Questions Response Code. Activity at Work. Q1. Does your work involve vigorous -intensity activity that causes large increases in breathing or. GPAQ: a survey tool to help practices improve their services to patients. The GPAQ questionnaire fulfills the requirements for the practice patient survey, GP. The WHO-endorsed Global Physical Activity Questionnaire (GPAQ) has been widely used in developing countries, but the evidence base for its.

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The data that support the findings of this study are available from the corresponding author upon reasonable request. 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. Valid accelerometer data i.

The overall correlation between the GPAQ and accelerometer for sitting was low rho: GPAQ is an acceptable measure for physical activity surveillance in Bangladesh particularly for urban residents, women and people with questionnaife 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. Physical activity PA is a key behavioural factor for maintaining health and well-being at individual and population levels [ 1 — 3 ].

The World Health Organization WHO has therefore promoted the development of PA surveillance tools in order to evaluate public health interventions and policies [ 56 ] aimed at reducing the burden of non-communicable diseases NCDs [ 7 ]. The GPAQ was developed with special consideration of key physical activity domains questiohnaire developing countries and of a length qudstionnaire complexity suitable for inclusion in STEPS [ 11 ].

The most extensive study to date assessing the validity of the GPAQ was conducted in — in nine countries including Bangladesh [ 12 ]. However, since then an updated measure was released by the STEP wise program and evidence for the questionnaure of the new version is still limited. Furthermore, six of these eight countries, including Bangladesh, used pedometers, a criterion measure which is not sensitive to activity intensity, and only four, of which Bangladesh was not one, included rural populations in their sample.

Given there are substantial differences in patterns and frequency of PA between rural and urban populations [ 13 — 16 ], it is yet to be determined if GPAQ is an appropriate instrument to assess the status of PA among rural populations [ 12 ]. A questuonnaire of the prevalence rates indicates that diabetes is becoming as problematic in rural questioonnaire in urban populations [ 17 — 19 ].

Quextionnaire the Bangladeshi sample in the validation of the previous version of the Questipnnaire was urban, validated against pedometers and showed very poor results, this study aimed to determine the criterion validity of the new version of GPAQ in both rural and urban populations using accelerometer as the criterion measure of physical activity. We excluded participants with chronic medical conditions that restricted their usual activity, those with mental retardation, those who were unwilling to participate and pregnant women.

We calculated our sample size to detect a Spearman correlation coefficient of 0. As we will be correlating self-reported MVPA against accelerometers in each region separately the minimal questiomnaire sample was 55 urban and 55 rural in total.

The research assistants RA approached the selected households HHintroduced the study and its importance and asked permission to enroll one eligible person from each HH. Once a person was chosen and volunteered to participate, a date and time for data collection was arranged and the recruitment continued until the sample size reached.

There are 12 different employment grades from the highest grade e. To ensure the validity study included all grades we used poster advertisements and emails to staff as well as actively approaching individual workers who were less likely to have access to email or more likely to be illiterate.

We used the GPAQ scoring protocol [ 21 ] to questionnqire the following indicators: To investigate the criterion validity we chose the Actigraph Qeustionnaire accelerometers as objective sensor-based activity monitors to provide the criterion measure.

Accelerometers are considered as more accurate than self-report for measuring time spent in different intensities and therefore used as criterion in validation questionaire subjective self-report questionnaires [ 22 ].

The GT3X accelerometer is small, noninvasive and contains a 3-axis microelectromechanical system which measures the quantity and intensity of movement http: Participants wore the accelerometer for seven consecutive days, except gpa sleep and water based activities. The device was worn at waist level above the hip of the left side. The data were stored in s intervals and aggregated into 1-min epochs, a procedure recommended for accelerometer studies in adults [ 23 ].


Actigraph Actilife software was used for initialization and analyses of accelerometer data. Hence for the sake of keeping the large questionnaaire we chose the lowest number of days. Six trained research assistants with a minimum of university graduation were recruited for data collection. All field research assistants were trained in conducting face to face interviews, including the GPAQ, and in measurements, including accelerometer data collection.

Training sessions were properly guided by the facilitators and supervisors.

Validity of the global physical activity questionnaire (GPAQ) in Bangladesh

On the first meeting day, study procedures were explained and informed consent obtained. Each participant was then fitted with an accelerometer and shown how to remove and re-wear the device. Basic socio-economic information was taken by interview on that day. A second meeting with the same interviewer was scheduled 7 days later at which the GPAQ interview was undertaken and the accelerometer collected for data downloading.

After data entry, range and consistency were checked. We have presented correlations for total sample and by subgroup. Main stratification was done by place, but further stratified by gender, age and education. To interpret agreement we used following standards: All p values presented were two tailed.

Data was analyzed using SPSS version23 statistical software. There were no significant differences in the age by gender distribution. However, stratification by place of residency indicated good correlations for urban residents rho: The domain specific correlations across all indicators i.

Time in light intensity was inversely related to travel-related activity in rural area.

A significant, low level of agreement between the GPAQ and accelerometer data for sitting was observed rho: The agreement for categorization of participants into meeting sufficient physical activity level was fair for all participants Kappa: A clear pattern of increased error was detected with increased average of PA.

After stratification by place, significant fair-to-moderate correlation was found for females, whereas urban young adults showed a significantly higher correlation than young rural adults. For education subgroups, the patterns of the correlations were inconsistent and did not follow gradient.

To the best of our knowledge this is the first validity study of the GPAQ in Bangladesh using accelerometer and also including rural population. Our results contradict some findings from the nine countries validity study by Bull et al.

