research

Adapted Physical Activity Quarterly, 2010, 27, 173-190

2010 Human Kinetics, Inc.

Physical Activity Measurement

Among Individuals With Disabilities:
A Literature Review
Carlos M. Cervantes
Texas State University

David L. Porretta
The Ohio State University
This review examined the literature on physical activity measurement among
individuals with disabilities utilizing Yun and Ulrichs (2002) view on measurement validity. Specific inclusion criteria were identified. The search produced
115 articles; however, only 28 met all specified criteria. Findings revealed that
self-reports and accelerometers were the most common approaches to measuring
physical activity, and individuals with orthopedic impairments, those with mental
retardation, and those with other health impairments received the most attention.
Of the 28 articles, 17 (61%) reported validity and reliability evidence. Among
those studies reporting validity, criterion-related evidence was the most common;
however, a number of methodological limitations relative to validity were observed.
Given the importance of using multiple physical activity measures, only five (18%)
studies reported the use of multiple measures. Findings are discussed relative to
conducting future physical activity research on persons with disabilities.

Historically, the physical activity needs of individuals with disabilities have

received little attention, but recently have become a national agenda (Rimmer,
Braddock, & Pitetti, 1996; Rimmer & Braddock, 2002; Rimmer, Wolf, Armour,
& Sinclair, 2007). These individuals demonstrate reduced levels of physical activity and higher prevalence of overweight and obesity, which increase their risk for
developing secondary health conditions (Cooper et al., 1999; Durstine et al., 2000;
Kinne, Patrick, & Lochner Doyle, 2004). According to Healthy People 2010 (United
States Department of Health and Human Services [USDHHS], 2000), 55% of adults
with disabilities do not engage in any leisure-time physical activity compared with
37% of adults without disabilities (Centers for Disease Control & Prevention [CDC],
2007). One of the Healthy People 2010 objectives is to reduce to 20% the number
of individuals (regardless of disability status) who do not engage in any leisure-time
Carlos M. Cervantes is with the Department of Health and Human Performance at Texas State
University-San Marcos. David L. Porretta is with the School of Physical Education at The Ohio State
University in Columbus.
173

174 Cervantes and Porretta

physical activity (USDHHS, 2000). Similarly, only 18% of adults with disabilities
reported engaging in regular moderate to vigorous physical activity (MVPA), 30
min or more per day for 5 or more days of the week when compared with 33% of
adults without disabilities (CDC, 2007).
Similar to their adult counterparts, youth with disabilities tend to be less physically active, less physically fit, and have higher prevalence of overweight/obesity
than their peers without disabilities (Hogan, McLellan, & Bauman, 2000; Longmuir
& Bar-Or, 2000; Whitt-Glover, ONeill, & Stettler, 2006). Rimmer, Rowland, and
Yamaki (2007), in a secondary analysis of data from the 2005 Youth Risk Behavior
Surveillance System (YRBSS), indicated a greater prevalence of overweight among
adolescents with disabilities (16.7%) compared with age-matched adolescents without disabilities (12.8%). The need for individuals with disabilities to be physically
active is even more important based on the paucity of research on physical activity
interventions (Heller, Hsieh, & Rimmer, 2004; Taylor, Baranowski, & Young, 1998)
and the lack of physical activity guidelines and recommendations for this subgroup
of the U.S. population (Cooper et al., 1999).
Physical activity has been widely accepted as any bodily movement produced
by skeletal muscle resulting in energy expenditure (Caspersen, Powell, & Christenson, 1985). Under this broad definition, physical activity includes day-to-day
body movements such as walking, climbing stairs, biking for transportation, house
work, and gardening (Biddle, 1994). For the purpose of this paper, physical activity
refers to any voluntary body movement produced by muscles resulting in energy
expenditure. The term voluntary has been included to eliminate involuntary body
movements that may characterize certain disabilities (e.g., cerebral palsy) because
involuntary movements are typically not under the individuals control. Physical
activity can be quantified or categorized by type (activity), duration (how long),
frequency (how often), and intensity (how hard; LaMonte, Ainsworth, & Reis,
2006; Sallis & Saelens, 2000).
With the recognition of increasing levels of recommended physical activity as
a national health priority, the identification and establishment of physical activity
measures that produce valid and reliable scores as well as improving the accuracy
of available assessment techniques for physical activity have become major research
priorities (Bauman, Phongsavan, Schoeppe, & Owen, 2006; Dishman, Washburn,
& Schoeller, 2001). Validity has traditionally been viewed as the degree to which
a test and/or instrument measures what it purports to measure (Thomas, Nelson,
& Silverman, 2005). The meaning of validity has changed over time, however,
shifting from the view of a characteristic of a test and/or measure to that of an
evaluative judgment of the extent to which meaningful interpretations can be
made from measurement scores (Messick, 1995; Rowe & Mahar, 2006; Yun &
Ulrich, 2002). In 2002, Yun and Ulrich described validation procedures pertinent
to adapted physical activity, recommending the reporting of several categories of
validity evidence: (a) content-related, (b) criterion-related, and (c) construct-related.
These categories of validity evidence rather than separate types of validity (e.g.,
content validity, criterion validity) are viewed as interdependent validity sources
(Yun & Ulrich, 2002). This paper focuses on Yun and Ulrichs sources of validity
evidence as it refers to adapted physical activity applications.

