Gai & Pos u e 109 (2024) 89–94
A ailable online 28 Janua y 2024
0966-6362/© 2024 The Au ho (s). Published by Else ie B.V. This is an open access a icle unde he CC BY-NC license (h p://c ea i ecommons.o g/licenses/by-
nc/4.0/).
Valida ion o Ac iG aph and Fi bi in he assessmen o ene gy expendi u e
in Hun ing on’s disease
Lucía Sim´
on-Vicen e
a
,
b
,
*
, Alejand o Rod íguez-Fe n´
andez
c
, J´
essica Ri adeney a-Posadas
a
,
b
,
Ma ía So o-C´
elix
d
,
g
, Ja ie Raya-Gonz´
alez
, Daniel Cas illo-Al i a
e
, Sa a Cal o
b
,
Na i idad Ma iscal
b
, ´
Al a o Ga cía-Bus illo
a
,
b
, Lau a Aguado
b
, Es he Cubo
a
,
b
a
Uni e si y o Bu gos, Spain
b
Hospi al Uni e si a io de Bu gos, Spain,
c
VALFIS Resea ch G oup, Ins i u e o Biomedicine (IBIOMED), Facul y o Sciences o Physical Ac i i y and Spo s. Uni e si y o Leon, Le´
on, Spain
d
Facul y o Heal h Sciences, Uni e sidad Isabel I, Bu gos, Spain,
e
Uni e sidad de Valladolid, Spain
Facul y o Spo Sciences, Uni e si y o Ex emadu a, C´
ace es, Spain
g
Endoc inología y Nu ici´
on. Se icio Medicina In e na. Hospi al Reina So ía. ´
A ea de Salud de Tudela, Se icio Na a o de Salud – Osasunbidea
ARTICLE INFO
Keywo ds:
Heal h p omo ion
Physical ac i i y
Ac i i y moni o
Rehabili a ion
Exe cise
Valida ion
ABSTRACT
Backg ound: Consume and esea ch ac i i y moni o s ha e become popula because o hei abili y o quan i y
ene gy expendi u e (EE) in ee-li ing condi ions. Howe e , he accu acy o ac i i y acke s in de e mining EE in
people wi h Hun ing on’s Disease (HD) is unknown.
Resea ch ques ion:
Can he Ac iG aph wGT3X-B o he Fi bi Cha ge 4 accu a ely measu e ene gy expendi u e du ing physical
ac i i y, in people wi h HD compa ed o Indi ec Calo ime y (IC) (Mediso E go Ca d)?
Me hods: We conduc ed a c oss-sec ional, obse a ional s udy wi h ou een pa icipan s wi h mild-mode a e HD
(mean age 55.7 ±11.4 yea s). All pa icipan s wo e an Ac iG aph and Fi bi du ing an inc emen al es , unning
on a eadmill a 3.2 km/h and 5.2 km/h o h ee minu es a each speed. We analysed and compa ed he ac-
cu acy o EE es ima es ob ained by Fi bi and Ac iG aph agains he EE es ima es ob ained by a me abolic ca ,
using wi h In a-class co ela ion (ICC), Bland-Al man analysis and co ela ion es s.
Resul s: A signi ican co ela ion and a mode a e eliabili y was ound be ween Ac iG aph and IC o he inc e-
men al es ( =0.667)(ICC=0.633). The e was a signi ican co ela ion be ween Fi bi and IC du ing he in-
c emen al es ( =0.701), bu he eliabili y was poo a all es ed speeds in he eadmill walk. Fi bi
signi ican ly o e es ima ed EE, and Ac iG aph unde es ima ed EE compa ed o IC, bu Ac iG aph es ima es we e
mo e accu a e han Fi bi in all es s.
Signi icance: Compa ed o IC, Fi bi Cha ge 4 and Ac iG aph wGT3X-BT ha e educed accu acy in es ima ing EE
a slowe walking speeds. These indings highligh he need o popula ion-speci ic algo i hms and alida ion o
ac i i y acke s.
1. In oduc ion
Hun ing on’s Disease (HD) is an inhe i ed au osomal dominan
neu odegene a i e diso de caused by an expanded iple (CAG) epea
in HTT gene on ch omosome 4p [1]. The disease has an es ima ed
p e alence o 3–7/100.000 people and i is cha ac e ized by mo emen
diso de s, cogni i e al e a ions, and psychia ic symp oms [1,2]. HD
pa ien s end o be ail, highly dependen on o he s, p one o losing
weigh , and physically inac i e. Inac i i y can ha e nega i e heal h
consequences such as ca dio ascula complica ions and sepsis [3].
Physical ac i i y (PA) is one o he a ious li es yle ac o s which
seems o modi y neu odegene a i e disease p og ession [4]. Regula
pa icipa ion in PA is associa ed wi h a dec eased isk o p ema u e
mo ali y and has posi i e e ec s on main aining unc ion and inde-
pendence as well as imp o ing quali y o li e. Fu he mo e, pa icipa ion
in egula exe cise has po en ial o esul in imp o ed s eng h, exe cise
* Co espondence o: Uni e sidad de Bu gos, Pº Comendado es, s/n., 09001 Bu gos, Spain.
E-mail add ess: [email p o ec ed] (L. Sim´
on-Vicen e).
Con en s lis s a ailable a ScienceDi ec
Gai & Pos u e
jou nal homepage: www.else ie .com/loca e/gai pos
h ps://doi.o g/10.1016/j.gai pos .2024.01.028
Recei ed 6 Oc obe 2022; Recei ed in e ised o m 20 No embe 2023; Accep ed 22 Janua y 2024
Gai & Pos u e 109 (2024) 89–94
90
ole ance, ca dio ascula i ness, mood and mobili y [5,6].
Se e al s udies sugges ha PA may be bene icial o indi iduals wi h
HD in e ms o mo o unc ion, gai speed, and balance [7]. Howe e , in
o de o aining o ha e a signi ican impac on he managemen o HD,
i is impo an o exe cise a he igh olume and in ensi y. Fo his
eason, i is c ucial o ha e accu a e de ices o measu e hese me ics in
esea ch and clinical p ac ice, being pa icula ly in e es ing o mul i-
disciplina y heal h eams [8].
