Clinical use of objective measures of physical activity
Abstract
With measurement of physical activity becoming more common in clinical practice, it is imperative that healthcare professionals become more knowledgeable about the different methods available to objectively measure physical activity behaviour. Objective measures do not rely on information provided by the patient, but instead measure and record the biomechanical or physiological consequences of performing physical activity, often in real time. As such, objective measures are not subject to the reporting bias or recall problems associated with self-report methods. The purpose of this article was to provide an overview of the different methods used to objectively measure physical activity in clinical practice. The review was delimited to heart rate monitoring, accelerometers and pedometers since their small size, low participant burden and relatively low cost make these objective measures appropriate for use in clinical practice settings. For each measure, strengths and weakness were discussed; and whenever possible, literature-based examples of implementation were provided.
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Wearable accelerometers enable the capturing of all components (intensity, type, or duration) of physical activity spread throughout the day and more accurately measure sedentary behavior by offsetting recall and social desirability biases.
“In contrast to self-reports, wearable accelerometers enable the capturing of all components (intensity, type, or duration) of PA spread throughout the day and more accurately measure SB by offsetting recall and social desirability biases.22”
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“The raw data are rectified by proprietary software to activity counts, which are proportionate to the HPA of the wearer.(78) Accelerometry has good concurrent validity with oxygen consumption (VO2) for PA intensity in youth with CP GMFCS I–III.”
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“Objective methods used to assess PA, such as accelerometers, are appropriate for clinical settings due to the low participant burden and relatively low cost (Trost and O'Neil, 2014).”
MethodMorelhao, P. K., Franco, M. R., Oliveira, C. B., Hisamatsu, T. M., Ferreira, P. H., Costa, L. O. P., Maher, C. G., & Pinto, R. Z. (2018) · Clinical Rehabilitation · doi:10.1177/0269215518787015 · Cited by 20 · see citing works
Why machine learning (ML) has failed physical activity research and how we can improve
Fuller, D., Ferber, R., & Stanley, K. G. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001259 · Cited by 20 · see citing works
Cook, A. J., Gargiulo, G. D., Lehmann, T., & Hamilton, T. J. (2015) · Electronics Letters · doi:10.1049/el.2015.2764 · Cited by 19 · see citing works
Friederichs, S. A. H., Bolman, C. A. W., Oenema, A., Verboon, P., & Lechner, L. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.11.003 · Cited by 18 · see citing works
“It is recommended that more objective measures of PA behaviors are used in future studies of web-based PA interventions (Lyons et al., 2014; Trost and O'Neil, 2014).”
MethodObjectively Measured Physical Activity in Older Adults With and Without Diabetes
Hult, A., Johansson, J., Nordström, P., & Nordström, A. (2018) · Clinical Diabetes · doi:10.2337/cd18-0041 · Cited by 18 · see citing works
de Müllenheim, P., Chaudru, S., Mahé, G., Prioux, J., & Faucheur, A. L. (2015) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12512 · Cited by 18 · see citing works
“…proposed an overview of the different ambulatory devices to be used in clinical practice, they specifically focused on the measurement of PA, not functional impairment, and they did not address the specific use of such ambulatory devices in PAD patients (Strath et al., 2013; Trost & O’Neil, 2014).”
MethodJimenez‐Moreno, C., Charman, S. J., Nikolenko, N., Larweh, M., Turner, C., Gorman, G. S., Lochmüller, H., & Catt, M. (2018) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1482376 · Cited by 18 · see citing works
Berger, M., Bertrand, A. M., Robert, T., & Chèze, L. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1236143 · Cited by 17 · see citing works
“These sensors measure the biomechanical characteristics and/or physiological effects of physical activity (16).”
BackgroundMethodBooth, G., Howarth, A., Stubbs, B., & USSHER, M. H. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.11.004 · Cited by 14 · see citing works
Validation of a pouch-mounted activPAL3 accelerometer
Stanton, R., Guertler, D., Duncan, M. J., & Vandelanotte, C. (2014) · Gait & Posture · doi:10.1016/j.gaitpost.2014.07.024 · Cited by 16 · see citing works
“The increased use of objective monitoring of sedentary and physical activity behaviours has advanced our knowledge of how these behaviours impact on health [1].”
BackgroundPetersen, B. A., Erickson, K. I., Kurowski, B. G., Boninger, M. L., & Treble‐Barna, A. (2024) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-024-01327-8 · Cited by 15 · see citing works
“Though accelerometry is becoming more accessible, heart rate monitoring has long been discussed as an appealing alternative measure of physical activity [87].”
