International Congress of Applied Sports Sciences, Sofia, Bulgaria 2017

View Presentation - Physical Activity Assessment using a modified PAQ-C questionnaire

International Congress of Applied Sports Sciences Sofia 2017

First International Congress of Applied Sports Sciences

Sofia 2017

Bulgaria Bulgaria, Sofia, National Sports Academy
website: www.icass2017.com

Video format: MP4 | watch on YouTube

ABOUT THE CONGRESS

First International Scientific Congress of Applied Sports Sciences - Sofia, Bulgaria 2017

The First International Scientific Congress of Applied Sports Sciences (ICASS) was organised by the National Sports Academy 'Vassil Levski' (NSA) and was held in Sofia, on 1-2 December, 2017. This Congress was dedicated to the 75th anniversary of the National Sports Academy, and was a platform for presenting and discussing the latest research in physical education and sport science.

OUR CONTRIBUTION

I presented our latest study in the parallel sessions of the ICASS Sofia on 2 December 2017. The fidings were part of our physical activity assessment, which was conducted on primary school children earlier in 2017. In addition to that, we submitted a full-length article, which was reviewed and published in the proceeding book of the Congress.

 

Physical activity assessment using a modified PAQ-C questionnaire

Presentation in the Parallel Sessions

Stefan Kolimechkov at the 1st ICASS in Sofia 2017

1st International Congress of Applied Sports Sciences

Physical activity assessment using a modified PAQ-C questionnaire

S. Kolimechkov, L. Petrov & A. Alexandrova,
Department of Physiology and Biochemistry,
National Sports Academy 'Vassil Levski', Sofia, Bulgaria

Physical activity assessment on primary school children

ABSTRACT

Physical activity plays an important role in a child’s development and is a powerful indicator of their health and well-being, and its assessment is an essential part of monitoring and surveillance in schools. The aim of this study was to measure and assess general levels of physical activity amongst Bulgarian and English children by applying a self-reported questionnaire. In total, 94 participants between the ages of 7 and 10, divided into four groups depending on their nationality and gender, took part in this study. Physical activity was measured by using the PAQ-C questionnaire, which was modified and adjusted for the purposes of our study. Weight, height and waist circumference were measured, and BMI and Waist-to-Height ratio were calculated. The Z-scores and percentile scores for weight, height and BMI were calculated and assessed using WHO software. The data was analysed by using one-way ANOVA with Bonferroni post hoc test. The final scores of the modified PAQ-C questionnaire for all four groups were recorded and shown to be within the range of medium physical activity for children (PAQ-C score >2.50 and <3.50), but there were significant differences between the Bulgarian (2.66±0.3 for girls and 2.90±0.3 for boys) and English children (3.17±0.7 and 3.41±0.6, respectively), (p<0.05). There was no significant difference between overweight and obese children (BMI Z-score >+1SD) and children with BMI within the norm (BMI Z-score <+1SD and >-1SD) in terms of the PAQ-C score, which has also been observed by other authors. Further research needs to be carried out on the Bulgarian population in order to obtain normative PAQ scores for children and adolescents.

Key Words: children, obese, overweight, waist-to-height ratio

 

INTRODUCTION

Physical activity (PA) includes any body movement produced by the contractions of skeletal muscles that increase energy expenditure (American College of Sports Medicine, 2014), plays an important role in children’s development, and it is a powerful indicator of their health and well-being. The benefits of PA are well-documented and include: improved health of muscles, bones, and joints, positive social and mental health, and a decreased chance of developing diseases (U.S. Department of Health and Human Services, 1996, Elliot et al., 2013). Based on these benefits, the World Health Organisation and the American Society of Health and Physical Educators recommend that children and adolescents should spend a minimum of one hour per day in moderate to vigorously intense PA (WHO, 2010, Ganley et al., 2011, Elliot et al., 2013).

