Cadence and Intensity in Children and Adolescents (CADENCE-KIDS)
Conditions: Healthy
Sponsor: Pennington Biomedical Research Center

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 1 of 23 
PI Name: William D. Johnson, PhD 
 
Co-Investigators Name: Timothy S. Church, MD, MPH, PhD  
      Catrine Tudor-Locke, PhD 
 
Medical Investigator: Daniel Hsia, MD 
 
Protocol Version Date: 07/10/2015 
1) 
Protocol Title 
Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
2) 
Objectives* 
 
The primary aim of this exploratory/developmental R21 study (CADENCE-KIDS) 
is to identify and evaluate objectively monitored cadence (steps/min) cut points 
associated with markers of increasing intensity across age in children and 
adolescents. 
 
To achieve this aim, we will identify and recruit 10 participants (5 boys, 5 girls) 
from each age-year between 6- 20 years (a span of 15 age-years for a total of 150 
participants) to a lab-based study of cadence. Cadence and oxygen uptake data will 
be collected during a treadmill assessment of incrementally faster paces and also 
using portable metabolic testing of common free-living activities, to test the 
following hypothesis: 
• Children’s activity intensity (oxygen uptake) will increase in a linear 
or nonlinear (curvilinear) fashion as cadence increases such that we 
will be able to develop statistical models for predicting markers (cut 
points) of intensity from cadence. This will be tested in the lab-based 
study that will provide objective and directly measured data of both 
cadence and intensity markers. 
 
The information derived from this exploratory/developmental study will be used to 
calibrate children’s and adolescent’s cadence data. The information will be used to 
inform a future study of cadence as an indicator of intensity in determining 
healthful levels of children’s and adolescent’s free-living physical activity. No 
similar data exist at this time so the approach described in this application is a 
critical first step to providing a common and interpretable objectively monitored 
metric. 
 
3) 
Background* 
 
The multiple and robust health benefits of a physically active lifestyle extend to 
children and adolescents. Physical activity guidelines from around the world are 
typically expressed in terms of frequency, duration, and intensity parameters. There 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 2 of 23 
is growing interest in translating public health physical activity recommendations in 
terms of the number of steps taken (i.e., steps/day), and this is also true for children 
and adolescents. Such an output does not reflect intensity, an important constituent 
of public health guidelines. However, capture and analysis of patterns of minute-by-
minute cadence, alone or together with steps/day, represents an overlooked 
opportunity in terms of both analysis and interpretability. In addition, cadence 
(steps/min) represents one of the few measures that can be collected and interpreted 
across different instrumentation without worrying about deriving or otherwise 
adjusting data. 
 
Cadence is just one of the temporal-spatial parameters of gait. Cadence multiplied 
by stride length equals speed. Assembled from adult studies of cadence and MET 
(metabolic equivalent - an indicator of absolute intensity) levels, the correlation 
between steps/minute and MET level is strong (r=0.93).1 Cadence is known to be 
the primary strategy for increasing free-living walking speed in adults2 and 
children3 and although stride lengthening becomes relatively more important in 
running, cadence still increases with running speed.4 In both children and adults it 
can be used to infer intensity of activity. The five studies5-9 that have directly 
measured cadence and verified absolutely-defined moderate intensity activity in 
adults came to similar conclusions: despite inter-individual variation, 100 
steps/minute represents a reasonable heuristic value associated with moderate 
intensity walking. We would expect that the cadence associated with moderate 
intensity in the growing child would be higher than this, however, there have been 
no studies at this time that have similarly looked at directly measured cadence and 
verified absolutely-defined moderate (or any other level) intensity activity in 
children and adolescents spanning these developmental years. 
 
4) 
Inclusion and Exclusion Criteria* 
 
Print and email advertisements will be developed to inform potential participants 
about CADENCE-KIDS, directing them to a web-screener or to call into the 
Pennington Biomedical Research Center Recruiting Core. The web-screener will be 
developed with the aid of the Recruiting Core to assess initial eligibility, focusing 
on the assessment of potential participants’ demographic information, health 
history, and ambulatory ability. Potential participants who are not rejected by the 
web-screener will be contacted via telephone by a Pennington Biomedical 
Recruiting Core member as a follow-up and asked to complete a confirmatory 
telephone-based screening questionnaire. Potential participants may choose to 
directly contact the Pennington Biomedical Recruiting Core via telephone without 
completing the web-screener, and these individuals will be administered the same 
telephone-based screening questionnaire to assess initial eligibility. Interested and 
eligible participants will then be asked to schedule for an orientation session at the 
Pennington Biomedical Research Center to learn more about the study. Following 
the orientation session, those eligible potential participants who remain interested in 
the study will then be asked to schedule for the single testing session (although we 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 3 of 23 
will accommodate schedules if they wish to spread the testing out over two separate 
days) required to complete the CADENCE-KIDS study protocol. 
 
See the following table (Table 1) for initial eligibility criteria to be assessed by 
phone screen. 
 
Table 1. Initial inclusion criteria 
• Children and adolescents between the ages of 6 and 20 years of age.  
 
See the following table (Table 2) for exclusion criteria to be assessed by phone 
screen. 
 
Table 2. Initial exclusion criteria 
Ambulatory 
ability 
• Since the focus herein is on ambulatory activities, 
participants who use wheelchairs or other impairments 
that prevent normal ambulation will be excluded. This 
criteria is similar to that used by NHANES when 
selecting individuals (6+ years of age) to wear motion 
sensors.10 
Other exclusions 
• Hospitalization for mental illness within the past 5 
years.  
• Any condition/medication that may affect heart rate 
response to exercise testing.  
• Previous history of, or clinical symptoms or signs of, 
cardiovascular disease, stroke or TIAs (transient 
ischemic attacks), chest pain, unusual dyspnea during 
physical activity/exercise, severe ankle edema, or 
intermittent claudication.  
• Previous history of musculoskeletal injuries or 
problems causing severe pain during physical activity 
or exercise which interferes with daily activities. 
• Participant has a pacemaker or other implanted 
medical device (including metal joint replacements). 
• Participant is pregnant. 
• Participant is unable to complete all testing (1 or two 
sessions, as preferred) within a maximal two week 
period. 
 
