Alex Rowlands

University of Leicester | LE · Diabetes Research Centre; NIHR Leicester Biomedical Research Centre - Lifestyle Theme

Purpose: Commonly used physical activity metrics tell us little about the intensity distribution across the activity profile. The purpose of this paper is to introduce a metric, the intensity gradient, which can be used in combination with average acceleration (overall activity level) to fully describe the activity profile. Methods: 1669 adolesc...

The lack of consensus on meaningful and interpretable physical activity outcomes from accelerometer data hampers comparison across studies. Cut-point analyses are simple to apply and easy to interpret but can lead to results that are not comparable. We propose that the optimal accelerometer metrics for data analysis are not the same as the optimal...

Purpose: High-impact physical activity is associated with bone health, but higher volumes of lower intensity activity may also be important. The aims of this study were to: 1) investigate the relative importance of volume and intensity of physical activity accumulated during late adolescence for bone health at age 23; and 2) illustrate interpretat...

Objectives: To determine whether quantifying both the absolute and relative intensity of accelerometer-assessed physical activity (PA) can inform PA interventions. We hypothesised that individuals whose free-living PA is at a low relative intensity are more likely to increase PA in response to an intervention, as they have spare physical capacity....

Background Physical frailty is associated with increased mortality in patients with end-stage liver disease (ESLD). Even though physical activity (PA) is recommended in ESLD, a lack of understanding of habitual patterns of PA (especially volume, intensity) and their relationship with physical frailty, limits healthcare professionals to generic NHS...

Purpose: Accelerometer-assessed physical activity (PA) can be summarised using cut-point-free or population-specific cut-point-based outcomes. We aimed to: 1) examine the interrelationship between cut-point-free (intensity gradient [IG] and average acceleration [AvAcc]) and cut-point-based accelerometer metrics, 2) compare the association between c...

Citation: Katsarova, S.S.; Redman, E.; Arsenyadis, F.; Brady, E.M.; Rowlands, A.V.; Edwardson, C.L.; Goff, L.M.; Khunti, K.; Yates, T.; Hall, A.P.; et al. Differences in Dietary Intake, Eating Occasion Timings and Eating Windows between Chronotypes in Adults Living with Type 2 Diabetes Mellitus. Nutrients 2023, 15, 3868. https://doi. Abstract: Chro...

Physical activity is increasingly being captured by accelerometers worn on different body locations. The aim of this study was to examine the associations between physical activity volume (average acceleration), intensity (intensity gradient) and cardiometabolic health when assessed by a thigh-worn and wrist-worn accelerometer. A sample of 659 offi...

Sleep is essential to life. Accurate measurement and classification of sleep/wake and sleep stages is important in clinical studies for sleep disorder diagnoses and in the interpretation of data from consumer devices for monitoring physical and mental well-being. Existing non-polysomnography sleep classification techniques mainly rely on heuristic...

Background: Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a >2.2°c difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); and (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting...

Background Sleep is essential to life. Accurate measurement and classification of sleep/wake and sleep stages is important in clinical studies for sleep disorder diagnoses and in the interpretation of data from consumer devices for monitoring physical and mental well-being. Existing non-polysomnography sleep classification techniques mainly rely on...

Aim This study was aimed to: (1) compare raw triaxial acceleration data from GENEActiv (GA) and ActiGraph GT3X+ (AG) placed on the non‐dominant wrist; (2) compare AG placed on the non‐dominant and dominant wrist, and waist; (3) derive brand‐ and placement‐specific absolute intensity thresholds for inactive and sedentary time, and physical activity...

High physical activity levels during wake are beneficial for health, while high movement levels during sleep are detrimental to health. Our aim was to compare the associations of accelerometer-assessed physical activity and sleep disruption with adiposity and fitness using standardized and individualized wake and sleep windows. People (N = 609) wit...

Aim: To quantify differences in device-measured physical activity (PA) behaviours, and physical function (PF), in people with type 2 diabetes mellitus (T2DM) with and without peripheral artery disease (PAD). Materials and methods: Participants from the Chronotype of Patients with T2DM and Effect on Glycaemic Control cross-sectional study wore ac...

