How many steps/day are enough? for children and adolescents
International Journal of Behavioral Nutrition and Physical Activity
How Many Steps/Day are Enough? for Children and Adolescents
Catrine Tudor-Locke 0 1
Cora L Craig 1
Michael W Beets 1
Sarahjane Belton 1
Greet M Cardon 1
Scott Duncan 1
Yoshiro Hatano 1
David R Lubans 1
Timothy S Olds 1
Anders Raustorp 1
David A Rowe 1
John C Spence 1
Shigeho Tanaka 1
Steven N Blair 1
0 Walking Behavior Laboratory, Pennington Biomedical Research Center , Baton Rouge, LA , USA
1 & Biostatistics, Arnold School of Public Health, University of South Carolina , Columbia , USA
Worldwide, public health physical activity guidelines include special emphasis on populations of children (typically 6-11 years) and adolescents (typically 12-19 years). Existing guidelines are commonly expressed in terms of frequency, time, and intensity of behaviour. However, the simple step output from both accelerometers and pedometers is gaining increased credibility in research and practice as a reasonable approximation of daily ambulatory physical activity volume. Therefore, the purpose of this article is to review existing child and adolescent objectively monitored step-defined physical activity literature to provide researchers, practitioners, and lay people who use accelerometers and pedometers with evidence-based translations of these public health guidelines in terms of steps/day. In terms of normative data (i.e., expected values), the updated international literature indicates that we can expect 1) among children, boys to average 12,000 to 16,000 steps/day and girls to average 10,000 to 13,000 steps/day; and, 2) adolescents to steadily decrease steps/day until approximately 8,000-9,000 steps/day are observed in 18-year olds. Controlled studies of cadence show that continuous MVPA walking produces 3,300-3,500 steps in 30 minutes or 6,600-7,000 steps in 60 minutes in 10-15 year olds. Limited evidence suggests that a total daily physical activity volume of 10,000-14,000 steps/day is associated with 60-100 minutes of MVPA in preschool children (approximately 4-6 years of age). Across studies, 60 minutes of MVPA in primary/elementary school children appears to be achieved, on average, within a total volume of 13,000 to 15,000 steps/day in boys and 11,000 to 12,000 steps/day in girls. For adolescents (both boys and girls), 10,000 to 11,700 may be associated with 60 minutes of MVPA. Translations of time- and intensity-based guidelines may be higher than existing normative data (e.g., in adolescents) and therefore will be more difficult to achieve (but not impossible nor contraindicated). Recommendations are preliminary and further research is needed to confirm and extend values for measured cadences, associated speeds, and MET values in young people; continue to accumulate normative data (expected values) for both steps/day and MVPA across ages and populations; and, conduct longitudinal and intervention studies in children and adolescents required to inform the shape of step-defined physical activity dose-response curves associated with various health parameters.
The profound and robust benefits of a physically
active lifestyle are recognized even for young people.
Hence, worldwide, public health physical activity
guidelines include special emphasis on children
(typically 6-11 years) and adolescents (typically 12-19
years) [1-3], and there is growing interest in providing
guidelines for preschool children . Existing
guidelines are commonly expressed in terms of frequency,
time, and intensity of behaviour. However, with the
technological advancement of objective monitoring of
physical activity using pedometers and accelerometers,
the opportunity now exists to offer another type of
message that is congruent with these established
guidelines. Although accelerometers offer a greater
potential to study complex patterns of physical activity
and sedentary behaviours in the course of research,
the simple step output from both accelerometers and
pedometers is gaining increased credibility in both
research and practice as a reasonable approximation
of daily ambulatory physical activity volume [5,6]. Of
the two types of instrumentation, pedometers are
more likely to be adopted for clinical and public
health applications, and ultimately are also more likely
to be embraced by the public themselves, due
primarily to interpretability and relative low cost. Such users
(i.e., clinicians, public health practitioners, and the
general public) require good reference data and
recommendations that are grounded in evidence in
order to facilitate an effective step-based translation of
public health guidelines. The purpose of this
manuscript is to convey findings that inform a translation
of public health guidelines for children and
adolescents in terms of steps/day.
This literature review was commissioned by the Public
Health Agency of Canada (PHAC) and includes: 1)
normative data (i.e., expected values); 2) incremental
changes expected from interventions; 3) controlled
studies translating cadence (i.e., steps/minute) to activity
intensity; 4) studies of steps/day associated with time in
moderate-to-vigorous physical activity (MVPA) under
free-living conditions; and, 5) health outcome-related
analyses (e.g., steps/day associated with valued health
outcomes). In February 2010 a professional librarian
executed the search strategy of CINAHL, ERIC,
MEDLINE, PsycINFO, SocINDEX, and SPORTDiscus using
the keywords (pedomet* or acceleromet*) and step* and
((physical activity) or walk*), limited to English language,
and published since 2000 (an earlier review covered
studies published before 2000 ). Articles were assembled,
additional research was identified by reviewing article
reference sections, and relevant content was abstracted
and summarized by the first author. Where recent
review articles were identified (e.g., normative data,
interventions), the summarized results were presented
to avoid redundancy and notable original articles
selected to make specific points. Subsequently,
researchers with practical experience collecting step data
worldwide were invited to critically review the report, identify
any additional relevant literature (including known
articles in press), and intellectually contribute to this
consensus document focused on children and adolescents.
Study details were tabulated as appropriate. Any
seeming inconsistencies in details catalogued within tables (e.
g., instrument brand, model, numbers of decimal points,
etc.) reflect underlying reporting inconsistencies as
taken directly from original articles. The adult  and
older adult/special populations  literature is reviewed
Normative data (expected values)
Normative steps/day data (or expected values) provide
an indication of central tendency and variability and are
useful for comparison purposes and interpreting change.
However, they should not imply what children or
adolescents should be taking, an index more appropriately
described as a cut point or threshold value. Early work
 that attempted to collate normative data (from
studies published between 1980 and 2000) reported, based
on a single study  published at the time, that we can
expect 8-10 year old children to take 12,000 to 16,000
steps/day (lower for girls than boys). No data were
available at the time to inform the number of steps/day that
adolescents take. Since then, however, studies of young
peoples step data collected using pedometers and
accelerometers have proliferated. In particular, two reviews
have published normative data for children, together
covering each sex-age group from 5-19 years of age
[11,12]. Among children, boys average 12,000 to 16,000
steps/day and girls average 10,000 to 13,000 steps/day
. Although there are exceptions among countries, in
general, peak values of mean steps/day occur before 12
years of age and decrease through adolescence until
mean values of approximately 8,000 and 9,000 steps/day
are observed in 18-year olds . Across studies,
physical education class participation generally contributes
9-24% of daily steps in boys and 11.4-17.2% in girls,
and afterschool activity accounts for 47-56% and
4759% (boys and girls respectively) of daily steps on school
days . Differences among countries are apparent,
with children from North America (Canada and United
States) showing lower values compared to other regions
of the world, for example, when compared to European
countries (Sweden, United Kingdom, Belgium, Czech
Republic, France, Greece, and Switzerland), but
especially when compared to Western Pacific countries
(Australia and New Zealand) .
