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Validity of low-cost measures for global surveillance of physical activity in pre-school children: The SUNRISE
Tawonga W Mwase-Vuma1, Xanne Janssen2, Anthony D Okely3
1School of Psychological Sciences and Health, University of Strathclyde, UK; Centre for Social Research, University of Malawi, Malawi.
Insights
Parent reports are unreliable for measuring preschooler physical activity. Step-counting offers a promising, cost-effective method for global surveillance of physical activity guidelines in early childhood.
Area of Science:
- Pediatric physical activity assessment
- Global health surveillance
- Childhood obesity prevention
Background:
- Accurate measurement of physical activity in preschoolers is crucial for public health.
- Existing methods for assessing habitual total physical activity in young children have limitations.
- Parental reports are commonly used but their validity requires rigorous evaluation.
Purpose of the Study:
- To validate parent-reported habitual total physical activity against accelerometry in preschoolers.
- To assess the accuracy of existing step-count thresholds for classifying physical activity guidelines.
- To compare parent-reported data with objective measures across diverse international settings.
Main Methods:
- Cross-sectional validation study involving 3- and 4-year-olds from 13 countries.
- Parental reports of total physical activity were compared with accelerometry (activPAL™) data over 3 days.
- Receiver Operating Characteristic (ROC) analysis was used to evaluate step-count thresholds.
Main Results:
- A very weak correlation was found between parent reports and accelerometer-measured physical activity (r=0.140).
- Parents consistently overestimated their child's physical activity levels.
- The De Craemer step-count threshold (11,500 steps/day) demonstrated excellent classification accuracy (AUC=0.945) for meeting physical activity guidelines.
Conclusions:
- Parental reports demonstrate limited validity for assessing preschooler physical activity.
- Step-counting presents a viable and promising alternative for large-scale physical activity surveillance.
- Pedometers could be utilized in low-cost global initiatives to monitor physical activity compliance in early childhood.
Objectives:
To validate parent-reported child habitual total physical activity against accelerometry and three existing step-count thresholds for classifying 3 h/day of total physical activity in pre-schoolers from 13 culturally and geographically diverse countries.
Design:
Cross-sectional validation study.
Methods:
We used data involving 3- and 4-year-olds from 13 middle- and high-income countries who participated in the SUNRISE study. We used Spearman's rank-order correlation, Bland-Altman plots, and Kappa statistics to validate parent-reported child habitual total physical activity against activPAL™-measured total physical activity over 3 days. Additionally, we used Receiver Operating Characteristic Area Under the Curve analysis to validate existing step-count thresholds (Gabel, Vale, and De Craemer) using step-counts derived from activPAL™.
Results:
Of the 352 pre-schoolers, 49.1 % were girls. There was a very weak but significant positive correlation and slight agreement between parent-reported total physical activity and accelerometer-measured total physical activity (r: 0.140; p = 0.009; Kappa: 0.030). Parents overestimated their child's total physical activity compared to accelerometry (mean bias: 69 min/day; standard deviation: 126; 95 % limits of agreement: -179, 316). Of the three step-count thresholds tested, the De Craemer threshold of 11,500 steps/day provided excellent classification of meeting the total physical activity guideline as measured by accelerometry (area under the ROC curve: 0.945; 95 % confidence interval: 0.928, 0.961; sensitivity: 100.0 %; specificity: 88.9 %).
Conclusions:
Parent reports may have limited validity for assessing pre-schoolers' level of total physical activity. Step-counting is a promising alternative - low-cost global surveillance initiatives could potentially use pedometers for assessing compliance with the physical activity guideline in early childhood.