To determine whether the association between self-reported walking pace and all-cause mortality (ACM) persists across categories of accelerometer-assessed physical activity status. Data from 93,709 UK Biobank participants were included. Physical activity was assessed using wrist-worn accelerometers for 7-days. Participants accumulating <150 min/wee...

New findings: What is the central question of this study? To what extent does musculoskeletal impairment occur (i.e., muscle mass, quality and function) in patients with end stage liver disease (ESLD) by comparison to a healthy age/sex-matched control group? What is the main finding and its importance? Muscle mass, quality and function are impaire...

The aim of this study was to (1) describe accelerometer-assessed physical behaviours by chronotype, and (2) examine the association between chronotype and accelerometer-assessed physical behaviours in a cohort of adolescent girls. Chronotype (single question) and physical behaviours (GENEActiv accelerometer on the non-dominant wrist) were assessed...

Objectives: To compare the association between cardiorespiratory fitness (CRF) and cut-point-free accelerometer metrics (intensity gradient [IG] and average acceleration [AvAcc]) to that with traditional metrics in healthy adults aged 20 to 89 years and patients with heart failure, and 2) provide age-, sex-, and CRF-related reference values for hea...

Aims: Assess effectiveness of a hybrid intervention targeting physical activity in women with prior gestational diabetes. Methods: Randomised controlled trial with parallel arms. 293 women (35.1±5.1 years; 40% ethnic minority) recruited from two hospitals and randomised to routine care or hybrid lifestyle intervention comprising two group sessio...

Introduction: This cross-sectional study examined associations of device-measured sedentary time and moderate-to-vigorous physical activity (MVPA) with adipose tissue insulin resistance in people with or at high-risk of type 2 diabetes (T2DM). Methods: Data were combined from six previous experimental studies (within our group) involving patient...

Purpose: To investigate associations between 4-year change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. Methods: In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of card...

Albert Einstein taught us that "everything is relative." People's experience of physical activity (PA) is no different, with "relativism" particularly pertinent to the perception of intensity. Markers of absolute and relative intensities of PA have different but complimentary utilities, with absolute intensity considered best for PA guideline adher...

Background and aims: We aimed to evaluate the life expectancy following the first cardiovascular disease (CVD) event by type 2 diabetes (T2D) status and ethnicity. Methods and results: We used the Clinical Practice Research Datalink database in England (UK), linked to the Hospital Episode Statistics information, to identify individuals with and...

Background: Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after d...

Background: Over the last decade use of raw acceleration metrics to assess physical activity has increased. Metrics such as Euclidean Norm Minus One (ENMO), and Mean Amplitude Deviation (MAD) can be used to generate metrics which describe physical activity volume (average acceleration), intensity distribution (intensity gradient), and intensity of...

Background A step cadence of 100 steps/minute is widely used to define moderate-intensity walking. However, the generalizability of this threshold to different populations needs further research. We investigate moderate-intensity step cadence values during treadmill walking and daily living in older adults. Methods Older adults (≥ 60 years) were r...

Background Accelerometer measures of physical behaviours (physical activity, sedentary behaviour and sleep) in observational studies offer detailed insight into associations with health and disease. Maximising recruitment and accelerometer wear, and minimising data loss remain key challenges. How varying methods used to collect accelerometer data i...

Background Accelerometry has gained increasing popularity and yields numerous physical activity (PA) outcomes (Rowlands et al., 2019). These include traditional cut-point-based (i.e. light, moderate, and vigorous PA) and cut-point-free metrics (i.e. intensity gradient [IG] and average acceleration [AvAcc]). IG reflects the intensity distribution o...

Two accelerometer metrics (intensity-gradient and average-acceleration) can be used to determine the relative contributions of physical activity (PA) volume and intensity for health, but it is unknown whether epoch length influences the associations detected. This is important when considering bone health, as bone is particularly responsive to high...

Objective: To investigate the association between age at diagnosis of type 2 diabetes and depressive symptoms, diabetes-specific distress, and self-compassion among adults with type 2 diabetes. Research design and methods: This analysis used data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycemic Control (CODEC) cross-se...

