The validity of activity trackers is affected by walking speed: the criterion validity of Garmin Vivosmart® HR and StepWatch™ 3 for measuring steps at various walking speeds under controlled conditions
Authors: Svarre Frederik Rose , Jensen Mads Møller , Nielsen Josephine , Villumsen Morten 
Published: July 2020

Introduction
The use of activity trackers has increased both among private consumers and in healthcare. It is therefore relevant to consider whether a consumer-graded activity tracker is comparable to or may substitute a research-graded activity tracker, which could further increase the use of activity trackers in healthcare and rehabilitation. Such use will require knowledge of their accuracy as the clinical implications may be significant. Studies have indicated that activity trackers are not sufficiently accurate, especially at lower walking speeds. The present study seeks to inform decision makers and healthcare personnel considering implementing physical activity trackers in clinical practice. This study investigates the criterion validity of the consumer-graded Garmin Vivosmart® HR and the research-graded StepWatch™ 3 compared with manual step count (gold standard) at different walking speeds under controlled conditions.

Methods
Thirty participants, wearing Garmin Vivosmart® HR at the wrist and StepWatch™ 3 at the ankle, completed six trials on a treadmill at different walking speeds: 1.6 km/h, 2.4 km/h, 3.2 km/h, 4.0 km/h, 4.8 km/h, and 5.6 km/h. The participants were video recorded, and steps were registered by manual step count. Medians and inter-quartile ranges (IQR) were calculated for steps and differences in steps between manually counted steps and the two devices. In order to assess the clinical relevance of the tested devices, the mean absolute percentage error (MAPE) was determined at each speed. A MAPE ≤3% was considered to be clinically irrelevant. Furthermore, differences between manually counted steps and steps recorded by the two devices were presented in Bland–Altman style plots.

Results
The median of differences in steps between Garmin Vivosmart® HR and manual step count ranged from −49.5 (IQR = 101) at 1.6 km/h to −1 (IQR = 4) at 4.0 km/h. The median of differences in steps between StepWatch™ 3 and manual step count were 4 (IQR = 14) at 1.6 km/h and 0 (IQR = 1) at all other walking speeds. The results of the MAPE showed that differences in steps counted by Garmin Vivosmart® HR were clinically irrelevant at walking speeds 3.2–4.8 km/h (MAPE: 0.61–1.27%) as the values were below 3%. Differences in steps counted by StepWatch™ 3 were clinically irrelevant at walking speeds 2.4–5.6 km/h (MAPE: 0.08–0.35%).

Conclusion
Garmin Vivosmart® HR tended to undercount steps compared with the manual step count, and StepWatch™ 3 slightly overcounted steps compared with the manual step count. Both the consumer-graded activity tracker (Garmin Vivosmart® HR) and the research-graded (StepWatch™ 3) are valid in detecting steps at selected walking speeds in healthy adults under controlled conditions. However, both activity trackers miscount steps at slow walking speeds, and the consumer graded activity tracker also miscounts steps at fast walking speeds.