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. Author manuscript; available in PMC: 2022 Jun 1.
Published in final edited form as: J Gerontol Nurs. 2021 Jun 1;47(6):35–42. doi: 10.3928/00989134-20210510-02

Sedentary Behavior in Older Adults with Preclinical Cognitive Impairment with and without Chronic Kidney Disease

Mary Hannan 1, Eileen G Collins 2, Shane A Phillips 3, Lauretta Quinn 4, Alana D Steffen 5, Ulf G Bronas 6
PMCID: PMC8670529  NIHMSID: NIHMS1758044  PMID: 34044686

Abstract

Older adults with preclinical cognitive impairment can have chronic conditions and lifestyle factors that influence health. Sedentary behavior is common in older adults with and without chronic kidney disease (CKD). The objective of the study was to determine the differences in sedentary behavior for older adults with preclinical cognitive impairment with and without CKD. Our study evaluated 48 older adults with preclinical cognitive impairment with and without CKD who underwent assessment of sedentary behavior via accelerometry. We found that older adults with preclinical cognitive impairment with and without CKD were sedentary, but there were not significant differences between groups. Fragmentation index was different (p<0.05)-with a lower fragmentation index found in those with CKD. Sedentary behavior should be assessed and evaluated as a potential target for interventions to improve health in these at-risk older adults but further investigation is needed.

Introduction

Chronic kidney disease (CKD), defined as functional or structural kidney damage that has been present for at least three months (National Kidney Foundation (NKF), 2002), is commonly associated with aging-with over 20% of older adults having CKD (Coresh et al., 2007). Another condition commonly experienced by older adults-both those with and without CKD-is cognitive impairment (Brookmeyer et al., 2007; Tamura et al., 2016). Less is known about how to prevent, slow, or reverse this complication of aging and CKD (Bronas et al., 2017; Dumas, 2017). Increased understanding of these complications of aging helps support nurses who care for these at-risk older adults.

Older adults-both those with and without CKD-have lifestyle factors including high levels of sedentary behavior that may place them at risk for adverse health outcomes, such as cognitive impairment (Owen et al., 2010; Younan, 2018). Older adults have been found to spend large amounts of time in sedentary behaviors (G. N. P. Healy et al., 2011). Sedentary behavior is also especially prevalent in individuals with CKD, with reports that those with CKD spend much of their time in sedentary activities and have extremely low levels of physical activity (Beddhu et al., 2015).

It remains unclear the extent to which there are differences in sedentary behavior for older adults with and without CKD, particularly older adults with preclinical cognitive impairment. Preclinical cognitive impairment is when an individual subjectively reports changes in cognitive function from a previous normal state of cognitive function that is not associated with an acute event (Jessen et al., 2014). Preclinical stages of cognitive impairment have gained attention as a potential time to begin interventions directed at prevention of further cognitive decline (Crous-Bou et al., 2017). Cognitive impairment is extremely relevant in the context of sedentary behavior because higher sedentary time has been associated with lower cognitive function (Falck et al., 2017; Vancampfort et al., 2019).

Although it has been found that older adults, those with cognitive impairment, and individuals with CKD are sedentary, it is unclear if individuals with all three of these risk factors are even more sedentary, which may make them more at risk for the complications associated with sedentary behavior. Knowing the differences in sedentary behavior between those with and without CKD is important so tailored nursing assessments, personalized education, and interventions can be developed to address the needs of these at-risk older adults. Therefore, the purpose of this study was to determine whether there are differences in sedentary behavior in older adults with preclinical cognitive impairment with and without CKD. We hypothesized for our primary outcome that older adults with preclinical cognitive impairment and CKD would be more sedentary than those without CKD.

Methods

The study population consisted of community dwelling adults, who were between the ages of 60 and 80 years (World Health Organization, 2016) with and without CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60mL/min/1.73m2 by the CKD-EPI equation (Levey et al., 2009). We included individuals who spoke English and had preclinical cognitive impairment, defined as self-identified cognitive decline (Jessen et al., 2014). Preclinical cognitive impairment was assessed by whether a participant answered affirmatively to the question “Do you think your thinking skills or memory have gotten worse?” We excluded participants that (1) required assistive ambulation (2) had diagnosed dementia or a score of <2 on the Mini-Cog (3) had limited exercise capacity due to comorbid health conditions (4) were on a medication to improve cognition or mood (5) had a resting systolic blood pressure >200 or diastolic blood pressure >110 (6) were pregnant, or (7) had a current or past diagnosis of a neurological or psychiatric disorder, as previously described (Hannan et al., 2020).

