There is not enough evidence to allow for any clear conclusions about whether programmes or policies are effective in reducing sedentary time in older adults. It is also uncertain whether these programmes or policies improve the physical or mental health of older adults.
Why did we do this review?
Older adults spend about 80% of their time being sedentary. Sedentary time is the amount of time spent sitting or lying down whilst awake. For example, sitting down watching TV is considered a sedentary behaviour. Long periods of sedentary time have been linked with an increased risk of several long-term diseases, becoming frailer, developing disabilities, needing help with everyday activities, and early death. We wanted to know if programmes or policies intended to help older adults reduce their sedentary time are effective. We also wanted to know if these programmes or policies also provide physical or mental health benefits.
What did we do?
We searched electronic databases and relevant journals to find studies. We included any randomised study (in which people have the same chance of being given the intervention or not) that looked at policies or programmes that were designed to reduce sedentary time in older adults (aged 60 or over) living independently in the community. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find out?
We found seven studies including a total of 397 older adults. All of the studies looked at ways to help individual older adults to change their sedentary behaviour. The support included a range of strategies like counselling, goal setting, and information sessions. Some of the studies used technology that records behaviour, such as activity monitors. We did not find any studies that looked at changes to the natural environment, the built environment, a person's social environment, or home environment where older adults live. We did not find any studies that looked at the effect of changing policies and laws that affect the sedentary behaviour of older adults. We did not find any studies that looked at whether the benefits and use of the programme were at least worth what was paid for them. None of the studies reported on unwanted effects.
What are the limitations of the evidence?
We have only low confidence in these findings, due to low sample sizes and because some studies were conducted in ways that may have introduced errors into their results. The findings also combined results from studies using self-reported measures of sedentary time together with device-based measures.
How up-to-date is the evidence?
The evidence is current to January 2021.
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.
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.
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.
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.
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).
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.
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.
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.
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.