There is no standardized method for the assessment of physical activity (PA). Therefore it is important to investigate the validity and comparability of different measures. The International Physical ...Activity Questionnaire (IPAQ) has been developed as an instrument for cross-national assessment of PA and has been validated in 12 countries. These instruments have acceptable measurement properties for monitoring population levels of PA among 18-65 year-old adults in diverse settings. However, there are some concerns that IPAQ may over-report PA.The purpose of this study is to evaluate the reliability and validity of IPAQ, short version, last 7-days in the Nord-Trøndelag Health Study (HUNT) population of men.
The questionnaire was administered twice to a random sample of 108 men aged 20-39 and validity by comparing results with VO2max and ActiReg, an instrument that measures PA and energy expenditure (EE). ActiReg discriminates between the body positions: stand, sit, bend forward and lie and also registers if there is motion or not in each of them or both.
Our results for reliability of the IPAQ short version were good for vigorous and fair for moderate activities. Intraclass correlations ranged from a low of 0.30 for moderate activity hours, to a high of 0.80 for sitting hours. Concerning validity, our results suggest that total IPAQ vigorous PA was a moderately good measure of vigorous activity, having moderately strong, significant correlations with VO2max, r = 0.41 (p < or = 0.01), but correlated not with metabolic equivalent (METs) values of 6 or more measured with ActiReg. Only total IPAQ walking was fair correlated with METs 1-3 and METs 3-6, respectively r = -0.27 and 0.26 (p < or = 0.05). The index for IPAQ sitting hours per week was moderate correlated with METs values of 1-3 and negatively correlated with METs values of 3-6. Classification of PA in three levels (low, moderate and high) correlated also most strongly with VO2max (0.31 p < or = 0.01) and METs 3-6 and METs 1-3 from ActiReg (r = 0.32 and -0.31, p < or = 0.01). Classification of BMI in three levels (normal, overweight and obese) correlated most strongly negative with VO2max (-0.42 p < or = 0.01) and MJ from ActiReg (r = 0.31 p < or = 0.01).
Our results indicate that IPAQ short version for men has acceptable reliability and criterion validity for vigorous activity and sitting. Walking has moderate reliability. Only the IPAQ for walking had a fair correlation with METs 6+. The questions about moderate activity had fair reproducibility and correlated poorly with most comparison measures.
Lifestyle risk behaviours are responsible for a large proportion of disease burden and premature mortality worldwide. Risk behaviours tend to cluster in populations. We developed a new lifestyle risk ...index by including emerging risk factors (sleep, sitting time, and social participation) and examine unique risk combinations and their associations with all-cause and cardio-metabolic mortality.
Data are from a large population-based cohort study in a Norway, the Nord-Trøndelag Health Study (HUNT), with an average follow-up time of 14.1 years. Baseline data from 1995-97 were linked to the Norwegian Causes of Death Registry. The analytic sample comprised 36 911 adults aged 20-69 years. Cox regression models were first fitted for seven risk factors (poor diet, excessive alcohol consumption, current smoking, physical inactivity, excessive sitting, too much/too little sleep, and poor social participation) separately and then adjusted for socio-demographic covariates. Based on these results, a lifestyle risk index was developed. Finally, we explored common combinations of the risk factors in relation to all-cause and cardio-metabolic mortality outcomes.
All single risk factors, except for diet, were significantly associated with both mortality outcomes, and were therefore selected to form a lifestyle risk index. Risk of mortality increased as the index score increased. The hazard ratio for all-cause mortality increased from 1.37 (1.15-1.62) to 6.15 (3.56-10.63) as the number of index risk factors increased from one to six respectively. Among the most common risk factor combinations the association with mortality was particularly strong when smoking and/or social participation were included.
This study adds to previous research on multiple risk behaviours by incorporating emerging risk factors. Findings regarding social participation and prolonged sitting suggest new components of healthy lifestyles and potential new directions for population health interventions.
Pooling data from thigh-worn accelerometers across multiple studies has great potential to advance evidence on the health benefits of physical activity. This requires harmonization of information on ...body postures, physical activity types, volumes and time patterns across different brands of devices. The aim of this study is to compare the physical behavior estimates provided by three different brands of thigh-worn accelerometers.
