Accuracy of consumer-level and research-grade activity trackers in ambulatory settings in older adults

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Tedesco, Salvatore
Sica, Marco
Ancillao, Andrea
Timmons, Suzanne
Barton, John
O'Flynn, Brendan
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Wrist-worn activity trackers have experienced a tremendous growth lately and studies on the accuracy of mainstream trackers used by older adults are needed. This study explores the performance of six trackers (Fitbit Charge2, Garmin VivoSmart HR+, Philips Health Watch, Withings Pulse Ox, ActiGraph GT9X-BT, Omron HJ-72OITC) for estimating: steps, travelled distance, and heart-rate measurements for a cohort of older adults. Eighteen older adults completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities. Less standardized activities were also included, such as: dusting, using a walking aid, or playing cards, in order to simulate real-life scenarios. Wrist-mounted and chest/waist-mounted devices were used. Gold-standards included treadmill, ECG-based chest strap, direct observation or video recording according to the activity and parameter. Every tracker showed a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. A large mean absolute percentage error (MAPE) was found for every monitor at slower walking speeds with the lowest reported MAPE at 2 km/h being 7.78%, increasing to 20.88% at 1.5 km/h, and 44.53% at 1 km/h. During household activities, the MAPE climbing up/down-stairs ranged from 8.38–19.3% and 10.06–19.01% (dominant and non-dominant arm), respectively. Waist-worn devices showed a more uniform performance. However, unstructured activities (e.g. dusting, playing cards), and using a walking aid represent a challenge for all wrist-worn trackers as evidenced by large MAPE (> 57.66% for dusting, > 67.32% when using a walking aid). Poor performance in travelled distance estimation was also evident during walking at low speeds and climbing up/down-stairs (MAPE > 71.44% and > 48.3%, respectively). Regarding heart-rate measurement, there was no significant difference (p-values > 0.05) in accuracy between trackers placed on the dominant or non-dominant arm. Concordant with existing literature, while the mean error was limited (between -3.57 bpm and 4.21 bpm), a single heart-rate measurement could be underestimated up to 30 beats-per-minute. This study showed a number of limitations of consumer-level wrist-based activity trackers for older adults. Therefore caution is required when used, in healthcare or in research settings, to measure activity in older adults.
Step-count accuracy , Physical-activity , Activity monitors , Validity , Reliability , Expenditure , Validation , Sensors
Tedesco, S., Sica, M., Ancillao, A., Timmons, S., Barton, J. and O'Flynn, B. (2019) 'Accuracy of consumer-level and research-grade activity trackers in ambulatory settings in older adults'. Plos One, 14(5), e0216891, (17 pp). doi: 10.1371/journal.pone.0216891