Evaluating Physical Activity

Original Editor - Anna Lowe

Top Contributors - Michelle Lee and Tarina van der Stockt  

Introduction

There are many reasons that, as physiotherapists we might want to measure physical activity (PA) levels.  If we are devoting clinical time to promoting PA then we need to be able to demonstrate effectiveness and show that we are making a difference, this might be with individual patients or with populations so measurement of some form is necessary.  Before you think about how to measure, think about why you want to measure and who the information is for.  For example you might want to measure for any of the following reasons;

  1. To understand baseline levels in the population of interest?
  2. To see whether a certain intervention is having an impact on PA levels?
  3. To motivate patients by showing progress?

Each of the above reasons might require a different type of data, for a different audience with a different objective.

There are also different components of PA that can be measured, for example you could measure the frequency with which someone is physically active, the intensity of their activity, the type of activity they engage in and the duration of that activity.  In some situations it's more appropriate to measure one of these aspects of activity but frequently it's more practical to try to get an overall meaurement of someones activity (their total physical activity over a given period of time).  It's really important to keep in mind that none of these measures are perfect and they all have advantages and disadvantages, it's a case of weighting up the pros and cons of a selection of measures in a given context.

Program evaluations using quality physical activity measures can contribute to achieving the goal of improved health.  At a community level good evaluations can lead to program improvements, documenting positive results can attract funding to continue and expand programs, and communicating results can persuade other communities to adopt effective approaches[1].

Ways of gathering physical activity data

Exisiting Records

This might include using information that is routinely collected, for example census information, surveys, polls, government data.  There is more information available than ever before and a quick literature search may reveal the information you need.  Sometimes the existing data doesn't quite meet our needs, this could be for many reasons including; it may be too broad and not focus on our population of interest, it may be in a format that doesn't suit us, it may have been gathered in a way that we don't feel is sufficiently detailed or it may be out of date.

Indirect Measures

These rely on self-report i.e. they ask the patient to estimate how much activity they have done in a given period.  They are useful because they are cheap and easy to complete.  There are obvious issues with relying on recall though, they may not be appropriate for some older populations and people with dementia for example.  There are also other issues such as trying to give a favourable result to please the assessor.  

There are lots of questionnaires and surveys available, in 2011 the UK National Obesity Observatory produced a report which reviewed the available tools and suggested the following shortlist are the most robust measurement tools (this doesn't mean that they are user friendly though!).   

Shortlist of selected questionnaires

Physical activity: children and young people

  1. The Physical Activity Questionnaire for Older Children/Adolescents (PAQC/PAQ-A)
  2. Youth Risk Behaviour Surveillance Survey (YRBSS)
  3. The Teen Health Survey

Physical activity: adults

  1. Stanford 7-day recall (7-DR)
  2. International Physical Activity Questionnaire Long version (IPAQ-Long)
  3. New Zealand Physical Activity Questionnaire (Short Form) (NZPAQ-Short)
  4. 7-day Physical Activity Diary

The IPAQ is a very well known method of quantifying physical activity levels, it's a useful document to find out more about quantifying and measuring physical activity:

Direct Measures

Direct measures use technology to measure activity levels, this is usually in the form of a device that will measure and record movement.  This might be a simple pedometer, an app on a smart phone or a sophisticated movement tracker.  

Direct measures are considered to be more accurate than self-report measures but they are costly and may not be appealing to some patients.  They also have limitations including;

  • Variable ability to detect very slow walking speeds; obvious implications for clinical populations.
  • Variable ability to measure movement in abnormal gait patterns.
  • Variable ability to gather data on certain types of activity.  Walking is usually fine but if the monitor is worn on the lower limb, upper limb activity is unlikely to be detected.  This has implications for wheelchair users or anyone who engages in chair-based exercise.

Evaluating PA is challenging and often hindered by the challenge of employing a valid, reliable measure that also adequately satisfies the research question or design[2] and literature suggests that there is little agreement between indirect and direct measures[3] However because of the barriers to accessing technology indirect measures are still frequently used. In their systematic review Skender et al [3] explored the correlation between self-reported PA and accelerometer data and found that accelerometers appear to provide slightly more consistent results in relation to self-reported physical activity but due to overall limited consistency both questionnaires and accelerometers should be used to gain the most complete physical activity information Kowalski[4] performed a systematic review of studies that had used direct and indirect tools to measure PA in older adults and found lack of a clear trend regarding the agreement between PA measures in older adults. 

Challenges

The more robust and reliable these are the more detailed and time consuming they become. Trying to find something that it valid, reliable AND user-friendly in clinical practice is a really difficult! It's important to remember;

  • Health and PA behaviours are complex.
  • Changes may take a long time to become apparent.
  • Different stakeholders are interested in different things.
  • You simply can't measure everything.

Resources

Physical activity assessment from the Medical Research Council

References

  1. Sallis JF. Measuring physical activity: practical approaches for program evaluation in Native American communities. Journal of public health management and practice: JPHMP. 2010 Sep;16(5):404.
  2. Sylvia LG, Bernstein EE, Hubbard JL, Keating L, Anderson EJ. A Practical Guide to Measuring Physical Activity. Journal of the Academy of Nutrition and Dietetics. 2014 Feb;114(2):199.
  3. 3.0 3.1 Skender S, Ose J, Chang-Claude J, Paskow M, Brühmann B, Siegel EM, Steindorf K, Ulrich CM. Accelerometry and physical activity questionnaires-a systematic review. BMC Public Health. 2016 Jun 16;16(1):1.
  4. Kowalski K, Rhodes R, Naylor PJ, Tuokko H, MacDonald S. Direct and indirect measurement of physical activity in older adults: a systematic review of the literature. International Journal of Behavioral Nutrition and Physical Activity. 2012 Dec 18;9(1):1.