title: Predicting physical activity energy expenditure in wheelchair users with a multisensor device.
abstract: OBJECTIVE
  To assess the error in predicting physical activity energy expenditure (PAEE), using a multisensor device in wheelchair users, and to examine the efficacy of using an individual heart rate calibration (IC) method.
  
  
  METHODS
  15 manual wheelchair users (36±10 years, 72±11 kg) completed 10 activities: resting, folding clothes, wheelchair propulsion on a 1% gradient (3456 and 7 km/h) and propulsion at 4 km/h (with an additional 8% of body mass, 2% and 3% gradient) on a motorised wheelchair treadmill. Criterion PAEE was measured using a computerised indirect calorimetry system. Participants wore a combined accelerometer and heart rate monitor (Actiheart). They also performed an incremental arm crank ergometry test to exhaustion which permitted retrospective individual calibration of the Actiheart for the activity protocol. Linear regression analysis was conducted between criterion (indirect calorimetry) and estimated PAEE from the Actiheart using the manufacturer's proprietary algorithms (group calibration, GC) or IC. Bland-Altman plots were used and mean absolute error was calculated to assess the agreement between criterion values and estimated PAEE.
  
  
  RESULTS
  Predicted PAEE was significantly (p<0.01) correlated with criterion PAEE (GC, r=0.76 and IC, r=0.95). The absolute bias ±95% limits of agreement were 0.51±3.75 and -0.22±0.96 kcal/min for GC and IC, respectively. Mean absolute errors across the activity protocol were 51.4±38.9% using GC and 16.8±15.8% using IC.
  
  
  CONCLUSIONS
  PAEE can be accurately and precisely estimated using a combined accelerometer and heart rate monitor device, with integration of an IC. Interindividual variance in cardiovascular function and response to exercise is high in this population. Therefore, in manual wheelchair users, we advocate the use of an IC when using the Actiheart to predict PAEE.
authors.affiliation: Department for Health , Centre for DisAbility Sport and Health (DASH), University of Bath , Bath , UK.
authors.forename: T E
authors.initials: TE
authors.lastname: Nightingale
authors.affiliation: Department for Health , Centre for DisAbility Sport and Health (DASH), University of Bath , Bath , UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Walhin
authors.affiliation: Department for Health , Centre for DisAbility Sport and Health (DASH), University of Bath , Bath , UK.
authors.forename: D
authors.initials: D
authors.lastname: Thompson
authors.affiliation: Department for Health , Centre for DisAbility Sport and Health (DASH), University of Bath , Bath , UK.
authors.forename: J L J
authors.initials: JL
authors.lastname: Bilzon
keywords: Disability; Multi-sensor; Physical Activity; Spinal Cord Injury