# Published cut-points and how to use them in GGIR

# 1 Summary of published cut-points

In this vignette we have compiled a list of published cut-points with instructions on how to use them with GGIR. As newer cut-points are frequently published the list below may not be up to date. Please let us know you if know of any cut-points we missed!

It is important to highlight that some of the presented cut-points were originally based on acceleration metrics that are not available in GGIR. In particular acceleration metrics that sum their values per epoch rather than average them per epoch like GGIR does. However, we can use them in GGIR by multiplying the cut-point by the sample frequency as used in the study that proposed it. For each of the studies this is detailed in the footnotes. In the tables below these conversion are already performed. Thus, some of the cut-points as shown differ with the values reported in the publications.

Note that GGIR intentionally does not sum values per epoch because that approach makes the cut-point sample frequency and epoch length dependent, which complicates comparisons and harmonisation of literature. The explained variance and accuracy remains identical because we are only multiplying with a constant, so no information will be lost.

## 1.1 Cut-points for preschoolers

Cut-points | Device Attachment site | Age | Relevant arguments | thresholds
--- | --- | --- | --- | ---
Roscoe 2017* | GENEActiv Non-dominant wrist | 4-5 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 61.8 Moderate: 100.4 Vigorous: N/A
Roscoe 2017* | GENEActiv Dominant wrist | 4-5 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 94.5 Moderate: 108.5 Vigorous: N/A

*These publications used acceleration metrics that sum their values per epoch rather than average them per epoch like GGIR does. So, to use their cut-point in GGIR, we provide a scaled version of the cut-points presented in the paper as: `(CutPointFromPaper_in_gsecs/85.7) * 1000`. Note that sample frequency of 87.5 as reported in the publication was incorrect and based on correspondence with authors we replaced this by 85.7.

## 1.2 Cut-points for children/adolescents

Cut-points | Device Attachment site | Age | Relevant arguments | thresholds
--- | --- | --- | --- | ---
Phillips 2013* | GENEA Left wrist | 8-14 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 87.5 Moderate: 250 Vigorous: 750
Phillips 2013* | GENEA Right wrist | 8-14 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 75 Moderate: 275 Vigorous: 700
Phillips 2013* | GENEA Hip | 8-14 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 37.5 Moderate: 212.5 Vigorous: 637.5
Schaefer 2014* | GENEActiv Non-dominant wrist | 6-11 yr | `do.bfen = TRUE` `lb = 0.2` `hb = 15` `do.enmo = FALSE` `acc.metric = "EN"` | Light: 190 Moderate: 314 Vigorous: 998
Hildebrand 2014 Hildebrand 2016 | ActiGraph Non-dominant wrist | 7-11 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 35.6 Moderate: 201.4 Vigorous: 707.0
Hildebrand 2014 Hildebrand 2016 | GENEActiv Non-dominant wrist | 7-11 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 56.3 Moderate: 191.6 Vigorous: 695.8
Hildebrand 2014 Hildebrand 2016 | ActiGraph Hip | 7-11 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 63.3 Moderate: 142.6 Vigorous: 464.6
Hildebrand 2014 Hildebrand 2016 | GENEActiv Hip | 7-11 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 64.1 Moderate: 152.8 Vigorous: 514.3
Aittasalo 2015 | ActiGraph Hip | 13-15 yr | Default values `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: 26.9 Moderate: 332 Vigorous: 558.3
Aittasalo 2015 | Hookie AM20 Hip | 13-15 yr | Default values `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: 28.7 Moderate: 338 Vigorous: 558.3

*These publications used acceleration metrics that sum their values per epoch rather than average them per epoch like GGIR does. So, to use their cut-point in GGIR, we provide a scaled version of the cut-points presented in the paper as: `(CutPointFromPaper_in_gmins/(sampleRateFromPaper * EpochLengthInSecondsPaper)) * 1000` ** This publication used acceleration metrics that expressed their cut-points in g units. So, to use their cut-point in GGIR, we provide a cut-point multiplied by 1000.

## 1.3 Cut-points for adults

Cut-points | Device Attachment site | Age | Relevant arguments | thresholds
--- | --- | --- | --- | ---
Esliger 2011* | Left wrist | 40-65 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 45 Moderate: 134 Vigorous: 377
Esliger 2011* | Right wrist | 40-65 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 80 Moderate: 92 Vigorous: 437
Esliger 2011* | Waist | 40-65 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 16 Moderate: 46 Vigorous: 428
Hildebrand 2014 Hildebrand 2016 | ActiGraph Non-dominant wrist | 21-61 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 44.8 Moderate: 100.6 Vigorous: 428.8
Hildebrand 2014 Hildebrand 2016 | GENEActiv Non-dominant wrist | 21-61 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 45.8 Moderate: 93.2 Vigorous: 418.3
Hildebrand 2014 Hildebrand 2016 | ActiGraph Hip | 21-61 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 47.4 Moderate: 69.1 Vigorous: 258.7
Hildebrand 2014 Hildebrand 2016 | GENEActiv Hip | 21-61 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 46.9 Moderate: 68.7 Vigorous: 266.8
Vähä-Ypyä 2015 | Hookie AM20 Hip | 35 (SD=11) yr | Default values `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: N/A Moderate: 91 Vigorous: 414
Dillon 2016*,† | GENEActiv Non-dominant wrist | 50-69 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 105.6 Moderate: 174.2 Vigorous: 330
Dillon 2016*,† | GENEActiv Dominant wrist | 50-69 yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 127.8 Moderate: 187.6 Vigorous: 396.4

*These publications used acceleration metrics that sum their values per epoch rather than average them per epoch like GGIR does. So, to use their cut-point in GGIR, we provide a scaled version of the cut-points presented in the paper as: `(CutPointFromPaper_in_gmins/(sampleRateFromPaper * EpochLengthInSecondsPaper)) * 1000` † In this publication, there are cut-point based on data sampled at 30 Hz and 100 Hz. When scaling the cut-points as specified in (*), the resulting thresholds are virtually the same (the ones presented in this table).

