Stephanie A. Prince

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

BackgroundAccurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults.MethodsEight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the reviews eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted.ResultsCorrelations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores.ConclusionThe findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report – direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: A systematic review

BACKGROUND Accurate assessment of physical activity (PA) in children and adolescents is required to establish PA levels, monitor changes and inform public healthy policy. This study systematically reviews the literature to determine the extent of agreement between indirect (e.g., questionnaire) and direct (e.g., accelerometry) assessments of PA in pediatric populations (<or=19 years). METHODS Literature was identified through searching electronic databases (e.g., MEDLINE, EMBASE), websites of relevant organizations and conference abstracts until April 2007. Studies were included if they collected indirect and direct measures of PA in pediatric populations and were reported in English. Quality of included studies was appraised using a modified Downs and Black tool. RESULTS A total of 83 studies were included; 24 describing comparable data and 59 including a correlation analysis. The majority of correlations reported between indirect and direct measures were low-to-moderate (range: -0.56 to 0.89). Overall, 72% of the indirect measures overestimated the directly measured values. Combined gender, as well as male- and female-only data comparing indirect measures to accelerometery, heart rate monitoring or direct observation, all reported an overestimation by indirect method. A similar trend was observed in combined gender data comparing indirect measures with doubly labelled water; however, the opposite trend was observed in the male- and female-only data with a slight underestimation by indirect measure. CONCLUSIONS Substantial discrepancies and moderate correlations between indirect methods and direct measures of assessing PA in pediatric populations are of concern, especially when trying to establish relationships with health outcomes.

A multilevel analysis of neighbourhood built and social environments and adult self-reported physical activity and body mass index in Ottawa, Canada

Canadian research examining the combined effects of social and built environments on physical activity (PA) and obesity is limited. The purpose of this study was to determine the relationships among built and social environments and PA and overweight/obesity in 85 Ottawa neighbourhoods. Self-reported PA, height and weight were collected from 3,883 adults using the International PA Questionnaire from the 2003–2007 samples of the Rapid Risk Factor Surveillance System. Data on neighbourhood characteristics were obtained from the Ottawa Neighbourhood Study; a large study of neighbourhoods and health in Ottawa. Two-level binomial logistic regression models stratified by sex were used to examine the relationships of environmental and individual variables with PA and overweight/obesity while using survey weights. Results identified that approximately half of the adults were insufficiently active or overweight/obese. Multilevel models identified that for every additional convenience store, men were two times more likely to be physically active (OR = 2.08, 95% CI: 1.72, 2.43) and with every additional specialty food store women were almost two times more likely to be overweight or obese (OR = 1.77, 95% CI: 1.33, 2.20). Higher green space was associated with a reduced likelihood of PA (OR = 0.93, 95% CI: 0.86, 0.99) and increased odds of overweight and obesity in men (OR = 1.10, 95% CI: 1.01, 1.19), and decreased odds of overweight/obesity in women (OR = 0.66, 95% CI: 0.44, 0.89). In men, neighbourhood socioeconomic scores, voting rates and sense of community belonging were all significantly associated with overweight/obesity. Intraclass coefficients were low, but identified that the majority of neighbourhood variation in outcomes was explained by the models. Findings identified that green space, food landscapes and social cohesiveness may play different roles on PA and overweight/obesity in men and women and future prospective studies are needed.

Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City

In Canada, there is limited research examining the associations between objectively measured neighborhood environments and physical activity (PA) and obesity. The purpose of this study was to determine the relationships between variables from built and social environments and PA and overweight/obesity across 86 Ottawa, Canada neighborhoods. Individual‐level data including self‐reported leisure‐time PA (LTPA), height, and weight were examined in a sample of 4,727 adults from four combined cycles (years 2001/03/05/07) of the Canadian Community Health Survey (CCHS). Data on neighborhood characteristics were obtained from the Ottawa Neighbourhood Study (ONS); a large study of neighborhoods and health in Ottawa, Canada. Binomial multivariate multilevel models were used to examine the relationships between environmental and individual variables with LTPA and overweight/obesity using survey weights in men and women separately. Within the sample, ∼75% of the adults were inactive (<3.0 kcal/kg/day) while half were overweight/obese. Results of the multilevel models suggested that for females greater park area was associated with increased odds of LTPA and overweight/obesity. Greater neighborhood density of convenience stores and fast food outlets were associated with increased odds of females being overweight/obese. Higher crime rates were associated with greater odds of LTPA in males, and lower odds of male and female overweight/obesity. Season was significantly associated with PA in men and women; the odds of LTPA in winter months were half that of summer months. Findings revealed that park area, crime rates, and neighborhood food outlets may have different roles with LTPA and overweight/obesity in men and women and future prospective studies are needed.

