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Brierley ML, Chater AM, Edwardson CL, Castle EM, Hunt ER, Biddle SJ, Sisodia R, Bailey DP. The Regulate your Sitting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: findings from a randomised-controlled feasibility trial. Diabetol Metab Syndr 2024; 16:87. [PMID: 38659052 PMCID: PMC11040907 DOI: 10.1186/s13098-024-01336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Reducing and breaking up sitting is recommended for optimal management of Type 2 diabetes mellitus (T2DM). Yet, there is limited evidence of interventions targeting these outcomes in individuals with this condition. The primary aim of this study was to assess the feasibility and acceptability of delivering and evaluating a tailored online intervention to reduce and break up sitting in adults with T2DM. METHODS A mixed-methods two-arm randomised controlled feasibility trial was conducted in ambulatory adults with T2DM who were randomised 1:1 to the REgulate your SItting Time (RESIT) intervention or usual care control group. The intervention included online education, self-monitoring and prompt tools (wearable devices, smartphone apps, computer apps) and health coaching. Feasibility outcomes were recruitment, attrition, data completion rates and intervention acceptability. Measurements of device-assessed sitting (intended primary outcome for definitive trial), standing and stepping, and physical function, psychosocial health and wellbeing were taken at baseline, 3 months and 6 months. Individual semi-structured interviews were conducted at six-months (post intervention) to explore acceptability, feasibility and experiences of the trial and intervention using the Framework Method. RESULTS Seventy participants aged 55 ± 11 years were recruited. Recruitment rate (proportion of eligible participants enrolled into the study) was 67% and participant retention rate at 6 months was 93% (n = 5 withdrawals). Data completion rates for daily sitting were 100% at baseline and ranged from 83 to 91% at 3 months and 6 months. Descriptive analysis demonstrated potential for the intervention to reduce device-measured sitting, which was 30.9 ± 87.2 and 22.2 ± 82.5 min/day lower in the intervention group at 3 and 6 months, respectively, compared with baseline. In the control group, sitting was 4.4 ± 99.5 and 23.7 ± 85.2 min/day lower at 3 and 6 months, respectively. Qualitative analysis identified three themes: reasons for participating in the trial, acceptability of study procedures, and the delivery and experience of taking part in the RESIT intervention. Overall, the measurement visits and intervention were acceptable to participants. CONCLUSIONS This study demonstrated the feasibility and acceptability of the RESIT intervention and evaluation methods, supporting a future definitive trial. If RESIT is found to be clinically effective, this could lead to changes in diabetes healthcare with a focus on reducing sitting. TRIAL REGISTRATION The trial was registered with ISRCTN (number ISRCTN14832389).
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Affiliation(s)
- Marsha L Brierley
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, MK41 9EA, Bedford, UK
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, WC1E 7HB, London, UK
| | - Charlotte L Edwardson
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester General Hospital, LE5 4PW, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, LE5 4PW, Leicester, UK
| | - Ellen M Castle
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Physiotherapy Division, Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 4PH, Uxbridge, UK
- Curtin School of Allied Health, School of Health Sciences, Curtin University, Western Australia, 6845, Bentley, Australia
| | - Emily R Hunt
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, 4300, Springfield, QLD, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, FI-40014, Jyväskylä, Finland
| | - Rupa Sisodia
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK
| | - Daniel P Bailey
- Centre for Physical Activity in Health and Disease, College of Health, Medicine and Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK.
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, UB8 3PH, Uxbridge, UK.
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Henson J, Tziannou A, Rowlands AV, Edwardson CL, Hall AP, Davies MJ, Yates T. Twenty-four-hour physical behaviour profiles across type 2 diabetes mellitus subtypes. Diabetes Obes Metab 2024; 26:1355-1365. [PMID: 38186324 DOI: 10.1111/dom.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To investigate how 24-h physical behaviours differ across type 2 diabetes (T2DM) subtypes. MATERIALS AND METHODS We included participants living with T2DM, enrolled as part of an ongoing observational study. Participants wore an accelerometer for 7 days to quantify physical behaviours across 24 h. We used routinely collected clinical data (age at onset of diabetes, glycated haemoglobin level, homeostatic model assessment index of beta-cell function, homeostatic model assessment index of insulin resistance, body mass index) to replicate four previously identified subtypes (insulin-deficient diabetes [INS-D], insulin-resistant diabetes [INS-R], obesity-related diabetes [OB] and age-related diabetes [AGE]), via k-means clustering. Differences in physical behaviours across the diabetes subtypes were assessed using generalized linear models, with the AGE cluster as the reference. RESULTS A total of 564 participants were included in this analysis (mean age 63.6 ± 8.4 years, 37.6% female, mean age at diagnosis 53.1 ± 10.0 years). The proportions in each cluster were as follows: INS-D: n = 35, 6.2%; INS-R: n = 88, 15.6%; OB: n = 166, 29.4%; and AGE: n = 275, 48.8%. Compared to the AGE cluster, the OB cluster had a shorter sleep duration (-0.3 h; 95% confidence interval [CI] -0.5, -0.1), lower sleep efficiency (-2%; 95% CI -3, -1), lower total physical activity (-2.9 mg; 95% CI -4.3, -1.6) and less time in moderate-to-vigorous physical activity (-6.6 min; 95% CI -11.4, -1.7), alongside greater sleep variability (17.9 min; 95% CI 8.2, 27.7) and longer sedentary time (31.9 min; 95% CI 10.5, 53.2). Movement intensity during the most active continuous 10 and 30 min of the day was also lower in the OB cluster. CONCLUSIONS In individuals living with T2DM, the OB subtype had the lowest levels of physical activity and least favourable sleep profiles. Such behaviours may be suitable targets for personalized therapeutic lifestyle interventions.
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Affiliation(s)
- Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Aikaterina Tziannou
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Heathcote LE, Pollard DJ, Brennan A, Davies MJ, Eborall H, Edwardson CL, Gillett M, Gray LJ, Griffin SJ, Hardeman W, Henson J, Khunti K, Sharp S, Sutton S, Yates T. Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e003516. [PMID: 38471669 PMCID: PMC10936471 DOI: 10.1136/bmjdrc-2023-003516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D. MATERIALS AND METHODS We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective. RESULTS Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years. CONCLUSIONS We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect. TRIAL REGISTRATION NUMBER ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
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Affiliation(s)
| | - Daniel J Pollard
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Melanie J Davies
- Diabetes Research Department, University of Leicester, Leicester, UK
| | - Helen Eborall
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Michael Gillett
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | | | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, UK
| | | | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Yates T, Biddle GJH, Henson J, Edwardson CL, Arsenyadis F, Goff LM, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Impact of weight loss and weight gain trajectories on body composition in a population at high risk of type 2 diabetes: A prospective cohort analysis. Diabetes Obes Metab 2024; 26:1008-1015. [PMID: 38093678 DOI: 10.1111/dom.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
AIM In a primary care population at high risk of type 2 diabetes, 24-month weight change trajectories were used to investigate the impact of weight cycling on fat mass (FM) and fat-free mass (FFM). MATERIALS AND METHODS Cohort data from the Walking Away from Type 2 Diabetes trial was used, which recruited adults at-risk of type 2 diabetes from primary care in 2009/10. Annual weight change trajectories based on weight loss/gain of ≥5% were assessed over two 24-month periods. Body composition was measured by bioelectrical impedance analysis. Repeated measures were analysed using generalized estimating equations with participants contributing up to two 24-month observation periods. RESULTS In total, 622 participants were included (average age = 63.6 years, body mass index = 32.0 kg/m2 , 35.4% women), contributing 1163 observations. Most observations (69.2%) were from those that maintained their body weight, with no change to FM or FFM. A minority (4.6% of observations) lost over 5% of body weight between baseline and 12 months, which was then regained between 12 and 24 months. These individuals regained FM to baseline levels, but lost 1.50 (0.66, 2.35) kg FFM, adjusted for confounders. In contrast, those that gained weight between baseline and 12 months but lost weight between 12 and 24 months (5.5% of observations) had a net gain in FM of 1.70 (0.27, 3.12) kg with no change to FFM. CONCLUSION Weight cycling may be associated with a progressive loss in FFM and/or gain in FM in those with overweight and obesity at-risk of type 2 diabetes.
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Affiliation(s)
- T Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G J H Biddle
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - F Arsenyadis
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L M Goff
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Papamargaritis
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D R Webb
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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Goldney J, Henson J, Edwardson CL, Khunti K, Davies MJ, Yates T. Long-term ambient air pollution exposure and prospective change in sedentary behaviour and physical activity in individuals at risk of type 2 diabetes in the UK. J Public Health (Oxf) 2024; 46:e32-e42. [PMID: 38103023 PMCID: PMC10901272 DOI: 10.1093/pubmed/fdad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Air pollution may be a risk factor for physical inactivity and sedentary behaviour (SED) through discouraging active lifestyles, impairing fitness and contributing to chronic diseases with potentially important consequences for population health. METHODS Using generalized estimating equations, we examined the associations between long-term particulate matter with diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10) and nitrogen dioxide (NO2) and annual change in accelerometer-measured SED, moderate-to-vigorous physical activity (MVPA) and steps in adults at risk of type 2 diabetes within the Walking Away from Type 2 Diabetes trial. We adjusted for important confounders including social deprivation and measures of the built environment. RESULTS From 808 participants, 644 had complete data (1605 observations; 64.7% men; mean age 63.86 years). PM2.5, NO2 and PM10 were not associated with change in MVPA/steps but were associated with change in SED, with a 1 ugm-3 increase associated with 6.38 (95% confidence interval: 0.77, 12.00), 1.52 (0.49, 2.54) and 4.48 (0.63, 8.34) adjusted annual change in daily minutes, respectively. CONCLUSIONS Long-term PM2.5, NO2 and PM10 exposures were associated with an annual increase in SED: ~11-22 min/day per year across the sample range of exposure (three standard deviations). Future research should investigate whether interventions to reduce pollution may influence SED.
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Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
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Mayne RS, Biddle GJH, Edwardson CL, Hart ND, Daley AJ, Heron N. The relationship between general practitioner movement behaviours with burnout and fatigue. BMC Prim Care 2024; 25:60. [PMID: 38365606 PMCID: PMC10870505 DOI: 10.1186/s12875-024-02289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Physical inactivity is associated with feelings of burnout and fatigue, which in turn are associated with reduced performance among healthcare practitioners. This study explored movement behaviours of general practitioners (GPs) and the association between these behaviours with burnout and fatigue. METHODS GPs in Northern Ireland were asked to wear a thigh-worn accelerometer for seven days and complete validated questionnaires to assess the association between daily number of steps, time spent sitting and standing with feelings of burnout and fatigue. RESULTS Valid accelerometer data were obtained from 47 (77.0%) participants. Average workday sitting time, standing time and number of steps were 10.6 h (SD 1.5), 3.8 h (SD 1.3), and 7796 steps (SD 3116) respectively. Participants were less sedentary (8.0 h (SD 1.6)) and more active (4.7 h (SD 1.4) standing time and 12,408 steps (SD 4496)) on non-workdays. Fourteen (30.4%) participants reported burnout and sixteen (34.8%) reported severe fatigue. There were no significant associations between sitting, standing and step counts with burnout or fatigue (p > 0.05). CONCLUSION GPs were less active on workdays compared to non-workdays and exhibited high levels of sitting. Feelings of burnout and fatigue were highly prevalent, however movement behaviours were not found to be associated with burnout and fatigue. Given the increased sedentariness among GPs on workdays compared to non-workdays, GPs should consider how they can improve their movement behaviours on workdays to help optimise their wellbeing.
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Affiliation(s)
- Richard S Mayne
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - Gregory J H Biddle
- School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Nigel D Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Amanda J Daley
- School of Sport, Exercise and Health Sciences, The Centre for Lifestyle Medicine and Behaviour, Loughborough University, Loughborough, UK
| | - Neil Heron
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, David Weatherall Building, Keele, UK
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Henson J, Davies MJ, Brady EM, Edwardson CL, Hall AP, Khunti K, Redman E, Rowlands AV, Sargeant J, Yates T. The potential blunting effect of metformin and/or statin therapy on physical activity-induced associations with HbA1c in type 2 diabetes. J Diabetes 2024; 16:e13495. [PMID: 37964490 PMCID: PMC10859307 DOI: 10.1111/1753-0407.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 09/22/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
Highlights Our analysis indicates a potential blunting effect of metformin and/or statin therapy on physical activity-induced associations with HbA1c. The benefit of daily physical activity on glycemic control in people with type 2 diabetes is potentially more apparent in those prescribed neither metformin nor statin therapy. As physical activity is rarely prescribed in isolation of other background medications used to manage type 2 diabetes, the results of this analysis may help to maximize interventions delivered through routine clinical care, while allowing for personalization in prescribed physical activity and pharmacotherapy.
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Affiliation(s)
- Joseph Henson
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Melanie J. Davies
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Emer M. Brady
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Charlotte L. Edwardson
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Andrew P. Hall
- Hanning Sleep LaboratoryLeicester General HospitalLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- NIHRApplied Health Research Collaboration – East Midlands (NIHR ARC‐EM), Leicester Diabetes CentreLeicesterUK
| | - Emma Redman
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Alex V. Rowlands
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human PerformanceUniversity of South Australia, Adelaide, AustraliaAdelaideSouth AustraliaAustralia
| | - Jack Sargeant
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Thomas Yates
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
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Edwardson CL, Abell L, Clarke-Cornwell A, Dunstan DW, Gray LJ, Healy GN, Hadjiconstantinou M, Wilson P, Maylor B, Munir F, Biddle SJ. Implementation and engagement of the SMART Work & Life sitting reduction intervention: an exploratory analysis on intervention effectiveness. Int J Behav Nutr Phys Act 2023; 20:148. [PMID: 38115044 PMCID: PMC10729557 DOI: 10.1186/s12966-023-01548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND To enhance the impact of interventions, it is important to understand how intervention engagement relates to study outcomes. We report on the level of implementation and engagement with the SMART Work & Life (SWAL) programme (delivered with (SWAL plus desk) and without a height-adjustable desk (SWAL)) and explore the effects of different levels of this on change in daily sitting time in comparison to the control group. METHODS The extent of intervention delivery by workplace champions and the extent of engagement by champions and participants (staff) with each intervention activity was assessed by training attendance logs, workplace champion withdrawal dates, intervention activities logs and questionnaires. These data were used to assess whether a cluster met defined criteria for low, medium, or high implementation and engagement or none of these. Mixed effects linear regression analyses tested whether change in sitting time varied by: (i) the number of intervention activities implemented and engaged with, and (ii) the percentage of implementation and engagement with all intervention strategies. RESULTS Workplace champions were recruited for all clusters, with 51/52 (98%) attending training. Overall, 12/27 (44.4%) SWAL and 9/25 (36.0%) SWAL plus desk clusters implemented all main intervention strategies. Across remaining clusters, the level of intervention implementation varied. Those in the SWAL (n = 8 (29.6%) clusters, 80 (32.1%) participants) and SWAL plus desk (n = 5 (20.0%) clusters, 41 (17.1%) participants) intervention groups who implemented and engaged with the most intervention strategies and had the highest percentage of cluster implementation and engagement with all intervention strategies sat for 30.9 (95% CI -53.9 to -7.9, p = 0.01) and 75.6 (95% CI -103.6 to -47.7, p < 0.001) fewer minutes/day respectively compared to the control group at 12 month follow up. These differences were larger than the complete case analysis. The differences in sitting time observed for the medium and low levels were similar to the complete case analysis. CONCLUSIONS Most intervention strategies were delivered to some extent across the clusters although there was large variation. Superior effects for sitting reduction were seen for those intervention groups who implemented and engaged with the most intervention components and had the highest level of cluster implementation and engagement. TRIAL REGISTRATION ISRCTN11618007. Registered on 24 January 2018. https://www.isrctn.com/ISRCTNISRCTN11618007 .
