J ClinEpidemtolVol. 46, No. 12,pp.

140%141 I, 1993 Pruned in Great Britain

0895-4356/93 $6.00+ 0.00 Pergamon Press Ltd

ACCURACY

OF THE COLLEGE ALUMNUS ACTIVITY QUESTIONNAIRE*

DAVID R. JACOBS*and R. S. PAFFENBARGER JR

PHYSICAL

BARBARAE. AINSWORTH, ~ ARTHUR S.LEON>~

MARKT.RICHARDSON,~

Applied Physiology Laboratory, Department of Physical Education, Exercise and Sport Science and Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill, NC 27599, Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, 3Division of Kinesiology, School of Kinesiology and Leisure Studies, University of Minnesota, Minneapolis, MN 4Area of Health and Human Performance, University of Alabama, Tuscaloosa, AL and %chool of Medicine, Stanford University, Palo Alto, CA, U.S.A.
(Received in revised form 25 June 1993)

Abstract-The validity and reproducibility of the Physical Activity Index from the College Alumnus Questionnaire (PAI-CAQ) were determined in 78 men and women (21-59 yr) with a broad range of physical activity habits. The PAX-CAQ was computed as the sum of energy expended in stair climbing, walking, and sports and recreational physical activity recalled from the past week. Data were validated against measures of cardiorespiratory fitness, body fatness, motion detection, and physical activity records. All physical activity was recorded by participants for six 48-hour periods. Each day of the week, including weekends, were represented at least twice in the physical activity records. Age-adjusted correlation coefficients between like activities on the College Alumnus Questionnaire and physical activity records ranged from 0.25 to 0.65 in men and 0.28 to 0.86 in women. Correlations between the PAI-CAQ and validation criteria that reflected total and heavy-intensity physical activities were higher (r = 0.34-0.69, p < 0.05) than for lighterintensity physical activities and motion detection expressed in MET-mind-r and kcald (r < 0.35, p > 0.05). Test-retest reproducibility was higher over 1 month (r = 0.72) than over 8 and 9 months (I = 0.34 and 0.43) (p < 0.05). Energy expended in walking and stair climbing was underestimated on the College Alumnus Questionnaire, resulting in lower PAI-CAQ scores, as compared to the physical activity records. Exercise Exertion Validity Reproducibility Leisure activities

INTRODUCTION
To study the association between physical activity and health outcomes in population surveys, questionnaires are needed that are easy to

*Sections of this paper were presented at the 1988 and 1990

American College of Sports Medicine Annual Meetings in Dallas, Texas and Salt Lake City, Utah and published in abstract form [2]. ?A11 correspondence should be addressed to: Barbara E. Ainsworth, Ph.D., MPH, Applied Physiology Laboratory, Department of Physical Education, Exercise & Sport Science, 25C Fetzer Gymnasium, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, U.S.A.

complete, valid, reliable, and assess physical activity habits equally well in men and women. Recent evaluations of commonly-used physical activity questionnaires indicate that many of these instruments focus primarily on participation in sports, formal exercise and other heavy-intensity physical activities [3,4]. One of the better known physical activity assessment tools is the College Alumnus Questionnaire [5]. From the College Alumnus Questionnaire, a Physical Activity Index (PAI-CAQ) is calculated, which is used to characterize physical activity habits [6,7], and study the associations between physical activity and

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et al.

chronic disease rates [5, S--13], longevity [14], cardiorespiratory fitness [15, 161, and energy balance in male alumni of Pennsylvania and Harvard University [5]. The validity of the PAI-CAQ, using several validation criteria concurrently, in a single sample of subjects has not been previously reported. This study examines the test-retest reproducibility and the validity of the PAI-CAQ against direct and indirect measures of physical activity in 78 men and women with a broad range of physical activity habits.
METHODS

