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⚡ From Movement to METs: ActTrust® Validation Study

A fully reproducible R/Quarto analysis pipeline validating the ActTrust® actigraphy device for energy expenditure estimation and physical activity intensity classification in young adults, benchmarked against the ActiGraph® GT3X+ and indirect calorimetry.

DOI Zenodo License: MIT R 4.4.1 Quarto


📖 About

This repository contains all data and analysis code for a controlled laboratory validation of the ActTrust® actigraphy device (Condor Instruments, São Paulo, Brazil). The study compares ActTrust® activity counts to those from the widely used ActiGraph® GT3X+ accelerometer, and relates both to metabolic equivalents (METs) measured by indirect calorimetry during a treadmill protocol in healthy young adults.

Batista ES, Basilio Gomes SR, Morais Ferreira AB, França LGSF, Fontenele Araújo J, Mortatti AL, Leocadio-Miguel MA.
From Movement to METs: A Validation of ActTrust® for Energy Expenditure Estimation and Physical Activity Classification in Young Adults.
bioRxiv 2025. https://doi.org/10.1101/2025.05.16.654458


🔬 Study Overview

56 healthy young adults (34 men, 22 women; aged 18–35) completed a controlled treadmill protocol in a single laboratory session. Participants simultaneously wore four devices — two ActiGraph® GT3X+ and two ActTrust® units at hip and wrist — while oxygen uptake was measured breath-by-breath by indirect calorimetry (Quark CPET, Cosmed®).

Protocol

Condition Speed Description
Rest Seated, no movement
Walking 3 km/h Slow walk
Walking 5 km/h Brisk walk
Walking/Running 7 km/h Fast walk / slow run
Running 9 km/h Running

Each condition lasted 10 minutes, separated by 5-minute rest periods. Activity counts and METs were averaged over the central 4 minutes of each condition to exclude transition effects.

Devices

Device Placement Mode Sample rate Export software
ActiGraph® GT3X+ Dominant hip Vector magnitude 30 Hz, 1-s epochs ActiLife v6.13.4
ActiGraph® GT3X+ Non-dominant wrist Vector magnitude 30 Hz, 1-s epochs ActiLife v6.13.4
ActTrust® Dominant hip PIM 25 Hz, 1-s epochs Act Studio
ActTrust® Non-dominant wrist PIM 25 Hz, 1-s epochs Act Studio

ActTrust® (ACTT) PIM counts are systematically higher in magnitude than GT3X+ vector magnitude counts. The two devices are not directly comparable in absolute terms — use device-specific equations and cut-points.


✨ Key Contributions

  • 🥇 First published cut-points for physical activity intensity classification using ActTrust® devices (hip and wrist placement)
  • 📐 General linear model for estimating energy expenditure (METs) from ActTrust® activity counts, with device × placement interaction terms
  • 🔁 Cross-device comparison of GT3X+ and ActTrust® at hip and wrist placements across the full intensity spectrum
  • 📊 Balanced accuracies above 0.77 for all intensity ranges, exceeding 0.90 for light and moderate activity
  • 🧪 Bland-Altman analysis of predicted vs measured METs per device × placement
  • 👥 Sex-stratified supplementary analysis addressing body composition differences in energy expenditure

🎯 Cut-points

Physical activity intensity cut-points derived by inverting the regression model at MET thresholds of 3, 6, and 9:

Device (Placement) Regression equation Light (< 3 METs) Moderate (3–6 METs) Vigorous (6–9 METs) Very Vigorous (≥ 9 METs)
GT3X+ (hip) MET⁰·⁵ = 1.06 + 0.02 × Activity⁰·⁵ < 1132 1132–4853 4853–9468 ≥ 9468
ACTT (hip) MET⁰·⁵ = 1.11 + 0.01 × Activity⁰·⁵ < 5057 5057–23339 23339–46410 ≥ 46410
ACTT (wrist) MET⁰·⁵ = 1.23 + 0.01 × Activity⁰·⁵ < 3761 3761–22368 22368–47203 ≥ 47203
GT3X+ (wrist) MET⁰·⁵ = 1.20 + 0.01 × Activity⁰·⁵ < 1698 1698–9503 9503–19787 ≥ 19787

All units in counts/min. 95% CIs via delta method (msm::deltamethod) are reported in the notebook output.


🗂️ Repository Structure

ACTT_validation_study/
├── data/
│   ├── acttrust_validation_full.csv   # Full dataset (participants × conditions × devices)
│   └── S1.csv                         # Supplementary data
├── raw_data/
│   ├── ACTTRUST/                      # Raw ActTrust® exports (.txt, Act Studio)
│   ├── Gt3x/                          # Raw ActiGraph® GT3X+ exports (.gt3x / .csv, ActiLife)
│   └── ERGO/                          # Indirect calorimetry exports (Quark CPET)
├── index.qmd                          # Quarto notebook — complete analysis and figures
├── ACTT_validation_study.Rproj        # RStudio project file
├── DATA_DICTIONARY.md                 # Variable descriptions and raw data sources
├── DEPENDENCIES.md                    # Software and R package requirements
├── Dockerfile                         # Reproducible R environment (rocker/r-base)
├── docker-compose.yml                 # Docker Compose configuration
└── README.md                          # This file

🚀 Reproducing the Analysis

Option A — RStudio (recommended)

1. Install R dependencies

install.packages(c(
  "tidyverse", "caret", "MuMIn", "MetBrewer",
  "broom", "cowplot", "pROC", "reshape2", "gt",
  "lmtest", "car", "msm"
))

2. Render the Quarto notebook

Open ACTT_validation_study.Rproj in RStudio, then open index.qmd and click Render, or from the terminal:

quarto render index.qmd

This produces a self-contained HTML report (index.html) with all figures, tables, and statistical output inline.


