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Journal of Sports Sciences

ISSN: 0264-0414 (Print) 1466-447X (Online) Journal homepage: http://www.tandfonline.com/loi/rjsp20

Validity of the “Samsung Health” application


to measure steps: A study with two different
samsung smartphones

Vicente J. Beltrán-Carrillo, Alejandro Jiménez-Loaisa, Miriam Alarcón-López &


Jose L. L. Elvira

To cite this article: Vicente J. Beltrán-Carrillo, Alejandro Jiménez-Loaisa, Miriam Alarcón-


López & Jose L. L. Elvira (2018): Validity of the “Samsung Health” application to measure
steps: A study with two different samsung smartphones, Journal of Sports Sciences, DOI:
10.1080/02640414.2018.1527199

To link to this article: https://doi.org/10.1080/02640414.2018.1527199

Published online: 17 Oct 2018.

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JOURNAL OF SPORTS SCIENCES
https://doi.org/10.1080/02640414.2018.1527199

PHYSICAL ACTIVITY, HEALTH AND EXERCISE

Validity of the “Samsung Health” application to measure steps: A study with two
different samsung smartphones
Vicente J. Beltrán-Carrillo , Alejandro Jiménez-Loaisa , Miriam Alarcón-López and Jose L. L. Elvira
Sport Research Centre, Miguel Hernández University of Elche, Alicante, Spain

ABSTRACT KEYWORDS
The purpose of this study was to examine the validity of a highly popular pedometer application Pedometer; physical activity;
(Samsung Health). Sixteen adults (28.8 ± 8.9 years of age) wore two Samsung smartphone models, walking; running; health
Samsung Galaxy Core Prime (SGCP) and Samsung Galaxy S4 (SGS4), at three body locations (waist, arm,
and hand) while walking and running over a 50-m test. All trials were recorded using a video as a gold
standard measure of step counts. Results indicated that the validity of Samsung Health varied depend-
ing on the smartphone model, its body location, and the type of gait (walking and running). Samsung
Health showed acceptable validity when the SGCP was located on the hand (Bias = −8.3%; RMSE = 5.6),
and especially on the arm (Bias = −7.2%; RMSE = 4.9) while running, and when the SGS4 was located on
the arm (Bias = −7.5%; RMSE = 5.4), and especially on the waist (Bias = 5.4%; RMSE = 3.7) while walking.
Samsung Health only showed good validity when the SGS4 was located on the arm (Bias = 2.9%;
RMSE = 3.6), and especially on the hand (Bias = 0.5%; RMSE = 2.5) while running. This application
showed unacceptable validity in the remaining options.

Introduction social obstacles entailed by this type of physical activity in


comparison to other forms of exercise (Alexander, Cowburn, &
Physical inactivity increases the risk of premature mortality
Foster, 2006; Pillay et al., 2015).
and many chronic diseases, including cardiovascular disease,
Given the importance of walking for public health, and
thromboembolic stroke, hypertension, Type 2 diabetes, osteo-
considering the high rates of physical inactivity in today’s
porosis, obesity, colon cancer, breast cancer, anxiety and
society (WHO, 2018), the tools that objectively measure this
depression (Lee & Buchner, 2008; World Health Organization
type of physical activity have gained special relevance in
[WHO], 2018).
recent years. Pedometers have been one of the most popular
Whereas the health benefits of vigorous activities like run-
devices for self-monitoring the number of daily steps, as they
ning have traditionally been recognized, moderate-intensity
are relatively inexpensive, small, and easy to use (Gardner &
physical activity, including walking, began to receive attention
Campagna, 2011).
as a healthy form of physical activity in the 1990s (Lee &
With the advances in smartphone technology and the
Buchner, 2008). Nowadays, there is strong evidence about
inclusion of motion sensors such as accelerometers and gyro-
the health benefits of walking. For instance, Caspersen and
scopes in these devices, smartphones can be used as ped-
Fulton (2008) indicated that walking can reduce the risk of
ometers via pedometer applications. Nowadays, more than
Type 2 diabetes by between approximately 20% and 40%.
250 pedometer applications can be downloaded from differ-
Dwyer et al. (2015) revealed that people who change from a
ent mobile platforms to measure steps and physical activity
sedentary state to take about 10,000 steps per day have more
(Leong & Wong, 2016).
than a 40% lower risk of all-cause mortality. Other studies have
If these applications were valid tools for the measurement
shown that walking is a healthy behaviour which can reduce
of steps, the population could use them to set their own goals,
cardiovascular risk markers such as systolic and diastolic blood
self-monitor their own step counts and, in this way, increase
pressure, body fat, cholesterol and waist circumference
their motivation for physical activity and compliance with
(Bravata et al., 2007; Murtagh, Murphy, & Boone-Heinonen,
physical activity recommendations (Boyce, Padmasekara, &
2010; Yuenyongchaiwat, 2016).
Blum, 2012; Gu, Chen, Jackson, & Zhang, 2018). Moreover,
Moreover, walking is the most commonly reported physical
researchers could use these tools to evaluate interventions
activity for the general population both in developed and
for the promotion of physical activity, replacing higher cost
developing countries (Eyler, Brownson, Bacak, & Housemann,
devices (Orr et al., 2015).
2003; Owen, Humpel, Leslie, Bauman, & Sallis, 2004; Pillay
Despite the popularity of pedometer applications, there is a
et al., 2015). This is, to a large extent, due to the low cost
lack of research about their validity as tools for physical activity
and easy accessibility of this activity for the majority of the
assessment. To date, the studies which have explored the validity
population, along with the lower physical, psychological and

