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Objective: We aimed to assess seasonal and age-related variations in sleep quality using Fitbit data and offer lifestyle recommendations for enhancing winter sleep quality. Methods: Fitbit sleep and activity data of 51 participants randomly recruited from members of the Association for Research in Supporting System of Chronic Disease, a nonprofit organization in the Yamanashi Prefecture of Japan, were collected and retrospectively analyzed from July to December 2022. Sleep stage targets were set at 10% to 25% for deep sleep, 50% to 60% for shallow sleep, and 20% to 25% for REM sleep. Participants were categorized into improved, unchanged, and worsened groups based on sleep stage unit changes between August and December. Results: The median (interquartile range) age was 71 (68–74) years old. There were eight participants in the improved group, 23 in the unchanged group, and nine in the worsened group. The improved group showed significantly more steps (990 ± 1,102 steps/day, p =.039) in December than in August, while the worsened group showed fewer steps (−507 ± 1,638 steps/day, p =.38). Conclusion: Increasing step count in winter may improve sleep quality, as assessed by sleep stage. Further research considering potential confounders and factors affecting winter sleep is needed to support and extend these findings. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultsConclusionFinding valid and accurate methods to count steps is important after a stroke. To determine the criterion validity and accuracy of the Actigraph and Xiaomi Smart Band to count steps in individuals after stroke. To explore the influence of walking speed on the accuracy of these activity monitors.Individuals after stroke performed the 2-min Walk Test while wearing the ActiGraph and Xiaomi Smart Band. The 2-min Walk Test was recorded, and the observed step count was compared with the estimated step count of both activity monitors.Fifty individuals after stroke were included. The ActiGraph had a low correlation (rho 0.41) between observed and estimated step count and a high percentage absolute error (39%). The Xiaomi Smart Band had a high correlation (rho 0.83) and a moderate percentage absolute error (12%). At high walking speeds, the Xiaomi Smart Band had a low percentage absolute error (3%) and at slow walking speeds had 18% a moderate percentage absolute error.The Xiaomi Smart Band has good criterion validity and moderate-to-high accuracy counting steps after stroke. It is a low-cost activity monitor that is a viable alternative to the more expensive activity monitors used in research.IMPLICATIONS FOR REHABILITATIONThe ActiGraph has low criterion validity and accuracy at counting steps after stroke.The Xiaomi Smart Band has good criterion validity and accuracy at counting steps after a stroke.The Xiaomi Smart Band is a low-cost activity monitor that is a viable alternative to the more expensive activity monitors used in research.The ActiGraph has low criterion validity and accuracy at counting steps after stroke.The Xiaomi Smart Band has good criterion validity and accuracy at counting steps after a stroke.The Xiaomi Smart Band is a low-cost activity monitor that is a viable alternative to the more expensive activity monitors used in research. [ABSTRACT FROM AUTHOR]

Abstract Purpose The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery. Methods Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques. Results Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from − 0.87 to 1.36 with limits of agreement (LOA) ranging between − 10.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between − 2.8 and 5.73 with LOA between − 13.51 and 24.97. Conclusions These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution.

Step counts can be estimated from wrist-worn accelerometers through the Verisense Step Count Algorithm. No study has assessed agreement between stepping metrics from ActiGraph accelerometers during free-living. Thirty-four participants (age: 22.9 ± 3.4 years) provided 24 h accelerometer data (non-dominant wrist) and waist. Agreement of two Verisense Algorithms (Verisense 1 & 2) for estimating daily steps, moderate-to-vigorous physical activity (MVPA), peak 1-min and 30-min accumulated steps, against the waist and ActiLife step-count Algorithm was assessed. Mean bias ± 95% limits of agreement (LoA) for daily steps was +1255 ± 3780 steps/day (mean absolute percent error (MAPE): 21%) (Verisense 1) and +1357 ± 3434 steps/day (MAPE: 20%) (Verisense 2). For peak 1-min accumulated steps, mean bias and 95% LoA was −17 ± 23 steps/min (MAPE: 17%) (Verisense 1) and −6 ± 5 steps/min (MAPE: 9%) with Verisense 2. For peak 30-min accumulated steps, mean bias and 95% LoA was −12 ± 45 steps/min (MAPE: 25%) (Verisense 1) and −2 ± 38 steps/min (MAPE: 13%) (Verisense 2). For MVPA steps/day, mean bias and 95% LoA was −1450 ± 3194 steps/day (MAPE: 420%) (Verisense 1) and −844 ± 2571 steps/day (MAPE: 211%) (Verisense 2). For MVPA min/day, mean bias and 95% LoA was −13 ± 27 min/day (MAPE: 368%) (Verisense 1) and −8 ± 24 min/day (MAPE: 209%) (Verisense 2). The Verisense 2 algorithm enhanced agreement for stepping intensity metrics but further refinement is needed to enhance agreement for MVPA against the waist. [ABSTRACT FROM AUTHOR]

Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. 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. 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. 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). 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. The stepwatch activity monitor worn on the hemiparetic limb provided the best accuracy and excellent reliability for step counts in this population of subacute stroke. For percent standing time all devices overestimated with poor reliability. For percent other time, the AP had the best accuracy and good reliability on the non-hemiparetic limb. The use of multiple devices may be warranted to capture a more accurate understanding of activity level in this population of individuals with sub-acute stroke. Clinicians and researchers need to be aware of the biases of these devices in this population. [ABSTRACT FROM AUTHOR]

Individuals with chronic pain due to knee osteoarthritis (OA) are insufficiently physically active, and alterations of facilitatory and inhibitory nociceptive signaling are common in this population. Our objective was to examine the association of these alterations in nociceptive signaling with objective accelerometer-based measures of physical activity in a large observational cohort. We used data from the Multicenter Osteoarthritis Study. Measures of peripheral and central pain sensitivity included pressure pain threshold at the knee and mechanical temporal summation at the wrist, respectively. The presence of descending pain inhibition was assessed by conditioned pain modulation (CPM). Physical activity was quantitatively assessed over 7 days using a lower back-worn activity monitor. Summary metrics included steps/day, activity intensity, and sedentary time. Linear regression analyses were used to evaluate the association of pain sensitivity and the presence of descending pain inhibition with physical activity measures. Data from 1873 participants was analyzed (55.9% female, age = 62.8 ± 10.0 years). People having greater peripheral and central sensitivity showed lower step counts. CPM was not significantly related to any of the physical activity measures, and none of the exposures were significantly related to sedentary time. In this cohort, greater peripheral and central sensitivity were associated with reduced levels of objectively-assessed daily step counts. Further research may investigate ways to modify or treat heightened pain sensitivity as a means to increase physical activity in older adults with knee OA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the validity of consumer grade step counter devices during the early recovery period after knee replacement surgery. Methods: Twenty-three participants wore a Fitbit Charge or Apple Watch Series 4 smart watch and performed a walking test along a 50-metre hallway. There were 9 males and 14 females included in the study with an average age of 68.5 years and BMI of 32. Each patient wore both the Fitbit Charge and Apple Watch while completing the walking test and an observer counted the ground truth value using a thumb-push tally counter. This test was repeated pre-operatively with no gait aid, immediately post operatively with a walker, at 6 weeks follow up with a cane and at 6 months with no gait aid. Bland-Altman plots were performed for all walking tests to compare the agreement between measurement techniques. Results: Mean overall agreement of step count for pre-operative and at 6 months for subjects walking without gait aids was excellent for both the Apple Watch vs. actual and Fitbit vs. actual with bias values ranging from − 0.87 to 1.36 with limits of agreement (LOA) ranging between − 10.82 and 15.91. While using a walker both devices showed extremely little agreement with the actual step count with bias values between 22.5 and 24.37 with LOA between 11.7 and 33.3. At 6 weeks post-op while using a cane, both the Apple Watch and Fitbit devices had a range of bias values between − 2.8 and 5.73 with LOA between − 13.51 and 24.97. Conclusions: These devices show poor validity in the early post operative setting, especially with the use of gait aids, and therefore results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Introduction: It is unknown what the benefits of cardio-oncologic rehabilitation programmes on cardiorespiratory fitness and cancer fatigue during anthracycline-based chemotherapies (AC) are with supervised exercise training (ET), compared to PA advice and tracking only. Methods: Patients with breast cancer or lymphoma were recruited from four cancer centres and randomly assigned to three months supervised ET during (EXduringAC) or after (EXpostAC) AC. All patients were counselled on physical activity (PA) and PA was objectively measured with an activity tracker. Primary endpoints were peak VO2, fatigue and quality of life (QoL) after AC (AC-end) and at follow-up (3 months after completion of AC). Secondary endpoints were daily PA and daily steps during AC and follow-up phase, which were compared between days with and without centre-based training sessions. All analyses were performed by linear mixed models. Results: Fifty-seven patients (median [1st and 3rd quartiles] age 47 years [38, 57 years]; 95 ​% women) consented to participate, of whom data from 51 patients were available. Despite the fact that PA on days with centre-based training sessions was 28 (95 ​% confidence interval 24–32) min higher with 4382 (3995–4768) more steps, neither PA nor steps differed between groups in neither AC nor follow-up phase, nor were there between group differences in peak VO2, QoL or fatigue at any time point. Conclusion: In physically active patients with cancer, PA advice and using an activity tracker was equally effective on changes in peak VO2, fatigue, or QoL as enrolling in centre-based ET performed during or after AC. Trial registration: NCT03850171, February 21, 2019.

Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort’s step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery.

