01 Jul 2017-Sports Medicine (Springer International Publishing)-Vol. 47, Iss: 7, pp 1303-1315
TL;DR: Currently, at least eight prospective, longitudinal studies using accelerometers are being conducted that may help to establish dose–response relationships between steps/day and health outcomes, and future challenges include the need to establish testing protocols and accuracy standards, and to decide upon the best placement sites.
Abstract: Step counting has long been used as a method of measuring distance. Starting in the mid-1900s, researchers became interested in using steps per day to quantify ambulatory physical activity. This line of research gained momentum after 1995, with the introduction of reasonably accurate spring-levered pedometers with digital displays. Since 2010, the use of accelerometer-based “activity trackers” by private citizens has skyrocketed. Steps have several advantages as a metric for assessing physical activity: they are intuitive, easy to measure, objective, and they represent a fundamental unit of human ambulatory activity. However, since they measure a human behavior, they have inherent biological variability; this means that measurements must be made over 3–7 days to attain valid and reliable estimates. There are many different kinds of step counters, designed to be worn on various sites on the body; all of these devices have strengths and limitations. In cross-sectional studies, strong associations between steps per day and health variables have been documented. Currently, at least eight prospective, longitudinal studies using accelerometers are being conducted that may help to establish dose–response relationships between steps/day and health outcomes. Longitudinal interventions using step counters have shown that they can help inactive individuals to increase by 2500 steps per day. Step counting is useful for surveillance, and studies have been conducted in a number of countries around the world. Future challenges include the need to establish testing protocols and accuracy standards, and to decide upon the best placement sites. These challenges should be addressed in order to achieve harmonization between studies, and to accurately quantify dose–response relationships.
TL;DR: High intensities were associated with significantly lower mortality rates among older women; however, after adjusting for steps per day, all associations were attenuated, and most were no longer significant.
Abstract: Importance A goal of 10 000 steps/d is commonly believed by the public to be necessary for health, but this number has limited scientific basis. Additionally, it is unknown whether greater stepping intensity is associated with health benefits, independent of steps taken per day. Objective To examine associations of number of steps per day and stepping intensity with all-cause mortality. Design, Setting, and Participants This prospective cohort study included 18 289 US women from the Women’s Health Study who agreed to participate by wearing an accelerometer during waking hours for 7 days between 2011 and 2015. A total of 17 708 women wore and returned their devices; data were downloaded successfully from 17 466 devices. Of these women, 16 741 were compliant wearers (≥10 h/d of wear on ≥4 days) and included in the analyses, which took place between 2018 and 2019. Exposures Steps per day and several measures of stepping intensity (ie, peak 1-minute cadence; peak 30-minute cadence; maximum 5-minute cadence; time spent at a stepping rate of ≥40 steps/min, reflecting purposeful steps). Main Outcomes and Measures All-cause mortality. Results Of the 16 741 women who met inclusion criteria, the mean (SD) age was 72.0 (5.7) years. Mean step count was 5499 per day, with 51.4%, 45.5%, and 3.1% of time spent at 0, 1 to 39 (incidental steps), and 40 steps/min or greater (purposeful steps), respectively. During a mean follow-up of 4.3 years, 504 women died. Median steps per day across low-to-high quartiles of distribution were 2718, 4363, 5905, and 8442, respectively. The corresponding quartile hazard ratios (HRs) associated with mortality and adjusted for potential confounders were 1.00 (reference), 0.59 (95% CI, 0.47-0.75), 0.54 (95% CI, 0.41-0.72), and 0.42 (95% CI, 0.30-0.60), respectively (P .05). Conclusions and Relevance Among older women, as few as approximately 4400 steps/d was significantly related to lower mortality rates compared with approximately 2700 steps/d. With more steps per day, mortality rates progressively decreased before leveling at approximately 7500 steps/d. Stepping intensity was not clearly related to lower mortality rates after accounting for total steps per day.
331 citations
Cites background from "Step Counting: A Review of Measurem..."
...of days with compliant wear, median (IQR)a 7 (6-7) 7 (7-7) 7 (7-7) 7 (7-7) H/d of wear on compliant daysa 14....
TL;DR: Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality and there was no significant association between step intensity and mortality after adjusting for total steps per day.