CONTACT Vicente J. Beltrán-Carrillo vbeltran@umh.es Centro de Investigación del Deporte, Universidad Miguel Hernández de Elche, Avenida de la
Universidad s/n, 03202 Elche, Alicante, Spain
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 V. J. BELTRÁN-CARRILLO ET AL.

of Android apps (Åkerberg, Lindén, & Folke, 2012; Leong & Wong, Material and methods
2016; Orr et al., 2015) or iPhone apps (Åkerberg et al., 2012;
Participants and ethics
Bergman, Spellman, Hall, & Bergman, 2012; Boyce et al., 2012;
Orr et al., 2015) have shown inconsistent results. Only two of Sixteen adults participated in this study (eight men and eight
these studies have found an acceptable validity in two ped- women). A purposive sampling was used to recruit partici-
ometer applications, the Android-based application Tayutau pants from the university setting. All participants were healthy
(Leong & Wong, 2016), and the iPhone-based application and injury-free in the moment of the study. Subjects with
Pedometer Ultimate GPS+ (Åkerberg et al., 2012). known medical problems or episodes of musculoskeletal
In addition, previous research has warned that the validity pain were excluded. Each participant signed and provided a
of pedometer applications depends on the body location of written informed consent before participating. This study was
the smartphone, the intensity with which a person walks, and approved by the Research Ethics Committee of the first
the quality of the movement sensors of a particular model of author’s university. Participants’ characteristics are presented
smartphone (Åkerberg et al., 2012; Boyce et al., 2012; Leong & in Table 1.
Wong, 2016). In this regard, pedometer applications are often
more valid when the smartphone is placed in the front pants
pocket than when placed on the arm (Åkerberg et al., 2012; Instruments and procedure
Bergman et al., 2012; Leong & Wong, 2016). The validity of This study used two different models of Samsung smart-
pedometer applications also improves when the walking phones based on the Android operating system, SGCP and
speed increases (Dondzila, Swartz, Miller, Lenz, & Strath, SGS4. Both models had already pre-installed the application
2012; Leong & Wong, 2016). Moreover, a pedometer applica- Samsung Health 5.7.1.0003. According to its website, this appli-
tion may differ in its measurement depending on the model of cation was designed to track users’ activity, nutrition and
smartphone used (Åkerberg et al., 2012). sleep, and to promote an active and healthy lifestyle among
In view of the previous evidence and the increasing users (see http://www.samsung.com/uk/apps/samsung-
popularity of pedometer applications, Bergman et al. health/). This application includes a pedometer function.
(2012) declared that further research with non-analysed Measurements of each participant were performed on a
applications is needed to assess their validity at different flat, straight running track. Participants were instructed to
locations and speeds. Therefore, the aim of this study was perform the tests over a distance of 50 m. This distance was
to examine the validity of a highly popular pedometer previously marked with two lines which perpendicularly
application based on an Android platform (Samsung crossed the running track. Participants stood still before the
Health; Samsung Electronics Co., Ltd), comparing two differ- starting line and after passing the finish line. We considered
ent Samsung smartphones (Samsung Galaxy Core Prime, the effect of the acceleration and deceleration in the 50-m
SGCP; and Samsung Galaxy S4, SGS4), three body locations section to be negligible because the maximum speeds were
(waist, arm and hand) and two different gaits (walking and relatively low. Participants had to walk at the pace they would
running). This application has been downloaded more than normally walk for health in their daily life. With regard to
100 million times in Google Play by 12 February 2018 and it running, participants were instructed to run at a moderate
is already being pre-installed on all modern Samsung smart- intensity (around 5–6 of the Borg CR10 Physical Exertion
phones. However, to our knowledge, only one previous Scale; Borg, 1998). In order to guarantee a correct understand-
study has analysed the validity of the Samsung Health appli- ing of moderate intensity, all participants were previously
cation for measuring steps (Johnson, Turek, Dornfeld, Drews, instructed to report appropriately perceived exertion with
& Hansen, 2016). Moreover, our study includes important Borg Scale. After the explanations and examples, participants
methodological innovations regarding the study of Johnson could raise doubts which were solved by the researcher in
et al. (2016). First, our study included video analysis as a charge of the measurements.
criterion or gold standard measure of step counts, whereas Participants had to perform a total of six trials, three for
Johnson et al. (2016) used the pedometer StepWatch 3, walking and, subsequently, three for running. In the first trial,
which indirectly estimates step counts. Second, our study the smartphones were placed laterally on the right side of the
compared the validity of two different Samsung waist, in vertical orientation, using a waistband. Concretely,
Smartphones (SGCP and SGS4), whereas Johnson et al. the smartphones were placed on the most lateral position of
(2016) only analysed the validity of SGS4. Third, the tests the waist, with their upper part aligned with the participants’
used in our study to examine the validity of the Samsung iliac crest. In the second trial, the smartphones were placed
Health application (to walk and run a 50-m track) were laterally on the right arm, in vertical orientation, using an
different from the test used by Johnson et al. (2016) (to armband (mid-point between the shoulder and the elbow).
walk a 200-m track and run on a treadmill). Fourth, our
study used different body locations of the smartphones
(waist, arm, hand) from those used by Johnson et al. Table 1. Participants’ characteristics (Mean ± SD).
(2016) (pants pocket and hand). Fifth, our study was carried Men (n = 8) Women (n = 8) All participants (n = 16)
out with the 5.7.1.0003 version of the Samsung Health Age (years) 28.5 ± 10.8 29.1 ± 7.2 28.8 ± 8.9
Height (cm) 180.62 ± 0.04 170.87 ± 0.05 175.70 ± 0.07
application, whereas Johnson et al. (2016) used the Weight (kg) 80.75 ± 2.91 62.75 ± 7.19 71.75 ± 10.70
2.0.0.009 version, and different versions may include differ- BMI (kg/m2) 24.76 ± 1.97 21.46 ± 1.97 23.11 ± 2.24
ent algorithms affecting step counting. BMI = Body Mass Index.
JOURNAL OF SPORTS SCIENCES 3

