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249
Journal of Physical Activity and Health, 2013, 10, 249-262
© 2013 Human Kinetics, Inc. Official Journal of ISPAH
www.JPAH-Journal.com
ORIGINAL RESEARCH
The authors are with the School of Sport, Exercise, and Health
Sciences, Loughborough University, Loughborough, United
Kingdom.
The Use of Pedometers for Monitoring Physical Activity
in Children and Adolescents: Measurement Considerations
Stacy A. Clemes and Stuart J.H. Biddle
Background: Pedometers are increasingly being used to measure physical activity in children and adolescents.
This review provides an overview of common measurement issues relating to their use. Methods: Studies
addressing the following measurement issues in children/adolescents (aged 3–18 years) were included:
pedometer validity and reliability, monitoring period, wear time, reactivity, and data treatment and report-
ing. Pedometer surveillance studies in children/adolescents (aged: 4–18 years) were also included to enable
common measurement protocols to be highlighted. Results: In children > 5 years, pedometers provide a valid
and reliable, objective measure of ambulatory activity. Further evidence is required on pedometer validity
in preschool children. Across all ages, optimal monitoring frames to detect habitual activity have yet to be
determined; most surveillance studies use 7 days. It is recommended that standardized wear time criteria are
established for different age groups, and that wear times are reported. As activity varies between weekdays
and weekend days, researchers interested in habitual activity should include both types of day in surveillance
studies. There is conicting evidence on the presence of reactivity to pedometers. Conclusions: Pedometers
are a suitable tool to objectively assess ambulatory activity in children (> 5 years) and adolescents. This review
provides recommendations to enhance the standardization of measurement protocols.
Keywords: validity and reliability, monitoring frame, reactivity, data treatment and reporting, instrument choice
Physical activity in young people is an important
public health issue. Increasing levels of physical activ-
ity in children and adolescents is a priority if we are to
combat the burden of disease associated with physical
inactivity, including obesity and rising levels of type 2
diabetes. The accurate measurement of physical activity
in children and adolescents, in both surveillance stud-
ies and for physical activity promotion is of paramount
importance.1
Pedometers are increasingly being used as a surveil-
lance tool to objectively assess ambulatory (walking)
activity levels and patterns in different populations. They
enable the accumulative measurement of daily activi-
ties, providing a measure of total volume of ambulatory
activity.2 The combination of their low cost ($10–$160
USD), small size, simplicity, and unobtrusive nature
make them practical tools for objectively monitoring
ambulatory activity in the free-living environment.3 The
standardized steps-per-day unit of measurement enjoys
universal interpretation, facilitating reliable cross-popu-
lation comparisons.4 Notwithstanding the importance of
accelerometers in research and well funded surveillance
studies, pedometers offer a practical and cost-effective
method for the objective assessment of physical activity
and will continue to be an instrument of choice for many.
This includes the important role of self-monitoring and
motivation, which is made possible by the pedometers
easily interpretable and immediately accessible visible
display of accumulated step counts, a function not avail-
able in accelerometers.
The majority of research-grade pedometers use
either a spring-levered or piezo-electric accelerometer
mechanism. Spring-levered pedometers contain a spring
suspended horizontal lever arm that moves up and down
in response to vertical accelerations of the hip. This
movement opens and closes an electrical circuit and
when the lever arm moves with sufcient force (above the
sensitivity threshold of the specic pedometer) electrical
contact is made and a step is registered.5,6 Piezo-electric
pedometers contain a horizontal cantilevered beam with
a weight on one end which compresses a piezo-electric
crystal when subjected to accelerations above the sensi-
tivity threshold. This generates voltage proportional to
the acceleration and the voltage oscillations are used to
record steps.5
The use of pedometers for the objective assessment
of physical activity in children and adolescents is rapidly
increasing. Despite the widespread use of pedometers
as a surveillance tool in children and adolescents, Craig
et al2 have reported a lack of standardization in terms
of the reporting of pedometer data in earlier studies.
For example, it has commonly been reported that boys
accumulate higher step counts than girls across all ages
250 Clemes and Biddle
and that step counts tend to peak before 12 years of age,
after which they decline throughout adolescence.7 Given
these observations, it will be important to take into con-
sideration age- and sex-related differences when reporting
pedometer data. Furthermore, there are also unanswered
questions regarding how many days of monitoring are
needed to reliably estimate habitual behavior, how many
hours per day constitute a valid day, should we exclude
data from a particular day if the pedometer was removed
for any duration, and is reactivity a threat to pedometer
data collected in children? The present review, therefore,
aims to provide a synthesis of common measurement
issues relating to the objective assessment of walking
behavior, using pedometers, in children and adolescents.
A number of similar approaches to the treatment of
pedometer data have been reported in recent surveillance
studies and a goal of this review is to provide recom-
mendations for data treatment and processing to aid the
standardization of reporting of pedometer data in future
surveillance studies.
Methods
The following electronic databases were searched:
PubMed, Science Direct, PsychInfo, Sportdiscus, and
the Education Resources Information Center (ERIC). The
databases were searched using the words ‘pedometer’ and
‘pedometry’ in combination with the following keywords:
children, adolescents, surveillance, population monitor-
ing, national, regional, reliability, validity, accuracy,
youth, and preschool. The search strategy also involved
examining the reference lists of the relevant articles found
to check for further studies.
The literature reviewed encompassed published
articles available in English. The review was conned
to articles in peer reviewed journals published between
1996–2010. Articles were included in the review if they 1)
reported assessing pedometer validity and/or reliability in
a sample of children and/or adolescents (up to the age of
18 years); 2) reported investigating a measurement related
issue associated with the use of pedometers in children
and/or adolescents (up to 18 years), for example the
presence of reactivity or the number of days of monitor-
ing needed to establish habitual activity; and 3) reported
using pedometers as a physical activity surveillance tool
in relatively large samples (n > 100) of healthy free-living
children and/or adolescents (up to 18 years).