Twenty participants volunteered for a 7-day free-living measurement. Three accelerometers - ActiGraph GT3X+, Axivity AX3 and ActivPAL Micro4 - were randomly placed in a vertical line on the midsection of the right thigh. Raw data from each accelerometer was processed and classified into 8 physical activities and postures using the Acti4 software. Absolute differences between estimates and the respective coefficient of variation (CV) were calculated.
We observed very minor differences between physical behavior estimates from three different accelerometer brands. When averaged over 24 h (1,440 min), the absolute difference (CV) between accelerometers were: 1.2 mins (0.001) for lying/sitting, 3.4 mins (0.02) for standing, 3.5 mins (0.06) for moving, 1.9 mins (0.03) for walking, 0.1 mins (0.19) for running, 1.2 mins (0.19) for stair climbing, 1.9 mins (0.07) for cycling. Moreover, there was an average absolute difference of 282 steps (0.03) per 24 h.
Physical behaviors were classified with negligible difference between the accelerometer brands. These results support harmonization of data from different thigh-worn accelerometers across multiple cohorts when analyzed in an identical manner.
To create and find accurate and reliable instruments for the measurement of physical activity has been a challenge in epidemiological studies. We investigated the reliability and validity of two ...different physical activity questionnaires in 71 adolescents aged 13-18 years; the WHO, Health Behaviour in Schoolchildren (HBSC) questionnaire, and the International Physical Activity Questionnaire (IPAQ, short version).
The questionnaires were administered twice (8-12 days apart) to measure reliability. Validity was assessed by comparing answers from the questionnaires with a cardiorespiratory fitness test (VO2peak) and seven days activity monitoring with the ActiReg, an instrument measuring physical activity level (PAL) and total energy expenditure (TEE).
Intraclass correlation coefficients for reliability for the WHO HBSC questionnaire were 0.71 for frequency and 0.73 for duration. For the frequency question, there was a significant difference between genders; 0.87 for girls and 0.59 for boys (p < 0.05). The intraclass correlation coefficients the IPAQ varied between 0.10 and 0.62 for the reliability. Spearman correlation coefficients for validity for both the WHO HBSC questionnaire and the IPAQ (recoded into low, moderate and high activity) measured against VO2peak were fair, ranging between 0.29 - 0.39. The WHO HBSC questionnaire measured against VO2peak for girls were acceptable, ranging between 0.30 - 0.55. Both questionnaires, except the walking question in IPAQ, showed a low correlation with PAL and TEE, ranging between 0.01 and 0.29.
These data indicate that the WHO HBSC questionnaire had substantial reliability and were acceptable instrument for measuring cardiorespiratory fitness, especially among girls. None of the questionnaires however seemed to be a valid instrument for measuring physical activity compared to TEE and PAL in adolescents.
Sedentary behavior is thought to pose different risks to those attributable to physical inactivity. However, few studies have examined the association between physical activity and sitting time with ...cancer incidence within the same population.
We followed 38,154 healthy Norwegian adults in the Nord-Trøndelag Health Study (HUNT) for cancer incidence from 1995-97 to 2014. Cox proportional hazards regression was used to estimate risk of site-specific and total cancer incidence by baseline sitting time and physical activity.
During the 16-years follow-up, 4,196 (11%) persons were diagnosed with cancer. We found no evidence that people who had prolonged sitting per day or had low levels of physical activity had an increased risk of total cancer incidence, compared to those who had low sitting time and were physically active. In the multivariate model, sitting ≥8 h/day was associated with 22% (95% CI, 1.05-1.42) higher risk of prostate cancer compared to sitting <8 h/day. Further, men with low physical activity (≤8.3 MET-h/week) had 31% (95% CI, 1.00-1.70) increased risk of colorectal cancer (CRC) and 45% (95% CI, 1.01-2.09) increased risk of lung cancer compared to participants with a high physical activity (>16.6 MET-h/week). The joint effects of physical activity and sitting time the indicated that prolonged sitting time increased the risk of CRC independent of physical activity in men.
