Total Daily Step Count Research Articles

Normative Values for Daily Functional Recovery Patterns Following Total Knee Arthroplasty

BackgroundWearable devices provide the ability for clinical teams to continuously monitor patients’ rehabilitation progress with objective data. Understanding expected recovery patterns following total knee arthroplasty (TKA) enables prompt identification of patients failing to meet these milestones. The aim of this study was to establish normative values for daily functional recovery in the first 6 weeks after TKA using a wearable device. MethodsThis prospective study included patients who underwent TKA between 2020 and 2023, treated by 11 surgeons from 8 institutions. Eligible participants were aged 18 or older, had a primary unilateral TKA, and owned a smartphone. Knee range of motion, total daily steps, cadence, and device usage were measured continuously over 6 weeks. Statistical analysis included analysis of variance using post hoc Tukey honest significant difference tests. ResultsThe cohort of 566 participants had a mean age of 65 and 69 for men and women, respectively (range, 50 to 80). Women comprised 61% (n = 345) of study participants. There were 82% of women and 90% of men who had a body mass index > 30. The average daily wear time of the device was 12 hours (±4) for a total of 45 days (±27). Recovery was nonlinear, with the greatest gains in the first 3 weeks postsurgery for all metrics. Men demonstrated greater total daily step counts and cadence when compared to women. Obese patients demonstrated poorer performance when compared to lower body mass index patients. ConclusionsTo our knowledge, this study presents the first normative data for tracking daily functional recovery in TKA patients using wearable sensors. Standardizing the TKA recovery timeline allows surgeons to isolate factors affecting patients’ healing processes, accurately counsel them preoperatively, and intervene more promptly postoperatively when rehabilitation is not within standard recovery parameters.

Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms

BackgroundAlthough stimulating patients’ mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards.MethodsMobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied.ResultsWearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9–93.6). The median total daily step count was 1326 (range 22-5362).ConclusionWe found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.

Exploring the feasibility and usability of smartphones for monitoring physical activity in orthopedic patients: A prospective observational study.

Smartphones are often equipped with inertial sensors that measure individuals' physical activities. However, their role in remote monitoring of the patients' physical activities in telemedicine needs to be adequately explored. The main objective of this study was to explore the correlation between a participant's actual daily step counts and the daily step counts reported by their smartphone. In addition, we inquired about the usability of using smartphones for collecting physical activity data. This prospective observational study was conducted on patients undergoing lower limb orthopedic surgery and a group of non-patients as control. The data from the patients were collected from 2 weeks before surgery until four weeks after the surgery, while the data collection period for the non-patients was two weeks. The participant's daily step count was recorded by physical activity trackers employed 24/7. In addition, a smartphone application collected the number of daily steps registered by the participants' smartphones. We compared the cross-correlation between the daily steps time-series taken from the smartphones and physical activity trackers in different groups of participants. We also employed mixed modeling to estimate the total number of steps, using smartphone step counts and the characteristics of the patients as independent variables. The System Usability Scale was used to evaluate the participants' experience with the smartphone application and the physical activity tracker. Overall, 1067 days of data were collected from 21 patients (11 females) and 10 non-patients (6 females). The median and IQR for the cross-correlation coefficient on the same day was 0.70 [0.53-0.83]. The correlation in the non-patients was slightly higher than in the patients (0.74 [0.60-0.90] and 0.69 [0.52-0.81], respectively). The likelihood ratio tests on the models fitted by mixed effect methods demonstrated that the smartphone step count was positively correlated with the physical activity tracker's total number of steps (χ2 = 34.7, p < .00001). In addition, the usability score for the smartphone app was 78 [73-88] compared to 73 [68-80] for the PA tracker. Considering the ubiquity, convenience, and practicality of smartphones, the high correlation between the smartphones and the total daily step count time-series highlights the potential usefulness of smartphones in detecting the change in the number of steps in remote monitoring of the patient's physical activity.

Remote Monitoring using Wearable Technology after Knee Arthroplasty Using a Joint-Specific Wearable Device: A Prospective Cohort Study of 435 patients with 6 week follow up.

