A new Brazilian Portuguese version of the Lifetime Total Physical Activity Questionnaire, or LTPAQ-Brazil, has shown strong measurement properties for assessing how much physical activity older adults have accumulated across their entire lives. The instrument, originally developed to record occupational, domestic, transportation and leisure activity over decades, was translated, culturally adapted and tested in Brazilian adults aged 60 to 80, filling a gap for researchers who previously lacked a validated Portuguese-language tool for lifetime activity recall in this population.
The study, published in the European Review of Aging and Physical Activity, was conducted in two phases. The first followed the Beaton guidelines for cross-cultural adaptation of self-report measures, involving two forward translators, two back-translators, a five-member expert committee and a pre-test with 30 older adults. The second phase applied the COSMIN consensus standards to evaluate reliability, measurement error, interpretability and construct validity in a separate sample of 80 community-dwelling older adults.
The adaptation process required only minor semantic adjustments. Discrepancies between the initial translations appeared mainly in wording and expressions related to activity intensity, and were resolved by consensus. After the expert panel clarified how intensity categories were described — sedentary, light, moderate and vigorous — the content validity index reached 0.94, well above the 0.90 threshold generally considered excellent. In pre-testing, 28 of 30 participants, or 93.3 percent, reported no difficulty understanding the instrument, and the two who asked questions needed only clarification, suggesting no further changes.
A distinctive feature of the questionnaire is its calendar recall method. Interviewers first record major life milestones, educational and occupational history, and relevant medical events, then ask when each physical activity began and ended, along with its weekly frequency and average duration. Cognitive interviewing techniques help participants reconstruct activity patterns that may span six or more decades. The instrument assigns intensity using MET values from the Compendium of Physical Activities, categorizing light activity as below 3 METs, moderate as 3 to 6 METs, and vigorous as 6 METs or more. Total lifetime hours are calculated from the years of participation, frequency and daily duration, and the primary outcome is average hours per week of activity over a lifetime, computed separately for each domain and intensity level.
In the measurement phase, 103 individuals were recruited, of whom 4 declined and 19 were excluded — three for low scores on the Six Item Screener cognitive test, one for inconsistent responses, and fifteen because they missed the retest appointment. The final validity sample of 80 participants had a mean age of 68.5 years and was balanced by sex. The questionnaire was re-administered after 7 to 14 days, an interval chosen to reduce recall bias while minimizing the chance of genuine changes in activity patterns.
Test-retest reliability ranged from good to excellent across all dimensions, with intraclass correlation coefficients between 0.89 and 0.96. The standard error of measurement was just 1 percent across all categories, indicating low measurement error, and minimum detectable difference values ranged from 0.003 to 0.170 hours per week. Bland-Altman analysis showed mean differences close to zero between assessments, indicating minimal systematic bias. Limits of agreement were narrow for transportation and exercise or sports, while light-to-moderate activities showed wider intervals, suggesting greater individual variability in recalling these behaviors over long periods. No ceiling effects were detected, but floor effects appeared in every domain except occupational activity, meaning at least 15 percent of participants reported zero hours in those categories.
The authors argue that the floor effects likely reflect genuine behavior patterns rather than instrument limitations. Many men in the sample reported no household activity across their lives, and many women reported no structured exercise or sports, patterns the researchers attribute to the sociocultural norms of the generations represented. Construct validity was supported through two approaches. Known-groups comparisons found significant differences by sex in occupational, household, exercise and sports, light and vigorous activity domains. Participants with lower socioeconomic status reported more occupational activity (0.68 versus 0.36 hours per week), transportation activity and moderate activity, while those with higher status reported more exercise and sports (0.47 versus 0.28 hours per week). Lower educational attainment was likewise associated with more occupational, transportation, moderate and vigorous activity, whereas higher educational attainment was associated with more light activity.
Hypothesis testing for construct validity produced a notably different result. The researchers had predicted weak positive correlations, below 0.30, between lifetime activity scores and measures of current physical activity (the IPAQ short form) and current health status (the EQ-5D and EQ-VAS). The observed correlations ranged from -0.219 to 0.204, and none reached statistical significance. The team interprets this as consistent with their hypothesis: the LTPAQ-Brazil measures cumulative exposure accumulated over decades, a construct distinct from recent activity levels or present health status, so strong associations were not expected.
The study has clear limitations. Lifetime recall is inherently susceptible to bias, particularly in older adults, although cognitive screening with the Six Item Screener was used to reduce this risk. Validation against short-term recall or objective measures is limited because those methods cannot capture lifetime patterns. The sample was non-probabilistic, drawn from a single Brazilian region, and results cannot be generalized to people over 80 years of age. The authors also note that interviews lasted about 40 minutes on average, with rest breaks as needed, and were well accepted by participants.
Within those constraints, the findings indicate that the LTPAQ-Brazil offers Brazilian aging researchers a reproducible instrument for characterizing lifetime physical activity exposure, something conventional short-term recall questionnaires cannot provide. Because retrospective assessment within existing cohorts is a practical alternative to decades-long longitudinal studies, a validated lifetime recall tool could strengthen observational research linking long-term activity patterns to outcomes such as cancer, cognitive disorders, depression and age-related functional decline. The authors caution, however, that further work should test the instrument in more diverse populations and examine its ability to predict health outcomes before broader applications are assumed.
Subject of Research: Cross-cultural validation and measurement properties of the Lifetime Total Physical Activity Questionnaire in Brazilian older adults
Article Title: Measuring physical activity over the life course: cross-cultural validation and measurement properties of the lifetime total physical activity questionnaire for Brazilian older adults
Article References: Batista de Souza, N., Guimarães Paiva, L., Friedenreich, C., Medina Dutra de Oliveira, T., Carneiro Oliveira, C., José, A., & Malaguti, C. (2026). Measuring physical activity over the life course: cross-cultural validation and measurement properties of the lifetime total physical activity questionnaire for Brazilian older adults. European Review of Aging and Physical Activity, 23(1), Article 33. https://doi.org/10.1186/s11556-026-00429-7
Image Credits: AI Generated
DOI: 10.1186/s11556-026-00429-7
Keywords: physical activity, questionnaire validation, older adults, Brazil, lifetime recall, test-retest reliability, COSMIN, cross-cultural adaptation, measurement error, healthy ageing, epidemiology, MET values
News Source: Beatrice Stafford. (October 29, 2026). Brazilian Portuguese Lifetime Physical Activity Questionnaire Proves Reliable for Older Adults. Scienmag.
