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Christopher E. Kline
Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA

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Journal article
Published: 19 August 2021 in Health Psychology Review
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A significant proportion of the population is classified as having overweight or obesity. One framework which has attempted to explain biobehavioral mechanisms influencing the development of overweight and obesity is the energy balance model. According to this model, the body continually attempts to balance energy intake with energy expenditure. When energy intake and energy expenditure become imbalanced, there is an increase in homeostatic and allostatic pressure, generally to either increase energy intake or decrease energy expenditure, so as to restore energy homeostasis.Recent research has indicated that circadian aspects of energy intake and energy expenditure may influence energy balance. This paper provides a narrative review of existing evidence of the role of circadian timing on components of energy balance. Research on the timing of food intake, physical activity, and sleep indicates that unhealthy timing is likely to increase risk of weight gain. Public health guidelines focus on how much individuals eat and sleep, what foods are consumed, and the type and frequency of exercise, but the field of circadian science has begun to demonstrate that when these behaviors occur may also influence overweight and obesity prevention and treatment efforts.

ACS Style

Allison C. Veronda M.S.; Christopher E. Kline; Leah A. Irish. The impact of circadian timing on energy balance: an extension of the energy balance model. Health Psychology Review 2021, 1 -43.

AMA Style

Allison C. Veronda M.S., Christopher E. Kline, Leah A. Irish. The impact of circadian timing on energy balance: an extension of the energy balance model. Health Psychology Review. 2021; ():1-43.

Chicago/Turabian Style

Allison C. Veronda M.S.; Christopher E. Kline; Leah A. Irish. 2021. "The impact of circadian timing on energy balance: an extension of the energy balance model." Health Psychology Review , no. : 1-43.

Review
Published: 12 August 2021 in International Journal of Environmental Research and Public Health
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Purpose: To evaluate if sedentary time (ST) is associated with heart rate (HR) and variability (HRV) in adults. Methods: We systematically searched PubMed and Google Scholar through June 2020. Inclusion criteria were observational design, humans, adults, English language, ST as the exposure, resting HR/HRV as the outcome, and (meta-analysis only) availability of the quantitative association with variability. After qualitative synthesis, meta-analysis used inverse variance heterogeneity models to estimate pooled associations. Results: Thirteen and eight articles met the criteria for the systematic review and meta-analysis, respectively. All studies were cross-sectional and few used gold standard ST or HRV assessment methodology. The qualitative synthesis suggested no associations between ST and HR/HRV. The meta-analysis found a significant association between ST and HR (β = 0.24 bpm per hour ST; CI: 0.10, 0.37) that was stronger in males (β = 0.36 bpm per hour ST; CI: 0.19, 0.53). Pooled associations between ST and HRV indices were non-significant (p > 0.05). Substantial heterogeneity was detected. Conclusions: The limited available evidence suggests an unfavorable but not clinically meaningful association between ST and HR, but no association with HRV. Future longitudinal studies assessing ST with thigh-based monitoring and HRV with electrocardiogram are needed.

ACS Style

Abdullah Bandar Alansare; Lauren C. Bates; Lee Stoner; Christopher E. Kline; Elizabeth Nagle; J. Richard Jennings; Erik D. Hanson; Mark A. Faghy; Bethany Barone Gibbs. Associations of Sedentary Time with Heart Rate and Heart Rate Variability in Adults: A Systematic Review and Meta-Analysis of Observational Studies. International Journal of Environmental Research and Public Health 2021, 18, 8508 .

AMA Style

Abdullah Bandar Alansare, Lauren C. Bates, Lee Stoner, Christopher E. Kline, Elizabeth Nagle, J. Richard Jennings, Erik D. Hanson, Mark A. Faghy, Bethany Barone Gibbs. Associations of Sedentary Time with Heart Rate and Heart Rate Variability in Adults: A Systematic Review and Meta-Analysis of Observational Studies. International Journal of Environmental Research and Public Health. 2021; 18 (16):8508.

Chicago/Turabian Style

Abdullah Bandar Alansare; Lauren C. Bates; Lee Stoner; Christopher E. Kline; Elizabeth Nagle; J. Richard Jennings; Erik D. Hanson; Mark A. Faghy; Bethany Barone Gibbs. 2021. "Associations of Sedentary Time with Heart Rate and Heart Rate Variability in Adults: A Systematic Review and Meta-Analysis of Observational Studies." International Journal of Environmental Research and Public Health 18, no. 16: 8508.

