Association of Schools of Public Health
Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related
Research
Author(s): Carl J. Caspersen, Kenneth E. Powell and Gregory M. Christenson
Source: Public Health Reports (1974-), Vol. 100, No. 2 (Mar. - Apr., 1985), pp. 126-131
Published by: Association of Schools of Public Health
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9.
S. N.,
D. R., and Powell,
K. E.: Relation
Jacobs,
or physical
and other health
exercise
ships between
activity
behaviors.
100: 172-180,
Public Health
Rep
March-April
Blair,
13.
1985.
10.
D. S., LaPort?,
R. E., and Newman,
J. M.: The
benefits
and risks of physical
and
disease-specific
activity
exercise.
Health
100: 180-188,
Public
Rep
March-April
1985.
Siscovick,
//.
D. S., and Goldbaum,
J. P., Siscovick,
G. M.: The
Koplan,
risks of exercise:
A public
health
and
of injuries
view
hazards.
Health
100: 189-195,
Public
Rep
March-April
1985.
12.
Taylor,
between
Public
C. B.,
R.: The relationship
Sallis, J. F., and Needle,
and exercise
and mental
health.
physical
activity
100: 195-202,
Health
1985.
Rep
March-April
and Dr.
epidemiologists
in the Behavioral
Epi
Educa
of Health
Division
Centers
for
Synopsis.
"physical
concepts.
or
study
of any concept
A he EPiDEMiOLOGic
event requires that the item under investigation
be
and measured.
defined
and profes
The common
sional uses of the terms "physical
''exer
activity,"
fitness"
reveal a need for clar
cise," and "physical
ac
ification. This paper, therefore, defines physical
and physical
fitness, with the hope
tivity, exercise,
a framework
will provide
in
that each definition
and compared.
studies can be interpreted
which
will
standardized
promote
terminology
Ideally,
greater understanding
ical activity,
exercise,
126
of the relation
physical
between
phys
and health.
fitness,
Government
Printing
Office,
Washington,
DC,
May
1979.
in daily
Physical
activity
into occupational,
sports,
or other activities.
Exer
household,
conditioning,
cise is a subset of physical
that is planned,
activity
and repetitive
and has as a final or an
structured,
or mainte
intermediate
the improvement
objective
nance of physical fitness. Physical fitness
is a set of
or skill-related.
that are either healthattributes
to which people
The degree
have these attributes
can be measured
tests.
with specific
GA 30333.
Atlanta,
Control,
to Dr. Caspersen.
Tearsheet
requests
Disease
and
"exercise/'
activity/'
terms that describe different
U.S.
in kilocalories.
measured
life can be categorized
are
Dr. Caspersen
and Dr. Powell
researcher
is an evaluation
Christenson
"Physical
are
fitness"
R. S.: Countercurrents
of physical
Paffenbarger,
activity
and heart attack
trends. In Proceedings
of the Conference
on the Decline
in Coronary
Heart Mortality,
edited by R. J.
Havlik
and M. Feinleib.
NIH
Publication
No.
79-1610.
is defined as any bodily move
Physical
activity
ment produced
that results in
by skeletal muscles
can be
The energy expenditure
energy expenditure.
CARL J. CASPERSEN, PhD, MPH
KENNETH E. POWELL, MD, MPH
GREGORY M. CHRISTENSON, PhD
and Education,
15.
1985.
212-224,
March-April
R. J., Wing,
A. L., and Hyde,
R. T.: Physical
Paffenbarger,
as an index of heart attack risk in college
alumni.
activity
Am J Epidemiol
108: 161-175,
1978.
September
However,
they are often confused with one another,
and the terms are sometimes
used interchangeably.
This paper proposes
to distinguish
them.
definitions
Physical Activity, Exercise,
and Physical Fitness:
and Distinctions
Definitions
for Health-Related
Research
and Evaluation
Branch,
demiology
for Health
Promotion
tion, Center
14.
D. C,
J. E., Crow, R. S., and Christen
Iverson,
Fielding,
of physical
son, G. M.: The promotion
in the U.S.
activity
the status of programs
in medical,
population:
worksite,
and school
Public Health
100:
community,
settings.
