Steps Per Day Research Articles

'We get to learn as we move': effects and feasibility of lesson-integrated physical activity in a Swedish primary school.

Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school. We evaluate a new method called 'Physical Activity and Lesson in Combination' (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n = 83) and the other the control group (C-school, n = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7-9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with < 10,000 SPD were compared. Statistical differences between the schools were tested with ANOVA, Chi2, t-tests, and ANCOVA. Interviews with students (n = 17), parents (n = 9) and teachers (n = 9) were conducted and analysed using qualitative content analysis. The results show that FALK led to the I-school getting more SPD and fewer students with < 10,000 SPD. Also, FALK was experienced as a positive, clear, and flexible method, simultaneously encouraging PA and learning. Challenges experienced concerned the teachers' work situation, time, finding suitable learning activities, outdoor school environment changes, and extreme weather conditions. This study indicates that FALK has the desired effects on PA and is a feasible method of integrating PA into theoretical teaching. We conclude that FALK is worth testing at more schools, given that implementation and sustainment of FALK considers both general enablers and barriers, as well as context-specific factors at the individual school.

Feasibility of functional evaluation in older adults with gastroesophageal cancer using fitness trackers.

298 Background: With advances in treatment and an aging population, gastroesophageal cancer (GEC) in older adults (OA) is increasing. Geriatric assessment (GA) is recommended as part of treatment decision in patients ≥ 65. Unfortunately, due to the complex nature and multiorgan effects of GEC, it is often difficult for oncologists to discern whether GA abnormalities are secondary to aging or the GEC itself. Because of their objectivity, fitness trackers are becoming increasingly popular in the functional evaluation of cancer patients. While fitness trackers have shown feasibility and validity in some cancers, data for their use in OA is currently limited. Objective: Evaluate the feasibility of functional status assessment via Fitbit activity tracker (FB) in comparison to traditional geriatric assessments in OA with GEC. Methods: Patients age ≥65 with any stage of GEC completed a GA and were given a FB to wear for 3 days in line with the battery life of the device. GA included a comprehensive evaluation of all geriatric domains with functional status assessed by performance status (PS), falls, Timed Up and Go (TUG), Activities of Daily Living (ADLs), and Instrumental Activities of Daily Living (IADLs). FB collected total steps per day (SPD), and patients’ mean SPD was calculated. We compared patient characteristics and outcomes using Fisher’s exact and Wilcoxon tests grouped by below and above median SPD. Results: 82 patients completed GA, of which 69 (84%) wore FB for ≥8 hours. Mean SPD for all patients was 2827 (38 – 11032), median SPD was 2264. Patients with ≤ median SPD were older (75 vs 72 p=0.034), female (32% vs 14% p=0.093), Black (24% vs 9% p=0.068), and living alone (29% vs 14% p=0.153). Patients SPD below and above the median had similar distributions of education level (≤12 yrs 35% vs 31% p=0.802) and Stage (&gt;2 82% vs 80% p=0.99). Patients with SPD below the median were more likely to have ≥ 2 abnormalities on GA (68% vs. 40%, p=0.03), self-reported PS &gt;2 (24% vs 0% p=0.013), and impaired IADL (33% vs 9% p=0.064). Patients with lower SPD had higher rates ≥Gr 3 toxicity (47% vs 20% p=0.022) and hospitalization (32% vs 6% p=0.006). The rate of abnormal TUG was similar in both groups (21% vs 17%, p=0.285). Conclusions: FB use for short objective evaluation functional status is feasible among OA with GEC and provides data which correlates with other GA abnormalities and treatment tolerance. Additional research is warranted to further incorporate this assessment tool into clinical care.

Clinical Impact of Physical Activity and Cough on Disease Progression in Fibrotic Interstitial Lung Disease.

