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Keywords:

  • longitudinal study;
  • motor activity;
  • pregnancy;
  • questionnaire;
  • reproducibility

ABSTRACT

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies

Objective

To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese.

Design

This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity.

Setting

A university hospital in Tokyo, Japan.

Participants

Sixty-nine pregnant women living in Tokyo and its suburbs were recruited.

Methods

The test–retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test–retest reliability. The data of 54 participants were used to analyze criterion validity.

Results

The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, −.21 to −.25 for vigorous activity, −.09 to .38 for moderate activity, and .01 to .28 for light activity.

Conclusion

The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Overall, approximately 259,575 Japanese women live in North America as either expatriates or permanent residents (Ministry of Foreign Affairs of Japan [MOFA], 2012). Furthermore, many of these Japanese women living in the United States are of childbearing age and receive prenatal care. It is necessary to provide sufficient guidance to these women so that they might live a healthful lifestyle similar to that of women living in Japan. Assessing physical activity (PA) is an important part of promoting health during pregnancy, given that PA is known to reduce the risk of depressive symptoms (Loprinzi, Fitzgerald, & Cardinal, 2012). Although most clinically applicable assessment tools for PA are self-administered questionnaires, few surveys exist that are specific to pregnant women. Furthermore, no available questionnaire has been adjusted for women who speak little English and who maintain a lifestyle that is more similar to that of their native country than to that of the United States. Thus, a need for a reliable, linguistically and culturally appropriate tool has been identified for assessing PA in Japanese expatriates receiving prenatal care in the United States.

Two questionnaires are typically used to assess PA in pregnant women: the Kaiser Physical Activity Survey (KPAS) (Ainsworth, Sternfeld, Richardson, & Jackson, 2000) and the Pregnancy Physical Activity Questionnaire (PPAQ) (Chasan-Taber et al., 2004). Of the two measures, the PPAQ is more widely used in the United States, Vietnam, and France (Chandonnet, Saey, Almeras, & Marc, 2012; Chasan-Taber et al., 2004; Ota et al., 2008) than is the KPAS. We intended to develop a questionnaire for Japanese expatriate women whose first language is Japanese and who live in the United States, because a significant number of Japanese women who give birth in the United States are expatriates. The PPAQ is based on Ainsworth, Haskell, et al.'s (2000) compendium of physical activities that measures the average daily energy expenditure (metabolic equivalents [METs] × hours/day) by the calculation of the duration of time spent in each activity multiplied by its intensity. Ainsworth, Bassett et al. (2000) and Ainsworth, Haskell et al. (2000) defined the intensity of each activity as <1.5 METs for sedentary activity, 1.5 to <3.0 for light activity, 3.0 to <6.0 for moderate activity, and ≥6.0 for vigorous activity. The duration of time spent on each activity was defined according to participants’ responses.

In a previous study, we reported the English to Japanese translated version of the PPAQ (PPAQ-J) had cross-cultural equivalency with the original English version (Matsuzaki et al., 2010). However, the reliability and criterion validity of the PPAQ-J had not yet been demonstrated.

No reliable and valid tools are available in a questionnaire format for assessing the physical activity of pregnant Japanese women.

Thus, the initial study had two aims: (1) translation of the existing questionnaire into Japanese and (2) assessment of the validity of this questionnaire in terms of its ability to estimate energy expenditure and the reliability in terms of its variability among women in Japan. The results of the first aim were published elsewhere (Matsuzaki et al., 2010); in this article we present the results for second aim. We decided to test the validity and reliability of the tool with women living in Japan instead of expatriates living in the United States for practical reasons because the investigators who translated it currently reside in Japan.

Methods

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies

Setting and Participants

This longitudinal study testing the reliability and criterion validity of the PPAQ-J was conducted at a university hospital in Tokyo from June 2007 to July 2008. This university-affiliated hospital is a tertiary center, has about 900 births per year, and serves pregnant women from Tokyo and its suburbs. We chose this hospital as the research setting because of its convenience for field research and because the reliability and validity could be assured by recruiting a wide range of participants of varying ages, working status, pregnancy trimester, education, and living area (Portney & Watkins, 1993).

