What Do Older People Do When Sitting and Why?

Implications for Decreasing Sedentary Behavior

Victoria J. Palmer, PhD; Cindy M. Gray, PhD; Claire F. Fitzsimons, PhD; Nanette Mutrie, DPE, MEd, PhD; Sally Wyke, PhD; Ian J. Deary, PhD; Geoff Der, MA, MSc; Sebastien F. M. Chastin, PhD; Dawn A. Skelton, PhD; on behalf of the Seniors USP Team

Disclosures

Gerontologist. 2019;59(4):686-697. 

In This Article

Abstract and Introduction

Abstract

Background and Objectives: Sitting less can reduce older adults' risk of ill health and disability. Effective sedentary behavior interventions require greater understanding of what older adults do when sitting (and not sitting), and why. This study compares the types, context, and role of sitting activities in the daily lives of older men and women who sit more or less than average.

Research Design and Methods: Semistructured interviews with 44 older men and women of different ages, socioeconomic status, and objectively measured sedentary behavior were analyzed using social practice theory to explore the multifactorial, inter-relational influences on their sedentary behavior. Thematic frameworks facilitated between-group comparisons.

Results: Older adults described many different leisure time, household, transport, and occupational sitting and non-sitting activities. Leisure-time sitting in the home (e.g., watching TV) was most common, but many non-sitting activities, including "pottering" doing household chores, also took place at home. Other people and access to leisure facilities were associated with lower sedentary behavior. The distinction between being busy/not busy was more important to most participants than sitting/not sitting, and informed their judgments about high-value "purposeful" (social, cognitively active, restorative) sitting and low-value "passive" sitting. Declining physical function contributed to temporal sitting patterns that did not vary much from day-to-day.

Discussion and Implications: Sitting is associated with cognitive, social, and/or restorative benefits, embedded within older adults' daily routines, and therefore difficult to change. Useful strategies include supporting older adults to engage with other people and local facilities outside the home, and break up periods of passive sitting at home.

Introduction

Sedentary behavior is defined as any waking activity in a sitting or reclining posture where energy expenditure is ≤1.5 metabolic equivalents (Sedentary Behaviour Research Network, 2012). Prolonged sedentary behavior throughout the day increases risk of poor health, even in people who are physically active (Gennuso, Gangnon, Matthews, Thraen-Borowski, & Colbert, 2013). Older adults are one of the most sedentary age groups, spending more than 60% (8.5–9.6 hr) of their waking day sitting (Harvey, Chastin, & Skelton, 2013, 2015), placing them at increased risk of all-cause mortality, metabolic syndrome, and obesity (Rezende, Rey-López, Matsudo, & do Carmo Luiz, 2014; Wullems, Verschueren, Degens, Morse, & Onambele, 2016). Reducing or breaking up periods of prolonged sitting therefore has potential to improve older adults' health, and UK physical activity guidance now advises older adults to limit the amount of time they spend sedentary (Department of Health, 2011). However, there is little evidence on which to guide sedentary behavior interventions (Martin et al., 2015).

Previous research has provided some insight into the type and context of sedentary behavior and has shown that sitting activities older adults typically engage in include watching TV, reading, eating meals, using the computer and transport (Lenz, 2014). One study using time-lapse cameras suggested that older adults often sit most in the afternoon and evening (compared with the morning), and when they are alone at home (Leask, Harvey, Skelton, & Chastin, 2015). However, to develop interventions to reduce their sedentary behavior, we also need to know why older adults spend time sitting and not sitting and how they understand sedentary and nonsedentary behavior.

A small number of qualitative studies have begun to explore factors that influence older adults' sedentary behavior. These studies suggest that older adults enjoy, and recognize the physical, social, and mental benefits, of some sitting activities (e.g., doing arts, crafts and puzzles, and going to the theatre; Chastin, Fitzpatrick, Andrews, & DiCroce, 2014; McEwan, Tam-Seto, & Dogra, 2016), but view excessive sitting as unhealthy. Many older adults report how aches and pains, poor health, and lack of energy make them sit more (Chastin et al., 2014; Dogra, Tam-Seto, & Weir, 2016; Greenwood-Hickman, Renz, & Rosenberg, 2015; McEwan et al., 2016), and some report using sitting to manage health conditions and energy expenditure (Chastin et al., 2014; Leask, Sandlund, Skelton, Tulle, & Chastin, 2016).

Societal attitudes toward aging can result in older adults feeling pressure to sit (Chastin et al., 2014; Greenwood-Hickman et al., 2015; McEwan et al., 2016). For example, lack of knowledge about the benefits of sitting less, mean that family, friends, and carers often encourage them to sit more (Chastin et al., 2014; Greenwood-Hickman et al., 2015), and many community activities aimed at older adults are sitting based (Chastin et al., 2014). Older adults blame bad weather and lack of outdoor seating for limiting their ability to go for a walk (Chastin et al., 2014; Greenwood-Hickman et al., 2015; McEwan et al., 2016), and that poor public transport and lack of availability of/information about community-based resources lead them to sit more (Chastin et al., 2014; Dogra et al., 2016). However, existing studies have mainly included women (Chastin et al., 2014; Dogra et al., 2016; Greenwood-Hickman et al., 2015; Leask et al., 2016; McEwan et al., 2016), people who were well-educated or from more affluent backgrounds (Chastin et al., 2014; Dogra et al., 2016; Greenwood-Hickman et al., 2015; McEwan et al., 2016), were either small-scale (Chastin et al., 2014; Dogra et al., 2016; Leask et al., 2016; McEwan et al., 2016) or interviewed older adults following active participation in a sedentary behavior intervention (Greenwood-Hickman et al., 2015), and have been largely descriptive in their approach to analysis (Chastin et al., 2014; Leask et al., 2016; McEwan et al., 2016).

To maximize the potential of interventions to effectively reduce sedentary behavior, it is essential to widen understanding of sitting and non-sitting activities within older adults' everyday lives by including the views of a larger and more diverse sample, including older men and women of varying ages from different socioeconomic status (SES) backgrounds and with different levels of sedentary behavior. It is also important to go beyond descriptive analysis and use a conceptual theoretical approach to identify generalizable factors that appear to be amenable to change, and ways in which change might be achieved that can be tested in future intervention development research (Wight, Wimbush, Jepson, & Doi, 2016).

This study therefore aims to compare the types and context of sitting (and non-sitting) activities and their role in the daily lives of older adults who sit more than average and those who sit less. Access to two existing large study cohorts (the Lothian Birth Cohort 1936 and Twenty-07 Study; see Benzeval et al., 2009; Deary, Gow, Pattie, & Starr, 2012 for full details of the cohorts) allowed us to interview and contrast the accounts of a large, diverse sample of community-living older adults according to gender, age, and SES, as well as their current objectively measured level of sedentary behavior.

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