Sleep Activity Research Articles

The Evaluation of Physical Activity Levels and Sleep Quality of High School and University Students During the COVID-19 Pandemic

The Evaluation of Physical Activity Levels and Sleep Quality of High School and University Students During the COVID-19 Pandemic

Physical activity and sleep moderate the relationship between stress and screen time in college-aged adults

For undergraduate students, excessive screen time is associated with poorer mental health and greater perceived stress. Objective: The purpose of the present investigation was to determine the potential moderating influence of physical activity and sleep on the relationship between screen time and stress. Participants & Methods: A cross-sectional sample of 513 undergraduate students between Fall 2017 & Spring 2020 were given a questionnaire to assess perceived stress level, physical activity engagement, screen time, and sleep. Results: Stepwise hierarchical regression analyses identified that screen time, sleep, and the three-way interaction between screen time, sleep, and physical activity were associated with stress. Post-hoc decomposition revealed that higher levels of physical activity and sleep both mitigated the relationship between screen time and stress. Conclusions: Findings suggest that modifiable health behaviors such as physical activity and sleep may be important factors for managing the negative effects of screen time on stress in college-aged adults.

Induction of Fatigue by Specific Anthracycline Cancer Drugs through Disruption of the Circadian Pacemaker.

Simple SummaryCancer-related fatigue (CRF) is a devastating side effect of cancer treatment, affecting the quality of life of many patients for years after treatment. This long-term side effect often results in loss of social functioning and even job loss. The cause of CRF is unknown, and consequently, CRF is often considered a ‘psychological problem’, much to the frustration of the patients. Here, we show in an animal model that the severity of CRF depends on the working mechanism of the treatment. In addition, the data show that the CRF is probably caused by a dysfunctioning circadian clock and thus has a physiological basis, as this effect depends on the anticancer drug. Therefore, the findings may have implications for the selection of chemotherapy and thus strongly improve the quality of life of future cancer survivors.Cancer-related fatigue (CRF) is the most devastating long-term side effect of many cancer survivors that confounds the quality of life for months to years after treatment. However, the cause of CRF is poorly understood. As a result, cancer survivors, at best, receive psychological support. Chemotherapy has been shown to increase the risk of CRF. Here, we study therapy-induced fatigue in a non-tumor-bearing mouse model with three different topoisomerase II-poisoning cancer drugs. These drugs either induce DNA damage and/or chromatin damage. Shortly before and several weeks after treatment, running wheel activity and electroencephalographic sleep were recorded. We show that doxorubicin, combining DNA damage with chromatin damage, unlike aclarubicin or etoposide, induces sustained CRF in this model. Surprisingly, this was not related to changes in sleep. In contrast, our data indicate that the therapy-induced CRF is associated with a disrupted circadian clock. The data suggest that CRF is probably a circadian clock disorder that influences the quality of waking and that the development of CRF depends on the type of chemotherapy provided. These findings could have implications for selecting and improving chemotherapy for the treatment of cancer in order to prevent the development of CRF.

Are individuals with disabilities using wearable devices? A secondary data analysis of 2017 BRFSS

Purpose The study aims to investigate the prevalence of individuals with disabilities who reported using wearable devices, to examine the association between wearable device usage and disability status, and to determine the characteristic of individuals with disabilities associated with wearable device usage using the 2017 Behavioural Risk Factor Surveillance System (BRFSS) through secondary data analysis. Materials and methods Data from the 2017 BRFSS of eight states were used in the analysis. Descriptive analysis, chi-square analysis, and multivariable logistic regressions were performed. Subsample analyses were also conducted for individuals with disabilities and different types of disability, including visual impairments, hearing impairments, cognitive disability, independent living disability, self-care disability, and mobility disability on wearable device usage. Results 14.6% (95% CI [11.7, 17.5]) of participants with disabilities were wearable device users. Individuals with disabilities were .63 (95% CI [.48, .83], p < 0.001) and .67 (95% CI [.50, .90], p = 0.007) times the odds of individuals without disabilities in using wearable devices, respectively, according to unadjusted and adjusted logistic regression. Individuals with mobility disability were less likely to utilise wearable devices than their counterparts. Among individuals with disabilities, those who were age 65 years or older had a lower odds of using wearable devices (OR = .55, 95% CI [0.35, 0.85), p = 0.007). Conclusion Individuals with disabilities are using wearable devices in collecting various health-related information. Further research is needed to determine reasons why individuals with disabilities are not using wearable devices and how individuals with disabilities are using wearable devices. IMPLICATIONS FOR REHABILITATION Wearable devices can track various health-related information such as physical activity levels, sleep patterns, calories intakes, and chronic health conditions. Using nationally represent data, individuals with disabilities have access and utilise wearable devices in free living setting. Compare to individuals without disabilities, individuals with disabilities are less likely to utilise wearable devices in free living setting. Further research is needed to determine the accessibility of wearable devices for individuals with disabilities and its usage in rehabilitation setting.

