Live Research Spotlight 12: Sleep, Quality of Life, & Physical Health

Introduction: Older adults spend the majority of their day engaging in sedentary behaviors, particularly after surgeries or health events. Independent of activity, excess sedentary time has negative health consequences; Thus, we developed a novel 2-month mHealth sedentary reduction program and evaluated its effects on sedentary behavior in older adults with knee replacement.
Methods: Older adults with knee replacement ≤1 year ago with a smartphone who self-reported spending ≥7 hours/day sitting were randomized to either an mHealth sedentary reduction program (NEAT!2) or an attention control group. NEAT!2 was guided by the Dual-Process Theory and targeted both automatic (implicit) and controlled (conscious) processes. NEAT!2 participants received an app that triggers notifications to stand up after ≥20 min of inactivity as well as 5 coaching calls which included goal setting and problem-solving around reducing sedentary time. The Control group received an app focused on knee replacement pre- and post-operative and 5 coaching calls discussing topics not related to sedentary behavior or physical activity. Multiple linear regression models with GEE adjusted for covariates were used to examine differences and changes in outcomes between groups including objectively-measured sedentary time and physical activity (ActiGraph and activPAL monitors), physical function (6-min walk test, timed up and go, chair stands), and WOMAC pain were assessed at baseline, 2-, and 5 months.
Results: A total of 83 participants were randomized (65.3±9.4 years, 32.7±6.9 kg/m2, 75% female, 77% White) and 98% and 85% of participants completed the 2- and 5-month assessments, respectively. Participants completed 4.8±0.7 calls (out of 5), with no differences between groups. NEAT!2 participants received an average of 10.3±6.1 notifications/day. At baseline, participants spent 73.7±6.8% of waking time in sedentary behavior and 65.2±79.8 min/week in moderate-vigorous activity. There were no group x time differences in sedentary time, physical activity, physical function, or pain at 2- or 5-months.
Conclusions: A brief mHealth sedentary reduction program was not effective at reducing sedentary time among older adults within 1 year of knee replacement. Given this population spends the majority of their day in sedentary behaviors, it is critical to explore individual variability in response as well as develop more intensive programs to determine the optimal way to reduce sedentary time.

Author - Christine Pellegrini, PhD, FSBM, PhD, FSBM,
University of South Carolina

Co-Author - Sara Wilcox, PhD, FSBM, PhD, FSBM,
University of South Carolina

Co-Author - Jungwha Lee, PhD,
Northwestern University

Co-Author - Katherine E. DeVivo,
University of South Carolina

Co-Author - Jeffrey Hopkins, MD,
Prisma Health

Co-Author - Scott Jamieson,
University of South Carolina

Co-Author - Kailyn Horn,
University of South Carolina

Despite long-standing disparities in symptom burden due to structural barriers and racism, Black and Latina Breast Cancer Survivors (BCS) persistently have worse physical health than White BCS. Integrative care approaches (e.g., yoga, aerobic training) help BCS manage symptoms to improve physical functioning. Yet, barriers remain to wide-spread adoption of these approaches. Self-administered acupressure (SA), is a low-cost, low-intensity, time flexible, and safe method of managing symptoms that could improve physical functioning for Black and Latina BCS.
We conducted a pilot Randomized-Controlled Trial (RCT) of a culturally adapted SA training video in English and Spanish. BCS diagnosed at stage 0-IV with limited physical functioning at baseline were randomized 2:1 to either the SA intervention or Usual Care (UC, a BCS fact sheet). The SA group learned SA for three acupoints daily (6 mins total) in an educational video and live training. We enrolled 47 BCS of whom 34 completed baseline (T0) and an 8 week follow-up (T1; 18 Black, 16 Latina; age Mean [M] = 54.55; 72.35% retention; n=21 in SA, n=13 in UC). The PROMIS 6-item short form assessed physical functioning. Preliminary analysis of SA impact on physical functioning was assessed with between and within group t-tests. We also explored whether the SA impact differed between BCS with high (at least 75% of days practiced) and low engagement in SA as documented by daily logs.
The SA group and UC group’s demographics and baseline physical functioning did not significantly differ, but SA experienced more symptoms (M=20) at baseline than UC (M=13). However, the SA group (mean difference; MD=1.90, p=0.07) improved their physical functioning from T0 to T1 slightly more than the UC group (MD=1.07, p=0.19). The improvement between the two groups was not significantly different. Within the SA group, the 13 BCS (62%) with high SA engagement (vs. 8 low) had clinically significant increases in physical functioning (MD=3.37) relative to low engagement (MD=-0.50).
This pilot RCT demonstrated the initial feasibility of SA for Black and Latina BCS who engaged in SA practice. The limited difference between SA and UC in physical functioning may have been impacted by 38% of the SA group having low SA engagement in practice, highlighting a need for targeting engagement in future trials. We are currently conducting interviews with BCS to gather feedback about maximizing engagement in a future RCT.

