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Systematic Review
DOI: 10.1016/j.bjpt.2019.04.002
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Available online 11 May 2019
Critical evaluation of physical activity questionnaires translated to Brazilian-Portuguese: a systematic review on cross-cultural adaptation and measurements properties
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Fernanda Gonçalves Silvaa, Crystian Bitencourt Oliveiraa, Thalysi Mayumi Hisamatsua, Ruben Faria Negrão Filhoa, Caio Russo Dutra Rodriguesa, Marcia Rodrigues Francob,c, Rafael Zambelli Pintod,
Corresponding author
rafaelzambelli@gmail.com

Corresponding author at: Avenida Pres. Antônio Carlos, 6627, Universidade Federal de Minas Gerais (UFMG), CEP 31270-901 Belo Horizonte, MG, Brazil.
a Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, SP, Brazil
b Centro Universitário UNA, Contagem, MG, Brazil
c Regional Public Hospital of Betim, Betim, MG, Brazil
d Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
Highlights

  • Measurement properties of most physical activity questionnaires have not been fully tested.

  • Construct validation and reliability of most physical activity questionnaires are not acceptable.

  • Methodological quality of most studies were considered poor.

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Tables (5)
Table 1. Description of measurement properties definition and the criteria adopted for methodological and results assessments.
Table 2. Characteristics of physical activity questionnaires.
Table 3. Characteristics of included studies and detailed information on measurement properties investigated.
Table 4. Summary of included studies and classification of measurement properties investigated.
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Abstract
Background

The number of questionnaires that measures physical activity levels has increased considerably. For Brazilian population it becomes a challenge, due to the need of a rigorous translation, adaptation and testing of measurement properties.

Objective

Evaluate the methodological quality and criteria of physical activity questionnaires translated to Brazilian-Portuguese.

Methods

Methodological quality and quality criteria was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

Results

Sixty-nine studies were included, the most frequent questionnaires investigated were the International Physical Activity Questionnaire (n=16) and the Baecke Physical Activity Questionnaire (n=12). Translation (n=13), reliability (n=37) and construct validity (n=44) were the measurement properties commonly investigated. For reliability, most studies were rated as ‘adequate’ for methodological quality. The Intraclass Correlation Coefficient of the questionnaires ranged from 0.20 to 1.0. For construct validity, 31 analyses showed ‘inadequate’ methodological quality, due to poor description of the comparator instrument. High level of evidence on reliability were found for Baecke Physical Activity Questionnaire, Self-administered Physical Activity Checklist and Physical Activity Questionnaire of the Surveillance System of Risk Factors and Protection for Chronic Diseases; on construct validity for Self-administered Physical Activity Checklist, Physical activity Questionnaire for Adolescents, Physical activity Questionnaire for Older Children and Saúde naBoa Questionnaire.

Conclusion

Most questionnaires showed poor methodological quality and measurement properties. The Baecke Physical Activity Questionnaire and Self-administred Physical Activity Checklist showed better scorings for methodological quality and quality criteria. Further high methodological quality studies are still warranted.

Keywords:
Psychometric properties
Validation
Reliability
Questionnaire
Physical activity
Physical therapy
Full Text
Introduction

Evidence shows that regular physical activity is associated with low level of mortality in adults and elderly.1 Sedentary lifestyle and physical inactivity are estimated to be responsible for between 6% and 10% of the major non-communicable diseases.2 Taken together, the available evidence suggest that physical inactivity is the biggest public health problem of the 21st century worldwide.3

Physical activity is defined as any activity involving bodily movement that produces energy expenditure greater than at rest.4 The term can be interpreted to include activities ranging from structured exercise programs to incidental daily activities.5 Currently, there are several methods described in the literature for measuring physical activity levels.6 Choosing the ideal method may depend on several factors, such as the physical activity domains of interest, number of individuals to be analyzed, population of interest and feasibility of the instrument.7 Physical activity levels can be measured by self-reported and objective assessment methods. The difference is that the self-reported methods rely on information provided by individuals, whereas the objective methods utilize technology to measure and record in real time the biomechanical and/or physiologic consequences of performing physical activity.8 The self-reported assessment methods have the advantages of being, quick, cheap and easy to administer in comparison to the objective methods.9

While the development of one instrument generates various costs, a commonly used and highly effective method is the translation and cultural adaptation of valid questionnaires.10 Another important step is to assess the measurement properties of the questionnaires to check whether the translated questionnaire behaviors the same way as the original one.11 More recently, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was proposed to evaluate the methodological quality of studies on the measurement properties of health instruments.12–14 A methodological quality criteria are helpful to legitimize what is the best instrument and whether a measuring instrument has adequate measurement properties.15,16

Given that the number of self-reported physical activity questionnaires available has increased considerably over the past decades, the choice of which questionnaire to use has become a challenge for clinicians and researches. In Brazil, this challenge is even greater due to the need of a rigorous translation and cultural adaptation process. Therefore, the purpose of this systematic review was to evaluate the procedures of translation and cultural adaptation as well as the measurement properties of physical activity questionnaires translated and adapted into Brazilian-Portuguese.

MethodsStudy selection

We included studies that: (1) presented a self-reported questionnaire; (2) included a questionnaire measuring aspects related to physical activity; (3) tested in the Brazilian population; (5) were published as full-text in peer-reviewed journals; and (6) tested its measurement properties (i.e.: assessing reliability, construct validity, responsiveness, content validity, measurement error or internal consistency). In addition, in person or online self-administered questionnaires and questionnaires administered by trained assessors were considered eligible. Questionnaires fully developed and tested in the Brazilian population were also considered eligible for this review. Studies conducted with healthy individuals of different age as well as populations with specific clinical diagnosis (i.e.: cancer, pregnancy, chronic low back pain, and cardiovascular disease) were also included in this review. We excluded studies that: (1) presented an instrument translated and/or adapted in another language.

Search strategy

The literature search was conducted in five electronic databases (MEDLINE, EMBASE, CINAHL, SCIELO and LILACS) from their inception until September 2018. Three groups of search terms were used: Terms of physical activity: exercise, physical inactivity, motor activity, physical fitness, sedentary, life style, leisure activities, walking, sports, aerobic and cycle; questionnaire terms: Questionnaire, index, scale, score, outcome assessment, self-assessment, self-report and inventory; and terms related to language: Portuguese, Brazil, Brasil and Brazilian. There were no restrictions to any specific language and date of publication, but only full texts publications in scientific journals were considered eligible. Appendix 1 shows the search strategy performed in MEDLINE.

Two independent reviewers (F.G.S. and C.B.O.) screened title and abstracts. Then, full-texts of the potentially eligible papers were evaluated according to the inclusion criteria. If there were any disagreement between the two reviewers a third reviewer (R.Z.P) was consulted to arbitrate. All reviewers are physical therapists with expertise in conducting systematic reviews and studies assessing measurement properties of health instruments.

Data extraction

Two independent reviewers (F.G.S. and C.B.O.) using a standardized form performed data extraction. The following information from self-reported questionnaires were extracted for each included study: (i) domains of physical activity (e.g. leisure time, household, transportation and occupational activity); (ii) recall period (e.g. activities performed in the last day or seven days, last month or last year); (iii) number of items; (iv) unit of measure and (v) type of population. Data regarding the measurement properties were also extracted.

Methodological quality assessment

We assessed the methodological quality of the included studies using the COSMIN Checklist.12–14 Two reviewers (F.G.S. and C.B.O.) rated independently each study, and, in case of disagreement, a third reviewer (R.Z.P.) was consulted to arbitrate. The checklist is composed by nine measurement properties: cross-cultural validity, measurement error, internal consistency, content validity, structural validity, reliability, construct validity, hypothesis-testing, criterion validity and responsiveness. Definition of each measurement property is provided in Table 1. Each measurement property consists of a number of items evaluated using a 4-point scale (i.e. very good, adequate, doubtful and inadequate). The final methodological quality score for each measurement property was determined considering the worst score among all items. For reliability, the time intervals considered appropriate were: (i) for a recall period of an usual week a time interval between 1 day and 3 months; (ii) for a recall period of the previous week a time interval between 1 day and 2 weeks; and (iii) a recall period of the previous day, a time interval between 1 day and 1 week.17

Table 1.

Description of measurement properties definition and the criteria adopted for methodological and results assessments.

