Active Aging and Public Health: Evidence, Implications, and Opportunities.

By 2050, 20% of the world's population will be over the age of 65 years, with projections that 80% of older adults will be living in low- to middle-income countries. Physical inactivity and sedentary time are particularly high in older adults, presenting unique public health challenges. In this article, we first review evidence that points to multiple beneficial outcomes of active aging, including better physical function, cognitive function, mental health, social health, and sleep, and we suggest the need to shift the research focus from chronic disease outcomes to more relevantoutcomes that affect independence and quality of life. Second, we review the critical role of age-friendly environments in facilitating active aging equitably across different countries and cultures. Finally, we consider emerging opportunities related to social engagement and technology-enabled mobility that can facilitate active aging. In all these contexts, it is a priority to understand and address diversity within the global aging population.

Sitting less and moving more for improved metabolic and brain health in type 2 diabetes: 'OPTIMISE your health' trial protocol.

BACKGROUND: Clinical practice guidelines recommend that adults with type 2 diabetes (T2D) sit less and move more throughout the day. The 18-month OPTIMISE Your Health Clinical Trial was developed to support desk-based workers with T2D achieve these recommendations. The two-arm protocol consists of an intervention and control arms. The intervention arm receives 6 months health coaching, a sit-stand desktop workstation and an activity tracker, followed by 6 months of text message support, then 6 months maintenance. The control arm receives a delayed modified intervention after 12 months of usual care. This paper describes the methods of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of the intervention, compared to a delayed intervention control. METHODS: This is a two-arm RCT being conducted in Melbourne, Australia. Desk-based workers (≥0.8 full-time equivalent) aged 35-65 years, ambulatory, and with T2D and managed glycaemic control (6.5-10.0% HbA1c), are randomised to the multicomponent intervention (target n = 125) or delayed-intervention control (target n = 125) conditions. All intervention participants receive 6 months of tailored health coaching assisting them to "sit less" and "move more" at work and throughout the day, supported by a sit-stand desktop workstation and an activity tracker (Fitbit). Participants receive text message-based extended care for a further 6-months (6-12 months) followed by 6-months of non-contact (12-18 months: maintenance). Delayed intervention occurs at 12-18 months for the control arm. Assessments are undertaken at baseline, 3, 6, 12, 15 and 18-months. Primary outcomes are activPAL-measured sitting time (h/16 h day), glycosylated haemoglobin (HbA1c; %, mmol/mol) and, cognitive function measures (visual learning and new memory; Paired Associates Learning Total Errors [adjusted]). Secondary, exploratory, and process outcomes will also be collected throughout the trial. DISCUSSION: The OPTIMISE Your Health trial will provide unique insights into the benefits of an intervention aimed at sitting less and moving more in desk-bound office workers with T2D, with outcomes relevant to glycaemic control, and to cardiometabolic and brain health. Findings will contribute new insights to add to the evidence base on initiating and maintaining behaviour change with clinical populations and inform practice in diabetes management. TRIAL REGISTRATION: ANZCTRN12618001159246 .

Interventions for reducing sedentary behaviour in community-dwelling older adults.

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.

Reducing Sitting Time in Obese Older Adults: The I-STAND Randomized Controlled Trial.

BACKGROUND: The authors tested the efficacy of the "I-STAND" intervention for reducing sitting time, a novel and potentially health-promoting approach, in older adults with obesity. METHODS: The authors recruited 60 people (mean age = 68 ± 4.9 years, 68% female, 86% White; mean body mass index = 35.4). The participants were randomized to receive the I-STAND sitting reduction intervention (n = 29) or healthy living control group (n = 31) for 12 weeks. At baseline and at 12 weeks, the participants wore activPAL devices to assess sitting time (primary outcome). Secondary outcomes included fasting glucose, blood pressure, and weight. Linear regression models assessed between-group differences in the outcomes. RESULTS: The I-STAND participants significantly reduced their sitting time compared with the controls (-58 min per day; 95% confidence interval [-100.3, -15.6]; p = .007). There were no statistically significant changes in the secondary outcomes. CONCLUSION: I-STAND was efficacious in reducing sitting time, but not in changing health outcomes in older adults with obesity.

Physical activity associates with disease characteristics of severe asthma, bronchiectasis and COPD.

