Afroditi Stathi

Associations between multiple indicators of objectively-measured and self-reported sedentary behaviour and cardiometabolic risk in older adults

OBJECTIVE To examine the associations between sedentary behaviour (SB) measured objectively and by self-report and cardiometabolic risk factors. METHOD Cross-sectional analyses of adults ≥60 years who participated in the 2008 Health Survey for England. Main exposures were self-reported leisure-time SB consisting of TV/DVD viewing, non-TV leisure-time sitting, and accelerometry-measured SB. Outcomes included body mass index (BMI), waist circumference, cholesterol ratio (total/HDL), Hb1Ac and prevalent diabetes. RESULTS 2765 participants (1256 men) had valid self-reported SB and outcomes/confounding variables data, of whom 649 (292 men) had accelerometer data. Total self-reported leisure-time SB showed multivariable-adjusted (including for moderate-to-vigorous physical activity) associations with BMI (beta for mean difference in BMI per 30 min/day extra SB: 0.088 kg/m(2), 95% CI 0.047 to 0.130); waist circumference (0.234, 0.129 to 0.339 cm); cholesterol ratio (0.018, 0.005 to 0.032) and diabetes (odds ratio per 30 min/day extra SB: 1.059, 1.030 to 1.089). Similar associations were observed for TV time while non-TV self-reported SB showed associations only with diabetes (1.057, 1.017 to 1.099). Accelerometry SB was associated with waist circumference only (0.633, 0.173 to 1.093). CONCLUSION In older adults SB is associated with cardiometabolic risk factors, but the associations are more consistent when is measured by self-report that includes TV viewing.

Neighbourhood deprivation and physical activity in UK older adults

The benefits of regular physical activity for older adults are now well-established but this group remain the least active sector of the population. In this paper, the association between levels of neighbourhood deprivation and physical activity was assessed. A sample of 125 males with a mean age of 77.5 (±5.6) years, and 115 females with a mean age of age 78.6 (±8.6) underwent 7-day accelerometry, a physical performance battery, and completed a daily journeys log. Univariate associations between physical activity parameters and level of deprivation of neighbourhood were extinguished in regression models controlling for age, gender, and level of educational attainment. Age, gender, educational attainment, body mass index, physical function, and frequency of journeys from the home explained between 50% and 54% of variance in activity parameters. These results suggest the importance of strategies to help older adults maintain physical function, healthy weight, and remain active in their communities.

Objective Indicators of Physical Activity and Sedentary Time and Associations with Subjective Well-Being in Adults Aged 70 and Over

This study explored the associations of the volume and intensity of physical activity and the volume of sedentary time with subjective well-being in a diverse group of 228 older adults in the UK (111 female, mean age 78.2 years (SD 5.8)). Physical activity (PA) and sedentary behaviour were assessed by accelerometry deriving mean steps per day, mean moderate/vigorous PA minutes per hour (MVPA min·h−1) and minutes of sedentary time per hour (ST min·h−1). Lower limb function was assessed by the Short Physical Performance Battery. Subjective well-being was assessed using the SF-12 health status scale, the Ageing Well Profile and the Satisfaction with Life Scale. Linear regressions were used to investigate associations between the independent variables which included physical activity (steps and MVPA), sedentary time, participant characteristics (gender, age, BMI, education, number of medical conditions), and lower limb function and dependent variables which included mental and physical well-being. Steps, MVPA and lower limb function were independently and moderately positively associated with perceived physical well-being but relationships with mental well-being variables were weak. No significant associations between sedentary behaviours and well-being were observed. The association between objectively evaluated physical activity and function and subjective evaluations of physical well-being suggest that improving perceptions of physical health and function may provide an important target for physical activity programmes. This in turn may drive further activity participation.

