This work was supported by R01-HL115941 from the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH; K.W. Davidson) and an NIH Diversity SupplementR01-HL116470-02S1 (K.M. Diaz).
People with end-stage kidney disease (ESKD) have very low physical activity, and the degree of inactivity is strongly associated with morbidity and mortality. We assessed the feasibility and effectiveness of a 12-week intervention coupling a wearable activity tracker (FitBit) and structured feedback coaching versus wearable activity tracker alone on changes in physical activity in hemodialysis patients.
Randomized controlled trial.
55 participants with ESKD receiving hemodialysis who were able to walk with or without assistive devices recruited from a single academic hemodialysis unit between January 2019 and April 2020.
All participants wore a Fitbit Charge 2 tracker for a minimum of 12 weeks. Participants were randomly assigned 1:1 to a wearable activity tracker plus a structured feedback intervention versus the wearable activity tracker alone. The structured feedback group was counseled weekly on steps achieved after randomization.
The outcome was step count, and the main parameter of interest was the absolute change in daily step count, averaged per week, from baseline to completion of 12 weeks intervention. In the intention-to-treat analysis, mixed-effect linear regression analysis was used to evaluate change in daily step count from baseline to 12-weeks in both arms.
Out of 55 participants, 46 participants completed the 12-week intervention (23 per arm). The mean age was 62 (± 14 SD) years; 44% were Black, and 36% were Hispanic. At baseline, step count (structured feedback intervention: 3,704 [1,594] vs wearable activity tracker alone: 3,808 [1,890]) and other participant characteristics were balanced between the arms. We observed a larger change in daily step count in the structured feedback arm at 12 weeks relative to use of the wearable activity tracker alone arm (Δ 920 [± 580 SD] versus Δ 281 [± 186 SD] steps; between-group difference Δ 639 [± 538 SD] steps; P <0.05).
Single-center study and small sample size.
This pilot randomized controlled trial demonstrated that structured feedback coupled with a wearable activity tracker led to a greater daily step count that was sustained over 12 weeks relative to a wearable activity tracker alone. Future studies are required to determine longer-term sustainability of the intervention and potential health benefits in hemodialysis patients.
Grants from industry (Satellite Healthcare) and government (National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK).
Human thermal comfort depends on objective variables -related to the environment- and to subjective variables, related to physiological conditions. While the former are relatively easy to be measured, the latter are difficult to be investigated since differ from person to person and they are characterized by sudden variations over time. The recent spread of off-the-shelf wearable devices for monitoring bio-signals has considerably facilitate this challenging task. The aim of this work is to provide a detailed framework about the use of off-the-shelf wearable devices for thermal comfort investigations. A systematic review of 35 scientific papers -selected over 302 results from the initial database query- was performed. The results highlight that wristbands (mainly, Empatica E4 and Fitbit), headbands (i.e., Muse 2), chest bands (mainly, BioHarness 3.0 and Polar H7), miniature data loggers (i.e., iButton), and activity sensors (i.e., Move 3) were the off-the-shelf devices whose use is predominant in thermal comfort investigations. Those devices were adopted for different purposes, namely finding correlations between physiological signals and thermal sensations, training and/or validating thermal comfort models, improving data acquisition, and controlling HVAC systems. The proposed framework could represent a solid background for future investigations which should focus on two main research streams. The first one should aim at strengthening the knowledge about statistical correlations between thermal sensations and physiological signals, as well as defining standardized procedures for the model development and validation. The second research stream should aim at integrating off-the-shelf wearable devices and personalized thermal comfort models into HVAC control systems.
To assess the relationship between adverse childhood experiences (ACEs) and objective measures of physical activity and sleep.
Data from the baseline and 2-year follow-up of the Adolescent Brain and Cognitive Development study were analyzed (n = 6227 for physical activity; n = 4151 for sleep). ACEs were assessed by parent report at baseline (mean age 9.9 years) with 3 levels: none, exposure to 1 ACE, and exposure to 2 or more ACEs. Objective measures of physical activity and sleep were assessed with an accelerometer at 2-year follow-up (mean age 11.9 years). Multivariate linear regression analyses were used to examine the relationship between ACEs and physical activity as well as sleep, adjusting for family income and sex.
Compared to children with no ACEs, children with ACEs had fewer daily steps: 1 ACE (β = −323 (95% CI: −508 to −138), P < .001) and 2 or more ACEs (β = −417 (95% CI: −624 to −209), P < .001). ACEs were also associated with shorter sleep duration (minutes), although only for participants with 2 or more ACEs (1 ACE: β = −2.2 (−5.3 to 0.8), P = .16; 2 or more ACEs: β = −6.2 (95% CI: −9.6 to −2.7), P < .001). Rapid eye movement (REM) sleep specifically was reduced in participants with ACEs (1 ACE (β = −1.4 (−2.7 to −0.01), P = .05) and 2 or more ACEs (β = −2.3 (−3.8 to −0.8), P = .003).
There is a dose-response relationship between ACEs and reduced daily steps, total sleep duration, and REM sleep in preadolescents.
Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) arcade-style “neurotraining” to enhance neurocognitive capacities to resist the temptation of unhealthy foods and more automatically select healthy foods. This study will use a 2 × 2 factorial design to examine the independent and combinatory efficacy of gamification and inhibitory control training (ICT). Men with overweight/obesity (N = 228) will receive a 12-month mobile weight loss program that incorporates behavioral weight loss strategies (e.g., self-monitoring, goal setting, stimulus control). Men will be randomly assigned to a non-gamified or gamified version, and an active or sham ICT. A game design company will create the program, with input from a male advisory panel. Aims of the project are to test whether a gamified (versus non-gamified) weight loss program and/or ICT (versus sham) promotes greater improvements in weight, diet, and physical activity; whether these treatment factors have combinatory or synergistic effects; to test whether postulated mechanisms of action (increased engagement, for gamification, and inhibitory control, for ICT) mediate treatment effects; and whether baseline gameplay frequency and implicit preferences for ICT-targeted foods moderate effects. It is hoped this study will contribute to improved mHealth programs for men and enhance our understanding of the impact of gamified elements and neurocognitive training on weight control.