The impacts of social restrictions during the COVID-19 pandemic on the physical activity levels of over 50-year olds: the CHARIOT COVID-19 Rapid Response (CCRR) cohort study (preprint)

Objectives To quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic. Methods Demographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between baseline shielding status, loneliness, and time-varying PA. Results Participants who felt "often lonely" at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week (95% CI: -809, -236, p<0.001) (95% CI: -818, -275, p<0.001) than those who felt "never lonely" in univariable and multivariable models adjusted for demographic factors respectively. Those who felt "sometimes lonely" completed 112 fewer MET minutes/week (95% CI: -219, -5, p=0.041) than those who felt "never lonely" following adjustment for demographic factors. Participants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/week than those who were not (95% CI: -432, -273; p<0.001) in univariable models and 228 fewer MET minutes/week (95% CI: -307, -150, p<0.001) following adjustment for demographic factors. No significant associations were found after further adjustment for health and lifestyle factors. Conclusions Those shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status.

Associations of Health, Lifestyle and Psycho-Social Factors With Sleep Quality During the Early Phase of the COVID-19 Pandemic: A Focus on UK Older Adults Deemed Clinically Extremely Vulnerable (preprint)

Background: Sleep quality is crucial for health and wellbeing in all ages and sleep abnormalities may contribute to multimorbidity in older adults. The impact of pandemic-related disruptions to sleep quality in older adults, particularly those deemed “clinically extremely vulnerable” to COVID-19-related complications (COVID-19CEV) remains unknown.Methods: In this cross-sectional study, conducted during the first UK lockdown (April- June 2020), we surveyed 5558 adults aged 50 years and over (of whom 523 met criteria for COVID-19CEV) with assessments of sleep quality, health/medical, lifestyle, psychosocial and sociodemographic factors. We identified associations between these factors and sleep quality and explored interactions of COVID-19CEV status with factors significantly associated with sleep quality to identify potential moderating variables.Findings: 37% of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included, among health/medical factors: COVID-19CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders; .and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. r Moderators of the COVID-19CEV status - sleep quality relationship included marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep quality. Interpretation: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct health/medical, lifestyle and psychosocial factors. Male and female older adults with COVID-19CEV status may benefit from targeted mental health and dietary interventions, respectively. Results inform tailored interventions and policy for older adults deemed COVID-19CEV. Funding Information: This study was sponsored by Imperial College London and partly funded by the ICHT BRC.Declaration of Interests: Dr. Middleton reports clinical trial grants from Janssen R&D, Novartis and Takeda outside the submitted work. All authors declare no competing interests related to this study.Ethics Approval Statement: Data collected as in this study are anonymized and kept strictlyconfidential in accordance with the UK General Data Protection Regulations (2016). The CCRR study was ethically approved by the Imperial College London Joint Research Compliance Office (20IC5942) and by the Health Research Authority (16/EM/0213).

The impact of social restrictions during the COVID-19 pandemic on the physical activity levels of older adults: a baseline analysis of the CHARIOT COVID-19 Rapid Response prospective cohort study (preprint)

Objectives Physical inactivity is more common in older adults, is associated with social isolation and loneliness, and contributes to increased morbidity and mortality. We examined the effect of social restrictions, implemented to reduce transmission of COVID-19 in the UK (lockdown), on physical activity (PA) levels of older adults, and the demographic, lifestyle and social predictors of this change. Design Baseline analysis of a survey-based prospective cohort study Setting Adults enrolled in the Cognitive Health in Ageing Register for Investigational and Observational Trials (CHARIOT) cohort from GP practices in North West London were invited to participate from April to July 2020. Participants 6,219 cognitively healthy adults aged 50 to 92 years completed the survey. Main outcome measures Self-reported PA before and after lockdown, as measured by Metabolic Equivalent of Task (MET) minutes. Associations of PA with demographic, lifestyle and social factors, mood and frailty. Results Mean PA was significantly lower following lockdown, from 3,519 MET minutes/week to 3,185 MET minutes/week (p<0.001). After adjustment for confounders and pre-lockdown PA, lower levels of PA after lockdown were found in those who were over 85 years old (640 [95% CI: 246 to 1034] MET minutes/week less); were divorced or single (240 [95% CI: 120 to 360] MET minutes/week less); living alone (277 [95% CI: 152 to 402] MET minutes/week less); reported feeling lonely often (306 [95% CI: 60 to 552] MET minutes/week less); and showed symptoms of depression (1007 [95% CI: 1401 to 612] MET minutes/week less) compared to those aged 50-64 years, married, co-habiting, and not reporting loneliness or depression, respectively. Conclusions and Implications Markers of social isolation, loneliness and depression were associated with lower PA following lockdown in the UK. Interventions to improve PA in older adults should take account of social and community factors, and targeted strategies to increase physical activity in socially isolated, lonely and depressed older adults should be considered.