Reliability and Validity of the Japanese Adaptation of Human Activity Profile for Evaluating Physical Activity in Patients Undergoing Hemodialysis: A cross-sectional study

Reliability and Validity of the Japanese Adaptation of Human Activity Profile for Evaluating Physical Activity in Patients Undergoing Hemodialysis: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reliability and Validity of the Japanese Adaptation of Human Activity Profile for Evaluating Physical Activity in Patients Undergoing Hemodialysis: A cross-sectional study Akira Amano, Ryota Matsuzawa, Naoyuki Tsujimoto, Takako Mikami, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6308331/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Aug, 2025 Read the published version in Renal Replacement Therapy → Version 1 posted You are reading this latest preprint version Abstract Background Physical inactivity is a significant risk factor for mortality in patients undergoing hemodialysis. Assessment of physical activity is crucial for clinical management and therapeutic decisions in this population. The Human Activity Profile (HAP) questionnaire is widely used to evaluate functional ability across various populations, including those with chronic diseases. Although the HAP is reliable and convenient for use in clinical settings, no validated Japanese adaptation is available. In this study, we aimed to create a Japanese version of the HAP and evaluate its reliability and validity in patients undergoing hemodialysis. Methods In this cross-sectional study, the Japanese version of the HAP was translated with the permission of the original author. Physical activity was assessed using both the HAP questionnaire and an accelerometer. The total steps and moderate-to-vigorous physical activity (MVPA) time were calculated using an accelerometer. Validity was assessed by evaluating the correlation between the HAP maximum activity score (MAS) and adjusted activity score (AAS) and objectively measured physical activity levels. Reliability was determined by re-administering the HAP questionnaire. Spearman's rank correlation coefficient and intraclass correlation coefficient (ICC) 2,1 were used to evaluate the validity and reliability, respectively. Results We included 32 Japanese patients undergoing hemodialysis (mean age 71.7 ± 9.2 years; 19 men). The Japanese version of HAP correlated with accelerometry data, excluding the MAS, and with the number of steps. The AAS moderately correlated with MVPA (ρ = 0.64, P < 0.001) and number of steps (ρ = 0.55, P = 0.003). The Japanese version of HAP indicated a high degree of reliability (ICC = 0.84). The cutoff points for HAP were set to identify participants engaging in < 4,000 steps per non-dialysis day, the minimum recommended physical activity level for patients undergoing hemodialysis, and objectively measure physical activity. The AAS cutoff value was determined to be 50, with an area under the curve of 0.81, a high predictive capability. Conclusions We demonstrated the robust reliability and validity of the Japanese version of the HAP questionnaire in patients undergoing hemodialysis. Given the strong reliability and validity of the Japanese HAP questionnaire, incorporating this assessment into standard care may be valuable for evaluating the physical activity of patients undergoing hemodialysis. CKD frailty sarcopenia sedentary validity reliability questionnaire hemodialysis physical activity human activity profile Figures Figure 1 Introduction Physical activity levels in patients undergoing hemodialysis are markedly reduced ( 1 ) and closely linked to various adverse health outcomes ( 2 – 4 ). Therefore, national and international guidelines recommend assessing physical activity in patients with renal disease as an essential component of care in patients with renal disease ( 5 , 6 ). Thus, effective management of physical activity in routine clinical practice is imperative. Factors contributing to decreased physical activity in patients undergoing hemodialysis include fatigue, lack of motivation, and fear of falling ( 7 ). However, previous studies suggest that therapeutic interventions, such as motivation enhancement, can improve physical activity levels ( 8 – 10 ). To implement such interventions, it is crucial to evaluate the physical activity levels of patients undergoing hemodialysis and determine whether they are diminished. Activity monitors are the gold standard for measuring physical activity. However, practical challenges, such as alterations in habitual behavior, adherence to wearing the device, intentional non-wearing, and underestimation of daily activities, limit their widespread application ( 11 ). Alternatively, questionnaires can provide practical and efficient solutions. These tools optimize time-use during dialysis sessions and circumvent the limitations associated with activity monitoring. A previous study identified the Human Activity Profile (HAP) as a valid questionnaire for assessing physical activity in patients undergoing hemodialysis ( 12 ). The HAP ( 13 ) is a widely validated and reliable physical activity questionnaire that encompasses items ranging from very easy to highly strenuous activities. Its comprehensive spectrum effectively measures functional ability without floor or ceiling effects ( 14 ), making it suitable for routine clinical use. Although the English version of the HAP has been extensively validated for reliability and accuracy in multiple clinical trials involving Western populations, a Japanese version remains lacking. In this study, we aimed to create a Japanese version of the HAP and evaluate its reliability and validity in patients undergoing hemodialysis. Confirming the reliability and validity of the Japanese version could improve the assessment of physical activity levels in these patients and enhance the quality of physical activity management in clinical practice. Methods Study participants This cross-sectional study enrolled clinically stable outpatients undergoing maintenance hemodialysis in two facilities in Japan who fulfilled the eligibility criteria. All participants provided written informed consent upon enrolment. The inclusion criteria were as follows: patients receiving hemodialysis therapy three times per week (the most common frequency in Japan, as reported by the Japanese Society of Dialysis Therapy), those who had not been hospitalized within 3 months prior to the study, and those capable of walking independently. Exclusion criteria included missing physical activity data and a diagnosis of dementia or a Mini-Cognitive Assessment Instrument (Mini-Cog) test score ≤ 2. This study was approved by the Ethics Review Board of the Hyogo Medical University, Japan (approval number: 4785) and conducted in accordance with the principles of the Declaration of Helsinki. Clinical characteristics Demographic data, including age, sex, and dialysis vintage, as well as physical attributes, such as dry weight, height, body mass index, primary kidney disease diagnoses, and comorbid conditions, were obtained from medical records at the time of patient enrollment. Laboratory parameters, including single-pool Kt/V urea , were extracted from the hospital records. Physical and cognitive functions Physical and cognitive functions were assessed using the Short Physical Performance Battery (SPPB) and Mini-Cog, respectively. The SPPB ( 15 ) is one of the most commonly used instruments for measuring physical performance and evaluating the decline in overall physical function. The SPPB comprises three tests: a 4 m walk at a normal pace, a five-repetition chair stand without using one’s arms, and a progressive test of standing balance (side-by-side, semi-tandem, tandem) for 10 s each. The times for each component were scored from 0 to 4, with higher scores indicating better performance. When all three component scores were combined, the final SPPB score ranged from 4 to 12. The Mini-Cog test ( 16 ) consists of two distinct components of a person's ability to recall three words and draw a clock designed to evaluate memory and executive function and is an effective tool for early identification of dementia. The Mini-Cog test is evaluated using a 5-point scale. In the three-word recall task, 1 point is assigned to each correctly recalled word, resulting in a total score between 0 and 3 points. In the clock drawing task, 2 points are awarded if the clock's shape is accurate and the hands correctly indicate the specified time; otherwise, a score of 0 is assigned. In the Mini-Cog test, a score ≤ 2 indicates a suspicion of dementia. The test has relatively high accuracy and demonstrates validity comparable to that of the Mini-mental State Examination. The administration time for Mini-Cog was 3 min. Translation process The Japanese version of HAP was developed in accordance with the procedures outlined in the guidelines for translating patient-reported outcome measures established by the International Society for Pharmacoeconomics and Outcomes Research Task Force ( 17 ). This process involved the following steps: ( 1 ) Preparation: The author obtained permission from David M. Daughton, the original author of HAP, to use and translate the instrument. ( 2 ) Forward translation: Two independent Japanese translators with advanced English proficiency translated the original instrument into Japanese. ( 3 ) Reconciliation: The authors and translators analyzed, compared, and synthesized the two forward translations into a single forward translation. ( 4 ) Back translation: The forward translation was back-translated into the original language by a translation agency (Crimson Interactive Pvt. Ltd.: Ulatus, Tokyo, Japan). ( 5 ) Back translation review: The original author