Joint associations of physical activity and sedentary time with body mass index: A prospective study of mortality risk.

Device-measured physical activity and sedentary time are suggested to be more important determinants of all-cause mortality compared to body mass index (BMI) in mainly older adults. However, the joint associations of physical activity and sedentary time with BMI in relation to mortality risk in relatively healthy middle-aged individuals are unclear. We followed 770 adults (56% women, mean age 55.6 years) from a population-based cohort study for up to 15.3 years. BMI categories were combined with tertiles of total, light, and moderate-to-vigorous physical activity and sedentary time. Cox proportional hazards models estimated hazard ratios (HR) of all-cause mortality with 95% confidence intervals (CI). High total and light intensity physical activity and low sedentary time were associated with a lower risk of mortality in normal weight individuals compared with low active overweight/obese; HR: 0.35 (CI: 0.14, 0.86), HR: 0.33 (CI: 0.12, 0.89), and HR: 0.34 (CI: 0.13, 0.92). Among overweight/obese individuals, those who were medium active in light physical activity had a lower mortality risk, HR: 0.36 (CI: 0.15, 0.83), compared with low active. Medium sedentary individuals had a lower risk, HR: 0.43 (CI: 0.20, 0.94) compared with those who were most sedentary. Associations among the most active or least sedentary tertiles were similar irrespective of BMI category. In conclusion, higher physical activity and lower sedentary time were associated with lower mortality risk irrespective of BMI. Physical activity should be promoted and prescribed to individuals with low physical activity levels irrespective of weight status.

Between commitment and avoidance - working age stroke survivors' perceptions of physical activity and sedentary behaviour: a qualitative study.

BACKGROUND: It is critical for stroke survivors in working age to develop skills and confidence for long-term self-management of physical activity and exercise training to maintain a healthy lifestyle and decrease the risk of recurrent stroke and other cardiovascular diseases. Still, knowledge is scarce about concerns and experiences of physical activity and sedentary behaviour after stroke in working age, and further qualitative studies are required. The aim of this study was to explore and describe perceptions of physical activity and sedentary behaviour in stroke survivors under 65 years who are living with disability. METHODS: A qualitative design with individual semi-structured interviews was selected to generate rich data. Ten informants aged 36-61 years were interviewed 0.5-25 years after their stroke. The interviews were analysed with qualitative content analysis, with an inductive and interpretive approach. RESULTS: A two-sided contradictory relationship to physical activity and sedentary behaviour was identified. The overarching theme found was "Physical activity and sedentary behaviour - between commitment and avoidance", comprising three main themes; "Physical activity - medicine for body and mind", "Physical activity reminds of limitations", and "Sedentary behaviour - risk, rest, and alternative". The informants perceived physical activity as medicine, important for both physical and mental functioning, but also as a constant reminder of having a body that no longer functions as it used to. These mixed perceptions and feelings influenced the informants' behaviours related to physical activity and sedentary behaviour, and both commitment and avoidance were clear strategies. CONCLUSIONS: Working age stroke survivors expressed a clear positive perception of the importance of physical activity for health. However, physical activity was also described as a strong reminder of limitations which paradoxically could lead to sedentary behaviour. To support a physically active lifestyle post stroke, effective interventions as well as health promotion, counselling and patient education are imperative. These should be delivered by appropriately skilled health care professionals.

Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies.

BACKGROUND: The joint associations of total and intensity-specific physical activity with obesity in relation to all-cause mortality risk are unclear. METHODS: We included 34 492 adults (72% women, median age 62.1 years, 2034 deaths during follow-up) in a harmonised meta-analysis of eight population-based prospective cohort studies with mean follow-up ranging from 6.0 to 14.5 years. Standard body mass index categories were cross-classified with sample tertiles of device-measured total, light-to-vigorous and moderate-to-vigorous physical activity and sedentary time. In five cohorts with waist circumference available, high and low waist circumference was combined with tertiles of moderate-to-vigorous physical activity. RESULTS: There was an inverse dose-response relationship between higher levels of total and intensity-specific physical activity and mortality risk in those who were normal weight and overweight. In individuals with obesity, the inverse dose-response relationship was only observed for total physical activity. Similarly, lower levels of sedentary time were associated with lower mortality risk in normal weight and overweight individuals but there was no association between sedentary time and risk of mortality in those who were obese. Compared with the obese-low total physical activity reference, the HRs were 0.59 (95% CI 0.44 to 0.79) for normal weight-high total activity and 0.67 (95% CI 0.48 to 0.94) for obese-high total activity. In contrast, normal weight-low total physical activity was associated with a higher risk of mortality compared with the obese-low total physical activity reference (1.28; 95% CI 0.99 to 1.67). CONCLUSIONS: Higher levels of physical activity were associated with lower risk of mortality irrespective of weight status. Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low.

