Comparison of home and away-from-home physical activity using accelerometers and cellular network-based tracking devices

Locations of Physical Activity: Where Are Children, Adolescents, and Adults Physically Active? A Systematic Review

The aim of this systematic review was to examine where physical activity (PA) takes place and how much time children, adolescents and adults spend being physically active within the identified locations. A systematic literature search was carried out in five electronic databases (PubMed, CINAHL, SPORTDiscus, PsycInfo, Scopus). For inclusion, primary studies had to identify locations of PA using device-based or self-report tools, whereas minutes of PA had to be examined using device-based tools only. Thirty-two studies were included, methodological quality and sex/gender sensitivity of the studies were assessed. The narrative data synthesis revealed that the highest average amount of daily moderate-to-vigorous PA was found in home and recreational locations, followed by school and neighborhood locations. In adults, highest average amount of daily moderate-to-vigorous PA was found in neighborhood and home locations followed by workplace and recreational locations. The majority of studies had a low risk of bias in four out of six domains; eight studies reported significant sex/gender differences in location-based PA. The results indicate that different locations are used for PA to a varying degree across the lifespan. Future research on the promotion of PA should focus on location-specific design features that encourage children, adolescents and adults to be physically active.

Predictors of Falls per Step and Falls per Year At and Away From Home in Glaucoma

OBJECTIVE

To determine where glaucoma patients most often fall and how integrated visual field (IVF) damage affects falls rates per year (falls/year) and per step (falls/step) at and away from home.

DESIGN

Prospective, observational cohort study.

METHODS

In 225 patients with glaucoma or suspected glaucoma, falls data were collected via calendars, fall location was classified through follow-up questionnaires, and steps taken at and away from home were judged by integrating data from annual week-long accelerometer and GPS trials. Main outcome measures were the association of IVF sensitivity with fall rates per year or step, stratified by location.

RESULTS

Participants took more away steps than home steps (2366 vs 1524, P < .001), and differences in away vs home steps did not vary with IVF sensitivity (P = .22). A total of 57% of falls occurred at home, with each home step twice as likely to result in a fall as compared to each away step (rate ratio = 2.02, P < .001). Worse IVF sensitivity was not associated with a higher rate of home falls/year or away falls/year (P > .1 for both), but was associated with a higher rate of home falls/step (rate ratio = 1.34/5 dB worse sensitivity, P = .03) and away falls/step (rate ratio = 1.47/5 dB worse sensitivity, P = .003).

CONCLUSIONS

In this glaucoma population, most falls occurred at home, and the risk of any step resulting in a fall was higher at home. Those with greater VF damage were more likely to fall for each step taken both at and away from home. Efforts such as home environmental modification should be considered in the visually impaired to prevent falls while maintaining physical activity.

Evidence synthesis - Where are children and adults physically active and sedentary? - a rapid review of location-based studies

INTRODUCTION

Geographical positioning systems (GPS) have the capacity to provide further context around where physical activity (PA) and sedentary time (ST) are accrued especially when overlaid onto objectively measured movement. The objective of this rapid review was to summarize evidence from location-based studies which employed the simultaneous use of GPS and objective measures of PA and/or ST.

METHODS

Six databases were searched to identify studies that employed the simultaneous use of GPS and objective measures of PA or ST to quantify location of movement. Risk of bias was assessed, and a qualitative synthesis completed.

RESULTS

Searching identified 3446 articles; 59 were included in the review. A total of 22 studies in children, 17 in youth and 20 in adults were captured. The active transportation environment emerged as an important location for moderate-to-vigorous intensity physical activity (MVPA) in children, youth and adults. In children and youth, the school is an important location for MVPA, especially the schoolyard for children. Indoor locations (e.g., schools, homes) appear to be greater sources of lighter intensities of PA and ST. The review was limited by a lack of standardization in the nomenclature used to describe the locations and methods, as well as measures of variance.

CONCLUSION

Evidence suggests that the active transportation environment is a potentially important contributor of MVPA across an individual's lifespan. There is a need for future location-based studies to report on locations of all intensity of movement (including minutes and proportion) using a whole-day approach in larger representative samples.

PrevenTing Falls in a high-risk, vision-impaired population through specialist ORientation and Mobility services: protocol for the PlaTFORM randomised trial

BACKGROUND

Older people with vision impairment have significant ongoing morbidity, including risk of falls, but are neglected in fall prevention programmes. PlaTFORM is a pragmatic evaluation of the Lifestyle-integrated Functional Exercise fall prevention programme for older people with vision impairment or blindness (v-LiFE). Implementation and scalability issues will also be investigated.

