Wrist-worn Accelerometry Research Articles

Validity of a wrist-worn consumer-grade wearable for estimating energy expenditure, sedentary behaviour, and physical activity in manual wheelchair users with spinal cord injury

Purpose To evaluate the validity of a consumer-grade wearable for estimating energy expenditure, sedentary behaviour, and physical activity in manual wheelchair users with spinal cord injury (SCI). Materials and methods Fifteen manual wheelchair users with SCI (C5-L1, four female) completed activities of daily living and wheelchair propulsion (2–8 km·h−1). Wrist-worn accelerometry data were collected using consumer-grade (z-Track) and research-grade (ActiGraph GT9X) devices. Energy expenditure was measured via indirect calorimetry. Linear regression was used to evaluate the prediction of criterion metabolic equivalent of task (MET) by each accelerometer’s vector magnitude (VM). Area under the receiver operating characteristic curve (ROC-AUC) evaluated the accuracy of VM for discriminating between physical activity intensities and for identifying accelerometer cut-points. Results Standardised β-coefficients for the association between z-Track and ActiGraph VM for criterion MET were 0.791 (p < 0.001) and 0.774 (p < 0.001), respectively. The z-Track had excellent accuracy for classifying time in sedentary behaviour (ROC-AUC = 0.95) and moderate-to-vigorous physical activity (ROC-AUC = 0.93); similar values to the ActiGraph (ROC-AUC = 0.96 and 0.88, respectively). Cut-points for the z-Track were ≤37 g·min−1 for sedentary behaviour and ≥222 g·min−1 for moderate-to-vigorous physical activity. Conclusions This study supports the validity of a consumer-grade wearable to measure sedentary time and physical activity in manual wheelchair users with SCI.

Physical Activity Fragmentation and Falls in Older Adults: Findings from the National Health and Aging Trends Study.

Physical activity (PA) may be an important fall prevention strategy. Current PA guidelines emphasize total PA dose, but daily patterning of PA is underappreciated. With aging, PA bouts become less frequent and shorter in duration (i.e.: more fragmented). PA fragmentation may be an indicator of fall risk, but the relationship is not well understood. This study examined daily PA accumulation and patterns with fall risk in older adults. Participants (n=685, 54.3% female, 61.5% aged 70-79 years) from the National Health and Aging Trends Study (NHATS) with wrist-worn accelerometry PA data from Round 11 (baseline) and sample person interviews with fall data from Round 12 (follow-up) were included. PA variables were categorized into tertiles and incident falls were defined as ≥1 self-reported fall in the year following the PA assessment between baseline and follow-up. A modified Poisson approach was used to estimate the relative risk of both PA accumulation and fragmentation with falls. Overall, 40.0% reported an incident fall. After adjustment for sociodemographic and health characteristics, those in the highest tertile of total PA accumulation had lower fall risk (aRR=0.74, 95% CI: 0.57, 0.95) and those in the highest tertile of PA fragmentation had increased fall risk (aRR=1.33, 95% CI: 1.03, 1.73). Models were attenuated after adjustment for physical functioning. PA fragmentation may identify fall risk in older adults. Longitudinal studies are needed to disentangle the temporal sequencing of the complex relationship between PA and physical functioning across the life-course.

Association between wrist-worn free-living accelerometry and hand grip strength in middle-aged and older adults

IntroductionWrist-worn activity monitors have seen widespread adoption in recent times, particularly in young and sport-oriented cohorts, while their usage among older adults has remained relatively low. The main limitations are in regards to the lack of medical insights that current mainstream activity trackers can provide to older subjects. One of the most important research areas under investigation currently is the possibility of extrapolating clinical information from these wearable devices.MethodsThe research question of this study is understanding whether accelerometry data collected for 7-days in free-living environments using a consumer-based wristband device, in conjunction with data-driven machine learning algorithms, is able to predict hand grip strength and possible conditions categorized by hand grip strength in a general population consisting of middle-aged and older adults.ResultsThe results of the regression analysis reveal that the performance of the developed models is notably superior to a simple mean-predicting dummy regressor. While the improvement in absolute terms may appear modest, the mean absolute error (6.32 kg for males and 4.53 kg for females) falls within the range considered sufficiently accurate for grip strength estimation. The classification models, instead, excel in categorizing individuals as frail/pre-frail, or healthy, depending on the T-score levels applied for frailty/pre-frailty definition. While cut-off values for frailty vary, the results suggest that the models can moderately detect characteristics associated with frailty (AUC-ROC: 0.70 for males, and 0.76 for females) and viably detect characteristics associated with frailty/pre-frailty (AUC-ROC: 0.86 for males, and 0.87 for females).Conclusions The results of this study can enable the adoption of wearable devices as an efficient tool for clinical assessment in older adults with multimorbidities, improving and advancing integrated care, diagnosis and early screening of a number of widespread diseases.