Results and Discussion
A total of 706 articles were identied from the above
search terms. Following elimination of duplicates, 89
articles were retrieved, of these, 16 articles reported test-
ing the validity and reliability of pedometers in children
and adolescents, 10 addressed a measurement-related
issue associated with the use of pedometers, and 36
reported the use of pedometers in large-scale studies
assessing activity levels of children and adolescents (for
the purpose of this review, a study was included if pedom-
eter data were collected from at least 100 participants). A
number of measurement-related themes emerged during
the review, and the ndings are discussed in relation to
the following topics: pedometer reliability and validity,
number of days of monitoring required, pedometer wear
time, reactivity, methods of data treatment, analysis and
reporting, and choice of pedometer.
Pedometer Reliability and Validity
A number of studies have assessed the validity and reli-
ability of pedometers in children and adolescents and the
main ndings are summarized in Table 1. Four studies
examined the use of pedometers in preschool children
(aged 3–5 years).8–11 Following comparisons between
pedometer counts and scores from the direct observation
of activity, McKee et al8 and Louie and Chan9 both con-
cluded that the spring-levered Yamax DW-200 pedometer
is a valid and reliable tool for the assessment of physical
activity in preschool children. Similar conclusions were
drawn by Cardon and De Bourdeaudhuij11 following their
study assessing the relationship between accelerometer-
based activity minutes and pedometer-determined step
counts. Cardon and De Bourdeaudhuij11 reported that
almost all children found it ‘pleasant’ to wear a pedom-
eter, and that compliance with data registration was
high. They suggested that daily step counts in preschool
children give valid information on daily physical activity
levels, which are low in this age range. However, Oliver
et al10 reported greater variability in pedometer counts at
slow walking speeds and have questioned the accuracy
of the Yamax pedometer for assessing physical activity
in preschool children. Following a review of activity
assessment measures in this age group, Oliver et al12 noted
that the spring-levered Yamax SW/DW-200 pedometer is
the only pedometer that has been assessed for validity in
preschool children, and the efcacy of other pedometer
models/brands has yet to be determined.
The majority of pedometer validation studies have
been completed on children between the ages of 5–12
years (Table 1), and it has generally been concluded that
for this age group pedometers provide an inexpensive
and valid method for assessing levels of ambulatory
activity,15,20 particularly when total volume of ambulatory
activity is the main outcome of interest.18 Duncan et al13
reported no differences in pedometer accuracy between
5- to 7-year-olds and 9- to 11-year-olds. Similarly, Nakae
et al16 reported comparable trends in terms of pedometer
accuracy across 7- to 12-year-olds at different walk-
ing speeds, suggesting that pedometer accuracy is not
affected by age in 5- to 12-year-olds.
As with adults,25–29 in children pedometers have been
shown to be less accurate at slower walking speeds (<
2.5 mph).13,14,16,21 For example, Mitre et al21 tested the
accuracy of 2 pedometers at slow walking paces (0.5, 1.0,
1.5, and 2.0 mph) and observed that they were unaccept-
ably inaccurate at all speeds. However, when participants
were asked to walk at a self-selected pace, they chose an
251
Table 1 A Summary of the Studies Assessing Pedometer Validity in Children, Presented According to Chronological Age
of the Sample Surveyed
Authors Sample Aim/pedometer Criterion measure Results/conclusions
McKee et al813 boys, 17 girls, 3–4 yrs Validity of the Yamax DW-200 in preschool
children
CARS Correlation between direct observation and
pedometer counts: r = .64–.95
Louie and Chan986 boys, 62 girls, 3–5 yrs Validity of the Yamax DW-200 in preschool
children
CARS Correlation between direct observation and
pedometer counts during free play: r = .64
Oliver et al10 7 boys, 6 girls, 3–5 yrs Validity of the Yamax SW-200 in preschool children CARS, hand tallied steps
during walking
Correlation between direct observation and
pedometer counts during free play: r = .59. Accuracy
decreased at slower walking paces
Cardon and De
Bourdeaudhuij11
37 boys, 39 girls, 4–5 yrs Compare daily pedometer (Yamax SW-200) counts
with accelerometer-determined minutes in MVPA
ActiGraph accelerometer Correlation between daily pedometer step counts
and minutes in MVPA: r = .73
Duncan et al13 43 boys, 42 girls, 5–7 and
9–11 yrs
Effects of walking speed, age and body composition
on accuracy of a spring-levered (Yamax SW-200)
and piezo-electric (NL-2000) pedometer
Hand tallied steps Both pedometers were acceptably accurate during
moderate and fast walking, but underestimated steps
at slow walking; the NL-2000 was more precise than
the SW-200; no effects of age or body composition
Beets et al14 10 boys, 10 girls, 5–11 yrs Accuracy of the Walk4Life LS2025, Yamax
SW-200, Sun TrekLINQ and Yamax SW-701
pedometers
Hand tallied steps The Walk4Life and the 2 Yamax pedometers
exhibited a high degree of accuracy at treadmill
speeds of
≥ 2.5 mph
Kilanowski et al15 7 boys, 3 girls, 7–12 yrs Validity of the Yamax SW-200 pedometer during
recreational PA and classroom activities
TriTrac triaxial
accelerometer and CARS
Pedometer vs accelerometer: recreation r = .98,
classroom r = .50; pedometer vs observation:
recreation r = .80, classroom r = .97
Nakae et al16 201 boys, 193 girls, 7–12 yrs Accuracy of spring-levered (Yamax EC-200)
and piezo-electric (Kenz Lifecorder and Omron
HJ-700IT) pedometers
Hand tallied steps Step counts from the EC-200 were signicantly
lower than actual steps at all paces; piezo-electric
pedometers were less accurate at slow speeds, but
highly accurate during normal and fast walking
Treuth et al17 68 girls, 8–9 yrs Comparison between pedometer (Yamax SW-200)
step counts and accelerometer activity counts
ActiGraph accelerometer Correlation between pedometer steps/minute
and accelerometer counts/minute was r = .47
Louie et al18 21 boys, 8–10 yrs Validate pedometry (Yamax DW-200), heart