METHODS

PlaTFORM is a single-blinded, randomised trial designed to evaluate the v-LiFE programme compared with usual care. Primary outcomes are fall rate over 12 months, measured using prospective monthly fall calendars, and function and participation assessed by the Late-Life Function and Disability Instrument (Late-Life FDI) Function component. The secondary outcome is rate of falls requiring medical care. Activity-normalised fall rate will be estimated using accelerometer-measured physical activity data. EuroQol 5-dimension 5-level questionnaire will measure quality of life and impact of falls. Health record linkage will estimate resource use associated with falls. v-LiFE cost-effectiveness will be determined compared with usual care. 500 participants (250 per group) can provide 90% power to detect a significant between-group difference in fall rates; 588 will be recruited to allow for drop-out. Falls per person-year and Late-Life FDI will be compared between groups.

DISCUSSION

PlaTFORM will determine if falls can be prevented among older people with vision loss through a home-based exercise programme. v-LiFE embeds balance and strength training within everyday activities with the aim of preventing falls. The study will also determine whether the programme can be effectively delivered by personnel who provide Orientation and Mobility training for people with vision impairment.

TRIAL REGISTRATION NUMBER

ACTRN12616001186448p.

Technologies That Assess the Location of Physical Activity and Sedentary Behavior: A Systematic Review

Background

The location in which physical activity and sedentary behavior are performed can provide valuable behavioral information, both in isolation and synergistically with other areas of physical activity and sedentary behavior research. Global positioning systems (GPS) have been used in physical activity research to identify outdoor location; however, while GPS can receive signals in certain indoor environments, it is not able to provide room- or subroom-level location. On average, adults spend a high proportion of their time indoors. A measure of indoor location would, therefore, provide valuable behavioral information.

Objective

This systematic review sought to identify and critique technology which has been or could be used to assess the location of physical activity and sedentary behavior.

Methods

To identify published research papers, four electronic databases were searched using key terms built around behavior, technology, and location. To be eligible for inclusion, papers were required to be published in English and describe a wearable or portable technology or device capable of measuring location. Searches were performed up to February 4, 2015. This was supplemented by backward and forward reference searching. In an attempt to include novel devices which may not yet have made their way into the published research, searches were also performed using three Internet search engines. Specialized software was used to download search results and thus mitigate the potential pitfalls of changing search algorithms.

Results

A total of 188 research papers met the inclusion criteria. Global positioning systems were the most widely used location technology in the published research, followed by wearable cameras, and radio-frequency identification. Internet search engines identified 81 global positioning systems, 35 real-time locating systems, and 21 wearable cameras. Real-time locating systems determine the indoor location of a wearable tag via the known location of reference nodes. Although the type of reference node and location determination method varies between manufacturers, Wi-Fi appears to be the most popular method.

Conclusions

The addition of location information to existing measures of physical activity and sedentary behavior will provide important behavioral information.

Physical activity restriction in age-related eye disease: a cross-sectional study exploring fear of falling as a potential mediator

BACKGROUND

Fear of falling (FoF) is predictive of decreased physical activity. This study sought to determine if FoF mediates the relationship between decreased vision and physical activity restriction in individuals with glaucoma and age-related macular degeneration (AMD).

METHODS

Accelerometers were used to measure physical activity over 1 week in 59 control, 83 glaucoma, and 58 AMD subjects. Subjects completed the University of Illinois at Chicago Fear of Falling Questionnaire, and the extent of FoF was estimated using Rasch analysis. In negative binomial models adjusting for demographic, health, and social factors, FoF was investigated as a potential mediator between the severity of visual field (VF) loss (in glaucoma patients) or the severity of contrast sensitivity (CS) loss (in AMD patients) and decreased engagement in physical activity, defined as minutes spent in moderate-to-vigorous physical activity (MVPA) per day.

RESULTS

In multivariate negative binomial regression models, 5-decibels worse VF mean deviation was associated with 26 % less engagement in MVPA [rate ratio (RR) = 0.74, p < 0.01] amongst glaucoma subjects. When FoF was added to the model, the RR increased from 0.74 to 0.78, and VF loss severity remained associated with less MVPA at a statistically significant level (p < 0.01). Likewise, 0.1 log units worse CS was associated with 11 % less daily MVPA (RR = 0.89, p < 0.01) amongst AMD subjects. When FoF was added to the model, the RR increased from 0.89 to 1.02, and CS loss was no longer associated with MVPA at a statistically significant level (p = 0.53).

