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Categorical answer modes provides superior validity to open answers when asking for level of physical activity: A cross-sectional study
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.ORCID iD: 0000-0003-3591-5123
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group.ORCID iD: 0000-0001-6058-4982
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.ORCID iD: 0000-0001-9040-2158
Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's and Mats Börjesson's research group. Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Solna.ORCID iD: 0000-0002-8786-0438
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2016 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 1, 70-76 p., 1403494815602830Article in journal (Refereed) Published
Abstract [en]

AIMS:

Physical activity (PA) used as prevention and treatment of disease has created a need for effective tools for measuring patients' PA level. Our aim was therefore to assess the validity of two PA questions and their three associated answer modes.

METHODS:

Data on PA according to the PA questions and Actigraph GT3X+ accelerometers, aerobic fitness (VO2max), cardiovascular biomarkers, and self-rated general health were collected in 365 Swedish adults (21-66 years). The PA questions ask about weekly PA via categories (Categorical), an open-ended answer (Open), or specified day by day (Table).

RESULTS:

The Categorical mode, compared with the Open mode, correlated (Spearman's rho) significantly more strongly (p<0.05) with accelerometer PA (0.31 vs. 0.18) and VO2max (0.27 vs. 0.06), and the level of BMI (-0.20 vs. -0.02), waist circumference (-0.22 vs. -0.03), diastolic blood pressure (-0.16 vs. 0.08), glucose (-0.18 vs. 0.04), triglycerides (-0.31 vs. -0.07), and general health (0.35 vs. 0.19). The validity of the Categorical and Table modes were similar regarding VO2max and accelerometry, but the Categorical mode exhibited more significant and stronger correlations with cardiovascular biomarkers. The capacity of the PA questions to identify insufficiently physically active individuals ranged from 0.57 to 0.76 for sensitivity and from 0.47 to 0.79 for specificity.

CONCLUSIONS:

The Categorical mode exhibits the strongest validity and Open mode the weakest. The PA questions may be used on a population level, or as a tool for determining patents' appropriateness for treatment.

Place, publisher, year, edition, pages
2016. Vol. 44, no 1, 70-76 p., 1403494815602830
National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-3958DOI: 10.1177/1403494815602830ISI: 000369969000011PubMedID: 26392418OAI: oai:DiVA.org:gih-3958DiVA: diva2:844284
Available from: 2015-08-04 Created: 2015-08-04 Last updated: 2016-09-05Bibliographically approved
In thesis
1. Studies of physical activity in the Swedish population
Open this publication in new window or tab >>Studies of physical activity in the Swedish population
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this.

Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI>25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL.

Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group.

Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model.

Place, publisher, year, edition, pages
Stockholm: Gymnastik- och idrottshögskolan, GIH, 2016. 71 p.
Series
Avhandlingsserie för Gymnastik- och idrottshögskolan, 05
Keyword
physical activity, physical fitness, sedentary, questionnaire, validity, self-rated health, sensitivity, specificity, physical activity on prescription, accelerometry, the Ekblom-Bak test, answer modes, movement pattern, health-related quality of life, physical health
National Category
Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4309 (URN)978-91-980862-5-6 (ISBN)
Public defence
2016-02-19, Aulan, Lidingövägen 1, Stockholm, 09:00 (Swedish)
Opponent
Supervisors
Projects
LIV 2013
Available from: 2016-01-28 Created: 2016-01-27 Last updated: 2016-02-17Bibliographically approved

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Olsson, Sven Johan GustavEkblom, ÖrjanAndersson, EvaBörjesson, MatsKallings, Lena
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