Introduction As wearable devices become more sophisticated, their application in monitoring the post-surgical recovery curve following Total Knee Arthroplasty (TKA) may be used to assist with rehabilitation and general care. While there is growing interest in this area, much of the research involves studies with small samples, non-pragmatic designs, and short monitoring periods. This study aims to characterize the progress and recovery kinetics of remote monitoring in the early post-TKA period, using many patients and across multiple surgeons and institutions. Methods Between June 2018 and June 2021, adult patients undergoing primary unilateral partial or total Knee Arthroplasty for end-stage knee osteoarthritis were preoperatively recruited to wear a remote monitoring system to track their recovery. Patients were provided with device education and knee specific surface sensors. The data collected by the sensors were transmitted to a smartphone application. Patients wore the surface sensors for a period as defined by their surgeon (2-, 4-, or 6-weeks duration). Primary measures were maximal daily flexion, minimal daily extension, and Total Daily Steps (TDS). Secondary outcomes were patient-reported pain scores. Results A total of 435 patients were recruited into the study. The primary outcomes of flexion and extension did not significantly differ from baseline, and TDS improved significantly from preoperative baseline to 6 weeks postoperative follow up. All metrics improved relative to surgical intervention relative to 6 weeks postoperative. Conclusions This study demonstrates that remote monitoring using knee specific surface sensors can capture the expected recovery kinetics following knee replacement surgery. The data provided, range of motion and total daily step counts can be used by providers to set expectations for recovery following intervention. Further work is required to compare surface sensor monitoring against standard post-surgical outcome measures to evaluate whether superior results may result from remote monitoring.

Outdoor Kindergartens: A Structural Way to Improve Early Physical Activity Behaviour?

Studies have shown that outdoor play in nature is associated with a higher physical activity level than indoor play. We aimed to examine the effect of outdoor versus conventional kindergartens on objectively measured physical activity. Using a pre-test-post-test design, we collected data in four kindergartens that provided a rotating outdoor and conventional kindergarten setting. Step counts were measured during one week in the outdoor setting and one week in the conventional setting. Differences in step counts between the outdoor and conventional setting were analysed using a paired t-test. In total, 74 children were included. There was no statistically significant difference in total daily step counts between children in the two settings. When we looked at step counts during kindergarten hours, we saw that children were more physically active in the outdoor setting compared to the conventional setting (mean difference: 1089, p < 0.0001). When we looked at activity during time outside the kindergarten, we discovered that children had a lower step count in the outdoor setting as compared to the conventional setting (mean difference -652, p = 0.01). This study indicates that children are more physically active during the time they spend in outdoor kindergartens compared to conventional kindergartens, but may compensate with more inactivity outside kindergarten hours.

Affective judgments, environmental determinants, and physical activity in emerging and young adults

Objective Affective judgements represent a promising target for promoting physical activity among adults. This study examined whether relations between affective judgments and physical activity are robust after adjusting for social, built, and natural environmental determinants. Design Prospective cross-sectional study with 173 adults (70.1% female) aged 18–29 years who self-reported less than 90 minutes of moderate-to-vigorous physical activity. Main Outcome Measure Physical activity volume (total daily step count, total activity counts) and durations of intensity-specific physical activity (light-intensity activity and moderate-to-vigorous intensity) were assessed for a seven-day period via waist-worn ActiGraph wGT3X-BT accelerometer. Results Affective judgements were not statistically associated with measures of physical activity volume or intensity-specific physical activity after adjusting for environmental influences. Support for exercise from friends was positively associated with measures of physical activity volume and moderate-to-vigorous physical activity duration. More favorable perceptions of the built environment were positively associated with moderate-to-vigorous intensity physical activity and negatively associated with duration of light-intensity physical activity. Longer photoperiods were associated with more light-intensity physical activity. Conclusion Physical activity interventions for young and emerging adults reporting inactivity should target environmental determinants first and possibly wait until participants have a motivational stake in physical activity before targeting affective judgments.

Reference Values for Wristband Accelerometry Data in Children Aged 6-11 Years of Age.

