Mgr. Robert Vysoký, Ph.D.
Department of Public Health – Faculty of Medicine - Masaryk University Brno
ASSESSMENT OF PHYSICAL ACTIVITY
Programme: General Medicine, Seminar: Public Health II

Introduction
•Physical activity has a fundamental role in the prevention and treatment of chronic disease
•Increasing physical activity is a key component of recommendations to decerease morbidity and
mortality (Haskell WL, Lee IM, Pate RR et al., Med Sci Sports Exerc, 2007)
•Monitoring physical activity levels is important for surveillance, for assessing the effectiveness
of interventions and for physical activity prescription
•Investigation of the dose-response relationship between physical activity and health outcomes is
dependent on a reliable and valid responsive assessment of physical activity
•Physical inactivity is defined as the fourth of the major risk factors of global mortality
•

Introduction
•Approximately 60 years ago, Jeremy Morris and colleagues showed that the incidence of coronary
artery disease in bus conductors who climbed up and down stairs of double-deck buses and postal
carriers who delivered the mail on foot was lover than that of relatively inactive bus drivers or
postal office workers, who spent most of their occupational time sitting
•Since then – numerous other investigators have confirmed the strong link between physical activity
and health
•In 1992, the American Heart Association included physical inactivity as a major risk factor for
coronary artery disease
•The deleterious effects of physical inactivity are associated with many of the most common chronic
diseases - cardiovascular diseases, T2DM, hypertension, obesity, osteoporosis, depression and
breast and colorectal cancers

Introduction
•In USA chronic diseases cause 7 in 10 deaths and accout for 70% of all healthcare spending
•The financial impact of physical inactivity for all US adults was 251 billion USD
•The first public health recommendations for physical activity in USA were released and in 2008 EBM
culminated in the firs-ever federal guidelines for physical activity
•
•It includes the following recommendations:
-adults should avoid inactivity (some physical activity is better than none)
-substantial health benefits are obtained from accumulating, in bouts of ≥ 10 minutes, 150 mintes
per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic activity
-additional and more extensive health benefits are obtained by increasing aerobic activity to 300
minutes per week at moderate intensity or 150 minutes per week at vigorous intensity
-muscle strenghtening activities of moderate to high intensity should be performed ≥ 2 days per
week

Introduction
•For assessing physical activity we have subjective (self-report) and objective (accelerometry)
measurement methods •The assessment of PA is needed to allow the clinician to provide specific
recommendations for patients identified as insufficiently active •With documented health benefits
of physically active lifestyle as its guiding principle, scientific statement recommends that PA be
assessed regularly, as are the other risk factors
•
•The primary objectives of this statement are:
-provide the rationale for the importance of assessing PA
-explain key concepts involved in the assessment of PA
-provide an overview of options for assessment of PA available to clinicians and researchers
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Significance and promotion of optimum movement activity in prevention and treatment of civilization
diseases
•Chronic non-infectious diseases of mass occurrence in the prevention context
•Metabolic diseases (T2D, obesity), cardiovascular diseases, certain oncologic diseases and
diseases of the movement apparatus -high incidence in the general population •Connected with life
style and are a result of the discrepancy between slowly changing human genotype and fast changing
environment (as a result of anthropogenic acivities) •Genetic (non-influenced) risk factors are
interacting with strong (but influenced) risk factors of environment and life style •Physical
inactivity as risk factor is a cause of 1.9 million of deaths a year worldwide •Identified as
4th out of the major risk factors of total mortality (6 % deaths worldwide)
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Chronic non-infectious diseases of mass occurrence, such as metabolic diseases (T2D, obesity),
cardiovascular diseases, certain oncologic diseases and diseases of the movement apparatus, show
high incidence in the general population.
These diseases are connected with life style and are a result of the discrepancy between slowly
changing human genotype and fast changing environment (as a result of anthropogenic acivities).
Genetic (non-influenced) risk factors are interacting with strong (but influenced) risk factors of
environment and life style.
Movement activity as risk factor is a cause of 1.9 million of deaths a year worldwide.
Identified as 4^th out of the major risk factors of total mortality (6% deaths worldwide)

