Sedentary Time in Older Adults: What we know, and where we need to go.

Today’s post comes from Dr Jennifer Copeland, and Dr Shilpa Dogra.  More information on the authors can be found at the bottom of this post.

We often hear about the health consequences of excessive screen time in children, and too much sitting among adults working in office settings. But what about older adults? People over the age of 60 face unique health challenges, such as age-associated declines in physical and cognitive function; prolonged periods of muscular unloading- that is, excessive sitting- could exacerbate these declines. For example, using Canadian data we found that taking fewer breaks in sedentary time was associated with lower cardiorespiratory fitness in adults aged 60-79 years [1].

Older adults are a diverse group with a range of abilities, but we know that physical activity levels decline with increasing age. In fact, people over 60 are the least active and accumulate the most sedentary time of any other age group, regardless of whether they are working or not [2]. These low levels of physical activity could mean that prolonged sedentary time has an even greater effect on health and wellness [3] compared to more active young adults or youth. Given that globally there will be more than two billion older adults by the year 2050, understanding the relationship between sedentary time and healthy ageing is urgent and important.

When a field is in its early stages, and when there are pressing practice implications, scientific consensus is needed to ensure that there is a collective effort to move the field forward. We therefore decided to lead an international group through a critical review [4] and consensus process [5]. Experts in the area of sedentary behaviour and aging from five countries came together to examine the current state of evidence and set priorities for future research. Here we have highlighted some of the conclusions that resulted from the process.

What We Know:

Similar to younger adults, sedentary time is associated with an increased risk of mortality and cardiometabolic disease in older adults [6]. While these outcomes are important, there are other conditions and challenges that are particularly relevant to an older population.  These include impairments in physical and cognitive function, poor mental health, incontinence, and problems with sleep. These non-disease outcomes strongly impact the quality of life of older adults, so we wanted to know if reducing sedentary time could improve these geriatric-relevant outcomes.

As is often the case, critically reviewing the literature revealed that the quality of available evidence is generally low. While there is research to suggest that sedentary time and breaks in sedentary time are associated with physical function, there is little information available on other geriatric-relevant outcomes. Some studies have suggested an inverse relationship between sedentary time and cognitive function, but the evidence is not sufficient to draw any conclusions. Interestingly, some sedentary behaviours that are cognitively-engaging– like reading, using the internet, socializing – may actually benefit the health and wellness of older adults. But in order to confirm that suggestion, we need measurement tools that can accurately and reliably measure both the volume of sedentary time, the type of sedentary behaviour, and the context in which it is accumulated.

Importantly, there is a lack of longitudinal evidence looking specifically at these geriatric-relevant outcomes. Furthermore, none of these outcomes were assessed consistently in intervention studies. So although we know that individual behavior change interventions can reduce sitting time among older adults, we can’t say whether this change in behaviour impacts health or quality of life.

Where We Need To Go:

First and foremost, it is clear that when conducting research with older adults, we need to move beyond typical disease outcomes and study the issues that have a major impact on quality of life. It is also clear that interventions need to start assessing health outcomes instead of behaviour change alone. When assessing sedentary behaviour, we must consider not only the volume but also the context in which sedentary time is accumulated, and therefore, need to work on creating tools that can provide this information. We also need to explore and compare the different effects of changing sedentary behaviour in men and women, in the young-old and oldest-old adults, and across the mobility spectrum. Finally, we are clearly at a point where sedentary time should be integrated into movement behavior guidelines for older adults. Although more work is needed to develop specific evidence-informed recommendations, the expert panel strongly agreed that older adults would benefit from sitting less, breaking up their sitting time, and moving more.

There is still a lot to learn about the relationship between sedentary behavior and healthy ageing. Our hope with this review and consensus paper is that researchers in the area will consider some of the issues we identified, and that funders will recognize the importance of these priorities. We hope that the field will move forward collectively to ensure that we can provide older adults, and individuals working with older adults, appropriate information to improve their health and quality of life.

About the Authors:

Dr Jennifer Copeland, PhD, is an Associate Professor in the Department of Kinesiology and Physical Education at the University of Lethbridge.

Dr Shilpa Dogra, PhD, is an Associate Professor and the Director of Kinesiology at the University of Ontario Institute of Technology.

 

References

1. Dogra, S., J.M. Clarke, and J.L. Copeland, Prolonged sedentary time and physical fitness among Canadian men and women aged 60 to 69. Health Reports, 2017. 28(2): p. 3.
2. Copeland, J.L., J. Clarke, and S. Dogra, Objectively measured and self-reported sedentary time in older Canadians. Preventive Medicine Reports, 2015. 2: p. 90-5.
3. Ekelund, U., et al., Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet, 2016. 388(10051): p. 1302-10.
4. Copeland, J.L., et al., Sedentary time in older adults: a critical review of measurement, associations with health, and interventions. Br J Sports Med, 2017: p. bjsports-2016-097210.
5. Dogra, S., et al., Sedentary time in older men and women: an international consensus statement and research priorities. Br J Sports Med, 2017: p. bjsports-2016-097209.
6. de Rezende, L.F., et al., Sedentary behavior and health outcomes among older adults: a systematic review. BMC Public Health, 2014. 14: p. 333.