convergent validity of the physical activity … · nanette p. kowalski ... the paq-c total...

Pediatric Exercise Science, 1997, 9, 342-352 0 1997 Human Kinetics Publishers, Inc.

Convergent Validity of the Physical Activity Questionnaire for Adolescents

Kent C. Kowalski, Peter R.E. Crocker, and Nanette P. Kowalski

This study assessed the convergent validity of the Physical Activity Question- naire for Adolescents (PAQ-A). The PAQ-A is a modified version for high school students of the Physical Activity Questionnaire for Older Children (PAQ- C). The PAQ-A is a 7-day recall used to assess general physical activity levels during the school year. Eighty-five high school students in Grades 8 through 12 filled out the PAQ-A and other physical activity measures. The PAQ-A was moderately related to an activity rating (r = .73), the Leisure Time Exercise Questionnaire (r = .57), a Caltrac motion sensor (r = .33), and the 7-day physical activity recall interview (r = .59). The results of this study support the convergent validity of the PAQ-A as a measure of general physical activity level for high school students.

Reliable and valid assessment of physical activity is needed to understand the relationship between physical activity and health-related variables for children and adolescents. There is a variety of assessment methods (5), with self-report questionnaires offering a low-cost, easy-to-administer option. Many self-report instruments have been used, often having been designed for specific study objectives (5, 13). Frequently, reliability and validity evidence has not been provided (14) or evidence has been supported indirectly (1 8).

The foremost limitation to providing validity evidence for physical activity assessment in children and adolescents is that there is no "gold standard by which self-reports can be validated (1). An appropriate criterion is needed to establish criterion-related validity; thus, it may be more appropriate to look at the correlations among physical activity test scores as evidence of convergent validity. Physi- cal activity measures, including self-report questionnaires and interviews (7, 11, 16, 17) and motion sensors (9, 12, 14), are expected to be related to one another. Examining correlations among measures has been used in other physical activity assessment validation studies (10, 11, 15). The various measures assess either actual or usual activity levels, but one would expect a relationship among them

K.C. Kowalski, P.R.E. Crocker, and N.P. Kowalski are with the College of Physical Education at the University of Saskatchewan, 105 Gymnasium Place, Saskatoon, SK Canada S7N 5C2.

Physical Activity Questionnaire for Adolescents - 343

because they are measuring a similar construct. Thus, correlations among the physical activity measures which assess either actual or usual activity would provide some evidence of construct validity, as well as convergent validity.

The Physical Activity Questionnaire for Adolescents (PAQ-A)

The Physical Activity Questionnaire for Adolescents (PAQ-A) is a high school student version of the Physical Activity Questionnaire for Older Children (PAQ- C), which was developed for the University of Saskatchewan pediatric bone study to assess general levels of physical activity during the school year for students beyond Grade 3 (4, 11). It is a self-administered 7-day recall questionnaire that asks students to recall physical activity for the last 7 days. The PAQ-A was designed for large-sample studies and can be completed in a classroom setting. It takes approximately 10 to 15 min for a student to complete the PAQ-A. For elementary school students, the PAQ-C total activity score is derived from nine items, each scored on a 5-point scale. For high school students, the PAQ-A total activity score consists of eight items (the question about activity at recess is removed).

There is reliability and validity evidence for the elementary school version of the PAQ-C. Test-retest reliability of the PAQ-C over a one-week period was r = .75 for males and r = .82 for females from Grades 4 to 8 (4). Two validity studies have also been conducted for students in Grades 4 through 8 (11). The first study found the PAQ-C to be related to Sallis et al.'s (17) activity rating (r = .63), Simons- Morton et al.'s (21) week summation of daily activity recalls (r = .53), Saris et al.'s (20) teacher's rating of physical activity (r = .45), and Harter's (8) perceptions of athletic competence (r = .48). In the second study, the PAQ-C was moderately related to the activity rating (r = .57), Godin and Shephard's (7) Leisure Time Exercise Questionnaire (r = .4 I), Sallis et al.'s (16) 7-day physical activity recall interview (r = .46), Bailey and Minvald's (2) step-test of fitness (r = .28), and the Caltrac motion sensor (r = .39).

