the impact of covid19 restrictions on accelerometerassessed physical activity and CORD-Papers-2022-06-02 (Version 1)

Title: The impact of COVID19 restrictions on accelerometerassessed physical activity and sleep in individuals with type 2 diabetes
Abstract: AIMS: Restrictions during the COVID19 crisis will have impacted on opportunities to be active. We aimed to (a) quantify the impact of COVID19 restrictions on accelerometerassessed physical activity and sleep in people with type 2 diabetes and (b) identify predictors of physical activity during COVID19 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 COVID19 restrictions. Accelerometer outcomes included the following: overall physical activity moderatetovigorous physical activity (MVPA) time spent inactive days/week with 30minute continuous MVPA and sleep. Predictors of change in physical activity taken preCOVID included the following: age sex ethnicity body mass index (BMI) socioeconomic status and medical history. RESULTS: In all 165 participants (age (meanS.D = 64.2 8.3 years BMI=31.4 5.4 kg/m(2) 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 30minute 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 COVID19 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.
Published: 2021-03-23
Journal: Diabet Med
DOI: 10.1111/dme.14549
DOI_URL: http://doi.org/10.1111/dme.14549
Author Name: Rowlands Alex V
Author link: https://covid19-data.nist.gov/pid/rest/local/author/rowlands_alex_v
Author Name: Henson Joseph J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/henson_joseph_j
Author Name: Coull Nicole A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/coull_nicole_a
Author Name: Edwardson Charlotte L
Author link: https://covid19-data.nist.gov/pid/rest/local/author/edwardson_charlotte_l
Author Name: Brady Emer
Author link: https://covid19-data.nist.gov/pid/rest/local/author/brady_emer
Author Name: Hall Andrew
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hall_andrew
Author Name: Khunti Kamlesh
Author link: https://covid19-data.nist.gov/pid/rest/local/author/khunti_kamlesh
Author Name: Davies Melanie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/davies_melanie
Author Name: Yates Tom
Author link: https://covid19-data.nist.gov/pid/rest/local/author/yates_tom
sha: 83b3e9442f7c0b1d3c9704c4c1610b8992d7eb26
license: no-cc
license_url: [no creative commons license associated]
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33650112
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33650112
pmcid: PMC7995208
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995208
url: https://www.ncbi.nlm.nih.gov/pubmed/33650112/ https://doi.org/10.1111/dme.14549
has_full_text: TRUE
Keywords Extracted from Text Content: women wrist coronavirus participants Women people UK woman COVID-19 ≥1 body BMI=31.4 ± 5.4 kg/m 2 lockdown Patients post-COVID people ≃20 <3 patients SARS-CoV-2 virus lockdown ActivInsights coronavirus 2 men −2.0 sedatives West Midlands-Black Country Research Ethics Committee (16/WM/0457) Spain 4 CODEC HbA1c COVID-19 vaccines β(95 coronavirus disease-2019 women heart UK Type 2 Spain, 6 COVID-19 self-isolate HbA1c ≤86 Patients NCT02973412 ≥3 ENMO participants Women T A B L E 3 Pre-COVID Figure 1 woman SARS-CoV-2 GENEActivs COVID participants
Extracted Text Content in Record: First 5000 Characters: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/m 2 , 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. accelerometer, activity monitor, CODEC, coronavirus, MVPA, lockdown Novelty statement • Self-report data suggest COVID-19 restrictions have had a detrimental impact on physical activity. • Studies in high-risk groups with objective measures of physical activity are lacking. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease-2019 (COVID- 19) , has devastated global economies and fundamentally changed patterns of daily life for many. Restrictions put in place to limit the movement and interaction of people during the COVID-19 crisis will have impacted on opportunities to be active, potentially leading to decreases in physical activity and increased sedentary behaviour, which could have negative consequences for cardiometabolic health. 1, 2 As people with type 2 diabetes mellitus have impaired cardiometabolic health and are already less active and more sedentary than those without the condition, 3 it is important to quantify the impact of the COVID-19 national lockdown on their physical activity. Evidence is beginning to accumulate documenting a detrimental impact of COVID-19 restrictions on self-reported physical activity levels. For example, declines in total physical activity and in moderate-to-vigorous activity of approximately 35% and 23%, respectively, were reported by 2524 Italian participants completing an online survey. 4 A similar decline in total activity, but 60% decline in moderate-tovigorous activity was self-reported by 143 physiotherapy professionals and students in an online survey in India. 5 The pattern of decline was similar in a small sample of adults with type 2 diabetes in Spain, with self-reported moderateto-vigorous activity decreasing by 66% in men and 52% in women. 6 As well as physical activity, restrictions will have disrupted other behaviours, e.g. time spent inactive including sedentary (sitting) behaviours. Self-reported sitting increased by 48% (men) and 21% (women) in adults with type 2 diabetes in Spain, 6 and nearly four-fold in physiotherapy students and professionals in India. 5 To date, most research on change in physical activity during the COVID-19 pandemic has relied on self-report, with participants asked to recall their activity during and prior to heightened restrictions, exacerbating the well-documented limitations of self-report. 7 A small study of 26 heart failure patients that used device-based measures of activity also showed a 16% decrease in steps/day. 8 However, larger studies in high-risk groups with objective measures are lacking, as are studies examining patterns of physical activity which may also be related to health. 9 As well as identifying whether COVID-19 restrictions had a detrimental impact on physical activity, it is important to determine factors that exacerbate or mitigate any decline to inform strategies aiming to prevent further declines in physical activity. This is particularly pertinent given the continued risk of COVID-19 10 and greater likelihood of self-isolating in those with underlying conditions, placing them at increased risk of severe COVID-19. 11 We are in a unique position t