Physical activity limitations and cough are common in patients with interstitial lung disease (ILD), potentially leading to reduced health-related quality of life. We aimed to compare physical activity and cough between patients with subjective, progressive idiopathic pulmonary fibrosis (IPF) and fibrotic non-IPF ILD. In this prospective observational study, wrist accelerometers were worn for seven consecutive days to track steps per day (SPD). Cough was evaluated using a visual analog scale (VAScough) at baseline and weekly for six months. We included 35 patients (IPF: n = 13; non-IPF: n = 22; mean ± SD age 61.8 ± 10.8 years; FVC 65.3 ± 21.7% predicted). Baseline mean ± SD SPD was 5008 ± 4234, with no differences between IPF and non-IPF ILD. At baseline, cough was reported by 94.3% patients (mean ± SD VAScough 3.3 ± 2.6). Compared to non-IPF ILD, patients with IPF had significantly higher burden of cough (p = 0.020), and experienced a greater increase in cough over six months (p = 0.009). Patients who died or underwent lung transplantation (n = 5), had significantly lower SPD (p = 0.007) and higher VAScough (p = 0.047). Long-term follow up identified VAScough (HR: 1.387; 95%-CI 1.081-1.781; p = 0.010) and SPD (per 1000 SPD: HR 0.606; 95%-CI: 0.412-0.892; p = 0.011) as significant predictors for transplant-free survival. In conclusion, although activity didn't differ between IPF and non-IPF ILD, cough burden was significantly greater in IPF. SPD and VAScough differed significantly in patients who subsequently experienced disease progression and were associated with long-term transplant-free survival, calling for better acknowledgement of both parameters in disease management.

Feasibility of Fitness Tracker Usage to Assess Activity Level and Toxicities in Patients With Colorectal Cancer.

Performance status (PS) is a subjective assessment of patients' overall health. Quantification of physical activity using a wearable tracker (Fitbit Charge [FC]) may provide an objective measure of patient's overall PS and treatment tolerance. Patients with colorectal cancer were prospectively enrolled into two cohorts (medical and surgical) and asked to wear FC for 4 days at baseline (start of new chemotherapy [± 4 weeks] or prior to curative resection) and follow-up (4 weeks [± 2 weeks] after initial assessment in medical and postoperative discharge in surgical cohort). Primary end point was feasibility, defined as 75% of patients wearing FC for at least 12 hours/d, 3 of 4 assigned days. Mean steps per day (SPD) were correlated with toxicities of interest (postoperative complication or ≥ grade 3 toxicity). A cutoff of 5,000 SPD was selected to compare outcomes. Eighty patients were accrued over 3 years with 55% males and a median age of 59.5 years. Feasibility end point was met with 68 patients (85%) wearing FC more than predefined duration and majority (91%) finding its use acceptable. The mean SPD count for patients with PS 0 was 6,313, and for those with PS 1, it was 2,925 (122 and 54 active minutes, respectively) (P = .0003). Occurrence of toxicity of interest was lower among patients with SPD > 5,000 (7 of 33, 21%) compared with those with SPD < 5,000 (14 of 43, 32%), although not significant (P = .31). Assessment of physical activity with FC is feasible in patients with colorectal cancer and well-accepted. SPD may serve as an adjunct to PS assessment and a possible tool to help predict toxicities, regardless of type of therapy. Future studies incorporating FC can standardize patient assessment and help identify vulnerable population.

Capacity vs. Performance: Maximizing a Patient's Carryover From Physical Therapy to Community Life

<h3>Research Objectives</h3> Assess PT's impact on a patient's community performance with and without attention to objective self-monitoring. <h3>Design</h3> Case study, within subject comparison. <h3>Setting</h3> Outpatient PT. <h3>Participants</h3> A 62-year-old male 1.5yrs post-stroke. No contraindications to high intensity gait training (HIGT). <h3>Interventions</h3> Treatment involved HIGT for 30minutes/session over 20 sessions. During the initial 10 visits the patient was encouraged to walk a minimum of 30minutes/day. For the second 10 visits the patient was instructed to: walk a minimum of 10,000 steps per day (SPD) and check his step totals daily. PT also reviewed the patient's steps each session. <h3>Main Outcome Measures</h3> SPD; 10-Meter Walk Test (10MWT); 6-Minute Walk Test (6MWT); Functional Gait Assessment (FGA). <h3>Results</h3> By his 10th visit the patient's functional capacity objectively improved in a clinically meaningful way: 10MWT 1.05m/s to 1.50m/s; 6MWT 432m to 530m; and FGA 17/30 to 24/30. Patient consistently achieved HIGT target HR range (average session intensity 83% HRmax). Patient's community performance increased from 7,033 SPD (initial evaluation) to 7,781 SPD (10th visit). Following the above education his average SPD increased to 29,843. <h3>Conclusions</h3> This case study supports direct patient education and objective daily step monitoring to promote improved patient performance. This patient demonstrated minimal change in his daily functional performance, despite clinically significant changes to his capacity, without this education. Greater emphasis on self-monitoring appeared to positively influence the patient's average SPD between his 10th and 20th visit (Δ 22,062 SPD). In conclusion, it should not be assumed that improvements in capacity correlate automatically with increased performance outside of the clinical setting. Objectively tracking performance, and problem solving with the patient to overcome any self-perceived barriers, may help bridge the gap between the clinic and community to maximize quality of life. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Beyond Physical Capacity: Factors Associated With Real-world Walking Activity After Stroke