ObjectivesWristband activity trackers (accelerometers) could serve as a convenient monitoring tool to continuously quantify physical activity throughout the day. We aim to provide reference values for the use of these devices in healthy children.MethodsChildren were recruited at a local school and provided with activity trackers (Fitbit Charge 2). Pupils were instructed to wear devices during all normal daytime activities over a period of 11–15 days. Demographic data, total number of daily steps and heart rate were recorded. In addition, all children/parents were asked to complete a questionnaire providing information about daily physical routine (mode of transport to school, sporting activities as well as sport club memberships).ResultsThree hundred two children (54.6% boys; median age 8.7 years) participated in this prospective study. Median wearing time of the device was 12.1 h/day. Overall, the median daily total step count was 12,095. Median step counts/day were significantly higher in boys compared to girls (13,015 vs. 11,305 steps/day; p < 0.0001). In addition, step counts were significantly higher during the week, compared to weekend days. The effect of age on daily step count was found to be non-linear: the total daily step count increased from 6 to 8.5 years of age, while older children (aged >8.5 years) had lower step counts compared to the younger children. Significant predictors of the daily step count were male gender (+1,324.9 steps, p = 0.0008), mode of transportation to school (walking, bicycle, scooter: +865.5 steps p = 0.049), active membership in a sports club (+1,324.9 steps/day, p = 0.0008), and number of structured units of physical exercise performed (+336.5/per 45 min, p < 0.0001). Severe obesity was associated with a significant reduction in total daily step count (−3037.7 steps/day, p = 0.015).ConclusionOur prospective cohort study of healthy school children provides reference values for wristband accelerometers in normal individuals. In addition, it clarifies the effect of age, body weight and lifestyle on normal daily step counts in school children. This data should be helpful to judge the degree of physical limitation of patients compared to healthy peers.

Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study.

Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics, has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and interteam competition inherent in sports. A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams' fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls. Users' daily steps increased by 574 (95% confidence interval, 83-1064) steps 3 months after installation, compared with controls. The increase was maintained for up to 9 months (559 (99-1018) more steps per day vs baseline), attenuating over a longer follow-up. Positive effect modification was found by high-frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000-step achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photographs; P < 0.001). Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status underrepresented in traditional health programs.

Revisiting the limitation to with ageing: is mitochondrial (dys)function the key?

Revisiting the limitation to with ageing: is mitochondrial (dys)function the key?

Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial

Rationale & ObjectiveWe aimed to test interventions to improve physical activity in persons with advanced chronic kidney disease not yet receiving dialysis.Study DesignRandomized controlled trial with parallel-group design.Setting & ParticipantsWe embedded a pragmatic referral to exercise programming in high-volume kidney clinics servicing diverse populations in San Jose, CA, and Atlanta, GA. We recruited 56 participants with estimated glomerular filtration rates < 45 mL/min/1.73 m2.InterventionsWe randomly assigned participants to a mobile health (mHealth) group—wearable activity trackers and fitness professional counseling, or an Exercise is Medicine intervention framework (EIM) group—mHealth components plus twice-weekly small-group directed exercise sessions customized to persons with kidney disease. We performed assessments at baseline, 8 weeks at the end of active intervention, and 16 weeks after passive follow-up and used multilevel mixed models to assess between-group differences.OutcomesActivity tracker total daily step count.ResultsOf 56 participants, 86% belonged to a racial/ethnic minority group; randomly assigned groups were well balanced on baseline step count. In intention-to-treat analyses, the EIM and mHealth groups both experienced declines in daily step counts, but there was an attenuated reduction in light intensity physical activity (standard error 0.2 [5.8] vs −8.5 [5.4] min/d; P = 0.08) in the EIM compared with the mHealth group at 8 weeks. In as-treated analyses, total daily step count, distance covered, and light and moderate-vigorous activity minutes per day improved in the EIM group and declined in the mHealth group at 8 weeks (standard error +335 [506] vs −884 [340] steps per day; P = 0.05; P < 0.05 for secondary measures), but group differences faded at 16 weeks. There were no differences in quality-of-life and mental health measures during the study.LimitationsSmall sample size, limited duration of study, assessment of intermediate outcomes (steps per day).ConclusionsA clinic-integrated referral to small-group exercise sessions is feasible, safe, and moderately effective in improving physical activity in an underserved population with high comorbid conditions.FundingNormon S Coplon Applied Pragmatic Clinical Research program.Trial RegistrationNCT03311763

Preserved skeletal muscle oxidative capacity in older adults despite decreased cardiorespiratory fitness with ageing.

