Open Access Research Systematic review of the measurement

Systematic review of the measurementproperties of self-report physicalactivity questionnaires in healthyadult populations

Zoë Silsbury,1,2 Robert Goldsmith,1,3 Alison Rushton2

To cite: Silsbury Z,Goldsmith R, Rushton A.Systematic review of themeasurement properties ofself-report physical activityquestionnaires in healthyadult populations. BMJ Open2015;5:e008430.doi:10.1136/bmjopen-2015-008430

▸ Prepublication historyand additional material isavailable. To view please visitthe journal (http://dx.doi.org/10.1136/bmjopen-2015-008430).

Received 17 April 2015Revised 22 July 2015Accepted 13 August 2015

1Physiotherapy Department,University Hospital of Wales,Cardiff, UK2School of Sport, Exerciseand Rehabilitation Sciences,College of Life andEnvironmental Sciences,University of Birmingham,Birmingham, UK3School of Physiotherapy,Cardiff University, Cardiff, UK

Correspondence toZoë Silsbury;[email protected]

ABSTRACTObjective: This systematic review evaluated themeasurement properties of current self-report physicalactivity questionnaires (SRPAQs) completed withinhealthy adult populations.Design: Two reviewers independently searched sevenelectronic databases and hand searched for articlesinvestigating measurement properties of a SRPAQevaluating physical activity over the previous 6 months.Articles published from 1 May 2001 to 4 December2014 were systematically screened and eligible studieswere not limited to English language sources. Articlesinvestigating specific race, gender or socioeconomicpopulations were excluded.Results: 10 studies investigating 10 SRPAQs wereincluded. The methodological quality of the includedstudies was evaluated using COnsensus-based Standardsfor the selection of health Measurement INstruments(COSMIN) and ranged from ‘poor’ to ‘good’. The RecentPhysical Activity Questionnaire, International PhysicalActivity Questionnaires and Physical Activity AssessmentTool demonstrated good/excellent test–retest reliability(intra-class coefficient (ICC)=0.76, p<0.0001; r=0.627–0.91; r=0.618, p<0.001, respectively), but variablecriterion validity (r=0.67, p<0.0001; r=−0.02–0.43;r=0.392, p<0.01, respectively). The single-item measureshowed significant criterion validity against anaccelerometer (for moderate to vigorous physical activity(MVPA) k=0.23, 95% CI 0.05 to 0.41; and physicalactivity ≥10 min bouts 0.39 (95% CI 0.14 to 0.64).Construct validity of the six-point scale and HumanActivity Profile varied significantly with age, marital statusand presence of comorbidities (p<0.05, <0.01, <0.000and p<0.05, <0.05, <0.000, respectively). The 1 weekGodlin-Shephard recall demonstrated ‘moderate’ validitywith the gold standard measure of accelerometry (r=0.43).Conclusions: Inconclusive evidence exists. Furtherinvestigation of criterion validity of the short-formInternational Physical Activity Questionnaire is required,as it demonstrated excellent test–retest reliability.PROSPERO number: CRD42012002484.

INTRODUCTIONPhysical activity (PA) prevents chronic dis-eases, independent of ethnicity, income,

education and body morphology.1 The WHOestimated that, in 2008, 31% of the globalhealthy adult population failed to achievethe recommended 150 min of moderate-intensity aerobic PA, or 75 min of vigorousintensity PA, a week.2 This has beendescribed as the greatest public healthproblem of the 21st century.3 PA encom-passes ‘any bodily movement produced bycontraction of skeletal muscle resultingin energy expenditure above basal level’.4

Strengths and limitations of this study

▪ The ambiguity of common terminology may haveaffected the electronic database search for thissystematic review, possibly contributing to omis-sions in the included studies.

▪ This review searched for articles, reported in anylanguage, investigating the English languageversion of a self-report physical activity question-naire (SPARQ). In one study, this led to theexclusion of a subset of the overall sample thatinvestigated the non-English version(s) of theSRPAQ. This may have diminished the overallconfidence in this study’s findings.

▪ Studies investigating use of SRPAQs on healthysubjects were used, which reduces the inferenceof the conclusions on those suffering fromcomorbidities or populations with disease.

▪ The focus of the systematic review was all meas-urement properties of SRPAQs; however, the eli-gible studies only investigated the properties oftest–retest reliability, internal consistency, criter-ion, construct and structural validity.

▪ The COnsensus-based Standards for the selec-tion of health Measurement INstruments(COSMIN) methodological quality analysis wasself-taught by both the reviewers, using thehandbook and articles explaining its use. Thismay have affected the ranking outcome for theincluded articles; however, as it was completedindependently, this reduced the risk of error andbias.

Silsbury Z, et al. BMJ Open 2015;5:e008430. doi:10.1136/bmjopen-2015-008430 1

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A recent systematic review5 described a positive associ-ation between PA and physical as well as psychologicalhealth; however, heterogeneity of study designs reducesconfidence in these findings. This was supported by asystematic review evaluating the use of PA in managingthe pathogenesis, physical strength and fitness, quality oflife and symptoms of patients with chronic disease.6 Thereview found strong evidence for effectiveness within car-diovascular disease, type 2 diabetes and obesity; andstrong evidence for improved symptom managementand quality of life for patients with cancer, osteoarthritis,osteoporosis, fibromyalgia and depression. The evidencesupporting the role of PA in the prevention and man-agement of chronic disease assists advancement of thepublic health research agenda,7 thus improving qualityof life and healthcare cost-effectiveness.8 Research inves-tigating PA in healthy participants is therefore valuableto inform prevention of chronic disease.The International Classification of Functioning,

Disability, and Health (ICF)9 considers the individual’sPA level and participation alongside external factors (eg,environment) for disease management. The integrationof the biopsychosocial model and the ICF into physio-therapy practice has enabled a focus on physical abilityand graded return to function rather than pain.Healthcare professionals commonly see patients for painrelief prior to the development of chronic disease andare best placed to address issues surrounding riskfactors, including lack of PA. Therefore, the demand onphysiotherapists to accurately evaluate PA for healthstatus and treatment efficacy is increasing.Physiotherapists use a wide range of outcome measuresto inform and evaluate their clinical practice, but selec-tion of the most appropriate measure is challenging.10

PA outcome measures assess the actual or perceivedability of an individual to carry out a variety of daily tasksand recreational or competitive sport.11 However, themultidimensional and individual-specific nature of PAhas resulted in a diverse range of outcome measures,contributing to a lack of consensus from clinicians/researchers regarding the best measure.Patient-reported PA outcome measures are relatively

inexpensive and easy to administer. It is acknowledgedthat self-report PA questionnaires (SRPAQs) comprise adetailed assessment to allow the detection of clinicallyrelevant change in diverse populations.12 However, dueto the breadth of the activity dimensions analysed, it isargued that SRPAQs may lead to misclassification.12 Theadvancement of real-time data acquisition fromperformance-based outcome measures including accel-erometers, and the doubly labelled water (DLW) tech-nique, are now considered the most accurate methodsfor determining energy expenditure; as PA is defined asenergy expended above the metabolic rate, thesemethods are considered the gold standard for assessingPA. However, as the DLW technique cannot predict pat-terns or type of activity performed, and accelerometersare not able to provide information on swimming,

step/inclined activity, or strength training, there is a riskof under-estimating the energy expended in these activ-ities.13 Furthermore, performance-based outcome mea-sures tend to use expensive equipment and require dataanalysis from trained professionals, which is generallybeyond the scope of departments interested in evaluat-ing PA. Therefore, real-time data acquisition is used incombination with SRPAQs that consider the multidimen-sional nature of the activity completed.13 This informsthe development of government guidelines.Limited resources for implementing performance-

based outcome measures reinforce the need to identifythe best SRPAQ for clinical practice and research, asthey are the most practical and economical outcomemeasures for heterogeneous populations.14 It is import-ant that the measurement properties of SRPAQs areevaluated to reduce the risk of data misinterpretationand bias.15 An International Delphi study of experts for-mulated the COnsensus-based Standards for the selec-tion of health Measurement INstruments (COSMIN),defining the essential properties of outcome measuresas: reliability, measurement error, validity, responsivenessand interpretability.16

