International Journal of Behavioral

Nutrition and Physical Activity BioMed Central

Research Open Access

Objectively measured physical activity of USA adults by sex, age,
and racial/ethnic groups: a cross-sectional study
Marquis S Hawkins*†1, Kristi L Storti†1, Caroline R Richardson†2,3,
Wendy C King†1, Scott J Strath†4, Robert G Holleman†2 and
Andrea M Kriska†1

Address: 1Department of Epidemiology, University of Pittsburgh, 130 Desoto Street, Pittsburgh, Pennsylvania 15261, USA, 2Ann Arbor VA Medical
Center, PO Box 130170, Ann Arbor, Michigan, 48113-0170, USA, 3Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann
Arbor, Michigan, 48104-1213, USA and 4Department of Human Movement Sciences, University of Wisconsin, Enderis Hall, Room 435 PO Box
413, Milwaukee, Milwaukee, Wisconsin 53201-0413, USA
Email: Marquis S Hawkins* - [email protected]; Kristi L Storti - [email protected]; Caroline R Richardson - [email protected];
Wendy C King - [email protected]; Scott J Strath - [email protected]; Robert G Holleman - [email protected];
Andrea M Kriska - [email protected]
* Corresponding author †Equal contributors

Published: 3 June 2009 Received: 26 August 2008

Accepted: 3 June 2009
International Journal of Behavioral Nutrition and Physical Activity 2009, 6:31 doi:10.1186/1479-5868-6-31
This article is available from: http://www.ijbnpa.org/content/6/1/31
© 2009 Hawkins et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract
Background: Accelerometers were incorporated in the 2003–2004 National Health and Nutritional Examination Survey
(NHANES) study cycle for objective assessment of physical activity. This is the first time that objective physical activity data are
available on a nationally representative sample of U.S. residents. The use of accelerometers allows researchers to measure total
physical activity, including light intensity and unstructured activities, which may be a better predictor of health outcomes than
structured activity alone. The aim of this study was to examine objectively determined physical activity levels by sex, age and
racial/ethnic groups in a national sample of U.S. adults.
Methods: Data were obtained from the 2003–2004 NHANES, a cross-sectional study of a complex, multistage probability
sample of the U.S. population. Physical activity was assessed with the Actigraph AM-7164 accelerometer for seven days following
an examination. 2,688 U.S. adults with valid accelerometer data (i.e. at least four days with at least 10 hours of wear-time) were
included in the analysis. Mean daily total physical activity counts, as well as counts accumulated in minutes of light, and moderate-
vigorous intensity physical activity are presented by sex across age and racial/ethnic groups. Generalized linear modeling using
the log link function was performed to compare physical activity in sex and racial/ethnic groups adjusting for age.
Results: Physical activity decreases with age for both men and women across all racial/ethnic groups with men being more active
than women, with the exception of Hispanic women. Hispanic women are more active at middle age (40–59 years) compared
to younger or older age and not significantly less active than men in middle or older age groups (i.e. age 40–59 or age 60 and
older). Hispanic men accumulate more total and light intensity physical activity counts than their white and black counterparts
for all age groups.
Conclusion: Physical activity levels measured objectively by accelerometer demonstrated that Hispanic men are, in general,
more active than their white and black counterparts. This appears to be in contrast to self-reported physical activity previously
reported in the literature and identifies the need to use objective measures in situations where the contribution of light intensity
and/or unstructured physical activity cannot be assumed homogenous across the populations of interest.

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Background intensity activity and moderate-vigorous intensity activity