Objectively-measured sedentary time and its association with markers of cardiometabolic health and fitness among cardiac rehabilitation graduates:

Background Sedentary time is an independent risk factor for cardiometabolic disease and mortality. It is unknown how much time individuals with coronary artery disease spend being sedentary or how their sedentary time relates to markers of health. The objectives of this study were to: (a) quantify sedentary time in a post-cardiac rehabilitation (CR) population, and (b) assess association with cardiometabolic risk, independent of moderate-to-vigorous physical activity. Design Cross-sectional. Methods As part of a larger trial, 263 recent CR graduates (∼10 days post-CR, mean age 63.6 ± 9.3 years, 75% male) wore an ActiGraph GT3X accelerometer during waking hours (≥4 days, ≥10 hours/day) to quantify sedentary time (≤150 counts per minute). Spearman correlations were computed to assess relationships between sedentary time (adjusted for wear time) with markers of cardiometabolic health and fitness. Significant markers were examined using multiple linear regressions. Results Participants spent an average of 8 hours/day sedentary (∼14 bouts/day). Sedentary time was negatively correlated with high-density lipoprotein and V · O2peak and positively correlated with triglycerides, body mass index and waist circumference. After adjusting for age, sex, medications and moderate-to-vigorous physical activity, hours/day of sedentary time remained significantly associated with log V · O2peak (β = −0.02, p = 0.001) and body mass index (β = 0.49, p = 0.02). Conclusions Findings suggest that even among a group of post-CR individuals who are already probably more active than patients who have not undergone CR, sedentary time remains high and is associated with poorer cardiorespiratory fitness, suggesting a possible new area of focus among CR programs.

Correlates of sedentary behaviour in adults: a systematic review

The objective of this study was to systematically review evidence to identify intrapersonal, social environmental, physical environmental and policy correlates of sedentary behaviour (SB) among adults.

Lifestyle Interventions Targeting Body Weight Changes during the Menopause Transition: A Systematic Review

Objective. To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition. Methods. A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively. Results. Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns. Conclusions. High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity.

Why are adult women physically active? A systematic review of prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants.

This study aims to systematically review available evidence from prospective cohort studies to identify intrapersonal, social environmental and physical environmental determinants of moderate‐to‐vigorous intensity physical activity (MVPA) among working‐age women.

Self-measured Waist Circumference in Older Patients With Heart Failure: A Study of Validity and Reliability Using a Myo Tape®

PURPOSE Evidence supports the use of waist circumference (WC) as an important clinical measure of body composition and obesity-related health risk. Self-monitoring of WC may be problematic for older persons, especially for those with a chronic illness such as heart failure (HF). No studies to date have measured the accuracy of self-measured WC in older persons with HF. Therefore, the objective of this study was to determine the reliability and validity of self-measured WC in older patients with HF. METHODS The reliability of self-measured WC was evaluated over 7 days in 100 older (65–93 years) men and women with HF. The validity and accuracy of self-measured WC in comparison with technician-measured WC was evaluated in a second group of 45 men and women (40–91 years) recruited from a HF clinic. RESULTS Reliability results identified a high intraclass correlation between the 7 self-measurements (r = 0.99, P < .0001). The validity analysis yielded a correlation of 0.98 between self- and technician-measured WC (P < .0001). Mean differences between technician- and self-measurement were insignificant (0.60 cm; 95% CI: −0.35–1.50). Limits of agreement were −5.5 to 6.7 cm and indicated no systematic differences between self- and technician-measured WC. Ninety-six percent of participants were able to correctly classify themselves into the appropriate WC risk category. CONCLUSIONS Results indicate that a single self-measurement of WC is reliable. Validation results indicate that WC self-measured by older HF patients may be appropriate for large epidemiologic studies. However, the large limits of agreement suggest that self-measured WC may not be adequately sensitive for monitoring individual changes.

Impact of Workplace Physical Activity Interventions on Physical Activity and Cardiometabolic Health Among Working-Age Women: A Systematic Review and Meta-Analysis

Background— Cardiovascular disease is the leading cause of death among women in high-income Organization for Economic Co-operation and Development countries. Physical activity is protective for cardiovascular disease. The realities of modern life require working-age women to address work-related, family, and social demands. Few working-age women meet current moderate-to-vigorous–intensity physical activity (MVPA) recommendations. Given that working-age women spend a substantial proportion of their waking hours at work, places of employment may be an opportune and a controlled setting to implement programs, improving MVPA levels and enhancing cardiometabolic health. Methods and Results— Eight electronic databases were searched to identify all prospective cohort and experimental studies reporting an MVPA outcome of workplace interventions for working-age women (mean age, 18–65 years) in high-income Organization for Economic Co-operation and Development countries. Risk of bias was assessed using the Cochrane risk of bias tool; quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A qualitative synthesis was performed for all studies, and meta-analyses were conducted where possible. Twenty-four studies met the inclusion criteria; 20 studies were included in the meta-analyses. Workplace interventions significantly increased minutes per week of metabolic equivalents (4 studies; standardized mean differences, 2.07; 95% confidence interval [CI], 1.44 to 2.69), but not minutes per week of MVPA (13 studies; standardized mean differences, 0.38; 95% CI, −0.15 to 0.92) or metabolic equivalents per week (3 studies; standardized mean differences, 0.11; 95% CI, −0.48 to 0.71). Workplace interventions also significantly decreased body mass (7 studies; mean differences, −0.83 kg; 95% CI, −1.64 to −0.02), body mass index (6 studies; mean differences, −0.35 kg/m2; 95% CI, −0.62 to −0.07), low-density lipoprotein (4 studies; mean differences, −0.11 mmol/L; 95% CI, −0.17 to −0.04), and blood glucose (2 studies; mean differences, −0.18 mmol/L; 95% CI, −0.29 to −0.07). These workplace interventions targeting MVPA levels and known beneficial cardiometabolic health sequelae were of lower quality evidence. Conclusions— Workplace interventions variably improve MVPA levels and related cardiometabolic health sequelae of working-age women in high-income Organization for Economic Co-operation and Development countries. Our findings underscore the need for ongoing research in this area but also increased dissemination of the existing programs and knowledge.