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Susan Park, Lindsay P. Toth, Scott E. Crouter, Cary M. Springer, Robert T. Marcotte, and David R. Bassett

Purpose: To examine the effect of activity monitor placement on daily step counts when monitors are worn at different positions on the wrist/forearm and the hip. Methods: Participants (N = 18) wore eight different models (four wrist and four hip models) across four days. Each day, one hip and one wrist model were selected, and four identical monitors of each model were worn on the right hip and the non-dominant wrist/forearm, respectively, during all waking hours. Step counts of each monitor were compared to the same model worn in the referent position (wrist: proximal to ulnar styloid process; hip: midline of thigh). Percent of referent steps and mean difference between observed and referent positions were computed. Significant differences in steps between positions for each method were determined using one-way repeated measures ANOVAs. For significant main effects, pairwise comparisons with Bonferroni corrections were used to determine which positions were significantly different. Results: All wrist methods showed a significant main effect for placement (p < .05) and alternate positions were 1–16% lower than the referent position. For hip methods, only the Omron HJ-325 differed across positions (p < .05), but differences were among non-referent positions and all were within ±2% of steps recorded by the referent position. Conclusions: Researchers should be aware that positions that deviate from the manufacturer’s recommended position at the wrist could influence step counts. Of all hip methods examined, the Omron had a significant placement effect which did not constitute a practical difference.

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Samantha F. Ehrlich, Amanda J. Casteel, Scott E. Crouter, Paul R. Hibbing, Monique M. Hedderson, Susan D. Brown, Maren Galarce, Dawn P. Coe, David R. Bassett, and Assiamira Ferrara

Background: This study sought to compare three sensor-based wear-time estimation methods to conventional diaries for ActiGraph wGT3X-BT accelerometers worn on the non-dominant wrist in early pregnancy. Methods: Pregnant women (n = 108) wore ActiGraph wGT3X-BT accelerometers for seven days and recorded their device on and off times in a diary (criterion). Average daily wear-time estimates from the Troiano and Choi algorithms and the wGT3X-BT accelerometer wear sensor were compared against the diary. The Hibbing 2-regression model was used to estimate time spent in activity (during periods of device wear) for each method. Wear-time and time spent in activity were compared with multiple repeated measures ANOVAs. Bland Altman plots assessed agreement between methods. Results: Compared to the diary (825.5 minutes [795.1, 856.0]), the Choi (843.0 [95% CI: 812.6, 873.5]) and Troiano (839.1 [808.7, 869.6]) algorithms slightly overestimated wear-time, whereas the sensor (774.4 [743.9, 804.9]) underestimated it, although only the sensor differed significantly from the diary (p < .0001). Upon adjustment for average daily wear-time, there were no statistically significant differences between the wear-time methods in regards to minutes per day of moderate-to-vigorous physical activity (MVPA), vigorous physical activity, and moderate physical activity. Bland Altman plots indicated the Troiano and Choi algorithms were similar to the diary and within ≤0.5% of each other for wear-time and MVPA. Conclusions: The Choi or Troiano algorithms offer a valid and efficient alternative to diaries for the estimation of daily wear-time in larger-scale studies of MVPA during pregnancy, and reduce burden for study participants and research staff.

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Susan Park, Lindsay P. Toth, Paul R. Hibbing, Cary M. Springer, Andrew S. Kaplan, Mckenzie D. Feyerabend, Scott E. Crouter, and David R. Bassett

It has become common to wear physical activity monitors on the wrist to estimate steps per day, but few studies have considered step differences between monitors worn on the dominant and non-dominant wrists. Purpose: The purpose of this study was to compare four step counting methods on the dominant versus non-dominant wrist using the Fitbit Charge (FC) and ActiGraph GT9X (GT9X) across all waking hours of one day. Methods: Twelve participants simultaneously wore two monitors (FC and GT9X) on each wrist during all waking hours for an entire day. GT9X data were analyzed with three step counting methods: ActiLife algorithm with default filter (AG-noLFE), ActiLife algorithm with low-frequency extension (AG-LFE), and the Moving Average Vector Magnitude (AG-MAVM) algorithm. A 2-way repeated measures ANOVA (method × wrist) was used to compare step counts. Results: There was a significant main effect for wrist placement (F(1,11) = 11.81, p = .006), with the dominant wrist estimating an average of 1,253 more steps than the non-dominant wrist. Steps differed between the dominant and non-dominant wrist for three of the step methods: AG-noLFE (1,327 steps), AG-LFE (2,247 steps), AG-MAVM (825 steps), and approached statistical significance for FC (613 steps). No significant method x wrist placement interaction was found (F(3,9) = 2.62, p = .115). Conclusion: Findings suggest that for step counting algorithms, it may be important to consider the placement of wrist-worn monitors since the dominant wrist location tended to yield greater step estimates. Alternatively, standardizing the placement of wrist-worn monitors could help to reduce the differences in daily step counts across studies.

