Association of daily step count and serum testosterone among men in the United States

Abstract Purpose To describe the association between daily activity (i.e., daily step counts and accelerometer intensity measures) and serum TT levels in a representative sample of US adults aged 18 years or older. Methods A retrospective cohort study was carried out utilizing the NHANES (National Health and Nutrition Examination Survey) 2003–2004 cycle. Physical activity was measured with a waist-worn uniaxial accelerometer (AM-7164; ActiGraph) for up to 7 days using a standardized protocol. Using linear and multivariable logistic regression controlling for relevant social, demographic, lifestyle, and comorbidity characteristics, we assessed the association between daily step counts and TT. Results A total of 279 subjects with a median age 46 (IQR: 33–56) were included in the analysis. 23.3% of the cohort had a low serum TT level (TT < 350 ng/dl). Compared to men who took <4000 steps per day, men who took >4000 or >8000 steps/day had a lower odd of being hypogonadal (OR 0.14, 95% CI: 0.07–0.49 and 0.08, 95%CI: 0.02–0.44, respectively). While a threshold effect was noted on average, TT increased 7 ng/dL for each additional 1000 steps taken daily (β-estimate: 0.007, 95% CI: 0.002–0.013). Conclusions Patients with the lowest daily step counts had higher odds of being hypogonadal. The current work supports a possible association between daily steps, total testosterone, and hypogonadism for men in the US.

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Should All Steps Count When Using a Pedometer as a Measure of Physical Activity in Older Adults?

Journal of Physical Activity and Health ◽

10.1123/jpah.4.3.305 ◽

2007 ◽

Vol 4 (3) ◽

pp. 305-314 ◽

Cited By ~ 8

Author(s):

Alison L. Marshall

Keyword(s):

Older Adults ◽

Feedback Condition ◽

Daily Step ◽

Step Counts ◽

Telephone Interviews ◽

Significant Difference ◽

Daily Step Count ◽

Steps Per Day ◽

The Difference ◽

Clinically Significant

Purpose:The aim of this study was to determine if feedback on step counts from a pedometer encourages participants to increase walking.Methods:Randomly recruited older adults (n = 105) were asked to wear a pedometer for 2 wk. Half the participants were asked to monitor and record daily step counts during week 1 (feedback), then seal the pedometer shut during week 2 (no feedback). Half completed the study in reverse order. Self-reported walking was assessed via telephone interviews.Results:Significantly more steps were recorded per day (approximately 400 steps per day) when participants (n = 103, 63% women; mean BMI 25 ± 4) monitored their daily step count [t (102) = –2.30, P = 0.02)] compared to the no feedback condition. There was no statistically significant difference in self-reported walking (P = 0.31) between feedback conditions.Conclusion:The difference in daily step counts observed between conditions, while statistically significant, may not be considered clinically significant. Further, the non-significant difference in self-reported walking between conditions suggests that feedback on daily step counts from a pedometer does not encourage participants to increase their walking.

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Abstract 11: mActive: A Blinded, Randomized mHealth Trial Supporting Digital Tracking and Smart Texting for Promotion of Physical Activity

Circulation ◽

10.1161/circ.131.suppl_1.11 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Seth S Martin ◽

David I Feldman ◽

Roger S Blumenthal ◽

Steven R Jones ◽

Wendy S Post ◽

...

Keyword(s):