Measurement property  Definition12  Methodological quality assessment12  Quality criteria assessment12 
Content validity  The degree to which the content of an instrument is an adequate reflection of the construct to be measured.  Assessment of general requirements (e.g. relevance of items, comprehensiveness of the instrument and any important flaws in the design or methods of the study)  (+) A clear description is provided of the measurement aim, the target population, the concepts that are being measured, and the item selection AND target population and (investigators OR experts) were involved in item selection;(?) A clear description of above-mentioned aspects is lacking OR only target population involved OR doubtful design or method;(−) No target population involvement15 
Structural validity  The degree to which the scores of an instrument are an adequate reflection of the dimensionality of the construct to be measured  Assessment of design requirements and statistical methods (e.g. adequate sample size, information on exploratory factor analysis or IRT tests and any important flaws in the design or methods of the study)  (+) CTTCFA: CFI or TLI or comparable measure >0.95 OR RMSEA <0.06 OR SRMR <0.082IRT/RaschNo violation of unidimensionality: CFI or TLI or comparable measure >0.95 OR RMSEA <0.06 OR SRMR <0.08 AND no violation of local independence: residual correlations among the items after controlling for the dominant factor <0.20 OR Q3's <0.37 AND no violation of monotonicity: adequate looking graphs OR item scalability >0.30 AND adequate model fit: IRT: χ2>0.01 Rasch: infit and outfit mean squares ≥0.5 and ≤1.5 OR Z-standardized values >−2 and <2(?) Not all information for ‘+’ reportedIRT/Rasch: Model fit not reported(−) Criteria for ‘+’ not met 
Internal consistency  The degree of the interrelatedness among the items.  Assessment of design requirements and statistical methods (e.g. information on Cronbach's alpha analysis and any important flaws in the design or methods of the study)  (+) At least low evidence for sufficient structural validity AND Cronbach's alpha(s) ≥0.70 for each unidimensional scale or subscale;(?) Criteria for “At least low evidence for sufficient structural validity” not met;(−) At least low evidence for sufficient structural validity AND Cronbach's alpha(s) <0.70 for each unidimensional scale or subscale 
Cross-cultural validity  The degree to which the performance of the items on a translated or culturally adapted instrument are an adequate reflection of the performance of the items of the original version of the instrument.  Assessment of design requirements and statistical methods (e.g. adequate sample size, characteristics similarity on sample and if the regression analysis or IRT was assessed)  (+) No important differences found between group factors (such as age, gender, language) in multiple group factor analysis OR no important DIF for group factors (McFadden's R2<0.02)(?) No multiple group factor analysis OR DIF analysis performed(−) Important differences between group factors OR DIF was found 
Reliability  The proportion of the total variance in the measurements which is due to true differences between Individuals. The extent to which scores for individuals who have not changed are the same for repeated measurement under several conditions.  Assessment of design requirements and statistical methods (e.g. test conditions, information on time interval, ICC or Kappa analysis assessment)  (+) ICC or weighted Kappa >0.70;(?) ICC or weighted Kappa not reported;(−) ICC or weighted Kappa <0.70 
Measurement error  The systematic and random error of an individual's score that is not attributed to true changes in the construct to be measured.  Assessment of design requirements (e.g. information on time interval, test conditions, SEM, SDC or LoA analysis assessment and any important flaws in the design or methods of the study)  (+) SDC or LoA<MIC;(?) MIC not defined;(−) SDC or LoA>MIC5 
Criterion validity  The degree to which the scores of an instrument are an adequate reflection of a ‘gold standard’.  Assessment of design requirements and statistical methods (e.g. AUC analysis, sensitivity and specificity determined and any important flaws in the design or methods of the study)  (+) Correlation with gold standard ≥0.70 OR AUC ≥0.70;(?) Not all information for ‘+’ reported;(−) Correlation with gold standard <0.70 OR AUC <0.70 
Construct validity  The degree to which the scores of an instrument are consistent with hypotheses (for instance with regard to internal relationships, relationships to scores of other instruments, or differences between relevant groups) based on the assumption that the instrument validly measures the construct to be measured.  Assessment of design requirements and statistical methods (e.g. measurement properties of comparator instrument, comparison between subgroups and any important flaws in the design or methods of the study)  (+) The result is in accordance with the hypothesis;(?) No hypothesis defined (by the review team);(−) The result is not in accordance with the hypothesis 
Responsiveness  The ability of an instrument to detect change over time in the construct to be measured.  Assessment of design requirements and statistical methods (e.g. gold standard use, ROC curve calculated, sensitivity and specificity determined, measurement properties of comparator instrument and any important flaws in the design or methods of the study)  (+) The result is in accordance with the hypothesis 7 OR AUC0.70;(?) No hypothesis defined (by the review team);(−) The result is not in accordance with the hypothesis 7 OR AUC<0.70 

AUC, area under the curve; CFA, confirmatory factor analysis; CFI, comparative fit index; CTT, classical test theory; CTV, content validity; DIF, differential item functioning; ICC, intraclass correlation coefficient; IRT, item response theory; LoA, limits of agreement; MIC, minimal important change; RMSEA, root mean square error of approximation; ROC, receiver operator curve; SDC, smallest detectable change; SEM, standard error of measurement; SRMR, standardized root mean residuals; TLI, Tucker–Lewis index.

(+)=sufficient rating, (?)=indeterminate rating, (−)=insufficient rating.

Quality criteria assessment

We also assessed whether the measurement properties reported in the included studies were adequate using the quality criteria proposed in the COSMIN checklist. For each measurement property a criterion was defined for sufficient (+), insufficient (−) or indeterminate (?) rating. Details of the quality criteria are described in Table 1. For reliability assessment, it was considered the ‘Total physical activity’ score from each questionnaire if available. For studies reporting only separate data by Physical activity (PA) domains, we assessed each domain separately and the final quality criteria was determined considering the consistency for most (>50%) physical activity domains (e.g. a study to be rated as + more than 50% of the domains had to show an Intraclass Correlation Coefficient greater than 0.70). For construct validity, in addition to the quality criteria assessment we also assessed the degree of similarity between the physical activity domain measured with the questionnaire and the comparator instrument using the level of evidence classification for the comparator instrument (i.e. Levels 1, 2 and 3) described elsewhere.18 In this classification, the level of evidence varies depending on how the physical activity dimension of interest was measured. In brief, comparator instrument close to level 1 indicates that the comparator instrument chosen has the highest degree of similarity to the physical activity domain of the questionnaire.

Assessment of overall level of evidence

Each measurement property analyzed from all questionnaires was assessed according to the overall level of evidence. Data from all studies investigating the same questionnaire were combine and levels of evidence provided for each measurement property. The quality of the evidence refers to the confidence that the summarized result is trustworthy. We assesed the quality of evidence using a modified version of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and downgraded the evidence level considering the following four domains: (1) methodological quality (2) inconsistency of results across studies, (3) imprecision (i.e. total sample size of the available studies) and (4) indirectness (i.e. evidence from different populations than the population of interest in the review). The quality of the evidence was classified as graded as high, moderate, low, or very low evidence.

Results

The search strategy identified a total of 11.022 records. After title and abstracts screening, 69 records were considered potentially eligible and the full-text retrieved. Details of the selection process are described in Fig. 1.

Figure 1.

Flowchart for the included studies after systematic review.

(0.24MB).
Physical activity questionnaires

Sixty-nine included studies investigated 30 different self-report physical activity questionnaires. Table 2 describes the included questionnaires in terms of target population, recall period, domain of activity investigated, number of items, and unit of measurement. The target population varied across studies including broad population of adolescents, young adults, adults and older people as well as specific clinical population such as adults with claudication, pregnant women, individuals with heart disease, low back pain and juvenile dermatomyositis population. The recall period varied across questionnaires including past 24h, last week, last month, last 12 months and present way of life.

Table 2.

Characteristics of physical activity questionnaires.

Physical activity questionnaire (abbreviation)  Domains:  Recall period:  No. of items  Unit of measure:  Target population: 
Active Australia Questionnaire (AAQ)  Walk, Yard-work PA, Sports, Household PA, Leisure-time PA  Last week  Min/week  Elderly 
Baltimore Activity Scale for Intermittent Claudication (BASIC)  Leisure-time PA and Transportation PA  Lately, weekly  Dimensionless score  Individuals with intermittent claudication 
Baecke Physical Activity Questionnaire (BPAQ)  Occupational PA; Sports; Leisure-time PA  Last 12 months  16  Dimensionless score  Adults, elderly, people living with HIV, youth 
Questionnaire of a typical physical activity and food intake day (DAFA)  Transportation PA; Sports; Leisure-time PA  Typical day  11  Dimensionless score  Youth 
Internet Version of the Questionnaire of a typical physical activity and food intake day (DAFA)  Transportation PA; Household PA, Leisure-time PA  Typical day  11  Dimensionless score  Youth 
Questionnaire of previous physical activity and food intake day (DAFA)  Transportation PA; Sports, Leisure-time PA  Previous day  11  Dimensionless score  Youth 
Internet Version of the Questionnaire of previous physical activity and food intake day (DAFA)  Transportation PA; Sports, Leisure-time PA  Previous day  11  Dimensionless score  Youth 
Godin Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ)  Leisure-time PA  Typical week  11  METs and dimensionless score  Adults, people with heart disease 
Human Activity Profile Questionnaire (HAP)  Transportation PA; Sports; Leisure-time PA; Sedentary activities  In the present moment, lately.  94  Sedentary activity/day Moderate activity/day – min/day  Elderly 
Health-Promoting Lifestyle Profile-II (HPLP-II)  Leisure-time PA; Sports; Transportation PA  Present way of life or personal habits  52  Dimensionless score  Adults 
International Physical Activity Questionnaire (IPAQ) Long Version  Occupational PA; Transportation PA; Household PA; Leisure-time PA; Sedentary activities  Last week  27  METs.min/week  Adults, youth, adult with high blood pressure, elderly with Alzheimer's disease 
International Physical Activity Questionnaire (IPAQ) Short Version  Occupational PA; Transportation PA; Household PA; Leisure-time PA; Sedentary activities  Last week  METs.min/week  Adults, climateric women 
Minnesota Leisure Time Activities Questionnaire in elderly (MLTAQ)  Household PA, Sports; Leisure-time PA  Last year  63  METs/min/week/month/year  Elderly 
Netherlands Physical Activity Questionnaire (NPAQ)  Leisure-time PA and Sports  Usual preferences  Dimensionless score  Youth 
Physical Activity Checklist Interview (PACI)  Regular PA; Leisure PA; Transportation PA; Sedentary activities  Past 2421  min/min×MET/min×MET×intensity rate  Youth 
Physical Activity Questionnaires for Adolescents (PAQ-A)  Sports and Leisure-time PA  Last week  Dimensionless score  Adolescents from 14 to 18 years old 
Physical Activity Questionnaires for Older Children (PAQ-C)  Sports and Leisure-time PA  Last week  Dimensionless score  Childrens from 8 to 13 years old 
Physical Activity Questionnaire for Pregnant Women (PAQPW)  Leisure-time PA; Sports; Transportation PA; Sedentary activities; Household PA  Present way of life  Not provided  Dimensionless score  Pregnant women 
Physical Activity Rating (PAR)  Overall level of PA  Last month  0–7 (Scale)  Dimensionless score  Elderly 
Three day physical activity questionnaire (3DPAR)  Transportation PA; Sports; Leisure-time PA  Habitual PA  Recordatory  Min/day – Hour/day MET  Adolescents 
24h physical activity recordatory (24PAR)  Transportation PA; Sports; Leisure-time PA  24Recordatory  Min/day – Hour/day MET  Adults 
Physical activity level and sedentary behavior evaluation questionnaire for school students (PASBEQ)  Sports, Leisure-time PA, Transportation PA, School-time PA, Sedentary activities  Typical week    Hour/week and METs/week  Adolescents from 10 to 13 years old 
Questionnaire to measure physical activity and sedentary behavior (PASBQ)  Leisure-time PA and Sedentary activity  Typical weekday, weekend  12  Min/day score (0–24)  Youth 
Brazilian National School-Based Health Survey (PeNSE)  Sports; Leisure-time PA; Sedentary activities  Last week  11  Minutes/week.  Adolescents 
Pregnancy Physical Activity Questionnaire (PPAQ)  Household/caregiving PA; Occupational PA; Sports; Transportation PA and Sedentary activities  Daily routine activity  33  Minutes or hours per day – MET – MET-hour/week.  Pregnant women 
Self-Administered Physical Activity Checklist (SAPAC)  Regular PA; Leisure PA; Transportation PA; Sedentary activities  Last week  24  min/min×MET/min×MET×intensity rate  Youth 
Saúdes Vitória Study's physical activity assessment questionnaire for children (Saúdes)  Sedentary activities; Transportation PA; Sports; Leisure-time PA  Typical day  13  Hours and minutes  Youth 
Saúde na Boa Questionnaire (SBQ)  Not provided  Typical week and last seven days  Not provided  Not provided  Adolescents 
Short version Physical Activity Questionnaire (SVPAQ)  Transportation PA, Sports; Leisure-time PA  Last week  Min/week  Adolescents 
Questionário de atividade física do sistema de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (VIGITEL)  Transportation PA; Occupational PA; Leisure-time PA; Household PA  Last three months, last week, lately  20  Min/day – Min/week  Adults 

