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Journal ArticleDOI

Public health surveillance of habitual physical activity in adolescents and adults in Namibia: a cross-sectional validation of activity questionnaires against accelerometry.

16 Jun 2020-Journal of Public Health (Oxford University Press (OUP))-

TL;DR: The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and adult females in Namibia, though more suitable for population than individual level measurement.
Abstract: Background Monitoring population-level physical activity is crucial for examining adherence to global guidelines and addressing obesity. This study validated self-reported moderate-to-vigorous physical activity (MVPA) against an accurate device-based method in Namibia. Methods Adolescent girls (n = 52, mean age 16.2 years [SD 1.6]) and adult women (n = 51, mean age 31.3 years [SD 4.7]) completed the PACE+/GPAQ self-report questionnaires and were asked to wear an Actigraph accelerometer for 7 days. Validity of self-reported MVPA was assessed using rank-order correlations between self-report and accelerometry, and classification ability of the questionnaires with Mann-Whitney tests, kappa's, sensitivity and specificity. Results In the adolescents, Spearman's rank coefficients between self-reported MVPA (days/week) and accelerometry measured MVPA were positive but not significant (r = 0.240; P = 0.104). In the adults, self-reported MVPA (minutes/day) was moderately and significantly correlated with accelerometer-measured MVPA (r = 0.396; P = 0.008). In both groups, there was fair agreement between accelerometry and questionnaire-defined tertiles of MVPA (adolescents κ = 0.267; P = 0.010; adults κ = 0.284; P = 0.008), and measured MVPA was significantly higher in the individuals self-reporting higher MVPA than those reporting lower MVPA. Conclusions The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and adult females in Namibia, though more suitable for population than individual level measurement.
Topics: Population (51%)

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1
This is a peer-reviewed, author accepted manuscript of the following research article: Nashandi, H. L., Reilly, J.
J., & Janssen, X. (2020). Public health surveillance of physical activity in adolescents and adults in Namibia: a
cross-sectional validation of activity questionnaires against accelerometry. Journal of Public
Health. https://doi.org/10.1093/pubmed/fdaa067
Public Health Surveillance of Habitual Physical Activity in Adolescents and Adults in Namibia: A
Cross-sectional Validation of Activity Questionnaires against Accelerometry
Authors: Hilde L Nashandi
1*
, John J Reilly
2
, Xanne Janssen
2
1 University of Namibia, Faculty of Health Sciences, School of Nursing, Windhoek, Namibia
2 University of Strathclyde Glasgow, Physical Activity for Health Group, Glasgow, Scotland G1 1XQ
*
Address for correspondence
H.L. Nashandi, MPH, School of Nursing, Faculty of Health Sciences, University of Namibia, Private Bag
13301, 340 Mandume Ndemufayo Ave, Pionierspark, Windhoek, NAMIBIA. Email:
hildeliisa@yahoo.com
Keywords: Physical activity; Global Physical Activity Questionnaire; validity; accelerometer; obesity;
exercise; Africa

2
This is a peer-reviewed, author accepted manuscript of the following research article: Nashandi, H. L., Reilly, J.
J., & Janssen, X. (2020). Public health surveillance of physical activity in adolescents and adults in Namibia: a
cross-sectional validation of activity questionnaires against accelerometry. Journal of Public
Health. https://doi.org/10.1093/pubmed/fdaa067
ABSTRACT
Background: Monitoring population-level physical activity is crucial for examining adherence to global
guidelines and addressing obesity. This study validated self-reported moderate-to-vigorous physical
activity (MVPA) against an accurate device-based method in Namibia.
Methods: Adolescent girls (n 52, mean age 16.2y [SD 1.6]) and adult women (n 51, mean age 31.3y
[SD 4.7]) completed the PACE+/GPAQ self-report questionnaires, and were asked to wear an Actigraph
accelerometer for seven days. Validity of self-reported MVPA was assessed using rank order
correlations between self-report and accelerometry, and classification ability of the questionnaires
with Mann-Whitney tests, kappa’s, sensitivity and specificity.
Results: In the adolescents, Spearman’s rank coefficients between self-reported MVPA (days/week)
and accelerometry measured MVPA were positive but not significant (r=0.240, p=0.104). In the adults,
self-reported MVPA (minutes/day) was moderately and significantly correlated with accelerometer-
measured MVPA (r=0.396, p=0.008). In both groups there was fair agreement between accelerometry
and questionnaire-defined tertiles of MVPA (adolescents κ=0.267; p=0.010; adults κ=0.284; p=0.008),
and measured MVPA was significantly higher in the individuals self-reporting higher MVPA than those
reporting lower MVPA.
Conclusions: The PACE+ and GPAQ questionnaires have a degree of validity in adolescent girls and
adult females in Namibia, though more suitable for population than individual level measurement.
Keywords: Physical activity, Validity, Adult women, Adolescent girls

