Relative validity and repeatability of a new questionnaire on physical activity

Association between Alcohol Consumption and Body Composition in Russian Adults and Patients Treated for Alcohol-Related Disorders: The Know Your Heart Cross-Sectional Study

There is conflicting evidence about the association between alcohol consumption and body composition (BC). We aimed to investigate this association in Russian adults. The study population included 2357 residents of Arkhangelsk aged 35-69 years, and 272 in-patients treated for alcohol problems (narcological patients) who participated in the Know Your Heart (KYH) cross-sectional study in 2015-2017. The participants were divided into five subgroups based on their alcohol use characteristics: non-drinkers, non-problem drinkers, hazardous drinkers, harmful drinkers, and narcological patients. Considering men, hazardous drinkers had a larger waist circumference (WC), waist-to-hip ratio (WHR), and percentage of body fat mass (%FM) compared to non-problem drinkers. In harmful drinking men, these differences were the opposite: a lower body mass index (BMI), hip circumference (HC), and %FM. Men among narcological patients had the lowest mean BMI, WC, HC, WHR, and %FM compared to other subgroups of men. As for women, non-drinkers had a lower BMI, WC, HC, and %FM compared to non-problem drinkers. Women among narcological patients had the lowest mean BMI and HC but an increased WHR compared to other subgroups of women. In conclusion, alcohol consumption levels had an inverted J-shaped association with adiposity-related BC parameters: they were elevated in hazardous drinkers but were reduced in harmful drinkers, and were even lower in patients with alcohol-related diagnoses.

Questionnaires measuring movement behaviours in adults and older adults: Content description and measurement properties. A systematic review

Background

Sleep, sedentary behaviour and physical activity are constituent parts of a 24h period and there are several questionnaires to measure these movement behaviours, the objective was to systematically review the literature on content and measurement properties of self- and proxy-reported questionnaires measuring movement behaviours in adults and older adults.

Methods

The databases PubMed, CINAHL, PsycINFO and SPORTDiscus were systematically searched until April 2021. Articles were included if: the questionnaires were design for adults and older adults; the sample size for validity studies had at least 50 participants; at least, both validity and test-retest reliability results of questionnaire that were developed specifically to measure the amount of sleep, sedentary behaviour or physical activity, or their combination were reported; and articles had to be written in English, Spanish, French, Portuguese, German, Italian or Chinese.

Findings and conclusions

Data extraction, results, studies’ quality, and risk of bias were evaluated using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Fifty-five articles were included in this review, describing 60 questionnaires. None of the questionnaires showed adequate criterion validity and adequate reliability, simultaneously; 68.3% showed adequate content validity. The risk of bias for criterion validity and reliability were very low in 72.2% and 23.6% of the studies, respectively. Existing questionnaires have insufficient measurement properties and frequent methodologic limitations, and none was developed considering the 24h movement behaviour paradigm. The lack of valid and reliable questionnaires assessing 24h movement behaviours in an integrated way, precludes accurate monitoring and surveillance systems of 24h movement behaviours.

Comparison of Self-Reported and Device-Based Measured Physical Activity Using Measures of Stability, Reliability, and Validity in Adults and Children

Quantification of physical activity (PA) depends on the type of measurement and analysis method making it difficult to compare adherence to PA guidelines. Therefore, test-retest reliability, validity, and stability for self-reported (i.e., questionnaire and diary) and device-based measured (i.e., accelerometry with 10/60 s epochs) PA was compared in 32 adults and 32 children from the SMARTFAMILY study to examine if differences in these measurement tools are systematic. PA was collected during two separate measurement weeks and the relationship for each quality criteria was analyzed using Spearman correlation. Results showed the highest PA values for questionnaires followed by 10-s and 60-s epochs measured by accelerometers. Levels of PA were lowest when measured by diary. Only accelerometry demonstrated reliable, valid, and stable results for the two measurement weeks, the questionnaire yielded mixed results and the diary showed only a few significant correlations. Overall, higher correlations for the quality criteria were found for moderate than for vigorous PA and the results differed between children and adults. Since the differences were not found to be systematic, the choice of measurement tools should be carefully considered by anyone working with PA outcomes, especially if vigorous PA is the parameter of interest.

Pre- to postdiagnosis leisure-time physical activity and prognosis in postmenopausal breast cancer survivors

BACKGROUND

Physical activity (PA) before and after breast cancer diagnosis has been reported to be associated with lower mortality. However, whether changes in the activity after diagnosis impact prognosis is unclear and has not received much attention. This study aimed to examine pre- to postdiagnosis leisure-time PA and breast cancer prognosis.

