Reliability and validity of the Sinhala version of the physical activity questionnaire for older children (PAQ-C)

E. Liyanage; C. Jayasinghe; I. Liyanage

doi:10.1371/journal.pone.0343709

Abstract

Introduction

In Sri Lanka, as non-communicable diseases rise, the significance of physical activity is increasingly recognised, particularly in children. The Physical Activity Questionnaire for Older Children (PAQ-C) is widely used and can be considered as one of the best available tools for assessing physical activity in children. However, a validated tool for Sinhala-speaking children in Sri Lanka has been lacking. This study aims to culturally adapt and validate the PAQ-C for Sinhala-speaking children and evaluate its psychometric properties.

Methodology

This cross-sectional study involved 301 schoolchildren (197 males and 104 females) aged 8–11 years, during which the PAQ-C was translated into Sinhala, and a pre-final version was developed. In terms of validity, content validity, that is, the degree to which the content of an instrument is an adequate reflection of the construct to be measured, was assessed using the content validity index. In terms of reliability, test-retest reliability was measured with the intraclass correlation coefficient (ICC).

Results

The Sinhala version of the PAQ-C demonstrated CVI at both item and scale levels is as one. The ICC was acceptable at 0.83.

Conclusion

The Sinhala version of the PAQ-C demonstrates good content validity and acceptable test–retest reliability, affirming its suitability as a cost-effective tool for assessing physical activity levels among Sinhala-speaking children in Sri Lanka and supporting informed interventions and public health strategies in the country.

Citation: Liyanage E, Jayasinghe C, Liyanage I (2026) Reliability and validity of the Sinhala version of the physical activity questionnaire for older children (PAQ-C). PLoS One 21(3): e0343709. https://doi.org/10.1371/journal.pone.0343709

Editor: Heather Macdonald, UBC: The University of British Columbia, CANADA

Received: September 3, 2025; Accepted: February 10, 2026; Published: March 23, 2026

Copyright: © 2026 Liyanage et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information file.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The increasing prevalence of digital technologies and screen-based entertainment has contributed to a noticeable decline in physical activity among children [1, 2]. Furthermore, the growing preference for transportation by car and other motor vehicles has reduced active modes of transportation such as walking and cycling, further diminishing physical activity levels [3]. A similar pattern is observed in Sri Lanka, particularly in urban areas like Colombo [4]. Although data at the national level for children aged 8–12 remain limited, regional studies consistently highlight insufficient physical activity among Sri Lankan schoolchildren [5, 6]. Both the Rathnapura and Kalutara studies applied the WHO-recommended threshold of at least 60 minutes of moderate-to-vigorous physical activity per day for children aged 5–17 [7]. In Rathnapura District, 72.5% of 13–14-year-olds did not meet this benchmark, with girls and urban children showing particularly low engagement [8]. Similarly, in Kalutara District, 76.4% of 14–15-year-olds fell short of the same threshold, indicating widespread sedentary behaviour [9].

Low physical activity levels in children are associated with increased risks of obesity, cardiovascular disease, and metabolic conditions like type 2 diabetes [10]. Children who engage in insufficient physical activity may be at increased risk of developing chronic health conditions later in life [11]. Regular physical activity helps children to improve their cardiovascular and muscular fitness and also helps to manage body weight. Other than these physical well-being, it also helps to improve psychological well-being and reduce the risk of developing chronic diseases such as diabetes mellitus type II, hypertension, cancer-related diseases, and lower peak bone mass [12].

Valid and reliable assessment tools are required to gain insight into the level of physical activity and the health benefits and issues related to it. A variety of instruments exist for evaluating physical activity. Objective measurement of physical activity is often carried out using devices like accelerometers and pedometers [13]. However, these tools are very expensive and also not feasible for use among large populations. Moreover, objective tools often face compliance challenges; for instance, children may forget to wear them consistently [14]. Additionally, objective tools may also underestimate certain types of physical activity, such as cycling and resistance training, due to limited detection of non-ambulatory movements [15, 16]. There are self-reporting measures used to estimate the physical activity level, such as self-report questionnaires and self-report activity diaries/ logs [13]. Self-administered questionnaires offer a practical and cost-effective method for assessing physical activity, particularly in large populations, as they require minimal logistical support and participant burden [17]. Additionally, such questionnaires can be completed in a brief timeframe. Thus, those tools make it possible to investigate a large sample of children within a short time period [18].

The Physical Activity Questionnaire (PAQ) series comprises validated self-report instruments for assessing general physical activity levels in youth populations. Specifically, the PAQ-A (Physical Activity Questionnaire for Adolescents) targets adolescents aged 14–20 years [19], while the PAQ-C (Physical Activity Questionnaire for Older Children) is designed for older children aged approximately 8–14 years [20]. PAQ-C is a self-administered, 7-day recall questionnaire which can be used to evaluate school and leisure time physical activity levels [21]. The PAQ-C comprises ten items: nine core items rated on a five-point Likert scale, designed to capture overall physical activity levels and a final question that determines whether the reported week was typical or influenced by illness or other factors affecting usual activity level. Its format allows for easy administration within classroom settings, making it suitable for school-based assessments [22]. The questionnaire captures children’s activity behaviours across multiple timeframes spanning school hours, after-school periods, and weekends to provide a comprehensive view of weekly physical activity patterns. In general, the PAQs have shown relatively high correlation coefficients with alternative physical activity measures compared to other recall measures [21]. The Physical Activity Questionnaire for Older Children (PAQ-C) is widely used and can be considered as one of the best available tools for assessing physical activity in children [23]. Evidence shows that PAQ-C has been translated into numerous languages, such as Japanese [14], Chinese [24], Malay [25], Dutch [19], Spanish [26], and Turkish [27], and the pooled construct validity of the PAQ-C varies across its cross-culturally adapted language versions, ranging from very low to high [23]. The PAQ-C also shows acceptable test–retest reliability (ICC ranging from 0.70–0.82), with results depending on retest interval, language version, and study quality [28]. Furthermore, PAQ-C can be used to assess the physical activity in obese and overweight children [29].

