Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health

Associations of daily steps and step intensity with peripheral arterial disease in Chinese community-dwelling older women

AIMS

This study aims to investigate the associations of objectively measured daily steps and step intensity with peripheral arterial disease (PAD) in Chinese community-dwelling older women.

METHODS

Cross-sectional data were derived from the baseline survey of the Physical Activity and Health in Older Women Study. Peripheral arterial disease was evaluated through ankle-brachial index (ABI), ABI ≤ 0.9 was defined as cut-off point. Daily steps and step intensity were measured via tri-axial accelerometers. Multivariate logistic regression was used to investigate associations of step variable with PAD. Receiver operating characteristic (ROC) analysis was applied to identify an optimal cut-off value for step variables to screen PAD.

RESULTS

After adjusting for confounding factors, it was found that daily steps was not independently associated with PAD, and brisk steps, peak 30 as well as peak 60, were significantly associated with PAD, with ORs of 0.68 (0.50-0.93), 0.71 (0.52-0.96) and 0.60 (0.40-0.90), respectively. The optimal cut-off values for brisk steps, peak 30 and 60 screening PAD were 952.3 steps, 76.7 steps/min and 51.8 steps/min, respectively.

CONCLUSIONS

Step intensity rather than daily steps was independently associated with PAD in Chinese community-dwelling older women. Increasing the intensity during walking may be a viable strategy to reduce the risk of PAD in self-care and cardiovascular nursing.

Results of an Organization-wide Physical Activity Promotion Intervention Within a Very Large Academic Health Care System

Although healthcare workers may be aware of the risks of physical inactivity, their levels of physical activity (PA) are similar to those of all US adults, with less than half engaging in sufficient PA. The purpose of this health promotion was to encourage daily PA among employees in a large academic healthcare system. We also tested whether individualized progress updates further influenced PA. This 10-week program was available to all employees of NYU Langone Health. Employees could sync their phone or accelerometer via app or web browser to count.it - the vendor chosen to monitor and manage step counts. Participants were asked to voluntarily provide basic information (age, sex, job role, work location) and complete the Physical Activity Vital Sign (minutes/week and intensity of PA) at enrollment and 10 weeks. For 10 weeks, participants were sent a message through their employee 'MyChart' portal with a link to information on the benefits of PA, and a reminder of that week's step-count challenge. Those meeting criteria for weekly challenges were included in gift card raffles. Participants were randomized 1:1 to receive the standard message ± additional emails detailing their progress. 3528 employees registered to participate (8% of all employees) although active users diminished over time (1225 at week 10). Average daily steps remained stable throughout (7319 + 4540 in week 1, 7229 + 5010 in week 10). Although there was no difference in any individual week, receipt of personalized feedback was associated with significantly higher average step counts throughout the 10-wk intervention as a whole (P = 0.01). Age and an urban work location were positively associated with steps, while female sex and a clerical job role were negatively associated with steps counts (all P < 0.005). Our findings provide important insight for workplace interventions to promote PA. They further suggest specific groups that may benefit from targeted efforts.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Fine-tuning Large Language Models in Behavioral Psychology for Scalable Physical Activity Coaching

Personalized, smartphone-based coaching improves physical activity but relies on static, human-crafted messages. We introduce My Heart Counts (MHC)-Coach, a large language model fine-tuned on the Transtheoretical Model of Change. MHC-Coach generates messages tailored to an individual's psychology (their "stage of change"), providing personalized support to foster long-term physical activity behavior change. To evaluate MHC-Coach's efficacy, 632 participants compared human-expert and MHC-Coach text-based interventions encouraging physical activity. Among messages matched to an individual's stage of change, 68.0% (N=430) preferred MHC-Coach-generated messages ( P < 0.001). Blinded behavioral science experts (N=2) rated MHC-Coach messages higher than human-expert messages for perceived effectiveness (4.4 vs. 2.8) and Transtheoretical Model alignment (4.1 vs. 3.5) on a 5-point Likert scale. This work demonstrates how language models can operationalize behavioral science frameworks for personalized health coaching, promoting long-term physical activity and potentially reducing cardiovascular disease risk at scale.

Step Count Accuracy of the Life Plus Connected Watch at Different Localizations and Speeds in Healthy Adults, Patients With Cardiovascular Disease, and Patients With Peripheral Artery Disease: Step Count Validation Study in Laboratory Settings

Background

Smartwatches are increasingly used to monitor and motivate physical activity. Patients with cardiovascular disease (CVD) and peripheral artery disease (PAD) often do not meet national physical activity recommendations. They may, thus, benefit from a physical activity program using smartwatches. The Life Plus smartwatch is designed to facilitate activity monitoring by counting steps, but its validity needs to be determined, particularly in patients who may not have a normal gait, such as those with cardiovascular pathology.

Objective

This study evaluates the accuracy of the Life Plus smartwatch (versions 2 and 3) in healthy adults, patients with CVD, and patients with PAD at different walking speeds (1.8, 2.5, 3.2, and 4 km/h) and different localizations (wrists, hips, and ankles) to determine best accuracy.

Methods

In total, 34 participants, comprising healthy individuals (n=10), patients with CVD (n=14), and patients with PAD (n=10), wore 6 Life Plus watches simultaneously (3 of version 2 and 3 of version 3), located on wrists, hips, and ankles. Participants walked on a treadmill for 3-minute sessions at speeds of 1.8, 2.5, 3.2, and 4 km/h; they then performed a 10-minute free walking on the ground and again walked for 3-minute sessions on a treadmill at the same speeds. Actual step counts were recorded through video footage.

Results

When worn at the wrist, no significant difference between the actual number of steps and step count by version 2 watches was found in each group independently (healthy group: P=.25; CVD group: P=.50; and PAD group: P=.37). Significant differences were found with the version 2 watches at the wrist in the healthy group at 3.2 (-5.26%; P=.01) and 4 km/h (-6.13%; P=.008) and in the CVD group at 2.5 (-5.94%; P=.008), 3.2(-13.1%; P=.008), and 4 km/h (-13.96%; P=.004). When worn at the wrist, no significant difference between actual number of steps and step count by version 3 watches was found in the healthy group (P=.02) and the PAD group (P=.90). Significant differences were found with the version 3 watches at the wrist in the CVD group at 3.2 (-6.43%; P=.001) and 4 km/h (-7.3%; P=.01) and in the PAD group at 4 km/h (-5.77%; P=.04).

Conclusions

For optimized counting when worn at the wrist, healthy individuals should prefer version 2 watches for slow walking (1.8 and 2.5 km/h) and version 3 for higher speeds (3.2 and 4 km/h). Patients (CVD and PAD) should prefer version 2 watches at 1.8 km/h and version 3 watches for higher speeds (2.5, 3.2, and 4 km/h).

Physical activity and heat stress shape water needs in pregnant endurance athletes

Background and objectives

Pregnancy, heat stress, and physical activity (PA) are all known to independently increase human water requirements. We hypothesize that climate conditions and behavioral strategies interact to shape water needs in highly active pregnancies.

Methodology

We recruited 20 female endurance runners who were pregnant (8-16 weeks gestational age; n = 13) or planning to be pregnant (n = 7) for an observational, prospective cohort study. At three timepoints in the study (preconception, 8-16 weeks, and 32-35 weeks), we measured water turnover (WT) using the deuterium dilution and elimination technique, PA using ActiGraph wGT3X-BT accelerometers, and heat index (HI) using historical temperature and humidity data. We also compared athletes to nonathletes from a previously published study.

Results

Athletes maintained high WT from preconception through the end of pregnancy. PA was positively associated with WT among athletes for preconception and early pregnancy time periods but not for the third trimester. HI weakly moderated the relationship between PA and WT in predicting a more positive slope in hotter and more humid weather conditions. WT in athletes was higher than in nonathletes, but this difference attenuated during the third trimester, as nonathletes increased their WT.

Conclusions and implications

Athletes experience higher WT with greater levels of PA, and this relationship is somewhat stronger in higher HI conditions. With the threat of climate change expected to exacerbate extreme heat conditions, evidence-based, global policies are required for particularly vulnerable populations.

Associations of daily step count with all-cause mortality and cardiovascular mortality in hypertensive US adults: a cohort study from NHANES 2005-2006

BACKGROUND

The health benefits of physical activity, including walking, are well-established, but the relationship between daily step count and mortality in hypertensive populations remains underexplored. This study investigates the association between daily step count and both all-cause and cardiovascular mortality in hypertensive American adults.

