The Importance of Reducing Sedentary Behavior in Older Adults Lisa H. Colbert, PhD, MPH Dept. of Kinesiology University of Wisconsin-Madison

What is Sedentary 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 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): , October DOI: /JES.0b013e d1a

2 Active Couch Potato The Evolving Definition of "Sedentary". Pate, Russell; ONeill, Jennifer; Lobelo, Felipe Exercise & Sport Sciences Reviews. 36(4): , October DOI: /JES.0b013e d1a

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

Why should we care?

Time Spent Sedentary Matthews et al., 2008

Sitting Time and All-Cause Mortality - Women Patel A V et al. Am. J. Epidemiol. 2010;172:

Sitting Time and All-Cause Mortality - Men

2 KATZMARZYK, PETER; CHURCH, TIMOTHY; CRAIG, CORA; BOUCHARD, CLAUDE, Medicine & Science in Sports & Exercise. 41(5): , May 2009., DOI: /MSS.0b013e 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 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 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 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

MadisonRock County SB & physical function XX SB & balance testing X Pilot test “Sit Less, Live Better” X

Participants adults aged ≥ 65 years ◦ Community-dwelling and able to walk unaided Protocol Visit 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 Behavior and Physical Activity Actigraph GT1M ◦ Uniaxial accelerometer ◦ Time spent in PA ActivPal ◦ Time spent in SB and Pattern of SB (breaks)

How well do older adults report daily sitting time?

ActivPAL information

Measures: self-reported SB SB domain questionnaire ◦ Adapted from Gardiner et al ◦ 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 Function 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 Function Hand 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” intervention ◦ Participants  2 groups of 10 adults from the cross-sectional study – Rock County ◦ Protocol  Four small group sessions held weekly  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….. Jane Mahoney Rachel Smedley Jill Ballard Joyce Lubben Diane Lauver Keith Gennuso

Thoughts or Questions????