1

Sedentary behaviour in patients in

hospital

Jorunn L Helbostad The Geriatrics, Movement and Stroke research group

Norwegian University of Science and Technology,

Trondheim, Norway

2

3

Sitting time in Norwegian politicians

http://www.aftenposten.no/nyheter/iriks/Verdens-sprekeste-folk-Tvert-i-

mot--7765990.html

Mean

545 minutes

4

Sedentary time in the Norwegian adult population (minutes per day)

Sedentary=

<100 counts/min

5

Sitting time in Europe, aged 18-64 years

Bauman et al. 2011

6

Sample Women n=833, 53% Men n=759, 48%

Age (years) 72.5 ± 2.1 72.4 ± 2.1

Height (cm) 163.4 ± 5.2 176.9 ± 5.9

Weight (kg) 68.2 ± 10.7 83.0 ± 11.8

BMI (kg/m2) 25.5 ± 3.7 26.5 ± 3.3

No. medications 1.2 ± 1.9 2.5 ± 3.9

Fallen past year 32 % 30 %

7

Physical activity and sitting time

Women Men

Normal gait speed (m/sec) 1.29 ± 1.94 1.33 ± 2.00

Active >30 minutes daily 79 % 68 %

Daily sitting time (hours) 5.5 ± 3.7 6.5 ± 4.5

Daily time in MVA 34.8 ± 19.8 min 36.6 ± 20.9 min

Sitting time is not associated with

physical activity, but with lower muscle

strength

8

Sitting time, physical activity and

depression

Van Uffelen og medarb., 2013

>7 hours 47% increased risk

< 150 min

per uke 99% increased risk

+ 196% increased risk

9

9 9

Effect of inactivity in older people

Ten days of bed rest

• ↓ 1 kg muscle mass

• ↓ 16% muscle strength

• Physical performance did not decline

Long term immobilization

• ↓ Activities of daily living

• ↓ Mobility

• ↓ Physical activity

• ↓ Social activity

Kortebein P. et al 2007, 2008

Gill TM et al 2004

10

Kortebein et.al 2007, JAMA http://nhi.no/livsstil/livsstil/diverse/sengeleie-gir-hurtig-tap-av-styrke-og-muskelmasse-25827.html

11

Reduced muscle strength with increasing

age and spare capacity

alder

Threshold for function

strength

spare

capacity

100%

12

Frailty and vulnerability

Clegg et al., Lancet 2013

13

Time in upright during the day by

location

Figure 1 — Mean time upright by hour and location

Grant, JAPA, 2010

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Time in upright during the day by location

• Community-dwellers: 360 ±112 minutes

• Day hospital: 233• ± 112 minutes

• Ward (city): 70 ±• 50 minutes

• Ward (rural): 80 • ±• 41 minutes

Grant, JAPA, 2010

15 Harstad apirl 2011

Monitored activity during a rehab stay and

at home

16

The Trondheim hip fracture trial

• An RCT comparing the effect of being treated in an orthogeriatric ward

compared to an orthopeadic ward (n=397)

Inclusion criteria

• Home-dwelling before the fracture

• >70 years of age

• Able to walk before the fracture

• Length of stay

– Orthogeriatric department: 12.6 ± 0.43 days

– Orthopeadic department: 11.0 ± 0.54 days

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Mobilization regime in the orthogeriatric ward

• Interdiciplinary team approach

• Individually tailored mobilisation

plans

• Physiotherapists prioritized the

frailest patients

• Use of pre-fracture ADL level to set

goals for the mobilisation

Saltvedt et al. 2013

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Activity monitoring

Day 4 after surgery

4 months

12 months

27 min

Upright time

3 h 58 min

Upright time

3 h 16 min

Upright time

19

Results – 4th day after hip surgery

Orthogeriatric Orthopeadic

Taraldsen et al. 2013

20

Time in upright through the day

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Tid

i o

pp

reis

t sti

llin

g (

min

utt

er)

DG

DOS

GERIATRISK AVDELING

ORTOPEDISK AVDELING

Taraldsen m.fl, J Gerontol A Biol Sci Med 2013

21

Mean upright time and number of sedentary breaks 4 days after surgery

0

2

4

6

8

10

12

14

16

18

20

H1 H2 H3 H4 H5 H6 H7 H8 H9 H10H11H12H13H14H15H16H17H18H19H20H21H22H23H24

No of sedentary breaks

Orthogeriatric

Orthopeadic

Upright time

22

Activity pattern over four days for a patient with impaired cognition

23

Upright time and number of sedentary breaks 4 and 12 months after surgery

4 months 12 months

Orthoger. Orthopead.

p=0.003 p=0.018

Upright time in favour of the orthogeriatric group Hospital: 13 minutes 4 months: 40 minutes 12 months: 32 minutes

Orthoger. Orthopead.

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Gait speed

Better than normal: > 1.4 m/s m/sec

Normal: 1.0 – 1.4 m/s

Reduced: 0.6-1.0 m/s

Severely reduced: < 0.6 m/sec

4mnth 12mnth 12mnth 4mnth

Orthogeriatric Orthopeadic The I.A.N.A task force, 2009

Older people

25

Physical activity and sedentary behaviour the

first six months after stroke: Median (IQR) Askim et al. 2013

2 weeks 1 month 3 months 6 months

Lying (minutes) 924

(714-1130)

755

(656-910)

760

(663-877)

786

(655-919)

Standing (minutes) 92

(11-141)

146

(29-321)

144

(31-248)

144

(66-232)

Transitions (no) 50

(16-103)

63

(32-103)

62

(35-123)

59

(48-89)

Change in upright time was associated

with change in function (Berg Balance

Scale, ADL)

26

Physical activity early after stroke

-Behavioural mapping

Askim et al. 2011

27

Percentage of time spent on different

activities

28

Stroke patients: Time spent in bed in

relation to severity of the stroke

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Who are the stroke patients spending time

with?

30

Physical activity in hospitalised stroke patients

West and Bernhardt, 2014

31

Physical activity in hospitalised stroke patients

• Nearly 50% of the time is spent inactive

• About 50% of the time is spent alone in the bedroom

• About 1 hour per day is spent in physiotherapy and in occupational

therapy

– Limited amount of time with therapists is spent in moderate to high level

activity

• Activity is lowest the twoo first weeks after the stroke

– Activity is lower in neurological wards compared to stroke units.

West and Bernhardt, 2014

32

Summary

• Old hospital patients are vulnerable for functional decline

• Hip fracture patients and stroke patients in hospital spend

most of the day in sitting/lying

• Ward matters when it comes to sedentary and low

intensity activity

• Inactive time in hospital predicts function

• Reducing sedentary time and increasing mobilisation

during the hospital stay improve functional outcomes up to

a year after the hospital stay

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Thank you!