Author - Katarina E. AuBuchon, PhD, PhD,
Georgetown Lombardi Comprehensive Cancer Center

Co-Author - Kristi D. Graves, PhD, FSBM, PhD, FSBM,
Georgetown University

Co-Author - Suzanne Danhauer, MD,
Wake Forest University School of Medicine

Co-Author - Jae Eun Chung, PhD,
Howard University

Co-Author - Emily Cramer, PhD, PhD,
Howard University

Co-Author - Lourdes Inbar-Albo, MA,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Amrita Bonthu, BA, MA,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Ella Lowry,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Carla Arieta,
Effective Integrative Healthcare

Co-Author - Dingyue Yang,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Jacqueline Chen,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Sophia Urdinola,
Georgetown Lombardi Comprehensive Cancer

Co-Author - Claudacia Clemmons,
Georgetown Lombardi Comprehensive Cancer

Background: Many mind-body therapies have been evaluated in people living with cancer for managing symptoms and side effects; however, few have been tested head-to-head in comparative effectiveness designs to determine differential efficacy. This study is the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors (Mindfulness-Based Cancer Recovery [MBCR] and Taichi/Qigong [TCQ]).

Methods: The design was a pragmatic preference-based multi-site randomized comparative effectiveness trial. Participants with a preference for either MBCR or TCQ received their preferred intervention, while those without a preference were randomized into either program. Further, within the preference and nonpreference groups, participants were randomized 2:1 into immediate intervention or wait-list control. Group interventions were delivered in-person in cohorts of up to 20 participants, over 9-11 weeks. Profile of Mood States (POMS) Total Mood Disturbance (TMD) scores post-intervention were the primary outcome, with 6 POMS subscales also investigated.

Results: 587 participants were enrolled, 75% females. Average age was 60.7 years, with 12 different cancer types represented. Half were diagnosed at stage I - II (50.1%), 64% had a preference, of TCQ (213; 57% of those with a preference) and MBCR (163; 43%), and the remaining 36% with no preference were randomized equally to either program. Both randomized MBCR (p=0.0173) and TCQ (p=0.0135) groups showed significantly more improvement on the POMS TMD scores than their respective waitlists, but the preference groups did not. Both MBCR and TCQ (whether randomized or chosen) significantly reduced the subscale of anger, only TCQ reduced depression and improved vigor, only MBCR improved tension-anxiety, and neither intervention significantly reduced confusion or fatigue subscales. Effect sizes were small to medium.

Conclusions: Both active interventions improved overall mood disturbance compared to control in this large, broad pragmatic sample of cancer survivors, and the role of program preference was minor. MBCR was more effective for reducing anxiety, while TCQ was more effective for depression and vigor. A wide range of secondary outcomes and biomarker data has yet to be reported, which will further characterize the differential effects of these two therapies.

Co-Author - Jennifer Jones, PhD,
University Health Network/University of Toronto

Co-Author - Devesh Oberoi, MD PhD,
University of Calgary

Co-Author - Katherine-Ann Piedalue, BSc,
Memorial University

Co-Author - Peter Wayne, PhD,
Harvard University

Co-Author - Oluwaseyi Lawal, PhD,
University of Calgary

Life satisfaction (LS) is increasingly recognized as a crucial indicator and predictor of health and well-being across the lifespan. The impact of LS may be enhanced through physical activity (PA), although studies exploring the dynamic and bi-directional nature of the relationship are scarce. One principal goal of this project is to examine the interactions between LS and PA and other factors such as air quality. We used data from a 12-month prospective cohort study (N = 1314, mean age = 38.1 (12.56); range 18-65) with four 2-week intensive measurement bursts to evaluate the bi-directional relationship between PA and LS and explore whether exercise identity (EXID) moderates this relationship. The sample included both active (runners) (n = 747, 57%) and inactive (n = 567, 43%) individuals living in geographic areas with random disturbances in VAR levels of air pollution. The data comprised ecological momentary assessments (EMAs) of LS using smartphones and daily per-hour average step count assessed by Fitbit Charge 3 or 4 in four 2-week measurement bursts. To explore the relationship between LS and PA we used a dynamic Bayesian model based on an extension of vector autoregressive model (VAR; Lütkepohl, 2005) to model both lagged and contemporaneous associations between LS and PA. The model was developed to allow for adjustment to the 4-wave design, separation of between- and within-individual covariate effects as well as EXID covariate effect upon contemporaneous correlation (i.e., upon correlation of the random disturbances in VAR). The model also adjusted for seasonality effects as well as education, socio-economic status, age, and gender. The results demonstrated autoregressive effects for both LS (β = 0.394, p = 0.001) and PA (β = 0.316, p = 0.001), and a within-person contemporaneous association between LS and PA (β = 0.087, p < 0.001) that was influenced by EXID (β = 0.011, p < 001). This indicates that the relationship between LS and PA may be stronger when exercise is a core part of one’s identity. It remains to be determined whether nurturing exercise identity may lead to greater enhancement of LS through PA.