BACKGROUND AND OBJECTIVE: Physical activity (PA) in obstructive airway diseases (OAD) is likely to be impaired but this has not been extensively studied outside of chronic obstructive pulmonary disease (COPD). We describe PA levels in severe asthma and bronchiectasis compared to moderate-severe COPD and to controls, and tested the cross-sectional associations of PA (steps/day) with shared disease characteristics in the OAD group. METHODS: Adults with OAD (severe asthma = 62, COPD = 67, bronchiectasis = 60) and controls (n = 63) underwent a multidimensional assessment, including device-measured PA levels. RESULTS: The OAD group included 189 participants (58.7% females), with median (interquartile range) age of 67 (58-72) years and mean forced expiratory volume in the first second (FEV1 ) % predicted of 69.4%. Demographic characteristics differed between groups. Compared to controls (52.4% females, aged 55 (34-64) years, median 7640 steps/day), those with severe asthma, bronchiectasis and COPD accumulated less steps/day: median difference of -2255, -2289, and -4782, respectively (P ≤ 0.001). Compared to COPD, severe asthma and bronchiectasis participants accumulated more steps/day: median difference of 2375 and 2341, respectively (P ≤ 0.001). No significant differences were found between the severe asthma and bronchiectasis group. Exercise capacity, FEV1 % predicted, dyspnoea and systemic inflammation differed between groups, but were each significantly associated with steps/day in OAD. In the multivariable model adjusted for all disease characteristics, exercise capacity and FEV1 % predicted remained significantly associated. CONCLUSION: PA impairment is common in OAD. The activity level was associated with shared characteristics of these diseases. Interventions to improve PA should be multifactorial and consider the level of impairment and the associated characteristics.

Effects of replacing sitting time with physical activity on lung function: An analysis of the Canadian Longitudinal Study on Aging.

BACKGROUND: Sitting time and physical activity may be modifiable determinants of lung function. The purpose of this study was to assess the effect that replacing various movement behaviours has on lung function among individuals with and without obstructive lung disease. DATA AND METHODS: For analysis, data were used from participants of the Canadian Longitudinal Study on Aging, recruited between 2012 and 2015. Lung function was assessed using spirometry. A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Isotemporal substitution analysis was performed to analyze the effects of replacing 30 minutes per day of one movement behaviour with another, keeping the total time constant. Analyses were run separately for individuals with an obstructive lung disease (asthma, chronic obstructive pulmonary disease, or forced expiratory volume in 1 second [FEV1] ⟨ 5th percentile lower limit of normal; n=3,398), and healthy adults (n=14,707). RESULTS: When sitting time was replaced with 30 minutes per day of any type of physical activity or sleep, an increase in percent (%) of predicted FEV1 (i.e., ß=0.65, confidence interval [CI]: 0.43, 0.88 for replacing sitting time with strenuous or strengthening activity) was observed among healthy adults. Among adults with obstructive lung disease, replacing 30 minutes per day of sitting time or sleep duration with strenuous or strengthening activity was associated with an improvement in the percent of predicted FEV1 (i.e., ß=0.98, CI: 0.13, 1.82 for replacing sleep duration with strenuous or strengthening activity). DISCUSSION: Replacing sitting time with physical activity leads to significant improvements in lung function among adults with an obstructive lung disease, as well as among adults without a respiratory disease.

Association of 12-Year Trajectories of Sitting Time With Frailty in Middle-Aged Women.

Prolonged sitting time is associated with several health outcomes; limited evidence indicates associations with frailty. Our aims in this study were to identify patterns of sitting time over 12 years in middle-aged (ages 50-55 years) women and examine associations of these patterns with frailty in older age. We examined 5,462 women born in 1946-1951 from the Australian Longitudinal Study on Women's Health who provided information on sociodemographic attributes, daily sitting time, and frailty in 2001 and then again every 3 years until 2013. Frailty was assessed using the FRAIL (fatigue, resistance, ambulation, illness, loss of weight) scale (0 = healthy; 1-2 = prefrail; 3-5 = frail), and group-based trajectory analyses identified trajectories of sitting time. We identified 5 sitting-time trajectories: low (26.9%), medium (43.1%; referent), increasing (6.9%), decreasing (18.1%), and high (4.8%). In adjusted models, the likelihoods of being frail were statistically higher for women in the increasing (odds ratio (OR) = 1.29, 95% confidence interval (CI): 1.03, 1.61) and high (OR = 1.42, 95% CI: 1.10, 1.84) trajectories. In contrast, women in the low trajectory group were less likely to be frail (OR = 0.86, 95% CI: 0.75, 0.98), and there was no difference in the likelihood of frailty in the decreasing trajectory group. Our study suggests that patterns of sitting time over 12 years in middle-aged women predict frailty in older age.

Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking?

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Associations of context-specific sitting time with markers of cardiometabolic risk in Australian adults.

BACKGROUND: High volumes of sitting time are associated with an elevated risk of type 2 diabetes and cardiovascular disease, and with adverse cardiometabolic risk profiles. However, previous studies have predominately evaluated only total sitting or television (TV) viewing time, limiting inferences about the specific cardiometabolic health impacts of sitting accumulated in different contexts. We examined associations of sitting time in four contexts with cardiometabolic risk biomarkers in Australian adults. METHODS: Participants (n = 3429; mean ± SD age 58 ± 10 years) were adults without clinically diagnosed diabetes or cardiovascular disease from the 2011-2012 Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Multiple linear regressions examined associations of self-reported context-specific sitting time (occupational, transportation, TV-viewing and leisure-time computer use) with a clustered cardiometabolic risk score (CMR) and with individual cardiometabolic risk biomarkers (waist circumference, BMI, resting blood pressure, triglycerides, HDL- and LDL-cholesterol, and fasting and 2-h post-load plasma glucose). RESULTS: Higher CMR was significantly associated with greater TV-viewing and computer sitting time (b [95%CI] = 0.07 [0.04, 0.09] and 0.06 [0.03, 0.09]), and tended to be associated with higher occupational and transport sitting time (0.01 [- 0.01, 0.03] and 0.03 [- 0.00, 0.06]), after adjustment for potential confounders. Furthermore, keeping total sitting time constant, accruing sitting via TV-viewing and computer use was associated with significantly higher CMR (0.05 [0.02, 0.08] and 0.04 [0.01, 0.06]), accruing sitting in an occupational context was associated with significantly lower CMR (- 0.03 [- 0.05, - 0.01]), while no significant association was seen for transport sitting (0.00 [- 0.03, 0.04]). Results varied somewhat between the respective biomarkers; however, higher sitting time in each domain tended to be associated detrimentally with individual biomarkers except for fasting glucose (non-significant associations) and systolic blood pressure (a beneficial association was observed). Overall, associations were stronger for TV-viewing and computer use, and weaker for occupational sitting. CONCLUSIONS: Higher context-specific sitting times tended to be detrimentally associated, albeit modestly, with CMR and several cardiometabolic risk biomarkers. There was some evidence suggesting that the context in which people sit is relevant above and beyond total sitting time. Methodological issues notwithstanding, these findings may assist in identifying priorities for sitting-reduction initiatives, in order to achieve optimal cardiometabolic health benefits.

Movement behaviours are associated with lung function in middle-aged and older adults: a cross-sectional analysis of the Canadian longitudinal study on aging.

BACKGROUND: Physical activity has been shown to attenuate the age-associated decline in lung function; however, there is little research evaluating different movement behaviours as potential correlates of lung function. Modifiable determinants need to be identified, as the prevalence of chronic respiratory disease is on the rise. The purpose of this study was to investigate associations of self-reported movement behaviours (i.e., sitting time, walking, different intensities of physical activity, and strengthening activities), with lung function in middle-aged and older adults without a respiratory disease, according to their smoking history. METHODS: Data from participants of the Canadian Longitudinal Study on Aging were used for analysis (n = 16,839). Lung function was assessed using spirometry. A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Smoking status was classified as non-smoking, < 10 pack years smoking, and 10 or more pack years of smoking. The association between movement behaviours and lung function was assessed using hierarchical linear regression models with all covariates (age, sex, smoking status, body mass index, education, retirement status, and sleep duration) entered into block 1, and all movement behaviours entered into block 2. RESULTS: All movement behaviours were associated with Forced Expiratory Volume in 1 s (FEV1) and Forced Vital Capacity (FVC) % predicted in crude and adjusted models, regardless of smoking status. Sitting time was negatively associated with both FEV1%pred (ß: -0.094, CI: -0.140, - 0.047) and FVC%pred (ß: -0.087, CI: -0.128, -0.045) among those who never smoked, and strength activity was positively associated with both FEV1%pred (ß: 0.272, CI: 0.048, 0.496) and FVC%pred (ß: 0.253, CI: 0.063,0.442) among those who smoked < 10 pack years, as well as with FVC%pred among those who smoked 10 or more pack years (ß: 0.309, CI: 0.064, 0.554). CONCLUSIONS: This is the first study to assess the association of different movement behaviours with lung function among middle-aged and older adults without a respiratory disease. These findings indicate that movement behaviours are correlates of lung function, and that they may be modifiable determinants of the age-associated decline in lung function.