Rep
as an
are offered
These definitions
tional framework
studies
for comparing
and physical
exercise,
activity,
physical
health.
interpreta
that relate
to
fitness
Physical Activity
of physical
elements
activity have been
is
(see box page 127). Physical
activity
as any bodily movement
defined
by
produced
that results in energy expenditure.
skeletal muscles
an
to accomplish
The amount of energy
required
can be measured
in kilojoules
(kJ) or
activity
Several
identified
kilocalories
(kcal); 4.184 kJ is essentially
equivalent
be
to 1 kcal (7). Technically,
the kJ is preferred
cause it is a measure
how
of energy expenditure;
the kcal, a measure
of heat, has
ever, historically
Public Health Reports
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All use subject to JSTOR Terms and Conditions
been employed more often. We have chosen to fol
low historical
precedent.
as a rate (kcal per unit time),
the
Expressed
a
amount of energy expended
is
each
person
by
from
low
to
The
continuous
variable,
high.
ranging
total amount
with
associated
of caloric expenditure
amount
is
the
of
determined
by
physical
activity
movements
and
the
muscle mass producing
bodily
con
of muscular
intensity, duration, and frequency
tractions
(2).
in order to
Everyone
activity
performs
physical
sustain life; however,
the amount is largely subject
to personal
from
choice and may vary considerably
as
as
a
to
well
for
person
person
given person over
time. The most common units of time used to refer
to kcals spent in physical
(3)
activity are the week
Elements
of physical
ACTIVITY
PHYSICAL
1. Bodily movement
skeletal muscles
2.
in
Results
energy
EXERCISE
via
1. Bodily movement
skeletal muscles
ex-
2. Results
penditure
3. Energy expenditure (kilocalories)
varies
continu-
continu
ously from low to high
4. Very positively
corre
lated with physical fit
ness
5.
and
structured,
Planned,
repetitive
bodily move
ment
6. An objective
or maintain
prove
ical
time periods.
fitness
is to im
phys
compo
nentes)
of physical activity. Physical
activity can
Categories
in a variety of ways. A commonly
be categorized
used approach
is to segment physical activity on the
basis of the identifiable portions of daily life during
the activity occurs. The simplest categoriza
which
tion identifies the physical activity that occurs while
at work, and at leisure (4). A simple for
sleeping,
mula can be used to express the caloric contribution
of each category
to the total energy
to physical
activity:
expenditure
due
=
KCaIsieep+ KCaloccupation' KCaliejSure KCaltotal daily physicalactivity
to the
of each category
is
total energy expenditure
due to physical
activity
rate and does not include the
above basal metabolic
effect of diet-induced
(which is the
thermogenesis
rate in the
above
the
metabolic
energy expenditure
The
due to
energy expenditure
resting state) (5).
physical
ex
energy
varies
calories)
ously from low to high
4. Positively correlated with
physical fitness
the day (2). Physical
activity during monthly,
to
seasonal, or yearly periods may also be examined
establish
the stability of physical activity for longer
caloric
in
via
penditure
3. Energy expenditure (kilo
and
The
and exercise
activity
contribution
activity
during
sleep would,
of course,
be
small.
Leisure-time
physical activity can be further sub
divided
into categories
such as sports, conditioning
tasks (for example,
household
exercises,
yardwork,
cleaning, and home repair) (6), and other activities.
in the formula these subcategories
for
Substituting
the leisure category
the formula
used,
previously
becomes:
+ ^ca'other
+ KCalh0usehold
kcalsieep+ KCaioccupation+ KCalcon(iitioning
=
KCaltotal daily physicalactivity
is complex
behavior,
however,
Physical
activity
and may be meaningfully
into other cat
partitioned
exclusive
of each other but not
egories mutually
of those mentioned
Exam
previously.
be
to
divide
all
activities
into
ples might
physical
or heavy intensity;
those that are of light, moderate,
or those that
those that are willful or compulsory;
are weekday
or weekend
activities. All of these are
necessarily
acceptable
The only
ways
of
subdividing
physical
activity.
is that the subdivisions
be
requirement
sum
to
exclusive
and
that
the
total
mutually
they
caloric expenditure
due to physical
activity.