Abstract: Importance It is unclear whether the number of steps per day and the intensity of stepping are associated with lower mortality. Objective Describe the dose-response relationship between step count and intensity and mortality. Design, Setting, and Participants Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). Mortality was ascertained through December 2015. Exposures Accelerometer-measured number of steps per day and 3 step intensity measures (extended bout cadence, peak 30-minute cadence, and peak 1-minute cadence [steps/min]). Accelerometer data were based on measurements obtained during a 7-day period at baseline. Main Outcomes and Measures The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Hazard ratios (HRs), mortality rates, and 95% CIs were estimated using cubic splines and quartile classifications adjusting for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema. Results A total of 4840 participants (mean age, 56.8 years; 2435 [54%] women; 1732 [36%] individuals with obesity) wore accelerometers for a mean of 5.7 days for a mean of 14.4 hours per day. The mean number of steps per day was 9124. There were 1165 deaths over a mean 10.1 years of follow-up, including 406 CVD and 283 cancer deaths. The unadjusted incidence density for all-cause mortality was 76.7 per 1000 person-years (419 deaths) for the 655 individuals who took less than 4000 steps per day; 21.4 per 1000 person-years (488 deaths) for the 1727 individuals who took 4000 to 7999 steps per day; 6.9 per 1000 person-years (176 deaths) for the 1539 individuals who took 8000 to 11 999 steps per day; and 4.8 per 1000 person-years (82 deaths) for the 919 individuals who took at least 12 000 steps per day. Compared with taking 4000 steps per day, taking 8000 steps per day was associated with significantly lower all-cause mortality (HR, 0.49 [95% CI, 0.44-0.55]), as was taking 12 000 steps per day (HR, 0.35 [95% CI, 0.28-0.45]). Unadjusted incidence density for all-cause mortality by peak 30 cadence was 32.9 per 1000 person-years (406 deaths) for the 1080 individuals who took 18.5 to 56.0 steps per minute; 12.6 per 1000 person-years (207 deaths) for the 1153 individuals who took 56.1 to 69.2 steps per minute; 6.8 per 1000 person-years (124 deaths) for the 1074 individuals who took 69.3 to 82.8 steps per minute; and 5.3 per 1000 person-years (108 deaths) for the 1037 individuals who took 82.9 to 149.5 steps per minute. Greater step intensity was not significantly associated with lower mortality after adjustment for total steps per day (eg, highest vs lowest quartile of peak 30 cadence: HR, 0.90 [95% CI, 0.65-1.27];Pvalue for trend = .34). Conclusions and Relevance Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.
TL;DR: A taxonomy of sensors, functionalities, and methods used in non-invasive wrist-wearable devices was assembled and the main features of commercial wrist- wearable devices are presented.
Abstract: Wearable devices have recently received considerable interest due to their great promise for a plethora of applications. Increased research efforts are oriented towards a non-invasive monitoring of human health as well as activity parameters. A wide range of wearable sensors are being developed for real-time non-invasive monitoring. This paper provides a comprehensive review of sensors used in wrist-wearable devices, methods used for the visualization of parameters measured as well as methods used for intelligent analysis of data obtained from wrist-wearable devices. In line with this, the main features of commercial wrist-wearable devices are presented. As a result of this review, a taxonomy of sensors, functionalities, and methods used in non-invasive wrist-wearable devices was assembled.
180 citations
Cites background from "Step Counting: A Review of Measurem..."
...Regarding the comprehensive study, we can conclude that modern devices allow end-users very complex functionalities, as for example sleep tracking, stroke detection, detection of exercise and much more [67,68]....
TL;DR: Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 stepsper day.
Abstract: Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c) The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019 Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations Seventeen prospective studies involving over 30,000 adults were identified Five studies reported on all-cause mortality (follow-up time 4–10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years) For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6–36%) and CVD (5–21%) at follow-up were estimated across a subsample of included studies There was no evidence of significant interaction by age, sex, health conditions or behaviors (eg, alcohol use, smoking status, diet) among studies that tested for interactions Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day However, the shape of the dose-response relation is not yet clear Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit
150 citations
Cites background from "Step Counting: A Review of Measurem..."
...Pedometers, while extremely useful for epidemiologic assessment, often lack the ability to store data in memory on the device, requiring participants to complete step logs [36]....
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...Newer devices, such as accelerometers, have demonstrated excellent reliability and validity for walking, though this depends on where they are placed (usually waist-worn) and the model of the accelerometer [36, 37]....
TL;DR: The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac teleRehabilitation intervention during the COVID-19 pandemic.