Promotion of physical activity – global and European strategy
•Documents on promotion of physical activity in Europe:
•
•are based on a complex preventive program “Global strategy for nutrition, physical activity and
health” (WHO 2004) •The green book (2005): to enforce and promote healthy nutrition and movement
activity
•The white book of sport (2007)
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Documents on promotion of movement activity in Europe:
-are based on a complex preventive program “Global strategy for nutrition, physical activity and
health” (WHO 2004)
-The green book (2005): to enforce and promote healthy nutrition and movement activity
-The white book of sport (2007)

The importance of optimal PA for primary prevention of civilization diseases and movement apparatus
disorders
•Humans - morphological and functional adaptation for life style which required good physical
fitness •We are phylogenetically adapted to bipedal locomotion, periodical and uniform static and
dynamic load •Current life style – up to 60% of world population suffers from major lack of
physical activity, sedentary lifestyle
•Excessive static postures
•Lack of medium intensity dynamic load
•Population groups at risk: women and seniors, children and youth, individuals with special needs
(need of targeted applied MA) •each population group – different requirements on intensity,
duration and type of MA to fulfill the criteria for optimum MA
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Humans are morphologically and functionally adapted for life style which required good physical
fitness
We are phylogenetically adapted to bipedal locomotion, periodical and uniform static and dynamic
load
Current life style – up to 60% of world population suffers from major lack of physical activity,
sedentary lifestyle
Excessive static postures (additionally with unsuitable postural position of individual body parts)
Lack of medium intensity dynamic load
Population groups at risk: women and seniors, children and youth, individuals with special needs
(need of targeted applied MA)
each population group – different requirements on intensity, duration and type of MA to fulfill the
criteria for optimum MA

The importance of optimal PA for primary prevention of civilization diseases and movement apparatus
disorders
•Optimization of PA especially for untrained population
•The expected effect: increase of health oriented fitness level
•Not a need to reach maximum physical performance regardless the possibility of health
complications
•No quantification or evaluation of physical performance – evaluation of PA in regards to risk
factors or increased markers of these risk factors, in regard to limitation in clinical state or
movement limitations
•Optimal level of PA positively supports and affects:
•cardiorespiratory and neurohumoral system
•optimum shape and function of movement system (muscular balance, physiologic vertebra and spinal
position, range of motion, joins flexibility and strength)
•PA should not overload movement apparatus, the aim is to add PA to successful functional and
morphological adaptation for environmental burden
•

The importance of optimum MA for primary prevention of civilization diseases and movement apparatus
disorders
Optimization of MA especially for untrained population
The expected effect of application of individually selected MA – increase of health oriented
fitness level
Not a need to reach maximum physical performance regardless the possibility of health complications
No quantification or evaluation of physical performance – evaluation of MA in regards to risk
factors or increased markers of these risk factors, in regard to limitation in clinical state or
movement limitations
Optimum MA positively supports and affects:
-cardiorespiratory and neurohumoral system
-optimum shape and function of movement system (muscular balance, physiologic vertebra and spinal
position, optimum movement range, joins flexibility and strength)
-MA should not overload movement apparatus, the aim is to add MA to successful functional and
morphological adaptation for environmental burden

•Recommended PA is “individually optimal” under these conditions:
•Current health status, PA and functional and morphological components of health oriented physical
fitness
•Functional components of physical fitness: cardiorespiratory system and neuromuscular fitness
•Morphological (structural) components of physical fitness: anthropometry (height and weight),
selected circumference characteristics and indexes (BMI), assessment of nutrition lifestyle
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Recommended MA is “individually optimal” under these conditins:
It is based on current health status, current MA, functional and morphological components of helth
oriented physical fitness
Functional components of physical fitness: cardiorespiratory system and neuromuscular fitness
Morphological (structural) components of physical fitness: anthropometry (height and weight),
selected circumference characteristics and indexes (BMI), assessment of nutrition lifestyle

Negative results of insufficient PA level
•Due to lack of PA, the physiological fitness level decreases during life
•It has major role in occurrence of cardiometabolic and oncologic diseases
•Development of supportive movement apparatus disorders
•Movement apparatus diseases – second place in the cause of absence at work, cause longest lasting
absence at work
•MA diseases – low mortality rate
•
•Secondarily, they lead to health complications in late adult and senior age:
•-stressing the RF
•-limited movement, limits everyday life activity
•-movement immobilization leads to health complications (osteoporosis, fractures, bronchopneumonia,
urinary infections, depressive state)
•
•

