Average Number Of Daily Steps Research Articles

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

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. 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. 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. 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.

Step away from depression-results from a multicenter randomized clinical trial with a pedometer intervention during and after inpatient treatment of depression.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-Åsberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Association of accelerometer-measured physical activity, back static muscular endurance and abdominal obesity with radicular pain and non-specific low back pain

Low back pain (LBP) is the leading cause of disability worldwide and often associated with lifestyle factors. However, studies further examining the role of these lifestyle factors in non-specific low back pain in comparison with radicular pain are sparse. The aim of this cross sectional study was to investigate how diverse lifestyle factors are associated with LBP. The study population of 3385 middle aged adults with and without low back pain was drawn from a large Birth 1966 Cohort. Outcome measures were steps per day, abdominal obesity, physical activity and endurance of the back muscles. Back static muscular endurance, abdominal obesity and physical activity were measured by means of the Biering–Sørensen test, waist circumference and a wrist worn accelerometer, respectively. Logistic regression analysis was applied to estimate associations of back static muscular endurance, abdominal obesity and accelerometer-measured physical activity with non-specific low back pain and radicular pain. An additional 1000 steps per day were associated with 4% lower odds of having non-specific low back pain. Participants with abdominal obesity had 46% higher odds of having radicular pain, whereas increases of 10 s in back static muscular endurance and 10 min in daily vigorous physical activity were associated with 5% and 7% lower odds of having radicular pain, respectively. In this population-based study, non-specific low back pain and radicular pain were associated with different lifestyle and physical factors at midlife. Non-specific low back pain was associated only with the average daily number of steps, whereas abdominal obesity was the strongest determinant of radicular pain, followed by vigorous physical activity and back static muscular endurance. The findings of this study contribute to better understand the role of lifestyle factors in both non-specific low back pain and radicular pain. Future longitudinal studies are required to explore causality.

The Impact of Neighborhood Factors on Physical Activity in Older Adults With Visual Impairment

To investigate the associations of neighborhood-level socioeconomic and environmental characteristics with physical activity in persons with glaucoma. Cross-sectional study (N=230). Home addresses were used to extract neighborhood factors (NFs): Area Deprivation Index, crime rate, and the proportion of racial and ethnic minorities, poverty, college graduates, and park area in their census tract. Participants' average number of daily steps and nonsedentary minutes were collected over 7 days using an accelerometer. Visual field (VF) loss was quantified as integrated VF sensitivity. Multivariable negative binomial regression models and additional models with an interaction term evaluated the effect of NF on physical activity and whether these relationships differed by VF loss severity. Participants were on average 70.6 years of age, 51.7% were male, and 27.8% were black. A higher Area Deprivation Index or poverty share was associated with fewer NSM (incidence rate ratio [IRR]=0.96 per 1 Area Deprivation Index decile increment, P=.01; IRR=0.92 per 10% poverty share increment, P=.02), while higher share of college graduates was associated with greater NSM (IRR=1.03 per 10% increment; P=.03). Stronger associations were noted between both high crime rate and poverty share with NSM in individuals with severe VF damage as opposed to no/mild VF damage (IRR=0.44, P=.001; IRR=0.81, P=.02). Select NFs (poverty share and crime rate) may disproportionately affect physical activity in patients with severe VF loss. Interventions to overcome activity limitations within the context of poverty and high socioeconomic disadvantage are important for addressing glaucoma-related disability, particularly in those with severe VF loss.

P06-03 Associations between walkability and physical activity of Hungarian adults, preliminary study of the EUPASMOS project

