Reducing sedentary behaviour in older adults: Development of a brief habit-based intervention

Lead Research Organisation: University College London
Department Name: Epidemiology and Public Health

Abstract

Physical activity in later life can improve health and quality of life, yet around 30% of adults aged 65-74 in England do less than 10 consecutive minutes of leisure-time activity a month. Previous activity promotion initiatives for older adults have failed to have real-world impact, perhaps because targets (e.g. 150 minutes of activity per week) have been unrealistic, or because observed changes in activity have been dependent on external support, so that when the intervention period ends so too does engagement in activity.

We will design and assess the feasibility of a novel intervention to promote activity among sedentary older adults. The work is novel in two aspects: first, we focus on promoting activity by recommending small and easily-adopted changes to existing routines, and second, we aim to create 'activity habits' which will persist after the intervention has ended. Our intervention is based on recent advances in psychological theory which show that, if an activity is performed repeatedly in the same situation, it becomes a relatively effortless and automatic response to that situation (i.e. a 'habit'). Our work follows a recent weight-loss intervention in which simple written advice on how to form eating and activity 'habits' was provided, and which led users to form 'habits' and lose more weight than a control group.

We propose three studies. In Study 1, a panel of 20 sedentary older adults, recruited via Age UK, will brainstorm ideas for activities that they could feasibly and consistently undertake (e.g. climbing stairs, walking, stretching and balancing exercises). A group of experts will then draft a series of recommended activities that could feasibly become 'habitual'. When both the older adult panel and the experts agree on the feasibility of the recommendations, a second panel of older adults will rate the recommendations for ease of understanding, whether they are motivated or likely to perform them, and how difficult they would be to perform.

In Study 2, 30 sedentary older adults with no disabling physical impairments will be recruited via Age UK and given the recommendations, together with a tick-sheet to monitor adherence. They will be asked to return at four and eight weeks later for assessment of 'habit' formation, activity and health. We will assess rates of adherence and attrition, changes in 'habit' and activity, and whether intervention users felt that additional support (e.g. telephone counselling, community support) would assist them in adhering to the recommendations.

In Study 3, a small-scale controlled trial will be undertaken to evaluate the intervention in a primary care setting. 120 sedentary older adults with no disabling physical impairments will be allocated to receive either the 'activity habit' recommendations (supplemented with any necessary additional support identified via Study 2), or a control treatment which promotes activity in older adulthood but not 'habit' formation. We will assess rates of recruitment, adherence and attrition, and changes in 'habit', activity, health and wellbeing. This study would generate an estimate of effect size for a subsequent full randomised controlled trial.

Technical Summary

This study aims to develop a theory-based intervention to promote the formation of physical activity 'habits' among sedentary older adults. The proposed work is cross-disciplinary and covers 'Development' and 'Feasibility/Piloting' stages of intervention design stipulated by MRC guidance.

Study 1 is designed to develop a series of recommendations for simple 'activity habits', using consensus methods (focus groups, nominal groups, and a Delphi process) among panels of users and experts. Qualitative data will be analysed using thematic and content analysis.

Study 2 will assess the feasibility of the recommendations among a group of 30 sedentary older adults, using a pre-post design with measures at baseline, 4 and 8 week follow-up. Analysis will focus on recruitment, adherence, attrition, and favourability of the intervention. Quantitative data relating to self-reported 'habit' formation, activity and health will be analysed using t-tests. Semi-structured interviews conducted at the end of the intervention period will be evaluated using thematic and content analysis.

Study 3 will use an exploratory controlled trial design to pilot the 'habit' formation intervention relative to a control treatment which does not use 'habit' formation principles, and assess the feasibility of recruiting to such a trial. 120 sedentary older adults will be allocated to intervention or control in blocks, and will be followed up at 8 and 12 weeks. Analysis will focus on rates of recruitment, adherence and attrition, and changes in self-reported habit, and self-reported and objective measures of behaviour, physical health and wellbeing. Completer analysis and intention-to-treat analysis will be undertaken using ANCOVAs.

The study will generate an intervention suitable for full testing using a randomised controlled trial design. Findings will be disseminated to the lay public via press releases, and to the scientific community via journal publications and conferences.

