European Journal of Epidemiology

, Volume 22, Issue 6, pp 353–362 | Cite as

Assessment of physical activity and energy expenditure in epidemiological research of chronic diseases

Review Paper


Physical inactivity has emerged as an important risk factor for a number of diseases, but the typically crude exposure assessments in epidemiological studies, with entailing variation in measurement accuracy, may be a source of heterogeneity contributing to inconsistent results among studies. Consequently, the choice of method for the assessment of physical activity in epidemiological studies is important. Good methods increase our chances of avoiding misclassification and may enhance our understanding of the association between physical activity and health. Since physical activity is also a potential confounder of other lifestyle-health relationships, good methods may enhance our ability to control for confounding. But despite a steadily increasing selection of methods to choose from, no method is suitable for every situation and every population. Although the questionnaire is the most widely used method in epidemiological studies, and laboratory methods are mainly used for validation purposes, improved technology may change our ways of assessing physical activity in the future. This paper describes different methods to measure physical activity and energy expenditure from the epidemiological perspective, and attempts to address the concepts related to the measurement of physical activity.


Energy metabolism Epidemiologic methods Exercise Leisure activities Questionnaires Review 


  1. 1.
    Morris JN, Crawford MD. Coronary heart disease and physical activity of work; evidence of a national necropsy survey. Br Med J 1958;2:1485–96.PubMedGoogle Scholar
  2. 2.
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep 1985;100:126–31.PubMedGoogle Scholar
  3. 3.
    Bassett DR Jr. Validity and reliability issues in objective monitoring of physical activity. Res Q Exerc Sport 2000;71:S30–6.PubMedGoogle Scholar
  4. 4.
    IARC. IARC handbooks of cancer prevention: weight control and physical activity. Lyon: IARC Press; 2002.Google Scholar
  5. 5.
    Howley ET. Type of activity: resistance, aerobic and leisure versus occupational physical activity. Med Sci Sports Exerc 2001;33:S364–9; discussion S419–20.PubMedCrossRefGoogle Scholar
  6. 6.
    Guyton AC. Textbook of medical physiology. United States of America: W.B. Saunders Company, Harcourt Brace Jovanovich, Inc.; 1991.Google Scholar
  7. 7.
    Lamonte MJ, Ainsworth BE. Quantifying energy expenditure and physical activity in the context of dose response. Med Sci Sports Exerc 2001;33:S370–8; discussion S419–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities [see comments]. Med Sci Sports Exerc 1993;25:71–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32:S498–504.PubMedCrossRefGoogle Scholar
  10. 10.
    Ainsworth BE. The compendium of physical activities tracking guide: Prevention Research Center, Norman J. Arnold School of Public Health, University of South Carolina; 2002 (January).Google Scholar
  11. 11.
    Shephard RJ. Absolute versus relative intensity of physical activity in a dose-response context. Med Sci Sports Exerc 2001;33:S400–18; discussion S419–20.PubMedCrossRefGoogle Scholar
  12. 12.
    McTiernan A, Kooperberg C, White E, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 2003;290:1331–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Sequeira MM, Rickenbach M, Wietlisbach V, Tullen B, Schutz Y. Physical activity assessment using a pedometer and its comparison with a questionnaire in a large population survey. Am J Epidemiol 1995;142:989–99.PubMedGoogle Scholar
  14. 14.
    Liu S, Lee IM, Linson P, Ajani U, Buring JE, Hennekens CH. A prospective study of physical activity and risk of prostate cancer in US physicians. Int J Epidemiol 2000;29:29–35.PubMedCrossRefGoogle Scholar
  15. 15.
