title: Estimation of Physical Activity Energy Expenditure during Free-Living from Wrist Accelerometry in UK Adults.
abstract: BACKGROUND
  Wrist-worn accelerometers are emerging as the most common instrument for measuring physical activity in large-scale epidemiological studies, though little is known about the relationship between wrist acceleration and physical activity energy expenditure (PAEE).
  
  
  METHODS
  1695 UK adults wore two devices simultaneously for six days; a combined sensor and a wrist accelerometer. The combined sensor measured heart rate and trunk acceleration, which was combined with a treadmill test to yield a signal of individually-calibrated PAEE. Multi-level regression models were used to characterise the relationship between the two time-series, and their estimations were evaluated in an independent holdout sample. Finally, the relationship between PAEE and BMI was described separately for each source of PAEE estimate (wrist acceleration models and combined-sensing).
  
  
  RESULTS
  Wrist acceleration explained 44-47% between-individual variance in PAEE, with RMSE between 34-39 J•min-1•kg-1. Estimations agreed well with PAEE in cross-validation (mean bias [95% limits of agreement]: 0.07 [-70.6:70.7]) but overestimated in women by 3% and underestimated in men by 4%. Estimation error was inversely related to age (-2.3 J•min-1•kg-1 per 10y) and BMI (-0.3 J•min-1•kg-1 per kg/m2). Associations with BMI were similar for all PAEE estimates (approximately -0.08 kg/m2 per J•min-1•kg-1).
  
  
  CONCLUSIONS
  A strong relationship exists between wrist acceleration and PAEE in free-living adults, such that irrespective of the objective method of PAEE assessment, a strong inverse association between PAEE and BMI was observed.
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Tom
authors.identifier: http://orcid.org/0000-0001-8456-0803
authors.initials: T
authors.lastname: White
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Westgate
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Soren
authors.initials: S
authors.lastname: Brage
mesh_terms: D061725:Accelerometry / Q000379:methods / Q000706:statistics & numerical data*; D000328:Adult; D000465:Algorithms; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000517:prevention & control; D004734:Energy Metabolism / Q000502:physiology*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D009765:Obesity / Q000503:physiopathology / Q000517:prevention & control; D011446:Prospective Studies; D015203:Reproducibility of Results; D006113:United Kingdom; D014953:Wrist / Q000502:physiology*