One systematic review11 has evaluated the measure-ment properties of SRPAQs in patients aged 18–55 years.The authors incorporated all SRPAQs regardless oftime frame, administration type and whether the partici-pants were already experiencing chronic disease.Heterogeneity and ambiguity in terminology may havecontributed to their diverse data, making synthesis diffi-cult; and hence identification of the best SRPAQ was notpossible. Therefore, further study utilising a more homo-genous population was advocated; results of which mayallow for focused data analysis and synthesis, enablingconclusions to be drawn.The global recommendation for health documents

the dose–response relationship of PA to prevent non-communicable diseases in healthy people in specific agecategories.1 This recognises the differing PA levels to evi-dentially achieve optimum results,17 and addresses thehealth benefits of PA in healthy populations to preventchronic disease. Research investigating PA in an elderlypopulation found that motivation was the most signifi-cant barrier.18 As motivation is not a component in mostSRPAQs, specific PA questionnaires were developed forthe elderly, and their role and measurement propertieshave already been evaluated.19 Furthermore, it has beenreported that assessing PA for greater than a 6-monthperiod and across seasons is unreliable due to poorsubject recall.19 Consequently, a systematic review investi-gating the best existing SRPAQ for the healthy adultpopulation of 18–60 years will improve accuracy of PAreporting. As WHO guidelines stipulate the health bene-fits gained from PA over 1 week and the subjectivity ofself-reported PA in greater than a 6-month period, thesystematic review targeted daily, weekly and monthly PAto inform health assessments and recommendations fordisease prevention.

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METHODObjectiveTo evaluate the measurement properties of existingSRPAQs to ascertain the optimum PA outcome measurefor use in a healthy adult population.

Study designThe systematic review followed a predefined and pub-lished protocol adapted from the Cochrane Handbook,20

the Centre for Reviews and Dissemination Group,21 andPreferred Reporting Items for Systematic reviews andMeta-Analyses (PRISMA).22

Search strategyThe following electronic databases were searched tomaximise the identification of appropriate articles20:▸ OVID Medline without Revisions▸ CINAHL Plus with Full Text Database▸ EMBASE▸ CAB Abstracts▸ Health Management Information Consortium▸ Journals @ OVID Full Text▸ PubMedDatabases were searched from 1 May 2001, when the

WHO first highlighted the importance of PA evalu-ation,9 to 4 December 2014. Citation tracking of refer-ence lists ensured all relevant articles were obtained21

(boxes 1 and 2).

Keywords:“Self Report*” AND “Motor Activity” OR “Physical

Activity” AND “Outcome Assessment” AND “Healthcare”OR “Outcome Measure*” OR Questionnaire* AND[“Physical Activity” OR “GPAQ” OR “InternationalPhysical Activity Questionnaire”] AND Valid* OR Reliab*OR “Measurement Propert*” NOT Obesity NOT GirlNOT Boy NOT Psych* NOT Environment* NOT Elderly.

Eligibility criteriaIncluded articles were original studies investigating ≥1measurement property of an English language SRPAQfocusing on PA within the past 6 months,34 in a non-exclusive group. Articles published in any language (toensure comprehensiveness20), investigating English lan-guage SRPAQs in participants aged 18–60 years,19 wereincluded. Articles investigating SRPAQs focusing onpain, specific injury or pathological conditions wereexcluded.

Box 1 Inclusion criteria for this systematic review: Inclusioncriteria were articles

▸ Completed on the adult human population (>18 and <60 yearsold); The National Institute for Health and Care Excellenceguidelines recognise different activity thresholds for varyingage groups and so specific questionnaires were developed forthe adult population.23 Further research suggests that motiv-ation and the ability to perform activities is more of a limita-tion for the elderly, rather than the amount.18 Therefore theage group of 60 years old and above have specific physicalactivity (PA) questionnaires which were beyond the scope ofthis review.19

▸ Reporting assessment of ≥1 measurement property; Includingcontent, construct or criterion validity, internal consistency,interpretability, responsiveness, reliability or absolute measure-ment error; justified for self-report PA questionnaires(SRPAQs) by an International Delphi study.16

▸ Reporting assessment of ≥1 written self-report standardisedoriginal English version outcome measure(s) focusing on PA;SRPAQs were used as they are practical for both cost and par-ticipant convenience, and feasible for use and analysis byclinicians.24

▸ Investigating English SRPAQs as this was the aim of this sys-tematic review.

▸ Utilising a participant group representative of the generalpopulation, non-exclusive of race, gender or socioeconomicgroup. This allows transfer of the findings to the generalpopulation.25

Box 2 Exclusion criteria for this systematic review:Exclusion criteria were articles

▸ That were systematic reviews as original articles were requiredfor methodological quality analysis.26

▸ Completed on patients where reduced physical activity (PA)was due to neurological conditions or psychological factors.This reduces the variables that may have affected PA or com-pletion of the self-report PA questionnaires (SRPAQs).27

▸ Completed on a specific population group as this reducestransferability of the conclusions drawn to the generalpopulation.27

▸ Utilising occupational PA or sedentary questionnaires or thoseconducted via the telephone. PA should be explicitly measuredrather than being defined by involuntary occupational activityor a lack of sedentary behaviour.28 Telephone conducted ques-tionnaires introduce the potential for inconsistent administra-tion from the interviewer and potentially limit the number ofparticipants from low socioeconomic groups.29 As theInternational Classification of Functioning, Disability, andHealth emphasises the importance of PA for health promotionthis is the concept of interest.30

▸ Examining outcome measures focusing on pain or specificlimb injury as the causative factor for activity modification.Assessment of PA due to pain or potentially short-terminactivity reduces transfer of the results to the generalpublic.31

▸ Examining PA logbooks rather than questionnaires. PA log-books are less likely to reflect usual behaviour as PA levelsmay vary between seasons or as a result of illness or timeconstraints.24

▸ Investigating long-term recall of PA (classified as >6 months).As the recall accuracy for vigorous and less intense activityover this timescale has been deemed unreliable.32

Furthermore, seasonal variations of PA are difficult to accountfor in the same survey.19

▸ Investigating SRPAQs written in a language other thanEnglish. As investigating the consistency and accuracy ofSRPAQ translation was beyond the scope of the review.33


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Study selectionTwo reviewers (ZS and RG) completed an independentsearch of electronic databases using the keywords. Titlesand abstracts were evaluated independently by bothreviewers using the eligibility criteria, removing duplicatearticles. The two reviewers then independently evaluatedthe full-text article for eligibility.20 Any disagreements wereresolved through discussion, and inconsistencies discussedwith a third reviewer (AR).35 Level of agreement was evalu-ated using Cohen’s κ. Details of study inclusion wererecorded using the PRISMA flow diagram.22