    Lamb KL, Brodie DA. Leisure-time physical activity as an estimate of physical fitness: a validation study. J Clin Epidemiol 1991;44:41–52.PubMedCrossRefGoogle Scholar
  16. 16.
    Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999;341:650–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Aaron DJ, Kriska AM, Dearwater SR, Cauley JA, Metz KF, LaPorte RE. Reproducibility and validity of an epidemiologic questionnaire to assess past year physical activity in adolescents. Am J Epidemiol 1995;142:191–201.PubMedGoogle Scholar
  18. 18.
    The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol 1988;41:105–14.CrossRefGoogle Scholar
  19. 19.
    Luoto R, Latikka P, Pukkala E, Hakulinen T, Vihko V. The effect of physical activity on breast cancer risk: a cohort study of 30,548 women. Eur J Epidemiol 2000;16:973–80.PubMedCrossRefGoogle Scholar
  20. 20.
    Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med 2003;37:197–206; discussion 206.PubMedCrossRefGoogle Scholar
  21. 21.
    American College of Sports Medicine position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 1990;22:265–74.Google Scholar
  22. 22.
    CDC. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: USA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.Google Scholar
  23. 23.
    Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine [see comments]. JAMA 1995;273:402–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Kesaniemi YK, Danforth E Jr, Jensen MD, Kopelman PG, Lefebvre P, Reeder BA. Dose-response issues concerning physical activity and health: an evidence-based symposium. Med Sci Sports Exerc 2001;33:S351–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Pivarnik JM, Reeves MJ, Rafferty AP. Seasonal variation in adult leisure-time physical activity. Med Sci Sports Exerc 2003;35:1004–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Matthews CE, Freedson PS, Hebert JR, et al. Seasonal variation in household, occupational, and leisure time physical activity: longitudinal analyses from the seasonal variation of blood cholesterol study. Am J Epidemiol 2001;153:172–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Levin S, Jacobs DR Jr, Ainsworth BE, Richardson MT, Leon AS. Intra-individual variation and estimates of usual physical activity. Ann Epidemiol 1999;9:481–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Merrill RM, Shields EC, White GL Jr, Druce D. Climate conditions and physical activity in the United States. Am J Health Behav 2005;29:371–81.PubMedGoogle Scholar
  29. 29.
    Ma Y, Olendzki BC, Li W, et al. Seasonal variation in food intake, physical activity, and body weight in a predominantly overweight population. Eur J Clin Nutr 2006;60(4):519–28.Google Scholar
  30. 30.
    Fogelholm M, Suni J, Rinne M, Oja P, Vuori I. Physical activity pie: a graphical presentation integrating recommendations for fitness and health. J Physical Activity Health 2005;2:391–6.Google Scholar
  31. 31.
    Pols MA, Peeters PH, Kemper HC, Grobbee DE. Methodological aspects of physical activity assessment in epidemiological studies. Eur J Epidemiol 1998;14:63–70.PubMedCrossRefGoogle Scholar
  32. 32.
    Ainsworth BE, Montoye HJ, Leon AS. Methods of assessing physical activity during leisure, work. In: Bouchard C, Shepard RJ, Stephens T, editors. Physical Activity, fitness and health: international proceedings and consensus statement. Champaign IL: Human Kinetics; 1994. p. 146–59.Google Scholar
  33. 33.
    Franks PW, Ravussin E, Hanson RL, et al. Habitual physical activity in children: the role of genes and the environment. Am J Clin Nutr 2005;82:901–8.Google Scholar
  34. 34.
    Montgomery C, Reilly JJ, Jackson DM, et al. Validation of energy intake by 24-hour multiple pass recall: comparison with total energy expenditure in children aged 5–7 years. Br J Nutr 2005;93:671–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Butte NF, Wong WW, Treuth MS, Ellis KJ, O’Brian Smith E. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 2004;79:1078–87.PubMedGoogle Scholar
  36. 36.