BackgroundWalkability is a new definition in sport and health science in Hungary. In our study the walkability was measured by NEWS-Hungarian questionnaire first time in Hungary and our research aim was to compare neighbourhood walkability to physical activity level.MethodsThe study comprised 593 participating adults (248 males and 345 females). The data was collected during February-May 2019 using quota sampling by age and gender representing the Hungarian adult (18+) population. The physical activity was measured by RM 42 hip-worn triaxial accelerometer for 7 consecutive days using vigorous, moderate to vigorous activities and daily steps scores. The walkability was measured by walking and cycling facilities subscale (10 questions) of NEWS-Hungarian questionnaire. The subscale measured the environment's possibilities and quality for walking and cycling. Data were presented as mean ± standard deviation, Spearman's rank correlation was used to analyse data using SPSS 24. program, where level of significance was set at p > 0.05.ResultsThe mean age of the participants was 44.41±18.64 and their average number of daily steps was 7308.47±6993.86. 69.05% was lived in cities and 30.05% in rural areas. The respondent's opinion about the walking and cycling around their place of living was measured by a 4 point scale (1 = strongly disagree and 4 = strongly agree), where we found 2.76±2.8 mean scores. The walkability score was showed significant but weak correlation with accelerometer-measured vigorous PA (R = 0.124, p = 0.004). But the accelerometer-based number of steps was not showed correlation with walkability (R = 0.058, p = 0.184).ConclusionsAccording to our results the built environment, especially walking and cycling places had significant but weak effect on physical activity patters. The participants were somewhat satisfied with walking and cycling possibilities of their built environment but this was not affected directly the time spent physically active. This study used first time the NEWS-Hungarian walkability scale to have a better understanding of the country specific details and compared them with PA level of the population further analysis needed.

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke

Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40–5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.

Different association between physical activity and physical function according to walking independence in hospital-based rehabilitation program patients with sub-acute stroke

ObjectiveTo investigate the association between physical activity and physical function in ambulatory independent and non-independent patients with sub-acute stroke during hospitalization. MethodsThis cross-sectional observational study included 107 patients with stroke admitted to a rehabilitation unit. The average daily number of steps taken was considered as physical activity. Physical function was assessed using the 6 min walk test (6MWT), lower limb Fugl-Meyer assessment (FMA), and Berg balance scale (BBS). Walking independence was assessed using the functional ambulation category (FAC). The subjects were divided into a walking independence group (FAC ≥ 4) and a non-independence group (FAC ≤ 3). Multiple regression analysis was used to investigate the relationship between the daily number of steps and physical function in each group. ResultsThe daily number of steps (p < 0.001), lower limb FMA (p < 0.001), 6MWT (p < 0.001), and BBS (p < 0.001) were higher in the independent walking group than in the non-walking group. The daily number of steps in the walking independence group was significantly associated with the 6MWT (standard β = 0.489, p = 0.039). In the non-independence group, the daily number of steps was significantly associated with the BBS (standard β = 0.594, p < 0.001). ConclusionPhysical activity was associated with walking endurance in patients with ambulatory independence, even though it was associated with balance function in patients with non-ambulatory independence.

Lumbar disc herniation in patient with long-term postural in stabilty from achilles tendon rupture: A single case study

Lumbar Disc Herniation (LDH) may be triggered by many factors acting on the posterior kinetic chain as foot posture, foot and ankles malalignment and abnormal proprioception. Achilles Tendon (AT) rupture can impact heel position, ankle biomechanics, proprioceptive regulation and promote postural instability. This single case study aims to highlight the long-term effects of AT rupture, and its unefficient rehabilitation, on trunk asymmetry that could lead to lumbar degenerative diseases. This study describes a 50 year old woman with long-term postural instabilty from past AT rupture, who undergone to surgery for LDH and physioteraphy. The tailored exercise program included three sessions/week of both physical activity on dry land and active/passive aquatic physiotherapy. Average number of daily steps performed along the patient’s diagnostic and therapeutic pathway has been used to compare the activity rate over time. The Functional Movement Screen, the Owestry Low Back Pain Disability and the Lower Extremity Functional scales have been used as main outcome measures. This work aims to propose an integrated approach to patients with LDH built (a) following the principles of individuality, causality and totality and (b) combining activities on dry land and hydrotherapy within the same physical session, to improve the efficacy of rehabilitation programmes for spine injuries.

Risk and Resilience Predictors of Recovery After Spinal Fusion Surgery in Adolescents.