There is reliability evidence but no validity evidence presently for the use of the PAQ-A with high school students. Generalizability coefficients were G = .90 for three scores and G = .85 for two scores for 97 students 13 years of age and older who were administered the PAQ-A three times over a one-year period (4). Although the PAQ-A and PAQ-C differ only by one question, the validity of the PAQ-A needs to be established with a high school population. High school students may participate in different activities and at different times, potentially mak- ing the PAQ-A inappropriate for high school students.

The purpose of this study was to assess the convergent validity of the PAQ- A with high school students. Various methods of physical activity assessment (questionnaires, an interview, and the Caltrac motion sensor) were included in the study to limit the effects of employing a single assessment method on correlations among physical activity measures. It was expected that the PAQ-A would be related to other measures of physical activity.

Method

Participants

Adolescents between Grades 8 and 12 were recruited from two private schools in Saskatchewan. All students and parentslguardians provided informed consent. The

344 - Kowalski, Crocker, and Kowalski

sample consisted of 85 students (41 male, 44 female) ranging in age from 13 to 20 years (M = 16.25, SD = 1.51).

Measures

The Physical Activity Questionnaire for Adolescents (PAQ-A). The PAQ-A is an eight-item version of the nine-item Physical Activity Questionnaire for Older Children (PAQ-C; 4, 11). The items on the PAQ-A (see Appendix) are the same as for the PAQ-C, except that the question regarding physical activity during recess is discarded and the activities on the activity checklist are slightly different. The items on the checklist can be modified to make the activities culturally and normatively relevant. The eight items on the PAQ-A, each scored on a 5-point scale, are used in the calculation of a summary total activity score for high school students. The PAQ-A composite is calculated as the mean of the eight items. The additional item pertaining to determining if sickness or other events prevented the student from doing her or his regular activity is not used in the calculation of the summary activity score.

Seven-Day Recall Interview (PAR). The 7-day physical activity recall (PAR) is a standardized interview that assists subjects in recalling various intensities of activity (16). Summary variables include moderate, hard, and very hard activities, as well as an index of caloric expenditure. For adolescents, the physical activity recall interview kilocalorie expenditure index had a 2-week test-retest correlation of r = .59 for 8th graders, and r = .81 for 1 lth graders (15). Validity coefficients comparing very hard recalls with heart rates on the same day were r = .45 for Grade 8 and r = .75 for Grade 11 students (15).

Activity Rating. The activity rating requires adolescents to rate their activity levels compared to others of their same age and sex (17). The scale responses range from 1 (much less active) to 5 (much more active). The activity index demonstrated test-retest reliability of r = .85 for 8th graders and r = .89 for 1 1th graders over a 2-week period (15). The activity index was related to the PAR kilocalorie expenditure index for Grade 8 students (r = .38), but not for Grade 11 students (15).

Leisure Time Exercise Questionnaire, The Leisure Time Exercise Ques- tionnaire consists of two scores (7). A total exercise score (Godin 1) asks for the frequency of strenuous, moderate, and mild exercise over an average 7-day period, while a second question (Godin 2) asks how often during a week the individual engages in sweat-inducing regular activity Two-week test-retest reliability for Godin 1 was r = .80 for Grade 8 students and r = .96 for Grade 11 students (15). Godin 1 was related to the PAR interview ( r = .60 for Grade 8; r = .3 2 for Grade 11) but not an activity rating for Grade 8 and 11 students (15).

Caltrac Motion Sensor. The Caltrac (Muscle Dynamics, Torrance, CA) is an electronic, single plane accelerometer that measures vertical acceleration. Interinstrument reliabilities for children from 8 to 13 years of age were r = .96 and r = .89 in the field and lab, respectively (14). The Caltrac was related to the PAR interview (r =.49 on Day 1 and r = .39 on Day 2) and heart rate monitoring (r = .54 on Day 1 and r = .42 on Day 2) for children from 8 to 13 years of age (14). The Caltrac has also been related to 24-hr energy expenditure (r = 30) and walking energy expenditure (r = .85) calorimeter values for female adolescents (3).


Procedures

Students from the two schools were assessed over separate 2-week periods (late March- early April and late May-early June). Special school events were avoided that may have changed normal activity behavior. Students were assessed on 2 separate days, 7 days apart. Due to the possibility of carryover effects, scores from the interview and Caltrac were obtained from a different 7-day period than the PAQ-A, activity rating, and Leisure Time Exercise Questionnaire.

