StepWatch Activity Monitor Research Articles

Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility

Purpose Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. Methods A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. Analysis Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. Results The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). Conclusions The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.

Investigating the association between self-reported physical function, temporo-spatial parameters, walking kinematics and community-based ambulatory activity: Analysis of post-operative hip preservation patients

IntroductionWearable sensors provide the ability to assess ambulatory activity in the community after hip preservation surgery (HPS). In combination with gait analysis and patient reported outcomes, more perspective on post-operative function is gained. The purpose of this study was to assess the relationship between self-reported function/activity, temporo-spatial parameters and walking kinematics to objectively measured ambulatory activity. MethodsForty-nine participants (38 Females; age range 16–38 years) who were five years or more post-surgery and the following diagnoses were included: Acetabular Dysplasia (n=34), Femoroacetabular Impingement (n=12) and Legg-Calvé Perthes disease (n=3). Participants underwent 3D gait analysis and gait deviations were quantified using the Gait Deviation Index (GDI) and Gait Profile Score (GPS). Temporo-spatial parameters were also calculated. Self-reported pain/function and activity level were assessed via the Harris Hip Score (HHS) and UCLA Activity Scale (UCLA). Participants wore a StepWatch Activity Monitor in their community and the Intensity/Duration of ambulatory bouts were analyzed. Spearman correlation coefficients were run to assess the following relationships: in-lab walking measures, self-reported function/activity vs.community ambulatory activity. ResultsThere were no statistically significant correlations between HHS, UCLA or temporospatial parameters with ambulatory activity (p>0.05). Worsening gait deviations (GDI/GPS scores) correlated with daily total ambulatory time (ρ=0.284/-0.284, p<0.05), time spent in Short duration ambulatory bouts (ρ=-0.321/0.321, p<0.05) and the amount of time in Long duration ambulatory bouts (ρ=0.366/-0.366, p<0.05). The amount of time spent in Easy intensity/Short duration and Easy intensity/Long duration ambulatory bouts did have a weak correlation with the GDI and GPS (p<0.05). ConclusionsIn HPS patients after long-term follow up, ambulatory activity in the community did not correlate with patient reported outcomes but there was a weak correlation with the presence of gait deviations. Incorporating wearable sensors to assess community ambulatory bout intensity/duration, provides additional quantifiable measures into the overall function of patients following HPS

COVID-19 Stay-at-home mandates impacts daily ambulatory bout intensity and duration in elementary school-aged children: A wearable sensor based analysis

IntroductionSARS COVID-19 pandemic resulted in major changes to how daily life was conducted. Health officials instituted policies to decelerate the spread of the virus, resulting in changes in physical activity patterns of school-aged children. The aim of this study was to utilize a wearable activity monitor to assess ambulatory activity in elementary-school aged children in their home environment during a COVID-19 Stay-at-Home mandate. MethodsThis institutional review board approved research study was performed between April 3rd – May 1st of 2020 during which health officials issued several stay-at-home (shelter-in-place) orders. Participant recruitment was conducted using a convenience sample of 38 typically developing children. Participants wore a StepWatch Activity Monitor for one week and data were downloaded and analyzed to assess global ambulatory activity measures along with ambulatory bout intensity/duration. For comparison purposes, SAM data collected before the pandemic, of a group of 27 age-matched children from the same region of the United States, was included. Statistical analyses were performed comparing SAM variables between children abiding by a stay-at-home mandate (Stay-at-Home) versus the Historical cohort (alpha=0.05). ResultsStay-at-Home cohort took on average 3737 fewer daily total steps compared to the Historical cohort (p<0.001). Daily Total Ambulatory Time (TAT), across all days was significantly lower in the Stay-at-Home cohort compared to the Historical cohort (mean difference: 81.9 minutes, p=0.001). The Stay-at-Home cohort spent a significantly higher percentage of TAT in Easy intensity ambulatory activity (mean difference: 2%, p<0.001) and therefore a significantly lower percentage of TAT in Moderate+ intensity (mean difference: 2%, p<0.001). ConclusionsThe stay-at-home mandates resulted in lower PA levels in elementary school-aged children, beyond global measures to also bout intensity/duration. It appears that in-person school is a major contributor to achieving higher levels of PA and our study provides additional data for policymakers to consider for future decisions.

