Introduction

Physical activity wearable devices are a popular and growing market for monitoring
physical activity, energy expenditure, sleep, and other health behaviors. Triaxial accelerometers
have been the gold standard, objective method, for assessing physical activity in field-based
research because they are small, non-invasive, easy-to use, and provide an objective indication
of physical activity behavior (Bassett 2012, Freedson 2012, Welk 2012). While still widely used
in research, companies have now begun to target a larger consumer market. Consumer-based
activity monitors became available in 2008-2009 when FitBit released its first wearable tracker.
FitBit became popular because it engages consumers and provides them with accurate data
related to physical activity at their fingertips through interactive applications on smartphones
(Lyons 2014, Cadmus-Bertram 2015, Almalki 2013). These consumer-based activity monitors
provide consumers and health professionals with the ability to estimate levels of physical activity
by day and track data across time. With technological advances, companies at the forefront of
the market, FitBit and Jawbone, are now focused on enhancing their monitoring technologies to
create more comprehensive and useful self-monitoring tools to help consumers track activity in
free-living.
These technologies include pedometers, global positioning systems (GPS), and heart
rate (HR) monitors. Pedometers and GPS have been calibrated to provide measurements such
as exercise intensity and energy expenditure. HR monitors, originally marketed to athletes, have
been modified and marketed to appeal to recreational consumers interested in health and
weight control and to health professionals interested in objective tracking for their clients during
free-living activities. A company has developed a new accelerometry based medical-grade
device, Metria IH1 (IH1), which has incorporated additional sensors to monitor sleep quality via
heat flux and galvanic skin response (GSR). The IH1 was designed for patients with disease or
patients attempting weight loss. GSR provides a mechanism to determine how much the
individual is sweating through changes in the skins electrical conductivity. Skin temperature is
also reflective of activity level. Heat flux determines how much heat is being produced by your
muscles and radiated into the ambient environment. Collectively, data from the sensors is
claimed to measure calorie burn with less than 10 percent error (McGrath 2013). In addition,
these sensors also measure sleep quantity and quality. Due to the continual technological
advances and release of research-grade activity trackers, data must be obtained related to the
validity under free-living conditions to assist consumers, health professionals, and researchers
in making informed decisions when selecting the appropriate model of an activity tracker. The
consumer based physical activity trackers were previously validated through several various
comparison measures. Validity for steps were compared against manual counts, pedometer
counts, video analysis, and step counts measured by the Actigraph GT3X+. Trackers worn at
the hip generally outperformed trackers worn at the wrist for step counts (Simpson 2015).
Energy expenditure was validated through direct and indirect calorimetry. There were no
substantial differences in energy expenditure correlations between devices being worn on the
hip or wrist (Diaz 2015, Evenson 2015).
The purpose of the study is to compare the leading two commercial physical activity
tracking devices, FitBit Surge (FS) and Jawbone UP3 (JU3), and one medical-grade physical
activity tracking device, Metria IH1, against validated laboratory equipment, EKG Cardiac
Science heart rate monitor and Metabolic System Maxx-II, to analyze the validity of the following
constructs: Heart rate, step count, and energy expenditure. This study will parallel what a typical
individual would do during an independent workout of moderate intensity which was completed
in a laboratory setting. The (IH1) is currently being used for tracking accelerometer based data
in the areas of fitness and lifestyle.

Methods
Participants
Fourteen apparently healthy college-age men (n=12) and women (n=3) were recruited
through word of mouth and class announcements during the fall semester 2015 at a small
private university in the Midwest. All participants met the following inclusion criteria through a
physical activity readiness questionnaire (PAR-Q+): 1) 18 years and older, 2) no
musculoskeletal limitations, 3) no recent surgeries in the past six months, 4) not prescribed any
medications that affect body weight or metabolism, 5) no current tobacco use, 6) participants
need to own an Android or Apple smartphone, and 7) no adhesive, latex, or nickel allergies. All
participants were made aware of the purpose and procedures of the study prior to signing a
release of liability and informed consent.
Instruments
Jawbone UP3 (JU3) The Jawbone UP3 (Jawbone, San Francisco, CA) is a triaxial
accelerometer. Bio-impedance markers include heart rate, respiration, and galvanic skin
response (GSR). Jawbone quantitatively presents the user with information on caloric
expenditure, steps taken, sleep quality, and heart rate.
Fitbit Surge (FS) The FS (Fitbit Inc., San Francisco, CA) is a triaxial accelerometer and
gyroscope that can measures steps taken, floors climbed, distance traveled, caloric
expenditure, sleep quality, and heart rate (HR).
MetriaIH1 Lifestyle Assessment System (IH1) (Avery Dennison Corporation., Pasadena, CA)
includes a triaxial accelerometer along with physiological sensors: skin temperature sensor,
near body temperature sensor and a galvanic skin response (GSR) that estimates the
conductivity of the skin. IH1 collects a plethora of data every minute for 24 hours up to 7 days,
providing an accurate indication of the participants lifestyle including caloric expenditure, activity
level, steps taken, and sleep duration and quality.
EKG Cardiac Science - CareCenter MD (Waukesha, WI) allows the researching team to
monitor the participants heart rate and rhythm during the various exercise modalities. Heart rate
variability will be compared between the modalities. The (make and model) will allow viewing
and analysis, of heart rate and rhythm, between the pre and post-test sessions.
Metabolic System Maxx-II (AEI Technologies, Pittsburgh, PA) will analyze the participants O2
and CO2 levels via breath by breath analysis. Through the metabolic system the participants
energy expenditure will be determined. Data collected through the metabolic system will then be
exported to Excel for further data extrapolation.
Procedures
Participants attended two sessions located in a graduate exercise physiology laboratory
at a small private university in the Midwest. The initial informational was used to record baseline
information, such as the participants height, weight, gender, and date of birth. Weight was
measured to the nearest 0.1 kg with the participants in lightweight shorts and t-shirt, and without
shoes. Height was measured to the nearest 0.1 cm with participants not wearing shoes.
Participants were instructed to download the Fitbit and UP applications (apps) on their personal
smartphone. Participants entered their recorded baseline information into the apps to ensure the
greatest accuracy in energy expenditure values. Participants then watched a video on how to
properly place the FS, on the right wrist, and the JU3, on the left wrist, as well as basic wearing
and upkeep instructions. The researchers synced the devices to the participants smartphones.