Major article
Published: 23 June 2021 in Journal of American College Health
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To investigate COVID-19’s impact on college student health behaviors. 189 college students. Participants completed an online survey on behaviors relating to sleep, sedentary activities, and physical activity before and during the COVID-19 pandemic. Comparisons utilized Students’ dependent t-test or Wilcoxon signed-rank tests. There was an increase in time to fall asleep (before: 23.4 ± 18.0 vs. during: 42.8 ± 44.3 min·day−1, p < 0.001), time spent in bed (before: 7.8 ± 1.5 vs. during: 8.5 ± 1.5 hr·day−1, p < 0.001), as well as shifts in later bed and awake time (p < 0.001). Total sedentary time increased during the pandemic (before: 9.0 ± 3.8 vs. during: 9.9 ± 4.1 hr·day−1, p = 0.016); and time spent using a TV, computer, or phone (before: 3.1 ± 1.9 vs. during: 4.2 ± 2.3 hr·day−1, p < 0.001). There was a significant decrease in moderate-vigorous activity (before: 123.8 ± 96.0 vs. during: 108.9 ± 75.5 min·week−1, p = 0.028) and resistance training days (before: 2.4 ± 2.1 vs. during: 1.7 ± 2.1 days·week−1, p < 0.001). COVID-19 negatively influenced health behaviors in college students.

ACS Style

Robert J. Kowalsky; Tyler M. Farney; Christopher E. Kline; Jessica N. Hinojosa; Seth A. Creasy. The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students. Journal of American College Health 2021, 1 -6.

AMA Style

Robert J. Kowalsky, Tyler M. Farney, Christopher E. Kline, Jessica N. Hinojosa, Seth A. Creasy. The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students. Journal of American College Health. 2021; ():1-6.

Chicago/Turabian Style

Robert J. Kowalsky; Tyler M. Farney; Christopher E. Kline; Jessica N. Hinojosa; Seth A. Creasy. 2021. "The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students." Journal of American College Health , no. : 1-6.

Review
Published: 09 April 2021 in Sleep Medicine Reviews
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Physical activity (PA) is widely considered to improve sleep, but a comprehensive review of the research on this topic has not been performed. In this umbrella review, conducted initially for the 2018 Physical Activity Guidelines for Americans Advisory Committee and updated to reflect more recent research, we examined whether PA enhances sleep outcomes across the lifespan as well as among individuals with sleep disorders. Systematic reviews and meta-analyses were utilized to assess the evidence. We also examined dose-response considerations and whether the association between PA and sleep was moderated by various factors (e.g., timing, sociodemographic characteristics). We found strong evidence that both acute bouts of PA and regular PA improved sleep outcomes. Moderate evidence indicated that longer bouts of PA (both acute and regular) improved sleep, and that the effects of PA on sleep outcomes were generally preserved across adult age groups and sex. Finally, moderate evidence demonstrated that PA improved sleep in adults with insomnia symptoms or obstructive sleep apnea. Several important areas in need of future research were also identified. Overall, the review supported the claim that PA improves sleep, but highlighted gaps that need to be addressed to facilitate more widespread utilization of PA for improving sleep.

ACS Style

Christopher E. Kline; Charles H. Hillman; Bonny Bloodgood Sheppard; Bethany Tennant; David E. Conroy; Richard F. Macko; David X. Marquez; Steven J. Petruzzello; Kenneth E. Powell; Kirk I. Erickson. Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report. Sleep Medicine Reviews 2021, 58, 101489 .

AMA Style

Christopher E. Kline, Charles H. Hillman, Bonny Bloodgood Sheppard, Bethany Tennant, David E. Conroy, Richard F. Macko, David X. Marquez, Steven J. Petruzzello, Kenneth E. Powell, Kirk I. Erickson. Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report. Sleep Medicine Reviews. 2021; 58 ():101489.

Chicago/Turabian Style

Christopher E. Kline; Charles H. Hillman; Bonny Bloodgood Sheppard; Bethany Tennant; David E. Conroy; Richard F. Macko; David X. Marquez; Steven J. Petruzzello; Kenneth E. Powell; Kirk I. Erickson. 2021. "Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report." Sleep Medicine Reviews 58, no. : 101489.

Accepted manuscript
Published: 11 March 2021 in Sleep
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Study Objectives Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function. Methods We utilized data from 1,627 Study of Women’s Health Across the Nation participants, aged 61.9 ± 2.7 years at the end of the 13-year follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early morning awakening) and sleep duration over 13 years. Physical function tests were performed at the end of the 13-year period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group. Results Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e. improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each p ≤ .05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR] = 0.36 and OR = 0.61, respectively; each p < .02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively. Conclusion These results suggest that women’s sleep during midlife has important implications for maintaining physical function during the transition into older adulthood.