Physical activity can prevent and delay the onset of to examine differences in physical activity by sex, age and
chronic diseases, such as diabetes and heart disease [1,2]. racial/ethnic groups in a national sample of adults.
Despite this, inactivity is common in the United States.
National surveillance systems have included measures of Methods
physical activity allowing researchers to measure trends in Study Population and Procedures
physical activity as well as identify groups that are physi- NHANES is a cross-sectional observational study con-
cally inactive. Historically, national reports, such as the ducted by the National Center for Health Statistics of the
Behavior Risk Factor Surveillance System (BRFSS) and Centers for Disease Control that uses a stratified, multi-
National Health and Nutrition Examination Survey stage probability design to obtain a nationally representa-
(NHANES), have incorporated subjective measures (e.g. tive sample of the U.S. household population [16]. The
questionnaires) because of their low cost and ease of use, survey population includes randomly selected neighbor-
which makes them ideal for large population studies. hoods in the United States. From these neighborhoods,
However, objective measures, such as pedometers, which random households are selected to incorporate individu-
count steps, and accelerometers, which measure move- als in this study. During the 2003–2004 NHANES study
ment intensity, are starting to be utilized to assess physical cycle, 12,761 individuals were selected for recruitment. Of
activity levels in population studies [3-6]. those selected, 10,122 individuals (79%) agreed to partic-
ipate in the study.
Both subjective and objective assessment tools have
advantages and disadvantages depending on the popula- NHANES 2003–2004 consisted of an interview, physical
tion being studied and the research question being inves- examination, and laboratory tests conducted in mobile
tigated [7]. Subjective measures often provide detailed examination centers (MEC) by trained staff. Physical
information regarding type of activity. However, because activity assessment was restricted to NHANES participants
they rely on self-report of activity they are subject to who were not prevented by impairments from walking or
response bias and recall bias. In particular, they have lim- wearing an accelerometer. Our analysis was further
ited accuracy at capturing activities that are unstructured, restricted to individuals who were at least 18 years of age,
and of light intensity [8], both of which tend to be per- not pregnant, and never reported having had a stroke,
formed in greater frequency in women and in older pop- congestive heart failure, angina, emphysema, chronic
ulations [9-11]. Thus, using a subjective measure of bronchitis, or renal dialysis to exclude individuals whose
physical activity may not provide an accurate description physical activity was limited because of illness or health
of activity in these groups. It is important to measure total status (N = 3840). Fewer than 5% of the remaining partic-
physical activity (which includes light intensity and ipants reported a race other than non-Hispanic white,
unstructured activities) because it may have a greater non-Hispanic black or Hispanic so they were subse-
impact on several health outcomes, such as diabetes, com- quently excluded from this analysis due to insufficient
pared to moderate-to-vigorous physical activity alone [12- sample size (N = 149). Participants who had at least four
14]. Objective measures, such as accelerometers, do not days of valid accelerometer data with relevant covariates
provide detailed information on the type of activities were used in the analysis (N = 2688) (Figure 1).
being performed. However, they do record physical activ-
ity across all intensities and are not subject to the biases of Measures
self-report. In addition, accelerometers can be used to esti- Physical Activity
mate the time spent in light, moderate, and high intensity Physical activity was assessed with the Actigraph AM-7164
physical activity and the contribution of each to total accelerometer (formerly the CSA/MTI AM-7164, manu-
physical activity [15]. factured by ActiGraph of Ft. Walton Beach, Florida, USA),
which is a pager size device powered by a small lithium
Accelerometers were incorporated in the 2003–2004 battery. The accelerometers were attached to an elasticized
NHANES study cycle for objective assessment of physical belt and worn on the right hip. The accelerometer meas-
activity. This is the first time that objective physical activ- ures the duration and intensity of physical activity by cap-
ity data are available on a nationally representative sam- turing the magnitude of acceleration (intensity) and
ple of U.S. residents. A previous effort by Troiano et al summing up the magnitudes (intensity counts) within a
focuses on physical activity at moderate-to-vigorous levels specified time interval (epoch). A one-minute epoch was
of intensity describing, on a population level, who's meet- used by NHANES.
ing the Surgeon General's recommendations of physical
activity using this accelerometry data from NHANES [6]. Participants were asked to wear the device for seven days
In contrast, given the potential importance of total physi- while they were awake, and to take it off for swimming or
cal activity, the current effort includes assessments of light bathing. Monitors were returned by express mail to

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respectively, were individually summed and divided by

the number of days worn to calculate daily averages for
Population those specific intensities. Total physical activity was the
sum of the counts derived during minutes of light and
N=10,122 moderate-vigorous activity.