METHODS

We used data from the MARIE study, a prospective population-based patient cohort study of 3813 postmenopausal breast cancer patients, aged 50-74 at diagnosis, recruited from 2002 to 2005, re-interviewed in 2009, and followed up until June 2015. Prediagnosis PA was assessed at recruitment; postdiagnosis PA was assessed at re-interview in 2009. To examine pre- to postdiagnosis change in PA, women were categorized by pre- and postdiagnosis PA using a cut-off of 7.5 MET-h/week for meeting PA recommendations and combined into four groups: insufficiently active, increasingly active, decreasingly active, and sufficiently active. Cox regression models with delayed entry were used to assess associations between pre- to postdiagnosis patterns of PA and overall mortality (OM), breast cancer mortality (BCM), and recurrence-free survival (RFS). Additional analyses of pre- and postdiagnosis PA (no activity (reference), low activity, sufficient activity) with cancer outcomes, such as using a time-dependent model, were performed. In total, 2042 patients were included in the analyses.

RESULTS

There were 206 deaths (114 from breast cancer) after a median follow-up time of 6.0 years after the 2009 interview. Compared to insufficiently active women, increasingly active women were at lower risk of OM, BCM, and RFS (HR (95%CI) of 0.50 (0.31-0.82), 0.54 (0.30-1.00), 0.58 (0.40-0.84), respectively). In sufficiently active women, associations for OM (0.75 (0.48-1.15)), BCM (0.61 (0.33-1.13)), and RFS 0.80 (0.57-1.14)) were similar to increasingly active women but attenuated, and decreasingly active women were not at lower risk for OM (0.91 (0.61-1.36)), BCM (0.80 (0.45-1.42)), and RFS (1.04 (0.76-1.43)). In time-dependent analyses, sufficient activity vs. no activity was associated with better OM (0.73 (0.57-0.93)), BCM (0.64 (0.46-0.89)), and RFS (0.82 (0.68-0.99)). Low activity was not significantly associated with prognosis.

CONCLUSION

Our data support benefits for breast cancer prognosis in being physically active pre- and postdiagnosis particularly for women who were insufficiently active prediagnosis.

Aging-related trajectories of lung function in the general population-The Doetinchem Cohort Study

The objective of this study was to explore trajectories of lung function decline with age in the general population, and to study the effect of sociodemographic and life style related risk factors, in particular smoking and BMI. For this purpose, we used data from the Doetinchem Cohort Study (DCS) of men and women, selected randomly from the general population and aged 20–59 years at inclusion in 1987–1991, and followed until the present. Participants in the DCS are assessed every five years. Spirometry has been performed as part of this assessment from 1994 onwards. Participants were included in this study if spirometric measurement of FEV₁, which in this study was the main parameter of interest, was acceptable and reproducible on at least one measurement round, leading to the inclusion of 5727 individuals (3008 females). Statistical analysis revealed three typical trajectories. The majority of participants followed a trajectory that closely adhered to the Global Lung Initiative Reference values (94.9% of men and 96.4% of women). Two other trajectories showed a more pronounced decline. Smoking and the presence of respiratory complaints were the best predictors of a trajectory with stronger decline. A greater BMI over the follow-up period was associated with a more unfavorable FEV₁ course both in men (β = -0.027 (SD = 0.002); P < 0.001) and in women (β = -0.008 (SD = 0.001); P < 0.001). Smokers at baseline who quit the habit during follow-up, showed smaller decline in FEV₁ in comparison to persistent smokers, independent of BMI change (In men β = -0.074 (SD = 0.020); P < 0.001. In women β = -0.277 (SD = 0.068); P < 0.001). In conclusion, three typical trajectories of age-related FEV1 decline could be distinguished. Change in the lifestyle related risk factors, BMI and smoking, significantly impact aging-related decline of lung function. Identifying deviant trajectories may help in early recognition of those at risk of a diagnosis of lung disease later in life.

A systematic literature review of reviews on techniques for physical activity measurement in adults: a DEDIPAC study

The links between increased participation in Physical Activity (PA) and improvements in health are well established. As this body of evidence has grown, so too has the search for measures of PA with high levels of methodological effectiveness (i.e. validity, reliability and responsiveness to change). The aim of this “review of reviews” was to provide a comprehensive overview of the methodological effectiveness of currently employed measures of PA, to aid researchers in their selection of an appropriate tool. A total of 63 review articles were included in this review, and the original articles cited by these reviews were included in order to extract detailed information on methodological effectiveness.

Self-report measures of PA have been most frequently examined for methodological effectiveness, with highly variable findings identified across a broad range of behaviours. The evidence-base for the methodological effectiveness of objective monitors, particularly accelerometers/activity monitors, is increasing, with lower levels of variability observed for validity and reliability when compared to subjective measures. Unfortunately, responsiveness to change across all measures and behaviours remains under-researched, with limited information available.

Other criteria beyond methodological effectiveness often influence tool selection, including cost and feasibility. However, researchers must be aware of the methodological effectiveness of any measure selected for use when examining PA. Although no “perfect” tool for the examination of PA in adults exists, it is suggested that researchers aim to incorporate appropriate objective measures, specific to the behaviours of interests, when examining PA in free-living environments.

