This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Physical Activity Readiness Questionnaire (PAR-Q)+ 2020 has been utilized to measure readiness for physical activity (PA). However, it is unavailable in the Indonesian language. We aimed to adapt and evaluate the validity and reliability of the PAR-Q+ 2020 culturally for the Indonesian population and its application in general and family medicine.
Methods
We conducted a cross-sectional study to adapt the PAR-Q+ 2020 to the Indonesian language. A face validity interview with 20 participants followed the translation and back-translation processes. Subsequently, an online questionnaire was distributed between June and October 2022, with 378 participants responding and a 72.2% response rate for the second test. Cohen’s kappa was calculated to determine the intra-rater reliability of each item. Intra-class correlation (ICC) and Cronbach’s alpha analyses were conducted to examine the first and second parts of the questionnaire and the overall intra-rater reliability and internal consistency of the questionnaire.
Results
The median age of the participants was 27 years (range, 18–61 years), and 63% (n=172) were female. The Cohen’s kappa value of each item ranged from to 0.801–1.000 (almost perfect to perfect agreement). The ICC values for the first and second parts and the overall questionnaire were 0.957, 0.993, and 0.987, respectively. Cronbach’s alpha was adequate for the first part (α=0.958), second part (α=0.993), and overall questionnaire (α=0.987).
Conclusion
The Indonesian version of the PAR-Q+ 2020 demonstrated reliability and preliminary evidence of its validity in measuring individual readiness for PA. Further studies involving a broader population and employing more comprehensive validation methods are necessary to establish its validity and applicability fully.
Regular physical activity (PA) is a cornerstone of preventive medicine and is associated with a substantial reduction (approximately 33%) in all-cause mortality and a 35% reduction in mortality owing to cardiovascular disease [1]. However, engaging in PA may pose risks for individuals with pre-existing medical conditions, highlighting the importance of appropriate and convenient pre-PA screening [2]. The readiness of an individual for PA can be assessed using various evaluations, including cardiovascular disease risk assessment and fitness evaluation, medical examinations [3,4], questionnaires completed by health professionals [5,6], and self-completed questionnaires. Several tools have been developed for this purpose [7-14], and among the questionnaires, the Physical Activity Readiness Questionnaire (PAR-Q) has been used extensively to assess general readiness to initiate PA. This tool identifies medical conditions or other factors based on an individual’s medical history that may require further evaluation prior to the initiation of PA [15]. The PAR-Q has evolved since its first development [16], and the current PAR-Q+ 2020 is widely employed [17]. It is concise and practical, consisting of seven binary “yes” or “no” questions. Any “yes” answer to at least one of the binary questions warrants further evaluation using the second part of the tool [15].
The validity and reliability of the PAR-Q are well established. The original 2011 version demonstrated high reliability (0.99) over a 3-month period, with a sensitivity of 0.90 (95% confidence interval [CI], 0.77–0.96) and a specificity of 1.00 (95% CI, 0.99–1.00) [18]. Similarly, the PAR-Q+ 2020 has been validated in other countries, including Brazil [19], Spain [20], India (the Odia [21] and Gujarati [22] languages), and Canada [17]. The Brazilian, Spanish, and Indian versions of the PAR-Q+ 2020 have exhibited excellent internal consistency, with Cronbach’s alpha values of 0.993, 0.995 (P<0.01), and 1 (P<0.05), respectively [19,20,22]. The reproducibility (reliability) was found to be robust, with a kappa value of 0.901 (95% CI, 0.887–0.914) in the Brazilian version [19], 1 in the Indian version [22], and almost perfect in the Spanish version [20]. Thus, it has demonstrated excellent validity and reliability as an instrument to assess readiness to initiate PA across language and culture.
Although this tool has been extensively validated in various languages and cultures, an eminent gap remains as it is unavailable for the Indonesian population. Cultural and healthcare differences across Indonesian populations can affect the relevance and effectiveness of the PAR-Q+ 2020, as the Indonesian population culture differs from that of Western countries where the tool was developed. Moreover, cultural disparities across areas (e.g., urban or rural), age groups, and socioeconomic status could affect the understanding and awareness of PA and the ability to comprehend and complete the questionnaire.
This study aims to adapt and validate the PAR-Q+ 2020 culturally for the Indonesian population. This adaptation ensures the accuracy, reliability, and cultural appropriateness of the PAR-Q+ 2020. We evaluate whether the adapted version is linguistically appropriate and whether it resonates with the population’s understanding of PA. By adapting the tool, we aim to contribute to illness prevention measures and research on PA across Indonesia, while identifying individuals who are at risk for adverse reactions to PA and contributing to screening and early intervention.
