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Review Article

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

, , , &
Pages 2-27 | Received 22 Apr 2008, Published online: 12 Jul 2009
 

Abstract

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 (≤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: −0.56–0.89). 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.

Acknowledgements

The authors would like to thank Margaret Sampson and Raymond Daniel for their assistance in designing and performing the search strategy and Hanna Imad for aiding with the title and abstract screening. A special thank you goes to Jill Hardt for her assistance in the creation of the Forest plots and review of the manuscript. KBA acknowledges financial support from Statistics Canada for the development of the present paper. SAP is funded by an Ontario Graduate Scholarship and University of Ottawa Excellence Scholarship. ACT is funded by a University of Ottawa Excellence Scholarship and a Canadian Institutes of Health Research Graduate Scholarship.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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