Physical Activity Scale for the Elderly (PASE)

Introduction

A physical activity questionnaire is a practical and widely used approach for physical activity assessment in epidemiologic investigations[1].

Activity questionnaires have been used in studies relating physical activity to fall and fracture risk, balance and gait characteristics, bone density, and coronary heart disease in older people[2][3][4][5].

PASE was initially developed in early 90s to provide an instrument to investigate specifically older people with an age-specific physical activity questionnaire, filling what was an important need in epidemiological research at that time[6].

Exercise older person.jpg

Objective and Intended Population

Physical Activity Scale for the Elderly (PASE) is a brief (5 minutes) and easily scored survey designed specifically to assess physical activity in epidemiological studies of persons age 65 years and older[6].

The PASE score combines information on leisure, household and occupational activity[7].

Method of Use

Occupational, household and leisure activities are investigated by PASE, over a one-week period[6][8].

The questionnaire can be administered by mail or interview (telephone or in person)[7]. The observed effect of mode of administration on physical activity estimates is of concern and authors recommend that the telephone version of PASE be the method of first choice, furthermore they suggest that the mail questionnaire be used in a modified form with additional respondent instructions in order to clarify the proper categorisation of activities, thus reducing reporting error in the mail version[6].

PASE - Physical Activity Scale for the Elderly

The questionnaire comprises section on leisure time activity, household activity and work-related activity as follows[8]:

Instruction

Please complete this questionnaire by either circling the correct response or filling in the blank. Here is an example:

During the past 7 days, how often have you seen the sun?

                                 [0.] NEVER

                                 [1.] SELDOM (1-2 DAYS)

                                 [2.] SOMETIMES (3-4 DAYS)

                                 [3.] OFTEN (5-7 DAYS)

Answer all items as accurately as possible. All information is strictly confidential.

Leisure time activity

1. Over the past 7 days, how often did you participate in sitting activities such as reading, watching TV, or doing handcrafts?

                                [0.] NEVER (go to question 2)

                                [1.] SELDOM (1-2 DAYS) (go to question 1.a and 1.b)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 1.a and 1.b)

                                [3.] OFTEN (5-7 DAYS) (go to question 1.a and 1.b)

          1.a What were these activities? (open end question)

         1.b On average, how many hours did you engage in these sitting activities?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours


2. Over the past 7 days, how often did you take a walk outside your home or yard for any reason? For example, for fun or exercise, walking to work, walking the dog, etc

                                [0.] NEVER (go to question 3)

                                [1.] SELDOM (1-2 DAYS) (go to question 2.a)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 2.a)

                                [3.] OFTEN (5-7 DAYS) (go to question 2.a)

          2a. On average, how many hours per day did you spend walking?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours


3. Over the past 7 days, how often did you engage in light sport or recreational activities such as bowling, golf with a cart, shuffleboard, fishing from a boat or pier or other similar activities?

                                [0.] NEVER (go to question 4)

                                [1.] SELDOM (1-2 DAYS) (go to question 3.a and 3.b)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 3.a and 3.b)

                                [3.] OFTEN (5-7 DAYS) (go to question 3.a and 3.b)

         3.a What were these activities? (open end question)

          3.b On average, how many hours did you engage in these light sport or recreational activities?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours


4. Over the past 7 days, how often did you engage in moderate sport and recreational activities such as doubles tennis, ballroom dancing, hunting, ice skating, golf without a cart, softball or other similar activities?    

                                [0.] NEVER (go to question 5)

                                [1.] SELDOM (1-2 DAYS) (go to question 4.a and 4.b)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 4.a and 4.b)

                                [3.] OFTEN (5-7 DAYS) (go to question 4.a and 4.b)

          4.a What were these activities? (open end question)

         4.b On average, how many hours did you engage in these moderate sport or recreational activities?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours


5. Over the past 7 days, how often did you engage in strenuous sport and recreational activities such as jogging, swimming, cycling, singles tennis, aerobic dance, skiing (downhill or cross-country) or other similar activities?

                                [0.] NEVER (go to question 6)

                                [1.] SELDOM (1-2 DAYS) (go to question 5.a and 5.b)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 5.a and 5.b)

                                [3.] OFTEN (5-7 DAYS) (go to question 5.a and 5.b)

          5.a What were these activities? (open end question)

         5.b On average, how many hours did you engage in these strenuous sport or recreational activities?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours


6. Over the past 7 days, how often did you do any exercises specifically to increase muscle strength and endurance, such as lifting weights or pushups, etc.?
                                [0.] NEVER (go to question 7)

                                [1.] SELDOM (1-2 DAYS) (go to question 6.a and 6.b)

                                [2.] SOMETIMES (3-4 DAYS) (go to question 6.a and 6.b)

                                [3.] OFTEN (5-7 DAYS) (go to question 6.a and 6.b)

         6.a What were these activities? (open end question)

         6.b On average, how many hours did you engage in these strenuous sport or recreational activities?