Beyond these reviews, a few specific references relative
to normative data in young people are noteworthy.
Vincent and Pangrazi  reported normative data for a U.
S. sample in 2002 and at that time suggested that the
mean values of 13,000 for U.S boys and 11,000 for U.S.
girls could be used as reasonable standards for
evaluation purposes. The U.S. Presidents Challenge: Physical
Activity and Fitness Awards Program  adopted these
same values to recognize physically active U.S. children
(ages 6-17 years). A number of researchers from around
the world have used these same values as cut points to
evaluate data [15-17] although they can only be traced
back to mean values based on a single descriptive study
 of weekday step values obtained by 711 children
aged 6-12 years living in the Southwestern U.S. The
National Health and Nutrition Examination Survey
(NHANES) in the U.S. adopted an accelerometer to
objectively monitor physical activity in the 2003-2004
and 2005-2006 cycles; step data for children and
adolescents collected in 2005-2006 have been recently
published . Once adjusted (i.e., reduced to those steps
taken above a specified intensity) to make these
accelerometer-determined step data interpretable against
common pedometer-based scales, the results indicate that
American young people aged 6-19 years take
approximately 9,500 (boys) and 7,900 (girls) steps/day . The
2005-2007 Canadian Physical Activity Levels Among
Youth (CANPLAY) pedometer-determined physical
activity data (based on a nationally representative
sample of > 11,500 Canadian young people) are also just
recently available [6,18]. The results indicate that
Canadian young people aged 5-19 years of age take 12,000
(boys) and 11,000 (girls) steps/day . To put these
American and Canadian values in context, Amish young
people 6-18 years of age, who purposefully refrain from
adopting most technologies of modern living, average
over 15,000 steps/day .
Tudor-Locke and Bassett  established
pedometerdetermined physical activity cut points for healthy
adults: 1) < 5,000 steps/day (sedentary); 2) 5,000-7,499
steps/day (low active); 3) 7,500-9,999 steps/day
(somewhat active); 4) 10,000-12,499 steps/day (active); and
5) 12,500 steps/day (highly active). These categories
were reinforced in an updated review in 2008  and
in 2009 the original sedentary level was segmented into
two additional levels: < 2,500 steps/day (basal activity)
and 2,500 to 4,999 steps/day (limited activity) . A
similar (but sex-specific) graduated step index has been
introduced for children (ages 6-12 years) . Values
for boys are: 1) < 10,000; 2) 10,000-12,499; 3)
12,50014,999; 4) 15,000 - 17,499; and, 5) 17,500 steps/day.
The corresponding values for girls are: 1) < 7,000; 2)
7,000-9,499; 3) 9,500-11,999; 4) 12,000 - 14,499 and, 5)
14,500 steps/day. The primary anchors for both of
these sex-specific indices were based on a
BMI-referenced criterion study of U.S., Australian, and Swedish
children 6-12 years of age , and the appropriateness
and generalizability of these cut points have been
questioned . The increments in the childrens graduated
step index were selected to be congruent with the adult
index. For both sexes, each escalating category can be
interpreted as sedentary, low active, somewhat
active, active, and highly active similar to the labels
used to define levels in the adult graduated step index,
however, they have also been given labels of copper,
bronze, silver, gold, and platinum, in keeping
with a style reflective of current physical activity and
fitness award programs in the U.S. . Another strategy
might be to adopt existing graduated Canadian Physical
Activity, Fitness and Lifestyle Approach (CPAFLA) 
labels: Needs Improvement, Fair, Good, Very Good, and
Excellent. It may be difficult to avoid unintentional
potential for stigmatization using any qualitative label,
however . Only a single study has used this index to
describe distribution of child data at this time  and
we know of no validation study with regards to any
other health parameter. An additional criticism of this
version of childrens graduated index could be that there
are not enough rungs on the ladder leading up to the
identified floor values separating sedentary from low
active. As indicated above, two additional levels have
been added to the adult version. There is very little step
data to inform an adolescent-specific graduated step
index at this time.
Seventeen studies were identified that have reported
relative achievement of various step-defined cut points
and these are presented in Table 1 by publication year.
Three of these have used the Vincent and Pangrazi 
and/or Presidents Active Lifestyle Award  values of
13,000 for boys and 11,000 for girls (based on normative
values for American adolescents ). Six have used
BMI-referenced values (15,000 for boys, 12,000 for girls)
described above . Four have examined both of these,
one used the Rowlands and Eston  cut points of
13,000 (boys) and 12,000 (girls) based on accumulating
> 60 minutes in accelerometer-determined MVPA
within the course of daily activity, one used the
sex-specific childrens graduated step index , and the
remainder have used other variations. In general, 1)
relatively more children than adolescents achieve a given
cut point, 2) relatively more children and adolescents
are able to achieve lower (rather than higher) cut points,
and 3) relatively fewer U.S. children and adolescents
achieve the same cut points when compared to those
from other countries. Not included in the table is a
study by Beets et al.  which evaluated the
BMI-referenced cut points (e.g., in terms of sensitivity and
specificity) but did not report the actual percentage of the
sample achieving them.
In summary, the updated normative data (i.e.,
expected values) based on international studies indicates
that we can expect 1) among children, boys to average
12,000 to 16,000 steps/day and girls to average 10,000 to
13,000 steps/day; and, 2) steps/day values in adolescents
to steadily decrease until approximately 8,000-9,000
steps/day are observed in 18-year olds.
A systematic review of studies that have used
pedometers to promote physical activity in children and
adolescents has been recently published . Only 14
studies were identified, and 12 of these documented
increases in physical activity. The magnitude of the
th ;n ve ve [1 ren ,20
;ilrsg irrtceeud rsyae ;ilrs8g lilrceohd ;ilrs639g irttsaeenp ,ilrs329g irttsaeenp ittavaaed iiilfccehdC ,;)1199941
65 tsn .076 ,s14 scho rsae ,sy5 lrye rs ,sy1 lrye rs ronm -sxp -00
, e ; o l a o l a . e ,5
sy sc ls yo ry y b an ye b an ye .S .S )9
ob leo hoo .15 53b iram t9o 386 itao -91 182 itao -91 izU il)rs ;93
50 ad sc 14 1 p 6 5 n 5 1 n 6 rag (g 49
;lirs rsycah ;ilrsg teund s ;ilrsg lcoho
g tn rs 1 ls ra 54 sc rs
8 e a 4 y a
9 e 14 oo ye , r e
, m y , h 8 sy ta y
sy le 1 sy sc 1 o n 2
e 1 o b e 1
intervention effects was variable and could very well
reflect differences in study participants (e.g., children vs.
adolescents, obese vs. non-obese), program factors,
study design (e.g., 1-week to 6-month interventions),
and/or assessment protocols. Limited evidence suggests
that the intervention effects are greater in participants
who are low active to begin with. In particular,
adolescents who already take 13,000-15,000 steps/day do not
appear to respond to goal-setting or activity monitoring
strategies using pedometers. The magnitude or pattern
of change that can be expected from pedometer-based
interventions in children and adolescents is not known
at this time. The authors of that review concluded that
since there were so few intervention studies published,
yet the results were generally positive, continued
research should be encouraged to inform guidelines
with regards to using pedometers to promote physical
activity in children and adolescents. It is clear that this
area of knowledge is lacking, especially when compared
with what is known about pedometer-based
interventions in adults [27-29].