There is a lack of reliable and valid assessment tools to evaluate the physical activity level among school children in Sri Lanka. Although the original PAQ-C is one of the best assessment tools for this purpose [23], language barriers may affect its accuracy when administered among non-English speaking children [30]. Moreover, differences in cultural and social aspects may also alter the results. However, the PAQ-C has not been translated into the Sinhala language and no existing studies have examined the reliability and validity of the Sinhala version of such a questionnaire. Therefore, the purpose of this study was to culturally adapt the PAQ-C into the Sinhala language and to examine the validity and reliability of the Sinhala version among Sri Lankan children aged 8–14 years.

Materials and methods

This cross-sectional study was conducted between 2^nd May 2023 and 31^st July 2023 following the Helsinki Declaration. Ethical approval for this study was obtained from the Ethics Review Committee, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka (No: AHS/ERC/2022/132). An information sheet was provided to the parents, and written informed consent was obtained from each. Only the children whose parents consented to their participation in the study completed the questionnaire. All data collection forms were assigned code numbers, and coded data were used throughout the data management process. Phase I involved the translation of the original PAQ-C into Sinhala, while Phase II focused on assessing the psychometric properties of the translated version. Prior to translation, formal permission was obtained from the original developer, Prof. Kent Kowalski [21].

Phase I-PAQ-C sinhala translation and cross-cultural adaptation

The questionnaire was culturally adapted following internationally endorsed procedures for translation and validation [31].

Forward Translation: Two translations were made from the original English questionnaire. One of the translators is a senior academic with more than 30 years of experience as a physiologist, who is now residing in Australia. He is a native Sinhala speaker. The other translator is a graduate specialising in English, currently working as a teacher at the English Language Teaching Unit of the Faculty of Allied Health Sciences, University of Peradeniya. She is also a native Sinhala speaker and resides in Sri Lanka.

Synthesis of Translations: A third person who was not involved in the study, but who was familiar with the questionnaire, participated in the synthesis process. Both the translated version and the original questionnaire were compared. Both translators commented that some of the sports mentioned in question one are not practised in Sri Lanka (e.g.,: ice-skating), and because of that, no specific Sinhala terms are present for those. Furthermore, it had been hard to translate adverbs of frequency, such as ‘often’ and ‘very often’, because there is a lack of appropriate Sinhala terms to properly communicate the exact, intended idea. To resolve this issue, phrases which give almost similar meanings to the adverbs of frequency in the original questionnaire were used. For some of the questions and answers, the two translators included different terms which give the same meanings. In such cases, words that seem to be most appropriate for the target population were selected. The synthesised version was sent to the translators for back translation.

Back Translation: Back translation was done by two translators who are native Sinhala speakers. One translator is from a physics background and has lived in the United States for five years. The other translator is an English instructor, teaching in the Faculty of Engineering, University of Peradeniya, Sri Lanka.

The two back translations were reviewed with the original questionnaire and back-translated documents were more or less similar to the original, with minor changes in some of the words. However, the meanings were almost similar. In such cases, the words which seemed easier to understand by the target group were selected.

This version was evaluated by an expert panel including 2 physiotherapists, 2 school teachers, and 2 exercise science experts. The original questionnaire contains 22 sports items as options to select in the first question. Among them, ice skating, cross-country skiing, and ice-hockey/ ringette were eliminated in the Sinhala version, since those are not at all performed in Sri Lanka. Rowing/canoeing and street hockey were also eliminated as they are not very common sports among Sri Lankan schoolchildren. In addition, soccer was removed since it is similar to football. Nine new sports items were newly added to the Sinhala version which are commonly played by Sri Lankan school children, namely, karate, netball, cricket, table tennis, elle, boxing, gymnastics, rugby, and tennis. Finally, there were 25 sports items in the first question of the Sinhala version of PAQ-C. A space was provided to mention other sports activities performed by the child, as in the original questionnaire. The final pre-version was prepared after reviewing all deviations. The content validity index (CVI) was calculated to measure content validity. The explanation of CVI can be found under statistical analysis for content validity.

Pilot testing.

The final pre-version of the PAQ-C was pilot-tested among 55 school children from a different school within the same educational zone to assess clarity, readability, and comprehensibility.

Phase II: Evaluating the psychometric properties of PAQ-C Sinhala Version

The PAQ-C questionnaire was regarded as a formative model questionnaire according to COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) [32]. For formative models, COSMIN recommends focusing on content validity and reliability, as structural validity and internal consistency are not applicable. Accordingly, we evaluated content validity through expert opinion on item relevance, comprehensibility through a pre-test, and reliability through test-retest to assess the stability of responses over time.

Participants.