ACS Style

Christopher E Kline; Alicia B Colvin; Kelley Pettee Gabriel; Carrie A Karvonen-Gutierrez; Jane A Cauley; Martica H Hall; Karen A Matthews; Kristine M Ruppert; Genevieve S Neal-Perry; Elsa S Strotmeyer; Barbara Sternfeld. Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women’s Health Across the Nation. Sleep 2021, 1 .

AMA Style

Christopher E Kline, Alicia B Colvin, Kelley Pettee Gabriel, Carrie A Karvonen-Gutierrez, Jane A Cauley, Martica H Hall, Karen A Matthews, Kristine M Ruppert, Genevieve S Neal-Perry, Elsa S Strotmeyer, Barbara Sternfeld. Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women’s Health Across the Nation. Sleep. 2021; ():1.

Chicago/Turabian Style

Christopher E Kline; Alicia B Colvin; Kelley Pettee Gabriel; Carrie A Karvonen-Gutierrez; Jane A Cauley; Martica H Hall; Karen A Matthews; Kristine M Ruppert; Genevieve S Neal-Perry; Elsa S Strotmeyer; Barbara Sternfeld. 2021. "Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women’s Health Across the Nation." Sleep , no. : 1.

Journal article
Published: 01 March 2021 in SLEEP Advances
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Study Objectives The relationships between daytime sedentary behavior and that night’s sleep and sleep and next day’s sedentary behavior are unknown. The purpose of this analysis was to examine these potentially bidirectional associations. Methods This study was a secondary analysis of baseline data from an ecological momentary assessment study to determine the triggers for dietary lapses during a weight loss intervention. Sedentary behavior, physical activity, and sleep were objectively measured using accelerometers. Linear mixed modeling was used to examine the bidirectional multivariate associations between activity and sleep characteristics for each outcome examined separately. The models included sex, age, body mass index (BMI), education, and day of the week (weekday vs. weekend). Results Participants were predominantly white (81.5%) and female (88.9%) with a mean age of 51.2 ± 10.6 years. Longer previous night’s total sleep time (TST) (b = −0.320, standard error [SE] = 0.060; p < .001) and being a weekend (b = −63.845, SE = 9.406; p < .001) were associated with less sedentary time the next day. More daytime sedentary time was associated with less wake after sleep onset (b = −0.018, SE = 0.008; p = .016), fewer awakenings (b = −0.010, SE = 0.004; p = .016), and less TST (b = −0.060, SE = 0.028; p = .029) that night. Conclusions The bidirectional relationships between sedentary time and sleep characteristics are complex and may vary depending on participant characteristics and duration of sedentary and sleep time. Interventions to decrease sedentary behavior may benefit by targeting sleep duration and weekday activity.

ACS Style

Christopher C Imes; Zhadyra Bizhanova; Christopher E Kline; Bonny Rockette-Wagner; Eileen R Chasens; Susan M Sereika; Lora E Burke. Bidirectional relationship between sleep and sedentary behavior in adults with overweight or obesity: A secondary analysis. SLEEP Advances 2021, 2, zpab004 .

AMA Style

Christopher C Imes, Zhadyra Bizhanova, Christopher E Kline, Bonny Rockette-Wagner, Eileen R Chasens, Susan M Sereika, Lora E Burke. Bidirectional relationship between sleep and sedentary behavior in adults with overweight or obesity: A secondary analysis. SLEEP Advances. 2021; 2 (1):zpab004.

Chicago/Turabian Style

Christopher C Imes; Zhadyra Bizhanova; Christopher E Kline; Bonny Rockette-Wagner; Eileen R Chasens; Susan M Sereika; Lora E Burke. 2021. "Bidirectional relationship between sleep and sedentary behavior in adults with overweight or obesity: A secondary analysis." SLEEP Advances 2, no. 1: zpab004.

Journal article
Published: 07 January 2021 in International Journal of Obesity
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Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention. Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as “good” or “poor” using questionnaires and actigraphy. A composite score was calculated by summing the number of “good” dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea–hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI. Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were −9.3 ± 6.1%, −16.9 ± 13.5%, and −3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, −0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041). Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.