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Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Lucy Abell
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Alex Clarke-Cornwell
- School of Health & Society, University of Salford, Salford, Greater Manchester, M6 6PU, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, 3125, Australia
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | | | - Panna Wilson
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - Benjamin Maylor
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, 4300, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, FI-40014, Finland
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9
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Biddle GJ, Thomas N, Edwardson CL, Clemes SA, Daley AJ. Burnout, psychological wellbeing, and musculoskeletal complaints in UK GPs: an observational study. BJGP Open 2023; 7:BJGPO.2023.0007. [PMID: 37474254 DOI: 10.3399/bjgpo.2023.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Healthcare systems are under unprecedented pressure. GPs are crucial to the health of the population, yet their own health and wellbeing is often overlooked. AIM To investigate feelings of burnout, psychological wellbeing, and musculoskeletal complaints in GPs across the UK and to examine whether these health outcomes vary according to the time GPs spent sitting, their participation in physical activity each day, and the time spent working per day or week. DESIGN & SETTING Observational study involving GPs located across the UK. METHOD An online survey was emailed to working members of the Royal College of General Practitioners and shared on social media between October and December 2020. The survey included questions on burnout, psychological wellbeing, musculoskeletal complaints, sitting time, physical activity, and time spent working. Mean differences were examined for burnout, psychological wellbeing, and musculoskeletal complaints. RESULTS Data from 406 GPs showed a high level of burnout (35.5%) and musculoskeletal complaints (neck, shoulder and back: 81.8%; arms: 28.3%; and legs: 49.8%). Psychological wellbeing was low in 22.9% of GPs. Burnout was lower in GPs who met current physical activity guidelines, while psychological wellbeing was higher in those with >2 breaks in sitting per hour. Musculoskeletal complaints were higher in those spending >50% of sitting time in prolonged bouts (≥30 minutes). CONCLUSION A high proportion of GPs reported experiencing burnout and musculoskeletal complaints, but these health concerns were less evident in GPs who spent less time in prolonged sitting, took more breaks in sitting, and who were more physically active.
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Affiliation(s)
- Gregory Jh Biddle
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Nicholas Thomas
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Charlotte L Edwardson
- Research, Royal College of General Practitioners, London, UK
- Sedentary Behaviour and Health, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- Sedentary Behaviour and Health, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stacy A Clemes
- School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Science, Loughborough University, Loughborough, UK
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10
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Maylor BD, Hough J, Edwardson CL, Zakrzewski-Fruer JK, Bailey DP. Stress and Work Performance Responses to a Multicomponent Intervention for Reducing and Breaking up Sitting in Office Workers: A Cluster Randomized Controlled Trial. J Occup Environ Med 2023; 65:e744-e751. [PMID: 37733990 DOI: 10.1097/jom.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE The aim of the study is to explore the potential of a sitting reduction workplace intervention for improving stress and work performance. METHODS A cluster randomized controlled trial evaluated an intervention to reduce and break up occupational sitting in 12 clusters ( n = 89 office workers) over 8 weeks. Outcomes were physiological stress (cortisol concentrations), perceived stress, and work performance. RESULTS Linear mixed model group × time interaction effects were nonsignificant. Exploratory analyses showed a trend, with a large effect, for lower cortisol concentrations over the day in the intervention group relative to controls at 8 weeks (-0.85; 95% confidence interval, -1.70 to 0.03 nmol·L -1 ; P = 0.06, d = 0.79). The intervention group had higher vigor and cognitive liveliness at 8 weeks relative to controls ( P ≤ 0.05). CONCLUSIONS This exploratory study suggests that there could be meaningful changes in physiological stress and work-related outcomes that should be investigated in future studies.
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Affiliation(s)
- Benjamin D Maylor
- From the Institute for Sport and Physical Activity Research, School of Sport Science and Physical Activity, University of Bedfordshire, Bedfordshire, United Kingdom (B.D.M., J.H., J.K.Z.-F., D.P.B.); Diabetes Research Centre, University of Leicester, Leicester, United Kingdom (B.D.M., C.L.E.); Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom (B.D.M., C.L.E.); School of Science and Technology, Department of Sport Science, Nottingham Trent University, Nottingham, United Kingdom (J.H.); Centre for Physical Activity in Health and Disease, Brunel University London, Uxbridge, United Kingdom (D.P.B.); and Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom (D.P.B.)
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11
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Edwardson CL, Maylor BD, Biddle SJH, Clarke-Cornwell AM, Clemes SA, Davies MJ, Dunstan DW, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Wilson P, Munir F, Yates T, Eborall H. Participant and workplace champion experiences of an intervention designed to reduce sitting time in desk-based workers: SMART work & life. Int J Behav Nutr Phys Act 2023; 20:142. [PMID: 38037043 PMCID: PMC10691052 DOI: 10.1186/s12966-023-01539-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND A cluster randomised controlled trial demonstrated the effectiveness of the SMART Work & Life (SWAL) behaviour change intervention, with and without a height-adjustable desk, for reducing sitting time in desk-based workers. Staff within organisations volunteered to be trained to facilitate delivery of the SWAL intervention and act as workplace champions. This paper presents the experiences of these champions on the training and intervention delivery, and from participants on their intervention participation. METHODS Quantitative and qualitative feedback from workplace champions on their training session was collected. Participants provided quantitative feedback via questionnaires at 3 and 12 month follow-up on the intervention strategies (education, group catch ups, sitting less challenges, self-monitoring and prompts, and the height-adjustable desk [SWAL plus desk group only]). Interviews and focus groups were also conducted at 12 month follow-up with workplace champions and participants respectively to gather more detailed feedback. Transcripts were uploaded to NVivo and the constant comparative approach informed the analysis of the interviews and focus groups. RESULTS Workplace champions rated the training highly with mean scores ranging from 5.3/6 to 5.7/6 for the eight parts. Most participants felt the education increased their awareness of the health consequences of high levels of sitting (SWAL: 90.7%; SWAL plus desk: 88.2%) and motivated them to change their sitting time (SWAL: 77.5%; SWAL plus desk: 85.77%). A high percentage of participants (70%) reported finding the group catch up session helpful and worthwhile. However, focus groups highlighted mixed responses to the group catch-up sessions, sitting less challenges and self-monitoring intervention components. Participants in the SWAL plus desk group felt that having a height-adjustable desk was key in changing their behaviour, with intrinsic as well as time based factors reported as key influences on the height-adjustable desk usage. In both intervention groups, participants reported a range of benefits from the intervention including more energy, less fatigue, an increase in focus, alertness, productivity and concentration as well as less musculoskeletal problems (SWAL plus desk group only). Work-related, interpersonal, personal attributes, physical office environment and physical barriers were identified as barriers when trying to sit less and move more. CONCLUSIONS Workplace champion and participant feedback on the intervention was largely positive but it is clear that different behaviour change strategies worked for different people indicating that a 'one size fits all' approach may not be appropriate for this type of intervention. The SWAL intervention could be tested in a broader range of organisations following a few minor adaptations based on the champion and participant feedback. TRIAL REGISTRATION ISCRCTN registry (ISRCTN11618007).
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Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Benjamin D Maylor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, 4350, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, FI-40014, Finland
| | | | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Malcolm H Granat
- School of Health & Society, University of Salford, Salford, Greater Manchester, M6 6PU, UK
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | | | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Panna Wilson
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Helen Eborall
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Scotland, EH8 9AG, UK
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12
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Krouwel M, Greenfield SM, Chalkley A, Sanders JP, Parretti HM, Gokal K, Jolly K, Skrybant M, Biddle SJH, Greaves C, Maddison R, Mutrie N, Ives N, Esliger DW, Sherar L, Edwardson CL, Yates T, Frew E, Tearne S, Daley AJ. Promoting participation in physical activity through Snacktivity: A qualitative mixed methods study. PLoS One 2023; 18:e0291040. [PMID: 37695785 PMCID: PMC10495025 DOI: 10.1371/journal.pone.0291040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Public health guidance acknowledges the benefits of physical activity of any duration. We have proposed a whole-day approach to promoting physical activity called Snacktivity™, which encourages frequent 2-5 minute 'activity snacks' of moderate-to-vigorous intensity. METHODS Using repeated semi-structured interviews and a think aloud protocol, this study aimed to understand participants' experiences of integrating Snacktivity™ into daily life, to provide insights to refine the delivery of Snacktivity™ interventions. Physically inactive adults recruited via primary care and a community health service engaged with an intervention to encourage Snacktivity™ over three weeks, which included using a Fitbit and linked mobile phone app (SnackApp). Participants took part in semi-structured interviews on two occasions during the intervention, with a sub-group participating in a think aloud study. Three study data sets were generated and independently explored using inductive thematic analysis, with findings combined into a single set of themes. RESULTS Eleven adults participated in the interview study who were interviewed twice (total interviews completed n = 21, 1 participant declined the second interview), of whom six completed the think aloud study (total voice recordings n = 103). Three main themes emerged from the combined data; lived experience of participating in Snacktivity™, motivation for Snacktivity™ and experiences with the Snacktivity™ technology. Participants undertook a variety of activity snacks, utilising their environment, which they believed improved their psychological wellbeing. Participants were enthusiastic about Snacktivity™, with some stating that activity snacks were more accessible than traditional exercise, but perceived they were often prevented from doing so in the presence of others. Participants were mostly enthusiastic about using the Snacktivity™ technology. CONCLUSION Participants were able to incorporate Snacktivity™ into their lives, particularly at home, and found this approach acceptable. Participants felt they experienced health benefits from Snacktivity™ although barriers to participation were reported. This study offers insights for translating guidance into practice and supporting people to become more physically active.
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Affiliation(s)
- Matthew Krouwel
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Sheila M. Greenfield
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anna Chalkley
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
| | - James P. Sanders
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Helen M. Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, United Kingdom
| | - Kajal Gokal
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Kate Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Magdalena Skrybant
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Stuart J. H. Biddle
- University of Southern Queensland, Springfield, Australia and Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Dale W. Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Lauren Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Charlotte L. Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Amanda J. Daley
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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13
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Katsarova SS, Redman E, Arsenyadis F, Brady EM, Rowlands AV, Edwardson CL, Goff LM, Khunti K, Yates T, Hall AP, Davies MJ, Henson J. Differences in Dietary Intake, Eating Occasion Timings and Eating Windows between Chronotypes in Adults Living with Type 2 Diabetes Mellitus. Nutrients 2023; 15:3868. [PMID: 37764651 PMCID: PMC10537296 DOI: 10.3390/nu15183868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Chronotype studies investigating dietary intake, eating occasions (EO) and eating windows (EW) are sparse in people with type 2 Diabetes mellitus (T2DM). This analysis reports data from the CODEC study. The Morningness-Eveningness questionnaire (MEQ) assessed chronotype preference. Diet diaries assessed dietary intake and temporal distribution. Regression analysis assessed whether dietary intake, EW, or EO differed by chronotype. 411 participants were included in this analysis. There were no differences in energy, macronutrient intake or EW between chronotypes. Compared to evening chronotypes, morning and intermediate chronotypes consumed 36.8 (95% CI: 11.1, 62.5) and 20.9 (95% CI: -2.1, 44.1) fewer milligrams of caffeine per day, respectively. Evening chronotypes woke up over an hour and a half later than morning (01:36 95% CI: 01:09, 02:03) and over half an hour later than intermediate chronotypes (00:45 95% CI: 00:21; 01:09. Evening chronotypes went to sleep over an hour and a half later than morning (01:48 95% CI: 01:23; 02:13) and an hour later than intermediate chronotypes (01:07 95% CI: 00:45; 01:30). Evening chronotypes' EOs and last caffeine intake occurred later but relative to their sleep timings. Future research should investigate the impact of chronotype and dietary temporal distribution on glucose control to optimise T2DM interventions.
