Questions
about adult physical activity were first asked in the National Health
Interview Survey in July-December, 1975 (Physical Fitness Supplement). NHIS
respondents aged 20 years and over were asked a series of questions about their
participation in exercise and sports activities and their self-perceptions
of their physical activity levels relative to others the same age (23).
Leisure-time
physical activity questions were next asked in the 1984 NHIS Supplement on
Aging (SOA) in a section entitled “Health Opinions.” This section had a
question about frequency of walking a mile or more, asked of adults aged 55
years and over. Although the question did not specify the reason for the
walking (e.g., leisure, transportation, occupational, etc.), the context was
consistent with leisure-time activity. Older adults in the 1984 SOA were
also asked “Do you follow a REGULAR routine of physical exercise?”--a
question that was repeated in the 1994 Supplement on Aging (SOA II).
In
the early 1980’s the NHIS became the data source for tracking progress
toward achieving many of the physical activity objectives outlined in the
National Health Objectives for the Nation (9). In 1985 and 1990, the NHIS
Health Promotion and Disease Prevention Supplements contained questions
consisting of a list of
specific leisure-time physical activities and includedfrequency, duration, and intensity questions for
each activity mentioned. The questionnaire and documentation should be
examined carefully to determine the universe for these questions as age and
disability status determined which respondents were asked certain questions.
Also asked in the 1985 and 1990 Health Promotion and Disease Prevention
Supplements was a question on regularity of physical activity, “Do you
exercise or play sports regularly?” and if yes, “For how long have you
exercised or played sports regularly?”
Questions
for national surveillance of leisure-time physical activity continued
through much of 1990s, with Health Promotion and Disease Prevention/Year
2000 Objectives Supplements in 1991, 1995, and 1998. The content of these
questionnaires (renamed to Year 2000 Objectives supplements in 1995),
was
similar to the 1985 and 1990versions although there were some
important differences which should be considered when analyzing data across
years. For example, in the 1985 and 1990 supplements, some of the physical
activity questions were limited to selected age groups. However, beginning
in 1991, all adults aged 18 years and over were asked all of the physical
activity questions.
In
1997, as part of the National Health Interview Survey annual (core)
questionnaire redesign, physical activity questions were included in the
annual questionnaire for the first time. Questions used in Australia,
Finland, and Canada, as well as studies of older adults and youth in the
United States, influenced the development of the NHIS Sample Adult annual
physical activity questions (27-31). Question wording and response options
were modified for use in the NHIS Sample Adult questionnaire, tested in the
Questionnaire Design Research Laboratory (QDRL) of CDC’s National Center for
Health Statistics, and included in a field pretest. Decisions concerning
question phrasing, reference period, and response options were based on
results of cognitive testing and debriefing of
interviewersafter the pretest. Consistency with other parts of the
National Health Interview Survey questionnaire was also considered. The
final NHIS core physical activity questions consisted of asking frequency
and duration of usual leisure-time vigorous and light-moderate activities
and frequency of strengthening activities.
Additional
physical activity questions have been added to the NHIS in supplements in
selected years since 1997 and asked of the same adults who responded to the
Sample Adult core questions.
The
1998 Healthy People 2000 Supplement and the 2000 and 2005 Cancer Modules
included questions related to leisure-time physical activity.
Perceived
Physical Activity Level (leisure and non-leisure)
A
question about self-assessed perceived physical activity level compared with
activity level of other persons in the
same age group
was first asked in the NHIS in 1975. Respondents were asked
“Would you say that you are physically more active, less active, or about as
active as other persons your age?” Variations
of this question were included in the NHIS in 1977, 1983, 1984, 1985 and
1990.Research has suggested that self-perception of physical
activity compared with peers has reasonable validity (32,
33).
A
second indicator of perceived activity level, activity level compared
with one year earlier,
was first asked in the NHIS in the 1984 Supplement on Aging (SOA) for adults
aged 55 years and over. The question was repeated in the 1994 Disability
Follow-back Supplement (NHIS Phase II) Supplement on Aging Questionnaire (SOA
II) and Adult’s Questionnaire and asked of adults aged 70 years and over.
In
the 1984 Supplement on Aging, older adults were also asked about the
perceived adequacy of their activity level: “Do you feel that you get as
much exercise as you need,less than you need?”
Transportation-Related
Activity
Transportation-related
physical activity was first asked in the NHIS in the 2000 Sample Adult
Cancer Control Supplement.Sample adults 18 years and over
were asked “Do you usually walk or bike to work, school, or to do errands?”
The 2005 NHIS Cancer Control supplement also included questions about
physical activity for transportation, although these questions differed from
the 2000 question.
Occupational
Activity
Occupation-relatedphysical
activity is an important component of physical activity for many U.S.
adults. The 1985 and 1990 NHIS Health Promotion and Disease Prevention
Supplements had questions to assess the amount of physical activity
associated with a person’s job or main daily activity.
A
1988 Occupational Health Supplement had a few questions pertaining to
physical activity on the job, although these questions were designed
primarily to assess risk of repetitive motion injury.
In
2000 and 2005, the NHIS Cancer Control Modules measured activity associated
with one’s job, although the frame of reference was expanded beyond
occupation to include activities associated with any main daily activity to
encompass adults not in the workforce such as homemakers or retired
individuals.
Other
Physical Activity Topics In addition to the measures of physical
activity highlighted above, the NHIS has periodically included questions
related to the broader context of the study of physical activity.
Many of these haveincluded in the survey to measure progress toward specific national health
promotion objectives. These additional physical activity-related topics
include:
Knowledge
of the health benefits of physical activity to strengthen heart and lungs
(1985 and 1990), and to lose weight (1985
and 1990).
Increases
in physical activity behavior in order to lose weight (1985
and 1990) or in
order to control weight (1991 and 1995).
Medical
advice received about physical activity generally (1993, 1994,
and 2006), or
specifically for high blood pressure (1985, 1990, and 2003), or for arthritis
(2002, 2003, and 2006).
Availability
of/participation in employer-offered exercise facilities and programs
(1991, 1993, and 1994).
Family
discussions about exercise or physical activity (1994).
Participation
in exercise classes (1995).
Participation
in alternative health exercises--yoga, tai chi, Qi Chong (2002
and
2007).
Acknowledgements:
Special thanks to Susan Jack and Veronica Benson for their exhaustive review
of the historic NHIS questionnaires for this project.