Change In Step Count Research Articles

Development of a model predicting falls in older emergency department patients using smartphone-based mobility measures.

While emergency departments (EDs) are crucial for identifying patients at risk for falls, existing fall risk measures are often inaccurate. This study aimed to assess whether iPhone sensor-based mobility measures collected after ED discharge can improve fall prediction compared with traditional ED-based screening measures. This single-center, observational cohort study recruited ED patients aged 60 or older who owned an iPhone. Participants completed baseline assessments, downloaded a custom app to track mobility measures from the iPhone, and were followed for 90 days post-discharge. Fall outcomes were self-reported via the app or follow-up phone calls. Logistic regression and the LASSO technique were employed to identify significant predictors. The discriminative ability of the models was assessed by comparing the C-statistics. Of the 149 participants enrolled, 76.5% (N = 114) provided at least 7 days of post-discharge iPhone sensor-based mobility data. The cohort had a mean age of 73 years, with 16.7% (N = 19) experiencing a fall. Participants who fell showed a significantly greater increase in daily steps over time compared with those who did not (p = 0.002). The extended logistic regression model, by incorporating mean gait asymmetry and change in step count, demonstrated a higher but nonsignificant improvement in discriminative ability (C-statistic = 0.84) compared with the base model (C-statistic = 0.79). This study demonstrates that iPhone mobility measures collected after ED discharge can enhance fall prediction relative to self-reported fall risk screening questions in older adults. The strongest mobility predictors were gait asymmetry and changes in step count. While the findings suggest that post-discharge mobility monitoring could improve fall prevention strategies, further validation in diverse populations is necessary.

Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation.

Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)-hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z.

Impact on step count by commitment-based health application.

Prior research has implied that promoting sustaining physical activity through nudges is challenging and boosting health literacy is important for the long-term establishment of behaviors. This study aimed to investigate the effects of commitment-based health application on step count and health literacy. A control experiment was conducted involving employees from companies located in Shizuoka Prefecture, Japan. Participants were divided into three groups: the commitment app group (utilizing a commitment-based application "Minchalle," where teams of around five members were randomly assigned to declare a target step count and report daily step count with pictures), the self-commitment group (individuals declaring a target step count and endeavoring on their own), and the control group (no intervention). Changes in step count and health literacy were examined over one month. A total of 109 employees from 7 companies participated. The changes in step count were an increase of 893 steps for the commitment app group, 243 steps for the self-commitment group, and 178 steps for the control group, with a significant increase in the commitment app group compared to the control group. Regarding health literacy measures, there was significant progress in four items out of five for the commitment app group compared to the control group, and significant progress in one item for the self-commitment group compared to the control group. Communication within the app teams, such as commitment, sharing photos of their goal achievements and provide encouraging comments to others, functioned as social nudges, suggesting the potential for an immediate increase in step count and long-term behavioral reinforcement through improved health literacy.

Association between changes in habitual stepping activity and cognition in older adults

Advancing age is associated with declines in cognitive function. Although physical activity is thought to protect against this decline, it is unclear how a short-term uptake in daily steps or a decline in day-to-day step variability may contribute to cognition among older adults. We tested associations between changes in step counts, day-to-day step variability and executive cognitive functions among older adults taking part in a physical activity intervention. Thirty-seven older adults (33 females; 71.4 ± 6.3 years) completed a 10-week personalized physical activity intervention. Participants wore a Fitbit to measure daily step counts throughout the study. They also completed a computerized Stroop task before and after the intervention. Average step counts and step count variability via average-real-variability (ARV) were determined. Compared to pre-intervention, step counts increased (p < 0.001) and step variability decreased post-intervention (p = 0.04). Models describing the changes in step counts and ARV over the 10-weeks were cubic (both, p < 0.04). Reaction times during the simple (p = 0.002) and switching (p = 0.04) conditions were faster post-intervention. Change in step variability was positively associated with the change in reaction time for the switching condition (β = 0.029, p = 0.002). On average, a reduction in day-to-day step variability was associated with improvements in cognitive flexibility.

Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial

IntroductionPhysical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study...

