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  2. Yale Physical Activity Survey

Yale Physical Activity Survey

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Purpose

A two-part interview that describes the amount, as indicated by energy and time, and types of physical activity in the older adult population.

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Instrument Details

Acronym YPAS

Area of Assessment

Activities of Daily Living

Assessment Type

Patient Reported Outcomes

Cost

Free

Actual Cost

$0.00

Populations

Pulmonary Diseases
Older Adults and Geriatric Care
Arthritis

Key Descriptions

  • YPAS has 2 sections that provide 3 summary indices and a seasonal adjustment score, all of which are calculated as a recall of physical activity in a typical week in the past month:

    1. Total time in hours/week
    2. Total energy expenditure in Kcal/week
    3. Total activity summary index score with no units
  • Part one: 32 items
    Part one min score: 0 kcal/week
    Part one max score: 85,680 kcal/week
    Part one scoring: Each activity item time estimate (in minutes) is multiplied by an intensity code. Each activity is summed to estimate the kcal/week expended by the patient.
  • Part two: 8 items
    Part two min score: 0
    Part two max score: 142
    Part two scoring: Each item represents either a duration score or frequency score as estimated by the patient. These scores are multiplied for each of the subjections, and then weighted. The scores of each subsection are then summed to create the patient’s activity index score.
  • Seasonal adjustment score= Sum of all seasons/4.
    Minimum score = 0.7
    Maximum score = 1.3
  • Patient and interviewer instructions are provided on the survey.

Number of Items

41

Equipment Required

  • writing utensil
  • questionnaire

Time to Administer

20 minutes

Required Training

No Training

Instrument Reviewers

Sonal Nikam PT, MHS & Tyler Helm, PT, DPT

ICF Domain

Activity

Measurement Domain

Participation & Activities

Considerations

  • Reliability has been tested in diverse populations and is generally moderate to excellent (De Abajo, et al., 2001) (Kobe-Alexander, et al., 2006) (Gennuso, et al, 2013) (Machado, et al., 2016) (Dipietro, et al., 1993) but validity is poor to adequate (Kolbe-Alexander, et al., 2006) (Bonnefoy, et al., 2001) (De Abajo, et al., 2001).
  • The survey shows good internal consistency but testing has been limited (Machado, et al., 2016).
  • Studies are lacking in several areas, particularly with validity normative data, cut-off scores, MCID, validity, floor/ceiling effects, and responsiveness.

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

 

Older Adults: (Calculated from Dipietro, et al., 1993; Repeatability sample n=25; mean age = 71.1(6.3) years; Spanish sample)

Activity

SD

r

SEM Image removed.

SD* √(1-ICC)

 

Shopping

2.6

0.52

1.80

Stairs/load

1.8

0.29

1.52

Laundry

1.2

0.51

0.84

Light Housework

3.3

0.38

2.60

Heavy Housework

2.6

0.20

2.33

Preparing Food

3.5

0.43

2.64

Serving Food

2.8

0.34

2.28

Dishwashing

1.7

0.60

1.08

Light Repair

0.6

0.30

1.26

Heavy Repair

0.14

0.98

0.50

Gardening

0.40

0.48

2.02

Lawn Mowing

0.13

0.62

0.31

Raking/Sweeping

0.32

0.55

0.74

Adult Care

0.06

0.18

1.09

Child Care

0.08

0.29

2.44

Brisk Walking

0.27

0.53

1.30

Stretch/Yoga

0.39

0.26

1.20

Calisthenics

0.22

0.84

0.52

Cycling

0.10

0.90

0.13

Swimming Laps

0.17

0.86

0.45

Leisure Walk

0.56

0.24

2.35

Needlework

0.33

0.91

1.95

Dancing

0.23

0.92

0.76

Bowling

0.06

0.75

0.40

Golf

0.06

0.96

0.54

Billiards

0.09

0.97

0.47

Racquet Sports

N/A

 

 

Minimal Detectable Change (MDC)

Older Adults: (Calculated from Dipietro, et al., 1993)

