Methodological aspects of physical activity assessment in epidemiological studies

Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years

Childhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5-7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11-13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.

Development and evaluation of the sedentary behavior and light-intensity physical activity questionnaire

[Purpose] To describe our newly developed Sedentary Behavior and Light-Intensity Physical Activity Questionnaire and examine its reliability and validity. [Participants and Methods] We identified and selected self-reported items through a literature review and interviews with 11 inactive individuals. Thirty-one individuals with lower limb prostheses and an expert panel assessed the content validity of the integrated items and identified 17 items. Patients who had undergone lower limb surgeries were regarded as inactive individuals, and 112 patients completed the questionnaire twice for test-retest reliability and wore an accelerometer for criterion validity. The ethics committee of Kyushu University approved this study (2019-126 and 2019-273). [Results] Item analysis was revised to the Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 (six light-intensity physical activity and four sedentary behavior items) because of the floor effect. The test-retest correlation coefficient showed high reliability. Moderate to weak correlation coefficient was observed between the questionnaire and accelerometer (light-intensity physical activity: 0.43 and sedentary behavior: 0.20), and the Bland-Altman plots indicated no bias. [Conclusion] The Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 had acceptable validity and reliability among inactive individuals and it could be used for studying light-intensity physical activity.

Ethnic and biological differences in the association between physical activity and survival after breast cancer

Physical activity is recommended for most cancer patients as a nonpharmacological therapy to improve prognosis. Few studies have investigated the association between physical activity and breast cancer prognosis by ethnicity, biological, and modifiable risk factors for mortality. We investigated the association between physical activity and long-term survival among breast cancer survivors. A total of 397 survivors (96 Hispanic and 301 non-Hispanic White (NHW)) from the New Mexico HEAL study contributed baseline and biological data approximately 6 months after diagnosis. Study outcomes included all-cause, breast cancer-specific, and non-breast cancer mortality. The exposure was self-reported physical activity within the past month. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox Proportional Hazards regression. A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. Engaging in >6.9 metabolic equivalent hours/week (MET-h/week) of moderate to vigorous physical activity (active) was inversely associated with all-cause mortality among all women (HR 0.66, 95% CI 0.43-0.99) and NHWs (HR 0.58, 95% CI 0.36-0.94). Active NHW women also had a reduced risk of non-breast cancer mortality (HR 0.56, 95% CI 0.31-0.99), compared to inactive women (0 MET-h/week). In subgroups, we observed the inverse associations with all-cause mortality among women >58 years old (p-interaction= 0.03) and with localized stage (p-interaction = 0.046). Our results confirm the protective association between physical activity and mortality after breast cancer diagnosis, and demonstrate that this association significantly differs by age and cancer stage. Larger studies are warranted to substantiate our findings.

Physical activity in patients with cancer: self-report versus accelerometer assessments

Purpose

The level of daily physical activity in patients with cancer is frequently assessed by questionnaires, such as the Physical Activity Scale for the Elderly (PASE). Objective assessments, with for example accelerometers, may be a good alternative. The aim of this study was to investigate the agreement between the PASE questionnaire and accelerometer-assessed physical activity in a large group of patients with different types of cancer.

Methods

Baseline accelerometer and PASE questionnaire data of 403 participants from the REACT (Resistance and Endurance Exercise After Chemotherapy, n = 227), the EXIST (Exercise Intervention After Stem-Cell Transplantation, n = 74), and NET-QUBIC (NEtherlands QUality of Life And Biomedical Cohort Studies In Cancer, n = 102) studies were available for the current analyses. Physical activity was assessed by the PASE questionnaire (total score) and accelerometers (total minutes per day > 100 counts). Linear mixed models regression analysis was used to assess the agreement between the PASE questionnaire and accelerometer-assessed physical activity.

Results

The mean (SD) PASE score was 95.9 (75.1) points and mean (SD) time in physical activity measured with the accelerometer was 256.6 (78.8) min per day. The agreement between the PASE score and the accelerometer data was significant, but poor (standardized regression coefficient (B) = 0.36, 95%CI = 0.27; 0.44, p < 0.01).

Conclusion

Agreement between the PASE questionnaire and accelerometer-assessed physical activity was poor. The poor agreement indicates that they measure different physical activity constructs and cannot be used interchangeably to assess the level of daily physical activity in patients with cancer.

Persuasive technology to support active and healthy ageing: An exploration of past, present, and future

The age of the population worldwide is rapidly increasing, bringing social and economic challenges. Persuasive technology can alleviate the burden on traditional healthcare services when used to support healthy behaviors, for instance in the prevention and treatment of chronic diseases. Additionally, healthy behaviors are key factors for active and healthy ageing by delaying or even reversing functional decline. In this manuscript, we present a multi-perspective analysis of technologies that can be used in the support of active and healthy ageing in the daily life. First, we take the perspective of physical and mental health, by focusing on the promotion of physical activity and emotional wellbeing. From a temporal perspective, we look at how technology evolved from past, present and future. The overview of the literature is structured in four main sections: (1) measurement of current behavior (monitoring), (2) analysis of the data gathered to derive meaningful information (analyzing & reasoning), (3) support the individual in the adoption or maintenance of a behavior (coaching), and (4) tools or interfaces that provide the information to the individual to stimulate the desired behavior (applications). Finally, we provide recommendations for the design, development and implementation of future technological innovations to support Active and Healthy Ageing in daily life.

Technologies for physical activity self-monitoring: a study of differences between users and non-users

BACKGROUND

Different kinds of physical activity (PA) self-monitoring technologies are used today to monitor and motivate PA behavior change. The user focus is essential in the development process of this technology, including potential future users such as representatives from the group of non-users. There is also a need to study whether there are differences between the groups of users and non-users. The aims of this study were to investigate possible differences between users and non-users regarding their opinions about PA self-monitoring technologies and to investigate differences in demographic variables between the groups.