ACS Style

Christopher E. Kline; Eileen R. Chasens; Zhadyra Bizhanova; Susan M. Sereika; Daniel J. Buysse; Christopher C. Imes; Jacob K. Kariuki; Dara D. Mendez; Mia I. Cajita; Stephen L. Rathbun; Lora E. Burke. The association between sleep health and weight change during a 12-month behavioral weight loss intervention. International Journal of Obesity 2021, 45, 639 -649.

AMA Style

Christopher E. Kline, Eileen R. Chasens, Zhadyra Bizhanova, Susan M. Sereika, Daniel J. Buysse, Christopher C. Imes, Jacob K. Kariuki, Dara D. Mendez, Mia I. Cajita, Stephen L. Rathbun, Lora E. Burke. The association between sleep health and weight change during a 12-month behavioral weight loss intervention. International Journal of Obesity. 2021; 45 (3):639-649.

Chicago/Turabian Style

Christopher E. Kline; Eileen R. Chasens; Zhadyra Bizhanova; Susan M. Sereika; Daniel J. Buysse; Christopher C. Imes; Jacob K. Kariuki; Dara D. Mendez; Mia I. Cajita; Stephen L. Rathbun; Lora E. Burke. 2021. "The association between sleep health and weight change during a 12-month behavioral weight loss intervention." International Journal of Obesity 45, no. 3: 639-649.

Book chapter
Published: 20 October 2020 in Encyclopedia of Behavioral Medicine
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Christopher E. Kline. Sleep Duration. Encyclopedia of Behavioral Medicine 2020, 2061 -2063.

AMA Style

Christopher E. Kline. Sleep Duration. Encyclopedia of Behavioral Medicine. 2020; ():2061-2063.

Chicago/Turabian Style

Christopher E. Kline. 2020. "Sleep Duration." Encyclopedia of Behavioral Medicine , no. : 2061-2063.

Book chapter
Published: 20 October 2020 in Encyclopedia of Behavioral Medicine
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ACS Style

Christopher E. Kline. Sleep Quality. Encyclopedia of Behavioral Medicine 2020, 2064 -2066.

AMA Style

Christopher E. Kline. Sleep Quality. Encyclopedia of Behavioral Medicine. 2020; ():2064-2066.

Chicago/Turabian Style

Christopher E. Kline. 2020. "Sleep Quality." Encyclopedia of Behavioral Medicine , no. : 2064-2066.

Book chapter
Published: 20 October 2020 in Encyclopedia of Behavioral Medicine
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Christopher E. Kline. Polysomnography. Encyclopedia of Behavioral Medicine 2020, 1700 -1704.

AMA Style

Christopher E. Kline. Polysomnography. Encyclopedia of Behavioral Medicine. 2020; ():1700-1704.

Chicago/Turabian Style

Christopher E. Kline. 2020. "Polysomnography." Encyclopedia of Behavioral Medicine , no. : 1700-1704.

Book chapter
Published: 20 October 2020 in Encyclopedia of Behavioral Medicine
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ACS Style

Christopher E. Kline. Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep). Encyclopedia of Behavioral Medicine 2020, 20 -24.

AMA Style

Christopher E. Kline. Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep). Encyclopedia of Behavioral Medicine. 2020; ():20-24.

Chicago/Turabian Style

Christopher E. Kline. 2020. "Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep)." Encyclopedia of Behavioral Medicine , no. : 20-24.

Review
Published: 13 October 2020 in Current Epidemiology Reports
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The use of wearable activity monitors (WAM) has burgeoned over recent years. The increasing use of WAM in research studies is not surprising given their commercial availability and improving reliability, which make them attractive alternatives to more expensive research-grade devices. However, the effects of WAM as an intervention or as part of the intervention are largely unknown. The present review aimed to explore the range and characteristics of interventions that utilize WAM and descriptively summarize the efficacy of these interventions. A total of 65 articles (61 studies) were included in this review. Most of the WAM-based interventions (n = 58) were designed to improve physical activity (PA). Interventions intended to address sedentary behavior (SB) were much less common (n = 12), and even less frequent were WAM-based interventions that targeted sleep (n = 3). Most studies tested the feasibility of WAM-based interventions; hence, efficacy of these interventions in improving PA, SB, and/or sleep could not be conclusively determined. Nonetheless, WAM-based interventions showed considerable potential in increasing PA and decreasing SB. This review examines and summarizes available evidence on the use of WAM in interventions targeting PA, SB, and/or sleep. WAM-based PA interventions exhibited preliminary efficacy in increasing PA. Although not as many interventions were focused on SB, current interventions also showed potential in decreasing sedentary time. Meanwhile, more evidence is needed to determine the utility of WAM in improving sleep. Major challenges with including WAM as part of interventions are reduced engagement in using the devices over time and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.