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Affiliation(s)
- Stanislava S. Katsarova
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Emma Redman
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Franciskos Arsenyadis
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Alex V. Rowlands
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Charlotte L. Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Louise M. Goff
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Kamlesh Khunti
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- NIHR Applied Health Research Collaboration—East Midlands (NUHR ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Andrew P. Hall
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- Hanning Sleep Laboratory, Leicester General Hospital, Leicester LE5 4PW, UK
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Melanie J. Davies
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Joseph Henson
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
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14
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Engin B, Willis SA, Malaikah S, Sargeant JA, Biddle GJH, Razieh C, Argyridou S, Edwardson CL, Jelleyman C, Stensel DJ, Henson J, Rowlands AV, Davies MJ, Yates T, King JA. Sedentary Time Is Independently Related to Adipose Tissue Insulin Resistance in Adults With or at Risk of Type 2 Diabetes. Med Sci Sports Exerc 2023; 55:1548-1554. [PMID: 37093903 DOI: 10.1249/mss.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION This cross-sectional study examined associations of device-measured sedentary time and moderate-to-vigorous physical activity (MVPA) with adipose tissue insulin resistance in people with or at high risk of type 2 diabetes (T2DM). METHOD Data were combined from six previous experimental studies (within our group) involving patients with T2DM or primary risk factors (median (interquartile range) age, 66.2 (66.0-70.8) yr; body mass index (BMI), 31.1 (28.0-34.4) kg·m -2 ; 62% male; n = 179). Adipose tissue insulin resistance was calculated as the product of fasted circulating insulin and nonesterified fatty acids (ADIPO-IR), whereas sedentary time and MVPA were determined from wrist-worn accelerometery. Generalized linear models examined associations of sedentary time and MVPA with ADIPO-IR with interaction terms added to explore the moderating influence of ethnicity (White European vs South Asian), BMI, age, and sex. RESULTS In finally adjusted models, sedentary time was positively associated with ADIPO-IR, with every 30 min of sedentary time associated with a 1.80-unit (95% confidence interval, 0.51-3.06; P = 0.006) higher ADIPO-IR. This relationship strengthened as BMI increased ( β = 3.48 (95% confidence interval, 1.50-5.46), P = 0.005 in the upper BMI tertile (≥33.2 kg·m -2 )). MVPA was unrelated to ADIPO-IR. These results were consistent in sensitivity analyses that excluded participants taking statins and/or metformin ( n = 126) and when separated into the participants with T2DM ( n = 32) and those at high risk ( n = 147). CONCLUSIONS Sedentary time is positively related to adipose tissue insulin sensitivity in people with or at high risk of T2DM. This relationship strengthens as BMI increases and may help explain established relationships between greater sedentary time, ectopic lipid, and hyperglycemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Charlotte Jelleyman
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, NEW ZEALAND
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15
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Edwardson CL, Maylor BD, Biddle SJ, Clemes SA, Cox E, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Jaicim NB, Lawton S, Mandalia P, Munir F, Richardson G, Walker S, Yates T, Clarke-Cornwell AM. A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT. Public Health Res (Southampt) 2023; 11:1-229. [PMID: 37786938 DOI: 10.3310/dnyc2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007.
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Affiliation(s)
| | | | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Sarah Lawton
- School of Health & Society, University of Salford, Salford, UK
| | - Panna Mandalia
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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McBride P, Henson J, Edwardson CL, Maylor B, Dempsey PC, Rowlands AV, Davies MJ, Khunti K, Yates T. Four-Year Increase in Step Cadence Is Associated with Improved Cardiometabolic Health in People with a History of Prediabetes. Med Sci Sports Exerc 2023; 55:1601-1609. [PMID: 37005498 DOI: 10.1249/mss.0000000000003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate associations between 4-yr change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. METHODS In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index, waist circumference, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides, and glycated hemoglobin A1c [HbA1c]), and free-living stepping activity (activPAL3™) at baseline, 1 yr, and 4 yr. Brisk steps per day were defined as the number of steps accumulated at ≥100 steps per minute and slow steps per day as those accumulated at <100 steps per minute; the mean peak stepping cadence during the most active 10 minutes of the day was also derived. Generalized estimating equations examined associations between 4-yr change in step cadence and change in cardiometabolic risk factors, with interactions by sex and ethnicity. RESULTS Seven hundred ninety-four participants were included (age, 59.8 ± 8.9 yr; 48.7% women; 27.1% ethnic minority; total steps per day, 8445 ± 3364; brisk steps per day, 4794 ± 2865; peak 10-min step cadence, 128 ± 10 steps per minute). Beneficial associations were observed between change in brisk steps per day and change in body mass index, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-min step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps per day and change in peak 10-min step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-min peak step cadence with measures of adiposity were stronger in South Asians. CONCLUSIONS Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity.
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Maylor BD, Edwardson CL, Clarke-Cornwell AM, Davies MJ, Dawkins NP, Dunstan DW, Khunti K, Yates T, Rowlands AV. Physical Activity Assessed by Wrist and Thigh Worn Accelerometry and Associations with Cardiometabolic Health. Sensors (Basel) 2023; 23:7353. [PMID: 37687813 PMCID: PMC10489920 DOI: 10.3390/s23177353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023]
Abstract
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.
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Affiliation(s)
- Benjamin D. Maylor
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Charlotte L. Edwardson
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | | | - Melanie J. Davies
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Nathan P. Dawkins
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- School of Sport and Wellbeing, Leeds Trinity University, Leeds LS18 5HD, UK
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- NIHR Applied Research Collaboration East Midlands, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Tom Yates
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Alex V. Rowlands
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
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Jackson C, Stewart ID, Plekhanova T, Cunningham PS, Hazel AL, Al-Sheklly B, Aul R, Bolton CE, Chalder T, Chalmers JD, Chaudhuri N, Docherty AB, Donaldson G, Edwardson CL, Elneima O, Greening NJ, Hanley NA, Harris VC, Harrison EM, Ho LP, Houchen-Wolloff L, Howard LS, Jolley CJ, Jones MG, Leavy OC, Lewis KE, Lone NI, Marks M, McAuley HJC, McNarry MA, Patel BV, Piper-Hanley K, Poinasamy K, Raman B, Richardson M, Rivera-Ortega P, Rowland-Jones SL, Rowlands AV, Saunders RM, Scott JT, Sereno M, Shah AM, Shikotra A, Singapuri A, Stanel SC, Thorpe M, Wootton DG, Yates T, Gisli Jenkins R, Singh SJ, Man WDC, Brightling CE, Wain LV, Porter JC, Thompson AAR, Horsley A, Molyneaux PL, Evans RA, Jones SE, Rutter MK, Blaikley JF. Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study. Lancet Respir Med 2023; 11:673-684. [PMID: 37072018 PMCID: PMC10156429 DOI: 10.1016/s2213-2600(23)00124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. METHODS CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect. INTERPRETATION Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. FUNDING UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Callum Jackson
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Iain D Stewart
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart & Lung Institute, Imperial College London, London, UK
| | - Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Peter S Cunningham
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew L Hazel
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Bashar Al-Sheklly
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Raminder Aul
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Charlotte E Bolton
- Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; NIHR Nottingham BRC respiratory theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK; Persistent Physical Symptoms Research and Treatment Unit, South London and Maudsley NHS Trust, London, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gavin Donaldson
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Neil J Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Neil A Hanley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Victoria C Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Luke S Howard
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK
| | - Caroline J Jolley
- Faculty of Life Sciences & Medicine, King's College Hospital NHS Foundation Trust, London, UK; Kings College London, London, UK
| | - Mark G Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospitals Southampton, Southampton, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Keir E Lewis
- Hywel Dda University Health Board, Wales, UK; University of Swansea, Wales, UK; Respiratory Innovation Wales, Wales, UK
| | - Nazir I Lone
- The Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Hamish J C McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Melitta A McNarry
- Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Brijesh V Patel
- Anaesthetics, Pain Medicine, and Intensive Care, Imperial College London, London, UK; Royal Brompton and Harefield Clinical Group, Guy's andSt Thomas' NHS Foundation Trust, London, UK
| | - Karen Piper-Hanley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Pilar Rivera-Ortega
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Sarah L Rowland-Jones
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Janet T Scott
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ajay M Shah
- Faculty of Life Sciences & Medicine, King's College Hospital NHS Foundation Trust, London, UK; Kings College London, London, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stefan C Stanel
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Mathew Thorpe
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Daniel G Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R Gisli Jenkins
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Sally J Singh
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - William D-C Man
- National Heart & Lung Institute, Imperial College London, London, UK; Kings College London, London, UK; Royal Brompton and Harefield Clinical Group, Guy's andSt Thomas' NHS Foundation Trust, London, UK
| | - Christopher E Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Joanna C Porter
- UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK; ILD Service, University College London Hospital, London, UK
| | - A A Roger Thompson
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alex Horsley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | | | - Rachael A Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Samuel E Jones
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - John F Blaikley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.
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Perks J, Zaccardi F, Rayt H, Sayers R, Brady EM, Davies MJ, Rowlands AV, Edwardson CL, Hall A, Yates T, Henson J. Device-measured physical activity behaviours, and physical function, in people with type 2 diabetes mellitus and peripheral artery disease: A cross-sectional study. Exp Gerontol 2023; 178:112207. [PMID: 37196824 DOI: 10.1016/j.exger.2023.112207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023]
Abstract
AIM To quantify differences in device-measured physical activity (PA) behaviours, and physical function (PF), in people with type 2 diabetes mellitus (T2DM) with and without peripheral artery disease (PAD). MATERIALS AND METHODS Participants from the Chronotype of Patients with T2DM and Effect on Glycaemic Control cross-sectional study wore accelerometers on their non-dominant wrist for up to 8-days to quantify: volume and intensity distribution of PA, time spent inactive, time in light PA, moderate-to-vigorous PA in at least 1-minute bouts (MVPA1min), and the average intensity achieved during the most active continuous 2, 5, 10, 30, and 60-minute periods of the 24-h day. PF was assessed using the short physical performance battery (SPPB), the Duke Activity Status Index (DASI), sit-to-stand repetitions in 60 s (STS-60); hand-grip strength was also assessed. Differences between subjects with and without PAD were estimated using regressions adjusted for possible confounders. RESULTS 736 participants with T2DM (without diabetic foot ulcers) were included in the analysis, 689 had no PAD. People with T2DM and PAD undertake less PA (MVPA1min: -9.2 min [95 % CI: -15.3 to -3.0; p = 0.004]) (light intensity PA: -18.7 min [-36.4 to -1.0; p = 0.039]), spend more time inactive (49.2 min [12.1 to 86.2; p = 0.009]), and have reduced PF (SPPB score: -1.6 [-2.5 to -0.8; p = 0.001]) (DASI score: -14.8 [-19.8 to -9.8; p = 0.001]) (STS-60 repetitions: -7.1 [-10.5 to -3.8; p = 0.001]) compared to people without; some differences in PA were attenuated by confounders. Reduced intensity of activity for the most active continuous 2-30 min in the 24-h day, and reduced PF, persisted after accounting for confounders. There were no significant differences in hand-grip strength. CONCLUSIONS Findings from this cross-sectional study suggest that, the presence of PAD in T2DM may have been associated with lower PA levels and PF.
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Affiliation(s)
- Jemma Perks
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Rowlands AV, van Hees VT, Dawkins NP, Maylor BD, Plekhanova T, Henson J, Edwardson CL, Brady EM, Hall AP, Davies MJ, Yates T. Accelerometer-Assessed Physical Activity in People with Type 2 Diabetes: Accounting for Sleep when Determining Associations with Markers of Health. Sensors (Basel) 2023; 23:5382. [PMID: 37420551 DOI: 10.3390/s23125382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
High physical activity levels during wake are beneficial for health, while high movement levels during sleep are detrimental to health. Our aim was to compare the associations of accelerometer-assessed physical activity and sleep disruption with adiposity and fitness using standardized and individualized wake and sleep windows. People (N = 609) with type 2 diabetes wore an accelerometer for up to 8 days. Waist circumference, body fat percentage, Short Physical Performance Battery (SPPB) test score, sit-to-stands, and resting heart rate were assessed. Physical activity was assessed via the average acceleration and intensity distribution (intensity gradient) over standardized (most active 16 continuous hours (M16h)) and individualized wake windows. Sleep disruption was assessed via the average acceleration over standardized (least active 8 continuous hours (L8h)) and individualized sleep windows. Average acceleration and intensity distribution during the wake window were beneficially associated with adiposity and fitness, while average acceleration during the sleep window was detrimentally associated with adiposity and fitness. Point estimates for the associations were slightly stronger for the standardized than for individualized wake/sleep windows. In conclusion, standardized wake and sleep windows may have stronger associations with health due to capturing variations in sleep durations across individuals, while individualized windows represent a purer measure of wake/sleep behaviors.
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Affiliation(s)
- Alex V Rowlands
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | | | - Nathan P Dawkins
- School of Sport and Wellbeing, Leeds Trinity University, Leeds LS18 5HD, UK
| | - Benjamin D Maylor
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Tatiana Plekhanova
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Joseph Henson
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory and Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Melanie J Davies
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Thomas Yates
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
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Plekhanova T, Crawley E, Davies MJ, Gorely T, Harrington DM, Ioannidou E, Khunti K, Rowlands AV, Sherar LB, Yates T, Edwardson CL. Association between Chronotype and Physical Behaviours in Adolescent Girls. Children (Basel) 2023; 10:children10050819. [PMID: 37238367 DOI: 10.3390/children10050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
The aim of this study was to (1) describe accelerometer-assessed physical behaviours by chronotype, and (2) examine the association between chronotype and accelerometer-assessed physical behaviours in a cohort of adolescent girls. Chronotype (single question) and physical behaviours (GENEActiv accelerometer on the non-dominant wrist) were assessed in 965 adolescent girls (13.9 ± 0.8 years). Linear mixed-effects models examined the relationships among chronotype and physical behaviours (time in bed, total sleep time, sleep efficiency, sedentary time, overall, light and moderate-to-vigorous physical activity) on weekdays and weekend days. Over the 24 h day, participants spent 46% sedentary, 20% in light activity, 3% in moderate-to-vigorous physical activity, and 31% in 'time in bed'. Seventy percent of participants identified as 'evening' chronotypes. Compared to evening chronotypes, morning chronotypes engaged in less sedentary time (10 min/day) and had higher overall physical activity (1.3 mg/day, ~30 min of slow walking) on weekdays. Most girls identified as evening chronotypes with a large proportion of their day spent sedentary and a small amount in physical activities which may be exacerbated in evening chronotypes on weekdays. The results maybe be important for programmes aiming to promote physical activity in adolescent girls.
