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Characterising walking behaviours in aged residential care using accelerometery: a cross-sectional comparison of care level, cognitive status and physical function

Lookup NU author(s): Dr Ríona McArdle, Professor Lynn RochesterORCiD, Dr Silvia Del DinORCiD, Professor Ngaire Kerse



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: Walking is important for maintaining physical and mental wellbeing in aged residential care (ARC). Walking behaviours are not well characterised in ARC due to inconsistencies in assessment methods and metrics, and limited research regarding the impact of care environment, cognition or physical function on these behaviours. It is recommended that walking behaviours in ARC are assessed using validated digital methods which can capture low volumes of walking activity. Objective: This study aims to characterise and compare accelerometery-derived walking behaviours in ARC residents across different care levels, cognitive abilities, and physical capacities. Methods: 306 ARC residents were recruited from the Staying Upright RCT from three care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants’ cognitive status was classified as mild (n=87), moderate (n=128) or severe impairment (n=61), and physical function as high-moderate (n=74), low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cut-off scores respectively. To assess walking, participants wore an accelerometer (Axivity AX3, York, UK; 23x32.5x7.6mm, 11g; sampling rate: 100Hz, range ± 8 g, memory: 512 M) on their lower back for seven days. Outcomes included volume (daily time spent walking, steps, bouts), pattern (mean walking bout duration, alpha) and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviours between groups as categorised level of care, cognition, or physical function, while controlling for age and sex. Tukey HSD tests for multiple comparisons were used to determine where significant differences occurred. Effect size of group differences were calculated using Hedges’ G (0.2-0.4 = small, 0.5-0.7 = medium, and ≥0.8 = large). Results: Dementia care residents showed greater volumes of walking (p<.01; Hedges g = 1.0-2.0), with longer (p<.01, Hedges g = 0.7-0.8), more variable bouts (p<.01, Hedges g 0.6-0.9) compared to other care levels. Residents with severe cognitive impairment took longer (p<.01), more variable (p<.01) bouts with moderate-large effect sizes (Hedges g =0.6-0.7) compared to those with mild cognitive impairment and small-moderate effect sizes (Hedges g= 0.4-0.5) compared to moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (p<.01, Hedges g = 0.4-0.5) and higher variability (p=.04, Hedges g=0.2) compared to high-moderate capacity. Conclusions: ARC residents across different levels of care, cognition and physical function demonstrate different walking behaviours. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multi-morbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern and variability of walking behaviours in ARC. Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.

Publication metadata

Author(s): Mc Ardle R, Taylor L, Cavadino A, Rochester L, Del Din S, Kerse N

Publication type: Article

Publication status: Published

Journal: JMIR Aging

Year: 2024

Volume: 7

Online publication date: 04/06/2024

Acceptance date: 06/03/2024

Date deposited: 07/03/2024

ISSN (electronic): 2561-7605

Publisher: JMIR Publications, Inc.


DOI: 10.2196/53020


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Funder referenceFunder name
Health Research Council of New Zealand project grant (reference 18/414)