Self-report use-of-time tools for the assessment of physical activity and sedentary behaviour in young people: systematic review

Validity and reliability of self-reported methods for assessment of 24-h movement behaviours: a systematic review

BACKGROUND

Time spent in sleep, sedentary behaviour (SB), and physical activity are exhaustive and mutually exclusive parts of a 24-h day that need to be considered in a combination. The aim of this study was to identify validated self-reported tools for assessment of movement behaviours across the whole 24-h day, and to review their attributes and measurement properties.

METHODS

The databases PubMed, Scopus, and SPORTDiscus were searched until September 2023. Inclusion criteria were: (i) published in English language, (ii) per-reviewed paper, (iii) assessment of self-reported time spent in sleep, SB, and physical activity, (iv) evaluation of measurement properties of all estimates across the full 24-h day, and (v) inclusion of adolescents, adults, or older adults. The methodological quality of included studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments checklist.

RESULTS

Our search returned 2064 records. After studies selection, we included 16 articles that reported construct validity and/or test-retest reliability of 12 unique self-reported tools - eight questionnaires, three time-use recalls, and one time-use diary. Most tools enable assessment of time spent in sleep, and domain-specific SB and physical activity, and account that sum of behaviours should be 24 h. Validity (and reliability) correlation coefficients for sleep ranged between 0.22 and 0.69 (0.41 and 0.92), for SB between 0.06 and 0.57 (0.33 and 0.91), for light-intensity physical activity between 0.18 and 0.46 (0.55 and 0.94), and for moderate- to vigorous-intensity physical activity between 0.38 and 0.56 (0.59 and 0.94). The quality of included studies being mostly fair-to-good.

CONCLUSIONS

This review found that only a limited number of validated self-reported tools for assessment of 24-h movement behaviours are currently available. Validity and reliability of most tools are generally adequate to be used in epidemiological studies and population surveillance, while little is known about adequacy for individual level assessments and responsiveness to behavioural change. To further support research, policy, and practice, there is a need to develop new tools that resonate with the emerging 24-h movement paradigm and to evaluate measurement properties by using compositional data analysis.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022330868.

Measuring change in adolescent physical activity: Responsiveness of a single item

Self-report measures are frequently used to assess change in physical activity (PA) levels. Given the limited data from adolescent populations, the primary objective of this study was to examine the responsiveness of a single item measure (SIM) of PA for adolescents to detect change in moderate-to-vigorous physical activity (MVPA) using accelerometer data as the reference measure. A secondary objective was to provide further data on the validity of the measure at one point in time. The validity of the SIM to determine the number of days ≥60 minutes of MVPA was based on data from 200 participants (62% female; age: 14.0 ± 1.6 years) and analysis of change was based on data from 177 participants (65% female; age: 14.0 ± 1.6 years). Validity of change in days ≥60 minutes of MVPA was examined through agreement in classification of change between the SIM and accelerometry as the reference measurement and Spearman’s correlation. Cohen’s d and standardised response means were used to assess the responsiveness to change of the measure. The responsiveness of the SIM and accelerometer data were comparable and modest (0.27–0.38). The correlation for change in number of days ≥60 minutes MVPA between the SIM and accelerometery was low (r = 0.11) and the accuracy of the SIM for detecting change, using accelerometry as the reference, was only marginally above chance (53%). Therefore, the adolescent version of the SIM is adequate for assessing PA at a single time point but not recommended for assessing change.

