Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity

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Abstract

Objective

The purpose of this study is to determine reproducibility and relative validity of the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH).

Methods

Participants (36 men and 14 women, aged 27–58) were asked to complete the SQUASH twice with an inbetween period of approximately 5 weeks. In addition, participants wore the Computer Science and Applications (CSA) Activity Monitor for a 2-week period following the first questionnaire.

Results

The Spearman correlation for overall reproducibility of the SQUASH was 0.58 (95%-CI 0.36–0.74). Correlations for the reproducibility of the separate questions varied between 0.44 and 0.96. Spearman's correlation coefficient between CSA readings and the total activity score was 0.45 (95%-CI 0.17–0.66).

Conclusion

In conclusion, the SQUASH is a fairly reliable and reasonably valid questionnaire and may be used to order subjects according to their level of physical activity in an adult population. Because the SQUASH is a short and simple questionnaire, it may proof to be a very useful tool for the evaluation of health enhancing physical activity in large populations.

Introduction

Epidemiologic studies often use questionnaires to assess physical activity levels, because it is an inexpensive and generally useful tool in categorizing subjects in high and low levels of physical activity. In addition, questionnaires are relatively easy to administer and generally acceptable to study participants [1], [2]. Consequently, self-report questionnaires remain the most commonly used method of assessing physical activity [3]. However, because statistics on physical activity depend on the questionnaire used to assess physical activity, it is often not possible to compare results of population studies. Especially for national and regional health institutes, this constitutes a definite need to standardize measures of physical activity [1], [3].

Following the Americans, Dutch physical activity experts reached consensus about a physical activity guideline, which states that every adult should accumulate 30 min or more of moderate intense physical activity (⩾4 MET) on most, preferably all days of the week. Most of the frequently used physical activity questionnaires like the Baecke [4], [5], the EPIC [6], and the Voorrips questionnaire [7] are not designed to estimate compliance to this guideline.

Therefore, the Dutch National Institute of Public Health and the Environment developed a Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). The basic assumption for the questionnaire was that it should (a) be reproducible and valid, (b) be short (less than 5 min to fill in), and (c) contain questions on habitual activities with respect to occupation, leisure time, household, transportation means, and other daily activities.

It should be noted that the questionnaire was not designed to measure energy expenditure, but to give an indication of the habitual activity level. The SQUASH was structured in such a way that it would be possible to assess compliance to physical activity guidelines.

The aim of this study was to investigate reproducibility and relative validity of the SQUASH in measuring the habitual activity level of a population.

Section snippets

Study population

Participants were recruited from a commercial bank in the cities of Arnhem and Zoetermeer in The Netherlands. The age range of the source population was 18–65 years of age. Recruitment took place in July and August 1999. The aim was to recruit 60 participants, equally divided over men and women. Of the eligible source population 55 employees voluntary applied for the study. Of these, five men withdrew from the study because of time restraints. Eventually, 50 subjects (36 men and 14 women) were

Results

The average age of the study population was 44 years and about 70% were men. Approximately two-thirds of the study population had a primary or lower vocational education. Approximately 50% of the study population had a good, high, or very high fitness (Table 2).

According to the SQUASH 84% of the total minutes of activity per week was spent in the intensity category 2 to <4 MET, whereas according to CSA readings 91% of registered time was spent in this category. The mean absolute amount of time

Discussion

The SQUASH is a short physical activity questionnaire with the general purpose to assess habitual physical activity. Overall reproducibility of the SQUASH was 0.58 (95%-CI 0.36–0.74). High intense activities were more reliable than low intense activities. The SQUASH activity score was significantly correlated with the activity counts per minute measured by the CSA (rSpearman = 0.45, 95%-CI 0.17–0.66). Consequently, the SQUASH is able to explain 4–49% of the total variation in physical activity.

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