Mean Daily Step Count Research Articles

The potential effect of mobile application-based telerehabilitation on physical activity levels in heart failure patients: insights from the intelliot EU project

Abstract Background Regular physical activity is paramount in heart failure (HF) patients and, due to its well-established benefit in quality of life, functional capacity and prognosis, carries a Class I indication in international guidelines. However, satisfactory compliance rates remain suboptimal, which is largely attributable to unavailability or suboptimal utilization of comprehensive cardiac rehabilitation programs. Digital health application-based telerehabilitation, on the other hand, has emerged as a potentially valuable tools in enhancing risk factor control and lifestyle modification rates in this high-risk patient population. Purpose In this study, we aimed to investigate whether the use of a purpose-designed Internet of Things (IoT)-based e-health system could lead to a clinically relevant increase in physical activity in a cohort of patients with HF across the spectrum of left ventricular ejection fraction (LVEF). Methods Nineteen HF patients were enrolled in the study. Subjects' key clinical characteristics are summarized in Picture 1. All subjects were provided with: a) a set of medical devices with wireless connectivity, b) a state-of-the-art smartwatch and c) a latest-generation smartphone, to which a dedicated patient application was installed. The latter was coupled with a web-based platform designed for physician use, forming the patient-physician interface (PFI). On top of standard-of-care verbal and written exercise recommendations, study physicians also prescribed individualized, guideline-directed exercise regimens for each patient via the PFI, which, in turn, delivered to subjects notifications upon detection of deviations (Picture 2). The first month of participation -during which the smartwatch was used as an activity tracker but exercise notifications had not been activated- served as the baseline period; baseline physical activity level in steps per day was then compared to the respective value measured during each of the 5 following months. Results Mean baseline-to-peak increase in daily step count was calculated at 23.34% (-20.33 - 103.63%). A baseline-to-peak increase in physical activity level of at least 20% was observed in 9/19 patients, with 6 more demonstrating a baseline-to-peak increase in the order of magnitude of 15-19.99%. Only 3 patients failed to achieve any increase in daily step count average. However, after the study month in which the peak physical activity value was observed (typically in the 2nd-4th study month), mean daily step count declined to baseline again in all but 2 patients. Conclusions Despite the study's non-randomized design and small sample size, our results suggest that mobile application-based telerehabilitation constitutes a promising approach in HF patients’ care, as it could aid them achieve a clinically relevant increase in physical activity; this effect, however, can be transient, and this highlights the importance of continued physician oversight.Picture 1: Clinical characteristicsPicture 2: Exercise prescription example

Feasibility of a problem-solving exercise program based on short physical performance battery for older patients with chronic respiratory diseases: A multicenter, pilot clinical trial

BackgroundThis study aimed to assess the feasibility and safety of a problem-solving exercise program based on the items in the short physical performance battery (SPPB) for older patients with chronic respiratory diseases (CRDs) to inform future randomized controlled trials. MethodsThis was a multicenter, prospective, non-randomized feasibility study. Participants with CRD received an enhancement program based on the SPPB decline items (balance, walk, and/or chair stand) for 4 weeks. The feasibility, safety, and efficacy of the problem-solving exercise program in improving the SPPB score, physical function, and step count (measured using a pedometer) were assessed. ResultsOverall, 36 patients were enrolled in this study, and adherence to the exercise program was high (100%). No exercise program-related adverse events were observed. The implementation of the exercise program ranged from 70 to 100%. The mean daily step count increased from 2152 ± 1498 steps during the first week to 2899 ± 1865 steps in the last week (p<0.01). Additionally, the SPPB total score increased from 8.9 ± 1.8 points to 10.7 ± 1.3 points at the end of the program (p<0.001). ConclusionsThe problem-solving exercise program based on SPPB is feasible and safe for older patients with CRDs. However, the effectiveness of this exercise program should be validated in large-scale, randomized-controlled trials in the future. Trial registrationUniversity Hospital Medical Information Network Center (UMIN-CTR) UMIN: approval number: UMIN000048761.

