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Hypertension is one of the greatest contributors to premature morbidity and mortality worldwide. It has been demonstrated that lowering blood pressure (BP) by just a few mmHg can bring substantial clinical benefits, reducing the risk of stroke and ischemic heart disease. Properly managing high BP is one of the most pressing global health issues, but accurate methods to continuously monitoring BP at home are still under discussion. Indeed, the BP for any given individual can fluctuate significantly during intervals as short as a few minutes. In clinical settings, the guidelines suggest to wait for 5 or 10 minutes in seated rest before taking the measure, in order to alleviate the effect of the stress induced by the clinical environment. Alternatively, BP measured in the home environment is thought to provide a more accurate measure free of the stress of a clinical environment, but there is currently a lack of extensive studies on the trajectory of serial BP measurements over minutes in the home setting. In this paper, we aim at filling this gap by analyzing a large dataset of more than 16 million BP measurements taken at home with commercial BP monitoring devices. In particular, we propose new techniques to analyze this dataset, taking into account the limitations due to the uncontrolled data collection, and we study the characteristics of the BP trajectory for consecutive measures over several minutes. We show that the BP values significantly decrease after 10 minutes minutes from the initial measurement (4.1 and 6.6 mmHg for the diastolic and systolic BP, respectively), and continue to decrease for about 25 minutes. We also describe statistically the clinical relevance of this change, observing more than 50% misclassifications for measurements in the hypertension region. We then propose a model to study the inter-subject variability, showing significant variations in the expected decrease in systolic BP. These results may provide the initial evidence for future large clinical studies using participant-monitored BP.

Objective: Fewer than 10% of French children meet the WHO recommendations for physical activity (PA). As engaging in play activities is a key way to promote PA in children, we evaluated the effect of a sports kit called “Le Sport Ca Me Dit” (“Sport is fun”) that provides a recreational way to engage in sports. Design: This was an open longitudinal controlled study. The children were divided into two groups for the first 7 weeks (Period 1): an Action group that used the kit for two recreational sessions per week (comprising six different activities) and a Control group that was not provided use of the kit. For the next 7 weeks (Period 2), neither group was provided use of the kit. Setting: Six towns in northern France. Subjects: 213 children aged 8-11 were recruited: 122 for the Control group and 91 for the Action group. Each child received a 3D accelerometer wristband to measure their level of PA during the 14 weeks of the study. In parallel, the children completed a questionnaire, 3 times (before (T0), during (T1) and at the end of the study (T2)), regarding their PA habits, screen time, and sleep habits. Results: A significant increase in the steps number was observed when the sports kit was used (p=0.025); although this effect was lost over time (p=0.672). Subpopulation analysis revealed a significant increase in the steps number and light PA in overweight children in the Action group for both periods (p=0.018 and p=0.012). Conclusion: The use of the sports kit increased the PA level of the children, and particularly in overweight children. Although these results require further investigation, they provide novel insights in regard to overweight children.

BACKGROUND Using the data from 56,365 individuals, from 185 countries, and a Nokia Health Wireless blood pressure (BP) monitor, we investigated real-world characteristics of BP variability (BPV). METHODS All included individuals self-measured and uploaded their BP using Bluetooth at least 20 times over a period of ≥1 month at a frequency and duration of their choosing. In total, 16,904,844 BP measurements were analyzed, with a median of 146 measurements per person (interquartile range [IQR] 73–321) over a median of 14 months (IQR 7–31). SD, coefficient of variation, maximum BP, and maximum minus minimum BP difference were all calculated as measures of BPV. RESULTS BPV showed a distinct pattern, influenced by season of year, day of week, and time of day. BPV index was higher in females compared with males (P < 0.001) and increased with age (P < 0.001). Compared to the weekend, the weekday BPV index was significantly higher, and this finding was more prominent in females (P = 0.001). In multivariate analysis, BPV index were significantly associated with age, gender, geographic location, and mean BP values. CONCLUSION Using the largest BP data set we are aware of, with the benefits and limitations of real-world measurement, we could show the pattern of BPV and provide reference values that may be helpful in understanding the nature of BPV as self-measurement at home becomes more common, and help guide individualized management.

