Physical Activity, Physical Fitness and Mental Health Assessment of Physical Activity and Sedentary Behavior Dr. Stijn De Baere Prof. Dr. Johan Lefevre KEY KNOWLEDGE / What is a subjective, objective and criterion physical activity assessment method? What are the advantages and disadvantages of each method? When should I use a certain method? BACKGROUND / (Global health risks WHO;2009) BACKGROUND / Recognition of the crucial role of PA for health purposes Increased interest in the (correct) assessment of PA: • Research & health professionals Epidemiology Development and evaluation of interventions Clinical purposes • Consumer-based self-monitoring Feedback Motivation & goal setting PHYSICAL ACTIVITY / PA is a multidimensional behavior: FITT-principle - Frequency : Intensity : Time : Type : # of sessions physiological effort duration of sessions what type of activity? + Context: time & place, posture, social parameters PA = complex behavior Assessing PA is a challenging tasks Why measuring physical activity and sedentary behavior? To measure is to know: ‘If you cannot measure it, you cannot improve it’ L. Kelvin, 1824-1907 WHY ? / At the population level: • To understand the dose-response relationship between • • • • PA/SB and health outcomes To identify current and changing activity levels within populations To monitor compliance with public health guidelines To identify the biological, psychological and environmental factors that influence PA/SB To determine the effectiveness of interventions WHY ? / At the individual level: • To identify current activity levels • To detect change in an individual’s behavior • Feedback, motivation and goal-setting Physical (in)activity assessment techniques PA ASSESSMENT / overview 1. SUBJECTIVE METHODS • Questionnaires • Diaries 2. OBJECTIVE METHODS • Heart rate monitors • Pedometers • Acclerometers • GPS • Multisensor devices 3. CRITERION METHODS • Direct calorimetry • Indirect calorimetry • Doubly labeled water • Direct observation PA ASSESSMENT / overview 1. SUBJECTIVE METHODS • Questionnaires • Diaries 2. OBJECTIVE METHODS • Heart rate monitors • Pedometers • Accelerometers • GPS • Multisensor devices 3. CRITERION METHODS • Direct calorimetry • Indirect calorimetry • Doubly labeled water • Direct observation PA ASSESSMENT / overview 1. SUBJECTIVE METHODS • Questionnaires • Diaries 2. OBJECTIVE METHODS • Heart rate monitors • Pedometers • Acclerometers • GPS • Multisensor devices 3. CRITERION METHODS • Direct calorimetry • Indirect calorimetry • Doubly labeled water • Direct observation SUBJECTIVE METHODS SUBJECTIVE / types Self-report techniques: • Self-administered questionnaire IPAQ, Baecke, Pfaffenberger,… • Interviewer-administered questionnaire Face-to-face, phone, Skype • Proxy-report questionnaire e.g. parents on PA behavior of children • Diaries Daily chronological recall of activity behavior • PA logs Similar to diaries but less burdensome: checklist SUBJECTIVE / pro’s & con’s • • • • • Inexpensive, allowing large sample sizes Quantitative and qualitative information Low participant burden Can be administered quickly Estimate EE trough Ainsworth Compendium • Reliability and validity: recall of PA Especially in youth and elderly • Interpretation bias • Social desirability bias • Data processing: labour- and time-consuming Implications for large-scale studies SUBJECTIVE / evolution Digital evolution: - Computerized questionnaires: No missing data, no coding error, no data entry, immediate report, skip needless questions - Electronic diaries Real-time registration of activity type (no recall bias) - Ecological momentary assessment = answer on prompts on smartphone or PDA Context of activity behavior - Environmental - Social - Emotional -… OBJECTIVE / overview Established methods Emerging methods Topics • • • • • • Definition Placement Outcome parameters Mechanism Research devices Specific devices Consumer devices Pro’s & Con’s OBJECTIVE METHODS: established techniques OBJECTIVE / heart rate Heart rate provides a direct indicator of the physiological response to PA Moderate to vigorous PA: linear relationship between HR and oxygen consumption Lower intensities and rest: non-linear = confounded by other factors: e.g. caffeine, stress, smoking, temperature,… Outcomes • Heart rate bpm (average, min and max ) • EE (subject/group derived regression equations) OBJECTIVE / heart rate Placement • Classic HR belt + watch • Wrist-worn: optical sensors (consumer devices) OBJECTIVE / heart rate Photoplethysmography (PPG) OBJECTIVE / heart rate Moov HR: Head sweatband with integrated