Am J Clin Nutr-1982-Baecke-936-42.pdf

8/10/2019 Am J Clin Nutr-1982-Baecke-936-42.pdf

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T he m er ica n Jou rna l o f lin ic a l N u trition 36: N OV EM BE R 1982 , p p 9 36 -94 2 . P rin ted in USA

1982 Am erican Soc iety for C lin ica l N utr itio n

A sho rt ques tio nna ire fo r th e m easu rem en t o f

h ab itu a l phys ica l ac tiv ity in ep idem io log ica l

s tudies

Jos A H B a ecke , M Sc , Ja n B urem a , M Sc , a nd Ja n E R F r te rs ,3 P h D

A BSTR AC T T he con stru ct val id i ty an d th e te st- re te st re liab ili ty o f a self-adm in is tere d que s-

t ion naire abo ut h ab i tua l ph ysical act iv i ty w ere in ve stig ate d in yo ung m ales n 13 9 and fem ale s

n

167 i n th re e age gro up s 2 0 to 2 2 , 25 to 27 , and 30 to 3 2 yr in a D utch p opula tion . B y

p rin cip al c om ponen ts an aly sis th re e concep tual ly m eanin gfu l fa cto rs w ere d ist ing u ished . T hey w ere

in terpreted a s:

I)

phys ica l act iv ity a t w ork ;

2)

spo rt du ring le isu re tim e; and

3)

physical ac tiv ity

d uring le isu re tim e exc lud ing sp ort . T e st- re te st show ed th at the reliab i lity o f the th ree ind ices

cons tru cte d from th ese facto rs w as adequ ate . Fur the r, it w as foun d tha t leve l o f edu cat ion w as

in versely rela ted to the w o rk index , and po sit ive ly re la te d to th e le isu re- tim e ind ex in bo th sex es.

T he sub jective ex per ien ce o f w ork load w as n ot re la ted to the w o rk index , bu t w a s inv ersely re la ted

to the sp ort in dex , a nd th e leisure-tim e ind ex in b oth sexe s. Th e lean body m ass w as p osi tive ly

re la te d to the w ork index , and th e sp ort in dex in m ales, bu t w a s not re la te d to th e leisure -tim e

ind ex in ei the r sex . Th ese d if ferenc es in th e re la t ion sh ips su pport the sub div ision of h ab itua l

ph ys ical ac tiv ity in to th e three com ponen ts m entio ned ab ov e.

Am J

l in N u tr 1982:36 :936-942 .

K EY W O RD S H ab itua l p hys ica l activ ity , sub ject ive exp erienc e o f w o rk load , le an b ody m ass

In troduct ion

M easu rem en t o f p hysica l ac tiv ity is o ften

fo und to be im po rtan t in re sea rch ab ou t

hea lth , e spec ia lly in the a rea o f ca rd io vascu -

la r d isea se an d obesity . The accu racy in as-

se ssing en ergy exp en d itu re b y bo th d irec t and

ind irec t ca lo r im e try techn iques is goo d , b u t

the se labo ra to ry tech n iqu es are n o t ap p lica-

b le to la rge sca le ep idem iobog ical s tu d ie s .

T he re a re va rio us m e tho ds fo r m easu ring

phy sical ac tiv ity in large r sca le ep id em io log -

ica l s tud ie s . B ody m ov em en t can be m easu red

w ith pedom ete rs , bu t th is m e thod has lim i-

tatio ns as it on ly m easu res ce rta in ty pes o f

mov emen t

(

1 . T w o fu rth er techn iques a re

m on ito r ing hea rt ra te w ith a portab le heart

ra te reco rde r 1 , 2 an d th e use o f an ac tiv ity

d ia ry in w hich th e sub jec ts reco rd the ir activ -

ities 1 . W ith all th ree m e tho ds, in fo rm a tion

is on ly co llected fo r a re la tive ly short pe rio d

of tim e and th e lon g-te rm pa tte rn o f h ab itua l

phy sical ac tiv ity o f the ind iv idu al is no t m eas-

u red . In stu dy in g th e re latio nsh ip b etw een

phy sical ac tiv ity an d health , it is necessary to

co nsid er no t on ly the to ta l ene rgy exp en d itu re

d uring a ce rtain day or w eek , b u t a lso to

93 6

co nsid er the pa tte rn o f hab itua l phy sical ac -

tiv ity ov er a lon ge r p e riod .

