title: Accuracy of a step counter during treadmill and daily life walking by healthy adults and patients with cardiac disease.
abstract: Step counters have been used to observe activity and support physical activity, but there is limited evidence on their accuracy.
  
  
  
  The purpose was to investigate the step accuracy of the Fitbit Zip (Zip) in healthy adults during treadmill walking and in patients with cardiac disease while hospitalised at home.
  
  
  
  Twenty healthy adults aged 39±13.79 (mean ±SD) wore four Zips while walking on a treadmill at different speeds (1.7-6.1 km/hour), and 24 patients with cardiac disease (age 67±10.03) wore a Zip for 24 hours during hospitalisation and for 4 weeks thereafter at home. A Shimmer3 device was used as a criterion standard.
  
  
  
  At a treadmill speed of 3.6 km/hour, the relative error (±SD) for the Zips on the upper body was -0.02±0.67 on the right side and -0.09 (0.67) on the left side. For the Zips on the waist, this was 0.08±0.71 for the right side and -0.08 (0.47) on the left side. At a treadmill speed of 3.6 km/hour and higher, the average per cent of relative error was <3%. The 24-hour test for the hospitalised patients showed a relative error of -47.15±24.11 (interclass correlation coefficient (ICC): 0.60), and for the 24-hour test at home, the relative error was -27.51±28.78 (ICC: 0.87). Thus, none of the 24-hour tests had less than the expected 20% error. In time periods of evident walking during the 24 h test, the Zip had an average per cent relative error of <3% at 3.6 km/hour and higher speeds.
  
  
  
  A speed of 3.6 km/hour or higher is required to expect acceptable accuracy in step measurement using a Zip, on a treadmill and in real life. Inaccuracies are directly related to slow speeds, which might be a problem for patients with cardiac disease who walk at a slow pace.
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Charlotte Brun
authors.initials: CB
authors.lastname: Thorup
authors.affiliation: Department of Cardiothoracic Surgery, Aalborg University Hospital, Denmark.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Jan Jesper
authors.identifier: 0000-0002-2382-3734
authors.initials: JJ
authors.lastname: Andreasen
authors.affiliation: Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.|Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Erik Elgaard
authors.identifier: 0000-0001-6293-0447
authors.initials: EE
authors.lastname: Sørensen
authors.affiliation: Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Grønkjær
authors.affiliation: Laboratory of Assistive Technologies-Telehealth and Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Birthe Irene
authors.initials: BI
authors.lastname: Dinesen
authors.affiliation: Laboratory for Cardio Technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: John
authors.identifier: 0000-0003-4989-8117
authors.initials: J
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D015444:Exercise; D005260:Female; D000072936:Fitness Trackers; D064368:Healthy Volunteers; D006331:Heart Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D016138:Walking; D000072797:Walking Speed
keywords: Accuracy; Activity monitor; Exercise; Step counter; validation study