Vol.:(0123456789)

Sports Medicine (2018) 48:2797–2842 https://doi.org/10.1007/s40279-018-0987-0

SYSTEMATIC REVIEW

An Updated Systematic Review of Childhood Physical Activity Questionnaires

Lisan M. Hidding1  · Mai. J. M. Chinapaw1  · Mireille N. M. van Poppel1,2  · Lidwine B. Mokkink3  · Teatske M. Altenburg1

Published online: 8 October 2018 © The Author(s) 2018

AbstractBackground and Objective This review is an update of a previous review published in 2010, and aims to summarize the avail-able studies on the measurement properties of physical activity questionnaires for young people under the age of 18 years.Methods Systematic literature searches were carried out using the online PubMed, EMBASE, and SPORTDiscus databases up to 2018. Articles had to evaluate at least one of the measurement properties of a questionnaire measuring at least the dura-tion or frequency of children’s physical activity, and be published in the English language. The standardized COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used for the quality assessment of the studies.Results This review yielded 87 articles on 89 different questionnaires. Within the 87 articles, 162 studies were conducted: 103 studies assessed construct validity, 50 assessed test–retest reliability, and nine assessed measurement error. Of these studies, 38% were of poor methodological quality and 49% of fair methodological quality. A questionnaire with acceptable validity was found only for adolescents, i.e., the Greek version of the 3-Day Physical Activity Record. Questionnaires with acceptable test–retest reliability were found in all age categories, i.e., preschoolers, children, and adolescents.Conclusion Unfortunately, no questionnaires were identified with conclusive evidence for both acceptable validity and reli-ability, partly due to the low methodological quality of the studies. This evidence is urgently needed, as current research and practice are using physical activity questionnaires of unknown validity and reliability. Therefore, recommendations for high-quality studies on measurement properties of physical activity questionnaires were formulated in the discussion.PROSPERO Registration Number CRD42016038695.

Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s4027 9-018-0987-0) contains supplementary material, which is available to authorized users.

* Lisan M. Hidding l.hidding@vumc.nl

1 Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

2 Institute of Sport Science, University of Graz, Mozartgasse 14, 8010 Graz, Austria

3 Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

Key Points

No conclusive evidence was found for both the validity and reliability for any of the included physical activity questionnaires for youth.

High-quality studies on the measurement properties of the most promising physical activity questionnaires are urgently needed, e.g., by using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

More attention on the content validity of physical activ-ity questionnaires is needed to confirm that question-naires measure what they intend to measure.

2798 L. M. Hidding et al.

1 Introduction

Numerous studies have demonstrated beneficial effects of physical activity, in particular of moderate to vigorous intensity, on metabolic syndrome, bone strength, physical fitness, and mental health in children and adolescents [1, 2]. In order to monitor trends in physical activity, exam-ine associations between physical activity and health out-comes, and evaluate the effectiveness of physical activity-enhancing interventions, valid, reliable, responsive, and feasible measures of physical activity are needed.

Accelerometers are considered to provide valid and reli-able measures of physical activity in children and adoles-cents [3]. However, accelerometers are not gold standard and underestimate activities such as cycling, swimming, weight lifting, and many household chores. Moreover, physical activity estimates vary depending on subjective decisions in data reduction such as the choice of cut-points for intensity levels, the minimum number of valid days, the minimum number of valid hours per day, and the defini-tion of non-wear time [4]. Furthermore, accelerometers cannot provide information on the type and context of the behavior and are labor-intensive and costly, especially in large populations [5].

Self-report or proxy-report questionnaires are seen as a convenient and affordable way to assess physical activity that can provide information on the context and type of the activity [5, 6]. However, questionnaires have their limita-tions as well, such as the potential for social desirability and recall bias [6, 7]. Thus, for measuring physical activ-ity a combination of the more objective measures such as accelerometers and self-report questionnaires seems most promising.

A great many questionnaires measuring physical activ-ity in children and adolescents have been developed, with varying formats, recall periods, and types of physical activity recalled. To be able to select the most appropriate questionnaire, an overview of the measurement properties of the available physical activity questionnaires in children and adolescents is highly warranted. In 2010, Chinapaw et al. [8] reviewed the measurement properties of self-report and proxy-report measures of physical activity in children and adolescents. As many studies assessing meas-urement properties of physical activity questionnaires have been published since then, an update is timely.

Therefore, we aimed to summarize studies that assessed the measurement properties (e.g., responsiveness, relia-bility, measurement error, and validity) of self-report or proxy-report questionnaires in children and adolescents under the age of 18 years published since May 2009. Fur-thermore, we aimed to provide recommendations regarding

the best available questionnaires, taking into account the best available questionnaires from the previous review.

2 Methods

This review is an update of the previously published review of Chinapaw et al. [8]. We followed the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) report-ing guidelines and registered the review on PROSPERO (international prospective register of systematic reviews; registration number: CRD42016038695).

2.1 Literature Search

Systematic literature searches were carried out in PubMed, EMBASE, and SPORTDiscus (from January 2009 up until April 2018). In PubMed more overlap in time was main-tained (search from May 2008), as our previous searches showed that the PubMed time filter can be inaccurate, e.g., due to incorrect labeling of publication dates. The full search strategy can be found in the Electronic Supplementary Mate-rial (Online Resource 1).

Search terms in PubMed were used in AND-combination, and related to physical activity (e.g., motor activity, exer-cise), children and adolescents (e.g., schoolchildren, ado-lescents), measurement properties (e.g., reliability, repro-ducibility, validity) [9], and self- or proxy-report measures (e.g., child-reported questionnaire). Medical Subject Head-ing (MESH), title and abstract (TIAB), and free-text search terms were used, and a variety of publication types (e.g., biography, comment, case reports, editorial) were excluded. In EMBASE, search terms related to physical activity, meas-urement properties [9], and self- or proxy-report measures were used in AND-combination. The search was limited to children and adolescents (e.g., child, adolescent), and EMBASE-only. EMBASE subject headings, TIAB, and free-text search terms were used. In SPORTDiscus, TIAB and free-text search terms were used in AND-combination, related to physical activity, children and adolescents, and self- or proxy-report measures.

2.2 Inclusion and Exclusion Criteria

Studies were eligible for inclusion when (1) the aim of the study was to evaluate at least one of the measurement properties of a self-report or proxy-report physical activity questionnaire, or a questionnaire containing physical activ-ity items; (2) the questionnaire under study at least reported data on the duration or frequency of physical activity; (3) the mean age of the study population was < 18 years; and (4) the study was available in the English language. Studies were excluded in the following situations: (1) studies assessing

2799An Updated Systematic Review of Childhood Physical Activity Questionnaires

physical activity using self-report measures administered by an interview (one-on-one assessment) or using a diary; (2) studies evaluating the measurement properties in a specific population (e.g., children who are affected by overweight or obesity); (3) studies examining structural validity and/or internal consistency for questionnaires that represent a formative measurement model; (4) construct validity studies examining the relationship between the questionnaire and a non-physical activity measure, e.g., body mass index (BMI) or percentage body fat; and (5) responsiveness studies that did not use a physical activity comparison measure, e.g., accelerometer, to assess a questionnaire’s ability to detect change.

2.3 Selection Procedures

Titles and abstracts were screened for eligible studies by two independent researchers [Lisan Hidding (LH) and either Mai Chinapaw (MC), Mireille van Poppel (MP), Teatske Altenburg (TA), or Lidwine Mokkink (LM)]. Subsequently, full texts were obtained and screened for eligibility by two independent researchers (LH and either TA or MP). A fourth researcher (MC) was consulted in the case of doubt.

2.4 Data Extraction

For all eligible studies, two independent reviewers (LH and either TA or MP) extracted data regarding the characteristics of studies and results of the assessed measurement proper-ties, using a structured form. Extracted data regarding the methods and results of the assessed measurement proper-ties included study population, questionnaire under study, studied measurement properties, comparison measures, time interval, statistical methods used, and results regarding the studied measurement properties. In the case of disagree-ment regarding data extraction, a fourth researcher (MC) was consulted.

2.5 Methodological Quality Assessment

Two independent reviewers (LH and either MC or LM) rated the methodological quality of the included studies using the standardized COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist [10–12]. For each measurement property, the design require-ments were rated using a 4-point scale (i.e., excellent, good, fair, or poor). The lowest score counts method was applied, e.g., the final methodological quality was scored as poor in the case of a poor score on one of the items. The lowest rated items that determined the final score for each study are shown in Electronic Supplementary Material Online Resource 2. The methodological quality of the content valid-ity studies was not assessed as often little or no information

on the development of the questionnaire or on the assess-ment of relevance, comprehensiveness, and comprehen-sibility of items was available. One minor adaption to the original COSMIN checklist, also described in a previous review [13], was applied: Percentage of Agreement (PoA) was removed from the reliability box and added to the meas-urement error box as an excellent statistical method [14]. To assess the methodological quality of test–retest reliability studies, standards previously described by Chinapaw et al. [8] regarding the time interval were applied: between > 1 day and < 3 months for questionnaires recalling a standard week; between > 1 day and < 2 weeks for questionnaires recalling the previous week; and between > 1 day and < 1 week for questionnaires recalling the previous day.

2.6 Questionnaire Quality Assessment

2.6.1 Reliability

Reliability is defined as “the degree to which a measurement instrument is free from measurement error” [15]. Test–retest reliability outcomes were considered acceptable under the following conditions: (1) intraclass correlation coefficients and kappa values ≥ 0.70 [16]; or (2) Pearson, Spearman, or unknown correlations ≥ 0.80 [17]. Measurement error is defined as “the systematic and random error of a score that is not attributed to true changes in the construct” [15]. Meas-urement error outcomes were considered acceptable when the smallest detectable change (SDC) was smaller than the minimal important change (MIC) [16].

The majority of the included studies reported multiple correlations per questionnaire for test–retest reliability, e.g., separate correlations for each questionnaire item. Therefore, an overall evidence rating was applied in order to obtain a final test–retest reliability rating, incorporating all correlations per questionnaire for each study. A positive (+) evidence rating was obtained if ≥ 80% of correlations were acceptable, a mixed (±) evidence rating was obtained when ≥ 50% and < 80% of correlations were acceptable, and a negative (–) evidence rating was obtained when < 50% of correlations were acceptable. For measurement error, no final evidence rating could be applied, as to our knowledge no information on the MIC is available for the included questionnaires. Furthermore, in the case of PoA, higher scores represent less measurement error.

2.6.2 Validity

For validity, three different measurement properties can be distinguished, i.e., content validity, construct validity, and criterion validity [15]. Content validity is defined as “the degree to which the content of a measurement instrument is an adequate reflection of the construct to be measured”

2800 L. M. Hidding et al.

[15]. Construct validity is “the degree to which the scores of a measurement instrument are consistent with (a priori drafted) hypotheses” [15]. Hypotheses can concern inter-nal relationships, i.e., structural validity, or relationships with other instruments. Criterion validity is defined as “the degree to which the scores of an instrument are an adequate reflection of a gold standard” [15].

Content validity could not be assessed, as for most stud-ies a justification of choices, e.g., comprehensibility find-ings based on input from the target population or experts in the field, were missing. A summary of the studies examin-ing content validity has been added in the results section. Since a priori formulated hypotheses for construct validity were often lacking, in line with previous reviews [13, 18] we formulated criteria with regard to the relationships with other instruments; see Table 1 for criteria. The criteria were subdivided by level of evidence, level 1 indicating strong evidence, level 2 indicating moderate evidence, and level 3 indicating weak evidence. Table 1 also includes criteria for criterion validity, e.g., when doubly labeled water was used as a comparison measure for questionnaires aiming to assess physical activity energy expenditure.

Most construct validity studies examined relationships with other instruments, reporting separate correlations for each questionnaire item. As with reliability, an overall evi-dence rating was applied incorporating all available cor-relations for each questionnaire per study (i.e., a positive, mixed, or negative evidence rating was obtained). Since no hypotheses were available for mean differences and limits of agreement, only a description of these results is included in the Results section (Sect. 3).

2.7 Inclusion of Results from the Previous Review

To draw definite conclusions regarding the best available questionnaires, the most promising questionnaires based on the previous review [8], i.e., published before May 2009, were also taken into account. As the previous review combined the methodological quality assessment and the questionnaire quality (i.e., results regarding measurement properties) in one rating, we reassessed the methodologi-cal and questionnaire quality of these previously published studies. We included only the studies that received a posi-tive rating in the previous review for each measurement property. However, in the previous review, no final rating for measurement error was applied; therefore, all measure-ment error studies were reassessed and included in the cur-rent review. In addition, for construct validity, no final rat-ing was applied in the previous review, as the majority of studies did not formulate a priori hypotheses. We chose to reassess the two studies showing the highest correlations between the questionnaire and an accelerometer, for each age category. The studies below this ‘top 2’ showed such

low correlations that they would receive a negative evi-dence rating using our criteria. Furthermore, we assessed three other studies that formulated a priori hypotheses, as these studies may score higher regarding methodological quality. The reassessed studies are included in Tables 2, 3, 4 in the Results section.

2.8 Best Evidence

We chose to divide the included studies in three age cat-egories, i.e., preschoolers, children, and adolescents, and draw conclusions on the best available questionnaire(s) for each age category. A questionnaire was considered of interest when at least a fair methodological quality and a positive evidence rating were achieved. Additionally, for construct validity, the level of evidence (see Table 1) was taken into account, so questionnaires with a higher level of evidence comparison measure were considered more valuable. Because no evidence ratings were available for measurement error, these measurement properties were not taken into account when drawing conclusions about the best available questionnaire.

3 Results

Systematic literature searches using the PubMed, EMBASE, and SPORTDiscus databases yielded 15,220 articles after removal of duplicates. After title and abstract screening, 110 eligible articles remained. Another 21 articles were found through cross-reference searches. Therefore, 131 full-text articles were screened, which resulted in the inclusion of 71 articles examining 76 (versions of) questionnaires. After additionally including 16 articles from the previous review, this resulted in 87 articles examining 89 (versions) of questionnaires. See Fig. 1 for the full selection process. Within the 87 articles, 162 studies were conducted, with 103 assessing construct validity, 50 test–retest reliability, and nine measurement error. Four of the included question-naires were assessed by two of the included studies, i.e., the 3-Day Physical Activity Recall (3DPARecall) [19, 20], the Activity Questionnaire for Adults and Adolescents (AQuAA) [21, 22], the Oxford Physical Activity Question-naire (OPAQ) [23, 24], and a physical activity, sedentary behavior, and strength questionnaire [25, 26]. Furthermore, two of the questionnaires were assessed by three of the included studies, i.e., the Physical Activity Questionnaire for Older Children (PAQ-C) [27–29], and the Previous Day Physical Activity Recall (PDPAR) [30–32]. In addition, vari-ous modified versions of questionnaires were assessed by the included studies.

2801An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 1

Con

struc

ts o

f phy

sica

l act

ivity

mea

sure

d by

the

ques

tionn

aire

s eva

luat

ing

cons

truct

and

/or c

riter

ion

valid

ity, s

ubdi

vide

d by

leve

l of e

vide

nce,

and

crit

eria

for a

ccep

tabl

e co

rrel

atio

ns

PAEE

phy

sica

l act

ivity

ene

rgy

expe

nditu

re, V

O2m

ax m

axim

al o

xyge

n up

take

a Pref

erab

ly a

ctiv

ity c

ount

s (i.e

., lig

ht, m

oder

ate,

and

vig

orou

s); h

owev

er, a

s sed

enta

ry c

ount

s hav

e a

min

imal

con

tribu

tion,

tota

l cou

nts a

re a

lso

acce

ptab

leb If

use

d as

a c

ompa

rison

for c

yclin

g

Con

struc

ts o

f phy

sica

l act

ivity

mea

sure

dLe

vel 1

Leve

l 2Le

vel 3

Phys

ical

act

ivity

, all

cons

truct

s (i.e

., at

leas

t in

clud

ing

activ

e tra

nspo

rt, sp

orts

, phy

si-

cal e

duca

tion,

recr

eatio

nal a

ctiv

ities

, and

ch

ores

)

Dire

ct o

bser

vatio

n ≥ 0.

70A

ccel

erom

eter

tota

l or a

ctiv

ity c

ount

s ≥ 0.

60a

PAEE

mea

sure

d by

dou

bly

labe

led

wat

er ≥

0.60

Acc

eler

omet

er v

igor

ous c

ount

s, m

oder

-at

e co

unts

, or m

oder

ate

and

vigo

rous

co

unts

≥ 0.

40Pe

dom

eter

cou

nts ≥

0.40

Que

stion

naire

, dia

ry, o

r int

ervi

ew; c

orre

spon

d-in

g co

nstru

cts ≥

0.70

VO

2max

≥ 0.

40

Phys

ical

act

ivity

, not

all

cons

truct

s or t

ime-

fram

es (e

.g.,

excl

udin

g tim

e sp

ent a

t sch

ool

or c

hore

s)

Dire

ct o

bser

vatio

n ≥ 0.

70A

ccel

erom

eter

tota

l or a

ctiv

ity c

ount

s; c

or-

resp

ondi

ng ti

mef

ram

e ≥ 0.

60

Acc

eler

omet

er to

tal o

r act

ivity

cou

nts;

tota

l da

ytim

e ≥ 0.

40A

ccel

erom

eter

mod

erat

e an

d vi

goro

us

coun

ts ≥

0.50

Que

stion

naire

, dia

ry, o

r int

ervi

ew; c

orre

spon

d-in

g co

nstru

cts ≥

0.70

VO

2max

≥ 0.

40

Phys

ical

act

ivity

, sin

gle

cons

truct

s (e.

g., o

nly

unstr

uctu

red

free

pla

y, c

yclin

g, ti

me

spen

t ou

tdoo

rs)

Acc

eler

omet

er to

tal o

r act

ivity

cou

nts ≥

0.40

Acc

eler

omet

er m

oder

ate

and

vigo

rous

co

unts

≥ 0.

50Pe

dom

eter

cou

nts ≥

0.40

Que

stion

naire

, dia

ry, o

r int

ervi

ew; c

orre

spon

d-in

g co

nstru

cts ≥

0.70

VO

2max

≥ 0.

40C

ycle

com

pute

r ≥ 0.

70b

Phys

ical

act

ivity

ene

rgy

expe

nditu

rePA

EE m

easu

red

by d

oubl

y la

bele

d w

ater

≥ 0.

70A

ccel

erom

eter

tota

l or a

ctiv

ity c

ount

s ≥ 0.

50Pe

dom

eter

cou

nts ≥

0.40

Que

stion

naire

, dia

ry, o

r int

ervi

ew; c

orre

spon

d-in

g co

nstru

cts ≥

0.70

VO

2max

≥ 0.

40V

igor

ous a

ctiv

ityA

ccel

erom

eter

vig

orou

s cou

nts ≥

0.60

Acc

eler

omet

er to

tal o

r act

ivity

cou

nts ≥

0.40

Pedo

met

er c

ount

s ≥ 0.

40Q

uesti

onna

ire, d

iary

, or i

nter

view

; cor

resp

ond-

ing

cons

truct

s ≥ 0.

70V

O2m

ax ≥

0.60

Mod

erat

e an

d vi

goro

us a

ctiv

ityA

ccel

erom

eter

mod

erat

e an

d vi

goro

us

coun

ts ≥

0.60

Acc

eler

omet

er to

tal o

r act

ivity

cou

nts ≥

0.40

Pedo

met

er c

ount

s ≥ 0.

40Q

uesti

onna

ire, d

iary

, or i

nter

view

; cor

resp

ond-

ing

cons

truct

s ≥ 0.

70V

O2m

ax ≥

0.60

Mod

erat

e ac

tivity

Acc

eler

omet

er m

oder

ate

coun

ts ≥

0.60

Acc

eler

omet

er to

tal o

r act

ivity

cou

nts ≥

0.40

Pedo

met

er c

ount

s ≥ 0.

40Q

uesti

onna

ire, d

iary

, or i

nter

view

; cor

resp

ond-

ing

cons

truct

s ≥ 0.

70V

O2m

ax ≥

0.50

Wal

king

Pedo

met

er, a

ccel

erom

eter

wal

king

co

unts

≥ 0.

70A

ccel

erom

eter

tota

l or a

ctiv

ity c

ount

s ≥ 0.

40Q

uesti

onna

ire, d

iary

, or i

nter

view

; cor

resp

ond-

ing

cons

truct

s ≥ 0.

70

2802 L. M. Hidding et al.

Tabl

e 2

Con

struc

t val

idity

of p

hysi

cal a

ctiv

ity q

uesti

onna

ires f

or y

outh

sorte

d by

age

cat

egor

y, m

etho

dolo

gica

l qua

lity,

and

leve

l of e

vide

nce

and

evid

ence

ratin

g

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

Pres

choo

lers

(mea

n ag

e < 6 

year

s) P

resc

hool

-age

Chi

ldre

n’s

Phys

ical

Act

ivity

Que

stion

-na

ire (P

re-P

AQ

) (pr

oxy)

[58]

n = 67

Age

: 3–5

 yea

rsSe

x: 4

8% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

Leve

l 3 P

re-P

AQ

vs.

LPA

(S

irard

): M

D −

4.8,

LoA

[−

105.

4; 9

6.0]

, r −

0.07

Leve

l 4 P

re-P

AQ

vs.

MPA

(S

irard

): M

D 4

8.2,

LoA

[−

24.9

; 121

.3],

r 0.1

3Le

vel 5

Pre

-PA

Q v

s. V

PA

(Sira

rd):

MD

1.9

, LoA

[−

37.5

; 41.

3], r

0.1

7Le

vel 4

-5 P

re-P

AQ

vs.

MV

PA

(Sira

rd):

MD

50.

1, L

oA

[− 42

.9; 1

43.1

], r 0

.17

Leve

l 3–5

Pre

-PA

Q v

s. no

n-se

dent

ary

(Rei

lly):

MD

20.

9,

LoA

[− 12

1.9;

163

.7],

r 0.1

6Le

vel 3

–5 P

re-P

AQ

vs.

LMV

PA

(Sira

rd):

MD

45.

2, L

oA

[− 10

3.6;

194

.1],

r 0.0

5

Goo

dLe

vel 1

: –

 Mod

ified

Bur

dette

pro

xy

repo

rt (p

roxy

) [59

]n =

107

Age

: 3.4

± 1.

2 ye

ars

Sex:

per

cent

age

girls

unk

now

n

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: L

PA 3

8–41

9 co

unts

/15 

s.; M

VPA

≥ 42

0 co

unts

/15 

s)

PA: v

s. to

tal P

A m

in/d

ay, P

CC

0.