The Relation Between Television Viewing Time and Reading Achievement in Elementary School Children: A Test of Substitution and Inhibition Hypotheses

Research has focused on the relations between television (TV) viewing time and children’s reading achievement. Two hypotheses have been proposed to explain this relation. The substitution hypothesis proposes that TV viewing distracts students from activities that are important for their learning. The inhibition hypothesis proposes that watching television inhibits important affective/cognitive skills. In this study, we test both hypotheses by estimating the relation between TV viewing time and reading achievement. We use the frequency of students’ leisure reading and the frequency of interactions between students and their parents as potential mediators to test the substitution hypothesis, whereas for the inhibition one, we use students’ intrinsic motivation to read and their level of inattention. Data come from the Québec Longitudinal Study of Child Development (QLSCD). Designed by the Institut de la statistique du Québec, QLSCD covers a wide range of themes. The QLSCD is representative of children in Québec and contains 2223 participants who were followed from 0 to 21 years old. The four structural models tested are built as follows: the TV viewing time at 6 years old predicts the four mediating variables at 8 years old, which in turn predicts reading achievement at 10 years old. In addition, we have tested models’ gender invariance. Results indicate that TV viewing time is not directly or indirectly associated with reading achievement. Specifically, it is not associated with the mediating variables of child-parent interactions, intrinsic motivation, and inattention. However, the frequency of leisure reading is negatively associated with the time spent watching TV. This association is very small (−0.07) and has no indirect effect on reading achievement. Finally, results do not vary according to the gender of the participants. Our results are in line with those of previous studies in the field and cast some doubts on the potential negative effects of TV viewing time on reading achievement.

Calibration of the Online Youth Activity Profile Assessment for School-Based Applications

A balance between the feasibility and validity of measures is an important consideration for physical activity research - particularly in school-based research with youth. The present study extends previously tested calibration methods to develop and test new equations for an online version of the Youth Activity Profile (YAP) tool, a self-report tool designed for school applications. Data were collected across different regions and seasons to develop more robust, generalizable equations. The study involved a total of 717 youth from 33 schools (374 elementary (ages 9-11), 224 middle (ages 11-14), and 119 high school (ages 14-18)) in two different states in the U.S. Participants wore a Sensewear monitor for a full week and then completed the online YAP at school to report physical activity (PA) and sedentary behaviors (SB) in school and at home. Accelerometer data were processed using an R-based segmentation program to compute PA and SB levels. Quantile regression models were used with half of the sample to develop item-specific YAP calibration equations and these were cross validated with the remaining half of the sample. Computed values of Mean Absolute Percent Error (MAPE) ranged from 15-25% with slightly lower error observed for the middle school sample. The new equations had improved precision compared to the previous versions when tested on the same sample. The online version of the YAP provides an efficient and effective way to capture school level estimates of PA and SB in youth.

Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years

Childhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5-7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11-13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.

Sensor-based physical activity, sedentary time, and reported cell phone screen time: A hierarchy of correlates in youth

BACKGROUND

Evidence on correlates relies on subjective metrics and fails to include correlates across all levels of the ecologic model. We determined which correlates best predict sensor-based physical activity (PA), sedentary time (ST), and self-reported cell phone screen time (CST) in a large sample of youth, while considering a multiplicity of correlates.

METHODS

Using sensor-based accelerometry, we assessed the PA and ST of 2179 youths. A χ² automatic interaction detection algorithm was used to hierarchize the correlates associated with too much ST (> 50th percentile), insufficient moderate-to-vigorous PA (MVPA) (<60 min/day), and prolonged CST (≥2 h/day).

RESULTS

Among youth 10-14 years old, the correlates for being inactive consisted of being a girl, not having sport facilities in the neighborhood, and not perceiving the neighborhood as a safe place, whereas in the youth 15-18 years old, the correlate for being inactive was not performing sports (9.7% chance of being active). The correlates for predicting high ST in the younger group was not performing sports (55.8% chance for high ST), and in the older group, the correlates were not owning a pet, perceiving the neighborhood as safe, and having inactive parents (63.7% chance for high ST). In the younger group, the greatest chances of having high CST were among those who were in the last elementary school years, who were girls, and who did not have friends in the neighborhood (73.1% chance for high CST), whereas in the older group, the greatest chance for having high CST was among those who were girls and had a TV in the bedroom (74.3% chance for high CST).

