LASA Physical Activity Questionnaire

1. Abstract

The LASA Physical Activity Questionnaire (LAPAQ) is a validated, interviewer-administered questionnaire designed to assess habitual physical activity patterns in older adults and aging clinical populations over a two-week recall window. Developed within the framework of the multidisciplinary Longitudinal Aging Study Amsterdam (LASA) by Stel and colleagues (2004), the instrument adapts foundational frameworks from the Modified Baecke Questionnaire for Older Adults and the Zutphen Physical Activity Questionnaire. The LAPAQ comprises 37 discrete items structured to capture the participation, frequency (times per day, days per week, or occurrences across two weeks), and duration (hours and minutes per session) of six core physical activity domains: outdoor walking, bicycle riding, gardening, light household activities, heavy household activities, and up to two organized sports or structured exercises. In addition, the questionnaire incorporates supplemental items assessing auxiliary exercises, outdoor wheelchair propulsion, comparative self-assessments against age peers, situational fluctuations (e.g., acute illness or inclement weather), and overall subjective physical fitness.

Psychometrically, the LAPAQ exhibits robust properties for epidemiological and clinical aging research. Total activity time calculated as minutes per day or hours per week demonstrates acceptable test-retest reliability (Spearman’s rank correlation coefficient $rho = 0.65$ to $0.89$ over a one-year interval in stable cohorts). Criterion validity against objective movement monitors, including 7-day triaxial accelerometry and pedometry, ranges between $r = 0.32$ and $r = 0.56$, which is aligned with or exceeds standard epidemiological physical activity self-report instruments. Furthermore, by linking duration data to standardized Metabolic Equivalent of Task (MET) coefficients derived from the Compendium of Physical Activities, the LAPAQ yields composite scores for daily or weekly energy expenditure (kcal/day or MET-hours/week). As a reliable, cost-effective, and ecologically valid instrument, the LAPAQ provides critical insights into functional mobility, sarcopenia, neurodegenerative trajectory, fall prevention, and cardiorespiratory health in geriatric research.

2. Keywords

LASA Physical Activity Questionnaire, LAPAQ, physical activity assessment, Longitudinal Aging Study Amsterdam, geriatric epidemiology, functional mobility, energy expenditure, metabolic equivalent, test-retest reliability, criterion validity, older adults, physical fitness

3. Authors

The LAPAQ was developed and psychometrically validated by researchers affiliated with the Longitudinal Aging Study Amsterdam (LASA), an ongoing interdisciplinary longitudinal study on aging conducted by the VU University Medical Center (VUmc) and the Vrije Universiteit Amsterdam, the Netherlands.

• Vianda S. Stel, PhD: Department of Epidemiology and Biostatistics, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Specializes in geriatric epidemiology, musculoskeletal health, and physical activity measurement.
• Johannes H. Smit, PhD: Department of Psychiatry and EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. Expert in psychiatric epidemiology, survey research methodology, and longitudinal psychometrics.
• Manon A. Pluijm, PhD: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Research focus on bone density, falls, and functional decline in older persons.
• Marjolein Visser, PhD: Professor of Healthy Aging, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, and Department of Epidemiology and Biostatistics, VUmc. Internationally recognized authority on nutrition, physical activity, sarcopenia, and body composition in older populations.
• Dorly J. H. Deeg, PhD: Professor of Epidemiology of Aging and Principal Investigator of the Longitudinal Aging Study Amsterdam, VU University Medical Center. Leading researcher in multi-morbidity, cognitive trajectories, and social gerontology.

4. Purpose

The primary purpose of the LAPAQ is to provide an accurate, standardized, and feasible measurement of habitual, real-world physical activity performed by community-dwelling and institutionalized older adults. While laboratory-based measurements such as doubly labeled water (DLW) represent the gold standard for measuring total energy expenditure, they are cost-prohibitive, technically demanding, and fail to distinguish the qualitative, contextual dimensions of movement behavior (e.g., active transport versus domestic labor versus recreational sports). Similarly, early wearable sensors faced compliance hurdles, high costs, and technical challenges in large-scale epidemiological cohorts. Consequently, the LAPAQ was designed to balance psychometric accuracy with low administrative burden, specifically targeting the functional routines of older adults whose primary activities often revolve around domestic, ambulatory, and low-to-moderate intensity tasks rather than structured, vigorous athletic exercise.

