Energy Costs of Physical Activities in

Children and Adolescents

JOANNE S. HARRELL1, ROBERT G. MCMURRAY2, CHRISTOPHER D. BAGGETT3, MICHAEL L. PENNELL3,
PATRICIA F. PEARCE4, and SHRIKANT I. BANGDIWALA3
1
School of Nursing, 2Department of Exercise and Sports Science, 3School of Public Health, University of North Carolina
at Chapel Hill, Chapel Hill, NC; and 4College of Nursing, University of Utah, Salt Lake City, UT

ABSTRACT
HARRELL, J. S., R. G. MCMURRAY, C. D. BAGGETT, M. L. PENNELL, P. F. PEARCE, and S. I. BANGDIWALA. Energy Costs
of Physical Activities in Children and Adolescents. Med. Sci. Sports Exerc., Vol. 37, No. 2, pp. 329 –336, 2005. Purpose: The primary
aim was to determine the energy expenditure (EE: kcal·kg⫺1·h⫺1) in terms of caloric cost and metabolic equivalents of activities
commonly performed by children and adolescents. Secondary aims were to determine at what age and pubertal developmental stage
values approach those of adults. Methods: In this descriptive study, 295 volunteer youth 8 –18 yr of age completed 18 common physical
activities (including rest) while EE was measured continuously with a portable metabolic system. Three sets of activities were assigned
in random order for each subject. Activities ranged from television viewing and video game play to running and rope skipping. Pubertal
development was estimated from a self-report questionnaire. Results: At rest, V̇O2 and EE were highest in the youngest children and
decreased with advancing age and higher pubertal stage in both genders. The age-adjusted and puberty-adjusted energy expenditure
values were generally lower than the compendium MET values for sedentary and moderate activities but were more varied for
high-intensity activities. However, the ratio of activity EE to REE was comparable in children and adults. Conclusions: Energy
expenditure per kilogram of body mass at rest or during exercise is greater in children than adults and varies with pubertal status, thus
using the definition of a MET in the compendium of physical activities without adjustment is inadequate for energy estimation in
children, until a child reaches Tanner Stage 5. However, the ratio of activity EE to resting EE in children appears to be similar or slightly
less than in the compendium, suggesting that the compendium MET increments used with our adjusted EE values more closely
approximate the true EE of activities in children than present adult norms. Key Words: ENERGY METABOLISM, PHYSICAL
ACTIVITY, LEISURE ACTIVITIES: CLASSIFICATION, REFERENCE VALUES, DEVELOPMENT

