Physical activity (PA) and sedentary behavior (SB) have important implications for health benefits. A growing number of people use consumer available wearables such as activity trackers, which claim to objectively monitor PA and SB in free-living conditions. These devices could provide essential information to understand the influence of behavior on health. This understanding assumes that available consumer products correctly monitor PA in the everyday life. A general approach in science is to validate such activity devices in a controlled environment. The classical procedure to investigate criterion validity is to examine new devices based on the gold standard. To our knowledge, the resulting validation data are not often analyzed and shared with manufacturers to further develop and improve the activity device. The current study can be seen as a validation study to check the criterion validity of a consumer-level activity device. The novelty of this study was the application of a stepwise approach to optimize the calculations of a consumer available activity device (i.e., Activ8; www.activ8all.com/product/activ8-professionalactivity-monitor/) for estimating energy expenditure (EE) in walking and running. Forty adults (27 males and 13 females) participated in three substudies. Each substudy consisted of several walking and running activities in which EE was simultaneously measured with indirect calorimetry (as reference value) and the Activ8 activity device. EE values at each walking and running speed were compared to identify the accuracy of the Activ8 device. After completion of the first and second substudies, the results were shared and discussed with the manufacturer of Activ8. Next, the calculations for EE were adapted to the indirect calorimetry values to improve accuracy. In the second and third substudies, the modifications were tested, and results were used to further optimize the calculation of EE. The results of this study show an improved correlation between EE measured by indirect calorimetry and the Activ8 activity device (R2 from 0.91 to 0.95); a decrease in differences between substudy A and substudy B considering EE measured (indirect calorimetry) and calculated (Activ8 calculation) was observed. The second modification in the calculation showed a further increase in correlation (R2 from 0.95 to 0.97) between the measured and calculated EE; however, the absolute difference between the two values increased. The results from a validation study are valuable to use for further adaptation of accelerometer device calculations. A stepwise science-industry collaboration can improve the calculation accuracy and may be a practical approach for validation studies in which human movement scientists and technology manufacturers work together to successfully improve the validity and accuracy of consumer-based activity devices.
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Rationale: Predictive equations for resting energy expenditure (REE) are used in the treatment of overweight and obesity, but the validity of these equations in overweight older adults is unknown. This study evaluates which predictive REE equation is the best alternative to indirect calorimetry in overweight older adults with and without diabetes. Methods: In total 273 adults aged ≥55 years with a BMI of ≥25 kg/m2 were included. REE (by indirect calorimetry), body weight, body height, age, gender, and fat-free and fat mass (from air-displacement plethysmography) were measured. The measured REE was used as a reference and compared with 28 existing REE equations. The accuracy of the equations was evaluated by the percentage accurate predictions (within 10% of REE measured), the root mean squared error (RMSE), and the mean percentage difference (bias) between predicted and measured REE. Subgroup analyses were performed for type 2 diabetics (T2D) and non-T2D. Results: Mean age was 64 ± (SD 6) years, 42% had T2D (n = 116), and mean BMI was 32.8 ± (SD 4.5) with range 25–54 kg/m2. The adjusted Harris & Benedict (1984) provided the highest percentage accurate predictions in all adults (70%) and in T2D (74%), and second best in non-T2D (67%). RMSE was 184, 175 and 191 kcal/day, and bias −1.2%, −1.5% and −1.0% for all adults, T2D and non-T2D, respectively. Conclusion: For Dutch overweight older adults with and without diabetes the adjusted Harris–Benedict (1984) predictive equation for REE seems to be the best alternative to indirect calorimetry.
BACKGROUND: When indirect calorimetry is not available, predictive equations are used to estimate resing energy expenditure (REE). There is no consensus about which equation to use in hospitalized patients. The objective of this study is to examine the validity of REE predictive equations for underweight, normal weight, overweight, and obese inpatients and outpatients by comparison with indirect calorimetry.METHODS: Equations were included when based on weight, height, age, and/or gender. REE was measured with indirect calorimetry. A prediction between 90 and 110% of the measured REE was considered accurate. The bias and root-mean-square error (RMSE) were used to evaluate how well the equations fitted the REE measurement. Subgroup analysis was performed for BMI. A new equation was developed based on regression analysis and tested.RESULTS: 513 general hospital patients were included, (253 F, 260 M), 237 inpatients and 276 outpatients. Fifteen predictive equations were used. The most used fixed factors (25 kcal/kg/day, 30 kcal/kg/day and 2000 kcal for female and 2500 kcal for male) were added. The percentage of accurate predicted REE was low in all equations, ranging from 8 to 49%. Overall the new equation performed equal to the best performing Korth equation and slightly better than the well-known WHO equation based on weight and height (49% vs 45% accurate). Categorized by BMI subgroups, the new equation, Korth and the WHO equation based on weight and height performed best in all categories except from the obese subgroup. The original Harris and Benedict (HB) equation was best for obese patients.CONCLUSIONS: REE predictive equations are only accurate in about half the patients. The WHO equation is advised up to BMI 30, and HB equation is advised for obese (over BMI 30). Measuring REE with indirect calorimetry is preferred, and should be used when available and feasible in order to optimize nutritional support in hospital inpatients and outpatients with different degrees of malnutrition.
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