Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity

Researchers and practitioners require guidelines for using electronic pedometers to objectively quantify physical activity (specifically ambulatory activity) for research and surveillance as well as clinical and program applications. Methodological considerations include choice of metric and length of monitoring frame as well as different data recording and collection procedures. A systematic review of 32 empirical studies suggests we can expect 12,000-16,000 steps/day for 8-10-year-old children (lower for girls than boys); 7,000-13,000 steps/day for relatively healthy, younger adults (lower for women than men); 6,000-8,500 steps/day for healthy older adults; and 3,500-5,500 steps/day for individuals living with disabilities and chronic illnesses. These preliminary recommendations should be modified and refined, as evidence and experience using pedometers accumulates.     

Associations of subjective social status with accelerometer-based physical activity and sedentary time among adolescents

This study examined the associations of subjective social status (SSS) with physical activity (PA) and sedentary time (ST) among adolescents. The study population consisted of 420 Finnish adolescents aged 13 to 14 years. The adolescents reported their own SSS within their school (school SSS) and their family’s social position within society (society SSS) based on the youth version of the Subjective Social Status Scale. Adolescents’ moderate- to vigorous-intensity physical activity (MVPA) and ST were measured objectively by accelerometers and analyzed separately for the whole day and the school day. The associations between SSS and MVPA and ST outcomes were analyzed using multilevel modeling. School SSS was positively associated with whole-day MVPA and negatively associated with school-time ST. Society SSS was not significantly associated with objectively measured MVPA or ST. Both MVPA and ST are important behavioral determinants of health. As an important correlate of MVPA and ST, school SSS should be addressed by providers when discussing obesity risk and healthy behaviors with adolescents.     

A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents

Lack of physical activity (PA) and high levels of sedentary behaviour (SB) have been associated with health problems. This systematic review evaluates the effectiveness of school-based interventions to increase PA and decrease SB among 15–19-year-old adolescents, and examines whether intervention characteristics (intervention length, delivery mode and intervention provider) and intervention content (i.e. behaviour change techniques, BCTs) are related to intervention effectiveness. A systematic search of randomised or cluster randomised controlled trials with outcome measures of PA and/or SB rendered 10 results. Risk of bias was assessed using the Cochrane risk of bias tool. Intervention content was coded using Behaviour Change Technique Taxonomy v1. Seven out of 10 studies reported significant increases in PA. Effects were generally small and short-term (Cohen's d ranged from 0.132 to 0.659). Two out of four studies that measured SB reported significant reductions in SB. Interventions that increased PA included a higher number of BCTs, specific BCTs (e.g., goal setting, action planning and self-monitoring), and were delivered by research staff. Intervention length and mode of delivery were unrelated to effectiveness. More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents.     

Weekday and weekend patterns of physical activity and sedentary time among Liverpool and Madrid youth

Abstract

Levels of physical inactivity and sedentary behaviour among English and Spanish youth are high and vary within different regions of each country. Little though is known about these during specific periods of the day. The purpose of this study was to describe physical activity (PA) and sedentary time during segments of the day and week, and compare these critical contexts between youth in the Liverpool and Madrid areas of England and Spain, respectively. PA was objectively assessed in 235 Liverpool- and 241 Madrid youth (aged 10–14 years) who wore accelerometers for seven consecutive days. Minutes of sedentary time, moderate PA, vigorous PA and moderate-to-vigorous physical activity (MVPA) were calculated for weekdays, weekend days, school time, non-school time and after-school. Between-country differences were analysed using analysis of covariance (ANCOVA). Madrid youth spent significantly more time in sedentary activities than their Liverpool counterparts. Madrid youth engaged in more minutes of moderate intensity physical activity (MPA) than Liverpool youth during weekdays, school time and non-school time (P<0.01). Liverpool children recorded more time in vigorous physical activity (VPA) than Madrid peers during week days and weekend days (P<0.01) and during school time and after-school periods (P <0.01). The MVPA was significantly higher among Madrid youth during non-school time (P<0.01). Around 25% of all youth achieved recommended levels of MVPA. Low levels of MVPA and systematic differences in sedentary time, MPA and VPA exist between Liverpool and Madrid youth. Interventions targeted at the least-active children during weekends, after-school and non-school periods within the cultural contexts common to each city are required.     