In the third trial, participants had to wear the smartphones on at a p-value of less than 0.05. In addition, the corrected effect
their right hand (the smartphones were placed along the size (ES) or Hedges’ g for related samples with pooled stan-
longitudinal axis). Both models of Samsung phones were dard deviation was calculated between the video and each
placed one together with the other, always in the same posi- smartphone measurement. ES 95% confidence intervals were
tion, and with their screens facing away from the participant’s calculated as described in Nakagawa and Cuthill (2007), and
body. Thus, both smartphones would provide step counts used to determine statistical differences when the confidence
concerning the same trials. interval did not contain the zero value. Threshold values for
Simultaneously, the trials were video recorded with an Cohen’s ES statistic were < 0.2 (small), around 0.5 (moderate)
iPhone SE (30 Hz), held at a fixed central point about 15 m and > 0.8 (large) (Cohen, 1988). Additional comparisons
from the track to appropriately follow the participants with between each smartphone and the video included: relative
the smartphone camera along the 50-m test. After each trial, bias and root mean square error (RMSE) to account for preci-
the researcher registered the steps counted by the Samsung sion and accuracy, respectively; Pearson’s correlation (with its
Health application. 95% confidence interval) to test the association between mea-
The videos were later analysed to count the steps, and used surements; and Bland-Altman plots (Bland & Altman, 1986) to
as the gold standard when compared with the smartphones establish the agreement between measurements. All the cal-
measurements. The video analysis was carried out by the same culations were made using custom Python 2.7 scripts.
researcher who did the measurements. The videos were repro-
duced with the Brain Craft Ltd application (version 1.5) in slow-
motion option to favour the count of steps. Each video was
Results
analysed two times to check that the counting was correct. If
the two step counts did not coincide, the researcher had to The mean differences in step counts between Samsung Health
analyse the video a third time. One step was defined oper- with each smartphone (SGCP, SGS4) and the video (gold stan-
ationally as the interval between two consecutive counter- dard) are presented in Figure 1. These differences are specified
footsteps. To minimize the error, the count began when either for the three body locations of the smartphones (waist, arm,
foot touched the ground after the starting line, and finished and hand) and the two types of gait (walking and running).
when either foot touched the ground after the finish line. Statistical comparisons are presented in Table 2. Paired
sample t-tests showed significant statistical differences
(p < 0.001), with large effect sizes, in most of the comparisons
Statistical analysis
between the two Samsung smartphones and the video,
The Shapiro-Wilk test was calculated, and all the data showed regardless of body location and type of gait. However, no
a normal distribution. Paired sample t-tests were used to significant differences with respect to the video were found
compare mean differences between the step counts of the when the smartphone SGS4 was placed on the arm (p = 0.066;
two models of smartphones (SGCP, SGS4) with the steps ES = 0.57 [−0.11, 1.25], moderate) or on the hand (p = 0.700;
recorded in the video. Statistical differences were established ES = 0.06 [−0.30, 0.43], small) while running.

Figure 1. Differences (Mean ± SD) in step counts between Samsung Health with each smartphone and the video (gold standard).
4 V. J. BELTRÁN-CARRILLO ET AL.

Table 2. Statistical differences between Samsung Health with each smartphone placed on three different body positions and the video (gold standard).
SGCP vs. Video SGS4 vs. Video
p ES [95% CI] Bias (%) RMSE r [95% CI] p ES [95% CI] Bias (%) RMSE r [95% CI]
Walking
Waist < .001 −6.60 [−9.18, −4.02] −28.1 18.5 0.91 [0.74, 0.97] < .001 1.12 [0.64, 1.60] 5.4 3.7 0.93 [0.80, 0.98]
Arm < .001 −1.88 [−2.71, −1.05] −10.3 7.3 0.73 [0.33, 0.91] < .001 −1.53 [−2.24, −0.83] −7.5 5.4 0.75 [0.37, 0.92]
Hand < .001 −3.34 [−4.71, −1.97] −16.0 11.1 0.67 [0.21, 0.88] < .001 −2.43 [−3.42, −1.44] −12.9 8.9 0.86 [0.59, 0.95]
Running
Waist < .001 2.25 [1.24, 3.25] 14.1 9.0 0.56 [0.04, 0.84] < .001 4.26 [2.57, 5.94] 28.3 17.1 0.84 [0.56, 0.95]
Arm < .001 −1.70 [−2.49, −0.91] −7.2 4.9 0.67 [0.21, 0.88] 0.066 0.57 [−0.11, 1.25] 2.9 3.6 0.27 [−0.31, 0.70]
Hand < .001 −1.69 [−2.44, −0.94] −8.3 5.6 0.77 [0.40, 0.92] 0.700 0.06 [−0.30, 0.43] 0.5 2.5 0.76 [0.39, 0.92]
SGCP, Samsung Galaxy Core Prime; SGS4, Samsung Galaxy S4; p, t-test p-value; ES, Effect Size; CI, Confidence Interval; RMSE, Root-Mean-Square Error in step counts;
r, correlation coefficient.

