Validation of the Yale Physical Activity Survey in Chronic Obstructive Pulmonary Disease Patients

Background Patients with chronic obstructive pulmonary disease (COPD) perform limited physical activity. Surprisingly, there is a lack of research in COPD about the validity of physical activity questionnaires. Our aim was to validate the Yale Physical Activity Survey in COPD patients in order to quantify and classify their levels of physical activity. Methods 172 COPD patients from 8 university hospitals in Spain wore an accelerometer (SenseWear®Pro2Armband) for 8 days and answered the questionnaire 15 days later. Statistical analyses used to compare both tools measures included: (i) Spearman's correlation coefficient, (ii) intraclass correlation coefficient (ICC) and Bland-Altman plots, (iii) distribution of accelerometer measurements according to tertiles of the questionnaire, and (iv) receiver operating characteristic (ROC) curves to detect sedentary patients. Results 94% of participants were men, 28% were active smokers and 7% were currently working. Mean (standard deviation) age was 70 (8) years, mean post-bronchodilator FEV1 was 52 (15)% predicted, and median (p25-p75) steps taken was 5,702 (3,273-9,253) steps per day−1. Spearman correlations were low to moderate (from 0.29 to 0.52, all P < .001). ICCs showed weak agreement (from 0.34 to 0.40, all P < .001). A wide variability in agreement was observed in the Bland-Altman plots. Significant differences in accelerometer measurements were found according to questionnaire tertiles (all P < .001). The area under the ROC for identifying sedentarism was 0.71 (95% CI: 0.63-0.79). Conclusions The Yale Physical Activity Survey may be a valid tool to classify, but not to quantify, physical activity performed by COPD patients. The summary index of this questionnaire, based on seven short questions, shows the best validity properties. This suggests that it should be considered a screening tool to identify patients at risk for sedentarism.