Cadence is the expression of steps taken per unit time
(i.e., steps/minute) and it can be used to infer intensity
of continuous ambulation [30,31]. Four controlled
studies have been conducted with healthy young people
[32-35]. The series of studies conducted by Scruggs and
colleagues [36-41] were not considered here since they
focus on steps detected specifically during physical
education classes, which would logically include at least
some sedentary time (e.g., for instruction, class
management, etc.), and this would effectively lower mean
cadence values. In a similar manner, a study by Beets et
al.  focused on steps associated with time in MVPA
detected during afterschool programs was not
Jago et al.  studied pedometer-determined steps
taken by 78 11-15 year old USA-based Boy Scouts at
externally-paced slow (10 minutes at 4.83 km/hr 3
METs or moderate intensity) and fast walks (10 minutes
at 6.44 km/hr 5.0 METs or moderate-vigorous
intensity) and running (5 minutes at 8 km/hr 8 METs or
vigorous intensity) on a 200 m track. METs (metabolic
equivalents) are often used to quantify physical activity
intensity with respect to resting or basal metabolic rate
(1 MET 3.5 ml O2/kg/min or 1 kcal/kg/min for
adults). In the Jago et al.  study MET level was not
directly measured but rather was inferred from the
Compendium of Physical Activities . Although
participants also wore a CSA accelerometer (an earlier
version of the ActiGraph accelerometers) during these
trials, the output of that instrument was only used to
assess pedometer (New Lifestyles Digiwalker SW-200)
validity by correlation and was not otherwise used to
inform how many steps are enough? Mean
steps/minute overall for the slow and fast walks and the run were
117, 127, and 163, respectively. The authors focused on
the results of the fast walk (taken at 5 METs) to
extrapolate that approximately 4,000 steps in 30 minutes or
8,000 steps in 60 minutes was equivalent to
adolescentappropriate amounts of time in MVPA. However, if 3
METs is considered the floor of moderate intensity
activity , it follows that 3,510 steps in 30 minutes or
7,020 steps in 60 minutes would be a more literal
translation of the results of the slow 3 MET walk. It must be
noted, that moderate intensity might be more correctly
considered to be 4 METs in children . Since
cadences were only measured for 3 MET (slow) and 5
MET (fast) walks, 122 steps/min is a mid-way estimate
for a 4 MET walk. This produces an estimate of 3,660
steps in 30 minutes and 7,320 steps in 60 minutes.
Since Jago et al.  also reported that adolescents at
risk of overweight (BMI > 85th percentile) took
somewhat fewer steps/minute (i.e., 111, 123, and 156 steps/
min for each of the trials), 111 steps/min is the cadence
associated with 3 METS and 117 steps/min would be
the cadence associated with 4 METs. Together, the
floor of moderate intensity might be better captured by
a range of approximately 3,300-3,500 steps in 30
minutes (or 6,600-7,000 steps in 60 minutes) of continuous
walking at 3 METs or approximately 3,500-3,700 steps
in 30 minutes (or 7,000-7,400 steps in 60 minutes) at 4
Graser et al.  asked 34 girls and 43 boys aged
1012 years to wear a pedometer and walk on a treadmill
at 3, 3.5, and 4 miles/hour. Intensity was not directly
measured; however, the authors considered these speeds
to represent a range of MVPA walking intensities. The
boys and girls cadence values were similar across the
walking speeds and the researchers concluded that, in
general, 120-140 steps/minute represented a reasonable
cadence range associated with MVPA. Intensity-related
translations based on taking 120 steps/minute at 3
miles/hour correspond to 3,600 steps in 30 minutes, or
7,200 steps in 60 minutes. Graser et al.  studied a
somewhat younger age group than the Jago et al. 
study and this might have produced relatively higher
cadence ranges. Taken together, the two studies indicate
that continuous MVPA walking (assuming at least 3
METs) produces 3,300-3,600 steps in 30 minutes or
6,600-7,200 steps in 60 minutes in 10 - 15 year olds. It
is important to emphasize that such a translation should
only be applied to continuous ambulation performed
over the specified amounts of time. It is most important
to emphasize that definitions of MVPA differed between
these two studies and neither used a direct measure of
Lubans et al.  studied 47 boys and 59 girls (all 14
years old) walking and running on a treadmill at 65-75%
of maximum heart rate (confirmed by heart rate
monitor). Twenty-seven participants repeated the test three
times over the course of a month to determine reliability
of results. The results were highly repeatable (ICC =
.83-.87). Pedometer-determined cadence associated with
the designated heart rate range was 147 steps/minute
(range 125 to 149 steps/minute) for boys and 137 steps/
minute (range 125 to 149 steps/minute) for girls.
Cadence also differed by fitness level (assessed by the
3min Queens College Step Test): adolescents in the
lowest quintile of cardiorespiratory fitness took 129 steps/
min, those in the next two quintiles averaged 138 steps/
min, and those in the top two quintiles averaged 152
steps/min. It is difficult to use these cadence values to
extrapolate to MVPA. The authors did not report when
running vs. walking occurred, but it seems likely that
the boys and girls with the top fitness levels were
running at this higher cadence. Extrapolating from the
adult data where the floor value (in absolute terms) of
moderate and vigorous intensity is 100 and 130 steps/
minute respectively , we would expect that a child/
adolescent-specific vigorous intensity cadence is likewise
at least 30 steps/minute (and likely even higher in
children) more than the child/adolescent-specific moderate
intensity cadence, or approximately 141 to 157 steps/
minute. The Lubans et al.  study is grounded by a
relative (vs. absolute) indicator of intensity (i.e., heart
rate). Further, the heart rate range tested in this study is
somewhat narrower than previously included in physical
activity recommendations (i.e., 55-90% of maximum
heart rate) . Public health guidelines issued by the
American College of Sports Medicine and American
Heart Association in 2007 do not provide explicit
guidelines in terms of heart rate-determined intensity .
More recently, Graser et al.  conducted another
study of pedometer-determined cadence and heart-rate
determined intensity in 12-14 year old adolescents.