A
insworth and associates (2,3) published an adult
compendium of physical activities that designates
the intensity level of most common activities by
units of metabolic equivalents (MET), using “multiples of
one MET, or the ratio of the associated metabolic rate for the
specific activity divided by the resting metabolic rate
(RMR).” The assigned MET values for activity intensities
are generalized estimates based on the literature and expert
opinion (2; p. 72). The authors of the compendium define a
MET as the energy expenditure of sitting quietly, equivalent
to resting oxygen intake (3.5 mL·kg⫺1·min⫺1 or 1
kcal·kg⫺1·h⫺1). Compendium values are commonly used to
convert subjects’ physical activity recalls into an estimation
of calorie use. However, the compendium MET levels are
applicable for adults, not for children (2). Currently, it is not
Address for correspondence: Joanne S. Harrell, Ph.D., R.N., FAHA, Uni-
versity of North Carolina at Chapel Hill, School of Nursing, CB#7460,
Chapel Hill, NC 27599; E-mail: joannesh@email.unc.edu.
Submitted for publication January 2004.
Accepted for publication October 2004.
0195-9131/05/3702-0329
MEDICINE & SCIENCE IN SPORTS & EXERCISE®
Copyright © 2005 by the American College of Sports Medicine
DOI: 10.1249/01.MSS.0000153115.33762.3F
329
clear to what degree or at what age the values of the
Compendium can be applied to children.
Research indicates that resting energy expenditure (REE)
is higher in children than in adults (5,6,11) and somewhat
higher in boys than in girls (5). The increased relative REE
in children compared with adults is probably due to a variety
of factors, including growth and puberty, and differences in
body mass. In addition, energy cost may be greater for
children due to the greater proportional amount of internal
organs in children, their shorter legs, and smaller muscle
mass. Puberty increases muscle mass, especially in boys,
which could reduce the differences in EE between children
and adults (8,9,23,24). Bitar and associates (5) found that
absolute EE (kJ·min⫺1) was higher in pubertal than in pre-
pubertal youth. Conversely, Roemmich and others (24)
found that REE relative to body mass was higher in prepu-
bertal youth.
The energy cost of completing a task may also be greater
for children than for adults, although research on the actual
energy expenditure of children has been limited to very few
activities. Early work by Robinson (23) showed that the
energy cost of walking for boys under 13 yr of age was
approximately 5.5 mL·kg⫺1·min⫺1 more than for those over
13 yr of age and was related to their REE. Other studies
compared the energy expenditure of running and walking in
men and boys, finding the energy cost was greater for boys
than for men (8,9,22). However, small sample sizes and a
general failure to include females reduce the generalizability
of the studies.
Some studies have evaluated the age-related EE of exer-
cise through childhood and adolescence to determine at
what point the disparity in metabolic cost between children
and adults disappears. Studies suggest that: 1) from 7 yr up
to 12 yr of age, there is no difference in energy cost between
boys and girls; 2) at about 12–14 yr of age girls may have
attained adult responses; and 3) boys do not achieve adult
responses until they near the end of adolescence (8,9,26).
However, these hypotheses have been directly tested only
for walking, running, and cycling. We know very little about
the age shift in energy expenditure (EE) for other physical
activities that are common in youth.
Data are needed on the EE of children and adolescents to
provide researchers and clinicians with a means of more
accurately assessing EE during physical activity in youth
and evaluating the effectiveness of interventions to increase
children’s daily activity (20). Such information is needed for
studies of physical activity in youth with obesity, diabetes,
cystic fibrosis, and asthma, as well as studies of primary
prevention of obesity, diabetes, and CVD in youth.
The primary aim of the Energy Expenditure of Physical
Activity in Youth (EEPAY) study was to determine the
energy expenditure and age-adjusted metabolic equivalents
(A-AME) of activities commonly performed by children
and adolescents. Secondary aims were to determine at what
age and pubertal developmental stage values approach those
of adults.
METHODS
Ethical conduct. Clearance for human subject study
was obtained through a multiple assurance institutional re-
view board (IRB). All study procedures were conducted
according to ethical and legal parameters of the IRB, and
participation was strictly voluntary. Subjects who were 18
yr of age provided written consent to participate, and parents
of all other subjects gave written consent for their children
to be in the study, whereas their children gave written
assent. To assure safety, research assistants accompanied
the subjects during each activity. Weight-training activities
used have been shown to be safe with children as young as
age 6.
Subjects and setting. We studied 295 youth 8 –18 yr
of age, 53% males and 47% females, with at least 10 boys
and 10 girls at each age (see Table 1). Because the earlier
smaller studies of children indicated that energy expenditure
differs for boys and girls, we tested a similar number of boys
and girls at each age range, using the same activities for
both. There were 223 (75.6%) white youth, 46 (15.6%)
African Americans, and 26 (8.8%) other races. To be in-
TABLE 1. Number of subjects of each age by gender.
Age (yr) 8 9 10 11 12
Girls (N ) 13 14 13 14 13
Boys (N ) 13 14 18 15 15
Total (N ) 26 28 31 29 28
330 Official Journal of the American College of Sports Medicine
cluded in the study, the youth had to be essentially healthy
and have no limitations in exercise participation. Subjects
were recruited via advertisements placed in local newspa-
pers, mass e-mails sent to departments on the UNC campus,
flyers placed around the campus and other locations around
Chapel Hill, as well as flyers sent home from local schools.
The study was conducted primarily in the Applied Physiol-
ogy Laboratory on the campus of the University of North
Carolina at Chapel Hill.
Instruments. Energy expenditure was measured with
open-circuit, indirect calorimetry, using the Cosmed K4b2
(Cosmed, Rome, Italy), a portable metabolic system that
measures breath-by-breath ventilation (V̇E), fraction of ex-
pired oxygen (FEO2), and carbon dioxide (FECO2). Subjects
breathe through a rubber face mask (Hans Rudolph Inc.,
Kansas City, MO) that directs air into the ventilation tur-
bine, and into the portable unit housing the O2 and CO2 gas
analyzers. This lightweight system (total mass ⬃1.5 kg)
attaches by harness to the subject’s torso, allowing the
subject freedom of movement during the measurement pe-
riods. The system estimates EE by measuring breath-by-
breath oxygen uptake (mL O2·min⫺1) and converts this to
kilocalories per minute (or kcal·kg⫺1·min⫺1) using the Hal-
dane correction for inspired min ventilation and standard
equations (30; pp. 455– 463). The K4b2 has been shown to
accurately measure V̇O2 and estimate EE over a wide range
of metabolic rates in adults (17). To validate this system in
children, we conducted a pilot test with 14 children 8 –14 yr
of age, comparing V̇O2 obtained with the K4b2 system with
results using our standard laboratory metabolic system
(Parvo Medics Truemax 2400, Salt Lake City, UT) during
rest, walking (4.0 km·h⫺1), and running (8.0 km·h⫺1). The
K4b2 system showed a small positive bias of 5.1 mL·min⫺1
at rest, 32.7 mL·min⫺1 while walking, and 43.9 mL·min⫺1