CONCLUSION

To counteract ST and boost MVPA among youths, a specific focus on girls, the promotion of sport participation and facilities, neighborhood safety, and involvement of family must be prioritized.

[Reproducibility of a questionnaire on physical activity among school students from 9 to 15 years of age]

The objective of this study was to analyze the "test-retest" reproducibility of a questionnaire on physical activity among 1189 school students of both genders, from 9 to 15 years age in public schools in Curitiba/PR. The reproducibility of the questionnaire was determined by the repeated measures procedure called "test-retest", with an interval of one week between applications. For data analysis the Intraclass Correlation Coefficient (ICC), the percentage of correlation, the Kappa index, adjusted Kappa (Kappa PABAK) and Bland-Altman scatter diagram were used. Statistical analyses were performed using SPSS 21.0 adopting a 5% significance level. All ICC were higher than 0.80. The correlation between the application replicas of the questionnaire was moderate, Kappa ranging from 0.51 to 0.61. There was a correlation between the questionnaire applications, the average difference between the first and second being equal to 106.49 min/wk (IC95%: 79.05-133.92) with limits of correlation ranging from 1070.97 (+2SD) to -857.99 (-2SD) min/week. In conclusion, the survey analyzed in this study showed satisfactory levels of reproducibility, having the possibility of being used to measure physical activity in both children and adolescents.

Effect of a School-Based Activity Tracker, Companion Social Website, and Text Messaging Intervention on Exercise, Fitness, and Physical Activity Self-Efficacy of Middle School Students

This study examined the effect of a 10-week activity tracker, companion social website, and text messaging intervention on body mass index (BMI), body fat percentage, physical fitness, and physical activity (PA) self-efficacy of children. Children (n = 98) were assigned to one of three groups: activity tracker group, text messaging group, and activity tracker + text messaging group. Pre-/posttest fitness, BMI, PA self-efficacy, and body fat percentage were measured. The activity tracker group had a significant increase in fitness, no significant difference in PA self-efficacy, and an increase in body fat percentage and BMI (p < .05). The text messaging group had a significant increase in BMI (p < .05). The activity tracker + text messaging group had no significant differences in fitness, BMI, PA self-efficacy, or body fat percentage. This study gives no clear support to the hypothesis that use of activity trackers and a text messaging intervention have a positive effect on fitness, PA self-efficacy, or body fat percentage.

Assessment of physical activity intensity and duration in the paediatric population: evidence to support an a priori hypothesis and sample size in the agreement between subjective and objective methods

We aimed to provide evidence for an a priori hypothesis and sample size for subjectively assessing physical activity intensity and duration in paediatric population, adopting objective methods as the reference. We searched electronic databases, reference lists and author databases. Correlation coefficients were pooled as an indicator of agreement estimates. We found 183 agreement analyses (94.5% based on correlation coefficients) from 89 studies that met our inclusion criteria. We identified four physical activity parameters addressing intensity and two parameters addressing duration. The physical activity parameters focusing on intensity were measured only by questionnaires, and the best correlation was achieved by moderate-to-vigorous physical activity compared with a heart rate monitor. In addition, total physical activity duration had a stronger correlation with an accelerometer when measured by diaries or logs than when measured by questionnaires. In both cases, the correlation was moderate. Studies with sample sizes between 50 and 99 subjects showed measurements that were stable in both magnitude and interpretation. Our findings suggest that the agreement between subjective and objective methods for assessing physical activity intensity and duration is weak to moderate. Furthermore, sample sizes ranging from 50 to 99 subjects provide stable agreement estimates between methods.

Reliability and validity of the Youth Leisure-time Sedentary Behavior Questionnaire (YLSBQ)

OBJECTIVES

To develop a questionnaire able to assess time spent by youth in a wide range of leisure-time sedentary behaviors (SB) and evaluate its test-retest reliability and criterion validity.