was requested to review and compare the forward and back translations. Revisions were made by the author and the translators based on their feedback. ( 6 ) Cognitive debriefing: Five Japanese-speaking patients undergoing hemodialysis were asked to complete the Japanese version of the HAP. Researchers assessed the comprehensibility, cognitive validity, and appropriateness of the translated version of the questionnaire. ( 7 ) Review of cognitive debriefing results and finalization: The results of the cognitive debriefing were reviewed, and the Japanese version of HAP was revised to enhance clarity for the respondents. The translation process was then finalized. ( 8 ) Proofreading: The author conducted the final proofreading of the completed translation. ( 9 ) Final report: The author prepared a comprehensive report detailing the translation process. Measurement of physical activity questionnaires The HAP ( 13 ) is a 94-item questionnaire designed to assess daily activities. Respondents evaluate their ability to perform each activity by selecting one of three options: “Still doing this activity” (tasks they can perform independently), “Have stopped doing this activity” (tasks they previously performed but no longer do), and “Never did this activity” (tasks they have never attempted). Two scores are generated from the HAP: the maximum activity score (MAS) and adjusted activity score (AAS). MAS reflects the most challenging activities that the respondent can still perform, whereas AAS represents MAS adjusted by subtracting the number of less demanding activities that the respondent has stopped performing. AAS is regarded as a more stable measure of daily activity levels, whereas MAS may overestimate typical energy expenditure. Activities in HAP are listed in order of their difficulty, starting with basic tasks (such as getting in and out of a chair or bed without help) and ending with strenuous activities (such as running 3 miles in ≤ 30 min). These activities were selected based on their known energy requirements and ranked accordingly. MAS and AAS provide valuable insights into an individual’s physical capacity and lifestyle. To assess reliability, HAP was re-administered 4 weeks after the baseline assessment. The International Physical Activity Questionnaire Long Form (IPAQ-LF) ( 18 ) was chosen because of its extensive global use and established validity and reliability as a standardized tool for monitoring physical activity. A validated Japanese version of the IPAQ-LF, back-translated to ensure accuracy, was used. All questionnaires were administered via interviews conducted during the dialysis sessions, following a standardized protocol. Accelerometry A triaxial accelerometer, iAide-2W (Tokai Co., Ltd., Shizuoka, Japan), was used to obtain objective data on physical activity patterns, including the intensity, duration, and frequency of activities. The accuracy and reliability of these devices are well established. Participants were asked to maintain their typical weekly routines. Accelerometry data were included in the validity analyses if they were recorded for at least 10 h per day over a minimum period of 7 days. Statistical analyses Baseline characteristics were summarized as mean and standard deviation for continuous variables and as frequency and proportion for categorical variables. The validity and reliability of physical activity levels derived from the questionnaire were assessed using Spearman's rank correlation coefficients. Following a previous study ( 19 ), correlation coefficients were categorized as follows: <0.20 as very weak, 0.20–0.39 as weak, 0.40–0.59 as moderate, 0.60–0.79 as strong, and 0.80–1.0 as very strong. The reliability of the physical activity levels derived from the questionnaire was assessed using intraclass correlation coefficients [ICC ( 2 , 1 )]. Based on a previous study ( 20 ), the ICC ( 2 , 1 ) values were categorized as follows: <0.20 as poor, 0.21–0.40 as fair, 0.41–0.60 as moderate, 0.61–0.80 as good, and 0.81–1.00 as excellent. To determine the optimal cutoff points of AAS and MAS derived from the HAP questionnaire in predicting 4,000 steps per non-dialysis day as the minimum recommended physical activity level for patients undergoing hemodialysis ( 21 ), a receiver operating characteristic (ROC) curve analysis was conducted. The Youden index ( 22 ), which measures the combined specificity and sensitivity of a parameter, was used. The Youden index is defined as the maximum vertical distance between the ROC curve and the diagonal chance line and is calculated as the highest value of [sensitivity + specificity − 1]. This optimal Youden index was used to establish the cutoff point for the primary predictor. Additionally, the area under the curve (AUC), sensitivity, and specificity were calculated at the identified cutoff points. Statistical analyses were performed using EZR Statistics for Windows, R version 1.67 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) ( 23 ). Statistical significance was defined as P < 0.05, and all tests were two-tailed. Results The Japanese version of HAP The Japanese version of HAP is presented in Supplementary table 1-2. The instructions on the cover and descriptions of the 94 activities were translated from English to Japanese. To enhance the accuracy and clarity of this self-report measure, a new title and illustrative examples have been added to the cover page. Additionally, certain elements were adapted to better align with Japanese culture and lifestyle. To ensure consistency, we consulted the original author regarding the definition of one block, which is 200–300 feet (60–90 m). Specific cultural adaptations included adding “futon” to activity 33: “Making a bed or futon,” and “traditional Japanese dance” to activity 66: “Dancing or traditional Japanese dance.” Furthermore, activity 51: “Carrying a large suitcase” was revised to ”Carrying a travel bag” to avoid associations with rolling suitcases. Clinical characteristics Initially, 32 participants were enrolled in the study. However, for validity analysis, the sample size was reduced to 27 due to the following reasons: one participant scored ≤2 on the Mini-Cog test, and four had incomplete accelerometry-derived physical activity data. For the reliability analysis, 27 participants were included after one participant who scored ≤2 on the Mini-Cog test, two who were hospitalized, and two who withdrew from the study were excluded. The characteristics of the 27 participants eligible for this study are summarized in Table 1. The physical activity data, Min-Cog scores, and SPPB scores of all participants in the first test are presented in Table 2. Table 1. Clinical characteristics at baseline Characteristics Validity cohort (n=27) Reliability cohort (n=27) Age, years 74.00 [69.00, 77.00] 74.00 [49.00, 84.00] Male, n (%) 18 (58.1) 15 (55.6) Dry weight, kg 55.25 ± 9.05 54.72 ± 8.13 Body mass index, kg/m² 21.93 ± 2.64 21.87 ± 2.65 Dialysis vintage, years 4.80 [1.35, 7.35] 4.80 [0.60, 35.80] Kt/V 1.40 ±0.36 1.41 ± 0.38 Primary kidney diseases, n (%) Diabetes 13 (40.6) 11 (40.7) Hypertension 5 (15.6) 4 (14.8) Glomerulonephritis 4 (12.5) 4 (14.8) Others 10 (31.2) 8 (29.6) Data are expressed as mean ± standard deviation or median [interquartile range] for continuous variables, and number (percentage) for categorical variables. Table 2. Physical activity levels and physical and cognitive functions Validity cohort (n=27) Reliability cohort (n=27) Measures 7-day Dialysis days Non-dialysis days 7-day Dialysis days Non-dialysis days Number of steps (steps/day) 3707.01 ± 4607.94 3395.23 ± 4302.87 3691.25 ± 4432.13 4034.36 ± 4794.37 3673.42 ± 4491.64 4030.85 ± 4588.62 MVPA (min/day) 30.70 ± 46.40 27.84 ± 42.28 31.32 ± 45.04 33.36 ± 48.61 30.45 ± 44.20 34.17 ± 46.98 HAP MAS 73.30 ± 8.73 73.30 ± 8.73 HAP AAS 48.78 ± 10.78 49.22 ± 10.61 IPAQ 1494.23 ± 487.57 1494.23 ± 1487.57 Min-Cog score 5.00 [5.00, 5.00] 5.00 [4.00, 5.00] SPPB score 11.00 [10.00, 12.00] 11.00 [5.00, 12.00] Abbreviations: MVPA, Moderate-to-Vigorous Physical Activity; HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; IPAQ, International Physical Activity Questionnaire Long Form; Mini-Cog, Mini-Cognitive assessment instrument; SPPB, Short Physical Performance Battery. Validity of the Japanese version of HAP The results of the correlation analysis between HAP and accelerometer-derived data are presented in Table 3. Correlation coefficients of 0.54, 0.41, and 0.40 were observed between MAS and accelerometer-measured MVPA on non-dialysis days over a week. Similarly, on non-dialysis days over a week, correlation coefficients of 0.55, 0.53, and 0.56 were found between AAS and accelerometer data for the number of steps and correlation coefficients of 0.64, 0.58, and 0.60 were found between AAS and MVPA. On non-dialysis days over a week, correlation coefficients of 0.48, 0.46, and 0.50 were identified between IPAQ and accelerometer data for the number of steps and correlation coefficients of 0.64, 0.58, and 0.58 were found between IPAQ and MVPA. HAP demonstrated moderate correlations with accelerometer data, comparable to those observed for IPAQ. Additionally, the two physical activity recall questionnaires, HAP and IPAQ-LF, yielded similar results when compared with accelerometry and were moderately correlated with each other. Table 3. The association between HAP- or IPAQ-derived activity scores and accelerometer-derived activities such as number of steps and MVPA (n=27) Number of steps MVPA Questionnaire-derived scores ρ P-value ρ P-value HAP MAS 0.31 0.1 0.54 0.004 HAP AAS 0.55 0.003 0.64 < 0.001 IPAQ 0.48 0.01 0.64 0.001 Abbreviations: MVPA, Moderate-to-Vigorous Physical Activity; HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; IPAQ, International