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• W2125366971 abstract "ViewpointCommentaries on Viewpoint: Expending our physical activity (measurement) budget wiselyPublished Online:01 Aug 2011https://doi.org/10.1152/japplphysiol.00650.2011MoreSectionsPDF (72 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInEmailWeChat Todd M. Manini.Author AffiliationsAssistant Professor Department of Aging and Geriatric Research, University of Florida.to the editor: The authors of “Expending our physical activity (measurement) budget wisely” (2) discussed and provided data on potential pitfalls with using self-reported physical activity (PA) to understand interactions with health. The authors rightfully suggest that despite the major efforts placed into developing reliable and valid questionnaires, they remain largely inaccurate for the majority of adults (1). The error is thought to originate from a disproportionate focus on volitional type exercise (biking, jogging, and walking), while not capturing low to moderate intensity movements that accumulate a significant proportion to total activity energy expenditure (6). However, while I agree with the author's conclusions, the use of self-reported behaviors will remain a staple in telephone-based and large epidemiological studies. We simply can't ask for objectively measured PA in such designs and we can't afford to lose this vital information for understanding demographics of PA at a global level. As an example, there are several national and international studies that will continue to use such methodology for understanding PA and health (3, 5). Therefore, improved questionnaires should be created to enhance capturing nonexercise (household chores, standing, walking for purpose) and sedentary behaviors (sitting or lying) that are uniquely associated with public health. The inclusion of such behaviors in these questionnaires will help distinguish types of activities that might have a critical role in health and potentially distinct interactions with volitional exercise. The development of such questionnaires is ongoing for these purposes (4).REFERENCES1. Anton SD , Manini TM. Does self-reported physical activity underestimate the importance of activity in cardiovascular disease prevention? Curr Cardiovasc Risk Reports 4: 293–301, 2010.Crossref | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Craig CL , Marshall AL , Sjostrom M , Bauman AE , Booth ML , Ainsworth BE , Pratt M , Ekelund U , Yngve A , Sallis JF , Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35: 1381–1395, 2003.Crossref | PubMed | ISI | Google Scholar4. Gardiner PA , Clark BK , Healy GN , Eakin EG , Winkler EA , Owen N. Measuring older adults' sedentary time: reliability, validity and responsiveness. Med Sci Sports Exerc [March 25, 2011; epub ahead of print].ISI | Google Scholar5. Pleis JR , Lucas JW , Ward BW. Summary health statistics for US adults: National Health Interview Survey, 2008. Vital Health Stat 10: 1–157, 2009.Google Scholar6. Westerterp KR. Pattern and intensity of physical activity. Nature 410: 539, 2001.Crossref | PubMed | ISI | Google ScholarREFERENCES1. Anton SD , Manini TM. Does self-reported physical activity underestimate the importance of activity in cardiovascular disease prevention? Curr Cardiovasc Risk Reports 4: 293–301, 2010.Crossref | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Craig CL , Marshall AL , Sjostrom M , Bauman AE , Booth ML , Ainsworth BE , Pratt M , Ekelund U , Yngve A , Sallis JF , Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35: 1381–1395, 2003.Crossref | PubMed | ISI | Google Scholar4. Gardiner PA , Clark BK , Healy GN , Eakin EG , Winkler EA , Owen N. Measuring older adults' sedentary time: reliability, validity and responsiveness. Med Sci Sports Exerc [March 25, 2011; epub ahead of print].ISI | Google Scholar5. Pleis JR , Lucas JW , Ward BW. Summary health statistics for US adults: National Health Interview Survey, 2008. Vital Health Stat 10: 1–157, 2009.Google Scholar6. Westerterp KR. Pattern and intensity of physical activity. Nature 410: 539, 2001.Crossref | PubMed | ISI | Google ScholarMONITORS OF PHYSICAL ACTIVITY: REPLACEMENT OF TRADITIONAL SURVEYS OR A VALUABLE SUPPORTING METHOD?Valdir A. Braga.Author AffiliationsProfessor of Physiology Federal University of Paraiba.to the editor: Physical activity is generally considered to be a central factor