Activity

SEM

MDC

1.96*SEM*√2

Shopping

1.80

4.99

Stairs/load

1.52

4.21

Laundry

0.84

2.33

Light Housework

2.60

7.21

Heavy Housework

2.33

6.45

Preparing Food

2.64

7.32

Serving Food

2.28

6.31

Dishwashing

1.08

2.98

Light Repair

1.26

3.48

Heavy Repair

0.50

1.37

Gardening

2.02

5.60

Lawn Mowing

0.31

0.85

Raking/Sweeping

0.74

2.05

Adult Care

1.09

3.01

Child Care

2.44

6.77

Brisk Walking

1.30

3.61

Stretch/Yoga

1.20

3.34

Calisthenics

0.52

1.44

Cycling

0.13

0.35

Swimming Laps

0.45

1.25

Leisure Walk

2.35

6.52

Needlework

1.95

5.41

Dancing

0.76

2.12

Bowling

0.40

1.11

Golf

0.54

1.50

Billiards

0.47

1.30

Racquet Sports

N/A

 

Test/Retest Reliability

Spanish Elderly: (De Abajo, Larriba, and Marquez, 2001; n=108 (males n=38 & females n=70), mean age males = 69.8 (7.1) years; mean age females = 67.7 (6.4) years; Spanish sample)

  • Adequate test-retest reliability, time (ICC=0.66)
  • Adequate test-retest reliability, energy expenditure (ICC=0.65)
  • Poor test-retest reliability for activity summary index, ICC=0.31

South African Elderly: (Kolbe-Alexander, et al., 2006; n=122 (males n=52 & females n=70), mean age males = 68 (5.4) years; mean age female = 66 (5.8) years; South African sample)

  • Adequate test-retest reliability, Men energy expenditure (Spearman=0.57)
  • Adequate test-retest reliability, Women energy expenditure (Spearman = 0.62)

Older Adults: (Gennuso, et al., 2013; n=58, mean age=75.1 (6.5) years)

  • Adequate test-retest reliability (ICC=0.59)

 

 

Portuguese Elderly: (Machado, Tavares et al,2016; n=30, mean age=71.9(3.9) years,43.3 % women)

  • Excellent test-retest reliability, time (ICC = 0.925)
  • Excellent test-retest reliability, energy expenditure (ICC = 0.921)
  • Adequate test-re-test reliability, activity summary index (ICC = 0.650

 

Older Adults: (Dipietro, et al., 1993)

  • Adequate test-retest reliability, time (ICC=0.57)
  • Adequate test-retest reliability, energy expenditure (ICC=0.58)
  • Adequate test re-test reliability, summary (ICC=0.65)
  • Adequate test retest reliability for activity dimensions, (ICC=0.65)
  • Adequate test retest reliability for sitting subscore, (ICC=0.42)
  • Adequate test retest reliability for vigorous, (ICC=0.61)

(Schuler, Richardson, Ochoa, & Wang,2001; women n=31, mean age = 68(8) years, range = 56-86 years; men n=25, mean age = 68(6) years, range = 55-79 years)

  • Adequate test retest reliability for total time,(ICC=0.74)
  • Adequate test retest reliability for total energy expenditure, (ICC=0.72)          
  • Adequate test retest reliability for activity summary index, (ICC=0.55)
  • Adequate test retest reliability for vigorous, (ICC=0.48)
  • Adequate test retest reliability for walking, (ICC= 0.41)
  • Adequate test retest reliability for moving, (ICC=.60)
  • Poor test retest reliability for standing, (ICC=0.22)
  • Poor test retest reliability for sitting, (ICC= 0.13)

 

Older Mexican American adults: (Pennathur, Magham, Contreras, & Dowling, 2004; n=15, mean age = 77.67(8.49) years)

  • Adequate test-retest reliability or estimated energy expenditure, (ICC=0.437 and Spearman’s correlation co-efficient r =0.626)

Portuguese older adults: (Machado, et al., 2016)

  • Excellent test re-test reliability for total time, (ICC=0.925)
  • Excellent test re-test reliability for energy expenditure, (ICC=0.921)
  • Adequate test re-test reliability for activity summary index, (ICC= 0.650)

Internal Consistency

Portuguese Elderly: (Machado, et al., 2016)

