This study examined gender-specific typologies of sedentary behaviors and their cross-sectional associations with health-related outcomes and socio-demographic characteristics in older adults. To the best of our knowledge, no previous studies have identified gender-specific sedentary behavioral typologies in older adults. Nevertheless, previous studies have suggested that not all sedentary behaviors may be similarly associated with physical and mental health risks in older adults, and thus, understanding the associations between sedentary behavioral typologies and health-related outcomes is important to inform risk stratification and preventive interventions. Insight into the socio-demographic differences between typologies is useful to target at-risk populations.
Results of the latent profile analyses identified five unique typologies in men, and three in women. Typologies differed most on computer time, motorized transport and sedentary hobbies, and least on meals and reading. The majority of the typologies had at least one dominating sedentary behavior that distinguishes it from the other typologies. Only the most common typology – i.e. the one characterized by low overall levels of sedentary behavior – had no clear dominating sedentary behavior in both genders. Although the latter typology is labelled ‘low sitting’, it should be noted that this is based on relative values and that older adults of this typology are still spending most of their time sedentary. When analyzing the typologies in detail, it becomes clear that older adults’ motorized transport and computer time tend to cluster (in men), and that television time is generally opposite to computer time (in men) and to motorized transport (in both genders). The opposition between television time and computer time is not unexpected since different correlates are identified for both types of sedentary behavior (24, 30, 31). For example, lower educated older adults have been shown to be more likely to watch television, whereas higher educated adults have been shown to be more likely to use the computer. The latter finding is supported by the results of our analyses with socio-demographic characteristics. The coexistence of older adults’ computer time and motorized transport, on the other hand, was less expected and has, to our knowledge, not been identified in the literature. More research is needed to confirm this finding, and to examine if older adults’ computer time and motorized transport share the same correlates.
Results of the analyses of covariance showed that certain typologies of sedentary behaviors are indeed more strongly related to negative health outcomes than others. Unfortunately, the cross-sectional nature of this study prevents drawing causal inferences from the associations. Specifically, participants of typologies with high motorized transport and/or computer time (i.e. typology 1 and 5 in men, and typology 3 in women) generally have better health outcomes; i.e. they scored better on the grip strength test, and had a better physical and mental health-related QOL compared to participants of other typologies. Or vice versa, that participants of typologies with high television time (i.e. typology 3 and 4 in men, and typology 2 in women) scored less well on health-related outcomes, like BMI, grip strength, physical health-related QOL, and mental health-related QOL. This finding is in line with previous studies showing that television time is strongly associated with cardiovascular diseases, metabolic syndrome, and all-cause mortality (12, 32); and stresses, once again, the importance of reducing prolonged television time. Although the underlying mechanisms for the stronger relationships between television time and negative health outcomes are still not fully understood, it can be assumed that the associated unhealthy dietary habits play an important role (16, 33).
In contrast to our expectations, participants belonging to the typology represented by relatively low levels of overall sedentary behavior (i.e. typology 2 in men, and typology 1 in women) were not the ones with the most positive (physical) health outcomes. Although they have a lower BMI (both in men and in women), and a lower waist circumference (in women), they did not score better, or even worse, on grip strength, physical health-related QOL, and mental health-related QOL compared to participants of typologies represented by high motorized transport (i.e. typology 1 and 5 in men, and 3 in women). The positive associations between motorized transport and health outcomes are in line with previous studies (34, 35), and are assumed to be bidirectional. Older adults with physical health problems, impaired mobility, and visual and cognitive deficit might experience difficulties to drive a car, as car driving is a complex activity requiring a range of cognitive and psychomotor abilities (36). These difficulties can make them reduce, or even cease, driving a car (37). On the other hand, participants who do not drive a car might experience transportation deficiency (38) and face social exclusion (39), which might affect older adults’ mental health. Given that social interaction as well as engagement in social activities are basic components of successful aging (34), it is recommended that healthy aging researchers focus on older adults who are in the transition to driving cessation, and on the increase of alternative transport modes, such as public transport and e-bikes (40), rather than on reducing transport-related sitting time.
A major strength of this study is its uniqueness, as no previous studies have identified typologies of older adults’ sedentary behaviors, and have linked these typologies with health outcomes, and socio-demographic characteristics. A second strength is the use of objective measures (BMI, waist circumference, and grip strength), which were assessed using standardized examinations. A third strength is the application of face-to-face interviews to complete the validated questionnaires (sedentary behavior and health-related QOL). The use of face-to-face interviews is recommended in older adults, as some older adults may experience cognitive difficulties when responding to paper-based questionnaires (41). Important limitations of the current study are its cross-sectional design, which does not allow establishing causal relationships. Although there is good evidence for the causal influence of sedentary behaviors on weight status (42) and health-related QOL (43), these health outcomes may also causally influence sedentary behaviors. A second limitation is the low response rate, which raises the probability of response bias. While all socio-demographic subgroups are well represented in the sample, it remains plausible that participants who are more concerned with their health are overrepresented. Finally, the study is limited by the lack of information on cognitive functioning, and social health. Cognitive decline, and social health problems have been shown to be highly prevalent in older adults, and are serious threats to older adults’ independence, quality of life, and daily life functional abilities (44). As some types of sedentary behavior might be protective for cognitive decline, and social exclusion (45), future studies should include cognitive functioning and social health measures.