Data collection was conducted in provincial schools in Gangawata Korale, comprising both males and females. Gangawata Korale is an administrative division that includes urban, rural and estate sector areas, and the participating schools enrol pupils drawn from this mix of residential settings; therefore, the sample includes children from urban, rural and estate sectors within the Peradeniya and is representative of mainstream provincial government‑school pupils in similar central‑region settings. Permission was obtained from the Provincial Director of the Department of Education in Kandy District to conduct the data collection in schools. Children whose native language was Sinhala and who studied in grades 4 and 5, between the ages of 9 and 11 years, were included in the study. In Sri Lanka, Grade 6 marks the transition to secondary school; we therefore limited recruitment to Grades 4 and 5 to focus on primary school children with comparable routines, developmental stages, and comprehension levels suitable for self-administered questionnaires like the PAQ‑C. Children who were involved in regular physical activity were included. Children with acute illnesses, chronic medical condition or disability that prevented them from participation in regular physical activities were excluded. Children whose parents did not grant consent for the participation of their child in the study were also not included.

As a rule of thumb, 10 participants are described as essential for each item in the questionnaire [33]. However, there are suggestions independent of the number of items; it is proposed to have 300 respondents after pre-testing [34]. The sample size was determined as 300 for this study in order to have a good sample for validation of the tool [35]. Two schools were selected randomly as clusters, and participants were selected by convenient sampling within the schools. A total of 330 students were invited to participate in the study, of whom 318 provided informed consent. Seventeen students were excluded in total this including those who, based on their responses to Question 10, reported that their physical activity levels had been affected by illness during the preceding week, as well as others who met additional exclusion criteria. The final analytical sample comprised 301 students.

Procedure.

During the first visit, school authorities and children were given a detailed explanation of the study and questionnaire. Then, consent forms were sent with the children to be read and signed by their parents/ guardians. After three days, the researchers visited the schools again to collect the consent forms. After collecting the consent forms, all children who returned signed parental consent forms were assessed. The periods for data collection were decided by the school authorities in order not to cause interruptions to academic activities.

On the day of data collection, the participants were asked to fill out the Sinhala version of the PAQ-C questionnaire, and they were assessed for body weight and height.

PAQ-C Measure: PAQ-C was used for assessing the level of physical activity. This questionnaire comprises ten questions. The first question includes a checklist of common leisure and sports activities. Two supplemental blank spaces are also provided for participants to enter other activities which are not mentioned in the list. Five points Likert scale (no activity – 1, 7 or more days – 5) is used for scoring this item. The mean score of all activities is calculated and is considered as the composite score of question number 1. The next eight questions are regarding activities conducted at different time periods during the day [e.g.,: at recess, lunchtime, after school, etc.] or the week. The composite value obtained by calculating the mean of the scores of the above-mentioned nine items is the overall PAQ-C score. The tenth item is used for identifying whether a sickness or another event has prevented the child from participating in regular physical activities. This item is not included in the calculation of activity scores.

The PAQ-C was delivered to students after explaining the questionnaire in detail. The researchers were there throughout the completion of the questionnaire by the students to provide any clarifications pertaining to the questionnaire if needed. The researchers visited one of the schools two weeks later and 75 participants were randomly selected from the student log of those who filled out the questionnaire earlier and they were requested to fill the questionnaire again to determine the test-retest reliability of the questionnaire. The random selection was conducted using a computer-generated number list applied to the student log maintained during the initial administration. The retest was carried out in the same school environment, under similar conditions, and with the same level of researcher presence and guidance. The retest sample was drawn exclusively from the original respondents at that school and did not differ demographically or contextually from the main sample.

Statistical analysis

All the analysis was conducted using SPSS version 25 and all the significant tests were conducted at a 5% significance level and 95% confidence interval.

Content validity

We assessed content validity by calculating item-level (I-CVI) and scale-level (S-CVI) content validity indexes [36]. The I-CVI was determined by ratings from all expert committee members. The expert committee comprised of two physiotherapists, three school teachers and one psychologist. We used a 4-point ordinal scale to rate each question/item based on its relevance to the fundamental concept. In this scale, 1 meant not relevant, 2 indicated somewhat relevant, 3 meant quite relevant, and 4 indicated highly relevant. To calculate the I-CVI, we divided the number of experts rating an item as 3 or 4 by the total number of experts for each item. We then calculated the average I-CVIs of all items to obtain the S-CVI for each question. An I-CVI > 0.78 was considered excellent, and a S-CVI of ≥ 0.80 was deemed acceptable [37].

Test-retest reliability

The intraclass correlation coefficient (ICC) one-way random-effects model was used for the analysis of test-retest reliability [38], in which a value > 0.70 was considered acceptable [32].

Results

Characteristics of participants

A total of 301 children participated in the study. The majority of children were boys (65.4%). Participants’ characteristics are shown in Table 1.

Download:

Table 1. Participants’ characteristics.

https://doi.org/10.1371/journal.pone.0343709.t001

Physical activity pattern

The average score for the PAQ-C was 2.94 ± 0.71. Table 2 presents the analysis of the PAQ-C questionnaire items by male and female participants and for the total sample. The average PAQ-C score for male participants was 3.04 (SD = 0.75), while female participants had an average score of 2.75 (SD = 0.60).

Download:

Table 2. Descriptive analysis of the PAQ-C questionnaire.

https://doi.org/10.1371/journal.pone.0343709.t002

Validity of the PAQ-C

Content validity.

The I‑CVI and S‑CVI were both 1.00, indicating unanimous expert agreement and good content validity in terms of relevance.

