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.
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.
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.
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
Gardner B
(2012)
Making health habitual: the psychology of 'habit-formation' and general practice.
in The British journal of general practice : the journal of the Royal College of General Practitioners
Gardner B
(2014)
Sociodemographic, behavioural and health factors associated with changes in older adults' TV viewing over 2 years.
in The international journal of behavioral nutrition and physical activity
Suzuki T
(2015)
Locomotion and eye behaviour under controlled environment in individuals with Alzheimer's disease.
in Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
Matei R
(2015)
Acceptability of a theory-based sedentary behaviour reduction intervention for older adults ('On Your Feet to Earn Your Seat').
in BMC public health
Gardner B
(2015)
'On Your Feet to Earn Your Seat': update to randomised controlled trial protocol.
in Trials
Gardner B
(2015)
How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults
in Health Psychology Review
Tyler Nick
(2015)
Accessibility and the Bus System: Concepts to practice: 2nd edition
White I
(2017)
On Your Feet to Earn Your Seat: pilot RCT of a theory-based sedentary behaviour reduction intervention for older adults.
in Pilot and feasibility studies
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 | Germany |
Start | 07/2012 |
End | 09/2012 |
Description | Grant |
Amount | £131,150 (GBP) |
Organisation | Action Medical Research |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 01/2012 |
End | 12/2014 |
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 | Public |
Country | United Kingdom |
Start | 03/2017 |
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 | 03/2017 |
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 | 03/2017 |
End | 03/2018 |
Title | Interactive Website Forum |
Description | The Crucible website offers Crucible members a place to meet collaborators, share and discuss ideas and to post research ideas. The poster of research ideas has control of their idea and can open it to all members or close it to a select few. There is scope to chat to other members and to upload/download documents and discuss them. The website is open to all members of UCL but closed to others to allow an open space to raise ideas without having to worry about ideas being stolen by other research organisations. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2008 |
Provided To Others? | No |
Impact | To date there are 700 Crucible members whom have posted and discuss over 90 research ideas. This has lead to 12 of the feasibility studies being funded by Crucible. The site is continually used by others as a place to visit to find collaborators or information on funding calls and conferences. The site has had over 17500 visits since its launch in 2009. |
Description | PEARL in the community |
Organisation | London Borough of Barking and Dagenham Council |
Country | United Kingdom |
Sector | Charity/Non Profit |
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 |
Country | China |
Sector | Academic/University |
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 |