in the etiology, prevention, and treatment of some pathological states such as obesity. To get more insight into the benefits of daily physical activity, an accurate and reliable method for the assessment of physical activity in free-living subjects is required. The method should be suitable to measure physical activity in large populations over relatively long and representative periods, present minimal discomfort to the subjects, and be cost effective.In their Viewpoint, Dr. Colbert and colleagues (1) highlight the advantages and disadvantages of employing traditional questionnaires, the doubly labeled water (DLW) measure of energy expenditure, and the recently developed accelerometers for measuring physical activity in subjects. Although authors clearly support the concept that the use of monitors reduces the value of traditional survey methods for most studies (2, 3), we believe that, based on the limitations of the current commercially available devices for measuring physical activity, the acquisition of physical activity data using monitors must be complemented by traditional surveys documenting the type of exercise (i.e., resistance exercise, biking, swimming, and so on) whenever possible.We believe that combining traditional surveys and modern low-cost accelerometers will improve the quality and accuracy of the data regarding physical activity. However, there is still need for more precise monitors and more detailed questionnaires to do that task.REFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Colbert LH , Matthews CE , Havighurst TC , Kim K , Schoeller DA. Comparative validity of physical activity measures in older adults. Med Sci Sports Exerc 43: 867–876, 2011.Crossref | ISI | Google Scholar3. Troiano RP , Berrigan D , Dodd KW , Masse LC , Tilert T , McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40: 181–188, 2008.Crossref | PubMed | ISI | Google ScholarREFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Colbert LH , Matthews CE , Havighurst TC , Kim K , Schoeller DA. Comparative validity of physical activity measures in older adults. Med Sci Sports Exerc 43: 867–876, 2011.Crossref | ISI | Google Scholar3. Troiano RP , Berrigan D , Dodd KW , Masse LC , Tilert T , McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40: 181–188, 2008.Crossref | PubMed | ISI | Google ScholarIlona CsizmadiResearch Scientist, Brigid M. Lynch, Heather K. Neilson, and Christine M. FriedenreichAlberta Health Services-Cancer Care.to the editor: We agree that self-reported measures of physical activity need to be improved and that objective monitoring should be incorporated into research studies. However, Colbert and Schoeller (2) overestimate the utility, functionality, and ease of objective monitoring, while underestimating the value of PAQs for measuring different activity types, patterns, domains, and contexts in which activity occurs. Objective monitoring can increase PA assessment accuracy, but is not always superior to self-report. Furthermore, self-report measures are independently associated with health-related biomarkers suggesting that they capture distinct aspects of PA (1). Hence, there is a need to examine the unique strengths of each approach.While Colbert and Schoeller (2) compare self-report PAQs to doubly labeled water (DLW)-estimated activity energy expenditure (AEE; see Figure), it is noteworthy that none of the PAQs cited were specifically designed for AEE estimation. Similarly, in their landmark study Manini et al. (3) highlight the value of accurately and precisely ascertaining DLW-derived AEE compared with substantially lower self-reported physical activity-derived measures of AEE. Manini et al. (3) did not attempt to ascertain, by self-report, the duration and intensity of high-intensity activities that could contribute to AEE. Moreover, in our own review of DLW validation studies, we concluded that discrepancies between PAQ- and DLW-derived estimates of AEE may have been due in part to the lack of face validity of PAQs to estimate AEE (4). We therefore propose abandoning the approach of validating PAQs against measures for which they were not designed to ascertain and then generalizing their poor performance to all self-report measures.REFERENCES1. Atienza AA , Moser RP , Perna F , Dodd K , Ballard-Barbash R , Troiano RP , Berrigan D. Self-reported, and objectively measured activity related to