Reliability and validity of remote Life Space Assessment: LSA in persons with chronic stroke.

StepWatch Activity Monitor (SAM) is used to measure the mobility of chronic hemiparetic patients and the Life Space Assessment (LSA) scale was developed to assess the displacement of hemiparetic patients in different contexts through self-reporting. Studies that apply the LSA remotely and correlate it with the number of steps measured by the SAM were not found. To evaluate the measurement properties of the LSA applied remotely and to evaluate the correlation between the LSA scale score and the number of steps measured by the SAM in post-stroke chronic hemiparetic patients. Nineteen patients participated in the study. The LSA scale was applied remotely and later, face to face. The SAM measured the steps taken by the participants over a period of three consecutive days. The correlation between the LSA and the SAM was performed using Pearson's correlation. The measurement properties calculated of remote LSA were the intraclass correlation coefficient (ICC), Cronbrach's alpha, standard error of measurement (SEM), and smallest real difference (SRD). The reproducibility of the LSA scale between remote and face-to-face applications was considered excellent with ICC = 0.85 (IC 95% 0.62-0.94); SEM = 8.4; SRD = 23.2, and Cronbach's alpha = 0.85. The correlation between SAM and LSA was positive, considered moderate (r = 0.51) and significant (p = 0.025). The LSA is a reproducible measure for post-stroke chronic hemiparetic patients even if applied remotely and can be used as a remote measurement for mobility in a real-world environment for people with chronic hemiparesis after stroke.

Comparison of three device generations of the StepWatch Activity Monitor: analysis of model version agreement in pediatric and adult independent ambulators.

Devices such as the StepWatch Activity Monitor (SAM) have been available for 20 years and have been shown to accurately measure ambulatory activity. This study aimed to evaluate the agreement among the three generations of the StepWatch Activity Monitor (SW3, SW4, and SW5) with respect to stride count. A total of 36 participants (age range, 6-55 years) participated in this institutional review board-approved study. The participants concurrently wore three different SAM model devices on the same leg and performed a 6-min walk test (6MWT). A research staff member of the laboratory manually counted the number of strides for the first 2 min of the test (2MWT). Agreement among the device models was evaluated by calculating ANOVAs and interclass correlation coefficients (ICCs) and creating Bland-Altman plots. There was no significant difference among the model versions during the 6MWT and 2MWT (p > 0.05). The ICC for the total stride count was 0.993 (95% CI = 0.988-0.996) during the 2MWT and 0.992 (95% CI = 0.986-0.996) during the 6MWT. There was a near-perfect agreement (ICC ≥ 0.990) of each model version to the manually counted strides during the 2MWT. The systematic bias of all three SAM model versions was <1 step. The results from the present study demonstrate that the stride counts among all three devices are comparable and relative to the manual stride count. All three SAM model versions had an ICC of >0.90. Researchers can safely incorporate historical data from previous SAM model versions with newer data collected with the latest SAM model version.

Potential limitations of measuring ambulatory activity of part-time wheelchair users: a comparative study of two research grade activity monitors

