International Physical Activity Questionnaire (IPAQ) and New Zealand Physical Activity Questionnaire (NZPAQ): A doubly labelled water validation

Background  

Accurate measurement of physical activity is a pre-requisite for monitoring population health and for evaluating effective interventions. The International Physical Activity Questionnaire (IPAQ) is used as a comparable and standardised self-report measure of habitual physical activity of populations from different countries and socio-cultural contexts. The IPAQ has been modified to produce a New Zealand physical activity questionnaire (NZPAQ). The aim of this study was to validate the IPAQ and NZPAQ against doubly labelled water (DLW). Method: Total energy expenditure (TEE) was measured over a 15-day period using DLW. Activity-related energy expenditure (AEE) was estimated by subtracting the energy expenditure from resting metabolic rate and thermic effect of feeding from TEE. The IPAQ (long form) and NZPAQ (short form) were completed at the end of each 7-day period. Activity-related energy expenditure (IPAQ_AEE and NZPAQ_AEE) was calculated from each questionnaire and compared to DLW_AEE.     

Physical activity questionnaire for adolescents validated against doubly labelled water

OBJECTIVE: To validate a physical activity questionnaire for adolescents (PAQA) adapted from the International Physical Activity Questionnaire (IPAQ). DESIGN: Energy expenditure was measured during a 14-day period with doubly labelled water (DLW). PAQA was administered as an interview at the end of the period, asking for physical activity in school, during transportation and leisure-time, during a habitual week. Energy expenditure (EE(PAQA)) was calculated as the product of total physical activity + sleep and predicted resting metabolic rate, and was compared to energy expenditure from DLW (EE(DLW)), thermic effect of feeding excluded. SETTING: Participants were recruited from grade 9 in a compulsory school in G?teborg, Sweden. All data were collected at school, and distribution of DLW and measuring of resting metabolic rate were performed at Sahlgrenska University Hospital. SUBJECTS: A total of 33 adolescents (16 girls, 17 boys) 15.7 (0.4) y performed all measurements. RESULTS:: For the whole group, PAQA underestimated energy expenditure by 3.8 (1.7) MJ (P<0.001). There was a strong correlation (r = 0.62, P<0.001) between EE(PAQA) and EE(DLW), but not for boys (r = 0.42, P = 0.090) and girls (r = 0.33, P = 0.22) separately. CONCLUSIONS: PAQA is not able to predict energy expenditure in Swedish adolescents, largely explained by the amount of unreported time. The ability to rank adolescents energy expenditure is questioned because of the gender effect, although we found a strong correlation for the whole group.     

Comparison of energy expenditure estimated in healthy infants using the doubly labelled water and energy balance methods

The doubly labelled water method was used to estimate energy expenditure in 20 formula-fed infants (10 aged 1 month and 10 aged 4 months). We then compared the energy expenditure values with energy balance values calculated from energy intake and energy cost of growth. Our purpose was to compare various published equations for calculating CO2 expiration rates (and thus energy expenditure values) from the isotopic data. Those equations in which we used measured values for 18O and 2H isotope dilution spaces and estimated or measured values for insensible water losses yielded energy expenditure values (69.7 +/- 8.4 kcal/kg/d) that agreed most closely with energy balance data (70.3 +/- 11.9 kcal/kg/d). Equations in which we used a constant ratio of 1.03 between the 2H and 18O isotope dilution spaces resulted in energy expenditure values (66.3 +/- 10.2 kcal/kg/d) lower than those predicted by the energy balance data. Data analysis by nonlinear curve fitting compared to logarithmic transformation did not alter the estimates of energy expenditure obtained in these infants.     

Energy expenditure and socioeconomic status in Guatemala as measured by the doubly labelled water method

The energy expenditure of lower (group 1) and upper socioeconomic group females (group 2) from a marginal community in Guatemala City was determined by using the doubly labelled water method. Energy expenditure values were 1925 +/- 66 (mean, SEM) kcal/d (group 1) and 2253 +/- 145 kcal/d group 2 (p less than 0.03). About half of this difference can be attributed to size.     

Simultaneous measurement of free-living energy expenditure by the doubly labeled water method and heart-rate monitoring

Total energy expenditure (TEE) was measured simultaneously in 14 free-living adults over 15 d by the doubly labeled water (DLW) method and for 2-4 separate days by heart-rate (HR) monitoring. Individual curves for HR vs oxygen consumption (VO2) were obtained and an HR (FLEX HR: 97 +/- 8 beats/min, range 84-113 beats/min) that discriminated between rest and activity was identified. Calibration curves were used to assign an energy value to daytime HR above FLEX HR. Below FLEX HR energy expenditure was taken as resting metabolism. Sleeping energy expenditure was assumed to be equal to basal metabolic rate. Average HR TEE (12.99 +/- 3.83 MJ/d) and average DLW TEE (12.89 +/- 3.80 MJ/d) were similar. HR TEE discrepancies ranged from -22.2% to +52.1%, with nine values lying within +/- 10% of DLW TEE estimates. The FLEX HR method provides a close estimation of the TEE of population groups. However, an increased number of sampling days may improve the precision of individual estimates of TEE.     

Self-reported physical activity using International Physical Activity Questionnaire in adolescents and young adults with visual impairment

Background

Young people with visual impairment (VI) face many environmental barriers that influence physical activity.

Measurement of energy expenditure in free-living humans by using doubly labeled water

The doubly labeled water method is a form of indirect calorimetry that has been developed only recently to the stage of application to human studies. The method measures integral CO2 production for up to 3 wk from the difference in elimination rates of deuterium and 18O from labeled body water. Validations against near-continuous respiratory gas exchange have demonstrated that the method is accurate and has a precision of 2-8% depending on the isotope dose and the length of the elimination period. Although the method has been validated, there is still some debate on refinements of the kinetic model that may lead to improved accuracy and precision. Because the method only requires periodic sampling of body fluids, it is non-restrictive and ideally suited to use in free-living subjects. Recent applications of the method have included obesity research, determination of energy requirements in both developing and developed countries and studies of human growth.     

Validation of ActiReg to measure physical activity and energy expenditure against doubly labelled water in obese persons

ActiReg is an instrument that uses combined recordings of body position and motion to calculate energy expenditure (EE) and physical activity (PA). The aim of the study was to compare mean total energy expenditure (TEE) measured by ActiReg and doubly labelled water (DLW) in obese subjects. TEE was measured by the DLW method during a period of 14 d in fifty obese men and women with metabolic risk factors. During the same period ActiReg recordings were obtained for 7 d. RMR was measured by indirect calorimetry and also estimated by standardized equations. Because EE may be disproportionately increased in obese subjects during weight-bearing activities, we established a new set of physical activity ratios (PAR). These ratios were based on oxygen uptake measurements during treadmill walking. The mean TEE according to the DLW was 13.94 (sd 2.47) MJ/d. Mean TEE calculated from the ActiReg data and measured RMR was 13.39 (sd 2.26) MJ/d, an underestimation of 0.55 MJ (95 % CI 0.13, 0.98; P = 0.012) or 3.9 %. RMR derived from standard equations based on weight, age and sex were overestimated while the RMR based on fat-free mass values in addition was underestimated. Despite slight underestimation ActiReg may be used to measure TEE in obese subjects on two premises: RMR should be measured, and the increased EE during weight-bearing activities in obese subjects should be considered.     

Determinants of free-living energy expenditure in normal weight and obese women measured by doubly labeled water

Total free-living energy expenditure (TEE) was measured in 9 normal weight controls and 5 obese women using the doubly labeled water (DLW) method. Resting energy expenditure (REE) and the thermic effect of food (TEF) were measured by indirect calorimetry and the energy cost of physical activity (PA) calculated by deduction, in order to quantify the components and identify determinants of free-living TEE. Although REE was quantitatively the major component of TEE in both groups, PA best explained the variability, contributing 76% to the variance in free-living TEE. The obese women had elevated values for TEE (12397 +/- 2565 vs. 8339 +/- 1787 kJ/d, mean +/- SD; p < 0.005), compared with the control women. PA (5071 +/- 2385 vs. 2552 +/- 1452; p < 0.05) and REE (6393 +/- 678 vs. 5084 +/- 259; p < 0.0005) were also raised in the obese, whereas TEF was not significantly different between the groups, accounting for 7.6% of energy expenditure for the obese and 8% for the control subjects. Body weight was the single best determinant of mean daily free-living TEE across both groups. We conclude that PA and body weight are the main determinants of free-living TEE.     

Estimating free-living human energy expenditure: Practical aspects of the doubly labeled water method and its applications

The accuracy and noninvasive nature of the doubly labeled water (DLW) method makes it ideal for the study of human energy metabolism in free-living conditions. However, the DLW method is not always practical in many developing and Asian countries because of the high costs of isotopes and equipment for isotope analysis as well as the expertise required for analysis. This review provides information about the theoretical background and practical aspects of the DLW method, including optimal dose, basic protocols of two- and multiple-point approaches, experimental procedures, and isotopic analysis. We also introduce applications of DLW data, such as determining the equations of estimated energy requirement and validation studies of energy intake.     

国际体力活动问卷中体力活动强度对中老年人糖尿病患病率的影响

目的 采用国际体力活动问卷(IPAQ)评价广州市中老年人体力活动状况对糖尿病患病率的影响.方法 2006年11月至2007年9月从"广州生物库队列研究"第三期招募研究对象中随机选出1996名年龄≥50岁的广州市居民,进行包括详细的生活方式、疾病史等调查,以及身高、体重、腰围、臀围和空腹血糖及葡萄糖耐量等指标的测量和检测.采用IPAQ调查并评价受检者体力活动状况.结果 共1932名(96.8%)受试者接受IPAQ体力活动调查,其中体力活动活跃(60.0%)、充分(中等,29.8%)和不足者(10.2%)糖尿病患病率分别为9.1%、12.0%和14.2%.多因素logistic回归分析,在调整了年龄、性别、肥胖等多种潜在混杂因素之后,相对体力活动不足组,体力活动充分和活跃组患糖尿病的OR值分别为0.75(95%CI:0.46～1.26)和0.60(95%CI:0.38～0.97),趋势分析P=0.03.结论 经常性的适度体力活动有助于降低中老年人糖尿病患病风险.     

Comparison of total energy intakes estimated by 24-hour diet recall with total energy expenditure measured by the doubly labeled water method in adults

BACKGROUND/OBJECTIVESThe doubly labeled water (DLW) method is the gold standard for estimating total energy expenditure (TEE) and is also useful for verifying the validities of dietary evaluation tools. In this study, we compared the accuracy of total energy intakes (TEI) estimated by the 24-h diet recall method with TEE obtained using the doubly labeled water method.SUBJECTS/METHODSThis study involved 71 subjects aged 20–49 yrs. Over a 14-day period, three 24-h diet recalls per subject (2 weekdays and 1 weekend day) were used to estimate energy intakes, while TEE was measured using the DLW method. The paired t-test was used to determine the significance of differences between TEI and TEE results, and the accuracy of the 24-h recall method was determined by accuracy predictions percentage, root mean square error, and bias.RESULTSAverage study subject age was 33.4 ± 8.6 yrs. The association between TEI and TEE was positive and significant (r = 0.463, P < 0.001), and the difference between TEI (2,084.3 ± 684.2 kcal/day) and TEE (2,401.7 ± 480.3 kcal/day) was also significant (P < 0.001). In all study subjects, mean TEI was 12.0% (307.5 ± 629.3 kcal/day) less than mean TEE, and 12.2% (349.4 ± 632.5 kcal/day) less in men and 11.8% (266.7 ± 632.5 kcal/day) less in women. Rates of TEI underprediction for all study subjects, men, and women, were 60.5%, 51.4%, and 66.7%, respectively.CONCLUSIONSThis study shows that 24-h diet recall underreports energy intakes. More research is needed to corroborate our findings and evaluate the accuracy of 24-h recall with respect to additional demographics.     

Estimating energy expenditure from the Minnesota Leisure Time Physical Activity and Tecumseh Occupational Activity questionnaires - a doubly labeled water validation

An accurate, simple method for assessing energy expenditure in individuals and in free-living populations continues to be elusive. To compare estimates of energy expenditure (EE) from a combination of two previously validated physical activity questionnaires: Tecumseh Occupational (EE(TEC)) and a 4-wk history version of the Minnesota Leisure Time Physical Activity that included household activities (EE(MNLTPA)) and EE from sleep (EE(SLEEP)), to EE obtained from doubly labeled water (EE(DLW)). We studied free-living males (n = 24) eating a controlled diet designed to maintain body weight and determined EE from doubly labeled water (DLW) during 14 days and EE from physical activity instruments used in epidemiological studies (EE(TEC) and EE(MNLTPA)). There was excellent agreement between EE(DLW) (mean +/- SEM, 13.55 +/- 0.38 MJ/d) and EE(TEC) + EE(MNLTPA) + EE(SLEEP) (EE(TOTAL1)) (13.79 +/- 0.89 MJ/d) with a difference of only 1.0% +/- 5.4%. When the EE from watching TV, reading, and childcare activities was added the total EE (EE(TOTAL2)) (14.87 +/- 0.90 MJ/D) overestimated EE(DLW) by 8.9% +/- 5.4%. Both of these estimates of EE had significant regressions against EE(DLW) (EE(TEC) + EE(MNLTPA) + EE(SLEEP), R(2) = 0.38, P < 0.001; EE(TOTAL2), R(2) = 0.39, P < 0.001). Men whose occupations involved significant intermittent moderate activity had the largest disagreement between EE(DLW) and estimates from the questionnaires. This investigation demonstrates that a combination of previously validated physical activity questionnaires can be used to accurately determine the mean energy expenditure of a population of employed males.     

Energy expenditure in underweight free-living adults: impact of energy supplementation as determined by doubly labeled water and indirect calorimetry

The effect of energy supplementation was evaluated in six underweight adults under free-living conditions. Customary energy intake (EI) over 4 wk and estimated body composition were defined. Then for 12 wk subjects were fed their customary EI under controlled conditions to assure stable energy reserve. Finally, intake was increased by a mean of 720 kcal/d for 8 wk adjusted to increase body fat from 9 to 18%. Body weight (means +/- SD) increased from 55.2 +/- 3.4 to 57.0 +/- 4.2 kg. Body fat gain was highly variable ranging from 0.6 to 3.8 kg. Energy expenditure (EE) by the factorial and doubly labeled water methods did not change. Fat storage accounted for 66% of the supplemental energy; 237 kcal/d remained unaccounted for. EE by the factorial method, which uses indirect calorimetry or isotopic measurements, were highly correlated (r = 0.8; p less than 0.01). Under the conditions of this study EI does not affect EE. The labeled water method permits the evaluation of energy expenditure in free-living conditions.     

Alterations in growth and body composition during puberty. IV. Energy intake estimated by the youth-adolescent food-frequency questionnaire: validation by the doubly labeled water method

BACKGROUND: Estimates of energy intake are required for an understanding of growth and disease; however, few methods of energy intake in children have been validated. OBJECTIVE: Our objective was to validate energy intake estimated by the Youth-Adolescent Food-Frequency Questionnaire (YAQ) against the criterion total energy expenditure (TEE) by doubly labeled water (DLW). DESIGN: Twenty-three boys and 27 girls (8.6-16.2 y of age) completed the YAQ and TEE measurements in 1 y. RESULTS: Energy intake by the YAQ (10. 03 +/- 3.12 MJ) and energy expenditure by DLW (9.84 +/- 1.79 MJ) were similar (P: = 0.91) with large lower (-6.30 MJ) and upper (6.67 MJ) +/-2 SD limits of agreement. When within-subject CVs of repeated measures of the DLW and YAQ methods were used, 25 of the 50 subjects were deemed to have misreported their energy intake. The discrepancy in energy intake (YAQ - TEE) was related to body weight (r = -0.25, P: = 0.077) and percentage body fat (r = -0.24, P: = 0.09) but not to age (r = -0.07, P: = 0.63) or the time between measures. From logistic regression, fatter boys were more likely to underreport energy intake than were fatter girls. CONCLUSION: The YAQ provides an accurate estimation of mean energy intake for a group but not for an individual.     

Concurrent validity of the International Physical Activity Questionnaire (IPAQ) in an liyiyiu Aschii (Cree) community

BACKGROUND: Culturally acceptable and validated instruments for assessing physical activity among Indigenous Peoples are lacking. Given the current trends in obesity, health behaviour surveillance tools are needed to evaluate trends and to determine the effectiveness of health promotion efforts aimed at curbing the obesity epidemic. OBJECTIVE: To evaluate whether the International Physical Activity Questionnaire (IPAQ) scores correlate with anthropometric indices in an liyiyiu Aschii community (Cree Territory of northern Quebec, Canada). METHODS: A cross-sectional study was carried out in a Cree community as part of a larger research effort entitled, "Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Longitudinal Study in liyiyiu Aschii". Randomly selected adult participants (n = 161) underwent an anthropometric assessment and answered the IPAQ which was administered by bilingual research assistants. Concurrent validity of the IPAQ was evaluated by the extent to which the physical activity scores were related to anthropometric measures. RESULTS: Significant inverse correlations were observed between the IPAQ Total MET score and % body fat (r = -.19, p < or = 0.01) and the IPAQ Vigorous MET score and % body fat (r = -.26, p < or = 0.001), but not for waist circumference or BMI. Walkers (6-7 days/wk for > or = 60 minutes/day), however, had a waist circumference that was, on average, 5 cm smaller than non-walkers in age- and sex-adjusted linear regression analyses (beta = -4.97; SE = 2.5; p < or = 0.05). DISCUSSION: The results indicate that the IPAQ holds promise as a culturally adaptable questionnaire for the liyiyiuch. However, modifications will help improve its acceptability for community members.