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Review of Validity and Reliability of Garmin Activity Trackers

Kelly R. Evenson and Camden L. Spade

Purpose: A systematic review to summarize the validity and reliability of steps, distance, energy expenditure, speed, elevation, heart rate, and sleep assessed by Garmin activity trackers. Methods: Searches included studies published through December 31, 2018. Correlation coefficients (CC) were assessed as low (<0.60), moderate (0.60 to <0.75), good (0.75 to <0.90), or excellent (≥0.90). Mean absolute percentage errors (MAPE) were assessed as acceptable at <5% in controlled conditions and <10% for free-living conditions. Results: Overall, 32 studies of adults documented validity. Four of these studies also documented reliability. The sample size ranged from 1–95 for validity and 4–31 for reliability testing. Step inter- and intra-reliability was good-to-excellent and speed intra-reliability was excellent. No other features were explored for reliability. Step validity, across 16 studies, generally indicated good-to-excellent CC and acceptable MAPE. Distance validity, tested in three studies, generally indicated poor CC and MAPE that exceeded acceptable limits, with both over and underestimation. Energy expenditure validity, across 12 studies, generally indicated wide variability in CC and MAPE that exceeded acceptable limits. Heart rate validity in five studies had low-to-excellent CC and all MAPE exceeded acceptable limits. Speed, elevation, and sleep validity were assessed in only one or two studies each; for sleep, the criterion relied on self-report rather than polysomnography. Conclusion: This systematic review of Garmin activity trackers among adults indicated higher validity of steps; few studies on speed, elevation, and sleep; and lower validity for distance, energy expenditure, and heart rate. Intra- and inter-device feature reliability needs further testing.

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Sector Activities and Lessons Learned Around Initial Implementation of the United States National Physical Activity Plan

Kelly R. Evenson and Sara B. Satinsky

Background:

National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences.

Methods:

During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes.

Results:

The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals.

Conclusions:

These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans.

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Progress and Future Directions on Physical Activity Research Among Youth

Kelly R. Evenson and Jorge Mota

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Self-Reported and Objectively Measured Physical Activity Among a Cohort of Postpartum Women: The PIN Postpartum Study

Kelly R. Evenson, Amy H. Herring, and Fang Wen

Background:

Few studies measure physical activity objectively or at multiple time points during postpartum. We describe physical activity at 3- and 12-months postpartum among a cohort of women using both self-reported and objective measures.

Methods:

In total, 181 women completed the 3-month postpartum measures, and 204 women completed the 12-month postpartum measures. Participants wore an ActiGraph accelerometer for 1 week and completed in-home interviews that included questions on physical activity. A cohort of 80 women participated at both time points. Poisson regression models were used to determine whether physical activity differed over time for the cohort.

Results:

For the cohort, average counts/minute were 364 at 3-months post-partum and 394 at 12-months postpartum. At both time periods for the cohort, vigorous activity averaged 1 to 3 minutes/day, and moderate activity averaged 16 minutes/day. Sedentary time averaged 9.3 hours at 3-months postpartum and 8.8 hours at 12-months postpartum, out of a 19-hour day. Average counts/minute increased and sedentary behavior declined from 3- to 12-months postpartum.

Conclusion:

Interventions are needed to help women integrate more moderate to vigorous physical activity and to capitalize on the improvements in sedentary behavior that occur during postpartum.

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Physical Activity and Sedentary Behavior Among Adults 60 Years and Older: New York City Residents Compared With a National Sample

Kelly R. Evenson, Kimberly B. Morland, Fang Wen, and Kathleen Scanlin

This study describes moderate to vigorous physical activity (MVPA) and sedentary behavior among New York City (NYC) residents 60 years and older and compared with national United States’ estimates. Adults aged 60 or older living in NYC (n = 760) were compared with similar aged adults from the National Health and Nutrition Examination Survey (NHANES; n = 2,451 adults). Both groups wore an ActiGraph accelerometer for one week. The NYC sample recorded 13.2, 23.8, and 37.8 mean min/day of MVPA and the NHANES sample recorded 10.6, 21.1, and 39.3, depending on the definition. Sedentary behavior averaged 9.6 hr/day for the NYC sample and 9.3 hr/day for the NHANES sample. The NYC sample spent a longer proportion of time in sedentary behavior and light activities, but more time in MVPA than the NHANES sample. Urbanicity may explain some of the differences between the two samples.