Physical Activity Questionnaire Long Form. Optimal cutoff points for AAS and MAS derived from the HAP questionnaire ROC analysis identified the optimal cutoff values for AAS and MAS as ≤50 and ≤74, respectively, with an AUC of 0.81 for AAS and 0.63 for MAS. Sensitivity was 85.7% for both, whereas specificity was 70.0% for AAS and 50.0% for MAS. The ROC curves are shown in Figure 1. Reliability of the Japanese version of HAP Table 4 presents the an HAP's test-retest reliability for participants retested 4 weeks after the initial test. The analysis yielded ICC values of 0.76 for MAS and 0.84 for AAS, indicating a high degree of reliability. Table 4. Test-retest reliability (n=27) HAP-derived scores ICC HAP MAS 0.76 HAP AAS 0.84 Abbreviations: HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; ICC, Intraclass Correlation Coefficient. Discussion In this study, we developed a Japanese version of the HAP questionnaire, tailored to align more closely with the Japanese culture and lifestyle, and evaluated its reliability and validity among Japanese patients undergoing maintenance hemodialysis. Among the scores derived from HAP, AAS, which represents the most demanding activities and excluded the less challenging ones, showed a strong correlation with the objectively measured activity data. Its validity was comparable with that of IPAQ. The optimal AAS cutoff value for predicting 4,000 steps on a non-dialysis day was determined to be 50, with an AUC of 0.81, indicating high predictive capability. Furthermore, AAS exhibited high consistency at baseline and 4 weeks later. To the best of our knowledge, this is the first study to validate the reliability of a Japanese version of the HAP questionnaire among Japanese patients undergoing hemodialysis. The HAP questionnaire is a straightforward and practical tool for evaluating physical activity levels and is well-suited for use during dialysis. Consequently, the development of this tool and confirmation of its reliability and validity are expected to contribute to the effective management of physical activity levels in sedentary patients undergoing hemodialysis. HAP effectively evaluates dynamic and static activities and provides a comprehensive assessment of physical activity. AAS correlated with step count and MVPA, whereas MAS showed no such association. This finding is consistent with that of previous studies validating the English version of the HAP ( 24 ). AAS, which accounts for sudden bursts of activity, offers a more precise estimation of an individual’s daily movements, whereas MAS tends to overestimate typical energy expenditure, often producing unrealistically high values ( 13 ). Given the brief duration of this study, the focus was possibly confined to routine activities, potentially resulting in the underestimation of MAS. Conversely, AAS, recognized for its greater consistency, was most strongly correlated with objective data. The Physical Exercise Working Group of the Italian Society of Nephrology recently issued 16 statements addressing clinically relevant aspects of physical activity and exercise for individuals with chronic kidney disease ( 25 ). In their paper, they advocated facilitating the integration of physical activity into patient care and recommended accurately assessing patients' physical activity levels using validated questionnaires, including the HAP ( 13 ). Our study identified an optimal AAS cutoff value of 50 points, derived from the Japanese version of the HAP, for distinguishing recommended step counts, with an AUC of 0.81, demonstrating a high discriminative capability. This cutoff allows for easy identification of sedentary or inactive patients through interviews conducted during dialysis. Implementing this approach could serve as a foundation for lifestyle modifications and promotion of physical activity. Several recent studies have demonstrated that motivational interventions effectively increase physical activity in the short term ( 26 , 27 ). A recent meta-analysis, which included 129 papers reporting 97 randomized controlled trials examining behavioral interventions incorporating motivational interviews for physical activity, revealed that these interventions led to a greater increase in step count (an additional 1,300 steps/day) and MVPA (an additional 95 min/day), and a reduction in sedentary time (reduction of 50 min/day) ( 27 ). In our study, HAP was significantly correlated with step count and MVPA and enabled the identification of a recommended threshold of 4,000 steps per non-dialysis day. These findings suggest that HAP assessment extends beyond mere measurement by providing individuals with the opportunity to recognize variations in their activity levels. Moreover, this study highlights the fact that HAP can be implemented in a simple, noninvasive, and cost-effective manner, making it suitable for large-scale applications in clinical and health promotion programs. Although self-monitoring is believed to enhance intrinsic motivation, its actual effects should be verified in future interventional studies. This study had several limitations. First, the study was conducted in a specific region of Japan with a relatively small sample size, which limits the generalizability of the findings to a broader Japanese population. Therefore, further large-scale studies are necessary. Second, the study included only patients capable of walking independently, as physical activities below walking intensity cannot be measured using an accelerometer. Consequently, the applicability of the questionnaire to patients with activities of daily living disabilities remains unclear. Third, although the questionnaire was tailored to align with the Japanese culture and lifestyle, it may not fully address individual cultural and social differences. Finally, as with any questionnaire-based assessment, factors such as respondents' memory inaccuracies and social desirability bias may have affected the results. Conclusion We developed a Japanese version of the HAP questionnaire and demonstrated its reliability and validity in patients undergoing hemodialysis, which is expected to aid in the efficient management of physical activity levels in these patient populations. Abbreviations HAP Human Activity Profile IPAQ-LF International Physical Activity Questionnaire Long Form MAS Maximum Activity Score AAS Adjusted Activity Score MVPA Moderate to Vigorous Physical Activity Mini-Cog Mini-Cognitive Assessment Instrument SPPB Short Physical Performance Battery AUC Area Under the Curve ICC Intraclass Correlation Coefficient ROC Receiver Operating Characteristic Declarations Ethics approval and consent to participate Informed consent was obtained from all participants in accordance with the ethical principles of the Declaration of Helsinki. This study was approved by the Research Ethics Review Board of the Hyogo Medical University, Japan (approval number: 4785). Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the author; however, it is subject to restrictions, because the data were used under license for the current study and are not publicly available. However, data are available from the authors upon reasonable request and with their permission. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the research funding received from the Hyogo Medical University Graduate School of Health Science, Japan. Authors' contributions AA, MR, TN, MT, KT, AK, and TA designed the study. AA, TN, and TK collected the data. AA, MR, and TN analyzed the data. AA, MR, and TN wrote the manuscript. All authors have read and approved the final version of the manuscript. All authors have reviewed and approved the manuscript’s content before submission. Acknowledgements The authors acknowledge the medical staff for their support and the study participants for their participation. References Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57(6):2564–70. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–62. Lear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390(10113):2643–54. Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016;176(6):816–25. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1-153. Yamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, et al. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. Renal Replacement Therapy. 2019;5(1):1–19. Jafarzadeh Esfehani A, Dashti S. Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant. 2012;27(10):3964; author reply Howden EJ, Coombes JS, Strand H, Douglas B, Campbell KL, Isbel NM. Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. 2015;65(4):583–91. Nowicki M, Murlikiewicz K, Jagodzińska M. Pedometers as a means to increase spontaneous physical activity in chronic hemodialysis patients. J Nephrol. 2010;23(3):297–305. Sheshadri A, Kittiskulnam P, Lazar AA, Johansen KL. A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial. Am J Kidney Dis. 2020;75(4):488–96. Pedišić Ž, Bauman A. Accelerometer-based measures in physical activity surveillance: current practices and issues. Br J Sports Med. 2015;49(4):219–23. Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, et al. Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int. 2001;59(3):1121–7. Fix A, Daughton D. Human activity profile: professional manual. Odessa, FL: Psychological Assessment Resources Inc.; 1986. Davidson M, de Morton N. A systematic review of the Human Activity Profile. Clin Rehabil. 2007;21(2):151–62. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–61. Brodaty H, Lee-Fay L, Gibson L, Burns K. What Is the Best Dementia Screening Instrument for General Practitioners to Use? The American Journal of Geriatric Psychiatry. 2006;14(5):391–400. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94–104. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95. Evans JD. Straightforward statistics for the behavioral sciences: Thomson Brooks/Cole Publishing Co; 1996. Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155–63. Matsuzawa R, Roshanravan B, Shimoda T, Mamorita N, Yoneki K, Harada M, et al. Physical Activity Dose for Hemodialysis Patients: Where to Begin? Results from a Prospective Cohort Study. Journal of renal nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2018;28(1):45–53. Perkins NJ, Schisterman EF. The inconsistency of "optimal" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163(7):670–5. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8. Bastone Ade C, Moreira Bde S, Vieira RA, Kirkwood RN, Dias JM, Dias RC. Validation of the human activity profile questionnaire as a measure of physical activity levels in older community-dwelling women. J Aging Phys Act. 2014;22(3):348–56. Battaglia Y, Baciga F, Bulighin F, Amicone M, Mosconi G, Storari A, et al. Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology. J Nephrol. 2024;37(7):1735–65. O'Halloran PD, Blackstock F, Shields N, Holland A, Iles R, Kingsley M, et al. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil. 2014;28(12):1159–71. Zhu S, Sinha D, Kirk M, Michalopoulou M, Hajizadeh A, Wren G, et al. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ. 2024;386:e078713. Additional Declarations No competing interests reported. Supplementary Files supplementarytable1.xls supplementary table1, Human Activity Profile 94 items, Both the English and Japanese versions of HAP are provided. supplementarytable2.pdf supplementary table2, Human Activity Profile 94 items, The assessment table of the Japanese version of HAP is provided. Cite Share Download PDF Status: Published Journal Publication published 26 Aug, 2025 Read the published version in Renal Replacement Therapy → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6308331","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":450977107,"identity":"c214abf1-03ed-4d25-97af-530e977612f9","order_by":0,"name":"Akira Amano","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCQbGBxIGEnIGEC4zmDQgoIXZwKLCwpgkLWwSFWcqEjcga8ELdGc3H5C42SaRvl0i+QDTjQprBv72AwzFBXi0mN05lmA4s00id+eMtATmnDPpDBJnEhiMZ+DTciPHIFkSqGXDjRzz37lthxkYbjAwGPPg1ZL/4fBfoMMMgHqZc/8dZpAnrCWHsUHijEQCREvDYQYDwlrSjBkkKiQMN5x5BvTLsXQewzOJDQT8kvz8h4RBnbzB8eQDzDk11nJyxw8fM8YXYgggkACmgE5ibDMmSgcD/wE4k/kxcVpGwSgYBaNghAAAgaVMsC/aROAAAAAASUVORK5CYII=","orcid":"","institution":"Hyogo Medical University","correspondingAuthor":true,"prefix":"","firstName":"Akira","middleName":"","lastName":"Amano","suffix":""},{"id":450977109,"identity":"b006d557-fec2-495d-818a-99f1bb8a94eb","order_by":1,"name":"Ryota Matsuzawa","email":"","orcid":"","institution":"Hyogo Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ryota","middleName":"","lastName":"Matsuzawa","suffix":""},{"id":450977110,"identity":"97a84c96-db51-40fd-a2d3-d2b3ae563de9","order_by":2,"name":"Naoyuki Tsujimoto","email":"","orcid":"","institution":"Mikami Clinic Second branch","correspondingAuthor":false,"prefix":"","firstName":"Naoyuki","middleName":"","lastName":"Tsujimoto","suffix":""},{"id":450977111,"identity":"69ab327e-84ec-4f96-be9e-65b6ed51848d","order_by":3,"name":"Takako Mikami","email":"","orcid":"","institution":"Mikami Clinic Second branch","correspondingAuthor":false,"prefix":"","firstName":"Takako","middleName":"","lastName":"Mikami","suffix":""},{"id":450977112,"identity":"cc260218-375a-43d4-aef8-d91bbf0c8f56","order_by":4,"name":"Tetsuya Kaneko","email":"","orcid":"","institution":"Mikami Clinic Second branch","correspondingAuthor":false,"prefix":"","firstName":"Tetsuya","middleName":"","lastName":"Kaneko","suffix":""},{"id":450977113,"identity":"81a79945-46b2-4092-9aa6-a6ab2d45e48c","order_by":5,"name":"Kiho Azuma","email":"","orcid":"","institution":"Mikami Clinic Second branch","correspondingAuthor":false,"prefix":"","firstName":"Kiho","middleName":"","lastName":"Azuma","suffix":""},{"id":450977114,"identity":"06956f7a-0240-406b-bf4c-120a55ac8b86","order_by":6,"name":"Kenta Tanaka","email":"","orcid":"","institution":"Sousei Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kenta","middleName":"","lastName":"Tanaka","suffix":""},{"id":450977116,"identity":"84024c36-1cca-4932-9fb5-49e44968c4df","order_by":7,"name":"Akira Tamaki","email":"","orcid":"","institution":"Hyogo Medical University","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Tamaki","suffix":""}],"badges":[],"createdAt":"2025-03-26 03:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6308331/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6308331/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s41100-025-00659-y","type":"published","date":"2025-08-26T15:57:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82162729,"identity":"2f2e9632-e54a-4a65-a04a-34a081ac5396","added_by":"auto","created_at":"2025-05-07 08:48:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154377,"visible":true,"origin":"","legend":"\u003cp\u003eThe results of ROC curves are presented,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe figure presents the optimal cutoff points derived from the HAP questionnaire.\u003c/p\u003e","description":"","filename":"Slide1.png","url":"https://assets-eu.researchsquare.com/files/rs-6308331/v1/36e7d0c4b522b0d35e44f3b7.png"},{"id":90344833,"identity":"3cae75f4-15ec-44ae-ae46-2d147e866c92","added_by":"auto","created_at":"2025-09-01 16:04:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":884928,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6308331/v1/6b85d3c5-b6c3-41b6-9509-3e5b8120f509.pdf"},{"id":82160381,"identity":"84216649-2a20-4ddd-bb1e-42d98ea9469c","added_by":"auto","created_at":"2025-05-07 08:32:20","extension":"xls","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":47616,"visible":true,"origin":"","legend":"\u003cp\u003esupplementary table1, Human Activity Profile 94 items, Both the English and Japanese versions of HAP are provided.\u003c/p\u003e","description":"","filename":"supplementarytable1.xls","url":"https://assets-eu.researchsquare.com/files/rs-6308331/v1/21cedce289b7f209ac3de198.xls"},{"id":82160388,"identity":"f96acd11-031a-4eaf-a544-45730648f1a0","added_by":"auto","created_at":"2025-05-07 08:32:20","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":713910,"visible":true,"origin":"","legend":"\u003cp\u003esupplementary table2, Human Activity Profile 94 items, The assessment table of the Japanese version of HAP is provided.\u003c/p\u003e","description":"","filename":"supplementarytable2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6308331/v1/fcbf28a3498cf8d1504d3cda.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reliability and Validity of the Japanese Adaptation of Human Activity Profile for Evaluating Physical Activity in Patients Undergoing Hemodialysis: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePhysical activity levels in patients undergoing hemodialysis are markedly reduced (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and closely linked to various adverse health outcomes (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Therefore, national and international guidelines recommend assessing physical activity in patients with renal disease as an essential component of care in patients with renal disease (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Thus, effective management of physical activity in routine clinical practice is imperative. Factors contributing to decreased physical activity in patients undergoing hemodialysis include fatigue, lack of motivation, and fear of falling (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, previous studies suggest that therapeutic interventions, such as motivation enhancement, can improve physical activity levels (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). To implement such interventions, it is crucial to evaluate the physical activity levels of patients undergoing hemodialysis and determine whether they are diminished.\u003c/p\u003e \u003cp\u003eActivity monitors are the gold standard for measuring physical activity. However, practical challenges, such as alterations in habitual behavior, adherence to wearing the device, intentional non-wearing, and underestimation of daily activities, limit their widespread application (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Alternatively, questionnaires can provide practical and efficient solutions. These tools optimize time-use during dialysis sessions and circumvent the limitations associated with activity monitoring. A previous study identified the Human Activity Profile (HAP) as a valid questionnaire for assessing physical activity in patients undergoing hemodialysis (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe HAP (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) is a widely validated and reliable physical activity questionnaire that encompasses items ranging from very easy to highly strenuous activities. Its comprehensive spectrum effectively measures functional ability without floor or ceiling effects (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), making it suitable for routine clinical use. Although the English version of the HAP has been extensively validated for reliability and accuracy in multiple clinical trials involving Western populations, a Japanese version remains lacking.