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Cited by 460Physical Activity and HealthContext-Aware Activity Recognition SystemsMobile Health and mHealth Applications

Step Counting: A Review of Measurement Considerations and Health-Related Applications

Open access
Bassett, David R., Toth, Lindsay P., LaMunion, Samuel R., Crouter, Scott E.·2017·Sports Medicine
DOI 10.1007/s40279-016-0663-1PMC PMC5488109
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Abstract

Step counting has long been used as a method of measuring distance. Starting in the mid-1900s, researchers became interested in using steps per day to quantify ambulatory physical activity. This line of research gained momentum after 1995, with the introduction of reasonably accurate spring-levered pedometers with digital displays. Since 2010, the use of accelerometer-based "activity trackers" by private citizens has skyrocketed. Steps have several advantages as a metric for assessing physical activity: they are intuitive, easy to measure, objective, and they represent a fundamental unit of human ambulatory activity. However, since they measure a human behavior, they have inherent biological variability; this means that measurements must be made over 3-7 days to attain valid and reliable estimates. There are many different kinds of step counters, designed to be worn on various sites on the body; all of these devices have strengths and limitations. In cross-sectional studies, strong associations between steps per day and health variables have been documented. Currently, at least eight prospective, longitudinal studies using accelerometers are being conducted that may help to establish dose-response relationships between steps/day and health outcomes. Longitudinal interventions using step counters have shown that they can help inactive individuals to increase by 2500 steps per day. Step counting is useful for surveillance, and studies have been conducted in a number of countries around the world. Future challenges include the need to establish testing protocols and accuracy standards, and to decide upon the best placement sites. These challenges should be addressed in order to achieve harmonization between studies, and to accurately quantify dose-response relationships.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes step counting as an objective, intuitive metric of ambulatory physical activity, covering device types, measurement error, and health-related applications. It concludes that steps/day is strongly associated with health variables in cross-sectional studies, that pedometer interventions can increase activity by about 2500 steps/day, and that standardization and longitudinal evidence are still needed.

Key findings

  • Cross-sectional studies show inverse associations between steps/day and cardiometabolic risk: in NHANES 2005–2006, each 1000-step increase was associated with 10% lower metabolic syndrome prevalence, and active/high-active adults had OR = 0.28 (95% CI 0.18–0.44) versus sedentary adults.
  • In Australian data, high-active men taking ≥12,500 steps/day had a metabolic syndrome prevalence ratio of 0.29 (95% CI 0.11–0.79) versus sedentary men; women showed lower prevalence ratios across higher step categories, though trend P values were 0.06–0.10.
  • Pedometer-based interventions can increase activity: Bravata et al. found RCT pedometer users increased by 2491 steps/day more than controls, and uncontrolled studies increased by 2183 steps/day; pooled reductions were BMI −0.38 kg/m² and systolic blood pressure −3.8 mmHg.
  • Meta-analyses of step-counting interventions reported modest weight loss (−1.29 kg, 95% CI −1.85 to −0.70 kg) and an overall mean effect size of 0.62, corresponding to about 2000 steps/day increase.

Methods

  • Narrative review of step counting measurement considerations and health-related applications, including device mechanisms, accuracy, sources of error, and placement sites.
  • Synthesizes prior cross-sectional, prospective observational, intervention, surveillance, and validation studies; includes tables of Fitbit sales, steps-per-day categories, metabolic syndrome prevalence, and ongoing longitudinal accelerometer cohorts.
  • No new primary data collection or formal systematic search/meta-analysis is reported; findings are drawn from cited literature and existing studies.

Limitations

  • The paper states that future challenges include establishing testing protocols and accuracy standards, deciding best placement sites, and achieving harmonization across studies to quantify dose–response relationships.
  • The paper notes that cross-sectional studies cannot establish causality and that longitudinal studies are needed; it also states that wrist-worn device accuracy during activities of daily life has not been studied.
  • The paper states that step counters cannot determine whether physical activity guidelines are met because most cannot measure frequency, intensity, and duration, and cannot capture bicycling, swimming, and resistance training.
  • Evident from the text: this is a narrative review without a described systematic search strategy, and device accuracy varies widely by speed, body size, placement, and activity type.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s40279-016-0663-1

Cites

56 of 56 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 94 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    In cross-sectional studies, strong associations between steps per day and health variables have been documented.