Changes in the Step Counts of University Students Living in Hokkaido during the COVID-19 Pandemic

Background. Coronavirus disease (COVID-19) countermeasures, such as lockdowns, have been reported to reduce people’s physical activity levels. Purpose. To determine changes in the step counts among university students before and after the COVID-19 pandemic and identify the risk factors for decreased step counts. Materials and Methods. An online questionnaire was sent by e-mail to 1,851 students enrolled in a university in Hokkaido, Japan; of these, 127 participated. The questionnaire items were average monthly step counts from October 2019 to March 2022, type of residence, part-time job, club activities, personal demographics, height, and weight. The average step counts in October/November 2019 (before the pandemic) were used as the baseline, and changes in step counts were studied at five time points (every 6 months): April/May 2020 (first state of emergency declared), October/November 2020 (period of contained infection), April/May 2021 (second state of emergency declared), and October/November 2021 (period of contained infection). We also examined changes in the number of steps due to different lifestyle factors and factors that contributed to decreased step counts during the study period. Results. Significantly lower step counts than those at baseline were observed in April/May 2020 and April/May 2021; however, there was no significant difference in October/November 2020 and October/November 2021 compared with baseline. In addition, significantly lower step counts were observed in April/May 2020 than in April/May 2021. The risk of decreased step counts was significantly associated with nonparticipation in club activities, even after adjustment for other variables. Conclusion. The step counts of university students decreased significantly during the declaration of a state of emergency and recovered to pre-pandemic levels after the declaration was lifted. Lifestyle status revealed differences in the number of steps taken before and after the pandemic. Nonparticipation in club activities was identified as a major risk factor for a decrease in step counts.

Sequential multiple assignment randomised trial to develop an adaptive mobile health intervention to increase physical activity in people poststroke in the community setting in Ireland: TAPAS trial protocol

IntroductionStroke is the second-leading cause of death and disability globally. Participation in physical activity (PA) is a cornerstone of secondary prevention in stroke care. Given the heterogeneous nature of stroke,...

Abstract 17966: Behavioral Characteristics of High-Risk Postpartum Individuals Predict Response to a Digital Health Intervention to Improve Physical Activity

Background: Hypertensive disorders of pregnancy (HDP) are common among women and increase risk for cardiovascular disease later in life. Postpartum interventions can motivate healthy lifestyle changes but are not universally effective. Patient demographics insufficiently predict intervention response. Our goal is to use cluster analysis to determine how behavioral phenotypes are associated with response to a digital health intervention targeting postpartum women with HDP. Methods: We analyzed 122 participants in the STEP-UP Mom study, a randomized clinical trial comparing wearable step tracker and team-based gamification (intervention) to wearable step tracker alone (control) over 12 weeks. Behavioral characteristics were collected at baseline using validated surveys, to which we applied the k-means method to identify two distinct patient clusters. Linear mixed-effects models were used to estimate mean step count difference between arms from baseline across 12-week follow-up in each cluster. Results: Among the 122 participants, the median age was 33 years and 54% identified as Black. Participant characteristics in each cluster are shown in the Table. Participants in Cluster 1 had higher baseline steps, lower exercise self-efficacy and greater psychosocial distress. There was no significant difference in change in step count in the intervention arm compared to the control arm (-289 steps, 95% CI -1294, 717; p=0.57). Participants in cluster 2 had lower baseline steps, higher exercise self-efficacy, and less psychosocial distress. In cluster 2, participants in the intervention arm walked 1,309 more steps per day on average compared to the control arm (95% CI 475, 2144; p= 0.003). Conclusion: Participants had varied response to a digital health intervention based on behavioral phenotype. This finding may help identify individuals who may benefit from a higher touch or tailored intervention in future studies to increase step count in the postpartum period.

Using an electronic diary and wristband accelerometer to detect exacerbations and activity levels in COPD: a feasibility study.