\u003c/p\u003e \u003cp\u003eIn this study, we aimed to create a Japanese version of the HAP and evaluate its reliability and validity in patients undergoing hemodialysis. Confirming the reliability and validity of the Japanese version could improve the assessment of physical activity levels in these patients and enhance the quality of physical activity management in clinical practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study enrolled clinically stable outpatients undergoing maintenance hemodialysis in two facilities in Japan who fulfilled the eligibility criteria. All participants provided written informed consent upon enrolment. The inclusion criteria were as follows: patients receiving hemodialysis therapy three times per week (the most common frequency in Japan, as reported by the Japanese Society of Dialysis Therapy), those who had not been hospitalized within 3 months prior to the study, and those capable of walking independently. Exclusion criteria included missing physical activity data and a diagnosis of dementia or a Mini-Cognitive Assessment Instrument (Mini-Cog) test score\u0026thinsp;\u0026le;\u0026thinsp;2. This study was approved by the Ethics Review Board of the Hyogo Medical University, Japan (approval number: 4785) and conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical characteristics\u003c/h3\u003e\n\u003cp\u003eDemographic data, including age, sex, and dialysis vintage, as well as physical attributes, such as dry weight, height, body mass index, primary kidney disease diagnoses, and comorbid conditions, were obtained from medical records at the time of patient enrollment. Laboratory parameters, including single-pool Kt/V\u003csub\u003eurea\u003c/sub\u003e, were extracted from the hospital records.\u003c/p\u003e\n\u003ch3\u003ePhysical and cognitive functions\u003c/h3\u003e\n\u003cp\u003ePhysical and cognitive functions were assessed using the Short Physical Performance Battery (SPPB) and Mini-Cog, respectively.\u003c/p\u003e \u003cp\u003eThe SPPB (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) is one of the most commonly used instruments for measuring physical performance and evaluating the decline in overall physical function. The SPPB comprises three tests: a 4 m walk at a normal pace, a five-repetition chair stand without using one\u0026rsquo;s arms, and a progressive test of standing balance (side-by-side, semi-tandem, tandem) for 10 s each. The times for each component were scored from 0 to 4, with higher scores indicating better performance. When all three component scores were combined, the final SPPB score ranged from 4 to 12.\u003c/p\u003e \u003cp\u003eThe Mini-Cog test (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) consists of two distinct components of a person's ability to recall three words and draw a clock designed to evaluate memory and executive function and is an effective tool for early identification of dementia. The Mini-Cog test is evaluated using a 5-point scale. In the three-word recall task, 1 point is assigned to each correctly recalled word, resulting in a total score between 0 and 3 points. In the clock drawing task, 2 points are awarded if the clock's shape is accurate and the hands correctly indicate the specified time; otherwise, a score of 0 is assigned. In the Mini-Cog test, a score\u0026thinsp;\u0026le;\u0026thinsp;2 indicates a suspicion of dementia. The test has relatively high accuracy and demonstrates validity comparable to that of the Mini-mental State Examination. The administration time for Mini-Cog was 3 min.\u003c/p\u003e\n\u003ch3\u003eTranslation process\u003c/h3\u003e\n\u003cp\u003eThe Japanese version of HAP was developed in accordance with the procedures outlined in the guidelines for translating patient-reported outcome measures established by the International Society for Pharmacoeconomics and Outcomes Research Task Force (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This process involved the following steps: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Preparation: The author obtained permission from David M. Daughton, the original author of HAP, to use and translate the instrument. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Forward translation: Two independent Japanese translators with advanced English proficiency translated the original instrument into Japanese. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Reconciliation: The authors and translators analyzed, compared, and synthesized the two forward translations into a single forward translation. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Back translation: The forward translation was back-translated into the original language by a translation agency (Crimson Interactive Pvt. Ltd.: Ulatus, Tokyo, Japan). (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Back translation review: The original author was requested to review and compare the forward and back translations. Revisions were made by the author and the translators based on their feedback. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Cognitive debriefing: Five Japanese-speaking patients undergoing hemodialysis were asked to complete the Japanese version of the HAP. Researchers assessed the comprehensibility, cognitive validity, and appropriateness of the translated version of the questionnaire. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Review of cognitive debriefing results and finalization: The results of the cognitive debriefing were reviewed, and the Japanese version of HAP was revised to enhance clarity for the respondents. The translation process was then finalized. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Proofreading: The author conducted the final proofreading of the completed translation. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Final report: The author prepared a comprehensive report detailing the translation process.\u003c/p\u003e\n\u003ch3\u003eMeasurement of physical activity questionnaires\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe HAP (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) is a 94-item questionnaire designed to assess daily activities. Respondents evaluate their ability to perform each activity by selecting one of three options: \u0026ldquo;Still doing this activity\u0026rdquo; (tasks they can perform independently), \u0026ldquo;Have stopped doing this activity\u0026rdquo; (tasks they previously performed but no longer do), and \u0026ldquo;Never did this activity\u0026rdquo; (tasks they have never attempted). Two scores are generated from the HAP: the maximum activity score (MAS) and adjusted activity score (AAS). MAS reflects the most challenging activities that the respondent can still perform, whereas AAS represents MAS adjusted by subtracting the number of less demanding activities that the respondent has stopped performing. AAS is regarded as a more stable measure of daily activity levels, whereas MAS may overestimate typical energy expenditure. Activities in HAP are listed in order of their difficulty, starting with basic tasks (such as getting in and out of a chair or bed without help) and ending with strenuous activities (such as running 3 miles in \u0026le;\u0026thinsp;30 min). These activities were selected based on their known energy requirements and ranked accordingly. MAS and AAS provide valuable insights into an individual\u0026rsquo;s physical capacity and lifestyle. To assess reliability, HAP was re-administered 4 weeks after the baseline assessment.\u003c/p\u003e \u003cp\u003eThe International Physical Activity Questionnaire Long Form (IPAQ-LF) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) was chosen because of its extensive global use and established validity and reliability as a standardized tool for monitoring physical activity. A validated Japanese version of the IPAQ-LF, back-translated to ensure accuracy, was used.\u003c/p\u003e \u003cp\u003eAll questionnaires were administered via interviews conducted during the dialysis sessions, following a standardized protocol.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAccelerometry\u003c/h2\u003e \u003cp\u003eA triaxial accelerometer, iAide-2W (Tokai Co., Ltd., Shizuoka, Japan), was used to obtain objective data on physical activity patterns, including the intensity, duration, and frequency of activities. The accuracy and reliability of these devices are well established. Participants were asked to maintain their typical weekly routines.\u003c/p\u003e \u003cp\u003eAccelerometry data were included in the validity analyses if they were recorded for at least 10 h per day over a minimum period of 7 days.