when running. However, the differences in V̇O2 were less
than 6% at each time point (P ⬎ 0.05) (Baggett, McMurray,
Harrell, Bangdiwala, unpublished data).
Anthropometrics. Height was measured to the nearest
0.1 cm with a stadiometer (Perspective Enterprises, Kalama-
zoo, MI), with the subjects shoeless. Body mass was mea-
sured to the nearest 0.1 kg using a calibrated balance beam
metric scale (Detecto Scales, Inc., Brooklyn, NY), with the
subjects clothed but shoeless. Body mass index (BMI) was
calculated: body mass (kg) divided by height squared (m2).
Puberty. Each subject’s stage of puberty was estimated
by self-report using the Pubertal Development Scale (PDS)
based on the five stages characterized by Marshall and
Tanner (15,16). The PDS has two five-item subscales, one
for each gender, which consist of specific developmental
characteristics. The scale is reliable, with Cronbach’s alphas
ranging from 0.68 to 0.83 (median of 0.77) (21). Validity
has been assessed in several ways. Moderate to high corre-
13 14 15 16 17 18 Total
11 12 11 14 9 14 138
16 17 14 11 11 13 157
27 29 25 25 20 27 295
http://www.acsm-msse.org
TABLE 2. List of activities studied in each of three visits to the laboratory.
Set A Set B
Homework/reading Resting
Video games Television watching
(sitting)
Walking at 4 kph Stretching
(2.5 mph)
Walking at 5.6 kph Vacuuming
(3.5 mph)
Shoveling Weight lifting: bench
press
Weight lifting: leg
press
Stairclimbing
lations have been found between the PDS and physician
ratings of sexual maturity based on the Tanner scale (r ⫽
0.61– 0.67), between the PDS and adolescent self-reports
based on Tanner scale pictures (r ⫽ 0.72– 0.80), and be-
tween the PDS and age at peak height velocity and inter-
viewer assessments of maturity (21).
Procedures. The activities were determined by exam-
ining a variety of relevant studies (7,19,25). Once potential
subjects were identified, subjects were scheduled to come to
the laboratory on three separate occasions to perform three
sets of activities. Consent and assent were obtained in the
first visit to the laboratory. During visit 1, height and body
mass were measured and the youth were fitted with the
K4b2, and taken to a private room where they became
accustomed to the instruments and filled out the question-
naires. The children then completed one of the three sets of
activities. Each set began with sedentary activities, followed
by activities of moderate intensity, and ended with high
intensity activities. The order of the sets for each child was
determined in computer-generated random order. See Table
2 for the activities in each set. Standard procedures were
followed for each activity.
To measure REE, subjects were placed in a quiet dark-
ened room in the supine position and allowed to rest for 5
min before values were recorded. Energy expenditure was
then measured for 15 min with the subject quiet, but awake.
The first 5 min as well as the last minute of measurement
were eliminated and the REE was obtained from the average
of 9 min. To measure EE during the activities, all activities
were performed continuously for 10 min, unless the subjects
could not continue, as was sometimes the case with rope
skipping. To ensure that steady state was attained and main-
tained, data from the first 2 min and last minute of each
activity were not used in the analyses. Thus, EE was aver-
aged for 7 min of the activities. Steady state was verified for
each subject by one of the investigators (RGM). (See the
Appendix for activity descriptions.)
We followed stringent quality control protocols for the
activities and for mechanical and environmental controls of
relative humidity, mask fitting, sampling lines, etc. The
metabolic system was calibrated before each use and was
tested regularly for reliability using standard gases and
ventilatory volumes. Research assistants (RA) were fully
trained in the use of all equipment and were observed by the
investigators until all techniques were mastered. The RA
ENERGY COSTS OF PHYSICAL ACTIVITY
practiced instructing the children in the proper and stan-
Set C dardized performance of each activity and the investigators
Board games observed data collection continuously for the first 15 sub-
Math test jects, and then at frequent intervals.
Video games Data analysis. Our first goal was to determine age or
(standing) pubertal differences in resting EE. There were significant
Sweeping
differences in V̇O2 by age (P ⬍ 0 0.0001); thus, we per-
Running at 8 kph formed Newman–Keuls multiple comparison tests. Using an
(5 mph)
Rope skipping
alpha of 0.05, we determined that in boys V̇O2 was not
significantly different for those between the ages of 8 –12 yr
(group 1), nor for those aged 13–15 yr (group 2), nor those
in the 16 –18-yr-old (group 3). We performed the same
analyses with girls, and the age groups were slightly differ-
ent for girls: group 1 included girls aged 8 –11 yr, group 2
was those aged 12–14 yr, and group 3 was aged 15–18 yr.
This is consistent with studies showing that girls enter and
complete pubertal development earlier than boys (14,15).
To determine an aged-adjusted metabolic equivalent (A-
AME) we divided the measured V̇O2 of the observed ac-
tivity for each subject by that subject’s resting V̇O2. We
examined the resulting values by age and pubertal stage.
Because the purpose of this study was to examine energy
cost of activities in the context of the compendium of
physical activities, we chose to examine the data with re-
spect to oxygen uptake (mL·kg⫺1·min⫺1) or EE
(kcal·kg⫺1·h⫺1), rather with than other scaling methods,
such as allometric scaling.
RESULTS
Subject characteristics by gender and age group are
shown in Table 3. As expected, height, body mass, and BMI
increased as the youth aged. Pubertal status was widely
distributed, with 21.0% at Tanner stage 1, 14.2% at stage 2,
20.0% at stage 3, 30.5% at stage 4, and 14.2% at stage 5.
Rest results. Resting oxygen uptake (mL·kg⫺1·min⫺1)
did not differ between girls and boys (P ⫽ 0.13); however,
it declined in both as the ages of the groups increased. The
actual values representative of a metabolic equivalent at rest
are shown by age group in Table 4 and by Tanner stage in
Table 5 using units of V̇O2 (mL·kg⫺1·min⫺1) and EE
(kcal·kg⫺1·h⫺1). The differences by age group and by Tan-
ner stage were statistically significant (P ⬍ 0.0001). These
data demonstrate that EE at rest, estimated as 1.0 in adults,
is higher in children and young adolescents than in adults.
The highest REE were found in the younger children and in
TABLE 3. Physical characteristics of the participants presented by age group
and gender.
BMI
Gender Age Group (N) Height (cm) Body Mass (kg) (kg䡠mⴚ2)
Girls 1 (54) 140.6 ⫾ 9.2 36.3 ⫾ 10.2 18.1 ⫾ 3.5
2 (36) 160.2 ⫾ 7.6 54.5 ⫾ 13.8 21.0 ⫾ 3.8
3 (48) 164.2 ⫾ 5.4 63.4 ⫾ 11.6 23.6 ⫾ 4.5
Boys 1 (75) 143.0 ⫾ 12.6 38.0 ⫾ 10.8 18.2 ⫾ 2.7
2 (47) 167.2 ⫾ 9.4 56.5 ⫾ 13.4 20.0 ⫾ 3.3
3 (35) 174.6 ⫾ 5.4 70.5 ⫾ 11.1 23.1 ⫾ 3.1
For girls: age group 1 ⫽ 8 –11 yr; 2 ⫽ 12–14 yr; 3 ⫽ 15–18 yr.
For boys: age group 1 ⫽ 8 –12 yr; 2 ⫽ 13–15 yr; 3 ⫽ 16 –18 yr.
Medicine & Science in Sports & Exercise姞 331
TABLE 4. Resting EE (REE): age-adjusted metabolic equivalents (A-AME) values by age group.
Mean V̇O2 (mL䡠kgⴚ1䡠minⴚ1) Mean EE (kcal䡠kgⴚ1䡠hⴚ1)
Age Group* V̇O2 SD CI EE SD CI
1 5.92 1.41 5.67, 6.17 1.71 0.41 1.64, 1.78
2 4.58 1.22 4.31, 4.85 1.34 0.36 1.26, 1.42
3 4.00 0.79 3.83, 4.17 1.16 0.22 1.11, 1.21
Adult 3.5 1.00
* P ⬍ 0.0001: groups 1 vs 2 vs 3.
Age group 1 ⫽ 8 –12 for boys, 8 –11 for girls.
Age group 2 ⫽ 13–15 for boys, 12–14 for girls.
Age group 3 ⫽ 16 –18 for boys, 15–18 for girls.
Adult ⫽ Compendium of Physical Activities (3).