Early and accurate identification of acute exacerbations of COPD may lead to earlier treatment and prevent hospital admission. Electronic diaries have been developed for symptom monitoring and accelerometers to monitor activity. However, it is unclear whether this technology is usable in the COPD population. This study aimed to assess the feasibility of an electronic diary (eDiary) for symptom reporting using the MoreCare app and activity monitoring with the Garmin Vivofit 2 in COPD. Participants were recruited from the London COPD Cohort. Participants were provided a Garmin Vivofit 2 activity monitor and an android tablet with the MoreCare app for a period of 3 months. 25 COPD patients were recruited (mean±sd age 70.8±7.1 years, forced expiratory volume in 1 s (FEV1) 49.8±14.8% predicted). Age, gender, disease severity and exacerbation frequency had no impact on eDiary compliance. There was a moderate positive correlation between median daily very active minutes and FEV1 % pred (ρ=0.62, p=0.005). Daily step counts decreased during the initial 7 days of exacerbation and recovery compared to a pre-exacerbation baseline. A decision-tree model identified change in sputum colour, change in step count, severity of cold, exacerbation history and use of rescue medication as the most important predictors of acute exacerbations of COPD in this cohort. Symptom and activity monitoring using digital technology is feasible in COPD. Further large-scale digital health studies are needed to assess whether eDiaries can be used to identify patients at risk of exacerbation and guide early intervention.

The STEPWISE study: study protocol for a smartphone-based exercise solution for people with Parkinson’s Disease (randomized controlled trial)

BackgroundExercise has various health benefits for people with Parkinson’s disease (PD). However, implementing exercise into daily life and long-term adherence remain challenging. To increase a sustainable engagement with physical activity of people with PD, interventions that are motivating, accessible, and scalable are needed. We primarily aim to investigate whether a smartphone app (STEPWISE app) can increase physical activity (i.e., step count) in people with PD over one year. Our second aim is to investigate the potential effects of the intervention on physical fitness, and motor- and non-motor function. Our third aim is to explore whether there is a dose-response relationship between volume of physical activity and our secondary endpoints.MethodsSTEPWISE is a double-blind, randomized controlled trial. We aim to include 452 Dutch people with PD who can walk independently (Hoehn & Yahr stages 1–3) and who do not take more than 7,000 steps per day prior to inclusion. Physical activity levels are measured as step counts on the participant’s own smartphone and scaled as percentage of each participant’s baseline. Participants are randomly assigned to an active control group with an increase of 5–20% (active controls) or any of the three intervention arms with increases of 25–100% (intermediate dose), 50–200% (large dose), or 100–400% (very large dose). The primary endpoint is change in step count as measured by the STEPWISE smartphone app from baseline to 52 weeks. For our primary aim, we will evaluate the between-group difference in average daily step count change from baseline to 52 weeks. For our second aim, measures of physical fitness, and motor- and non-motor function are included. For our third aim, we will associate 52-week changes in step count with 52-week changes in secondary outcomes.DiscussionThis trial evaluates the potential of a smartphone-based intervention to increase activity levels in people with PD. We envision that motivational apps will increase adherence to physical activity recommendations and could permit conduct of remote clinical trials of exercise for people with PD or those at risk of PD.Trial registrationClinicalTrials.gov; NCT04848077; 19/04/2021. Clinicaltrials.gov/ct2/show/NCT04848077.

Activity behaviors and relative changes in activity patterns recorded by precision technology were associated with diarrhea status in individually housed calves

The objective of this case-control study was to quantify if there was an association of daily activity behaviors and relative changes in activity patterns (lying time, lying bouts, step count, activity index) with diarrhea status in preweaned dairy calves. Individually housed calves sourced from auction were health scored daily for signs of diarrhea (fecal consistency loose or watery for 2 consecutive d) for the 28 d after arrival. Calves with diarrhea were pair matched to healthy controls (n = 13 matched by arrival date, arrival weight, and diagnosis d to diarrheic calves). Mixed linear regression models were used to evaluate the association of diarrhea status, and the diarrhea status by day interaction with activity behaviors (d -3 to d 4) and relative changes in activity patterns (d -3 to d 4) relative to diagnosis of a diarrhea bout. The serum Brix % at arrival and daily THI from the calf barn were explored as quantitative covariates, with d as a repeated measure. The baseline for relative changes in activity patterns was set at 100% on d 0. Diarrheic calves were less active; they averaged less steps (119.1 ± 18.81 steps/d) than healthy calves (227.4 ± 18.81 steps/d, LSM ± SEM). Diarrheic calves also averaged lower activity indices (827.34 ± 93.092 daily index) than healthy calves (1396.32 ± 93.092 daily index). There was also a diarrhea status by day interaction for lying time on d -3, with diarrheic calves spending more time lying (20.80 ± 0.300 h/d) than healthy calves (19.25 ± 0.300 h/d). For relative changes in activity patterns, there was a diarrhea status by day interaction on d -2, where diarrheic calves had greater relative changes in step counts (diarrhea 634.85 ± 87.581% vs. healthy 216.51 ± 87.581%) and activity index (diarrhea 316.83 ± 35.692% vs. healthy 150.68 ± 35.692%). Lying bouts were not associated with diarrhea status. These results show that diarrheic calves were more lethargic, and they had relative changes in activity patterns -2 d before clinical signs of diarrhea. Future research should explore the potential of an activity alert which positively indicates an individually housed calf at-risk for a diarrhea bout using deviations from relative changes in individual calf activity patterns.