Role of the insulin-like growth factor system in bone health and military relevance during military training

Introduction: Bone is in a constant state of remodelling to remove old or damaged bone and form new bone. This process of bone resorption and formation is ‘coupled’ to preserve bone size, structure, and mass. Several physiological challenges—typical of military training and employment—can disturb bone metabolism including high levels of physical activity and energy and sleep restriction. Accumulation of damaged bone during exercise stimulates targeted remodelling, a process where the resorption of damaged bone can cause pores in the cortical bone and eventually stress fracture.

Longitudinal association between the timing of adiposity peak and rebound and overweight at seven years of age

BackgroundThe timing of adiposity peak (AP) or adiposity rebound (AR) is a determinant of overweight or obesity in adolescence and adulthood. However, limited studies have reported the association in young school-age children. We aimed to evaluate this association and explore the role of health behaviours in it.MethodsRoutinely collected, sequential, anthropometric data from the 1st to 80th months of age were used to estimate AP and AR timings in 2330 children born in Shanghai between 2010 and 2013. Multivariate regression analyses were applied to identify the associations between the AP or AR timings and the risk of developing overweight or obesity in first-grade school children. The roles of health behaviours, including dietary patterns, physical activity level, sleep and snacking habits, and screen time, were also evaluated.ResultsChildren with a late AP or an early AR were at higher risk of overweight but not obesity or central obesity in their first grade. A high physical activity level was associated with a lower risk of having overweight in children with a late AP, and limited screen time was associated with a decreased risk of having overweight or obesity in children with an early AR. The absence of a late-night snacking habit in children with a non-early AR indicated a decreased risk of having overweight. However, this association was not observed among children with an early AR.ConclusionThe timings of AP and AR are tied to overweight in middle childhood. Prevention strategies are suggested to move forward to control late AP and early AR.

Associations between sleep, physical activity, and emotional well-being in emerging young adults: Implications for college wellness program development

Objectives: To examine sleep, physical activity, and their joint associations with physical functioning and affect. Participants: 108 undergraduates completed questionnaires assessing sleep, activity levels, emotional well-being and physical health markers. Results: Participants reported poor sleep quality, suboptimal sleep duration, and inconsistent physical activity. Poor sleep quality was associated with higher fatigue for both active and insufficiently active groups (F = 9.94, p = .002). There was a significant interaction between activity level and sleep duration on negative affect (F = 7.14, p = .009). Students who reported insufficient physical activity and less than 6 hours of sleep had the highest negative affect. Conclusions: Poor sleep quality was associated with increased fatigue. Students who inconsistently exercise and have suboptimal sleep may be at greater risk for affective difficulties. We recommend that college wellness interventions jointly target health behaviors and affect to optimize prevention efforts aimed at addressing physical and mental health outcomes, including depression and chronic illness.

Prevalence and correlates of meeting physical activity, screen time, and sleep duration guidelines among Brazilian adolescents: findings from ERICA.

The prevalence of meeting movement guidelines is low in developed countries; however, there is a lack of data among medium-income countries, including Brazil. We evaluated the prevalence and correlates of meeting physical activity, screen time, and sleep guidelines in Brazilian adolescents. Employing a cross-sectional design, Brazilian adolescents (aged 12-17years) were surveyed about their physical activity levels, sleep, and screen time. Data were collected at schools through a self-administered questionnaire using a personal digital assistant for entering the data. Poisson regression models were used to examine the associations between correlates (sex, age, socioeconomic status, region, skin colour, and shift of school) and meeting movement guidelines. A total of 58 535 adolescents were included. Although only 8.7% of the adolescents met all three movement guidelines, the prevalence of those who met physical activity, screen time, and sleep duration guidelines was 46.4%, 42.5%, and 40%, respectively. Moreover, male sex, age 14-15 years, black or brown skin colour, afternoon shift of school, and living in the Northern and Northeastern regions were associated with a higher prevalence of meeting all movement guidelines. The prevalence of adolescents who met all three movement guidelines was low among Brazilian adolescents. Adolescents living in less developed regions showed greater adherence to movement guidelines, suggesting a possible impact of the urbanization process on these behaviours. Novelty: The prevalence of Brazilian adolescents who met all three movement behaviour guidelines was around 9%. Among all adolescents, 40% met only one movement guideline.

