After decades of evolution, measuring instruments for quantitative gait analysis have become an important clinical tool for assessing pathologies manifested by gait abnormalities. However, such instruments tend to be expensive and require expert operation and maintenance besides their high cost, thus limiting them to only a small number of specialized centers. Consequently, gait analysis in most clinics today still relies on observation-based assessment. Recent advances in wearable sensors, especially inertial body sensors, have opened up a promising future for gait analysis. Not only can these sensors be more easily adopted in clinical diagnosis and treatment procedures than their current counterparts, but they can also monitor gait continuously outside clinics – hence providing seamless patient analysis from clinics to free-living environments. The purpose of this paper is to provide a systematic review of current techniques for quantitative gait analysis and to propose key metrics for evaluating the existing, as well as emerging methods for qualifying the gait features extracted from wearable sensors. It aims to highlight key advances in this rapidly evolving research field and outline potential future directions for both research and clinical applications.

Metabolic chambers are powerful tools for assessing human energy expenditure, providing flexibility and comfort for the subjects in a near free-living environment. However, the flexibility offered by the large living room size creates challenges in the assessment of dynamic human metabolic signals—such as those generated during high-intensity interval training and short-term involuntary physical activities—with sufficient temporal accuracy. Therefore, this paper presents methods to improve the temporal accuracy of metabolic chambers. The proposed methods include 1) adopting a shortest possible step size, here one minute, to compute the finite derivative terms for the metabolic rate calculation, and 2) applying a robust noise reduction method—total variation denoising—to minimize the large noise generated by the short derivative term whilst preserving the transient edges of the dynamic metabolic signals. Validated against 24-hour gas infusion tests, the proposed method reconstructs dynamic metabolic signals with the best temporal accuracy among state-of-the-art approaches, achieving a root mean square error of 0.27 kcal/min (18.8 J/s), while maintaining a low cumulative error in 24-hour total energy expenditure of less than 45 kcal/day (188280 J/day). When applied to a human exercise session, the proposed methods also show the best performance in terms of recovering the dynamics of exercise energy expenditure. Overall, the proposed methods improve the temporal resolution of the chamber system, enabling metabolic studies involving dynamic signals such as short interval exercises to carry out the metabolic chambers.

Whole-room indirect calorimeters (WRICs) have traditionally been used for real-time resting metabolic rate (RMR) measurements, while metabolic rate (MR) during short-interval exercises has commonly been measured by metabolic carts (MCs). This study aims to investigate the feasibility of incorporating short-interval exercises into WRIC study protocols by comparing the performance of WRICs and an MC. We assessed the 40-min RMR of 15 subjects with 2-day repeats and the 10–15 min activity MR (AMR) of 14 subjects at three intensities, using a large WRIC, a small WRIC, and an MC. We evaluated the biases between the instruments and quantified sources of variation using variance component analysis. All three instruments showed good agreement for both RMR (maximum bias = 0.07 kcal/min) and AMR assessment (maximum bias = 0.53 kcal/min). Moreover, the majority of the variability was between-subject and between-intensity variation, whereas the types of instrument contributed only a small amount to total variation in RMR (2%) and AMR (0.2%) data. In Conclusion, the good reproducibility among the instruments indicates that they may be used interchangeably in well-designed studies. Overall, WRICs can serve as an accurate and versatile means of assessing MR, capable of integrating RMR and short-interval AMR assessments into a single protocol.

The emerging technology of wearable inertial sensors has shown its advantages in collecting continuous longitudinal gait data outside laboratories. This freedom also presents challenges in collecting high-fidelity gait data. In the free-living environment, without constant supervision from researchers, sensor-based gait features are susceptible to variation from confounding factors such as gait speed and mounting uncertainty, which are challenging to control or estimate. This paper is one of the first attempts in the field to tackle such challenges using statistical modeling. By accepting the uncertainties and variation associated with wearable sensor-based gait data, we shift our efforts from detecting and correcting those variations to modeling them statistically. From gait data collected on one healthy, non-elderly subject during 48 full-factorial trials, we identified four major sources of variation, and quantified their impact on one gait outcome—range per cycle—using a random effects model and a fixed effects model. The methodology developed in this paper lays the groundwork for a statistical framework to account for sources of variation in wearable gait data, thus facilitating informative statistical inference for free-living gait analysis.

Summary: Sleep is a complex biological process regulated by networks of neurons and environmental factors. As one falls asleep, neurotransmitters from sleep–wake regulating neurones work in synergy to control the switching of different sleep states throughout the night. As sleep disorders or underlying neuropathology can manifest as irregular switching, analysing these patterns is crucial in sleep medicine and neuroscience. While hypnograms represent the switching of sleep states well, current analyses of hypnograms often rely on oversimplified temporal descriptive statistics (TDS, e.g., total time spent in a sleep state), which miss the opportunity to study the sleep state switching by overlooking the complex structures of hypnograms. In this paper, we propose analysing sleep hypnograms using a seven‐state continuous‐time Markov model (CTMM). This proposed model leverages the CTMM to depict the time‐varying sleep‐state transitions, and probes three types of insomnia by distinguishing three types of wake states. Fitting the proposed model to data from 2056 ageing adults in the Multi‐Ethnic Study of Atherosclerosis (MESA) Sleep study, we profiled sleep architectures in this population and identified the various associations between the sleep state transitions and demographic factors and subjective sleep questions. Ageing, sex, and race all show distinctive patterns of sleep state transitions. Furthermore, we also found that the perception of insomnia and restless sleep are significantly associated with critical transitions in the sleep architecture. By incorporating three wake states in a continuous‐time Markov model, our proposed method reveals interesting insights into the relationships between objective hypnogram data and subjective sleep quality assessments.

Sleep–wake (SW) cycle detection is a key step for extracting temporal sleep metrics from actigraphy. Various supervised learning algorithms have been developed, yet their generalizability from sensor to sensor or study to study is questionable. In this paper, we detail and validate an unsupervised algorithm—CircaCP—for detecting SW cycles from actigraphy. It first uses a robust cosinor model to estimate circadian rhythm, then searches for a single change point (CP) within each circadian cycle. Using CircaCP, we estimated sleep/wake onset times (S/WOTs) from 2125 individuals’ data in the MESA sleep study and compared the estimated S/WOTs against self-reported S/WOT event markers, using Bland–Altman analysis as well as variance component analysis. On average, SOTs estimated by CircaCP were 3.6 min behind those reported by event markers, and WOTs by CircaCP were less than 1 min behind those reported by markers. These differences accounted for less than 0.2% variability in S/WOTs, considering other sources of between-subject variations. Rooted in first principles of human circadian rhythms, our algorithm transferred seamlessly from children’s hip-worn ActiGraph data to ageing adults’ wrist-worn Actiwatch data. The generalizability of our algorithm suggests that it can be widely applied to actigraphy collected by other sensors and studies.