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Lindsay P. Toth, Susan Park, Whitney L. Pittman, Damla Sarisaltik, Paul R. Hibbing, Alvin L. Morton, Cary M. Springer, Scott E. Crouter, and David R. Bassett

Purpose: To examine the effect of brief, intermittent stepping bouts on step counts from 10 physical activity monitors (PAMs). Methods: Adults (N = 21; M ± SD, 26 ± 9.0 yr) wore four PAMs on the wrist (Garmin Vivofit 2, Fitbit Charge, Withings Pulse Ox, and ActiGraph wGT3X-BT [AG]), four on the hip (Yamax Digi-Walker SW-200 [YX], Fitbit Zip, Omron HJ-322U, and AG), and two on the ankle (StepWatch [SW] with default and modified settings). AG data were processed with and without the low frequency extension (AGL) and with the Moving Average Vector Magnitude algorithm. In Part 1 (five trials), walking bouts were varied (4–12 steps) and rest intervals were held constant (10 s). In Part 2 (six trials), walking bouts were held constant (4 steps) and rest intervals were varied (1–10 s). Percent of hand-counted steps and mean absolute percentage error were calculated. One sample t-test was used to compare percent of hand-counted steps to 100%. Results: In Parts 1 and 2, the SWdefault, SWmodified, YX, and AGLhip captured within 10% of hand-counted steps across nearly all conditions. In Part 1, estimates of most methods improved as the number of steps per bout increased. In Part 2, estimates of most methods decreased as the rest duration increased. Conclusion: Most methods required stepping bouts of >6–10 consecutive steps to record steps. Rest intervals of 1–2 seconds were sufficient to break up walking bouts in many methods. The requirement for several consecutive steps in some methods causes an underestimation of steps in brief, intermittent bouts.

Open access

Monika Uys, Susan Bassett, Catherine E. Draper, Lisa Micklesfield, Andries Monyeki, Anniza de Villiers, Estelle V. Lambert, and the HAKSA 2016 Writing Group


We present results of the 2016 Healthy Active Kids South Africa (HAKSA) Report Card on the current status of physical activity (PA) and nutrition in South African youth. The context in which we interpret the findings is that participation in PA is a fundamental human right, along with the right to “attainment of the highest standard of health.”


The HAKSA 2016 Writing Group was comprised of 33 authorities in physical education, exercise science, nutrition, public health, and journalism. The search strategy was based on peer-reviewed manuscripts, dissertations, and ‘gray’ literature. The core PA indicators are Overall Physical Activity Level; Organized Sport Participation; Active and Outdoor Play; Active Transportation; Sedentary Behaviors; Family and Peer Influences; School; Community and the Built Environment; and National Government Policy, Strategies, and Investment. In addition, we reported on Physical Fitness and Motor Proficiency separately. We also reported on nutrition indicators including Overweight and Under-nutrition along with certain key behaviors such as Fruit and Vegetable Intake, and policies and programs including School Nutrition Programs and Tuck Shops. Data were extracted and grades assigned after consensus was reached. Grades were assigned to each indicator ranging from an A, succeeding with a large majority of children and youth (81% to 100%); B, succeeding with well over half of children and youth (61% to 80%); C, succeeding with about half of children and youth (41% to 60%); D, succeeding with less than half but some children and youth (21% to 40%); and F, succeeding with very few children and youth (0% to 20%); INC is inconclusive.


Overall PA levels received a C grade, as we are succeeding with more than 50% of children meeting recommendations. Organized Sports Participation also received a C, and Government Policies remain promising, receiving a B. Screen time and sedentary behavior were a major concern. Under- and over-weight were highlighted and, as overweight is on the rise, received a D grade.


In particular, issues of food security, obesogenic environments, and access to activity-supportive environments should guide social mobilization downstream and policy upstream. There is an urgent need for practice-based evidence based on evaluation of existing, scaled up interventions.

Open access

Catherine E. Draper, Simone A. Tomaz, Susan H. Bassett, Cora Burnett, Candice J. Christie, Colleen Cozett, Monique de Milander, Soezin Krog, Andries Monyeki, Niri Naidoo, Rowena Naidoo, Alessandra Prioreschi, Cheryl Walter, Estelle Watson, and Estelle V. Lambert