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Comparison of IPAQ-SF and Two Other Physical Activity Questionnaires with Accelerometer in Adolescent Boys.

05 Jan 2017-PLOS ONE (Public Library of Science)-Vol. 12, Iss: 1
TL;DR: None of the questionnaires can be used as a reliable individual-level estimate of MVPA in male adolescents, as underreporting was more marked in active boys with average daily MVPA, and was not significant in less active boys.
Abstract: Self-report measures of physical activity (PA) are easy to use and popular but their reliability is often questioned. Therefore, the general aim of the present study was to investigate the association of PA questionnaires with accelerometer derived PA, in a sample of adolescent boys. In total, 191 pubertal boys (mean age 14.0 years) completed three self-report questionnaires and wore an accelerometer (ActiGraph GT1M) for 7 consecutive days. The PA questionnaires were: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Tartu Physical Activity Questionnaire (TPAQ), and the Inactivity subscale from Domain-Specific Impulsivity (DSI) scale. All three questionnaires were significantly correlated with accelerometer derived MVPA: the correlations were 0.31 for the IPAQ-SF MVPA, 0.34 for the TPAQ MVPA and -0.29 for the DSI Inactivity scale. Nevertheless, none of the questionnaires can be used as a reliable individual-level estimate of MVPA in male adolescents. The boys underreported their MVPA in IPAQ-SF as compared to accelerometer-derived MVPA (respective averages 43 and 56 minutes); underreporting was more marked in active boys with average daily MVPA at least 60 minutes, and was not significant in less active boys. Conversely, MVPA index from TPAQ overestimated the MVPA in less active boys but underestimated it in more active boys. The sedentary time reported in IPAQ-SF was an underestimate as compared to accelerometer-derived sedentary time (averages 519 and 545 minutes, respectively).

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RESEARCH ARTICLE
Comparison of IPAQ-SF and Two Other
Physical Activity Questionnaires with
Accelerometer in Adolescent Boys
Triin Ra
¨
a
¨
sk
1
*, Jarek Ma
¨
estu
1
, Evelin La
¨
tt
1
, Jaak Ju¨ rima
¨
e
1
, Toivo Ju¨ rima
¨
e
1†
, Uku Vainik
2
,
Kenn Konstabel
2,3
*
1 Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia,
2 Department of Psychology, University of Tartu, Tartu, Estonia, 3 National Institute for Health Development,
Tallinn, Estonia
These authors contributed equally to this work.
Deceased.
*
triin.raask@ut.ee (TR); kenn.konstabel@tai.ee (KK)
Abstract
Self-report measures of physical activity (PA) are easy to use and popular but their reliability
is often questioned. Therefore, the general aim of the present study was to investigate the
association of PA questionnaires with accelerometer derived PA, in a sample of adolescent
boys. In total, 191 pubertal boys (mean age 14.0 years) completed three self-report ques-
tionnaires and wore an accelerometer (ActiGraph GT1M) for 7 consecutive days. The PA
questionnaires were: International Physical Activity Questionnaire-Short Form (IPAQ-SF),
Tartu Physical Activity Questionnaire (TPAQ), and the Inactivity subscale from Domain-
Specific Impulsivity (DSI) scale. All three questionnaires were significantly correlated with
accelerometer derived MVPA: the correlations were 0.31 for the IPAQ-SF MVPA, 0.34 for
the TPAQ MVPA and -0.29 for the DSI Inactivity scale. Nevertheless, none of the question-
naires can be used as a reliable individual-level estimate of MVPA in male adolescents. The
boys underreported their MVPA in IPAQ-SF as compared to accelerometer-derived MVPA
(respective averages 43 and 56 minutes); underreporting was more marked in active boys
with average daily MVPA at least 60 minutes, and was not significant in less active boys.
Conversely, MVPA index from TPAQ overestimated the MVPA in less active boys but
underestimated it in more active boys. The sedentary time reported in IPAQ-SF was an
underestimate as compared to accelerometer-derived sedentary time (averages 519 and
545 minutes, respectively).
Introduction
Self-report methods for assessing physical activity (PA) include retrospective questionnaires,
interview-administered recall, activity diaries and mail surveys [
1]. Questionnaires have been
most commonly used to assess children’s subjective rating of PA, because of being relatively
inexpensive and easy to use in large-scale studies [
23]. However, self-report questionnaires
PLOS ONE | DOI:10.1371/journal.pone.0169527 January 5, 2017 1 / 14
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OPEN ACCESS
Citation: Ra¨a¨sk T, Ma¨estu J, La¨tt E, Ju¨rima¨e J,
Ju¨rima¨e T, Vainik U, et al. (2017) Comparison of
IPAQ-SF and Two Other Physical Activity
Questionnaires with Accelerometer in Adolescent
Boys. PLoS ONE 12(1): e0169527. doi:10.1371/
journal.pone.0169527
Editor: Maciej Buchowski, Vanderbilt University,
UNITED STATES
Received: February 15, 2016
Accepted: December 19, 2016
Published: January 5, 2017
Copyright: © 2017 Ra¨ a¨sk et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
file.
Funding: The research was supported by
institutional grant number IUT 20-58 from the
Estonian Research Council and institutional grant
no. SF0180048s09 from the Estonian Ministry of
Education and Science (
https://hm.ee/en). The
funders had no role in study design, data collection
and analysis, decistion to publish, or preparation of
the manuscript.