rate and accelerometry for predicting energy
expenditure
VO2Hip worn pedometer: r = .77–.93, ankle worn
pedometer: r = .68–.92, wrist worn pedometer:
r = .29–.82
(continued)
252
Authors Sample Aim/pedometer Criterion measure Results/conclusions
Rowlands et al19 17 boys, 17 girls, 8–10 yrs Assess the relationship between activity levels,
aerobic tness, and body fat in children
TriTrac triaxial
accelerometer
Correlation between accelerometer and pedometer
(Yamax DW-200) counts: r = .85 for boys and r = .88
for girls
Eston et al20 15 boys, 15 girls, 8–11 yrs Validate pedometry (Yamax DW-200), heart
rate and accelerometry for predicting energy
expenditure
VO2Hip worn pedometer: r = .81, ankle worn pedometer:
r = .79, wrist worn pedometer: r = .67
Mitre et al21 13 boys, 14 girls, 8–12 yrs Accuracy of the Omron HJ-105 and Yamax SW-200
pedometer at 0.5 1.0, 1.5, and 2.0 mph
Hand tallied steps Both pedometers were unacceptably inaccurate at
all speeds; inaccuracy was greater in overweight
children
Graser et al22 77 children, 10-12 yrs Determine whether the accuracy of the Walk4Life
LS2505 pedometer changes according to placement
Hand tallied steps Recommended pedometers are worn on the midaxil-
lary line, on the right; accuracy was improved when
pedometers were worn on a belt
Scruggs23 144 boys, 144 girls, 11–13
yrs
Evaluate step and activity time outputs
of the Walk4Life LS2505 pedometer
Yamax SW701
(steps/min), SOFIT
(activity time)
LS2505 signicantly underestimated steps/minute
and overestimated PA time
Jago et al24 78 boys, 11-15 yrs Pedometer (Yamax SW-200) validity at different
body locations (right hip, left hip, directly above
the umbilicus)
ActiGraph accelerometer No effects of pedometer placement on step counts
were observed. Pedometers provide a reliable
and accurate assessment of PA in adolescents
Abbreviations: CARS, Children’s activity rating scale; MVPA, moderate-to-vigorous physical activity; PA, physical activity; r, correlation coefcient; VO2, Oxygen consumption; SOFIT, System for Observing Fit-
ness Instruction Time.
Table 1 (continued)
Pedometry Methods in Children and Adolescents 253
average speed of 2.5 mph, and improvements in accuracy
were seen at this speed. Duncan et al13 have questioned
the practical signicance of this common nding since the
relationship between slow walking and health benets in
children is not well understood. Furthermore, in studies
requesting children to walk at a self-selected pace, it has
been observed that children tend to walk faster than the
slower speeds applied in treadmill protocols,14,21 sug-
gesting that speed-related pedometer error may not be an
issue during self-paced walking in children.13
The majority of pedometer validation studies in
children aged 5–12 years have focused on the spring-
levered Yamax pedometer, and this pedometer has been
the most widely used in large-scale studies assessing
pedometer-determined activity in children (see Table 2).
However, evidence has suggested that pedometers with
a piezo-electric mechanism are more accurate than the
Yamax pedometer range.5,13,16 For example, Nakae et al16
compared the accuracy of the Yamax pedometer with 2
piezo-electric (Kenz Lifecorder and Omron HJ-700IT)
pedometers during self-paced walking in children aged
7–12 years. It was observed that the step counts from
the Yamax pedometer were significantly lower than
actual steps taken at all walking paces (participants each
walked at slow, normal and fast walking speeds). The
piezo-electric pedometers were more accurate than the
Yamax pedometer at all walking paces and steps recorded
by the Kenz Lifecorder did not differ signicantly from
actual steps taken at normal and fast walking paces.
Based upon their ndings, Nakae et al16 have advised
that spring-levered pedometers are not appropriate for
use in children and they advocate the use of the more
accurate piezo-electric pedometers. In a similar study
assessing the accuracy of the Yamax SW-200 and the
piezo-electric New Lifestyles NL-2000 pedometer during
treadmill walking in children, Duncan et al13 observed
that the NL-2000 was more accurate than the SW-200 at
slow, moderate and fast paces.
Duncan et al13 investigated the inuence of body
composition on pedometer accuracy and observed no
signicant relationship between BMI, waist circumfer-
ence and body composition on pedometer error. They
did observe, however, that pedometer tilt angle was
associated with the magnitude of pedometer error, par-
ticularly with the Yamax pedometer. It was observed
that the NL-2000 exhibited superior performance than
the Yamax SW-200 at large tilt angles, something which
has also been observed in adults.5 From their study,
Duncan et al13 have proposed that in children, the style
of waistband on their clothing is likely to be the largest
determinant of pedometer tilt and children with loose
tting clothing may experience a reduction in pedometer
accuracy, especially if a spring-levered pedometer is used.
It is therefore suggested that fastening the pedometer to
a belt could minimize errors associated with pedometer
tilt in future studies.
In one of few studies to assess the accuracy and reli-
ability of the Yamax SW-200 pedometer in adolescents,
Jago et al24 observed no signicant effect of pedometer
placement on accuracy in males. It was concluded that
pedometers provide an accurate and reliable assessment
of the amount of activity in which adolescents engage.
Limited data currently exist, however, on the accuracy
of pedometers in female adolescents and further work
should be conducted to access the accuracy of different
pedometers (for example piezo-electric versus spring
levered) in this population.
The pedometer validation studies summarized in
Table 1 have largely focused on the pedometer output of
steps per day, or step counts achieved over a particular
period of time. According to Corder et al,30 pedometer
output should be expressed as steps per day without any
further inference of distance or energy expenditure as
the uncertainty in these predictions may be unaccept-
ably high. Trost31 has also advised against using energy
expenditure estimates from pedometers as the algorithms
for these calculations are derived from adults and may
not be appropriate for children.