BackgroundŠilarova, B., Lucas, J., Butterworth, A. S., Angelantonio, E. D., Girling, C., Lawrence, K., Mackintosh, S., Moore, C. S., Payne, R., Sharp, S. J., et al. (2015) · BMC Public Health · doi:10.1186/s12889-015-2192-5 · Cited by 14 · see citing works
“Response Efficacy ✓ ✓ self-report as used in previous behavioural research [52, 69]”
BackgroundMethodA Descriptive Study of Objectively Measured Pokémon GO Playtime in College Students
Fountaine, C. J., Springer, E. J., & Sward, J. R. (2018) · International journal of exercise science · doi:10.70252/ghml5307 · Cited by 14 · see citing works
“The potential for reporting bias or recall problems associated with self-report instruments is a well-known limitation (19), whereas measuring step counts with smartphone applications that have not been well validated (3) is also a serious limitation of previous Pokémon GO research.”
BackgroundPhysical Activity in a Randomized Culturally Adapted Lifestyle Intervention
Siddiqui, F., Koivula, R. W., Kurbasic, A., Lindblad, U., Nilsson, P. M., & Bennet, L. (2018) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2018.04.016 · Cited by 13 · see citing works
Braakhuis, H. E. M., Roelofs, J. M. B., Berger, M., Ribbers, G. M., Weerdesteyn, V., & Bussmann, J. B. J. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1851781 · Cited by 13 · see citing works
“Walking is the most common and important movement for stroke survivors in daily activities and participation in society [11,38,39].”
BackgroundThe importance of physical activity
Langer, D., Demeyer, H., Troosters, T., & Gosselink, R. (2015) · European Respiratory Society eBooks · doi:10.1183/2312508x.10019914 · Cited by 12 · see citing works
“Objective measures of physical activity do not rely on information provided by the patient, but instead register biomechanical and/or physiological consequences of performing physical activity [43].”
BackgroundMethodInfluentialAccuracy of piezoelectric pedometer and accelerometer step counts
Cruz, J., Brooks, D., & Marques, A. S. P. D. D. (2017) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.16.06177-x · Cited by 12 · see citing works
Baque, E., Sakzewski, L., Trost, S. G., Boyd, R. N., & Barber, L. A. (2017) · Pediatric Physical Therapy · doi:10.1097/pep.0000000000000439 · Cited by 11 · see citing works
Physical activity dimensions after stroke: patterns and relation with lower limb motor function
Braakhuis, H. E. M., Berger, M., Regterschot, R. G. R. H., van Wegen, E. E. H., Selles, R. W., Ribbers, G. M., Bussmann, J. B. J., Meskers, C. G. M., Kwakkel, G., van Wegen, E. E. H., et al. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00960-x · Cited by 10 · see citing works
Daniels, K., Quadflieg, K., Robijns, J., Vry, J. D., Alphen, H. V., Beers, R. V., Sourbron, B., Vanbuel, A., Meekers, S., Mattheeussen, M., et al. (2025) · Sensors · doi:10.3390/s25030858 · Cited by 10 · see citing works
“These tools offer reliable, precise, and reproducible data on the frequency, intensity, and duration of PA, facilitating greater standardization and reproducibility [11–13].”
Lee, J. A., Heberlein, E., Pyle, E. E., Caughlan, T., Rahaman, D., Sabin, M., & Kaar, J. L. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100721 · Cited by 10 · see citing works
Leveraging technology to move more and sit less
Rubin, D. S., Severin, R. S., Arena, R. A., & Bond, S. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.10.007 · Cited by 9 · see citing works
He, Y., Wang, J., Zhang, W., Chen, X., Wu, Q., Li, Y., Ou, Y., Liu, Y., Feng, H., Zhang, J., et al. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.13726 · Cited by 9 · see citing works
Khan, K., Windt, A., Davis, J. C., Dawes, M. G., Liu-Ambrose, T. Y. L., Madden, K. M., Marra, C. A., Housden, L., Hoppmann, C. A., & Adams, D. J. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007441 · Cited by 8 · see citing works
Jones, T., O’Grady, K.-A. F., Goyal, V., Masters, I. B., McCallum, G. B., Drovandi, C., Lung, T. W.-C., Baque, E., Brookes, D. S. K., Terranova, C. O., et al. (2022) · Trials · doi:10.1186/s13063-022-06256-2 · Cited by 8 · see citing works
“Habitual physical activity Habitual physical activity will be assessed with accelerometers (ActiGraph GT3X+, ActiGraph Corporation, Pensacola, FL, USA), worn on the child’s non-dominant wrist for 7 days [33, 34].”
