Update and Novel Validation of the Pregnancy Physical Activity Questionnaire (PPAQ)

项目摘要 怀孕期间缺乏身体活动是一个紧迫的公共卫生问题， 妊娠期体重增加、妊娠期糖尿病、先兆子痫和早产。自我报告的评估 体力活动（PA）仍然是监测、流行病学和 妊娠期PA对活动监测仪佩戴依从性低的干预研究， 用于大样本量和高成本的监视器。因此，PA问卷必须同时 有效和可靠。本课题组于2004年编制了孕期体力活动问卷 （R 03 HD 039341）作为第一个经过验证的妊娠PA问卷，此后成为最受欢迎的 广泛使用的工具来评估PA在这一人群中。然而，PPAQ是使用 在固定持续时间的模拟实验室活动期间从佩戴在臀部上的加速度计导出的算法， 在自由生活环境中表现不佳，特别是在检测久坐和 光强度活动。从那时起，在加速度计和直接测量方面取得了进展。 用于确定自我报告PA有效性的观察校准和验证方法， 久坐行为（SB）这一点很重要，因为SB最近已成为一个重要的新风险因素， 不良妊娠结局与PA无关。因此，我们正处于一个关键的时间点， 验证方法可用于评估PPAQ在自由生活环境中的表现，并更新和 完善这个广泛使用的自我报告工具。我们高素质的研究团队将首先更新PPAQ， 包括现代SB选项（目标#1）。然后，我们将招募一个50人的种族多样化的前瞻性队列， 孕妇在怀孕早期。在每三个月，参与者将完成更新的PPAQ，然后 佩戴腕戴式Actigraph GT3 XP-BTLE和可穿戴式摄像头超过7天的自由生活活动。可穿戴 相机图像是目前可用于对加速度计的上下文进行分类的最佳客观方法， 自由生活活动的定义片段。使用这些数据，我们将：1）创建一个新的简短版本的 PPAQ（PPAQ-SF），用于在测量广泛的其他生活方式因素的研究中减轻受试者负担 (Aim#2）; 2）确定更新的PPAQ和PPAQ-SF的准确度和精密度，以估计花费的时间 在类型（例如，家庭/工作、职业、体育/锻炼、交通、运动）和强度 在自由生活环境中PA和SB的分类（轻、中、剧烈）（目标#3）。因此，更新的 PPAQ和新的PPAQ-SF将是第一个在自由生活中验证的问卷 设置，以提供准确和精确的估计PA和SB在孕妇。这些工具将 关键在于：1）评估PA指南依从性的监测研究，2）PA的病因学研究， 母胎结局旨在确定预防这些妊娠的最佳剂量PA 3）确定旨在增加妊娠期PA的运动干预的有效性。

Project Summary Physical inactivity during pregnancy is an urgent public health concern and is implicated in excessive gestational weight gain, gestational diabetes, pre-eclampsia, and preterm birth. Self-reported assessments of physical activity (PA) continue to be the most common method for surveillance, epidemiological, and intervention studies of pregnancy PA given low compliance with activity monitor wear during pregnancy, need for large sample sizes, and the high cost of monitors. Therefore, it is critical that PA questionnaires be both valid and reliable. The Pregnancy Physical Activity Questionnaire (PPAQ) was developed by our group in 2004 (R03HD039341) as the first validated pregnancy PA questionnaire and has since become one of the most widely used instruments for assessing PA in this population. However, the PPAQ was validated using algorithms derived from accelerometers worn on the hip during fixed-duration simulated laboratory activities, which have been shown to perform poorly in free-living settings, particularly in the detection of sedentary and light intensity activity. Since that time, advances have been made in accelerometer and direct observation calibration and validation methods used to determine the validity of self-reported PA and sedentary behavior (SB). This is important as SB has recently emerged as an important new risk factor for adverse pregnancy outcomes independent of PA. Therefore, we are at a key point in time where innovative validation methods can be used to evaluate PPAQ performance in free-living settings and update and refine this widely used self-report tool. Our highly qualified research team will first update the PPAQ to include contemporary SB options (Aim #1). We will then recruit an ethnically diverse prospective cohort of 50 pregnant women in early pregnancy. In each trimester, participants will complete the updated PPAQ, then wear a wrist-worn Actigraph GT3XP-BTLE and a wearable camera over 7-d of free-living activity. Wearable camera images are the best objective method currently available to categorize the context of accelerometer- defined episodes of free-living activity. Using these data, we will: 1) Create a new short-form version of the PPAQ (PPAQ-SF) to reduce participant burden in studies which measure a wide range of other lifestyle factors (Aim #2); 2) Determine the accuracy and precision of the updated PPAQ and PPAQ-SF to estimate time spent in type (e.g., household/caregiving, occupational, sports/exercise, transportation, locomotion) and intensity classification (light, moderate, vigorous) of PA, and SB in a free-living setting (Aim #3). Thus, the updated PPAQ and new PPAQ-SF developed from this work will be the first questionnaires validated in free-living settings to provide accurate and precise estimates of PA and SB in pregnant women. These tools will be critical for: 1) surveillance studies assessing compliance with PA guidelines, 2) etiologic studies of PA and maternal-fetal outcomes designed to identify the optimal dose of pregnancy PA for the prevention of these disorders, and 3) to determine the efficacy of exercise interventions designed to increase PA in pregnancy.