Objective. Research grade activity monitors such as the StepWatch Activity Monitor (SAM) and Actigraph have been shown to be highly accurate for the assessment of ambulatory activity, but some individuals function in the community using a combination of both walking and wheelchair activity. The purpose of this study was to assess the accuracy of the SAM and Actigraph at not detecting ambulatory activity, during wheelchair activities at two intensity levels. Approach. Two independent cohorts were tested while simultaneously wearing a SAM and Actigraph on the ankle. Group 1 consisted of twelve adults performing a six-minute push test (6MPT). Group 2 were eighteen members of an adolescent wheelchair basketball team tested during a scrimmage/practice and regional tournament. Visual observation was used to confirm the number of ambulatory steps taken during testing was zero. Main results. The average number of ‘steps’ detected during a 6MPT was 19 ± 25 (range: 0–85) with the Actigraph. No ‘steps’ were detected using the SAM in Group 1. In Group 2, the average ‘step’ count during basketball practice was 1421 ± 750 (range: 612–2798) using the Actigraph and 1363 ± 1238 (range: 84–3462) using the SAM, and correlated with playing time, despite the leg/ankle being strapped down. Similar findings were observed during the wheelchair basketball regional tournament. Significance. Caution should be heeded when utilizing these activity monitors in individuals with disabilities who participate in wheelchair sports. Additional written activity logs should be used to exclude periods of time during which high acceleration wheelchair sporting activity occurs, or study participants should be fully educated in removing the activity monitors during non-ambulatory wheelchair sports.

Evaluation Tools Developed for Rett Syndrome.

Rett syndrome (RTT) is a complex neurodevelopmental X-linked disorder associated with severe functional impairments and multiple comorbidities. There is wide variation in the clinical presentation, and because of its unique characteristics, several evaluation tools of clinical severity, behavior, and functional motor abilities have been proposed specifically for it. This opinion paper aims to present up-to date evaluation tools which have specifically been adapted for individuals with RTT often used by the authors in their clinical and research practice and to provide the reader with essential considerations and suggestions regarding their use. Due to the rarity of Rett syndrome, we found it important to present these scales in order to improve and professionalize their clinical work. The current article will review the following evaluation tools: (a) the Rett Assessment Rating Scale; (b) the Rett Syndrome Gross Motor Scale; (c) the Rett Syndrome Functional Scale; (d) the Functional Mobility Scale-Rett Syndrome; (e) the Two-Minute Walking Test modified for Rett syndrome; (f) the Rett Syndrome Hand Function Scale; (g) the StepWatch Activity Monitor; (h) the activPALTM; (i) the Modified Bouchard Activity Record; (j) the Rett Syndrome Behavioral Questionnaire; and (k) the Rett Syndrome Fear of Movement Scale. The authors recommend that service providers consider evaluation tools validated for RTT for evaluation and monitoring to guide their clinical recommendations and management. In this article, the authors suggest factors that should be considered when using these evaluation tools to assist in interpreting scores.

A Mixed-methods Study on Prosthesis Use Among Older Canadians With Lower-limb Amputations.

The prevalence of lower-limb amputations (LLA) in older adults is increasing. Due to the substantial resources required for rehabilitation, there is growing interest in exploring prosthesis use as well as the factors that impact use for individuals with LLA. To examine how older adults, those over 50 years old, with a new LLA use their prostheses following rehabilitation and to identify factors that increase or decrease prosthesis use after discharge from a rehabilitation hospital. The StepWatch Activity Monitor, the Prosthetic Profile of the Amputee Questionnaire, and a semi-structured interview were used to measure prosthesis use and factors affecting use at 12 weeks post-discharge from a rehabilitation hospital. Descriptive statistics were calculated for the quantitative data and the qualitative interviews were analyzed using the International Classification of Functioning and Disability. Two user profiles emerged from the 11 participants' use patterns. The Regular Users integrated their prosthesis into their lives, using it for various types of activities, while the Strategic Users wore their prosthesis to perform specific activities of daily and instrumental activities of daily living tasks. Body functions (e.g., pain), personal (e.g., feeling of independence), and environmental factors (e.g., home adaptations or social support) impacted prosthesis use. The emergence of profiles suggests variability in how older adults with LLA use their prosthesis after rehabilitation. However, the factors affecting prosthesis use were similar between the profiles. Therefore, while it is important for rehabilitation teams to consider patients' individual needs when setting goals for prosthetic training, they must also consider common factors affecting prosthesis use.

