Real-time human ambulation, activity, and physiological monitoring:taxonomy of issues, techniques, applications, challenges and limitations

Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions

CaloriNet: From silhouettes to calorie estimation in private environments

We propose a novel deep fusion architecture, CaloriNet, for the online estimation of energy expenditure for free living monitoring in private environments, where RGB data is discarded and replaced by silhouettes. Our fused convolutional neural network architecture is trainable end-to-end, to estimate calorie expenditure, using temporal foreground silhouettes alongside accelerometer data. The network is trained and cross-validated on a publicly available dataset, SPHERE_RGBD + Inertial_calorie. Results show state-of-the-art minimum error on the estimation of energy expenditure (calories per minute), outperforming alternative, standard and single-modal techniques.Comment: 11 pages, 7 figure

Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review.

BACKGROUND Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking. OBJECTIVE This study aimed to raise researchers' and consumers' attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies. METHODS Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time). RESULTS Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk. CONCLUSIONS Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity

Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review

Background: Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking. Objective: This study aimed to raise researchers’ and consumers’ attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies. Methods: Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time). Results: Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk. Conclusions: Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity

Advancing the measurement of sedentary behaviour : classifying posture and physical (in-)activity

Sedentary behaviour, defined by a sitting body posture with minimal-intensity physical activity, is an emergent public health topic. The time spent sedentary is associated with the incidence of non-communicable chronic diseases such as type 2 diabetes and cardiovascular disease and significantly shortens life-expectancy in a dose-response relationship. Office workers are at particular risk of developing diseases related to sedentary behaviour due to their excessive sedentary work. Even though thigh-worn posture sensors are recommended to measure sedentary behaviour, the vast majority of the evidence was collected with waist-worn physical activity sensors, and we still lack a method to measure the posture and the physical activity component of sedentary behaviour simultaneously. This thesis aims to advance the measurement of sedentary behaviour in an office context by developing new device-based methods to measure both components simultaneously, and by validating and subsequently applying the most promising method to measure the actual amount of sedentary behaviour in the daily life of office workers. The method development showed that it is possible to measure both components of sedentary behaviour with only one sensor, preferably worn on the thigh or waist. While an accelerometer is sufficient for the thigh, an inertial-measurement-unit is preferable for the waist due to a significantly improved posture classification. The method validation subsequently confirmed that waist-worn physical activity sensors, the prevailing choice to measure sedentary behaviour, measure minimal-intensity physical activity. Furthermore, the study uncovered a serious postural dependency causing a systematic overestimation of minimal-intensity physical activity while sitting compared to standing. The subsequent method application considered the posture dependency and combined a thigh-worn posture sensor with a waist-worn physical activity sensor to POPAI, the Posture and Physical Activity Index. POPAI has a sensitivity of 92.5% and a specificity of 91.9% to measure sedentary behaviour and classified 45.0% of the office workers wake-time sedentary. The posture sensor alone overestimated sedentary time by 30.3%, and the physical activity sensor alone overestimated sedentary time by 22.5%. The difference can be explained by active sitting (2.0 hours per day) and inactive standing (1.8 hours per day), both of which are much more common than previously thought. This thesis confirms the recommendation to use a thigh-worn accelerometer to measure sedentary behaviour and adds the information that such a sensor is also able to measure physical (in-)activity in sitting. Thus, there is no need to approximate sedentary behaviour with sitting, nor is there a need to approximate it with inactivity. In fact, these approximations lead to inaccurate and imprecise results substantially overestimating sedentary behaviour. Due to the predominant use of physical activity sensors to measure sedentary behaviour, recommendations to limit sedentary behaviour should address a limitation of the time spent inactive rather than the time spent sitting. If it turns out that sitting matters, one could expect a much stronger relationship between sedentary behaviour measured with a combined method such as POPAI and detrimental health effects

Assessment of 24-hour physical behaviour in children and adolescents via wearables: a systematic review of free-living validation studies