In summary, the evidence suggests that in children
above the age of 5, pedometers provide a valid and reli-
able objective measure of total volume of ambulatory
activity. Pedometers are most accurate at normal and fast
walking paces. Further validation evidence is required
before the suitability of pedometers for use in preschool
children can be conrmed. The majority of pedometer
validation studies have focused on the spring-levered
Yamax pedometer. However, emerging evidence has
suggested that pedometers with a piezo-electric mecha-
nism (for example, the New Lifestyles NL series, Kenz
Lifecorder, and Omron HJ-700IT), are more accurate than
the Yamax pedometer range. Piezo-electric pedometers
have been shown to be more accurate than the Yamax
pedometer at all walking speeds,16 and less affected by
tilt angle,13 and their use, as opposed to spring-levered
pedometers, has been recommended in future studies.16
How Many Days of Monitoring?
Research assessing physical activity is typically inter-
ested in quantifying a person’s usual or habitual activity
level.32 Day-to-day uctuations in pedometer-determined
ambulatory activity are not random and can, in part, be
explained by real life uctuations in behavior caused by
factors such as attendance at school and participation in
sports/physical education. The most appropriate moni-
toring frame to estimate habitual ambulatory activity of
children and adolescents is currently unknown. When
considering research design, a balance has to be met
between ensuring the monitoring period is sufcient to
reliably estimate habitual behavior without producing
unnecessary participant burden.
Few studies have investigated the consistency of
pedometer data collected in children and adolescents.
Strycker et al33 reported that at least 5 days of pedom-
eter data are needed in a sample of 10- to 14-year-olds
to reliably (intraclass correlation ≥ 0.8) predict habitual
activity (based upon data collected over a period of 7
days). Vincent and Pangrazi34 have also reported that at
254
Table 2 A Summary of Large-Scale Studies (>100 Children/Adolescents) That Have Used Pedometers to Assess Habitual Activity
in Children and Adolescents, Presented According to Chronological Age of the Sample Surveyed
Authors Sample Pedometer and monitoring frame
Main findings—mean daily step count
(steps/day) of the samples studied Compliance
Cardon
and De Bourdeaudhuij11
59 boys, 63 girls, 4–5 yrs.
Flanders, Belgium
Yamax SW-200, worn unsealed for 5 days Whole sample: 9980; boys: 10,121; girls: 9867
(P > .05)
95%
Tanaka and Tanaka68 127 boys, 85 girls, 4–6 yrs.
Tokyo, Japan
Lifecorder EX worn for 6 days Whole sample: 13,037; boys: 13,650; girls:
12,255 (P < .05)
74%
Sigmund et al52 92 boys, 84 girls, mean age at preschool:
5.7 yrs, rst-grade 6.7 yrs.
Moravian region, Czech Republic
Yamax SW-200, worn unsealed for 7
days, monitoring repeated 1 yr later
Preschool children: boys, weekdays: 11,864;
weekend days: 11,182; Girls, weekdays: 9923;
weekend days: 10,606. First-grade children: boys,
weekdays: 8252; weekend days: 7194; Girls,
weekdays: 7911; weekend days: 6872
72%
Duncan et al40 536 boys, 579 girls, 5–12 yrs.
Auckland, New Zealand
New Lifestyles NL-2000, worn sealed
for 7 days
Boys: weekday 16,132; weekend 12,702; girls:
weekday 14,124; weekend 11,158 (day and sex
P < .05)
91%
Duncan et al42 1513 girls, 5–16 yrs,
Auckland, New Zealand
New Lifestyles NL-2000, worn sealed
for 7 days
Weekday: 12,597; weekend: 9528 92%
Craig et al2,37 11669 children, 5–19 yrs.
Canada
Yamax SW-200, worn unsealed for 7 days Boys: 12,259; girls: 10,906 58%
Belton et al50 153 boys, 148 girls, 6–9 yrs.
Dublin, Ireland
Yamax SW-200, worn sealed for 7 days Whole sample: 15,760; boys: weekday 11,463;
weekend 37,009; girls: weekday 10,434; weekend
32,768 (day and sex P < .05). Normal weight:
16,281; overweight: 13,859; obese: 12,937
60–96%
depending
on analyses
Vincent and Pangrazi60 325 boys, 386 girls, 6–12 yrs.
Southwest US
Yamax SW-200, worn sealed for 4 days Boys: 13,162; girls: 10,923 (P < .05) 75%
Vincent et al44 325 boys, 386 girls (US), 278 boys, 285
girls (Australia), 356 boys, 324 girls
(Sweden), 6–12 yrs
Yamax SW-200, worn sealed for 4 days Boys: range 15,673–18,346 (Sweden), 13,864–
15,023 (Australia), 12,554–13,872 (US); girls:
range 12,041–14,825 (Sweden), 11,221–12,322
(Australia), 10,661–11,383 (US)
Laurson et al69 358 boys, 454 girls, 6–12 yrs,
Lakeville, MN and Cedar Rapids, IA, US
Yamax SW-200, worn unsealed for 7 days Boys: 12,736; girls: 10,852 (P < .01). 59%
Le Masurier et al46 793 boys, 1046 girls, 6–18 yrs.
Phoenix, US
Yamax SW-200/Walk4Life LS2525,
worn sealed for 4 days
Boys: range 12,891–10,329; girls: range 11,237–
9067. Elementary students accumulated more
steps/day than middle and high school students
(continued)
255
Table 2 (continued)
Authors Sample Pedometer and monitoring frame
Main findings—mean daily step count
(steps/day) of the samples studied Compliance
Mitsui et al66 73 boys, 72 girls, 7–11 yrs,
Hashikami Town, Japan
Yamasa EM-180, worn unsealed for 14
days
Boys, school days: 13,586; weekend days: 9531;
girls, school days: 12,248; weekend days: 9419
99%
Raustorp et al70 457 boys, 435 girls, 7–14 yrs. Kalmar,
Oskarshamn and Morbylanga, Sweden
Yamax SW-200, worn sealed for 4 days Boys: range 14,911–18,346; girls: range 12,238–
14,825 (P < .05)
96%
Hands and Parker64 787 boys, 752 girls, 7–15 yrs.
