Wrist-worn Activity Monitor Research Articles

Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis.

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD) and many patients get readmitted. Intervening with hospitalised patients may be optimal timing to provide support. Our previous work demonstrated use of a digital monitoring and self-management support tool in the community. However, we wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD.MethodsPatients were recruited to the EDGE2 study between May 2019 and March 2020. Patients were identified by the clinical teams and patients were recruited by members of the clinical research team. Participants were aged 40 years or older, had a diagnosis of COPD and were attending or admitted to hospital for an AECOPD. Participants were given a tablet computer, Bluetooth-linked pulse oximeter and wrist-worn physical activity monitor to use until 6 months post-discharge. Use of the system aimed to support COPD self-management by enabling self-monitoring of vital signs, COPD symptoms, mood and physical activity, and access to multi-media educational resources.Results281 patients were identified and 126 approached. The main referral source was the specialist respiratory nursing and physiotherapist team (49.8% of patients identified). Twenty-six (37.1%) patients were recruited. As of 21 April 2020, 14 (53.8%) participants withdrew and 11 (of 14; 78.6%) participants withdrew within four weeks of discharge. The remaining participants withdrew between one and three months follow-up (1 of 14; 7.1%) and between three and six months follow-up (2 of 14; 14.3%).ConclusionA large number of patients were screened to recruit a relatively small sample and a high rate of dropout was observed. It does not appear feasible to recruit patients with COPD to digital interventional studies from the hospital setting when they have the burden of coping with acute illness.

Satellite Imaging-Based Residential Greenness and Accelerometry Measured Physical Activity at Midlife-Population-Based Northern Finland Birth Cohort 1966 Study.

Background: Recently, the importance of light physical activity (LPA) for health has been emphasized, and residential greenness has been positively linked to the level of LPA and a variety of positive health outcomes. However, people spend less time in green environments because of urbanization and modern sedentary leisure activities. Aims: In this population-based study, we investigated the association between objectively measured residential greenness and accelerometry measured physical activity (PA), with a special interest in LPA and gender differences. Methods: The study was based on the Northern Finland Birth Cohort 1966 (5433 members). Participants filled in a postal questionnaire and underwent clinical examinations and wore a continuous measurement of PA with wrist-worn Polar Active Activity Monitor accelerometers for two weeks. The volume of PA (metabolic equivalent of task or MET) was used to describe the participant’s total daily activity (light: 2–3.49 MET; moderate: 3.5–4.99 MET; vigorous: 5–7.99 MET; very vigorous: ≥8 MET). A geographic information system (GIS) was used to assess the features of each individual’s residential environment. The normalized difference vegetation index (NDVI) was used for the objective quantification of residential greenness. Multiple linear regression and a generalized additive model (GAM) were used to analyze the association between residential greenness and the amount of PA at different intensity levels. Results: Residential greenness (NDVI) was independently associated with LPA (unadjusted β = 174; CI = 140, 209) and moderate physical activity (MPA) (unadjusted β = 75; CI = 48, 101). In the adjusted model, residential greenness was positively and significantly associated with LPA (adjusted β = 70; CI = 26, 114). In men, residential greenness was positively and significantly associated with LPA (unadjusted β = 224; CI = 173, 275), MPA (unadjusted β = 75; CI = 48, 101), and moderate to vigorous physical activity (MVPA) (unadjusted β = 89; CI = 25, 152). In women, residential greenness was positively related to LPA (unadjusted β = 142; CI = 96, 188) and inversely associated with MPA (unadjusted β = −22; CI = −36, −8), vigorous/very vigorous physical activity (VPA/VVPA) (unadjusted β = −49; CI = −84, −14), and MVPA (unadjusted β = −71; CI = −113, −29). In the final adjusted models, residential greenness was significantly associated only with the amount of LPA in men (adjusted β = 140; CI = 75, 204). Conclusions: Residential greenness was positively associated with LPA in both genders, but the association remained significant after adjustments only in men. Residential greenness may provide a supportive environment for promoting LPA.