Physical Activity Measurement and Disability 175

Estimating measurement validity is critical for research on physical activity

among individuals with disabilities because it provides the foundation for interpreting scores derived from the different measures of physical activity and decision
making processes (Yun & Ulrich, 2002). The use of physical activity measures that
produce valid and reliable scores is necessary because it serves to (a) identify current
levels of physical activity among different groups in the population, (b) document
the frequency and distribution of physical activity among particular groups, (c)
examine the dose-response (i.e., how much physical activity) relationship between
physical activity and health, (d) identify correlates of physical activity, and (e)
evaluate program effectiveness (Sirard & Pate, 2001; Trost, 2007).
Equally important are the development and refinement of physical activity
measures to quantify physical activity among individuals with disabilities (Cooper
et al., 1999; Rimmer et al., 1996; Warms, 2006). A panel of experts in health and
disability issues has identified several areas in need of further research related to
physical activity and health among individuals with disabilities; these include (a)
characterizing physical activity patterns, (b) explaining physical activity impact,
and (c) determining the dose-response relationship between physical activity and
health outcomes (Cooper et al., 1999). These and other questions can be difficult
to answer without first establishing adequate procedures to provide validity and
reliability evidence, as well as identifying physical activity measures capable of
producing such evidence among individuals with disabilities (Beets, Combs et al.,
2007; Motl, McAuley, Snook, & Scott, 2006; Warms, 2006).
To date, a range of methods and/or techniques have been used to assess physical activity. These include (a) self-reports, (b) pedometers and accelerometers, (c)
direct observation systems, (d) heart rate monitors, and (e) indirect calorimetry and
doubly labeled water (Dishman, Washburn, Schoeller, 2001; Welk, 2002). Measuring physical activity behavior is a complex task (Caspersen et al., 1985; LaMonte,
Ainsworth, & Reis, 2006), however, and no single measure of physical activity is
capable of capturing the entire range of dimensions and/or behaviors that encompass
physical activity (Dishman et al., 2001; Laporte, Montoye, & Caspersen, 1985).
A number of reviews on the existing methods to assess physical activity have
been published (e.g., Dishman et al., 2001); however, only one publication to date
(Warms, 2006) has focused on measurement-related physical activity issues and
applications among individuals with disabilities. In Warms (2006) review, the
strengths, weaknesses, and special considerations of existing physical activity measurement techniques for individuals with disabilities were identified. Warms also
used the term disability in a broad sense and did not identify measures for validity
evidence. As a result, further examination of issues related to physical activity
measurement among individuals with disabilities is warranted. Describing in detail
these measures, their adequacy and usefulness among individuals with disabilities is
not the main purpose of this paper. For a discussion on when each physical activity
measure is most appropriate, the reader is referred to Fittipaldi-Wert and Brock
(2006). Therefore, using a known framework for identifying individuals with disabilities, the purpose of this review is to extend Warms (2006) work by reviewing
the various methods of physical activity measurement with focus on those methods
in which validity and reliability evidence have been reported.

176 Cervantes and Porretta

Method
Individuals With Disabilities
Individuals with disabilities in this review are classified as those identified in
Public Law 108446 Individuals with Disabilities Educational Improvement Act
(IDEIA) of 2004: (a) autism, (b) deaf-blindness, (c) hearing impairments, (d) mental
retardation, (e) orthopedic impairments, (f) speech or language impairments, (g)
visual impairments including blindness, (h) emotional disturbance, (i) learning
disabilities, (j) multiple disabilities, (k) other health impairments, (l) traumatic
brain injuries, and (m) deafness.