Abstract 25: The Blood Pressure Effects of a Just-in-time-adaptive Intervention for Physical Activity and Diet in Patients with Hypertension: A Randomized Controlled Trial

Background: Emerging data suggest mobile health interventions are a promising approach for managing hypertension, but large-scale studies are lacking. The myBPmyLife mobile application is a just-in-time adaptive intervention incorporating behavioral change strategies such as goal setting, prompts, visualizations, and feedback to encourage increased physical activity and lower-sodium food choices. Methods: The study was a prospective, randomized-controlled trial that enrolled patients with hypertension from the University of Michigan Health in Ann Arbor, MI, and the Hamilton Community Health Network, a series of federally qualified health center clinics, in Flint, MI. Participants were randomized 1:1 to either the intervention group receiving the myBPmyLife mobile application or the control group and followed for 6 months. Participants in both groups received a smartwatch and a Bluetooth blood pressure (BP) monitor and were prompted to perform BP measurements once weekly. The primary outcome was systolic BP (SBP) change from baseline to 6 months. Secondary outcomes included change from baseline to 6 months in mean daily step count assessed by smartwatch and mean daily sodium intake assessed by the Block sodium screener. Results: The study enrolled 602 participants between December 2021 and July 2023. Mean age was 59.6 years (SD 14), with 74.4% self-identifying as White and 51.7% as men. Baseline estimated sodium intake was 3089 mg (SD 1078) per day, mean step count was 7618 (SD 3778) steps per day, SBP was 132 (SD 15) mmHg, and diastolic blood pressure (DBP) was 82 (SD 10) mmHg. Change in SBP from baseline to 6 months was -5.2 (SD 15) mmHg in the intervention and -5.7 (SD 15) mmHg in the control group (Table; p=0.76). Change in DBP from baseline to 6 months was -3.0 (SD 9) mmHg in the intervention and -3.6 (SD 10) mmHg in the control group (p=0.52). From baseline to 6 months, estimated daily sodium intake decreased by 1145 mg (SD 1023) in the intervention and 860 mg (SD 1001) in the control group (p=0.002), while mean daily step count increased by 170 steps (SD 2690) in the intervention and decreased by 319 steps (SD 2612) in the control group (p=0.040). Conclusion: A mobile health intervention, myBPmyLife, promoting lifestyle modification in hypertensive patients did not change SBP over 6 months compared to the control group despite significantly improving daily sodium intake and step count over that period.

Effect of gamification with a support partner to increase physical activity in older adults at risk for Alzheimer's disease: The STEP 4Life randomized clinical trial.

Physical activity is associated with reduced risk of cognitive and functional decline but scalable, sustainable interventions for populations at risk for Alzheimer's disease (AD) and AD and related dementias (ADRD) are lacking. A 12-week randomized-controlled trial was conducted with a 3-week follow-up using a national AD prevention registry (GeneMatch). The control group (n=50) set step goals and received daily feedback. The intervention group (n=44) also received a behaviorally designed game based on achieving step goals and reinforced by a support partner. Intervention participants (94 participants, mean age 70, 78% female) had greater change in mean daily step count than control of 1699 steps/day (95% confidence interval [CI], 1149-2249), P<0.0001, which was sustained in the follow-up period at 1219 steps/day (95% CI, 455-1983), P=0.0018. Carriers of the apolipoprotein E ε4 gene (high risk) did not perform differently than non-carriers; however, high self-reported risk perception was associated with higher activity. A gamified intervention was effective in promoting and sustaining higher physical activity in older adults at genetic risk for AD/ADRD. A simple game played with a support partner increased walking in older adults at risk for Alzheimer's disease (AD). The game also increased minutes of moderate-to-vigorous physical activity per day. Perception of lifelong AD risk was associated with increased activity but genetic risk (apolipoprotein E ε4+) was not. ClinicalTrials.gov: NCT05069155.

Evaluation of a mobile behavior change program for weight loss in breast cancer survivors

Post-diagnosis weight gain is common in early-stage breast cancer and is associated with increased risk of recurrence and mortality. Intentional weight loss is difficult to maintain, and digital lifestyle interventions may provide a scalable approach to address this challenge. In this prospective single-arm study (ClinicalTrials.gov NCT04753268; February 15, 2021), key eligibility criteria included: stage I–III breast cancer, body mass index (BMI) ≥ 27.5 kg/m2, and completion of cancer treatment ≥6 months before study enrollment. Participants were provided with a behavioral change mobile application (Noom®). The primary endpoint was a change in self-reported weight from baseline to 26 weeks. Secondary endpoints included engagement, changes in physical activity, dietary patterns, and patient-reported outcomes (PRO). In total, 31 patients were enrolled (mean age 56.8 ± 9.9, mean baseline BMI 33.5 kg/m2 ± 6.5). The mean weight change was −4.8 kg ( ± 4.4, P < 0.001), mean percent weight change was −5.6% ( ± 5.0%); 11/31 patients (35.5%) lost ≥5% of their initial weight. Metrics of digital application engagement associated with weight loss ≥5% included articles read (P = 0.012), weights logged (P = 0.006), food records logged (P = 0.001), messages sent (P = 0.001), and application open count (P = 0.014). Significant increases were seen in mean daily step count (P = 0.004), GPAQ scores (P = 0.002), and Body Image Scale scores (P < 0.001). Mean energy intake remained consistently in a calorie-restricted range of 1300–1400 kcal/day. In this study, breast cancer survivors were highly engaged with a behavioral change smartphone application which led to clinically significant weight loss, increased physical activity, maintenance of an energy-restricted diet, and improvements in body image.

