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Faculty of Health Sciences School of Public Health 9501477y maharaja@therapy.wits.ac.za / This study aimed to understand the physical demands of upper and lower body dressing in 23 stroke survivors and 23 control subjects. Measurement of the energy expenditure and time take was done by means of a triaxial accelerometer. The amount of active movement present in the limbs was also documented. Activities health was measured in the experimental group. Results indicated that significantly more energy was expended in dressing the upper body in the experimental group (p<0.05). No significant differences were found in the energy expenditure in dressing the lower limbs. There were significant differences found in the perception of difficulty of the tasks. Patients with stroke took four times longer to dress than controls. Despite having motor ability, stroke survivors were not able to use this in activities of daily living (ADL). Patients with stroke were unsatisfied and spent excessive amounts of time in their day in sedentary, unconstructive activity. Recommendations include increased endurance training in patients with neurological disorder in order to reengage them into ADL.

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Abstract Aim The aim of the study was to examine the capability of accelerometers to estimate energy expenditure during high-intensity complex physical activity patterns. Also, to investigate whether placing the monitor on the hip or wrist influenced its prediction ability. Furthermore, the purpose was also to evaluate if there was a significant difference in the aforementioned estimations using data from one axis compared to all three axis combined.     Method A total of 14 subjects, eight men and six women, mean (SD) age of 26, 4 (5,5) years were recruited for the study. The participants performed standardised aerobic exercise while accelerometer data and oxygen uptake was measured simultaneously. Two triaxial accelerometers (Actigraph GT3X) were worn on the hip and wrist during the experiment. Indirect calorimetry, using Oxycon mobile, was chosen as the criterion measure. Validity was determined by comparing accelerometer counts with estimated energy expenditure (EE) in kcal/min, derived from measured oxygen consumption, using bivariate Pearson correlation, linear regression and stepwise regression analyses. Equations were calculated using each participant’s individual regression analyses.   Results The experiment reveals that GT3x presents a moderate correlation (r= 0, 47) for estimating EE from aerobics when worn on the hip and a weak correlation (r = 0.34) when worn on the wrist. However, when combined with the body mass variable, a strong correlation was found between accelerometer data for the hip and EE (r= 0.73). At both positions the vector magnitude (r = 0.47 for the hip and r = 0.34 for the wrist) yielded stronger correlations compared to just using the Y-axis (r = 0.15 for the hip and r= 0.08 for the wrist).     Conclusions In conclusion, this study found that GT3x was not particularly valid for assessing energy expenditure in high intensity complex activities. Wearing the accelerometer on the hip yielded higher correlations compared to wearing it on the wrist. When using the accelerometer for estimations of EE the Vector magnitude is to prefer before the Y-axis solely.

Diabetes mellitus is a chronic disease in which the body does not produce sufficient insulin or in which the body has high insulin resistance thus making the regulation of blood glucose metabolism difficult. Currently, diabetes is still incurable. All patients need to well manage their blood glucose levels to reduce the risk of complications. This dissertation is comprised of two major studies. In diabetes type I, the blood glucose can only be managed by multiple daily injection of insulin. However, most patients tend to have difficulty in deciding the right amount of insulin dose. The first study is the development of a mathematical model of blood glucose levels, which leads to the development of a decision support system for diabetes type I using the Markov theory. In some type II and gestational diabetes, blood glucose can be managed by choosing diet properly and by exercising regularly. However, people tend to overestimate their activity levels. The second study describes the design and development of a wearable device based on the triaxial accelerometer that estimates the energy levels of normal daily physical activity with comparable accuracy to the gas analysis. This device development leads to two clinical studies. The first clinical study investigates whether the energy monitor could help people with diabetes in promoting and managing their daily activity and help to improve the glycosylated haemoglobin and body mass index. The second clinical study investigates whether the energy monitor could help pregnant women with gestational diabetes in managing their daily activity, blood glucose levels and body weight gain. This thesis also develops a telemedicine system to automate the data collection during the clinical trial period. The system would securely transmit all diabetes and energy data from the participants' home to a remote server. A key finding of this study was that a higher activity score results in smaller fluctuations in blood glucose levels between measurements in both diabetes and gestational diabetes subjects. This suggests that higher activity levels would make the management of diabetes more effective by reducing the fluctuation in blood glucose levels.