Negative results of insufficient MA level
Due to lack of MA, the physiological fitness level decreases during life
It has major role in occurrence of cardiometabolic and oncologic diseases
Development of supportive movement apparatus disorders
MA diseases – second place in the cause of absence at work, cause longest lasting absence at work
Prevalence in 16-30% Czech adult population (age dependent, more frequent in women)
Painful status at ca 40% adults
MA diseases – low mortality rate
Secondarily, they lead to health complications in late adult and senior age:
-stressing the RF
-limited movement, limits everyday life activity
-movement immobilization leads to health complications (osteoporosis, fractures, bronchopneumonia,
urinary infections, depressive state)

Physical acivity assessment - introduction
•Observation of actual individual PA levels includes:
•Determination of the type, frequency, intensity and total amount of performed PA
•data are collected using questionnaires
•Disadvantages : under or overestimation
•For ongoing monitoring and obtaining details – use of aids (step meter, accelerometer)
•For the possibility of international comparison of MA level in population – GPAQ/IPAQ
•Observing PA performed not only at leisure time, but also at work and sport
•Observed PA monitored during 7 days (minimum continual PA 10 minutes)
•Total amount of PA displayed in MET minutes
•MET is a unit of intensity of physical load
•1 MET equals to common oxygen consumption (=3.5 mL/kg/min equals to resting metabolism)= resting
energy consumption of organism ca 1 kCal/kg/hour
•
•
•

Movement acivity assessment - introduction
Observation of actual individual MA levels includes:
Determination of the type, frequency, intensity and total amount of performed MA
data are collected using questionnaires
Disadvantages :  under or overestimation
For ongoing monitoring and obtaining details – use of aids (step meter, accelerometer)
For the possibility of international comparison of MA level in population – GPAQ/IPAQ
Observing MA performed not only at leisure time, but also at work and sport
Oberved MA monitored during 7 days (minimum continual MA 10 minutes)
Total amount of MA displayed in MET minutes
MET is a unit of intensity of physical load
1 MET equals to common oxygen consumption (=3.5 mL/kg/min equals to resting metabolism)= resting
energy consumption of organism ca 1 kCal/kg/hour

Recommended total amount of physical activity
•Adults
•-600 MET minutes per week – 150 minutes MA of medium intensity
•-frequency: 3-5 times a week
•-recommended also postural therapy, muscular dysbalances therapy
•-for adults over 65, resistance training and balance therapy
•
•Children (5-17 years old)
•-minimum of 60 minutes PA of medium to high intensity
•-variety of exercises
•-balanced development of aerobic fitness and muscular strength
•-flexibility exercises, deftness and balance
•-prevention of one-sided burden
•-compensational exercises
•
•

Recommended total amount of movement activity
Adults
600 MET minutes per week – 150 minutes MA of medium intensity
-frequency: 3-5 times a week
-recommended also postural therapy, muscular dysbalances therapy
-for adults over 65, body-building and balance therapy
Children (5-17 years old)
-minimum of 60 minutes MA of medium to high intensity
-variety of exercises
-balanced development of aerobic fitness and muscular strength
-flexibility exercises, deftness and balance
-prevention of one-sided burden
-compensational exercises

Key Concepts for Understanding Physical Activity Assessment
•Physical Activity – definition
•The most popular and widely cited definition of PA was published by Caspersen et al. (1985): „any
bodily movements produced by skeletal muscles that result in energy expenditure“
•
•PA can be clasified as structured (planned,  or incidental to promote health and fitness benefits)
and incidental (not planned and usually is the result of daily activities at work, at home, or
during transport)
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•Dimensions of PA
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•Domains of PA
•Central to undrestanding the assessment of PA

Quantifying Units of Measure Indicative of PA Level
•Exercise (or exercise training)  is a component of leisure time PA, and is where planned,
structured and repetitive bodily movements are performed to improve or maintain one or more
components of physical fitness (Howley ET, Med Sci Sport Exerc 2001)
•
•Physical fitness (PF) comprises cardiorespiratory endurance  (assessed by measured or estimated
VO2max , muscle endurance  and muscle strenght
•Flexibility, balance, agility nad coordination are additional components of PF
•Distinction between PA and PF is the intraindividual day-to-day variability
•PA will vary on a daily basis, whereas PF will remain relatively static, taking time to change
•

