Flexible Activity Tracking for Older Adults Using Mobility Aids —
An Exploratory Study on Automatically Identifying Movement
Modality
Dimitri Vargemidis
dimitri.vargemidis@kuleuven.be
KU Leuven
Leuven, Belgium
Luc Geurts
luc.geurts@kuleuven.be
KU Leuven
Leuven, Belgium
ABSTRACT
Wearable activity trackers are inaccessible to older adults who use
mobility aids (e.g., walker, wheelchair), because the accuracy of
trackers drops considerably for such movement modalities (MMs).
As an initial step to address this problem, we implemented and
tested a minimum distance classifer to automatically identify the
used MM out of seven modalities, including movement with or
without a mobility aid, and no movement. Depending on the test
setup, our classifer achieves accuracies between 82 % and 100 %.
These fndings can be leveraged in future work to combine the
classifer with algorithms tailored to each mobility aid to make
activity trackers accessible to users with limited mobility.
CCS CONCEPTS
• Human-centered computing → Accessibility; • Computing
methodologies → Machine learning.
KEYWORDS
wearables, activity tracking, mobility aids, accessibility, machine
learning
ACM Reference Format:
Dimitri Vargemidis, Kathrin Gerling, Luc Geurts, and Vero Vanden Abeele.
2022. Flexible Activity Tracking for Older Adults Using Mobility Aids —
An Exploratory Study on Automatically Identifying Movement Modality.
In The 24th International ACM SIGACCESS Conference on Computers and
Accessibility (ASSETS ’22), October 23–26, 2022, Athens, Greece. ACM, New
York, NY, USA, 5 pages. https://doi.org/10.1145/3517428.3550371
1 INTRODUCTION
Wearables for activity tracking are routinely leveraged to measure
physical activity (PA) in medical and research settings (e.g., [6,
7]), and can be used for self-refection on activity routines [12].
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For all other uses, contact the owner/author(s).
ASSETS ’22, October 23–26, 2022, Athens, Greece
© 2022 Copyright held by the owner/author(s).
ACM ISBN 978-1-4503-9258-7/22/10.
https://doi.org/10.1145/3517428.3550371
Kathrin Gerling
kathrin.gerling@kuleuven.be
KU Leuven
Leuven, Belgium
Vero Vanden Abeele
vero.vandenabeele@kuleuven.be
KU Leuven
Leuven, Belgium
Particularly in the context of older adults, activity tracking supports
physicians and therapists to follow up and better understand the
rehabilitation progress of their patients [3, 6], e.g., while recovering
from surgery or injuries after a fall, or coping with back pain and
other chronic conditions. In terms of personal exercise, activity
trackers help older adults to keep an automated record of their levels
of PA, which can make them more aware of their daily activity,
ftness, and physical wellbeing in general [16].
However, currently available wearable tracking systems do not
adapt well to this audience. We identifed two main problems. (1)
The accuracy of step counting for older adults is lower than for
younger adults. A lower walking speed and divergent gait are the
most important reasons for this problem [4, 14], and result, in most
cases, in an underestimation of the number of steps [14]. (2) Existing
activity trackers are not accessible to older adults who use mobility
aids, as these movement modalities are not supported, resulting
in even less accurate results [10]. Considering the likelihood of
older adults needing such mobility aids in late life due to sudden
(e.g., surgery, rehabilitation) or gradual changes (e.g., loss of muscle
strength, aching joints), staying physically active and being aware
of their own levels of PA is particularly important [5].
Several studies discuss and compare the accuracy of activity
trackers in diferent settings. Activity trackers are designed to op-
erate within a set parameter range. For example, walking slowly or
running fast negatively impacts the accuracy of the computed step
count [13]. For older adults, with a slower gait in general, consumer-
grade activity trackers can have accuracies ranging from 18 % to
78 %, depending on the tracker’s brand and the user’s walking speed
[14]. Younger adults’ step count accuracies are on average 90 %
[1]. Mobility aids further impede the accuracy of existing activity
trackers, rendering them unreliable for use in clinical contexts [8].
Because of these known accuracy issues, stand-alone algorithms
have been designed to address this, focusing on one MM at a time.
For example, with an improved algorithm tailored to rollator use,
accuracies of about 84 % can be achieved, compared to 10 % with
out-of-the-box wearable trackers [11]. Moreover, studies discuss
the implementation of an activity tracking system that has sepa-
rate algorithms for walking and running activities, using machine
ASSETS ’22, October 23–26, 2022, Athens, Greece Vargemidis, et al.

