The effect of mere measurement from a cardiovascular examination program on physical activity and sedentary time in an adult population Wearable activity monitors to assess performance status and predict clinical outcomes in advanced cancer patients Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program. SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes [SMART-REHAB Trial]: a randomized controlled trial protocol Variability in Physical Activity Assessed with Accelerometer Is an Independent Predictor of Mortality in CHF Patients Wearable Activity Technology And Action-Planning (WATAAP) to promote physical activity in cancer survivors: Randomised controlled trial protocol Determination of the effectiveness of accelerometer use in the promotion of physical activity in cardiac patients: a randomized controlled trial. Feasibility and Effectiveness of a Wearable Technology-Based Physical Activity Intervention in Preschoolers: A Pilot Study Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients Using Internet and Mobile Phone Technology to Deliver an Automated Physical Activity Program: Randomized Controlled Trial Accelerometer-measured sedentary time and physical activity-A 15 year follow-up of mortality in a Swedish population-based cohort. Impact of accelerometer data processing decisions on the sample size, wear time and physical activity level of a large cohort study Cluster randomized controlled trial of a multilevel physical activity intervention for older adults The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design Study design and methods for the ACTIVity And TEchnology (ACTIVATE) trial. Comparison of accelerometer cut points for predicting activity intensity in youth. Multicenter randomized study of anticoagulation guided by remote rhythm monitoring in patients with implantable cardioverter-defibrillator and CRT-D devices: Rationale, design, and clinical characteristics of the initially enrolled cohort The IMPACT study.
Background Measuring physical activity ( PA ) and sedentary time ( ST ) by self-report or device as well as assessing related health factors may alter those behaviors . Thus , in intervention trials assessment s may bias intervention effects . The aim of our study was to examine whether leisure-time PA , transport-related PA , and overall ST measured via self-report vary after assessment s and whether a brief tailored letter intervention has an additional effect . Methods Among a sample of subjects with no history of myocardial infa rct ion , stroke , or vascular intervention , a number of 175 individuals participated in a study comprising multiple repeated assessment s. Of those , 153 were analyzed ( mean age 54.5 years , st and ard deviation = 6.2 ; 64 % women ) . At baseline , participants attended a cardiovascular examination ( st and ardized measurement of blood pressure and waist circumference , blood sample taking ) and wore an accelerometer for seven days . At baseline and after 1 , 6 , and 12 months , participants completed the International Physical Activity Question naire . A r and om sub sample received a tailored counseling letter intervention at month 1 , 3 , and 4 . Changes in PA and ST from baseline to 12-month follow-up were analyzed using r and om-effects modelling . Results From baseline to 1-month assessment , leisure-time PA did not change ( Incidence rate ratio = 1.13 , p = .432 ) , transport-related PA increased ( Incidence rate ratio = 1.45 , p = .023 ) , and overall ST tended to decrease ( b = − 1.96 , p = .060 ) . Further , overall ST decreased from month 6 to month 12 ( b = − 0.52 , p = .037 ) . Time trends of the intervention group did not differ significantly from those of the assessment -only group . Conclusions Results suggest an effect of measurements on PA and ST . Data of r and om-effects modelling results revealed an increase of transport-related PA after baseline to 1-month assessment . Decreases in overall ST may result from repeated assessment s. A brief tailored letter intervention seemed to have no additional effect . Thus , measurement effects should be considered when planning intervention studies and interpreting intervention effects . Trial registration Clinical Trials.gov NCT02990039 . Registered 7 December 2016 . Retrospectively registered An objective evaluation of patient performance status ( PS ) is difficult because patients spend the majority of their time outside of the clinic , self-report to providers , and undergo dynamic changes throughout their treatment experience . Real-time , objective activity data may allow for a more accurate assessment of PS and physical function , while reducing the subjectivity and