Objective: This study aimed to quantify the association between step count and multiple health outcomes in a healthy population. Methods: PubMed, Embase, Web of Science, and The Cochrane Library were systematically searched for systematic reviews and meta‐analyses from inception to April 1, 2022. Literature screening, data extraction, and data analysis were performed in this umbrella review. The intervention factor was daily step counts measured based on devices. Multiple health outcomes included metabolic diseases, cardiovascular diseases, all‐cause mortality, and other outcomes in the healthy population. Results: Twenty studies with 94 outcomes were identified in this umbrella review. The increase in daily step count contributed to a range of human health outcomes. Furthermore, the special population, different age groups, countries, and cohorts should be carefully considered. Negative correlation between step counts and the following outcomes: metabolic outcomes, cardiovascular diseases, all‐cause mortality, postural balance, cognitive function, and mental health. However, there was no association between participation in the outdoor walking group and the improvement of systolic blood pressure and diastolic blood pressure. Analysis of the dose–response association between increasing daily step count and the risk of cardiovascular disease events and all‐cause mortality showed a substantially linear relationship. Conclusion: A wide range of health outcomes can benefit from the right number of steps. [ABSTRACT FROM AUTHOR]

With the increased push for personalized medicine, researchers and clinicians have begun exploring the use of wearable sensors to track patient activity. These sensors typically prioritize device life over robust onboard analysis, which results in lower accuracies in step count, particularly at lower cadences. To optimize the accuracy of activity-monitoring devices, particularly at slower walking speeds, proven methods must be established to identify suitable settings in a controlled and repeatable manner prior to human validation trials. Currently, there are no methods for optimizing these low-power wearable sensor settings prior to human validation, which requires manual counting for in-laboratory participants and is limited by time and the cadences that can be tested. This article proposes a novel method for determining sensor step counting accuracy prior to human validation trials by using a mechanical camshaft actuator that produces continuous steps. Sensor error was identified across a representative subspace of possible sensor setting combinations at cadences ranging from 30 steps/min to 110 steps/min. These true errors were then used to train a multivariate polynomial regression to model errors across all possible setting combinations and cadences. The resulting model predicted errors with an R2 of 0.8 and root-mean-square error (RMSE) of 0.044 across all setting combinations. An optimization algorithm was then used to determine the combinations of settings that produced the lowest RMSE and median error for three ranges of cadence that represent disabled low-mobility ambulators, disabled high-mobility ambulators, and healthy ambulators (30–60, 20–90, and 30–110 steps/min, respectively). The model identified six setting combinations for each range of interest that achieved a ±10% error in cadence prior to human validation. The anticipated range of errors from the optimized settings at lower walking speeds are lower than the reported errors of wearable sensors (±30%), suggesting that pre-human-validation optimization of sensors may decrease errors at lower cadences. This method provides a novel and efficient approach to optimizing the accuracy of wearable activity monitors prior to human validation trials. [ABSTRACT FROM AUTHOR]

Patients with end-stage osteoarthritis are recommended to engage in physical activity (PA) to reduce pain and improve function but may avoid PA due to joint pain. Our goal was to investigate patient-reported outcomes and objective mobility metrics (step counts) in total hip arthroplasty (THA) patients as a function of pre-operative PA levels. In total, 1647 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation that underwent THA and were included in analysis. The entire cohort's step count was divided into quartiles to categorize patients with low, moderate, and high baseline PA. Outcomes including pain, EQ-5D-5L, HOOS JR, and step counts were compared according to activity group by ANOVA. Pre-operative pain scores were lowest, with smallest improvements, in the high-baseline PA group. Low-PA patients demonstrated the greatest improvements in EQ-5D-5L, while changes in EQ-VAS, HOOS JR, and satisfaction were similar between groups. Low- and moderate-PA patients increased physical activity by six weeks, reaching 180% and 114% of pre-operative steps; high-PA patients did not return to full step counts until one-year post-operation. Patients who perform high levels of PA undergoing THA report lower levels of pain and higher function pre-operatively but may appreciate less improvement in PA up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations prior to surgery. [ABSTRACT FROM AUTHOR]

Background: eHealth applications can support early mobilization and physical activity (PA) after surgery. This systematic review provides an overview of eHealth services to enhance or record PA after visceral surgery interventions. Methods: Two electronic databases (MEDLINE PubMed and Web of Science) were systematically searched (November 2023). Articles were considered eligible if they were controlled trials and described digital devices used to promote PA after visceral surgery. The Cochrane risk of bias (RoB-2) tool was used to determine the methodological quality of studies. Results: A total of nine randomized controlled studies (RCT) were included in this systematic review. The studies differed with respect to the interventions, surgical indications and evaluation variables. The risk of bias of the individual studies was moderate. The six studies using activity trackers (AT) predominantly showed insignificant improvements in the postoperative step count. The more complex fitness applications could partially reveal significant advantages compared to the control groups and the home-based online training also showed a significant increase in functional capacity. Conclusion: Activity tracking alone has so far failed to show clinically relevant effects. In contrast, the more complex eHealth applications revealed advantages compared to usual postoperative care. More high-quality studies are needed for evidence-based recommendations for eHealth services in conjunction with visceral surgery. [ABSTRACT FROM AUTHOR]