Methods
Study design, sample size, and sampling methods
This cross-sectional study was conducted between April and October 2022. This study aimed to adapt the PAR-Q+ 2020 questionnaire and evaluate its preliminary (face) validity and reliability to measure individual readiness to initiate PA in the Indonesian population. We designed the study to assess the face validity and test-retest (i.e., intra-rater) and internal reliability of the adapted scale. The inclusion criteria for this study were adults (≥18 years old) with basic Indonesian language abilities. The exclusion criteria for this study were as follows: (1) age <18 years, (2) low literacy, which may cause language barriers, (3) prior knowledge of the PAR-Q+ 2020, and (4) inability or unwillingness to provide informed consent.
We followed the guidelines provided by Bujang et al. [23] to determine the minimum sample size required for the study. According to the guidelines, using the categorical answer (i.e., “yes” or “no” answer; 2×2 category) with K1 of 0.0 (due to no agreement expected in the first completion of the questionnaire), K2 of 0.8 (expected kappa value for almost perfect agreement), power at 90%, and alpha of 0.05, the study required at least 12 participants [23]. We multiplied the number of participants by 10 to accommodate the variation of proportions; thus, the minimum required number of participants was 120. For the intra-class correlation (ICC) study, to detect a value of 0.50, a minimum sample size of 30 is needed when alpha and power are fixed at 0.05 and 90%, respectively [24]. It is customary to add 20% more to the dropout rate to account for respondents who would otherwise be unable to attend the follow-up session (i.e., retest). As a result, the required sample size would increase to 38 (i.e., 30/0.8=38) [24].
We used convenience sampling to select participants based on their availability and willingness to participate. Efforts were made to ensure diverse sampling by targeting various demographic groups using multiple platforms.
PAR-Q+ 2020
The PAR-Q is a pre-participation screening tool that is used to assess individuals’ readiness for PA. It generally includes questions regarding an individual’s health, medical history, and diseases that may be of concern when participating in PA. Depending on their responses, the PAR-Q may guide individuals to proceed with PA, seek further medical evaluation, or consult a healthcare provider before starting a PA program.
The PAR-Q, which was first developed in 1970 [25], has been improved with the development of the PAR-Q 2011 [16] and PAR-Q+ 2020 [17]. The PAR-Q has continuously been evaluated over the years; therefore, it is regularly updated and revised by an international consensus committee [17]. The PAR-Q+ 2020 incorporates substantial modifications that represent the current evidence-based and consensus panel-approved version of the PAR-Q+ compared with the 2011 version. The PAR-Q+ 2020 version contains separate questions regarding high blood pressure, more detailed questions regarding hypoglycemia, and added questions regarding Down syndrome in the section on mental health problems or learning difficulties [17]. The PAR-Q+ 2020 questionnaire contains seven “yes” and “no” questions to determine whether individuals can be more physically active. When a person responds “no” to all seven initial questions, they are deemed eligible for unrestricted participation in PA. If the person answers at least one “yes” to these questions, they must answer follow-up questions related to chronic medical conditions. When completing the follow-up questions (a total of 41 items), if the individual answers “no” to all questions, they are cleared to engage in increased PA. However, if any follow-up questions have a “yes” answer, they are advised to consult a medical professional for an exercise recommendation program [15].
Translation and back-translation of PAR-Q+ 2020
Adapting the PAR-Q+ 2020 for the Indonesian population involved a rigorous and multi-step process, as recommended by the guidelines of Beaton et al. [26] for cross-cultural adaptation. Initially, two independent native Indonesian speakers (a sports medicine specialist and a layperson sworn translator) conducted the English-to-Indonesian translation. Both provided us with two Indonesian versions of the PAR-Q+ 2020. Subsequently, both versions were reviewed and refined by a team of researchers, experts, and translators to ensure that the final version was clear, aligned with the intended meaning, and culturally relevant. This meeting produced the pre-final version of the adapted tool. Two independent native English translators (a medical doctor and a layperson translator) who were not involved in the study or previous translation conducted the back-translation from Indonesian to English. Their result was discussed with the team, and a “pre-final” back-translated version was sent to the original developer of the PAR-Q+ for review and verification. The developers confirmed that the original and translated versions were semantically identical.
Although the effort to gather experts and original developer input is similar to content validity evaluation, it lacks statistical evaluation that is usually conducted in the development and adaptation of measurement tools [27]. In this study, expert judgments constituted our efforts to ensure that each item was translated correctly and appropriately for Indonesian culture and context. Given the nature of the method, this effort might be seen as part of face validity from the expert’s perspective.