30; v

s. M

VPA

min

/day

, PC

C

0.34

Fair

Leve

l 1: –

 Mod

ified

Har

ro p

roxy

repo

rt (p

roxy

) [59

]n =

131

Age

: 3.8

± 1.

3 ye

ars

Sex:

per

cent

age

girls

unk

now

n

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: L

PA

38–4

19 c

ount

s/15

 s;

MV

PA ≥

420 

coun

ts/1

5 s)

MV

PA: v

s. M

VPA

min

/day

, PC

C 0

.10;

vs.

tota

l PA

min

/da

y, P

CC

0.0

9

Fair

Leve

l 1: –

 Phy

sica

l act

ivity

que

stion

naire

fo

r par

ents

of p

resc

hool

ers i

n M

exic

o [4

0]

n = 35

Age

: 4.4

± 0.

7 ye

ars [

3–5]

Sex:

51%

girl

s

Acc

. (A

ctig

raph

)(a

ge-s

peci

fic c

ut-p

oint

s use

d)M

PA v

s.  %

of t

ime

in M

PA:

Sira

rd S

CC

− 0.

23, P

ate

SCC

−

0.07

VPA

vs.

 % o

f tim

e in

VPA

: Si

rard

SC

C 0

.53,

Pat

e SC

C

0.41

MV

PA v

s.  %

of t

ime

in M

VPA

: Si

rard

SC

C 0

.49,

Pat

e SC

C

0.34

Poor

Leve

l 1: –

 Chi

ldre

n’s P

hysi

cal A

ctiv

-ity

Que

stion

naire

(CPA

Q)

(pro

xy) [

60] f

n = 27

Age

: 4.9

± 0.

7 ye

ars [

4, 5

]Se

x: 3

8% g

irls

DLW

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: M

VPA

≥ 30

00

or ≥

1952

 cpm

)

MV

PA: v

s. ac

c. c

ut-p

oint

30

00 c

pm S

CC

0.4

2, M

D

(SD

) 235

.9 (3

62.0

); vs

. acc

. cu

t-poi

nt 1

952 

cpm

MD

(SD

) −

76.5

(361

.6)  

     

     

     

    

      

     

     

     

     

     

     

     

 PA

EE v

s. D

LW: S

CC

0.2

2, M

D

(SD

) − 14

.4 (5

2.4)

Poor

(all

com

paris

on m

easu

res)

Leve

l 1: –

2803An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Phy

sica

l act

ivity

and

sede

ntar

y be

havi

or p

roxy

que

stion

naire

(b

ased

on

Can

adia

n H

ealth

M

easu

res S

urve

y [C

HM

S])

(pro

xy) [

61]

n = 87

Age

: 4–7

0 m

onth

sSe

x: 5

4% g

irls

Acc

. (A

ctic

al)

(cut

-poi

nts:

LPA

10

0–11

49 c

pm;

MV

PA ≥

1150

 cpm

; tot

al

PA ≥

100

cpm

)

Tota

l PA

vs.

tota

l PA

min

/day

: M

Dg 1

31 m

in/d

ay, L

oA [–

80;

290]

h , SRO

C 0

.39

(95%

CI

0.19

-0.5

6)O

utdo

or u

nstru

ctur

ed fr

ee p

lay

asid

e fro

m sc

hool

day

care

se

tting

vs.

tota

l PA

min

/da

y: S

ROC

0.3

0 (9

5% C

I 0.

09–0

.49)

Uns

truct

ured

pla

y in

scho

ol/

dayc

are

setti

ng v

s. to

tal P

A

min

/day

: SRO

C 0

.42

(95%

CI

0.23

–0.5

8)St

ruct

ured

PA

vs.

tota

l PA

min

/da

y: S

ROC

0.2

6 (9

5% C

I 0.

05–0

.46)

Poor

Leve

l 1: –

Leve

l 2: –

Chi

ldre

n (m

ean

age ≥

6 to

< 12

 yea

rs)

 Out

-of-

scho

ol P

hysi

cal A

ctiv

-ity

que

stion

naire

[62]

n = 12

6A

ge: 1

1 ye

ars

Sex:

60%

girl

s (in

tota

l sam

ple

n = 15

5)

Acc

. (A

ctig

raph

)(c

ut-p

oint

: MV

PA ≥

2296

 cpm

)M

VPA

dur

atio

n vs

. MV

PA

min

/day

: SC

C 0

.25,

MD

g −

6.3 

min

MV

PA fr

eque

ncy

vs. M

VPA

m

in/d

ay: S

CC

0.2

5

Fair

Leve

l 1: –

2804 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Chi

ldre

n’s L

eisu

re A

ctiv

ities

St

udy

Surv

ey C

hine

se-v

er-

sion

que

stion

naire

(CLA

SS-

C) [

50]

n = 13

9A

ge: [

9–12

 yea

rs]

Sex:

65%

girl

s

Acc

. (A

ctig

raph

)(a

ge-s

peci

fic c

ut-p

oint

s use

d)M

PA v

s. M

PA m

in/w

eek:

bo

ys w

eekd

ays S

ROC

0.2

1,

wee

kend

s SRO

C 0

.32,

1 w

eek

SRO

C 0

.33,

girl

s wee

kday

s SR

OC

0.1

9, w

eeke

nds S

ROC

0.

22, 1

 wee

k SR

OC

0.2

9, to

tal

sam

ple

MD

− 18

.9 m

in, L

oA

[–89

.3; 5

1.5]

VPA

vs.

VPA

min

/wee

k:

boys

wee

kday

s SRO

C 0

.35,

w

eeke

nds S

ROC

0.3

3, 1

 wee

k SR

OC

0.2

9, g

irls w

eekd

ays

SRO

C 0

.48,

wee

kend

s SRO

C

0.19

, 1 w

eek

SRO

C 0

.43,

tota

l sa

mpl

e M

D 1

2.6 

min

, LoA

[–

34.8

; 60.

0]B

land

–Altm

an p

lot d

epic

ts a

po

sitiv

e m

agni

tude

bia

si

MV

PA v

s. M

VPA

min

/wee

k:

boys

wee

kday

s SRO

C 0

.21,

w

eeke

nds S

ROC

0.1

3, 1

 wee

k SR

OC

0.2

7, g

irls w

eekd

ays

SRO

C 0

.44,

wee

kend

s SRO

C

0.19

, 1 w

eek

SRO

C 0

.48,

tota

l sa

mpl

e M

D −

6.2 

min

, LoA

[–

101.

5; 8

9.1]

Bla

nd–A

ltman

plo

t dep

icts

a

smal

l pos

itive

mag

nitu

de b

iasj

Fair

Leve

l 1: –

 Phy

sica

l Act

ivity

Que

stion

-na

ire fo

r Old

er C

hild

ren

(PA

Q-C

) [27

] f

n = fr

om 7

3 (C

altra

c) to

97

(act

ivity

ratin

g an

d G

odin

1)

Age

: 11.

3 ± 1.

4 ye

ars [

9–14

]Se

x: 5

8% g

irls

Acc

. (C

altra

c)(n

o cu

t-poi

nts u

sed)

7-da

y PA

reca

ll by

inte

rvie

w

(PA

R)

Act

ivity

ratin

gG

odin

1 a

nd 2

(lei

sure

tim

e ex

erci

se q

uesti

onna

ires)

CH

FT

PAQ

-C: v

s. ac

cum

ulat

ed c

ount

s r 0

.39;

vs.

PAR

r 0.

46; v

s. PA

R h

r 0.

43; v

s. ac

tivity

ra

ting

r 0.5

7; v

s. G

odin

 1 r

0.41

; vs.

God

in 2

r −

0.57

; vs.

CH

FT r

0.28

3 of

6 h

ypot

hese

s cor

rect

Fair

(all

com

paris

on m

easu

res)

Leve

l 1: –

2805An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Pre

viou

s Day

Phy

sica

l Act

iv-

ity R

ecal

l (PD

PAR

) [30

]n =

37A

ge: 1

0.8 ±

0.1 

year

s (in

tota

l sa

mpl

e n =

38)

Sex:

51%

girl

s

Acc

. (C

SA a

ctiv

ity m

onito

r)(c

ut-p

oint

not

repo

rted)

Mea

n M

ETs:

vs.

tota

l cou

nts

SRO

C 0

.39;

vs.

MV

PA m

in

SRO

C 0

.43

PA ≥

3 M

ETs:

vs.

tota

l cou

nts

SRO

C 0

.23;

vs.

MV

PA m

in

SRO

C 0

.19

PA ≥

6 M

ETs:

vs.

tota

l cou

nts

SRO

C 0

.35;

vs.

MV

PA m

in

SRO

C 0

.38

Fair

Leve

l 2: –

Leve

l 1: –

 Phy

sica

l Act

ivity

Que

stion

-na

ire fo

r old

er C

hild

ren

(PA

Q-C

) (Sp

anis

h ve

rsio

n)

[52]

n = 78

Age

: 11.

0 ± 1.

2 ye

ars (

in to

tal

sam

ple

n = 83

)Se

x: 4

5% g

irls (

in to

tal s

ampl

e n =

83)

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: S

B 0

–100

 cpm

; LP

A 1

01–2

295 

cpm

; M

PA 2

296–

4011

 cpm

; V

PA ≥

4012

 cpm

)

Tota

l sco

re v

s. to

tal P

A: S

ROC

0.

28, M

D z

valu

e 0.

10, L

oA z

valu

es [–

1.82

; 2.0

2]k

Act

ivity

che

cklis

t: vs

. tot

al P

A

SRO

C 0

.08,

vs.

MV

PA S

ROC

0.

04PE

vs.

MV

PA: S

ROC

0.0

4Re

cess

: vs.

tota

l PA

SRO

C 0

.14,

vs

. MV

PA S

ROC

0.1

9Lu

nch:

vs.

tota

l PA

SRO

C 0

.07,

vs

. MV

PA S

ROC

0.0

0A

fter s

choo

l: vs

. tot

al P

A S

ROC

0.

15, v

s. M

VPA

SRO

C 0

.15

Afte

rnoo

n: v

s. to

tal P

A S

ROC

0.

29, v

s. M

VPA

SRO

C 0

.28

Wee

kend

: vs.

tota

l PA

SRO

C

0.12

, vs.

MV

PA S

ROC

0.0

8In

tens

ity la

st w

eek:

vs.

tota

l PA

SR

OC

0.2

4, v

s. M

VPA

SRO

C

0.21

Wee

k su

mm

ary:

vs.

tota

l PA

SR

OC

0.3

0, v

s. M

VPA

SRO

C

0.31

Fair

Leve

l 1: –

Leve

l 2: –

 God

in L

eisu

re-T

ime

Exer

cise

Q

uesti

onna

ire [6

3]n =

31A

ge: 1

0.6 ±

0.2 

year

sSe

x: 4

5% g

irls

Acc

. (C

altra

c)(n

o cu

t-poi

nts u

sed)

Ave

rage

tota

l lei

sure

act

ivity

sc

ore:

PC

C 0

.50

(0.8

6 w

hen

two

outli

ers w

ere

rem

oved

)

Fair

Leve

l 2: +

 Mul

timed

ia A

ctiv

ity R

ecal

l for

C

hild

ren

and

Ado

lesc

ents

(M

ARC

A) [

64] f

n = 66

Age

: 11.

6 ± 0.

8 ye

ars

Sex:

50%

girl

s

Acc

. (A

ctig

raph

)(n

o cu

t-poi

nts u

sed)

PAL

vs. c

pm: r

0.4

5M

VPA

vs.

tota

l cou

nts:

r 0.

35M

in. l

ocom

otio

n vs

. tot

al

coun

ts: r

0.3

75

of 5

hyp

othe

ses c

orre

ct

Fair

Leve

l 2: –

2806 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Chi

nese

ver

sion

of t

he P

hysi

-ca

l Act

ivity

Que

stion

naire

fo

r Old

er C

hild

ren

(PA

Q-C

) [4

3]

n = 35

8A

ge: 1

0.5 ±

1.1 

year

s [8–

13] (

in

tota

l sam

ple

n = 74

2)Se

x: 4

6% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: M

PA 2

296–

4011

 cpm

; VPA

≥ 40

12 c

pm)

PAQ

-C: v

s. M

PA m

in/d

ay S

CC

0.24

; vs.

VPA

min

/day

SCC

0.

36; v

s. M

VPA

min

/day

SCC

0.

33

Fair

Leve

l 2: –

 You

th A

ctiv

ity P

rofil

e (Y

AP)

[3

8]n =

291

Age

: 9.7

± 1.

0 ye

ars (

n = 13

5),

11.7

± 0.

8 ye

ars (

n = 67

), 15

.7 ±

1.2 

year

s (n =

89)

Sex:

56%

girl

s

Sens

e W

ear A

rmba

nd (S

WA

)(c

ut-p

oint

not

repo

rted)

Scho

ol a

ctiv

ity v

s. M

VPA

min

/w

eek.

: MD

− 15

.6 ±

6.2 

min

, Lo

A [−

25.8

; − 5.

3], r

0.5

8O

ut-o

f-sc

hool

act

ivity

wee

kday

vs

. MV

PA m

in/w

eek:

MD

3.

4 ± 16

.6 m

in, L

oA [−

24.2

; 31

.0],

r 0.1

9O

ut-o

f-sc

hool

act

ivity

wee

kend

vs

. MV

PA m

in/w

eeke

nd:

MD

− 21

.7 ±

13.2

 min

, LoA

[−

43.7

; 0.3

], r 0

.22

Fair

Leve

l 2: –

 Foo

d, H

ealth

, and

Cho

ices

qu

estio

nnai

re (F

HC

-Q) [

37]

n = 66

Age

: < 9

to >

12 y

ears

Sex:

50%

girl

s

PAQ

-CFr

eque

ncy

of b

oth

med

ium

and

he

avy

activ

ity v

s. PA

Q-C

: PC

C 0

.52

Freq

uenc

y of

med

ium

act

ivity

vs

. PA

Q-C

med

ium

act

ivity

: PC

C 0

.42

Freq

uenc

y of

hea

vy a

ctiv

ity v

s. PA

Q-C

hea

vy a

ctiv

ity: P

CC

0.46

Fair

Leve

l 3: –

 Sel

f-ad

min

ister

ed q

uesti

on-

naire

to a

sses

s phy

sica

l ac

tivity

and

sede

ntar

y be

havi

ors [

65]

n = 86

Age

: 10.

2 ± 1.

1 ye

ars

Sex:

54%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

MV

PA v

s. M

VPA

acc

.: IC

C

0.06

, MD

− 11

7.6 

min

. LoA

[−

864.

3; 6

29.0

]g,l

Poor

Leve

l 1: –

 The

Sou

th A

mer

ican

You

th/

Chi

ld C

ardi

ovas

cula

r and

En

viro

nmen

t Stu

dy (S

AY-

CAR

E) P

hysi

cal A

ctiv

ity

(PA

) que

stion

naire

(pro

xy)

[66]

n = 82

Age

: 3–1

0 ye

ars

Sex:

54%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: L

PA 2

6–57

3 cp

m;

MPA

574

–100

2 cp

m;

VPA

≥ 10

03 c

pm)

MPA

vs.

acc.

MPA

: SCC

0.6

1,

bias

− 13

.6 m

in/d

ay, L

oA

− [–

15.2

; 41.

4]V

PA v

s. ac

c. V

PA: S

CC 0

.27,

bi

as −

35.3

 min

/day

, LoA

[−

36.8

; 56.

1]W

eekl

y to

tal M

VPA

vs.

acc.

tota

l M

VPA

: 0.4

4, b

ias −

22.9

 min

/da

y, Lo

A [−

24.6

; 19.

9] %

of a

gree

men

t with

PA

gui

de-

lines

≥ 60

 min

/day

: κ −

0.40

Poor

Leve

l 1: –

2807An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Can

adia

n H

ealth

Mea

sure

s Su

rvey

(CH

MS)

[67]

n = 87

8A

ge: 8

.7 y

ears

(95%

CI

8.5–

8.9)

 [6–1

1]Se

x: 4

9% g

irls

Acc

. (A

ctic

al)

(cut

-poi

nt: M

VPA

≥ 15

00 c

pm)

MV

PA v

s. M

VPA

min

/day

: PC

C 0

.29

Poor

Leve

l 1: –

Man

y R

iver

s Phy

sica

l Act

iv-

ity R

ecal

l Que

stion

naire

(M

RPA

RQ

) (m

odifi

ed v

ersi

on

of th

e A

PAR

Q) [

68]

n = 86

Age

: 11.

1 ± 0.

7 ye

ars

Sex:

59%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

not

repo

rted)

MV

PA v

s. m

ean

wee

kday

M

VPA

min

/day

: PC

C 0

.37,

IC

C 0

.25

Bla

nd–A

ltman

plo

t dep

icts

a

posi

tive

mag

nitu

de b

iasm

Poor

Leve

l 1: –

 Pat

ient

Ass

essm

ent a

nd C

oun-

cil f

or E

xerc

ise

(PA

CE)

[69]

n = 18

Age

: 11.

9 ± 2.

0 ye

ars

Sex:

59%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

22)

Acc

. (se

nsew

ear S

P3 P

RO)

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

Dia

ry (S

RI a

nd S

RA

)

Act

ive

days

/wee

k: v

s. A

ctig

raph

(≥

60 M

VPA

min

/day

) PC

C

0.27

; vs.

SP3

(≥ 60

MV

PA

min

/day

) PC

C 0

.17;

vs.

SRI

PCC

0.2

5; v

s. SR

A P

CC

0.3

4M

eetin

g gu

idel

ine

(1 h

MV

PA/

day)

: vs.

Act

igra

ph P

oA 5

6%,

sens

28%

, spe

c 10

0%, k

appa

0.

22; v

s. SP

3 Po

A 3

3%, s

ens

20%

, spe

c 10

0%, k

appa

0.0

7

Poor

(all

com

paris

on m

easu

res)

Leve

l 1: –

 Sel

f-Adm

inist

ered

Phy

sica

l A

ctiv

ity C

heck

list (

SAPA

C)

(Gre

ek v

ersi

on) [

49]

n = 90

Age

: 11.

4 ± 0.

6 ye

ars (

boys

), 11

.3 ±

0.6 

year

s (gi

rls)

Sex:

57%

girl

s

Acc

. (RT

3 Re

sear

ch T

rack

er)

(cut

-poi

nts n

ot re

porte

d)To

tal-M

ET v

s. to

tal M

ETs:

K

enda

ll’s t

au-b

r 0.

31, M

D

− 60

0, L

oA [−

1800

; 400

]n

MET

-LPA

vs.

LPA

MET

s: K

en-

dall’

s tau

-b r

0.03

, MD

− 75

0,

LoA

[− 12

50; −

200]

n

Bla

nd–A

ltman

plo

t dep

icts

a

nega

tive

mag

nitu

de b

iaso

MET

-MV

PA v

s. M

VPA

MET

s:

Ken

dall’

s tau

-b r

0.37

, MD

0,

LoA

[− 90

0; 9

00]n

Poor

Leve

l 1: –

 Ass

essm

ent o

f You

ng C

hil-

dren

’s A

ctiv

ity u

sing

Vid

eo

Tech

nolo

gy (A

CTI

VIT

Y)

[70]

f

n = 47

Age

: 7.7

± 0.

5 ye

ars

Sex:

40%

girl

s

Acc

. (C

altra

c)(n

o cu

t-poi

nts u

sed)

HR

mon

itor (

Pola

r)

AC

TIV

ITY

tota

l sco

re: v

s. cp

m

r 0.4

0; v

s. H

R av

erag

e ac

tivity

0.

17, v

s. 50

% H

R re

serv

e 0.

51

Poor

(all

com

paris

on m

easu

res)

Leve

l 1: –

 Syn

chro

nise

d N

utrit

ion

and

Act

ivity

Pro

gram

(SN

AP)

[7

1] f

n = 12

1A

ge: 1

0.7 ±

2.2 

year

s [7–

15]

Sex:

60%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

not

repo

rted)

MV

PA v

s. to

tal M

VPA

min

.: M

D −

9 m

in (9

0% C

I − 23

to

5)

Prop

ortio

n co

mpl

ying

to M

VPA

gu

idel

ine:

MD

0.0

2 (9

0% C

I −

0.08

to 0

.12)

Poor

Leve

l 1:?

2808 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 PA

que

stion

naire

for p

aren

ts

and

teac

hers

[72]

fn =

62A

ge: 7

.0 ±

0.7 

year

s [4–

8]Se

x: 5

2% g

irls

Acc

. (C

altra

c)(n

o cu

t-poi

nts u

sed)

HR

mon

itor (

Pola

r)

MV

PA v

s. to

tal C

altra

c sc

ore:

r 0.

53; v

s. H

R: ≥

140

and ≥

150 

bpm

r 0.

40

Poor

(all

com

paris

on m

easu

res)

Leve

l 2: +

 Phy

sica

l Act

ivity

Que

stion

-na

ire fo

r old

er C

hild

ren

(PA

Q-C

) [51

]

n = 58

Age

: 7–9

 yea

rsSe

x: 4

8% g

irls

Pedo

met

er (O

mro

n)PA

Q-C

scor

e: v

s. av

erag

e ste

ps/

day

SRO

C 0

.49;

vs.

tota

l no.

of

step

s wee

kday

s SRO

C 0

.53

Poor

Leve

l 2: +

 The

Mod

ified

God

in L

eisu

re-

Tim

e Ex

erci

se Q

uesti

onna

ire

[45]

n = 13

9A

ge: 1

1.1 ±

0.4 

year

sSe

x: 5

2% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

God

in-C

hild

Que

stion

naire

tota

l no

. of m

in o

f act

ivity

/wee

k.

vs. a

cc. M

VPA

: r 0

.22

(fall/

autu

mn)

, r 0

.24

(spr

ing)

Poor

Leve

l 2: –

 Par

ent p

roxy

-rep

ort o

f phy

sica

l ac

tivity

and

sede

ntar

y ac

tivi-

ties (

prox

y) [7

3]

n = 16

7 (v

alid

ity v

s. ac

c.),

n = 12

5 (v

alid

ity v

s. di

ary)

Age

: 6–1

0 ye

ars,

13–1

4 ye

ars

Sex:

51%

girl

s (in

tota

l sam

ple

n = 18

9)

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

Tim

e ac

tivity

dia

ry (P

A re

cord

)

vs. a

cc. (

adju

sted

for s

choo

l gr

ade,

age,

sex,

and

mat

erna

l ed

ucat

ion)

:A

ctiv

e be

havi

or sc

ore

vs.

