Professor Leon Straker [00:00:28] Good morning and good afternoon, depending on where in Australia you are. And good evening if you're somewhere else. Good night. Its given people some time to get in so hopefully everybody's in. Welcome along to this seminar today from the Wellbeing, Health and Youth NHMRC Centre of Research Excellence in Adolescent Health. We're delighted to have you here, for this seminar today. We'd like to acknowledge the funding support from the NHMRC and also the contributions from our research partners at these universities across Australia. 

Professor Leon Straker [00:01:06] We'd like to acknowledge the traditional owners of the lands throughout Australia that we're all meeting on. Charlotte and I are from Curtin University. The campus sits on Whadjuk/Nyungar country in Western Australia, and we'd like to pay our respects to their elders, past, present and emerging, and those around Australia as well. 

Professor Leon Straker [00:01:26] Just pointing out to everybody here that WH&Y has a community of practice website, which is a great place where researchers, clinicians, policymakers and young people can come together to share ideas and exchange information. And it's a nice, simple URL to remember: why.org.au. 

Professor Leon Straker [00:01:45] During the seminar you'll be listening to Charlotte's, and your microphone will be muted and your video switched off. As we're going through the presentation I encourage you to use the chat function on the right hand side, you can see there, you can type in your question or comment down the bottom and I'll share a Q&A session at the end of Charlotte's talk. 

Professor Leon Straker [00:02:11] So it's with great delight that I'd like to introduce Charlotte Lund Rasmussen, who's a postdoc research fellow with us here at Curtin University in Perth. As you can see from the text there, Charlotte's originally from Denmark, and she completed a PhD in Public Health in 2020. And a lot of her research is focussed on developing the state of the art systems for measuring physical activity behaviours, and considering how these behaviours may be influenced by the use of technology. And then a little bit more background for you, the project that, Charlotte is going to be talking about today, she was actually awarded, the equivalent of an NHMRC fellowship, the very prestigious European Fellowship to actually do this research. But she fell in love with Australia and turned in a very prestigious research to come in and, and work in Australia. Maybe too much Scandinavian winter, not enough Australian sun. But, that's the sort of backdrop to, why, this project had got funded in Europe and, but now she's moved to Australia and we're working on, projects around this in other age groups. And Charlotte will tell you that what's happening with this one.  Over to you, Charlotte, and thank you very much for presenting the seminar today. 

Charlotte Lund Rasmussen [00:03:26] Thank you so much, Leon, for that very nice presentation and introduction. Hi, everyone. I was just telling Leon, it's still awkward for me that I can't see you, but, hi. I'm pretending to have eye contact. I'm Charlotte, and I'm here to present, as Leon mentioned, a project, I want to call it 'an idea', because it was funded but hasn't been done, called Physical Activity Behaviours in Youth, PACEY,  a system for measurements of physical behaviours among youth. 

Charlotte Lund Rasmussen [00:04:02] As Leon mentioned as well, I'm so delighted to be joining his group here at Curtin University. And those are the names you see at the bottom - Danica, Amber, Sarah, Juliana, Paul,  Andrew,  Leon and Amity. I want to mention their names too, because they are of much inspiration for what I'm about to say today. 

Charlotte Lund Rasmussen [00:04:22] So I thought I would start with setting a bit of a scene. Why we should care about physical activity behaviours, and especially among youth. So, you know, we know that today's youth is faced with significant, mental and physical health challenges worldwide. We see that 241 million young people today live with mental health disorders and 324 million are overweight. We also know that a key determinant of young people's health is how much time they spend being sedentary, physically active, and sleeping. And these are the behaviours I'm talking about when I talk about physical activity behaviours. This is well acknowledged among health authorities worldwide and within Australia. 

