1. Physical Activity and Long Words

Here is an excerpt from an article published in the Lancet (1).

Inclusion criteria were that data be from national or subnational cross-sectional populations based surveys undertaken with random sampling, reporting prevalence of inactivity based on the current or former recommendations, and including all domains of activity (work, household, transport, leisure). (WSEG =39/39.0/0.0/25.6)

​This 39-word sentence uses many long words. We underlined each word with three syllables or more. (But we didn’t count a two-syllable word that takes on a third syllable by adding an -s or –ing ending.) We call these long words. The percentage of long words is high (11 long words/39 total words =28.2%).

​The long sentence and long words result in a reading ease score of 0.0 on a scale from 0.0 to 100.0. The grade level is 25.6. This is equivalent to medical school plus 5.6 more years of training. 

​How can we improve reading ease?

Since this excerpt does not contain complex science, we can probably find a way to revise it to improve reading ease. One technique for improving reading ease is to break up a long sentence. Another is to replace long words with shorter words, where you can. Table 1 shows our thinking, as we tried to find shorter words to replace the long words.

Table 1. Trying to replace long words with shorter words

Long word	Shorter words
inclusion	​to Include
criteria	reason, how to choose
national	country
subnational	region, part of country
cross-sectional	cross sectional
population	people, resident
undertaken	undertake, take
prevalence	rate
inactivity	lack of activity
recommendations	recommend, suggest
activity	exercise, active, movement

Here is our attempt to revise the excerpt to minimize long words (Table 2).

Table 2. Revising to improve reading ease

Original	Revised
Inclusion criteria were that data be from national or subnational cross-sectional populations based surveys undertaken with random sampling, reporting prevalence of inactivity based on the current or former recommendations, and including all domains of activity (work, household, transport, leisure). (WSEG =39/39.0/0.0/25.6)	How did we choose what data to include?  It had to be from a survey of a cross section of people from a country or region. The survey had to report on a lack of activity based on current or former recommendations. The survey also had to report on all kinds of activity (work, housework, transport, leisure). (WSEG = 57/14.2/66.2/7.5)

​Our revision uses four sentences instead of one. It uses only two long words. The percentage of long words is much lower (2 long words/57 total words = 3.5%).
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Is this a good paraphrase of the original? Do you find it easier to grasp? Perhaps, you can think of a better way to say the same thing.
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Let’s compare WSEG [Way-seg] scores for the excerpt and our revision (Table 3). 

Table 3. Comparing WSEG scores

WSEG	Meaning	Original	Revised	Change
W	Total words	39	57	18
S	Average sentence length	39.0	14.2	-24.8
E	Flesh reading ease score	0.0	66.2	66.2
G	Flesh-Kincaid grade level	25.6	7.5	-18.1

These data show a reader would likely find the revised version easier to read. Our revision uses 18 more words, but since the words are shorter, it takes up less space. Average sentence length is lower. These changes improve the reading ease score by 66.2 points. The grade level decreases from 25.6 to 7.5. The WSEG score for the revision seems more in line with this excerpt’s level of science content. If the whole article could be revised in plain English, it could reach a much wider audience.

Conclusion

In this post, we looked at a long sentence and long words—two symptoms of medicus incomprehensibilis. We showed how we would revise to break up the long sentence and use fewer long words. These simple changes made the excerpt much easier to read. We talk more about sentence length and word length in Chapters 1 and 2 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, Spring 2017).
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This blog post is first in a series on Symptoms of Medicus Incomprehensibilis.

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(1) Sallis J, et al., "Progress in Physical Activity over the Olympic Quadrennium," Lancet 388, no. 10051 (2016), under "Adult Estimates."