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Individualized Estimation of Physical Activity in Older Adults with Type 2 Diabetes


Medicine & Science in Sports & Exercise: November 2017 - Volume 49 - Issue 11 - p 2185–2190
doi: 10.1249/MSS.0000000000001355

Purpose Compare physical activity intensity in older adults with type 2 diabetes mellitus (T2DM) using individualized, relative cutpoints with standard, absolute cutpoints.

Methods One hundred older adults with T2DM (68.9 ± 5.1 yr, 65% male, 32.7 ± 6.3 kg·m−2, 7.2% ± 1.1% glycosylated hemoglobin) completed a two-speed walking protocol (varying, walking between 1 and 2.5 mph), followed by a modified Bruce peak exercise test. Participants wore an accelerometer-based physical activity monitor at their waist, and oxygen consumption was measured. Afterward, participants wore the activity monitor for seven consecutive days. Linear equations for each individual were derived from the activity counts and energy expenditure measured during the walking protocol. Relative intensity cutpoints were calculated by using standard classifications of 44% oxygen consumption (V˙O2)peak to determine moderate and 59% V˙O2peak to determine vigorous intensity. Average time spent in intensity categories per day were calculated using relative and absolute (moderate, 2020 counts per minute; vigorous, 5999 counts per minute) cutpoints. t-Tests were run to compare estimated time spent in intensity category by cutpoint.

Results Mean V˙O2peak was 17.9 ± 4.5 mL·kg−1·min−1 and relative cutpoints were, on average, 1033.5 counts per minute (SD, 741.2 counts per minute) for moderate and 2211.7 counts per minute (SD, 1512.4) for vigorous activity. Using the relative cutpoints, participants accumulated an average of 157.2 min (SD, 73.7 min) of light, 33.3 min (SD, 35.6 min) of moderate, and 15.6 min (SD, 26.7 min) of vigorous activity per day. Use of the absolute cutpoint resulted in significantly different estimations based on intensity category: light, 200.7 min (SD, 74.7 min; P < 0.05); moderate, 7.1 min (SD, 9.2 min; P < 0.05); and vigorous, 0.006 min (SD, 0.04 min; P < 0.05) of activity per day.

Conclusions These results suggest utilization of absolute cutpoints may underestimate daily relative intensity levels of physical activity in older adults with T2DM. This misclassification may improperly inform dose–response relationships and population-based prevalence of physical activity in these and may extend to other clinically important populations.

1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Veterans Administration Ann Arbor Health Care System Geriatrics Research Education and Clinical Center (GRECC); Ann Arbor, MI; 3Department of Kinesiology, The University of Wisconsin-Milwaukee, Milwaukee, WI; and 4Center for Aging and Translational Research, The University of Wisconsin-Milwaukee, Milwaukee, WI

Address for correspondence: Whitney A. Welch, Ph.D., Northwestern University Feinberg School of Medicine, 680N Lake Shore Dr. Suite 1400, Chicago, IL 60611; E-mail:

Submitted for publication March 2017.

Accepted for publication June 2017.

© 2017 American College of Sports Medicine