A three-inch by three-inch area was then cleansed with an alcohol wipe and dried for two
minutes per the manufacturer's instructions for placement of the IH1 patch. The IH1 patch was
activated and then placed on the medial left triceps. The patch was applied and immediately
held on the participants arms for thirty seconds to ensure adhesion. Participants could carry on
normal daily activities once the tracking devices had been placed. Lastly, the participants
received a handout that regarded their four hour fast prior to data collection the next day with
dietary recommendations. A food log with examples on how to record was given, as well, diet
recommendations for their meal prior to testing will be to consume a light meal consisting of
protein and carbohydrates, limiting fat (400 calories).
After 24 hours passed, participants reported back to the laboratory, dressed in the same
shorts, t-shirt, and shoes worn during the informational session with the FS on right wrist and
JU3 on left wrist. Participants were asked to turn in their dietary food log regarding their pre-test
meal. They then rested for five minutes for collection of resting vitals; heart rate, blood pressure,
and EKG. The following activities were chosen for analyses, after extensive discussions, on the
basis that moderate to vigorous physical activity has established health benefits which are
widely supported in scientific literature and because it is the focus of public health physical
activity guidelines (Diaz 2015). The participants walked and jogged on the treadmill (Woodway
Continuum) at four different intensities for three to four minutes. Duration of time for each
activity was determined by when the participants reached their steady state heart rate plus two
minutes. Intensities are classified as slow (1.9 mph), moderate (3.0 mph), brisk (4.0 mph), and
jogging (5.2 mph). The participants then cycled (Monark Ergomedic 828E) at a moderate
intensity of 50 revolutions per minute (RPM) at a resistance of 60 Watts for three to four minutes
until steady state heart rate was reached. Participants then performed a resistance training
exercise, the bench press at 6-8% body weight (BW) in kilograms. Participants achieved a
steady-state HR of 30% heart rate reserve (HRR) and continued to perform the bench press for
two to three minutes, at a pace of 60 beats/minute set by a metronome. Exercise order was
randomly selected via a random number generator. Participants were randomly selected to
perform two additional activities for re-test. Participants were unaware that they were being retested so results would not be biased. The participants were monitored by a 12 lead EKG,
Cardiac Science - CareCenter MD, to monitor heart rate and heart rhythm during the various
activities in order to classify exercise intensity. Indirect calorimetry was measured through the
use of a metabolic cart, Maxx II - AEI Technologies. Steps were counted manually in order to
compare with step counts from IH1 and FS.
During the next five days, participants were instructed to simultaneously wear the FS
and JU3 trackers for approximately one-24 hour period in order to capture a full 24 hours of
activity data. The wear period was not limited to a particular period of the week, and no
guidelines or restrictions on activity levels or sleep were provided, however, the participants
were highly encouraged to engage in moderate intensity physical activity during that 24 hour
period. This ensured that the study broadly represented free living conditions.
On day six, the participants returned to the exercise physiology laboratory; the IH1 patch
was removed by a researcher, and then the FS and JU3 were turned in. Data collection took
place in November 2015.
Data Analysis
Descriptive analyses of laboratory and demographic data were conducted to examine
associations between the consumer based physical activity trackers and IH1 to standardized
laboratory grade equipment, specifically looking at validity of step count, energy expenditure,

and heart rate. The JU3 physical activity tracker was omitted from individual protocol analysis
because the activity tracker did not report minute-by-minute data.
Step count validity was determined by comparing the consumer level physical activity
trackers with manually counted observed steps for each protocol and for total steps. The validity
of energy expenditure was measured through the Maxx II and compared to the recorded
energy expenditure from the three devices for each protocol and totals. Heart rate validity was
analyzed through maximum heart rate recorded per protocol for the FS in comparison with the
Cardiac Science EKG through mean absolute difference (MAD).
Bland altman plots with corresponding limits of agreement and fitted lines (from
regression analyses between mean and difference) with their corresponding parameters were
presented. A fitted line that provides a slope of 0 and an intercept of 0 signifies perfect
agreement. MAD and Pearsons r were also calculated to provide an indicator of overall
measurement error and linear correlation, respectively. MAD is a measure of statistical
dispersion equal to the average absolute difference of two independent variables, calculated
from a probability distribution. These methods of analysis were chosen because of predicted
outliers and skewed data.
Results
A total of fourteen participants agreed to participate in the study. However, due to subject
illness, non-compliance, data extraction error, and device malfunction only eight participants
data was analyzed. Gender distribution was significantly skewed with eight males (Age 22 1.4)
and two females (Age 21.5 2.1). Additional descriptive statistics for participants are provided in
Table 1.
Table 1. Physical characteristics of male (n=6) and female (n=2) subjects
Male
Range
Female
Age (yrs)
22 1.4
20.0 - 24.0
21.5 2.1