On the first testing occasion, the PAQ-A was administered in class, followed by the activity rating and the Leisure Time Exercise Questionnaire. Research as- sistants gave verbal instructions and were available to answer questions. Follow- ing completion of the questionnaires, instructions on the use and care of the Caltrac were given. Standardized constants were entered into the Caltrac. They were taped in a holster to prevent tampering. Students in both schools wore the Caltrac for 7 days. Students at the first school received a phone call each evening as a reminder to wear the Caltrac. At the second school, the students lived in dormitories and did not have telephones; therefore, reminding students to wear the Caltracs was done by school administrators. The Caltrac was recovered at the end of the 7-day period, and the activity per day (corrected for the number of days worn) was recorded. In order for the students' Caltrac data to be used, it had to have been worn for at least 5 of the 7 days, including at least one weekend day. A 5-day minimum was chosen to minimize loss of subjects while providing sufficient data to estimate habitual activity for the week.

Caltrac data was collected for only 56.47% of students (7 students did not wear the Caltrac for at least 5 days, 28 tampered with the Caltrac, 1 was absent when the Caltrac data were recorded, and 1 forgot the Caltrac on the final day of testing). Following collection of the Caltrac, each participant was interviewed using the 7-day recall.

Results and Discussion

Descriptive statistics for the PAQ-A, activity rating, the two scores on the Leisure Time Exercise Questionnaire (Godin I and Godin 2), Caltrac (average activity counts per day), the physical activity recall kilocalorie energy expenditure index (PAR), and the physical activity recall interview total hours spent in moderate, hard, and very hard activity (PAR hours) are shown in Table 1. Compared to the PAQ-C validation study previously done with elementary school children (1 I), the high school student's mean activity levels on all scales were lower.

Pearson product-moment correlations among physical activity measures are shown in Table 2. The hypothesis that the PAQ-A would be moderately correlated with other physical activity measures was supported, with the magnitude of come- lations ranging from r = .33 to .73 ( p < .05). The correlations between Godin 2 and other measures are negative because higher scores on the Godin 2 scale represent lower activity levels. Compared with the correlations among measures for elementary school students (1 l), correlations for high school students were higher except with the Caltrac. This indicates that with age, children and adolescents become more consistent in their self-reports, regardless of method of assessment, but these self-reports may be less related to objective measures. Although self-reports are more reliable for older students, they may be less accurate. In fact, only the PAQ-A and the two scores on the physical activity recall interview (PAR and PAR hours) were re-


Table 1 Descriptives for the PAQ-A Activity Rating, Godin 1, Godin 2, Caltrac, PAR, and PAR Hours

Variable n M SD

PAQ-A Full sample Males Females

Activity rating Full sample Males Females

Godin 1 Full sample Males Females

Godin 2 Full sample Males Females

Caltrac Full sample Males Females

PAR Full sample Males Females

PAR hours Full sample Males Females

Note. PAQ-A = Physical Activity Questionnaire for Adolescents; PAR = 7-day physical activity recall kilocalorie energy expenditure index; PAR hours = PAR interview total hours spent in moderate, hard, and very hard activity. The possible range of scale scores are as follows: PAW-A, 1 (low activity) to 5 (high activity); activity rating, 1 (low) to 5 (high); Godin 1,0 (low) to unlimited (high); Godin 2, 3 (low) to 1 (high); Caltrac, 0 (low) to unlimited (high); PAR, 24 (low) to unlimited (high); PAR hours, 0 (low) to unlimited (high).

lated to the Caltrac motion sensor, but all self-report indicators were significantly correlated with each other. Measures that assessed usual (activity rating, Godin 1, Godin 2) or actual activity (Caltrac, PAR, PAR hours) did not have systematically higher or lower correlations with the PAQ-A, which assesses activity over the previous 7 days. This result suggests that assessment of actual physical activity

a 7-day period may provide mst imate of gen-eral activity level:


Table 2 Pearson Product-Moment Correlations Among Measures

Variable

1. PAQ-A - 2. Activity rating .73*

(85) 3. Godin 1 .57*

(85) 4. Godin 2 -.62*

(85) 5. Caltrac .33*

(48) 6. PAR .59*

(83) 7. PAR hours .51*

(83)

Note. PAQ-A = Physical Activity Questionnaire for Adolescents; PAR = 7-day physical activity recall kilocalorie energy expenditure index; PAR hours = PAR interview total hours spent in moderate, hard, and very hard activity. Correlation matrix is based on pairwise comparisons, and the n values (in parentheses) may differ. *p < .05 (one-tail significance).

Although the small and nonsignificant correlations between the Caltrac and other physical activity measures may indicate lack of validity in adolescents' self- reports, the correlations may be due to excessive tampering with the Caltrac by students. Only 48 of 85 students had usable Caltrac data, due mainly to tampering with the devices. As a result, the correlations between the Caltrac and other measures were based on a smaller number of students, resulting in reduced power and greater instability in the magnitude of the correlation coefficients. There was some tampering with the Caltrac in the elementary school study (ll) , but it was not as great as for the high school students.

The problem of participants tampering with objective measures of physical activity in field studies needs to be addressed. In the present study the group with usable Caltrac data differed significantly on the PAQ-A from the group who did not have useable Caltrac data, t(83) = 2.78, p < .05, suggesting that lower activity individuals may be more likely to tamper with mechanical devices. It may also be that either the group of students that tampered with the Caltrac, or the group that did not tamper, were less likely to provide accurate self-reports on the questionnaires. Sallis et al. (14) did not report high rates of tampering with the Caltrac, but this may be primarily due to fewer subjects and a shorter time period over which the Caltrac was worn. One solution to the tampering problem is to reduce the number of days of monitoring to 4 or 5. This shorter period is adequate to get a reliable estimate of physical activity from an accelerometer (lo), but the validity of the shorter time period as a measure of usual activity needs to be established.

The Caltrac motion sensor is also limited as a physical activity measure because it cannot be worn in water, can potentially be damaged in contact sports, and


can be forgotten to be worn in multiple-day studies because its use is not part of a student's daily routine. Also, it is very difficult for a researcher to know if the Caltrac was worn throughout the entire course of the study. Low activity values may result from low activity levels or failure to wear the Caltrac.

Gender differences were found only on the PAQ-A, t(83) = 3.01, p < .05, with males having higher activity levels than females. Males and females did not significantly differ on any of the other physical activity measures. The lack of consistent gender differences across measures was unexpected (except for the activity rating). In the elementary school studies (1 I), males and females differed on the PAQ-C in only one of the two studies. The PAR and Godin 1 measures were administered in only the second of the two studies, and the PAR demonstrated gender differences, whereas the Godin 1 score did not. Other studies using the PAR or Leisure Time Exercise Questionnaire have not statistically tested for gender differences, although it appears that males generally have higher scores than do females (6, 15). In the present study, students were volunteers, which limits the generalizability of the results. Further examination of gender differences in studies that do not utilize self-selection is definitely warranted.

Overall, the results of this study support the convergent validity of the PAQ- A. Consistent with the correlations among physical activity measures in the elementary school study (1 l), the PAQ-Agenerally had the highest correlations with other measures. An advantage of the PAQ-A is that it is quick to administer and inexpensive, and appears to provide a valid measure of high school students' general activity levels. Although the PAR interview is more time consuming and ex- pensive than the PAQ-A, it allows for the breakdown of activity into intensity level. The purpose of the PAQ-A is to assess general levels of physical activity, and was not designed to provide information on frequency, intensity, or duration of activity. Another limitation of the PAQ-A is that it only assesses physical activity during the school year. The choice of an activity measure must be driven by the research question and the specific study needs and objectives. Thus, there can be no univer- sally accepted standard technique for assessing physical activity (5). Correlations between the PAQ-A and PAR moderate (r = -.06, ns), hard (r = .37, p < .05), and very hard (r = .58, p < .05) activities indicate that the PAQ-A measures more vigorous types of activities. These results are consistent with the correlations between the PAQ-C and the PAR activity levels for elementary school students (11).

Construct validity studies should be conducted in future research, and convergent validity of the PAQ-A would be strengthened by comparing it to physical activity measures such as doubly labelled water (19) or the Tritrac motion sensor (12). The Tritrac would also be useful in helping to establish the boundary condi- tions for the PAQ-A. It is important to determine what types and intensity of activities are accurately assessed by the PAQ-A. Also, both the PAQ-C and the PAQ-A should be able to discriminate between various groups of children and adolescents who are known to differ in physical activity levels, and because highly active individuals often engage in specific activities during certain time periods, it is possible that both measures underestimate high activity levels.

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Appendix

Physical Activity Questionnaire for Adolescents

Name:

Sex: M F

Age:

Grade:

Teacher:

We are trying to find out about your level of physical activity fromthe last 7days (in the last week). This includes sports or dance that make you sweat or make your legs feel tired, or games that make you breathe hard, like tag, skipping, running, climbing and others.

Remember: A. There are no right and wrong answers-this is not a test. B. Please answer all the questions as honestly and accurately as you can-this is very

important.

1. Physical activity in your spare time: Have you done any of the following activities in the past 7 days (last week)? If yes, how many times? (Mark only one circle per row.)

7 times No 1-2 3-4 5-6 or more

Skipping ....................................... Rowinglcanoeing ......................... In-line skating .............................. Tag ............................................... Walking for exercise .................... Bicycling ......................................

....................... Jogging or running Aerobics ....................................... Swimming ................................... Baseball, softball ......................... Dance ........................................... Football ........................................ Badminton ................................... Skateboarding .............................. Soccer .......................................... Street hockey ...............................

continued

Physical Activity Questionnaire for Adolescents . 351

7 times No 1-2 3-4 5-6 or more

Volleyball ..................................... 0 0 0 0 0 Floor hockey ................................ 0 0 0 0 0 Basketball .................................... 0 0 0 0 0 Ice skating .................................... 0 0 0 0 0 Cross-country skiing .................... 0 0 0 0 0 Ice hockeylringette ...................... 0 0 0 0 0 Other:

0 0 ..... 0 0 0 0 0 ..... 0 0 0

2 . In the last 7 days. during your physical education (PE) classes. how often were you very active (playing hard. running. jumping. throwing)? (Check one only.)

I don't do PE .................................................................. 0 Hardly ever .................................................................... 0 Sometimes .................................................................... 0 Quite often ...................................................................... 0 Always ............................................................................ 0

3 . In the last 7 days. what did you normally do at lunch (besides eating lunch)? (Check one only.)

Sat down (talking. reading. doing schoolwork) ............. 0 Stood around or walked around ..................................... 0 Ran or played a little bit ................................................. 0 Ran around and played quite a bit .................................. 0 Ran and played hard most of the time ............................ 0

4 . In the last 7 days. on how many days right after school. did you do sports. dance. or play games in which you were very active? (Check one only.)

None ............................................................................... 0 1 time last week .............................................................. 0

..................................................... 2 or 3 times last week 0 4 times last week ............................................................ 0 5 times last week ............................................................ 0

5 . In the last 7 days. on how many evenings did you do sports. dance. or play games in which you were very active? (Check one only.)

............................................................................... None 1 time last week .............................................................. 2 or 3 times last week ..................................................... 4 times last week ............................................................ 6 or 7 times last week .....................................................


6. On the last weekend. how many times did you do sports, dance, or play games in which you were very active? (Check one only.)

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 1 time .............................................................................. 0 2-3 times ........................................................................ 0 4-5 times ........................................................................ 0 6 or more times .............................................................. 0

7. Which one of the following describes you best for the last 7 days? Read allfive state- ments before deciding on the one answer that describes you.

A. All or most of my free time was spent doing things that involve little physical effort 0

B. I sometimes (1-2 times last week) did physical things in my free time (e.g., played sports, went running, swimming, bike riding, did aerobics) 0

C. I often (3-4 times last week) did physical things in my free time 0 D. I quite often (5-6 times last week) did physical things in my free time 0 E. I very often (7 or more times last week) did physical things in my free time 0

8. Mark how often you did physical activity (like playing sports, games, doing dance, or any other physical activity) for each day last week.

Little None bit

Monday .. .. .. .. .. . .. . . ... .. .. 0 0 Tuesday ...... .. .. .. .... ... ... 0 0 Wednesday ..... .. . ... . .. .. . 0 0 Thursday ...... .. .. . .. . . .. .... 0 0 Friday ......................... 0 0 Saturday ...... .. .. .. . ... . .. . . . 0 0 Sunday . .. . . ... .. .. .. .... . .. .. . 0 0

Medium

0 0 0 0 0 0 0

very Often often

0 0 0 0 0 0 0 0 0 0 0 0 0 0

9. Were you sick last week, or did anything prevent you from doing your normal physical activities? (Check one.)

Yes .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . 0

If Yes, what prevented you?

Acknowledgments

The first two authors made equal contributions in the writing of this paper. Funding for this project was provided by the Canadian Heart and Stroke Foundation. The authors would like to thank the editor and two anonymous reviewers for their helpful comments, as well as the students and administrators involved in the study.

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