have been shown to have weak to modest correspondence to objectively measured PA [46].
In contrast, accelerometers are found to be reliable and valid objective instruments for measur-
ing PA in children and adolescents, but more expensive and time-consuming to use than self-
report methods [
68].
Objective and subjective methods assess PA in different ways. The criterion validity of The
International Physical Activity Questionnaire (IPAQ) is usually assessed using accelerometers;
with both instruments, one can use minutes per day in different intensity categories (e.g., mod-
erate or sedentary) as unit [
2,9,10]. Comparing absolute values, one has to take into account
that accelerometer data reduction methods have shown large influence on the comparison of
objective and subjective methods [
1,10,11]. Meta-analysis results have shown small-to medium
correlations between IPAQ and objective measurement [
12], but in a few studies, no or very
low correlations have been found [
1314].
In previous papers we have compared a moderate to vigorous physical activity (MVPA)
index derived from Tartu Physical Activity Questionnaire (TPAQ, a self-report questionnaire
of PA) with accelerometer derived MVPA in adolescent boys [
1516]. We have found that
TPAQ-derived MVPA index was weakly associated with accelerometer-derived MVPA [
16].
The differences between self-reported and accelerometer-measured PA are found to be
larger at higher activity and intensity levels [
11,12,17]. In addition, people do not have a built-
in mechanism for telling moderate from vigorous activity, and the subjective boundary may
considerably vary from person to person. The convergent correlations could thus be expected
to be stronger for MVPA than for moderate PA (MPA) or vigorous PA (VPA) taken sepa-
rately. In addition, international PA recommendations for adolescents are mostly about
MVPA [
18]. Our focus in this paper will therefore also be MVPA.
Adults and adolescents tend to overreport their PA in IPAQ, as compared to accelerometer
measures [
2,19,20]. Adolescents tend to overreport VPA and underreport their MPA in IPAQ
short form (IPAQ-SF) [
1,10,21]. In one study [22], however, underreporting of MPA and VPA
was found in adolescents. The problem in that study may have been inaccurate criterion rather
than underreporting: using ActiReg, they had weekly (7-day) average values of MPA and VPA
as 845 and 256 minutes, respectively, which amounts to an unusually high level of 157 minutes
of daily MVPA; using IPAQ, the comparable value was 55 minutes which is more realistic in
European adolescents.
As the reliability of self-report measures of PA in adolescents is being questioned, there is a
clear need of studies comparing questionnaires to objective criteria. Therefore, the general aim
of the present study was to investigate the association of PA questionnaires with accelerome-
ter-derived (ActiGraph GT1M) PA in a sample of 13-14-years-old pubertal boys. More specifi-
cally, we will examine both relative agreement (correlations) and absolute agreement (e.g.,
over- and underestimation) between the respective methods.
Materials and Methods
Participants and study design
This study was a part of the project “Risk factors for metabolic syndrome in boys during
pubertal development: A longitudinal study with special attention to PA and fitness”. This
project started in 2009 when all boys from 3
th
and 4
th
grades from Tartu, Estonia and its imme-
diate surroundings were invited to participate [
16,23,24]. The project invitation was then
given to each boy of particular classes in those schools who agreed to participate and approxi-
mately 84% of them agreed to take part. Initial exclusion criteria were different health prob-
lems that did not allow the potential subjects to participate in physical education classes
[
15,25]. All participants were thoroughly informed of the purposes and contents of the project
IPAQ vs Accelerometer
PLOS ONE | DOI:10.1371/journal.pone.0169527 January 5, 2017 2 / 14
Competing Interests: The authors have declared
that no competing interests exist.