There are undoubtedly
of catego
many methods
Each
rizing daily physical
system would
activity.
allow measurement
not only of total calories
ex
but
a
also
the
of
calories
in
vari
pended
expended
ety of subcategories,
any one of which may relate to
a specific aspect of health. Distinction
an
between
accumulated
total
caloric
evenly
(that
expenditure
contribution
from several categories)
is, equivalent
and an unevenly
accumulated
total expenditure
from one category)
is
(that is, major contribution
In
can
this
individuals
and
manner,
possible.
groups
be described by the absolute energy expenditure
for
a specific category,
the
relative
of
contribution
by
that category
to total energy expenditure,
or both.
To the extent that each of the categories
has differ
ent determinants
and
different
health
(7)
effects,
these categorical
distinctions
have both epidemi
ologic
terms
and public
utility
of promotion
and
(8).
Few studies of physical
for each of the categories
health
in
implications
intervention
strategies
activity allow estimates
or for the total. Discus
March-April
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1985, Vol. 100, No. 2
127
Figure 1. Probability that physical activity performed during
selected
categories
is exercise
Steep
Occupation
|
Leisure:
I
Conditioning
|
"1 I
Sports
Household I
Other
|
[
Zero or low
Hjgn
Probability
Figure
2. Components
of physical
fitness
Cardioresplratory endurance
Muscular endurance
? Health-related fitness < Muscular strength
Body composition
Flexibility
fitness
/
Physical
Agility
Balance
Coordination
Skill-related fitness
Speed
Power
Reaction time
sion and comparison
of studies of physical activity
if the data in the studies are dis
will be facilitated
identifiable categories.
in terms of specific
cussed
it is more likely to
activity except sleep. However,
of physical
some
be an important part of
categories
vir
For
than of others
example,
(fig. 1).
activity
are
activities
and
many sports
tually all conditioning
of
or
maintain
to
components
improve
performed
are
instances
such
In
planned,
they
physical fitness.
than not, repetitive.
and, more often
structured,
and
such as occupational,
household,
Activities
the
in
are
tasks
performed
typically
many
daily
ac
These
manner
most efficient
physical
possible.
tivities are done with little regard to physical fitness
of
with
conservation
structured
and are often
a
worker
a
as
goal. However,
energy expenditure
of some
the performance
may plan and structure
to
manner
a
efficient
in
less
tasks
work
develop
Simi
muscular
strength or to "burn up" calories.
structure
the
and
a
perfor
person may plan
larly,
in a labor
or other
tasks
mance
of household
rather than a labor-saving manner. Tasks
producing
are considered
in this manner
regularly performed
exercise.
Physical
Fitness
is related
In contrast with physical activity, which
that people
to the movements
physical
perform,
have or
that people
is a set of attributes
fitness
as
defined
been
has
fit
achieve.
Being physically
"the ability to carry out daily tasks with vigor and
undue fatigue and with ample
without
to enjoy leisure-time
pursuits and to meet
energy
the defini
unforeseen
(10). Although
emergencies"
tion may be conceptually
sound,
things such as
are not eas
fatigue, and enjoyment
vigor, alertness,
a
of
number
On the other hand,
ily measured.
to physical
do contribute
measurable
components
alertness,
Exercise
has been used
The term "exercise"
with
(9), and,
activity"
"physical
ably
elements
have a number of common
interchange
in fact, both
(see box p.
both
For
physical activity and exer
example,
127).
by
involve
cise
produced
any bodily movement
are
measured
that
muscles
skeletal
expends energy,
from low to
ranging continuously
by kilocalories
with
correlated
are
and
physical
positively
high,
of
and frequency
fitness as the intensity, duration,
is not
however,
increase.
movements
Exercise,
it is a subcate
with physical
activity:
synonymous
is
Exercise
of
physical activ
gory
physical activity.
