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      Relationships between sitting time and health indicators, costs, and utilization in older adults

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          Abstract

          Objective

          To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65.

          Methods

          A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online health risk assessment (HRA) between 2009 and 2011 (N = 3538) were eligible. The HRA assessed sitting time, physical activity, and health status. Diagnosis codes for diabetes and cardiovascular disease (CVD), height and weight for body mass index (BMI) calculations, health care utilization and health costs were extracted from the EHR. Linear regression models with robust standard errors tested differences in sitting time by health status, BMI category, diabetes and CVD, health costs, and utilization adjusting for demographic variables, BMI, physical activity, and health conditions.

          Results

          People classified as overweight and obese, that had diabetes or CVD, and with poorer self-rated health had significantly higher sitting time (p < .05). Total annual adjusted health care costs were $126 higher for each additional hour of sitting (p < .05; not significant in final models including health conditions).

          Conclusion

          Sitting time may be an important independent health indicator among older adults.

          Highlights

          • One-third of older adults completing health risk assessments had high sitting time.

          • Older adults with chronic conditions had higher self-reported sitting time.

          • Older adults with poor self-rated health had the highest sitting time.

          • Health care costs increased by $126 for each additional hour of sitting time.

          • Sitting time may be an important independent health indicator in older adults.

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          Most cited references8

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          Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers

          Purpose Imprecise measurement of physical activity variables might attenuate estimates of the beneficial effects of activity on health-related outcomes. We aimed to compare the cardiometabolic risk factor dose-response relationships for physical activity and sedentary behaviour between accelerometer- and questionnaire-based activity measures. Methods Physical activity and sedentary behaviour were assessed in 317 adults by 7-day accelerometry and International Physical Activity Questionnaire (IPAQ). Fasting blood was taken to determine insulin, glucose, triglyceride and total, LDL and HDL cholesterol concentrations and homeostasis model-estimated insulin resistance (HOMAIR). Waist circumference, BMI, body fat percentage and blood pressure were also measured. Results For both accelerometer-derived sedentary time ( 50% lower for the IPAQ-reported compared to the accelerometer-derived measure (p<0.0001 for both interactions). The relationships for moderate-to-vigorous physical activity (MVPA) and risk factors were less strong than those observed for sedentary behaviours, but significant negative relationships were observed for both accelerometer and IPAQ MVPA measures with glucose, and insulin and HOMAIR values (all p<0.05). For accelerometer-derived MVPA only, additional negative relationships were seen with triglyceride, total cholesterol and LDL cholesterol concentrations, BMI, waist circumference and percentage body fat, and a positive relationship was evident with HDL cholesterol (p = 0.0002). Regression coefficients for HOMAIR, insulin and triglyceride were 43–50% lower for the IPAQ-reported compared to the accelerometer-derived MVPA measure (all p≤0.01). Conclusion Using the IPAQ to determine sitting time and MVPA reveals some, but not all, relationships between these activity measures and metabolic and vascular disease risk factors. Using this self-report method to quantify activity can therefore underestimate the strength of some relationships with risk factors.
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            Determinants of Sedentary Behavior, Motivation, Barriers and Strategies to Reduce Sitting Time in Older Women: A Qualitative Investigation

            Sedentary behavior defined as time spent non-exercising seated or reclining posture has been identified has a health risk and associated with frailty and disablement for older adults. Older adults are the most sedentary segment of society. To date no study has investigated the determinants of sedentary behavior in older adults. This study reports a qualitative investigation of the determinants of sedentary behavior, strategies and motivator to reduce sitting time by structured interviews in a group of community dwelling older women (N = 11, age 65 and over). Older women expressed the view that their sedentary behavior is mostly determined by pain which acts both as an incentive to sit and a motivator to stand up, lack of energy in the afternoon, pressure from direct social circle to sit and rest, societal and environmental typecasting that older adult are meant to sit, lack of environmental facilities to allow activity pacing. This qualitative investigation highlighted some factors that older adults consider determinants of their sedentary behavior. Some are identical to those affecting physical activity (self-efficacy, functional limitations, ageist stereotyping) but some appear specific to sedentary behavior (locus of control, pain) and should be further investigated and considered during intervention design. Tailored interventions that pay attention to the pattern of sedentary behavior of individuals appear to be supported by the views of older women on their sedentary behavior.
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              Assessment of sedentary behavior with the International Physical Activity Questionnaire.

              This study explored definitions of sedentary behavior and examined the relationship between sitting time and physical inactivity using the sitting items from the International Physical Activity Questionnaire (IPAQ). Participants (N = 289, 44.6% male, mean age = 35.93) from 3 countries completed self-administered long- and short-IPAQ sitting items. Participants wore accelerometers; were classified as inactive (no leisure-time activity), insufficiently active, or meeting recommendations; and were classified into tertiles of sitting behavior. Reliability of sitting time was acceptable for men and women. Correlations between total sitting and accelerometer counts/min <100 were significant for both long (r = .33) and short (r = .34) forms. There was no agreement between tertiles of sitting and the inactivity category (kappa = .02, P = .68). Sedentary behavior should be explicitly measured in population surveillance and research instead of being defined by lack of physical activity.
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                Author and article information

                Contributors
                Journal
                Prev Med Rep
                Prev Med Rep
                Preventive Medicine Reports
                Elsevier
                2211-3355
                30 March 2015
                2015
                30 March 2015
                : 2
                : 247-249
                Affiliations
                Group Health Research Institute, USA
                Author notes
                [* ]Corresponding author. rosenberg.d@ 123456ghc.org
                Article
                S2211-3355(15)00036-4
                10.1016/j.pmedr.2015.03.011
                4721445
                26844078
                9f83f817-01e8-44de-930b-e70b34b3f715
                © 2015 Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Categories
                Brief Original Report

                motor activity,aged,health information systems
                motor activity, aged, health information systems

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