@Article{info:doi/10.2196/30089,
author="Greysen, S Ryan
and Waddell, Kimberly J
and Patel, Mitesh S",
title="Exploring Wearables to Focus on the ``Sweet Spot'' of Physical Activity and Sleep After Hospitalization: Secondary Analysis",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Apr",
day="27",
volume="10",
number="4",
pages="e30089",
keywords="sleep; physical activity; hospitalization; wearables; health care; digital health; patient reported outcomes; hospital",
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 Activit{\'e} 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://clinicaltrials.gov/ct2/show/NCT03321279 ",
issn="2291-5222",
doi="10.2196/30089",
url="https://mhealth.jmir.org/2022/4/e30089",
url="https://doi.org/10.2196/30089",
url="http://www.ncbi.nlm.nih.gov/pubmed/35476034"
}