Figure 2 presents the Bland-Altman plots of the compar- The r-values concerning SGCP showed that the highest
isons. They showed no trend in the differences, which means association between the SGCP and the video step counts
that the agreement between methods did not vary over the was found when the smartphone was placed on the waist
range of measurements. The limits of agreement were about while walking (r = 0.91 [0.74, 0.97]). Conversely, the lowest
10 steps in all conditions except for walking with the smart- association between the SGCP and the video step counts was
phones on the waist, where it was about 5 steps. found when the smartphone was placed on the waist while
For the SGCP, the Samsung Health application was more running (r = 0.56 [0.04, 0.84]).
precise and accurate when the smartphone was placed on the Regarding the SGS4, the Samsung Health application was
arm, both while walking (Bias = −10.3%, RMSE = 7.3 steps) and more precise and accurate when participants ran with the
running (Bias = −7.2%, RMSE = 4.9 steps), but less so when the smartphone placed on the arm (Bias = 2.9%, RMSE = 3.6
device was placed on the waist, both while walking steps) and especially when they ran with the smartphone
(Bias = −28.1%, RMSE = 18.5 steps) and running (Bias = 14.1%, placed on the hand (Bias = 0.5%, RMSE = 2.5 steps). Again,
RMSE = 9.0 steps). All measures underestimated step counts wearing the smartphone on the waist was the least precise
except when participants ran with the SGCP placed on the waist. and accurate location when running (Bias = 28.3%,

Figure 2. Bland-Altman plots of step counts comparing Samsung Health with each smartphone and the video. The thick line represents the mean difference and the
dashed line its 95% limits of agreement. SGCP, Samsung Galaxy Core Prime; SGS4, Samsung Galaxy S4; VI, video. Note. Some dots overlap.
JOURNAL OF SPORTS SCIENCES 5