CORRELATION BETWEEN PHYSICAL ACTVITIY AND SLEEP QUALITY IN MEDICAL STUDENTS DURING COVID-19 PANDEMIC

A downward trend of physical activity level within the population of college students was observed during the COVID-19 pandemic. Various adjustments within their daily habits caused changes to the population’s sleep quality and physical activity level. The purpose of this study is to research the correlation between physical activity level and sleep quality in preclinical medical students in Udayana University. This study was conducted using an analytic cross-sectional method and consecutive sampling technique involving 282 preclinical medical students of Udayana University from academic year of 2018, 2019, and 2020. The data were obtained via the scores of Global Physical Activity Questionnaire and Pittsburgh Sleep Quality Index. The GPAQ score showed that 123 (43.6%), 127 (45%), and 32 respondents (11.4%) respectively had a low, moderate, and high level of physical activity. Meanwhile, the PSQI score showed that 102 respondents (36.2%) had a good sleep quality and 180 respondents (63.8%) had a bad sleep quality. The average PSQI score of the respondents was 5.23 (cut off = 5). The correlation between the level of physical activity and sleep quality was analyzed using the Chi-Square method and was deemed insignificant (p = 0.172; 2-sided). The majority of preclinical medical students had low-to-moderate level of physical activity and bad sleep quality. No significant correlation was found between level of physical activity and sleep quality in preclinical medical students during the COVID-19 pandemic. Further studies are needed to determine other factors that might affect physical activity level and sleep quality within the population.&#x0D; Keywords : Physical Activity Level; Sleep Quality; GPAQ; PSQI; COVID-19

IDF21-0667 The associating factors on health-related quality of life in Korean midlife women with type 2 diabetes

Background: Midlife women have a higher prevalence rate of type II diabetes mellitus (DM) in their menopausal transition due to alternations in their insulin sensitivity and glucose metabolism. These hormonal changes during the menopausal transition could have negative impacts on women’s health-related quality of life (HRQoL). However, little is clearly known on the associations between type II DM and HRQoL among midlife women in South Korea. Aim: This study was to identify the associating factors on HRQoL among Korean midlife women with type II DM in their menopausal transition. Method: A secondary analysis was conducted with the data from the Korea National Health and Nutrition Examination Survey (2019). The data from 751 midlife women aged 40-64 who have HbA1c 5.7% or above were selected for this study. EQ-5D was used to assess HRQoL. Various background characteristics and health-related factors were also included. Data were analyzed using descriptive statistics, independent t-tests, chi-square test, and hierarchical multiple regression analyses with SPSS 28.0 program. Results: Mean age was 54.89(SD=6.48) years and the data included 628 prediabetes (HbAlc 5.7–6.4%), and 123 diabetes (HbA1c 6.5% or above) women. In subgroup analysis, diabetes group had earlier menopause age than prediabetes group (p < .001). Also, there was statistically significant difference in the score of HRQoL between diabetes status (p < .001). When background characteristics were controlled, the HRQoL was significantly correlated with menopausal status, physical activity level, sleep hours, stress, and depression. These variables explained 23.8% of the variance of HRQoL. Discussion: Both diabetes and menopausal-related symptoms have a negative impact on HRQoL among midlife women with type II DM. This study findings highlight the importance of intervening postmenopausal women with diabetes for sleep, stress, and depression, to improve their quality of life.

