Maria Hagströmer

The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity

INTRODUCTION The International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The short version of the IPAQ has been tested extensively and is now used in many international studies. The present study aimed to explore the validity characteristics of the long-version IPAQ. SUBJECTS AND METHODS Forty-six voluntary healthy male and female subjects (age, mean +/- standard deviation: 40.7 +/- 10.3 years) participated in the study. PA indicators derived from the long, self-administered IPAQ were compared with data from an activity monitor and a PA log book for concurrent validity, and with aerobic fitness, body mass index (BMI) and percentage body fat for construct validity. RESULTS Strong positive relationships were observed between the activity monitor data and the IPAQ data for total PA (rho = 0.55, P < 0.001) and vigorous PA (rho = 0.71, P < 0.001), but a weaker relationship for moderate PA (rho = 0.21, P = 0.051). Calculated MET-h day(-1) from the PA log book was significantly correlated with MET-h day(-1) from the IPAQ (rho = 0.67, P < 0.001). A weak correlation was observed between IPAQ data for total PA and both aerobic fitness (rho = 0.21, P = 0.051) and BMI (rho = 0.25, P = 0.009). No significant correlation was observed between percentage body fat and IPAQ variables. Bland-Altman analysis suggested that the inability of activity monitors to detect certain types of activities might introduce a source of error in criterion validation studies. CONCLUSIONS The long, self-administered IPAQ questionnaire has acceptable validity when assessing levels and patterns of PA in healthy adults.

BEST PRACTICES FOR USING PHYSICAL ACTIVITY MONITORS IN POPULATION-BASED RESEARCH

The use of physical activity monitors in population-based research has increased dramatically in the past decade. In this report, we review the major purpose for using physical activity monitors in different types of population-based studies (i.e., surveillance, intervention, association studies) and discuss the strengths and weaknesses for the various behavioral outcomes derived from monitors for each study type. We also update and extend previous recommendations for use of these instruments in large-scale studies, particularly with respect to selecting monitor systems in the context of technological advances that have occurred in recent years. The current state of the science with respect to optimal measurement schedules for use of physical activity monitors is also discussed. A checklist and flowchart are provided so that investigators have more guidance when reporting key elements of monitor use in their studies.

Health-enhancing physical activity across European Union countries: the Eurobarometer study

The World Health Organisation (WHO) recommends the development of comparable national physical activity surveillance systems to assess trends within and amongst countries as the Global Strategy for Diet and Physical Activity is implemented. To date, the lack of well-standardised measurement instruments has impeded such efforts, but new methodologies are being developed for this purpose. This paper describes the usefulness of the International Physical Activity Questionnaire (IPAQ) in population samples. The Special Eurobarometer Wave 58.2 2002 covered physical activity and provided a good vehicle for assessment of health-enhancing physical activity (HEPA) in the European Union. Data from around 1,000 individuals in each of the 15 member states were collected after careful translation of the questionnaire. IPAQ scoring protocol version 2 was used for definition of activity categories. Data on the prevalence of sufficient total activity, sedentariness, frequent walking and sitting, in total and by gender across European Union (EU) countries showed consistent patterns. The prevalence of sufficient physical activity for health across the member countries was 29%. It ranged from 44% in the Netherlands to 23% in Sweden. The prevalence of sedentariness across countries was in general the mirror image. Regular walking was most prevalent in Spain. Gender was related to physical activity in that men were 1.6 times more likely than women to be sufficiently active, less likely to be sedentary and slightly more likely to sit for at least 6 hours daily. The findings suggest that two thirds of the adult populations of the European countries are insufficiently active for optimal health benefits. As the IPAQ measurement provides information about the patterns of total physical activity and inactivity, the findings indicate possibilities for targeted health promotion efforts.

Levels and Patterns of Objectively Assessed Physical Activity—A Comparison Between Sweden and the United States

This study compares levels and patterns of objectively assessed physical activity in Sweden and the United States by using identical accelerometer metrics. Data of adult respondents with > or =4 days with > or =10 hours per day of accelerometer wear from Sweden (2001-2002, n = 1,172) and the United States (2003-2004, n = 2,925) were compared. Outcomes reported by age and body mass index within sex include accelerometer counts per minute and amounts and bouts of activity at different intensities, that is, sedentary, low, lifestyle, and moderate or higher intensity physical activity. The mean counts per minute were 375 (95% confidence interval (CI): 360, 390) and 377 (95% CI: 363, 391) for Swedish and US males, respectively, and 363 (95% CI: 347, 379) and 298 (95% CI: 289, 307) for Swedish and US females. Older respondents and those with higher body mass index had lower activity levels. Swedish and US males spent 36 (95% CI: 34, 38) and 33 (95% CI: 31, 36) minutes per day, and Swedish and US females spent 32 (95% CI: 29, 34) and 19 (95% CI: 17, 21) minutes per day in moderate or higher intensity physical activity. Older Swedes were more active in moderate or higher intensity activities than were older US respondents. However, younger Swedish males had more sedentary behavior time than did younger US males. These results provide a framework for international comparisons of physical activity levels and patterns, and they represent strong evidence for the importance of investment in objective measurement of physical activity.