Western Australia
Yamax SW-700, worn sealed for 8 days Boys: 13,194; girls: 11,103 (P < .05) 68%
Telford et al67 389 boys, 387 girls, mean age 8.0 yrs
during rst measurement. Protocol
repeated at 2 and 3 yr follow-up. Canberra,
Australia
Walk 4 Life DUO, unsealed yr 1. New
Lifestyle AT-82, sealed yrs 2 and 3. 7 days
of monitoring
Median steps: boys: yr 1 12,014; yr 2 10,564; yr
3 11,092. Girls: yr 1 9795; yr 2 8475; yr 3 9086.
Across all measurement periods, step counts were
signicantly lower on weekend days
Drenowatz et al51 117 boys, 154 girls, 8–11 yrs.
Iowa, US
Yamax SW-200, worn unsealed for 7 days Boys: 12,086; girls: 10,053 (P < .001) 46%
Duncan et al41 101 boys, 107 girls, 8–11 yrs,
Birmingham, UK
New Lifestyles NL-2000, worn sealed for
4 days
Boys: weekday 14,111; weekend 10,854; girls:
weekday 13,159; weekend 9922 (day and sex P
< .05)
90%
Al-Hazzaa63 296 boys, 8–12 yrs. Riyadh,
Saudi Arabia
Yamax SW-701, worn unsealed for 3 days Whole sample: 13,489; normal weight boys:
14,271; obese boys: 10,602 (P < .01)
Eisenmann et al71 267 boys, 339 girls, mean age: 9.6 yrs.
Midwest US
Yamax SW-200, worn unsealed for 7 days Boys: 12,709; girls: 10,834 (P < .01). Children
not meeting step count guidelines were 2 times
more likely to be overweight/obese
63%
Munakata et al72 105 boys, 111 girls, 9–10 yrs.
Tokushima, Japan
Lifecorder EX (no more information pro-
vided)
Boys: 14,929; girls 12,389 (P < .001)
Coppinger et al48 42 boys, 64 girls, 9–11 yrs.
London, UK
Yamax SW-200, worn sealed for 3 days Boys: 11,959; girls: 10,938. Steps in the same
sample at 1-year follow-up: boys: 12,175; girls:
10,395
88%
Drenowatz et al73 268 girls, 9.5–11.5 yrs.
Lakeville, MN and Cedar Rapids, IA, US
Yamax SW-200, worn unsealed for 7 days Whole sample: 10,822. Early maturing girls had
lower step counts than average and late maturing
girls, but these differences were not independent
of BMI (continued)
256
Authors Sample Pedometer and monitoring frame
Main findings—mean daily step count
(steps/day) of the samples studied Compliance
Maher et al74 1029 boys, 1042 girls. 9–16 yrs,
Australia
New Lifestyles NL-1000, worn for 7 days Step counts stratied by 4 income bands:
1 (wealthiest): 11,196; 2: 11,066; 3: 10,671;
4 (poorest): 10,735
Chia75 350 boys, 527 girls, 9–18 yrs.
Singapore
Yamax SW-200, worn unsealed for 7 days Boys: age 9–12 yrs: 13,563; 13–16 yrs: 9913;
17–18 yrs: 8766. Girls: age 7–12 yrs: 8668;
13–16 yrs: 8637; 17–18 yrs: 8061
97%
Johnson et al47 273 boys, 309 girls, 10-11 yrs.
South-western state, US
Yamax SW-200 and Walk4Life 2505 worn
sealed and unsealed for at least 5 school/
week-days
Boys: 12,853; girls:10,409 (P < .001). Ethnic dif-
ferences: African American: 10,709; Caucasian:
11,668; Hispanic: 11,845. Differences by metro
status: Urban: 10,856; Suburban: 12,297; Rural:
11,934
Rowe et al35 299 children, 10-14 yrs.
North Carolina, US
Yamax SW-200, worn unsealed for 6 days Whole sample: 9338 96%
Strycker et al33 183 boys, 184 girls, 10-14 yrs.
Pacic Northwest, US
Yamax SW-200, worn unsealed for 7 days Whole sample: 10,365; boys: 11,283; girls:
9472 (P < .001)
98%
Loucaides et al65 109 boys, 123 girls, 11-12 yrs,
Cyprus
Yamax DW-200 worn unsealed for 5 days
during summer & winter
Boys: summer 17,651; winter 15,763, girls:
summer 13,701; winter 11,361 (season and sex
P < .05)
86–91%
Loucaides et al61 116 urban and 96 rural children, 11-12 yrs.
Cyprus
Yamax DW-200, worn sealed for 4 days
during summer & winter
Urban children: summer 14,531; winter 13,583;
rural children: summer 16,450; winter 12,436.
Signicant interaction between season and
location
88%
Hohepa et al39 95 males, 141 females, 12-18 yrs.
Auckland, New Zealand
New Lifestyles NL-2000, worn sealed
for 7 days
Boys: 10,849; girls: 9652 (P < .01). Juniors:
11,079; seniors: 9422 (P < .01)
72%
Raustorp and Ekroth49 2000 cohort: 124 boys, 111 girls; 2008
cohort: 79 boys, 107 girls. Both cohorts
aged 13-14 yrs. South eastern Sweden
Yamax SW-200, worn sealed for
4 weekdays
Boys, cohort 2000: 15,623; cohort 2008: 15,174.
Girls, cohort 2000: 12,989; cohort 2008: 13,338
76% and 96%
Hands et al76 330 boys, 362 girls, mean age: 14.1 yrs.
Western Australia
Yamax SW-200, worn unsealed for 7 days Whole sample: 10,747; boys: 11,655; girls: 9920
(P < .001)
Van Dyck77 47 boys, 73 girls, 12-18 yrs.