3
This is a peer-reviewed, author accepted manuscript of the following research article: Nashandi, H. L., Reilly, J.
J., & Janssen, X. (2020). Public health surveillance of physical activity in adolescents and adults in Namibia: a
cross-sectional validation of activity questionnaires against accelerometry. Journal of Public
Health. https://doi.org/10.1093/pubmed/fdaa067

4
This is a peer-reviewed, author accepted manuscript of the following research article: Nashandi, H. L., Reilly, J.
J., & Janssen, X. (2020). Public health surveillance of physical activity in adolescents and adults in Namibia: a
cross-sectional validation of activity questionnaires against accelerometry. Journal of Public
Health. https://doi.org/10.1093/pubmed/fdaa067
INTRODUCTION
There has been a “physical activity transition¹ʾ² across Africa: levels of moderate-to-vigorous physical
activity (MVPA) are now very low ³ʾ²ʾ⁴ particularly among adolescent girls and adult women, who are
also at highest risk of obesity across Sub-Saharan Africa³ʾ. In Namibia, childhood obesity prevalence
is high and probably increasing. The 2013 Global School-based Student Health Survey (GSHS)
reported that in Namibia, 10.4% of females aged 13-17 were overweight or obese, and the prevalence
of insufficient physical activity among adolescents exceeded 80% . In Namibia, only 5% of women
and 12% of men age 15-49 are physically active at work, while only 16% of women and 32% percent
of men engage in non-work-related physical activity.
Surveillance of habitual MVPA levels in adolescents and adults in most countries still depends on
subjective, self-report, measures. For example, the PACE+
8
is used widely among adolescents as part
of the Global Student Health Survey (https://www.cdc.gov/GSHS/), and the General Physical Activity
Questionnaire (GPAQ)
9
is used widely as part of the WHO ‘STEPS’ global NCD surveillance
(https://www.who.int/ncds/surveillance/steps/en/). However, the validity of MVPA measured by self-
report is in question-in children and adolescents few self-report measures have been subject to
validations against more accurate measures of MVPA such as accelerometry
10
. In the adolescent
population, there is a dearth of validation study evidence from low-middle income countries
11
and
some validations from high-income countries have been discouraging
12
. Out of 38 validation studies
included in a recent review, only two showed acceptable correlations (r>0.40) compared to
accelerometry
13
. In adults too, validation of many self-report questionnaires used in public health
surveillance has been rare in low-middle income countries, and in high-income countries results have
also been discouraging. For example, prevalence of meeting physical activity guidelines may be
overestimated by self-report in adults in the UK and USA
14,15
. A recent review of physical activity
measures showed the mean difference between questionnaires using a 7-day recall (like those
included in this study) and the gold standard (doubly labelled water) ranged from an underestimation
of 60% to an overestimation of 60%
16
.
Increasing habitual physical activity among children, adolescents, and adults is central to prevention
of obesity and many non-communicable diseases (NCDs)
17,18,19
. If global targets are to be met, or even
monitored, unbiased methods of public health surveillance of physical activity are required. The