Es ima es o daily ene gy expendi u e (EE) a e an impo an
componen in s udies o PA. Indi ec Calo ime y (IC) is a non-in asi e
echnique ha has been used as a gold s anda d o assessing in ensi y
and EE o PA by measu ing oxygen consump ion (O
2
) and ca bon di-
oxide p oduc ion (CO
2
) (pulmona y gas exchanges). Al hough i is he
bes ool o measu e and moni o EE, i is a cos ly and complexi y
me hod ha canno be used in ee-li ing en i onmen s [9,10].
Wi h ad ances in echnology, comme cial ac i i y acke s (also
e e ed o as accele ome e s) such as Ga min, Fi bi de ices o Ac i-
g aph a e inc easingly used in PA esea ch and allow an es ima e o EE.
Recen s udies ha e compa ed PA measu emen s aken by low-cos and
easy- o-in e p e de ices wi h measu emen s aken by high-cos de ices,
wi h some esea ch ocused on heal hy popula ions and o he s ocused
on popula ions wi h disease [10]. Fo example, he Ac ig aph has been
used in la ge-scale epidemiological s udies [9] as well as a e iew a icle
ha epo ed an exponen ial inc ease in he use o a popula comme cial
ac i i y moni o (Fi bi ) in esea ch [12]. These de ices ha a e ypi-
cally wo n on he w is o wais , can be summa ized in "coun s pe
minu e" o ans o med using di e en algo i hms o es ima e EE o he
ask and Me abolic equi alen s (METs), whe e 1 MET is how much en-
e gy a pe son uses up while a es [13]. Al hough mos o he moni o s
cu en ly a ailable ha e been alida ed in di e en popula ions, he
accu acy o low-cos de ices has no been e alua ed o pa icipan s
wi h HD [9]. Because people wi h HD ha e di icul ies wi h gai and
walking pe o mance due o hype kine ic and hypokine ic mo emen s,
i is especially impo an o e alua e he alidi y o moni o s in o de o
a oid inaccu a e conclusions [7].
To begin o ill his gap in in o ma ion abou he use o accele om-
e e s in HD, his s udy aimed o de e mine he accu acy o wo accel-
e ome e s ( esea ch- ocused de ice and low-cos de ice) in es ima ing
EE compa ed o IC ( he gold s anda d) in pa icipan s wi h HD.
2. Ma e ials and me hods
2.1. Design
A c oss-sec ional, obse a ional s udy was conduc ed a he Uni e -
si y Isabel I and Bu gos Uni e si y Hospi al, Spain. The s udy was con-
duc ed in wo isi s. In he i s one, we collec ed clinical in o ma ion,
and in he second isi , wi hin h ee mon hs, we collec ed o al EE da a.
2.2. Pa icipan s
A con enience sample o symp oma ic, ambula o y people diagnosed
wi h HD wi h a con i med gene ic mu a ion o >36 CAG epea s in he
HTT gene was ec ui ed. Conside ing he low p e alence o HD and
sample sizes included in p e ious alida ion s udies [14], 14 HD pa -
icipan s we e included. Symp oma ic HD pa icipan s we e de ined
wi h a sco e g ea e han 4 on he mo o subdomain o he Uni ied
Hun ing on´s Disease Ra ing Scale (UHDRS) [15], and a diagnos ic
con idence le el (DCL) o 4, able o walk wi h minimal suppo .
People diagnosed wi h diabe es melli us, hy oid dis u bances,
ac i e cance , neu odegene a i e condi ions, ca diac, pulmona y, o
skele al-muscula diseases we e excluded. People who we e p egnan o
b eas eeding, o aking medica ion ha could a ec me abolism/
endoc ine unc ion we e also excluded.
This s udy was conduc ed in acco dance wi h Good Clinical P ac ice
s anda ds in ol ing humans and was app o ed by he Ins i u ional
Re iew Boa d (Uni e si y Isabel I and Bu gos Uni e si y Hospi al, Ce -
i ica e numbe : CEIM-2429, Janua y 26 h, 2021). All pa icipan s
p o ided in o med consen by signing he consen o m p io o
pa icipa ing.
2.3. Tes p o ocol
Pa icipan s we e ins uc ed o a oid igo ous exe cise on he day
be o e es ing and e ain om alcohol, nico ine, and ca eine ou hou s
be o e he s udy isi . The de e mina ion o o al EE was pe o med by
as ing o a leas 5 h.
In he second session, all pa icipan s ecei ed adequa e ime o
amilia ize hemsel es wi h he eadmill p io o he es . Pa icipan s
we e accus omed o walking a di e en speeds wi hou using he
hand ails while b ea hing h ough he acemask. They we e ad ised o
s op a any ime by gi ing an ag eed signal o p essing he s op bu on.
EE ela ed o PA was e alua ed wi h a eadmill walk (Cosmos Pulsa
4.0, Cosmos Spo s & Medical, Nussdo -T auns ein, Ge many) wi h a
cons an slope (1%), unde h ee di e en speed condi ions: i) walking
a 3.2 km/h o h ee minu es, ii) walking a 5.2 km/h o h ee minu es
and iii) walking speed s a ed a 1.5 km/h and was inc eased by 0.5 km/
h e e y minu e un il he pa icipan exp essed, hey we e unable o
con inue. The pa icipan used a ha ness h oughou he es ( isk p o-
ec ion) and we e encou aged o only use he sideba s i hey needed o.
Walking a a cons an in ensi y o 3.2 km/h wi h a cons an g adien
o 1%, se ed as a measu e o he ac i i y o daily li ing – walking; a a
cons an in ensi y o 5.2 km/h wi h a cons an g adien o 1% as a
measu e o mode a e ac i i y; and he inc emen al es as a measu e o
igo ous ac i i y [16]. Du ing he es p o ocol, pa icipan s b ea hed
h ough he mask equipped wi h inspi a o y al es ha ansmi ed he
O
2
da a o a compu e o analysis [17]. Gas exchange was con inuously
moni o ed o analyse O
2
and CO
2
concen a ions by he use o a
b ea h-by-b ea h sys em (E go Ca d®, Mediso , So innes, Belgium).
