Reducing sedentary behaviour in older adults: Development of a brief habit-based intervention. (360G-Wellcome-099406_Z_12_Z)

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.