Objectively Measured Sedentary Time and its Association With Physical Function in Older Adults

The relationship of objectively measured sedentary time (ST), frequency of breaks in ST, and lower extremity function (LEF) was investigated in a diverse sample aged ≥ 70 years (n = 217). Physical activity (PA) was assessed by accelerometry deriving moderate-vigorous PA (MVPA) minutes per registered hour (MVPA min · hr(-1)), registered ST (ST min · hr(-1)), and breaks in ST min · hr(-1) (breaks · hr(-1)). LEF was assessed by the Short Physical Performance Battery. Univariate associations with overall LEF were MVPA (r = .523), ST (r = -.499), and breaks (r = .389). Adjusted linear regression including MVPA min · hr(-1), ST min · hr(-1), and breaks · hr(-1) explained 41.5% of LEF variance. Each additional break · hr(-1) was associated with 0.58 point increase in LEF. Breaks and MVPA had strongest independent associations with LEF. Promoting regular breaks might be useful in maintaining or increasing LEF and later life independence. This novel finding is important for the design of effective lifestyle interventions targeting older adults.

Processes associated with participation and adherence to a 12-month exercise programme for adults aged 70 and older

This study investigated the processes associated with the engagement of adults aged 70 years and older in a 12-month long research-based structured exercise programme. A sample of 21 participants (Mean age (SD) 75.8 (3.9); 14 females) and six exercise class leaders or researchers involved in the programme participated in individual semi-structured interviews. Transcripts were analysed with the principles of interpretive qualitative analysis. Our findings suggest that a programme that runs locally, provides individual attention/tailoring, delivers meaningful benefits, offers a staged approach to efficacy building, creates a sense of ownership, and provides intergenerational support and opportunities for social interaction, facilitates exercise engagement in later life.

Food shopping habits, physical activity and health-related indicators among adults aged

OBJECTIVE To investigate the food shopping habits of older adults in the UK and explore their potential associations with selected health-related indicators. DESIGN A cross-sectional study including objectively measured physical activity levels, BMI, physical function and self-reported health status and dietary intake. SETTING Bristol, UK. SUBJECTS A total of 240 older adults aged ≥70 years living independently. RESULTS Mean age was 78·1 (sd 5·7) years; 66·7 % were overweight or obese and 4 % were underweight. Most (80·0 %) carried out their own food shopping; 53·3 % shopped at least once weekly. Women were more likely to shop alone (P < 0·001) and men more likely to shop with their spouse (P < 0·001). Men were more likely than women to drive to food shopping (P < 0·001), with women more likely to take the bus or be driven (P < 0·001). Most reported ease in purchasing fruit and vegetables (72·9 %) and low-fat products (67·5 %); 19·2 % reported low fibre intakes and 16·2 % reported high fat intakes. Higher levels of physical function and physical activity and better general health were significantly correlated with the ease of purchasing fresh fruit, vegetables and low-fat products. Shopping more often was associated with higher fat intake (P = 0·03); higher levels of deprivation were associated with lower fibre intake (P = 0·019). CONCLUSIONS These findings suggest a pattern of food shopping carried out primarily by car at least once weekly at large supermarket chains, with most finding high-quality fruit, vegetables and low-fat products easily accessible. Higher levels of physical function and physical activity and better self-reported health are important in supporting food shopping and maintaining independence.

70 years

Objective To explore general practitioners’ (GPs) and primary care nurses’ perceived barriers to raising the topic of weight in general practice. Design A qualitative study using the Theoretical Domains Framework (TDF). 34 semistructured interviews were conducted to explore views, opinions and experiences of initiating a discussion about weight. Content and thematic analyses were used to analyse the interview transcripts. Setting General practices located in one primary care trust in the South West of England. Participants 17 GPs and 17 nurses aged between 32 and 66 years. The modal age range for GPs was 30–39 years and for nurses, 40–49 years. Results Barriers were synthesised into three main themes: (1) limited understanding about obesity care, (2) concern about negative consequences, and (3) having time and resources to raise a sensitive topic. Most barriers were related to raising the topic in more routine settings, rather than when dealing with an associated medical condition. GPs were particularly worried about damaging their relationship with patients and emphasised the need to follow their patients agenda. Conclusions Uncertainty about obesity, concerns about alienating patients and feeling unable to raise the topic within the constraints of a 10 min consultation, is adding to the reluctance of GPs and nurses to broach the topic of weight. Addressing these concerns through training or by providing evidence of effective interventions that are feasible to deliver within consultations may lead to greater practitioner engagement and willingness to raise the topic.