those at an earlier stage of physical development (lower
developmental stage).
Activity Results. Tables 6 – 8 present the mean V̇O2
and the conversion to age-adjusted metabolic equivalents
(A-AME) by age group for each of the activities examined,
arranged by sedentary (Table 6), low to moderate (Table 7),
and moderate to high intensity levels of activity (Table 8).
The compendium of physical activities MET levels for each
of the activities are also shown in these tables, as well as the
values resulting when the actual V̇O2 measured during each
activity is divided by 3.5, the value used for 1 MET in the
compendium. For all activities, the values resulting when
using 3.5 as the denominator were significantly different
from the A-AME values, which used the measured V̇O2 at
rest (P ⬍ 0.0001), even after Bonferroni adjustments for the
17 comparisons.
For 14 of the activities, there were no significant differ-
ences in boys and girls in A-AME when adjusting for age
group, based upon a Type I error of 0.001 (adjusted for
multiple comparisons). However, there were some small
differences in V̇O2 by gender in leg press, rope skipping,
shoveling, and stretching in age groups 2 and 3 (P ⬍ 0.002).
Because these differences by gender were minor (⬍0.5
A-AME) and found in only four activities, we are reporting
all results with boys and girls combined. This is consistent
with the approach used by the compendium of physical
activities (2,3).
For sedentary and moderate activities, the mean A-AME
values we report (see Tables 6 and 7) were slightly lower
than the values presented in the compendium of physical
activities, by 0.1–1.5 units, except for vacuuming and walk-
ing at 2.5 mph, where our values were higher by 0.1– 0.5
units. For the higher intensity activities shown in Table 8,
the A-AME were more variable. For rope skipping and
running, our values were lower for the youngest age group,
but similar for the other two age groups. The values we
report for climbing stairs and walking at 3.5 mph are higher
than the compendium values.
DISCUSSION
There are three main conclusions from this study. First,
REE is greater in children than adults, so using the value of
3.5 mL·kg⫺1·min⫺1 to represent 1 MET for children, as used
in the compendium of physical activities, can generally lead
to an underestimate of energy expenditure in children. How-
ever, by the age of about 15 for girls and 16 for boys, the
lower ages in our third group, the adult compendium values
appear to be acceptable, keeping in mind that the 3.5
mL·kg⫺1·min⫺1 is an approximate average value (2). Our
results are consistent with those of Roemmich and others
(24), who studied 31 girls and 29 boys, half prepubertal and
half pubertal. They also found basal metabolic rate (BMR)
was higher in children than adults until about 16 yr of age,
and that using the compendium of physical activities MET
value of 3.5 mL·kg⫺1·min⫺1 (1 kcal·kg⫺1·h⫺1) to assign EE
to activities for youth resulted in an underestimation of
energy expenditure, compared with doubly labeled water.
Our results are congruent with other studies that have
shown that REE is higher in children than in adults. Early
work of Boothby et al. (6) provided a standard for BMR in
boys, showing a steady drop from age 6 to 18 yr. Several
studies indicate the REE is much higher in children than in
adults and somewhat lower in girls than in boys (5). Also,
Goran et al. (11) measured REE in young children and in
their parents, and found that REE was somewhat higher in
boys than in girls (1093 vs 1019 kcal·d⫺1) and much higher
in men than in women (2116 vs 1625 kcal·d⫺1, respec-
tively). However, in spite of these known differences in EE
by gender in adults, the compendium of physical activities
uses the same values for men and women, most likely for
simplicity and ease of use.