MATERIALS AND METHODS

Participants were randomly selected from seven municipalities in central Sweden. In total, 107 adults responded to the Physical Activity Products Questionnaire, which consisted of 22 questions.

RESULTS

Significant differences between the users and non-users were shown for six of the 20 measurement-related items: measures accurately (p=0.007), measures with high precision (p=0.024), measures distance (p=0.020), measures speed (p=0.003), shows minutes of activity (p=0.004), and shows geographical position (p=0.000). Significant differences between the users and non-users were also found for two of the 29 encouragement items: measures accurately (p=0.001) and has long-term memory (p=0.019). Significant differences between the groups were also shown for level of education (p=0.030) and level of physical exercise (p=0.037).

CONCLUSION

With a few exceptions, the users and the non-users in this study had similar opinions about PA self-monitoring technologies. Because this study showed significant differences regarding level of education and level of physical exercise, these demographic variables seemed more relevant to investigate than differences in opinions about the PA self-monitoring technologies.

Is there a U-shaped relationship between physical activity in leisure time and risk of chronic low back pain? A follow-up in the HUNT Study

Background

Physical activity in leisure time is often considered to have favourable effects on the risk of low back pain (LBP), but demonstrating a definite association in epidemiological studies has proven difficult. The purpose of the present study was to explore associations between physical activity and risk of chronic LBP in an adult population and to investigate whether relationships are limited to certain age groups or to females or males. A particular objective was to determine whether support could be found for a U-shaped relationship, with both low and high activity levels carrying greater risk.

Methods

The relationship between physical activity and risk of chronic LBP was examined in a Norwegian prospective study using data from the community-based HUNT2 and HUNT3 surveys. Participants were 9616 women and 8452 men without LBP at baseline, who reported after 11 years whether they suffered from LBP. Associations between baseline physical activity in leisure time and risk of chronic LBP at end of follow-up were evaluated by generalized linear modelling with adjustment for potential confounders.

Results

Significant associations between leisure time physical activity and risk were observed in both sexes after age adjustment, mainly suggesting inverse relationships. Women participating in hard physical activity 1–2 h per week had a relative risk (RR) of chronic LBP of 0.81 (95 % CI 0.71–0.93) compared to those with only light physical activity less than 1 h per week. The corresponding RR in men was 0.71 (95 % CI 0.60–0.85). After adjustment for education, employment, occupational activity, body mass index (BMI) and smoking, significant relationships could only be demonstrated in those aged 50 years or more at baseline. The associations differed between female educational groups, with more U-shaped relationships being observed among women with basic education only.

Conclusion

No strong support was found overall for U-shaped relationships. However, no further general decrease in risk was seen among those with 3 h or more of hard physical activity per week. The contrasts observed between female educational groups may reflect different preferences regarding specific strenuous activities. Men aged 50 years or more seem in particular to benefit from hard physical activities.

Comparison of the Physical Activity and Sedentary Behaviour Assessment Questionnaire and the Short-Form International Physical Activity Questionnaire: An Analysis of Health Survey for England Data

Background

The Physical Activity and Sedentary Behaviour Assessment Questionnaire (PASBAQ), used within the Health Survey for England (HSE) at 5-yearly intervals, is not included annually due to funding and interview-length constraints. Policy-makers and data-users are keen to consider shorter instruments such as the Short-form International Physical Activity Questionnaire (IPAQ) for the annual survey. Both questionnaires were administered in HSE 2012, enabling comparative assessment in a random sample of 1252 adults.

Methods

Relative agreement using prevalence-adjusted bias-adjusted Kappa (PABAK) statistics was estimated for: sufficient aerobic activity (moderate-to-vigorous physical activity [MVPA] ≥150minutes/week); inactivity (MVPA<30minutes/week); and excessive sitting (≥540minutes/weekday). Cross-sectional associations with health outcomes were compared across tertiles of MVPA and tertiles of sitting time using logistic regression with tests for linear trend.

Results

Compared with PASBAQ data, IPAQ-assessed estimates of sufficient aerobic activity and inactivity were higher and lower, respectively; estimates of excessive sitting were higher. Demographic patterns in prevalence were similar. Agreement using PABAK statistics was fair-to-moderate for sufficient aerobic activity (0.32–0.49), moderate-to-substantial for inactivity (0.42–0.74), and moderate-to-substantial for excessive sitting (0.49–0.75). As with the PASBAQ, IPAQ-assessed MVPA and sitting each showed graded associations with mental well-being (women: P for trend = 0.003 and 0.004, respectively) and obesity (women: P for trend = 0.007 and 0.014, respectively).

Conclusions

Capturing habitual physical activity and sedentary behaviour through brief questionnaires is complex. Differences in prevalence estimates can reflect differences in questionnaire structure and content rather than differences in reported behaviour. Treating all IPAQ-assessed walking as moderate-intensity contributed to the differences in prevalence estimates. PASBAQ data will be used for population surveillance every 4 to 5 years. The current version of the Short-form IPAQ was included in HSE 2013–14 to enable more frequent assessment of physical activity and sedentary behaviour; a modified version with different item-ordering and additional questions on walking-pace and effort was included in HSE 2015.

Lack of exercise of "moderate to vigorous" intensity in people with low levels of physical activity is a major discriminant for sociodemographic factors and morbidity

INTRODUCTION

The aim is to examine the differences between participation at low and zero moderate to vigorous physical activity (MVPA) in relation to their trends and associations with known socio-demographic and health factors. We hypothesised that the number of people at zero MVPA level could be rising despite a parallel increase in the population meeting the recommended MVPA level. We also hypothesised that graded associations of sociodemographic and health factors exist across MVPA levels.

METHODS

Two independent population-based samples (n = 4320 [2004] and n = 2176 [1997]), were recruited with a stratified and random sampling procedure and interviewed at home by professional interviewers. The MVPA was assessed by validated questionnaire. The participants were classified into three MVPA levels: zero, low and recommended MVPA. The trend of each MVPA level was analysed with the standardized prevalence ratios. Correlates of low and zero MVPA levels were examined using multinomial logistic regression.

