Effect of a physical activity and sleep m-health intervention on a composite activity-sleep behaviour score and mental health: A mediation analysis of two randomised controlled trials

Background: To examine if a composite activity-sleep behaviour index (ASI) mediates the effects of a combined physical activity and sleep intervention on symptoms of depression, anxiety, or stress, quality of life (QOL), energy and fatigue in adults. Methods: This analysis used data pooled from two studies: Synergy and Refresh. Synergy: Physically inactive adults (18–65 years) who reported poor sleep quality were recruited for a two-arm Randomised Controlled Trial (RCT) (Physical Activity and Sleep Health (PAS; n = 80), or Wait-list Control (CON; n = 80) groups). Refresh: Physically inactive adults (40–65 years) who reported poor sleep quality were recruited for a three-arm RCT (PAS (n = 110), Sleep Health-Only (SO; n = 110) or CON (n = 55) groups). The SO group was omitted from this study. The PAS groups received a pedometer, and accessed a smartphone/tablet “app” using behaviour change strategies (e.g., self-monitoring, goal setting, action planning), with additional email/SMS support. The ASI score comprised self-reported moderate-to-vigorous-intensity physical activity, resistance training, sitting time, sleep duration, efficiency, quality and timing. Outcomes were assessed using DASS-21 (depression, anxiety, stress), SF-12 (QOL-physical, QOL-mental) and SF-36 (Energy & Fatigue). Assessments were conducted at baseline, 3 months (primary time-point), and 6 months. Mediation effects were examined using Structural Equation Modelling and the product of coefficients approach (AB), with significance set at 0.05. Results: At 3 months there were no direct intervention effects on mental health, QOL or energy and fatigue (all p > 0.05), and the intervention significantly improved the ASI (all p < 0.05). A more favourable ASI score was associated with improved symptoms of depression, anxiety, stress, QOL-mental and of energy and fatigue (all p < 0.05). The intervention effects on symptoms of depression ([AB; 95%CI] -0.31; − 0.60,-0.11), anxiety (− 0.11; − 0.27,-0.01), stress (− 0.37; − 0.65,-0.174), QOL-mental (0.53; 0.22, 1.01) and ratings of energy and fatigue (0.85; 0.33, 1.63) were mediated by ASI. At 6 months the magnitude of association was larger although the overall pattern of results remained similar. Conclusions: Improvements in the overall physical activity and sleep behaviours of adults partially mediated the intervention effects on mental health and quality of life outcomes. This highlights the potential benefit of improving the overall pattern of physical activity and sleep on these outcomes. Trial registration: Australian New Zealand Clinical Trial Registry: ACTRN12617000680369; ACTRN12617000376347. Universal Trial number: U1111–1194-2680; U1111–1186-6588. Human Research Ethics Committee Approval: H-2016-0267; H-2016–0181

Onset and progression of chronic disease and disability in a large cohort of older Australian women

Objective: To estimate the probability of onset and progression of disease and disability, length of life with or without disease and/or disability, and incidence of mortality, and to identify factors associated with transitioning to disease and/or disability over time. Study design: A prospective cohort study. Data were provided by 12,432 participants (born 1921–26) of the Australian Longitudinal Study of Women's Health linked with National Death Index data from 1996 (age: 70–75) to 2016 (age: 90–95). Main outcome measures: A five-state Markov model was fitted to estimate the transition probability, length of life with or without disease and/or disability, and the association between baseline characteristics and disease/disability/mortality risk. Results: Over two-thirds of women had died by age 90–95, and only 3.8% of these had died with no chronic disease and disability. Those reporting chronic disease were more likely to have experienced disability (Transition Rate Ratio: 2•72, 95%CI= 2•52–2•93) than those who died without disability. At age 70–75, the expected life without chronic disease and disability was 7•68 (95%CI: 7•52–7•80) years, life with chronic disease but no disability was 4•39 (95%CI=4•23–4•49) years, and life with disability was 3.76 (95%CI=3•66–3•92) years. The factors difficulties managing on available income (HR=1•18, 95%CI=1•02–1•38), did not complete secondary school (HR=1•19, 95%CI=1•03–1•37), and overweight/obese (HR=1•36, 95%CI=1•20–1•55) were associated with an increased risk of disability. Conclusions: Our findings provide important insights on the onset and progression of disease and disability in older women, underscoring the importance of addressing mid-/early old-life risk factors, managing chronic conditions, and delaying disability onset and progression through targeted intervention programs