MV

PA m

in/d

ay: S

CC

0.2

1Ti

me s

pent

out

door

s vs.

MV

PA

min

/day

: SCC

0.1

0Pl

ayin

g vi

goro

usly

activ

e ind

oors

vs

. MV

PA m

in/d

ay: S

CC 0

.08

Play

ing

vigo

rous

ly ac

tive

outd

oors

vs.

MV

PA m

in/d

ay:

SCC

0.19

Cycl

ing

vs. M

VPA

min

/day

: SCC

0.

11Ti

me s

pent

bre

athi

ng h

ard

and

swea

ting

vs. M

VPA

min

/day

: SC

C 0.

07A

ttend

ing

spor

ts tra

inin

g (o

utsid

e sc

hool

) vs.

MV

PA m

in/d

ay:

SCC

0.11

vs. d

iary

:Te

nded

to o

vere

stim

ate a

ctiv

ely

play

ing

indo

ors a

nd cy

clin

g,

activ

e play

out

side w

as co

mpa

-ra

ble a

cros

s bot

h m

easu

res

Poor

(all

com

paris

on m

easu

res)

Leve

l 2: –

 Die

t and

life

style

que

stion

naire

[7

4]n =

446

Age

: 9.0

–11.

9 ye

ars (

in to

tal

sam

ple

n = 56

3)Se

x: 5

3% g

irls (

in to

tal s

ampl

e n =

563)

Acc

. (A

ctiG

raph

)(c

ut-p

oint

: MV

PA ≥

3000

 cpm

)N

o./d

ays c

hild

was

ac

tive >

60 m

in: v

s. m

ean

MV

PA m

in/d

ay S

CC

0.0

4;

vs.  

% th

at M

ET M

VPA

gu

idel

ines

SC

C 0

.07

Poor

Leve

l 2: –

2809An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Act

ive

Tran

spor

tatio

n to

sc

hool

and

wor

k in

Nor

way

(A

TN) q

uesti

onna

ire [7

5]

n = 58

Age

: 11.

4 ± 0.

5 ye

ars

Sex:

54%

girl

s

Cyc

le c

ompu

ter

Acc

.(A

ctig

raph

)(n

o cu

t-poi

nts u

sed)

No.

of t

rips w

alki

ng v

s. to

tal

cpm

: SRO

C 0

.12

No.

of t

rips c

yclin

g vs

. cyc

ling

km/w

eek:

SRO

C 0

.60

Poor

(all

com

paris

on m

easu

res)

Leve

l 2: –

Leve

l 3: –

 The

EN

ERG

Y-ch

ild q

uesti

on-

naire

[48]

n = 96

Age

: [11

.4 ±

0.6

to

12.0

± 0.

6 ye

ars]

Sex:

[31–

67%

girl

s]

Cog

nitiv

e in

terv

iew

Wal

king

to sc

hool

(no.

/day

s):

ICC

0.84

, PoA

75%

, (am

ount

of

time)

, ICC

0.5

9, P

oA 7

4%Tr

ansp

ort t

oday

to sc

hool

: ICC

0.

67, P

oA 7

4%A

ctiv

ity d

urin

g br

eaks

: ICC

0.6

5,

PoA

81%

Spor

t (h)

: (fir

st sp

ort)

ICC

0.61

, Po

A 5

0%, (

seco

nd sp

ort)

ICC

1.

00, P

oA 3

6%, (

yeste

rday

) ICC

0.

22, P

oA 5

0%Bi

ke to

scho

ol (n

o./d

ays)

: ICC

0.

81, P

oA 7

3%, (

amou

nt o

f tim

e), I

CC 0

.66,

PoA

75%

Poor

Leve

l 3: –

 A p

hysi

cal a

ctiv

ity q

uesti

on-

naire

[76]

n = 42

54A

ge: 1

1.3 

year

sSe

x: 5

1% g

irls (

in to

tal s

ampl

e n =

4452

)

Repo

rted

PA le

vel o

f the

ado

-le

scen

t by

the

mot

her a

nd th

e ad

oles

cent

PA: v

s. m

othe

rs p

erce

ptio

n ka

ppa

0.13

, PoA

64.

7%; v

s. ad

oles

cent

s per

cept

ion

kapp

a 0.

11, P

oA 6

4.8%

Poor

Leve

l 3: –

2810 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Instr

umen

t to

asse

ss c

hild

ren’

s ou

tdoo

r act

ive

play

in v

ari-

ous l

ocat

ions

(pro

xy) [

77]

n = 46

Age

: 9.2

 yea

rs [7

.9–1

1.7]

Sex:

50%

girl

s

Dia

ry (p

aren

t-rep

ort)

Wee

kday

: yar

d at

hom

e ka

ppa

0.48

, PoA

63.

0% fr

iend

’s/ne

ighb

or’s

yard

kap

pa 0

.40,

Po

A 6

5.2%

, ow

n str

eet/c

ourt/

foot

path

kap

pa 0

.51,

PoA

67

.4%

, nea

rby

stree

ts/co

urt/

foot

path

kap

pa 0

.60,

PoA

80

.4%

, par

k/pl

aygr

ound

kap

pa

0.39

, PoA

73.

9%, f

acili

ties o

r sp

ort o

vals

kapp

a 0.

35, P

oA

67.4

%, s

choo

l gro

unds

for f

ree

play

out

side

scho

ol h

ours

PoA

67

.4%

, oth

er p

lace

s PoA

86.

9%W

eeke

nd d

ay: y

ard

at h

ome k

appa

0.

44, P

oA 7

1.7%

, frie

nd’s/

neig

hbor

’s ya

rd k

appa

0.5

0, P

oA

76.1

%, o

wn

stree

t/cou

rt/fo

ot-

path

kap

pa 0

.43,

PoA

67.

4%,

near

by st

reets

/cou

rt/fo

otpa

th

kapp

a 0.4

4, P

oA 7

8.3%

, par

k/pl

aygr

ound

kap

pa 0

.37,

PoA

71

.7%

, fac

ilitie

s or s

port

oval

s ka

ppa 0

.37,

PoA

71.

7%, s

choo

l gr

ound

s for

free

play

out

side

scho

ol h

ours

PoA

100

.0%

, oth

er

plac

es k

appa

0.2

2, P

oA 7

6.1%

Poor

Leve

l 3: –

 Que

stion

s fro

m th

e N

atio

nal

Long

itudi

nal S

urve

y of

Chi

l-dr

en a

nd Y

outh

[78]

n = 39

40 (o

rgan

ized

spor

ts

ques

tion)

n = 39

58 (l

eisu

re sp

orts

que

s-tio

n)A

ge: 5

th g

rade

rsSe

x: p

erce

ntag

e gi

rls u

nkno

wn

Pare

nt-r

epor

ted

ques

tions

from

th

e N

atio

nal L

ongi

tudi

nal S

ur-

vey

of C

hild

ren

and

Yout

h

Org

aniz

ed sp

orts

: kap

pa 0

.41

(95%

CI 0

.39–

0.44

)Le

isur

e sp

orts

: kap

pa 0

.11

(95%

C

I 0.0

8–0.

14)

Poor

Leve

l 3: –

 Phy

sica

l Act

ivity

Que

stion

-na

ire fo

r Old

er C

hild

ren

(PA

Q-C

) (m

inor

mod

ifica

-tio

ns) [

44]

n = 13

2A

ge: 1

0.3 ±

0.6 

year

s [9–

11]

Sex:

48%

girl

s

Car

diov

ascu

lar fi

tnes

s (½

mile

w

alk

run

test)

PAQ

-C su

mm

ary

scor

e: P

CC

−

0.38

In-s

choo

l fac

tor:

PCC

− 0.

27O

utsi

de-o

f-sc

hool

: PC

C −

0.37

Poor

Leve

l 3: –

Old

er c

hild

ren

and

adol

esce

nts (

mea

n ag

e ≥ 12

 yea

rs)

2811An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 A p

hysi

cal a

ctiv

ity q

uesti

on-

naire

of t

he E

stoni

an C

hil-

dren

Per

sona

lity

Beh

avio

r an

d H

ealth

Stu

dy (E

CPB

HS)

[7

9]

n = 22

4A

ge: 1

2.2 ±

0.8 

year

sSe

x: 0

% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

: MV

PA ≥

2000

 cpm

)Pa

rent

-rep

orte

d ch

ild P

A (s

ame

ques

tionn

aire

)

Chi

ld M

VPA

inde

x: v

s. ac

c.

MV

PA m

in/d

ay r

0.28

(95%

C

I 0.1

6–0.

40);

vs. p

aren

t r

0.54

(95%

CI 0

.44–

0.62

), M

D

0.33

 min

, LoA

[–14

.8; 1

5.4]

Goo

d (a

ll co

mpa

rison

mea

s-ur

es)

Leve

l 1: –

 A p

hysi

cal a

ctiv

ity q

uesti

on-

naire

of t

he E

stoni

an C

hil-

dren

Per

sona

lity

Beh

avio

r an

d H

ealth

Stu

dy (E

CPB

HS)

(p

roxy

) [79

]

n = 22

4A

ge: 1

2.2 ±

0.8 

year

sSe

x: 0

% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

: MV

PA ≥

2000

 cpm

)C

hild

-rep

orte

d ch

ild P

A (s

ame

ques

tionn

aire

)

Pare

nt M

VPA

inde

x: v

s. ac

c.

MV

PA m

in/d

ay r

0.30

(95%

C

I 0.1

8–0.

42);

vs. c

hild

r 0.

54

(95%

CI 0

.44–

0.62

), M

Dp

0.33

 min

, LoA

[–14

.8; 1

5.4]

Goo

d (a

ll co

mpa

rison

mea

s-ur

es)

Leve

l 1: –

 3-D

ay P

hysi

cal A

ctiv

ity

Reco

rd (3

DPA

Reco

rd)

(Gre

ek v

ersi

on) [

33]

n = 33

Age

: 13.

7 ± 0.

8 ye

ars

Sex:

43%

girl

s (ag

e an

d se

x to

tal s

ampl

e n =

40)

Acc

. (M

TI/C

SA)

(no

cut-p

oint

s use

d)3D

PAR

aver

age

scor

es v

s. cp

m:

PCC

0.6

3Fa

irLe

vel 1

: +

Seve

n-D

ay P

hysi

cal A

ctiv

ity

Reca

ll (7

Day

-PA

R) (

Span

ish

vers

ion)

[80]

n = 12

3A

ge: 1

4.9 ±

0.9 

year

s [13

–17]

Sex:

59%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: S

B 0

–100

 cpm

; LP

A 1

01–2

295 

cpm

; M

PA 2

296–

4011

 cpm

; V

PA ≥

4012

 cpm

)A

erob

ic fi

tnes

s (20

 m sh

uttle

ru

n)

LPA

vs.

LPA

acc

.: r −

0.22

MPA

: vs.

MPA

acc

. r 0

.25,

vs.

fitne

ss r

− 0.

17H

ard

PA: v

s. V

PA a

cc. r

0.1

8,

fitne

ss r

0.07

Very

har

d: P

A v

s. V

PA a

cc. r

0.

38, fi

tnes

s r 0

.42

Fair

(all

com

paris

on m

easu

res)

Leve

l 1: –

 You

th P

hysi

cal A

ctiv

ity Q

ues-

tionn

aire

(YPA

Q) [

81]

n = 44

Age

: 12.

7 ye

ars [

12–1

3]Se

x: 6

1% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: M

VPA

≥ 22

95 c

pm)

MV

PA v

s. ac

c. M

VPA

: PC

C

0.47

, SRO

C 0

.39,

MD

25

.7 m

in, L

oA [−

72.7

; 12

4.0]

q

Fair

Leve

l 1: –

 Inte

rnat

iona

l Phy

sica

l Act

ivity

Q

uesti

onna

ire –

Sho

rt Fo

rm

(IPA

Q-S

F) [8

2]

n = 19

1A

ge: 1

4.0 ±

0.7 

year

sSe

x: 0

% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: S

B <

100 

cpm

; LP

A >

100 

cpm

; M

PA >

2000

 cpm

; V

PA >

4000

 cpm

)

MPA

min

/day

vs.

acc.

MPA

m

in/d

ay: P

CC

0.1

1V

PA m

in/d

ay v

s. ac

c. V

PA m

in/

day:

PC

C 0

.24

MV

PA m

in/d

ay v

s. ac

c. M

VPA

m

in/d

ay: P

CC

0.3

1, M

D

13.4

 min

/day

, LoA

[− 54

.2;

80.8

]g,r

Wal

king

min

/day

: vs.

acc.

ste

ps P

CC

0.3

2, v

s. ac

c.

LPA

min

/day

PC

C 0

.07,

MD

−

146.

1 m

in/d

ay

Fair

Leve

l 1: –

2812 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Tar

tu P

hysi

cal A

ctiv

ity Q

ues-

tionn

aire

(TPA

Q) [

82]

n = 19

1A

ge: 1

4.0 ±

0.7 

year

sSe

x: 0

% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: S

B <

100 

cpm

; LP

A >

100 

cpm

; M

PA >

2000

 cpm

; V

PA >

4000

 cpm

)

MV

PA m

in/d

ay v

s. ac

c. M

VPA

m

in/d

ay: P

CC

0.3

5, M

D

− 3.

40 m

in/d

ay, L

oA [–

49.6

; 42

.8]g,

s

Wal

king

/cyc

ling

min

/day

: vs

. acc

. ste

ps P

CC

0.1

9, v

s. M

VPA

PC

C 0

.21,

vs.

LPA

PC

C −

0.02

, MD

− 12

5.1 

min

/da

y

Fair

Leve

l 1: –

 Phy

sica

l Act

ivity

and

Life

style

Q

uesti

onna

ire (P

ALQ

) (G

reek

ver

sion

) [33

]

n = 33

Age

: 13.

7 ± 0.

8 ye

ars

Sex:

43%

girl

s (ag

e an

d se

x to

tal s

ampl

e n =

40)

Acc

. (M

TI/C

SA)

(no

cut-p

oint

s use

d)PA

LQ av

erag

e sc

ores

vs.

cpm

: PC

C 0

.53

Fair

Leve

l 1: –

 Mod

erat

e an

d vi

goro

us

phys

ical

act

ivity

item

s of t

he

Yout

h R

isk

Beh

avio

r Sur

vey

(YR

BS)

[83]

n = 12

5A

ge: 1

2.2 ±

0.6 

year

sSe

x: 5

3% g

irls (

age

and

sex

tota

l sam

ple

n = 13

9)

Acc

. (A

ctig

raph

)(a

ge-s

peci

fic c

ut-p

oint

s use

d [F

reed

son]

)

Mee

ting

MPA

reco

mm

enda

tions

(≥

30 m

in/d

ay fo

r ≥ 5 

days

/w

eek)

vs.

accu

mul

ated

MPA

m

in.: ≥

5 da

ys P

oA 2

0.8%

, < 5

days

PoA

8.8

%, s

ens 0

.23,

sp

ec 0

.92,

kap

pa a

cros

s fou

r ac

c. m

easu

res r

ange

d fro

m

− 0.

05 to

0.0

3M

eetin

g V

PA re

com

men

datio

ns

(≥ 20

 min

/day

for ≥

3 da

ys/

wee

k) v

s. ac

cum

ulat

ed V

PA

min

: ≥ 3 

days

PoA

19.

2, <

3 da

ys P

oA 2

0.0,

sens

0.8

6, sp

ec

0.26

; kap

pa a

cros

s fou

r acc

. m

easu

res r

ange

d fro

m −

0.00

2 to

0.0

6

Fair

Leve

l 1: –

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3

DPA

Reca

ll) in

strum

ent

[20]

n = 70

Age

: 14.

0 ± 0.

9 ye

ars [

13–1

6]Se

x: 1

00%

girl

s

Acc

. (C

SA a

ctiv

ity m

onito

r)(c

ut-p

oint

s not

repo

rted)

Tota

l MET

s/da

y: v

s. 7 

days

co

unts

/day

PC

C 0

.51;

vs.

3 da

ys c

ount

s/da

y PC

C 0

.46

MV

PA b

lock

s/da

y: v

s. 7 

days

M

VPA

min

/day

PC

C 0

.35;

vs.

3 da

ys M

VPA

min

/day

PC

C

0.27

VPA

blo

cks/

day:

vs.

7 da

ys

VPA

min

/day

PC

C 0

.45;

vs.

3 da

ys V

PA m

in/d

ay P

CC

0.

41

Fair

Leve

l 1: –

2813An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Inte

rnat

iona

l Phy

sica

l Act

ivity

Q

uesti

onna

ire -

Shor

t For

m

(IPA

Q -

SF) [

84]

n = 10

21A

ge: 1

4.3 ±

1.6 

year

s [12

–18]

Sex:

47%

girl

s

Acc

. (A

ctiG

raph

)(c

ut-p

oint

s: L

PA 1

01–

2799

 cpm

; MPA

280

0–39

99 c

pm; V

PA ≥

4000

 cpm

)

Tota

l act

iviti

es v

s. cp

m: S

CC

0.

31M

PA a

nd w

alki

ng v

s. M

PA

min

/day

: SC

C 0

.20

VPA

vs.

VPA

min

/day

: SC

C

0.22

MV

PA a

nd w

alki

ng v

s. M

VPA

m

in/d

ay: S

CC

0.2

2

Fair

Leve

l 1: –

 PA

CE

+ qu

estio

nnai

re [8

5]n =

235

Age

: 14.

7 ± 3.

1 ye

ars

Sex:

59%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

not

repo

rted)

PA (d

ays/

wee

k ≥ 60

 min

M

VPA

): vs

. MV

PA m

in/

day ≥

5 va

lid d

ays S

CC

0.3

4;

vs. M

VPA

min

/day

7 v

alid

SC

C 0

.27;

vs.

cpm

≥ 5

valid

da

ys S

CC

0.3

3; v

s. cp

m 7

va

lid S

CC

0.3

0A

gree

men

t mee

ting

PA g

uide

-lin

e, av

erag

e m

etho

d: ≥

5 va

lid

days

PoA

78.

7%, 7

val

id d

ays

PoA

77.

9%A

gree

men

t mee

ting

PA g

uide

-lin

e, a

ll da

y m

etho

d: ≥

5 va

lid

days

PoA

90.

2%, 7

val

id d

ays

PoA

90.

2%

Fair

Leve

l 1: –

2814 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3

DPA

Reca

ll) (m

odifi

ed fo

r A

ustra

lian

yout

h) [8

6]

n = 15

5A

ge: 1

2.3 ±

0.9 

year

sSe

x: 5

0% g

irls

Act

ivity

mon

itor (

CSA

)(c

ut-p

oint

s not

repo

rted)

MPA

: vs.

3 da

ys c

ount

s/da

y SC

C 0

.16;

vs.

6 da

ys c

ount

s/da

y SC

C 0

.15;

vs.

3 da

ys M

PA

min

/day

SC

C 0

.15;

vs.

6 da

ys

MPA

min

/day

SC

C 0

.14;

vs.

3 da

ys M

VPA

min

/day

SC

C

0.14

; vs.

6 da

ys M

VPA

min

/da

y SC

C 0

.12

MET

: vs.

3 da

ys c

ount

s/da

y SC

C 0

.31;

vs.

6 da

ys c

ount

s/da

y SC

C 0

.31;

vs.

3 da

ys M

PA

min

/day

SC

C 0

.28;

vs.

6 da

ys

MPA

min

/day

SC

C 0

.26;

vs.

3 da

ys M

VPA

min

/day

SC

C

0.29

; vs.

6 da

ys M

VPA

min

/da

y SC

C 0

.27

MV

PA: v

s. 3 

days

cou

nts/

day

SCC

0.2

7; v

s. 6 

days

cou

nts/

day

SCC

0.2

6; v

s. 3 

days

MPA

m

in/d

ay S

CC

0.2

4; v

s. 6 

days

M

PA m

in/d

ay S

CC

0.2

4; v

s. 3 

days

MV

PA m

in/d

ay S

CC

0.

23; v

s. 6 

days

MV

PA m

in/

day

SCC

0.2

5V

PA: v

s. 3 

days

VPA

min

/day

m

ales

SC

C 0

.19,

fem

ales

SC

C

0.33

; vs.

6 da

ys V

PA m

in/

day

mal

es S

CC

0.1

6, fe

mal

es

SCC

0.3

0

Fair

Leve

l 1: –

 Sin

gle-

item

act

ivity

mea

sure

[2

3]n =

96 (a

cc. w

ear t

ime 4

80 m

in/

day)

Age

: 14.

7 ± 0.

5 ye

ars

Sex:

38%

girl

s (to

tal s

ampl

e)(A

ge an

d se

x to

tal s

ampl

e n =

123)

n = 72

(acc

. wea

r tim

e 600

 min

/da

y)A

ge: 1

4.7 ±

0.5 

year

sSe

x: 3

8% g

irls

(Age

and

sex

tota

l sam

ple

n = 12

3)

Acc

. (A

ctig

raph

)(c

ut-p

oint

not

repo

rted)

No.

of d

ays b

eing

phy

sica

lly

activ

e ≥ 60

 min

: vs.

time

spen

t in

MV

PA (4

80 m

in/d

ay w

ear

time)

PC

C 0

.46

(95%

CI 0

.24–

0.63

); vs

. tim

e sp

ent i

n M

VPA

(6

00 m

in/d

ay w

ear t

ime)

PC

C

0.44

(95%

CI 0

.24–

0.63

)

Fair

Leve

l 1: –

2815An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Oxf

ord

Phys

ical

Act

ivity

Q

uesti

onna

ire (O

PAQ

) [23

]n =

96 (a

cc. w

ear t

ime 4

80 m

in/

day)

Age

: 14.

7 ± 0.

5 ye

ars

Sex:

38%

girl

s (to

tal s

ampl

e)(A

ge an

d se

x to

tal s

ampl

e n =

123)

n = 72

(acc

. wea

r tim

e 600

 min

/da

y)A

ge: 1

4.7 ±

0.5 

year

sSe

x: 3

8% g

irls

(Age

and

sex

tota

l sam

ple

n = 12

3)

Acc

. (A

ctig

raph

)(c

ut-p

oint

not

repo

rted)

MV

PA: v

s. tim

e sp

ent i

n M

VPA

(4

80 m

in/d

ay w

ear t

ime)

PC

C

0.43

(95%

CI 0

.23–

0.62

); vs

. tim

e sp

ent i

n M

VPA

(6

00 m

in/d

ay w

ear t

ime)

PC

C

0.50

(95%

CI 0

.30–

0.65

)

Fair

Leve

l 1: –

 MV

PA se

lf-re

port

ques

tion-

naire

[87]

n = 20

3 (5

val

id a

cc. d

ays)

Age

: 15.