Improving the identification of bone-specific physical activity using wrist-worn accelerometry: A cross-sectional study in 11-12-year-old Australian children.

Physical activity (PA) during childhood and adolescence is important for the accrual of maximal peak bone mass. The precise dose that benefits bone remains unclear as methods commonly used to analyze PA data are unsuitable for measuring bone-relevant PA. Using improved accelerometry methods, this study identified the amount and intensity of PA most strongly associated with bone outcomes in 11-12-year-olds. Participants (n=770; 382 boys) underwent tibial peripheral quantitative computed tomography to assess trabecular and cortical density, endosteal and periosteal circumference and polar stress-strain index. Seven-day wrist-worn raw acceleration data averaged over 1-s epochs was used to estimate time accumulated above incremental PA intensities (50 milli-gravitational unit (mg) increments from 200 to 3000mg). Associations between time spent above each 50mg increment and bone outcomes were assessed using multiple linear regression, adjusted for age, sex, height, weight, maturity, socioeconomic position, muscle cross-sectional area and PA below the intensity of interest. There was a gradual increase in mean R2 change across all bone-related outcomes as the intensity increased in 50mg increments from >200 to >700mg. All outcomes became significant at >700mg (R2 change=0.6%-1.3% and p=0.001-0.02). Any further increases in intensity led to a reduction in mean R2 change and associations became non-significant for all outcomes >1500mg. Using more appropriate accelerometry methods (1-s epochs; no a priori application of traditional cut-points) enabled us to identify that ∼10min/day of PA >700mg (equivalent to running ∼10km/h) was positively associated with pQCT-derived measures of bone density, geometry and strength in 11-12-year-olds.

Maternal 24-h movement patterns across pregnancy and postpartum: The LIFE-Moms consortium

ObjectiveTime spent among the 24-h movement behaviors (physical activity [PA], sleep, sedentary behavior [SB]) in the perinatal period is important for maternal and child health. We described changes to 24-h movement behaviors and behavior guideline attainment during pregnancy and postpartum and identified correlates of behavior changes. MethodsThis secondary data analysis included the standard of care group (n = 439) from the U.S.-based Lifestyle Interventions For Expectant Moms (LIFE-Moms) consortium, including persons with overweight and obesity. Wrist-worn accelerometry was used to measure movement behaviors early (9–15 weeks) and late (35–36 weeks) pregnancy, and ∼ 1-year postpartum. Sleep and moderate-to-vigorous PA (MVPA) were compared to adult and pregnancy-specific guidelines, respectively. SB was classified into quartiles. PA and SB context were quantified using questionnaires. Mixed models were used to examine changes in behaviors and guidelines and identify correlates. ResultsParticipants were 31.3 ± 3.5 years, 53.5 % were Black or Hispanic, and 45.1 % had overweight. Sleep duration decreased across time, but participants consistently met the guideline (range: 85.0–93.6 %). SB increased during pregnancy and decreased postpartum, while light PA and MVPA followed the inverse pattern. Participants met slightly fewer guidelines late pregnancy (1.2 ± 0.7 guidelines) but more postpartum (1.7 ± 0.8 guidelines) than early pregnancy (1.4 ± 0.8 guidelines). Black or Hispanic race/ethnicity, higher pregravid body mass index, and non-day work-shift (e.g., night-shift) were identified correlates of lower guideline adherence and varying PA and SB context. ConclusionPerinatal interventions should consider strategies to prevent SB increase and sustain MVPA to promote guideline adherence.

Painful distortions: people with painful knee osteoarthritis have biased visuospatial perception of the environment.