Association of Remote Patient-Reported Outcomes and Step Counts With Hospitalization or Death Among Patients With Advanced Cancer Undergoing Chemotherapy: Secondary Analysis of the PROStep Randomized Trial.

Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death. The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death. The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data. Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI -277 to -213; P<.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change -892), nausea score (-677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P=.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P<.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P=.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P=.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P=.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P=.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively. In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes. ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768. RR2-10.1136/bmjopen-2021-054675.

A randomized controlled trial of an app-based intervention on physical activity and glycemic control in people with type 2 diabetes.

We investigated the effects of a physical activity encouragement intervention based on a smartphone personal health record (PHR) application (app) on step count increases, glycemic control, and body weight in patients with type 2 diabetes (T2D). In this 12-week,single-center, randomized controlled, 12-week extension study, patients with T2D who were overweight or obese were randomized using ratio 1:2 to a group using a smartphone PHR app (control group) or group using the app and received individualized motivational text messages (intervention group) for 12weeks. During the extension period, the sending of the encouraging text messages to the intervention group was discontinued. The primary outcome was a change in daily step count after 12weeks and analyzed by independent t-test. The secondary outcomes included HbA1c, fasting glucose, and body weight analyzed by paired or independent t-test. Of 200 participants, 62 (93.9%) and 118 (88.1%) in the control and intervention group, respectively, completed the 12-week main study. The change in daily step count from baseline to week 12 was not significantly different between the two groups (P = 0.365). Among participants with baseline step counts < 7,500 steps per day, the change in the mean daily step count at week 12 in the intervention group (1,319 ± 3,020) was significantly larger than that in control group (-139 ± 2,309) (P = 0.009). At week 12, HbA1c in the intervention group (6.7 ± 0.5%) was significantly lower than that in control group (6.9 ± 0.6%, P = 0.041) and at week 24, changes in HbA1c from baseline were significant in both groups but, comparable between groups. Decrease in HbA1c from baseline to week 12 of intervention group was greater in participants with baseline HbA1c ≥ 7.5% (-0.81 ± 0.84%) compared with those with baseline HbA1c < 7.5% (-0.22 ± 0.39%) (P for interaction = 0.014). A significant reduction in body weight from baseline to week 24 was observed in both groups without significant between-group differences (P = 0.370). App-based individualized motivational intervention for physical activity did not increase daily step count from baseline to week 12, and the changes in HbA1c levels from baseline to week 12 were comparable. ClinicalTrials.gov (NCT03407222).

Cross-sectional associations between temporal patterns and composition of upright and stepping events with physical function in midlife: Insights from the 1970 British Cohort Study.

Age-related decline in physical functioning has significant implications for health in later life but declines begin earlier in midlife. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between patterns of PA accumulation, including the composition, variation, and temporal distribution of upright and stepping events, with physical function in midlife. Participants (n = 4378) from the 1970 British Cohort Study wore an activPAL3 accelerometer on the thigh for 7 consecutive days. Exposure measures included a suite of metrics describing the frequency, duration, and composition of upright events, as well as the duration and volume (total steps) of stepping events. In addition, patterns of accumulation of upright and sedentary events were examined including how fragmented/transient they were (upright-to-sedentary transition probability [USTP]) and their burstiness (the tendency for events to be clustered together followed by longer interevent times). Physical function outcomes included grip strength (GS), balance, and SF-36 physical functioning subscale (SF-36pf). Cross-sectional analyses included multivariable linear regression models to assess associations, adjusting for covariates including overall PA volume (mean daily step count). Higher upright event burstiness was associated with higher GS, and higher USTP was associated with lower GS. Duration and step volume of stepping events were positively associated with SF-36pf in females. Step-weighted cadence was positively associated with SF-36pf and balance. Contradictory findings were also present (e.g., more transient stepping events were associated with better GS) particularly for GS in males. Inconsistencies between sexes were observed across some associations. Our study reveals that diverse patterns of PA accumulation exhibit distinct associations with various measures of physical function in midlife, irrespective of the overall volume. Contradictory findings and inconsistency between sexes warrant further investigation. Patterns of PA accumulation, in addition to volume, should be considered in future PA research. Longitudinal studies are required to determine whether a given volume of activity accumulated in different patterns, impacts associations between PA and health outcomes.

