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

Marco Giurgiu; Simon Kolb; Carina Nigg; Alexander Burchartz; Irina Timm; Marlissa Becker; Ellen Rulf; Ann-Kathrin Doster; Elena Koch; Johannes B J Bussmann; Claudio Nigg; Ulrich W Ebner-Priemer; Alexander Woll

doi:10.1136/bmjsem-2021-001267

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

BMJ Open Sport Exerc Med. 2022 May 12;8(2):e001267. doi: 10.1136/bmjsem-2021-001267. eCollection 2022.

Authors

Marco Giurgiu^{1

2}, Simon Kolb¹, Carina Nigg^{1

3}, Alexander Burchartz¹, Irina Timm¹, Marlissa Becker⁴, Ellen Rulf¹, Ann-Kathrin Doster¹, Elena Koch¹, Johannes B J Bussmann⁵, Claudio Nigg⁶, Ulrich W Ebner-Priemer^{2

7}, Alexander Woll¹

Affiliations

¹ Department of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
² Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
³ Department of Sport Pedagogy, University of Bern, Bern, Switzerland.
⁴ Department of Orthopedics, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁵ Department of Rehabilitation Medicine and Physical Therapy, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶ Department of Health Science, University of Bern, Bern, Switzerland.
⁷ Department of Sports and Sports Science, Institute of Sports and Sports Science, Karlsruhe, Germany.

Abstract

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.

Keywords: accelerometer; physical activity; sedentary; sleep; validation.

Publication types

Systematic Review