Visuospatial perception is thought to be adaptive-ie, hills are perceived as steeper when capacity is low, or threat is high-guiding appropriate interaction with the environment. Pain (bodily threat) may similarly modulate visuospatial perception, with the extent of modulation influenced by threat magnitude (pain intensity, fear) and associated with behaviour (physical activity). We compared visuospatial perception of the environment between 50 people with painful knee osteoarthritis and 50 age-/sex-matched pain-free control participants using 3 virtual reality tasks (uphill steepness estimation, downhill steepness estimation, and a distance-on-hill measure), exploring associations between visuospatial perception, clinical characteristics (pain intensity, state and trait fear), and behaviour (wrist-worn accelerometry) within a larger knee osteoarthritis group (n = 85). People with knee osteoarthritis overestimated uphill (F 1,485 = 19.4, P < 0.001) and downhill (F 1,480 = 32.3, P < 0.001) steepness more so than pain-free controls, but the groups did not differ for distance-on-hill measures (U = 1273, P = 0.61). There was also a significant group x steepness interaction for the downhill steepness task (F 4,480 = 3.11, P = 0.02). Heightened overestimation in people with knee osteoarthritis relative to pain-free controls increased as downhill slopes became steeper. Results were unchanged in a replication analysis using all knee osteoarthritis participants (n = 85), except the downhill steepness interaction was no longer significant. In people with knee osteoarthritis, higher state fear was associated with greater over-estimation of downhill slope steepness (rho = 0.69, P < 0.001), and greater visuospatial overestimation (distance-on-hill) was associated with lower physical activity levels (rho = -0.22, P = 0.045). These findings suggest that chronic pain may shift perception of the environment in line with protection, with overestimation heightened when threat is greater (steeper hills, more fearful), although impact on real-world behaviour is uncertain.

Measuring functional hand use in children with unilateral cerebral palsy using accelerometry and machine learning.

To investigate wearable sensors for measuring functional hand use in children with unilateral cerebral palsy (CP). Dual wrist-worn accelerometry data were collected from three females and seven males with unilateral CP (mean age = 10 years 2 months [SD 3 years]) while performing hand tasks during video-recorded play sessions. Video observers labelled instances of functional and non-functional hand use. Machine learning was compared to the conventional activity count approach for identifying unilateral hand movements as functional or non-functional. Correlation and agreement analyses compared the functional usage metrics derived from each method. The best-performing machine learning approach had high precision and recall when trained on an individual basis (F1 = 0.896 [SD 0.043]). On an individual basis, the best-performing classifier showed a significant correlation (r = 0.990, p < 0.001) and strong agreement (bias = 0.57%, 95% confidence interval = -4.98 to 6.13) with video observations. When validated in a leave-one-subject-out scenario, performance decreased significantly (F1 = 0.584 [SD 0.076]). The activity count approach failed to detect significant differences in non-functional or functional hand activity and showed no significant correlation or agreement with the video observations. With further development, wearable accelerometry combined with machine learning may enable quantitative monitoring of everyday functional hand use in children with unilateral CP.

Measuring Upper Extremity Activity of Children With Unilateral Cerebral Palsy Using Wrist-Worn Accelerometers: A Pilot Study.

Children with unilateral cerebral palsy (UCP) have poor strength and movement control on one side of their body, leading to impaired bimanual coordination skills. To compare duration and intensity of all-day habitual movement of the dominant and nondominant upper extremities (UEs) in typically developing (TD) children and children with UCP. Two-group observational study. Children's naturalistic settings. Convenience sample of 9 TD children and 9 children with UCP. Children wore accelerometers on both wrists all day and night for 1 wk. We compared the extent of asymmetry in bilateral arm use (intensity and duration) between the 2 groups. Compared with TD children who use both UEs equally, children with UCP were more likely to use their dominant or unaffected UE than their nondominant or affected UE during daily activities. There were no differences between groups in dominant UE activity. However, children with UCP engaged in lower levels of moderate to vigorous activity and greater levels of light activity with their nondominant or affected UE than their TD peers. Wrist-worn accelerometry can provide objective information on real-world habitual activity with both arms in children. Accelerometers are nonintrusive, easy to use, and well tolerated by children, and they allow prolonged monitoring of UE activity outside therapeutic contexts. Occupational therapists can use wrist-worn accelerometers as sensitive tools to assess asymmetries in UE use at baseline and as an outcome measure to assess the efficacy of behavioral interventions and carryover into real-world settings among children with UCP. Plain-Language Summary: This pilot study provides promising evidence that supports the use of wrist-worn accelerometry as an accurate, easy-to-use, and objective assessment tool for children with unilateral cerebral palsy (UCP) to detect asymmetries in bilateral real-world arm activity at baseline and after intensive occupational therapy interventions to improve arm function. The authors used wrist-worn accelerometry for one week with 9 typically developing (TD) children and 9 children with UCP to compare dominant or unaffected versus nondominant or affected upper extremity (UE) use for intensity and duration of activity. Compared with TD children, children with UCP had lower relative intensity of activity in the nondominant UE than the dominant UE. Wrist-worn accelerometers seem to be a sensitive measure to detect asymmetries in bilateral all-day UE use in children with UCP. The findings have implications for the use of wrist-worn accelerometers as an outcome measure to assess the efficacy of intensive therapies to improve real-world affected UE activity and bimanual function among children with UCP.