RESULTS

The population at zero and recommended MVPA levels rose between 1997-2004 by 12% (95% CI, 5-20%) and 7% (95% CI,-4-19%) respectively, while the population at low MVPA level decreased. At zero MVPA level, associative patterns were observed with sociodemographic and health factors which were different when compared to the population at low MVPA level.

CONCLUSIONS

Despite the slight increase of population meeting the recommended MVPA level, a higher trend of increase was observed at zero MVPA level. Both recommended and low MPVA levels increased their participation by absorbing participants from the low MVPA level. The sociodemographic profile of those with low MVPA was more similar to the population at recommended MVPA than at zero MVPA level. Methodological implications about the combination of light and moderate-intensity PA could be derived. The prevention of decline in actual low MVPA could change the trend of increase in the population at zero MVPA level, particularly among young adults.

Physical Activity Monitoring in Patients with Chronic Obstructive Pulmonary Disease

Reduced physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality (e.g. exacerbations) and eventually leads to disability, depression, and social and physical isolation. Measuring PA in this population is important to accurately characterize COPD and to help clinicians during a baseline evaluation and patient follow-up. Also, it may help increase adherence to PA programs. There are reliable objective and subjective methods available to measure PA. Recently, several new monitors have been developed that have improved accuracy of such measurements. Because these devices provide real-time feedback, they may help to improve participant self-motivation strategies and reinforce daily lifestyle modifications, one of the main goals in COPD management. This review focuses on describing available instruments to measure PA, specifically in patients with COPD. The reliability, validity, advantages, limitations, and clinical applications of questionnaires, pedometers, and accelerometers are discussed. Finally, based on current published literature, we propose recommendations about which methods may be most useful in different research or clinical settings.

Age- and sex-specific criterion validity of the health survey for England Physical Activity and Sedentary Behavior Assessment Questionnaire as compared with accelerometry

The criterion validity of the 2008 Physical Activity and Sedentary Behavior Assessment Questionnaire (PASBAQ) was examined in a nationally representative sample of 2,175 persons aged ≥16 years in England using accelerometry. Using accelerometer minutes/day greater than or equal to 200 counts as a criterion, Spearman's correlation coefficient (ρ) for PASBAQ-assessed total activity was 0.30 (95% confidence interval (CI): 0.25, 0.35) in women and 0.20 (95% CI: 0.15, 0.26) in men. Correlations between accelerometer counts/minute of wear time and questionnaire-assessed relative energy expenditure (metabolic equivalent-minutes/day) were higher in women (ρ = 0.41, 95% CI: 0.36, 0.46) than in men (ρ = 0.32, 95% CI: 0.26, 0.38). Similar correlations were observed for minutes/day spent in vigorous activity (women: ρ = 0.39, 95% CI: 0.33, 0.46; men: ρ = 0.31, 95% CI: 0.26, 0.36) and moderate-to-vigorous activity (women: ρ = 0.42, 95% CI: 0.36, 0.48; men: ρ = 0.38, 95% CI: 0.32, 0.45). Correlations for time spent being sedentary (<100 counts/minute) were 0.30 (95% CI: 0.24, 0.35) and 0.25 (95% CI: 0.19, 0.30) in women and men, respectively. Sedentary behavior correlations showed no sex difference. The validity of sedentary behavior and total physical activity was higher in older age groups, but validity was higher in younger persons for vigorous-intensity activity. The PASBAQ is a useful and valid instrument for ranking individuals according to levels of physical activity and sedentary behavior.

Validity and reproducibility of the Physical Activity Scale for the Elderly (PASE) questionnaire for the measurement of the physical activity level in patients after total knee arthroplasty

Background

The need for valid and reproducible questionnaires to routinely assess the physical activity level of patients after total knee arthroplasty (TKA) is of particular concern in clinical settings. Aims of this study were to evaluate the validity and reproducibility of the physical activity scale for the elderly (PASE) questionnaire in TKA patients, with a particular view on gender differences.

Methods

A total of 50 elderly patients (25 women and 25 men aged 70 ± 6 years) following primary unilateral TKA were recruited. The reproducibility was evaluated by administering the PASE questionnaire during two occasions separated by 7 days. The construct (criterion) validity was investigated by comparing the physical activity level reported by patients in the PASE questionnaire to that measured by accelerometry. Reproducibility was evaluated using intraclass correlation coefficients (ICC_3,1) for reliability and standard error of measurement (SEM) and smallest detectable change (SDC) for agreement, while validity was investigated with Pearson correlation coefficients.

Results

Reliability of the PASE total score was acceptable for men (ICC = 0.77) but not for women (ICC = 0.58). Its agreement was low for both men and women, as witnessed by high SEM (32% and 35%, respectively) and SDC (89% and 97%, respectively). Construct validity of the PASE total score was low in both men (r = 0.45) and women (r = 0.06).

Conclusions

The PASE questionnaire has several validity and reproducibility shortcomings, therefore its use is not recommended for the assessment of physical activity level in patients after TKA, particularly in women.

Prediction equations of energy expenditure in Chinese youth based on step frequency during walking and running

PURPOSE

This study set out to examine the relationship between step frequency and velocity to develop a step frequency-based equation to predict Chinese youth's energy expenditure (EE) during walking and running.

METHOD

A total of 173 boys and girls aged 11 to 18 years old participated in this study. The participants walked and ran on a treadmill at speeds of 3 km/hr, 4 km/hr, 5 km/hr, 6 km/hr, 7 km/hr, and 8 km/hr. EE was measured using indirect calorimetry of open circuit spirometry (Cosmed K4b2 metabolic analyzer). Using multiple regression analysis, the relationship between step frequency and velocity was first examined, and the prediction equation of EE based on step frequency, age, and gender was derived.