bias associated with current assessment s. Consenting patients with advanced cancer wore a wearble activity monitor for three consecutive visits in a prospect i ve , single-cohort clinical trial . Provider-assessed PS ( ECOG/Karnofsky ) and NIH PROMIS ® patient-reported outcomes ( PROs ) were assessed at each visit . Associations between wearable activity monitor metrics ( steps , distance , stairs ) and PS , clinical outcomes ( adverse events , hospitalizations , survival ) , and PROs were assessed using correlation statistics and in multivariable logistic regression models . Thirty-seven patients were evaluated ( 54 % male , median 62 years ) . Patients averaged 3700 steps , 1.7 miles , and 3 flights of stairs per day . Highest correlations were observed between average daily steps and ECOG-PS and KPS ( r = 0.63 and r = 0.69 , respectively p < 0.01 ) . Each 1000 steps/day increase was associated with reduced odds for adverse events ( OR : 0.34 , 95 % CI 0.13 , 0.94 ) , hospitalizations ( OR : 0.21 95 % CI 0.56 , 0.79 ) , and hazard for death ( HR : 0.48 95 % CI 0.28–0.83 ) . Significant correlations were also observed between activity metrics and PROs . Our trial demonstrates the feasibility of using wearable activity monitors to assess PS in advanced cancer patients and suggests their potential use to predict clinical and patient-reported outcomes . These findings should be vali date d in larger , r and omized trials . Wearable tech : Activity monitor tracks wellbeing of advanced cancer patients  Wearable activity monitors provide an objective and continuous measure of general wellbeing and physical function among patients with advanced cancer . Gillian Gresham from Cedars-Sinai Medical Center in Los Angeles , California , USA , and colleagues enlisted 37 patients with metastatic or inoperable cancer to wear wristb and s that wireless measure heart rate and activity patterns over the span of 2 weeks . At weekly clinic visits , the patients also filled in health question naires and their healthcare providers made independent evaluations . The research ers found a reasonably high correlation between the clinician-assessed performance status and the average daily step total calculated by the wristb and . More steps also translated into lower odds of serious complications , hospitalizations or death . The study shows the feasibility of using wearable technology to track the ability of patients with advanced cancer to perform certain activities of daily living OBJECTIVE To assess the efficacy of a strategy , based on telephone support oriented by accelerometer measurements , on the adherence to physical activity ( PA ) recommendations in cardiac patients not achieving PA recommendations . DESIGN Prospect i ve and r and omized study . SETTING A cardiac rehabilitation program ( CRP ) at a clinic . PARTICIPANTS Stable , noncompliant cardiac ( coronary artery disease , heart failure , post-cardiovascular surgery ) patients ( weekly moderate-intensity PA < 150 min ) were r and omly assigned to an intervention group ( n=19 ) or a control group ( n=10 ) . INTERVENTIONS The intervention group wore an accelerometer for 8 weeks . Every 15 days , feedback and support were provided by telephone . The control group wore the accelerometer during the 8th week of the intervention only . MAIN OUTCOME MEASURES Active energy expenditure ( EE ) ( in kilocalories ) and the time spent doing light , moderate , or intense PA ( minutes per week ) . RESULTS In the intervention group , the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week ( P=.002 ) , with 36.8 % of the sample achieving the target amount of moderate-intensity PA . During the 8th week , the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group , respectively ( P=.004 ) . CONCLUSIONS Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients . This intervention could be implemented after a CRP as an inexpensive , modern , and easy-to-use strategy Background There are well-documented treatment gaps in secondary prevention of coronary heart disease and no clear guidelines to assist early physical activity after acute coronary syndromes ( ACS ) . Smartphone technology may provide an innovative platform to close these gaps . This paper describes the study design of a r and omized controlled trial assessing whether a smartphone-based secondary prevention program can facilitate early physical activity and improve cardiovascular health in patients with ACS . Methods We have developed a multi-faceted , patient-centred smartphone-based secondary prevention program emphasizing early physical activity with a graduated walking program initiated on discharge from ACS admission . The program incorporates ; physical activity tracking through the smartphone ’s accelerometer with interactive feedback and goal setting ; a dynamic dashboard to review and optimize cardiovascular risk factors ; educational messages delivered twice weekly ; a photographic food diary ; pharmacotherapy review ; and support through a short message service . The primary endpoint of the trial is change in exercise capacity , as measured by the change in six-minute walk test distance at 8-weeks when compared to baseline . Secondary endpoints include improvements in cardiovascular risk factor status , psychological well-being and quality of life , medication adherence , uptake of cardiac rehabilitation and re-hospitalizations . Discussion This r and omized controlled trial will use a smartphone-phone based secondary prevention program to emphasize early physical activity post-ACS . It will provide evidence regarding the feasibility and utility of this innovative platform in closing the treatment gaps in secondary prevention . Trial registration The trial was retrospectively registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) on April 4 , 2016 . The registration number is ACTRN12616000426482 Aims Patients with heart failure often display a distinct pattern of walking characterized by short step-length and frequent short pauses . In the current study we sought to explore if qualitative aspects of movement have any additive value to established factors to predict all-cause mortality in patients with advanced heart failure . Methods and results 60 patients with advanced heart failure ( NYHA III , peak VO2 < 20 ml/kg and LVEF < 35 % ) underwent symptom-limited CPX , echocardiography and routine chemistry .  Physical activity was assessed using an accelerometer worn attached to the waist during waking hours for 7 consecutive days . The heart-failure survival score ( HFSS ) was calculated for each patient . All accelerometer-derived variables were analyzed with regard to all-cause mortality and added to a baseline model utilizing HFSS scores . HFSS score was significantly associated with the incidence of death ( P<0.001 ; c-index 0.71 ; CI , 0.67–0.73 ) . The addition of peak skewness to the HFSS model significantly improved the predictive ability with an increase in c-index to 0.74 ( CI , 0.69–0.78 ) , likelihood ratio P<0.02 , establishing skewness as a predictor of increased event rates when accounting for baseline risk . Conclusion The feature skewness , a measure of asymmetry in the intensity level of periods of high physical activity , was identified to be predictive of all-cause mortality independent of the established prognostic model – HFSS and peak VO2 . The findings from the present study emphasize the use of accelerometer analysis in clinical practice to make more accurate prognoses in addition to extract features of physical activity relevant to functional classification Background / Objective : Colorectal and gynecologic cancer survivors are at cardiovascular risk due to comorbidities and sedentary behaviour , warranting a feasible intervention to increase physical activity . The Health Action Process Approach ( HAPA ) is a promising theoretical framework for health behaviour change , and wearable physical activity trackers offer a novel means of self-monitoring physical activity for cancer survivors . Method : Sixty-eight survivors of colorectal and gynecologic cancer will be r and omised into 12-week intervention and control groups . Intervention group participants will receive : a Fitbit Alta ™ to monitor physical activity , HAPA-based group sessions , booklet , and support phone-call . Participants in the control group will only receive the HAPA-based booklet . Physical activity ( using accelerometers ) , blood pressure , BMI , and HAPA constructs will be assessed at baseline , 12-weeks ( post-intervention ) and 24-weeks ( follow-up ) . Data analysis will use the Group x Time interaction from a General Linear Mixed Model analysis . Conclusions : Physical activity interventions that are acceptable and have robust theoretical underpinnings show promise for improving the health of cancer survivors OBJECTIVE To investigate the effect of the self-monitoring of physical activity by hospitalized cardiac patients attending phase I cardiac rehabilitation ( CR ) . DESIGN R and omized controlled trial . SETTING University hospital CR program . PARTICIPANTS CR patients ( N=126 ) with a mean age of 59.1 years . INTERVENTIONS Patients were r and omly assigned to the self-monitoring group ( group A , n=63 ) or the control group ( group B , n=63 ) . Along with CR , group A patients performed self-monitoring