Abstract A07: Connecting remote patient monitoring, DNA-based immunophenotyping, and clinical outcomes data

Abstract Our objective is to develop methods for utilizing highly repeated remotely monitored data, clinical assessments, and DNA methylation-based immunophenotyping. We used data from a pilot clinical trial examining the impact of physical activity tracking and counseling with dietary supplementation in older adults with obesity. Elevated body mass index (BMI) contributes to excess cancer burden and many specific cancers are directly associated with obesity. Obesity promotes inflammatory cytokines, such as TNF-alpha, hormonal dysregulation, such as estrogen and adipokines, in addition to impairments in insulin and cell growth regulators, all of which impact cell proliferation and cancer. Although physical activity is a key component in obesity interventions, specific relationships between physical activity, inflammatory, and immune markers are less clear. We examine integration methods for testing the association of physical activity data, biomarkers, and immune cell proportions inferred from DNA methylation in a trial investigating the impact of a multicomponent obesity intervention. Older obese (>= 65 years, BMI >= 30 kg/m2) who received primary care services at Dartmouth-Hitchcock were recruited (n = 15). All participants received regular in-person nutrition counseling, group exercises, and health coaching while being monitored through a wrist-worn physical activity monitor, and received additional protein supplementation. Baseline and 12-week measurements were taken for 12 clinical assessments, such as objective measures (i.e., hand grip strength and 5 times sit-to-stand), subjective (i.e., Late-Life Function and Disability Instrument), 32 blood-based biomarkers (i.e., leptin and TNF-alpha), and DNA methylation of whole blood. Physical activity and steps were measured continuously throughout the study period using a Fitbit Alta HR. To compare analytical methods, we used mixed-effects models, difference in difference, and elastic net regression models to examine the association of physical activity, immunomethylation phenotypes, and clinical outcomes. We followed 15 older adults (100% white, females), whose mean age was 73.4 years (SD = 6.0) years and mean BMI = 35.5 kg/m3 (SD = 4.68). All clinical assessments and blood-based biomarkers were collected on all 15 participants for both baseline and follow-up timepoints. An average of 92.2 days of data (steps, distance, total calories, activity calories, or minutes in sedentary, light activity, or fairly active, and very active) were recorded (SD = 9.5). We collected DNA methylation data on 10 participants at baseline and 14 participants in follow-up. Through developing newly linked data sources longitudinally, we will be able to examine new subpopulations of phenotypes that could elucidate the relationship between BMI and cancer impacting cancer screening, diagnosis, and treatment. Note: This abstract was not presented at the conference. Citation Format: Curtis L. Petersen, Brock C. Christensen, John A. Batsis. Connecting remote patient monitoring, DNA-based immunophenotyping, and clinical outcomes data [abstract]. In: Proceedings of the AACR Special Conference on Modernizing Population Sciences in the Digital Age; 2019 Feb 19-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(9 Suppl):Abstract nr A07.

The associations between thermal variety and health: Implications for space heating energy use.

Fossil fuels dominate domestic heating in temperate climates. In the EU, domestic space heating accounts for around 20% of final energy demand. Reducing domestic demand temperatures would reduce energy demand. However, cold exposure has been shown to be associated with adverse health conditions. Using an observational dataset of 77,762 UK Biobank participants, we examine the standard deviation of experienced temperature (named here thermal variety) measured by a wrist worn activity and temperature monitor. After controlling for covariates such as age, activity level and obesity, we show that thermal variety is 0.15°C 95% CI [0.07-0.23] higher for participants whose health satisfaction was 'extremely happy' compared to 'extremely unhappy'. Higher thermal variety is also associated with a lower risk of having morbidities related to excess winter deaths. We argue that significant CO2 savings would be made by increasing thermal variety and reducing domestic demand temperatures in the healthiest homes. However, great care is needed to avoid secondary health impacts due to mould and damp. Vulnerable households should receive increased attention.