RESULTS

The hypothesized relationship between step frequency and velocity was confirmed and an accurate (R2 = .78) EE prediction equation was derived: NetEE = - 13.7744 + 1.8004 (step frequency) - 5.5715 (age) - 11.5244 (gender).

CONCLUSION

A step frequency-, age-, and gender-based equation was derived to predict the EE of youth during walking and running. The equation can be used to develop a simple device to estimate EE during walking and running in this population.

Reliability and validity of the Dutch version of the International Physical Activity Questionnaire in patients after total hip arthroplasty or total knee arthroplasty

STUDY DESIGN

Psychometric assessment.

OBJECTIVES

To determine test-retest reliability and concurrent validity of the International Physical Activity Questionnaire (IPAQ) in patients after total hip arthroplasty or total knee arthroplasty.

BACKGROUND

Despite recognized benefits of regular physical activity, little is known about the physical activity level of patients after total hip arthroplasty or total knee arthroplasty. None of the currently used questionnaires is internationally accepted. The IPAQ tries to address this problem, but its validity and reliability in those who have had a total hip arthroplasty or total knee arthroplasty are unknown.

METHODS

Forty-four patients completed the IPAQ (short and long forms) twice. Test-retest reliability was assessed by Spearman correlation coefficients (r) and intraclass correlation coefficients. Additionally, standard error of measurement and minimal detectable change were calculated. Concurrent validity was determined by an accelerometer. Spearman correlation coefficients were calculated between IPAQ scores and accelerometer data. Bland-Altman analyses were performed for both reliability and validity.

RESULTS

Fair to good correlation coefficients were found for test-retest reliability of the total and activity scores (r = 0.49-0.81, intraclass correlation coefficient = 0.27-0.71). Standard error of measurement and minimal detectable change were large. For concurrent validity, weak to moderate correlation coefficients were found for total and activity scores (r = -0.07 to 0.54). Systematic bias was found between the IPAQ and accelerometer data, with higher scores on the IPAQ.

CONCLUSION

Overall, the IPAQ showed fair reliability and weak concurrent validity. These results are in line with previous studies of the reliability and validity of the IPAQ. Due to systematic bias and large standard error of measurement and minimal detectable change, the IPAQ may only be suitable for intergroup comparisons.

Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

BACKGROUND

Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct.

METHODS

Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria.

RESULTS

In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls.

CONCLUSION

Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls.

A systematic review of the validity and reliability of sedentary behaviour measures used with children and adolescents

The aim of this review was to evaluate the reliability and validity of methods used to assess the multiple components of sedentary behaviour (i.e. screen time, sitting, not moving and existing at low energy expenditure) in children and adolescents. Twenty-six studies met our inclusion criteria and were reviewed. Thirteen studies reported the reliability of self- and proxy-report measures of sedentary behaviour and seven of these were found to have acceptable test-retest reliability. Evidence for the criterion validity of self- and proxy-report measures was examined in three studies with mixed results. Seven studies examined the reliability and/or validity of direct observation and the findings were generally positive. Five studies demonstrated the utility of accelerometers to accurately classify sedentary behaviour. Self-report measures provide reliable estimates of screen time, yet their validity remains largely untested. While accelerometers can accurately classify participants' behaviour as sedentary, they do not provide information about type of sedentary behaviour or context. Studies utilizing measures of sedentary behaviour need to more adequately report on the validity and reliability of the measures used. We recommend the use of objective measures of sedentary behaviour such as accelerometers, in conjunction with subjective measures (e.g. self-report), to assess type and context of behaviour.

Instruments to assess physical activity in patients with osteoarthritis of the hip or knee: a systematic review of measurement properties

OBJECTIVE

There is no consensus on the best approach for measuring physical activity in patients with osteoarthritis (OA) of the hip or knee. The aims of this study were (1) to identify all physical activity measures that have been validated in patients with OA of the hip or knee and to systematically review their measurement properties, and (2) to give recommendations on which instrument is most suitable for what purpose.

DESIGN

A search was performed in PubMed, Embase, and Sportdiscus (complete databases until November 10, 2010). Three reviewers independently evaluated the quality of the included studies, using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Subsequently, the reviewers independently evaluated the quality of the included physical activity instruments, using the recently developed QAPAQ checklist for appraising the qualitative attributes and measurement properties of physical activity questionnaires.

RESULTS

Nine studies were included, in which 12 measurement instruments were evaluated: five single-item rating scales, six multi-item questionnaires, and one pedometer. In general, the methodological quality of the studies was poor to moderate. Only the Lower-Extremity Activity Scale (LEAS) and the pedometer received positive ratings for content validity. The LEAS and Baecke questionnaire received positive ratings for reliability. The University of California at Los Angeles (UCLA), the Tegner score, and the LEAS received positive ratings for construct validity. The Daily Activity Questionnaire (DAQ) received a positive rating for criterion validity. Responsiveness was not evaluated for any of the included instruments.

CONCLUSION

For monitoring physical activity levels of populations the UCLA or LEAS seem most useful. For studies measuring physical activity as a risk factor for developing OA or as a protective factor against functional decline there is not enough evidence for any instrument to conclude that it has adequate measurement properties. For follow-up studies on wear in joint replacement patients we recommend to use accelerometers. However, more validation studies of adequate quality are needed for all included instruments.

Self-administered physical activity questionnaires for the elderly: a systematic review of measurement properties

OBJECTIVE

To systematically review and appraise studies examining self-administered physical activity questionnaires (PAQ) for the elderly. This article is one of a group of four articles in Sports Medicine on the content and measurement properties of PAQs. LITERATURE SEARCH METHODOLOGY: Searches in PubMed, EMBASE and SportDiscu (until May 2009) on self-administered PAQ. Inclusion criteria were as follows: (i) the study examined (at least one of) the measurement properties of a self-administered PAQ; (ii) the questionnaire aimed to measure physical activity (PA) in older people; (iii) the average age of the study population was >55 years; (iv) the article was written in English. We excluded PA interviews, diaries and studies that evaluated the measurement properties of a self-administered PAQ in a specific population, such as patients. We used a standard checklist (qualitative attributes and measurement properties of PA questionnaires [QAPAQ]) for appraising the measurement properties of PAQs.

