Validation of the Italian version of the Pregnancy Physical Activity Questionnaire
Keywords:
PPAQ, pregnancy, physical activity, questionnaire, Italian validation, PPAQ-ITAbstract
Background. A growing body of evidence suggests that physical activity during pregnancy may have significant health benefits. Self-reported questionnaires may represent an important instrument for gathering information and quantifying the amount of physical activity that women engage during pregnancy. In this study we analyzed the reliability and validity of the Italian version of the Pregnancy Physical Activity Questionnaire.
Methods. The reliability and construct validity of the Italian Version of the Pregnancy Physical Activity Questionnaire was analyzed in a sample of pregnant women. Intraclass correlation coefficients (ICCs) were calculated to investigate the test-retest reliability of the Italian Version of the Pregnancy Physical Activity Questionnaire scores at baseline and after 1 week. Intraclass correlation coefficients >0.70 were considered to denote an adequate reliability. Validity was assessed using Spearman’s rank order correlation coefficients between the Italian Version of the Pregnancy Physical Activity Questionnaire scores and the equivalent measures obtained by accelerometers. Coefficients (ρ) >0.50 were considered adequate for construct validity.
Results. The test-retest analysis revealed an adequate reliability for sedentary (Intraclass correlation coefficient = 0.785), moderate (Intraclass correlation coefficient = 0.751), and vigorous physical activity (Intraclass correlation coefficient = 0.931), while lower reliability was found for total (Intraclass correlation coefficients = 0.689) and light physical activity (Intraclass correlation coefficients = 0.632). All Spearman’s rank correlation coefficients between the Italian Version of the Pregnancy Physical Activity Questionnaire and the accelerometers measures were <0.50 and non-statistically significant.
Conclusion. The results of this study showed that the Italian Version of the Pregnancy Physical Activity Questionnaire has almost adequate reliability, while construct validity, based on correlation between Italian Version of the Pregnancy Physical Activity Questionnaire scores and accelerometer data, is very low. Still, the Pregnancy Physical Activity Questionnaire may represent a useful tool to capture daily life activities of pregnant women.
References
1. DiPietro L, Evenson KR, Bloodgood B, Sprow K, Troiano RP, Piercy KL, et al. Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review. Med
Sci Sports Exerc. 2019 Jun;51(6):1292-302. doi: 10.1249/ MSS.0000000000001941. PMID: 31095086; PMCID: PMC6527310.
2. Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020 Apr;135(4):e178-88. doi:
10.1097/AOG.0000000000003772. PMID: 32217980.
3. WHO guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
4. Ruchat SM, Mottola MF, Skow RJ, Nagpal TS, Meah VL, James M, et al. Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and metaanalysis. Br J Sports Med. 2018 Nov 1;52(21):1347-56. doi: 10.1136/bjsports-2018-099399. PMID: 30337461.
5. Strath SJ, Kaminsky LA, Ainsworth BE, Ekelund U, Freedson PS, Gary RA, et al. Guide to the Assessment of Physical Activity: Clinical and Research Applications. Circulation. 2013 Nov 12;128(20):2259-79. doi: 10.1161/01. cir.0000435708.67487.da. Epub 2013 Oct 14. PMID: 24126387.
6. Sattler MC, Jaunig J, Watson ED, van Poppel MNM, Mokkink LB, Terwee CB, et al. Physical Activity Questionnaires for Pregnancy: A Systematic Review of Measurement Properties. Sports Med. 2018 Oct 1;48(10):2317-46. doi: 10.1007/s40279-018-0961-x. PMID: 30094797; PMCID: PMC6132497.
7. Chasan-Taber L, Schmidt MD, Roberts DE, Hosmer D, Markenson G, Freedson PS. Development and validation of a Pregnancy Physical Activity Questionnaire. Med Sci Sports Exerc. 2004 Oct;36(10):1750–60. doi: 10.1249/01. mss.0000142303.49306.0d. PMID: 15595297.
8. Rovcanin M, Jankovic S, Mikovic Z, Sipetic Grujicic S, Ersk IRB, et al. The Translation and Cross-Cultural Adaptation of the Pregnancy Physical Activity Questionnaire: Validity and Reliability of a Serbian Version (PPAQ-SRB). Healthc Basel Switz. 2022 Aug 7;10(8):1482. doi: 10.3390/healthcare10081482. PMID: 36011143; PMCID: PMC9408768.
9. Santos PC, Maciel LYS, Abreu S, Mesquita AR, Mesquita CC, Lopes S, et al. Cultural adaptation and validation of the “Pregnancy Physical Activity Questionnaire” for the Portuguese population. PLoS One. 2023 Jan 10;18(1):e0279124. doi: 10.1371/journal.pone.0279124. PMID: 36626393; PMCID: PMC9831324.