Practical considerations when using pedometers to assess physical activity in population studies: lessons from the Burnie Take Heart Study

The aim of this study was to summarize both practical and methodological issues in using pedometers to assess physical activity in a large epidemiologic study. As part of a population-based survey of cardiovascular disease risk factors, physical activity was assessed using pedometers and activity diaries in 775 men and women ages 25-64 years who were residents of Burnie, Tasmania, 1998-99. Common data problems were classified by type. The frequency of each problem and the methods used to identify it are reported along with strategies to correct or prevent each problem type. Pedometer data from 15 (1.9%) participants could not be used due to errors in completing the pedometer protocol. Among 760 participants with usable data, the median number of steps was 9,729 for men and 10,388 for women. Pedometer steps per day were modestly correlated (r = .20, p < .0001) with the duration of pedometer wear, which ranged from 4.50 to 21.75 hr. Adjustment for wear time, however, did not alter observed correlations between pedometer steps and cardiovascular risk factors. The authors conclude that pedometers can be used in large population studies with a relatively low frequency of data errors. However guidelines for consistent data collection and interpretation are needed.     

Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.     

Health-enhancing physical activity and sedentary behaviour in children and adolescents

We provide a wide-ranging review of health-related physical activity in children and adolescents using a behavioural epidemiology framework. In contrast to many other reviews, we highlight issues associated with true sedentary behaviours alongside physically active behaviours. Specifically, we review the evidence concerning the links between physical activity and cardiovascular disease, overweight and obesity, psychosocial measures, type II diabetes, and skeletal health. Although the evidence is unconvincing at times, several factors lead to the conclusion that promoting physical activity in youth is desirable. A review of the prevalence of physical activity and sedentary behaviours shows that many young people are active, but this declines with age. A substantial number are not adequately active for health benefits and current trends in juvenile obesity are a cause for concern. Prevalence data on sedentary behaviours are less extensive but suggest that total media use by young people has not changed greatly in recent years. Most children and adolescents do not exceed recommended daily hours of TV viewing. Physical activity is unrelated to TV viewing. We also identified the key determinants of physical activity in this age group, highlighting demographic, biological, psychological, behavioural, social and environmental determinants. Interventions were considered for school, family and community environments. Finally, policy recommendations are offered for the education, governmental, sport and recreation, health, and mass media sectors.     

Comparability of accelerometer- and IPAQ-derived physical activity and sedentary time in South Asian women: A cross-sectional study

Abstract

There is limited research documenting objectively measured physical activity (PA) and sedentary time (ST) in South Asian (SA) women, with no published evidence of the validity of self-report methods for assessment of PA/ST in SA. The purpose of this study was to compare accelerometer- and International Physical Activity Questionnaire (IPAQ)-derived PA/ST among SA women in the United Kingdom (UK) via a mixed-methods approach. One hundred and forty SA women wore an accelerometer for seven consecutive days; a sub-sample (n = 50) completed the IPAQ-Short Form (IPAQ-SF) and a brief structured interview. Accelerometer-derived metabolic equivalent (MET) minutes per week (min/wk) moderate-to-vigorous physical activity (MVPA) (mean ± SD) for the full sample was 793.94 (±519.44) and mean accelerometer-derived ST wk was 530.20 (±81.76). IPAQ-SF-derived MVPA (MET min/wk) was 636.80 (±2113.56) and mean ST wk was 315.31 (±266.98). Pearson correlations were not significant between accelerometer- and IPAQ-SF-assessed MVPA (r = ?.119, p = .579) and ST (r = ?.140, p = .229). Major themes synthesised from interviews included inability to recall sitting time and limited general knowledge of real-life examples of MVPA. These results suggest that the IPAQ-SF may not accurately measure PA/ST in the UK SA women. These findings are supported by qualitative evidence indicating several issues with interpretation and recall of PA/ST as assessed via this questionnaire.     

