A recently released article that points out the dangers of inactivity among older adults is receiving wide media attention for its conclusion that regardless of time spent in moderate-vigorous activity, each hour spent in sedentary behavior significantly increases the odds of disability in 1 or more activities of daily living (ADL). For physical therapists (PTs) and physical therapist assistants (PTAs) the findings include big news about how the damage of sedentary behavior is independent of activity level—but the study also confirms what they've always known about inactivity and reinforces the importance of PTs and PTAs as agents of change.
Since its February 19 advance e-publication in the Journal of Physical Activity & Health, "Sedentary Time in U.S. Older Adults Associated With Disability in Activities of Daily Living Independent of Physical Activity" (.pdf) has received attention from Reuters, National Public Radio, CBC, and NBC, among other media outlets. The reason for all the notice is fairly simple: the study's title just about says it all, and the study's contents definitively support the assertion.
Researchers based their conclusions on an analysis of data from the National Health and Examination Surveys (NHANES), a cross-sectional study that combined household interviews with a physical examination and accelerometer monitoring of daily activities. For the purposes of the just-released article, authors focused on results from 2,286 adults over 60 that represented a wide range of demographic and health variables.
Researchers analyzed accelerometer data to gauge average daily sedentary time in both hours spent and as a percentage of waking hours. They found that among older adults, during an average 14 waking hours per day, 8.9 hours on average were spent in sedentary behaviors, with 63.4% of the study group being sedentary at least 9 hours a day.
By linking sedentary data to reports on ADL disability in the NHANES, authors found a dramatic relationship between hours spent in sedentary behavior and the odds of an ADL problem at the rate of more than 50% for every additional hour of inactivity. More significantly for the study, researchers were able to tease out the kinds of nonsedentary activity and found that the risk was not mitigated by engaging in moderate or vigorous activity. "For example, if 2 women of the same age engaged in identical moderate-vigorous hours, but 1 spent an additional hour each day being sedentary, the odds of ADL disability would significantly increase by 60%," the authors write.
Lisa Culver, PT, DPT, MBA, senior specialist for clinical practice at APTA, says the results should not be too surprising for PTs and PTAs. "I believe PTs have always recognized risk inherent in limited mobility, whether the limited mobility is due to injury or because of voluntary sedentary behavior," she said. "It's a key reason why our focus is to increase an individual's capacity for safe functional movement."
"The study highlights an important fact—that being active is just one factor to being healthy," Culver said. "Other studies have shown that physical activity is an independent indicator compared to obesity for all-cause mortality, so the study further strengthens the value of an overall healthy and active lifestyle."
Getting older adults to engage in a more active and healthy lifestyle is addressed in what turns out to be one of the brighter spots in the study. Researchers noted that even minor changes in activity time can make a significant impact on health, and that often these changes can be sparked by brief education and counseling, or by simply incorporating an element of physical activity "before or after social programs." Overall, authors write, "reducing sedentary behavior may be a more attainable goal than increasing moderate-vigorous activity, particularly in persons with chronic illness, pain, and … preexisting disabilities."
Culver believes that PTs and PTAs can play a key role in lifestyle change. "As with other areas of prevention, health, wellness, and chronic disease management, PTs are key to communication and behavior change in the individuals we see," she said. "PTs typically follow patients and clients for longer periods of time than most health care professionals, and we have the ability to educate them while understanding their readiness and physical capacity for change."
APTA offers educational resources that address the role of the PT in health and wellness in older adults and provide insight into older adults and exercise adherence. Additionally, APTA's consumer-focused MoveForwardPT.com website includes a webpage featuring videos addressing the importance of fitness across the lifespan. The association also offers a prevention and wellness webpage that includes videos, podcasts, and educational resources.
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