Demographics and Anthropometrics

At least 18 yrs of age
Participants were categorized as non-Hispanic white, non-
N= 5620 Hispanic black, and Hispanic (including Mexican Ameri-
can and other Hispanic) based on self-report. Age in years
was calculated from self-report. Participants over the age
Not pregnant and free from disease
of 85 were assigned the age of 85 to protect confidential-
N= 3840 ity. For descriptive purposes, activity was tabulated by age
groups: 18–39, 40–59 and 60 or more years. Body Mass
White, Black, or Hispanic Race Index (BMI) was calculated (BMI) (kg/m2) from height
and weight, which were measured at MEC using standard-
N= 3691
ized protocol and equipment. General health status was
self-reported as excellent, very good, good, fair, or poor.
Accelerometer data met NHANES
validity and reliability criteria and was Data Analyses
Statistical analyses were performed using STATA 10.0
worn for at least 4 days
(StataCorp Stata Statistical Software: Release 10.1. Stata-
N= 2720 Corp LP: College Station, TX, 2007). For all analyses, sig-
nificance was set at an alpha level of <0.05. Unadjusted
Included information on relevant values were calculated stratified by sex, race/ethnicity and
age groups. Generalized linear modeling using the log
covariates (BMI)
link function was performed to compare total, light, and
N= 2688 moderate-vigorous activity counts by sex and race/ethnic
groups adjusting for age and age-squared because it's non-
linear relationship with physical activity. To determine
Figureinclusion
Study 1 flow chart whether there were interactions between age and race in
Study inclusion flow chart. either males or females interaction terms were added to
the models. All analysis took into account the complex
survey design of NHANES, which includes weighting,
NHANES, where data were downloaded from the device, stratification and clustering.
and the device was checked to determine whether it was
still within the manufacturer's calibration specifications Results
using an Actigraph calibrator. Demographic characteristics of the 2,688 participants are
presented in Table 1. Participants were stratified by sex
NHANES used standardized data quality procedures to and race/ethnicity to form six groups that consisted of
assess the validity and reliability of the accelerometry white men, black men, Hispanic men and white women,
data, which are described in more detail elsewhere [17]. In black women and Hispanic women. As a group, Hispanic
brief, participants with at least four days in which the men and women on average appeared to be younger than
accelerometer was worn for at least 600 minutes are their white and black counterparts. The majority of the
included in analysis. Any block of time greater than or participants in the study were in good or very good health
equal to 60 minutes where the activity count was equal to which is reflective of inclusion criteria because we whose
zero was considered time when the monitor was not physical activity may possibly be limited by underlying
worn. Based on a previous calibration study by Freedson conditions.
and colleagues, a minute of accelerometer data was coded
as sedentary if it contained less than 260 activity counts. A Age-adjusted physical activity counts by race/ethnicity
minute was coded as light physical activity if it recorded and gender are presented in Table 2. Hispanic men
an accelerometer count between 260–1951. A minute was appeared to have both higher age-adjusted total and light
coded as moderate-vigorous intensity if activity counts activity counts compared to white and black men (p <
were greater than or equal to 1952 [18]. Counts derived 0.01). Moderate-vigorous physical activity followed a sim-
during minutes of light and moderate-vigorous activity ilar pattern of higher counts in Hispanic men but the dif-

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Table 1: Descriptive characteristics of the study population stratified by sex

Male Female
White Black Hispanic White Black Hispanic
(N= 714) (N= 277) (N= 369) (N= 713) (N= 258) (N= 357)

General characteristics
BMI (kg/m2) 27.9 ± 3.4 28.4 ± 8.0 27.6 ± 5.3 27.4 ± 4.4 31.5 ± 8.4 28.1 ± 7.4

Age (years) 45.5 ± 10.9 42.1 ± 19.7 38.8 ± 16.0 47.7 ± 11.3 44.2 ± 17.3 40.1 ± 18.5
Health Status (%)

Excellent 14.7 15.2 15.3 7.9 15.7 11.3

Very Good 23.0 41.4 31.2 25.5 41.3 31.3
Good 41.8 33.3 40.1 38.4 32.8 32.9
Fair 19.6 8.7 11.1 25.4 8.1 23.4
poor 1.1 1.4 2.3 2.7 2.1 1.1

Wear time 1000 ± 115 1051 ± 240 996 ± 183 973 ± 80 1025 ± 228 981 ± 161
(mean min/day)

