Vol.3, No.3, 141-145 (2011) Health
doi:10.4236/health.2011.33026
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Efficacy and educational role of a daily employment of the
accelerometer to improve the life style in
overweight-hypertensive population
Laura Stefani*, Antonio Maone, Gabriele Mascherini, Irene Scacciati, Ilaria Corsani, Alessandro Gi-
lardetti, Giulio Ciullini, Giorgio Galanti
Sports Medicine Center, University of Florence, Florence, Italy; *Corresponding Author:
Received December 14, 2010; revised February 23, 2011; accepted March 2, 2011.
ABSTRACT
The daily evaluation of the life style is funda-
mental for the “exercise as prescription” to re-
duce the cardiovascular risks factors. The regi-
stration by an accelerometer can identify active
from inactive subjects. The aim of the present
study is to verify, in a small cohort of subject s a t
high risk level (obese–hypertensive), the health
outcomes. A group of 22 subjects were evalu-
ated by the questionnaire and also by an accele-
rometer positioned on belt for 5 days to estab-
lish the daily Physical Activity Level (PAL).The
anthropometrics parameters, Body Mass Index
(BMI), Waist Circumference, Hip Circumference,
Fat Mass, Free Fat Mass, Total Body–Intracellular
and Extracellular Water and Phase Angle (PA)
were measured at the beginning and after 3
months of regular exercise. The amount of the
exercise prescribed for three months and at
least 3 times in a weak, was determined by the
Cardiopulmonary test at the 60% of the VO2.
Statistical analysis included T-Student test for
paired data with a significance at P < 0.05value.
Respect of the questionnaire the accelerometer
report showed a predominantly inactive life
style (PAL = 1.49 ± 0.13). After three months the
BMI was significantly reduced in all (p < 0.05)
and in addition a trend toward a reduction was
also observed for Fatty Mass and for the body
composition parameters. The employment of
the accelerometer is therefore associated to an
improvement of the parameters strongly related
with the cardiovascular risk. The results obt ained
are suggestive for an educational role of this
tool in subjects at high risk level.
Keywords: Accelerometer; Life Style; Spontaneous
Physical Activity; Body Composition and Phisycal
Activity; Exercise as Prescription
1. INTRODUCTION
In subjects at high risk level, a correct investigation of
the daily Spontaneous Physical Activity (SPA) in term of
time, frequency, intensity and kind of exercise can play a
relevant role to plan the “exercise as prescription” pro-
gram. The daily evaluation of the life style (LS) is fun-
damental to distinguish “active” from “inactive” subjects
and it normally represents the first step to establish the
amount of the physical activity as therapy in order to
contrast and therefore to reduce the global cardiovascu-
lar risk [1,2] Currently, in addition to a simple question-
naire, that summarily identifies sedentary from non-
sedentary subjects [3], a longer period of registration by
an accelerometer, can verify the effective SPA and quan-
tify the time spends to practice exercise at different level
of intensity [4,5]. It is note that the poor recognition of
physical inactivity may be in fact an important barrier to
the healthy behavior change [6]. The accelerometer can
discover the presence of several “daily sedentary behav-
iors “and therefore can play an educational role promot-
ing an improvemen t of the own LS [7- 9]. I t is reasonable
to think that this kind of approach, applied at the onset of
a program of exercise as therapy and whose intensity is
normally established and addressed to contrast the global
cardiovascular risk of the subjects analyzed, can be
helpful for a stronger of and objective realization of the
real characteristics of own LS [10,11]. The aim of the
study is to verify the role of the accelerometer in identi-
fying sedentary behaviors and also to quantify the im-
mediate positive impact on the improvement of th e main
anthropometrics and body composition parameters, in a
small cohort of overweight hypertensive subjects in
consequence of the application of this popular tool for
motivating their Physical Activity (PA).

L. Stefani et al. / Health 3 (2011) 141-145
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2. MATERIALS AND METHODS
Subjects studied: A cohort of 22 hypertensive and
overweight patients (15 male, 7 female) were enrolled
for exercise-prescription program planned at Sport Me-
dicine Center at the University of Florence, Italy. They
were substantially homogeneous for the general charac-
teristics (aged 60 ± 12.77 y), globally in stable condi-
tions and without any clinical contraindications to prac-
tice regularly physical activity. All they were affected by
mild- hypertension, as the ESC-AHA classification [12]
reports, under pharmacological treatment including ace-
inhibitors or Calcium-antagonist drugs. Following our
local research ethic committee, they all gave their in-
formal consent to approve and participate to th e protocol
study.
