背景

随着社会经济发展、医疗卫生技术进步和人口老龄化进程的推进，人群的慢性病发病率和患病率不断增加，成为影响健康的主要疾病。2019年，心血管疾病、癌症、慢性呼吸系统疾病以及糖尿病等慢性病造成全球范围内4100万人的死亡，相当于全球所有死亡人数的74%。不健康的生活方式如吸烟、不健康饮食、过度饮酒以及缺乏身体活动是造成慢性病发病率和患病率增加的重要行为危险因素。其中，缺乏身体活动是造成全球范围死亡的第4位危险因素。尽管全球积极推动和鼓励增加身体活动，但是无论是整体还是不同年龄组的人群，身体活动量和世界卫生组织的推荐量都存在较大差距。造成这种现象的原因除了身体活动本身需要个人积极主动、社区环境支持以外，身体活动本身的测量难度大也是一个重要方面。由于身体活动的测量是多层面、多维度的，因此尚未形成标准化的测量方法。目前广泛使用的身体活动问卷调查法在大规模流行病学调查中具有显著优势，而加速度计等客观监测设备则更适用于精准测量身体活动。尽管已成功编制和验证了儿童身体活动问卷，但我国成年人休闲性身体活动测量仍存在局限性。为了准确测量我国成年人身体活动，在对常用的身体活动问卷的优缺点进行综合考量后，本研究将国际身体活动问卷（International Physical Activity Questionnaire, IPAQ）长问卷进行了优化，结合加速度计形成了一套本土化国际身体活动问卷（modified International Physical Activity Questionnaire, mIPAQ），对其进行信效度验证，并首次在人群流行病学调查中进行应用。

研究目的

本研究于2023年7月至9月期间在北京市房山区开展。采用mIPAQ问卷、IPAQ长问卷、加速度计测量研究对象的身体活动，验证mIPAQ问卷的信效度，为mIPAQ问卷的可行性提供科学依据。应用mIPAQ问卷开展流行病学调查，描述人群身体活动水平及其分布特征，为今后开展身体活动水平的大人群流行病学调查提供参考和依据。

研究方法

本研究采用横断面研究设计，分为两个阶段。第一阶段采用方便抽样的方法，从北京市房山区选取20~79岁的110名居民，开展问卷调查并发放加速度计，验证mIPAQ问卷的信效度。第二阶段采用多阶段整群目的性抽样的方法，在北京市房山区招募20岁及以上的2671名居民，开展问卷调查，在更大样本人群中描述人群身体活动水平及其分布特征。使用Stata 17.0软件进行数据分析。

研究结果

mIPAQ问卷的问卷水平的内容效度指数（scale-level CVI, S-CVI）为0.992，条目水平的内容效度指数（item-level CVI, I-CVI）为0.833~1.000，说明内容效度良好。采用主轴因素法进行探索性因子分析，通过碎石图辅助判断，得到3个因子共42个条目，累积方差贡献率为55.28%，说明结构效度良好。以IPAQ长问卷作为效标，mIPAQ问卷与IPAQ长问卷的相关系数为0.88，说明效标效度良好；以ACTi Graph wGT3X-BT加速度计作为效标，mIPAQ问卷与actigraphy wGT3X-BT加速度计的相关系数为0.59，说明效标效度良好。因此，mIPAQ问卷具有良好的效度。

mIPAQ问卷的总体重测信度为0.86，各维度重测系数在0.68~0.94之间，说明重测信度良好。总体分半系数为0.88，各维度分半系数在0.86~0.92之间，说明分半信度良好。总体Cronbach's α系数为0.85，各维度Cronbach's α系数在0.81~0.91之间，说明内在一致性信度良好。因此，mIPAQ问卷具有良好的信度。

（3）北京市房山区调查人群身体活动不足率为18.23%，低于全国水平的22.3%。身体活动不足与年龄和工作类型等因素有关（P均<0.05），而性别、婚姻状况、BMI、受教育程度和户籍类型则未显示出统计学差异。

研究结论

本研究应用的mIPAQ问卷，是在沿用IPAQ长问卷职业、交通及家务性身体活动模块的基础上，针对我国成年人休闲活动特征对休闲性身体活动模块进行细化而成的：

① 通过重测信度、分半信度和内在一致性信度分析，证明mIPAQ问卷具有良好的信度。

② 通过内容效度、结构效度和效标效度分析，证明mIPAQ问卷具有良好的效度。

③ mIPAQ问卷可用于评估20~79岁成年人的身体活动水平，不仅简便易行，且能够取得良好的应用效果。在现有测量工具的基础上，进一步完善身体活动测量工具，弥补在休闲性身体活动测量上的局限性，保证身体活动测量的准确性。

北京市房山区调查人群身体活动不足率低于全国水平。身体活动不足率在不同人口统计学特征和社会经济因素上存在差异。身体活动不足与年龄和工作类型等因素有关。

Background: 