photoplethysmography sensor (consumer device) OBJECTIVE / heart rate Infrared sensor OBJECTIVE / heart rate • • • • Directly related to physiological response to PA Lightweight and portable Relatively cheap Minute-by-minute data collection (time pattern) • Confounding factors of HR - VO2 relationship temperature, humidity, hydratation, stress, age, gender, muscle mass • Individual calibration of HR - VO2 relationship required Implications for large-scale studies • Not suited for low intensity EE estimation • Discomfort of chest strap OBJECTIVE / pedometer A pedometer or step counter records the number of steps taken. Placement • • • • Usually worn on belt or waistband Midline of the thigh Left or right (consistency!) Also wrist, ankle or shoe Outcomes • # steps • Distance (stride length) • Calories (sum of EE per step) OBJECTIVE / pedometer Mechanims • Spring-levered Plastic lever arm (e.g. Digiwalker) Electric circuit Spring Battery • Piezo-electric Piezo element External force Electric voltage (cut-off) OBJECTIVE / pedometer Research devices Stepwatch Digiwalker OBJECTIVE / pedometer Consumer devices Fitbit Zip Yamax Powerwalker Pedometer apps … OBJECTIVE / pedometer • • • • • Simple and accurate Inexpensive Unobtrusive (low participant burden) Extended periods of monitoring possible 10.000 steps guideline (goal setting) • Only ambulatory activities • Less accurate for distance constant stride length • Less accurate for EE no distinction between walking/running/stair climbing • Validity compromised in: obese, frail older individuals, gait abnormalities • No information on activity pattern OBJECTIVE / accelerometer Accelerometers measure body movement in terms of acceleration. Placement • Mostly on belt or waistband • Recently: wrist-worn (less obstructive) Outcomes • Counts Product of amplitude and frequency of the acceleration • Energy expenditure Linear regression equation using counts and personal data • Intensity classification Intensity cut points for activity counts • Steps OBJECTIVE / accelerometer Output: Downloading the data to the computer for data processing and analysis OBJECTIVE / accelerometer Mechanism • Registration of acceleration on 1, 2 or 3 axis • Piezo-electric sensors voltage proportional to acceleration filtering of raw signal OBJECTIVE / accelerometer Research devices RT3 - Tritrac ActiGraph Actical OBJECTIVE / accelerometer Consumer devices Polar Loop Caloriscan FitBit Flex 2 … Moov OBJECTIVE / accelerometers • Accurate (counts) • Information on patterns of PA: duration, intensity, frequency • Minute-by-minute data • Multiple days of monitoring possible • Missed activities: upper body, load-carrying, cycling, water-based • • • • More technical expertise Wear vs non-wear Different intensity cut-offs (generalization) Underestimation at highest intensities OBJECTIVE METHODS: emerging techniques OBJECTIVE / activPAL Classification of periods of sitting/lying, standing and walking. Objective recording of sedentary behavior Inclinometer + uniaxial accelerometer OBJECTIVE / activPAL OBJECTIVE / posture OBJECTIVE / GPS Global positioning system and physical activity monitoring: Mostly consumer devices Focus on sports Combination with classic heart-rate belt Outcomes • • • • Speed Distance Altitude Location (context) OBJECTIVE / GPS Emerging in physical activity research for contextual data. complex analysis OBJECTIVE / GPS Importance of up-to-date geographical information systems (GIS). OBJECTIVE / GPS • Promising tool for complementing other PA measures • Relationship between environment and activity where does activity occur? • Accuracy • Loss of signal • Quality of geographical information system OBJECTIVE / multisensor Integration of multiple sensors into one device. Research Devices: Actiheart IDEEA SenseWear OBJECTIVE / actiheart HR monitor + integrated accelerometer Placement Clip on to ECG electrodes on the chest Outcomes: o o o o Counts HR PAEE Time spent in different intensity categories OBJECTIVE / actiheart • Waterproof • More precise estimate of PAEE Counters disadvantages of each method alone • Relatively expensive • Skin irritation • Individual calibration needed OBJECTIVE / sensewear The device combines 3-axial accelerometry with different physiological measures for the estimation of EE. Placement Left upper arm over the triceps Outcomes • Energy expenditure PAL and calories • • • • Intensity classification Steps Sleep Activity classification OBJECTIVE / sensewear Mechanism OBJECTIVE / sensewear • • • • • • Location on body 24 h per day (also sleep) Wear vs non-wear Activity classification