Impact of sleep quality and physical activity on blood pressure variability.

Increased blood pressure variability (BPV) is linked to cardiovascular disease and mortality, yet few modifiable BPV risk factors are known. We aimed to assess the relationship between sleep quality and activity level on longitudinal BPV in a cohort of community-dwelling adults (age ≥18) from 17 countries. Using Withings home measurement devices, we examined sleep quality and physical activity over one year, operationalized as mean daily step count and number of sleep interruptions, both transformed into tertiles. The primary study outcome was high BPV, defined as the top tertile of systolic blood pressure standard deviation. Our cohort comprised 29,375 individuals (mean age = 58.6 years) with 127.8±90.1 mean days of measurements. After adjusting for age, gender, country, body mass index, measurement days, mean blood pressure, and total time in bed, the odds ratio of having high BPV for those in the top tertile of sleep interruptions (poor sleep) was 1.37 (95% CI, 1.28-1.47) and 1.44 (95% CI, 1.35-1.54) for those in the lowest tertile of step count (physically inactive). Combining these exposures revealed a significant excess relative risk of 0.20 (95% CI, 0.04-0.35, p = 0.012), confirming their super-additive effect. Comparing individuals with the worst exposure status (lowest step count and highest sleep interruptions, n = 2,690) to those with the most optimal status (highest step count and lowest sleep interruptions, n = 3,531) yielded an odds ratio of 2.01 (95% CI, 1.80-2.25) for high BPV. Our findings demonstrate that poor sleep quality and physical inactivity are associated with increased BPV both independently and super-additively.

117 Standardizing Wearable-based Real-life Physical Activity Monitoring in Patients Undergoing Surgery for Degenerative Lumbar Disorders

INTRODUCTION: Assessment of function in patients with degenerative thoracolumbar disorders (DTD) has traditionally relied solely on the patient’s subjective perception of disability. There is a clear need to better understand an objective measure of physical activity impairment in this patient cohort. METHODS: This analysis is part of the Stanford SpineTrak study, a RCT to assess the feasibility of using a commercially available smartwatch (AppleWatch) to monitor outcome in patients with DTD. Mean preoperative physical activity 2 weeks before surgery was expressed as raw step count, as well as in standardized z-scores that wre referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures (PROMs) and impairment in activity was stratified into performance groups based on z-score cut-off values. RESULTS: Of 67 patients with DTD, 65 patients (62% female) with a mean age (SD) of 63.8 (12.8) years were available for analysis with a mean (SD) daily step count of 5215 (3868). Physical activity showed significant correlation with the ODI (r = 0.28, 95% CI -0.49-0.03), SF36-PCS (r = -0.34, 95% CI 0.11-0.54) and PROMIS-PF (r = -0.48, 95% CI 0.27-0.65). No, Mild, moderate, and severe impairment in activity performance were defined as corresponding z-scores of &gt;0, 0 to -0.99, -1 to -1.99 and = -2, accounting for 20%, 29%, 43% and 8% of the study population. Each 1-step increase in activity impairment resulted in increased subjective disability as measured by the ODI, SF36-PCS and PROMIS-PF (all &lt; 0.05). CONCLUSIONS: This study establishes a new wearable-based objective measure of real-life physical activity as well as corresponding standard scores that allow for a direct comparison of test results between individual patients and different study populations.