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eBaseline characteristics were summarized as mean and standard deviation for continuous variables and as frequency and proportion for categorical variables. The validity and reliability of physical activity levels derived from the questionnaire were assessed using Spearman's rank correlation coefficients. Following a previous study (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), correlation coefficients were categorized as follows: \u0026lt;0.20 as very weak, 0.20\u0026ndash;0.39 as weak, 0.40\u0026ndash;0.59 as moderate, 0.60\u0026ndash;0.79 as strong, and 0.80\u0026ndash;1.0 as very strong. The reliability of the physical activity levels derived from the questionnaire was assessed using intraclass correlation coefficients [ICC (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)]. Based on a previous study (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), the ICC (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) values were categorized as follows: \u0026lt;0.20 as poor, 0.21\u0026ndash;0.40 as fair, 0.41\u0026ndash;0.60 as moderate, 0.61\u0026ndash;0.80 as good, and 0.81\u0026ndash;1.00 as excellent. To determine the optimal cutoff points of AAS and MAS derived from the HAP questionnaire in predicting 4,000 steps per non-dialysis day as the minimum recommended physical activity level for patients undergoing hemodialysis (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), a receiver operating characteristic (ROC) curve analysis was conducted. The Youden index (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), which measures the combined specificity and sensitivity of a parameter, was used. The Youden index is defined as the maximum vertical distance between the ROC curve and the diagonal chance line and is calculated as the highest value of [sensitivity\u0026thinsp;+\u0026thinsp;specificity \u0026minus;\u0026thinsp;1]. This optimal Youden index was used to establish the cutoff point for the primary predictor. Additionally, the area under the curve (AUC), sensitivity, and specificity were calculated at the identified cutoff points. Statistical analyses were performed using EZR Statistics for Windows, R version 1.67 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Statistical significance was defined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and all tests were two-tailed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eThe Japanese version of HAP\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Japanese version of HAP is presented in Supplementary table 1-2. The instructions on the cover and descriptions of the 94 activities were translated from English to Japanese. To enhance the accuracy and clarity of this self-report measure, a new title and illustrative examples have been added to the cover page. Additionally, certain elements were adapted to better align with Japanese culture and lifestyle. To ensure consistency, we consulted the original author regarding the definition of one block, which is 200\u0026ndash;300 feet (60\u0026ndash;90 m). Specific cultural adaptations included adding \u0026ldquo;futon\u0026rdquo; to activity 33: \u0026ldquo;Making a bed or futon,\u0026rdquo; and \u0026ldquo;traditional Japanese dance\u0026rdquo; to activity 66: \u0026ldquo;Dancing or traditional Japanese dance.\u0026rdquo; Furthermore, activity 51: \u0026ldquo;Carrying a large suitcase\u0026rdquo; was revised to \u0026rdquo;Carrying a travel bag\u0026rdquo; to avoid associations with rolling suitcases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, 32 participants were enrolled in the study. However, for validity analysis, the sample size was reduced to 27 due to the following reasons: one participant scored \u0026le;2 on the Mini-Cog test, and four had incomplete accelerometry-derived physical activity data. For the reliability analysis, 27 participants were included after one participant who scored \u0026le;2 on the Mini-Cog test, two who were hospitalized, and two who withdrew from the study were excluded. The characteristics of the 27 participants eligible for this study are summarized in Table 1. The physical activity data, Min-Cog scores, and SPPB scores of all participants in the first test are presented in Table 2.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"610\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 67.7049%;\"\u003e\n \u003cp\u003e\u003cem\u003eTable 1. Clinical characteristics at baseline\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.0164%;\"\u003e\n \u003cp\u003eValidity cohort (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 32.2951%;\"\u003e\n \u003cp\u003eReliability cohort (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e74.00 [69.00, 77.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e74.00 [49.00, 84.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e18 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e15 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eDry weight, kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e55.25 \u0026plusmn; 9.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e54.72 \u0026plusmn; 8.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eBody mass index, kg/m\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e21.93 \u0026plusmn; 2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e21.87 \u0026plusmn; 2.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eDialysis vintage, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e4.80 [1.35, 7.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e4.80 [0.60, 35.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003eKt/V\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e1.40 \u0026plusmn;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e1.41 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003ePrimary kidney diseases, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003e\u0026nbsp; Diabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e13 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e11 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003e\u0026nbsp; Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e5 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e4 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003e\u0026nbsp; Glomerulonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e4 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e4 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.6885%;\"\u003e\n \u003cp\u003e\u0026nbsp; Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.0164%;\"\u003e\n \u003cp\u003e10 (31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.2951%;\"\u003e\n \u003cp\u003e8 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003eData are expressed as mean \u0026plusmn; standard deviation or median [interquartile range] for continuous variables, and number (percentage) for categorical variables.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1040\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"bottom\" style=\"width: 1040px;\"\u003e\n \u003cp\u003eTable 2. Physical activity levels and physical and cognitive functions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 419px;\"\u003e\n \u003cp\u003eValidity cohort (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 422px;\"\u003e\n \u003cp\u003eReliability cohort (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMeasures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e7-day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eDialysis days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eNon-dialysis days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e7-day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003eDialysis days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003eNon-dialysis days\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eNumber of steps (steps/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e3707.01 \u0026plusmn; 4607.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e3395.23 \u0026plusmn; 4302.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e3691.25 \u0026plusmn; 4432.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e4034.36 \u0026plusmn; 4794.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e3673.42 \u0026plusmn; 4491.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e4030.85 \u0026plusmn; 4588.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eMVPA (min/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e30.70 \u0026plusmn; 46.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e27.84 \u0026plusmn; 42.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e31.32 \u0026plusmn; 45.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e33.36 \u0026plusmn; 48.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e30.45 \u0026plusmn; 44.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e34.17 \u0026plusmn; 46.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eHAP MAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e73.30 \u0026plusmn; 8.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e73.30\u0026nbsp;\u0026plusmn;\u0026nbsp;8.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eHAP AAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e48.78 \u0026plusmn; 10.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e49.22\u0026nbsp;\u0026plusmn;\u0026nbsp;10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eIPAQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1494.23 \u0026plusmn; 487.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e1494.23\u0026nbsp;\u0026plusmn;\u0026nbsp;1487.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eMin-Cog score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e5.00 [5.00, 5.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e5.00 [4.00, 5.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eSPPB score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e11.00 [10.00, 12.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139px;\"\u003e\n \u003cp\u003e11.00 [5.00, 12.00]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 1040px;\"\u003e\n \u003cp\u003eAbbreviations: MVPA, Moderate-to-Vigorous Physical Activity; HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; IPAQ, International Physical Activity Questionnaire Long Form; Mini-Cog, Mini-Cognitive assessment instrument; SPPB, Short Physical Performance Battery.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eValidity of the Japanese version of HAP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the correlation analysis between HAP and accelerometer-derived data are presented in Table 3. Correlation coefficients of 0.54, 0.41, and 0.40 were observed between MAS and accelerometer-measured MVPA on non-dialysis days over a week. Similarly, on non-dialysis days over a week, correlation coefficients of 0.55, 0.53, and 0.56 were found between AAS and accelerometer data for the number of steps and correlation coefficients of 0.64, 0.58, and 0.60 were found between AAS and MVPA. On non-dialysis days over a week, correlation coefficients of 0.48, 0.46, and 0.50 were identified between IPAQ and accelerometer data for the number of steps and correlation coefficients of 0.64, 0.58, and 0.58 were found between IPAQ and MVPA. HAP demonstrated moderate correlations with accelerometer data, comparable to those observed for IPAQ. Additionally, the two physical activity recall questionnaires, HAP and IPAQ-LF, yielded similar results when compared with accelerometry and were moderately correlated with each other.