Self-selected Walking Cadence After Light-intensity Physical Activity Intervention For Older Cancer Survivors

PURPOSE: The MY Health randomized controlled trial evaluated the effectiveness of a wrist-worn activity monitor and health coaching to replace sedentary behavior with bouts of light-intensity physical activity among older cancer survivors. Participants were asked to 1) increase average daily steps ≥ 3000 above baseline and 2) disrupt sedentary behavior at least twice per hour. No specific recommendations regarding intensity or minimum bout duration were provided. In this secondary analysis, we hypothesized that participants would self-select to walk faster to meet their daily step goal. METHODS: Average daily steps and free-living walking cadence were measured in 41 participants (age 69±3.1 yr), using an ActivPAL activity monitor for 7 days pre- and post-intervention. Step accumulation patterns associated with intensity of ambulatory behavior were sorted in cadence bands of 20 steps/min from 40-59 (incidental movement) to ≥120 steps/min (fast locomotor movement). Repeated measures ANOVA was used to evaluate intervention induced changes in walking cadence; Wilcoxon rank-sum tests were used to highlight group differences within cadence bands. Medians and interquartile range are reported. RESULTS: Intervention (n=24) and Waitlist Control (n=17) participants exhibited similar characteristics at baseline. The Intervention group increased average daily steps by 976 (IQR: -388 to 3532) from pre- to post-intervention; the control group increased by 354 steps/day (IQR: -658 to 1300); p=.19). There was a significant interaction of the intervention on cadence bands (p<.001). Steps taken in cadence bands denoting moderate intensity physical activity (MPA; 100-119 steps/min) increased by 478 (IQR: -121 to 1844) steps/day in the intervention group, compared to a decrease of 92 (IQR: -510 to 181) steps/day in the control group (p<.01). CONCLUSION: While only 29% of intervention group participants met the daily step goal, there was a displacement of steps taken from cadence bands associated with lower to those of higher intensity of stepping, i.e., participants self-selected to walk faster. These findings may have important clinical implications as both duration and intensity have shown to offer cardioprotective and other health-related benefits.

90: Assessing activity and recovery following benign gynecologic surgery using an activity monitor and validated tool sets: A pilot study

Assessment of recovery after surgery in women following benign gynecologic surgery remains highly subjective and elusive, as the majority of patient recovery is taking place at home and outside of the hospital. However, advances in wearable technology present an opportunity for clinicians to have an objective assessment of postoperative recovery. The aims of this pilot study are to 1) feasibility of the use of an activity monitor in a gynecologic surgical patient population, 2) use activity monitor data to characterize the recovery trajectory of physical activity for laparoscopic and open surgeries. Women aged 18-51 years old undergoing elective inpatient and outpatient surgical procedures at an academic tertiary medical center, specifically myomectomy and hysterectomy, were invited to participate. Physical activity was measured using an Actigraph GT3X wrist worn activity monitor. Participants wore the activity monitor a week before the surgery to assess preoperative baseline activity and they were asked to wear them for a minimum 6 weeks postop. The total number of steps was measured for each patient per day, and the time (in days) to baseline recovery activity was measured. Of the 15 patients enrolled, 13 patients completed the study procedures and were included in the analysis. 9 underwent a laparoscopic or robot-assisted laparoscopic procedure; 4 underwent a laparotomy. Of the 9 minimally invasive procedures, 7 were hysterectomies and 2 were myomectomies. Of the laparotomies, 2 were hysterectomies and 2 were myomectomies. The mean number of days the activity monitor was worn was 45 days (SD 27) for all procedures. For minimally invasive outpatient procedures, the total number of steps per day reached preoperative average levels on postoperative day (POD) 7.8 (SD 7.5). For laparotomies that required inpatient stay, the total number of steps per day reached preoperative average levels on POD 33.5 (SD 24.5). An adverse event in 1 patient was associated with a decline in activity. This study demonstrates that objective monitoring of postoperative physical activity using activity monitors is feasible in the benign gynecologic surgical population. Recovery trajectories for inpatient laparotomies and outpatient minimally invasive procedures differ. Activity monitors present clinicians with a new potential tool for assessing and managing surgical recovery, and for determining if women are not recovering as expected.