Impact of dopamine-related genetic variants on physical activity in old age - a cohort study.

OBJECTIVES: The beneficial effects of a physically active lifestyle in aging are well documented. Understanding the factors of importance for physical activity in older adults are therefore essential. Informed by animal and human data linking the dopamine system to motivation and reward processes, we investigated the associations between variations in dopamine genes and objectively measured physical activity and sedentary behaviour. Further, we aimed to verify whether higher age may exacerbate the impact of dopamine genes on physical activity. METHODS: We analyzed data from 504 older adults, 66-87 years, from the population-based Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Physical activity was measured with activPAL accelerometers and DNA was extracted from blood samples for genotyping. We assessed the effects of three dopamine relevant genetic variations (DRD1, DRD2, and DRD3) on daily time in sedentary behavior, light-intensity physical activity and moderate-to-vigorous physical activity using analyses of covariance, adjusting for sex, age and physical function. RESULTS: Higher dopamine receptor efficacy was related to moderate-to-vigorous physical activity, but not to light-intensity physical activity or sedentary time. DRD1 explained 2.7% of variance in moderate-to-vigorous physical activity, with more pronounced effect in people aged ≥80 years, about 10% of explained variance. CONCLUSION: Stronger genetic effects in older adults are in line with the well-established nonlinear effects of dopamine signaling on performance, expected to be exacerbated with aging. Individuals over 80 years, genetically predisposed to lower dopamine receptor efficacy, engaged on average 100 min/week in moderate-to-high physical activity, below the recommended levels beneficial for healthy aging. Our findings highlight that some individuals might need extra support to maintain a physically active lifestyle.

Latent profile analysis of physical activity and sedentary behavior with mortality risk: A 15-year follow-up.

By exploring multiple characteristics of physical activity and sedentary behavior (SB), different physical activity profiles could be obtained, which may be beneficial for health and targeted physical activity interventions. The aim of this study was to identify distinct physical activity profiles based on accelerometer-derived activity characteristics and to determine whether these profiles are associated with all-cause mortality. Eight hundred fifty-one participants (56% women, mean age: 53 years) provided objectively assessed physical activity data using an ActiGraph accelerometer and were followed for 15 years. Physical activity profiles were determined using latent profile analyses of 14 derived activity variables, resulting in that three profiles were identified: "Low Active" (n = 147), "Average Active" (n = 397), and "High Active" (n = 307). "Low Active" was characterized by participants with low absolute, relative, and limited variation of time spent in physical activity, and high time spent in SB. "Average Active" had the most balanced movement behavior with values close to the mean for all activity variables. "High Active" was characterized by participants with high absolute, relative, and great variation of time spent in physical activity. Overall, a potentially non-linear pattern between multiple activity variables and all-cause mortality was found as "Low Active" was significantly (P < .05) positively associated with all-cause mortality, and no difference in mortality risk was found between "High Active" and "Average Active." Our data suggest that day-to-day variation in SB is not associated with all-cause mortality. The important message is to keep the overall time spent in SB low and replace this behavior with physical activity.

Association between physical activity and all-cause mortality: A 15-year follow-up using a compositional data analysis.

The association between the composition of movement behaviors and mortality risk, acknowledging the composition nature of daily time data, is limited explored. The aim was to investigate how the composition of time spent in sedentary behaviors (SB), light intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) is associated with all-cause mortality, in a cohort with 15 years follow-up time, using compositional data analysis. Eight hundred fifty-one participants (56% women, mean age 53 years) provided objectively assessed physical activity data using an ActiGraph accelerometer and were followed for 15 years. Association of daily time composition of movement behaviors with risk of mortality was explored using compositional data analysis and hazard ratios (HR) of mortality were estimated based on a cox regression model. A significant (P < .001) positive association between time spent in SB relative to time in other behaviors and a significant (P = .018) negative association between time spent in LIPA relative to time in other behaviors, with all-cause mortality, were found. Substituting time spent in LIPA or MVPA with time in SB increased the hazard for all-cause mortality, with greater effect found for MVPA (20 minutes replacement; HR 1.26, 95% CI 1.04-1.52) than for LIPA (20 minutes replacement; HR 1.06, 95% CI 0.65-1.73). In a public health perspective, it is recommended to substitute SB with either LIPA or MVPA, but for individuals with little time spent in MVPA, the most important message may be to try to maintain that behavior.