Physical Activity ◽

Phase I ◽

Real Time ◽

Phase Ii ◽

The United States ◽

Step Count ◽

Daily Step ◽

Baseline Activity ◽

Daily Step Count ◽

Digital Tracking

Introduction: The recent advent of smartphone-linked wearable pedometers offers a novel opportunity to promote physical activity using mobile health (mHealth) technology. Hypothesis: We hypothesized that digital activity tracking and smart (automated, real-time, personalized) texting would increase physical activity. Methods: mActive (NCT01917812) was a 5-week, blinded, sequentially-randomized, parallel group trial that enrolled patients at an academic preventive cardiovascular center in Baltimore, MD, USA from January 17 th to May 20 th , 2014. Eligible patients were 18-69 year old smartphone users who reported low leisure-time physical activity by a standardized survey. After establishing baseline activity during a 1-week blinded run-in, we randomized 2:1 to unblinded or blinded tracking in phase I (2 weeks), then randomized unblinded participants 1:1 to receive or not receive smart texts in phase II (2 weeks). Smart texts provided automated, personalized, real-time coaching 3 times/day towards a daily goal of 10,000 steps. The primary outcome was change in daily step count. Results: Forty-eight patients (22 women, 26 men) enrolled with a mean (SD) age of 58 (8) years, body mass index of 31 (6), and baseline daily step count of 9670 (4350). The phase I change in activity was non-significantly higher in unblinded participants versus blinded controls by 1024 steps/day (95% CI -580-2628, p=0.21). In phase II, smart text receiving participants increased their daily steps over those not receiving texts by 2534 (1318-3750, p<0.001) and over blinded controls by 3376 (1951-4801, p<0.001). The unblinded-texts group had the highest proportion attaining the 10,000 steps/day goal (p=0.02) (Figure). Conclusions: In present-day adult smartphone users receiving preventive cardiovascular care in the United States, a technologically-integrated mHealth strategy combining digital tracking with automated, personalized, real-time text message coaching resulted in a large short-term increase in physical activity.

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Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: a 24-week matched case control study

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-01043-1 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Emma Pearson ◽

Harry Prapavessis ◽

Christopher Higgins ◽

Robert Petrella ◽

Lauren White ◽

...

Keyword(s):

Physical Activity ◽

Financial Incentives ◽

Step Count ◽

Daily Step ◽

Individual Level ◽

Significant Difference ◽

Daily Step Count ◽

Steps Per Day ◽

The Impact ◽

Experimental Group

Abstract Background Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results The main analysis included 61,170 users (mean age = 32 yrs.; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.

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A Pilot Study Comparing Pedometer Counts with Reported Physical Activity in Elementary Schoolchildren

Pediatric Exercise Science ◽

10.1123/pes.16.4.355 ◽

2004 ◽

Vol 16 (4) ◽

pp. 355-367 ◽

Cited By ~ 18

Author(s):

Greet Cardon ◽

Ilse De Bourdeaudhuij

Keyword(s):

Physical Activity ◽

Pilot Study ◽

Vigorous Physical Activity ◽

Step Count ◽

Regression Equations ◽

Moderate Correlation ◽

Daily Step ◽

Step Counts ◽

Daily Step Count

In this study pedometer counts were recorded for 6 consecutive days for 92 children (mean age = 9.6 years; range 6.5–12.7) and were compared with the number of minutes per day in which the participants engaged in moderate-to-vigorous physical activity (MVPA). Diaries filled out with the assistance of one of the children’s parents were used to determine minutes of MVPA. The average daily step count was significantly higher in boys than in girls, although the average daily MVPA engagement in minutes did not vary significantly between genders. Based on the regression equations, 60 min of MVPA was equivalent to 15,340 step counts in boys, 11,317 step counts in girls, and 13,130 step counts when results for both genders were combined. A moderate correlation (r = .39, p < .001) was found between pedometer step counts and reported minutes of MVPA. According to the present study findings, however, predictions and promotion of daily MVPA engagement in children based on pedometer counts per day should be made with caution.

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Daily step counts to predict hospitalizations during chemoradiotherapy for head and neck cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1571 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1571-1571

Author(s):

Elena S. Izmailova ◽

Andrew Cohen ◽

Rafi Kabarriti ◽

Jeremy Eichler ◽

Chengrui Huang ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cox Regression ◽