Flanders, Belgium
Yamax SW-200, worn unsealed for 7 days Adolescents living in an urban neighborhood:
12,055; adolescents living in a suburban neigh-
borhood: 13,426 (P > .05)
Lubans and Morgan62 119 adolescents, 14-15 yrs,
New South Wales, Australia
Yamax SW-701, worn sealed for 4 days Boys: 11,865; girls: 9466 (P < .01) 95%
Wilde et al45 179 males, 190 females, 14-18 yrs,
US
Yamax DW-200, worn sealed for 4 days Boys: range from grades 9–12 10,329–11,564;
girls: range 9068–10,986
61%
Schoeld et al43 415 girls, 15-16 yrs,
Central Queensland, Australia
Yamax SW-700, worn sealed for 4 days Whole sample: 9617 90%
Table 2 (continued)
Pedometry Methods in Children and Adolescents 257
least 5 days of monitoring are needed to reliably predict
pedometer-determined activity in 7- to 12-year-olds,
although data collection in this study was restricted to
after school periods on week days only thus limiting the
application of these ndings. In contrast to Strycker et
al.,33 Rowe et al.,35 have reported that at least 6 consecu-
tive days of monitoring are needed to reliability predict
habitual activity in 10- to 14-year-olds. Rowe et al35
also recommend that this 6-day monitoring period is
preceded by a familiarization day, and that it includes
both weekend days and weekdays. Recently, Craig et
al2 have reported that 2 days of monitoring would be
sufcient to achieve acceptable reliability for population
estimates of step counts in a large sample (n = 11,477)
of 5- to 19-year-olds. However, Craig et al2 caution that
this recommendation is based upon the reliability of
population estimates, and the reliability of step counts at
the individual level are likely to require higher standards
and thus longer monitoring periods.
In a review of objective measures for the assessment
of young people’s physical activity, Dollman et al36 report
that 1 week of pedometer monitoring is necessary to
capture habitual activity. In a similar review, Corder et
al30 have reported that there is evidence to suggest that
between 4–9 full days of monitoring, including 2 week-
end days, are required for reliable estimates of habitual
activity in children and adolescents. However, they go on
to state that while 7 days of monitoring seems logical,
as compliance decreases with increases in the monitor-
ing period, it may be more feasible to opt for 4 full days
with at least 1 weekend day. Corder et al30 acknowledge
that their recommendations for an optimal pedometer
monitoring frame are based upon the reliability of accel-
erometer data in children, and not on pedometer data.
When considering appropriate monitoring frames, it
is also important to consider seasonal and geographical
location differences that impact physical activity levels
of children and adolescents.37,38 According to Corder et
al30 seasonal variations in activity, resulting from changes
in climate, school terms, and school holidays, means that
a single measurement period may not adequately reect
a child’s habitual activity. It is therefore recommended
that if a habitual estimate of activity, dened as an annual
average, is required, measurements should take place over
more than 1 season.30
Pedometer Wear Time
A related issue to the length of monitoring frame is
pedometer wear time. It is common practice to ask
participants to record in a diary the times in which the
pedometer was put on in the morning and taken off at
night, along with any other instances throughout the day
(including duration) where the pedometer was removed.
A number of researchers have excluded data from a
particular day, or all of the data from a participant, if par-
ticipants have reported removing the pedometer for more
than an hour.11,39–50 To enhance comparability between
studies it is recommended that future studies apply the
same protocol of excluding data from a particular day
if participants report removing the pedometer for more
than 1 hour on that day.
There is currently no single accepted criterion for the
identication of how much wear time is necessary to con-
stitute a valid day of pedometer measurement in children
and adolescents.30 Recently, some authors have reported
the wear time criteria applied to distinguish a valid day
of pedometer monitoring. For example, Drenowatz et
al51 included participants in their analyses if their 8- to
11-year-old children reported wearing the pedometer for
at least 10 hours per day on at least 4 days (including 1
weekend day) of the 7-day monitoring period. Similarly,
Sigmund et al52 required 5- to 7-year-olds to wear their
pedometer for at least 8 hours per day on every day of the
7-day monitoring period to be included in the analyses.
To enhance comparability between studies, it is recom-
mended that authors report wear time criteria that have
been applied to constitute a valid day of monitoring. It is
also recommended that standardized wear time criteria
are established for different age groups to aid the stan-
dardization of protocols for the assessment of pedometer-
determined activity in children and adolescents.
Reactivity
When used as a measurement tool, researchers often
provide participants with unsealed pedometers (ie, no
restriction on participants viewing their step count) and
request that they record their daily step count in an activity
diary or step log. However, if activity changes as a result
of wearing the pedometer, dened as reactivity,53 this
could affect the validity of pedometer-determined activ-
ity data. The presence of reactivity is usually examined
by studying whether step counts are higher over the rst
few days of monitoring relative to step counts collected
toward the end of the monitoring period. To date, what
limited evidence there is provides conicting reports on
the presence of reactivity to wearing pedometers in chil-
dren and adolescents. Rowe et al35 reported no evidence
of reactivity occurring in response to wearing unsealed
pedometers over a period of 6 days in a sample of 10- to
14-year-olds. Adopting a similar approach, Craig et al2
also reported no evidence of reactivity in a nationally
representative sample of 5- to 19-year-olds when wear-
ing unsealed pedometers for 7 days. Similarly, Ozdoba
et al54 reported no differences in step counts measured
using sealed (where the visible display of the pedometer
is restricted) and unsealed pedometers worn for 4 days in
each condition in 9- to 10-year-olds, and concluded that
reactivity is not a cause for concern in this age group.
Vincent and Pangrazi34 also reported no evidence of reac-
tivity occurring in response to wearing sealed pedometers
for 8 days in 7- to 12-year-olds.