Planned Impact

The proposed work seeks to develop an intervention to increase physical activity among sedentary older adults which is novel both in its theoretical basis (habit theory) and its practical approach (promoting activity via small and easily adopted changes to existing routines). As an intervention design project, our work is essentially applied in nature, and end-users (older adults), intermediate users (primary care specialists, Age UK), and academic experts are all regarded as critical partners in and key beneficiaries of this work.

Who will benefit from this research?

Beneficiaries of the research are likely to include the following:
- Older adults involved in the research, and older adults in the general public
- Academic researchers working in older adulthood, intervention design and implementation, behaviour change, and psychological theory
- Policy-makers
- Intervention designers
- Older adult charities (e.g. Age UK)
- Public service bodies (e.g. NHS, Social Services)
- Business and industry
- The research team

How will they benefit?
- Older adults involved in Studies 2 and 3 are expected to benefit from increasing and maintaining engagement in physical activity, which is expected to lead to sustainable gains in health, wellbeing and functioning. If the intervention is found to be effective among study participants, these health and wellbeing gains are likely to be replicated among older adults in the general public.
- Academic researchers will gain novel theory-based ideas for promoting and sustaining physical activity in older adults. They will also benefit from developments in understanding and promotion of habit as a mechanism for long-term behaviour change. This will help to inform future behaviour change interventions which do not rely on external support to sustain behaviour gains. Academic researchers will also gain an insight into attitudes, beliefs and perceptions towards physical activity and sedentary behaviour among sedentary older adults.
- Policy-makers will develop better health policy if they understand the principles of habit formation for behaviour change purposes, which will be illustrated by the promotion of a series of simple activity changes designed to be performed in unchanging situations.
- Intervention designers will gain insight into how to design behaviour change interventions that are likely to have a lasting impact beyond the active intervention period. This may lead to the development of more effective long-term behaviour change interventions for preventive health promotion purposes.
- Older adult charities will benefit from gains in understanding of how to promote greater activity among the sedentary older adult population. This will improve the range of services offered by, or to which older adults may be signposted by, such charities.
- Public service bodies (e.g. NHS, Social Services) will benefit if activity rates can be increased, because this should lead to lower health and social service demand and use among currently sedentary older adults.
- There is potential for benefit among business and local economies, because a more active older adult population is likely to consume more services (e.g. leisure services, transport, entertainment).
- The research team will benefit from further experience of multidisciplinary intervention design work.

Publications

10 25 50
 
Description ACCA21
Amount £400,000 (GBP)
Funding ID LCCD 
Organisation Administrative Centre for China's Agenda 21 
Sector Public
Country China
Start 01/2009 
 
Description Cpn grant
Amount € 900 (EUR)
Organisation European Health Psychology Society (EHPS) 
Sector Charity/Non Profit
Country European Union (EU)
Start 08/2012 
End 09/2012
 
Description UK Co-laboratorium for Research on Infrastructure and Cities (UKCRIC) Person Environment Activity Research Laboratory (PEARL)
Amount £125,000,000 (GBP)
Funding ID EP/P018629/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Academic/University
Country United Kingdom
Start 04/2017 
End 03/2018
 
Description UKCRIC - Person Environment Activity Research Laboratory
Amount £5,000,000 (GBP)
Organisation University College London 
Department Faculty of Engineering Sciences
Sector Academic/University
Country United Kingdom
Start 04/2017 
End 03/2022
 
Description UKCRIC Person Environment Activity research Laboratory (PEARL)
Amount £5,000,000 (GBP)
Organisation University College London 
Department Faculty of Engineering Sciences
Sector Academic/University
Country United Kingdom
Start 04/2017 
End 03/2018
 
Description PEARL in the community 
Organisation London Borough of Barking and Dagenham Council
Country United Kingdom 
Sector Public 
PI Contribution We provide the expertise on accessibility and scientific measurement of capabilities for urban design
Collaborator Contribution They provide contacts and involvement in a steering group, site for demonstrations and further research
Impact This is still underway. At the moment this has moved into site identification for a future engagement activity, relationship-building with New York City, Greater Manchester and others
Start Year 2017
 