Physical Activity Profiles among Patients Admitted with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

People with hospitalised acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exhibit low levels of physical activity (PA) and increased risks of future exacerbations. While methods to objectively measure and express PA are established for people with stable COPD, less clarity exists for people during AECOPD. Further, the relationship between PA during AECOPD and clinically relevant outcomes remains uncertain. The purpose of the study was to evaluate how much PA (step count and intensity) people accumulate during hospitalised AECOPDs, and the effect of accumulated inpatient PA (expressed via differing metrics) on length of stay (LOS), PA recovery, and readmission risk. This study was a secondary analysis of prospective observational cohort data collected with Actigraph wActiSleep-BT devices from patients with AECOPD in a Melbourne hospital from 2016 to 2018. Step counts and PA intensity throughout the hospital admission and at one-month follow-up were collected and analysed. Sixty-eight participants were recruited for inpatient measurement, and 51 were retained for follow-up. There were no significant changes in step count or intensity across the inpatient days, but 33/51 (65%) of participants demonstrated a clinically meaningful improvement in steps per day from 3817.0 to 6173.7 at follow-up. Participants spent most time sedentary and in light PA, with both PA metrics demonstrating significant influences on LOS and follow-up PA intensity, but with generally low explanatory power (R2 value range 7-22%). Those who had LOS < 5 days spent significantly less time sedentary and more time in light PA than those with LOS ≥ 5 days (p < 0.001 for both). Time spent sedentary or in light PA appears to be the most promising metric to associate with clinically relevant outcomes related to recovery following AECOPD. These findings can inform future clinical practice for the evaluation of inpatient PA to better establish its role in the clinical management of patients with AECOPD.

Comparing physical activity prescription with verbal advice for general practice patients with cardiovascular risk factors: results from the PEPPER randomised controlled trial

BackgroundRegular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity.ObjectiveTo evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care.MethodsThe randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months.ResultsOne hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 – 7.4]) reaching 48 min after 12 months (95% CI: 8 – 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 – 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 – 14700]) increase was observed in the prescription group.ConclusionPrescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity.Trial registrationThe PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).

Effects of museum-based art activities on older community dwellers' physical activity: the A-health randomized controlled trial results.

Museum-based art activities have demonstrated health benefits in older adults. Few clinical trials, however, have examined physical health benefits specifically. This randomized controlled trial (RCT) aims to compare changes in daily step count over a 3-month period in older adults participating in museum-based art activities and their control counterparts. Using a subset of 53 participants recruited in the A-health RCT, the daily step count of 28 participants in the intervention group (age 70.5 ± 4.9 and 92.0% female) and 25 in the control group (age 71.5 ± 5.3 and 78.6% female) were recorded using a Fitbit Alta HR. Weekly art activities were carried out at the Montreal Museum of Fine Arts (MMFA, Quebec, Canada) over a 3-month period. The outcomes were the mean step count per active hours (i.e., between noon and 6pm), inactive hours (i.e., between midnight and 6 am) and over the full day (i.e., 24h) and the change in step count following the 3-month (M3) art-based intervention at the MMFA. The intervention group had a greater daily step count compared to the control group at M3, regardless of the step parameters examined (P ≤ 0.026). Linear regressions showed that the change in daily step count for the full day (P ≤ 0.010) and active hours (P ≤ 0.026) increased significantly with the MMFA art-based activities. MMFA-based art activities improved daily physical activity in older community-dwellers who participated in the RCT, confirming health benefits and suggesting the potential of museums in health promotion and disease prevention.