Reliability of the PAQ-C

The test’s reliability was assessed using the ICC. The overall ICC value for the questionnaire was 0.83, with ICC; one-way random-effects mode showing adequate test-retest reliability. The average ICC for each item of the questionnaire is presented in Table 3

Download:

Table 3. ICC for each item of the questionnaire.

https://doi.org/10.1371/journal.pone.0343709.t003

Discussion

The PAQ-C questionnaire was culturally adapted for the Sinhalese population using a sample of 301 schoolchildren. This study provided the first valid measurement tool to examine the physical activity patterns of Sinhala-speaking children in Sri Lanka. The examination of the psychometric properties of the Sinhala version of the PAQ-C demonstrated good content validity in terms of relevance based on expert agreement and comprehensibility based on pretest results.

The translation process adhered to the standardised guidelines proposed by Beaton and Bombardier [31]. The original structure of the questionnaire was retained, with the exception of item one. In this item, activities that were not commonly practised by Sri Lankan children were removed and replaced with culturally relevant and frequently performed alternatives. This approach aligns with the adaptations reported in the Japanese [14], Turkish [27], and Hungarian [17] versions of the PAQ-C, and is consistent with Beaton and Bombardier’s protocol Beaton, Bombardier (32), which emphasises the importance of achieving both semantic and cultural equivalence during cross-cultural translation.

Regarding content validity, the COSMIN guideline highlights three domains: relevance, comprehensibility, and comprehensiveness. In our study, relevance was assessed by calculating the item-level and overall Content Validity Index (CVI). A similar method was used in the cross-cultural validation of the PQC into the Turkish language [27].

We assessed comprehensibility in terms of readability and understandability using a pilot test of 50 students. Similar procedures were used in cross‑cultural adaptations of the PAQ‑C, with a smaller pilot for the Japanese [14], Hong Kong Chinese version [24] and pilot studies for the Brazilian, Arabic [20], Turkish [27] and Spanish [26] versions, while the UK [39] adaptation used a focus group to evaluate clarity and readability. Our retest reliability analysis showed high consistency of the scale over time, with an ICC of 0.83. Similar research on Spanish children revealed an even higher ICC of 0.96 [26], while studies involving Chinese children in Hong Kong reported an ICC of 0.82 [24], and Japanese children showed 0.83 [14]. Additionally recent systematic review has identified the PAQ-C as demonstrating sufficient reliability and the strongest reliability evidence among physical activity questionnaires for children [23]. These results confirm that the scale consistently performs well over time within the target group.

All participants presented a summarised PAQ-C score, which is lower than that in the studies among different racial groups of children, i.e., 3.4 ± 0.68 for British samples [39], 3.36 ± 0.80 for European American children, and 3.37 ± 0.69 for African American children [40], but it was higher than the PAQ-C scores of Japanese children, 2.76 ± 0.69 [14]. This difference may be due to cultural variations in the country. It also indicates that the physical activity level of Sri Lankan children needs improvement. The spare time activity checklist (question 1) of the Sinhala version of PAQ-C has shown the lowest score. Similar observations were made among the British [39] and Turkish schoolchildren [27]. The lower mean for question one is interpreted as a consequence of the large number of activities listed on the checklist. Many children did not perform most of these activities, leading to lower scores [27].Additionally, prior studies in Italian and Spanish cohorts have proposed a PAQ-C score threshold of 2.75 to classify children as active or non-active [41, 42]. Although our study did not apply such thresholds, the validated Sinhala PAQ-C could support future national-level comparisons using these benchmarks.

Limitation

The study was conducted with 4th and 5th-grade students between the ages of 9 and 11. To apply the study’s findings more broadly, further research should be carried out with school children between the ages of 12 and 14..To enhance the instrument’s accuracy, concurrent validity should be evaluated against an accelerometer; until this is confirmed, researchers should use the questionnaire cautiously or in conjunction with an accelerometer.

Future research may consider employing the Sinhala PAQ-C within longitudinal study designs to monitor physical activity trends over extended periods, evaluate the effectiveness of targeted interventions, and facilitate comparative analyses across geographic regions and demographic subgroups. Furthermore, the integration of internationally recognised thresholds could enhance the potential for cross-cultural comparisons and contribute meaningfully to national physical activity surveillance initiatives.

Conclusion

This study was the first to thoroughly examine the validity and reliability of the PAQ-C among Sinhala-speaking children. The Sinhala version of the PAQ-C showed an acceptable level of content validity and adequate test-retest reliability. This cost-effective tool will assist researchers and clinicians in assessing physical activity levels among Sinhala-speaking children in Sri Lanka and abroad, enabling them to understand PA levels and take appropriate measures. Its ease of administration and cultural relevance further support its practical use in school-based assessments and community-level health initiatives, enabling broader monitoring of physical activity patterns among Sri Lankan children.

Supporting information

S1 File. PAQC-English Version.

The English version of the PAQ-C used in this study.

https://doi.org/10.1371/journal.pone.0343709.s001

(PDF)

S2 File. PAQ-C-PLOSONE.

Dataset used for statistical analysis.

https://doi.org/10.1371/journal.pone.0343709.s002

(XLSX)

S3 File. Sinhala Questionnaire-final.

The Sinhala version of the PAQ-C questionnaire.

https://doi.org/10.1371/journal.pone.0343709.s003

(DOCX)

Acknowledgments

We extend our gratitude to Professor Kowalski Kent, the original developer, for granting permission.

