Changes in health promoting behavior during COVID-19 physical distancing: Utilizing wearable technology to examine trends in sleep, activity, and cardiovascular indicators of health

The Night-Time Sleep and Autonomic Activity of Male and Female Professional Road Cyclists Competing in the Tour de France and Tour de France Femmes

BACKGROUND

Sleep is a critical component of recovery, but it can be disrupted following prolonged endurance exercise. The objective of this study was to examine the capacity of male and female professional cyclists to recover between daily race stages while competing in the 2022 Tour de France and the 2022 Tour de France Femmes, respectively. The 17 participating cyclists (8 males from a single team and 9 females from two teams) wore a fitness tracker (WHOOP 4.0) to capture recovery metrics related to night-time sleep and autonomic activity for the entirety of the events and for 7 days of baseline before the events. The primary analyses tested for a main effect of 'stage classification'-i.e., rest, flat, hilly, mountain or time trial for males and flat, hilly or mountain for females-on the various recovery metrics.

RESULTS

During baseline, total sleep time was 7.2 ± 0.3 h for male cyclists (mean ± 95% confidence interval) and 7.7 ± 0.3 h for female cyclists, sleep efficiency was 87.0 ± 4.4% for males and 88.8 ± 2.6% for females, resting HR was 41.8 ± 4.5 beats·min-1 for males and 45.8 ± 4.9 beats·min-1 for females, and heart rate variability during sleep was 108.5 ± 17.0 ms for males and 119.8 ± 26.4 ms for females. During their respective events, total sleep time was 7.2 ± 0.1 h for males and 7.5 ± 0.3 h for females, sleep efficiency was 86.4 ± 1.2% for males and 89.6 ± 1.2% for females, resting HR was 44.5 ± 1.2 beats·min-1 for males and 50.2 ± 2.0 beats·min-1 for females, and heart rate variability during sleep was 99.1 ± 4.2 ms for males and 114.3 ± 11.2 ms for females. For male cyclists, there was a main effect of 'stage classification' on recovery, such that heart rate variability during sleep was lowest after mountain stages. For female cyclists, there was a main effect of 'stage classification' on recovery, such that the percentage of light sleep (i.e., lower-quality sleep) was highest after mountain stages.

CONCLUSIONS

Some aspects of recovery were compromised after the most demanding days of racing, i.e., mountain stages. Overall however, the cyclists obtained a reasonable amount of good-quality sleep while competing in these physiologically demanding endurance events. This study demonstrates that it is now feasible to assess recovery in professional athletes during multiple-day endurance events using validated fitness trackers.

The Use of Wearable Devices to Measure Sedentary Behavior during COVID-19: Systematic Review and Future Recommendations

The SARS-CoV-2 pandemic resulted in approximately 7 million deaths and impacted 767 million individuals globally, primarily through infections. Acknowledging the impactful influence of sedentary behaviors, particularly exacerbated by COVID-19 restrictions, a substantial body of research has emerged, utilizing wearable sensor technologies to assess these behaviors. This comprehensive review aims to establish a framework encompassing recent studies concerning wearable sensor applications to measure sedentary behavior parameters during the COVID-19 pandemic, spanning December 2019 to December 2022. After examining 582 articles, 7 were selected for inclusion. While most studies displayed effective reporting standards and adept use of wearable device data for their specific research aims, our inquiry revealed deficiencies in apparatus accuracy documentation and study methodology harmonization. Despite methodological variations, diverse metrics, and the absence of thorough device accuracy assessments, integrating wearables within the pandemic context offers a promising avenue for objective measurements and strategies against sedentary behaviors.

Hit the gym or hit the hay: can evening exercise characteristics predict compromised sleep in healthy adults?