5
This is a peer-reviewed, author accepted manuscript of the following research article: Nashandi, H. L., Reilly, J.
J., & Janssen, X. (2020). Public health surveillance of physical activity in adolescents and adults in Namibia: a
cross-sectional validation of activity questionnaires against accelerometry. Journal of Public
Health. https://doi.org/10.1093/pubmed/fdaa067
primary aim of the present study was therefore to validate the self-report of habitual MVPA among
adolescent girls (using the PACE+ questionnaire) and among adult women (using the GPAQ) against
an accurate device-based method (accelerometry) in Namibia.
METHODS
Study sample, recruitment and ethics
The project was approved by the Ministry of Health and Social Services Research Management
Committee. All participants provided informed written consent. The present validation study was part
of a larger study focusing on lifestyle and obesity risk among adolescent girls and adult women in
Namibia. Participants of this larger study were drawn from urban public schools in Khomas region
using stratified random sampling of schools. For the larger study a total of 207 adolescent girls’
participants had their parents give consent and 212 women provided consent and participated in the
study. A subsample of 52 adolescents and 51 adult women were randomly selected (using a random
number selector) to take part in the current study. All measures were taken at school during school
time. In addition, questionnaires regarding physical activity were completed via interviews at schools.
Body fat percentage was measured accurately via deuterium oxide dilution method, as described in
detail elsewhere
6,20
though this variable was used only for descriptive purposes in the present study.
Measurement of habitual MVPA by accelerometry
Participating (n 52) adolescents and adults (n 51) were given an Actigraph GT3X+ accelerometer
(ActiGraph, Pensacola, FL) to wear on the right hip for 7 full days, taking the device off only when
sleeping or during water based activities, as described previously
21,22
. The Actigraph monitor is an
acceptable criterion measure for evaluating questionnaire validity
9
. For feasibility reasons and to
reduce participant burden, accelerometers were distributed to participants on the same day as
questionnaire completion. Data was collected in 30Hz and transformed into 15-second epochs. To be
included in the analysis participants required at least 3 valid days (i.e., at least 10 hours of wear),
including at least one weekend day, in order to obtain an estimate of habitual MVPA
23,24,25
. Data from
the devices were downloaded and cleaned using ActiLife software version 6.12.1 (ActiGraph,
Pensacola, FL). Non-wear time was removed using a 60 minutes of consecutive zeros criteria
21
. The
ActiLife data scoring programme was used to determine daily minutes spent in sedentary time, light
PA intensity (LPA), moderate PA intensity (MPA), vigorous PA intensity (VPA), and MVPA using the
Evenson activity cut point for adolescents which is most accurate to use in this age group
26
and the

Citations
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Journal ArticleDOI
Abstract: One of the strategic actions identified in the Global Action Plan on Physical Activity (PA) 2018–2030 is the enhancement of data systems and capabilities at national levels to support regular population surveillance of PA. Although national and international standardized surveillance of PA among children and adolescents has increased in recent years, challenges for the global surveillance of PA persist. The aims of this paper were to: (i) review, compare, and discuss the methodological inconsistencies in children and adolescents’ physical activity prevalence estimates from intercontinental physical activity surveillance initiatives; (ii) identify methodological limitations, surveillance and research gaps. Intercontinental physical activity surveillance initiatives for children and adolescents were identified by experts and through non-systematic literature searches. Prevalence of meeting PA guidelines by country, gender, and age were extracted when available. A tool was created to assess the quality of the included initiatives. Methods and PA prevalence were compared across data/studies and against the methodological/validity/translation differences. Eight intercontinental initiatives were identified as meeting the selection criteria. Methods and PA definition inconsistencies across and within included initiatives were observed, resulting in different estimated national prevalence of PA, and initiatives contradicting each other’s cross-country comparisons. Three findings were consistent across all eight initiatives: insufficient level of PA of children and adolescents across the world; lower levels of PA among girls; and attenuation of PA levels with age. Resource-limited countries, younger children, children and adolescents not attending school, with disability or chronic conditions, and from rural areas were generally under/not represented. There are substantial inconsistencies across/within included initiatives, resulting in varying estimates of the PA situation of children and adolescents at the global, regional and national levels. The development of a new PA measurement instrument that would be globally accepted and harmonized is a global health priority to help improve the accuracy and reliability of global surveillance.

2 citations


References
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Journal ArticleDOI
J. R. Landis1, Gary G. KochInstitutions (1)
01 Mar 1977-Biometrics
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.