Search Strategy
Primary searches were conducted through the search engines PubMed and SPORTDiscus. The searches were designed to identify studies in which physical activity
among individuals with disabilities was measured. The keywords used to identify
articles were autism, developmental disability, pervasive developmental disorder,
deaf-blindness, hearing impairments, mental retardation, intellectual disabilities,
cognitive disabilities, orthopedic impairments, physical disability, speech or language impairments, visual impairments, blindness, emotional disturbances, learning disabilities, multiple disabilities, severe disabilities, chronic health disability and
impairment, traumatic brain injuries, spinal cord injuries, and deafness. Each of
the keywords was combined with physical activity, physical activity measurement,
physical activity assessment, and exercise to identify the literature on the topic of
interest for this review. This search produced a total of 115 articles. Secondary
searches were conducted by examining the reference sections of retrieved papers
to identify additional studies that may not have been identified through either of
the search engines.

Inclusion and Exclusion Criteria

Inclusion criteria included (a) English language articles whose primary and/or one
of the main purposes was to measure physical activity among individuals with
disabilities, (b) studies in which a measure of physical activity was validated for a
particular group of individuals with disabilities, (c) studies in which the target was
individuals with a disabling condition identified among one of IDEIAs disability
categories, (d) studies in which physical activity data were reported, and (e) studies
published from January 1990 to December 2007. Based on these criteria, 28 out
of 115 articles met all inclusion criteria and were reviewed.
The review focused on articles published in peer-reviewed journals, primarily because of the accessibility to retrieve such literature. Unpublished papers
from proceedings were excluded because of convenience. Inclusion criteria were
applied to all retrieved papers. To determine eligibility, each article was independently reviewed by the first author and two other reviewers. If any disagreement
was observed among the reviewers, the paper(s) was discussed as a group until
agreement was reached. Any paper that failed to meet all inclusion criteria was

Physical Activity Measurement and Disability 177

not reviewed. In addition, no studies involving the use of heart rate monitoring,
indirect calorimetry, and doubly labeled water were included because they did
not meet the inclusion criteria. While these are appropriate measures of energy
expenditure (LaMonte, Ainsworth, & Reis, 2006), they are not direct measures of
physical activity behavior. It is important to note that physical activity and energy
expenditure cannot be equated, as they are two distinct constructs (LaMonte et al.,
2006; Tudor-Locke & Myers, 2001).

Results
Seventeen of the reviewed studies (60.7%) reported validity and reliability evidence
of the measure(s) of physical activity, while 11 studies (39.3%) reported validity
coefficients only. Criterion-related validity evidence was found to be the most
common approach to estimating measurement validity among the studies reviewed
(22 studies, 78.6%), while the most commonly reported reliability estimates were
test-retest for self-reported physical activity and interinstrument in motion sensors
(see Table 1). Interinstrument reliability refers to the variability between two likemodel measurement instruments (e.g., two Actical accelerometers) worn during a
single trial (Esliger & Tremblay, 2006).

Self-Reported Physical Activity

Among the studies that met all inclusion criteria, eight (28.6%) used a self-report
as the primary measurement source (see Table 1). These included self-administered
recalls (Latimer, Martin Ginis, Craven, & Hicks, 2006; Martin Ginis, Latimer,
Hicks, & Craven, 2005) and surveys (Kayes et al., 2007; Nosek, Hughes, RobinsonWhelen, Taylor, & Howland, 2006; Rimmer, Riley, & Rubin, 2001; Rimmer, Rubin,
Braddock, & Hedman, 1999; van der Ploeg et al., 2007; Washburn, Zhu, McAuley,
Frogley, & Figoni, 2002). Six studies were primarily designed to evaluate the validity of a self-report measure of physical activity (e.g., survey, questionnaire, recall).
Among the number of self-reports used, there were three especially designed
for individuals with disabilities: (a) the Physical Activity and Disability Survey
(PADS; Rimmer et al., 1999), (b) the Physical Activity Recall Assessment for
People with Spinal Cord Injuries (PARA-SCI; Martin Ginis et al., 2005), and (c)
the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD;
Washburn et al., 2002). These three measures have been further described elsewhere.
The most common approaches to validity evidence reported for self-report physical activity measures were criterion-related (reported in five studies) and content
and construct-related (reported in three studies each). Regarding reliability, the
most common methods were test-retest and internal consistency, reported in five
and four studies, respectively. The specific groups of individuals with disabilities
for which evidence of validity for a self-report physical activity measure has been
reported were adults with orthopedic impairments (Latimer et al., 2006; Martin
Ginis et al., 2005; Nosek et al., 2006; Rimmer et al., 1999; van der Ploeg et al.,
2007; Washburn et al., 2002) and adults with other health impairments (Kayes et
al., 2007; Rimmer et al., 2001).