Charlotte Lund Rasmussen [00:05:15] The Australian government recommends young people to participate in at least 60 minutes of moderate to vigorous physical activity each day. To limit recreational screen time to two hours each day, and to get approximately 8 to 10 hours of sleep on a daily basis. But we see that, within Australia, young people are not meeting these recommendations. Based on self-reported data, so questionnaire data, we see that 89% of 15 to 17 year old Australians are insufficiently active, meaning they are not getting the 60 minutes of moderate to vigorous physical activity every day. 80% of the same age group are watching more than two hours of television on a daily basis, and half of 16 to 17 year olds are not getting enough sleep on school nights. 

Charlotte Lund Rasmussen [00:06:16] This is alarming. And why is it so? Well, why is this a major concern? Not only, as just stated, do we see that youth have significant mental and health challenges that could be improved, if they were meeting these recommendations from the Australian government. But we also know that health behaviours throughout youth track into adulthood. So studies are showing that how active you are as a young person likely to predict how active you will be as an adult. And we also know that young people today, they will be the parents for the next generation. So their health will determine a healthy start for the children to come. Meaning that if we focus on young people's health behaviours today, it will have a triple benefit not only for the youth themselves, but for their future health and for the health of the next generation, making this a huge, huge concern. 

Charlotte Lund Rasmussen [00:07:29] So why should we care about how we measure it? Why should we care about measuring physical activity behaviours? Well, in order to change behaviours we need successful interventions and policies, but these require accurate data. A current surveillance or monitoring of physical activity relies on self-reported measurements, which are known to be inaccurate. So what I mean by inaccurate is that we often see that young people are asked about the day-to-day behaviours. Well, at least for me, I have a tendency to want to look good to others, so I'll over-report how active I am and I might underreport how sedetary I am. And often I can barely remember what I did during the week, let alone that day. Meaning that these measurements we get are inaccurate. 

Charlotte Lund Rasmussen [00:08:30] This has been acknowledged, and device-based measurements are increasingly being used among adults. I've pictured two examples of some devices here. And we see that when used within research among adults, these devices, are often used to measure something called 'activity counts'. And these counts are then summarised into average time spent either sedentary or light intensity physical activity, or moderate to vigorous intensity physical activity. While this type of measurement, it does provide more accurate data, that's also a limitation when summarised into these intensity bands. 

Charlotte Lund Rasmussen [00:09:26] First of all, we see when we put these different activities, for example, if you look at sedentary, that's often the mix of lying and then standing and sitting that's clumped into this behaviour group. But each behaviour might have different health implications, especially sitting and standing has been shown to, be quite related to energy expenditure. So, by standing you might have a higher energy expenditure and therefore have, a different, implication for risk of obesity compared to a lot of sitting time or lying time. 

Charlotte Lund Rasmussen [00:10:04] There's also a challenge with interpretation. For example, it can be hard for a receiver of public health measures to understand what moderate intensity physically activity actually is, how intense that activity has to be before it's considered moderate. And by grouping behaviours into these lumps of classes, we are losing information on these behaviours that might be really important, such as how much variation there is in a day-to-day behaviour, if there are bouts of behaviours and the sequence of behaviours too. 

Charlotte Lund Rasmussen [00:10:55] So instead, we are focusing, on using a system that can provide intensity or different measures than intensities. And this is the system I'm going to talk a bit about, it's called MOTUS. So it's a sensor-based system used for surveillance among working adults in Denmark. And here at Curtin, we are currently refining and working on refining the system to be used among young children. And so this project aims to refine the MOTUS system together with youth, to be able to be used for physical activity behaviour surveillance among young people. 

Charlotte Lund Rasmussen [00:11:43] For me, MOTUS isn't that catchy of a name. So I thought the first thing would be to brand it as a new catchy name. Physical Activity Behaviours in Youth (PACEY). And one of the first steps that, well, myself and the people involved in this group, was very keen on, is to having youth involved in the study and involved in this project from the get go. And one of the main reasons was that we see major challenges in terms of recruitment and compliance among youth for physical activity behaviour measurements, and especially on a large scale. So we thought that it was an essential part of this project that we asked young people what they thought. We wanted them to be heard and able to contribute to the project. And one of the main reasons was, of course, that the methods and the findings would be more likely to be accepted and meaningful and understood by this population group. 