ACS Style

Maan Isabella Cajita; Christopher E. Kline; Lora E. Burke; Evelyn G. Bigini; Christopher C. Imes. Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. Current Epidemiology Reports 2020, 1 -15.

AMA Style

Maan Isabella Cajita, Christopher E. Kline, Lora E. Burke, Evelyn G. Bigini, Christopher C. Imes. Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. Current Epidemiology Reports. 2020; ():1-15.

Chicago/Turabian Style

Maan Isabella Cajita; Christopher E. Kline; Lora E. Burke; Evelyn G. Bigini; Christopher C. Imes. 2020. "Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep." Current Epidemiology Reports , no. : 1-15.

Journal article
Published: 06 October 2020 in JMIR Research Protocols
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Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: African Americans (AAs) experience greater sleep quality problems than Non-Hispanic Whites (NHWs). Meditation has shown promise in improving sleep though dose levels needed to achieve such benefits have not been studied. No trials have utilized smartphone application (app) delivery and monitoring of adherence to meditation protocols. Objective: This 6-month feasibility trial investigated effects of a breathing awareness meditation, Tension Tamer (TT), on secondary outcomes of sleep quality using self-report and actigraphy derived measures. Methods: Sixty-four prehypertensive adults (SBP <139 mmHg; 31 AAs, 33 NHWs) were randomized into 3 different TT dose conditions (5 ,10 or 15 minutes twice daily). Sleep quality was assessed at baseline, 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and one-week bouts of continuous wrist actigraphy monitoring. Results: At baseline, PSQI and actigraphy data indicated AAs experienced shorter sleep duration, greater sleep disturbance, poorer efficiency and worse quality of sleep (P-range <.03 to <.001). Longitudinal GLM modeling revealed a dose effect modulated by ethnicity (P<.01). Multi-method assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-minute dose. They reported greater improvements in sleep efficiency and quality dimensions, as well as PSQI global value compared to 10- and 15-minute doses (P-value range: .04 to <.001). Actigraphy findings revealed a consistent but generally not statistically significant pattern in the 5-minute group showing lower fragmentation, longer sleep duration and higher efficiency compared to the other two dose conditions. Among AAs, actigraphy indicated exhibited lower sleep fragmentation in the 5-minute group compared to 10 and 15-minute doses (Ps=.03, <.001 respectively). The 10-minute group showed longer sleep duration than the 5- and 15-minute groups (Ps =.02, <.001, respectively). The 5-minute group also exhibited significantly longer average sleep compared to the 15-minute group (p=.03). Conclusions: These findings indicate need for further study of potential modulating influence of ethnicity upon impact of breathing awareness meditation upon sleep indices, and user-centered exploration to ascertain the potential merits of refining the TT app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints. Clinical Trial: NCT03168789

ACS Style

John C Sieverdes; Frank A Treiber; Christopher E Kline; Martina Mueller; Brenda Brunner-Jackson; Luke Sox; Mercedes Cain; Maria Swem; Vanessa Diaz; Jessica Chandler. Ethnicity Differences in Sleep Changes Among Pre-hypertensive Adults Using a Smartphone Meditation Application: A Dose-Response Trial (Preprint). JMIR Research Protocols 2020, 4, e20501 .

AMA Style

John C Sieverdes, Frank A Treiber, Christopher E Kline, Martina Mueller, Brenda Brunner-Jackson, Luke Sox, Mercedes Cain, Maria Swem, Vanessa Diaz, Jessica Chandler. Ethnicity Differences in Sleep Changes Among Pre-hypertensive Adults Using a Smartphone Meditation Application: A Dose-Response Trial (Preprint). JMIR Research Protocols. 2020; 4 (10):e20501.

Chicago/Turabian Style

John C Sieverdes; Frank A Treiber; Christopher E Kline; Martina Mueller; Brenda Brunner-Jackson; Luke Sox; Mercedes Cain; Maria Swem; Vanessa Diaz; Jessica Chandler. 2020. "Ethnicity Differences in Sleep Changes Among Pre-hypertensive Adults Using a Smartphone Meditation Application: A Dose-Response Trial (Preprint)." JMIR Research Protocols 4, no. 10: e20501.