178 Cervantes and Porretta

Motion Sensors: Pedometers and Accelerometers

Pedometers. Among the studies that met all inclusion criteria, four (14.3%)
reported the use of pedometers as the primary source of measuring physical activity
behavior (see Table 1). Based on the studies included in this review, validity
evidence has been reported for the following groups: (a) youth with different
disabilities (Beets, Combs et al., 2007), (b) youth with visual impairments (Beets,
Foley, Tindall, & Lieberman, 2007), (c) adults with mental retardation (Stanish,
2004), and (d) adults with other health impairments (Motl, McAuley, Snook, &
Scott, 2005). All four studies reported criterion-related validity. In three of the
studies, reliability was primarily reported as interinstrument.
Accelerometers. Regarding the use of accelerometers among individuals

with disabilities, eight studies (28.6%) met all inclusion criteria (see Table 1).
Validity evidence for accelerometers has been reported among (a) adolescents and
young adults with mental retardation (Kozub, 2003), (b) adults with orthopedic
impairments (Bussman, Reuvekamp, Veltink, Martens, & Stam, 1998; Warms &
Belza, 2004; Washburn & Copay, 1999), (c) adults with other health impairments
(Busse, Pearson, Van Deursen, & Wiles, 2004; van den Berg-Emons, Bussman,
Balk, & Stam, 2000), (d) adults with traumatic brain injury (Tweedy & Trost,
2005), and (e) children and adolescents with visual impairments (Kozub, Oh, &
Rider, 2005). Similar to pedometer validity, all eight studies reported criterionrelated validity evidence.

Direct Observation
Two studies (7.2%) were reviewed in which a direct observation instrument was
used as the primary source of measurement (see Table 1). It is important to note that
one study specifically addressed the psychometric properties of two direct observation instruments, the System for Observing Fitness Instruction Time (SOFIT) and
the Childrens Activity Rating Scale (CARS; Taylor & Yun, 2006). In both studies
reporting validity evidence for the direct observation instruments, criterion-related
was the preferred approach. Interobserver agreement (IOA) was used in one study
as the form of reliability, while in the second study, generalizability theory was used
for reliability estimation. Based on the reviewed literature, validity evidence for
direct observation has been reported only among children with mental retardation
(i.e., Faison-Hodge & Porretta, 2004; Taylor & Yun, 2006).

Multiple Measures of Physical Activity

Given the known limitations of each of the existing physical activity measures,
the use of multiple measures has been suggested to provide a more comprehensive
assessment of physical activity behavior (Bassett, 2000; Dishman et al., 2001).
This is based on the rationale that by using multiple measures, one measure will
compensate for the weakness of another. Among the studies that met all inclusion
criteria, only five (17.9%) reported using multiple measures to assess physical
activity (see Table 1). These included a combination of (a) self-reports, pedometers, and accelerometers (Gosney, Scott, Snook, & Motl, 2007; Motl, McAuley,
Snook, & Scott, 2006); (b) accelerometers and self-reports (Pan & Frey, 2005;

 179

73 adults with Spinal Cord Injury (SCI)

Reliability- 102 adults with SCI; validity14 adults with SCI

386 women with orthopedic impairments

103 adults with disabilities and other

health impairments

50 African American women with orthope- Self-report

dic and other health impairments

45 adults with orthopedic and other health

impairments

372 adults with orthopedic impairments

Latimer et al., 2006

Martin Ginis et al., 2005

Nosek et al., 2006

Rimmer et al., 2001

Rimmer et al., 1999

van der Ploeg et al., 2007

Washburn et al., 2002

Measure(s)