Range
20.0 - 23.0

Height (cm)

177.7 7.9

164.0 - 185.7

161.3 3.6

158.8 - 163.8

Weight (kg)

89.6 15.4

64.9 - 106.6

59.6 1.6

58.5 - 60.8

BMI (kg/m2)

28.3 3.2

24.2-32.6

23 1.7

21.8-24.2

Yrs: years of age

Kg: kilograms

Cm: centimeters
BMI: body mass index

Table 2 shows the correlations and MAD between energy expenditure (kilocalories) and
steps between the consumer based physical activity trackers compared to laboratory grade
equipment. All of the consumer based physical activity trackers measured total steps and
energy expenditure. Energy expenditure measured for FS, JU3, and IH1 had moderate
correlations with the laboratory grade equipment (r=0.51-0.65). Correlations between the
physical activity trackers and observed steps ranged from poor for JU3 (0.08) to very strong for
IH1 (r=0.94)
Table 2. Pearson r and MAD of kcals and steps in laboratory
Kilocalories
Pearson R
MAD
Pearson R
Fitbit 1.9
0.181
7.43
0.94
Fitbit 3.0
0.191
6.10
0.88
Fitbit 4.0
0.513
7.64
0.93
Fitbit 5.2
0.179
12.39
0.58
Fitbit Cycle
0.102
7.85
n/a

Steps
MAD
59.09
57.81
89.25
69.14
2.49

Fitbit BP
Fitbit Total
JU3 Total
Metria 1.9
Metria 3.0
Metria 4.0
Metria 5.2
Metria cycle
Metria BP
Metria total
BP: bench press

0.49
0.56
0.65
0.09
-0.05
-0.11
0.44
0.17
0.45
0.51
JU3: Jawbone UP3

8.69
48.42
61.34
3.09
4.08
8.60
9.17
8.17
6.09
43.42

n/a
0.52
0.08
0.68
0.86
0.96
0.94
n/a
n/a
0.94

108.51
316.92
484.50
51.89
58.37
75.62
50.12
n/a
n/a
228.44

Table 3 depicts the correlation between each protocol for the FS and Cardiac Science
EKG. Recorded heart rate for JU3 was not analyzed in the laboratory or free living due to
smartphone consumer based app only reporting resting and passive heart rate. FS heart rate
was compared to the average of steady state heart rate recorded by Cardiac Science EKG.
Cycling and 4.0 mph had the best correlation (r=0.80-0.89), with the largest MAD, while bench
press reported the worst correlation (r=0.26). The cycling protocol had the largest MAD (20.69).
Table 3. Pearson r and MAD for heart rate in laboratory between FS and Cardiac Science EKG
Pearson R
MAD
1.9 mph
0.47
11.90
3.0 mph
0.61
8.13
4.0 mph
0.89
11.40
5.2 mph
0.56
8.50
cycle
0.80
20.68
BP
0.26
14.92
Table 4 represents an average 24-hour daily routine for each participant. FS for both
steps and total energy expenditure had the strongest correlation when compared to the IH1
(r=0.97). JU3 had a moderate correlation for total energy expenditure (r=0.82) and a strong
correlation for total steps (r=0.92).
Table 4. Pearson r and MAD of FS and JU3 in freeliving
Freeliving Total Steps
Pearson R
FitBit vs Metria Total Steps
0.97
Jawbone vsThe Metria Total Steps
0.92
Freeliving Total Calories
Pearson R
FitBit vs Metria Total Calories
0.97
Jawbone vs Metria Total Calories
0.82

MAD
5403.65
4889.11
MAD
659.96
691.22

Figure 1 shows a scatterplot analyzing the Pearsons r against the MADs for the total
steps and kcals of various physical activity tracking devices within the free-living setting.
Correlations and difference varied between the two physical activity trackers. Kilocalories had
the strongest correlation and smallest differences for the Fitbit, followed by steps.

Table 5. Means (SD), MAD, and Bland Altman output for each device in the laboratory setting on
the constructs of total steps and kcals
FitBit Surge

Jawbone UP3

Metria IH1

Total Steps
Mean (SD)

2766.87 345.68

2253.25 1076.26

2217.12 304.53

0.52

0.08

.94

MAD

316.93

484.50

228.44

Bias

415.87

-97.75

-133.87

CI - Lower

160.11

-1006.20

-221.95

CI - Upper

671.63

810.70

-45.79

Total Calories
Mean (SD)

254.87 66.86

261.28 120.05

158.30 26.71

0.56

0.65

0.51

MAD

48.42

61.34

43.42

Bias

43.23

59.30

-53.33

CI - Lower

-15.82

-26.19

-99.84

CI - Upper

102.29

144.79

-6.83

CI: confidence interval

SD: standard deviation

Table 5 portrays the correlation, MAD, bias, and confidence intervals for total steps and
total calories analyzed by the consumer based physical activity trackers relative to the MAXII
and observed. The IH1 patch had the strongest correlation for steps (r=0.94). Total energy
expenditure for the three devices in the laboratory showed moderate correlations when
compared to Maxx II. JU3 showed the greatest variation in energy expenditure recordings of all
three consumer based physical activity trackers.
Discussions/Limitations/Conclusions
This study aimed to examine the validity of the FS and JU3 physical activity monitors
during a typical moderate intensity workout. In general, the FS and IH1 physical activity tracking
devices were valid in measuring steps. JU3 had weak correlations for steps. However,
measures of energy expenditure for all three devices showed weaker validity when compared to
laboratory grade equipment. This demonstrates, in general, moderate correlation with researchgrade accelerometers. However, large mean absolute deviations were observed with step
counts. In a comparison between data collected from standardized laboratory equipment and
the FS and JU3, the FS generally performed stronger. Steps were generally counted with a high
degree of accuracy by both physical activity trackers. Although, the JU3 had a larger standard
deviation compared to the FS. The findings of the current study concur with similar studies in
that step counts are valid in healthy subjects (Takacs 2013). The current findings from this study