Description of the characteristics of each questionnaire, such as the domains evaluated through the items, number of questions (items), the period considered when answering the questions, the unit of measure generated by the questionnaire and the population to which the instrument was submitted.

MET, metabolic equivalent of task; PA, physical activity.

Measurement properties

A total of 110 analyses on measurement properties were investigated in 69 included studies. Of these, 44 (40%) analyses were on construct validity, 37 (33.6%) on reliability, 13 (11.8%) on translation and cross-cultural adaptation, nine (8%) on measurement error, four (3.6%) on internal consistency, two (2%) on content validity and one (1%) on responsiveness. According to COSMIN checklist, 18 (16.4%) measurement properties were rated as “very good”, 28 (25.5%) as “adequate”, 25 (22.7%) as “doubtful” and 39 (35.4%) as “inadequate”. Table 3 shows the methodological quality and quality criteria assessment for all measurement analyses investigated in each study.

Table 3.

Characteristics of included studies and detailed information on measurement properties investigated.

Reference  Physical activity questionnairea  Analysis performed  Study characteristics  Sample size (gender); Mean age (SD); Target population  Results  COSMIN rank  Quality criteria assessment 
Rocha et al., 201730  AAQ  Translation and cross-cultural adaptationReliability  Translation processTest re-test:422 (F: 22); 72.5 (5.3);Elderly women  Reliability:ICC: 0.97  Cross-cultural validity: DoubtfulReliability: Inadequate  Reliability: (+) 
Souza Barbosa et al., 201238  BASIC  Reliability; Measurement error  Test re-test: 7 days apart  38 (F: 20/M: 18); 64 (11.4);Individuals with intermittent claudication  Reliability:ICC: 0.87 (CI 95%: 0.74–0.93)Measurement error:LoA: −117 to 250kcal  Reliability: AdequateMeasurement error: Very good  Reliability: (+)Measurement error: (?) 
Lopes et al., 201376  BASIC  Construct validity  Comparator: Pedometer  150 (F: 56/M: 94); 64 (9); Individuals with intermittent claudication  Construct validity: r=0.34  Construct validity: Doubtful  Construct validity: (?), level of evidence=3− 
Florindo et al., 200440  BPAQ  Translation and cross-cultural adaptation; Internal consistency  Translation process  326 (M: 326); 62.5 (7.9);Men aged 50 or more  Internal consistency:Cronbach alphaOPA – 0.52SPA – 0.52LPA+TPA – 0.62  Cross-cultural validity: DoubtfulInternal consistency: Very good  Internal consistency: (?) 
Sardinha et al., 201021  BPAQ  Translation and cross-cultural adaptation  Translation process  30 (M: 11/F: 19); 48.13 (15.99); Adults  n/a  Cross-cultural validity: Doubtful  n/a 
Garcia et al., 201366  BPAQ  Construct validity  Comparator: accelerometer  58 (F: 40/M: 18); 39.9 (11.5);Adults  Construct validity:SPA+LPA+TPA: r=0.36Total score: r=0.54  Construct validity: Inadequate  Construct validity: (?), level of evidence=2−/2 + 
Florindo et al., 200348  BPAQ  Reliability;Construct validity  Test re-test: 45 daysComparator: VO2max  27 (M: 21); 32.6 (3.1);Adult men  Reliability:Total score – ICC: 0.77LPA+TPA score – ICC: 0.80SPA – ICC: 0.69Construct validity:Total score: r=0.17LPA+TPA score: r=0.24SPA: r=0.04  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=3?/3?/3? 
Florindo et al., 200649  BPAQ  Reliability;Construct validity  Test re-test: 15–30 daysComparator: VO2max  29; 37.2 (range: 26.0–49.5);HIV population  Reliability:Total score – ICC: 0.72LPA+TPA score – ICC: 0.44SPA – ICC: 0.70OPA – ICC: 0.85Construct validity: Total score: r=0.27LPA+TPA score: r=0.19SPA: r=0.41OPA: r=−0.14  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence= 3?/3?/3?/3? 
Glaner et al., 200770  BPAQ  Construct validity  Comparator: VO2max  105 (F: 28/M: 77); 24.8 (5.3);Adults  Construct validity:% concordance=64.1%  Construct validity: Inadequate  Construct validity: (?), level of evidence=3+ 
Mazo et al., 200150 (Modified for elderly women)  BPAQ  Reliability;Construct validity  Test re-test: 15 days apartComparator: Pedometer  30 (F: 30); 71.2 (4.6);Elderly women  Reliability:SPA: ICC=0.84LPA: ICC=0.85Home activities: ICC=0.82Total PA: ICC=0.83Construct validity:Total score: 0.27  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=3? 
Carvalho et al., 201762  BPAQ  Reliability;Construct validity  Test re-test: 7 daysComparator: Accelerometer  73 (F: 23/M: 50); 37.2 (12.2);Adults with chronic low back pain  Reliability:Total PA ICC2,1: 0.77OPA ICC2,1: 0.84SPA ICC2,1: 0.83LPA ICC2,1: 0.61Construct validity: Total PA (counts/min) r=0.18Total PA (VM counts/min) r=0.26Total PA (MVPAmin/day) r=0.17Total PA (Steps/day) r=0.27  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence: 2−/3−/3−/3− 
Guedes et al., 2005B63  BPAQ  Reliability;Construct validity  Test re-test: 2 weeks apartComparator: PA recordatory  ≤14 years girls 59; 12.92 (0.86);>14 years girls 33; 15.8 (0.93);≤14 years boys 38; 13 (0.81);>14 years boys 31; 15.81 (0.70);Adolescents  Reliability:≤14 years/≥ 14 years ♀OPA ICC: 0.55/ICC: 0.61SPA ICC: 0.79/ICC: 0.85TPA ICC: 0.61/ICC: 0.70Total PA ICC: 0.66/ICC: 0.76≤14 years/≥14 years ♂OPA ICC: 0.68/ICC: 0.69SPA ICC: 0.73/ICC: 0.82TPA ICC: 0.71/ICC: 0.76Total PA ICC: 0.75/ICC: 0.80Construct validity:≤14 years/≥14 years ♀Total PA r: 0.36/r: 0.46≤14 years/≥14 years ♂Total PA r: 0.41/r: 0.59  Reliability: AdequateConstruct validity: Doubtful  Reliability: (+) for ≥14 years old girls and boys and ≤14 years old boys.(−) for ≤14 years old girls.Construct validity: (?), level of evidence= 3−/3?/3?/3? 
Romero et al., 201136 (Internet version)  BPAQ  Reliability;Measurement error  Test re-test:14 days apart  135 (F: 74/M: 61);Youth  Reliability:k=0.47Measurement error:% of agreement: 95.5%  Reliability: AdequateMeasurement error: Very good  Reliability: (−)Measurement error: (?) 
Florindo et al., 2006b51  BPAQ  Development reliability;Construct validity  Test re-test:15 days apartComparator: 20-m shuttle run testFrequency meterVO2maxWaist circumference  94 (F: 64/M: 30); 13 (1.1);Youth  Reliability:ICC>0.60Construct validity:Yearly/weekly VO2max: r=0.18/r=0.28Total speed: r=0.15/r=0.24Total time: r=0.19/r=0.30Maximum heart rate: r=0.05/r=0.08Waist circumference: r=−0.12/r=−0.06  Reliability: AdequateConstruct validity: Doubtful  Reliability: (−)Construct validity: (?), level of evidence=3− (all analysis) 
Morelhão et al., 201882  BPAQ  Responsiveness  Follow up period:2 months  106 (F: 56/M: 50); 40 (11.6);Adults with chronic low back pain  Responsiveness:Mean difference: 0.18 (2.25)Effect size (84% CI): 0.12 (−0.08 to 0.34)  Responsiveness: Inadequate  Responsiveness: (−) 
Costa et al., 201053  DAFA  Reliability  Test re-test:15 days apart  101 (F: 44/M: 57); 9.4 (1.0);Youth  Dance – ICC: 0.50Walk/run – ICC: 0.51Play with the dog – ICC: 0.75Household – ICC: 0.68Cycle – ICC: 0.79Rope jump – ICC: 0.51Climb stairs – ICC: 0.62Play soccer – ICC: 0.86Swim – ICC: 0.79Skateboard – ICC: 0.83Gymnastics – ICC: 0.77  Reliability: Adequate  Reliability: (+) 
Barros et al., 200754  DAFA  Reliability;Construct validity  Test re-test: days apartComparator: Questionnaire answered by parents/teachers  69 (F: 35/M: 35);7–10 years old  Reliability:Dance ICC: 0.62Walk/run ICC: 0.55Play with the dog ICC: 0.77Household ICC: 0.75Cycle ICC: 0.63Jump rope ICC: 0.65Climb stairs ICC: 0.75Play soccer ICC: 0.79Swim ICC: 0.33Skate ICC: 0.63Gymnastics ICC: 0.75General PA ICC: 0.85Construct validity:k=0.28  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+/−) UnclearConstruct validity: (?), level of evidence=3− 
Legnani et al., 201337  DAFA (Internet version)  Reliability;Measurement error  Test re-test: a day apart  127 (F: 58/M: 69); 8.4 (1.1);Youth  Reliability:General PA ICC: 0.94Measurement error: Mean error: 1.7 (95% CI: −25.6 to 29.1)  Reliability: AdequateMeasurement error: Very good  Reliability: (+)Measurement error: (?) 
Cabral et al., 201179  DAFA (previous day version)  Construct validity  Comparator: Pedometer  50 (F: 25/M: 25); 10.2 (1.49);Youth  Construct validity:r=0.45  Construct validity: Very good  Construct validity: (?), level of evidence=3− 
Jesus et al., 201664  DAFA (Internet version of the previous day)  Reliability;Construct validity  Test re-test: 3h apartComparator: Direct observation  Reliability:94 (F: 25/M: 25)Validity:390 (F: 194/M: 196)9.53 (1.53); Youth  Reliability:Incidence ratio ranged from 0.63 to 7.52 Construct validity:Childs play incidence ratio ranged from 0.52 to 18.1  Reliability: InadequateConstruct validity: Inadequate  Reliability: (?)Construct validity: (?), level of evidence=1? 