Step Count ◽

Daily Step ◽

Step Counts ◽

The Past ◽

Daily Step Count ◽

Ecog Ps

1571 Background: Wearable activity trackers could provide useful data for managing cancer patients with respect to treatment selection, toxicity monitoring, and implementation of supportive care measures. Here, we seek to evaluate the association between daily step counts and hospitalizations in a cohort of patients with head and neck cancer (HNC). Methods: This analysis consists of patients enrolled in one of three prospective trials involving activity monitoring (NCT02649569, NCT03115398, NCT03102229) during chemoradiation. Study subjects were asked to wear a commercial fitness tracker continuously during the therapy. ECOG performance status (PS) was assessed at baseline, and quality of life (QoL) EORTC QLQ-C30 questionnaires were completed weekly. Multivariable Cox regression models with time-dependent covariates (average step count over the past 3 days, most recent QoL score) and time-fixed covariates (age, sex, baseline PS, study number, baseline tumor volume, and treatment setting [definitive versus postoperative]) were used to identify predictors of first hospital admission during the chemoradiotherapy course. In addition to the Cox regression models, linear mixed models were fitted with daily step count as the dependent variable to examine its relationship with certain independent variables including age, sex, weekend status, days after treatment initiation, and study number. Results: Sixty-six HNC patients who received chemoradiotherapy between 2015 and 2019 were included in the analysis. Median age was 60 (range: 27-88). 47% of patients had ECOG PS score 0, 47% ECOG score 1, and 6% ECOG score 2. 29% of patients had HPV-positive oropharyngeal tumors, and the most common other tumor subsites were larynx (27%), and nasopharynx (12%). The Cox regression survival model demonstrated a 26% reduction in the short-term hospitalization risk for every 1000 daily steps (averaged over the past 3 days, hazard ratio 0.74; 95% confidence interval (CI) 0.55-0.98, p = 0.0367). Hospitalizations were not significantly associated with most recent QoL or baseline ECOG PS. Additionally, according to the linear mixed model results, daily step count was not associated with age (p = 0.8048). Study subjects moved less on weekends (on average 245 fewer steps on weekends than weekdays, 95% CI 134-357, p < 0.0001). Also, an increase in most recently measured ECOG PS was associated with a decrease in daily step count (167 fewer steps for every increase in ECOG PS, 95% CI -289 to -45, p < 0.0072). Conclusions: Daily step counts are a dynamic predictor of hospitalizations in patients undergoing chemoradiotherapy for head and neck cancer. Interventional studies are needed to demonstrate feasibility of leveraging physical activity data to optimize supportive care during cancer therapy and enhance cancer care quality. Clinical trial information: NCT02649569, NCT03115398, NCT03102229.

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Cutoff Points for Step Count to Predict 1-year All-Cause Mortality in Patients with Idiopathic Pulmonary Fibrosis

Respiration ◽

10.1159/000517030 ◽

2021 ◽

pp. 1-7

Author(s):

Kazuya Shingai ◽

Toshiaki Matsuda ◽

Yasuhiro Kondoh ◽

Tomoki Kimura ◽

Kensuke Kataoka ◽

...

Keyword(s):

Physical Activity ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Step Count ◽

Cutoff Point ◽

Daily Step ◽

All Cause Mortality ◽

Cutoff Points ◽

Daily Step Count ◽

Steps Per Day

Background: Although physical activity is associated with mortality in patients with idiopathic pulmonary fibrosis (IPF), reference values to interpret levels of physical activity are lacking. Objectives: This study aimed to investigate the prognostic significance of physical activity assessed by step count and its cutoff points for all-cause mortality. Methods: We measured physical activity (steps per day) using an accelerometer in patients with IPF at the time of diagnosis. Relationships among physical activity and mortality, as well as cutoff points of daily step count to predict all-cause mortality were examined. Results: Eighty-seven patients (73 males) were enrolled. Forty-four patients (50.1%) died during the follow-up (median 54 months). In analysis adjusting for Gender-Age-Physiology stage and 6-min walk distance, daily step count was an independent predictor of all-cause mortality (hazard ratio (HR) = 0.820, 95% confidence interval (CI) = 0.694–0.968, p = 0.019). The optimal cutoff point (receiving operating characteristic analysis) for 1-year mortality was 3,473 steps per day (sensitivity = 0.818 and specificity = 0.724). Mortality was significantly lower in patients with a daily step count exceeding 3,473 steps than in those whose count was 3,473 or less (HR = 0.395, 95% CI = 0.218–0.715, p = 0.002). Conclusions: Step count, an easily interpretable measurement, was a significant predictor of all-cause mortality in patients with IPF. At the time of diagnosis, a count that exceeded the cutoff point of 3,473 steps/day more than halved mortality. These findings highlight the importance of assessing physical activity in this patient population.

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Adding Team-Based Financial Incentives to the Carrot Rewards App Increases Daily Step Count on a Population Scale: A 24-Week Matched Pairs Study

10.21203/rs.3.rs-54028/v1 ◽

2020 ◽

Author(s):

Emma Pearson ◽

Harry Prapavessis ◽

Christopher Higgins ◽

Robert Petrella ◽

Lauren White ◽

...