METHODS

We used data from the National Health and Nutrition Examination Survey 2005-2006, including 1,629 hypertensive participants with accelerometer-measured step counts. Cox proportional hazards models and restricted cubic spline regression were employed to assess the associations between daily step count and mortality outcomes. Analyses were adjusted for demographics, lifestyle factors, and comorbidities.

RESULTS

Over an average follow-up of 12.57 years, 370 deaths occurred, of which 177 were due to cardiovascular causes. We observed non-linear associations between daily step count and mortality. Mortality risks were significantly reduced with step counts to 8,250 steps/day for all-cause mortality and 9,700 steps/day for cardiovascular mortality. Beyond these thresholds, the benefits plateaued.

CONCLUSION

Increasing daily step count is associated with reduced all-cause and cardiovascular mortality in hypertensive individuals, with optimal benefits observed below 8,250 and 9,700 daily steps, respectively. Moderate levels of physical activity provide substantial health benefits, highlighting the importance of setting realistic and attainable activity goals for hypertensive populations.

Patterns of daily ambulatory activity and the onset of metabolic syndrome in middle-aged and older Japanese women: the Toon Health Study

BACKGROUND

This cohort study aimed to identify the accumulation patterns of objectively measured ambulatory activity (AA) variables in the middle-aged and older Japanese women and examine the relationship of these derivative patterns with onset of metabolic syndrome (MetS).

METHODS

A total of 794 women (mean age: 56.2 years) provided objectively assessed AA data using a uniaxial accelerometer. The number of steps, time accumulated in light-intensity AA (LIAA) and moderate-to-vigorous intensity AA (MVAA) and the ratio of MVAA to total AA (LIAA + MVAA) were calculated. Latent profile analysis was used to identify participant groups based on their distinct AA patterns. Logistic regression models were used to assess the association of groups with the onset of MetS after adjusting for age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline.

RESULTS

Four distinct groups were identified: Group A had low levels of the AA variable; group B accumulated a certain number or more steps primarily through MVAA; group C accumulated a certain number or more steps primarily through LIAA; and group D had high level of the AA variables. Over the course of the 5-year follow-up period, 61 participants (7.7%) developed MetS. The multivariate-adjusted odds ratio (95% confidence interval) for onset of MetS in groups B, C, and D relative to group A were 0.416 (0.166-1.218), 0.451 (0.223-0.914), and 0.933 (0.365-2.382), respectively. Group C had a significantly lower odds ratio of MetS onset than group A.

CONCLUSION

AA patterns accumulating a certain number or more steps, regardless of the intensity of AA, may help reduce the risk of MetS compared to inactive AA patterns.

Analysing physical activity measures and clustering in patients with type 2 diabetes in secondary care: insights from the DIAbetes and LifEstyle Cohort Twente (DIALECT)-an observational cohort study

OBJECTIVES

To analyse variance in accelerometer-based physical activity (PA) measures in patients with type 2 diabetes, identify the most distinctive PA measures and classify patients into different PA clusters based on these measures.

DESIGN

DIAbetes and LifEstyle Cohort Twente (DIALECT), an observational cohort study.

SETTING

Secondary care in the Netherlands.

PARTICIPANT

253 patients, with three excluded due to insufficient data. The cohort was predominantly male (66%) with an average age of 64.7 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes of DIALECT were all-cause mortality, microvascular and macrovascular diseases. The secondary outcomes are blood pressure levels, kidney function indicators and albuminuria levels RESULTS: Principal component analysis (PCA) was applied to 53 accelerometer-derived PA measures. Principal components were identified using a scree plot, key measures determining the principal components were derived and k-mean cluster analysis was applied to the components. The main PA measures were steps/day, active time, zero steps, total sedentary behaviour (SB) bout duration and total moderate to vigorous physical activity (MVPA) bout duration. Based on three PCA components, three clusters were identified. The inactive cluster had a higher BMI, diabetes duration, age and SB bout duration, and lower steps/day and MVPA bout duration compared with the other clusters (p<0.05). The active cluster still scores low on MVPA bout duration (18 min/week) and high on SB bout duration (5.0 hours/day).

CONCLUSIONS

PA behaviour in patients can be categorised into three distinct clusters. The identified PA measures and behaviour clusters offer promising opportunities for tailored lifestyle treatment. However, further studies are needed to determine which PA measures are clinically most relevant, validate the usefulness of this classification and evaluate whether tailoring lifestyle advice according to these clusters adds clinical value.

TRIAL REGISTRATION NUMBER

NTR5855.

Association of Daily Step Count and Postoperative Complication among All of Us Research Participants

BACKGROUND

The association between preoperative wearable device step counts and surgical outcomes has not been examined using commercial devices linked to electronic health records (EHRs). This study measured the association between daily preoperative step counts and postoperative complications.

STUDY DESIGN

Data were obtained using the All of Us (AOU) Research program, a nationwide initiative to collect EHR and health-related data from the population. Patients who underwent a surgical procedure included in the NSQIP-targeted procedures dataset were included. Patients who did not have available physical activity FitBit data were excluded. Primary outcome was the development of a postoperative complication. All analyses were performed in the AOU researcher workbench.

RESULTS

Of 27,150 patients who underwent a surgical procedure, 475 participants with preoperative wearable data were included: 74.7% were female and 85.2% were White. The average age was 57.2 years. The overall rate of postoperative complications was 12.6%. Patients averaging less than 7,500 daily steps were at increased odds for developing a postoperative complication (odds ratio 1.83, 95% CI 1.01 to 3.31). After adjustment for age, sex, race, comorbid disease, BMI, and relative procedure risk, patients with a baseline average steps per day less than 7,500 were at increased odds for postoperative complication (adjusted odds ratio 2.06, 95% CI 1.05 to 4.06).

CONCLUSIONS

This study found an increase in overall postoperative complication rate in patients recording lower average preoperative step counts. Patients with a baseline of less than 7,500 steps per day had increased odds of postoperative complications in this cohort. These data support the use of wearable devices for surgical risk stratification and suggest step count may measure preoperative fitness.

Associations between number of steps and health outcomes in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Today's public health discourse prioritizes the health and well-being of children and adolescents. As step counts include both light and moderate-to-vigorous physical activities, and monitoring steps has become a popular method for assessing daily physical activity, it is critical to gain a better understanding of how measuring daily steps may contribute to overall health in children and adolescents. The aim of this study was to thoroughly review the studies that investigated the associations between daily number of steps (DNoS) and health outcomes (HO) in children and adolescents.

METHODS

Electronic searches were conducted in PubMed, Google Scholar, Cochrane, MEDLINE, Web of Science, SPORTDiscus (2000 -January 2024.). Key terms such as number of steps, daily steps, average steps, physical activity, health outcomes were used. The primary outcomes were (1) body composition/obesity risk factors; (2) cardiorespiratory fitness (CRF); and (3) cardiovascular risk factors. Secondary outcomes were psychological/psychosocial parameters (sleep habits, i.e. quality of life). We assessed the methodological quality of each trial using AXIS quality assessment tool. In instances where continuous data emanated from two or more trials, a meta-analysis was undertaken.

RESULTS

The main findings of this systematic review and meta-analysis are that an increased number of DNoS is associated with better HO in children and adolescents, as evidenced by improvements in body mass index (BMI), body weight, waist circumference, body fat percentage, and cardiorespiratory fitness (i.e., VO2max). However, due to a dearth of studies and conflicting results from current studies, no inferences can be drawn about the correlations between DNoS and sleep quality, quality of life, or cardiovascular risk factors (i.e., blood pressure). Across most of the studies, the average correlation between the DNoS and HO reflected a small, but significant, association with a small effect size.

CONCLUSIONS

Our findings highlight the importance of daily physical activity, as evidenced by the association between the number of steps and health outcomes in children and adolescents.

TRIAL REGISTRATION

PROSPERO # CRD42024523729.

Influence of physical activity measurement on the association between Life's Essential 8 and incident cardiovascular disease in older women

Objective

The American Heart Association's Life's Essential 8 (LE8) metric includes self-reported physical activity as one of the metrics for assessing cardiovascular health. Self-reported physical activity is prone to misclassification, whereas accelerometer measures are less biased. We examined associations of LE8 and incident cardiovascular disease (CVD) using self-reported and accelerometer-measured physical activity.