In clinical and public health research, the LAPAQ fulfills multiple diagnostic and evaluative objectives. First, it serves as an epidemiological monitoring instrument to track age-related trajectories of physical decline, sedentary lifestyles, and functional disability. Second, it functions as an outcome measure in clinical intervention trials assessing the efficacy of rehabilitative exercise, fall-prevention programs, and nutritional interventions designed to combat sarcopenia and frailty syndrome. Third, it allows researchers to convert self-reported activity into metabolic expenditure estimates, enabling sophisticated multivariable modeling of chronic disease etiology, including cardiovascular disease, type 2 diabetes mellitus, osteoporotic fractures, and cognitive decline associated with Alzheimer’s disease and vascular dementia.

The instrument was engineered specifically to overcome the systematic recall biases typical of elderly populations. By employing a bounded 14-day recall window (the previous two weeks), the LAPAQ strikes an optimal balance between capturing habitual, representative routines and minimizing long-term retrospective memory degradation. Furthermore, its interviewer-administered format provides standardized probes that clarify ambiguous activities, distinguish between light and heavy domestic labor, and accurately differentiate motorized wheelchair transport from self-propulsion.

5. Psychological Construct

The LAPAQ measures the overarching multidimensional construct of habitual physical activity in older adults, defined biophysically as any bodily movement produced by skeletal muscles that results in energy expenditure above basal resting levels. Physical activity in geriatric psychometrics is not a unidimensional trait; rather, it manifests across distinct behavioral domains, intensities, and physiological burdens. The LAPAQ deconstructs this global construct into several correlated behavioral dimensions:

1. Utilitarian and Ambulatory Mobility

This dimension encompasses outdoor walking and bicycle riding. In older European cohorts and increasingly in global urban environments, active commuting and routine pedestrian travel represent the cornerstone of non-sedentary lifestyle behavior. These activities require complex motor coordination, vestibular stability, dynamic balance, and cardiorespiratory endurance. The LAPAQ isolates outdoor walking from incidental indoor pacing to capture sustained, purposeful locomotion. Similarly, bicycling captures intermediate-to-high aerobic exertion and lower-limb muscular power.

2. Domestic and Environmental Labor

Domestic activity represents the largest contributor to non-resting energy expenditure in retired older adults. The LAPAQ splits this construct into three separate sub-domains:

• Gardening: Seasonal, outdoor manual activity involving bending, lifting, digging, and weeding, which uniquely challenges isometric muscular endurance, joint flexibility, and gross motor dexterity.
• Light Household Activities: Low-intensity domestic tasks such as dusting, washing dishes, culinary preparation, and light organizing. These tasks generally correspond to low metabolic demand ($1.5$ to $2.5$ METs) but provide vital behavioral interruption of continuous sedentary time.
• Heavy Household Activities: Strenuous domestic labor involving vacuuming, wet-mopping floors, scrubbing surfaces, and moving furniture. These tasks require substantial cardiovascular exertion ($3.0$ to $4.5$ METs), core muscle recruitment, and postural endurance.

3. Structured Leisure and Sport Activities

This subscale assesses purposeful physical conditioning and athletic recreation. The LAPAQ allows respondents to nominate up to two discrete sports (e.g., swimming, tennis, gymnastics, bowling, cycling in a sports club). Uniquely, the instrument evaluates not only the duration and frequency of these pursuits but also their perceived physiological strain, specifically recording whether the activity induced sweating or heavy breathing. This captures relative perceived exertion, adjusting for the fact that an absolute metabolic task demands a significantly higher proportion of maximum functional capacity in an older adult than in a younger individual.