Validity of Hip and Ankle Worn Actigraph Accelerometers for Measuring Steps as a Function of Gait Speed during Steady State Walking and Continuous Turning.

This study aimed to investigate the accuracy and reliability of hip and ankle worn Actigraph GT3X+ (AG) accelerometers to measure steps as a function of gait speed. Additionally, the effect of the low frequency extension filter (LFEF) on the step accuracy was determined. Thirty healthy individuals walked straight and walked with continuous turns in different gait speeds. Number of steps were recorded with a hip and ankle worn AG, and with a Stepwatch (SW) activity monitor positioned around the right ankle, which was used as a reference for step count. The percentage agreement, interclass correlation coefficients and Bland–Altmann plots were determined between the AG and the reference SW across gait speeds for the two walking conditions. The ankle worn AG with the default filter was the most sensitive for step detection at >0.6 m/s, whilst accurate step detection for gait speeds < 0.6 m/s were only observed when applying the LFEF. The hip worn AG with the default filter showed poor accuracy (12–78%) at gait speeds < 1.0 m/s whereas the accuracy increased to >87% for gait speeds < 1.0 m/s when applying the LFEF. Ankle worn AG was the most sensitive to measure steps at a vast range of gait speeds. Our results suggest that sensor placement and filter settings need to be taken into account to provide accurate estimates of step counts.

Hydraulic- and Microprocessor-Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study

ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.

Implementing telehealth support to increase physical activity in girls and women with Rett syndrome—ActivRett: protocol for a waitlist randomised controlled trial

IntroductionIndividuals with Rett syndrome (RTT) experience impaired gross motor skills, limiting their capacity to engage in physical activities and participation in activities. There is limited evidence of the effectiveness of...

Physical activity coaching for adults with mobility limitations: protocol for the ComeBACK pragmatic hybrid effectiveness-implementation type 1 randomised controlled trial

IntroductionMobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and...

Easy to Perform Physical Performance Tests to Identify COPD Patients with Low Physical Activity in Clinical Practice.

BackgroundThe study investigates which physical performance or muscle function/mass tests significantly correlate with objectively measured physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) and could potentially serve to identify physically inactive COPD patients in routine clinical practice.MethodsA cross-sectional, observational study was conducted in outpatients with moderate to very severe COPD. PA was measured during one week with the StepWatch Activity Monitor®, an ankle-worn accelerometer, and expressed in steps per day. Physical fitness and peripheral muscle function/mass were evaluated by the 4-meter gait speed (4MGS) test, the 6-minute walk distance (6MWD), the 30-second chair stand test (30sCST), the timed up and go test (TUGT), handgrip strength, arm muscle area, calf circumference, the fat-free mass index (FFMI), and ultrasound measurement of the quadriceps muscle. Spearman’s rank correlation analysis and ROC analysis were performed.ResultsThe study population (N=111, 69% men, mean age 68 years) walked a mean of 8059 steps/day. The daily step count strongly correlated with the 6MWD (rho=0.684, p<0.001) and moderately with the 4MGS (rho=0.464, p<0.001), the TUGT (rho= −0.463, p<0.001), and the 30sCST (rho=0.402, p<0.001). The correlation with the FFMI was weak (rho=0.210, p=0.027), while the other parameters did not significantly correlate with the daily step count. The 6MWD had the best discriminative power to identify patients with very low PA defined as <5000 steps/day (AUC=0.802 [95% CI: 0.720–0.884], p<0.001), followed by the TUGT, the 4MGS, and the 30sCST.ConclusionThe 6MWD, the 4MGS, the TUGT, and the 30sCST are easy to perform in any clinical setting and may be used by clinicians in the screening of physically inactive COPD patients.