Dietary Habits, Physical Activity and Sleep Pattern Among In-School Adolescents in Lagos, Nigeria

Background: Overnutrition has been documented at epidemic levels in children and adults. The associated risk factors may include poor dietary habits, sedentary behaviour, inadequate sleep and low parental education.&#x0D; Objective: To describe dietary habits, physical activity and sleep patterns among secondary school adolescents.&#x0D; Methods: A cross-sectional study of 1,120 adolescents recruited from public and private secondary schools in Lagos, Nigeria, was carried out to study the dietary habits, sleep patterns and physical activity in relation to nutritional status.&#x0D; Results: Ten per cent of the adolescents skipped breakfast, while 28% had fruits on up to five days of the week. Eleven per cent had a sweetened drink every day, while 20 % had a sweetened drink on most days of the week. One out of four (26%) adolescents had more than two hours of screen time daily, and only 5% engaged in sporting activities up to five times weekly. One-third of the students slept for less than six hours daily and experienced sleeping difficulties. Multivariate analysis showed that females were twice as likely not to participate in sports (OR = 2.38, CI = 1.3-4.37, p = 0.002 and to have a higher intake of confectionaries (OR = 1.47, CI = 1.07-2.04, p = 0.01.&#x0D; Conclusion: Poor dietary habits, inadequate physical activity and insufficient sleep were observed among secondary school adolescents. A multi-pronged approach to improve these behaviours is recommended.

Associations between physical activity, sleep, and self-reported health with burnout of medical students, faculty and staff in an academic health center.

Background and objectivesHealth behaviors of physical activity and sleep are critical to the prevention of numerous chronic diseases. The health behaviors of healthcare professionals are even more critical, as healthcare providers who practice positive health behaviors are more likely to promote these healthy behaviors in their patients.AimsTo assess the health status and health behaviors of medical students, faculty, and staff in an academic health center in the US, and examine the associations between behaviors, physical and mental health outcomes and burnout.MethodsStudents, faculty, residents and staff from a large university medical system completed an online survey between late-September and mid-November 2019. Associations were examined between health behaviors and health status including mental health outcomes with burnout.ResultsParticipating in any leisure time physical activity and having a Pittsburgh Sleep Quality Index score < 5 were associated with fewer physical health conditions and lower odds of reporting pain at any site (n = 2060; students n = 242, residents n = 32, staff n = 1425, faculty n = 361). Leisure physical activity and fewer sleep symptoms were associated with fewer reported depressive, anxiety and stress-related symptoms. Participating in leisure physical activity and good-quality sleep were associated with lower odds of burnout.ConclusionsThe current study found high rates of physical inactivity and poor sleep among medical students, faculty and staff at an academic health center. These health behaviors were associated with poor mental health and high burnout. Programs and policies are needed improve these health behaviors to reduce burnout.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11332-022-00902-7.

Relationship of Physical Activity and Sleep Duration with Self-Concept, Mediterranean Diet and Problematic Videogame Use in Children: Structural Equation Analysis as a Function of Gender

Engagement in physical activity and sleep duration are crucial to the adequate psychosocial and healthy development of children. Thus, the aim of this study was to develop an explanatory model of the relationships of physical activity and sleep duration with self-concept, Mediterranean diet and problematic use of videogames. Accordingly, a structural model was contrasted by means of a multi-group analysis according to gender. A non-experimental study was conducted with a descriptive, cross-sectional design for a sample of 1154 students aged 11–12 years (M = 11.41 ± 0.49). An ad hoc questionnaire was used to record sociodemographic and physical-health attributes (physical activity time and sleep). Adherence to a Mediterranean diet was assessed using the KIDMED questionnaire, self-concept was assessed using “self-concept form-5” (AF-5) and problematic videogame use was assessed using the “Video Game-Related Experiences Questionnaire”. For data analysis, a multi-group structural equation analysis was performed. The results showed that physical activity was positively associated with self-concept, while sleep duration and self-concept were negatively related to problematic videogame use. In boys there was a direct effect of self-concept on sleep duration and adherence to the Mediterranean diet, while girls did not generate such differences. Although there is a negative association between physical activity and problematic videogame use in the theoretical model and in boys, girls showed a direct association between these factors. Finally, physical activity and sleep duration were directly related in boys and indirectly related in girls.

Zebrafish as a Tool in the Study of Sleep and Memory-related Disorders.

