Purpose Temperament and physical activity (PA) and sedentary behavior (SB) have been studied in children, but less is known about these associations in midlife. The present study examined association between temperament traits, self-reported and objectively measured PA levels and sedentary time in midlife.

Method The study comprised 5049 subjects from the Northern Finland Birth Cohort 1966. In this study temperament was measured with Cloninger´s Temperament and Character Inventory (TCI). TCI includes four dimensions of temperament [Novelty seeking (NS), Harm avoidance (HA), Reward dependence (RD), Persistence (P)] and their subscales. Cluster analysis was used to identify groups that have similar temperament traits. LTPA was self-reported with the following question: how often and for how long do you participate in light and brisk physical activities/exercises during leisure time. PA was objectively measured at the age of 46 using wrist-worn uniaxial accelerometer (Polar Electro Ltd, Finland. The participants were instructed to wear the activity monitor 24 h/day for 14 days on their non-dominant hand. Measured PA was classified at four levels (SED: 1-1.99 MET, light: 2<3.49 MET, moderate to vigorous: ≥3.5 MET and total PA≥2.0 MET). Daily sitting time (ST) was assessed by self-administered questionnaire. The one-way analysis of variance was used to determine whether there were statistically significant differences between the PA levels and SB amongst temperament clusters. Also linear regression analysis was used to analyse the statistical significance of the association between individual temperament dimensions, PA at different intensity levels and time spent sedentary.

Results Individuals with high HA reported lowest brisk PA levels in both genders. Similar findings was observed with objective measurement, however statistically significant differences were observed only among women. Participants with high NS reported highest ST in both genders. Post hoc comparison showed that the SED was statistically significantly lower among women with high P and RD compared to individuals with high NS.

Conclusion This large population-based study indicate that there are temperament-specific differences in physical activity levels and sedentary behavior. The findings of this study can be used in identifying adults who are heightened risk for sedentary lifestyle. 

Purpose: Older adults' perceptions about sedentary behavior (SB) are often inconsistent with current messaging regarding the negative effects of SB. This may limit the effectiveness of SB interventions through traditional “top-down” approaches. Therefore, in this study we developed an intervention to reduce SB in inactive older adults using a collaborative approach driven by older adults’ perspectives.

Methods: Community-dwelling older adults (N=4; age=78.3±7.2) were recruited from a local community center to co-create a SB intervention with researchers. Using a participatory action research (PAR) approach, the intervention was developed with participants over the course of 7 interactive weekly meetings. Each 90-minute meeting followed a semi-structured outline and discussion guide to address a specific topic or aspect of the intervention development. The Heath Action Process Approach was utilized as a guiding theory. Data were collected using audio recording, questionnaires, worksheet tasks, and field notes. Following each meeting, the audio recording was transcribed and data were coded, segmented into categories, and grouped into themes. The findings were summarized in a narrative form and member-checking of the data was performed the following week. The intervention was finalized at the last meeting and then reviewed by a separate focus group (N=6; age=75.0±4.1). Feedback from the focus group participants was used to revise the implementation procedures and refine the intervention workbook and worksheets.

Results: Participants co-created an 8-week SB intervention tailored to inactive community-dwelling older adults. Key components of the intervention included: a workbook that includes both educational resources and worksheets to encourage and support behavioral change, multiple home and telephone visits, activities to build self-efficacy, goal-setting and action-planning activities, self-monitoring, journaling, and strategies to interrupt SB. Emerging themes included the importance of social support and flexibility in the implementation of the intervention. As the development of the intervention progressed, participants expressed a growing sense of ownership and empowerment over their work.

Conclusion: Using a PAR approach to co-create a SB intervention for older adults shows promise and may improve the relevance and appropriateness of these programs.  Further research is needed to evaluate the feasibility of the developed intervention. 

Purpose: The WHO Global Action Plan on Physical Activity and Health 2018-2030 advocates the promotion of participation in sports and active recreation is an essential strategy for increasing population levels of physical activity across the lifespan. The aims of this study were to 1) describe participation in specific sports and active recreation by gender and age in a cohort of mid-age Australian adults; and 2) investigate whether participation in sports and recreation is associated with achieving current physical activity guidelines.

Methods: We analysed data from 10,809 participants in the HABITAT study, a population-based cohort of adults aged 40-65 years in 2007 and living in Brisbane, Australia. Mail- surveys in 2007, 2009 and 2011 were used to collect data on the frequency of participation in 15 recreational sports and active recreation in the past 12 months, and time spent physical activity overall.