Associations between app usage and behaviour change in a m-health intervention to improve physical activity and sleep health in adults: Secondary analyses from two randomised controlled trials

Background To examine associations between user engagement and activity-sleep patterns in a 12-week m-health behavioural intervention targeting physical activity and sleep. Methods This secondary analysis used data pooled from two Randomised Control Trials (RCT, [Synergy and Refresh]) that aimed to improve physical activity and sleep (PAS) among physically inactive adults with poor sleep. Both RCTs include a PAS intervention group (n = 190 [Synergy n = 80; Refresh n = 110]) and a wait list Control (CON n = 135 [Synergy n = 80; Refresh n = 55]). The PAS groups received a pedometer and accessed a smartphone/tablet “app” with behaviour change strategies, and email/SMS support. Activity-sleep patterns were quantified using the activity-sleep behaviour index (ASI) based on self-report measures. Intervention usage was quantified as a composite score of the frequency, intensity and duration of app usage during intervention (range: 0–30). Assessments were conducted at baseline, 3 and 6 months. Relationships between usage and ASI were examined using generalised linear models. Differences in ASI between the control group and intervention usage groups (Low [0–10.0], Mid [10.1–20.0], High [20.1–30.0]) were examined using generalised linear mixed models adjusted for baseline values of the outcome. Trial Registration: ACTRN12617000376347; ACTRN12617000680369. Results During the 3-month intervention, the mean (± sd) usage score was 18.9 ± 9.5. At 3 months (regression coefficient [95%CI]: 0.45 [0.22, 0.68]) and 6 months (0.48 [0.22, 0.74]) there was a weak association between usage score and ASI in the intervention group. At 3 months, ASI scores in the Mid (Mean [95%CI] = 57.51 [53.99, 61.04]) and High (60.09 [57.52, 62.67]) usage groups were significantly higher (better) than the control group (51.91 [49.58, 54.24]), but not the Low usage group (47.49 [41.87, 53.12]). Only differences between the high usage and control group remained at 6 months. Conclusion These findings suggests that while higher intervention usage is associated with improvements in behaviour, the weak magnitude of this association suggests that other factors are also likely to influence behaviour change in m-health interventions

Behavioural mediators of reduced energy intake in a physical activity, diet, and sleep behaviour weight loss intervention in adults

Reduced energy intake is a major driver of weight loss and evidence suggests that physical activity, dietary, and sleep behaviours interact to influence energy intake. Energy restriction can be challenging to sustain. Therefore to improve intervention efficacy, evaluation of how changes in physical activity, diet, and sleep behaviours mediate reduced energy intake in adults with overweight/obesity who participated in a six-month multiple-behaviour-change weight loss intervention was undertaken. This was a secondary analysis of a 3-arm randomised controlled trial. Adults with body mass index (BMI) 25-40 kg/m2 were randomised to either: a physical activity and diet intervention; physical activity, diet, and sleep intervention; or wait-list control. Physical activity, dietary intake, and sleep was measured at baseline and six-months using validated measures. The two intervention groups were pooled and compared to the control. Structural equation modelling was used to estimate the mediated effects (AB Coefficient) of the intervention on total energy intake. One hundred and sixteen adults (70% female, 44.5y, BMI 31.7 kg/m2) were enrolled and 70% (n = 81) completed the six-month assessment. The significant intervention effect on energy intake at six-months (-1011 kJ/day, 95% CI -1922, -101) was partially mediated by reduced fat intake (AB = -761.12, 95% CI -1564.25, -53.74) and reduced consumption of energy-dense, nutrient-poor foods (AB = -576.19, 95% CI -1189.23, -97.26). In this study, reducing fat intake and consumption of energy-dense, nutrient-poor foods was an effective strategy for reducing daily energy intake in adults with overweight/obesity at six-months. These strategies should be explicitly targeted in future weight loss interventions