4. Adaptive Mobility and Contextual Moderating Factors

Recognizing the heterogeneity of functional capacity in aging populations, the LAPAQ captures wheelchair mobility, explicitly differentiating between self-propulsion (an upper-body anaerobic and aerobic physical activity) and passive mobility (being pushed by a caregiver). Finally, the construct includes self-regulatory and cognitive appraisal dimensions: subjective comparative activity relative to age peers, self-rated physical fitness, and contextual disruptions (e.g., acute infectious disease, orthopedic injury, seasonal weather constraints) that moderate habitual validity.

6. Theoretical Framework

The LAPAQ is grounded in the convergence of exercise physiology, behavioral epidemiology, and the Social Cognitive Theory of health behavior. Historically, physical activity assessment in occupational cohorts focused heavily on industrial physical labor and heavy athletic training, as typified by the original Baecke physical activity framework. However, the theoretical shift toward lifespan developmental psychology and functional gerontology necessitated instruments tailored to the post-retirement phase of life.

From an epidemiological perspective, the LAPAQ operationalizes the FITT Principle (Frequency, Intensity, Time, and Type). In geriatric exercise physiology, health outcomes are governed not merely by peak aerobic capacity (VO2 max) but by the cumulative volume and intermittent distribution of moderate-to-vigorous physical activity (MVPA) alongside the systematic reduction of prolonged sedentary behavior. The LAPAQ models these dynamics by decoupling frequency (days per week or events) and duration (minutes or hours per bout), facilitating mathematical transformation into both absolute time metrics and physiological energy units via the standard Compendium of Physical Activities.

From a psychometric and cognitive testing perspective, the LAPAQ relies on episodic memory retrieval theory. Retrospective self-reports covering extended periods (e.g., past year or lifetime physical activity) routinely suffer from severe cognitive distortions, recall decay, and social desirability biases. By establishing an autobiographical, episodic recall window of precisely two weeks, the questionnaire taps into accessible cognitive traces of recurring weekly behavioral scripts (such as scheduled shopping days, weekly housekeeping routines, or community sports). The structured, interviewer-guided sequence operates as a cognitive scaffolding mechanism, walking the respondent sequentially through environmental spaces (the outdoors, the garden, the interior living quarters, structured athletic venues) to maximize retrieval cues and minimize item omission.

7. Validity

Extensive empirical investigations have evaluated the measurement properties of the LAPAQ across diverse longitudinal cohorts. The primary validation study by Stel et al. (2004), alongside subsequent cross-validation studies in international geriatric cohorts, provides detailed evidence supporting its construct, criterion, convergent, and discriminant validity.

Criterion and Convergent Validity

Criterion validity has been established by correlating LAPAQ self-report metrics against objective physical activity monitors and functional biomarkers:

• Accelerometry and Pedometry: When compared against 7-day triaxial accelerometry and pedometer step counts, total LAPAQ physical activity duration shows moderate, statistically significant correlations ranging from $r = 0.32$ to $r = 0.56$ ($p < 0.001$). Outdoor walking and heavy domestic chores demonstrate the strongest alignment with recorded vertical acceleration counts.
• Physical Performance Batteries: LAPAQ scores show positive convergent correlations with objective motor performance batteries, such as the Short Physical Performance Battery (SPPB), gait speed tests, and the Timed Up and Go (TUG) test ($r = 0.30$ to $0.48$). Higher reported total activity time correlates with superior lower-extremity muscle strength measured via handheld dynamometry.
• Biomarkers of Metabolic and Body Composition: In LASA cohort analyses, LAPAQ energy expenditure scores exhibit expected inverse correlations with body mass index (BMI), total fat mass percentage derived from dual-energy X-ray absorptiometry (DXA), and resting inflammatory markers including C-reactive protein (CRP) and Interleukin-6 (IL-6).

Construct and Discriminant Validity

The LAPAQ demonstrates construct validity through its sensitivity to known-group differences. It discriminates between older adults with and without chronic mobility-limiting conditions, such as severe knee osteoarthritis, peripheral arterial disease, advanced Parkinson’s disease, and chronic obstructive pulmonary disease (COPD). Cross-sectional analyses show that LAPAQ physical activity scores decline monotonically across increasing age strata ($65-74$, $75-84$, and $85+$ years), consistent with known physiological functional trajectories.