                                                     [0.] Less than 1 hour

                                                     [1.] 1 but less than 2 hours

                                                     [2.] 2 - 4 hours

                                                     [3.] more than 4 hours

Household activity

7. During the past 7 days, have you done any light housework, such as dusting or washing dishes?

                           [1.] NO
                           [2.] YES


8. During the past 7 days, have you done any heavy housework or chores, such as vacuuming, scrubbing floors, washing windows, or carrying wood?

                           [1.] NO
                           [2.] YES


During the past 7 days, did you engage in any of the following activities? Please answer YES or NO for each item.

          a. Home repairs like painting, wallpapering, electrical work, etc.

          b. Lawn work or yard care, including snow or leaf removal, wood chopping, etc.

          c. Outdoor gardening

          d. Caring for another person, such as children, dependent spouse, or another adult

Work-related activity

10. During the past 7 days, did you work for pay or as a volunteer?

                           [1.] NO
                           [2.] YES (go to questions 10.a and 10.b)

    10a. How many hours per week did you work for pay and or as a volunteer? ____ hours

    10b. Which of the following categories best describes the amount of physical activity required on your job and or volunteer work?

  1. Mainly sitting with some slight arm movement (Examples: office worker, watchmaker, seated assembly line worker, bus driver, etc.)
  2. Sitting or standing with some walking (Examples: cashier, general office worker, light tool and machinery worker)
  3. Walking with some handling of materials generally weighing less than 50 pounds (Examples: mailman, waiter/waitress, construction worker, heavy tool and machinery worker)
  4. Walking and heavy manual work often requiring handling of materials weighting over 50 pounds (Ex: lumberjack, stone mason, farm or general labourer)


Calculations

The PASE authors devised a set of item weights (Table 1) for the PASE questionnaire by using principal components analysis and regression techniques[6]. Total PASE scores are computed by multiplying activity weights by activity frequencies.

Table 1: Contribution of each questionnaire item to the overall PASE score is determined by the product of the sample mean and activity weight.

Evidences

PASE shows strong evidences for validity and reliability useful for large epidemiological studies on general population. On more specific conditions this instrument may not be as accurate as required, and further studies on specific conditions are needed.

Validity

Washburn et al. first studied PASE construct validity in early 90s, and it has been established by correlating PASE scores with health status and physiologic measures[6]. PASE scores were positively associated with grip strength (r = 0.37), static balance (r = +0.33), leg strength (r = 0.25) and negatively correlated with resting heart rate (r = - 0.13), age (r = - 0.34) and perceived health status (r = -0.34); and overall Sickness Impact Profile score (r = -0.42)[6], thus showing a strong validity of this instrument.

PASE construct validity has been further studied in 1999. This time it was established by correlating PASE scores with physiologic and performance characteristics: peak oxygen uptake, resting heart rate and blood pressure, percent body fat, and balance[7]. PASE scores were significantly associated (P<0.05) with peak oxygen uptake (r = 0.20), systolic blood pressure (r = -0.18) and balance score (r = 0.20); despite this, no significant associations of PASE score and diastolic blood pressure, resting heart rate, or percent body fat were noted[7]. Anyway, these results provided additional evidence for the validity of the PASE as a measure of physical activity suitable for use in epidemiology studies on the association of physical activity, health, and physical function in older individuals[7].

In 2004, PASE stability and convergent validity has been assessed among rural, community dwelling elderly persons using Computer Science and Applications, Inc. Actigraph Monitors (Actigraph) as the direct criterion measure[9]. The study showed there was a statistically significant Spearman correlation coefficient of 0.43 (p<0.01) between Actigraph data and total PASE scores[9], thus showing good validity even when compared with digital technologies.

in 2008 Hagiwara et al. evaluated a Japanese translated version of the PASE with three hundred and twenty-five (325) healthy and elderly subjects over 65 years enrolled[10]. Concurrent validity was evaluated by Spearman's rank correlation coefficient between PASE scores and an accelerometer (waking steps and energy expenditure), a physical activity questionnaire for adults in general (the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire, JALSPAQ), grip strength, mid-thigh muscle area per body-weight, static balance and body-fat percentage[10]. The PASE score was significantly correlated with walking steps (ρ = 0.17, P = 0.014), energy expenditure (ρ = 0.16, P = 0.024), activity measured with the JALSPAQ (ρ = 0.48, P < 0.001), mid-thigh muscle area per body-weight (ρ = 0.15, P = 0.006) and static balance (ρ = 0.19, P = 0.001)[10]. Therefore, the Japanese version of PASE was shown to have acceptable validity[10].