Quantifying Units of Measure Indicative of PA Level
•PA results in an incerease in energy expenditure (EE) above resting levels, and the rate of EE is
directly linked to the intensity of the PA •The energy expended during PA is just  of the 3
components of total daily energy expenditure (TEE):
•    60-75% resting energy expenditure
•    15-30% physical activity related energy expenditure (PAEE)
•    10% thermic effect of food
•PAEE is the most variable portion of TEE
•In extremly active individuals, PAEE may constitute 60-70% of TEE
•PA are commonly quantified by determining  the EE in kilocalories or by using metabolic equivalent
(MET) of the activity
•

Quantifying Units of Measure Indicative of PA Level
•Kilocalories
•One liter of oxygen consumption is aproximatelly equal to 5 kcal energy
•Example: 70kg individual walking for 30 minutes at 4 mph, which results in an oxygen consumption
of 1 L/min. For 30-minute walk, the individual would consume 30 L of oxygen. EE would be 150kcal
(30 Lx5 kcal/L).
•PAEE would be 112,5 kcal (30 Lx5-1.25[5-1.25 (resting kilocalories expenditure)] kcal/L)
•Metabolic Equivalent (MET)
•Is common unit used to express exercise intensity
•1 MET represents the resting energy expenditure during quiet sitting and is defined as 3.5 mL
O2.kg-1.min-1  or 250 mL/min of oxygen consumed, which represents the average  value for a standard
70-kg person
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Quantifying Units of Measure Indicative of PA Level
•Metabolic Equivalent (MET)
•METs can be converted to kilocalories (1 MET=1kcal.kg-1.min-1
•Oxygen consumption increases with intensity of PA, for quantifying the intensity of PA is to use
multiples of resting EE
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•Physical Activity Intensity
•Moderate and vigorous intensity PA can be defined in both absolute and relative terms •Absolute
intensity is determined by the external work performed, whereas relative intensity is determined
relative to an individual´s level of cardiorespiratory fitness (VO2max)
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Quantifying Units of Measure Indicative of PA Level
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Available Methods of Assessing PA
•Subjective methodologies rely on the individual either to record activities as they occur to
recall previous activities (questionnaires and diaries/logs)
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•Objective methodologies include all wearable monitors that directly measure 1 or more biosignals,
such as acceleration, heart rate, or some other indicator of PA or EE, as they occur.

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Subjective Methods of Assessing PA
•Consideration for researchers when using
•questionnaires
•What exactly is the questionnaire designed to measure: which dimension (s) and domain (s) of PA?
•What is the time frame for the questionnaire?
•Has the instrument been tested for reliability?
•Has appropriate validation been undertaken, that is, against an objective measure?
•Was the validation undertaken in a similar population?
•What is the primary outcome of the questionnare and does this fit with the research question?
•How will the questionnaire be administered (face-to-face, by telephone, Internet, through post)?
•How will be data cleaned, reduced and analysed?
•What will constitute an outlier or an invalid recording?
•What will be done with missing data, and in case of inputing data what will the basis of these
decisions be?
•For which population has the questionnaire been designed?
•What is the responsiveness of the questionnaire?
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Subjective Methods of Assessing PA
•A) Physical Activity Questionnaires
•To identify the dimensions and domains of PA behaviors from either self-reported responses or
interviews
•1. Global Physical Activity Questionnaires
•Provide a quick overview of a person´s PA level
•Typically short (2 – 4 items) and used to identify whether an individual meets a PA standard (e.g.
150 min/wk of moderate to vigorous PA) or provide a classification (e.g. active versus inactive)
•Preferred in many clinical settings, epidemiological studies and surveillance settings for their
ease administration, brevity and ability to determine a PA score
•2. Short Recall Physical Activity Questionnaires
•Provide a quick assessment of the total volume of PA classified by dimension of intensity level or
by domain
•Are often used to determine the proportion of adults meeting national PA guidelines in
surveillance and descriptive epidemiology settings and to identify PA behavior change in
intervention studies
•Generally have from 7 to 12 items and can be self-administered or interviewer administered
•A physical activity score can be a simple ordinal number, with higher numbers reflecting greater
levels of activity, or a volume score computed by multiplying the frequency in sessions pre week
(or month), minutes per session, and intensity of the activity recalled. The intensity often
expressed as METs.
•International Physical Activity Questionnaire (IPAQ)