Q uestion na ire s deve lop ed to m easu re ha -

b itua l p hys ica l ac tiv ity a t w ork and during

leisu re tim e have been u sed in observa tion al

stud ie s , su ch as the F ram in gham S tu dy 3

an d the Tecum seh C om m unity H ealth S tud y

4 . A questio nna ire w as a lso d eve loped to

as ses s hab itua l ph ysica l activ ity o n ly during

leisu re tim e by T ay lo r e t a l (5 ) . The th ree

questio nna ire s , w h ich w ere n o t d esigned to

b e se lf-adm in iste red , m easu red h ab itua l

phy sical activ ity in te rm s of th e usua l tim e

spen t in va rio us ty pes o f ac tiv ity . T h is w as

then m ultip lied by the en ergy expen d itu re

pe r un it o f tim e o f th e ac tiv ity . Th e va lues

fo r the in tensity o f the ac tiv itie s w ere d erived

F rom th e D epa rtm en t o f H um an Nu trit ion , A g ri-

cu ltu ral U niv ers ity , D c D rei jen 12 , 670 3 BC W agen in-

gen , Th e N ether land s.

Suppo rted b y a gran t f rom the P ra even tiefo nds ,

F ran ckenstraa t 3 , 25 82 SC s-G raven hag e, T he N ether -

lands.

A uthor to w hom requ ests fo r repr in ts sho uld be

addressed .

R eceiv ed D ecem ber 2 4 , 198 1 .

A ccep ted fo r pub lica tio n M ay 12 , 19 82 .


2/7

M EA SU REM EN T OF H A B I T U A L PH Y SI CA L A CT IV IT Y

937

f rom data in the l i terature. In the H eal th

Insurance Plan Study , a sel f -adm inistered

questionnai re containing 10 i tem s about oc-

cupational and lei sure-time physical acti v i ty

w as used (6). T he scores w ere calculated w i th-

out the use of intensi ti es for the di f ferent

types of acti vi ti es.

T o the authors know ledge, the rel i abi l i ty

of the questionnaires m entioned above has

not been tested. Cri ter i on-oriented val i dati on

(concurrent val i dati on) i s not possible be-

cause a val i d ref erence m ethod that m easures

habi tual physical acti v i ty independentl y , does

not ex i st. T heref ore, some investigators hav e

studied the relati onship betw een the assessed

habi tual physical acti v i ty and another param-

eter that i s assum ed to be related to habi tual

phy sical acti v i ty , eg, physical w ork capaci ty

(5). I t i s of i nterest to study the construct

val i di ty of the questionnai re (7), especial l y

w hen a completel y val i d cr i teri on i s not av ai l -

able. T his impl ies that an adequate investi -

gati on encompasses the study of subdiv i sion

of phy sical acti v i ty into more speci f i c group-

ings of acti v i ti es. U nti l now tw o dimensions

of habi tual physical acti v i ty have been disti n-

guished, namely , occupational and lei sure-

time physical acti v i ty . H ow ever, i t m ay be

possible to disti nguish more or other dimen-

sions, w hich are important to the descr ipti on

of the pattern of habi tual physical acti v i ty .

T he purpose of the present study in young

adul ts i s f i rst, to inv estigate the construct

val i di ty of a sel f -adm inistered questionnai re

about habi tual physical acti v i ty and to estab-

l i sh meaningful i ndi ces of physical acti v i ty ,

second, to estim ate the test-retest rel i abi l i ty

of the questionnai re, and thi rd, to inv estigate

the relati onship betw een the indices of phy s-

i cal acti v i ty and age, level of education, sub-

jecti ve ex perience of w ork load, and lean

body mass.