Our findings suggest that prolonged sitting and low physical activity are positively associated with colorectal-, prostate- and lung cancer among men. Sitting time and physical activity were not associated with cancer incidence among women. The findings emphasizing the importance of reducing sitting time and increasing physical activity.
Participation in cultural activities may protect against cause-specific mortality; however, there is limited knowledge regarding this association. The present study examines the association between ...participation in a range of receptive and creative cultural activities and risk of cardiovascular disease- and cancer-related mortality. We also examined whether participation in such activities and influence by gender have on this association. We followed 35,902 participants of the Nord-Trøndelag Health Study (HUNT3) of Cardiovascular-Disease and Cancer Mortality from 2006-08 to 2016. Cox proportional-hazards regression was used to estimate the risk of specific mortality based on baseline cultural participation. During the eight-year follow-up, there were 563 cardiovascular-disease- and 752 cancer-related deaths among the sample (292,416 person years). Risk of cardiovascular-disease mortality was higher among non-participants in associations/club meetings (22%) and outdoor activities (23%), respectively, as well as non-attendees of art exhibitions (28%). People who engaged in music, singing, and theatre had a 27% reduced risk of cancer-related mortality when compared to non-participants. Among women, participating in associations/club meetings reduced the risk of cardiovascular-disease mortality by 36%. Men who participated in music, singing, and theatre had a 33% reduced risk of cancer mortality. Overall, a reduced risk of cardiovascular-disease mortality was associated with engaging in creative activities on weekly basis to less than twice per week. For both genders, participating in creative activities less than once a week reduced cardiovascular-disease mortality risk by 40% and 33%, respectively. For the overall sample, participating > 2 times per week in combined receptive and creative activities reduced cancer-related mortality by 29%. Participating frequently in both receptive and creative activities cultural activities was associated with lower risks of CVD and cancer-related mortality. Our data suggest that, to counteract the public health burden of cardiovascular disease- and cancer mortality, policies and initiatives to increase citizens' participation in cultural activities should be considered.
ObjectivesPublic health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents ...and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes.DesignRepeated population-based health surveys to monitor decennial changes.SettingData from three cross-sectional surveys in 1995–1997, 2006–2008 and 2017–2019 in the population-based HUNT Study in Norway were used.ParticipantsThe general population in a Norwegian county covering participants aged 13–79 years, ranging from 48 000 to 62 000 000 in each survey.Main outcome measuresPrevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults.ResultsAdolescents’ and young adults’ mental distress increased sharply, especially between 2006–2008 and 2017–2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups.ConclusionsOur trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people’s living conditions and behaviour, including the increased influence of screen-based media.
Little is known about the effect maintaining physical activity throughout adolescence has on cardiovascular risk factors and health status in early adulthood. This ten-year prospective longitudinal ...study investigated whether differences in physical activity patterns from adolescence to young-adulthood showed different associations with subsequent cardio-metabolic risk factors and mental health in young-adulthood.
Based on the second and third Norwegian Nord-Trøndelag Health Surveys (HUNT2 and 3), we included 1869 individuals (838 males) participating in Young-HUNT (1995-97), aged 13-19 years and followed-up at HUNT3 (2006-08), aged 23-31. Self-reported physical activity (PA), mental health and perceived health were recorded, along with measurements of body mass index (BMI), waist circumference (WC), total cholesterol (TC), HDL cholesterol, glucose, triglycerides, resting heart rate (HR) and blood pressure. We used separate linear regressions models to investigate associations between physical activity and each CVD risk factor, and logistic regression analysis to examine PA patterns and subsequent mental health. Physically active maintainers were compared to inactive maintainers. Adopters (inactive as adolescents and physically active as young adults) were compared to inactive maintainers and to those who discontinued activity (relapsers).
Active maintainers had significantly lower HR, compared to all other PA patterns. Active maintaining men had significantly lower WC than relapsers and inactive maintainers. When adjusted for age and gender, WC, BMI, HR, diastolic blood pressure and HDL-C showed significant differences comparing active maintaining to other PA patterns. Comparing inactive maintainers against adopters, only HR was significantly lower. Male adopters did not differ significantly in CVD risk compared to inactive maintainers and relapsers. Among females adopting was associated with lower HR and TC compared to inactive maintainers. Active maintainers showed better mental health than inactive maintainers. Active maintaining males had an increased likelihood of good mental health compared to adopters. Active maintaining females reported greater satisfaction with life compared to adopters.
Those who maintained their physical activity from adolescence to young adulthood demonstrated a significantly lower CVD risk and better mental health, compared to inactive maintainers. Compared to inactivity maintainers and relapsers, adopting physical activity was not significantly associated with lowered CVD risk. Adopting physical activity between adolescence and young adulthood may not necessarily protect against mental distress.
Background: To validate the physical activity (PA) questionnaire in Nord-Trøndelag Health Study (HUNT 2). Methods: The questionnaire was administered twice to a random sample of 108 men aged 20–39 ...and validity by comparing results with VO2max and ActiReg, measuring PA and energy expenditure and with the International Physical Activity Questionnaire (IPAQ). Results: Spearman correlation coefficients indicated poor and moderate significant agreement by test-retest (light activity, r = 0.17, and hard activity, r = 0.50). We found a moderate significant correlation r = 0.46 (p ≤ 0.01) between hard PA and VO2max and n.s for light activity (r = −03). Metabolic equivalent (METs) values 6+ from ActiReg most strongly correlated with hard PA r = 0.31 (p ≤ 0.01), though associations of other measures obtained from ActiReg with questionnaire measures were weaker. Occupational activity was strongest correlated for METs 3–6 r = 0.48 (p ≤ 0.01) by ActiReg. Conclusions: The HUNT 2 question for "hard" LTPA has acceptable repeatability and appears to be a reasonably valid measure of vigorous activity, as reflected in moderate correlations with several other measures including VO2max, and with corresponding results from IPAQ and ActiReg. The HUNT 2 question on occupational activity had good repeatability and appears to best reflect time spent in moderate activity, with moderate associations with measured time at intermediate intensity levels. The "light" activity question from HUNT 2 had poor reproducibility and did not correlate well with most of the comparison measures. Thus, the "hard" PA and the occupational activity question should be useful measures of vigorous PA, if time and space allow only very brief assessment. The utility of the "light" PA questions remains to be established.
Aims/hypothesis
We examined the association between sitting time and diabetes incidence, overall and by strata of leisure-time physical activity and BMI.
Methods
We followed 28,051 adult participants ...of the Nord-Trøndelag Health Study (the HUNT Study), a population-based study, for diabetes incidence from 1995–1997 to 2006–2008 and estimated HRs of any diabetes by categories of self-reported total daily sitting time at baseline.
Results
Of 28,051 participants, 1253 (4.5%) developed diabetes during 11 years of follow-up. Overall, sitting ≥8 h/day was associated with a 17% (95% CI 2, 34) higher risk of developing diabetes compared with sitting ≤4 h/day, adjusted for age, sex and education. However, the association was attenuated to a non-significant 9% (95% CI −5, 26) increase in risk after adjustment for leisure-time physical activity and BMI. The association between sitting time and diabetes risk differed by leisure-time physical activity (
p
Interaction
= 0.01). Among participants with low leisure-time physical activity (≤2 h light activity per week and no vigorous activity), sitting 5–7 h/day and ≥8 h/day were associated with a 26% (95% CI 2, 57) and 30% (95% CI 5, 61) higher risk of diabetes, respectively, compared with sitting ≤4 h/day. There was no corresponding association among participants with high leisure-time physical activity (≥3 h light activity or >0 h vigorous activity per week). There was no statistical evidence that the association between sitting time and diabetes risk differed by obesity (
p
Interaction
= 0.65).
Conclusions/interpretation
Our findings suggest that total sitting time has little association with diabetes risk in the population as a whole, but prolonged sitting may contribute to an increased diabetes risk among physically inactive people.
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