  • Excellent internal consistency for activity checklist of Portuguese version (Cronbach's alphas>0.835)
  • Poor internal consistency for total time in minutes/week dimension of YPAS-Portuguese version (Cronbach’s alpha < 0.454)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

South African Elderly: (Kolbe-Alexander, et al., 2006)

  • Adequate validity for energy expenditure vs. accelerometer, moderate activity men (Spearman rank order correlation = 0.31)
  • Adequate validity for energy expenditure vs. accelerometer, continuous activity women (Spearman rank order correlation = 0.35)
  • Poor relationship for validity energy expenditure vs accelerometer, moderate activity women (Spearman rank order correlation = -0.17)
  • Poor relationship for validity energy expenditure vs accelerometer, continuous activity women (Spearman rank order correlation = -0.19)
  • Adequate validity for energy expenditure vs. accelerometer, exercise men (Spearman rank order correlation = 0.40)
  • Poor validity for energy expenditure vs. accelerometer, exercise women (Spearman rank order correlation = 0.29)

Older Men: (Bonnefoy, et al., 2001; n=19, mean age = 73.4 (4.1) years; French sample)

  • Poor correlation with total energy expenditure summary index vs. contemporary questionnaires, (Spearman rank order correlation = 0.11)

Older Adults: (Dipietro et al,1993)

  • Adequate validity and positive correlation of YPAS activity dimension summary index with estimated V02max, Spearman rank correlation coefficient, (r = 0.58)
  • Adequate validity and negative correlation of YPAS activity dimension summary index with body fat percent, Spearman rank correlation coefficient, (r = -0.43)
  • Adequate validity of sitting activity index with resting diastolic blood pressure, Spearman rank correlation coefficient, (r = 0.53)
  • Adequate validity and positive correlation of vigorous activity index with estimated vo2 max, Spearman rank correlation coefficient, (r = 0.60)
  • Poor validity and negative correlation of moving activity index with body mass index, Spearman rank correlation coefficient, (r = -0.37)

(Gennuso, et al., 2013)

  • Poor agreement with accelerometer for sedentary time (𝜿= -0.0003)

Portuguese older adults: (Machado, et al., 2016)

•     Adequate validity of YPAS total time and accelerometer measured time for moderate to vigorous, Spearman’s correlation coefficient, r = 0.408

•     Adequate validity of YPAS time-moderate to vigorous activity and accelerometer measured time for moderate to vigorous, r = 0.396

•     Adequate validity of YPAS of total energy expenditure and accelerometer measured time for moderate to vigorous activity, r = 0.305

•     Adequate validity of YPAS energy expenditure-moderate to vigorous and accelerometer measured time for moderate to vigorous activity, r = 0.363

•     Adequate validity and negative correlation of sitting activity index and accelerometer measured time for moderate to vigorous activity, r = -0.305

Construct Validity

Spanish Elderly: (De Abajo, et al., 2001)

  • Adequate validity for YPAS sitting index vs. diastolic blood pressure (Pearson product correlation= 0.5)
  • Poor validity for YPAS sitting vs. weight (Pearson product correlation =0.20)
  • Poor validity for YPAS sitting vs. skinfold measures (Pearson product correlation =0.02)
  • Poor validity for YPAS energy expenditure vs. weight (Pearson product correlation = -0.25)

Elderly: (Colbert, et al., 2011; n = 56, mean age = 74.7 (6.5) years)

  • Poor correlation with energy expenditure (Spearman correlation coefficient = 0.074)
  • Poor correlation with energy expenditure adjusted for body weight (Spearman correlation coefficient = 0.093)

(Harada et al, 2001; n=87, mean age = 75(6) years, range = 65-89 years)

  • Excellent validity and positive correlation of YPAS and PASE, (r = 0.61)
  • Adequate validity and positive correlation of YPAS total energy expenditure and activity count on Mini-Log ankle,

(r = 0.46)

  • Excellent validity and positive correlation of YPAS total energy expenditure and activity count on Mini-Log waist,

(r = 0.61)

  • Adequate validity and positive correlation of YPAS total energy expenditure and EPESE lower body functioning,

(r = 0.49)