    “In cross-sectional studies, strong associations between steps per day and health variables have been documented.”
    • Also stated in: § Key Points · boosted
      “In cross-sectional studies, strong associations between steps per day and health variables have been documented.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Hatano Y. Pedometer-assessed physical activity: Measurement and motivations. In: Presented at 48th annual meeting of the American College of Sports Medicine (May 30–June 3), 2001, Baltimore, MD; 2001.

      Not checked in the free run.

    • cites [40] Hatano Y. Prevalence and use of pedometer [article written in Japanese]. Res J Walk. 1997;1:45–54.

      Not checked in the free run.

  • Interpretationreasoning

    Because steps measure a human behavior with inherent biological variability, measurements must be made over 3-7 days to attain valid and reliable estimates.

    “However, since they measure a human behavior, they have inherent biological variability; this means that measurements must be made over 3–7 days to attain valid and reliable estimates.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Smartwatches such as the Apple Watch, Samsung Gear S2, and Pebble Watch have acceptable validity and reliability for measuring steps during overground walking.

    “Smartwatches such as the Apple Watch, Samsung Gear S2, and Pebble Watch are also reported to have acceptable validity and reliability, at least for measuring steps during overground walking [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] El-Amrawy F, Nounou MI. Are currently available wearable devices for activity tracking and heart rate monitoring accurate, precise, and medically beneficial? Healthc Inform Res. 2015;21(4):315–20. source

      Not checked in the free run.

  • Premisenone given

    The accuracy of wrist-worn step counters for counting steps during activities of daily life has not been studied.

    “Their accuracy for counting steps during activities of daily life has not been studied.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    The Omron pocket step counter fails to detect steps taken in brief walking bouts because of a 4-s filter.

    “Also, in the case of the Omron, steps taken in brief walking bouts go undetected because of the presence of a 4-s filter [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Tyo B, Fitzhugh E, Bassett D, John D, Thompson D. Effects of body mass index and step rate on pedometer error in a free-living environment. Med Sci Sports Exerc. 2011;43(2):350–6. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 17
  • May combine two claims. 39

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Steps are a fundamental unit of human locomotion and thus a preferred metric for quantifying physical activity.

    “Steps are a fundamental unit of human locomotion, and thus are a preferred metric for quantifying physical activity.”
    • Also stated in: § Why Count Steps? · plain
      “Tryon [32] has noted that steps are a fundamental unit of human locomotion, and thus are a preferred metric for quantifying physical activity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Tryon WW. Activity measurement in psychology and medicine. New York: Springer Science & Business Media; 2013.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Individuals who take more steps per day have more favorable cardiometabolic risk profiles.

    “With recent studies showing that individuals who take more steps per day have more favorable cardiometabolic risk profiles, in the future it may be possible to develop criterion-referenced standards for steps per day and assign terms that refer to disease risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Daily step counts are inversely related to body mass index, hypertension, and diabetes in cross-sectional studies.

    “Cross-sectional studies have shown that daily step counts are inversely related to body mass index (BMI), hypertension, and diabetes [11, 40].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] Hatano Y. Pedometer-assessed physical activity: Measurement and motivations. In: Presented at 48th annual meeting of the American College of Sports Medicine (May 30–June 3), 2001, Baltimore, MD; 2001.

      Not checked in the free run.

    • cites [40] Hatano Y. Prevalence and use of pedometer [article written in Japanese]. Res J Walk. 1997;1:45–54.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Yamax DW-500 step counter was used to validate questions about walking distance on physical activity questionnaires.

    “A few years later, this step counter was used to validate questions about walking distance on physical activity questionnaires [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Bassett DR, Cureton AL, Ainsworth BE. Measurement of daily walking distance-questionnaire versus pedometer. Med Sci Sports Exerc. 2000;32(5):1018–23. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the free-living environment, the waist-worn ActiGraph measured 6743 ± 2398 (default filter) and 13,029 ± 3734 (low-frequency extension) steps per day; the wrist ActiGraph measured 9301 ± 2887 and 15,493 ± 3958 steps per day.

    “In the free-living environment, the waist-worn ActiGraph measured 6743 ± 2398 (default filter) and 13,029 ± 3734 (low-frequency extension) steps per day. The wrist ActiGraph measured 9301 ± 2887 (default filter) and 15,493 ± 3958 (low-frequency extension) steps per day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Tudor-Locke C, Barreira TV, Schuna JM Jr. Comparison of step outputs for waist and wrist accelerometer attachment sites. Med Sci Sports Exerc. 2015;47(4):839–42. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The wrist placement site and a waterproof case increased wear times and provided a valid assessment of sleep duration and quality.

