Forming New Habits: An Intervention to Decrease Sedentary Behavior in Medically Stable Older Adults

PURPOSE: This study aimed to determine the effectiveness of the Everyday Meaningful Activities (EMA) Intervention in forming active lifestyle behavior habits and decreasing perceived sedentary time in medically stable older adults living in the community. 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 approximately 60% of an adult’s non-sleeping hours are spent in sedentary behaviors (Owen, 2017). As sedentary behavior increases, so do diagnoses of chronic illnesses such as diabetes, hypertension, and cardiovascular disease. Older adults are particularly at risk for sedentary behavior and the related chronic illnesses due to the challenges they face with physical and/or cognitive limitations and unstable medical conditions. Often times older adults feel that their only option for safe physical activity is low-speed walking (Markle et al., 2014), and occupational therapy intervention options that can decrease sedentary behavior in older adults in the community are scarce.

DESIGN: A pretest/posttest, experimental design was used. Twelve medically stable older adults living in the community were recruited. The eligibility criteria included (1) 65 years of age and older, (2) intact cognition, (3) no self-reported physical activity limitations, (4) having a sedentary lifestyle, and (5) no acute illnesses or unstable medical conditions.

METHOD: The EMA Intervention takes the concept from Habit Formation Theory (Lally & Gardener, 2013) and uses the components from the Ecology of Human Performance (Dunn, 2017). It is an individualized, client-centered intervention that aims to increase adherence to active lifestyle behaviors in older adults’ lives. Participants engaged in the EMA Intervention to create new active lifestyle behavior habits by incorporating new active lifestyle behaviors to currently existing daily routines. During six intervention sessions over 6 weeks, participants selected two new active lifestyle behaviors to make them habitual and created action plans for implementation. The first behavior was implemented at the first intervention session, and the second behavior was implemented at the fourth session. The participants were assessed three times over their 8-week study participation. The outcome measures to assess habit formation and sedentary behavior include the Self-Report Habit Index (SRHI), Sedentary Behavior Questionnaire (SBQ), and ActiGraph GT9X Link accelerometer. The SRHI assesses habit strength; the SBQ is a subjective report of amount of time spent performing sedentary behaviors; and the ActiGraph assesses actual time spent in sedentary behaviors. Wilcoxon signed-ranks tests were used for data analyses.

RESULTS: The first active lifestyle behavior habit strength significantly increased from time 1 to time 2 (z = -2.703, p = .007) but not from time 2 to time 3 (z = -1.532, p = .126). The second active lifestyle behavior habit strength did not significantly differ from time 2 to time 3 (z = -1.735, p = .083). In addition, there was a significant decrease in perceived sedentary time at time 3 compared to time 1 (z = -2.401, p = .016).

CONCLUSION: Our study showed the preliminary effectiveness of the EMA intervention in forming new active lifestyle behavior habits and decreasing perceived sedentary time in medically stable older adults living in the community. The EMA Intervention can be used in preventive care as well as existing occupational therapy practice settings in order to prevent negative health outcomes associated with sedentary behaviors. It reinforces the need for client-centered, occupation-based approaches to creating lasting habit formation for health benefits.

References

Dunn, W. (2017). The ecological model of occupation. In J. Hinojosa, P. Kramer & C. Brasic Royeen (Eds.), Perspectives on human occupation: Theories underlying practice (2nd ed., pp. 207-235). Philadelphia, PA: F. A. Davis Company.

Lally, P., & Gardner, B. (2013). Promoting habit formation. Health Psychology Review, 7 (supplement 1), S137-S158 https://doi.org/10.1080/17437199.2011.603640

Markle, G. L., Attell, B. K., & Treiber, L. A. (2014). Dual, yet dueling illnesses: Multiple chronic illness experience at midlife. Qualitative Health Research, 25(9), 1271-1282. https://doi.org/10.1177/1049732314559948

Emergence of research on sedentary behavior and health. In W. Zhu & N. Owen (Eds.), Sedentary behavior and health: Concepts, assessments, and interventions (pp. 3-12). Champaign, IL: Human Kinetics.