P io o each es , he analyse was calib a ed by means o a sy inge
(Hans Rudolph®. Model 3800. Kansas. USA) and gas cylinde wi h gas
mix u e (G5512 5.04% CO
2
and 11.87% O
2
. Ai liquide), coupled o a
p essu e educe (Gloo ®. Swi zde land). The da a we e analysed by
speci ic so wa e (Mediso ®, So innes, Belgium).
2.4. Func ional assessmen s
A ce i ied mo emen diso de neu ologis e alua ed all HD pa ic-
ipan s a baseline using a s anda dized HD assessmen ool, he UHDRS,
including he mo o subscale (UHDRS-TM) wi h high sco es deno ing
g ea e impai men [15]. Disease se e i y was assessed using he To al
Func ional Capaci y (TFC) [18], wi h highe sco es indica ing mo e
in ac unc ioning. The se e i y o psychia ic symp oms was assessed
using he P oblem Beha io s Assessmen (PBA), wi h highe sco es
indica ing g ea e se e i y [19]. Cogni ion was sc eened using he
Mini-Men al S a e Examina ion (MMSE) [20].
2.5. Ac i i y moni o s
The Ac iG aph accele ome e (wGT3X-BT), he mos commonly used
accele ome e o assessing PA in esea ch unde ee-li ing condi ions,
was used o PA assessmen [10]. I was a small (4.6 cm ×3.3 cm×1.5
cm) and ligh weigh (19 g) de ice ha used a iaxial accele ome e o
measu e accele a ions in he ange o 8 G G’s wi h a band-limi ed e-
quency o 30–100 He z. Ten minu es be o e s a ing he p o ocol, he
de ice was a ached o a nylon bel and posi ioned on he igh hip
ollowing he manu ac u e ’s ins uc ions. Raw accele ome e da a we e
downloaded using Ac ili e 6 so wa e and hen ans o med in o 10-sec-
ond epochs iles. F eedson and colleagues [21] de eloped an equa ion o
con e coun s pe minu e in o METS, he s anda d uni o measu ed
ac i i y in ensi y. This equa ion allowed o meaning ul in e p e a ion
o Ac iG aph da a and he classi ica ion o ac i i y in ensi ies in o ligh ,
L. Sim´
on-Vicen e e al.
Gai & Pos u e 109 (2024) 89–94
91
mode a e o igo ous. All da a we e ans o med using he ollowing
equa ion: “ac i i y in ensi y (METS) =1.439008 +(0.000795 x
coun s
.
min
1
)”.
The Fi bi Cha ge 4, a w is -wo n ac i i y moni o (3.58 ×2.27
×1.25 cm and weighs 20 g) ha measu es dis ance, ac i e minu es, s ep
coun s, and calo ies, was also used. Ten minu es be o e s a ing he
p o ocol, he de ice was posi ioned on he dominan hand’s w is [12].
This ac i i y moni o calcula es METs h ough a a io ( a e o ene gy
expended du ing an ac i i y: a e o ene gy expended du ing es ),
conside ing ha du ing es o si ing quie ly people expend 1 MET [22].
Raw da a we e expo ed o CSV and hen con e ed in o an Excel ile o
da a in e p e a ion.
2.6. S a is ical analysis
Simila o p e ious s udies [10], EE es ima ion was compa ed o IC.
Desc ip i e s a is ics o pa icipan s and main ou comes a e p esen ed
as he mean and s anda d de ia ion (SD) o con inuous a iables, he
median, and he 25 h-75 h pe cen iles o non-no mally dis ibu ed o
o dinal da a. The no mali y o he a iables was e alua ed using he
Shapi o Wilk es . We calcula ed he equency dis ibu ion and pe -
cen ages o desc ibe ca ego ical a iables.
The accu acy o METs ob ained om Fi bi Cha ge 4 and he Ac i-
G aph wGT3X-BT compa ed o IC (gold s anda d) was calcula ed wi h
In a-class co ela ion (ICC) using wo-way mixed models wi h absolu e
ag eemen and co ela ion assessmen wi h Pea son and Spea man’s
es . ICCs we e analysed sepa a ely o bo h ac i i y moni o s measu ing
EE. ICC alues can ange om 0 (measu emen s a e no in ag eemen ) o
1(measu emen s a e eliable). These alues may be in e p e ed as
excellen eliabili y i ICC >0.90, ICC be ween 0.75 and 0.90 indica es
good eliabili y, alues be ween 0.5 and 0.75 indica e mode a e eli-
abili y and ICC <0.5 is in e p e ed as poo eliabili y [23].
Bland-Al man s a is ics we e pe o med o de e mine he limi s o
ag eemen (LoA) o each de ice compa ed wi h he c i e ion measu e.
Da a we e analysed using SPSS e sion 28 o Windows (SPSS Inc.,
Chicago, IL, USA) and Mic oso Excel. The le el o signi icance was se
a p <0.05. Sca e plo we e used o e alua e he linea i y o he asso-
cia ion be ween IC wi h Ac iG aph wGT3X-BT and Fi bi Cha ge 4.
3. Resul s
A o al o 14 HD pa icipan s (7 women) wi h a mean age o 55.7 ±
11.47 yea s we e included in his s udy. Clinical and An h opome ic
da a a e p o ided in Table 1. Compa ed o IC, Ac iG aph wGT3X-BT
p o ided lowe mean measu es o EE a he speed o 3.2 km/h and
highe mean measu es a he speed o 5.2 km/h as well as du ing he
inc emen al es . Compa ed o IC, Fi bi Cha ge 4 p o ided highe mean
measu es o EE in all es s (Table 2). Du ing he inc emen al es , Ac i-
G aph wGT3X-BT, could no p o ide alues when he speed was e y
low.