First, the rural samples Ethiopia, Indonesia and India had better coefficients rho: Third, China and South Africa used accelerometers as the criterion measure for urban samples and the coefficient between GPAQ total PA across all domains and accelerometer moderate-intensity counts per minute were 0. In the nine countries study, criterion validity for urban Bangladesh was assessed by pedometer, which is a less sensitive objective measure than the accelerometer used in the current study.

The overall correlation was 0. Our results are comparable to other studies where low-to-moderate validity rho: Additionally, in the 12 countries study validation of the short International Physical Activity Questionnaire IPAQthe pooled validity correlations against accelerometers was found to be 0.

Validity of the global physical activity questionnaire (GPAQ) in Bangladesh

In the Bland-Altman plot a clear pattern of increased error was detected with increased average of PA for rural and urban participants. Overestimation of GPAQ was observed in the US [ 27 ] and Singapore [ 28 ], whereas negative bias was seen in the Northern Ireland with the majority of points falling below zero [ 6 ].

Several reasons may explain the low validity of GPAQ for our rural population as opposed to the urban sample; firstly, the dominant work-related PA in rural area is farming, it is a hard work that involves digging, cutting crops, rice processing, carrying heavy loads etc. Further, non-ambulatory activities such as cycling is also not captured by waist-worn accelerometers, and cycling is a very prevalent mode of transport in rural areas [ 3536 ], particularly among men.

Additional explanation may be related to the pace of ambulation in the country-side which may result in accelerometer counts below the cut-off point for moderate activity [ 25 ]. For example, the Freedson determination of questiohnaire and vigorous PA accelerometer cut points were based on walking and running on a treadmill [ g;aq ] and are unlikely to capture the intensity associated with walking carrying heavy loads or on uneven surface questionnaiee is common in rural areas of developing countries such as Bangladesh and thus accelerometer may underestimate total 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 GPAQ occupation and travel-related physical activity, a correlation that was in the same range as for accelerometer MVPA.

This may indicate that lowering the cut-point may improve the indicators for GPAQ validity. This could be more problematic if there is strong seasonal questionnwire. In Bangladesh, there are 6 seasons and the main occupation in rural area is agriculture which follows the seasons [ 38 ]. A multi-site study of nine Asian rural areas including Bangladesh showed that PA was lower in the middle questionnqire the harvest season and increased during the more intensive harvest period [ 39 ].

On the other hand urban residents had almost quesyionnaire work patterns throughout the year because our urban participants were selected from one work site where occupation related PA is stable throughout the questionbaire. In the subgroup analysis, females showed consistent correlations across all indicators of PA. In male overall correlation across indicators of PA was not seen, whereas other studies showed reverse result [ 64041 ].

This may be due to questiionnaire context specific nature of activities undertaken within both urban, and, particularly, rural Bangladesh which often requires considerable upper-body motion such as labor-intensive farming practices, as noted before, or construction jobs gpas the city.

Moreover, males carry heavy loads such as crops, seeds, sacks etc. Both pedometers and accelerometers are likely to underestimate the intensity of these activities despite their being moderate-intensity efforts subjectively, as well quesrionnaire by energy expenditure measure Ainsworth range 5METs to 8.

In addition, swimming and qustionnaire are common activities for rural people. Because accelerometers do not measure water-based and non-ambulatory activities, this quesfionnaire have contributed to the poor correlations found in males.

In case of education, the patterns of the correlations were inconsistent and did not follow gradient, quetionnaire, higher correlation was found in tertiary education group than other groups. This finding is similar to that of a study by Lee et al. Therefore it is possible that the overall low validity in rural sample was confounded by the lack of representation of participants with graduate degree in this sample. Yet, the coefficients for the illiterate groups, in both places, were better than those with primary and high-school education.

The lack queztionnaire gradient in coefficients by education levels suggest that factors other than cognitive errors may have contributed to the low validity questionnaige as the type of occupation they do static, non-ambulatory.

The current study found the volume of sedentary behaviour SB was greater when measured by the accelerometer than by the GPAQ. This finding is similar to that of recent study where found that when SB was measured with a self-reported single item it significantly underestimates SB in comparison to accelerometer data [ 43 ].

However, a study conducted on a Chilean population found the single question from the GPAQ had fair validity for measuring SB, though poor ability for correctly classifying individuals into tertiles or quartiles of SB [ 30 ]. Our finding of a low correlation rho: More accurate measurement of SB may be provided by using a multiple item domain-specific questionnaire [ 2443 ].

The study had a number of strengths as it assessed validity of GPAQ-2 both in urban and rural population which is rare in Bangladesh and in general. Secondly, there was good compliance with accelerometer wear and adherence to the study protocol. Additionally, we followed WHO guidelines questionnaier administering the GPAQ, queestionnaire intensive training on data collection staff and close supervision during data collection to minimize avoidable sources of measurement error.

We used a triaxial Actigraph accelerometer as a reference measure for criterion validity. The gold standard measurement for assessing energy expenditure are indirect calorimetry, doubly labelled water or heart rate monitoring, however, these are expensive and require technical expertise for implementation. Accelerometers are a widely used alternative for objective measurement as they are relatively less expensive, feasible, have been validated against DLW and showed a good level of reliability [ 644 ].

Nevertheless, accelerometers have their limitations. For example, in this study uqestionnaire data likely underestimated MVPA in the rural sample due to its inability to capture water-based, non-ambulatory and statics activities. Thus, using accelerometer as a criterion might be considered as concurrent or convergent instrument due questionnaire its pitfalls.