|Year : 2014 | Volume
| Issue : 2 | Page : 77-82
Validation of short international physical activity questionnaire Punjabi version in India
Shweta Shenoy, Jasmine Kaur Chawla, Jaspal Singh Sandhu
Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar, Punjab, India
|Date of Web Publication||9-Oct-2014|
Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar - 143 005, Punjab
Source of Support: Results are a part of major research project entitled”
Nutrition and Bone health in Punjab- A community study” Funded
by Department of Science and technology, Ministry of Science and
technology, New Delhi-110026. DST REF no: / WD? 012/ 2010/ GNDU, Conflict of Interest: None
Aim: The purpose of this study was to translate the short form international physical activity questionnaire (IPAQ-SF) to the Punjabi language and evaluate the validity of Punjabi version of IPAQ-SF in India. Settings and Design: This was cross-sectional study conducted in Amritsar. Subjects and Methods: The English IPAQ-SF was translated into the Punjabi language, synthesized, back translated, and subsequently subjected to an expert committee for review and pretesting. The final product (Punjabi IPAQ-SF) was tested for concurrent and construct validity in a sample population of 100 apparently healthy adults.
Statistical Analysis: Spearman coefficient correlation was applied using SPSS 17. Results: The Spearman coefficient ranged from (ρ = 0.994) to (ρ = 1.00), indicating good concurrent validity of Punjabi version of IPAQ-SF. High significant positive correlation was found for time spent (metabolic equivalent of task-min/week) in vigorous (ρ =1.00, P < 0.001), moderate (ρ = 0.995, P < 0.001), and walking (ρ = 0.999, P < 0.001) activities between Punjabi IPAQ-SF and original IPAQ-SF. Poor construct validity was observed with cardiorespiratory fitness and body mass index (BMI). Total time spent in sitting (min/week) of Punjabi IPAQ-SF was significantly correlated to BMI was observed (ρ = 0.285, P < 0.001). Conclusion: The Punjabi IPAQ-SF indicated good concurrent validity among all the variables. The Punjabi IPAQ-SF can be used for physical activity assessment in India.
التحقق من صحة استبانة قصيرة حول النشاط البدني النسخة البنجابية الدولية.
هدف الدراسة: كان الهدف من هذه الدراسة ترجمة الاستبانة الدولية القصيرة حول النشاط البدني (IPAQ-SF) إلى اللغة البنجابية و تقييم صلاحيتها في الهند.
الإعدادات و التقييم : كانت هذه الدراسة من نوع الدراسات المستعرضة ، و أجريت في ( أمريستار).
منهج الدراسة: ترجمت النسخة الإنجليزية من الاستبانة إلى اللغة البنجابية ، و أعيدت ترجمتها ، و عرضت على لجنة من الخبراء لمراجعتها و اختبارها ثم اختيار النسخة النهائية ( البنجابية) ووزعت على 100 من السكان الأصحاء البالغين .
التحليل الإحصائي: استعمل برنامج (Spearman) من خلال برنامج (SPSS 17)
النتائج: تراوحت نتائج معامل سبيرمان من P=0.994 إلى ح=1.00 مما يدل على صحة النسخة البنجابية من(IPAQ-SF) كما وجدت علاقة إيجابية عالية للوقت الذي يقضيه أي ما يعادل0.995 >P= و المشيp 0.001)، P=0.999 بين النسخة البنجابية و الأصل.
ولوحظ ارتباط بناء اللياقة الفلبية التنفسية مع مؤشر كتلة الجسم (BMI) و ارتباط إجمالي الوقت الذي يقضيه في الجلوس ( دقيقة/ أسبوع ) مع مؤشر كتلة الجسم(P0.001 ، P=0.285 )
الاستنتاج: أشارت النسخة البجابية إلى صحة التزامن بين جميع المتغيرات وأنه يمكن استخدامها لتقييم النشاط البدني في الهند.