In addition to the exclusion criteria listed above, those participants between 6-17 
years of age whose refuse to provide assent (verbal for 6-8 year-olds, written for 9-
17 year-olds), or whose parents/legal guardians refuse to sign an informed consent 
document will be excluded from the study. Also, those participants (18-20 years of 
age) who refuse to sign a written informed consent document will be excluded from 
the study. Consent/assent will be obtained upon each participant’s arrival at the 
Pennington Biomedical Research Center’s Outpatient Clinic before participating in 
any study procedures. To further safeguard participant safety and internal validity 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 4 of 23 
of the study, inclusion and exclusion criteria will be reassessed by Pennington 
Biomedical Research Center clinic staff following the completion of required 
assent/consent forms. The inclusion/exclusion form used for this assessment is 
provided in Appendix A. 
 
5) 
Study-Wide Number of Subjects 
 
All participants will be recruited to participate and complete all study-related 
procedures at the Pennington Biomedical Research Center in Baton Rouge, 
Louisiana. We will identify and recruit 10 participants (5 boys, 5 girls) from each 
age-year between 6-20 years (a span of 15 age-years) for a total of 150 participants. 
This is an exploratory/developmental R21 study to collect preliminary data for the 
purpose of investigating the statistical relationships between objectively monitored 
cadence (steps/min) and increasing intensity, specifically metabolic equivalents or 
METS, measured in a laboratory treadmill setting and in free-living among young 
people ages 6-20 years. Calibration studies have typically been conducted using 
small select samples.11 Freedson et al.12 has recommended that calibration studies in 
children be conducted with at least 10 participants in each age group (e.g., 8-10, 10-
12 years of age, etc.). We exceed this requirement by enlisting 10 participants for 
each sex-age year, for a total of 150 participants. This strategy will make this the 
second largest accelerometer calibration study to date among children and 
adolescents, but the most age-distributed study. Mattocks et al.13 studied 246 
children, but all age 12 years, and Freedson et al.12 studied children and adolescents 
6-18 years of age, but only 80 in total. The estimates of statistical relationships and 
variability in cadence and intensity markers within sex-age specific cohorts will be 
used to power a larger study with expanded objectives. 
 
6) 
Study-Wide Recruitment Methods* 
This is not a multi-center trial and all recruitment will be conducted by the 
Pennington Biomedical Research Center’s Recruiting Core, with all testing 
occurring at the Pennington Biomedical Research Center. 
 
7) 
Study Timelines* 
It will take 1 day (approximately 3 hours) for CADENCE-KIDS participants to 
complete all the study procedures taking place at Pennington Biomedical Research 
Center (consent/assent and entire research protocol). However, we will 
accommodate each participant’s preferences should they wish to split the testing 
over 2 days, as long as both testing days are scheduled within a two-week period. 
 
We anticipate that it will take approximately 18 months to recruit, enroll, and 
complete all data collections on the 150 participants in CADENCE-KIDS. The 
estimated date for completing recruitment is December 31, 2014 and for the 
completion of the CADENCE-KIDS study is June 30, 2015. 
 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 5 of 23 
8) 
Study Endpoints 
The primary endpoints of interest that we will evaluate are oxygen uptake (METs) 
and cadence (steps/minute) during treadmill walking and various free-living 
activities. Oxygen uptake will be measured using a portable metabolic system 
(COSMED, K4b2). Cadence will be measured using a variety of step measuring 
devices (Pedometers, Accelerometer, Multi-Sensor Devices), all of which are non-
invasive. We will utilize appropriate statistical modeling techniques (e.g., linear 
[ordinary linear and polynomial] models, piecewise models, receiver operating 
characteristic (ROC) curve analysis) to identify cut-points of cadence (steps/minute) 
corresponding to intensity of activity during treadmill and selected free-living 
activities. 
 
9) 
Procedures Involved* 
CADENCE-KIDS is an exploratory study (cross-sectional – one assessment period) 
which will collect treadmill and selected free-living physical activity data 
performed in the Pennington Biomedical Research Center Exercise Testing Lab 
using a number of wearable step measuring devices while oxygen uptake is 
concurrently measured via a portable metabolic system. Results from this study will 
help to inform future investigations by establishing best methodology practices 
when collecting and/or analyzing step data from step measuring devices. A brief 
overview of the procedures to be completed in CADENCE-KIDS is presented in 
Table 3 (below). Each procedure is presented in more detail following the table. 
 
Table 3. CADENCE-KIDS procedures (approximately 3 hours in total) 
• Screening questions (approximately 3-5 minutes) 
o Screening questions to determine participant eligibility. 
• Height and weight measures data collection (approximately 10 minutes) 
o Measures of height, body weight, body fat percentage, and waist 
circumference. 
• Instrument attachment, treadmill walking, free-living activities 
(approximately 140 minutes) 
o Participants will be fitted with non-invasive devices to 
measure/monitor physical activity throughout the testing session. 
o Participants will then complete several low intensity free-living 
activities while their physical activity and oxygen uptake are 
concurrently assessed. Specifically, participants will rest in a chair, 
watch a portion of a child-friendly movie while seated in a chair, 
and color in a coloring book while seated in a chair. Each activity 
will last for 5 minutes and a 2 minute rest will occur between each 
activity. 
o Participants will then complete a series of walking bouts on a 
treadmill while their physical activity and oxygen uptake are 
concurrently assessed. The walking bouts start at 0.5 miles per hour 
and end at 5 miles per hour (0.5 miles per hour increments). 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 6 of 23 
Treadmill testing stops when the participant finishes the bout where 
they naturally select to jog/run, or following the completion of the 
last bout at 5.0 miles per hour, whichever occurs first. A 2 minute 
rest will occur between each treadmill bout. 
o Participants will then complete three additional free-living activities 
where physical activity and oxygen uptake continue to be 
concurrently measured. Specifically, participants will step up and 
down on an aerobic step at 88 beats per minute, dribble a 
basketball, and perform jumping jacks at 126 beats per minute (63 
jumping jacks per minute). Each activity will last for 5 minutes and 
a 2 minute rest will occur between each activity. 
 
Assessments: 
 
Anthropometric measurements:  Using standardized procedures, we are 
collecting weight, height, sitting height, body fat percentage by bioelectrical 
impedance analysis (BIA; Tanita scale), BMI (calculated from weight and height), 
and circumferences (waist) on all participants in CADENCE-KIDS. This portion of 
the assessment should take approximately 10 minutes to complete. 
 
Standing Height. The participant’s height is measured using a stadiometer. The 
participant is required to remove their shoes and have their heels, buttocks and 
upper part of the back remain in contact with the stadiometer with their arms 
hanging naturally at their side. The participant is asked to inhale and hold their 
breath, while the technician lightly applies traction to the patient’s head in order 
to maintain alignment with the Frankfort Plane. A second technician then lowers 
the slide until it reaches the vertex of the skull and records the reading from the 
indicator, rounding to the nearest 0.1 centimeter. This process is repeated, and the 
average of the two heights is used in analysis (a third measurement is obtained if 
the first two measurements are greater than 0.5 cm apart). 
 