The assessment of PA is an essential part of profiling and monitoring in schools. Subjective methods for assessing physical activity, such as questionnaires, interviews and diaries, are often preferred to the objective ones (heart rate monitors, pedometer, and accelerometer) because of the simplicity with which they are conducted on children, without the need for special equipment (Bervoets et al., 2014). However, self-reporting questionnaires have their own difficulties due to the nature of the children’s activity patterns and their lack of cognitive ability to accurately recall the amount and intensity of activity (Hagstromer and Sjostrom, 2010).

A systematic review, which was carried out on many available self-report questionnaires for assessing PA in children and adolescents, identified three such questionnaires as potentially most suitable: Youth Risk Behaviour Surveillance Survey (YRBS), Teen Health Survey, and The Physical Activity Questionnaire (PAQ-C/PAQ-A) (Biddle et al., 2011). The Youth Risk Behaviour Surveillance Survey (YRBS) was developed in 1989 by the Center for Disease Control and Prevention (CDC) to monitor health risk behaviours that contribute to the leading causes of mortality, morbidity, and social problems amongst adolescents and adults in the United States (Brener et al., 1995). The Teen Health Survey was developed for adolescents only, and includes just two items (Biddle et al., 2011).

The Physical Activity Questionnaire (PAQ-C/PAQ-A) has two slightly different versions, one for elementary school children (8-14 years of age) and one for high school students (14-20 years of age). The questionnaires use a common scoring system and were applied successfully in many studies (Kowalski et al., 2004). Results indicated that PAQ-C provides a reliable and valid measure of general physical activity levels in children during the school year (Crocker et al., 1997, Kowalski et al., 1997, Wang et al., 2016). PAQ-C is based on questions for the last seven days and requires participants to check a list of activities, as far as frequency is concerned, by using the following scale: ‘None’, ‘1-2 times per week’, ‘3-4 times’, ‘5-6 times’, ‘7 times or more’. The other questions cover ‘physical activity in PE lessons’, ‘recess’, ‘lunch time’, ‘right after school’, and ‘evenings’, as well as ‘the last weekend’. A five-scale measure of frequency of participation is given for each question. The Physical Activity Questionnaire for Older Children (PAQ-C) has been used to classify children and adolescents into different activity levels and to investigate the relationship between physical activity and health outcomes (Kowalski et al., 2004).

Aim and objectives of the study

The aim of this study was to measure and assess the general level of physical activity amongst Bulgarian and English school children by applying a modified PAQ-C questionnaire.

 

METHODS

In total, 94 participants (30 females and 31 males from Bulgaria, and 15 females and 18 males from England) between the ages of 7 and 10 took part in this study. Informed consent was obtained from the parent/guardian of each child.

The anthropometric parameters, weight, height and waist circumference, were measured, and the BMI was calculated as: weight in kilograms / height in metres squared. Body weight was measured to within an accuracy of 0.1 kg by using an electronic scale, and height was measured to the nearest 0.1 cm with a stadiometer. The Z-scores and percentile scores for weight, height and BMI of each individual were calculated and assessed by using specialised software of the World Health Organisation, called ‘WHO Anthro Plus’ (WHO, 2007). Waist circumference was measured to the nearest 0.1 cm with the Lufkin W606PM anthropometric tape measure, and Waist-to-Height ratio was calculated as: waist circumference (cm) / height (cm).

In order to measure and assess levels of physical activity, we applied a widely used questionnaire for children, called PAQ-C (Kowalski et al., 2004), after adjusting it for our purposes (STK-SPORT, 2017a). Firstly, questions were reformulated to obtain information about a “usual week” (instead of the last seven days). Secondly, Question 9 (Q9 - physical activity frequencies for each day from the last week), and Q10 (Were you sick last week?) were excluded from the original PAQ-C test, as these questions did not fit into the modified test, which is concerned with a “usual week”. Instead of Q9 and Q10, we added two new questions for verification of Q2 (activity during physical education classes) and Q3 (break-time activity), in which we asked the same thing in a different way in order to exclude children who answer such questions without paying attention. The scoring system of the test remained the same as in the original PAQ-C, where a value of 1 indicates low physical activity and a value of 5 indicates high physical activity for each question. The final PAQ-C activity score of the test is calculated as the mean value of the answers to the first eight questions. In addition, a Bulgarian language version of the test was provided (STK-SPORT, 2017b).