Ac oss he de ices, we ound a mode a e ag eemen be ween Ac i-
G aph wGT3X-BT and IC du ing he inc emen al es (ICC=0.633) and a
poo ag eemen in he o e all eadmill walk in ela ion o Fi bi Cha ge
4 and IC (Table 3). The c i e ion o IC de i ed ac i i y EE yielded he
s onges co ela ions wi h ac i i y EE es ima es om Ac iG aph
wGT3X-BT (p =0.667, p ≤0.001) and wi h Fi bi Cha ge 4 du ing in-
c emen al es (p =0.701, p ≤0.001).
Bland-Al man plo s (Fig. 1) e lec he di e ence be ween Ac iG aph
wGT3X-BT EE wi h IC, and Fi bi Cha ge 4 EE es ima es wi h IC.
Compa ed o IC, a he speed o 3.2 km/h (ligh in ensi y), Ac iG aph
wGT3X-BT p o ided he na owes 95% LoA. In ela ion o Fi bi Cha ge
4, he na owes 95% LoA we e a a speed o 3.2 km/h. In addi ion, he
plo s indica ed a lowe sys ema ic bias o IC and Ac iG aph wGT3X-BT
a 5.2 km/h, ollowed by he inc emen al es . In his ega d, Fi bi
Cha ge 4 o e es ima ed EE a a speed o 3.2, 5.2 km/h, and du ing in-
c emen al es compa ed o IC.
Rega ding he pe cen age o e o , Ac iG aph wGT3X-BT was mo e
accu a e han Fi bi Cha ge 4 in all es s (3.2 km/h, 5.2 km/h, and in-
c emen al). Ac iG aph showed he lowes e o pe cen age a 3.2 km/h
and Fi bi a 5.2 km/h (Table 3).
4. Discussion
To ou knowledge, his is he i s s udy ha analyses he accu acy o
wo accele ome e s o quan i y EE a di e en exe cise in ensi ies unde
con olled condi ions o HD pa icipan s.
We ound ha bo h de ices in all speeds ha e poo ag eemen wi h
IC, he gold s anda d o EE measu emen s, excep du ing he inc e-
men al es , o which he Ac ig aph wGT3X-BT indica ed mode a e
eliabili y. Du ing he inc emen al es , he e was a mode a e co ela ion
o bo h de ices wi h IC, bu as exe cise in ensi y inc eased, he Fi bi
Cha ge 4 o e es ima ed EE compa ed o IC and he Ac iG aph wGT3X-
BT.
P e ious s udies ha e examined he accu acy o a ious comme cial
ac i i y accele ome e s du ing di e en ac i i ies on he eadmill in
heal hy adul s [10,12,24]. Vanhels e al. [25] ound a high co ela ion
( =0.89) be ween accele ome y and oxygen consump ion, wi h a
mean di e ence e y close o 0 (1.1 ±1.3), wi h he LoA anging om
−2.9 o 2.9, sugges ing ha is a alid measu e o PA a a ying le els o
in ensi y.
By con as , B azeau e al. [26] e alua ed he accu acy o SenseWea
A mband and Ac ical compa ed o IC. These au ho s ound a signi ican
co ela ion be ween bo h ac i i y moni o s wi h IC ( =0.804;
=0.807; p<0.05, espec i ely), wi h good and excellen eliabili ies
(ICC o 0.892 and 0.906, espec i ely), bu hese de ices we e no ac-
cu a e o EE es ima ions du ing speci ic exe cise and es . Simila ly,
Anas asopoulou e al. [27] ound a mode a e co ela ion be ween
Ac iG aph GT3X ( =0.53; =0.70; p<0.05) and IC ( o bo h walking
and as walking ac i i y), bu he de ices did no show ag eemen
(ICC=0.23; ICC=0.35). Kossi e al. [28] compa ed he EE es ima ions by
Ac iG aph GT3X+wi h a gold s anda d measu emen and also ound
ha he ag eemen be ween bo h we e poo (ICC=0.32; ICC=0.21).
Fu he mo e, he de ice does no p o ide accu a e EE es ima es ac oss a
ange o placemen loca ions du ing mode a e and high-in ensi y PA.
Table 1
Desc ip i e cha ac e is ics o he pa icipan s.
Va iable n ¼14
Heigh (cm), mean ±SD 161.1 ±6
Weigh (kg), mean ±SD 64.2 ±11.6
BMI (kg/m
2
), mean ±SD 24.8 ±5.1
TMS, mean ±SD 29.3 ±13.6
TFC, median ( ange) 10 (8-13)
PBA, median ( ange) 1 (0-9.25)
MMSE, mean ±SD 27.2 ±2.7
BMI, Body mass index; TMS, To al Mo o Sco e; TFC, To al
Func ion Capaci y; PBA, P oblems Beha io s Assessmen ; MMSE,
Mini-Men al S a e.
Table 2
Ins umen a iabili y.
Tes Mean ± SD SEM
Indi ec Calo ime y 3.2 km/h 2.61 ±0.31 0.086
5.2 km/h 3.35 ±0.47 0.135
Inc emen al 2.96 ±0.96 0.081
Ac iG aph wGT3X-BT 3.2 km/h 1.68 ±0.74 0.212
5.2 km/h 3.45 ±1.14 0.345
Inc emen al 2.69 ±1.8 0.161
Fi bi Cha ge 4 3.2 km/h 5.75 ±1.47 0.425
5.2 km/h 6.17 ±1.6 0.480
Inc emen al 5.36 ±2.28 0.204
SEM: S anda d e o o he mean
L. Sim´
on-Vicen e e al.
Gai & Pos u e 109 (2024) 89–94
92
Table 3
Compa ison o EE o Ac iG aph and Fi bi wi h Indi ec Calo ime y (c i e ion).
