Comparison of methods to assess energy expenditure and physical activity in people with spinal cord injury

Abstract

Objective: To compare different methods of assessing energy expenditure (EE) and physical activity (PA) in people with spinal cord injury (SCI) under community-dwelling conditions.

Methods: A reference standard encompassing the doubly labelled water (DLW) technique, heart rate monitoring (FLEX-HR), a multi-sensor armband (SenseWear Armband (SWA)), and two PA recall questionnaires were employed in 14 people with SCI to estimate EE and leisure-time PA.

Results: Mean total daily energy expenditure (TDEE) assessed by DLW, FLEX-HR, and SWA were 9817 ± 2491 kJ/day, 8498 ± 1516 kJ/day, and 11414 ± 3242 kJ/day, respectively. Physical activity energy expenditure (PAEE) quantified by DLW was 2841 ± 1626 kJ/day, 2935 ± 1732 kJ/day estimated from FLEX-HR, and 2773 ± 2966 kJ/day derived from SWA. After converting the PA recall questionnaire data to EE in kJ/day, PAEE for the Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) was 2339 ± 1171 kJ/day and for Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) 749 ± 1026 kJ/day. DLW-quantified PAEE was moderately associated with PARA-SCI (R(2) = 0.62, P < 0.05), but not with the other estimates of PAEE (R(2) ranged between 0.13 and 0.30, P > 0.05).

Conclusion: Our findings revealed that the PARA-SCI recall questionnaire was the best estimate of PAEE compared to the reference standard DLW approach. Although the between-method variability for SWA, FLEX-HR, and PASIPD-derived PAEE was small, there was a weak association between these methods and the criterion DLW technique. The best estimate of DLW-quantified TDEE was by FLEX-HR. SWA significantly overestimated TDEE in this population.

Figure 1

Protocol over the 5-day visit. Anthro. = anthropometric measurements; Demog. = demographic measurements; BMR = basal metabolic rate; RMR = resting metabolic rate; TM1 = first treadmill test; TM2 = second treadmill test; DLW = doubly labelled water; HR = heart rate monitoring; SWA = SenseWear Armband; PARA-SCI = Physical Activity Recall Assessment for People with Spinal Cord Injury; PASIPD = Physical Activity Scale for Individuals with Physical Disabilities.

Figure 2

TDEE and PAEE (kJ/day ± SD) of reference-standard method and predictive techniques. TDEE = total daily energy expenditure; PAEE = physical Activity-associated energy expenditure; DLW = doubly labelled water; SWA = SenseWear Armband; FLEX-HR = Flex heart rate monitoring; PARA-SCI = Physical Activity Recall Assessment for People with Spinal Cord Injury; PASIPD = Physical Activity Scale for Individuals with Physical Disabilities.

Figure 3

Comparison of TDEE between DLW (reference-standard method) and SWA, FLEX-HR, PARA-SCI, and PASIPD (predictive methods). TDEE = total daily energy expenditure; DLW = doubly labelled water; SWA = SenseWear Armband; FLEX-HR = Flex heart rate monitoring; PARA-SCI = Physical Activity Recall Assessment for People with Spinal Cord Injury; PASIPD = Physical Activity Scale for Individuals with Physical Disabilities. Shown in the legend are the coefficients of determination (R²) between DLW-derived TDEE and predicted TDEE.

Figure 4

Comparison of PAEE between DLW (reference-standard method) and SWA, FLEX-HR, PARA-SCI, and PASIPD (predictive methods). PAEE = physical activity-associated energy expenditure; DLW = doubly labelled water; SWA = SenseWear Armband; FLEX-HR = Flex heart rate monitoring; PARA-SCI = Physical Activity Recall Assessment for People with Spinal Cord Injury; PASIPD = Physical Activity Scale for Individuals with Physical Disabilities. Shown in the legend are the coefficients of determination (R²) between DLW-derived PAEE and predicted PAEE.

Figure 5

Bland and Altman plot of PAEE (kJ/day) using DLW and SWA (A) and of PAEE using DLW and FLEX-HR (B). PAEE = physical activity-associated energy expenditure; DLW = doubly labelled water; SWA = SenseWear Armband; FLEX-HR = Flex heart rate monitoring.

Figure 6

Bland and Altman plot of PAEE (kJ/day) using DLW + indirect calorimetry and PARA-SCI (A) and of PAEE using DLW + indirect calorimetry and FLEX-HR (B). PAEE = Physical activity-associated energy expenditure; DLW = doubly labelled water; PARA-SCI = Physical Activity Recall Assessment for People with Spinal Cord Injury; PASIPD = Physical Activity Scale for Individuals with Physical Disabilities.