Joint associations of accelero-meter measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals.

OBJECTIVES: To examine the joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality. METHODS: We conducted a harmonised meta-analysis including nine prospective cohort studies from four countries. 44 370 men and women were followed for 4.0 to 14.5 years during which 3451 participants died (7.8% mortality rate). Associations between different combinations of moderate-to-vigorous intensity physical activity (MVPA) and sedentary time were analysed at study level using Cox proportional hazards regression analysis and summarised using random effects meta-analysis. RESULTS: Across cohorts, the average time spent sedentary ranged from 8.5 hours/day to 10.5 hours/day and 8 min/day to 35 min/day for MVPA. Compared with the referent group (highest physical activity/lowest sedentary time), the risk of death increased with lower levels of MVPA and greater amounts of sedentary time. Among those in the highest third of MVPA, the risk of death was not statistically different from the referent for those in the middle (16%; 95% CI 0.87% to 1.54%) and highest (40%; 95% CI 0.87% to 2.26%) thirds of sedentary time. Those in the lowest third of MVPA had a greater risk of death in all combinations with sedentary time; 65% (95% CI 1.25% to 2.19%), 65% (95% CI 1.24% to 2.21%) and 263% (95% CI 1.93% to 3.57%), respectively. CONCLUSION: Higher sedentary time is associated with higher mortality in less active individuals when measured by accelerometry. About 30-40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self-reported data.

Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits - a prospective cohort study with 15 years follow-up.

BACKGROUND: Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking. OBJECTIVE: To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days. METHODS: In total, 1220 women and men, 18-75 years, from the population-based Sweden Attitude Behaviour and Change study 2000-2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay. RESULTS: Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48-0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33-0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37-0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20-4.74). CONCLUSION: This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message "sit less and move more".

Gait Speed, Quality of Life, and Sedentary Time are Associated with Steps per Day in Community-Dwelling Older Adults with Osteoporosis.

AIM: To describe objectively-measured physical activity levels and patterns among community-dwelling older adults with osteoporosis, impaired balance, and fear of falling, and to explore the associations with gait, balance performance, falls self-efficacy, and health-related quality of life (HRQoL). METHODS: Ninety-four individuals (75.6 ± 5.4 years) were included. Physical activity was assessed with pedometers and accelerometers. Mean steps/day, dichotomized into < 5,000 or ≥ 5,000 steps/day, and time spent in different physical activity intensities were analyzed. Gait was assessed with a GAITRite walkway, balance performance was assessed with the modified figure-eight test and one-leg stance, falls self-efficacy was assessed with the Falls Efficacy Scale International, and HRQoL was assessed with Short Form-36. RESULTS: Mean steps/day were 6,201 (991-17,156) and 40% reported < 5,000 steps/day. Participants with < 5,000 steps/day spent more time sedentary, had slower gait speed, poorer balance performance, and lower HRQoL than participants with ≥ 5,000 steps/day. No participants with < 5,000 met the recommended level of physical activity.

Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme.

OBJECTIVE: To give the rationale and evidence for and a detailed description of a rehabilitation programme of proven effectiveness in improving balance in older adults. BACKGROUND THEORY AND EVIDENCE: Based on the knowledge that balance loss usually occurs in situations when attention is divided, especially when being older, and that balance control relies on the interaction of several physiological systems, we have developed a specific and progressive balance training programme with dual- and multi-task exercises for older adults. PRACTICAL APPLICATION: Balance demanding exercises, specific to the various components of balance control and to situations in daily life, were performed in sitting, standing and walking at three different levels of progression (basic, moderate and advanced) of increasing difficulty and complexity. The training was performed in 45-minutes group sessions, with 6-10 participants in each group, three times per week during 12 weeks, with two or three physiotherapists present. CONCLUSIONS: This balance training programme strengthens self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function. Participants found the programme motivating, valuable, fun, and enjoyable, which was reflected in a high attendance rate.