8 ± 0.

7 ye

ars

Sex:

61%

girl

sn =

103

(7 v

alid

acc

. day

s)A

ge: 1

5.8 ±

0.7

(tota

l sam

ple

n = 20

3)Se

x: 6

7% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

MV

PA: v

s. M

VPA

min

/day

(5

valid

day

s) S

ROC

0.40

(95%

CI

0.28

–0.5

1); v

s. M

VPA

min

/day

(7

val

id d

ays)

SRO

C 0.

49 (9

5%

CI 0

.32–

0.62

); vs

. tot

al cp

m/d

ay

(5 v

alid

day

s) S

ROC

0.42

(95%

CI

0.3

0–0.

5); v

s. to

tal c

pm/d

ay

(7 v

alid

day

s) S

ROC

0.49

(95%

CI

0.3

3–0.

63)

Mee

ting

PA re

com

men

datio

ns

(≥ 60

MV

PA m

in/d

ay):

vs.

aver

age m

etho

d (a

vera

ge o

f 60

MV

PA m

in/v

alid

day

) (5

valid

da

ys) P

oA 7

1.9%

, sen

s 45.

5%,

spec

73.

4%; v

s. av

erag

e met

hod

(7 v

alid

day

s) P

oA 8

8.2%

, se

ns 1

6.7%

, spe

c 92.

7%; v

s. al

l-day

met

hod

(60

MV

PA m

in

on ≥

5 da

ys) (

5 va

lid d

ays)

PoA

71

.9%

, sen

s 0%

, spe

c 72.

3%; v

s. al

l-day

met

hod

(60

MV

PA m

in

on ≥

7 da

ys) (

7 va

lid d

ays)

PoA

69

.6%

, spe

c 69.

6%

Fair

Leve

l 1: –

2816 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Act

ivity

Que

stion

naire

for

Adu

lts a

nd A

dole

scen

ts

(AQ

uAA

) [21

]

n = 42

Age

: 13.

4 ± 1.

0 ye

ars

Sex:

50%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: L

PA 7

00–

4478

 cpm

; MPA

447

9–82

52 c

pm; V

PA; ≥

8253

 cpm

)

Ligh

t act

iviti

es v

s. LP

A m

in/

wee

k: S

CC

0.1

1M

oder

ate

activ

ities

vs.

MPA

m

in/w

eek:

SC

C −

0.21

Vig

orou

s act

iviti

es v

s. V

PA

min

/wee

k: S

CC

0.2

1M

oder

ate

to v

igor

ous a

ctiv

ities

vs

. MV

PA m

in/w

eek:

SC

C

− 0.

23A

QuA

A sc

ore

vs. P

A c

pm: S

CC

0.

13

Fair

Leve

l 1: –

 Phy

sica

l Act

ivity

Que

stion

-na

ire fo

r Ado

lesc

ents

(PA

Q-

A) [

88] f

n = ra

ngin

g fro

m 4

8 (C

altra

c) to

85

(Act

ivity

ratin

g, G

odin

 1

and

2)A

ge: 1

6.3 ±

1.5 

year

sSe

x: 5

2% g

irls

Acc

. (C

altra

c)(c

ut-p

oint

s not

repo

rted)

7-da

y re

call

inte

rvie

w (P

AR

)A

ctiv

ity ra

ting

God

in 1

and

2 (l

eisu

re ti

me

exer

cise

que

stion

naire

s)

PAQ

-A: v

s. ac

c. a

ctiv

ity c

ount

s/da

y r 0

.33;

vs.

PAR

0.5

9; v

s. PA

R h

ours

r 0.

51; v

s. ac

tivity

ra

ting

r 0.7

3; v

s. G

odin

1 r

0.57

; vs.

God

in 2

r −

0.62

3 of

5 h

ypot

hese

s cor

rect

Fair

(all

com

paris

on m

easu

res)

Leve

l 1: –

2817An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Mod

ified

Phy

sica

l Act

ivity

Q

uesti

onna

ire fo

r Ado

les-

cent

s (PA

Q-A

) [34

]

n = 88

Age

: 14.

5 ± 1.

7 ye

ars

Sex:

42%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

169)

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

IFIS

(Fitn

ess)

PAQ

-A to

tal s

core

: vs.

daily

M

VPA

min

/day

SC

C 0

.39;

vs.

daily

PA

min

/day

SC

C 0

.42

Spor

t and

act

ivity

list:

vs.

daily

M

VPA

min

/day

SC

C 0

.12;

vs.

daily

PA

min

/day

SC

C 0

.21

Bef

ore

scho

ol a

ctiv

ity: v

s. da

ily

MV

PA m

in/d

ay S

CC

0.0

2; v

s. da

ily P

A m

in/d

ay S

CC

0.1

4To

scho

ol a

ctiv

e tra

vel:

vs. d

aily

M

VPA

min

/day

SC

C 0

.32;

vs.

daily

PA

min

/day

SC

C 0

.33

PE: v

s. da

ily M

VPA

min

/day

SC

C 0

.25;

vs.

daily

PA

min

/da

y SC

C 0

.12

Afte

r-sch

ool a

ctiv

ity: v

s. da

ily

MV

PA m

in/d

ay S

CC

0.2

6; v

s. da

ily P

A m

in/d

ay S

CC

0.2

6Fr

om sc

hool

act

ive

trave

l: vs

. da

ily M

VPA

min

/day

SC

C

0.30

; dai

ly P

A m

in/d

ay S

CC

0.

22Ev

enin

g ac

tivity

: vs.

daily

M

VPA

min

/day

SC

C 0

.23;

vs.

daily

PA

min

/day

SC

C 0

.23

Wee

kend

act

ivity

: vs.

daily

M

VPA

min

/day

SC

C 0

.10;

vs.

daily

PA

min

/day

SC

C 0

.28

Stat

emen

t: vs

. dai

ly M

VPA

min

/da

y SC

C 0

.38;

vs.

daily

PA

m

in/d

ay S

CC

0.3

3W

eekl

y ac

tivity

: vs.

daily

M

VPA

min

/day

SC

C 0

.34;

vs.

daily

PA

min

/day

SC

C 0

.29

PAQ

-A to

tal s

core

: vs.

IFIS

sc

ores

SC

C 0

.35

Fair

(all

com

paris

on m

easu

res)

Leve

l 1: –

Leve

l 2: –

 An

adap

ted

vers

ion

of th

e A

sses

smen

t of P

hysi

cal

Act

ivity

Lev

els Q

uesti

on-

naire

(APA

LQ) [

53]

n = 77

Age

: 13.

6 ± 1.

1 ye

ars

Sex:

35%

girl

s

Acc

. (C

SA)

(cut

-poi

nts:

MPA

300

0–53

99 c

pm; V

PA >

5400

 cpm

)

PA in

dex:

vs.

acc.

MV

PA m

in/

day

PCC

0.5

3, v

s. ste

ps/d

ay

PCC

0.4

7

Fair

Leve

l 2: +

2818 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3

DPA

Reca

ll) in

strum

ent

(Sin

gapo

rean

ver

sion

) [42

]

n = 21

9A

ge: 1

4.5 ±

1.1 

year

s [13

–16]

Sex:

53%

girl

s (ag

e an

d se

x to

tal s

ampl

e n =

221)

Pedo

met

er (D

igiw

alke

r)3-

day

aver

age

mea

n M

ETs v

s. ste

p co

unts

: SC

C 0

.40

3-da

y av

erag

e V

PA b

lock

s vs.

step

coun

ts: S

CC

0.3

43-

day

aver

age

MV

PA b

lock

s vs.

step

coun

ts: S

CC

0.3

2

Fair

Leve

l 2: –

 Web

-bas

ed p

hysi

cal A

ctiv

-ity

Que

stion

naire

for O

lder

C

hild

ren

(PA

Q-C

) [28

]

n = 34

2 (p

edom

eter

), 39

1 (s

hut-

tleru

n)A

ge: 1

2.8 

year

sSe

x: 5

1% g

irls

(Age

and

sex

tota

l sam

ple

n = 45

9)

Pedo

met

er (D

igiw

alke

r)20

mSR

TPA

Q-C

: vs.

3 da

ys p

edom

eter

re

cord

PC

C 0

.28,

vs.

20m

SRT

PCC

0.2

8

Fair

(all

com

paris

on m

easu

res)

Leve

l 2: –

 Phy

sica

l act

ivity

que

stion

naire

of

the

Ara

b Te

en L

ifesty

le

Stud

y [8

9]

n = 75

Age

: 16.

1 ± 1.

1 ye

ars

Sex:

48%

girl

s

Pedo

met

er (D

igi-w

alke

r SW

70

1)A

ll ac

tiviti

es v

s. ste

p co

unts

/da

y: P

CC

0.3

7M

PA v

s. ste

p co

unts

/day

: PC

C

0.27

VPA

vs.

step

coun

ts/d

ay: P

CC

0.

34Sp

ecifi

c ac

tiviti

es v

s. ste

p co

unts

/day

: wal

king

PC

C

0.35

, jog

ging

PC

C 0

.38,

sw

imm

ing

PCC

0.1

4, h

ouse

-ho

ld a

ctiv

ities

PC

C 0

.14,

bi

cycl

ing

PCC

0.1

2, m

artia

l ar

ts P

CC

0.1

0, w

eigh

t tra

inin

g PC

C 0

.04

Fair

Leve

l 2: –

 Pre

viou

s Day

Phy

sica

l Act

iv-

ity R

ecal

l (PD

PAR

) [31

]A

CTI

VIT

YG

RA

Mn =

147

Age

:12.

4 ± 0.

4 ye

ars

Sex:

44%

girl

sB

iotra

iner

(firs

t sam

ple)

n = 28

[25–

28]

Age

: 12.

4 ± 0.

5 ye

ars

Sex:

50%

girl

sB

iotra

iner

(sec

ond

sam

ple)

n = 12

8A

ge: u

nkno

wn

Sex:

36%

girl

s

Act

ivity

mon

itor (

Bio

train

er

Pro)

(no

cut-p

oint

s use

d)A

CTI

VIT

YG

RA

M se

lf-re

port

asse

ssm

ent

PDPA

R1

(com

pute

no.

of

time

inte

rval

s > 4

MET

s):

vs. B

iotra

iner

act

ivity

cou

nts

afte

rnoo

n/ev

enin

g r 0

.65

(95%

C

I 0.3

6–0.

94) (

first

sam

ple)

, r 0

.50

(sec

ond

sam

ple)

; vs.

AC

TIV

ITY

GR

AM

r 0.

40

(95%

CI 0

.25–

0.55

)PD

PAR

2 (S

RI l

evel

was

us

ed in

stead

of M

ETs)

vs.

Bio

train

er a

ctiv

ity c

ount

s af

tern

oon/

even

ing

r 0.5

6 (9

5%

CI 0

.24–

0.88

) (fir

st sa

mpl

e),

r 0.5

2 (s

econ

d sa

mpl

e); v

s. A

CTI

VIT

YG

RA

M r

0.50

(9

5% C

I 0.3

6–0.

64)

Poor

vs.

Bio

train

erFa

ir vs

. que

stion

naire

Leve

l 1: ±

(PD

PAR

1)Le

vel 1

: – (P

DPA

R2)

2819An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Act

ivity

gram

self-

repo

rt as

sess

men

t [31

]PD

PAR

n = 14

7A

ge:1

2.4 ±

0.4 

year

sSe

x: 4

4% g

irls

Bio

train

ern =

28 [2

5–28

]A

ge: 1

2.4 ±

0.5 

year

sSe

x: 5

0% g

irls

Act

ivity

mon

itor (

Bio

train

er

Pro)

(no

cut-p

oint

s use

d)PD

PAR

AC

TIV

ITY

GR

AM

: vs.

PDPA

R 1

(com

pute

no.

of

time

inte

rval

s > 4

MET

s) r

0.40

(95%

CI 0

.25–

0.55

); vs

. PD

PAR

 2 (S

RI l

evel

scor

ing

was

use

d in

stead

of M

ETs)

r 0.

50 (9

5% C

I 0.3

6–0.

64);

vs.

Bio

train

er a

ctiv

ity c

ount

s r

0.50

(95%

CI 0

.17–

0.83

)

Poor

vs.

Bio

train

erFa

ir vs

. que

stion

naire

Leve

l 1: –

 MV

PA sc

ores

of t

he In

ter-

natio

nal P

hysi

cal A

ctiv

ity

Que

stion

naire

Sho

rt fo

rm

(IPA

Q-S

F) [9

0]

n = 76

(vs.

acc.

)A

ge: 1

2.7 ±

1.4 

year

s (to

tal

sam

ple

n = 99

8)Se

x: 5

3% g

irls

n = 99

8 (v

s. qu

estio

nnai

re)

Age

: 12.

7 ± 1.

4 ye

ars

Sex:

50%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

MV

PA ≥

3581

 cpm

), M

VPA

scor

es o

f the

HB

SC

Rese

arch

Pro

toco

l

MV

PA IP

AQ

-SF

T0: v

s. M

VPA

ac

c. T

0 gi

rls r

0.08

, boy

s r

0.10

; vs.

MV

PA H

BSC

T0

girls

r 0.

55, b

oys r

0.6

2M

VPA

IPA

Q-S

F T1

: vs.

MV

PA

acc.

T1

girls

r 0.

38, b

oys r

−

0.05

; vs.

MV

PA H

BSC

T1

girls

r 0.

76, b

oys r

0.7

0

Fair

vs. a

cc.

Poor

vs.

ques

tionn

aire

Leve

l 1: –

 MV

PA sc

ores

of t

he H

ealth

B

ehav

ior i

n Sc

hool

-age

d C

hild

ren

(HB

SC) R

esea

rch

Prot

ocol

[90]

n = 76

(vs.

acc.

)A

ge: 1

2.7 ±

1.4 

year

s (to

tal

sam

ple

n = 99

8)Se

x: 5

3% g

irls

n = 99

8 (v

s. qu

estio

nnai

re)

Age

: 12.

7 ± 1.

4 ye

ars

Sex:

50%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

MV

PA ≥

3581

 cpm

), M

VPA

scor

es o

f the

IPA

Q-S

F

MV

PA H

BSC

T0:

vs.

MV

PA

acc.

T0

girls

r 0.

10, b

oys r

0.

35; v

s. M

VPA

IPA

Q-S

F T0

gi

rls r

0.55

, boy

s r 0

.62

MV

PA H

BSC

T1:

vs.

MV

PA

acc.

T1

girls

r 0.

37, b

oys r

0.

04; v

s. M

VPA

IPA

Q-S

F T1

gi

rls r

0.76

, boy

s r 0

.70

Fair

vs. a

cc.

Poor

vs.

ques

tionn

aire

Leve

l 1: –

 The

Sou

th A

mer

ican

You

th/

Chi

ld C

ardi

ovas

cula

r and

En

viro

nmen

t Stu

dy (S

AY-

CAR

E) P

hysi

cal A

ctiv

ity

(PA

) que

stion

naire

[66]

n = 60

Age

: 11–

18 y

ears

Sex:

56%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: L

PA 1

01–

1999

 cpm

; MPA

200

0–49

99 c

pm; V

PA ≥

4000

 cpm

)

MPA

vs.

acc.

MPA

: SC

C 0

.11,

bi

as −

19.5

 min

/day

, LoA

[–

41.6

; 58.

9]V

PA v

s. ac

c. V

PA: S

CC

0.6

5,

bias

18.

3 m

in/d

ay, L

oA

[–92

.6; 5

6.0]

Wee

kly

tota

l MV

PA v

s. ac

c.

tota

l MV

PA: 0

.88,

bia

s 16

.0 m

in/d

ay, L

oA [–

14.2

; 17

.4]

 % o

f agr

eem

ent w

ith P

A g

uide

-lin

es ≥

60 m

in/d

ay: κ

0.51

Poor

Leve

l 1: ±

 Pel

otas

Birt

h co

hort

phys

ical

ac

tivity

que

stion

naire

[91]

n = 25

Age

: 13.

0 ± 0.

3 ye

ars

Sex:

64%

girl

s

DLW

PA: v

s. to

tal e

nerg

y ex

pend

iture

SR

OC

0.4

1; v

s. PA

EE S

ROC

0.

30

Poor

Leve

l 1: –

2820 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3

DPA

Reca

ll) q

uesti

onna

ire

(mod

ified

) [92

]

n = 20

Age

: 13.

3 ± 0.

9 ye

ars

Sex:

100

% g

irls

Acc

. (C

SA)

(cut

-poi

nts n

ot re

porte

d)To

tal M

ETs/

day:

vs.

7 da

ys

coun

ts/d

ay P

CC

0.3

6; v

s. 3 

days

cou

nts/

day

PCC

0.6

3M

PA b

lock

s/da

y: v

s. 7 

days

M

PA m

in/d

ay P

CC

0.2

5; v

s. 3 

days

MPA

min

/day

PC

C

0.29

VPA

blo

cks/

day:

vs.

7 da

ys

VPA

min

/day

PC

C 0

.57;

vs.

3 da

ys V

PA m

in/d

ay P

CC

0.

49

Poor

Leve

l 1: –

 Sho

rt Q

uesti

onna

ire to

A

Sses

s Hea

lth-e

nhan

cing

(S

QU

ASH

) phy

sica

l act

ivity

in

ado

lesc

ents

[93]

n = 17

Age

: 17.

5 ± 0.

6 ye

ars

Sex:

53%

girl

s

DLW

PAEE

: MD

t 126

 kca

l/day

, 95%

Lo

A [–

1207

; 145

9], S

ROC

0.

50

Poor

Leve

l 1: –

 Inte

rnat

iona

l Phy

sica

l Act

ivity

Q

uesti

onna

ire fo

r Ado

les-

cent

s (ad

apte

d ve

rsio

n of

the

IPA

Q) [

94]

n = 20

18A

ge: [

12.5

–17.

5 ye

ars]

Sex:

54%

girl

s

Acc

. (A

ctig

raph

)(c

ut-p

oint

s: M

PA 2

000–

3999

 cpm

; VPA

≥ 40

00 c

pm)

VO

2max

MPA

: vs.

MPA

acc

. min

/day

SR

OC

0.1

5, M

D 3

1.6 

min

/da

y Lo

A [−

74.0

; 137

.2];

vs.

VO

2max

SRO

C 0

.08

MV

PA: v

s. ac

c. M

VPA

min

/da

y SR

OC

0.2

1; v

s. V

O2m

ax

SRO

C 0

.21

VPA

: vs.

acc.

VPA

min

/day

SR

OC

0.2

5, M

D 1

3.2 

min

/day

Lo

A [–

65.0

; 91.

4]; v

s. V

O2m

ax

SRO

C 0

.35

Bla

nd–A

ltman

plo

ts d

epic

t a

posi

tive

mag

nitu

de b

iasu

Poor

(all

com

paris

on m

easu

res)

Leve

l 1: –

2821An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Rec

ess P

hysi

cal A

ctiv

ity

Reca

ll (R

PAR

) [95

]n =

49 (p

edom

eter

)A

ge: 1

3.3 ±

0.5 

year

sSe

x: 6

5% g

irls

n = 32

(Bio

train

er)

Age

: 12.

9 ± 0.

8 ye

ars

Sex:

31%

girl

sn =

32 (A

ctig

raph

)A

ge: 1

2.7 ±

0.8 

year

sSe

x: 3

8% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

s not

repo

rted)

Acc

. (B

iotra

iner

)(c

ut-p

oint

s not

repo

rted)

Pedo

met

er (Y

amax

dig

iwal

ker)

Tota

l PA

: vs.

pedo

met

er st

eps

PCC

0.3

5; v

s. B

iotra

iner

tota

l co

unts

PC

C 0

.40,

cou

nts

adju

sted

for m

ovem

ent t

ime

PCC

0.5

4; v

s. A

ctig

raph

tota

l co

unts

PC

C 0

.42

MPA

vs.

MPA

min

: PC

C 0

.47

VPA

vs.

VPA

min

: PC

C 0

.31

MV

PA v

s. M

VPA

min

: PC

C

0.52

, MD

g 2.1

5 ± 3.

67 m

in,

LoA

[–5.

04; 9

.34]

, sys

t. bi

as

r = −

0.51

Bla

nd–A

ltman

plo

t dep

icts

a

posi

tive

mag

nitu

de b

iasv

Tota

l PA

terti

les c

lass

ifica

tion

agre

emen

t (lo

w, m

ediu

m,

high

): vs

. ped

omet

er st

eps

PoA

46.

9% k

appa

0.2

1; v

s. B

iotra

iner

tota

l PA

cou

nts

PoA

59.

3% k

appa

0.3

9, c

ount

s ad

juste

d fo

r mov

emen

t tim

e Po

A 4

3.8%

kap

pa 0

.16;

vs.

Act

igra

ph to

tal c

ount

s 43.

8%,

kapp

a 0.

16M

VPA

terti

les c

lass

ifica

tion

agre

emen

t (lo

w, m

ediu

m,

high

) vs.

Act

igra

ph M

VPA

m

in: P

oA 6

2.5%

, kap

pa 0

.44

Poor

(all

com

paris

on m

easu

res)

Leve

l 1: –

 Sw

edis

h A

dole

scen

t Phy

si-

cal A

ctiv

ity Q

uesti

onna

ire

(SA

PAQ

) [96

] f

n = 50

Age

: 16.

9 ± 0.

4 ye

ars

Sex:

62%

girl

s

Acc

. (M

TI)

(cut

-poi

nts:

LPA

500

–19

99 c

pm; M

PA 2

000–

5500

 cpm

; VPA

≥ 55

00)

Tota

l PA

: vs.

time

spen

t in

PA r

0.51

; vs.

coun

ts/d

ay r

0.49

; vs.

cpm

r 0.

45

Poor

Leve

l 1: –

2822 L. M. Hidding et al.

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

Act

ivity

Que

stion

naire

for

Adu

lts a

nd A

dole

scen

ts

(AQ

uAA

) [22

]

n = 23

6A

ge: 1

5.0 ±

1.0 

year

sSe

x: 6

0% g

irls

Acc

. (PA

M)

(cut

-poi

nts n

ot re

porte

d)M

PA v

s. M

PA m

in/w

eek:

MD

60

0 m

in/w

eek,

LoA

[− 60

0;

1800

]n

VPA

vs.

VPA

min

/wee

k: M

D

200 

min

/wee

k, L

oA [−

500;

90

0]n

MV

PA v

s. M

VPA

min

/wee

k:

MD

800

 min

/wee

k, L

oA

[− 70

0; 2

100]

n

MV

PA (-

cycl

ing)

vs.