Sitting Height. The participants sitting height will be measured with a 
stadiometer. Sitting height will be measured to the nearest 0.1 cm with the 
participant seated on a table with legs hanging freely and arms resting on the 
thighs. The back of the knees will be close to but not touching the table. The 
participant will sit as erect as possible and head will be positioned in the Frankfort 
Horizontal Plane. This process will be repeated, and the average of the two 
heights will be used in analysis (a third measurement is obtained if the first two 
measurements are greater than 0.5 cm apart).  
 
Weight, Body Fat Percentage, and Bioelectrical Impedance Analysis. The 
participant’s weight, body fat percentage, and impedance are measured using the 
portable Tanita Body Composition Analyzer (SC-240) after outer clothing (e.g., 
coat, jacket) heavy pocket items and shoes and socks are removed. After the unit 
has been initialized (flashes “step on”), the participant steps onto the middle of the 
body composition analyzer, with their bare feet situated such that the heels are 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 7 of 23 
placed on the posterior electrodes and the front part of the feet are in contact with 
the anterior electrodes. The participant stands on the unit in a stable position 
without bending their knees. This process is repeated and the average of each of 
the two weights and body fat percentages is used in analysis (a third measurement 
is obtained if the first two weights are greater than 0.5 kg apart or if the body fat 
percentages are greater than 2.0% apart). 
 
Circumferences. Waist circumference is measured with a non-elastic 
anthropometric tape midway between the lower rib margin and the iliac crest, at 
the end of gentle expiration. The participant is asked to expose the areas to be 
measured by pulling undergarments down and to stand in an upright position with 
their feet together and arms relaxed at their sides. Measures are made at the end of 
normal expiration with special attention paid to ensure the tape lays perpendicular 
to the long axis of the body and parallel to the floor. This process is repeated and 
the average of each of the two circumferences is used in analysis (a third 
measurement is obtained if the first two measurements are greater than 0.5 cm 
apart).  
 
Derived Anthropometric Indices. The Body Mass Index (BMI) is determined 
using the following formula: weight (kg)/height (m2). 
 
Measures of standing height, sitting height, waist circumference, body weight, body 
fat percentage, and impedance will all be recorded on an anthropometric data 
recording form. 
 
Portable metabolic testing during sedentary free-living activites (following 
anthropometric measurements): Following the recommendations of Freedson et 
al.14 and Welk15 for accelerometer calibration in children, we are including an 
evaluation of a wide variety of common free-living activities using a portable 
metabolic unit.  
 
Participants will be required to be fasted (no food) for a period of no less than 4 
hours prior to the start of the portable metabolic testing. Specific to our primary 
aim, we will concurrently detect cadence using multiple step measuring devices 
(Table 4 – below) compared to a criterion of directly observed and counted steps 
during each activity. We will also obtain measured gases (steady-state oxygen 
uptake) using a portable metabolic system (COSMED K4b2; COSMED) so we can 
compute absolute intensity by MET levels. The K4b2 portable metabolic system 
consists of a small gas analysis unit (6.7 in x 2.2 in x 3.9 in; 0.75 pounds) and a 
battery (6.7 in x 1.9 in x 3 in; 0.75 pounds) positioned on the abdomen and mid-
back, respectively. The units are connected to each other via a strapped harness 
system (worn like a back-pack) which holds each unit close to the body. A small 
face mask is used for gas collection and allows for breath-by-breath gas analysis by 
the COSMED system. The mask is small and fits over the mouth and nose and is 
secured to the participant by elastic straps which wrap around the head. The mask 
does not restrict a participant’s vision or line of sight. Participants are able to 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 8 of 23 
breathe normally while wearing the mask. The straps securing the mask to the 
participant’s head are adjustable to accommodate different shapes and sizes of 
heads. 
 
Table 4. Wearable Step, Heart Rate, and Metabolic Measurement Devices 
Used in CADENCE-KIDS 
Device 
Manufacturer 
Body location 
Digiwalker Pedometer 
Yamax 
Waist 
NL-1000 Pedometer 
New Lifestyles 
Waist  
StepWatch Activity Monitor Orthocare Innovations 
Right ankle  
SenseWear Armband 
Body Media 
Right upper arm  
GT3X+ Accelerometer 
ActiGraph 
Right hip and non-dominant 
wrist 
GENEActiv Accelerometer Activinsights 
Right hip and non-dominant 
wrist 
Actical Accelerometer 
Respironics 
Left hip 
ActivPal Accelerometer 
Pal Technologies 
Right thigh 
Polar Heart Rate Monitor 
Polar 
Chest strap 
COSMED K4b2 Portable 
Metabolic System 
COSMED 
Positioned around abdomen 
and lower back (worn like a 
back-pack). Attached face 
mask collects expired gases 
for analysis by unit 
positioned around abdomen 
and lower back. 
We will obtain heart rate (chest strap) and self-reported rating of perceived exertion 
(RPE) so we can track relative intensity levels during all testing. A video camera 
will be aimed at the participant’s feet during each activity to record an objectively 
observed measure of cadence. In addition, a CADENCE-KIDS staff member will 
use a tally counter to count the number of steps taken during each activity. 
 
The wearable step measuring devices listed in Table 4 will be attached to 
participants at the locations listed in the table. Devices attached along the waist and 
hips (Digiwalker Pedometer, NL-1000 Pedometer, Actical Accelerometer, 
GENEActiv accelerometer, and GT3X+ Accelerometer) will be fastened to the 
participant’s body using an elastic waist-belt on top of clothing. The GT3X+ 
accelerometer and the GENEActiv accelerometer will also be attached at the wrist 
using a watch-like strap. The StepWatch Activity Monitor will be wrapped around 
the ankle with a Velcro strap. In addition, the SenseWear Armband will be wrapped 
around the right upper-arm using a Velcro strap. The Polar Heart Rate Monitor will 
be secured around the chest using a chest strap.  
 