and a written informed consent was obtained from the parents before participation in the proj-
ect. The participants gave verbal assent. All participants had the right to stop participating at
any time-point of the project. This project was approved by the Medical Ethics Committee of
the University of Tartu, Estonia.
This project had for four waves of data collection. After the first testing in the laboratory
the participants were called back in the following three years. All four waves of data collections
took place at approximately same time of the year: the first wave of data collection lasted from
November 2009 to April 2010, the second wave from November 2010 to April 2011, the third
wave from November 2011 to April 2012, and the fourth wave from November 2012 to April
2013.
In the present paper, we use data from the fourth data collection wave. The total sample size
was 217, but due to missing data, the sample available for our analyses was 191 boys (age
14.0 ± 0.7 years).
During the research day, all participants completed self-report PA questionnaires:
IPAQ-SF, TPAQ, and Domain-Specific Impulsivity (DSI) Inactivity scale. At the end of the
research day, participants were asked to wear an ActiGraph GT1M accelerometer for seven
consecutive days.
Measurement of body parameters
Measurements of all body parameters were conducted by trained researchers. Participants’
body height and mass were measured on the first day of the measurements. Body height was
measured in standing position to the nearest 0.1 cm using Martin metal anthropometer. Body
mass was measured with minimal clothing with a medical balance scale (A&D Instruments,
UK) to the nearest 0.05 kg. Body mass index (BMI) was calculated as the body mass divided by
the square of body height (kg/m
2
).
Objective measurement of PA
PA was assessed by accelerometer GT1M ActiGraph (Monrovia, CA, USA). The accelerometer
has been previously validated in laboratory and free-living conditions in young people [26
28]. The accelerometer is compact, small (3.8x3.7x1.8cm) and light-weight (27g) uniaxial mon-
itor designed to detect vertical accelerations ranging in magnitude from 0.05 to 2.00 G’s with a
frequency of 0.25–2.50 Hz and converts the signal to numeric values known as activity counts
[
2,26]. We used the same intensity categories as previously used in other similar studies [27
29]: sedentary time (< 100 counts per min), light PA (LPA) (> 100 counts per min), MPA
(> 2000 counts per min) and VPA (> 4000 counts per min). Additionally, MVPA was calcu-
lated by summing the highest two intensity categories. At the end of the research day, partici-
pants were asked to wear the accelerometer always on the right hip with adjustable elastic belt
for 7 consecutive days during waking hours, except during water and bathing activities. The
participants received the accelerometer together with written and verbal instructions, and
were demonstrated how to wear the device. The accelerometer was programmed to record
activity counts in 15-s epochs; non-wear time (excluded from the analysis) was defined as 20
consecutive minutes of 0 counts. PA data were included for further analyses if the subject had
accumulated a minimum of 8-hours of activity data per day for at least 3 days [
27]. Raw data
were downloaded into the ActiLife software (version 5.3.0) computer software and then
imported to R [
30] for further analysis. To avoid confounding by wear time, the variables refer-
ring to time in activity categories were transformed to “adjusted minutes” [
31] by dividing the
raw minutes by wear time and multiplying the resulting fraction by the average wear time.
IPAQ vs Accelerometer
PLOS ONE | DOI:10.1371/journal.pone.0169527 January 5, 2017 3 / 14