Abstract: The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
TL;DR: Key guidelines in the Physical Activity Guidelines for Americans, 2nd edition, provide information and guidance on the types and amounts of physical activity that provide substantial health benefits and emphasize that moving more and sitting less will benefit nearly everyone.
Abstract: Importance Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases. Objective To summarize key guidelines in thePhysical Activity Guidelines for Americans, 2nd edition (PAG). Process and Evidence Synthesis The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the2018 Physical Activity Guidelines Advisory Committee Scientific Report. Recommendations The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial. Conclusions and Relevance ThePhysical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.
TL;DR: The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure.
Abstract: ContextWithout detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.ObjectiveTo evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.Data SourcesEnglish-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.Study SelectionStudies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.Data Extraction and Data SynthesisTwo investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.ResultsOur searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P < .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P < .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10 000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P < .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).ConclusionsThe results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.
2,085 citations
"Step Counting: A Review of Measurem..." refers background in this paper
...Several excellent, comprehensive reviews have been conducted that summarize this research [15, 46, 47]....
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...[15] identified eight randomized controlled trials (RCTs) and 18 studies without a control group that used step counters in an attempt to increase physical activity....
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...At about this time, other researchers began using pedometers for population surveillance [14] and walking interventions [15]....
TL;DR: This article evaluates popular recommendations for steps/day and attempts to translate existing physical activity guidelines into steps/ day equivalents and proposes the following preliminary indices be used to classify pedometer-determined physical activity in healthy adults.
Abstract: readily being used by researchers and practitioners to assess and motivate physical activity behaviours. Pedometer-determined physical activity indices are needed to guide their efforts. Therefore, the purpose of this article is to review the rationale and evidence for general pedometer-based indices for research and practice purposes. Specifically, we evaluate popular recommendations for steps/day and attempt to translate existing physical activity guidelines into steps/day equivalents. Also, we appraise the fragmented evidence currently available from associations derived from cross-sectional studies and a limited number of interventions that have documented improvements (primarily in body composition and/or blood pressure) with increased steps/day. A value of 10 000 steps/day is gaining popularity with the media and in practice and can be traced to Japanese walking clubs and a business slogan 30+ years ago. 10 000 steps/day appears to be a reasonable estimate of daily activity for apparently healthy adults and studies are emerging documenting the health benefits of attaining similar levels. Preliminary evidence suggests that a goal of 10 000 steps/day may not be sustainable for some groups, including older adults and those living with chronic diseases. Another concern about using 10 000 steps/ day as a universal step goal is that it is probably too low for children, an important target population in the war against obesity. Other approaches to pedometer-determined physical activity recommendations that are showing promise of health benefit and individual sustainability have been based on incremental improvements relative to baseline values. Based on currently available evidence, we propose the following preliminary indices be used to classify pedometer-determined physical activity in healthy adults: (i) 12 500 steps/day are likely to be classified as ‘highly active’.
TL;DR: In general, pedometers are most accurate for assessing steps, less accurate for assessing distance, and even less accurately for assessing kilocalories.
Abstract: CROUTER, S. E., P. L. SCHNEIDER, M. KARABULUT, and D. R. BASSETT, JR. Validity of 10 Electronic Pedometers for Measuring Steps, Distance, and Energy Cost. Med. Sci. Sports Exerc., Vol. 35, No. 8, pp. 1455–1460, 2003.PurposeThis study examined the effects of walking speed on the accuracy and
TL;DR: Methods for assessing physical activity and challenges for research measurement issues for the assessment of physical activity construct validity in physical activity research are presented.
Abstract: Methods for assessing physical activity and challenges for research measurement issues for the assessment of physical activity construct validity in physical activity research physical activity data - odd distributions yield strange answers equating and linking of physical activity questionnaires power calculations and the design of behavioural interventions use of self-report instruments to assess physical activity use of accelerometry-based activity monitors to assess physical activity use of heart rate monitors to assess physical activity use of pedometers to assess physical activity use of direct observation to assess physical activity use of doubly labelled water and indirect calorimetry to assess physical activity applying multiple methods to improve the accuracy of activity assessments physical activity assessment issues in population-based interventions - a stage environmental and policy measurement in physial activity research.
724 citations
"Step Counting: A Review of Measurem..." refers background in this paper
...In the 1990s, the use of step counters to measure physical activity and study relationships between physical activity and health began in earnest [2]....