Results: At baseline, home-based exercises (26.0%), weights exercises (19.4%), and running (16.3%) were the most commonly reported weekly activities, with slight differences between men and women. Frequencies were higher among men than women for running, cycling, golf and team sports, and higher in women than men for home-based exercises, exercise classes, swimming and yoga/Pilates/t’ai chi/qigong. Reported weekly running, cycling, swimming, participation in team sports and weight training decreased with age, while participation in golf and lawn bowls increased with age. Over 60% of participants achieved the current recommendations for physical activity (≥ 500 MET.minutes/week). Overall, those who reported participation in sports and recreational activities were more likely to meet current recommendations for physical activity, than those who did not.

Conclusion: In this large population-based cohort of mid-age Australian adults, the participation in a wide range of recreational sports and active recreation varied by gender and age. These findings support the notion that increasing participation in sports can be beneficial for achieving physical activity guidelines and, consequently, improve health in mid-age.

Purpose: To understand the perceived constraints that older adults must negotiate to engage in active transportation, and to determine whether these perceptions of constraints align with characteristics of the built environment.

Methods: We used a mixed-methods design. Nine semi-structured focus groups were conducted with a culturally and socioeconomically diverse group of older adults (n=52). An online survey was circulated to older adults in the same city (n=110). Using postal code data, survey data were linked with Active Living Environment data from the Canadian Urban Environmental Health Research Consortium and WalkScore data on walkability, cycling, and public transit. Newell’s model of constraints was used to inform the analysis of the focus group data, and the development of the survey.

Results/Findings: Three main themes were identified: constraints (environmental, individual, and task) and the interactions between constraints, neighborhood perception, and promoters. Interactions were observed between each type of constraint, indicating that non-modifiable (e.g. functional ability) interacted with modifiable constraints (e.g. weather or icy sidewalks). Older adults of low socioeconomic status as well as those who were new to Canada had more positive neighbourhood perceptions. Many older adults indicated that the constraints to active transportation were so significant, that it limited their mobility in their community.

Data from the survey and linked environmental datasets indicated clear differences between the different neighbourhoods examined. The top five constraints cited by residents of each of the neighborhoods varied, and indicated some interesting trends. In particular, in one of the neighbourhoods examined, 100% of the participants indicated that a lack of bike lanes with barriers was a constraint to active transportation. This aligned with the neighbourhood’s low bike score (37.4); the lowest bike score of the four neighbourhoods examined. This neighbourhood also had the lowest points of interest (34.8) but none of the constraints to proximity or density were constraints; this may be because residents rely on personal vehicles as active transportation is simply is not feasible.

Conclusions: Data from these two studies indicate that understanding and investing in active transportation is essential to building a truly age-friendly community.

Purpose:

There is strong evidence that exercise can reduce falls in community-dwelling older people, but low rates of population uptake highlight a need for innovative broad-reaching strategies to increase participation in effective programs. Home-based programs appeal to some older people due to their low cost and convenience.  The Otago Exercise Programme is an evidence-based home-based falls prevention program involving balance and strength exercises, however it’s delivery, involving five nurse or physiotherapist home visits, means that it may be too expensive for widespread implementation.

We developed the BEST at Home Program, comprising lower limb exercises targeting balance and strength (based on the Otago Programme) and exercises to improve shoulder function, with the aim of preventing falls and promoting healthy ageing. In order to reduce the burden on health service resources BEST at Home exercise programs are delivered via three group-based exercise workshops led by physiotherapists and involving 12 participants per group.

This study evaluated participant impressions of the BEST at Home Program to inform possible future scale-up and implementation.

Methods:

Design: Process evaluation from a randomised controlled trial.

Participants: Community-dwelling people aged 65 years and over, living in Illawarra and Shoalhaven regions of New South Wales, Australia.

Measures: Perceived program benefit (rating out of 10), confidence to complete exercises at home (proportion of people), intention to continue exercise program (proportion), and recommendation of the program to others (proportion).  

Analyses: Descriptive statistics were used to summarise participant responses.

Results:

Four hundred and seventy three participants (mean age 72.9, SD 6.0) were included in the analyses. The mean rating of program benefit was 7.6/10 (SD 2.2). At three-month follow-up, 436 participants (97%) felt confident completing the exercises at home, and 374 (80.8%) intended to continue to do the exercises. Overall, 435 (93%) of participants would recommend this program to other people aged 65+.