While physical activity (PA) is understood to promote vascular health, little is known about whether the daily and weekly patterns of PA accumulation associate with vascular health. Accelerometer‐derived (activPAL3) 6‐ or 7‐day stepping was analyzed for 6430 participants in The Maastricht Study (50.4% women; 22.4% Type 2 diabetes mellitus (T2DM)). Multivariable regression models examined associations between stepping metrics (average step count, and time spent slower and faster paced stepping) with arterial stiffness (measured as carotid–femoral pulse wave velocity (cfPWV)), and several indices of microvascular health (heat‐induced skin hyperemia, retinal vessel reactivity and diameter), adjusting for confounders and moderators. PA pattern metrics were added to the regression models to identify associations with vascular health beyond that of stepping metrics. Analyses were stratified by T2DM status if an interaction effect was present. Average step count and time spent faster paced stepping was associated with better vascular health, and the association was stronger in those with compared to those without T2DM. In fully adjusted models a higher step count inter‐daily stability was associated with a higher (worse) cfPWV in those without T2DM (std β = 0.04, p = 0.007) and retinal venular diameter in the whole cohort (std β = 0.07, p = 0.002). A higher within‐day variability in faster paced stepping was associated with a lower (worse) heat‐induced skin hyperemia in those with T2DM (std β = −0.31, p = 0.008). Above and beyond PA volume, the daily and weekly patterns in which PA was accumulated were additionally associated with improved macro‐ and microvascular health, which may have implications for the prevention of vascular disease. [ABSTRACT FROM AUTHOR]

Commercially available wearable activity monitors can promote physical activity behaviour. Clinical trials typically quantify physical activity with research grade activity monitors prior to testing interventions utilising commercially available wearable activity monitors aimed at increasing step count. Therefore, it is important to test the agreement of these two types of activity monitors. Observational. Thirty adults (20–65 years, n = 19 females) were provided a Fitbit Charge 4©. To determine reliability using an intraclass correlation coefficient, two, one-minute bouts of treadmill walking were performed at a self-selected pace. Subsequently, participants wore both an ActiGraph wGT3X-BT and the Fitbit for seven days. To determine agreement, statistical equivalence and the mean absolute percentage error were calculated and represented graphically with a Bland–Altman plot. Ordinary least products regression was performed to identify fixed or proportional bias. The Fitbit showed 'good' step count reliability on the treadmill (intraclass correlation coefficient = 0.75, 95 % CI = 0.53–0.87, p < 0.001). In free-living however, it overestimated step count when compared to the ActiGraph wGT3X-BT (mean absolute percentage error = 26.02 % ± 14.63). Measurements did not fall within the ± 10 % equivalence region and proportional bias was apparent (slope 95 % CI = 1.09–1.35). The Fitbit Charge 4© is reliable when measuring step count on a treadmill. However, there is an overestimation of daily steps in free-living environments which may falsely indicate compliance with physical activity recommendations. [ABSTRACT FROM AUTHOR]

Abstract Background Established health-related quality of life scores do not consider both subjective and objective indices of health. We propose the subjective and objective quality of life score (SOQOL) for the comprehensive assessment of health-related quality of life and aim to provide normative population data. The SOQOL is compatible with smartphone applications, allowing widespread use on a global scale. Methods Normative SOQOL population data was sourced from pre-existing datasets on the EQ-5D-5L, daily step count, and walking speed. Normative values were calculated using weighted grand means. We trialled the SOQOL in a group of five patients presenting to a spinal neurosurgery clinic. Results SOQOL scores decreased with age, and women had lower scores in every age group. In our case series, the spine patients with the biggest SOQOL deficit compared to age- and sex-matched population averages were found to be surgical while the rest were non-surgical. Conclusions The SOQOL shows promise as a simple and effective scoring tool that is compatible with smartphones, potentially useful for screening in primary and specialized care settings, and for assessment following healthcare interventions. This study, however, is preliminary, and the findings are primarily suggestive. They underline the necessity for future, more comprehensive studies to validate and expand upon these initial observations. The conclusion of both this abstract and the full paper will clearly state these limitations and the preliminary nature of the study.

Purpose: Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. Methods: This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. Results: The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P < 0.05). No significant difference was found between three months and one year postoperatively. In multivariate analysis, younger age and higher preoperative contralateral gluteal medius volume were the predictors of higher postoperative step counts (P < 0.05). Conclusions: Physical activity, including step counts, OHS, and UCLA score increased significantly until three months after unilateral THA. Early surgical intervention before contralateral muscle declines and preoperative rehabilitation including contralateral side may additionally improve postoperative activity levels. [ABSTRACT FROM AUTHOR]

Background and Objectives: Mild cognitive impairment (MCI) is an early stage of dementia in which everyday tasks can be maintained; however, notable challenges may occur in memory, focus, and problem-solving skills. Therefore, motor-cognitive dual-task training is warranted to prevent cognitive decline and improve cognition in aging populations. This study aimed to determine the influence of such dual-task activities during straight and curved walking on the activities of the prefrontal cortex and associated gait variables in older adults with MCI. Materials and Methods: Twenty-seven older adults aged ≥65 years and identified as having MCI based on their scores (18–23) on the Korean Mini-Mental State Examination were enrolled. The participants performed four task scenarios in random order: walking straight, walking straight with a cognitive task, walking curved, and walking curved with a cognitive task. The activation of the prefrontal cortex, which is manifested by a change in the level of oxyhemoglobin, was measured using functional near-infrared spectroscopy. The gait speed and step count were recorded during the task performance. Results: Significant differences were observed in prefrontal cortex activation and gait variables (p < 0.05). Specifically, a substantial increase was observed in prefrontal cortex activation during a dual task compared with that during a resting-state (p < 0.013). Additionally, significant variations were noted in the gait speed and step count (p < 0.05). Conclusions: This study directly demonstrates the impact of motor-cognitive dual-task training on prefrontal cortex activation in older adults with MCI, suggesting the importance of including such interventions in enhancing cognitive function. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA. [ABSTRACT FROM AUTHOR]

