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Validation of the General Practice Physical Activity Questionnaire after severe COVID-19

Lin Wang, Kimon Ntotsis, James Manifield, Katerina Tziannou, Tatiana Plekhanova, Alex Rowlands, Charlotte L. Edwardson, Maxime Taquet, Amisha Singapuri, Annemarie Docherty, Aarti Shikotra, Alexander Horsley Orcid Logo, Beatriz Guillen-Guio Orcid Logo, Betty Raman Orcid Logo, Charlotte Bolton Orcid Logo, Claire Nolan Orcid Logo, Claudia Efstathiou Orcid Logo, Daniel Lozano-Rojas, David J. Stensel Orcid Logo, Enya Daynes, Ewen Harrison, Hamish McAuley Orcid Logo, Ioannis Vogiatzis, Jack Sargeant, James Chalmers, Jennifer K. Quint Orcid Logo, Joseph Jacob Orcid Logo, Nicolette C. Bishop, Linzy Houchen-Wolloff Orcid Logo, Ling-Pei Ho, Lucy Gardiner, Marco Sereno, Mathew Thorpe, Matthew Richardson, Melitta McNarry Orcid Logo, Michael Marks Orcid Logo, Molly Baldwin, Nazir Lone Orcid Logo, Neil Greening Orcid Logo, Omer Elneima, Olivia Leavy, Ruth M. Saunders, Victoria Harris, William Greenhalf, William Man Orcid Logo, Louise V. Wain Orcid Logo, Iain Stewart Orcid Logo, Sally Singh Orcid Logo, Christopher E. Brightling, Claire Lawson, Tom Yates, Rachael A. Evans Orcid Logo

ERJ Open Research

Swansea University Author: Melitta McNarry Orcid Logo

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DOI (Published version): 10.1183/23120541.01496-2025

Abstract

Background: Physical inactivity is a risk factor for severe COVID-19 and often worsens after hospitalisation. Clinicians need quick, accurate assessments to target interventions. We aimed to assess the validity of the General Practice Physical Activity Questionnaire (GPPAQ) in adults recovering one...

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Published in: ERJ Open Research
ISSN: 2312-0541
Published: European Respiratory Society (ERS) 2026
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URI: https://cronfa.swan.ac.uk/Record/cronfa71662
first_indexed 2026-03-23T13:18:02Z
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Methods: Post-hospitalisation for COVID-19, adults attended a one-year-visit and completed the GPPAQ Physical Activity Index (PAI-4 active), 14-day wrist-worn accelerometry (Moderate-Vigorous PA [MVPA]- active), and other health outcomes. Validity was examined via: (i) internal consistency (factor analysis); (ii) measurement invariance across sex, age, and ethnicity using differential item functioning (DIF); (iii) convergent validity (GPPAQ sensitivity/specificity versus accelerometry); and (iv) construct validity (correlations with health outcomes). Results: 752 participants had GPPAQ and accelerometry (265 female, mean&#xB1;sd age 60.9&#xB1;11.6&#x2005;years, MVPA 18.75&#x2005;min&#xB7;day&#x2212;1 (IQR 7.55, 36.11), PAI-1 46.8%, PAI-2 15.6%, PAI-3 19.4%, PAI-4 18.2%. Factor analyses supported good internal consistency with two factors (daily activities, physical exercise). Confirmatory factor Index (CFI) showed excellent fit (CFI 0.965). DIF indicated moderate variability by sex and age. GPPAQ-PAI showed limited sensitivity (26.3%) for correctly classifying physically active individuals, but higher specificity (88.4%) for classifying physical inactivity, and weak-to-moderate correlations with health outcomes. Conclusions: GPPAQ demonstrates internal consistency, with construct and convergent validity in adults 1-year post-COVID-19 hospitalisation. GPPAQ effectively identifies inactive individuals to support clinical care; however, its sensitivity suggests underestimation of activity relative to accelerometry. Future pathways should combine GPPAQ with device-based assessment to optimise evaluation of physical activity to guide pulmonary rehabilitation and targeted interventions.