A total of 69 eligible pregnant women were recruited using convenience sampling over 9 days from June 2007 to July 2008. The participants were recruited while they were waiting for a pregnancy check-up in the hospital. We recruited each participant by giving her a description of the research, after which we obtained her informed consent; of the 69 recruited women, 60 consented to participate. The incentive for participation was a picture book for the child or a shopping coupon worth $5.00 ($1 = \100 in 2008), as well as an individual report of the actigraph results. The research protocol was approved by the research ethics committee of the Graduate School of Medicine, The University of Tokyo.

A sample of 55 pregnant women was necessary to ensure sufficient reliability and validity according to the developmental method of the original PPAQ (Chasan-Taber et al., 2004). The eligibility criteria included women with (a) a singleton pregnancy without complications and (b) the ability to read and speak Japanese.

Procedures

Recruitment occurred within the outpatient department. After written informed consent, participants completed the PPAQ-J and a questionnaire about their demographic characteristics, and their weights were measured. For the subsequent sessions that took place 7 and 14 days after recruitment, the PPAQ-J and weight measurements were conducted in the participants’ homes. During that same period, the participants wore an actigraph (Manufacturing Technology, Inc., Fort Walton Beach, FL, USA, formerly known as the Computer Science Application [CSA] accelerometer) so that we could determine criterion validity. For 14 days after recruitment, the actigraph was placed on an adjustable belt on the right hip under participants’ clothing during active hours, except during bathing, showering, swimming, and sleeping (Melanson & Freedson, 1995). Throughout the research period, the participants recorded their activities as well as when and for how long they removed the actigraph in a diary. After 2 weeks, participants removed the actigraphs by themselves and returned them to us by mail. We then downloaded the data from the actigraph onto a personal computer, using the reader interface unit.

PPAQ-J

The original PPAQ calls for pregnant women to report the time spent participating in 32 activities (Chasan-Taber et al., 2004). The PPAQ is easily understood by respondents in a variety of settings, making it useful for epidemiological research and health guidance during pregnancy. In another study, we translated and adapted the PPAQ so that it is appropriate with Japanese culture (Matsuzaki et al., 2010); this PPAQ-J was found to have cross-cultural equivalency with the original English version (Matsuzaki et al., 2010). The PPAQ-J is a semiquantitative questionnaire that calls for respondents to report the duration, frequency, and intensity of PA, just as in the original PPAQ, and assesses their total PA on 33 activities in the following categories: household/caregiving (13 activities), occupational (5 activities), sports/exercise (8 activities), transportation (4 activities), and inactivity (3 activities) Matsuzaki et al., 2010). Self-administration of the PPAQ-J takes approximately 5–15 minutes.

The method described by Chasan-Taber et al. 2004 was used to calculate the PPAQ-J energy expenditure. The self-reported time spent on each activity was multiplied by activity intensity (in METs) to arrive at a measure of average daily energy expenditure (METs × hours/day). Activity intensity was based on field-based measurements of pregnant women (Roberts, Fragala, Pober, Chasan-Taber, & Freedson, 2002) and the 2000 version of the compendium-based MET values (Ainsworth, Haskell et al., 2000). The energy expenditures of all activities of light intensity and above were summed to derive the average MET hours per day for total activity. In addition, each activity was classified by its intensity (sedentary, <1.5 METs; light, 1.5 to <3.0 METs; moderate, 3.0 to <6.0 METs; or vigorous, ≥6.0 METs), and the average number of MET hours per day expended at each intensity level was calculated. Activities were also classified by type (household/caregiving, occupational, sports/exercise, transportation, and inactivity), and the average number of MET hours per day spent in each activity type was calculated.

Actigraph

An actigraph (single-axial) detects vertical accelerations ranging in magnitude from 0.05 to 2.00 g, with a frequency response from 0.25 to 2.50 Hz. These parameters can detect normal human motion and filter out high-frequency movements such as vibrations (Melanson & Freedson, 1995). However, the actigraph cannot detect upper body movements, including sedentary activity, pushing or carrying a load, and isometric exercise in which neither large muscles nor joints move. Actigraph data were collected in 1-minute activity counts. Three separate estimates of the number of minutes per day spent in activity of moderate intensity (≥3 METs) or above were calculated using the following count cut-points developed from three prior studies: ≥191 counts (Hendelman, Miller, Baggett, Debold, & Freedson, 2000), ≥574 counts (Swartz et al., 2000), and ≥1952 counts (Freedson, Melanson, & Sirard, 1998) according to original PPAQ (Chasan-Taber et al., 2004). Participants recorded their activities and the length of each instance of their removing the actigraph throughout the research period in a diary.