A limitation of the studies described above employ-
ing sealed pedometers to assess the presence of reactivity,
is the fact that in this condition the participants were
still aware that they were wearing a pedometer, which
in itself may elicit some degree of reactivity. Only when
258 Clemes and Biddle
participants are unaware that their activity levels are
being monitored (termed covert monitoring) can a true
investigation into reactivity be undertaken.55 Recent
evidence from adults has highlighted a reactive effect
occurring in response to wearing unsealed pedometers
when baseline step counts were determined using covert
monitoring.56,57 A second limitation associated with the
above studies is the relatively short monitoring period
applied. Ling et al58 have recently assessed the presence
of reactivity in response to wearing sealed pedometers
(with 7-day memory chips) over a period of 3 weeks in
9- to 12-year-olds. They observed that mean daily step
counts recorded during the rst week of monitoring were
signicantly higher than those recorded during the third
week of monitoring, and suggested that a reactive effect
did occur during the rst week. Using a different approach
to determine the presence of reactivity in response to
wearing unsealed pedometers in third to fth grade chil-
dren, Beets et al59 retrospectively questioned children and
their parents on whether changes in activity levels (child)
occurred or were observed (parent) while the child wore
an unsealed pedometer. It was concluded from this study
that both parents and children perceived a reactive effect
in response to wearing an unsealed pedometer. Further
research using covert monitoring with pedometers with
memory chips, along with extended monitoring peri-
ods, should therefore be conducted into the presence of
reactivity in children, as reactivity, if present, could have
validity implications for short term studies investigating
young people’s habitual activity.
Methods of Data Treatment, Analysis,
and Reporting
A number of studies have successfully used pedometers
for the assessment of ambulatory activity in children
and adolescents30 and these studies are summarized in
Table 2. The primary ndings, in terms of mean daily
step counts, along with the type of pedometer worn, the
sample studied and compliance data (where available) are
also summarized. From the studies reviewed, the moni-
toring frames ranged from 3–8 days, with monitoring
periods of 7 days being the most common. From those
studies providing compliance data, compliance ranged
from 46%–99%. Thirteen (50%) studies with compli-
ance data reported participant compliance rates above
90%. Some studies restricted data collection to weekdays
only,44,47,49,60–63 whereas others included data collected on
both weekdays and weekend days.11,33,35,37,39–43,50,51,64–67
Signicant differences in activity have been reported
between weekdays and weekends, with decreases in
activity generally being reported during the week-
ends,37,40–42,66,67 with the exception of one study which
showed the opposite.50 From the studies reporting a
decrease in activity on weekends, on average step counts
declined by 20% (range: 6%–30%) on weekend days in
comparison with weekdays. It is therefore recommended
that for studies interested in determining habitual activity
that step count data are collected on both weekdays and
on weekend days.
A number of studies reviewed applied specic cri-
teria to pedometer data during data processing to ensure
the reliability and quality of the data. For example,
Rowe et al35 have recommended upper and lower cut-
offs for identifying outliers, of fewer than 1000 steps
and greater than 30,000 steps. They recommend that
data points (step counts) falling beyond these cut-points
are treated as missing data. A number of studies have
subsequently adopted these cut-points and applied them
during data treatment and analysis.37,39,40,42,64,67,74 Craig et
al2 have recently investigated the proportion of children’s
pedometer data falling outside of these cut-points and
examined the effects of truncating step counts outside of
this range to these values. They reported that removal of
step counts < 1000 and > 30,000 had little impact on the
overall derived population estimates for young people’s
mean daily step counts and concluded that this form of
data manipulation does not appear to be warranted in
terms of population estimates of pedometer-determined
physical activity. Craig et al2 have recommended that
researchers report raw estimates of daily step counts in
future surveillance studies to enable comparisons across
studies and different populations.
As highlighted, pedometer output should be
expressed as the number of steps accumulated per day
(steps/day), and this has been the predominant method
of reporting pedometer data in the surveillance studies
reviewed. An advantage of pedometers is the fact that
their relatively simple output, in terms of steps/day, makes
it straight forward to compare walking levels between
populations and between studies due to the limited
number of data reduction techniques required to sum-
marize this type of data.30 Depending upon the research
question, study authors report collecting participant’s
daily step count and using these daily values to calculate
the mean step count for each participant over the course of
the monitoring period. Using the mean step counts for all
participants within the study, or within a particular demo-
graphic group (eg, boys/girls), the mean daily step count
for the sample as a whole (or subgroup) are calculated and
reported. The majority of studies reviewed have reported
that boys have signicantly higher daily step counts than
girls, at all ages, with boys on average accumulating 15%
more steps/day (range: 3%–36%) than girls. It is therefore
common practice to report mean daily step counts for
boys and girls separately. Other categorization variables
commonly applied where appropriate include age group
or school year/grade and BMI since it has been reported
that step counts decline with increasing age39,46,52,75 and
BMI.50,63 Ethnic differences in step counts have also
been reported,47 therefore where relevant it may also be
important to report step count data according to ethnicity.
In addition to reporting mean daily step counts of
the sample, a number of researchers have reported the
Pedometry Methods in Children and Adolescents 259
percentage of participants achieving a particular step
count.41,71 A limitation of this approach, however, is the
fact that there are currently no validated step count cut-
offs for children and adolescents. A number of studies
have used different cut-points thereby eliminating the
possibility of making comparisons across studies of the
number of participants achieving particular cut-points.
For example, Vincent and Pangrazi60 have recommended
that a reasonable standard for girls and boys aged 6–12
years is to accumulate 11,000 and 13,000 steps/day,
respectively. However, Tudor-Locke et al78 have recom-
mended that 6- to 12-year-old girls and boys accumulate
12,000 and 15,000 steps/day. Recently, Tudor-Locke et
al7 have suggested that there is no single steps/day cut-
off that spans across all ages of children and adolescents.
They report that as a preliminary recommendation male
primary/elementary school children should accumulate
13,000–15,000 steps/day, female primary/elementary
school children should accumulate 11,000–12,000 steps/
day, and adolescents should accumulate 10,000–11,700
steps/day. Given the differences in step count recommen-
dations reported in the literature, and until more is known
about the dose-response relationship between step counts
and various health parameters,7 it is recommended that
researchers apply caution when interpreting their nd-
ings in terms of the proportion of participants achieving
a particular step count.
