Up and active

The University of Auckland researchers Philippa Mandeno and Dawn Jun investigate the implications of sedentary behaviour in older adults living in residential care.*

There is the phrase in the healthcare parlance that says Use it or lose it. Meaning that mental or physical capabilities that we take for granted may wane with age. Unless we remain active, alert and alive.

Two students at The University of Auckland, supported by the Selwyn Institute and with research conducted in The Selwyn Foundation care homes, have assessed how an over sedentary lifestyle could affect people’s quality of life and wellbeing.

Philippa Mandeno’s thesis Can interventions be used effectively to increase non-sedentary behaviour starts from the premise that excessive sedentary (sitting and reclining) has only recently started emerging as a significant risk to both physical and mental health.

This is true across the population but more significantly among residents of retirement communities who are among the most sedentary. Due to a real, or perceived, inability, lack of resources and education or simply as a matter of habit.

Breaking the sedentary ‘cycle’ is challenging but success has come from using techniques aligned with behaviour modification that have applications in getting people up and active. This study implemented techniques including prompting, social reinforcement with praise and goal setting procedures to increase breaks in sedentary behavior and time engaged in non-sedentary activities.

Results revealed that, although some improvements in non-sedentary behaviour took place, effect sizes were negligible and therefore inconclusive. Some larger effects on non-sedentary behaviour did occur during maintenance probes after the intervention leading to a recommendation that future research ought to focus on motivation and antecedent-based interventions as well as behaviour modification and related techniques.

Dawn Jun’s thesis An evaluation of vibrotactile prompt, social praise and goal setting on reducing sedentary behaviour in older adults living in residential care settings also focused on the increasing problem of people not continuing to be active. The proposition being that sedentary behavior is a distinct and independent contributor to the adverse health outcomes and mortality.

Again, the prevalence of sedentary behavior is ever growing with the older adult population engaging in the highest level of sedentary behavior out of all age groups. Similar to the first study the orientation was on the use of intervention techniques including vibrotactile prompts, social praise and goal setting in changing habits.

Vibrotactile prompts involve stimulus (either motion or force) is applied to the skin fast acting mechanoreceptors are activated. When vibratory stimuli (either motion or force) are applied to the skin, fast-acting mechanoreceptors are activated which are an effective means of delivering tactile cues to humans.

The intervention components were arranged in order of complexity and ‘superimposed’ on one another in order to identify the simplest, most effective, components. The results suggest that the interventions were not effective in reducing sedentary behaviour on a consistent basis. Future research can build on the successful outcomes achieved in some aspects of the interventions.

*Findings from both research studies will be presented at The Selwyn Institute Gerontology Nursing Conference 4th October 2019.

How big is the problem?

The Lancet is a weekly peer-reviewed general medical journal. It is among the world's oldest, most prestigious, and best-known general medical journals. An article looked at the economic burden of inactivity of which residential age care is a component. Their findings:

• The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well-documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.
• Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality.
• Conservatively estimated, physical inactivity cost health-care systems international (INT$)ø $53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.
• In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden.

ø A hypothetical currency linked with the buying power of the US$.