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PubMed2001

Estimating energy expenditure by heart-rate monitoring without individual calibration.

UNLABELLED: Heart rate monitoring has been shown to be a valid method for measuring free-living energy expenditure at the group level, but its use in large-scale studies is limited by the need for an individual calibration of the relationship between heart rate and energy expenditure. PURPOSE: To determine whether energy expenditure can be estimated from heart rate monitoring without individual calibration in epidemiological studies. METHODS: Our previously validated heart rate monitoring method relies on measuring individual calibration parameters obtained from resting energy expenditure and the regression line between energy expenditure and heart rate during exercise. We developed prediction equations for these parameters using easily measured variables in a population-based study of 789 individuals. The predictive ability of these parameters was tested in a separate population-based sample (N = 97). RESULTS: Physical activity level (PAL = total energy expenditure/basal metabolic rate) using the four estimated parameters was correlated with PAL using the measured parameters (r = 0.82, P < 0.01). Comparison of measured and estimated PAL showed that 97.9% of the scores were placed in the same or adjacent quartile. CONCLUSION: A combination of simple measurements and heart rate monitoring produces estimates of energy expenditure that are highly correlated with those obtained using full individual calibration. This simplification of the heart rate monitoring method could extend its use in ranking individuals in epidemiological studies.

Calibration↗
PubMed2004

Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period.

OBJECTIVE: Compare the energy expenditure, predicted by anthropometric equations, with that measured by continuous on-line indirect calorimetry in ventilated, critically ill children during the early postinjury period. DESIGN: Prospective, clinical study. SETTING: Pediatric intensive care unit of a pediatric university hospital. PATIENTS: A total of 43 ventilated, critically ill children during the first 6 hrs after injury. INTERVENTIONS: An indirect calorimeter was used to continuously measure the energy expenditure for 24 hrs. MEASUREMENTS AND MAIN RESULTS: Clinical data collected were age, gender, actual and ideal weight, height, and body surface. Nutritional status was assessed by Waterlow and Shukla Index. Severity of illness was determined by Pediatric Risk of Mortality, Physiologic Stability Index, and Therapeutic Intervention Scoring System. Energy expenditure was measured (MEE) by continuous on-line indirect calorimetry for 24 hrs. Predicted Energy Expenditure (PEE) was calculated using the Harris-Benedict, Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Maffeis, Fleisch, Kleiber, Dreyer, and Hunter equations, using the actual and ideal weight. MEE and PEE were compared using paired Student's t-test, linear correlation (r), intraclass correlation coefficient (pI), and the Bland-Altman method. Mean MEE resulted in 674 +/- 384 kcal/day. Most of the predictive equations overestimated MEE in ventilated, critically ill children during the early postinjury period. MEE and PEE differed significantly (p<.05) except when the Caldwell-Kennedy and the Fleisch equations were used. r2 ranged from 0.78 to 0.81 (p<.05), and pI was excellent (>.75) for the Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Fleisch, and Kleiber equations. The Bland-Altman method showed poor accuracy; the Caldwell-Kennedy equation was the best predictor of energy expenditure (bias, 38 kcal/day; precision, +/- 179 kcal/day). The accuracy in the medical group was higher (pI range,.71-.94) than in surgical patients (pI range,.18-.75). CONCLUSIONS: Predictive equations do not accurately predict energy expenditure in ventilated, critically ill children during the early postinjury period; if available, indirect calorimetry must be performed.

Algorithms↗
PubMed2005

General medical and pharmacy claims expenditures in users of behavioral health services.

OBJECTIVE: To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. DESIGN: Retrospective cost trends and 24-month cohort analyses. SETTING: A Midwest health plan. PARTICIPANTS: Over 250,000 health plan enrollees during 2000 and 2001. MEASUREMENTS: Claims expenditures for behavioral health services, general medical services, and prescription medications. MAIN RESULTS: Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. CONCLUSIONS: The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.

Adolescent↗
PubMed1996

Total energy expenditure and body composition in early infancy.