TABLE 5. Resting EE (REE): puberty-adjusted metabolic equivalents (P-AME) values by Tanner stage.

Tanner Mean V̇O2 (mL䡠kgⴚ1䡠minⴚ1) Mean EE (kcal䡠kgⴚ1䡠hⴚ1)

Stage* V̇O2 SD CI EE SD CI
1 6.08 1.38 5.73, 6.43 1.76 0.41 1.65, 1.86
2 6.01 1.35 5.59, 6.43 1.74 0.39 1.62, 1.87
3 5.16 1.39 4.80, 5.52 1.49 0.39 1.39, 1.59
4 4.25 0.96 4.05, 4.45 1.23 0.28 1.17, 1.29
5 3.80 0.74 3.57, 4.03 1.11 0.21 1.04, 1.17
Adult 3.5 1.00
* P ⬍ 0.0001 all stages from each other.
Adult, compendium of physical activities (3).

332 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

TABLE 6. Mean V̇O2 (mL䡠kg⫺1䡠min⫺1), age-adjusted metabolic equivalents (A-AME)a and compendium of physical activities MET levels (3) for sedentary activities.
Ageb A-AME 95% METs from
Activity Group N V̇O2 A-AME CI V̇O2/3.5c Compendium
Board games 1 120 7.5 1.31 1.25, 1.37 2.15 1.5
2 73 5.8 1.32 1.24, 1.40 1.67 1.5
3 78 5.2 1.33 1.26, 1.40 1.50 1.5
Math test 1 121 7.1 1.23 1.17, 1.28 2.03 1.5
2 74 5.7 1.27 1.19, 1.35 1.62 1.5
3 78 4.9 1.24 1.17, 1.30 1.40 1.5
Homework/reading 1 126 6.6 1.13 1.09, 1.17 1.87 1.3
2 82 5.2 1.17 1.12, 1.22 1.49 1.3
3 81 4.5 1.13 1.08, 1.18 1.27 1.3
TV watching 1 113 6.0 1.03 0.99, 1.07 1.72 1
2 73 4.8 1.06 1.02, 1.10 1.37 1
3 80 4.2 1.02 1.02, 1.11 1.21 1
Video game (sitting) 1 126 7.1 1.22 1.17, 1.27 2.02 1.5
2 83 5.7 1.28 1.22, 1.34 1.63 1.5
3 81 5.0 1.26 1.19, 1.32 1.41 1.5
Video game (standing) 1 121 8.3 1.45 1.37, 1.54 2.38 2.3
2 74 6.5 1.47 1.37, 1.56 1.86 2.3
3 77 5.8 1.47 1.35, 1.55 1.65 2.3
a
A-AME ⫽ V̇O2 of activity/V̇O2 at rest.
b
Age group 1 ⫽ 8 –12 yr for boys, 8 –11 yr for girls.
Age group 2 ⫽ 13–15 yr for boys, 12–14 yr for girls.
Age group 3 ⫽ 16 –18 yr for boys, 15–18 yr for girls.
c
Difference between measured V̇O2 divided by 3.5 and MET value ⬍0.0001.

Our second conclusion is that energy expenditure, both at
rest and during activities, varies by pubertal stage, with
results approximating adult values by Tanner stage 5 (see
Table 5). Regarding puberty, our results agree with Bitar
and associates (5), who found that absolute resting EE was
higher in prepubertal than in postpubertal subjects, and are
also similar to those of Roemmich and others (24), who
found that resting EE relative to body mass was higher in
prepubertal youth. The decision to analyze EE by pubertal
level or by age must be made by each investigator and will
probably depend on the age range, gender, and ethnic back-
ground of the subjects. For example, if the subjects are in the
age range during which puberty shows the greatest varia-
tion, that is, about 9 –12 yr for girls and 10 –14 yr for boys
(13,14), assessing pubertal level may be important. Also, if
the sample contains both African Americans and white
subjects, it might be wise to assess pubertal level, because
African American youth, especially girls, mature earlier
than white youth (18).
Our third conclusion is that the ratio of EE during activity
to EE at rest is generally slightly lower for children com-
pared with adults for most activities. Although slightly
lower, this ratio of activity/rest is a better fit than the results
produced using the standard definition of a MET (3.5
mL·kg⫺1·min⫺1 or 1 kcal·kg⫺1·h⫺1). Thus, using our esti-
mates of resting EE and multiplying by compendium values

TABLE 7. Mean V̇O2 (mL䡠kg⫺1䡠min⫺1), age-adjusted metabolic equivalents (A-AME)a and compendium of physical activities MET levels (3) for low to moderate intensity activities.
Ageb A-AME METs from
Activity Group N V̇O2 A-AME 95% CI V̇O2/3.5c Compendium
Bench press 1 107 10.5 1.83 1.72, 1.94 2.99 3
2 70 10.8 2.45 2.27, 2.64 3.08 3
3 77 10.3 2.60 2.42, 2.79 2.94 3
Leg press 1 106 12.1 2.08 1.97, 2.20 3.44 3
2 71 12.7 2.90 2.70, 3.11 3.62 3
3 79 11.2 2.85 2.68, 3.02 3.19 3
Shoveling 1 123 20.5 3.61 3.41, 3.80 5.84 5
2 82 17.3 3.95 3.64, 4.26 4.95 5
3 80 13.6 3.45 3.24, 3.67 3.87 5
Stretching 1 113 11.7 2.01 1.92, 2.10 3.33 2.5
2 73 9.9 2.25 2.09, 2.40 2.82 2.5
3 78 8.6 2.17 2.05, 2.29 2.45 2.5
Sweeping 1 118 17.2 3.03 2.87, 3.19 4.92 3.3
2 72 13.9 3.12 2.91, 3.34 3.96 3.3
3 78 11.2 2.83 2.64, 3.01 3.29 3.3
Vacuuming 1 112 21.1 3.63 3.45, 3.81 6.02 3.5
2 74 16.7 3.81 3.51, 4.10 4.77 3.5
3 78 13.3 3.37 3.14, 3.59 3.80 3.5
Walking (4 kph/2.5 mph) 1 118 18.3 3.23 3.09, 3.37 5.22 3
2 80 15.2 3.49 3.30, 3.69 4.33 3
3 79 12.8 3.32 3.14, 3.49 3.67 3
a
A-AME ⫽ V̇O2 of activity/V̇O2 at rest.
b
Age group 1 ⫽ 8 –12 yr for boys, 8 –11 yr for girls.
Age group 2 ⫽ 13–15 yr for boys, 12–14 yr for girls.
Age group 3 ⫽ 16 –18 yr for boys, 15–18 yr for girls.
c
Difference between measured V̇O2 divided by 3.5 and MET value ⫽ ⬍0.0001.