Ac i i y Moni o Tes n Mean
di e ence
1
Lowe
LoA
2
Uppe
LoA
2
Absolu e pe cen age
e o
ICC 95% CI Co ela ion
coe icien
Lowe Uppe
Ac iG aph wGT3X-
BT
3.2 km/h 14 0.924 -0.803 2.651 132 -0.055 -0.253 0.308 -0.160 (0.601)
3
5.2 km/h 14 -0.097 -2.482 2.287 142 0.131 -0.520 0.65 0.159 (0.622)
4
Inc emen al 125 0.169 -2.383 2.723 165 0.633 0.515 0.728 0.667 * * (<0.001)
4
Fi bi Cha ge 4 3.2 km/h 14 -3.169 -6.304 -0.033 243 -0.009 -0.084 0.177 0.579 (0.170)
4
5.2 km/h 14 -2.9 -6.121 0.321 197 0.020 -0.088 0.272 0.523 (0.081)
4
Inc emen al 122 -2.59 -6.143 0.962 260 0.188 -0.080 0.435 0.701 * * (<0.001)
4
Mean di e ence=di e ence be ween he gold s anda d and he ac i i y moni o s o each speed
1
95% LoA=Limi s o ag eemen
2
ICC=In a-class co ela ion
CI=Con idence in e al
Pea son’s es
3
Spea man’s es
4
Fig. 1. - Bland-Al man plo isualizing ag eemen o ene gy expendi u e (MET) (A) Ac ig aph ’s IC a 3.2 km; (B) Fi bi ’s IC a 3.2 km/h; (C) Ac ig aph ’s IC a
5.2 km; (D) Fi bi ’s IC a 5.2 km/h; (E) Ac ig aph ’s IC du ing Inc emen al es ; (F) Fi bi ’s IC du ing Inc emen al es .
L. Sim´
on-Vicen e e al.
Gai & Pos u e 109 (2024) 89–94
93
In diseased popula ions, including pa icipan s wi h Mul iple Scle-
osis, Ac iG aph es ima es o EE compa ed o IC ha e shown good
ag eemen s (ICC=0.859). Howe e , in Bland Al man plo s, he di e -
ences pe eadmill speed be ween bo h measu emen s we e gene ally
wi hin 2 SD, wi h up o 30.3% disc epancy on slow-walking speeds. The
disag eemen be ween bo h de ices could be explained by he di e ence
in ou pu unde slow-walking condi ions [29]. Likewise, Abel e al. [30],
ound ha Ac iG aph was no accu a e o low-in ensi y mo emen s.
These esul s ag ee wi h ou esul s, wi h poo sensi i i y o EE o he
Ac ig aph a low speeds du ing he inc emen al es . The lack o
ag eemen could be because he de ice may no be sensi i e by clinical
cha ac e is ics o he pa icipan s, he disease i sel , o ha he loga-
i hms used a e no alida ed o people wi h cho ea.
In o he popula ions, Sean e al. [31] e alua ed he alidi y o
Ac iG aph in people wi h acqui ed b ain inju y and hey ound posi i e,
mode a e co ela ions ( ange 0.58 – 0.70, p <0.05). Howe e ,
Bland–Al man plo spanned 5.1 METs and, when compa ed wi h
measu ed MET le els, METs anged om 1.6 METs o e p edic ion o 4.3
METs unde p edic ion, so he absolu e ag eemen be ween measu ed
and p edic ed METs was no s ong, limi ing he alidi y o he Ac i-
g aph. Again, he disc epancy be ween de ices may be because people
wi h acqui ed b ain inju y who pa icipa ed in he s udy had ela ed gai
pa e n impai men s a ec ing he condi ions and pe o mance o he
s udy subs an i ely. Mandigou e al. [32] also compa ed he EE e al-
ua ed by IC, his ime in subacu e pos -s oke pa ien s. Du ing a scena io
consis ing o e e yday ac i i ies, hey es ima ed he EE using se e al
senso s and concluded a low co ela ion ( =0.04) and a e y poo
ag eemen o all senso s.
O e all, ou esul s ag ee wi h p e ious esea ch wi h heal hy adul s.
In hese s udies, epo ed Fi bi Cha ge 4 o e es ima ed EE wi h a
nega i e bias when ac i i ies we e pe o med on he eadmill (−19.3%
[SD 28.9]) [33], and a end o o e es ima e EE compa ed wi h IC wi h a
di e ence o es ima es o o al EE o −29.6% [34]. Ou indings ag ee
wi h a p e ious s udy ca ied ou by Sj¨
obe g [35] ha concluded ha
Fi bi sys ema ically o e es ima ed EE in pa icipan s wi h ch onic pain
(ICC=–0.03). Likewise, in ag eemen wi h ou esul s, He ke e al.
[36] demons a ed low accu acy o Fi bi (ICC=0.10) in es ima ing EE in
people wi h co ona y a e y disease. A possible explana ion o hese
esul s migh be due o Fi bi algo i hm employs an equa ion o es i-
ma ing es ing me abolic a e ha is s ill no debugged [37]. On he
o he hand, in people wi h Ch onic Obs uc i e Pulmona y Disease,
Ac iG aph seems o measu e s anda dized and common physical ac i -
i ies accu a ely, and i is ecommended o assessing ac i i ies o pa-
ien s in e ms o in ensi y and/o amoun . Howe e , Ac iG aph seems o
be s ill impe ec o measu ing EE in his popula ion [38].
Di e ences be ween Ac iG aph and Fi bi es ima es may be due o
he loca ion o he de ice. Hip-wo n moni o s, which a e close o he
cen e o mass, es ima es MET alues and o al EE be e han w is -wo n
de ices [11]. A e iew pe o med o e alua e he in luence o body
placemen o he accu acy o EE es ima ion concluded ha w is -wo n
moni o s gene ally lead o o e es ima ing EE [39]. This could be why
Fi bi Cha ge 4, loca ed on he w is , es ima ed METs alues wo se han
Ac iG aph wGT3X-BT, loca ed on he hip. In addi ion, o he con using
ac o s including HD mo o abno mali ies such as cho ea, in olun a y
je king o w i hing mo emen s, may a ec and cause di e ences in he
es ima ion o he EE [40].
5. Limi a ions
A po en ial limi a ion o his s udy is ha he accu acy o he Ac i-
G aph wGT3X-BT and Fi bi Cha ge 4 was examined only du ing
walking and jogging exe cise in ensi ies (i.e., ligh , mode a e, and
igo ous in ensi y) in a labo a o y unde con olled condi ions. How-
e e , i is unclea whe he simila indings would be obse ed unde
di e en en i onmen al condi ions.