UNLABELLED: In adults greater energy expenditure, primarily on physical activity, is associated with greater leanness. Such an association has proved more difficult to demonstrate in infants, partly due to the difficulty of measuring fatness and free living energy expenditure in this age group. Stable isotope techniques now make such investigations more viable. OBJECTIVE: The relationship between body composition and energy expenditure was investigated in 12 week infants. METHODS: Total energy expenditure and fat mass were estimated using the doubly labelled water technique. SUBJECTS: 92 normal healthy infants. RESULTS: Fat mass was correlated with both triceps and subscapular skinfold thicknesses (p < 0.001). After controlling for body size, age was a significant predictor of fat mass (p = 0.003), whereas total energy expenditure was not (p = 0.463). CONCLUSIONS: The cross sectional link between activity level and fatness in young infants, reported previously, does not persist when energy expenditure is considered.

Aging↗
PubMed1998

Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan.

STUDY OBJECTIVES: To assess whether the introduction of "managed care" (capitated budget and utilisation control by general practitioners) in a Swiss health insurance plan caused a selective disenrolment of plan members, and whether it achieved its goal of reducing health care expenditures. DESIGN: Controlled before-after analysis of health insurance claims. SETTING: Health insurance plan of the University of Geneva, Switzerland, which introduced managed care at the end of 1992, and comparison plan, which reimbursed health care expenditures without setting a budget or controlling access. PARTICIPANTS: Analysis of self selection: university plan members who accepted (3993) or refused (659) transfer to managed care. Analysis of change in expenditures: cohorts of persons continuously enrolled in the university (1575) and comparison (3384) plans in 1992 and 1993. MAIN RESULTS: During 1992, the year before the transformation of the university plan, persons who refused managed care had generated 35% higher expenditures than those who accepted managed care (p < 0.001). Between 1992 and 1993, expenditures per member decreased by 9% in the university cohort and increased by 11% in the comparison cohort (p = 0.004). Technical procedures (laboratory tests, physical therapy, drugs) decreased most in the university plan. No impact on hospital admissions was detected. CONCLUSIONS: Introduction of gatekeeping and budget management by physicians caused a favourable self selection process for the university plan. In addition, the managed care plan achieved a substantial decrease in overall health care expenditures in its first year of operation, chiefly by reducing outlays for technical procedures.

Adult↗
PubMed1993

Total energy expenditure in 4- to 6-yr-old children.

There is a sparsity of data on energy expenditure in young children. We therefore examined the components of daily energy expenditure in a group of 30 children (16 boys, 14 girls; age 4-6 yr) characterized for body weight, height, heart rate, and body composition from bioelectrical resistance. Total energy expenditure (TEE) was measured over 14 days under free living conditions by doubly labeled water, resting energy expenditure (REE) from indirect calorimetry, and activity energy expenditure was estimated from the difference between TEE and REE. Mean TEE was 1,379 +/- 290 kcal/day, which was 475 +/- 202 kcal/day lower than energy intake recommendations for this age group. Activity-related energy expenditure was estimated to be 267 +/- 203 kcal/day. TEE was most significantly related to fat-free mass (FFM; r = 0.86; P < 0.001), body weight (r = 0.83; P < 0.001), and REE (r = 0.80; P < 0.001). When TEE was adjusted for FFM, a significant correlation with heart rate was observed (partial r = 0.54; P = 0.002). Collectively, 86% of interindividual variation in TEE was accounted for by FFM, heart rate, and REE. We conclude that, in young 4- to 6-yr-old children, 1) TEE is approximately 25% lower than current recommendations for energy intake and 2) combined measurement of FFM, heart rate, and REE explain 86% of interindividual variation in TEE, thus providing a possible alternative method to estimate TEE in young children.

Body Constitution↗
PubMed1998

Total, resting, and activity-related energy expenditures are similar in Caucasian and African-American children.

There is some evidence to suggest that ethnic differences in energy expenditure in adults may modulate different propensities for obesity. However, there is lack of data for the components of energy expenditure in young children of different ethnic backgrounds. In this study, we examined total energy expenditure (TEE), resting energy expenditure (REE), and physical activity-related energy expenditure (AEE) in healthy prepubertal Caucasian (18 girls, 21 boys) and African-American (29 girls, 30 boys) children. TEE was measured over 14 days under free-living conditions with the doubly labeled water technique, REE was from indirect calorimetry after an overnight fast, and AEE was estimated from the difference between TEE and REE after reducing TEE by 10% to account for the thermic effect of feeding. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry. There were no significant effects of ethnicity or gender on TEE after adjustment for FFM or for both FFM and FM. For REE, there was no effect of ethnicity, but a significant effect of gender, with a higher REE in boys after adjustment for FFM and FM (P < 0.001). For AEE, there were no significant effects of ethnicity or gender after adjustment for FFM or for FFM and FM. In conclusion, ethnicity was not a significant determinant for any of the components of energy expenditure. TEE, REE, and AEE were similar in Caucasian and African-American prepubertal children after adjustment for FFM or for FFM and FM.