FINDINGS

Eighteen articles on 13 PAQs were reviewed, including 16 reliability analyses and 25 validity analyses (of which 15 were on construct validity, seven on health/functioning associations, two on known-groups validity and one on responsiveness). Many studies suffered from methodological flaws, e.g. too small sample size or inadequate time interval between test and retest. Three PAQs received a positive rating on reliability: IPAQ-C (International Physical Activity Questionnaire-Chinese), intraclass correlation coefficient (ICC) > or = 0.81; WHI-PAQ (Women's Health Initiative-PAQ), ICC = 0.76; and PASE (Physical Activity Scale for the Elderly), Pearson correlation coefficient (r) = 0.84. However, PASE was negatively rated on reliability in another study (ICC = 0.65). One PAQ received a positive rating on construct validity: PASE against Mini-Logger (r > 0.52), but PASE was negatively rated in another study against accelerometer and another PAQ, Spearman correlation coefficient = 0.17 and 0.48, respectively. Three of the 13 PAQs were tested for health/functioning associations and all three were positively rated in some categories of PA in many studies (r > 0.30).

CONCLUSIONS

Even though several studies showed an association between the tested PAQ and health/functioning variables, the knowledge about reliability and construct validity of self-administrated PAQs for older adults is still scarce and more high-quality validation studies are needed.

Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture

OBJECTIVE

To examine the association between physical activity recorded by actigraphy during therapy sessions (therapy) with therapist-rated patient participation and self-reported future functional outcomes. We hypothesized those participants who were more active during rehabilitation would have higher participation scores and better functional outcomes after hip fracture compared with those who were less active.

DESIGN

Longitudinal study with a 3- and 6-month follow-up.

SETTING

Participants were recruited from skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).

PARTICIPANTS

Participants included 18 community-dwelling older adults admitted to SNFs or IRFs facilities after hip fracture. Participants were included if they were 60 years of age or older and ambulatory with or without assistance from a device or another person.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Physical activity was quantified during participants' rehabiliation by using the actigraph accelerometer worn consecutively over 5 days. The Pittsburgh Participation Rating Scale was used to quantify patient participation during their inpatient therapy sessions. Self-reported functional outcomes were measured by the Hip Fracture Functional Recovery Scale at baseline and 3 and 6 months after fracture.

RESULTS

Participants with higher actigraphy counts during rehabilitation were ranked by their therapists as having excellent participation compared with those who were less active. Participants who were more active reported better functional abilities at both the 3- and 6-month time points and achieved 78% and 91% recovery of self-reported prefracture function compared with those who were less active achieving 64% and 73% recovery.

CONCLUSIONS

Actigraphy provides an objective measure of physical activity exhibiting predictive validity for future functional outcomes and concurrent validity against patient participation in patients after hip fracture.

Validation of self-reported recreational exercise in pregnant women in the Norwegian Mother and Child Cohort Study

We compared the self-reported frequency of recreational exercise and corresponding metabolic equivalent (MET)-minutes with physical activity measured with a position and motion sensor in pregnant women. One hundred and twelve women in the Norwegian Mother and Child Cohort Study (MoBa) completed questions about weekly participation in recreational exercise by week 17 of pregnancy and participated in the validation study around week 20. Data from a validated motion sensor (ActiReg) that measures physical activity and total energy expenditure (TEE) served as the "gold standard." Self-reported recreational exercise was compared with the following ActiReg-based measures: physical activity energy expenditure (PAEE), minutes of vigorous physical activity (VPA), physical activity level (PAL) and TEE. Pearson's correlations between self-reported weekly exercise and the objectively assessed variables were: rPAEE=0.26, rVPA=0.32, rPAL=0.30 (all P<0.01) and rTEE=0.17 (P=0.07). The partial correlation coefficients between the questionnaire responses and the ActiReg measurements were similar after adjusting for parity, body mass index, education, age, height and smoking, but rTEE increased (r=0.27, P<0.01). We observed significant positive associations between self-reported exercise activities and motion sensor measurements of physical activity, indicating that the questions used for exercise assessment in MoBa may be useful for ranking pregnant women according to the recreational exercise level.

Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study

INTRODUCTION

Identifying modifiable factors that reduce the risk of recurrence and improve survival in breast cancer survivors is a pressing concern. The purpose of this study was to examine the association of physical activity following diagnosis and treatment with the risk of breast cancer recurrence and mortality and all-cause mortality in women with early-stage breast cancer.

MATERIALS AND METHODS

The sample consisted of 1,970 women from the Life After Cancer Epidemiology study, a prospective investigation of behavioral risk factors and health outcomes. Self-reported frequency and duration of work-related, household and caregiving, recreational, and transportation-related activities during the six months prior to enrollment were assessed. Outcomes were ascertained from electronic or paper medical charts. Hazard ratios and 95% confidence intervals were estimated from delayed entry Cox proportional hazards models.

RESULTS

Although age-adjusted results suggested that higher levels of physical activity were associated with reduced risk of recurrence and breast cancer mortality (P for trend = 0.05 and 0.07, respectively for highest versus lowest level of hours per week of moderate physical activity), these associations were attenuated after adjustment for prognostic factors and other confounding variables (P for trend = 0.36 and 0.26). In contrast, a statistically significant protective association between physical activity and all-cause mortality remained in multivariable analyses (hazard ratio, 0.66; 95% confidence interval, 0.42-1.03; P for trend = 0.04).

CONCLUSIONS

These findings do not support a protective effect of physical activity on breast cancer recurrence or mortality but do suggest that regular physical activity is beneficial for breast cancer survivors in terms of total mortality.

