467

Journal of Physical Activity and Health, 2009, 6, 467-474

2009 Human Kinetics, Inc.
Background: Although many Japanese older
adults spend more than an hour each day walk-
ing for exercise, the intensity is often lower
than the minimum level associated with vari-
ous health benefts. The purpose of this study
was to evaluate the effcacy of a lifestyle phys-
ical activity intervention on improving quan-
tity and quality of daily physical activity (DPA)
as well as cardiorespiratory endurance in com-
munity-dwelling older women. Methods: 68
women (6078 yr of age) were randomly
assigned to either a lifestyle physical activity
intervention group (LIFE) or control group.
During the 12-wk intervention, feedback based
on accelerometer DPA data (number of daily
steps (STEPS) and time spent performing daily
moderate intensity physical activity (MPA)
was provided to each participant in LIFE every
two weeks. Cardiorespiratory endurance was
evaluated using the 12-Minute Walk Test (12-
MW). Results: Following the 12-wk interven-
tion, signifcant group interactions were
observed for STEPS, MPA, and cardiorespira-
tory endurance. LIFE increased STEPS by
16%, MPA by 53%, and the distance walked
during the 12-MW by 10%. Conclusions: Pro-
motion of DPA using accelerometers can sig-
nifcantly improve quantity and quality of daily
physical activity as well as cardiorespiratory
endurance in older women.
Keywords: elderly, data feedback, moderate
intensity, walking
Koizumi, Islam, and Takeshima are with the Graduate School
of Natural Sciences, Nagoya City University, Nagoya, Japan.
NL Rogers is with the School of Community Affairs Gerontol-
ogy Program, Wichita State University, Wichita, KS, USA.
ME Rogers is with the Center for Physical Activity and Aging,
Dept of Human Performance Studies, Wichita State Univer-
sity, Wichita, KS, USA. Kusunoki is with the School of
Biology-Oriented Technology, Kinki University, Kinokawa,
Japan.
Efficacy of an Accelerometer-Guided Physical Activity
Intervention in Community-Dwelling Older Women
Daisuke Koizumi, Nicole L. Rogers, Michael E. Rogers, Mohammod M. Islam,
Masanobu Kusunoki, and Nobuo Takeshima
Physical inactivity is a leading public health prob-
lem associated with decreased longevity as well as car-
diovascular disease, cancer, obesity, diabetes, and other
diseases.
9,27
It has been demonstrated that regular exer-
cise plays an important role in maintaining and promot-
ing health, physical ftness, and functional independence
in older adults.
1
Many intervention programs have been
implemented to enhance physical activity among older
adults
28
and improved health status and functional per-
formance have been noted in these studies.
30
However,
despite the demonstrated benefts of implemented inter-
ventions, the number of older adults participating in
regular exercises is still very low.
27
Recently, older adult physical activity program-
ming has focused on promoting daily physical activity
4

(DPA). This approach provides opportunities and
options to increase physical activity for individuals
while attempting to take into consideration lifestyle
preference and is targeted toward individuals who are
inactive or inadequately active. Adequate lifestyle phys-
ical activity is defned
6
as the daily accumulation of at
least 30 minutes of self-selected activities, which
includes all planned and unplanned leisure, occupa-
tional, household, and other daily activities that are at
least moderate to vigorous in their intensity. To fulfll
the prescribed amount of DPA in adequate intensities, a
unique method of measuring quantity as well as the
intensity of DPA is needed. Quantifcation of DPA in
older adults is an area of interest for many public health
professionals. Several methods of quantifying physical
activity and energy expenditure are available.
18
Many of
these methods are limited in accuracy and/or feasibility
for estimating physical activity or energy expenditure in
particular populations or circumstances.
18
Recently,
accelerometers have become increasingly popular for
assessing the intensity of physical activity in communi-
ty-dwelling older adults.
7
Many studies have docu-
mented the validity of accelerometry-based activity
monitors under both laboratory and feld con-
ditions.