POST DISCHARGE WALKING ACTIVITY AND 30-DAY READMISSION IN OLDER ADULTS

The Centers for Medicare and Medicaid Services has determined high rates of unplanned 30-day readmission to be an indicator of substandard care. More research is needed to identify strong, objective markers of readmission risk. The purpose of this analysis was to investigate the utility of average steps per day as a biomarker in determining the 30-day readmission risk of recently discharged older adults. 133 men and women, aged 65 and older, who were capable of walking on their own, recently hospitalized with an acute illness, and discharged to home were given a StepWatch Activity Monitor and monitored for up to 30 days following discharge. Average steps per day and clinical characteristics were assessed and compared with 30-day readmission. 20 of 133 participants were readmitted within 30 days. Those who were readmitted took significantly fewer steps per day overall: 4412 vs. 5948, p=0.027, and had significantly longer stays in the hospital: 4.50 vs. 2.90 days, p=0.002. Survival analysis of our sample, grouped by tertile of mean daily steps, while not statistically significant, p=0.093, demonstrated a trend toward greater probability of readmission over the 30 days post discharge for those who were in the lowest tertile. Walking activity appears to be a moderate predictor of readmission risk. A more extensive study must be conducted to better understand the relationship of walking activity after discharge and readmission.

Reduced Step Count and Clinical Frailty in Hospitalized Adults With Community-Acquired Pneumonia.

In adults hospitalized with community-acquired pneumonia (CAP), increasing ward-based walking may reduce length of stay (LOS). There are few data to describe ward-based walking in this population. In adults hospitalized with CAP, we aimed to report variables of walking and non-walking time, to determine whether demographic or clinical variables influenced daily step count, and to determine whether daily step count influenced LOS. Following admission, daily step count and variables related to walking and non-walking time were quantified using the StepWatch Activity Monitor. Details regarding demographics, clinical characteristics, clinical care, and LOS were extracted from the medical records and hospital electronic data systems. Frailty was calculated via the 7-point Clinical Frailty Scale; disease severity was measured via the CURB-65 score. Health care utilization at 30 d following discharge was measured via telephone interview. Two hundred participants completed the study, of whom 121 contributed ≥ 24 h of data from the StepWatch Activity Monitor. The median (interquartile range (IQR)) number of daily steps was 926 (457-1706). These were accumulated over 66 (41-121) min/d, with a usual bout duration of 3 (2-4) min and 1-min peak cadence of 56 (43-74) steps/min. An average of 93% (89-96) of waking hours was spent in non-walking time. In the multivariable model, increased frailty was retained as a predictor of lower step count (incidence rate ratio [IRR] 0.59, 95% CI 0.41-0.85). For every increase in 500 steps/d, LOS reduced by 11% (IRR 0.89, 95% CI 0.80-0.99). Subjects hospitalized with CAP did very little walking, most of which was accumulated in short bouts at a low intensity. Compared with subjects with mild frailty, those with moderate to severe frailty took 59% fewer steps per day. Those with a higher daily step count had a shorter LOS.

Accuracy of 6 Commercially Available Activity Monitors in Measuring Heart Rate, Caloric Expenditure, Steps Walked, and Distance Traveled

Purpose: The purpose of this study was to determine the accuracy of 5 different commercially available activity monitors (AMs) and 1 smartphone application in identifying mean number of steps, mean distance traveled, estimated caloric expenditure, and heart rate (HR). Methods: Subjects (N = 120) performed two 6-minute walks (MWs), one at a comfortable pace (C6MW) and the other at a fast pace (F6MW), around an indoor track wearing all 6 AMs and a StepWatch Activity Monitor in the community. Accuracy and agreement between AM-estimated metrics and actual metrics were examined using the intraclass correlation coefficient (ICC2,1) and Bland–Altman technique (BAM). Results: The ICC2,1 and BAM varied for all 3 conditions with the Fitbit Zip being the most accurate. Conclusions: The AMs exhibited varying degrees of accuracy for identifying steps, calories expended, HR, and distance walked across all different walking conditions. No single AM was accurate across conditions or metrics. Clinicians should be cautious when using data from these AMs to estimate patient activity levels.