of their physical activity at the beginning of a phase I CR program ( acute in-hospital phase for in patients ) and ending just before they began a phase II CR program ( postdischarge recovery phase for out patients ) . MAIN OUTCOME MEASURES Physical activity ( averages of daily number of steps taken and daily energy expenditure for 1wk ) as measured by accelerometer was assessed in both groups at baseline ( t1 ) and before the beginning of phase II CR ( t2 ) . RESULTS Although there were no significant differences in physical activity values between groups A and B at t1 , values of group A at t2 were significantly higher than those of group B ( 8609.6 vs 5512.9 steps , P<.001 ; 242.6 vs 155.9kcal , P<.001 ) . CONCLUSIONS Self-monitoring of patient physical activity from phase I CR might effectively increase the physical activity level in preparation for entering a phase II CR program . Results of the present study could contribute to the development of new strategies for the promotion of physical activity in cardiac patients The purpose of this pilot study was to evaluate the feasibility and the effectiveness of an intervention that employed a technology-based physical activity ( PA ) monitoring system and teacher-regulated strategies to promote PA  in preschoolers . A total of 93 preschoolers ( 53 % girls , 4.7 years ) from 5 child care centers were recruited for a one-week intervention and r and omly assigned into control ( 2 centers , n = 45 ) or intervention ( 3 centers , n = 48 ) group . Key intervention components included : ( 1 ) wearable device-based , real-time monitoring of children ’s PA by classroom teachers and ( 2 ) teacher-regulated strategies for providing more opportunities for PA . Sedentary behavior ( SED ) and PA were measured using accelerometers . Overall , children in the intervention group showed significantly lower level of SED ( 31.6 vs. 33.6 min/h ) and higher level of total PA ( 28.4 vs. 26.4 min/h ) than children in the control group , after adjusting for age , sex , race , parent education level , parent perception of their child ’s PA , BMI , and childcare centers . Teachers in the intervention group reported that the intervention was highly feasible to be implemented in their current classroom setting s. In conclusion , we observed high acceptability and initial effectiveness of the current intervention . Subsequent research at larger-scale is warranted to fully evaluate the effectiveness of the intervention strategies tested in this study Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention Background The Internet has potential as a medium for health behavior change programs , but no controlled studies have yet evaluated the impact of a fully automated physical activity intervention over several months with real-time objective feedback from a monitor . Objective The aim was to evaluate the impact of a physical activity program based on the Internet and mobile phone technology provided to individuals for 9 weeks . Methods A single-center , r and omized , stratified controlled trial was conducted from September to December 2005 in Bedfordshire , United Kingdom , with 77 healthy adults whose mean age was 40.4 years ( SD = 7.6 ) and mean body mass index was 26.3 ( SD = 3.4 ) . Participants were r and omized to a test group that had access to an Internet and mobile phone – based physical activity program  ( n = 47 ) or to a control group ( n = 30 ) that  received no support . The test group received tailored solutions for perceived barriers , a schedule to plan weekly exercise sessions with mobile phone and email reminders , a message board to share their experiences with others , and feedback on their level of physical activity . Both groups were issued a wrist-worn accelerometer to monitor their level of physical activity ;  only the test group received real-time feedback via the Internet . The main outcome measures were accelerometer data and self-report of physical activity . Results At the end of the study period , the test group reported a significantly greater increase over baseline than did the control group for perceived control ( P < .001 ) and intention/expectation to exercise ( P < .001 ) . Intent-to-treat analyses of both the accelerometer data ( P = .02 ) and leisure time self-report data ( P = .03 ) found a higher level of moderate physical activity in the test group . The average increase ( over the control group ) in accelerometer-measured moderate physical activity was 2 h 18 min per week . The test group also lost more percent body fat than the control group ( test group : −2.18 , SD = 0.59 ; control group : −0.17 , SD = 0.81 ; P = .04 ) . Conclusions