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      Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

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          Abstract

          Background

          Immobility is major contributor to poor outcomes for older people during hospitalisation with an acute medical illness. Yet currently there is no specific mobility guidance for this population, to facilitate sustainable changes in practice. This study aimed to generate draft physical activity (PA) and sedentary behaviour (SB) recommendations for older adults’ during hospitalisation for an acute medical illness.

          Methods

          A 4-Round online Delphi consensus survey was conducted. International researchers, medical/nursing/physiotherapy clinicians, academics from national PA/SB guideline development teams, and patients were invited to participate. Round 1 sought responses to open-ended questions. In Rounds 2–3, participants rated the importance of items using a Likert scale (1–9); consensus was defined a priori as: ≥70% of respondents rating an item as “critical” (score ≥ 7) and ≤ 15% of respondents rating an item as “not important” (score ≤ 3). Round 4 invited participants to comment on draft statements derived from responses to Rounds 1–3; Round 4 responses subsequently informed final drafting of recommendations.

          Results

          Forty-nine people from nine countries were invited to each Round; response rates were 94, 90, 85 and 81% from Rounds 1–4 respectively. 43 concepts (items) from Rounds 2 and 3 were incorporated into 29 statements under themes of PA, SB, people and organisational factors in Round 4. Examples of the final draft recommendations (being the revised version of statements with highest participant endorsement under each theme) were: “ some PA is better than none”,older adults should aim to minimise long periods of uninterrupted SB during waking hours while hospitalised”, “when encouraging PA and minimising SB, people should be culturally responsive and mindful of older adults’ physical and mental capabilities” and “opportunities for PA and minimising SB should be incorporated into the daily care of older adults with a focus on function, independence and activities of daily living”.

          Conclusions

          These world-first consensus-based statements from expert and stakeholder consultation provide the starting point for recommendations to address PA and SB for older adults hospitalised with an acute medical illness. Further consultation and evidence review will enable validation of these draft recommendations with examples to improve their specificity and translation to clinical practice.

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          Most cited references72

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          GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.

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            Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome

            Background The prominence of sedentary behavior research in health science has grown rapidly. With this growth there is increasing urgency for clear, common and accepted terminology and definitions. Such standardization is difficult to achieve, especially across multi-disciplinary researchers, practitioners, and industries. The Sedentary Behavior Research Network (SBRN) undertook a Terminology Consensus Project to address this need. Method First, a literature review was completed to identify key terms in sedentary behavior research. These key terms were then reviewed and modified by a Steering Committee formed by SBRN. Next, SBRN members were invited to contribute to this project and interested participants reviewed and provided feedback on the proposed list of terms and draft definitions through an online survey. Finally, a conceptual model and consensus definitions (including caveats and examples for all age groups and functional abilities) were finalized based on the feedback received from the 87 SBRN member participants who responded to the original invitation and survey. Results Consensus definitions for the terms physical inactivity, stationary behavior, sedentary behavior, standing, screen time, non-screen-based sedentary time, sitting, reclining, lying, sedentary behavior pattern, as well as how the terms bouts, breaks, and interruptions should be used in this context are provided. Conclusion It is hoped that the definitions resulting from this comprehensive, transparent, and broad-based participatory process will result in standardized terminology that is widely supported and adopted, thereby advancing future research, interventions, policies, and practices related to sedentary behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0525-8) contains supplementary material, which is available to authorized users.
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              The economic burden of physical inactivity: a global analysis of major non-communicable diseases

              The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.
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                Author and article information

                Contributors
                claire.baldwin@flinders.edu.au
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                25 May 2020
                25 May 2020
                2020
                : 17
                : 69
                Affiliations
                [1 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, Caring Futures Institute, College of Nursing and Health Sciences, , Flinders University, ; Flinders Drive, Bedford Park, Adelaide, South Australia 5042 Australia
                [2 ]GRID grid.1026.5, ISNI 0000 0000 8994 5086, Allied Health and Human Performance, , University of South Australia, ; Adelaide, Australia
                [3 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, , Flinders University, ; Adelaide, Australia
                Author information
                http://orcid.org/0000-0002-5022-8498
                Article
                970
                10.1186/s12966-020-00970-3
                7249667
                32450879
                86c7fbcf-09d6-4f23-befc-f6e013c24365
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 6 February 2020
                : 11 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001785, Flinders University;
                Award ID: Establishment Grant
                Award Recipient :
                Funded by: Caring Futures Institute (AU)
                Award ID: Accelerator Grant
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Nutrition & Dietetics
                physical activity,sedentary behaviour,ageing,hospitalisation,clinical guideline,physiotherapy,acute illness,older adult,delphi

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