One-way ANOVA with Bonferroni post hoc test was applied to analyse the data from all participants, divided into four groups depending on their nationality and gender. In addition, eta-squared measure of effect size for use in ANOVA (η2) (Lakens, 2013) was also calculated in order to present the magnitude of the effects. Statistically significant differences between the average values were evaluated at p < 0.05, and all data in the text are presented as average ± SD.

 

RESULTS

After calculating the differences between Q2, Q3 and their verification questions, we discovered that thirteen children (three Bulgarian females, seven English females, and three English males) did not provide reliable enough answers according to the criteria which we set (the sum of the differences was greater than a value of 2), and therefore they were excluded from the study. Following this test verification, the groups were reduced to 27 females and 31 males from Bulgaria, and 8 females and 15 males from England.

The anthropometric data of the participants is presented in Table 1. Their age, weight, height and their Z-scores and percentile scores, as well as BMI, BMI Z-score, waist circumference and waist-to-height ratio did not show any significant statistical differences between the groups. Only in the BMI percentile score was there a significant difference between English girls and boys (p < 0.05).

Table 1. Anthropometric data of all 81 participants who passed the test verification criteria (Mean ± SD)

 

Bulgarian Females (n=27)

Bulgarian Males
(n=31)

English
Females
(n=8)

English
Males
(n=15)

Age (y)

9.0 ± 0.6

8.8 ± 0.5

8.7 ± 0.4

8.6 ± 0.4

Weight (kg)

34.1 ± 8.0

33.0 ± 6.7

35.8 ± 13.1

34.6 ± 5.8

Weight Z-score

0.9 ± 1.1

0.9 ± 1.3

1.2 ± 1.5

1.4 ± 0.9

Weight Perc. Score

71.3 ± 24.5

72.1 ± 27.5

69.6 ± 25.8

86.1 ± 13.7

Height (cm)

137.0 ± 7.2

136.0 ± 7.7

136.8 ± 8.3

134.4 ± 4.6

Height Z-score

0.7 ± 0.94

0.7 ± 1.2

0.9 ± 1.3

0.7 ± 0.7

Height Perc. Score

68.9 ± 25.8

68.0 ± 29.9

66.4 ± 25.9

71.4 ± 20.0

BMI (kg/m2)

18.0 ± 3.1

17.7 ± 2.3

19.0 ± 5.4

19.1 ± 2.6

BMI Z-score

0.7 ± 1.1

0.8 ± 1.1

0.8 ± 1.8

1.4 ± 1.0

BMI Perc. Score

65.2 ± 26.7

69.0 ± 27.9

50.2 ± 30.1*

84.7 ± 15.6*

Waist circ. (cm)

64.8 ± 6.2

64.3 ± 6.6

63.6 ± 10.6

64.8 ± 6.3

WHtR

0.47 ± 0.1

0.47 ± 0.1

0.46 ± 0.1

0.48 ± 0.1

* - p < 0.05

The calculated average Z-scores and Percentile scores of weight, height and BMI in Bulgarian girls and boys were within the norm, according to the international standards of the World Health Organisation (WHO, 2007). The average Z-scores and Percentile scores of weight and BMI in English boys, as well as the Z-scores of weight in English girls, were shown to be slightly above the norm for their gender and age. The other scores for English children were within the WHO norms. The average waist-to-height ratio (WHtR) in all groups was below the global cut-off value of 0.5 (health risk of obesity).