biomarkers using NHANES. Med Sci Sports Exerc 43: 815–821, 2011.Crossref | ISI | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Manini TM , Everhart JE , Patel KV , Schoeller DA , Colbert LH , Visser M , Tylavsky F , Bauer DC , Goodpaster BH , Harris TB. Daily activity energy expenditure, and mortality among older adults. JAMA 296: 171–179, 2006.Crossref | PubMed | ISI | Google Scholar4. Neilson HK , Robson PJ , Friedenreich CM , Csizmadi I. Estimating activity energy expenditure: how valid are physical activity questionnaires? Am J Clin Nutr 87: 279–291, 2008.Crossref | ISI | Google ScholarREFERENCES1. Atienza AA , Moser RP , Perna F , Dodd K , Ballard-Barbash R , Troiano RP , Berrigan D. Self-reported, and objectively measured activity related to biomarkers using NHANES. Med Sci Sports Exerc 43: 815–821, 2011.Crossref | ISI | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Manini TM , Everhart JE , Patel KV , Schoeller DA , Colbert LH , Visser M , Tylavsky F , Bauer DC , Goodpaster BH , Harris TB. Daily activity energy expenditure, and mortality among older adults. JAMA 296: 171–179, 2006.Crossref | PubMed | ISI | Google Scholar4. Neilson HK , Robson PJ , Friedenreich CM , Csizmadi I. Estimating activity energy expenditure: how valid are physical activity questionnaires? Am J Clin Nutr 87: 279–291, 2008.Crossref | ISI | Google ScholarAnthony S. Leicht.Author AffiliationsDirector Institute of Sport and Exercise Science, James Cook University, Australia.to the editor: Colbert and Schoeller (2) highlight an interesting point of view concerning the potential shift in physical activity (PA) monitoring. While the use of objective measures is highly encouraged, one must still recognize the limitations of such devices (3, 4) and importantly that we don't currently possess or utilize the perfect PA assessment tool. As indicated by Colbert and Schoeller (2), many studies have reported various correlations between questionnaire responses and objective monitors indicating similarities in PA assessment though the specific attributes of PA being assessed may be quite diverse. Very recently, the uniqueness of questionnaire assessment was reported in a large population study with self-reported PA suggested to identify PA aspects not concurrently assessed by accelerometers (1). Therefore, the notion that objective PA tools are more valid or accurate than nonobjective tools such as questionnaires should be considered with caution as these tools may in fact assess different aspects of PA. While the cost and size of objective monitors has been dramatically reduced recently, the use of such monitors still remains challenging for assessment of different activity modes and intensities, and for all populations, despite all good intentions. Hence, the use of simple, less intrusive tools like questionnaires will always be of relevance until the elusive, flawless PA assessment tool(s) has/have been developed. Of most importance are the identification of current PA assessment tool limitations and the development of BETTER PA assessment methodologies that exhibit high validity and applicability to a range of populations for a greater understanding of the interplay between PA and health.REFERENCES1. Atienza AA , Moser RP , Perna F , Dodd K , Ballard-Barbash R , Troiano RP , Berrigan D. Self-Reported and objectively measured activity related to biomarkers using NHANES. Med Sci Sports Exerc 43: 815–821, 2011.Crossref | ISI | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Leicht AS , Crowther RG. Pedometer accuracy during walking over different surfaces. Med Sci Sports Exerc 39: 1847–1850, 2007.Crossref | ISI | Google Scholar4. Leicht AS , Crowther RG. Influence of non-level walking on pedometer accuracy. J Sci Med Sport 12: 361–365, 2009.Crossref | ISI | Google ScholarREFERENCES1. Atienza AA , Moser RP , Perna F , Dodd K , Ballard-Barbash R , Troiano RP , Berrigan D. Self-Reported and objectively measured activity related to biomarkers using NHANES. Med Sci Sports Exerc 43: 815–821, 2011.Crossref | ISI | Google Scholar2. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar3. Leicht AS , Crowther RG. Pedometer accuracy during walking over different surfaces. Med Sci Sports Exerc 39: 1847–1850, 2007.Crossref | ISI | Google Scholar4. Leicht AS , Crowther RG. Influence of non-level walking on pedometer accuracy. J Sci Med Sport 12: 361–365, 2009.Crossref | ISI | Google ScholarBUT WAIT—THE PA GUIDELINES INCLUDE MUSCLE-STRENGTHENING ACTIVITIES, TOO!James R. Morrow, Jr.Regents Professor and Jakob L. VingrenUniversity of North Texas.to the editor: Colbert and Schoeller (1) raise important points about valid assessment of physical activity (PA) behaviors. Although they mention muscle-strengthening activities assessment, their concern/criticism is primarily directed at assessing aerobic PA. In addition to aerobic activities, the 2008 USDHHS Physical Activity Guidelines for Americans recommend ≥3 days of muscle-strengthening activities in youth and ≥2 days in adults. Musculoskeletal fitness is increasingly identified as related to mortality (4) and morbidities (2, 3). Assessment of resistance/muscle strengthening (RMS) activities and the associated measurement issues are similar to those suggested for aerobic PA, but accelerometers, pedometers, or doubly labeled water cannot assess involvement in specific RMS activities. Outside laboratory settings, RMS activities behaviors are typically assessed with self-report. Research on the nature, types, and prevalence of self-reported RMS activities is limited; the relation between self-reported RMS and health outcomes needs further investigation. We suggest that much is misunderstood about RMS activity behaviors. Research validating self-report of RMS behaviors in youth and adults is important and needed. For example, what types of activities are conducted? By whom? How often? What resistance? What relations exist? Only when the full array of PA providing health benefits is assessed can we better understand the relations between specific PA behaviors and health outcomes. Given the relatively poor quality of some PA measurements, it might well be that the true impact of PA behaviors on health outcomes and quality of life are underestimated. This might be particularly true for RMS activities as they are more difficult to measure.REFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Jackson AW , Lee DC , Sui X , Morrow JR , Church TS , Maslow AL , Blair SN. Muscular strength is inversely related to prevalence and incidence of obesity in adult men. Obesity 28: 1988–1995, 2010.Crossref | ISI | Google Scholar3. Ruiz JR , Sui X , Lobelo F , Lee DC , Morrow JR , Jackson AW , Hébert JR , Matthews CE , Sjöström M , Blair SN. Muscular strength and adiposity as predictors of adulthood cancer mortality in men. Cancer Epid Biom Prev 18: 1468–1476, 2009.Crossref | ISI | Google Scholar4. Ruiz JR , Sui X , Lobelo F , Morrow JR , Jackson AW , Sjostrom M , Blair SN. Association between muscular strength and mortality in men: Prospective cohort study. Brit Med J 337: a439doi:10.1136/bmj.a439, 2008.Crossref | Google ScholarREFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Jackson AW , Lee DC , Sui X , Morrow JR , Church TS , Maslow AL , Blair SN. Muscular strength is inversely related to prevalence and incidence of obesity in adult men. Obesity 28: 1988–1995, 2010.Crossref | ISI | Google Scholar3. Ruiz JR , Sui X , Lobelo F , Lee DC , Morrow JR , Jackson AW , Hébert JR , Matthews CE , Sjöström M , Blair SN. Muscular strength and adiposity as predictors of adulthood cancer mortality in men. Cancer Epid Biom Prev 18: 1468–1476, 2009.Crossref | ISI | Google Scholar4. Ruiz JR , Sui X , Lobelo F , Morrow JR , Jackson AW , Sjostrom M , Blair SN. Association between muscular strength and mortality in men: Prospective cohort study. Brit Med J 337: a439doi:10.1136/bmj.a439, 2008.Crossref | Google ScholarTHE EXPRESS NEED FOR ACCURATELY MEASURING THE PHYSICAL ACTIVITYMary C. Vagula.Author AffiliationsAssistant Professor Gannon University.to the editor: Physical activity (PA) is established to promote health and well being in addition to preventing various types of maladies including obesity and cancers (5). Medical costs associated with obesity in the US as of 2008 are about $147 billion (2) and the National Institutes of Health estimated overall annual costs of cancer in 2008 as $228.1 billion. There is thus an express need to qualitatively and quantitatively measure PA. Among various PAs, emphasis must not only be placed on volitional PA but also on household, transport, and recreation. A reliable measurement scheme that applies to all of them, to all ages, and allows a systematic inventory thereof remains unexplored (3). It is a research challenge to devise “the