Sample Characteristics

The questionnaire included each participant's age, height, prepregnancy weight, gestational age, working status, income, and education at recruitment.

Data Analysis

Test-retest reliability was assessed for total PPAQ-J scores separately according to intensity and type of exercise from the first to the third PPAQ-J measures. Intraclass correlation coefficients (ICCs) (McGraw & Wong, 1996; Yen & Lo, 2002) and the Bland and Altman method (Bland & Altman, 1995, 1999) were calculated using log-transformed data. The ICC values above .75 indicated excellent reliability, .40 to .75 fair to good, and <.40 poor (Nunnally & Bernstein, 1994). The criterion validity of the PPAQ-J was determined by calculating Spearman's correlation coefficients between the results of the first and second and the first and third PPAQ-J measurements (METs × hours/day) and three published cut-points used to classify actigraph measures (minutes/day). We analyzed only the data of participants who wore the actigraph at least 10 hours per day and for at least 10 of the 12 days, excluding the first and 14th days.

The actigraph data from 56 participants were also classified into lowest, middle, or highest groups, or tertiles, which created an ordered distribution of energy expenditure according to total activity on the first PPAQ-J data and for each tertile. The mean actigraph value was calculated and shown for each tertile. The linear trend in the mean actigraph value across increasing tertiles for data on the first PPAQ-J was assessed by ANOVA with significant levels equal to an alpha level of .05 for two-tailed tests. All statistical analyses were performed using SPSS version 18.

The Japanese version of the PPAQ had good reliability in measuring total activity and varying intensities and types, excluding vigorous activity.

Results

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies

Participants

Of the 69 pregnant women, only 60 (87%) agreed to participate in the study. The main reasons for refusal were that they took a trip during the research period (n = 2) and that participating in the study was burdensome (n = 7). Furthermore, four of the 60 participants had missing actigraph data, with fewer than at least 10 hours per day for at least 10 of the 12 days (excluding the first and 14th days), and another two participants had missing data on the actigraph and PPAQ-J. Therefore, data from 58 participants were analyzed for test–retest reliability using the three PPAQ-J values. Furthermore, the data of 54 participants were used to analyze criterion validity using the actigraph. The participants’ characteristics are shown in Table 1. Thirty-six (62.1%) of all pregnant women had a normal body mass index (BMI) (18.5–24.9). Thirty-seven (63.8%) participants were primiparas. The average (SD) time per day that participants removed the actigraph was 8.8 h (1.2; median: 8.7; range: 6.8–12.3). When participants did not wear the actigraph, they were usually engaged in activities such as sleeping, napping, bathing, showering, cooking breakfast, yoga, and swimming.

Table 1. Participant Characteristics (n = 58)
 Mean ± SD (range)cn (%)
Note
  1. a

    1 US $ is 100 JPY.

Age (years)32.9 ± 3.9 (24–41) 
Prepregnancy body mass index20.6 ± 3.2 (16.1–31.2) 
< 18.5 16 (27.6)
18.6–24.9 36 (62.1)
≧25.0 6 (10.3)
Trimester and gestational age (weeks)
First12.3 ± 2.1 (9.0–15.0)13 (22.4)
Second22.2 ± 3.6 (16.0–27.0)21 (36.2)
Third30.6 ± 2.4 (28.0–36.0)24 (41.4)
Parity
Primipara 37 (63.8)
Multipara 21 (36.2)
Working status
Employed currently 24 (41.4)
Housewives 15 (25.9)
Maternity leave stopped work 15 (25.8)
Other 4 (6.9)
Sports/exercise
Swimming 1 (1.7)
Stretch 1 (1.7)
Yoga 4 (6.9)
None 52 (89.7)
Income per year (US $)a
20,000–<35,000 1 (1.7)
35,000–<50,000 6 (10.3)
50,000–<65,000 13 (22.4)
65,000–<80,000 13 (22.4)
80,000–<100,000 11 (19.0)
100,001–< ‘ 13 (22.4)
No answer 1 (1.7)
Education
Eighth grade or less  
Some high school 1 (1.7)
High school or Graduate Equivalency Diploma certificate 8 (13.8)
Some technical school 2 (3.4)
Technical school graduate 7 (12.1)
Junior college graduate 9 (15.5)
Some college 1 (1.7)
College graduate 28 (48.4)
Postgraduate or professional degree 2 (3.4)