Physical activity among pregnant inpatients and outpatients and associations with anxiety

ObjectivePhysical activity is linked to lower anxiety, but little is known about the association during pregnancy. This is especially important for antepartum inpatients, who are known to have increased anxiety yet may not be able to achieve target levels of physical activity during hospitalization. We compared physical activity metrics between pregnant inpatients and outpatients and explored correlations with anxiety. Materials and MethodsThis was a prospective cohort between 2021 and 2022 of pregnant people aged 18–55 years carrying singleton gestations ≥ 16 weeks. Three exposure groups were matched for gestational age: 1) outpatients from general obstetric clinics; 2) outpatients from high-risk Maternal-Fetal Medicine obstetric clinics; and 3) antepartum inpatients. Participants wore Actigraph GT9X Link accelerometer watches for up to 7 days to measure physical activity. The primary outcome was mean daily step count. Secondary outcomes were metabolic equivalent tasks (METs), hourly kilocalories (kcals), moderate to vigorous physical activity (MVPA) bursts, and anxiety (State-Trait Anxiety Inventory [STAI]). Step counts were compared using multivariable generalized estimating equations adjusting for maternal age, body-mass index, and insurance type as a socioeconomic construct, accounting for within-group clustering by gestational age. Spearman correlations were used to correlate anxiety scores with step counts. Results58 participants were analyzed. Compared to outpatients, inpatients had significantly lower mean daily steps (primary outcome, adjusted beta −2185, 95 % confidence interval [CI] −3146, −1224, p < 0.01), METs (adjusted beta −0.18, 95 % CI −0.23, −0.13, p < 0.01), MVPAs (adjusted beta −38.2, 95 % CI −52.3, −24.1, p < 0.01), and kcals (adjusted beta –222.9, 95 % CI −438.0, −7.8, p = 0.04). Over the course of the week, steps progressively decreased for inpatients (p-interaction 0.01) but not for either of the outpatient groups. Among the entire cohort, lower step counts correlated with higher anxiety scores (r = 0.30, p = 0.02). ConclusionWe present antenatal population norms and variance for step counts, metabolic equivalent tasks, moderate to vigorous physical activity bursts, and kcals, as well as correlations with anxiety. Antepartum inpatients had significantly lower physical activity than outpatients, and lower step counts correlated with higher anxiety levels. These results highlight the need for physical activity interventions, particularly for hospitalized pregnant people.

Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort.

Adults with type 1 diabetes should perform daily physical activity to help maintain health and fitness, but the influence of daily step counts on continuous glucose monitoring (CGM) metrics are unclear. This analysis used the Type 1 Diabetes Exercise Initiative (T1DEXI) dataset to investigate the effect of daily step count on CGM-based metrics. In a 4 week free-living observational study of adults with type 1 diabetes, with available CGM and step count data, we categorised participants into three groups-below (<7000), meeting (7000-10,000) or exceeding (>10,000) the daily step count goal-to determine if step count category influenced CGM metrics, including per cent time in range (TIR: 3.9-10.0 mmol/l), time below range (TBR: <3.9 mmol/l) and time above range (TAR: >10.0 mmol/l). A total of 464 adults with type 1 diabetes (mean±SD age 37±14 years; HbA1c 48.8±8.1 mmol/mol [6.6±0.7%]; 73% female; 45% hybrid closed-loop system, 38% standard insulin pump, 17% multiple daily insulin injections) were included in the study. Between-participant analyses showed that individuals who exceeded the mean daily step count goal over the 4 week period had a similar TIR (75±14%) to those meeting (74±14%) or below (75±16%) the step count goal (p>0.05). In the within-participant comparisons, TIR was higher on days when the step count goal was exceeded or met (both 75±15%) than on days below the step count goal (73±16%; both p<0.001). The TBR was also higher when individuals exceeded the step count goals (3.1%±3.2%) than on days when they met or were below step count goals (difference in means -0.3% [p=0.006] and -0.4% [p=0.001], respectively). The total daily insulin dose was lower on days when step count goals were exceeded (0.52±0.18 U/kg; p<0.001) or were met (0.53±0.18 U/kg; p<0.001) than on days when step counts were below the current recommendation (0.55±0.18 U/kg). Step count had a larger effect on CGM-based metrics in participants with a baseline HbA1c ≥53 mmol/mol (≥7.0%). Our results suggest that, compared with days with low step counts, days with higher step counts are associated with slight increases in both TIR and TBR, along with small reductions in total daily insulin requirements, in adults living with type 1 diabetes. The data that support the findings reported here are available on the Vivli Platform (ID: T1-DEXI; https://doi.org/10.25934/PR00008428 ).