and pur
is
that
structured,
repetitive,
planned,
ity
or
mainte
sense
that
in
the
improvement
posive
of
nance
of one or more
physical
components
The formula relating physical
fitness is an objective.
is:
activity and exercise
KCaJexerci8e+KCalnonexercise=KCaltotal dally physicalactivity
then, is a subset of physical activity and
Exercise,
all or part of each category of daily
constitute
may
fitness
(fig. 2). The most
nents fall into two groups:
the other related to skills
cited compo
frequently
one related to health and
that pertain more to ath
letic ability (//).
of physical fitness
The health-related
components
are (a) cardiorespiratory
endurance,
(b) muscular
(d) body compo
strength,
endurance,
(c) muscular
are
These
components
sition, and (e) flexibility.
as
amount
the
in the glossary
defined
(p. 129). Just
of physical activity ranges from low to high, so does
the levels of
the level of physical fitness. Moreover,
need not vary in
the five health-related
components
a person may be strong but
for example,
concert;
The five health-related
lack flexibility.
components
to public
are more
fitness
of physical
important
to
athletic
related
health than are the components
to
these.
our
discussion
ability; therefore, we limit
128 Public Health Reports
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and methods
of measuring
definitions
Operational
the inter
with
fitness
of
vary
components
physical
ests and needs of investigators
and evaluators
(12
lists procedures
commonly
14). The table below
fitness
to evaluate health-related
physical
employed
and
for
components
epidemiologic,
laboratory,
the compara
Although
techniques.
measures
has not been addressed
and accuracy
of the
the cost, precision,
are generally
to decline as one
assumed
self-assessment
bility of these
formally,
measures
Health-related
physical
moves
to self-assess
laboratory measures
one
these three levels of evaluation,
a
measure
to
of
choose
different
may
employ
or
or
lesser
accuracy,
greater
precision
depending
on the specific objectives
and
of the investigation
from
Within
ment.
cost
constraints.
Discussion
of physical
definitions
activity and physical
we have proposed
contain useful parallels.
The
fitness
measures
fitness
Evaluation procedures
Fitness component
Maximum
Cardiorespiratory
oxygen
..
composition
strength
..
(17),
weighing,
(20).
tensiometer
Cable
Canadian
Home
Self-assessment
Fitness
Test
ergometer
cycle
Canadian
(17),
(18).
(23).
tests
Isokinetic
endurance
Fitness
Test
run (79).
Skinfold (209, body mass
index (21).
Skinfold pinch test (22).
Handgrip
Upper-lower
dynamometer
(24).
trunk
lift,
hanging
leg lift (26).
Pull-ups,
flexed
(24,25).
Muscular
Home
12-minute
(15).
Underwater
potassium-40
Muscular
on
uptake
treadmill (16) or cycle
ergometer
Body
Epidemiologie
Laboratory
arm
hang,
situps (26).
Leighton flexometer (27).
Flexibility.
Sit-and-reach
flexometer
test
Sit-and-reach
(13).
(26).
Glossary
skill-related component of physical fitness that
Agility?A
relates to the ability to rapidly change the position of
the
entire
body
in space
with
and
speed
Body
cal
cle,
fat,
bone,
health-related
and
other
and
after
of
parts
the
systems
compo
to supply
fuel
dur
activity and to eliminate fatigue
Coordination?A
skill-related
of physical
component
fitness that relates to the ability to use the senses, such
as sight and hearing, together with body parts in per
motor
forming
Exercise?Planned,
movement
tasks
smoothly
structured,
done
to
improve
and
accurately.1
and
repetitive
or maintain
one
components of physical fitness.
health-related component
Flexibility?A
ness
joint.1
that
relates
to
Muscular
the
range
of motion
bodily
or more
of physical
fit
available
at a
external
component
of
to the ability of muscle
for many
force
repetitions
or
exertions.1
health-related
of physi
component
strength?A
that relates
fitness
to the amount
of external
force
that
a muscle
Physical
can
exert.1
bodily movement
activity?Any
that
muscles
results
in energy
produced
by
expenditure.
set of attributes that people have or
Physical fitness?A
achieve that relates to the ability to perform physical
activity.