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Affiliation(s)
- Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Emily Crawley
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Deirdre M Harrington
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Lauren B Sherar
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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22
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Yates T, Henson J, McBride P, Maylor B, Herring LY, Sargeant JA, Davies MJ, Dempsey PC, Rowlands AV, Edwardson CL. Moderate-intensity stepping in older adults: insights from treadmill walking and daily living. Int J Behav Nutr Phys Act 2023; 20:31. [PMID: 36934275 PMCID: PMC10024004 DOI: 10.1186/s12966-023-01429-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/26/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND A step cadence of 100 steps/minute is widely used to define moderate-intensity walking. However, the generalizability of this threshold to different populations needs further research. We investigate moderate-intensity step cadence values during treadmill walking and daily living in older adults. METHODS Older adults (≥ 60 years) were recruited from urban community venues. Data collection included 7 days of physical activity measured by an activPAL3™ thigh worn device, followed by a laboratory visit involving a 60-min assessment of resting metabolic rate, then a treadmill assessment with expired gas measured using a breath-by-breath analyser and steps measured by an activPAL3™. Treadmill stages were undertaken in a random order and lasted 5 min each at speeds of 1, 2, 3, 4 and 5 km/h. Metabolic equivalent values were determined for each stage as standardised values (METSstandard) and as multiples of resting metabolic rate (METSrelative). A value of 3 METSstandard defined moderate-intensity stepping. Segmented generalised estimating equations modelled the association between step cadence and MET values. RESULTS The study included 53 participants (median age = 75, years, BMI = 28.0 kg/m2, 45.3% women). At 2 km/h, the median METSstandard and METSrelative values were above 3 with a median cadence of 81.00 (IQR 72.00, 88.67) steps/minute. The predicted cadence at 3 METSstandard was 70.3 (95% CI 61.4, 75.8) steps/minute. During free-living, participants undertook median (IQR) of 6988 (5933, 9211) steps/day, of which 2554 (1297, 4456) steps/day were undertaken in continuous stepping bouts lasting ≥ 1 min. For bouted daily steps, 96.4% (90.7%, 98.9%) were undertaken at ≥ 70 steps/minute. CONCLUSION A threshold as low as 70 steps/minute may be reflective of moderate-intensity stepping in older adults, with the vast majority of all bouted free-living stepping occurring above this threshold.
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Affiliation(s)
- T Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - J Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - P McBride
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - B Maylor
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - L Y Herring
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | - J A Sargeant
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - P C Dempsey
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - A V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - C L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
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23
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Daley AJ, Griffin RA, Moakes CA, Sanders JP, Skrybant M, Ives N, Maylor B, Greenfield SM, Gokal K, Parretti HM, Biddle SJH, Greaves C, Maddison R, Mutrie N, Esliger DW, Sherar L, Edwardson CL, Yates T, Frew E, Tearne S, Jolly K. Snacktivity™ to promote physical activity and reduce future risk of disease in the population: protocol for a feasibility randomised controlled trial and nested qualitative study. Pilot Feasibility Stud 2023; 9:45. [PMID: 36932423 PMCID: PMC10021043 DOI: 10.1186/s40814-023-01272-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Many people do not regularly participate in physical activity, which may negatively impact their health. Current physical activity guidelines are focused on promoting weekly accumulation of at least 150 min of moderate to vigorous intensity physical activity (MVPA). Whilst revised guidance now recognises the importance of making small changes to physical activity behaviour, guidance still focuses on adults needing to achieve at least 150 min of MVPA per week. An alternative 'whole day' approach that could motivate the public to be more physically active, is a concept called Snacktivity™. Instead of focusing on achieving 150 min per week of physical activity, for example 30 min of MVPA over 5 days, Snacktivity™ encourages the public to achieve this through small, but frequent, 2-5 min 'snacks' of MVPA throughout the whole day. METHODS The primary aim is to undertake a feasibility trial with nested qualitative interviews to assess the feasibility and acceptability of the Snacktivity™ intervention to inform the design of a subsequent phase III randomised trial. A two-arm randomised controlled feasibility trial aiming to recruit 80 inactive adults will be conducted. Recruitment will be from health and community settings and social media. Participants will be individually randomised (1:1 ratio) to receive either the Snacktivity™ intervention or usual care. The intervention will last 12 weeks with assessment of outcomes completed before and after the intervention in all participants. We are interested in whether the Snacktivity™ trial is appealing to participants (assessed by the recruitment rate) and if the Snacktivity™ intervention and trial methods are acceptable to participants (assessed by Snacktivity™/physical activity adherence and retention rates). The intervention will be delivered by health care providers within health care consultations or by researchers. Participants' experiences of the trial and intervention, and health care providers' views of delivering the intervention within health consultations will be explored. DISCUSSION The development of physical activity interventions that can be delivered at scale are needed. The findings from this study will inform the viability and design of a phase III trial to assess the effectiveness and cost-effectiveness of Snacktivity™ to increase physical activity. TRIAL REGISTRATION ISRCTN: 64851242.
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Affiliation(s)
- Amanda J Daley
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Ryan A Griffin
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Catherine A Moakes
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - James P Sanders
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Magdalena Skrybant
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ben Maylor
- Diabetes Research Centre, College of Life Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Sheila M Greenfield
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kajal Gokal
- Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Helen M Parretti
- Norwich Medical School, Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Stuart J H Biddle
- University of Southern Queensland, Springfield, Australia.,Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Lauren Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Emma Frew
- Health Economics Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
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24
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Maylor BD, Edwardson CL, Dempsey PC, Patterson MR, Plekhanova T, Yates T, Rowlands AV. Stepping towards More Intuitive Physical Activity Metrics with Wrist-Worn Accelerometry: Validity of an Open-Source Step-Count Algorithm. Sensors (Basel) 2022; 22:s22249984. [PMID: 36560353 PMCID: PMC9786909 DOI: 10.3390/s22249984] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 05/14/2023]
Abstract
Stepping-based targets such as the number of steps per day provide an intuitive and commonly used method of prescribing and self-monitoring physical activity goals. Physical activity surveillance is increasingly being obtained from wrist-worn accelerometers. However, the ability to derive stepping-based metrics from this wear location still lacks validation and open-source methods. This study aimed to assess the concurrent validity of two versions (1. original and 2. optimized) of the Verisense step-count algorithm at estimating step-counts from wrist-worn accelerometry, compared with steps from the thigh-worn activPAL as the comparator. Participants (n = 713), across three datasets, had >24 h continuous concurrent accelerometry wear on the non-dominant wrist and thigh. Compared with activPAL, total daily steps were overestimated by 913 ± 141 (mean bias ± 95% limits of agreement) and 742 ± 150 steps/day with Verisense algorithms 1 and 2, respectively, but moderate-to-vigorous physical activity (MVPA) steps were underestimated by 2207 ± 145 and 1204 ± 103 steps/day in Verisense algorithms 1 and 2, respectively. In summary, the optimized Verisense algorithm was more accurate in detecting total and MVPA steps. Findings highlight the importance of assessing algorithm performance beyond total step count, as not all steps are equal. The optimized Verisense open-source algorithm presents acceptable accuracy for derivation of stepping-based metrics from wrist-worn accelerometry.
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Affiliation(s)
- Benjamin D. Maylor
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Correspondence:
| | - Charlotte L. Edwardson
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Paddy C. Dempsey
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 1TN, UK
- Baker Heart and Diabetes Institute, Melbourne 3004, Australia
| | - Matthew R. Patterson
- The Realtime Building, Clonshaugh Business and Technology Park, Shimmer Research Ltd., D17 H262 Dublin, Ireland
| | - Tatiana Plekhanova
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Tom Yates
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Alex V. Rowlands
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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25
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Dempsey PC, Rowlands AV, Strain T, Zaccardi F, Dawkins N, Razieh C, Davies MJ, Khunti KK, Edwardson CL, Wijndaele K, Brage S, Yates T. Physical activity volume, intensity, and incident cardiovascular disease. Eur Heart J 2022; 43:4789-4800. [PMID: 36302445 DOI: 10.1093/eurheartj/ehac613] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/26/2022] [Accepted: 10/12/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. METHODS AND RESULTS Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5-23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. CONCLUSION Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals.
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Affiliation(s)
- Paddy C Dempsey
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Baker Heart and Diabetes Institute, Melbourne, Australia.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Tessa Strain
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nathan Dawkins
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Cameron Razieh
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Kamlesh K Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Tom Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Road, Leicester, LE54PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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26
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Ruettger K, Clemes SA, Chen YL, Edwardson CL, Guest A, Gilson ND, Gray LJ, Johnson V, Paine NJ, Sherry AP, Sayyah M, Troughton J, Varela-Mato V, Yates T, King JA. Drivers with and without Obesity Respond Differently to a Multi-Component Health Intervention in Heavy Goods Vehicle Drivers. Int J Environ Res Public Health 2022; 19:15546. [PMID: 36497618 PMCID: PMC9739045 DOI: 10.3390/ijerph192315546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
Physical inactivity and obesity are widely prevalent in Heavy Goods Vehicle (HGV) drivers. We analysed whether obesity classification influenced the effectiveness of a bespoke structured lifestyle intervention ('SHIFT') for HGV drivers. The SHIFT programme was evaluated within a cluster randomised controlled trial, across 25 transport depots in the UK. After baseline assessments, participants within intervention sites received a 6-month multi-component health behaviour change intervention. Intervention responses (verses control) were stratified by obesity status (BMI < 30 kg/m2, n = 131; BMI ≥ 30 kg/m2, n = 113) and compared using generalised estimating equations. At 6-months, favourable differences were found in daily steps (adjusted mean difference 1827 steps/day, p < 0.001) and sedentary time (adjusted mean difference -57 min/day, p < 0.001) in drivers with obesity undertaking the intervention, relative to controls with obesity. Similarly, in drivers with obesity, the intervention reduced body weight (adjusted mean difference -2.37 kg, p = 0.002) and led to other favourable anthropometric outcomes, verses controls with obesity. Intervention effects were absent for drivers without obesity, and for all drivers at 16-18-months follow-up. Obesity classification influenced HGV drivers' behavioural responses to a multi-component health-behaviour change intervention. Therefore, the most at-risk commercial drivers appear receptive to a health promotion programme.
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Affiliation(s)
- Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Stacy A. Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Yu-Ling Chen
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Charlotte L. Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Amber Guest
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Nicholas D. Gilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Nicola J. Paine
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Aron P. Sherry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Mohsen Sayyah
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - James A. King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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27
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Cox E, Walker S, Edwardson CL, Biddle SJH, Clarke-Cornwell AM, Clemes SA, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Healy GN, Maylor BD, Munir F, Yates T, Richardson G. The Cost-Effectiveness of the SMART Work & Life Intervention for Reducing Sitting Time. Int J Environ Res Public Health 2022; 19:14861. [PMID: 36429578 PMCID: PMC9690649 DOI: 10.3390/ijerph192214861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Sedentary behaviours continue to increase and are associated with heightened risks of morbidity and mortality. We assessed the cost-effectiveness of SMART Work & Life (SWAL), an intervention designed to reduce sitting time inside and outside of work, both with (SWAL-desk) and without (SWAL-only) a height-adjustable workstation compared to usual practice (control) for UK office workers. Health outcomes were assessed in quality-adjusted life-years (QALY) and costs in pound sterling (2019-2020). Discounted costs and QALYs were estimated using regression methods with multiply imputed data from the SMART Work & Life trial. Absenteeism, productivity and wellbeing measures were also evaluated. The average cost of SWAL-desk was £228.31 and SWAL-only £80.59 per office worker. Within the trial, SWAL-only was more effective and costly compared to control (incremental cost-effectiveness ratio (ICER): £12,091 per QALY) while SWAL-desk was dominated (least effective and most costly). However, over a lifetime horizon, both SWAL-only and SWAL-desk were more effective and more costly than control. Comparing SWAL-only to control generated an ICER of £4985 per QALY. SWAL-desk was more effective and costly than SWAL-only, generating an ICER of £13,378 per QALY. Findings were sensitive to various worker, intervention, and extrapolation-related factors. Based on a lifetime horizon, SWAL interventions appear cost-effective for office-workers conditional on worker characteristics, intervention cost and longer-term maintenance in sitting time reductions.
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Affiliation(s)
- Edward Cox
- Centre for Health Economics, University of York, York YO10 5DD, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York YO10 5DD, UK
| | - Charlotte L. Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Stuart J. H. Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD 4300, Australia
| | | | - Stacy A. Clemes
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester LE5 4PW, UK
| | - David W. Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Baker-Deakin Department Lifestyle and Diabetes, Deakin University, Melbourne, VIC 3004, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh EH16 4UX, UK
| | - Malcolm H. Granat
- School of Health & Society, University of Salford, Salford M6 6PU, UK
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Genevieve N. Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Benjamin D. Maylor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Yates T, Sargeant JA, King JA, Henson J, Edwardson CL, Redman E, Gulsin GS, Brady EM, Ahmad E, Stensel DJ, Webb DR, McCann GP, Khunti K, Davies MJ. Initiation of New Glucose-Lowering Therapies May Act to Reduce Physical Activity Levels: Pooled Analysis From Three Randomized Trials. Diabetes Care 2022; 45:2749-2752. [PMID: 35984425 DOI: 10.2337/dc22-0888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) reduce body weight and improve cardiometabolic health, but their effect on physical activity is unknown. RESEARCH DESIGN AND METHODS We pooled data (n = 148) from three randomized trials to investigate the effect of empagliflozin (SGLT2i) and liraglutide (GLP-1RA), in comparison with sitagliptin (dipeptidyl peptidase 4 inhibitor) and dietary therapies, on accelerometer-assessed physical activity. RESULTS Liraglutide (mean -1,144 steps/day; 95% CI -2,069 to -220), empagliflozin (-1,132 steps/day; -1,739, -524), and sitagliptin (-852 steps/day; -1,625, -78) resulted in reduced total daily physical activity after 6 months (P < 0.01 vs. control). Moderate- to vigorous-intensity physical activity was also reduced. Dietary interventions led to no change or an increase in physical activity. CONCLUSIONS The initiation of all glucose-lowering therapies was associated with reduced physical activity, warranting further investigation.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - James A King
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
| | - Joe Henson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma Redman
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Gaurav S Gulsin
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Emer M Brady
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - David J Stensel
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, U.K
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- NIHR Applied Research Collaboration East Midlands, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester, U.K
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Clemes SA, Varela-Mato V, Bodicoat DH, Brookes CL, Chen YL, Cox E, Edwardson CL, Gray LJ, Guest A, Johnson V, Munir F, Paine NJ, Richardson G, Ruettger K, Sayyah M, Sherry A, Paola ASD, Troughton J, Walker S, Yates T, King J. A multicomponent structured health behaviour intervention to improve physical activity in long-distance HGV drivers: the SHIFT cluster RCT. Public Health Res 2022. [DOI: 10.3310/pnoy9785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background
Long-distance heavy goods vehicle drivers are exposed to a multitude of risk factors associated with their occupation. The working environment of heavy goods vehicle drivers provides limited opportunities for a healthy lifestyle, and, consequently, heavy goods vehicle drivers exhibit higher than nationally representative rates of obesity and obesity-related comorbidities, and are underserved in terms of health promotion initiatives.
