Validity and Accuracy of Step Count as an Indicator of a Sedentary Lifestyle in People With Chronic Obstructive Pulmonary Disease

Published:February 10, 2023DOI:



      To determine the validity and accuracy of <5000 steps/day as a sedentary lifestyle indicator, and the optimal step count cut point value for indicating a sedentary lifestyle in people with chronic obstructive pulmonary disease (COPD).


      Analysis of baseline data from a randomized clinical trial.


      Sydney, Australia.


      Stable COPD on the waitlist for pulmonary rehabilitation.


      Not applicable.

      Main Outcome Measures

      Step count and time in sedentary behavior (SB) were assessed using thigh-worn accelerometry. A sedentary lifestyle was defined as <5000 steps/day. Pearson correlation coefficients were analyzed between step count and time spent in SB. Sensitivity, specificity, and accuracy were calculated for the <5000 steps/day threshold. Receiver operating characteristic curves with the area under the curve were computed for step count in identifying a sedentary lifestyle.


      69 people with COPD (mean age=74 years, SD=9; forced expiratory volume in 1 second, mean=55%, SD=19 predicted) had sufficient wear data for analysis. There was a moderate inverse correlation between step count and time spent in SB (r=−0.58, P<.001). Step count had a fair discriminative ability for identifying a sedentary lifestyle (area under the curve=0.80, 95% confidence interval [CI], 0.68-0.91). The <5000 steps/day threshold had a sensitivity, specificity, and accuracy of 82% (95% CI, 70-94), 70% (95% CI, 54-86), and 78%, respectively. A lower threshold of <4300 steps/day was more accurate for ruling in a sedentary lifestyle.


      Compared with thigh-worn accelerometry, <5000 steps/day is a valid and reasonably accurate indicator of a sedentary lifestyle in this population.


      List of abbreviations:

      6MWD (6-minute walk distance), AUC (area under the curve), CI (confidence interval), COPD (chronic obstructive pulmonary disease), FEV1 (forced expiratory volume in 1 second), MVPA (moderate-vigorous physical activity), PA (physical activity), SB (sedentary behavior)
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      1. World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Available at: Accessed January 7, 2022.