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Maximizing the Utility and Comparability of Accelerometer Data From Large-Scale Epidemiologic Studies

I-Min Lee, Christopher C. Moore, and Kelly R. Evenson

There is much evidence showing that physical activity is related to optimal health, including physical and mental function, and quality of life. Additionally, data are accumulating with regard to the detrimental health impacts of sedentary behavior. Much of the evidence related to long-term health outcomes, such as cardiovascular disease and cancer—the two leading causes of death in the United States and worldwide—comes from observational epidemiologic studies and, in particular, prospective cohort studies. Few data on these outcomes are derived from randomized controlled trials, conventionally regarded as the “gold standard” of research designs. Why is there a paucity of data from randomized trials on physical activity or sedentary behavior and long-term health outcomes? A further issue to consider is that prospective cohort studies investigating these outcomes can take a long time to accrue sufficient numbers of endpoints for robust and meaningful findings. This contrasts with the rapid pace at which technology advances. Thus, while the use of devices for measuring physical behaviors has been an important development in large-scale epidemiologic studies over the past decade, cohorts that are now publishing results on health outcomes related to accelerometer-assessed physical activity and sedentary behavior may have been initiated years ago, using “dated” technology. This paper, based on a keynote presentation at 8th International Conference on Ambulatory Monitoring of Physical Activity and Movement 2022, discusses the issues of study design and slow pace of discovery in prospective cohort studies and suggests some possible ways to maximize the utility and comparability of “dated” device data from prospective cohort studies for research investigations using the Women’s Health Study as an example.

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Physical Activity and Injuries During Pregnancy

Catherine J. Vladutiu, Kelly R. Evenson, and Stephen W. Marshall

Background:

Although physical activity can provide health benefits to pregnant women, population-based research on the circumstances surrounding injuries from physical activity during pregnancy is lacking.

Methods:

Physical activity and subsequent injuries among a cohort of 1469 pregnant women in North Carolina were examined prospectively from the third phase of the Pregnancy, Infection, and Nutrition Study between 2001 and 2005. Chi-square analyses were used to compare distributions of maternal characteristics among women who sustained injuries from physical activity and women who reported no injuries during pregnancy. Injury incidence rates were calculated.

Results:

Few pregnant women (N = 34) reported a physical activity-related injury during pregnancy. The rates of physical activity-related and exercise-related injuries during pregnancy were 3.2 per 1000 physical activity hours and 4.1 per 1000 exercise hours, respectively. The most common types of injuries were bruises or scrapes (55%). Among all injuries, 33% resulted from exercise and 67% resulted from nonexercise physical activities. Sixty-four percent of all injuries were due to falls.

Conclusions:

The incidence of injury from physical activity was low during pregnancy. Women should continue to be encouraged to maintain involvement in physical activity during pregnancy, while being aware of the potential for injury, particularly falls, from these activities.

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Evaluation of the Physical Activity and Public Health Course for Researchers

Kelly R. Evenson, Joan M. Dorn, Ricky Camplain, Russell R. Pate, and David R. Brown

Background:

From 1995–2013, an 8-day Physical Activity and Public Health Course for Researchers has been offered yearly in the United States.

Methods:

In 2013, an evaluation quantified time that fellows spent in different course offerings, surveyed fellows on course impact, documented grant funding, and identified fellow participation on leading physical activity-related journals.

Results:

The number of fellows that attended the course ranged from 20 per year to 35 per year. Fellows who participated in the web survey (n = 322) agreed that the course: met their expectations (99%), had a positive impact on the physical activity research or practice work they did (98%), and helped increase their professional networking in the field (93%). Following the course, 73% of fellows had further contact with course faculty and 71% had further contact with other fellows. From the National Institutes of Health, 117 grants were awarded to 82 fellows (21% of eligible fellows). Out of 14 journals reviewed, 11 had at least 1 fellow on their staff as editor, associate editor, or editorial board member.

Conclusion:

The Physical Activity and Public Health Course for Researchers helps address a training need by providing instruction and building capacity in the US and abroad for conducting research on physical activity and public health.

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Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review

Alison K. Brinson, Shana G. da Silva, Kathryn R. Hesketh, and Kelly R. Evenson

Background: Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility. Method: PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men. Results: Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case–control studies, 5 randomized controlled trials, and one case–cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association. Conclusions: The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.

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Planning for Pedestrians and Bicyclists: Results From a Statewide Municipal Survey

Kelly R. Evenson, Semra A. Aytur, Sara B. Satinsky, Zachary Y. Kerr, and Daniel A. Rodríguez

Background:

We surveyed North Carolina (NC) municipalities to document the presence of municipal walking- and bicycling-related projects, programs, and policies; to describe whether prevalence of these elements differed if recommended in a plan; and to characterize differences between urban and rural municipalities.

Methods:

We surveyed all municipalities with ≥ 5000 persons (n = 121) and sampled municipalities with < 5000 persons (216/420), with a response rate of 54% (183/337). Responses were weighted to account for the sampling design.

Results:

From a list provided, staff reported on their municipality’s use of walking- and bicycling-related elements (8 infrastructure projects, 9 programs, and 14 policies). The most commonly reported were projects on sidewalks (53%), streetscape improvements (51%), bicycle/walking paths (40%); programs for cultural/recreational/health (25%), general promotional activities (24%), Safe Routes to School (24%), and law enforcement (24%); and policies on maintenance (64%), new facility construction (57%), and restricted automobile speed or access (45%). Nearly all projects, programs, or policies reported were more likely if included in a plan and more prevalent in urban than rural municipalities.

Conclusion:

These results provide cross-sectional support that plans facilitate the implementation of walking and bicycling elements, and that rural municipalities plan and implement these elements less often than urban municipalities.