CONCLUSIONS

FoF may mediate the relationship between vision loss and physical activity restriction amongst patients with AMD. Future work should determine optimal strategies for reducing FoF in individuals with vision loss in order to prevent the deleterious effects of physical activity restriction.

Evaluation of real-world mobility in age-related macular degeneration

Background

Previous research has suggested an association between poor vision and decreased mobility, including restricted levels of physical activity and travel away from home. We sought to determine the impact of age-related macular degeneration (AMD) on these measures of mobility.

Methods

Fifty-seven AMD patients with bilateral, or severe unilateral, visual impairment were compared to 59 controls with normal vision. All study subjects were between the ages of 60 and 80. Subjects wore accelerometers and cellular network-based tracking devices over 7 days of normal activity. Number of steps taken, time spent in moderate-to-vigorous physical activity (MVPA), number of excursions from home, and time spent away from home were the primary outcome measures.

Results

In multivariate negative binomial regression models adjusted for age, gender, race, comorbidities, and education, AMD participants took fewer steps than controls (18% fewer steps per day, p = 0.01) and spent significantly less time in MVPA (35% fewer minutes, p < 0.001). In multivariate logistic regression models adjusting for age, sex, race, cognition, comorbidities, and grip strength, AMD subjects showed an increased likelihood of not leaving their home on a given day (odds ratio = 1.36, p = 0.04), but did not show a significant difference in the magnitude of time spent away from home (9% fewer minutes, p = 0.11).

Conclusion

AMD patients with poorer vision engage in significantly less physical activity and take fewer excursions away from the home. Further studies identifying the factors mediating the relationship between vision loss and mobility are needed to better understand how to improve mobility among AMD patients.

Glaucomatous visual field loss associated with less travel from home

PURPOSE

To determine the association between glaucoma and travel away from home.

METHODS

Fifty-nine glaucoma suspect controls with normal vision and 80 glaucoma subjects with bilateral visual field (VF) loss wore a cellular tracking device during 1 week of normal activity. Location data were used to evaluate the number of daily excursions away from home as well as daily time spent away from home.

RESULTS

Control and glaucoma subjects were similar in age, race, sex, employment, driving support, cognitive ability, mood, and comorbid illness (p > 0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and -11.1 dB in glaucoma subjects. In multivariable models, glaucoma was associated with fewer daily excursions (β = -0.20; 95% confidence interval [95% CI], -0.38 to -0.02) and a greater likelihood of not leaving home on a given day (odds ratio [OR], 1.82; 95% CI, 1.05 to 3.06). Each 5-dB decrement in the better-eye VF MD was associated with fewer daily excursions (β = -0.06; 95% CI, -0.11 to -0.01) and a greater chance of not leaving home on a given day (OR, 1.24; 95% CI, 1.04 to 1.47). Time spent away from home did not significantly differ between the glaucoma subjects and suspects (p = 0.18). However, each 5-dB decrement in the better-eye MD was associated with 6% less time away (95% CI, -12 to -1%).

CONCLUSIONS

Individuals with glaucoma, particularly those with greater VF loss, are more home bound and travel away from home less than individuals with normal vision. Because being confined to the home environment may have detrimental effects on fitness and health, individuals with glaucoma should be considered for interventions such as orientation and mobility training to encourage safe travel away from home.

Alteration of travel patterns with vision loss from glaucoma and macular degeneration

IMPORTANCE

The distance patients can travel outside the home influences how much of the world they can sample and to what extent they can live independently. Recent technological advances have allowed travel outside the home to be directly measured in patients' real-world routines.

OBJECTIVE

To determine whether decreased visual acuity (VA) from age-related macular degeneration (AMD) and visual field (VF) loss from glaucoma are associated with restricted travel patterns in older adults.

DESIGN

Cross-sectional study.

SETTING

Patients were recruited from an eye clinic, while travel patterns were recorded during their real-world routines using a cellular tracking device.

PARTICIPANTS

Sixty-one control subjects with normal vision, 84 subjects with glaucoma with bilateral VF loss, and 65 subjects with AMD with bilateral or severe unilateral loss of VA had their location tracked every 15 minutes between 7 am and 11 pm for 7 days using a tracking device.

MAIN OUTCOMES AND MEASURES

Average daily excursion size (defined as maximum distance away from home) and average daily excursion span (defined as maximum span of travel) were defined for each individual. The effects of vision loss on travel patterns were evaluated after controlling for individual and geographic factors.

