real world evaluation of physical activity using … · real world evaluation of physical activity...
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Real World Evaluation of Physical Activity Using Objective Monitors
Catrine Tudor-Locke, PhD, FACSMAssociate Professor Director, Walking Behavior LaboratoryPennington Biomedical Research CenterBaton Rouge, Louisiana
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Real world evaluation of physical activity using objective monitors Key distinctions between research and
evaluation Which instrument is best? Practical pedometry
Expected values Step indices
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Key distinctions between research and evaluation: Purpose Research
Advances scholarly knowledge
Review by peers Is published
Evaluation Provides timely
information for decision making
Answers to stakeholders Has practical utility
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Key distinctions between research and evaluation: Focus Research
Examines efficacy under highly controlled, artificial conditions
Subjects are carefully selected
Has strict inclusion, exclusion criteria
Evaluation Examines effectiveness
and efficiency under real-world conditions
Participants are self-selected
No restrictions
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Key distinctions between research and evaluation: Methods Research
Rigorous methodologies Research assistants
collect data Batteries of tests Significant group
differences
Evaluation Good enough
methodologies Staff and volunteers
collect data Practical assessments Relative client benefits
(% improving)
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Which instrument is best??
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Yamax Corporation, Tokyo, JapanCost: US$17-22
Raw Outputs:
Steps
Derived Outputs:
Steps/day
Steps/min
Yamax pedometer- SW Series
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ActiGraph
ActiGraph, LLC,; Pensacola, FLCost: US$325/unitUS$349 Cable/software
Raw Outputs:
Steps
Activity Counts
Time in intensity categories
Energy expenditure
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NL-1000
New-Lifestyles, Inc., Lee Summit, MOCost: US$48
Raw Outputs:Steps
Distance
Time in MVPA
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activPAL Professional
PAL Technologies, LTD, Glasgow
Cost: Initially $US1450Software, docking station, unit$US950 additional units
Outputs:Steps
Time in sitting, standing, ambulating
Transitions
Sit/stand bouts
Energy expenditure
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What I Do and Do Not Know Now What I know now Commercial items Patents Change Buyer beware Choose, rationalize,
and justify your own choice
What I don’t know The best instrument
for all situations How well they
translate Obsolescence Future
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Summary of validity evidence
Review of 25 articles since 1980 median r=.86 with
different accelerometers median r=.82 with time in
observed activity median r=.68 with
different measures of energy expenditure
median r=-.38 with self-reported sitting time
median r=.33 with self-reported physical activity
Tudor-Locke et al., Sports Med 2002
Pedometers
Accelerometers
Self-reported physical activity
Energy Expenditure
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Practical Pedometry
Expected values Standard protocols Screening Surveillance Program evaluation Step indices Intervention tool
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0
2000
4000
6000
8000
10000
12000
14000
Mean steps/day
1 2 3 4 5Population groups
Legend
1=8-10 year olds
2=14-16 year olds
3= Healthy younger adults (approx. 20-50 years)
4= Healthy older adults (>50 years)
5= Individuals living with disabilities and chronic illnesses
Tudor-Locke, Research Digest, 2002
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0
2
4
6
8
10
12
14
0-99
9
1000
-199
9
2000
-299
9
3000
-399
9
4000
-499
9
5000
-599
9
6000
-699
9
7000
-799
9
8000
-899
9
9000
-999
9
1000
0-10
999
1100
0-11
999
1200
0-12
999
1300
0-13
999
1400
0-14
999
1500
0-15
999
1600
0-16
999
1700
0-17
999
1800
0-18
999
1900
0-19
999
Mean Steps/Day
Perc
ent
Normative data
Tudor-Locke et al., Medicine and Science in Sport and Exercise, 2004
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Normative data
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Expected values for special populations
0
2,000
4,000
6,000
8,000
10,000
12,000
Heart and
Vas
cular
Dise
ases
(15)
COPD (2)
Type 2
diabete
s (11
)
Type 1
diabete
s (1)
Dialysis
(1)
Breast
Cance
r Surv
ivor (9
)
Breast
Cance
r in Trea
tmen
t (1)
Neuromusc
ular D
iseas
es (3
)
Arthriti
s (2)
Joint
Rep
lacem
ent (9
)
Fibromya
lgia (
1)
Disable
d Older
Adults (
2)
Intell
ectua
l Disa
bility
(4)
HIV (4
)
Multiple
Chronic
Illnes
s (1)
Tudor-Locke et al., Preventive Medicine, 2009
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CANPLAY data
Craig et al., MSSE, under review
0
2
4
6
8
10
12
14
0-99
9
1000
-199
9
2000
-299
9
3000
-399
9
4000
-499
9
5000
-599
9
6000
-699
9
7000
-799
9
8000
-899
9
9000
-999
9
1000
0-10
999
1100
0-11
999
1200
0-12
999
1300
0-13
999
1400
0-14
999
1500
0-15
999
1600
0-16
999
1700
0-17
999
1800
0-18
999
1900
0-19
999
Mean Steps/Day
Per
cent
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Normative values for free-living youth
10000
11000
12000
13000
14000
15000
16000
17000
6 7 8 9 10 11 12 13 14 15 16 17 18
Age in years
Med
ian
step
s/da
y
BoysGirls
Tudor-Locke et al., Research Quarterly for Exercise and Sport, 2009
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Tudor-Locke et al., Medicine and Science in Sports and Exercise, in press
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Time
T4T3
W8W7
W6W5
T2W4
W3W2
W1T1
Ave
rage
ste
ps/d
ay
14,000
12,000
10,000
8,000
6,000
4,000
Tudor-Locke et al., Patient Education and Counseling, 2002
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Meta-analysis of change in steps/day in pedometer-based programming
Bravata et al., JAMA, 2007
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12,500+ steps/day
10,000-12,499 steps/day
7,500-9,999 steps/day
5,000-7,499 steps/day
2,500-4,999 steps/day
<2,500 steps/day Basal
Activity
Limited Activity
Low Active
Somewhat Active
Active
Highly Active
Sedentary Lifestyle
Graduated Step IndexAdapted from Tudor-Locke and Bassett, 2004and Tudor-Locke et al., 2009
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Pedometer-determined step guidelines for children (6-12 years of age)
Boys >17000 steps/day
highly active 15000-17999 steps/day
active 12500-14999 steps/day
somewhat active 10000-12499 steps/day
low active <10000 steps/day
sedentary
Girls >14500 steps/day
highly active 12000-14999 steps/day
active 9500-11999 steps/day
somewhat active 7000-9499 steps/day
low active <7000 steps/day
sedentary
Tudor-Locke et al., MSSE, 2008
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18000
17000
16000
15000
14000
13000
12000
11000
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
Boys 6-11 years
Girls 6-11 years
Adults 20-65 years
Individuals living with disability and/or chronic illness
Youth 12-19 yearsPre-school
children4-6 years
At least 6,000 daily steps in moderate-to-vigorous physical activity
At least 15,000 steps/week in moderate-to-vigorous
physical activity, e.g., 3,000 daily steps in moderate-to-vigorous physical activity
most days of the week
Arrows indicate that higher is even better
Step
s/da
y
Healthy older adults 65+ years
Additional benefits can come from adding in vigorous intensity activityTudor-Locke et al., in progress
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Thank you!