Sao Joao et al., 201325  GSLTPAQ  Translationand cross-cultural adaptationReliability;Content validity  Translation processTest re-test:15 days apart  80 (F: 48/M: 32); 53.2 (10.4);Healthy individuals and individuals with cardiovascular disease  Reliability:Strenuous PA ICC: 0.79Moderate PA ICC: 0.80Mild PA ICC: 0.82Total PA ICC: 0.84  Cross-cultural validity: DoubtfulReliability: AdequateContent validity: Inadequate  Reliability: (+)Content validity: (−) 
São João et al., 201580  GSLTPAQ  Construct validity  Comparator: VO2peak, VO2pred, PA Questionnaires  236 (F: 138/M: 98); 52.8 (11.1);Healthy individuals and with cardiovascular disease  VO2peak: Total PA r=0.09/MVPA r=0.03VO2pred: Total PA r=0.15: MVPA r=0.19PA Questionnaire (VSAQ): Total PA r=0.23/MVPA r=0.34PA Questionnaire (Baecke): Total PA r=0.36/MVPA r=0.25PA in leisure: r=0.62  Construct validity: Very good  Construct validity: (+), level of evidence=3− (all analysis) 
Souza et al., 200624  HAP  Translation and cross-cultural adaptation;Internal consistency  Translation process  230 (F: 198/M: 32); 66.32 (8.50);Elderly  Internal consistency: Rash analysis: 0.91  Cross-cultural validity: DoubtfulInternal consistency: Inadequate  Internal consistency: (?) 
Bastone et al., 201473  HAP  Construct validity  Comparator: Accelerometer  120 (F: 120); 71.8 (6.6);Elderly women  Construct validity: Counts/day: r=0.61Moderate activity/day: r=0.63Steps/day: r=0.69Energy expenditure/day: r=0.55  Construct validity: Inadequate  Construct validity: (?), level of evidence=2+/1+/1−/2+ 
Tajik et al., 201022  HPLP-II  Translation and cross-cultural adaptation; Internal consistency  Translation process  30 (F: 18/M: 12); 37.4;Adults  Internal consistency: Cronbach alphaTotal – 0.93PA subscale – 0.85  Cross-cultural validity: DoubtfulInternal consistency: Very good  Internal consistency: (?) 
Barros et al., 200042  IPAQ – long version  Reliability  Test re-test:7 days apart  42 (F: 20/M: 22); 34.7 (8.8);Adult  OPA ICC: 0.88/k=0.33Household PA ICC: 0.67/k=0.25TPA ICC: 0.68/k=0.41LPA ICC: 0.71/k=0.32Total ICC: 0.86/k=0.39  Reliability: Adequate  Reliability: (+) 
Benedetti et al., 200433  IPAQ – long version  Reliability;Construct validity  Test re-test:15 days apartComparator: Pedometer and PA diary  41 (F: 41); 67 (4.8);Elderly women  Reliability:OPA ICC: 0.97/r=1.00Household PA ICC: 0.89/r=0.77TPA ICC: 0.73/r=0.67LPA ICC: 0.86/r=0.95Sitting time ICC: 0.76/r=0.60Total ICC: 0.88/r=0.77Construct validity:r=0.12–0.27 Pedometerr=0.16–0.37 PA diary  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=3?/3? 
Benedetti et al., 200733  IPAQ – long version  Reliability;Construct validity;Measurement error  Test re-test:21 days apart Comparator: Pedometer and PA diary  29 (M: 29); 66.6 (4.3);Elderly men  Reliability:rs=0.95Construct validity:r=0.24/k=0.03 Pedometerr=0.38/k=0.35 PA diaryMeasurement error: LoA: 7.29kcal/min to −14.0kcal/min  Reliability: DoubtfulConstruct validity: InadequateMeasurement error: Very good  Reliability: (?)Construct validity: (?), level of evidence=3?/3?Measurement error: (?) 
Lima et al., 201044  IPAQ – long version  Reliability;Construct validity  Test re-test:7 days apartComparator: Pedometer  26 (F: 22/M: 4); 74.4 (6.5);Elderly with Alzheimer's disease  Reliability:ICC: 0.56Construct validity: r=0.57  Reliability: AdequateConstruct validity: Inadequate  Reliability: (−)Construct validity: (?), level of evidence=3? 
Guedes et al., 2005A34  IPAQ – long version  Reliability;Construct validity;Measurement error  Test re-test:4 days apart Comparator: 24h recordatory  ≤14 years 97 (F: 59/M: 33); 12.9 (0.84)≥14 years 64 (F: 33/M: 31); 15.8 (0.84);Youth  Reliability:≤14 years/≥14 years ♀Walk rs=0.52/rs=0.55Moderate PA rs=0.49/rs=0.63Intense PA rs=0.70/rs=0.55Sitting rs=0.58/rs=0.61≤14 years/≥14 years ♂Walk rs=0.56/rs=0.61Moderate PA rs=0.59/rs=0.66Intense PA rs=0.67/rs=0.83Sitting rs=0.62/rs=0.82Construct validity:≤14 years/≥14 years ♀Walk rs=0.17/rs=0.11Moderate PA rs=0.24/rs=0.35Intense PA rs=0.26/rs=0.43Sitting rs=0.16/0.24≤14 years/≥14 years ♂Walk rs=0.09/rs=0.12Moderate PA rs=0.29/rs=0.34Intense PA rs=0.35/rs=0.51Sitting rs=0.29/rs=0.39Measurement error: LoA: ♂14 years: 16±92minLoA: ♀14 years: 131±429min  Reliability: DoubtfulConstruct validity: DoubtfulMeasurement error: Very good  Reliability: (?)Construct validity: (?), level of evidence=3+ (for ≤14 years girls at Int. efforts and ≥14 years boys at Int. efforts and sitting) 3− (for all other analyses)Measurement error: (?) 
Garcia et al., 201366  IPAQ – long version  Construct validity  Comparator: Accelerometer  58 (F: 40/M: 18); 39.9 (11.5);Adults  Construct validity:Moderate vigorous intensity: r=0.34  Construct validity: Inadequate  Construct validity: (?), level of evidence=1− 
Hallal et al., 201035  IPAQ – long version  Reliability;Construct validity;Measurement error  Test re-test:5 daysComparator: Accelerometer  156 (F: 81/M: 75); 40.3 (15.1);Adults  Reliability:TPA rs=0.87LPA rs=0.92TPA+LPA rs=0.90Construct validity: Moderate intensity: r=0.23Vigorous intensity: r=0.30Total score: r=0.22Measurement error:Mean difference: 3min% of agreement: 89.8%  Reliability: DoubtfulConstruct validity: InadequateMeasurement error: Very good  Reliability: (?)Construct validity: (?), level of evidence=1−/1−/2−Measurement error: (?) 
Carvalho et al., 201762  IPAQ –long version  Reliability;Construct validity  Test re-test:7 daysComparator: Accelerometer  73 (F: 23/M: 50); 37.2 (12.2);Adults with low back pain  Reliability:Total PA ICC2,1: 0.37OPA ICC2,1: 0.32TPA ICC2,1: 0.20Household PA ICC2,1: 0.40LPA ICC2,1: 0.38Walking ICC2,1: 0.72MVPA ICC2,1: 0.25Construct validity:Total PA (counts/min) r=0.33Total PA (VM counts/min) r=0.33Total PA (MVPAmin/day) r=0.22Total PA (steps/day) r=0.37MVPA (counts/min) r=0.18MVPA (VM counts/min) r=0.21MVPA (MVPAmin/day) r=0.22MVPA (steps/day) r=0.25  Reliability: AdequateConstruct validity: Inadequate  Reliability: (−)Construct validity: (?), level of evidence=2−/3−/3−/3−/2−/1−/1−/3− 
Pardini et al., 200146  IPAQ –long version  Reliability;Construct validity  Test re-test:one day apart Comparator: PA recordatory and accelerometer  43 (F: 21/M: 22); 24 (4.5);Young adults  Reliability:Total PA rs: 0.71Construct validity:PA Recordatory r=0.49Accelerometer r=0.24  Reliability: DoubtfulConstruct validity: Inadequate  Reliability: (?)Construct validity: (?), level of evidence=3?/2? 
Lopes et al., 201577  IPAQ – long version  Construct validity  Comparator: Questionnaire for physical activity and sedentary lifestyle  240 (F: 157/M: 83); 54.6 (range: 18–69 years);Adults with high blood pressure  Construct validity:Accuracy – ROC curve: 0.70 (95% CI: 0.64–0.75)  Construct validity: Doubtful  Construct validity: (?), level of evidence=3+ 
Alves et al., 201067  IPAQ – Short Version  Construct validity  Comparator: Celafisc criteria  173 (F: 98/M: 75); 40 (13);Adults  Construct validity:k=0.85  Construct validity: Inadequate  Construct validity: (?), level of evidence=3+ 
Matsudo et al., 200147  IPAQ – Short Version  Reliability;Construct validity  Test re-test:3–10 days apartComparator: Accelerometer  Reliability:257 (F: 149/M: 108); 36.8 (13.8)Validity:28 (F: 16/M: 12) 42.9 (14.2);Adults  Reliability:Total PA ICC: 0.77Total PA: rs=0.74Construct validity:Total PA r=0.75  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=2? 
Colpani et al., 201469  IPAQ – Short Version  Construct validity  Comparator: Pedometer  292 (F: 292); 57.1 (5.3); Climateric women  Construct validity: r=0.13  Construct validity: Inadequate  Construct validity: (?), level of evidence=3− 
Glaner et al., 200770  IPAQ – Short Version  Construct validity  Comparator: VO2max  105 (F: 28/M: 77); 24.8 (5.3);Young adults  Construct validity:% concordance=47%  Construct validity: Inadequate  Construct validity: (?), level of evidence=3− 
Pinto et al., 201671  IPAQ – Short Version  Construct validity  Comparator: Accelerometer  19; 14.6 (3.9); Juvenile dermatomyositis20; 14.5 (2.4); Juvenile systemic lupus erythematosus  Construct validity:Total PA r=0.51 JSLETotal PA r=0.29 JDMLight-intensity PA and MVPA ranged from r=0.05 to r=0.32  Construct validity:Inadequate  Construct validity: (?), level of evidence=2?/2?/2/1 
Moraes et al., 201368  IPAQ – Short Version  Construct validity  Comparator: American College of Sport Medicine criteria  2197 Adults  Construct validity: Male: k=0.95 Female: k=0.93  Construct validity: Inadequate  Construct validity: (?), level of evidence= 3+/3+ 
Lustosa et al., 201129  MLTAQ  Translation and cross-cultural adaptation  Translation process  39 (F: 32/M: 7); 71.2 (6.8);Elderly  n/a  Cross-cultural validity: Doubtful  n/a 