Subjective assessment of PA
The subjective assessments of PA included the IPAQ-SF, TPAQ, and DSI Inactivity scale
(assessing the tendency to avoid being physically active). The self-report questionnaires were
filled out during the research day and with the assistance of researchers.
IPAQ-SF is a self-report questionnaire that assesses PA in the last 7 days [
910]. Using the
IPAQ-SF scoring system, the total number of days and minutes of PA were calculated for each
participant as recommended in the IPAQ website [
32]. The IPAQ-SF records the activity in
four intensity levels: sitting, walking, moderate intensity (e.g., leisure cycling), and vigorous
intensity (e.g, running or aerobics). In this study we used sitting time, walking, and MVPA as
converted to minutes per day.
TPAQ is a short self-report questionnaire that consists of 26 questions about the last week
PA [
16,33,34]. Nineteen of the questions were not directly about PA level (e.g., costs of attend-
ing the sports club; reasons for missing the physical education classes; does the respondent’s
best friend attend to a sports club, etc.). In our study, we only used the questions that were
directly related to sedentary time, walking and MVPA; in some cases, information from two or
more questions was combined to make up a single variable: (Question [Q]1) walking/cycling
(minutes per week were computed by multiplying two answers: how many days in a typical
week did the child go to school by foot or by bike, and how many minutes did it take; after
this, weekly minutes of going to school and going home from school were added); (Q2) Sport
club minutes per week (computed analogously to Q1); (Q3) Frequency of PA (how many days
in the previous week was the child at least moderately active for at least 30 minutes); the score
ranged from 0 to 7; (Q4) Frequency of PA yes vs. no (at least 30 minutes 5 times a week was
the child moderately active); (Q5) Screen time (how many hours a day watching TV or using
computer), coded as no time = “1”; less than 1 h = “2”; 2–3 h = “3”; 4–5 h = “4”; more than
6 h = “5”.
The TPAQ MVPA index was calculated as in a previous paper [
15] using the formula
derived from a multiple regression conducted with the data from the third wave of data collec-
tion of the same project: MVPA (logit transformed proportion) = -2.25476 + 0.00018
Q1
+ 0.00023
Q2 + 0.01543
Q3 + 0.18694
Q4–0.05822
Q5. After this, the estimate was back
transformed to proportion units using inverse logit, and then, for ease of presentation and
comparability with objective MVPA, transformed to “adjusted minutes” by multiplying it by
the average wear time. The rationale behind using the MVPA index is twofold. First, for com-
paring objective and subjective assessments of PA, we need to express both in a comparable
way; that is, items from the questionnaire need to be combined into a single index. Secondly,
the self-report questionnaire variables had different units (minutes per week, yes/no scale,
number of days per week) which could not be combined by just adding all items. Using regres-
sion weights, we combined the information from all items in a concise way, and at the same
time made the unit of the resulting index comparable with the objective assessment of MVPA.
As a measure of self-reported inactivity, we used the Inactivity subscale from the DSI scale
(translated with the permission of the authors) [
35]. That scale was developed to assess tenden-
cies for short-term gratification at the expense of long-term goals and standards across six
impulsivity domains, including exercise. The respondents were asked to rate how often they
did each of the activities, on a scale from 0 = "Never" to 4 = "Very often". Sample items from
the exercise subscale include "Avoiding working out (e.g., jogging, going to the gym, etc.)" and
"Being sedentary". To the four original questions, we added "I prefer to move as little as possi-
ble". As the content of these as well as the other items in this subscale refer to being inactive or
avoiding activity, we refer henceforth to this subscale as inactivity scale; the remaining DSI
subscales were not used in the present study. The theoretical maximum of inactivity score was
IPAQ vs Accelerometer
PLOS ONE | DOI:10.1371/journal.pone.0169527 January 5, 2017 4 / 14