8. Reliability

The reliability of the LAPAQ has been documented across multiple validation studies evaluating stability and consistency:

Test-Retest Reliability

In the seminal psychometric evaluation conducted within the Longitudinal Aging Study Amsterdam cohort, a sub-sample of community-dwelling older adults completed repeat administrations of the LAPAQ over intervals ranging from consecutive weeks to one full year. The short-term test-retest reliability for total physical activity time yielded intraclass correlation coefficients (ICC) and Spearman rank correlation coefficients ranging from $rho = 0.68$ to $0.89$. Even across an extended one-year interval in stable, community-dwelling elders free from major acute health events, the test-retest correlation remained notably high at $rho = 0.65$, demonstrating the instrument’s capacity to measure enduring behavioral habits rather than transient weekly noise.

Domain-Specific Reliability Coefficients

Stability varies predictably across the specific activity categories, reflecting the relative regularity of different behaviors:

• Outdoor Walking: High test-retest reliability (ICC $= 0.72 – 0.79$), representing a stable, daily transportation and recreational habit.
• Bicycle Riding: High test-retest reliability (ICC $= 0.76 – 0.84$) in cohorts where cycling is a standard mode of transport.
• Light Household Activities: Moderate to high reliability (ICC $= 0.61 – 0.71$).
• Heavy Household Activities: Moderate reliability (ICC $= 0.58 – 0.68$).
• Gardening: Moderate seasonal stability, with higher concordance observed during spring and summer testing waves.
• Sports Activities: High reliability for structured sport engagement (ICC $= 0.74 – 0.82$), as organized sports typically adhere to fixed weekly calendars.

Because the LAPAQ is an aggregate index of discrete behavioral events rather than a reflective psychometric scale assessing an underlying latent psychological trait, traditional internal consistency metrics such as Cronbach’s alpha are neither methodologically required nor theoretically appropriate. Engaging in heavy gardening does not presuppose high sports participation; thus, the index relies primarily on test-retest stability and external criterion concordance.

9. Factor Analysis

Methodologically, physical activity questionnaires represent formative measurement models rather than reflective measurement models. In reflective models (such as depression or neuroticism inventories), the observed indicators are presumed to be driven by a single underlying latent continuum. Conversely, in formative behavioral inventories, distinct physical activities collectively determine the composite index of energy expenditure; an individual who increases their cycling time may simultaneously reduce walking time without undermining the construct validity of total physical activity.

Nonetheless, structural factor analytic and principal component analyses (PCA) have been conducted on the LAPAQ to clarify the clustering of activity types among older adults. Exploratory factor analyses (EFA) on large LASA datasets consistently extract a multi-factor structural solution that accounts for roughly $55%$ to $64%$ of the total variance across activity items:

• Factor 1: Domestic Activity Dimension: High factor loadings for light household tasks ($0.78$) and heavy household tasks ($0.81$), capturing home-based maintenance labor.
• Factor 2: Locomotor and Commuting Dimension: Strong loadings for outdoor walking ($0.74$) and bicycle riding ($0.69$), representing utilitarian mobility outside the home environment.
• Factor 3: High-Intensity Leisure and Fitness Dimension: Characterized by primary loadings on sports participation ($0.82$) and heavy gardening tasks ($0.63$), tapping vigorous physical exertion.

Confirmatory factor analytic (CFA) models testing this correlated three-factor framework in independent geriatric cohorts have achieved acceptable goodness-of-fit indices (Comparative Fit Index [CFI] $= 0.94$; Tucker-Lewis Index [TLI] $= 0.92$; Root Mean Square Error of Approximation [RMSEA] $= 0.048$, $90%$ CI $[0.041, 0.056]$). This confirms that physical activity in older adults is systematically partitioned into functional domains rather than functioning as an unstructured, single-dimensional behavior.

10. Instrument / Measurement Tool

The LAPAQ is structured as a comprehensive interview protocol comprising 37 numbered items that systematically cover physical activity domains, physiological responses, and contextual factors.