Effect of fractional exhaled nitric oxide (F_ENO)-based asthma management during pregnancy versus usual care on infant development, temperament, sensory function and autism signs

Asthma during pregnancy is associated with a range of adverse perinatal outcomes. It is also linked to increased rates of neurodevelopmental conditions in the offspring. We aimed to assess whether fractional exhaled nitric oxide (FENO)-based asthma management during pregnancy improves child developmental and behavioural outcomes compared to usual care. The Breathing for Life Trial was a randomised controlled trial that compared FENO-based asthma management during pregnancy to usual care. Participants were invited to the developmental follow-up, the Breathing for Life Trial – Infant Development study, which followed up infants at 6 weeks, 6 months and 12 months. The primary outcomes were measured in infants at 12 months using the Bayley-III: Cognitive, Language and Motor composite scores. Secondary outcomes included Bayley-III social-emotional and adaptive behaviour scores, autism likelihood and sensory and temperament outcomes. The exposure of interest was the randomised intervention group. Two hundred and twenty-two infants and their 217 participating mothers were recruited to the follow-up; 107 mothers were in the intervention group and 113 were in the control group. There was no evidence of an intervention effect for the primary outcomes: Bayley-III cognitive (mean = 108.9 control, 108.5 intervention, p = 0.93), language (mean = 95.9 control, 95.6 intervention, p = 0.87) and motor composite scores (mean = 97.2 control, 97.9 intervention, p = 0.25). Mean scores for secondary outcomes were also similar among infants born to control and FENO group mothers, with few results reaching p < 0.05. Conclusion: In this sample, FENO-guided asthma treatment during pregnancy did not improve infant developmental outcomes in the first year of life. </p

The impact of the 2019/2020 Australian landscape fires on infant feeding and contaminants in breast milk in women with asthma

Background: The 2019/2020 Australian landscape fires (bushfires) resulted in prolonged extreme air pollution; little is known about the effects on breastfeeding women and their infants. This study aimed to examine the impact of prolonged landscape fires on infant feeding methods and assess the concentration of polycyclic aromatic hydrocarbons (PAHs) and elements in breast milk samples. Methods: From May – December 2020, women with asthma, who were feeding their infants during the fires, were recruited from an existing cohort. Data on infant feeding and maternal concern during the fires were retrospectively collected. Breast milk samples were collected from a sample of women during the fire period and compared with samples collected outside of the fire period for levels of 16 PAHs (gas chromatography coupled with mass spectrometry), and 20 elements (inductively coupled plasma-mass spectrometry). Results: One-hundred-and-two women who were feeding infants completed the survey, and 77 provided 92 breast milk samples. Two women reported concern about the impact of fire events on their infant feeding method, while four reported the events influenced their decision. PAHs were detected in 34% of samples collected during, versus no samples collected outside, the fire period (cross-sectional analysis); specifically, fluoranthene (median concentration 0.015 mg/kg) and pyrene (median concentration 0.008 mg/kg) were detected. Women whose samples contained fluoranthene and pyrene were exposed to higher levels of fire-related fine particulate matter and more fire days, versus women whose samples had no detectable fluoranthene and pyrene. Calcium, potassium, magnesium, sodium, sulphur, and copper were detected in all samples. No samples contained chromium, lead, nickel, barium, or aluminium. No statistically significant difference was observed in the concentration of elements between samples collected during the fire period versus outside the fire period. Conclusions: Few women had concerns about the impact of fire events on infant feeding. Detection of fluoranthene and pyrene in breast milk samples was more likely during the 2019/2020 Australian fire period; however, levels detected were much lower than levels expected to be related to adverse health outcomes