With the development of social economy, the progress of medical and health technology and the advancement of population aging process, the incidence rate and prevalence of chronic diseases among the population are increasing, becoming the main disease affecting health. In 2019, chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases and diabetes will cause 41 million deaths worldwide, equivalent to 74% of all deaths worldwide. Unhealthy lifestyle such as smoking, unhealthy diet, excessive drinking and lack of physical activity are important behavioral risk factors that cause the incidence rate and increase of chronic diseases. Among them, lack of physical activity is the fourth risk factor for global mortality. Despite global efforts to promote and encourage increased physical activity, there is a significant gap in physical activity levels between the overall population and different age groups, as recommended by the World Health Organization. The reason for this phenomenon is not only that physical activity itself requires individual initiative and community environmental support, but also the difficulty of measuring physical activity itself is an important aspect. Due to the multidimensional nature of measuring physical activity, standardized measurement methods have not yet been established. The widely used physical activity questionnaire survey method has significant advantages in large-scale epidemiological investigations, while objective monitoring devices such as accelerometers are more suitable for accurately measuring physical activity. Although a children's physical activity questionnaire has been successfully developed and validated, there are still limitations in measuring leisure physical activity among adults in China. In order to accurately measure the physical activity of adults in China, after comprehensive consideration of the advantages and disadvantages of commonly used physical activity questionnaires, this study optimized the International Physical Activity Questionnaire (IPAQ) long questionnaire and combined it with an accelerometer to form a modified International Physical Activity Questionnaire (mIPAQ). The reliability and validity of the questionnaire were verified and applied for the first time in a population epidemiological survey.

Objective：

This study was conducted in Fangshan District, Beijing from July to September 2023. Using the mIPAQ questionnaire, IPAQ long questionnaire, and accelerometer to measure the physical activity of the research subjects, the reliability and validity of the mIPAQ questionnaire were verified, providing scientific basis for the feasibility of the mIPAQ questionnaire. Conduct epidemiological surveys using the mIPAQ questionnaire to describe the physical activity levels and distribution characteristics of the population, providing reference and basis for future large-scale epidemiological surveys on physical activity levels.

Methods：

This study adopts a cross-sectional research design and is divided into two stages. In the first stage, a convenience sampling method was used to select 110 residents aged 20 to 79 from Fangshan District, Beijing. A questionnaire survey was conducted and accelerometers were distributed to verify the reliability and validity of the mIPAQ questionnaire. In the second stage, a multi-stage cluster purposive sampling method was used to recruit 2671 residents aged 20 and above in Fangshan District, Beijing. A questionnaire survey was conducted to describe the physical activity level and distribution characteristics of the population in a larger sample. Use Stata 17.0 software for data analysis.

Results：

(1) The S-CVI/Ave of the mIPAQ questionnaire is 0.992, and the I-CVI is 0.833-1.000, indicating good content validity. Exploratory factor analysis was conducted using the principal axis factor method, and 42 items were obtained from 3 factors with a cumulative variance contribution rate of 55.28%, indicating good construct validity. Using the IPAQ long questionnaire as the criterion, the correlation coefficient between the mIPAQ questionnaire and the IPAQ long questionnaire is 0.88, indicating good criterion validity; Using the ACTi Graph wGT3X BT accelerometer as the criterion, the correlation coefficient between the mIPAQ questionnaire and the actigraphy wGT3X BT accelerometer is 0.59, indicating good criterion validity. Therefore, the mIPAQ questionnaire has good validity.

(2) The overall test-retest reliability of the mIPAQ questionnaire is 0.86, with test-retest coefficients for each dimension ranging from 0.68 to 0.94, indicating good test-retest reliability. The overall split coefficient is 0.88, and the split coefficients of each dimension are between 0.86 and 0.92, indicating good split reliability. The overall Cronbach's α coefficient is 0.85, and the Cronbach's α coefficients of each dimension are between 0.81 and 0.91, indicating good internal consistency reliability. Therefore, the mIPAQ questionnaire has good reliability.

(3) The rate of insufficient physical activity among the surveyed population in Fangshan District, Beijing is 18.23%, which is lower than the national level of 22.3%. Insufficient physical activity is related to factors such as age and job type (P<0.05), while gender, marital status, BMI, education level and registered residence registration type did not show statistical difference.

Conclusion：

(1) The mIPAQ questionnaire used in this study was refined based on the occupational, transportation, and household physical activity modules of the IPAQ long questionnaire, targeting the leisure activity characteristics of adults in China

① Through retest reliability, split half reliability, and intrinsic consistency reliability analysis, it is demonstrated that the mIPAQ questionnaire has good reliability.

② Through content validity, construct validity, and criterion validity analysis, it has been proven that the mIPAQ questionnaire has good validity.

③ The mIPAQ questionnaire can be used to assess the physical activity level of adults aged 20 to 79, which is not only simple and feasible, but also achieves good application results. On the basis of existing measurement tools, further improve physical activity measurement tools to compensate for the limitations in measuring leisure physical activity and ensure the accuracy of physical activity measurement.

(2) The rate of insufficient physical activity among the surveyed population in Fangshan District, Beijing is lower than the national level. There are differences in the rate of physical inactivity among different demographic characteristics and socio-economic factors. Lack of physical activity is related to factors such as age and job type.