Charlotte Lund Rasmussen [00:12:56] And so PACEY would be the first system that was co-designed with the target population, young people. Now coming back to this motor system that PACEY would be based on. It consists of several steps. It consists, firstly, of collection of five worn accelerometer data. And here I'm returning to my point regarding the risk or the limitation of using  intensity based measurements. Because this data collection or by collecting data using this type of sensor on the thigh, we are able to obtain information about a range of postures and movements instead of solely intensities. So we would be able to measure time spent lying, time spent sitting, time spent standing, time spent in a category called 'moving', which is when you're not quite walking, but you're definitely not standing still, a 'walking' category and 'running as they are climbing', and a cycling category. 

Charlotte Lund Rasmussen [00:14:14] A second step or a second component of MOTUS is a smartphone app. So the participants who would be recruited for participating in MOTUS would get this sensor sent to them, which are attached on the thigh, and then, while wearing the sensor on each day, they would report their wok hours and their sleep hours using a smartphone app. The data from the sensor and from the app is then transferred to a secure cloud infrastructure and managed using a web application. The data is analysed and feedback reports are generated based on this analysis. And these feedback reports are then sent back to the participant by email. The feedback report, it will contain information about average time spent on different activities throughout the day and as a weekly average. And one of the major comments from the participants in this grant or in the system has been that this was very meaningful for them. 

Charlotte Lund Rasmussen [00:15:35] So in the PACEY system, what we aim to do is copy-paste these five components and they work well. So there's no reason to change all of the components. But what we would like to do is refine some of it, because this is developed for and with adults, a quite different population group than young people. So what we aim to do was refine the sensor itself, to refine the smartphone app and the feedback report. And the goal for doing this would be to have an advisory group of young people. We aim to recruit 10 to 12 young people, age 15 to 18 years old, and having a number of workshops asking them firstly about the sensor, if they like the design or if they would like something different, if they had issues with the patch we are using, trying to identify barriers for young people to be wearing the sensor for a week of data collection. Then we would ask them about the smartphone app. Currently it is for adults. It's not great. As a teenager myself, I wouldn't be it too inclined to be using that on a daily basis. 

Charlotte Lund Rasmussen [00:17:02] So that would be the first type of refinement, trying to edit the app so that, first of all, it's no longer only work hours. We recognise that young people in this age will be working, but it might be relevant as well to capture the time they spend in school, as well as sleeping hours. And then the feedback report. For starters, we believe it would be nice for them to have that not solely by email but on the app as well. And there might be huge potential here in making some sort of gamification, like a small intervention using the app to actually encourage the young people to be more active. And we've seen other examples of applications where this has been successful. So something in a change of design, co-designed with this group of young people was the primary goal of the project. 

Charlotte Lund Rasmussen [00:18:12] I know I haven't spoken for a long time, but I feel like this is really a setting where I could ask for your voice more  because this is still a project to be done and hasn't been done. There are heaps of opportunities to hear, to have an insightful discussion with you guys about if you, as an individual, would find information about daily physical behaviours useful and if there are any youth health workers here, if you would find it useful to understand the needs of the community you're working with and evaluating potential programs or intervention policies that are implemented to increase physical activities among this population group. So that gives us a heap of time for hopefully some insights and good discussions. So thank you for listening to my bit about the background for this project. 

Professor Leon Straker [00:19:19] Thanks, Charlotte. Really interesting to hear about the work that you're doing and hope that the people listening have found it interesting as well. So we might come back to those two sort of prompts that you've and that people can add something to the chat, while we're talking about some of the questions, we've had some come in that I'll go with in the moment. So just those two things that people will be thinking about, whether they would find it useful as an individual, to have information about their physical activity behaviours over the 24 hour periods. And if you're someone who works with youth organisations, would you find it useful or how would you potentially use such a system to look at the needs of the youth that you work with, and to evaluate any programs that you are involved in that try to encourage, increased physical activity and listening to behaviour, perhaps, or more sleep in the people that you work with. 