Treadmill speeds were set at 4.0, 4.8, 5.64, and 6.42 km/
hr after confirming that this age group could perform
all speeds without breaking into a run. These
researchers defined moderate intensity as 40-59% of maximum
heart rate, which may be considered low compared with
physical activity recommendations (i.e., 55-90% of
maximum heart rate) . The corresponding cadence
averaged 122 (range 108-134) steps/minute in boys and 102
(range 80-123) steps/minute in girls, suggesting great
individual variation in intensity-associated cadence, a
phenomenon that may reflect underlying variation in
development as well as fitness. Limitations include the
use of heart rate to define moderate intensity and the
use of a target heart rate formula originally produced
for adults. Heart rate reflects relative intensity, unlike
direct measures of intensity such as MET values. As in
each of the controlled studies in children and
adolescents described above, steps were detected by a
bodyworn instrument instead of by direct observation, which
is arguably the more appropriate criterion for these
types of lab-based studies.
In summary, no controlled studies of cadence have
used a direct measure of absolutely-defined intensity at
this time and none have counted steps taken using
direct observation. The limited evidence at this time
suggests that, in 10-15 year olds, continuous MVPA
walking produces 3,300-3,500 steps in 30 minutes or
6,600-7,000 steps in 60 minutes (assuming at least 3
METs). No studies were located that have attempted to
intervene specifically on cadence. Hypothetically,
however, such a practical approach might be useful for
increasing time spent in MVPA.
Translating existing physical activity guidelines
As stated earlier, public health physical activity
guidelines are typically expressed in terms of frequency, time,
and intensity. For example, a recent
PHAC-commissioned systematic review  of physical activity and
health concluded that Children and youth 5-17 years of
age should accumulate an average of at least 60 minutes
per day and up to several hours of at least moderate
intensity physical activity. Some of the health benefits
can be achieved through an average of 30 minutes per
day. It remains logically implicit (although not expressly
stated) that these recommended minutes of at least
moderate intensity be accumulated over and above such
functional activities of daily life. There are no data at
this time to inform a quantity of steps suggestive of
these background activities in children or adolescents,
necessary to compute an estimate of steps/day that will
also include recommended amounts of time spent in
MVPA. However, studies of free-living behaviour
present an opportunity to identify what total volume of
steps/day also includes recommended amounts of
activity that is of at least moderate intensity. Seven
free-living studies were located that have attempted to provide
such information. These studies are presented in
Table 2 by year of publication. Two have focused on
preschool samples [49,50], three with
elementary/primary school children [15,16,51], one with adolescents
recruited through primary care providers , and one
of children and adolescents spanning 9-16 years of age
recruited as part of a national survey .
Cardon et al.  reported that 13,874
pedometerdetermined steps/day equated to a total volume of
physical activity that included at least 60 minutes of
accelerometer-determined time in MVPA in Belgian preschool
children; only 8% of their sample actually achieved this
level of steps/day. Tanaka and Tanaka  used a
13 boys, 13 girls;
8,3 to 10.8 years
12 boys, 28 girls;
11 to 16 years
127 boys, 85 girls;
4.5 to 6.8 years
DigiWalker DW-200, Yamasa,
MVPA: Tritrac-R3D, models
T303 and T303A,
Steps/day and Activity
Time*: MLS 2505, Walk4Life,
Ind., Plainfield, IL
Digiwalker SW-200, Yamax
MVPA: MTI Actigraph, 7164
(Fort Walton Beach, FL)
Steps and MVPA: Actigraph
Steps/day: Lifecorder EX,
MVPA: ActivTracer, GMS,
New Lifestyles 1000
of six days
Linear regression equation to predict
steps/day from self-reported 60
minutes in MVPA
5 weekdays Sensitivity/specificity analysis of various
and 1 thresholds to ascertain likelihood of
weekend attaining 60 minutes of
accelerometerday determined MVPA
Linear regression to predict
pedometer-determined daily activity
time from daily step count
Regression equation to predict steps/
day from accelerometer-determined
time (60 minutes) in MVPA
ROC to determine steps/day related to
achieving 60 minutes
accelerometerdetermined MVPA; two definitions of
moderate intensity used
Total: 13,130 steps/day = 60
Boys: 15,340 steps/day = 60
Girls: 11,317 steps/day = 60
Boys: 18,000 steps/day = 60
Girls: 15,000 steps/day = 60
5,000 steps/day = 64.5
minutes of activity
10,000 steps/day = 114.5
minutes of activity
12,000 steps/day = 134.5
minutes of activity
15,000 steps/day = 164.5
minutes of activity
13,874 steps/day = 60
Table 2 Studies of steps/day associated with time in MVPA in young people
51 boys, 41 girls; Steps/day: Yamax Digiwalker
elementary school SW-200, Yamax Corp, Japan
children; MVPA: self-report
6.5-12.7 years questionnaire
Linear regression equation to predict
self-reported MVPA from steps/day
1 minute MVPA = 103 steps;
by extrapolation 60 minutes
would approximately equal
6180 steps (taken over and
above lifestyle activities)
*Activity Time is not necessarily time in MVPA. Activity Time detected by this instrument is accumulated seconds of movement while the step counting lever arm
is in motion.
similar analytical approach, but collected accelerometer
data using a triaxial accelerometer to conclude that 60,
100, and 120 minutes of MVPA corresponded to 9,934,
12,893, and 14,373 steps/day, respectively, in Japanese
preschool children. Furthermore, 92.4%, 51.6%, and
27.4% of the sample achieved these levels. Although a
direct comparison between the Belgian and Japanese
studies must be tempered by the fact that different
instruments were used to collect step and MVPA data,
the latter sample appears to have been much more
active than the former; approximately 52% of the
Japanese children achieved almost 13,000 steps/day and
100 minutes in MVPA while only 8% of the Belgian
sample achieved a similar value of steps/day and only 60
minutes in MVPA.
In a separate study, Cardon et al.  examined the
relationship between 60 minutes of self-reported time in
MVPA and pedometer-determined steps/day in Belgian
elementary school children. Overall, 13,130 steps/day
was equivalent to a total volume of daily physical
activity that included 60 minutes of self-reported time in
MVPA. Sex-specific values were 15,340 steps/day (boys)
and 11,317 steps/day (girls). These results must be
interpreted with caution; the correlation between
pedometerdetermined steps/day and self-reported time in MVPA
was r=.39. In a another study comparing pedometer
data with self-reported time in MVPA conducted with
9-16 year olds, the correlations ranged from .44 to .50
. Linear regression was used to determine that
approximately 100 steps equated to about 1 minute of
MVPA. By extrapolation, the authors suggested that at
least 6,000 steps would be required to accumulate 60
min of MVPA (assumedly taken over and above lifestyle
Rowlands and Eston  conducted a
sensitivity/specificity analysis of various thresholds to ascertain
likelihood of attaining 60 minutes of triaxial
accelerometerdetermined MVPA in Welsh primary school children.
They concluded that 13,000 steps/day (boys) and
12,000 steps/day (girls) provided the most reasonable
estimation of attainment of 60 minutes of MVPA by
way of accumulating a total volume of daily steps.