Physical activity and sedentary time are related to clinically relevant health outcomes among adults with obstructive lung disease.

BACKGROUND: The purpose of the current study was to determine the association between sedentary time and physical activity with clinically relevant health outcomes among adults with impaired spirometry and those with or without self-reported obstructive lung disease (asthma or COPD). METHODS: Data from participants of the Canadian Longitudinal Study on Aging were used for analysis (n = 4156). Lung function was assessed using spirometry. Adults were said to have impaired spirometry if their Forced Expiratory Volume in 1 s was <5th percentile lower limit of normal (LLN). A modified version of the Physical Activity Scale for the Elderly was used to assess sitting time and physical activity levels. Healthcare use and quality of life outcomes were assessed using self report. RESULTS: Among those with asthma, participating in strengthening activities was associated with lower odds of reporting poor perceived health (OR = 0.65, CI: 0.53, 0.79), poor perceived mental-health (OR = 0.73, CI: 0.60, 0.88), unhealthy aging (OR = 0.68, CI: 0.56, 0.83), and reporting an emergency department visit in the past 12 months (OR = 0.76, CI: 0.60, 0.95). Among those with COPD, those who reported highest weekly sedentary time had higher odds of reporting poor perceived health (OR = 2.70, CI: 1.72, 4.24), poor perceived mental-health (OR = 1.99, CI: 1.29, 3.06), and unhealthy aging (OR = 3.04, CI: 1.96, 4.72). Among those below the LLN, sitting time (OR = 2.57, CI: 1.40, 4.72) and moderate intensity physical activity (OR = 0.23, CI: 0.09, 0.63) were associated with overnight hospital stays. CONCLUSIONS: Higher physical activity levels and lower sedentary time may be associated with lower healthcare use and better quality of life. This research may have implications related to the use of physical activity for improving health outcomes and quality of life among adults with obstructive lung disease or impaired spirometry.

The Association of Sitting Time With Sarcopenia Status and Physical Performance at Baseline and 18-Month Follow-Up in the Residential Aged Care Setting.

This study investigated the association of sitting time with sarcopenia and physical performance in residential aged care residents at baseline and 18-month follow-up. Measures included the International Physical Activity Questionnaire (sitting time), European Working Group definition of sarcopenia, and the short physical performance battery (physical performance). Logistic regression and linear regression analyses were used to investigate associations. For each hour of sitting, the unadjusted odds ratio of sarcopenia was 1.16 (95% confidence interval [0.98, 1.37]). Linear regression showed that each hour of sitting was significantly associated with a 0.2-unit lower score for performance. Associations of baseline sitting with follow-up sarcopenia status and performance were nonsignificant. Cross-sectionally, increased sitting time in residential aged care may be detrimentally associated with sarcopenia and physical performance. Based on current reablement models of care, future studies should investigate if reducing sedentary time improves performance among adults in end of life care.

Citizen science applied to building healthier community environments: advancing the field through shared construct and measurement development.

BACKGROUND: Physical inactivity across the lifespan remains a public health issue for many developed countries. Inactivity has contributed considerably to the pervasiveness of lifestyle diseases. Government, national and local agencies and organizations have been unable to systematically, and in a coordinated way, translate behavioral research into practice that makes a difference at a population level. One approach for mobilizing multi-level efforts to improve the environment for physical activity is to engage in a process of citizen science. Citizen Science here is defined as a participatory research approach involving members of the public working closely with research investigators to initiate and advance scientific research projects. However, there are no common measures or protocols to guide citizen science research at the local community setting. OBJECTIVES: We describe overarching categories of constructs that can be considered when designing citizen science projects expected to yield multi-level interventions, and provide an example of the citizen science approach to promoting PA. We also recommend potential measures across different levels of impact. DISCUSSION: Encouraging some consistency in measurement across studies will potentially accelerate the efficiency with which citizen science participatory research provides new insights into and solutions to the behaviorally-based public health issues that drive most of morbidity and mortality. The measures described in this paper abide by four fundamental principles specifically selected for inclusion in citizen science projects: feasibility, accuracy, propriety, and utility. The choice of measures will take into account the potential resources available for outcome and process evaluation. Our intent is to emphasize the importance for all citizen science participatory projects to follow an evidence-based approach and ensure that they incorporate an appropriate assessment protocol. CONCLUSIONS: We provided the rationale for and a list of contextual factors along with specific examples of measures to encourage consistency among studies that plan to use a citizen science participatory approach. The potential of this approach to promote health and wellbeing in communities is high and we hope that we have provided the tools needed to optimally promote synergistic gains in knowledge across a range of Citizen Science participatory projects.

