Validity of a short questionnaire to assess physical activity in 10 European countries

European Journal of Epidemiology, Jan 2012

To accurately examine associations of physical activity (PA) with disease outcomes, a valid method of assessing free-living activity is required. We examined the validity of a brief PA questionnaire (PAQ) used in the European Prospective Investigation into Cancer and Nutrition (EPIC). PA energy expenditure (PAEE) and time spent in moderate and vigorous physical activity (MVPA) was measured in 1,941 healthy individuals from 10 European countries using individually-calibrated combined heart-rate and movement sensing. Participants also completed the short EPIC-PAQ, which refers to past year’s activity. Pearson (r) and Spearman (σ) correlation coefficients were calculated for each country, and random effects meta-analysis was used to calculate the combined correlation across countries to estimate the validity of two previously- and one newly-derived ordered, categorical PA indices (“Cambridge index”, “total PA index”, and “recreational index”) that categorized individuals as inactive, moderately inactive, moderately active, or active. The strongest associations with PAEE and MVPA were observed for the Cambridge index (r = 0.33 and r = 0.25, respectively). No significant heterogeneity by country was observed for this index (I2 = 36.3%, P = 0.12; I2 = 0.0%, P = 0.85), whereas heterogeneity was suggested for other indices (I2 > 48%, P < 0.05, I2 > 47%, P < 0.05). PAEE increased linearly across self-reported PA categories (P for trend <0.001), with an average difference of approximately 460 kJ/d for men and 365 kJ/d for women, between categories of the Cambridge index. The EPIC-PAQ is suitable for categorizing European men and women into four distinct categories of overall physical activity. The difference in PAEE between categories may be useful when estimating effect sizes from observational research.

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Validity of a short questionnaire to assess physical activity in 10 European countries

The InterAct Consortium 0 1 2 0 The InterAct Consortium (&) Cambridge , UK 1 InterAct project was coordinated by the Medical Research Council Epidemiology Unit , Cambridge , UK 2 The members of the InterAct consortium is given in Appendix To accurately examine associations of physical activity (PA) with disease outcomes, a valid method of assessing free-living activity is required. We examined the validity of a brief PA questionnaire (PAQ) used in the European Prospective Investigation into Cancer and Nutrition (EPIC). PA energy expenditure (PAEE) and time spent in moderate and vigorous physical activity (MVPA) was measured in 1,941 healthy individuals from 10 European countries using individually-calibrated combined heart-rate and movement sensing. Participants also completed the short EPIC-PAQ, which refers to past year's activity. Pearson (r) and Spearman (r) correlation coefficients were calculated for each country, and random effects meta-analysis was used to calculate the combined correlation across countries to estimate the validity of two previously- and one newly-derived ordered, categorical PA indices (''Cambridge index'', ''total PA index'', and ''recreational index'') that categorized individuals as inactive, moderately inactive, moderately active, or active. The strongest associations with PAEE and MVPA were observed for the Cambridge index (r = 0.33 and r = 0.25, respectively). No significant heterogeneity by country was observed for this index (I2 = 36.3%, P = 0.12; I2 = 0.0%, P = 0.85), whereas heterogeneity was suggested for other indices (I2 [ 48%, P \ 0.05, I2 [ 47%, P \ 0.05). PAEE increased linearly across self-reported PA categories (P for trend 0.001), with an average difference of approximately 460 kJ/d for men and 365 kJ/d for women, between categories of the Cambridge index. The EPIC-PAQ is suitable for categorizing European men and women into four distinct categories of overall physical activity. The difference in PAEE between categories may be useful when estimating effect sizes from observational research. - Physical inactivity is a major risk factor for mortality and for several chronic diseases, including type 2 diabetes [1]. Large cohort studies are required to examine the etiology of chronic disease outcomes among healthy individuals, and in large, multi-site prospective studies of physical activity in relation to chronic disease, self-report methods such as physical activity questionnaires (PAQs) are currently the most feasible method for assessing physical activity. PAQs are commonly used for practical reasons such as limiting cost and reducing participant and researcher burden, and PAQs have been used for several purposes, including international surveillance (e.g., the International Physical Activity Questionnaire [IPAQ] [2]), risk stratification (e.g., the EPIC Physical Activity Questionnaire [EPIC-PAQ] [3]), and etiologic investigation (e.g. the short European Prospective Investigation into Cancer and Nutrition [EPIC]-Norfolk Physical Activity Questionnaire [EPAQ2] [4]). However, PAQs may misclassify an individuals physical activity level due to deliberate misreporting or cognitive limitations related to recall or comprehension [5, 6]. Therefore, it is necessary to examine the validity of any self-report instrument using independent criterion methods in a population representative of that in which it is used for answering epidemiological questions. The EPIC study was designed to investigate the relationship of nutrition and cancer in over 500,000 individuals from 10 European countries [7]. At enrolment (19922000), study participants completed questionnaires assessing diet and lifestyle factors, including physical activity. Specifically, physical activity was assessed by a brief questionnaire (the short EPIC-PAQ) interrogating occupational, household, and recreational activities during the past year [8]. An initial evaluation of the validity of questions selected from a more extensive questionnaire used in a pilot study of the EPIC protocol that resembled questions interrogated by the short EPIC-PAQ was performed in the Netherlands [9]. The authors assessed the validity and reliability of these representative questions against physical activity reported on 3-day diaries and determined that although the absolute validity and reliability of the questions for estimating physical activity energy expenditure (PAEE) was poor, the questionnaire would be suitable for ranking physical activity levels. Accordingly, two indices for categorizing physical activity levels have been derived from the short EPICPAQ, the Cambridge index [3] and the total physical activity index [10]. The validity of these indices for categorizing individuals physical activity levels has not yet been assessed in the EPIC cohort. Therefore, the aim of this study was to evaluate the validity of these indices for ranking physical activity among adults from the 10 countries participating in the EPIC-Eu (...truncated)


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The InterAct Consortium. Validity of a short questionnaire to assess physical activity in 10 European countries, European Journal of Epidemiology, 2012, pp. 15-25, Volume 27, Issue 1, DOI: 10.1007/s10654-011-9625-y