Face validity evaluation and pilot study
Face validity is a subjective validity measure. This validity type aims to evaluate whether the measurement tool appears to measure the concept that it is intended to measure in the targeted responders [28]. We conducted a face validity evaluation from the perspective of the targeted population through a pilot test. The pre-final version of the PAR-Q+ 2020 Indonesia was presented to 20 participants from the target population. The targeted participants were contacted and asked to read the questionnaire and provide us with information on whether they understood the items. They were also asked to provide input for each item. Later, we conducted an online structured interview to evaluate their understanding of each item and collected their input to improve the questionnaire. We conducted an online face validity evaluation to achieve wider accessibility, optimal efficiency, convenience, and cost-effectiveness. This process provided insight into the development of the final Indonesian version of the PAR-Q+ 2020, while providing face validity evidence from the perspective of the participants.
Data collection and ethical considerations
The final Indonesian version of the PAR-Q+ 2020 was distributed through social media (e.g., Instagram or other available platforms) and groups in communication applications (e.g., WhatsApp) between June and October 2022 (Supplement 1). We also asked willing participants to communicate with others to help to disseminate information about the study. A link to an online survey tool (Google Forms; Google LLC) was embedded in the message for all participants who were willing to access the study. We also monitored the progress regularly to ensure that the required number was sufficient and that the backgrounds of the participants were diverse.
An online format was developed using Google Forms (Google LLC). The form started with a consent form that included the purpose of the study, nature of participation, and confidentiality assurances. If the participants provided their consent, their demographic information, including name, sex, age, educational background, and contact details (either phone number or email) were collected. All participants were required to complete both parts of the PAR-Q+ 2020 despite their answers to the first part of the survey (initial screening). Upon completion of the survey, they were thanked and informed that they would be reminded of the scheduled follow-up 2 weeks later for the second completion of the survey, as mentioned in the information form.
The participants were contacted 2 weeks later to complete the questionnaire again. Four reminders were sent at 3-day intervals following the second invitation for those yet to respond to enhance the response rate. We monitored the responses regularly to ensure the sample size and diversity among the demographic profiles.
Ethical approval was obtained from the Research Ethics Committee of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia (No. LB.02.01/X.6.5/70/2021). We did not provide any incentives to the participants. The researchers stored all data and opened them only during data analysis, without disclosing personal information.
Data analysis
Normally distributed data were presented as the mean±standard deviation, and non-parametric data were presented as the median (min–max). Each item was evaluated for its test-retest (i.e., intra-observer) reliability using kappa analysis with a 95% CI [29]. The values of the kappa analysis were classified as <0 (no agreement), 0–0.19 (poor agreement), 0.20–0.39 (fair agreement), 0.40– 0.59 (moderate agreement), 0.60–0.79 (substantial agreement), and 0.8–1.00 (almost perfect agreement) [30]. An ICC analysis was conducted for each section and the overall questionnaire for the intra-observer reliability investigation. A 95% CI was used for the ICC based on the mean rating, absolute agreement, two-way mixed-effects model, and 80% study. ICC values of <0.5, 0.5–0.75, 0.75–0.9, and >0.9 reflect poor, moderate, good, and excellent reliability, respectively [31]. The internal consistency was calculated using Cronbach’s alpha and was considered significant when the score was >0.7 [32].
Results
Demographic profile
Of the 378 participants who consented to be enrolled in the study on their first attempt, 273 completed the questionnaire twice, yielding a response rate of 72.2%. The median age of the participants was 27 years (range, 18–61 years). Most participants were female (n=172; 63%) and had graduated from college or higher education (n=251; 91.9%). Table 1 presents the demographic profiles of the study population.