</abstract><type>Journal Article</type><journal>ERJ Open Research</journal><volume>0</volume><journalNumber/><paginationStart/><paginationEnd/><publisher>European Respiratory Society (ERS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2312-0541</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>5</publishedMonth><publishedYear>2026</publishedYear><publishedDate>2026-05-01</publishedDate><doi>10.1183/23120541.01496-2025</doi><url/><notes/><college>COLLEGE NANME</college><department>Engineering and Applied Sciences School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>EAAS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>National Institute for Health and Care Research (NIHR) and UK Research and Innovation (UKRI) [PHOSP COVID, grant references: MR/V027859/1 and COV0319].</funders><projectreference/><lastEdited>2026-05-18T11:34:25.7245436</lastEdited><Created>2026-03-23T13:13:44.7748731</Created><path><level id="1">Faculty of Science and Engineering</level><level id="2">School of Engineering and Applied Sciences - Sport and Exercise Sciences</level></path><authors><author><firstname>Lin</firstname><surname>Wang</surname><order>1</order></author><author><firstname>Kimon</firstname><surname>Ntotsis</surname><order>2</order></author><author><firstname>James</firstname><surname>Manifield</surname><order>3</order></author><author><firstname>Katerina</firstname><surname>Tziannou</surname><order>4</order></author><author><firstname>Tatiana</firstname><surname>Plekhanova</surname><order>5</order></author><author><firstname>Alex</firstname><surname>Rowlands</surname><order>6</order></author><author><firstname>Charlotte L.</firstname><surname>Edwardson</surname><order>7</order></author><author><firstname>Maxime</firstname><surname>Taquet</surname><order>8</order></author><author><firstname>Amisha</firstname><surname>Singapuri</surname><order>9</order></author><author><firstname>Annemarie</firstname><surname>Docherty</surname><order>10</order></author><author><firstname>Aarti</firstname><surname>Shikotra</surname><order>11</order></author><author><firstname>Alexander</firstname><surname>Horsley</surname><orcid>0000-0003-1828-0058</orcid><order>12</order></author><author><firstname>Beatriz</firstname><surname>Guillen-Guio</surname><orcid>0000-0002-3703-1738</orcid><order>13</order></author><author><firstname>Betty</firstname><surname>Raman</surname><orcid>0000-0002-1239-9608</orcid><order>14</order></author><author><firstname>Charlotte</firstname><surname>Bolton</surname><orcid>0000-0002-9578-2249</orcid><order>15</order></author><author><firstname>Claire</firstname><surname>Nolan</surname><orcid>0000-0001-9067-599x</orcid><order>16</order></author><author><firstname>Claudia</firstname><surname>Efstathiou</surname><orcid>0000-0001-6125-8126</orcid><order>17</order></author><author><firstname>Daniel</firstname><surname>Lozano-Rojas</surname><order>18</order></author><author><firstname>David J.</firstname><surname>Stensel</surname><orcid>0000-0001-9119-8590</orcid><order>19</order></author><author><firstname>Enya</firstname><surname>Daynes</surname><order>20</order></author><author><firstname>Ewen</firstname><surname>Harrison</surname><order>21</order></author><author><firstname>Hamish</firstname><surname>McAuley</surname><orcid>0000-0001-8997-0764</orcid><order>22</order></author><author><firstname>Ioannis</firstname><surname>Vogiatzis</surname><order>23</order></author><author><firstname>Jack</firstname><surname>Sargeant</surname><order>24</order></author><author><firstname>James</firstname><surname>Chalmers</surname><order>25</order></author><author><firstname>Jennifer K.