        • Tremblay MS
        • Aubert S
        • Barnes JD
        • et al.
        Sedentary Behavior Research Network (SBRN)—Terminology Consensus Project process and outcome.
        Int J Behav Nutr Phys Act. 2017; 14: 75
        • Bossenbroek L
        • de Greef MH
        • Wempe JB
        • et al.
        Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review.
        COPD. 2011; 8: 306-319
        • Vorrink SN
        • Kort HS
        • Troosters T
        • et al.
        Level of daily physical activity in individuals with COPD compared with healthy controls.
        Respir Res. 2011; 12: 33
        • Kawagoshi A
        • Kiyokawa N
        • Sugawara K
        • et al.
        Quantitative assessment of walking time and postural change in patients with COPD using a new triaxial accelerometer system.
        Int J Chron Obstruct Pulm Dis. 2013; 8: 397-404
        • McNamara RJ
        • McKeough ZJ
        • McKenzie DK
        • et al.
        Physical comorbidities affect physical activity in chronic obstructive pulmonary disease: a prospective cohort study.
        Respirology. 2014; 19: 866-872
        • Mesquita R
        • Nakken N
        • Janssen DJA
        • et al.
        Activity levels and exercise motivation in patients with COPD and their resident loved ones.
        Chest. 2017; 151: 1028-1038
        • Orme MW
        • Steiner MC
        • Morgan MD
        • et al.
        24-hour accelerometry in COPD: exploring physical activity, sedentary behavior, sleep and clinical characteristics.
        Int J COPD. 2019; 14: 419-430
        • Ekelund U
        • Tarp J
        • Steene-Johannessen J
        • et al.
        Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis.
        BMJ. 2019; 366: l4570
        • Cheng SWM
        • Alison JA
        • Stamatakis E
        • et al.
        Patterns and correlates of sedentary behaviour accumulation and physical activity in people with chronic obstructive pulmonary disease: a cross-sectional study.
        COPD. 2020; 17: 156-164
        • Geidl W
        • Carl J
        • Cassar S
        • et al.
        Physical activity and sedentary behaviour patterns in 326 persons with COPD before starting a pulmonary rehabilitation: a cluster analysis.
        J Clin Med. 2019; 8: 1346
        • Schneider LP
        • Furlanetto KC
        • Rodrigues A
        • et al.
        Sedentary behaviour and physical inactivity in patients with chronic obstructive pulmonary disease: two sides of the same coin?.
        COPD. 2018; 15: 432-438
        • McDonald VM
        • Fingleton J
        • Agusti A
        • et al.
        participants of the Treatable Traits Down Under International Workshop. Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report.
        Eur Respir J. 2019; 531802058
        • Chastin SFM
        • Dontje ML
        • Skelton DA
        • et al.
        • Seniors USP team
        Systematic comparative validation of self-report measures of sedentary time against an objective measure of postural sitting (activPAL).
        Int J Behav Nutr Phys Act. 2018; 15: 21
        • Prince SA
        • Adamo KB
        • Hamel M
        • et al.
        A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review.
        Int J Behav Nutr Phys Act. 2008; 5: 56
        • Tudor-Locke C
        • Craig CL
        • Brown WJ
        • et al.
        How many steps/day are enough? for adults.
        Int J Behav Nutr Phys Act. 2011; 8: 79
        • Tudor-Locke C
        • Craig CL
        • Aoyagi Y
        • et al.
        How many steps/day are enough? For older adults and special populations.
        Int J Behav Nutr Phys Act. 2011; 8: 80
        • Tudor-Locke C
        • Aguiar EJ
        • Han H
        • et al.
        Walking cadence (steps/min) and intensity in 21-40 year olds: CADENCE-adults.
        Int J Behav Nutr Phys Act. 2019; 16: 8
        • Tudor-Locke C
        • Ducharme SW
        • Aguiar EJ
        • et al.
        Walking cadence (steps/min) and intensity in 41 to 60-year-old adults: the CADENCE-Adults Study.
        Int J Behav Nutr Phys Act. 2020; 17: 137
        • Tudor-Locke C
        • Craig CL
        • Thyfault JP
        • et al.
        A step-defined sedentary lifestyle index: <5000 steps/day.
        Appl Physiol Nutr Metab. 2013; 38: 100-114
        • Jennersjo P
        • Ludvigsson J
        • Lanne T
        • et al.
        Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in type 2 diabetes.
        Diabet Med. 2012; 29: 1119-1125
        • Schmidt MD
        • Cleland VJ
        • Shaw K
        • et al.
        Cardiometabolic risk in younger and older adults across an index of ambulatory activity.
        Am J Prev Med. 2009; 37: 278-284
        • Sisson SB
        • Camhi SM
        • Church TS
        • et al.
        Accelerometer-determined steps/day and metabolic syndrome.
        Am J Prev Med. 2010; 38: 575-582
        • Tudor-Locke C
        • Ainsworth BE
        • Whitt MC
        • et al.
        The relationship between pedometer-determined ambulatory activity and body composition variables.
        Int J Obes Relat Metab Disord. 2001; 25: 1571-1578
        • Bell GJ
        • Harber V
        • Murray T
        • et al.
        A comparison of fitness training to a pedometer-based walking program matched for total energy cost.
        J Phys Act Health. 2010; 7: 203-213
        • Musto A
        • Jacobs K
        • Nash M
        • et al.
        The effects of an incremental approach to 10,000 steps/day on metabolic syndrome components in sedentary overweight women.
        J Phys Act Health. 2010; 7: 737-745
        • Swartz AM
        • Strath SJ
        • Bassett DR
        • et al.
        Increasing daily walking improves glucose tolerance in overweight women.
        Prev Med. 2003; 37: 356-362
        • Cheng SWM
        • Alison J
        • Dennis S
        • et al.
        A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial.
        J Physiother. 2017; 63: 182
        • Cheng SWM
        • Alison J
        • Stamatakis E
        • et al.
        Six-week behaviour change intervention to reduce sedentary behaviour in people with chronic obstructive pulmonary disease: a randomised controlled trial.
        Thorax. 2022; 77: 231-238
        • Grant PM
        • Ryan CG
        • Tigbe WW
        • et al.
        The validation of a novel activity monitor in the measurement of posture and motion during everyday activities.
        Br J Sports Med. 2006; 40: 992-997
        • Ryan CG
        • Grant PM
        • Tigbe WW
        • et al.
        The validity and reliability of a novel activity monitor as a measure of walking.
        Br J Sports Med. 2006; 40: 779-784
        • Ng CLW
        • Jenkins S
        • Hill K.
        Accuracy and responsiveness of the stepwatch activity monitor and ActivPAL in patients with COPD when walking with and without a rollator.
        Disabil Rehabil. 2012; 34: 1317-1322
        • Demeyer H
        • Mohan D
        • Burtin C
        • et al.
        Chronic Lung Disease Biomarker and Clinical Outcome Assessment Qualification Consortium Task Force on Physical Activity. Objectively measured physical activity in patients with COPD: recommendations from an international task force on physical activity.
        Chronic Obstr Pulm Dis. 2021; 28: 528-550
        • Edwardson CL
        • Winkler EAH
        • Bodicoat DH
        • et al.
        Considerations when using the activPAL monitor in field-based research with adult populations.
        J Sport Health Sci. 2017; 6: 162-178
        • Stamatakis E
        • Ekelund U
        • Ding D
        • et al.
        Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings.
        Br J Sports Med. 2019; 53: 377-382
        • Furlanetto KC
        • Donaria L
        • Schneider LP
        • et al.
        Sedentary behavior is an independent predictor of mortality in with COPD.
        Respir Care. 2017; 62: 579-587
      2. BMJ Publishing Group. Correlation and regression. Available at: Accessed January 7, 2022.