Association Between 24-Hour Movement Behaviors and Adiposity in Malaysian Schoolchildren: A Compositional Isotemporal Substitution Analysis.

Physical activity (PA), sedentary behavior (SB), and sleep are interrelated 24-hour movement behaviors that are important for the growth and well-being of children. This cross-sectional study examined the relationship between 24-hour movement behaviors and adiposity, and predicted changes in adiposity following compositional time reallocations in 7- to 12.9-year-old Malaysian children from the South East Asian Nutrition Surveys II Malaysia. A total of 381 children (mean age 9.7 [1.6]y, 57% girls) provided 24-hour wrist-worn GENEActiv accelerometry data which captured time spent for sleep, SB, light PA and moderate to vigorous PA (MVPA). Indicators of adiposity were derived from anthropometry and bioelectrical impedance analysis: body-mass-index-for-age, waist circumference, waist-to-height ratio, percent body fat, and body mass index. The composition of 4-part movement behaviors was expressed as isometric log-ratio coordinates which were entered into regression models. Isotemporal substitution analysis was used to assess changes in adiposity indicators when reallocating time between movement behaviors. Relative to other movement behaviors, time spent on MVPA was significantly associated with waist circumference, waist-to-height ratio, percent body fat, and fat mass index. A 15-minute one-to-one reallocation from other movement behaviors to MVPA predicted lower body-mass-index-for-age (-0.03 to -0.11), smaller waist circumference (-0.67to -1.28cm), lower waist-to-height ratio (-0.004 to -0.008), percent body fat (-0.87% to -1.47%), and fat mass index (-0.23 to -0.42). Replacing SB and light PA with sleep or MVPA was associated with lower adiposity. The overall composition of movement behavior was significantly associated with the adiposity of Malaysian schoolchildren. Promoting MVPA and sleep and reducing SB and light PA are important for prevention of childhood obesity.

CARDIORESPIRATORY FITNESS IS ASSOCIATED WITH CIRCADIAN BEHAVIORAL PARAMETERS OF PHYSICAL ACTIVITY IN OLDER ADULTS

Abstract Cardiorespiratory fitness (VO2peak) declines with age, and this may be due in part to weakened circadian functions. Rhythmic patterns of rest-activity behavior over 24h represents a novel feature of physical activity, indicative of circadian behavior. Whether VO2peak relates to rest-activity rhythms (RAR) is unknown. We determined cross-sectional associations between VO2peak and RAR in SOMMA (N=714, Age: ≥70 yrs). Activity data from wrist-worn accelerometry (ActiGraph GT9X) were collected in one-minute epochs, over 8, 24h periods. An extension to the traditional cosine model was used to map RAR to activity data, calculating these parameters: strength of the rhythm (amplitude); robustness of rhythm (pseudo-F statistic); and timing of peak activity (acrophase). RAR parameters were expressed as quartiles. Linear models examining associations of RAR and VO2peak were adjusted for potential confounders (age, race, height, comorbidities and lifestyle). Interactions of RAR predictors with sex were examined. Associations between VO2peak and rhythmic amplitude appears to differ by sex (p-interaction=0.07). Among men, VO2peak was positively associated with amplitude (adjusted mean Q1: 21.3 vs. Q4: 23.9, p-trend=0.005)-even after adjusting for moderate-to-vigorous physical activity levels (MVPA)-although associations were more modest and not significant in women. Those with higher VO2peak had an earlier acrophase (time of peak activity) (adjusted mean: Q1 &amp;lt;1:30PM: 21.0 vs. Q4&amp;gt;3:09PM 19.3, p-trend &amp;lt;0.0001) and no sex interaction was observed. There were no associations between the robustness of RAR and VO2peak. Analyses reveal that better cardiorespiratory fitness relates to features of circadian behavior independent of MVPA, supporting emerging research that circadian-based interventions promote healthy aging.