Factors Associated With Orthopaedic Resident Burnout: A Pilot Study.

Burnout is an occupational hazard for physicians at all stages of training and medical practice. The purpose of the current study was to determine whether residency factors, with the use of an activity monitor, including the amount of exercise, have any impact on burnout among orthopaedic surgery residents in varying years of training. Orthopaedic residents at a single institution were recruited immediately before beginning a new clinical rotation and followed for four weeks. On enrollment, the participants were given a wrist-worn activity monitor (Fitbit Flex) and instructed on its use for tracking physical activity. REDCap was used to collect burnout levels (as assessed by using the Maslach Burnout Inventory and the Patient Health Questionnaire-9), which were completed a total of five times, once at enrollment and weekly during the study period. Twenty-seven residents were enrolled, including 13 junior residents (interns and second years) and 14 senior residents (third, fourth, and fifth years). Seven residents were on fracture rotations, whereas 20 were not. As measured by using the Maslach Burnout Inventory, juniors were more emotionally exhausted (P = 0.01) and depersonalized (P = 0.027). No difference in the objective physical activity data as measured by using the Fitbit Flex and no difference in the self-reported hours of sleep were observed. Residents on orthopaedic trauma rotations also reported significantly higher rates of emotional exhaustion and depersonalization (P < 0.001) than other residents and were more physically active on average (P < 0.030). Although depersonalization and depression are common symptoms seen among orthopaedic surgery residents, this study demonstrated that quality of life improves markedly as they progress through their residency training. Residents on orthopedic trauma rotations have greater levels of emotional exhaustion and depersonalization. This pilot study suggests that burnout prevention programs should begin at the start of training to provide residents with strategies to combat and then reinforced while on orthopaedic trauma rotations. Level III Diagnostic Study.

Correlation and Wear-Time Compliance of the Wrist-Worn SQORD Activity Monitor Compared to the Actigraph 3TGX in Measuring Free-Living Physical Activity in Low SES Elementary Youth

Background and Purpose: Activity trackers have grown increasingly popular, yet research grade accelerometers, like Actigraph, are still very expensive and must be worn on the waist. This study correlated the low-cost wrist-worn SQORD band to the Actigraph accelerometer to assess physical activity (PA) in youth from a low-income area. Methods: Forty-one participants (22:19 male:female; mean age= 10.7 years) in an after-school program participated. Participants wore a waist-worn Actigraph accelerometer and a wrist-worn SQORD for seven days. Abdominal, upper and lower body strength and endurance, and aerobic capacity were assessed through FITNESSGRAM tests. Bivariate correlations were used to analyze the relationship between moderate-to-vigorous PA (MVPA) via the Actigraph and SQORD and to examine relationships between physical fitness and MVPA. Results: At 8- and 10-hour wear-time, compliance with wearing the devices was higher with the SQORD than the Actigraph. A correlation was found between MVPA via SQORD and Actigraph (r=0.651). Neither the SQORD or Actigraph was associated with any fitness measures (r = -0.061; – 0.817). Conclusion: The SQORD appears to be successful in tracking MVPA in youth and was worn more than the Actigraph. Wrist-worn, consumer-grade devices may be a cost-effective alternative to traditional accelerometers for physical education programs and research in low-income populations.

How stress affects sleep and mental health: nocturnal heart rate increases during prolonged stress and interacts with childhood trauma exposure to predict anxiety.

