Cited by 139Physical Activity and HealthContext-Aware Activity Recognition SystemsMobile Health and mHealth Applications

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Clinical use of objective measures of physical activity

Trost, Stewart G, O'Neil, Margaret·2014·British Journal of Sports Medicine

DOI 10.1136/bjsports-2013-093173

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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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Method
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BackgroundMethod
The Effectiveness of Interventions and Intervention Components for Increasing Physical Activity and Reducing Sedentary Behaviour in People With Persistent Musculoskeletal Pain: A Systematic Review and Meta-Analysis
Booth, G., Howarth, A., Stubbs, B., & USSHER, M. H. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.11.004 · Cited by 16
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
“The increased use of objective monitoring of sedentary and physical activity behaviours has advanced our knowledge of how these behaviours impact on health [1].”
Background
Emerging methods for measuring physical activity using accelerometry in children and adolescents with neuromotor disorders: a narrative review
Petersen, 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
“Though accelerometry is becoming more accessible, heart rate monitoring has long been discussed as an appealing alternative measure of physical activity [87].”
Background
Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour
Šilarova, 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 15
“Response Efficacy ✓ ✓ self-report as used in previous behavioural research [52, 69]”
BackgroundMethod
A 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
“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.”
Background
Physical 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
Intensity of daily physical activity – a key component for improving physical capacity after minor stroke?
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
“Walking is the most common and important movement for stroke survivors in daily activities and participation in society [11,38,39].”
Background
The importance of physical activity
Langer, D., Demeyer, H., Troosters, T., & Gosselink, R. (2015) · European Respiratory Society eBooks · doi:10.1183/2312508x.10019914 · Cited by 11
“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].”
BackgroundMethodInfluential
Accuracy 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 14
Validity of Accelerometry to Measure Physical Activity Intensity in Children With an Acquired Brain Injury
Baque, E., Sakzewski, L., Trost, S. G., Boyd, R. N., & Barber, L. A. (2017) · Pediatric Physical Therapy · doi:10.1097/pep.0000000000000439 · Cited by 12
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
From Steps to Context: Optimizing Digital Phenotyping for Physical Activity Monitoring in Older Adults by Integrating Wearable Data and Ecological Momentary Assessment
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 12
“These tools offer reliable, precise, and reproducible data on the frequency, intensity, and duration of PA, facilitating greater standardization and reproducibility [11–13].”
Study protocol for a school-based single group pragmatic trial to promote resilience in youth: Building Resilience for Healthy Kids
Lee, J. A., Heberlein, E., Pyle, E., Caughlan, T., Rahaman, D., Sabin, M., & Kaar, J. L. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100721 · Cited by 11
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 10
Device‐Measured Physical Activity, Sedentary Behaviour and Risk of Chronic Kidney Diseases Across Levels of Grip Strength
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
Group Medical Visits (GMVs) in primary care: an RCT of group-based versus individual appointments to reduce HbA1c in older people
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
Bronchiectasis - Exercise as Therapy (BREATH): rationale and study protocol for a multi-center randomized controlled trial
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
“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].”
Method
Barriers and facilitators to physical activity participation among community-dwelling physically inactive individuals after stroke: a qualitative exploratory study
Karadağ‐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
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
Health-Related and Behavioral Factors Associated With Lung Cancer Stage at Diagnosis: Observations From Alberta’s Tomorrow Project
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
“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.”
Background
FitViz: 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
“Therefore, there is a growing interest in using a patient’s lifelog data in clinical practice [16].”
Background
Validation of two novel human activity recognition models for typically developing children and children with Cerebral Palsy
Tørring, 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
Identifying Optimal Wearable Devices for Monitoring Mobility in Hospitalized Older Adults: Feasibility, Acceptability, and Validity Study
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
“Several wearable monitors have been validated in healthy individuals including among older adults living in the community [9,10].”
The effects of tandem skiing on posture and heart rate in children with profound intellectual and multiple disabilities
Degache, F., Bonjour, A., Michaud, D., Mondada, L., & Newman, C. J. (2018) · Developmental Neurorehabilitation · doi:10.1080/17518423.2018.1462268 · Cited by 6
“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…”
Background
Agreement 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
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
Validation and Determination of Physical Activity Intensity GT3X+ Cut-Points in Children and Adolescents with Physical Disabilities: Preliminary Results in a Cerebral Palsy Population
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 6
“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
“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].”
Method
Comparing 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
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
“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).”
Integrating Pedometers in Early Childhood Settings to Promote the Development of Positive Health Trajectories
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
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
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
A case report of lumbosacral plexopathy in a patient with a history of sacral chordoma and radiotherapy: Will the detection of myokymia on the EMG help to solve the case?1
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
“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
“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].”
Background
Perspectives of the World Health Organization's physical activity guidelines among patients with musculoskeletal conditions: A mixed‐methods survey
Rickenbach, A., Acheampong, M. K., Bogar, A., & Booth, G. (2024) · Musculoskeletal Care · doi:10.1002/msc.1868 · Cited by 4
Accelerometer-measured “weekend warrior” physical activity and incident cardiovascular disease in adults with type 2 diabetes mellitus or prediabetes: A prospective cohort study
Yang, H., Qiao, Y., Lin, R., Yu, Y., Zhao, M., Magnussen, C. G., & Xi, B. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112948 · Cited by 3
New Insights Into Accelerometer-Measured Habitual Physical Activity and Sedentary Time During Early Recovery in Pediatric Concussion
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
Motivation for physical activity in the Jordanian military: Possible determinants of physical activity in male and female recruits
Malkawi, A. M., Kremers, S., & Meertens, R. M. (2024) · Military Psychology · doi:10.1080/08995605.2024.2356499 · Cited by 3
“However, these methods need well-trained staff (Trost & O’Neil, 2014).”
A survey across four European countries to determine rheumatology health professionals’ awareness of physical activity measures in people with inflammatory joint diseases
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
Health and Fitness Wearables
Butler, M. S., & Luebbers, P. E. (2018) · IGI Global eBooks · doi:10.4018/978-1-5225-5484-4.ch003 · Cited by 3
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
“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
DOI: 10.1136/bjsports-2013-093173
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 › Public Health, Environmental and Occupational Health › 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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Clinical use of objective measures of physical activity

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