Report on Barriers and Facilitators to Reducing Sedentary Behavior in Older Adults

Introduction: Aligning with Sustainable Development Goal 3

A systematic study utilizing the COM-B model and the Theoretical Domains Framework (TDF) has identified critical barriers and facilitators to reducing sedentary behavior among older adults. The findings reveal a significant disparity between sedentary and non-sedentary populations, offering crucial insights for developing targeted interventions. This report reframes these findings to emphasize their direct contribution to achieving Sustainable Development Goal 3 (SDG 3): Good Health and Well-being, which aims to ensure healthy lives and promote well-being for all at all ages. By addressing sedentary behavior, interventions can directly impact Target 3.4, which seeks to reduce premature mortality from non-communicable diseases through prevention and treatment.

Analysis of Barriers in Sedentary Older Adults

Sedentary older adults face multifaceted barriers that impede behavior change. Addressing these obstacles is fundamental to reducing health inequalities within aging populations, a key aspect of SDG 10 (Reduced Inequalities).

Psychological and Physical Capability Deficits

• Lack of Knowledge: A primary barrier is an insufficient understanding of what constitutes sedentary behavior and a lack of structured methods to interrupt it. This knowledge gap prevents the adoption of healthier habits.
• Absence of Systematic Strategies: Many older adults lack tools like electronic reminders or systematic plans to support behavior change, making adherence difficult.
• Inaccessible Support: Traditional behavioral counseling is often perceived as inaccessible due to time, location, or availability constraints.
• Habitual and Environmental Factors: Sedentary behavior is frequently linked to entertainment activities (e.g., watching television, playing Mahjong) and reinforced by aging, physical limitations, and personal habits.

Social and Physical Opportunity Constraints

External factors significantly influence sedentary behavior, highlighting the need for supportive environments as envisioned in SDG 11 (Sustainable Cities and Communities).

• Insufficient Social Support: Sedentary older adults often lack encouragement or reminders from family and friends, reinforcing inactive patterns. In some cases, social interaction is minimal.
• Environmental Limitations: Work or home environments that require prolonged sitting or offer limited space for physical activity present significant physical barriers to behavior change.

Reflective and Automatic Motivation Challenges

• Low Confidence: A prevalent issue is a lack of confidence in the positive outcomes of reducing sedentary behavior. Many doubt that such changes will yield noticeable health benefits.
• Motivation-Action Gap: While recognizing the risks of prolonged sitting, many older adults struggle to translate this awareness into action due to low motivation, unclear goals, and deeply ingrained habits.

Comparative Analysis: Facilitators in Non-Sedentary Older Adults

In contrast, non-sedentary older adults demonstrate key facilitators that promote active lifestyles and align with the principles of healthy aging central to SDG 3.

1. Enhanced Psychological Capability: They possess a clearer understanding of sedentary risks and implement simple, effective strategies such as setting reminders or integrating walking into daily routines.
2. Stronger Social and Physical Opportunities: This group benefits from robust social support networks that actively encourage physical activity. They also show greater adaptability in overcoming external barriers like adverse weather by engaging in indoor activities.
3. Robust Motivation: Non-sedentary individuals exhibit strong reflective and automatic motivation, driven by clear goals, a firm belief in the health benefits (e.g., improved blood sugar, reduced pain), and consistent, habit-driven actions.

Strategic Interventions for Promoting Active Aging

To overcome the identified barriers, a focus on targeted interventions is necessary. Leveraging technology and behavioral science can create scalable solutions that advance global health and equality goals.

Leveraging mHealth for Enhanced Capability (SDG 9)

The development of mHealth platforms represents a significant opportunity to apply SDG 9 (Industry, Innovation, and Infrastructure) by using technology to solve pressing health challenges. These platforms can deliver personalized Behavior Change Techniques (BCTs):

• Education and Knowledge: Provide information on health outcomes and benefits of reducing sedentary time.
• Behavioral Regulation: Use prompts, cues, and self-monitoring tools to track sedentary time and encourage breaks.
• Goal Setting: Assist users in setting and tracking goals to reduce sedentary behavior.
• Skills Training: Offer instructional videos and behavioral modeling to demonstrate how to interrupt sedentary periods effectively.

Building Supportive Environments (SDG 10 & SDG 11)

Interventions must address the social and physical environment to reduce inequalities and create healthier communities.

• Social Support Integration: mHealth platforms can incorporate features allowing users to share progress with family and friends, fostering a supportive community. BCTs can include prompts for emotional support and social environment restructuring.
• Environmental Adaptation: Platforms can suggest practical strategies for staying active despite environmental constraints, such as indoor exercises during bad weather, contributing to the resilience of community health initiatives.

Strengthening Motivation through Behavioral Techniques

Enhancing motivation is critical for sustainable behavior change. Interventions should focus on building self-efficacy and reinforcing positive actions.

• Commitment and Self-Efficacy: Employ BCTs that encourage users to reaffirm their commitment and build confidence in their ability to change.
• Reinforcement and Feedback: Implement positive reinforcement mechanisms like rewards, real-time feedback, and progress tracking to enhance motivation and a sense of achievement.
• Action Planning: Use BCTs to help users create detailed plans for when and how they will interrupt sedentary behavior.
• Emotional Regulation: Provide guidance on managing negative emotions that may arise from a perceived lack of autonomy, explaining how activity can improve mental well-being.