      3. Herbert R. Confidence interval calculator. Available at: Accessed January 7, 2022.

        • Altman DG
        • Bland JM.
        Diagnostic tests 2: predictive values.
        BMJ. 1994; 309: 102
        • Deeks JJ
        • Altman DG.
        Diagnostic tests 4: likelihood ratios.
        BMJ. 2004; 329: 168-169
        • Jaeschke R
        • Guyatt GH
        • Sackett DL.
        Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group.
        JAMA. 1994; 271: 703-707
        • Parikh R
        • Parikh S
        • Arun E
        • Thomas R.
        Likelihood ratios: clinical application in day-to-day practice.
        Indian J Ophthalmol. 2009; 57: 217-221
        • Hosmer Jr., DW
        • Lemeshow S
        • Sturdivant RX
        Applied logistic regression.
        3rd ed. John Wiley & Sons, New York2013
        • Perkins NJ
        • Schisterman EF.
        The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve.
        Am J Epidemiol. 2006; 163: 670-675
        • Youden WJ.
        Index for rating diagnostic tests.
        Cancer. 1950; 3: 32-35
        • Unal I.
        Defining an optimal cut point value in ROC analysis: an alternative approach.
        Comput Math Methods Med. 2017; 20173762651
        • Xavier RF
        • Pereira ACAC
        • Lopes AC
        • et al.
        Identification of phenotypes in people with COPD: influence of physical activity, sedentary behaviour, body composition and skeletal muscle strength.
        Lung. 2019; 197: 37-45
        • Simel DL
        • Samsa GP
        • Matchar DB.
        Likelihood ratios with confidence: sample size estimation for diagnostic test studies.
        J Clin Epidemiol. 1991; 44: 763-770
        • Hanley JA
        • McNeil BJ.
        The meaning and use of the area under a receiver operating characteristic (ROC) curve.
        Radiology. 1982; 143: 29-36
        • Depew ZS
        • Novotny PJ
        • Benzo RP.
        How many steps are enough to avoid severe physical inactivity in patients with chronic obstructive pulmonary disease?.
        Respirology. 2012; 17: 1026-1027
        • Byrom B
        • Rowe DA.
        Measuring free-living physical activity in COPD patients: deriving methodology standards for clinical trials through a review of research studies.
        Contemp Clin Trials. 2016; 47: 172-184
        • Byrom B
        • Stratton G
        • McCarthy M
        • et al.
        Objective measurement of sedentary behaviour using accelerometers.
        Int J Obes (Lond). 2016; 40: 1809-1812
        • Montoye AHK
        • Pivarnik JM
        • Mudd LM
        • et al.
        Validation and comparison of accelerometers worn on the hip, thigh, and wrists for measuring physical activity and sedentary behavior.
        AIMS Public Health. 2016; 3: 298-312
        • Modave F
        • Guo Y
        • Bian J
        • et al.
        Mobile device accuracy for step counting across age groups.
        JMIR Mhealth Uhealth. 2017; 5: e88
        • Furlanetto KC
        • Bisca GW
        • Oldemberg N
        • et al.
        Step counting and energy expenditure estimation in patients with chronic obstructive pulmonary disease and healthy elderly: accuracy of 2 motion sensors.
        Arch Phys Med Rehabil. 2010; 91: 261-267
        • Donaire-Gonzalez D
        • Gimeno-Santos E
        • Balcells E
        • et al.
        Benefits of physical activity on COPD hospitalisation depend on intensity.
        Eur Respir J. 2015; 46: 1281-1289
        • Demeyer H
        • Donaire-Gonzalez D
        • Gimeno-Santos E
        • et al.
        Physical activity is associated with attenuated disease progression in chronic obstructive pulmonary disease.
        Med Sci Sports Exerc. 2019; 51: 833-840
        • Master H
        • Annis J
        • Huang S
        • et al.
        Association of step counts over time with the risk of chronic disease in the All of Us Research Program.
        Nature Med. 2022; 28: 2301-2308
        • Burge AT
        • Cox NS
        • Abramson MJ
        • Holland AE.
        Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD).
        Cochrane Database Syst Rev. 2020; 4CD012626
        • Park SK
        • Richardson CF
        • Holleman RG
        • et al.
        Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006).
        Heart Lung. 2013; 42: 235-240
        • Wootton SL
        • Hill K
        • Alison JA
        • et al.
        Effects of ground-based walking training on daily physical activity in people with COPD: a randomised controlled trial.
        Respir Med. 2017; 132: 139-145