De-identified data from the parent study, Exercise Training and Cognitive Function in Kidney Disease (#NCT03197038), was utilized from the baseline assessment of a sub-sample (the first 24 participants enrolled) of the older adults with CKD that met the inclusion criteria. The parent study’s purpose was to test the hypothesis that older adults with moderate to severe CKD and pre-clinical cognitive impairment randomized to a 6-month home-based exercise program would have improved cognitive function and MRI measured brain structure, compared to a usual care control group. As previously described (Hannan et al., 2020), for our comparison group, a new sample of older adults without CKD (eGFR > 60mL/min/1.73m2 by the CKD-EPI equation) was recruited through community outreach, flyers, and ResearchMatch, a national health volunteer registry that was created by several academic institutions and supported by the U.S. National Institutes of Health as part of the Clinical Translational Science Award (CTSA) program that has a large population of volunteers who have consented to be contacted by researchers about health studies for which they may be eligible (ResearchMatch, 2018). The sample without CKD was age matched-within 5 years- and sex matched, as a sample, to the sample with CKD. The sample size was determined, with statistical consultation, to be powered to answer the primary outcome (differences between groups). The full recruitment of older adults without CKD consisted of 51 individuals screened. There were a total of 27 individuals screened ineligible based on age or medical reasons or who decided not to participate (six individuals) due to travel, schedule, or were lost to follow up. The study was approved by the University of Illinois Chicago Institutional Review Board, and informed consent was obtained from all participants.

Measures

Sedentary behavior was measured with accelerometry (ActiGraph, GTX3) (Byrom & Rowe, 2016; Troiano et al., 2008). The participants were instructed to wear the ActiGraph on the right hip for 24 hours per day over 8 days with the intent to capture 7 days of at least 10 wake-hours/day of activity. Data were analyzed in 60 second epochs (Diaz et al., 2016; G. N. P. Healy et al., 2011). Non-wear time was defined as 60 minutes of no counts (except for one to two minutes of zero to 100 counts)(Troiano et al., 2008). A day was defined for each participant based on the time the participant reported they wake up and go to sleep, with a valid day containing at least eight valid hours. The energy expenditure algorithm utilized was the vector magnitude combination. The bout parameters and length were set to the adult criteria by Freedson (Freedson et al., 1998). Sedentary time, sedentary breaks (a non-sedentary time period between sedentary periods), and sedentary bouts (periods of uninterrupted sedentary time of at least 10 minutes) were evaluated based on cut points and criteria established by previous work (Byrom & Rowe, 2016; Freedson et al., 1998). Fragmentation index was calculated by dividing number of sedentary bouts by total sedentary time (Byrom & Rowe, 2016). All analysis was conducted utilizing ActiLife software (ActiGraph).

Statistical analysis

Statistical analyses were conducted with Stata Statistics/Data Analysis (Version 14.2). Descriptive statistics were calculated for both groups. Differences between groups were compared with independent samples t tests, and our sample size was powered to achieve 83% power to detect a difference of −0.6 using a two-sided z test with a significance of 0.05. Additionally, as an exploratory analysis, ordinary least squares (OLS) regression analysis was used to explore the differences in sedentary behavior between those with and without CKD, while controlling for the covariates of age and sex, which were chosen based on the previous literature (Bellettiere et al., 2015).

Results

The samples of older adults with preclinical cognitive impairment with and without CKD were not significantly different in age (p=0.92) or sex (p=0.56). Those without CKD had higher years of education than the sample with CKD (p<0.05). There were more participants with CKD who had hypertension and diabetes (p<0.05), and those with CKD had a higher body mass index (BMI) (p<0.05). (Table 1)

Table 1.