Objective
The aim of this trial was to test the effectiveness and cost-effectiveness of the multicomponent Structured Health Intervention For Truckers (SHIFT) programme, compared with usual care, at both 6 months and 16–18 months.
Design
A two-arm cluster randomised controlled trial, including a cost-effectiveness analysis and process evaluation.
Setting
Transport depots throughout the Midlands region of the UK.
Participants
Heavy goods vehicle drivers.
Intervention
The 6-month SHIFT programme included a group-based interactive 6-hour education session, health coach support and equipment provision [including a Fitbit® (Fitbit Inc., San Francisco, CA, US) and resistance bands/balls to facilitate a ‘cab workout’]. Clusters were randomised following baseline measurements to either the SHIFT arm or the control arm.
Main outcome measures
Outcome measures were assessed at baseline, with follow-up assessments occurring at both 6 months and 16–18 months. The primary outcome was device-measured physical activity, expressed as mean steps per day, at 6-month follow-up. Secondary outcomes included device-measured sitting, standing, stepping, physical activity and sleep time (on any day, workdays and non-workdays), along with adiposity, biochemical measures, diet, blood pressure, psychophysiological reactivity, cognitive function, functional fitness, mental well-being, musculoskeletal symptoms and work-related psychosocial variables. Cost-effectiveness and process evaluation data were collected.
Results
A total of 382 participants (mean ± standard deviation age: 48.4 ± 9.4 years; mean ± standard deviation body mass index: 30.4 kg/m2 ± 5.1 kg/m2; 99% male) were recruited across 25 clusters. Participants were randomised (at the cluster level) to either the SHIFT arm (12 clusters, n = 183) or the control arm (13 clusters, n = 199). At 6 months, 209 (54.7%) participants provided primary outcome data. Significant differences in mean daily steps were found between arms, with participants in the SHIFT arm accumulating 1008 more steps per day than participants in the control arm (95% confidence interval 145 to 1871 steps; p = 0.022), which was largely driven by the maintenance of physical activity levels in the SHIFT arm and a decline in physical activity levels in the control arm. Favourable differences at 6 months were also seen in the SHIFT arm, relative to the control arm, in time spent sitting, standing and stepping, and time in moderate or vigorous activity. No differences between arms were observed at 16–18 months’ follow-up. No differences were observed between arms in the other secondary outcomes at either follow-up (i.e. 6 months and 16–18 months). The process evaluation demonstrated that the intervention was well received by participants and that the intervention reportedly had a positive impact on their health behaviours. The average total cost of delivering the SHIFT programme was £369.57 per driver, and resulting quality-adjusted life-years were similar across trial arms (SHIFT arm: 1.22, 95% confidence interval 1.19 to 1.25; control arm: 1.25, 95% confidence interval 1.22 to 1.27).
Limitations
A higher (31.4%) than anticipated loss to follow-up was experienced at 6 months, with fewer (54.7%) participants providing valid primary outcome data at 6 months. The COVID-19 pandemic presents a major confounding factor, which limits our ability to draw firm conclusions regarding the sustainability of the SHIFT programme.
Conclusion
The SHIFT programme had a degree of success in positively impacting physical activity levels and reducing sitting time in heavy goods vehicle drivers at 6-months; however, these differences were not maintained at 16–18 months.
Future work
Further work involving stakeholder engagement is needed to refine the content of the programme, based on current findings, followed by the translation of the SHIFT programme into a scalable driver training resource.
Trial registration
This trial is registered as ISRCTN10483894.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | | | - Yu-Ling Chen
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Charlotte L Edwardson
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Amber Guest
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | - Nicola J Paine
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | - Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mohsen Sayyah
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Aron Sherry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
| | | | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - James King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, Leicester, UK
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30
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Plekhanova T, Rowlands AV, Davies MJ, Hall AP, Yates T, Edwardson CL. Validation of an automated sleep detection algorithm using data from multiple accelerometer brands. J Sleep Res 2022; 32:e13760. [PMID: 36317222 DOI: 10.1111/jsr.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 02/25/2023]
Abstract
To evaluate the criterion validity of an automated sleep detection algorithm applied to data from three research-grade accelerometers worn on each wrist with concurrent laboratory-based polysomnography (PSG). A total of 30 healthy volunteers (mean [SD] age 31.5 [7.2] years, body mass index 25.5 [3.7] kg/m2 ) wore an Axivity, GENEActiv and ActiGraph accelerometer on each wrist during a 1-night PSG assessment. Sleep estimates (sleep period time window [SPT-window], sleep duration, sleep onset and waking time, sleep efficiency, and wake after sleep onset [WASO]) were generated using the automated sleep detection algorithm within the open-source GGIR package. Agreement of sleep estimates from accelerometer data with PSG was determined using pairwise 95% equivalence tests (±10% equivalence zone), intraclass correlation coefficients (ICCs) with 95% confidence intervals and limits of agreement (LoA). Accelerometer-derived sleep estimates except for WASO were within the 10% equivalence zone of the PSG. Reliability between data from the accelerometers worn on either wrist and PSG was moderate for SPT-window duration (ICCs ≥ 0.65), sleep duration (ICCs ≥ 0.54), and sleep onset (ICCs ≥ 0.61), mostly good for waking time (ICCs ≥ 0.80), but poor for sleep efficiency (ICCs ≥ 0.08) and WASO (ICCs ≥ 0.08). The mean bias between all accelerometer-derived sleep estimates worn on either wrist and PSG were low; however, wide 95% LoA were observed for all sleep estimates, apart from waking time. The automated sleep detection algorithm applied to data from Axivity, GENEActiv and ActiGraph accelerometers, worn on either wrist, provides comparable measures to PSG for SPT-window and sleep duration, sleep onset and waking time, but a poor measure of wake during the sleep period.
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Affiliation(s)
- Tatiana Plekhanova
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK
| | - Alex V. Rowlands
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK
| | - Melanie J. Davies
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK
| | - Andrew P. Hall
- University Hospitals of Leicester NHS Trust Leicester UK
- Department of Health Sciences University of Leicester Leicester UK
| | - Tom Yates
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK
| | - Charlotte L. Edwardson
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK
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31
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Rowlands AV, Maylor B, Dawkins NP, Dempsey PC, Edwardson CL, Soczawa-Stronczyk AA, Bocian M, Patterson MR, Yates T. Stepping up with GGIR: Validity of step cadence derived from wrist-worn research-grade accelerometers using the verisense step count algorithm. J Sports Sci 2022; 40:2182-2190. [PMID: 36384415 DOI: 10.1080/02640414.2022.2147134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Verisense Step Count Algorithm facilitates generation of steps from wrist-worn accelerometers. Based on preliminary evidence suggesting a proportional bias with overestimation at low steps/day, but underestimation at high steps/day, the algorithm parameters have been revised. We aimed to establish validity of the original and revised algorithms relative to waist-worn ActiGraph step cadence. We also assessed whether step cadence was similar across accelerometer brand and wrist. Ninety-eight participants (age: 58.6±11.1 y) undertook six walks (~500 m hard path) at different speeds (cadence: 92.9±9.5-127.9±8.7 steps/min) while wearing three accelerometers on each wrist (Axivity, GENEActiv, ActiGraph) and an ActiGraph on the waist. Of these, 24 participants also undertook one run (~1000 m). Mean bias for the original algorithm was -21 to -26.1 steps/min (95% limits of agreement (LoA) ~±65 steps/min) and mean absolute percentage error (MAPE) 17-22%. This was unevenly distributed with increasing error as speed increased. Mean bias and 95%LoA were halved with the revised algorithm parameters (~-10 to -12 steps/min, 95%LoA ~30 steps/min, MAPE ~10-12%). Performance was similar across brand and wrist. The revised step algorithm provides a more valid measure of step cadence than the original, with MAPE similar to recently reported wrist-wear summary MAPE (7-11%).
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Affiliation(s)
- Alex V Rowlands
- Assessment of Movement Behaviours Group (Amber), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Benjamin Maylor
- Assessment of Movement Behaviours Group (Amber), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Nathan P Dawkins
- Assessment of Movement Behaviours Group (Amber), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Paddy C Dempsey
- Assessment of Movement Behaviours Group (Amber), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK.,MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Charlotte L Edwardson
- Assessment of Movement Behaviours Group (Amber), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Artur A Soczawa-Stronczyk
- School of Engineering, University of Leicester, Leicester, UK.,Bridge Engineering and Civil Structures Team, Buro Happold, London, UK
| | - Mateusz Bocian
- School of Engineering, University of Leicester, Leicester, UK.,Biomechanics and Immersive Technology Laboratory, University of Leicester, Leicester, UK.,Department of Roads, Bridges, Railways and Airports, Wrocław University of Science and Technology, Poland
| | - Matthew R Patterson
- Shimmer Research Ltd., The Realtime Building, Clonshaugh Business and Technology Park, Dublin, Ireland
| | - Tom Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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32
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Edwardson CL, Biddle SJH, Clemes SA, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Healy GN, Jaicim NB, Lawton S, Maylor BD, Munir F, Richardson G, Yates T, Clarke-Cornwell AM. Effectiveness of an intervention for reducing sitting time and improving health in office workers: three arm cluster randomised controlled trial. BMJ 2022; 378:e069288. [PMID: 35977732 PMCID: PMC9382450 DOI: 10.1136/bmj-2021-069288] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of an intervention, with and without a height adjustable desk, on daily sitting time, and to investigate the relative effectiveness of the two interventions, and the effectiveness of both interventions on physical behaviours and physical, biochemical, psychological, and work related health and performance outcomes. DESIGN Cluster three arm randomised controlled trial with follow-up at three and 12 months. SETTING Local government councils in Leicester, Liverpool, and Greater Manchester, UK. PARTICIPANTS 78 clusters including 756 desk based employees in defined offices, departments, or teams from two councils in Leicester, three in Greater Manchester, and one in Liverpool. INTERVENTIONS Clusters were randomised to one of three conditions: the SMART Work and Life (SWAL) intervention, the SWAL intervention with a height adjustable desk (SWAL plus desk), or control (usual practice). MAIN OUTCOMES MEASURES The primary outcome measure was daily sitting time, assessed by accelerometry, at 12 month follow-up. Secondary outcomes were accelerometer assessed sitting, prolonged sitting, standing and stepping time, and physical activity calculated over any valid day, work hours, workdays, and non-workdays, self-reported lifestyle behaviours, musculoskeletal problems, cardiometabolic health markers, work related health and performance, fatigue, and psychological measures. RESULTS Mean age of participants was 44.7 years, 72.4% (n=547) were women, and 74.9% (n=566) were white. Daily sitting time at 12 months was significantly lower in the intervention groups (SWAL -22.2 min/day, 95% confidence interval -38.8 to -5.7 min/day, P=0.003; SWAL plus desk -63.7 min/day, -80.1 to -47.4 min/day, P<0.001) compared with the control group. The SWAL plus desk intervention was found to be more effective than SWAL at changing sitting time (-41.7 min/day, -56.3 to -27.0 min/day, P<0.001). Favourable differences in sitting and prolonged sitting time at three and 12 month follow-ups for both intervention groups and for standing time for the SWAL plus desk group were observed during work hours and on workdays. Both intervention groups were associated with small improvements in stress, wellbeing, and vigour, and the SWAL plus desk group was associated with improvements in pain in the lower extremity, social norms for sitting and standing at work, and support. CONCLUSIONS Both SWAL and SWAL plus desk were associated with a reduction in sitting time, although the addition of a height adjustable desk was found to be threefold more effective. TRIAL REGISTRATION ISRCTN Registry ISRCTN11618007.
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Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, UK
| | - Malcolm H Granat
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Sarah Lawton
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Benjamin D Maylor
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicester, UK
| | | | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
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33
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Sargeant JA, King JA, Yates T, Redman EL, Bodicoat DH, Chatterjee S, Edwardson CL, Gray LJ, Poulin B, Waheed G, Waller HL, Webb DR, Willis SA, Wilding JPH, Khunti K, Stensel DJ, Davies MJ. The effects of empagliflozin, dietary energy restriction, or both on appetite-regulatory gut peptides in individuals with type 2 diabetes and overweight or obesity: The SEESAW randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2022; 24:1509-1521. [PMID: 35441435 PMCID: PMC9541107 DOI: 10.1111/dom.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To assess the impact of the sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin (25 mg once-daily), dietary energy restriction, or both combined, on circulating appetite-regulatory peptides in people with type 2 diabetes (T2D) and overweight or obesity. MATERIALS AND METHODS In a double-blind, placebo-controlled trial, 68 adults (aged 30-75 years) with T2D (drug naïve or on metformin monotherapy; HbA1c 6.0%-10.0% [42-86 mmol/mol]) and body mass index of 25 kg/m2 or higher were randomized to (a) placebo only, (b) placebo plus diet, (c) empagliflozin only or (d) empagliflozin plus diet for 24 weeks. Dietary energy restriction matched the estimated energy deficit elicited by SGLT2 inhibitor therapy through urinary glucose excretion (~360 kcal/day). The primary outcome was change in postprandial circulating total peptide-YY (PYY) during a 3-hour mixed-meal tolerance test from baseline to 24 weeks. Postprandial total glucagon-like peptide-1 (GLP-1), acylated ghrelin and subjective appetite perceptions formed secondary outcomes, along with other key components of energy balance. RESULTS The mean weight loss in each group at 24 weeks was 0.44, 1.91, 2.22 and 5.74 kg, respectively. The change from baseline to 24 weeks in postprandial total PYY was similar between experimental groups and placebo only (mean difference [95% CI]: -8.6 [-28.6 to 11.4], 13.4 [-6.1 to 33.0] and 1.0 [-18.0 to 19.9] pg/ml in placebo-plus diet, empagliflozin-only and empagliflozin-plus-diet groups, respectively [all P ≥ .18]). Similarly, there was no consistent pattern of difference between groups for postprandial total GLP-1, acylated ghrelin and subjective appetite perceptions. CONCLUSIONS In people with T2D and overweight or obesity, changes in postprandial appetite-regulatory gut peptides may not underpin the less than predicted weight loss observed with empagliflozin therapy. CLINICAL TRIALS REGISTRATION NCT02798744, www. CLINICALTRIALS gov; 2015-001594-40, www.EudraCT.ema.europa.eu; ISRCTN82062639, www.ISRCTN.org.
