Automated algorithms for detecting sleep period time using a multi-sensor pattern-recognition activity monitor from 24 h free-living data in older adults

Methodological Choices on 24-h Movement Behavior Assessment by Accelerometry: A Scoping Review

BACKGROUND

There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups.

MAIN BODY

PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and  ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data.

CONCLUSIONS

Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options.

Associations of pattern-recognition-measured daily activities with sarcopenia and sarcopenic obesity in old age: The IMPACT65+ study

BACKGROUND

Physical activity has shown beneficial effects for a good state of muscles in aging, but the specific activities of daily living that could be protective remains unclear. This study aimed to analyse the associations of different pattern-recognition-measured daily activities with sarcopenia and sarcopenic obesity in a sample of older adults.

METHODS

200 community-dwelling older adults wore the Intelligent Device for Energy Expenditure and Activity for two consecutive days. Twelve major daily activities recorded were merged in to three common intensity categories: sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA). For physical performance measurements included, hand grip dynamometer and chair-stand tests were used. Skeletal muscle mass and fat mass were estimated by bioelectrical impedance analysis. Associations of daily activities with the study variables were examined using linear regression models.

RESULTS

There were no significant associations between total time spent in SB, LPA, or MVPA and sarcopenia. Sarcopenic obesity showed a negative association with total time spent in MVPA [ß (95%CI): -0.29 (-0.41, -0.17)]. Walk at a brisk pace was significatively associated with lower limb physical performance, muscle mass and fat mass % [ß (95%CI): 1.15 (0.40, 1.91); 1.45 (0.68, 2.22) and -2.63 (-4.12, -1.14) respectively]. Other MVPA activities were also significatively associated with the same sarcopenic obesity components [ß (95%CI): 4.65 (0.55, 8.75); 8.59 (4.51, 12.67) and -13.98 (-21.96, -5.99) respectively].

CONCLUSION

Time spent in daily activities of moderate-to-vigorous intensity is negatively associated with sarcopenic obesity but not with sarcopenia.

Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review

Background

Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking.

Objective

This study aimed to raise researchers’ and consumers’ attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies.

Methods

Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time).

Results

Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk.

Conclusions

Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity.

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes

BACKGROUND

Although clinical gait speed may indicate health and well-being in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

OBJECTIVE

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44-m walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

DESIGN

A cross-sectional design was used.

METHODS

The study population comprised 432 high-functioning, community-dwelling older adults (287 women) aged between 65 and 92 years. Clinical and ambulatory gait speeds were measured using the 2.44-m walk test and a portable gait analysis device, respectively. Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (body mass index, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper- and lower-body strength, physical and mental health status, cognitive status, and self-rated cognitive status).

RESULTS

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared. Clinical gait speed was associated with 7 health outcomes, and the ambulatory gait speed was associated with 6 health outcomes. The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied; however, the strength of associations was singly different between measures.

LIMITATIONS

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

CONCLUSION

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed. Both measures have construct validity because they have been associated with physical and health outcomes; however, they may have different predictive validity. Further research should be conducted to compare their predictive validity in longitudinal designs.

Associations of Frailty and Physical Function with a Daily Activities Measured by a Pattern-Recognition Activity Monitor: An Isotemporal Substitution Analysis in the IMPACT65+ Study

OBJECTIVES

The aims of this study were (i) to examine the independent associations of the time spent in daily activities measured by multi-sensor pattern-recognition with frailty and physical functioning (PF); and (ii) to analyze how relocating time between these daily activities is associated with frailty and PF in a sample of older adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

The study sample consists of 436 (287 women) high-functioning community-dwelling older adults, aged 65 to 92 years, who participated in the IMPACT65+ Study.

MEASUREMENTS

Frailty was calculated as a continuous measure; based on the five widely recognized Fried's criteria. PF was assessed using the SF-12 questionnaire. The time in daily activities was assessed by the Intelligent Device for Energy expenditure and Activity (IDEEA). Independent associations of daily activities with frailty and PF were examined using linear regression models adjusting for potential confounders. The isotemporal substitution models for estimate the effect of replacing time in one activity with the same amount of time in another activity while holding wake time constant.