Face validity
As in the original version of the PAR-Q+ 2020, the PAR-Q+ 2020 Indonesia consists of seven general health questions and 10 groups of follow-up questions regarding chronic medical conditions, which were completed by all participants (n=20) within 5–10 minutes. Based on the interviews, several amendments were implemented. No amendments were made to the general health questions section. However, several items in the follow-up questions were changed according to the input of the participants. The changes were as follows: item 1 (ever diagnosed with arthritis, osteoporosis, or back problems by a medical doctor); item 1b (ever diagnosed with joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer, etc. by a medical doctor); item 2 (ever diagnosed with cancer by a medical doctor); item 3 (ever diagnosed with heart or cardiovascular diseases by a medical doctor); item 3b (ever diagnosed with irregular heartbeat that requires medical management by a medical doctor); item 3c (ever diagnosed with chronic heart failure disease by a medical doctor); item 3d (ever diagnosed with coronary heart (cardiovascular) disease by a medical doctor); item 4 (ever diagnosed with high blood pressure by a medical doctor); item 5 (ever diagnosed with any metabolic disease by a medical doctor); item 5d (ever diagnosed with other metabolic diseases by a medical doctor); item 6 (ever diagnosed with mental health problems or learning difficulties); item 6b (ever diagnosed with Down syndrome or back problems affecting nerves or muscles by a medical doctor); item 7 (ever diagnosed with respiratory diseases by a medical doctor); item 8 (ever diagnosed with spinal cord injury by a medical doctor); item 9 (ever diagnosed with a stroke by a medical doctor); item 9c (ever diagnosed with a stroke and impairments in nerves or muscles in the past 6 months by a medical doctor); item 10 (ever diagnosed with other diseases not listed above by a medical doctor); and item 10b (ever diagnosed with other diseases not listed above, such as epilepsy, neurological problems, and kidney problems by a medical doctor). Changes to each question or item were applied to the item statement, answer options, or both. The revisions resulted in the final version of the PAR-Q+ 2020 Indonesia, which was used for validation. To improve the understanding, we added explanations of several Indonesian medical terminologies, particularly in part 2 of the questionnaire: arthritis and osteoporosis (item 1), spondylolysis (item 1b), multiple myeloma (part 2 item 2a), tetraplegia and paraplegia (item 8), and transient ischemic attack (item 9). Table 2 (English version) and Supplement 2 (Indonesian version) summarize the results and changes from the face validity and pilot study evaluation.
Test-retest and internal reliability
A total of 273 participants were included in the statistical analyses. For all items of the questionnaire, the Cohen’s kappa analysis indicated almost perfect agreement (item 3: κ=0.801, P<0.001) to perfect agreement (part 1, items 5 and 7; part 2, items 2, 2a, 2b, 3, 3a, 3b, 3c, 3d, 4a, 4b, 5, 5a, 5b, 5c, 5d, 5e, 6, 6a, 6b, 7a, 7b, 7c, 7d, 8, 8a, 8b, 8c, 9, 9a, 9b, 9c, and 10a; κ=1.00, P<0.001) (refer to Supplement 1 for the text of each item).
ICC analysis was conducted for the first and second sections of the questionnaire, as well as for the overall score. The ICC score for the first part of the questionnaire was 0.957 (95% CI, 0.946–0.966; P<0.001), indicating excellent reliability. Similarly, the ICC score for the second part was 0.993 (95% CI, 0.991–0.994; P<0.001), suggesting excellent reliability. The intra-observer reliability of the questionnaire showed an excellent ICC value of 0.987 (95% CI, 0.984–0.990; P<0.001). The Cronbach’s alpha analysis exhibited good internal consistency in the first part, second part, and overall questionnaire, with alpha values of 0.958, 0.993, and 0.987, respectively. Table 3 summarizes the kappa, ICC, and Cronbach’s alpha results.
Discussion
This study constitutes the first validation of the PAR-Q+ 2020 questionnaire in Indonesians, demonstrating its reliability and preliminary validity as a pre-engagement screening tool for PA. This study showed that all items have “almost perfect” to “perfect” agreement. The ICC and Cronbach’s alpha scores indicated that the first part, second part, and overall questionnaire had excellent reproducibility and adequate internal consistency.
Our results contribute to the positive evidence of the adapted PAR-Q+ 2020 reliability study, as we found excellent agreement in the overall reproducibility. Our results are comparable to those reported in the Brazilian (κ=0.901; ICC, 0.901) [19], Spanish (κ=0.88–1) [20], and Indian Gujarati (κ=1) [21] versions, which showed almost perfect reproducibility. The Indonesian version of the PAR-Q+ 2020 questionnaire also exhibited good internal reliability (α=0.987), which is similar to that of the Brazilian (α=0.993) [18], Spanish (α=0.995) [19], and Indian Gujarati (α=1) versions [22].
The comparable reproducibility and internal reliability of the Indonesian version of the PAR-Q+ 2020 compared with other translations may stem from several factors. First, although cultural nuances could affect the results in the sense that the perception of several terminologies might be different from those speaking English or other languages, our endeavor to ensure face validity and understanding of the participants through interviews and adding several explanations of “unfamiliar” terminology might pose certain benefits. Second, although it might be considered a bias, a short period between the attempts might help in the recall process or prevent changes in the condition of the patient, and thus, their answers. The original version of the questionnaire is recommended to be administered every 12 months, which is much longer than that used in this study.
Study limitations, implications, and future research
To our knowledge, our study is the first to provide evidence of the face validity and reliability of the culturally adapted PAR-Q+ 2020 in the Indonesian population. We have presented and added insightful information on the adaptation and validation of the PAR-Q+ 2020 across the population. However, several limitations in the demographic composition and nature of this study should be acknowledged.