Comparison of pedometer and accelerometer derived steps in older individuals with Parkinson's disease or osteoporosis under free-living conditions.

AIM: To compare self-reported pedometer steps with accelerometer steps under free-living conditions in individuals with Parkinson's disease (PD) or osteoporosis (OP). METHODS: Seventy-three individuals with PD and 71 individuals with OP wore a pedometer (Yamax LS2000) and an accelerometer (ActiGraph GT1M/GT3X+) simultaneously for one week. RESULTS: Fifty-one individuals with PD (72.6 ± 5.3 years) and 61 with OP (75.6 ± 5.3 years) provided simultaneously recorded data for 3-7 consecutive days. Pedometer steps were significantly lower than accelerometer steps in the PD group (p = .002) but not in the OP group (p = .956). Bland-Altman plots demonstrated wide limits of agreement between the instruments in both PD (range = 6,911 steps) and OP (range = 6,794 steps). CONCLUSION: These results suggest that the ActiGraph GT1M/GT3X+ should be preferred over the Yamax LS2000 for the assessment of steps in both research and clinical evaluations, particularly in individuals with PD or altered gait.

Device-measured physical activity and sedentary time in the Nordic countries: A scoping review of population-based studies.

PURPOSE: The purpose of this scoping review was to summarize and describe the methodology and results from population-based studies of physical activity and sedentary time measured with devices in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) and published in 2000 or later. METHODS: A systematic search was carried out in PubMed and Web of Science in June 2023 using predefined search terms. RESULTS: Fourteen unique research projects or surveillance studies were identified. Additionally, 2 surveillance studies published by national agencies were included, resulting in a total of 16 studies for inclusion. National surveillance systems exist in Finland and Norway, with regular survey waves in school-aged children/adolescents and adults. In Denmark, recent nationally representative data have been collected in school children only. So far, Sweden has no regular national surveillance system using device-based data collection. No studies were found from Iceland. The first study was conducted in 2001 and the most recent in 2022, with most data collected from 2016 to date. Five studies included children/adolescents 6-18 years, no study included preschoolers. In total 11 studies included adults, of which 8 also covered older adults. No study focused specifically on older adults. The analytical sample size ranged from 205 to 27,890. Detailed methodology is presented, such as information on sampling strategy, device type and placement, wear protocols, and physical activity classification schemes. Levels of physical activity and sedentary time in children/adolescents, adults, and older adults across the Nordic countries are presented. CONCLUSION: A growing implementation of device-based population surveillance of physical activity and sedentary behavior in the Nordic countries has been identified. The variety of devices, placement, and data procedures both within and between the Nordic countries highlights the challenges when it comes to comparing study outcomes as well as the need for more standardized data collection.

Ett steg på vägen till precisionshälsa.

Healthcare professionals play a central role in health promotion and supporting patients to healthy lifestyles. The handbook FYSS (Physical Activity in the Prevention and Treatment of Disease), produced by Swedish Professional Associations for Physical Activity (YFA), can facilitate this work by providing evidence-based recommendations on how to prevent and treat common diseases and conditions using physical activity in a systematic way. This thematic issue presents a sample of the chapters included in the new FYSS 2021.

"A manageable and challenging fall prevention intervention with impact on society" - older women's perspectives on participation in the stayBalanced training programme.

INTRODUCTION: Efficient and effective evidence-based practice (EBP) strategies for managing fall prevention in primary health care are of great importance. To ensure that EBP methods have the potential to be implemented and maintained in clinical practice, patient perspective must be ensured. Novel programs need to be perceived as meaningful and feasible, and in line with the patients' values, preferences and needs. PURPOSE: To describe how older women with osteoporosis experience participation in the StayBalanced Programme. METHODS: Individual semi-structured interviews with 39 women aged 67-86 with osteoporosis, impaired balance and fear of falling. Data were analyzed with thematic analysis. RESULTS: The analysis resulted in three main themes; "Managing and challenging training through support and enjoyment," "Structured training leads to safety and self-awareness" and "Lack of structured balance training means missed benefits, for both the individual and society." The participants experienced that the increased safety and self-awareness achieved through the challenging and motivating training, were transferred to daily life, thus, leaving them less exposed to falls, fall injuries and fear of falling. They expressed concerns about lack of knowledge translation regarding the positive effects of structured and challenging balance training, which left older adults and society without the benefits of evidence-based intervention. CONCLUSIONS: The StayBalanced Programme was appreciated and acceptable from the perspective of the participants, and in line with their values and preferences, one of three key components of EPB. The results of this study may support the uptake of the evidence-based StayBalanced Programme for fall prevention in clinical practice.

