Step Counting: A Review of Measurement Considerations and Health-Related Applications

Abstract

Step counting has long been used as a method of measuring distance. Starting in the mid-1900s, researchers became interested in using steps per day to quantify ambulatory physical activity. This line of research gained momentum after 1995, with the introduction of reasonably accurate spring-levered pedometers with digital displays. Since 2010, the use of accelerometer-based “activity trackers” by private citizens has skyrocketed. Steps have several advantages as a metric for assessing physical activity: they are intuitive, easy to measure, objective, and they represent a fundamental unit of human ambulatory activity. However, since they measure a human behavior, they have inherent biological variability; this means that measurements must be made over 3–7 days to attain valid and reliable estimates. There are many different kinds of step counters, designed to be worn on various sites on the body; all of these devices have strengths and limitations. In cross-sectional studies, strong associations between steps per day and health variables have been documented. Currently, at least eight prospective, longitudinal studies using accelerometers are being conducted that may help to establish dose–response relationships between steps/day and health outcomes. Longitudinal interventions using step counters have shown that they can help inactive individuals to increase by 2500 steps per day. Step counting is useful for surveillance, and studies have been conducted in a number of countries around the world. Future challenges include the need to establish testing protocols and accuracy standards, and to decide upon the best placement sites. These challenges should be addressed in order to achieve harmonization between studies, and to accurately quantify dose–response relationships.

Objective physical activity levels in people with multiple sclerosis: Meta‐analysis

“…In the healthy population literature, Tudor‐Locke and Basset’s classification system for steps per day suggests that reaching 10 000 steps or more categorizes an individual as physically active. Additionally, physically active people have a more favorable cardio‐metabolic risk profile .…”

“…In the healthy population literature, Tudor‐Locke and Basset’s classification system for steps per day suggests that reaching 10 000 steps or more categorizes an individual as physically active. Additionally, physically active people have a more favorable cardio‐metabolic risk profile . However, recent evidence has called for a need to potentially revise these figures within the classification system as it has been suggested that by breaking up extended bouts of sitting with ambulatory activity health benefits could still be achieved, regardless of meeting recommended steps .…”

“…Additionally, physically active people have a more favorable cardio-metabolic risk profile. 55 However, recent evidence has called for a need to potentially revise these figures within the classification system as it has been suggested that by breaking up extended bouts of sitting with ambulatory activity health benefits could still be achieved, regardless of meeting recommended steps. 56 Such evidence may be more applicable for pwMS who due to gait abnormalities and fatigue may be not able to meet the "recommended 10 000" steps per day.…”

Are fitness club members likely to meet the current physical activity recommendations?

“…It is also likely that members reported time spent at the fitness club, rather than time spent in MVPA. In our study, we aimed to investigate resistance exercise and other activities performed in a fitness club setting (such as cycling and rowing), and an accelerometer is likely to underestimate upper body movement and horizontal accelerations of the body . As such, when adding accelerometer measures with self‐reported activities, more participants met PA recommendations.…”

Unobstrusive mobile monitoring of well-being of ambulatory patients in palliative care: what can remote data tell us?

“…Whereas patient A is walking in average 7768 steps per day, patient B has an average of 1344 steps per day due to his walker. According to [23], the daily step count can be categorized into "sedentary behavior", "physically inactive", "moderately physically active", "physically active" and "very active. Patient A would be classified as being sedentary to physically inactive in the first two weeks up to physically active after two months with some very active days in the last month of his study participation.…”