Assessment of methodological quality and data extractionThe COSMIN checklist of measurement properties26 wasused to evaluate the methodological quality of includedstudies. When studies are deemed to have good methodo-logical quality, it indicates that their conclusions are moretrustworthy.26 The COSMIN checklist was developed in anInternational Delphi study36 and comprises 12 components.Nine components analyse the standard of the includedmeasurement property and one component assesses theinterpretability of the study. Finally, two components ques-tion the generic requirements needed for the studies whereItem Response Theory methods are utilised. Furthermore,there is a section to record the general requirements ofresults found to summarise the study’s findings.Training in use of the COSMIN analysis involved

reading the background to its development and themanual on its use and scoring system.36 26 The COSMINscoring system and manual were referred to when inter-preting the checklist for each measurement property.16 37

The two independent reviewers completed the COSMINanalysis, with disagreement resolved by the third reviewerwho was experienced in using COSMIN. Agreement wasreached before data extraction. Level of agreementbetween reviewers was calculated at each stage of theprocess using Cohen’s κ.38 The two independent reviewersextracted the data from the included studies,39 and thethird reviewer mediated any discrepancies in data.

Data synthesis within and across studiesThe SRPAQ investigated by each study was documentedalong with the measurement property assessed and thestudy’s design and aim. The demographics of the popu-lation examined within each study were outlined andthe COSMIN ranking for each measurement propertymethodology was recorded.37

For SRPAQs investigated in more than one study, theresults and observed trends across the studies were col-lated. Consequently, a narrative synthesis of the data wasused to discuss the relationship between the studies andtheir findings.

RESULTSIncluded articlesTen studies investigating the measurement properties ofSRPAQs, comprising of over 2500 participants of

multiple ethnicities across 11 countries, were included.Figure 1 depicts the PRISMA process of study eligibility(adapted from Moher et al22). All 346 articles electronic-ally identified were written in English, with 269 removedas they were duplicates or did not satisfy the inclusioncriteria from title and abstract assessment. Forty-ninearticles were retrieved by hand searching reference listsbut all were excluded. The full text of the remainingarticles (n=77) was screened. Following full text screen-ing, a further 67 articles were excluded. The mostcommon reason for exclusion was that the article didnot analyse an appropriate outcome measure (n=26), orpopulation group (n=16). Complete agreement (withdiscussion between only n=3 articles that were subse-quently excluded) did not necessitate use of Cohen’s κ.

PA questionnaires and measurement propertiesThe data extraction for each article is presented inonline supplementary table S1. Consensus betweenreviewers was reached at each stage following discussionon each article and reference to the COSMIN hand-book, providing perfect agreement.38 Online supple-mentary table S2 summarises data synthesis acrossmultiple studies investigating an SRPAQ by combiningdata analyses from individual studies.

Self-report physical activity questionnairesTen SRPAQs were investigated over the 10 studies, withfour versions of the International Physical Activity

Figure 1 Flow diagram depicting study identification

(adapted from Preferred Reporting Items for Systematic

Reviews and Meta-Analyses (PRISMA)).


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Questionnaire (IPAQ) identified. The studies analysedtest–retest reliability and criterion validity of SRPAQs,except for the human activity profile (HAP), six-point scaleand Godlin-Shephard 1 week (G-S) recall. Comparison ofthe six-point scale, HAP and IPAQ long form ‘Past 7 days’(IPAQ-L7S), was evaluated, and specific demographicgroups were assessed for differing PA.40 The COSMINmethodological rank ranged between poor and good.

International Physical Activity QuestionnaireBoth the written IPAQ short form ‘Usual Week’(IPAQ-SUS) and IPAQ short form ‘Past 7 days’ (IPAQ-S7S)demonstrated excellent test–retest reliability over 7 days(r=0.79 and 0.75, respectively).41 Pooled correlationbetween the short and long forms, and within the shortversions was moderate (p=0.67; 95% CI 0.64 to 0.70; andp=0.58, 0.51, 0.64, respectively).41 Assessment of the IPAQshort form (IPAQ-SF) walking component demonstratedexcellent reliability over 3 days (r=0.77 for IPAQ-S7S, 0.72for IPAQ-SUS) and was very good over 7 days (r=0.91 forIPAQ-SUS).42 The criterion validity of the IPAQ-SUS andits walking component against an accelerometer was poor(r=0.1331 and 0.26,35 respectively). Whereas the IPAQ-S7Sand its separate walking component demonstrated smallto moderate (r=0.26–0.4)41 and moderate criterion validity(r=0.39),42 respectively.Similarly, the IPAQ-L7S demonstrated very good/

excellent repeatability over 1 week (r=0.627, p<0.00143;p=0.7–0.8841; r=0.74–0.79, p<0.000144) and 2 weeks(r=0.74–0.79; p<0.0001), even when tested on a smallsample (n=36).44 Furthermore, no significant differencewas found between repeated IPAQ-L7S administrationsfor separate intensities of PA (r=0.74–0.84) in a study ofgood methodological quality.45 The IPAQ-L7S demon-strated moderate validity with both the accelerometer(p=0.05–0.43)42 and DLW technique (for activity-relatedenergy expenditure (AEE) r=0.31, p=0.06 and metabolicenergy equivalent per week r=0.33, p<0.05).44 Moreover,classification of ‘active’ and ‘non-active’ participantsdemonstrated good agreement between the IPAQ-L7Sand accelerometer (p<0.001).43

The test–retest reliability of the IPAQ long form‘Usual Week’ (IPAQ-LUS) was excellent (r=0.91), butpoor correlation was found with an accelerometer(p=0.91), although the sample size was small (n=28).41

The IPAQ-LUS demonstrated better agreement with theActigraph accelerometer for combined moderate andvigorous PA (r=0.3), and solely vigorous PA (r=0.42),than for moderate PA (r=0.19).46 Above this intensity,the IPAQ-LUS tends to over-estimate moderate/vigorousPA, which correlates to a 165% increase in PA,46 whereasthe IPAQ-L7S has been shown to under-estimate PA by27%.44 This component of the study demonstrated fairmethodological quality.

Recent Physical Activity QuestionnaireThe Recent Physical Activity Questionnaire (RPAQ) pos-sesses high test–retest reliability for physical AEE (PAEE)

(ICC=0.76), with the separate PA domains demonstrat-ing poor (home ICC=0.62) to high reliability (workICC=0.85).47 Validity of the estimated PAEE was asso-ciated significantly with the DLW technique (r=0.39;p=0.0004), and strongly with vigorous PA (r=0.67;p<0.0001).47 The study was deemed to be of goodCOSMIN rank.