Life-course social participation and physical activity in midlife: longitudinal associations in the 1970 British Cohort Study (BCS70)

A hypothesized benefit of social participation is that it encourages people to be more physically active. However, limited evidence exists on the association between social participation over the life-course and physical activity in midlife. We sought to apply a life-course framework to examine the association of social participation and device measured physical activity in midlife in the UK. We used the 1970 British Birth Cohort Study (BCS70), which includes all people born in Britain during a single week in 1970. Social participation was assessed at ages 16, 30, 34 and 42. Physical activity was measured by accelerometery at age 46, as mean daily step count and time spent in moderate to vigorous physical activity (MVPA). The associations of social participation and physical activity were tested using two different life-course models: the sensitive period model and the accumulation model. Individuals with medium and high participation compared to no social participation over their life-course had higher mean daily step count and MVPA in midlife, supporting the accumulation model. In the sensitive period model, only those that actively participated at age 42 had higher mean daily steps and MVPA compared to those who did not participate. Our study provides empirical evidence on the importance of sustaining social participation at all ages over the life-course rather than at a particular timepoint of someone’s life. If our findings reflect causal effects, interventions to promote social participation throughout the life-course could be an avenue to promote physical activity in middle life.

Standardizing Continuous Physical Activity Monitoring in Patients with Cervical Spondylosis.

Prospective cohort study. To use a commercial wearable device to measure real-life, continuous physical activity in patients with CS and to establish age-adjusted and sex-adjusted standardized scores. Patients with cervical spondylosis (CS) often present with pain or neurologic deficits that result in functional limitations and inactivity. However, little is known regarding the influence of CS on the patient's real-life physical activity. This study included 100 English-speaking adult patients with cervical degenerative diseases undergoing elective spine surgery at Stanford University who owned iPhones. Patients undergoing surgery for spine infections, trauma, tumors, or lumbar degenerative disease were excluded. Activity two weeks before surgery was expressed as raw daily step counts. Standardized z-scores were calculated based on age-specific and sex-specific values of a control population. Responses to patient-reported outcome measures (PROMs) surveys assessed convergent validity. Functional impairment was categorized based on predetermined z-score cut-off values. Thirty CS with a mean (±SD) age of 56.0 (±13.4) y wore an Apple Watch for ≥8 hours/day in 87.1% of the days. The mean watch wear time was 15.7 (±4.2) hours/day, and the mean daily step count was 6400 (±3792). There was no significant difference in activity between 13 patients (43%) with myelopathy and 17 (57%) without myelopathy. Test-retest reliability between wearable step count measurements was excellent (ICC β=0.95). Physical activity showed a moderate positive correlation with 36-Item Short Form Survey Physical Component Summary, EuroQol-5-dimension visual analog scale, and Patient-Reported Outcomes Measurement Information System Physical Function Subscale. Activity performance was classified into categories of "no impairment" [step count=9640 (±2,412)], "mild impairment" [6054(±816)], "moderate impairment" [3,481 (±752)], and "severe impairment" [1,619 (±240)]. CS patients' physical activity is significantly lower than the general population or the frequently stated goals of 7000 to 10,000 steps/day. Standardized, continuous wearable physical activity monitoring in CS is a reliable, valid, and normalized outcome tool that may help characterize functional impairment before and after spinal interventions.

Effect of kaempferol ingestion on physical activity and sleep quality: a double-blind, placebo-controlled, randomized, crossover trial.

Kaempferol (KMP), a flavonoid in edible plants, exhibits diverse pharmacological effects. Growing body of evidence associates extended lifespan with physical activity (PA) and sleep, but KMP's impact on these behaviors is unclear. This double-blind, placebo-controlled, crossover trial assessed KMP's effects on PA and sleep. A total of 33 city workers (17 males and 16 females) participated in this study. They were randomly assigned to take either 10 mg of KMP or placebo for 2 weeks in the order allocated, with a 7-day washout period in between. All participants wore an accelerometer-based wearable device (Fitbit Charge 4), which monitored daily PA, heart rate (HR), and HR variability during sleep. The duration of wearing the device was 23.73 ± 0.04 h/day. HR decreased in each PA level, and the mean daily step count and distance covered increased significantly during KMP intake compared to placebo. The outing rate, number of trips, number of recreational activities, and time spent in recreation on weekends increased. Sleep quality improved following KMP intake. The decrease in HR and increase in RMSSD may be important in mediating the effects of these KMPs. KMP leads to behavioral changes that subsequently improve sleep quality and potentially improve long-term quality of life. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048447, UMIN000042438.

Accuracy of consumer-based activity trackers to measure and coach patients with lower limb lymphoedema.

