FORMING NEW HABITS: AN INTERVENTION TO DECREASE SEDENTARY BEHAVIOR IN MEDICALLY STABLE OLDER ADULTS

Abstract

Rationale: Sedentary behavior is characterized by too much sitting. It is estimated that 4 out of every 10 Americans never engage in physically active behaviors, and that approximately 60% of an adult's non-sleeping hours are spent in sedentary behaviors. As sedentary behavior increases, so do diagnoses of chronic illnesses such as diabetes, hypertension, cardiovascular disease, and kidney disease. Older adults are particularly at risk for sedentary behavior and the related chronic illnesses due to the challenges they face with balancing physical and/or cognitive limitations, medical conditions, and the requirements to remain physically active. Often times older adults feel that their only option for safe physical activity is low-speed walking. Occupational therapy intervention options that can decrease sedentary behavior in older adults in the community are scarce, thus the Everyday Meaningful Activities (EMA) intervention is proposed. The EMA Intervention combines concepts from Habit Formation Theory and the Ecology of Human Performance model. It is an individualized, client-centered intervention that aims to increase adherence to meaningful active lifestyle behaviors in older adults' lives. Meaningful active lifestyle behaviors are tasks or activities that promote enjoyment in time spent moving around (i.e. cooking, gardening, creating art, etc.). Participants created new habits by attaching these new active lifestyle behaviors to currently existing daily routines. The aims of this study are (1) to investigate the feasibility of implementing the EMA intervention with medically stable older adults, (2) to investigate the effectiveness of the EMA intervention in forming new active lifestyle behavior habits, and (3) to investigate the effectiveness of the EMA intervention in decreasing sedentary time. Method: Twelve medically stable older adults in the Greenville, NC community were recruited for this pretest/posttest, experimental design study. During six intervention sessions over six weeks, participants selected two new active lifestyle behaviors to make habitual and created action plans for implementation. Results: The recruitment rate for this study was 18%. The Rapid Assessment Disuse Index (RADI) was found to not be an appropriate measure for sedentary behavior for this population. The Short Blessed Test (SBT) was found to be an appropriate measure for screening cognitive impairment over the phone. Video conferencing was found to be an appropriate delivery method for selected intervention sessions if the participant is comfortable. Participants' subjective report of activity performance times is not a reliable subjective data collection method. The EMA intervention was effective in forming new active lifestyle behavior habits according to the Self- Report Habit Index (SRHI) and in decreasing perceived sedentary time spent according to the Sedentary Behavior Questionnaire (SBQ). Discussion: The EMA intervention is a viable intervention for decreasing sedentary behavior in medically stable older adults. With minor changes to the assessments used for screening, a wellrounded sample of participants can be created for pilot testing. In future applications of the EMA intervention, more reliable subjective data on activity performance should be collected in order to compare subjective and objective reports of activity performance.