Abstract
BackgroundFeasible and cost-effective as well as population specific instruments for monitoring physical activity (PA) levels are needed for the management and prevention of non-communicable diseases. The WHO-endorsed Global Physical Activity Questionnaire (GPAQ) has been widely used in developing countries, but the evidence base for its validity, particularly for rural populations, is still limited. The aim of the study was to validate GPAQ among rural and urban residents in Bangladesh.MethodsA total of 162 healthy participants of both genders aged 18–60 years were recruited from Satia village (n = 97) and Dhaka City (n = 65). Participants were invited to take part in the study and were asked to wear an accelerometer (GT3X) for 7 days, after which they were invited to answer the GPAQ in a face to face interview.ResultsValid accelerometer data (i.e., ≥10 h of wear times over ≥3 days) were received from 155 participants (rural = 94, urban = 61). The mean age was 35 (SD = ±9) years, 55% were females and 19% of the participants had no schooling, which was higher in the rural area (21% vs 17%). The mean ± SD steps/day was 9998 ± 3936 (8658 ± 2788 and 12,063 ± 4534 for rural and urban respectively, p = 0.0001) and the mean ± SD daily moderate-to-vigorous physical activity (MVPA) was 58 ± 30 min (51 ± 26 for rural and 69 ± 34 for the urban, p = 0.001) for accelerometer. In case of GPAQ, rural residents reported significantly higher moderate work related PA (MET-minutes/week: 600 vs. 360 p = 0.02). Spearman correlation coefficients between GPAQ total MVPA MET-min/day and accelerometer MVPA min/day, counts per minute (CPM) or steps counts/day were acceptable for urban residents (rho: 0.46, 0.55 and 0.63, respectively; p < 0.01) but poor for rural residents. The overall correlation between the GPAQ and accelerometer for sitting was low (rho: 0.23; p < 0.001). GPAQ-Accelerometer correlation for MVPA was higher for females (rho: 0.42), ≤35 age group (rho: 0.31) and those with higher education attainment (rho: 0.48). The Bland-Altman plots illustrated bias towards over estimation of GPAQ MVPA with increased activity levels for urban and rural residents.ConclusionGPAQ is an acceptable measure for physical activity surveillance in Bangladesh particularly for urban residents, women and people with high education. Given waist worn accelerometers do not capture the typical PA in rural context, further study using a physical activity diary and a combination of multiple sensors (e.g., wrist, ankle and waist worn accelerometers) to capture all movement is warranted among rural population with purposive sampling of all education levels.
Highlights
Feasible and cost-effective as well as population specific instruments for monitoring physical activity (PA) levels are needed for the management and prevention of non-communicable diseases
Fifty-four percent were female, the overall mean age was 35 (SD = ±9) years and 19% of the participants had no schooling, which was higher in the rural compared to the urban population (21% vs 17%)
The Freedson determination of moderate and vigorous PA accelerometer cut points were based on walking and running on a treadmill [25] and are unlikely to capture the intensity associated with walking carrying heavy loads or on uneven surface as is common in rural areas of developing countries such as Bangladesh and accelerometer may underestimate total moderateto-vigorous physical activity (MVPA) in these populations [37]. Support for this argument is the good correlation we found with time spent on light-intensity PA based on accelerometer and Global Physical Activity Questionnaire (GPAQ) occupation and travel-related physical activity, a correlation that was in the same range as for accelerometer MVPA
Summary
Feasible and cost-effective as well as population specific instruments for monitoring physical activity (PA) levels are needed for the management and prevention of non-communicable diseases. The WHO-endorsed Global Physical Activity Questionnaire (GPAQ) has been widely used in developing countries, but the evidence base for its validity, for rural populations, is still limited. Physical activity (PA) is a key behavioural factor for maintaining health and well-being at individual and population levels [1,2,3]. The Global Physical Activity Questionnaire (GPAQ) is one such instrument that was endorsed by the WHO for its STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS) [8,9,10,11]. The GPAQ was developed with special consideration of key physical activity domains in developing countries and of a length and complexity suitable for inclusion in STEPS [11]
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