Data are reported from the Survey of Activity, Fitness, and Exercise study (SAFE). SAFE was a NHLBI-funded study designed to examine the validity and reproducibility of a variety of physical activity questionnaires commonly used in epidemiologic research projects. A detailed study protocol and subject eligibility requirements for SAFE were reported elsewhere [3,4, 171. Participants Participants consisted of 28 men and 50 women, ranging in age from 21 to 59 years (mean + D, 38 f 9 years). The study design was approved by the University of Minnesota s institutional review board for studies involving human subjects and written informed consent was obtained. Subjects were recruited by advertisements placed on bulletin boards in the University s academic and hospital facilities. One hundred and three volunteers attended a prestudy orientation meeting and were stratified by physical activity status into low, moderate, or high activity groups using a modified scoring scheme for the Lipid Research Clinics physical activity questionnaire [4]. Seventy-eight of these subjects completed the study. Of the 25 nonfinishers, 20 dropped-out prematurely, while 5 were screened but never participated. Comparison of the results indicated no statistically significant differences in baseline physical fitness and physical activity measurements between those who did and did not complete the study. Data collection The SAFE study protocol included 14 clinic visits, spaced approximately 26 days apart.
*A MET is defined as the ratio of the associated metabolic rate for a specific activity divided by the resting metabolic rate. It is also defined as an energy expenditure of I kcal.hr- per kg body mass.

Forty eight-hours before each clinic visit, subjects recorded all physical activity at least every 4 hours in a diary designed for the study. During the same 48 hour period, subjects wore a Caltrac accelerometer (Caltrac, Hemokinetics, Madison, WI) and recorded their energy expenditure readings in kilocalories from the Caltrac on their physical activity record form. During each clinic visit, participants completed various questionnaires regarding their physical activity habits and reviewed their physical activity records with trained interviewers. The Caltrac motion detectors also were checked at each clinic visit to ensure proper functioning. In addition, during three of the clinic visits, subjects performed maximal treadmill graded exercise tests with gas analysis and body composition studies to assess physical fitness status. An average clinic visit lasted 50 minutes. College Alumnus Questionnaire. This questionnaire was mailed to participant s homes (similar to the manner of administration in the College Alumnus Study) [5] at the beginning and during the middle of the study (i.e., after the pre-study orientation visit 1 and before visits 8 and 9). Participants completed the questionnaire at home and brought it with them to the next clinic visit. The questionnaire was collected by the study staff without editing in order to duplicate the methods used by Paffenbarger et al. [5] for administering this questionnaire in the College Alumnus Study. Questionnaire results averaged over clinic visits 1, 8, and 9 were used in this report to test the validity and the short-and long-term reproducibility of the PAI-CAQ. Physical activity is assessed by three questions that are used to comprise the PAI-CAQ. Respondents are asked to identify the number of flights of stairs climbed per day and city blocks walked per day, and the frequency and duration of sports and recreational activities performed during the past week. Adjustment for variability in participation habits for the sports and recreational activities listed is made by having subjects identify the weeks in the past year each was performed. Intensity levels activity in METS* for sports and recreational activities were obtained from the Compendium of Physical Activities developed for the SAFE study [18]. The PAI-CAQ was computed as MET-minewk- using the formula obtained from

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Paffenbarger et al. [5]: (city blocks walked per day x 7 days per week x 8 METS per block) + flights of stairs climbed per day x 7 days per week x 4 METS per flight) + [activity MET intensity x events per week x duration in minutes per event)/(weeks participated per year/52 weeks per year)]. The term METminawk- was used in this study to express the energy costs of physical activities independent of body weight. MET-minewk- is equivalent to the kcalwk- term used by Paffenbarger et al. [5] who excluded body weight when computing the PAI-CAQ scores in their 1978 paper.