Introduction: Recent sleep guidelines regarding evening exercise have shifted from a conservative (i.e., do not exercise in the evening) to a more nuanced approach (i.e., exercise may not be detrimental to sleep in circumstances). With the increasing popularity of wearable technology, information regarding exercise and sleep are readily available to the general public. There is potential for these data to aid sleep recommendations within and across different population cohorts. Therefore, the aim of this study was to examine if sleep, exercise, and individual characteristics can be used to predict whether evening exercise will compromise sleep. Methods: Data regarding evening exercise and the subsequent night's sleep were obtained from 5,250 participants (1,321F, 3,929M, aged 30.1 ± 5.2 yrs) using a wearable device (WHOOP 3.0). Data for females and males were analysed separately. The female and male datasets were both randomly split into subsets of training and testing data (training:testing = 75:25). Algorithms were trained to identify compromised sleep (i.e., sleep efficiency <90%) for females and males based on factors including the intensity, duration and timing of evening exercise. Results: When subsequently evaluated using the independent testing datasets, the algorithms had sensitivity for compromised sleep of 87% for females and 90% for males, specificity of 29% for females and 20% for males, positive predictive value of 32% for females and 36% for males, and negative predictive value of 85% for females and 79% for males. If these results generalise, applying the current algorithms would allow females to exercise on ~ 25% of evenings with ~ 15% of those sleeps being compromised and allow males to exercise on ~ 17% of evenings with ~ 21% of those sleeps being compromised. Discussion: The main finding of this study was that the models were able to predict a high percentage of nights with compromised sleep based on individual characteristics, exercise characteristics and habitual sleep characteristics. If the benefits of exercising in the evening outweigh the costs of compromising sleep on some of the nights when exercise is undertaken, then the application of the current algorithms could be considered a viable alternative to generalised sleep hygiene guidelines.

Recommendations for the care of patients with cardiovascular disease in health emergency situations: a call to action

COVID-19 has had a negative impact on the health care of patients with cardiovascular disease and patients at high risk of cardiovascular disease. The restrictions affecting access to the health care system have conditioned the care received, resulting in poorer control and a higher risk of events. Taking action to improve the care provided during health emergencies is mandatory. It is important to promote the development of telemedicine and patient empowerment by fostering health literacy and a higher degree of self-care. In addition, primary care and coordination between health care levels should be improved. Moreover, the simplification and optimization of treatment, for example, using the cardiovascular polypill, have led to an improvement in adherence, better control of vascular risk factors, and a reduced risk of events. The present document provides specific recommendations for improving the care provided to patients under a health emergency.

Monitoring one heart to help two: heart rate variability and resting heart rate using wearable technology in active women across the perinatal period

BACKGROUND

Characterizing normal heart rate variability (HRV) and resting heart rate (RHR) in healthy women over the course of a pregnancy allows for further investigation into disease states, as pregnancy is the ideal time period for these explorations due to known decreases in cardiovascular health. To our knowledge, this is the first study to continuously monitor HRV and RHR using wearable technology in healthy pregnant women.

METHODS

A total of 18 healthy women participated in a prospective cohort study of HRV and RHR while wearing a WHOOP® strap prior to conception, throughout pregnancy, and into postpartum. The study lasted from March 2019 to July 2021; data were analyzed using linear mixed models with splines for non-linear trends.

RESULTS

Eighteen women were followed for an average of 405.8 days (SD = 153). Minutes of logged daily activity decreased from 28 minutes pre-pregnancy to 14 minutes by third trimester. A steady decrease in daily HRV and increase in daily RHR were generally seen during pregnancy (HRV Est. = - 0.10, P < 0.0001; RHR Est. = 0.05, P < 0.0001). The effect was moderated by activity minutes for both HRV and RHR. However, at 49 days prior to birth there was a reversal of these indices with a steady increase in daily HRV (Est. = 0.38, P < 0.0001) and decrease in daily RHR (Est. = - 0.23, P < 0.0001), regardless of activity level, that continued into the postpartum period.

CONCLUSIONS

In healthy women, there were significant changes to HRV and RHR throughout pregnancy, including a rapid improvement in cardiovascular health prior to birth that was not otherwise known. Physical activity minutes of any type moderated the known negative consequences of pregnancy on cardiovascular health. By establishing normal changes using daily data, future research can now evaluate disease states as well as physical activity interventions during pregnancy and their impact on cardiovascular fitness.

