Improvement of the EHIS module:

PHYSICAL ACTIVITY

Leila Oja, Ardo Matsi National Institute for Health Development

Estoniawww.tai.ee

National Institute for Health Development (NIHD) is a governmental organisation under the Ministry of Social Affairs of Estonia.

The main activities of the NIHD are the research, development and implementation of activities in the health and social sectors

Content of the presentation

1.Description of the problems2.Definitions of the concept3.Final suggestion for the

instrument4.Presentation of the

instrument

1. Description of the problemsEHIS first wave modified International Physical Activity Questionnaire (IPAQ) was used to evaluate population based PA PE.1 During the past 7 days, on how many days did you do vigorous physical activities?PE.2 During the past 7 days, how much time did you spend doing vigorous physical activities?PE.3 During the past 7 days, on how many days did you do moderate physical activities?PE.4 During the past 7 days, how much time did you spend doing moderate physical activities?PE.5 During the past 7 days, on how many days did you walk for at least 10 minutes at a time?PE.6 During the past 7 days, how much time did you usually spend walking?It was decided to remove the question about sedentary behaviour:PE.7 During the last 7 days, how much time did you spend sitting on a week day?

1. Description of the problems: responses of MS

Problems concerning respondents

• Difficulties to distinguish between moderate and vigorous PA

• Questions are difficult to understand, examples are not suitable, explanations are too long, and not clear enough.

• The same activity could be understood differently by respondents of different age, health status and living conditions.

• Respondents had serious problems to report not only the number of days but also to calculate the amount of time used for different levels of PA

• There is no information about sedentary activity, which is still important concerning health.

• It is difficult to clean the data and assess given answers according to the whole amount of daily PA.

• It would be better to ask PA in different domain (leasure time, domestic work, occupational PA) separately

According to the feedback based on MS experience, certain weaknesses in using the PA module were brought out. The problems reported most often were the following:

Problems concerning analysing the data

1. Description of the problems

Some of the mentioned problems have clear reasons or explanations:

• Different MS have made their own modifications, that makes it difficult to compare the results.

• Too much freedom has been left to translators.

• Given examples are not relavant across EU

1. Description of the problems: evaluation of PA module Responses of MS about PA Module

PE1 PE2 PE3 PE4 PE5 PE60%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3632 35 36

41 41

1418

20 149 9

41 4135

4136 36

9 9 10 914 14

Should be removed

Should be changed totally

Should be kept with some adaptation

Should be kept without any change

2. Definitions of the concept: The terms used in module

Physical activityOccupational physical activityLeisure timeSleeping time

EHIS takes into account all PA during a day. From the proposals of MS it became evident that it would be good to make difference between occupational and leisure time PA, and add also a question about sleeping time.

2. Definition of the conceptsPhysical activityPA is any body movement that works your muscles and uses more energy than you use when you're resting. Public health surveys focuses more on health enhancing physical activity (HEPA). Occupational physical activityOccupational PA explains physical effort of the respondent's everyday workLeisure time PALeisure time PA includes different versions of physical fitness, such as improving aerobic capacity and muscle strength. Sleeping timeInsufficient sleep is associated with a number of chronic diseases and conditions — such as diabetes, cardiovascular disease, obesity, and depression, also it may complicate daily activities and productivity.

. 

2. Definition of the concepts/ standardized instruments

Several instruments that have been used for the population based assessment of physical activity have not been validated and therefore they cannot be used for EHIS II. Two widely used standardized short self-report or interview-based instruments for physical activity surveillance are available:

. 

• IPAQ - was developed in 1997 as result of various research projects. The short IPAQ form about last 7 days.

• GPAQ (Global PA Questionnaire) was developed in 2001 as part of the WHO Stepwise approach to HCD risk factor surveillance (STEPS) program.

2. Definitions of the concept. Pros and cons

. 

IPAQ• IPAQ requires respondents to recall PA on the

past 7 days compared to a “typical week” in GPAQ.

• IPAQ measurement provides information about the patterns of total physical activity and inactivity.

