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

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.

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.

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.