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Affiliation(s)
- Jack A. Sargeant
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - James A. King
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- School of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUK
| | - Thomas Yates
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Emma L. Redman
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | | | - Charlotte L. Edwardson
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Laura J. Gray
- Department of Health SciencesUniversity of LeicesterLeicesterUK
| | - Benoit Poulin
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Ghazala Waheed
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - Helen L. Waller
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
| | - David R. Webb
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Scott A. Willis
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- School of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUK
| | - John P. H. Wilding
- Department of Cardiovascular and Metabolic MedicineUniversity of LiverpoolLiverpoolUK
| | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicesterUK
| | - David J. Stensel
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- School of Sport, Exercise and Health SciencesLoughborough UniversityLeicestershireUK
- Faculty of Sport SciencesWaseda UniversityTokorozawaJapan
| | - Melanie J. Davies
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
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34
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Henson J, Arsenyadis F, Redman E, Brady EM, Coull NA, Edwardson CL, Hall AP, James L, Khunti K, Rowlands AV, Stevenson EJ, West DJ, Davies MJ, Yates T. Relative protein intake and associations with markers of physical function in those with type 2 diabetes. Diabet Med 2022; 39:e14851. [PMID: 35426174 PMCID: PMC9546206 DOI: 10.1111/dme.14851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 04/11/2022] [Indexed: 12/02/2022]
Abstract
AIMS To examine the independent associations between relative protein intake (g kg-1 day 1 ) and markers of physical function in those with type 2 diabetes, while also comparing with current guidelines for protein intake. METHODS This analysis reports data from the ongoing Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) study. Functional assessments included: Short Physical Performance Battery (SPPB), 60 s sit-to-stand (STS-60), 4-m gait speed, time to rise from a chair (×5) and handgrip strength. Participants also completed a self-reported 4 day diet diary. Regression analyses assessed whether relative protein intake was associated with markers of physical function. Interaction terms assessed whether the associations were modified by sex, age, HbA1c or body mass index (BMI). RESULTS 413 participants were included (mean ± SD:age = 65.0 ± 7.7 years, 33% female, BMI = 30.6 ± 5.1 kg/m2 ). The average total protein intake was 0.88 ± 0.31 g kg-1 day-1 . 33% of individuals failed to meet the reference nutrient intake for the United Kingdom (≥0.75 g kg-1 day-1 ), and 87% for European recommendations (≥1.2 g kg-1 day-1 ). After adjustment, each 0.5 g/kg of protein intake was associated with an 18.9% (95% CI: 2.3, 35.5) higher SPPB score, 22.7% (1.1, 44.3) more repetitions in STS-60, 21.1% (4.5, 37.7) faster gait speed and 33.2% (16.9, 49.5) lower chair rise time. There were no associations with handgrip strength or any interactions. CONCLUSIONS Relative protein intake was positively associated with physical function outcomes, even after consideration of total energy intake. As a number of individuals were below the current guidelines, protein intake may be a modifiable factor of importance for people with type 2 diabetes.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Frank Arsenyadis
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- University Hospitals of Leicester NHS TrustLeicesterUK
| | - Emma Redman
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- University Hospitals of Leicester NHS TrustLeicesterUK
| | - Emer M. Brady
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Nicole A. Coull
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Charlotte L. Edwardson
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Andrew P. Hall
- University Hospitals of Leicester NHS TrustLeicesterUK
- Department of Health SciencesUniversity of LeicesterLeicesterUK
- Hanning Sleep LaboratoryLeicester General HospitalLeicesterUK
| | - Lewis J. James
- NIHR Leicester Biomedical Research CentreLeicesterUK
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Kamlesh Khunti
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- NIHR Applied Health Research Collaboration – East Midlands (NIHR ARC‐EM)Leicester Diabetes CentreLeicesterUK
| | - Alex V. Rowlands
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA)Sansom Institute for Health ResearchDivision of Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Emma J. Stevenson
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Daniel J. West
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Melanie J. Davies
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Thomas Yates
- NIHR Leicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
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35
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Plekhanova T, Rowlands AV, Evans RA, Edwardson CL, Bishop NC, Bolton CE, Chalmers JD, Davies MJ, Daynes E, Dempsey PC, Docherty AB, Elneima O, Greening NJ, Greenwood SA, Hall AP, Harris VC, Harrison EM, Henson J, Ho LP, Horsley A, Houchen-Wolloff L, Khunti K, Leavy OC, Lone NI, Marks M, Maylor B, McAuley HJC, Nolan CM, Poinasamy K, Quint JK, Raman B, Richardson M, Sargeant JA, Saunders RM, Sereno M, Shikotra A, Singapuri A, Steiner M, Stensel DJ, Wain LV, Whitney J, Wootton DG, Brightling CE, Man WDC, Singh SJ, Yates T. Device-assessed sleep and physical activity in individuals recovering from a hospital admission for COVID-19: a multicentre study. Int J Behav Nutr Phys Act 2022; 19:94. [PMID: 35902858 PMCID: PMC9330990 DOI: 10.1186/s12966-022-01333-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background The number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acute illness severity and ongoing symptoms. Methods One thousand seventy-seven patients with COVID-19 discharged from hospital between March and November 2020 were recruited. Using a 14-day wear protocol, wrist-worn accelerometers were sent to participants after a five-month follow-up assessment. Acute illness severity was assessed by the WHO clinical progression scale, and the severity of ongoing symptoms was assessed using four previously reported data-driven clinical recovery clusters. Two existing control populations of office workers and individuals with type 2 diabetes were comparators. Results Valid accelerometer data from 253 women and 462 men were included. Women engaged in a mean ± SD of 14.9 ± 14.7 min/day of moderate-to-vigorous physical activity (MVPA), with 12.1 ± 1.7 h/day spent inactive and 7.2 ± 1.1 h/day asleep. The values for men were 21.0 ± 22.3 and 12.6 ± 1.7 h /day and 6.9 ± 1.1 h/day, respectively. Over 60% of women and men did not have any days containing a 30-min bout of MVPA. Variability in sleep timing was approximately 2 h in men and women. More severe acute illness was associated with lower total activity and MVPA in recovery. The very severe recovery cluster was associated with fewer days/week containing continuous bouts of MVPA, longer total sleep time, and higher variability in sleep timing. Patients post-hospitalisation with COVID-19 had lower levels of physical activity, greater sleep variability, and lower sleep efficiency than a similarly aged cohort of office workers or those with type 2 diabetes. Conclusions Those recovering from a hospital admission for COVID-19 have low levels of physical activity and disrupted patterns of sleep several months after discharge. Our comparative cohorts indicate that the long-term impact of COVID-19 on physical behaviours is significant. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01333-w.
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Affiliation(s)
- Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachael A Evans
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK. .,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - Nicolette C Bishop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Charlotte E Bolton
- University of Nottingham, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Enya Daynes
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Paddy C Dempsey
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Omer Elneima
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Sharlene A Greenwood
- Department of Physiotherapy and Renal Medicine, King's College Hospital, London, UK.,Department of Renal Medicine, King's College London, London, UK
| | - Andrew P Hall
- University Hospitals of Leicester NHS Trust, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - Victoria C Harris
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Linzy Houchen-Wolloff
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nazir I Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK.,Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.,Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - Ben Maylor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Royal Brompton and Harefield Clinical Group, Guy's and St, Thomas' NHS Foundation Trust, London, UK.,College of Health, Medicine and Life Sciences, Department of Health Sciences, Brunel University London, Uxbridge, UK
| | | | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Richardson
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK.,College of Life Sciences, University of Leicester, Leicester, UK
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Marco Sereno
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Michael Steiner
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK.,Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - David J Stensel
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Louise V Wain
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK.,Department of Health Sciences, University of Leicester, Leicester, UK
| | - Julie Whitney
- School of Life Course & Population Sciences, King's College London, London, UK.,Department of Clinical Gerontology, King's College Hospital, London, UK
| | - Dan G Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christopher E Brightling
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - William D-C Man
- Royal Brompton and Harefield Clinical Group, Guys and St Thomas NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Sally J Singh
- NIHR Leicester Biomedical Research Centre, The Institute for Lung Health, University of Leicester, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Guest AJ, Paine NJ, Chen YL, Chalkley A, Munir F, Edwardson CL, Gray LJ, Johnson V, Ruettger K, Sayyah M, Sherry A, Troughton J, Varela-Mato V, Yates T, King J, Clemes SA. The structured health intervention for truckers (SHIFT) cluster randomised controlled trial: a mixed methods process evaluation. Int J Behav Nutr Phys Act 2022; 19:79. [PMID: 35799298 PMCID: PMC9261004 DOI: 10.1186/s12966-022-01316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background This paper presents the mixed methods process evaluation of the randomised controlled trial (RCT) of the Structured Health Intervention For Truckers (SHIFT), a multi-component intervention targeting physical activity and positive lifestyle behaviours in a cohort of 382 truck drivers in the UK. The SHIFT RCT found a significant difference in daily steps between intervention and control groups at 6-months in favour of the intervention participants. Methods SHIFT was evaluated within a cluster-RCT and involved 25 transport sites (12 intervention and 13 control sites). Intervention components included an education session, Fitbit, text messages, and cab workout equipment. Participants completed questionnaires at baseline and 6-months follow-up. Semi-structured focus groups/interviews were conducted with drivers (n = 19) and managers (n = 18) from each site, after completion of the final follow-up health assessment (16-18 months post-randomisation). Questionnaires and interviews collected information on fidelity, dose, context, implementation, barriers, sustainability, and contamination. Results Questionnaire and interview data from intervention participants indicated favourable attitudes towards SHIFT, specifically towards the Fitbit with a high proportion of drivers reporting regularly using it (89.1%). 79.2% of intervention participants attended the education session, which was deemed useful for facilitating improvements in knowledge and behaviour change, dietary changes were predominantly recalled. Despite not being part of the intervention, participants reported that feedback from the health assessments motivated them to change aspects of their lifestyle (intervention = 91.1%, control = 67.5%). The cab workout equipment was used less and spoken unfavourably of in the interviews. The main barriers to a healthy lifestyle at work were reported as long hours and irregular shift patterns. The most suggested improvement for the intervention was more frequent contact with drivers. Managers were positive about the objectives of SHIFT, however almost all mentioned the challenges related to implementation, specifically in smaller sites. Conclusions Overall, SHIFT was predominantly implemented as intended, with minimal discrepancies seen between the delivery and protocol. Having said this, transport sites each have distinct characteristics, which may require adaptations to individual settings to encourage participation. Managers and drivers reported enthusiasm and necessity for SHIFT to be included in future Certificate of Professional Competence training. Trial registration ISRCTN10483894 (date registered: 01/03/2017).
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Affiliation(s)
- Amber J Guest
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
| | - Nicola J Paine
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Yu-Ling Chen
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Anna Chalkley
- Centre for Physically Active Learning, Western Norway University of Applied Sciences, Bergen, Norway.,Wolfson Centre for Applied Research, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Charlotte L Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Mohsen Sayyah
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Aron Sherry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Diabetes Research Centre, University of Leicester, Leicester, UK
| | - James King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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37
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Clemes SA, Varela-Mato V, Bodicoat DH, Brookes CL, Chen YL, Edwardson CL, Gray LJ, Guest AJ, Johnson V, Munir F, Paine NJ, Richardson G, Ruettger K, Sayyah M, Sherry A, Di Paola AS, Troughton J, Yates T, King JA. The effectiveness of the Structured Health Intervention For Truckers (SHIFT): a cluster randomised controlled trial (RCT). BMC Med 2022; 20:195. [PMID: 35606763 PMCID: PMC9126630 DOI: 10.1186/s12916-022-02372-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Long distance heavy goods vehicle (HGV) drivers exhibit higher than nationally representative rates of obesity, and obesity-related co-morbidities, and are underserved in terms of health promotion initiatives. The purpose of this study was to evaluate the effectiveness of the multicomponent 'Structured Health Intervention For Truckers' (SHIFT), compared to usual care, at 6- and 16-18-month follow-up. METHODS We conducted a two-arm cluster RCT in transport sites throughout the Midlands, UK. Outcome measures were assessed at baseline, at 6- and 16-18-month follow-up. Clusters were randomised (1:1) following baseline measurements to either the SHIFT arm or usual practice control arm. The 6-month SHIFT programme included a group-based interactive 6-h education and behaviour change session, health coach support and equipment provision (Fitbit® and resistance bands/balls to facilitate a 'cab workout'). The primary outcome was device-assessed physical activity (mean steps/day) at 6 months. Secondary outcomes included the following: device-assessed sitting, physical activity intensity and sleep; cardiometabolic health, diet, mental wellbeing and work-related psychosocial variables. Data were analysed using mixed-effect linear regression models using a complete-case population. RESULTS Three hundred eighty-two HGV drivers (mean ± SD age: 48.4 ± 9.4 years, BMI: 30.4 ± 5.1 kg/m2, 99% male) were recruited across 25 clusters (sites) and randomised into either the SHIFT (12 clusters, n = 183) or control (13 clusters, n = 199) arms. At 6 months, 209 (55%) participants provided primary outcome data. Significant differences in mean daily steps were found between groups, in favour of the SHIFT arm (adjusted mean difference: 1008 steps/day, 95% CI: 145-1871, p = 0.022). Favourable differences were also seen in the SHIFT group, relative to the control group, in time spent sitting (- 24 mins/day, 95% CI: - 43 to - 6), and moderate-to-vigorous physical activity (6 mins/day, 95% CI: 0.3-11). Differences were not maintained at 16-18 months. No differences were observed between groups in the other secondary outcomes at either follow-up. CONCLUSIONS The SHIFT programme led to a potentially clinically meaningful difference in daily steps, between trial arms, at 6 months. Whilst the longer-term impact is unclear, the programme offers potential to be incorporated into driver training courses to promote activity in this at-risk, underserved and hard-to-reach essential occupational group. TRIAL REGISTRATION ISRCTN10483894 (date registered: 01/03/2017).