7,8,29
Various interventions such as mass and print media
have been effectively used to motivate people to increase
DPA.
15
Direct contact interventions such as telephone
468 Koizumi et al
replacement therapy; had diagnosed coronary heart dis-
ease; or were engaging in an established walking pro-
gram for health benefts. Participants were matched on
age and then randomly assigned to one of two groups:
lifestyle physical activity intervention group (LIFE) or
control group (CON). LIFE consisted of 34 participants
(aged 60 to 78 yr, average: 66 4) and CON consisted
of 34 participants (aged 60 to 76 yr, average: 67 4).
Accelerometers
In this study, a Kenz Lifecorder accelerometer (ACCEL;
Suzuken Company, Nagoya, Japan) was given to each
participant in both groups. This ACCEL is uniaxial,
small in size (62.5 mm 46.5 mm 26.0 mm), light in
weight (40 g), and powered by a lithium battery
(CR2032, 3V). Participants were able to wear the device
at waist-level for long periods of time without it inter-
fering with normal DPA.
11
ACCEL records physical
activity intensities in ten different levelszero to nine,
with higher numbers indicating higher intensity. Inten-
sity is determined through the use of a proprietary flter-
ing process that considers both frequency and magni-
tude of accelerations. Acceleration is sampled every
four seconds and recorded at two-minute intervals.
Daily activity summary fles (summary of steps and the
number of 4-second intervals measured in each of the 9
activity categories) are easily downloaded to an Excel
spreadsheet. Simple formulas can then be used to calcu-
late time spent performing a range of physical activity
intensities. The following physical activity categories
have been validated in adults
14
(13 = light, 46 = mod-
erate, 79 = vigorous). Zero corresponds to nonambula-
tory physical activities performed in everyday life.
20

The ACCEL has the ability to store continuous data for
as long as 6 weeks. The Kenz Lifecorder ACCEL has
been validated as an accurate step counter
23
and its
intensities of 4 to 6 have been shown to correspond to
MPA
25
(4 MET to 6 MET). Crouter et al
5
reports an
accuracy of 1% to 3% when ACCEL downloaded data
are compared against observed steps. Such accuracy
makes this accelerometer a good choice for use in
research.
6
When studying the older adult population, a
minimum of fve days wearing the ACCEL is needed to
accurately estimate DPA.
25
Cardiorespiratory Endurance
Endurance was assessed by performing the 12-Minute
Walk Test
26,30
(12-MW). The 12-MW assessed the max-
imum distance in meters walked in 12 minutes around a
60-m rectangular course marked into 5-m segments.
The walking course was in a well-lit indoor gymnasium
with a level nonslip surface. For each lap completed, a
chopstick was handed to the participant so that the
number of laps could be easily counted at the end of the
test. The score was the total number of meters walked to
the nearest 5 meters in the allotted time period.
calls have also been shown to increase adherence to
home-based exercise programs of physical activity.
16

Thus, cognitive-behavioral techniques have been used
in the experimental treatment to systematically teach
participants how to identify, monitor, and achieve valued
outcomes associated with a physically active lifestyle.
In addition, studies have described the usefulness of
pedometers to increase DPA. Rooney et al
22
reported
that wearing a pedometer for 8 weeks increased the
amount of physical activity and improved activity
awareness in a group of young adults. Chan et al
3

reported that a pedometer-based intervention in seden-
tary workers was effective in increasing the number of
daily steps taken. Although pedometers and accelerom-
eters are similar in that they are both noninvasive tools
that allow instant feedback regarding a persons activity
level, they differ in the fact that pedometers only count
the number of steps while accelerometers track step
number as well as the frequency of the step (ie, intensity
of physical activitysedentary, light, moderate, and
vigorous). Therefore, accelerometers directly address
public health recommendations suggesting adults
engage in 30 minutes of moderate intensity.
27
Acceler-
ometers may therefore be an effective tool to enhance
both DPA quantity and intensity, an aspect that other
studies have not addressed.