Keywords: Physical activity, Punjabi language, short form international physical activity questionnaire, validity
|How to cite this article:|
Shenoy S, Chawla JK, Sandhu JS. Validation of short international physical activity questionnaire Punjabi version in India
. Saudi J Sports Med 2014;14:77-82
|How to cite this URL:|
Shenoy S, Chawla JK, Sandhu JS. Validation of short international physical activity questionnaire Punjabi version in India
. Saudi J Sports Med [serial online] 2014 [cited 2023 Dec 8];14:77-82. Available from: https://www.sjosm.org/text.asp?2014/14/2/77/142349
| Introduction|| |
In recent years, the importance of physical activity (PA) in the prevention and management of cardiovascular disease has acquired greater prominence.  Accurate assessment of PA is important in determining the risk for cardiovascular disease, stroke, type 2 diabetes, cancer, and obesity in developing countries. , Several routine instruments are available to measure PA, including self-report questionnaires, indirect calorimetry, direct observation, heart rate telemetry, and movement sensors.  All of these methods have well-known limitations,  and for PA there is currently no perfect gold-standard criterion. , Movement sensors such as accelerometers have grown in popularity recently as a measure of PA,  but due to their high costs, accelerometers are not usually practical in large-scale cohort studies and instead questionnaires are frequently used to obtain PA data. , The international physical activity questionnaire (IPAQ) was developed as an instrument for cross-national assessment of PA and for standardizing measures of the health-related PA behaviors of the population in many countries and in different sociocultural contexts. , The IPAQ has since become the most widely used PA questionnaire,  with two versions available. Both the long (31-item) and the short (7-item) versions of this instrument, elicits information on PA over the "last 7-day" period, have been used to compare PA behaviors among and between populations. ,,, The short form records the activity of four intensity levels: (1) Vigorous-intensity activity such as aerobics, (2) moderate-intensity activity such as leisure cycling, (3) walking, and (4) sitting.  The short form of IPAQ (IPAQ-SF) has been recommended for population prevalence studies, where time is limited, because it is easier and more feasible to complete than the long form.  The IPAQ has been translated into many languages and extensively tested in many countries around the world, ,,,,, except in India. Culturally adapting the IPAQ, rather than developing a new PA questionnaire, is economical and it may facilitate future comparisons among populations. In order to make the IPAQ applicable for research among nonEnglish speaking populations in  India, it needs to be translated and properly evaluated. In India, Punjabi is the 10 th most widely spoken language, spoken by 3% of Indians.  It is the official language of Indian states of Punjab, Haryana, and Himachal Pradesh. It is also the 3 rd most natively spoken language in the Indian sub-continent. Punjabi spoken by 130 million native speakers worldwide, making it the 10 th most widely spoken language in the world.  Therefore, the purpose of this study was to translate and culturally adapt the English IPAQ-SF, and to evaluate the aspects of validity of Punjabi - translated version of the IPAQ-SF.
| Subjects and methods|| |
Amritsar is one of the largest cities of Punjab state in India. This city has an estimated population of 132,761. The inhabitants of Amritsar use Punjabi as the local language. 
The international physical activity questionnaire
The questionnaire collects information on the time (i.e., number of days and average time per day) spent being physically active and measures vigorous-intensity activity, moderate-intensity activity, walking activity, and sitting in the last seven consecutive day period. These activity categories may be treated separately to obtain the specific activity patterns or multiplied by their estimated value in metabolic equivalent of tasks (METs) and summed to gain an overall estimate of PA in a week http://www.ipaq.ki.se.  One MET represents the energy expended while sitting quietly at rest and is equivalent to 3.5 ml/kg/min of VO 2 max.  The MET intensity values used to score IPAQ questions in this study were vigorous (8 METs), moderate (4 METs) and walking (3.3 METs) http://www.ipaq.ki.se. The IPAQ sitting question is an indicator of the time spent in sedentary activity and was not included as part of the summary score of total PA. Data were cleaned to ensure that the daily time spent on each of vigorous, moderate, and walking activities ranged between 10 and 180 min for all participants http://www.ipaq.ki.se. The outcomes measures used in this study were (1) minutes reported in vigorous, moderate, walking, and sedentary activities per week (min/week) and (2) MET minutes per week. Time spent in each activity category was derived by multiplying the number of days per week with the minutes spent doing the activity per day, while total weekly PA (MET-min/week) was calculated by multiplying the number of minutes spent in each activity category with the specific MET score for each activity. 