ObjectiveTo identify homogeneous subsets of survivors of chronic stroke who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in survivors of chronic stroke. DesignCross-sectional, secondary data analysis. SettingUniversity/laboratory. ParticipantsA total of 283 individuals with chronic (≥6mo) stroke (N=238). InterventionsNot applicable. Main Outcome MeasuresThirteen variables representing 5 domains were included: (1) walking ability: 6-minute walk test (6MWT), self-selected speed (SSS) of gait; (2) psychosocial: Patient Health Questionnaire-9, Activities-specific Balance Confidence (ABC) scale; (3) physical health: low-density lipoprotein cholesterol, body mass index, Charlson Comorbidity Index (CCI); (4) cognition: Montreal Cognitive Assessment (MoCA); and (5) environment: living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of survivors of stroke. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking ResultsA model with 3 latent classes was selected. The 6MWT, SSS, ABC scale, and Walk Score were significantly different among all 3 classes. Differences were also seen for the MoCA, ADI, and CCI between 2 of the 3 classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real-world walking activity differs among the groups identified by the mixture model. ConclusionsSurvivors of stroke with lower walking ability, lower self-efficacy, lower cognitive abilities, and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.

A 20-Year Follow-Up Study of Objectively Measured Physical Activity.

Background: The objectives of this study were to explore the effect of time, long-term tracking, and the proportion of objectively measured physical activity (PA) from early adolescence to the mid-thirties. Methods: PA was measured as mean steps per day (SPD) with pedometers during 2000 (T1), 2003 (T2), 2005 (T3), 2010 (T4), 2016 (T5) and 2020 (T6). Data from 64 participants (n = 32 males) were analysed from their early adolescence (T1) to their mid-thirties (T6). Results: SPD decreased in the total sample and among males and females (all, p < 0.001). Males took more mean SPD than females during T1 (p = 0.002), whereas females took more mean SPD during T2 (p = 0.009) and T6 (p = 0.008). Males’ mean SPD tracked between T1 and T2 (p = 0.021), T2 and T3 (p = 0.030), T3 and T4 (p = 0.015) and T4 and T5 (p = 0.003). Females’ mean SPD tracked between T3 and T4 (p = 0.024) and T5 and T6 (p < 0.001). In the total sample, more mean SPD were found on weekdays compared to weekend days at T3 (p = 0.017) and T5 (p < 0.001). Conclusions: SPD decreased between T1 and T6. Mean SPD tracked low-to-moderate in the short time span. From late adolescence to the mid-thirties, more mean SPD was observed during weekdays compared to weekend days.

Feasibility of using fitness tracker to assess activity level and toxicities in colorectal cancer (CRC) patients (Pts).

91 Background: Performance status (PS) is used to predict tolerance and morbidity associated with CRC treatment. Monitoring activity level at the start of therapy using a wearable fitness tracker Fitbit (Fb) may provide a more accurate estimate of a pt’s overall PS and help predict treatment related toxicity (T). Methods: With IRB approval, we prospectively enrolled CRC pts undergoing therapy into 2 cohorts, medical undergoing chemotherapy (M) and surgical undergoing definitive surgery (S). Our objective was to assess feasibility of using Fb to track pt activity level and secondarily correlate with T. After documenting baseline ECOG PS, M and S pts wore Fb for 4 days while receiving chemotherapy or prior to surgery, respectively. Pts’ mean steps per day (SPD) were calculated excluding days Fb was worn &lt;12 hours. To stratify prediction of toxicity risk, a cutoff of 5000 SPD was selected and any post-operative complication (S pts) or ≥grade 3 toxicity (M pts) was counted as T. The study met accrual of 80 pts. Results: On final analysis, 80 pts were evaluated for the primary aim. 68 pts had at least 3 days with ≥12 hours of Fb usage, meeting the 75% feasibility endpoint. 76 pts had at least 1 day with ≥12 hours of Fb usage with data for analysis. SPD correlated with PS and the SPD and active minutes (read by device) for PS 0 and PS 1 pts was 6313 steps and 122 min and 2925 steps and 55 min, respectively (p=0.0003). Rate of T was 25% in pts with PS 0 and 33% in pts with PS 1. With SPD, rate of T was numerically lower in pts with &gt;5000 SPD compared to pts with &lt;5000 SPD (21% vs 32%, p = NS). Conclusions: We observed high rates of compliance with Fb in CRC pts. SPD cutoff of 5000 correlated with ECOG PS 0 vs 1. We observed usefulness of SPD as an identifier for toxicities and suggestion that it may be more reliable compared to PS alone in this small sample of pts. These findings provide rationale to study SPD in conjunction with PS for risk stratification of pts undergoing therapy, and can possibly be incorporated into pre-habilitation selection in high risk groups. [Table: see text]