A fully automated Internet and mobile phone – based motivation and action support system can significantly increase and maintain the level of physical activity in healthy adults OBJECTIVES To investigate the associations of objective ly assessed sedentary time , light intensity physical activity ( PA ) , moderate to vigorous intensity PA ( MVPA ) , and total PA with all-cause mortality and mortality from cardiovascular disease ( CVD ) or cancer in a Swedish population -based cohort with 15 years follow-up time . DESIGN Longitudinal prospect i ve cohort study . METHODS Data from 851 persons ( 56 % women ) ≥35 years at baseline were included . Primary exposure variables were  time ( min/day ) spent sedentary , in light intensity PA and in MVPA , and total counts from an Actigraph 7164 accelerometer . Data on all-cause mortality and mortality from CVD or cancer were obtained from Swedish registers . Cox proportional hazards models estimated hazard ratios ( HR ) of mortality with 95 % confidence intervals ( CI ) . RESULTS Compared with the least sedentary participants , those in the most sedentary tertile had an increased risk of all-cause mortality , HR : 2.7 ( 1.4 , 5.3 ) , CVD mortality , HR : 5.5 ( 1.4 , 21.2 ) and cancer mortality , HR : 4.3 ( 1.2 , 16.0 ) . For all-cause mortality , those in the highest light intensity PA tertile had a HR 0.34 ( 0.17 , 0.67 ) compared with the lowest tertile . A similar pattern was found for CVD and cancer mortality . More time spent in MVPA was associated with the largest risk reduction for CVD mortality , with an almost 90 % lower risk in the tertile with the most time in MVPA . CONCLUSIONS This study confirms a strong inverse relationship between MVPA and mortality , and adds new insight for the underst and ing of the associations between sedentary time  and light intensity PA  and mortality Background Accelerometers objective ly assess physical activity ( PA ) and are currently used in several large-scale epidemiological studies , but there is no consensus for processing the data . This study compared the impact of wear-time assessment methods and using either vertical (V)-axis or vector magnitude ( VM ) cut-points on accelerometer output . Methods Participants ( 7,650 women , mean age 71.4 y ) were mailed an accelerometer ( ActiGraph GT3X+ ) , instructed to wear it for 7 days , record date s and times the monitor was worn on a log , and return the monitor and log via mail . Data were processed using three wear-time methods ( logs , Troiano or Choi algorithms ) and V-axis or VM cut-points . Results Using algorithms alone result ed in " mail-days " incorrectly identified as " wear-days " ( 27 - 79 % of subjects had > 7-days of valid data ) . Using only date s from the log and the Choi algorithm yielded : 1 ) larger sample s with valid data than using log date s and times , 2 ) similar wear-times as using log date s and times , 3 ) more wear-time ( V , 48.1 min more ; VM , 29.5 min more ) than only log date s and Troiano algorithm . Wear-time algorithm impacted sedentary time ( ~30 - 60 min lower for Troiano vs. Choi ) but not moderate-to-vigorous ( MV ) PA time . Using V-axis cut-points yielded ~60 min more sedentary time and ~10 min less MVPA time than using VM cut-points . Conclusions Combining log- date s and the Choi algorithm was optimal , minimizing missing data and research er burden . Estimates of time in physical activity and sedentary behavior are not directly comparable between V-axis and VM cut-points . These findings will inform consensus development for accelerometer data processing in ongoing epidemiologic studies Background Older adults are the least active population group . Interventions in residential setting s may support a multi-level approach to behavior change . Methods In a cluster r and omized control trial , 11 San Diego retirement communities were assigned to a physical activity ( PA ) intervention or a healthy aging attention control condition .  Participants were 307 adults over 65 years old . The multilevel PA intervention was delivered with the assistance of peer leaders , who were trained older adult from the retirement communities . Intervention components included individual counseling & self-monitoring with pedometers , group education sessions , group walks , community advocacy and pedestrian community change projects . Intervention condition by time interactions were tested using generalized mixed effects regressions . The primary outcomes was accelerometer measured physical activity . Secondary outcomes were blood pressure and objective ly measured physical functioning . Results Over 70 % of the sample were 80 years or older .  