The individual results revealed that 17 children had a BMI Z-score greater than +1SD (overweight) and 16 had a BMI Z-score greater than +2SD (obese) according to the WHO norms. These children included individuals from each group, and none of the four groups was shown to have a significantly higher level of overweight or obese pupils, because the number of cases was insufficient in order to be able to draw this conclusion. The WHtR of 27 children (20 of whom were assessed as overweight or obese according to their BMI Z-score) was above the global cut-off point where obesity is deemed to pose a health risk. Only four individuals had a BMI Z-score less than -1SD (1st grade thinness), and there were no cases of very low BMI Z-score (2nd grade thinness < -2SD and 3rd grade thinness < -3SD).

The results of the modified PAQ-C test of the Bulgarian and English children are presented in Table 2. Significant differences between the groups were recorded in four out of the eight questions which comprise the modified PAQ-C. Bulgarian boys and girls showed significantly higher levels of physical activity during physical education classes (Q2), and lower physical activity during break-time, lunch-time and after-school activities (Q3, Q4 and Q5) in comparison with English children.

Table 2. Descriptive characteristics of the modified PAQ-C of all the 81 participants who met the verification criteria (Mean ± SD)

 

Bulgarian Females
(n=27)

Bulgarian
Males
(n=31)

English Females (n=8)

English Males (n=15)

Q1. Spare-time activity: sports

2.0 ± 0.6

2.1 ± 0.2

1.9 ± 0.7

2.2 ± 0.5

Q2. Activity during PE classes

4.8 ± 0.5 c, D

5.0 ± 0.0 C, D

4.0 ± 0.8

4.1 ± 0.9

Q3. Break-time activity

2.2 ± 0.7 C, D

2.8 ± 0.9 C, D

4.3 ± 1.0

4.7 ± 0.6

Q4. Lunch-time activity

2.6 ± 0.7 C, D

2.7 ± 0.9 C, D

4.3 ± 1.0

4.3 ± 1.2

Q5. After-school activity

1.0 ± 0.0 C, D

1.0 ± 0.0 C, D

3.1 ± 1.4

3.0 ± 1.4

Q6. Evening activity

3.1 ± 0.7

3.3 ± 0.7

2.6 ± 1.3

2.6 ± 1.1

Q7. Weekend-activity

2.9 ± 0.6

3.1 ± 0.6

3.1 ± 1.4

3.4 ± 0.9

Q8. Activity frequency

2.6 ± 0.8

3.2 ± 0.9

2.1 ± 1.0

3.0 ± 1.4

Total PAQ-C activity

2.66 ± 0.26 c', D

2.90 ± 0.28 d

3.17 ± 0.67

3.41 ± 0.62

p < 0.001 vs. Bulgarian Females (A); vs. Bulgarian Males (B); vs. English Females (C); vs. English Males (D)

p < 0.01 vs. English Females (c); vs. English Males (d)

p < 0.05 vs. English Females (c')

The average total PAQ-C score for all four groups was shown to be within the range of medium physical activity for children (PAQ-C score > 2.50 and < 3.50). Statistically significant differences in the total PAQ-C scores were observed between the Bulgarian and English girls (2.66 ± 0.26 vs. 3.17 ± 0.67, respectively, p < 0.05), the Bulgarian and English boys (2.90 ± 0.28 vs. 3.41 ± 0.62, respectively, p < 0.01), and between the Bulgarian girls and the English boys (2.66 ± 0.26 vs. 3.41 ± 0.62, respectively, p < 0.001). In addition, eta-squared (η2) measure of effect size employed in ANOVA was also calculated and shown to be 0.319, which indicated large effects, according to the benchmarks provided by Cohen (Cohen, 1988).

There was no significant difference between children with a BMI Z-score greater than +1SD (overweight and obese, n=33) and children with a BMI Z-score within the norm in terms of the total PAQ-C score.

 

DISCUSSION

The average total PAQ-C scores for English boys and girls were above the cut-off level (2.9 and 2.7, respectively), which categorises them into either “sufficiently active” or “low-active”, according to normative PAQ scores for English children and adolescents (Voss et al., 2013). Further research need to be carried out in order to obtain normative PAQ scores for Bulgarian children and adolescents.