Concurrent validity of a modified version of the International Physical Activity Questionnaire (IPAQ-A) in European adolescents: The HELENA Study.

Introduction:The International Physical Activity Questionnaire (IPAQ) was developed to measure health-enhancing physical activity in adult populations. This study explores the concurrent validity of a modified version of the long IPAQ (the IPAQ-A) for the assessment of physical activity among adolescents.Participants and methods:In total, 248 healthy adolescents, divided into one older and one younger age group (aged 15–17 years (N=188) and 12–14 years (N=60), respectively) from nine Healthy Lifestyle by Nutrition in Adolescence (HELENA) Study centres across Europe, voluntarily participated in the study. Data on total physical activity, as well as activities in different intensities derived from the IPAQ-A, were compared using Spearmans correlation coefficient and Bland–Altman analysis, with data from an accelerometer. Tertiles of total physical activity for the IPAQ-A and the accelerometer were compared using Kendalls tau-b.Results:For the older age group, significant correlations between the instruments were found for time spent walking, for moderate and vigorous activities as well as for total physical activity (Rs=0.17–0.30, P<0.05). No significant correlations were found for any of the variables studied in the younger age group. Kendalls tau-b showed low but significant correlations for tertiles of total physical activity (P<0.001).Conclusions:The IPAQ-A has reasonable validity properties for assessing activities in different intensities and for total physical activity in healthy European adolescents aged 15–17 years. For adolescents aged 14 years and younger, the correlations were unsatisfactorily low and objective methodology, such as accelerometry, may be the appropriate alternative.

Patterns in sedentary and exercise behaviors and associations with overweight in 9–14-year-old boys and girls - a cross-sectional study.

BackgroundBefore starting interventions addressing energy-balance related behaviors, knowledge is needed about the prevalence of sedentary behaviors and low physical exercise, their interrelationships, possible gender differences. Therefore this study aimed to describe gender differences in sedentary and physical exercise behaviors and their association with overweight status in children from nine European countries. Additionally, to identify clusters of children sharing the same pattern regarding sedentary and physical exercise behavior and compare these groups regarding overweight status.MethodsCross-sectional study among 11-year-old children in nine countries (n = 12538). Self-administered questionnaires assessed the time spent on TV viewing during dinner and during the day, PC use and on physical exercise. The parents reported childrens weight and height. Descriptive statistics, cluster analyses, and logistic regression analyses were used for data analyses.ResultsBoys spent more time on sedentary behaviors but also more on physical exercise than girls. High TV viewing and low exercise behavior independently increased the risk of being overweight. Based on the behaviors, five clusters were identified. Among boys, clear associations with being overweight were found, with the most unhealthy behavior pattern having the highest risks of being overweight. Among girls, high TV viewers and high PC users had increased risk of being overweight. In girls sedentary behaviors seemed more important than physical exercise with regard to overweight status.ConclusionDespite selective non-response on BMI and reliance on self-reports, the associations between clusters and overweight in boys were clear, and differences between boys and girls regarding the behaviors and risks for overweight are noteworthy. These differences need to be considered when developing tailored intervention strategies for prevention of overweight.

Adherence to physical activity recommendations and the influence of socio-demographic correlates - a population-based cross-sectional study.

BackgroundCurrent physical activity guidelines acknowledge the importance of total health enhancing physical activity (HEPA) compared to leisure time physical activity or exercise alone. Assessing total HEPA may result in different levels of adherence to these as well as the strength and/or direction of associations observed between total HEPA and socio-demographic correlates. The aim of this study was to estimate the proportion of the population adhering to the recommendation of at least 30 minutes of HEPA on most days, and to examine the influences of socio-demographic correlates on reaching this recommendation.MethodsSwedish adults aged 18–74 years (n = 1470) were categorized, based on population data obtained using the IPAQ, into low, moderately and highly physically active categories. Independent associations between the physical activity categories and socio-demographic correlates were studied using a multinomial logistic regression.ResultsOf the subjects, 63% (95% CI: 60.5–65.4) adhered to the HEPA recommendation. Most likely to reach the highly physical active category were those aged < 35 years (OR = 1.8; 95% CI: 1.1–3.3), living in small towns (OR = 1.8; 95% CI: 1.1–2.7) and villages (OR = 2.4; 95% CI: 1.6–3.7), having a BMI between 25.0–29.9 kg/m2 (OR = 2.7; 95% CI: 1.4–5.3) having a BMI < 25 kg/m2 (OR = 2.5; 95% CI: 1.3–4.9), or having very good (OR = 2.1; 95% CI: 1.3–3.3) or excellent self-perceived health (OR = 4.1; 95% CI: 2.4–6.8). Less likely to reach the high category were women (OR = 0.6; 95% CI: 0.5–0.9) and those with a university degree (OR = 0.5; 95% CI: 0.3–0.9). Similar, but less pronounced associations were observed for the moderate group. Gender-specific patterns were also observed.ConclusionAlmost two-thirds of the Swedish adult population adhered to the physical activity recommendation. Due to a large diversity in levels of physical activity among population subgroups, social-ecological approaches to physical activity promotion may be warranted.

