Review
Expected values for steps/day in special populations

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Abstract

Objective

To assemble expected values for free-living steps/day in special populations living with chronic illnesses and disabilities.

Method

Studies identified since 2000 were categorized into similar illnesses and disabilities, capturing the original reference, sample descriptions, descriptions of instruments used (i.e., pedometers, piezoelectric pedometers, accelerometers), number of days worn, and mean and standard deviation of steps/day.

Results

Sixty unique studies represented: 1) heart and vascular diseases, 2) chronic obstructive lung disease, 3) diabetes and dialysis, 4) breast cancer, 5) neuromuscular diseases, 6) arthritis, joint replacement, and fibromyalgia, 7) disability (including mental retardation/intellectual difficulties), and 8) other special populations. A median steps/day was calculated for each category. Waist-mounted and ankle-mounted instruments were considered separately due to fundamental differences in assessment properties. For waist-mounted instruments, the lowest median values for steps/day are found in disabled older adults (1214 steps/day) followed by people living with COPD (2237 steps/day). The highest values were seen in individuals with Type 1 diabetes (8008 steps/day), mental retardation/intellectual disability (7787 steps/day), and HIV (7545 steps/day).

Conclusion

This review will be useful to researchers/practitioners who work with individuals living with chronic illness and disability and require such information for surveillance, screening, intervention, and program evaluation purposes.

Introduction

The benefits of a physical active lifestyle are relevant to special populations living with chronic illness and disability, however, we know little about the actual physical activity patterns of such special populations (Tudor-Locke and Myers, 2001a). Accurate quantification of physical activity behaviors using feasible and appropriate assessment tools is essential to epidemiologists, physiologists, and behavioral scientists, as well as clinicians charged with the treatment of chronic illness and disability.

Objective monitoring of physical activity, using body worn accelerometers and pedometers, has advanced greatly in recent years. Accelerometers contain a piezoelectric element and typically provide time-stamped estimates of activity volume (i.e., total counts or steps taken) or activity rates (counts/min). Although accelerometers are without reproach in terms of the study of physical activity intensity in relation to health outcomes, pedometers are generally considered more practical for individual and population level applications, largely due to instrument cost and feasibility of data collection and management. Pedometers are typically based on a horizontal spring-suspended lever arm and on-instrument digital data presentation; their output correlates highly (median r = 0.86) with that of different accelerometers (Tudor-Locke et al., 2002b). Although they are not designed to directly detect physical activity intensity, they do provide a simple and affordable means of tracking daily physical activity volume (especially walking) expressed as a summary output of steps/day. An indicator of volume is likely sufficient when studying sedentary populations, who by definition, do not engage in high levels of physical activity (Tudor-Locke and Myers, 2001b).

Piezoelectric pedometers are a recent addition to the options for objective monitoring. Their measurement system is based on a basic accelerometer-type mechanism sensitive to detecting steps taken. They typically also provide on-instrument digital data and have been classified as pedometers since outputs include only steps and variables derived from steps. Most objective monitoring instruments are worn at the waist with few notable exceptions, for example, the ankle-mounted StepWatch Activity Monitor (SAM, originally developed by the Prosthetic Research Study, Seattle, WA and now distributed through CYMA Corporation, Mountlake Terrace, WA). The SAM is worn on one leg and detects a “stride,” or “gait cycle,” although this output has also been presented as steps/day. However, in order to generate a steps/day output comparable to waist-mounted instruments, it should be doubled.

Expected values are normative or benchmark values that convey estimates of central tendency and variability and are derived from a review of published literature (Myers, 1999). They are necessary to facilitate research and program planning and aid in comparisons and interpretation of similar data (for example in surveillance efforts, and especially identifying and studying “unusual” samples). When we first compiled expected values of habitual pedometer-determined physical activity in free-living samples (Tudor-Locke and Myers, 2001a), we located 12 studies that together represented heart and vascular diseases, chronic obstructive pulmonary disease, diabetes, joint replacement, and disabilities including blindness, physical handicaps, and mental retardation. From that review we concluded that adults living with chronic illnesses and disabilities accumulate 3500–5500 steps/day. In comparison, we found that relatively healthy adults (aged ≈ 20–50 years) took 7000–13,000 steps/day. The purpose of this review is to update expected values for steps/day pertinent to free-living special populations.