Methods

Participants in the Women's Health Initiative (WHI) Objective Physical Activity and Cardiovascular Health Study (n = 4,243; mean age = 79 ± 7 years) with no CVD history completed the WHI physical activity questionnaire and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire prior to wearing a hip-worn accelerometer for up to seven days in 2012-2014. LE8 components (physical activity, diet, sleep, body mass index, smoking, blood pressure, non-HDL cholesterol, and glucose) were scored according to guidelines. Scores were created using five physical activity measures: WHI questionnaire (LE8WHI), CHAMPS (LE8CHAMPS), accelerometer-measured physical activity (LE8A), and sample quantiles of accelerometer-measured physical activity (LE8AQ) and daily steps (LE8STEPS). Hazard ratios (HR) for physician-adjudicated CVD were estimated using Cox regression.

Results

707 incident CVD events occurred over an average 7.5 years. Multivariable HRs (95 % CI) comparing women in the highest vs. lowest quartiles of LE8 scores were: LE8WHI = 0.53 (0.43-0.67), LE8CHAMPS = 0.47 (0.38-0.60), LE8A = 0.44 (0.36-0.56), LE8AQ = 0.44 (0.35-0.55), and LE8STEPS = 0.45 (0.35-0.57).

Conclusions

The LE8-incident CVD association varies by physical activity measurement, however all methods showed reduced risk. Device-measures of physical activity may be more accurate in the LE8, but when impractical to implement, also support use of self-reported measures.

Objectively measured daily steps and health outcomes: an umbrella review of the systematic review and meta-analysis of observational studies

OBJECTIVES

The purpose of this review is to summarise the evidence from a systematic review and meta-analysis of observational studies that objectively measure daily steps and health outcomes.

DESIGN

This is an umbrella review.

DATA SOURCES

PubMed, Embase, Scopus, the Cochrane Library and Web of Science databases were searched through 31 January 2024.

ELIGIBILITY

We included systematic reviews of observational studies (with or without meta-analysis) that assessed the association of objectively measured daily steps with human health-related outcomes. Methodological quality was assessed using 'A MeaSurement Tool to Assess systematic Reviews 2'.

RESULTS

A total of 10 systematic reviews and 6 health outcomes were included after excluding irrelevant and duplicate studies. Higher daily steps were associated with more benefits than harms for a range of health-related outcomes, including all-cause mortality, cardiovascular event, skeletal muscle lesions, metabolic diseases and respiratory disease. A dose-response analysis showed that an increase of 500-1000 steps per day was associated with lower all-cause mortality and cardiovascular events. Beneficial associations were also found in patients with asthma and acutely hospitalised older adults. Conversely, one study within a systematic review suggested that higher daily steps (≥10 000) might be associated with an increased 52% risk of meniscal pathologies in individuals without knee osteoarthritis. However, one study within a systematic review suggested a potential increased risk of meniscal pathologies in individuals without knee osteoarthritis. Specifically, those exceeding 10 000 steps per day showed a 52% increase in risk.

CONCLUSION

The results of this study suggest that daily steps are associated with a lower risk of all-cause mortality and cardiovascular events. Future research could focus on identifying specific populations that may benefit most from increased daily steps and exploring potential mechanisms to enhance our understanding of how daily steps contribute to improved health outcomes.

PROSPERO REGISTRATION NUMBER

CRD42022347055.

Passive sensing of smartphone use, physical activity and sedentary behavior among adolescents and young adults during the COVID-19 pandemic

The research that links excessive screen time to adverse health outcomes is based on self-reported screen use. Few studies have documented how passively-sensed smartphone and app use relate to health behaviors like activity and sitting. Furthermore, they have not considered that daily fluctuations in smartphone/app use may have different relationships to these behaviors than a person's usual smartphone/app use. This study evaluated whether physical activity or sedentary (sitting) behavior are associated with either smartphone screen time or specific smartphone app use by adolescents and young adults during the COVID-19 pandemic. Adolescents and young adults aged 13-29 years wore activPAL4 micro activity monitors while their smartphones logged daily screen time and app use durations for nine days. Data were collected in 2020-2021 and analyzed in 2022-2023. Participants (N = 125) had a mean (SD) age of 19.7 (4.3) years. Participants' usual smartphone screen time was negatively associated with daily step counts. Daily deviations in smartphone screen time were negatively associated with daily step counts and moderate-vigorous physical activity durations. Time spent on Instagram, YouTube and, to a lesser extent, TikTok were linked with reduced activity levels. Daily sedentary behavior was not associated with usual or daily screen time. Interventions to promote physical activity during the transition into adulthood may benefit from limiting excessive smartphone screen time. Specific intervention targets could include limiting use of apps with infinite scrolling feeds algorithmically tuned to maintain user engagement, such as Instagram, YouTube and TikTok.

Effects of Breaking Up Sitting on Gut Hormone Responses and Subsequent Compensatory Behaviors in Physically Inactive Adults

INTRODUCTION

The effects of breaking up sitting on gut hormone responses and free-living energy compensatory behaviors are still unclear in people of Asian ethnicity.

METHODS

Twenty-six Asians including 13 lean individuals (Lean) and 13 individuals with centrally overweight/obesity (OW), aged between 20 and 45 yr, completed a randomized crossover study with either 5.5-h uninterrupted sitting (SIT) or 5.5-h sitting with 2-min walking at 6.4 km·h -1 every 20 min (ACTIVE) in the laboratory. Blood samples were collected at regular time points to examine postprandial glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and glucose-dependent insulinotropic polypeptide (GIP) concentrations. Free-living physical activity and energy intake were recorded using wearable devices and weighed food diaries outside the laboratory until midnight. Paired t -tests were conducted to compare responses between trials.

RESULTS

Postprandial GLP-1 and PYY incremental area under the curve values were higher in the ACTIVE trial versus SIT in both Lean and OW groups (all, P < 0.05), but there was no difference in GIP in either group (both, P > 0.05). There were no differences in free-living physical activity (volume and intensity) or energy intake (total and macronutrients) between trials in either group (all, P > 0.05), resulting in greater total physical activity over the 24-h monitoring period in ACTIVE trial versus SIT trial (both, P < 0.05).

CONCLUSIONS

Breaking up sitting increases postprandial GLP-1 and PYY concentrations in Asians, but does not induce subsequent behavioral compensation, resulting in greater 24-h physical activity levels and lower relative energy intake, in inactive individuals irrespective of bodyweight status.

Objectively Measured Physical Activity and Sedentary Behaviour on Cardiovascular Risk and Health-Related Quality of Life in Adults: A Systematic Review

BACKGROUND

This systematic review analysed the association between objectively measured physical activity and sedentary behaviour with cardiovascular risk and HRQoL in adults without previous CVD. Additionally, we analysed the impact of the intensity of the physical activity in this association.

METHODS

The search was carried out in three electronic databases with access until February 2023 to find studies with an observational design. For quality assessment, we used The National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

We identified 5819 references, but only five studies were included. One study shows a positive association between physical activity and HRQoL, while sedentary behaviour was negatively related to HRQoL. Another study showed an association between high-intensity physical activity with a better physical component of HRQoL and low-intensity physical activity with a better mental component of HRQoL. Three studies concluded that higher levels of physical activity are associated with lower levels of cardiovascular risk and higher levels of sedentary behaviour are associated with higher levels of cardiovascular risk.

CONCLUSION

Our findings suggested that people who spend more time being active and spend less time being sedentary appear to have lower cardiovascular risk and higher HRQoL.

Associations of steps per day and step intensity with the risk of cancer: Findings from the Women's Health Accelerometry Collaboration cohort

OBJECTIVE

Accumulating more steps/day is associated with a lower risk of cancer mortality and composite cancer outcomes. However, less is known about the relationship of steps/day with the risk of multiple site-specific cancers.

METHODS

This study included >22,000 women from the Women's Health Accelerometry Collaboration Cohort (2011-2022), comprised of women from the Women's Health Study and Women's Health Initiative Objective Physical Activity and Cardiovascular Health Study. Steps/day and step intensity were collected with accelerometry. Incident cancer cases and deaths were adjudicated. Stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the associations of steps/day and step intensity with incident breast, colon, endometrial, lung, and ovarian cancers, a composite of 13 physical activity-related cancers, total invasive cancer, and fatal cancer.