add to the previous research by indicating that these devices are valid tools for health
professionals to utilize in order to prescribe exercise prescriptions and track progress objectively
instead of subjectively.
The FS and JU3 measured total daily energy expenditure (TDEE). In general, analyzing
one-24 hour time period, from 12:00 am to 12:00 pm, showed a moderate to strong TDEE (r =
0.82-0.97). Of the two devices, the FS was better than the JU3 when compared to the Metria
IH1 in free-living. However, the FS, JU3, and IH1 in the laboratory all had moderate TDEE (r =
0.51-0.65) compared to the MaxxII. Opposite of most findings, the FS and JU3 underestimated
energy expenditure in the laboratory setting compared to the MaxxII (Lee 2014). However, in
free-living conditions, both devices had improved validity, another reason health professionals
should use these devices with clients.
Strengths of the current study are that the devices were testing in the laboratory and in
free-living conditions for a 24 hour period. This study analyzed heart rate, total steps, and TDEE
which are typically variables that health professionals care about. With those variables being
validated, health professionals can confidently prescribe exercise prescriptions to clients based
on target heart rate for various exercise intensities. Also, steps and energy expenditure can then
be utilized to track goals and weight loss.
While conducting the study, a number of limitations were identified that should be
addressed. The small sample size (n=8) and testing only college aged, apparently healthy,
young adults does not allow the results to be generalized to a larger population. In addition, the
small number of consumer based physical activity trackers that were analyzed was limited due
to budgetary reasons and concerns around participant burden wearing more than two physical
activity trackers. Furthermore, updated models for FitBit and Jawbone have entered the market
prior to data collection. Incomplete data sets were obtained for some values related to the JU3
(steps, TDEE) due to the inability to flag activities on the JU3, data extraction error, and
participant error. Caution should be taken when interpreting findings for the above mentioned
results.
There was noted inconsistency of heart rate recordings every minute for each protocol.
This could have affected steady state and hence total protocol duration. Also, there were
variations in steady state heart rate between test and re-test due to fatigue. This was
problematic because it was difficult to determine validity of heart rate for repeated measures.
When extracting data from the IH1 patch, it was difficult to sum every minute for each
protocol for steps and energy expenditure because the protocols would not consistently start at
the same minute the IH1 patch records. This lead to under and overestimation in some data
points due to variability in recording time. In addition, IH1 data for energy expenditure needed to
be converted from kilojoules to kilocalories. Total energy expenditure per protocol may not be as
accurate due to rounding.
Further research examining larger sample sizes that reflect the age and demographics
of the various target populations of consumer based physical activity trackers is needed. Also,
studying physical activity tracker size and fit compared to the accuracy of heart rate would be a
good addition to the previous study. Lastly, looking at activities of daily living in the laboratory
would reflect the typical daily routine of the average person.
Conclusions
In conclusion, the present study supports the validity of the FS for steps and energy
expenditure. Results with the FS heart rate must be viewed with caution due to inconsistent
findings compared to laboratory grade equipment. An advantage of wearable physical activity
trackers with bluetooth capabilities is that they offer additional feedback online and are less
obtrusive compared to standard research grade devices. The new physical activity trackers
provide goal setting features, tracking tools, social networking links, and online competitions
with friends.

References
1. Almalki M, Gray K, Sanchez FM. The use of self-quantification systems for personal
health information: big data management activities and prospects. Health Information
Science Systems. 2015;3(Suppl 1 HISA Big Data in Biomedicine and Healthcare 2013
Con):S1. doi: 10.1186/2047-2501-3-S1-S1
2. Bassett DR, Rowlands A, Trost SG. Calibration and validation of wearable monitors.
Med Sci Sports Exerc. 2012;44:S32-8.
3. Cadmus-Bertram LA, Marcus BH, Patterson RE, Parker BA, Morey BL. Randomized trial
of a Fitbit-Based physical activity intervention for women. Am J Prev Med.
2015;49(3):4148.
4. Diaz KM, Krupka DJ, Chang MJ, Peacock J, Ma Y, Goldsmith J, et al. Fitbit: An accurate
and reliable device for wireless physical activity tracking. Intl J Cardiol. 2015;185:13840
5. Evenson KR, Goto MM, Furberg RD. Systematic review of the validity and reliability of
consumer-wearable activity trackers. Intl J of Behavioral Nutrition and Physical Activity.
2015;12:159
6. Freedson P, Bowles HR, Troiano R, Haskell W. Assessment of physical activity using
wearable monitors: recommendations for monitor calibration and use in the field. Med
Sci Sports Exerc. 2012;44:S1-4.
7. Lee JM, Kim Y, Wlk, GJ. Validity of consumer-based physical activity monitors. Med Sci
Sports Exer. 2014; Feb 5
8. Lyons EJ, Lewis ZH, Mayrsohn BG, Rowland JL. Behavior change techniques
implemented in electronic lifestyle activity monitors: A systematic content analysis. J Med
Internet Res. 2014;16(8):e192. doi:10.2196/jmir.3469.
9. McGrath, M. J., & Scanaill, C. N. (2013). Sensor Technologies: Healthcare, Wellness
and Environmental Applications. Apress.
10. Simpson LA, Eng JJ, Klassen TD, Lim SB, Louie DR, Parappilly B, et al. Capturing step
counts at slow walking speeds in older adults: Comparison of ankle and waist placement
of measuring device. J Rehabil Med. 2015;47(9):8305
11. Takacs J, Pollock CL, Guenther JR, Bahar M, Napier C, Hunt MA. Validation of the fitbit
one activity monitor device during treadmill walking. J Sci Med Sport. 2013;17(5):496500
12. Welk JG, Mcclain J, Anisworth BE. Protocols for evaluating equivalency of
accelerometry-based activity monitors. Med Sci Sports Exerc. 2012;44:S39-49