Direct validation criteria Physical activity records. All physical activity was recorded by participants on a physical activity record for 48-hour periods before each clinic visit. Each day of the week, including weekends, were represented at least twice during the course of the study year. For each physical

activity record entry, subjects recorded a general and specific description of physical activity, an estimate of the intensity or pace of the effort, the duration of activity in minutes, and noted if the activity was occupationally-related. Types of physical activity recorded included, but were not limited to, sports and recreational activities, household chores, shopping, cooking, personal care and hygiene, activities of daily living, child care, sleeping, transportation, lawn and garden activities, and various occupational tasks. Subjects made physical activity record entries every 4 hours during the 48 hour time period. At each visit, a trained interviewer edited the 48-hour record for clarity in the presence of the participant. Trained coders transferred the data to data entry forms and assigned each activity a MET intensity code. The MET levels for the recorded physical activities were obtained from the SAFE study s Compendium of Physical Activities [ 181.Energy expenditure was computed as MET-mins for

Table 1. Mean MET-minwk- + SD for the visit-specific physical activity indices (PAI) for the College Alumnus Questionnaire and the Physical Activity 48-hour records* College Alumnus PAI Clinic visits Variables 1 8 9 Average 1897 (1192) 1243 (832) 1270 (1086) 1180 (1138) $8) 806 (916) 470 (303) 433 (286) 416 (291) 2 4562 (2577) 3953 (Z (2468) 1888 (2510) 1368 (2233) 1555 (2333) 2225 (1138) 2231 (1101) 2229 (1107) Physical Activity Record PA1 Clinic visits 8 4166 (2580) 3310 (2035) 3630 (2276) 9 4671 (2884) 3455 (1743) 3894 (2280) 2511 (2684) 795 (1116) 1415 (2004) 1705 (1176) 2137 (1167) 1982 (1181) E) Average 4420 (1875) 3540 (1543) 3856 (1711)

Phvsical Activitv Index (Met-min wk -I) Men - 2033 . 1885 1618 (1583) (1467) (1371) Women 1570 1122 1063 (1186) (998) (824) All 1736 1376 1270 (1351) (1219) (1086) Sports & recreation (MET-min .wk ) Men 1311 1094 949 (1505) (1360) (1289) Women 829 547 1063 (1024) (842) (688) All 505 729 (363) (1065) City blocks walked (Met-min.wk- ) Men 486 537 (376) (348) Women 515 380 (358) (347) All 505 432 (362) (353)

1616 (2131) 676 (1329) 1027 (1722) 2238 (1887) 2151 (1401) 2182 (1581)

1964 (1675) 915 (1176) 1291 (1456) 2056 (997) 2173 (845) 2131 (898)

418 (399) 380 (341) 394 (361)

Flights of stairs climbed (MET-min.wk -). Men 238 253 250 247 488 (429) (321) (410) Women 187 (z? 195 355 (172) (145) (158) (155) All 230 215 212 222 (27;) (178) (272) (232) (192) (330) *All: visits 1 & 2 (n = 78), visit 8 (n = 75), visit 9 (n = 74). Women: (n = 47), visit 9 (n = 46). Men: all visits (n = 28).

(f z!)

