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Meta-Analysis
. 2021 Jun 25;6(6):CD012784.
doi: 10.1002/14651858.CD012784.pub2.

Interventions for reducing sedentary behaviour in community-dwelling older adults

Sebastien Chastin  1   2 , Paul A Gardiner  3   4 , Juliet A Harvey  1 , Calum F Leask  5 , Javier Jerez-Roig  6 , Dori Rosenberg  7 , Maureen C Ashe  8 , Jorunn L Helbostad  9 , Dawn A Skelton  1
Affiliations
Meta-Analysis

Interventions for reducing sedentary behaviour in community-dwelling older adults

Sebastien Chastin et al. Cochrane Database Syst Rev. .

Abstract

Background: Older adults are the most sedentary segment of society, often spending in excess of 8.5 hours a day sitting. Large amounts of time spent sedentary, defined as time spend sitting or in a reclining posture without spending energy, has been linked to an increased risk of chronic diseases, frailty, loss of function, disablement, social isolation, and premature death.

Objectives: To evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, EPPI-Centre databases (Trials Register of Promoting Health Interventions (TRoPHI) and the Obesity and Sedentary behaviour Database), WHO ICTRP, and ClinicalTrials.gov up to 18 January 2021. We also screened the reference lists of included articles and contacted authors to identify additional studies.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-RCTs. We included interventions purposefully designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We included studies if some of the participants had multiple comorbidities, but excluded interventions that recruited clinical populations specifically (e.g. stroke survivors).

Data collection and analysis: Two review authors independently screened titles and abstracts and full-text articles to determine study eligibility. Two review authors independently extracted data and assessed risk of bias. We contacted authors for additional data where required. Any disagreements in study screening or data extraction were settled by a third review author.

Main results: We included seven studies in the review, six RCTs and one cluster-RCT, with a total of 397 participants. The majority of participants were female (n = 284), white, and highly educated. All trials were conducted in high-income countries. All studies evaluated individually based behaviour change interventions using a combination of behaviour change techniques such as goal setting, education, and behaviour monitoring or feedback. Four of the seven studies also measured secondary outcomes. The main sources of bias were related to selection bias (N = 2), performance bias (N = 6), blinding of outcome assessment (N = 2), and incomplete outcome data (N = 2) and selective reporting (N=1). The overall risk of bias was judged as unclear. Primary outcomes The evidence suggests that interventions to change sedentary behaviour in community-dwelling older adults may reduce sedentary time (mean difference (MD) -44.91 min/day, 95% confidence interval (CI) -93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low-certainty evidence). We could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes. Secondary outcomes We are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community-dwelling older adults. We were able to pool change data for the following outcomes. • Physical function (MD 0.14 Short Physical Performance Battery (SPPB) score, 95% CI -0.38 to 0.66; higher score is favourable; 98 participants; 2 studies; I2 = 26%; low-certainty evidence). • Waist circumference (MD 1.14 cm, 95% CI -1.64 to 3.93; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). • Fitness (MD -5.16 m in the 6-minute walk test, 95% CI -36.49 to 26.17; higher score is favourable; 80 participants; 2 studies; I2 = 29%; low-certainty evidence). • Blood pressure: systolic (MD -3.91 mmHg, 95% CI -10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low-certainty evidence) and diastolic (MD -0.06 mmHg, 95% CI -5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low-certainty evidence). • Glucose blood levels (MD 2.20 mg/dL, 95% CI -6.46 to 10.86; 100 participants; 2 studies; I2 = 0%; low-certainty evidence). No data were available on cognitive function, cost-effectiveness or adverse effects.

Authors' conclusions: It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community-dwelling older adults. We are uncertain if these interventions have any impact on the physical or mental health of community-dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision. Future studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device-based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost-effectiveness, and adverse event data.

PubMed Disclaimer

Conflict of interest statement

Authors of this review were not allowed to screen, extract data from, or assess the risk of bias of studies on which they were a co‐author. Authors of this review were also authors of one of the studies included in this review (Rosenberg 2020).

Sebastien Chastin: no other conflicts of interest

Paul A Gardiner: no other conflicts of interest

Juliet A Harvey: no other conflicts of interest

Calum F Leask: no other conflicts of interest

Javier Jerez‐Roig: no other conflicts of interest

Dori Rosenberg: no other conflicts of interest

Maureen C Ashe: no other conflicts of interest

Jorunn L Helbostad is a professor at the Norwegian University of Science and Technology, Trondheim, Norway. She is a board member for the Norwegian Research Council. She has no competing interest related to this project.

Dawn A Skelton: no other conflicts of interest

All authors have worked on this review during the course of their employment and were therefore supported by their employing institutions as per their affiliation.

Figures

1
1
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison between intervention to reduce sedentary behaviour and control. Plot also shows subgroup analysis per measurement method for sedentary time.
5
5
Forest plot of comparison between intervention to reduce sedentary behaviour and control for time spent in specific sedentary behaviour [min/day].
1.1
1.1. Analysis
Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 1: Sedentary time [min/day]
1.2
1.2. Analysis
Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 2: Sedentary time [min/day] per intervention duration
1.12
1.12. Analysis
Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 12: Sedentary time in specific domains [min/day]
1.13
1.13. Analysis
Comparison 1: Intervention for reducing sedentary behaviour versus control: main outcomes, Outcome 13: Breaks in sedentary behaviour
2.1
2.1. Analysis
Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 1: SPPB
2.2
2.2. Analysis
Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 2: Gait speed
2.3
2.3. Analysis
Comparison 2: Intervention for reducing sedentary behaviour versus control: physical function outcomes, Outcome 3: Chair stands (seconds)
3.1
3.1. Analysis
Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 1: BMI
3.2
3.2. Analysis
Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 2: Waist circumference (cm)
3.3
3.3. Analysis
Comparison 3: Intervention for reducing sedentary behaviour versus control: obesity outcomes, Outcome 3: Body fat (%)
4.1
4.1. Analysis
Comparison 4: Intervention for reducing sedentary behaviour versus control: fitness outcomes, Outcome 1: 6‐minute walk (metres)
5.1
5.1. Analysis
Comparison 5: Intervention for reducing sedentary behaviour versus control: blood pressure outcomes, Outcome 1: Systolic [mmHg]
5.2
5.2. Analysis
Comparison 5: Intervention for reducing sedentary behaviour versus control: blood pressure outcomes, Outcome 2: Diastolic [mmHg]
6.1
6.1. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 1: Cholesterol [mg/dL]
6.2
6.2. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 2: HDL [mg/dL]
6.3
6.3. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 3: LDL [mg/dL]
6.4
6.4. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 4: Triglycerides [mg/dL]
6.5
6.5. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 5: Glucose [mg/dL]
6.6
6.6. Analysis
Comparison 6: Intervention for reducing sedentary behaviour versus control: cardiometabolic markers outcomes, Outcome 6: Glycated haemoglobin
7.1
7.1. Analysis
Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 1: SF‐36 Physical function
7.2
7.2. Analysis
Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 2: SF‐36 Energy
7.3
7.3. Analysis
Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 3: SF‐36 Emotional well‐being
7.4
7.4. Analysis
Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 4: SF‐36 Pain
7.5
7.5. Analysis
Comparison 7: Intervention for reducing sedentary behaviour versus control: quality of life, Outcome 5: SF‐36 General health
8.1
8.1. Analysis
Comparison 8: Intervention for reducing sedentary behaviour versus control: depression, Outcome 1: Depression (Center for Epidemiological Studies‐Depression (CES‐D))
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References to ongoing studies

Kleinke 2018 {published data only}
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