The purpose of this study was to evaluate the eff-
cacy of an accelerometer-based lifestyle intervention for
community-dwelling older women. It was hypothe-
sized that accelerometer-based feedback and recom-
mendations provided to the intervention group would
result in an increase in the quantity and intensity of DPA
and a subsequent improvement in cardiorespiratory
endurance.
Methods
Participants
The Ethical Committee of the Graduate School of Natu-
ral Sciences at Nagoya City University approved the
study. Sixty-eight community-dwelling older women
residing in N. Iida city were recruited through senior
centers and advertisements in local papers. All partici-
pants received written and oral instructions for the study
and each gave their written informed consent before
participation. The average age of the participants was 67
4 yr (SD). All participants were physically indepen-
dent and lived in a small community where the local
economy is based on agriculture and forestry. All were
untrained but physically healthy, which is common
among older adults who frequent community centers in
Japan. Participants were excluded if they had any gait
abnormalities which would affect the measurement of
daily activity via an accelerometer; were taking medica-
tion prescribed for stroke, hypertension, or hormone
Accelerometer-Guided Physical Activity Intervention 469
served as the within-subject factor. A probability value
of less than 0.05 was considered statistically signifcant
and a Bonferroni adjustment was used to correct for
multiple measurements.
Results
Normality and Assumptions
Nonsignifcant Kolomogorov-Smirnov tests indicated
that all variables, excluding the daily steps, were nor-
mally distributed. To correct for nonnormality, daily
steps were transformed using a Log10 transformation.
Conducting a second Kolomogorov-Smirnov test on the
transformed daily step variable revealed a successful
transformation, with daily steps being normally distrib-
uted. In addition, histograms and normal Q-Q plots
revealed normal distributions for both groups. Assump-
tions of homogeneity of variance and sphericity were
evaluated and not violated.
Baseline Comparison
An analysis of pretest physical characteristics, STEPS,
MPA, and cardiorespiratory endurance was completed
to determine if differences existed between the groups.
No differences were found between LIFE and CON
before the start of the intervention. All participants com-
pleted the program.
Accelerometer Measures
Table 1 represents changes in physical activity variables
for both groups. There was a signifcant interaction for
STEPS (F = 10.53, P .01,
2
= .14) that resulted from
the LIFE group increasing their biweekly step average
16% (7811 3268 to 9046 2620 steps). No change
was observed in STEPS of the CON group (Figure 2).
There was also a signifcant interaction for MPA (F =
11.76, P .01,
2
= .15) in which the LIFE group
increased their biweekly moderate-intensity activity
minutes by 53% (17.83 13.3 to 27.23 14.71 min).
There was no change in moderate-intensity activity
minutes of the CON group (Figure 3).
12-Minute Walk Time
Analysis revealed a signifcant interaction for 12-MW
(F = 9.28, P .01,
2
= .30). Distance walked during the
12-MW improved by 10% for the LIFE (Table 2).
Discussion
This study was designed to determine the effcacy of
wearing an ACCEL along with individualized feedback
as a mode to improve quantity and quality of DPA and
the cardiorespiratory endurance in older women. A
Prescription Program
The LIFE prescription recommended participants accu-
mulate 9000 steps and 30 minutes of moderate intensity
physical activity per day. These recommendations were
derived from both Japanese and US sources. Recently,
the Ministry of Health, Labor, and Welfare of Japan set
reference values for physical activity, exercise, and
physical ftness for Japanese age 20 to 69 years.
13
With
respect to DPA, the Ministry recommends the accumu-
lation of 8000 to 10,000 steps per day. The US Surgeon
General recommends 30 minutes of moderate-intensity
physical activity per day.
27
During the 12-wk interven-
tion, the only contact made with participants was when
both LIFE and CON groups reported to a local commu-
nity center with their ACCEL to meet with the research-
ers who downloaded the data to a computer. ACCEL-
based DPA feedback was provided to the LIFE group at
this time. Participants were provided with a) quantity of
physical activity (stepsd
1
) [STEPS], and b) time spent
in moderate intensity DPA performed (mind
1
) [MPA].