DESIGN

Cross-sectional observational.

METHODS

The reliability sample included 194 youth, aged 10-18 years, who completed the questionnaire twice, separated by one-week interval. The validity study comprised 1207 participants aged 8-18 years. Participants wore an accelerometer for 7 consecutive days. The questionnaire was designed to assess the amount of time spent in twelve different SB during weekdays and weekends, separately. In order to avoid usual phenomenon of time over reporting, values were adjusted to real available leisure-time (LT) for each participant. Reliability was assessed by using Intraclass Correlation Coefficients (ICC) and weighted (quadratic) kappa (k), and validity was assessed by using Pearson correlation and Bland-Altman plots.

RESULTS

The reliability of questionnaire showed a moderate-to-substantial agreement for the most (91%) of items (k=0.43-0.74; ICC=0.41-0.79) with three items (4%) reaching an almost perfect agreement (ICC=0.82-0.83). Only 'sitting and talking' evidenced fair-to-moderate reliability (k=0.27-0.39; ICC=0.34-0.46). The relationship between average sedentary time assessed by the questionnaire and accelerometry was moderate (r=0.36; p<0.001). Systematic biases were not found between questionnaire and accelerometer sedentary time for average day (r=0.05; p=0.11) but Bland-Altman plots suggest moderate discrepancies between both methods of SB measurement (mean=19.86; limits of agreement=-280.04 to 319.76).

CONCLUSIONS

The questionnaire showed moderate to good test-retest reliability and a moderate level of validity for assessing SB in youth, similar or slightly better to previously published in this population.

[Accelerometry does not match with self-reported physical activity and sedentary behaviors in Mexican children]

BACKGROUND

An accurate assessment of physical activity in schoolchildren is necessary to implement strategies that promote active lifestyles. The objective of this study was to validate a self-administered questionnaire to assess physical activity and sedentary behaviors and to analyze differences in the validity according to nutritional status in Mexican schoolchildren.

METHODS

Schoolchildren of 8-12 years of age answered a self-report physical activity and sedentary behaviors questionnaire to evaluate sedentary and light physical activity (SLPA) and moderate to vigorous physical activity (MVPA). The data of children who wore a triaxial accelerometer days was analyzed. Concordance between both methods to determine the time schoolchildren spend watching television was assessed using intraclass correlation coefficients and Bland-Altman method.

RESULTS

The estimation of MVPA by questionnaires was higher than that of accelerometers by 117.6minutes per week, and the estimation of SLPA was lower by 1,924.7minutes per week. No correlation between the time assessed by accelerometers and the time reported in the questionnaires for SLPA and MVPA was detected. In normal-weighted children, a low correlation between the time dedicated to play videogames with sedentary activities (r_ic=0.29, p=0.031) assessed by accelerometers was observed.

CONCLUSIONS

Schoolchildren over-estimate MVPA and under-estimate SLPA. Body weight can be a factor influencing such bias.

Improved Physical Activity Screening Enhances Intervention Effectiveness in Ethnic Minority Women

This study identified inconsistencies in physical activity (PA) reported at screening and baseline of a 6-month health promotion intervention and explored how these inconsistencies influenced intervention effectiveness in African American and Hispanic women. Participants completed a telephone screener to determine eligibility for a PA intervention. Inactive participants (≤90 minutes of PA/week) were invited to a baseline assessment, where they completed the International Physical Activity Questionnaire, measuring work, transportation, gardening/housework, and leisure-time PA. Women returned after 6 months to complete an identical post-intervention assessment. Despite being screened as inactive, baseline Questionnaire data indicated that 85.0% of participants (N = 274, M age = 44.6 years, M body mass index = 34.8 kg/m2) were active (>90 minutes of PA/week). Women who reported any work-related PA were 20.9 times more likely to be active at baseline than those who did not (p < .001). Participants who were inactive at both screening and baseline reported greater increases in domestic and gardening PA and total PA from baseline to postintervention (ps < .05). Overweight/obese ethnic minority women may misreport being physically inactive during screening if specific questions about type of PA are not included. Post hoc analyses controlling for screening inaccuracies may improve effectiveness of PA interventions and help intervention programs reach women who may benefit the most.