Conclusions

Participation, acceptance and perceived benefit of the BEST at Home Program was high. This innovative method of delivery has potential for translation into population-level delivery models for older people which could be integrated within existing health services.

Purpose: Physical activity across the lifespan is important, and for older adults specifically, it is important to be physically active and break up sedentary time, as a means of maintaining function and preventing the development of major mobility disability (MMD). For older adults, particularly those in residential aged care, medications with anticholinergic or sedative effects are frequently used, but can affect cognition and increase the risk of falls and adverse events. The purpose of this study was to examine the impact of medications with sedative effects on movement behaviour.

Methods: Twenty-eight older adults (68 to 97 years; 23 females) living in residential aged care in metropolitan Australia participated. Medication data were collected from participants’ medical charts and anticholinergic burden and sedative load were determined. Seven-day movement behaviour was objectively assessed by a wrist-worn triaxial accelerometer (GENEActiv). Raw accelerations were converted to sleep, sedentary time, and time in light, moderate, and moderate-to-vigorous physical activity, using a purpose-designed program, Cobra Processing. Stepwise regression analysis was performed to assess the relationship between anticholinergic or sedative load and movement behaviour.

Results: Cross-sectional analysis indicates that anticholinergic burden was not associated with movement behaviour; however, sedative load was, accounting for 27% variance in moderate intensity physical activity (r² change = 0.27, Beta = - .45, p<0.01) and MVPA (r² change=0.27, Beta = -.46, p<0.01). The mean number of medicines used per participant was ten. Participants spent 50.3% of their day sedentary and 44.2% of their day sleeping, with only 5.5% of their day spent being physically active, on average. 

Conclusions: The findings of this study suggest that sedative load due to medicine use may have a negative impact on an individual’s movement behaviours. Using accelerometers, to objectively examine the movement behaviours of older adults in residential aged care facilities, may enable monitoring of sedative load and its subsequent impact on movement behaviours. This may contribute to the maintenance of movement behaviour sufficient to prevent the development of major mobility disability (MMD).

Purpose: As older adults transition to assisted living, the need to complete domestic chores is removed and many people accumulate excessive sedentary time which can increase the risk of functional decline. The purpose of this study was to develop and pilot test an intervention to reduce sedentary time (ST) and increase breaks in ST in assisted living residences (ALR).

Methods: Intervention strategies were developed based on a review of literature and focus groups with AL residents (N=31). Residents discussed barriers and motivators for reducing ST; many were individual (e.g.: lack of motivation, pain, fatigue) while others were associated with the organizational and social environment, including safety concerns, lack of evening and weekend activities, and social norms that promote sitting. Thus, the Stand When You Can (SWYC) intervention was developed to target multiple levels of the social ecological model by promoting individual behaviour change, modifying the social and physical environment, and encouraging organizational changes. Potential strategies were presented to AL staff (N=16) for expert validation. Ten residents (82.2 ± 8.7 years; 90% female) at two different ALRs participated in a 6-week pilot study of SWYC. Participants completed pre- and post-intervention assessments of physical function [Short Physical Performance Battery (SPPB)], quality of life (QoL)[EQ-5D and ICECAP-O questionnaires], and daily movement behaviour [activPAL4 and self-report]. 

Results: Post-intervention consultation with residents and staff suggested SWYC is feasible and acceptable, but better staff education and engagement is necessary to achieve organization-level change. Although there were no improvements in function or QoL in the whole sample, participants in one ALR (N=5) demonstrated a clinically meaningful increase in SPPB over 6 weeks (p = 0.035). There were no significant changes in device-measured ST and there was a non-significant decrease in self-reported sitting (142 minutes/day; p=.086).

Conclusions: Most ST interventions for older adults target only individual behaviour change, but SWYC is a novel, multi-level approach to reduce ST and promote more standing and moving. SWYC is evidence-based and co-created, with good potential for low-cost implementation and scale-up. Preliminary results suggest that with a longer intervention SWYC could help delay functional decline among older adults in assisted living.

Background: Chronic pain is associated with a reduction in physical functionality and higher levels of disability in older adults. On the other hand, an increase in physical activity has been shown to improve physical functions in frail older adults. This cross-sectional study examined if physical activity buffered the effect of chronic pain on the physical functions in older adult adults.

