Can older adults improve the identification of moderate intensity using walking cadence?

Efficacy of a Wearable Activity Tracker With Step-by-Step Goal-Setting on Older Adults' Physical Activity and Sarcopenia Indicators: Clustered Trial

BACKGROUND

Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia.

OBJECTIVE

The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults' physical activity and sarcopenia indicators.

METHODS

The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests.

RESULTS

All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group.

CONCLUSIONS

A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults' physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations.

Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: a systematic scoping review and suggestions for future reporting and research

Strategies for dissemination (purposive distribution of a guideline to specific audiences) and implementation (actions to support the general public in meeting guideline recommendations/behavioural benchmarks) of national movement guidelines (physical activity (PA), sedentary behaviour, and sleep) have yet to be synthesized. The purpose of this systematic scoping review was to identify strategies for dissemination and implementation of national PA, sedentary behaviour, and/or sleep guidelines among community-dwelling adults (aged >18 years) and/or stakeholders in Canada and analogous countries. Five search approaches (e.g., published literature, grey literature, targeted web-based, custom Google, and content expert consultation) identified records (e.g., empirical studies, organizational reports, website pages, or guideline messages) that discussed and/or evaluated dissemination or implementation strategies for a prespecified list of guidelines. A modified strategy classification system was developed to chart the data. Forty-seven reports met inclusion criteria. Dissemination strategies (n = 42) were more frequently reported than implementation strategies (n = 24). Implementation strategies were more frequently evaluated (n = 13 vs. 7 dissemination strategies) and associated with positive outcomes. The 13 studies that evaluated strategies were at high or serious risk of bias. We identified limited information about the dissemination and implementation of national movement guidelines and identified strategies were rarely evaluated. Greater efforts are required to increase the impact of guidelines among the general public and stakeholders and to build the evidence base in this field. (Open Science Framework registration: https://osf.io/4tyw3.) Novelty An adapted movement guideline dissemination and implementation strategy classification framework is provided. Knowledge translation efforts should be documented and evaluated to advance science and practice in the movement guideline field.

Remote Monitoring Model for the Preoperative Prehabilitation Program of Patients Requiring Abdominal Surgery

Physical fitness and level of activity are considered important factors for patients with cancer undergoing major abdominal surgery. Cancer patients with low fitness capacity are at greater risk of postoperative complications, longer hospital stays, and mortality. One of the main challenges facing both healthcare providers and patients is to improve the patient’s physical fitness within the available short period (four to six weeks) prior to surgery. Supervised and unsupervised physical prehabilitation programs are the most common recommended methods for enhancing postoperative outcomes in patients undergoing abdominal surgery. Due to obstacles such as geographical isolation, many patients have limited access to medical centers and facilities that provide onsite prehabilitation programs. This article presents a review of the literature and the development of a model that can remotely monitor physical activities during the prehabilitation period. The mixed prehabilitation model includes the identification of fundamental parameters of physical activities (type, intensity, frequency, and duration) over time. A mathematical model has been developed to offer a solution for both the healthcare provider and patients. This offers the opportunity for physicians or physiotherapists to monitor patients performing their prescribed physical exercises in real time. The model that has been developed is embedded within the internet of things (IoT) system, which calculates the daily and weekly efforts made by the patients and automatically stores this in a comma-separated values (CSV) file that medical staff can access. In addition, this model allows the patient to compensate for missed prescribed activity by adding additional efforts to meet the prehabilitation requirements. As a result, healthcare staff are provided with feedback on patient engagement in prescribed exercise during the period of the prehabilitation program.

Physical activity monitors to enhance amount of physical activity in older adults - a systematic review and meta-analysis

Background

The body of evidence related to the effect of physical activity monitor-based interventions has grown over the recent years. However, the effect of physical activity monitor-based interventions in older adults remains unclear and should be systematically reviewed.

Objective

The objective of this systematic review was to estimate the effect of physical activity monitor-based interventions on physical activity behavior in participants aged 65 and above. Subsequently we explored the effect on body mass index, physical capacity, and health-related quality of life and finally the impact of patient- and intervention characteristics.

Methods

Searches in MEDLINE, EMBASE, SPORTDiscus, CINAHL, and CENTRAL were performed on April 26, 2018. No publication date filters were applied. References of eligible studies were scrutinized and relevant journals were hand-searched. Randomized controlled trials and randomized cross-over trials investigating the effect of a physical activity monitor-based intervention on physical activity were included. Studies were included if the mean age of the participants was above 65 years, and participants could walk independently with or without walking aids. The Cochrane handbook was used as a template for extracting data and the RoB 2.0 tool was used to assess risk of bias. Random-effects meta-analysis using Hedges g, were used to pool the study results. The main outcome of this study was physical activity.

Results

Twenty-one studies with 2783 participants were included. The median participant age in the studies was 70.5 years, the median percentage of male participants was 42%, and the median baseline daily step count was 5268. Physical activity monitor-based interventions had a moderate effect (SMD = 0.54, 95% CI: 0.34 to 0.73) compared to control interventions, corresponding to an average increase of 1297 steps per day in the intervention groups. No impact of patient and intervention characteristics on the effect estimates were found.

Short conclusion

Low quality of evidence was found for a moderate effect of physical activity monitor-based interventions on physical activity compared with control interventions. More studies with higher research methodology standards are required.

PROSPERO registration

CRD42018083648.

Electronic supplementary material

The online version of this article (10.1186/s11556-019-0213-6) contains supplementary material, which is available to authorized users.