This prospective study examined risk and resilience predictors of pain and functional recovery in the first 6 months after spinal fusion surgery in adolescents. Adolescents with adolescent idiopathic scoliosis undergoing spinal fusion surgery (n=100, aged 12 to 18 y, 77% girls) completed assessments before surgery and at 3 weeks, 6 weeks, and 6 months after surgery. Recovery trajectories in pain, health-related quality of life (HRQOL), and objectively registered physical activity were identified. Presurgical pain catastrophizing and pain intensity (risk), and psychological flexibility, and postsurgical pain acceptance (resilience) were examined as predictors of recovery. Latent growth class analyses revealed 4 distinct pain recovery trajectories (ie, Severe-Moderate [11%, n=9], Mild-No [58%, n=49], Moderate-Mild [24%, n=20], and Moderate-Severe [7%, n=6] pain trajectory), 2 HRQOL recovery trajectories; 2 trajectories characterizing recovery in average daily physical activity at moderate-to-vigorous intensity (MVPA); and 3 trajectories characterizing recovery in total physical activity volume characterized by the average daily number of steps. Subsequent multivariate analyses of variance revealed that presurgical pain intensity (partial η2=0.21, P<0.001) and pain catastrophizing (partial η2=0.13, P<0.01) were both predictive of poorer recovery in HRQOL, and pain catastrophizing additionally predicted poorer pain recovery (partial η2=0.15, P<0.05). Psychological flexibility (partial η2=0.25, P<0.001) and postsurgical pain acceptance (partial η2=0.07, P<0.05) were predictive of more favorable recovery trajectories in HRQOL, and psychological flexibility additionally predicted more favorable recovery trajectories in postsurgical pain (partial η2=0.15, P<0.05). Daily MVPA trajectories were not significantly predicted by any of the hypothesized factors, while presurgical pain catastrophizing levels were predictive of a delayed recovery trajectory in the daily amount of steps (partial η2=0.17 P<0.01). Presurgical screening could include assessment of pain intensity, pain catastrophizing, psychological flexibility, and pain acceptance to identify adolescents who are at risk for poorer recovery. These are potentially modifiable factors that can be targeted in presurgical interventions to prevent poor and foster adaptive outcomes after major surgery in adolescents.

Daily cumulative load and body mass index alter knee cartilage response to running in women.

It is unknown whether a greater accumulation of knee load over a typical day is related to how cartilage responds to an acute bout of loading. This information may clarify the role of habitual activity on cartilage function. Is there a relationship between change in tibial and femoral cartilage thickness, volume, and T2 relaxation time following running with daily cumulative knee load in women? Secondarily, is there a relationship between cartilage change following running and the statistical interaction of body mass index (BMI) and daily steps? Participants (n = 15) completed gait analyses and wore an accelerometer over a week. Daily cumulative knee load was the statistical interaction between tibial compressive joint reaction force (JRF) impulse with the average number of daily steps measured using accelerometry. Magnetic resonance imaging scans were acquired before and immediately after 15-min of treadmill running. Changes in tibial and femoral cartilage thickness, volume, and T2 relaxation time were calculated. Multiple linear regressions tested the associations of cartilage change outcomes with: baseline (thickness, volume, T2), JRF impulse, steps, and the interaction JRF impulse*steps. Secondarily, BMI was substituted for JRF impulse. Tibial volume change was explained by baseline volume, JRF impulse, steps, and JRF impulse*steps (R2 = 0.50, p = 0.013). Additionally, tibial volume change was explained by baseline volume, BMI, steps, and BMI*steps (R2 = 0.43, p = 0.002). Those who were more physically active with lower JRF impulse (or lower BMI) showed less change in tibial cartilage after a running exposure. This may suggest cartilage conditioning.

Do Physical Activity and Sleep Correlate with Patient-Reported Outcomes in Total Hip Arthroplasty?