Introduction et but de l’etude Aujourd’hui, a peine 50 % des enfants francais atteignent le niveau d’activite physique recommande par l’OMS (soit 1 h d’activite moderee a intense par jour). Le jeu est sans doute un moyen de promouvoir l’activite physique chez les jeunes. Le but de cette etude est d’etudier l’impact a court et moyen terme d’un outil ludique et original, le kit « Le sport ca me dit » (LSCMD) sur l’activite physique des enfants de 8 a 11 ans. Materiel et methodes Deux cent treize enfants âges de 8 a 11 ans ont ete recrutes au sein du programme communautaire EPODE de la commune de Flandre-Lys. Quatre-vingt-onze enfants, composant le groupe action, ont beneficie de seances d’activite physique bihebdomadaires en utilisant le kit, qui comprend 6 activites differentes, pendant les 7 premieres semaines de l’etude. Les 122 autres enfants ont compose le groupe temoin. Chaque enfant de l’etude a recu un bracelet accelerometre 3D afin de mesurer precisement son activite physique reelle. Ces mesures ont ete relevees pendant une periode de 7 semaines d’action et pendant une autre periode de 7 semaines supplementaires apres l’action. En parallele, tous les enfants ont rempli un questionnaire, avant, pendant et a la fin de l’etude, sur leurs habitudes concernant leur activite physique, le temps d’ecran et les habitudes de sommeil. L’activite physique des enfants a ete etudiee via les reponses aux questionnaires et via l’accelerometre. Les donnees ont ete traitees statistiquement afin de comparer la difference entre les groupes action et controle et de mesurer leur difference d’evolution dans le temps. Resultats et analyse statistique Quatre-vingt-six pour cent des enfants ont declare avoir envie de bouger apres l’utilisation du kit. On observe chez le groupe action une evolution positive du comportement actif des enfants (deplacement a pied ou a velo…), significativement differente (p = 0,021) du groupe temoin. Un effet significatif (p = 0,038) du kit est observe sur l’intensite de la pratique physique des enfants du groupe action. Aucun impact n’est observe sur les temps passes des enfants devant la television. Au niveau des donnees de l’accelerometre, on observe un effet significatif (p = 0,025) du kit, durant la periode de son utilisation, sur le nombre de pas effectues en semaine (mais pas le week-end) ; neanmoins, cet effet s’estompe par la suite (p = 0,672). L’analyse de la sous-population des enfants en surcharge ponderale montre un impact du kit significatif plus important sur le nombre de pas de cette population et ce sur les deux periodes de l’etude (p = 0,018 et p = 0,012) ; neanmoins, l’effectif de cette population est faible. Conclusion Cette etude montre l’interet chez les enfants, de cet outil ludique sur le niveau d’activite physique et sur la motivation a pratiquer une activite physique. Un effet positif est observable a court terme mais s’estompe a moyen terme. L’impact positif de l’utilisation du kit sur les enfants en surcharge ponderale merite consideration, s’il est confirme sur un effectif superieur, il ouvre des perspectives interessantes pour ces enfants.

Background: Digital self-monitoring, particularly of weight, is increasingly prevalent. The associated data could be reused for clinical and research purposes. Objective: The aim was to compare participants who use connected smart scale technologies with the general population and explore how use of smart scale technology affects, or is affected by, weight change. Methods: This was a retrospective study comparing 2 databases: (1) the longitudinal height and weight measurement database of smart scale users and (2) the Health Survey for England, a cross-sectional survey of the general population in England. Baseline comparison was of body mass index (BMI) in the 2 databases via a regression model. For exploring engagement with the technology, two analyses were performed: (1) a regression model of BMI change predicted by measures of engagement and (2) a recurrent event survival analysis with instantaneous probability of a subsequent self-weighing predicted by previous BMI change. Results: Among women, users of self-weighing technology had a mean BMI of 1.62 kg/m 2 (95% CI 1.03-2.22) lower than the general population (of the same age and height) ( P