Sample Characteristics

Without CKD n=24 With CKD n=24 t χ2
Mean(SD) >Range >Mean(SD) >Range>
Age 68.5(5.5) (60-80) 68.4(5.6) (61-79) 0.10
Years of Education 16.6 (1.4) (14-18) 13.75 (1.6) (12-18) 6.68 *
eGFR (ml/min/1.73m2) 82.7(12.3) (65-108) 43.9(11.6) (18-59) 11.28 *
Body mass index 26.4(4.2) (21.6-38.5) 30.8(6.4) (18.9-44.9) −2.81 *
n(%) n(%)
Sex 0.34
  Male 14 (58.3) 12 (50)
  Female 10 (41.7) 12 (50)
Race 24.59 *
  African American 2 (8.3) 16 (66.7)
  Asian 0 1 (4.2)
  Caucasian 22 (91.7) 5 (20.8)
  Chose not to report 0 2 (8.3)
History of diabetes 2(8.3) 10(41.7) 7.11 *
History of hypertension 6(25) 22(91.7) 21.94 *
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*

p<0.05

Sedentary Behavior

The mean sedentary time per day for the sample without CKD was 654.17 (106.3) minutes and for the sample with CKD was 707.64 (107.3) minutes. The difference in sedentary time between groups was not significantly different (p=0.09), but the regression explained 23% of the of the variance in sedentary time per day (R2= 0.23, F(3,43)=4.35, p=0.01). The mean number of sedentary breaks per day was higher for those without CKD compared to those with CKD (18.17 (3.5) vs. 17.80 (4.83)) but was not significantly different (p=0.10). The fragmentation index for the sample without CKD was 0.028(0.002) and for the sample with CKD 0.026 (0.005), which was significantly different (p=0.04). Additionally, sedentary bouts per day and maximum sedentary bout length were not significantly different between groups (p=0.76, p=0.12, respectively). (Table 2)

Table 2.

Sedentary Behavior

Without CKD
n=24
Mean
(SD)
(range)		 With CKD
n=24
Mean
(SD)
(range)		 t R2a CKD
β coefficientc (95% CI)		 t
Sedentary Time per Dayb (minutes) 654.17
(106.3)
(493.7-841.4)		 707.64
(107.3)
(462-880.1)		 −1.72 0.23 * 62.60
(4.13, 121.06)		 2.16 *
Sedentary Breaks Per Day 18.17
(3.50)
(10.86-24.71)		 17.80
(4.83)
(8.5-26)		 0.02 0.06 −0.22
(−2.66, 2.23)		 −0.18
Fragmentation Index (bouts/total sedentary time (minutes)) 0.028
(0.002)
(0.022-0.033)		 0.026
(0.005)
(0.016-0.032)		 2.14 * 0.08 −0.002
(−0.004, 0.000)		 −1.93
Sedentary bouts/day (≥ 10 minutes) 18.32
(3.50)
(11-24.86)		 17.95
(4.82)
(8.75-26.14)		 0.30 0.06 −0.21
(−2.65, 2.23)		 −0.17
Maximum sedentary bout length (minutes) 136.63
(53.11)
(63-313)		 180.08
(123.37)
(68-694)		 −1.59 0.11 47.67
(−7.45, 102.18)		 1.74
% Total Time spent sedentary 69.4% 72.8%
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a

OLS Regression with covariates age and sex.

b

n=24 non-CKD and n=23 CKD (extreme outlier excluded)

c

Unstandardized

*

p<0.05

Discussion

Our findings uniquely and importantly describe the sedentary behavior in high risk older adults with preclinical cognitive impairment with and without CKD. Our samples had high amounts of sedentary behavior-spending 69% and 73% of their time being sedentary (non-CKD and CKD, respectively). Given that sedentary behavior has been associated with cognitive impairment (Younan, 2018), our findings may have important implications for the development of interventions for these at-risk older adults at a time before cognitive function can potentially worsen and individuals may become even more sedentary (Falck et al., 2017; Vancampfort et al., 2019). This is particularly relevant given that our sample had pre-clinical cognitive impairment, a prodromal time where interventions could potentially have the possibility of influencing quality of life and the progression of cognitive decline (Bhome et al., 2018; Jessen et al., 2014).