PA Assessment ToolA single study of good COSMIN methodological qualityevaluating the PA Assessment Tool (PAAT) demonstratedsignificant test–retest reliability (r=0.618, p<0.001).43

When assessing the PAAT against the accelerometer, sig-nificant correlation (r=0.38–0.392; p<0.01) and fairagreement regarding participant classification as ‘active’(k=0.338) was found.43

Six-point scaleFair agreement was found between the six-point scaleand IPAQ-L7S (k=0.46), and good agreement with theHAP (k=0.57), in a study of poor COSMIN rank.40 Theyfound that increasing age and presence of comorbiditieshad a significant negative effect on PA (p<0.05 and0.000, respectively). Gender and smoking had no effect(p>0.05) in an experiment of fair COSMIN methodo-logical quality.40

Human activity profileOne study found that the HAP poorly correlated withthe IPAQ-L7S (k=0.38), with this portion being of poorCOSMIN ranking. Age (p<0.05) and the presence ofcomorbidities (p<0.000) significantly affected PA, whilegender and smoking did not (p>0.05), which wassimilar to the six-point scale.40 The findings demon-strated that occupation significantly affected PA categor-isation using the HAP (p<0.000), and this portion of thestudy was deemed to have fair COSMIN ranking.37

Single-item measureOne study of good COSMIN methodological qualityreported significant correlation between the accelerom-eter and the single-item measure for all moderate-vigorous PA over 30 min (r=0.46; p<0.001). Stronger cor-relation was shown when this intensity of PA was taken at10 min intervals (r=0.57; p<0.001).48 Participants werefound to under-report activity using the single-itemmeasure (−1.59 days) compared with all objectively mea-sured moderate-vigorous PA, although when comparedwith recorded PA in 10 min bouts, there was strongercorrelation of data (0.38 days).

G-S 1 week recallModerate correlation of the G-S recall with an acceler-ometer when the PA was of moderate to moderate-vigorous intensity (r=0.3 and 0.4, respectively) was shownbut a stronger association for vigorous PA (r=0.5) wasexhibited. It was demonstrated that the G-S recall datawere not significantly altered by their use in participants


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of different genders, weight classifications or ethnicity(p>0.05).49 Furthermore, the subgroup analysis demon-strated that males performed more moderate-vigorousactivity than females (p<0.001), and non-overweight par-ticipants completed more moderate and moderate-vigorous PA than overweight/obese individuals(p<0.05). The COSMIN rank for this study was poor.

DISCUSSIONMeasurement propertiesSelf-report physical activity questionnairesThis systematic review identified available English lan-guage SRPAQs, updating and focusing on the previouslycompleted research.11 Single studies of good methodo-logical quality each evaluated the RPAQ,47 PAAT,43

single-item measure48 and G-S recall,49 giving confi-dence to the demonstrated significant test–retest reliabil-ity and criterion validity. The six-point scaledemonstrated a moderate level of agreement with theHAP and IPAQ-L7S, whereas the HAP only demon-strated a fair level of agreement with the IPAQ-L7S.40

The HAP was able to distinguish PA differences betweenparticipant subgroups, however, fair COSMIN methodo-logical quality was calculated for this study,40 due tolimited statistical analysis, and the sample size was small,which reduces the confidence in this study’s results. TheG-S recall identified females as less active than malesand the overweight/obese subgroup as less active thanthose who are non-overweight.49 This study also demon-strated that gender, ethnicity and weight did not signifi-cantly alter the data derived from the accelerometer orG-S recall questionnaire. This testing of different partici-pant subgroups supports the construct validity of theSRPAQs, and consequently their use in heterogenoussample groups, which is representative of healthcarepatient populations.

International Physical Activity QuestionnaireThe most investigated SRPAQ was the IPAQ, specificallythe IPAQ-L7S, which is the most extensively used SRPAQworldwide, due to its varying formats and translationinto many different languages. All forms of the IPAQdemonstrated very good/excellent test–retest reliabil-ity,41–45 with the results for the IPAQ-L7S and short formIPAQ ‘walking only’ component being classified as excel-lent. The English IPAQ-SUS was evaluated with a smallsample, which limits its generalisability. However, cross-cultural comparisons involving non-English speakingcountries corroborate the excellent reliability of theIPAQ-SF50 and, consequently, their use in clinical prac-tice. Repeated administrations for separate PA intensitiesdemonstrated no significant difference on IPAQ-L7Svalue, demonstrating excellent test–retest reliability.Unfortunately, this was completed on a group of univer-sity students of limited age range,45 which reduces trans-ferability to the general population, and the authorsstated poor recording consistency of the data collected.

However, total PA was correlated, albeit weakly, to motiv-ation and competency, demonstrating an attempt toexplain PA scores within the excellent sample size.The criterion validity of the IPAQ against an acceler-

ometer or DLW technique was variable for the differingintensities of PA across the studies, with poorer correl-ation being found for total PA.41 42 The use of limitedaccelerometer data on a small convenience sample mayhave caused this and, with increased numbers, the valid-ity of the IPAQ-S7S did significantly improve.41

Furthermore, a systematic review analysing the IPAQ-SFreported an over-estimation of PA by approximately84%,51 so despite being reliable, the validity of theIPAQ-SF requires further investigation. Poor correlationbetween the IPAQ-LUS and accelerometer was signifi-cantly improved by increasing the sample size by addingits non-English counterpart,41 but it demonstrated bettercriterion validity at <1000 min/week of PA.46

Testing the ability of the SRPAQ to identify PA changein different subgroups of participants assesses its con-struct validity.16 Expectedly, the IPAQ-L7S showed thatage significantly affects an individual’s PA; however, thepresence of comorbidities and smoking did not.40 Thismay be due to low numbers within these participantgroups and lack of clarity over the degree to which thecomorbidity affected their health status. The authorssuggested that the unexpected weak associationsbetween total PA, motivation and the ability to under-take PA,45 were due to variability in the recording skillsof participants, affecting data consistency, so repeatedexperimentation would be beneficial.Encouragingly, it has been shown that higher IPAQ

scores correlate with lower mortality rates and a reducedrisk of cardiovascular disease, demonstrating its worthfor public health assessment.52 This supports its inter-pretability, which although not considered a measure-ment property, is a clinically important characteristic ofany outcome measure. However, suggestion of inconsist-ent translation of the IPAQ may not allow the sameaccreditation to non-English versions, therefore investi-gation into each translation would be necessary.33

Recent Physical Activity QuestionnaireThe development of the RPAQ with a 1 month recallperiod was to calculate the individual’s PA in relation tohome, work, transport and leisure time.37 The RPAQdemonstrated high test–retest reliability and was stronglyassociated with the DLW technique for vigorous PA,giving the RPAQ criterion validity. This single study useddifferent populations for the reliability and validity com-ponents of analyses, with the validity study consisting ofa good sample size.37 The stability of the PA betweenrepeated measures was assumed and the testing environ-ment was not described, allowing for the COSMIN meth-odological quality to be described as good. Interestingly,the authors evaluated the ICC of 0.62 for home activityas poor, whereas the other literature would have ranked


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this more highly,53 which reduces standardisation of theICC and data synthesis across studies.

PA Assessment ToolThe PAAT measures moderate and vigorous PA over thepreceding 7 days, and is intended to be completedwithin 7 min.43 This tool would be ideal for implementa-tion in a healthcare professional’s waiting area anddetermines whether this 7-day PA is similar to thepatient’s normal activity. A single study evaluating thePAAT demonstrated significant reliability for vigorousactivity (r=0.618; p<0.001); however, by only using 67participants, the strength of the evidence is reduced.Furthermore, participant interpretation of moderateand vigorous PA may introduce ambiguity of reporting,and cause inconsistency in results. This study evaluated ahigh proportion of female volunteers who, it has beenstated, may demonstrate reduced PA in their lifetimedue to pregnancy and child care. This could reduce theapplication of findings into male populations; however,limited research on female PA neither supports norrefutes this hypothesis.54 Additionally, the PAAT quanti-fies the energy for moderate and vigorous PA only, andagainst potentially outdated Compendium values,55

which may affect the applicability of the results found.

