Effectiveness of physical activity and sedentary behaviour interventions in altering sedentary behaviour among older adults: a systematic review

BackgroundLong and frequent bouts of sedentary behaviour pose a major risk to health and increase the incidence of hypokinetic diseases and mortality, independent of the risks caused by physical inactivity alone. The aim of this systematic review was to determine the effectiveness of interventions used by researchers in altering sedentary behaviour among adults aged 60 years or older.MethodsTwo independent reviewers searched five databases (CINAHL, Medline, Embase, ProQuest, and SBRN) to identify intervention studies from database inception to May 31, 2017, with the following inclusion criteria: published in English, participants aged 60 and older, and a reported outcome measure of sedentary behaviour (eg, sitting time, lying or reclining time, screen time). Intervention studies with no reported sedentary behaviour outcome were excluded. The Cochrane Collaboration tool was used to assess risk of bias. This study is registered with PROSPERO, number CRD 42017050303.FindingsTen studies with 1087 participants were included in the qualitative synthesis. The methodological quality of interventions was generally poor, and most were pre-experimental or pilot studies. Homogeneity in study design was low. Sedentary behaviour was measured objectively and subjectively in a wide range of physical activity and behaviour change interventions. Reduced sedentary behaviour (ranging from 3 min to 137 min per day) was reported for all interventions (ranging from 1 week to 6 months). Statistical heterogeneity was high, but data were pooled from two studies showing a small effect in favour of the treatment group (standardised mean difference 0·3, 95% CI 0·3–0·8). There was some positive evidence for interventions that used behaviour change techniques to reduce sedentary behaviour.InterpretationThere is insufficient evidence to determine the most effective means of targeting sedentary behaviour in older adults, although multicomponent approaches that combine behaviour change with sedentary behaviour or physical activity designs are currently favoured by researchers. Issues to be resolved include agreement on the measurement tools used to record sedentary behaviour and optimum duration of interventions. Future research should include longitudinal studies with extended follow-up periods and those that seek to accurately identify the duration and quantity of sedentary bouts that are harmful to health. Because of the complex nature of being sedentary, the categorising, subdividing, and specific targeting of behaviours appears to be a key factor in designing interventions to reduce inactivity among older adults