Basal Metabolism↗
PubMed1986

Determinants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber.

Daily human energy requirements calculated from separate components of energy expenditure are inaccurate and usually in poor agreement with measured energy intakes. Measurement of energy expenditure over periods of 24 h or longer is needed to determine more accurately rates of daily energy expenditure in humans. We provide a detailed description of a human respiratory chamber and methods used to determine rates of energy expenditure over 24-h periods in 177 subjects. The results show that: fat-free mass (FFM) as estimated by densitometry is the best available determinant of 24-h energy expenditures (24EE) and explains 81% of the variance observed between individuals (24EE [kcal/d] = 597 + 26.5 FFM); 24EE in an individual is very reproducible (coefficient of variation = 2.4%); and even when adjusted for differences in FFM, there is still considerable interperson variability of the daily energy expenditure. A large portion of the variability of 24EE among individuals, independent of differences in body size, was due to variability in the degree of spontaneous physical activity, i.e., "fidgeting," which accounted for 100-800 kcal/d in these subjects.

Activities of Daily Living↗
PubMed2003

Psychotropic medication expenditures for community-dwelling elderly persons.

Psychotropic medication expenditures for community-dwelling elderly persons in the United States were examined with the 1996 Medical Expenditure Panel Survey (MEPS). According to the MEPS, an estimated $1.07 billion US dollars was spent on psychotropic agents, and 53 percent of that was paid out of pocket. Antidepressants represented 61 percent of psychotropic expenditures. High expenditures were found for selective serotonin reuptake inhibitors ($469 million US dollars, or 44 percent of psychotropic expenditures), benzodiazepines ($241 million US dollars, or 22 percent), and tricyclic antidepressants ($119 million US dollars, or 11 percent). Estimates for psychotropic expenditures in 2002 totaled $1.41 billion US dollars after adjustment for inflation. Although psychotropic prescription costs were substantial, increased generic medication use and Medicare prescription plans could reduce the financial burden on elderly persons.

Aged↗
PubMedDate not supplied

Effect of neuromuscular blockade on energy expenditure in patients with severe head injury.

BACKGROUND: The purpose of this study was to determine the effect of neuromuscular blockade on energy expenditure in severely head-injured patients; to determine the effects of body temperature, nutrition support, and morphine use on metabolic rate; and to compare measured energy expenditure with values from predictive equations. METHODS: Energy expenditure was measured using indirect calorimetry in 2 groups of ventilated patients-18 with severe head injury during and after administration of pancuronium bromide and morphine, and second, 14 severely traumatized patients without severe head injury (trauma group) who received morphine without neuromuscular blockade. RESULTS: The mean energy expenditure of head-injured patients increased significantly once pancuronium was discontinued, ie, from 24.2 +/- 3.1 to 28.7 +/- 4.6 kcal/kg (p = .002). This effect was independent of other relevant variables such as morphine dose, body temperature, and nutrition support. When compared with the Harris-Benedict and World Health Organization predictive equations, neuromuscular blockade resulted in a stress factor of only 0.96 and 0.95, respectively, which increased to 1.19 and 1.18, respectively, once blockade was discontinued. Head-injured patients not on neuromuscular blockade had a significantly greater energy expenditure when compared with the trauma group (p = .02). CONCLUSIONS: Neuromuscular blockade in severely head-injured patients decreases energy expenditure to basal levels, independent of morphine use, body temperature, and feeding. Levels of hypermetabolism in both the head-injured and trauma groups were relatively low, at 19% and 5% above predicted values, respectively. This study provides useful information for the management of nutrition support in severely traumatized patients.

Adolescent↗
PubMedDate not supplied

Standard equations are not accurate in assessing resting energy expenditure in patients with amyotrophic lateral sclerosis.