Children should engage in at least 60 min of physical activity daily to develop or maintain healthy habits (Centers for Disease Control and Prevention, 2021a). Previous research suggests that contingent attention is a powerful tool for increasing moderate to vigorous physical activity. In this study, the researchers examined the effects of a group game on steps per minute at recess in an inclusive classroom with preschoolers. The researcher taught the game called the T‐Rex game in which the game rules (chasing students who were moving) involved contingencies for natural attention to follow moderate to vigorous physical activity. The results showed a functional relation between step count and the group game in which students engaged in higher step counts when the group game was in place than during baseline. These findings extend other work by demonstrating that contingent attention embedded in group games can increase step count. [ABSTRACT FROM AUTHOR]

With the increased push for personalized medicine, researchers and clinicians have begun exploring the use of wearable sensors to track patient activity. These sensors typically prioritize device life over robust onboard analysis, which results in lower accuracies in step count, particularly at lower cadences. To optimize the accuracy of activity-monitoring devices, particularly at slower walking speeds, proven methods must be established to identify suitable settings in a controlled and repeatable manner prior to human validation trials. Currently, there are no methods for optimizing these low-power wearable sensor settings prior to human validation, which requires manual counting for in-laboratory participants and is limited by time and the cadences that can be tested. This article proposes a novel method for determining sensor step counting accuracy prior to human validation trials by using a mechanical camshaft actuator that produces continuous steps. Sensor error was identified across a representative subspace of possible sensor setting combinations at cadences ranging from 30 steps/min to 110 steps/min. These true errors were then used to train a multivariate polynomial regression to model errors across all possible setting combinations and cadences. The resulting model predicted errors with an R2 of 0.8 and root-mean-square error (RMSE) of 0.044 across all setting combinations. An optimization algorithm was then used to determine the combinations of settings that produced the lowest RMSE and median error for three ranges of cadence that represent disabled low-mobility ambulators, disabled high-mobility ambulators, and healthy ambulators (30–60, 20–90, and 30–110 steps/min, respectively). The model identified six setting combinations for each range of interest that achieved a ±10% error in cadence prior to human validation. The anticipated range of errors from the optimized settings at lower walking speeds are lower than the reported errors of wearable sensors (±30%), suggesting that pre-human-validation optimization of sensors may decrease errors at lower cadences. This method provides a novel and efficient approach to optimizing the accuracy of wearable activity monitors prior to human validation trials.

Background and Objectives: Mild cognitive impairment (MCI) is an early stage of dementia in which everyday tasks can be maintained; however, notable challenges may occur in memory, focus, and problem-solving skills. Therefore, motor-cognitive dual-task training is warranted to prevent cognitive decline and improve cognition in aging populations. This study aimed to determine the influence of such dual-task activities during straight and curved walking on the activities of the prefrontal cortex and associated gait variables in older adults with MCI. Materials and Methods: Twenty-seven older adults aged ≥65 years and identified as having MCI based on their scores (18–23) on the Korean Mini-Mental State Examination were enrolled. The participants performed four task scenarios in random order: walking straight, walking straight with a cognitive task, walking curved, and walking curved with a cognitive task. The activation of the prefrontal cortex, which is manifested by a change in the level of oxyhemoglobin, was measured using functional near-infrared spectroscopy. The gait speed and step count were recorded during the task performance. Results: Significant differences were observed in prefrontal cortex activation and gait variables (p < 0.05). Specifically, a substantial increase was observed in prefrontal cortex activation during a dual task compared with that during a resting-state (p < 0.013). Additionally, significant variations were noted in the gait speed and step count (p < 0.05). Conclusions: This study directly demonstrates the impact of motor-cognitive dual-task training on prefrontal cortex activation in older adults with MCI, suggesting the importance of including such interventions in enhancing cognitive function.

