Development of Step-Count Cut Points for School-Day Vigorous Physical Activity

Background. No study has established step-count cut points for varying amounts of accelerometer-assessed vigorous physical activity (VPA) accrued during the school day in children. The purpose of this study was to establish step-count cut points for discriminating children meeting VPA in 5 minutes, 10 minutes, 15 minutes, and 20 minutes per 7-hour school day. Methods. Participants were a convenience sample of 1,053 children (mean age = 8.4 (1.8) years) recruited from 5 schools from the Mountain West region of the USA. Data within students were observed across multiple semesters totaling 2,119 separate observations. Step counts and time in VPA were assessed using ActiGraph wGT3X-BT triaxial accelerometers that were worn during the entirety of a 7-hour school day for one school week. Average censored step counts and minutes in VPA were calculated across 3 to 5 days. Receiver operating characteristic (ROC) curves were employed to derive step counts via calculation of the maximum Youden.. statistic. Results. Area-under-the-curve (AUC) scores ranged from AUC = 0.81 (95% CI: 0.78-0.83;P < 0.001) formeeting at least 5 minutes of VPA to AUC = 0.94 (95% CI: 0.88-1.00,p < 0.001) for meeting at least 20 minutes of VPA. Approximately 3,460 steps best discriminated children meeting at least 5 minutes of VPA (sensitivity = 74.0%, specificity = 74.0%, and accuracy = 74.1%) and approximately 5,628 steps best discriminated children meeting at least 20 minutes per day of VPA (sensitivity = 85.7%, specificity = 95.1%, and accuracy = 95.1%). Conclusion. Step counts can discriminate with reasonable accuracy children that meet at least 5 minutes of school-day VPA and with strong accuracy children that meet 20 minutes of school-day VPA.