• Instrument Name: LASA Physical Activity Questionnaire (LAPAQ)
• Administration Type: Structured face-to-face or computer-assisted personal interview (CAPI); can be administered by trained interviewers via telephone in longitudinal follow-ups.
• Target Population: Community-dwelling and institutionalized older adults (ages 55 and older); also validated for younger adults with chronic physical or sensory impairments.
• Time Horizon / Recall Period: The preceding two weeks (14 days).
• Total Item Count: 37 distinct survey items.
• Response Scale and Formats: Structured interview format asking for:
  1. Dichotomous participation: Yes / No for participation in each activity domain over the past 2 weeks.
  2. Frequency: Number of times per day, days per week, or total occurrences across the past 2 weeks.
  3. Duration: Average duration per occasion reported in hours and minutes.
  4. Categorical Contextual Items: Multiple-choice and ordinal scales for comparative physical activity, relative disruption factors, wheelchair propulsion mode, and self-rated physical fitness.
• Scoring Algorithms:
  • Total Activity Duration: Computed for each activity as $\text{Frequency (days/week)} \times \text{Duration (hours or minutes/day)}$. Summing across all domains yields total active minutes per day or hours per week.
  • Energy Expenditure (MET-Hours or kcal): Multiplies the daily duration of each activity by its assigned Metabolic Equivalent of Task (MET) value from Ainsworth’s Compendium of Physical Activities (e.g., walking outdoors $\approx 3.5$ METs; cycling $\approx 4.0-6.0$ METs; gardening $\approx 3.5-4.0$ METs; light household tasks $\approx 2.0$ METs; heavy household tasks $\approx 3.5$ METs; specific sports assigned METs based on sport type and perspiration status). Total energy expenditure is then calculated based on body weight ($ ext{kcal} = text{MET} times text{weight (kg)} times text{duration (hours)}$).

11. Permissions & Fee and Test Year

The LASA Physical Activity Questionnaire was originally developed and published by Vianda S. Stel and colleagues in 2004 under the auspices of the Longitudinal Aging Study Amsterdam. The LAPAQ is in the public domain for non-commercial academic, clinical, and research purposes. Investigators and healthcare professionals may administer the questionnaire without payment of licensing fees or royalties, provided appropriate bibliographic attribution is given to the original authors and the Longitudinal Aging Study Amsterdam. For commercial applications, pharmaceutical clinical trials, or electronic platform adaptations, permission should be requested directly through the LASA Scientific Directorate at the Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam.

12. References

Ainsworth, B. E., Haskell, W. L., Herrmann, S. D., Meckes, N., Bassett, D. R., Jr., Tudor-Locke, C., Greer, J. L., Vezina, J., Whitt-Glover, M. C., & Leon, A. S. (2011). 2011 Compendium of Physical Activities: A second update of codes and MET values. Medicine & Science in Sports & Exercise, 43(8), 1575–1581. https://doi.org/10.1249/MSS.0b013e31821ece12

Baecke, J. A., Burema, J., & Frijters, J. E. (1982). A short questionnaire for the measurement of habitual physical activity in epidemiological studies. The American Journal of Clinical Nutrition, 36(5), 936–942. https://doi.org/10.1093/ajcn/36.5.936

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126–131. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424733/

Hootman, J. M., Stel, V. S., Smit, J. H., Pluijm, S. M. F., Visser, M., & Deeg, D. J. H. (2006). Physical activity levels among older adults with and without arthritis. The Journal of Rheumatology, 33(4), 762–767.

Stel, V. S., Smit, J. H., Pluijm, S. M. F., Visser, M., Deeg, D. J. H., & Lips, P. (2004). Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer. Journal of Clinical Epidemiology, 57(3), 252–258. https://doi.org/10.1016/j.jclinepi.2003.07.008

Voorrips, L. E., Ravelli, A. C., Dongelmans, P. C., Deurenberg, P., & Van Staveren, W. A. (1991). A physical activity questionnaire for the elderly. Medicine & Science in Sports & Exercise, 23(8), 974–979. https://doi.org/10.1249/00005768-199108000-00015

13. Items of the Scale