Literature Review
Introduction
Physical activity plays a vital role in both the primary and secondary prevention of
chronic diseases. Research indicates physical activity helps prevent several major health
conditions, such as: cardiovascular diseases, diabetes, hypertension, chronic kidney disease,
dyslipidemia, and some cancers (Brien 2007, Avery 2012, Walker 2011, Stump 2011,
Laaksonen 2002). There are also numerous studies to support the importance of cardiovascular
fitness for improved health and reduced mortality (Lee 2011, Liu 2012). However, to quantify
positive effects physical activity has on chronic diseases, accurate measurements are needed
(Takacs 2014).
Over the years, studies have provided details supporting the roles of physical activity in
various health conditions and the overall benefits of an active lifestyle related to public health.
ACSM recommendations for physical activity in adults is at least 150 minutes per week of
moderate intensity exercise, 75 minutes of vigorous intensity exercise, or a combination of
moderate and vigorous exercise. Additional health benefits are possible with exercise
accumulation of over 150 minutes/week.
The recommended amounts of physical activity to improve fitness and promote health
have been described and well publicized. However, the majority of U.S. adults do not meet
physical activity recommendation guidelines (Brownson 2005). Based on observation of
physical activity, the prevalence of individuals who did not engage in leisure-time physical
activity, declined from 29.8% in 1994 to 23.7% in 2004 (Center for Disease Control and
Prevention (CDC), 2005). Additionally, national surveys show the prevalence of obesity and
overweight has dramatically risen to more than 30 and 65.7% in the United States, respectively
(Hedley 2002, Ogden 2006, Pate 1995). Overweight and obesity are critical public health
concerns and cause a large number of the nations health problems (Kopelman 2007).
Engaging in physical activity is one mechanism to help the pandemic of overweight and obesity
in the United States. Based on these statistics, a low-to-moderate cost effective treatment is
necessary to assist Americans in increasing their physical activity and weight management.
While there has been some progress in public health, a promising development is the increased
availability of consumer-based tools such as physical activity trackers and smartphones with
built-in technology designed to help people become more physically active.
An advantage of these tools is they are actively marketed and promoted by companies
in the consumer marketplace. A number of factors have contributed to the convergence toward
consumer-based activity monitor technology, including the availability of a low-cost
accelerometer, increased utility of wireless data transfer, as well as widespread use of
smartphones and social media applications. These approaches present an exciting opportunity
to advance public health, but it is important to validate existing monitoring systems (i.e.,
consumer-based activity monitors) to study an individuals physical activities and sedentary
behaviors. While some devices have been developed, based on established research devices,
most monitors have been released into the marketplace without any formalized evidence of
accuracy. The first section of this literature review summarizes the progression of research with
traditional accelerometry-based physical activity monitors. The second section describes the
measurement basis and features for various consumer-based activity monitors. The final section
summarizes the available technology within smartphones that would enable them to monitor
physical activity, as well as promising approaches used for calibrating and validating
Smartphone applications.
Progression of Research on Accelerometry-Based Physical Activity Monitors