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 595px;\"\u003e\n \u003cp\u003eTable 3. The association between HAP- or IPAQ-derived activity scores and accelerometer-derived activities such as number of steps and MVPA (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber of steps\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMVPA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eQuestionnaire-derived scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026rho;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026rho;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eHAP MAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eHAP AAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eIPAQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 595px;\"\u003e\n \u003cp\u003eAbbreviations: MVPA, Moderate-to-Vigorous Physical Activity; HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; IPAQ,\u0026nbsp;International Physical Activity Questionnaire Long Form.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOptimal cutoff points for AAS and MAS derived from the HAP questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eROC analysis identified the optimal cutoff values for AAS and MAS as \u0026le;50 and \u0026le;74, respectively, with an AUC of 0.81 for AAS and 0.63 for MAS. Sensitivity was 85.7% for both, whereas specificity was 70.0% for AAS and 50.0% for MAS. The ROC curves are shown in Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability of the Japanese version of HAP\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 presents the an HAP\u0026apos;s test-retest reliability for participants retested 4 weeks after the initial test. The analysis yielded ICC values of 0.76 for MAS and 0.84 for AAS, indicating a high degree of reliability.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eTable 4. Test-retest reliability (n=27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eHAP-derived scores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eHAP MAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eHAP AAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 340px;\"\u003e\n \u003cp\u003eAbbreviations: HAP, Human Activity Profile; MAS, Maximum Activity Score; AAS, Adjusted Activity Score; ICC, Intraclass Correlation Coefficient.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we developed a Japanese version of the HAP questionnaire, tailored to align more closely with the Japanese culture and lifestyle, and evaluated its reliability and validity among Japanese patients undergoing maintenance hemodialysis. Among the scores derived from HAP, AAS, which represents the most demanding activities and excluded the less challenging ones, showed a strong correlation with the objectively measured activity data. Its validity was comparable with that of IPAQ. The optimal AAS cutoff value for predicting 4,000 steps on a non-dialysis day was determined to be 50, with an AUC of 0.81, indicating high predictive capability. Furthermore, AAS exhibited high consistency at baseline and 4 weeks later. To the best of our knowledge, this is the first study to validate the reliability of a Japanese version of the HAP questionnaire among Japanese patients undergoing hemodialysis. The HAP questionnaire is a straightforward and practical tool for evaluating physical activity levels and is well-suited for use during dialysis. Consequently, the development of this tool and confirmation of its reliability and validity are expected to contribute to the effective management of physical activity levels in sedentary patients undergoing hemodialysis.\u003c/p\u003e \u003cp\u003eHAP effectively evaluates dynamic and static activities and provides a comprehensive assessment of physical activity. AAS correlated with step count and MVPA, whereas MAS showed no such association. This finding is consistent with that of previous studies validating the English version of the HAP (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). AAS, which accounts for sudden bursts of activity, offers a more precise estimation of an individual\u0026rsquo;s daily movements, whereas MAS tends to overestimate typical energy expenditure, often producing unrealistically high values (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Given the brief duration of this study, the focus was possibly confined to routine activities, potentially resulting in the underestimation of MAS. Conversely, AAS, recognized for its greater consistency, was most strongly correlated with objective data.\u003c/p\u003e \u003cp\u003eThe Physical Exercise Working Group of the Italian Society of Nephrology recently issued 16 statements addressing clinically relevant aspects of physical activity and exercise for individuals with chronic kidney disease (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In their paper, they advocated facilitating the integration of physical activity into patient care and recommended accurately assessing patients' physical activity levels using validated questionnaires, including the HAP (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Our study identified an optimal AAS cutoff value of 50 points, derived from the Japanese version of the HAP, for distinguishing recommended step counts, with an AUC of 0.81, demonstrating a high discriminative capability. This cutoff allows for easy identification of sedentary or inactive patients through interviews conducted during dialysis. Implementing this approach could serve as a foundation for lifestyle modifications and promotion of physical activity.\u003c/p\u003e \u003cp\u003eSeveral recent studies have demonstrated that motivational interventions effectively increase physical activity in the short term (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). A recent meta-analysis, which included 129 papers reporting 97 randomized controlled trials examining behavioral interventions incorporating motivational interviews for physical activity, revealed that these interventions led to a greater increase in step count (an additional 1,300 steps/day) and MVPA (an additional 95 min/day), and a reduction in sedentary time (reduction of 50 min/day) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In our study, HAP was significantly correlated with step count and MVPA and enabled the identification of a recommended threshold of 4,000 steps per non-dialysis day. These findings suggest that HAP assessment extends beyond mere measurement by providing individuals with the opportunity to recognize variations in their activity levels. Moreover, this study highlights the fact that HAP can be implemented in a simple, noninvasive, and cost-effective manner, making it suitable for large-scale applications in clinical and health promotion programs. Although self-monitoring is believed to enhance intrinsic motivation, its actual effects should be verified in future interventional studies.\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, the study was conducted in a specific region of Japan with a relatively small sample size, which limits the generalizability of the findings to a broader Japanese population. Therefore, further large-scale studies are necessary. Second, the study included only patients capable of walking independently, as physical activities below walking intensity cannot be measured using an accelerometer. Consequently, the applicability of the questionnaire to patients with activities of daily living disabilities remains unclear. Third, although the questionnaire was tailored to align with the Japanese culture and lifestyle, it may not fully address individual cultural and social differences. Finally, as with any questionnaire-based assessment, factors such as respondents' memory inaccuracies and social desirability bias may have affected the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWe developed a Japanese version of the HAP questionnaire and demonstrated its reliability and validity in patients undergoing hemodialysis, which is expected to aid in the efficient management of physical activity levels in these patient populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Activity Profile\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIPAQ-LF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Physical Activity Questionnaire Long Form\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMaximum Activity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Activity Score\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMVPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModerate to Vigorous Physical Activity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMini-Cog\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMini-Cognitive Assessment Instrument\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPPB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort Physical Performance Battery\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAUC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArea Under the Curve\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntraclass Correlation Coefficient\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eROC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReceiver Operating Characteristic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants in accordance with the ethical principles of the Declaration of Helsinki. This study was approved by the Research Ethics Review Board of the Hyogo Medical University, Japan (approval number: 4785).