Sleep is an evolutionarily conserved phenomenon, being an important biological necessity for the learning process and memory consolidation. The brain displays two types of electrical activity during sleep: slow-wave activity or Non-Rapid Eye Movement (NREM) sleep, and desynchronized brain wave activity or Rapid Eye Movement (REM) sleep. There are many theories regarding "Why we need to sleep?"; one of them is the synaptic homeostasis. This theory suggests the role of sleep in the restoration of synaptic homeostasis, which is destabilized by synaptic strengthening triggered by learning during waking and by synaptogenesis during development. Sleep diminishes the plasticity load on neurons and other cells to normalize synaptic strength whereas it reestablishes neuronal selectivity and the ability to learn, leading to the consolidation and integration of memories. The use of zebrafish as a tool to assess sleep and its disorders is growing, although sleep in this animal is not yet divided, for example, into REM and NREM states. However, zebrafish are known to have a regulated daytime circadian rhythm, and their sleep state is characterized by periods of inactivity accompanied by an increase in arousal threshold, preference for resting place, and the "rebound sleep effect" phenomenon, which causes an increased slow-wave activity after a forced waking period. In addition, drugs known to modulate sleep, such as melatonin, nootropics, and nicotine have been tested in zebrafish. In this review, we discuss the use of zebrafish as a model to investigate sleep mechanisms and their regulation, demonstrating this species as a promising model for sleep research.

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study

Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655–2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35–80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized β-coefficient 0.214), followed by HDL-cholesterol (standardized β-coefficient − 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.

Abstract P222: The Psychological Predictors Of Recovery After Acute Cardiac Events Study: Rationale And Design

Objective: To estimate the prospective association of cardiac anxiety at cardiac arrest (CA) discharge with subsequent risk for cardiovascular disease (CVD)/mortality after adjusting for general psychological distress and test its independent association with health-related quality of life (HRQoL). Our second objective is to test whether cardiac anxiety after CA is associated with low physical activity (PA) and/or short sleep shortly after discharge. Our third objective will test if low PA and/or short sleep mediate the association between cardiac anxiety and 12-month CVD/mortality post-discharge for CA. Further, the study will test the associations of general psychological distress with cardiac vagal control assessed by activity-adjusted heart rate variability. Background: Survivorship after CA is on the rise. However, survivors remain at markedly elevated risk for CVD, and many report poor HRQoL in the year after CA. Cardiac anxiety (i.e., cardiac specific-fear, avoidance behavior, and excessive cardiac symptom monitoring) has been shown in non-CA CVD patients to be associated with higher rates of psychological distress, avoidance of PA and poor sleep, patient-reported disability, and poor perceived health. Further, despite the association of low PA and poor sleep in CVD risk, no study has assessed those health behaviors in CA survivors. Design/Methods: This observational cohort study (anticipated n = 246) will evaluate CVD prognosis, HRQoL in the first year of survivorship of neurologically intact CA survivors admitted to New York Presbyterian Hospital between May 2021 and April 2026. At hospital discharge, 1, 6, and 12 months, study participants will be assessed for cardiac anxiety, and general psychological distress (screening measures for depression, posttraumatic stress, generalized anxiety symptoms), positive psychological factors (optimism, positive affect, purpose in life), functional (modified Rankin Scale) and telephone-based cognitive assessments. For 1-week post-discharge, and 1 week at 6-months post-discharge we will assess the level of PA and sleep duration using wrist-worn actigraphy, daily psychological factors using mobile ecological momentary assessment, and heart rate/heart rate variability using chest-worn patches. Results: Of the 21 patients enrolled to date (mean age 57 years, 10 women). The presentation will describe patterns of physical activity, sleep, both negative and positive psychological factors at 1-month post-discharge relative to discharge status. Conclusions: This is the first major prospective cohort study of CA survivorship, and the first to objectively assess health behaviors. By identifying malleable intervention targets for improving both CVD/mortality risk and post-CA HRQoL, this study could ignite the development of the first generation of CA survivorship interventions.

A healthy lifestyle is the base of maintaining the health of schoolchildren

A healthy lifestyle is the base of maintaining the health of schoolchildren

Identification of Geriatric Depression and Anxiety Using Activity Tracking Data and Minimal Geriatric Assessment Scales

The identification of geriatric depression and anxiety is important because such conditions are the most common comorbid mood problems that occur in older adults. The goal of this study was to build a machine learning framework that identifies geriatric mood disorders of depression and anxiety using low-cost activity trackers and minimal geriatric assessment scales. We collected activity tracking data from 352 mild cognitive impairment patients, from 60 to 90 in age, by having them wear activity trackers on their wrist for more than a month. We then extracted the features of 24-h activity rhythms and sleep patterns from the time-series activity tracking data. To increase the accuracy, we designed a novel method to incorporate additional features from questionnaire-based assessments of the geriatric depression scale and geriatric anxiety inventory into the activity tracking features. In the multi-label classification, we applied the binary relevance method to develop two single-label classifiers for depression and anxiety. The best hyper-parameters of classification algorithms for each label were selected by comparing the classification performance. We finally selected the combination of classifiers for depression and anxiety with the lowest Hamming loss as a multi-label classifier. This study successfully demonstrated the possibility of identifying geriatric depression and anxiety using low-cost activity trackers and minimal geriatric assessment scales for use in the real fields.