Accelerometry-based physical activity monitors have been used to monitor and provide a
description of lifestyle and physical activity behavior in laboratory and free-living settings.
Acceleration can be used to estimate intensity and frequency of physical activity (Freedson
2011, Chen 2005). Accelerometry comes in three different types of technology to capture the
direction of movement. Uniaxial accelerometers can only detect acceleration in one plane, such
as side-to-side movements, and it can miss activities with high accelerations. Biaxial and triaxial
accelerometers measure acceleration of the body up to three planes (i.e. horizontal, vertical,
and lateral) (Mathie 2004).
Other measurement challenges accelerometry-based activity monitors face is the raw
activity count data produced by each device. Commercial accelerometers usually produce data
in the form of activity counts (i.e., counts/min) per defined time period (epoch). The data
represents the estimated intensity of measured activities during each time period. However,
there are discrepancies in cut-points converting the data into meaningful outcome measures
(e.g., VO2 or EE) due to differences in the regression models used to generate point estimates
of energy expenditure and cut-points from accelerometer counts. For instance, it is difficult to
directly compare the estimation of moderate and vigorous physical activity (MVPA) from one set
of cut-points to MVPA estimates using different cut-points, even when the same outcome data is
reported (Bornstein 2011).
In addition, a well-recognized disadvantage of accelerometers is the devices are unable
to account for the increased energy costs associated with various activities, such as, walking up
stairs or an incline; and do not accurately estimate non-locomotive activities, such as, stationary
biking and weightlifting. The cost of these devices may also limit the use of accelerometers in
large-scale research studies. Other disadvantages include subject compliance, altered physical
activity patterns, and a cost of approximately $200 per monitor (Welk 2000, Lamonte 2001).
Currently, there is limited definitive evidence that exists to indicate that one model of
accelerometer is more valid and reliable than others. This especially holds true when
researching physical activity in free-living conditions. Research difficulty in free living conditions
arises from length of monitoring required for reliable estimates of habitual physical activity,
accelerometer placement, epoch length, and distribution and collection (Trost 2005). One major
limitation of accelerometers, however, is that they can only accurately assess the energy
expenditure of movements that are ambulatory in nature. For example, a bout of resistance
training is unlikely to score high in terms of counts because of the stationary nature of the
activity. When a person moves, the limbs or body are accelerated, theoretically in proportion to
the muscular force exerted, and thus to energy expenditure. Portable accelerometers measure
accelerations of the body part to which they are attached, producing data in the form of counts
per minute or estimated energy expenditure. Although the accelerometer provides an objective
summary of body movements, it often underestimates energy expenditure because it cannot
accurately detect physical activity in free-living situations where much of the body remains
stationary. Examples include: cycling, resistance training, or seated assembly line work (Esliger
2005).
Research on Calibration of Accelerometry-Based Physical Activity Monitors
Accelerometry-based physical activity monitors provide raw data. However, for
this information to be useful, it needs to be calibrated (Bassett 2012). There are a number of
published studies describing calibration and validity of commercial grade accelerometers and
their associated prediction equations to measure energy expenditure in laboratory and freeliving settings.
The first accelerometer calibration study linking accelerometer counts per minute to
energy expenditure was performed in a laboratory setting by Montoye et al. (Montoye). The
researchers used walking and running as their modes of aerobic exercise, and analyzed the
relationship between energy expenditure and activity counts. Montoye et al. fit a linear

regression to the data so they could predict energy expenditure related to activity counts. Since
then, numerous studies have used similar approaches to calibrate other monitors.
The ActiGraph 7164 (ActiGraph LLC, Pensacola, FL) accelerometer was first
calibrated by Freedson et al. against indirect calorimetry during treadmill walking and running. A
regression equation to estimate energy expenditure from the counts was developed and crossvalidated on participants. A high correlation in estimating EE was achieved, r =.88 with the
developed equation (Freedson 1998). They also developed equations used to identify cut points
representing the lower and upper bounds to classify intensity categories of light, moderate, and
vigorous intensity. Chen and Sun examined the Tritrac with 125 subjects, while they performed
activities of daily living and light exercise, and compared with the total EE to whole room
calorimetry for two 24-hour periods (Chen 1997). The results demonstrated the estimated EE
correlated with the measured total EE for the 2 days (r =.925 and r =.855; p < .001). The Tritrac
demonstrated a significant underestimation of energy expenditure in most studies (Rodriguez
2002, Jakicic 1999, Sherman 1998). However, a few other studies reported large
overestimations of energy expenditures in various activities (Campbell 2002, Nichols 1999,
Welk 1995). The accuracy of measure energy expenditure is highly influenced by the study
population, type of accelerometer used, and the activity monitored. A major finding in the studies
that used commercial grade accelerometers were that each regression equation tended to be
valid for the activities for which it was calibrated. However, linear regression models developed
for locomotion activities underestimated lifestyle activities (Crouter 2006).
Consumer-Based Physical Activity Monitors
In recent years, many companies have released a variety of consumer-based physical
activity monitors that are designed to facilitate physical activity behavior change. The release of
these new devices presents challenges and opportunities for researchers, fitness educators,
and practitioners. These consumer-based devices are marketed to the general population to
provide personal information on levels of physical activity. Some devices are based on standard,
research-based devices with documented reliability and validity. Other devices have been
developed specifically for the consumer market with typically little or no evidence documenting
their accuracy or utility. A number of factors have contributed to the convergence toward
consumer-based activity monitor technology, including the availability of low-cost
accelerometers, the increased utility of wireless data transfer, as well as the widespread use of
Smartphones and social media applications.
Common data points that are collected in research from physical activity trackers are
steps, energy expenditure, intensity levels (light, moderate, vigorous), and posture (lying, sitting,
stepping). Physical activity device placements that are validated include: waist, back, wrist, and
ankle. For research studies, goals need to be established for the amount of time monitored each
day, the number of days the device should be worn, and number of monitoring periods required.
Seven days of activity monitoring captures a significantly high level of inter-individual variation.
Multiple measurement periods is also shown to be appropriate when using a larger number of
observation days. Optimal monitoring periods for physical activity monitoring studies is seven
days because this provides an intra-class correlation of more than 80%. Seven days of
monitoring also allows for weekday and weekend activity tracking to allow for total physical
activity representation (Matthews 2012).
The gold standard of these interventions are triaxial accelerometers, which have been
widely used in research settings to describe physical activity and total daily energy expenditure.
However, over the past decade technological advances have led to accelerometer based
devices being available within the consumer market with additional sensors to monitor sleep
quality via heat flux, galvanic skin response (GSR), and heart rate (HR). These advances in
technology have not ceased, and many of the corporations at the forefront of this market
including Fitbit Inc. and Jawbone, continue to release new models. Due to the continual release