Identifying correlates and determinants of physical activity in youth: How can we advance the field?

This commentary provides a critical discussion of current research investigating the correlates and determinants of physical activity in young people, with specific focus on conceptual, theoretical and methodological issues. We draw on current child and adolescent literature and our own collective expertise to illustrate our discussion. We conclude with recommendations that will strengthen future research and help to advance the field.

Reliability and validity of a single-item physical activity measure for adolescents

AIMS

The aim of this study was to examine the test-retest reliability and concurrent validity of an adolescent single-item physical activity measure by comparing it with the existing Oxford Physical Activity Questionnaire (OPAQ) and accelerometer output.

METHODS

Participants were 123 adolescents (14.7 ± 0.5 years) from three secondary schools in New South Wales, Australia. To determine reliability, participants completed both questionnaires on two occasions separated by 2 weeks. To assess validity, participants wore Actigraph GT3X+ accelerometers for a 7-day monitoring period and completed both physical activity questionnaires. Bivariate correlations between self-reported moderate-to-vigorous physical activity (MVPA) and accelerometer MVPA min/day were calculated.

RESULTS

The single-item (intra-class correlation coefficient (ICC) = 0.75, 95% confidence interval (CI) = 0.64-0.83, P < 0.001) ) and the OPAQ (ICC = 0.79, 95% CI = 0.69-0.86, P < 0.001) were both found to have moderate-to-strong reliability. Correlations between self-reported and objectively measured MVPA were similar for the single-item measure (r = 0.44, 95% CI = 0.24-0.63, P < 0.001) and the OPAQ (r = 0.50, 95% CI = 0.30-0.65, P < 0.001).

CONCLUSIONS

These findings suggest the single-item measure can provide a reliable and valid assessment of youth physical activity.

Use of time in people with chronic obstructive pulmonary disease--a systematic review

“Physical inactivity” and “sedentary lifestyles” are phrases often used when describing lifestyles of people with chronic obstructive pulmonary disease (COPD). Evidence suggests activity types, independent of energy expenditure, influence health outcomes, so understanding patterns of time use is important, particularly in chronic disease. We aimed to identify reports of time use in people with COPD. Predefined search strategies were used with six electronic databases to identify individual activity reports (including frequencies and/or durations) in which community-dwelling people with COPD engaged. Eligible studies were assessed independently against predefined criteria and data were extracted by two reviewers. Data synthesis was achieved by aggregating activity reports into activity domains (sports/exercise, screen time, transport, quiet time, self-care, sociocultural, work/study, chores, and sleep). Twenty-six publications reported 37 specific daily activities. People with COPD were found to spend extended periods in sedentary behaviors (eg, standing [194 min/day]; sitting [359 min/day]; lying [88 min/day]), have limited engagement in physical activity (eg, walking [51 min/day]; exercising [1.2 episodes per week {ep/w}, 13 min/day]), have high health care needs (medical appointments [1.0 ep/w]), and experience difficulties associated with activities of daily living (eg, showering [2.5 ep/w, 60 minutes per episode]; preparing meals [4.7 ep/w]). Little data could be found describing how people with COPD use their time, and data synthesis was problematic because of variations in methodologies, population differences, and research emphases. Identified data largely referred to posture and were skewed according to country, assessment methods, and disease severity. Comparisons with age-matched population data showed people with COPD spent less time engaged in personal-care activities (self-care and sleeping) and chores than people in similar age groups. The incorporation of time-use outcomes in future research designs should be encouraged. Ideally, these tools should use consistent frameworks and comparable outcome measures in order to provide clearer descriptions of time use in chronic disease.