Six-point scaleThe six-point scale was devised to reduce time andfinancial constraints associated with lengthy question-naires. PA is classified on a sliding scale with additionaldescriptors referring to the amount of perspiration anddepth of breathing when examples of exercise areinappropriate.40 This may introduce subjectivity in par-ticipant reporting and inconsistency between test sub-jects. Structural validity was assessed by comparing thesix-point scale and HAP with the IPAQ-L7S,40 demon-strating that a brief scale can assess PA adequately whencompared to the longer SRPAQs on a heterogeneoussample recruited by verbal invitation. By subgroupingthe participant group, they were able to discover thatincreasing age and the presence of comorbidities hadan expected negative effect on PA. Smoking did nothave an effect on the amount of PA completed, but asmall sample size may not have enabled suitable analysisto be performed. It was concluded that the six-pointscale can be used for assessing PA in large-scale hetero-geneous sample epidemiological studies, but the poorCOSMIN methodological quality, due to reduceddescription of the six-pont scale and the non-directionalhypotheses, limits confidence in this finding and morerigorous investigations are encouraged.37

Human activity profileThe HAP measures PA levels to give an estimate of theindividual’s average energy expenditure.37 The HAPpoorly correlated with the IPAQ-L7S40; although using adifferent κ classification this would have been describedas fair,56 and deemed moderate with the six-point scale.

Smoking did not significantly affect the PA, but expect-edly, physicality of occupation did significantly affect thecategorisation of PA by the HAP, which improves its con-struct validity. Disappointingly, this study did not useexploratory or factor analysis statistical methods and,consequently, methodological quality was poor,37 redu-cing confidence in findings.

Single-item measureThe single-item measure was investigated to observewhether the longer SRPAQs were, in fact, any morebeneficial. The validity of the single-item measure48 wastested against the accelerometer in a healthy populationof good representation to the general public. This studyreports significant correlation between the accelerom-eter, which is stronger when PA was taken at 10 minintervals. By analysing 10 min PA intervals, the sensitivityof testing was improved, although the specificity wasbetter when testing total moderate-vigorous PA.57 Thislack of standardisation may limit the use of the single-item measure in clinical practice and research. However,the idea that a single question could be as reliable andvalid as the longer SRPAQ is interesting and clinicallyrelevant, so further investigation would be beneficial.

G-S recallThe criterion validity of the G-S recall against the accel-erometer resulted in moderate to strong correlation invarying PA. The authors of this study did note a greatervariability with higher levels of PA and reported that theG-S recall has restrictions when used to assess individualPA levels, however, the G-S recall data were not signifi-cantly altered by their use in heterogeneous groups.49

The ranking of this portion of the validity study wasdeemed as ‘poor’ by COSMIN, due to the lack ofhypotheses prior to data collection. Furthermore, thestatistical analysis was not optimal,16 causing the infer-ences to clinical and research practice to be restricted.This may limit its use, so further investigation for use isencouraged.

PAQs in research and clinical practiceTo enable SRPAQ data to be equated to national guide-lines,23 units need to be comparable. This is a limitationfor questionnaires assessing PAEE, as the guidelinesfocus on time, thereby reducing the clinical significanceof SRPAQ data, the comparison between differentSRPAQs due to ambiguity and transferability into prac-tice.58 Development of SRPAQs has reduced completiontime, with the PAAT, six-point scale and single-itemmeasure feasible for use in clinical practice, but furtherresearch is required to support their use across lan-guages/populations. Conversely, the HAP is a lengthyquestionnaire, thus increasing costs and reducing clin-ical usability.The RPAQ demonstrates a strong correlation for asses-

sing monthly vigorous PA energy expenditure, but notsedentary PA.47 Likewise, the PAAT and single-item


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measure only investigate moderate/vigorous PA over thepreceding 7 days, questioning its use for all intensities ofactivity, as it may affect the categorisation of the individ-ual as active or sedentary. The inconsistency of recording10 and 30 min PA data for the single-item measurereduces standardisation, potentially leading to errors indata analysis.48 The G-S recall did detect differencesbetween gender and weight classifications, with no differ-ence shown when correlating their data with the goldstandard.49 Similarly, there was moderate to strong correl-ation between moderate to vigorous PA collected compar-able to the accelerometer. However, poor COSMINmethodological quality for its hypothesis testing sub-study16 questions the inference that can be made whenusing the tool clinically or in research. Therefore, due tothe ambiguity surrounding the PA intensity analysed,further scrutiny is required to improve consistency.The IPAQ has the advantage of being researched

extensively across languages, populations and demo-graphic groups. It has been developed into multipleformats, making the IPAQ the most extensively usedSRPAQ worldwide.51 There is good correlation betweenthe long and short forms via all modes of delivery;however, caution should be used if comparing the two,as the IPAQ long form (IPAQ-LF) can over-estimate PAto a greater extent than the IPAQ-SF.46 The questionablevalidity of the IPAQ-SUS and time-consuming adminis-tration of the IPAQ-LF restrict their use clinically. TheIPAQ-S7S is, at present, the preferred measure, owing toits excellent test–retest reliability over 7 days. Moreover,the IPAQ-S7S is supported across cultures withinnon-English speaking countries, assisting transferabilityof information, and this, along with its short format,makes it feasible for research and clinical practice.Owing to studies with low sample sizes demonstratingpoor validity, a study investigating an adequate samplesize of over 100 participants is required.

LimitationsLimited narrative comparison of the SRPAQs was achiev-able due to their individual aims to report different PAintensities. For example, the IPAQ, HAP and RPAQ inves-tigate a wide variety of PA, whereas the six-point scale andsingle-item measure are brief overviews of daily activity orexercise, and the PAAT concentrates on moderate/vigor-ous activity. The individual studies did not define theirunderstanding of PA; and the SRPAQs did not indicatethe difference between PA intensities. Furthermore, thesingle-item measure57 may compromise breadth anddepth of recorded data for speed of administration.49

The main methodological flaws encountered were fromthe use of limited statistical tests and low subjectnumbers. Using the COSMIN scoring system, successivemethodological limitations will reduce the rank fromexcellent methodological quality through to good, fair orpoor, reflecting the confidence we can have in study find-ings. Additionally, within the reliability studies, it was gen-erally assumed that no change in PA occurred rather

than statistically analysing PA stability. Furthermore, theSpearman correlation coefficient indicates associationrather than true agreement.40 Therefore, caution shouldbe taken when accepting validity with only this support-ing statistical test, which is true for the majority ofincluded studies. Moreover, there were discrepancies inranking the numerical outcome of the statistical testsbetween studies, which should be noted during data syn-thesis for each SRPAQ.The ambiguity of common terminology used within

PA research may have affected the electronic databasesearch for this systematic review, possibly contributing toomissions in the included studies. In addition, as onlyEnglish language SRPAQs were included, the samplesizes within the Craig et al41 study were greatly reduced,diminishing the significance of their results.Furthermore, the aim of this systematic review was tocomment on the measurement properties of SRPAQs,but, unfortunately, only studies investigating test–retestreliability, internal consistency and criterion, constructand structural validity, were identified, reflecting thelimited research to date on measurement properties.