The high amounts of sedentary time per day in both samples are somewhat consistent with what has been found in other studies of older adults and those with CKD, although great variability in sedentary time has been reported (G. N. Healy et al., 2011; Parsons et al., 2017; West et al., 2017). Our findings are also consistent with studies that have evaluated sedentary time in older adults with mild cognitive impairment (Falck et al., 2017). In our sample, older adults with preclinical cognitive impairment with CKD were more sedentary than those without CKD but the differences were not significant, although the variance in sedentary time was explained in our exploratory regression. These results are consistent with other studies that have found that individuals with CKD have high amounts of sedentary time (Beddhu et al., 2015). Our findings have important implications because older adults in the general population are sedentary (G. N. P. Healy et al., 2011), and this study has shown that older adults with CKD also have high amounts of sedentary time. Individuals with CKD already experience a high burden of comorbidities (Fraser & Taal, 2016), and high amounts of sedentary time may place older adults with CKD at additional risk due to maladaptive physiological changes related to being sedentary but further investigation in this area is needed (Hamilton et al., 2007; Owen et al., 2010).

Sedentary breaks per day were not significantly different between those with and without CKD. This is similar to the Maastricht study, which found that more sedentary breaks per day was associated with a higher eGFR, but the relationship did not persist after full covariate adjustment (Martens et al., 2018). Our findings add to what is known about the low number of sedentary breaks per day found in older adults with and without CKD (Bankoski et al., 2011; Diaz et al., 2016; Jefferis et al., 2015; Martens et al., 2018; Sardinha et al., 2015). It is possible that sedentary breaks per day were not different between older adults with and without CKD because the sedentary behavior in both populations has been characterized by prolonged sedentary periods with few sedentary breaks (Bankoski et al., 2011; Diaz et al., 2016; Martens et al., 2018; Sardinha et al., 2015). Sedentary breaks have gained attention as a potentially healthful behavior. Individuals with diabetes who have more sedentary breaks were found to have lower waist circumference, body mass index, triglycerides, and 2-hour glucose levels (Healy et al., 2008). To our knowledge, sedentary breaks and their health impact have not been explored in older adults with preclinical cognitive impairment, particularly in those with CKD. Further investigation is warranted in this area.

Our findings related to sedentary bouts add to what is known about the sedentary behavior of older adults with and without CKD (Bankoski et al., 2011; Diaz et al., 2016; Martens et al., 2018). Sedentary bouts per day and maximum sedentary bout length were not significantly different between the older adults with preclinical cognitive impairment with and without CKD. This is dissimilar to the Maastricht study that found that prolonged sedentary bouts were significantly associated with having a lower eGFR (Martens et al., 2018), which may be due to our small sample size. It is also possible that the number of sedentary bouts per day and maximum sedentary bout length were not different between groups because both older adults in general population and those with CKD tend to accumulate their sedentary time in prolonged bouts (Diaz et al., 2016; Martens et al., 2018). Fragmentation index was higher for those without CKD and was significantly different between those with and without CKD. Based on our review, fragmentation index has not been previously explored in older adults with CKD. Additionally, the concept of sedentary bouts has been less studied in those with cognitive impairment. When sedentary bouts were evaluated in a recent cohort study, those with more severe cognitive impairment had sedentary bouts of longer length (Lu et al., 2018). Our findings support the need for further investigation into sedentary behavior patterns and the health effects of the manner in which older adults with preclinical cognitive impairment accumulate sedentary time. Additionally, investigations are needed to explore how interventions to limit sedentary time should be implemented in this population.

Clinical Nursing Implications

Older adults require tailored nursing care to promote health and function (Grady, 2011). Specialized nursing care is particularly critical for older adults with cognitive impairment and for those with CKD (Gomez, 2017; Lin et al., 2012). Part of this specialized care includes evaluating physical activity levels to get a holistic picture of an older adult and what complications they may be at risk for (Washburn, 2000). Our study adds to what is known about the sedentary behavior of older adults with preclinical cognitive impairment with and without CKD. These findings support that level of sedentary behavior should be assessed in older adults with preclinical cognitive impairment with and without CKD. Assessing function and physical activity levels are aspects of the scope of practice for gerontology nurses to help promote the health and safety of older adults (American Nurses Association, 2019). Sedentary behavior is important to consider for these at-risk older adults because sedentary behavior has been associated with adverse health outcomes and may potentially contribute to further morbidity and debility (Owen et al., 2010; Younan, 2018). This is particularly relevant for older adults with preclinical cognitive impairment, since cognitive impairment has been associated with sedentary behavior (Falck et al., 2017; Lu et al., 2018; Vancampfort et al., 2019). When assessing older adults’ sedentary behavior and planning tailored interventions, it is important to assess barriers to decreasing sedentary behavior, since both older adults and those with CKD endorse barriers to exercise and being physically active (Baert et al., 2011; Hannan & Bronas, 2017). When interventions are developed for older adults to decrease sedentary behavior, there are additional considerations that should be made. In the context of Age Friendly Health Systems, the 4M Framework for older adults could be considered when developing interventions, specifically as it relates to what matters most to older adults and the promotion of mobility (Institute for Healthcare Improvement, n.d.). This framework recommends that interventions consider what matters to older adults and are in the context of the individual’s medications, mentation, and mobility (Institute for Healthcare Improvement, n.d.). Additionally, when developing interventions to reduce sedentary behavior in older adults, evidenced based resources should be utilized that promote and support mobility in the older adult population, such as the Mobility Action Group Change Packet and Toolkit (Inouye, 2018; Lorgunpai et al., 2020).

Future Directions

Although there is growing attention on the health impacts of sedentary behavior, more research is needed on sedentary behavior in at risk populations, including older adults with preclinical cognitive impairment with and without CKD. Although our study uniquely contributed to the literature by focusing on sedentary behavior in older adults with and without CKD with preclinical cognitive impairment, additional exploration is needed. Further evaluation is needed into the sedentary behavior of older adults with more severe CKD and those with more advanced cognitive impairment to increase the understanding of how sedentary behavior relates to these complications of aging. Sedentary behavior is influenced by numerous factors, and there is a need for research on environmental, social, and health related factors that could influence older adults with and without CKD to be sedentary (Owen et al., 2011). When interventions are developed, tailored interventions need to be investigated that are specific for older adults with comorbidities, given what is known about the differences in sedentary behavior in different age groups and in individuals with different health factors (Rhodes et al., 2012).

Limitations

This study uniquely explored differences in sedentary behavior in older adults with preclinical cognitive impairment with and without CKD, but it was not without limitations. The sample was a convenience sample. Our study was powered for the primary outcome of differences between groups, but it was not powered for the exploratory regression analyses. The study is cross-sectional so causality cannot be assumed. Despite the limitations, the study had great strength in its exploration of sedentary behavior in older adults with preclinical cognitive impairment with and without CKD with device assessed sedentary behavior.

Conclusion

This study adds to the breadth of knowledge on older adults and sedentary behavior, by uniquely focusing on high risk older adults with preclinical cognitive impairment with and without CKD. The findings of this study support that older adults with preclinical cognitive impairment in the presence and absence of CKD should be assessed to characterize physical activity patterns, which will assist nurses in determining interventions to address sedentary behavior in these populations that are at risk for further cognitive impairment.

Acknowledgments

Dr. Hannan is a T32 Postdoctoral Fellow. Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL134634. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Dr. Hannan is a Robert Wood Johnson Foundation Future of Nursing Scholar Postdoctoral Fellow. The views expressed here do not necessarily reflect the views of the Foundation.

Funding:

This study was supported by a grant made available by the American Nephrology Nurses Association (ANNA). Findings of the study do not necessarily reflect the opinions of ANNA. The views expressed herein are those of the author and no official endorsement by ANNA is intended or should be inferred.

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Dr. Bronas and the parent study were supported by NIH-NIA AG022849-15S1 and NIH-NIA AG022849.

Dr. Hannan is a Robert Wood Johnson Foundation Future of Nursing Scholar Postdoctoral Fellow. The views expressed here do not necessarily reflect the views of the Foundation.

Dr. Hannan is a T32 Postdoctoral Fellow. Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL134634. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Conflict of Interest: The authors declare that they have no conflicts of interest.

References

  1. American Nurses Association. (2019). Gerontological nursing: scope and standards of practice (Second;2; ed.). American Nurses Association. [Google Scholar]
  2. Baert V, Gorus E, Mets T, Geerts C, & Bautmans I (2011). Motivators and barriers for physical activity in the oldest old: a systematic review. Ageing research reviews, 10(4), 464–474. [DOI] [PubMed] [Google Scholar]
  3. Bankoski A, Harris TB, McClain JJ, Brychta RJ, Caserotti P, Chen KY, Berrigan D, Troiano RP, & Koster A (2011). Sedentary Activity Associated With Metabolic Syndrome Independent of Physical Activity. Diabetes Care, 34(2), 497–503. 10.2337/dc10-0987 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Beddhu S, Wei G, Marcus RL, Chonchol M, & Greene T (2015). Light-intensity physical activities and mortality in the United States general population and CKD subpopulation. Clin J Am Soc Nephrol, 10(7), 1145–1153. 10.2215/CJN.08410814 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bellettiere J, Carlson JA, Rosenberg D, Singhania A, Natarajan L, Berardi V, LaCroix AZ, Sears DD, Moran K, Crist K, & Kerr J (2015). Gender and Age Differences in Hourly and Daily Patterns of Sedentary Time in Older Adults Living in Retirement Communities. PLoS One, 10(8), e0136161–e0136161. 10.1371/journal.pone.0136161 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bhome R, Berry AJ, Huntley JD, & Howard RJ (2018). Interventions for subjective cognitive decline: systematic review and meta-analysis. BMJ Open, 8(7), e021610. 10.1136/bmjopen-2018-021610 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bronas UG, Puzantian H, & Hannan M (2017). Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BioMed Research International, 2017. 10.1155/2017/2726369 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Brookmeyer R, Johnson E, Ziegler-Graham K, & Arrighi HM (2007). Forecasting the global burden of Alzheimer’s disease. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, 3(3), 186. 10.1016/j.jalz.2007.04.381 [DOI] [PubMed] [Google Scholar]
  9. Byrom B, & Rowe DA (2016). Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies. Contemporary Clinical Trials, 47, 172–184. 10.1016/j.cct.2016.01.006 [DOI] [PubMed] [Google Scholar]
  10. Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, & Levey AS (2007). Prevalence of Chronic Kidney Disease in the United States. JAMA, 298(17), 2038–2047. 10.1001/jama.298.17.2038 [DOI] [PubMed] [Google Scholar]
  11. Crous-Bou M, Minguillón C, Gramunt N, & Molinuevo JL (2017). Alzheimer’s disease prevention: from risk factors to early intervention. Alzheimer’s research & therapy, 9(1), 71. 10.1186/s13195-017-0297-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Diaz KM, Howard VJ, Hutto B, Colabianchi N, Vena JE, Blair SN, & Hooker SP (2016). Patterns of Sedentary Behavior in US Middle-Age and Older Adults: The REGARDS Study. Medicine & Science in Sports & Exercise, 48(3), 430–438. 10.1249/MSS.0000000000000792 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Dumas JA (2017). Strategies for Preventing Cognitive Decline in Healthy Older Adults. In (Vol. 62, pp. 754–760). Los Angeles, CA: SAGE Publications. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Falck RS, Landry GJ, Best JR, Davis JC, Chiu BK, & Liu-Ambrose T (2017). Cross-Sectional Relationships of Physical Activity and Sedentary Behavior With Cognitive Function in Older Adults With Probable Mild Cognitive Impairment. Physical therapy, 97(10), 975–984. 10.1093/ptj/pzx074 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Fraser SDS, & Taal MW (2016). Multimorbidity in people with chronic kidney disease: implications for outcomes and treatment. Curr Opin Nephrol Hypertens, 25(6). https://journals.lww.com/co-nephrolhypertens/Fulltext/2016/11000/Multimorbidity_in_people_with_chronic_kidney.2.aspx [DOI] [PubMed] [Google Scholar]
  16. Freedson PS, Melanson E, & Sirard J (1998). Calibration of the Computer Science and Applications, Inc. accelerometer. Medicine and science in sports and exercise, 30(5), 777–781. 10.1097/00005768-199805000-00021 [DOI] [PubMed] [Google Scholar]
  17. Gomez N (2017). Scope of Practice for Nephrology Nursing | American Nephrology Nurses Association. https://www.annanurse.org/professional-development/practice/scope-of-practice/nephrology-nursing
  18. Grady PA (2011, Jul-Aug). Advancing the health of our aging population: a lead role for nursing science. Nursing outlook, 59(4), 207–209. 10.1016/j.outlook.2011.05.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hamilton MT, Hamilton DG, & Zderic TW (2007). Role of Low Energy Expenditure and Sitting in Obesity, Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease. Diabetes, 56(11), 2655–2667. 10.2337/db07-0882 [DOI] [PubMed] [Google Scholar]
  20. Hannan M, & Bronas UG (2017). Barriers to exercise for patients with renal disease: an integrative review. J Nephrol. 10.1007/s40620-017-0420-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Hannan M, Collins EG, Phillips SA, Quinn L, Steffen A, & Bronas UG (2020, 2020/September/09). Cognitive and vascular function in older adults with and without CKD. Aging clinical and experimental research. 10.1007/s40520-020-01695-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Healy GN, Dunstan DW, Salmon J, Cerin E, Shaw JE, Zimmet PZ, & Owen N (2008). Breaks in Sedentary Time. Diabetes Care, 31(4), 661. 10.2337/dc07-2046 [DOI] [PubMed] [Google Scholar]
  23. Healy GN, Matthews CE, Dunstan DW, Winkler EAH, & Owen N (2011). Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. European Heart Journal, 32(5), 590–597. 10.1093/eurheartj/ehq451 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Healy GNP, Clark BKMPH, Winkler EAHP, Gardiner PAB, Brown WJP, & Matthews CEP (2011). Measurement of Adults’ Sedentary Time in Population-Based Studies. American Journal of Preventive Medicine, 41(2), 216–227. 10.1016/j.amepre.2011.05.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Inouye S (2018). Mobility Actiion Group: Change packaged and toolkit. Retrieved from https://www.johnahartford.org/dissemination-center/view/mobility-change-package-and-toolkit
  26. Institute for Healthcare Improvement. (n.d.) “What Matters” to Older Adults? Retrieved from http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/Join%20the%20Movement.aspx
  27. Jefferis BJ, Sartini C, Shiroma E, Whincup PH, Wannamethee SG, & Lee I-M (2015). Duration and breaks in sedentary behaviour: accelerometer data from 1566 community-dwelling older men (British Regional Heart Study). BRITISH JOURNAL OF SPORTS MEDICINE, 49(24), 1591–1594. 10.1136/bjsports-2014-093514 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Jessen F, Amariglio RE, van Boxtel M, Breteler M, Ceccaldi M, Chételat G, Dubois B, Dufouil C, Ellis KA, van der Flier WM, Glodzik L, van Harten AC, de Leon MJ, McHugh P, Mielke MM, Molinuevo JL, Mosconi L, Osorio RS, Perrotin A, Petersen RC, Rabin LA, Rami L, Reisberg B, Rentz DM, Sachdev PS, de la Sayette V, Saykin AJ, Scheltens P, Shulman MB, Slavin MJ, Sperling RA, Stewart R, Uspenskaya O, Vellas B, Visser PJ, Wagner M, & Subjective Cognitive Decline Initiative Working, G. (2014). A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s & dementia : the journal of the Alzheimer’s Association, 10(6), 844–852. 10.1016/j.jalz.2014.01.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, & for the C-E (2009). A New Equation to Estimate Glomerular Filtration Rate. Annals of Internal Medicine, 150(9), 604. 10.7326/0003-4819-150-9-200905050-00006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Lin F, Vance DE, Gleason CE, & Heidrich SM (2012). Caring for older adults with mild cognitive impairment: an update for nurses. Journal of gerontological nursing, 38(12), 22–37. 10.3928/00989134-20121106-02 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Lorgunpai SJ, Finke B, Burrows I, Brown CJ, Rubin FH, Wierman HR, Heisey SJ, Gartaganis S, Ling SM, Press M, & Inouye SK (2020). Mobility Action Group: Using Quality Improvement Methods to Create a Culture of Hospital Mobility. J Am Geriatr Soc, 68(10), 2373–2381. 10.1111/jgs.16699 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Lu Z, Harris TB, Shiroma EJ, Leung J, & Kwok T (2018). Patterns of Physical Activity and Sedentary Behavior for Older Adults with Alzheimer’s Disease, Mild Cognitive Impairment, and Cognitively Normal in Hong Kong. Journal of Alzheimer’s disease : JAD, 66(4), 1453–1462. 10.3233/JAD-180805 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Martens RJH, van der Berg JD, Stehouwer CDA, Henry RMA, Bosma H, Dagnelie PC, van Dongen MCJM, Eussen SJPM, Schram MT, Sep SJS, van der Kallen CJH, Schaper NC, Savelberg HHCM, van der Sande FM, Kroon AA, Kooman JP, & Koster A (2018). Amount and pattern of physical activity and sedentary behavior are associated with kidney function and kidney damage: The Maastricht Study. PLoS One, 13(4), e0195306. 10.1371/journal.pone.0195306 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. National Kidney Foundation (NKF). (2002). KDOQI Clinical Practice Guidelines for Chronic Kidney Diseases: Evaluation, classification, and stratification. Retrieved 3-1-18 from https://www.kidney.org/sites/default/files/docs/ckd_evaluation_classification_stratification.pdf [PubMed]
  35. Owen N, Healy GN, Matthews CE, & Dunstan DW (2010). Too much sitting: the population health science of sedentary behavior. Exercise and sport sciences reviews, 38(3), 105–113. 10.1097/JES.0b013e3181e373a2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Owen N, Sugiyama T, Eakin EE, Gardiner PA, Tremblay MS, & Sallis JF (2011, 2011/August/01/). Adults’ Sedentary Behavior: Determinants and Interventions. American Journal of Preventive Medicine, 41(2), 189–196. 10.1016/j.amepre.2011.05.013 [DOI] [PubMed] [Google Scholar]
  37. Parsons TJ, Sartini C, Ash S, Lennon LT, Wannamethee SG, Lee IM, Whincup PH, & Jefferis BJ (2017). Objectively measured physical activity and kidney function in older men; a cross-sectional population-based study. Age and Ageing, 46(6), 1010–1014. 10.1093/ageing/afx091 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Research Match. (2018). https://www.researchmatch.org/researchers/faq
  39. Rhodes RE, Mark RS, & Temmel CP (2012, 2012/March/01/). Adult Sedentary Behavior: A Systematic Review. American Journal of Preventive Medicine, 42(3), e3–e28. 10.1016/j.amepre.2011.10.020 [DOI] [PubMed] [Google Scholar]
  40. Sardinha LB, Santos DA, Silva AM, Baptista F, & Owen N (2015). Breaking-up sedentary time is associated with physical function in older adults. J Gerontol A Biol Sci Med Sci, 70(1), 119–124. 10.1093/gerona/glu193 [DOI] [PubMed] [Google Scholar]
  41. Tamura MK, Yaffe K, Hsu CY, Yang JR, Sozio S, Fischer M, Chen J, Ojo A, DeLuca J, Xie DW, Vittinghoff E, Go AS, Chronic Renal Insufficiency C, & Chronic Renal Insufficiency Cohort Study, I. (2016). Cognitive Impairment and Progression of CKD. American Journal of Kidney Diseases, 68(1), 77–83. 10.1053/j.ajkd.2016.01.026 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, & McDowell M (2008). Physical activity in the United States measured by accelerometer. Medicine and science in sports and exercise, 40(1), 181. 10.1249/mss.0b013e31815a51b3 [DOI] [PubMed] [Google Scholar]
  43. Vancampfort D, Stubbs B, Lara E, Vandenbulcke M, Swinnen N, & Koyanagi A (2019). Correlates of sedentary behavior in middle-aged and old age people with mild cognitive impairment: a multinational study. International Psychogeriatrics, 31(4), 579–589. 10.1017/S1041610218001163 [DOI] [PubMed] [Google Scholar]
  44. Washburn RA (2000). Assessment of physical activity in older adults. Research Quarterly for Exercise and Sport, 71(sup2), 79–87. [DOI] [PubMed] [Google Scholar]
  45. West SL, Ma C, Chaudhry M, Thomas SG, & Lok CE (2017). The Association of Daily Activity Levels and Estimated Kidney Function in Men and Women With Predialysis Chronic Kidney Disease. Kidney International Reports, 2(5), 874–880. 10.1016/j.ekir.2017.05.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. World Health Organization (WHO). (2016). Proposed working definition of an older person in Africa for the MDS Project. Retrieved October 30, 2017 from http://www.who.int/healthinfo/survey/ageingdefnolder/en/
  47. Younan B (2018). Cognitive Functioning Differences Between Physically Active and Sedentary Older Adults. Journal of Alzheimer’s disease reports, 2(1), 93–101. 10.3233/ADR-180053 [DOI] [PMC free article] [PubMed] [Google Scholar]

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