Understanding and influencing sedentary behaviour in older adults

Gardiner, Paul (2011). Understanding and influencing sedentary behaviour in older adults PhD Thesis, School of Population Health, The University of Queensland.

       
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Author Gardiner, Paul
Thesis Title Understanding and influencing sedentary behaviour in older adults
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2011-11
Thesis type PhD Thesis
Supervisor Professor Neville Owen
Professor Elizabeth Eakin
Dr Genevieve Healy
Total pages 241
Total colour pages 42
Total black and white pages 199
Language eng
Subjects 111712 Health Promotion
111706 Epidemiology
110699 Human Movement and Sports Science not elsewhere classified
Abstract/Summary Background: Australia, like many developed countries, has an ageing population. Despite the substantial evidence that participation in moderate- to vigorous-intensity physical activity (MVPA) is able to minimize some of the physiologic changes associated with ageing, and alter the progression and development of chronic disease and disabling conditions, many older adults spend very little time engaged in MVPA. Instead, older adults spend the majority of their time engaged in sedentary behaviours – behaviours that expend very little energy and are characterised by prolonged periods of sitting. However to date, little empirical research has been conducted to understand the implications of these prolonged periods of sitting in older adults, or investigated interventions to change this behaviour. Aim: The primary aim of this research is to understand and influence sedentary behaviour in older adults (aged 60 years and older). This aim was addressed by examining: the potential cardiometabolic health impacts of sedentary behaviour in older adults; the feasibility of changing older adults’ sedentary behaviour; and, issues around measuring sedentary behaviour in older adults. Methods and Results: The studies in this Thesis comprise three empirical investigations, from two data sources. 1. An observational study was conducted with 1,958 participants in the population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study. This cross-sectional study reported that overall sitting time was deleteriously associated with the metabolic syndrome in older men and women, while TV viewing time was deleteriously associated with the metabolic syndrome in older women only. Television (TV) viewing time was detrimentally associated with lower high-density lipoprotein cholesterol (HDL-C) levels and glucose intolerance in women, while overall sitting time was associated with high triglyceride levels in men and women, abdominal obesity in women only, and lower HDL-C levels in men only. These findings indicate that high levels of time spent in sedentary behaviour are a risk factor for poor cardiometabolic health in older adults. The differential associations for men and women suggest it is important to measure sedentary time across all domains, and not focus on one specific leisure-time sedentary behaviour. While these findings need to be confirmed in prospective studies, they suggest that sedentary time is potentially an important health behaviour change target. 2. A single-group pre-post two-week study was conducted with 59 participants to evaluate an intervention (Stand Up For Your Health) designed to reduce and break up time spent in sedentary behaviours. The intervention, which was informed by Social Cognitive Theory and Behavioural Choice Theory, consisted of one face-to-face goal setting consultation, and one individually-tailored mailing providing feedback on device-measured sedentary behaviour. This study demonstrated that, at least in the short term, it was feasible to reduce sedentary behaviour in older adults, as evidenced by a 30 minute/day reduction in device-measured (ActiGraph GT1M accelerometer) sedentary behaviour. Reductions in sedentary behaviour mostly occurred between 10am and 6pm, with a higher number of breaks occurring between 7pm and 9pm. The high participant satisfaction suggests that older adults are receptive to messages about reducing their sedentary behaviour. The next phase of research in influencing sedentary behaviour should be to conduct randomised controlled trials to investigate the causality of sedentary behaviour on health outcomes important to older adults, for example, cardiometabolic health and physical function. In order to effectively evaluate future interventions, measures of sedentary behaviour that are reliable, valid and responsive to change are needed. 3. A study investigating the measurement properties of individual items and a summary measure of sedentary behaviour was conducted with 48 participants from the feasibility study described above. Self-report items to capture time in TV viewing, computer use and reading had excellent test-retest reliability, while the summary measure and item to capture time in hobbies had acceptable test-retest reliability. The summary measure had modest validity (relative to an accelerometer criterion), but was similarly modest to those reported for other self-report measures. This suggests that there may be issues with criterion measures used in validity studies. Thus, it is recommended that inclinometers, i.e. those that assess body postures such as sitting, be used in future validation studies. The summary measure was similarly responsive to changes in sedentary behaviour as was the device measure, following an intervention. When measuring sedentary behaviour in intervention studies, it is recommended that changes are reported across the spectrum of individual behaviours, as well as across the entire day. A combination of self-report and device measures of sedentary behaviour would allow this. Conclusion: This Thesis addressed an important, emerging issue in population health: sedentary behaviour. It confirmed the link between sedentary behaviour and cardiometabolic health in older adults, and demonstrated that it is feasible to change sedentary time, at least in the short term. It also demonstrated the importance of using appropriate measures for assessing sedentary behaviour in epidemiological and health behaviour research.
Keyword Older Adults
Sedentary Behaviour
Metabolic Syndrome
Television viewing
Sitting
Intervention
Feasibility
Questionnaire
Accelerometer
measurement
Additional Notes Pages to be printed in colour: 27, 70, 99, 114, 120, 176-188, 190, 196-197, 199-205, 218, 226-228, 232-241. Pages which are landscape: 149-164, 170-173, 178-181, 183, 185-190, 196-197, 203-225 Note, page numbers are the page number of the PDF document, not the page number of your thesis.

 
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