M ethods

opu l a t i o n

I n the f i rst part of 1980 a study w as carried out in the

M unici pal i ty of Ede i n T he N etherlands in w hi ch al l the

i nhabi tants in three age groups (19 to 21, 24 to 26, and

29 to 31 yr as of January 1, 1980) w ere inv i ted to

par ti ci pate (8). T hei r addresses w ere obtained f rom the

Civ i l R egistrati on O f f i ce in Ede. A l l the parti cipants

f rom three secti ons of the m unicipal i ty , w i th a distribu-

tion of sex , age, and l evel of education com parabl e w i th

the total study populat ion, w ere inv i ted agai n i n N ovem-

ber 1980 to par ti ci pate in the present study . Com plete

i nform ation w as obtai ned f rom 309 subjects, represent-

in g

70

of al l i nv i ted subjects. W om en, pregnant f or 3

m onths or longer (n 3), w ere ex cluded f rom further

analyses.

r o c e d u r e

A l l subjects w ere inv i ted by m ai l to com plete the

questionnai re at hom e and then to v isi t a m obi le research

uni t that w as stat ioned i n each section of the m unici pal i ty

f or 7 days. T he questionnai re w as check ed for complete-

ness and the anthropometri c m easurem ents w ere m ade

at the mobi l e research uni t. B ody w ei ght and body height

w i thout shoes and jack et w ere m easured to the nearest

0. 1 kg and 0. 1 cm , respecti vel y . B iceps, tri ceps, suprai l i ac,

and subscapular sk infold thick nesses w ere measured,

according to D urnin and Raham an (9), tw ice on the lef t

si de of the body to the nearest 0.2 m m usi ng a H ol tain

sk inf old cal iper. B ody fat w as calculated as a percentage

of total body w eight (B F ) f rom the average sum of the

four sk infol d thi cknesses, usi ng l i near regression equa-

ti ons for 20- to 29-y r-ol d m al es and fem al es (10). L ean

body mass (L B M ) w as calculated f rom total body w eight

(W ) and B F [L B M

W ( l O O

-

BF ) /100].

A pprox im atel y 3 months af ter this exami nat ion, the

par ti ci pants w ere v i si ted at hom e and requested again to

complete the quest ionnai re on habi tual physi cal act i v i ty

so that the test- retest rel iabi l i ty could be studi ed. T he

v i si t w as part ofa food consum ption study i n w hich 90

(n 277) of al l subjects parti cipated.

Qu e s t i o n n a i r e

U sing a questionnai re, inf ormation w as col lected on

the l evel of education, subj ecti ve ex per ience of w ork

load, and habi tual physical act i v i ty . T he present subdi -

v ision of education into three level s has been descri bed

elsew here (8) . Subjecti ve experience of w ork load w as

measured by means of an ex isting D utch quest ionnai re

(SEW L ) dev i sed by losten (I 1). T his questi onnai re con-

sists of 53 i tems ref err ing to dai l y acti v i t i es. I t contai ns

a dichotom ous response format; a subject experiences a

certai n acti v i ty ei ther as physical l y strenuous or not. T his

response scale is di f f erent f rom the B org s percei ved

ex erti on rating scal e ( 12) ; how ever, i t m ay be assum ed

that both scales are related to the identi cal concept.