</firstname><surname>Quint</surname><orcid>0000-0003-0149-4869</orcid><order>26</order></author><author><firstname>Joseph</firstname><surname>Jacob</surname><orcid>0000-0002-8054-2293</orcid><order>27</order></author><author><firstname>Nicolette C.</firstname><surname>Bishop</surname><order>28</order></author><author><firstname>Linzy</firstname><surname>Houchen-Wolloff</surname><orcid>0000-0003-4940-8835</orcid><order>29</order></author><author><firstname>Ling-Pei</firstname><surname>Ho</surname><order>30</order></author><author><firstname>Lucy</firstname><surname>Gardiner</surname><order>31</order></author><author><firstname>Marco</firstname><surname>Sereno</surname><order>32</order></author><author><firstname>Mathew</firstname><surname>Thorpe</surname><order>33</order></author><author><firstname>Matthew</firstname><surname>Richardson</surname><order>34</order></author><author><firstname>Melitta</firstname><surname>McNarry</surname><orcid>0000-0003-0813-7477</orcid><order>35</order></author><author><firstname>Michael</firstname><surname>Marks</surname><orcid>0000-0002-7585-4743</orcid><order>36</order></author><author><firstname>Molly</firstname><surname>Baldwin</surname><order>37</order></author><author><firstname>Nazir</firstname><surname>Lone</surname><orcid>0000-0003-2707-2779</orcid><order>38</order></author><author><firstname>Neil</firstname><surname>Greening</surname><orcid>0000-0003-0453-7529</orcid><order>39</order></author><author><firstname>Omer</firstname><surname>Elneima</surname><order>40</order></author><author><firstname>Olivia</firstname><surname>Leavy</surname><order>41</order></author><author><firstname>Ruth M.</firstname><surname>Saunders</surname><order>42</order></author><author><firstname>Victoria</firstname><surname>Harris</surname><order>43</order></author><author><firstname>William</firstname><surname>Greenhalf</surname><order>44</order></author><author><firstname>William</firstname><surname>Man</surname><orcid>0000-0002-3782-659x</orcid><order>45</order></author><author><firstname>Louise V.</firstname><surname>Wain</surname><orcid>0000-0003-4951-1867</orcid><order>46</order></author><author><firstname>Iain</firstname><surname>Stewart</surname><orcid>0000-0002-1340-2688</orcid><order>47</order></author><author><firstname>Sally</firstname><surname>Singh</surname><orcid>0000-0002-9834-0366</orcid><order>48</order></author><author><firstname>Christopher E.</firstname><surname>Brightling</surname><order>49</order></author><author><firstname>Claire</firstname><surname>Lawson</surname><order>50</order></author><author><firstname>Tom</firstname><surname>Yates</surname><order>51</order></author><author><firstname>Rachael A.</firstname><surname>Evans</surname><orcid>0000-0002-1667-868x</orcid><order>52</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2026-05-18T11:34:25.7245436 v2 71662 2026-03-23 Validation of the General Practice Physical Activity Questionnaire after severe COVID-19 062f5697ff59f004bc8c713955988398 0000-0003-0813-7477 Melitta McNarry Melitta McNarry true false 2026-03-23 EAAS Background: Physical inactivity is a risk factor for severe COVID-19 and often worsens after hospitalisation. Clinicians need quick, accurate assessments to target interventions. We aimed to assess the validity of the General Practice Physical Activity Questionnaire (GPPAQ) in adults recovering one year after COVID-19 hospitalisation. Methods: Post-hospitalisation for COVID-19, adults attended a one-year-visit and completed the GPPAQ Physical Activity Index (PAI-4 active), 14-day wrist-worn accelerometry (Moderate-Vigorous PA [MVPA]- active), and other health outcomes. Validity was examined via: (i) internal consistency (factor analysis); (ii) measurement invariance across sex, age, and ethnicity