A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): results of a randomised-controlled feasibility study

Abstract

Background Osteoarthritis is a prevalent condition in older adults that causes many patients to require a hip or knee replacement. Reducing patients' sedentariness prior to surgery may improve physical function and post-operative outcomes. Methods We conducted a pragmatic randomised-controlled feasibility study with 2:1 allocation into intervention or usual care groups. The intervention, based on Self-Determination Theory, involved techniques to reduce sedentary behaviour, including motivational interviewing, setting of behavioural goals, and more. The primary outcome was feasibility, assessed using mixed methods. We included exploratory measures to inform a future definitive trial, such as ActivPal3 accelerometry to measure movement, the Short Physical Performance Battery (SPPB), Basic Psychological Needs, and cardiometabolic biomarkers. Assessments were at baseline, 1-week pre-surgery, and 6-week post-surgery. Results We recruited 35 participants aged ≥ 60 years approximately 8 weeks before hip or knee arthroplasty. Participant uptake rate was 14.2%, and retention rate 85.7%. Participants were very satisfied with the study which was found to be feasible with some modifications. Exploratory within-group comparisons found that the intervention has potential to improve SPPB by 0.71 points from baseline to pre-surgery, a clinically significant increase, and reduce sedentary time by up to 66 min d −1. Conclusion In this older surgical population, it is feasible to use behavioural techniques to displace sedentary time to activity and to conduct a trial spanning the period of surgical intervention. This may improve physical function and surgical outcomes. The INTEREST intervention is now ready for evaluation in a full-scale randomised-controlled trial. Registration This trial was registered on Clinicaltrials.gov on 13/11/2018. ID: NCT03740412.

Sedentary behaviour and bone health in older adults: a systematic review

“…This is consistent with other research in post-menopausal women, whereby a greater number of breaks in SB resulted in a 10% reduction in the odds of being diagnosed with osteoporosis/osteopenia [35]. A small study in frailer older adults found that breaking SB on a roughly hourly basis throughout the day improved physical function (timed up and go and 30 second chair stand) over a 10-week period, with no significant change in total ST or PA [36]. Similarly, Aunger et al [37] reported clinically significant improvement in physical function with non-significant increases in daily steps and time spent upright, despite non-significant decreases in SB.…”

Content and delivery of pre-operative interventions for patients undergoing total knee replacement: a rapid review

“…The only area of overlap was that both studies reported participants' views of personal tailoring. Patients in the study by Aunger et al [72] felt their sedentary behavior reduction goals were well suited to their individual circumstances, but most patients still had difficulties attaining their goals. Health professionals in the study by Snowden et al [86] highlighted that tailoring the alcohol consumption reduction intervention and associated screening to patients' individual needs helped keep their interactions positive.…”

“…The remaining two studies were mixed methods pilot and/or feasibility studies that investigated interventions aimed at reducing sedentary behavior [72] or alcohol consumption [86]. The only area of overlap was that both studies reported participants' views of personal tailoring.…”

Objective and subjective measurement of sedentary behavior in human adults: A toolkit

“…This means that researchers targeting non‐Western populations may have to develop and validate new domain‐specific questionnaires against objective devices or direct observation prior to beginning their study to ensure that key, relevant behaviors are included. Even within industrialized contexts, many questionnaires such as the Measure of Older Adults Sedentary Time (Gardiner et al, 2011 ) focus on “leisure time” activities but miss key behaviors such as eating, which is typically seated and occupies a large amount of the day (Aunger et al, 2020 ). It is also important to note that questionnaires have generally been written and validated in English and may require specific validation for use in other languages.…”

“…They can also be delivered in the native languages of the population of interest. PDR approaches are also able to capture sedentary behaviors that are common but often excluded from questionnaires, such as sitting to eat a meal (Aunger et al, 2020 ). The semi‐structured interview nature of PDR also lends itself to clarifications to understand the postures associated with each activity the participant reports.…”