Stress can adversely impact sleep health by eliciting arousal increase and a cascade of endocrine reactions that may impair sleep. To date, little is known regarding continuous effects of real-world stress on physiological sleep characteristics and potential effects on stress-related psychopathology. We examined effects of stress on heart rate (HR) during sleep and total sleep time (TST) during prolonged real-world stress exposure in medical interns. Moreover, we investigated the influence of previous stress and childhood trauma exposure on HR during sleep, TST, and its interaction in predicting anxiety. We examined a sample of 50 medical students prior to and during their first internship, a well described real-world stressor. HR and TST were continuously collected over 12 weeks non-invasively by a wrist-worn activity monitor. Prior to starting the internship, at baseline, participants reported on their sleep, anxiety, and childhood trauma exposure. They also tracked stress exposure during internship and reported on their anxiety symptoms 3 months after this professional stress. Mean HR during sleep increased over time, while TST remained unchanged. This effect was more pronounced in interns exposed to childhood trauma exposure. In multilevel models, childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. Prolonged stress may lead to increased HR during sleep, whereas individuals with childhood trauma exposure are more vulnerable. Childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. These findings may inform prevention and intervention measures.

Using the Wrist-Worn Atlas Wristband2 Monitor to Objectively Measure Resistance Training Exercises

Background: Devices for monitoring physical activity have focused mainly on measuring aerobic activity; however, the 2018 Physical Activity Guidelines for Americans also recommend muscle-resistance training two or more days per week. Recently, a wrist-worn activity monitor, the Atlas Wristband2, was developed to recognize resistance training exercises. Purpose: To assess the ability of the Wristband2 to identify the type and number of repetitions of resistance training exercises, when worn on the left wrist as directed by the manufacturer, and when worn on the right wrist. Methods: While wearing monitors on both wrists, 159 participants completed a circuit-style workout consisting of two sets of 12 repetitions of 14 different resistance training exercises. Data from the monitors were used to determine classification accuracies for identifying exercise type verses direct observation. The average repetitions and mean absolute error (MAE) for repetitions were calculated for each exercise. Results: The Wristband2 classification accuracy for exercise type was 78.4 ± 2.5%, ranging from 54.7 ± 3.4% (dumbbell [DB] bench press) to 97.5 ± 1.0% (DB biceps curls), when worn on the left wrist. An average of 11.0 ± 0.2 repetitions, ranging from 9.0 ± 0.3 repetitions (DB lunges) to 11.9 ± 0.1 repetitions (push-ups), were identified. For all exercises, MAE ranged from 0.0–4.6 repetitions. When worn on the right wrist, exercise type classification accuracy dropped to 24.2 ± 5.1%, and repetitions decreased to 8.1 ± 0.8 out of 12. Conclusions: The Wristband2, worn on the left wrist, had acceptable exercise classification and repetition counting capabilities for many of the 14 exercises used in this study, and may be a useful tool to objectively track resistance training.

Validity of a Wrist-Worn Activity Monitor During Resistance Training Exercises at Different Movement Speeds

Speed of movement has been shown to affect the validity of physical activity (PA) monitors during locomotion. Speed of movement may also affect the validity of accelerometer-based PA monitors during other types of exercise. Purpose: To assess the ability of the Atlas Wearables Wristband2 (a PA monitor developed specifically for resistance training [RT] exercise) to identify the individual RT exercise type and count repetitions during RT exercises at various movement speeds. Methods: 50 male and female participants completed seven sets of 10 repetitions for five different upper/lower body RT exercises while wearing a Wristband2 on the left wrist. The speed of each set was completed at different metronome-paced speeds ranging from a slow speed of 4 sec·rep−1 to a fast speed of 1 sec·rep−1. Repeated Measures ANOVAs were used to compare the actual exercise type/number of repetitions among the seven different speeds. Mean absolute percent error (MAPE) and bias were calculated for repetition counting. Results: For each exercise, there tended to be significant differences between the slower speeds and the fastest speed for activity type identification and repetition counting (p &lt; .05). Across all exercises, the highest accuracy for activity type identification (91 ± 1.8% correct overall), repetition counting (8.77 ± 0.17 of 10 reps overall) and the lowest MAPE (14 ± 1.7% overall) and bias (−1.23 ± 0.17 reps overall) occurred during the 1.5 sec·rep−1 speed (the second fastest speed tested). Conclusions: The validity of the Atlas Wearables Wristband2 to identify exercise type and count repetitions varied based on the speed of movement during RT exercises.

Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments.

Sleep loss and circadian misalignment contribute to a meaningful proportion of operational accidents and incidents. Countermeasures and work scheduling designs aimed at mitigating fatigue are typically evaluated in controlled laboratory environments, but the effectiveness of translating such strategies to operational environments can be challenging to assess. This manuscript summarizes an approach for collecting sleep, circadian, fatigue, and performance data in a complex operational environment. We studied 44 airline pilots over 34 days while they flew a fixed schedule, which included a baseline data collection with 5 days of mid-morning flights, four early flights, four high-workload mid-day flights, and four late flights that landed after midnight. Each work block was separated by 3-4 days of rest. To assess sleep, participants wore a wrist-worn research-validated activity monitor continuously and completed daily sleep diaries. To assess the circadian phase, pilots were asked to collect all urine produced in four or eight hourly bins during the 24 h after each duty block for the assessment of 6-sulfatoxymelatonin (aMT6s), which is a biomarker of the circadian rhythm. To assess subjective fatigue and objective performance, participants were provided with a touch-screen device used to complete the Samn-Perelli Fatigue Scale and Psychomotor Vigilance Task (PVT) during and after each flight, and at waketime, mid-day, and bedtime. Using these methods, it was found that sleep duration was reduced during early starts and late finishes relative to baseline. Circadian phase shifted according to duty schedule, but there was a wide range in the aMT6s peak between individuals on each schedule. PVT performance was worse on the early, high-workload, and late schedules relative to baseline. Overall, the combination of these methods was practical and effective for assessing the influence of sleep loss and circadian phase on fatigue and performance in a complex operational environment.

Equation to Estimate Total Energy Expenditure in Military Populations Using a Wrist-Worn Physical Activity Monitor

Equation to Estimate Total Energy Expenditure in Military Populations Using a Wrist-Worn Physical Activity Monitor

Observational evidence of the seasonal and demographic variation in experienced temperature from 77 743 UK Biobank participants.

Exposure to cold is known to be associated with severe health impacts. The primary epidemiological evidence for this is the seasonal variation in mortality. However, there is a paucity of directly measured data for personal cold temperature exposure. This paper develops the concept of experienced temperature, and reports how it varies with season, demographics and housing factors. This study uses data from 77 743 UK Biobank participants. A novel method to directly measure participant's exposure to low temperatures using a thermistor in a wrist-worn activity monitor is described. These readings are combined with demographic and housing factor variables in a multiple regression model to understand underlying relationships. The study reveals a significant difference in experienced temperature of ~1.8°C between the periods of coldest and hottest external temperature. A number of demographic differences were also observed-such as people of Chinese ethnic background experiencing 0.65°C lower temperatures than other groups. This paper presents primary evidence for a seasonal variation in experienced temperature. This variation likely contributes to cold related mortality and morbidity. It is hypothesized that this relationship would be less strong in countries which suffer fewer impacts of cold winter temperatures.

The Feasibility and Impact of the EMOVE Intervention on Self-efficacy and Outcome Expectations for Exercise in Epilepsy.

