Purpose. To critically review the validity of accelerometry-based prediction models to estimate activity energy expenditure (AEE) in children and adolescents. Methods. The CINAHL, EMBASE, PsycINFO, and PubMed/MEDLINE databases were searched. Inclusion criteria were development or validation of an accelerometer-based prediction model for the estimation of AEE in healthy children or adolescents (6–18 years), criterion measure: indirect calorimetry, or doubly labelled water, and language: Dutch, English or German. Results. Nine studies were included. Median methodological quality was ？IR (out of a maximum 10 points). Prediction models combining heart rate and counts explained 86–91% of the variance in measured AEE. A prediction model based on a triaxial accelerometer explained 90%. Models derived during free-living explained up to 45%. Conclusions. Accelerometry-based prediction models may provide an accurate estimate of AEE in children on a group level. Best results are retrieved when the model combines accelerometer counts with heart rate or when a triaxial accelerometer is used. Future development of AEE prediction models applicable to free-living scenarios is needed. 1. Introduction Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure (EE) [1]. Research has shown that there is a positive relationship between physical activity and health-related fitness [2, 3]. Health-related fitness refers to those components of fitness that benefit from a physically active lifestyle and relate to health [4]. The relationships between physical activity, health-related fitness, and health status are described by Bouchard et al. [4]. Valid and reliable instruments are necessary, when examining the dose-response relationship between physical activity and health-related fitness [5]. Estimation of physical activity and energy expenditure in children is difficult since children show physical activities of varying intensity and short of duration [6]. Subjective techniques are less preferable in children because of their complex movement behavior and their ability to accurately recall intensity, frequency, and duration of their activities [5]. Direct observation is considered a gold standard for the assessment of physical activity. Gold standard methods to assess activity related energy expenditure (AEE) are doubly labelled water and indirect calorimetry [5, 7]. These methods are mainly used for calibration and validation of objective and subjective measurements in laboratory and field settings. Due to their costs
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