Because his was a labo a o y-based s udy, pa icipan s only had o
wea he wea ables o app oxima ely 1 h 30 min. This s udy canno
de e mine whe he people wi h HD would be willing o wea he de ices
o longe pe iods. In addi ion, we canno ex apola e he esul s o a
communi y-dwelling indi iduals wi h HD in ee-li ing condi ions.
Howe e , despi e hese limi a ions, we belie e ha ou s udy has se e al
s eng hs, including being he i s s udy p o iding e idence abou he
accu acy o wo common accele ome e s in de ec ing EE in people wi h
HD in di e en body posi ions.
6. Conclusion
The e is a g owing in e es in using ac i i y moni o de ices o
p omo e heal hy li es yles and physical exe cise. Compa ed o IC, ou
esul s sugges ha Fi bi Cha ge 4 and Ac iG aph wGT3X-BT ha e
educed accu acy in es ima ing EE a slowe walking speeds. The loca-
ion o he de ice is ano he pa ame e o conside since hip-wo n
moni o s es ima e o al EE be e han w is -wo n de ices. These ind-
ings highligh he need o popula ion-speci ic algo i hms and alida ion
o ac i i y acke s.
Despi e he inding ha he Fi bi de ice o e es ima ed METS, i
could s ill be a bene icial ool o clinical applica ions in people wi h HD
gi en he ease o use, he ela i ely low cos , and i s abili y o gi e im-
media e eedback. Fu he mo e, when people wi h HD moni o hei PA
beha iou s, his can inc ease hei mo i a ion and p omo e he adop ion
o main enance o heal hy PA habi s. O e ime, hese beha iou s could
ha e a signi ican posi i e impac on peoples´daily li es by inc easing
hei le els o au onomy and independence as well as po en ially
delaying hei age o ins i u ionaliza ion.
CRediT au ho ship con ibu ion s a emen
Ma iscal Na i idad: Me hodology, Visualiza ion, W i ing – e iew
& edi ing. Ga cía-Bus illo Al a o: Supe ision, W i ing – e iew &
edi ing. Aguado Lau a: In es iga ion, P ojec adminis a ion, Valida-
ion, W i ing – e iew & edi ing. Cubo Es he : Concep ualiza ion, Da a
cu a ion, Fo mal analysis, Funding acquisi ion, Valida ion, W i ing –
o iginal d a , W i ing – e iew & edi ing. SIM´
ON LUC´
IA: Concep ual-
iza ion, Da a cu a ion, Fo mal analysis, In es iga ion, Me hodology,
So wa e, Valida ion, W i ing – o iginal d a , W i ing – e iew & edi -
ing. Cas illo-Al i a Daniel: Da a cu a ion, Fo mal analysis, In es iga-
ion, So wa e, Supe ision, W i ing – o iginal d a , W i ing – e iew &
edi ing. Cal o Sa a: Da a cu a ion, Fo mal analysis, Valida ion.
Rod íguez-Fe n´
andez Alejand o: Concep ualiza ion, In es iga ion,
Me hodology, P ojec adminis a ion, So wa e, W i ing – o iginal d a ,
W i ing – e iew & edi ing. Ri adeney a-Posadas Jessica: Da a cu a-
ion, Supe ision, W i ing – e iew & edi ing. So o-C´
elix Ma ía:
Concep ualiza ion, Funding acquisi ion, In es iga ion, W i ing – e iew
& edi ing. Raya-Gonz´
alez Ja ie : In es iga ion, Me hodology, So -
wa e, Valida ion.
Decla a ion o Compe ing In e es
The au ho s ha e no con lic o in e es o decla e.
Acknowledgmen s
The esea ch leading o hese esul s has ecei ed unding om “la
Caixa” Founda ion and Caja de Bu gos Founda ion, unde ag eemen
LCF/PR/PR18/51130008".
We would like o hank he pa ien s, he ca egi e s, all he people
who ha e collabo a ed in his p ojec and he Fundaci´
on la Caixa and
Fundaci´
on Caja de Bu gos. We also hank he Domino-HD Conso ium
o hei suppo (Mul i-Domain Li es yle Ta ge s o Imp o ing P og-
NOsis in Hun ing on’s Disease. DOMINO-HD. Ho izon 2020), and
especially o D . Be nha d Lande meye .
Ja ie Raya-Gonz´
alez was suppo ed by a Ramon y Cajal
L. Sim´
on-Vicen e e al.

Gai & Pos u e 109 (2024) 89–94
94
pos doc o al ellowship (RYC2021-031072-I) 2 gi en by he Spanish
Minis y o Science and Inno a ion, he S a e Resea ch Agency (AEI),
and he Eu opean Union (Nex Gene a ionEU/PRTR).
Re e ences
[1] N. Quinn, A. Sch ag, Hun ing on’s disease and o he cho eas, J. Neu ol. 245 (11)
(1998) 709–716.
[2] C. Cepeda, X.P. Tong, Hun ing on’s disease: om basic science o he apeu ics, CNS
Neu osci. The . 24 (4) (2018) 247–249.
[3] A.C. Ogil ie, P.C. Nopoulos, J.L. Schul z, Quan i ying he onse o unin ended
weigh loss in Hun ing on’s disease: a e ospec i e analysis o en oll-HD,
J. Hun ing on’s Dis. 10 (4) (2021) 485–492, h ps://doi.o g/10.3233/JHD-
210488.
[4] S.M. Muelle , J.A. Pe e sen, H.H. Jung, Exe cise in Hun ing on’s disease: cu en
s a e and clinical signi icance, T emo O he Hype kine ic Mo . (2019).
[5] K.S. Bhalsing, M.M. Abbas, L.C.S. Tan, Role o physical ac i i y in Pa kinson’s
disease, Ann. Indian Acad. Neu ol. 21 (2018) 242–249.