    “The wrist placement site and a waterproof case increased wear times, and had the added benefit of providing a valid assessment of sleep duration and quality [30].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Troiano RP, McClain JJ, Brychta RJ, Chen KY. Evolution of accelerometer methods for physical activity research. Br J Sports Med. 2014;48(13):1019–23. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other researchers began using pedometers for population surveillance and walking interventions.

    “At about this time, other researchers began using pedometers for population surveillance [14] and walking interventions [15].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Sequeira MM, Richardson M, Wietlisbach V, Tullen B, Schutz Y. Physical activity assessment using a pedometer and its comparison with a questionnaire in a large population study. Am J Epidemiol. 1995;142(9):989–99. source

      Not checked in the free run.

    • cites [15] Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298(19):2296–304. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Wrist-worn step counters record invalid steps when folding laundry or gesturing while talking.

    “Furthermore, wrist-worn step counters record invalid steps when folding laundry [28], or gesturing while talking.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Chen MD, Kuo CC, Pellegrini CA, Hsu MJ. Accuracy of wristband activity monitors during ambulation and activities. Med Sci Sports Exerc. 2016;48(10):1942–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most waist-mounted pedometers are very accurate at speeds of 3.0 mph and above, but accuracy declines at slower speeds; at 2.0 mph they may capture 75% of steps, and at 1.0 mph they hardly register steps.

    “Studies have demonstrated that most waist-mounted pedometers are very accurate at speeds of 3.0 mph (80.4 m/min) and above, but their accuracy declines at slower speeds. At 2.0 mph (54 m/min) they may capture 75% of steps, and at 1.0 mph they hardly register steps at all.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] Bergman RJ, Bassett DR, Klein DA. Validity of 2 devices for measuring steps taken by older adults in assisted-living facilities. J Phys Act Health. 2008;5(Supp 1):S166–75. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The activPAL accurately counts steps down to 1.5 mph and only underestimates steps by 3.5% at 1.0 mph.

    “It accurately counts steps down to 1.5 mph (40.2 m/min) [21] and only underestimates steps by 3.5% at 1.0 mph (26.8 m/min) [22].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Grant PM, Dall PM, Mitchell SL, Granat MH. Activity-monitor accuracy in measuring step number and cadence in community-dwelling older adults. J Aging Phys Act. 2008;16(2):201–14. source

      Not checked in the free run.

    • cites [22] Kanoun N. Validation of the ActivPAL activity monitor as a measure of walking at pre-determined slow walking speeds in a healthy population in a controlled setting. Age (Years). 2009;23(4.0):18.0–39.0.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Spring-levered pedometers have diminished accuracy in obese individuals because tilting away from the vertical axis diminishes sensitivity, causing undercounting.

    “Spring-levered pedometers have diminished accuracy in obese individuals. According to Crouter et al. [18], this is because when they are tilted away from the vertical axis their sensitivity is diminished, causing them to undercount steps.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Crouter SE, Schneider PL, Bassett DR Jr. Spring-levered versus piezo-electric pedometer accuracy in overweight and obese adults. Med Sci Sports Exerc. 2005;37(10):1673–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Yamax DW-500 pedometer was found to be more accurate and reliable than other pedometers.

    “One pedometer (Yamax DW-500) was found to be more accurate and reliable than others [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Bassett DR, Ainsworth BE, Leggett SR, Mathien CA, Main JA, Hunter DC, et al. Accuracy of five electronic pedometers for measuring distance walked. Med Sci Sports Exerc. 1996;28(8):1071–7. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Tudor-Locke and Bassett proposed a classification scheme for categorizing adults based on their daily steps.

    “Tudor-Locke and Bassett [33] proposed a classification scheme for categorizing adults based on their daily steps (Table 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Tudor-Locke CE, Bassett DR. How many steps are enough? Pedometer-determined physical activity indices. Sports Med. 2004;34(1):1–8. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The main sources of error for waist-worn spring-levered pedometers are slow walking speeds and obesity, both causing underestimation of steps.

