The measurement of physical activity and sedentary behaviour in older adults residing in care homes

Introduction: Evidence suggests engagement in physical activity (PA) is beneficial for older care home (CH) residents. However, few studies measure PA or sedentary behaviour; likely due to the unique challenges surrounding measurement of these behaviours in this population. Thus, the overarching aim of this thesis was to identify and evaluate an appropriate method of assessing PA and sedentary behaviour (i.e. PA behaviour) in CH residents. Methods: Reviews were undertaken to: a) determine which method was best suited to assessing PA behaviour in a CH population and b) synthesise existing literature detailing accelerometer use in CH residents. Experimental work explored the impact of methodological decisions on the validity and reliability of estimates of PA behaviour in older adults, including CH residents. A phased, iterative approach was adopted to develop and refine an accelerometer data collection protocol for use with CH residents. The feasibility and acceptability of this protocol was then evaluated within the context of a cluster randomised control trial. Accelerometer data collected throughout this thesis was pooled and the levels and patterns of PA behaviour in CH residents were described. Results: Accelerometers have potential application in a CH setting. The validity of energy expenditure estimates were better with a hip- compared to wrist-worn accelerometer. Classification agreement of PA behaviour was better for vector magnitude compared to vertical axis accelerometer counts. Wearing an accelerometer for eight hours on any four days was sufficient to achieve reliable estimates of PA behaviour. Compliance rates improved following the refinement of the accelerometer data collection protocol. CH residents spent the majority of their time sedentary and the little PA they did engage in was typically of low intensity. Conclusions: Accelerometers can be used to collect valid and reliable PA behaviour data in older CH residents, though it appears that a tailored data collection protocol is key.