Introduction: There is conflicting data in the literature regarding the clinical utility of wearable devices. This study examined the association between patient reported outcome measures (PROMs) and step and stair flight counts obtained from wearable devices in postoperative total hip arthroplasty (THA) patients., Methods: Data was collected from a multicenter prospective longitudinal cohort study from October 2018 to February 2022. A smartphone-based platform with smartwatch was utilized for collection of daily step and stair flight counts. Subjects (N = 1644) completed the Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and numerical rating scale (NRS) pain scores preoperatively and at 1 and 3 months postoperatively. Patients who reported living in a multi-level home (N = 931) were included in analysis of stair flight counts. Pearson correlation coefficients were calculated to determine correlations between step and stair flight counts with NRS pain and HOOS JR scores., Results: Step counts demonstrated a weak negative correlation to NRS pain scores at preoperative (r = - 0.15, p < 0.0001), 1-month (r = - 0.15, p < 0.0001), and 3-months follow-up (r = - 0.06, p = 0.05). Step counts demonstrated a weak positive correlation with HOOS JR scores at preoperative (r = 0.16, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.13, p < 0.0001). Stair flight counts demonstrated a weak negative correlation with NRS pain preoperatively (r = - 0.19, p < 0.0001) and at 1-month (r = - 0.11, p = 0.003). Stair flight counts positively correlated with HOOS JR scores at preoperative (r = 0.24, p < 0.0001), 1-month (r = 0.15, p < 0.0001), and 3-months (r = 0.09, p = 0.02)., Conclusion: The utilization of wearable technology can enhance the evaluation of patient outcomes after THA, primarily due to the observed correlation between data collected from wearables and PROMs. Our study highlights the importance of the use of objective data, in addition to subjective patient reported data, when analyzing postoperative patient progress, which propels forward the field of postoperative THA patient care., Competing Interests: Declarations. Conflict of interests: Mr. Nickelas Huffman, Dr. Ignacio Pasqualini, Dr Shujaa T. Khan, and Ms. Alison Klika do not have any conflicts of interest to disclose. Ethical approval: The study was approved by the WCG Institutional Review Board and registered in ClinicalTrials.gov prior to enrollment activities (NCT03737149); all subjects provided written informed consent., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Appropriate levels of physical activity (PhA) provide health benefits to patients with chronic diseases, including patients with pulmonary arterial hypertension (PAH). In this study, we examined the effect of physicians' PhA recommendations on PhA, and the benefits and effectiveness of PhA self-monitoring using a pedometer for PAH patients., Methods: A prospective clinical trial was performed from 22 April 2021, with consecutive PAH outpatients in stable condition at least three months prior to the study. Each patient was educated about the benefits of PhA in PAH during the initial visit. Patients wore pedometers (Omron HJ-321-E) for 2 weeks. After PhA assessment, the patients were contacted by a physician by phone. Patients who walked <5,000 steps per day (inactive group) were recommended to increase their PhA, and patients who walked ≥5,000 steps per day (active group) were recommended to maintain this level of PhA. Patients wore pedometers for 3 months. The primary endpoint was the number of steps taken after 12 weeks of the study. The secondary endpoints were the 6-minute walk distance (6MWD), quality of life (QoL) (36-Item Short-Form Health Survey), and anxiety and depression levels., Results: The study included 41 PAH patients aged 45.9±11.9 years, with 32 (78%) of them women. Initially, 18 (44%) patients were in the inactive group (2-week mean: 3,318±1,185 steps/day) while 23 (56%) patients were in the active group (2-week mean: 7,647±1,991 steps/day). The entire study group showed an insignificant decrease in their PhA from 5,203 [interquartile range (IQR), 3,787-7,387] to 4,672 (IQR, 3,821-7,201) steps per day (P=0.57). Patients in the inactive group showed an insignificant increase in their PhA after 12 weeks [increase in the average number of steps per day by 104 (IQR, -244 to 1,007), P=0.52], while patients in the active group showed an insignificant trend towards PhA reduction [change in average daily steps: -815 (IQR, -1,400 to 580), P=0.37]. There were no differences at week 12 in the 6MWD, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) level, QoL, or levels of anxiety and depression, all P values >0.05., Conclusions: Education, a simple recommendation about PhA, and self-monitoring with a pedometer are insufficient to achieve intervention in PAH patients. Additional methods of motivating and supervising these patients are necessary., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-24-249/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

This study aimed to describe the variability in estimates of the association of daily steps and all-cause mortality in systematic reviews with meta-analyses, to identify the factors potentially responsible for it, and to provide an updated estimate. Five databases were systematically searched up to May 2024 to identify systematic reviews with meta-analyses and prospective cohort studies. A qualitative synthesis of previous reviews and an updated meta-analysis of cohort studies were performed. Pooled hazard ratios (HRs) with their 95% confidence intervals (CIs) were calculated using a random-effects model. Eleven systematic reviews with meta-analyses and 14 cohort studies were included, revealing considerable variability in result presentation. Our updated meta-analysis showed a nonlinear association, indicating a lower risk of all-cause mortality with increased daily steps, with a protective threshold at 3143 steps/day, and a pooled HR of 0.91 (95% CI: 0.87, 0.95) per 1000 steps/day increment. Physical activity categories consistently indicated progressively reduced mortality risk, with the highly active category (>12,500 steps/day) exhibiting the lowest risk (0.35 (95% CI: 0.29, 0.42)). Systematic reviews and meta-analyses showed considerable variability in effect estimates due to different methods of quantifying exposure. Despite it, our study underscores the importance of increased daily steps in reducing all-cause mortality, with a minimum protective dose of 3000 steps/day, although the optimal dose differed according to age and sex. It is recommended that future studies categorise daily steps by physical activity category, perform dose-response analyses, and use increments of 1000 steps/day. [Display omitted] • This umbrella review is the largest synthesis of daily steps and all-cause mortality in the general population. • Systematic reviews and meta-analyses published to date showed substantial variability in the effect estimates provided. • All-cause mortality risk decreases with more steps: minimum protection at 3143 steps/day, with the lowest risk for >12,500 steps/day. • Future research should categorise daily steps by activity level, analise dose-response, and use 1000 step/day increments. [ABSTRACT FROM AUTHOR]