Direct and self-reported measures of physical activity and sedentary behaviours by weight status in school-aged children: results from ISCOLE-Kenya

BACKGROUND

Previous work has shown little association between self-report and directly measured physical activity. The objective of this study was to investigate the relationships between self-reported and directly assessed measures of physical activity and sedentary time by weight status in Kenyan children.

METHODS

Direct assessment of body weight, physical activity and sedentary time of 563 children was collected through anthropometry and accelerometry, while self-reported assessment was achieved by administering a questionnaire.

RESULTS

Under/healthy weight children had significantly higher directly measured mean daily minutes of moderate-to-vigorous physical activity (MVPA) compared to overweight/obese children (39 vs 20 minutes); had lower mean weekend-day minutes of sedentary time (346 vs 365 minutes); had a higher proportion who met accepted physical activity guidelines (15.3% vs 2.6%); and a higher number reported using active transportation to/from school (49.2% vs 32.4%). Self-reported time spent outside before and after school and active transport to/from school were significantly associated with mean weekday minutes of MVPA (r-value range = 0.12-0.36), but only for the under/healthy weight children.

CONCLUSIONS

The results of this study found a number of differences in the accumulation of MVPA and sedentary time by weight status and weak-to-moderate correlations between self-report and direct measures of weekday and weekend-day physical activity among the under/healthy weight children.

Assessment of physical activity and energy expenditure: an overview of objective measures

The ability to assess energy expenditure (EE) and estimate physical activity (PA) in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity), and diabetes. It is also important to appreciate that PA and EE are different constructs with PA defined as any bodily movement that results in EE and accordingly, energy is expended as a result of PA. However, total energy expenditure, best assessed using the criterion doubly labeled water (DLW) technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate PA in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of PA and their relationship with EE. The measures discussed include those based on EE or oxygen uptake including DLW, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures.

A comparison of physical activity and sedentary behaviour in 9-11 year old British Pakistani and White British girls: a mixed methods study

BACKGROUND

Previous studies suggest that British children of South Asian origin are less active and more sedentary than White British children. However, little is known about the behaviours underlying low activity levels, nor the familial contexts of active and sedentary behaviours in these groups. Our aim was to test hypotheses about differences between British Pakistani and White British girls using accelerometry and self-reports of key active and sedentary behaviours, and to obtain an understanding of factors affecting these behaviours using parental interviews.

METHODS

Participants were 145 girls (70 White British and 75 British Pakistani) aged 9-11 years and parents of 19 of the girls. Accelerometry data were collected over 4 days and girls provided 24-hour physical activity interviews on 3 of these days. Multilevel linear regression models and generalised linear mixed models tested for ethnic differences in activity, sedentary time, and behaviours. Semi-structured interviews were conducted with parents.

RESULTS

Compared to White British girls, British Pakistani girls accumulated 102 (95% CI 59, 145) fewer counts per minute and 14 minutes (95% CI 8, 20) less time in moderate to vigorous physical activity per day. British Pakistani girls spent more time (28 minutes per day, 95% CI 14, 42) sedentary. Fewer British Pakistani than White British girls reported participation in organised sports and exercise (OR 0.22 95% CI 0.08, 0.64) or in outdoor play (OR 0.42 95% CI 0.20, 0.91). Fewer British Pakistani girls travelled actively to school (OR 0.26 95% CI 0.10, 0.71). There was no significant difference in reported screen time (OR 0.88 95% CI 0.45, 1.73). Parental interviews suggested that structural constraints (e.g. busy family schedules) and parental concerns about safety were important influences on activity levels.

CONCLUSIONS

British Pakistani girls were less active than White British girls and were less likely to participate in key active behaviours. Sedentary time was higher in British Pakistani girls but reported screen-time did not differ, suggesting that British Pakistani girls engaged more than White British girls in other sedentary behaviours. Interviews highlighted some differences between the groups in structural constraints on activity, as well as many shared constraints.