CONCLUSIONAmbiguity in PA terminology, patient reporting of PA, andthe variable nature of activity across the seasons and7 days, makes daily activity difficult to assess using struc-tured SRPAQs. Further inconsistencies within the PAassessed by each SRPAQ, limited measurement propertiesbeing evaluated and poor methodological quality of manystudies, contributed to difficult data synthesis acrossstudies. Consequently, the optimum SRPAQ has not beenreported. The IPAQ-L7S is the most investigated SRPAQ,with all versions reported to have good test–retest reliabil-ity but limited criterion validity, potentially due to limitedmethodological quality. Based on current data, theIPAQ-S7S is the most appropriate outcome measure forclinical and research use, as it has excellent reliability andmoderate correlation with accelerometry. The shortversion makes it efficient for clinicians, also making itmore cost-effective. Future research should continue toassess SRPAQs against the ‘gold standard’ PAperformance-based measures, in diverse socioeconomicgroups worldwide. Assessment of responsiveness and inter-pretability would be valuable to relate the levels of PArequired to reduce the risk of chronic disease for the indi-vidual. This is fundamental for disease prevention andtherefore essential for the promotion of public health.

Acknowledgements The authors acknowledge Mr Gethin Lynch, affiliated toSchool of Sport, Exercise and Rehabilitation Sciences, University ofBirmingham, UK, for assisting with article selection.

Contributors ZS was involved in finding and appraising all articles,completing COSMIN analysis, data extraction, analysis and synthesis, andwrote the article. This included documenting the supporting evidence for theneed for the systematic review, adapting pre-defined protocol for itscompletion, and recording and synthesising the results obtained withinferences for clinical practice and research. RG was involved in the selectionof articles, COSMIN analysis, and data extraction and synthesis for this


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manuscript. AR was the mediating third reviewer, academic supervisor of theresearch and peer reviewed the submitted article.

Funding This research received no specific grant from any funding agency inthe public, commercial or not-for-profit sectors.

Competing interests None declared.

Ethics approval Ethical approval was obtained from the University ofBirmingham.

Provenance and peer review Not commissioned; externally peer reviewed.

Data sharing statement No additional data are available.

Open Access This is an Open Access article distributed in accordance withthe Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license,which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, providedthe original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Table 1 – Table of data extraction and COSMIN methodological quality ranking for the articles found. Reference Outcome

Measure a Measurement Property Assessed

Study Design and Aim

Gender and Age Distribution b

Study Findings c COSMIN Rank d [37]

1 Besson et al. (2010),[47]

SRPAQ - Recent Physical Activity Questionnaire (RPAQ)

Reliability Test Re-test. 14 days apart

n= 131; Age range: 31-57

ICC=0.76 (p<0.0001)

Subscales ranged from 0.32 (transport) to 0.85 (work).

Box B: ‘good’

N M 60

F 71

Comparative i) DLW +Resting Metabolic Rate (RMR)

ii) accelerometer + Heart Rate (Acc+HR)

Criterion Validity Comparison n= 50; Age range: 21-55

-RPAQ significantly associated TEE (r=0.67 p<0.0001) and PAEE (r=0.39 p=0.0004) with DLW+RMR. -Estimated self-reported time spent exercising vigorously significantly associated with Acc + HR (r=0.70 p<0.0001). -Estimated sedentary time was not (r=0.27 p=0.06).

Box H: ‘good’

n Age

BMI - kg/m2 Body fat

M 25 34.3+-8.8 25.1 +-3.1 22% +-7.9

F 25 35.2+-9.9 23.9 +-3.8 32.1% +-7.6

2 Boon et al. (2010),[46]

SRPAQ International Physical Activity Questionnaire -Usual week Long Form (IPAQ-LUS)

Comparative Actigraph accelerometer

Criterion Validity Comparison n= 64; Age = 18-65 years old Mean(SD)= 35.2 (14.4) M:F = 28 : 36 Height (SD)= 1.73m (0.09) Weight (SD)= 72.1kg (13.6) BMI (SD)= 24.5kg/m2 (4.1)

-The IPAQ-LUS showed moderate correlation with the Actigraph for combined moderate and vigorous activity (r=0.30). -A strong correlation for vigorous activity (r=0.42) and a small correlation with moderate activity (r=0.19). -Overall the IPAQ-LUS tended to over-estimate mean PA by approximately 165%

Box H: ‘good’

aDLW = Doubly Labelled Water; RMR = Resting Metabolic Rate; HR = Heart Rate; b Gender = M = Male; F = Female; SD = Standard Deviation; BMI = Body Mass Index; cICC = IntraClass Coefficient; TEE = Total Energy Expenditure; PAEE = Physical Activity Energy Expenditure; r= Spearman’s Correlation; p=Significance value; AEE = Activity Related Energy Expenditure; MVPA = Moderate to Vigorous Physical Activity d COSMIN = Consensus-based Standards for selection of health Measurement INstruments;

3 Craig et al. (2003),[41]

SRPAQ - IPAQ 7-day Long Form (IPAQ-L7S)

IPAQ-LUS

IPAQ 7-day Short Form (IPAQ-S7S)

IPAQ Usual Week Short Form (IPAQ-SUS)

Reliability Test Re-test <10 days apart

UK1 n= 149; M:F = 68:81; Age= 35.2yrs(SD10.6); Education= 16.3yrs (SD 3.6); Employed= 128 Hours worked= 35.6/wk (SD 13.4); Live in large city= 117; Good Health= 137.

USA1 n=28; M:F = 7:21; Age= 48.9 (SD6.1); Employed= 28; Height= 168.3cm (SD10.0); Weight= 78.8kg (SD22.7).

USA2 V1-V2 and V2-V3 n=30; M:F= 14:16; Age= 36.1 (SD12.8); Education= 17.4(SD 3) Employed= 27 Hours worked= 35/wk (SD12.7); Live in large city= 25; Good Health= 28; Height = 171.4cm (SD9.7); Weight= 77.3cm (SD17.3)

-All English forms of the IPAQ demonstrated good to very good Spearman’s reliability correlation coefficients ranging from 0.66 to 0.91 depending on the version and population used: IPAQ-L7S: UK1 p=0.70; USA1 p=0.87; USA2 p=0.72; USA2 p=0.88

IPAQ-LUS: USA1 p=0.91;

IPAQ-S7S: UK1 p=0.69; USA1 p=0.81; USA2 p=0.88; USA2 p=0.66;

IPAQ-SUS: USA1 p=0.84.

Box B: ‘fair’

Box A: ‘poor’

Box H: ‘good ‘

IPAQ-Short Form (SF) vs. Long Form (LF)

Internal Consistency

Comparison The IPAQ-LF and IPAQ-SF showed reasonable correlation (p=0.67; 95%CI 0.64-0.70)

Comparative CSA accelerometer

Criterion Validity Comparison All IPAQ–LFs showed moderate (p=0.33) and IPAQ-SFs fair correlation (p=0.30) with the CSA accelerometer.

English forms of the IPAQ demonstrated Spearman’s correlation coefficients from -0.02 to 0.43 with the CSA accelerometer: IPAQ-L7S:UK1 p=0.43; USA1 p=0.05; USA2 p=0.32.

IPAQ-LUS: USA1 p=-0.02.

IPAQ-S7S: UK1 p=0.40; USA1 p=0.26; USA2 p=0.27.

IPAQ-SUS: USA1 p=0.13.

4 Levy and Readdy (2009),[45]

SRPAQ - IPAQ-L7S

Comparative Physical Activation Measure (PAM)

Perceptions of Competence

Reliability Test Re-Test 4 days apart

Comparison

n= 151 M:F= 52:99 Mean Age(SD)=24.2 (5.0) Marital status

Partnered/Married 43%; Single 56.2%; Has job = 80.1%

Ethnicity Caucasian 64.2%; Hispanic 13.2%; Asian-American 5.3%; Pacific Islanders 2.6%; African American 1.3%; Middle Eastern 1.4%; Other 10.6%.