PHYSICAL ACTIVITY AND DEMENTIA IN THE NATIONAL HEALTH AND AGING TRENDS STUDY (NHATS)

Abstract Individuals living with dementia exhibit disrupted sleep/wake rhythms; however, whether daily physical activity volume and patterns are worse among those living with dementia is not well established. We examined the cross-sectional association between dementia classification and accelerometry-derived patterns of daily physical activity in NHATS. Wrist-worn accelerometry was collected using the Actigraph Centrepoint Insight Watch in a subset of Round 11 (2021) participants. Dementia status, including possible and probable dementia, was determined using the NHATS dementia algorithm. We characterized daily physical activity patterns using: most active 10-hours/day (M10), time of M10, least active 5-hours/day (L5), time of L5, relative amplitude (RA), intra-daily variability (IV), inter-daily stability (IS), and activity fragmentation using the active-to-sedentary transition probability (ASTP). We used separate linear regression models to study the association between dementia and each actigraphy feature, adjusting for relevant demographic features including age, gender, race, BMI, and education. 721 participants had ≥3 days of valid accelerometry data, dementia status, and complete covariate data (40% aged ≥80 years, 54% women). Compared to cognitively normal participants, those living with dementia averaged fewer activity counts/day (beta: -382K counts/day p&amp;lt;0.0001), lower M10 (beta: -261K counts, p&amp;lt;0.0001), lower IS (beta: -0.04; p= 0.0066), and higher ASTP (beta: 7.1%; p&amp;lt;0.0001). Participants with and without dementia did not differ in terms of IV, L5, or RA (p&amp;gt;0.05 for all). These results suggest important differences in volume and patterns of daily movement by dementia status. Future studies should investigate whether similar differences exist in earlier stages of cognitive impairment to enhance preventative efforts.

MUSCULOSKELETAL PAIN CHARACTERISTICS AND OBJECTIVELY MEASURED PHYSICAL ACTIVITY IN OLDER ADULTS

Abstract Pain is associated with reports of restricted physical activity (PA), yet the associations between multiple musculoskeletal pain characteristics and objectively measured PA quantities and patterns in late life are not well understood. A total of 553 adults (mean age 75.8±8.4 years, 54.4% women) in the Baltimore Longitudinal Study of Aging (BLSA) completed pain assessments and subsequent 7-day wrist-worn accelerometry in the free-living environment between 2015 and 2020. Pain characteristics included pain presence in the shoulders, hands/wrists, low back, hip, knees, and feet, pain laterality in each site (no pain, unilateral pain, and bilateral pain), and pain distribution (no pain, single site pain, and multisite pain). PA metrics were summarized into total daily activity counts (TAC), activity fragmentation, active minutes/day, and diurnal patterns of activity. Linear regression models adjusted for demographics and comorbidities suggested that unilateral knee pain was associated with 184,070 fewer TAC/day (p=0.04) and 36.2 fewer active minutes/day (p=0.03) while hand/wrist pain was associated with 24.8 more active minutes/day compared to those without pain (p=0.04). By time-of-day, participants with hip pain had less activity during the morning (6:00am to 11:59am) while those with unilateral knee pain had fewer activity counts during the afternoon (12:00pm to 5:59pm). Analyses stratified by sex showed that these associations were only significant among women. Our study highlights the importance of assessing pain laterality in addition to traditional pain measures (e.g., pain presence) and suggest that pain interferes with multiple aspects of daily activity. Longitudinal studies are needed to assess the temporality of these findings.

ACCELEROMETER-DERIVED PHYSICAL ACTIVITY IN THE NATIONAL HEALTH AND AGING TRENDS STUDY

Abstract Physical activity (PA) is a modifiable risk factor for disability, chronic conditions, and functional outcomes with aging. Yet the amount of PA in which older adults engage is not well understood, as objective evidence is lacking, particularly among those aged ≥80 years. To address this gap, the National Health and Aging Trends Study (NHATS) implemented wrist-worn accelerometry (Actigraph Centrepoint Insight Watch) in a subset of Round 11 (2021) participants (N=747, 54% women, 40% aged≥80) using a seven-day 24-hour/day protocol. Mean daily PA (total activity counts/day) was examined in those with ≥3 valid wear days by health and demographic factors with analytic survey weights applied. Daily PA averaged 1.67M counts/day, was lower at older ages and varied widely across health and demographic factors, notably: women were more active than men (β=208K), married participants more active than unmarried (β=163K), those with impaired contrast vision were less active than those with normal vision (β=-231K), those with hearing loss were less active than those without hearing loss (β=-233K), and participants with possible or probable dementia were less active than those without dementia (β=-457K) (p&amp;lt;.001 for all). With regards to care and accommodations, those who reported getting help with mobility were less active than those who did not (β=-459K) and those residing in the community were more active than those in (non-nursing home) residential care (β=394K). These data present unique insights into factors that may shape daily PA in older adults. Future work should examine longitudinal trends and potential interaction with the disablement process.