    “The main sources of error for this class of devices are slow walking speeds and obesity, which both result in underestimation of steps.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] Bergman RJ, Bassett DR, Klein DA. Validity of 2 devices for measuring steps taken by older adults in assisted-living facilities. J Phys Act Health. 2008;5(Supp 1):S166–75. source

      Not checked in the free run.

    • cites [18] Crouter SE, Schneider PL, Bassett DR Jr. Spring-levered versus piezo-electric pedometer accuracy in overweight and obese adults. Med Sci Sports Exerc. 2005;37(10):1673–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the free-living environment, the wrist recorded more steps than the waist, likely due to extraneous arm movements.

    “However, in the free-living environment the wrist recorded more steps than the waist, likely due to extraneous arm movements.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Tudor-Locke C, Barreira TV, Schuna JM Jr. Comparison of step outputs for waist and wrist accelerometer attachment sites. Med Sci Sports Exerc. 2015;47(4):839–42. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The New Lifestyles NL-2000 and Omron HJ-720 are not impacted by obesity or tilt angle.

    “Two such devices (New Lifestyles NL-2000 and Omron HJ-720) are not impacted by obesity or tilt angle [18, 19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Crouter SE, Schneider PL, Bassett DR Jr. Spring-levered versus piezo-electric pedometer accuracy in overweight and obese adults. Med Sci Sports Exerc. 2005;37(10):1673–9. source

      Not checked in the free run.

    • cites [19] Feito Y, Bassett D, Tyo B, Thompson D. Effects of body mass index and tilt angle on output of two wearable activity monitors. Med Sci Sports Exerc. 2011;43(5):861–6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Sources of error with foot step counters have not been investigated, but they most likely exhibit the same errors as ankle step counters.

    “The sources of error with foot step counters have not been investigated, but they most likely exhibit the same errors as ankle step counters.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The US President's Council on Fitness, Sports, and Nutrition has set daily step goals as part of its President's Active Lifestyle Award (PALA+): 12,000 steps per day for youth aged 6-17 years, and 8500 steps per day for adults.

    “However, the US President’s Council on Fitness, Sports, and Nutrition has set daily step goals as part of its President’s Active Lifestyle Award (PALA+): 12,000 steps per day for youth aged 6–17 years, and 8500 steps per day for adults [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] President’s Council on Fitness Sports and Nutrition. PALA+: activity plus nutrition. 2016. http://www.fitness.gov/participate-in-programs/pala/ . Accessed 15 July 2016.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Orendurff showed that the most common walking bouts last only four steps, and the next most common bouts last six, eight, ten, 12 steps, etc.

    “Orendurff [37] showed that the most common walking bouts last only four steps, and the next most common bouts last six, eight, ten, 12 steps, etc.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Orendurff MS, Schoen JA, Bernatz GC, Segal AD, Klute GK. How humans walk: bout duration, steps per bout, and rest duration. J Rehabil Res Dev. 2008;45(7):1077–89. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In women, those taking ≥5000 steps per day had substantially lower likelihood of overweight obesity and hypertension than women taking fewer steps; further increases in steps/day were only accompanied by modest decreases in odds ratios.

    “In women, those taking ≥5000 steps per day had substantially lower likelihood of overweight obesity and hypertension than women taking fewer steps; however, further increases in steps/day were only accompanied by modest decreases in odds ratios.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Inoue S, Ohya Y, Tudor-Locke C, Yoshiike N, Shimomitsu T. Step-defined physical activity and cardiovascular risk among middle-aged Japanese: the National Health and Nutrition Survey of Japan 2006. J Phys Act Health. 2012;9(8):1117–24. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    The intensity of steps can vary with one's level of aerobic fitness; frail elderly individuals tend to take slower, shorter steps while younger, more athletic individuals often take running steps.

    “Finally, the intensity of steps can vary with one’s level of aerobic fitness. Frail, elderly individuals tend to take slower, shorter steps while younger, more athletic individuals often take running steps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Greater effects of step-counting interventions were seen in females and with the use of a 10,000 steps per day goal.

    “Greater effects were seen in females, and with the use of a 10,000 steps per day goal.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Kang M, Marshall SJ, Barreira TV, Lee JO. Effect of pedometer-based physical activity interventions: a meta-analysis. Res Quart Exerc Sport. 2009;80(3):648–55.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Japanese Ministry of Economy Trade and Industry has set industrial standards for pedometers requiring accuracy within ±3% for approval.