Bielemann et al., 201174  NPAQ  Construct validity  Comparator: Accelerometer  239 (F: 123/M: 116);Youth  Daily counts r=0.24Mean counts per min r=0.21Sedentary activity r=−0.08Moderate activity r=0.27Vigorous activity r=0.21Moderate to vigorous activity r=0.27  Construct validity: Inadequate  Construct validity: (?), level of evidence=1−/1−/3−/1−/1−/1− 
Cruciani et al., 201119  PACI  Translation and cross-cultural adaptation;Content validity  Translation process  24; 8.5 (1.5); Youth  n/a  Cross-cultural validity: DoubtfulContent validity: Inadequate  Content validity: (−) 
Adami et al., 201131  PACI  Reliability;Measurement error  Test re-test: 3h apart  83 (F: 42/M: 41); 9.3 (1.0);Youth  Reliability:PA time ICC: 0.89/r=0.83Total MET ICC: 0.91/r=0.87Total weighted MET ICC: 0.89/r=0.86Sedentary time ICC: 0.97/r=0.97Measurement error:PA time MD: 4.48 (LoA=50min)Total MET MD: 17.8 (LoA=294.6min)Total weighed MET MD: 25.8 (LoA=298.4min)Sedentary time MD: 1.35 (LoA=47.4min)  Reliability: InadequateMeasurement error: Inadequate  Reliability: (+)Measurement error: (?) 
Adami et al., 201365  PACI  Construct validity  Comparator: Accelerometer  83 (F: 42/M: 41); 9.3 (1.0);Youth  Construct validity: PA time – r=0.34 (counts/min)MET – r=0.38 (counts/min)Weighted MET – r=0.34 (counts/min)  Construct validity: Inadequate  Construct validity: (?), level of evidence=2−/2−/2− 
Guedes et al., 201528  PAQ-A  Translation and cross-cultural adaptation;Reliability;Construct validity  Translation processTest re-test:14 days apartComparator: Accelerometer  296 (F: 161/M: 135); F: 15.96 (1.25) M: 15.41 (1.09);Adolescents  Reliability:Total PA ICC: 0.77Construct validity:Total PA: r=0.56MVPA: r=0.54  Cross-cultural validity: DoubtfulReliability: AdequateConstruct validity: Very good  Reliability: (+)Construct validity: (?), level of evidence=2+/1+ 
Guedes et al., 201528  PAQ-C  Translation and cross-cultural adaptation;Reliability;Construct validity  Translation processTest re-test:14 days apartComparator: Accelerometer  232 (F: 124/M: 108); F: 11.12 (1.38) M: 11.48 (1.15);Childrens  Reliability:Total PA ICC: 0.74Construct validity:Total PA: r=0.40MVPA: r=0.48  Cross-cultural validity: DoubtfulReliability: AdequateConstruct validity: Very good  Reliability: (+)Construct validity: (?), level of evidence=2−/1− 
Takito et al., 200860  PAQPW  Reliability;Construct validity  Test re-test:7 days apartComparator: Heart rate monitor  68 (F: 68); 26.9 (6.1);Pregnant women  Reliability:Sport k=0.41Vigorous PA k=0.32Moderate PA k=0.29Sedentary activity ICC: 0.81Light PA ICC: 0.85Moderate ICC: 0.75Walking ICC: 0.80Construct validity:LoA: 7–11Reliability: AdequateConstruct validity: Inadequate  Reliability: (+) for ICC (−) for KappaConstruct validity: (?), level of evidence=3? 
Neto et al., 200826  PAR  Translation and cross-cultural adaptation;Reliability  Translation processTest re-test:14 days apart  12 (F: 11/M: 1); 75 (4);Elderly population  Reliability: ICC: 0.92  Cross-cultural validity: DoubtfulReliability: Adequate  Reliability: (+) 
Neto et al., 201175  PAR  Construct validity  Comparator: VO2max  98 (F: 43/M: 55); 67 (7);Elderly population  Construct validity: r=0.61  Construct validity: Inadequate  Construct validity: (?), level of evidence=3+ 
Damasceno et al., 201727  PAR-3D  Translation and cross-cultural adaptation  Translation process  n/a  n/a  Cross-cultural validity: Doubtful  n/a 
Farias Júnior et al., 200258  PAR-3D  Reliability  Test re-test:24h apart  45 (F: 20/M: 25); 16 (1.28);Adolescents  Reliability:Habitual PA: ICC: 0.84Light PA: ICC: 0.51Moderate PA: ICC: 0.80Vigorous PA: ICC: 0.78  Reliability: Adequate  Reliability: (+) 
Ribeiro et al., 201181  PAR-24  Development; Construct validity  Comparator: Accelerometer  98 (F: 65/M: 33); 39.4 (11); Adults  Construct validity:Counts – r=0.38kcal – r=0.31  Construct validity: Very good  Construct validity: (?), level of evidence=2−/2− 
Militão et al., 201341 (Developed)  PASBEQ  Reliability;Construct validity;Internal consistency  Test re-test:72h apartComparator: Shuttle run test (VO2max)  Reliability:47Validity:46 (F: 23/M: 23); 10–13 years old  Reliability:SPA ICC: 0.63–0.85LPA (week days) ICC: 0.42–0.74LPA (weekend) ICC: 0.44–0.75Total LPA ICC: 1.00TPA ICC: 0.60–0.86PA in school ICC: 0.63–0.85Total PA ICC: 0.61–0.84Construct validity:SPA r=0.04LPA (week days) r=0.27LPA (weekend) r=0.28Total LPA r=0.35TPA r=0.07PA in school r=0.19Total PA r=0.37Internal consistency:Cronbach AlfaSPA – 0.86LPA (week days) – 0.75LPA (weekend) – 0.77Total LPA – 1.0TPA – 0.87PA in school – 0.86Total PA – 0.86  Reliability: AdequateConstruct validity: InadequateInternal consistency: Very good  Reliability: bv UnclearConstruct validity: (?), level of evidence=3? (all analysis)Internal consistency: (?) 
Oliveira et al., 201156 (Developed)  PASBQ  Reliability  Test re-test:7 days apart  65 (F: 27/M: 38); 4.2 (1.2);Youth  Reliability:Outdoor playtime rs=0.92Sedentary behavior rs=0.75  Reliability: Doubtful  Reliability: (?) 
Tavares et al., 201472  PeNSE  Construct validity  Comparator: 24h Recordatory  174 (F: 94/M: 80); 14.7;Adolescents  Construct validity:Accuracy: ≥300min – 73.1%≥150min – 78.4%Inactive – 92.4%  Construct validity: Inadequate  Construct validity: (?), level of evidence=3+/3+/3+ 
Silva et al., 201523  PPAQ  Translationand cross-cultural adaptation  Translation process  305 (F: 305)Pregnant women  n/a  Cross-cultural validity: Doubtful  n/a 
Farias Junior et al., 201232  SAPAC  Reliability;Construct validity;Measurement error  Test re-test:7 days apartComparator: 24h PA recalls  Test re-test:239 (F: 133/M: 106); 16 (1.2)Validity:70 (F: 39/M: 31); 15.7 (1.2);Youth  Reliability:ICC: 0.88/k=0.52Construct validity:All: rho=0.62/k=0.59Male: rho=0.52/0.41Female: rho=0.51/k=0.6914–15 years: rho=0.52/k=0.5816–19 years: rho=0.60/0.61Measurement error:% of agreement: 75.7%LoA: 871.1 to −639.4  Reliability: AdequateConstruct validity: Very goodMeasurement error: Very good  Reliability: (+)Construct validity: (?), level of evidence=3−/3−/3−/3−/3−Measurement error: (?) 
Prazeres Filho et al., 201761  SAPAC  Reliability;Construct validity  Test re-test:2 days apartComparator: Accelerometer  Test re-test:171 (F: 102/M: 69); 12.3 (1.1)Validity:341 (F: 172/M: 169); 11.9 (1.0);Youth  Reliability:ICC: 0.73/k=0.58Construct validity:All: rho=0.37Male: rho=0.38Female: rho=0.3710–11 years: rho=0.3612–14 years: rho=0.39  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=2− 
Checon et al., 201152 (Developed)  Saúdes  Reliability  Test re-test:15 days apart  91 (F: 49/M: 42);Youth  Reliability:k or rs: from −0.01 to 1.00  Reliability: Doubtful  Reliability: (?) 
Nahas et al., 200757 (Developed)  SBQ  Reliability;Construct validity  Test re-test:7 days apartComparator: Pedometer  122 (F: 78/M: 44); 15.8 (1.6);Adolescents  Reliability:ICC from 0.76 to 0.93Construct validity:r=0.23  Reliability: AdequateConstruct validity: Very good  Reliability: (+)Construct validity: (?), level of evidence=3− 
Hallal et al. 201378  SVPAQ  Construct validity  Comparator: Doubly labeled water  25 (F: 16/M: 9); 13 (0.3);Adolescents  Construct validity:Total energy expenditure: r=0.41Physical activity energy expenditure: r=0.30  Construct validity: Doubtful  Construct validity: (?), level of evidence=1? 
Monteiro et al., 200859 (Developed)  VIGITEL  Reliability;Construct validity  Test re-test:7–15 days apartComparator: 24h Recordatory  Reliability:110 (F: 63/M: 47); 45Construct validity: 111 (F: 61/M: 50); 44;Adults  Reliability:Sufficient active in LPA: k=0.80Inactive in four domains of PA: k=0.78Television for long periods: k=0.53Construct validity: Specificity greater than 80%Sensibility: long period on TV: 69.7%Sedentary activity: 59.1%Sufficiently active in leisure: 50%  Reliability: AdequateConstruct validity: Inadequate  Reliability: (+)Construct validity: (?), level of evidence=3−/3−/3− 
Moreira et al., 201739  VIGITEL  Reliability;Construct-validity;Measurement error  Test re-test:7–15 days apartComparator: 24h Recordatory  305 (F: 177/M: 128); 49.7 (18.2); Adults  Reliability: Active in LPA k=0.70Active in TPA k=0.35Inactive – k=0.64Watch Television – k=0.56Construct validity:PA LeisureSensibility=67.7%Specificity=82.8% PA LocomotionSensibility=11.9%Specificity=91.2%Sedentary LevelSensibility=54.8%Specificity=87.8%Measurement error:% of Agreement: 65%  Reliability: AdequateConstruct validity: InadequateMeasurement error: Very good  Reliability: (−)Construct validity: (?), level of evidence=3−/3−/3−Measurement error: (?) 