Section snippets

Methods

A literature search (current and verified as of January 05, 2009) began with a keyword (pedometer, “step counter,” “step activity monitor” or “accelerometer” AND “steps/day”) search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SportDiscus, and PsychInfo. A publication date limit was set from 2000, coinciding with the acceptance of the original review (Tudor-Locke and Myers, 2001a). As unique studies were identified and assembled, and to the extent that it was

Heart and vascular diseases (Table 1)

Ten studies reporting expected values for habitual steps/day using waist-mounted instruments were identified representing populations described as living with chronic heart failure (Houghton et al., 2002), coronary artery disease (VanWormer et al., 2004), myocardial infarction/cardiac rehabilitation (Ayabe et al., 2008, Izawa et al., 2004, Savage and Ades, 2008), peripheral arterial disease (Crowther et al., 2007) and/or intermittent claudication (Nasr et al., 2002), hypertension (Hyman et al.,

Chronic obstructive lung disease (COPD; Table 2)

Only two studies (de Blok et al., 2006, McGlone et al., 2006) were identified reporting expected values for habitual steps/day using waist-mounted instruments in COPD samples. Only one (de Blok et al., 2006) of these studies reported mean steps/day in at least two samples (the other (McGlone et al., 2006) reported median values). Therefore the computed median expected value for this category was 2237 steps/day. No studies of COPD samples were identified using ankle-mounted instruments (Table 2).

Diabetes and dialysis (Table 3)

Seven unique studies using waist-mounted instruments were identified focused on Type 2 diabetic populations (Araiza et al., 2006, Bjorgaas et al., 2005, Matsushita et al., 2005, Richardson et al., 2007, Strycker et al., 2007, Tudor-Locke, 2001, Tudor-Locke et al., 2002a), and another study captured both Type 1 and Type 2 diabetes (Smaldone et al., 2006). We also included a single study of a dialysis population (Zamojska et al., 2006) in this category, since diabetes is a leading cause of

Breast cancer (Table 4)

Five studies of habitual steps/day using waist-mounted instruments in breast cancer survivors were identified (Irwin et al., 2008, Matthews et al., 2007, Rogers et al., 2005, Vallance et al., 2007, Wilson et al., 2005). The study that used a waist-mounted accelerometer (Matthews et al., 2007) reported steps/day values after censoring those values coinciding with accelerometer activity counts below 260 counts/min. A third study focused on breast cancer patients undergoing treatment (Rogers et

Neuromuscular diseases (Table 5)

Two original articles were identified reporting steps/day determined by waist-mounted instruments (Gosney et al., 2007, Motl et al., 2006). A third one presented steps/day data only in a figure (Kilmer et al., 2005). We successfully contacted the first author directly to obtain the exact mean and SD for steps/day. Therefore, the median expected value for this category was 5887 steps/day (Table 5).

Two studies were identified that used the ankle-mounted instrument to detect steps/day in

Arthritis, joint arthroplasty and fibromyalgia (Table 6)

Eight unique studies were identified that presented habitual steps/day using waist-mounted instruments in individuals with arthritis (Talbot et al., 2003), joint (hip or knee) arthroplasty (Bennett et al., 2008, Goldsmith et al., 2001, Schmalzried et al., 2000, Silva et al., 2002, Silva et al., 2005), a combination of arthritis and arthroplasty (Ono et al., 2007), or fibromyalgia (Fontaine and Haaz, 2007). The median expected value for individuals with arthritis was 4086 steps/day and for those

Disability (Table 7)

We located five unique studies of disabled individuals reporting steps/day using waist-mounted instruments (Mitsui et al., 2003, Mitsui et al., 2006, Peterson et al., 2008, Stanish and Draheim, 2005, Temple, 2007). Two studies (Mitsui et al., 2003, Mitsui et al., 2006) examined older (i.e., over 70 years) disabled individuals and three studies examined younger (i.e., between 30 and 40 years) individuals with mental retardation/intellectual disability (Peterson et al., 2008, Stanish and Draheim,

Other special populations (Table 8)

HIV infection is a chronic disease and we identified a single study that used both waist-mounted pedometers (DigiWalker Model 200) and accelerometers (ActiGraph Model GT7164) (Ramirez-Marrero et al., 2008). The computed median expected value for waist-mounted instruments combined from these four samples within the same study is 7545 steps/day (Table 8).

Another study was identified that focused on older community-dwelling individuals living with multiple chronic illnesses (Ashe et al., 2007).

Discussion

An amalgamation of expected values of steps/day focused on special populations, specifically those defined by chronic illness or disability, was missing from the scientific literature. We ultimately located 60 unique studies of free-living special populations published since 2000 that provided descriptive data necessary to address this gap. Forty-three studies used waist-mounted instruments, specifically, waist-mounted pedometers (n = 31), accelerometers (n = 9), both pedometers and accelerometers (

Conflict of interest statement

The authors declare that there are no conflicts of interest.