    Wareham NJ, Hennings SJ, Prentice AM, Day NE. Feasibility of heart-rate monitoring to estimate total level and pattern of energy expenditure in a population-based epidemiological study: the Ely Young Cohort Feasibility Study 1994–1995. Br J Nutr 1997;78:889–900.PubMedCrossRefGoogle Scholar
  37. 37.
    Wareham NJ, Jakes RW, Rennie KL, et al. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 2003;6:407–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Healey J. Future possibilities in electronic monitoring of physical activity. Res Q Exerc Sport 2000;71:S137–45.PubMedGoogle Scholar
  39. 39.
    LaMonte MJ, Blair SN, Church TS. Physical activity and diabetes prevention. J Appl Physiol 2005;99:1205–13.PubMedCrossRefGoogle Scholar
  40. 40.
    Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc 2001;33:S379–99; discussion S419–20.PubMedCrossRefGoogle Scholar
  41. 41.
    Franks PW, Wong MY, Luan J, Mitchell J, Hennings S, Wareham NJ. Non-esterified fatty acid levels and physical inactivity: the relative importance of low habitual energy expenditure and cardio-respiratory fitness. Br J Nutr 2002;88:307–13.PubMedCrossRefGoogle Scholar
  42. 42.
    Brage S, Wedderkopp N, Ekelund U, et al. Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS). Diabetes Care 2004;27:2141–8.PubMedCrossRefGoogle Scholar
  43. 43.
    Franks PW, Ekelund U, Brage S, Wong MY, Wareham NJ. Does the association of habitual physical activity with the metabolic syndrome differ by level of cardiorespiratory fitness? Diabetes Care 2004;27:1187–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Bouchard C, An P, Rice T, et al. Familial aggregation of VO(2max) response to exercise training: results from the HERITAGE Family Study. J Appl Physiol 1999;87:1003–8.PubMedGoogle Scholar
  45. 45.
    Le Masurier GC, Lee SM, Tudor-Locke C. Motion sensor accuracy under controlled and free-living conditions. Med Sci Sports Exerc 2004;36:905–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Tudor-Locke CE, Myers AM. Challenges and opportunities for measuring physical activity in sedentary adults. Sports Med 2001;31:91–100.PubMedCrossRefGoogle Scholar
  47. 47.
    Plasqui G, Joosen AM, Kester AD, Goris AH, Westerterp KR. Measuring free-living energy expenditure and physical activity with triaxial accelerometry. Obes Res 2005;13:1363–9.PubMedGoogle Scholar
  48. 48.
    Bouten CV, Westerterp KR, Verduin M, Janssen JD. Assessment of energy expenditure for physical activity using a triaxial accelerometer. Med Sci Sports Exerc 1994;26:1516–23.PubMedGoogle Scholar
  49. 49.
    Ekelund U. Assessment of physical activity and energy expenditure in adolescents [Dissertation]. The Department of Medical Nutrition. Stockholm: Karolinska Institutet; 2002.Google Scholar
  50. 50.
    Brage S, Brage N, Franks PW, Ekelund U, Wareham NJ. Reliability and validity of the combined heart rate and movement sensor Actiheart. Eur J Clin Nutr 2005;59:561–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Zhang K, Pi-Sunyer FX, Boozer CN. Improving energy expenditure estimation for physical activity. Med Sci Sports Exerc 2004;36:883–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Pereira MA, FitzerGerald SJ, Gregg EW, et al. A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 1997;29:S1–205.PubMedGoogle Scholar
  53. 53.
    Borg GA. Perceived exertion. Exerc Sport Sci Rev 1974;2:131–53.PubMedCrossRefGoogle Scholar
  54. 54.
    Borg G. Psychophysical scaling with applications in physical work and the perception of exertion. Scan J Work Environ Health 1990;16:55–8.Google Scholar
  55. 55.
    Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. Relative intensity of physical activity and risk of coronary heart disease. Circulation 2003;107:1110–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Warnecke RB, Johnson TP, Chavez N, et al. Improving question wording in surveys of culturally diverse populations. Ann Epidemiol 1997;7:334–42.PubMedCrossRefGoogle Scholar
  57. 57.