Option B — Docker (fully reproducible environment)

docker-compose up

This builds the rocker/r-base:4.0.4 environment with all dependencies installed and renders the notebook.


📊 Analysis Sections

The notebook (index.qmd) runs end-to-end in the following order:

Section Description
📦 Load libraries tidyverse, caret, MuMIn, MetBrewer, broom, cowplot, pROC, lmtest, car
🎨 Set theme and palette MetBrewer "Archambault" palette; ggplot2 theme_bw
📁 Load data data/acttrust_validation_full.csv
⚖️ ANOVA sqrt(act_value) ~ Conditions:act; Tukey HSD post-hoc
🔗 Correlation matrix Pearson correlations across all four device × placement combinations (Figure 2a)
📈 Linear model sqrt(METs) ~ sqrt(act_value) * act; GT3X+ (hip) as reference level
📊 Regression plot Device-specific fitted lines overlaid on scatter (Figure 2b)
🤖 Classification metrics Fitted METs → intensity classes → confusion matrix and AUC (Figure 2c, Table 3)
🧮 Cut-point derivation Count thresholds at 3, 6, 9 METs per device × placement with 95% CIs via delta method (Table 2)
📊 Summary plots Activity counts and METs by condition (Figure 1a, 1b)
🔲 Device-specific confusion matrices Per-device 2×2 panel confusion matrix heatmaps (Figure 3)
👥 Sex-stratified analysis Confusion matrices and AUC per sex (supplementary)
📉 Bland-Altman plots Predicted vs measured METs: bias and limits of agreement per device × placement
🔍 Model diagnostics Shapiro-Wilk (normality), Breusch-Pagan (homoscedasticity), VIF (multicollinearity)

🧮 Model Details

General linear model (Equation 1)

lm(sqrt(METs) ~ sqrt(act_value) * act, data = dfm)

Where act is a factor with four levels — GT3X+ (hip) (reference), GT3X+ (wrist), ACTT (hip), ACTT (wrist). The * operator includes main effects and interaction, allowing each device × placement to have its own slope and intercept.

Cut-point derivation

Cut-points are derived by inverting the regression equation per device:

Activity = ((sqrt(MET_threshold) - β0_device) / β1_device)^2

95% confidence intervals use the delta method (msm::deltamethod) to propagate uncertainty from the coefficient covariance matrix.

PA intensity classification

Class MET range Intensity
[0,3) 0 ≤ METs < 3 Light
[3,6) 3 ≤ METs < 6 Moderate
[6,9) 6 ≤ METs < 9 Vigorous
[9,∞) METs ≥ 9 Very Vigorous

👥 Authors

Author Affiliation
Elias dos Santos Batista UFRN / IFRN, Brazil
Stephania Ruth Basilio Gomes UFRN, Brazil
Ayrton Bruno de Morais Ferreira UFRN, Brazil
Lucas G. S. França Northumbria University, UK / King's College London, UK
John Fontenele Araújo UFRN, Brazil
Arnaldo Luis Mortatti UFRN, Brazil
Mario André Leocadio-Miguel (corresponding) Northumbria University, UK

Correspondence: mario.miguel@northumbria.ac.uk


⚖️ Ethics

Approved by the Human Ethics Committee of the Federal University of Rio Grande do Norte (Protocol 3.672.214; CAAE: 15857419.5.0000.5537) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.


💰 Funding

Supported by the Brazilian National Council for Scientific and Technological Development (CNPq).


📄 Citation

@article{batista_2025_acttrust,
  author  = {Batista, Elias dos Santos and Basilio Gomes, Stephania Ruth and
             Morais Ferreira, Ayrton Bruno de and França, Lucas G. S. and
             Fontenele Araújo, John and Mortatti, Arnaldo Luis and
             Leocadio-Miguel, Mario André},
  title   = {From Movement to METs: A Validation of ActTrust® for Energy
             Expenditure Estimation and Physical Activity Classification in
             Young Adults},
  journal = {bioRxiv},
  year    = {2025},
  doi     = {10.1101/2025.05.16.654458},
  url     = {https://doi.org/10.1101/2025.05.16.654458}
}

Data archived at Zenodo: https://doi.org/10.5281/zenodo.15315735


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📄 Licence

Released under the MIT License.

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⌚️ A fully reproducible R/Quarto analysis pipeline validating the ActTrust® actigraphy device for energy expenditure estimation and physical activity intensity classification in young adults, benchmarked against the ActiGraph® GT3X+ and indirect calorimetry.

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