Beighle and Pangrazi  used a pedometer that had
both a step counting function and an internal
stopwatch that accumulates seconds of movement while
the step counting lever arm is in motion. The resulting
output is labeled activity time but also logically
includes movement that is likely performed at less
than MVPA. Although the outputs were dependent
(obtained from the same counting mechanism), the
researchers used regression to predict daily activity
time from steps/day. They reported that 5,000 steps/
day was equivalent to 64.5 minutes of activity, 10,000
steps/day equals 114.5 minutes, 12,000 steps/day
equals 134.5 minutes, and 15,000 steps/day equals
164.5 minutes. This study must be interpreted with
due caution (and cannot be reasonably considered
together with the other two studies of
primary/elementary school children) since the activity time output
from this instrument does not necessarily reflect time
spent specifically in MVPA, but rather accumulated
time associated with all detected movement.
Only a single study has attempted to translate
timeand intensity-based physical activity guidelines into a
steps/day value specific to adolescents , and this was
specifically done in overweight 11-16 year olds recruited
through their primary care providers. The authors used
receiver operating characteristic (ROC) curves to
determine a total volume of steps/day most likely related to
also achieving 60 minutes of accelerometer-determined
MVPA. Two definitions of moderate intensity were used
(3 and 4 METs). Depending on the definition, between
10,000 (3 METs) and 11,700 (4 METs) steps/day
produced the best sensitivity and specificity values for
achieving at least 60 minutes of MVPA accumulated
within the course of daily living.
In summary, the use of different approaches to
measure steps and also time in MVPA hamper the ability to
combine results and inform how many steps are
enough in terms of attainment of recommended
amounts of MVPA. Overall, limited evidence suggests
that a total daily physical activity volume of
10,00014,000 steps/day is associated with 60-100 minutes in
MVPA for preschool children (4-6 years of age)
[49,50]. Sixty minutes of MVPA in primary/elementary
school children appears to be achieved, on average,
within a total volume of 13,000 to 15,000 steps/day in
boys and 11,000 to 12,000 steps/day in girls, although
these ranges reflect findings based on both self-report
 and triaxial-determined time in MVPA . For
adolescents, 10,000 to 11,700 steps/day may be
associated with 60 minutes of MVPA, however there is only
a single study, and it is based primarily on overweight
adolescent girls .
Health outcome-related analyses
Besides a translation of time in intensity, steps/day
recommendations could also be informed by studies
that relate step-defined physical activity to desired
health outcomes. Four studies (Table 3) were located
that examined steps/day related to indicators of healthy
vs. unhealthy body composition in young people.
Tudor-Locke et al.  combined pedometer data
collected in 6-12 year olds from three countries (Australia,
Sweden, USA) and used a contrasting groups method to
identify criterion-referenced steps/day cut points related
to BMI-defined normal weight vs. overweight/obese.
The median value for 6-12 year olds was 15,000 steps/
day for boys and 12,000 steps/day for girls. Duncan et
al.  performed a similar analysis but using percent
body fat obtained through bioelectric impedance in 5-12
year old New Zealanders. Overweight was defined as >
85th percentile and compared with nonoverweight (<
85th percentile). The authors reported that 16,000 steps/
day (boys) and 13,000 steps/day (girls) were the best
predictors of body fat percent-defined weight status.
Laurson et al.  used ROC analysis to match
sensitivity and specificity of various cut points and to identify
the optimized cut point (which minimized
misclassification error for normal weight vs overweight/obese
children) in a sample of U.S. children. The optimized cut
points approximated 13,500 steps/day (boys) and 10,000
steps/day (girls). Dollman et al.  also used ROC
analysis in a sample of 2,071 5-16 year old Australian
children. The optimized cut points for discriminating
between normal weight and overweight/obese children
were 12,000 steps/day for 5-12 year old boys, 10,000
steps/day for 5-12 year old girls, and 11,000 steps/day
for 13-16 year old boys. The optimized cut point for
1316 year old girls (14,000 steps) did not significantly
959 boys, 995 MyLife Stepper
school Yamax, Tokyo, Japan
6 to 12 years
Lifestyles Inc., Lees
4 week days
Contrasting groups method to identify optimal steps/day
related to BMI- defined normal weight vs. overweight/
3 weekdays, 2
Contrasting groups method to identify overweight vs.
nonoverweight based on 95th percentile for % body fat by
4-7 days including
at least one
ROC, specificity, sensitivity to determine maximal accuracy
of identifying BMI-defined normal weight vs. overweight/
obese (IOTF criteria)
7 days including
ROC, specificity, sensitivity to determine maximal accuracy
of identifying BMI-defined normal weight vs. overweight/
obese (IOTF criteria)
discriminate between those who were classified as
normal weight versus overweight.
In summary, the two studies that have applied the
contrasting groups method applied to different weight
status criteria (BMI and percent body fat) have
produced consistently high values for steps/day:
15,00016,000 steps/day for boys and 12,000-13,000 steps/day
for girls [23,54], but these findings may be an artefact of
the samples studied . The ROC analyses conducted
in the other two studies [55,56] demonstrate better
sensitivity and specificity with much lower values of steps/
day (approximately 10,000-13,500 steps/day). Although
Eisenmann et al.  reported that children not meeting
the BMI-reference cut points were more likely to be
classified as overweight, Beets et al.  also reported
concerns about the sensitivity and specificity of the
BMI-referenced cut points, and in particular questioned
their utility across countries, for example in the U.S.
where activity levels are lower (i.e., where even normal
weight children have relatively lower activity levels).
Across studies, the lowest estimate has been 10,000
steps/day, and most can agree that even lower values
are of increasing concern, and higher values are
increasingly desirable. However, since BMI is obviously
influenced by more than just ambulatory activity, it may be
more appropriate to seek agreement on a step-based
translation of public health guidelines than to pursue a
more precise estimate associated with a healthy BMI in
children and adolescents that is also universally
applicable at this time.
