Abstract
Objective
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).
Design
Analysis of baseline data from a randomized clinical trial.
Setting
Sydney, Australia.
Participants
Stable COPD on the waitlist for pulmonary rehabilitation.
Interventions
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.
Results
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.
Conclusions
Compared with thigh-worn accelerometry, <5000 steps/day is a valid and reasonably
accurate indicator of a sedentary lifestyle in this population.
Keywords
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)To read this article in full you will need to make a payment
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References
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Available at: https://www.who.int/publications/i/item/9789240015128. Accessed January 7, 2022.
- Sedentary Behavior Research Network (SBRN)—Terminology Consensus Project process and outcome.Int J Behav Nutr Phys Act. 2017; 14: 75
- Daily physical activity in patients with chronic obstructive pulmonary disease: a systematic review.COPD. 2011; 8: 306-319
- Level of daily physical activity in individuals with COPD compared with healthy controls.Respir Res. 2011; 12: 33
- 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
- Physical comorbidities affect physical activity in chronic obstructive pulmonary disease: a prospective cohort study.Respirology. 2014; 19: 866-872
- Activity levels and exercise motivation in patients with COPD and their resident loved ones.Chest. 2017; 151: 1028-1038
- 24-hour accelerometry in COPD: exploring physical activity, sedentary behavior, sleep and clinical characteristics.Int J COPD. 2019; 14: 419-430
- 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
- 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
- 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
- Sedentary behaviour and physical inactivity in patients with chronic obstructive pulmonary disease: two sides of the same coin?.COPD. 2018; 15: 432-438
- 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
- 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
- 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
- How many steps/day are enough? for adults.Int J Behav Nutr Phys Act. 2011; 8: 79
- How many steps/day are enough? For older adults and special populations.Int J Behav Nutr Phys Act. 2011; 8: 80
- Walking cadence (steps/min) and intensity in 21-40 year olds: CADENCE-adults.Int J Behav Nutr Phys Act. 2019; 16: 8
- 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
- A step-defined sedentary lifestyle index: <5000 steps/day.Appl Physiol Nutr Metab. 2013; 38: 100-114
- Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in type 2 diabetes.Diabet Med. 2012; 29: 1119-1125
- Cardiometabolic risk in younger and older adults across an index of ambulatory activity.Am J Prev Med. 2009; 37: 278-284
- Accelerometer-determined steps/day and metabolic syndrome.Am J Prev Med. 2010; 38: 575-582
- The relationship between pedometer-determined ambulatory activity and body composition variables.Int J Obes Relat Metab Disord. 2001; 25: 1571-1578
- A comparison of fitness training to a pedometer-based walking program matched for total energy cost.J Phys Act Health. 2010; 7: 203-213
- 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
- Increasing daily walking improves glucose tolerance in overweight women.Prev Med. 2003; 37: 356-362
- 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
- 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
- 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
- The validity and reliability of a novel activity monitor as a measure of walking.Br J Sports Med. 2006; 40: 779-784
- 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
- 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
- Considerations when using the activPAL monitor in field-based research with adult populations.J Sport Health Sci. 2017; 6: 162-178
- 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
- Sedentary behavior is an independent predictor of mortality in with COPD.Respir Care. 2017; 62: 579-587
BMJ Publishing Group. Correlation and regression. Available at: http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one/11-correlationand-regression. Accessed January 7, 2022.
Herbert R. Confidence interval calculator. Available at: https://pedro.org.au/english/resources/confidence-interval-calculator/. Accessed January 7, 2022.
- Diagnostic tests 2: predictive values.BMJ. 1994; 309: 102
- Diagnostic tests 4: likelihood ratios.BMJ. 2004; 329: 168-169
- 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
- Likelihood ratios: clinical application in day-to-day practice.Indian J Ophthalmol. 2009; 57: 217-221
- Applied logistic regression.3rd ed. John Wiley & Sons, New York2013
- The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve.Am J Epidemiol. 2006; 163: 670-675
- Index for rating diagnostic tests.Cancer. 1950; 3: 32-35
- Defining an optimal cut point value in ROC analysis: an alternative approach.Comput Math Methods Med. 2017; 20173762651
- Identification of phenotypes in people with COPD: influence of physical activity, sedentary behaviour, body composition and skeletal muscle strength.Lung. 2019; 197: 37-45
- Likelihood ratios with confidence: sample size estimation for diagnostic test studies.J Clin Epidemiol. 1991; 44: 763-770
- The meaning and use of the area under a receiver operating characteristic (ROC) curve.Radiology. 1982; 143: 29-36
- How many steps are enough to avoid severe physical inactivity in patients with chronic obstructive pulmonary disease?.Respirology. 2012; 17: 1026-1027
- 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
- Objective measurement of sedentary behaviour using accelerometers.Int J Obes (Lond). 2016; 40: 1809-1812
- 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
- Mobile device accuracy for step counting across age groups.JMIR Mhealth Uhealth. 2017; 5: e88
- 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
- Benefits of physical activity on COPD hospitalisation depend on intensity.Eur Respir J. 2015; 46: 1281-1289
- Physical activity is associated with attenuated disease progression in chronic obstructive pulmonary disease.Med Sci Sports Exerc. 2019; 51: 833-840
- 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
- Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD).Cochrane Database Syst Rev. 2020; 4CD012626
- Physical activity in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006).Heart Lung. 2013; 42: 235-240
- Effects of ground-based walking training on daily physical activity in people with COPD: a randomised controlled trial.Respir Med. 2017; 132: 139-145
Article info
Publication history
Published online: February 10, 2023
Accepted:
January 25,
2023
Received in revised form:
January 4,
2023
Received:
September 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was supported by the Physiotherapy Research Foundation under a Seeding Grant (No. S16-011). Sonia Cheng is a scholarship recipient of the Better Breathing Foundation. Emmanuel Stamatakis is funded by Australian National Health and Medical Research Council (NHMRC) Investigator Grant Level 2 (APP 1194510).
Clinical trial registration number: This study is a secondary analysis of baseline assessment data from a randomized clinical trial that was registered prospectively on the Australian New Zealand Clinical Trials Registry (ACTRN12616001534471).
Disclosures: none.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