MethodKaradağ‐Saygı, E., Giray, E., Eren, N., Yolcu, G., Keniş-Coşkun, Ö., & Çifçili, S. (2024) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000610 · Cited by 8 · see citing works
Questionnaires for assessing self-perceived physical fitness: A systematic review
Sánchez-Lastra, M. A., Varela, S., Martínez-Aldao, D., & Ayán, C. (2021) · Experimental Gerontology · doi:10.1016/j.exger.2021.111463 · Cited by 8 · see citing works
Aktary, M. L., Ghebrial, M., Wang, Q., Shack, L., Robson, P. J., & Kopciuk, K. A. (2022) · Cancer Control · doi:10.1177/10732748221091678 · Cited by 7 · see citing works
“Incorporating objective measures, such as those for physical activity, may help reduce bias associated with self-reports.(55) At the time of this study, there were few study participants older than 75 years, the age in which incidence rates peak in Canada,(1) which may impact our findings.”
BackgroundFitViz: A Personal Informatics Tool for Self-management of Rheumatoid Arthritis
Gupta, A., Tong, X., Shaw, C., LI, L. C., & Feehan, L. M. (2017) · Communications in computer and information science · doi:10.1007/978-3-319-58753-0_35 · Cited by 7 · see citing works
“Therefore, there is a growing interest in using a patient’s lifelog data in clinical practice [16].”
BackgroundTørring, M. F., Logacjov, A., Brændvik, S. M., Ustad, A., Roeleveld, K., & Bardal, E. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308853 · Cited by 7 · see citing works
do Nascimento, P. R. C., Kirkwood, R. N., Griffith, L. E., Duong, M., Cooper, C., Hao, Y., Zheng, R., Raza, S., & Beauchamp, M. (2025) · JMIR Aging · doi:10.2196/64372 · Cited by 8 · see citing works
“Several wearable monitors have been validated in healthy individuals including among older adults living in the community [9,10].”
Degache, F., Bonjour, A., Michaud, D., Mondada, L., & Newman, C. J. (2018) · Developmental Neurorehabilitation · doi:10.1080/17518423.2018.1462268 · Cited by 6 · see citing works
“Wearable microsensors are increasingly used during various sport activities to track physiological parameters such as heart rate and motion during exercise.(19) Specifically, inertial measurement units that combine 3D accelerometers and 3D gyroscopes have recently allowed body movement quantification during snow sport…”
BackgroundAgreement between activPAL3c accelerometers placed at different thigh positions
Stanton, R., Guertler, D., Duncan, M. J., & Vandelanotte, C. (2016) · Gait & Posture · doi:10.1016/j.gaitpost.2016.06.013 · Cited by 6 · see citing works
Surface Acoustic Wave (SAW) force myography sensor for muscle force output identification
Kohler, M. C., Voiculescu, I., & Li, F. (2024) · Sensors and Actuators A: Physical · doi:10.1016/j.sna.2024.115959 · Cited by 5 · see citing works
Matey-Rodríguez, C., López‐Ortiz, S., Peñín‐Grandes, S., Pinto-Fraga, J., Valenzuela, P. L., Pico, M., Fiuza‐Luces, C., Lista, S., Lucía, A., & Santos‐Lozano, A. (2023) · Children · doi:10.3390/children10030475 · Cited by 5 · see citing works
“However, although complex, these analyses [22,23] may be useful to estimate PA in children and adolescents with severe motor impairments because their patterns may be modified [22,23,43].”
Monostatic Multi-Target Wi-Fi-Based Breathing Rate Sensing Using Openwifi
Kristensen, A. T., Li, S., Balatsoukas‐Stimming, A., & Burg, A. P. (2024) · IEEE Wireless Communications and Networking Conference · doi:10.1109/wcnc57260.2024.10570912 · Cited by 5 · see citing works
“Various methods are currently used for monitoring physical activity and vital signs, such as self-reported measures [2] and objective measures using wearable devices and other sensors [3].”