RESULTS

Time spent lying was directly associated, while time in walk at average and brisk pace was inversely associated with frailty. The independent associations for PF were similar to lying, walk at average pace and walk at brisk pace. Isotemporal substitution analyses revealed a clear beneficial effect of hypothetically replacing 30 min/day of sedentary behaviors or light physical activity by the same amount of moderate-to-vigorous physical activity for frailty and PF.

CONCLUSION

This is the first study examining the activity-specific and isotemporal association of daily activities with frailty and PF in older adults. Isotemporal substitution analyses showed that replacing sedentary behaviors (lie, recline, passive sit) by light-intensity activities (active sit, stand and walk at slow pace), as well as light-intensity activities by activities at MVPA such as walk at brisk pace, may produce theoretical improvements in frailty and PF. These findings are important for the development of effective interventions focused on reducing age-related frailty and declines in PF.

Criterion Validity of the Sedentary Behavior Question From the Global Physical Activity Questionnaire in Older Adults

BACKGROUND

To assess the validity of the single question to determine sedentary behavior (SB) by using the Global Physical Activity Questionnaire (GPAQ) in older adults.

METHODS

The sample included 163 participants (96 women) aged 65-92 years. Self-reported SB was obtained from the GPAQ. Objectively measured SB was assessed using the Intelligent Device for Energy Expenditure and Activity. Participants wore the Intelligent Device for Energy Expenditure and Activity continuously during 2 consecutive days while following their daily routine. The relative validity was assessed using the Spearman rank correlation coefficient (ρ), and the agreement was examined using mean bias and 95% limit of agreement with the Intelligent Device for Energy Expenditure and Activity as reference.

RESULTS

The results showed small correlations (ρ = .291, P < .001) between the SB from the GPAQ and the objective measures, and ranged from ρ = .217 to ρ = .491 depending on the potential moderator. Similarly, the GPAQ underestimates the SB for approximately 2 hours per day in older adults (limit of agreement = -7.3 to 3.4 h/d).

CONCLUSION

The GPAQ may not be the most suitable questionnaire for measuring SB in this population and should be used with caution because those studies that use this questionnaire in older adults may have an inaccurate measurement of SB levels.

Associations of daily activities measured by a pattern-recognition activity monitor with overall and abdominal obesity in older people: the IMPACT65+ study

OBJECTIVES

The aims of the present study were: (i) to analyze the associations of the time spent in daily activities (i.e., lie, recline, passive sit, active sit, stand, walk at slow pace, walk at average pace, walk at brisk pace, and other activities) with body mass index (BMI) and waist circumference (WC); and (ii) to examine how theoretically reallocating time between these daily activities is associated with BMI and WC.

METHODS

The sample included 437 older adults (288 women), aged 65 to 92 years, participating in the IMPACT65+ study. The time in daily activities was assessed by the Intelligent Device for Energy Expenditure and Activity (IDEEA). BMI and WC were measured following standardized procedures. Associations of daily activities with BMI and WC were examined using linear regression models adjusting for potential confounders. Isotemporal substitution models were performed to estimate the theoretical effect of replacing one activity with another activity while holding total time constant.

RESULTS

The time spent lying and reclining was associated with increased BMI and WC, while the time spent standing, walking at average pace, and walking at brisk pace was associated with decreased BMI and WC. Isotemporal substitution analyses revealed significant hypothetical reductions in BMI and WC when reallocating 15 min from lying or reclining to standing or walking at average pace. Moreover, replacing 15 min from any sedentary activity or light physical activity (except for walking at average pace) with an equal amount of time in walking at brisk pace was associated with lower BMI and WC.

CONCLUSIONS

This is the first study examining the activity specific and isotemporal associations of daily behaviors (considering body postures and movements) with overall and abdominal obesity in older people. The results could be used in the development of specific recommendations encouraging an active lifestyle in older people.