Sleep and Alcohol Use Patterns During Federal Holidays and Daylight Saving Time Transitions in the United States

We conducted a retrospective observational study using remote wearable and mobile application data to evaluate whether US public holidays or Daylight Saving Time transitions were associated with significant changes in sleep behaviors, including sleep duration, sleep onset and offset, and the consistency of sleep timing, as well as changes in the point prevalence of alcohol use. These metrics were analyzed using objective, high resolution sleep-wake data (10,350,760 sleep episodes) and 5,777,008 survey responses of 24,250 US subscribers (74.5% male; mean age of 37.6 ± 9.8 years) to the wrist-worn biometric device platform, WHOOP (Boston, Massachusetts, United States), who were active users during 1 May 2020, through 1 May 2021. Compared to baseline, statistically significant differences in sleep and alcohol measures were found on most DST transitions, US public holidays, and their eves. For example, New Year's Eve corresponded with a sleep consistency decrease of 13.8 ± 0.3%, a sleep onset delay of 88.9 ± 3.2 min (00:01 vs. 22:33 baseline) later, a sleep offset delay of 78.1 ± 3.1 min (07:56 vs. 06:39), and an increase in the prevalence of alcohol consumption, with more than twice as many participants having reported alcohol consumption [+138.0% ± 6.7 (74.2% vs. 31.2%)] compared to baseline. In this analysis of a non-random sample of mostly male subscribers conducted during the COVID-19 pandemic, the majority of US public holidays and holiday eves were associated with sample-level increases in sleep duration, decreases in sleep consistency, later sleep onset and offset, and increases in the prevalence of alcohol consumption. Future work would be warranted to explore the generalizability of these findings and their public health implications, including in more representative samples and over longer time intervals.

Self-tracking via smartphone app: Potential tool for athletes’ recovery self-management?

Self-tracking technologies are possible approaches to support recovery self-management activities for athletes. These may have become even more appealing due to stay-at-home restrictions as part of the 2020 pandemic regulations. This study examined user behaviour of smartphone and wearable technologies among 217 athletes (29% women, M age = 26.9 ± 7 years). The online survey comprised demographic questions and standardised questionnaires to assess usage of technologies, sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), attitudes about sleep (Dysfunctional Beliefs and Attitudes about Sleep Scale), bedtime procrastination (Bedtime Procrastination Scale), and self-control (Brief Self-Control Scale). Fitness apps (46.5%) were more popular than sleep apps (15.7%) followed by nutrition apps (12%). The correlation between sleep apps and the other two apps indicate that non-users of sleep apps are probably also non-users of fitness or nutrition apps. Wearables were more frequently used to track fitness activities (36.9%) than sleep (17.5%). Considering sex, type of sport, competition participation, and training volume, no remarkable characteristics among users versus non-users of sleep apps were identified. There were also no significant differences among sleep indices between sleep app users and non-users. However, self-control was highest among sleep app users compared to non-users (d = 0.58). Despite 34.1% being identified as poor sleepers, behavioural sleeping patterns were within normal range. The results imply that athletes are not as attracted to self-tracking technologies as expected, which makes them less vulnerable to unsubstantiated feedback and inappropriate interventions by those tools. This serves as a starting point to explore the potential of self-tracking ambulatory assessment for physical activity and sleep behaviour of athletes in the post-pandemic era.

Prior sleep-wake behaviors are associated with mental health outcomes during the COVID-19 pandemic among adult users of a wearable device in the United States

Objectives

To characterize objective sleep patterns among U.S. adults before and during the COVID-19 pandemic, and to assess for associations between adverse mental health symptoms and (1) sleep duration and (2) the consistency of sleep timing before and during the pandemic.

Design

Longitudinal objective sleep-wake data during January-June 2020 were linked with mental health and substance use assessments conducted during June 2020 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

Setting

Adult users of WHOOP—a commercial, digital sleep wearable.

Participants

Adults residing in the U.S. and actively using WHOOP wearable devices, recruited by WHOOP, Inc.

Intervention

The COVID-19 pandemic and its mitigation.