MethodComparing Accelerometer and Heart Rate Monitor in Interval Running, Interval Spinning and Zumba
Dyrstad, S. M. (2014) · IJASS(International Journal of Applied Sports Sciences) · doi:10.24985/ijass.2014.26.2.89 · Cited by 5 · see citing works
Lifestyle Composite and Resilience to Alzheimer's Disease Pathology in Down Syndrome
Schworer, E. K., Zammit, M. D., Handen, B. L., Piro‐Gambetti, B., Jenkins, M. R., Brothers, C., Okonkwo, O. C., Hom, C. L., Ances, B. M., Christian, B., et al. (2025) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.70109 · Cited by 4 · see citing works
“Step count was calculated by the device, and average daily step count was used to estimate participants' physical activity (Peven et al. 2022; Trost and O'Neil 2014).”
Robinson, L. E., Webster, E. K., Palmer, K. K., & Persad, C. (2018) · Springer eBooks · doi:10.1007/978-3-319-76006-3_8 · Cited by 4 · see citing works
Physical activity in professional training of physiotherapists
Frömel, K., Dygrýn, J., Vorlíček, M., Jakubec, L., Groffik, D., Smékal, D., & Mitáš, J. (2025) · Annals of Medicine · doi:10.1080/07853890.2024.2446687 · Cited by 4 · see citing works
Physical Activity in Clinical Pediatric Weight Management Programs
Kist, C., Gier, A., Tucker, J. M., BARBIERI, T. F., Johnson-Branch, S., Moore, L., Picard, S., Lukasiewicz, G., & Coleman, N. J. (2015) · Clinical Pediatrics · doi:10.1177/0009922815620772 · Cited by 4 · see citing works
Giray, E., Albayrak, O., Keniş-Coşkun, Ö., Yağcı, İ., & Gündüz, O. H. (2022) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.3233/bmr-210324 · Cited by 4 · see citing works
“Between bursts there is electrical silence [7].”
A Study on the Influence of Sensors in Frequency and Time Domains on Context Recognition
de Souza, P., Silva, D., de Andrade, I., Dias, J., Lima, J. P., Teichrieb, V., Quintino, J. P., da Silva, F. Q. B., & Santos, A. L. M. (2023) · Sensors · doi:10.3390/s23125756 · Cited by 4 · see citing works
“Researchers and healthcare professionals usually measure patients’ physical activity with self-report questionnaires, which heavily rely on patients’ memory, making it a burdensome and not reliable task [2,3].”
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Sharma, B., Obeid, J., DeMatteo, C. A., Noseworthy, M. D., & Timmons, B. W. (2023) · Pediatric Exercise Science · doi:10.1123/pes.2023-0016 · Cited by 3 · see citing works
Malkawi, A. M., Kremers, S., & Meertens, R. M. (2024) · Military Psychology · doi:10.1080/08995605.2024.2356499 · Cited by 3 · see citing works
“However, these methods need well-trained staff (Trost & O’Neil, 2014).”
Kennedy, N., McKenna, S. G., O’Neill, A., Esbensen, B. A., Swinnen, T. W., Nordgren, B., Willemijns, S., Hammer, N. M., & Brodin, N. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020809 · Cited by 3 · see citing works
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Outcome Measures for Respiratory Physiotherapy in Cystic Fibrosis — Challenges and Advances
Marques, A. S. P. D. D., Cruz, J., Jácome, C. I. O., & Oliveira, A. (2015) · InTech eBooks · doi:10.5772/60674 · Cited by 3 · see citing works
“Given the small size of the devices, low participant burden and relatively low cost, objective measures are appropriate for use in research and clinical practice [148].”
Background
- Authors
- Trost, S. G., & O'Neil, M.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Trost, Stewart G
- ORCID
- Trost, Stewart G
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2013-12-05
- Volume
- 48
- Issue
- 3
- Pages
- 178-181
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W1558745131
- Cited by
- 139
- References
- 33
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 11 · 2023: 11 · 2022: 8 · 2021: 7 · 2020: 11 · 2019: 10 · 2018: 19 · 2017: 13 · 2016: 9 · 2015: 17 · 2014: 9
- FWCI
- 1.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Faculty of Health
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Context-Aware Activity Recognition Systems
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- objective physical activity measurement, heart rate monitoring, accelerometer, pedometers, clinical practice, self-report bias, recall bias, physical activity behavior
- MeSH terms
- Data Interpretation, Statistical, Heart Rate, Humans, Monitoring, Physiologic, Exercise, Walking, Monitoring, Ambulatory, Accelerometry
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