312 (151) 326 (303) 321 (258) visits 1 &

353 (232) 330 (301) (235) 307 339 (340) (233) 2 (n = 50), visit 8

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Table 2. Age-adjusted correlations between direct and indirect validation criteria and the College Alumnus Questionnaire Physical Activity Index (PAX-CAQ) PI-CAQ and Component Parts Men? Flights stairs Validation Criteria Physical activity record-PA1 specific (MET-min.wk- ) Flights stairs climbed 0.45* 0.19 0.03 0.12 City blocks walked 0.32 0.64** 0.20 0.37 Sports & recreation -0.08 -0.12 0.25 0.29 Z fits, blks, & spts 0.07 0.14 0.51** 0.65** Physical activity record-intensity specific (MET-minwk- ) Total LTPA 0.17 0.17 0.46* 0.60** Heavy intensity LTPA 0.04 -0.01 0.56** 0.69** Moderate intensity LTPA 0.03 0.07 -0.38 -0.24 Light intenstiy LTPA 0.20 0.27 0.30 0.35 Caltrac (k&d- ) 0.14 0.16 -0.19 -0.05 Caltrac (METsd- ) 0.38* 0.21 -0.02 0.19 -0.02 0.00 0.55** 0.5l?** 0.21 -0.09 -0.40 -0.36 PAI-CAQ and Component Parts ALLt Flights stairs Validation criteria Physical activity record-PA1 specific (MET-minwk- ) Flights stairs climbed 0.79** 0.09 -0.02 City blocks walked 0.06 0.34** 0.25* sports. & recreation -0.02 0.17 0.39** Z Flts, blks, & spts 0.26 0.13 0.53** Physical activity record-intensity specific (MET-minwk- ) Total LTPA 0.22 0.23* 0.21 Heavy intensity LTPA 0.22 0.30 0.49,. Moderate intensity LTPA -0.03 0.12 -0.05 Light intensity LTPA 0.18 0.14 -0.05 Caltrac (k&d- ) -0.00 0.17 Caltrac (METsd- ) 0.07 0.21 8% 0.17 0.22 0.16 -0.12 City blocks sports & rec. PAS Index City blocks sports & rec. PA% Index Flights stairs Woment City blocks sports & rec. PA% In&x

0.86** 0.03 -0.05 0.13 0.25 0.25 -0.08 0.24 -0.21 -0.11 0.21 -0.26

0.06 0.28 0.27 0.30* 0.27 0.38. 0.16 0.11 0.17 0.19 0.26 -0.11

-0.08 0.36* 0.43** 0.53** 0.03 0.42** 0.12 -0.25 0.10 0.16 0.32 -0.26

0.13 0.32* 0.54. 0.5421 0.34** 0.65** 0.15 0.03 0.08 0.19 0.53** -0.36

0.17 0.24* 0.48** 0.60** 0.42. 0.69** 0.04 0.08 0.17 0.29

0.43** 0.60** -0.34** - .0&l**

?? p < 0.05; ?? *p < 0.01. tSample sixes: direct validation criteria (men, II = 28; women, n = 50; all n = 78). Indirect validation criteria (men. n = 27: women. n = 49: all, n = 76). $PA =physical activity. \ each activity by multiplying the MET level x duration in minutes per event. Forty-eight hour MET-mm scores also were summed for leisuretime physical activities according to intensity levels (light, ~4 METS; moderate, 4.5-5.5 METS; heavy, 26.0 METS) as well as by activity types listed on the PAI-CAQ (e.g. Sights of stairs climbed, walking, and sports and recreational activities), multiplied by 3.5 (to obtain weekly MET-min scores) and were presented in MET-rninwk- Physical activity records obtained at clinic visits 2, 3, 8, 9, 12, and 13 were averaged to compute leisure-time physical activity scores by intensity and thus reflect seasonal variability in physical activity habits. Physical activity records obtained at clinic visits 2, 8, and 9 were averaged to compute Physical Activity Index scores (PAI-PAR) and thus reflected visit-specific validation criteria for the College Alumnus Questionnaire scores. Since the physical activity records were not kept by subjects at the pre-study orientation visit (visit 1) when the first College Alumnus Questionnaire was completed, physical activity records from visit 2, completed 28 days later, were used to compare the visit 1 PAI-CAQ scores.