References

1. Piores VF, Dev Omar Dev R, Muhamad MM, Puad Mohd Kari DN. Current trends and issues involving screen time and physical activity engagement among school students: A thematic review. Teor metod fiz vihov. 2023;23(3):447–57.
- View Article
- Google Scholar
2. Almaqhawi A, Albarqi M. The effects of technology use on children’s physical activity: A cross-sectional study in the Eastern province of Saudi Arabia. J Med Life. 2022;15(10):1240–5. pmid:36420281
- View Article
- PubMed/NCBI
- Google Scholar
3. Sa TH, Salvador EP, Florindo AA. Factors associated with physical inactivity in transportation in Brazilian adults living in a low socioeconomic area. J Phys Act Health. 2013;10(6):856–62. pmid:23074086
- View Article
- PubMed/NCBI
- Google Scholar
4. Ranawake J, Siriwardene S. A study on the barriers and challenges for the usage of active transportation in Sri Lanka. 2024.
5. Institute of Sports Medicine. Physical Activity and Sedentary Behaviour Guidelines for Sri Lankan Children and Adolescents. Ministry of Sports and Youth Affairs, Sri Lanka. 2020.
6. Ministry of Health. National Physical Activity Action Plan 2021–2025. Directorate of Non-Communicable Diseases, Sri Lanka. 2021.
7. World Health Organization. Global recommendations on physical activity for health. Global recommendations on physical activity for health 2010. 60-.
8. Ranasinghe RMSK, Fonseka CL. Physical activity levels among school children in Rathnapura District. International Journal of Physical Education, Sports and Health. 2021;8(2):45–9.
- View Article
- Google Scholar
9. Godakanda I, Abeysena C, Lokubalasooriya A. Pattern of physical activity among school children aged 14-15 years in the district of Kalutara, Sri Lanka. J Coll Community Phys Sri Lanka. 2018;24(2):82.
- View Article
- Google Scholar
10. González K, Fuentes J, Márquez JL. Physical inactivity, sedentary behavior and chronic diseases. Korean J Fam Med. 2017;38(3):111–5. pmid:28572885
- View Article
- PubMed/NCBI
- Google Scholar
11. Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obes Res. 2005;13(1):163–9. pmid:15761176
- View Article
- PubMed/NCBI
- Google Scholar
12. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. CMAJ. 2006;174(6):801–9. pmid:16534088
- View Article
- PubMed/NCBI
- Google Scholar
13. Sylvia LG, Bernstein EE, Hubbard JL, Keating L, Anderson EJ. Practical guide to measuring physical activity. J Acad Nutr Diet. 2014;114(2):199–208. pmid:24290836
- View Article
- PubMed/NCBI
- Google Scholar
14. Isa T, Sawa R, Torizawa K, Murata S, Saito T, Ebina A, et al. Reliability and validity of the japanese version of the physical activity questionnaire for older children. Clin Med Insights Pediatr. 2019;13:1179556519835833. pmid:30911226
- View Article
- PubMed/NCBI
- Google Scholar
15. Bassett DR, Strath SJ. To assess physical activity. Physical activity assessments for health-related research. 2002. 163.
16. Skender S, Ose J, Chang-Claude J, Paskow M, Brühmann B, Siegel EM, et al. Accelerometry and physical activity questionnaires - a systematic review. BMC Public Health. 2016;16:515. pmid:27306667
- View Article
- PubMed/NCBI
- Google Scholar
17. Makai A, Prémusz V, Dózsa-Juhász O, Fodor-Mazzag K, Melczer C, Ács P. Examination of Physical activity patterns of children, reliability and structural validity testing of the hungarian version of the PAQ-C Questionnaire. Children (Basel). 2023;10(9):1547. pmid:37761508
- View Article
- PubMed/NCBI
- Google Scholar
18. Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997;29(10):1344–9. pmid:9346166
- View Article
- PubMed/NCBI
- Google Scholar
19. Bervoets L, Van Noten C, Van Roosbroeck S, Hansen D, Van Hoorenbeeck K, Verheyen E, et al. Reliability and Validity of the Dutch Physical Activity Questionnaires for Children (PAQ-C) and Adolescents (PAQ-A). Arch Public Health. 2014;72(1):47. pmid:25671114
- View Article
- PubMed/NCBI
- Google Scholar
20. Sirajudeen MS, Waly M, Manzar MD, Alqahtani M, Alzhrani M, Alanazi A, et al. Physical activity questionnaire for older children (PAQ-C): Arabic translation, cross-cultural adaptation, and psychometric validation in school-aged children in Saudi Arabia. PeerJ. 2022;10:e13237. pmid:35433134
- View Article
- PubMed/NCBI
- Google Scholar
21. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the Physical Activity Questionnaire for Older Children. Pediatric Exercise Science. 1997;9(2):174–86.
- View Article
- Google Scholar
22. Kowalski K, Crocker P, Donen R, Honours B. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. 2004.
23. Rostami Haji Abadi M, Kwaghbo N, Onyeso OK, Sadia F, Benavides Castro JK, Silva DAS, et al. Psychometric properties of physical activity questionnaires for children and adolescents: An updated systematic review. Sports Med. 2025;55(9):2225–301. pmid:40715989
- View Article
- PubMed/NCBI
- Google Scholar
24. Wang JJ, Baranowski T, Lau WP, Chen TA, Pitkethly AJ. Validation of the physical activity questionnaire for older children (PAQ-C) among Chinese children. Biomed Environ Sci. 2016;29(3):177–86. pmid:27109128
- View Article
- PubMed/NCBI
- Google Scholar
25. Zaki NAM, Sahril N, Omar MA, Ahmad MH, Baharudin A, Nor NSM. Reliability and validity of the physical activity questionnaire for older children (PAQ-C) in Malay language. International Journal of Public Health Research. 2016;6(1):670–6.
- View Article
- Google Scholar
26. Benítez-Porres J, López-Fernández I, Raya JF, Álvarez Carnero S, Alvero-Cruz JR, Álvarez Carnero E. Reliability and Validity of the PAQ-C Questionnaire to Assess Physical Activity in Children. J Sch Health. 2016;86(9):677–85. pmid:27492937
- View Article
- PubMed/NCBI
- Google Scholar
27. Erdim L, Ergün A, Kuğuoğlu S. Reliability and validity of the Turkish version of the Physical Activity Questionnaire for Older Children (PAQ-C). Turk J Med Sci. 2019;49(1):162–9. pmid:30764593
- View Article
- PubMed/NCBI
- Google Scholar
28. Hidding LM, Chinapaw MJM, van Poppel MNM, Mokkink LB, Altenburg TM. An updated systematic review of childhood physical activity questionnaires. Sports Med. 2018;48(12):2797–842. pmid:30298479
- View Article
- PubMed/NCBI
- Google Scholar
29. Ellery CVL, Weiler HA, Hazell TJ. Physical activity assessment tools for use in overweight and obese children. Int J Obes (Lond). 2014;38(1):1–10. pmid:23828100
- View Article
- PubMed/NCBI
- Google Scholar
30. Cuberek R, Janíková M, Dygrýn J. Adaptation and validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Czech children. PLoS One. 2021;16(1):e0245256. pmid:33434223
- View Article
- PubMed/NCBI
- Google Scholar
31. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. pmid:11124735
- View Article
- PubMed/NCBI
- Google Scholar
32. Mokkink LB, Elsman EBM, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures version 2.0. Qual Life Res. 2024;33(11):2929–39. pmid:39198348
- View Article
- PubMed/NCBI
- Google Scholar
33. Gorsuch RL. Factor analysis. L. Erlbaum Associates. 1983.
34. Comrey AL, Lee HB. A First Course in Factor Analysis. Taylor & Francis. 2013.
35. Osborne JW, Costello AB. Sample size and subject to item ratio in principal components analysis. Practical Assessment, Research, and Evaluation. 2019;9(1):11.
- View Article
- Google Scholar
36. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489–97. pmid:16977646
- View Article
- PubMed/NCBI
- Google Scholar
37. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382–5. pmid:3640358
- View Article
- PubMed/NCBI
- Google Scholar
38. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychological Methods. 1996;1(1):30–46.
- View Article
- Google Scholar
39. Thomas EL, Upton D. Psychometric properties of the physical activity questionnaire for older children (PAQ-C) in the UK. Psychology of Sport and Exercise. 2014;15(3):280–7.
- View Article
- Google Scholar
40. Moore JB, Hanes JC, Barbeau P, Gutin B, Treviño RP, Yin Z. Validation of the Physical Activity Questionnaire for Older Children in children of different races. Pediatr Exerc Sci. 2007;19(1):6–19. pmid:17554153
- View Article
- PubMed/NCBI
- Google Scholar
41. Benítez-Porres J, Alvero-Cruz JR, Sardinha LB, López-Fernández I, Carnero EA. Cut-off values for classifying active children and adolescents using the Physical Activity Questionnaire: PAQ-C and PAQ-A. Nutricion hospitalaria. 2016;33(5):1036–44.
- View Article
- Google Scholar
42. Lupo C, Boccia G, Ungureanu AN, Mulasso A, De Pasquale P, Mancini A, et al. The Cut-Off Value for Classifying Active Italian Children Using the Corresponding National Version of the Physical Activity Questionnaire. Sports (Basel). 2022;10(4):61. pmid:35447871
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Piores VF, Dev Omar Dev R, Muhamad MM, Puad Mohd Kari DN. Current trends and issues involving screen time and physical activity engagement among school students: A thematic review. Teor metod fiz vihov. 2023;23(3):447–57.
View Article
Google Scholar