Abstract 11546: Functional Co-Clustering of Physical Activity Patterns Among Sexual and Gender Minority Adults

Introduction: Physical activity (PA) is a important modifiable risk factor for cardiovascular disease (CVD) and CVD mortality. There is growing evidence that sexual and gender minority (SGM; lesbian/gay, bisexual, transgender) adults are at higher risk of insufficient PA and CVD. Accelerometers allow for collection of granular PA data that can identify individual- and temporal heterogeneity in daily patterns. To date, no studies have investigated accelerometry-based PA patterns among SGM adults. Goal: To characterize daily PA trajectories among SGM adults and identify distinct phenotypes using a time series-based clustering technique. Methods: We recruited an online sample of healthy SGM adults in the United States who completed continuous wrist-worn accelerometry for 30 days to collect step counts. For clustering, we used a functional latent block models (FLBMs), where each 24-hour period was a Fourier-smoothed data curve. FLBMs allow hierarchical time-series data clustering by simultaneously clustering person- and day-level data. The optimal number of clusters was selected using the integrated completed likelihood (ICL) criterion. Results: Forty-two SGM adults with a mean age of 27.0 years (+/- 7.7) provided 1207 person-level days of accelerometry (range=6-31 days/person). A final model with 4 blocks (2 x 2 clusters) provided the best fit (ICL= -70086.4). Two person-level clusters were identified, which were characterized by differences in the amount and distribution of steps throughout the day were identified. Cluster 1 (n=26) had higher overall steps counts with significant morning and evening increases in step counts. Cluster 2 (n=16) had fewer steps that were within a narrower time period. We further identified 2 day-level clusters. Cluster 2 (n=14) had a wider temporal distribution of step counts and a higher variance on weekend days vs. weekdays relative to Cluster 1 (n=17). Conclusions: This is the first study to elucidate daily PA trajectories in SGM people. Using FLBM, we accounted for individual heterogeneity and relations among days. Findings can help identify individuals at increased risk of physical inactivity and subsequent negative health outcomes, providing important knowledge to inform behavioral interventions.

Accelerometric Classification of Resting and Postural Tremor Amplitude.

Clinical rating scales for tremors have significant limitations due to low resolution, high rater dependency, and lack of applicability in outpatient settings. Reliable, quantitative approaches for assessing tremor severity are warranted, especially evaluating treatment effects, e.g., of deep brain stimulation (DBS). We aimed to investigate how different accelerometry metrics can objectively classify tremor amplitude of Essential Tremor (ET) and tremor in Parkinson's Disease (PD). We assessed 860 resting and postural tremor trials in 16 patients with ET and 25 patients with PD under different DBS settings. Clinical ratings were compared to different metrics, based on either spectral components in the tremorband or pure acceleration, derived from simultaneous triaxial accelerometry captured at the index finger and wrist. Nonlinear regression was applied to a training dataset to determine the relationship between accelerometry and clinical ratings, which was then evaluated in a holdout dataset. All of the investigated accelerometry metrics could predict clinical tremor ratings with a high concordance (>70%) and substantial interrater reliability (Cohen's weighted Kappa > 0.7) in out-of-sample data. Finger-worn accelerometry performed slightly better than wrist-worn accelerometry. We conclude that triaxial accelerometry reliably quantifies resting and postural tremor amplitude in ET and PD patients. A full release of our dataset and software allows for implementation, development, training, and validation of novel methods.