[Purpose] This study aimed to examine the characteristics of preoperative physical activity and its impact on the postoperative period in patients who underwent surgery for esophageal cancer. [Participants and Methods] The participants were 30 patients who were diagnosed with esophageal cancer, underwent surgery, and fulfilled their conditions. Preoperative physical activity was measured using the step count, and metabolic equivalents as the amount of physical activity. We examined the relationships between preoperative step count and METs, patient demographics, treatment-related factors, preoperative physical function, and activities of daily living. Moreover, we examined the relationships of preoperative step count and METs with postoperative mobilization, physical activity, physical function, and activities of daily living. [Results] Preoperative step count was related to age, Glasgow prognostic score, and preoperative functional independence and associated with step count on postoperative days 7-13, METs on postoperative days 7-9, 6-min walking distance, and functional independence measures at discharge. [Conclusion] Improving the nutritional status and increasing preoperative physical activity by walking for esophageal cancer may help improve physical activity after postoperative day 7, exercise tolerance, and activities of daily after discharge., Competing Interests: There are no conflicts of interest to disclose., (2024©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Introduction: Very few studies have examined patterns of physical activity (PA) during a pulmonary rehabilitation (PR) program in people with COPD., Aims: To compare the patterns of PA in: 1) the week before commencing PR (pre-PR) with a week during PR (PR week); 2) PR days and non-PR days during a PR week; 3) pre-PR and the week following PR completion (post-PR)., Methods: This was a multicenter, prospective cohort study. Participants attended twice weekly supervised PR for 8-12 weeks. Daily step count (primary outcome), time in light activities, time in moderate to vigorous PA (MVPA), total sedentary time and sit-to-stand (STS) transitions were measured using a thigh worn accelerometer for seven days, at each assessment time point: pre-PR, PR week and post-PR., Results: 29 participants, mean age (SD) 69years(7), FEV 1 53%pred(16). The PR week compared to pre-PR, showed higher daily: step count (mean difference (95%CI)), 941steps(388-1494); and MVPA, 11mins(6-15), with no difference in: time in light activities, -1min(-6-5); total sedentary time, 7mins(-21-36); or STS transitions, 0(-5-6). PR days compared to non-PR days showed higher: step count, 2810steps(1706-3913); time in light activities 11mins(1-20); time in MVPA, 27mins(17-35) and STS transitions, 8(4-12), with no difference in total sedentary time: -33mins(-80-15). There were no differences in any PA measures post-PR compared to pre-PR (p < 0.05)., Conclusion: Daily step count and time spent in MVPA increased significantly during the PR week, solely due to increased PA on days participants attended PR., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time. External motivation was negatively associated with the square root of daily step count (β = -4.57; p < .001) and square root of daily stepping time (β = -0.49; p < .001). Older adults living in retirement communities demonstrated low levels of daily activity, with a negative association between external motivation and daily activity. Strategies are needed to make an active lifestyle supportive and enticing for older adults in these communities.

Background/objectives: Few studies have investigated associations between the motivational outcome based on physical activity (PA) affective experiences (i.e., attraction vs. antipathy toward PA) and behavior. This study investigated cross-sectional and longitudinal associations between attraction (vs. antipathy) toward PA and device-based PA in older adults., Methods: Older adults (n = 139; 71% female, Mage = 70.5) completed assessments of attraction (vs. antipathy) toward PA and 14 days of device-based accelerometry at Times 1 and 2., Results: Greater attraction toward PA at Time 1 was associated with greater steps (β = 5.31, p < .01) and moderate to vigorous intensity PA (β = 3.08, p < .05) at Time 1. Greater attraction toward PA at Time 1 was not significantly associated with steps or moderate to vigorous intensity PA at Time 2., Conclusion: Greater emphasis on resultant motivation from PA affective experiences may be useful in promoting PA in older adults. Significance/Implications: In spite of mixed findings in the present study, there is strong evidence that positive affective responses during a single bout of PA play an important role in predicting future engagement. Yet, affective experiences during PA can be individualistic and often influenced by contextual factors. Interventions designed to increase PA should focus on factors that may create positive affective experiences for participants.