Associations between changes of smartphone pedometer-assessed step counts and levels of obesity-related breast cancer biomarkers in non-cancer women: A population-based observational study

ABSTRACT While a higher level of physical activity (PA) is inversely associated with a higher breast cancer (BC) risk, the health benefits of daily steps on obesity-related BC biomarkers remain unclear. We aimed to understand the associations of changes in step counts with levels of five obesity-related BC biomarkers during a two-year follow-up. In total, 144 non-cancer women (47.96 ± 5.72) were observed on both 2019 and 2021. A structured questionnaire, daily steps and fasting blood samples were collected before (t0, 2019) and after (t1, 2021). Levels of biomarkers (IGF-binding proteins 3, adiponectin, soluble leptin receptor, C-reactive protein, and resistin) were assayed by ELISA. Participants were divided into persistent low steps, decreasing steps, increasing steps, and persistent high steps. Associations of categories on proposed biomarkers were estimated using linear regression models, with persistent low steps as reference. Associations between time-varying step counts with biomarkers were quantified using mixed linear models. Compared with persistent low steps, increasing steps is associated with a reduction in C-reactive protein level (β=−0.74, 95%CI=−1.23-−0.26, P-value = 2.98 × 10−3). An inverse association between time-varying step counts with C-reactive protein level was identified, consistent across different obesity types and baseline step level categories. No association with daily step counts was observed for other proteins.

Maintenance effects of a gamification intervention on motivation and physical activity in patients with coronary heart disease: intermediate results of a randomized controlled trial

Abstract Background Despite the benefits of cardiac rehabilitation and secondary prevention, patients with coronary heart disease frequently fail to meet their daily physical activity goals. When one is stuck in a cycle of bad habits, changing one's behavior can be very challenging. One of the difficulties to maintaining a healthy lifestyle may be a lack of motivation. The use of game design elements (such as points, leaderboards, progress bars, and badges) in non-game contexts to promote motivation and engagement is known as gamification. It could be a powerful tool for encouraging patients to engage in physical activity. However, solid ideas that utilize the fundamental experience and psychological impacts of gaming mechanics must be built upon. Purpose The aim of this study is to look into the impact of a smartphone-based gamification intervention on physical activity engagement and other related psychological outcomes in patients with coronary heart disease, as well as the 24-week maintenance of effects beyond the 12-week intervention. Methods Participants with coronary heart disease were randomly assigned to three groups (control group, individual group and team group). The individual and team groups received gamified behavior intervention based on behavioral economic principles. Based on the Individual group, the team earned social incentives (collaboration). The intervention lasted 12 weeks, with another 12 weeks of follow-up. The primary outcomes included the change in daily steps and the proportion of patient-days that step goals achieved. The secondary outcomes included competence, autonomous, relatedness and autonomous motivation. Results The follow-up period has now been completed by 65 participants (mean age 52.8+10.3, 18.2% female) completed the follow-up period. Compared with the control group (n=17), participants in the individual group (n=25) had a significantly greater increase in mean daily steps from baseline during the intervention group (difference 956; 95% CI, 243–1623; P&amp;lt;0.01), and had a significantly greater proportion of patient-days that step goals achieved (difference 0.35; 95% CI, 0.03–0.12; P&amp;lt;0.001), competence (difference 0.5, 95% CI, 0.3–0.7; P&amp;lt;0.001), autonomous motivation (difference 3.2; 95% CI, 2.0–4.0; P&amp;lt;0.001). However, no significant difference of change in step counts was found between team group (n=23) and control group. During the follow-up period, mean daily steps and autonomous motivation in the individual declined but remained significantly greater than that in the control arm compared with baseline (steps: difference 452; 95% CI, 138–818; P&amp;lt;0.05) (motivation: difference 1.2; 95% CI, 0.3–1.8; P&amp;lt;0.05). Conclusions A smartphone-based gamification intervention was found to be an effective strategy to enhance motivation and physical activity engagement, as well as having a great maintenance effect. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work is financially supported by a Construction Programme of Independent Innovation Ability of Community Health Nursing Engineering Laboratory in Jilin Province (Study code: 2020C038-8) awarded to FL.