Total Activity and Reliability of the PPAQ-J

The median values (METs × hours/day) from the first, second, and third PPAQ-J measurements for total activity, activity intensities, and type of activity are shown in Table 2. As shown in Table 3, ICCs for total activity and activity broken down by intensity and type ranged from .56 to .93 between the first and second PPAQ-J, and between the first and third PPAQ-J measurements. Only five participants reported vigorous PA in the first PPAQ-J, none in the second PPAQ-J, and one in the third PPAQ-J. Therefore, the ICCs for vigorous PA were not calculated.

Table 2. Median, 25th and 75th Percentile Values (METs · h/d) from First to Third Pregnancy Physical Activity Questionnaires in Japanese (PPAQ-Js) (N = 58)
 1st PPAQ-J (METs · h/d)2nd PPAQ-J (METs · h/d)3rd PPAQ-J (METs · h/d)
 25thMedian75th25thMedian75th25thMedian75th
Summary activity scores
Total activity (light and above)16.519.726.016.221.727.114.520.525.3
By intensity
Sedentary(<1.5 METs)2.64.04.72.64.46.32.64.46.3
Light (1.5–<3.0 METs)14.717.121.714.918.722.212.617.020.6
Moderate (3.0–< 6.0 METs)1.13.15.61.12.86.11.42.64.8
Vigorous (≥6.0 METs)0.00.00.0---0.00.00.0
By type
Household/caregiving6.411.315.16.711.016.06.39.514.1
Occupational0.00.010.90.00.010.90.00.010.8
Sports/exercise0.00.61.40.00.41.10.10.71.4
Transportation1.82.84.31.02.54.61.02.84.9
Inactivity3.14.86.93.15.37.43.15.37.3
Table 3. Intraclass Correlation Coefficients between First and Second and First and Third Pregnancy Physical Activity Questionnaires in Japanese (PPAQ-Js) (N = 58)
 Intraclass correlation coefficients (ICC) (95% CI)
 1st and 2nd1st and 3rd
Note
  1. ICCs were calculated on log-transformed data.

Summary activity scores
Total activity (light and above)0.87 (0.79–0.92)0.77 (0.64–0.86)
By intensity
Sedentary (<1.5 METs)0.78 (0.66–0.87)0.72 (0.57–0.82)
Light(1.5–< 3.0 METs)0.83 (0.73–0.89)0.76 (0.63–0.85)
Moderate (3.0–< 6.0 METs)0.79 (0.66–0.87)0.71 (0.55–0.82)
Vigorous (≥ 6.0 METs)
By type
Household/caregiving0.93 (0.89–0.96)0.84 (0.74–0.90)
Occupational0.66 (0.37–0.96)0.84 (0.74–0.90)
Sports/exercise0.61 (0.36–0.77)0.56 (0.31–0.74)
Transportation0.66 (0.37–0.73)0.58 (0.36–0.76)
Inactivity0.74 (0.66–0.87)0.71 (0.55–0.82)

The Bland and Altman analysis showed differences between the first and second and the first and third PPAQ-J in terms of total activity (n = 58, arithmetic mean −0.015; 95% confidence interval [CI] [0.038, 0.009], and arithmetic mean 0.0489; 95% CI [0.016, 0.082], respectively), with most values falling within 1.96 SD. Furthermore, the Bland and Altman analysis showed a significant difference in total activity between the first and third PPAQ-J.

