Global physical activity questionnaire (GPAQ)

The GPAQ is an interviewer-administered questionnaire that was developed by WHO as a physical activity surveillance tool across populations, and as part of their STEPwise approach to surveillance of NCDs and associated risk factors [27, 28]. The GPAQ has demonstrated reasonable validity and reliability in studies across multiple populations [29, 30]. In this questionnaire, physical activity was categorised into three main domains – work or training, travelling (via walking and/or cycling), and leisure activities. This was further divided into vigorous- or moderate-intensity work activity, and vigorous- or moderate-intensity leisure activity. Participants were asked if they engaged in such activities for at least 10 min at a time in a typical week, as well as the number of days and amount of time they spent per day doing such activities. Definitions and examples of such activities were also given to participants to aid in their recall and answers. Lastly, participants also answered a question on sedentary behaviour, pertaining specifically to the amount of time they spent sitting or reclining on a typical day. GPAQ data was processed and analysed using the analysis guide provided by WHO [31]. For activity level, high activity level was computed as either a minimum of 3 days of vigorous-intensity activities and 1500 metabolic equivalent (MET) minutes in a week, or at least 7 days of walking, moderate- or vigorous-intensity activities (MVPA) and 3000 MET minutes per week. Moderate activity level was computed as not meeting the criteria for high levels, but either having at least 3 days of vigorous-intensity activity for 20 min or more per day, or at least 5 days of moderate-intensity activity or walking for 30 min or more per day, or at least 5 days of combined walking and MVPA with a minimum of 600 MET-minutes per week. Low activity level was computed as not meeting the criteria for either high or moderate physical activity level.

Criteria for meeting WHO-recommended physical activity guidelines for health maintenance were also computed based on the recommended cut-off values from the GPAQ analysis guide, which was either two and a half hours of moderate-intensity activity, 1 h and 15 min of vigorous-intensity activity, or at least 600 MET-minutes of an equivalent combination of moderate- and vigorous-intensity activity, within a week [31].