Step-Counting Validity of Wrist-Worn Activity Monitors During Activities With Fixed Upper Extremities

Abstract

Little is known about validity of wrist-worn physical activity monitors during activities when an arm-swing is not present. The purpose of this study was to compare the step-counting validity of wrist-worn activity monitors (Fitbit Charge HR Series 2, ActiGraph GT9X Link, Apple Watch Series 4) during functional physical activities with fixed upper extremities. Tasks included treadmill walking at 3 mph and five free-living tasks (walking with a baby doll on the left hip and the right hip, holding groceries, and pushing a stroller while walking and while jogging). Device step counts were compared to hand-counted steps from GoPro video footage. Fitbit Charge had less error when compared to the left ActiGraph in both stroller walking and jogging, treadmill walking, and grocery walking tasks (p < .001 to .020). For grocery walking, walking with a baby on the right, and walking with a baby on the left, device percentage errors ranged from 0 (0.5%) to −7.6 (15.8%). For stroller jogging, stroller walking, and treadmill walking, device percentage errors ranged from −8.3 (7.3%) to −94.3 (17.9%). Tasks with the hands fixed to an item that also had contact with the floor (stroller and treadmill) had more error than when participants held an item that was not in contact with the floor (doll and groceries). Though wrist-worn, consumer-grade step-counting devices typically undercount steps in general, consumers should be aware that their devices may particularly undercount steps during activities with the hands fixed. This may be especially true with items in contact with the floor.