94INCREASED PHYSICAL ACTIVITY LEVELS AMONG HOSPITALISED OLDER PEOPLE: THE ROLE OF TRAINED VOLUNTEERS

Introduction: sedentary behaviour among older inpatients is associated with increased risk of functional decline, institutionalisation and death. Studies have shown that exercise and mobility interventions can reduce the risks of some of these adverse effects. However, most studies use paid staff to deliver such interventions. We explored the feasibility and acceptability of training volunteers to promote increased physical activity among older inpatients. Methods: this pre-post mixed methods study was conducted on acute medical wards for older people. Eligible patients were aged ≥70 years, mobile prior to admission and able to provide written consent. Physical activity levels were measured using two accelerometers: the ankle-worn StepWatch Activity Monitor and wrist-worn GENEActiv. Volunteers were trained and supported by therapists to deliver individual twice-daily activity sessions, which consisted of walking, chair, and/or bed exercises. Six nurses, seven therapists, six volunteers and six patients were interviewed to determine their views of the intervention. Results: 50 participants pre-intervention (mean age 87 years, SD 4.6) had a median daily step count of 626 (IQR 298–1468) and mean daily acceleration of 9.1 milligravity (SD 3.3) ( Conclusions: findings from this study demonstrate the sedentary behaviour of older medical inpatients. Trained volunteers can safely deliver mobility and exercise interventions for older inpatients. A controlled trial is required to determine the impact of trained volunteers on patient outcomes.

Reliability of StepWatch Activity Monitor to Measure Locomotor Activity in Youth With Lower Limb Salvage.

The study purpose was to determine the minimum number of monitoring days necessary to reliably capture walking among individuals with lower limb salvage. Nineteen participants with lower limb salvage wore an ankle-mounted motion sensor over a 7-day period to obtain step counts. Generalizability theory was used to examine the variance components in step counts (G study) and to determine the appropriate length of activity monitoring using various combinations of days (D study). Mean step counts were higher on weekends than on weekdays. Fifty percent of the total variance in step counts was accounted for by interindividual variability in walking (D study). Eighty percent was reached individually with 4 weekdays, 2 weekend days, or 3 week days + weekend days. The study provides data for an appropriate monitoring method to track walking outcomes of rehabilitation for individuals with lower limb salvage.

Commentary on "Reliability of StepWatch Activity Monitor to Measure Locomotor Activity in Youth With Lower Limb Salvage".

Commentary on "Reliability of StepWatch Activity Monitor to Measure Locomotor Activity in Youth With Lower Limb Salvage".

Physical activity among hospitalised older people: insights from upper and lower limb accelerometry

BackgroundFew studies have explored the activity levels of hospitalised older people and the intra-daily activity patterns in this group have not been described.AimsTo describe the quantity and daily pattern of physical activity among hospitalised older people using two accelerometers: the ankle-worn StepWatch Activity Monitor (SAM), and the wrist-worn GENEActiv.MethodsThis cross-sectional observational study was conducted on the acute medical wards for older people in one UK hospital. Inclusion criteria: participants aged ≥ 70 years, and able to mobilise prior to admission. Participants wore both devices for up to seven consecutive days, or until hospital discharge, whichever was sooner. Intra-daily activity levels were analysed hourly over each 24 h period.Results38 participants (mean age 87.8 years, SD 4.8) had their activity levels measured using both devices. The SAM median daily step count was 600 (IQR 240–1427). Intra-daily activity analysis showed two peak periods of ambulatory activity between 9 am–11 am and 6 pm–7 pm. With physical activity defined as ≥ 12 milli-g (GENEActiv), the median time spent above this cut-off point was 4.2 h. 62% of this activity time was only sustained for 1–5 min. Acceptability of both devices was high overall, but the wrist-worn device (96%) was more acceptable to patients than the ankle-worn device (83%).ConclusionActivity levels of these hospitalised older people were very low. Most physical activity was sustained over short periods. The intra-daily pattern of activity is an interesting finding which can help clinicians implement time-specific interventions to address the important issue of sedentary behaviour.