Physical Activity as a New Tool to Evaluate the Response to Omalizumab and Mepolizumab in Severe Asthmatic Patients: A Pilot Study

Asthma is a chronic inflammatory airway disease, representing one of the most severe pathologies in developed countries. Based on a report of the World Health Organization (WHO), it affects about 300 million people worldwide. Few studies have analyzed the effects of daily life physical activity (PA) levels in patients with asthma: moreover, little research has been carried out on PA levels in patients suffering from severe asthma (SA). This study aimed to investigate the PA levels in two groups of patients suffering from SA; in particular, this study analyzed the changes that occur in patients treated with biologic therapy (BT group) and patients who underwent traditional treatment (TT group) over 6 months. Moreover, this study represents a pilot study because, to the best of our knowledge, it is the first investigation that analyzed if the kind of biologic drug (omalizumab or mepolizumab) can produce differences in the PA levels of SA patients. Fifty SA patients were enrolled and PA parameters were monitored for 6 months. Subjects were divided into two treatment groups: TT (20 patients) and BT (30 patients), the BT group was further subdivided according to the drugs used (15, omalizumab; 15, mepolizumab). During drug treatment, all subjects improved their PA levels: indeed, considering the intragroup variation, the PA levels were significantly higher comparing the T6 levels to baseline (T0, p < 0.01). Considering the intragroup variation, it is very interesting to note that biologic therapy improved PA levels compared to the effects of traditional therapy; while at T0 there were no significant differences in the steps per day (SPD) values between the two groups (T0, p = 0.85), the differences become statistically significant at T1, T3, and T6 (T1, p = 0.019; T3, p = 3.48x10−6; T6, p = 4.78x10−10). As expected, the same differences were reported analyzing the energy expenditure data. In conclusion, this pilot study reports a positive relationship between biologic drug therapy and PA patterns, even if further studies are needed.

Feasibility of using a fitness tracker to assess activity level and toxicity in colorectal cancer patients.

684 Background: Performance status (PS) is traditionally used to predict tolerance and morbidity associated with colorectal cancer (CRC) treatment. Monitoring activity level at the start of therapy using a wearable fitness tracker (Fitbit) may provide a more accurate estimate of overall patient (pt) PS and help predict treatment-related toxicity. Methods: With IRB approval, we prospectively enrolled CRC pts undergoing therapy into two cohorts: medical (M) and surgical (S). Our primary aim was to assess the feasibility of using Fitbit to assess activity level and toxicity. After documenting baseline ECOG PS, M and S pts wore Fitbit for four days while receiving chemotherapy or prior to surgery, respectively. Pts’ mean steps per day (SPD) were calculated, excluding days Fitbit was worn &lt; 12 hours. To stratify the prediction of toxicity risk, a cutoff of 5,000 SPD was selected and any post-operative complication (S pts) or ≥ grade 3 toxicity (M pts) was counted as toxicity. The study is ongoing to accrue 80 pts. Results: On interim analysis, 43 pts were evaluated for the primary aim. Seventy nine percent (34/43) of pts had at least 3 days with ≥ 12 hours of Fitbit usage, meeting the 75% feasibility endpoint. Forty pts (25 M, 15 S) had at least 1 day with ≥ 12 hours of Fitbit usage and had data available for analysis. Mean SPD for PS 0 and PS 1 pts was 7,183 and 3,214, respectively (p=0.01), and overall was 6,290 (SD 4,416). Eight M pts and 2 S pts experienced toxicity (Table). The rate of toxicity was 23% (7/30) in pts with PS 0 and 33% (3/10) in pts with PS 1. With SPD as cutoff, the toxicity rate was 11% (2/19) in pts with &gt; 5000, compared to 38% (8/21) in pts with &lt; 5000. Conclusions: We observed high rates of compliance with a fitness tracker in CRC pts. SPD serves as a useful identifier for toxicity and may be a better predictor than traditional PS. These findings provide rationale to study SPD in lieu of PS for risk stratification of patients undergoing therapy and possibly incorporate pre-habilitation programs in high-risk groups, though validation in larger studies is needed. [Table: see text]

