calorimeters require considerable resources to operate. They are generally found in high-level research and clinical spaces and are built, operated, validated, and maintained by a multidisciplinary team of experts. As an alternative to whole-room metabolic chambers, hoods may be used with stationary metabolic carts that are equipped with flow control to measure resting energy expenditure at the bedside. Metabolic carts can also work with face masks or mouthpieces to measure the oxygen cost during submaximal and maximal exer- cise, but this method is limited to mostly aerobic activities on a treadmill or cycle ergometer. Several portable indirect calorimeters are also available; they are worn in backpack-type harness systems and use a face mask to measure gas exchange. Portable systems allow for a broader range of activities to be captured and can be used in free-living applications.18-20


However, these systems are typically reserved


for research development and validation studies and are limited by cost, participant burden, and a short assessment period (less than 6 hours).3,21


In addition, indirect


calorimetry only measures the energy expended as a result of aerobic metabolism (ie, oxygen consumed) and is not able to capture the energy expenditure from anerobic metabolism. Although both the DLW method and indirect calorimetry are considered


gold standard measures of energy expenditure, they are typically only used in development and validation studies as they require a precisely structured or lab- oratory environment, specialized equipment, and expertise to collect, process, and analyze the data, and they can be time intensive and expensive. Two types of assessment methods for assessing free-living physical behavior more practically are report-based methods (eg, self-report questionnaires, recalls, surveys, diaries, or logs) and device-based measures (eg, wearable monitors such as pedometers or accelerometer-based devices). Both types are validated against the criterion mea- sures previously discussed, and while they have some limitations, they are practical and the most widely applicable for many practitioners and their patients or clients. For this reason, it is important to understand their strengths and limitations so that an informed decision about the best method of assessment for a specific use case can be made. Table 8.1 on page 120 provides a general overview of the charac- teristics of the primary physical behavior assessment methods.


Report-Based Measures


Report-based measures include recalls (recalling physical activity or behavior from the previous day, week, year, or other time frame) and self-reported ques- tionnaires that ask about prior or typical behavior patterns or habits, as well as diaries or logs of current behavior habits.3


Report-based instruments are often


aimed at capturing data as bouts of physical activity, which can be interpreted in terms of intensity or energy expenditure using the Compendium of Physical Activities.7,22,23


Report-based methods are generally easy to use and inexpensive


to administer, making them well suited for large-scale cross-sectional studies. However, they are susceptible to recall bias and social desirability bias because data are either self-reported or reported in a structured interview conducted via paper, internet, telephone, or in person. Common report-based instruments are the Global Physical Activity Questionnaire (GPAQ),24 Activity Questionnaire (IPAQ),25


the International Physical Completed Over Time in 24 Hours (ACT24) previous-day recall.26


and the more recently developed Activities These report-


based instruments work well to capture contextual and behavioral information to complement device-based data when making an assessment in an outpatient


CHAPTER 8: Physical Activity Assessment 119


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