Professor Leon Straker [00:20:11] So we have a question, to start off with, from Peter. It's probably in two parts. And it's about a smartwatch and, so I guess I'll separate that into two bits for you. One is 'why go for something that attaches to the thigh rather than something that goes on the wrist, like a watch? Given that people are more used to having something like a watch on'. Yeah. And then the second question will be about commercial smartwatches. 

Charlotte Lund Rasmussen [00:20:42] Thank you. Thanks, Peter, good question. So the first bit about the placement of the sensor. So a limitation by putting any type of sensor on the wrist is that it cannot differentiate between different postures and movements. So for example sitting and standing, you wouldn't be able to differentiate those two when your sensor is placed on the wrist, whereas when it is on the thigh, we are able to look at angles and inclanations of the thighs to give us a differentiation between different postures of movements. Going back to my arguments about the limitation of only looking at intensities. 

Charlotte Lund Rasmussen [00:21:26] And then, yeah, why not just use a smartwatch or like a Fitbit or something of that sort? Because those are already, as we know, very much available and quite popular among different age populations. The first risk is how this data is analysed, we are blind for it as researchers, it's a bit of a black box. So we don't know exactly how the outputs are being generated. And we don't know if there's being changes made in how the data is being analysed over the years. So, say, you have an intervention and you're comparing some data collection at time point one. And then two years after or one year after, you wouldn't know if the changes you are observing in the behaviours are caused by a change in their algorithm or a change in the actual behaviours conducted by the participant. Another issue could be data security, there have been questioned by the different scientific communities. And on a psychological aspect of this as well, it might contribute to disordered behaviours among young people if they keep tracking their own behaviours. So it might be nice for them to be able to be blinded for that. 

Professor Leon Straker [00:22:53] So can you just clarify that last bit about being blinded with the MOTUS system, does the wearer not get this sort of hourly, daily feedback like you do with a smartwatch? 

Charlotte Lund Rasmussen [00:23:03] Not at the current stage, no. You will get it at the end of the data collection, but that is one of the features that personally I would say should be, you can choose not to know your behaviours. 

Professor Leon Straker [00:23:17] Right. Thanks, Charlotte. Okay. Got a question from Rebecca about whether that device stays on the thigh over that whole week of measurement period or whether they sort of can take it on and off like a watch. 

Charlotte Lund Rasmussen [00:23:30] Yeah, so the idea is to have it on constantly. Myself and a colleague, we tried it for a couple of days. My colleagues is an excellent swimmer. So she went to water polo with it, it stayed on. I went to the gym and did a lot of lifts and banged it a bit with a barbell, and it stayed on, too. So in terms of what it's capable of, it's capable of staying on. I didn't have any issues. But of course we will encourage participants to take it off if any irritation causes is caused, but it is meant to be worn 24/7 and without being taken off. 

Professor Leon Straker [00:24:08] Okay. And Michelle, your question about the watch collecting data, I think that's probably covered in what Charlotte talked about from Peter's question. And Helen sort of raised the issue for you about, where the young people are going to be reasonably accepting of wearing this device, on their leg for a period of time. And, there going to be any challenges in implementing it with young people, which I guess is what your projects going to find out. 

Charlotte Lund Rasmussen [00:24:37] Yeah, hopefully. Well, I can say a bit on a on a personal note as well. So, I'm diabetic and I wear a patch to measure blood sugar 24/7 and one of my first thoughts when I looked at this device was that it's ugly. And that might be a barrier for young people if they don't want to wear something like that on their thigh. So an idea would be to ask them, could we redesign it, make it a fancy colour, so you might want to wear it? but yeah, it's one of those things that we would like to assist with this project is some of the main challenges for implementation. 

