Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Technical Report
  • Published:

The Stanford Leisure-Time Activity Categorical Item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women

International Journal of Obesity volume 37, pages 1597–1602 (2013)Cite this article

Subjects

Abstract

Background:

Physical activity is essential for chronic disease prevention, yet <40% of overweight/obese adults meet the national activity recommendations. For time-efficient counseling, clinicians need a brief, easy-to-use tool that reliably and validly assesses a full range of activity levels, and, most importantly, is sensitive to clinically meaningful changes in activity. The Stanford Leisure-Time Activity Categorical Item (L-Cat) is a single item comprising six descriptive categories ranging from inactive to very active. This novel methodological approach assesses national activity recommendations as well as multiple clinically relevant categories below and above the recommendations, and incorporates critical methodological principles that enhance psychometrics (reliability, validity and sensitivity to change).

Methods:

We evaluated the L-Cat’s psychometrics among 267 overweight/obese women who were asked to meet the national activity recommendations in a randomized behavioral weight-loss trial.

Results:

The L-Cat had excellent test–retest reliability (κ=0.64, P<0.001) and adequate concurrent criterion validity; each L-Cat category at 6 months was associated with 1059 more daily pedometer steps (95% CI 712–1407, β=0.38, P<0.001) and 1.9% greater initial weight loss at 6 months (95% CI −2.4 to −1.3, β=−0.38, P<0.001). Of interest, L-Cat categories differentiated from each other in a dose-response gradient for steps and weight loss (Ps<0.05) with excellent face validity. The L-Cat was sensitive to change in response to the trial’s activity component. Women increased one L-Cat category at 6 months (M=1.0±1.4, P<0.001); 55.8% met the recommendations at 6 months whereas 20.6% did at baseline (P<0.001). Even among women not meeting the recommendations at both baseline and 6 months (n=106), women who moved ⩾1 L-Cat categories at 6 months lost more weight than those who did not (M=−4.6%, 95% CI −6.7 to −2.5, P<0.001).

Conclusions:

Given strong psychometrics, the L-Cat has timely potential for clinical use such as tracking activity changes via electronic medical records, especially among overweight/obese populations who are unable or unlikely to reach national recommendations.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report.. United States Department of Health and Human Services: Washington DC, 2008.

  2. Haskell WL, Lee I, Pate RR, Powell KE, Blair SN, Franklin BA et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39: 1423–1434.

    Article  Google Scholar 

  3. Centers for Disease Control and Prevention. Prevalence of regular physical activity among adults - United States, 2001 and 2005. MMWR Morb Mortal Wkly Rep 2007; 56: 1209–1212.

    Google Scholar 

  4. Spees CK, Scott JM, Taylor CA . Differences in amounts and types of physical activity by obesity status in US adults. Am J Health Behav 2012; 36: 56–65.

    Article  Google Scholar 

  5. Sallis R . Developing health care systems to support exercise: exercise as the fifth vital sign. Br J Sports Med 2011; 45: 473–474.

    Article  Google Scholar 

  6. Sudman S, Bradburn NM . Asking Questions: A Practical Guide To Questionnaire Design. Jossey-Bass Publishers: San Francisco, 1983.

    Google Scholar 

  7. Burton S, Blair E . Task conditions, response formulation proceses, and response accuracy for behavioral frequency questions in surveys. Public Opinion Q 1991; 55: 50–79.

    Article  Google Scholar 

  8. Ainsworth BE, Macera CA, Jones DA, Reis JP, Addy CL, Bowles HR et al. Comparison of the 2001 BRFSS and the IPAQ physical activity questionnaires. Med Sci Sports Exerc 2006; 38: 1584–1592.

    Article  Google Scholar 

  9. van Poppel MNM, Chinapaw MJM, Mokkink LB, van Mechelen W, Terwee CB . Physical activity questionniares for adults: a systematic review of measurement properties. Sports Med 2010; 40: 565–600.

    Article  Google Scholar 

  10. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402–407.

    Article  CAS  Google Scholar 

  11. Stecker T, Sparks S . Prevalence of obese patients in a primary care setting. Obesity 2006; 14: 373–376.

    Article  Google Scholar 

  12. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W . Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs 2009; 28: w822–w831.