    “The Japanese Ministry of Economy Trade and Industry has set industrial standards for pedometers (they must be accurate to within ±3% for approval) [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Hatano Y. Pedometer-assessed physical activity: Measurement and motivations. In: Presented at 48th annual meeting of the American College of Sports Medicine (May 30–June 3), 2001, Baltimore, MD; 2001.

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    At 54 m/min many devices begin to undercount steps, and at 26.8 m/min most devices record only 50-75% of actual steps.

    “However, at 54 m/min (2 mph) many devices begin to undercount steps, and at 26.8 m/min (1 mph) most devices will record only 50–75% of actual steps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Schmidt et al. analyzed data from the Childhood Determinants of Adult Health study (N = 1793) and the Tasmanian Older Adult Cohort Study (N = 1014) in Australia, measuring prevalence of metabolic syndrome in younger and older adults who wore a pedometer for 7 days.

    “Schmidt et al. [41] analyzed data from the Childhood Determinants of Adult Health study (N = 1793) and the Tasmanian Older Adult Cohort Study (N = 1014); both studies were done in Australia. They measured the prevalence of metabolic syndrome in younger and older adults who wore a pedometer for 7 days.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Schmidt M, Cleland V, Shaw K, Dwyer T, Venn A. Cardiometabolic risk in younger and older adults across an index of ambulatory activity. Am J Prev Med. 2009;2009(37):4.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Yamasa corporation discovered a way to prevent double-counting in 1987; their DW-500 step counter will not record an event as a step if it follows too closely in the wake of a preceding step.

    “As mentioned previously, the Yamasa corporation discovered a way to prevent this in 1987. Their DW-500 step counter will not record an event as a step, if it follows too closely in the wake of a preceding step.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Hatano Y. Pedometer-assessed physical activity: Measurement and motivations. In: Presented at 48th annual meeting of the American College of Sports Medicine (May 30–June 3), 2001, Baltimore, MD; 2001.

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Inoue et al. examined 1166 men and 1453 women (40-64 years of age) in the National Health and Nutrition Survey of Japan, 2006, using a Yamasa AS-200 pedometer worn during all waking hours for a single day except when bathing and showering.

    “Inoue et al. [43] examined 1166 men and 1453 women (40–64 years of age) in the National Health and Nutrition Survey of Japan, 2006. They used a Yamasa (Yamax) AS-200 pedometer which participants were instructed to wear during all waking hours for a single day, except when bathing and showering.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Inoue S, Ohya Y, Tudor-Locke C, Yoshiike N, Shimomitsu T. Step-defined physical activity and cardiovascular risk among middle-aged Japanese: the National Health and Nutrition Survey of Japan 2006. J Phys Act Health. 2012;9(8):1117–24. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    When a step counter is jostled or exposed to mechanical vibrations, erroneous steps can be recorded even though none are taken.

    “When a step counter is jostled or exposed to mechanical vibrations, erroneous steps can be recorded even though none are taken.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a meta-analysis of step counting interventions, the overall mean effect size was 0.62, corresponding to an average increase of 2000 steps per day in the intervention group.

    “For the remaining 32 studies, the overall mean effect size was 0.62, corresponding to an average increase of 2000 steps per day in the intervention group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Kang M, Marshall SJ, Barreira TV, Lee JO. Effect of pedometer-based physical activity interventions: a meta-analysis. Res Quart Exerc Sport. 2009;80(3):648–55.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The amount of energy expended per step is roughly proportional to a person's body weight (cal/kg/step), although it also depends on speed of locomotion and whether one is walking or running.

    “The amount of energy expended per step is roughly proportional to a person’s body weight (cal/kg/step) [34], although it is also dependent upon speed of locomotion and whether one is walking or running (Fig. 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Hatano Y. Use of the pedometer for promoting daily walking exercise. Int Counc Health Phys Educ Recreat (ICHPER) J. 1993;29(4):4–8.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Sisson et al. analyzed data from 1446 adults in NHANES 2005-2006 using the Actigraph 7164 worn at the waist and censored steps taken at lower intensity levels.

    “Sisson et al. [42] analyzed data from 1446 adults in the NHANES study (2005–2006). This study used the Actigraph 7164 worn at the waist, and the authors “censored” steps taken at lower intensity levels.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Sisson S, Camhi S, Church T, Tudor-Locke C, Johnson W, Katzmarzyk P. Accelerometer-determined steps/day and metabolic syndrome. Am J Prev Med. 2010;38(6):575–82. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In walking and running, each leg has a stance phase and a swing phase; in walking there is a double-stance period, but in running this does not occur.