RMSE = 17.1 steps). However, this phenomenon was reversed front pants pocket than in the chest pocket of the jacket or on
when participants had to walk, as the measure with the the arm. Leong and Wong (2016), when testing the validity of
smartphone on the waist was the most precise and accurate three pedometer applications in laboratory, confirmed that
(Bias = 5.4%, RMSE = 3.7 steps), whereas the measure with the the pedometer application improved in step counting validity
smartphone on the hand was the least precise and accurate when the walking speed on a treadmill increased and the
(Bias = −12.9%, RMSE = 8.9 steps). smartphone was placed in the front pants pocket (compared
The r-values concerning SGS4 showed that the highest to the waist and the arm). This increase in validity as walking
association between the SGS4 and the video step counts speed increases was also found in studies with electronic
was found when the smartphone was placed on the waist pedometers (Crouter, Schneider, Karabulut, & Bassett, 2003;
while walking (r = 0.93 [0.80, 0.98]). The lowest association Dondzila et al., 2012). It seems that faster movements gener-
was found at running gait, when participants wore the smart- ate higher accelerations that can trigger step detection by
phone on the arm (r = 0.27 [−0.31, 0.70]). different smartphone applications (Bergman et al., 2012;
Leong & Wong, 2016).
In our study, Samsung Health showed more valid results
Discussion
with both smartphones located on the arm or the hand while
In view of the increasing popularity of pedometer-based appli- running, when compared to the waist location (Table 2). This
cations to measure and monitor physical activity, and the lack finding could be due to the larger arm swinging action at
of knowledge about their validity, the aim of this study was to faster speeds, generating higher accelerations to be identified
analyse the validity of the highly popular application Samsung as steps (Åkerberg et al., 2012; Leong & Wong, 2016; Meyns,
Health to measure steps. The results of this study generally Bruijn, & Duysens, 2013).
indicated that the validity of Samsung Health varied depend- Our results concerning waist location while walking were
ing on the smartphone model, the body location of the inconsistent. The waist location was the least valid with SGCP,
smartphone and the type of gait (walking or running). while it was the most valid with SGS4 (see Figure 1). In line
With regard to the smartphone model, the different validity with this last result, Leong and Wong (2016) found more valid
results between SGCP and SGS4 are in line with previous step counts when a SGS4 (same model of smartphone as in
research. Åkerberg et al. (2012), who evaluated the validity our study) was located on the waist than on the arm at low
of six different pedometer applications for three different walking speed. Hence, our results with SGS4 may be due to a
smartphones, also found that the same pedometer applica- light arm swinging action at walking compared to running,
tions registered broad differences in the number of steps influencing the underestimation of step counts at arm/hand
depending on the smartphones in which they were installed. location. Future studies with Samsung Health and other mod-
Leong and Wong (2016), when analysing the validity of three els of smartphones are necessary to clarify which is the most
pedometer applications in free-living settings, also confirmed recommended body location to measure steps while walking.
that each concrete application provided clearly different step In view of Leong and Wong’s (2016) results, these studies
counts with different smartphones. Hence, the different valid- should also include the location in the front pants pocket to
ity results observed between SGCP and SGS4 could be due to confirm that this location may be the most recommendable
the quality of the movement sensors incorporated in each for users when walking. Moreover, future studies should follow
different smartphone. In general, Samsung Health showed more similar methodologies to favour comparison of results.
