Moldovan Ioana A, Bragg Alexa, Nidhiry Anna S, De La Cruz Barbara A, Mitchell Suzanne E
Department of Family Medicine, Boston Medical Center, Boston, MA, United States.
Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States.
Interact J Med Res. 2022 Sep 6;11(2):e34433. doi: 10.2196/34433.
Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking.
This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist.
We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized.
A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants' mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study.
An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning.
建议2型糖尿病患者将体育活动纳入日常生活习惯中。加速度计为客观测量体育活动及评估干预措施提供了一种很有前景的方法。然而，关于2型糖尿病中老年患者通过加速度计测量体育活动的现有文献尚不足。
本研究旨在识别那些使用基于加速度计的切点将2型糖尿病中老年患者的体育活动强度分类为久坐、轻度、中度、剧烈和非常剧烈的研究，并确定是否存在专门针对该人群的经过验证的加速度计切点。
我们遵循乔安娜·布里格斯研究所的范围综述方法。在2020年6月23日至7月12日期间，两名评审员独立筛选来自四个数据库（PubMed、科学网、Embase、工程索引）以及ActiGraph公司网站的记录，以查找符合条件的研究，这些研究需纳入平均年龄≥50岁的2型糖尿病患者，使用研究级加速度计，应用切点对客观测量的体育活动进行分类，且有英文版本。我们排除了仅报告通过加速度计或计步器测量的步数或步数计数的研究以及会议摘要或其他无全文的来源。使用Microsoft Excel完成数据提取。基于频率分布将以下变量的数据制成表格：研究设计、加速度计类型、设备放置、采样时长、总佩戴时间以及使用的切点。总结了研究目的和参与者的人口统计学数据。
在摘要层面共筛选了748条记录，对88篇全文进行了资格评估。最终，保留并分析了46篇文章。参与者的平均年龄在50至79.9岁之间。ActiGraph加速度计以及Freedson等人和Troiano等人的每分钟计数切点在文献中使用最为频繁。Freedson等人和Troiano等人针对轻度、中度和剧烈活动的每分钟计数切点分别对应<1952、1952 - 5724和≥5725，以及100 - 2019、2020 - 5998和≥5999。Lopes等人的切点是通过在超重/肥胖和2型糖尿病的中老年患者中校准ActiGraph得出的。这些每分钟计数阈值为≥200（轻度）、≥1240（中度）和≥2400（剧烈），并应用于1项干预研究。
研究人员使用了各种加速度计切点对糖尿病中老年患者的体育活动强度进行分类。在我们感兴趣的人群中，只有一组切点经过了验证和校准。有必要进行更多研究以满足对糖尿病特异性切点的需求，为公共卫生建议提供依据。这包括确认Lopes等人的切点反映了除超重/肥胖外还患有其他合并症的糖尿病成年人体育活动中具有临床意义的变化，以及开发可能更适合身体功能欠佳者的相对强度切点。