Stepping-based targets such as the number of steps per day provide an intuitive and commonly used method of prescribing and self-monitoring physical activity goals. Physical activity surveillance is increasingly being obtained from wrist-worn accelerometers. However, the ability to derive stepping-based metrics from this wear location still lacks v...

Background Sleep disturbance is common following hospitalisation both for COVID-19 and other causes. The clinical associations are poorly understood, despite it altering pathophysiology in other scenarios. We, therefore, investigated whether sleep disturbance is associated with dyspnoea along with relevant mediation pathways. Methods Sleep paramete...

Background: Evidence investigating associations between hospitalization and physical activity is scarce and limited to specific populations of older adults. Objective: The current study aimed to describe the impact of past hospitalization on current physical activity levels of a large representative sample of European older adults with accelerom...

Considering physical activity (PA) volume and intensity may provide novel insights into the relationships of PA with bone, lean, and fat mass. This study aimed to assess the associations of PA volume, PA intensity distribution, including moderate‐to‐vigorous PA (MVPA) with total‐body‐less‐head bone mineral content (BMC), lean, and fat mass in child...

The Verisense Step Count Algorithm facilitates generation of steps from wrist-worn accelerometers. Based on preliminary evidence suggesting a proportional bias with overestimation at low steps/day, but underestimation at high steps/day, the algorithm parameters have been revised. We aimed to establish validity of the original and revised algorithms...

To evaluate the criterion validity of an automated sleep detection algorithm applied to data from three research-grade accelerometers worn on each wrist with concurrent laboratory-based polysomnography (PSG). A total of 30 healthy volunteers (mean [SD] age 31.5 [7.2] years, body mass index 25.5 [3.7] kg/m2 ) wore an Axivity, GENEActiv and ActiGraph...

Aims: The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. Methods and results: Data were from 88,412 UK Biobank middle-aged adults (58% women) without p...

Physical activity (PA) intensity of people living with chronic obstructive pulmonary disease (COPD) is typically evaluated using intensity thresholds developed in younger, healthier populations with greater exercise capacity and free from respiratory symptoms. This study therefore compared (i) PA differences between COPD and non-COPD controls using...

Introduction Low self-compassion and poor sleep quality have been identified as potential key predictors of distress in type 2 diabetes (T2D). This study investigated relationships between sleep behaviors (sleep duration, social jetlag and daytime sleepiness), diabetes-related distress (DRD) and self-compassion in people with T2D. Research design...

Background Physical frailty is prevalent in end-stage liver disease (ESLD) and is associated with poor clinical outcomes. Increasing physical activity has been used to combat physical frailty, yet current knowledge of daily physical activity patterns is limited to subjective and/or step count reports, making prescription of targeted exercise progra...

Objectives: Sleep variability levels are unknown in heavy goods vehicle (HGV) drivers yet are associated with adverse health outcomes and reduced driver vigilance when high. Methods: Two hundred and thirty-three HGV drivers recruited across 25 UK depots provided sleep variability, sleep duration, and sleep efficiency data via wrist-worn accelero...

Background The number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acu...

We examined the compositional associations between the intensity spectrum derived from incremental acceleration intensity bands and the body mass index (BMI) z-score in youth, and investigated the estimated differences in BMI z-score following time reallocations between intensity bands. School-aged youth from 63 schools wore wrist accelerometers, a...

Introduction: Higher levels of physical activity are associated with lower cardio-metabolic risk. However, the relative contribution of overall activity and the intensity of activity is unclear. Our aim was to determine the relative contribution of overall activity and intensity distribution of activity to cardio-metabolic risk in in a cross-secti...

Walking pace is a simple and functional form of movement and a strong predictor of health status, but the nature of its association with leucocyte telomere length (LTL) is unclear. Here we investigate whether walking pace is associated with LTL, which is causally associated with several chronic diseases and has been proposed as a marker of biologic...

the benefits of physical activity (PA) and sleep for health, accurate and objective population-based surveillance is important. Monitor-based surveillance has potential, but the main challenge is the need for replicable outcomes from different monitors. This study investigated the agreement of movement behavior outcomes assessed with four research-...