[Recommendations on physical activity and sedentary behaviour]. / Sitt mindre ­ all rörelse räknas.

Recommendations on physical activity and sedentary behaviour for improved health have been prepared by Professional Associations for Physical Activity (YFA) and approved by the Swedish Society of Medicine. All adults should do aerobic physical activity 150-300 minutes at moderate or 75-150 minutes at high intensity, or combined, at a weekly basis. For additional health benefits, muscle-strengthening activity should be performed on at least 2 days a week, and sedentary time should be limited and replaced by physical activity. Older adults should, as part of their weekly physical activity, do multicomponent physical activity that emphasizes balance and strength on at least 2-3 days a week to enhance functional capacity and prevent falls. The benefits of physical activity outweigh the risks. The Swedish National Board of Health and Welfare recommends that healthcare providers offer counselling with exercise on prescription to individuals with physical activity under the recommended dose.

[The healthcare system plays a key role in promoting physical acitivity]. / Sjukvården spelar en nyckelroll i främjandet av fysisk aktivitet.

Physical inactivity is recognised as a major public health problem. In Sweden about 1/3 of the adult population reports being insufficiently active. A central task in public health work is to support the individual, without blaming, in making healthy choices. Initiatives in healthcare, such as counselling on physical activity, have been shown to be both cost-effective and effective for disease prevention and treatment. The use of a physical activity vital sign and brief advice from physicians can make a big difference. In this paper we present how the healthcare system as one of eight evidence-based investments can promote physical activity. The eight investment areas are: whole-of-school programs, active transport, active urban design, health care, public education, sports and recreation, workplaces and community-wide programs. Evidence suggests that the largest population health benefit will be achieved by combining these investments and implementing a systems-based approach.

StayBalanced: implementation of evidence-based fall prevention balance training for older adults-cluster randomized controlled and hybrid type 3 trial.

BACKGROUND: The StayBalanced programme has shown positive effects on fall prevention, balance control and fear of falling. Despite convincing evidence on the efficacy and effectiveness of balance training, there is a gap between research findings and what is provided in community-based and clinical health care settings. Therefore, transferring evidence-based balance training into clinical practice is needed. METHODS: This project, designed as a hybrid type 3 trial, is a cluster-randomized study with a mixed-method design, carried out in primary health care settings. The aim is to investigate the effectiveness of two different strategies to facilitate the implementation of an intervention, the StayBalanced balance training programme, in primary health care, including evaluation of relative changes and maintenance in patient outcomes between intervention arms over 24 months. The StayBalanced programme will be launched through a website with information on the balance training and how to use it in clinical practice. One implementation strategy will include close facilitation, i.e. support and close follow-ups initiated by the researchers, in addition to access to the website. The other strategy simply includes access to the StayBalanced website. Outcome measures in the project consist of implementation outcomes, such as acceptability, feasibility, fidelity and sustainability of the StayBalanced programme. Outcomes at an individual level for older adults participating in the training will include fall-related concerns, health-related quality of life, balance performance, gait, physical activity, muscle strength in lower extremities, number of falls and compliance with training. DISCUSSION: This study will generate new understanding of effective strategies for transferring research to clinical practice and thereby reduce an important knowledge gap, as well as aid decision-making for future implementation of evidence-based methods. Furthermore, it will contribute to improved balance and gait, increased level of physical activity and function, and improved health-related quality of life for the individuals participating in the programme. TRIAL REGISTRATION: ClinicalTrials.gov NCT02909374 . Registered on September 21, 2016.

Self-Reported and Device-Measured Physical Activity in Leisure Time and at Work and Associations with Cardiovascular Events-A Prospective Study of the Physical Activity Paradox.