2.1. Protocol Study
All the subjects were submitted to a general check up
in order to verify the absence of any possible acute symp-
tom as chest pain, dyspnea or the presence of metabolic
disorders contraindicating regular physical activity. Dur-
ing the clinical anamnesis a simple questionnaire was
used to investigate the LS perception of the subjects
studied. It consisted on an interview conducted singu-
larly for every subject enrolled before to prescribe the
individual exercise program. The questionnaire was ad-
dressed to co llect data about the occupation, leisu re time
activity (watching TV, reading, cycling, planning indoor
games), smoking behavior, regular alcohol consumption,
PA and dietary habits. For every activity declared on
behalf of the subjects, a corresponding METS range
value was obtained. From this information, the subjects
were therefore classified as “sedentary or active” attrib-
uting to the first group a correspondent amount of the
daily physical activity lower than 2 METS, while in case
of subject more active the limit was up to 3-4 METS.
Moreover, to better evaluate the daily PA, including for
example fast walk or jogging, it was particularly impor-
tant to verify the rate of the exercise (i.e. 1, 2, 3 or more
times a weak) and also approximately the duration time,
expressed in minutes, dedicated to this one. After this
step, the exploration of LS was also completed by the
accelerometer (AiperMotion 440 PC-Aipermon GmBH
-Germany) report. It was positioned on belt of the patient,
asking to the subject to wear this one for almost 6 days
with the exclusion of the night time. After these periods
and before to submit the subjects to the CPT (Cardio
Pulmonary Test), the data obtained from the acceler-
ometer registration were downloaded to a laptop com-
puter for the analysis of the SPA: More than 3 hours a
weak represents the point to distinguish sedentary from
active subjects. Several else parameters were analyzed:
The Physical Activity Level (PAL: definite as EE/resting
Energy Expenditure), medium daily distance and inten-
sity of the PA expressed as slow (up to 3 Km/h) or fast
(up to 5/km/h) walk, and also the number of total daily
steps. The daily PA, was further classified as “low walk-
ing” (LW), “fast walking” (FW) and jogging. In the
same session, after the acquisition of the accelerometer
report, following the AHA, ACC guidelines [13] an 2D
Echocardiographyc exam and a CPT were performed to
obtain either the standard morphological and functional
parameters of the heart or the estimation of the Energy
Expenditure (EE) and heart rate (HR) to calculate the
amount of the PA to prescribe. The physical exercise was
programmed up to the 60% of the VO2 max for at least 3
times in a weak. The BIA (Bioelectrical Impedance
Analysis-Akern/STA/BIA-Italy) was used to measure the
body compositions parameters at the beginning (T0) and
after 3 months (T3) of physical exercise. The parameters
considered included the Fat Mass (FM), Total Body Wa-
ter (TBW), Extra Cellular Water (ECW), Intra Cellular
Water (ICW), the Angle Phase (AP), and the TBW/ECW
ratio. The anthropometrics parameters were the (BMI)
Body Mass Index, Waist Circumference (WC), Hip Cir-
cumference (HC) and the ration between them.
3. STATISTICAL ANALYSIS
Statistical analysis was performed using the SPSS
13.0 package for Windows XP. All data are expressed as
mean ± Standard Deviation (SD). All the data were com-
pared by T-Student test for paired data. A probability
value (p) of <0.05 was considered statistically signifi-
cant.
