title: Validity and usability of low-cost accelerometers for internet-based self-monitoring of physical activity in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life.
  
  
  OBJECTIVE
  Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients' preferences with regards to the presentation of and feedback on monitored physical activity.
  
  
  METHODS
  To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device
  
  
  RESULTS
  The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices.
  
  
  CONCLUSIONS
  The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients.
authors.affiliation: Rijnlands Rehabilitation Center, Department of Cardiac and Pulmonary Rehabilitation, Leiden, Netherlands. m.vooijs@rrc.nl.
authors.forename: Martijn
authors.identifier: http://orcid.org/0000-0002-3303-7171
authors.initials: M
authors.lastname: Vooijs
authors.forename: Laurence L
authors.identifier: http://orcid.org/0000-0002-8243-0607
authors.initials: LL
authors.lastname: Alpay
authors.forename: Jiska B
authors.identifier: http://orcid.org/0000-0002-3598-7971
authors.initials: JB
authors.lastname: Snoeck-Stroband
authors.forename: Thijs
authors.identifier: http://orcid.org/0000-0002-8998-3407
authors.initials: T
authors.lastname: Beerthuizen
authors.forename: Petra C
authors.identifier: http://orcid.org/0000-0003-0005-4407
authors.initials: PC
authors.lastname: Siemonsma
authors.forename: Jannie J
authors.identifier: http://orcid.org/0000-0002-0397-5554
authors.initials: JJ
authors.lastname: Abbink
authors.forename: Jacob K
authors.identifier: http://orcid.org/0000-0002-5840-0651
authors.initials: JK
authors.lastname: Sont
authors.forename: Ton A
authors.identifier: http://orcid.org/0000-0002-6226-2060
authors.initials: TA
authors.lastname: Rövekamp
keywords: accelerometers; activity monitoring; chronic obstructive pulmonary disease; usability; validity