Measuring physical activity in children and adolescents for dietary surveys: practicalities, problems and pitfalls

Physical inactivity is an important risk factor for many chronic diseases and contributes to obesity and poor mental well-being. The present paper describes the main advantages and disadvantages, practical problems, suggested uses, and future developments regarding self-reported and objective data collection in the context of dietary surveys. In dietary surveys, physical activity is measured primarily to estimate energy expenditure. Energy expenditure surveillance is important for tracking changes over time, particularly given the debates over the role of the relative importance of energy intake and expenditure changes in the aetiology of obesity. It is also important to assess the extent of underreporting of dietary intake in these surveys. Physical activity data collected should include details on the frequency, duration and relative intensity of activity for each activity type that contributes considerably to overall activity and energy expenditure. Problems of validity and reliability, associated with inaccurate assessment, recall bias, and social desirability bias, are well-known; children under 10 years cannot report their activities accurately. However, despite such limitations, questionnaires are still the dominant method of physical activity assessment in dietary surveys due to their low cost and relatively low participant burden. Objective, time-stamped measures that monitor heart rate and/or movement can provide more comprehensive, quantitative assessment of physical activity but at greater cost and participant burden. Although overcoming many limitations of questionnaires, objective measures also have drawbacks, including technical, practical and interpretational issues.

Reliability and validity of the multimedia activity recall in children and adults (MARCA) in people with chronic obstructive pulmonary disease

Objective

To determine the reliability and validity of the Multimedia Activity Recall for Children and Adults (MARCA) in people with chronic obstructive pulmonary disease (COPD).

Design

People with COPD and their carers completed the Multimedia Activity Recall for Children and Adults (MARCA) for four, 24-hour periods (including test-retest of 2 days) while wearing a triaxial accelerometer (Actigraph GT3X+®), a multi-sensor armband (Sensewear Pro3®) and a pedometer (New Lifestyles 1000®).

Setting

Self reported activity recalls (MARCA) and objective activity monitoring (Accelerometry) were recorded under free-living conditions.

Participants

24 couples were included in the analysis (COPD; age 74.4±7.9 yrs, FEV₁ 54±13% Carer; age 69.6±10.9 yrs, FEV₁ 99±24%).

Interventions

Not applicable.

Main Outcome Measure(s)

Test-retest reliability was compared for MARCA activity domains and different energy expenditure zones. Validity was assessed between MARCA-derived physical activity level (in metabolic equivalent of task (MET) per minute), duration of moderate to vigorous physical activity (min) and related data from the objective measurement devices. Analysis included intra-class correlation coefficients (ICC), Bland-Altman analyses, paired t-tests (p) and Spearman's rank correlation coefficients (r_s).

Results

Reliability between occasions of recall for all activity domains was uniformly high, with test-retest correlations consistently >0.9. Validity correlations were moderate to strong (r_s = 0.43–0.80) across all comparisons. The MARCA yields comparable PAL estimates and slightly higher moderate to vigorous physical activity (MVPA) estimates.

Conclusion

In older adults with chronic illness, the MARCA is a valid and reliable tool for capturing not only the time and energy expenditure associated with physical and sedentary activities but also information on the types of activities.

Exercise and type 1 diabetes (T1DM)