    Article  Google Scholar 

  13. Kiernan M, Brown SD, Schoffman DE, Lee K, King AC, Taylor CB et al. Promoting healthy weight with 'Stability Skills First': a randomized trial. J Consult Clin Psychol 2012. e-pub ahead of print 29 October 2012.

  14. Taylor-Piliae RE, Norton LC, Haskell WL, Mahbouda MH, Fair JM, Iribarren C et al. Validation of a new brief physical activity survey among men and women aged 60-69 years. Am J Epidemiol 2006; 164: 598–606.

    Article  Google Scholar 

  15. Pate RR, O'Neill JR, Lobelo F . The evolving definition of 'sedentary'. Exerc Sport Sci Rev 2008; 36: 173–178.

    Article  Google Scholar 

  16. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C et al2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 2011; 43: 1575–1581.

    Article  Google Scholar 

  17. Kozey SL, Lyden K, Howe CA, Staudenmayer JW, Freedson PS . Accelerometer output and MET values of common physical activities. Med Sci Sports Exerc 2010; 42: 1776–1784.

    Article  Google Scholar 

  18. Matthews CE, Ainsworth BE, Thompson RW, Bassett DR Jr . Sources of variance in daily physical activity levels as measured by an accelerometer. Med Sci Sports Exerc 2002; 34: 1376–1381.

    Article  Google Scholar 

  19. Trost SG, Mciver KL, Pate RR . Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc 2005; 37: S531–S543.

    Article  Google Scholar 

  20. Levin S, Jacobs DR Jr, Ainsworth BE, Richardson MT, Leon AS . Intra-individual variation and estimates of usual physical activity. Ann Epidemiol 1999; 9: 481–488.

    Article  CAS  Google Scholar 

  21. Landis JR, Koch GG . The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

    Article  CAS  Google Scholar 

  22. Glasgow RE, Kaplan RM, Ockene JK, Fisher EB, Emmons KM . Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records. Health Affairs 2012; 31: 497–504.

    Article  Google Scholar 

  23. American College of Sports Medicine and American Medical Association. ACSM and AMA launch "Exercise is Medicine" program: Calls for physicians to prescribe exercise to patients. http://exerciseismedicine.org/images/PressReleaseNov07.pdf 2007.

  24. Society for Behavioral Medicine and the National Institutes of Health. Identifying core behavioral and psychosocial data elements for the electronic health record: Executive Summary. http://www.sbm.org/UserFiles/file/EHR_Meeting_May_2-3-2011--Executive_Summary.pdf 2011.

  25. Bacon L, Aphramor L . Weight science: evaluating the evidence for a paradigm shift. Nutr J 2011; 10: 9.

    Article  Google Scholar 

Download references

Acknowledgements

We gratefully thank the trial participants and research staff. We also thank the following for significant contributions to data analysis (Alex McMillan, PhD and Ann Varady MS, Stanford University School of Medicine), data interpretation (Matt Buman, PhD and Erik Hekler, PhD, Arizona State University, and Mary Rosenberger, PhD, Stanford University School of Medicine), and the L-Cat 2.2 version (Catherine Cubbin, PhD, University of Texas at Austin and Paul Estabrooks, PhD, VirginiaTech). The research was supported by Public Health Service Grant R01 CA112594 to Michaela Kiernan, PhD from the National Institutes of Health.

Disclaimer

The funding source did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Author information

Author notes

  1. J M Fair: Joan Fair is now retired.

Authors and Affiliations

  1. Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA, USA

    M Kiernan, D E Schoffman, K Lee, S D Brown, J M Fair & W L Haskell

  2. Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    D E Schoffman

  3. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    K Lee

  4. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    S D Brown

  5. College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA

    M G Perri

Authors
  1. M Kiernan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D E Schoffman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S D Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J M Fair
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M G Perri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. W L Haskell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Kiernan.

Ethics declarations

Competing interests

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kiernan, M., Schoffman, D., Lee, K. et al. The Stanford Leisure-Time Activity Categorical Item (L-Cat): a single categorical item sensitive to physical activity changes in overweight/obese women. Int J Obes 37, 1597–1602 (2013). https://doi.org/10.1038/ijo.2013.36

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2013.36

Keywords

This article is cited by

Search

Advanced search

Quick links