Healthy older adults exhibit lower cardiorespiratory fitness ( ) than young in the absence of any age-related difference in skeletal muscle mitochondrial capacity, suggesting central haemodynamics plays a larger role in age-related declines in . Total physical activity did not differ by age, but moderate-to-vigorous physical activity was lower in older compared to young adults. Moderate-to-vigorous physical activity is associated with and muscle oxidative capacity, but physical inactivity cannot entirely explain the age-related reduction in . Declining fitness ( ) is a hallmark of ageing and believed to arise from decreased oxygen delivery and reduced muscle oxidative capacity. Physical activity is a modifiable lifestyle factor that is critical when evaluating the effects of age on parameters of fitness and energy metabolism. The objective was to evaluate the effects of age and sex on , muscle mitochondrial physiology, and physical activity in young and older adults. An additional objective was to assess the contribution of skeletal muscle oxidative capacity to age-related reductions in and determine if age-related variation in and muscle oxidative capacity could be explained on the basis of physical activity levels. In 23 young and 52 older men and women measurements were made of , mitochondrial physiology in permeabilized muscle fibres, and free-living physical activity by accelerometry. Regression analyses were used to evaluate associations between age and , mitochondrial function, and physical activity. Significant age-related reductions were observed for (P<0.001), but not muscle mitochondrial capacity. Total daily step counts did not decrease with age, but older adults showed lower moderate-to-vigorous physical activity, which was associated with (R2 =0.323, P<0.001) and muscle oxidative capacity (R2 =0.086, P=0.011). After adjusting for sex and physical activity, age was negatively associated with but not muscle oxidative capacity. Healthy older adults exhibit lower but preserved mitochondrial capacity compared to young. Physical activity, particularly moderate-to-vigorous, is a key factor in observed age-related changes in fitness and muscle oxidative capacity, but cannot entirely explain the age-related reduction in .

Activity and Cognition in Older Adults With and Without Sleep Apnea

Many older adults have sleep apnea. It often goes undiagnosed. Sleep apnea is associated with decreased oxygen to the brain, fragmented sleep, shorter sleep duration, impaired cognition, increased risk for dementia, and less clearance of amyloid and tau. Little longitudinal data are available identifying objective measures of sleep apnea over time that may facilitate improved identification of affected persons. One hundred ninety-five participants age 57 or older were enrolled as part of Collaborative Aging Research using Technology (CART) initiative, a national study examining the feasibility of unobtrusive remote sensing and monitoring of cognitive, behavioral, physiological, and health-related activities. Nightly hours of sleep and total daily step count were acquired using a wrist worn device. Sixty (31%) reported having sleep apnea. Those with sleep apnea had a significantly lower MoCA total score than those without (22.9 vs. 24.2, p<0.01) and were more likely to be classified as MCI by MoCA cutoff <23 (49% vs. 24%, p<0.001). Volunteers who live alone were less likely to be diagnosed with sleep apnea (p<0.01). Males were much more likely to report having sleep apnea than females (p<0.0001). Of those with watch-derived activity data, sleep apnea cases had shorter mean sleep duration (7.2 vs. 7.8 hours, p=0.05) and fewer total daily steps than those without sleep apnea (2384 vs 3327, p=0.04). Sleep apnea may be identified by its association with mildly impaired cognition, with shorter sleep duration, and less total daily activity as measured at home via remote continuous monitoring techniques.

Methods for Step Count Data: Determining “Valid” Days and Quantifying Fragmentation of Walking Bouts

BackgroundStep count monitors are frequently used in clinical research to measure walking activity. Systematically determining valid days and extracting informative measures of walking beyond total daily step count are among major analytical challenges. Research QuestionWe introduce a novel data-driven anomaly detection algorithm to determine days representing typical walking activity (valid days) and examine the value of measures of walking fragmentation beyond total daily step count. MethodsStepWatch data were collected on 230 adults with severe foot or ankle fractures. Average steps per minute (SC), average steps per active minute (SCA), active to sedentary transition probability (ASTP) and sedentary to active transition probability (SATP) were computed for each participant. The joint distribution of these measures was used to identify and eliminate invalid days through a multi-step process based on the support vector machine. The value of SCA, ASTP and SATP beyond SC were assessed by regressing Short Musculoskeletal Functional Assessment (SMFA), a measure of self-reported function, on these measures and quantifying the increase in the adjusted R-squared. In an unsupervised comparison, the total joint variability of SCA, ASTP and SATP was decomposed into the variability explained by SC and the unique variability of these three measures. ResultsOf the 4,448 days in the original data set, 39% were determined invalid. Individuals with higher average SC had higher SCA, lower ASTP and higher SATP. Measures of fragmentation (SCA, ASTP and SATP) explained 25% more of the variability in SMFA compared with SC alone. Approximately 41% of the variability in SCA, ASTP and SATP could not be explained by SC suggesting that these three measures provide unique information about walking patterns. SignificanceApplying SVM and quantifying fragmentation in walking bouts for step count data can help to more precisely assess activity in clinical studies employing this modality.