better validity with SGS4, probably because this model of Previous research has established that instruments provid-
smartphone possesses newer and better technology. ing step counts below 10% of absolute percentage error show
The validity of Samsung Health also varied depending on acceptable validity, regardless of a tendency to over- or under-
the body location of the smartphone (waist, arm and hand) count, although they would not be valid enough for research
and the type of gait (walking and running) (see Table 2). In purposes (Leong & Wong, 2016; Tudor-Locke et al., 2006).
contrast, the only previous study with the Samsung Health Therefore, Samsung Health users should consider that this
application (Johnson et al., 2016) found no significant differ- application showed good validity only when the SGS4 was
ences between Samsung Health estimated steps and the mea- located on the arm, and especially on the hand, while running,
sures of the pedometer StepWatch 3 while walking or running, and acceptable validity when located on the arm, and espe-
regardless of the body location of the smartphone (pants cially on the waist, while walking. On another hand, Samsung
pocket and hand). These results are understandable consider- Health showed acceptable validity only when the SGCP was
ing the methodological differences between the study of located on the hand, and especially on the arm, while running
Johnson et al. (2016) and our study (see last paragraph of but not while walking. However, when the SGCP was placed
the introduction). Concretely, the differences could be due to on the waist while walking, the correlation was high (r = 0.91
the fact that Johnson et al. (2016) used an indirect and less [0.74, 0.97]) and the limits of agreement of the Bland-Altman
accurate criterion measure of step counts. Another possible plot were quite narrow (about 5 steps). This leads us to
explanation is that the front pants pocket could be as valid a assume that adding the bias or mean raw difference (18
body location as the hand, although our study did not analyse steps) to the steps measured with SGCP could provide a
this specific issue because the pants pocket location was not good approximation for this smartphone while walking. This
included. Nevertheless, the findings of our study are congru- application showed unacceptable validity in the remaining
ent with other previous research. Åkerberg et al. (2012) found options (see Table 2 and Figure 2). Therefore, these results
more valid step counts with the smartphone located in the lead to the following use recommendations. Populations who
6 V. J. BELTRÁN-CARRILLO ET AL.

cannot run or walk fast, like some older adults, should use the motion video seems to be quite an easy task, with reduced
SGS4 and wear it on the waist for a valid step count. Runners risk of error.
should use the SGS4 and wear it on the hand. If this position is
uncomfortable for long distances, they could wear it on
the arm. Disclosure statement
The results of this study also indicated that correlations (r) No potential conflict of interest was reported by the authors.
can be misleading statistical values when assessing the validity
of pedometer applications. For instance, step counts with the
SGCP on the waist while walking showed the second highest ORCID
correlation (r = 0.91) with the video step counts, although this Vicente J. Beltrán-Carrillo http://orcid.org/0000-0001-8794-5901
measure showed the second highest Bias % (−28.14). In this Alejandro Jiménez-Loaisa http://orcid.org/0000-0003-0033-2374
sense, step counts with the SGS4 on the arm while running Miriam Alarcón-López http://orcid.org/0000-0001-9900-5335
Jose L. L. Elvira http://orcid.org/0000-0003-0821-9210
showed the lowest correlation (r = 0.27), although this mea-
sure showed the second smallest Bias % (2.86). This highlights
the importance of analysing the validity from different view-
points using different statistics that provide complementary
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