  • Adequate validity and positive correlation of YPAS total energy expenditure and 6-minute walk test, (r = 0.58)
  • Poor validity and negative correlation of YPAS total energy expenditure and body mass index, (r = - 0.10)
  • Adequate validity and positive correlation of YPAS total energy expenditure and SF-36-physical function, (r = 0.31)
  • Adequate validity and positive correlation of YPAS total energy expenditure and SF-36-general health, (r = 0.31)
  • Poor validity and positive correlation of YPAS total energy expenditure and SF-36-mental health, (r = 0.24)
  • Poor validity and positive correlation of YPAS total energy expenditure and SF-36- pain, (r = 0.23)

  Spanish Elderly women: (Martin et al, 2011; n=44, mean age = 68.1(5.4) years)

  • Adequate validity and positive correlation of YPAS energy expenditure and walked distance on 6MWT, (Spearman’s correlation coefficient = 0.380)
  • Adequate validity and positive correlation between YPAS total time and walked distance on 6MWT, (Spearman’s correlation coefficient = 0.349)

Pulmonary Diseases

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Criterion Validity (Predictive/Concurrent)

COPD: (Donaire-Gonzalez et al,2011)

  • Adequate validity of YPAS activity dimensions summary index and steps on monitor, Spearman’s correlation coefficient, (r = 0.52)
  • Adequate validity of YPAS activity dimensions’ summary index and Time of Activity ≥1.4 MET on monitor, Spearman’s correlation coefficient, (r = 0.38)
  • Adequate validity of YPAS activity dimensions summary index and MET of Activity ≥1.4 MET on monitor, Spearman’s correlation coefficient, (r = 0.42)
  • Adequate validity of YPAS activity dimensions summary index and energy expenditure of Activity ≥1.4 MET on monitor, Spearman’s correlation coefficient, (r = 0.43)
  • Adequate validity of YPAS activity dimensions summary index and distance walked on 6MWT Spearman’s correlation coefficient, (r = 0.40)
  • Knee Osteoarthritis (Semanik et al,2011; n=139, mean age = 63(13) years)
  • Adequate validity between YPAS activity dimensions summary index and average daily minutes of bouted moderate, vigorous activity, (r =0.36)
  • Poor validity between YPAS activity dimensions summary index and average daily counts, (r =0.24)

Face Validity

COPD: (Donaire-Gonzalez et al,2011; n=172, mean age = 70 (8) years, Spanish sample)

Performance of the Physical Activity Summary Index of the YPAS in order to Identify sedentary Individuals (Defined as <30 minutes/day of moderate physical activity for 8 days in 172 patients with COPD, answered questionnaire 15 days later)

Activity summary index

Sensitivity

Specificity

Positive predictive value

Negative predictive value

Kappa

Score 38

54%

81%

78%

59%

0.32

Score 47

71%

64%

71%

64%

0.35

Score 51

75%

59%

69%

66%

0.34

Arthritis

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Criterion Validity (Predictive/Concurrent)

Rheumatoid Arthritis: (Semanik et al,2010; n=69, range = 20-81 years)

  • Adequate validity of activity dimension index summary with average accelerometer counts/day, Spearman correlation coefficient, r = 0.421
  • Adequate validity of total time with average accelerometer counts/day, Spearman’s correlation coefficient, r = 0.451
  • Adequate validity of energy expenditure with average accelerometer counts/day, Spearman’s correlation coefficient, r = 0.515
  • Adequate validity of activity dimension index summary with total moderate/vigorous accelerometer minutes, Spearman correlation coefficient, r = 0.432
  • Adequate validity of total time with total moderate/vigorous accelerometer minutes, Spearman correlation coefficient, r = 0.523
  • Adequate validity of energy expenditure with total moderate/vigorous accelerometer minutes, Spearman correlation coefficient, r = 0.566.