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Caltrac Accelerometer. The Caltrac Accelerometer was used to provide a direct, objective measurement of daily energy expenditure [19]. Caltrac 24-hour scores were reported both in kcal, which factors in the metabolic data of height, weight, age, and sex (Caltrac,_,), and METS, which is independent of metabolic data (CaltracM,). The Caltrac,,, score was computed by dividing each participant s Caltrac,, score by their estimated resting metabolic rate as described elsewhere [4]. Caltrac,,, and CaltracMETs scores were averaged over all 14 study visits to represent a measure of daily physical activity during the study year and thereby reflect seasonal variability in physical activity habits. Indirect validation criteria Cardiorespiratory fitness. Cardiorespiratory fitness was assessed by direct measurement of peak or symptom-limited oxygen uptake (VoZpll;) using a Beckman Metabolic Measurement Cart during a treadmill graded exercise test developed for the SAFE study. The treadmill test protocol begins at 3 m.p.h. and 0% grade and progressively increases in grade or speed at an energy cost of approximately 1 MET per stage. The test protocol and procedures used to determine I oZ, are described in detail elsewhere [4]. vole,, values presented here are the average of three measurements (clinic visits 2, 3, 13). Body composition. Body density was measured by hydrostatic weighing [20] and converted to percent body fat by the Siri equation [21] at clinic visit 1. Residual lung volume used in the determination was measured by the closed circuit oxygen dilution method of Wilmore [22]. Data analyses Means and standard deviations were calculated for the validation realms and the PAICAQ data for men and women. Skewed data from the PAI-CAQ and physical activity records were normalized using decimal logarithmic transformations. Before taking logarithms, 1.0 was added to each value to account for the chance of having zero values for some variables. Average PAI-CAQ results from the three clinic visits previously described were used in the validation analyses. The average PAI-CAQ score also was compared with average physical activity records data from visits 2, 8, and 9. Validity was investigated using sex-specific, ageadjusted linear regression analysis to identify the amount of variability (r2) in the validation

realms explained by the log PAI-CAQ and its component parts (flights of stairs climbed, city blocks walked, and sports and recreational activities). Correlation coefficients were computed by taking the square root of the r2 obtained from the regression analyses. Short-term (clinic visits 8 and 9) and long-term (clinic visits 1 and 8 and clinic visits 1 and 9) reproducibility of the log PAI-CAQ scores were determined using Pearson product-moment correlation analysis adjusted for age in men and women. Data were analyzed using SAS statistical software (SAS Institute, Cary, NC).

RESULT!3

weans f standard deviations for the validation realm measures were: cardiorespiratory (V,, pul; = 35.6 &-9.6 mlkg- fitness amin- ), body fatness (%fat = 27.5 & 9.6), motion detecCaltion (Caltrac,, = 2,225 f 449 kcald- ; trac,, = 1.29 f 0.10); physical activity record leisure-time physical activity scores (total = 471 f 222 MET-mind ; heavy intensity = 113 f 122 MET-mind ; moderate intensity = 41 + 37 MET-mined- ; light intensity = 75 &-43 MET-mind ). Non-occupational leisure-time physical activity energy expenditure averaged across 6 physical activity records was 1915 f 260 MET-mind- for the study sample. Age-and sex-adjusted data for the validation criteria were presented elsewhere [3]. Analysis of the Physical Activity Index score from physical activity records showed the PAIPAR represented about 20% of the total daily non-occupational energy expenditure (379 MET-mind /1915 + 260 MET-mined- ). Sexspecific means and standard deviations for the PAI-CAQ and its component parts and the physical activity records are presented in Table 1. PAI-CAQ scores were generally higher at the first clinic visit as compared to clinic visits 8 and 9. Scores also were generally higher in men as compared to women. In comparison to the physical activity records at each clinic visit, walking and stair climbing appeared to be underestimated by the College Alumnus Questionnaire in both men and women. The sports and recreation scores also were significantly lower on the College Alumnus Questionnaire as compared to the physical activity records. This resulted in significantly lower Physical Activity Index obtained from the College Alumnus Questionnaire as compared to the physical activity records.

