Consumer wearable and smartphone devices provide an accessible means to objectively measure physical activity (PA) through step counts. With the increasing proliferation of this technology, consumers, practitioners and researchers are interested in leveraging these devices as a means to track and facilitate PA behavioural change. However, while the acceptance of these devices is increasing, the validity of many consumer devices have not been rigorously and transparently evaluated. The Towards Intelligent Health and Well-Being Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives to develop best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice consumer wearable and smartphone step counter validation protocol. A two-step process was used to aggregate data and form a scientific foundation for the development of an optimal and feasible validation protocol: (1) a systematic literature review and (2) additional searches of the wider literature pertaining to factors that may introduce bias during the validation of these devices. The systematic literature review process identified 2897 potential articles, with 85 articles deemed eligible for the final dataset. From the synthesised data, we identified a set of six key domains to be considered during design and reporting of validation studies: target population, criterion measure, index measure, validation conditions, data processing and statistical analysis. Based on these six domains, a set of key variables of interest were identified and a ‘basic’ and ‘advanced’ multistage protocol for the validation of consumer wearable and smartphone step counters was developed. The INTERLIVE consortium recommends that the proposed protocol is used when considering the validation of any consumer wearable or smartphone step counter. Checklists have been provided to guide validation protocol development and reporting. The network also provide guidance for future research activities, highlighting the imminent need for the development of feasible alternative ‘gold-standard’ criterion measures for free-living validation. Adherence to these validation and reporting standards will help ensure methodological and reporting consistency, facilitating comparison between consumer devices. Ultimately, this will ensure that as these devices are integrated into standard medical care, consumers, practitioners, industry and researchers can use this technology safely and to its full potential.

Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.

Performing physical activity is considered health promoting but may induce a need for subsequent rest periods. This study aimed to determine the within-day interactions between vigorous physical activity (VPA) and sedentary behaviour (SB) in participants with low cardiorespiratory fitness. We tested the hypothesis that VPA is associated with a temporary subsequent increase in SB. One week of accelerometer data containing a minimum of one 10-min bout of VPA from 62 participants with low cardiorespiratory fitness (31-50 years old) were obtained from the MILE study. A comparison of SB was made between days with a bout of VPA and days without (control). Due to a positive association between VPA and number and duration of sedentary bouts, the time accumulated in both uninterrupted and total sedentary bouts were 27 (95% CI, 10-45) min and 29 (95% CI, 9-50) min higher on VPA days compared to control days (P < 0.05). Our results indicate that in participants with low cardiovascular fitness, unprompted VPA is positively associated with an increase in subsequent sedentary time. We propose that such VPA-associated sedentary time may be viewed as part of a healthy activity pattern.

Accelerometers are widely used to measure physical activity, but limitations in the ability to differentiate between running intensities have been reported. This problem may relate to accelerometer placement. In this study, we compare the validity of accelerometers placed on the hip and the thigh for the measurement of walking and running speed under laboratory and field conditions. Young healthy men and women wore ActiGraph GT3X+ accelerometers on the hip and on the thigh while performing walking and running activities in laboratory (n = 31) and field conditions (n = 17). Vector magnitude counts per minute (VM cpm) were correlated with speed of locomotion and, during laboratory trials, with oxygen consumption (VO2, ml·min−1·kg−1). Both hip- and thigh-placed VM cpm showed strong correlations with walking speed ranging from 3 to 7 km·h−1 (r = 0.93 and r = 0.95, respectively) and VO2 (r = 0.85 and r = 0.91, respectively). Compared with the hip-placed VM cpm, thigh-placed VM cpm showed significantly stronger correlations with running speed ranging from 7 to 20 km·h−1 (r = 0.29 and r = 0.89, respectively) and the corresponding VO2 (r = 0.25 and r = 0.87, respectively). Regardless of accelerometer placement, VM cpm were similar between laboratory and field tests performed at comparable walking and running speeds. These results show that accelerometers placed on the thigh, but not on the hip, provide proportional output across a wide range of walking and running speeds. Thus, thigh-placed accelerometers are able to differentiate between running intensities in both laboratory and field conditions.