Validation of the self-report EXERNET questionnaire for measuring physical activity and sedentary behavior in elderly

Highlights

• EEPAQ had adequate reliability and validity for assessing physical activity and sedentary time in a sample of elderly population from Spain.

• Validity, measured by correlating the EEPAQ with accelerometers, was higher in women than in men.

• The reported estimates support the use of this questionnaire in epidemiological studies to measure PA in elderly population.

• The simplicity of the EEPAQ makes it an user-friendly tool to gather physical activity and sedentary time in the elderly population.

Abstract

This study aims to examine the validity and reliability of the Elderly EXERNET Physical Activity Questionnaire (EEPAQ) in a sample of Spanish elderly population. A sample of 73 elderly successfully completed the EEPAQ and wore an accelerometer over 7 consecutive days. Test-retest reliability of the EEPAQ was assessed by having the participants answer the EEPAQ twice within 14 days. Criterion validity was assessed for the questionnaire against the accelerometer, as the gold standard. Results indicated that EEPAQ had adequate reliability measured by Intraclass correlation coefficient (ICC) (walking ICC = 0.88; sitting ICC = 0.68; household activities ICC = 0.97), and good validity against the accelerometer. Walking had a significant (p < 0.05) correlation with counts min⁻¹ (r = 0.56) and moderate to vigorous physical activity (MVPA) (r = 0.51), as well as a negative significant (p < 0.01) correlation with sedentary minutes (r = −0.33). Sitting time was positively correlated (r = 0.57; p < 0.01) with sedentary time and negatively correlated with the counts min⁻¹ and MVPA. EEPAQ seems to be a valid and reliable tool to measure physical activity (PA) in a population of elderly living in Spain.

Introduction

Physical activity (PA) is important to maintain a good health at all ages. It is particularly critical for people over 65 years old, where inadequate PA not only increases the risk of chronic diseases, but also progressively compromises the ability to live independently (Liffiton, Horton, Baker, & Weir, 2012). A healthy lifestyle where PA is a key factor, contributes to the lower incidence of mortality rates, lower incidence of developing diseases such as hypertension, diabetes or obesity, reduces the risk of falls, improves mood and physical and mental well-being, and decreases functional impairment (Kahn et al., 2002, Taylor et al., 2004; Karmisholt, Gyntelberg, & Gotzche, 2005).

There are a multitude of different methods available to assess PA behavior that can be broadly categorized as either objective or subjective. A common objective measure of PA is the use of accelerometers (Hendelman, Miller, Baggett, Debold, & Freedson, 2000; Welk, Schaben, & Morrow, 2004), which can be used to characterize the duration, intensity, frequency, and total volume of activity performed throughout the day, typically by way of time spent in various intensity ranges (Trost et al., 1998; Welk, Blair, Wood, Jones, & Thompson, 2000; Esliger, Copeland, Barnes, & Tremblay, 2005; Baquet, Stratton, Van Praagh, & Berthoin, 2007; Copeland & Esliger, 2009). Subjective methods of PA assessment include the use of PA surveys or questionnaires that ask participants to recall their PA behavior over a specified time frame or through daily or weekly diaries for current PA behaviors (Grimm, Swartz, Hart, Miller, & Strath, 2012).

Subjective methods to measure PA, such as questionnaires, represent the most convenient means of evaluating PA in epidemiological studies (Armstrong & Welsman, 2006). PA questionnaires are inexpensive, easy to administer to large groups, and allow both quantitative and qualitative data to be collected. While self-report questionnaires generally exhibit good test-retest reliability, they have traditionally been limited by low to moderate validity (Peiro-Velert, Devis-Devis, Beltran-Carrillo, & Fox, 2008), particularly in elderly population, where there are often problems of eyesight, hearing, memory and cognition. Moreover, most of this kind of instruments used are designed and validated in young adults, making its specific validation necessary in elderly (DiPietro, Caspersen, Ostfeld, & Nadel, 1993; Pereira et al., 1997; Harada, Chiu, King, & Stewart, 2001). In addition, most of the available questionnaires have not been validated against a gold standard (Starling, 2001), which restricts its validity. In this sense, accelerometers are frequently used to establish criterion validity in questionnaires (Murphy, 2009), and previously have been validated in adult populations for quantifying the intensity of PA (Brage, Wedderkopp, Franks, Andersen, & Froberg, 2003; Plasqui & Westerterp, 2007) in free-living conditions (Welk, 2002).

The elderly EXERNET PA Questionnaire (EEPAQ), is a short extension tool, easy to use and administer in elderly, which has recently been used in the multi-center EXERNET Study (Gomez-Cabello et al., 2011). To date, it has not been reported whether this questionnaire is valid to assess PA among elderly and whether it is reliable as a tool for the same purpose. There are other more extensive questionnaires in the literature but consequently less applicable in population over 65 years. Furthermore, few questionnaires have been validated in the Spanish population (Roman-Viñas et al., 2010). The purpose of the present study was to determine the reliability and validity of the EEPAQ among a sample of Spanish elderly population. We assessed reliability by a test-retest method, where the participants answered the EEPAQ twice within 14 days. We assessed validity by comparing the questionnaire with the measurements provided by the accelerometer. In Spain, as in many populations throughout the world, there are substantially more, older women than men, therefore data will be analysed separately for males and females to compare results.