Intensity of lifetime physical activity and breast cancer risk among Polish women

Abstract

Physical activity is associated with a lower risk of breast cancer, although research findings are inconsistent regarding the type, duration, intensity, and frequency of activities that are necessary to reduce the risk, as well as dependence on menopausal status. To address these issues, I examined the effect of physical activity on breast cancer risk among 858 Polish invasive breast cancer cases and 1085 controls. Data on components of lifetime household, occupational, and recreational activities were collected in 2003–2007, using a self-administered questionnaire. Odds ratios with 95% confidence intervals were estimated using unconditional logistic regression analyses and a full assessment of confounding variables. For all types of physical activity, odds ratios were calculated for self-reported and compendium-based assigned levels of activity. Moderate- and vigorous-intensity total and recreational activities, as well as moderate- and long-lasting low-intensity household activities, lowered the risk by at least 44% for the highest versus lowest quartiles of activity in both menopausal groups. The associations were linear (P_trend≤ 0.009). There was a suggestion of a risk reduction for occupational activity among post-menopausal women. These findings show that a risk reduction can be achieved by vigorous-intensity activities or by longer-lasting activities of moderate-intensity.     

Associations of accelerometer-measured sedentary time,sedentary bouts,and physical activity with adiposity and fitness in children

ABSTRACT

Sedentary time (ST) has been inconsistently associated with adiposity and cardiorespiratory fitness in children in previous studies. We studied cross-sectional associations of ST, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with fat mass index (FMI) and cardiorespiratory fitness (estimated VO₂max). Associations were evaluated with and without considering pattern of ST by bout length. We measured ST and activity by a wrist-worn accelerometer, FMI by bioelectrical impedance, and VO₂max by Pacer test in 443 children (51.2% girls, 10.2 ± 0.6 years). Isotemporal substitution regression models estimated the effects of substituting ST, LPA, and MVPA on FMI and VO₂max. Further models repeated analyses separating ST into short (<10 min) and long (≥10 min) bouts. Only replacing ST or LPA with MVPA was consistently associated with lower FMI and greater VO₂max. When separated by bout length, only one unique association was found where replacing long ST bouts with short ST bouts was associated with lower FMI in girls only. In conclusion, activity pattern is associated with adiposity in girls and fitness in boys and girls. Separating ST into long and short ST bouts may be of minimal importance when assessing associations with adiposity and fitness using wrist-worn accelerometry in children.     

Promoting physical activity using a wearable activity tracker in college students: A cluster randomized controlled trial

This study examined the effects of utilizing a wearable activity tracker in a credit-based physical activity instructional program (PAIP) for promoting physical activity (PA) in college students. Fourteen PAIP courses in a large public university were randomly assigned into intervention (k = 7; n = 101) and control (k = 7; n = 86) groups. All courses focused on a core curriculum that covers basic exercise and behavioral science contents through lectures and activity sessions. A Misfit Flash activity tracker was provided to students in the intervention group. Objective PA assessments occurred at baseline, mid-, and end-of-semester during a 15-week academic semester. The control group showed a significant reduction in moderate- and vigorous-intensity PA (MVPA) minutes from baseline to the end-of-semester (P <.05), whereas the intervention group showed no changes in MVPA minutes over time. However, the intervention group also showed increased sedentary time and decreased time spent in light-intensity PA during the intervention period. Taken together, the present study found null effects of utilizing the wearable activity tracker in promoting PA in college students suggesting that intervention of primary using the wearable activity tracker as a behavior change strategy may not be effective to increase in PA in this setting.     

Exploring the challenges in obtaining physical activity data from women using hip-worn accelerometers