• IPAQ - for the respondents it is hard to assess the whole amount of daily PA

• IPAQ is the most tested and used in the European context (Eurobarometer (EU), N=15; World Health Survey (WHO), N=50; Int Prevalence Study (IPS), N=19; Eurobarometer 2 (EU), N=25).

• Short IPAQ form is recommended for national monitoring, the shortest instrument available

• Developed formula to estimate PA levels based MET-s (metabolic units)

GPAQ • GPAQ is very similar to the long

version of IPAQ. Both assess frequency, duration and intensity of PA.

• GPAQ has been used in 58 countries across five WHO regions.

• GPAQ questionnaire is not prevalent in the EU countries

• GPAQ has 15 questions in three domains (work, travel, recreation) and is validated for use 16-84 years old compared to 7 questions of short IPAQ which is validated for use among 15-69 years old.

Expert meeting in Tallinn, Sept 7-8, 2010

3. Final suggestion for the instrument

NB! It was the origin of the questions used in EHIS I. Unfortunately many different modifications derived from IPAQ which makes it difficult to compare the results.

Our recommendation is to use the whole package of the original short version IPAQ, which deals with the whole dimension of PA.

IPAQ short version has some limitations, but it is the best instrument available at the moment to measure PA at the population level.

The question about sitting should be included again, and the questions about time in different intensity levels should be modified back to the original version.

3. Final suggestion for the instrumentAttention should be paid:

1) Translation of the Questionnaire, including back-translation and testing2) Interviewers training3) The detailed development of the manual, etc are important to ensure optimal compliance with the aims and data comparability4) Data cleaning and handling must be carried out centrally.5) To those who would like to separate occupational and leisure time PA and estimate about sleeping time we recommend the same additional question for all MS in order to have comparable data

In conclusion :•To use the original IPAQ short version, but explain better different levels of PA and use better explanations in interviewer`s manual•add an optional question about (1) occupational PA

(2) leisure time PA(3) sleeping time

4. Presentation of the instrument: IPAQ short version1. During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting,

digging, aerobics, or fast bicycling?_____ days per weekNo vigorous physical activities Skip to question 3

2. How much time did you usually spend doing vigorous physical activities on one of those days?_____ hours per day _____ minutes per dayDon’t know/Not sure

3. During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or doubles tennis? Do not include walking._____ days per weekNo moderate physical activities Skip to question 5

4. How much time did you usually spend doing moderate physical activities on one of those days?_____ hours per day _____ minutes per dayDon’t know/Not sure

5. During the last 7 days, on how many days did you walk for at least 10 minutes at a time?_____ days per weekNo walking Skip to question 76. How much time did you usually spend walking on one of those days?_____ hours per day _____ minutes per dayDon’t know/Not sure7. During the last 7 days, how much time did you spend sitting on a week day?_____ hours per day _____ minutes per dayDon’t know/Not sure

1. In the last 7 days, how much of the following sports-related activities did you do in your leisure time?

Endurance training, which elevates your heart beat and makes you breath more rapidly (e.g. jogging, ball games, cycling)_____ days per week_____ hours _____ minutes per day

Muscle training, which improves or maintains strength of your muscles (e.g. weight training, sequence training, muscle exercises at home)_____ days per week_____ hours _____ minutes per day

2. In the last 7 days, how would you describe the physical activity level of your work?I do not currently work Go to question X

Mainly sitting without interruptions. Mainly sitting with short periods of physical exertion such as standing, walking,

light carrying etc.

Mainly standing or walking with no extra physical exertion.

Mainly standing or walking with some extra physical exertion such as climbing stairs, light carrying or lifting etc.

A lot of physical activity with heavy physical exertion such as digging, shoveling, hacking, heavy lifting and carrying etc.

3. In the last 7 days, how much did you sleep per 24 hours?_____ hours _____ minutes per 24 hours

4. Presentation of the instrument: optional questions

Remarks for optional questions

By the questionnaire structure the occupational PA questions may be part of the occupational background variables and locate separate from health determinants module.

The question about sleeping time might give extra information to other modules, such as mental health, and therefore in the structure of the questionnaire, it may also be located separately from the PA issues.

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References

Thank you!

Be Active!