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Purpose: To examine the effect of activity monitor placement on daily step counts when monitors are worn at different positions on the wrist/forearm and the hip. Methods: Participants (N = 18) wore eight different models (four wrist and four hip models) across four days. Each day, one hip and one wrist model were selected, and four identical monitors of each model were worn on the right hip and the non-dominant wrist/forearm, respectively, during all waking hours. Step counts of each monitor were compared to the same model worn in the referent position (wrist: proximal to ulnar styloid process; hip: midline of thigh). Percent of referent steps and mean difference between observed and referent positions were computed. Significant differences in steps between positions for each method were determined using one-way repeated measures ANOVAs. For significant main effects, pairwise comparisons with Bonferroni corrections were used to determine which positions were significantly different. Results: All wrist methods showed a significant main effect for placement (p < .05) and alternate positions were 1-16% lower than the referent position. For hip methods, only the Omron HJ-325 differed across positions (p < .05), but differences were among nonreferent positions and all were within ±2% of steps recorded by the referent position. Conclusions: Researchers should be aware that positions that deviate from the manufacturer's recommended position at the wrist could influence step counts. Of all hip methods examined, the Omron had a significant placement effect which did not constitute a practical difference. [ABSTRACT FROM AUTHOR]

Introduction: Wrist-worn accelerometers can capture stepping behavior passively, continuously, and remotely. Methods utilizing peak detection, threshold crossing, and frequency analysis have been used to detect steps from wrist-worn accelerometer data, but it remains unclear how different approaches perform across a range of walking speeds and free-living activities. In this study, we evaluated the performance of four open-source methods for deriving step counts from wrist-worn accelerometry data, when applied to data from a range of structured locomotion and free-living activities. In addition, we assessed how modifying the parameters of these methods would affect their performance., Methods: Twenty-one participants (ages 20-33) wore an ActiGraph CentrePoint Insight Watch (Actigraph, LLC) on their non-dominant wrist while completing structured locomotion activities in a motion capture laboratory and during a free-living period in a mock apartment. Criterion step counts were determined from motion capture heel-strike events and from StepWatch 3 (Modus Health, LLC) during the free-living period. Four open-source methods implementing different algorithmic approaches were applied to CPIW data to derive step counts. The quantity and timing of method-derived and criterion steps during each type of activity were then compared., Results: In terms of performance during structured locomotion, methods that relied on a single parameter, such as peak detection or threshold crossing, demonstrated the lowest bias among those investigated. Furthermore, three of the four investigated methods overestimated step counts during slow walking and underestimated step counts during fast walking, while the last method consistently underestimated at least half of the recorded steps across all speeds. During free-living activities, the method relying on frequency analysis exhibited the lowest percent error of all methods. Finally, we found that the incorporation of a locomotion classifier, wherein steps were only estimated during identified locomotion periods, reduced error for two methods when applied to data across structured and free-living settings., Conclusion: In studying the performance of different step-counting approaches across different settings, we found a tradeoff between performance during structured walking and that during free-living activities. These findings highlight the opportunity for novel, context-aware methods for accurate step counting across real-world settings., Competing Interests: R.T.M. was a paid intern at VivoSense, Inc. S.L.B., Y.Z., I.C., and K.L. are employees of VivoSense, Inc. I.C. is on the Editorial Board of Karger Digital Biomarkers and the Scientific Advisory Board for IMI IDEA FAST and has received fees for lectures and consulting on digital health at ETH Zürich and FHNW Muttenz., (© 2024 The Author(s). Published by S. Karger AG, Basel.)