## 1.4 Cut-points for older adults

Cut-points | Device Attachment site | Age | Relevant arguments | thresholds
--- | --- | --- | --- | ---
Sanders 2019* | GENEActiv Non-dominant wrist | 60-86 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 20 Moderate: 32 Vigorous: N/A
Sanders 2019** | GENEActiv Non-dominant wrist | 60-86 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 57 Moderate: 104 Vigorous: N/A
Sanders 2019* | ActiGraph Hip | 60-86 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 6 Moderate: 19 Vigorous: N/A
Sanders 2019** | ActiGraph Hip | 60-86 yr | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 15 Moderate: 69 Vigorous: N/A
Migueles 2021 | ActiGraph Non-dominant wrist | ≥70 yr (mean: 78.7 yr) | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 18 Moderate: 60 Vigorous: N/A
Migueles 2021 | ActiGraph Dominant wrist | ≥70 yr (mean: 78.7 yr) | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 22 Moderate: 64 Vigorous: N/A
Migueles 2021 | ActiGraph Hip | ≥70 yr (mean: 78.7 yr) | Default values `do.enmo = TRUE` `acc.metric = "ENMO"` | Light: 7 Moderate: 14 Vigorous: N/A
Fraysse 2020† | GENEActive Non-dominant wrist | ≥70 yr (mean: 77 yr) | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 42.5 Moderate: 98 Vigorous: N/A
Fraysse 2020† | GENEActiv Dominant wrist | ≥70 yr (mean: 77 yr) | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 62.5 Moderate: 92.5 Vigorous: N/A
Dibben 2020‡ | GENEActiv Right wrist | 70.7 (SD=14.1) yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 18.6 Moderate: 45.5 Vigorous: N/A
Dibben 2020‡ | GENEActiv Right wrist | 70.7 (SD=14.1) yr | `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: 18.3 Moderate: 26.2 Vigorous: N/A
Dibben 2020‡ | GENEActiv Left wrist | 70.7 (SD=14.1) yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 16.7 Moderate: 43.6 Vigorous: N/A
Dibben 2020‡ | GENEActiv Left wrist | 70.7 (SD=14.1) yr | `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: 18.7 Moderate: 22.8 Vigorous: N/A
Dibben 2020‡ | GENEActiv Hip | 70.7 (SD=14.1) yr | `do.enmoa = TRUE` `do.enmo = FALSE` `acc.metric = "ENMOa"` | Light: 7.6 Moderate: 40.6 Vigorous: N/A
Dibben 2020‡ | GENEActiv Hip | 70.7 (SD=14.1) yr | `do.mad = TRUE` `do.enmo = FALSE` `acc.metric = "MAD"` | Light: 1 Moderate: 2.4 Vigorous: N/A

*Cut-points derived from applying the Youden index on ROC curves.
** Cut-points derived from increasing Sensitivity over Specificity for light and vice versa for moderate on ROC curves (see paper for more details).
† These publications used acceleration metrics that sum their values per epoch rather than average them per epoch like GGIR does. So, to use their cut-point in GGIR, we provide a scaled version of the cut-points presented in the paper as: `(CutPointFromPaper_in_gmins/(sampleRateFromPaper * EpochLengthInSecondsPaper)) * 1000` ‡ More cut-points excluding data on aided walking and washing up activities can be found in the publication.

# 2 Notes on cut-point validity

Sensor calibration

In all of the studies above, excluding Hildebrand et al. 2016, no effort was made to calibrate the acceleration sensors relative to gravitational acceleration prior to cut-point development. Theoretically this can be expected to cause a bias in the cut-point estimates proportional to the calibration error in each device, especially for cut-points based on acceleration metrics which rely on the assumption of accurate calibration such as metrics: ENMO, EN, ENMOa, and by that also metric SVMgs used by studies such as Esliger 2011, Phillips 2013, and Dibben 2020.

Idle sleep mode and ActiGraph

As discussed in the main package vignette, studies using the ActiGraph sensor often forget to clarify whether idle sleep mode was used and if so, how it was accounted for in the data processing.

How about all the criticism towards cut-point methods?

For a more elaborate reflection on the limitations of cut-points and a motivation why cut-points still have value in GGIR see: https://www.accelting.com/updates/why-does-ggir-facilitate-cut-points/

# 3 References

- Esliger 2011: https://journals.lww.com/acsm-msse/Fulltext/2011/06000/Validation_of_the_GENEA_Accelerometer.22.aspx
- Phillips 2013: https://www.jsams.org/article/S1440-2440(12)00112-0/fulltext
- Schaefer 2014: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960318/
- Hildebrand 2014: https://journals.lww.com/acsm-msse/Fulltext/2014/09000/Age_Group_Comparability_of_Raw_Accelerometer.17.aspx
- Hildebrand 2016: https://doi.org/10.1111/sms.12795
- Vähä-Ypyä 2015: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134813
- Aittasalo 2015: https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-015-0010-0
- Roscoe 2017: https://link.springer.com/article/10.1007/s00431-017-2948-2
- Sanders 2018: https://doi.org/10.1080/02640414.2018.1555904
- Migueles 2021: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150960/
- Fraysse 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843957/
- Dibben 2020: https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-020-00196-7
- Dillon 2016: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858250/