358 / Journal of Cardiopulmonary Rehabilitation and Prevention 2008;28:358–369 www.jcrpjournal.com ■ PURPOSE: Given the importance of physical activity (PA) in cardiac reha- bilitation and prevention, measuring it in a valid and reliable manner is a practical challenge. Measuring self-reported PA in elderly cardiac patients can be problematic because of the need to assess many activities of short duration that may occur as part of routine daily functions. The primary purpose of this article was to identify and evaluate instruments that have been used over the last 15 years in studies of cardiac patients. ■ METHODS: A comprehensive MEDLINE search was carried out to identi- fy articles from studies undertaken to assess PA in cardiac patients. The self-report PA instruments were subjected to evaluation concern- ing suitability for use with cardiac patients. ■ RESULTS: The initial electronic and hand searches yielded 203 articles. After removing articles that did not meet the inclusion criteria, a total of 86 articles were selected. Twenty-three self-report instruments were identified for evaluation. Most of the instruments had problems asso- ciated with inadequate validation methods or suitability for cardiac patients. Many of the instruments failed to demonstrate adequate validity or reliability, particularly when measuring low-intensity PA. ■ CONCLUSIONS: Some instruments are more suited to epidemiologic research than to clinical interventions where responsiveness to inter- ventions is crucial. Recommendations for the constituents of an acceptable self-report PA instrument for cardiac patients are presented and the most suitable existing instruments are identified. An Evaluation of Self-report Physical Activity Instruments Used in Studies Involving Cardiac Patients Michael R. Le Grande, MPH, Peter C. Elliott, PhD, Marian U. C. Worcester, PhD, Barbara M. Murphy, PhD, and Alan J. Goble, MD Author Affiliation: Heart Research Centre, The Royal Melbourne Hospital, Melbourne (Mr Le Grande and Drs Elliott, Worcester, Murphy, and Goble); and Department of Psychiatry (Drs Elliott, Murphy, and Worcester), The University of Melbourne, Melbourne, Victoria, Australia. Corresponding Author: Michael R. Le Grande, MPH, Heart Research Centre, PO Box 2137, The Royal Melbourne Hospital 3050, Melbourne, Victoria, Australia (michael.legrande@heartresearchcentre.org). K E Y W O R D S cardiac patients physical activity measurement reproducibility validity Cardiovascular disease (CVD) is the leading cause of death in both men and women throughout the world, 1 and physical inactivity has been identified as a major modifiable risk factor in the prevention of CVD. 2 Research supports the view that, particularly for the frail elderly and the sedentary, health advantages may accrue even from low-intensity physical activity (PA). 3,4 The prevalence of CVD is known to increase with age and the number of older patients with CVD is expected to rise over the next several decades. 1 Thus, accurately assessing PA in older cardiac patients represents an important public health issue. Accurate quantification of PA in cardiac patients in secondary prevention settings is essential for a num- ber of reasons. These include monitoring trajectories of PA, evaluating the effectiveness of interventions, studying dose-response relationships, and determin- ing which dimensions of PA are important for a spe- cific health outcome. 5 Several methods are available for measuring PA, including accelerometers, heart rate monitors, direct and indirect calorimetry, activi- ty diaries, and self-report questionnaires. For practi- cal reasons, including cost and investigator and respondent burden, 6 measurement of PA in cardiac