Mapping Sedentary Behaviour in Older Adults Who Are Frail

Study Overview
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Brief Summary
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The purpose of this study is to map the context of sedentary behaviour among older adults who are frail. This study uses a unique combination of objective and self-report measures to assess context. The investigators will also hold focus groups to understand which behaviours can be modified and conduct an analysis to understand which types of behaviours are associated with negative health outcomes.

Detailed Description
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Older adults who are frail are potentially the population that might benefit the most from a reduction in sedentary time as they are the most sedentary group and have the highest chronic disease burden. However, there is a dearth of evidence on effective interventions to reduce sedentary behaviour or total sedentary time in older adults, especially among individuals that are frail. Previous studies focused on reducing total sedentary time, while other studies aimed to increase physical activity levels with the assumption that sedentary time will be reallocated to physical activity. But, to date, such interventions have not been effective at reducing total sedentary behaviour time in older adults. Previous studies to reduce sedentary time and behaviour in older adults may not be effective because there is no research on the context of sedentary behaviour, about when and where to intervene, and which specific sedentary behaviours should be targeted. Almost all studies in older adults have assessed total sedentary time, which does not provide enough information to understand the context of sedentary behaviours. The main reason to understand context is because not all sedentary behaviours should be modified as some cognitively engaging sedentary behaviours (e.g., reading, socializing) appear to benefit health, while time spent in more passive activities may be detrimental. Therefore, the goal should not be to reduce total sedentary time, but rather identify sedentary behaviours that may be detrimental to the health of older adults who are frail. Before we can develop an intervention to reduce sedentary behaviour among older adults, we must first assess the context of sedentary behaviour. Context is defined as the purpose of the sedentary behaviours, the location where the behaviours occur, the posture of the behaviours (e.g., lying, sitting), social context (e.g., alone or with others), and time of day the behaviours occur. The purpose of this study was to assess the feasibility of measuring the context of sedentary behaviour among older adults who are frail. We defined feasibility using recruitment, retention, and refusal rates (process) and the feasibility resource (i.e., can the tools capture context and are participants willing to use the tools). Our criteria for success were to recruit 20 participants within two months, 85% retention, and 20% refusal. Our secondary objectives are: 1) to determine the context of using objective and subjective measures to assess sedentary behaviours among older adults who are frail; 2) to identify which types of sedentary behaviours can be modified and when and where to intervene; and 3) to conduct an exploratory analysis to determine the association of certain types of sedentary behaviours on health-related outcomes.

Official Title
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MAPping Sedentary Behaviour (MAPS-B) in Older Adults: A Mix-methods Longitudinal Study

Conditions
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Frailty

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 60 years and older; Categorizes as frail on the FRAIL scale ≥ 3 of 5; Lives in the Greater Hamilton Area (GHA) Speaks English or can attend with a translator. Exclusion Criteria: Requires a wheelchair at least 55% of the awake day; needs to sit for long periods of time due to a medical condition; or not independently mobile (i.e., requires assistance from another individual to ambulate); Has travel plans or other commitments that means missing >30% of the rollout study period; Unable to follow two-step instructions.

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 105 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Total number of participants<br>As this is not an intervention study, the investigators only have one group which the investigators will follow at two-time points to map the context of sedentary behaviour. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility process and resources | The purpose of this study was to assess the feasibility of measuring the context of sedentary behaviour among older adults who are frail. We defined feasibility using recruitment, retention, and refusal rates (process feasibility) and the feasibility resource (i.e., can the tools capture context and are participants willing to use the tools). Our criteria for success for process feasibility were to recruit 20 participants within two-months with 85% retention by end of study, and a 20% refusal rate. | Two months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Focus group (Winter) | The investigators will hold focus groups in groups of 5 participants or less after the winter collection periods to mitigate recall bias. The investigators will use semi-structured interviews to guide the focus group. Transcripts will be transcribed verbatim and analyzed in NVivo using codebook reliability thematic analysis | 1 day | 
| Regression analysis (Winter) | The investigators will conduct an exploratory analysis of secondary outcomes using multiple linear regression in SPSS Statistics version 27 (IBM Corp, Armonk, New York, USA). The independent variable will be the most common sequences of sedentary behaviour during the Winter period, and the dependent variable will be the secondary health outcomes (e.g., frailty level, cognitive status). The covariates will include variables from PROGRESS (i.e., age and sex). | 7 consecutive days | 
| Focus group (Spring) | The investigators will hold focus groups in groups of 5 participants or less after the spring collection periods to mitigate recall bias. The investigators will use semi-structured interviews to guide the focus group. Transcripts will be transcribed verbatim and analyzed in NVivo using codebook reliability thematic analysis | 1 day | 
| Regression analysis (Spring) | The investigators will conduct an exploratory analysis of secondary outcomes using multiple linear regression in SPSS Statistics version 27 (IBM Corp, Armonk, New York, USA). The independent variable will be the most common sequences of sedentary behaviour during the Spring period, and the dependent variable will be the secondary health outcomes (e.g., frailty level, cognitive status). The covariates will include variables from PROGRESS (i.e., age and sex). | 3 consecutive days (2 weekdays and 1 weekend) | 
| Context of sedentary behaviour (Winter) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekday #1 | 
| Context of sedentary behaviour (Winter) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekday #2 | 
| Context of sedentary behaviour (Winter) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekend #1 | 
| Context of sedentary behaviour (Spring) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekday #1 | 
| Context of sedentary behaviour (Spring) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekday #2 | 
| Context of sedentary behaviour (Spring) | Data analyses from the activPAL4TM and indoor positioning system and participants' diaries will be mapped to the Sedentary behaviour International Taxonomy (SIT) using classification scheme content analysis. SIT is a framework developed to help researchers understand the context and determinants of sedentary behaviours. The investigators will post process the data from the indoor positioning system in 15-minute intervals. | Weekend #1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sedentary behaviour, Frailty, Falls, Old adults