Background Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking. Objective This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist. Methods We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized. Results A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants’ mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study. Conclusions An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning.

BACKGROUND Incorporating physical activity in lifestyle routines is recommended for individuals living with type 2 diabetes. Accelerometer devices offer a promising alternative to self-report methods for measuring physical activity performance. However, the extant literature for accelerometer-measured physical activity among middle-aged/older adults with chronic conditions is lacking. OBJECTIVE We conducted a comprehensive scoping review of the literature to capture accelerometry methodologies in older adults with type 2 diabetes, specifically in relation to cutpoints that classify physical activity into intensity categories (sedentary, light, moderate, vigorous, very vigorous). METHODS Applying the Joanna Briggs Institute’s methodology, we searched PubMed, Web of Science, EMBASE, and Engineering Village to identify studies that used research-grade accelerometers to objectively measure physical activity intensity levels of adults with type 2 diabetes using cutpoints in participant samples of mean age 50 years and older. RESULTS We identified 46 studies that met our inclusion criteria. The ActiGraph was the most popular accelerometer among researchers, and the Freedson (1998) and Troiano (2008) cutpoints were favored the most. The Lopes (2009) cutpoints were developed by calibrating the ActiGraph accelerometer in middle-aged and older adults with overweight/ obesity and type 2 diabetes. Several studies noted limitations of accelerometry use that could lead to an underestimation or inaccurate representation of physical activity for our population of interest. Limitations included decreased accuracy due to variation in device placement and underestimation of activity intensity attributed to using cutpoints in older adults with lower fitness levels that were originally validated with younger adults. CONCLUSIONS Considering the high variability among accelerometry methodologies, more work needs to be done to understand activity intensity cut-offs for populations with a high burden of chronic disease, older age, and suboptimal physical functioning.