Table presents the description of the instruments evaluated in alphabetical order, also the psychometric properties assessed in each study, relevant characteristics of each property, such as the time between each test–retest (reproducibility) analysis, comparator instrument (construct validity), sample characteristics, relevant results to the statistical analyzes carried out, classification regarding the methodological quality, classification of the results of the analyzes and level of evidence of the comparator instrument (construct validity). The type of ICC used was specified in subscript when informed by the article.

ICC, intraclass correlation coefficient; LoA, limits of agreement; LPA, leisure physical activity; MD, mean difference; MET, metabolic equivalent of task; MVPA, moderate and vigorous physical activity; n/a, not applicable; OPA, occupational physical activity; PA, physical activity; ROC, receiver operating characteristic; SD, standard deviation; SPA, sports physical activity; SPPB, short physical performance battery; TPA, transportation physical activity; VO2, oxygen volume; WHODAS, Word Health Organization Disability Assessment Schedule.

(+)=sufficient rating, (?)=indeterminate rating, (−)=insufficient rating.

a

For the abbreviation listed in the physical activity questionnaire refer to Table 2.

Translation and cross-cultural adaptation

Thirteen19–30 translation and cross-cultural adaptation analyses of physical activity questionnaires were reported. The methodological quality assessment was rated as ‘Doubtful’, due to unclear information regarding whether the study samples were similar for relevant characteristics. Additionally, all studies were rated as ‘Inadequate’ because the sample size and the statistical methods used to analyze the data were inappropriate.

Measurement error

Nine31–39 studies performed the analysis of measurement error. Of these, eight31,32,34–39 studies were rated as ‘Very Good’ and one as ‘Inadequate’ in the methodological quality assessment. The study rated as ‘Inadequate’ used an inappropriate time interval between assessments. For the quality criteria assessment, all studies received an indeterminate (?) rating because minimal important change was not calculated. The Baecke Physical Activity Questionnaire for adolescents showed the highest percent of agreement (95.5%). The International Physical Activity Questionnaire – long version and the Baltimore Activity Scale for Intermittent Claudication showed the highest limits of agreement (IPAQ-LV=−14.0 to 7.29kcal/min; BASIC=−117 to 250kcal).

Internal consistency

Four22,24,40,41 studies performed the internal consistency analysis for the following questionnaires Habitual Physical Activity Baecke Questionnaire, Health Promoting Lifestyle Profile-II (HPLP-II), Physical Activity Level and Sedentary Behavior Evaluation Questionnaire (PASBEQ) and the Human Activity Profile Questionnaire (HAP). The methodological quality assessment revealed that three22,40,41 studies were rated as ‘Very Good’ with Cronbach's alpha ranging from 0.52 to 1.0 (including analysis of sub-dimensions), whereas one24 study was rated as ‘Inadequate’ due to inadequate statistical analysis. In the quality criteria assessment, all four studies received an indeterminate (?) rating because they failed to meet the criterion for low evidence for sufficient structural validity.

Reliability

Thirty-seven25,26,30–39,41–59,28,60,61 reliability analyses were reported in the included studies. Of these, twenty-eight25,26,32,36–39,41–44,47,49–51,53,54,57–59,28,60,61,48,62,63 analyses were rated as ‘Adequate’, six33–35,46,52,56 rated as ‘Doubtful’, and three30,31,64 rated as ‘Inadequate’ in the methodological quality assessment. The item most rated as ‘Inadequate’ referred to the time interval between test–retest and the item most rated as ‘doubtful’ referred to statistical method used. In addition, most studies were rated as ‘Adequate’ because they failed to include a detailed description for the test conditions and whether the individuals were stable in the interim period on the construct to be measured. The studies assessed reliability using ICC, correlation coefficient or Kappa coefficient and the interval for test-retest ranged from 3h to 45 days. The ICC of the questionnaires varied from 0.20 to 1.00, the coefficient correlation from 0.49 to 1.00 correlation and the Kappa coefficients from −0.01 to 1.00. Overall, the most reliable questionnaire was the internet version of Questionnaire of a Typical Physical Activity and Food Intake to youth population, which was rated as ‘Adequate’ in the methodological quality assessment and showed an ICC of 0.94 for total physical activity score which indicates a positive rating in the quality criteria assessment. For healthy adults, the Baecke Physical Activity Questionnaire, International Physical Activity Questionnaire – long version and short version questionnaires were rated as ‘Adequate’ in the methodological quality assessment and achieved a sufficient (+) rating in the quality criteria assessment (ICC>0.70). For the elderly population, the Baecke Physical Activity Questionnaire, International Physical Activity Questionnaire – long version and Physical Activity Rating was rated as ‘Adequate’ in the methodological quality assessment but only the International Physical Activity Questionnaire – long version (ICC=0.88) and Physical Activity Rating (ICC 0.92) achieved a sufficient (+) rating in the quality criteria assessment. The reliability analyses for people with specific conditions (i.e. individuals with intermittent claudication and cardiovascular disease), the Baltimore Activity Scale for Intermittent Claudication and Godin Shepard Leisure-time Physical Activity Questionnaire were rated as ‘Adequate’ in the methodological quality assessment and both questionnaires achieved a sufficient (+) rating in the quality criteria assessment (ICC ranging from 0.84 to 0.87).

Content validity

Two19,25 studies assessed the content validity of the Physical activity checklist interview and Godin shepard leisure-time physical activity questionnaire. In the methodological assessment, both studies were rated as ‘Inadequate’ because they failed to consult the target population about relevance and comprehensiveness of the questionnaire items. In the quality criteria assessment, both studies received an insufficient (−) rating because did not involve the target population in the process of content validation. Overall, the most studies focused predominantly on the terminologies and language expressions.

