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Previously, the National Health and Examination Survey measured physical activity with an accelerometer worn on the hip for 7 d but recently changed the location of the monitor to the wrist. This study compared estimates of physical activity intensity and type with an accelerometer on the hip versus the wrist.Healthy adults (n = 37) wore triaxial accelerometers (Wockets) on the hip and dominant wrist along with a portable metabolic unit to measure energy expenditure during 20 activities. Motion summary counts were created, and receiver operating characteristic (ROC) curves were then used to determine sedentary and activity intensity thresholds. Ambulatory activities were separated from other activities using the coefficient of variation of the counts. Mixed-model predictions were used to estimate activity intensity.The ROC for determining sedentary behavior had greater sensitivity and specificity (71% and 96%) at the hip than at the wrist (53% and 76%), as did the ROC for moderate- to vigorous-intensity physical activity on the hip (70% and 83%) versus the wrist (30% and 69%). The ROC for the coefficient of variation associated with ambulation had a larger AUC at the hip compared to the wrist (0.83 and 0.74). The prediction model for activity energy expenditure resulted in an average difference of 0.55 ± 0.55 METs on the hip and 0.82 ± 0.93 METs on the wrist.Methods frequently used for estimating activity energy expenditure and identifying activity intensity thresholds from an accelerometer on the hip generally do better than similar data from an accelerometer on the wrist. Accurately identifying sedentary behavior from a lack of wrist motion presents significant challenges.