The Structure of Walking Activity in People After Stroke Compared With Older Adults Without Disability: A Cross-Sectional Study

People with stroke have reduced walking activity. It is not known whether this deficit is due to a reduction in all aspects of walking activity or only in specific areas. Understanding specific walking activity deficits is necessary for the development of interventions that maximize improvements in activity after stroke. The purpose of this study was to examine walking activity in people poststroke compared with older adults without disability. A cross-sectional study was conducted. Fifty-four participants poststroke and 18 older adults without disability wore a step activity monitor for 3 days. The descriptors of walking activity calculated included steps per day (SPD), bouts per day (BPD), steps per bout (SPB), total time walking per day (TTW), percentage of time walking per day (PTW), and frequency of short, medium, and long walking bouts. Individuals classified as household and limited community ambulators (n=29) did not differ on any measure and were grouped (HHA-LCA group) for comparison with unlimited community ambulators (UCA group) (n=22) and with older adults without disability (n=14). The SPD, TTW, PTW, and BPD measurements were greatest in older adults and lowest in the HHA-LCA group. Seventy-two percent to 74% of all walking bouts were short, and this finding did not differ across groups. Walking in all categories (short, medium, and long) was lowest in the HHA-LCA group, greater in the UCA group, and greatest in older adults without disability. Three days of walking activity were captured. The specific descriptors of walking activity presented provide insight into walking deficits after stroke that cannot be ascertained by looking at steps per day alone. The deficits that were revealed could be addressed through appropriate exercise prescription, underscoring the need to analyze the structure of walking activity.

Changes in Energy Expenditure, Physical Activity, and Hemoglobin Measures Associated with Fatigue Reports During Radiation Treatment for Breast Cancer: A Descriptive and Correlation Study

Introduction: Radiation related fatigue is assessed through subjective evaluations that may not adequately describe the fatigue experience. This study measured changes in energy expenditure (Kcals/day), steps per day (SPD), and hemoglobin (Hb) in women undergoing radiation for breast cancer and evaluated correlations with fatigue reports. Subjects: 17 females [51.2 (10.3) years of age] scheduled to receive radiation for breast cancer. Methods/Materials: A prospective, repeated measures design measured Kcals/day and SPD during the first, fourth, and sixth weeks of radiation using the SenseWear© Body Monitoring System. Fatigue reports were assessed weekly using the Brief Fatigue Inventory (BFI), and Hb was measured the first and sixth weeks of treatment. Friedman's Analysis of Variance assessed differences over time and Pearson's Product Moment determined correlations between variables with p ≤ .05 considered significant. Results: Energy expenditure was similar between weeks one [2164 (317) Kcals/day] and 4 [2198 (424) Kcals/day] but declined significantly (p = .012) at week 6 [2103 (390) Kcals/day] by 4.3%. Steps per day were similar between weeks one [7382 (3768)] and 4 [7407 (5079)], but declined significantly (p = .014) by 14.02% by week 6 [6369 (4156)]. The BFI scores gradually increased by 43.31%; changes were not statistically significant (p = .145). Correlations were significant between Kcals/day and BFI (r = -.346, p = .011), between Hb and Kcals/day (r = .458; p = .003), and between Hb and SPD (r = .426; p = .006). Conclusions: The study found an inverse correlation between energy expenditure and fatigue scores and a positive correlation between Hb and Kcals/day as well as SPD. Women with the highest fatigue scores had the lowest Kcals/day, SPD, and Hb; therefore, maintaining healthy activity levels and monitoring Hb may reduce fatigue reports and preserve function during radiation for breast cancer.

10,000 Steps Per Day Or A 2,500 Increase

10,000 Steps Per Day Or A 2,500 Increase