4. RESULTS
All the echocardiographic parameters were in the sub-
jects analyzed, within the normal range (Ta bl e 1). Con-
sidering the LS analysis, respect of the questionnaire
(Tab le 2 ) where only 8/22 subjects resulted to be seden-
tary, the accelerometer showed a predominantly inactive
LS (PAL = 1.57 ± 0.16) in all. The PAL observed by the
accelerometer was 1.57 ± 0.16, medium daily distance
was 6300.27 ± 2525.15 m. The amount of inactive LS
time during 6 days, consisted on 50 ± 8.52 hours; while
the hours of exercise corresponding to 3 METs were 22.5
± 6.13, the time of exercise at 3-4.5 METs was 11.23 ±
3.89 hours, and the minutes spent for jogging were 72.41
± 80.67. The time of hours corresponding to the different
daily PA degree were 8 h 15 min in case of sedentary, 3
h 45 min for slow walk, 1 h 50 min for fast walk. The
number of the daily steps was around 9413 .25 ± 40 03.12
in all the subjects analyzed. The daily calories spent
were 889.5 ± 272.02 (Table 3, Figure 1). After three

L. Stefani et al. / Health 3 (2011) 141-145
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143
Table 1. Echocardiographic pa ra meter s of the o bese -hy pertensi ve
subjects.
22 obese-hypertensive Mean ± SD
HR 70.71 ± 6.87
SBP 129.00 ± 11.98
DBP 77.67 ± 7.28
IVS 10.22 ± 0.67
PW 10.05 ± 0.58
LVDd 48.50 ± 5.10
LVSd 30.00 ± 5.95
RV 23.6 ± 1.2
CMI 111.6 ± 19.87
F.E. 61.29 ± 9.7
E_peak 72.93 ± 37.11
A_peak 66.86 ± 16.58
IVR 83.46 ± 10.48
DT 186.26 ± 18.73
LA 40.46 ± 6.5
Ao diameter 32. ± 3.14
Legend: HR: Heart Rate; SAP: Systolic Blood Pressure; DBP: Diastolic
Blood Pressure; IVS: Inter Ventricular Septum; PW: Posterior Wall; LVDd:
Left Ventricle Diastolic diameter; LVSd: Left Ventricle Systolic diameter;
RV: Right Ventricle; CMI: Cardiac Mass Index; EF: Ejection Fraction;
IVRT: Isovolumic Relaxat ion Time, DT: Deceleration Time; LA: Left Atria;
Ao diameter: Aortic diameter.
Table 2. Questionnaire investigation.
8 Subjects Sedentary
10 Subjects Moderate Active
Activity Self Perception
4 Subjects Active
7 Pensioners + 5 Housewife
5 Sedentary Work
Occupational Activity
5 Active W ork
8 Subjects Watching TV and Reading
2 Subjects Modeling
2 Subjects Gardening
4 Subjects Walking
2 Subjects Gymnastic
2 Subjects Cycling
Leisur e Time Activity
2 Subjects Evening Sport
Caption: Report of the questionnaire investigation among the overweight-
hypertensive subjects.
Table 3. Physical Activity Level expressed as daily and weekly
duration time.
Physical Activity (in duration of time during 6 days )
Sedentary
(hours) 3 METs (hours)
3-4.5
METs
(hours)
Jogging
(minutes) PAL
50 ± 8.5222.5 ± 6.1311.23 ± 3.89 72.41 ± 80.67 1.57 ± 0.16
Physical Activity (in duration of time per day)
Sedentary
(min ) 3 METs (min)
3-4.5
METs
(min)
Distance
(m) Steps Calories
Spent
(kcal)
8 h 15 min3 h
45 min1 h 50 min6300.27 ± 2525.15 9413.25 ± 4003.12 889.5 ± 272.02
Caption: PAL: Physical Activity Level; 6 days time of physical activity at
different intensity level. Daily physical activity expressed as intensity, time,
distance and calories.
Figure 1. Weeklyand daily physical activity level. Caption:
Time (minutes and hours) of phy sical activity spents at different
intensity level .
months of exercise the BMI (Figure 2) was significantly
reduced (T0 = 29,61 ± 9,11; T3 = 28,8 ± 8,89 P < 0.05).
A trend toward a reduction was observed (Ta ble 4) also
for the FM (T0 = 26.23 ± 10.5; T3 = 23.08 ± 8.03), the
WC (T0 = 102 ± 13; T3 = 93.63 ± 15), the HC (T0 = 106
± 7.29; T3 = 10 1.2 ± 2) , th e TBW (T0 = 49.3 ± 9.0; T3 =
41.36 ± 9.46) and ICW (T0 = 23.91 ± 6.25; T3 = 22.90 ±
6.16) (Figure 3). The AP values maintain (Table 4)

L. Stefani et al. / Health 3 (2011) 141-145
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144
Figure 2. Weight and BMI media values of the overweight-
hypetensive group at T0 and T3. Caption: Reduction of the
weight and BMI parameters of the subjects investigated after 3
months of the physical exercise individually prescribed.