Drawing from the studies reviewed above, the minimal
recommendation (embodied in most public health
guidelines world-wide) of 60 minutes of MVPA is
associated with 10,000-14,000 free-living steps/day in
preschool children (4-6 years of age), 13,000 to 15,000
steps/day in male primary/elementary schoolchildren,
11,000 to 12,000 steps/day in female primary/elementary
school children, and 10,000-11,700 steps/day for
adolescents. Boys and girls appear to be more similar in their
step patterns during the preschool years and again in
the adolescent years. In contrast, the consistent
sexassociated discrepancy in steps/day observed in primary/
elementary schoolchildren, perhaps most clearly
illustrated in the sex-and-age specific graphs assembled by
Beets et al. representing data from 13 different
countries, and the differential empirical evidence related
to step-defined attainment of public health guidelines, is
difficult to ignore but must continue to be debated and
Overall, the primary/elementary schoolchildren values
are reasonably compatible with matched normative data
[11,12] and fit within ranges of criterion-referenced data
that have been associated with healthy body
composition parameters . Since adolescents (compared to
children) steadily decline in their daily physical activity
levels [11,12], the step/based recommendations above (e.
g., translations of time- and intensity-based guidelines)
are higher than existing normative data and therefore
will be more difficult (but neither necessarily impossible
nor contraindicated) for adolescents to achieve. There
are no step values based on any health parameters (e.g.,
BMI, body fat percent, blood pressure, etc.) for
adolescents or preschool children at this time to aid in
As noted above, the notion of a graduated step index
has been introduced for children . The anchors for
this index have been criticized  and there remains a
concern about the appropriateness of labeling children
as sedentary . An improvement to the original
graduated step index would be to offer a more fully
expanded steps/day scale. Such a scale would
incorporate child and adolescent-specific step-based translations
of public health guidelines within the context of the full
lifespan, but also provide additional incremental rungs
corresponding with roughly 10-minute bouts of activity.
It would begin at zero and continue to 18,000+ steps/
day (the highest mean value reported for any sample at
this time, that is, Amish men ). Adoption of such a
scale would be useful for both research and health
promotion purposes. A schematic of this concept showing
1,000 step increments is presented in the accompanying
Figure 1. The ranges shown in Figure 1 represent the
best evidence (albeit preliminary) linking objectively
monitored time in MVPA with steps/day.
The implied relationship between steps/day and
various health outcomes is a primary consideration for
setting any steps-based translation of physical activity
guidelines. However, the data patterns presented above
suggest that step cut points should also consider natural
variation in average activity levels associated with age.
However, then the concern is that as populations
experience anticipated societal decreases in average activity
levels, normative-based cut points would also decrease
over time. This would make any static, standardized cut
point out of touch with local reality, and therefore less
useful. Standardized cut points, however they are set,
would facilitate global comparisons (and they could be
used to illuminate gross discrepancies in
between-country behaviour). The compromise is within-country cut
points that reflect normative behaviour and also include
locally-relevant incremental levels, thereby providing
additional rungs on the ladder for promotion of
activity in less active populations. However, such a strategy
must be cautiously applied to avoid validating or
otherwise absolving, or even endorsing, underachievement
At least 6,000 daily steps in
At least 15,000
activity, e.g., 3,000
daily steps in
activity most days
of the week
Additional benefits can come from adding in vigorous intensity activity
Figure 1 Steps/day scale schematic linked to time spent in
and thus promoting perpetuation of a low active
The evidence accumulated to date indicates that there is
no simple or magical number of steps/day that cuts
across all ages. Preschool children are different from
primary/elementary school age children, and children are
different from adolescents, and the objectively
monitored data presented in this review support this. In a
similar way, dietary guidelines have historically
recommended different amounts of various food groups
depending on sex and age. Applying the findings
reviewed herein, primary/elementary schoolchildren
would be directed (in both public health messages and
targeted interventions) to higher levels (boys
13,00015,000 steps/day; girls 11,000-12,000 steps/day, as
indicated by collected evidence reviewed above), adolescents
(10,000-11,700 steps/day) would be intermediate to
children and adults , and adults and older adults 
directed to the ranges more specifically appropriate for
them, adjusting of course in consideration of abilities
and lifestyles that must accommodate disability or
chronic illnesses. No potentially stigmatizing labelling
would be applied. Regardless, however, every individual
would be able to identify their level and the ones
If adopted, such a steps/day scale should continue to
reinforce the importance and added value of taking at
least an age-appropriate portion of daily steps (e.g.,
6,000 steps over 60 minutes) at minimally moderate
intensity, and if at all possible, at vigorous intensity,
congruent with public health guidelines world-wide. Of
course, non-ambulatory moderate and vigorous
intensity activities (e.g., swimming, bicycling) are also
valuable. Recommendations are based on a limited number
of relevant studies and must therefore be considered
preliminary. Further research is needed to confirm and
extend values for directly measured cadences,
associated speeds, and MET values in young people;
continue to accumulate normative data (expected values)
for both steps/day and MVPA across ages and
populations; and, conduct more cross-sectional, longitudinal,
and intervention studies in children and adolescents to
inform the shape of dose-response curves of
stepdefined physical activity associated with various health
Acknowledgements and Funding
Production of this literature review has been made possible through a
financial contribution from the Public Health Agency of Canada (PHAC). The
funding body had no role in study design, in the collection, analysis, and
interpretation of the data, in the writing of the manuscript, or in the
decision to submit the manuscript for publication. The views expressed
herein solely represent the views of the authors. We would like to thank Dr.
David R. Bassett, Jr. (Department of Kinesiology, Recreation, and Sport
Studies, The University of Tennessee, Knoxville, TN, USA) for his thorough
review of this manuscript prior to submission.
CT-L and CLC conceived and designed the project. CT-L acquired the data
and prepared analysis for initial interpretation. All authors contributed to
subsequent analysis and interpretation of data. CT-L prepared a draft of the
manuscript. All authors contributed to critically revising the manuscript for
important intellectual content. MWB, JSD, DRL, TSO, edit checked the tables.
All authors gave final approval of the version to be published and take
public responsibility for its content.
The following authors declare they have no competing interests: CT-L, MWB,
SB, GMC, SD, YH, DRL, TSO, AR, DAR, JCS, and ST. CLC is associated with the
Canadian Fitness and Lifestyle Research Institute which is funding in part by
the Public Health Agency of Canada (PHAC). AR has served as medical
advisor for Keep Walking Scandinavia AB, a company in the wellness sector
with online consulting, online distribution of literature and online
distribution of pedometers of different brands. SNB receives book royalties
(<$5,000/year) from Human Kinetics; honoraria for service on the Scientific/
Medical Advisory Boards for Alere, Technogym, Santech, and Jenny Craig;
and honoraria for lectures and consultations from scientific, educational, and
lay groups. During the past 5-year period SNB has received research grants
from the National Institutes of Health, Department of Defence, Body Media,
and Coca Cola.
1. U.S. Department of Health and Human Services: 2008 Physical Activity Guidelines for Americans: Be Active , Healthy, and Happy! Washington, D. C. ; 2008 .
2. Public Health Agency of Canada & Canadian Society for Exercise Physiology: Canada's Physical Activity Guide to Healthy Active Living for Children . Ottawa, Ont.: Public Health Agency ; 2002 .
3. Public Health Agency of Canada & Canadian Society for Exercise Physiology: Canada's Physical Activity Guide to Healthy Active Living for Youth . Ottawa, Ont.: Public Health Agency ; 2002 .
4. Timmons BW , Naylor PJ , Pfeiffer KA : Physical activity for preschool children-how much and how? Can J Public Health 2007 , 98 (Suppl 2): S122 - 134 .