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measures that reflected participation in both heavy-intensity and total leisure-time physical activity. In addition, as would be expected, significant correlations were found between like activities on the College Alumnus Questionnaire and the physical activity records. This suggests that the PAI-CAQ questionnaire items are recalled reasonably well and that they contribute to the validity of the PAI-CAQ as a measure of overall leisure-time physical activity energy expenditure. However, subjects tended to underestimate the amount of walking and stairclimbing they reported on the College Alumnus Questionnaire. Weekly energy cost estimates for walking on the College Alumnus Questionnaire were about one fifth of those obtained from the physical activity records. The underestimation of walking may be related to the wording on the College Alumnus Questionnaire which queries subjects on the number of city blocks walked in a usual day. This wording may cause subjects to think only about walking in the context of city blocks and does not reflect the majority of walking each day which occurs in and around the house and for transportation. Thus, clarification of the questionnaire items to ensure that all walking is recalled would most likely reduce this under-representation. The Physical Activity Index scores from the College Alumnus Questionnaire also were nearly two thirds lower than those recorded on the physical activity records. Based on the physical activity records, only 8% of the study participants had a PAI-PAR score of less than 2000 MET-minwk- This is in contrast to 41% of the participants who reported expending less than 2000 MET-minwk- on the College Alumnus Questionnaire. Paffenbarger et al. [5] obDISCUSSION served that a Physical Activity Index of 2000 The results presented here suggest that the MET-minwk- appeared to be the optimal for College Alumnus Questionnaire Physical Ac- association with reduced incidence of fatal and tivity Index is a moderately good instrument for non-fatal myocardial infarctions in male college alumni. It is unknown if the participants in the classifying people for habitual activity status College Alumnus Study also underestimated and that the instrument has acceptable shorttheir total amount of weekly walking as obterm repeatability. These results are consistent with earlier vali- served in our SAFE study. If so, it is possible dation studies that showed statistically signifi- that the 2000 MET&inwk- estimate for opticant associations among the PAI-CAQ and mal reduction of heart attack risk may actually measures of cardiorespiratory fitness [ 163 be an underestimation of energy expenditure. Even though the PAI-CAQ appears to be recorded body motion [23], and body fatness a reasonably valid and reproducible physical [24]. Other studies also showed a significant correlation between the PAI-CAQ and high activity assessment tool for the activities inof total daily density lipoprotein cholesterol [l 1,251. The cluded, the relatively low amount leisure energy expenditure accounted for by the PAI-CAQ correlated best with validation

Table 2 shows the correlations between the PAI-CAQ and its component parts and the direct and indirect validation realm data. Statistically significant correlation coefficients were observed between like categories from the College Alumnus Questionnaire and physical activity records for all categories except sports and recreation in men, and city blocks walking in women. In men, the Physical Activity Index from the College Alumnus Questionnaire also was significantly correlated with the direct validation measures of total-and heavy-intensity leisure-time physical activity and the indirect validation measure of Vo,,. In women, the Physical Activity Index from the College Alumnus Questionnaire also was significantly correlated with the direct validation measures of city blocks walked, sports and recreation activities, total-and heavy-intensity leisure-time physical activity from the physical activity records, and the indirect validation measures of Vozw and percent body fat scores. The sports and recreation scores from the College Alumnus Questionnaire were significantly correlated with the physical activity records heavy-intensity physical activity and Vo2pal;in men and women. The majority of other correlations between the PAI-CAQ and its component parts and the validation realms were low order and non-significant. Table 3 presents the age-adjusted correlation coefficients for the short-and long-term reproducibility of the PAI-CAQ and its component parts. Short-term reproducibility ranged from r = 0.31 to 0.88. Long-term reproducibility ranged from r = 0.01 to 0.63 for repeat administrations of the questionnaire 8 and 9 months apart.