[2] View Article

[3] Google Scholar

[ref2] 2. Almaqhawi A, Albarqi M. The effects of technology use on children’s physical activity: A cross-sectional study in the Eastern province of Saudi Arabia. J Med Life. 2022;15(10):1240–5. pmid:36420281
View Article
PubMed/NCBI
Google Scholar

[5] View Article

[6] PubMed/NCBI

[7] Google Scholar

[ref3] 3. Sa TH, Salvador EP, Florindo AA. Factors associated with physical inactivity in transportation in Brazilian adults living in a low socioeconomic area. J Phys Act Health. 2013;10(6):856–62. pmid:23074086
View Article
PubMed/NCBI
Google Scholar

[9] View Article

[10] PubMed/NCBI

[11] Google Scholar

[ref4] 4. Ranawake J, Siriwardene S. A study on the barriers and challenges for the usage of active transportation in Sri Lanka. 2024.

[ref5] 5. Institute of Sports Medicine. Physical Activity and Sedentary Behaviour Guidelines for Sri Lankan Children and Adolescents. Ministry of Sports and Youth Affairs, Sri Lanka. 2020.

[ref6] 6. Ministry of Health. National Physical Activity Action Plan 2021–2025. Directorate of Non-Communicable Diseases, Sri Lanka. 2021.

[ref7] 7. World Health Organization. Global recommendations on physical activity for health. Global recommendations on physical activity for health 2010. 60-.