Validity and reliability of measures of television viewing time and other non-occupational sedentary behaviour of adults: a review

Time spent in non-occupational sedentary behaviours (particularly television viewing time) is associated with excess adiposity and an increased risk of metabolic disorders among adults; however, there are no reviews of the validity and reliability of assessing these behaviours. This paper aims to document measures used to assess adults' time spent in leisure-time sedentary behaviours and to review the evidence on their reliability and validity. Medline, CINAHL and Psych INFO databases and reference lists from published papers were searched to identify studies in which leisure-time sedentary behaviours had been measured in adults. Sixty papers reporting measurement of at least one type of leisure-time sedentary behaviour were identified. Television viewing time was the most commonly measured sedentary behaviour. The main method of data collection was by questionnaire. Nine studies examined reliability and three examined validity for the questionnaire method of data collection. Test-retest reliabilities were predominantly moderate to high, but the validity studies reported large differences in correlations of self-completion questionnaire data with the various referent measures used. To strengthen future epidemiological and health behaviour studies, the development of reliable and valid self-report instruments that cover the full range of leisure-time sedentary behaviour is a priority.

Concurrent validity of the International Physical Activity Questionnaire (IPAQ) in an liyiyiu Aschii (Cree) community

BACKGROUND

Culturally acceptable and validated instruments for assessing physical activity among Indigenous Peoples are lacking. Given the current trends in obesity, health behaviour surveillance tools are needed to evaluate trends and to determine the effectiveness of health promotion efforts aimed at curbing the obesity epidemic.

OBJECTIVE

To evaluate whether the International Physical Activity Questionnaire (IPAQ) scores correlate with anthropometric indices in an liyiyiu Aschii community (Cree Territory of northern Quebec, Canada).

METHODS

A cross-sectional study was carried out in a Cree community as part of a larger research effort entitled, "Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Longitudinal Study in liyiyiu Aschii". Randomly selected adult participants (n = 161) underwent an anthropometric assessment and answered the IPAQ which was administered by bilingual research assistants. Concurrent validity of the IPAQ was evaluated by the extent to which the physical activity scores were related to anthropometric measures.

RESULTS

Significant inverse correlations were observed between the IPAQ Total MET score and % body fat (r = -.19, p < or = 0.01) and the IPAQ Vigorous MET score and % body fat (r = -.26, p < or = 0.001), but not for waist circumference or BMI. Walkers (6-7 days/wk for > or = 60 minutes/day), however, had a waist circumference that was, on average, 5 cm smaller than non-walkers in age- and sex-adjusted linear regression analyses (beta = -4.97; SE = 2.5; p < or = 0.05).

DISCUSSION

The results indicate that the IPAQ holds promise as a culturally adaptable questionnaire for the liyiyiuch. However, modifications will help improve its acceptability for community members.

Validity of two physical activity questionnaires (IPAQ and PAQA) for Vietnamese adolescents in rural and urban areas

BACKGROUND

Although physical activity is recognised to be an important determinant of health and nutritional status, few instruments have been developed to assess physical activity in developing countries. The aim of this study was to compare the validity of the short form of the International Physical Activity Questionnaire (IPAQ) and a locally adapted version of the Physical Activity Questionnaire for Adolescents (PAQA) for use in school going adolescents in rural and urban areas in Vietnam.

METHODS

Sixteen year old adolescents from rural areas (n = 137) and urban areas (n = 90) completed the questionnaires in 2006. Test-retest reliability was assessed by comparing registrations after 2 weeks. Criterion validity was assessed by comparison with 7 days continuous accelerometer logging. Validity of the two methods was assessed using Spearman correlation coefficient, intra class correlation coefficients (ICC) and Kappa statistics.

RESULTS

Reliability of both questionnaires was poor for both the IPAQ (ICC = 0.37) and the PAQA (ICC = 0.40). Criterion validity of both questionnaires was acceptable and similar for the IPAQ (rho = 0.21) and the PAQA (rho = 0.27) but a significantly lower validity was observed in rural areas. Both forms poorly estimated time spent on light, moderate and vigorous physical activity. Agreement of both questionnaires to classify individuals was also low but the IPAQ performed better than the PAQA.

CONCLUSION

Both questionnaires have a similar and overall poor validity to be used as a population instrument in Vietnam. Low reliability and classification properties in rural areas call for further research for specific use in such settings.

Actividades de la vida diaria en pacientes con enfermedad pulmonar obstructiva crónica: validación de la traducción española y análisis comparativo de 2 cuestionarios

BACKGROUND AND OBJECTIVE

Exercise limitation is a common finding in chronic obstructive pulmonary disease (COPD) patients and has an important role in disease prognosis and the use of health care services. There are no questionnaires in Spanish language that evaluate the impact of the disease in the activities of daily living in these patients. Our objective was to adapt and validate the Spanish versions of 2 standard questionnaires for assessment of physical activity: the London Chest Activity of Daily Living scale (LCADL) and the Modified Baecke Physical Activity Questionnaire (modified Baecke).

PATIENTS AND METHOD

After carrying out the translation and back-translation, the 2 questionnaires were administered to 55 patients with COPD (mean age [standard deviation]: 66 [8] years; forced expiratory volume in 1 s: 1.2 [0.5] l, 38 [15]%) in 2 occasions and a conventional exercise test was performed.

RESULTS

Cronbach's alpha coefficient was very high (0.98 and 0.97 for LCADL and modified Baecke, respectively; p < 0.0001 each). Intraclass correlation coefficients of the test re-test reliability was also very high (0.97 and 0.96, respectively). Mean values of the questionnaires in the 2 administrations were 20 (11) vs 19 (11) for LCADL (p = 0.26), and 15 (9) vs 14 (9) for modified Baecke (p = 0.51). The 2 questionnaires showed a significant correlation with quality of life (St. George's Respiratory Questionnaire), dyspnea score (Medical Research Council scale) and 6 min walk test.