Methods: Study participants were 116 adults (mean age 71.27 (SD 6.64), 73% female, 57% Hispanic/Latino) recruited from a community center for older adults. The participants performed the five-time sit to stand, 6-minute walk for distance, and forward lean test, which were summarized as an index measure of physical functions. The Brief Pain Inventory was used to measure pain severity and pain interference. Levels of physical activity were evaluated as meeting or not meeting the physical activity recommendation (150 minutes of moderate and vigorous physical activity a week) by accelerometry. A hierarchical regression on physical function index was performed, separately for the pain severity and pain interference. In step 1, age, gender, obesity status, poverty status, and race/ethnicity were entered in the model; in step 2, pain severity (or pain interference) score was entered in the model; in step 3, levels of physical activity was entered in the model; and in step 4, an interaction term between physical activity and pain severity (or pain interference) score was entered in the model. The level of significance was set at p < .05.

Results: There was a significant interaction between the levels of physical activity and pain severity score (B=.12, p <.037, 95%CI .008,.238) in the regression model on the physical function index. This result suggested that higher levels of physical activity buffered the negative effect of pain severity in older adult's level of physical functions. No mediation effect of physical activity was found between the physical function index and pain interference score.

Conclusion: Higher levels of physical activity were associated with a protective effect on declining physical functions among older adults experience high levels of severity of pain. 

Purpose: For prevention of sarcopenia and functional decline in community dwelling older adults, a higher daily protein intake is needed in addition to increased exercise. A new e-health strategy for dietary counseling was used with the aim to increase total daily protein intake to optimal levels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use of regular food products.

Methods: The VITAMIN (VITal AMsterdam older adults IN the city) RCT included 245 community dwelling older adults (age ≥ 55y): control, exercise, and exercise plus dietary counseling (protein) group. The dietary counseling intervention was based on behavior change and personalization was offered by a dietitian coach, by use of face-to-face contacts and videoconferencing during a 6-month intervention. Dietary intake was measured by a 3d dietary record at baseline, after 6-month intervention and 12-month follow-up. The primary outcome was average daily protein intake (g/kg/day). Sub-group analysis and secondary outcomes included daily protein distribution, sources, product groups. A Linear Mixed Models (LMM) of repeated measures was performed with STATA v13.

Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of 26.0(4.2) and 71% were female. The LMM showed a significant effect of time and time*group (p<0.001). The dietary counseling group showed higher protein intake than either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercise group (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month intervention and 12-month follow-up (1.24 vs 1.05; β +0.23; p<0.001 | 1.24 vs 1.07 β +0.19; p<0.001). Additional analysis revealed the higher protein intake was fully accounted for by animal protein intake. 

Conclusions: This study shows digitally supported dietary counseling improves protein intake sufficiently in community dwelling older adults with use of regular food products. Protein intake increase by personalized counseling with e-health is a promising strategy for dietitians with the upcoming rising ageing population.

Keywords:    Ageing, Behavior change, Nutrition, Physical Functioning, Sarcopenia

Purpose: Recruitment into physical activity programs can be difficult and as such, challenges and successes in recruitment strategies should be explored in process evaluations of clinical trials. The CHAnGE trial, is a 2-arm cluster RCT of healthy ageing, targeting recruitment of established community groups in a metropolitan (Sydney) and regional (Orange) location in Australia. Groups of participants were randomised to receive either a physical activity behavioural intervention or a nutrition intervention. This study summarises the recruitment approach and highlights key effective aspects and barriers.

Methods: Community groups e.g. service, social, sports, religious, retirement villages were approached and if agreeable, a talk on healthy ageing was provided by research physiotherapist at their regular meetings.

In order to engage with possible participants with different values we took a holistic approach and spoke about healthy ageing rather than fall prevention or physical activity alone. At the end of the talk, group members were invited to participate in the 12-month trial, with expressions of interest recorded and followed up later to confirm interest and eligibility.

Results: Six hundred and six participants were recruited (mean age 72 (SD 7.3), 426 (70%) females) from 72 community groups between September 2015 and September 2018. Forty-two groups participated in Sydney (306 participants, representing 48% of those attending group presentations) and 30 groups in Orange (300 participants, 44% of those attending presentations). Recruited groups ranged in size from 4 to 17 participants.

The successful aspects of the approach include the emphasis on healthy ageing broadly at group presentations. Spending time talking individually with potential participants after the presentation was also important. The participation of many community groups at the regional site indicates that future studies should consider sites in regional locations as older people there seem open to research.

One challenge with this recruitment approach was the required delay in randomising participants until all within each cluster had completed baseline measures.

Trial results will be explored to determine if group-based recruitment influenced people being active together.

Conclusions: Direct approaches to community-based groups is a useful way to recruit older people to health coaching interventions within regional and urban centres.