Quality objective physical activity data are required to inform physical activity-based health improvement initiatives, however, various challenges undermine acquisition of such data. We examined the efficacy and challenges of a hip-worn accelerometry protocol in women. Specific objectives included determining accelerometer-wear-compliance rates and understanding the barriers and acceptability of wearing accelerometers. Healthy New Zealand women (n?=?406) of three ethnicities (Māori (indigenous New Zealander), Pacific, European) aged 16–45 years (30.9?±?8.7 y) wore hip-mounted Actigraph wGT3X+ accelerometers for 7 consecutive days under a 24-h wear protocol. Post hoc, a sub-sample (n?=?45; age: 29.4?±?9.0 y) was interviewed to investigate comfort/convenience and burdens of accelerometer-wear. Wear-compliance (≥10?h/day, ≥4 day) was 86%. European women returned more valid data (92.7%, p?<?.04) than Pacific (73.0%) or Māori women (82.1%). Twenty-two participants (5.4%) had completely missing data; 13 due to lost accelerometers. Burden of accelerometer-wear was greatest during sleeping (66.7%) due to discomfort. Embarrassment of accelerometer visibility through clothing and consequent restricted clothing choices caused high burden in social settings (45.2%). Discomfort during sleeping, embarrassment due to perceived appearance in social settings and ethnicity are key factors affecting the efficacy of collecting physical activity data from women using hip-worn accelerometers. Refining accelerometer design to reduce size and subsequently participant burden should improve acceptability and wear-compliance. Increasing overall participant compliance by reducing burden and ensuring appropriate understanding of study aims and relevance should reduce attrition and improve wear-compliance and data quality when collecting accelerometry data from women of different ethnicities.     

Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors: A systematic review and meta-analysis

Purpose:This systematic review and meta-analysis aimed to evaluate the effect of wearable devices for improving physical activity and healthrelated outcomes in cancer survivors.Methods:CINAHL,Cochrane,Ebscohost,MEDLINE,Pubmed,ProQuest Health and Medical Complete,ProQuest Nursing and Allied Health Source,ScienceDirect,and SPORTDiscus databases were searched for randomized controlled trials published before September 1,2020,that evaluated interventions involving wearable devices in cancer survivors.Standardized mean differences(SMDs)were calculated to assess effects on physical activity and health-related outcomes.Subgroup analyses were conducted to assess whether the effects differed by interventions and cancer characteristics.Risk of bias was assessed using the Cochrane risk of bias tool.Results:Thirty-five trials were included(breast cancer,n=15,43%).Intervention durations ranged between 4 weeks and 1 year.Most trials(n=25,71%)involved pedometer-based physical activity interventions.Seven(20%)involved Fitbit-based interventions,and 3(9%)involved other wearable physical activity trackers(e.g.,Polar,Garmin).Compared to usual care,wearable devices had moderate-to-large effects(SMD range 0.54-0.87,p<0.001)on moderate-intensity physical activity,moderate-to-vigorous-intensity physical activity,total physical activity,and daily steps.Compared to usual care,those in the intervention had higher quality of life,aerobic fitness,physical function,and reduced fatigue(SMD range=0.18-0.66,all p<0.05).Conclusion:Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer.Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.     

Associations of total sedentary time,screen time and non-screen sedentary time with adiposity and physical fitness in youth: the mediating effect of physical activity

The aims of the present study were: i) to examine the associations of total accelerometer-based sedentary time (ST) and specific-domain self-reported ST (i.e., screen-based, educational-based, social-based, and other-based ST) with adiposity and physical fitness in youth; and ii) to analyse the mediation effect of physical activity (PA) on associations.

This study was conducted with 415 children (9.1 ± 0.4 years) and 853 adolescents (13.6 ± 1.6 years) in Spain during 2011–2012. Total ST and PA were assessed by accelerometry. Leisure-time spent in twelve sedentary behaviours was self-reported. Adiposity and physical fitness was measured following the ALPHA battery for youth.

Total accelerometer-based ST was positively associated with global adiposity score in children, and negatively associated with global physical fitness score in children and adolescents; but relationships were not independent of PA. PA mediated all associations of accelerometer-based and self-reported ST with adiposity or physical fitness in children. Conversely, screen-, educational-, social-, and other-based ST were negatively related to physical fitness in adolescents, independently of PA.

These findings give an impetus to developing effective strategies for specifically promoting PA in children and for increasing PA while reducing ST in adolescents in order to produce improvements on adiposity and physical fitness.     

Randomized controlled trial of effectiveness of pedometers on general practitioners' attitudes to engagement in and promotion of physical activity

Abstract

Pedometers have been identified as a tool for health professionals to promote physical activity. This study, which aimed to evaluate the effectiveness of wearing a pedometer on general practitioners' attitudes to promoting physical activity, was a pragmatic, multi-centred, randomized controlled trial within a primary care trust in England. The participants were 102 general practitioners (GPs). Eighty-five (48 males, 37 females) of the GPs completed pre and post questionnaires, 43 of whom were in the intervention group. Statistical analysis revealed no significant changes between the control and intervention groups for attitude to engage in physical activity (t ₈₃ = 1.13, CI ?0.362 to 0.099) or attitude to promote physical activity in their patients (t ₈₃ = 1.7, CI ?0.593 to 0.045). A higher volume of walking was significantly correlated with a more positive attitude to engage in physical activity (r = 0.58, P < 0.01) but not with a more positive attitude to promoting physical activity. Wearing a pedometer had no significant effect on GPs' attitudes to engaging in physical activity or promoting physical activity in their patients.     

Compensatory changes in physical activity and sedentary time in children and adolescents with cystic fibrosis

Physical activity (PA) is a key element in Cystic Fibrosis (CF) treatment strategies, yet little is known as to whether activity compensation occurs. This study examined whether PA and/or sedentary time on one day were temporally associated with time spent in these intensities the following day in youth with CF. Time spent sedentary and in different PA intensities were objectively-measured for seven consecutive days in 50 youth (22 boys; 12.0 ± 2.7 years); 25 with mild-to-moderate CF and 25 age- and sex-matched controls. Multilevel analyses (day and child) were conducted using generalised linear latent and mixed models. On any given day, every additional 10 minutes spent in sedentary time or moderate-to-vigorous physical activity (MVPA) were associated with 1.9 (95%CI: ?3.6 to ?1.2) and 12.4 (95%CI: ?22.1 to ?2.9) minutes less sedentary time the following day, respectively. These temporal associations were also observed when split by group (3.1 vs. 1.9 minutes for healthy and CF, respectively). These findings indicate that youth do not compensate their PA, irrespective of disease status, between days, but may compensate their sedentary time between days. Experimental studies are warranted to fully elucidate whether compensatory responses to PA and sedentary time occur, which is fundamental for informing PA promotion strategies.     

Associations of physical activity,sedentary time,and physical fitness with mental health during pregnancy: The GESTAFIT project

PurposeThis study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy.MethodsFrom 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain.ResultsModerate-to-vigorous PA was negatively associated with depression (β = –0.222, adjusted R² = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (β = –0.260, adjusted R² = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (β = 0.195, adjusted R²= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05).ConclusionAn active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.     

Inter-participant variability in daily physical activity and sedentary time among male youth sport footballers: independent associations with indicators of adiposity and cardiorespiratory fitness

Participation in youth sport is assumed to promote and contribute towards more physically active lifestyles among children and adolescents. The aim of this study was to examine inter-participant variability in objectively measured habitual physical activity (PA) behaviours and sedentary time among youth sport participants and their implications for health. One-hundred-and-eighteen male youth sport footballers (Mean ± s = 11.72 ± 1.60) wore a GT3X accelerometer for 7 days. Average daily PA [min · day^?1, in light (LPA), moderate (MPA), vigorous (VPA) and combined moderate-to-vigorous (MVPA)] and sedentary time were calculated. Participants’ body mass index adjusted for age and sex (BMI–standard deviation score), per cent body fat (BF%), waist circumference and cardiorespiratory fitness were assessed. Results revealed that variability in daily PA behaviours and sedentary time (min · day^?1) was associated with BMI–standard deviation score [VPA (?), MVPA (?)], BF% [sedentary time (+), VPA (?), MVPA (?)], waist circumference [sedentary time (+), LPA (?)] and cardiorespiratory fitness [sedentary time (?), MPA (+), VPA (+), MVPA (+)]. Whilst sedentary time and MVPA were not related to health outcomes independent of one another, associations with markers of adiposity and cardiorespiratory fitness were stronger for sedentary time. Sedentary time was also significantly positively related to waist circumference independent of VPA. Results demonstrate inter-participant variability in habitual PA and sedentary time among youth sport participants which holds implications for their health. Thus, promoting PA and, in particular, reducing sedentary time may contribute towards the prevention of adverse health consequences associated with a physically inactive lifestyle for children and adolescents active in the youth sport context.