ENERGY COSTS OF PHYSICAL ACTIVITY Medicine & Science in Sports & Exercise姞 333
TABLE 8. Mean V̇O2 (mL䡠kg⫺1䡠min⫺1), age-adjusted metabolic equivalents (A-AME)a and compendium of physical activities MET levels (3) for high intensity activities.
Ageb A-AME 95% METs from
Activity Group N V̇O2 A-AME CI V̇O2/3.5c Compendium
Rope skipping 1 113 35.3 6.24 5.87, 6.60 10.10 8
2 71 35.2 8.04 7.47, 8.60 10.06 8
3 78 29.5 7.52 6.97, 8.06 8.42 8
Running (8 kph/5 mph) 1 108 38.5 6.72 6.42, 7.02 11.00 8
2 70 36.2 8.25 7.71, 8.78 10.35 8
3 74 32.1 8.13 7.72, 8.54 9.16 8
Stairclimbingd 1 105 30.6 5.40 5.11, 5.69 8.75 5.5
2 70 28.4 6.51 6.06, 6.96 8.11 5.5
3 76 25.5 6.51 6.15, 6.87 7.28 5.5
Walking (5.6 kph/3.5 mph) 1 125 24.6 4.31 4.13, 4.49 7.02 3.8
2 83 20.2 4.66 4.41, 4.92 5.78 3.8
3 79 17.5 4.52 4.28, 4.77 4.99 3.8
a
A-AME ⫽ V̇O2 of activity/V̇O2 at rest.
b
Age group 1 ⫽ 8 –12 yr for boys, 8 –11 yr for girls.
Age group 2 ⫽ 13–15 yr for boys, 12–14 yr for girls.
Age group 3 ⫽ 16 –18 yr for boys, 15–18 yr for girls.
c
Difference between measured V̇O2 divided by 3.5 and MET value ⫽ ⬍0.0001.
d
It should be noted that the compendium has values for climbing up and down stairs separately, which we do not, so the Compendium value here is the average of the
two.