Adolescents’ Physical Activity in Education Systems Varying in the Number of Weekly Physical Education Lessons

ABSTRACT Purpose: School physical activity (SPA) is a significant component of daily PA. We investigated differences in PA between boys and girls in two differing education systems—Poland and the Czech Republic—which have four and two physical education lessons (PELs) per week, respectively. Method: This project was conducted from 2012–2016 at 17 Polish and 23 Czech secondary schools (N = 921; mean age = 16.2 ± 0.7 years). ActiTrainer accelerometers were used to monitor participants’ PA and heart rate during school days. Weekly PA was measured using pedometers. Subjective levels of weekly PA were self-reported on the International Physical Activity Questionnaire–long form. Results: The Polish education system enabled adolescents to meet the recommendations for moderate-to-vigorous PA more likely than did the Czech system. SPA also represented a higher portion of daily PA in the Polish (vs. Czech system); however, the differences in total daily step count between Polish and Czech adolescents were non-significant. SPA accounted for 30–37% of the daily PA (as measured by step count) of Polish girls (23–30% of Czech girls) and 28–39% of Polish boys (25–37% of Czech boys). Conclusions: Participation in PELs was associated with a higher rate of meeting SPA recommendations in both countries. Compared with the Czech Republic, more PELs in the Polish education system was associated with increased daily vigorous PA and a greater portion of SPA in daily PA. Differences in overall daily and weekly moderate-to-vigorous PA between Polish and Czech adolescents were non-significant.

The Accuracy of Fitness Trackers Varies with Their Location on the Body (P16-019-19)

ObjectivesAdvances in low cost physiologic monitoring devices have led to the possibility of making objective measures of physical activity in clinical practice. In a previous study, total daily step counts measured by a pedometer were lower than those obtained from a smartphone application, while exercise step counts were similar. It is uncertain which is the more accurate value for total daily steps. Most pedometers are worn on the torso while most fitness trackers are worn on the wrist. Overestimation of daily step counts by wrist-worn fitness trackers have been demonstrated by others.Specific aims: To estimate the precision of pedometer step counts measured during a 400 m walk. To compare daily step counts using a pedometer on the torso and fitness trackers worn on the wrist or on the torso. MethodsSix subjects wore a pedometer (Omron Alvita HJ327T) and an activity monitor (Letscom Fitness Tracker ID130Plus ColorHR). Each subject wore the pedometer on the torso and two activity monitors for 3 days; both activity monitors on one wrist, one activity monitor on a wrist and the other on the torso (belt), and the reverse positions of the activity monitors. In addition, each subject completed a 400 m walk on two occasions and walked a total of 500 counted steps. Total and 400 m step counts for the pedometer and activity monitor and the test/retest results during the 400 m walk were compared by paired T test and inter-individual variations were compared by one-way analysis of variance (ANOVA). ResultsPedometer-measured and counted steps differed by 1%. Test/retest pedometer step counts and times to completion for the 400 m walk both differed by 1.4%. Wrist-worn fitness trackers produced higher step counts than did the pedometers (18.6 + 0.18%, P < 0.002). Fitness trackers worn on the torso gave lower step counts than did the pedometer (−9.2 + 0.08%, P < 0.001). The inter-individual differences were not statistically significant for wrist or torso step counts. ConclusionsA pedometer worn on the torso is a precise measure of step counts during a 400 m walk and accurate compared to counted steps. Wrist-worn fitness trackers overestimate total daily step counts, at least compared to a pedometer. The location of the fitness tracker on the body greatly influences its estimation of total daily step counts. Funding SourcesDiscretionary funds.

Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study.

The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.

Patterns of Sedentary Behaviour in Female Office Workers.