The beneficial health effects of physical activity, in particular moderate-to-vigorous physical activity (MVPA), are well documented, but there is an ongoing scientific debate whether the domain matters, i.e., whether leisure time physical activity is beneficial and occupational physical activity is detrimental to health, referred to as the physical activity paradox. The present study, therefore, analyzed the association between self-reported and device-measured physical activity and cardiovascular events in both domains. A representative sample of 807 individuals was followed for 14.6 ± 1.1 years, in which 59 cardiovascular events occurred. For self-reported data, Cox proportional hazard models showed no effect of physical activity in leisure and at work, while for device-measured MVPA, beneficial associations with total time spent in MVPA and occupational time spent in MVPA were found, but not for leisure time spent in MVPA. When accounting for both domains in the same model, the associations disappeared. These results indicate that it matters how physical activity is measured and that MVPA is beneficial for cardiovascular health, but the domain in which MVPA occurs does not seem to matter.

Correlations of Subjective and Social Well-Being With Sedentary Behavior and Physical Activity in Older Adults-A Population-Based Study.

BACKGROUND: Subjective and social well-being, avoiding sedentary behavior (SB), and engaging in physical activity (PA) are important factors for health in older adults, but the extent to which they are related to each other remains unclear. We aimed to investigate these correlations, and whether they differ by age. METHOD: A cross-sectional study was carried out in 595 people aged 66 years and older, from the Swedish National study on Aging and Care in Kungsholmen. Subjective and social well-being (life satisfaction, positive and negative affect, social connections, social support, and social participation) were assessed through validated questionnaires and activPAL3 accelerometers provided information on SB and PA. Data were analyzed using multi-adjusted quantile regression models. RESULTS: Higher positive affect was significantly associated with less daily sitting time (ß = -27.08, 95% confidence interval [CI]: -47.77, -6.39) and higher levels of light PA (LPA) (ß = 40.67, 95% CI: 21.06, 60.28). Higher levels of social support and social participation were associated with less daily sitting time (ß = -22.79, 95% CI: -39.97, -5.62; and ß = -21.22, 95% CI: -39.99, -2.44) and more time in LPA (ß = 23.86, 95% CI: 4.91, 42.81; and ß = 25.37, 95% CI: 6.27, 44.47). Stratified analyses suggested that the associations of positive affect and social participation were strongest for individuals aged 80 years and older. CONCLUSIONS: Our results suggest that older adults with higher levels of subjective and social well-being spend less time sitting and engage more in PA. This was especially evident among the oldest-old individuals. Future research should longitudinally investigate the directionality of these correlations.

Device-measured sedentary behavior and physical activity in older adults differ by demographic and health-related factors.

BACKGROUND: Our aim was to describe and explore older adults' device-measured sedentary behavior and physical activity (PA) pattern by sex, age, education, marital status, body mass index, and physical function; and to assess agreement regarding fulfillment of PA recommendations, i.e. 150 min/week of moderate-to-vigorous intensity PA (MVPA), between device-measured and self-reported PA. METHOD: We included 656 older adults (64% women), aged 66, 81-87 or ≥ 90 years from a Swedish population-based cohort study. The activPAL3 accelerometer provided information on sedentary behavior (sedentary time, sedentary bouts, sit-to-stand transitions) and PA. Stepping ≥100 steps/min was considered MVPA; standing and stepping < 100 steps/min were considered light-intensity PA (LPA). Self-reported PA was compared with min/week in MVPA and steps/day. RESULTS: On average, 60% of wear time was spent sedentary, 36% in LPA, and 4% in MVPA. Relative to men, women, had significantly (p < 0.05) more sit-to-stand transitions, spent 33 min/day less sedentary and 27 min/day more in LPA, and were more likely to report meeting PA recommendations, but showed no difference in steps/day, MVPA, or sedentary bout duration. Older age was associated with more sedentary time, lower MVPA and fewer steps/day. The prevalence of meeting PA recommendations was 59% device-measured and 88% by self-report with limited agreement between methods (Cohen's Kappa = 0.21, Spearman's rho = 0.28). Age differences were much more pronounced with objective measures than by self-report. CONCLUSIONS: We found significant sex differences in sedentary behavior and time in LPA in older adults, but not in MVPA, in contrast to previous findings. Sedentary time increased with age, with small differences in accumulation pattern. MVPA time was lower with older age, obesity, and poor physical function. A majority of the participants > 80 years did not meet the PA recommendations. Given the strong relationships between sedentary behavior, PA and health in older adults, programs are needed to address these behaviors. Agreement between device-measured and self-reported fulfillment of PA recommendations was limited. Device-based measurement adds value to PA studies, providing richer and different data than self-report.