Exploring Wearables to Focus on the "Sweet Spot" of Physical Activity and Sleep After Hospitalization: Secondary Analysis

S Ryan Greysen, Kimberly J Waddell, Mitesh S Patel, S Ryan Greysen, Kimberly J Waddell, Mitesh S Patel

Abstract

Background: Inadequate sleep and physical activity are common during and after hospitalization, but their impact on patient-reported functional outcomes after discharge is poorly understood. Wearable devices that measure sleep and activity can provide patient-generated data to explore ideal levels of sleep and activity to promote recovery after hospital discharge.

Objective: This study aimed to examine the relationship between daily sleep and physical activity with 6 patient-reported functional outcomes (symptom burden, sleep quality, physical health, life space mobility, activities of daily living, and instrumental activities of daily living) at 13 weeks after hospital discharge.

Methods: This secondary analysis sought to examine the relationship between daily sleep, physical activity, and patient-reported outcomes at 13 weeks after hospital discharge. We utilized wearable sleep and activity trackers (Withings Activité wristwatch) to collect data on sleep and activity. We performed descriptive analysis of device-recorded sleep (minutes/night) with patient-reported sleep and device-recorded activity (steps/day) for the entire sample with full data to explore trends. Based on these trends, we performed additional analyses for a subgroup of patients who slept 7-9 hours/night on average. Differences in patient-reported functional outcomes at 13 weeks following hospital discharge were examined using a multivariate linear regression model for this subgroup.

Results: For the full sample of 120 participants, we observed a "T-shaped" distribution between device-reported physical activity (steps/day) and sleep (patient-reported quality or device-recorded minutes/night) with lowest physical activity among those who slept <7 or >9 hours/night. We also performed a subgroup analysis (n=60) of participants that averaged the recommended 7-9 hours of sleep/night over the 13-week study period. Our key finding was that participants who had both adequate sleep (7-9 hours/night) and activity (>5000 steps/day) had better functional outcomes at 13 weeks after hospital discharge. Participants with adequate sleep but less activity (<5000 steps/day) had significantly worse symptom burden (z-score 0.93, 95% CI 0.3 to 1.5; P=.02), community mobility (z-score -0.77, 95% CI -1.3 to -0.15; P=.02), and perceived physical health (z-score -0.73, 95% CI -1.3 to -0.13; P=.003), compared with those who were more physically active (≥5000 steps/day).

Conclusions: Participants within the "sweet spot" that balances recommended sleep (7-9 hours/night) and physical activity (>5000 steps/day) reported better functional outcomes after 13 weeks compared with participants outside the "sweet spot." Wearable sleep and activity trackers may provide opportunities to hone postdischarge monitoring and target a "sweet spot" of recommended levels for both sleep and activity needed for optimal recovery.

Trial registration: ClinicalTrials.gov NCT03321279; https://ichgcp.net/clinical-trials-registry/NCT03321279.

Keywords: digital health; health care; hospital; hospitalization; patient reported outcomes; physical activity; sleep; wearables.

Conflict of interest statement

Conflicts of Interest: MSP is the owner of Catalyst Health LLC, a behavior change and technology consulting company. MSP is also an advisory board member for Humana and GlaxoSmithKline .

©S Ryan Greysen, Kimberly J Waddell, Mitesh S Patel. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 27.04.2022.

Figures

Figure 1
Figure 1
Mean daily sleep by baseline (prehospitalization) Pittsburgh Sleep Quality Index (PSQI) score.
Figure 2
Figure 2
Mean daily sleep by level of physical activity after discharge.
Figure 3
Figure 3
Mean daily sleep and mean daily activity distributions.
Figure 4
Figure 4
Beta estimates, with 95% CIs, at 13 weeks for the less active cohort; orange bars indicate significant (P<.05) comparisons, while the blue bars indicate nonsignificant comparisons. ADL: activities of daily living; IADL: instrumental activities of daily living.

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