This study investigated the accuracy of activity trackers in chronic lower limb lymphoedema (LLL) patients and in comparison to matched controls. Seventeen LLL patients and 35 healthy subjects wore an activity tracker at the hip (Fitbit Zip/Inspire; hip-AT) and one at the wrist (Fitbit Alta/Inspire; wrist-AT) combined with a reference activity monitor (Dynaport Movemonitor; DAM), for 14 consecutive days. To analyze accuracy and agreement, mean daily step count from both AT's were compared to DAM. To evaluate the accuracy as coaching tool, day-by-day differences were calculated. The Kendall correlation coefficient was used to test consistency of ranking daily steps between the AT's and the DAM. The wrist-AT significantly overestimated daily step count compared to DAM in the LLL group (+1221 ± 1754 steps per day, p = 0.011) while the hip-AT underestimated the step count, although not significantly. Similar results were found in the healthy control group. As a coaching tool, both wrist-AT and hip-AT showed a moderate correlation with the DAM (r = 0.507 and 0.622, respectively) in the LLL group regarding consistency of ranking from most to least active days. Wrist-AT's significantly overestimate daily step count in a LLL population. As a coaching tool, both trackers show moderate validity, indicating applicability to improve physical activity.

Sharing History through Active Reminiscence and Photo‐imagery‐SHARP: Feasibility and acceptability of digital biomarker technology among older Black adults

AbstractBackgroundMore nuanced data collection beyond pre/post measures can detect real‐time changes in activity levels, sleep, and other factors that may signal transition in cognitive health.MethodNine Black adults (n = 4 healthy, mean age 71.1; n = 5 mildly cognitively impaired (MCI), mean age 79.2) tested the feasibility of adding digital biomarker technology to the SHARP walking study in Portland, Oregon. Up to 8 weeks, participants wore an actigraphy watch that captured continuous activity data, used an under‐the‐mattress sensor that captured daily sleep data, and completed online health forms that captured weekly changes. The second 4‐8 weeks and in triads, participants walked and conversationally reminisced together on three 1‐mile routes/week using the SHARP smartphone application. Means were calculated from group aggregated data (MCI/healthy). Content analysis of group discussions assessed technology acceptability.ResultWatch step data was collected on average 60.4±51.2 days per participant, representing on average 75.0±29.2% of the days step data was collected. Watch sleep data was collected on average 47.6±40.5 days per participant, representing on average 62.5±33.7% of the days sleep data was collected. Under‐the‐mattress sensor sleep data was collected on average 79.3±42.9 days per participant, representing on average 79.0±24.8% of the days sensor data was collected. MCI participants had lower mean daily step count at 1140 compared to 2570 steps for healthy participants, and lower mean sleep time at 5.07 hours compared to 6.71 hours for healthy participants. MCI had lower mean survey response rates, even with weekly reminders, at 60% compared to 91% for healthy participants, and notably longer mean response times at 472 seconds compared to 195 seconds for healthy participants. Participants generally accepted technology, with caveats: more explanation of technology, better watch step count displays, and watch band options as silicone was uncomfortable in heat and water, prompting discontinuous wear.ConclusionUsing digital biomarker technology for more continuous data capture with older adults including those with MCI is feasible. However, teams should anticipate increased support for MCI participants and potentially longer technology deployment and set‐up. More continuous data reveal real‐time changes that may signal transitions in cognitive health, allowing for a timelier response from healthcare partners.

Wearable technology interventions in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and is associated with multiple medical and psychological comorbidities. Therefore, future strategies to improve COPD management and outcomes are needed for the betterment of patient care. Wearable technology interventions offer considerable promise in improving outcomes, but prior reviews fall short of assessing their role in the COPD population. In this systematic review and meta-analysis we searched ovid-MEDLINE, ovid-EMBASE, CINAHL, CENTRAL, and IEEE databases from inception to April 2023 to identify studies investigating wearable technology interventions in an adult COPD population with prespecified outcomes of interest including physical activity promotion, increasing exercise capacity, exacerbation detection, and quality-of-life. We identified 7396 studies, of which 37 were included in our review. Meta-analysis showed wearable technology interventions significantly increased: the mean daily step count (mean difference (MD) 850 (494–1205) steps/day) and the six-minute walk distance (MD 5.81 m (1.02–10.61 m). However, the impact was short-lived. Furthermore, wearable technology coupled with another facet (such as health coaching or pulmonary rehabilitation) had a greater impact that wearable technology alone. Wearable technology had little impact on quality-of-life measures and had mixed results for exacerbation avoidance and prediction. It is clear that wearable technology interventions may have the potential to form a core part of future COPD management plans, but further work is required to translate this into meaningful clinical benefit.