Physical exercise is firmly incorporated in the management of type 1 diabetes (T1DM), due to multiple recognized beneficial health effects (cardiovascular disease prevention being preeminent). When glycemic values are not excessively low or high at the time of exercise, few absolute contraindications exist; practical guidelines regarding amount, type, and duration of age-appropriate exercise are regularly updated by entities such as the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes. Practical implementation of exercise regimens, however, may at times be problematic. In the poorly controlled patient, specific structural changes may occur within skeletal muscle fiber, which is considered by some to be a disease-specific myopathy. Further, even in well-controlled patients, several homeostatic mechanisms regulating carbohydrate metabolism often become impaired, causing hypo- or hyperglycemia during and/or after exercise. Some altered responses may be related to inappropriate exogenous insulin administration, but are often also partly caused by the "metabolic memory" of prior glycemic events. In this context, prior hyperglycemia correlates with increased inflammatory and oxidative stress responses, possibly modulating key exercise-associated cardio-protective pathways. Similarly, prior hypoglycemia correlates with impaired glucose counterregulation, resulting in greater likelihood of further hypoglycemia to develop. Additional exercise responses that may be altered in T1DM include growth factor release, which may be especially important in children and adolescents. These multiple alterations in the exercise response should not discourage physical activity in patients with T1DM, but rather should stimulate the quest for the identification of the exercise formats that maximize beneficial health effects.

Meeting physical activity guidelines and health-related fitness in youth

BACKGROUND

National physical activity guidelines have been developed for Americans. Interest lies in the relationship between meeting the national physical activity guidelines and physical fitness outcomes in youth. Theoretically, those who meet the physical activity guidelines are more physically fit, which translates to better health and reduced risk.

PURPOSE

To examine the relationship between youth self-reported physical activity behaviors sufficient to meet DHHS Physical Activity Guidelines for Americans and an external health criterion: achievement of the FITNESSGRAM(®) Healthy Fitness Zone™ (HFZ).

METHODS

Logistic regression was used to examine achievement of the HFZ for three physical fitness measures (i.e., aerobic capacity, BMI, and muscle fitness) separately, and for all three combined, based on self-reported physical activity of 7 days per week for aerobic activity and ≥3 days per week of muscle-strengthening activity. One model examined the direct relationship between physical activity and fitness measures, and a second model assessed the same relationship while controlling for gender, age, ethnicity, economic status, and school. Data were collected during the 2009-2010 academic year and analyzed in 2012.

RESULTS

Adolescents failing to meet national aerobic and muscle-strengthening physical activity guidelines have higher odds of not achieving healthy physical fitness levels of aerobic capacity, BMI, muscle fitness, and the combination of all three. An increase in the number of days of aerobic activity was related to decreased odds of being in the Needs Improvement Fitness Zone.

CONCLUSIONS

The findings provide further support that meeting the national physical activity guidelines produces health benefits for youth.

Doubly labeled water validation of a computerized use-of-time recall in active young people

OBJECTIVE

Low levels of daily energy expenditure (insufficient physical activity and increased sedentary time) have been associated with adverse health outcomes in young people. The Multimedia Activity Recall for Children and Adolescents (MARCA) is a computerized, self-report, use-of-time tool that can assess daily energy expenditure. The study aim was to validate the MARCA for the estimation of energy expenditure in young people, using the criterion standard doubly labeled water.

MATERIALS/METHODS

Over a 15 day assessment period, 32 participants (10-18 years) completed the MARCA and underwent a doubly labeled water protocol. Indirect calorimetry was used to assess resting metabolic rate. Total daily energy expenditure (TEE) and activity-related energy expenditure (AEE) were estimated from both the MARCA and doubly labeled water. Association and agreement between methods for TEE and AEE were assessed using Spearman correlations and Bland-Altman plots, respectively.

RESULTS

Compared to doubly labeled water, the MARCA over-estimated TEE by an average of 50 kcal/day (limits of agreement -1 589 to 1 490 kcal/day) and under-estimated AEE 105 kcal/day (limits of agreement -1 404 to 1 614 kcal/day). The MARCA showed strong correlation with doubly labeled water for TEE (rho=0.70, p<0.0001) and moderate correlation for AEE (rho=0.56, p=0.0009).

CONCLUSIONS

Overall, the MARCA indicated moderate validity for the assessment of daily TEE and AEE. The wide limits of agreement indicate the MARCA has greater utility for group-level rather than individual-level estimates.