thus 20, but in reality, the options “often” and “very often” were seldom used, and almost half
of the sample (47%) indicated a complete disagreement with all 5 items receiving thus a score
of zero. 37% of the sample received a score between 1 and 5, and 16% had a score of 6 or
higher.
Statistical analyses
All analyses were made using R version 3.1.2 [
30]. Descriptive statistics of the participants are
presented as means ± standard deviation (SD), as well as quartiles. Differences between PA
intensity categories measured by IPAQ-SF, TPAQ, DSI Inactivity scale and the accelerometer
GT1M ActiGraph were examined by paired-sample t-test.
Pearson correlations were used to indicate the degree of association between variables. All
variables with minute as measurement unit (i.e., accelerometer-measured time in intensity cat-
egories; subjective estimates of sedentary time, MPA and VPA from IPAQ-SF, as well as
MVPA index from TPAQ) were log transformed before regression analyses (i.e., log transfor-
mation was used for correlations and multiple regression; the means and SDs were calculated
with untransformed data and expressed in minutes).
Agreement between the questionnaires and accelerometer were also assessed using the
Bland and Altman method [
36] as implemented in R package MethComp version 1.22 [37].
Results and Discussion
Descriptive statistics of the anthropometric variables, accelerometer derived PA, and self-
reported PA in 13-14-years-old boys, are shown in
Table 1.
Note that IPAQ-based estimates of MVPA and sedentary time were somewhat smaller than
the corresponding accelerometer-derived measures (respective averages were 43 and 56 min-
utes for MVPA, and 519 and 545 minutes for sedentary time).
Correlations between self-report questionnaires and accelerometer derived PA are shown
in
Table 2.
All questionnaires were correlated with accelerometer-measured PA; the significant corre-
lations ranged from 0.07 to 0.36 for IPAQ-SF, from 0.02 to 0.35 for TPAQ, and from 0.13 to
0.29 for the DSI Inactivity scale.
To find whether questionnaires under- or overestimated PA as compared to accelerometer-
derived PA, we used paired t-tests. We found that IPAQ-SF underestimated MVPA (mean
difference -13.4 minutes per day as compared to accelerometer; t (186) = -5.46, p < 0.0001).
Underreporting was more marked in active boys, whose daily MVPA was at least 60 minutes
(mean difference -31,5 minutes per day; t (72) = 8.3, p < 0.0001), and was not significant in
less active boys (mean difference -1.9 minutes per day; t (113) = 0.68, p = 0.50). The IPAQ-SF
walking, as well as TPAQ walking/cycling were gross underestimates of LPA as measured by
the accelerometer (IPAQ walking: mean difference -146.1 minutes per day; t (187) = 1.81,
p < 0.0001; TPAQ walking/cycling: mean difference -125.1 minutes per day; t (186) = -30.16,
p < 0.0001). The IPAQ-SF walking time was, on the average, significantly lower than TPAQ
walking/cycling time (mean difference 24.0 minutes per day; t (206) = 8.07, p < 0.0001).
Finally, the IPAQ-SF sedentary time was an underestimate as compared to the accelerometer-
derived sedentary time (mean difference -27.1 minutes per day; t (184) = -3.32, p = 0.001).
Agreement between the questionnaires and accelerometer was also assessed using the
Bland and Altman method [
36]. In Fig 1, one can see that the IPAQ-SF underestimated the
MVPA slightly less at higher activity levels (r = -0.14, p < 0.05). In Fig 2, one can see a reverse
but much stronger pattern for TPAQ MVPA index: overestimation at low activity levels but
underestimation at higher activity levels (r = 0.78, p < 0.0001). For IPAQ sedentary time (Fig
IPAQ vs Accelerometer
PLOS ONE | DOI:10.1371/journal.pone.0169527 January 5, 2017 5 / 14

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Journal ArticleDOI
TL;DR: Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings.
Abstract: CRAIG, C. L., A. L. MARSHALL, M. SJOSTROM, A. E. BAUMAN, M. L. BOOTH, B. E. AINSWORTH, M. PRATT, U. EKELUND, A. YNGVE, J. F. SALLIS, and P. OJA. International Physical Activity Questionnaire: 12-Country Reliability and Validity. Med. Sci. Sports Exerc., Vol. 35, No. 8, pp. 1381-1395, 2003. Background: Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Methods: Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Results: Overall, the IPAQ questionnaires produced repeatable data (Spearman's clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. Conclusions: The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment. Key Words: MEASUREMENT, SURVEILLANCE, EPIDEMIOLOGY

15,345 citations

Journal ArticleDOI
TL;DR: In this article, an alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability, which is often used in clinical comparison of a new measurement technique with an established one.

9,160 citations

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