Determination of cut-off points for the Move4 accelerometer and assessment of energy expenditure in children and adolescents aged 6-16 years using manual wheelchairs: a validation and calibration study.
Selina Seemüller, Anne Kerstin Reimers, Benedikt Meixner and 2 others
Valid cut-off points for the Move4 accelerometer were established for children in manual wheelchairs.
Upper-arm placement classified the four intensity levels most accurately. These are the first such thresholds for this age group.
Key findings
1Cut-off points separating sedentary, light, moderate, and vigorous activity were derived for all three sensor positions (wrist, upper arm, chest) using both the MAD and MAI metrics. The upper-arm placement showed the best overall classification performance.
2MAI values were consistently higher than MAD values across all activities and sensor positions, and MAI showed smaller and more consistent differences between the two measurement sessions.
3MET values for light, moderate, and vigorous activities fell within their expected reference ranges, but the mean MET for sedentary behavior (reading and being pushed) was 2.1, above the expected 1.0 to 1.5 range.
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What it does not show
Only 24 children, and only 7 of them had metabolic cart measurements, so the physiological reference is very thin. No power calculation was done; the sample size was guided by what similar studies used. All activities were performed in a laboratory at predefined speeds, so the cut-off points may not hold in free-living or sport contexts where pacing is self-selected. The sedentary-behavior MET values (2.0 to 2.1) exceeded the expected 1.0 to 1.5 range, and the authors could not explain why. Some children could not sustain the fast-wheeling task for the full four minutes, so data had to be trimmed, and the sample size varied across analyses. The protocol ran from low to high intensity with only two minutes between activities, so heart rate during later tasks may have been elevated by the previous one. The sample included a wide range of body sizes (BMI 10.4 to 32.6) and fitness levels, which the authors note could affect heart-rate responses. Only wheelchair-based activities were tested; floor-based or sitting-based physical activity common in this age group was not included.
Declared interests
Funded by Friedrich-Alexander-Universität Erlangen-Nürnberg. The accelerometer is manufactured by movisens GmbH, but no industry funding, design involvement, or manuscript contribution by the manufacturer is declared.
The easy way to misread this
Do not apply these cut-off points to free-living monitoring or to children with different mobility impairments. The study tested only six standardized wheelchair activities at fixed speeds in a laboratory, with 24 children of widely varying fitness and body size. The sedentary-behavior energy expenditure came in above the expected range and the authors say this needs further investigation, so the lowest intensity boundary is the least certain.
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