Sedentary time in older men and women: an international consensus statement and research priorities.

Sedentary time is a modifiable determinant of poor health, and in older adults, reducing sedentary time may be an important first step in adopting and maintaining a more active lifestyle. The primary purpose of this consensus statement is to provide an integrated perspective on current knowledge and expert opinion pertaining to sedentary behaviour in older adults on the topics of measurement, associations with health outcomes, and interventions. A secondary yet equally important purpose is to suggest priorities for future research and knowledge translation based on gaps identified. A five-step Delphi consensus process was used. Experts in the area of sedentary behaviour and older adults (n=15) participated in three surveys, an in-person consensus meeting, and a validation process. The surveys specifically probed measurement, health outcomes, interventions, and research priorities. The meeting was informed by a literature review and conference symposium, and it was used to create statements on each of the areas addressed in this document. Knowledge users (n=3) also participated in the consensus meeting. Statements were then sent to the experts for validation. It was agreed that self-report tools need to be developed for understanding the context in which sedentary time is accumulated. For health outcomes, it was agreed that the focus of sedentary time research in older adults needs to include geriatric-relevant health outcomes, that there is insufficient evidence to quantify the dose-response relationship, that there is a lack of evidence on sedentary time from older adults in assisted facilities, and that evidence on the association between sedentary time and sleep is lacking. For interventions, research is needed to assess the impact that reducing sedentary time, or breaking up prolonged bouts of sedentary time has on geriatric-relevant health outcomes. Research priorities listed for each of these areas should be considered by researchers and funding agencies.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

Sedentary time in older adults: a critical review of measurement, associations with health, and interventions.

Sedentary time (ST) is an important risk factor for a variety of health outcomes in older adults. Consensus is needed on future research directions so that collaborative and timely efforts can be made globally to address this modifiable risk factor. In this review, we examined current literature to identify gaps and inform future research priorities on ST and healthy ageing. We reviewed three primary topics:(1) the validity/reliability of self-report measurement tools, (2) the consequences of prolonged ST on geriatric-relevant health outcomes (physical function, cognitive function, mental health, incontinence and quality of life) and(3) the effectiveness of interventions to reduce ST in older adults. METHODS: A trained librarian created a search strategy that was peer reviewed for completeness. RESULTS: Self-report assessment of the context and type of ST is important but the tools tend to underestimate total ST. There appears to be an association between ST and geriatric-relevant health outcomes, although there is insufficient longitudinal evidence to determine a dose-response relationship or a threshold for clinically relevant risk. The type of ST may also affect health; some cognitively engaging sedentary behaviours appear to benefit health, while time spent in more passive activities may be detrimental. Short-term feasibility studies of individual-level ST interventions have been conducted; however, few studies have appropriately assessed the impact of these interventions on geriatric-relevant health outcomes, nor have they addressed organisation or environment level changes. Research is specifically needed to inform evidence-based interventions that help maintain functional autonomy among older adults.This consensus statement has been endorsed by the following societies: Academy of Geriatric Physical Therapy, Exercise & Sports Science Australia, Canadian Centre for Activity and Aging, Society of Behavioral Medicine, and the National Centre for Sport and Exercise Medicine.

Late-Life Exercise and Difficulty with Activities of Daily Living: an 8-Year Nationwide Follow-up Study in Taiwan.

BACKGROUND: Many studies have shown that low levels of exercise in later life are associated with the progression of difficulties with activities of daily living. However, few have assessed the independent effect of exercise components on difficulty in performing activities of daily living and explored whether the relationship between exercise and activities of daily living is reciprocal. PURPOSES: This study aimed to examine, in a nationally representative sample of older Taiwanese, the independent effect of the frequency, duration, and intensity of exercise on difficulty with activities of daily living. A secondary objective was to explore the degree to which the relationship of late-life exercise with activities of daily living is bi-directional. METHODS: Data from a fixed cohort (n = 1268, aged 70+) in 1999 with 8 years of follow-up were analyzed. Generalized estimating equation models with multivariate adjustment were performed. RESULTS: Participants engaging in higher levels of exercise had less difficulty with subsequent activities of daily living. Among the components of exercise, only duration, especially 30 min or more per session, was associated with fewer difficulties with activities of daily living. The relationship between exercise and activities of daily living was reciprocal, although the influence of activities of daily living on subsequent exercise levels was weaker. CONCLUSIONS: Exercise in later life may be able to minimize the difficulties in activities of daily living and help maintain the mobility and independence of older adults.