    “Biomechanical studies show that in walking and running, each leg has a stance phase corresponding to the period of time when the foot is on the ground, and a swing phase corresponding to the period of time when the foot is off the ground and moving forward. In walking, there is a double-stance period where both legs are on the ground, but in running this does not occur.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    Only a few research grade step counters (StepWatch, activPAL) can accurately record steps at 1.0 mph, and these devices cost around US$500 each.

    “Only a few research grade step counters (i.e., StepWatch, activPAL) can accurately record steps at 1.0 mph, and these devices cost around US$500 each.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Having a step goal and keeping a physical activity log were helpful in increasing physical activity.

    “Having a step goal and keeping a physical activity log were other elements found to be helpful in increasing physical activity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Bravata DM, Smith-Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA. 2007;298(19):2296–304. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In Western Australian adults, average steps per day was 9695, and less than half (47%) took 10,000 or more steps per day.

    “On average, Western Australian adults took 9695 steps per day, and less than half (47%) took 10,000 or more steps per day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] McCormack G, Milligan R, Giles-Corti B, Clarkson JP. Physical activity levels of Western Australian Adults: results from the adult physical activity survey and pedometer study. Perth: Western Australian Government; 2003.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the CANPLAY surveillance study, girls took fewer steps per day than boys (10,682 vs. 11,059) and had less variability in daily step counts.

    “Girls were found to take fewer steps per day than boys (10,682 vs. 11,059, respectively), and to have less variability in daily step counts [59].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Tudor-Locke C, Craig CL, Cameron C, Griffiths JM. Canadian children’s and youth’s pedometer-determined steps/day, parent-reported TV watching time, and overweight/obesity: the CANPLAY Surveillance Study. Int J Behav Nutr Phys Act. 2011;8:66. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After censoring steps to be more similar to Yamax pedometer steps, men took 7431 ± 129 steps per day and women took 5756 ± 120 steps per day.

    “After censoring steps to make them more similar to Yamax pedometer steps per day, the authors concluded that men took 7431 ± 129 steps per day and women took 5756 ± 120 steps per day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Tudor-Locke C, Johnson WD, Katzmarzyk PT. Accelerometer-determined steps per day in US adults. Med Sci Sports Exerc. 2009;41(7):1384–91. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    While the relationship between stepping rate and energy expenditure has been quantified for walking/running, there appears to be a different relationship between these variables when other activities are performed.

    “Another thing to consider is that while the relationship between stepping rate and energy expenditure has been quantified for walking/running, there appears to be a different relationship between these variables when other activities are performed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The ability of wearable devices to continuously store vast amounts of information on small, inexpensive computer chips has fundamentally changed the field of physical activity assessment.

    “The ability of wearable devices to continuously store vast amounts of information on small, inexpensive computer chips has fundamentally changed the field of physical activity assessment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    By using step counters in physical activity interventions, they facilitate behavior change and can be helpful in motivating inactive individuals to increase their activity levels by about 2500 steps per day (the equivalent of walking 1 mile).

    “By using step counters in physical activity interventions, we have learned that they facilitate behavior change and can be helpful in motivating inactive individuals to increase their activity levels by about 2500 steps per day (the equivalent of walking 1 mile).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Waist-mounted devices are accurate enough that they can yield useful information on the relationship between steps per day and health outcomes.

    “However, waist-mounted devices are accurate enough that they can yield useful information on the relationship between steps per day and health outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Step counters might be able to assess the likelihood that an individual is meeting physical activity guidelines, but they cannot determine if the guidelines are being met.

    “In our view, step counters might be able to assess the likelihood that an individual is meeting the guidelines, but they cannot determine if the guidelines are being met.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Most step counters cannot measure frequency, intensity, and duration, nor capture bicycling, swimming, and resistance training.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The ideal location for accurately measuring steps seems to be the ankle or foot.

    “The ideal location for accurately measuring steps seems to be the ankle or foot.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the Swiss MONICA study, average steps per day decreased from 11,900 to 6700 for men and from 9300 to 7300 for women from the youngest to the oldest age categories.