Measurements

Anxiety or depression symptoms, burnout symptoms, and new or increased substance use to cope with stress or emotions.

Results

Of 4912 participants in the primary analytic sample (response rate, 14.9%), we observed acutely increased sleep duration (0.25 h or 15 m) and sleep consistency (3.51 points out of 100) and delayed sleep timing (onset, 18.7 m; offset, 36.6 m) during mid-March through mid-April 2020. Adjusting for demographic and lifestyle variables, participants with persistently insufficient sleep duration and inconsistent sleep timing had higher odds of adverse mental health symptoms and substance use in June 2020.

Conclusions

U.S. adult wearable users displayed increased sleep duration, more consistent sleep timing, and delayed sleep onset and offset times after the COVID-19 pandemic onset, with subsample heterogeneity. Associations between adverse mental health symptoms and pre- and mid-pandemic short sleep duration and inconsistent sleep timing suggest that these characteristics warrant further investigation as potential modifiable mental health and substance use risk factors.

Predicting attitudes towards easing COVID-19 restrictions in the United States of America: The role of health concerns, demographic, political, and individual difference factors

Despite rising cases of COVID-19 in the United States of America, several states are easing restrictions (e.g., relaxing physical distancing requirements, reopening businesses) that were imposed to limit community transmission of the virus. Individuals hold differing opinions regarding whether restrictions should continue to be imposed or lifted, evidenced, for example, by debate and protests regarding reopening of businesses and venues. Health and social psychological research suggest that perceptions of COVID-19related risk, experiences of the virus, and individual difference factors can help explain individuals’ attitudes towards health initiatives and their tendency to be persuaded towards a specific course of action. The purpose of this study was to investigate what factors influence support or opposition to easing COVID-19-related restrictions. A sample of 350 United States citizens, responding to an anonymous survey, were asked about the extent to which they support/oppose easing of COVID-19-related restrictions, both generally and in relation to specific restrictions. Respondents completed measures of their experiences of COVID-19, individual difference factors, and demographic variables, including political affiliation and degree of social and economic conservatism. In a series of regression analyses, significant demographic predictors of support or opposition for easing restrictions were gender, age, ethnicity, and education, with political affiliation and degree of social and economic conservatism also predicting attitudes. Experiences related to COVID-19 that predicted attitudes were concerns for self and family, perceptions of threat posed by the virus, perceived ability to adhere to restrictions, willingness to take government direction, and belief in COVID-19-related conspiracy theories. At an individual differences level, uncertainty avoidance, collectivism, long-term orientation, masculinity, empathic concern, personal distress, reactance, and general conspiracy theory beliefs all significantly precited attitudes to easing restrictions. Understanding the factors that help explain attitudes towards COVID-19 restrictions can inform how best to position health messaging and initiatives going forward, particularly as states or countries open borders.

Biometrics from a Wearable Device Reveals Temporary Effects of COVID-19 Vaccines on Cardiovascular, Respiratory, and Sleep Physiology

Although vaccines against SARS-CoV-2 have been proven safe and effective, transient side-effects lasting 24-48 h postvaccination have been reported. To better understand the subjective and objective response to COVID-19 vaccination, we conducted a retrospective analysis on 69,619 subscribers to a wrist-worn biometric device (WHOOP Inc., Boston, MA) who received either the AstraZeneca, Janssen/Johnson & Johnson, Moderna, or Pfizer/BioNTech vaccine. The WHOOP device measures resting heart rate (RHR), heart rate variability (HRV), respiratory rate (RR), and sleep architecture, and these physiological measures were normalized to the same day of the week, 1 wk before vaccination. Averaging across vaccines, RHR, RR, and percent sleep derived from light sleep were elevated on the first night following vaccination and returned to baseline within 4 nights postvaccination. When statistical differences were observed between doses on the first night postvaccination, larger deviations in physiological measures were observed following the first dose of AstraZeneca and the second dose of Moderna and Pfizer/BioNTech. When statistical differences were observed between age groups or gender on the first night postvaccination, larger deviations in physiological measures were observed in younger populations and in females (compared with males). When combining self-reported symptoms (fatigue, muscle aches, headache, chills, or fever) with the objectively measured physiological parameters, we found that self-reporting fever or chills had the strongest association with deviations in physiological measures following vaccination. In summary, these results suggest that COVID-19 vaccines temporarily affect cardiovascular, respiratory, and sleep physiology and that dose, gender, and age affect the physiological response to vaccination.