best method” that combines both the objective and subjective techniques involving electronic gadgetry and PAQ-based registry. The Viewpoint of Colbert et al. (1) commends the use of gadgets and downplays the traditional self-reported questionnaires. I also believe that eliciting PA determinants from questionnaires is not easy unless they are intelligently posed. As the sensor technology is looming large today, additional strides seem possible in making gadgets that can capture very many parameters for a comprehensive picture of PA. Once their reliability and validity are ensured and they are introduced into the market on a larger scale, it is expected that their benefits outweigh cost (4). These benefits flow at both proximal and contextual levels in the causal pathway of PA awareness programs and provide objective means for institutionalization and sustainability.REFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Finkelstein EA , Trogdon JG , Cohen JW , Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 28: w822–w831, 2009.Crossref | PubMed | ISI | Google Scholar3. Tudor-Locke CE , Myers AM. Challenges and opportunities for measuring physical activity in sedentary adults. Sports Medicine 31: 91–100, 2001.Crossref | ISI | Google Scholar4. Washburn R , Heath G , Jackson A. Reliability and validity issues concerning large scale surveillance of physical activity. Res Q Exerc Sport 71: 104–113, 2000.Crossref | ISI | Google Scholar5. Welk GJ. Physical activity assessments for health-related research. Human Kinetics, 2002.Google ScholarREFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Finkelstein EA , Trogdon JG , Cohen JW , Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs 28: w822–w831, 2009.Crossref | PubMed | ISI | Google Scholar3. Tudor-Locke CE , Myers AM. Challenges and opportunities for measuring physical activity in sedentary adults. Sports Medicine 31: 91–100, 2001.Crossref | ISI | Google Scholar4. Washburn R , Heath G , Jackson A. Reliability and validity issues concerning large scale surveillance of physical activity. Res Q Exerc Sport 71: 104–113, 2000.Crossref | ISI | Google Scholar5. Welk GJ. Physical activity assessments for health-related research. Human Kinetics, 2002.Google ScholarTAKING A STEP BACK: UNDERSTANDING THE UNDERLYING MECHANISMS BEFORE MOVING FORWARD WITH LARGE-SCALE EPIDEMIOLOGIC STUDIESKonstantinos N. Aronis.Author AffiliationsResearch Fellow Division of Endocrinology Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Med.to the editor: The fact that increased physical activity has beneficial effects on various conditions, including coronary artery disease, hypertension (2), obesity, diabetes mellitus, metabolic syndrome (3), and various neoplasias, is well established. As Colbert et al. (1) properly acknowledge, the interest of biomedical research is shifting its focus toward more specific questions, such as whether there is a dose-response or threshold relationship between exercise levels and their beneficial effects. Indeed, studies aiming to answer such questions would require large sample sizes and thus an affordable and effective method of quantification of exercise level. However, investigators should realize that there will always be a trade-off between validity and reliability over cost and feasibility (4). Thus, according to my opinion, the most important priority for investigators is to set clear goals in terms of how much of a difference in the physical activity level is expected for a beneficial effect in each particular setting. This is something that we should not try to address through large-scale epidemiologic studies, but instead through pilot interventional studies, meta-analyses and in vivo human basic research studies that assess the mechanisms through which exercise acts on the involved systems. Only after the exercise “dose increment” that causes a clinically relevant change is established, can we decide on the method that should be used in the setting of a large-scale epidemiologic study with hard clinical outcomes.REFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Metkus TS , Baughman KL , Thompson PD. Exercise prescription and primary prevention of cardiovascular disease. Circulation 121: 2601–2604, 2010.Crossref | ISI | Google Scholar3. Umpierre D , Ribeiro PA , Kramer CK , Leitao CB , Zucatti AT , Azevedo MJ , Gross JL , Ribeiro JP , Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305: 1790–1799, 2011.Crossref | PubMed | ISI | Google Scholar4. Warren JM , Ekelund U , Besson H , Mezzani A , Geladas N , Vanhees L. Assessment of physical activity—a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 17: 127–139, 2010.Crossref | Google ScholarREFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Metkus TS , Baughman KL , Thompson PD. Exercise prescription and primary prevention of cardiovascular disease. Circulation 121: 2601–2604, 2010.Crossref | ISI | Google Scholar3. Umpierre D , Ribeiro PA , Kramer CK , Leitao CB , Zucatti AT , Azevedo MJ , Gross JL , Ribeiro JP , Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305: 1790–1799, 2011.Crossref | PubMed | ISI | Google Scholar4. Warren JM , Ekelund U , Besson H , Mezzani A , Geladas N , Vanhees L. Assessment of physical activity—a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 17: 127–139, 2010.Crossref | Google ScholarTHE KEY POINT IS TO MEASURE AND INCREASE V̇o2maxVeronique L. Billat.Author AffiliationsDirector INSERM, University Evry-Paris.to the editor: I agree with Colbert and Schoeller (1) that the major research issue is now to solve questions regarding the effectiveness of training interventions, i.e., not to increase the quantity of physical activity but firstly to increase maximal aerobic capacity. Research has shown that a one MET increment in maximal aerobic capacity was associated with a 13–15% decrement in all-cause mortality, and this association appears consistent across disease condition, gender, and age (3). The difficulty is to be sure that V̇o2max is valid and then that implies to yield a V̇o2max plateau and it has been proved that this plateau can be extended to 16 min, irrespective of individual fitness, using a variable pace protocol (4, 5). Before starting any effect-dose research a real personal training must be proposed knowing the individual's metabolic scope. This self-pace exercise protocol (4, 5) can be also performed using walking for certain persons (senior or obese individuals) who have a maximal aerobic speed <8 km/h (5 miles/h) that is the transition between walking and running (2). This variable pace exercise gives new insights and new perspectives for improving cardiorespiratory fitness thanks to more pleasant and feasible protocols increasing subject adherence, which must also be accurately measured. The democratization of heart rate and speed data collection by internet in an interactive training log is the future key to success for validating the effectiveness of individual training program to improve maximal aerobic capacity improvement.REFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Kline GM , Porcari JP , Hintermeister R , Freedson PS , Ward A , McCarron RF , Ross J , Rippe JM. Estimation of VO2max from a one-mile track walk, gender, age, and body weight. Med Sci Sports Exerc 19: 253–259, 1987.Crossref | ISI | Google Scholar3. Kodama S , Saito K , Tanaka S , Maki M , Yachi Y , Asumi M , Sugawara A , Totsuka K , Shimano H , Ohashi Y , Yamada N , Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301:2024–2035, 2009.Crossref | PubMed | ISI | Google Scholar4. Mauger AR , Sculthorpe N. A new VO2max protocol allowing self-pacing in maximal incremental exercise. Br J Sports Med 2011 Apr 19. [Epub ahead of print.]ISI | Google Scholar5. Morton RH , Billat LV. The critical power for intermittent exercise. Eur J Appl Physiol 91: 303–307 2004.Crossref | PubMed | ISI | Google ScholarREFERENCES1. Colbert LH , Schoeller DA. Viewpoint: Expending our physical activity (measurement) budget wisely. J Appl Physiol; doi:10.1152/japplphysiol.00089.2011.Google Scholar2. Kline GM , Porcari JP , Hintermeister R , Freedson PS , Ward A , McCarron RF , Ross J , Rippe JM. Estimation of VO2max from a one-mile track walk, gender, age, and body weight. Med Sci Sports Exerc 19: 253–259, 1987.Crossref | ISI | Google Scholar3. Kodama S , Saito K , Tanaka S , Maki M , Yachi Y , Asumi M , Sugawara A , Totsuka K , Shimano H , Ohashi Y , Yamada N , Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301:2024–2035, 2009.Crossref | PubMed | ISI | Google Scholar4. Mauger AR , Sculthorpe N. A new VO2max protocol allowing self-pacing in maximal incremental exercise. Br J Sports Med 2011 Apr 19. [Epub ahead of print.]ISI | Google Scholar5. Morton RH , Billat LV. 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