Validity and reliability of the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in individuals with congenital heart disease

Objective To assess the criterion validity, internal consistency, reliability and cut-point for the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in children and adolescents with congenital heart disease-a special population at high cardiovascular risk in whom physical activity has not been extensively evaluated. Methods We included 84 participants (13.6 +/- 2.9 yrs, 50% female) with simple (37%), moderate (31%), or severe congenital heart disease (27%), as well as cardiac transplant recipients (6%), from BC Children's Hospital, Canada. They completed the PAQ-C (<= 11yrs, n = 28) or-A (>= 12yrs, n = 56), and also wore a triaxial accelerometer (GT3X+ or GT9X) over the right hip for 7 days (n = 59 met valid wear time criteria). Results Median daily moderate-to-vigorous physical activity was 46.9 minutes per day (IQR 31.6-61.8) and 25% met physical activity guidelines defined as >= 60 minutes of moderate-to-vigorous physical activity per day. Median PAQ-score was 2.6 (IQR 1.9-3.0). PAQ-Scores were significantly related to accelerometry-derived metrics of physical activity (rho = 0.44-0.55, all p<0.01) and sedentary behaviour (rho = -0.53, p<0.001). Internal consistency was high (alpha = 0.837), as was reliability (stability) of PAQ-Scores over a 4-months period (ICC = 0.73, 95% CI 0.55-0.84; p<0.001). We identified that a PAQ-Score cut-point of 2.87 discriminates between those meeting physical guidelines and those that do not in the combined PAQ-C and-A samples (area under the curve = 0.80 (95% CI 0.67-0.92). Conclusion Validity and reliability of the PAQ in children and adolescents with CHD was comparable to or stronger than previous studies in healthy children. Therefore, the PAQ may be used to estimate general levels of physical activity in children and adolescents with CHD.