A Prospective Cluster-Randomized Trial of Telehealth Coaching to Promote Bone Health and Nutrition in Deployed Soldiers

Findings from previous studies suggest that inadequate consumption of calcium and vitamin D and a decrease in exercise while deployed can be detrimental to bone health. This study enrolled 234 soldiers randomized to receive one-time nutrition and exercise education pre-deployment (n = 149), or telehealth coaching (n = 85), throughout the deployment cycle. Results suggest that online educational efforts may enhance sports activity, bone turnover, and vitamin D status. Improving vitamin D status and remaining active while deployed appears to sustain healthy bone density in young soldiers. Early and aggressive educational outreach to young adults may prevent chronic musculoskeletal conditions and disabling osteoporosis later in life.

All-cause mortality risk of metabolically healthy abdominal obese individuals: the EPIC-MORGEN study

OBJECTIVE

It appears that a certain proportion of obese individuals have a normal metabolic profile despite having excess weight. Whether these so-called "metabolically healthy" obese express lower disease and mortality risks than "metabolically unhealthy" obese is still unclear. The mortality risk of "metabolically healthy" abdominal obese (MHAO) individuals was investigated.

DESIGN AND METHODS

Prospective cohort study (EPIC-MORGEN) among 22,654 individuals aged 20-59 years followed for an average of 13.4 years (SD 2.3). MHAO was assessed at baseline (1993-1997) and defined as abdominal obesity (waist circumference ≥102 cm/≥88 cm (men/women)) with normal glucose, blood pressure, and plasma lipids. All-cause mortality risks adjusted for age and sex were estimated using Cox proportional hazards models.

RESULTS

Individuals who were "metabolically healthy" nonabdominal obese (MHNAO) comprised the reference group. As compared to MHNAO, mortality risk for MHAO was around 40% higher (Hazard ratio (HR) 1.43; 95% confidence interval (CI): 1.00-2.04) and of the same magnitude as that for "metabolically unhealthy" nonabdominal obese (MUNAO) (HR 1.31; 95% CI: 1.08-1.59). The HR for MUAO was 1.99 (95% CI: 1.62-2.43).

CONCLUSIONS

Mortality risk of MHAO individuals was significantly higher than that of MHNAO individuals and lower than, but not statistically significantly different from, that of MUAO individuals.

Psychometric Evaluation of the Timeline Followback for Exercise among College Students

OBJECTIVES: Two separate studies assessed the psychometric properties of a retrospective behavioral measure adapted for exercise called the Timeline Followback for Exercise (TLFB-E). Study one examined criterion, convergent, and predictive validity. Study two examined test-retest reliability. METHODS: Study one participants (N = 66) were college students 20.0 ± 1.4yr. Validity of frequency, intensity, time, and type (FITT) of exercise as assessed on the TLFB-E was examined using Pearson r correlations with accelerometers, weekly exercise contracts between participants and researchers, question four of the College Alumni Questionnaire, and a health-related physical fitness battery. Study two participants were a different sample (N = 40) of college students 18.63 ± 1.0yr. Pearson r correlations determined reliability of the TLFB-E for exercise frequency, intensity, and time between two interviews separated by one month. Kappa statistic determined reliability of the TLFB-E for type of exercise. RESULTS: The TLFB-E displayed evidence of criterion validity when compared to accelerometers (r = .35 to .39) and evidence of convergent validity when compared to weekly exercise contracts (r = .65 to .80) and question four of the College Alumni Questionnaire (r = .06 to .75). The TLFB-E displayed evidence of modest to adequate test-retest reliability (r = .79 to .97) for exercise frequency, intensity, and time and moderate Kappa (k = .49) for exercise type. CONCLUSIONS: The TLFB-E produces evidence of reliable and valid scores among college students and improves upon other self-report, retrospective questionnaires by enabling daily collection of exercise FITT over a specified time period.

Patient-reported physical activity questionnaires: a systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.

Physical activity and endogenous sex hormones in postmenopausal women: to what extent are observed associations confounded or modified by BMI?

OBJECTIVES

To investigate associations between physical activity and endogenous sex hormones after menopause with a special focus on confounding and effect modification by body mass index (BMI).

METHODS

A cross-sectional study among 1,260 postmenopausal women was conducted. Generalized linear models were used to compare levels of total leisure-time physical activity, sports activities, bicycling, and walking with levels of sex hormones and sex-hormone-binding-globulin (SHBG).

RESULTS

Higher sports activity levels were significantly associated with lower levels of estrone and total and free testosterone in multivariate adjusted models. After additional adjustment for BMI, associations with estrone and free testosterone were attenuated; the association with total testosterone remained unchanged. No physical activity variable was significantly related to total and free estradiol, androstenedione, or SHBG. We did not observe effect modification by BMI.