Keyword(s):

Physical Activity ◽

Financial Incentives ◽

Step Count ◽

Matched Pairs ◽

Daily Step ◽

Significant Difference ◽

Daily Step Count ◽

Steps Per Day ◽

The Impact ◽

Experimental Group

Abstract Background Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements. Methods A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1–12; intervention: weeks 13–24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (± 500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week). Results The main analysis included 61,170 users (mean age = 32yrs; % female = 64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p < 0.0001; ηp2 = 0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2 = 0.699) with each new STC corresponding to approximately 200 more steps per day. Conclusion Despite an explosion of physical activity app interest (100,000 + published apps), low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.

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Ambulation Orderlies and Recovery After Cardiac Surgery: A Pilot Randomized Controlled Trial

Journal of Clinical Exercise Physiology ◽

10.31189/2165-6193-6.3.42 ◽

2017 ◽

Vol 6 (3) ◽

pp. 42-49 ◽

Cited By ~ 2

Author(s):

Quinn R. Pack ◽

Erin A. Woodbury ◽

Samuel Headley ◽

Paul Visintainer ◽

Richard Engelman ◽

...

Keyword(s):

Functional Recovery ◽

Barthel Index ◽

Controlled Trial ◽

Functional Independence ◽

Step Count ◽

Daily Step ◽

Unique Identifier ◽

Step Counts ◽

Daily Step Count ◽

The Impact

Background: One potential strategy to increasing physical activity after surgery is to use an ambulation orderly (AO), a dedicated employee who assures frequent patient walking. However, the impact of an AO on physical and functional recovery from surgery is unknown. Methods: We randomized postoperative cardiac surgical patients to receive either the AO or usual care. We measured average daily step count, changes in 6-min walk test (6MWT) distance, and changes in functional independence (Barthel Index). Our primary goal was to test protocols, measure variability in activity, and establish effect sizes. Results: Thirty-six patients were randomized (18 per group, 45% bypass surgery). Overall, patients exhibited significant recovery of physical function from baseline to discharge in the 6MWT (from 83 to 172 meters, p < 0.001) and showed improvement in independent function (Barthel Index, 67 to 87, p < 0.001). Moreover, each additional barrier to ambulation (supplemental oxygen, intravenous poles/fluid, walkers, urinary catheters, and chest tubes) reduced average daily step count by 330 steps/barrier, p = 0.04. However, the AO intervention resulted in only a small difference in average daily step counts (2718 versus 2541 steps/d, Cohen's d = 0.16, 608 patients needed for larger trial), which we attributed to several trial factors that likely weakened the AO intervention. Conclusion: In this pilot study, we observed significant in-hospital physical and functional recovery from surgery, but the addition of an AO made only marginal differences in daily step counts. Future studies should consider stepped-wedge or cluster trial designs to increase intervention effectiveness. Clinical Trials Registration: Clinicaltrials.gov unique identifier: NCT02375282.

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Adding team-based financial incentives to the Carrot Rewards physical activity app increases daily step count on a population scale: A 24-week matched case control study

10.21203/rs.3.rs-54028/v3 ◽

2020 ◽

Author(s):

Emma Pearson ◽

Harry Prapavessis ◽

Christopher Higgins ◽

Robert Petrella ◽

Lauren White ◽

...

Keyword(s):

Physical Activity ◽

Financial Incentives ◽

Step Count ◽

Daily Step ◽

Individual Level ◽

Significant Difference ◽

Daily Step Count ◽

Steps Per Day ◽

The Impact ◽

Experimental Group

Abstract Background: Mobile health applications (mHealth apps) targeting physical inactivity have increased in popularity yet are usually limited by low engagement. This study examined the impact of adding team-based incentives (Step Together Challenges, STCs) to an existing mHealth app (Carrot Rewards) that rewarded individual physical activity achievements.Methods: A 24-week quasi-experimental study (retrospective matched pairs design) was conducted in three Canadian provinces (pre-intervention: weeks 1-12; intervention: weeks 13-24). Participants who used Carrot Rewards and STCs (experimental group) were matched with those who used Carrot Rewards only (controls) on age, gender, province and baseline mean daily step count (±500 steps/d). Carrot Rewards users earned individual-level incentives (worth $0.04 CAD) each day they reached a personalized daily step goal. With a single partner, STC users could earn team incentives ($0.40 CAD) for collaboratively reaching individual daily step goals 10 times in seven days (e.g., Partner A completes four goals and Partner B completes six goals in a week).Results: The main analysis included 61,170 users (mean age=32yrs; % female=64). Controlling for pre-intervention mean daily step count, a significant difference in intervention mean daily step count favoured the experimental group (p<0.0001; ηp2=0.024). The estimated marginal mean group difference was 537 steps per day, or 3759 steps per week (about 40 walking min/wk). Linear regression suggested a dose-response relationship between the number of STCs completed (app engagement) and intervention mean daily step count (adjusted R2=0.699) with each new STC corresponding to approximately 200 more steps per day.Conclusion: Despite an explosion of physical activity app interest, low engagement leading to small or no effects remains an industry hallmark. In this paper, we found that adding modest team-based incentives to the Carrot Rewards app increased mean daily step count, and importantly, app engagement moderated this effect. Others should consider novel small-teams based approaches to boost engagement and effects.