The CON group wore a locked ACCEL (ie, tied close
with a plastic strap) and therefore was not aware of
ACCEL-based DPA feedback throughout the study. The
CON group was told to continue their normal daily
activity patterns during the intervention. LIFE partici-
pants were provided with graphs and scatter plots repre-
senting their activity levels for the previous 2-wk period
(Figure 1). Based on activity level, recommendations
(eg, increase STEPS by 500 and engage in 3 more min-
utes of MPA per day) were provided to each participant.
Therefore, every 2 weeks participants could modify
their DPA level to better meet the targeted goal. Aver-
ages (24 hr) of DPA were statistically evaluated at 2
points of this 12-wk study. Daily averages of the frst 2
weeks were used as baseline data and daily averages of
11th and 12th week were used as post data.
Data Analysis
The data are expressed as mean SD. Data analysis was
completed using the statistical software program SPSS
for Windows V.14.0 (SPSS Inc., Chicago, IL). Data
were screened for outliers and the assumptions of nor-
mality and homoscedasticity. To reduce the potential
infuence of outliers on the statistical analysis, box-and-
whiskers plots were used to identify outliers, which
were subsequently eliminated before analysis. Each
variable was examined for normality using the Kolo-
mogorov-Smirnov test. Assumptions of homogeneity of
variance and sphericity were evaluated. Baseline group
mean comparisons were performed using 2-tailed inde-
pendent t tests. At postintervention, change in STEPS,
MPA, and cardiorespiratory endurance were evaluated
using a 2-way analysis of variance (ANOVA) with
repeated measures to determine differences between
CON and LIFE. Group (CON, LIFE) served as the
between-subject factor, while Time (pre- and posttest)
470 Koizumi et al
12-wk program, indicating the intervention was also
successful in increasing the amount of MPA in older
women. Furthermore, participants improved the maxi-
mum distance they could walk during 12 minutes by
10%, suggesting that the program also results in signif-
cant improvements in cardiorespiratory endurance.
Accelerometers were used to encourage individuals
to change their DPA behavior by monitoring the quan-
tity of activity (STEPS) and quality of activity (MPA)
and providing recommendations. In the current study,
no signifcant difference was noted in STEPS or MPA at
baseline between groups. After the 12-wk intervention,
a signifcant group interaction was noted between LIFE
and CON with signifcant improvement in STEPS and
MPA. This indicates that wearing an ACCEL alone
nationwide survey performed by the Japan Ministry of
Health, Labor, and Welfare
12
reported that women of
age 70 years or older walk less than 5000 step/day. It
has been proposed that older women age 70 years or
older should walk a minimum of 5900 steps per day by
the year 2010.
21
Although the participants in this study
were slightly younger (67 4 yr) and the quantity of
DPA they performed was well above recommended
levels, they were still able to signifcantly increase
STEPS by 10% as a result of the intervention. Con-
versely, they spent only about 18 minutes performing
MPA, which was far below the recommend time of at
least 30 minutes a day.
27
As a result of this intervention,
the LIFE group increased the time spent performing
MPA by 53% to approximately 27 minutes after the
Figure 1 Example of biweekly participant feedback presenting proportion of MPA relative to total STEPS (bottom left), average
daily STEPS for 2 wk (bottom right), graphical representation of MPA and STEPS within 4 activity quadrants (upper left), and
quadrant defnitions and activity recommendation (upper right).
Table 1 Accelerometer Measures (Values are Mean SD)
Pre Post % Change
Bi-weekly step average
Lifestyle physical activity 7811 3268 9046 2620 16%
Control 7583 2220 7221 2390 0.04%
Mod intensity activity (min)
Lifestyle physical activity 17.83 13.3 27.23 14.71 53%
Control 19.21 10.43 18.97 9.76 0.01%
471
Figure 2 Bi-Weekly Step Average Number of steps per day and standard error of the mean before and after 12 weeks in each
group. LIFE: Intervention group; CON: control group * P < .05.
