Steps/day translation of the moderate-to-vigorous physical activity guideline for children and adolescents

Background: An evidence-based steps/day translation of U.S. federal guidelines for youth to engage in >= 60 minutes/day of moderate-to-vigorous physical activity (MVPA) would help health researchers, practitioners, and lay professionals charged with increasing youth's physical activity (PA). The purpose of this study was to determine the number of free-living steps/day (both raw and adjusted to a pedometer scale) that correctly classified children (6-11 years) and adolescents (12-17 years) as meeting the 60-minute MVPA guideline using the 2005-2006 National Health and Nutrition Examination Survey (NHANES) accelerometer data, and to evaluate the 12,000 steps/day recommendation recently adopted by the President's Challenge Physical Activity and Fitness Awards Program. Methods: Analyses were conducted among children (n = 915) and adolescents (n = 1,302) in 2011 and 2012. Receiver Operating Characteristic (ROC) curve plots and classification statistics revealed candidate steps/day cut points that discriminated meeting/not meeting the MVPA threshold by age group, gender and different accelerometer activity cut points. The Evenson and two Freedson age-specific (3 and 4 METs) cut points were used to define minimum MVPA, and optimal steps/day were examined for raw steps and adjusted to a pedometer-scale to facilitate translation to lay populations. Results: For boys and girls (6-11 years) with >= 60 minutes/day of MVPA, a range of 11,500-13,500 uncensored steps/day for children was the optimal range that balanced classification errors. For adolescent boys and girls (12-17) with >= 60 minutes/day of MVPA, 11,500-14,000 uncensored steps/day was optimal. Translation to a pedometer-scaling reduced these minimum values by 2,500 step/day to 9,000 steps/day. Area under the curve was >= 84% in all analyses. Conclusions: No single study has definitively identified a precise and unyielding steps/day value for youth. Considering the other evidence to date, we propose a reasonable 'rule of thumb' value of >= 11,500 accelerometer-determined steps/day for both children and adolescents (and both genders), accepting that more is better. For practical applications, 9,000 steps/day appears to be a more pedometer-friendly value.