-IPAQ-L7S scores for total PA was excellent (r=0.84), good for vigorous activity (r=0.77) and moderate activity (r=0.78), and good for total walking activity (r=0.74).

Box B: ‘good’

Box F: ‘good’

Hypothesis Testing

PAM: weak correlation between PA motivation and total PA (p=0.17)

Competence: weak correlation between PA competence and total PA (p=0.17)

5 Maddison et al. (2007),[44]

SRPAQ - IPAQ-L7S

Reliability Test-Retest: 0, 8 and 15 days

n= 36 M:F= 16:20; Age= 18-64yrs, Mean 39, SD 10; Height= 171.5cm (159-185), SD 7.4; Weight= 75.9kg (55.2-122), SD 14.8; BMI= 25.7 (19.9-37.2), SD 4; Fat Free Mass= 54.74 (40.66-85.54), SD 10.3;

Ethnicity: NZ Euro 27; NZ Mauri 4; Tongan 1; Asian 2; Other 5.

IPAQ-L7S demonstrated acceptable reliability at two different intervals with Spearman correlation coefficients of 0.74-0.79 (p<0.0001).

Box B: ’fair’

Box H: ‘Fair’

Comparative DLW Criterion Validity Comparison -The IPAQ-L7S showed moderate

correlation with DLW for AEE (r=0.31 p=0.06) and metabolic energy equivalent per week (r=0.33 p<0.05).

-Overall the IPAQ-L7S tended to under-estimate mean PA by approximately 27%, with a more marked under-estimation at higher activity levels.

6 Meriwether et al. (2006),[43]

SRPAQ - Physical Activity Assessment Tool (PAAT)

Reliability Test Re-test, 7 days apart

n=67; M:F= 9:58; Age Mean = 37.5 (20-61); BMI = 25.7 (18.3-37.6)

-PAAT demonstrated significant test-retest reliability with Spearman correlation coefficients (r=0.618; p<0.001)

Box B: ‘good’

Box H: ‘good’

IPAQ-L7S Reliability IPAQ-L7S demonstrated significant reliability with Spearman correlation coefficients (r=0.627 p<0.001)

Comparative MTI accelerometer

Criterion Validity Comparison -PAAT correlated significantly with the Accelerometer for combined moderate and vigorous PA (r=0.392 p<0.01) No data for the correlation of IPAQ-L7S with the MTI Accelerometer data was reported.

7 Milton et al. (2013),[48]

SRPAQ – Single item measure [27] Comparative Actigraph Accelerometer

Criterion Validity Comparison n=66; M:F=23:43; Age Mean = 39 (11) Age Range = 21 – 62 years old

-The single item measure showed a significant correlation with accelerometer data. When all data assessed, r=0.46. When only MVPA accumulated in bouts of ≥10 mins was assessed r=0.57.

-Participants underreported activity on the single item measure (-1.59 days) when compared with all objectively measured MVPA, but stronger congruence was observed when compared with MVPA accumulated in bouts of ≥10 mins (0.38 days).

Box H: ‘good’

8 Sirard at al (2013),[49]

SRPAQ - Godlin-Shephard (G-S) recall (1 week)

Hypothesis Testing

Comparison n=121; M:F = 61:60; Age Mean = 24 (1.7) years; 50.8% White; 53.4% Overweight or obese evenly distributed within each subgroup

-SRPAQ derived PA measure demonstrated females less active than males, overweight individuals less active than non-overweight individuals and no differences detected for PA levels between race.

-Gender, Ethnicity or Weight did not significantly alter the correlation between the G-S recall and the Accelerometer data.

Box F: ‘poor’

Comparative Accelerometer

Criterion Validity Comparison -Reported correlations for moderate (r=0.3), moderate-vigorous (r=0.4) and vigorous (r=0.5) physical activity were reported as ‘adequate’.

Box H: ‘good’

9 Van der Ploeg et al. (2010),[42]

SRPAQ - IPAQ-S7S-Walking component only

Reliability Test Re-test, 3 days apart

S7S n= 278; M:F= 124:154; Age (SD)= 36(11); Education (SD)= 16(4); Employed= 250 (90%). SUS n= 763; M:F= 324:421; Age(SD)= 39(13); Education (SD)= 14(5); Employed= 430(76%). Validity S7S n= 446; M:F= 203:243; Age(SD)= 40(13); Education (SD)= 15(4); Employed= 376 (84%). SUS n= 202; M:F= 93:109; Age (SD)= 37(12); Education (SD)= 16(3); Employed= 161(80%).

-The IPAQ-S7S estimate of total time walked demonstrated excellent reliability over 3 days n=240 (spearman correlation r=0.77).

Box B: ‘good’

Box H: ‘good’

IPAQ-SUS Walking component only

Reliability Test Re-test, 3 or seven days apart

-The IPAQ-SUS estimate of total walking time demonstrated very good (r=0.91; n=78) to excellent (r=0.72; n=684) reliability over 3 and 7 days, respectively

Comparative CSA accelerometer vs. IPAQ-S7S

Criterion Validity Comparison -Using individuals who reported moderate activity as walking only, the IPAQ-S7S estimate of total walking demonstrated a moderate correlation (r=0.39; n=137) with the accelerometer data of moderate PA.

CSA accelerometer vs. IPAQ-SUS

-Using individuals who reported no other moderate activity other than walking, the IPAQ-SUS estimate of total time walked demonstrated a poor correlation coefficient (r=0.26; n=84) with accelerometer data of moderate-intensity PA.

10 Webster et al. (2011),[40]

SRPAQ a) IPAQ-L7Sb) 6-point

scalec) Human

ActivityProfile(HAP)

Hypothesis Testing

Comparison a)Ageb)Genderc)Smokingstatus d)Maritalstatus e)Co-morbidities f)Occupation

n=100; Age=18-80 years, Mean = 49.3; M:F= 22:78; Married= 61; Completed High School= 72; Smoker= 10; 1+ Co-morbidities= 25; Occupation: Sedentary= 49, Very heavy= 0.

-Age significantly different between the PA categories of all three SRPAQs (p<0.05).

-Gender and smoking status did not vary between the PA categories in any of the three SRPAQs (p>0.05).

-Marital status, co-morbidity and occupation did not have a significant effect on the PA categories of the IPAQ-LF (p>0.05).

Box F: ‘fair’

-Marital status varied significantly between the PA categories on the HAP (p<0.05) and the 6-point scale (p<0.01).

-The presence of one or more co-morbidities had a significant effect on the PA category for the HAP (p<0.000) and the 6-point scale (p<0.000).

-Having a physical occupation had a significant effect on the PA categories of the HAP (p<0.000).

Box E: ‘poor’

a) IPAQ-L7Svs. HAP

b) IPAQ-L7Svs. 6 pointscale

c) 6 pointscale vs.HAP

Structural Validity

Comparison a)IPAQ-L7S vs. HAP: poor agreement,kappa value of k=0.38

b)IPAQ-L7S vs. 6 point scale: fair to goodagreement, kappa=0.46

c)6 point scale vs. HAP: fair to goodagreement, kappa value of k=0.57

Table 2 – Summary of data extraction and methodological quality for each SRPAQ.

SRPAQ Measurement

Property

Article Methodological

COSMIN Rank

Results Conclusions

RPAQ Test-Re-test Reliability Besson et al.