using differential item functioning (DIF); (iii) convergent validity (GPPAQ sensitivity/specificity versus accelerometry); and (iv) construct validity (correlations with health outcomes). Results: 752 participants had GPPAQ and accelerometry (265 female, mean±sd age 60.9±11.6 years, MVPA 18.75 min·day−1 (IQR 7.55, 36.11), PAI-1 46.8%, PAI-2 15.6%, PAI-3 19.4%, PAI-4 18.2%. Factor analyses supported good internal consistency with two factors (daily activities, physical exercise). Confirmatory factor Index (CFI) showed excellent fit (CFI 0.965). DIF indicated moderate variability by sex and age. GPPAQ-PAI showed limited sensitivity (26.3%) for correctly classifying physically active individuals, but higher specificity (88.4%) for classifying physical inactivity, and weak-to-moderate correlations with health outcomes. Conclusions: GPPAQ demonstrates internal consistency, with construct and convergent validity in adults 1-year post-COVID-19 hospitalisation. GPPAQ effectively identifies inactive individuals to support clinical care; however, its sensitivity suggests underestimation of activity relative to accelerometry. Future pathways should combine GPPAQ with device-based assessment to optimise evaluation of physical activity to guide pulmonary rehabilitation and targeted interventions. Journal Article ERJ Open Research 0 European Respiratory Society (ERS) 2312-0541 1 5 2026 2026-05-01 10.1183/23120541.01496-2025 COLLEGE NANME Engineering and Applied Sciences School COLLEGE CODE EAAS Swansea University Another institution paid the OA fee National Institute for Health and Care Research (NIHR) and UK Research and Innovation (UKRI) [PHOSP COVID, grant references: MR/V027859/1 and COV0319]. 2026-05-18T11:34:25.7245436 2026-03-23T13:13:44.7748731 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Lin Wang 1 Kimon Ntotsis 2 James Manifield 3 Katerina Tziannou 4 Tatiana Plekhanova 5 Alex Rowlands 6 Charlotte L. Edwardson 7 Maxime Taquet 8 Amisha Singapuri 9 Annemarie Docherty 10 Aarti Shikotra 11 Alexander Horsley 0000-0003-1828-0058 12 Beatriz Guillen-Guio 0000-0002-3703-1738 13 Betty Raman 0000-0002-1239-9608 14 Charlotte Bolton 0000-0002-9578-2249 15 Claire Nolan 0000-0001-9067-599x 16 Claudia Efstathiou 0000-0001-6125-8126 17 Daniel Lozano-Rojas 18 David J. Stensel 0000-0001-9119-8590 19 Enya Daynes 20 Ewen Harrison 21 Hamish McAuley 0000-0001-8997-0764 22 Ioannis Vogiatzis 23 Jack Sargeant 24 James Chalmers 25 Jennifer K. Quint 0000-0003-0149-4869 26 Joseph Jacob 0000-0002-8054-2293 27 Nicolette C. Bishop 28 Linzy Houchen-Wolloff 0000-0003-4940-8835 29 Ling-Pei Ho 30 Lucy Gardiner 31 Marco Sereno 32 Mathew Thorpe 33 Matthew Richardson 34 Melitta McNarry 0000-0003-0813-7477 35 Michael Marks 0000-0002-7585-4743 36 Molly Baldwin 37 Nazir Lone 0000-0003-2707-2779 38 Neil Greening 0000-0003-0453-7529 39 Omer Elneima 40 Olivia Leavy 41 Ruth M. Saunders 42 Victoria Harris 43 William Greenhalf 44 William Man 0000-0002-3782-659x 45 Louise V. Wain 0000-0003-4951-1867 46 Iain Stewart 0000-0002-1340-2688 47 Sally Singh 0000-0002-9834-0366 48 Christopher E. Brightling 49 Claire Lawson 50 Tom Yates 51 Rachael A. Evans 0000-0002-1667-868x 52
title Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
spellingShingle Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
Melitta McNarry
title_short Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
title_full Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
title_fullStr Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
title_full_unstemmed Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
title_sort Validation of the General Practice Physical Activity Questionnaire after severe COVID-19
author_id_str_mv 062f5697ff59f004bc8c713955988398