Responsiveness of an activity tracker as a measurement tool in a knee osteoarthritis clinical trial (ACTIVe-OA study).

In osteoarthritis (OA) clinical trials, reliable and responsive outcome measures to document physical and functional improvements are limited. This study aimed to assess whether the use of an activity tracker in an OA clinical trial is a responsive measurement tool. Secondary objectives assessed feasibility and validity. We recruited 65 participants in a prospective cohort study nested in a placebo-controlled clinical trial of platelet-rich plasma injection in knee OA. Participants wore an activity tracker (Fitbit Flex 2), and a smartphone was preloaded with a mobile application (OApp) designed to monitor load rates as a surrogate of knee loading. Participants used the systems for 7 days at baseline and for 7 days before the 2-month follow-up assessment. Effect size (ES) and standardised response mean (SRM) were calculated for change in step count and knee loading rate and regularly used knee OA outcome measures. Correlation coefficients (r) were calculated to examine the strength of the association between outcome measures. . Step count showed a trivial ES and SRM and mean knee loading rate measurements a moderate ES and SRM. We found a weak but significant correlation between change in mean steps per day and global improvement overall (r=0.28) and Western Ontario and McMaster Universities Osteoarthritis Index function (r=-0.28). Compliance was high with the activity trackers. Despite good feasibility, this study did not show significant responsiveness or validity of the activity trackers as compared with currently recommended outcome measures in OA clinical trials. The main challenge is the lack of a gold standard outcome measure to validate against, and because of the complex interplay between pain and measured function, a lack of correlation does not necessarily represent a failed validation in this context. ACTRN12617000853347. This trial is a substudy of the "Platelet-rich plasma as a symptom-and disease-modifying treatment for knee osteoarthritis - the RESTORE trial".

Smartphone-based gamification intervention to increase physical activity participation among patients with coronary heart disease: intermediate results of a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work is financially supported by a Construction Programme of Independent Innovation Ability of Community Health Nursing Engineering Laboratory in Jilin Province (Study code: 2020C038-8) awarded to FL. Background Despite the benefits, patients with coronary heart disease are less likely to engage in physical activity. Gamification is the use of game design elements (such as points, leaderboards, progress bars, and badges) in nongame contexts to increase motivation and engagement. Scientific evidence suggests that smartphone-based gamification interventions have the potential to increase physical activity participation. However, empirical evidence on the efficacy of such interventions among patients with coronary heart disease is still emerging. Purpose This study incorporates behavioral economics into a gamification intervention based on a smartphone app (WeChat applet) to explore whether a gamification intervention can improve participation in physical activity and other related physical and psychological outcomes in patients with coronary heart disease. Methods A group of 108 participants (mean age 53.0+10.5, 18.5% female) with coronary heart disease were randomly assigned to three groups (Control group: WeChat applet+step goal setting; Individual group: WeChat applet+step goal setting+gamification; Team group: WeChat applet+step goal setting+gamification+collaboration). The primary outcomes included the change in daily steps and the proportion of patient-days that step goals achieved. Patients also completed Psychological Needs Satisfaction in Exercise Scale (PNSE), Behavioural Regulation in Exercise Questionnaire (BREQ)-3, Physical Activity Enjoyment Scale (PACES), Generalised Anxiety Disorder (GAD)-7, Patient Health Questionnaire (PHQ)-9 at baseline, 12 weeks and 24 weeks. Results Compared with the control group (n=36), participants in the individual group (n=36) had a significantly greater increase in mean daily steps from baseline during the intervention group (difference 988; 95% CI, 259 - 1717; P&amp;lt;0.01), and had a significantly greater proportion of patient-days that step goals achieved (difference 0.38; 95% CI, 0.04 - 0.13; P&amp;lt;.001), competence (difference 0.6, 95% CI, 0.3 - 0.8; P&amp;lt;.001), autonomous motivation (difference 3.3; 95% CI, 2.2 to 4.4; P&amp;lt;.001), weight (difference -1.2, 95% CI, -1.8 to -0.6; P&amp;lt;.001), BMI (difference -0.4; 95% CI -0.6 to -0.2; P&amp;lt;.001) and waist circumference (difference -1.2; 95% CI -1.7 to -0.6; P&amp;lt;.001). Participants in team group (n=36) had a significantly greater increase in competence (difference 0.3; 95% CI 0.1 to 0.6; P&amp;lt;.001), relatedness (difference 0.9; 95% CI 0.7 to 1.2; P&amp;lt;.001), autonomous motivation (difference 3.0; 95% CI 2.1 to 4.0; P&amp;lt;.001),however, no significant difference of change in step counts was found between team group and control group. Conclusions A smartphone-based gamification intervention may be an effective way to promote physical activity in patients with coronary heart disease within 12 weeks if we incorporate appropriate game elements into the smartphone application.