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Affiliation(s)
- Stacy A Clemes
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK. .,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Veronica Varela-Mato
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | | | - Cassandra L Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, LE1 7RH, UK
| | - Yu-Ling Chen
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Charlotte L Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | - Amber J Guest
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Vicki Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Nicola J Paine
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Mohsen Sayyah
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Aron Sherry
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Ana Suazo Di Paola
- Leicester Clinical Trials Unit, University of Leicester, Leicester, LE1 7RH, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.,Diabetes Research Centre, University of Leicester, Leicester, LE5 4PW, UK
| | - James A King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
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Ruettger K, Varela-Mato V, Chen YL, Edwardson CL, Guest A, Gilson ND, Gray LJ, Paine NJ, Sherry AP, Sayyah M, Yates T, King JA, Clemes SA. Physical Activity, Sedentary Time, and Cardiometabolic Health in Heavy Goods Vehicle Drivers. J Occup Environ Med 2022; 64:e217-e223. [PMID: 35051962 DOI: 10.1097/jom.0000000000002484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Physical inactivity, prolonged sitting, and unhealthy dietary habits are common in Heavy Goods Vehicle (HGV) drivers. These factors increase risk of long-term health conditions. METHODS 329 HGV drivers across 25 UK depots completed a health assessment, including questionnaire completion, and objectively measured anthropometrics, blood biomarkers, physical activity (PA), and sedentary behavior. RESULTS The sample demonstrated a high-risk cardiometabolic health profile. 88.1% were overweight or had obesity, and 11.9% had pre-diabetes or diabetes. 28.3% had hypertension, 83.6% had clinically elevated circulating low-density lipoprotein-cholesterol concentrations (>2mmol/l), and 66.6% had high total cholesterol levels (>4mmol/l). On workdays drivers accumulated 12 hours/day of sitting, 1.7 hours/day of light PA, and 9.8 mins/day of moderate-to-vigorous PA. Associations between light PA and cardiometabolic markers were observed. CONCLUSION This sample presents high levels of inactivity, overweight, and obesity, and unhealthy cardiometabolic health profiles.
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Affiliation(s)
- Katharina Ruettger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (Miss Ruettger, Dr Varela-Mato, Dr Chen, Miss Guest, Dr Paine, Dr Sherry, Dr Sayyah, Dr King, Dr Clemes), NIHR Leicester Biomedical Research Centre, United Kingdom (Dr Varela-Mato, Dr Edwardson, Dr Paine, Dr Sherry, Dr Yates, Dr King, Dr Clemes), Diabetes Research Centre, University of Leicester, United Kingdom (Dr Edwardson, Dr Yates), School of Human Movement and Nutrition Sciences, University of Queensland, Australia (Dr Gilson), Department of Health Sciences, University of Leicester, Leicester, United Kingdom (Dr Gray)
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39
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Millet N, McDermott HJ, Munir F, Edwardson CL, Moss EL. ACCEPTANCE: protocol for a feasibility study of a multicomponent physical activity intervention following treatment for cervical cancer. BMJ Open 2022; 12:e048203. [PMID: 34980607 PMCID: PMC8724712 DOI: 10.1136/bmjopen-2020-048203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cervical cancer treatment can have life changing sequelae and be associated with poor short-term and long-term quality of life. Physical activity (PA; that is, bodily movement) is known to improve health outcomes and quality of life for cancer survivors, both physically and psychologically. To date, no interventions to increase PA following cervical cancer have been evaluated. This study aims to (1) determine the feasibility of conducting a PA intervention after cervical cancer and (2) to explore the acceptability of the programme and evaluation measures. METHODS AND ANALYSIS The design is a pre study and post study design. Thirty participants aged between 18 and 60 years from the Midlands region, UK, who have completed primary treatment for cervical cancer at least 6 months previously and do not meet the national PA guidelines will be recruited. Identification of potential participants will take place through the University Hospitals of Leicester National Health Service (NHS) Trust. Participants will receive an intervention focused on increasing PA through the provision of education, action planning, goal setting, problem solving and self-monitoring of PA behaviour, particularly steps per day. Device assessed PA and questionnaires will be completed at baseline, week 6, week 12 and week 24. Feasibility will be assessed in terms of recruitment, retention, attrition, completion of measures and intervention compliance, for which specific feasibility criteria have been established. The process evaluation will explore the experiences and acceptability of the intervention components and evaluation measures. ETHICS AND DISSEMINATION Ethical approval has been granted by the West of Scotland Research Ethics Committee 1 for this study. Results will inform intervention refinement for the design of a definitive pilot trial. These results will be disseminated via peer-reviewed publications and international conferences while input from a patient and public involvement (PPI) group will inform effective ways to circulate results among the wider community. TRIAL REGISTRATION NUMBER ISRCTN16349793, Registered 30 September 2020.
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Affiliation(s)
- Nessa Millet
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Hilary J McDermott
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
- NIHR Leicester Biomedical Research Centre, Leicester, Leicestershire, UK
| | - Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, Leicestershire, UK
- Department of Gynaecological Oncology, University Hospitals of Leicester, Leicester, UK
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40
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Rowlands AV, Henson JJ, Coull NA, Edwardson CL, Brady E, Hall A, Khunti K, Davies M, Yates T. The impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in individuals with type 2 diabetes. Diabet Med 2021; 38:e14549. [PMID: 33650112 PMCID: PMC7995208 DOI: 10.1111/dme.14549] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/12/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Restrictions during the COVID-19 crisis will have impacted on opportunities to be active. We aimed to (a) quantify the impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in people with type 2 diabetes and (b) identify predictors of physical activity during COVID-19 restrictions. METHODS Participants were from the UK Chronotype of Patients with type 2 diabetes and Effect on Glycaemic Control (CODEC) observational study. Participants wore an accelerometer on their wrist for 8 days before and during COVID-19 restrictions. Accelerometer outcomes included the following: overall physical activity, moderate-to-vigorous physical activity (MVPA), time spent inactive, days/week with ≥30-minute continuous MVPA and sleep. Predictors of change in physical activity taken pre-COVID included the following: age, sex, ethnicity, body mass index (BMI), socio-economic status and medical history. RESULTS In all, 165 participants (age (mean±S.D = 64.2 ± 8.3 years, BMI=31.4 ± 5.4 kg/m2 , 45% women) were included. During restrictions, overall physical activity was lower by 1.7 mg (~800 steps/day) and inactive time 21.9 minutes/day higher, but time in MVPA and sleep did not statistically significantly change. In contrast, the percentage of people with ≥1 day/week with ≥30-minute continuous MVPA was higher (34% cf. 24%). Consistent predictors of lower physical activity and/or higher inactive time were higher BMI and/or being a woman. Being older and/or from ethnic minorities groups was associated with higher inactive time. CONCLUSIONS Overall physical activity, but not MVPA, was lower in adults with type 2 diabetes during COVID-19 restrictions. Women and individuals who were heavier, older, inactive and/or from ethnic minority groups were most at risk of lower physical activity during restrictions.
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Affiliation(s)
- Alex V. Rowlands
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA)Sansom Institute for Health ResearchDivision of Health SciencesUniversity of South AustraliaAdelaideAustralia
| | - Joseph J. Henson
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Nicole A. Coull
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Charlotte L. Edwardson
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Emer Brady
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Andrew Hall
- Hanning Sleep LaboratoryLeicester General HospitalLeicesterUK
| | - Kamlesh Khunti
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
- NIHR Applied Research Collaboration East MidlandsLeicester General HospitalLeicesterUK
| | - Melanie Davies
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
| | - Tom Yates
- NIHR Leicester Biomedical Research CentreUK and Diabetes Research CentreCollege of Life SciencesUniversity of LeicesterLeicesterUK
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Dawkins NP, Yates T, Soczawa-Stronczyk AA, Bocian M, Edwardson CL, Maylor B, Davies MJ, Khunti K, Rowlands AV. Normative wrist-worn accelerometer values for self-paced walking and running: a walk in the park. J Sports Sci 2021; 40:81-88. [PMID: 34544319 DOI: 10.1080/02640414.2021.1976491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to a) determine whether wrist acceleration varies by accelerometer brand, wear location, and age for self-paced "slow", "normal" and "brisk" walking; b) develop normative acceleration values for self-paced walking and running for adults. One-hundred-and-three adults (40-79 years) completed self-paced "slow", "normal" and "brisk" walks, while wearing three accelerometers (GENEActiv, Axivity, ActiGraph) on each wrist. A sub-sample (n = 22) completed a self-paced run. Generalized estimating equations established differences by accelerometer brand, wrist, and age-group (walking only, 40-49, 50-59, 60-69, 70-79 years) for self-paced walking and running. Brand*wrist interactions showed ActiGraph dominant wrist values were ~10% lower than GENEActiv/Axivity values for walking and running, and non-dominant ActiGraph values were ~5% lower for running only (p < 0.001). Acceleration during brisk walking was lower in those aged 70-79 (p < 0.05). Normative acceleration values (non-dominant wrist, all brands; dominant wrist GENEActiv/Axivity) for slow and normal walking were 140 mg and 210 mg. Brisk walking, values were 350 mg in those aged 40-69 years, but 270 mg in those aged 70-79 years. Accelerations >600 mg approximated running. These values facilitate user-friendly interpretation of accelerometer-determined physical activity in large cohort and epidemiological datasets.
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Affiliation(s)
- Nathan P Dawkins
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK
| | | | - Mateusz Bocian
- School of Engineering, University of Leicester, Leicester, UK.,Biomechanics and Immersive Technology Laboratory, University of Leicester, Leicester, UK.,Department of Bridges and Railways, Wrocław University of Science and Technology, Poland
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK
| | - Ben Maylor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Applied Research Collaboration East Midlands, Leicester General Hospital, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, UK.,Alliance for Research in Exercise, Nutrition and Activity (Arena), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
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Harrington DM, Ioannidou E, Davies MJ, Edwardson CL, Gorely T, Rowlands AV, Sherar LB, Staiano AE. Concurrent screen use and cross-sectional association with lifestyle behaviours and psychosocial health in adolescent females. Acta Paediatr 2021; 110:2164-2170. [PMID: 33570799 PMCID: PMC9134851 DOI: 10.1111/apa.15806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/05/2021] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
Aim: To describe concurrent screen use and any relationships with lifestyle behaviours and psychosocial health. Methods: Participants wore an accelerometer for seven days to calculate physical activity sleep and sedentary time. Screen ownership and use and psychosocial variables were self-reported. Body mass index (BMI) was measured. Relationships were explored using mixed models accounting for school clustering and confounders. Results: In 816 adolescent females (age: 12.8 SD 0.8 years; 20.4% non-white European) use of ≥2 screens concurrently was: 59% after school, 65% in evenings, 36% in bed and 68% at weekends. Compared to no screens those using: ≥1 screens at weekends had lower physical activity; ≥2 screens at the weekend or one/two screen at bed had lower weekend moderate-to-vigorous physical activity; one screen in the evening had lower moderate-to-vigorous physical activity in the after-school and evening period; ≥1 screens after school had higher BMI; and ≥3 screens at the weekend had higher weekend sedentary time. Compared to no screens those using: 1–3 after-school screens had shorter weekday sleep; ≥1 screens after-school had lower time in bed. Conclusion: Screen use is linked to lower physical activity, higher BMI and less sleep. These results can inform screen use guidelines.
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Affiliation(s)
- Deirdre M. Harrington
- Diabetes Research Centre University of Leicester Leicester UK
- School of Psychological Sciences and Health University of Strathclyde Glasgow UK
| | | | | | | | - Trish Gorely
- Department of Nursing and Midwifery University of the Highlands and Islands Inverness UK
| | - Alex V. Rowlands
- Diabetes Research Centre University of Leicester Leicester UK
- NIHR Leicester Biomedical Research Centre Leicester UK
| | - Lauren B. Sherar
- School of Sport, Exercise and Health Loughborough University Loughborough UK
| | - Amanda E. Staiano
- Pennington Biomedical Research Center Louisiana State University Baton Rouge USA
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies MJ, Eborall HC, Edwardson CL, Gray LJ, Hardeman W, Heathcote L, Henson J, Pollard D, Sharp SJ, Sutton S, Troughton J, Yates T. Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Med 2021; 19:130. [PMID: 34078362 PMCID: PMC8173914 DOI: 10.1186/s12916-021-01997-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention. METHODS Those at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013-2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables. RESULTS One thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up. CONCLUSIONS Combining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months. TRIAL REGISTRATION ISRCTN 83465245 (registered on 14 June 2012).
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK. .,NIHR Applied Research Collaboration - East Midlands, Leicester, UK.
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration - East Midlands, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | | | - Charlotte L Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Laura J Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joe Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
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Mickute M, Henson J, Rowlands AV, Sargeant JA, Webb D, Hall AP, Edwardson CL, Baldry EL, Brady EM, Khunti K, Davies MJ, Yates T. Device-measured physical activity and its association with physical function in adults with type 2 diabetes mellitus. Diabet Med 2021; 38:e14393. [PMID: 32844472 DOI: 10.1111/dme.14393] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
AIM To quantify how differences in metrics characterizing physical activity and sedentary behaviour in type 2 diabetes are associated with physical function. METHODS This analysis included participants' data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) cross-sectional study. Data were stratified into two groups according to their short physical performance battery (SPPB) score (impaired physical function = SPPB < 10 and normal physical function = SPPB ≥ 10). Hand-grip strength, sit-to-stand 60 (STS-60) and the Duke Activity Status Index (DASI) score were used to assess functional capacity, while physical activity metrics were measured with a wrist-worn accelerometer. The associations between physical activity metrics and measures of functional capacity were analysed using generalized linear modelling. RESULTS Some 635 adults (median age 66 years, 34% female) were included in this analysis. Overall, 29% of the cohort scored < 10 in the SPPB test indicating impaired physical function. This group spent more time in prolonged sedentary behaviour (600.7 vs. 572.5 min) and undertook less-intense physical activity. Each sd increase in physical activity volume and intensity gradients for those with impaired physical function was associated with 17% more repetitions for STS-60 with similar associations seen for DASI score. Each sd in sedentary time was associated with 15% fewer repetitions in STS-60 and 16% lower DASI score in those with impaired physical function, whereas in normal physical function group it was 2% and 1%, respectively. CONCLUSIONS The strength of the associations for physical activity measures and functional capacity were modified by physical function status, with the strongest association seen in those with impaired physical function.