RESULTS

On average, women were 73.4 years old, accumulated 4993 steps/day, and had 7.9 years of follow-up. There were small nonsignificant inverse associations with the risks of colon cancer (HR = 0.94, 95% CI: 0.83, 1.05), endometrial cancer (HR = 0.91, 95% CI: 0.82, 1.01), and fatal cancer (HR = 0.95 95% CI: 0.90, 1.00) per 1000 steps/day. More minutes at ≥40 steps/min and a faster peak 10- and 30-min step cadence were associated with a lower risk of endometrial cancer, but findings were attenuated after adjustment for body mass index and steps/day.

CONCLUSIONS

Among women 62-97 years, there were small nonsignificant inverse associations of colon, endometrial, and fatal cancer with more steps/day. Epidemiologic studies with longer follow-up and updated assessments are needed to further explore these associations.

Can step count be used to identify older adults with high sedentary time and low moderate-to-vigorous physical activity?

INTRODUCTION

Combined high sedentary time (ST) and low moderate-to-vigorous physical activity (MVPA) has been associated with adverse cardiovascular events. However, accurately assessing ST and MVPA in older adults is challenging in clinical practice.

PURPOSE

To investigate whether step count can identify older adults with unhealthier movement behavior (high ST/low MVPA) and poorer cardiometabolic profile.

METHODS

Cross-sectional study (n = 258; 66 ± 5 years). Step count, ST, and MVPA were assessed by hip accelerometry during 7 days. The cardiometabolic profile was assessed using a continuous metabolic syndrome score (cMetS), including blood pressure, HDL-cholesterol, triglycerides, fasting glucose, and waist circumference. Receiving operating curve analysis was used to test the performance of step count in identifying older adults with unhealthier movement behavior (highest tertile of ST/lowest tertile of MVPA). Healthier movement behavior was defined as lowest tertile of ST/highest tertile of MVPA, with neutral representing the remaining combinations of ST/MVPA.

RESULTS

A total of 40 participants (15.5%) were identified with unhealthier movement behavior (ST ≥ 11.4 h/day and MVPA ≤ 10 min/day). They spent ~73% and 0.4% of waking hours in ST and MVPA, respectively. Step count identified those with unhealthier movement behavior (area under the curve 0.892, 0.850-0.934; cutoff: ≤5263 steps/day; sensitivity/specificity: 83%/81%). This group showed a higher cMetS compared with neutral (β = .25, p = .028) and healthier movement behavior groups (β = .41, p = .008).

CONCLUSION

Daily step count appears to be a practical, simple metric for identifying community-dwelling older adults with concomitant high ST and low MVPA, indicative of unhealthier movement behavior, who have a poorer cardiometabolic profile.

Physical Demands of Walking Football in Patients With Cardiovascular Risk Factors and Diseases

OBJECTIVE

To compare the exercise intensity of walking football (WF) with walking (WA) and to describe specific movement characteristics of WF.

DESIGN

Cross-sectional study.

SETTING

Sports facilities Saarland University, Germany.

PATIENTS

Eighteen patients with cardiovascular risk factors CVRFs and diseases (13 men and 5 women, age: 69 ± 10 years).

INDEPENDENT VARIABLES

Patients completed a WF match and WA session of 2 x 10 min each. Video analysis was used to characterize movements during WF.

MAIN OUTCOME MEASURES

Rate of perceived exertion (RPE, Borg Scale 6-20), % maximum heart rate (HR max ), musculoskeletal pain on a visual analog scale (VAS, 1-100 mm) before and up to 72 hours after exercise, and movement patterns during WF.

RESULTS

The mean RPE during WF (12.1 ± 2.7) and WA (11.9 ± 3.0) did not differ ( P = 0.63). The mean HR during WF (79 ± 12% of HR max ) was higher than during WA (71% ± 11%; P < 0.01). The HR variability coefficient of variation during WF (10.3% ± 5.8%) and WA (7.1 ± 5.5%) did not differ ( P = 0.13). There was no influence of exercise mode (WF vs WA) on musculoskeletal pain perception ( P = 0.96 for interaction). Injury-inciting activities such as lunges (median: 0.5 [interquartile range (IQR) 0-1.3]) and goal kicks (median: 4 [IQR: 1.8-5.3]) occurred rarely during WF.

CONCLUSIONS

Walking football might represent an alternative to WA for health prevention programs in patients with CVRF and diseases as it is characterized by a manageable cardiocirculatory strain, moderate RPE, low pain induction, and a low number of injury-inciting activities.

Association of Daily Physical Activity With Motivation in Prefrail and Frail Older Adults Living in Retirement Communities

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (β = -4.57; p < .001) and square root of daily stepping time (β = -0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

Physical activity based on daily steps in patients with chronic musculoskeletal pain: evolution and associated factors

BACKGROUND

People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature.

METHODS

This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters.

RESULTS

Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen's d = 0.769, and 4757 [2680], p < 0.001, Cohen's d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen's d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness.

CONCLUSIONS

Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population.

Apple Watch 6 vs. Galaxy Watch 4: A Validity Study of Step-Count Estimation in Daily Activities

The purpose of this study was to examine the validity of two wearable smartwatches (the Apple Watch 6 (AW) and the Galaxy Watch 4 (GW)) and smartphone applications (Apple Health for iPhone mobiles and Samsung Health for Android mobiles) for estimating step counts in daily life. A total of 104 healthy adults (36 AW, 25 GW, and 43 smartphone application users) were engaged in daily activities for 24 h while wearing an ActivPAL accelerometer on the thigh and a smartwatch on the wrist. The validities of the smartwatch and smartphone estimates of step counts were evaluated relative to criterion values obtained from an ActivPAL accelerometer. The strongest relationship between the ActivPAL accelerometer and the devices was found for the AW (r = 0.99, p < 0.001), followed by the GW (r = 0.82, p < 0.001), and the smartphone applications (r = 0.93, p < 0.001). For overall group comparisons, the MAPE (Mean Absolute Percentage Error) values (computed as the average absolute value of the group-level errors) were 6.4%, 10.5%, and 29.6% for the AW, GW, and smartphone applications, respectively. The results of the present study indicate that the AW and GW showed strong validity in measuring steps, while the smartphone applications did not provide reliable step counts in free-living conditions.

Step count and multiple health outcomes: An umbrella review

OBJECTIVE

This study aimed to quantify the association between step count and multiple health outcomes in a healthy population.

METHODS

PubMed, Embase, Web of Science, and The Cochrane Library were systematically searched for systematic reviews and meta-analyses from inception to April 1, 2022. Literature screening, data extraction, and data analysis were performed in this umbrella review. The intervention factor was daily step counts measured based on devices. Multiple health outcomes included metabolic diseases, cardiovascular diseases, all-cause mortality, and other outcomes in the healthy population.

RESULTS

Twenty studies with 94 outcomes were identified in this umbrella review. The increase in daily step count contributed to a range of human health outcomes. Furthermore, the special population, different age groups, countries, and cohorts should be carefully considered. Negative correlation between step counts and the following outcomes: metabolic outcomes, cardiovascular diseases, all-cause mortality, postural balance, cognitive function, and mental health. However, there was no association between participation in the outdoor walking group and the improvement of systolic blood pressure and diastolic blood pressure. Analysis of the dose-response association between increasing daily step count and the risk of cardiovascular disease events and all-cause mortality showed a substantially linear relationship.

CONCLUSION

A wide range of health outcomes can benefit from the right number of steps.

Associations between daily step count classifications and continuous glucose monitoring metrics in adults with type 1 diabetes: analysis of the Type 1 Diabetes Exercise Initiative (T1DEXI) cohort

AIMS/HYPOTHESIS

Adults with type 1 diabetes should perform daily physical activity to help maintain health and fitness, but the influence of daily step counts on continuous glucose monitoring (CGM) metrics are unclear. This analysis used the Type 1 Diabetes Exercise Initiative (T1DEXI) dataset to investigate the effect of daily step count on CGM-based metrics.

METHODS

In a 4 week free-living observational study of adults with type 1 diabetes, with available CGM and step count data, we categorised participants into three groups-below (<7000), meeting (7000-10,000) or exceeding (>10,000) the daily step count goal-to determine if step count category influenced CGM metrics, including per cent time in range (TIR: 3.9-10.0 mmol/l), time below range (TBR: <3.9 mmol/l) and time above range (TAR: >10.0 mmol/l).