OBJECTIVE: To assess the utility of standard equations for calculating caloric requirements in patients with amyotrophic lateral sclerosis (ALS). BACKGROUND: Malnutrition substantially increases the risk of death in ALS. Weight loss can be stabilized and survival prolonged with early gastrostomy feeding. However the use of standard nutrition equations has not been validated in this population. We therefore compared measured caloric expenditure to 2 predictive equations in patients with varying stages of ALS. METHODS: Thirty-four patients were studied. Caloric expenditure and respiratory quotient (R) were measured using indirect calorimetry. Results were compared with the Harris-Benedict equation. RESULTS: The prediction error for the Harris-Benedict equation was 18.6 + 14.9%. Limits of agreement showed this equation could overestimate caloric expenditure by 591 kcal/d and underestimate requirements by 677 kcal/d. R was >0.86 in 11 patients, suggesting overfeeding, and <0.8 in 15 patients, suggesting underfeeding. The difference between predicted and measured caloric expenditure did not correlate with disease severity, disease duration, or body mass index. Mechanically ventilated patients had higher than predicted energy expenditure. CONCLUSIONS: We found that standard equations used to calculate energy expenditure were not valid for patients with ALS. Moreover, the majority of our patients were either overfed or underfed. As underfeeding can cause diaphragm impairment, and overfeeding can increase ventilatory load, indirect calorimetry should be considered in ALS patients to determine optimal caloric requirement.

Adult↗
PubMed2004

Activities Contributing to Total Energy Expenditure in the United States: Results from the NHAPS Study.

BACKGROUND: Physical activity is increasingly recognized as an important factor influencing health and disease status. Total energy expenditure, both low-intensity and high-intensity, contributes to maintenance of healthy body weight. This paper presents the results of a quantitative approach to determining the activities that contribute to total energy expenditure in the United States. METHODS: Data from the National Human Activity Pattern Survey (NHAPS) were used. In 1992-1994 the NHAPS sampled 4,185 females and 3,330 males, aged 18 years and over, weighted to be representative of the 48 contiguous United States. A detailed report of each activity performed in the previous 24 hours was obtained. A score was created for each activity, by multiplying duration and intensity for each individual and summing across individuals. This score was then used to rank each activity according to its contribution to total population energy expenditure, for the total sample and separately for each gender, race, age, region, and season. RESULTS: This analysis reveals our society to be primarily sedentary; leisure time physical activity contributed only approximately 5% of the population's total energy expenditure. Not counting sleeping, the largest contributor to energy expenditure was "Driving a car", followed by "Office work" and "Watching TV". Household activities accounted for 20.1% and 33.3% of energy expenditure for males and females respectively. CONCLUSION: The information presented in this paper may be useful in identifying common activities that could be appropriate targets for behavioral interventions to increase physical activity.

Journal Article↗
PubMed1998

Reduced energy expenditure in preobese children treated for acute lymphoblastic leukemia.

Children with acute lymphoblastic leukaemia (ALL) typically gain weight at excessive rates during and after therapy, and a high proportion of young adult survivors are obese. Previous studies have failed to identify the abnormalities in energy balance that predispose these children to obesity. The aim of this study was to determine the cause of excess weight gain in children treated for ALL by testing the hypothesis that energy expenditure is reduced in these patients. Twenty children [9 boys, 11 girls; mean age 10.9 (3.2) y] treated for ALL who had shown excess weight gain, but were not obese [mean body mass index SD score 0.70 (1.04)], were closely and individually matched with 20 healthy control children [9 boys, 11 girls; mean age 10.7 (3.0) y; mean body mass index SD score 0.27 (0.91)]. In each child we measured total energy expenditure by doubly-labeled water method, resting energy expenditure, energy expended on habitual physical activity, and energy intake. Total energy expenditure was significantly higher in control subjects than in patients: mean paired difference 1185 kJ/d (282 kcal/d), 95% confidence interval (CI) 218-2152. This difference was largely due to reduced energy expended on habitual physical activity in the patients. Resting energy expenditure was lower in the patients: mean paired difference 321 kJ/d (76 kcal/d), 95% CI 100-541. Energy intake was also lower in the patients: mean paired difference 1001 kJ/d (238 kcal/d), 95% CI 93-1909. Children treated for ALL are predisposed to excess weight gain, and subsequently obesity, by reduced total energy expenditure secondary to reduced habitual physical activity. Prevention of obesity in ALL should focus on modest increases in habitual physical activity, modest restriction of dietary intake, and monitoring of excess weight gain.