 

(Semanik et al,2011; n=171, mean age = 55(14) years)

  • Adequate validity between YPAS activity dimensions summary index and average daily minutes of bouted moderate/vigorous activity, r = 0.51
  • Adequate validity between YPAS activity dimensions summary index and measured average daily accelerometer counts, r = 0.45
  • Adequate validity between YPAS activity dimensions summary index and average daily minutes of moderate vigorous activity, r=0.43

Bibliography

Bonnefoy, M, Normand S, Pachiaudi C, Lacour R, Laville M, Kostka T. Simultaneous Validation of Ten Physical Activity Questionnaires in Older Men: A Doubly Labeled Water Study. Journal of the American Geriatrics Society. 2001;49(1):28-35. doi:10.1046/j.1532-5415.2001.49006.x. Find it on PubMed

Colbert LH, Matthews CE, Havighurst TC, Kim K, Schoeller DA.  Comparative validity of physical activity measures in older adults. Med Sci Sports Exerc. 2011 May;43(5):867-76. Find it on Pubmed

De Abajo S, Larriba R, Marquez S. Validity and reliability of the Yale Physical Activity Survey in Spanish Elderly. J Sports Med Phys Fitness. 2001;41:479-485. Find it on Pubmed

Dipietro L, Caspersen C, Ostfeld A, Nadel ER. A survey for assessing physical activity among older adults. Medicine and Science In Sports And Exercise. May 1993;25(5):628-642. Find it on Pubmed

Donnaire-Gonzalez D, Gimeno-Santos E, Serra I, Roca J, Balcells E, Rodríguez E, et al. Validation of the Yale Physical Activity Survey in Chronic Obstructive Pulmonary Disease patients. Arch Bronconeumol. 2011; 47: 552-560. Find it on PubMed

Gennuso KP, Matthews CE, Colbert LH. Reliability and Validity of 2 Self-Report Measures to Assess Sedentary Behavior in Older Adults. Journal of Physical Activity and Health. 2015;12(5):727-732. doi:10.1123/jpah.2013-0546. Find it on Pubmed

Gilbert, A. L., Lee, J., Ma, M., Semanik, P. A., DiPietro, L., Dunlop, D. D., & Chang, R. W. Comparison of subjective and objective measures of sedentary behavior using the Yale Physical Activity Survey and accelerometry in patients with Rheumatoid Arthritis. Journal of Physical Activity & Health.2016;13(4): 371-376.

Harada ND, Chiu V, King AC, Stewart AL. An evaluation of three self-report physical activity instruments for older adults. Med Sci Sports Exerc. 2001; 33: 962-970.

Kolbe-Alexander TL, Lambert EV, Harkins JB, Ekelund U. Comparison of Two Methods of Measuring Physical Activity in South African Older Adults. Journal of Aging and Physical Activity. 2006;14(1):98-114. doi:10.1123/japa.14.1.98. Find it on Pubmed

Machado M. Validation of YPAS-PT – The Yale Physical Activity Survey for Portuguese Older People. Science Journal of Public Health. 2016;4(1):72. doi:10.11648/j.sjph.20160401.20.

Martín V, Ayán C, Molina AJ, Alvarez MJ, Varela S, Cancela JM. Correlation between the Yale Physical Activity Survey (YPAS) and submaximal performance-based test: a study in a population of elderly Spanish women.” Arch Gerontol Geriatr. 2012; 55(1): 31-34.

Pennathur A, Magham R, Contreras Lr, Dowling W. Test retest reliability of Yale Physical Activity Survey among older Mexican American adults: a pilot investigation. Exp Aging Res. 2004; 30(3): 291-303. Find it on PubMed

Schuler PB, Richardson MT, Ochoa P, Wang MQ. Accuracy and repeatability of the Yale Physical Activity Survey in assessing physical activity of older adults. Percept Mot Skills.2001;93(1): 163-177.

Semanik P, Dunlop D, Song J et al. Validation of The Yale Physical Activity Survey in Persons with Rheumatoid Arthritis: 2036: Board #165 June 3 8:00 AM - 9:30 AM. Medicine and Science in Sports and Exercise. 2010; 42(5): 486.

Semanik P, Lee J, Manheim L, Dipietro L, Dunlop D, Chang RW. Relationship between accelerometer-based measures of physical activity and the Yale Physical Activity Survey in adults with arthritis. Arthritis Care Res. 2011; 63 (12): 1766- 1772. Find it on PubMed

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