Kayes et al., 2007

Self-report

Self-report

Self-report

Self-report

Self-report

Self-report

Self-report

Sample

30 adults with Multiple Sclerosis (MS)

Study

Content and construct

*Factor analysis

Criterion
(Accelerometers)
Spearman r = 0.30

Content

Construct, concurrent,
and predictive
(Oxygen uptake)
Multiple scores1

Construct *Exploratory
factor analysis

Face, content,
and criterion
(Indirect calorimetry)
Multiple scores1

Convergent
(Fitness measures)
Multiple scores1

Criterion
(Accelerometer)
*Regression analysis
95%CI

Validity

Table 1 Physical Activity Studies Reporting Validity and Reliability Measures

Reliability

(continued)

Internal consistency
Cronbach = 0.37 0.65

Test-retest Spearman
r = 0.77

Internal consistency,
interrater and test-retest
Multiple scores1

Internal consistency:
Cronbachs = 0.67 0.71
Interrater: 0.92 0.99
Test-retest: 0.78 0.95

Internal consistency
Cronbachs = 0.64

Test-retest
Multiple scores1

Not applicable
Multiple scores1

Test-retest: ICC = .92

Bland-Altman: 95%
limits of agreement
(-17.4, 17.4)

180

Pedometer

Talking
Pedometer

Beets, Combs et al., 2007 18 youth with a single or multiple

disabilities

35 youth with visual impairments

23 adults with other health impairments

20 adults with mental retardation (MR)

Reliability- 10 healthy and 10 individuals

with other health impairments; Validity30 healthy participants and 30 with other
health impairments

4 men with orthopedic impairment and 4

age-matched men without disability

7 individuals with MR

19 youth with visual impairments

Beets, Foley, Tindall,

& Lieberman, 2007

Motl, McAuley, Snook,

& Scott, 2005

Stanish, 2004

Busse, Pearson, Van

Deursen, & Wiles, 2004

Bussman, Reuvekamp,
Veltink, Martens,
& Stam, 1998

Kozub, 2003

Kozub, Oh, & Rider,

2005

Triaxial
Accelerometer

Triaxial
Accelerometer

Accelerometer

Accelerometer

Pedometer

Pedometer

Measure(s)

Sample

Study

Table 1 (continued)

Interunit Multiple scores1

Interinstrument,
Interobserver agreement
(IOA) Multiple scores1

Reliability

Concurrent
(Direct observation)
R = 0.89, p < .05

Concurrent
(Direct observation)
r = 0.76

Concurrent: 90%
agreement Predictive:
80% + (Video recording)

Criterion
(Movement checklist)
r = 0.45, p = 0.001

Criterion
(Hand-held counter)
ICC = 0.95+ *ANOVA
analysis

Interinstrument
R = 0.98, p < .001

Not reported

Not specified

(continued)

Day to day, week to week

ICC = 0.86

Interinstrument:
r = 0.98 .99 IOA: 99%

Criterion (Hand tally

Not specified
counter and video
recording) Multiple scores1
*ANOVA analysis

Concurrent
(NL 2000 pedometer)
Multiple scores1

Criterion
(Video recording)
Multiple scores1

Validity

 181

11 children with MR

196 adults with MS

Taylor & Yun, 2006

Gosney, Scott, Snook,

& Motl, 2007

Self-report
Pedometer
Accelerometer

Direct observation

Direct
observation

Accelerometer

8 children with MR and 38 children

without disabilities

Warms and Belza, 2004

Accelerometer

Faison-Hodge
& Porretta, 2004

Phase 1 and 26 adults with SCI; Phase

316 adults with SCI

van den Berg-Emons,

Bussman, Balk, & Stam,
2000

Measure(s)
Accelerometer

Accelerometer

10 adults with other health impairments

Tweedy & Trost, 2005

Washburn & Copay, 1999 21 individuals with orthopedic

impairments

Sample

14 adults with traumatic brain injuries

(TBI)

Study

Table 1 (continued)

Unified Multiple scores1

Concurrent (Accelerometer) SOFIT: r = 0.10

CARS: r = 0.61

Concurrent
(Heart rate monitoring)
PE: r = 0.81
(0.720.86) Recess:
r = .69 (0.060.90)

Criterion
(Indirect calorimetry)
Multiple scores1

Concurrent
(Self-report) r = 0.60,
p < .01

Concurrent: 90%
agreement (8297%)
Predictive: 80% +
(Video tape analysis)