Construct validity

Among included studies, fifty-seven construct validity analyses were identified. Forty-four analyses33,35,39,41,43,44,46–48,50,51,54,55,59–62,65–75 were rated as ‘Inadequate’ and six34,51,63,76–78 rated as ‘Doubtful’ in the methodological quality assessment due to the lack or insufficient information on the measurement properties of the comparator instrument. Also, seven32,57,28,79–81 analyses, reporting the results for Questionnaire of a Typical Physical Activity and Food Intake (previous day), Godin Shepard Leisure-time Physical Activity Questionnaire, Physical Activity Questionnaire for Adolescents, Physical Activity Questionnaire for Older Children, 24-Physical Activity Rating, Self-administered Physical Activity Checklist and Saúde na Boa Questionnaire, were rated as ‘Very Good’. Regarding the level of evidence for the comparator instrument, ten35,55,28,62,66,71,73,74,78 analyses (23%) used a comparator instrument classified as level 1, eight46,47,61,62,65–67,81 analyses (18%) as level 2 and twenty-six32–34,39,41,43,44,48–51,54,57,59,60,63,67–70,72,75–77,79,80 analyses (59%) as level 3. Thirty-five analyses reported the construct validity using objective measures as comparator, such as accelerometer35,45–47,28,61,65–67,71,73,74,81 (n=16), pedometer33,43,44,50,57,69,70,76,79 (n=9), frequency meter51,60 (n=2), doubly labeled water78 (n=1) and VO2max41,48,49,51,70,75,80 (n=7). For the criterion validity, all studies received an indeterminate (?) rating because they failed to test prior-formulated hypotheses. The correlation coefficients between the questionnaire and the comparator instrument ranged from −0.08 to 0.75 with accelerometer as the comparator, from 0.12 to 0.57 with pedometer, from 0.05 to 0.08 with frequency meter, from 0.30 to 0.41 with doubly labeled water and from −0.14 to 0.61 with VO2max. In addition, the physical activity questionnaires were compared with American College of Sports Medicine criteria, other questionnaires, recordatory and diary. The correlation coefficients of physical activity questionnaires with other self-report measures32–34,39,43,46,54,59,63,68,72,77,80 (n=13) ranged from 0.09 to 0.88 and the kappa coefficient ranged from 0.28 to 0.95.

Responsiveness

Only one82 study assessed the responsiveness of a physical activity questionnaire. The methodological quality was rated as ‘Inadequate’, due to the lack or insufficient information on measurement properties of the comparator instrument. In the quality criteria assessment, this study received an insufficient (−) rating, indicating that the result was not in accordance with the hypothesis.

Overall findings and level of evidence

Our findings showed that none of the questionnaire had their measurement properties fully tested. The Baecke Physical Activity Questionnaire and Physical Activity Checklist Interview were the most frequent investigated questionnaires, with five measurement properties evaluated. Only eight questionnaires had at least one measurement property classified as high for level of evidence, of those, the Baecke Physical Activity Questionnaire demonstrated high level of evidence for reliability, measurement error and internal consistency; and the Self-administered Physical Activity Checklist Questionnaire presented high level of evidence for reliability and construct validity. Table 4 presents the levels of evidence for each measurement property from each questionnaire.

Table 4.

Summary of included studies and classification of measurement properties investigated.

Physical activity questionnaired  Analysis performed  Total sample size (no. of studies)  Results  COSMIN rank (no. of studies)  Quality criteria assessment (no. of studies)  Grade 
AAQ  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  22 (1)  ICC: 0.97  Inadequate (1)  (+) (1)  ⊖(3)⊕⊖(2)⊕Very lowa,c 
BASIC  Reliability  38 (1)  ICC: 0.87  Adequate (1)  (+) (1)  ⊖⊕⊖(2)⊕Very lowa,c 
  Measurement error  38 (1)  LoA: −117kcal to 250kcal  Very Good (1)  (?) (1)  ⊕⊕⊖(2)⊕Low3 
  Construct validity  150 (1)  r=0.34  Doubtful (1)  (?) (1)  ⊖(2)⊕⊕⊕Lowa 
BPAQ  Translation  –  –  Doubtful (2)  –  ⊖⊖⊕⊕Lowa,b 
  Reliability  594 (7)  ICC: 0.44–0.85  Adequate (7)  (−) (3)(+) (7)  ⊕⊕⊕⊕High 
  Measurement error  135 (1)  % of agreement: 95.5%  Adequate (1)  (?) (1)  ⊕⊕⊕⊕High 
  Construct validity  577 (8)  r=−0.14 to 0.59  Inadequate (6) Doubtful (2)  (?) (8)  ⊖⊖⊕⊕Lowa,b 
  Internal consistency  326 (1)  Cronbach alpha: 0.52–0.76  Very Good (1)  (?) (1)  ⊕⊕⊕⊕High 
DAFA  Reliability  170 (2)  ICC: 0.33–0.86  Adequate (2)  (+) (1)Unclear (1)  ⊕⊖⊕⊕Moderateb 
  Construct validity  69 (1)  k=0.28  Inadequate (1)  (?)  ⊖(2)⊕⊖⊕Very lowa,c 
DAFA-IV  Reliability  127 (1)  ICC: 0.94  Adequate (1)  (+) (1)  ⊖⊕⊕⊕Moderatea 
  Measurement error  127 (1)  Mean error: 1.7  Very Good (1)  (?) (1)  ⊕⊕⊕⊕High 
DAFA-PD  Construct validity  50 (1)  r=0.45  Very Good (1)  (?) (1)  ⊕⊕⊖⊕Moderate3 
DAFA-IVPD  Reliability  94 (1)  Incidence ratio: 0.63–7.52  Inadequate (1)  (?) (1)  ⊖(3)⊕⊖⊕Very lowa,c 
  Construct validity  390 (1)  Incidence ration: 0.52–18.1  Inadequate (1)  (?) (1)  ⊖(3)⊕⊕⊕Very lowa 
GSLTPAQ  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  80 (1)  ICC: 0.79–0.84  Adequate (1)  (+) (1)  ⊖⊕⊖⊕Lowa,c 
  Content validity  80 (1)  –  Inadequate (1)  (−) (1)  ⊖(3)⊕⊖⊕Very lowa,c 
  Construct validity  236 (1)  r=0.03–0.62  Very Good (1)  (+) (1)  ⊕⊖⊕⊕Moderateb 
HAP  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Internal Consistency  230 (1)  Rash analysis: 0.91  Inadequate (1)  (?) (1)  ⊖(3)⊕⊕⊕Very lowa 
  Construct validity  120 (1)  r=0.55–0.69  Inadequate (1)  (?) (1)  ⊖(3)⊕⊕⊕Very lowa 
HPLP-II  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Internal consistency  30 (1)  Cronbach alpha: 0.85–0.93  Very Good (1)  (?) (1)  ⊕⊕⊖(2)⊕Low3 
IPAQ-LV  Reliability  571 (8)  ICC: 0.20–0.97k=0.25–1.00rs=0.49–0.95  Adequate (4)Doubtful (4)  (?) 4(−) 2 (+) 2  ⊕⊖⊕⊕Moderateb 
  Measurement error  346 (3)  LoA: −14.0 to 131min  Adequate (3)  (?) 3  ⊕⊕⊕⊕High 
  Construct validity  827 (9)  r=0.12–0.57rs=0.09–0.51k=0.03–0.35ROC curve: 0.70  Inadequate (7)Doubtful (2)  (?) (9)  ⊖⊕⊕⊕Moderatea 
IPAQ-SV  Reliability  257 (1)  ICC: 0.77r=0.74  Adequate (1)  (+) (1)  ⊖⊕⊕⊕Moderatea 
  Measurement error  39 (1)  % of agreement: 95%LoA: 236.6–278.8  Adequate (1)  (?) (1)  ⊖(2)⊕⊖⊕Very lowa,c 
  Construct validity  2834 (6)  k=0.85–0.95r=0.05–0.75% Concordance=47%  Inadequate (6)  (?) (6)  ⊖⊕⊕⊕Lowa 
MLTAQ  Translation  30 (1)  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
NPAQ  Construct validity  239 (1)  r=−0.08 to 0.27  Inadequate (1)  (?) (1)  ⊖(3)⊕⊕⊕Very lowa 
PACI  Translation  24 (1)  –  Doubtful (1)  –  ⊖(2)⊕⊖(2)⊕Very lowa,c 
  Content validity  24 (1)  –  Inadequate (1)  (−) (1)  ⊖(3)⊕⊖(2)⊕Very lowa,c 
  Reliability  83 (1)  ICC: 0.89–0.97r=0.83–0.97  Inadequate (1)  (+) (1)  ⊖(3)⊕⊖⊕Very lowa,c 
  Measurement error  83 (1)  Mean difference: 1.35–25.8LoA: 50–294.6min  Inadequate (1)  (?) (1)  ⊖(3)⊕⊖⊕Very lowa,c 
  Construct validity  83 (1)  r=0.34–0.38  Inadequate (1)  (?) (1)  ⊖(3)⊕⊖⊕Very lowa,c 
PAQ-A  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  296 (1)  ICC: 0.77  Adequate (1)  (+) (1)  ⊖⊕⊕⊕Moderatea 
  Construct validity  296 (1)  r=0.54–0.56  Very Good (1)  (?) (1)  ⊕⊕⊕⊕High 
PAQ-C  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  232 (1)  ICC: 0.74  Adequate (1)  (+) (1)  ⊖⊕⊕⊕Moderatea 
  Construct validity  232 (1)  r=0.40–0.48  Very Good (1)  (?) (1)  ⊕⊕⊕⊕High 
PAQPW  Reliability  68 (1)  ICC: 0.75–0.85k=0.29–0.41  Adequate (1)  (+) (1)  ⊖⊕⊖⊕Lowa,c 
  Construct validity  68 (1)  LoA: 7–11Inadequate (1)  (?) (1)  ⊖(3)⊕⊖⊕Very Lowa,c 
PAR  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  12 (1)  ICC: 0.92  Adequate (1)  (+) (1)  ⊖⊕⊖(2)⊕Very Lowa,c 
  Construct validity  98 (1)  r=0.61  Inadequate (1)  (?) (1)  ⊖(3)⊕⊖⊕Very Lowa,c 
PAR-3D  Translation  –  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
  Reliability  45 (1)  ICC: 0.51–0.84  Adequate (1)  (+) (1)  ⊖⊕⊖(2)⊕Very Lowa,c 
PAR-24  Construct validity  98 (1)  r=0.31–0.38  Very Good (1)  (?) (1)  ⊕⊕⊖⊕Moderate3 
PASBEQ  Reliability  47 (1)  ICC: 0.42–1.00  Adequate (1)  Unclear (1)  ⊖⊖⊖(2)⊕Very Lowa,b,c 
  Construct validity  46 (1)  r=0.04–0.37  Inadequate (1)  (?) (1)  ⊖(3)⊕⊖(2)⊕Very Lowa,c 
  Internal consistency  46 (1)  Cronbach alfa: 0.75–1.00  Very Good (1)  (?) (1)  ⊕⊕⊖(2)⊕Lowa 
PASBQ  Reliability  65 (1)  rs=0.75–0.92  Doubtful (1)  (?) (1)  ⊖(2)⊕⊖⊕Very Lowa,c 
PeNSE  Construct validity  174 (1)  Accuracy: 73.1%–92.4%  Inadequate (1)  (?) (1)  ⊖(3)⊕⊕⊕Very Lowa 
PPAQ  Translation  305 (1)  –  Doubtful (1)  –  ⊖(2)⊕⊕⊕Lowa 
SAPAC  Reliability  410 (2)  ICC: 0.73–0.88k=0.52–0.58  Adequate (2)  (+) (2)  ⊕⊕⊕⊕High 
  Measurement error  239 (1)  % of agreement: 75.7% LoA: 871.1–-639.4  Adequate (1)  (?) (1)  ⊖⊕⊕⊕Moderatea 
  Construct validity  411 (2)  rho=0.36–0.62k=0.41–0.69  Very Good (1)Inadequate (1)  (?) (2)  ⊕⊕⊕⊕High 
Saudes  Reliability  91 (1)  k or rs: from −0.01 to 1.00  Doubtful (1)  (?) (1)  ⊖(2)⊖⊖⊕Very lowa,b,c 
SBQ  Reliability  122 (1)  ICC: 0.76–0.93  Adequate (1)  (+) (1)  ⊖⊕⊕⊕Moderatea 
  Construct validity  122 (1)  r=0.23  Very Good (1)  (?) (1)  ⊕⊕⊕⊕High 
SVPAQ  Construct validity  25 (1)  r=0.30–0.41  Doubtful (1)  (?) (1)  ⊖(2)⊕⊖(2)⊕Very lowa,c 
VIGITEL  Reliability  415 (2)  k=0.35–0.80  Adequate (2)  (+) (1)(−) (1)  ⊕⊕⊕⊕High 
  Measurement error  305 (1)  PoA: 65%  Adequate (1)  (?) (1)  ⊖⊕⊕⊕Moderatea 
  Construct validity  416 (2)  Specificity: >80%Sensibility: 11%–69.7%  Inadequate (2)  (?) (2)  ⊖(2)⊕⊖⊕Low1 
a