Figure 3 Moderate-Intensity Physical Activity Time (minutes) spent performing moderate-intensity physical activity per day
and standard error of the mean before and after 12 weeks in each group. LIFE: Intervention group; CON: control group * P < .05.
472 Koizumi et al
clinic resulted in improvement of daily steps, walking
stage of change, and walking self-effcacy. However,
few studies have reported improvement of moderate-
intensity physical activity (MPA). The U.S. Surgeon
General Report recommends that individuals participate
in 30 minutes of MPA on most days of the week. Addi-
tional health and functional benefts of physical activity
can be achieved by increasing the quantity of MPA or by
substituting activity that is more vigorous.
27
It is of
value to public health care professionals to fnd that
moderate intensity DPA can be increased by using
ACCEL. Signifcant improvements were noted in the
time spent performing MPA after the 12-wk interven-
tion in LIFE. However, participants still did not reach 30
min/day of MPA. Therefore, future research should be
designed to examine the effcacy of interventions that
are implemented for long periods of time.
When interpreting results, it is important to con-
sider the limitations of this study. Physical activity was
de-limited to walking and thus limited the promotion of
activities to only those measurable by ACCEL. There-
fore nontranslatory activities such as bicycling and
swimming were not promoted or accounted for. Future
studies should develop methodology to incorporate DPA
activities not measured by ACCEL. Such a design might
also be successful in further increasing MPA by not lim-
iting older adults solely to walking for DPA but also
encouraging participation in safe and enjoyable non-
translatory activities. With respect to the Hawthorne
effect, interpretation of the fndings should take into
account that participant feedback and recommendations
were provided by the researcher. This face-to-face con-
tact may have positively infuenced older adults to
increase their DPA independent of the ACCEL informa-
tion. Future studies should teach participants how to
record their daily STEPS and MPA to be used in setting
their own goals based on ACSM recommendations. This
will also enhance the ability of researchers to offer the
intervention to larger populations. Finally, complete
understanding of a lifestyle intervention is limited by
the brief length of this prescription. During a follow-up
by Mutrie et al
19
a signifcant decrease in steps follow-
ing an initial gain at 16 weeks was found. After a year,
the intervention group had returned to their baseline
step level. Conversely, a long intervention may be more
successful in assisting older adults to meet the recom-
mended 30 min/day of MPA.
In conclusion, our results indicate that the use of
accelerometers combined with feedback regarding the
amount and intensity of activity can signifcantly im-
prove quantity and quality of daily physical activity and
without DPA-related data feedback or recommenda-
tions was not enough to motivate older subjects to
improve quality of DPA. The importance of data feed-
back has been previously described by Mihalko et al,
17

who reported that individual ftness feedback affects
attendance of introductory physical activity. This report
supports the fndings of the current study indicating that
awareness of individual information about ftness or
activity level may be an important factor in determining
physical activity participation.
Many reports describe the importance of the quan-
tity and quality of DPA. Compared with women whose
usual walking pace was easy (<2.0 mph [3.2 km/h]),
multivariate relative risks of total stroke were 0.81 (95%
CI, 0.63 to 1.03) for women walking at a moderate pace
(2.0 to 2.9 mph [3.2 to 4.6 km/h]) and 0.49 (95% CI,
0.36 to 0.68) for women walking at a brisk (3.0 to 3.9
mph [4.8 to 6.2 km/h]) or very brisk (4 mph [6.4
km/h]) pace independent of the number of hours spent
walking.
10
It has also been reported that sedentary
women who became active in middle and later adult-
hood had lower stroke risk than their counterparts who
remained sedentary, implying a relatively prompt bene-
ft of physical activity that older adults obtain from exer-
cise even if they were sedentary for a long time.
10
These
fndings are encouraging, because walking is a highly
accessible activity that is readily adopted, inexpensive,
and rarely associated with exercise-related injury.
