Validity of the Physical Activity Questionnaires IPAQ-SF and GPAQ for Cancer Survivors: Insights from a Spanish Cohort

Abstract

Regular physical activity (PA) decreases mortality risk in survivors of breast and colorectal cancer. Such impacts of exercise have prompted initiatives designed both to promote and adequately monitor PA in cancer survivors. This study examines the validity of 2 widely used self-report methods for PA determination, the International Physical Activity Questionnaire short version (IPAQ-SF) and Global Physical Activity Questionnaire (GPAQ). Both instruments were compared with the triaxial accelerometry (Actigraph) method as an objective reference standard. Study participants were 204 cancer survivors (both sexes, aged 18–79 years). Compared with accelerometry, both questionnaires significantly overestimated PA levels (across all intensities) and underestimated physical inactivity levels. No differences were detected between the 2 questionnaires except for a shorter inactivity time estimated by GPAQ (p=0.001). The Bland and Altman method confirmed that both questionnaires overestimated all PA levels. Receiver operating characteristic (ROC) analysis classified IPAQ and GPAQ as fair and poor predictors, respectively, of the proportions of survivors fulfilling international PA recommendations (≥150 min·week⁻¹ of moderate-vigorous PA). IPAQ-SF showed a higher sensitivity but lower specificity than GPAQ. Our data do not support the use of IPAQ-SF or GPAQ to determine PA or inactivity levels in cancer survivors.

Key words

tumor - self-reported physical activity - physical inactivity - accelerometer

• References

• 1 Abioye AI, Odesanya MO, Abioye AI, Ibrahim NA. Physical activity and risk of gastric cancer: a meta-analysis of observational studies. Br J Sports Med 2015; 49: 224-229
• 2 Armstrong T, Bull F. Development of the World Health Organisation Global Physical Activity Questionnaire (GPAQ). J Public Health 2006; 14: 66-70
• 3 Behrens G, Jochem C, Keimling M, Ricci C, Schmid D, Leitzmann MF. The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis. Eur J Epidemiol 2014; 29: 151-170
• 4 Behrens G, Leitzmann MF. The association between physical activity and renal cancer: systematic review and meta-analysis. Br J Cancer 2013; 108: 798-811
• 5 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
• 6 Boyle T, Keegel T, Bull F, Heyworth J, Fritschi L. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. J Natl Cancer Inst 2012; 104: 1548-1561
• 7 Campbell PT, Patel AV, Newton CC, Jacobs EJ, Gapstur SM. Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol 2013; 31: 876-885
• 8 Celis-Morales CA, Perez-Bravo F, Ibanez L, Salas C, Bailey ME, Gill JM. Objective vs. self-reported physical activity and sedentary time: effects of measurement method on relationships with risk biomarkers. PLoS One 2012; 7: e36345
• 9 Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003; 35: 1381-1395
• 10 Chen KY, Bassett Jr DR. The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc 2005; 37: S490-S500
• 11 Chu AH, Ng SH, Koh D, Muller-Riemenschneider F. Reliability and validity of the self- and interviewer-administered versions of the global physical activity questionnaire (GPAQ). PLoS One 2015; 10: e0136944
• 12 Dyrstad SM, Hansen BH, Holme IM, Anderssen SA. Comparison of self-reported versus accelerometer-measured physical activity. Med Sci Sports Exerc 2014; 46: 99-106
• 13 Farris MS, Mosli MH, McFadden AA, Friedenreich CM, Brenner DR. The association between leisure time physical activity and pancreatic cancer risk in adults: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2015; 24: 1462-1473
• 14 Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications, inc. accelerometer. Med Sci Sports Exerc 1998; 30: 777-781
• 15 Hagstromer M, Ainsworth BE, Oja P, Sjostrom M. Comparison of a subjective and an objective measure of physical activity in a population sample. J Phys Act Health 2010; 7: 541-550
• 16 Hagstromer M, Oja P, Sjostrom M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr 2006; 9: 755-762
• 17 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Lancet Physical Activity Series Working G. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012; 380: 247-257
• 18 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2016; 36: 1121-1124
• 19 Helmerhorst HJ, Brage S, Warren J, Besson H, Ekelund U. A systematic review of reliability and objective criterion-related validity of physical activity questionnaires. Int J Behav Nutr Phys Act 2012; 9: 103
• 20 Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-2486
• 21 Johnson-Kozlow M, Sallis JF, Gilpin EA, Rock CL, Pierce JP. Comparative validation of the IPAQ and the 7-Day PAR among women diagnosed with breast cancer. Int J Behav Nutr Phys Act 2006; 3: 7
• 22 Kim Y, Park I, Kang M. Convergent validity of the international physical activity questionnaire (IPAQ): meta-analysis. Public Health Nutr 2013; 16: 440-452
• 23 Klesges RC, Eck LH, Mellon MW, Fulliton W, Somes GW, Hanson CL. The accuracy of self-reports of physical activity. Med Sci Sports Exerc 1990; 22: 690-697
• 24 Kuiper JG, Phipps AI, Neuhouser ML, Chlebowski RT, Thomson CA, Irwin ML, Lane DS, Wactawski-Wende J, Hou L, Jackson RD, Kampman E, Newcomb PA. Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer Causes Control 2012; 23: 1939-1948
• 25 Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies. Acta Oncol 2015; 54: 635-654
• 26 Laukkanen JA, Rauramaa R, Makikallio TH, Toriola AT, Kurl S. Intensity of leisure-time physical activity and cancer mortality in men. Br J Sports Med 2011; 45: 125-129
• 27 Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Lancet Physical Activity Series Working G. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219-229
• 28 Lee PH, Macfarlane DJ, Lam TH, Stewart SM. Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act 2011; 8: 115
• 29 Leitzmann M, Powers H, Anderson AS, Scoccianti C, Berrino F, Boutron-Ruault MC, Cecchini M, Espina C, Key TJ, Norat T, Wiseman M, Romieu I. European Code against Cancer 4th Edition: Physical activity and cancer. Cancer Epidemiol 2015;
• 30 Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, Deng Y, Chen Q, Wei S, Nie S, Liu L. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med 2015;
• 31 Li Y, Gu M, Jing F, Cai S, Bao C, Wang J, Jin M, Chen K. Association between physical activity and all cancer mortality: Dose-response meta-analysis of cohort studies. Int J Cancer 2015;
• 32 Liu L, Shi Y, Li T, Qin Q, Yin J, Pang S, Nie S, Wei S. Leisure time physical activity and cancer risk: evaluation of the WHO’s recommendation based on 126 high-quality epidemiological studies. Br J Sports Med 2015;
• 33 Lu Y, John EM, Sullivan-Halley J, Vigen C, Gomez SL, Kwan ML, Caan BJ, Lee VS, Roh JM, Shariff-Marco S, Keegan TH, Kurian AW, Monroe KR, Cheng I, Sposto R, Wu AH, Bernstein L. History of recreational physical activity and survival after breast cancer: The california breast cancer survivorship consortium. Am J Epidemiol 2015; 181: 944-955
• 34 Lynch BM, Boyle T, Winkler E, Occleston J, Courneya KS, Vallance JK. Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control 2015;
• 35 Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N. Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003–2006). Cancer Causes Control 2010; 21: 283-288
• 36 Lynch BM, Dunstan DW, Winkler E, Healy GN, Eakin E, Owen N. Objectively assessed physical activity, sedentary time and waist circumference among prostate cancer survivors: findings from the National Health and Nutrition Examination Survey (2003–2006). Eur J Cancer Care (Engl) 2011; 20: 514-519
• 37 Maddison R, Ni Mhurchu C, Jiang Y, Vander Hoorn S, Rodgers A, Lawes CM, Rush E. International Physical Activity Questionnaire (IPAQ) and New Zealand Physical Activity Questionnaire (NZPAQ): a doubly labelled water validation. Int J Behav Nutr Phys Act 2007; 4: 62
• 38 Martinez SM, Ainsworth BE, Elder JP. A review of physical activity measures used among US Latinos: guidelines for developing culturally appropriate measures. Ann Behav Med 2008; 36: 195-207
• 39 Matthews CE, Hagstromer M, Pober DM, Bowles HR. Best practices for using physical activity monitors in population-based research. Med Sci Sports Exerc 2012; 44: S68-S76
• 40 Medina C, Barquera S, Janssen I. Validity and reliability of the International Physical Activity Questionnaire among adults in Mexico. Rev Panam Salud Publica 2013; 34: 21-28
• 41 Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 2008; 5: 56
• 42 Ruiz-Casado A, Verdugo AS, Solano MJ, Aldazabal IP, Fiuza-Luces C, Alejo LB, del Hierro JR, Palomo I, Aguado-Arroyo O, Garatachea N, Cebolla H, Lucia A. Objectively assessed physical activity levels in Spanish cancer survivors. Oncol Nurs Forum 2014; 41: E12-E20
• 43 Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport 2000; 71: S1-S14
• 44 Sanchis-Gomar F, Lucia A, Yvert T, Ruiz-Casado A, Pareja-Galeano H, Santos-Lozano A, Fiuza-Luces C, Garatachea N, Lippi G, Bouchard C, Berger NA. Physical inactivity and low fitness deserve more attention to alter cancer risk and prognosis. Cancer Prev Res (Phila) 2015; 8: 105-110
• 45 Santos-Lozano A, Marin PJ, Torres-Luque G, Ruiz JR, Lucia A, Garatachea N. Technical variability of the GT3X accelerometer. Med Eng Phys 2012; 34: 787-790
• 46 Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol 2014; 25: 1293-1311
• 47 Sims J, Smith F, Duffy A, Hilton S. The vagaries of self-reports of physical activity: a problem revisited and addressed in a study of exercise promotion in the over 65 s in general practice. Fam Pract 1999; 16: 152-157
• 48 Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and site-specific. Med Sci Sports Exerc 2001; 33: S530-S550 discussion S609–S510
• 49 Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc 2005; 37: S531-S543
• 50 Tucker JM, Welk GJ, Beyler NK. Physical activity in U.S.: adults compliance with the Physical Activity Guidelines for Americans. Am J Prev Med 2011; 40: 454-461
• 51 van Poppel MN, Chinapaw MJ, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults: a systematic review of measurement properties. Sports Med 2010; 40: 565-600
• 52 Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Initiative S. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297
• 53 von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577
• 54 Wolin KY, Heil DP, Askew S, Matthews CE, Bennett GG. Validation of the International Physical Activity Questionnaire – Short among Blacks. J Phys Act Health 2008; 5: 746-760
• 55 Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat 2013; 137: 869-882
• 56 Zhong S, Ma T, Chen L, Chen W, Lv M, Zhang X, Zhao J. Physical activity and risk of lung cancer: A meta-analysis. Clin J Sport Med 2015;