56,227 citations


Journal ArticleDOI
Abstract: TROST, S. G., P. D. LOPRINZI, R. MOORE, and K. A. PFEIFFER. Comparison of Accelerometer Cut Points for Predicting Activity Intensity in Youth. Med. Sci. Sports Exerc., Vol. 43, No. 7, pp. 1360–1368, 2011. The absence of comparative validity studies has prevented researchers from reaching consensus regarding the application of intensity-related accelerometer cut points for children and adolescents. Purpose: This study aimed to evaluate the classification accuracy of five sets of independently developed ActiGraph cut points using energy expenditure, measured by indirect calorimetry, as a criterion reference standard. Methods: A total of 206 participants between the ages of 5 and 15 yr completed 12 standardized activity trials. Trials consisted of sedentary activities (lying down, writing, computer game), lifestyle activities (sweeping, laundry, throw and catch, aerobics, basketball), and ambulatory activities

1,047 citations


Journal ArticleDOI
TL;DR: GPAQ provides reproducible data and showed a moderate-strong positive correlation with IPAQ, a previously validated and accepted measure of physical activity, indicating that it is a suitable and acceptable instrument for monitoring physical activity in population health surveillance systems.
Abstract: Purpose: Instruments to assess physical activity are needed for (inter)national surveillance systems and comparison. Methods: Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). GPAQ and the International Physical Activity Questionnaire (IPAQ) were administered on at least 2 occasions. Eight countries assessed criterion validity using an objective measure (pedometer or accelerometer) over 7 days. Results: Reliability coefficients were of moderate to substantial strength (Kappa 0.67 to 0.73; Spearman’s rho 0.67 to 0.81). Results on concurrent validity between IPAQ and GPAQ also showed a moderate to strong positive relationship (range 0.45 to 0.65). Results on criterion validity were in the poor-fair (range 0.06 to 0.35). There were some observed differences between sex, education, BMI and urban/rural and between countries. Conclusions: Overall GPAQ provides reproducible data and showed a moderate-strong positive correlation with IPAQ, a previously validated and accepted measure of physical activity. Validation of GPAQ produced poor results although the magnitude was similar to the range reported in other studies. Overall, these results indicate that GPAQ is a suitable and acceptable instrument for monitoring physical activity in population health surveillance systems, although further replication of this work in other countries is warranted.

1,007 citations


Journal ArticleDOI
TL;DR: The calibration of four different accelerometers used most frequently to assess physical activity and sedentary behavior in children are reviewed and alternative data processing using the raw acceleration signal is recommended as a possible alternative approach where the actual acceleration pattern is used to characterize activity behavior.
Abstract: Understanding the determinants of physical activity behavior in children and youths is essential to the design and implementation of intervention studies to increase physical activity. Objective methods to assess physical activity behavior using various types of motion detectors have been recommended as an alternative to self-report for this population because they are not subject to many of the sources of error associated with children's recall required for self-report measures. This paper reviews the calibration of four different accelerometers used most frequently to assess physical activity and sedentary behavior in children. These accelerometers are the ActiGraph, Actical, Actiwatch, and the RT3 Triaxial Research Tracker. Studies are reviewed that describe the regression modeling approaches used to calibrate these devices using directly measured energy expenditure as the criterion. Point estimates of energy expenditure or count ranges corresponding to different activity intensities from several studies are presented. For a given accelerometer, the count cut points defining the boundaries for 3 and 6 METs vary substantially among the studies reviewed even though most studies include walking, running and free-living activities in the testing protocol. Alternative data processing using the raw acceleration signal is recommended as a possible alternative approach where the actual acceleration pattern is used to characterize activity behavior. Important considerations for defining best practices for accelerometer calibration in children and youths are presented.

983 citations


Journal ArticleDOI
01 May 2001-JAMA Pediatrics
TL;DR: The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents and correct classification, sensitivity, and false-positive rates were reasonable.
Abstract: Objective: To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings. Study Designs We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity. Results: In study 1 (N=250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N=148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r=0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable. Conclusion: The moderate to vigorous physical activity screening measure is recommended for clinical practice with adolescents.

789 citations


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