Physical activity derived from questionnaires and wrist-worn accelerometers: comparability and the role of demographic, lifestyle, and health factors among a population-based sample of older adults

Clinical Epidemiology Dovepress open access to scientific and medical research ORIGINAL RESEARCH Clinical Epidemiology downloaded from https://www.dovepress.com/ by 213.32.59.121 on 12-Jul-2018 For personal use only. Open Access Full Text Article Physical activity derived from questionnaires and wrist-worn accelerometers: comparability and the role of demographic, lifestyle, and health factors among a population-based sample of older adults This article was published in the following Dove Press journal: Clinical Epidemiology Chantal M Koolhaas 1 Frank JA van Rooij 1 Magda Cepeda 1 Henning Tiemeier 1–3 Oscar H Franco 1 Josje D Schoufour 1 1 Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; 3Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands Background: Agreement between questionnaires and accelerometers to measure physical activity (PA) differs between studies and might be related to demographic, lifestyle, and health characteristics, including disability and depressive symptoms. Methods: We included 1,410 individuals aged 51–94 years from the population-based Rotterdam Study. Participants completed the LASA Physical Activity Questionnaire and wore a wrist-worn accelerometer on the nondominant wrist for 1 week thereafter. We compared the Spearman correlation and disagreement (level and direction) for total PA across levels of demographic, lifestyle, and health variables. The level of disagreement was defined as the absolute difference between questionnaire- and accelerometer-derived PA, whereas the direction of disagreement was defined as questionnaire PA minus accelerometer PA. We used linear regression analyses with the level and direction of disagreement as outcome, including all demographic, lifestyle, and health variables in the model. Results: We observed a Spearman correlation of 0.30 between questionnaire- and accelerometerderived PA in the total population. The level of disagreement (ie, absolute difference) was 941.9 (standard deviation [SD] 747.0) minutes/week, and the PA reported by questionnaire was on average 529.4 (SD 1,079.5) minutes/week lower than PA obtained by the accelerometer. The level of disagreement decreased with higher educational levels. Additionally, participants with obesity, higher disability scores, and more depressive symptoms underestimated their selfreported PA more than their healthier counterparts. Conclusion: We observed large differences in PA time derived from the LASA Physical Activity Questionnaire and the wrist-worn accelerometer. Differences between the methods were related to body-mass index, level of disability, and presence of depressive symptoms. Future studies using questionnaires and/or accelerometers should account for these differences. Keywords: physical activity, questionnaire, accelerometer, disagreement, elderly Introduction Correspondence: Chantal Koolhaas Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000 CA, The Netherlands Tel +31 10 704 3484 Fax +31 10 704 4657 Email 1 submit your manuscript | www.dovepress.com Clinical Epidemiology 2018:10 1–16 Dovepress © 2018 Koolhaas et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/CLEP.S147613 Powered by TCPDF (www.tcpdf.org) Physical activity (PA) is an important modifiable risk factor in the prevention of diseases, including cardiovascular disease, diabetes mellitus, and several types of cancer.1 For practical reasons, PA is often measured subjectively by questionnaire.2 However, selfreported PA can suffer from reporting bias, partially attributable to the cognitive challenge of estimating the frequency, intensity, and duration of PA.3 Moreover, activities of light intensity are hard to recall and might not be reported.4,5 Objective methods, including accelerometers, offer a solution to these problems and can give objective estimates Clinical Epidemiology downloaded from https://www.dovepress.com/ by 213.32.59.121 on 12-Jul-2018 For personal use only. Koolhaas et al on duration and intensity of PA. Therefore, accelerometers are increasingly being used in current research.2,6 However, when comparing questionnaire data with objective methods applied in large populations, major discrepancies emerge.7,8 The inconsistency might be related to recall bias, which can be influenced by population characteristics, such as age, sex, and health status.2,9 In addition, the inconsistency might stem from the fact that accelerometers cannot measure all PA accurately.10,11 For example, weightlifting and cycling are generally underestimated by accelerometers worn on the upper body.12 Considering the increased use of accelerometers in current research,2,6 it is important to understand and quantify how PA assessed with questionnaires and accelerometers differs and how these differences relate to population characteristics.13 Previous studies have shown that the correlation between self-reported and objectively measured PA differs by age, sex, ethnicity, socioeconomic status, and level of PA.8,9 However, results presented referred to correlation coefficients, which are a measure of the extent to which two variables are linearly related, but do not take into account their measurement scales. As such, these studies did not provide information regarding the level of agreement and direction of disagreement of the two methods.14 A study that accounted for the direction of disagreement between objective and subjective measured PA in young adults suggested that overweight adults had a tendency to overestimate the time spent in vigorous PA more than normal-weight individuals.15 Information from older adults, a population with different PA patterns than younger adults,16 is currently lacking. Moreover, the effect of socioeconomic status and mental and physical health on the agreement between accelerometer and questionnaire remains unclear. Therefore, we aimed to quantify the level and direction of disagreement between questionnaire-assessed PA and accelerometerassessed PA and to investigate if differences in agreement are explained by sociodemographic, lifestyle, and health factors. Subjects and methods Study population This paper utilizes data from the Rotterdam Study, a population-based cohort (...truncated)