Criterion
(Indirect calorimetry)
r = 0.74, p < .05

Validity

Reliability

Not applicable

(continued)

Generalizability theory
(G-Theory)
= 0.98 (SOFIT)
= 0.75 (CARS)

IOA 94.4%
(82100%)

Interinstrument
r = 0.42

Interinstrument
r = 0.95 0.96;
p = .000

Not specified

Not specified

182

30 adults with MS

30 children with autism, 26 mothers,

and 24 fathers

6 adults with MR

37 individuals MR

Motl, McAuley, Snook,

& Scott, 2006

Pan & Frey, 2005

Temple, Anderson,
Walkley, 2000

Temple & Walkley, 2003

Self-report
Accelerometer

Accelerometer
Self-report

Accelerometer
Self-report

Self-report
Pedometer
Accelerometer

Measure(s)

Concurrent for self-report

(Accelerometer)
ICC = 0.78

Concurrent for self-report

(Accelerometer)
ICC = 0.83

Criterion
(for self-report)
r = 0.31 0.47

Unified Multiple scores

Validity

Reader can refer to the actual study for more information.

* Researchers did not conduct correlation analysis and/or did not provide a single score but multiple scores.

Sample

Study

Table 1 (continued)

Not specified

Not specified

Test-retest
(for self-report)
r = 0.73 0.94

Not applicable

Reliability

Physical Activity Measurement and Disability 183

Temple & Walkley, 2003); and (c) accelerometers and direct observations (Temple,
Anderson, & Walkley, 2000). Among these, three studies reported validity evidence
(criterion-related) for one of the two measures used, while two studies reported
validity evidence as a unified entity was reported for pedometers, accelerometers,
and self-reports. Reliability was specified in only one study (i.e., Pan & Frey, 2005).
Participants in the studies using multiple measures of physical activity included (a)
adults with mental retardation (two studies), (b) adults with other health impairments (two studies), and (c) children with autism spectrum disorders (one study).

Individuals With Disabilities

Among the reviewed studies, the most common studied classifications of individuals with disabilities included (a) orthopedic impairments (10 studies, 35.7%), (b)
other health impairments (9 studies, 32.1%), and (c) mental retardation (6 studies,
21.4%). Of these, 20 studies (71.4%) targeted adults. Based on studies that met
all inclusion criteria, no studies were found for individuals exhibiting deafness,
deaf-blindness, learning disabilities, speech and language impairments, or serious
emotional disturbances. It is important to note that among the studies reviewed
focusing on individuals with mental retardation, some studies used samples including participants with Down syndrome (DS). Although studies using samples of
individuals with DS were grouped together as part of studies on mental retardation
(MR) and physical activity, it is important to acknowledge that individuals with DS
and MR have differences that may affect physical activity and sedentary behavior
in unique ways. In this review, they were grouped together because IDEA was used
as the frame to identify individuals with disabilities.

Discussion and Conclusion

Consistent with the literature in measuring physical activity among individuals
without disabilities, self-reports were found to be one of the most commonly used
forms of assessing physical activity among individuals with disabilities. Among
the self-report measures, three were specially designed for individuals with disabilities. The advantages and disadvantages of self-reported physical activity have
been reviewed extensively elsewhere (e.g., Kriska & Caspersen, 1997); however,
there are methodological and conceptual considerations researchers should take
into consideration when using self-reports among individuals with disabilities.
Particular to those with mental retardation, recalling physical activity may
become an issue due to cognitive limitations, thus affecting the validity of the data
obtained (Rimmer, 2006). As a result, some researchers have used self-reports as
proxy information completed by a direct care-provider and/or family member.
Although practical and a way of minimizing issues of cognition, proxy reports
may not provide a true representation of an individuals habitual physical activity
because proxy respondents may not accurately report all activity performed by the
individual (Rimmer, 2006; Sallis & Saelens, 2000).
Another issue is the use of Metabolic Equivalent values (METs) to estimate
activity intensity. Metabolic equivalents for various physical activities were established using healthy young to middle aged adults without disabilities (Ainsworth
et al., 2000), thus limiting their utility for those with disabilities (Rikli, 2000;