Adult↗
PubMed1999

Energy expenditure and energy intake during dexamethasone therapy for chronic lung disease.

Dexamethasone is commonly administered to ventilator-dependent preterm infants with chronic lung disease. Infants receiving dexamethasone therapy frequently exhibit decreased rates of weight gain. The purpose of this investigation was to determine whether decreased growth in infants receiving dexamethasone therapy is caused by increased energy expenditure. Twelve infants were studied: 6 received dexamethasone treatment at 2 wk of age and crossed over to receive placebo treatment at 4 wk; the treatment order was reversed in the other 6 infants. The doubly labeled water method was used to determine energy expenditure for a 1-wk period during each treatment phase. The rate of weight gain during dexamethasone treatment was 6.5+/-10.6 and 20.0+/-5.7 g/kg/d during placebo treatment. Energy expenditure was 93.1+/-34.6 kcal/kg/d during dexamethasone treatment and 88.3+/-37.1 kcal/kg/d during placebo treatment. Energy intake was 119.2+/-29.0 kcal/kg/d during dexamethasone treatment and 113.8+/-23.7 kcal/kg/d during placebo treatment. The difference between intake and expenditure, or the energy available for growth, was 26.2+/-36.8 kcal/kg/d during dexamethasone treatment and 25.5+/-37.4 kcal/kg/d during placebo treatment. No significant differences were found in energy expenditure or energy intake between the treatment phases. The reduced growth seen in infants receiving dexamethasone treatment cannot be explained by increased energy expenditure or decreased energy intake, but may be due to differences in the composition of newly accreted tissue.

Anti-Inflammatory Agents↗
PubMed2003

Energy expenditure of rhesus monkeys subjected to 11 years of dietary restriction.

Dietary restriction (DR) is currently the only paradigm that has consistently extended maximal life span and reduced the onset of age-related chronic diseases in all of the nonprimate species tested. Although it is controversial, some investigators have suggested that the underlying mechanisms may be mediated by adaptations in energy expenditure. We evaluated the extent to which DR alters energy metabolism in a unique cohort of rhesus monkeys submitted to DR for 11 yr. Total energy expenditure (doubly labeled water), resting energy expenditure (REE; indirect calorimetry), and nonbasal energy expenditure (calculated by difference) were measured in DR (n = 12) and control (n = 11) animals. Body composition was determined by dual energy x-ray absorptiometry. Both fat mass and fat-free mass were lower in the restricted animals (56 and 12%, respectively). DR induced a 17% lower total energy expenditure that was attributable to a 20% decrease in REE without changes in the nonbasal energy expenditure. Adjusted for fat-free mass, REE was 13% lower with DR (-250 kJ/d). Taken together with a reanalysis of previous DR experiments published in humans, rodents, and monkeys, these results suggest that DR may lower REE independent of the DR-induced changes in body composition. Whether this reduction in REE contributes to the life-extending properties of DR warrants further analysis, but it suggests that the long-standing debate regarding DR effects on metabolic rates may derive from the lack of consensus on how to adjust for body size and composition.

Animals↗
PubMed2006

Water-induced thermogenesis reconsidered: the effects of osmolality and water temperature on energy expenditure after drinking.