for the activity is a closer estimate to the metabolic cost of
the activity in children than using the standard definition of
a MET. For example, if you are using a physical activity
recall questionnaire that indicates a 9-yr-old who weighs 35
kg has accumulated 40 MET䡠h over the course of a day, with
our age-adjusted resting metabolic equivalent (Table 4), this
child’s total daily EE would be 35 kg ⫻ 1.71
kcal·kg⫺1·min⫺1 ⫻ 40 MET䡠h ⫽ 2394 kcal·d⫺1. Using the
adult value of 1 kcal·kg⫺1·h⫺1 from the compendium of
physical activities to estimate total daily EE for this child
would result in only 1400 kcal·d⫺1, an underestimation of
42% (35 kg ⫻ 1 kcal·kg⫺1·h⫺1 ⫻ 40 MET䡠h ⫽ 1400
kcal·d⫺1).
The history of the MET is not clear. The concept of a
MET likely originated from the early work of Dill (10), who
defined the ratio of work metabolism/rest metabolism, but
the origin of the specific value of 3.5 mL·kg·⫺1·min⫺1 as 1
MET is vague. Nevertheless, this value is commonly ac-
cepted for adults and is reported in most texts (3,12). How-
ever, the authors of the compendium of physical activities
state that the most accurate way to determine EE is to assess
EE at rest and use that REE to compute energy cost of
activity (2; p. 72).
This study provides a way to adapt the adult compendium
of physical activities MET intensity values of common
activities using the age/pubertal-adjusted REE, to determine
EE for children and adolescents. Although not ideal, this
methodology improves the precision in assessing energy
expenditure in children and youth. The method also pro-
vides a more solid foundation for researchers and clinicians
alike, to better assess physical activity levels, develop and
evaluate appropriate interventions for children, and predict
health outcomes related to levels of physical activity and
energy expenditure. Physical activities are often evaluated
from subjects’ diaries or recalls of previous days (29),
weeks (27), or months of activity (1). The activities reported
are then evaluated for frequency, duration, and intensity to
determine the caloric usage and, ultimately, daily caloric
need. Using the age- or pubertal-adjusted metabolic equiv-
334 Official Journal of the American College of Sports Medicine
alent we present, investigators could compute the energy
cost for common activities of children and adolescents uti-
lizing the adult compendium of physical activities MET
levels (2,3).
A limitation of this study is that we presented data on a
relatively small number of activities (N ⫽ 18, including
rest). However, the activities we measured are commonly
performed in childhood and adolescence but not generally
reported in the literature. Each activity was carefully mea-
sured for its energy cost using strict protocols. One reason
for the differences between the A-AME and the compen-
dium values may be the actual values we chose for com-
parison. The compendium of physical activities includes
over 600 activities, with many choices for some activities,
and it was often difficult to make an exact match between
activities. For example, the compendium lists stair climbing
in differing codes, varying from walking downstairs
(#17070, 3.0 METs), walking upstairs (#17130, 8.0 METs),
to an array of walking upstairs while carrying a variety of
differing weights (codes #17025–17030, 5–12 METs). We
averaged the compendium METs for walking downstairs
and upstairs (5.5 METs) for our calculations. The compen-
dium lists rope skipping with two codes, varying by quali-
fiers of “slow” (#15551, 8 METs) or “moderate” (#15552,
10 METs). The children in this study skipped at what we
considered closer to slow than moderate speeds, thus we
used the lesser MET value in our calculations.
In addition, while not all the compendium activities were
directly measured, many of the activities were assigned
MET levels based on indirect calorimetry similar to the
methods used in our study. Thus, although not an absolute
match between age-adjusted metabolic equivalents and
adult MET increments, it appears logical to use the MET
levels from the compendium of physical activities and the
age- (pubertal-) adjusted REE obtained in the present study
to compute the EE of children and adolescents.
We recognize that a relatively small number of subjects
were measured for each age and gender group (Table 1). If
we had studied more subjects in each group we may or may
http://www.acsm-msse.org
not have detected gender differences. However, for the
projected uses of the findings of this study, it was not
deemed necessary to provide that level of detail, especially
because the compendium of physical activities is applied
similarly to men and women, even though it is known that
EE differs by gender in adults (4). The results of our study
cannot be generalized to children less than 8 yr of age.
Clinicians play an important role in health promotion and
disease prevention, and promoting a physically active life-
style is an essential element in primary prevention of many
diseases. Physical activity must be assessed and can be
prescribed in primary, secondary, and tertiary prevention.
Exercise prescription will vary in type, frequency, duration,
and intensity, but to appropriately target needs in any of
these areas, energy expenditure must be considered (28).
Nutritional prescriptive decision-making parallels similar
decision-making issues—precise energy expenditure in chil-
dren is integral in diagnosing and monitoring eating disor-
ders (including under and over-nourishment and related
behaviors) (20).
REFERENCES
1. AARON, D. J., A. M. KRISKA, S. R. DEARWATER, J. A. CAULEY, K. F.
METZ, and R. E. LAPORTE. Reproducibility and validity of an
epidemiologic questionnaire to assess past year physical activity in
adolescents. Am. J. Epidemiol. 142:191–201, 1995.
2. AINSWORTH, B. E., W. L. HASKELL, A. S. LEON, et al. Compendium
of physical activities: classification of energy costs of human
physical activities. Med. Sci. Sports Exerc. 25:71– 80, 1993.
3. AINSWORTH, B. E., W. L. HASKELL, M. C. WHITT, et al. Compen-
dium of physical activities: an update of activity codes and MET
intensities. Med. Sci. Sports Exerc. 32:S498 –S504, 2000.
4. ARCIERO, P. J., M. I. GORAN, and E. T. POEHLMAN. RMR is lower
in women than in men. J. Appl. Physiol. 75:2514 –2520, 1993.
5. BITAR, A., N. FELLMANN, J. VERNET, J. COUDERT, and M. VERMOREL.
Variations and determinants of energy expenditure as measured by
whole- body indirect calorimetry during puberty and adolescence.
Am. J. Clin. Nutr. 69:1209 –1216, 1999.
6. BOOTHBY, W. M., J. BERKSON, and H. L. DUNN. Studies of the
energy of metabolism of normal individuals: a standard for basal
metabolism with a nomogram for clinical application. Am. J.
Physiol. 116:468 – 484, 1936.
7. BRADLEY, C. B., R. G. MCMURRAY, J. S. HARRELL, and S. DENG.
Changes in common activities of 3rd through 10th graders: the
CHIC study. Med. Sci. Sports. Exerc. 32:2071–2078, 2000.
8. COOKE, C. B., M. J. MCDONAGH, A. M. NEVILL, and C. T. DAVIES.
Effects of load on oxygen intake in trained boys and men during
treadmill running. J. Appl. Physiol. 71:1237–1244, 1991.
9. DANIELS, J., N. OLDRIDGE, F. NAGLE, and B. WHITE. Differences and
changes in V̇O2 among young runners 10 to 18 years of age. Med.
Sci. Sports Exerc. 10:200 –203, 1978.
10. DILL, D. B. The economy of muscular exercise. Physiol. Rev.
16:263–291, 1936.
11. GORAN, M. I., M. KASKOUN, R. JOHNSON, C. MARTINEZ, B. KELLY,
and V. HOOD. Energy expenditure and body fat distribution in
Mohawk children. Pediatriacs 95:89 –95, 1995.
12. HOWLEY, E. T. You asked for it: question authority [Letter].
ACSM’s Health & Fitness Journal Jan-Feb:6, 2000.
13. KAPLOWITZ, P. B., E. J. SLORA, R. C. WASSERMAN, S. E. PEDLOW,
and M. E. HERMAN-GIDDENS. Earlier onset of puberty in girls:
relation to increased body mass index and race. Pediatrics 108:
347–353, 2001.
14. KARPATI, A. M., C. H. RUBIN, S. M. KIESZAK, M. MARCUS, and R. P.
TROIANO. Stature and pubertal stage assessment in American boys:
ENERGY COSTS OF PHYSICAL ACTIVITY
In conclusion, resting EE is higher in children than adults.
Although not a perfect match, results from the activities
measured suggest that the compendium of physical activi-
ties can be used to estimate EE with children and adoles-
cents aged 8 –18, if the user adjusts for the higher resting EE
of children. The adjustment might be made either for age or
for pubertal stage, depending on the focus of the study.
Although this estimate may produce a value that is some-
what different from the actual EE, it is closer to the actual
value than the presently available norms. After age 16, or
once puberty is nearly completed, the compendium of phys-
ical activities MET increments may be used without adjust-
ment. Further research is needed to determine the EE of
children younger than 8 yr of age, both at rest and during a
range of activities.
The authors thank Dr. Barbara Ainsworth for her consultation and
invaluable assistance with this research, and Lisa Kelleher, Primary
Research Assistant for her help in contacting, scheduling, and data
collection.
This study was funded by grant no. NR04564 from the National
Institute of Nursing Research of the National Institutes of Health.
the 1988 –1994 Third National Health and Nutrition Examination
Survey. J. Adolesc. Health 30:205–212, 2002.
15. MARSHALL, W. A., and J. M. TANNER. Variations in pattern of
pubertal changes in girls. Arch. Dis. Child. 44:291–303, 1969.
16. MARSHALL, W. A., and J. M. TANNER. Variations in the pattern of
pubertal changes in boys. Arch. Dis. Child. 45:13–23, 1970.
17. MCLAUGHLIN, J. E., G. A. KING, E. T. HOWLEY, D. R. BASSETT Jr.,
and B. E. AINSWORTH. Validation of the COSMED K4 b2 portable
metabolic system. Int. J. Sports Med. 22:280 –284, 2001.
18. MORRISON, J. A., B. BARTON, F. M. BIRO, D. L. SPRECHER, F.
FALKNER, and E. OBARZANEK. Sexual maturation and obesity in 9-
and 10-year-old black and white girls: the National Heart, Lung,
and Blood Institute Growth and Health Study. J. Pediatr. 124:
889 –995, 1994.
19. MYERS, L., P. K. STRIKMILLER, L. S. WEBBER, and G. S. BERENSON.
Physical and sedentary activity in school children grades 5– 8: the
Bogalusa Heart Study. Med. Sci. Sports Exerc. 28:852– 859, 1996.
20. PENCHARZ, P. B., and M. P. AZCUE. Measuring resting energy
expenditure in clinical practice. J. Pediatr. 127:269 –271, 1995.
21. PETERSEN, A. C., L. CROCKETT, M. RICHARDS, and A. BOXER. A
self-report measure of pubertal status: reliability, validity, and
initial norms. J. Youth Adolesc. 17:117–133, 1988.
22. PIACENTINI, V., and A. BOLLETTINO. Il metabolismo respiratoria dei
bambini durante l’esercizio muscolare [Metabolism of respiration
of children during muscle exercise]. Arbeitsphysiologie [Work
Physiol.] 12:272–285, 1942.
23. ROBINSON, S. Experimental studies of physical fitness in relation to
age. Arbeitsphysiologie [Work Physiol.] 10:251–323, 1939.
24. ROEMMICH, J. N., P. A. CLARK, K. WALTER, J. PATRIE, A. WELTMAN,
and A. D. ROGOL. Pubertal alterations in growth and body com-
position. V. Energy expenditure, adiposity, and fat distribution.
Am. J. Physiol. Endocrinol. Metab. 279:E1426 –E436, 2000.
25. ROSS, J. G., C. O. DOTSON, G. G. GILBERT, and S. J. KATZ. National
Children and Youth Fitness Study I: Physical activity outside of
school physical education program. J. Phys. Educ. Recreation
Dance 56:35–39, 1985.
26. ROWLAND, T., L. CUNNINGHAM, L. MARTEL, P. VANDERBURGH, T.
MANOS, and N. CHARKOUDIAN. Gender effects on submaximal
energy expenditure in children. Int. J. Sports Med. 18:420 – 425,
1997.
27. SALLIS, J. F., M. J. BUONO, J. J. ROBY, F. G. MICALE, and J. A.
NELSON. Seven-day recall and other physical activity self-reports
in children and adolescents. Med. Sci. Sports Exerc. 25:99 –108,
1993.
Medicine & Science in Sports & Exercise姞 335
28. SOTHERN, M. S. Exercise as a modality in the treatment of
childhood obesity. Pediatr. Clin. North Am. 48:995–1015,
2001.
29. TROST, S. G., R. R. PATE, M. DOWDA, R. SAUNDERS, D. S. WARD,
and G. FELTON. Gender differences in physical activity and deter-
minants of physical activity in rural fifth grade children. J. Sch.
Health 66:145–150, 1996.
30. WASSERMAN, K., J. E. HANSEN, D. Y. SUE, B. J. WHIPP, and R.
CASABURI. Principles of Exercise Testing and Interpretation. Phil-
adelphia: Lea & Febiger, 1994, pp. 455– 463.

