Return to Everyday Activity in the Community and Home: a feasibility study for a lifestyle intervention to sit less, move more, and be strong

Abstract

Background: Many interventions designed to meet physical activity guideline recommendations focus on a single component (e.g., walking), to the detriment of other elements of a healthy lifestyle, such as reducing prolonged sitting and doing balance and strength exercises (i.e., bundled multiple behaviors). Adopting these multiple health behaviors within daily life routines may facilitate uptake and support longer-term behavior change. We tested feasibility for a three-part lifestyle intervention to support older women to sit less, move more, and complete balance and strength exercises. Methods: We used a convergent parallel mixed-methods, single-arm study design to test feasibility for a 6-week lifestyle intervention: Return to Everyday Activities in the Community and Home (REACH). We collected information at baseline, 3 and 6 weeks (final), and 6 months (follow-up) using questionnaires, semi-structured interviews, and performance-based measures. We describe three key elements: (1) implementation factors such as recruitment, retention, program delivery, and adherence; (2) participants' acceptability and experience with the program; and (3) health outcomes, including participants' global mobility, activity, and perceptions of their physical activity identity, and habit strength for (i) physical activity, (ii) breaking up sitting time, and (iii) balance and strength exercises. Results: We were able to recruit enough participants in the allotted time to conduct one cycle of the REACH group-based program. There were 10 community-dwelling women, median (p25, p75) age 61 (57.5, 71) years, who completed the study. The program was feasible to deliver, with high attendance (mean 5/6 sessions) and positive overall ratings (8/10). Participants rated session content and length high, and educational materials as highly acceptable and understandable. Although participants were active walkers at baseline, few were breaking up prolonged sitting or participating in any balance and strength exercises. At final and follow-up assessments, participants reported developing habits for all three health behaviors, without diminishing physical activity. Conclusion: These results show acceptability of the program and its materials, and feasibility for bundling multiple health behaviors within the REACH program. It also provides confirmation to advance to testing feasibility of this three-part lifestyle intervention with older, less active, adults.

A Systematic Review Examining the Relationship Between Habit and Physical Activity Behavior in Longitudinal Studies

“…An additional five studies were eliminated because the results did not answer the research question of this review. These included a validity study of another measurement of habit (Boiché et al, 2016 ), a feasibility study with insufficient statistical results (Ashe et al, 2019 ), and studies not reporting habit as an individual variable and its relationship to physical activity (Phillips et al, 2016 ; Duan et al, 2017 ; Howlett et al, 2019 ). One study was excluded, because habit did not refer directly to physical activity but to wearing a Fitbit (Ellingson et al, 2019 ).…”

Understanding for whom, under which circumstances and how sedentary behavior interventions for older adults work: A Realist Review

“…Older adults also need to believe they have the capabilities to change their behavior 87 . BCT's such as goal setting 33,39,41,[44][45][46][47]51,55,58,59,[64][65][66]68,69,76,84,[88][89][90][91][92][93][94] , action planning , coping planning 88,93 and motivational interviewing 50,74,89 can be used to increase self-efficacy towards changing SB in older adults.…”

“…To break the habit of SB, several studies suggested that older adults need to become aware about the automaticity of their behavior 39,46,99 . Providing feedback on behavior and stimulating older adults to monitor their own behavior are frequently used BCT's that might lead to an increased awareness 39,40,45,49,56,62,84,88 . However, only bringing habitual behavior into conscious awareness seems insufficient to generate behavior change 39,49,57 .…”

“…Other BCT's focusing on reflective processes such as action planning or goal setting are needed to consciously disrupt sedentary habits and to substitute it with a new behavior 40,[52][53][54] . Habit disruption strategies such as context-dependent repetition to strengthen the cue-response association seem promising to reduce the habit strength of the old behavior and subsequently form a new behavior 45,46,[51][52][53][54]88 . For example, the intervention 'On your feet to earn your seat' made use of a booklet with tips to substitute sedentary activities with physical activities 52,53 .…”

Impact of Activity Tracker Usage in Combination with a Physical Activity Intervention on Physical and Cognitive Parameters in Healthy Adults Aged 60+: A Randomized Controlled Trial

“…Further, the rising use of the internet in older adults in Germany (50% of adults aged 60 years and older use the internet on a regular basis [ 33 ]) means that individualized PA programs may be integrated into web-based formats [ 34 ]. As such, older populations may be able to utilize home-based interventions that are offered on a print or web basis [ 35 , 36 , 37 , 38 ].…”