All values are means + standard deviations unless labeled otherwise

ference was not statistically significant (p = 0.13). group, the pattern of higher activity counts in Hispanic
Likewise, Hispanic women appeared to have significantly men remained, however, significance was only reached in
higher counts of light intensity physical activity compared total and light activity in the youngest age groups (p =
to their white and black counterparts (p = 0.02). Total 0.001 and p = 0.002 respectively). There was also a pattern
activity followed a similar pattern of higher counts in His- for higher activity counts in Hispanic women in the mid-
panic women but the difference did not reach statistical dle age groups, reaching significance for total and light
significance (p = 0.14). Moderate -vigorous physical activ- activity (p = 0.006 and p = 0.003 respectively). Women
ity counts appeared to be similar in women (p = 0.50). appeared to have similar activity counts across race/eth-
There was a statistically significant interaction with regard nicity groups in the younger and older age groups.
to age for Hispanic men, which suggests that Hispanic
men experience a faster decline in moderate-vigorous Discussion
physical activity with increasing age (p = 0.03). No other The current study examined objectively measured physi-
significant interactions were noted (data not shown). cal activity data collected on a nationally representative
sample of U.S. adults and thus provided a unique oppor-
Physical activity counts per day for total, light, and mod- tunity to investigate total physical activity and various lev-
erate-to-vigorous intensity stratified by age, sex, and race/ els of physical activity intensity across racial/ethnic and
ethnicity are presented in Table 3. When stratifying by age sex groups. The most striking findings were the relatively

Table 2: Daily age-adjusted activity counts (thousands) by intensity level and by sex and race

Hispanic White Black p-value

MEN
Total physical activity 303.9 258.0 266.4 0.001
(288.1, 320.6) (243.6, 273.3) (239.2,296.6)
Light Physical Activity 195.3 165.4 168.3 0.001
(185.9, 205.2) (156.5, 174.9) (153.9, 184.2)
Moderate-Vigorous Physical Activity 106.6 90.0 96.2 0.12
(93.0, 122.3) (81.1, 100.0) (78.1, 118.7)
WOMEN
Total physical activity 217.9 206.2 192.6 0.14
(198.4, 239.3) (196.0, 216.9) (177.1, 209.4)
Light Physical Activity 159.3 149.0 142.6 0.02
(151.9, 167.2) (142.6, 155.8) (133.1, 152.9)
Moderate-Vigorous Physical Activity 55.7 55.1 48.3 0.49
(44.9, 69.1) (48.8, 62.3) (38.6, 60.6)

All values are means (95% confidence intervals)

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Table 3: Daily physical activity counts (thousands) by intensity level and by sex, race and age groups

Male Female
Physical Activity Level Age Hispanics Whites Blacks Hispanics Whites Blacks

Total physical activity 18–39 411.7 337.9 338.7 249.6 263.5 234.4
(385.6, 437.8) (318.4, 357.5) (291.4, 386.0) (228.0, 271.2) (247.2, 279.7) (208.0, 260.7)
40–59 319.2 293.0 317.0 286.7 222.2 224.8
(288.9, 349.6) (268.8, 317.2) (270.5, 363.6) (253.5, 319.8) (209.4, 234.9) (198.3, 251.2)
60+ 211.6 182.4 171.3 155.7 158.8 145.4
(169.3, 254.0) (162.5, 202.3) (148.2, 194.3) (134.0, 177.4) (147.2, 170.4) (130.7, 160.2)
Light Physical Activity 18–39 239.8 197.6 189.8 170.4 173.5 160.3
(224.9, 254.8) (178.7, 216.5) (168.1, 211.5) (158.5, 182.3) (163.3, 183.7) (148.7, 171.9)
40–59 210.3 187.5 199.0 196.3 162.5 163.3
(183.1, 237.4) (176.0, 199.0) (176.7, 221.4) (185.2, 207.4) (155.4, 169.7) (143.6, 183.1)
60+ 149.4 131.8 134.6 129.7 128.4 124.5
(124.6, 174.2) (119.9, 143.8) (116.1, 153.0) (113.4, 146.0) (118.0, 138.7) (112.1, 136.9)
Moderate-Vigorous Physical 18–39 171.9 140.3 148.9 79.2 90.0 74.1
Activity (147.6, 196.1) (123.4, 157.2) (114.2, 183.5) (63.2, 95.2) (73.4, 106.6) (50.2, 98.0)
40–59 109.0 105.5 117.9 90.4 59.7 61.4
(95.0, 123.0) (88.9, 122.1) (84.0, 152.0) (62.5, 118.2) (49.3, 70.0) (44.3, 78.6)
60+ 62.2 50.6 36.7 26.0 30.5 21.0
(40.0, 84.4) (40.7, 60.4) (28.8, 44.7) (18.6, 33.4) (25.5, 35.4) (13.2, 28.7)

