Validity of low-cost measures for global surveillance of physical activity in pre-school children: The SUNRISE validation study

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 partici-pated in the SUNRISE study. We used Spearman's rank-order correlation, Bland-Altman plots, and Kappa statis-tics to validate parent-reported child habitual total physical activity against activPALTM-measured total physical activity over 3 days. Additionally, we used Receiver Operating Characteristic Area Under the Curve analysis to val-idate existing step-count thresholds (Gabel, Vale, and De Craemer) using step-counts derived from activPALTM. 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 ac-tivity (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 classifica-tion 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 pedome-ters for assessing compliance with the physical activity guideline in early childhood.(c) 2022 The Authors. Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).