CONCLUSIONS

The Spanish versions of these 2 questionnaires to assess physical activity are relibale and they display the expected association with health related quality of life, dyspnea score, and the 6 min walk test, confirming their validity. Therefore, we propose its use to complement the assessment of physical activity in those patients with COPD in whom direct measurements of this variable are not available.

Assessment of physical activity and energy expenditure in epidemiological research of chronic diseases

Physical inactivity has emerged as an important risk factor for a number of diseases, but the typically crude exposure assessments in epidemiological studies, with entailing variation in measurement accuracy, may be a source of heterogeneity contributing to inconsistent results among studies. Consequently, the choice of method for the assessment of physical activity in epidemiological studies is important. Good methods increase our chances of avoiding misclassification and may enhance our understanding of the association between physical activity and health. Since physical activity is also a potential confounder of other lifestyle-health relationships, good methods may enhance our ability to control for confounding. But despite a steadily increasing selection of methods to choose from, no method is suitable for every situation and every population. Although the questionnaire is the most widely used method in epidemiological studies, and laboratory methods are mainly used for validation purposes, improved technology may change our ways of assessing physical activity in the future. This paper describes different methods to measure physical activity and energy expenditure from the epidemiological perspective, and attempts to address the concepts related to the measurement of physical activity.

Validation of the Kaiser Physical Activity Survey in pregnant women

PURPOSE

Participation in physical activity during pregnancy may reduce the risk of maternal and fetal disorders. However, few studies have validated physical activity questionnaires for use during pregnancy, a time characterized by different patterns of activity than nonpregnancy. Therefore, the aim of this study was to assess the validity and reliability of the Kaiser Physical Activity Survey (KPAS) for use during pregnancy.

METHODS

The KPAS, adapted from the Baecke physical activity survey, was designed specifically to assess physical activity in women. Unique features of the KPAS include the assessment of multiple domains of physical activity (household/caregiving, occupational, active living, and sports/exercise) as well as total activity. Summary KPAS indices were compared with objective (ActiGraph accelerometer by ActiGraph LLC) and subjective (Pregnancy Physical Activity Questionnaire (PPAQ)) measures of physical activity. Participants completed the self-administered PPAQ followed by the interviewer-administered KPAS and then wore the accelerometer for the following 7 d. At the end of the 7-d period, the questionnaires were repeated.

RESULTS

Intraclass correlation coefficients used to measure reproducibility of the KPAS were r = 0.84 for total activity and ranged from r = 0.76 for active living activities to r = 0.86 for occupational activity. Spearman correlations between the KPAS and three published cut points used to classify accelerometer data ranged from r = 0.49-0.59 for total activity, r = 0.12-0.26 for household/caregiving, r = 0.26-0.33 for occupational activity, r = 0.31-0.36 for active living, and r = 0.34-0.51 for sports/exercise. Spearman correlations between the KPAS and the PPAQ ranged from r = 0.71 for household/caregiving to r = 0.84 for sports/exercise.

CONCLUSIONS

The KPAS is a reliable and reasonably accurate instrument for estimating physical activity among pregnant women.

Development and validation of a Pregnancy Physical Activity Questionnaire

PURPOSE

The effect of physical activity during pregnancy on maternal and fetal health remains controversial and studies have yet to identify the optimal dose of physical activity associated with favorable pregnancy outcomes. The aim of this study was to develop and validate a pregnancy physical activity questionnaire (PPAQ).

METHODS

To ascertain the type, duration, and frequency of physical activities performed by pregnant women, three 24-h physical activity recalls were administered to 235 ethnically diverse prenatal care patients at a large tertiary care facility in western Massachusetts. The relative contribution of each activity to between-person variance in energy expenditure was used to establish the list of activities for the PPAQ. The PPAQ is self-administered and asks respondents to report the time spent participating in 32 activities including household/caregiving, occupational, sports/exercise, transportation, and inactivity. To validate the PPAQ, 54 pregnant women completed the PPAQ and then wore a Manufacturing Technology, Inc. actigraph for the following 7 d. At the end of the 7-d period, the PPAQ was repeated.

RESULTS

Intraclass correlation coefficients used to measure reproducibility of the PPAQ were 0.78 for total activity, 0.82 for moderate activity, 0.81 for vigorous activity, and ranged from 0.83 for sports/exercise to 0.93 for occupational activity. Spearman correlations between the PPAQ and three published cut points used to classify actigraph data ranged from 0.08 to 0.43 for total activity, 0.25 to 0.34 for vigorous activity, 0.20 to 0.49 for moderate activity, and -0.08 to 0.22 for light-intensity activity. Correlations were higher for sports/exercise and occupational activities as compared to household/caregiving activities.

CONCLUSIONS

household/caregiving activities.

CONCLUSIONS

The PPAQ is a reliable instrument of physical activities during pregnancy.

A new accelerometric method to assess the daily walking practice

OBJECTIVE

To describe a method to obtain a profile of the duration and intensity (speed) of walking periods over 24 hours in women under free-living conditions.

DESIGN

A new method based on accelerometry was designed for analyzing walking activity. In order to take into account inter-individual variability of acceleration, an individual calibration process was used. Different experiments were performed to highlight the variability of acceleration vs walking speed relationship, to analyze the speed prediction accuracy of the method, and to test the assessment of walking distance and duration over 24-h.

SUBJECTS

Twenty-eight women were studied (mean+/-s.d.) age: 39.3+/-8.9 y; body mass: 79.7+/-11.1 kg; body height: 162.9+/-5.4 cm; and body mass index (BMI) 30.0+/-3.8 kg/m(2).