MV

PA m

in/

wee

k: M

D 5

00 m

in/w

eek,

LoA

[−

800;

180

0]n

Agr

eem

ent b

etw

een

self-

repo

rt an

d ac

c. di

ffere

d by

gen

der

Blan

d–A

ltman

plo

ts de

pict

a

posit

ive m

agni

tude

bia

sw

Poor

Leve

l 1:?

 Com

pute

r ass

isted

inte

rvie

w

base

d on

Nat

iona

l Hea

lth an

d N

utrit

ion

Exam

inat

ion

Surv

ey

(NH

AN

ES) s

urve

y [9

7]

n = 27

61A

ge: 1

2–19

 yea

rsSe

x: 4

8% g

irls

Acc

. (A

ctig

raph

)(c

ut-p

oint

: MV

PA ≥

3000

 cpm

)M

VPA

vs.

MV

PA m

in/d

ay:

med

ian

diffe

renc

e 27.

4 m

in/d

ayB

land

–Altm

an p

lot d

epic

ts a

ne

gativ

e m

agni

tude

bia

sx

Poor

Leve

l 1:?

 Pre

viou

s Day

Phy

sica

l Act

iv-

ity R

ecal

l (PD

PAR-

24) s

elf-

repo

rt in

strum

ent [

32]

n = 12

2A

ge: 1

3.8 ±

1.2 

year

sSe

x: 5

3% g

irls

Pedo

met

er (D

igiw

alke

r)M

ean

MET

s vs.

step

coun

ts:

SCC

0.3

430

 min

blo

cks V

PA v

s. ste

p co

unts

: SC

C 0

.30

30 m

in b

lock

s MV

PA v

s. ste

p co

unts

: SC

C 0

.29

Poor

Leve

l 2: –

 Dut

ch P

hysi

cal A

ctiv

ity

Che

cklis

t for

Ado

lesc

ents

(P

AQ

-A) [

35]

n = 44

Age

: 14.

2 ± 1.

8 ye

ars

Sex:

41%

girl

s

Car

diop

ulm

onar

y ex

erci

se te

st (C

PET)

Spar

e-tim

e ac

tivity

—sp

orts

: SC

C −

0.01

Act

ivity

dur

ing

PE: S

CC

0.4

4Lu

ncht

ime

activ

ity: S

CC

0.0

1A

fter-s

choo

l act

ivity

: SC

C 0

.05

Even

ing

activ

ity: S

CC

0.5

5W

eeke

nd a

ctiv

ity: S

CC

0.6

1A

ctiv

ity fr

eque

ncy

durin

g la

st 7 

days

: SC

C 0

.43

Act

ivity

freq

uenc

y du

ring

each

da

y la

st w

eek:

SC

C 0

.41

Tota

l PA

: SC

C 0

.52

Poor

Leve

l 3: ±

 God

in-S

heph

ard

Surv

ey [9

8]n =

102

Age

: 11.

2 ± 0.

7 ye

ars (

n = 36

), 13

.6 ±

0.5 

year

s (n =

36),

16.4

± 0.

8 ye

ars (

n = 30

)Se

x: 5

1% g

irls

Act

ivity

ratin

gSe

ven-

day

Phys

ical

Act

ivity

Re

call

(PA

R)

God

in-S

heph

ard

surv

ey: v

s. PA

R to

tal k

cal o

f exp

endi

ture

an

d kc

al p

er k

g bo

dy w

eigh

t (K

KD

) r 0

.39;

vs.

activ

ity

ratin

g r 0

.32

Poor

Leve

l 3: –

2823An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 2

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Com

paris

on m

easu

reRe

sults

b,c

Met

hodo

logi

cal q

ualit

ydLe

vel o

f evi

denc

e an

d ev

iden

ce ra

tinge

 Chi

ldre

n’s L

eisu

re A

ctiv

i-tie

s Stu

dy S

urve

y (C

LASS

) qu

estio

nnai

re (m

odifi

ed

vers

ion)

[99]

n = 10

8A

ge: 1

2 ye

ars

Sex:

58.

3% g

irls

Euro

fit te

st ba

ttery

: aer

obic

fit

ness

Tota

l PA

: SRO

C 0

.43

MPA

: SRO

C 0

.13

VPA

: SRO

C 0

.20

Poor

Leve

l 3: –

20m

SRT

20 m

shu

ttle

run

test,

acc

. acc

eler

omet

er, b

pm b

eats

per

min

, CH

FT C

anad

ian

Hom

e Fi

tnes

s Te

st, C

I co

nfide

nce

inte

rval

, CO

SMIN

CO

nsen

sus-

base

d St

anda

rds

for

the

sele

ctio

n of

he

alth

Mea

sure

men

t Ins

trum

ents

, cpm

cou

nts

per

min

, DLW

dou

bly

labe

led

wat

er, H

R he

art r

ate,

IC

C in

tracl

ass

corr

elat

ion

coeffi

cien

t, LM

VPA

light

, mod

erat

e, a

nd v

igor

ous

phys

ical

act

iv-

ity, L

oA li

mits

of a

gree

men

t, LP

A lig

ht p

hysi

cal a

ctiv

ity, M

D m

ean

diffe

renc

e, M

ET m

etab

olic

equ

ival

ent,

MPA

mod

erat

e ph

ysic

al a

ctiv

ity, M

VPA

mod

erat

e to

vig

orou

s ph

ysic

al a

ctiv

ity, P

A ph

ysic

al a

ctiv

ity, P

AEE

phys

ical

act

ivity

ene

rgy

expe

nditu

re, P

CC

Pea

rson

cor

rela

tion

coeffi

cien

t, PE

phy

sica

l edu

catio

n, P

oA p

erce

ntag

e of

agr

eem

ent,

r cor

rela

tion

coeffi

cien

t with

out s

peci

fic

info

rmat

ion

on th

e ki

nd o

f co

rrel

atio

n, S

CC

Spe

arm

an c

orre

latio

n co

effici

ent,

SD s

tand

ard

devi

atio

n, s

ens

sens

itivi

ty, s

pec

spec

ifici

ty, S

RA s

elf-

repo

rted

activ

ity, S

RI s

elf-

repo

rted

inte

nsity

, SR

OC

Spe

arm

an ra

nk o

rder

cor

rela

tion,

VO

2max

max

imal

oxy

gen

upta

ke, V

PA v

igor

ous p

hysi

cal a

ctiv

itya A

ge p

rese

nted

as m

ean

age ±

SD

[ran

ge]

b MD

repr

esen

ts m

ean

ques

tionn

aire

val

ue –

mea

n co

mpa

rison

mea

sure

val

ue, u

nles

s sta

ted

othe

rwis

ec D

ata

are

pres

ente

d in

the

follo

win

g or

der:

(i) c

onstr

uct m

easu

red

by q

uesti

onna

ire; (

ii) v

ersu

s con

struc

t mea

sure

d by

com

paris

on m

easu

re; a

nd (i

ii) st

atist

ical

met

hod(

s) a

nd o

utco

me(

s). T

erm

s us

ed in

the

orig

inal

pap

ers t

o cl

arify

the

cutp

oint

s use

d ar

e pr

ovid

ed in

par

enth

eses

d Bas

ed o

n th

e CO

SMIN

che

cklis

te B

ased

on

Tabl

e 1

and

best

avai

labl

e co

mpa

rison

mea

sure

: + in

dica

tes ≥

80%

acc

epta

ble

corr

elat

ions

; ± in

dica

tes ≥

50%

to <

80%

acc

epta

ble

corr

elat

ions

; – in

dica

tes <

50%

acc

epta

ble

corr

ela-

tions

f Stud

y fro

m p

revi

ous r

evie

wg M

ean

acce

lero

met

er v

alue

− m

ean

ques

tionn

aire

val

ueh Lo

A e

xtra

cted

from

figu

re in

arti

cle

i Bla

nd–A

ltman

plo

t ind

icat

es la

rger

ove

resti

mat

ion

by q

uesti

onna

ire w

ith in

crea

sing

mea

n V

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)j B

land

–Altm

an p

lot i

ndic

ates

larg

er o

vere

stim

atio

n by

que

stion

naire

with

incr

easi

ng m

ean

MV

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)k B

land

–Altm

an p

lot i

ndic

ates

und

eres

timat

ion

by q

uesti

onna

ire w

ith d

ecre

asin

g m

ean

MV

PA ti

me

and

over

estim

atio

n w

ith in

crea

sing

mea

n M

VPA

tim

e (n

o st

atist

ical

ana

lysi

s app

lied)

l Bla

nd–A

ltman

plo

t ind

icat

es u

nder

estim

atio

n by

que

stion

naire

with

dec

reas

ing

mea

n M

VPA

tim

e an

d ov

eres

timat

ion

with

incr

easi

ng m

ean

MV

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)m

Bla

nd–A

ltman

plo

t ind

icat

es u

nder

estim

atio

n by

que

stion

naire

with

dec

reas

ing

mea

n M

VPA

tim

e an

d ov

eres

timat

ion

with

incr

easi

ng m

ean

MV

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)n Lo

A a

nd M

D e

xtra

cted

from

figu

re in

arti

cle

o Bla

nd–A

ltman

plo

t ind

icat

es la

rger

und

eres

timat

ion

by q

uesti

onna

ire w

ith in

crea

sing

mea

n LP

A ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)p C

hild

repo

rt m

ean

valu

e −

par

ent r

epor

t mea

n va

lue

q Bla

nd–A

ltman

plo

t ind

icat

es u

nder

estim

atio

n by

que

stion

naire

with

dec

reas

ing

mea

n M

VPA

tim

e an

d ov

eres

timat

ion

with

incr

easi

ng m

ean

MV

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)r B

land

–Altm

an p

lot i

ndic

ates

smal

ler u

nder

estim

atio

n by

que

stion

naire

with

incr

easi

ng m

ean

MV

PA ti

me

(r =

0.14

, p <

0.05

)s B

land

–Altm

an p

lot i

ndic

ates

ove

resti

mat

ion

by q

uesti

onna

ire w

ith d

ecre

asin

g m

ean

MV

PA ti

me

and

unde

resti

mat

ion

with

incr

easi

ng m

ean

MV

PA ti

me

(r =

0.78

, p <

0.00

01)

t DLW

mea

n va

lue

− q

uesti

onna

ire m

ean

valu

eu Fo

r bot

h M

PA a

nd V

PA th

e B

land

–Altm

an p

lot i

ndic

ates

ove

resti

mat

ion

by q

uesti

onna

ire w

ith in

crea

sing

mea

n M

PA a

nd V

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)v B

land

–Altm

an p

lot i

ndic

ates

und

eres

timat

ion

by q

uesti

onna

ire w

ith d

ecre

asin

g tim

e sp

ent i

n PA

and

ove

resti

mat

ion

with

incr

easi

ng ti

me

spen

t in

PA (n

o st

atist

ical

ana

lysi

s app

lied)

w Fo

r MPA

, MV

PA, M

VPA

(-cy

clin

g) a

nd V

PA th

e B

land

–Altm

an p

lot i

ndic

ates

larg

er o

vere

stim

atio

n by

que

stion

naire

with

incr

easi

ng m

ean

activ

ity m

in/w

eek

(no

stat

istic

al a

naly

sis a

pplie

d)x B

land

–Altm

an p

lot i

ndic

ates

ove

resti

mat

ion

by q

uesti

onna

ire w

ith d

ecre

asin

g m

ean

MV

PA ti

me

and

unde

resti

mat

ion

with

incr

easi

ng m

ean

MV

PA ti

me

(no

stat

istic

al a

naly

sis a

pplie

d)

2824 L. M. Hidding et al.

Tabl

e 3

Rel

iabi

lity

of p

hysi

cal a

ctiv

ity q

uesti

onna

ires f

or y

outh

sorte

d by

age

cat

egor

y, m

etho

dolo

gica

l qua

lity,

and

evi

denc

e ra

ting

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

Pres

choo

lers

(mea

n ag

e < 6 

year

s) P

resc

hool

-age

Chi

ldre

n’s P

hysi

cal

Act

ivity

Que

stion

naire

(Pre

-PA

Q) [

58]

n = 10

3A

ge: 3

.8 ±

0.74

 yea

rsSe

x: 4

8% g

irls

2 w

eeks

Pre-

PAQ

leve

l 3: I

CC

0.5

3Pr

e-PA

Q le

vel 4

: IC

C 0

.44

Pre-

PAQ

leve

l 5: I

CC

0.6

4Ti

me

spen

t in

fast-

pace

d ac

tiviti

es:

ICC

0.6

4Ti

me

spen

t in

orga

nize

d ac

tiviti

es:

ICC

rang

ed fr

om 0

.96

to 0

.99

Goo

d–

 Ene

rgy

Bal

ance

Rel

ated

Beh

av-

iors

(ER

Bs)

self-

adm

inist

ered

pr

imar

y ca

regi

vers

que

stion

naire

(P

CQ

), fro

m th

e To

yBox

-stu

dy

(pro

xy) [

46]

n = 93

pre

scho

oler

s2 

wee

ksSp

orts

: tim

e pe

r wee

k IC

C 0

.93

(95%

CI 0

.85–

0.97

), ty

pe o

f spo

rt 0.

71 (9

5% C

I 0.4

6–0.

86)

Act

ive/

pass

ive

trans

port:

trav

el fo

rth

ICC

0.9

1 (9

5% C

I 0.8

7–0.

94),

time

0.82

(95%

CI 0

.73–

0.88

), tra

vel h

ome

0.88

(95%

CI

0.82

–0.9

2), t

ime

0.89

(95%

CI

0.83

–0.9

3)

Fair

+

 Chi

ldre

n’s L

eisu

re A

ctiv

ities

Stu

dy

Surv

ey (C

LASS

) (pr

oxy)

[100

] cn =

58A

ge: 5

.3 ±

0.5 

year

s [5–

6]Se

x: 3

7% g

irls

At l

east

14 d

ays

MPA

: IC

C fr

eque

ncy

0.74

, dur

atio

n 0.

49V

PA: I

CC

freq

uenc

y 0.

87, d

urat

ion

0.81

Tota

l PA

: IC

C fr

eque

ncy

0.83

, dur

a-tio

n 0.

76Li

st of

act

iviti

es: I

CC

freq

uenc

y ra

ngin

g fro

m −

0.03

to 0

.94,

dur

a-tio

n ra

ngin

g fro

m −

0.04

to 0

.91

Fair

–

 Phy

sica

l act

ivity

que

stion

naire

fo

r par

ents

of p

resc

hool

ers i

n M

exic

o [4

0]

n = 21

Age

: 3–5

 yea

rsSe

x: p

erce

ntag

e gi

rls u

nkno

wn

1 w

eek

Dur

atio

n m

oder

ate

activ

ity: r

0.7

9D

urat

ion

vigo

rous

act

ivity

: r 0

.94

Ove

rall

activ

ity: r

0.9

7

Poor

±

Kid

Act

ive

Q (W

eb-b

ased

)(pr

oxy)

[1

01]

n = 20

Age

: 4.2

± 1.

3 ye

ars [

2–6]

Sex:

50%

girl

s

3 w

eeks

Ove

rall

PA le

vel:

ICC

0.6

6 (9

5% C

I 0.

41–0

.91)

Tim

e sp

ent o

utdo

ors:

ICC

0.6

0 (9

5% C

I 0.3

1–0.

88)

Poor

–

Chi

ldre

n (m

ean

age ≥

6 to

< 12

 yea

rs)

 Chi

nese

ver

sion

of t

he P

hysi

cal

Act

ivity

Que

stion

naire

for O

lder

C

hild

ren

(PA

Q-C

) [43

]

n = 92

Age

: 8–1

3 ye

ars

Sex:

45%

girl

s

7–10

 day

sPA

Q-C

: IC

C 0

.82

Goo

d+

 Act

ive

Tran

spor

tatio

n to

scho

ol

and

wor

k in

Nor

way

(ATN

) qu

estio

nnai

re [4

1]

n = 87

Age

: 11–

12 y

ears

Sex:

per

cent

age

girls

unk

now

n

2 w

eeks

Wal

king

: SRO

C 0

.92

Cyc

ling:

SRO

C 0

.92

Cla

ssifi

catio

n in

maj

or m

ode

of

com

mut

ing:

kap

pa 0

.93

Goo

d+

2825An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Chi

ldre

n’s L

eisu

re A

ctiv

ities

Stu

dy

Surv

ey C

hine

se-v

ersi

on q

uesti

on-

naire

(CLA

SS-C

)[5

0]

n = 21

4A

ge: 1

0.9 ±

0.9 

year

s [9–

12] 

Sex:

62%

girl

s

App

rox.

1 w

eek

Wee

kly

MPA

(min

): IC

C 0

.61

(95%

C

I 0.4

9–0.

70)

Wee

kly

VPA

(min

): IC

C 0

.73

(95%

C

I 0.6

4–0.

79)

Wee

kly

MV

PA (m

in):

ICC

0.7

1 (9

5% C

I 0.6

1–0.

77)

Goo

d±

 Out

-of-

scho

ol P

hysi

cal A

ctiv

ity

ques

tionn

aire

[62]

n = 15

1A

ge: 1

1 ye

ars

Sex:

60%

girl

s (in

tota

l sam

ple

n = 15

5)

App

rox.

30 

days

MV

PA d

urat

ion:

ICC

0.6

5M

VPA

freq

uenc

y: IC

C 0

.64

Goo

d–

 The

Ene

rgy-

child

que

stion

naire

[4

8]n =

730

Age

: [11

.3 ±

0.5

to 1

2.5 ±

0.6 

year

s]Se

x: [4

7–58

% g

irls]

1 w

eek

Wal

king

to sc

hool

: (no

./day

s) IC

C

0.91

; (am

ount

of t

ime)

ICC

0.7

0Tr

ansp

ort t

oday

to sc

hool

: IC

C 0

.79

Act

ivity

dur

ing

brea

ks: I

CC

0.8

0Sp

ort h

ours

: (fir

st sp

ort)

ICC

0.7

4,

(sec

ond

spor

t) IC

C 1

.00,

(yes

ter-

day)

ICC

0.2

2B

ike

to sc

hool

: (no

./day

s) IC

C 0

.94,

(a

mou

nt o

f tim

e) IC

C 0

.81

Fair

+

 Sel

f-Adm

inist

ered

Phy

sica

l Act

iv-

ity C

heck

list (

SAPA

C) (

Gre

ek

vers

ion)

[49]

n = 72

Age

: 11.

5 ± 0.

5 ye

ars

Sex:

49%

girl

s

2 w

eeks

Tota

l-MET

: IC

C 0

.87

(95%

CI

0.85

–0.8

8)M

ET-L

PA: I

CC

0.8

5 (9

5% C

I 0.

82–0

.88)

MET

-MV

PA: I

CC

0.8

8 (9

5% C

I 0.

86–0

.90)

Fair

+

 Phy

sica

l Act

ivity

Que

stion

naire

for

Old

er C

hild

ren

(PA

Q-C

) [29

] cn =

84A

ge: 9

–14 

year

sSe

x: 4

9% g

irls

1 w

eek

ICC

boy

s 0.7

5, g

irls 0

.82

Fair

+

 Girl

s hea

lth E

nric

hmen

t Mul

tisite

St

udy

Act

ivity

Que

stion

naire

(G

AQ

) [10

2] c

n = 68

Age

: 9.0

± 0.

6 ye

ars

Sex:

100

% g

irls

4 da

ys28

act

iviti

es: y

este

rday

ICC

0.7

8,

usua

l 0.8

218

act

iviti

es: y

este

rday

ICC

0.7

0,

usua

l 0.7

9

Fair

+

 Foo

d, H

ealth

, and

Cho

ices

que

s-tio

nnai

re (F

HC

-Q) [

37]

n = 82

(dig

ital v

s. pa

per)

Age

: < 9

to >

12 y

ears

Sex:

51%

girl

sn =

73 (d

igita

l vs.

digi

tal)

Age

: < 9

to >

12 y

ears

Sex:

45%

girl

s

2 w

eeks

PA d

igita

l vs.

pape

r: IC

C 0

.73

PA d

igita

l vs.

digi

tal:

ICC

0.6

6Fa

ir (b

oth

grou

ps)

±

2826 L. M. Hidding et al.

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 The

Sou

th A

mer

ican

You

th/C

hild

C

ardi

ovas

cula

r and

Env

ironm

ent

Stud

y (S

AY

CAR

E) P

hysi

cal

Act

ivity

(PA

) que

stion

naire

(p

roxy

) [66

]

n = 16

1A

ge: 3

–10 

year

sSe

x: 5

0% g

irls

15 d

ays

Act

ive

com

mut

ing:

SC

C 0

.28

PA a

t sch

ool:

SCC

0.3

1PA

at l

eisu

re ti

me:

SC

C 0

.33

MPA

: SC

C 0

.37

VPA

: SC

C 0

.89

Wee

kly

tota

l MV

PA: S

CC

0.5

6 %

of a

gree

men

t with

cur

rent

PA

gu

idel

ines

≥ 60

 min

/day

: κ 0

.32

Fair

–

 Dut

ch P

hysi

cal A

ctiv

ity C

heck

list

for C

hild

ren

(PA

Q-C

) [35

]n =

192

Age

: 8.9

± 1.

7 ye

ars [

5–12

]Se

x: 5

3% g

irls

NA

: int

er-r

ater

(par

ent v

s. ch

ild)

Spar

e-tim

e ac

tivity

—sp

orts

: kap

pa

0.50

(95%

CI 0

.41–

0.60

)A

ctiv

ity d

urin

g PE

cla

sses

: 0.4

8 (9

5% C

I 0.3

7–0.

59)

Bre

ak-ti

me

activ

ity: 0

.64

(95%

CI

0.55

–0.7

3)Lu

ncht

ime

activ

ity: 0

.68

(95%

CI

0.60

–0.7

7)A

fter-s

choo

l act

ivity

: 0.6

3 (9

5% C

I 0.

54–0

.71)

Even

ing

activ

ity: 0

.69

(95%

CI

0.62

–0.7

7)W

eeke

nd a

ctiv

ity: 0

.56

(95%

CI

0.46

–0.6

7)A

ctiv

ity fr

eque

ncy

last

7 da

ys: 0

.65

(95%

CI 0

.56–

0.74

)A

ctiv

ity fr

eque

ncy

durin

g ea

ch d

ay:

0.64

(95%

CI 0

.55–

0.72

)To

tal P

A: 0

.60

(95%

CI 0

.52–

0.67

)

Fair

–

2827An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Instr

umen

t to

asse

ss c

hild

ren’

s ou

tdoo

r act

ive

play

in v

ario

us

loca

tions

(pro

xy) [

77]

n = 53

Age

: 9.5

± 0.