Validity of self-reported total physical activity questionnaire among older women

Aim of this study was to assess the validity of a short self-administered physical activity questionnaire, intended to measure past year total daily physical activity, by comparison with activity records and accelerometers. Over a 1-year period, data from a questionnaire, 7-day activity records and accelerometers were obtained from a subset of 116 women between the ages of 56 and 75 years from the population-based Swedish Mammography Cohort. We estimated concordance correlations as measure of validity, deattenuated for intraindividual variation in the reference method. Deattenuated concordance correlations comparing total daily activity measured by the questionnaire with the accelerometers and the records were 0.38 (95% CI: 0.22–0.54) and 0.64 (95% CI: 0.45–0.83), respectively. Validity of leisure-time activity (walking/bicycling and exercise) and inactivity (watching TV/reading) estimates comparing the records with the questionnaire were 0.42 (95% CI: 0.22–0.62) and 0.52 (95% CI: 0.36–0.69), respectively. These data indicate that the average past year total physical activity, leisure-time activity and inactivity can be estimated with a reasonable validity using our short self-administered questionnaire.

The International Physical Activity Questionnaire modified for the elderly: aspects of validity and feasibility.

OBJECTIVE To modify the self-administered, short version of the International Physical Activity Questionnaire (IPAQ) for adults to be used in the elderly (aged 65 years and above), and to validate this modified IPAQ for the elderly (IPAQ-E). DESIGN A direct validity study using accelerometer-measured physical activity (PA) as the criterion measure, and an indirect criterion validity study using high-sensitivity C-reactive protein (hs-CRP) as a biological marker of activity. SETTING Organisations for retired persons in Sweden. SUBJECTS The direct validity study consisted of fifty-four participants and the indirect criterion validity study consisted of 359 participants. All participants were retired persons (66-91 years) living independently. RESULTS All self-reported activity domains (sitting, walking, moderate and vigorous) were positively correlated with the corresponding variable objectively assessed by an accelerometer (ρ = 0·277-0·471), but a systematic error was observed. The specificity of IPAQ-E to identify low-active participants was 85 %, and the sensitivity to identify the more active participants was 81 %. A main effect of IPAQ-E category (Low, Moderate or High) was observed for hs-CRP (P = 0·041). CONCLUSIONS We found this modified version of IPAQ, the IPAQ-E, to be well accepted by our sample of socially active elderly. It provided acceptable estimates of PA, well in line with other questionnaires, even though it had a systematic error. The IPAQ-E was able to identify an expected response of a biomarker (hs-CRP) to PA. We recommend the use of the IPAQ-E to classify participants aged 65 years and above into PA categories, to rank individuals or to identify individuals meeting certain PA criteria.

Comparison of the IPAQ-A and Actigraph in relation to VO2max among European adolescents: The HELENA study

The purpose was to compare data obtained from a modified, long, self-administered version of the International Physical Activity Questionnaire (IPAQ-A) with objective data obtained in parallel from Actigraph accelerometers, and VO(2)max in adolescents. The study comprised a total of 2018 adolescents (46% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity was assessed over seven consecutive days by accelerometry and expressed as min/day of moderate, vigorous, and moderate to vigorous (MVPA) physical activity (PA). PA was also assessed with the IPAQ-A. VO(2)max was estimated from a 20-m shuttle run test. Poor to fair correlations between the two methodologies were found for the whole study sample and when stratified by age and gender (r(s) = 0.08-0.26, p < 0.01). On average, the self-reported time spent in moderate PA was higher compared to the time measured with the accelerometer, while the differences between both instruments were less clear for vigorous intensity. Adolescents reporting high levels of PA (3rd tertile IPAQ-A) also showed higher levels of PA (accelerometers) in all the study variables (moderate, vigorous and MVPA), compared to adolescents reporting low PA (1st tertile IPAQ-A) (all p < 0.001). Both methods were moderately correlated with estimated VO(2)max. Within the HELENA-study, the IPAQ-A showed the modest comparability with the accelerometer data for assessing PA in each intensity level and was the highest for vigorous intensity. Both instruments are able to detect the adolescents with the highest cardio respiratory fitness, which are the most active adolescents.