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physical activity records (20%) should be noted. This is probably because the PAI-CAQ does not assess activities of daily living or other non-sport and non-recreational activities. The PAI-CAQ also does not assess for occupational physical activity. These limitations, therefore, appear to result in a gross underestimation of total daily physical activity. Thus, to account for a larger percent of habitual daily physical activity, additional questionnaire items would be required, particularly to identify occupational, household, child care, activities of daily living, inactivity, and other non-structured physical activities, which contribute substantially to one s total daily energy expenditure. The Physical Activity Index from the College Alumnus Questionnaire yielded consistent results when administered over one month s time, however, recall over 8 and 9 months was less accurate. These findings are in agreement with previous studies that show good repeatability of the PAI-CAQ over a l-month period [6], but are in disagreement with those that show good repeatability over a l-year period [6,23]. The relatively low test-retest correlation over the 8 and 9 month periods in our SAFE study (e.g. January to August and September) may reflect seasonal differences in physical activity for this cohort residing in Minnesota as well as variability in physical activity habits over time. It is also possible that inaccurate recall of physical activity habits over time or that statistical regression to the mean of the PAI-CAQ scores from visit 1 to visits 8 and 9 may have biased the long-term test-retest correlation coefficients observed in this study toward the null. Although our SAFE Study provides the most comprehensive evaluation of the College Alumnus Questionnaire to date, it has limitations specific to the methodology used and population studied. First, the College Alumnus Questionnaire was mailed to each participant s home and returned by them to the clinic without editorial checking by the clinic staff. As previously mentioned, this approach was used to replicate the procedure used by Paffenbarger et al. [Sl. It is quite conceivable that errors in the way the subjects interpreted the College Alumnus Questionnaire or recorded the information may have introduced errors into the results in this, as well as in the College Alumnus Study. However, if so, the error is probably minimal since the results of the PAI-CAQ were fairly consistent from one administration to the next.

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B~ARA E. AINSWORTH et al. 4. Ainsworth BE, Jacobs DR Jr, Leon AS. Validity and reliability of self-reported physical activity: the Lipid Research Clinics Questionnaire. Med Sci Sports Exert 1993; 25: 92-98. Paffenbarger RS Jr, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol 1978; 108: 161-175. Cauley JA, LaPorte RE, Black-Sandler RB, Schramm MM, Kriska AM. Comparison of methods to measure physical activity in postmenopausal women. Am J Epidemiol 1987; 45: 14-22. Ainsworth BE, Berry CB, Schnyder VN, Vickers SR. Leisure-time physical activity and aerobic fitness in African-American young adults. J Adoles Health 1992; 13: 606-611. L.ee I-M, Palfenbarger RS Jr, Hsieh C-C. Physical activity and risk of prostatic cancer among college alumni. Am J Epidemiol 1992; 135: 169-179. Lee I-M, Paffenbarger RS Jr, Hsieh C-C. Physical activity and risk of developing colorectal cancer among college alumni. J Natl Cancer Imt 1991; 83: 13241329. Ainsworth BE, Berry CB, Garrett JS, Schnyder VN, Vickers SR. Interaction of obesity and physical activity on blood pressure. Manuscript submitted for publication. Cook TC, LaPorte RE, Washburn RA, Traven ND, Slemenda CW, Metx KF. Chronic low level physical activity as a determinant of high density lipoprotein cholesterol and subfractions. Med Sci Sports Exert 1986; 18: 653-657. Gwen JF, Mathews KA, Wing RR, Kuller LH. Physical activity and cardiovascular risk: a cross-sectional study of middle-aged pmmenopausal women. Prev Med 1990; 19: 147-157. Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL. Physical activity and incidence of hypertension in college alumni. Am J Epidemiol 1983; 117: 2245-2257. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh C. Physical activity, all-cause mortality, and longevitity of college alumni. N En@ J Med 1986; 314: 605-613. Cauley JA, LaPorte RE, Sandler RB, Bayles C, Petrini A, Slemenda C. Physical activity and HDL-C subfractions in postmenopausal women (Abstract). Med Sci Sports Exert 1984; 16: 176. Siconolfi SF, Lasater TM, Snow RCK, Carleton RA. Self-reported physical activity compared with maximal oxygen uptake. Am J Epidmiol 1985; 122: 101-105. Ainsworth BE, Richardson MT, Jacobs DR Jr, Leon AS. Prediction of cardiorespiratory fitness using physical activity questionnaire data. Med Exer Nutr Health 1992; 2: 75-82. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HR, Salhs JF, Paffenbarger RS. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exer 1993; 25: 71-80. Montoye I-U, Washburn R, Servais S, Ertl A, Webster JG, Nagle FJ. Estimation of energy expenditure by a portable accelerometer. Med Sci Sports Exer 1983; 15: 403-407. Pollock ML, Wilmore JH, Fox SM. Exercise in Health and Disease. Philadelphia, PA: WB Saunders; 1984: 97-130. Siri W. The gross composition of the body. Adv Biol Med Phys 1956; 4: 239-272. Wilmord JH. A simplified method for determination of residual lung volumes. J Ann1 1969: 27: _- Physiol 96400. -