CONCLUSIONS

Sports activities may lead to lower levels of estrone and testosterone in postmenopausal women. While effects on estrone and free testosterone seem to be largely mediated by BMI, effects on total testosterone appear to be mainly independent of BMI. The BMI-independent effects on these hormones (especially on total testosterone) could at least partly explain why physical activity has been frequently reported to be preventive for postmenopausal breast cancer, even after accounting for BMI.

Physical activity questionnaires for adults: a systematic review of measurement properties

Many questionnaires have been developed to measure physical activity (PA), but an overview of the measurement properties of PA questionnaires is lacking. A summary of this information is useful for choosing the best questionnaire available. Therefore, the objective of this study was to evaluate and compare measurement properties of self-administered questionnaires assessing PA in adults. We searched MEDLINE, EMBASE and SportDiscus, using 'exercise', 'physical activity', 'motor activity' and 'questionnaire' as keywords. We included studies that evaluated the measurement properties of self-report questionnaires assessing PA. Article selection, data extraction and quality assessment were performed by two independent reviewers. The quality and results of the studies were evaluated using the Quality Assessment of Physical Activity Questionnaires (QAPAQ) checklist. Construct validity, reliability and responsiveness were rated as positive, negative or indeterminate, depending on the methods and results. We included 85 (versions of) questionnaires. Overall, the quality of the studies assessing measurement properties of PA questionnaires was rather poor. Information on content validity was mostly lacking. Construct validity was assessed in 76 of the questionnaires, mostly by correlations with accelerometer data, maximal oxygen uptake or activity diaries. Fifty-one questionnaires were tested for reliability. Only a few questionnaires had sufficient construct validity and reliability, but these need to be further validated. Responsiveness was studied for only two questionnaires and was poor. There is a clear lack of standardization of PA questionnaires, resulting in many variations of questionnaires. No questionnaire or type of questionnaire for assessing PA was superior and therefore could not be strongly recommended above others. In the future, more attention should be paid to the methodology of studies assessing measurement properties of PA questionnaires and the quality of reporting.

Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32·7 % of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2·79; 95 % CI 1·70, 4·58), eating store-bought rather than homemade bread (OR 8·18; 95 % CI 4·34, 15·41) and currently dieting (OR 4·67; 95 % CI 1·28, 17·11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23·3 (se 0·6) v. 41·8 (se 1·0) g/d; P ≤ 0·001), a higher intake of saturated fats (26·9 v. 24·6 % of total fat; P = 0·013) and lower intakes of Fe (11·0 (se 0·3) v. 16·7 (se 0·4) mg/d), Mg (262·2 (se 5·9) v. 490·3 (se 9·8) mg/d), vitamin E (6·5 (se 0·2) v. 8·6 (se 0·3) mg/d) and most B vitamins than PWWB consumption (P < 0·001 for all), after adjusting for total energy intake. Among those aged ≥ 40 years, PWB consumption was associated with a 9·85-fold risk (95 % CI 2·64, 36·71; P = 0·001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.

Assessing individual dietary intake from common-plate meals: a new tool for an enduring practice

Objective

The purposes of the present study were to estimate individual intake from common-plate meals among Bedouin Arabs using a modified 24 h recall questionnaire, and to evaluate reported energy intake (EI) by comparison with estimated energy requirement (EER).

Design

Weighed records were used to develop a method of quantifying intake from common plates. Reported EI and nutrient intakes were obtained from administration of the modified 24 h recall. The relative standard error (RSE) was used to evaluate the reliability of reported nutrient intakes. The FAO/WHO/United Nations University and Oxford equations and reported physical activity levels were used to compute ratios of reported EI to BMR and EER.

Setting

Population centres of traditionally semi-nomadic Bedouin Arabs undergoing sedentarization/urbanization in southern Israel.

Subjects

A convenience sample of 451 adults (aged 19–82 years).

Results

Mean (se) energy intake was 9648 (276) kJ/d (2306 (66) kcal/d) for men and 8230 (172) kJ/d (1967 (41) kcal/d) for women, of which carbohydrates accounted for 63–64 %. The nutrient intakes evaluated had RSE ratios of less than 25 %. EI:EER ratios ranged from 0·86 to 0·89, and from 0·87 to 0·93 among non-dieters who ate the usual amount on the recall day.

Conclusions

The modified 24 h recall produced plausible estimates of energy and nutrient intakes, comparable to those obtained with the 24 h recall in other populations. The modified questionnaire makes an important contribution to facilitating large-scale nutritional surveillance in the Bedouin population, and may serve as a model for modifying dietary instruments to quantify individual intake in other populations that practise common-plate eating.