Participants will first perform several sedentary free-living activities while wearing 
the portable metabolic testing unit: resting in a chair, watching a movie (seated in a 
chair), and coloring books (seated in a chair). We will measure breath-by-breath 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 9 of 23 
oxygen consumption of each activity in 5 minute bouts using the portable metabolic 
measuring system described above (COSMED K4b2). A 5 minute rest period will 
precede the first activity (sitting in a chair) and a 2 minute rest period will occur 
between activities. Accumulated step counts from displays on several of the 
instruments (Digiwalker and NL-1000 pedometers) will be read and recorded 
during the 2 minute rest periods. Heart rate will be assessed continuously during the 
protocol. RPE will be queried during the final 15 seconds of each bout. Specifically, 
participants will be asked to point to the number on the scale representing how hard 
they believe they are working. Participants between 9-20 years of age will use the 
standard Borg RPE scale. A separate RPE scale specifically designed for and 
validated in young children (OMNI scale) will be used with the youngest 
participants (6-8 years of age).16 During these activities participants will wear all 
the step measuring devices identified earlier in Table 4. A video camera will be 
aimed at the participant’s feet during all the free-living activities to record an 
objectively observed measure of steps taken. This portion of the testing will take 
approximately 25 minutes. 
 
Portable metabolic testing during treadmill walking (following sedentary free-
living activities): Participants will begin the treadmill walking portion of the 
protocol by sitting on a chair positioned next to the treadmill for at least 2 minutes. 
The chair will be removed and then participants will be asked to step onto the 
treadmill and walk for 10 – 5 minute bouts at a 0% grade. The test will increase in 
0.5 mph increments from a starting speed of 0.5 mph, with a 2-minute standing rest 
between bouts. Breath-by-breath oxygen consumption during each 5 minute activity 
bout will be measured using the portable metabolic measuring system described 
above (COSMED K4b2). Heart rate will be assessed continuously during the 
protocol. RPE will be queried during the last 15 seconds of each bout. Specifically, 
participants will be asked to point to the number on the scale representing how hard 
they believe they are working. Participants between 9-20 years of age will use the 
standard Borg RPE scale. A separate RPE scale specifically designed for and 
validated in young children (OMNI scale) will be used with the youngest 
participants (6-8 years of age).16 Accumulated step counts from displays on several 
of the instruments (Digiwalker and NL-1000 pedometers) will be read and recorded 
during each 2-minute standing rest period. The treadmill portion of the protocol will 
cease following completion of the first bout when the participant naturally selects to 
run instead of walk, or before this as the participant prefers, reflecting their personal 
tolerance. Based on pilot testing in young adults, we found that all participants were 
running by approximately 5 mph, and once running occurred increases in cadence 
were modest compared to changes in stride length. The anticipated range of speeds 
to be tested (in both meters/min and miles/hour) are shown in Table 5 (below) and 
should accommodate the full range of ages to be tested. This portion of testing 
should take approximately 70 minutes. 
 
 
 
 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 10 of 23 
Table 5. Treadmill Speeds 
Stage 
Meters/min 
Miles/hour 
1 
14 
0.52 
2 
27 
1.00 
3 
40 
1.49 
4 
54 
2.01 
5 
67 
2.49 
6 
80 
2.98 
7 
94 
3.50 
8 
107 
3.98 
9 
121 
4.51 
10 
134 
4.99 
 
Portable metabolic testing of select common free-living activities (following 
treadmill walking): Participants will perform a number of common free-living 
activities while wearing the portable metabolic testing unit: step up and down on an 
aerobic step at 88 beats per minute, dribbling a basketball, and jumping jacks at 126 
beats per minute (63 jumping jacks per minute). Participants will be instructed to 
complete the basketball dribbling at their own self-selected (preferred) level of 
intensity (effort). 
 
This testing will begin following the treadmill testing protocol (5 minute rest before 
beginning testing of free-living activities). We will measure breath-by-breath 
oxygen consumption of each activity in 5 minute bouts using the portable metabolic 
measuring system described above (COSMED K4b2). A 2 minute standing rest 
period will occur between bouts. Accumulated step counts from displays on several 
of the instruments (Digiwalker and NL-1000 pedometers) will be read and recorded 
during the 2 minute standing rest periods. Heart rate will be assessed continuously 
during the protocol. RPE will be queried during the last 15 seconds of each bout. 
Specifically, participants will be asked to point to the number on the scale 
representing how hard they believe they are working. Participants between 9-20 
years of age will use the standard Borg RPE scale. A separate RPE scale 
specifically designed for and validated in young children (OMNI scale) will be used 
with the youngest participants (6-8 years of age).16 During these activities 
participants will wear all the step measuring devices identified earlier in Table 4. A 
video camera will be aimed at the participant’s feet during all the free-living 
activities to record an objectively observed measure of steps taken. This portion of 
the testing will take approximately 25 minutes. 
 
For each bout during the treadmill walking and free-living activities portions of the 
protocol, beginning time, ending time, hand tallied steps Digiwalker steps, NL-1000 
steps, heart rate, and RPE will be recorded on a separate data collection sheet . 
 
Accommodations: We are able to accommodate participants’ (and their families’) 
schedules, and minimize participant burden by insuring that: 1) the research 
laboratory will be open 5 days per week for 9 hours/day; 2) all laboratory-based 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 11 of 23 
measurements will be scheduled for the same day (i.e., requiring only a single visit) 
unless the families/participants request testing over multiple days (e.g., treadmill 
testing one day, metabolic testing of common free-living activities on another day). 
We anticipate, however, that most families/participants will opt for a single day of 
testing. Participants and/or their parents/legal guardians will be asked to call as far 
as possible ahead of time to reschedule appointments. 
 
All testing will be overseen by a trained Pennington Biomedical Research Center 
exercise technician with an MS or PhD in Exercise Science/Physiology or BS in 
Exercise Science with ACSM certification as Exercise Test Technologist. 
 
The Pennington Biomedical Research Center, including its Exercise Testing Lab 
(Exercise Testing Core), has well-defined emergency procedures already in place 
should any adverse events be encountered. The staff have recently practiced and 
refined this same protocol on 6 different occasions. As previously mentioned, all 
testing will be conducted in the presence of a trained Pennington Biomedical 
Research Center exercise technician. In addition, a physician will always be on call 
within the Pennington Biomedical Research Center. All Pennington Biomedical 
Research Center exercise technicians which will oversee/administer testing at the 
Pennington Biomedical Research Center are trained in basic CPR and/or ACLS. 
 
No drugs will be used in this study. Wearable step and metabolic measuring devices 
(pedometers, accelerometers, and portable metabolic measuring equipment) are all 
non-invasive. 
 
