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A wrist or hip device records steps, activity and sleep continuously, at home, without anyone being asked a question. It measures behaviour rather than capacity, which is the gap a corridor test leaves, and it is the one measurement of recovery that does not stop when the person leaves the hospital.
Every other measurement here is a snapshot taken in a clinical setting. A wearable is a continuous record of what the body did, which is a different and complementary thing: a walk test measures what a person can do when encouraged, a step count measures what they did on a Tuesday.
What it adds. Performance status, the single number most used to decide whether somebody is fit for treatment, is assigned by a clinician in a consultation and is known to disagree between observers and between clinician and patient. Continuous activity data is an objective alternative, and the PRO-TECT weekly survey included a performance status question for exactly this reason. Step counts also track recovery after surgery day by day rather than at a six-week appointment, and they capture sleep, which is otherwise measured only by questionnaire.
What the evidence does and does not say. The association between higher activity and better outcomes in cancer populations is consistent and is reported in many cohorts. That association is not the same as showing that monitoring somebody's steps changes anything. The randomised evidence that a measurement can be an intervention, on this front, is for symptom reporting with a clinical response attached, not for activity tracking, and this record does not borrow that evidence. A wearable with no response attached is a record, not a treatment.
The practical limits are specific and worth naming.
Validity differs by device and by speed. Consumer step counters are least accurate in exactly the population of interest, people walking slowly with an aid, and a device validated in healthy walkers can misread them substantially.
Wear time is the dropout problem again in another form. People stop wearing devices, and they stop when unwell, so a dataset of worn days has the same informative-missingness structure as a dataset of returned questionnaires.
Access is unequal. A device, a phone and a data plan are not free, so a measurement that depends on them will systematically miss the people with the fewest resources, who are also the people least likely to be offered rehabilitation.
There is no agreed outcome. Steps per day, moderate-to-vigorous minutes, sedentary time, sleep efficiency and cadence are all reported, with no consensus on which is the endpoint or what change counts as meaningful, which is the state the quality of life field was in before the minimally important difference work was done.
The honest position is that this is the most promising measurement on this front and the least mature. It is included here, rather than left out, because readers are already wearing these devices and deserve to know what the data can and cannot support.
Accelerometry samples limb or trunk acceleration continuously and derives step counts, activity intensity bands and sleep estimates from the signal. Because the record is passive and continuous, it measures habitual behaviour in the person's own environment rather than capacity under standardised conditions, which is a different construct and not a substitute.
Query for this technology: (TITLE:"Wearables and step counts: measuring what someone actually does" OR ABSTRACT:"Wearables and step counts: measuring what someone actually does") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Wearables and step counts: measuring what someone actually does, not a curated reading list.
Shares Walking, gripping and standing up: the tests that take five minutes, The exercise prescription after cancer: the dose the guidelines state, Survivorship and late effects are neglected, HR-positive / HER2-negative breast cancer and the tags rejuvenation, survivorship, measurement, objective.
Shares Walking, gripping and standing up: the tests that take five minutes, Survivorship and late effects are neglected, Colorectal cancer, Non-small-cell lung cancer and the tags rejuvenation, survivorship, measurement, objective.
Shares The questionnaires that were never returned, and the people never asked, Asking people how they are, every week, as a treatment in its own right, Patients lack understanding, navigation and agency, Quality of life and the tags rejuvenation, survivorship, measurement.
Shares The questionnaires that were never returned, and the people never asked, Asking people how they are, every week, as a treatment in its own right, Walking, gripping and standing up: the tests that take five minutes, Patients lack understanding, navigation and agency and the tags rejuvenation, survivorship, measurement.
Shares Asking people how they are, every week, as a treatment in its own right, Patients lack understanding, navigation and agency, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement.
Shares The questionnaires that were never returned, and the people never asked, Telehealth and hospital-at-home in oncology, Asking people how they are, every week, as a treatment in its own right, Real-world evidence and the tags rejuvenation, survivorship, measurement.
Shares Walking, gripping and standing up: the tests that take five minutes, Structured exercise programmes after curative treatment, Quality of life, Biomarkers are not validated or standardised and the tags rejuvenation, survivorship, objective.
Shares Telehealth and hospital-at-home in oncology, Patients lack understanding, navigation and agency, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, measurement.