PA  significantly increased in the intervention condition ( 56 min of moderate-vigorous PA per week ; 119 min of light PA ) compared with the control condition and remained significantly higher across the 12 month study . Men and participants under 84 years old benefited most from the intervention . There was a significant decrease in systolic ( p < .007 ) and diastolic ( p < .02 ) blood pressure at 6 months . Physical functioning improved but the changes were not statistically significant . Conclusions Intervention fidelity was high demonstrating feasibility . Changes in PA and blood pressure achieved were comparable to other studies with much younger participants . Men , in particular , avoided a year-long decline in PA.Trial registration clincialtrials.gov Identifier : NCT01155011 Background  Physical activity  is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes . A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients . As a prerequisite for useful technology , it is important to involve the end-users in the design process from an early stage . Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity  , embedded in primary care practice . The leading principle of this tool is to change behavior by self-monitoring , goal - setting , and feedback . Methods The research team collected qualitative data among 15 patients , 16 care professionals , and several experts . A prototype was developed in three stages . In stage 1 , the literature was search ed to identify end-users and context . In stage 2 , the literature , experts and patient representatives were consulted to set up a use case with the general idea of the innovation . In stage 3 , individual interviews and focus groups were held to identify the end-user requirements . Based on these requirements a prototype was built by the engineering team . Results The development process has led to a tool that generally meets the requirements of the end-users . A tri-axial activity sensor  , worn on the hip , is connected by Bluetooth to a smartphone . In an app , quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization , and an image shows a sun when the goal is reached . Overviews about activity per half an hour , per day , week , and month are provided . In the menu of the app and on a secured website , patients can enter information in individual sessions or read feedback messages generated by the system . The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient . Conclusions This study demonstrates that a user-centered approach brings in valuable details ( such as the requirements for feedback in activity minutes per day ) to improve the fit between the user , technology , and the organization of care , which is important for the usability and acceptability of the tool . The tool embedded in primary care will be evaluated in a r and omized controlled trial BACKGROUND Physical activity is positively associated with survival and quality of life among breast cancer survivors . Despite these benefits , the majority of breast cancer survivors are insufficiently active . The potential health benefits of reducing sedentary behaviour ( sitting time ) in this population have not been extensively investigated . The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology ( the Garmin Vivofit2 ® ) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors . METHODS / DESIGN This r and omised controlled trial includes inactive , postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment . Participants are r and omly assigned to the primary intervention group ( Garmin Vivofit2 ® ; behavioural feedback and goal setting session ; and , five telephone-delivered health coaching sessions ) or to the wait-list control group . The primary intervention is delivered over a 12-week period . The second 12-week period comprises a maintenance phase for the primary intervention group , and an abridged intervention ( Garmin Vivofit2 ® only ) for the wait-list control group . Moderate- to vigorous-intensity physical activity ( MVPA ) and sedentary behaviour are assessed by accelerometry at baseline ( T1 ) , end of intervention ( T2 ) , and end of maintenance phase ( T3 ) . DISCUSSION The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors . If the use of wearable technology ( in combination with behaviour change strategies , or alone ) proves efficacious , it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context . TRIAL REGISTRATION ACTRN12616000175471 UNLABELLED The absence of comparative validity studies has prevented research ers from reaching consensus regarding the application of intensity-related accelerometer cut points for children and adolescents . PURPOSE This study aim ed to evaluate the classification accuracy of five sets of independently developed ActiGraph cut points using energy expenditure , measured by indirect calorimetry , as a criterion reference st and ard . METHODS A total of 206 participants between the ages of 5 and 15 yr completed 12 st and ardized activity trials . Trials consisted of sedentary activities ( lying down , writing , computer game ) , lifestyle activities ( sweeping , laundry , throw and catch , aerobics , basketball ) , and ambulatory activities ( comfortable walk , brisk walk , brisk treadmill walk , running ) . During each trial , participants wore an ActiGraph GT1 M , and V˙O2 was measured breath-by-breath using the Oxycon Mobile portable metabolic system . Physical activity intensity was estimated using five independently developed cut points : Freedson/Trost ( FT ) , Puyau ( PU ) , Treuth ( TR ) , Mattocks ( MT ) , and Evenson ( EV ) . Classification accuracy was evaluated via weighted κ statistics and area under the receiver operating characteristic curve ( ROC-AUC ) . RESULTS Across all four intensity levels , the EV ( κ=0.68 ) and FT ( κ=0.66 ) cut points exhibited significantly better agreement than TR ( κ=0.62 ) , MT ( κ=0.54 ) , and PU ( κ=0.36 ) . The EV and FT cut points exhibited significantly better classification accuracy for moderate- to vigorous-intensity physical activity ( ROC-AUC=0.90 ) than TR , PU , or MT cut points ( ROC-AUC=0.77 - 0.85 ) . Only the EV cut points provided acceptable classification accuracy for all four levels of physical activity intensity and performed well among children of all ages . The widely applied sedentary cut point of 100 counts per minute exhibited excellent classification accuracy ( ROC-AUC=0.90 ) . CONCLUSIONS On the basis of these findings , we recommend that research ers use the EV ActiGraph cut points to estimate time spent in sedentary , light- , moderate- , and vigorous-intensity activity in children and adolescents Atrial fibrillation and atrial flutter are common cardiac arrhythmias associated with an increased risk of stroke in patients with additional risk factors .  Anticoagulation ameliorates stroke risk , but because these arrhythmias may occur intermittently without symptoms , initiation of prophylactic therapy is often delayed until electrocardiographic documentation is obtained . The IMPACT study is a multicenter , r and omized trial of remote surveillance technology in patients with implanted dual-chamber cardiac resynchronization therapy defibrillator ( CRT-D ) devices design ed to test the hypothesis that initiation and withdrawal of oral anticoagulant therapy guided by continuous ambulatory monitoring of the atrial electrogram improve clinical outcomes by reducing the combined rate of stroke , systemic embolism , and major bleeding compared with conventional clinical management . For those in the intervention group , early detection of atrial high-rate episodes ( AHRE ) generates an automatic alert to initiate anticoagulation based on patient-specific stroke risk stratification . Subsequently , freedom from AHRE for predefined periods prompts withdrawal of anticoagulation to avoid bleeding . Patients in the control arm are managed conventionally , the anticoagulation decision prompted by incidental detection of atrial fibrillation or atrial flutter during routine clinical follow-up . The results will help define the clinical utility of wireless remote cardiac rhythm surveillance and help establish the critical threshold of AHRE burden warranting anticoagulant therapy in patients at risk of stroke . In this report , we describe the study design and baseline demographic and clinical features of the initial cohort ( 227 patients )
CONCLUSIONS Current evidence suggests that D-PA may be useful for assessing physical activity and predicting clinical outcomes in patients with cardiovascular implantable electronic devices when combined with other device parameters .
BACKGROUND  Physical activity  is predictive of cardiovascular outcomes in patients with cardiovascular implantable electronic devices , yet it is not regularly assessed in routine care .
Current-generation cardiovascular implantable electronic devices , however , continuously monitor patient activity through a built-in accelerometer , which provides new opportunities to remotely assess patient activity , detect changes in clinical status , and incorporate these data in risk stratification models .
This review critically examines the literature on device-measured physical activity ( D-PA ) , with a focus on identifying method ological issues that may affect interpretation of study results .