[6] K. Do, B.T. Laing, T. Land y, W. Bunne , N. Me saud, T. Ma suba a, e al., The
e ec s o exe cise on hypo halamic neu odegene a ion o Alzheime ’ s disease
mouse model, PLoS One 17 (1) (2018).
[7] L. Quinn, M. Busse, J. Ca ie , N. F i z, J. Ha den, L. Ha el, D. Kegelmeye ,
A. Kloos, A. Rao, Physical he apy and exe cise in e en ions in Hun ing on’s
disease: a mixed me hods sys ema ic e iew p o ocol, JBI Da abase Sys . Re .
Implemen . Rep. 15 (7) (2017) 1783–1799, h ps://doi.o g/10.11124/JBISRIR-
2016-003274.
[8] D.E.R. Wa bu on, S.S.D. B edin, Heal h bene i s o physical ac i i y: a sys ema ic
e iew o cu en sys ema ic e iews, Cu . Opin. Ca diol. [In e ne ] 32 (5) (2017).
A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /28708630/〉.
[9] R.P. T oiano, J.J. McClain, R.J. B ych a, K.Y. Chen, E olu ion o accele ome e
me hods o physical ac i i y esea ch, B . J. Spo s Med [In e ne ] 48 (13) (2014)
1019–1023. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /24782483/〉.
[10] P. Topalidis, C. Flo ea, E.S. Eigl, A. Ku apo , C.A.B. Leon, M. Schabus, E alua ion
o a low-cos comme cial ac ig aph and i s po en ial use in de ec ing cul u al
a ia ions in physical ac i i y and sleep, Senso s 21 (11) (2021 1). A ailable om:
〈h ps://pubmed.ncbi.nlm.nih.go /34072347/〉.
[11] C.E. Mo is, P.A. Wessel, R.A. Tinius, M.A. Scha e , J.M. Maples, Validi y o ac i i y
acke s in es ima ing ene gy expendi u e du ing high-in ensi y unc ional aining
(A ailable om:), Res Q Exe c Spo 90 (3) (2019), h ps://doi.o g/10.1080/
02701367.2019.1603989].
[12] S.P. W igh , T.S. Hall B own, S.R. Collie , K. Sandbe g, How consume physical
ac i i y moni o s could ans o m human physiology esea ch, Am. J. Physiol.
-Regul., In eg . Comp. Physiol. 312 (3) (2017) R358–R367, h ps://doi.o g/
10.1152/ajp egu.00349.2016).
[13] J. Siddique, D. Aaby, S.E. Mon ag, S. Sidney, B. S e n eld, W.A. Welch, e al.,
Indi idualized ela i e-in ensi y physical ac i i y accele ome e cu poin s, Med
Sci. Spo s Exe c 52 (2) (2020 1).
[14] R.M. Lamon , H.L. Daniel, C.L. Payne, S.G. B aue , Accu acy o wea able physical
ac i i y acke s in people wi h Pa kinson’s disease, Gai Pos u e 63 (2018 1).
A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /29729611/〉.
[15] K. Kiebu z, Uni ied Hun ing on’s disease a ing scale: eliabili y and consis ency,
Hun ing . S udy G oup. Mo . Diso d. [In e ne ] 11 (2) (1996) 136–142. A ailable
om: 〈h ps://pubmed.ncbi.nlm.nih.go /8684382/〉.
[16] H. Ne o, M. Benka Wall´
en, E. F anz´
en, A. S åhle, M. Hags ¨
ome , Accele ome e
cu poin s o physical ac i i y assessmen o olde adul s wi h Pa kinson’s disease,
PLoS One 10 (9) (2015) e0135899, h ps://doi.o g/10.1371/jou nal.
pone.0135899.
[17] M. Delsoglio, N. Acham ah, M.M. Be ge , C. Picha d, Indi ec calo ime y in
clinical p ac ice, J. Clin. Med [In e ne ] 8 (9) (2019 1). A ailable om: 〈h ps://p
ubmed.ncbi.nlm.nih.go /31491883/〉.
[18] I. Shoulson, Hun ing on disease: unc ional capaci ies in pa ien s ea ed wi h
neu olep ic and an idep essan d ugs, Neu ol. [In e ne ]ogy 31 (10) (1981)
1333–1335. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /6125919/〉.
[19] E.M. Kingma, E. an Duijn, R. Timman, R.C. an de Mas , R.A.C. Roos,
Beha iou al p oblems in Hun ing on’s disease using he P oblem Beha iou s
Assessmen , Gen. Hosp. Psychia y 30 (2) (2008) 155–161. A ailable om: 〈h p
s://pubmed.ncbi.nlm.nih.go /18291297/〉.
[20] M.F. Fols ein, S.E. Fols ein, P.R. McHugh, “Mini-men al s a e”. A p ac ical me hod
o g ading he cogni i e s a e o pa ien s o he clinician, J. Psychia . Res. 12 (3)
(1975) 189–198 (A ailable om), 〈h ps://pubmed.ncbi.nlm.nih.go /1202204/〉.
[21] P.S. F eedson, E. Melanson, J. Si a d, Calib a ion o he compu e science and
applica ions, Inc. accele ome e , Med Sci. Spo s Exe c [In e ne ] 30 (5) (1998)
777–781. A ailable om: 〈h ps://eu opepmc.o g/a icle/med/9588623〉.
[22] M. Je ´
e, K. Sidney, G. Blümchen, Me abolic equi alen s (METS) in exe cise es ing,
exe cise p esc ip ion, and e alua ion o unc ional capaci y, Clin. Ca diol. 13 (8)
(1990) 555–565. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /2204507/〉.
[23] T.K. Koo, M.Y. Li, A guideline o selec ing and epo ing in aclass co ela ion
coe icien s o eliabili y esea ch, J. Chi op . Med [In e ne ] 15 (2) (2016)
155–163. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /27330520/〉.
[24] J.E. Ba kley, E. Glickman, C. Fennell, M. Kobak, M. F ank, G. Fa nell, The alidi y
o he comme cially-a ailable, low-cos , w is -wo n Mo band accele ome e
du ing eadmill exe cise and ee-li ing physical ac i i y, J. Spo s Sci. 37 (7)
(2019 3) 735–740. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /30
238836/〉.
