Counting Steps in Activities of Daily Living in People With a Chronic Disease Using Nine Commercially Available Fitness Trackers: Cross-Sectional Validity Study

Abstract

BackgroundMeasuring physical activity with commercially available activity trackers is gaining popularity. People with a chronic disease can especially benefit from knowledge about their physical activity pattern in everyday life since sufficient physical activity can contribute to wellbeing and quality of life. However, no validity data are available for this population during activities of daily living.ObjectiveThe aim of this study was to investigate the validity of 9 commercially available activity trackers for measuring step count during activities of daily living in people with a chronic disease receiving physiotherapy.MethodsThe selected activity trackers were Accupedo (Corusen LLC), Activ8 (Remedy Distribution Ltd), Digi-Walker CW-700 (Yamax), Fitbit Flex (Fitbit inc), Lumoback (Lumo Bodytech), Moves (ProtoGeo Oy), Fitbit One (Fitbit inc), UP24 (Jawbone), and Walking Style X (Omron Healthcare Europe BV). In total, 130 persons with chronic diseases performed standardized activity protocols based on activities of daily living that were recorded on video camera and analyzed for step count (gold standard). The validity of the trackers’ step count was assessed by correlation coefficients, t tests, scatterplots, and Bland-Altman plots.ResultsThe correlations between the number of steps counted by the activity trackers and the gold standard were low (range: –.02 to .33). For all activity trackers except for Fitbit One, a significant systematic difference with the gold standard was found for step count. Plots showed a wide range in scores for all activity trackers; Activ8 showed an average overestimation and the other 8 trackers showed underestimations.ConclusionsThis study showed that the validity of 9 commercially available activity trackers is low measuring steps while individuals with chronic diseases receiving physiotherapy engage in activities of daily living.

Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review

“…A total of 90 studies (979 comparisons) examined wearable device step count measurements compared with reference standard criterion measures of manual counting [ 32 , 34 - 38 , 42 , 46 , 47 , 50 - 53 , 57 , 58 , 72 , 80 - 84 , 88 - 102 , 109 , 114 - 125 , 138 - 141 , 144 - 147 , 149 - 153 , 158 - 161 , 165 , 169 - 171 , 173 ] and accelerometry [ 20 , 60 , 64 - 66 , 85 , 103 , 109 , 126 - 128 , 148 , 154 , 164 ] ( Multimedia Appendix 6 ). Of these, 67 studies recruited healthy adults (mean age 35.4 years, SD 17.4 years), 20 studies recruited adults living with limited mobility/chronic diseases (mean age 60.1 years, SD 10.5 years), two studies recruited children living with limited mobility/chronic diseases (mean age 12.5 years, SD 2.9 years), and one study recruited healthy children (mean age 3.7 years, SD 0.6 years).…”

The Validation of a Pocket Worn Activity Tracker for Step Count and Physical Behavior in Older Adults during Simulated Activities of Daily Living

“…From previous research it is known that consumer-grade activity trackers can’t measure step count and physical behavior validly during low walking speeds, which often occurs in older adults and during ADL ( Alharbi et al, 2016 ; Beevi et al, 2016 ; Cyarto et al, 2004 ; Evenson et al, 2015 ; Ferguson et al, 2015 ; Floegel et al, 2016 ; Martin et al, 2012 ; Straiton et al, 2018 ; Ummels et al, 2018 ; Van Blarigan et al, 2017 ). Apparently, daily life of older adults differs that much from the target group of these consumer-grade activity trackers that their algorithms are not sufficient for older adults.…”

“…To simulate free-living, participants were free to choose the order and duration of a series of daily activities. The activity protocol, shown in Table 1 , was based on earlier activity protocols with ADL in people with chronic diseases and older adults ( Cavalheri et al, 2011 ; Erasmus MC University Medical Center Rotterdam, 2013 ; Langer et al, 2009 ; Sant’Anna et al, 2012 ; Ummels et al, 2018 ).…”

Accuracy of Wearable Trackers for Measuring Moderate- to Vigorous-Intensity Physical Activity: A Systematic Review and Meta-Analysis

“…The validity of wearable fitness trackers-including Apple Watches, Fitbits, and Garmins-has been assessed for steps, energy expenditure, moderate-to vigorous-intensity physical activity (MVPA), sedentary time, and sleep (Dooley, Golaszewski, & Bartholomew, 2017;Evenson, Goto, & Furberg, 2015;Floegel, Florez-Pregonero, Hekler, & Buman, 2017;Henriksen et al, 2018;Huang, Xu, Yu, & Shull, 2016;Jo, Lewis, Directo, Kim, & Dolezal, 2016;Kang et al, 2017;Mantua, Gravel, & Spencer, 2016;Price et al, 2017;Roos, Taube, Beeler, & Wyss, 2017;Shcherbina et al, 2017;Toth et al, 2018;Treacy et al, 2017;Woodman, Crouter, Bassett, Fitzhugh, & Boyer, 2017). Published reviews regarding the validity of the steps feature comprise the majority of the evidence base for wearable fitness trackers (Adam Noah, Spierer, Gu, & Bronner, 2013;An, Jones, Kang, Welk, & Lee, 2017;Chandrasekar, Hensor, Mackie, Backhouse, & Harris, 2018;Treacy et al, 2017;Ummels, Beekman, Theunissen, Braun, & Beurskens, 2018). In 2015, Evenson et al synthesized the findings of 22 published studies on the validity and reliability of wearable fitness trackers (including Fitbit and Jawbone) and the specific abilities of the devices to measure steps, distance, physical activity, energy expenditure, and sleep.…”