Professor Leon Straker [00:25:17] And maybe you can sort of say a little bit about the MOTUS hardware lump in the patch and what's being done with adults, with that versus the other sort of lumpier accelerometers that have been used in adult studies and how that's going. Why you're thinking this one might be better for young people. 

Charlotte Lund Rasmussen [00:25:36] Thank you. Leon. So, this device is one of the smallest on the market. I want to say it's the size of my thumb. I think that's about the size of it. It's very small, so it's very thin as well. Meaning the device itself is not bulky as some of the other devices on the market are. And it's been tested among adults to be a feasible device to be wearing for several days. So there are is low risk of skin irritation from this. 

Professor Leon Straker [00:26:14] Thanks Charlotte. Helen's asking what the approximate cost is for the device. 

Charlotte Lund Rasmussen [00:26:20] I think at the stage, it's around 200 AUD per unit. And we know that the SENS company is working hard to reduce that price, but that's the current cost. 

Professor Leon Straker [00:26:32] Okay. And Rebecca's asked about you made an interesting comment about analysis and that being done in the cloud. Is that being done by a third party? And how does that work from an ethical perspective? 

Charlotte Lund Rasmussen [00:26:47] Well, that's a really good question. So, because we actually already work quite closely with the SENS company, I feel like we have a bit more freedom in terms of how we would like to do it with this project in particular, but the motor system as a standard set up is that, the data is transferred to a cloud where it's analysed using, an open source code, a program. And so the current process is that is done by third party being the SENS company and not locally by the researcher. What you can ask or what you can change, as a researcher, is for that step not to be included that the data is still secured, on the cloud, but you can download it, the raw data, and analyse it yourself. From an ethical perspective. I'm assuming it's regarding data security. That ethical perspective? 

Professor Leon Straker [00:27:53] I think privacy, yeah. 

Charlotte Lund Rasmussen [00:27:54] Privacy issues, yeah. I might be a bit biased, coming from Europe, which is known to have the highest data security regulations there are. So I am confident in saying that was the first step, for this system to be developed, was that it followed the highest level of security in terms of data. Yeah, so there is no risk of data breach and that the participants can be secure, that the data will not be shared or stored on a computer able to be hacked from somewhere, because that is a major concern when people hear of cloud store data, at least for me. 

Professor Leon Straker [00:28:35] And I guess in your project, you'll be able to sort of talk to young people and get their current perceptions about that, how important that is for them. Which may well be more so here, given the last 12 months of lots of media reports about some data breaches in lots of organisations. That'll be interesting to find out in the project. 

Professor Leon Straker [00:28:56] Another question coming in about, people who work in a children's hospital. And so young people with chronic diseases and with disabilities. 'Is there any plan in the future and actually Helen says 'near future' have to adapt the PACEY system in the MOTUS system to, say, physically challenged or wheelchair bound young people?'. 

Professor Leon Straker [00:29:19] Oh, I like the the optimism of 'near future'. Yes. I think that that could be the optimal next step to, start out with a non-challenged population in that sense and then, well, again, I might be a bit biased, it could be nice to see if we could get chronically diseased people as well. I know work is being done among certain population groups within different disease categories as well. So I think there's definitely options here to expand further than the typical young person. 

Professor Leon Straker [00:29:58] Yeah, I think so. Okay. Well, I think that just about wraps us up now, unless anyone has a last final comment they can get in while I'm wrapping up. So I'd like you all to virtually join with me in thanking Charlotte very much for a really interesting presentation on an idea about how we can get a better measurement system to get better evidence on what is clearly a really important health issue for young people. And it would be great if we can get you back in the future, Charlotte, so you can tell us what young people have told you about what's really important in such a measurement system, and be able to give a demonstration about the system that I think lots of people are going to be really interested in, using in the future. So thank you very much, Charlotte. Everyone, enjoy your day. Goodbye. 

Charlotte Lund Rasmussen [00:30:47] Thank you, Leon. Thanks, everyone.