of research-grade activity trackers data must be obtained related to accuracy under free-living
conditions to assist consumers, fitness professionals, and researchers in making informed
decisions when selecting the appropriate model. This study aims to add information to the
literature regarding the accuracy of three different activity monitors: the Fitbit Surge, Jawbone
UP3, and MetriaIH1 Lifestyle Assessment Patch.
Jawbone UP3 (JU3) The Jawbone UP3 (Jawbone, San Francisco, CA) is a triaxial
accelerometer designed to be worn on the wrist. Bio-impedance markers include heart rate,
respiration, and galvanic skin response (GSR). Jawbone quantitatively presents the user with
information on caloric expenditure, steps taken, sleep quality, and heart rate. The UP is waterresistant up to 1-meter and has a battery life span of 10 days. JU3 incorporates a vibration
function that prompts users to move. Limited published research has been reported on the JU3
due to Jawbone releasing the UP4.
Fitbit Surge (FS) The FS (Fitbit Inc., San Francisco, CA) is a triaxial accelerometer and
gyroscope designed to be worn on the wrist that can measures steps taken, floors climbed,
distance traveled, caloric expenditure, sleep quality, and heart rate (HR). The battery in the FS
lasts five to seven days and has an internal memory that can store data. The function of
wireless data transfer to the website does not necessitate connecting the monitor to the
computer. The unique feature of the FS is it provides information about sleep efficiency, but one
study found Fitbit had the high intra-device reliability, but overestimated both sleep time and
quality [52]. FS has been shown to be accurate and reliable device for wireless physical activity
tracking (Diaz 2015).
MetriaIH1 Lifestyle Assessment System (IH1) (Avery Dennison Corporation.,
Pasadena, CA) is a consumer version of a research-based accelerometer known as the
SenseWear. SenseWear is a well-validated, multi-sensory activity monitors worn on the left
triceps as a patch. IH1 includes a triaxial accelerometer along with physiological sensors: skin
temperature sensor, near body temperature sensor and a galvanic skin response (GSR) that
estimates the conductivity of the skin. IH1 collects a plethora of data every minute for 24 hours
up to 7 days, providing an accurate indication of the participants lifestyle including caloric
expenditure, activity level, steps taken, and sleep duration and quality. The device is used to
facilitate personal self-monitoring and weight maintenance. Data can be downloaded through a
USB cable and viewed through a personalized web-based software tool to monitor results over
time. Numerous studies have validated the SenseWear program but not the IH1 patch
specifically (Drenowatz 2011, Johannsen 2010, Calabro 2009).
Available Technology within Smartphones
The increasing popularity of smartphones provides numerous opportunities for
developing innovative technology. The inclusion of accelerometers in Smartphones makes it
possible for cell phones to perform the same functions as many of the previously mentioned
activity monitoring devices. Smartphones provide a new technology for activity assessment. To
date, smartphones incorporated with accelerometers have become very common. More than
6.2 billion people worldwide are estimated to carry a smartphone throughout the day. In the
United States, 114 million Americans were estimated using Smartphones in 2012 (McCarra
2012). Most Smartphones have many powerful and diverse sensors including GPS sensors,
vision sensors (i.e., cameras), audio sensors (i.e., microphones), light sensors, temperature
sensors, direction sensors (i.e., magnetic compasses), gyroscope, and acceleration sensors
(i.e., accelerometer). The array of sensors is impressive, considering the types used in many
commercially-available activity monitors. With calibration and development, these sensors could

potentially be used to identify an individuals activity, context, and situation. For now,
smartphones are a great tool to help consumers visually their data from their physical activity
tracking device through bluetooth.
Summary
The literature reviewed in this section provided an overview of accelerometry-based
activity monitors and described how they have been used in research to objectively assess
physical activity. The popularity of these devices has also led many companies to release a
variety of consumer-based monitors; however, most are focused on facilitating physical activity
behavior change. Some devices are based on standard, research-based devices with
documented reliability and validity. However, other devices have been developed specifically for
the consumer market and have been released with little or no evidence documenting their
validity. The purpose of this study is to compare heart rate, step count, and energy expenditure
against reliable and accurate instruments for each variable in the FS and JU3. There are
multiple studies that look at validity of physical activity trackers. However, there are very limited
studies looking at the accuracy of trackers. Our study would help fill the void of studies looking
at accuracy in wearable physical activity trackers.

References
Avery, L., et al., Changing Physical Activity Behavior in Type 2 Diabetes: A systematic review
and meta-analysis of behavioral interventions. Diabetes Care, 2012. 35(12): p. 2681-9.
Bassett, D.R., Device-based monitoring in physical activity and public health research. Physiol
Meas, 2012. 33(11): p. 1769-83.
Bornstein, D.B., et al., Equating accelerometer estimates of moderate-to-vigorous physical
activity: in search of the Rosetta Stone. J Sci Med Sport, 2011. 14(5): p. 404-10.
Brien, S.E., et al., Physical activity, cardiorespiratory fitness and body mass index as predictors
of substantial weight gain and obesity: the Canadian physical activity longitudinal study. Can J
Public Health, 2007. 98(2): p. 121-4.
Brownson, R.C., T.K. Boehmer, and D.A. Luke, Declining rates of physical activity in the United
States: what are the contributors? Annu Rev Public Health, 2005. 26: p. 421-43.
Calabro, M.A., G.J. Welk, and J.C. Eisenmann, Validation of the SenseWear Pro Armband
algorithms in children. Med Sci Sports Exerc, 2009. 41(9): p. 1714-20.
Chen, K.Y. and M. Sun, Improving energy expenditure estimation by using a triaxial
accelerometer. J Appl Physiol, 1997. 83(6): p. 2112-22.
Chen, K.Y. and D.R. Bassett, Jr., The technology of accelerometry-based activity monitors:
current and future. Med Sci Sports Exerc, 2005. 37(11 Suppl): p. S490- 500.
Chen, K.Y. and M. Sun, Improving energy expenditure estimation by using a triaxial
accelerometer. J Appl Physiol, 1997. 83(6): p. 2112-22.
Crouter, S.E., J.R. Churilla, and D.R. Bassett, Jr., Estimating energy expenditure using
accelerometers. Eur J Appl Physiol, 2006. 98(6): p. 601-12.
Diaz, K. M., Krupka, D. J., Chang, M. J., Peacock, J., Ma, Y., Goldsmith, J., & Davidson, K. W.
(2015). Fitbit: An accurate and reliable device for wireless physical activity tracking.
International journal of cardiology, 185, 138-140
Drenowatz, C. and J.C. Eisenmann, Validation of the SenseWear Armband at high intensity
exercise. Eur J Appl Physiol, 2011. 111(5): p. 883-7.
Esliger, D. W., Copeland, J. L., Barnes, J. D., & Tremblay, M. S. (2005). Standardizing and
optimizing the use of accelerometer data for free-living physical activity monitoring. J Phys Act
Health, 3, 366-383.
Freedson, P.S., et al., Evaluation of artificial neural network algorithms for predicting METs and
activity type from accelerometer data: validation on an independent sample. J Appl Physiol,
2011. 111(6): p. 1804-12.

