Device-assessed sleep and physical activity in individuals recovering from a hospital admission for COVID-19: a prospective, multicentre study

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Abstract

Objectives

To describe physical behaviours following hospital admission for COVID-19 including associations with acute illness severity and ongoing symptoms.

Methods

1077 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 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 minutes/day of moderate-to-vigorous physical activity (MVPA), with 725.6±104.9 minutes/day spent inactive and 7.22±1.08 hours/day asleep. The values for men were 21.0±22.3 and 755.5±102.8 minutes/day and 6.94±1.14 hours/day, respectively. Over 60% of women and men did not have any days containing a 30-minute bout of MVPA. Variability in sleep timing was approximately 2 hours 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 sleep duration, 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

Physical activity and regulating sleep patterns are potential treatable traits for COVID-19 recovery programmes.

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  1. ScreenIT

    SciScore for 10.1101/2022.02.03.22270391: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: 3 All study participants provided written informed consent.
    IRB: The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Accelerometer data processing: Accelerometer files were processed with R-package GGIR version 2.2-0 (http://cran.r-project.org).
    http://cran.r-project.org
    suggested: (CRAN, RRID:SCR_003005)
    Data were analysed using SPSS (version 26.0).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Key strengths of this study are its size, the comprehensively phenotyped multicentre cohort with novel clinical phenotypes, and accelerometer-assessed physical behaviours at scale. Irrespective, the study has several limitations. Notably, it was not possible to obtain measures of physical behaviours for the participants before they were infected with COVID-19. To account for this, we compared the data to a similarly aged cohort of office workers and a cohort of adults with type 2 diabetes who were well-matched on key characteristics including sex, multimorbidity status, and BMI.13,14 However, the data were collected on the comparator cohorts prior to the pandemic; we acknowledge that patterns of physical behaviours may also have been impacted due to the COVID-19 restrictions that have been imposed in the UK (and worldwide) to limit the spread of the virus. Variability in sleep timing and sleep efficiency were the main differences between the PHOSP-COVID and comparator cohorts in the present study. We have previously shown that these sleep-related variables did not differ before and during COVID-19 restrictions, suggesting the differences observed are unlikely due to differences in the measurement period.26 Due to missing patient-reported outcome data within the PHOSP-COVID cohort, a cluster assignment was not derived for all participants. Finally, over 66% of the cohort had valid accelerometer data but those with data tended to be older, from less d...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN10980107NANA

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.02.03.22270391 on medRxiv