RESULTS

A total of 464 adults with type 1 diabetes (mean±SD age 37±14 years; HbA1c 48.8±8.1 mmol/mol [6.6±0.7%]; 73% female; 45% hybrid closed-loop system, 38% standard insulin pump, 17% multiple daily insulin injections) were included in the study. Between-participant analyses showed that individuals who exceeded the mean daily step count goal over the 4 week period had a similar TIR (75±14%) to those meeting (74±14%) or below (75±16%) the step count goal (p>0.05). In the within-participant comparisons, TIR was higher on days when the step count goal was exceeded or met (both 75±15%) than on days below the step count goal (73±16%; both p<0.001). The TBR was also higher when individuals exceeded the step count goals (3.1%±3.2%) than on days when they met or were below step count goals (difference in means -0.3% [p=0.006] and -0.4% [p=0.001], respectively). The total daily insulin dose was lower on days when step count goals were exceeded (0.52±0.18 U/kg; p<0.001) or were met (0.53±0.18 U/kg; p<0.001) than on days when step counts were below the current recommendation (0.55±0.18 U/kg). Step count had a larger effect on CGM-based metrics in participants with a baseline HbA1c ≥53 mmol/mol (≥7.0%).

CONCLUSIONS/INTERPRETATION

Our results suggest that, compared with days with low step counts, days with higher step counts are associated with slight increases in both TIR and TBR, along with small reductions in total daily insulin requirements, in adults living with type 1 diabetes.

DATA AVAILABILITY

The data that support the findings reported here are available on the Vivli Platform (ID: T1-DEXI; https://doi.org/10.25934/PR00008428 ).

The influence of the COVID-19 pandemic on physical activity in Stockholm County - Evidence from time series models of smartphone measured daily steps data spanning over 3 years

BACKGROUND

It has been reported that physical activity levels decreased during the COVID-19 pandemic. Previous studies often relied on self-reported physical activity, which has low accuracy. Studies based on objectively measured physical activity have had short data collection periods, thereby not allowing the consideration of pre-pandemic levels of physical activity or the influence over the different waves of the pandemic.

METHODS

In this study, we utilize smartphone-measured step data from a nonprobability sample in Stockholm County, Sweden, where measures to limit the spread of COVID-19 differed from those in many other countries. The results are based on 522 individuals and 532,739 person-days with step data spanning from 2019 to 2021. Generalized additive models were fitted for each individual, and meta-regression was used to combine the results from individual models.

RESULTS

Daily steps decreased during the first wave but increased during the third wave compared to individual pre-pandemic levels. The decrease in daily steps occurred primarily in young individuals and those with occupations allowing remote work. Individuals of retirement age on the contrary increased their daily steps during the same period.

CONCLUSIONS

This study reveal that the influence of the COVID-19 pandemic was temporary and that younger age and the possibility of working from home were associated with a decreasing trend in physical activity.

Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study

BACKGROUND

Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process.

OBJECTIVE

The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D.

METHODS

The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together.

RESULTS

The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box.

CONCLUSIONS

After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.

Discriminant analysis of ecological factors influencing sarcopenia in older people in South Korea

This study aimed to investigate the ecological system factors that influence discrimination of sarcopenia among older individuals living in contemporary society. Data analysis included information from 618 older adults individuals aged 65 years or older residing in South Korea. To assess variations in ecological system factors related to SARC-F scores, we conducted correlation analysis and t-tests. Discriminant analysis was used to identify factors contributing to group discrimination. The key findings are summarized as follows. First, significant differences at the p < 0.001 level were observed between the SARC-F score groups in various aspects, including attitudes toward life, wisdom in life, health management, social support, media availability, sports environment, collectivist values, and values associated with death. Further, service environment differences were significant at p < 0.01 level, while social belonging and social activities exhibited significance at p < 0.05. Second, factors influencing group discrimination based on the SARC-F scores were ranked in the following order: health management, attitudes toward life, fear of own death, wisdom in life, physical environment, sports environment, media availability, social support, fear of the own dying, collectivist values, service environment, social activities, and social belonging. Notably, the SARC-F tool, which is used for sarcopenia discrimination, primarily concentrates on physical functioning and demonstrates relatively low sensitivity. Therefore, to enhance the precision of sarcopenia discrimination within a score-based group discrimination process, it is imperative to incorporate ecological system factors that exert a significant influence. These modifications aimed to enhance the clarity and precision of the text in an academic context.

Prospective association of daily ambulatory activity with metabolic syndrome in middle-aged and older Japanese adults: the Toon Health Study

BACKGROUND

This cohort study aimed to examine the relationship between objectively measured daily ambulatory activity (AA) variables and the onset of metabolic syndrome (MetS) in middle-aged and older Japanese individuals.

METHODS

A total of 1,034 participants (women, 76.8%; mean age, 56.9 years) who were initially free from MetS, underwent objective assessment of daily AA using a uniaxial accelerometer at baseline. The number of steps, time accumulated in light-intensity AA (LIAA), moderate-to-vigorous intensity AA (MVAA), and total AA (LIAA + MVAA) were calculated. The diagnostic criteria outlined by the Japanese standards were employed to define the presence of MetS. To explore the association between AA variables and MetS onset, both multivariate logistic regression and a restricted cubic spline model were used while controlling for variables such as age, sex, education, alcohol habit, smoking habit, energy intake, and the number of MetS components present at baseline.

RESULTS

Over the course of the 5-year follow-up period, 116 participants (11.2%) developed MetS. In terms of the number of steps, LIAA, and total AA, the third quartile had significantly lower multivariate adjusted odds ratios for MetS onset than the first quartile. The odds ratios (95% confidence intervals) were 0.386 (0.197-0.755), 0.527 (0.285-0.975), and 0.392 (0.206-0.745), respectively. In the spline model, an L-shaped association with MetS was observed for the number of steps (p for nonlinearity = 0.066), LIAA (p for nonlinearity = 0.034), and total AA (p for nonlinearity = 0.040).

CONCLUSIONS

Among the variables related to AA, the index of daily amount AA, in particular, may be linked to the onset of MetS.

Impact of automated data flow and reminders on adherence and resource utilization for remotely monitoring physical activity in individuals with stroke or chronic obstructive pulmonary disease

As rehabilitation advances into the era of digital health, remote monitoring of physical activity via wearable devices has the potential to change how we provide care. However, uncertainties about patient adherence and the significant resource requirements needed create challenges to adoption of remote monitoring into clinical care. Here we aim to determine the impact of a novel digital application to overcome these barriers. The Rehabilitation Remote Monitoring Application (RRMA) automatically extracts data about physical activity collected via a Fitbit device, screens the data for adherence, and contacts the participant if adherence is low. We compare adherence and estimate the resources required (i.e., time and financial) to perform remote monitoring of physical activity with and without the RRMA in two patient groups. Seventy-three individuals with stroke or chronic obstructive pulmonary disease completed 28 days of monitoring physical activity with the RRMA, while 62 individuals completed 28 days with the data flow processes being completed manually. Adherence (i.e., the average percentage of the day that the device was worn) was similar between groups (p=0.85). However, the RRMA saved an estimated 123.8 minutes or $50.24 per participant month when compared to manual processes. These results demonstrate that automated technologies like the RRMA can maintain patient adherence to remote monitoring of physical activity while reducing the time and financial resources needed. Applications like the RRMA can facilitate the adoption of remote monitoring in rehabilitation by reducing barriers related to adherence and resource requirements.

The associations of daily steps and body mass index with incident gastroesophageal reflux disease in older adults

Background

High body mass index (BMI) is a major risk factor of gastroesophageal reflux disease (GERD), a prevalent morbidity of older adulthood linked to lower quality of life and an increased risk of esophageal cancers. Daily stepping behavior, the most common physical activity of older adulthood, is associated with an array of favorable health outcomes, sometimes independent of high BMI. Whether stepping behavior is associated with the incidence of GERD independently or in combination with BMI is currently unclear.

Materials and methods

We followed 442 individuals (58.4% female) aged 65-91 years enrolled in the Physical Activity and Aging Study. Baseline steps were obtained by pedometer and categorized by tertiles (lower, middle, upper), while BMI was categorized into normal weight, overweight, and obesity. To explore joint associations, daily steps were dichotomized into "high steps" (middle/upper tertiles) and "low steps" (lower tertile), while BMI was dichotomized into normal weight and overweight/obesity. The joint exposure categories included "low steps and overweight/obesity," "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight."