Criterion Validity of the PPAQ-J

Using the actigraph, the average (SD) minutes per day and range (minimum–maximum) spent in moderate or vigorous intensity activity for each cut-point were as follows: 218.3 (63.4) and 102.3 to 58.1 using the Hendelman et al. (2000) cut-point; 100.5 (37.7), 26.0 to 193.3 using the Swartz et al. (2000) cut-point; and 25.0 (22.7) and 0 to 99.0 using the Freedson et al. (1998) cut-point, respectively. Summary measures from the first PPAQ-J were compared with the minutes per day spent in activity for each cut-point according to the actigraph (Table 4). Overall, Spearman's correlation coefficients were highest using the Hendelman et al. cut-point (≥191 counts) compared with the Freedson et al. (≥1952 counts) and the Swartz et al. cut-points (≥574 counts). Spearman's correlation coefficients for total activity, non-vigorous activity (sedentary, light, and moderate activity) were significant.

Table 4. Correlation between First, Second and Third Pregnancy Physical Activity Questionnaire in Japan (PPAQ-J) and Manufacturing Technology Actigraph Data (N = 54)
 Actigraph Measures
 Actigraph cut-points (min/d)a
 Hendelman et al.Swartz et al.Freedson et al.
Note
  1. a

    Activity of moderate – intensity and greater. Count cut points were as follows: ≥191 (Hendelman et al., 2000); ≥574 (Swartz et al., 2000); ≥1952 (Freedson et al., 1998)

  2. bAmong participants who were currently employed (n = 24 or 42.9% of sample).

  3. Data shown have Spearman's correlation coefficient.

  4. *p < .05, **p < .01

First PPAQ measures
Total activity (≥ light)0.35*0.36**0.02
By intensity   
Sedentary (<1.5 METs)‘−0.30*−0.130.20
Light (1.5–<3.0 METs)0.28*0.34*0.007
Moderate (3.0–< 6.0 METs)0.38**0.30*−0.09
Vigorous (≥ 6.0 METs)−0.21−0.23−0.25
Second PPAQ measures
Total activity (≥ light)0.29**0.24−0.05
By intensity   
Sedentary (<1.5 METs)−0.27*−0.210.001
Light (1.5–<3.0 METs)0.130.13−0.01
Moderate (3.0–< 6.0 METs)0.38**0.23−0.11
Vigorous (≥ 6.0 METs)---
Third PPAQ measures
Total activity (≥ light)0.130.200.04
By intensity   
Sedentary (<1.5 METs)−0.120.030.20
Light (1.5–<3.0 METs)0.050.120.09
Moderate (3.0–< 6.0 METs)0.150.12−0.03
Vigorous (≥6.0 METs)−0.09−0.18−0.18

The linear trends also indicated that the PPAQ-J showed valid results for total activity at the first measurement (Table 5). There was a significant linear trend of increasing activity across tertiles according to PPAQ-J scores for the Hendelman et al. (2000; p = .048) and the Swartz et al. (2000; p = .044) cut-points, but not for the Freedson et al. (1998; p = .81) cut-point.

Table 5. Manufacturing Technology Actigraph Data and Tertiles of Total Energy Expenditure Based on the First Pregnancy Physical activity Questionnaire in Japanese (PPAQ-J) (N = 54)
 Lowest TertileMiddle TertileHighest TertileLinear Trend
 Mean (SD)Mean (SD)Mean (SD)p value
Note
  1. a

    Count cut-points were as follows: ≥191 (Hendelman et al.); ≥574 (Swartz et al.); ≥1952 (Freedson et al.)

  2. *p < .05

Actigraph data by each cut pointsa(min/d)
Hendelman et al. (2000)201.0 (63.9)210.4 (52.4)248.7 (64.2)0.048*
Swartz et al. (2000)88.5 (32.6)96.9 (31.6)118.4 (42.7)0.044*
Freedson et al. (1998)23.8 (18.9)28.3 (24.2)24.5 (25.5)0.818

Discussion

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies

The currently tested instrument can offer a clear and comprehensive picture of the activity of Japanese pregnant women. Because Japanese women are more involved in household and childcare activities than are their husbands (National Institute of Population and Social Security Research, 2011), and the PPAQ-J contains measurements for household and childcare activities, it seems to be a suitable tool for identifying the PA of Japanese women. In addition, previous researchers have reported that PA and related factors differ among racial and ethnic groups (Jonsson, Palmer, Ohlsson, Sundquist, & Sundquist, 2012; Neighbors, Marquez, & Marcus, 2008). Because the PPAQ has been used to assess pregnant women in the United States and Japan (Chasan-Taber et al., 2004; Matsuzaki et al., 2010), the use of this measure will enable us to study PA in pregnant Japanese expatriates and Japanese Americans in the future. To the best of our knowledge, this report represents the first validated questionnaire of PA for pregnant Japanese women.