Measures of physical activity and their correlates: the Swedish National March Cohort

We compared the results of self-estimates of physical activity obtained with a novel instrument (the Energy Expenditure Questionnaire, EEQ) to those obtained from questions typically asked in epidemiological investigations (reference method) in a cohort of 42,150 Swedish men and women, aged 18-94. In the EEQ, participants were asked to report total physical activity by estimating the total time during a typical day and night spent on different physical activity intensity levels from the lowest (corresponding to lying in bed, 0.9 Metabolic Energy Turnover; MET) to the highest, (exceeding the intensity of to shovelling snow by hand, i.e., >6 MET). As a comparison, they also estimated hours per week devoted to household chores, commuting and leisure time physical activities classified as; light, moderate and heavy. The average physical activity estimated with the EEQ was 1.36 MET or 32.6 METh/day or 2,341 kcal/day. In comparison, physical activity estimated with the reference method represented no more than 17% of this amount. The Spearman's correlation coefficient between the two measures was 0.26. Using EEQ, men reported significantly more physical activity than women (mean = 36.3 vs. 30.6 METh/day). Body mass index (BMI) > or = 25, education > or = 12 years, and age > or = 60 years were significantly associated with lower physical activity. Questions focusing on leisure time exercise and a few other selected activities provide estimates of activity that correlate poorly with self-reported total energy output from all physical activity and inactivity. Investigators need to be more explicit about which component of activity they investigate.

Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness

Background

Low back pain (LBP) and neck pain (NP) are a major public health problem with considerable costs for individuals, companies and society. Therefore, prevention is imperative. The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics (PE) to prevent LBP and NP among workers.

Methods

In a randomised controlled trial (RCT), a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline. The departments consisting of about 150 workers are pre-stratified and randomised. The control departments receive usual practice and the intervention departments receive PE. Within each intervention department a working group is formed including eight workers, a representative of the management, and an occupational health and safety coordinator. During a one day meeting, the working group follows the steps of PE in which the most important risk factors for LBP and NP, and the most adequate ergonomic measures are identified on the basis of group consensus. The implementation of ergonomic measures at the department is performed by the working group. To improve the implementation process, so-called 'ergocoaches' are trained.

The primary outcome measure is an episode of LBP and NP. Secondary outcome measures are actual use of ergonomic measures, physical workload, psychosocial workload, intensity of pain, general health status, sick leave, and work productivity. The cost-effectiveness analysis is performed from the societal and company perspective. Outcome measures are assessed using questionnaires at baseline and after 6 and 12 months. Data on the primary outcome as well as on intensity of pain, sick leave, work productivity, and health care costs are collected every 3 months.

Discussion

Prevention of LBP and NP is beneficial for workers, employers, and society. If the intervention is proven (cost-)effective, the intervention can have a major impact on LBP and NP prevention and, thereby, on work disability prevention. Results are expected in 2010.

Trial registration

ISRCTN27472278

Dietary intake and different types of physical activity: full-day energy expenditure, occupational and leisure-time

Objective

To describe the relationship between dietary intake and different levels and types of physical activity (PA).

Design

Cross-sectional evaluation of the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and dietary intake during the past year were assessed using a PA questionnaire and a semi-quantitative food-frequency questionnaire, respectively.

Setting

Representative sample of adults in Porto, Portugal.

Subjects

Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and 92 years.

Results

For total PA, males who were active had significantly higher mean intake of energy (10·76 (2570·7) vs. 9·78 (2336·9) MJ/d (kcal/d), P < 0·001) and lower level of protein consumption (16·9 vs. 17·6 % of energy, P < 0·001) compared with sedentary males. In males, the association between total PA and energy intake remained after adjustment for age, education and body mass index. Similar results were observed when occupational activity was analysed. Concerning the energy expended in leisure time, in both genders, after adjustment for the previously described variables, a significant positive association was found between PA and intake of vitamin C (g/d): β = 0·12, 99 % confidence interval (CI) 0·02, 0·21 for females and β = 0·13, 99 % CI 0·03, 0·22 for males. Leisure-time activity in females was also positively associated with intakes of fibre, vitamin E, folate, calcium and magnesium, and negatively associated with saturated fat.

Conclusions

Higher levels of PA in leisure time were associated with higher intakes of micronutrients and lower intakes of saturated fat, particularly in females. For total and occupational PA, similar nutrient intake was observed between active and sedentary individuals.

Validity and reliability of self-reported total energy expenditure using a novel instrument

Improved methods for quantitative self-reports of total physical activity in epidemiological studies are needed. We evaluated randomly selected individuals' ability to integrate their perception of physical activity over time to produce an estimate of the "usual" level, using a novel instrument for self-quantification of energy expenditure. A population-based sample of 418 Swedish men and women, age 20-59, completed a questionnaire containing the new instrument. For validation, three 24 hour recalls by phone served as gold standard. Reproducibility was assessed through administering the instrument another three times. The validation involved 133 subjects and another 160 completed the reproducibility evaluation. Pearson correlation between usual daily energy expenditure measured by the instrument and the mean of the 24 hour recalls was 0.73. After subdividing the self-reported daily energy expenditure and the mean of the 24 hour recalls into quintiles, 83.5% of the participants remained in the same quintile, or one quintile apart. There was a tendency towards overestimation of usual daily physical activity. This was significantly associated with low education. Reproducibility showed an intraclass correlation of 0.55. Although integrated reports of usual daily energy expenditure over longer periods seem to be afflicted with a tendency of overestimation, total energy expenditure can be estimated with reasonable validity and reproducibility using our instrument.