To establish content validity, the translation of the IPAQ-SF was performed in several steps following the guidelines prescribed by the IPAQ core group http://www.ipaq.ki.se.  The English version of IPAQ-SF was translated into the Punjabi language by two independent translators, both native speakers of Punjabi who speak, read and write Punjabi as well as speak, read and write English. One of the translators was a Punjabi language expert based in the Linguistic Department of the University of Amritsar, and the second translator was a physiotherapist clinician at a teaching hospital who was knowledgeable about the concept of cardiorespiratory fitness examined in IPAQ. The two translations, one each from the translators, were synthesized into a single Punjabi version by a panel of experts consisting of the translators, two physiotherapists who specialize in exercise physiology and sports physiotherapy, the principal investigator, and a university student who was raised in Punjabi language and culture. Following back translations of the synthesized Punjabi version by two university lecturers from the Punjabi ethnic group in Amritsar, each of them with over 5 years of professional experience in health sciences, the panel of experts compared the two back translations with the original English version to ensure that the concept measured by IPAQ had not been lost during the translations.  The synthesized translation and the two back translations were then merged into one prefinal version of the Punjabi IPAQ-SF (Punjabi IPAQ-SF). The expert panel then compared the original English IPAQ and the prefinal Punjabi version for conceptual equivalence (conceptual meaning to terms and concept in the Punjabi population), experiential equivalence (cultural relevance of the tasks and examples used in the questionnaire), linguistic equivalence (meaning and grammatical correctness), and metric equivalence (ensuring that the substituting cultural items and examples of activity are equivalent in intensity with the original items and examples). The compendium of PA (available at http://prevention.sph.sc.edu) was used by the expert panel to ensure that the substitute culturally acceptable examples and items were equivalent in MET to the original examples and items in the English version. The prefinal version of the Punjabi IPAQ-SF was self-administered to 15 Punjabi-speaking and writing volunteers from a broad range of backgrounds. After the completion of the survey, each of the volunteers was separately interviewed by the principal investigator for their understanding of the words in the questionnaire, the clarity of each item, and their opinion and suggestions for improvement. They were also asked to indicate if any question made them feel uncomfortable and if any relevant items were not included in the questionnaire. Items that were difficult to understand as expressed by two or more volunteers were referred to the expert panel for consideration and the panel's recommendations were incorporated in all such cases. 
Evaluation of psychometric properties
The final version of the Punjabi IPAQ-SF was evaluated for validity in a nonprobability sample of 100 apparently healthy individuals, age 20-60 years. In this cross-sectional study, participants were recruited directly from various workplaces (e.g. university, teaching hospital, private establishments) and neighborhoods in Amritsar city. The study protocol was approved by Clinical Research Ethics Committee of Faculty of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar. Informed consent form was taken from all participants. Demographic characteristics, including educational level and employment status of the participants were obtained on their 1 st day of contact for the study.  Height and weight were measured using standardized equipment. Body mass index (BMI) was calculated as body weight divided by the square of height (kg/m 2 ). Participants were eligible for this study if they were willing to complete surveys in both English and Punjabi languages and were not having any disability that prevented independent walking. One of the researchers was in attendance to provide translation and interpretation. Assistance to participants (n = 6) who were unable to independently complete the survey. 
