Mumu Shirin Jahan, Ali Liaquat, Barnett Anthony, Merom Dafna
School of Science & Health, Western Sydney University, Sydney, Australia.
Dept of Epidemiology, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
BMC Public Health. 2017 Aug 10;17(1):650. doi: 10.1186/s12889-017-4666-0.
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, particularly for rural populations, is still limited. The aim of the study was to validate GPAQ among rural and urban residents in Bangladesh.
A 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.
Valid 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.
GPAQ 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.
管理和预防非传染性疾病需要可行、具有成本效益且针对特定人群的身体活动（PA）监测工具。世界卫生组织认可的全球身体活动问卷（GPAQ）已在发展中国家广泛使用，但其有效性的证据基础，尤其是针对农村人口的证据，仍然有限。本研究的目的是在孟加拉国的农村和城市居民中验证GPAQ。
从萨蒂亚村（n = 97）和达卡市（n = 65）招募了162名年龄在18 - 60岁的健康参与者，男女不限。邀请参与者参加研究，并要求他们佩戴加速度计（GT3X）7天，之后邀请他们在面对面访谈中回答GPAQ。
从155名参与者（农村 = 94名，城市 = 61名）获得了有效的加速度计数据（即，≥3天内佩戴时间≥10小时）。平均年龄为35（标准差 = ±9）岁，55%为女性，19%的参与者未接受过学校教育，农村地区这一比例更高（21%对17%）。加速度计测量的平均每日步数±标准差为9998 ± 3936（农村为8658 ± 2788，城市为12063 ± 4534，p = 0.0001），平均每日中等至剧烈身体活动（MVPA）为58 ± 30分钟（农村为51 ± 26分钟，城市为69 ± 34分钟，p = 0.001）。就GPAQ而言，农村居民报告的与工作相关的中等PA显著更高（代谢当量 - 分钟/周：600对360，p = 0.02）。城市居民中，GPAQ总MVPA代谢当量 - 分钟/天与加速度计MVPA分钟/天、每分钟计数（CPM）或每日步数之间的斯皮尔曼相关系数是可接受的（相关系数分别为：0.46、0.55和0.63；p < 0.01），但农村居民的相关系数较差。GPAQ与加速度计在久坐方面的总体相关性较低（相关系数：0.23；p < 0.001）。女性（相关系数：0.42）、年龄≤35岁组（相关系数：0.31）以及受教育程度较高者（相关系数：0.48）的GPAQ - 加速度计在MVPA方面的相关性更高。布兰德 - 奥特曼图表明，随着城市和农村居民活动水平的增加，GPAQ在MVPA方面存在高估偏差。
GPAQ是孟加拉国身体活动监测的一种可接受的测量方法，特别是对于城市居民、女性和受过高等教育的人群。鉴于腰部佩戴的加速度计无法捕捉农村环境中的典型PA，有必要在农村人口中采用所有教育水平的有目的抽样，进一步使用身体活动日记和多种传感器（如手腕、脚踝和腰部佩戴的加速度计）组合进行研究，以捕捉所有运动。
