Children's Activity Rating Scale (CARS): Description and Calibration

Abstract

A five-level Children's Activity Rating Scale (CARS) was designed to categorize the intensity of physical activities and discriminate between levels of energy expenditure in young children. The CARS was used by trained observers over a 12-month period to assess physical activities of 3-4 year-old children during field observations. Agreement among observers using the CARS was 84.1% for 389 paired observation periods. The energy expenditure for each level was assessed by measuring VO2s and heart rates of 5-6 year-old children (12 boys, 13 girls) while they performed eight activities representing the CARS levels. Mean VO2s for the eight activities in Levels 1-5 ranged from 7.1 to 37.5 ml.kg BW-1.min-1 (1 to 5.42 METS; 14.5% to 80.6% of VO2max). Mean heart rates ranged from 89 to 183 b.min-1 for activities in Levels 1-5. VO2s and heart rates at each level were significantly different from all other levels. These data demonstrate that the CARS encompasses a wide range of energy expenditures, discriminates between levels of energy expenditure, and can be used by trained observers to reliably evaluate physical activity and estimate energy expenditure of young children.

Validity of wrist worn accelerometers and comparability between hip and wrist placement sites in estimating physical activity behaviour in preschool children

“…One example is the variability in processing and interpretation of the CARS in calibration studies of accelerometers with preschool children and in particular differences in the classification of sedentary behaviour. In the original CARS scoring system, there is no distinction made between sitting and standing and both these stationary activities, which are level 1 and 2 activities, are classified as being 'sedentary' (Puhl et al 1990). However, more recent consensus is that 'true' sedentary behaviour should be defined as sitting or reclining activities where the resting metabolic rate is typically ≤ 1.5 METS (Sedentary Behaviour Research Network 2012).…”

“…The Children's Activity Rating Scale (CARS) (Puhl et al 1990) is a direct observation scale which is argued to be the 'gold standard' method of measuring physical activity behaviour in preschool children (Sirard et al 2005). Using the video data children's activity were coded using the CARS method adapted from the original study which used 1-minute sampling period to using a 5-s sampling period (Puyau et al 2002).…”

“…Standing activities (CARS 2) (Puhl et al 1990) 20.0 (9.3) Wrist 'low' intensity PA (Johansson et al 2013) 16.9 (6.6) Hip 'light' intensity PA (Evenson et al 2008) 17.2 (6.6) Locomotion activities (CARS ≥3), (Puhl et al 1990) 9.5 (5.5)…”

Predictors of total body bone mineral density in non‐corticosteroid‐treated prepubertal children with juvenile rheumatoid arthritis

“…Parents recorded to the nearest 15-minute interval the number of hours slept and all activities performed for 3 days. Activities recorded were rated according to Puhl's 5-level rating scale (33). The total number of hours spent performing the recorded activity combined with the total hours slept was subtracted from 24 hours.…”

Evaluation of Actical equations and thresholds to predict physical activity intensity in young children

“…Scale (Puhl, 1990). The Children's Activity Rating Scale is based on a 1 to 5 coding scheme and is a reliable and valid tool to assess physical activity levels in young children (DuRant, Baranowski, Puhl, & Rhodes, 1993).…”