10
In a
study by Hootman et al,
9
running and sport participation
(in people age 20 to 85 years at the time of follow-up)
was associated with approximately 1.5 to 1.7 times
higher risk of training-related injury in women com-
pared with the sedentary counterparts. No signifcant
difference was reported between walkers and sedentary
subjects for the risk of activity-related injury in women.
9

Thus, for most adults, walking is a safe form of physical
activity.
In the current study, accelerometers were used to
measure DPA in community-dwelling older women.
Although questionnaires may be cost effective com-
pared with using accelerometers, it has been found pre-
viously that estimates of walking reported on question-
naires were only 34% of the distance measured by
pedometers in the same participants.
2
Thus, to evaluate
DPA more accurately, accelerometers are a better choice
than questionnaire survey. Some earlier physical activ-
ity intervention studies using pedometers have shown
improvement in the quantity of daily steps. According
to Stovitz et al,
24
pedometer-based physical activity
interventions over 9 weeks focusing on increasing
ambulatory activity in patients at a family medicine
Table 2 Cardiorespiratory Endurance (Values are Mean SD)
Pre Post % Change
12minute walk
Lifestyle physical activity 1090.72 186.59 1197.86 94.04 10%
Control 1089.22 157.38 1117.25 153.72 3%
Accelerometer-Guided Physical Activity Intervention 473
14. Kumahara H, Schutz Y, Ayabe M, et al. The use of uni-
axial accelerometry for the assessment of physical-
activity-related energy expenditure: a validation study
against whole-body indirect calorimetry. Br J Nutr.
2004;91:235243. PubMed doi:
15. Marcus BH, Owen N, Forsyth LH, Cavill NA, Fridinger
F. Physical activity interventions using mass media, print
media, and information technology. Am J Prev Med.
1998;15:362378. PubMed doi:
16. Martin KA, Sinden AR. Who will stay and who will go?
A review of older adults adherence to randomized con-
trolled trials of exercise. J Aging Phys Act. 2001;99:91
114.
17. Mihalko SL, Wickley KL, Sharpe BL. Promoting physi-
cal activity in independent living communities. Med Sci
Sports Exerc. 2006;38:112115. PubMed doi:
18. Montoye HJ. Introduction: evaluation of some measure-
ments of physical activity and energy expenditure. Med
Sci Sports Exerc. 2000;32:439441. PubMed doi:
19. Mutrie N, Wright AE, Wilson RE, Gunnyeon KA. Do
pedometers motivate people to walk more? J Sports Sci.
2004;22:254.
20. Niinomi M, Takeuchi Y, Nakamura R, et al. Assessment
of physical activity by an accelerometer with relatively
large memory. Practice. 1998;15:433438 (in Japanese).
21. Physical exercise recommendation for the health promo-
tion of Japanese in 21 Century (KenkoNippon21) (1999).
http://www.kenkounippon21.gr.jp/kenkounippon21/
about/intro/menu1_p1.html (in Japanese).
22. Rooney B, Smalley K, Larson J, Havens S. Is know-
ing enough? Increasing physical activity by wearing a
pedometer. Wis Med J. 2003;102:3136.
23. Schneider PL, Crouter SE, Basset DR. Pedometer mea-
sures of free-living physical activity: comparison of
13 models. Med Sci Sports Exerc. 2004;36:331335.
PubMed doi:
24. Stovitz SD, Vanwormer JJ, Center BA, Bremer KL.
Pedometers as a means to increase ambulatory activity
for patients seen at a family medicine clinic. J Am Board
Fam Pract. 2005;18:335343. PubMed doi:
25. Takeshima N, Koizumi D, Islam MM, Okada A, Rogers
ME, Fujiwara T, Lee M. Measuring quantity and qual-
ity of daily physical activity by using accelerometers
in older adults with the aim of health promotion and
independent lifean international collaborative study.
Research papers of the Suzuken Memorial Foundation.
2002;21:26-31. (in Japanese).
26. Takeshima N, Tanaka K, Kobayashi F, Sumi K, Watanabe
T, Kato T. Validity of the maximal aerobic capacity esti-
mated from submaximal cycling exercise and feld per-
formance tests in the elderly. Jpn J Phys Fitness Sports
Med. 1992;41:295303.