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Affiliation(s)
- M Mickute
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - J Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - A V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - J A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - D Webb
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - A P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - E L Baldry
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - E M Brady
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - T Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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Millet N, McDermott HJ, Moss EL, Edwardson CL, Munir F. Increasing physical activity levels following treatment for cervical cancer: an intervention mapping approach. J Cancer Surviv 2021; 16:650-658. [PMID: 34041674 PMCID: PMC8153850 DOI: 10.1007/s11764-021-01058-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/15/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to utilise the intervention mapping (IM) protocol as a framework with which to develop an intervention underpinned by relevant behaviour change theory to promote physical activity (PA) following treatment for cervical cancer. METHODS The six steps of the IM protocol were followed. A qualitative semi-structured interview study and a rapid review of the literature were conducted along with the development of a logic model of the problem and a logic model of change to inform intervention development. RESULTS An intervention was developed which aims to increase PA levels following treatment for cervical cancer, tailored to address key findings from the IM needs assessment. These include embedding behavioural and social strategies that help participants to overcome perceived barriers to PA participation; goal setting strategies to gradually increase PA levels with a view of reaching relevant PA guidelines for cancer survivors and feedback to encourage self-assessment of well-being and PA capability. CONCLUSION This study maps the development of a novel PA intervention for those who have been treated for cervical cancer. The use of a systematic development framework was necessary as little insight exists regarding PA preferences after treatment for cervical cancer. IMPLICATIONS FOR CANCER SURVIVORS PA behaviour is associated with positive physical and psychological health outcomes for cancer survivors. Optimising targeted promotion of PA behaviour following treatment for cervical cancer may result in an enhanced survivorship experience through increased PA behaviour and improved quality of life (QOL).
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Affiliation(s)
- Nessa Millet
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Hilary J McDermott
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, LE11 3TU, UK
| | - Esther L Moss
- Diabetes Research Centre, University of Leicester, Leicester, LE54PW, UK
| | - Charlotte L Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester, LE3 9QP, UK.,Leicester Cancer Research Centre, University of Leicester, Leicester, LE2 7Lx, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, LE11 3TU, UK
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Biddle SJH, Henson J, Davies MJ, Khunti K, Sutton S, Yates T, Edwardson CL. Device-assessed total and prolonged sitting time: associations with anxiety, depression, and health-related quality of life in adults. J Affect Disord 2021; 287:107-114. [PMID: 33774318 DOI: 10.1016/j.jad.2021.03.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Assessment of sitting has been challenging and nuances in the length of sitting are often missed. METHODS The present study assessed total, short and prolonged sitting time, and number of breaks from sitting, and their association with anxiety, depression, and health-related quality of life (HRQoL). Adults (M=59.1 years) in three studies (n=1,574) wore the activPAL accelerometer (thigh) to obtain a measure of sitting, and the Actigraph accelerometer (hip) for estimating moderate-to-vigorous physical activity (MVPA). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and HRQoL using the EQ-5D-5L (for health state and utility scores). Generalised linear modelling tested associations. RESULTS Total and prolonged sitting were associated with higher depression [total: β = 0.132 (0.010, 0.254); prolonged: β = 0.178 (0.053, 0.304)] and worse HRQoL health state scores [(total: β = -0.985 (-1.471, -0.499); prolonged: β = -0.834 (-1.301, -0.367)] and utility scores [(total: β = -0.008 (-0.012, -0.003); prolonged: β = -0.008 (-0.012, -0.004)], after controlling for covariates. MVPA was associated with better HRQoL health state and utility scores [health state: β =0.554 (0.187, 0.922); utility: β = 0.001 (0.001, 0.002)]. Total and prolonged sitting were associated with a 14% increased odds of being in the borderline/abnormal category for depression. No interactions were observed between MVPA status (active vs. inactive) and total or prolonged sitting. Anxiety was unrelated to any sitting variable. CONCLUSION Device-based measures of both total and prolonged sitting time were associated with depression and health-related quality of life, but not anxiety.
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Affiliation(s)
- Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, Australia.
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital Leicester LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; NIHR Applied Health Research Collaboration - East Midlands (NIHR ARC-EM), Leicester Diabetes Centre, Leicester, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
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Bailey DP, Edwardson CL, Pappas Y, Dong F, Hewson DJ, Biddle SJH, Brierley ML, Chater AM. A randomised-controlled feasibility study of the REgulate your SItting Time (RESIT) intervention for reducing sitting time in individuals with type 2 diabetes: study protocol. Pilot Feasibility Stud 2021; 7:76. [PMID: 33741077 PMCID: PMC7977248 DOI: 10.1186/s40814-021-00816-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background People with type 2 diabetes mellitus (T2DM) generally spend a large amount of time sitting. This increases their risk of cardiovascular disease, premature mortality, diabetes-related complications and mental health problems. There is a paucity of research that has evaluated interventions aimed at reducing and breaking up sitting in people with T2DM. The primary aim of this study is to assess the feasibility of delivering and evaluating a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM. Methods This is a mixed-methods randomised controlled feasibility trial. Participants (n=70) with T2DM aged 18-85 years who sit ≥7 h/day and are able to ambulate independently will be randomly allocated to receive the REgulate your SItting Time (RESIT) intervention or usual care (control group) for 24 weeks. RESIT is a person-focused intervention that delivers a standardised set of behaviour change techniques to the participants, but the mode through which they are delivered can vary depending on the tools selected by each participant. The intervention includes an online education programme, health coach support, and a range of self-selected tools (smartphone apps, computer-prompt software, and wearable devices) that deliver behaviour change techniques such as self-monitoring of sitting and providing prompts to break up sitting. Measures will be taken at baseline, 12 and 24 weeks. Eligibility, recruitment, retention and data completion rates will be used to assess trial feasibility. Sitting, standing and stepping will be measured using a thigh-worn activity monitor. Cardiometabolic health, physical function, psychological well-being, sleep and musculoskeletal symptoms will also be assessed. A process evaluation will be conducted including evaluation of intervention acceptability and fidelity. Discussion This study will identify the feasibility of delivering a tailored intervention to reduce and break up sitting in ambulatory adults with T2DM and evaluating it through a randomised controlled trial (RCT) design. The findings will inform a fully powered RCT to evaluate the effectiveness of the intervention. Trial registration ISRCTN, ISRCTN14832389; Registered 6 August 2020.
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Affiliation(s)
- Daniel P Bailey
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK. .,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.
| | - Charlotte L Edwardson
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.,NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Feng Dong
- Department of Computer and Information Sciences, University of Strathclyde, G1 1XH, Glasgow, UK
| | - David J Hewson
- Institute for Health Research, University of Bedfordshire, Luton, LU1 3JU, UK
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, 4300, Australia
| | - Marsha L Brierley
- Sedentary Behaviour, Health and Disease Research Group, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Angel M Chater
- Institute for Sport and Physical Activity Research, Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Polhill Avenue, Bedford, MK41 9EA, UK
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48
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Harrington DM, Brady EM, Weihrauch-Bluher S, Edwardson CL, Gray LJ, Hadjiconstantinou M, Jarvis J, Khunti K, Vergara I, Erreguerena I, Ribeiro RT, Troughton J, Vazeou A, Davies MJ. Development of an Interactive Lifestyle Programme for Adolescents at Risk of Developing Type 2 Diabetes: PRE-STARt. Children (Basel) 2021; 8:children8020069. [PMID: 33494347 PMCID: PMC7912284 DOI: 10.3390/children8020069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
Background: Type 2 diabetes (T2D) is increasing in young people. Reporting on the processes used when developing prevention interventions is needed. We present the development of a family-based interactive lifestyle intervention for adolescents with risk factors for T2D in the future. Method: A multidisciplinary team in the UK site led the intervention development process with sites in Portugal, Greece, Germany and Spain. Potential programme topics and underpinning theory were gathered from literature and stakeholders. A theoretical framework based on self-efficacy theory and the COM-B (capability, opportunity, motivation, behaviour) model was developed. Sessions and supporting resources were developed and refined via two iterative cycles of session and resource piloting, feedback, reflection and refinement. Decision on delivery and content were made by stakeholders (young people, teachers, parents, paediatricians) and all sites. Materials were translated to local languages. Site-specific adaptations to the language, content and supporting resources were made. Results: The “PRE-STARt” programme is eight 90-min interactive sessions with supporting curriculum and resources. Iterative development work provided valuable feedback on programme content and delivery. Conclusion: Reporting on the intervention development process, which includes stakeholder input, could yield a flexible approach for use in this emerging ‘at risk’ groups and their families.
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Affiliation(s)
- Deirdre M. Harrington
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK
- Correspondence: ; Tel.: +44-078-4776-5092
| | - Emer M. Brady
- Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK;
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Susann Weihrauch-Bluher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University of Leipzig, 04103 Leipzig, Germany;
- Department for Operative and Nonoperative Pediatric and Adolescent Medicine, University HospitalHalle (Saale), 06120 Halle (Saale), Germany
| | - Charlotte L. Edwardson
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
| | - Laura J. Gray
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | | | - Janet Jarvis
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK; (C.L.E.); (M.H.); (K.K.)
| | - Itziar Vergara
- Instituto de Investigación en Servicios de Salud Kronikgune, 48902 Barakaldo (Bizkaia), Spain; (I.V.); (I.E.)
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas-REDISSEC, 48902 Barakaldo (Bizkaia), Spain
| | - Irati Erreguerena
- Instituto de Investigación en Servicios de Salud Kronikgune, 48902 Barakaldo (Bizkaia), Spain; (I.V.); (I.E.)
| | - Rogério T. Ribeiro
- Education and Research Department (ERC), APDP-Portuguese Diabetes Association, 1250-189 Lisbon, Portugal;
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
| | - Andriani Vazeou
- Diabetes Center, Department of Pediatrics, P&A Kyriakou Children’s Hospital, 115 27 Athens, Greece;
| | - Melanie J. Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (J.J.); (J.T.); (M.J.D.)
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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49
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Sargeant JA, Jelleyman C, Coull NA, Edwardson CL, Henson J, King JA, Khunti K, McCarthy M, Rowlands AV, Stensel DJ, Waller HL, Webb DR, Davies MJ, Yates T. Improvements in Glycemic Control After Acute Moderate-Intensity Continuous or High-Intensity Interval Exercise Are Greater in South Asians Than White Europeans With Nondiabetic Hyperglycemia: A Randomized Crossover Study. Diabetes Care 2021; 44:201-209. [PMID: 33158948 DOI: 10.2337/dc20-1393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether circulating metabolic responses to low-volume high-intensity interval exercise (LV-HIIE) or continuous moderate-intensity aerobic exercise (CME) differ between white Europeans and South Asians with nondiabetic hyperglycemia (NDH). RESEARCH DESIGN AND METHODS Thirteen white Europeans and 10 South Asians (combined median [interquartile range] age 67 [60-68] years, HbA1c 5.9% [5.8-6.1%] [41.0 (39.9-43.2) mmol ⋅ mol-1]) completed three 6-h conditions (sedentary control [CON], LV-HIIE, and CME) in a randomized order. Exercise conditions contained a single bout of LV-HIIE and CME, respectively (each ending at 2 h), with meals provided at 0 and 3 h. Circulating glucose (primary outcome), insulin, insulin resistance index (IRI), triglycerides, and nonesterified fatty acids were measured at 0, 0.5, 1, 2, 3, 3.5, 4, 5, and 6 h. Data were analyzed as postexercise time-averaged area under the curve (AUC) adjusted for age, sex, and preexercise AUC. RESULTS Glucose was similar in each condition and with ethnicity, with no condition-by-ethnicity interaction (P ≥ 0.28). However, insulin was lower in LV-HIIE (mean [95% CI] -44.4 [-23.7, -65.1] mU ⋅ L-1) and CME (-33.8 [-13.7, -53.9] mU ⋅ L-1) compared with CON. Insulin responses were greater in South Asians (interaction P = 0.03) such that values were similar in each ethnicity during exercise conditions, despite being 33% higher in South Asians during CON. IRI followed a similar pattern to insulin. Lipids were unaffected by exercise. CONCLUSIONS Reductions in insulin and insulin resistance after acute LV-HIIE and CME are greater in South Asians than in white Europeans with NDH. Further trials are required to examine the longer-term impact of LV-HIIE and CME on cardiometabolic health.
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Affiliation(s)
- Jack A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, U.K. .,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte Jelleyman
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K.,School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Nicole A Coull
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - James A King
- NIHR Leicester Biomedical Research Centre, Leicester, U.K.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Applied Research Collaboration East Midlands, Leicester, U.K.,Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Matthew McCarthy
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David J Stensel
- NIHR Leicester Biomedical Research Centre, Leicester, U.K.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, U.K
| | - Helen L Waller
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David R Webb
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K.,Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
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50
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Rowlands AV, Kloecker DE, Chudasama Y, Davies MJ, Dawkins NP, Edwardson CL, Gillies C, Khunti K, Razieh C, Islam N, Zaccardi F, Yates T. Association of Timing and Balance of Physical Activity and Rest/Sleep With Risk of COVID-19: A UK Biobank Study. Mayo Clin Proc 2021; 96:156-164. [PMID: 33413813 PMCID: PMC7604071 DOI: 10.1016/j.mayocp.2020.10.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/30/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022]
Abstract
Behavioral lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for coronavirus disease 2019 (COVID-19). We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data and complete covariate and linked COVID-19 data to July 19, 2020, were included. The risk of SARS-CoV-2 positivity and COVID-19 severity-in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest-was assessed with adjusted logistic regression. Of 207 individuals with a positive test result, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, whereas a poor balance between activity and sleep/rest was (odds ratio [OR] per standard deviation: 0.71; 95% confidence interval [CI], 0.62 to 0.81]). This finding was related to higher daytime activity being associated with lower risk (OR, 0.75; 95% CI, 0.61 to 0.93) but higher movement during sleep/rest being associated with higher risk (OR, 1.26; 95% CI, 1.12 to 1.42) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR, 1.21; 95% CI, 1.08 to 1.35). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently approximately 1.2-fold greater per approximately 40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns.
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Affiliation(s)
- Alex V Rowlands
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom.
| | - David E Kloecker
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Yogini Chudasama
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; NIHR Applied Research Collaboration - East Midlands, Leicester General Hospital, Leicester, United Kingdom
| | - Nathan P Dawkins
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Charlotte L Edwardson
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Clare Gillies
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom; NIHR Applied Research Collaboration - East Midlands, Leicester General Hospital, Leicester, United Kingdom
| | - Cameron Razieh
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Nazrul Islam
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom
| | - Tom Yates
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital Gwendolen Rd, Leicester, United Kingdom; National Institute for Health Research, Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, United Kingdom
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