The purpose of this pilot study was to evaluate the feasibility of the self-efficacy based Epilepsy-Motivate and Outcome Expectations for Vigorous Exercise (EMOVE) intervention and report on the preliminary efficacy of this intervention aimed at improving exercise behaviors in adults with epilepsy. Methods: A single-group, repeated-measures design was used in 30 outpatients. Data were collected at baseline and 12 weeks after the intervention. Participant outcomes included Self-Efficacy and Outcome Expectations for Exercise in Epilepsy, Beck Depression Inventory-II, Quality of Life in Epilepsy Inventory-31, seizure frequency, average daily steps, and body mass index. Daily number of steps was measured using a wrist-worn activity monitor. Feasibility data were assessed using evidence of treatment fidelity including intervention delivery, receipt, and enactment. Results: Participants were single (63%), white (53%), female (63%), had a mean (SD) age of 46.7 (13) years (range, 26-68 years), had low levels of self-efficacy (mean, 5.10; range, 0-10) and high outcome expectations (mean, 3.90; range, 0-5), took under the recommended 10 000 steps per day (mean, 5107), and had an average of 6 seizures per month. Postintervention testing showed statistical improvement in depressive symptoms (mean [SD], 9.95 [9.47]; P < .05). There were no significant differences found for the other study outcomes. Our study showed the EMOVE intervention was feasible. Study participants had improved depressive symptoms. Future research should focus on increasing the sample size, improving exercise performance through group or individualized exercise sessions, and adding a control group to better evaluate the relationship between the intervention and improved depressive symptoms.

Association between sleep disturbance and nocturnal blood pressure profiles by a linear mixed model analysis: the Nagahama study

ObjectivesWe aimed to analyze associations of sleep disturbance, including sleep disordered breathing, sleep fragmentation, and sleep efficiency, with abnormal nocturnal blood pressure (BP) profiles that may be risk factors for adverse cardiovascular outcomes. MethodsThe study included 5854 community residents with 20,725 multi-day measurements. Sleep fragmentation and efficiency were evaluated using a wrist-worn activity monitor. Sleep disordered breathing was assessed using the 3% oxygen desaturation index corrected for actigraphy-determined sleep duration. A timer-equipped standard cuff-oscillometric device was used for home and sleep BP monitoring. ResultsMean nocturnal systolic BP (SBP) change was −8.6 ± 9.7% (−11.1 ± 12.6 mmHg), and inter-day correlation coefficient of the nocturnal SBP change was 0.443. Results of a linear mixed model analysis using daily measured values identified lower sleep efficiency (coefficient = −0.130, p < 0.001) as a determinant for decreased nocturnal SBP dipping beyond the interday variations of these parameters. Number of nocturnal urinations was another strong determinant (coefficient = 1.191, p < 0.001), although the association of sleep efficiency was independent of nocturnal urination, awake SBP, and sleep disordered breathing (coefficient = −0.102, p < 0.001). Sleep efficiency was also independently associated with sleep SBP level (coefficient = −0.138, p < 0.001). Estimated differences in nocturnal SBP dipping and sleep SBP level as a function of the degree of sleep efficiency (less than 80%) reached 1.63% (1.09–2.17%) and 2.16 mmHg (1.49–2.82%), respectively. ConclusionMore attention should be paid to sleep efficiency as a factor in maintaining circadian BP rhythm.

Acceptability and feasibility of wearing activity monitors in community‐dwelling older adults with dementia

Measuring physical activity is complicated particularly in people with dementia, where activity levels are low and subjective measures are susceptible to inaccurate recall. Activity monitors are increasingly being used within research; however, it is unclear how people with dementia view wearing such devices and what aspects of the device effect wear time. The aim of the study was to evaluate the acceptability and feasibility of people with dementia wearing activity monitors. Twenty-six, community-dwelling, people with mild dementia were asked to wear an activity monitor (GENEactiv Original) over a 1-month period. Perceptions of the device were measured using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) 2.0, alongside qualitative interviews. Device diary and activity monitor data were used to assess compliance. Participants tended to find wearing the activity monitors acceptable, with only three participants (12%) withdrawing prior to the study end date. Participants were generally satisfied with wearing the devices as measured by the QUEST (Mdn=4.4, IQR=1.1). Four themes were identified that influenced perceptions of wearing the device: external influences, design, routine, and perceived benefits. Asking people with dementia to wear a wrist-worn activity monitor for prolonged periods appears to be both feasible and acceptable. Researchers need to consider the needs and preferences of the sample population prior to selecting activity monitors.

Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP): A Randomized Controlled Trial.

To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial. WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC. Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months. Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80-112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs -5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52). The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.

Baby Steps \u2013 a structured group education programme with accompanying mobile web application designed to promote physical activity in women with a history of gestational diabetes: study protocol for a randomised controlled trial

BackgroundA diagnosis of gestational diabetes (GDM) is associated with an over sevenfold increase in the risk of developing type 2 diabetes (T2D), while among parous women with T2D, up to 30% have a history of GDM. Lifestyle interventions have been shown to reduce the risk of incident T2D in adults with impaired glucose tolerance, including in women with a history of GDM. The aim of this study is to establish whether a group self-management education programme, supported by a mobile web application, can improve levels of physical activity at 12 months in women who have had GDM.MethodsThe study is a randomised controlled trial with follow-up at 6 and 12 months. Primary outcome is change in objectively measured average daily physical activity at 12 months. Secondary outcomes include lipid profile, blood pressure, glycated haemoglobin, obesity, smoking and alcohol status, self-reported physical activity, anxiety, depression and quality of life. Participants are recruited from maternity and diabetes departments in hospital trusts in two sites in the UK. Women aged > 18 years, with a diagnosis of GDM during any pregnancy in the previous 60 months are eligible. Participants need to have a good understanding of written and verbal English, be able to give informed consent and have access to a smart-phone. Women who are pregnant or have type 1 or type 2 diabetes are not eligible. In total, 290 participants will be recruited and randomly assigned, with stratification for age and ethnicity, to either the control group, receiving usual care, or the intervention group who are invited to participate in the Baby Steps programme. This comprises a group education programme and access to a mobile web application which provides an education component and interacts with a wrist-worn activity monitor providing automated messages, setting challenges and encouraging motivation.DiscussionIf effective, the Baby Steps programme could be translated into a primary care-based intervention that women with GDM are referred to in the postnatal period. This could help them make lifestyle changes that could reduce their future risk of T2D.Trial registrationISRCTN, ISRCTN17299860. Registered on 5 April 2017.

The Feasibility and Longitudinal Effects of a Home-Based Sedentary Behavior Change Intervention After Stroke

ObjectiveTo evaluate the feasibility and preliminary effects of a sedentary behavior change intervention on sedentary behavior, physical activity, function, and quality of life following inpatient stroke rehabilitation. DesignSingle-group, longitudinal, intervention study with 1-week baseline, 8-week intervention, and 8-week follow-up. SettingCommunity. ParticipantsIndividuals (N=34) with subacute stroke recruited within 1 month following discharge home from inpatient stroke rehabilitation. InterventionSTand Up Frequently From Stroke (STUFFS) intervention that involved interrupting and replacing sedentary time with upright activities (standing and walking) at home and in the community. A motivational wrist-worn activity monitor was used throughout the intervention. Main Outcome MeasuresPrimary outcomes were reach (enrolled/eligible), retention (completed/enrolled), satisfaction, and compliance with the intervention. Secondary outcomes were sedentary behavior, physical activity, lower extremity impairment, self-efficacy, cognitive status, mobility, and quality of life outcomes. ResultsForty-four participants were eligible to participate. Of the eligible, 34 (77.3%; time since stroke onset: 3.5±1.1 months) were enrolled at baseline and 32 (94.1%) of the enrolled had complete data at follow-up. Satisfaction with the program was 89%. Sedentary time decreased by 54.2±13.7 minutes per day (P<.01) at postintervention and 26.8±14.0 minutes per day (P=.07) at follow-up, relative to baseline. There were significant improvements in walking speed, cognition, impairment, and self-reported quality of life over time (P<.05). Self-efficacy was high across all time points. The number of steps and time spent stepping were not statistically different across both time periods. ConclusionsThe program was feasible to deliver in the home environment with good retention and satisfaction. Further research is required to test the effectiveness of the STUFFS program compared with usual care.