Health Signatures During COVID-19: A Precision Fitness Case Study

BACKGROUND Stay-at-home orders have proven a controversial, while effective, method of SARS-CoV-2 containment. However objective measures of how the pandemic and stay-at-home orders are affecting the daily health of uninfected individuals have been lacking. METHODS We investigated the effect of pandemic-related events on 61 individuals in San Antonio, Texas whose daily activity and sleep data were recorded via wearable activity trackers from April 2019 to August 2020. We assessed changes in six fitness metrics (steps walked, resting heart rate, sedentary minutes, wake duration after sleep onset, rapid eye movement (REM) duration, total sleep duration). Cluster analysis and time-course analysis identified trends in activity before, after and during stay-at-home orders. Quantitative measures of activities were compared to survey responses. RESULTS Four behavior patterns during stay-at-home orders were identified. Most individuals suffered declines in healthy habits compared to their daily activity in 2019 and early 2020 (e.g., up to −60% steps walked). Inflection points corresponded with key dates relevant to SARS-CoV-2 including the first reported case in the U.S. (Feb 29) and city-wide stay-at-home orders (Mar 23). Pre-existing conditions (diabetes, asthma) were associated with a steeper than average decline in sleep quality during stay-at-home orders. Unexpectedly, we also identified a group of predominately male individuals who improved their daily fitness during stay-at-home orders. CONCLUSIONS Objective measures of daily activity indicated most individuals’ fitness suffered at the onset of stay-at-home orders and slowly returned towards baseline. For a subset of individuals, fitness quantitatively improved – better sleep, more exercise, lower resting heart rate – during stay-at-home orders. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement NSF Neural and Cognitive Systems grant 1533708 to A.A.Q. and a Brain Health Consortium fellowship to E.P.P. helped support initial studies that developed the modeling infrastructure and data collection of this current study. No external funding explicitly covered this paper's topic. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB Protocol 19-077R All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data described and analyzed in the paper is provided and archived.