Figure 3. Total body water and intracellular –extracellular
water distribution. Caption: Total Body Water, Intracellular ed
Extracellular water distribution in all the subjects at the onset
(T0) and after 3 months of physical exercise (T3).
within the normal range (T0 = 7.84 ± 1.4; T3 = 6.48 ±
1.23). A effective tendency to a reduction was observed
on the TBW/ECW ratio (T0 = 2.41 > T3 = 2.24). A trend
to a slight reduction was observed in th e mean values of
the systolic and diastolic blood pressure (T0 = 129.00 ±
Table 4. Anthropometrics and body composition parameters of
the obese-overweight subjects analyzed.
Obese-overweight T 0 T 3 P value
Fat Mass (kg) 26.23 ± 10.5 23.08 ± 8.03 NS (0.08)
Waist
Circunference (cm) 102.00 ± 13.45 93.63 ± 15.99NS (0.39)
Hip
Circunference (cm) 106.00 ± 7.29 101.2 ± 2.69 NS (0.23)
Total Body Water (l) 40.7 ± 9.0 41.36 ± 9.46 NS (0.65)
Intra Cellular Water (l)23.91 ± 6.25 22.90 ± 6.16 NS (0.41)
Angle Phase (degrees)7.84 ± 1.4 6.48 ± 1.23 NS (0. 14)
TBW/ECW ratio 2.41 2.24 NS (0.31)
Weight (kg) 85.13 ± 20.10 83.01 ± 19.490.026
BMI 29.61 ± 9.12 28.88 ± 8.90 0.021
Caption: trend toward a reduction of the main anthropometrics and body
composition parameters. Legend: TBW/ECW: Total Body Water/Extra Cellu-
lar Water; BMI: Body Mass Index.
11.98, 77.67 ± 7.28; T3 = 122 ± 10.80, 70.50 ± 5.40). An
inverse relationship (R -0.31) between PAL and the BMI
results has been found.
5. Discussion
A correct LS is normally associated to a reduction of
the global cardiovascular risk [1,14], however the aware-
ness of the presence of a predominant sedentary behav-
iors is not commonly easily demonstrable [6]. Before to
start with a regular training program, the necessity to
evaluate the SPA to plan the daily physical activity is
mandatory [4,5,8]. Normally a “questionnaire”, repre-
sents the most common tool to investigate this relevant
aspect [3], however it can maximally depends on the
subjective [15] evaluation of the own LS giving general
and often wrong information about the PAL with few
data about the type, the intensity of the exercises prac-
ticed (as walking, jogging ect.). The inevitable tendency
to underestimate the PAL that is in fact often associated
with an high BMI values. The evaluation of SPA is the
contrary very important to prescribe the exercise as
therapy, that is currently addressed to change the LS and
to improve the main anthropometrics in a sho rt time. The
data obtained demonstrate the accelerometer can typify
[4,5,9], much more than the simple questionnaire, the
presence of the “sedentary behaviors” and in addition
can investigate the intensity, time and the kind of exer-
cise practiced. The information related to the SPA result
in fact in a good definition of the LS that is in many
cases misunderstood. Th e i d ent ifi c a t i o n o f t h e p r ese n ce of
a predominant moderate PA L in a group at high risk level,
can therefore play a relevant role to encourage to start

L. Stefani et al. / Health 3 (2011) 141-145
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145
with a “more adequate” PA program in subjects were the
balancing of the moderate versus intense exercise is in
agreement with the recent ACSM Guidelines [16]. All
the values obtained h ave an inverse relationship with the
intensity of the PA that cannot be evaluated by a simple
questionnaire. According to the recent literatu re [17], the
results demonstrate also the role of the accelerometer, to
determine direct improvement in a short time of the pa-
rameters strongly related with the cardiovascular risk. In
conclusion the data support the glob al educational role in
this context of the employment of the accelerometer that
could be considered as an additional tool for the peri-
odical assessment of the LS changes in order to enhance
the empowerment on the exercise program.
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