Using Genetics to Inform Interventions Related to Sodium and Potassium in Hypertension

BACKGROUND: Hypertension is a key risk factor for major adverse cardiovascular events but remains difficult to treat in many individuals. Dietary interventions are an effective approach to lower blood pressure (BP) but are not equally effective across all individuals. BP is heritable, and genetics may be a useful tool to overcome treatment response heterogeneity. We investigated whether the genetics of BP could be used to identify individuals with hypertension who may receive a particular benefit from lowering sodium intake and boosting potassium levels. METHODS: In this observational genetic study, we leveraged cross-sectional data from up to 296 475 genotyped individuals drawn from the UK Biobank cohort for whom BP and urinary electrolytes (sodium and potassium), biomarkers of sodium and potassium intake, were measured. Biologically directed genetic scores for BP were constructed specifically among pathways related to sodium and potassium biology (pharmagenic enrichment scores), as well as unannotated genome-wide scores (conventional polygenic scores). We then tested whether there was a gene-by-environment interaction between urinary electrolytes and these genetic scores on BP. RESULTS: Genetic risk and urinary electrolytes both independently correlated with BP. However, urinary sodium was associated with a larger BP increase among individuals with higher genetic risk in sodium- and potassium-related pathways than in those with comparatively lower genetic risk. For example, each SD in urinary sodium was associated with a 1.47-mm Hg increase in systolic BP for those in the top 10% of the distribution of genetic risk in sodium and potassium transport pathways versus a 0.97-mm Hg systolic BP increase in the lowest 10% (P=1.95×10-3). This interaction with urinary sodium remained when considering estimated glomerular filtration rate and indexing sodium to urinary creatinine. There was no strong evidence of an interaction between urinary sodium and a standard genome-wide polygenic score of BP. CONCLUSIONS: The data suggest that genetic risk in sodium and potassium pathways could be used in a precision medicine model to direct interventions more specifically in the management of hypertension. Intervention studies are warranted.</p

The impact of prolonged landscape fire smoke exposure on women with asthma in Australia

Background: Little is known about the physical and mental health impact of exposure to landscape fire smoke in women with asthma. This study examined the health impacts and information-seeking behaviours of women with asthma exposed to the 2019/2020 Australian fires, including women who were pregnant. Methods: Women with asthma were recruited from the Breathing for Life Trial in Australia. Following the landscape fire exposure period, self-reported data were collected regarding symptoms (respiratory and non-respiratory), asthma exacerbations, wellbeing, quality of life, information seeking, and landscape fire smoke exposure mitigation strategies. Participants’ primary residential location and fixed site monitoring was used to geolocate and estimate exposure to landscape fire-related fine Particulate Matter (PM2.5). Results: The survey was completed by 81 pregnant, 70 breastfeeding and 232 non-pregnant and non-breastfeeding women with asthma. Participants had a median daily average of 17 μg/m3 PM2.5 and 105 μg/m3 peak PM2.5 exposure over the fire period (October 2019 to February 2020). Over 80% of participants reported non-respiratory and respiratory symptoms during the fire period and 41% reported persistent symptoms. Over 82% reported asthma symptoms and exacerbations of asthma during the fire period. Half the participants sought advice from a health professional for their symptoms. Most (97%) kept windows/doors shut when inside and 94% stayed indoors to minimise exposure to landscape fire smoke. Over two in five (43%) participants reported that their capacity to participate in usual activities was reduced due to prolonged smoke exposure during the fire period. Participants reported greater anxiety during the fire period than after the fire period (mean (SD) = 53(13) versus 39 (13); p < 0.001). Two in five (38%) pregnant participants reported having concerns about the effect of fire events on their pregnancy. Conclusion: Prolonged landscape fire smoke exposure during the 2019/2020 Australian fire period had a significant impact on the health and wellbeing of women with asthma, including pregnant women with asthma. This was despite most women taking actions to minimise exposure to landscape fire smoke. Effective and consistent public health messaging is needed during landscape fire events to guard the health of women with asthma