Power?A
relates
fuel.1
supplying
to exert
health-related
that relates
fitness
successive
skeletal
body.1
health-related
respiratory
ing sustained physical
products
vital
that relates to the ability of the
nent of physical fitness
circulatory
amounts
relative
endurance?A
Cardiorespiratory
of physi
of mus
component
to the
relates
endurance?A
physical
cal
or moving.1
composition?A
that
fitness
Muscular
groups
accuracy.1
Balance?A
skill-related component of physical fitness
of equilibrium while
that relates to the maintenance
stationary
of Terms
skill-related
to
the
rate
component
at which
one
of physical
fitness
that
can perform
work.
Reaction time?A
skill-related component of physical
fitness that relates to the time elapsed between stimula
tion and the beginning of the reaction to it.1
skill-related component of physical fitness that
Speed?A
relates
to
the
ability
to perform
a movement
within
a
short period of time.1
'From Corbin, Charles B., et al., Concepts
in physical education with
laboratories and experiments,
4th ed. ?
1970, 1974,1978,1980 Wm. C.
Brown Publishers, Dubuque,
IA. All Rights Reserved.
Adapted by
special permission.
March-April
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1985, Vol. 100, No. 2
129
I Both
and physical
fitness
vary
physical
activity
of
members
the
from
low to high.
among
population
has no activity just as no person has no
No member
are active or fit to greater or lesser de
fitness?all
to categorize members
it is necessary
grees. When
of the population
into those who achieve
certain
levels and those who do not, operational
definitions
can be used.
we have
In contrast,
the definition
of exercise
more
is considerably
restrictive
proposed
cused than those in common use. A crucial
1.
of
ob
of fitness may be an intermediate
the participant
does not need to be
aware of it. The proposed
definition
continuously
and
at
all
does not
levels
of
fitness
physical
applies
S
Ac
levels of achievement.
require predetermined
to improve or maintain
of a
tivities
the flexibility
maintenance
and
jective,
less
with arthritis may require and achieve
of the gymnast,
yet still
joint flexion than activities
of exercise.
satisfy this definition
2.
facilitate
living will
daily
Discussion
activities
of
cross-study
comparisons.
that are not "exercise"
may require more descrip
tive words but should produce a clearer understand
of
the
components
ing of how
to physical
activity
in the
of reports
This would
facilitate
comparison
I scientific
in this im
literature and hasten progress
Passmore,
nutrition
J. F., and Truswell,
R., Brook,
and dietetics.
Ed.
7. Churchill
New York,
1979.
Livingstone,
H. L., et al.: A questionnaire
for the assessment
of
Taylor,
time physical
leisure
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Dis
31: 741-755
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is it still a risk factor? Prev
Taylor,
activity:
Med
12: 20-24
(1983).
on Physical
President's
Council
and Sports:
Fitness
Physi
cal Fitness
Research
Series
1.Washington,
1, No.
Digest.
DC,
//.
relate
The
behavior.
is a complex
activity
Physical
to
has
been
this
of
encourage
paper
purpose
major
more careful descriptions
of physi
of the categories
that are being studied and discussed.
cal activity
Davidson,
S.,
A. S.: Human
Epidemiol 108: 161-175 (1978).
4.
of
of physical
the categories
or mental
health.
we
(1978).
3.
person
We have not addressed
the underlying motivation
to do so would
to perform;
the concept
compound
reason
with
the
for
defined
One
doing.
being
of
exercise
advantage
carefully
defining
hoped-for
as we propose
is that investigators
will be encour
to
the
under
describe
study with more
activity
aged
care. More careful descriptions
and considerations
In addition,
References
and fo
all of the
whether
I bered by questions
concerning
nor does it
five components
of fitness are achieved,
of whether
the desired
I require the determination
level of fitness has, or even could be, achieved
by
In contrast,
the
under consideration.