[25] J. Vanhels , R. Hu diel, J. Mikulo ic, G. Bui-Xuˆ
an, P. Fa dy, D. Theunynck, e al.,
Valida ion o he Vi ago W is -Wo n accele ome e in he assessmen o physical
ac i i y, BMC Public Heal h 12 (1) (2012). A ailable om: 〈h ps://pubmed.ncbi.
nlm.nih.go /22913286/〉.
[26] A.S. B azeau, N. Beaudoin, V. B´
elisle, V. Messie , A.D. Ka elis, R. Rabasa-Lho e ,
Valida ion and eliabili y o wo ac i i y moni o s o ene gy expendi u e
assessmen , J. Sci. Med Spo 19 (1) (2016) 46–50. A ailable om: 〈h ps://p
ubmed.ncbi.nlm.nih.go /25466490/〉.
[27] P. Anas asopoulou, M. Tubic, S. Schmid , R. Neumann, A. Woll, e al., Valida ion
and compa ison o wo me hods o assess human ene gy expendi u e du ing ee-
li ing ac i i ies, PLoS One 9 (2) (2014) e90606, h ps://doi.o g/10.1371/jou nal.
pone.0090606.
[28] Oy´
en´
e Kossi, Jus ine Lac oix, B.´
ea ice Fe y, Cha les S.`
ebiyo Ba cho, Anne Julien-
Ve gonjanne, e al., Reliabili y o Ac iG aph GT3X+placemen loca ion in he
es ima ion o ene gy expendi u e du ing mode a e and high-in ensi y physical
ac i i ies in young and olde adul s, J. Spo s Sci. (2021) 1–8.
[29] B.M. Sand o , R.W. Mo l, Compa ison o Ac iG aph ac i i y moni o s in pe sons
wi h mul iple scle osis and con ols, Disabil. Rehabil. 35 (9) (2013) 725–731.
[30] M.G. Abel, J.C. Hannon, K. Sell, T. Lillie, G. Conlin, D. Ande son, Valida ion o he
Kenz Li eco de EX and Ac iG aph GT1M accele ome e s o walking and unning
in adul s, Appl. Physiol. Nu . Me ab. 33 (6) (2008) 1155–1164. A ailable om:
〈h ps://pubmed.ncbi.nlm.nih.go /19088773/〉.
[31] S.M. Tweedy, S.G. T os , Validi y o accele ome y o measu emen o ac i i y in
people wi h b ain inju y, Med Sci. Spo s Exe c [In e ne ] 37 (9) (2005)
1474–1480. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /16177597/〉.
[32] S. Mandigou , J. Lac oix, B. Fe y, N. Vuille me, M. Compagna , J.C. Da ie , Can
ene gy expendi u e be accu a ely assessed using accele ome y-based wea able
mo ion de ec o s o physical ac i i y moni o ing in pos -s oke pa ien s in he
subacu e phase? Eu . J. P e . Ca diol. 24 (18) (2017) 2009–2016, h ps://doi.o g/
10.1177/2047487317738593. Epub 2017 Oc 25. PMID: 29067851.
[33] R. Kondama Reddy, R. Pooni, D.P. Zaha ie a, B. Sen , J. El Yousse , E. Dassau, e
al., Accu acy o w is -wo n ac i i y moni o s du ing common daily physical
ac i i ies and ypes o s uc u ed exe cise: e alua ion s udy, JMIR mHeal h
uHeal h 6 (12) (2018). A ailable om: /pmc/a icles/PMC6305876/.
[34] Y. Bai, P. Hibbing, C. Man is, G.J. Welk, Compa a i e e alua ion o hea a e-
based moni o s: apple Wa ch s Fi bi Cha ge HR, J. Spo s Sci. 36 (15) (2018)
1734–1741, h ps://doi.o g/10.1080/02640414.2017.1412235. Epub 2017 Dec 6.
PMID: 29210326.
[35] V. Sjobe g, J. Wes e g en, A. Monnie , R. Lo Ma i e, M. Hags ome , B.O. Ang, e
al., W is -wo n ac i i y acke s in labo a o y and ee-li ing se ings o pa ien s
wi h ch onic pain: c i e ion alidi y s udy, JMIR mHeal h uHeal h 9 (1) (2021 1)
[ci ed 2022 May 13];.
[36] C. He ke , J.J. K aal, E.M.A. Van Loon, M. Van Hoo , H.M.C. Kemps, Use ulness o
mode n ac i i y acke s o moni o ing exe cise beha io in ch onic ca diac
pa ien s: alida ion s udy, JMIR mHeal h uHeal h 7 (12) (2019) [ci ed 2022 Jul
12];.
[37] Ge io S., Juan W.Y., Basio is P. An Easy App oach o Calcula ing Es ima ed
Ene gy Requi emen s. P e Ch onic Dis [In e ne ]. 2006 [ci ed 2022 Jul 12];3(4).
A ailable om: /pmc/a icles/PMC1784117/.
[38] H. Van Remoo el, Y. Ras e, Z. Lou a is, S. Gia edoni, C. Bu in, D. Lange , e al.,
Validi y o six ac i i y moni o s in ch onic obs uc i e pulmona y disease: a
compa ison wi h indi ec calo ime y, PLoS One 7 (6) (2012).
[39] L.M. Feehan, J. Geldman, E.C. Say e, C. Pa k, A.M. Ezza , J. Young Yoo, e al.,
Accu acy o i bi de ices: sys ema ic e iew and na a i e syn heses o
quan i a i e da a, JMIR mHeal h uHeal h 6 (8) (2018). A ailable om: 〈h ps://p
ubmed.ncbi.nlm.nih.go /30093371/〉.
[40] P. McColgan, S.J. Tab izi, Hun ing on’s disease: a clinical e iew, Eu . J. Neu ol.
25 (1) (2018) 24–34. A ailable om: 〈h ps://pubmed.ncbi.nlm.nih.go /288
17209/〉.
L. Sim´
on-Vicen e e al.