Time-efficient intervention to improve older adolescents' cardiorespiratory fitness: Findings from the a € Burn 2 Learn' cluster randomised controlled trial

Background Cardiorespiratory fitness (CRF) is an important marker of current and future health status. The primary aim of our study was to evaluate the impact of a time-efficient school-based intervention on older adolescents' CRF. Methods Two-arm cluster randomised controlled trial conducted in two cohorts (February 2018 to February 2019 and February 2019 to February 2020) in New South Wales, Australia. Participants (N=670, 44.6% women, 16.0±0.43 years) from 20 secondary schools: 10 schools (337 participants) were randomised to the Burn 2 Learn (B2L) intervention and 10 schools (333 participants) to the control. Teachers in schools allocated to the B2L intervention were provided with training, resources, and support to facilitate the delivery of high-intensity interval training (HIIT) activity breaks during curriculum time. Teachers and students in the control group continued their usual practice. The primary outcome was CRF (20 m multi-stage fitness test). Secondary outcomes were muscular fitness, physical activity, hair cortisol concentrations, mental health and cognitive function. Outcomes were assessed at baseline, 6 months (primary end-point) and 12 months. Effects were estimated using mixed models accounting for clustering. Results We observed a group-by-time effect for CRF (difference=4.1 laps, 95% CI 1.8 to 6.4) at the primary end-point (6 months), but not at 12 months. At 6 months, group-by-time effects were found for muscular fitness, steps during school hours and cortisol. Conclusions Implementing HIIT during curricular time improved adolescents' CRF and several secondary outcomes. Our findings suggest B2L is unlikely to be an effective approach unless teachers embed sessions within the school day. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12618000293268)

‘Breathing Fire’: Impact of Prolonged Bushfire Smoke Exposure in People with Severe Asthma

Wildfires are increasing and cause health effects. The immediate and ongoing health impacts of prolonged wildfire smoke exposure in severe asthma are unknown. This longitudinal study examined the experiences and health impacts of prolonged wildfire (bushfire) smoke exposure in adults with severe asthma during the 2019/2020 Australian bushfire period. Participants from East-ern/Southern Australia who had previously enrolled in an asthma registry completed a questionnaire survey regarding symptoms, asthma attacks, quality of life and smoke exposure mitigation during the bushfires and in the months following exposure. Daily individualized exposure to bush-fire particulate matter (PM2.5) was estimated by geolocation and validated modelling. Respondents (n = 240) had a median age of 63 years, 60% were female and 92% had severe asthma. They experienced prolonged intense PM2.5 exposure (mean PM2.5 32.5μg/m3 on 55 bushfire days). Most (83%) of the participants experienced symptoms during the bushfire period, including: breathlessness (57%); wheeze/whistling chest (53%); and cough (50%). A total of 44% required oral corticosteroid treatment for an asthma attack and 65% reported reduced capacity to participate in usual activities. About half of the participants received information/advice regarding asthma management (45%) and smoke exposure minimization strategies (52%). Most of the participants stayed indoors (88%) and kept the windows/doors shut when inside (93%), but this did not clearly mitigate the symptoms. Following the bushfire period, 65% of the participants reported persistent asthma symptoms. Monoclonal antibody use for asthma was associated with a reduced risk of persistent symptoms. Intense and prolonged PM2.5 exposure during the 2019/2020 bushfires was associated with acute and persistent symptoms among people with severe asthma. There are opportunities to improve the exposure mitigation strategies and communicate these to people with severe asthma