Results

We identified 35 (7.9%) cases of GERD over a mean follow-up of 2.5 years. Compared to the lower tertile of steps, the hazard ratios (HRs) [95% confidence intervals (95% CIs)] of GERD were 0.44 (0.20-0.96) and 0.17 (0.05-0.54) for the middle and upper tertiles, respectively, after adjusting for confounders (including BMI). Compared to normal weight, the HRs (95% CIs) of GERD were 1.35 (0.54-3.37) and 3.00 (1.19-7.55) for overweight and obesity, respectively, after adjusting for confounders (including steps). In a joint analysis, compared to "low steps and overweight/obesity," the HRs (95% CIs) of GERD were 0.32 (0.10-1.00), 0.23 (0.10-0.54), and 0.20 (0.07-0.58) for "low steps and normal weight," "high steps and overweight/obesity," and "high steps and normal weight," respectively.

Conclusion

Higher daily steps were associated with a lower risk of GERD in older adults, independent of BMI. Since accumulating steps through walking is an achievable and acceptable modality of physical activity in older adulthood, future lifestyle interventions designed to achieve high daily steps counts may have favorable implications for the development of GERD in older adults of any BMI status.

Higher number of steps is related to lower endogenous progesterone but not estradiol levels in women

OBJECTIVES

Sex steroid hormones are important not only for reproduction but also for many aspects of women's health, including the risk of breast cancer. Physical activity has been shown to influence sex hormone levels in women. This study aimed to investigate a relationship between the average daily number of steps and the sex hormone (estradiol and progesterone) levels in premenopausal women.

MATERIALS AND METHODS

Data were collected from 85 healthy, urban women of reproductive age who performed at least 180 minutes/week of moderate physical activity for two complete menstrual cycles. Physical activity was measured using wrist bands. Estradiol and progesterone concentrations were measured in daily-collected saliva samples in the second menstrual cycle.

RESULTS

There was a significant negative association between the average number of steps taken daily and salivary progesterone levels after adjusting for potential confounding factors (age, BMI). Women who took more than 10,000 steps a day had significantly lower progesterone levels compared to women who took less than 10,000 steps. The association between physical activity and estradiol levels was statistically insignificant.

DISCUSSION

Our results indicate that taking at least 10,000 steps a day reduces progesterone levels, but this intensity of physical activity may not be high enough to affect estradiol levels. Daily step tracking is a valuable element of health promotion, but currently recommended levels of physical activity may not be high enough for healthy premenopausal women to significantly reduce both sex hormone levels and thus their risk of postmenopausal breast cancer.

Training program intervention to encourage physical activity for health in people with transtibial amputation: A feasibility study

BACKGROUND

People with transtibial amputation (PTTA) would benefit from increased physical activity levels (PAL) but generic programs developed to support increased PAL do not address the barriers which PTTA experience.

OBJECTIVE

To evaluate the effect of a 12-week training program, developed for PTTA, on their PAL.

METHODS

Ten PTTA participated in a 12-week training program, which involved one instructor-led supervised group session per week. The program incorporated balance, flexibility, cardiovascular endurance, strength, and agility, as well as educational elements. Personalized starting level and progression intensity were based on the instructor's assessment in the first training session. The effect of the intervention on PAL (self-report questionnaire and accelerometer), fitness, walking symmetry, and adverse effects was determined by analysis of variance before and after the intervention.

RESULTS

There was a significant increase in self-reported time in moderate-intensity activity and accelerometer-measured step count and time in movement after the program compared with baseline ( p = 0.02). The distance walked in the Six-Minute Walk Test (6MWT) ( p < 0.001), time to perform agility test ( p = 0.01), and lower-limb strength power ( p = 0.01) and endurance ( p = 0.01) were significantly greater after the program, and no adverse effects were identified.

CONCLUSIONS

This study demonstrated an intervention designed specifically for PTTA that can increase PAL.

Daily Step Count and its Association with Arterial Stiffness Parameters in Older Adults

BACKGROUND

Daily step count is a simple parameter for assessing physical activity. However, the potential advantages of setting daily step goals below the traditional 10,000-step threshold remain unclear. The cross-sectional study aimed to determine the relationship between daily step counts and arterial stiffness outcomes in older individuals.

METHODS

Forty-eight older adults recorded their daily step counts over a 7-day period using a pedometer. The participants were classified into two groups based on their daily step count: Group 1 (n = 28) consisted of individuals taking fewer than 5000 steps per day, while Group 2 (n = 20) included those who recorded 5,000 to 9,999 steps per day. To evaluate arterial stiffness parameters, we measured pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), and ankle-brachial index (ABI). Hemodynamic and biochemical parameters were also determined.

RESULTS

Participants who accumulated fewer daily steps exhibited higher PWV compared to each group. An inverse association was observed between average steps per day and PWV. However, no significant differences were found between daily step counts and CAVI or ABI.

CONCLUSION

Conclusions: As individuals increase their daily step count, they may experience a reduction in arterial stiffness. Consequently, the assessment of daily steps has benefits for enhancing vascular health and overall well-being among older individuals.

Heart disease and stroke statistics 2023 update from the American Heart Association-implications for nephrology

The annual American Heart Association (AHA) and National Institutes of Health statistical report details the most up to date statistics related to heart disease, stroke and cardiovascular risk factors, primarily within the USA. Although not a formal systematic review or meta-analysis, this 600 page report provides the most comprehensive and best summary of cardiovascular statistics for the year in question. Although data are collated from USA data registries, it serves as a critical resource for clinicians, policymakers, administrators and researchers in the northern and southern hemispheres. In this special report, we have chosen to highlight aspects of the document that are relevant to nephrologists, given the overlap of cardiovascular and renal disease. These include (i) key and emerging cardiovascular data signals in the general and chronic kidney disease (CKD) populations, (ii) ethnic and socio-economic disparity, (iii) environmental and behavioural factors that drive high levels of cardiovascular disease and which are key components of the AHA's eight components of the Life Essential cardiovascular health score, and (iv) the impact of COVID-19 both directly and indirectly on heart health. We provide some commentary and critical analysis of both the data and of the production of such data sets suggesting that similar data on CKD could also be published and linked to the AHA and other datasets.

Physical activity during pregnancy and the risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis

BACKGROUND

Previous research has indicated the inverse association between physical activity (PA) and gestational diabetes mellitus (GDM). However, the dose-response relationship currently remains undetermined. This study aims to explore the dose-response relationship between PA during the first and second trimesters of pregnancy and GDM risk.

METHODS

Studies on the relationship between PA during pregnancy and GDM risk published before April 25, 2023, were searched for in six databases. According to the inclusion and exclusion criteria, all literature was screened for eligibility. The Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. Publication bias was examined using funnel plots, Begg's and Egger's tests, as well as trim-and-fill analysis. We harmonized exposure estimates of PA during pregnancy to the common unit of the metabolic equivalent of task (MET)-h/week. Restricted cubic splines were used to model the dose-response relationship. The criteria from the World Cancer Research Fund were used to assess the certainty of evidence across outcomes. All analyses were performed using Stata 15.1.

RESULTS

The results indicated that in contrast with the lowest level of PA, promoting the highest PA level lowers the risk of GDM by 36% (RR = 0.64, 95%CI: 0.53 ~ 0.78). We found a curvilinear dose-response association between PA during the first trimester and incident GDM (Pnonlinearity = 0.012). Compared to inactive pregnant women, for those who achieved the guidelines-suggested minimum level (10 MET-h/week) of PA during the first trimester, the GDM risk was decreased by 13% (RR = 0.87, 95%CI: 0.79 ~ 0.96). A linear relationship was found between PA during the second trimester and the GDM risk (Pnonlinearity = 0.276). The results with a restricted cubic spline model suggested that pregnant women who accumulate 10 MET-h/week have a 1% reduced risk of GDM compared to completely inactive individuals. Twice (20 MET-h/week) or a higher amount of PA (50 MET-h/week) contributed to further reductions in GDM risk.

CONCLUSION

There is a dose-response relationship between higher levels of PA in both the first and second trimesters and reduced risk of GDM; the relationship is stronger in the first trimester. Increasing PA during pregnancy can prevent the development of GDM.