Commentary
Published: 16 September 2020 in Children
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In the wake of the COVID-19 pandemic, social restrictions to contain the spread of the virus have disrupted behaviors across the 24-h day including physical activity, sedentary behavior, and sleep among children (5–12 years old) and adolescents (13–17 years old). Preliminary evidence reports significant decreases in physical activity, increases in sedentary behavior, and disrupted sleep schedules/sleep quality in children and adolescents. This commentary discusses the impact of COVID-19-related restrictions on behaviors across the 24-h day in children and adolescents. Furthermore, we suggest recommendations through the lens of a socio-ecological model to provide strategies for lasting behavior change to insure the health and well-being of children and adolescents during the COVID-19 pandemic.

ACS Style

Lauren Bates; Gabriel Zieff; Kathleen Stanford; Justin Moore; Zachary Kerr; Erik Hanson; Bethany Barone Gibbs; Christopher Kline; Lee Stoner. COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep. Children 2020, 7, 138 .

AMA Style

Lauren Bates, Gabriel Zieff, Kathleen Stanford, Justin Moore, Zachary Kerr, Erik Hanson, Bethany Barone Gibbs, Christopher Kline, Lee Stoner. COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep. Children. 2020; 7 (9):138.

Chicago/Turabian Style

Lauren Bates; Gabriel Zieff; Kathleen Stanford; Justin Moore; Zachary Kerr; Erik Hanson; Bethany Barone Gibbs; Christopher Kline; Lee Stoner. 2020. "COVID-19 Impact on Behaviors across the 24-Hour Day in Children and Adolescents: Physical Activity, Sedentary Behavior, and Sleep." Children 7, no. 9: 138.

Preprint content
Published: 20 May 2020
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BACKGROUND African Americans (AAs) experience greater sleep quality problems than non-Hispanic Whites (NHWs). Meditation may aid in addressing this disparity, although the dosage levels needed to achieve such benefits have not been adequately studied. Smartphone apps present a novel modality for delivering, monitoring, and measuring adherence to meditation protocols. OBJECTIVE This 6-month dose-response feasibility trial investigated the effects of a breathing awareness meditation (BAM) app, Tension Tamer, on the secondary outcomes of self-reported and actigraphy measures of sleep quality and the modulating effects of ethnicity of AAs and NHWs. METHODS A total of 64 prehypertensive adults (systolic blood pressure <139 mm Hg; 31 AAs and 33 NHWs) were randomized into 3 different Tension Tamer dosage conditions (5,10, or 15 min twice daily). Sleep quality was assessed at baseline and at 1, 3, and 6 months using the Pittsburgh Sleep Quality Index (PSQI) and 1-week bouts of continuous wrist actigraphy monitoring. The study was conducted between August 2014 and October 2016 (IRB #Pro00020894). RESULTS At baseline, PSQI and actigraphy data indicated that AAs had shorter sleep duration, greater sleep disturbance, poorer efficiency, and worse quality of sleep (range P=.03 to P<.001). Longitudinal generalized linear mixed modeling revealed a dose effect modulated by ethnicity (P=.01). Multimethod assessment showed a consistent pattern of NHWs exhibiting the most favorable responses to the 5-min dose; they reported greater improvements in sleep efficiency and quality as well as the PSQI global value than with the 10-min and 15-min doses (range P=.04 to P<.001). Actigraphy findings revealed a consistent, but not statistically significant, pattern in the 5-min group, showing lower fragmentation, longer sleep duration, and higher efficiency than the other 2 dosage conditions. Among AAs, actigraphy indicated lower sleep fragmentation with the 5-min dose compared with the 10-min and 15-min doses (P=.03 and P<.001, respectively). The 10-min dose showed longer sleep duration than the 5-min and 15-min doses (P=.02 and P<.001, respectively). The 5-min dose also exhibited significantly longer average sleep than the 15-min dose (P=.03). CONCLUSIONS These findings indicate the need for further study of the potential modulating influence of ethnicity on the impact of BAM on sleep indices and user-centered exploration to ascertain the potential merits of refining the Tension Tamer app with attention to cultural tailoring among AAs and NHWs with pre-existing sleep complaints.

ACS Style

John C Sieverdes; Frank A Treiber; Christopher E Kline; Martina Mueller; Brenda Brunner-Jackson; Luke Sox; Mercedes Cain; Maria Swem; Vanessa Diaz; Jessica Chandler. Ethnicity Differences in Sleep Changes Among Prehypertensive Adults Using a Smartphone Meditation App: Dose-Response Trial (Preprint). 2020, 1 .