Choice of Pedometer
The most widely used pedometer in large-scale surveil-
lance studies to date has been the spring-levered Yamax
pedometer range. Recently, however, some researchers
have used the piezo-electric New Lifestyles NL-2000
pedometer in large studies.39,40,42 The advantage of
this pedometer over the Yamax SW range is the NL-
series 7-day memory capacity, making this pedometer
capable of storing step counts in 1-day epochs. This is
particularly useful for those studies employing the use
of sealed pedometers. It should be noted however that
newer models of the Yamax pedometer (for example,
the CW-700 which uses the same internal mechanism as
the SW-200) also now includes a 7-day memory chip,
although the use of this device is yet to be reported in
the literature.
When gathering pedometer data there is always a risk
of participants tampering with the pedometer, for example
by shaking it to give the illusion of more steps, or acci-
dentally hitting the reset button and loosing data. Clearly,
such things can compromise the integrity of the data.22
When comparing step counts derived from sealed and
unsealed pedometers in 9- to 10-year-olds, Ozdoba et al54
reported more usable days of data being obtained from
the sealed condition and have therefore recommended
the use of sealed pedometers in research studies, particu-
larly in studies wishing to monitor free-living activity. A
number of surveillance studies (53%) included in Table
2 have used sealed pedometers, which are likely to yield
more reliable data in children and adolescents, at a cost
of increased researcher burden when the pedometer used
has no memory function. For example, the most common
practice applied with the use of sealed pedometers (with
no memory function) is for the researcher to collect the
pedometer from the participant at a set time each morning
(usually upon arrival at school), unseal the pedometer and
record the step counts measured from the previous day,
and then return the resealed pedometer back to the par-
ticipant. This researcher burden is eliminated, however,
when pedometers with multiday memory functions are
used, and it is recommended that for future studies wish-
ing to use sealed pedometers, researchers consider using
pedometers with multiday memory functions.
Summary and Recommendations
The evidence from this review suggests that in children
above the age of 5, pedometers provide a valid and reli-
able objective measure of children’s total volume of
ambulatory activity. However, further validation evidence
is required before the suitability of pedometers for use
in preschool children can be conrmed. The relative low
cost of pedometers makes them a feasible measurement
tool for use in large-scale epidemiological and surveil-
lance studies2,30 where total volume of ambulatory activity
is a desirable outcome. Pedometers have relatively low
burden for both the researcher, in terms of initialization
of the device and data output, and for the participant, in
terms of recording their daily step count at the end of the
day. Compliance to pedometer protocols has generally
been good.
The majority of pedometer validation studies
(reviewed in Table 1) have focused on the spring-levered
Yamax pedometer, and this pedometer has been the most
widely used in surveillance studies assessing pedometer-
determined activity in children. However, evidence has
suggested that pedometers with a piezo-electric mecha-
nism are more accurate than spring-levered pedometers
and their use has been recommended in future studies.16
Optimal monitoring frames to detect habitual activ-
ity in youth have yet to be determined, however the most
common monitoring frame used in surveillance stud-
ies has been 7 consecutive days. There is currently no
accepted criterion for the identication of how much wear
time is necessary to constitute a valid day of pedometer
measurement in children and adolescents. To enhance
comparability between studies it is recommended that
authors report their wear time criteria applied to consti-
tute a valid day of monitoring. It is also recommended
that standardized wear time criteria are established for
different age groups to aid further the standardization of
protocols for the assessment of pedometer-determined
activity in children and adolescents. It has been common
practice to exclude pedometer data from a day when a
participant reports not wearing the pedometer for more
260 Clemes and Biddle
than 1 hour on that particular day. To enhance further the
standardization of processing and reporting of pedometer
data, it is recommended that future studies apply the same
protocol in terms of excluding data from a particular day
where the participant reports removing the pedometer for
more than 1 hour. A number of researchers have excluded
step counts below 1000 steps/day and above 30,000 steps/
day, and treated this as missing data. However, there have
been recent calls for researchers to report raw estimates of
daily step counts in future surveillance studies to enable
comparisons across studies and different populations.2
Evidence suggests that children and adolescents
accumulate signicantly fewer steps during the week-
ends, and it is recommended that for an accurate indi-
cation of habitual activity, pedometer data should be
collected throughout both weekdays and weekend days.
There is evidence to suggest that mean daily step counts
decline with age, and it is recommended that for studies
examining a wide age range, data are reported according
to different age groups. Similarly boys generally report
signicantly higher mean daily step counts than girls
across all ages, and it has become common practice
to report and analyze boys and girls pedometer data
separately. Finally, studies investigating the presence of
pedometer reactivity have produced conicting results in
children. Further work applying covert monitoring with
memory chip pedometers and extended monitoring peri-
ods should be conducted to determine whether reactivity
is a threat to the validity of pedometer-determined activity
data collected in children and adolescents.
A limitation of pedometers, like accelerometers, is
the fact that they only detect ambulatory activity and are
insensitive to nonlocomotor forms of movement,31,36 for
example, cycling. Furthermore pedometers are not capa-
ble of distinguishing levels of activity intensity, duration,
or frequency of activity bouts undertaken throughout the
day.30 They are also susceptible to tampering/data loss36
which could be a larger problem when used with children
as opposed to adults, because they may be viewed as an
interesting ‘toy’ to take apart. However, this can partly
be overcome by the use of sealed pedometers.
Despite these limitations, according to McClain and
Tudor-Locke,6 given young peoples’ activity patterns are
often described as consisting of sporadic and/or intermit-
tent bursts of intense movements, and given the public
health focus of accumulating physical activity throughout
the day, the cumulative record of daily steps provided by
a pedometer is a suitable marker to measure and track in
children and adolescents.
Acknowledgments
The writing of this article was supported by a grant for Project
ALPHA, funded by the EU Commission Director General
Public Health [DG SANCO] as part of Work Package 4.4 (PI:
Professor Fiona Bull). This package was led by the British Heart
Foundation National Centre for Physical Activity & Health at
Loughborough University, UK.
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