Comparison of the TriTrac-R3D accelerometer and a self-report activity diary with heart-rate monitoring for the assessment of energy expenditure in children

Determining total energy expenditure (EE) in children under free-living conditions has become of increasingly clinical interest. The aim of this study was to compare three different methods to assess EE triaxial accelerometry (TriTrac-R3D; Professional Products, Division of Reining International, Madison, WI, USA), activity diary and heart-rate (HR) monitoring combined with indirect calorimetry (IC). Twenty non-obese children and adolescents, aged 5.5 to 16.0 years, participated in this study. Results from the three methods were collected simultaneously under free-living conditions during the same 24 h schoolday period. Neither activity diary (5904 (SD 1756) KJ) NOR THE TRITRAC-R3D (6389 (sd 979) kJ) showed statistical differences in 24 h total EE compared with HR monitoring (5965 (sd 1911) kJ). When considering different physical activity (PA) periods, compared with HR monitoring, activity diary underestimates total EE during sedentary periods (P<0·001) and overestimates total EE and PA-EE during PA periods (P<0·001) because of the high energy cost equivalence of activity levels. The TriTrac-R3D, compared with HR monitoring, shows good agreement for assessing PA-EE during PA periods (mean difference +0·25 (sd 1·9) kJ/min; 95 % CI for the bias -0·08, 0·58), but underestimates PA-EE and it does not show good precision during sedentary periods (-0·87 (sd 1·4) kJ/min, P<0·001). Correlation between the vector magnitude generated by the TriTrac-R3D accelerometer and EE of activities derived from HR monitoring is high. When compared with the HR method, the TriTrac-R3D and activity diary are not systematically accurate and must be carefully used for the assessment of children's EE depending on the purpose of each study.

Evaluation of a short retrospective questionnaire for physical activity in women

Physical activity (PA) is discussed as a preventive factor for many chronic diseases. Thus, in epidemiological studies it often is an important covariate. Due to frequently long latency periods, long-term PA in the past is of greater interest than current PA. However, there is a lack of retrospective questionnaires that are validated for long-term PA, including occupational, household, and leisure activities. We therefore evaluated a short questionnaire for the comprehensive assessment of usual PA in distant age periods, administered with cognitive interviewing techniques. From an ongoing study on postmenopausal breast cancer 110 cases and 101 controls, age 50-74 years, were randomly selected. Our questionnaire was administered in a telephone interview more than two months after the main study interview, which included a detailed questionnaire on PA performed in the age periods 30-49 years and 50+ years. Total PA scores were derived from both interviews as MET-hours per week. Degree of agreement was assessed using Bland-Altman analyses. Further, potential sources of systematic and random error were investigated. The mean difference between both questionnaires was 3 MET hours/week, and 53.6% of absolute differences were below 35 MET hours/week, i.e. showing good agreement. Further 28.9% of differences could be considered acceptable agreement. Measurement errors seem to be non-differential with respect to cancer status. The median interviewing time was 10 min. Overall, this short questionnaire appears to be a useful and valid tool to distinguish between high and low levels of women's physical activity in the distant past.

Prospective research on musculoskeletal disorders in office workers (PROMO): study protocol

Background

This article describes the background and study design of the PROMO study (Prospective Research on Musculoskeletal disorders in Office workers). Few longitudinal studies have been performed to investigate the risk factors responsible for the incidence of hand, arm, shoulder and neck symptoms among office workers, given the observation that a large group of office workers might be at risk worldwide. Therefore, the PROMO study was designed. The main aim is to quantify the contribution of exposure to occupational computer use to the incidence of hand, arm, shoulder and neck symptoms. The results of this study might lead to more effective and/or cost-efficient preventive interventions among office workers.

Methods/Design

A prospective cohort study is conducted, with a follow-up of 24 months. In total, 1821 participants filled out the first questionnaire (response rate of 74%). Data on exposure and outcome is collected using web-based self-reports. Outcome assessment takes place every three months during the follow-up period. Data on computer use are collected at baseline and continuously during follow-up using a software program.

Discussion

The advantages of the PROMO study include the long follow-up period, the repeated measurement of both exposure and outcome, and the objective measurement of the duration of computer use. In the PROMO study, hypotheses stemming from lab-based and field-based research will be investigated.

Indices de mesure de l'activité physique dans le domaine des affections cardiovasculaires

PURPOSE

To identify the more useful among many methods available for the measurement of physical activity in patients with cardiovascular disease. For practical and financial reasons only questionnaires and mechanical monitoring, which are appropriate for use in large studies, were assessed.

METHODS

To select tools valuable for clinical and epidemiological measurement of physical activity, with sufficient validity, reproducibility and sensitivity, we reviewed the literature in Medline with use of keywords: accelerometry, ambulatory accelerometry, ambulatory monitoring, cardiovascular diseases, daily activity, heart disease, pedometer, physical activity, questionnaire.