SAT088 Poor Sleep Quality And Insufficient Sleep Duration Are Common In Maturity Onset Diabetes Of The Young

Abstract Disclosure: M.A. Arosemena: None. K. Wroblewski: None. E. Tasali: None. L. Philipson: Research Investigator; Self; Novo Nordisk, Novartis Pharmaceuticals. Background: Poor sleep quality and insufficient sleep duration are highly common in type 1 and type 2 diabetes. Maturity Onset Diabetes of the Young (MODY) is a unique form of diabetes that is usually characterized by patients being lean, not using insulin, or using diabetes-related technology. This subpopulation has not been studied in regards to their sleep patterns. Objective: To evaluate objective and subjective sleep patterns and their association with glycemic variability in adults with MODY. Methods: Adults with MODY were recruited from the Monogenic Diabetes Registry at the University of Chicago. Subjective sleep quality was measured by a validated survey, the Pittsburgh Sleep Quality Index (PSQI), and sleep patterns were objectively assessed at home by wrist-worn accelerometry (Fitbit Inspire 2) for two consecutive weeks. Glycemic variability was assessed by 2 weeks of continuous glucose monitoring (CGM). Results: To date, a total of 51 patients completed the study. Participants (age:46 ± 12.4 years; BMI:24.6 ± 3.5 kg/m2, diabetes duration: 22.6 ± 13.5, HbA1c: 6.3 ±0.6%) were mostly white (84%), premenopausal (68%), and female (74%). Pathogenic variants included 51% GCK-MODY, 25% HNF1A-MODY, 16% HNF4A-MODY, and 8% HNF1B-MODY. Most participants (71%) reported engaging in regular exercise ( i.e., exercising more than twice and accumulating at least 90 min of moderate or 40 min of vigorous activity in an average week), 45% were only on diet and exercise as their diabetes therapy and 20% were on insulin. Only 27% were on diabetes-related technology (insulin pump and/or CGM) and 88% had no diabetes-related complications. Based on accelerometry (630 nights of analyzed Fitbit data; n=45) 39% of patients had a sleep duration of &amp;lt;7 hours, below the healthy adult recommendations, 90% had a wake after sleep onset (WASO) &amp;gt;40 minutes (normative criteria ≤40 minutes) and, 14% had a sleep efficiency &amp;lt;85% (normative criteria ≥85%)Most patients (69%) reported poor sleep quality with a PSQI mean score of 7.2±3.3 (a score of &amp;gt;5 reflecting poor sleep quality). The data analyses on the association between sleep and glycemic patterns (from CGM) are ongoing. Conclusion: Poor subjective and objective sleep quality and insufficient objective sleep duration are common among MODY patients despite most of them being lean, not on insulin or using diabetes-related technology. Further research should investigate sleep-glycemia relationship in this unique diabetes population. Presentation: Saturday, June 17, 2023

Brief bouts of device-measured intermittent lifestyle physical activity and its association with major adverse cardiovascular events and mortality in people who do not exercise: a prospective cohort study

Guidelines emphasise the health benefits of bouts of physical activity of any duration. However, the associations of intermittent lifestyle physical activity accumulated through non-exercise with mortality and major adverse cardiovascular events (MACE) remain unclear. We aimed to examine the associations of bouts of moderate-to-vigorous intermittent lifestyle physical activity (MV-ILPA) and the proportion of vigorous activity contributing within these bouts with mortality and MACE. In this prospective cohort study, we used data from the UK Biobank on adults who do not exercise (ie, those who did not report leisure-time exercise) who had wrist-worn accelerometry data available. Participants were followed up until Nov 30, 2022, with the outcome of interest of all-cause mortality obtained through linkage with NHS Digital of England and Wales, and the NHS Central Register and National Records of Scotland, and MACE obtained from inpatient hospitalisation data provided by the Hospital Episode Statistics for England, the Patient Episode Database for Wales, and the Scottish Morbidity Record for Scotland. MV-ILPA bouts were derived using a two-level Random Forest classifier and grouped as short (<1 min), medium (1 to <3 min; 3 to <5 min), and long (5 to <10 min). We further examined the dose-response relationship of the proportion of vigorous physical activity contributing to the MV-ILPA bout. Between June 1, 2013, and Dec 23, 2015, 103 684 Biobank participants wore an accelerometer on their wrist. 25 241 adults (mean age 61·8 years [SD 7·6]), of whom 14 178 (56·2%) were women, were included in our analysis of all-cause mortality. During a mean follow-up duration of 7·9 years (SD 0·9), 824 MACE and 1111 deaths occurred. Compared with bouts of less than 1 min, mortality risk was lower for bouts of 1 min to less than 3 min (hazard ratio [HR] 0·66 [0·53-0·81]), 3 min to less than 5 min (HR 0·56 [0·46-0·69]), and 5 to less than 10 min (HR 0·48 [0·39-0·59]). Similarly, compared with bouts of less than 1 min, risk of MACE was lower for bouts of 1 min to less than 3 min (HR 0·71 [0·54-0·93]), 3 min to less than 5 min (0·62 [0·48-0·81]), and 5 min to less than 10 min (0·59 [0·46-0·76]). Short bouts (<1 min) were associated with lower MACE risk only when bouts were comprised of at least 15% vigorous activity. Intermittent non-exercise physical activity was associated with lower mortality and MACE. Our results support the promotion of short intermittent bouts of non-exercise physical activity of moderate-to-vigorous intensity to improve longevity and cardiovascular health among adults who do not habitually exercise in their leisure time. Australian National Health, Medical Research Council, and Wellcome Trust.