RESULTS

In multivariable models comparing subjects with AMD and control subjects, average excursion size and span decreased by approximately one-quarter mile for each line of better-eye VA loss (P ≤ .03 for both). Similar but not statistically significant associations were observed between average daily excursion size and span for severity of better-eye VF loss in subjects with glaucoma and control subjects. Being married or living with someone and younger age were associated with more distant travel, while less-distant travel was noted for older individuals, African Americans, and those living in more densely populated regions.

CONCLUSIONS AND RELEVANCE

Age-related macular degeneration-related loss of VA, but not glaucoma-related loss of VF, is associated with restriction of travel to more nearby locations. This constriction of life space may impact quality of life and restrict access to services.

Accelerometer-assessed physical activity and objectively determined dual sensory impairment in US adults

OBJECTIVE

To examine the association between hearing and vision impairment (with the focus on dual sensory impairment) and accelerometer-assessed physical activity (PA) in a national sample of US adults because limited research has examined this association.

PATIENTS AND METHODS

Data from the cross-sectional 2003-2006 National Health and Nutrition Examination Survey were used. The data were evaluated between May 28, 2012, and March 27, 2013. To assess moderate- to vigorous-intensity PA, participants wore an accelerometer for at least 4 days. Hearing and visual acuity were objectively measured in the mobile examination center. After exclusions, 1445 participants provided complete data on the study variables. A negative binomial regression was used to examine the association between PA and dual sensory impairment.

RESULTS

After adjusting for age, sex, race/ethnicity, education, body mass index, comorbidity index, cotinine level, C-reactive protein level, number of valid days of accelerometry, and accelerometer wear time, there was evidence of joint effects of vision and hearing on PA (incident rate ratio, 0.45; 95% CI, 0.29-0.68), indicating that participants experiencing both vision and hearing loss participated in less PA than would be expected based on their individual effects.

CONCLUSION

Adults with dual sensory impairment may be at increased risk for decreased PA. Possible strategies include, but are not limited to, teaching the patient how to make modifications to their indoor and outdoor environments, encouraging patients to engage in balance and resistance training, and advocating changes to public and private institutions to address common concerns.

Real-world assessment of physical activity in glaucoma using an accelerometer

OBJECTIVE

To determine the association between glaucomatous visual field (VF) loss and the amount of physical activity and walking in normal life.

DESIGN

Prospective, observational study.

PARTICIPANTS

Glaucoma suspects without significant VF or visual acuity loss (controls) and glaucoma subjects with bilateral VF loss between 60 and 80 years of age.

METHODS

Participants wore an accelerometer over 7 days of normal activity.

MAIN OUTCOME MEASURES

Daily minutes of moderate or vigorous physical activity (MVPA) was the primary measure. Steps per day was a secondary measure.

RESULTS

Fifty-eight controls and 83 glaucoma subjects provided sufficient study days for analysis. Control and glaucoma subjects were similar in age, race, gender, employment status, cognitive ability, and comorbid illness (P>0.1 for all). Better-eye VF mean deviation (MD) averaged 0.0 decibels (dB) in controls and -11.1 dB in glaucoma subjects. The median control subject engaged in 16.1 minutes of MVPA daily and walked 5891 steps/day, as compared with 12.9 minutes of MVPA daily (P = 0.25) and 5004 steps/day (P = 0.05) for the median glaucoma subject. In multivariate models, glaucoma was associated with 21% less MVPA (95% confidence interval [CI], -53% to 32%; P = 0.37) and 12% fewer steps per day (95% CI, -22% to 9%; P = 0.21) than controls, although differences were not statistically significant. There was a significant dose response relating VF loss to decreased activity, with each 5 dB decrement in the better-eye VF associated with 17% less MVPA (95% CI, -30% to -2%; P = 0.03) and 10% fewer steps per day (95% CI, -16% to -5%; P = 0.001). Glaucoma subjects in the most severe tertile of VF damage (better-eye VF MD worse than -13.5 dB) engaged in 66% less MVPA than controls (95% CI, -82% to -37%; P = 0.001) and took 31% fewer steps per day (95% CI, -44% to -15%; P = 0.001). Other significant predictors of decreased physical activity included older age, comorbid illness, depressive symptoms, and higher body mass index.

CONCLUSIONS

Overall, no significant difference in physical activity was found between individuals with and without glaucoma, although substantial reductions in physical activity and walking were noted with greater levels of VF loss. Further study is needed to characterize better the relationship between glaucoma and physical activity.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.