Bulgarian children showed significantly lower scores in Q3, Q4 and Q5 (break-time, lunch-time and after-school activities) in comparison with English children. These differences probably occurred due to the variety of before-school and after-school activities added to the English curriculum.

In this study, we recorded 17 overweight (BMI Z-score > +1SD) and 16 obese children (BMI Z-score > +2SD), which made a total of 33 pupils (41% of all participants) at risk as far as health is concerned. The waist-to-height ratio (WHtR) assessment showed that 27 out of 81 children (33% of all participants) were at risk according to the global cut-off value of 0.5 (Ashwell and Hsieh, 2005). The findings of our study are in accordance with other authors who observed overweight/obesity frequency in children to range from 30% to 45% (Guinhouya et al., 2009, Sanchez-Vaznaugh et al., 2015). WHtR provided a good alternative assessment to the BMI, which was also found in other studies (McCarthy and Ashwell, 2006, Brown et al., 2017) Moreover, WHtR is seen to be an effective and simple screening index of body composition during growth, both because it predicts cardiovascular disease risk factors better than BMI (Savva et al., 2000, Hara et al., 2002, Kahn et al., 2005), and because it is only loosely correlated to age, so there is no need for age- and gender-specific values in its assessment (Taylor et al., 2011).

The overweight and obese children (BMI Z-score > +1SD, n=33) and those within the norm (BMI Z-score < +1SD and > -1SD) had almost identical physical activity levels, as assessed by the total PAQ-C score (2.98 ± 0.48 and 2.92 ± 0.50, respectively), which was also observed in obese and normal weight girls (Rourke et al., 2003). Similar findings of the total PAQ-C score were recorded in a study of 83 obese children, who were divided into groups of high health risk and low health risk (3.00 ± 0.66 and 3.01 ± 0.65, respectively) (Ball et al., 2003).

In addition, we compared the physical activity levels of children at risk due to obesity according to the WHtR classification (n=27) and those within the norms (WHtR < 0.5, n=54). In the same way, there was no significant difference in the total PAQ-C score between children experiencing a health risk owing to obesity and the rest (2.83 ± 0.37 vs 2.99 ± 0.52, respectively).

Physical inactivity has been defined by the WHO as one of the leading risk factors in terms of global mortality (6% of deaths worldwide), along with blood pressure (13%), tobacco use (9%), high blood glucose (6%), and overweight and obesity (5%) (WHO, 2009). Children and young people should be physically active on a daily basis, with play, games, sports, transportation, recreation, physical education, or planned exercises being part of their everyday activities (WHO, 2010), and we believe it to be of particular importance to improve the methods for assessing PA and to implement them as part of regular monitoring in schools.

 

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Presentation and full-length article: Physical activity assessment using a modified PAQ-C questionnaire

Presenting Author: Stefan Kolimechkov

Date & time: Saturday, 2nd December 2017

Parallel Session 'Health and Fitness', National Sports Academy,
Hall A5, 9:00 am, Sofia (Bulgaria)

PDF Presentation - Physical activity assessment using a modified PAQ-C questionnaire
Physical activity assessment using a modified PAQ-C questionnaire
Read our full-length ARTICLE published in the Proceeding Book of the Congress.

To download the modified PAQ-C questionnaire applied in this study, please click here. A Bulgarian language version of the test is also available.

 

This study is also available on ResearchGate

Research Gate

 

Authors

Stefan Kolimechkov

Lubomir Petrov, PhD

Albena Alexandrova, PhD

Contact information with the corresponding author: kolimechkov@gmail.com

 

How to cite this study?

A full-length article was published in the Proceeding Book of this Congress, so you can cite it as follows:

Kolimechkov, S., Petrov, L. & Alexandrova, A. (2017). Physical activity assessment using a modified PAQ-C questionnaire. In T. Iancheva (Ed.), Proceeding Book of the International Scientific Congress 'Applied Sports Sciences' (pp. 346-350). Sofia, Bulgaria: NSA Press

 

 

1st International Congress of Applied Sports Sciences, Sofia 2017