T he original questionnai re on habi tual phy sical act i v -

i ty consisted of 29 i tem s concerning the fol low ing f i ve

com ponents: occupation, movem ent, sport, leisure tim e

act i v i t i es excl udi ng sport, and sl eeping habi ts. A l l re-

sponses w ere precoded on f iv e-point scales w i th the

ex ception of the questions on the nam e of m ain occu-

pat ion and the types of sport played. T hree lev els of

occupati onal phy sical acti v i ty w ere def ined accordi ng to

T he N ether lands N utr i ti on Counci l (13): the l ow lev el

f or occupations such as, cleri cal w ork , dri v ing, shopkeep-

i ng, teaching, study ing, housew ork , medical pract i ce, and

al l other occupations w i th a universi ty educat ion; the

mi ddl e level f or occupations such as, f actory w ork ,

plumbing,

carpentry,

and farm i ng: and the high level f or

occupati ons such as, dock w ork , construct ion w ork , and

sport.

Spor ts w ere subdi v ided into three l evels of physical

act i v i ty accordi ng to D urnin and Passm ore (14); the low

lev el f or sports such as, bi l l i ards, sai l i ng, bow l i ng, and

gol f (average energy ex pendi ture 0.76 M I /h); the m iddle

lev el f or sports such as, badmi nton, cycl ing, dancing,


3/7

T A B L E 2

M ean body w ei ght , body hei ght, and percentage

of body fat in males and females

938

B A ECK E ET A L

sw im mi ng, and tenni s (average energy expendi ture 1.26

MI /h ) ;

and the high level f or sports such as, box i ng,

bask etbal l , f ootbal l , rugby , and row i ng (average energy

ex pendi ture 1.76 M I /h). A sport score w as calculated

f rom a com bi nat ion of the intensi ty of the sport w hich

w as played, the am ount of tim e per w eek play ing that

sport,

and the proportion of the year in w hich the sport

w as played regularl y (see A ppendix ).

S ta tis tic al m e th od s

Pri ncipal -com ponents analysis w i th quarti max rota-

t ion (15 ) w as used to f i nd m eaningful under ly ing dim en-

sions of habi tual physi cal acti v i ty . O nly factors w i th

Ei genval ues greater than 1 .0 w ere retai ned for the f inal

rotated soluti on. I ndices of phy sical act i v i ty w ere con-

structed f rom the underl y ing concepts by com bi ning the

var iables w i th high loadi ngs ( 0.50) on the factor in

questi on as descr ibed i n the A ppendix . W i th a second

method, f actor scores of separate one- factor solutions of

the appropriate set of v ariables w ere calculated. Final l y

the f i rst method was chosen because i t w as the si mplest

and the cor relation betw een the tw o m ethods w as hi gh

for al l i ndices ( r

>

0.95).

Product-moment correl ation-coef f i cients w ere calcu-

hated in order to study the test-retest rel iabi l i ty , and f or

the determ inat ion of the relat ionships betw een the m di -

ces of phy sical acti v i ty and age, l evel of educat ion, and

SEW L . M ul tip le regression analy sis

was

used to study

the relat ionshi p betw een L B M and the i ndi ces of phy sical

acti v i ty , w i th adjustm ents for body height and percentage

of body fat bei ng made by addi ng these variables sim ul -

taneously in the analy sis.

Results

T able 1 show s the f requency distr i buti on

of age and lev el of education in the present

study populati on. T here w ere a reasonable

number of subjects in each age group and

each level of education in both sexes. T able

2 show s the mean and SD of body w eight,

body height, and percentage of body fat. T he

distri buti on of the percentage of body f at i n

m ales and body w eight in f em ales w ere sig-

ni f i cantl y skew ed to the r ight, but other meas-

T A B L E 1

Frequency di stri but ion of age and l evel of

educati on i n m ales and f em ales

Variab le

Males

n - 39

emales

n - 67

A ge (y r)

20-22

38.1

35.9

25-27

35.3

31.1

30-32

26.6

32.9

L ev el of education

L ow

18.0

25.7

Midd le

48.2

52.1

H igh

33.8

22.2

M ales Fem ales

Meas u r em en t

(n

-

39) (n

=

67)

m n S m e a n S

B ody w t ( k g) 76.9 10.1 62.5 8.3

B ody ht (cm) 180.5 7.2 167.3 5.6

B ody fat ( ) 17.0 4.5 27.3 5.0

T A B L E 3

Factor-l oading m atr i x of the i tem s about

phy sical acti v i ty ; com bi ned resul ts of

m al es (n

=

139) and f emales (n

=

167)