(2010),[47]

Good ICC = 0.76; p<0.0001 -High test re-test reliability when measuring PAEE which can be accepted due to good methodological quality.

Criterion Validity against DLW and RMR

Good PAEE – r = 0.39; p = 0.0004 Total Energy Expenditure – r = 0.67; p <0.0001.

-Significant associations with total PA measured by RPAQ and DLW plus RMR.

PAAT Test-Re-test Reliability Meriwether

et al. (2006),[43]

Good r = 0.618; p<0.001. -Significant reliability for the PAAT measurement of total PA.

Criterion Validity against MTI accelerometer

Good For combined vigorous and moderate PA - r = 0.392; p<0.01

-Low but significant values linking the PAAT with accelerometer. PAAT under-estimates 15.6% of active participants compared to the accelerometer and misclassified 68.4% as under-active but this was not significant (p=0.169).

6-Point Scale

Structural Validity against HAP and IPAQ-L7S

Webster et al. (2011),[40]

Poor With HAP – k = 0.57 With IPAQ-L7S – k = 0.46

-Moderate agreement of both the HAP and the IPAQ-L7S and the 6-point scale.

Hypothesis Testing

Fair Age – p<0.05; Presence of co-morbidities – p<0.000; Marital Status – p<0.01;Gender – p>0.05; Smoking – p>0.05.

-Age, marital status and the presence of co-morbidities had a significant effect on PA measured. Gender and smoking did not.

HAP Structural Validity against IPAQ-L7S


Poor With IPAQ-L7S – k = 0.38 -Fair level of agreement of the HAP and the IPAQ-L7S.

Hypothesis Testing

Fair Age – p<0.05; Presence of co-morbidities – p<0.000; Marital Status – p<0.05;Physical Occupation – p<0.000; Gender – p>0.05; Smoking – p>0.05.

-Age, marital status, presence of co-morbidities and occupation significantly affected PA therefore the HAP can distinguish PA between these groups.

Abbreviations: ICC = Intra-Class Coefficient; r = Spearman Correlation Coefficient; p = Levels of significance; k = Cohen’s kappa

Single Item Measure

Criterion Validity against Actigraph Accelerometer

Milton et al. (2013),[48]

Good All MVPA data assessed r=0.46 (p<0.001); Overall agreement of MVPA between measures 58% with k statistic 0.23 (95% CI 0.05 to 0.41). In objectively measured PA in ≥10min bouts r=0.57 (p<0.001); Overall agreement 76% with k statistic 0.39 (95% CI 0.14 to 0.64).

-Using all MVPA data the single item measure correctly identified 88% of participants meeting PA recommendations (specificity) and 48% of those not (sensitivity). Using PA data in ≥10min sessions specificity was 56% and sensitivity was 83%. Fair agreement shown with kappa statistic.

Godlin-Shephard Recall (1 week)

Criterion Validity against Accelerometer

Sirard et al. (2013),[49]

Good For moderate PA r=0.3; For moderate-vigorous PA r=0.4; For vigorous PA r=0.5; Combined PA r=0.43.

-Reported correlations between stratified PA levels described as ‘moderate in magnitude’. Scatterplots demonstrated that the SRPAQ did not systematically over- or under-estimate MVPA compared to the Accelerometer.

Hypothesis Testing

Poor Gender – Male 3.5(3.65): Female 1.6(1.94) hours/week MVPA; Weight – Overweight and obese 2.2(3.00): Non-overweight 3.0(3.10) hours/week MVPA; - Overweight and obese 1.4: Non-overweight 2.2 (2.01) hours/week moderate PA

-SRPAQ demonstrated females completed less MVPA than males and overweight individuals reported less moderate PA and MVPA than non-overweight individuals. No significant difference between the correlation of SRPAQ and Accelerometer data for Gender, Ethnicity or Weight (all p>0.05).

IPAQ-SUS Test-Re-test Reliability

Craig et al. (2003),[41]

Fair For USA1 r = 0.84. -Excellent reliability with repeated testing over three and seven days for both the walking component and entire IPAQ-SUS.

Van der Ploeg et al. (2010),[42]

Good For walking component: Over three days – r = 0.91; Over seven days - r = 0.72.

Criterion Validity against accelerometer

Craig et al. (2003),[41]

Good For USA1 r = 0.13. -Poor correlation was found between the walking component of, and the total, IPAQ-SUS and the Accelerometer.


Good For walking component r = 0.26.

IPAQ-S7S Test-Re-test Reliability

Craig et al. (2003),[41]

Fair UK1 r = 0.69; USA1 r = 0.81; USA2 (V1-2) r = 0.88; USA2 (V2-V3) r = 0.66.

-Excellent test re-test reliability demonstrated over three days for total and ‘walking only’ IPAQ-S7S.




Craig et al. (2003),[41]

Good UK1 r = 0.4; USA1 r = 0.26; USA2 r = 0.27. -Moderate correlation between the walking

component and the Accelerometer. There was a small to moderate correlation for the full IPAQ-S7S.



IPAQ-LUS Test-Re-test Reliability

Craig et al. (2003),[41]

Fair USA1 r = 0.91. -Excellent reliability demonstrated albeit with fair methodological quality.


Boon et al. (2010),[46]

Good For combined moderate and vigorous PA r = 0.3. Overall IPAQ-LUS over-estimated by approximately 165%

-Poor correlation found for total PA, and moderate correlation for combined moderate and vigorous PA, against an accelerometer. However, IPAQ-LUS over-estimated mean PA by approximately 165%.

Craig et al. (2003),[41]

Good USA1 r = -0.02.

IPAQ-L7S Test-Re-test Reliability

Meriwether et al. (2006),[43]

Good r = 0.627; p<0.001.

-Very good to excellent reliability found for the IPAQ-L7S on repeated testing.

Maddison et al. (2007),[44]

Fair Between 0 and 8 days r = 0.79; p<0.0001. Between 8 and 15 days r = 0.74; p<0.0001.

Craig et al. (2003),[41]

Fair UK1 r = 0.7; USA1 r = 0.87; USA2 (V1-V2) r = 0.72; USA2 (V1-V2) r = 0.88.

Levy and Readdy (2009),[45]

Good Total PA ICC = 0.84.

Criterion Validity against accelerometer and DLW

Meriwether et al. (2006),[43]

Good IPAQ-L7S significantly classified participants as “active” compared to the accelerometer (p<0.001).

-Poor to moderate validity found for the IPAQ-L7S against an accelerometer.

-The IPAQ-L7S marked 80% of participants as “active” corresponding to 71.4% by the accelerometer showing a significant level of agreement.

-Moderate correlation for PAEE and significant values for metabolic equivalents against DLW.

-However, comparative to DLW the IPAQ-L7S tended to under-estimate mean PA by 27%.

Craig et al. (2003),[41]

Good UK1 r = 0.43; USA1 r = 0.05; USA2 r = 0.32 against accelerometer.

Maddison et al. (2007),[44]

Fair PAEE r = 0.31; p=0.06; Metabolic equivalents r = 0.33; p<0.05. Tends to under-estimate mean PA by 27% compared to DLW.

Hypothesis Testing


Fair Age – p<0.05; Presence of co-morbidities – p>0.05; Marital Status – p>0.05; Gender – p>0.05; Smoking – p>0.05.

-Age significantly affected PA categorisation by IPAQ-L7S. The other sub-categories did not.

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