AbstractPatients have increasingly high expectations of return to activity following total hip arthroplasty (THA). The current literature demonstrates marked improvements in subjective patient-reported satisfaction, and pain and functional outcomes following THA. However, there is limited evidence showing objective improvement in gait and sleep measures. The purpose of this study was to compare accelerometry-measured physical activity and sleep to patient-reported outcomes following THA.A nonrandomized, prospective cohort study was performed at a single institution from 2017 to 2019. Patients were included in the study if they were ≥ 18 years old, had a primary diagnosis of osteoarthritis of the hip, and were undergoing primary, elective THA. Eligible patients received a tracker device upon enrollment which recorded the average number of daily steps and minutes slept at baseline, 1 to 2 weeks, 1 month, and 3 months postoperatively. Hip disability and osteoarthritis outcome score for joint replacement (HOOS Jr) scores were recorded at the same intervals. Paired two-tailed t-tests and chi-squared analyses were performed to compare means. Pearson correlation tests were utilized to determine the correlation between objective measurements and HOOS Jr.Fifty subjects were enrolled, however, only 41 had sufficient data for analysis at 3-month follow-up. Patients demonstrated improved HOOS Jr scores from preoperatively to 2 weeks (p &lt; 0.001) and 3 months (p &lt; 0.001) postoperatively. Average daily steps ambulated and minutes slept preoperatively were statistically similar to average daily steps and minutes slept 3 months postoperatively (p = 0.67 and p = 0.24, respectively). Pearson correlation models only detected a weak negative correlation between average steps preop and preop HOOS Jr (r = –0.401, p = 0.013).Patients returned to similar ambulation distances and sleep time by 3 months postoperatively. Changes in accelerometry-measured activity level and sleep may not correlate with functional outcomes in early follow-ups after THA. While patients report improvements in subjective clinical outcomes, our findings suggest a return to preoperative levels in objective measures at 3 months post-THA.

Effect of Statewide Lockdown in Response to COVID-19 Pandemic on Physical Activity Levels of Hemodialysis Patients

Background/Objectives: On March 22, 2020, a statewide stay-at-home order for nonessential tasks was implemented in New York State. We aimed to determine the impact of the lockdown on physical activity levels (PAL) in hemodialysis patients. Methods: Starting in May 2018, we are conducting an observational study with a 1-year follow-up on PAL in patients from 4 hemodialysis clinics in New York City. Patients active in the study as of March 22, 2020, were included. PAL was defined by steps taken per day measured by a wrist-based monitoring device (Fitbit Charge 2). Average steps/day were calculated for January 1 to February 13, 2020, and then weekly from February 14 to June 30. Results: 42 patients were included. Their mean age was 55 years, 79% were males, and 69% were African Americans. Between January 1 and February 13, 2020, patients took on average 5,963 (95% CI 4,909–7,017) steps/day. In the week prior to the mandated lockdown, when a national emergency was declared, and in the week of the shutdown, the average number of daily steps had decreased by 868 steps/day (95% CI 213–1,722) and 1,222 steps/day (95% CI 668–2300), respectively. Six patients were diagnosed with COVID-19 during the study period. Five of them exhibited significantly higher PAL in the 2 weeks prior to showing COVID-19 symptoms compared to COVID-19 negative patients. Conclusion: Lockdown measures were associated with a significant decrease in PAL in hemodialysis patients. Patients who contracted COVID-19 had higher PAL during the incubation period. Methods to increase PAL while allowing for social distancing should be explored and implemented.

What gait features influence the amount and intensity of physical activity in people with multiple sclerosis?

Although the mutual relationship between ambulation and physical activity (PA) in people with multiple sclerosis (pwMS) has been described in several studies, there is still a lack of detailed information about the way in which specific aspects of the gait cycle are associated with amount and intensity of PA. This study aimed to verify the existence of possible relationships among PA parameters and the spatio-temporal parameters of gait when both are instrumentally assessed.Thirty-one pwMS (17F, 14 M, mean age 52.5, mean Expanded Disability Status Scale (EDSS) score 3.1) were requested to wear a tri-axial accelerometer 24 hours/day for 7 consecutive days and underwent an instrumental gait analysis, performed using an inertial sensor located on the low back, immediately before the PA assessment period. Main spatio-temporal parameters of gait (i.e., gait speed, stride length, cadence and duration of stance, swing, and double support phase) were extracted by processing trunk accelerations. PA was quantified using average number of daily steps and percentage of time spent at different PA intensity, the latter calculated using cut-point sets previously validated for MS. The existence of possible relationships between PA and gait parameters was assessed using Spearman rank correlation coefficient rho.Gait speed and stride length were the parameters with the highest number of significant correlations with PA features. In particular, they were found moderately to largely correlated with number of daily steps (rho 0.62, P< .001), percentage of sedentary activity (rho = –0.44, P < .001) and percentage of moderate-to-vigorous activity (rho = 0.48, P < .001). Small to moderate significant correlations were observed between PA intensity and duration of stance, swing and double support phases.The data obtained suggest that the most relevant determinants associated with higher and more intense levels of PA in free-living conditions are gait speed and stride length. The simultaneous quantitative assessment of gait parameters and PA levels might represent a useful support for physical therapists in tailoring optimized rehabilitative and training interventions.