More recently, PASE validity has been studied for specific conditions. In cancer patients, PASE has shown a low construct validity but a good content validity[11]. In hip osteoarthritis patients, the PASE construct validity was poor revealing that it was unable to assess PA intensity levels. Therefore authors stated that PASE is not recommended as a valid tool to examine PA level for patients with hip OA[12].

Reliability

On Washburn et al. paper from 1993 authors stated that the PASE test-retest reliability coefficient (0.75) exceeded those reported for other physical activity surveys[6]. Back then, test-retest reliability has been assessed over a 3-7 week interval, resulting in a 0.75 (95% CI = 0.69-0.80). Results showed also reliability for mail administration (r = 0.84) was higher than for telephone administration (r = 0.68)[6].

Hagiwara et al. in 2008 evaluated reliability of the PASE Japanese version, by the test–retest method over a period of 3–4 weeks[10]. The proportion of consistency in the response between the first and second surveys was adequately high, with a intraclass correlation coefficient for the PASE score of 0.65, showing this instrument to have acceptable reliability too[10].

Reliability has been evaluated also in specific conditions. In cancer patients, reliability for the PASE scores ranged from good to excellent (ICC = 0.67 to 0.90)[11]; in hip osteoarthritis patients, the test-retest reliability of the total PASE score was moderate, with acceptable ICC, but with large measurement errors[12].


Resources

Physical activity page in Physiopedia

Physical activity and older adults in Physiopedia

All Physiopedia pages with PHYSICAL ACTIVITY as their category

All Physiopedia pages with OLDER PEOPLE/GERIATRICS as their category

Physiotherapy, Exercise and Physical Activity Course from Exercise Works and Physiopedia

Recent Related Research (from Pubmed)

References

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  1. Washburn RA, Montoye HJ. The assessment of physical activity by questionnaire. Am J Epidemiol. 1986 Apr;123(4):563–76.
  2. Sorock GS, Bush TL, Golden AL et al. Physical activity and fracture risk in a free-living elderly cohort. J Gerontol 1986; 43: M134-139.
  3. Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44: Ml12-117.
  4. Dalsky GP, Stocke KS, Ehsani AA et al. Weight- bearing exercise training and lumbar bone mineral content in post-menopausal women. AM Intern Med 1988; 108: 824-828.
  5. Marti B, Pekkanen J, Nissinen A et al. Association of physical activity with coronary risk factors and physical ability: twenty year follow-up of a cohort of Finnish men. Age Aging 1989; 18: 103-109.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): Development and evaluation. Journal of Clinical Epidemiology. 1993 Feb 1;46(2):153–62.
  7. 7.0 7.1 7.2 7.3 7.4 Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The Physical Activity Scale for the Elderly (PASE): Evidence for Validity. Journal of Clinical Epidemiology. 1999 Jul;52(7):643–51.
  8. 8.0 8.1 Physical Activity Scale for the Elderly : Medicine & Science in Sports & Exercise [Internet]. LWW. [cited 2016 Jun 10]. Available from: http://journals.lww.com/acsm-msse/Fulltext/1997/06001/Physical_Activity_Scale_for_the_Elderly.22.aspx
  9. 9.0 9.1 Dinger MK, Oman RF, Taylor EL, Vesely SK, Able J. Stability and convergent validity of the Physical Activity Scale for the Elderly (PASE). J Sports Med Phys Fitness. 2004 Jun;44(2):186–92.
  10. 10.0 10.1 10.2 10.3 10.4 10.5 Hagiwara A, Ito N, Sawai K, Kazuma K. Validity and reliability of the Physical Activity Scale for the Elderly (PASE) in Japanese elderly people. Geriatrics & Gerontology International. 2008 Sep 1;8(3):143–51.
  11. 11.0 11.1 Liu RDK, Buffart LM, Kersten MJ, Spiering M, Brug J, van Mechelen W, et al. Psychometric properties of two physical activity questionnaires, the AQuAA and the PASE, in cancer patients. BMC Med Res Methodol. 2011;11:30.
  12. 12.0 12.1 Svege I, Kolle E, Risberg MA. Reliability and validity of the Physical Activity Scale for the Elderly (PASE) in patients with hip osteoarthritis. BMC Musculoskelet Disord. 2012;13:26.