RESULTS

Accelerometer output was significantly correlated with speed during treadmill walking (r=0.95, P<0.01), and short unconstrained walks (r=0.86, P<0.01), although with a large inter-individual variation of the regression parameters. By using individual calibration, it was possible to predict walking speed on a standard urban circuit (predicted vs measured r=0.93, P<0.01, s.e.e.=0.51 km/h). In the free-living experiment, women spent on average 79.9+/-36.0 (range: 31.7-168.2) min/day in displacement activities, from which discontinuous short walking activities represented about 2/3 and continuous ones 1/3. Total walking distance averaged 2.1+/-1.2 (range: 0.4-4.7) km/day. It was performed at an average speed of 5.0+/-0.5 (range: 4.1-6.0) km/h.

CONCLUSION

An accelerometer measuring the anteroposterior acceleration of the body can estimate walking speed together with the pattern, intensity and duration of daily walking activity.

Development and validation of a questionnaire for the assessment of physical activity in epidemiological studies in Sub-Saharan Africa

OBJECTIVE

To develop and validate a questionnaire for measuring physical activity within Sub-Saharan Africa. Methods We designed the Sub-Saharan Africa Activity Questionnaire (SSAAQ), based upon existing questionnaires and an activity survey carried out in Cameroon. The questionnaire targeted past-year occupation, walking/cycling and leisure-time activities, and was administered by trained interviewers on two occasions, 10-15 days apart to 89 urban and rural consenting Cameroonians aged 19-68 years. Reliability was assessed by inter-interview comparison and repeatability coefficients (standard deviation of the test-retest difference). Validation was performed against a 24-hour heart rate monitoring and accelerometer recording.

RESULTS

The questionnaire was highly reproducible (rho = 0.95; P < 0.001). The inter-interview difference did not differ significantly from 0, with a repeatability coefficient of 0.46-1.46 hours. Total energy expenditure from the questionnaire was significantly correlated to heart rate monitoring (rho = 0.41-0.63; P < 0.05) and accelerometer measures (rho = 0.60-0.74; P < 0.01). Subject's self ranking of their activity did not match the questionnaire's quartiles of activity.

CONCLUSIONS

The present study presents the design and confirms the reliability and validity of SSAAQ in a rural and urban population of Cameroon and shows that subject's self ranking of activity might not accurately serve epidemiological purpose.

Relationships between physical activity, obesity and diabetes mellitus in a French elderly population: the POLA study. Pathologies Oculaires lieés á l' Age

OBJECTIVE

To analyse the relationships between body mass index, waist circumference, waist-to-hip ratio, physical activity and the risk of type 2 diabetes in a French elderly population.

DESIGN AND SUBJECTS

We conducted a cross-sectional study on 1113 men and 1419 women aged 60 y or more, participating in the POLA Study.

RESULTS

The prevalence of diabetes was two-fold higher in men than in women (19.1% and 9.3%, respectively). The anthropometric variables studied-body mass index (BMI), waist circumference (WC) and the waist/hip ratio (WHR)-were all positively related to the prevalence of type 2 diabetes. The strongest relationships were found for BMI in men and WHR in women. In both genders, sport activity and diabetes were inversely linked whereas no relationship was shown between the amount of household activity and diabetes mellitus.

CONCLUSION

In the elderly, overall obesity in men and abdominal fat accumulation in women appeared strongly related to diabetes. Sport activity was negatively and independently associated with the prevalence of diabetes mellitus.

Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease

BACKGROUND

Patients on dialysis are less physically active than sedentary persons with normal kidney function. To assess the consequences of inactivity and the results of efforts to increase activity in the end-stage renal disease (ESRD) population, valid instruments to measure physical activity and physical functioning in this group are needed.

METHODS

We performed a cross-sectional study to establish the validity in ESRD of several questionnaires designed to measure physical activity or physical functioning in the general population. Questionnaires studied included the Stanford 7-day Physical Activity Recall questionnaire (PAR), the Physical Activity Scale for the Elderly (PASE), the Human Activity Profile (HAP), and the Medical Outcomes Study Short Form 36-item questionnaire (SF-36). Physical activity was measured using three-dimensional activity monitors (accelerometers) over a seven-day period (the "gold standard"). Patients also underwent physical performance tests, including measurement of gait speed, stair climbing time, and chair rising time. Study questionnaires were administered, and questionnaire results were compared with each other and with activity monitor and physical performance test results.

RESULTS

Thirty-nine maintenance hemodialysis patients participated in the study. Dialysis patients scored worse than previously published healthy norms on all tests. All questionnaires correlated with seven-day accelerometry and with at least one measure of physical performance. The HAP correlated best with accelerometry (r = 0.78, P < 0.0001). Seventy-five percent of the variability in physical activity measured by accelerometry could be explained by a model that combined information from the HAP and the PASE. The HAP and the physical functioning scale of the SF-36 were about equally well correlated with physical performance measures.

CONCLUSIONS

These questionnaires are valid in patients on hemodialysis and should be used to study the physical activity and rehabilitation efforts in this population further.

Can accelerometry accurately predict the energy cost of uphill/downhill walking?

To evaluate whether an activity monitor based on body acceleration measurement can accurately assess the energy cost of the human locomotion, 12 subjects walked a combination of three different speeds (preferred speed +/- 1 km/h) and seven slopes (-15 to +15% by steps of 5%) on a treadmill. Body accelerations were recorded using a triaxial accelerometer attached to the low back. The mean of the integral of the vector magnitude (norm) of the accelerations (mIAN) was calculated. VO2 was measured using continuous indirect calorimetry. When the results were separately analysed for each incline, mIAN was correlated to VO2 (average r = 0.87, p<0.001, n = 36). VO2 was not significantly correlated to mIAN when data were globally analysed (n = 252). Large relative errors occurred when predicted VO2 (estimated from data of level walking) was compared with measured VO2 for different inclines (-53% at +15% incline, to +55% at -15% incline). It is concluded that without an external measurement of the slope, the standard method of analysis of body accelerations cannot accurately predict the energy cost of uphill or downhill walking.