Downgraded for risk of bias by one level if there is serious risk of bias (i.e. multiple studies of doubtful quality available, or one study of adequate quality), two levels (e.g. from high to low) if there is very serious risk of bias (i.e. multiple studies of inadequate quality, or one study of doubtful quality available), or three levels (i.e. from high to very low) of there is extremely risk of bias (i.e. only one study of inadequate quality available).

b

Downgraded for inconsistency if the results are inconsistent (i.e. interpretation of the summary results generates different interpretations considering the range).

c

Downgraded for imprecision by one level if the total sample size of the summary results was below 100 and two level if the total sample size is below 50.

d

For the abbreviation listed in the physical activity questionnaire refer to Table 2.

Discussion

To our knowledge this is the first systematic review assessing the methodological quality of physical activity questionnaires translated to Brazilian-Portuguese. Systematic reviews on physical activity questionnaire translated to a specific language is important because valid and reliable questionnaires are needed in the context of clinical practice to evaluate and monitor physical activity outcomes as well as in the context of research to allow physical activity data to be generalized to a specific population and to be compared across countries.18 Our findings identified a wide variety of questionnaires, designed for different target populations and assessing different constructs and dimensions of physical activity. In summary, our review shows that the International Physical Activity Questionnaire, the Baecke Physical Activity Questionnaire and the Physical Activity Checklist Interview were the most frequent investigated questionnaires. The measurement properties most frequently investigated among included studies were construct validity, reliability and translation. In addition, the methodological quality of the included studies revealed that majority of the included studies were rated as ‘Inadequate’, ‘Doubtful’ or ‘Adequate’. Importantly, most of the questionnaires identified were found to have their measurement properties partially tested or even not tested. Previous systematic reviews investigating physical activity and sedentary behavior questionnaires also showed similar results.17,18 The common methodological flaws found in this review were poor reporting methods, the lack of prior-formulated hypothesis, inadequate statistical analyses and sample size. Another possible explanation for these findings is that the COSMIN criteria is a considerably recent tool.

Strengths and limitations

A strength of our review was the use of two independent reviewers to perform the study selection, data extraction and quality rating. Our review also had some limitations that should be considered in the interpretation of the results. Although we conducted an extensively search in five electronic database aided by hand searching of reference list of included studies, we could not exclude the possibility of missing studies.

Physical activity questionnaires recommendation

The most recent recommendation for physical activity5 states that adults should do at least 150min of moderate-intensity throughout the week. Therefore, physical activity questionnaires should include the five domains (leisure-time, occupational, transportation, sports and household) to comprise total physical activity levels, as well as, duration and frequency of the practices. Of the included questionnaires (n=30), only two questionnaires (i.e. International Physical Activity Questionnaire – long and short versions) included the five domains of physical activity. However, high level of evidence was demonstrated only for measurement error on International Physical Activity Questionnaire – long version. In contrast, questionnaires specifically designed to assess physical activity levels of children or adolescents included relevant domains for these populations (e.g. School-time PA). In addition, the choice of the questionnaire should involve the physical activity domain of interest, which does not necessarily characterize the individual's total physical activity level. Our findings showed that ‘high’ level of evidence were found for Baecke Physical Activity Questionnaire, Self-administered Physical Activity Checklist and Physical Activity Questionnaire of the Surveillance System of Risk Factors and Protection for Chronic Diseases on reliability; for Self-administered Physical Activity Checklist, Physical Activity Questionnaire for Adolescents, Physical Activity Questionnaire for Older Children and Saúde na boa Questionnaire on construct validity; for Baecke Physical Activity Questionnaire, Questionnaire of a Typical Physical Activity and Food Intake (Internet version) and International Physical Activity Questionnaire – long version on measurement error; and finally only for Baecke Physical Activity Questionnaire on internal consistency. For all other measurement properties, the evidence remains untested or with moderate, low or very low level of evidence due to poor methodological quality of the studies, insufficient quality criteria or even lack of evidence.

Recommendations for future research

The results of this review should be used to guide future high methodological quality studies investigating measurement properties of physical activity questionnaires. For instance, studies investigating construct validity of physical activity questionnaires should use reference instruments that measures the construct to be investigated83 as well as test prior-formulated hypotheses. Additional studies are warranted in other measurement properties, such as content validity and responsiveness. In addition, the COSMIN checklist should be used in future studies to ensure the high methodological quality.

Conclusion

Given the results obtained with this review, few conclusions could be made about the best physical activity questionnaire, since many of them did not have their measurement properties fully tested and the studies showed in general poor methodological quality. Nevertheless, the questionnaires Baecke Physical Activity Questionnaire for adults and the Self-administered Physical Activity Checklist for youth demonstrated better scores considering methodological quality, quality criteria and also high level of evidence for some measurement properties tested. Therefore, further high methodological quality studies investigating the measurement properties of physical activity questionnaires are still needed in this area.

Funding source

F.G.S was supported with a scholarship, grant number 2014/09560-1, from Sao Paulo Research Foundation (FAPESP)

Conflicts of interest

The authors declare no conflicts of interest.

Appendix 1

Search strategy for Medline database:

exp exercise/ 
physical inactivity.mp. 
physical activity.mp. 
exp motor activity/ 
Physical Fitness/ 
sedentary.ab. or sedentary.ti. 
exp life style/ 
exp leisure activities/ 
exp walking/ 
10  exp sports/ 
11  (exercise$ adj aerobic$).tw. 
12  (physical$ adj5 (fit$ or train$ or activ$ or endur$)).tw. 
13  (exercis$ adj5 (train$ or physical$ or activ$)).tw. 
14  sport$.tw. 
15  walk$.tw. 
16  cycle$.tw. 
17  ((“lifestyle” or life-style) adj5 activ$).tw. 
18  ((“lifestyle” or life-style) adj5 physical$).tw. 
19  1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 
20  Questionnaires/ 
21  index.mp. 
22  scale.mp. 
23  score.mp. 
24  Patient Outcome Assessment/ or Self-Assessment/ 
25  Evaluation Studies as Topic/ 
26  Psychometrics/ or Self Report/ 
27  inventory.mp. 
28  20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 
29  Brazil/ 
30  brasil.mp. 
31  Brazilian.mp. 
32  Brazilian Portuguese.mp. 
33  29 or 30 or 31 or 32 
34  19 and 28 and 33 

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Brazilian Journal of Physical Therapy

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