Keywords Extracted from PMC Text: GENEActivs people high‐risk HbA1c post‐COVID β(95 woman samples pre‐ heart for'exercise Patient patients women SES UK <3 coronavirus 2 COVID‐19 follow‐up 24‐h coronavirus UK Government's glycated haemoglobin GENEActiv alcohol 30‐ CODEC chi‐square men ENMO ActivInsights participants 10–30 body moderate‐to‐vigorous lockdown self‐report Spain self‐isolate Figure 1 −2.0 60‐minutes http://cran.r‐project.org Patient Health Questionnaire 9 Non‐wear ≃20 COVID‐19
Extracted PMC Text Content in Record: First 5000 Characters:The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease‐2019 (COVID‐19), has devastated global economies and fundamentally changed patterns of daily life for many. Restrictions put in place to limit the movement and interaction of people during the COVID‐19 crisis will have impacted on opportunities to be active, potentially leading to decreases in physical activity and increased sedentary behaviour, which could have negative consequences for cardiometabolic health. 1 , 2 As people with type 2 diabetes mellitus have impaired cardiometabolic health and are already less active and more sedentary than those without the condition, 3 it is important to quantify the impact of the COVID‐19 national lockdown on their physical activity. Evidence is beginning to accumulate documenting a detrimental impact of COVID‐19 restrictions on self‐reported physical activity levels. For example, declines in total physical activity and in moderate‐to‐vigorous activity of approximately 35% and 23%, respectively, were reported by 2524 Italian participants completing an online survey. 4 A similar decline in total activity, but 60% decline in moderate‐to‐vigorous activity was self‐reported by 143 physiotherapy professionals and students in an online survey in India. 5 The pattern of decline was similar in a small sample of adults with type 2 diabetes in Spain, with self‐reported moderate‐to‐vigorous activity decreasing by 66% in men and 52% in women. 6 As well as physical activity, restrictions will have disrupted other behaviours, e.g. time spent inactive including sedentary (sitting) behaviours. Self‐reported sitting increased by 48% (men) and 21% (women) in adults with type 2 diabetes in Spain, 6 and nearly four‐fold in physiotherapy students and professionals in India. 5 To date, most research on change in physical activity during the COVID‐19 pandemic has relied on self‐report, with participants asked to recall their activity during and prior to heightened restrictions, exacerbating the well‐documented limitations of self‐report. 7 A small study of 26 heart failure patients that used device‐based measures of activity also showed a 16% decrease in steps/day. 8 However, larger studies in high‐risk groups with objective measures are lacking, as are studies examining patterns of physical activity which may also be related to health. 9 As well as identifying whether COVID‐19 restrictions had a detrimental impact on physical activity, it is important to determine factors that exacerbate or mitigate any decline to inform strategies aiming to prevent further declines in physical activity. This is particularly pertinent given the continued risk of COVID‐19 10 and greater likelihood of self‐isolating in those with underlying conditions, placing them at increased risk of severe COVID‐19. 11 We are in a unique position to quantify the impact of the COVID‐19 restrictions on those with type 2 diabetes, through our existing large comprehensively phenotyped cohort. 12 We aimed to quantify the change in device‐measured physical activity before and during the major COVID‐19 restrictions in the UK. Second, we aimed to identify key predictors of change in physical activity levels. Potential predictor variables included demographics, health status and physical function. Pre‐COVID measures were taken between 2017 and 2020. These included the following: date of birth, date of assessment, sex (men/women), ethnicity (White, Black and minority ethnic), body mass index (kg/m2), smoking status, alcohol intake, index of multiple deprivation (postcode was used to estimate socio‐economic status [SES]; lower values indicate more deprived, higher values less deprived), medical history [duration of diabetes and number of diabetes medications], occupation, depressive symptoms [Patient Health Questionnaire 9]), physical function (Short Physical Performance Battery) and HbA1c (glycated haemoglobin). These measures have been described previously. 12 Baseline physical activity outcomes were derived from the GENEActiv accelerometer (ActivInsights Ltd, Cambridgeshire, UK) which participants wore 24 h a day for 8 days on their non‐dominant wrist. Monitors were initialised to record accelerations at 100 Hz. Season of measurement was categorised as Spring, Summer, Autumn and Winter. Participants were asked a series of COVID‐19‐related questions over the phone. These included whether they were self‐isolating, had been advised to self‐isolate, had been tested for COVID‐19 and, if so, the result. A GENEActiv was subsequently mailed out to each participant. To prevent transmission of the SARS‐CoV‐2 virus, GENEActivs were sterilised prior to posting. Participants were provided with a sterilisation kit to clean the device prior to wearing and were instructed over the phone to leave the accelerometer in the envelope for 2 days prior to wearing to minimise risk of infection/spread. A pre‐paid envelope was provided to
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