Conclusion and Future Directions

This analysis underscores the necessity of developing tailored, evidence-based interventions to reduce sedentary behavior in older adults. By focusing on the specific barriers related to capability, opportunity, and motivation, future strategies, particularly those leveraging mHealth technology, can effectively promote healthier lifestyles. Such efforts are integral to advancing SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). Future research should validate these findings in diverse cultural contexts and incorporate insights from healthcare professionals to ensure interventions are both effective and practical for global implementation.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s central theme is improving the health of older adults by reducing sedentary behavior. It directly discusses health outcomes such as “improving blood sugar control, reducing joint pain, and increasing vitality.” It also touches on mental well-being, noting that “older adults with anxiety and/or depression tend to be more sedentary” and suggests interventions to manage negative emotions.

SDG 9: Industry, Innovation, and Infrastructure

• The article strongly advocates for technology-driven solutions to health problems. It repeatedly proposes the development of “mHealth intervention tools,” “mobile apps or wearable devices,” and technology-integrated Behavior Change Techniques (BCTs). This focus on leveraging information and communications technology (ICT) to create accessible and scalable health interventions aligns with fostering innovation.

SDG 10: Reduced Inequalities

• The study focuses on older adults, a specific demographic group that often faces unique health challenges and requires tailored interventions. It highlights that “studies and practical interventions targeting older adults remain significantly inadequate.” By aiming to create accessible solutions like mHealth platforms to overcome barriers such as distance (“residing far from behavioral counseling for sedentary reduction centers”), the article addresses the need for equal access to health opportunities for all ages.

SDG 11: Sustainable Cities and Communities

• The article identifies “environmental constraints, such as… limited space for physical activity at home” as a barrier to reducing sedentary behavior. It also emphasizes the importance of the social environment, noting that sedentary older adults “lack clear social support” while non-sedentary individuals benefit from family and friends who create a supportive atmosphere. This relates to creating inclusive and supportive living environments that promote physical activity.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article’s goal of reducing sedentary behavior is a preventative measure against non-communicable diseases. It explicitly mentions health benefits like improved blood sugar control and also addresses mental health by suggesting interventions for older adults with anxiety and depression.
• Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services… for all. The article’s emphasis on using mHealth platforms is a strategy to provide more accessible and personalized health interventions, overcoming barriers like cost and location associated with “traditional behavioral counseling,” thereby increasing access to health services for older adults.

SDG 9: Industry, Innovation, and Infrastructure

• Target 9.c: Significantly increase access to information and communications technology and strive to provide universal and affordable access to the Internet. The core proposal of the article is to develop and implement “mHealth platform[s],” “mobile apps,” and “wearable devices” to deliver health interventions. This directly supports the goal of increasing access to and utilization of ICT for societal benefits like health.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age… The article focuses specifically on older adults, aiming to empower them with knowledge and tools (mHealth apps) to manage their health and well-being, promoting their inclusion and active participation in health-promoting behaviors.

SDG 11: Sustainable Cities and Communities

• Target 11.7: By 2030, provide universal access to safe, inclusive and accessible, green and public spaces, in particular for… older persons… While not focused on public spaces, the article addresses the micro-environment, such as “limited space for physical activity at home” and the need for a supportive social environment. It discusses overcoming these environmental constraints to enable physical activity, which aligns with the principle of creating accessible environments for older persons.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

SDG 3: Good Health and Well-being

• Reduction in sedentary time: The primary goal is to “reduce sedentary time.” Progress can be measured by tracking the “type, duration, frequency, and/or intensity of sedentary behavior” using self-monitoring tools on the proposed mHealth platforms.
• Increase in physical activity: The article mentions tracking “how many steps they have taken each day” as a form of feedback, which is a direct indicator of increased physical activity.
• Improved health outcomes: The article implies measuring progress through health benefits cited by non-sedentary adults, such as “improving blood sugar control, reducing joint pain, and increasing vitality.”
• Improved mental well-being: Progress could be measured by a reduction in self-reported negative emotions, as the article suggests offering “guidance on how to manage negative emotions” for those with anxiety and depression.

SDG 9: Industry, Innovation, and Infrastructure

• Adoption and adherence to mHealth platforms: The success of the intervention is dependent on its use. The article states that the design should “ensure high engagement and adherence over time,” which are measurable indicators of technology adoption by the target group.

SDG 10: Reduced Inequalities

• Increased self-efficacy and confidence: The article notes that sedentary older adults “lacked confidence in the outcomes.” An indicator of empowerment would be an increase in their confidence and belief “in their ability to perform a behavior,” which can be measured through psychological assessments.

SDG 11: Sustainable Cities and Communities

• Level of social support: The article contrasts the strong social support for non-sedentary adults with the lack thereof for sedentary ones. Progress can be measured by tracking the implementation and effectiveness of social support BCTs, such as having participants “share activity logs with family and friends and exchange encouraging messages.”

4. Table of SDGs, Targets, and Indicators

Source: bmcpublichealth.biomedcentral.com