In terms of the demographic distribution, our study was limited by the skewness of age, sex, and educational background. The age distribution of the participants was skewed towards younger individuals (18–30 years old; 73.63%), thus underrepresenting middle-aged and older individuals. This limits the applicability of our findings to older populations. Although the findings in younger populations are promising, generalization to older individuals warrants further examination. Different genders might respond differently to health questionnaires, and health risks may differ between genders. Therefore, the unbalanced sex distribution in this study may have altered the generalizability of the results. This imbalance is likely owing to women’s higher engagement in social media platforms or communication groups. Using more recruitment channels with higher male participant engagement may help to balance the distribution in future studies. Finally, educational background was skewed towards people with higher educational levels. This imbalance might hinder the potential bias in the impact of health literacy or understanding of health terminology in those with lower levels of education. However, we should ensure a more diverse representation through more channels and direct contact with populations with lower education or socioeconomic backgrounds.
Furthermore, the online platform used, while convenient, may have several limitations. The main challenges of an online survey are the potential lack of focus, misunderstanding of questions, and insincere responses, especially in this study, which was conducted without real-time supervision of participants. Some participants might not have paid full attention to follow-up questions when completing the questionnaire for a second time, especially those who did so online without professional supervision. Survey-based research often encounters inattentive responses, suggesting that self-administered online surveys can lead to careless responses owing to a lack of personal interaction. To mitigate this risk, we provided the participants with clear instructions at the beginning of the survey. We also divided the survey into segments to ensure that no questions were omitted. Prior to the wide enrollment of participants, we conducted a face validity evaluation based on the perspectives of the participants. We also encouraged engagement through reminders while providing an email contact for questions or clarifications. However, despite these efforts, we acknowledge that bias may not be entirely eliminated and may cause response inconsistencies. Further studies could benefit from using a mixed method (i.e., online and offline platforms) to prevent this type of bias in data collection.
The nature of the PAR-Q+ as a self-reported questionnaire may have caused subjectivity bias. The questions were based on medical history, but recall and subjectivity biases may still exist. Participants may not always provide honest or accurate responses regarding their previous medical conditions, especially if they do not entirely understand their health or omit relevant information. Second, this study was the first to examine the adaptation and validation of the PAR-Q+ 2020 in Indonesia. However, we only performed a preliminary evaluation of the face validity of the adapted version from the perspective of the participants. Face validity is widely understood to be the weakest evidence of validity. Therefore, the validity and reliability of PAR-Q+ 2020 Indonesia needs to be studied further with a more sophisticated statistical analysis, such as ICC with a larger sample size. Moreover, where appropriate, further validity evaluations should include broader types of validity evidence, such as content, construct, and clinical validity evaluations, to ensure the robustness and generalizability of the tool.
Future studies should consider conducting subgroup analyses based on demographic information. Although insightful, a subgroup analysis was not conducted in this study, which could be a limitation. The primary aim of this study was to validate the tool in the Indonesian population. Therefore, we advise further studies to address this limitation.
Despite these limitations, this study has valuable implications for literature on the PAR-Q+ 2020. First, this adapted Indonesian version of the PAR-Q+ 2020 can enable a wide range of individuals in Indonesia to initiate or improve their participation in PA safely, while also providing valuable data for further research. Second, as this study provides the first validity and reliability evidence of the PAR-Q+ 2020 in the Indonesian population, it may open the door for similar adaptations in other languages and be used in relatively similar cultures, particularly in Southeast Asia. Third, our study provides healthcare workers and researchers working in physical exercise, training, and physical education or other fields with a valid and reliable instrument to measure a person’s readiness to engage in PA. Further replication studies are necessary, particularly with larger sample sizes and across diverse regions of Indonesia in various settings, to ensure that the validity and reliability of the questionnaire represent the entire Indonesian population accurately.
Conclusion
The adapted PAR-Q+ 2020 demonstrated reliability and preliminary face validity in assessing readiness for PA. Its nationwide adoption could enable many Indonesians to increase their participation in PA and fitness assessments safely. It also offers avenues for improving overall well-being and contributing to the prevention and management of chronic diseases within this population. However, further studies using more comprehensive validation methods for validity evaluation, such as content, construct, and clinical validity assessments across cultures, are required.
Article Information
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Acknowledgments
We thank the Indonesian Heart Foundation, West Java Chapter, for initiating the study and providing support throughout this study. We are grateful for the support from the Department of Cardiology and Vascular Medicine, Dr Hasan Sadikin General Hospital, Universitas Padjadjaran. We greatly appreciate all participants who provided valuable time for this study. We also sincerely thank the translators and other experts who contributed to this study.
