Clinimetric review of motion sensors in children and adolescents

Abstract

Background and Objectives

To review the clinimetric quality of motion sensors used to assess physical activity in healthy children and adolescents (2–18 years).

Methods

A systematic literature search was performed in PubMed, Embase, and SpycINFO. The clinimetric quality of two pedometers (Digi-Walker, Pedoboy), four one-dimensional accelerometers (LSI, Caltrac, Actiwatch, CSA/ActiGraph), and three three-dimensional accelerometers (Tritrac-R3D, RT3, Tracmor2) was evaluated and compared using a 20-item checklist.

Results

Overall, the quality of the studies (n = 35), and therefore the level of evidence for the reproducibility, validity, and feasibility of the motion sensors was modest (mean = 6.4 ± 1.6 out of 14 points). There was strong evidence for a good reproducibility of the Caltrac in adolescents (12–18 years), a poor reproducibility of the Digi-Walker in children (8–12 years), a good validity of the CSA/ActiGraph in children and adolescents (8–18 years), and a good validity of the Tritrac-R3D in children (8–12 years).

Conclusions

The CSA/ActiGraph and the Caltrac are the only motion sensors in which the reproducibility, validity, and feasibility have been examined in different age groups. Further studies of the reproducibility of motion sensors in preschool children, improvement of the quality of clinimetric studies, and evaluation of the acceptability of motion sensors are warranted.

Introduction

There is tremendous interest in assessing and promoting physical activity among children and adolescents, mainly because of the worldwide increase in the prevalence of pediatric overweight and obesity [1], [2]. This increase in overweight and obesity has focused attention on the need to understand its etiology, consequences, treatment, and prevention. Physical inactivity, and hence a low energy expenditure level, is suggested to be a major risk factor for overweight and obesity [3]. Although many health professionals and scientists have expressed concern about the relative lack of physical activity among children and adolescents, there is conflicting information on children's physical activity levels, mainly because of the difficulty in measuring it in this age group [4].

Numerous methods are available to measure physical activity, such as doubly labeled water, direct observation, (in)direct calorimetry, heart rate monitoring, motion sensors, questionnaires, diaries, and interviews [5], [6], [7], [8]. In the past decades, motion sensors have evolved from simple mechanical devices to three-dimensional accelerometers that can be used to assess physical activity or to estimate energy expenditure. Because many children and adolescents have difficulties in accurately recalling their physical activities, motion sensors are being used with increasing regularity. In addition, motion sensors are lightweight, unobtrusive, and relatively inexpensive compared to other objective methods, such as direct observation or doubly labeled water. As motion sensor-based research evolved, researchers have validated and calibrated them in diverse populations, including children and adolescents. However, few studies have evaluated and compared the published evidence of the clinimetric quality of different motion sensors [9].

The purpose of the present study was to systematically review published evidence on the reproducibility, validity, and feasibility of motion sensors used to assess physical activity in healthy children and adolescents. Important methodologic issues are discussed and priorities for future research are identified.