Concurrent validity of the Punjabi IPAQ-SF was assessed by comparing the durations (METS-min/week) of PA (vigorous, moderate, walking, and sitting) from the Punjabi IPAQ-SF with that obtained from the original English version of IPAQ-SF. A simple random technique (flip of the coin) was used to determine the order of administration of the two questionnaires.  Participants whose coin returned with heads completed the Punjabi IPAQ-SF first, while those with tails completed the original English version first. An interval of 1 h was allowed between administrations of the two questionnaires. Craig et al.,  in a 12-country international study on validity and reliability of IPAQ, directly compared different versions of IPAQ and described the process as concurrent or inter method validation. For construct validity, the participants' rate pressure product (RPP) was compared with duration (METS-min/week) of PA (vigorous, moderate, walking, and sitting) from the Punjabi IPAQ-SF. RPP is an index of cardiorespiratory fitness and was derived by multiplying participants' resting systolic blood pressure and heart rate.  The systolic blood pressure was a measure with sphygmomanometer Lifecare™ (N and B Medical Products. Co, Delhi, India.) and heart rate were measured with Polar S410™ heart rate monitors (CEO537, Finland). Three measurements were taken at intervals of 3-5 min, and the mean systolic blood pressure and heart rate were used for computing the RPP used in the analysis. A correlation between duration in PA and RPP would suggest that the Punjabi IPAQ-SF was sensitive to construct of PA such as cardiorespiratory fitness. Other important construct validity measures, such as VO 2 max, motion sensors e.g. Accelerometers, diaries and indicators of lipid and glucose metabolism, ,, were not used in this study due to cost and ease of utility. 
Descriptive data were reported as mean, standard deviation, and percentages. Mean group differences in PA (METS-min/week) by gender were examined by independent t-test. To assess the validity, the nonparametric spearman correlation coefficients (ρ) were calculated to assess the relationship between METS-min/week of PA from the Punjabi IPAQ-SF and RPP and BMI for construct validity, and with METS-min/week in PA from the English version of IPAQ for concurrent validity.  To prevent type 2-error due to the small sample size in the socioeconomic status-based analyses, education was respectively grouped into 5 (illiterate, primary, secondary, graduate, and postgraduate) and employment status was grouped into 2 (employed or not employed (homemaker, student, retired, or unable to work).  All the analyses were performed with SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered to be statistically significant.
| Results|| |
The personal characteristics of the subjects are:  Mean age (35.57 ± 10.84 years), mean BMI (27.67 ± 2.705 kg/m 2 ), heart rate (78.42 ± 5.182 beat/min),
and systolic blood pressure (127.17 ± 7.383 mmHG) [Table 1]. The majority of the participants were men (n = 65; 65%) while 76% (n = 76) and 45% (n = 45) were employed and had secondary education respectively. 48% (n = 48) of the participants were found to overweight [Table 2]. The men reported higher mean MET expenditure value (METS-min/week) in vigorous (3881.85 vs. 2315.43, P = 0.064), walking (1507.26 vs. 1211.10, P = 0.181) and total PA (METS-min/week) (7332.18 vs. 7124.24, P = 0.845). However, higher mean time (min/week) was reported by women in sitting (1016 vs. 996.15, P = 0.793) and total physical activities (1900.57 vs. 1636.15, P = 0.170) than men. Furthermore, moderate energy expenditure (METS-min/week) was also reported significantly  higher in women (3597.71 vs. 1943.08) than men [Table 3].
|Table 1: Sociodemographic and personal characteristics of the participants (n=100)|
Click here to view
|Table 3: Descriptive characteristics and independent sample t test of the participants|
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Spearman coefficient ranged from (ρ = 0.994) to (ρ = 1.00), indicating good concurrent validity of Punjabi version of IPAQ-SF.  Total PA (MET-min/week) was significantly and highly correlated with total PA (MET-min/week) from original English version IPAQ-SF (ρ = 0.998, P < 0.001). High significant positive correlation was found for time spent (MET-min/week) in vigorous
(ρ =1.00, P < 0.001), moderate (ρ =0.995, P < 0.001) and walking (ρ =0.999, P < 0.001) activities between Punjabi IPAQ-SF and original IPAQ-SF.  Total time spent in PA (min/week) and sitting (min/week) were also found to be highly correlated to original IPAQ-SF  with
(ρ = 1.00, P < 0.001) and (ρ = 1.00, P < 0.001), respectively [Table 4].