7 ye

ars [

8.3–

12.3

]Se

x: 4

2% g

irls

2 w

eeks

Wee

kday

ICC

: yar

d at

hom

e 0.

80,

frie

nd’s

/nei

ghbo

r’s y

ard

0.70

, ow

n str

eet/c

ourt/

foot

path

0.8

2, n

earb

y str

eets

/cou

rt/fo

otpa

th 0

.40,

par

k/pl

aygr

ound

0.6

3, fa

cilit

ies o

r spo

rt ov

als 0

.48,

scho

ol g

roun

ds fo

r fre

e pl

ay o

utsi

de sc

hool

hou

rs 0

.51,

ot

her p

lace

s 0.4

7W

eeke

nd d

ay IC

C: y

ard

at h

ome

0.58

, frie

nd’s/

neig

hbor

’s ya

rd 0

.77,

ow

n str

eet/c

ourt/

foot

path

0.7

6,

near

by st

reet

s/cou

rt/fo

otpa

th 0

.33,

pa

rk/p

layg

roun

d 0.

64, f

acili

ties o

r sp

ort o

vals

0.63

, sch

ool g

roun

ds fo

r fre

e pl

ay o

utsid

e sc

hool

hou

rs 0

.18,

ot

her p

lace

s 0.6

2

Fair

–

 Par

ent p

roxy

-rep

ort o

f phy

sica

l ac

tivity

and

sede

ntar

y ac

tiviti

es

(pro

xy) [

73]

n = 14

7A

ge: 6

–10 

year

s, 13

–14 

year

sSe

x: 5

1% g

irls (

in to

tal s

ampl

e n =

189)

2 m

onth

s6 

mon

ths

Afte

r 2 m

onth

s:Pl

ayin

g vi

goro

usly

indo

ors:

ICC

0.

41, M

D −

8.7

(min

/day

) (−

17.6

to

0.1

)Pl

ayin

g vi

goro

usly

out

door

s: IC

C

0.43

, MD

− 10

.0 (−

19.2

to −

0.8)

Cyc

ling:

ICC

0.6

4 M

D −

1.4

(− 7.

2 to

4.5

)A

fter 6

 mon

ths:

Play

ing

vigo

rous

ly in

door

s: IC

C

0.67

, MD

− 8.

3 (−

14.2

to −

2.4)

Play

ing

vigo

rous

ly o

utdo

ors:

ICC

0.

60, M

D −

3.1

(− 11

.3 to

5.1

)C

yclin

g: IC

C 0

.45,

MD

2.6

(− 4.

4 to

9.7

)

2 m

onth

s’ ti

me

inte

rval

: fai

r6 

mon

ths’

tim

e in

terv

al: p

oor

–

 Phy

sica

l Act

ivity

Que

stion

naire

for

olde

r Chi

ldre

n (P

AQ

-C) (

Span

ish

vers

ion)

[52]

n = 83

Age

: 11.

0 ± 1.

2 ye

ars

Sex:

45%

girl

s

6 h

Tota

l sco

re: I

CC

0.9

6A

ctiv

ity c

heck

list:

ICC

0.9

6PE

: IC

C 0

.95

Rece

ss: I

CC

0.7

9Lu

nch:

ICC

0.8

7A

fter s

choo

l: IC

C 0

.82

Afte

rnoo

n: IC

C 0

.77

Wee

kend

: IC

C 0

.63

Inte

nsity

last

wee

k: IC

C 0

.90

Wee

k su

mm

ary:

ICC

0.9

5

Poor

+

2828 L. M. Hidding et al.

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 God

in L

eisu

re-T

ime

Exer

cise

Q

uesti

onna

ire [6

3]n =

31A

ge: 1

0.6 ±

0.2 

year

sSe

x: 4

5% g

irls

Sam

e da

y (b

egin

ning

and

end

of t

he

scho

ol d

ay)

Mild

exe

rcis

e: P

CC

0.2

5M

oder

ate

exer

cise

: PC

C 0

.38

Stre

nuou

s exe

rcis

e: P

CC

0.6

9To

tal l

eisu

re a

ctiv

ity sc

ore:

PC

C

0.62

, MD

− 33

.4, L

oA [−

239;

17

2.2]

Poor

–

 The

Mod

ified

God

in L

eisu

re-T

ime

Exer

cise

Que

stion

naire

[45]

n = 13

9A

ge: 1

1.1 ±

0.4 

year

sSe

x: 5

2% g

irls

Fall

(aut

umn)

and

sprin

g (6

 mon

ths)

Tota

l min

of e

xerc

ise:

PC

C 0

.68

Poor

–

Old

er c

hild

ren

and

adol

esce

nts (

mea

n ag

e ≥ 12

 yea

rs)

 Sin

gle-

item

act

ivity

mea

sure

[23]

n = 10

7A

ge: 1

4.7 ±

0.5 

year

sSe

x: 3

8% g

irls

(Age

and

sex

tota

l sam

ple

n = 12

3)

2 w

eeks

ICC

0.7

5 (9

5% C

I 0.6

4–0.

83),

MD

0.

08 (9

5% C

I − 0.

12 to

0.2

6)G

ood

+

 Web

-bas

ed a

nd p

aper

-bas

ed P

hysi

-ca

l Act

ivity

Que

stion

naire

for

Old

er C

hild

ren

(PA

Q-C

) [28

]

n = 32

3A

ge 1

2.8 

year

sSe

x: 5

1% g

irls

(Age

and

sex

tota

l sam

ple

n = 45

9)

App

rox.

8 d

ays

Web

-bas

ed v

s. w

eb-b

ased

: IC

C 0

.79

(95%

CI 0

.74–

0.82

), PC

C 0

.79,

M

D 0

.11

(95%

CI 0

.06–

0.15

)W

eb-b

ased

vs.

pape

r-bas

ed: I

CC

0.

70 (9

5% C

I 0.6

5–0.

75),

PCC

0.

70, M

D −

0.0

2 (9

5% C

I − 0.

06

to 0

.03)

Goo

d+

 An

adap

ted

vers

ion

of th

e A

sses

s-m

ent o

f Phy

sica

l Act

ivity

Lev

els

Que

stion

naire

(APA

LQ) [

53]

n = 15

0A

ge: 1

3.6 ±

1.1 

year

sSe

x: 5

2% g

irls

7 da

ysPA

inde

x: IC

C 0

.76

Org

aniz

ed sp

ort p

artic

ipat

ion

out-

side

scho

ol: I

CC

0.8

6N

on-o

rgan

ized

spor

t par

ticip

atio

n ou

tsid

e sc

hool

: IC

C 0

.58

PE: I

CC

0.6

1H

ours

per

wee

k ou

t of s

choo

l PA

in

tens

ity: I

CC

0.8

2Pa

rtici

patio

n in

com

petit

ive

spor

t: IC

C 0

.93

Goo

d±

 Inte

rnat

iona

l Phy

sica

l Act

ivity

Q

uesti

onna

ire -

Shor

t For

m

(IPA

Q-S

F) [8

4]

n = 92

Age

: 15.

9 ± 1.

4 ye

ars [

12–1

8]Se

x: 5

3% g

irls

1 w

eek

VPA

: IC

C 0

.79

(95%

CI 0

.70–

0.86

)M

PA: I

CC

0.5

3 (9

5% C

I 0.3

6–0.

66)

Wal

king

: IC

C 0

.66

(95%

CI

0.53

–0.7

6)To

tal P

A: I

CC

0.7

4 (9

5% C

I 0.

63–0

.82)

Goo

d±

2829An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Chi

ld a

nd A

dole

scen

t Phy

sica

l A

ctiv

ity a

nd N

utrit

ion

surv

ey

(CA

PAN

S-PA

) rec

all q

uesti

on-

naire

[103

]

n = 77

Age

: 12 ±

0.8 

year

s [11

–14]

Sex:

51%

girl

s

1 w

eek

Freq

uenc

y M

VPA

: IC

C M

onda

y–Fr

iday

0.7

7 (9

5% C

I 0.6

7–0.

85),

Satu

rday

0.7

3 (9

5% C

I 0.5

7–0.

84),

Sund

ay 0

.19

(95%

CI −

0.16

to

0.50

), M

onda

y–Su

nday

0.8

6 (9

5%

CI 0

.79–

0.91

)D

urat

ion

MV

PA: I

CC

Mon

day–

Frid

ay 0

.74

(95%

CI 0

.62–

0.83

), Sa

turd

ay 0

.70

(95%

CI 0

.51–

0.82

), Su

nday

0.3

6 (9

5% C

I 0.0

1–0.

63),

Mon

day–

Sund

ay 0

.78

(95%

CI

0.66

–0.8

5)Fr

eque

ncy

activ

e in

PE:

kap

pa 0

.51

(95%

CI 0

.34–

0.67

)Fr

eque

ncy

PA ri

ght a

fter s

choo

l: 0.

48 (9

5% C

I 0.3

7–0.

66)

Freq

uenc

y PA

eve

ning

s: 0

.50

(95%

C

I 0.3

7–0.

66)

Freq

uenc

y PA

last

wee

kend

: 0.4

9 (9

5% C

I 0.3

4–0.

64)

Parti

cipa

tion

in 3

2 PA

s: k

appa

rang

-in

g fro

m −

0.04

to 0

.82

Goo

d–

 Act

ivity

Que

stion

naire

for A

dults

an

d A

dole

scen

ts (A

QuA

A) [

21]

n = 53

Age

: 14.

1 ± 1.

4 ye

ars

Sex:

43%

girl

s

2 w

eeks

AQ

uAA

scor

e (M

ET ×

min

/wee

k):

ICC

0.4

4 (9

5% C

I 0.1

6–0.

65)

Ligh

t act

iviti

es (m

in/w

eek)

: IC

C

0.30

(95%

CI 0

.04–

0.52

)M

oder

ate

activ

ities

(min

/wee

k):

ICC

0.5

0 (9

5% C

I 0.2

7–0.

68)

Mod

erat

e to

vig

orou

s act

iviti

es: I

CC

0.

54 (9

5% C

I 0.3

2–0.

70)

Vig

orou

s act

iviti

es (m

in/w

eek)

: IC

C

0.59

(95%

CI 0

.38–

0.75

)

Goo

d–

 God

in-S

heph

ard

Surv

ey [9

8]n =

102

Age

: 11.

2 ± 0.

7 ye

ars (

n = 36

), 13

.6 ±

0.5 

year

s (n =

36),

16.4

± 0.

8 ye

ars (

n = 30

)Se

x: 5

1% g

irls

2 w

eeks

God

in-S

heph

ard

Surv

ey: r

0.8

1Fa

ir+

 VIS

A-T

EEN

que

stion

naire

[104

]n =

228

Age

: 15.

4 ± 1.

6 ye

ars

Sex:

46%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

396)

15 d

ays

MV

PA: (

days

/wee

k) IC

C 0

.77

(95%

C

I 0.7

1–0.

82),

(h/w

eek)

0.8

6 (9

5%

CI 0

.81–

0.89

)V

PA: (

h/w

eek)

ICC

0.8

0 (9

5% C

I 0.

75–0

.85)

Fair

+

2830 L. M. Hidding et al.

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Chi

ldre

n’s L

eisu

re A

ctiv

ities

Stu

dy

Surv

ey (C

LASS

) que

stion

naire

(m

odifi

ed v

ersi

on) [

99]

n = 10

8A

ge: 1

2 ye

ars

Sex:

58.

3% g

irls

3 w

eeks

MPA

: IC

C 0

.95

VPA

: IC

C 0

.83

Tota

l PA

: IC

C 0

.93

Fair

+

 Oxf

ord

Phys

ical

Act

ivity

Que

stion

-na

ire (O

PAQ

) [23

]n =

104

Age

: 14.

7 ± 0.

5 ye

ars

Sex:

38%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

123)

2 w

eeks

ICC

0.7

9 (9

5% C

I 0.6

9–0.

86),

MD

−

0.17

(95%

CI −

0.43

to 0

.10)

Fair

+

 Qua

ntifi

catio

n de

l’ac

tivité

phy

-si

que

en a

ltitu

de c

hez

les e

nfan

ts

(QA

PAC

E) [1

05] c

n = 12

1A

ge: 8

–16 

year

sSe

x: 5

4% g

irls

90 d

ays

Toile

t: IC

C 0

.90

(95%

CI 0

.87–

0.93

)Tr

ansp

orta

tion:

ICC

0.8

4 (9

5% C

I 0.

78–0

.89)

Man

dato

ry P

E: IC

C 0

.95

(95%

CI

0.93

–0.9

7)O

ther

act

iviti

es in

scho

ol: I

CC

0.9

4 (9

5% C

I 0.9

2–0.

96)

Pers

onal

arti

stic

activ

ities

: IC

C 0

.98

(95%

CI 0

.97–

0.99

)Sp

ort c

ompe

titio

n: IC

C 0

.98

(95%

C

I 0.9

7–0.

99)

Hom

e ac

tiviti

es: I

CC

0.8

9 (9

5% C

I 0.

85–0

.92)

Dai

ly E

E: L

oA [–

515.

5; 5

32.5

 kJ/d

]

Fair

+

 Oxf

ord

Phys

ical

Act

ivity

Que

stion

-na

ire (O

PAQ

) [24

] cn =

87A

ge: 1

3.1 ±

0.9 

year

sSe

x: 4

5% g

irls

1 w

eek

MPA

: IC

C 0

.76

(95%

CI 0

.63–

0.84

)V

PA: I

CC

0.8

0 (9

5% C

I 0.7

0–0.

87)

MV

PA: I

CC

0.9

1 (9

5% C

I 0.

87–0

.95)

Fair

+

Wor

ld H

ealth

Org

aniz

atio

n H

ealth

B

ehav

ior i

n Sc

hool

child

ren

ques

-tio

nnai

re (W

HO

HB

SC) [

106]

c

n = 71

Age

: 14.

9 ± 1.

6 ye

ars [

13–1

8]Se

x: 5

6% g

irls

8–12

 day

sFr

eque

ncy:

ICC

0.7

3 (9

5% C

I 0.

60–0

.82)

Dur

atio

n: IC

C 0

.71

(95%

CI

0.57

–0.8

1)

Fair

+

 Sel

ecte

d in

dica

tors

from

the

Hea

lth B

ehav

iour

in S

choo

l-age

d C

hild

ren

(HB

SC) q

uesti

onna

ire

(Chi

nese

ver

sion

) [10

7]

n = 95

(11 

year

s [n =

44],

15 y

ears

[n

= 51

])A

ge: [

11.7

± 0.

4 to

15.

8 ± 0.

3 ye

ars]

Sex:

46%

girl

s

3 w

eeks

MV

PA: l

ast 7

 day

s IC

C 0

.82

(95%

C

I 0.7

4–0.

88),

usua

l wee

k 0.

74

(95%

CI 0

.64–

0.82

)V

PA: f

requ

ency

0.6

8 (9

5% C

I 0.

55–0

.77)

, tim

es p

er w

eek

0.57

(9

5% C

I 0.4

2–0.

66)

Fair

±

2831An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Sel

ecte

d ph

ysic

al a

ctiv

ity it

ems o

f th

e in

tern

atio

nal H

ealth

Beh

avio

r in

Sch

ool-a

ged

Chi

ldre

n (H

BSC

) qu

estio

nnai

re (C

zech

ver

sion

) [1

08]

n = 69

3A

ge: 1

1.1 ±

0.5

and

15.1

± 0.

5 ye

ars

Sex:

49.

1% g

irls

4 w

eeks

(n =

580)

1 w

eek

(n =

113)

4-w

eek

time

inte

rval

:M

VPA

: IC

C 0

.52

(95%

CI 0

.46–

0.58

), ka

ppa

0.44

VPA

: IC

C 0

.55

(95%

CI 0

.49–

0.61

), ka

ppa

0.41

1-w

eek

time

inte

rval

:M

VPA

: IC

C 0

.98

(95%

CI

0.97

–0.9

9)V

PA: I

CC

0.9

0 (9

5% C

I 0.8

6–0.

93)

Fair

±

 Mea

sure

s of i

n-sc

hool

and

out

-of

-sch

ool p

hysi

cal a

ctiv

ity, a

nd

trave

l beh

avio

rs o

f the

inte

rna-

tiona

l Hea

lthy

Envi

ronm

ents

and

ac

tive

livin

g in

teen

ager

s – H

ong

Kon

g [iH

ealt(

H)]

stud

y [4

7]

n = 68

Age

: 15.

4 ye

ars

Sex:

47%

girl

s

13 d

ays (

rang

e: 8

–16 

days

)PE

min

/cla

ss: I

CC

0.8

9, m

in/w

eek

0.84

No.

of s

port

team

s or a

fter s

choo

l PA

in sc

hool

: IC

C 0

.74

No.

of s

port

team

s or a

fter s

choo

l PA

out

-of-

scho

ol: I

CC

0.8

9Le

isur

e tim

e PA

: pas

t 7 d

ays I

CC

0.

70, u

sual

wee

k IC

C 0

.79,

ave

r-ag

e IC

C 0

.76

Wal

king

or c

yclin

g to

/from

des

tina-

tions

: Ind

oor o

r exe

rcis

e fa

cilit

y 0.

61, f

riend

’s o

r rel

ativ

e’s h

ouse

0.

48, o

utdo

or re

crea

tion

plac

e 0.

47, f

ood

store

or r

esta

uran

t/ca

fe 0

.82,

oth

er re

tail

store

s 0.5

1,

non-

scho

ol so

cial

or e

duca

tiona

l ac

tiviti

es 0

.51,

pub

lic tr

ansp

orta

-tio

n sto

p 0.

71, t

otal

scor

e w

alki

ng

or c

yclin

g tim

es/w

eek

0.59

Wal

k to

scho

ol: I

CC

0.8

9W

alk

from

scho

ol: I

CC

0.7

6

Fair

±

 Phy

sica

l Act

ivity

and

Life

style

Q

uesti

onna

ire (P

ALQ

) (G

reek

ve

rsio

n) [3

3]

n = 21

Age

: 13.

7 ± 0.

8 ye

ars

Sex:

43%

girl

s (ag

e an

d se

x to

tal

sam

ple

n = 40

)

2 w

eeks

PALQ

: IC

C 0

.52,

typi

cal e

rror

2.3

9,

MD

(LoA

) − 1.

88 ±

6.82

Fair

–

The

Sout

h A

mer

ican

You

th/C

hild

C

ardi

ovas

cula

r and

Env

ironm

ent

Stud

y (S

AY

CAR

E) P

hysi

cal

Act

ivity

(PA

) que

stion

naire

[66]

n = 17

7A

ge: 1

1–18

 yea

rsSe

x: 5

8% g

irls

15 d

ays

Act

ive

com

mut

ing:

SC

C 0

.51

PA a

t sch

ool:

SCC

0.6

3PA

at l

eisu

re ti

me:

SC

C 0

.68

MPA

: SC

C 0

.36

VPA

: SC

C 0

.93

Wee

kly

tota

l MV

PA: S

CC

0.6

0 %

of a

gree

men

t with

cur

rent

PA

gu

idel

ines

≥ 60

 min

/day

: κ 0

.56

Fair

–

2832 L. M. Hidding et al.

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Sel

f-ad

min

ister

ed q

uesti

onna

ire o

n ch

ildre

n’s t

rave

l to

scho

ol [3

9]n =

61 (s

tudy

1),

n = 6

8 (s

tudy

2)

Age

: 11–

14 y

ears

Sex:

per

cent

age

of g

irls u

nkno

wn

1 w

eek

Afte

r sch

ool e

xerc

ise

no. o

f day

s:

study

 1, k

appa

0.0

7; st

udy

2,

kapp

a 0.

01A

fter s

choo

l exe

rcis

e no

. of h

ours

: stu

dy 1

, kap

pa N

A; s

tudy

2, k

appa

0.

01Ph

ysic

al tr

aini

ng: s

tudy

1, k

appa

0.

07; s

tudy

2, k

appa

− 0.

01

Fair

–

 Dut

ch P

hysi

cal A

ctiv

ity C

heck

list

for A

dole

scen

ts (P

AQ

-A)

[35]

n = 94

Age

: 13.

6 ± 1.

4 ye

ars [

12–1

7]Se

x: 5

5% g

irls

NA

: int

er-r

ater

(par

ent v

s. ch

ild)

Spar

e-tim

e ac

tivity

—sp

orts

: kap

pa

0.67

(95%

CI 0

.54–

0.81

)A

ctiv

ity d

urin

g PE

cla

sses

: 0.5

3 (9

5% C

I 0.3

3–0.

72)

Lunc

htim

e ac

tivity

: 0.6

0 (9

5% C

I 0.

46–0

.73)

Afte

r-sch

ool a

ctiv

ity: 0

.61

(95%

CI

0.47

–0.7

6)Ev

enin

g ac

tivity

: 0.6

8 (9

5% C

I 0.

53–0

.79)

Wee

kend

act

ivity

: 0.5

1 (9

5% C

I 0.

38–0

.65)

Act

ivity

freq

uenc

y la

st 7 

days

: 0.6

3 (9

5% C

I 0.5

1–0.

76)

Act

ivity

freq

uenc

y du

ring

each

day

: 0.

51 (9

5% C

I 0.3

8–0.

64)

Tota

l PA

: 0.6

4 (9

5% C

I 0.5

1–0.

77)

Fair

–

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3

DPA

Reca

ll) in

strum

ent (

Sing

a-po

rean

ver

sion

) [42

]

n = 10

6A

ge: 1

4.5 ±

1.1 

year

s [13

–16]

Sex:

53%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

221)

6–8 

h3-

day

aver

age

MET

leve

l: IC

C 0

.88

(95%

CI 0

.83–

0.92

)Po

or+

 3-D

ay P

hysi

cal A

ctiv

ity R

ecor

d (3

DPA

Reco

rd) (

Gre

ek v

ersi

on)

[33]

n = 21

Age

: 13.

7 ± 0.

8 ye

ars

Sex:

43%

girl

s(A

ge a

nd se

x to

tal s

ampl

e n =

40)

2 w

eeks

All

days

: IC

C 0

.97,

typi

cal e

rror

38

2.51

, LoA

[–37

5.3;

109

2.7]

W

eeke

nd: I

CC

0.8

8, ty

pica

l err

or

276.

4, L

oA [–

230.