10) Data Management* 
 
Each participant will be issued an ID number that will be utilized throughout the 
study. A secure master file linking names, addresses and ID numbers will be 
maintained in a confidential computer file accessible only to the investigators. 
Access to data files can be made only with permission of the Principal Investigator. 
Privacy in the context of this study includes confidentiality of data and personal 
information. During interviews and measurements, the study staff will ensure full 
privacy of participants and will ensure that the data are stored in a secured area. All 
study staff must be HIPAA certified. The Pennington Biomedical Research 
Center’s Biostatistics Core will cooperate with the data manager who will manage 
the data entry into the clinical database to ensure quality of data.   
 
The Pennington Biomedical Research Center’s Data Management Core will have 
the prime responsibility for database design and implementation, programming, 
coordination and manual data entry of the study data into the study database. 
This is an exploratory/developmental study to collect preliminary data for the 
purpose of investigating the statistical relationships between objectively monitored 
cadence (steps/min) and increasing intensity, specifically metabolic equivalents or 
METS, measured in a laboratory treadmill setting in young people ages 6-20 years. 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 12 of 23 
Calibration studies have typically been conducted using small select samples.11 
Freedson et al. has recommended that calibration studies in children be conducted 
with at least 10 participants in each age group (e.g., 8-10, 10-12 years of age, etc.). 
We exceed this requirement by enlisting 10 participants for each sex-age year, for a 
total of 150 children/adolescents. This strategy will make this the second largest 
children’s accelerometer calibration study to date, but the most age-distributed 
study; Mattocks et al.13 studied 246 children, but all age 12 years, and Freedson et 
al.14 studied children/adolescents 6-18 years of age, but only 80 in total. 
 
As previously stated, we hypothesize that children’s activity intensity (oxygen 
uptake) will increase in a linear or nonlinear (curvilinear) fashion as cadence 
increases such that we will be able to develop statistical models for predicting 
markers (cut points) of intensity from cadence. This hypothesis will be tested in the 
lab-based study that will provide objective and directly measured data of both 
cadence and intensity markers. For each treadmill speed, actual METs will be 
calculated by dividing steady-state oxygen uptake by 3.5 ml/kg/min. Cadence will 
be determined for the middle 3-minutes of each treadmill speed (discarding the first 
and last minute). Stride length (meters/step) will then be determined by dividing 
treadmill speed (meters/min) by steps/min. Sex- and age-specific linear regression 
models will be used to initially assess the value of cadence as a predictor of 
metabolic cost in terms of METs across all treadmill speeds after examining data 
for potential outliers. Mixed effects regression models will then be analyzed to 
properly account for the variability among repeated assessments at different 
treadmill speeds on each participant in addition to gender differences and variability 
across age groups.  Previous research in young adults has indicated that the 
relationship between cadence and METs is curvilinear.6,17 See Figure 2 in paper by 
Abel et al.17 We expect the relationship between cadence and METs in children to 
follow a similar pattern, suggesting a polynomial model would be appropriate to 
predict METs from cadence. However, we will still consider linear models 
(straight-line) and segmented (piecewise) regression models. We will analyze the 
data in five 3-year categories (6-8, 9-11, 12-14, 15-17, 18-20 years) which will give 
us 30 participants per category (15 boys and 15 girls) to analyze for this exploratory 
study, again a sample size larger than recommended by Dr. Patty Freedson (our 
consultant) in a comprehensive review of these types of calibration studies.14  
 
First, we will fit subject specific second order (quadratic) models for each child 
using the random coefficients option of SAS proc mixed. This provides all (one set 
for each of 30 children) estimated subject-specific regression coefficients in a single 
analysis and enables us to test statistical significance of sex*age interactions and 
main effects among the regression equations as an interim step to gain insights into 
the necessity of separate modeling versus possibly collapsing the models into 
parsimonious subsets such as combining boys’ and girls’ data. Additional variables 
including anthropometric assessments (i.e., height, weight, sitting height, leg 
length) will be investigated for their influence when incorporated in the predictive 
models. Once the predictive relationship has been determined with both cadence 
and METS measured as continuous variables, the regression models (equations) 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 13 of 23 
will be used to estimate the cadence cut points corresponding to MET categories 
considered representative of sedentary, light, moderate, and vigorous activity, 
commonly expressed as 1-1.49, 1.5-2.99 METs, 3-5.99 METs, and vigorous >6 
METs, respectively.18,19 Since moderate intensity might be more correctly 
considered to be 4 METs in children,20  we will also solve for this cadence-intensity 
cut point. Additionally, we will use receiver operating characteristic (ROC) curves 
to examine optimal cadence cut points (maximum sensitivity and specificity) for the 
aforementioned sedentary, light, moderate, and vigorous categories. 
 
11) Provisions to Monitor the Data to Ensure the Safety of Subjects 
CADENCE-KIDS is a cross-sectional observational study with a minimal level of 
risk to study participants and does not warrant the establishment of an independent 
Data and Safety Monitoring Board. This plan describes the safety monitoring 
procedures for the proposed study, including a description of how often and to 
whom serious and unexpected adverse events will be reported. The plan will help 
ensure the safety of all participants. The PI will communicate via electronic 
submission to the IRB all unanticipated problems as defined by the IRB and all 
serious adverse events (SAEs) to the program officer within 24 hours. All less 
serious adverse events will be reported to the program officer within 3 days of 
occurrence. 
 
The study investigators will monitor conduct of CADENCE-KIDS. Study staff will 
report adverse events or other problems directly to the PI as they occur. The PI will 
schedule monthly meetings with study staff to review data on adverse events, and 
recruitment or adherence to regimen problems. Any significant health problems 
coming to our attention during the study will be referred to the participant’s usual 
source of medical care, with his/her permission. We will cooperate fully with 
his/her physician by providing relevant medical records. The following criteria, if 
detected during any part of the study regimen, will lead to referral to the 
participant’s usual source of medical care: 
o 1. Clinical symptoms or signs of CVD to include chest pain suggestive of 
angina pectoris, unusual dyspnea on exertion, severe ankle edema, 
symptoms suggestive of transient ischemic attacks or intermittent 
claudication. 
o 2. Musculoskeletal injuries or problems causing severe pain during 
exercise or interference with daily activities. 
12) Withdrawal of Subjects* 
We anticipate that many of the participants will elect to complete their study 
procedures in a single visit; therefore reducing the risk and number of dropouts. For 
those individuals that elect to complete their procedures across multiple days, every 
possible research based strategy will be utilized to minimize dropouts and maximize 
the number of participants that complete the trial to insure high internal validity. 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 14 of 23 
This will involve organizing the recruitment, screening, and testing to enhance 
adherence.  
 