184 Cervantes and Porretta

Shephard, 2003). Due to the heterogeneity of individuals with disabilities, the

large number of disabling conditions, and the high within and between variability
among individuals with the same disability (Rikli, 1997; Rimmer, 2006), Warms
(2006) argued that it may not be worthwhile to establish a compendium of MET
values for such groups.
While the use of direct observations was minimal, the use of accelerometers as
physical activity measures were as common as self-reports. This is consistent with
the literature on physical activity measurement in which the use of more objective
physical activity monitoring has been advocated (Janz, 2006). Only five studies in
this review reported the use of multiple physical activity measures. Yet, the use of
multiple measures has been considered the best alternative to minimize the limitations innate to each of the existing measures of physical activity (Dishman et al.,
2001). Sallis and Saelens (2000) suggest the use of self-reports and motion sensors
to better represent habitual physical activity. Self-report measures would provide
context and type of physical activity, while motion sensors would provide duration
and intensity. Dishman et al. (2001) have argued that the future of physical activity
measurement may be in the use of multiple measures.
Of concern is the paucity of studies reporting validity evidence. Considering
that the search produced 115 studies, only 28 (24.35%) met all inclusion criteria,
which included reporting validity of the measures and/or validity of the scores
obtained from the measures. Among the studies failing to meet the criterion in which
a measure of physical activity was validated and validity estimates reported, authors
indicated that the measure or measures used were previously validated; however,
they did not validate and/or provide evidence of validity for the measure(s) used
among the participants in their own study. Researchers have argued against this
practice by stating that once a test or measure has been validated for one population, it cannot be generalized for use with other populations (Rikli, 1997; Yun &
Ulrich, 2002). Subsequent uses of an instrument should be validated again for the
new sample. Thus, validity is not test-specific.
Of the studies reporting validity, criterion-related validity evidence was found
to be the most commonly reported. With the lack of true gold standards to serve as
criterion measures of physical activity, however, we may be limited to evaluating
agreement and disagreement between measures (Tudor-Locke & Myers, 2001).
Patterson (2000) adds that even in studies where it is assumed that criterion-related
evidence has been provided, researchers have merely provided convergent evidence
since no existing measure of physical activity can be considered to be a true criterion
measure of physical activity. This is significant since identifying a criterion measure
is critical in establishing criterion-related validity evidence (Yun & Ulrich, 2002).
When establishing criterion-related evidence, the identification of an appropriate criterion is a critical first step because the evidence is obtained from the degree
of empirical relationship between the physical activity measure and the criterion
measures scores (Yun & Ulrich, 2002). In addition, obtaining a representative
sample of the entire population of interest is required rather than using only a
subgroup of that population (Yun & Ulrich, 2002). Unfortunately, in some of the
studies reviewed, the researchers failed to identify an adequate criterion and/or
the sample was not representative of the population. For example, in two studies,
fitness measures were used to establish criterion-related validity evidence for two
self-report measures; however, physical activity cannot be equated with physical