Factor

I t e m

I

2 3

1 0 . 7 4 -0.08 -0.08

2

-0 .85

0.05 -0.01

3

0 .80

-0.02 0.01

4

0 .81

-0.06 -0.02

5 0 .8 3

0.02 -0.01

6

0 .59

-0.23 0.10

7

0 .57

0.04 -0.09

8

0 . 71

0.04 -0.05

9 -0.09

0 .86

-0.09

1 0.04

0 . 78

0.23

11 -0.13

0 .59

0.18

12 -0.12 0 .87 -0.06

13 0.15 -0.10

-0 .52

14 -0.02 -0.09

0 .72

15 -0.03 0.15 0 .79

16 0.03 0.04

0 .50

Explained v ariation

( )t

See A ppendix for the i tems.

t

A f ter ro tati on.

28.0 16.0 11.1

urem ents w ere approx imatel y normal l y di s-

tributed.

T hi r teen of the original 29 i tems about

habi tual phy sical activ i ty w ere ex cluded, be-

cause of a bimodal di stri buti on of responses,

or because the i tem s did not hav e a high

loading on one speci f i c f actor. T able 3 con-

tains the factor- l oading matr i x of the 16 re-

maining i tems. D ata on males and females

w ere pooled because the sex-speci f i c matri ces

show ed a sim i lar pattern. I tems 1 to 8 had

high loadings on the f i rst factor. B ecause

these i tems w ere concerned w i th occupational

phy sical acti v i ty , the f i rst factor may be in-

terpreted as a dimension of phy sical acti v i ty

at w ork . T he second f actor i s indi cati ve of

sport during lei sure time, because i tems 9 and

12 w hich w ere concerned w i th sport had high

loadings on thi s f actor. I t appeared that i tem


4/7

T A B L E 4

M ean scores of the indices of phy sical acti v i ty

in mal es and females

m ales and fem ales

M EA SU REM EN T O F H A B I T U A L PH Y SICA L A C T IV IT Y

939

I n d e x

Ma l e s

n - 1 3 9

F e ma l e s

n

=

6 7 p

mean S mean S

Wor k

2.6 0. 1 2.9 0.0


5/7

940

cal acti v i ty w hich w ere studied. T he f i rst

factor consisted of aspects of occupational

phy sical acti v i ty (i tems 1 to 8). A s al l occu-

pations have been precoded according to

three lev els of physical acti v i ty , i tem 1 giv es

an objecti ve measure of phy sical acti v i ty at

w ork . H ow ever, thi s measure has the disad-

vantage that a parti cular occupation i s alw ays

classi f i ed in the same w ay and therefore in-

ter i ndi v idual v ar iabi l i ty i n phy sical acti v i ty

w i thin a certain occupation i s not taken into

account. T he m easurement of phy sical acti v -

i ty at w ork can be improved w i th the addi ti on

of i tems 2 to 8 concerning sel f -assessm ent of

phy sical acti v i ty . I t has been show n that sel f -

assessment of phy sical acti v i ty paral l el s the

scores of actual phy sical acti v i ty reasonably

w el l (16).

T he second f actor can be interpreted as

sport during lei sure time. I tems 10 and 11

concerning habi tual physical acti v i ty during

lei sure time in general w ere related to sport.