Second, the weekly energy expenditure score for the sports and recreation activities from the physical activity records at each visit was estimated from the 48-hour MET-min score. Since the frequency of participation during the week when the physical activity records were recorded and the weeks of participation for the activities during the past year were unknown, the activities were scored as if they were performed daily without adjustment for participation habits in the past year. This may have resulted in a slight overestimation of the energy expended in sports and recreational activities on the physical activity records. Third, the sample consisted of a volunteer cohort of participants who were Caucasian, college educated, urban dwellers, nonsmokers, and worked in professional, clinical, or other white-collar occupations. Furthermore, two-thirds of the study subjects were women. It is unknown how these demographic factors may have influenced the results of this study and thus our results require replication in other populations. In summary, the simultaneous evaluation of the College Alumnus Questionnaire with directand indirect measures of physical activity shows this instrument to be a valid and reliable physical activity assessment tool. However, energy expenditure in walking and stair climbing activities appears to be underestimated by the current instrument, resulting in a lower PAI-CAQ score than computed from similar activities on physical activity records. Rewording of some questionnaire items may be useful to ensure accurate recall of all activities in future revisions of the College Alumnus Questionnaire.
Acknowledgements-This project was supportedby funding by a National Heart, Lung, and Blood Institute grant, lROl-HL37354, awarded to Drs Leon and Jacobs. The data in this paper were used for a MPH thesis from the Division of Epidemiology, School of Public Health, University of Minnesota by Dr Ainsworth. We would like to thank M. Carl McNally, Yvonne Guptil, and Terry1 Hartman for their help in the data collection phase of this study. REFERENCES Ainsworth BE, McNally MC, Richardson M, Rutlin M, Cook T, Jacobs DR Jr, Serfass RC, Leon AS. Validity of the Paffenbarger College Alumni Physical Activity Questionnaire. Med Sd Sparta Exert (Abstract) 1988; 20(2) Suppl.: S46. A&worth BE, Jacobs DR Jr, Leon AS. Validity of Assessment of Physical Activity using the College Alumnus Questionnaire.. Med Sd Sports Exer (Abstract) 1990, 22(2) Suppl.: S79. Jacobs DR Jr, Ainsworth BE, Hartmann TJ, Leon AS. Simultaneous evaluation of ten physical activity questionnaires. Med d Sports Exert 1993; 25: 81-91.

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23. Washburn RA, Adams LL, Haile GT. Physical activity assessment for epidemiologic research the utility of two simplified approaches. Rev Med 1987; 16: 636-646.

Physical Activity Questionnaires 24. LaPorte RE, BlackSandIer R, Cauley JA, Link M, Bayles C, Markes B. The assessment of physical activity in older women: analysis of the interrelationship and reliability of activity monitoring, activity surveys, and caloric intake. J Gerontol 1983; 38: 394-397.

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25. Cauley JA, LaPorte RE, Kuller LH, Black-Sandler R. The epidemiology of high density lipoprotein cholesterol in post menopausal women. J Geruntol1982; 30: lo-15