learning to decide which algorithm should be applied to each situa- Table 1: Overview of all data recording setups for each partic-
tion. For example, Bagui et al. report an accuracy of 93 % with this ipant as a combination of MM, sensor position, and location.
approach [2]. For each setting, we made two recordings
With a similar strategy, we aspire to build a fexible activity
tracking system for older adults to (1) recognise their MM, and (2) Movement modality Sensor position Location
apply an algorithm for that specifc modality to accurately com- Inside
Mobility aid
pute the achieved levels of PA. In this study, we focus on the frst Outside
Cane
objective, and consider six MMs: walking with a cane, crutches, Inside
Wrist
walker, rollator, using a wheelchair, or walking without a mobility Outside
aid (Figure 1). Our goal is to investigate the possibility of identi- Inside
Mobility aid
fying the user’s MM based on sensor data from a single inertial Outside
Crutches
measurement unit (IMU). Since this is part of an exploratory study, Inside
Wrist
we recorded a dataset with only three younger participants (two Outside
persons in the age range of 25-35, and one in 60-65). This allowed Inside
Mobility aid
us to avoid exposing older adults to health risks in light of the Outside
Walker
ongoing COVID-19 pandemic. Next, we implemented a minimum Inside
Wrist
distance classifer, and used the dataset to verify the accuracy of Outside
our classifer’s prediction. Inside
Mobility aid
Outside
Rollator
2 DATASET Inside
Wrist
Outside
We gathered 3-axes accelerometer and gyroscope data from three
participants engaging in the six MMs we considered in this study. In Inside
Mobility aid
addition to these MMs, we wanted to distinguish between a person Outside
Wheelchair
being in motion or not. Therefore, we also collected data while Inside
Wrist
the participants were sitting down calmly. For each modality, we Outside
recorded sensor data in a combination of diferent setups: having Inside
No mobility aid Wrist
the IMU attached to either the participant’s wrist or to the mobility Outside
aid being used, and recording the data either inside (smooth foor) Sitting Wrist Inside
or outside (uneven pavement). For each specifc setup, we made
Table 2: Three derived types of IMU data
two recordings (Table 1): the frst one to train our classifcation
model, the second one to verify the accuracy of its predictions.
Type of data Symbol
Each recording is about 60 seconds long, and data is sampled √
at a rate of approximately 20Hz. We used an Adafruit Flora micro- ®
Magnitude of angular velocity (�) � �2 + � �2 + ��2 = �
controller and a BNO055 IMU to register all activity and send the
√
Magnitude of acceleration (®
�) ��2 + � 2� + ��2 = �
sensor data in real time to a laptop, where everything was stored
in a CSV fle. We recorded movement data for each setup of Table Magnitude of acceleration (® �) along �® · �® = ��
1. The entire data collection process took about three to four hours ®
the gravitational force’s direction (�)
per participant. None of the participants used mobility aids in their
Table 3: Overview of all considered, mostly statistical, base
daily lives. However, for this exploratory study, having experience
features
with all aids is less important, as we investigate whether each aid
afords a sufciently distinct pattern of movement to automatically
recognise it using a machine learning algorithm. Base feature Abbreviation
Frequency of the signal f
Minimum value of the signal min
3 IMPLEMENTATION OF THE CLASSIFIER Maximum value of the signal max
We opted to use a minimum distance classifer because of its simplic- The diference between max and min range
ity and low use of resources, e.g., memory and computing power, Average value of the signal mean
and trained a model based on a feature set that highlights the most Standard deviation of all values of the signal sd
pronounced diferences between parameters of MMs. We derived Median value of the signal median
three types of data samples from the IMU, i.e., angular velocity mag- First quartile, 25th percentile of all values Q1
nitude, acceleration magnitude, and magnitude of the acceleration
Third quartile, 75th percentile of all values Q3
component along the gravitational force’s direction (Table 2). For
The diference between Q3 and Q1 IQR
each of these data types, we considered 11 possible base features
Total energy of the data signal e
(Table 3). Thus, to train our classifer’s model, we can compose a
feature set from a selection of 33 diferent features in total.
To train our minimum distance classifer, we select a feature
set, group all participants’ data per MM, and compute the mean
Flexible Activity Tracking for Older Adults Using Mobility Aids ASSETS ’22, October 23–26, 2022, Athens, Greece

Algorithm 1: Pseudo-code of the train function

for each movement modality do
for each selected feature do
compute mean feature value
end for
end for

Algorithm 2: Pseudo-code of the predict function

compute feature values of given data sample
for each movement modality do
compute Mahalanobis distance
(a) (b) end for
return movement modality with smallest distance

Table 4: Confusion matrix showing the classifer’s predic-

tions (only wrist-worn IMU) as a relative ratio (in %). The
mean accuracy is 88 %, and all results in this table are obtained
using the following features: ��3 , � ��� , ������ , ������� ,
� � , ��1 , ���� , ��� , ����� , ������� , � � , ��,�3 , ��,��� , ��,���� ,
��,������ , ��,�

Actual

Wheelchair
Crutches

Rollator

Walker

Sitting
No aid
Cane
(c) (d)

Cane 67 0 8 8 0 0 0
Crutches 25 92 0 8 0 0 0
Predicted

Rollator 0 0 92 0 0 8 0
Walker 0 0 0 84 8 0 0
Wheelchair 0 8 0 0 92 0 0
No aid 8 0 0 0 0 92 0
Sitting 0 0 0 0 0 0 100