AMA Style

John C Sieverdes, Frank A Treiber, Christopher E Kline, Martina Mueller, Brenda Brunner-Jackson, Luke Sox, Mercedes Cain, Maria Swem, Vanessa Diaz, Jessica Chandler. Ethnicity Differences in Sleep Changes Among Prehypertensive Adults Using a Smartphone Meditation App: Dose-Response Trial (Preprint). . 2020; ():1.

Chicago/Turabian Style

John C Sieverdes; Frank A Treiber; Christopher E Kline; Martina Mueller; Brenda Brunner-Jackson; Luke Sox; Mercedes Cain; Maria Swem; Vanessa Diaz; Jessica Chandler. 2020. "Ethnicity Differences in Sleep Changes Among Prehypertensive Adults Using a Smartphone Meditation App: Dose-Response Trial (Preprint)." , no. : 1.

Journal article
Published: 01 April 2020 in Sleep Health
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To examine how health behaviors and outcomes differ based on restful nights of sleep among college students. This is a cross-sectional study. The study was conducted in a large, northeastern United States university. The participants include college students (n = 4376), the majority of whom were women (59.2%) and non-Hispanic white (76.1%). Students completed an online survey, self-reporting sex, height, weight, cumulative grade point average (GPA), physical activity (PA), fruit and vegetable consumption (FVC), substance use, and depressive symptoms, along with nights of restful sleep. Participants were grouped into those who had frequent (≥4 nights/week) or infrequent (<4 nights/week) nights of restful sleep. Analyses included independent sample t-tests, chi-square tests for independence, and logistic regression analyses to compute odds ratios. Parametric analyses indicated a significant, although unmeaningful, association between frequent restful sleep and PA and GPA, but not body mass index or FVC. Nonparametric analyses indicated a positive association between frequent restful sleep and the absence of depressive symptoms. Odds ratios revealed a positive association between the absence of depressive symptoms and GPA with frequent restful sleep. Findings indicate that restful sleep is associated with the absence of depressive symptoms and higher GPA among college students. Further research is required to examine the relationship, particularly directionality, between the amount of sleep and health behaviors and outcomes. Future researchers should consider using better measures of mental health, dietary quality, and objective measures of sleep and PA were possible. College administrators and health professionals should consider ways in which they can educate students about the benefits of sleep to mental health and academic performance.

ACS Style

Anthony C. Rosso; Oliver W.A. Wilson; Zack Papalia; Michele Duffey; Christopher Kline; Melissa Bopp. Frequent restful sleep is associated with the absence of depressive symptoms and higher grade point average among college students. Sleep Health 2020, 6, 618 -622.

AMA Style

Anthony C. Rosso, Oliver W.A. Wilson, Zack Papalia, Michele Duffey, Christopher Kline, Melissa Bopp. Frequent restful sleep is associated with the absence of depressive symptoms and higher grade point average among college students. Sleep Health. 2020; 6 (5):618-622.

Chicago/Turabian Style

Anthony C. Rosso; Oliver W.A. Wilson; Zack Papalia; Michele Duffey; Christopher Kline; Melissa Bopp. 2020. "Frequent restful sleep is associated with the absence of depressive symptoms and higher grade point average among college students." Sleep Health 6, no. 5: 618-622.

Review
Published: 28 January 2020 in Current Epidemiology Reports
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This review explored the characteristics of interventions that use wearable activity monitors (WAM) and descriptively summarize their efficacy. A total of 61 studies were included. Most of the WAM-based interventions (n = 58) were designed to improve physical activity (PA). Interventions targeting sedentary behavior (SB) were much less common (n = 12), and even less frequent were WAM-based sleep interventions (n = 3). Most studies tested the feasibility of WAM-based interventions. WAM-based interventions exhibited preliminary efficacy in increasing PA and potential in decreasing sedentary time. More evidence are needed to determine the utility of WAM in improving sleep. The efficacy of interventions using WAM to improve PA, SB, and/or sleep could not be conclusively determined. Major challenges with including WAM as part of interventions are reduced engagement with the devices over time, and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.

ACS Style

Maan Isabella Cajita; Christopher E. Kline; Lora E. Burke; Evelyn G. Bigini; Christopher C. Imes. Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. Current Epidemiology Reports 2020, 7, 25 -38.

AMA Style

Maan Isabella Cajita, Christopher E. Kline, Lora E. Burke, Evelyn G. Bigini, Christopher C. Imes. Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep. Current Epidemiology Reports. 2020; 7 (1):25-38.