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the author; however, it is subject to restrictions, because the data were used under license for the current study and are not publicly available. However, data are available from the authors upon reasonable request and with their permission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the research funding received from the Hyogo Medical University Graduate School of Health Science, Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAA, MR, TN, MT, KT, AK, and TA designed the study. AA, TN, and TK collected the data. AA, MR, and TN analyzed the data. AA, MR, and TN wrote the manuscript. All authors have read and approved the final version of the manuscript. All authors have reviewed and approved the manuscript\u0026rsquo;s content before submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the medical staff for their support and the study participants for their participation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJohansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, et al. Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int. 2000;57(6):2564\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLear SA, Hu W, Rangarajan S, Gasevic D, Leong D, Iqbal R, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017;390(10113):2643\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016;176(6):816\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1-153.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamagata K, Hoshino J, Sugiyama H, Hanafusa N, Shibagaki Y, Komatsu Y, et al. Clinical practice guideline for renal rehabilitation: systematic reviews and recommendations of exercise therapies in patients with kidney diseases. Renal Replacement Therapy. 2019;5(1):1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafarzadeh Esfehani A, Dashti S. Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant. 2012;27(10):3964; author reply\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowden EJ, Coombes JS, Strand H, Douglas B, Campbell KL, Isbel NM. Exercise training in CKD: efficacy, adherence, and safety. Am J Kidney Dis. 2015;65(4):583\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNowicki M, Murlikiewicz K, Jagodzińska M. Pedometers as a means to increase spontaneous physical activity in chronic hemodialysis patients. J Nephrol. 2010;23(3):297\u0026ndash;305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheshadri A, Kittiskulnam P, Lazar AA, Johansen KL. A Walking Intervention to Increase Weekly Steps in Dialysis Patients: A Pilot Randomized Controlled Trial. Am J Kidney Dis. 2020;75(4):488\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePedišić Ž, Bauman A. Accelerometer-based measures in physical activity surveillance: current practices and issues. Br J Sports Med. 2015;49(4):219\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, et al. Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int. 2001;59(3):1121\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFix A, Daughton D. Human activity profile: professional manual. Odessa, FL: Psychological Assessment Resources Inc.; 1986.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavidson M, de Morton N. A systematic review of the Human Activity Profile. Clin Rehabil. 2007;21(2):151\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrodaty H, Lee-Fay L, Gibson L, Burns K. What Is the Best Dementia Screening Instrument for General Practitioners to Use? The American Journal of Geriatric Psychiatry. 2006;14(5):391\u0026ndash;400.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8(2):94\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCraig CL, Marshall AL, Sj\u0026ouml;str\u0026ouml;m M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans JD. Straightforward statistics for the behavioral sciences: Thomson Brooks/Cole Publishing Co; 1996.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016;15(2):155\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuzawa R, Roshanravan B, Shimoda T, Mamorita N, Yoneki K, Harada M, et al. Physical Activity Dose for Hemodialysis Patients: Where to Begin? Results from a Prospective Cohort Study. Journal of renal nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2018;28(1):45\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerkins NJ, Schisterman EF. The inconsistency of \"optimal\" cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163(7):670\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013;48(3):452\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBastone Ade C, Moreira Bde S, Vieira RA, Kirkwood RN, Dias JM, Dias RC. Validation of the human activity profile questionnaire as a measure of physical activity levels in older community-dwelling women. J Aging Phys Act. 2014;22(3):348\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBattaglia Y, Baciga F, Bulighin F, Amicone M, Mosconi G, Storari A, et al. Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology. J Nephrol. 2024;37(7):1735\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Halloran PD, Blackstock F, Shields N, Holland A, Iles R, Kingsley M, et al. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil. 2014;28(12):1159\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu S, Sinha D, Kirk M, Michalopoulou M, Hajizadeh A, Wren G, et al. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ. 2024;386:e078713.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"CKD, frailty, sarcopenia, sedentary, validity, reliability, questionnaire, hemodialysis, physical activity, human activity profile","lastPublishedDoi":"10.21203/rs.3.rs-6308331/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6308331/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysical inactivity is a significant risk factor for mortality in patients undergoing hemodialysis. Assessment of physical activity is crucial for clinical management and therapeutic decisions in this population. The Human Activity Profile (HAP) questionnaire is widely used to evaluate functional ability across various populations, including those with chronic diseases. Although the HAP is reliable and convenient for use in clinical settings, no validated Japanese adaptation is available. In this study, we aimed to create a Japanese version of the HAP and evaluate its reliability and validity in patients undergoing hemodialysis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, the Japanese version of the HAP was translated with the permission of the original author. Physical activity was assessed using both the HAP questionnaire and an accelerometer. The total steps and moderate-to-vigorous physical activity (MVPA) time were calculated using an accelerometer. Validity was assessed by evaluating the correlation between the HAP maximum activity score (MAS) and adjusted activity score (AAS) and objectively measured physical activity levels. Reliability was determined by re-administering the HAP questionnaire. Spearman's rank correlation coefficient and intraclass correlation coefficient (ICC) 2,1 were used to evaluate the validity and reliability, respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe included 32 Japanese patients undergoing hemodialysis (mean age 71.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 years; 19 men). The Japanese version of HAP correlated with accelerometry data, excluding the MAS, and with the number of steps. The AAS moderately correlated with MVPA (ρ\u0026thinsp;=\u0026thinsp;0.64, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and number of steps (ρ\u0026thinsp;=\u0026thinsp;0.55, P\u0026thinsp;=\u0026thinsp;0.003). The Japanese version of HAP indicated a high degree of reliability (ICC\u0026thinsp;=\u0026thinsp;0.84). The cutoff points for HAP were set to identify participants engaging in \u0026lt;\u0026thinsp;4,000 steps per non-dialysis day, the minimum recommended physical activity level for patients undergoing hemodialysis, and objectively measure physical activity. The AAS cutoff value was determined to be 50, with an area under the curve of 0.81, a high predictive capability.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe demonstrated the robust reliability and validity of the Japanese version of the HAP questionnaire in patients undergoing hemodialysis. Given the strong reliability and validity of the Japanese HAP questionnaire, incorporating this assessment into standard care may be valuable for evaluating the physical activity of patients undergoing hemodialysis.\u003c/p\u003e","manuscriptTitle":"Reliability and Validity of the Japanese Adaptation of Human Activity Profile for Evaluating Physical Activity in Patients Undergoing Hemodialysis: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 08:32:15","doi":"10.21203/rs.3.rs-6308331/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ed17f990-662e-4cd0-a3b0-3bb3f94ab338","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T15:59:24+00:00","versionOfRecord":{"articleIdentity":"rs-6308331","link":"https://doi.org/10.1186/s41100-025-00659-y","journal":{"identity":"renal-replacement-therapy","isVorOnly":false,"title":"Renal Replacement Therapy"},"publishedOn":"2025-08-26 15:57:06","publishedOnDateReadable":"August 26th, 2025"},"versionCreatedAt":"2025-05-07 08:32:15","video":"","vorDoi":"10.1186/s41100-025-00659-y","vorDoiUrl":"https://doi.org/10.1186/s41100-025-00659-y","workflowStages":[]},"version":"v1","identity":"rs-6308331","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6308331","identity":"rs-6308331","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}