CONTEXT: A recent study reported that drinking 500 ml of water causes a 30% increase in metabolic rate. If verified, this previously unrecognized thermogenic property of water would have important implications for weight-loss programs. However, the concept of a thermogenic effect of water is controversial because other studies have found that water drinking does not increase energy expenditure. OBJECTIVE: The objective of the study was to test whether water drinking has a thermogenic effect in humans and, furthermore, determine whether the response is influenced by osmolality or by water temperature. DESIGN: This was a randomized, crossover design. SETTING: The study was conducted at a university physiology laboratory. PARTICIPANTS: Participants included healthy young volunteer subjects. INTERVENTION: Intervention included drinking 7.5 ml/kg body weight (approximately 518 ml) of distilled water or 0.9% saline or 7% sucrose solution (positive control) on different days. In a subgroup of subjects, responses to cold water (3 C) were tested. MAIN OUTCOME MEASURE: Resting energy expenditure, assessed by indirect calorimetry for 30 min before and 90 min after the drinks, was measured. RESULTS: Energy expenditure did not increase after drinking either distilled water (P = 0.34) or 0.9% saline (P = 0.33). Drinking the 7% sucrose solution significantly increased energy expenditure (P < 0.0001). Drinking water that had been cooled to 3 C caused a small increase in energy expenditure of 4.5% over 60 min (P < 0.01). CONCLUSIONS: Drinking distilled water at room temperature did not increase energy expenditure. Cooling the water before drinking only stimulated a small thermogenic response, well below the theoretical energy cost of warming the water to body temperature. These results cast doubt on water as a thermogenic agent for the management of obesity.

Adult↗
PubMed2001

Peripheral administration of human corticotropin-releasing hormone: a novel method to increase energy expenditure and fat oxidation in man.

CRH increases energy expenditure and decreases food intake in experimental animals. We proposed the hypothesis that peripheral administration of CRH might increase energy expenditure in human subjects. Four men and four women (age, 19-39 yr) were randomized to a double blind, cross-over trial to test the effect of human CRH (hCRH), ovine CRH (oCRH), and placebo on resting energy expenditure measured by indirect calorimetry. CRH was administered by primed continuous infusion at progressively increasing doses of 0.5, 1.0, and 2.0 microg/kg.h at 2-h intervals. hCRH increased resting energy expenditure by 13.9% at the end of the infusion. Respiratory quotient fell from 0.828 to 0.768 during the hCRH infusion compared with a fall from 0.836 to 0.807 during placebo infusion (P < 0.05). Fat oxidation increased by 55% compared with placebo at the highest dose of hCRH. Heart rate increased during hCRH to 10.7 bpm higher than placebo (P < 0.05). oCRH did not increase heart rate. oCRH also had no significant effect on respiratory quotient, and only a small effect on energy expenditure. During hCRH infusion, venous plasma epinephrine, norepinephrine, glycerol, and nonesterified fatty acid levels were not significantly different from those during placebo treatment. Peripheral CRH administration offers a novel strategy to increase energy expenditure.

Adult↗
PubMed2005

Predicting energy expenditure from accelerometry counts in adolescent girls.

PURPOSE: Calibration of accelerometer counts against oxygen consumption to predict energy expenditure has not been conducted in middle school girls. We concurrently assessed energy expenditure and accelerometer counts during physical activities on adolescent girls to develop an equation to predict energy expenditure. METHODS: Seventy-four girls aged 13-14 yr performed 10 activities while wearing an Actigraph accelerometer and a portable metabolic measurement unit (Cosmed K4b2). The activities were resting, watching television, playing a computer game, sweeping, walking 2.5 and 3.5 mph, performing step aerobics, shooting a basketball, climbing stairs, and running 5 mph. Height and weight were also assessed. Mixed-model regression was used to develop an equation to predict energy expenditure (EE) (kJ.min(-1)) from accelerometer counts. RESULTS: Age (mean [SD] = 14 yr [0.34]) and body-weight-adjusted correlations of accelerometer counts with EE (kJ.min(-1)) for individual activities ranged from -0.14 to 0.59. Higher intensity activities with vertical motion were best correlated. A regression model that explained 85% of the variance of EE was developed: [EE (kJ.min(-1)) = 7.6628 + 0.1462 [(Actigraph counts per minute - 3000)/100] + 0.2371 (body weight in kilograms) - 0.00216 [(Actigraph counts per minute - 3000)/100](2) + 0.004077 [((Actigraph counts per minute - 3000)/100) x (body weight in kilograms)]. The MCCC = 0.85, with a standard error of estimate = 5.61 kJ.min(-1). CONCLUSIONS: We developed a prediction equation for kilojoules per minute of energy expenditure from Actigraph accelerometer counts. This equation may be most useful for predicting energy expenditure in groups of adolescent girls over a period of time that will include activities of broad-ranging intensity, and may be useful to intervention researchers interested in objective measures of physical activity.

Adolescent↗