Body mass index was only significantly correlated to sitting (min/week)  from the Punjabi IPAQ-SF (ρ = 0.285, P < 0.001). Rate of pressure product and BMI showed no significant relationship with time (METS-min/week) spent in vigorous, moderate, walking, and total PA (METS-min/week) from English IPAQ-SF [Table 5].
| Discussion|| |
This study was performed with an objective to translate, culturally adapt and validate the Punjabi version of IPAQ-SF in Amritsar, Punjab, India. The results indicated that Punjabi version IPAQ-SF had high acceptance properties for assessing physical activities in healthy adults. We found a highest concurrent validity of the Punjabi IPAQ-SF (ρ = 0.004 − 1.00) in comparison to Hausa version of IPAQ-SF
(ρ = 0.83 − 0.92)  and a study that directly compared the long and short versions of IPAQ in one language in 12 countries , (ρ = 0.51 − 0.64). The concurrent validity found in the present study was better when compared to Hausa language because unlike Hausa,  there was no misunderstanding reported in reading and understanding the questions, which lead to better concurrent validity. The questionnaire seemed to be well-defined. However, Consistent with the However, consistent with previous studies where comparisons of IPAQ data were made with accelerometer monitors, ,, we found higher correlation value for the Punjabi IPAQ-SF with vigorous-intensity (ρ = 1.00) activity than with moderate activity (ρ = 0.995) and walking (ρ = 0.99). This finding therefore affirms an earlier report that shows the IPAQ-SF to be more sensitive to intense PA than moderate and low intensity activities. , In the absence of objective criterion standards for evaluating an absolute estimate of PA, the consistency of items on IPAQ with variables known to be related to PA such as BMI, blood pressure, heart rate, indicators of lipid and glucose metabolism, and fitness index have been used as important validation characteristics, ,, referred to as indirect or construct validity. ,, Poor construct validity of the Punjabi IPAQ-SF in this study is indicated by no significant relation between RPP as an index of cardiorespiratory fitness index and modes of PA. The poor relationship between cardiorespiratory fitness and modes of PA is consistent with previous research where significant association was observed only between sitting and RPP but inconsistent with other previous reported studies that reported weak, but significant correlations between indices of cardiorespiratory fitness and time spent in vigorous-intensity activity, ,,, moderate-intensity activity  and total PA. ,,, Perhaps, the results are attributed to disparate measures of cardiorespiratory fitness utilized.  Researches suggest that, RPP as the index of cardiorespiratory fitness incorporated resting heart rate and blood pressure unlike others that utilized submaximal heart rate derived from response to work load as the index of cardiorespiratory fitness. ,, It has been documented that heart rate response to submaximal workload estimates cardiorespiratory fitness or VO 2 max better than resting heart rate. 
Nonreproducibility of the Punjabi IPAQ-SF to assess the reliability of Punjabi IPAQ-SF and cross cultural adaptation nonutilization of a PA diary or any objective measure as a criterion standard to evaluate the validity of the Hausa IPAQ-SF are limitations of the present study. Even with utilization of convenience sampling technique utilized, recruitment of participants from diverse work places allowed hetrogenicity in the age and education level, which depicts general applicability of the questionnaire to the population.  The study demonstrated good validity of Punjabi IPAQ-SF questionnaire.
| Conclusion|| |
The results of the current study indicated that Punjabi IPAQ-SF has good concurrent validity. It has been well-translated and understood by the sample population. Vigorous PA (METS-min/week), total time spent in PA and sitting (min/week) had perfect concurrent validity. The cardiorespiratory fitness (RPP) and BMI did not correlate with levels of PA. Further, assessment is required to evaluate cross cultural adaptation and test retest reliability measures of this questionnaire in a large sample population.
| Acknowledgments|| |
The authors would like to thank the translators for their patience, efforts and keen interest in translation of Punjabi questionnaire and also, would like to thank the participants for their cooperation in completion of this study.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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