10. Marini S, Parma D, Masini A, Bertini V, Leccese V, Caravita I, et al. Co-Design and Evaluation of the Feasibility and the Efficacy of a Multiple-Targeted Adapted Physical Activity Intervention to Promote Quality of Life, WellBeing and Physical Activity Levels in Pregnant Women: The “WELL-DONE!” Study Protocol. Sustainability. 2021 Jan;13(21):12285. https://doi.org/10.3390/su132112285.
11. Migueles JH, Cadenas-Sanchez C, Ekelund U, Delisle Nyström C, Mora-Gonzalez J, Löf M, et al. Accelerometer Data Collection and Processing Criteria to Assess Physical Activity and Other Outcomes: A Systematic Review and
Practical Considerations. Sports Med. 2017 Sep;47(9):182145. doi: 10.1007/s40279-017-0716-0. PMID: 28303543; PMCID: PMC6231536.
12. Rich C, Geraci M, Griffiths L, Sera F, Dezateux C, CortinaBorja M. Quality Control Methods in Accelerometer Data Processing: Identifying Extreme Counts. PLoS One. 2014
Jan 13;9(1):e85134. doi: 10.1371/journal.pone.0085134. PMID: 24454804; PMCID: PMC3890298.
13. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998 May;30(5):777-81. doi:
10.1097/00005768-199805000-00021. PMID: 9588623.
14. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of selfreport measures. Spine. 2000 Dec 15;25(24):3186-91. doi: 10.1097/00007632-200012150-00014. PMID: 11124735.
15. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May 1;39(2):175-91. doi: 10.3758/bf03193146. PMID: 17695343.
16. Terwee CB, Mokkink LB, van Poppel MNM, Chinapaw MJM, van Mechelen W, de Vet HCW. Qualitative Attributes and Measurement Properties of Physical Activity Questionnaires. Sports Med. 2010 Jul 1;40(7):525-37. doi: 10.2165/11531370-000000000-00000. PMID: 20545379.
17. Chasan-Taber L, Park S, Marcotte RT, Staudenmayer J, Strath S, Freedson P. Update and Novel Validation of a Pregnancy Physical Activity Questionnaire. Am J Epidemiol. 2023 Oct 10;192(10):1743-53. doi: 10.1093/aje/kwad130. PMID: 37289205; PMCID: PMC11484608.
18. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011 Aug;43(8):1575-81. doi: 10.1249/MSS.0b013e31821ece12. PMID: 21681120.
19. Hammouri HM, Sabo RT, Alsaadawi R, Kheirallah KA. Handling Skewed Data: A Comparison of Two Popular Methods. Appl Sci. 2020 Jan;10(18):6247. https://doi. org/10.3390/app10186247.
20. Guelfi KJ, Wang C, Dimmock JA, Jackson B, Newnham JP,
Yang H. A comparison of beliefs about exercise during pregnancy between Chinese and Australian pregnant women. BMC Pregnancy Childbirth. 2015 Dec 22;15(1):345. doi: 10.1186/s12884-015-0734-6. PMID: 26693690; PMCID: PMC4689036.
21. Matsuzaki M, Haruna M, Nakayama K, Shiraishi M, Ota E, Murayama R, et al. Adapting the Pregnancy Physical Activity Questionnaire for Japanese Pregnant Women. J Obstet Gynecol Neonatal Nurs. 2014 Jan 1;43(1):107-16. doi: 10.1111/1552-6909.12267. Epub 2013 Dec 19. PMID: 24428147.
22. Chandonnet N, Saey D, Alméras N, Marc I. French Pregnancy Physical Activity Questionnaire Compared with an Accelerometer Cut Point to Classify Physical Activity among Pregnant Obese Women. PLoS One. 2012 Jun 11;7(6):e38818. doi: 10.1371/journal.pone.0038818. Epub 2012 Jun 11. PMID: 22701717; PMCID: PMC3372468.
23. Swartz AM, Strath SJ, Bassett DR, O’Brien WL, King GA,
Ainsworth BE. Estimation of energy expenditure using CSA accelerometers at hip and wrist sites. Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S450-456. doi: 10.1097/00005768200009001-00003. PMID: 10993414.
24. Hendelman D, Miller K, Baggett C, Debold E, Freedson P. Validity of accelerometry for the assessment of moderate intensity physical activity in the field. Med Sci Sports Exerc. 2000 Sep;32(9 Suppl):S442-S449. doi:10.1097/00005768200009001-00002. PMID: 10993413.
25. O’Brien WJ, Shultz SP, Firestone RT, George L, Breier BH, Kruger R. Exploring the challenges in obtaining physical activity data from women using hip-worn accelerometers. Eur J Sport Sci. 2017 Aug;17(7):922-30. doi: 10.1080/17461391.2017.1323952. Epub 2017 May 15. PMID: 28504054.
26. Shephard RJ. Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med. 2003 Jun;37(3):197-206; discussion 206. doi: 10.1136/ bjsm.37.3.197. PMID: 12782543; PMCID: PMC1724653.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.