This study investigated associations between step cadence and physical function in healthy South Asian (SA) and White European (WE) older adults, aged ≥60. Participants completed the 60-s Sit-to-Stand (STS-60) test of physical function. Free-living stepping was measured using the activPAL3™. Seventy-one WEs (age = 72 ± 5, 53% male) and 33 SAs (age...

Aims: To examine the independent associations between relative protein intake (g kg-1 day 1 ) and markers of physical function in those with type 2 diabetes, while also comparing with current guidelines for protein intake. Methods: This analysis reports data from the ongoing Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Con...

OBJECTIVE To investigate the association between admission blood glucose levels and risk of in-hospital cardiovascular and renal complications. RESEARCH DESIGN AND METHODS In this multicenter prospective study of 36,269 adults hospitalized with COVID-19 between 6 February 2020 and 16 March 2021 (N = 143,266), logistic regression models were used t...

Background Although the cardiovascular disease (CVD) benefits of both overall volume and intensity of physical activity (PA) are known, the role of PA intensity, over and above volume, is poorly understood. We aimed to investigate the interplay between PA volume and intensity in relation to incident CVD. Methods Data were from 88,412 UK Biobank pa...

Objective: To assess the association between household size and risk of non-severe or severe COVID-19. Design: A longitudinal observational study. Setting: This study utilised UK Biobank linked to national SARS-CoV-2 laboratory test data. Participants: 401,910 individuals with available data on household size in UK Biobank. Main outcome mea...

Objective Using a large national database of people hospitalised with COVID-19, we investigated the contribution of cardio-metabolic conditions, multi-morbidity and ethnicity on the risk of in-hospital cardiovascular complications and death. Methods A multicentre, prospective cohort study in 302 UK healthcare facilities of adults hospitalised with...

Background: Physical activity and sleep are important for health; whether device-measured physical activity and sleep differ by ethnicity is unclear. This study aimed to compare physical activity and sleep/rest in white, South Asian (SA), and black adults by age. Methods: Physical activity and sleep/rest quality were assessed using accelerometer...

This study aimed to a) determine whether wrist acceleration varies by accelerometer brand, wear location, and age for self-paced “slow”, “normal” and “brisk” walking; b) develop normative acceleration values for self-paced walking and running for adults. One-hundred-and-three adults (40–79 years) completed self-paced “slow”, “normal” and “brisk” wa...

Objectives: Walking pace is a strong marker of functional and health status. We investigated whether walking pace is also associated with leucocyte telomere length (LTL), which is causally associated with several diseases and has been proposed as a marker of biological age. Methods: We used baseline data from UK Biobank participants recruited from...

Background Pre-existing comorbidities have been linked to SARS-CoV-2 infection but evidence is sparse on the importance and pattern of multimorbidity (2 or more conditions) and severity of infection indicated by hospitalisation or mortality. We aimed to use a multimorbidity index developed specifically for COVID-19 to investigate the association be...

Identifying clusters of physical activity (PA) from accelerometer data is important to identify levels of sedentary behaviour and physical activity associated with risks of serious health conditions and time spent engaging in healthy PA. Unsupervised machine learning models can capture PA in everyday free-living activity without the need for labell...

Objective To quantify the association between accelerometer-assessed physical activity and COVID-19 outcomes. Patients and Methods Data from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015), complete covariate data, and linked COVID-19 data from 16th March 2020 to 16th March 2021 were included. Two outcomes were investig...

Abstract Background Although age, obesity and pre-existing chronic diseases are established risk factors for COVID-19 outcomes, their interactions have not been well researched. Methods We used data from the Clinical Characterisation Protocol UK (CCP-UK) for Severe Emerging Infection developed by the International Severe Acute Respiratory and emerg...

Objectives To profile sleep duration and sleep efficiency in UK long-distance heavy goods vehicle (HGV) drivers and explore demographic, occupational and lifestyle predictors of sleep. Methods Cross-sectional analyses were carried out on 329 HGV drivers (98.5% men) recruited across an international logistics company within the midland’s region, UK...