5. Tudor-Locke C , Johnson WD , Katzmarzyk PT : Accelerometer-determined steps/day in U.S. children and youth. Med Sci Sports Exerc 2010 , 42 : 2244 - 2250 .
6. Craig CL , Cameron C , Griffiths JM , Tudor-Locke C : Descriptive epidemiology of youth pedometer-determined physical activity : CANPLAY. Med Sci Sports Exerc 2010 , 42 : 163 - 1643 .
7. Tudor-Locke C , Myers AM : Methodological considerations for researchers and practitioners using pedometers to measure physical (ambulatory) activity . Res Q Exerc Sport 2001 , 72 : 1 - 12 .
8. Tudor-Locke C , Craig CL , Brown WJ , Clemes SA , De Cocker K , Giles-Corti B , Hatano Y , Inoue S , Matsudo SM , Mutrie N , et al: How many steps/day are enough? For adults . Int J Behav Nutr Phys Act 2011 , 8 : 79 .
9. Tudor-Locke C , Craig CL , Aoyagi Y , Bell RC , Croteau KA , De Bourdeaudhuij I , Ewald B , Gardner AW , Hatano Y , Lutes LD , et al: How many steps/day are enough? For older adults and special populations . Int J Behav Nutr Phys Act 2011 , 8 : 80 .
10. Rowlands AV , Eston RG , Ingledew DK : Relationship between activity levels, aerobic fitness, and body fat in 8- to 10-yr-old children . J Appl Physiol 1999 , 86 : 1428 - 1435 .
11. Tudor-Locke C , McClain JJ , Hart TL , Sisson SB , Washington TL : Expected values for pedometer-determined physical activity in youth . Res Q Exerc Sport 2009 , 80 : 164 - 174 .
12. Beets MW , Bornstein D , Beighle A , Cardinal BJ , Morgan CF : Pedometermeasured physical activity patterns of youth: a 13-country review . Am J Prev Med 2010 , 38 : 208 - 216 .
13. Vincent SD , Pangrazi RP : An examination of the activity patterns of elementary school children . Pediatr Exerc Sci 2002 , 14 : 432 - 441 .
14. The President's Challenge: Physical Activity & Fitness Awards Program. [http://www.presidentschallenge.org].
15. Cardon G , De Bourdeaudhuij I : A pilot study comparing pedometer counts with reported physical activity in elementary schoolchildren . Pediatr Exerc Sci 2004 , 16 : 355 - 367 .
16. Rowlands AV , Eston RG : Comparison of accelerometer and pedometer measures of physical activity in boys and girls, ages 8-10 years . Res Q Exerc Sport 2005 , 76 : 251 - 257 .
17. Lubans D , Morgan P : Evaluation of an extra-curricular school sport programme promoting lifestyle and lifetime activity for adolescents . J Sports Sci 2008 , 26 : 519 - 529 .
18. Craig CL , Tudor-Locke C , Cragg S , Cameron C : Process and Treatment of Pedometer Data Collection for Youth: The CANPLAY Study . Med Sci Sports Exerc 2010 , 42 : 430 - 435 .
19. Bassett DR Jr, Schneider PL , Huntington GE : Physical activity in an Old Order Amish community . Med Sci Sports Exerc 2004 , 36 : 79 - 85 .
20. Tudor-Locke C , Bassett DR Jr: How many steps/day are enough? Preliminary pedometer indices for public health . Sports Med 2004 , 34 : 1 - 8 .
21. Tudor-Locke C , Hatano Y , Pangrazi RP , Kang M : Revisiting How many steps are enough? . Med Sci Sports Exerc 2008 , 40 : S537 - 543 .
22. Tudor-Locke C , Johnson WD , Katzmarzyk PT : Accelerometer-determined steps per day in US adults . Med Sci Sports Exerc 2009 , 41 : 1384 - 1391 .
23. Tudor-Locke C , Pangrazi RP , Corbin CB , Rutherford WJ , Vincent SD , Raustorp A , Tomson LM , Cuddihy TF : BMI-referenced standards for recommended pedometer-determined steps/day in children . Prev Med 2004 , 38 : 857 - 864 .
24. Beets MW , Le Masurier GC , Beighle A , Rowe DA , Morgan CF , Rutherford J , Wright M , Darst P , Pangrazi R : Are current body mass index referenced pedometer step-count recommendations applicable to US youth ? J Phys Act Health 2008 , 5 : 665 - 674 .
25. Canadian Society of Exercise Physiology: The Canadian Physical Activity, Fitness & Lifestyle Approach (CPAFLA): CSEP-Health & Fitness Program's HealthRelated Appraisal and Counselling Strategy. 3 edition . Ottawa, Ont.: Canadian Society of Exercise Physiology ; 2003 .
26. Lubans DR , Morgan PJ , Tudor-Locke C : A systematic review of studies using pedometers to promote physical activity among youth . Prev Med 2009 , 48 : 307 - 315 .
27. Kang M , Marshall SJ , Barreira TV , Lee JO : Effect of pedometer-based physical activity interventions: a meta-analysis . Res Q Exerc Sport 2009 , 80 : 648 - 655 .
28. Bravata DM , Smith-Spangler C , Sundaram V , Gienger AL , Lin N , Lewis R , Stave CD , Olkin I , Sirard JR : Using pedometers to increase physical activity and improve health: a systematic review . JAMA 2007 , 298 : 2296 - 2304 .
29. Richardson CR , Newton TL , Abraham JJ , Sen A , Jimbo M , Swartz AM : A meta-analysis of pedometer-based walking interventions and weight loss . Ann Fam Med 2008 , 6 : 69 - 77 .
30. Tudor-Locke C , Sisson SB , Collova T , Lee SM , Swan PD : Pedometerdetermined step count guidelines for classifying walking intensity in a young ostensibly healthy population . Can J Appl Physiol 2005 , 30 : 666 - 676 .
31. Marshall SJ , Levy SS , Tudor-Locke CE , Kolkhorst FW , Wooten KM , Ji M , Macera CA , Ainsworth BE : Translating physical activity recommendations into a pedometer-based step goal: 3000 steps in 30 minutes . Am J Prev Med 2009 , 36 : 410 - 415 .
32. Graser SV , Groves A , Prusak KA , Pennington TR : Pedometer steps-perminute, moderate intensity, and individual differences in 12-14-year-old youth . J Phys Act Health 2011 , 8 : 272 - 278 .
33. Graser SV , Pangrazi RP , Vincent WJ : Step It Up: Activity Intensity Using Pedometers . JOPERD 2009 , 80 : 22 - 24 .
34. Lubans DR , Morgan PJ , Collins CE , Boreham CA , Callister R : The relationship between heart rate intensity and pedometer step counts in adolescents . J Sports Sci 2009 , 27 : 591 - 597 .
35. Jago R , Watson K , Baranowski T , Zakeri I , Yoo S , Baranowski J , Conry K : Pedometer reliability, validity and daily activity targets among 10- to 15- year-old boys . J Sports Sci 2006 , 24 : 241 - 251 .
