JOURNAL OF APPLIED BEHAVIOR ANALYSIS 2012, 45, 871–875 NUMBER 4 (WINTER 2012)

ASSESSING AND INCREASING PHYSICAL ACTIVITY

CAROLE M. VAN CAMP AND LYNDA B. HAYES
UNIVERSITY OF NORTH CAROLINA WILMINGTON

Increasing physical activity is a crucial component of any comprehensive approach to combat the
growing obesity epidemic. This review summarizes recent behavioral research on the
measurement of physical activity and interventions aimed at increasing physical activity and
provides directions for future research.
Key words: exergaming, measurement, obesity, physical activity, and self-management

The most recent estimates suggest that over pedometers, accelerometers, and heart-rate
half of the United States population is monitors. Pedometers typically are worn on
overweight, and an estimated 34% of adults the waist and use a spring-arm or pendulum
and 17% of children are obese (Ogden, Carroll, mechanism that records steps. Pedometers are
Kit, & Flegal, 2012). The prevalence of obesity relatively unobtrusive and inexpensive, but
has increased in recent decades, and the rise in reliability and validity of the measures produced
vary greatly by model (Butte, Ekelund, &Wes-
associated health factors (e.g., hypertension,
terterp, 2012). Recent behavioral studies used
Type 2 diabetes), as well as direct and indirect validated pedometers as the primary source of
health-related costs, has increased the need for data (i.e., steps per day or steps per session) in
research aimed at preventing and treating this evaluations that focused on increasing physical
problem (Normand, 2008). activity in both children and adults. New
Regular physical activity reduces many of the Lifestyles 2000 pedometers (Hustyi, Normand,
risks associated with being overweight or obese in & Larson, 2011; Normand, 2008) and Yamax
both children and adults (U.S. Department of Digi-Walker Model SW-200 pedometers (Van-
Health and Human Services, 2012). It is Wormer, 2004) also provided data via digital
recommended that children and adolescents display, which contributed to the self-monitor-
engage in at least 60 min of moderate to vigorous ing component of the self-management inter-
physical activity each day. For adults, at least 150 vention. Pedometers are particularly useful
when direct observation is not feasible, includ-
min of moderate-intensity activity is recom-
ing assessments of daylong activity or measure-
mended each week. The purpose of this review is ment of activity of multiple individuals at one
to describe recent behavioral research on the time. One limitation of pedometers is the lack
assessment of physical activity and interventions of memory storage on some models, making it
aimed at increasing physical activity. We also necessary for someone (likely not the experi-
provide directions for future research. menter) to record the total number of steps
taken at the end of each day. VanWormer
MEASURING ACTIVITY (2004), for example, required subjects to self-
report the number of steps on the display, and a
Mechanical Instruments family member performed reliability checks.
Quantitative measures of physical activity Pedometers also may underestimate overall
may be collected via wearable monitors, such as physical activity because they only measure
translocation.
Address correspondence to Carole Van Camp, Heart-rate monitors (HRMs) also have been
Department of Psychology, University of North used to track physical activity (Larson, Nor-
Carolina Wilmington, 601 South College Road, mand, & Hustyi, 2011; McKenzie et al., 1991).
Wilmington, North Carolina 28403 (e-mail:
vancampc@[Link]). HRMs typically measure electrical activity of
doi: 10.1901/jaba.2012.45-871 the heart via a device worn on the chest in

871
872 CAROLE M. VAN CAMP and LYNDA B. HAYES

direct contact with the skin. A readout display yet, experimenters may gather measures of
is available on the accompanying watch. Larson reliability and convergent validity by having
et al. (2011) compared the number of steps subjects wear two devices simultaneously and
taken (measured via pedometer) to beats per by comparing the new technology to more
minute as measured via an HRM (Polar F-4) established devices. One concern is that
while children engaged in structured activities individuals other than the research subjects
that varied in intensity. The data produced by may wear the device when these devices are used
the HRMs covaried with the increasing inten- to collect data in the absence of the experi-
sity of the activities much more so than did the menter. Although it may not be feasible to
data produced by the pedometers. HRMs prevent this in all cases, some recent advance-
(UNIQ Heart Watch) also were used as the ment in video cell-phone technology may allow
primary source of measurement in a similar researchers to check in visually with research
study demonstrating that heart rate covaried subjects from a distance.
with the intensity of structured activities, The studies described above focused on
ranging from lying down to running (McKen- direct measures of physical activity. Weight
zie et al., 1991). In addition to providing direct loss is an important indirect measure that also
measures of heart rate in real time, HRMs also should be evaluated in future research. Van-
may be calibrated to the specifications of the Wormer (2004) reported modest weight loss
individual to estimate calories expended. Many correlated with increased activity levels, but
modern HRMs have a memory feature that Normand (2008) did not. Donaldson and
retains data collected for 7 days or more, thus Normand (2009) reported weight loss in four
allowing the automatic collection and retention of five subjects; however, subjects were enrolled
of data while a subject is not in the presence of simultaneously in a weight management pro-
the experimenter. Donaldson and Normand gram.
(2009) used HRMs (Polar F6) with 12-day
memory to measure calories expended per day Direct Observation Coding Systems
in an evaluation of a self-management inter- Mechanical instruments allow the automatic
vention. The memory feature allowed weekly collection of activity-related measures, but they
meetings with the experimenters to verify the do not provide qualitative information, such as
subjects’ daily self-reports. It should be noted, activity type and setting. McKenzie et al.
however, that although HRMs may allow (1991) developed the Behaviors of Eating and
precise measures of heart rate throughout the Activity for Children’s Health Evaluation
day, heart rate may be affected by variables System (BEACHES) to assess physical activity
other than activity (Butte et al., 2012). and eating behavior in a variety of contexts.
Accelerometers are relatively new devices that Observers code behavior and contextual infor-
mation using a 25-s observation interval
record steps and estimate activity level using
followed by a 35-s recording interval. In this
chip sensors that record movement in one or
validation study that focused on the activity
more planes. In addition, some accelerometers level codes, 19 children were asked to engage in
(e.g., Fitbit) may be worn on several locations the following activities that corresponded to the
on the body, and also may allow wireless five activity codes in BEACHES: (a) lying
uploading of data onto websites that store and down, (b) sitting, (c) standing, (d) walking, and
graph step and activity data. To date, no (e) very active. HRMs measured exertion, and
published behavioral studies have used acceler- results indicated that heart rate covaried with
ometers with online data access to assess and the different activity levels.
increase physical activity. When using new The Observational System for Recording
technology that may not have been validated Physical Activity in Children-Home (OSRAC-
 BRIEF REVIEW 873