PROSPERO REGISTRATION NUMBER

CRD42023420564.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

Objectively evaluated physical activity among individuals following anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Objective

To compare time spent in moderate-to-vigorous physical activity (MVPA) per week, MVPA per day, and steps per day between individuals that were subjected to the anterior cruciate ligament reconstruction (ACLR) and healthy control group.

Design

Systematic review and meta-analysis of observational studies.

Data sources

Web of Science, Scopus, and PubMed have been comprehensively searched to identify relevant investigations.

Eligibility criteria for selecting studies

An observational research that objectively evaluated physical activity among respondents with a history of ACLR.

Results

Of 302 records, a total of 12 studies fulfilled the eligibility criteria. Four hundred and forty-three participants underwent the ACLR, 153 men and 290 women. The mean time between anterior cruciate ligament (ACL) surgery and evaluation of analysed outcomes was 34.8 months. The main findings demonstrated that the ACLR group spent less time in weekly MVPA (standardised mean differences (SMD)=-0.43 (95% CI -0.66 to -0.20); mean = -55.86 min (95% CI -86.45 to -25.27); p=0.0003; τ2=0.00), in daily MVPA (SMD=-0.51 95% CI -0.76 to -0.26]; mean = -15.59 min (95% CI -22.93 to -8.25); p<0.0001; τ2=0.00), and they had fewer daily steps (SMD=-0.60 95% CI -0.90 to -0.30); mean = -1724.39 steps (95% CI -2552.27 to -896.50); p<0.0001; τ2=0.00) relative to their non-injured counterparts. Additionally, available investigations indicated that individuals with a history of ACLR participated in 316.8 min of MVPA per week, 67 min in MVPA per day, and 8337 steps per day.

Conclusion

Long-term after ACLR, participants undergoing ACL surgery were less physically active compared with their non-injured peers, and they did not satisfy recommendations regarding steps per day.

PROSPERO registration number

CRD42023431991.

Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey

BACKGROUND

There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking.

OBJECTIVE

This study explores the relationship between age and women's self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women.

METHODS

A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women's perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments.

RESULTS

Significant barriers to daily walking were observed in the 21-49-year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49-year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75-year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women's walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart.

CONCLUSIONS

Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women's ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages.

Effects of ankle-foot orthoses on step activities in the community: a systematic review

PURPOSE

To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders.

METHODS

Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale.

RESULTS

Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life.

CONCLUSIONS

Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.

Daily activity patterns in older adults receiving initial support: the association between daily steps and sitting in bouts of at least 60 min

BACKGROUND

Aging has a significant impact on health, underlining the importance of maintaining physical function and reducing time spent sitting among older adults. To understand how to reduce prolonged sitting or increase physical activity, factors related to the daily living and observed daily activity patterns should be explored. This study aimed to investigate the association between daily steps, self-rated health, physical activity, sedentary behavior, motivation to exercise and fear of falling among older adults receiving initial support.

METHOD

Cross-sectional design with total population questionnaire data from adults aged ≥ 60 years (n = 917), living at home with initial support from municipal care in southern Sweden. The older adults were offered to participate in a follow-up study measuring daily activity patterns with accelerometers (n = 72). Linear regression was used to analyze associations between daily steps and possible predictors.

RESULTS

The linear model ([Formula: see text]0.478) showed that sitting in unbroken bouts of > 60 min (β = -0.313, p < 0.05), walking independently outdoors (β = 0.301, p < 0.05), intending to increase physical activity (β = -0.294, p < 0.05), sex (β = 0.279, p < 0.05), relative autonomy index (β = 0.258, p < 0.05), fear of falling (β = -0.238, p < 0.05), and self-rated health (β = 0.213, p < 0.05) predicted daily steps.

CONCLUSION

The model of predictors brings new understanding regarding daily steps among community-dwelling older adults. The association between sitting in bouts of > 60 min and daily steps is interesting as 35% of participants had a number of sitting bouts that on average, showed 30% less steps taken. Minimizing long sitting bouts and maintaining physical functioning to promote independence when walking outdoors can be tools for clinical practitioners devising interventions to break prolonged sitting among community-dwelling older adults. Future research should prioritize studying older adults' outdoor walking independence, including its relation to walking with or without assistive devices and its impact on physical activity and sedentary behavior.

Lifelog-based daily step counts, walking speed, and metabolically healthy status

Objective

Optimal metabolically healthy status is important to prevent various chronic diseases. This study investigated the association between lifelog-derived physical activity and metabolically healthy status.

Methods

This cross-sectional study included 51 Korean adults aged 30-40 years with no history of chronic diseases. Physical activity data were obtained by the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Lifelog-derived physical activity was defined by step counts and walking speed for 1 week, as recorded by the Samsung Health application on both the Samsung Galaxy Fit2 and mobile phones. Participants without metabolic syndrome components were categorized as the metabolically healthy group (n = 31) and the remaining participants as the metabolically unhealthy group (n = 20). Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models. The predictive ability of each physical activity measure was evaluated according to the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) values.

Results

Among the physical activity measures, lifelog-derived walking speed was significantly inversely associated with prevalent metabolically unhealthy status. The lifelog component model including walking speed, age, and sex had the highest AUC value for metabolically unhealthy status. Adding lifelog-derived step counts to the IPAQ-SF-derived metabolic equivalent (MET) model (including age, sex, and IPAQ-SF-METs) yielded 37% and 13% increases in the NRI and IDI values, respectively. Incorporating walking speed into the IPAQ-SF-derived MET model improved metabolically unhealthy status prediction by 42% and 21% in the NRI and IDI analyses, respectively.

Conclusions

Slow walking speed derived from the lifelog was associated with a higher prevalence of metabolically unhealthy status. Lifelog-derived physical activity information may aid in identifying individuals with metabolic abnormalities.

Comparative effectiveness of interventions on promoting physical activity in older adults: A systematic review and network meta-analysis

Background

Despite the well-established health benefits of physical activity, a large population of older adults still maintain sedentary life style or physical inactivity. This network meta-analysis (NMA) aimed to compare the effectiveness of wearable activity tracker-based intervention (WAT), electronic and mobile health intervention (E&MH), structured exercise program intervention (SEP), financial incentive intervention (FI) on promoting physical activity and reducing sedentary time in older adults.

Methods

The systematic review based on PRISMA guidelines, a systematic literature search of PubMed, Web of Science, Google Scholar, EMbase, Cochrane Library, Scopus were searched from inception to December 10th 2022. The randomized controlled trials (RCT) were included. Two reviewers independently conducted study selection, data extraction, risk of bias and certainty of evidence assessment. The effect measures were standard mean differences (SMD) and 95% confidence interval (CI) in daily steps, moderate-to-vigorous physical activity (MVPA) and sedentary time.

Results

A total of 69 studies with 14,120 participants were included in the NMA. Among these included studies, the results of daily steps, MVPA and sedentary time was reported by 55, 25 and 15 studies, respectively. The NMA consistency model analysis suggested that the following interventions had the highest probability (surface under the cumulative ranking, SUCRA) of being the best when compared with control: FI + WAT for daily steps (SUCRA = 96.6%; SMD = 1.32, 95% CI:0.77, 1.86), WAT + E&MH + SEP for MVPA (SUCRA = 91.2%; SMD = 0.94, 95% CI: 0.36, 1.52) and WAT + E&MH + SEP for sedentary time (SUCRA = 80.3%; SMD = -0.50, 95% CI: -0.87, -0.14). The quality of the evidences of daily steps, MVPA and sedentary time was evaluated by very low, very low and low, respectively.

Conclusions

In this NMA, there's low quality evidence that financial incentive combined with wearable activity tracker is the most effective intervention for increasing daily steps of older adults, wearable activity tracker combined with electronic and mobile health and structured exercise program is the most effective intervention to help older adults to increase MVPA and reduce sedentary time.

Comparative Analysis of ActiGraph Step Counting Methods in Adults: A Systematic Literature Review and Meta-Analysis

PURPOSE

The primary aim of this study was to compare steps per day across ActiGraph models, wear locations, and filtering methods. A secondary aim was to compare ActiGraph steps per day to those estimated by the ankle-worn StepWatch.