the activity
definition
of exercise we propose
requires only that
to improve or maintain
the activity
be intended
or
some component
of fitness. The improvement
of study.
the different
think it is
of physical
subcategories
activity have different determinants,
may relate to
very specific aspects of physical fitness and health,
and may require different
and promo
intervention
tion strategies.
that
likely
element
to
this definition
is that exercise
be intended
or
maintain
of
fitness
improve
components
physical
an established
or maintain
rather than to achieve
to
not
it
is
the
level. Therefore,
determine
necessary
to
become "physi
necessary
specific achievements
cally fit," which will vary, at least, by age and sex.
is not encum
The proposed
definition
of exercise
area
portant
Sharkey,
Mountain
fitness
and weight
control.
Press
1974.
MT,
Missoula,
Publishing
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P. O., and Rodahl,
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S. F., Cullinane,
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E. M.,
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R. A.,
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Exer
Sports
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27.
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to your health. W.
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H. H.: Improvements
of objective
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V. L.: Exercise
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range of joint motion.
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38: 24-28
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23.
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of
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Assessment
of Physical
Synopsis
Activity in Epidemiologie
More
than 30 different methods
have been used
to assess physical
can be
These methods
activity.
into seven major categories:
grouped
calorimetry,
Problems
Research:
and Prospects
job classification,
survey procedures,
physiological
behavioral
mechanical
and
markers,
observation,
RONALD E. LAPORTE, PhD
HENRY J. MONTOYE, PhD
CARL J. CASPERSEN, PhD, MPH
Dr.
is an Associate
LaPorte
Professor
electronic
in the Department
of
of Public
of Wisconsin-Madison,
of Education,
University
is an Epidemiologist
in the
53706. Dr. Caspersen
of
and Evaluation
Division
Branch,
Epidemiology
School
Dance,
Madison,
Behavioral
Health
School
WI
Education,
Center
for Health
Promotion
and Education,
A.
30333. Richard
GA
Centers
for Disease
Control,
Atlanta,
of Epidemiol
PhD, Research
Washburn,
Fellow,
Department
of Pittsburgh,
made
of Public Health,
ogy, School
University
helpful
suggestions.
Tearsheet
requests
LaPorte.
CRITICAL FACTOR FOR EPIDEMIOLOGIC RE
Jl\
SEARCH is the accurate assessment
of the variables
under study. For the cardiovascular
risk factors of
serum
and
blood
cholesterol,
pressure,
smoking,
there are standardized
for assessment
of
techniques
the factors
that provide
measure
of
consistency
ment and definition
across studies. However,
with
research on physical
has
this
not
been
the
activity
case.
This
considers
No
in large-scale
practical
studies, al
approach
little is known about
their reliability
and
though
Studies
validity.
employing
objective
monitoring
and doubly
through heart rate, movement
sensors,
labeled water procedures
but are
appear promising,
still experimental
and costly. Despite
the difficulty
association
has
of measurement,
strong
relatively
been found
between
and
physical
activity
health,
suggesting
that,
even
with
in assessment
improvements
stronger
associations
should
be
seen.
their potential
for use in epidemiologic
to
four
respect
important criteria:
studies with
To be valid, the instrument must measure what
is intended to measure.
To be reliable,
the instrument must consistently
the same results
under
the
give
If the instrument
stances.
is reliable
also
seven major categories
of
assessment
that
have
physical
activity
procedures
been used in various settings (table 1) and evaluates
review
measures.
dietary
most
techniques,
to Dr.
and
monitors,
the criteria of being valid,
single instrument fulfills
while not affecting behavior.
reliable, and practical
The instruments
that are very precise
tend to be
on a population
basis. Surveys are the
impractical
of
Health,
University
PA 15261. Dr. Montoye
130 DeSoto
St., Pittsburgh,
Pittsburgh,
is a Professor
in the Department
of Physical
Education
and
Graduate
Epidemiology,
....
it
same circum
and valid, it is
accurate.
To be practical,
the instrument must have accept
able costs to both the investigator
and the partici
pant.
March-April
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1985, Vol. 100, No. 2
131