Standardizing Physical Activity Monitoring in Patients With Degenerative Lumbar Disorders.

Degenerative thoracolumbar disorders (DTDs) typically cause pain and functional impairment. However, little is known regarding the DTD impact on patient's real-life physical activity. The objective of this study is to validate a wearable measure of physical activity monitoring in patients with DTD and to create gender- and sex-specific performance thresholds that are standardized to the mean of a control population. A commercially available smartwatch (Apple Watch) was used to monitor preoperative physical activity in patients undergoing surgery for DTD. Mean preoperative physical activity 2 weeks before the scheduled surgery was expressed as raw step count. Standardized z-scores were referenced to age- and sex-specific values of a control population from a large public database. Step counts were assessed for convergent validity with established patient-reported outcome measures, and impairment in activity was stratified into performance groups based on z-score cutoff values. Sixty-five patients (62% female) with a mean (±SD) age of 63.8 (±12.8) years had a mean preoperative daily step count of 5556 (±3978). Physical activity showed significant correlation with patient-reported outcome measures, including Oswestry disability index (r = -0.26, 95% CI: -0.47-0.01), 36-Item Short Form Survey Physical Component Summary score (r = 0.30, 95% CI: 0.06-0.51), and Patient-Reported Outcomes Measurement Information System Physical Function (r = 0.49, 95% CI: 0.27-0.65). "No," "Mild," "moderate," and "severe impairment" in activity performance were defined as corresponding z-scores of >0, 0 to -0.99, -1 to -1.99, and ≤-2, accounting for 22%, 34%, 40%, and 5% of the study population. Each one-step category increase in activity impairment resulted in increased subjective disability as measured by the Oswestry Disability Index, 36-Item Short Form Survey Physical Component Summary, and Patient-Reported Outcomes Measurement Information System Physical Function (all P -values <.05). We establish the first wearable objective measure of real-life physical activity for patients with DTD, with the first age- and sex-adjusted standard scores to enable clinicians and researchers to set treatment goals and directly compare activity levels between individual patients with DTD and normal controls.

Reduction of Financial Health Incentives and Changes in Physical Activity.

Governments and others continue to use financial incentives to influence citizen health behaviors like physical activity. However, when delivered on a population scale they can be prohibitively costly, suggesting more sustainable models are needed. To evaluate the association of incomplete financial incentive withdrawal ("schedule thinning") with physical activity after more than a year of incentive intervention and to explore whether participant characteristics (eg, app engagement and physical activity) are associated with withdrawal outcomes. This case-control study with a pre-post quasi-experimental design included users of a government-funded health app focused on financial incentives. Eligible participants were residents in 3 Canadian provinces over 25 weeks in 2018 and 2019. Data were analyzed from July 2021 to December 2022. Due to fiscal constraints, financial incentives for daily physical activity goals were withdrawn in Ontario in December 2018 (case)-representing a 90% reduction in incentive earnings-but not in British Columbia or Newfoundland and Labrador (controls). The primary outcome was objectively assessed weekly mean daily step count. Linear regression models were used to compare pre-post changes in daily step counts between provinces (a difference-in-differences approach). Separate models were developed to examine factors associated with changes in daily step count (eg, app engagement and physical activity). Clinically meaningful initial effect sizes were previously reported (approximately 900 steps/d overall and 1800 steps/d among the physically inactive). In total there were 584 760 study participants (mean [SD] age, 34.3 [15.5] years; 220 388 women [63.5%]), including 438 731 from Ontario, 124 101 from British Columbia, and 21 928 from Newfoundland and Labrador. Significant physical activity declines were observed when comparing pre-post changes in Ontario to British Columbia (-198 steps/d; 95% CI, -224 to -172 steps/d) and Newfoundland and Labrador (-274 steps/d; 95% CI, -323 to -225 steps/d). The decrease was most pronounced for highly engaged Ontario users (-328 steps/d; 95% CI, -343 to -313 steps/d). Among physically inactive Ontario users, physical activity did not decline following withdrawal (107 steps/d; 95% CI, 90 to 124 steps/d). In this case-control study of incomplete financial incentive withdrawal, statistically significant daily step count reductions were observed in Ontario; however, these declines were modest and not clinically meaningful. Amidst substantial program savings, the physical activity reductions observed here may be acceptable to decision-makers working within finite budgets.