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Evaluating the Carrot Rewards App, a Population-Level Incentive-Based Intervention Promoting Step Counts Across Two Canadian Provinces: Quasi-Experimental Study

JMIR mhealth and uhealth ◽

10.2196/mhealth.9912 ◽

2018 ◽

Vol 6 (9) ◽

pp. e178 ◽

Cited By ~ 10

Author(s):

Marc Mitchell ◽

Lauren White ◽

Erica Lau ◽

Tricia Leahey ◽

Marc A Adams ◽

...

Keyword(s):

Mixed Effects Models ◽

Daily Step ◽

Step Counts ◽

Walking Program ◽

Multicomponent Intervention ◽

Steps Per Day ◽

Quasi Experimental ◽

The Mean ◽

Canadian Provinces ◽

Physically Inactive

Background The Carrot Rewards app was developed as part of an innovative public-private partnership to reward Canadians with loyalty points, exchangeable for retail goods, travel rewards, and groceries for engaging in healthy behaviors such as walking. Objective This study examined whether a multicomponent intervention including goal setting, graded tasks, biofeedback, and very small incentives tied to daily step goal achievement (assessed by built-in smartphone accelerometers) could increase physical activity in two Canadian provinces, British Columbia (BC) and Newfoundland and Labrador (NL). Methods This 12-week, quasi-experimental (single group pre-post) study included 78,882 participants; 44.39% (35,014/78,882) enrolled in the Carrot Rewards “Steps” walking program during the recruitment period (June 13–July 10, 2016). During the 2-week baseline (or “run-in”) period, we calculated participants’ mean steps per day. Thereafter, participants earned incentives in the form of loyalty points (worth Can $0.04 ) every day they reached their personalized daily step goal (ie, baseline mean+1000 steps=first daily step goal level). Participants earned additional points (Can $0.40) for meeting their step goal 10+ nonconsecutive times in a 14-day period (called a “Step Up Challenge”). Participants could earn up to Can $5.00 during the 12-week evaluation period. Upon meeting the 10-day contingency, participants could increase their daily goal by 500 steps, aiming to gradually increase the daily step number by 3000. Only participants with ≥5 valid days (days with step counts: 1000-40,000) during the baseline period were included in the analysis (n=32,229).The primary study outcome was mean steps per day (by week), analyzed using linear mixed-effects models. Results The mean age of 32,229 participants with valid baseline data was 33.7 (SD 11.6) years; 66.11% (21,306/32,229) were female. The mean daily step count at baseline was 6511.22. Over half of users (16,336/32,229, 50.69%) were categorized as “physically inactive,” accumulating <5000 daily steps at baseline. Results from mixed-effects models revealed statistically significant increases in mean daily step counts when comparing baseline with each study week (P<.001). Compared with baseline, participants walked 115.70 more steps (95% CI 74.59 to 156.81; P<.001) at study week 12. BC and NL users classified as “high engagers” (app engagement above sample median; 15,511/32,229, 48.13%) walked 738.70 (95% CI 673.81 to 803.54; P<.001) and 346.00 (95% CI 239.26 to 452.74; P<.001) more steps, respectively. Physically inactive, high engagers (7022/32,229, 21.08%) averaged an increase of 1224.66 steps per day (95% CI 1160.69 to 1288.63; P<.001). Effect sizes were modest. Conclusions Providing very small but immediate rewards for personalized daily step goal achievement as part of a multicomponent intervention increased daily step counts on a population scale, especially for physically inactive individuals and individuals who engaged more with the walking program. Positive effects in both BC and NL provide evidence of replicability.

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