The impact of COVID‐19 restrictions on accelerometer‐assessed physical activity and sleep in individuals with type 2 diabetes

Abstract

Aims: Restrictions during the COVID-19 crisis will have impacted on opportunities to be active. We aimed to (a) quantify the impact of COVID-19 restrictions on accelerometer-assessed physical activity and sleep in people with type 2 diabetes and (b) identify predictors of physical activity during COVID-19 restrictions. Methods: Participants were from the UK Chronotype of Patients with type 2 diabetes and Effect on Glycaemic Control (CODEC) observational study. Participants wore an accelerometer on their wrist for 8 days before and during COVID-19 restrictions. Accelerometer outcomes included the following: overall physical activity, moderate-to-vigorous physical activity (MVPA), time spent inactive, days/week with ≥30-minute continuous MVPA and sleep. Predictors of change in physical activity taken pre-COVID included the following: age, sex, ethnicity, body mass index (BMI), socio-economic status and medical history. Results: In all, 165 participants (age (mean±S.D = 64.2 ± 8.3 years, BMI=31.4 ± 5.4 kg/m 2 , 45% women) were included. During restrictions, overall physical activity was lower by 1.7 mg (~800 steps/day) and inactive time 21.9 minutes/day higher, but time in MVPA and sleep did not statistically significantly change.In contrast, the percentage of people with ≥1 day/week with ≥30-minute continuous MVPA was higher (34% cf. 24%). Consistent predictors of lower physical activity and/or higher inactive time were higher BMI and/or being a woman. Being older and/ or from ethnic minorities groups was associated with higher inactive time. Conclusions: Overall physical activity, but not MVPA, was lower in adults with type 2 diabetes during COVID-19 restrictions. Women and individuals who were heavier, older, inactive and/or from ethnic minority groups were most at risk of lower physical activity during restrictions.

COVID-19 and metabolic disease: mechanisms and clinical management

“…Overall, physical activity was lower in adults with type 2 diabetes during lockdown restrictions, particularly in women, older people, individuals with obesity, and minority ethnic populations. 106 Despite the expected negative impact of lockdown, retrospective analyses have not reported a worsening of glucose control due to lifestyle changes. 107

Current recommendations of metabolic disease management in a pandemic situation Encourage patients to restrict social contact to reduce risk of infection 97 Prioritise patients for vaccination 98 , 99 Encourage patients to incorporate a healthy lifestyle during lockdown and quarantine 22 Individual management: help patients to establish an individual set of self-management goals (eg, measurement rate, bodyweight, steps per day, waist circumference, blood pressure) and to adhere to these goals consistently 100 Digital support: help patients to make use of online education, virtual consultation, and digital health (eg, measurements of temperature, physical activity, bodyweight, waist circumference, and blood pressure, which will be digitally transferred to the physician) 101 Behavioural support: help patients to use digital stress management tools to increase resilience and stress resistance 102 Intensify foot care 103 Check for new diabetes 90 Manage cardiac risk 9 Encourage patients to adhere to lipid-lowering drugs 40 , 77 Monitor urinary excretion and oedema in patients with chronic kidney disease 12 Optimise metabolic and blood pressure control 101 Perform intensified glucose monitoring (eg, self-monitoring of blood glucose five times per day, flash and continuous glucose monitoring) to identify early deterioration of glycaemic condition and monitor blood pressure if hypertensive 101 Avoid grade 2 hypoglycaemia (2·2–3·0 mmol/L [40·0–55·0 mg/dL]) and grade 3 hypoglycaemia (1·7–2·2 mmol/L [30·0–40·0 mg/dL]) 104 Target ranges: 22 Fasting plasma glucose concentration: 4·0–8·0 mmol/L (72·0–144·0 mg/dL) Fasting plasma glucose concentration of patients in intensive care: 6·7–11·1 mmol/L (120·0–200·0 mg/dL) HbA 1c : <53·0 mmol/mol (7%)

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“…Overall, physical activity was lower in adults with type 2 diabetes during lockdown restrictions, particularly in women, older people, individuals with obesity, and minority ethnic populations. 106 Despite the expected negative impact of lockdown, retrospective analyses have not reported a worsening of glucose control due to lifestyle changes. 107 By contrast, it is evident that an endemic increase in excess weight and obesity in the global population, suggested to have caused more than a doubling of the number of people with type 2 diabetes over the past two decades, has now contributed to an excess of deaths due to COVID-19.…”

Physical Activity and Perceived Physical Fitness during the COVID-19 Epidemic: A Population of 40- to 69-Year-Olds in Japan

“…Lifestyle and health behavior including physical activity (PA) and dietary habits during the COVID-19 lockdown have been investigated [ 1 , 2 ]. The impact of the COVID-19 pandemic on dietary intake, PA, and sedentary behavior among different groups such as university students, elite para-athletes, community-dwelling older people, and patients with type 2 diabetes have been examined [ 1 , 3 , 4 , 5 ]. For instance, the COVID-19 state of emergency or lockdown has led to PA restrictions worldwide [ 6 ].…”

Physical activity and exercise in the management of type 2 diabetes: where to start?

“…The COVID‐19 pandemic has reminded us of the ongoing physical inactivity pandemic that should not be ignored 8 . There is evidence of an unprecedented drop in physical activity during lockdown in the general population 9 and those with T2D 10 . We believe that physical activity will be focused on more than ever due to links between obesity and COVID‐19, 11 motivated by the UK Prime Minister's ‘war against fat’ 12 and will predominantly be looking to solve the negative fall outs from COVID‐19.…”