Freedson, P.S., E. Melanson, and J. Sirard, Calibration of the Computer Science and
Applications, Inc. accelerometer. Med Sci Sports Exerc, 1998. 30(5): p. 777- 81.
Hedley, A.A., et al., Prevalence of overweight and obesity among US children, adolescents, and
adults, 1999-2002. JAMA, 2004. 291(23): p. 2847-50.
Jakicic, J.M., et al., The accuracy of the TriTrac-R3D accelerometer to estimate energy
expenditure. Med Sci Sports Exerc, 1999. 31(5): p. 747-54.
Johannsen, D.L., et al., Accuracy of armband monitors for measuring daily energy expenditure
in healthy adults. Med Sci Sports Exerc, 2010. 42(11): p. 2134-40.
Kopelman, P., Health risks associated with overweight and obesity. Obes Rev, 2007. 8 Suppl 1:
p. 13-7.
Laaksonen, D.E., et al., Low levels of leisure-time physical activity and cardiorespiratory fitness
predict development of the metabolic syndrome. Diabetes Care, 2002. 25(9): p. 1612-8.
Lamonte, M.J. and B.E. Ainsworth, Quantifying energy expenditure and physical activity in the
context of dose response. Med Sci Sports Exerc, 2001. 33(6 Suppl): p. S370-8; discussion
S419-20.
Lee, D.C., et al., Long-term effects of changes in cardiorespiratory fitness and body mass index
on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal
Study. Circulation, 2011. 124(23): p. 2483-90.
Liu, R., et al., Cardiorespiratory fitness as a predictor of dementia mortality in men and women.
Med Sci Sports Exerc, 2012. 44(2): p. 253-9.
Mathie, M.J., et al., Classification of basic daily movements using a triaxial accelerometer. Med
Biol Eng Comput, 2004. 42(5): p. 679-87.
Matthews, C. E., Hagstromer, M., Pober, D. M., & Bowles, H. R. (2012). Best practices for using
physical activity monitors in population-based research. Medicine and Science in Sports and
Exercise, 44(1 Suppl 1), S68-76. doi:10.1249/MSS.0b013e3182399e5b
McCarra, D., Android and Samsung rule the Smartphone market, but Apples the fastest riser.
2012.
Montoye, H.J., et al., Estimation of energy expenditure by a portable accelerometer. Med Sci
Sports Exerc, 1983. 15(5): p. 403-7.
Nichols, J.F., et al., Validity, reliability, and calibration of the Tritrac accelerometer as a measure
of physical activity. Med Sci Sports Exerc, 1999. 31(6): p. 908-12.
Ogden, C.L., et al., Prevalence of overweight and obesity in the United States, 1999-2004.
JAMA, 2006. 295(13): p. 1549-55.

Pate, R.R., et al., Physical activity and public health. A recommendation from the Centers for
Disease Control and Prevention and the American College of Sports Medicine. JAMA, 1995.
273(5): p. 402-7.
Rodriguez, G., et al., Comparison of the TriTrac-R3D accelerometer and a selfreport activity
diary with heart-rate monitoring for the assessment of energy expenditure in children. Br J Nutr,
2002. 87(6): p. 623-31.
Sherman, W.M., et al., Evaluation of a commercial accelerometer (Tritrac-R3 D) to measure
energy expenditure during ambulation. Int J Sports Med, 1998. 19(1): p. 43-7.
Stump, C.S., Physical Activity in the Prevention of Chronic Kidney Disease. Cardiorenal Med,
2011. 1(3): p. 164-173.
Takacs, J., Pollock, C. L., Guenther, J. R., Bahar, M., Napier, C., & Hunt, M. A. (2014). Validation
of the Fitbit One activity monitor device during treadmill walking. Journal of Science and
Medicine in Sport, 17(5), 496-500
Trost, S. G., McIver, K. L., & Pate, R. R. (2005). Conducting accelerometer-based activity
assessments in field-based research. Medicine and science in sports and exercise, 37(11),
S531
Walker, R.L., et al., Health behaviour advice from health professionals to Canadian adults with
hypertension: results from a national survey. Can J Cardiol, 2011. 27(4): p. 446-54.
Welk, G.J., et al., A comparative evaluation of three accelerometry-based physical activity
monitors. Med Sci Sports Exerc, 2000. 32(9 Suppl): p. S489-97.