Subjective Methods of Assessing PA
•The „Compendium of Physical Activities of Energy Costs of Human PA“ was published in 1993, with
updates in 2000 and 2011. •This publication provides a comprehensive list of physical activity MET
values for use in scoring PA questionnaires
•3. Quantitative History Physical Activity Questionnaires
•Are detailed surveys often performed over the past month of year or over a lifetime •May contain
20 to 60 detailed questions and are usually interviewer administered •Are used in epidemiological
studies  to understand what types and intensities of PA contribute to mortality, as well as to
examine various types of morbidities and health-enhancing behaviors •Bone Loading History
Questionnaire (PA performed at various ages from childhood to the past year for determination of
hip and spine weight-bearing and bone-loading activities)
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Subjective Methods of Assessing PA
•B) Physical Activity Diaries/Logs
•Often used to obtain a detailed hour-by-hour or activity-by-activity record of one´s PA and
sedentary behaviors
•To evaluate the psychometric properties of PA questionnaires and as an adjunct to objective
monitoring
•Are completed by the user and can be form of a paper-and-pencil booklet or a cell phone programmed
to remind the performed in the past 1 to 4 hours.
•Recorded informations: the time an activity started and stopped,a rating of intensity, and the
mode/type of activity
•Can be scored by use of the „Compendium of Physical Activities“
• The Bouchard Physical Activity Record is a well-known PA log that has users identify 1 of 9 types
of movement behaviors preformed every 15 minutes. The activities are rated on a 1 to 9 scale that
corresponds to a range of 1.0 to 7.8 METs
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Objective Methods of Assessing PA
Accelerometers
•Considerations for researchers when using accelerometers
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•One, two or three-dimensional accelerometry?
•Decide the primary outcome of the study; total activity, type, time spent at different intensity,
or estimates PAEE
•At the outset make a decision about the minimal wearing time to constitute a valid day
•What will constitute an outlier or an invalid recording?
•What time interval will be selected?
•What will be dome with missing data?
•How many days will be measured?
•Is there going to be a time lag between initializing the monitor and participant wearing? If so,
can the data analysis programme handle this delay?
•How are accelerometers going to be distributed and returned (face-to-face/mail)?
•Have sufficient instruction on placement, wearing and contact details been supplied?
•Are participants going to be contacted by phone, SMS or mail during the planned assessment to
encourage compliance?
•Are participants going to be asked to keep concurrent activity logs or detail wearing and
non-wearing times?
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Objective Methods of Assessing PA
Accelerometers
•When a person moves, the body is accelerated in relation to muscular forces responsible for the
acceleration of the body and to EE
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•Measure in one (vertical), two (vertical and medo-lateral) or three (vertical, medo-lateral and
anterior-posterior) planes by measuring the amplitude and frequency of acceleration
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•The device is enclosed in a case and then attached to the body (hip, ankle, wrist, lower back)
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•Able to record high-resolution data data, as well as store data for several weeks
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Objective Methods of Assessing PA
Accelerometers
•Accelerometer Data Transformation
•The main data outcome from accelerometers is a recording of body acceleration and deceleration
•This measurement (raw data) is typically recorded in units of acceleration due to gravity (g) and
expressed as acceleration in meters per second squared (m/s2) •This is then further transformed
into other units, most common unit of measure is the count, which can be expressed in different
ways: counts per second, counts per minute, or summed as total counts per day.
•Detailed data are collected between 5 and 60 s
•Published data on cut point for sedentary activities from one the most frequently used bands
typically ranges from 100-800 counts per minute, for moderate activities 1900-8200
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Objective Methods of Assessing PA
Accelerometers
•Accelerometer Data Converted to Meaning
•Physical Activity Outcomes
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•The strongest relationship is seen in walking and jogging activities
•Typically used to determine habitual activity, which necessitates measurement over multiple days
(4-9 days children, 3-5 days adults)
•Is important, that the recording period allows for the measurement of activity during the week and
also at weekends.
•To correctly interpret the information from the recording period, it is important to account for
the fact that the activity level may also vary according to the season (higher level during spring
and summer coimpared with autumn and winter)
•For assessment of PA, accelerometers must be calibrated to translate monitor signals into energy
expenditure units (kcal or METs) or activity intensity categories
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•More information: Ward DS, Evenson KR, Vaughn A, Rodgers AB, Troiano RP. Accelerometer use in
physical activity: best practices and research recommendations. Med Sci Sports Exerc 2005;
37:S582-588.
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Objective Methods of Assessing PA
Heart Rate Monitoring
•There is a linear relationship between the increase in HR and the increase in EE during dynamic
exercise involving the large muscle groups
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•Relationship varies within and between individuals; factors such as age, sex, weight and fitness
level modulate this relationship as do ambient temperature, body posture and emotional state
(anxiety or stress)
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•Measures of PA derived from HR monitoring are typically time spent in physical activities at
different intensity levels (moderate and vigorous) and PAEE
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•The accuracy of estimating outcomes indicative of PA from HR monitoring is improved by calibrating
an individual´s heart rate nad EE response (via oxygen consumption measurement) to different levels
of activity, thus accounting for variation across individual HR response
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Objective Methods of Assessing PA
Heart Rate Monitoring
•Considerations for researchers when using HR
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•What level of calibration is required?
•If individual calibration is to be undertaken using indirect calorimetry, decide on which
activities most likely will be performed by the volunteers while free living
•How many days will the monitor be worn?
•In data analysis what is going to constitute an outlier?
•Provide practical information on how to use the monitor
•How are monitors going to be distributed and returned (face-to-face, mail), have sufficient
instructions on placement and wearing and contact details been supplied?
•Are participants going to be contacted by phone, SMS or email during the planned assessment to
encourage compliance? Can incentives be used?
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Objective Methods of Assessing PA
Combined Accelerometer and Heart Rate Monitors
•An important development in the assessment of PA
•An early model was developed and piloted nearly 10 years ago
•In these devices, the pros of each method are combined
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•At lower levels of intensity, HR is less accurate at estimating EE; this is the level that
accelerometers are most accurate at
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•Advantage is, that these new monitors are waterproof and the intention is that participants do not
remove, except to replace pads that have perished
•The combined motion sensor is an accurate predictor of EE
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Objective Methods of Assessing PA
Combined Accelerometer and Heart Rate Monitors
•Consideration for researchers when using combinad
•accelerometer and HR monitor sensors
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•What level of calibration is required? Will calibration methods used commonly for fitness testing
be adequate?
•Is the participant confident and competent at placing the device, that is, have sufficient
explanation and written instructions have been given?
•Supply participants with additional pads to replace as required
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Objective Methods of Assessing PA
Pedometers
•Pedometers are relatively simple and inexpensive devices, which measure the number of steps taken
•Better accuracy has been reported at faster walking speeds but not running •Most pedometers are
accurate in the measurement of the number of accumulated steps during walking, and may be useful
when monitoring the effect of an intervention aimed to increasing walking •One of the most
promising uses of pedometers is as a motivational tool to achieve a predetermined target of daily
accumulated steps •An advantage of pedometers is that they can also be used in elementary school
children and preschool children