NEW & NOTEWORTHY Here we report the first large-scale study investigating the effect of COVID-19 vaccines on cardiovascular, respiratory, and sleep physiology. We find that vaccines temporarily impact measures of cardiovascular, respiratory, and sleep physiology and that the degree of change in physiology is influenced by the manufacturer and dose of the vaccine and the gender and age of the vaccine recipient. These results provide insights into physiological changes that occur with COVID-19 vaccination and indicate that the unique responses that occur postvaccination may depend on manufacturer, dose, gender, and age.

"Wearables on vogue": a scoping review on wearables on physical activity and sedentary behavior during COVID-19 pandemic

Background

Wearables are intriguing way to promote physical activity and reduce sedentary behavior in populations with and without chronic diseases. However, the contemporary evidence demonstrating the effectiveness of wearables on physical health during the COVID-19 pandemic has yet to be explored.

Aim

The present review aims to provide the readers with a broader knowledge of the impact of wearables on physical health during the pandemic.

Methods

Five electronic databases (Web of Science, Scopus, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature and Embase) were searched. The eligibility criteria of the studies to be included were based on PICOT criteria: population (adults, children and elderly), intervention (wearable, smartphones), comparison (any behavioral intervention), outcome (physical activity or sedentary behavior levels) and time frame (between December 1st, 2019 and November 19th, 2021). The present scoping review was framed as per the guidelines of the Arksey and O’Malley framework.

Results

Of 469 citations initially screened, 17 articles were deemed eligible for inclusion and potential scoping was done. Smartphone-based applications with inbuilt accelerometers were commonly used, while a few studies employed smart bands, smartwatches for physical health monitoring. Most of the studies observed the increased use of wearables in healthy adults followed by elderly, children and pregnant women. Considerable reduction (almost—50%) in physical activity during the pandemic: daily step count (− 2812 steps/min), standing (− 32.7%) and walking (− 52.2%) time was found.

Conclusion

Wearables appears to be impending means of improving physical activity and reducing sedentary behavior remotely during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11332-021-00885-x.

Physical Activity and Attitudes Toward Social Media Use of Active Individuals During the COVID-19 Pandemic in Saudi Arabia: Cross-Sectional Survey

Background: Social media became an integral part of the lives of people because it encourages social relations and shares interests, activities, and real-life connections. As quarantine and lockdown orders are prolonged, many people, as well as those physically active individuals, typically responded to this stressful condition by using social media platforms. Objective: This study aimed to examine the level of physical activity of physically active individuals and their attitudes toward social media use during the COVID-19 pandemic. Methods: A descriptive cross-sectional survey was conducted among physically active individuals in Saudi Arabia between June 2020 and July 2020. An online survey was employed among eligible participants who completed a self-administered questionnaire that covered reasons for physical activity and attitudes toward social media platforms during the COVID-19 pandemic. Results: Of these 323 participants, 29.1% were in the age group of 18-24 years, 66.6% were women, and 67.8% were single. The proportion of participants whose metabolic equivalent of tasks-min/week from vigorous activity <1,680 was 31.9%, and all of the participants follow people or pages in social media related to sports teams and fitness models. The average number of hours spent on social media per day was 2.95 ± 0.90 h. The majority of the participants showed positive attitudes toward social media used for exercise and physical activity. Of the eight variables, age, level of physical activity, and the average of hours spent on social media emerged as significant predictors of attitudes toward the use of social media (P < 0.05). Conclusions: The present survey results indicate adverse consequences of home quarantine as reflected by a small proportion of participants who had differences in levels of vigorous activities during the COVID-19 pandemic in Saudi Arabia. Social media appears to be a key avenue to promote and disseminate health interventions to promote physical activity during this COVID-19 pandemic.