Lameness changes the behavior of dairy cows: daily rank order of lying and feeding behavior decreases with increasing number of lameness indicators present in cow locomotion

Lameness is a major animal welfare problem in modern dairy farms. Although association between cow behavior and lameness is proven, functioning and reliable on-farm applications for automatic lameness detection is still lacking because large within and between farm variation in cow behavior exists. There were two aims in this study: 1) to investigate if a simple ranking of cows in an order based on their time spent on a specific behavior or number of behavior bouts could be used for normalizing behavior data, and 2) to study how daily lying and feeding behavior, and their rank order variables are affected by lameness. We followed in total 84 cows divided in two half-year trials (N = 45 and N = 49, ten cows enrolled in both trials). Cows were locomotion scored fortnightly and their lying,roughage feeding behavior, and step count were measured continuously with automatic sensors. In addition to using absolute values of daily behavior, animals were ranked in ascending order within experimental cows in the group for each day based on their absolute value (hours/number of bouts/number of steps) of the behavior in question. Daily behavioral and cow level factors were merged with temporally closest locomotion score. Two sets of linear mixed models were fitted: 1) to investigate the effect of trial on absolute and rank order values of behavior, and 2) to investigate effect of locomotion score, parity, breed and lactation stage on absolute and rank order values of behavior. There was a significant difference between the trials in lying behavior of the cows, but not in feeding behavior; cows spent more time lying down in the first trial (P= 0.0027). This difference was not evident in rank order values. Increasing the number of lameness indicators was associated with increasing lying time, increase in number of lying bouts, decreasing roughage feeding time and decrease in feeding bouts (P<0.0001). Similar differences were observed in rank order values of behaviors (P<0.0001). No consistent change in step count was observed with respect to increasing number of lameness indicators. Based on these data, ranking the cows within the herd based on their behavior did normalize the data between two trials, and rank order values behaved similarly to absolute daily behavior with respect to a cow's lameness status. Thus, using rank order variables could address some issues in development of automated lameness detection systems arising from within and between herd variability in dairy cow behavior.

668-P: Increased Step Count but No Improvements in Glucose Control: Using CGM as Visualization Tool in Adults with T2D

Background: Physical inactivity is common in people with T2D and behavior modification can be difficult due to lack of timely and knowledgeable feedback. Real-time CGM (rtCGM) visualization of impact of efforts on glucose can highlight opportunities for medication and behavior modification to clinicians and individuals. Methods: Glucose and step data in an observational study were collected with Dexcom G6 rtCGMs and activity trackers for 12 weeks in US adults with T2D. Participants did not receive education beyond standard of care. Paired T-tests were used to evaluate changes in step count, % time in range, peak glucose, and hyper- and hypoglycemic events between first and last weeks. Results are presented for the full T2D population (n=183) and a subgroup who increased average daily step count by ≥ 1000 steps (n=63) . Results: Morning steps significantly increased across all participants and steps in all meal-related time periods significantly increased for subgroup (Table 1) . There was not a sustained, significant glucose impact. Conclusion: Adding steps alone, supported by rtCGM, did not result in improvements in glucose. Such visualization provides information for individuals and clinicians to understand opportunities for therapy optimization, including activity and medication regimen. This is promising preliminary data and further research with prescribed intervention is required. Disclosure M.A.Crawford: Employee; Dexcom, Inc. D.R.Cherñavvsky: Employee; Dexcom, Inc. K.Barnard: Advisory Panel; Roche Diabetes Care, Sanofi, Research Support; Dexcom, Inc., Novo Nordisk. X.Wang: None. P.Genge: Employee; Dexcom, Inc. K.Greenawald: None. M.Tressler: Employee; Dexcom, Inc.