Author - Steriani Elavsky, PhD, PhD,
University of Ostrava

Co-Presenter - Marek Brabec, PhD,
Institute of Computer Science, The Czech Academy of Sciences

Co-Author - Lenka Knapova,
University of Ostrava

Co-Author - Barbora Kastovska,
University of Ostrava

Co-Author - Michal Sebera,
University of Ostrava

Co-Author - Vera Kristyna Jandackova,
University of Ostrava

Co-Author - Misha Pavel, BS, MSEE, Ph.D., BS, MSEE, Ph.D.,
Northeastern University

Background: Prior research has linked increased insomnia symptoms with cognitive decline among older adults, but few have explored the diverse trajectories of insomnia symptoms over time among older adults and their associations with cognitive changes. Individuals with subjective cognitive decline (SCD) are at higher risks for objective cognitive impairment, making it crucial to identify modifiable factors, such as insomnia symptoms, that could prevent cognitive decline in this population. This study aimed to identify the heterogeneous trajectories of insomnia symptoms in older adults with SCD and to examine their associations with a 10-year cognitive trajectory.

Methods: Data from six waves of the Health and Retirement Study (2010–2020) were analyzed. The study sample included 1,376 community-dwelling older adults aged 50 and above who had SCD at baseline and at least three waves of cognitive performance data. SCD was determined by self-reperceived memory decline without objective cognitive impairment (Modified Telephone Interview for Cognitive Status [TICS-M]>11) and no diagnosis of Alzheimer’s disease or dementia. Growth mixture modeling was used to identify classes of trajectories of insomnia symptoms based on the count of four symptoms from the Jenkins Sleep Scale. A multi-level modeling then examined the association between insomnia trajectory classes and cognitive performance (TICS-M scores) over the 10-year period, adjusting for sociodemographic and health-related variables.

Results: Four distinct insomnia symptom trajectories were identified among older adults with SCD: Minimal Insomnia Symptoms–Stable (76.1%); Low Insomnia Symptoms–Increasing (10.8%); Moderate Insomnia Symptoms–Decreasing (8.0%); and High Insomnia Symptoms–Stable (5.1%). The multi-level model revealed that older adults with SCD in the "Low Insomnia Symptoms–Increasing" class experienced a significantly faster rate of cognitive decline compared to those in the " Minimal Insomnia Symptoms–Stable" class (estimate = -0.25, 95%CI = -0.38, -0.12).

Conclusion: Increasing insomnia symptoms over time may be associated with faster cognitive decline. The importance of monitoring insomnia symptoms was highlighted in older adults with SCD. Early evaluation and intervention of insomnia symptoms may potentially mitigate cognitive decline in this at-risk population.

Presenter - Jing Huang, MPhil,
Johns Hopkins University School of Nursing

Co-Author - Nancy A. Perrin, PhD,
Johns Hopkins University School of Nursing

Co-Author - Chakra Budhathoki, PhD,
Johns Hopkins University School of Nursing

Co-Author - Sarah L. Szanton, PhD,
Johns Hopkins University School of Nursing

Co-Author - Junxin Li, PhD,
Johns Hopkins University School of Nursing

Background:
A growing evidence base is recognizing the deleterious effects of discrimination experiences on sleep health. Our study explores how experiences of discrimination related to one’s sexual identity is associated with global sleep health indicators in a sample of older sexual minority men living in New York City. We hypothesized that greater discrimination scores on the Everyday Discrimination Scale (adapted for sexual identity discrimination) would be associated with worse scores on sleep health.
Method:
Utilizing baseline data from an observational study, our 82 participants were NYC-based, older (50+) sexual minority men living with HIV. Measures included: the 10-item Everyday Discrimination Scale adapted to assess experiences in day-to-life of being treated badly or unfairly due to sexual identity status, and the Pittsburgh Sleep Quality Index administered in-office via an online Qualtrics survey. Multiple linear regressions, adjusting for age and race/ethnicity (dichotomized as Black/Latino or White) tested the association between discrimination and each of the PSQI’s sleep components: sleep quality, duration, latency, efficiency, disturbance, and daytime dysfunction.
Results:
Bivariate correlations showed significant associations between greater discrimination and two of the sleep components: greater sleep disturbance (r=.23, p= .037) and daytime dysfunction (r=.30, p= .006). In multivariable analyses adjusting for age and for race/ethnicity, greater discrimination was associated with greater sleep disturbance (B=0.02, p=.026), and with worse daytime dysfunction due to tiredness (B=0.03, p=.003).
Discussion:
We found that everyday experiences of sexual identity-related discrimination linked to greater past-month sleep disturbance and daytime dysfunction due to tiredness in a sample of older SMM living with HIV. This highlights the increasingly recognized negative impact of discrimination and stigma on sleep health, the sequalae of which include poorer immune functioning, poorer cardiovascular health, and poorer mental health, in an already vulnerable population. Reducing societal discrimination related to sexual identity has vital importance for improving and maintaining the health of sexual minority individuals more broadly. This contributes to the growing evidence base highlighting discrimination as a biopsychosocial hazard.

Co-Author - Carly Wolfer, MA,
Graduate Center of City University of New York (CUNY)

Co-Author - Patrick George, III, MSSR,
Albert Einstein College of Medicine

Co-Author - Hannah (Hyejin) Park, MSc,
Rutgers University

Co-Author - K. Marie Sizemore, PhD,
Rutgers University / Robert Wood Johnson Medical School

Co-Author - Devin English, PhD, PhD,
Rutgers University