Original articleComparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer
Introduction
Physical activity is important in maintaining health and functional ability in older people. Several studies showed that lack of physical activity is a risk factor for decline in bone mass [1], falls and hip fractures [2], [3], [4], [5], and cardiovascular mortality [6] in older people. Within the Longitudinal Aging Study Amsterdam (LASA), physical activity was an important determinant for falls and fractures [7], and was negatively associated with abdominal fat [8]. Conclusions drawn from these studies depend on the validity and repeatability of the physical activity assessment.
At the start of the LASA study in 1992, only two physical activity questionnaires, that is, the Modified Baecke Questionnaire for Older Adults [9] and the Zutphen Physical Activity Questionnaire [10] had been validated in older populations [9], [11]. Both questionnaires are applicable for physical activity assessment in older persons. However, each of the questionnaires has several limitations. The Zutphen Physical Activity Questionnaire does not include household activities, whereas these activities are the main activities in older adults [12], [13], [14]. The Modified Baecke Questionnaire for Older Adults does not assess the amount of walking and bicycling, which are common nonsport activities in the Dutch population. Furthermore, the recall period of 1 year, used in the Modified Baecke Questionnaire for Older Adults, was considered too long because of the high prevalence of cognitive impairment in older cohorts [15]. Therefore, a new physical activity questionnaire for older persons was developed (i.e., LASA Physical Activity Questionnaire, LAPAQ) based on both the Modified Baecke Questionnaire for Older Adults and the Zutphen Physical Activity Questionnaire.
Several reference methods exist to validate a physical activity questionnaire. There is growing consensus that the doubly labeled water method is the gold standard for assessing total energy expenditure [16]. However, the doubly labeled water method is not feasible for large studies, as this method is expensive, time-consuming, and the isotope availability is limited. Furthermore, doubly labeled water provides no information about specific activities. In epidemiologic studies two other methods can be used to validate a physical activity questionnaire: a physical activity diary, or a movement counter (e.g., a pedometer or an accelerometer).
The first objective of this study was to validate the LAPAQ by a 7-day activity diary and a pedometer in a large community-based population of older men and women. The second objective was to assess the repeatability of the LAPAQ in an older population. The third objective was to compare the feasibility of using the LAPAQ, 7-day diary, and pedometer to measure physical activity in an older population.
Section snippets
Subjects
The study was performed within the framework of the LASA. The sampling and data collection procedures have been described in more detail elsewhere [17]. For the present study, respondents were recruited from 1,509 men and women, aged 65 years and older as of January 1 in 1996, and who participated in a follow-up study on falls within LASA. Subjects who completed the third data-collection cycle within LASA in 1998/1999 and fell at least once between January 1998 and January 1999 (n = 328) were
Response
Participants in the study (n = 439) were significantly younger, were more active, had higher performance test scores, and had higher MMSE scores (P<.05) compared to nonparticipants (n = 85). The number of respondents that participated in the study and completed the LAPAQ, the 7-day diary, and/or the pedometer is shown in Table 1 (response rate is one of the feasibility aspects investigated in this study, and is therefore shown in Table 1). Of the four nonparticipants of the LAPAQ, one was bedridden
Discussion
The LAPAQ appears to be a valid and reliable instrument for classifying physical activity in older persons. The results showed that the LAPAQ was highly associated with the 7-day diary. The LAPAQ does not greatly over- or underestimated the data from the 7-day diary. Furthermore, the difference in scores between the LAPAQ and 7-day diary became larger as the respondents were more active. Each of the activities was highly correlated, except walking. This might be due to the fact that the LAPAQ
Acknowledgements
The study is based on data collected in the context of the Longitudinal Aging Study Amsterdam (LASA), which was funded by the Ministry of Health, Welfare, and Sports of The Netherlands. The study on risk factors for fall incidents was supported by Netherlands Organisation for Health Research and Development (ZonMw), The Hague. The authors thank Jan Poppelaars, Mariëtte Westendorp, and the research nurses Betty Cox, Ida Gelderman, Eva Stokx, and Marjanne Kostman for their help in collecting and
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