[ref8] 8. Ranasinghe RMSK, Fonseka CL. Physical activity levels among school children in Rathnapura District. International Journal of Physical Education, Sports and Health. 2021;8(2):45–9.
View Article
Google Scholar

[17] View Article

[18] Google Scholar

[ref9] 9. Godakanda I, Abeysena C, Lokubalasooriya A. Pattern of physical activity among school children aged 14-15 years in the district of Kalutara, Sri Lanka. J Coll Community Phys Sri Lanka. 2018;24(2):82.
View Article
Google Scholar

[20] View Article

[21] Google Scholar

[ref10] 10. González K, Fuentes J, Márquez JL. Physical inactivity, sedentary behavior and chronic diseases. Korean J Fam Med. 2017;38(3):111–5. pmid:28572885
View Article
PubMed/NCBI
Google Scholar

[23] View Article

[24] PubMed/NCBI

[25] Google Scholar

[ref11] 11. Field AE, Cook NR, Gillman MW. Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obes Res. 2005;13(1):163–9. pmid:15761176
View Article
PubMed/NCBI
Google Scholar

[27] View Article

[28] PubMed/NCBI

[29] Google Scholar

[ref12] 12. Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: The evidence. CMAJ. 2006;174(6):801–9. pmid:16534088
View Article
PubMed/NCBI
Google Scholar

[31] View Article

[32] PubMed/NCBI

[33] Google Scholar

[ref13] 13. Sylvia LG, Bernstein EE, Hubbard JL, Keating L, Anderson EJ. Practical guide to measuring physical activity. J Acad Nutr Diet. 2014;114(2):199–208. pmid:24290836
View Article
PubMed/NCBI
Google Scholar

[35] View Article

[36] PubMed/NCBI

[37] Google Scholar

[ref14] 14. Isa T, Sawa R, Torizawa K, Murata S, Saito T, Ebina A, et al. Reliability and validity of the japanese version of the physical activity questionnaire for older children. Clin Med Insights Pediatr. 2019;13:1179556519835833. pmid:30911226
View Article
PubMed/NCBI
Google Scholar

[39] View Article

[40] PubMed/NCBI

[41] Google Scholar

[ref15] 15. Bassett DR, Strath SJ. To assess physical activity. Physical activity assessments for health-related research. 2002. 163.

[ref16] 16. Skender S, Ose J, Chang-Claude J, Paskow M, Brühmann B, Siegel EM, et al. Accelerometry and physical activity questionnaires - a systematic review. BMC Public Health. 2016;16:515. pmid:27306667
View Article
PubMed/NCBI
Google Scholar

[44] View Article

[45] PubMed/NCBI

[46] Google Scholar

[ref17] 17. Makai A, Prémusz V, Dózsa-Juhász O, Fodor-Mazzag K, Melczer C, Ács P. Examination of Physical activity patterns of children, reliability and structural validity testing of the hungarian version of the PAQ-C Questionnaire. Children (Basel). 2023;10(9):1547. pmid:37761508
View Article
PubMed/NCBI
Google Scholar

[48] View Article

[49] PubMed/NCBI

[50] Google Scholar

[ref18] 18. Crocker PR, Bailey DA, Faulkner RA, Kowalski KC, McGrath R. Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. Med Sci Sports Exerc. 1997;29(10):1344–9. pmid:9346166
View Article
PubMed/NCBI
Google Scholar

[52] View Article

[53] PubMed/NCBI

[54] Google Scholar

[ref19] 19. Bervoets L, Van Noten C, Van Roosbroeck S, Hansen D, Van Hoorenbeeck K, Verheyen E, et al. Reliability and Validity of the Dutch Physical Activity Questionnaires for Children (PAQ-C) and Adolescents (PAQ-A). Arch Public Health. 2014;72(1):47. pmid:25671114
View Article
PubMed/NCBI
Google Scholar

[56] View Article

[57] PubMed/NCBI

[58] Google Scholar

[ref20] 20. Sirajudeen MS, Waly M, Manzar MD, Alqahtani M, Alzhrani M, Alanazi A, et al. Physical activity questionnaire for older children (PAQ-C): Arabic translation, cross-cultural adaptation, and psychometric validation in school-aged children in Saudi Arabia. PeerJ. 2022;10:e13237. pmid:35433134
View Article
PubMed/NCBI
Google Scholar

[60] View Article

[61] PubMed/NCBI

[62] Google Scholar

[ref21] 21. Kowalski KC, Crocker PRE, Faulkner RA. Validation of the Physical Activity Questionnaire for Older Children. Pediatric Exercise Science. 1997;9(2):174–86.
View Article
Google Scholar

[64] View Article

[65] Google Scholar

[ref22] 22. Kowalski K, Crocker P, Donen R, Honours B. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. 2004.

[ref23] 23. Rostami Haji Abadi M, Kwaghbo N, Onyeso OK, Sadia F, Benavides Castro JK, Silva DAS, et al. Psychometric properties of physical activity questionnaires for children and adolescents: An updated systematic review. Sports Med. 2025;55(9):2225–301. pmid:40715989
View Article
PubMed/NCBI
Google Scholar

[68] View Article

[69] PubMed/NCBI

[70] Google Scholar

[ref24] 24. Wang JJ, Baranowski T, Lau WP, Chen TA, Pitkethly AJ. Validation of the physical activity questionnaire for older children (PAQ-C) among Chinese children. Biomed Environ Sci. 2016;29(3):177–86. pmid:27109128
View Article
PubMed/NCBI
Google Scholar

[72] View Article

[73] PubMed/NCBI

[74] Google Scholar

[ref25] 25. Zaki NAM, Sahril N, Omar MA, Ahmad MH, Baharudin A, Nor NSM. Reliability and validity of the physical activity questionnaire for older children (PAQ-C) in Malay language. International Journal of Public Health Research. 2016;6(1):670–6.
View Article
Google Scholar