Objectives: Studies that assess all three dimensions of the integrative 24-hour physical behaviour (PB) construct, namely, intensity, posture/activity type and biological state, are on the rise. However, reviews on validation studies that cover intensity, posture/activity type and biological state assessed via wearables are missing. Design: Systematic review. The risk of bias was evaluated by using the QUADAS-2 tool with nine signalling questions separated into four domains (ie, patient selection/study design, index measure, criterion measure, flow and time). Data sources: Peer-reviewed validation studies from electronic databases as well as backward and forward citation searches (1970–July 2021). Eligibility criteria for selecting studies: Wearable validation studies with children and adolescents (age <18 years). Required indicators: (1) study protocol must include real-life conditions; (2) validated device outcome must belong to one dimension of the 24-hour PB construct; (3) the study protocol must include a criterion measure; (4) study results must be published in peer-reviewed English language journals. Results: Out of 13 285 unique search results, 76 articles with 51 different wearables were included and reviewed. Most studies (68.4%) validated an intensity measure outcome such as energy expenditure, but only 15.9% of studies validated biological state outcomes, while 15.8% of studies validated posture/activity type outcomes. We identified six wearables that had been used to validate outcomes from two different dimensions and only two wearables (ie, ActiGraph GT1M and ActiGraph GT3X+) that validated outcomes from all three dimensions. The percentage of studies meeting a given quality criterion ranged from 44.7% to 92.1%. Only 18 studies were classified as ‘low risk’ or ‘some concerns’. Summary: Validation studies on biological state and posture/activity outcomes are rare in children and adolescents. Most studies did not meet published quality principles. Standardised protocols embedded in a validation framework are needed

Assessment of 24-hour physical behaviour in children and adolescents via wearables: a systematic review of free-living validation studies.

Objectives Studies that assess all three dimensions of the integrative 24-hour physical behaviour (PB) construct, namely, intensity, posture/activity type and biological state, are on the rise. However, reviews on validation studies that cover intensity, posture/activity type and biological state assessed via wearables are missing. Design Systematic review. The risk of bias was evaluated by using the QUADAS-2 tool with nine signalling questions separated into four domains (ie, patient selection/study design, index measure, criterion measure, flow and time). Data sources Peer-reviewed validation studies from electronic databases as well as backward and forward citation searches (1970-July 2021). Eligibility criteria for selecting studies Wearable validation studies with children and adolescents (age <18 years). Required indicators: (1) study protocol must include real-life conditions; (2) validated device outcome must belong to one dimension of the 24-hour PB construct; (3) the study protocol must include a criterion measure; (4) study results must be published in peer-reviewed English language journals. Results Out of 13 285 unique search results, 76 articles with 51 different wearables were included and reviewed. Most studies (68.4%) validated an intensity measure outcome such as energy expenditure, but only 15.9% of studies validated biological state outcomes, while 15.8% of studies validated posture/activity type outcomes. We identified six wearables that had been used to validate outcomes from two different dimensions and only two wearables (ie, ActiGraph GT1M and ActiGraph GT3X+) that validated outcomes from all three dimensions. The percentage of studies meeting a given quality criterion ranged from 44.7% to 92.1%. Only 18 studies were classified as 'low risk' or 'some concerns'. Summary Validation studies on biological state and posture/activity outcomes are rare in children and adolescents. Most studies did not meet published quality principles. Standardised protocols embedded in a validation framework are needed. PROSPERO registration number CRD42021230894

Continuous physical activity recording - Consumer-based activity trackers in epidemiological studies

Physical activity is an important modifiable lifestyle factor that can improve general health and reduce the risk of disease. Currently, collecting data on physical activity in epidemiological studies are generally limited to long-term but self-reported and inaccurate physical activity questionnaires and/or using short-term but objective and more accurate accelerometers. Consumer-based activity trackers are designed for long-term objective data collection and can therefore potentially be used to close this gap. The objective of this dissertation was therefore to explore and develop new methods for collecting data on physical activity in epidemiological studies using consumer-based activity trackers. The four included papers apply different methods to explore the objective from multiple angles. Results includes an overview of how activity tracker sensor support has changed over time, recommendations when choosing an activity tracker model for future physical activity research, recommendations for increasing activity tracker wear time among participants in clinical studies, as well as knowledge about activity tracker validity and physical activity trends during the Norwegian COVID-19 lockdown in 2020. Finally, the dissertation describes a system for automatic and continuous data collection using consumer-based activity trackers from multiple providers. We show the usability of this system by accessing and analysing historic activity tracker data from participants who wore a tracker before-, during-, and after the COVID-19 lockdown period. The proposed system can be a valuable addition to existing methods for physical activity assessment by contributing to closing the above-mentioned method gap