    “The step counter was worn for 1 week, and the average number of steps per day decreased from 11,900 to 6700 and from 9300 to 7300 for men and women, respectively, in the youngest to the oldest age categories.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Sequeira MM, Richardson M, Wietlisbach V, Tullen B, Schutz Y. Physical activity assessment using a pedometer and its comparison with a questionnaire in a large population study. Am J Epidemiol. 1995;142(9):989–99. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In US NHANES 2005-2006, men took 10,578 ± 134 steps per day and women took 8882 ± 124 steps per day (ActiGraph 7164).

    “On average, men took 10,578 ± 134 steps per day (mean ± SE) and women took 8882 ± 124 steps per day.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Tudor-Locke C, Johnson WD, Katzmarzyk PT. Accelerometer-determined steps per day in US adults. Med Sci Sports Exerc. 2009;41(7):1384–91. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Men accumulated more steps per day (10,221 steps) than women (9178 steps), and younger adults accumulated more steps per day than older adults.

    “Men accumulated more steps per day (10,221 steps) than women (9178 steps), and younger adults accumulated more steps per day than older adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] McCormack G, Milligan R, Giles-Corti B, Clarkson JP. Physical activity levels of Western Australian Adults: results from the adult physical activity survey and pedometer study. Perth: Western Australian Government; 2003.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    Wearable devices (e.g., step counters) are facilitators, not drivers, of behavior change.

    “A recent viewpoint in the Journal of the American Medical Association concluded that wearable devices (e.g., step counters) are facilitators, not drivers, of behavior change [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Patel MS, Asch DA, Volpp KG. Wearable devices as facilitators, not drivers, of health behavior change. JAMA. 2015;313(5):459–60. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the 2003 Japanese National Health and Nutrition Survey, average steps per day for residents 15 years of age and older was 7168 ± 4248; males accumulated 7575 ± 4580 steps per day and women accumulated 6821 ± 3909 steps per day.

    “On average (mean ± SD), Japanese residents 15 years of age and older took 7168 ± 4248 steps per day; males accumulated 7575 ± 4580 steps per day and women accumulated 6821 ± 3909 steps per day.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [56] Inoue S, Ohya Y, Tudor-Locke C, Tanaka S, Yoshiike N, Shimomitsu T. Time trends for step-determined physical activity among Japanese adults. Med Sci Sports Exerc. 2011;43(10):1913–9. source

      Not checked in the free run.

    • cites [57] Inoue S, Takamiya T, Yoshiike N, Shimomitsu T. Physical activity among the Japanese: results of the National Health and Nutrition Survey. In: Prevention CfDCa, editor. Proceedings of the international congress on physical activity and public health; 17–20 April 2006. Atlanta, GA: U.S. Department of Health and Human Services; 2006. p. 79.

      Not checked in the free run.

48 of 48

  • The paper relies on this without support.

    The accuracy of consumer activity trackers is not regulated by any government agency or scientific body to ensure that they give valid information.

    “While consumer interest has increased in recent years, there is a problem in that the accuracy of these devices is not regulated by any government agency or scientific body to ensure that they are giving valid information.”

  • The paper relies on this without support.

    Visual observation and hand-tally of steps by a trained investigator can serve as a valid criterion measure for step counting accuracy.

    “For many purposes, visual observation and hand-tally of steps by a trained investigator can serve as a valid criterion.”

  • The paper relies on this without support.

    Steps are a behavior rather than an object or event, and thus cannot be quantified by absolute units like meters or kilojoule.

    “However, steps are a behavior rather than an object or event. Thus, the step is an “anthropometric” unit of measurement, they cannot be quantified by absolute units like meters or kilojoule.”

  • The paper relies on this without support.

    Step guidelines (e.g., 10,000 steps per day) have not been widely adopted by government health agencies.

    “Despite the potential utility of steps per day for translating research findings into public health recommendations, step guidelines (e.g., 10,000 steps per day) have not been widely adopted by government health agencies.”

  • The paper relies on this without support.

    Most step counters cannot measure frequency, intensity, and duration, nor capture bicycling, swimming, and resistance training.

    “This is due to the inability of most step counters to measure frequency, intensity, and duration, as well as their inability to capture bicycling, swimming, and resistance training.”

  • The paper relies on this without support.

    Cadence can be used to estimate walking speed and rate of energy expenditure.

    “Cadence is an important variable because it can be used to estimate walking speed and rate of energy expenditure.”

  • The paper relies on this without support.

    At least one step counter (StepWatch) has received US Food and Drug Administration (FDA) clearance as a class 2 medical device for use in research.