Changing physical activity and sedentary behaviour in people with COPD.

People with chronic obstructive pulmonary disease (COPD) engage in low levels of physical activity (PA). Given the evidence for the health benefits associated with participating in 150 min of moderate-to-vigorous intensity PA each week, there is considerable interest in methods to increase PA in people with COPD. Studies to date have focused largely on exercise training and behavioural approaches, and many have demonstrated minimal, if any effect. An intermediate goal that focuses on reducing time spent in sedentary behaviour (SB) and increasing participation in light intensity PA is a more realistic goal in this population and offers a gateway to higher intensity PA. Although strategies that are capable of reducing time spent in SB in COPD are unknown, studies that have shown some increase in PA in this population often provide individualized goal setting, motivational interviewing and frequent contact with health-care professionals to provide advice regarding strategies to overcome barriers. Therefore, these approaches should be considered in interventions to reduce time in SB. There are a range of devices available to monitor time in SB for use in both clinical and research settings. To move this area forward, a theoretically informed and systematic approach to behaviour change is needed. The theoretical model, the 'behaviour change wheel', is described and an example is provided of how it can be applied to a person with COPD.

Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE).

BACKGROUND: Stillbirths and neonatal deaths are devastating events for both parents and clinicians and are global public health concerns. Careful clinical management after these deaths is required, including appropriate investigation and assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An educational programme for health care professionals working in maternal and child health has been designed to address these needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth and is delivered as six interactive skills-based stations. We aimed to determine participants' pre- and post-programme knowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme. We also aimed to determine suitability for international use. METHODS: The IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian states and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the assistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation with local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme evaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well as a satisfaction questionnaire. RESULTS: Over the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758 participants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement between pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of satisfaction in all settings. CONCLUSIONS: The IMPROVE programme has been well received in Australia and in three different international settings and is now being made available through ISA. Future research is required to determine whether the immediate improvements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical practice and improvement in parents' experiences with care. The suitability for this programme in low-income countries also needs to be established.

Moderating effects of social engagement on driving cessation in older women.

BACKGROUND: Driving cessation in later life is associated with depression. This study examines if social support can buffer the negative effects of driving cessation on older women's mental health. METHODS: Participants were drawn from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) and included 4,075 older women (aged 76-87 years) who drove at baseline, following them for three years to assess driving cessation. The outcome variable was mental health, measured by the mental health index (MHI) of the SF-36. The explanatory variables were social support factors, including social interaction, whether the women were living alone or with others, and engagement in social activities. Control variables included age, country of birth, area of residence, ability to manage on income, marital status, and general health. RESULTS: Main effect results showed that poor mental health was predicted by driving cessation, low levels of social interaction, and non-engagement in social activities. There was a significant interaction effect of driving status by social activities engagement on mental health. Women who remained active in their engagement of social activities were able to maintain a good level of mental health despite driving cessation. CONCLUSION: Engagement and participation in social activities can help older women who stopped driving maintain a good level of mental health.

Television Viewing Time and 13-year Mortality in Adults with Cardiovascular Disease: Data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab).

BACKGROUND: In the general population, excessive sedentary behaviour is associated with increased all-cause mortality. Few studies have examined this relationship in people with cardiovascular disease (CVD). Using a sample of people with CVD who were excluded from an analysis of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, we examined the relationship between sedentary behaviour and 13-year all-cause mortality. METHODS: In the original AusDiab study, television viewing time was used as a marker of sedentary behaviour in 609 adults (≥45 years of age) with CVD. During 6,291 person-years of follow-up (median follow-up 13 years), there were 294 deaths (48% of sample). Using the time scale of attained age, the Cox proportional hazards model predicting all-cause mortality adjusted for sex, self-rated general health, leisure-time physical activity, smoking status, education, household income, body mass index, lipid levels, blood pressure, and diabetes mellitus was used. RESULTS: Compared with a TV viewing time of <2hours per day, the fully adjusted hazard ratios for all-cause mortality were 1.18 (95% CI, 0.88 to 1.57) for ≥2 to <4hours per day and 1.52 (95% CI, 1.09 to 2.13) for >4hours per day. CONCLUSIONS: Sedentary behaviour was associated with increased risk of all-cause mortality in people with CVD, independent of physical activity and other confounders. In addition to the promotion of regular physical activity, cardiac rehabilitation efforts which also focus on reducing sedentary behaviour may be beneficial.