Funding
None.
Data availability
Data of this research are available from the corresponding author upon reasonable request.
Author contribution
Conceptualization: IJTA, AW, BBT, FNH, PAP, RB. Data curation: IJTA, AW, BBT, FNH, PAP, RB, NP. Formal analysis: IJTA, AW, FNH, PAP, RB. Investigation: IJTA, AW, BBT, FNH, PAP, RB, NP. Methodology: IJTA, AW, BBT. Project administration: FNH, RB, NP. Validation: IJTA, AW, BBT, FNH, PAP, RB, NP. Writing-original draft: IJTA, FNH, RB, NP. Writing-review & editing: AW, BBT, PAP. Final approval of the manuscript: all authors.
Are you experiencing arthritis (joint inflammation), osteoporosis (bone loss), or back problems?
Have you ever been diagnosed with arthritis (joint inflammation), osteoporosis (bone loss), or back problems by a medical doctor?
1B
Do you have joint problems resulting in pain, a recent fracture, or fractures due to osteoporosis or cancer, shifts in the spine (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack on the spine)?
Have you ever been diagnosed with joint problems resulting in pain, a recent fracture, or fractures due to osteoporosis or cancer, shifts in the spine (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack on the spine) by a medical doctor?
2
Do you have cancer?
Have you ever been diagnosed with cancer by a medical doctor?
3
Do you have heart or cardiovascular disease? This includes coronary artery disease, heart failure, or heart rhythm abnormality.
Have you ever been diagnosed with heart or cardiovascular disease? This includes coronary artery disease, heart failure, or heart rhythm abnormality by a medical doctor?
3B
Do you have an irregular heart rhythm that requires medical management? (e.g., atrial fibrillation, premature ventricular contractions)
Have you ever been diagnosed with irregular heart rhythm that requires medical management by a medical doctor? (e.g., atrial fibrillation, premature ventricular contractions)
3C
Do you have chronic heart failure?
Have you ever been diagnosed with chronic heart failure by a medical doctor?
3D
Do you have diagnosed coronary heart (cardiovascular) disease and have not engaged in regular physical activity in the past 2 months?
Have you ever been diagnosed with coronary heart (cardiovascular) disease by a medical doctor? and have not engaged in regular physical activity in the past 2 months.
4
Do you have high blood pressure?
Have you ever been diagnosed with high blood pressure by a medical doctor?
5
Do you have any metabolic disease? This includes diabetes type 1 and 2, pre-diabetes.
Have you ever been diagnosed with any metabolic disease by a medical doctor? This includes diabetes type 1 and 2, pre- diabetes.
5D
Do you have other metabolic diseases, such as gestational diabetes, chronic kidney disease, or liver problems?
Have you ever been diagnosed with other metabolic diseases, such as gestational diabetes, chronic kidney disease, or liver problems by a medical doctor?
6
Do you have mental health problems or difficulty learning? This includes Alzheimer’s, dementia, depression, anxiety disorders, eating disorders, psychotic disorders, intellectual disabilities, Down syndrome.
Have you ever been diagnosed with mental health problems or difficulty learning by a medical doctor? This includes Alzheimer’s, dementia, depression, anxiety disorders, eating disorders, psychotic disorders, intellectual disabilities, Down syndrome.
6B
Do you have Down syndrome and a back problem affecting your nerves or muscles?
Have you ever been diagnosed with Down syndrome and a back problem affecting your nerves or muscles by a medical doctor?
7
Do you have respiratory disease? This includes chronic obstructive pulmonary disease, asthma, high blood pressure in pulmonary blood vessels.
Have you ever been diagnosed with respiratory disease by a medical doctor? This includes chronic obstructive pulmonary disease, asthma, high blood pressure in pulmonary blood vessels.
8
Do you have any spinal cord injuries? This includes tetraplegia (paralysis in both arms and legs) and paraplegia (paralysis of the legs).
Have you ever been diagnosed with any spinal cord injuries by a medical doctor? This includes tetraplegia (paralysis in both arms and legs) and paraplegia (paralysis of the legs).
9
Have you ever had a stroke? This includes TIA/mini stroke or a cerebrovascular accident.
Have you ever been diagnosed with Stroke by a medical doctor? This includes a TIA/mini stroke or a cerebrovascular accident.
9C
Have you experienced a stroke or nerve or muscle problems in the past 6 months?
Have you ever been diagnosed with a stroke or nerve or muscle problems in the past 6 months by a medical doctor?
10
Do you have any other illnesses that have not been mentioned above, or have 2 or more medical conditions?