Description Renewable energy and transport design in Xi'an 
Organisation Xi'an University of Architecture and Technology
PI Contribution We provide the modelling for estimation of impacts of modal shift
Collaborator Contribution They provide the renewable energy data related to domestic and industrial buildings
Impact None yet
Start Year 2017
 
Title On Your Feet To Earn Your Seat leaflet 
Description Leaflet promoting small increments in physical activity for older adults, and discouraging prolonged sitting time. Currently under development. Acceptability of first iteration is to be tested as part of award. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2013
Development Status Under active development/distribution
Impact None - still in early stages of development 
 
Description Barking Riverside Healthy New Town 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact A series of public engagement events to show how walking could be made easier for older people and others by changing the footway surfaces
Year(s) Of Engagement Activity 2017
 
Description Interview on Radio Lincolnshire describing study purpose and inviting participants 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact Talk sparked discussion with radio programme host on importance of physical activity in older adults, and sparked interest in participating in the study from potential participants in the region

After the interview, new expressions of interest in participating in the study were received, indicating an interest in physical activity and willingness to increase it among older adults
Year(s) Of Engagement Activity 2014
 
Description Member of the judging panel for the Unlimited Doha Design Prize 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was a Design Prize about future cities initiated by the Emirate and the British Council. The immediate event was attended by around 50 people, including the prize-winning teams, and the subsequent publicity reached a much wider audience.
Year(s) Of Engagement Activity 2016
 
Description Oral presentation (of acceptability study findings) to BPS Psychology Postgraduate Affairs Group (PsyPAG) conference 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Talk sparked questions and discussion afterwards

At the talk, we were contacted and asked for further details of the study findings
Year(s) Of Engagement Activity 2015
 
Description Oral presentation (of rationale for feasibility RCT) at BPS Psychology Postgraduate Affairs Group (PsyPAG) conference 2015 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Talk sparked questions and discussion afterwards about study design

After the talk, attendees approached the presenter to ask for advice on study design
Capacity-building - presenter (MSc student) gained experience of conference presentations.
Year(s) Of Engagement Activity 2015
 
Description Presentation of habit and behaviour maintenance as part of UCL Centre for Behaviour Change Summer School 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 25-30 academics, students and practitioners attended a week-long Summer School programme, run by the UCL Centre for Behaviour Change, on which I gave a talk about behaviour change and maintenance which drew heavily on this project. The workshop sparked questions and discussion afterwards.

Several attendees contacted me for further information on habit-formation as a behaviour change strategy
Year(s) Of Engagement Activity 2014
URL http://www.ucl.ac.uk/behaviour-change/cbc-events/event5
 
Description Presentation of study findings to local physical activity researchers 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk sparked discussion afterwards

Potential collaborator on next stage of intervention development identified
Year(s) Of Engagement Activity 2015
 
Description Talk in Chile 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Distinguished inaugural lecture for the new MSC in city planning in the School of Architecture and Urbanism, Ponitificia Universidad Catolica Chile
Year(s) Of Engagement Activity 2017
 
Description Visit and presentation to academics and practitioners at Singapore university 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 50 academic and practitioner peers attended a talk about using habit-formation as a basis for behaviour change interventions, which drew heavily on the NPRI-funded work. The talk sparked questions and discussion afterwards.

The talk led to my meeting with Singapore public health teams to discuss ways to integrate the habit-formation model into their existing behaviour change intervention plans, as a way of promoting maintenance of change.
Year(s) Of Engagement Activity 2014
URL http://www.sph.nus.edu.sg/index.php/17-events/357-sshsph-professional-update-putting-habit-into-prac...
 
Description Visit and presentation to academics and practitioners at University of British Columbia, Vancouver, Canada 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk sparked questions, discussion and sharing of research ideas.

Yielded interest in potential collaboration with colleagues from University of British Columbia, to develop our intervention and combine or compare it with a conceptually similar sedentary behaviour/physical activity intervention for older adults currently being trialled in Vancouver.
Year(s) Of Engagement Activity 2015