During the course of the study, participants may be withdrawn from the study for 
the following reasons: 
• Unwillingness on behalf of the child or adolescent to participate in the study 
or cooperate with study staff 
• Unwillingness on behalf of the parent/guardian to cooperate with study staff 
• Presentation of significant medical symptoms that would warrant termination 
of study participation to protect the participant’s safety 
• Termination of the study by the sponsor 
 
Data that has already been collected during the course of study participation from a 
withdrawn participant will be used, unless a specific request is otherwise received. 
 
13) Risks to Subjects* 
The risks for physical, psychological, social, or legal harm to participants and their 
parents/legal guardians associated with their participation in this study are minimal. 
The treadmill and free-living activities performed in CADENCE-KIDS are not 
maximal tests. 
 
There are no known risks associated with the height, weight, and body fat 
percentage measurements. However, weight and body fat percentage measurements 
using the bioelectrical impedance analysis scale will not be performed on any 
participant who is pregnant, or those with medical implants such as a pacemaker or 
metal joint replacements.  
 
Risks to participating children and adolescents during the treadmill test and free-
living activities are rare, but could include: 
• Temporary shortness of breath similar to moderate exercise 
• Muscle soreness the following day 
• Dizziness 
• Fainting 
• Blood pressure elevation 
• Irregular heartbeat or heart attack  
• Mild irritation of the skin from the wearable step measuring devices used to 
measure physical activity 
• Mild irritation of the skin around the nose, mouth, and the sides and back of 
the head from the face mask worn with the K4b2 portable metabolic system 
• Mild irritation of the skin around the shoulders, abdomen, and lower-back 
from the straps used to secure the K4b2 portable metabolic system to the 
body 
 
In addition to the risks listed above, participants may experience a previously 
unknown risk or side effect. 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 15 of 23 
 
All testing will be overseen by a trained Pennington Biomedical Research Center 
exercise technician with an MS or PhD in Exercise Science/Physiology or BS in 
Exercise Science with ACSM certification as Exercise Test Technologist. 
 
Risks associated with study procedures will be continually assessed and monitored 
throughout testing by the Pennington Biomedical Research Center exercise 
technician administering the study protocol. Heart rate telemetry via a chest strap 
heart rate monitor will be continually captured in real time during all testing. The 
K4b2 portable metabolic system wirelessly transmits this data to a laptop which will 
be running metabolic testing/monitoring software that displays heart rate data (and 
oxygen consumption data) in real time. Also, the Pennington Biomedical Research 
Center exercise technician will monitor each participant’s heart rate during testing 
with a watch monitor wirelessly interfaced with the heart rate strap. RPE will also 
be assessed during the last 15 seconds of each testing bout to gauge each 
participant’s perceived level of effort during testing. Participants will also be 
verbally asked by the Pennington Biomedical Research Center exercise technician 
at the mid-point of each 5 minute testing bout and during the rest periods between 
bouts how they feel and if they wish to continue with testing. 
 
The Pennington Biomedical Research Center, including its Exercise Testing Lab 
(Exercise Testing Core), has well-defined emergency procedures already in place 
should any adverse events be encountered. The staff have recently practiced and 
refined this same protocol on 6 different occasions. As previously mentioned, all 
testing will be conducted in the presence of a trained Pennington Biomedical 
Research Center exercise technician. In addition, a physician will always be on call 
within the Pennington Biomedical Research Center. All Pennington Biomedical 
Research Center exercise technicians which will oversee/administer testing at the 
Pennington Biomedical Research Center are trained in basic CPR and/or ACLS. 
 
 
14) Potential Benefits to Subjects* 
Participants will receive up to $50 in financial compensation for completing the 
CADENCE-KIDS protocol. 
 
No other benefits for participating in CADENCE-KIDS can be promised. However, 
participants may benefit from having their medical and health history reviewed as 
part of the study. 
 
15) Vulnerable Populations* 
The CADENCE-KIDS study will involve children as participants (6-17 years of 
age). As such, their parents and/or legal guardians will have to provide written 
informed consent allowing their child to participate in the study. In addition, 
participating children (6-17 years of age) will provide assent as well (verbal assent 
for children 6-8 years of age, written assent for children 9-17 years of age). 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 16 of 23 
 
All participants will be explicitly told that their participation is voluntary and that 
they may end (stop) their participation in CADENCE-KIDS at any time. If a 
participant indicates that they wish to stop participating, all study procedures they 
are undertaking at that time will stopped to protect their rights and welfare. 
 
16) Multi-Site Research* 
N/A 
17) Sharing of Results with Subjects* 
Individual participant results will not be provided; however, results from the study 
will be submitted for manuscripts in scholarly journals and presentations. All study 
reports will present only aggregated data to minimize the risks that a participant can 
be identified from their participation in the study. A detailed publication plan will 
be developed as the study progresses. 
18) Setting 
Potential participants will be recruited utilizing the recruiting services (Recruitment 
Core) of the Pennington Biomedical Research Center. All research procedures will 
be performed at the Pennington Biomedical Research Center, namely, at the 
Outpatient Clinic and the Exercise Testing Lab (Exercise Testing Core).  
 
19) Resources Available 
 
The Pennington Biomedical Research Center is a model for clinical and 
translational research, since it houses basic, clinical and population research 
programs in one facility. The Pennington Biomedical Research Center is well-
equipped to administer and support the CADENCE-KIDS research project. All 
study-related procedures will be completed in Pennington Biomedical Research 
Center’s Outpatient Clinic Building (including the Exercise Testing Lab) which has 
all the necessary equipment and research staff needed to perform the testing 
described herein. 
 
The study personnel and staff working on this study are highly qualified with 
extensive research backgrounds and experience conducting trials involving human 
participants, both here at the Pennington Biomedical Research Center, and at 
previous institutions. Dr. Catrine Tudor-Locke (Co-Investigator) is a walking 
behavior researcher who is a recognized world leader in objective physical activity 
assessment and promotion, specifically focused on pedometer or accelerometer- 
determined ambulatory activity captures as steps/day. Dr. Tudor-Locke will oversee 
all aspects of the CADENCE-KIDS research project. Dr. Hsia will oversee clinical 
aspects of screening and testing. In addition, Dr. Hsia will be engaged in day-to-day 
scientific decisions and problem solving. Dr. William Johnson is the Director of the 
Pennington Biomedical Research Center’s Biostatistics and Data Management 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 17 of 23 
Core. He supervises a staff that includes PhD and master’s level biostatisticians and 
skilled programmers, and data entry personnel. Dr. Johnson will be responsible for 
statistical analyses relevant to this funding. 
 
The greater Baton Rouge area has a considerable population (802,484 individuals) 
which serves as a more than adequate base to recruit the 150 required participants 
(6 to 20 years-old) for CADENCE-KIDS. 
 
Dr. Tudor-Locke will work closely with the investigators and staff to ensure that the 
study is executed with the utmost scientific integrity. Dr. Tudor-Locke will also 
provide oversight of the protocol to ensure adherence. 
 
20) Prior Approvals 
N/A 
21) Recruitment Methods 
We will use a variety of recruitment strategies including newspaper advertising and 
stories, television news stories, mass mailings, health fairs, and other strategies 
(including school-based recruitment efforts). Participants will be recruited from the 
greater Baton Rouge area in Louisiana. Recruitment will begin in fall 2013 and is 
expected to end in winter 2014/2015. These strategies have been successful in our 
previous studies. We will develop recruitment materials and submit them to the IRB 
for expedited review as they are developed. Materials will be used to inform 
prospective participants about the overall nature of the study, the basic eligibility 
criteria, the measurement protocols and timeframes, and the time commitment of 
the study. Following an initial recruitment web-screen (followed by a telephone 
screen) or telephone screen, potential participants will attend an orientation session 
at the Pennington Biomedical Research Center to learn more about the study. 
Following the orientation session, those eligible potential participants who remain 
interested in the study will be scheduled for their testing session at the Pennington 
Biomedical Research Center with their parent/guardian (if between 6-17 years of 
age) where clinic staff will obtain signed informed consent (and child assent if 
between 6-17 years of age), before participants take part in any of the study related 
procedures.  
 
22) Local Number of Subjects 
We will recruit and enroll 150 participants from the greater Baton Rouge area in 
Louisiana. 
 
23) Confidentiality 
All data collected in this project will be subject to the same confidentiality 
requirements that are in place for our other studies at the Pennington Biomedical 
Research Center. Study files will be kept in locked cabinets and access restricted to 
study staff. All Pennington Biomedical Research Center staff sign a confidentiality 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 18 of 23 
statement. Personal identifiers are not included in computer files. No individual’s 
data will be released without their specific written consent. 
 
24) Provisions to Protect the Privacy Interests of Subjects 
Privacy in the context of this study includes confidentiality of data and personal 
information. During interviews and measurements, the study staff will ensure full 
privacy of participants and will ensure that the data are stored in a secured area. 
 
25) Compensation for Research-Related Injury 
No form of compensation for medical treatment or for other damages (i.e., lost 
wages, time lost from work, etc.) will be available for this research study.  In the 
event of injury or medical illness resulting from the research procedures, 
participants will be referred to a treatment facility.  
 
26) Economic Burden to Subjects 
Participants will be required to bear the cost of any transportation to and from the 
Pennington Biomedical Research Center to complete the testing required in this 
study. In recognition of this and each participants time commitment to the study 
(approximately 3 hours), participants will receive $50 in compensation for 
participating in CADENCE-KIDS. 
 
27) Consent Process 
Informed consent (and assent when appropriate) will be obtained by Pennington 
Biomedical Research Center clinic staff prior to conducting any testing procedures. 
The study procedures will be explained to parent(s) and participants (6-17 years of 
age) or to participants only (those 18-20 years of age). Parents/legal guardians and 
participants will be asked if they have any questions about the study. The informed 
consent process will then proceed as follows for the three age categories (18-20 
years of age, 9-17 years of age, and 6-8 years of age) represented in CADENCE-
KIDS. 
 
For participants between 18-20 years of age: 
 
• 
Participants will be given an informed consent form to read and sign before 
participating in any study procedures. 
 
For participants between 9-17 years of age: 
 
• 
Parents/legal guardians will be given an informed consent form to read and 
sign indicating their permission to allow their child to participate in the 
study. 
 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 19 of 23 
• 
Following the obtainment of written parental consent, participants 9-17 
years of age will be given a written assent form to read and sign before 
participating in any study procedures. 
 
For participants between 6-8 years of age: 
 
• 
Parents/legal guardians will be given an informed consent form to read and 
sign indicating their permission to allow their child to participate in the 
study. 
 
• 
Following the obtainment of written parental consent, participants 6-8 years 
of age will be orally read an assent script by a Pennington Biomedical 
Research Center clinic staff member. The last sentence in the oral script will 
ask the participant if they wish to participate in the study, inquiring for a 
“yes” or “no” response. The Pennington Biomedical Research Center clinic 
staff member will then mark the appropriate box on the assent script 
indicating the participant’s voluntary response (“yes” or “no”).  
 
All participants and parents/legal guardians (if participant is between 6-17 years of 
age) will be verbally informed during the consent/assent process that their consent 
or assent can be withdrawn at any time for any reason and that they can stop 
participating at any time. In an effort to continually reassess assent or consent, 
participants will be asked if they wish to continue with the testing procedures at the 
mid-point of each 5 minute testing bout and during the scheduled rest periods 
between testing bouts. 
 
Cognitively Impaired Adults 
 
• 
N/A 
 
Adults Unable to Consent 
 
• 
N/A 
 
28) Drugs or Devices 
Table 6 (below) lists the different devices which will be used in the CADENCE-
KIDS study. The StepWatch, SenseWear Armband, GT3X+ Accelerometer, 
GENEActiv accelerometer, Actical Accelerometer, ActivPal Accelerometer, and 
K4b2 Portable Metabolic System all require initialization prior to being used. These 
devices will be initialized to collect data each scheduled day of testing (prior to 
testing). Data from each instrument will be downloaded onto a secure laptop (only 
accessible to study personnel) following the completion of all testing procedures 
(same day). Data from the Digiwalker and NL-1000 Pedometers will be recorded on 
a hard-copy data collection sheet and entered into an electronic database after the 
completion of all testing procedures (same day). 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 20 of 23 
Table 6. Devices Used in CADENCE-KIDS 
Device 
Manufacturer 
Body location 
Digiwalker Pedometer 
Yamax 
Waist 
NL-1000 Pedometer 
New Lifestyles 
Waist  
StepWatch Activity 
Monitor 
Orthocare Innovations 
Right ankle  
SenseWear Armband 
Body Media 
Right upper arm  
GT3X+ Accelerometer 
ActiGraph 
Right hip and non-
dominant wrist 
GENEActiv 
Accelerometer 
Activinsights 
Right hip and non-
dominant wrist 
Actical Accelerometer 
Respironics 
Right hip 
ActivPal Accelerometer 
Pal Technologies 
Right thigh 
Polar Heart Rate Monitor Polar 
Chest strap 
COSMED K4b2 Portable 
Metabolic System 
COSMED 
Positioned around 
abdomen and lower back 
(worn like a back-pack). 
Attached face mask 
collects expired gases for 
analysis by unit 
positioned around 
abdomen and lower back. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 21 of 23 
References 
 
1. 
Tudor-Locke C, Rowe DA. Using cadence to study free-living ambulatory 
behavior. Sports Med. 2012;42(5):381-398. 
2. 
Terrier P, Schutz Y. Variability of gait patterns during unconstrained 
walking assessed by satellite positioning (GPS). Eur J Appl Physiol. 
2003;90(5-6):554-561. 
3. 
Hillman SJ, Stansfield BW, Richardson AM, Robb JE. Development of 
temporal and distance parameters of gait in normal children. Gait Posture. 
2009;29(1):81-85. 
4. 
McArdle WD, Katch FI, Katch V. Exercise Physiology: Energy, Nutrition, 
and Human Performance (6th edition). Baltimore, MD: Lippincott 
Williams & Wilkins; 2007. 
5. 
Abel M, Hannon J, Mullineaux D, Beighle A. Determination of step rate 
thresholds corresponding to physical activity classifications in adults. J 
Phys Act Health. 2011;8:45-51. 
6. 
Beets MW, Agiovlasitis S, Fahs CA, Ranadive SM, Fernhall B. Adjusting 
step count recommendations for anthropometric variations in leg length. 
Journal of Science and Medicine in Sport. Jan 21 2010;13(5):509-512. 
7. 
Marshall SJ, Levy SS, Tudor-Locke CE, et al. Translating physical 
activity recommendations into a pedometer-based step goal: 3000 steps in 
30 minutes. American Journal of Preventive Medicine. May 
2009;36(5):410-415. 
8. 
Rowe DA, Welk GJ, Heil DP, et al. Stride rate recommendations for 
moderate intensity walking. Medicine and Science in Sports and Exercise. 
Jun 11 2011;43(2):312-318. 
9. 
Tudor-Locke C, Sisson SB, Collova T, Lee SM, Swan PD. Pedometer-
determined step count guidelines for classifying walking intensity in a 
young ostensibly healthy population. Canadian Journal of Applied 
Physiology. Dec 2005;30(6):666-676. 
10. 
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. 
Physical activity in the United States measured by accelerometer. Med Sci 
Sports Exerc. 2008;40(1):181-188. 
11. 
Kim Y, Beets MW, Welk GJ. Everything you wanted to know about 
selecting the "right" Actigraph accelerometer cut-points for youth, but...: a 
systematic review. J Sci Med Sport. Jul 2012;15(4):311-321. 
12. 
Freedson PS, Pober D, Janz KF. Calibration of accelerometer output for 
children. Med Sci Sports Exerc. 2005;37(11 Suppl):S523-530. 
13. 
Mattocks C, Leary S, Ness A, et al. Calibration of an accelerometer during 
free-living activities in children. Int J Pediatr Obes. 2007;2(4):218-226. 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

Cadence and Intensity in Children and Adolescents (CADENCE-KIDS) 
Page 22 of 23 
14. 
Freedson P, Pober D, Janz KF. Calibration of accelerometer output for 
children. Med Sci Sports Exerc. Nov 2005;37(11 Suppl):S523-530. 
15. 
Welk GJ. Principles of design and analyses for the calibration of 
accelerometry-based activity monitors. Med Sci Sports Exerc. Nov 
2005;37(11 Suppl):S501-511. 
16. 
Utter AC, Robertson RJ, Nieman DC, Kang J. Children's OMNI Scale of 
Perceived Exertion: walking/running evaluation. Med Sci Sports Exerc. 
Jan 2002;34(1):139-144. 
17. 
Abel M, Hannon J, Mullineaux D, Beighle A. Determination of step rate 
thresholds corresponding to physical activity classifications in adults. J 
Phys Act Health. 2011;8(1):45-51. 
18. 
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A 
recommendation from the Centers for Disease Control and Prevention and 
the American College of Sports Medicine. JAMA. Feb 1 1995;273(5):402-
407. 
19. 
Physical Activity Guidelines Advisory Committee. Physical Activity 
Guidelines Advisory Committee Report, 2008. Washington, D.C.: U.S. 
Department of Health and Human Services; 2008. 
20. 
Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. 
Physical activity in the United States measured by accelerometer. Med Sci 
Sports Exerc. Jan 2008;40(1):181-188. 
 
 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015 

 
Page 23 of 23 
APPENDIX A 
CADENCE-KIDS 
Pennington Biomedical Research Center 
Inclusion / Exclusion 
 
  
Inclusion Criteria  
A NO answer disqualifies a potential participant from entry into the study 
 
Yes     No 
___   ___ Participant is at least 6 years-old but no older than 20 years-old on day of signing informed consent/assent 
 
 
Exclusion Criteria 
A YES answer to any of the Exclusion Criteria disqualifies a potential participant from entry into the study 
 
Yes     No 
___  ___  Participant uses a wheelchair or has another impairment that prevents normal daily physical activities such 
as walking 
 
___  ___  Participant has been hospitalized for a mental illness within the past 5 years 
 
___  ___  Participant has a known medical condition/medication that may affect heart rate during physical activity or 
exercise 
 
___  ___  Participant has a previous history, or clinical symptoms or signs of, cardiovascular disease, stroke or TIAs 
(transient ischemic attacks), chest pain, unusual shortness of breath during physical activity or exercise, 
severe ankle edema, or intermittent claudication (pain caused by lack of blood flow during exercise) 
 
___  ___  Participant has previous history of muscle and/or bone injuries or problems causing severe pain during 
physical activity or exercise that interferes with daily activities 
 
___  ___  Participant has a pacemaker or other implanted medical device including metal joint replacements 
 
___  ___  Participant would be unable to complete all testing (1 or two session, as preferred) within a period of less 
than 2 weeks. For reference, the entire testing protocol takes approximately 3 hours  
 
___  ___  (For females only) - Participant is pregnant 
 
 
 
 
 
_______________________________ 
 
    ___________________ 
Signature of person completing form   
 
        Date Completed 
Pennington Biomedical IRB FWA 00006218 
Approved 7/13/2015