Research Study Abstract

Defining accelerometer cut-points for different intensity levels in motor-complete spinal cord injury

  • Published on June 26, 2019

The present aim was to define accelerometer cut-point values for wrist-worn accelerometers to identify absolute- and relative-intensity physical activity (PA) levels in people with motor-complete paraplegics (PP) and tetraplegics (TP).

Rehabilitation facility in Sweden.

The participants were 26 (19 men, 7 women) with C5–C8, AIS A and B (TP) and 37 (27 men, 10 women) with T7–T12 (PP), AIS A and B. Wrist-worn accelerometer recordings (Actigraph GT3X+) were taken during seven standardized activities. Oxygen consumption was measured, as well as at-rest and peak effort, with indirect calorimetry. Accelerometer cut-points for absolute and relative intensities were defined using ROC-curve analyses.

The ROC-curve analyses for accelerometer cut-points revealed good-to-excellent accuracy (AUC >0.8), defining cut-points for absolute intensity (2, 3, 4, 5, 6, 7 METs for PP and 2 to 6 METs for TP) and relative intensity (30, 40, 50, 60, 70, and 80% for PP and 40–80% for TP). The cut-points for moderate-to-vigorous physical activity was defined as ≥9515 vector magnitude counts per minute (VMC) for PP and ≥4887 VMC/min for TP.

This study presents cut-points for wrist-worn accelerometers in both PP and TP, which could be used in clinical practice to describe physical activity patterns and time spent at different intensity levels.


  • Tobias Holmlund 1,2
  • Elin Ekblom-Bak 3
  • Erika Franzén 1,4
  • Claes Hultling 1
  • Kerstin Wahman 1,2


  • 1

    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, 171 77, Stockholm, Sweden

  • 2

    Rehab Station Stockholm/Spinalis R&D Unit, Frösundaviks allé 4 169 89, Solna, Sweden

  • 3

    Åstrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Box 5626, 114 86, Stockholm, Sweden

  • 4

    Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, 171 76, Stockholm, Sweden


Spinal Cord