Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women

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Abstract

Objectives

Increased physical activity in pregnancy may reduce the risk of gestational diabetes and pre-eclampsia, which occur more commonly in overweight and obese women. There is limited assessment of physical activity questionnaires in pregnancy. This study compares self-reported physical activity using two questionnaire methods with objectively recorded physical activity using accelerometry in overweight and obese pregnant women.

Study design

59 women with booking BMI  25 kg/m2 completed the Recent Physical Activity Questionnaire (RPAQ) and Australian Women's Activity Survey (AWAS) or recorded at least 3 days of accelerometry at median 12 weeks’ gestation. Accelerometer thresholds of 100 counts/min and 1952 counts/min were used to define light and moderate or vigorous physical activity (MVPA) respectively.

Results

48% of women were in their first pregnancy and 41% were obese. Median daily self-reported MVPA was significantly higher for both AWAS (127 min, p < 0.001) and RPAQ (81 min, p < 0.001) than that recorded by accelerometer (35 min). There was low or moderate correlation between questionnaire and accelerometer estimates of total active time (AWAS ρ = 0.36, p = 0.008; RPAQ ρ = 0.53, p < 0.001) but no significant correlation between estimates of time spent in MVPA.

Conclusions

These self-report questionnaires over-estimated MVPA and showed poor ability to discriminate women on the basis of MVPA. Accelerometry measurement was feasible and acceptable. Objective methods should be used where possible in studies measuring physical activity in pregnancy. Questionnaires remain valuable to define types of activity.

Introduction

There is growing interest in the potential influence of physical activity (PA) on pregnancy outcome. In non-pregnant adults, PA has beneficial effects on glucose metabolism [1]. Evidence relating to pregnancy outcomes is mixed: some studies report that higher levels of PA may reduce the risks of gestational diabetes and pre-eclampsia [2], [3], [4], but others have found no beneficial effect [5].

Most studies assessing the effect of PA on pregnancy outcome have assessed PA by self report, often assessing only recreational or leisure time activity [6], [7]. Such measures rarely allow accurate assessment of light intensity activity and sedentary time, or of PA-related energy expenditure (PAEE), and may therefore be prone to misclassification. Some questionnaires have been specifically designed to overcome these limitations and to identify the duration of activity at different intensity, including sedentary time [8], [9].

The development of activity monitors such as accelerometers has facilitated objective measurement of the duration and intensity of body movement. Accelerometers demonstrate a high degree of reproducibility and validity for quantifying duration and intensity of PA, and correlate with energy expenditure in a variety of populations and settings [10].

There are specific challenges to measuring PA in pregnancy. It is a time of significant physiological change, and PA tends to decline as pregnancy progresses [11], [12]. The shape of the pregnant abdomen can alter the placement and tilt of any measurement devices, so affecting recording. Discomfort caused by the elastic belt and forgetting to re-attach the belt will also lead to inaccurate, incomplete data [13]. A significant proportion of PA in women with young children is derived from domestic chores and childcare, which are rarely explicitly measured by questionnaire [14]. Few PA measurement tools have been developed or evaluated for use in pregnancy. Chasan-Taber et al. developed a questionnaire specifically for use in pregnancy, but found only low to moderate correlation with accelerometry-derived estimates [15]. A small number of studies have used accelerometers in pregnancy [13], [16], [17]. In a study of 57 healthy primiparous women, Rousham et al. found that the correlation between self-reported (via seven day recall interview), and accelerometer-derived estimates of PA declined as pregnancy progressed [16], as did compliance with wearing the device. Harrison et al. compared accelerometry, pedometry and the International Physical Activity Questionnaire (IPAQ), in the second trimester of pregnancy [13]. They found that accelerometer and IPAQ estimates of PA did not correlate and there was poor absolute agreement.

Obese and overweight pregnant women are at higher risk of developing gestational diabetes and pre-eclampsia, and may particularly benefit from remaining physically active during pregnancy. The aim of this study was to assess the reproducibility, absolute and relative agreement of two self-completion questionnaires with objective measurement by accelerometry for the first time in overweight and obese pregnant women.

Section snippets

Study population

Pregnant women aged 16 or more, with a first trimester body mass index (BMI)  25 kg/m2 (based on measured weight and self-reported height), with normal first trimester ultrasound scan and singleton pregnancy were eligible for inclusion. Recruitment took place between October 2007 and January 2008 at the Royal Victoria Infirmary, a tertiary centre in Newcastle upon Tyne, UK, which had approximately 5000 deliveries per year during the recruitment period. Women were excluded if they were unable to

Study population (Table 1)

A total of 59 women had either valid accelerometry or questionnaire data, or both. Fifty-five women recorded at least three days of accelerometry at the first data collection point, 57 completed RPAQ questionnaires before and after accelerometry measurement and 56 completed AWAS questionnaires. Four women completed both questionnaires, but had no accelerometry data (one due to technical failure) and three completed at least three days of accelerometry but did not complete both questionnaires.

Comments

This study compared the measurement of PA using self-completion questionnaires with objective measurement of accelerometry in overweight and obese pregnant women. We found that both questionnaires, but particularly AWAS, over-estimated time spent in MVPA compared with accelerometry. There was no correlation between accelerometry or either questionnaire in measuring MVPA, and substantial disagreement in classification of those achieving at least 30 min of MVPA. There was low to moderate

Conclusions

The AWAS and RPAQ questionnaires show limited validity compared with accelerometry in pregnant women. Both questionnaires over-estimated MVPA activity and showed poor ability to discriminate duration of MVPA between women at individual or group level. Accelerometry measurement was feasible and acceptable. Objective methods should be used where possible in studies investigating PA and pregnancy outcome, unless and until questionnaires with demonstrably better validity have been developed.

Competing interests

None.

Authors’ contributions

All authors contributed to the design of the study, interpretation of the results, and critical revision of the manuscript. RB conceived the study and drafted the manuscript. CM recruited participants and collected the data. PWGT performed the statistical analysis.

Acknowledgements

We thank the study participants, and Brianna Fjeldsoe, Alison Marshall and Yvette Miller for use of the AWAS questionnaire. We thank Herve Besson for processing the RPAQ data to produce summary variables. Newcastle upon Tyne Hospitals NHS Foundation Trust acted as sponsors of the study and provided the salary for the research midwife but took no part in the collection, analysis and interpretation of data and in the writing of the manuscript.

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