of trips walked and cycled within various buffer sizes using GPS measures. Data were obtained from the Elderly And their Neighborhood study (Spijkenisse, the Netherlands (2011-2012)). Trip length and mode of transport were derived from the GPS data (N=120; total number of trips=337). Distance decay functions were fitted to estimate the percentage of trips to grocery stores within commonly used buffer sizes. Fifty percent of the trips walked had a distance of at least 729. m; for trips cycled this was 1665. m. Elderly aged under 75 years and those with functional limitations walked and cycled shorter distances than those over 75 years and those without functional limitations. Males cycled shorter distances than females. Distance decay functions may aid the selection of appropriate buffer sizes, which may be tailored to individual characteristics

Participation levels of physical activity programs for community-dwelling older adults: A systematic review

Background: Although many physical activity (PA) programs have been implemented and tested for effectiveness, high participation levels are needed in order to achieve public health impact. This study aimed to

Physical activity in non-frail and frail older adults

Introduction: Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA. Aim: This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels. Methods: Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA). Results: Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home. Conclusions: Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults

Move more: Combining gamification and physical nudges to promote walking breaks and reduce sedentary behavior of office workers. A randomized controlled trial

Background: Sedentary behaviour (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations, such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote health behaviour change. However, most studies of effectiveness so far lacked active controls, and few studies have tested interventions combining these two strategies. Objective: This study investigated the effectiveness of an intervention combining a gamified digital intervention with physical nudges to increase PA and reduce SB in Dutch office workers. Methods: Employees of the municipality of Rotterdam (N = 298) from two office locations were randomized at the location-level to either a 10-week intervention, combining a five-week gamification phase encompassing a gamified digital intervention with social support features and a five-week physical nudges phase, or to an active control (i.e. limited digital application with self-monitoring and goal-setting). The primary outcome was daily step count objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB. Mixed-effects models were used to analyse the effects of the intervention on the primary and secondary outcome measures of participants up to one month after the intervention. Results: A total of 234 participants completed the study and provided accelerometer data. During the gamification phase, participants in the intervention condition significantly increased their number of daily steps (from 10138 to 10901; 763.5 increase) compared to those in the active control (from 10403 to 10619; 215.6 increase) (p = 0.01). These improvements were not sustained during the physical nudges phase (p = 0.76) or follow-up (p = 0.88). Conclusions: A digital intervention with gamification and social support features significantly increased the step count of office workers, compared to an active control encompassing self-monitoring and goal-setting. Physical nudges in the workplace were insufficient to promote maintanence of behaviour change achieved in the gamification phase. Future research should explore how to improve the long-term effectiveness of gamified digital interventions