BackgroundProlonged sedentary behaviour is associated with poor health outcomes. Office workers often engage in excessive sedentary behaviour, however limited research reports on how this sedentary behaviour is accumulated. This study examines objectively measured patterns of prolonged sedentary behaviour in female office workers during weekdays and weekend days and across time of day.MethodsFull time female office workers from a Scottish University participated (N = 27 mean age 43.0 ± 11.5 yrs; BMI 25.8 ± 4.1 kg/m2). Participants wore an activPAL™ for 7 days and completed a diary of waking and working hours. Average week and weekend time sitting, standing and stepping was calculated and also expressed as a proportion of waking day. Average week and weekend daily step count and sit to stand transitions were calculated. Continuous bouts of sedentary behaviour were categorised as: 20–40, 40–60 and > 60 minutes and compared between week and weekend days and across time of day.ResultsAverage weekday sitting time and proportion was higher (P < 0.05) than weekend days [9.1 hrs (66%) vs 8.1 hrs (56%)]. Time and proportion spent standing was higher (P < 0.01) at weekends than weekdays [4.6 hrs (32%) vs 3.8 hrs (27%)]. Time spent stepping [weekday 1.8 hrs (12%) vs weekend 1.7 hrs (12%)] and total daily step count (weekday 8903 vs weekend day 8014) were not significanlty different (P > 0.05) on weekdays vs weekend days. The pattern of sedentary behaviour bouts was different between week and weekend days. Week days were dominated by a consistent pattern of shorter (20–40 mins) sedentary behaviour bouts. The longest continuous sedentary behaviour bouts occurred in the evening, particularly at weekends.ConclusionsIn office workers the most prolonged sedentary behaviour occurred in the evening, particularly at weekends. Interventions need to target these highly saturated periods of sedentary behaviour.

The Effect of Ankle-Foot Orthoses on Community-Based Walking in Cerebral Palsy: A Clinical Pilot Study.

To examine the effect of ankle-foot orthoses (AFO) on walking activity in children with cerebral palsy (CP). We used a randomized cross-over design with 11 children with bilateral CP, mean age 4.3 years. Subjects were randomized to current AFO-ON or AFO-OFF for 2 weeks and then crossed over. Walking activity (average total steps/day), intensity, and stride rate curves were collected via an ankle accelerometer. Group effects were examined with the Wilcoxon signed-rank test and within-subject effects examined for more than 1 standard deviation change. No significant group difference was found in average total daily step count between treatment conditions (P = .48). For the AFO-ON condition, 2 subjects (18%) increased total steps/day; 4 (36%) increased walking time; 2 (18%) had more strides at a rate of more than 30 strides/min; and 2 (18%) reached higher peak intensity. Clinically prescribed AFO/footwear did not consistently enhance walking activity levels or intensity. Larger studies are warranted.

Patients With COPD With Higher Levels of Anxiety Are More Physically Active

Physical activity (PA) has been found to be an excellent predictor of mortality beyond traditional measures in COPD. We aimed to determine the association between depression and anxiety with accelerometry-based PA in patients with COPD. We performed a cross-sectional analysis of baseline data from 148 stable patients with COPD enrolled in an ongoing, longitudinal, observational study. We measured PA (total daily step count) with a Stepwatch Activity Monitor over 7 days, depression and anxiety with the Hospital Anxiety and Depression Scales (HADSs), dyspnea with the Shortness of Breath Questionnaire, and functional capacity with the 6-min walk test. Increased anxiety was associated with higher levels of PA such that for every one-point increase in the HADS-Anxiety score there was a corresponding increase of 288 step counts per day (β=288 steps, P<.001), after adjusting for all other variables. Higher levels of depressive symptoms were associated with lower PA (β=-176 steps, P=.02) only when anxiety was in the model. The interaction term for anxiety and depression approached significance (β=26, P=.10), suggesting that higher levels of anxiety mitigate the negative effects of depression on PA. The increased PA associated with anxiety in COPD is, to our knowledge, a novel finding. However, it is unclear whether anxious patients with COPD are more restless, and use increased psychomotor activity as a coping mechanism, or whether those with COPD who push themselves to be more physically active experience more anxiety symptoms. Future studies should evaluate for anxiety and PA to better inform how to improve clinical outcomes. Clinicaltrials.gov; No.: NCT01074515; URL: www.clinicaltrials.gov.

Using Pedometers to Promote Physical Activity Among Clinical Populations

Using Pedometers to Promote Physical Activity Among Clinical Populations