Physiotherapists and physical activity at work among in Benin and France

Physical activity at work is an important indicator of the level of activity. Physiotherapists are one of professionals for the prevention against sedentary lifestyle. Objective: To assess the level of physical activity at work among physiotherapists in Benin and France. Method: Descriptive and analytical cross-sectional study, conducted from July 2017 to July 2018. With physiotherapists who consent to participate to this study we use a pedometer. They wear it at work for five consecutive days. The average number of daily steps at work was determined. Physiotherapist’s level of inactivity was assessed using the Baecke questionnaire. Data was analyzed using Epi Info 13.0. X2 of Pearson’s and ANOVA tests. They were used for the comparison of qualitative and quantitative variables respectively. Significance level was set at 0.05. Results: Among fifty-four physiotherapists evaluated, forty-four (81.5%) were sedentary, with a significant level of sedentary lifestyle in twenty-six cases (48.11%). This limitation of physical activity at the workplace and the level of sedentary lifestyle of the subjects were comparable among Beninese and French physiotherapists and they were not associated with any of the factors studied. Conclusion: The level of physical activity of physiotherapists at work is limited. Raising the awareness of these actors seems essential.

Does Multiple Sclerosis Differently Impact Physical Activity in Women and Man? A Quantitative Study Based on Wearable Accelerometers.

In people with multiple sclerosis (pwMS), fatigue, weakness and spasticity may reduce mobility and promote sedentary behavior. However, little is known about the existence of possible differences in the way MS modifies the propensity to perform physical activity (PA) in men and women. The present study aimed to partly close this gap by means of quantitative analysis carried out using wearable sensors. Forty-five pwMS (23 F, 22 M, mean age 50.3) and 41 unaffected age- and sex-matched individuals wore a tri-axial accelerometer 24 h/day for 7 consecutive days. Raw data were processed to calculate average number of daily steps, vector magnitude (VM) counts, and percentage of time spent in sedentary behavior and in PA of different intensities (i.e., light and moderate-to-vigorous, MVPA). Women with MS spent more time in sedentary behavior and exhibited a reduced amount of light intensity activity with respect to men, while MVPA was similar across sexes. However, in comparison with unaffected individuals, the overall PA patterns appear significantly modified mostly in women who, in presence of the disease, present increased sedentary behavior, reduced MVPA, number of daily steps and VM counts. The findings of the present study highlight the urgency of including sex as variable in all studies on PA in pwMS.

The MIPAM trial: a 12-week intervention with motivational interviewing and physical activity monitoring to enhance the daily amount of physical activity in community-dwelling older adults \u2013 a study protocol for a randomized controlled trial