6; 7

89.5

]W

eekd

ays:

ICC

0.9

7, d

ay 1

typi

cal

erro

r 119

.8, L

oA [–

66.1

2; 3

42.1

9],

day

2 ty

pica

l err

or 1

31.5

, MD

(L

oA) −

78.6

± 37

5.6

Poor

+

 Rec

ess P

hysi

cal A

ctiv

ity R

ecal

l (R

PAR

) [95

]n =

113

Age

: 13.

1 ± 0.

7 ye

ars

Sex:

48%

girl

s

1 h

Tota

l PA

: IC

C 0

.87

MV

PA: I

CC

0.8

8Po

or+

2833An Updated Systematic Review of Childhood Physical Activity Questionnaires

Tabl

e 3

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

hodo

logi

cal q

ualit

ybEv

i-de

nce

ratin

g

 Refi

ned

60-m

in M

VPA

scre

enin

g m

easu

re [1

09] c

n = 13

8A

ge: 1

2.1 ±

0.9 

year

sSe

x: 6

5% g

irls

Sam

e da

y up

to 1

 mon

thIC

C: t

otal

sam

ple

0.77

, sam

e da

y 0.

88 (n

= 42

), up

to 1

 mon

th 0

.53

(n =

31)

Kap

pa: t

otal

sam

ple

61%

, sam

e da

y 84

%, u

p to

1 m

onth

36%

Poor

+

 MV

PA sc

ores

of t

he H

ealth

Beh

av-

ior i

n Sc

hool

-age

d C

hild

ren

(HB

SC) R

esea

rch

Prot

ocol

[90]

n = 99

8A

ge: 1

2.7 ±

1.4 

year

sSe

x: 5

0% g

irls

1 ye

arM

VPA

girl

s r 0

.43,

boy

s r 0

.50

Poor

–

 MV

PA sc

ores

of t

he In

tern

atio

nal

Phys

ical

Act

ivity

Que

stion

naire

Sh

ort f

orm

(IPA

Q-S

F) [9

0]

n = 99

8A

ge: 1

2.7 ±

1.4 

year

sSe

x: 5

0% g

irls

1 ye

arM

VPA

girl

s r 0

.45,

boy

s r 0

.44

Poor

–

 Mod

erat

e an

d vi

goro

us p

hysi

cal

activ

ity it

ems o

f the

You

th R

isk

Beh

avio

r Sur

vey

(YR

BS)

[83]

n = 12

8A

ge: 1

2.2 ±

0.6 

year

s (in

tota

l sam

-pl

e n =

139)

Sex:

53%

girl

s

Ran

ged

from

1 to

40 

days

(n =

92

[≤ 15

 day

s] a

nd n

= 36

[> 15

 day

s])

MPA

: IC

C ≤

15 d

ays 0

.57,

> 15

 day

s 0.

35, t

otal

sam

ple

0.51

VPA

: IC

C ≤

15 d

ays 0

.47,

> 15

day

s 0.

34, t

otal

sam

ple

0.46

Poor

–

appr

ox. a

ppro

xim

atel

y, C

I con

fiden

ce in

terv

al, C

OSM

IN C

Ons

ensu

s-ba

sed

Stan

dard

s fo

r the

sel

ectio

n of

hea

lth M

easu

rem

ent I

nstru

men

ts, I

CC

intra

clas

s co

rrel

atio

n co

effici

ent,

LoA

limits

of

agre

emen

t, LP

A lig

ht p

hysi

cal a

ctiv

ity, M

D m

ean

diffe

renc

e, M

ET m

etab

olic

equ

ival

ent,

MPA

mod

erat

e ph

ysic

al a

ctiv

ity, M

VPA

mod

erat

e to

vig

orou

s ph

ysic

al a

ctiv

ity, N

A no

t app

licab

le, P

A ph

ysic

al a

ctiv

ity, P

CC

Pea

rson

cor

rela

tion

coeffi

cien

t, PE

phy

sica

l edu

catio

n, S

D s

tand

ard

devi

atio

n, S

ROC

Spe

arm

an ra

nk o

rder

cor

rela

tion,

VPA

vig

orou

s ph

ysic

al a

ctiv

ity; +

indi

cate

s ≥ 80

%

acce

ptab

le c

orre

latio

ns, ±

indi

cate

s ≥ 50

% to

< 80

% a

ccep

tabl

e co

rrel

atio

ns, –

indi

cate

s < 50

% a

ccep

tabl

e co

rrel

atio

nsa A

ge p

rese

nted

as m

ean

age ±

SD

[ran

ge]

b Bas

ed o

n th

e CO

SMIN

che

cklis

tc St

udy

from

pre

viou

s rev

iew

2834 L. M. Hidding et al.

Tabl

e 4

Mea

sure

men

t err

or o

f phy

sica

l act

ivity

que

stion

naire

s for

you

th so

rted

by a

ge c

ateg

ory

and

met

hodo

logi

cal q

ualit

y

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

h-od

olog

ical

qu

ality

b

Pres

choo

lers

(mea

n ag

e < 6 

year

s) P

resc

hool

-age

Chi

ldre

n’s P

hysi

cal A

ctiv

ity Q

ues-

tionn

aire

(Pre

-PA

Q) [

58]

n = 10

3A

ge: 3

.8 ±

0.74

yea

rsSe

x: 4

8% g

irls

2 w

eeks

Tim

e sp

ent i

n or

gani

zed

activ

ities

: ME

rang

ed fr

om

1.0

to 1

.1 m

inG

ood

Chi

ldre

n (m

ean

age ≥

6 to

< 12

 yea

rs)

 The

EN

ERG

Y-ch

ild q

uesti

onna

ire [4

8]n =

730

Age

: [11

.3 ±

0.5

to 1

2.5 ±

0.6 

year

s]Se

x: [4

7–58

% g

irls]

1 w

eek

Wal

king

to sc

hool

: (no

./day

s) P

oA 8

1%, (

amou

nt o

f tim

e) 7

6%Tr

ansp

ort t

oday

to sc

hool

: PoA

83%

Act

ivity

dur

ing

brea

ks: P

oA 8

6%Sp

ort h

ours

: (fir

st sp

ort)

PoA

55%

; (se

cond

spor

t) 43

%; (

yeste

rday

) 28%

Bik

e to

scho

ol (n

o./d

ays)

: PoA

88%

, (am

ount

of

time)

85%

Fair

 Dut

ch P

hysi

cal A

ctiv

ity C

heck

list f

or C

hild

ren

(PA

Q-C

) [35

]n =

192

Age

: 8.9

± 1.

7 ye

ars [

5–12

]Se

x: 5

3% g

irls

NA

: int

er-r

ater

(par

ent v

s. ch

ild)

Spar

e-tim

e ac

tivity

—sp

orts

: PoA

59.

9%A

ctiv

ity d

urin

g PE

cla

sses

: 71.

4%B

reak

-tim

e ac

tivity

: 74.

0%Lu

ncht

ime

activ

ity: 7

1.9%

Afte

r-sch

ool a

ctiv

ity: 6

7.7%

Even

ing

activ

ity: 7

1.9%

Wee

kend

act

ivity

: 69.

8%A

ctiv

ity fr

eque

ncy

last

7 da

ys: 7

2.4%

Act

ivity

freq

uenc

y du

ring

each

day

: 65.

6%To

tal P

A: 6

5.6%

Fair

 Chi

ldre

n’s L

eisu

re A

ctiv

ities

Stu

dy S

urve

y (C

LASS

) [10

0] c

n = 10

9A

ge: 1

0.6 ±

0.8 

year

s [10

–12]

(in

tota

l sam

ple

n = 11

1)Se

x: 6

3% g

irls

NA

: int

er-r

ater

(par

ent v

s. ch

ild)

Tota

l VPA

: PoA

58.

6%To

tal M

PA: P

oA 8

4.7%

Tota

l PA

: PoA

89.

2%In

divi

dual

act

iviti

es: P

oA ra

nges

from

8.0

% to

97

.8%

Fair

Old

er c

hild

ren

and

adol

esce

nts (

mea

n ag

e ≥ 12

 yea

rs)

 Act

ive

Tran

spor

tatio

n to

scho

ol a

nd w

ork

in

Nor

way

(ATN

) que

stion

naire

(day

s/w

eek

type

of

trans

porta

tion)

[41]

n = 87

Age

: 11–

12 y

ears

Sex:

per

cent

age

girls

unk

now

n

2 w

eeks

Cla

ssifi

catio

n in

maj

or m

ode

of c

omm

utin

g: P

oA

97%

Goo

d

 3-D

ay P

hysi

cal A

ctiv

ity R

ecal

l (3D

PARe

call)

[1

9] c

n = 65

Age

: 12.

5 ± 1.

1 ye

ars

Sex:

64%

girl

s(A

ge a

nd se

x in

tota

l sam

ple

n = 32

0)

1 da

yLi

st of

act

iviti

es: P

oA b

oys r

ange

s fro

m 0

% to

75%

, m

ean

(SD

) 51%

(29)

; girl

s fro

m 1

8% to

75%

, m

ean

(SD

) 47%

(18)

Goo

d

 Sel

f-Adm

inist

ered

Phy

sica

l Act

ivity

Che

cklis

t (S

APA

C) (

mod

ified

) [19

] cn =

84A

ge: 1

2.5 ±

1.1 

year

sSe

x: 6

4% g

irls

(Age

and

sex

in to

tal s

ampl

e n =

320)

1 da

yLi

st of

act

iviti

es: P

oA b

oys r

ange

s fro

m 7

% to

70%

, m

ean

(SD

) 34%

(20)

; girl

s fro

m 2

6% to

75%

, m

ean

(SD

) 42%

(15)

Goo

d

2835An Updated Systematic Review of Childhood Physical Activity Questionnaires

CO

SMIN

CO

nsen

sus-

base

d St

anda

rds f

or th

e se

lect

ion

of h

ealth

Mea

sure

men

t Ins

trum

ents

, ME

mea

sure

men

t err

or, M

PA m

oder

ate

phys

ical

act

ivity

, NA

not a

pplic

able

, PA

phys

ical

act

ivity

, PE

phys

ical

edu

catio

n, P

oA p

erce

ntag

e of

agr

eem

ent,

SD st

anda

rd d

evia

tion,

VPA

vig

orou

s phy

sica

l act

ivity

a Age

pre

sent

ed a

s mea

n ag

e ± S

D [r

ange

]b B

ased

on

the

COSM

IN c

heck

list

c Stud

y fro

m p

revi

ous r

evie

w

Tabl

e 4

(con

tinue

d)

Que

stion

naire

Stud

y po

pula

tiona

Tim

e in

terv

alRe

sults

Met

h-od

olog

ical

qu

ality

b

 Mea

sure

s of i

n-sc

hool

and

out

-of-

scho

ol p

hysi

cal

activ

ity, a

nd tr

avel

beh

avio

rs o

f the

inte

rnat

iona

l H

ealth

y En

viro

nmen

ts a

nd a

ctiv

e liv

ing

in te

en-

ager

s – H

ong

Kon

g [iH

ealt(

H)]

stud

y [4

7]

n = 68

Age

: 15.

4 ye

ars

Sex:

47%

girl

s

13 d

ays (

rang

e: 8

–16 

days

)PE

day

s/w

eek:

PoA

98%

No.

of s

port

team

s or a

fter s

choo

l PA

in sc

hool

: Po

A 7

9%N

o. o

f spo

rt te

ams o

r afte

r sch

ool P

A o

ut-o

f-sc

hool

: Po

A 9

0%Le

isur

e-tim

e PA

: pas

t 7 d

ays P

oA 7

6%, u

sual

wee

k Po

A 6

5%W

alki

ng o

r cyc

ling

to/fr

om d

estin

atio

ns: i

ndoo

r or

exer

cise

faci

lity

76%

, frie

nd’s

or r

elat

ive’

s hou

se

57%

, out

door

recr

eatio

n pl

ace

62%

, foo

d sto

re o

r re

stau

rant

/caf

e 80

%, o

ther

reta

il sto

res 6

2%, n

on-

scho

ol so

cial

or e

duca

tiona

l act

iviti

es 6

8%, p

ublic

tra

nspo

rtatio

n sto

p 69

%, w

ork

100%

, oth

er 1

00%

Tran

spor

tatio

n to

scho

ol: w

alk

PoA

90%

, bic

ycle

10

0%Tr

ansp

orta

tion

from

scho

ol: w

alk

PoA

79%

, bic

ycle

10

0%

Fair

 Dut

ch P

hysi

cal A

ctiv

ity C

heck

list f

or A

dole

scen

ts

(PA

Q-A

) [35

]n =

94A

ge: 1

3.6 ±

1.4 

year

s [12

–17]

Sex:

55%

girl

s

NA

: int

er-r

ater

(par

ent v

s. ch

ild)

Spar

e-tim

e ac

tivity

—sp

orts

: PoA

77.

7%A

ctiv

ity d

urin

g PE

cla

sses

: 73.

4%Lu

ncht

ime

activ

ity: 6

4.9%

Afte

r-sch

ool a

ctiv

ity: 6

9.2%

Even

ing

activ

ity: 7

1.0%

Wee

kend

act

ivity

: 57.

5%A

ctiv

ity fr

eque

ncy

last

7 da

ys: 7

0.2%

Act

ivity

freq

uenc

y du

ring

each

day

: 51.

0%To

tal P

A: 7

0.2%

Fair

2836 L. M. Hidding et al.

3.1 Construct Validity

The construct validity results are summarized in Table 2. Of the 72 questionnaires that were assessed on construct valid-ity, eight were from the previous review. Fifteen of the ques-tionnaires were assessed by two studies, two were assessed by three studies, one by four, one by five, and one by six studies. Six questionnaires were assessed in preschoolers, 29 in children, and 38 in adolescents (one questionnaire was assessed in both children and adolescents). The meth-odological quality rating of the construct validity studies ranged from poor to good: 49 studies received a poor, 49 a fair, and five a good rating. The low methodological scores were predominantly due to comparison measures with unac-ceptable or unknown measurement properties, and a lack of a priori formulated hypotheses. No definite conclusion could be drawn regarding the best available questionnaires

for preschoolers, as studies on construct validity within this age category were of low methodological quality or received negative evidence ratings. For children, the best available questionnaire was found to be the Godin Leisure-Time Exercise Questionnaire [63] (fair methodological qual-ity and positive level 2 evidence). Although the moderate level 2 evidence hampered our ability to draw conclusions on the validity, it is worthwhile to investigate further. We concluded that the most valid questionnaire in adolescents was the Greek version of the 3-Day Physical Activity Record (3DPARecord) [33] (fair methodological quality and posi-tive level 1 evidence rating). Note that the 3DPARecord uses a different format (i.e., different time segments and catego-ries) than the frequently used 3DPARecall.

Fig. 1 Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study inclusion

2837An Updated Systematic Review of Childhood Physical Activity Questionnaires

3.2 Content Validity

Six of the included questionnaires were qualitatively assessed on content validity, one of which was assessed by two studies [25, 26, 34–37]. Studies used cognitive inter-views, semi-structured interviews, and focus groups with children and adolescents and/or experts (e.g., researchers in the field of sports medicine, pediatrics, and measurement) to assess the comprehensibility, relevance of items, and com-prehensiveness of the questionnaires. Due to a lack of details on the methods used regarding testing or developing these questionnaires, the methodological quality of these studies and the quality of the questionnaires could not be assessed. Ten of the included questionnaires were pilot-tested with children and/or parents on, for example, comprehensiveness and time to complete [33, 38–45]. However, again, the study quality could not be assessed due to the minimal amount of information provided. Lastly, 15 of the questionnaires were translated versions [33, 35, 39, 40, 43, 46–53]; the majority of these studies provided little information on the translation processes. These studies did not assess the cross-cultural validity, and thus no definite conclusion about the content validity of the translated questionnaires could be drawn.

3.3 Test–Retest Reliability

The test–retest reliability results are summarized in Table 3. Of the 46 questionnaires assessed on test–retest reliability, five were from the previous review. Four of the question-naires were assessed by two studies. Five questionnaires were assessed in preschoolers, 16 in children, and 26 in adolescents (one questionnaire was assessed in both chil-dren and adolescents). The methodological quality of the studies was rated as follows: 13 scored poor, 26 fair, and 11 good. The majority of poor and fair scores were due to the lack of a description about how missing items were treated and inappropriate time intervals between test and retest. The most reliable questionnaire in preschoolers was the Energy Balance Related Behaviors (ERBs) self-administered pri-mary caregivers questionnaire (PCQ) [46] (fair methodo-logical quality and positive evidence rating). In children, the most reliable questionnaires were the Chinese version of the PAQ-C [43], and the Active Transportation to school and work in Norway (ATN) questionnaire [41] (both good methodological quality and positive evidence rating). The most reliable questionnaires in adolescents were a single-item activity measure [23], and the Web-based and paper-based PAQ-C [28] (both good methodological quality and positive evidence rating).

3.4 Measurement Error

Table 4 summarizes the measurement error outcomes. Of the nine questionnaires assessed on measurement error, two were from the previous review. One questionnaire was assessed in preschoolers, three in children, and five in ado-lescents. Four of the studies received a good methodological quality rating, and five received a fair one. Fair scores were predominantly due to the lack of a description about how missing items were treated.

4 Discussion

This review summarizes studies that assessed the measure-ment properties of physical activity questionnaires for chil-dren and adolescents under the age of 18 years. Question-naires varied in (sub)constructs measured, recall periods, number of questions and format, and different measure-ment properties that were assessed, e.g., construct validity, test–retest reliability, or measurement error. Unfortunately, most studies had low methodological quality scores and low evidence ratings, especially for construct validity. Addition-ally, no questionnaire was identified with both high method-ological quality and positive evidence ratings for reliability and validity. Furthermore, for the majority of questionnaires there was a lack of data on both reliability and validity. Con-sequently, no definite conclusion regarding the most promis-ing questionnaire can be drawn.

4.1 Construct Validity

For adolescents, one valid questionnaire was found, i.e., the Greek version of the 3DPARecord [33]. The 3DPAR-ecord is a questionnaire using a segmented day structure that divides the previous 3 days (1 weekend day) into timeframes of 15 min each, with the adolescents reporting their activity using nine categories ranging from 1 (sleep) to 9 (vigorous physical activity and sport) for each of the timeframes [33].

Due to the predominantly low methodological study qual-ity and negative evidence ratings for study results in children and preschoolers, no valid questionnaires were identified. The low methodological quality of the studies was predomi-nantly due to a lack of a priori formulated hypotheses and the use of comparison measures with unknown or unaccep-table measurement properties. Moreover, in some studies comparisons between non-corresponding constructs were made, e.g., moderate to vigorous physical activity (MVPA) measured by a questionnaire compared with total acceler-ometer counts.

2838 L. M. Hidding et al.

4.2 Test–Retest Reliability and Measurement Error

For preschoolers, one reliable questionnaire was identified: the ERBs self-administered PCQ [46]; two reliable question-naires were identified for children: the Chinese version of the PAQ-C [43] and the ATN questionnaire [41]; and two for adolescents: a single-item activity measure [23] and the web- and paper-based PAQ-C [28].

Many questionnaires received a positive evidence rating but due to the low methodological quality of the studies no definite conclusions regarding their reliability could be drawn. The low methodological quality was mainly due to inappropriate time intervals between test and retest, and the lack of a description about how missing items were handled. Unfortunately, no final evidence rating for measurement error could be computed as none of the studies provided information on the MIC.

4.3 Strengths and Limitations

A strength of this review is the separate assessment of the questionnaire quality (i.e., results for measurement proper-ties) and the methodological quality of the study in which the questionnaire was assessed. This provides transparency in the conclusion regarding the best available questionnaires. Furthermore, data extraction and assessment of methodo-logical quality were carried out by at least two independ-ent researchers, minimizing the chance of bias. In addition, cross-reference searches were carried out, thereby increasing the likelihood of finding all relevant studies. However, we only included English-language studies, disregarding rel-evant studies published in other languages.

4.4 Recommendations for Future Research

Due to the methodological limitations of existing studies, we cannot draw definite conclusions on the measurement prop-erties of physical activity questionnaires. This hampers the identification of the most suitable questionnaires for assess-ing physical activity in children. To improve future research we recommend the following:

• Using standardized tools for the evaluation of measure-ment properties such as COSMIN, to improve the quality of studies examining measurement properties [11, 54];

• Using appropriate translation methods [17];• Using the mode of administration in a validation study

that is intended in the field;• Defining the context of use and the measurement model

of the questionnaire to determine which measurement properties are relevant to examine;

• Conducting more studies assessing content validity to ensure questionnaires are comprehensive and an adequate reflection of the construct to be measured [13, 55];

• For construct validity, choosing a comparison meas-ure that measures a similar construct and formulating hypotheses a priori;

• For reliability studies, test and retest should concern the same day/week when recalling a previous day/week;

• More research on the responsiveness of valid and reliable questionnaires;

• Building on or improving the most promising existing questionnaires rather than developing new question-naires;

• Providing open access to the examined questionnaire; and• Editors of journals to request reviewers and authors to

use a standardized tool such as COSMIN for studies on measurement properties.

5 Conclusions

Unfortunately, conclusive evidence for both validity and reli-ability was not found for any of the identified physical activ-ity questionnaires. The lack of high-quality studies examin-ing both the reliability and the validity of a questionnaire hampered the ability to draw definite conclusions about the best available physical activity questionnaire for children and adolescents. Thus, high-quality methodological studies examining all relevant measurement properties are highly warranted. We strongly recommend researchers adopt stand-ardized tools, e.g., the COSMIN methodology [11, 56, 57], for the design and report of future studies. Current studies using physical activity questionnaires should keep in mind that their results may not adequately reflect children’s and adolescents’ physical activity levels, as most questionnaires lack appropriate validity and/or reliability.

Compliance with Ethical Standards

Funding The contribution of Lisan Hidding was funded by the munici-pality of Amsterdam, Amsterdam Healthy Weight Programme.

Conflict of interest Lisan Hidding, Mai Chinapaw, Mireille van Pop-pel, and Teatske Altenburg declare that they have no conflicts of inter-est. The institute of which Lidwine Mokkink is a part receives royalties for one of the references cited in this review (de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine: a practical guide. 1st ed. Cambridge: Cambridge University Press; 2011).

Open Access This article is distributed under the terms of the Crea-tive Commons Attribution 4.0 International License (http://creat iveco mmons .org/licen ses/by/4.0/), which permits unrestricted use, distribu-tion, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

2839An Updated Systematic Review of Childhood Physical Activity Questionnaires

References

1. Bangsbo J, Krustrup P, Duda J, Hillman C, Andersen LB, Weiss M, et al. The Copenhagen Consensus Conference 2016: children, youth, and physical activity in schools and during leisure time. Br J Sports Med. 2016;50:1177–8.

2. Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40.

3. Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37:531–43.

4. Toftager M, Kristensen PL, Oliver M, Duncan S, Christiansen L, Boyle E, et al. Accelerometer data reduction in adolescents: effects on sample retention and bias. Int J Behav Nutr Phys Act. 2013;10:140.

5. Welk GJ, Corbin CB, Dale D. Measurement issues in the assessment of physical activity in children. Res Q Exerc Sport. 2000;71:59–73.

6. Sallis JF. Self-report measures of children’s physical activity. J Sch Health. 1991;61:215–9.

7. Kohl HW, Fulton JE, Caspersen CJ. Assessment of physical activity among children and adolescents: a review and synthesis. Prev Med. 2000;31:S54–76.

8. Chinapaw MJM, Mokkink LB, van Poppel MNM, van Mechelen W, Terwee CB. Physical activity questionnaires for youth: a systematic review of measurement properties. Sports Med. 2010;40:539–63.

9. Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res. 2009;18:1115–23.

10. Terwee CB, Mokkink LB, Knol DL, Ostelo RWJG, Bouter LM, de Vet HCW. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2012;21:651–7.

11. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN checklist for assessing the meth-odological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539–49.

12. Terwee CB. COSMIN checklist with 4-point scale. 2011. https ://www.cosmi n.nl. Accessed 1 Apr 2016.

13. Hidding LM, Altenburg TM, Mokkink LB, Terwee CB, China-paw MJM. Systematic review of childhood sedentary behavior questionnaires: what do we know and what is next? Sports Med. 2017;47:677–99.

14. de Vet HCW, Mokkink LB, Terwee CB, Hoekstra OS, Knol DL. Clinicians are right not to like Cohen’s κ. BMJ. 2013;346:f2125.

15. Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international con-sensus on taxonomy, terminology, and definitions of measure-ment properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63:737–45.

16. Terwee CB, Bot SDM, de Boer MR, van der Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measure-ment properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42.

17. de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in medicine: a practical guide. 1st ed. Cambridge: Cambridge University Press; 2011.

18. van Poppel MNM, Chinapaw MJM, Mokkink LB, van Mechelen W, Terwee CB. Physical activity questionnaires for adults. Sports Med. 2010;40:565–600.

19. McMurray RG, Ring KB, Treuth MS, Gregory J, Pate RR, Schmitz KH, et al. Comparison of two approaches to structured physical activity surveys for adolescents. Med Sci Sports Exerc. 2008;36:2135–43.

20. Pate RR, Ross R, Dowda M, Trost SG, Sirard JR. Validation of a 3-day physical activity recall instrument in female youth recall. Pediatr Exerc Sci. 2003;15:257–65.

21. Chinapaw MJM, Slootmaker SM, Schuit AJ, van Zuidam M, van Mechelen W. Reliability and validity of the Activity Ques-tionnaire for Adults and Adolescents (AQuAA). BMC Med Res Methodol. 2009;9:58.

22. Slootmaker SM, Schuit AJ, Chinapaw MJM, Seidell JC, van Mechelen W, Sallis J, et al. Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status. Int J Behav Nutr Phys Act. 2009;6:17.

23. Scott JJ, Morgan PJ, Plotnikoff RC, Lubans DR. Reliability and validity of a single-item physical activity measure for adoles-cents. J Pediatr Child Health. 2015;51:787–93.

24. Lubans DR, Sylva K, Osborn Z. Convergent validity and test–retest reliability of the Oxford Physical Activity Questionnaire for secondary school students. Behav Change. 2008;25:23–34.

25. Tucker CA, Bevans KB, Teneralli RE, Smith AW, Bowles HR, Forrest CB. Self-reported pediatric measures of physical activity, sedentary behavior, and strength impact for PROMIS: conceptual framework. Pediatr Phys Ther. 2014;26:376–84.

26. Tucker CA, Bevans KB, Teneralli RE, Smith AW, Bowles HR, Forrest CB. Self-reported pediatric measures of physical activ-ity, sedentary behavior, and strength impact for PROMIS: item development. Pediatr Phys Ther. 2014;26:385–92.

27. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci. 1997;9:174–86.

28. Storey KE, McCargar LJ. Reliability and validity of Web-SPAN, a web-based method for assessing weight sta-tus, diet and physical activity in youth. J Hum Nutr Diet. 2012;25:59–68.

29. Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evi-dence for the physical activity questionnaire for older children. Med Sci Sports Exerc. 1997;29:1344–9.

30. Trost SG, Ward DS, Mcgraw B, Pate RR. Validity of the Previous Day Physical Activity Recall (PDPAR) in fifth-grade children: validity of the previous day physical activity. Pediatr Exerc Sci. 1999;11:341–8.

31. Welk GJ, Dzewaltowski DA, Hill JL. Comparison of the com-puterized ACTIVITYGRAM Instrument and the previous day physical activity recall for assessing physical activity in children. Res Q Exerc Sport. 2004;75:370–80.

32. Trost SG, Marshall AL, Miller R, Hurley JT, Hunt JA. Validation of a 24-h physical activity recall in indigenous and non-indige-nous Australian adolescents. J Sci Med Sport. 2007;10:428–35.

33. Argiropoulou EC, Michalopoulou M, Aggeloussis N, Avgerinos A. Validity and reliability of physical activity measures in Greek high school age children. J Sports Sci Med. 2004;3:147–59.

34. Aggio D, Fairclough S, Knowles Z, Graves L. Validity and reli-ability of a modified english version of the physical activity ques-tionnaire for adolescents. Arch Public Health. 2016;74:3.

35. Bervoets L, Van Noten C, Van Roosbroeck S, Hansen D, Van Hoorenbeeck K, Verheyen E, et al. Reliability and validity of the Dutch Physical Activity Questionnaires for Children (PAQ-C) and Adolescents (PAQ-A). Arch Public Health. 2014;72:47.

36. DiStefano C, Pate R, McIver K, Dowda M, Beets M, Murrie D. Creating a physical activity self-report form for youth using Rasch methodology. J Appl Meas. 2016;17:125–41.

2840 L. M. Hidding et al.

37. Gray HL, Koch PA, Contento IR, Bandelli LN, Ang I, Di Noia J. Validity and reliability of behavior and theory-based psycho-social determinants measures, using audience response system technology in urban upper-elementary schoolchildren. J Nutr Educ Behav. 2016;48:437–52.

38. Saint-Maurice PF, Welk GJ. Validity and calibration of the youth activity profile. PLoS One. 2015;10:e0143949.

39. Tetali S, Edwards P, Murthy GVS, Roberts I. Development and validation of a self-administered questionnaire to estimate the distance and mode of children’s travel to school in urban India. BMC Med Res Methodol. 2015;15:92.

40. Bacardi-Gascón M, Reveles-Rojas C, Woodward-Lopez G, Crawford P, Jiménez-Cruz A. Assessing the validity of a physical activity questionnaire developed for parents of preschool children in Mexico. J Health Popul Nutr. 2012;30:439–46.

41. Bere E, Bjørkelund LA. Test-retest reliability of a new self reported comprehensive adolescents commuting to school and their parents commuting to work—the ATN questionnaire. Int J Behav Nutr Phys Act. 2009;6:68.

42. Lee KS, Trost SG. Validity and reliability of the 3-day physical activity recall in Singaporean adolescents. Res Q Exerc Sport. 2005;76:101–6.

43. Wang JJ, Baranowski T, Lau WP, Chen TA, Pitkethly AJ. Vali-dation of the Physical Activity Questionnaire for Older Chil-dren (PAQ-C) among Chinese children. Biomed Environ Sci. 2016;29:177–86.

44. Thomas EL, Upton D. Psychometric properties of the physical activity questionnaire for older children (PAQ-C) in the UK. Psy-chol Sport Exerc. 2014;15:280–7.

45. Zelener J, Schneider M. Adolescents and self-reported physi-cal activity: an evaluation of the Modified Godin Leisure-Time Exercise Questionnaire. Int J Exerc Sci. 2016;9:587–98.

46. González-Gil EM, Mouratidou T, Cardon G, Androutsos O, De Bourdeaudhuij I, Góźdź M, et al. Reliability of primary caregiv-ers reports on lifestyle behaviours of European pre-school chil-dren: the ToyBox-study. Obes Rev. 2014;15:61–6.

47. Cerin E, Sit CHP, Huang Y-J, Barnett A, Macfarlane DJ, Wong SSH. Repeatability of self-report measures of physical activ-ity, sedentary and travel behaviour in Hong Kong adolescents for the iHealt(H) and IPEN—adolescent studies. BMC Pediatr. 2014;14:142.

48. Singh AS, Vik FN, Chinapaw MJM, Uijtdewilligen L, Verloigne M, Fernández-Alvira JM, et al. Test-retest reliability and con-struct validity of the ENERGY-child questionnaire on energy balance-related behaviours and their potential determinants: the ENERGY-project. Int J Behav Nutr Phys Act. 2011;8:136.

49. Gioxari A, Kavouras SA, Tambalis KD, Maraki M, Kollia M, Sidossis LS. Reliability and criterion validity of the self-admin-istered physical activity checklist in Greek children. Eur J Sport Sci. 2013;1:105–11.

50. Huang YJ, Wong SHS, Salmon J. Reliability and validity of the modified Chinese version of the Children’s Leisure Activi-ties Study Survey (CLASS) questionnaire in assessing physi-cal activity among Hong Kong children. Pediatr Exerc Sci. 2009;21:339–53.

51. Malan GF, Nolte K. Measuring physical activity in South Afri-can grade 2 and 3 learners: a self-report questionnaire versus pedometer testing. S Afr J Res Sport Phys Educ Recreation. 2017;39:79–91.

52. Benítez-porres J, López-Fernández I, Raya JF, Álvarez Carnero S, Alvero-Cruz JR, Álvarez Carnero E. Reliability and validity of the PAQ-C questionnaire to assess physical activity in children. J Sch Health. 2016;86:677–85.

53. Zaragoza Casterad J, Generelo E, Aznar S, Abarca-Sos A, Julián JA, Mota J. Validation of a short physical activity recall

questionnaire completed by Spanish adolescents. Eur J Sport Sci. 2012;12:283–91.

54. Terwee CB, Mokkink LB, Hidding LM, Altenburg TM, van Pop-pel MN, Chinapaw MJM, et al. Comment on “Should we reframe how we think about physical activity and sedentary behavior measurement? Validity and reliability reconsidered”. Int J Behav Nutr Phys Act. 2016;13:66.

55. Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, et al. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27:1159–70.

56. Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW, et  al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27:1147. https ://doi.org/10.1007/s1113 6-018-1798-3

57. Mokkink LB, de Vet HCW, Prinsen CAC, Patrick DL, Alonso J, Bouter LM, et al. COSMIN Risk of Bias checklist for systematic reviews of Patient-Reported Outcome Measures. Qual Life Res. 2018;27:1171. https ://doi.org/10.1007/s1113 6-017-1765-4

58. Dwyer GM, Hardy LL, Peat JK, Baur LA. The validity and reli-ability of a home environment preschool-age physical activity questionnaire (Pre-PAQ). Int J Behav Nutr Phys Act. 2011;8:86.

59. Rice KR, Joschtel B, Trost SG. Validity of family child care providers’ proxy reports on children’s physical activity. Child Obes. 2013;9:393–8.

60. Corder K, Van Sluijs EMF, Wright A, Whincup P, Wareham NJ, Ekelund U. Is it possible to assess free-living physical activity and energy expenditure in young people by self-report? Am J Clin Nutr. 2009;89:862–70.

61. Sarker H, Anderson LN, Borkhoff CM, Abreo K, Tremblay MS, Lebovic G, et al. Validation of parent-reported physical and sed-entary activity by accelerometry in young children. BMC Res Notes. 2015;8:735.

62. Määttä S, Nuutinen T, Ray C, Eriksson JG, Weiderpass E, Roos E. Validity of self-reported out-of-school physical activity among Finnish 11-year-old children. Arch Public Health. 2016;74:11.

63. Eisenmann JC, Milburn N, Jacobsen L, Moore SJ. Reliability and convergent validity of the godin leisure-time exercise question-naire in rural 5th-grade school-children. J Hum Movement Stud. 2002;43:135–49.

64. Ridley K, Olds TS, Hill A. The Multimedia activity recall for children and adolescents (MARCA): development and evalua-tion. Int J Behav Nutr Phys Act. 2006;3:10.

65. Ayala-Guzmán CI, Ramos-Ibáñez N, Ortiz-Hernández L. Accel-erometry does not match with self-reported physical activity and sedentary behaviors in Mexican children. Bol Med Hosp Infant Mex. 2017;74:272–81.

66. Nascimento-Ferreira MV, De Moraes ACF, Toazza-Oliveira PV, Forjaz CLM, Aristizabal JC, Santaliesra-Pasías AM, et al. Reliability and validity of a questionnaire for physical activity assessment in South American children and adolescents: the SAYCARE study. Obesity. 2018;26:S23–30.

67. Colley RC, Wong SL, Garriguet D, Janssen I, Gober SC, Trem-blay MS. Physical activity, sedentary behaviour and sleep in canadian children: parent-report versus direct measures and rela-tive associations with health risk. Health Rep. 2012;23:45–52.

68. Gwynn JD, Hardy LL, Wiggers JH, Smith WT, D’Este CA, Turner N, et al. The validation of a self-report measure and phys-ical activity of Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children. Aust N Z J Public Health. 2010;34:57–65.

69. Van Hoye A, Nicaise V, Sarrazin P. Self-reported and objec-tive physical activity measurement by active youth. Sci Sports. 2014;29:78–87.

2841An Updated Systematic Review of Childhood Physical Activity Questionnaires

70. Tremblay MS, Inman JW, Willms JD. Preliminary evaluation of a video questionnaire to assess activity levels of children. Med Sci Sports Exerc. 2001;33:2139–44.

71. Moore HJ, Ells LJ, McLure SA, Crooks S, Cumbor D, Sum-merbell CD, et al. The development and evaluation of a novel computer program to assess previous-day dietary and physical activity behaviours in school children: the Synchronised Nutri-tion and Activity Program (SNAP). Br J Nutr. 2008;99:1266–74.

72. Harro M. Validation of a questionnaire to assess physical activity of children ages 4-8 years. Res Q Exerc Sport. 1997;68:259–68.

73. Bringolf-Isler B, Mäder U, Ruch N, Kriemler S, Grize L, Braun-Fahrländer C. Measuring and validating physical activity and sedentary behavior comparing a parental questionnaire to accel-erometer data and diaries. Pediatr Exerc Sci. 2012;24:229–45.

74. Muthuri SK, Wachira LJM, Onywera VO, Tremblay MS. Direct and self-reported measures of physical activity and sedentary behaviours by weight status in school-aged children: results from ISCOLE-Kenya. Ann Hum Biol. 2015;42:239–47.

75. Børrestad L, Østergaard L, Andersen LB, Bere E. Associations between active commuting to school and objectively measured physical activity. J Phys Act Health. 2012;10:826–32.

76. Reichert FF, Menezes AMB, Araujo CL, Hallal PC. Self-report-ing versus parental reporting of physical activity in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. Cad Saude Publica. 2010;26:1921–7.

77. Veitch J, Salmon J, Ball K. The validity and reliability of an instrument to assess children’s outdoor play in various locations. J Sci Med Sport. 2009;12:579–82.

78. Sithole F, Veugelers PJ. Parent and child reports of children’s activity. Health Rep. 2008;19:19–24.

79. Rääsk T, Lätt E, Jürimäe T, Mäestu J, Jürimäe J, Konstabel K. Association of subjective ratings to objectively assessed physical activity in pubertal boys with differing BMI. Percept Mot Skills. 2015;121:245–59.

80. Beltrán-Carrillo VJ, González-Cutre D, Sierra AC, Jiménez-Loaisa A, Ferrández-Asencio MÁ, Cervelló E. Concurrent and criterion validity of the 7 Day-PAR in Spanish adolescents. Eur J Hum Mov. 2016;36:88–103.

81. McCrorie PRW, Perez A, Ellaway A. The validity of the Youth Physical Activity Questionnaire in 12–13-year-old Scottish ado-lescents. BMJ Open Sport Exerc Med. 2016;2:e000163.

82. Rääsk T, Maëstu J, Lätt E, Jürimäe J, Jürimäe T, Vainik U, et al. Comparison of IPAQ-SF and two other physical activity ques-tionnaires with accelerometer in adolescent boys. PLoS One. 2017;12:e0169527.

83. Troped PJ, Wiecha JL, Fragala MS, Matthews CE, Finkelstein DM, Kim J, et al. Reliability and validity of YRBS physical activity items among middle school students. Med Sci Sports Exerc. 2007;39:416–25.

84. Wang C, Chen P, Zhuang J. Validity and reliability of Interna-tional Physical Activity Questionnaire-Short Form in Chinese youth. Res Q Exerc Sport. 2013;84:S80–6.

85. Murphy MH, Rowe DA, Belton S, Woods CB. Validity of a two-item physical activity questionnaire for assessing attainment of physical activity guidelines in youth. BMC Public Health. 2015;15:1080.

86. Dollman J, Stanley R, Wilson A. The concurrent validity of the 3-Day Physical Activity Recall in Australian youth. Pediatr Exerc Sci. 2015;27:262–7.

87. Ridgers ND, Timperio A, Crawford D, Salmon J. Validity of a brief self-report instrument for assessing compliance with physi-cal activity guidelines amongst adolescents. J Sci Med Sport. 2012;15:136–41.

88. Kowalski KC, Crocker PRE, Kowalski NP. Convergent validity of the physical activity questionnaire for adolescents. Pediatr Exerc Sci. 1997;9:342–52.

89. Al-Hazzaa HM, Al-Sobayel HI, Musaiger AO. Convergent valid-ity of the Arab teens lifestyle study (ATLS) physical activity questionnaire. Int J Environ Res Public Health. 2011;8:3810–20.

90. Gråsten A, Watt A. A comparison of self-report scales and accelerometer-determined moderate to vigorous physical activ-ity scores of Finnish school students. Meas Phys Educ Exerc Sci. 2016;20:220–9.

91. Hallal PC, Reichert FF, Clark VL, Cordeira KL, Menezes AMB, Eaton S, et al. Energy expenditure compared to physical activ-ity measured by accelerometry and self-report in adolescents: a validation study. PLoS One. 2013;8:e77036.

92. Stanley R, Boshoff K, Dollman J. The concurrent validity of the 3-day Physical Activity Recall questionnaire administered to female adolescents aged 12–14 years. Aust Occup Ther J. 2007;54:294–302.

93. Campbell N, Gaston A, Gray C, Rush E, Maddison R, Prapa-vessis H. The Short QUestionnaire to ASsess Health-enhancing (SQUASH) physical activity in adolescents: a validation study using doubly labeled water. J Phys Act Health. 2016;13:154–8.

94. Ottevaere C, Huybrechts I, De Bourdeaudhuij I, Sjöström M, Ruiz JR, Ortega FB, et al. Comparison of the IPAQ-A and Acti-graph in relation to VO2max among European adolescents: the HELENA study. J Sci Med Sport. 2011;14:317–24.

95. Martínez-Gómez D, Calabro MA, Welk GJ, Marcos A, Veiga OL. Reliability and validity of a school recess physical activity recall in Spanish youth. Pediatr Exerc Sci. 2010;22:218–30.

96. Ekelund U, Neovius M, Linne Y, Rossner S. The criterion valid-ity of a last 7-day physical activity questionnaire (SAPAQ) for use in adolescents with a wide variation in body fat: the Stock-holm Weight Development Study. Int J Obes. 2006;30:1019–21.

97. LeBlanc AGW, Janssen I. Difference between self-reported and accelerometer measured moderate-to-vigorous physical activity in youth. Pediatr Exerc Sci. 2010;22:523–34.

98. Sallis JF, Buono MJ, Roby JJ, Micale FG, Nelson JA. Seven-day recall and other physical activity self-reports in children and adolescents. Med Sci Sports Exerc. 1993;25:99–108.

99. Tian H, Du Toit D, Toriola AL. Validation of the Children’s Leisure Activities Study Survey Questionnaire for 12-year old South African children. Afr J Phys Health Educ Recreat Dance. 2014;20:1572–86.

100. Telford A, Salmon J, Jolley D, Crawford D. Reliability and valid-ity of physical activity questionnaires for children: the Children’s Leisure Activities Study Survey (CLASS). Pediatr Exerc Sci. 2004;16:64–78.

101. Bonn SE, Surkan PJ, Trolle Lagerros Y, Bälter K. Feasibility of a novel web-based physical activity questionnaire for young children. Pediatr Rep. 2012;4:127–9.

102. Treuth MS, Sherwood NE, Butte NF, McClanahan B, Obarzanek E, Zhou A, et al. Validity and reliability of activity measures in African–American Girls for GEMS. Med Sci Sports Exerc. 2003;35:532–9.

103. Strugnell C, Renzaho A, Ridley K, Burns C. Reliability of the modified child and adolescent physical activity and nutrition sur-vey, physical activity (CAPANS-PA) questionnaire among Chi-nese–Australian youth. BMC Med Res Methodol. 2011;11:122.

104. Costa-Tutusaus L, Guerra-Balic M. Development and psycho-metric validation of a scoring questionnaire to assess healthy lifestyles among adolescents in Catalonia. BMC Public Health. 2015;16:89.

105. Barbosa N, Sanchez CE, Vera JA, Perez W, Thalabard J-C, Rieu M. A physical activity questionnaire: reproducibility and validity. J Sports Sci Med. 2007;6:505–18.

106. Rangul V, Holmen TL, Kurtze N, Cuypers K, Midthjell K, Bid-dle S, et al. Reliability and validity of two frequently used self-administered physical activity questionnaires in adolescents. BMC Med Res Methodol. 2008;8:47.

2842 L. M. Hidding et al.

107. Liu Y, Wang M, Tynjälä J, Lv Y, Villberg J, Zhang Z, et al. Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China. BMC Med Res Methodol. 2010;10:73.

108. Bobakova D, Hamrik Z, Badura P, Sigmundova D, Nalecz H, Kalman M. Test–retest reliability of selected physical activity

and sedentary behaviour HBSC items in the Czech Republic, Slovakia and Poland. Int J Public Health. 2014;60:59–67.

109. Prochaska JJ, Sallis JF, Long B. A physical activity screening measure for use with adolescents in primary care. Arch Pediatr Adolesc Med. 2001;155:554–9.