    Marcus PM, Newman B, Moorman PG, et al. Physical activity at age 12 and adult breast cancer risk (United States). Cancer Causes Control 1999;10:293–302.PubMedCrossRefGoogle Scholar
  58. 58.
    Verloop J, Rookus MA, van der Kooy K, van Leeuwen FE. Physical activity and breast cancer risk in women aged 20–54 years. J Natl Cancer Inst 2000;92:128–35.PubMedCrossRefGoogle Scholar
  59. 59.
    Villeneuve PJ, Morrison HI, Craig CL, Schaubel DE. Physical activity, physical fitness, and risk of dying. Epidemiology 1998;9:626–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Smith GD, Shipley MJ, Batty GD, Morris JN, Marmot M. Physical activity and cause-specific mortality in the Whitehall study. Public Health 2000;114:308–15.CrossRefGoogle Scholar
  61. 61.
    Ainsworth BE, Jacobs DR Jr, Leon AS. Validity and reliability of self-reported physical activity status: the Lipid Research Clinics questionnaire. Med Sci Sports Exerc 1993;25:92–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc 1993;25:81–91.PubMedCrossRefGoogle Scholar
  63. 63.
    Albanes D, Conway JM, Taylor PR, Moe PW, Judd J. Validation and comparison of eight physical activity questionnaires. Epidemiology 1990;1:65–71.PubMedCrossRefGoogle Scholar
  64. 64.
    Trolle-Lagerros Y, Mucci LA, Kumle M, et al. Physical activity as a determinant of mortality in women. Epidemiology 2005;16:780–5.PubMedCrossRefGoogle Scholar
  65. 65.
    Fogelholm M, Malmberg J, Suni J, et al. International Physical Activity Questionnaire: Validity against fitness. Med Sci Sports Exerc 2006;38:753–60.PubMedCrossRefGoogle Scholar
  66. 66.
    Vaz de Almeida MD, Graca P, Afonso C, D’Amicis A, Lappalainen R, Damkjaer S. Physical activity levels and body weight in a nationally representative sample in the European Union. Public Health Nutr 1999;2:105–13.CrossRefGoogle Scholar
  67. 67.
    Levi F, Pasche C, Lucchini F, La Vecchia C. Occupational and leisure time physical activity and the risk of breast cancer. Eur J Cancer 1999;35:775–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Taylor HL, Jacobs DR Jr, Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 1978;31:741–55.PubMedCrossRefGoogle Scholar
  69. 69.
    Folsom AR, Jacobs DR Jr, Caspersen CJ, Gomez-Marin O, Knudsen J. Test-retest reliability of the Minnesota Leisure Time Physical Activity Questionnaire. J Chronic Dis 1986;39:505–11.PubMedCrossRefGoogle Scholar
  70. 70.
    Elosua R, Garcia M, Aguilar A, Molina L, Covas MI, Marrugat J. Validation of the Minnesota Leisure Time Physical Activity Questionnaire In Spanish Women. Investigators of the MARATDON Group. Med Sci Sports Exerc 2000;32:1431–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Richardson MT, Leon AS, Jacobs DR Jr, Ainsworth BE, Serfass R. Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol 1994;47:271–81.PubMedCrossRefGoogle Scholar
  72. 72.
    Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95.PubMedCrossRefGoogle Scholar
  73. 73.
    Rutten A, Vuillemin A, Ooijendijk WT, et al. Physical activity monitoring in Europe. The European Physical Activity Surveillance System (EUPASS) approach and indicator testing. Public Health Nutr 2003;6:377–84.PubMedCrossRefGoogle Scholar
  74. 74.
    Falkner KL, McCann SE, Trevisan M. Participant characteristics and quality of recall of physical activity in the distant past. Am J Epidemiol 2001;154:865–72.PubMedCrossRefGoogle Scholar
  75. 75.
    Lagerros YT, Mucci LA, Bellocco R, Nyren O, Balter O, Balter KA. Validity and reliability of self-reported total energy expenditure using a novel instrument. Eur J Epidemiol 2006;21:227–36.PubMedCrossRefGoogle Scholar
  76. 76.
    Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport 2000;71:S1–14.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  1. 1.Unit of Clinical EpidemiologyKarolinska InstitutetStockholmSweden
  2. 2.Department of Hygiene and EpidemiologyUniversity of Athens Medical SchoolAthensGreece
  3. 3.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden

Personalised recommendations