Raising the topic of weight in general practice: perspectives of GPs and primary care nurses

Background: objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period. Participants: two hundred and forty older adults were randomly recruited from 12 general practices in urban and suburban areas of a city in the United Kingdom. Follow-up included 213 of the baseline sample. Methods: socio-demographic variables, height and weight, and self-reported diagnosed diseases were recorded at baseline. Seven-day accelerometry was used to assess total physical activity, moderate-to-vigorous activity and sedentary time. A log recorded trips from home. Lower limb function was assessed using the Short Physical Performance Battery. Medical records were accessed on average 50 months post baseline, when new diseases and deaths were recorded. Analyses: ANOVAs were used to assess socio-demographic, physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up. Regression models were constructed to assess the prospective associations between physical activity and function with mortality and new disease. Results: for every 1,000 steps walked per day, the risk of mortality was 36% lower (hazard ratios 0.64, 95% confidence interval (CI) 0.44–0.91, P = 0.013). Low levels of moderate-to-vigorous physical activity (incident rate ratio (IRR) 1.67, 95% CI 1.04–2.68, P = 0.030) and low frequency of trips from home (IRR 1.41, 95% CI 0.98–2.05, P = 0.045) were associated with diagnoses of more new diseases. Conclusion: physical activity should be supported for adults in their 70s and 80s, as it is associated with reduced risk of mortality and new disease development.

Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study

OBJECTIVES To identify an evidence-based intervention to promote changes in diet and physical activity and adapt it for a UK primary care setting for people with high cardiovascular risk. DESIGN A three-stage mixed-methods design was used to facilitate a strategic approach to programme selection and adaptation. METHOD Stage 1: Criteria for scientific quality and local appropriateness were developed for the selection/adaptation of an intervention to promote lifestyle change in people of high cardiovascular risk through (1) patient interviews, (2) a literature search to extract evidence-based criteria for behavioural interventions, and (3) stakeholder consultation. Stage 2: Potential interventions for adaptation were identified and ranked according to their performance against the criteria developed in Stage 1. Stage 3: Intervention mapping (IM) techniques were used to (1) specify the behavioural objectives that participants would need to reach in order to attain programme outcomes, and (2) adapt the selected intervention to ensure that evidence-based strategies to target all identified behavioural objectives were included. RESULTS Four of 23 potential interventions identified met the 11 essential criteria agreed by a multi-disciplinary stakeholder committee. Of these, the Greater Green Triangle programme (Laatikainen et al., 2007) was ranked highest and selected for adaptation. The IM process identified 13 additional behaviour change strategies that were used to adapt the intervention for the local context. CONCLUSIONS IM provided a useful set of techniques for the systematic adaptation of an existing lifestyle intervention to a new population and context, and facilitated transparent working processes for a multi-disciplinary team.

‘Waste the waist’: the development of an intervention to promote changes in diet and physical activity for people with high cardiovascular risk

OBJECTIVE This study assessed the environmental characteristics of ten universities, comparing the extent to which physical infra-structures are able to support a route-based walking intervention. METHOD Following protocol standardization between and within sites, major pedestrian routes at main suburban campuses in seven countries (Australia, Canada, England, Northern Ireland, Scotland, Spain and the United States) were audited by researchers using an established inventory (March-June 2008). The inventory assessed key characteristics (e.g. size and employee number) and nine specific items (pedestrian facilities, vehicle conflicts, crossings, route-maintenance, walkway width, roadway buffer, universal accessibility, aesthetics and cover), scored on a five-point scale (1=very poor; 5=excellent). Item scores for each route, were combined and weighted, to provide indicators of low (score of 20-39), fair (score of 40-69), or good (score of 70-100) physical infra-structure support. RESULTS Sites varied in area (range of 7-1000 acres) and employee numbers (range of 700-7500 employees). Audits reported good support for route-based walking at seven sites (overall route score range=72.5+/-13.9-82.2+/-17.4), fair support at two sites (overall route score of 69.1+/-11.7 and 61.7+/-14.6), and low support at one site (overall route score of 22.1+/-7.3). CONCLUSIONS Study methods highlight a valuable audit process, while findings identify the need to improve aspects of physical infra-structure at sites where the built environment may be less conducive for route-based walking.