author_id_fullname_str_mv 062f5697ff59f004bc8c713955988398_***_Melitta McNarry
author Melitta McNarry
author2 Lin Wang
Kimon Ntotsis
James Manifield
Katerina Tziannou
Tatiana Plekhanova
Alex Rowlands
Charlotte L. Edwardson
Maxime Taquet
Amisha Singapuri
Annemarie Docherty
Aarti Shikotra
Alexander Horsley
Beatriz Guillen-Guio
Betty Raman
Charlotte Bolton
Claire Nolan
Claudia Efstathiou
Daniel Lozano-Rojas
David J. Stensel
Enya Daynes
Ewen Harrison
Hamish McAuley
Ioannis Vogiatzis
Jack Sargeant
James Chalmers
Jennifer K. Quint
Joseph Jacob
Nicolette C. Bishop
Linzy Houchen-Wolloff
Ling-Pei Ho
Lucy Gardiner
Marco Sereno
Mathew Thorpe
Matthew Richardson
Melitta McNarry
Michael Marks
Molly Baldwin
Nazir Lone
Neil Greening
Omer Elneima
Olivia Leavy
Ruth M. Saunders
Victoria Harris
William Greenhalf
William Man
Louise V. Wain
Iain Stewart
Sally Singh
Christopher E. Brightling
Claire Lawson
Tom Yates
Rachael A. Evans
format Journal article
container_title ERJ Open Research
container_volume 0
publishDate 2026
institution Swansea University
issn 2312-0541
doi_str_mv 10.1183/23120541.01496-2025
publisher European Respiratory Society (ERS)
college_str Faculty of Science and Engineering
hierarchytype
hierarchy_top_id facultyofscienceandengineering
hierarchy_top_title Faculty of Science and Engineering
hierarchy_parent_id facultyofscienceandengineering
hierarchy_parent_title Faculty of Science and Engineering
department_str School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
document_store_str 0
active_str 0
description Background: Physical inactivity is a risk factor for severe COVID-19 and often worsens after hospitalisation. Clinicians need quick, accurate assessments to target interventions. We aimed to assess the validity of the General Practice Physical Activity Questionnaire (GPPAQ) in adults recovering one year after COVID-19 hospitalisation. Methods: Post-hospitalisation for COVID-19, adults attended a one-year-visit and completed the GPPAQ Physical Activity Index (PAI-4 active), 14-day wrist-worn accelerometry (Moderate-Vigorous PA [MVPA]- active), and other health outcomes. Validity was examined via: (i) internal consistency (factor analysis); (ii) measurement invariance across sex, age, and ethnicity using differential item functioning (DIF); (iii) convergent validity (GPPAQ sensitivity/specificity versus accelerometry); and (iv) construct validity (correlations with health outcomes). Results: 752 participants had GPPAQ and accelerometry (265 female, mean±sd age 60.9±11.6 years, MVPA 18.75 min·day−1 (IQR 7.55, 36.11), PAI-1 46.8%, PAI-2 15.6%, PAI-3 19.4%, PAI-4 18.2%. Factor analyses supported good internal consistency with two factors (daily activities, physical exercise). Confirmatory factor Index (CFI) showed excellent fit (CFI 0.965). DIF indicated moderate variability by sex and age. GPPAQ-PAI showed limited sensitivity (26.3%) for correctly classifying physically active individuals, but higher specificity (88.4%) for classifying physical inactivity, and weak-to-moderate correlations with health outcomes. Conclusions: GPPAQ demonstrates internal consistency, with construct and convergent validity in adults 1-year post-COVID-19 hospitalisation. GPPAQ effectively identifies inactive individuals to support clinical care; however, its sensitivity suggests underestimation of activity relative to accelerometry. Future pathways should combine GPPAQ with device-based assessment to optimise evaluation of physical activity to guide pulmonary rehabilitation and targeted interventions.
published_date 2026-05-01T09:39:00Z
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score 11.107856

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