The Effects of Multi-Theory Model based Behavior Change Intervention with Staircase Approach on Sedentary Lifestyle among Community-dwelling Older Adults： Study Protocol for A Randomized Controlled Trial

Abstract Background: Older people spend approximately 65-80% of their waking hours sedentary. It is concerning that fewer than 30 % of Chinese older adults participate in regular physical activity, indicating that sedentary lifestyles may be common among this population. The long-term presence of low energy expenditure during waking hours is detrimental to physical health and quality of life. Therefore, interventions targeting changes in sedentary lifestyles are necessary to improve health outcomes in older adults. An experimental study will be conducted to verify whether a sedentary lifestyle modification intervention based on the MTM and the staircase approach is more effective than conventional education in reducing sedentary time and improving physical activity levels, functional capacity, and quality of life among community-dwelling older people. Methods:This community-based, parallel-arm, assessor-blinded randomized controlled trial aims to estimate the effect of Multi-Theory Model based behavior change intervention with staircase approach on sedentary lifestyle among community-dwelling older adults. A total of 56 participants will be enrolled in this study and randomly assigned to the intervention group (participants will receive multi-theory model-based stepped sedentary lifestyle change intervention) and the control group (participants will receive conventional behavioral change advice). Endpoints will be collected at baseline (T1), immediately after the end of intervention (T2), week 12 (T3) and week 18 (T4). The primary endpoint is the change in self-reported sedentary time (min/day). Secondary endpoints include the changes in different domain sedentary time, sedentary behavior characteristics including the longest continuous sedentary time and theprevalence of prolonged sedentary bouts(≥30min), step count,time spent in light-intensity physical activity and moderate-to-vigorous physical activity, MCPAQ score, SPPB score, anthropometric parameters,blood pressure, SF-36score, and adverse events. Discussion: Our research aims to facilitate the transition from sedentary behaviors to exercise behaviors of varying intensities and to maintain long-term behavioral change through a staircase approach in behavioral change interventions for older people with predominantly sedentary lifestyles. The goal is to promote healthy aging by reducing sedentary behavior and increasing levels of physical activity among older people in the community, thereby improving health-related quality of life and preventing functional decline and non-communicable diseases. Trial registration: The trial was registered in the China Clinical Trial Registry on 25 Mar 2024 (ChiCTR2400082225)