The 58 participants in this study varied widely in age, trimester, working status, and education (Table 1). Therefore, these participants were appropriate to demonstrate the criterion validity of the PPAQ-J in pregnant Japanese women (Portney & Watkins, 1993). Only two participants had missing PPAQ-J data. These data provided evidence that people can easily understand and respond to the PPAQ-J. In this study, 27.6% of participants had a BMI < 18.5, whereas 10.3% had a BMI ≥ 25.0. The Ministry of Health, Labour and Welfare (2012), in their Comprehensive Survey of Living Conditions of the People on Health and Welfare, reported that 7.5% of Japanese women age 20 to 29  and 13.8% of those age 30 to 39  had a BMI ≥ 25.0, and 29.0% of Japanese women age 20 to 29 years and 21.7% of those age 30 to 39  had a BMI < 18.5 in 2010. Thus, the BMI distribution of the sample, drawn only from Tokyo, was similar to that of the general population of Japanese women.

Because participants were required to wear an activity monitor and complete the questionnaires, they may have had a heightened awareness of their activity. The activity monitor was worn for 2 weeks, and the questionnaires were administered 3 times at one-week intervals. As shown in the results, the Bland and Altman analysis indicated no significant difference between the first and second PPAQ-J total scores. The test–retest ICCs ranged from .56 to .93, indicating good reliability for total activity as well as for activities by varying intensities and type, excluding vigorous activity. Previous researchers from other countries showed good reliability for the English version of the PPAQ ICC = .78 To .93 (Chasan-Taber et al., 2004), the Vietnamese version ICC = .87 To .94 (Ota et al., 2008), and the French version ICC = .59 To .90 (Chandonnet et al., 2012). As shown in Table 2, the median value for vigorous activity was 0 for the three PPAQ-J measurements. This result was consistent with previous studies, which showed that the median values for vigorous activity were 0 in pregnant women in the United States and Vietnam (Chasan-Taber et al. 2004; Ota et al. 2008) at the first administration of the PPAQ. In addition, none of the pregnant women reported performing vigorous activities at the second PPAQ-J. The reason for the low reliability for vigorous activity was that most of the pregnant women in this population did not engage in vigorous PA. Vigorous PA may change along with various somatic symptoms as pregnancy progresses. Therefore, we must deal cautiously with vigorous activity; however other activity intensities and types, as well as total activity, were not limited, meaning that these aspects of the questionnaire can be used to accurately evaluate pregnant women.

The three previously identified cut-points were used to clarify the correlation between the PPAQ-J and the actigraph measures. These cut-points (minutes/day) were ≥191 (Hendelman et al., 2000), ≥574 (Swartz et al., 2000), and ≥1952 (Freedson et al., 1998). As shown in Table 5, the linear trends indicated that the PPAQ provided valid results for total activity on the first PPAQ-J. The present study reported that Hendelman et al. (2000) and Swartz et al. (2000) cut points showed a significant linear trend of increasing PPAQ-J activity across tertiles, p = .048 and p = .044, respectively, although no significant linear trend for Freedson et al. (1998) cut point (p = .81). This result was consistent with previous original research of the PPAQ (Chasan-Taber et al., 2004) that Hendelman et al. (2000) and Swartz et al. (2000) cut points showed a significant linear trend of increasing original PPAQ activity across tertiles, p = .001, p = .014, respectively, although no significant linear trend for Freedson et al. (1998) cut point (p = .77).

Use of the PPAQ-J in practice enables nurses to tailor lifestyle counseling for Japanese expatriates and domestic Japanese women.

