Stand When You Can: development and pilot testing of an intervention to reduce sedentary time in assisted living

Abstract

Background: Prolonged daily sedentary time is associated with increased risk of cardiometabolic diseases, impaired physical function, and mortality. Older adults are more sedentary than any other age group and those in assisted living residences accumulate more sedentary time as they often have little need to engage in light-intensity or standing activities such as cleaning or meal preparation. This "low movement" environment can hasten functional decline. Thus, the purpose of this study was to develop a multi-level intervention to reduce and interrupt sedentary time within assisted living residences and conduct a pilot study to determine if the intervention is feasible and if further testing is warranted. Methods: "Stand When You Can" (SWYC) was developed using a Social Ecological framework based on a review of literature and consultation with residents and staff at assisted living residences. After development, a six-week pilot study was conducted in two different residences with 10 older adults (82.2 ± 8.7 years). Before and after the 6 weeks, ActivPAL™ inclinometers were used to measure daily movement behaviours and self-report questionnaires assessed time spent in different sedentary behaviours and quality of life. Physical function was assessed using the Short Physical Performance Battery. Paired sample t-tests examined pre-post differences for pooled data and individual sites. At the end of the pilot study, feedback on the intervention was gathered from both residents and staff to examine feasibility. Results: There was a trend towards a decrease in self-reported sitting time (142 min/day; p = 0.09), although devicemeasured sedentary time did not change significantly. Participants with lower physical function at baseline showed clinically meaningful improvements in physical function after the 6 weeks (p = 0.04, Cohen's d = 0.89). There was no change in quality of life. Residents and staff reported that the intervention strategies were acceptable and practical. Conclusion: This study suggests that a multi-level intervention for reducing prolonged sedentary time is feasible for implementation at assisted living residences. The intervention could potentially help delay functional decline among older adults when they transition to a supportive living environment. Longer and larger trials to test the efficacy of SWYC are necessary.

Patterns of Sedentary Behavior among Older Adults in Care Facilities: A Scoping Review

“…The 18 included studies were published between 2002 to 2020 and conducted in seven countries, including The United States ( n = 6) [ 31 , 32 , 33 , 34 , 35 , 36 ], Australia ( n = 5) [ 37 , 38 , 39 , 40 , 41 ], The United Kingdom ( n = 2) [ 9 , 42 ], Canada ( n = 2) [ 18 , 43 ], The Netherlands ( n = 1) [ 44 ], and two countries (The United Kingdom and Spain) ( n = 2) [ 45 , 46 ]. In total, there were 11 cross-sectional studies [ 9 , 18 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], three randomized controlled trials [ 31 , 44 , 45 ], two pre-post intervention studies [ 34 , 43 ], one prospective cohort study [ 40 ], and one participatory action research [ 46 ], with sample sizes ranging from 9 to 230. Eleven studies were conducted in either intermediate [ 9 , 18 , 34 , 36 , 42 , 43 , 45 , 46 ] or mixed [ 31 , 33 , 44 ] level care facilities, wh...…”

“…In total, there were 11 cross-sectional studies [ 9 , 18 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 41 , 42 ], three randomized controlled trials [ 31 , 44 , 45 ], two pre-post intervention studies [ 34 , 43 ], one prospective cohort study [ 40 ], and one participatory action research [ 46 ], with sample sizes ranging from 9 to 230. Eleven studies were conducted in either intermediate [ 9 , 18 , 34 , 36 , 42 , 43 , 45 , 46 ] or mixed [ 31 , 33 , 44 ] level care facilities, while seven studies were conducted in high level care facilities [ 32 , 35 , 37 , 38 , 39 , 40 , 41 ]. The participants in intermediate/mixed and high level care facilities were mainly women (42–90% and 65–85%, respectively), and their respective ages ranged from 64–101 and 61–100 years.…”

“…There were three methods commonly used for measuring sedentary behavior in care facilities (e.g., objective, self-reported, and naturalistic observation). Ten studies reported objectively-measured sedentary behavior using either accelerometers [ 9 , 18 , 35 , 38 , 39 , 42 , 44 , 45 , 46 ] or pedometers [ 31 ], five studies used self-reported questionnaires for measuring sedentary behavior [ 34 , 36 , 37 , 40 , 41 ], and two studies reported sedentary behavior using both objective and self-reported methods [ 33 , 43 ] ( Table 2 and Table 3 ). Moreover, one study adopted naturalistic observation conducted by trained observers based on body postures and activity types to examine sedentary behavior in care facilities [ 32 ] ( Table 2 ).…”

“…The accelerometer-based instruments used across studies included ActiGraph/MTI [ 9 , 18 , 33 , 35 , 38 , 42 , 44 ] and ActiPAL [ 39 , 43 , 45 , 46 ] ( Table 2 ). One study measured sedentary behavior using digital pedometers (e.g., Fitbit Ultra activity tracker) [ 31 ].…”

Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities

“…This particular strategy may prove effective given that participants in our study mentioned accumulating long bouts of sedentary time during facility-sponsored activities. However, a recent pilot study incorporating a similar approach as part of a multicomponent intervention reported lack of follow through by facility staff to prompt breaks during activities and stressed the importance of staff engagement for successful implementation of this approach [ 32 ].…”