T his f i nding suggests that people connect

physical acti v i ty dur ing lei sure time m ainl y

w i th play ing sport. B ul l en et al (17), w ho

measured physical acti v i ty by observation,

show ed that there i s inter indi v idual variabi l -

i ty i n the energy expendi ture w i thin certain

types of sport. I t can be suggested that thi s

inter indi v idual v ar iabi l i ty i s partl y taken into

account by i tem s 10 and 1 1

I n addi ti on to

sport i n lei sure tim e, another dimension of

physical acti v i ty in lei sure time could be dis-

ti nguished. T his relates to w atching telev i -

sion, w alk ing, and cycl i ng during lei sure tim e

in general , and the time spent w alk ing and/

or cycl i ng per day to and f rom w ork , school

and shopping, in parti cular.

T he test-retest rel i abi l i ty of the indices of

phy sical acti v i ty , measured w ith an interval

of 3 m onths, being betw een 0.80 and 0.90 f or

the w ork index and sport i ndex , and 0.74 f or

the lei sure-time index , make the question-

nai re usef ul .

T he f inding, that the lev el of education w as

inv ersely related to the w ork index , and pos-

i ti vel y related to the lei sure-time index , i s in

accordance w i th the resul ts of the O slo Study

(18). T he sport i ndex also tended to be posi -

ti vel y related to the lev el of education, but

thi s w as only signi f i cant in females. T he in-

verse relati onship observ ed betw een SEW L

and the sport i ndex and lei sure-time index ,

B A EC K E ET A L

w hi le SEW L w as not related to the w ork

index , may be explained by the fact that there

i s more f reedom of choice in the selecti on of

acti v i ti es during lei sure time than at w ork .

People w ho have a high SEW L tend to choose

more sedentary acti v i ti es dur ing lei sure tim e

than people w i th a low SEW L .

L B M w as chosen as a parameter of body

com posi ti on because there i s supposed to be

a relati onship betw een L B M and physical

acti v i ty . H ow ever, i n analyzing the relati on-

ship betw een L B M and the indices of phy sical

acti v i ty , adjustments f or body height and the

percentage of body fat should be made. T he

ef fects of the percentage of body fat may be

especial l y conf using since the relati onship of

body f at to L B M is assumed to be posi ti v e

19, 20), w hereas the relati onship of body fat

to phy sical acti v i ty may be negati v e. T he

adjusted posi ti ve relati onship betw een L B M

and the w ork index and the sport i ndex in

males i s in accordance w i th the posi ti v e re-

lati onship betw een L B M and physical acti v -

i ty observed by others (2 1-23). T he lei sure-

time index w as not related to L B M , w hich

may indicate that the intensi ti es of the acti v -

i ti es dur ing lei sure-tim e are too low to af fect

L B M . T he independence of physical acti v i ty

and L B M observed in females may also be

ex plained in the sam e w ay.

I n summary , i t w as concluded that habi tual

phy sical acti v i ty encompassed three disti nct

dim ensions. T hese w ere physical acti v i ty at

w ork , sport dur ing lei sure-tim e, and other

physical acti v i ty during lei sure-time. T he in-

di ces of physical acti v i ty deri v ed f rom these

dimensions w ere rel i able. T he di f f erences in

the relati onships betw een the three indices of

physical acti v i ty on one side and level of

education, SEW L , and L B M on the other

side, em phasize the need to disti nguish the

three dimensions. T heref ore, the present

study suggests that habi tual phy sical acti v i ty

can be determ ined w hen these three f actors

are measured and included in the assessm ent.

T he authors thank the L ocal Governm ent Of f i ce and

the Ci v i l Registrati on O f f i ce i n Ede for assistance in the

preparati on of the study population; and al l the people

w ho parti cipated in the study . T he authors also thank K

B aerends-B os, P D eurenberg, Y van

Erp, R

Hoogkamer-

W ei jm an, W K nuim an-H i j l , E O ostenhav en-Rappard,

W van der W iel -W etzels, B Schol te, and H W est for

technical assi stance w i th the study .


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M EA SU REM EN T O F H A B I T U A L PH Y SI CA L A CT IV I T Y

941

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2. Saris W H M , Snel P. B aeck e I , W aesberghe F van,

B ink horst RA . A portable m iniature sol id-state heart

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