References (73)

  • MatsushitaY. et al.

    Relationship between the ability to recognized energy intake and expenditure, and blood sugar control in type 2 diabetes mellitus patients

    Diabetes Res. Clin. Pract.

    (2005)
  • NasrM.K. et al.

    The role of pedometers in the assessment of intermittent claudication

    Eur. J. Vasc. Endovasc. Surg.

    (2002)
  • PetersonJ.J. et al.

    Physical activity among adults with intellectual disabilities living in community settings

    Prev. Med.

    (2008)
  • Ramirez-MarreroF.A. et al.

    Self-reported physical activity in Hispanic adults living with HIV: comparison with accelerometer and pedometer

    J. Assoc. Nurses AIDS Care

    (2008)
  • SilvaM. et al.

    Average patient walking activity approaches 2 million cycles per year: pedometers under-record walking activity

    J. Arthroplasty.

    (2002)
  • SilvaM. et al.

    Activity sampling in the assessment of patients with total joint arthroplasty

    J. Arthroplasty

    (2005)
  • StepienJ.M. et al.

    Activity levels among lower-limb amputees: self-report versus step activity monitor

    Arch. Phys. Med. Rehabil.

    (2007)
  • Tudor-LockeC. et al.

    Pedometer-determined ambulatory activity in individuals with type 2 diabetes

    Diabetes Res. Clin. Pract.

    (2002)
  • VanWormerJ.J. et al.

    Lifestyle behavior change and coronary artery disease: effectiveness of a telephone-based counseling program

    J. Nutr. Educ. Behav.

    (2004)
  • XanthopoulosP. et al.

    An ambulatory persistence power curve: motor planning affects ambulatory persistence in Parkinson's disease

    Neurosci. Lett.

    (2008)
  • AsheM.C. et al.

    Disparity between physical capacity and participation in seniors with chronic disease

    Med. Sci. Sports Exerc.

    (2007)
  • AyabeM. et al.

    Target step count for the secondary prevention of cardiovascular disease

    Circ. J.

    (2008)
  • BjorgaasM. et al.

    Relationship between pedometer-registered activity, aerobic capacity and self-reported activity and fitness in patients with type 2 diabetes

    Diabetes Obes. Metab.

    (2005)
  • BowdenM.G. et al.

    Step activity monitor: accuracy and test–retest reliability in persons with incomplete spinal cord injury

    J. Rehabil. Res. Dev.

    (2007)
  • BowdenM.G. et al.

    Validation of a speed-based classification system using quantitative measures of walking performance poststroke

    Neurorehabilitation Neural Repair

    (2008)
  • BusseM.E. et al.

    Quantified measurement of activity provides insight into motor function and recovery in neurological disease

    J. Neurol. Neurosurg. Psychiatry

    (2004)
  • CavanaughJ.T. et al.

    Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults

    J. Am. Geriatr. Soc.

    (2007)
  • CrouterS.E. et al.

    Validity of 10 electronic pedometers for measuring steps, distance, and energy cost

    Med. Sci. Sports Exerc.

    (2003)
  • FontaineK.R. et al.

    Effects of lifestyle physical activity on health status, pain, and function in adults with fibromyalgia syndrome

    J. Musculoskelet. Pain

    (2007)
  • GosneyJ.L. et al.

    Physical activity and multiple sclerosis: validity of self-report and objective measures

    Family Commun. Health

    (2007)
  • HoughtonA.R. et al.

    Assessing exercise capacity, quality of life and haemodynamics in heart failure: do the tests tell us the same thing?

    Eur. J. Heart Fail.

    (2002)
  • HymanD.J. et al.

    Simultaneous vs sequential counseling for multiple behavior change

    Arch. Intern. Med.

    (2007)
  • IrwinM.L. et al.

    Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial: the Yale Exercise and Survivorship Study

    Cancer

    (2008)
  • IwaneM. et al.

    Walking 10,000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension

    Hypertens. Res.

    (2000)
  • IzawaK.P. et al.

    Long-term exercise maintenance, physical activity, and health-related quality of life after cardiac rehabilitation

    Am. J. Phys. Med. Rehabil.

    (2004)
  • KanadeR.V. et al.

    Walking performance in people with diabetic neuropathy: benefits and threats

    Diabetologia

    (2006)
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