(e)
Figure 1: Mobility aids supported by the fexible tracking
system: (a) cane, (b) crutches, (c) walker, (d) rollator, (e)
wheelchair. The sixth movement modality, i.e., walking with-
out a mobility aid, is not depicted here
value for each selected feature of all MMs (see Algorithms 1 and 2).
Once a model is trained, the algorithm predicts the user’s MM by
comparing the feature values of a given data sample to the mean
feature values of all MMs stored in the model. The smallest distance
between these values results in the classifer’s MM prediction. To
compensate for potential diferences in range and variance among
the selected features, we used the Mahalanobis distance instead of
the Euclidean distance [9].
4 RESULTS
Here, we consider four diferent subsets of our data to verify our
classifer. For each of these cases, we obtained a feature set through
forward selection, i.e., iteratively adding features that lead to the
biggest increase in prediction accuracy until it no longer increases.
Table 4 shows the resulting confusion matrix when we consider all
data recordings where participants wore the IMU on their wrist,
and train our classifer model with 16 selected features. The mean
prediction accuracy for this setup is 88 %. When the IMU is attached
to the mobility aid instead of the participant’s wrist, the prediction
accuracy is 82 % with four features selected to train the model
(Table 5). Note that no mobility aid is used for sitting and walking
without an aid. Therefore, only for those MMs, we included the data
recordings during which the IMU was attached to the participants’
wrist (see Table 1).
In a setting where an older adult would use no mobility aid to
walk short distances inside, and a rollator or a walker for longer dis-
tances outside, the classifer achieves a prediction accuracy of 96 %
(Table 6). Similarly, if a person only walks either with or without a
cane, the classifer always predicts the correct MM (Table 7).
ASSETS ’22, October 23–26, 2022, Athens, Greece Vargemidis, et al.

Table 5: Confusion matrix showing the classifer’s predic- distinguishing two diferent activities [2], we found that predictions
tions as a relative ratio (in %) (IMU attached to mobility aid, are still accurate when we include up to seven MMs, including MMs
except for No aid and Siting). The mean accuracy is 82 %, using fve mobility aids. Note that in a more realistic setting, one
and all results in this table are obtained using the following older adult is unlikely to use all considered types of mobility aids
features: ���� , ���� , ��,�3 , ��,����� on a regular basis. We can leverage this knowledge, e.g., by let-
ting users select which aids they regularly use through a one-time
Actual setup. This will further increase the classifer’s prediction accuracy,

Wheelchair
mounting to 96 % or higher.
Crutches

Rollator Additionally, the results suggest that the IMU’s location also

Walker

Sitting
No aid
impacts the prediction accuracy. Here, we found more favourable
Cane

results for a wrist-worn IMU. However, sensor placement is not

Cane 84 8 0 0 0 0 0 trivial [15, 17], and needs to be subject of follow-up studies.
Crutches 8 66 0 0 0 0 0
6 LIMITATIONS AND FUTURE WORK
Predicted

Rollator 0 0 50 0 0 0 0
Walker 8 8 0 92 0 0 0 This initial study allowed us to investigate the feasibility and poten-
Wheelchair 0 8 33 8 33 0 0 tial of a fexible tracking system. An important limitation is that we
No aid 0 8 0 0 0 100 0 recruited three participants only, and no older adults were involved
Sitting 0 0 17 0 17 0 100 for recording our dataset. We took this decision because the work
was carried out during the COVID-19 pandemic, and we did not
Table 6: Confusion matrix showing the classifer’s predic- want to put older adults at risk of exposure to collect preliminary
tions as a relative ratio (in %) for a subset of MMs (only wrist- data. Future studies need to verify whether the results found in
worn IMU). The mean accuracy is 96 %, and all results in this this study still apply to similar setups with older adults, specifcally
table are obtained using the following features: ����� , � � , those who are familiar with using mobility aids in their daily lives,
��,�3 , ��,�� and what adjustments would need to be made. Moreover, these re-
sults allow for continuing the fexible tracking approach, i.e., linking
Actual a MM prediction to a tailored algorithm for accurately computing
the user’s level of PA, e.g., step count or distance travelled.
Rollator

Walker

Sitting
No aid

7 CONCLUSION
Rollator 83 0 0 0 In this exploratory study, we examined fexible tracking as an ap-
proach to make activity tracking more accessible to older adults
Predicted

Walker 0 100 0 0 using mobility aids. As an initial step, we implemented and evalu-
No aid 17 0 100 0 ated a minimum distance classifer, achieving prediction accuracies
of more than 82 %. Future work should focus on evaluating this ap-
Sitting 0 0 0 100
proach with movement data of older adults, and linking predictions
to algorithms that can accurately track activity.
Table 7: Confusion matrix showing the classifer’s predic-
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