Significant differences in activity counts by gender are indicated with bold print
All values are means and 95% confidence interval

higher amounts of physical activity among Hispanic men time in sedentary activity than their white and black coun-
and women compared to their male and female counter- terparts.
parts.
Additionally, physical activity was found to be inversely
This current effort indentified a pattern of higher physical associated with age at all levels of intensity in all racial/
activity levels in Hispanic men compared to white and ethnic groups with the exception of Hispanic women. This
black men. The results also indicate that Hispanic women finding is consistent with results of previous studies using
engage in more light physical activity compared to their subjective data [22,23] suggesting a general pattern of
white and black counterparts. This is in contrast to previ- decreasing physical activity levels with increasing age. This
ous results from national surveys, which have indicated finding is also in line with the National Health Interview
that Hispanic men and women are less active compared to Survey (NHIS) which showed that adults in the 65+ years
their white and black counterparts. Results from the age group were about five times more likely than adults in
1994–2004 BRFSS showed that Hispanic men and the 18–24 years age group to report never being physical
women reported greater amounts of inactivity than white active [24]. Likewise, results from the Behavioral Risk Fac-
men and women [19]. However, the pattern of higher tor Surveillance System (BRFSS) indicated that 35% of
objectively measured physical activity in Hispanic men men and 54% of women aged 75+ years reported engag-
was also shown in a study by Bennett et al which showed ing in no physical activity compared to 15% of men and
higher pedometer step counts for Hispanic men com- 20% women aged 18–29 years who reported engaging in
pared to their white and black counterparts, though not no physical activity [19]. A national representative study
reaching significance [20]. A previous paper by Troiano et of Swedish adults by Hagstromer et al, using accelerome-
al using NHANES accelerometry data also showed that tery, also noted that physical activity levels decreased with
Hispanic men and women were more active than white age [4].
and black men and women at moderate-to-vigorous levels
of intensity [6]. This effort expands on the work by Troi- The 2003–2004 NHANES accelerometer effort found men
ano by including total activity encompassing all levels of to be more physically active than women across all age
intensity and comes to the same conclusion. Another groups with the exception of Hispanic women in the mid-
effort using the NHANES population was conducted by dle age group. There were no significant differences in
Matthews et al which looked at time spent in sedentary total, light, or moderate-vigorous activity when compar-
activity using the accelerometer [21]. The results of the ing men to Hispanic women (p = 0.36, p = 0.34, and p =
study indicated that Hispanic men and women spent less 0.61 respectively) in the middle age group. These findings

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need further investigation into what factors cause higher CR contributed to the design of manuscript as well as the
levels of activity in Hispanic women in the middle age interpretation of the data. CRR also contributed to the
group. revision of manuscript content and gave approval of the
final version to be published.
There are important limitations worth noting when inter-
preting accelerometry data. Accelerometers do not pro- WK contributed to the design of the manuscript as well as
vide qualitative information on what types of physical the analysis and interpretation of data. WCK also contrib-
activities are being performed (household, transportation, uted to the revision of the manuscript content and gave
leisure, etc.). Future studies will be needed to identify the approval of the final version to be published.
specific areas in which Hispanic male and females accu-
mulate more activity than their white and black counter- SS contributed to design of the manuscript as well as the
parts. Accelerometers are also unable to capture upper interpretation of the data and was also involved in the
arm movement. Thus, a portion of activity can be missed revising manuscript content. SJS also gave approval for the
(e.g. weight lifting). Walking gait must also be taken into final version to be published.
consideration because it can affect the validity of acceler-
ometer counts, especially in older adults. For example, RH contributed to the design of the manuscript as well as
some accelerometers are more likely to undercount activ- the acquisition and analysis of data. RGH also contributed
ity in adults with a non-standard gait [25]. This bias to the revision of manuscript content and gave final
should be minimal because we excluded individuals approval of the version to be published.
whose physical activity would likely be affected by illness
or health status. AK contributed to the design of the manuscript as well as
the analysis and interpretation of data. AMK also contrib-
Conclusion uted to the revision of the manuscript content and gave
The current study is one of only a few studies utilizing an approval of the final version to be published.
objective assessment of physical activity in a large repre-
sentative sample of U.S. adults. Findings from this study References
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Sir Paul Nurse, Cancer Research UK

Your research papers will be:

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peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central
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Submit your manuscript here: BioMedcentral

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