Open Access Highly Accessed Open Badges Review

Validity of activity monitors in health and chronic disease: a systematic review

Hans Van Remoortel1, Santiago Giavedoni2, Yogini Raste3, Chris Burtin1, Zafeiris Louvaris4, Elena Gimeno-Santos5, Daniel Langer1, Alastair Glendenning6, Nicholas S Hopkinson3, Ioannis Vogiatzis4, Barry T Peterson7, Frederick Wilson7, Bridget Mann6, Roberto Rabinovich2, Milo A Puhan89, Thierry Troosters111* and PROactive consortium10

Author Affiliations

1 Faculty of Kinesiology and Rehabilitation Sciences, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium and Respiratory Division, UZ Gasthuisberg, Leuven, Belgium

2 ELEGI Colt Laboratory, Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, United Kingdom

3 NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, United Kingdom

4 Department of Physical Education and Sports Sciences, Thorax Foundation, Research Centre of Intensive & Emergency Thoracic Medicine, Athens, Greece and National & Kapodistrian University of Athens, Athens, Greece

5 Centre for Research in Environmental Epidemiology, Barcelona, Spain

6 Global Health Economics and Outcomes Research, Novartis Horsham Research Centre, Horsham, United Kingdom

7 Precision Medicine, Pfizer Worldwide Research and Development, Sandwich, Kent, United Kingdom

8 Horten Centre for Patient-oriented Research, University Hospital of Zürich, Zürich, Switzerland

9 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

10 PROactive consortium, Europe, Europe

11 Respiratory Rehabilitation and Respiratory Division, UZ Gasthuisberg, Herestraat 49 bus 706, Onderwijs & Navorsing I, Labo Pneumologie, B-3000, Leuven, Belgium

For all author emails, please log on.

International Journal of Behavioral Nutrition and Physical Activity 2012, 9:84  doi:10.1186/1479-5868-9-84

Published: 9 July 2012


The assessment of physical activity in healthy populations and in those with chronic diseases is challenging. The aim of this systematic review was to identify whether available activity monitors (AM) have been appropriately validated for use in assessing physical activity in these groups. Following a systematic literature search we found 134 papers meeting the inclusion criteria; 40 conducted in a field setting (validation against doubly labelled water), 86 in a laboratory setting (validation against a metabolic cart, metabolic chamber) and 8 in a field and laboratory setting. Correlation coefficients between AM outcomes and energy expenditure (EE) by the criterion method (doubly labelled water and metabolic cart/chamber) and percentage mean differences between EE estimation from the monitor and EE measurement by the criterion method were extracted. Random-effects meta-analyses were performed to pool the results across studies where possible. Types of devices were compared using meta-regression analyses. Most validation studies had been performed in healthy adults (n = 118), with few carried out in patients with chronic diseases (n = 16). For total EE, correlation coefficients were statistically significantly lower in uniaxial compared to multisensor devices. For active EE, correlations were slightly but not significantly lower in uniaxial compared to triaxial and multisensor devices. Uniaxial devices tended to underestimate TEE (−12.07 (95%CI; -18.28 to −5.85) %) compared to triaxial (−6.85 (95%CI; -18.20 to 4.49) %, p = 0.37) and were statistically significantly less accurate than multisensor devices (−3.64 (95%CI; -8.97 to 1.70) %, p<0.001). TEE was underestimated during slow walking speeds in 69% of the lab validation studies compared to 37%, 30% and 37% of the studies during intermediate, fast walking speed and running, respectively. The high level of heterogeneity in the validation studies is only partly explained by the type of activity monitor and the activity monitor outcome. Triaxial and multisensor devices tend to be more valid monitors. Since activity monitors are less accurate at slow walking speeds and information about validated activity monitors in chronic disease populations is lacking, proper validation studies in these populations are needed prior to their inclusion in clinical trials.

Chronic diseases; Doubly labelled water; Indirect calorimetry; Activity monitoring; Physical activity; Validation study; Systematic review