Loree Pham MS, OTR/L, DipACLM(she/her/hers)

Relationships between activity engagement and health related quality of life (HRQOL) can differ based on the level of analyses. For instance, greater exercise on average may be linked with lower fatigue across individuals (between-person level), whereas the momentary experience of exercise may be associated with increased fatigue within an individual (within-person level). Disentangling the between- and within-person associations between everyday activities and HRQOL outcomes may provide insights for personalized lifestyle-oriented health promotion efforts for individuals with chronic conditions. The purpose of this paper was to examine the between- and within-person relationships between activity engagement and HRQOL relevant measures in a sample of 92 workers with type 1 diabetes (T1D), from whom we collected ecological momentary assessment (EMA) data 5–6 times daily over 14 days. At each EMA prompt, information was collected on the activity participants just engaged in, and HRQOL relevant metrics (e.g. mental health, blood glucose, fatigue, functioning). Momentary reports of “caring for others”, and more frequently “caring for others”, were both associated with decreased HRQOL. Reporting napping 10% or more of the time during a person’s waking hours, but not the momentary experience of napping, was associated with decreased HRQOL. Momentary reports of sleeping were associated with low activity satisfaction relative to other activities, but higher activity importance. Study results provided a quantitative representation of the lived experience of T1D covering multiple types of activity engagement, which potentially has health promotion implications for workers with T1D.

Keywords. Ecological momentary assessment; Health promotion; Human activities; Type 1 diabetes; Workers

Objective. While there is evidence that functioning, or ability to perform daily life activities, can be adversely influenced by type 1 diabetes, the impact of acute fluctuations in glucose levels on functioning is poorly understood.

Research design and methods. Using dynamic structural equation modeling, we examined whether overnight glucose (coefficient of variation[CV], percent time <70 mg/dL, percent time >250 mg/dL) predicted seven next-day functioning outcomes (mobile cognitive tasks, accelerometry-derived physical activity, self-reported activity participation) in adults with type 1 diabetes. We examined mediation, moderation, and whether short-term relationships were predictive of global patient-reported outcomes.

Results. Overall next-day functioning was significantly predicted from overnight CV (P = 0.017) and percent time >250 mg/dL (P = 0.037). Pairwise tests indicate that higher CV is associated with poorer sustained attention (P = 0.028) and lower engagement in demanding activities (P = 0.028), time <70 mg/dL is associated with poorer sustained attention (P = 0.007), and time >250 mg/dL is associated with more sedentary time (P = 0.024). The impact of CV on sustained attention is partially mediated by sleep fragmentation. Individual differences in the effect of overnight time <70 mg/dL on sustained attention predict global illness intrusiveness (P = 0.016) and diabetes-related quality of life (P = 0.036).

Conclusions. Overnight glucose predicts problems with objective and self-reported next-day functioning and can adversely impact global patient-reported outcomes. These findings across diverse outcomes highlight the wide-ranging effects of glucose fluctuations on functioning in adults with type 1 diabetes.

Background. The Glycemia Risk Index (GRI) was introduced as a single value derived from the ambulatory glucose profile that identifies patients who need attention. This study describes participants in each of the five GRI zones and examines the percentage of variation in GRI scores that is explained by sociodemographic and clinical variables among diverse adults with type 1 diabetes.

Methods. A total of 159 participants provided blinded continuous glucose monitoring (CGM) data over 14 days (mean age [SD] = 41.4 [14.5] years; female = 54.1%, Hispanic = 41.5%). Glycemia Risk Index zones were compared on CGM, sociodemographic, and clinical variables. Shapley value analysis examined the percentage of variation in GRI scores explained by different variables. Receiver operating characteristic curves examined GRI cutoffs for those more likely to have experienced ketoacidosis or severe hypoglycemia.

Results. Mean glucose and variability, time in range, and percentage of time in high, and very high, glucose ranges differed across the five GRI zones (P values < .001). Multiple sociodemographic indices also differed across zones, including education level, race/ethnicity, age, and insurance status. Sociodemographic and clinical variables collectively explained 62.2% of variance in GRI scores. A GRI score ≥84.5 reflected greater likelihood of ketoacidosis (area under the curve [AUC] = 0.848), and scores ≥58.2 reflected greater likelihood of severe hypoglycemia (AUC = 0.729) over the previous six months.

Conclusions. Results support the use of the GRI, with GRI zones identifying those in need of clinical attention. Findings highlight the need to address health inequities. Treatment differences associated with the GRI also suggest behavioral and clinical interventions including starting individuals on CGM or automated insulin delivery systems.

Few studies have investigated the short-term, momentary relationships between physical activity (PA) and well-being. This study focuses on investigating the dynamic relationships between PA and affective well-being among adults with type 1 diabetes. Participants (n = 122) wore an accelerometer and completed daily EMA surveys of current activities and affective states (e.g., happy, stressed, excited, anxious) via smartphone over 14 days. Within-person, increased sedentary time was associated with less positive affect (r = − 0.11, p < 0.001), while more PA of any intensity was associated with greater positive affect and reduced fatigue, three hours later. Between-person, increased light PA was associated with increased stress (r = 0.21, p = 0.02) and diabetes distress (r = 0.30, p = 0.001). This study provides evidence that positive affect and fatigue are predicted by previous activity regardless of the different activities that people engaged in. Positive affect increased after engaging in PA. However, participants with higher amounts of light PA reported higher stress ratings.

