Using the Staircase Approach to increase movement: a systematic search and review to inform a novel sedentary behaviour intervention for older adults.

Introduction: Traditional approaches to supporting older adults in adopting and maintaining an active lifestyle have largely failed. The previously proposed "Staircase Approach" offers a new foundation for developing interventions and public health strategies; this approach includes Step 1 (changing sedentary behaviour) and Steps 2 to 4 (incorporating more physical activity of increasing levels of intensity). In this systematic search and review, we aimed to inform the co-creation of a novel Staircase Approach intervention for community-dwelling, inactive older adults, primarily focussed on Step 1.

Methods: A systematic search was performed across six databases (MEDLINE, PsycInfo, CINAHL, Cochrane CENTRAL, SPORTDiscus and Scopus).

Results: After duplicates were removed, 3427 titles and abstracts were screened. Fourteen articles (including 17 intervention groups) were included after full-text review. Five were randomized controlled trials, three compared two interventions and six were single-arm studies. Sample sizes ranged from 9 to 176 participants, and included 617 older adults at baseline. Mean age of samples ranged from 64.3 (standard deviation [SD] 3.8) to 85.1 (SD 6.2) years, while the intervention length ranged from less than one day to 6 months. Sedentary time interventions are well accepted; most studies had completion rates above 80%. Based on findings from within-group comparisons, half of the studies showed a reduction in sedentary time (6/12 groups) and half showed an increase in physical activity (6/12 groups). Based on findings from between-group comparisons, 2 out of 5 intervention groups showed improvements in sitting time and physical activity outcomes compared to controls. Satisfaction and adherence to interventions were generally high.

Conclusion: Sedentary time interventions for older adults show promise and point to several components that may be included in an intervention focussed on Step 1 of the Staircase Approach.