Replacing device-measured sedentary time with physical activity is associated with lower risk of coronary heart disease regardless of genetic risk.

Excess sedentary time (ST) is recognized as an important modifiable risk factor for coronary heart disease (CHD). However, whether the associations of genetic susceptibility with CHD incidence can be modified by replacing wearable-device-measured ST with physical activity (PA) is unknown. To examine the associations of wearable-device-measured ST replaced by PA with incident CHD across strata of genetic susceptibility. This study included 77,500 White British (57% female) with valid wrist-worn accelerometry and without prevalent CHD/stroke from UK Biobank. Genetic susceptibility to CHD was quantified through weighted polygenic risk scores for CHD based on 300 single-nucleotide polymorphisms. Wrist-worn accelerometer data were used to derive ST, light PA, and moderate-to-vigorous PA (MVPA). Reallocation of 60min/day of ST into the same amount of MVPA was associated with approximately 9% lower relative risk of CHD for all participants and across strata of genetic risk: replacement of 1min/day of ST associated with <1% lower relative risk of CHD. No evidence of interaction (p: 0.784) was found between genetic risk and ST for CHD risk. Reallocating 60min/day of ST into the same MVPA time was associated with greater absolute CHD risk reductions at high genetic risk (0.27%) versus low genetic risk (0.15%). Replacing any amount of ST with an equal amount of MVPA time is associated with a lower relative risk of CHD, irrespective of genetic susceptibility to CHD. Reductions in CHD absolute risk for replacing ST with MVPA are greater at high genetic risk versus low genetic risk.

Physical Activity Assessed by Wrist and Thigh Worn Accelerometry and Associations with Cardiometabolic Health.

Physical activity is increasingly being captured by accelerometers worn on different body locations. The aim of this study was to examine the associations between physical activity volume (average acceleration), intensity (intensity gradient) and cardiometabolic health when assessed by a thigh-worn and wrist-worn accelerometer. A sample of 659 office workers wore an Axivity AX3 on the non-dominant wrist and an activPAL3 micro on the right thigh concurrently for 24 h a day for 8 days. An average acceleration (proxy for physical activity volume) and intensity gradient (intensity distribution) were calculated from both devices using the open-source raw accelerometer processing software GGIR. Clustered cardiometabolic risk (CMR) was calculated using markers of cardiometabolic health, including waist circumference, triglycerides, HDL-cholesterol, mean arterial pressure and fasting glucose. Linear regression analysis assessed the associations between physical activity volume and intensity gradient with cardiometabolic health. Physical activity volume derived from the thigh-worn activPAL and the wrist-worn Axivity were beneficially associated with CMR and the majority of individual health markers, but associations only remained significant after adjusting for physical activity intensity in the thigh-worn activPAL. Physical activity intensity was associated with CMR score and individual health markers when derived from the wrist-worn Axivity, and these associations were independent of volume. Associations between cardiometabolic health and physical activity volume were similarly captured by the thigh-worn activPAL and the wrist-worn Axivity. However, only the wrist-worn Axivity captured aspects of the intensity distribution associated with cardiometabolic health. This may relate to the reduced range of accelerations detected by the thigh-worn activPAL.

Effectiveness of a participatory approach to develop school health interventions in four low resource cities: study protocol of the ‘empowering adolescents to lead change using health data’ cluster randomised controlled trial

IntroductionComprehensive local data on adolescent health are often lacking, particularly in lower resource settings. Furthermore, there are knowledge gaps around which interventions are effective to support healthy behaviours. This study...