Physical Activity Measurement and Disability 185

fitness since they are two distinct constructs (Caspersen et al., 1985). Physical activity has been defined as bodily movement produced by skeletal muscle resulting in
energy expenditure, while physical fitness refers to a persons set of attributes or
traits that relate to the ability to perform physical activity (Caspersen et al., 1985).
Therefore, the use of these two terms interchangeably is not appropriate because
they describe different concepts. Failure to use appropriate criterion measures may
lead to equivocal and/or questionable results.
Energy expenditure measures have also been used (e.g., indirect calorimetry
and doubly labeled water) as criterion measures. These measures represent a product
of engaging in physical activity, rather than the behavior(s) itself. Physical activity, however, is a multidimensional construct comprised of four dimensions and/
or domains, which include (a) duration, (b) frequency, (c) type, and (d) intensity
(LaMonte et al., 2006; Montoye, Kemper, Saris, & Washburn, 1996: Welk, 2002).
In studies where indirect calorimetry or doubly labeled water were used as criterion
measures, the researchers may have provided evidence of measurement validity
for only one physical activity dimension. Therefore, inferences and/or decisions
based on the validity evidence for that single dimension may need to be used with
caution when the purpose of the study was to provide validity evidence in assessing
the construct of physical activity.
Two studies used a different approach to provide validity evidence. Motl et
al. (2006) and Gosney et al. (2007) used a nomological network of hypothesized
direction and magnitude of relationships among multiple measures of physical
activity to provide evidence of the validity of scores derived from such measures.
This approach is in line with the conception of validity as a unified entity (Messick,
1995) where rather than the existence of forms of validity, there are strengths of
evidence of validity (Messick, 1995; Yun & Ulrich, 2002) with construct validity
at the core (Messick, 1995).
Test-retest and interinstrument were the most common forms of reliability
reported in the studies reviewed; however, an important methodological concern
is that some researchers failed to report time elapsed between the first test administration and the retest. This is important because in many instances, participants
recalled different days on the first administration of a test than on the retest. If the
instrument required participants to recall the previous seven days of activity and
the retest was not given on the same day as the first administration, they would not
be recalling the same time period. This has been raised as a concern for researchers
in physical activity measurement (e.g., Patterson, 2000; Sallis & Saelens, 2000).
Regarding specific groups of individuals with disabilities, those with orthopedic
impairments, mental retardation, and other health impairments have received greater
attention in the reviewed literature compared with other disabilities such as deafness,
deaf-blindness, and/or multiple disabilities. Yet it is well accepted that physical
activity is important for all individuals with disabilities. On the contrary, those who
have received less attention reflect our limited understanding of the physical activity needs of a wide range of disabilities and our need to expand physical activity
research. In addition, most of the reviewed studies have focused on adults. This
is particularly interesting when an age-related trend in physical activity has been
identified among individuals with and without disabilities (Caspersen, Pereira, &
Curran, 1999; Longmuir & Bar-Or, 2000) where adolescence has been identified as
the key period for targeting physical inactivity (Rowland, 1999; USDHHS, 2000).

186 Cervantes and Porretta

In conclusion, based on the results of this review, there is a paucity of research

on the physical activity of individuals with disabilities. Using a known framework
for identifying disabilities, those with mental retardation, orthopedic impairments,
or other health impairments have received attention, while individuals with speech
and language impairments, deaf-blindness, deafness, specific learning disabilities,
or serious emotional disturbances have received little to no attention. With measurement validity as a primary need in the area of physical activity research, it is
important to consider moving from the traditional view of validity as a quality of a
test and/or instrument to that of the process of assuring the meaningfulness of the
inferences made and decision making from measurement taken on a group-specific
basis (Yun & Ulrich, 2002).
There are still many unanswered questions such as what the current levels of
physical activity are among individuals with disabilities and what types and amounts
of physical activity may be needed to achieve health-related outcomes (Rimmer,
2006). Through estimating measurement validity in physical activity research, we
may be able to better quantify progress toward meeting national physical activity
objectives and to better evaluate our efforts toward reducing physical activity disparities between those with and without disabilities (Rimmer, 2006). Laporte and
colleagues (1985) commented that in order for a physical activity measure to be
considered a gold standard, it must be valid, reliable, practical, and nonreactive.
To date, no existing measure has met these four criteria. Only through continuous
research and proper validity procedures can we further improve existing physical
activity measures. Developing valid and reliable measurement tools for individuals
with disabilities will not be a simple task. Every effort must be made, however, to
establish valid and reliable physical activity measures among those with disabilities
so that research is meaningful and effective (Rikli, 1997; Yun & Ulrich, 2002).

Limitations
This review was limited to the use of two search engines (PubMed and SPORTDiscus) as well as a specified time period (January 1990 to December 2007). In
addition, the review was limited to papers published in English only peer-reviewed
journals. As such, unpublished papers from proceedings and abstracts were excluded
because of convenience.

Implications for Research and Practice

One of the major findings of this review was the paucity of published studies reporting validity evidence of physical activity measures. As a result, there is a need for
more systematic physical activity reviews to address measurement issues (such as
quality procedures for reporting validity and reliability evidence) among individuals
with disabilities. Therefore, it is recommended that researchers in physical activity
of individuals with disabilities make every effort to report validity and reliability
evidence of measures used in the study (Rikli, 1997).
Future research should also focus on the physical activity of individuals with
various types of disabilities for which research has been minimal. As we further
our understanding about the physical activity of individuals with disabilities, the
use of a combination of measurement methods (i.e., multiple measures of physi-

Physical Activity Measurement and Disability 187

cal activity) appears to offer the most promise for understanding physical activity
behavior as well as helping to enhance the quality of research designs and program
interventions (Dishman et al., 2001; Fox & Riddoch, 2000; Sallis & Saelens, 2000).

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