Diabetes mellitus is a chronic disease in which the body does not produce sufficient insulin or in which the body has high insulin resistance thus making the regulation of blood glucose metabolism difficult. Currently, diabetes is still incurable. All patients need to well manage their blood glucose levels to reduce the risk of complications. This dissertation is comprised of two major studies. In diabetes type I, the blood glucose can only be managed by multiple daily injection of insulin. However, most patients tend to have difficulty in deciding the right amount of insulin dose. The first study is the development of a mathematical model of blood glucose levels, which leads to the development of a decision support system for diabetes type I using the Markov theory. In some type II and gestational diabetes, blood glucose can be managed by choosing diet properly and by exercising regularly. However, people tend to overestimate their activity levels. The second study describes the design and development of a wearable device based on the triaxial accelerometer that estimates the energy levels of normal daily physical activity with comparable accuracy to the gas analysis. This device development leads to two clinical studies. The first clinical study investigates whether the energy monitor could help people with diabetes in promoting and managing their daily activity and help to improve the glycosylated haemoglobin and body mass index. The second clinical study investigates whether the energy monitor could help pregnant women with gestational diabetes in managing their daily activity, blood glucose levels and body weight gain. This thesis also develops a telemedicine system to automate the data collection during the clinical trial period. The system would securely transmit all diabetes and energy data from the participants' home to a remote server. A key finding of this study was that a higher activity score results in smaller fluctuations in blood glucose levels between measurements in both diabetes and gestational diabetes subjects. This suggests that higher activity levels would make the management of diabetes more effective by reducing the fluctuation in blood glucose levels.

A selection of common children’s games were measured in a laboratory-based study to be enjoyable and to elicit sufficient physical activity energy expenditure (PAEE) in 3rd grade children to combat the purported chronic energy surplus of childhood obesity (~100 kcal.day-1). PAEE during the games was similar for boys and girls, yet overweight children expended greater PAEE relative to body weight than healthy weight children. During a subsequent simulated recess program, the enjoyment declined over the 10-session program with no significant decline in PAEE. Using the enjoyable games of known energy cost in a structured recess program for 9 weeks successfully increased total daily PA compared to the control school who reported substantially greater amount of free-play time. The greater amount of acquired PA in the intervention school children did not affect the amount of time spent in sedentary pursuits but it did result in a smaller increase in body weight after 9 weeks. More research is needed to expand on this initial list of games that reduce the excessive weight gain in children when incorporated into a structured recess intervention.

Commercially available fitness trackers have been found to accurately measure steps and caloric expenditure during walking and running activities. Circuit-style, highintensity functional training (HIFT) has become increasingly popular because it is inexpensive and effective in improving muscular strength and cardiovascular fitness. PURPOSE: To evaluate the accuracy of five accelerometers (ActiGraph GT3X, Nike Fuelband, Fitbit One, Fitbit Charge HR, and Jawbone UP Move) in estimating energy expenditure while performing an acute bout of HIFT. METHODS: Participants (n = 47) underwent baseline testing and at least 48 hours later, each participant completed the main test: a 15-minute workout consisting of 12 repetitions each of 7 different exercises; performed circuit-style by completing as many rounds as possible. During the main test, each participant wore the Cosmed K4b2 portable metabolic analyzer (PMA) and five different accelerometers. RESULTS: Four of the five fitness trackers reported lower (p <0.01) total caloric expenditure values compared to the PMA during the acute bout of HIFT. The waist-mounted device (ActiGraph, 182.55 ± 37.93 kcals) most closely mimicked caloric expenditure compared to the PMA (Cosmed, 144.99 ± 37.13 kcals) as indicated by an insignificant p value (0.056). Systematic differences between the activity monitors were calculated using an Intraclass Correlation (ICC) with an ICC = -0.032. The ICC of F (46,235) = 0.812 (p = 0.799) was not significant at the predetermined 0.05 alpha level. A Repeated Measures ANOVA showed that when compared to the Cosmed, all activity monitors were significantly different at the 0.05 alpha level. The Fitbit One and the Fitbit Charge HR were the only two activity monitors that are not significantly different from one another (p = 0.985). The range of error based on mean absolute percentage errors (MAPE) was lowest for the ActiGraph (15.1%) and highest for the Fitbit Charge HR (22.1%). CONCLUSION: The wrist- and hip-mounted fitness trackers do not accurately assess energy expenditure during HIFT exercise. Supported by: WKU Graduate School, NIGMS 2P20 GM103436-14; Institutional Development Award (IDeA) from National Institute of General Medical Sciences, National Institutes of Health, 5P20GM103436 and the WKU RCAP Grant 14-8007.

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