    “At least one step counter (StepWatch) has received US Food and Drug Administration (FDA) clearance as a class 2 medical device for use in research.”

  • The paper relies on this without support.

    Wearable physical activity monitors must be worn continuously (or at least during all waking hours) for extended periods (e.g., 3–7 days) to provide useful information.

    “However, unlike other medical devices that assess vital signs and clinical biomarkers (e.g., blood pressure monitors, pulse oximeters, and blood glucose monitors) at one point in time, wearable physical activity monitors assess a human behavior and must be worn continuously (or at least during all waking hours) for extended periods (e.g., 3–7 days) to provide useful information.”

  • The paper relies on this without support.

    Step counters have not yet become common in clinical practice.

    “Step counters have not yet become common in clinical practice”
9 of 9

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Prior studies have focused on a relatively targeted set of outcomes limited to mortality, diabetes and cardiovascular disease.

    “Second, prior studies have focused on a relatively targeted set of outcomes limited to mortality, diabetes and cardiovascular disease.”

    From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [6]

    The review’s Steps/Day and Health > Longitudinal Intervention Studies section reports prior step-counting studies that measured weight change, including a meta-analysis of nine studies. Weight change falls outside the claimed list, so the paper does not support describing prior outcomes as limited to mortality, diabetes, and cardiovascular disease. Page numbers were not available in our copy. (LLM, conf=0.85)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Prior studies consistently show that taking fewer steps per day is associated with higher risk of all-cause mortality and cardiovascular disease.

    “Prior studies consistently show that taking fewer steps per day1–6 is associated with higher risk of all-cause mortality and cardiovascular disease.”

    From Association of step counts over time with the risk of chronic disease in the All of Us Research Program (2022) · cites this paper as [6]

    The Cross-Sectional Studies section reports that fewer daily steps are associated with less favorable cardiometabolic risk factors, including hypertension. It does not report an association with all-cause mortality or cardiovascular disease outcomes; the Prospective Observational Studies section lists studies examining disease endpoints but gives no such results. No page numbers are available in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Wilson DL, Stanton L, editors. Jefferson Abroad. New York: Modern Library; 1999.
  2. Daniels G. The Art of Breguet. London: Sotheby Parke Bernet; 1975.
  3. Kanoun N. Validation of the ActivPAL activity monitor as a measure of walking at pre-determined slow walking speeds in a healthy population in a controlled setting. Age (Years). 2009;23(4.0):18.0–39.0.
  4. Definition of step. English Oxford Living Dictionaries. 2016. https://en.oxforddictionaries.com/definition/step . Accessed 20 Dec 2016.
  5. Hatano Y. Prevalence and use of pedometer [article written in Japanese]. Res J Walk. 1997;1:45–54.
  6. Inoue S, Takamiya T, Yoshiike N, Shimomitsu T. Physical activity among the Japanese: results of the National Health and Nutrition Survey. In: Prevention CfDCa, editor. Proceedings of the international congress on physical activity and public health; 17–20 April 2006. Atlanta, GA: U.S. Department of Health and Human Services; 2006. p. 79.

Cited by

Sorted by citations

Related

Authors
Bassett, D. R., Toth, L. P., LaMunion, S. R., & Crouter, S. E.
Affiliations
University of Tennessee at Knoxville (US)
Corresponding author
Bassett, David R.
ORCID
Venue
Sports Medicine
Publisher
Springer Science and Business Media LLC
Published
2016-12-22
Volume
47
Issue
7
Pages
1303-1315
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
DOI
10.1007/s40279-016-0663-1
PMC
PMC5488109
OpenAlex
W2565317782
Semantic Scholar
a37464d39e0f96c61261442992db7ee334425e9c
Cited by
460
References
56
Citations by year
2026: 35 · 2025: 43 · 2024: 59 · 2023: 42 · 2022: 64 · 2021: 89 · 2020: 61 · 2019: 39 · 2018: 25 · 2017: 2
FWCI
2.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Sports Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of North Florida Digital Commons (University of North Florida) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
step counting, pedometers, accelerometer, wearable activity trackers, physical activity measurement, biological variation, reliability and validity, dose-response relationship, health outcomes, physical activity surveillance
MeSH terms
Health Promotion, Humans, Motor Activity, Health Behavior, Exercise, Walking, Monitoring, Ambulatory, Accelerometry

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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