Several factors contribute to low physical activity levels of assisted living residents

Many people assume that when older loved ones move to an assisted living community, the planned activities will help their relatives get more physically active. But that's not often the case.

A new study from the University of Michigan School of Nursing examines factors that influence physical activity and sedentary behavior in residents who live in assisted living communities.

Researchers examined how the use of an assistive walking device, depression, sleep disturbance, pain, fatigue, social isolation and making social comparisons impacted physical activity and sedentary behavior. Fifty-four residents from eight assisted living communities participated in the pilot study.

The residents had low levels of physical activity and high levels of sedentary behavior, which confirmed results from previous studies, said study senior author Janet Larson, the Shake Ketefian Collegiate Professor of Nursing.

"What I was fascinated by is that 72% of time accumulated stepping was in less than two-minute bouts," Larson said. "That was startling. They're not walking for any length of time. They're not able to maintain their endurance and they're bound to be losing endurance.

"Basically, they're going from the recliner to the bathroom and back, or going to the recliner to the refrigerator and back, so that was a huge red flag."

Also, 65% of time accumulated sitting was in bouts greater than 30 minutes, and 34% in bouts of more than an hour, Larson said. What's considered prolonged sitting isn't well-established in the scientific community, so it's unclear what those numbers mean beyond the fact that the accumulated amount of sitting is high, she added.

Study co-author Carol Vos, adjunct assistant professor at the U-M School of Nursing, said the findings may be helpful in identifying opportunities to interrupt longer periods of sitting with standing or walking, both of which deliver health benefits.

Residents using an assistive walking device who were fatigued and who tended to make social comparisons with others were significantly more sedentary.

"Because residents frequently saw each other throughout the day, there may have been a tendency to compare activity levels and give one a false sense of being physically active, especially if they compared themselves to those with poorer physical function and very low levels of physical activity," Vos said.

Studies are mixed as to whether older adults prioritize physical activity, but it makes sense that residents in assisted living are more sedentary, Larson said.

"Some of the things they used to push themselves to do, like the laundry, the cooking, getting the mail, they no longer have to do," she said.

Residents in the U-M study said they valued physical activity, but these values weren't reflected in their daily lives.

"In this study, staying active was important and all of the participants expressed that moving was essential to maintaining health and function," Vos said. "They valued physical activity for the benefits it could afford them and were motivated to stay active.

Factors that weren't investigated but could contribute to low levels of physical activity include the degree of functional impairment, fear of falling, assisted living policies or procedures that limit engagement in activity for safety reasons, and environmental barriers to physical activity.

For people over 60, the Centers for Disease Control and Prevention suggests:

• At least 150 minutes a week of moderate intensity activity, such as brisk walking.
• At least two days a week of activities that strengthen muscles.
• Activities to improve balance, such as standing on one foot, at least three days a week.

Larson said the research team's next project will monitor physical activity in assisted living residents over six months. They are also exploring the effects of social factors in greater detail to determine how much impact they have on physical activity and sedentary behavior.

The research was published in Research in Gerontological Nursing.