Keywords. Ecological momentary assessments; Accelerometry; Physical activity; Mood; Type 1 diabetes

Although occupational therapy (OT) practitioners are well suited to address spirituality within client care, evidence suggests many practitioners feel discomfort or lack of knowledge of this subject. Few studies have delved into OTs’ experiences and encapsulated if and how spirituality has been experienced in practice. This study aimed to gain a deeper and more updated insight into this phenomenon. Utilizing a phenomenological approach with interviews, this study explored OT practitioners’ (n = 15) experiences with spirituality in client care. (a) Losing spirit: the inadequacy of only addressing mind and body, (b) spirituality as a vehicle for reaffirming purpose in both client and therapist, and (c) addressing spirituality through functional and measurable treatments. Although the concept of mind, body, and spirit is not new, occupational therapists often do not consistently address these components simultaneously, leading to missed opportunities in client practice.

Keywords. spirituality, occupational therapy, qualitative research

Background. While short-term blood glucose (BG) levels and variability are thought to underlie diminished function and emotional well-being in people with T1D, these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among BG, function, and emotional well-being in adults with T1D.

Objective. To present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely.

Methods. The FEEL-T1D study will recruit 200 adults 18-75 years old with T1D. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring (CGM), ecological momentary assessments (EMA), ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely, through mailing study equipment and using videoconferencing for study visits.

Results. To date, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Over 80% have provided concurrent CGM, EMA, and accelerometer data for at least 10 of the 14 days of data collection, and nearly 90% of EMA surveys have been completed, with minimal missing data.

Conclusions. Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships between blood glucose, emotional well-being, cognitive function and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatment to optimize function and well-being among individuals with T1D.

Background. Few studies have investigated the short-term, momentary relationships between physical activity (PA) and well-being. Gaining a better understanding of the meaning and importance of activities engaged in related physical activity may be beneficial in promoting participation in physical activity. This study focuses on investigating the dynamic relationships between physical activity and affective well-being in adults, while also investigating the potential effects of activity type and activity importance.

Methods. Participants were 122 adults (41±15 yrs, 56% female, 38% Latinx, 35% White, 11% Black, 12% multiethnic/other) who completed daily ecological momentary assessment surveys that looked at current activities (activity type and activity importance) and affective well-being states (e.g., happy, stressed, excited, anxious) by answering prompts on a mobile phone six times per day over 14 days. Time spent in vigorous PA, moderate PA, light PA, and sedentary was measured using wrist-worn accelerometers (Actigraph wGT3X-BT) worn continuously for 14 consecutive days, removed only for bathing or other water activities.

Results. Within person, increased time spent sedentary was associated with less positive affect (r = -0.03, p < 0.01), while more physical activity at any intensity was associated with greater positive affect and reduced fatigue, three hours later (p < 0.001). Between-person, however, increased light PA was associated with increased stress (r = 0.19, p = 0.042).

Conclusions. This study provides evidence that positive affect and fatigue are predicted by previous activity and this relationship is still pertinent even when adjusting for the different activities that people engaged in. There exists an independent effect that suggests a portion of the improved mood was derived from purely the physical activity component and some portion comes from the activities that are considered important and meaningful. This study also suggests that while people may experience increased positive affect after engaging in physical activity, people who, on average, experienced higher amounts of light physical activity had higher mean stress ratings.

The benefits of engaging in physical activity (PA) on an individual’s metabolic health are well established; however, between and within-person relationships of PA and blood glucose (BG) are not so clear. Drawing data from a larger longitudinal study of BG, function, and well-being in adults with type 1 diabetes (T1D), this study uses accelerometry and continuous glucose monitoring (CGM) to examine the within- and between-subject effects of PA bouts on BG.

Background. Excessive sitting is associated with poor health outcomes and increases the risk for chronic conditions. Sitting in chairs may be particularly harmful; yet, a cultural bias toward chair sitting has limited research on alternatives such as floor sitting, which have the potential to negate many of the adverse health risks.

Methods. A literature search was conducted to systematically identify and evaluate evidence related to sitting and health. PubMed and CINAHL databases were searched using keywords and phrases, controlled vocabulary, and constructed combinations of these terms. Search terms included: sedentary behavior, chronic conditions, physical activity, health, lifestyle, floor sitting, posture, sitting position, squatting, kneeling, cross-legged sitting. Reviewed articles were: peer-reviewed, published 2012 to present, and addressed floor sitting in relation to health. Exclusion articles were: non-English, dissertations, and positions such as squatting when related to fitness exercises instead of sitting postures.

Results. The literature examining floor sitting as related to health is relatively sparse. There was promising but limited research on how alternative seated positions such as floor sitting may positively impact cardiometabolic conditions. Findings also showed that sitting on the floor may not only help promote greater health, but the act of regularly sitting and rising from the floor can help promote the maintenance of coordination, muscle strength, and flexibility, thereby positively impacting life expectancy and longevity. Given the emerging understanding of floor sitting physiology and the health impacts of sedentary behavior, which is greatly influenced by our environment, there is a need for more research to expand public health and lifestyle medicine thinking beyond exercise and physical activity. Floor sitting may be a simple lifestyle change that can be used to address chronic conditions as well as improve health, well-being, and participation in daily life activities.

Conclusions. Floor sitting may be a healthier alternative to chair sitting and may be implemented wherever chairs are used. Increasing the knowledge of floor sitting as an active lifestyle change may reduce the harms of sedentary behavior, but a shift in cultural and social norms and the built environment is needed.