BACKGROUND: The past decade has seen an increase in the use of B-cell depleting infusions every 24 weeks as disease modifying treatment for multiple sclerosis (MS). Despite their effectiveness, some patients on these therapies retrospectively report a symptomatic wearing-off effect before subsequent doses. Remote ambulatory monitoring can reflect an individual's walking ability as well as their other symptoms (mood, fatigue, bladder function) and therefore can serve as an indicator of well-being. OBJECTIVES: To analyze average daily step count (STEPS) as a remote measure of physical activity in relation to B-cell depleting infusions in existing longitudinal cohorts of people with MS. Specifically, to test the hypothesis that STEPS would be lower in the month prior to infusion than in the midpoint between infusions. METHODS: This is a secondary analysis of data from remote monitoring studies following ambulatory adults with MS longitudinally for at least 1 year (enrollment from 2015, cumulative N = 145). To avoid confounding from B-cell lysis sequelae after a first infusion cycle, current analysis focused on participants who had already completed at least 1 full cycle of anti-CD20 monoclonal antibody therapy prior to the index time point analyzed. A weighted average of daily step count over each month was calculated and visually plotted over each infusion cycle. A t test compared STEPS in the month directly before infusion vs in the third month after infusion (other intervals: 2, 4, and 5 months). Regression analysis of the percentage change in STEPS (including sex, age, disease duration, MS type, and disability level) was performed. RESULTS: STEPS data between 2 infusions were available for 32 individuals. Mean age was 48.9 (SD 11.9) years, median Expanded Disability Status Scale score 4.0 (range 1.5-6.5), 56% female, and 56% relapsing MS. On visual inspection of each participant's infusion cycles, there was no visible trend in STEPS related to infusion timing. There was no difference in STEPS in the month prior to infusion and the third month after, or in months 2, 4, or 5 after infusion (t test, P > .05 for each). Overall, 81% of participants showed no meaningful (800 steps) difference in step count between these 2 intervals; 13% showed a decrease and 6% improved. Regression analysis indicated minimal predictive power of the model (Adj. R²: 0.001). CONCLUSIONS: In other studies, up to 48% of people with MS retrospectively report that they experience symptomatic worsening prior to infusions. The current analysis focusing on longitudinally collected behavioral data (ambulatory activity) reveals no significant change in STEPS relative to the timing of infusions. Future studies pairing objective and subjective measures and CD19 levels to evaluate potential immunological from temporal wearingoff effects may be informative. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with substantial impairment in physical function, which has been identified as a top concern among persons with pain. GetActive-Fitbit , a mind-body activity program, is feasible, acceptable, and associated with improvement in physical function among primarily White, sedentary individuals with pain. In preparation for a multisite efficacy trial, we must examine feasibility across multiple sites with diverse patient populations. Here we describe the protocol of a multisite, feasibility RCT comparing GetActive-Fitbit with a time- and attention-matched educational comparison (Healthy Living for Pain). We aim to 1) test multisite fidelity of clinician training; 2) evaluate multisite feasibility benchmarks, including recruitment of chronic pain patients taking <5000 steps/day and racial and ethnic minorities; and 3) optimize fidelity and study protocol in preparation for a future multisite efficacy trial. Clinician training fidelity was assessed via roleplays and mock group sessions. Feasibility (i.e., recruitment, acceptability, credibility, adherence, satisfaction), multimodal physical function (e.g., self-report, 6-Minute Walk Test, step-count), and other psychosocial outcomes are assessed at baseline, posttest, and 6 months. Protocol optimization will be assessed using exit interviews and cross-site meetings. The trial is ongoing. Clinician training is complete. 87 participants have been recruited. 54 completed baseline assessments and randomization, 44 are mid-intervention, and 9 have completed the intervention and posttest. This study addresses the critical need for feasible, acceptable mind-body-activity interventions for chronic pain that follow evidence-based guidelines and improve all aspects of physical function across diverse populations. Results will inform a future fully-powered multisite efficacy trial. Clinical Trial Registration: NCT05700383 [ABSTRACT FROM AUTHOR]

Behavioral interventions targeting moderate- to vigorous-intensity physical activity (MVPA) to ensure health benefits can be strengthened by a simple metric that helps adults understand if they are exercising at the target intensity. Laboratory studies have established that a cadence of 100 steps/min is equivalent to MVPA, but intervention application is largely unexplored. The aim of this narrative review was to describe how cadence has been implemented in behavioral interventions. PubMed, PsychInfo, and SCOPUS were searched with a standardized search string. Studies were included if peer-reviewed interventions reporting on targeting MVPA increases for adults through cadence or if non-intervention programs directly targeting cadence. Of 232 unique studies identified, 6 were included in the final sample. Cadence was monitored using subjective cues (n = 3), time-oriented goals (n = 2), step-counting (n = 2), auditory cues (n = 2), and visual cues (n = 2), and measured by pedometers (n = 5) or mp3 player (n = 1). No studies reported detailed participant instructions to teach cadence. Results suggest that use of cadence in behavioral interventions is feasible but nascent. Reviewed studies provided insufficient detail to replicate methods and there was no consensus on best practices for implementing cadence. Results point to the potential utility of cadence and offer approaches for future refinement and standardization., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 The Author(s).)

Although walking has proven efficacy for glycemic control, patients struggle to meet daily step goals. This secondary analysis investigated the effect of step count measurement rate on glycemic control. Patients with type 2 diabetes from eight hospitals in Japan participated in a 12-month randomized controlled trial. The intervention group received DialBetesPlus, a self-management support system that allowed patients to monitor step count using a pedometer. We divided the intervention group into two groups based on whether daily step count measurement rate (the percentage of days with pedometer use) increased or decreased during the last three months of the intervention (month 10-12), relative to the first three months of the intervention (month 1-3). Patients with a reduced measurement rate experienced a worsening in glycemic control, with between-group difference of 0.516% in the amount of change in HbA1c (p=0.012). We conclude that step count measurement may lead to a better glycemic profile.