Activity pattern Non-ambulatory activities • • • • Proprietary algorithms: issue in research Water-based activities Higher intensities (i.e. > 9 METs) No longer produced … OBJECTIVE / ideea = Intelligent Device for Energy Expenditure and Activity OBJECTIVE / ideea 5 small sensors (1 chest, 2 thigh, 2 feet) + 200g data collection device Pattern recognition identification of 32 activities Output: • Type of activity • Duration • Estimated intensity OBJECTIVE / ideea • Very accurate for assessing activity mode, duration and intensity • Detailed PA measurement useful for clinical applications (e.g. movement disorders) • Expensive • Limited memory (48h) • Intrusive with 5 wired sensors OBJECTIVE / multisensor Recent consumer Devices: Polar V800 FitBit Ionic … Jawbone UP3 OBJECTIVE / fitbit OBJECTIVE / fitbit OBJECTIVE / multisensor Recent consumer Devices: Polar V800 FitBit Ionic Jawbone UP3 Integration of sensor outputs = biggest challenge … ALGORITHMS / Translates the raw data of the different sensors into meaningful PA outcomes. Input data ALGORITHM ‘ BLACK BOX ’ PA output FUTURE: optimalisation of algorithms Pattern recognition: PA classification (when to apply a certain algorithm = complex flow-chart) New modelling approaches Important for research: open source algorithms PAVLOK / CRITERION METHODS CRITERION / direct calorimetry Measuring EE by measuring heat production or heat loss CRITERION / direct calorimetry • Accurate to quantify EE during rest and PA • • • • Expensive Time consuming: not for large-scale studies Requires expertise In most cases not feasible CRITERION / indirect calorimetry Measuring EE from O2 consumption and CO2 production with a mouthpiece, facemask or canopy during rest or exercise CRITERION / indirect calorimetry • Accurate and valid measurement of short term EE • Expensive • Time consuming: not for large-scale studies • Inability to simulate true free-living situation CRITERION / DLW Biochemical procedure that can estimate EE through biological markers that reflect the rate of metabolism in the body CRITERION / DLW • Ingestion of a standardized amount of 2 stable isotopes of water: 18O en 2H • The isotopes distribute themselves in equilibrium with the body water • Urine samples are collected at the beginning and end of the measurement period • Difference in elimination rates of the isotopes provide a measure of CO2 production and therefore EE CRITERION / DLW • Accurate and valid measurement of EE • Applicable for children and adults • Induces no change in PA behavior usual movement pattern • Expensive: not for large-scale studies • Requires expertise • No indication of PA pattern, only total EE CRITERION / direct observation Direct behavioral observation of the activities by experienced observers CRITERION / direct observation • Classify PA behaviors into distinct categories that can be quantified and analysed by using codes • Numerous instruments or systems each designed for specific purposes each with specific protocols for use • Mostly used for children or schools CRITERION / DLW • Excellent quantitative and qualitative information frequency, intensity, time, type and context • Applicable for children • • • • Time and labour intensive Not appropriate in large-scale studies Potential reactivity of subjects Subjectivity of observers intensive training needed Selection of an appropriate assessment technique SELECTION / The selection of appropriate tool depends on the characteristics of the… A. Study • • • • • Research question Design Resources & budget Sample size … B. Population • • • • • Age Etnicity Cognitive ability Health status … C. Activities • • • • • Activity type Activity domains Instensities Sports … SELECTION / SELECTION / SELECTION / combination Intensity, frequency, duration Type Full spectrum Overall and domain-specific PA and SB EVALUATION / profiling Create a more accurate and integrated image of an individuals PA behavior using all the important PA components. Health targets: 1. 2. 3. 4. 5. PAL: ≥ 1.75 METs MVPA: 30 min Vigorous: 20 min Steps: ≥ 10.000 Sedentary: ≤ 7h PAL Sedentary MVPA # Steps Vigorous EVALUATION / ‘bewegingsdriehoek’ EVALUATION / be critical Don’t take all the data ‘for granted’… be critical and evaluate with subject. - Reactivity - Seasonality - Specific pastimes -… KEY KNOWLEDGE / What is a subjective, objective and criterion physical activity assessment method? What are de advantages and disadvantages of each method? When should I use a certain method? THANK YOU FOR YOUR ATTENTION! QUESTIONS ?
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