27. U.S. Department of Health and Human Services. Physi-
cal activity and health: a report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human
Services, Center for Disease Control and Prevention,
National Center for Chronic Disease Prevention and
Health Promotion; 1996.
cardiorespiratory endurance in older women. Moreover,
the LIFE intervention is potentially feasible as it can be
delivered relatively easily to large populations, involves
a physical activity (walking) deemed to be not only pop-
ular, but safe for the older women, and is reasonably
inexpensive (one time cost of US$125 per person).
References
1. American College of Sports Medicine. The recommended
quality and quantity exercise for developing maintaining
cardiorespiratory and muscular ftness and fexibility in
healthy adults. Med Sci Sports Exerc. 1998;30:975991.
PubMed doi:
2. Bassett DR, Jr, Cureton AL, Ainsworth BE. Measure-
ment of daily walking distance-questionnaire versus
pedometer. Med Sci Sports Exerc. 2002;32:10181023.
3. Chan CB, Ryan DA, Tudor-Locke C. Health benefts of
a pedometer-based physical activity intervention in sed-
entary workers. Prev Med. 2004;39:12151222. PubMed
doi:
4. Cress ME, Buchner DM, Prohaska T, et al. Best practices
for physical activity programs and behavior counseling in
older adult populations. J Aging Phys Act. 2005;13:61
74 PubMed.
5. Crouter SE, Schneider PL, Karabulut M, Bassett DR,
Jr. Validity of 10 electronic pedometers for measuring
steps, distance, and energy cost. Med Sci Sports Exerc.
2003;35:14551460. PubMed doi:
6. Dunn AL, Andersen RE, Jakicic JM. Lifestyle physi-
cal activity interventions history, short- and long-
term effects, and recommendations. Am J Prev Med.
1998;15:398412. PubMed doi:
7. Freedson P, Melanson E, Sirard J. Calibration of the
Computer Science and Applications, Inc. accelerometer.
Med Sci Sports Exerc. 1998;30:777781. PubMed doi:
8. Hendelman D, Miller K, Baggett C, Debold E, Freedson
P. Validity of accelerometry for the assessment of moder-
ate intensity physical activity in the feld. Med Sci Sports
Exerc. 2000;32:S442S449. PubMed doi:
9. Hootman JM, Macera CA, Ainsworth BE, Martin M,
Addy CL, Blair SN. Association among physical activity
level, cardiorespiratory ftness, and risk of musculoskel-
etal injury. Am J Epidemiol. 2001;154:251258. PubMed
doi:
10. Hu FB, Stampfer MJ, Colditz GA, et al. Physical activ-
ity and risk of stroke in women. JAMA. 2000;283:2961
2967. PubMed doi:
11. Islam MM, Takeshima N, Koizumi D, Rogers ME,
Rogers NL. Relationship between balance, daily physical
activity, and ftness in older adults. Asian J Exerc Sport
Sci. 2004;1:918.
12. Japan Ministry of Health. Labour, and Welfare. 1999
annual report on health and welfare, 1999. Dai-ichi
Shuppan Publishing, Tokyo.
13. Japan Ministry of Health. Labour and Welfare. Exercise
and physical activity reference for health promotion,
2006. Dai-ichi Shuppan Publishing, Tokyo.
474 Koizumi et al
30. Yamauchi T, Islam MM, Koizumi D, Rogers ME, Rogers
NL, Takeshima N. Effect of home-based well-rounded
exercise in community-dwelling older adults. J Sports
Sci Med. 2005;4:563571.
28. Van Der Bij AK, Laurant MG, Wensing M. Effective of
physical activity interventions for older adults. Am J Prev
Med. 2002;22:120133. PubMed doi:
29. Welk GJ, Almeida J, Morss G. Laboratory calibration and
validation of the biotrainer and actitrac activity monitors.
Med Sci Sports Exerc. 2003;35:10571064. PubMed doi: