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A total of 120 participants were enrolled in the study. Finally 119 participants (99%) were included in the reliability analysis and 106 participants (88%) were included in the analysis of criterion validity (see ‘Flow diagram’ in Supplementary Figure S1, available in www.besjournal.com). Characteristics of the participants in reliability study and validity study stratified by sex are shown in Table 1. Boys spent more time in MVPA per day and had more physical activity energy expenditure than girls. Physical activity energy expenditure and daily time spent on total physical activity, MVPA and sedentary behaviors were longer on weekday than on weekend day (see Supplementary Table S1, available in www.besjournal.com).
Figure S1. Flow diagram outlining the number of included and excluded. CCPAQ 1&2, the first-time and the second-time administration of Chinese Children Physical Activity Questionnaire.
Characteristics Reliability study Validity study Total Boys Girls P Total Boys Girls P Sample number 119/120 enrolled 56 (47%) 63 (53%) 106/120 enrolled 53 (50%) 53 (50%) Age (years)a 13.1 ± 2.4 13.3 ± 2.5 13.0 ± 2.4 0.590 13.1 ± 2.5 13.3 ± 2.5 12.8 ± 2.4 0.279 Height (m)a 1.6 ± 0.1 1.6 ± 0.2 1.5 ± 0.1 < 0.001 1.6 ± 0.1 1.6 ± 0.2 1.5 ± 0.1 < 0.001 Weight (kg)a 50.2 ± 16.4 55.7 ± 19.0 45.4 ± 11.9 0.001 50.1 ± 16.9 56.0 ± 19.2 44.2 ± 11.5 < 0.001 BMI (kg/m2)a 20.1 ± 4.2 21.0 ± 5.1 19.3 ± 3.1 0.036 20.1 ± 4.4 21.1 ± 5.2 19.2 ± 3.2 0.023 Ethnicity, n(%)b Majority 109 (91.6%) 52 (92.9%) 57 (90.5%) 0.448 98 (92.5%) 50 (94.3%) 48 (90.6%) 0.358 Minority 10 (8.4%) 4 (7.1%) 6 (9.5%) 8 (7.5%) 3 (5.7%) 5 (9.4%) Note. BMI, body mass index. aDescripted as Mean ± SD because of the normal distribution. bDescripted as absolute number (percentage) because of categorical data. Table 1. Participant characteristics by sex
Total (n = 106) Pa Boys (n =52) Girls (n = 54) Pb PAEE (kcal/day) Week 354.9 (251.5, 448.9) < 0.001 411.9 (339.7, 576.6) 294.9 (219.1, 364.2) 0.001 Weekday 367.2 (267.5, 490.0) 446.0 (347.6, 558.4) 294.0 (216.3, 384.2) < 0.001 Weekend day 286.1 (194.6, 406.0) 345.1 (257.1, 475.2) 250.3 (168.4, 349.3) < 0.001 Total PA (min/day) Week 143.6 (110.5, 177.5) < 0.001 143.3 (114.5, 196.2) 143.9 (108.2, 175.8) 0.271 Weekday 143.5 (117.6, 187.1) 152.5 (116.0, 204.6) 138.4 (118.9, 182.3) 0.085 Weekend day 130.1 (82.8, 184.0) 125.6 (75.3, 189.4) 133.5 (86.9, 170.8) 0.538 MVPA (min/day) Week 57.6 (43.7, 67.0) < 0.001 59.0 (46.8, 67.9) 56.1 (41.9, 65.0) 0.103 Weekday 58.9 (48.7, 71.8) 60.0 (53.1, 72.2) 56.3 (44.4, 69.7) 0.008 Weekend day 45.9 (26.9, 62.0) 46.8 (23.2, 66.1) 45.3 (28.1, 57.8) 0.253 LPA (min/day) Week 89.8 (61.6, 118.6) 0.214 89.1 (63.9, 124.7) 91.2 (59.9, 116.0) 0.464 Weekday 90.0 (63.7, 120.8) 91.6 (66.0, 124.2) 90.0 (60.3, 119.5) 0.308 Weekend day 85.2 (51.2, 117.8) 82.0 (51.5, 124.2) 91.6 (51.2, 117.8) 0.795 Sedentary behavior (min/day) Week 594.4 (463.0, 672.9) < 0.001 607.9 (401.9, 680.1) 562.8 (472.9, 674.0) 0.943 Weekday 634.2 (512.5, 740.0) 648.5 (485.1, 764.8) 617.7 (527.8, 735.2) 0.506 Weekend day 541.8 (371.3, 643.0) 562.7 (302.9, 659.3) 509.0 (382.6, 619.7) 0.709 Numbers of achieving PA guidelines 16 (15%) − 4 (8%) 12 (24%) 0.056 Number of days spent time in MVPA ≥ 60 min (day) 4.0 ± 2.1 − 3.6 ± 1.9 4.4 ± 2.1 0.038 Note. PA, Physical Activity; PAEE, Physical Activity Energy Expenditure; MVPA, oderate-to-Vigorous Physical Activity; LPA, Light Physical Activity. Data were described as Median (25th percentile, 75th percentile). aThis is the P value for difference between weekday and weekend day. bThis is the P value for sex differences. Table S1. Accelerometer-measured physical activity and energy expenditure
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Reliability coefficient for time spent on total physical activity, MVPA, sedentary behavior and sleeping ranged from 0.7 to 0.9, while the reliability coefficient for LPA and screen time was slightly lower (0.4 to 0.7) (Table 2). Overall, the reliability coefficient was higher for physical behavior variables on weekday than on weekend day. Similarly, the reproducibility seemed to be higher for variables on boys than girls. The reliability coefficient for types of physical activity ranged from 0.57 to 0.88 (Table 3).
Physical Activity Variables Median (25th Percentile,
75th Percentile)Total (n = 119) Boys (n = 56) Girls (n = 63) CCPAQ 1 CCPAQ 2 ICC (95% CI) P ICC (95% CI) P ICC (95% CI) P PAEE (kcal/day) Week 598.5
(427.6, 799.7)534.6
(377.7, 814.7)0.93
(0.89, 0.95)< 0.001 0.93
(0.88, 0.96)< 0.001 0.90
(0.85, 0.94)< 0.001 Weekday 681.2
(463.2, 887.7)590.0
(447.0, 912.5)0.91
(0.87, 0.93)< 0.001 0.90
(0.83, 0.94)< 0.001 0.91
(0.85, 0.94)< 0.001 Weekend day 396.3
(220.2, 627.2)332.7
(192.2, 558.1)0.82
(0.74, 0.88)< 0.001 0.89
(0.81, 0.93)< 0.001 0.70
(0.53, 0.81)< 0.001 Total PA (min/day) Week 63.0
(42.5, 90.7)66.4
(43.4, 94.4)0.82
(0.74, 0.87)< 0.001 0.85
(0.76, 0.91)< 0.001 0.76
(0.64, 0.85)< 0.001 Weekday 69.4
(47.7, 98.0)72.1
(46.5, 100.8)0.80
(0.73, 0.86)< 0.001 0.85
(0.76, 0.91)< 0.001 0.72
(0.57, 0.82)< 0.001 Weekend day 40.3
(17.3, 90.0)42.5
(18.8, 80.0)0.70
(0.60, 0.78)< 0.001 0.64
(0.46, 0.77)< 0.001 0.77
(0.64, 0.85)< 0.001 MVPA (min/day) Week 27.5
(11.6, 54.4)28.2
(10.7, 50.0)0.79
(0.71, 0.85)< 0.001 0.85
(0.76, 0.91)< 0.001 0.70
(0.55, 0.81)< 0.001 Weekday 30.8
(14.3, 56.9)29.0
(12.0, 53.8)0.73
(0.63, 0.80)< 0.001 0.83
(0.72, 0.90)< 0.001 0.58
(0.38, 0.72)< 0.001 Weekend day 6.75
(0, 46.3)5.5
(0, 59.0)0.79
(0.71, 0.85)< 0.001 0.75
(0.61, 0.85)< 0.001 0.85
(0.76, 0.91)< 0.001 LPA (min/day) Week 29.6
(18.1, 49.1)31.4
(17.6, 51.8)0.63
(0.51, 0.73)< 0.001 0.57
(0.37, 073)< 0.001 0.69
(0.54, 0.80)< 0.001 Weekday 33.7
(18.8, 55.2)37.5
(17.1, 60.0)0.64
(0.52, 0.73)< 0.001 0.62
(0.43, 0.76)< 0.001 0.65
(0.48, 0.77)< 0.001 Weekend day 15.3
(5.0, 35.0)18.0
(5.0, 37.0)0.43
(0.27, 0.56)< 0.001 0.55
(0.35, 0.70)0.041 0.55
(0.35, 0.70)< 0.001 Sedentary behavior (min/day) Week 414.3
(312.1, 519.6)390.0
(289.6, 472.9)0.83
(0.77, 0.88)< 0.001 0.91
(0.85, 0.95)< 0.001 0.78
(0.66, 0.86)< 0.001 Weekday 467.0
(355.0, 552.0)443.0
(345.0, 526.0)0.85
(0.79, 0.89)< 0.001 0.88
(0.80, 0.93)< 0.001 0.83
(0.74, 0.90)< 0.001 Weekend day 270.0
(150.0, 405.0)251.3
(133.8, 337.5)0.52
(0.37, 0.64)< 0.001 0.80
(0.69, 0.88)< 0.001 0.40
(0.18, 0.59)< 0.001 Screen time (min/day) Week 32.1
(13.5, 68.6)25.7
(10.0, 57.1)0.65
(0.53, 0.74)< 0.001 0.78
(0.66, 0.87)< 0.001 0.56
(0.37, 0.71)< 0.001 Weekday 10.0
(0, 36.0)8.5
(0, 30.0)0.69
(0.58, 0.77)< 0.001 0.69
(0.53, 0.84)< 0.001 0.68
(0.52, 0.80)< 0.001 Weekend day 75.0
(30.0, 120.0)60.0
(22.5, 120)0.47
(0.32, 0.60)< 0.001 0.74
(0.60, 0.84)< 0.001 0.27
(0.30, 0.48)0.016 Sleeping time (min/day) Week 520.0
(460.0, 570.0)513.8
(467.5, 570.0)0.86
(0.81, 0.90)< 0.001 0.94
(0.91, 0.97)< 0.001 0.80
(0.68, 0.87)< 0.001 Weekday 480.0
(410.0, 540.0)480.0
(405.0, 540.0)0.89
(0.85, 0.92)< 0.001 0.91
(0.86, 0.95)< 0.001 0.87
(0.79, 0.92)< 0.001 Weekend day 560.0
(480.0, 600.0)570.0
(480.0, 630.0)0.70
(0.59, 0.77)< 0.001 0.88
(0.81, 0.93)< 0.001 0.57
(0.37, 0.71)< 0.001 Number of days spent time in MVPA ≥ 60 min 1.8 ± 1.8 1.6 ± 1.7 0.86
(0.80, 0.90)< 0.001 0.84
(0.73, 0.90)0.89
(0.83, 0.94)< 0.001 Note. CCPAQ, Chinese children’s physical activity questionnaire; CCPAQ 1, the first-time CCPAQ questionnaire investigation; CCPAQ 2, the second-time CCPAQ questionnaire investigation; ICC, intraclass correlation coefficients; PA, physical activity; PAEE, physical activity energy expenditure; MVPA, moderate-to-vigorous physical activity; LPA, light physical activity. Table 2. Test-retest reliability of CCPAQ stratified by sex with the use of intraclass correlation coefficient
Physical activity variables Total (n = 119) Boys (n = 56) Girls (n = 63) Median (25th percentile,
75th percentile)ICC (95% CI) P Median (25th percentile,
75th percentile)ICC (95% CI) P Median (25th percentile,
75th percentile)ICC (95% CI) P CCPAQ 1 CCPAQ 2 CCPAQ 1 CCPAQ 2 CCPAQ 1 CCPAQ 2 Transportation PAEE 38.3
(4.3, 86.7)40.5
(6.6, 96.3)0.73
(0.63, 0.80)< 0.001 41.2
(3.9, 97.5)40.9
(0.0, 142.4)0.70
(0.54, 0.81)< 0.001 33.7
(4.3, 79.1)33.8
(8.6, 81.1)0.79
(0.68, 0.87)< 0.001 TPA 20.0
(9.2, 33.8)23.6
(11.4, 35.7)0.65
(0.54, 0.75)< 0.001 21.1
(10.0, 35.4)26.8
(14.3, 35.7)0.57
(0.36, 0.72)< 0.001 20.0
(8.6, 31.5)21.4
(10.7, 34.6)0.70
(0.55, 0.81)< 0.001 Activity in School PAEE 90.5
(51.2, 162.9)79.3
(44.8, 167.1)0.84
(0.78, 0.89)< 0.001 106.8
(62.2, 183.8)87.8
(50.2, 193.6)0.82
(0.71, 0.89)< 0.001 83.7
(40.0, 155.6)77.9
(37.6, 122.1)0.86
(0.77, 0.91)< 0.001 TPA 23.9
(13.6, 36.6)24.6
(11.9, 35.9)0.86
(0.80, 0.90)< 0.001 24.9
(13.4, 36.5)24.8
(11.4, 38.5)0.88
(0.81, 0.93)< 0.001 23.0
(13.6, 37.1)23.7
(12.4, 35.2)0.80
(0.69, 0.87)< 0.001 Sports/exercise outside school PAEE 28.9
(0.0, 93.5)13.2
(0.0, 71.5)0.75
(0.66, 0.82)< 0.001 49.0
(0.0, 142.4)32.1
(0.0, 99.9)0.80
(0.68, 0.88)< 0.001 15.2
(0.0, 51.9)7.4
(0.0, 37.6)0.61
(0.43, 0.74)< 0.001 TPA 9.6
(0.0, 28.6)7.1
(0.0, 23.0)0.73
(0.63, 0.80)< 0.001 16.1
(0.2, 35.7)10.0
(0.0, 28.3)0.76
(0.63, 0.85)< 0.001 6.0
(0.0, 22.5)4.3
(0.0, 17.7)0.70
(0.55, 0.81)< 0.001 Household PAEE 3.0
(0.0, 11.0)3.0
(0.0, 10.9)0.70
(0.60, 0.78)< 0.001 5.3
(0.0, 16.2)5.4
(0.0, 19.4)0.70
(0.53, 0.81)< 0.001 1.7
(0.0, 9.1)2.0
(0.0, 7.0)0.68
(0.52, 0.79)< 0.001 TPA 2.9
(0.0, 7.1)2.9
(0.0, 8.6)0.84
(0.77, 0.88)< 0.001 3.2
(0.4, 7.1)3.2
(0.89, 8.6)0.86
(0.78, 0.92)< 0.001 2.9
(0.0, 7.5)2.9
(0.0, 8.6)0.80
(0.69, 0.88)< 0.001 Note. CCPAQ, Chinese Children’s Physical Activity Questionnaire; CCPAQ 1, the first-time CCPAQ questionnaire investigation; CCPAQ 2, the second-time CCPAQ questionnaire investigation; ICC, Intraclass Correlation Coefficients; CI, Confidence Interval; TPA, Total physical activity (Unit: minutes/day); PAEE, physical activity energy expenditure (Unit: kcal/day). Table 3. Test-retest reliability of different types of physical activity by CCPAQ with the use of intraclass correlation coefficients
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Content Validity The CCPAQ exhibits content validity as it provides information on the natural and intuitive of physical activity pattern, especially different intensity and types of physical activities as well as sedentary behaviors and sleep time across a whole day in the past week. Furthermore, the CCPAQ is capable of investigating other subset of activity, such as screen-based activities, activities in school, out of school, in household and in transportation.
Criterion Validity Physical activity energy expenditure displayed moderate validity on a week (rho = 0.58, P < 0.001) or on weekday (rho = 0.57, P < 0.001). Correlations between the CCPAQ and the accelerometer tended to be higher for total time spent on physical activity and sedentary behaviors compared with correlations for MVPA and LPA. Correlations were stronger for boys than for girls, except daily time spent on MVPA and sedentary behavior during weekend. Mean differences for time spent on all activity variables were negative which means CCPAQ values on average were lower than accelerometer-measured values. There was no correlation between the two methods for the average days in which at least 60 minutes of MVPA were accumulated in each day last week (Table 4).
Physical activity variables Spearman’s Correlation Coefficient (P value) Comparison between two measures Total (n = 106) Boys (n = 53) Girls (n = 53) Mean ± SD No. over No. under No. same PA energy expenditure (kcal/day) Week 0.58 (< 0.001) 0.57 (< 0.001) 0.55 (< 0.001) 226.8 ± 254.8 82 23 1 Weekday 0.57 (< 0.001) 0.58 (< 0.001) 0.45 (< 0.001) 315.3 ± 303.2 96 10 0 Weekend day 0.12 (0.217) 0.08 (0.601) 0.10 (0.504) 139.3 ± 396.1 65 41 0 Total PA (min/day) Week 0.32 (< 0.001) 0.39 (0.004) 0.27 (0.047) −78.0 ± 58.1 10 96 0 Weekday 0.34 (< 0.001) 0.38 (0.005) 0.29 (0.031) −71.7 ± 56.9 13 93 0 Weekend day 0.22 (0.021) 0.22 (0.116) 0.22 (0.107) −79.2 ± 81.5 15 91 0 MVPA (min/day) Week 0.20 (0.040) 0.24 (0.085) 0.14 (0.330) −19.4 ± 36.4 26 80 0 Weekday 0.26 (0.007) 0.28 (0.046) 0.24 (0.079) −18.2 ± 36.3 25 78 3 Weekend day 0.23 (0.017) 0.09 (0.521) 0.34 (0.011) −17.6 ± 45.7 26 79 1 LPA (min/day) Week 0.19 (0.054) 0.28 (0.045) 0.10 (0.469) −58.6 ± 43.9 8 98 0 Weekday 0.22 (0.021) 0.28 (0.047) 0.18 (0.200) −53.5 ± 43.9 10 94 2 Weekend day −0.08 (0.423) 0.09 (0.503) −0.23 (0.100) −61.7 ± 63.6 12 93 1 Sedentary behavior (min/day) Week 0.32 (< 0.001) 0.26 (0.060) 0.39 (0.003) −127.7 ± 213.3 24 82 0 Weekday 0.32 (0.001) 0.35 (0.011) 0.30 (0.030) −120.6 ± 248.5 23 83 0 Weekend day 0.33 (< 0.001) 0.30 (0.030) 0.35 (0.009) −154.9 ± 331.2 25 81 0 Number of days spent time in MVPA ≥ 60 min −0.15 (0.130) −0.29 (0.041) −0.04 (0.789) −2.8 ± 2.9 18 78 10 Note. CCPAQ, Chinese children’s physical activity questionnaire; PA, physical activity; MVPA, moderate-to-vigorous physical activity; LPA = light physical activity. Mean ± SD: Mean difference between the CCPAQ and the accelerometer ± Standard deviation of mean difference. No. over: number of participants that over-estimated; No. under: number of participants that under-estimated; No. same: number of participants that reported the same as the accelerometer-measured values. Table 4. Validity coefficients for movement behaviors and energy expenditure comparing CCPAQ and accelerometer measurement
Bland-Altman plots showed the degree of error in CCPAQ depended on the level of physical activity energy expenditure, MVPA or sedentary behaviors (Figure 2). Higher level of energy expenditure and MVPA were more likely to be overestimated and the difference between both methods was more obvious, whereas more time spent on sedentary behaviors was more likely to be underestimated and the difference between both methods was less obvious.
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Using the cut-off of Evenson et al., similar validity correlations of physical activity variables between the CCPAQ and the accelerometer were found. Accelerometer data were re-categorized using 0-799 counts as the threshold for sedentary behavior in the cut-off of Puyan et al., and then the correlation was only 0.14 and insignificant (P = 0.163). Using the cut-off of Freedson et al., lower than that of Vanhelst et al., there are no significant correlations in any physical activity variables (Table 5).
Intensities of PA Vanhelst et al.[23], 2011 Evenson et al.[29], 2008 Puyan et al.[30], 2002 Freedson et al.[31], 1998 Cut-points rho P Cut-points rho P Cut-points rho P Cut-points rho P Total activity ≥ 401 0.32 0.001 ≥ 101 0.33 0.001 ≥ 800 0.39 < 0.001 ≥ 150 0.13 0.172 MVPA ≥ 1,901 0.20 0.040 ≥ 2,096 0.24 0.016 ≥ 3,200 0.17 0.082 ≥ 500 0.11 0.267 LPA 401-1,900 0.19 0.054 101-2,295 0.14 0.145 800-3,199 0.20 0.043 150-499 0.15 0.043 Sedentary behavior ≤ 400 0.32 0.001 ≤ 100 0.31 0.002 ≤ 799 0.14 0.163 ≤ 149 0.01 0.992 Note. CCPAQ, Children and adolescents movement behaviors questionnaire; PA, physical activity; MVPA, moderate-to-vigorous physical activity; VPA, vigorous physical activity; MPA, moderate physical activity; LPA, light physical activity; rho, Spearman’s correlation coefficient. Table 5. Spearman’s validity coefficients for physical activity variables comparing CCPAQ and accelerometer measurement using different cut points for physical activity intensity
Validity and Reliability of Chinese Physical Activity Questionnaire for Children Aged 10-17 Years
doi: 10.3967/bes2019.084
- Received Date: 2018-04-22
- Accepted Date: 2018-06-05
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Key words:
- Physical activity /
- Sedentary behavior /
- Child /
- Questionnaire /
- Validity and reliability
Abstract:
Citation: | YANG Xi, JAGO Russell, ZHAI Yi, YANG Zhen Yu, WANG Yu Ying, SI Xiang, WANG Jun, GAO Jian Fen, CHEN Jing Ron, YU Ying Jie, ZHAO Wen Hua. Validity and Reliability of Chinese Physical Activity Questionnaire for Children Aged 10-17 Years[J]. Biomedical and Environmental Sciences, 2019, 32(9): 647-658. doi: 10.3967/bes2019.084 |