Objective Methods of Assessing PA
Pedometers
•Consideration for researchers when using pedometers •The aims and primary outcome of the study
should be carefully considered to ascertain whether a pedometer would be an adequate measure of
activity •What type of activities is the population to be studied likely to engage in? •Number of
monitored days, what will constitute valid wearing time
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Selection of an appropriate tool to assess PA
•Selection of the method is a crucial decision
•Careful consideration must be given to the research question in the first place, and the dimension
or domain of PA to be assessed
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Influence of study type on methodology choice
•The specific study type and design has an important bearing on the choice of method to measure PA
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Assessment of cardiorespiratory fitness – outputs for prescription of cardiometabolic or other
internal diseases
•Need of evaluation of absolute and relative contraindication of physical training before any
prescription of PA!
•Perform complex examination and cardiorespiratory fitness examination:
•determine maximal aerobic capacity by stress test = CPX = cardiopulmonary exercise testing
(spiroergometry)
•always risk factors CVD
•also for asymptomatic individuals, who have been inactive for more than 3 years and are planning
on doing systematic PA of medium to high intensity (men below 40, women below 50)
•The benefits: exact evaluation of physical fitness and effective setting up of PA training plan,
finding of non-physiological states unprofound until now
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Assessment of cardiorespiratory fitness – outputs for prescription of cardiometabolic or other
internal diseases
Need of evaluation of absolute and relative contraindication of physical training before any
prescription of movement activity
Perform complex examination and cardiorespiratory fitness examination:
-determine maximum aerobic capacity by spiroergometry under load
-always risk factors CVD
-also for asymptomatic individuals, who have been inactive for more than 3 years and are planning
on doing systematic MA of medium to high intensity (men below 40, women below 50)
The benefits: exact evaluation of physical fitness and effective setting up of movement activity
plan, finding of non-physiological states unprofound until now

