The growing ageing population in the Asia Pacific region has accelerated at an unprecedented pace. It is forecasted that by 2050 the 60 years or older age group will reach more than one quarter or approximately 1.3 billion people within the region.1 With this rapidly expanding age group a paradigm shift in demand for healthcare would be inevitable. Health issues associated with ageing would increase if not dealt with in a preventive manner. Chronic diseases such as cardiovascular disease, Type 2 Diabetes Mellitus, and age-related conditions such as sarcopenia and osteoporosis are some common health problems faced by the elderly today. If not mitigated early or managed well, age-related diseases could present a significant burden on healthcare resources and socioeconomic cost on the elderly.
In order to grasp a fundamental understanding of what could attribute to the rise of such diseases and conditions, a cross-sectional study was conducted by Singapore’s SingHealth Polyclinics (SHP). This study aimed to gather data on the physical activity levels as well as on sedentary behaviour of ambulatory older adults, comparing them in relation to their employment status and other associated factors.2 As the first of its kind in Singapore, the study will go on to provide essential data on both physical activity levels and sedentary behaviour among community dwelling older adults. Thereby, allowing the development of programmes to promote healthy ageing.
Adjunct A/Prof Tan Ngiap Chuan, Director of Research from SingHealth Polyclinics and one of the authors of the study shared, “We realised that our elderly can do a bit more to preserve their physical health. So SingHealth Polyclinics will be putting up programmes very soon to reach out to the elderly in the community. By organizing more structured exercise programmes senior citizens to reduce sedentary behaviour and increase physical activity.”
Physical Activity and Sedentary Behaviour
As defined by the study team, physical activity relates to any bodily movement produced by skeletal muscles that require expenditure of energy. This could include activities such as playing, working, active transportation through public transport, doing household chores or other recreational activities. Sedentary behaviour on the other hand was explained as the waking behaviour characterized by energy expenditure of 5 metabolic equivalents (METs) or less in a sitting or reclining position.
Both physical activity and sedentary behaviour have shown to independently influence health outcomes of older adults and each in different levels would affect successful and healthy ageing.
“These are two independent factors. So, in essence, more physical activity would not cancel out the negative impact of sedentary behaviour on health. The idea is really to increase as much as possible the physical activity and decrease sedentary behaviour.” Said Dr Ng Lok Pui, Clinical Lead for Preventive Care Workgroup for SingHealth Polyclinics and the corresponding author of the study.
The lack of physical activity among the elderly is known to cause reduced muscle strength and cause a loss in skeletal muscle mass. This could lead to age-related conditions and diseases such as frailty and sarcopenia, increasing susceptibility to fails and health-associated issues such as disability.
An earlier study conducted locally in Singapore found that in a study population of 1,051 older adults aged 65 and above one third of them were found to be pre-frail and six percent of the participants to be frail. The rate of muscle loss was also found to increase to about 15 percent each decade after 70 years of age.3
Physical activity has long proven to have multiple health benefits and is also associated with psychological and cognitive benefits even among the elderly. By contrast, sedentary behaviour can affect the risk of frailty would could lead to increased risk of adverse health-related outcomes as an individual age.
To assess the physical activity levels and sedentary behaviour, interviewer-administered questionnaires were conducted by the study team, with a total of 397 participants, aged 60 and above were included in the study.
The Physical Activity Scale for the Elderly (PASE) was used to measure physical activity levels. In the questionnaire, a score is generated based on three domains; leisure time, household and work-related activities over a one-week period. Developed by Washburn et. al., 1993,4 daily physical activity levels of community-dwelling older adults can be quantified by computing a score ranging from zero to more than 400. The final scored is determined by setting different amount of priority for each activity and frequency of the activity. A higher score would therefore relate to a more active individual.
Measurement of sedentary behaviour was done using the Sedentary Behaviour Questionnaire for the Elderly (SBQE).5 Time spent on different forms of sedentary activities were measured through this survey as well as the basic characteristics of the participants were collected. This self-reported questionnaire also obtains information regarding the attitudes towards physical activity.
From the cross-sectional study, there were two key findings reported by the authors.
The first was that employment status showed to statistically significance in affecting physical activity among the community-dwelling elderly study population. This was also proven to hold true after taking into account other associated factors. Participating seniors with employment, including voluntary or non-paid jobs were found to display higher physical activity levels.
This could be attributed to the fact that employed seniors are required to travel to and from workplaces which would involve more walking and use of public transport. Increase in promotion of a healthy workplace ecosystem, through company organized physical events as well as the provision of free or subsidised access to gymnasiums within or proximal to their workplaces as part of their company’s employment benefits could also add on to this result.
Another key finding from the study was that employed seniors also showed significantly increased levels of sedentary behaviour. It was found from the survey that employed older adults were twice more likely to have more than or equal to eight hours of sedentary behaviour each day.
Some occupations being inherently sedentary, such as those who are desk-bound for the majority of the work day could add on to increased sedentary behaviour among the employed seniors.
Technological advancements have allowed easy access to user-friendly mobile devices even for the elderly to stream content on the go. Increase in screen time could discourage employed older adults from engaging in physical activity.
This first ever cross-sectional study in Singapore assessing physical activity levels and sedentary behaviour among ambulatory older adults provided insights into their susceptibility to frailty and health status. Data could then be used to promote physical activities and programmes among the elderly in Singapore to reduce sedentary behaviour and increase physical activity earlier as a form of preventive care.
Dr Ng Lok Pui, Clinical Lead for Preventive Care Workgroup, SHP, highlighted that older adults should take extra effort to increase their physical activity levels. “Seniors should engage in more physical activities early, when they have fewer morbidities. This may help them to stay in employment longer, as being employed was found to be positively associated with their level of physical activity.”
Encouraging elderly to engage in physical activity through community programmes and television shows catered for the elderly to learn how to perform home exercises conveniently from the comfort of their homes.
“Sedentary behaviour increases the risk of low muscle mass and osteoporosis. We recommend that seniors reduce their sedentary hours. If our seniors watch TV, select the program on home exercises and join the trainers to work out conveniently at home.”, added Adjunct A/Prof Tan Ngiap Chuan, Director of Research, SHP.
- United Nations ESCAP, Social Development Division. 2016 Population Data Sheet. 9 September 2016 revision.
- Lok Pui Ng, MMed, FCFPS, Yi Ling Eileen Koh, BSc, Ngiap Chuan Tan, MMed, FCFPS, Physical activity and sedentary behaviour of ambulatory older adults in a developed Asian community: a cross-sectional study. Singapore Med J 2020; 61(5): 266-271. doi: https://doi.org/10.11622/smedj.2020022
- Felicia Choo, (n.d) Keep Muscles Strong as You Age. Retrieved from: https://www.healthxchange.sg/news/keep-muscles-strong-as-you-age
- Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 1993; 46:153-62.
- Ku PW, Sun WJ, Chen LJ. Development of the Sedentary Behavior Questionnaire for the Elderly. Sports Exercise Res 2016; 18:41-55.