Chicago/Turabian Style

Maan Isabella Cajita; Christopher E. Kline; Lora E. Burke; Evelyn G. Bigini; Christopher C. Imes. 2020. "Feasible but Not Yet Efficacious: a Scoping Review of Wearable Activity Monitors in Interventions Targeting Physical Activity, Sedentary Behavior, and Sleep." Current Epidemiology Reports 7, no. 1: 25-38.

Journal article
Published: 03 January 2020 in Sleep and Breathing
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Physical activity has been associated with several individual dimensions of sleep. However, the association between physical activity and sleep health, a construct that emphasizes the multidimensional nature of sleep, has not been explored. This analysis examined the relationship between physical activity and a composite measure of sleep health. A total of 114 adults (66% female, 60.3 ± 9.2 years) were included in the analyses. Participants reported daily light-intensity physical activity (LPA) and moderate- and vigorous-intensity physical activity (MVPA) via diary, while wearing a pedometer (Omron HJ-720ITC) to measure daily steps. Sleep health was measured using the RU_SATED questionnaire, which addresses regularity of sleep patterns, satisfaction with sleep, daytime alertness, and sleep timing, efficiency, and duration. Multiple linear regression, binary logistic regression, and analysis of covariance (ANCOVA) were utilized for analyses. Mean sleep health score was 9.6 ± 2.4 (0 [poor]–12 [good]). Participants reported 62.9 ± 66.0 and 51.2 ± 51.2 min/day of LPA and MVPA, respectively, and took 5585.5 ± 2806.7 steps/day. Greater MVPA was associated with better sleep health (β = 0.27, P = 0.005) and sleep health scores differed between those reporting < 30 min/day and ≥ 60 min/day of MVPA (P = 0.004). Greater MVPA was associated with higher odds of having good sleep satisfaction (OR = 1.58 [1.14–2.20], P < 0.01), timing (OR = 2.07 [1.24–3.46], P < 0.01), and duration (OR = 1.48 [1.02–2.18], P = 0.04). Pedometer-based physical activity and LPA were not related to sleep health or its individual dimensions. In middle- to older-aged adults, higher-intensity activity, but not lower-intensity or volume of activity, was associated with greater sleep health. These data suggest that physical activity intensity may be important for sleep health.

ACS Style

Andrew G. Kubala; Daniel J. Buysse; Ryan C. Brindle; Robert T. Krafty; Julian F. Thayer; Martica H. Hall; Christopher E. Kline. The association between physical activity and a composite measure of sleep health. Sleep and Breathing 2020, 24, 1207 -1214.

AMA Style

Andrew G. Kubala, Daniel J. Buysse, Ryan C. Brindle, Robert T. Krafty, Julian F. Thayer, Martica H. Hall, Christopher E. Kline. The association between physical activity and a composite measure of sleep health. Sleep and Breathing. 2020; 24 (3):1207-1214.

Chicago/Turabian Style

Andrew G. Kubala; Daniel J. Buysse; Ryan C. Brindle; Robert T. Krafty; Julian F. Thayer; Martica H. Hall; Christopher E. Kline. 2020. "The association between physical activity and a composite measure of sleep health." Sleep and Breathing 24, no. 3: 1207-1214.

Reference work
Published: 24 December 2019 in Encyclopedia of Behavioral Medicine
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ACS Style

Christopher E. Kline. Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep). Encyclopedia of Behavioral Medicine 2019, 1 -5.

AMA Style

Christopher E. Kline. Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep). Encyclopedia of Behavioral Medicine. 2019; ():1-5.

Chicago/Turabian Style

Christopher E. Kline. 2019. "Actigraphy (Wrist, for Measuring Rest/Activity Patterns and Sleep)." Encyclopedia of Behavioral Medicine , no. : 1-5.

Reference work
Published: 23 December 2019 in Encyclopedia of Behavioral Medicine
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Polysomnogram; Sleep study Polysomnography is the simultaneous recording of numerous physiological signals during attempted sleep, including activity of the brain, heart, eyes, and muscles....

ACS Style

Christopher E. Kline. Polysomnography. Encyclopedia of Behavioral Medicine 2019, 1 -5.

AMA Style

Christopher E. Kline. Polysomnography. Encyclopedia of Behavioral Medicine. 2019; ():1-5.

Chicago/Turabian Style

Christopher E. Kline. 2019. "Polysomnography." Encyclopedia of Behavioral Medicine , no. : 1-5.