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Open Access Highly Accessed Research

Direct and indirect measurement of physical activity in older adults: a systematic review of the literature

Kristina Kowalski1*, Ryan Rhodes2, Patti-Jean Naylor3, Holly Tuokko4 and Stuart MacDonald4

Author Affiliations

1 School of Exercise Science, Physical and Health Education and Department of Psychology, University of Victoria, Victoria, B.C, Canada

2 Behavioural Medicine Laboratory, Faculty of Education, University of Victoria, Victoria, B.C, Canada

3 School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, B.C, Canada

4 Department of Psychology, University of Victoria, Victoria, B.C, Canada

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International Journal of Behavioral Nutrition and Physical Activity 2012, 9:148  doi:10.1186/1479-5868-9-148

Published: 18 December 2012

Abstract

Background

Due to physiological and cognitive changes that occur with aging, accurate physical activity (PA) measurement in older adults represents a unique challenge. The primary purpose of this study was to systematically review measures of PA and their use and appropriateness with older adults. A secondary aim was to determine the level of agreement between PA measures in older adults.

Methods

Literature was identified through electronic databases. Studies were eligible if they examined the correlation and/or agreement between at least 2 measures, either indirect and/or direct, of PA in older adults (> 65 years of age).

Results

Thirty-six studies met eligibility criteria. The indirect and direct measures of PA across the studies differed widely in their ability to address the key dimensions (i.e., frequency, intensity, time, type) of PA in older adults. The average correlation between indirect and direct measures was moderate (r=0.38). The correlation between indirect and other indirect measures (r=0.29) was weak, while correlations between direct measures with other direct measures were high (real world: r= 0.84; controlled settings: r=0.92). Agreement was strongest between direct PA measures with other direct measures in both real world and laboratory settings. While a clear trend regarding the agreement for mean differences between other PA measures (i.e., direct with indirect, indirect with indirect) did not emerge, there were only a limited number of studies that reported comparable units.

Conclusions

Despite the lack of a clear trend regarding the agreement between PA measures in older adults, the findings underscore the importance of valid, accurate and reliable measurement. To advance this field, researchers will need to approach the assessment of PA in older adults in a more standardized way (i.e., consistent reporting of results, consensus over cut-points and epoch lengths, using appropriate validation tools). Until then researchers should be cautious when choosing measures for PA that are appropriate for their research questions and when comparing PA levels across various studies.

Keywords:
Older adults; Physical activity assessment; Direct measurement; Indirect measurement; Self-report; Questionnaires; Accelerometry; Pedometery; Heart rate monitoring; Indirect calorimetry; Doubly labeled water