APPENDIX. How each activity was performed.

Activity Description Duration
Board games Playing a variety of games that could be played by two people 10 min
Homework/reading Working on their homework or a book they liked 10 min
Math test Playing a computer math game that adjusts to an individual’s math abilities based 10 min
on the response to the previous problem.
Rope skipping Jumping rope at a self-selected pace 10 min
Running Running on a treadmill at 8 kph (5 mph) 5–10 min
Shoveling Shoveling sand from one container into another 10 min
Stairclimbing Walking up and down a flight of stairs at a steady pace of 88 steps per minute 10 min
(paced with music)
Stretching Performing stretching exercises, moving through stretch (10 s) and rest (5 s) 10 min
Sweeping Sweeping up dried beans scattered across the floor 10 min
Television viewing Watching videos of popular children’s TV shows and movies while seated. 10 min
Vacuuming Vacuuming confetti scattered across a 3.6 ⫻ 4.5 m (4 ⫻ 5 yd), medium pile rug at 10 min
subject’s self-selected pace
Video games (sitting) Playing nonviolent Nintendo姝 video games while seated 10 min
Video games (standing) Playing arcade-style video games while standing 10 min
Walking Walking on a treadmill at two speeds: 4 and 5.6 kph (2.5 and 3.5 mph) 5 min per speed
Weightlifting Performing 4 sets of 10 repetitions each of leg press and bench press. With each Self-selected pace; 2-min
set the amount of weight was increased. Leg press: weights ⫽ 70, 80, 90, and rest period between sets
100% of body mass. Bench press: weights ⫽ 20, 30, 40, and 50% of body
mass. If subjects could not lift the next weight, the previous weight was used.

336 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org