[76] View Article

[77] Google Scholar

[ref26] 26. Benítez-Porres J, López-Fernández I, Raya JF, Álvarez Carnero S, Alvero-Cruz JR, Álvarez Carnero E. Reliability and Validity of the PAQ-C Questionnaire to Assess Physical Activity in Children. J Sch Health. 2016;86(9):677–85. pmid:27492937
View Article
PubMed/NCBI
Google Scholar

[79] View Article

[80] PubMed/NCBI

[81] Google Scholar

[ref27] 27. Erdim L, Ergün A, Kuğuoğlu S. Reliability and validity of the Turkish version of the Physical Activity Questionnaire for Older Children (PAQ-C). Turk J Med Sci. 2019;49(1):162–9. pmid:30764593
View Article
PubMed/NCBI
Google Scholar

[83] View Article

[84] PubMed/NCBI

[85] Google Scholar

[ref28] 28. Hidding LM, Chinapaw MJM, van Poppel MNM, Mokkink LB, Altenburg TM. An updated systematic review of childhood physical activity questionnaires. Sports Med. 2018;48(12):2797–842. pmid:30298479
View Article
PubMed/NCBI
Google Scholar

[87] View Article

[88] PubMed/NCBI

[89] Google Scholar

[ref29] 29. Ellery CVL, Weiler HA, Hazell TJ. Physical activity assessment tools for use in overweight and obese children. Int J Obes (Lond). 2014;38(1):1–10. pmid:23828100
View Article
PubMed/NCBI
Google Scholar

[91] View Article

[92] PubMed/NCBI

[93] Google Scholar

[ref30] 30. Cuberek R, Janíková M, Dygrýn J. Adaptation and validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Czech children. PLoS One. 2021;16(1):e0245256. pmid:33434223
View Article
PubMed/NCBI
Google Scholar

[95] View Article

[96] PubMed/NCBI

[97] Google Scholar

[ref31] 31. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91. pmid:11124735
View Article
PubMed/NCBI
Google Scholar

[99] View Article

[100] PubMed/NCBI

[101] Google Scholar

[ref32] 32. Mokkink LB, Elsman EBM, Terwee CB. COSMIN guideline for systematic reviews of patient-reported outcome measures version 2.0. Qual Life Res. 2024;33(11):2929–39. pmid:39198348
View Article
PubMed/NCBI
Google Scholar

[103] View Article

[104] PubMed/NCBI

[105] Google Scholar

[ref33] 33. Gorsuch RL. Factor analysis. L. Erlbaum Associates. 1983.

[ref34] 34. Comrey AL, Lee HB. A First Course in Factor Analysis. Taylor & Francis. 2013.

[ref35] 35. Osborne JW, Costello AB. Sample size and subject to item ratio in principal components analysis. Practical Assessment, Research, and Evaluation. 2019;9(1):11.
View Article
Google Scholar

[109] View Article

[110] Google Scholar

[ref36] 36. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489–97. pmid:16977646
View Article
PubMed/NCBI
Google Scholar

[112] View Article

[113] PubMed/NCBI

[114] Google Scholar

[ref37] 37. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382–5. pmid:3640358
View Article
PubMed/NCBI
Google Scholar

[116] View Article

[117] PubMed/NCBI

[118] Google Scholar

[ref38] 38. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychological Methods. 1996;1(1):30–46.
View Article
Google Scholar

[120] View Article

[121] Google Scholar

[ref39] 39. Thomas EL, Upton D. Psychometric properties of the physical activity questionnaire for older children (PAQ-C) in the UK. Psychology of Sport and Exercise. 2014;15(3):280–7.
View Article
Google Scholar

[123] View Article

[124] Google Scholar

[ref40] 40. Moore JB, Hanes JC, Barbeau P, Gutin B, Treviño RP, Yin Z. Validation of the Physical Activity Questionnaire for Older Children in children of different races. Pediatr Exerc Sci. 2007;19(1):6–19. pmid:17554153
View Article
PubMed/NCBI
Google Scholar

[126] View Article

[127] PubMed/NCBI

[128] Google Scholar

[ref41] 41. Benítez-Porres J, Alvero-Cruz JR, Sardinha LB, López-Fernández I, Carnero EA. Cut-off values for classifying active children and adolescents using the Physical Activity Questionnaire: PAQ-C and PAQ-A. Nutricion hospitalaria. 2016;33(5):1036–44.
View Article
Google Scholar

[130] View Article

[131] Google Scholar

[ref42] 42. Lupo C, Boccia G, Ungureanu AN, Mulasso A, De Pasquale P, Mancini A, et al. The Cut-Off Value for Classifying Active Italian Children Using the Corresponding National Version of the Physical Activity Questionnaire. Sports (Basel). 2022;10(4):61. pmid:35447871
View Article
PubMed/NCBI
Google Scholar

[133] View Article

[134] PubMed/NCBI

[135] Google Scholar

Figures

Abstract

Introduction

Methodology

Results

Conclusion

Introduction

Materials and methods

Phase I-PAQ-C sinhala translation and cross-cultural adaptation

Pilot testing.

Phase II: Evaluating the psychometric properties of PAQ-C Sinhala Version

Participants.

Procedure.

Statistical analysis

Content validity

Test-retest reliability

Results

Characteristics of participants

Physical activity pattern

Validity of the PAQ-C

Content validity.

Reliability of the PAQ-C

Discussion

Limitation

Conclusion

Supporting information

S1 File. PAQC-English Version.

S2 File. PAQ-C-PLOSONE.

S3 File. Sinhala Questionnaire-final.

Acknowledgments

References