METHODS

We conducted a systematic literature review to identify studies of adults published before May 12, 2022, that compared free-living steps per day of ActiGraph step counting methods and studies that compared ActiGraph to StepWatch. Random-effects meta-analysis compared ActiGraph models, wear locations, filter mechanisms, and ActiGraph to StepWatch steps per day. A sensitivity analysis of wear location by younger and older age was included.

RESULTS

Twelve studies, with 46 comparisons, were identified. When worn on the hip, the AM-7164 recorded 123% of the GT series steps (no low-frequency extension (no LFE) or default filter). However, the AM-7164 recorded 72% of the GT series steps when the LFE was enabled. Independent of the filter used (i.e., LFE, no LFE), ActiGraph GT series monitors captured more steps on the wrist than on the hip, especially among older adults. Enabling the LFE on the GT series monitors consistently recorded more steps, regardless of wear location. When using the default filter (no LFE), ActiGraph recorded fewer steps than StepWatch (ActiGraph on hip 73% and ActiGraph on wrist 97% of StepWatch steps). When LFE was enabled, ActiGraph recorded more steps than StepWatch (ActiGraph on the hip, 132%; ActiGraph on the wrist, 178% of StepWatch steps).

CONCLUSIONS

The choice of ActiGraph model, wear location, and filter all impacted steps per day in adults. These can markedly alter the steps recorded compared with a criterion method (StepWatch). This review provides critical insights for comparing studies using different ActiGraph step counting methods.

The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis

AIMS

There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality.

METHODS AND RESULTS

We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81-0.91; P < 0.001], while a 500-step increment was associated with a 7% decrease in CV mortality (HR 0.93; 95% CI 0.91-0.95; P < 0.001). Compared with the reference quartile with median steps/day 3867 (2500-6675), the Quartile 1 (Q1, median steps: 5537), Quartile 2 (Q2, median steps 7370), and Quartile 3 (Q3, median steps 11 529) were associated with lower risk for all-cause mortality (48, 55, and 67%, respectively; P < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference [median steps 2337, interquartile range 1596-4000), higher quartiles of steps/day (Q1 = 3982, Q2 = 6661, and Q3 = 10 413) were linearly associated with a reduced risk of CV mortality (16, 49, and 77%; P < 0.05, for all). Using a restricted cubic splines model, we observed a nonlinear dose-response association between step count and all-cause and CV mortality (Pnonlineraly < 0.001, for both) with a progressively lower risk of mortality with an increased step count.

CONCLUSION

This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3867 steps/day for all-cause mortality and only 2337 steps for CV mortality.

Exercise therapy as a digital therapeutic for chronic disease management: consideration for clinical product development

Digital exercise therapies (DET) have the potential to bridge existing care gaps for people living with chronic conditions. Acting as either a standalone, embedded within multi-modal lifestyle therapy, or adjunct to pharmacotherapy or surgery, evidence-based DETs can favorably impact the health of a rapidly growing population. Given the nascent nature of digital therapeutics, the regulatory landscape has yet to mature. As such, in the absence of clear guidelines clinical digital product developers are responsible for ensuring the DET adheres to fundamental principles such as patient risk management and clinical effectiveness. The purpose of this narrative review paper is to discuss key considerations for clinical digital product developers who are striving to build novel digital therapeutic (DTx) solutions and thus contribute towards standardization of product development. We herein draw upon DET as an example, highlighting the need for adherence to existing clinical guidelines, human-centered design and an intervention approach that leverages the Chronic Care Model. Specific topics and recommendations related to the development of innovative and scalable products are discussed which ultimately allow for differentiation from a basic wellness tool and integration to clinical workflows. By embodying a code of ethics, clinical digital product developers can adequately address patients' needs and optimize their own future digital health technology assessments including appropriate evidence of safety and efficacy.

Open-Source, Step-Counting Algorithm for Smartphone Data Collected in Clinical and Nonclinical Settings: Algorithm Development and Validation Study

BACKGROUND

Step counts are increasingly used in public health and clinical research to assess well-being, lifestyle, and health status. However, estimating step counts using commercial activity trackers has several limitations, including a lack of reproducibility, generalizability, and scalability. Smartphones are a potentially promising alternative, but their step-counting algorithms require robust validation that accounts for temporal sensor body location, individual gait characteristics, and heterogeneous health states.

OBJECTIVE

Our goal was to evaluate an open-source, step-counting method for smartphones under various measurement conditions against step counts estimated from data collected simultaneously from different body locations ("cross-body" validation), manually ascertained ground truth ("visually assessed" validation), and step counts from a commercial activity tracker (Fitbit Charge 2) in patients with advanced cancer ("commercial wearable" validation).

METHODS

We used 8 independent data sets collected in controlled, semicontrolled, and free-living environments with different devices (primarily Android smartphones and wearable accelerometers) carried at typical body locations. A total of 5 data sets (n=103) were used for cross-body validation, 2 data sets (n=107) for visually assessed validation, and 1 data set (n=45) was used for commercial wearable validation. In each scenario, step counts were estimated using a previously published step-counting method for smartphones that uses raw subsecond-level accelerometer data. We calculated the mean bias and limits of agreement (LoA) between step count estimates and validation criteria using Bland-Altman analysis.

RESULTS

In the cross-body validation data sets, participants performed 751.7 (SD 581.2) steps, and the mean bias was -7.2 (LoA -47.6, 33.3) steps, or -0.5%. In the visually assessed validation data sets, the ground truth step count was 367.4 (SD 359.4) steps, while the mean bias was -0.4 (LoA -75.2, 74.3) steps, or 0.1%. In the commercial wearable validation data set, Fitbit devices indicated mean step counts of 1931.2 (SD 2338.4), while the calculated bias was equal to -67.1 (LoA -603.8, 469.7) steps, or a difference of 3.4%.

CONCLUSIONS

This study demonstrates that our open-source, step-counting method for smartphone data provides reliable step counts across sensor locations, measurement scenarios, and populations, including healthy adults and patients with cancer.

Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study

BACKGROUND

Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making.

OBJECTIVE

The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall.

METHODS

Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure.

RESULTS

Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased.

CONCLUSIONS

During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities.

Physical activity level and sedentary behavior in patients with bronchiectasis: A systematic review of outcome measures and determinants

BACKGROUND

Changes in respiratory functions negatively affect the physical activity (PA) levels of patients with bronchiectasis. Therefore, detecting the most frequently used assessments of PA is essential as determining related factors and improving PA. This review study aimed to investigate the PA levels, compare levels with the recommended PA guidelines, determine the outcome measurements of PA and examine the determinants related to PA in patients with bronchiectasis.

METHOD

This review was conducted using databases of MEDLINE, Web of Science, and PEDro. The searched terms were the variations of the words "bronchiectasis" and "physical activity". Full texts of cross-sectional studies and clinical trials were included. Two authors independently screened the studies for inclusion.

RESULT

The initial search identified 494 studies. A hundred articles were selected for full-text review. Following the application of the eligibility process, 15 articles were included. Twelve studies used activity monitors and five studies used questionnaires. The studies that used activity monitors presented daily step counts. The mean number of steps ranged between 4657 and 9164 for adult patients. It was approximately 5350 steps/day in older patients. One study investigated children's PA level reported 8229 steps/day. The functional exercise capacity, dyspnea, FEV1 and, quality of life as related determinants with PA have been reported in the studies.

CONCLUSION

PA levels of patients with non-cystic fibrosis bronchiectasis were lower than the recommended levels. The objective measurements were frequently used in PA assessment. In further studies, it is needed to investigate the related determinants of PA in patients.

Association of daily step counts and step intensity with fear of falling in Chinese community-dwelling older women

This study aimed to investigate the relationship between objectively measured step counts, step intensity and FOF in community-dwelling older Chinese women. Cross-sectional analyses were conducted on pooled data (n = 1101) from the baseline survey of the Physical Activity and Health Study (PAHIOWS). Step counts and step intensity were measured using wGT3X-BT accelerometers, and FOF was categorized into two levels (low and high) for logistic regression analysis. Higher step counts were significantly and negatively associated with FOF; however, after adjusting for step intensity, the association was no longer statistically significant. On the contrary, higher step intensity was negatively associated with FOF independent of step counts. This finding may provide new insights into the physical activity management of FOF in older women.

Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice

PURPOSE

Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity.

DESIGN AND METHODS

This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings.

RESULTS

The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress.

CLINICAL RELEVANCE

If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services.

CONCLUSION

RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.