BackgroundPhysical Activity Monitors (PAMs) have been shown to effectively enhance level of physical activity (PA) in older adults. Motivational interviewing is a person-centred model where participants are guided using self-reflection and counselling, and addresses the behavioural and psychological aspects of why people initiate health behaviour change by prompting increases in motivation and self-efficacy. The addition of motivational interviewing to PA interventions may increase the effectiveness of PAMs for older adults.MethodsThis motivational interviewing and PA monitoring trial is designed as an investigator-blinded, two arm parallel group, randomized controlled superiority trial with primary endpoint after 12 weeks of intervention. The intervention group will receive a PAM-based intervention and motivational interviewing and the control group will only receive the PAM-based intervention. The primary outcome is PA, objectively measured as the average daily number of steps throughout the intervention period. Secondary outcome measures include self-reported PA health-related quality of life, loneliness, self-efficacy for exercise, outcome expectancy for exercise, and social relations. The outcomes will be analysed with a linear regression model investigating between-group differences, adjusted for baseline scores. Following the intention to treat principle, multiple imputation will be performed to handle missing values.DiscussionA moderate effect of daily PA measured using PAMs is expected in this superiority RCT investigating the effect of adding motivational interviewing to a PAM intervention. According to the World Health Organization, walking and cycling are key activities in regular PA and should be promoted. To increase the general public health and lower the burden of inactivity in older adults, cost-beneficial solutions should be investigated further. If this RCT shows that motivational interviewing can enhance the effect of PAM-based interventions, it might be included as an add-on intervention when appropriate. No matter what the results of this study will be, the conclusions will be relevant for clinicians as the dependence on technology is increasing, especially in relation to public health promotion.Trial registrationNCT03906162, April 1, 2019.

Wearable Activity Trackers for Monitoring Adherence to Home Confinement During the COVID-19 Pandemic Worldwide: Data Aggregation and Analysis.

BackgroundIn the context of home confinement during the coronavirus disease (COVID-19) pandemic, objective, real-time data are needed to assess populations’ adherence to home confinement to adapt policies and control measures accordingly.ObjectiveThe aim of this study was to determine whether wearable activity trackers could provide information regarding users' adherence to home confinement policies because of their capacity for seamless and continuous monitoring of individuals’ natural activity patterns regardless of their location.MethodsWe analyzed big data from individuals using activity trackers (Withings) that count the wearer’s average daily number of steps in a number of representative nations that adopted different modalities of restriction of citizens’ activities.ResultsData on the number of steps per day from over 740,000 individuals around the world were analyzed. We demonstrate the physical activity patterns in several representative countries with total, partial, or no home confinement. The decrease in steps per day in regions with strict total home confinement ranged from 25% to 54%. Partial lockdown (characterized by social distancing measures such as school closures, bar and restaurant closures, and cancellation of public meetings but without strict home confinement) does not appear to have a significant impact on people’s activity compared to the pre-pandemic period. The absolute level of physical activity under total home confinement in European countries is around twofold that in China. In some countries, such as France and Spain, physical activity started to gradually decrease even before official commitment to lockdown as a result of initial less stringent restriction orders or self-quarantine. However, physical activity began to increase again in the last 2 weeks, suggesting a decrease in compliance with confinement orders.ConclusionsAggregate analysis of activity tracker data with the potential for daily updates can provide information regarding adherence to home confinement policies.

Postoperative physical activity in orthogeriatric patients – new insights with continuous monitoring

BackgroundAn early postoperative mobilization shows beneficial effects in terms of complications and long-term mobilization scores in elderly adult fracture patients. The primary objective of this study was to evaluate the overall mobilization of orthogeriatric patients during the postoperative hospital stay based on a continuous accelerometry measurement. Secondly, the collected data was analyzed to detect fracture related differences. We hypothesized that upper extremity fractures come along with higher levels of physical activity compared to fractures of the lower extremity. MethodsThirty-one orthogeriatric patients with proximal femur fractures (PFF) and proximal humerus fractures (PHF) were enrolled consecutively in a maximum care hospital in a prospective study design (level of evidence 2). In the PFF study group 9 patients received hip arthroplasty and 11 patients intramedullary nailing (PFNA) and in the PHF group 10 patients received osteosynthesis of the proximal humerus. All patients worn a waist placed accelerometer during the length of hospitalization to quantify mobilization and physical activity. ResultsThe PFF group (n = 21) had a mean age of 80.86 years (SD ± 6.75), the PHF (n = 10) group had a mean age of 75.20 (SD ± 6.86). A significantly higher gait speed was observed in the PHF group of 0.52 m/s (SD ± 0.27) compared to the slower PFF group with 0.29 (SD ± 0.45); p = 0.0403. Quantitative mobility was measured by using the average number of daily steps. This showed a significantly lower number of steps in the PFF group (102.7; SD ± 188.1) compared to the PHF group (413.5; SD ± 287.7; p = 0.0002). ConclusionsOur data demonstrates that it is feasible and accepted by the patient to continuously measure the mobility including gait speed and characteristics of orthogeriatric patients using waist worn accelerometry based wearables. Postoperative mobility and gait speed was generally low in both groups. Actions to improve postoperative mobility of orthogeriatric patients are urgently needed. Level Of Evidence Prospective cohort study, Level of Evidence 2

