Validation of two short questionnaires assessing physical activity in colorectal cancer patients

Henriksen et al. BMC Sports Science, Medicine and Rehabilitation (2018) 10:8 https://doi.org/10.1186/s13102-018-0096-2 RESEARCH ARTICLE Open Access Validation of two short questionnaires assessing physical activity in colorectal cancer patients Hege Berg Henriksen1, Sveinung Berntsen2, Ingvild Paur1,3, Manuela Zucknick4, Anne Juul Skjetne1,5, Siv Kjølsrud Bøhn1, Christine Henriksen1, Sigbjørn Smeland5,6, Monica Hauger Carlsen1 and Rune Blomhoff1,5* Abstract Background: In order to investigate the impact of adherence to recommendations of physical activity and sedentary time on health outcomes in clinical trials, there is a need for feasible tools such as questionnaires that can give representative estimates of these measures. The primary aim of the present study was to validate two such questionnaires and their ability to estimate adherence to the recommendations of physical activity defined as moderate-to- vigorous physical activity or moderate physical activity of at least 150 min/week in colorectal cancer patients. Secondarily, self-reported sedentary time from the HUNT-PAQ was also evaluated. Methods: Participants from 'The Norwegian dietary guidelines and colorectal cancer survival-study’ (CRC-NORDIET study) completed two short questionnaires; the NORDIET-FFQ (n = 78) and the HUNT-PAQ (n = 77). The physical activity monitor SenseWear Armband Mini was used as the reference method during seven consecutive days. Results: The NORDIET-FFQ provided better estimates of time in moderate-to- vigorous physical activity and moderate physical activity than the HUNT-PAQ. The NORDIET-FFQ was unable to rank individual time in moderateto- vigorous physical activity and moderate physical activity (Spearman’s rho = 0.08, p = 0.509 and Spearman’s rho rho = 0.01, p = 0.402, respectively). All intensities were under-reported by the HUNT-PAQ, but ranking of individual time in moderate physical activity and sedentary time were acceptable among women only (Spearman’s rho = 0.37, p = 0.027 and Spearman’s rho = 0.36, p = 0.035, respectively). The HUNT-PAQ correctly classified 71% of those not meeting the recommendations (sensitivity), and the NORDIET-FFQ correctly classified 63% of those who met the recommendations (specificity). About 67% and 33% reported to meet the recommendation of moderate-to- vigorous physical activity with the NORDIET-FFQ and HUNT-PAQ, respectively, whereas 55% actually met the moderate-tovigorous physical activity according to the SenseWear Armband Mini. Conclusions: The NORDIET-FFQ provided better specificity and better estimates of PA than the HUNT-PAQ. The HUNTPAQ provided better sensitivity, and provided better ranking of PA and sedentary time among women than NORDIETFFQ. It is important to be aware of the limitations documented in the present study. Trial registration: The study is registered on the National Institutes of Health Clinical Trials (Identifier: NCT01570010). Registered 4 April 2012. Keywords: Short questionnaire, Physical activity, Sedentary time, SenseWear armband mini, Physical activity recommendations * Correspondence: 1 Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway 5 Department for Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Henriksen et al. BMC Sports Science, Medicine and Rehabilitation (2018) 10:8 Background The preventive effect of physical activity (PA) on risk of colorectal cancer is well-established [1–3]. However, an increasing number of studies also examine beneficial effects of PA during cancer treatment as well as in the posttreatment period [4–16], such as decreased all-cause mortality, increased disease-free survival, improved physical function and quality of life [5, 6, 11–13, 17, 18]. Moreover, reduced sedentary time, such as sitting during daytime, may be associated with reduced mortality and lower risk of recurrence in cancer patients [19–22]. The recommendations of PA for cancer patients and survivors provided by the American Cancer Society [23] emphasize that exercise is safe and feasible during cancer treatment, and improves outcomes such as physical function, fatigue and completion of chemotherapy [23]. The American Cancer Society, the World Health Organization and others [24–27] recommend at least 150 min of moderate intensity PA (MPA) or 75 min of vigorous intensity PA (VPA) per week or an equivalent combination. In 2011, the Norwegian Directorate of Health published the Norwegian Food-Based Dietary Guidelines (FBDG) which also includes similar recommendations on PA as well as for sedentary time [3]. In Norway, colorectal cancer (CRC) is the third most common cancer type, and the incidence is among the highest in Europe [28]. Implementing the recommendations of PA and incorporating specific exercises in the clinical care may improve the health outcomes of CRC patients [1–3, 24]. In order to estimate adherence to PA recommendations according to the Norwegian FBDG in a Norwegian CRC population, a valid and accurate physical assessment tool is needed. Importantly, assessment of adherence to the PA recommendations is required in counselling and when evaluating effectiveness of intervention studies. The use of objective monitors to record PA has increased during recent decades and gives valid and reliable data on intensity of PA and energy expenditure [29]. However, these activity monitors are expensive and time consuming for the clinician and researcher, particularly when recording PA in larger populations. Therefore, less expensive and easier methods are required to measure adherence to PA recommendations. The most common self-reporting method to assess PA is the use of questionnaires [30, 31]. Over the past 2 or 3 decades, more than 30 PA questionnaires have been developed and validated [32]. Long questionnaires are challenging to complete for cancer patients often experiencing treatment and disease related side-effects such as fatigue and functional decline [33–36]. Questionnaires which contains few and well-defined questions regarding the different intensities of PA may be more suitable for this group of patients [37]. Page 2 of 12 Although many previous questionnaires have been successfully used to assess PA, there is no questionnaire specifically desi (...truncated)