H; McIver, Brown, Pfeiffer, Dowda, & Russell, interobserver reliability; however, observer
2009) also allows the coding of environmental training was intensive. In addition, the coding
and social contexts while physical activity is systems use momentary time sampling, which
measured using activity codes. Measures also only estimates the actual level of activity. These
include indoor and outdoor activity contexts, observation methods provide important quali-
social groups, and topography of activity. tative information, but it may be prudent to
Activity codes include (a) stationary or motion- combine these observations with more direct
less; (b) stationary with limb or trunk move- measures of activity (e.g., pedometers). In
ments; (c) slow, easy movements; (d) moderate addition, future research should consider as-
movements; and (e) fast movements. Observers sessment of the validity of self-reports so that
use momentary time sampling with a 5-s data on qualitative aspects of physical activity
observation interval followed by a 25-s record- could be gathered in the experimenters’ ab-
ing interval. McIver et al. (2009) evaluated the sence.
activity levels of 13 preschool children while
they were engaged in unstructured play. INTERVENTION
Overall, more than 66% of the activities were
coded as sedentary (Codes 1 and 2 combined), Recent behavioral interventions aimed at
and only 7% as moderate-to-vigorous physical increasing physical activity have included self-
activity (MVPA, Codes 4 and 5 combined); management and exergaming. Normand
higher levels of MVPA occurred when children (2008) used self-management to increase phys-
were outside. Hustyi, Normand, Larson, and ical activity of four nonobese adults. Results
Morley (2012) used the OSRAC activity coding indicated that self-monitoring, goal setting, and
system to study the effect of different outdoor feedback were successful at increasing total
activity contexts on physical activity in four number of steps per day. A similar treatment
preschool children. Results indicated that fixed package also was used to increase the daily
equipment produced the highest percentage of calorie expenditure of five obese adults (Don-
MVPA. Although MVPA occurred at some aldson & Normand, 2009). Results indicated
level in the outdoor toys and open space that all subjects were successful in increasing
conditions, MVPA rarely occurred in the table calorie expenditure during intervention phases.
play condition (in which children were seated). In both studies, feedback was in the form of
Combinations of OSRAC activity codes have daily e-mails, which required subjects to submit
become common practice (see also Hustyi et al., data via e-mail. A similar treatment package was
2011), but Larson et al. (2011) evaluated the used in an evaluation to increase daily steps
validity of the individual codes by instructing taken by three overweight adults (VanWormer,
four children to engage in activities associated 2004). The experimenters conducted a compo-
with each of the codes while exertion was nent analysis that indicated that self-monitoring
measured with pedometers and HRMs. Differ- alone (without the feedback via e-mail) was
ential levels of heart rate were observed with effective for all subjects, and e-mail feedback
each level of activity, suggesting that experi- produced further improvements for only one
menters should use all five individual OSRAC subject. Hustyi et al. (2011) evaluated self-
activity codes. However, only one activity per monitoring, goal setting, and reinforcement to
code was evaluated, and additional elements of increase the physical activity (steps per session)
the behavioral definitions warrant further of two obese children. Results indicated modest
investigation. or no increases in physical activity; however, the
The studies that used the entire BEACHES authors noted that the rewards used may not
and OSRAC systems have reported acceptable have functioned as reinforcers.
874 CAROLE M. VAN CAMP and LYNDA B. HAYES

Overall, self-management appears to be a recess may be an important area of research,

promising intervention to address increased because many schools have reduced formal
physical activity. Learned skills such as self- physical education to once or twice per week,
monitoring and goal setting may be maintained whereas recess remains a daily component of
past the subjects’ involvement in research, the school day (Leviton, 2008).
which may contribute to sustained increases in In conclusion, increasingly precise and
activity levels. However, such long-term effects widely available devices allow lay individuals
have yet to be evaluated. In addition, few and researchers to collect data on physical
studies have conducted component analyses of activity. Less common, however, are details
self-management treatment packages, and only regarding how these data could be used to
one study evaluated the effects of contrived change behavior. Self-management and contin-
reinforcers other than feedback from the gency-management programs, as well as exer-
experimenter. Additional research is needed to gaming and other exercise alternatives, have
identify effective reinforcers to increase physical shown some promise in the behavioral litera-
activity when self-monitoring, goal setting, and ture. Still, additional research is needed to
feedback are not sufficient. This may be advance behavioral interventions that are aimed
particularly important in research with chil- at increasing physical activity, which is a socially
dren. In addition, contingency management significant behavior for all individuals.
(e.g., Petry, Barry, Pescatello, & White, 2011)
may be a promising approach for increasing
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