RESULTS

Considering appropriate level of reproducibility and validity, 15 questionnaires are available. For measuring postures and motions during daily life, activity monitor seems to be more valid than pedometers or single accelerometers.

CONCLUSION

At present the preferred method is a questionnaire, provided it is valid, repeatable, easy to use and inexpensive. In the future mechanical monitoring (especially activity monitor) will be probably a good alternative.

Leisure-time versus full-day energy expenditure: a cross-sectional study of sedentarism in a Portuguese urban population

BACKGROUND

Low physical activity is known to be a potential risk factor for cardiovascular disease. With high prevalence of cardiovascular diseases in the Portuguese urban population, little is known about how sedentary this population is and what factors are associated to sedentary lifestyles. This study's objective was to examine sedentary lifestyles and their determinants through a cross-sectional study.

METHODS

2134 adults (18 years and older) were interviewed using a standard questionnaire, comprising of social, behavioural and clinical information. Time spent in a variety of activities per day, including: work, household chores, sports, sedentary leisure time and sleep, were self-reported. Energy expenditure was estimated based on the related metabolic equivalent (MET) and time spent in each activity (min/day). Those with less than 10% of energy expenditure at a moderate intensity of 4 METs or higher were categorised as sedentary. The proportion of sedentary people and 95% Confidence Intervals (CI) were calculated, and the magnitude of associations, between sedentary lifestyles and the population characteristics, were computed as age-adjusted odds ratios using logistic regression.

RESULTS

Sedentarism in both genders during leisure time is high at 84%, however in full day energy expenditure, which includes physical activity at work, sleeping hours and household chores, 79% of males and 86% of females are found to be sedentary. In leisure-time only, increased age is associated with higher odds of being sedentary in both genders, as well as in women with increased BMI. In comparison, in full-day energy expenditure, sedentarism is more likely to occur in those with higher levels of education and in white-collar workers.

CONCLUSIONS

A high prevalence of sedentarism is found in the study participants when measuring leisure-time and full-day energy expenditure. The Portuguese population may therefore benefit from additional promotion of physical activity.

The effectiveness of physical activity counseling in a work-site setting. A randomized, controlled trial

Voluntary employees (N = 155) from nine different companies were screened by questionnaire for the study. They were randomized into three study groups: counseling (n = 52), counseling + fitness testing (n = 51) and control group (n = 52). The counseling was based on a goal-oriented conversation session for each participant and three follow-up appointments with an occupational nurse over a period of 1 year. The fitness tests were adapted from the UKK Health-related Fitness Test Battery. The outcome measures were the changes in the amount of leisure-time physical activity (LTPA) assessed by diary, pedometer and questionnaire at baseline and at 6 and 12 month follow-up visits. As a result, no statistically significant differences were detected between the three groups at either of the follow-up visits. It seemed, thus, that the two PA counseling methods implemented had no direct mid- or long-term effects on the LTPA of voluntary employees with no specific disease-related indication to increase LTPA.

Worksite health promotion using individual counselling and the effectiveness on sick leave; results of a randomised controlled trial

AIMS

To investigate the effectiveness of a worksite health promotion programme by individual counselling on sick leave.

METHODS

Three municipal services of Enschede, the Netherlands, participated in this trial. A total of 299 civil servants were measured at baseline and were randomised by cluster into the intervention (n = 131) or the control group (n = 168). During nine months, subjects in the intervention group received a total of seven consultations, particularly aimed at increasing their physical activity level and improving their dietary habits. Both the intervention and the control subjects received written information as to several lifestyle factors. Sick leave data regarding the nine month intervention period (from May until January) were collected from each municipal service's personnel department. In addition, sick leave data concerning the nine month period pre- and post-intervention were collected. Sick leave data were analysed using multilevel analysis.

RESULTS

For both groups, the mean sick leave rate during the intervention increased compared to before the intervention. After the intervention period, the control group increased even more (from 22.9 to 27.6 days), whereas the intervention group slightly decreased (from 21.5 to 20.5 days). Median values of sick leave rate decreased for both groups. No statistically significant intervention effect was found. In both groups, the mean sick leave frequency slightly decreased over time (intervention effects were not significant).

CONCLUSIONS

Results showed no significant effect of individual counselling on sick leave. Continued research investigating the effectiveness of this individual counselling programme on several health related outcomes is useful to clarify the trend observed in sick leave.

Measuring the environment for friendliness toward physical activity: a comparison of the reliability of 3 questionnaires

OBJECTIVES

We tested the reliability of 3 instruments that assessed social and physical environments.

METHODS

We conducted a test-retest study among US adults (n = 289). We used telephone survey methods to measure suitableness of the perceived (vs objective) environment for recreational physical activity and nonmotorized transportation.

RESULTS

Most questions in our surveys that attempted to measure specific characteristics of the built environment showed moderate to high reliability. Questions about the social environment showed lower reliability than those that assessed the physical environment. Certain blocks of questions appeared to be selectively more reliable for urban or rural respondents.

CONCLUSIONS

Despite differences in content and in response formats, all 3 surveys showed evidence of reliability, and most items are now ready for use in research and in public health surveillance.

Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up

OBJECTIVE

The most common way to evaluate the effect of an intervention is to compare the intervention and nonintervention groups regarding the change in the outcome variable between baseline and follow-up; however, there are many different ways to define "changes." The purpose of this article is to demonstrate how different definitions of "change" used in the analysis can influence the results of a study.

STUDY DESIGN AND SETTING

Two different randomized controlled trials were used as examples.

RESULTS

The results of the analyses showed that for continuous outcome variables, analysis of covariance seems to be the most appropriate because it corrects for the phenomenon of regression to the mean. For dichotomous outcome variables, multinomial logistic regression analysis with all possible changes over time as outcome seems to be the most appropriate, especially because of its straightforward interpretation.

CONCLUSION

A different definition of "change" can lead to different results in the evaluation of the effect of an intervention.

Effect of individual counseling on physical activity fitness and health: a randomized controlled trial in a workplace setting

BACKGROUND

Physical inactivity and obesity are major public health problems. Our objective was to investigate the effectiveness of an individual counseling intervention at the workplace on physical activity fitness and health. Counseling content derived from the Patient-centered Assessment and Counseling for Exercise and Nutrition (PACE) program.

METHODS

A total of 299 employees of three municipal services in the Dutch town of Enschede were randomly allocated into intervention (n =131) and control group (n =168). Over a 9-month period, intervention group subjects were offered seven counseling sessions. Counseling was based on the individual's stage of behavioral change using PACE physical activity and nutrition protocols. Subjects in both the intervention and control group received written information about several lifestyle factors. Primary outcome measures were physical activity (total energy expenditure, during sports activities, during physical activity leisure time other than sports, and meeting the moderate-intensity public health recommendations); cardiorespiratory fitness; and prevalence of musculoskeletal symptoms. Secondary outcome measures were body composition (body mass index [BMI], and percentage of body fat measured via skinfold thicknesses); blood pressure; and blood cholesterol.

RESULTS

There were significant positive effects on total energy expenditure, physical activity during sports, cardiorespiratory fitness, percentage of body fat, and blood cholesterol. No effects were found for the proportion of subjects meeting the public health recommendation of moderate-intensity physical activity, physical activity during leisure time other than sports, prevalence of musculoskeletal symptoms, body mass index, and blood pressure.

CONCLUSIONS

Individual face-to-face counseling at the workplace based on PACE protocols positively influenced physical activity levels and some components of physical fitness. The implementation of workplace counseling programs for individuals should therefore be promoted.

Validity and reproducibility of self-reported total physical activity—differences by relative weight

OBJECTIVE

Physical activity is hypothesized to reduce the risk of obesity and several other chronic diseases and enhance longevity. However, most of the questionnaires used measure only part of total physical activity, occupational and/or leisure-time activity, which might lead to misclassification of total physical activity level and to dilution of risk estimates. We evaluated the validity and reproducibility of a short self-administered physical activity questionnaire, intended to measure long-term total daily 24 h physical activity.

METHOD

The questionnaire included questions on level of physical activity at work, hours per day of walking/bicycling, home/household work, leisure-time activity/inactivity and sleeping and was sent twice during one year (winter/spring and late summer). Two 7-day activity records, performed 6 months apart, were used as the reference method. One-hundred and eleven men, aged 44-78, completed the questionnaire and one or two activity records. The physical activity levels were measured as metabolic equivalents (MET)xh/day.

RESULTS

Spearman correlation coefficient between total daily activity score estimated from the first questionnaire and the records (validity) was 0.56 (deattenuated) and between the first and the second questionnaire (reproducibility) 0.65. Significantly higher validity correlations were observed in men with self-reported body mass index below 26 kg/m(2) than in heavier men (r=0.73 vs r=0.39).

CONCLUSIONS

This study indicates that the average total daily physical activity scores can be estimated satisfactorily in men using this simple self-administered questionnaire.

Methodological aspects of physical activity assessment in epidemiological studies

A range of epidemiological studies conducted over the past decades has produced strong support for the view that lack of physical activity is associated with increased risks of several chronic diseases, such as cardiovascular disease, diabetes mellitus, cancer, etc. Much is still unknown about the type and degree of activity that is required to influence the risk of specific diseases. Furthermore, physical activity can act as a confounder in relationships between other exposure variables (e.g. diet) and disease. Thus, the measurement of physical activity in epidemiological studies is of great importance. The questionnaire is the most frequently used method in epidemiological research. Before using a questionnaire on a large scale, validity and reproducibility should be assessed in a representative population. Some practical and methodological aspects of physical activity validation studies are described, together with the possible implications of the results.