Assessment of physical activity: a critical appraisal.

Assessment of physical activity in a free-living environment is important for understanding relations between physical activity and health and determining the effectiveness of interventions. Techniques include behavioral observation, questionnaires in the form of diaries, recall questionnaires and interviews, and physiological markers like heart rate, calorimetry, and motion sensors. The doubly labeled water method has become the gold standard for the validation of field methods of assessing physical activity. Then, questionnaires show a low reliability and validity but can be adequately applied as an activity-ranking instrument. The heart rate requires individual calibration to be an effective method to assess physical activity only at group level. The indicated method for the assessment of habitual physical activity in daily life is a doubly labeled water validated accelerometer. Future developments are simultaneous measurement of body acceleration and heart rate for the assessment of physical fitness. A new generation of accelerometers will provide information on body posture and activity recognition to allow objective assessment of subjects' habitual activities, options for a healthy change, and effects of the follow-up of any changes.