Assessment of cardiorespiratory fitness – outputs for prescription of cardiometabolic or other
internal diseases
•Need of finding any possible contraindications before testing (blood circulation insufficiency,
inflammation of myocardium, any other serious cardiopulmonary diseases)
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•Outputs:
•assessment of maximal aerobic capacity (VO2 max), volume of exhaled CO2, ratio of respiratory
exchange, breath frequency, total ventilation, lung volume, hemodynamic reaction to stress
•maximum heart rate
•anaerobic thershold
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Need of finding any possible contraindications before testing (blood circulation insufficiency,
inflammation of myocardium, any other serious cardiopulmonary diseases)
Outputs:
assessment of maximum aerobic capacity (VO[2 max]), volume of exhaled CO[2], ratio of respiratory
exchange, breath frequency, total ventilation, lung volume, hemodynamic reaction to stress
-maximum heart rate
-anaerobic thershold

Assessment of cardiorespiratory fitness – outputs for prescription of cardiometabolic or other
internal diseases
•Parameter VO2max shows the maximum oxygen amount that can be transported from outside, absorbed
and used to cover energy needs during PA by individuals
•Cardiac patients – parameter VO2peak
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•Average listed values for the Czech untrained population:
•women 35 mL/kg/min
•men 45 mL/kg/min
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•Maximum aerobic capacity is displayed in the multiples of one metabolic equivalent: 1 MET=3.5
mL/kg/min
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VO[2]max shows the maximum oxygen amount that can be transported from outside, absorbed and used to
cover energy needs during MA by individuals
Average listed values for the Czech untrained population:
women 35 mL/kg/min
men 45 mL/kg/min
Maximum aerobic capacity is displayed in the multiples of one metabolic equivalent: 1 MET=3.5
mL/kg/min

Assessment of cardiorespiratory fitness – outputs for prescription of cardiometabolic or other
internal diseases
•Recommended training intensity with cardio protective results:
•50-85 % VO2max
•by percentage of heart rate reserve (HRR) 50-85%
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•Start at low end of HRR percentage (min 10 minutes of training), after 30 minutes slowly increases
load intensity
•During training: check HR and blood pressure (pause-load-rest), check symptoms during training
(emphysema, tiredness, chest pain, lower limb pain)
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•VO2max is an important prognostic marker for individuals with CVD
•Kavangh et al. (2002, 2003) reports that with every improvement of VO2max by 1 mL/kg/min improves
the prognosis by 9%
•(Kavanagh T, Mertens DJ, Hamm LF, et al. Prediction of long-term prognosis in
•12 169 men reffered for cardiac rehabilitation. Circulation. 2002;106(6):666
•671.)
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•reaching 22 mL/kg/min is an optimum results (prognosis improved by 40-60%)
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Recommended training intensity with cardio protective results:
-50-85 % VO[2]max
by percentage of heart rate reserve (HRR) 50-85%
XXXX
Start at low end of HRR percentage (min 10 minutes of training), after 30 minutes slowly increases
load intensity
During training: check HR and blood pressure (pause-load-rest), check symptoms during training
(emphysema, tiredness, chest pain, lower limb pain)
VO[2]max is an important prognostic marker for individuals with XXX
Kavangh et al. (2002, 2003) reports that with every improvement of VO[2]max by 1 mL/kg/min improves
the prognosis by 9%
reaching 22 mL/kg/min is an optimum results (prognosis improved by 40-60%)

Thank you for your attention!
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Robert Vysoký, PT.,  Ph.D.
Department of Public Health – Faculty of Medicine MU Brno
E-mail: vysoky.rob@gmail.com
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