How Many Steps Per Day are Necessary to Prevent Postoperative Complications Following Hepato-Pancreato-Biliary Surgeries for Malignancy?

The current study was designed to investigate the association between the average preoperative physical activity and postoperative outcomes in patients undergoing surgeries for hepato-pancreato-biliary (HPB) malignancy. Patients who were scheduled to undergo open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were included. The average steps per day were recorded by a pedometer and calculated for each patient during the preoperative waiting period. Physical activity levels were classified according to the average number of daily steps as poor (< 5000 steps/day) and good (≥ 5000 steps/day). Of the 105 eligible patients, 78 met the inclusion criteria. The median number of steps per day was 6174. There were 48 patients (62%) with good physical activity and 30 patients (38%) with poor physical activity. Patients with poor physical activity revealed a significantly higher rate of major complications with Clavien grade ≥ 3 (63% vs. 35%, p = 0.016), a higher rate of infectious complications (53% vs. 23%, p = 0.006), and a longer postoperative hospital stay (median, 30 vs. 21days, p < 0.001) compared with those with good physical activity. After a multivariate analysis, poor physical activity was identified as an independent risk factor for the development of major complications (odds ratio, 2.842, p = 0.042) and infectious complications (odds ratio, 3.844, p = 0.007). The current study demonstrated that preoperative physical activity levels are associated with the incidence of major postoperative complications following HPB surgery for malignancy.

Use of a smartphone app combined with gamification to increase the level of physical activity of adults and older adults: protocol of a sequential multiple assignment randomized trial

BackgroundThere is scientific evidence suggesting that app-based interventions targeted to increase the level of physical activity might be effective, although multicomponent interventions appear to be more effective than app-based interventions alone. Despite the motivating results, it remains unclear whether or not app-based interventions can increase the level of physical activity and cardiovascular health. Our study aims to investigate the effect of a smartphone app combined with gamification on the level of physical activity of adults and older adults. The specific aims are (1) to verify the effects of the intervention on cardiometabolic and cardiovascular health, lung function, and cardiorespiratory fitness; and (2) to verify the relationship between age group and the response rate.Methods/designWe will conduct a sequential multiple assignment randomized trial (SMART). The adaptive intervention protocol will last 6 months. After baseline assessments, participants will be randomized into one of three groups (group 1: app + tailored messages; group 2: app + tailored messages + gamification I; control group: physical activity counseling). For 12 weeks, we will record the average number of steps per day of participants from groups 1 and 2. At 6 weeks from initiation of recording, participants will be classified into responders and non-responders according to their increase in the average number of daily steps; all those considered as non-responders will be re-randomized, with the chance to participate in a third group – group 3: app + tailored messages + gamification II. Finally, at 12 weeks, participants will continue using the app but will no longer receive direct intervention from investigators. All participants will be reassessed at 3 and 6 months from baseline. Our pilot SMART will require 42 participants (14 per arm). Following the SMART pilot, we will calculate the sample size for the trial based on the variation of the average number of steps/day, including an up to 40% loss to follow-up and a less optimistic nonresponse rate of 65%.DiscussionTo our knowledge, this will be the first trial with adaptive intervention to test the effectiveness of using a smartphone app to increase the level of physical activity of adults and older adults.Trial registrationBrazilian Clinical Trials Registry: RBR-8xtc9c. Registered on 3 August 2018, http://www.ensaiosclinicos.gov.br; UTN number: U1111–1218-1092.