Novel digital health technologies

Research and innovation projects being undertaken include:

• Device-measured physical activity, sedentary behaviour, and sleep
• Wearables and nearables sensors development and validation
• Health and Fitness Apps (development, evaluation, and validation)
• Digital Health (e.g., mHealth; eHealth; uHealth; telehealth)
• Fit-Tech
• Insurtech (i.e., projects with a Health & Fitness focus)
• Physiological Sensing (vital signs sensing e.g., ECG, heart rate (electrical, optical, ballistocardiography), sleep architecture, hearing, stress, blood pressure, breathing rate/depth, EMG, CGM, etc)
• Context/Location Sensing (indoor/outdoor sensing via GPS, RTLS, Bluetooth beacons, etc)

Snacktivity

An alternative whole day approach to PA that could engage and motivate the public to be more physically active is a concept we have called Snacktivity. Rather than focusing on encouraging 150-mins per week of PA (e.g., 30mins/day x 5 days), snacktivity focuses on promoting small, but frequent, doses of regular MVPA throughout the day, between 2-5-mins, e.g., walk-talk conversations, walking coffee breaks, using stairs not the lift, etc.

Technology is now available to provide real time/objective feedback on PA, so paper-based methods are now redundant. We therefore plan to use a smartphone application (snackapp) synchronised with a wrist worn PA tracker with the specific aim of facilitating self-monitoring of snacktivity and offering feedback on behaviour.

The findings will provide policy makers and commissioners with robust evidence regarding the effectiveness and value for money of an alternative approach to promoting PA in the population.

• Gokal K, Amos-Hirst R, Moakes CA, Sanders JP, Esliger DW, Sherar LB, et al. Views of the public about Snacktivity™: a small changes approach to promoting physical activity and reducing sedentary behaviour. BMC Public Health 22, 618 (2022). DOI: 10.1186/s12889-022-13050-x
• NIHR Programme Grant (Daley, Esliger, Sherar) £2,212,005: Snacktivity to promote physical activity and reduce future risk of disease in the population. Award ID: RP-PG-0618-20008

Predicting readmission following an acute exacerbation of COPD

The use of vital signs monitoring in the early recognition of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) post-hospital discharge is limited. This study investigated whether continuous vital signs monitoring could predict an AECOPD and readmission.

The study found that increased heart rate and reduced physical activity were associated with worsening symptoms. Even with high-resolution data, the variation in vital signs data remains a challenge for predicting AECOPDs. Respiratory rate and heart rate should be further explored as potential predictors of an impending AECOPD.

• Hawthorne G, Richardson M, Greening NJ, Esliger DW, et al. A proof of concept for continuous, non-invasive, free-living vital signs monitoring to predict readmission following an acute exacerbation of COPD: a prospective cohort study. Respir Res 23, 102 (2022). DOI: 10.1186/s12931-022-02018-5
• Kingsnorth AP, Rowlands AV, Maylor BD, Sherar LB, Steiner MC, Morgan MD, Singh SJ, Esliger DW, Orme MW. A More Intense Examination of the Intensity of Physical Activity in People Living with Chronic Obstructive Pulmonary Disease: Insights from Threshold-Free Markers of Activity Intensity. International Journal of Environmental Research and Public Health. 2022; 19(19):12355. DOI: 10.3390/ijerph191912355

Body mass index across adulthood and the development of airflow obstruction and emphysema

Low body mass index (BMI) is associated with COPD, but temporal relationships between airflow obstruction (AO) development and emphysematous change are unclear. We investigated longitudinal changes in BMI, AO, and lung density throughout adulthood using data from the Framingham Offspring Cohort (FOC).

This study found that Mean BMI is lower throughout adulthood in AO and LLD participants. Lower BMI is associated with a steeper decline in the ratio of FEV1/FVC. These findings suggest body mass may precede and potentially have a role in the development of COPD lung pathophysiology.

• Trethewey RE, Spartano NL, Vasan RS, Larson MG, O’Connor GT, Esliger DW, Petherick ES, Steiner MC. Body mass index across adulthood and the development of airflow obstruction and emphysema. Chronic Respiratory Disease. 2022;19. DOI:10.1177/14799731221139294

A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes

Mobile health technologies have advanced to now allow monitoring of the acute physiological responses to lifestyle behaviours. This research aimed to explore how people engaged with real-time feedback on their physical activity and glucose levels over several weeks.

Findings demonstrate that accessing behavioural and physiological feedback can increase self-awareness of how lifestyle impacts short-term health. Some participants noticed a link between the feedback presented by the two devices and changed their behaviour but many did not. Training and educational support, as well as efforts to optimize how feedback is presented to users, are needed to sustain engagement and behaviour change. Extensions of this work to involve people with diabetes are also warranted to explore whether behavioural and physiological feedback in parallel can encourage better diabetes self-management.

• Whelan ME, Denton F, Bourne CLA, Kingsnorth AP, Sherar LB, Orme MW, Esliger DW. A digital lifestyle behaviour change intervention for the prevention of type 2 diabetes: a qualitative study exploring intuitive engagement with real-time glucose and physical activity feedback. BMC Public Health 21, 130 (2021). DOI: 10.1186/s12889-020-09740-z

Digital health technology for soldier training musculoskeletal injury prevention

Ministry of Defence, Defence Science and Technology Laboratory (Esliger, Sanderson, Brooke-Wavell) £99,853: Wearable and nearable digital health technology for soldier training musculoskeletal injury prevention [2019].  This work contributes directly to the development of a systems map of potential correlates that may initiate musculoskeletal injury in military personnel.  This funding was part of a DASA Wearable technology for injury prevention call https://www.gov.uk/government/publications/competition-wearable-technology-for-injury-prevention/competition-document-wearable-technology-for-injury-prevention.

Sedentary behaviour in older adults

MRC Lifelong Health and Wellbeing (Esliger, Biddle) £853,099: Sedentary behaviour in older adults: Investigating a New Therapeutic Paradigm https://gtr.ukri.org/projects?ref=MR%2FK025090%2F1 [2013-17].  This grant focuses on investigating the impact of sitting in older adults. This research will inform larger studies and public health initiatives aimed at reducing sitting time in the future.