36. Scruggs PW : Quantifying activity time via pedometry in fifth- and sixthgrade physical education . J Phys Act Health 2007 , 4 : 215 - 227 .
37. Scruggs PW : Middle school physical education physical activity quantification: a pedometer steps/min guideline . Res Q Exerc Sport 2007 , 78 : 284 - 292 .
38. Scruggs PW : A comparative analysis of pedometry in measuring physical activity of children . Med Sci Sports Exerc 2007 , 39 : 1837 - 1846 .
39. Scruggs PW , Beveridge SK , Eisenman PA , Watson DL , Shultz BB , Ransdell LB : Quantifying physical activity via pedometry in elementary physical education . Med Sci Sports Exerc 2003 , 35 : 1065 - 1071 .
40. Scruggs PW , Beveridge SK , Watson DL , Clocksin BD : Quantifying physical activity in first-through fourth-grade physical education via pedometry . Res Q Exerc Sport 2005 , 76 : 166 - 175 .
41. Scruggs PW , Mungen JD , Oh Y : Quantifying moderate to vigorous physical activity in high school education: a pedometer steps/minute standard . Meas Phys Educ Exerc Sci 2010 , 14 : 104 - 115 .
42. Beets MW , Beighle A , Bottai M , Rooney L , Tilley F : Pedometerdetermined step count guidelines for afterschool programs . J Phys Act Health .
43. Ainsworth BE , Haskell WL , Whitt MC , Irwin ML , Swartz AM , Strath SJ , O'Brien WL , Bassett DR , Schmitz KH , Emplaincourt PO , et al: Compendium of physical activities: an update of activity codes and MET intensities . Med Sci Sports Exerc 2000 , 32 : S498 - 504 .
44. Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report , 2008 Washington, D.C.: U.S. Department of Health and Human Services ; 2008 .
45. Troiano RP , Berrigan D , Dodd KW , Masse LC , Tilert T , McDowell M : Physical activity in the United States measured by accelerometer . Med Sci Sports Exerc 2008 , 40 : 181 - 188 .
46. American College of Sports Medicine: Position Stand . The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults . Med Sci Sports Exerc 1998 , 30 : 975 - 991 .
47. Haskell WL , Lee IM , Pate RR , Powell KE , Blair SN , Franklin BA , Macera CA , Heath GW , Thompson PD , Bauman A : Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association . Med Sci Sports Exerc 2007 , 39 : 1423 - 1434 .
48. Janssen I , Leblanc AG : Systematic review of the health benefits of physical activity and fitness in school-aged children and youth . Int J Behav Nutr Phys Act 2010 , 11 : 40 .
49. Cardon G , De Bourdeaudhuij I : Comparison of pedometer and accelerometer measures of physical activity in preschool children . Pediatr Exerc Sci 2007 , 19 : 205 - 214 .
50. Tanaka C , Tanaka S : Daily physical activity in Japanese preschool children evaluated by triaxial accelerometry: the relationship between period of engagement in moderate-to-vigorous physical activity and daily step counts . J Physiol Anthropol 2009 , 28 : 283 - 288 .
51. Beighle A , Pangrazi RP : Measuring children's activity levels: The association between step-counts and activity time . J Phys Act Health 2006 , 3 : 221 - 229 .
52. Adams MA , Caparosa S , Thompson S , Norman GJ : Translating physical activity recommendations for overweight adolescents to steps per day . Am J Prev Med 2009 , 37 : 137 - 140 .
53. Olds T , Ridley K , Dollman J , Maher C : The validity of a computerised use of time recall, the Multimedia Activity Recall for Children and Adolescents . Pediatr Exerc Sci 2010 , 22 : 34 - 43 .
54. Duncan JS , Schofield G , Duncan EK : Step count recommendations for children based on body fat . Prev Med 2007 , 44 : 42 - 44 .
55. Laurson KR , Eisenmann JC , Welk GJ , Wickel EE , Gentile DA , Walsh DA : Evaluation of youth pedometer-determined physical activity guidelines using receiver operator characteristic curves . Prev Med 2008 , 46 : 419 - 424 .
56. Dollman J , Olds TS , Esterman A , Kupke T : Pedometer step guidelines in relation to weight status among 5- to 16-year-old Australians . Pediatr Exerc Sci 2010 , 22 : 288 - 300 .
57. Eisenmann JC , Laurson KR , Wickel EE , Gentile D , Walsh D : Utility of pedometer step recommendations for predicting overweight in children . Int J Obes (Lond) 2007 , 31 : 1179 - 1182 .
58. Cole TJ , Bellizzi MC , Flegal KM , Dietz WH : Establishing a standard definition for child overweight and obesity worldwide: international survey . BMJ 2000 , 320 : 1240 - 1243 .
59. Raustorp A , Pangrazi RP , Stahle A : Physical activity level and body mass index among schoolchildren in south-eastern Sweden . Acta Paediatr 2003 , 93 : 400 - 404 .
60. Parfitt G , Eston RG : The relationship between children's habitual activity level and psychological well-being . Acta Paediatr 2005 , 94 : 1791 - 1797 .
61. Zizzi S , Vitullo E , Rye J , O' Hara-Tompkins N , Abildso C , Fisher B , Bartlett M : Impact of a Three-week Pedometer Intervention on High School Students' Daily Step Counts and Perceptions of Physical Activity . Am J Health Edu 2006 , 37 : 35 - 40 .
62. Raustorp A , Ludvigsson J : Secular trends of pedometer-determined physical activity in Swedish school children . Acta Paediatr 2007 , 96 : 1824 - 1828 .
63. Duncan MJ , Al-Nakeeb Y , Woodfield L , Lyons M : Pedometer determined physical activity levels in primary school children from central England . Prev Med 2007 , 44 : 416 - 420 .
64. Raustorp A , Svenson K , Perlinger T : Tracking of pedometer-determined physical activity: a 5-year follow-up study of adolescents in Sweden . Pediatr Exerc Sci 2007 , 19 : 228 - 238 .
65. Reed JA , Brittenham SW , Phillips DA , Carlisle CS : A Preliminary Examination of the Fitness Levels of Children Who Meet the President's Council Physical Activity Recommendation . Physical Educator 2007 , 64 : 159 - 167 .
66. Downs SM , Marshall D , Ng C , Willows ND : Central adiposity and associated lifestyle factors in Cree children . Appl Physiol Nutr Metab 2008 , 33 : 476 - 482 .
67. Hohepa M , Schofield G , Kolt GS , Scragg R , Garrett N : Pedometerdetermined physical activity levels of adolescents: differences by age, sex, time of week, and transportation mode to school . J Phys Act Health 2008 , 5 ( Suppl 1 ): S140 - 152 .
68. Belton S , Brady P , Meegan S , Woods C : Pedometer step count and BMI of Irish primary school children aged 6-9 years . Prev Med 2010 , 50 : 189 - 192 .