Influence of Anthropometrics on Step-Rate Thresholds for Moderate and Vigorous Physical Activity in Older Adults: Scientific Modeling Study

BACKGROUND

Adults and older adults are recommended to engage in 150 minutes of moderate (MPA) to vigorous (VPA) aerobic physical activity (MVPA) per week, with the heuristic message of 3000 steps in 30 minutes (100 steps per minute [spm]). However, this message is based on adult populations, with a paucity of research on step-rate thresholds that correspond to absolute MVPA (moderate=3 metabolic equivalents [METs], vigorous=6 METs) and relative MVPA (moderate=40% estimated MET_max, vigorous=60% estimated MET_max) in older persons, who have lower stride lengths and a lower exercise capacity. Also, there is a need to consider the influence of anthropometric differences when quantifying the relationship between step rate and intensity-related physical activity.

OBJECTIVE

This study assessed absolute and relative MVPA step-rate thresholds and anthropometric factors (ie, height, leg length, and body mass index [BMI]) in older adults.

METHODS

Nineteen older adults (7 females; age 69 years, SD 2, BMI 26 kg/m², SD 4) completed a staged treadmill walking protocol: six minutes at 2.4, 3.2, 4.0, 5.6, and 6.4 km/h. Steps were manually counted and volume rate of oxygen consumed (VO₂) was measured via indirect calorimetry. Aerobic fitness was estimated via the submaximal single-stage treadmill protocol.

RESULTS

When BMI was considered, mixed effects modeling revealed absolute and relative MPA step-rate thresholds of 108 spm and 117 spm, respectively. Absolute and relative VPA corresponded to step rates of 135 spm and 132 spm, respectively. Neither height nor leg length improved the ability of the model to predict stepping cadence from METs.

CONCLUSIONS

In general, older adults need to walk faster than 100 spm (ie, approximately 110 spm) to reach MPA and in excess of approximately 130 spm to achieve VPA, depending on BMI status. Health care professionals and researchers should adjust cadence-based recommendations for differences in BMI in their older patients and consider using relative intensity to most appropriately tailor their physical activity recommendations.

Medical-Grade Physical Activity Monitoring for Measuring Step Count and Moderate-to-Vigorous Physical Activity: Validity and Reliability Study

Background

The use of physical activity (PA) monitors is commonly associated with an increase in habitual PA level in healthy and clinical populations. The PiezoRx is a medical-grade PA monitor that uses adjustable step rate thresholds to estimate moderate-to-vigorous physical activity (MVPA) and is a valid indicator of free-living PA in adults. Laboratory validation of step count derived MVPA in adults is needed to justify the use of these monitors in clinical practice to track individuals’ progress toward meeting PA guidelines that are based on MVPA, not steps.

Objective

The objective of our study was to assess the validity and interinstrument reliability of the PiezoRx to derive step count and MVPA in a laboratory setting compared with criterion measures and other frequently used PA monitors in a diverse sample of adults.

Methods

The adult participants (n=43; 39.4 years, SD 15.2) wore an Omron HJ-320 pedometer, an ActiGraph GT3X accelerometer, and four PiezoRx monitors during a progressive treadmill protocol conducted for 6 minutes at speeds of 2.4, 3.2, 4.0, 5.6, 6.4, and 7.2 km/hour, respectively. The four PiezoRx monitors were set at different MVPA step rate thresholds (MPA in steps/minute/VPA in steps/minute) 100/120, 110/130, height adjusted, and height+fitness adjusted.

Results

The PiezoRx was more correlated (intraclass correlation, ICC=.97; P<.001) to manual step counting than the ActiGraph (ICC=.72; P<.001) and Omron (ICC=.62; P<.001). The PiezoRxs absolute percent error in measuring steps was 2.2% (ActiGraph=15.9%; Omron=15.0%). Compared with indirect calorimetry, the height-adjusted PiezoRx and ActiGraph were accurate measures of the time spent in MVPA (both ICC=.76; P<.001).

Conclusions

The PiezoRx PA monitor appears to be a valid and reliable measure of step count and MVPA in this diverse sample of adults. The device’s ability to measure MVPA may be improved when anthropometric differences are considered, performing at par or better than a research grade accelerometer.

How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review

Background

Cadence (steps/min) may be a reasonable proxy-indicator of ambulatory intensity. A summary of current evidence is needed for cadence-based metrics supporting benchmark (standard or point of reference) and threshold (minimums associated with desired outcomes) values that are informed by a systematic process.

Objective

To review how fast, in terms of cadence, is enough, with reference to crafting public health recommendations in adults.

Methods

A comprehensive search strategy was conducted to identify relevant studies focused on walking cadence and intensity for adults. Identified studies (n=38) included controlled (n=11), free-living observational (n=18) and intervention (n=9) designs.

Results

There was a strong relationship between cadence (as measured by direct observation and objective assessments) and intensity (indirect calorimetry). Despite acknowledged interindividual variability, ≥100 steps/min is a consistent heuristic (e.g, evidence-based, rounded) value associated with absolutely defined moderate intensity (3 metabolic equivalents (METs)). Epidemiological studies report notably low mean daily cadences (ie, 7.7 steps/min), shaped primarily by the very large proportion of time (13.5 hours/day) spent between zero and purposeful cadences (<60 steps/min) at the population level. Published values for peak 1-min and 30-min cadences in healthy free-living adults are >100 and >70 steps/min, respectively. Peak cadence indicators are negatively associated with increased age and body mass index. Identified intervention studies used cadence to either prescribe and/or quantify ambulatory intensity but the evidence is best described as preliminary.

Conclusions

A cadence value of ≥100 steps/min in adults appears to be a consistent and reasonable heuristic answer to ’How fast is fast enough?' during sustained and rhythmic ambulatory behaviour.

Trial registration number

NCT02650258