Short Questionnaire to Assess Health-Enhancing Physical Activity

Abstract

The Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH) is a widely used, self-administered questionnaire designed to quantify habitual physical activity (PA) levels in adults. Developed in the Netherlands, the SQUASH is rooted in the principles of the Dutch Norm for Healthy Exercise (Nederlandse Norm Gezond Bewegen). This instrument comprises 11 items that capture the frequency, duration, and intensity across four distinct domains of activity: occupational activities, commuting activities, household activities, and leisure time activities. The resulting total score provides a summary measure of PA, where a higher score indicates greater time or intensity dedicated to physical movement.

Keywords

Physical activity, SQUASH, Questionnaire, Health-enhancing, Epidemiology, Activity measurement, Physical activity assessment, Dutch Norm Gezond Bewegen, Mobility.

Authors

Wendel-Vos GCW, Schuit AJ, Kromhout D (2003)

Purpose

The primary purpose of the SQUASH is to provide a standardized, yet brief, method for assessing habitual physical activity over a defined period, typically the past seven days. It is specifically designed to capture activities that contribute to overall health and meet established public health guidelines, such as the Dutch Norm for Healthy Exercise.

This instrument is valuable for large-scale epidemiological research, population health monitoring, and evaluating the effectiveness of interventions aimed at promoting a more active lifestyle. It allows researchers to derive quantifiable data on the intensity, duration, and frequency of various types of physical exertion that are categorized as health-enhancing.

Construct

The SQUASH measures the complex, multi-dimensional construct of total daily physical activity (PA). Unlike instruments focusing solely on structured exercise, SQUASH attempts to capture the full spectrum of movement that contributes to energy expenditure and cardiovascular fitness across various life domains.

The construct is operationalized across four distinct categories of activity: occupational activities (work-related movement), commuting activities (travel to and from work or school), household activities (e.g., cleaning, gardening), and leisure time activities (sports, hobbies, and general exercise). By summing up the frequency, duration, and perceived intensity within these domains, the scale quantifies the total volume of health-enhancing physical activity.

Validity

The validity of the SQUASH has been examined primarily through comparison with objective measures and established self-report instruments. Studies have generally indicated that the SQUASH demonstrates acceptable concurrent validity when compared to other comprehensive PA questionnaires, particularly in large cohorts of healthy adults.

In terms of criterion validity, research comparing SQUASH scores against objective measures, such as accelerometry or heart rate monitoring, suggests moderate to good correlation for total PA time, especially for activities of moderate and high intensity. However, like many self-report instruments, the SQUASH is susceptible to recall bias, which may lead to an overestimation of the total time spent in physical activity compared to objective device readings.

Reliability

The reliability of the Short QUestionnaire to ASsess Health-enhancing physical activity has been primarily established through test-retest procedures. Studies evaluating its stability over short periods, typically ranging from one to four weeks, have consistently reported moderate to high reliability coefficients, often measured using the Intraclass Correlation Coefficient (ICC), generally achieving values above 0.70.

This level of stability suggests that the instrument consistently measures an individual’s self-reported habitual physical activity over short time frames, making it suitable for assessing baseline PA levels in research settings. Because the SQUASH measures four distinct and separate domains of behavior, measures of internal consistency (like Cronbach’s alpha) are generally not appropriate or informative for assessing the scale’s quality.

Factor Analysis

The SQUASH is structured based on ecological and behavioral domains (occupational, commuting, household, and leisure) derived from public health recommendations, rather than being developed through exploratory identification of latent psychological factors. Consequently, traditional exploratory or confirmatory factor analysis is not typically applied to the item structure itself.

The theoretical structure is fixed: the 11 items are intended to provide data points within the four predetermined domains. The scale’s analytical focus is on the aggregation of these specific domain scores into a single proxy measure of overall health-enhancing physical activity volume, often expressed in MET (Metabolic Equivalent) minutes or hours per week.

Instrument

Test Type: Questionnaire (Self-report)

Format: Self-administered, 11-item instrument

Language Available: Primarily Dutch (original context). English and other language translations are commonly used in international research.

Population Group: General population

Age Group: Adults (typically 18 years and older)

Population Details: Suitable for healthy adults and those participating in epidemiological studies focused on health behavior, mobility, and chronic disease risk assessment.

Test Methodology: Respondents report the frequency (days/week), duration (hours/day or minutes/day), and perceived intensity (light, moderate, or vigorous) for each of the four activity domains over the reference period (usually the past week). Total PA is calculated by summing the metabolic equivalent (MET) hours/minutes across all reported activities, weighting activities by their intensity level.

Keywords

PA measurement, Health screening, Commuting activity, Leisure time, Occupational activity, Household activity, METs, Energy expenditure, Self-report instrument, Physical activity.

Authors

Author ORCID Identifier: N/A (Information not provided in source)

Affiliation Email addresses: N/A (Information not provided in source)

Correspondence Address: N/A (Information not provided in source)

Permissions & Fee and Test Year

Test Year: 2003 (Initial publication and validation)

Permissions and Fee: The SQUASH is generally regarded as a public domain instrument for non-commercial academic research use due to its nature as a health surveillance tool. Researchers seeking to utilize the scale should confirm permissions with the original authors (Wendel-Vos et al.) or their affiliated institutions. No explicit fee is typically required for its use in non-profit research.

The original Dutch manual (Handleiding) related to the SQUASH can be downloaded here: https://scales.arabpsychology.com/wp-content/uploads/instrumenten/503_2_N.pdf

Reference’s

The primary reference for the development and initial validation of the SQUASH is:

• Wendel-Vos GCW, Schuit AJ, Kromhout D. (2003). The Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Development and reproducibility in the context of the Dutch Norm for Healthy Exercise.

Items of the Short QUestionnaire to ASsess Health-enhancing physical activity

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The SQUASH consists of 11 self-report items structured around four main domains of physical activity, which quantify frequency, duration, and intensity:

1. Activity related to commuting: Measures frequency, duration, and type of activity (e.g., cycling, walking) related to travel to and from work or school.
2. Occupational activity: Measures the typical intensity and duration of work-related physical demands.
3. Household activities: Measures time spent on activities such as gardening, cleaning, and maintenance.
4. Leisure time activities: Measures frequency and duration of sports and other recreational physical exercise.

The original source content did not provide the literal text of the 11 items, but described their function based on the four domains of activity measured: ‘lichamelijke activiteit van en naar het werk, huishoudelijke activiteiten, activiteiten op het werk en lichamelijke activiteiten die worden uitgevoerd in vrije tijd.’