Navigating the Online World of Lifestyle Health Information: Qualitative Study With Adolescents.

BackgroundAdolescence is a critical life stage characterized by an interplay of biological, social, and environmental factors. Such factors influence lifestyle health-related trajectories, including dietary behaviors, physical activity levels, body weight, and sleep. Generation Z (born 1995-2015) is the most internet-dependent and technologically savvy generation in history with increasing rates of smartphone ownership across high- and low-income countries. Gaps exist in understanding what online platforms adolescents are using and barriers and facilitators of these platforms to seek lifestyle health information.ObjectiveWe evaluated adolescents’ perceptions on the use of contemporary digital platforms (websites, social media platforms, smartphone apps) to seek lifestyle heath information or advice.MethodsVirtual focus groups were held via Zoom teleconference between July 2021 and August 2021. Eligible participants were 13 years to 18 years old, were living in Australia, and had searched for online lifestyle health information in the previous 3 months. For this study, lifestyle health information referred to key behaviors and risk factors for chronic disease, namely, diet, physical activity, weight management, and sleep. Participants were recruited through an existing database of research participants and networks of the research team. Focus groups were analyzed using the framework approach, in which data are systematically searched to recognize patterns in the data and manage, analyze, and identify themes. Focus group audio files were transcribed verbatim and independently coded by 2 researchers (RR, SSJ). Through an iterative, reflexive process, a final coding matrix was agreed on by all researchers and used to thematically analyze the data.ResultsWe held 5 focus groups (n=32; mean age: 16.3 [SD 1.4] years; 18/32, 56% female; 13/32, 41% spoke language other than English at home). Thematic analysis revealed participants searched for information both actively (eg, on Google or YouTube) and passively (eg, scrolling social media and using existing apps preloaded to their smartphone such as Apple Health, Samsung Health, or Google Fit apps). Participants identified that the most helpful information was well-presented in terms of aesthetic appeal and layout and came from a credible and reliable source (eg, any sponsorships disclosed), and they expressed the need for the information to be relatable. Mixed views were reported for the application of lifestyle health information found online. Some participants reported behavior change, while others noted that certain advice was hard to maintain and incorporate into their lifestyle.ConclusionsThis study highlights the abundance and complexity of lifestyle health information online for adolescents. Adolescents in the digital age seek access to information that is appealing, credible, relevant, and actionable for lifestyle health behaviors. To appeal to needs of adolescents, future interventions for adolescents relating to lifestyle health must consider co-design methodological approaches. Furthermore, the regulation of lifestyle health information available online warrants further investigation.

Treatment resistant depression (TRD) service outpatient’s experience of sleep, activity, and using a Fitbit wearable activity and sleep tracker

PurposeDepression, physical health, well-being, sleep and physical activity are interlinked. Healthy levels of physical activity and effective night-time sleep can reduce depressive symptoms. In the context of their lives and symptoms of depression, this paper aims to understand participants’ experiences of using a Fitbit, physical activity and sleep and the barriers and facilitators for healthy sleep and physical activity.Design/methodology/approachQualitative methods were used to conduct interviews with 19 patients (4 male; 15 female) diagnosed with treatment-resistant depression undergoing transcranial magnetic stimulation (TMS) treatment for depression. Reflexive thematic analysis was used.FindingsHealthy sleep and physical activity levels are interlinked and reduce depressive symptoms as well as improving well-being and physical health. A Fitbit is useful to enhance physical activity, self-awareness, motivation, healthier lifestyles and effective sleep. Barriers to healthy sleep and physical activity levels included depressive symptoms, environmental factors and anxieties. Facilitators for healthy sleep and physical activity levels included knowledge of the benefits, support from family and friends and applying sleep hygiene.Practical implicationsThere is a need to provide interventions using wearable activity trackers that build on the links between increased physical activity, improved sleep, enhanced well-being, better physical health and lower depressive symptoms.Originality/valueTo the best of the authors’ knowledge, this is the first time that patients undergoing TMS have had their experiences of sleep, activity and using a Fitbit investigated and reported.