Have you ever been diagnosed with any other illnesses that have not been mentioned above, or have 2 or more medical conditions by a medical doctor?
10B
Do you have any medical conditions that have not been previously mentioned (such as epilepsy, neurological conditions, kidney problems)?
Have you ever been diagnosed with any medical conditions that have not been previously mentioned (such as epilepsy, neurological conditions, kidney problems) by a medical doctor?
Changes made after face validity evaluation are shown in bold.
TIA, transient ischemic attack.
Table 3.
Kappa, intra-class correlation, and Cronbach’s alpha results
Item
Kappa analysis
Intra-class correlation
Cronbach’s α
Value
P-value
Coefficient
P-value
First part
0.957
<0.001
0.958
1
0.875
<0.001
2
0.935
<0.001
3
0.801
<0.001
4
0.930
<0.001
5
1.00
<0.001
6
0.850
<0.001
7
1.000
<0.001
Second part
0.993
<0.001
0.993
1
0.891
<0.001
1a
0.907
<0.001
1b
0.855
<0.001
1c
1.000
<0.001
2
1.000
<0.001
2a
1.000
<0.001
2b
1.000
<0.001
3
1.000
<0.001
3a
1.000
<0.001
3b
1.000
<0.001
3c
1.000
<0.001
3d
1.000
<0.001
4
0.955
<0.001
4a
1.000
<0.001
4b
1.000
<0.001
5
1.000
<0.001
5a
1.000
<0.001
5b
1.000
<0.001
5c
1.000
<0.001
5d
1.000
<0.001
5e
1.000
<0.001
6
1.000
<0.001
6a
1.000
<0.001
6b
1.000
<0.001
7
0.950
<0.001
7a
1.000
<0.001
7b
1.000
<0.001
7c
1.000
<0.001
7d
1.000
<0.001
8
1.000
<0.001
8a
1.000
<0.001
8b
1.000
<0.001
8c
1.000
<0.001
9
1.000
<0.001
9a
1.000
<0.001
9b
1.000
<0.001
9c
1.000
<0.001
10
0.892
<0.001
10a
1.000
<0.001
10b
0.855
<0.001
10c
0.939
<0.001
Overall questionnaire
0.987
<0.001
0.987
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Role of Physical Activity in Protecting Against Dementia According to Menopausal Status Eun Ye Lim, Kyungdo Han, A-Hyun Cho Journal of Clinical Neurology.2026; 22(4): 427. CrossRef
Adaptation and validation of the Physical Activity Readiness Questionnaire (PAR-Q)+ 2020 for the Indonesian population: a cross-sectional study
Graphical abstract
Graphical abstract
Adaptation and validation of the Physical Activity Readiness Questionnaire (PAR-Q)+ 2020 for the Indonesian population: a cross-sectional study
Characteristic
No. (%)
Age group (y)
18–30
201 (73.63)
31–40
41 (15.02)
41–50
17 (6.23)
>50
14 (5.12)
Sex
Female
172 (63)
Male
101 (37)
Education
Primary-high school
22 (8)
Higher education (college or university)
251 (92)
No.
Pre-validation
Post-validation
1
Are you experiencing arthritis (joint inflammation), osteoporosis (bone loss), or back problems?
Have you ever been diagnosed with arthritis (joint inflammation), osteoporosis (bone loss), or back problems by a medical doctor?
1B
Do you have joint problems resulting in pain, a recent fracture, or fractures due to osteoporosis or cancer, shifts in the spine (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack on the spine)?
Have you ever been diagnosed with joint problems resulting in pain, a recent fracture, or fractures due to osteoporosis or cancer, shifts in the spine (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack on the spine) by a medical doctor?
2
Do you have cancer?
Have you ever been diagnosed with cancer by a medical doctor?
3
Do you have heart or cardiovascular disease? This includes coronary artery disease, heart failure, or heart rhythm abnormality.
Have you ever been diagnosed with heart or cardiovascular disease? This includes coronary artery disease, heart failure, or heart rhythm abnormality by a medical doctor?
3B
Do you have an irregular heart rhythm that requires medical management? (e.g., atrial fibrillation, premature ventricular contractions)
Have you ever been diagnosed with irregular heart rhythm that requires medical management by a medical doctor? (e.g., atrial fibrillation, premature ventricular contractions)
3C
Do you have chronic heart failure?
Have you ever been diagnosed with chronic heart failure by a medical doctor?
3D
Do you have diagnosed coronary heart (cardiovascular) disease and have not engaged in regular physical activity in the past 2 months?
Have you ever been diagnosed with coronary heart (cardiovascular) disease by a medical doctor? and have not engaged in regular physical activity in the past 2 months.
4
Do you have high blood pressure?
Have you ever been diagnosed with high blood pressure by a medical doctor?
5
Do you have any metabolic disease? This includes diabetes type 1 and 2, pre-diabetes.
Have you ever been diagnosed with any metabolic disease by a medical doctor? This includes diabetes type 1 and 2, pre- diabetes.
5D
Do you have other metabolic diseases, such as gestational diabetes, chronic kidney disease, or liver problems?
Have you ever been diagnosed with other metabolic diseases, such as gestational diabetes, chronic kidney disease, or liver problems by a medical doctor?
6
Do you have mental health problems or difficulty learning? This includes Alzheimer’s, dementia, depression, anxiety disorders, eating disorders, psychotic disorders, intellectual disabilities, Down syndrome.
Have you ever been diagnosed with mental health problems or difficulty learning by a medical doctor? This includes Alzheimer’s, dementia, depression, anxiety disorders, eating disorders, psychotic disorders, intellectual disabilities, Down syndrome.
6B
Do you have Down syndrome and a back problem affecting your nerves or muscles?
Have you ever been diagnosed with Down syndrome and a back problem affecting your nerves or muscles by a medical doctor?
7
Do you have respiratory disease? This includes chronic obstructive pulmonary disease, asthma, high blood pressure in pulmonary blood vessels.
Have you ever been diagnosed with respiratory disease by a medical doctor? This includes chronic obstructive pulmonary disease, asthma, high blood pressure in pulmonary blood vessels.
8
Do you have any spinal cord injuries? This includes tetraplegia (paralysis in both arms and legs) and paraplegia (paralysis of the legs).
Have you ever been diagnosed with any spinal cord injuries by a medical doctor? This includes tetraplegia (paralysis in both arms and legs) and paraplegia (paralysis of the legs).
9
Have you ever had a stroke? This includes TIA/mini stroke or a cerebrovascular accident.
Have you ever been diagnosed with Stroke by a medical doctor? This includes a TIA/mini stroke or a cerebrovascular accident.
9C
Have you experienced a stroke or nerve or muscle problems in the past 6 months?
Have you ever been diagnosed with a stroke or nerve or muscle problems in the past 6 months by a medical doctor?
10
Do you have any other illnesses that have not been mentioned above, or have 2 or more medical conditions?
Have you ever been diagnosed with any other illnesses that have not been mentioned above, or have 2 or more medical conditions by a medical doctor?
10B
Do you have any medical conditions that have not been previously mentioned (such as epilepsy, neurological conditions, kidney problems)?
Have you ever been diagnosed with any medical conditions that have not been previously mentioned (such as epilepsy, neurological conditions, kidney problems) by a medical doctor?
Item
Kappa analysis
Intra-class correlation
Cronbach’s α
Value
P-value
Coefficient
P-value
First part
0.957
<0.001
0.958
1
0.875
<0.001
2
0.935
<0.001
3
0.801
<0.001
4
0.930
<0.001
5
1.00
<0.001
6
0.850
<0.001
7
1.000
<0.001
Second part
0.993
<0.001
0.993
1
0.891
<0.001
1a
0.907
<0.001
1b
0.855
<0.001
1c
1.000
<0.001
2
1.000
<0.001
2a
1.000
<0.001
2b
1.000
<0.001
3
1.000
<0.001
3a
1.000
<0.001
3b
1.000
<0.001
3c
1.000
<0.001
3d
1.000
<0.001
4
0.955
<0.001
4a
1.000
<0.001
4b
1.000
<0.001
5
1.000
<0.001
5a
1.000
<0.001
5b
1.000
<0.001
5c
1.000
<0.001
5d
1.000
<0.001
5e
1.000
<0.001
6
1.000
<0.001
6a
1.000
<0.001
6b
1.000
<0.001
7
0.950
<0.001
7a
1.000
<0.001
7b
1.000
<0.001
7c
1.000
<0.001
7d
1.000
<0.001
8
1.000
<0.001
8a
1.000
<0.001
8b
1.000
<0.001
8c
1.000
<0.001
9
1.000
<0.001
9a
1.000
<0.001
9b
1.000
<0.001
9c
1.000
<0.001
10
0.892
<0.001
10a
1.000
<0.001
10b
0.855
<0.001
10c
0.939
<0.001
Overall questionnaire
0.987
<0.001
0.987
Table 1. Demographic profile of study participants (n=273)
Table 2. Face validity evaluation (English version)
Changes made after face validity evaluation are shown in bold.
TIA, transient ischemic attack.
Table 3. Kappa, intra-class correlation, and Cronbach’s alpha results
, Arief Wibowo2,3,4