In addition, previous researchers found the higher Spearman's correlation coefficients that we observed, excluding those for vigorous and sports/exercise activity (Chasan-Taber et al., 2004). Chasan-Taber et al. (2004) reported for the English version of the PPAQ that the Spearman's correlation coefficients between the Hendelman et al. (2000) cut-point and the PPAQ were .43 for total activity, −.34 for sedentary activity, .22 for light activity, .49 for moderate activity, and .25 for vigorous activity. Ota et al. (2008) reported for the Vietnamese version of the PPAQ that the Spearman's correlation coefficient between pedometer data and the PPAQ was .29 for total activity.

Our results had a negative correlation (−.21) for vigorous and sports/exercise activity between the Hendelman et al. (2000) cut-point and PPAQ scores, although previous researchers have shown a positive correlation of .25 (Chasan-Taber et al., 2004). When participants were swimming and doing yoga, the actigraph was not worn. In addition, only five participants responded that they were involved in vigorous PA. Three out these five pregnant women responded that they were involved in sports/exercise activity. One pregnant woman reported swimming, one stretching, and four reported doing yoga. These findings may have resulted in the weak, negative correlation between PPAQ-J and actigraph measures for sports/exercise activity.

The original English version of the PPAQ has been used in an intervention trial for measuring PA in pregnant women to prevent pregnancy complications such as gestational diabetes (Chasan-Taber et al., 2009) and for evaluating modification of pregnancy PA before and after health guidance about physical activity (Chasan-Taber et al., 2011).

Therefore, one goal for measuring PA among pregnant women would be to determine the intensity and amount of PA needed to prevent common minor symptoms and complications during pregnancy, such as gestational diabetes and pregnancy-induced hypertension, in Japan and for Japanese expatriates receiving prenatal care in the United States. Furthermore, we aimed to provide initial information for health care providers about the current activity levels of pregnant women (Matsuzaki et al., 2010).

This study had some limitations. First, the validity results were affected by the limited measurement ability of the actigraph and PPAQ measurements, as the actigraph cannot detect upper body movements. Second, this study may have had sampling bias because random sampling was not possible. Thus, the present participants may have engaged in more activity than the general population of pregnant women. Finally, we collected the data among pregnant Japanese women in Japan but not women in United States. Therefore, our results may apply only to pregnant Japanese women new to the United States. A follow-up study may reveal behavior differences between new immigrants/expatriates and Japanese-Americans.

In conclusion, the present data provide evidence that the PPAQ-J appears to be reliable and highly responsive. The PPAQ-J can contribute to a comprehensive measurement of the PA of pregnant Japanese women and can be used by clinicians to assess individual and group PA. In addition, the PPAQ-J would be useful for comparing PA among countries for international collaborative research in this area. In nursing research, the PPAQ-J may make it possible to clarify factors that influence PA in Japanese expatriates. It would then be possible to perform intervention studies to identify ways to promote a healthy lifestyle for these women.

Further research is needed to study vigorous activity among pregnant Japanese women. We also believe that future research with this tool will allow us to determine the amount of PA needed to prevent depressive symptoms and complications during pregnancy in Japan, and it now provides initial information for health care providers about the current activity levels of pregnant Japanese women.

REFERENCES

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies
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Biographies

  1. Top of page
  2. ABSTRACT
  3. Methods
  4. Results
  5. Discussion
  6. Acknowledgment
  7. REFERENCES
  8. Biographies
  • Masayo Matsuzaki, PhD, is a lecturer in the Department of Midwifery and Women's Health, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

  • Megumi Haruna, PhD, is an associate professor in the Department of Midwifery and Women's Health, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

  • Kae Nakayama, PhD, is an assistant professor in the Department of Nursing, Faculty of Human Sciences, Sophia University, Tokyo, Japan.

  • Mie Shiraishi, PhD, is a research associate in the Department of Midwifery and Women's Health, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

  • Erika Ota, PhD, is chief of the Division of Epidemiology, Department of Maternal and Child Health, National Center for Child Health and Development, Tokyo, Japan.

  • Ryoko Murayama, PhD, is project associate professor in the Department of Advanced Nursing Technology, Social Cooperation Program, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

  • Sachiyo Murashima, PhD, is president of Oita University of Nursing and Health Sciences, Oita, Japan.

  • SeonAe Yeo, PhD, is an associate professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina.