Arabic Translation and Psychometric Testing of the Physical Activity Index (PAI)

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Yet, physical inactivity remains widespread, including in Lebanon, with significant health consequences. While objective and subjective tools for measuring physical activity exist, self-report questionnaires like the Physical Activity Index (PAI) are practical and cost-effective for large-scale population studies. However, the PAI has not been validated in Arabic-speaking populations. This study intended to evaluate the psychometric properties of an Arabic translation of the PAI, with the aim of providing an adapted tool to assess physical activity, and support public health initiatives and research efforts in Arab-speaking regions. Methods: The forward-backward translation method was adopted. Data was collected through a one-time online survey from a sample of Lebanese adults (N = 462; mean age = 25.85 ± 9.69 years; 70.3% females). Results: Exploratory factor analysis revealed a single-factor structure for the Arabic version of the PAI. A Cronbach’s alpha of 0.71 indicated acceptable internal consistency. The factor structure was invariant across gender, with acceptable internal consistency for males (α = 0.78) and females (α = 0.68). In the total sample, the mean PAI was 23.15 ± 18.81, indicating poor physical activity, with no significant gender differences (males: 25.85 ± 21.32, females: 22.01 ± 17.55; t(460) = 1.86, p = 0.064). Convergent validity was supported by a significant positive correlation between PAI and Exercise scores (r = 0.50; p< 0.001). Concurrent validity was confirmed through positive correlations between PAI scores and general physical condition (r = 0.14; p< 0.01), general well-being (r = 0.18; p< 0.001), and emotional intelligence scores (r = 0.15; p< 0.01). Conclusion: These preliminary findings indicate that the Arabic version of the PAI has acceptable psychometric properties and holds potential for use in large-scale population studies due to its low cost, easy scoring, quick completion time, and suitability for the Lebanese young adult population. Further research is needed to confirm its validity and expand its applicability across different age groups and Arab countries. Psychology Physical activity physical activity index PAI psychometric properties Arabic Figures Figure 1 1. Introduction Physical activity (PA) refers to any movement of the body generated by skeletal muscles that leads to the expenditure of energy [ 1 ] and can be classified as structured or incidental. Structured PA is intentionally planned and performed with the aim of enhancing health and fitness, while incidental PA is unplanned and occurs as part of everyday tasks at work, home, or during transport [ 2 ]. The four dimensions of physical activity include (1) mode or type of activity, which refers to the specific kind of physical activity, such as walking, gardening, cycling, or categorizing activities as aerobic versus anaerobic, resistance or strength training, and balance or stability training; (2) frequency, which indicates how often the activity is performed, typically measured as the number of sessions per day or week; (3) duration, referring to the amount of time spent on the activity, measured in minutes or hours, within a defined time frame such as a day, week, month, or year; and (4) intensity, an indicator of the metabolic demand of the activity describing the level of effort involved [ 2 ]. Modernization has led to increasingly sedentary lifestyles due to the reliance on motorized transportation, elevators, mechanization, and the growing use of screens for work, education, and leisure activities [ 3 ]. In 2022, nearly one-third of adults worldwide (31%) failed to meet the recommended levels of physical activity [ 4 ]. That is, they did not achieve at least 150 minutes of moderate-intensity physical activity, or 75 minutes of vigorous-intensity activity, or an equivalent combination per week, as outlined in the 2020 World Health Organization (WHO) guidelines [ 5 ]. This marks a five-percentage increase in insufficient physical activity from 2010 to 2022. If this trend continues, the global prevalence of inadequate physical activity is projected to reach 35% by 2030. Consequently, the World Health Assembly's target of a 15% relative reduction in insufficient physical activity between 2010 and 2030 is unlikely to be achieved [ 4 ]. Engaging in regular physical activity positively impacts physiological and mental well-being, while the lack of it exerts negative effects. One of its most notable benefits is its role in preventing non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular conditions, and cancer [ 6 , 7 ]. It also has the potential to act as a protective factor against cognitive decline, reducing the risk of dementia and Alzheimer's disease [ 8 ]. The anxiolytic effect of PA is documented as well, with evidence supporting its role as an efficacious intervention for managing anxiety and stress-related disorders [ 9 ]. Moreover, physical activity interventions contribute to the cessation or reduction of substance use in individuals with substance use disorder [ 10 ]. Additionally, existing research has reported positive associations between PA and emotional intelligence (EI), suggesting that increased PA predicts a higher EI [ 11 ]. With the significance of a physically active lifestyle for physical and mental health and the economic burden associated with inactivity [ 12 ], it is essential to monitor PA and consider strategies to promote activity participation. Objective (e.g., accelerometers) and subjective (e.g., self-report questionnaires) measurement tools exist for assessing physical activity. The choice of an assessment method depends on several factors, such as the purpose of the assessment, the characteristics of the target population, available resources, the level of precision required, and the speed at which the results are needed [ 2 ]. Accelerometers can record high-resolution data; however, they often lead to compliance concerns, such as participants forgetting to wear the device, and their high-cost limits researchers' ability to study large populations [ 13 ]. On the other hand, self-administered questionnaires, while less accurate, can be distributed electronically, maximizing scalability and the speed of data collection and minimizing costs [ 14 ]. Nevertheless, ensuring acceptable psychometric properties in self-report questionnaires remains an important consideration [ 15 ]. The use of various physical activity measures prevents international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed between 1997 and 1998 by an International Consensus Group as an instrument for cross-national monitoring of physical activity for young to middle-aged adults. It exists in two forms, short and long, and has been validated for PA assessment in many countries [ 16 ]. However, it has been reported to be user-unfriendly, difficult to answer for many respondents, and requiring extensive calculations as one of its main disadvantages [ 17 ]. The Physical Activity Index (PAI) is another self-report questionnaire for PA assessment in adults. Besides consisting of only three items considering the critical dimensions of PA (intensity, duration, and frequency), it is easy to answer and score, time-sparing, and cost-effective [ 18 – 22 ]. Although the PAI has been extensively used in previous studies in Lebanon [ 23 – 26 ], this questionnaire had not been subjected to exploratory factor analysis (EFA), and its psychometric properties have not been evaluated in Arabic-speaking populations to the best of our knowledge. EFA is a statistical technique essential for validating measurement instruments. It helps identify the factors (also referred to as dimensions, latent variables, hypothetical constructs, synthetic variables, or internal attributes) that explain the covariation observed among a set of measured variables and helps detect items that do not empirically pertain to the intended construct and that should be removed from the questionnaire [ 27 , 28 ]. In Lebanon, according to WHO statistics in 2022, the prevalence of physical inactivity among adults aged 18 years or over was 40% in males and 33% in females, and the mortality rate in the total population due to chronic noncommunicable diseases (NCDs) was 89%. The direct healthcare costs attributable to NCDs and mental health associated with physical inactivity amounted to US $ 45,469,723 per year [ 12 ]. This study intends to provide a culturally and linguistically adapted tool that can offer insights into physical activity levels, supporting public health initiatives and research efforts aimed at monitoring and promoting physical activity in Lebanon and similar Arab-speaking regions to combat physical inactivity and its associated health risks. For practical reasons, such as time efficiency, cost-effectiveness, and ease of scoring, and due to the scarcity of validated questionnaires for assessing physical activity in Lebanon [ 29 ], this study aimed to evaluate the psychometric properties of the Arabic version of the PAI among a sample of Lebanese adults from the general population. The objectives of the study were as follows: (1) translate the English version of the PAI into Arabic, (2) conduct an exploratory factor analysis to identify the factor structure of the PAI, and (3) assess the internal consistency, convergent validity, and concurrent validity of the PAI. We expect the scale will show a unifactorial structure and good internal consistency. We also hypothesize that the convergent and concurrent validity of the Arabic PAI will be established by positive correlations between the PAI score and scores of related measures (exercise, general physical condition, general well-being, and emotional intelligence). 2. Methods 2.1 Data Collection and Sampling Procedure This cross-sectional study, conducted from December to January 2021, included 462 participants. Recruitment via the snowball method targeted a sample of Lebanese citizens aged 18 or older. A Google Forms survey, disseminated on social media platforms, was used for data collection. The research team initially shared the survey link with potential participants, who were encouraged to share it further in their networks with other eligible individuals. The survey was anonymous. Participants provided electronic informed consent before accessing the questionnaire. Participation was voluntary and unpaid. 2.2 Minimal Sample Size Calculation According to Comrey and Lee, at least 10 participants are required per scale item to avoid computational difficulties [ 30 ]. Consequently, this study required a minimum sample size of 30 participants to conduct exploratory factor analysis, as the PAI questionnaire consists of three items. 2.3 Questionnaire The questionnaire, written in Arabic—the official language of Lebanon—began with an introduction outlining the study’s objectives and included an online consent form to confirm voluntary participation and ensure the confidentiality and anonymity of responses. The sociodemographic section collected data on age, sex, marital status, education level, and the Household Crowding Index (HCI), an indicator of socioeconomic status (SES). The HCI was calculated by dividing the number of household members by the number of rooms (excluding the kitchen and bathrooms), with higher scores denoting lower SES [ 31 ]. Participants were then asked to assess their physical activity, healthy lifestyle (HL), general well-being, and emotional intelligence using self-administered scales provided as part of the questionnaire, described as follows: Physical Activity Index (PAI) [ 20 ]: The questionnaire parameters are the intensity, duration, and frequency of physical activity. The scoring range for each parameter is presented in Table 1 . The PAI, ranging from a minimum of 1 to a maximum of 100, is obtained by multiplying the score for each parameter: PAI = Intensity × Duration × Frequency. The total score can then be evaluated and categorized as shown in Table 2 . Higher score reflects more active lifestyle and higher activity level. Table 1 Scoring range for assessment of self-evaluated physical activity level using the Physical Activity Index. Score Activity Intensity 5 Sustained heavy breathing and perspiration 4 Intermittent heavy breathing and perspiration, as in tennis 3 Moderately heavy, as in cycling and other recreational sports 2 Moderate, as in volleyball, softball 1 Light, as in fishing Duration 4 Over 30 minutes 3 20 to 30 minutes 2 10 to 20 minutes 1 Less than 10 minutes Frequency 5 6 to 7 times per week 4 3 to 5 times per week 3 1 to 2 times per week 2 A few times per month 1 Less than once a month Table 2 Evaluation of physical activity score Score Evaluation Activity Category 81 to 100 Very active lifestyle High 60 to 80 Active and healthy Very good 40 to 59 Acceptable but could be better Fair 20 to 39 Not good enough Poor Under 20 Sedentary Very poor Healthy Lifestyle Screening Tool (HLST) [ 32 ]: The HLST, designed to evaluate HL in young adults, comprises 36 items divided into 9 factors, with 4 items per factor. The factors include sunlight, water, air, rest, exercise, nutrition, temperance, trust, and general physical condition. Responses are rated on a 4-point Likert scale, where 4 corresponds to “strongly agree,” 3 to "agree,” 2 to “disagree,” and 1 to “strongly disagree.” The total HLST score ranges from 36 to 144, while each factor-specific score ranges from 4 to 16. Higher scores on the HLST indicate a healthy lifestyle, and elevated scores in individual factors indicate greater adherence to the corresponding dimension of an HL. In this study, only the exercise (items 17 to 20) and general physical condition (items 33 to 36) factors were used in the analysis (Cronbach’s α = 0.73). General Well-Being Schedule (GWBS) [ 33 ]: The 18-item questionnaire assesses well-being over the past month across six domains: anxiety, depression, positive well-being, self-control, vitality, and general health. The first 14 items are rated on 6-point scales that measure intensity or frequency, with responses assigned numeric values from 0 to 5. The remaining four items use 0 to 10 rating scales defined by contrasting adjectives at each end. For scoring, the polarity of items 1, 3, 6, 7, 9, 11, 13, 15, and 16 is reversed. Subscale scores are summed to produce a total score ranging from 0 to 110. Higher scores indicate positive well-being, while lower scores reflect distress (Cronbach’s α = 0.89). Assessing Emotions Scale (AES) [ 34 ]: Validated in Arabic (AES-Ar) [ 35 ], this 33-item scale uses a 5-point Likert scale for responses, ranging from 1 (strongly agree) to 5 (strongly disagree). Three items (5, 28, and 33) are negatively worded, with agreement indicating lower emotional intelligence, and are reverse-coded. The total score is calculated by summing all item scores, with higher scores reflecting greater emotional intelligence (Cronbach’s α = 0.96). 2.4 Arabic Translation of the PAI The forward-backward translation method was applied to the PAI per guidelines for the cross-cultural adaptation of self-report measures [ 36 ]. A bilingual translator, whose native language is Arabic and who is proficient in English, translated the English version of the index into Arabic. An expert committee, consisting of the forward translator and healthcare professionals, then reviewed the Arabic translation to resolve any identified issues by consensus. Next, a translator, whose native language is English and who had no prior exposure to the original scale, translated the Arabic version back into English. An expert committee, which included both the forward and back translators along with healthcare professionals, compared the original English version and the back-translated version to detect and address any inconsistencies, ensuring semantic, idiomatic, experiential, and conceptual equivalence. Finally, the Arabic version was subjected to a pilot test with a group of 30 adults to assess its clarity and comprehensibility. 2.5 Statistical Analysis The SPSS software v.27 was used to analyze the data. An exploratory factor analysis was initially conducted to identify which items would load on which factor. The Kaiser–Meyer–Olkin (KMO) and the p -value obtained from Bartlett’s test of sphericity were computed to evaluate the adequacy of the data using the varimax rotation since items were not correlated. Factors with eigenvalues larger than one were retained and the scree plot method was used for determining the number of components to extract. Items with a loading > 0.4 were kept. The reliability analysis using Cronbach’s alpha was recorded. Comparison of PAI scores between genders was done using the Student’s t test. The PAI total score was considered normally distributed, as the skewness and kurtosis values were between ± 1; consequently, the Pearson test was used to assess the correlation between the PAI score and other scores (exercise, general physical condition, general well-being, and emotional intelligence). 3. Results 3.1 Participants Characteristics Four hundred sixty-two participants completed the survey, with a mean age of 25.85 ± 9.69 years and a mean HCI of 1.01 ± 0.41 persons/room, 70.3% females, 76.4% single, and 90.3% with a university education level. An active and healthy lifestyle characterized 7.4% of participants, whereas more than half of them (51.9%) were evaluated as sedentary, which means they are physically inactive. Results of all the descriptive variables are presented in Table 3 . Table 3 Descriptive variables of the study population (N = 462). Variable N (%) Sex Male 137 (29.7%) Female 325 (70.3%) Education Secondary or less 98 (21.3%) University 364 (78.7%) Physical activity evaluation Very active lifestyle 1 (0.2%) Active and healthy 34 (7.4%) Acceptable but could be better 63 (13.6%) Not good enough 124 (26.8%) Sedentary 240 (51.9%) Mean ± SD Age (years) 25.85 ± 9.69 Household crowding index (persons/room) 1.01 ± 0.41 Physical activity index 23.15 ± 18.81 Exercise 10.51 ± 2.04 General physical condition 11.19 ± 1.98 General well-being 60.40 ± 17.12 Emotional intelligence 107.78 ± 20.01 3.2 Exploratory Factor Analysis The varimax rotation was applied since the items were not correlated as shown by the anti-image. The three items loaded on one factor (as confirmed by Fig. 1 ), explaining a total of 63.47% variance in the total sample. The KMO was modest (= 0.576), with a significant Bartlett’s test of sphericity (p < 0.001), indicating the sample is acceptable and the data is suitable for factor analysis. The loading factors and communality values were adequate. The Cronbach’s α value (= 0.71) was satisfactory in the total sample (Table 4 ). Table 4 Loading factors of the physical activity index (PAI) items deriving from the exploratory factor analysis using the varimax rotation in the total sample, and in males and females exclusively. Total sample Males Females Factor loading Communality Factor loading Communality Factor loading Communality PAI frequency 0.892 0.343 0.937 0.393 0.874 0.319 PAI duration 0.874 0.765 0.900 0.810 0.864 0.746 PAI intensity 0.586 0.796 0.627 0.879 0.565 0.763 Percentage of variance explained 63.47 69.39 60.96 Cronbach’s α 0.71 0.78 0.68 3.3 Physical Activity Index in Total Sample and Comparison between Males and Females In the total sample, the mean PAI was 23.15 ± 18.81, categorized as poor. No significant difference in PAI scores was found between males and females (25.85 ± 21.32 vs 22.01 ± 17.55, t(460) = 1.86, p = 0.064, Cohen’s d = 0.205). 3.4 Convergent and Concurrent Validity Convergent validity was assessed by examining the correlation between the PAI and exercise scores. Concurrent validity was assessed by examining the correlations between the PAI and general physical condition, well-being, and emotional intelligence. Higher PAI was significantly associated with higher exercise, general physical condition, general well-being, and emotional intelligence scores (Table 5 ). Table 5 Pearson correlation matrix. 1 2 3 4 1. Physical activity index 1 2. Exercise 0.50*** 1 3. General physical condition 0.14** 0.30*** 1 4. General well-being 0.18*** 0.23*** 0.06 1 5. Emotional intelligence 0.14** 0.30*** 0.34*** 0.15** **p < 0.01; ***p < 0.001 4. Discussion To our knowledge, this study is the first to assess the psychometric properties of the PAI among adults in Lebanon, providing the first validation of the instrument in a country within the Arabic-speaking Middle East and North Africa region. Overall, statistical results indicated that the Arabic PAI has a unidimensional factor structure, acceptable reliability, and gender invariance, and they supported its convergent and concurrent validity in a sample of adults within the Arabic-speaking Lebanese population. To address the objectives of the study, the factor structure of the PAI was analyzed. The EFA resulted in a single-factor solution for the three items, with a 63.47% of variance explained. The factor loadings for all three items exceeded the cut-off value of 0.4 [ 37 ], as did the communality values (with a cut-off value of 0.25) [ 38 ], suggesting that the factor is well-defined. In other words, the items are effective indicators of the physical activity construct. Beyond factor structure, another important psychometric property that we sought to assess is the internal consistency of the PAI. The obtained Cronbach’s alpha of 0.71 indicates acceptable reliability [ 39 ]. A comparison with the literature was not possible because we were not able to find previous studies reporting values related to the PAI psychometric properties. To examine gender invariance of the PAI, an EFA was conducted separately for males and females. The results revealed that the unidimensional factor structure was consistent across genders, with comparable factor loadings and communalities for the three items. The percentage of variance explained was higher for males (69.39%) than for females (60.96%), though both values exceeded the acceptable threshold of 60% [ 40 ]. Additionally, while the Cronbach’s α value indicated higher internal consistency for males (0.78) compared to females (0.68), the reliability was deemed acceptable for both groups [ 39 ]. These findings suggest that the PAI shows sufficient gender invariance and can be used for assessing physical activity in both genders. It is generally believed and consistently documented that men are more physically active than women [ 41 , 42 ], which can be attributed to disparities in time availability, as women often shoulder greater family responsibilities, reducing the time they can dedicate to physical activity [ 43 ]. Additionally, men may exhibit higher intrinsic motivation, predictive of long-term exercise adherence, driven by factors like strength, competition, and desire to achieve mastery, compared to women, who are often motivated by extrinsic factors related to physical attractiveness and appearance [ 44 ]. Biological differences, such as variations in muscle mass and cardiovascular capacity, may also influence physical activity [ 45 ]. In our study, although the mean PAI scores were slightly higher for males than females, the difference was not statistically significant. Both genders had physical activity levels categorized as poor, aligning with findings from a 2020 pilot study reporting suboptimal physical activity levels among Lebanese adults [ 46 ], underscoring the need for public health strategies to promote physical activity engagement across the population. Previous research has identified several barriers to physical activity, such as lack of a safe environment, insufficient facilities, cost considerations, time constraints, lack of motivation, absence of a workout companion, and physical conditions, which may contribute to low physical activity levels [ 47 ]. Regarding the assessment of convergent validity, it was supported by a significant positive correlation between the PAI and Exercise scores. Additionally, concurrent validity was tested by showing that the PAI scores positively correlated, as theoretically expected, with other relevant constructs, including general physical condition, general well-being, and emotional intelligence. Our results align with existing literature reporting that higher levels of physical activity were associated with blood pressure reduction in adults with hypertension [ 48 ], improved glycemic control in patients with type 2 diabetes mellitus [ 49 ], alleviation of symptoms in constipation patients [ 50 ], enhanced memory function [ 51 ], increased emotional intelligence [ 11 ], greater life satisfaction [ 52 ], higher psychological well-being [ 53 ], and a reduction in symptoms of depression [ 54 ]. Limitations This study has some limitations that should be considered. First, the KMO value in the total sample was modest. However, it was higher than the bare minimum of 0.5 for factor analysis [ 55 ]. Second, sampling bias may have been introduced by the snowball sampling method, which often recruits interconnected participants, potentially resulting in a non-random sample and restricting its representativeness of the wider population. Third, the sample had a large percentage of female participants (70.3%), which could be explained by the fact that women tend to be more willing to participate in online surveys than men [ 56 ]. Additionally, the study was conducted on a sample of young adults from a single country and culture, Lebanon, which may limit the generalizability of the findings to other age groups and the entire Arab world. Therefore, further validation of the PAI is needed in different age groups and other Arab countries. Another limitation is the use of self-report measures, which may have led to information bias, as participants might have misinterpreted certain statements or underrated or overrated some items. Moreover, causality cannot be inferred as the study was conducted at a one-time point, restricting the analysis to identifying only correlations between the measures. Besides, the HLST and GWBS were not previously validated in Arabic, but showed acceptable internal reliability in this study. Lastly, while some psychometric properties were assessed for the Arabic PAI, other aspects, such as test-retest reliability, were not explored and still need to be considered in future research. Furthermore, the validity of the Arabic version of the PAI compared to a gold-standard criterion measure of physical activity could be studied in the future. Practical Implications With these preliminary findings supporting its validity, the Arabic version of the PAI appears to have potential for use by researchers and public health policymakers in large-scale population studies; its low cost, short completion time, easy scoring, and suitability for the adult Lebanese population make it a practical tool for assessing physical activity trends and informing evidence-based public health strategies. Additionally, it can benefit clinicians by enabling them to estimate physical activity levels, design tailored PA plans for individuals with low activity levels, and they can integrate this index into programs to track individuals' progress toward a more active lifestyle. 5. Conclusion To our knowledge, this study is the first to cross-culturally validate the PAI in the Arabic language. The Arabic version of this index revealed a unifactorial structure with acceptable psychometric properties. Nevertheless, further research is needed to confirm its validity, ensure that it is gender invariant, explore additional psychometric properties, and validate the index across diverse age groups and Arab countries to expand its applicability. Declarations Ethics approval and consent to participate: The Psychiatric Hospital of the Cross-ethics committee approved the study protocol (HPC-046-2020). Written informed consent was obtained from all patients upon submitting the online survey. All methods were performed in accordance with the relevant guidelines and regulations (in accordance with the Declaration of Helsinki). Consent for publication: None. Availability of data and materials : All data generated or analyzed during this study are not publicly available due the restrictions from the ethics committee, but are available upon a reasonable request from the corresponding author (SH). Competing interests: The authors have nothing to disclose. Funding: None. Author contributions: SO, FFR and SH designed the study; MF collected the data, MA drafted the manuscript; SH carried out the analysis and interpreted the results; RH, DM and SEK reviewed the final manuscript; all authors approved the final version and gave their consent. Clinical trial number : Not applicable Acknowledgements: The authors would like to thank all participants and Dr Marwan Akel for his help in the data collection. References Caspersen, C.J.; Powell, K.E.; Christenson, G.M. 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Validation of a Shortened Version of the Eating Attitude Test (EAT-7) in the Arabic Language. Journal of Eating Disorders 2022 , 10 , 127. Fekih-Romdhane, F.; He, J.; Malaeb, D.; Dabbous, M.; Hallit, R.; Obeid, S.; Hallit, S. Psychometric Properties of the Arabic Versions of the Three-Item Short Form of the Modified Weight Bias Internalization Scale (WBIS-3) and the Muscularity Bias Internalization Scale (MBIS). Journal of Eating Disorders 2023 , 11 , 82. Fekih-Romdhane, F.; Malaeb, D.; Dabbous, M.; Hallit, R.; Obeid, S.; Hallit, S. Psychometric Properties of an Arabic Translation of the Short 9-Item Drive for Muscularity Scale (DMS-9). BMC Psychiatry 2023 , 23 , 680. Fekih-Romdhane, F.; Malaeb, D.; Hallit, S.; Obeid, S. Does Mindfulness Moderate the Association between Impulsivity and Well-being in Lebanese University Students? International Journal of Environmental Health Research 2024 , 34 , 1397–1409. Watkins, M.W. Exploratory Factor Analysis: A Guide to Best Practice. Journal of Black Psychology 2018 , 44 , 219–246. Knekta, E.; Runyon, C.; Eddy, S. One Size Doesn’t Fit all: Using Factor Analysis to Gather Validity Evidence when using Surveys in Your Research. CBE Life Sci Educ 2019 , 18 , rm1. Helou, K.; El Helou, N.; Mahfouz, M.; Mahfouz, Y.; Salameh, P.; Harmouche-Karaki, M. Validity and Reliability of an Adapted Arabic Version of the Long International Physical Activity Questionnaire. BMC Public Health 2017 , 18 , 49. Comrey, A.L.; Lee, H.B. A First Course in Factor Analysis , 2nd ed.; Psychology Press: New York, 2013. Melki, I.S.; Beydoun, H.A.; Khogali, M.; Tamim, H.; Yunis, K.A. Household Crowding Index: A Correlate of Socioeconomic Status and Inter-Pregnancy Spacing in an Urban Setting. J Epidemiol Community Health 2004 , 58 , 476–480. Kim, C.H.; Kang, K. The Validity and Reliability of the Healthy Lifestyle Screening Tool. Physical Therapy Rehabilitation Science 2019 , 8 , 99–111. Fish, J. General Well-Being Schedule. 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In Encyclopedia of Social Measurement .; Kempf-Leonard, K., Ed.; Elsevier: New York, 2005, pp. 665–676. Taber, K.S. The use of Cronbach’s Alpha when Developing and Reporting Research Instruments in Science Education. Res Sci Educ 2018 , 48 , 1273–1296. Shkeer, A.S.; Awang, Z. Exploring the Items for Measuring the Marketing Information System Construct: An Exploratory Factor Analysis. International Review of Management and Marketing 2019 , 9 , 87–97. BERGIER, J.; BERGIER, B.; TSOS, A. Variations in Physical Activity of Male and Female Students from Different Countries. Iran J Public Health 2016 , 45 , 705–707. Sharara, E.; Akik, C.; Ghattas, H.; Makhlouf Obermeyer, C. Physical Inactivity, Gender and Culture in Arab Countries: A Systematic Assessment of the Literature. BMC Public Health 2018 , 18 , 639. Doan, T.; Yu, P.; LaBond, C.; Gong, C.; Strazdins, L. Time for Physical Activity: Different, Unequal, Gendered. J Health Soc Behav 2022 , 63 , 37–54. Molanorouzi, K.; Khoo, S.; Morris, T. Motives for Adult Participation in Physical Activity: Type of Activity, Age, and Gender. BMC Public Health 2015 , 15 , 66. Hunter, S.K.; S Angadi, S.; Bhargava, A.; Harper, J.; Hirschberg, A.L.; D Levine, B.; L Moreau, K.; J Nokoff, N.; Stachenfeld, N.S.; Bermon, S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc 2023 , 55 , 2328–2360. Fakhro, M.; Ibrahim, J.; Chlela, S. Physical Activity Status and Readiness for Exercise Participation among Lebanese Adults: A Pilot Study. British Journal of Medical & Health Sciences 2020 , 2 , 658–665. Hasan, A.B.M.N.; Sharif, A.B.; Jahan, I. Perceived Barriers to Maintain Physical Activity and its Association to Mental Health Status of Bangladeshi Adults: A Quantile Regression Approach. Sci Rep 2023 , 13 , 8993. Islam, F.M.A.; Islam, M.A.; Hosen, M.A.; Lambert, E.A.; Maddison, R.; Lambert, G.W.; Thompson, B.R. Associations of Physical Activity Levels, and Attitudes Towards Physical Activity with Blood Pressure among Adults with High Blood Pressure in Bangladesh. PLoS One 2023 , 18 , e0280879. Shah, S.Z.A.; Karam, J.A.; Zeb, A.; Ullah, R.; Shah, A.; Haq, I.U.; Ali, I.; Darain, H.; Chen, H. Movement is Improvement: The Therapeutic Effects of Exercise and General Physical Activity on Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Ther 2021 , 12 , 707–732. Gao, R.; Tao, Y.; Zhou, C.; Li, J.; Wang, X.; Chen, L.; Li, F.; Guo, L. Exercise Therapy in Patients with Constipation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Scand J Gastroenterol 2019 , 54 , 169–177. Loprinzi, P.D.; Roig, M.; Etnier, J.L.; Tomporowski, P.D.; Voss, M. Acute and Chronic Exercise Effects on Human Memory: What we Know and Where to Go from Here. J Clin Med 2021 , 10 , 4812. Maher, J.P.; Pincus, A.L.; Ram, N.; Conroy, D.E. Daily Physical Activity and Life Satisfaction Across Adulthood. Dev Psychol 2015 , 51 , 1407–1419. Granero-Jiménez, J.; López-Rodríguez, M.M.; Dobarrio-Sanz, I.; Cortés-Rodríguez, A.E. Influence of Physical Exercise on Psychological Well-being of Young Adults: A Quantitative Study. Int J Environ Res Public Health 2022 , 19 , 4282. Chen, C.; Beaunoyer, E.; Guitton, M.J.; Wang, J. Physical Activity as a Clinical Tool Against Depression: Opportunities and Challenges. J Integr Neurosci 2022 , 21 , 132. Ul Hadia, N.; Abdullah, N.; Sentosa, I. An Easy Approach to Exploratory Factor Analysis: Marketing Perspective. JESR 2016 , 6 , 215–223. Smith, W. Does Gender Influence Online Survey Participation? A Record-Linkage Analysis of University Faculty Online Survey Response Behavior. 2008 . Additional Declarations The authors declare no competing interests. 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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-5945662","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":410105394,"identity":"90a867f8-9608-4277-8e8c-3ca5fc3730ff","order_by":0,"name":"Melyssa Assaf","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Melyssa","middleName":"","lastName":"Assaf","suffix":""},{"id":410105395,"identity":"a23a9817-3839-4913-851e-a0ac9801b14f","order_by":1,"name":"Rabih Hallit","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Rabih","middleName":"","lastName":"Hallit","suffix":""},{"id":410105396,"identity":"08c38275-b156-4b21-886e-8585ea76cb4a","order_by":2,"name":"Mirna Fawaz","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mirna","middleName":"","lastName":"Fawaz","suffix":""},{"id":410105397,"identity":"8e4b5560-8a3c-40ec-a883-395a48370112","order_by":3,"name":"Diana Malaeb","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Diana","middleName":"","lastName":"Malaeb","suffix":""},{"id":410105398,"identity":"f7431778-0466-4531-b8a8-44b7e675d2ad","order_by":4,"name":"Sami El Khatib","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"El","lastName":"Khatib","suffix":""},{"id":410105399,"identity":"b0f558b6-095d-4ab4-a5a2-5eb69dece437","order_by":5,"name":"Feten Fekih-Romdhane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBAC9gYwJccgwczD+ADI4uEjpIXnADOIMgZpYTYACbARrwWoWALEJKyFvf/g4wIGAznJdt5jlV9z7GTYGJgfPrqBTwvPYWbjGQwGxtLMfGm3ZbclAx3GZmycg0eLvUQymzQPw5/Eecw8ZrcltzEDtfCwSePTwiP/mP03D4NBPUhLseS2eiK0SDCzMQO1JEgDtTB+3HaYCC08ycbSPAYGhjObeYylGbcd52FjJuAXHvaDDz/zVBjIS5w/Y/jx57Zqe3725oeP8WmBAAMIBXQhiCSoHAkw/iBF9SgYBaNgFIwYAADIazVH6EU/kAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-2569-8017","institution":"Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia.","correspondingAuthor":true,"prefix":"","firstName":"Feten","middleName":"","lastName":"Fekih-Romdhane","suffix":""},{"id":410105400,"identity":"29a318e1-bb7d-42bd-a7ed-2a4b1762d37c","order_by":6,"name":"Sahar Obeid","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Sahar","middleName":"","lastName":"Obeid","suffix":""},{"id":410105401,"identity":"dbceef9d-658c-4f25-ae70-050b8c541dc1","order_by":7,"name":"Souheil Hallit","email":"","orcid":"https://orcid.org/0000-0001-6918-5689","institution":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon","correspondingAuthor":false,"prefix":"","firstName":"Souheil","middleName":"","lastName":"Hallit","suffix":""}],"badges":[],"createdAt":"2025-02-02 12:11:21","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5945662/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5945662/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77106100,"identity":"79afae12-9e97-472f-8c7c-b302e0a99d57","added_by":"auto","created_at":"2025-02-25 08:10:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18462,"visible":true,"origin":"","legend":"\u003cp\u003eScree plot deriving from the exploratory factor analysis of the physical activity index items in the total sample.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5945662/v1/d64cc3aa078fb3098a3de2c5.png"},{"id":77106511,"identity":"fe196709-6731-45d8-87ac-f1dad220e7e6","added_by":"auto","created_at":"2025-02-25 08:18:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":957799,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5945662/v1/0a7cc74c-696f-4cae-ab28-417b9f9670fa.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eArabic Translation and Psychometric Testing of the Physical Activity Index (PAI)\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePhysical activity (PA) refers to any movement of the body generated by skeletal muscles that leads to the expenditure of energy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and can be classified as structured or incidental. Structured PA is intentionally planned and performed with the aim of enhancing health and fitness, while incidental PA is unplanned and occurs as part of everyday tasks at work, home, or during transport [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The four dimensions of physical activity include (1) mode or type of activity, which refers to the specific kind of physical activity, such as walking, gardening, cycling, or categorizing activities as aerobic versus anaerobic, resistance or strength training, and balance or stability training; (2) frequency, which indicates how often the activity is performed, typically measured as the number of sessions per day or week; (3) duration, referring to the amount of time spent on the activity, measured in minutes or hours, within a defined time frame such as a day, week, month, or year; and (4) intensity, an indicator of the metabolic demand of the activity describing the level of effort involved [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eModernization has led to increasingly sedentary lifestyles due to the reliance on motorized transportation, elevators, mechanization, and the growing use of screens for work, education, and leisure activities [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In 2022, nearly one-third of adults worldwide (31%) failed to meet the recommended levels of physical activity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. That is, they did not achieve at least 150 minutes of moderate-intensity physical activity, or 75 minutes of vigorous-intensity activity, or an equivalent combination per week, as outlined in the 2020 World Health Organization (WHO) guidelines [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This marks a five-percentage increase in insufficient physical activity from 2010 to 2022. If this trend continues, the global prevalence of inadequate physical activity is projected to reach 35% by 2030. Consequently, the World Health Assembly's target of a 15% relative reduction in insufficient physical activity between 2010 and 2030 is unlikely to be achieved [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEngaging in regular physical activity positively impacts physiological and mental well-being, while the lack of it exerts negative effects. One of its most notable benefits is its role in preventing non-communicable diseases (NCDs), such as type 2 diabetes, cardiovascular conditions, and cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It also has the potential to act as a protective factor against cognitive decline, reducing the risk of dementia and Alzheimer's disease [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The anxiolytic effect of PA is documented as well, with evidence supporting its role as an efficacious intervention for managing anxiety and stress-related disorders [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, physical activity interventions contribute to the cessation or reduction of substance use in individuals with substance use disorder [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, existing research has reported positive associations between PA and emotional intelligence (EI), suggesting that increased PA predicts a higher EI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the significance of a physically active lifestyle for physical and mental health and the economic burden associated with inactivity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], it is essential to monitor PA and consider strategies to promote activity participation. Objective (e.g., accelerometers) and subjective (e.g., self-report questionnaires) measurement tools exist for assessing physical activity. The choice of an assessment method depends on several factors, such as the purpose of the assessment, the characteristics of the target population, available resources, the level of precision required, and the speed at which the results are needed [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Accelerometers can record high-resolution data; however, they often lead to compliance concerns, such as participants forgetting to wear the device, and their high-cost limits researchers' ability to study large populations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. On the other hand, self-administered questionnaires, while less accurate, can be distributed electronically, maximizing scalability and the speed of data collection and minimizing costs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nevertheless, ensuring acceptable psychometric properties in self-report questionnaires remains an important consideration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of various physical activity measures prevents international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed between 1997 and 1998 by an International Consensus Group as an instrument for cross-national monitoring of physical activity for young to middle-aged adults. It exists in two forms, short and long, and has been validated for PA assessment in many countries [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, it has been reported to be user-unfriendly, difficult to answer for many respondents, and requiring extensive calculations as one of its main disadvantages [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Physical Activity Index (PAI) is another self-report questionnaire for PA assessment in adults. Besides consisting of only three items considering the critical dimensions of PA (intensity, duration, and frequency), it is easy to answer and score, time-sparing, and cost-effective [\u003cspan additionalcitationids=\"CR19 CR20 CR21\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although the PAI has been extensively used in previous studies in Lebanon [\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], this questionnaire had not been subjected to exploratory factor analysis (EFA), and its psychometric properties have not been evaluated in Arabic-speaking populations to the best of our knowledge. EFA is a statistical technique essential for validating measurement instruments. It helps identify the factors (also referred to as dimensions, latent variables, hypothetical constructs, synthetic variables, or internal attributes) that explain the covariation observed among a set of measured variables and helps detect items that do not empirically pertain to the intended construct and that should be removed from the questionnaire [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Lebanon, according to WHO statistics in 2022, the prevalence of physical inactivity among adults aged 18 years or over was 40% in males and 33% in females, and the mortality rate in the total population due to chronic noncommunicable diseases (NCDs) was 89%. The direct healthcare costs attributable to NCDs and mental health associated with physical inactivity amounted to US\u003cspan\u003e$\u003c/span\u003e 45,469,723 per year [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study intends to provide a culturally and linguistically adapted tool that can offer insights into physical activity levels, supporting public health initiatives and research efforts aimed at monitoring and promoting physical activity in Lebanon and similar Arab-speaking regions to combat physical inactivity and its associated health risks. For practical reasons, such as time efficiency, cost-effectiveness, and ease of scoring, and due to the scarcity of validated questionnaires for assessing physical activity in Lebanon [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], this study aimed to evaluate the psychometric properties of the Arabic version of the PAI among a sample of Lebanese adults from the general population. The objectives of the study were as follows: (1) translate the English version of the PAI into Arabic, (2) conduct an exploratory factor analysis to identify the factor structure of the PAI, and (3) assess the internal consistency, convergent validity, and concurrent validity of the PAI. We expect the scale will show a unifactorial structure and good internal consistency. We also hypothesize that the convergent and concurrent validity of the Arabic PAI will be established by positive correlations between the PAI score and scores of related measures (exercise, general physical condition, general well-being, and emotional intelligence).\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data Collection and Sampling Procedure\u003c/h2\u003e \u003cp\u003eThis cross-sectional study, conducted from December to January 2021, included 462 participants. Recruitment via the snowball method targeted a sample of Lebanese citizens aged 18 or older. A Google Forms survey, disseminated on social media platforms, was used for data collection. The research team initially shared the survey link with potential participants, who were encouraged to share it further in their networks with other eligible individuals. The survey was anonymous. Participants provided electronic informed consent before accessing the questionnaire. Participation was voluntary and unpaid.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Minimal Sample Size Calculation\u003c/h2\u003e \u003cp\u003eAccording to Comrey and Lee, at least 10 participants are required per scale item to avoid computational difficulties [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Consequently, this study required a minimum sample size of 30 participants to conduct exploratory factor analysis, as the PAI questionnaire consists of three items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Questionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire, written in Arabic\u0026mdash;the official language of Lebanon\u0026mdash;began with an introduction outlining the study\u0026rsquo;s objectives and included an online consent form to confirm voluntary participation and ensure the confidentiality and anonymity of responses. The sociodemographic section collected data on age, sex, marital status, education level, and the Household Crowding Index (HCI), an indicator of socioeconomic status (SES). The HCI was calculated by dividing the number of household members by the number of rooms (excluding the kitchen and bathrooms), with higher scores denoting lower SES [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Participants were then asked to assess their physical activity, healthy lifestyle (HL), general well-being, and emotional intelligence using self-administered scales provided as part of the questionnaire, described as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003ePhysical Activity Index (PAI)\u003c/em\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]: The questionnaire parameters are the intensity, duration, and frequency of physical activity. The scoring range for each parameter is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The PAI, ranging from a minimum of 1 to a maximum of 100, is obtained by multiplying the score for each parameter: PAI\u0026thinsp;=\u0026thinsp;Intensity \u0026times; Duration \u0026times; Frequency. The total score can then be evaluated and categorized as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Higher score reflects more active lifestyle and higher activity level.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScoring range for assessment of self-evaluated physical activity level using the Physical Activity Index.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eIntensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSustained heavy breathing and perspiration\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntermittent heavy breathing and perspiration, as in tennis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerately heavy, as in cycling and other recreational sports\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate, as in volleyball, softball\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLight, as in fishing\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOver 30 minutes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 to 30 minutes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 to 20 minutes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than 10 minutes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 to 7 times per week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 to 5 times per week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 to 2 times per week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA few times per month\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than once a month\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of physical activity score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eActivity Category\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81 to 100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery active lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60 to 80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActive and healthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40 to 59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcceptable but could be better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20 to 39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot good enough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSedentary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery poor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eHealthy Lifestyle Screening Tool (HLST)\u003c/em\u003e [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]: The HLST, designed to evaluate HL in young adults, comprises 36 items divided into 9 factors, with 4 items per factor. The factors include sunlight, water, air, rest, exercise, nutrition, temperance, trust, and general physical condition. Responses are rated on a 4-point Likert scale, where 4 corresponds to \u0026ldquo;strongly agree,\u0026rdquo; 3 to \"agree,\u0026rdquo; 2 to \u0026ldquo;disagree,\u0026rdquo; and 1 to \u0026ldquo;strongly disagree.\u0026rdquo; The total HLST score ranges from 36 to 144, while each factor-specific score ranges from 4 to 16. Higher scores on the HLST indicate a healthy lifestyle, and elevated scores in individual factors indicate greater adherence to the corresponding dimension of an HL. In this study, only the exercise (items 17 to 20) and general physical condition (items 33 to 36) factors were used in the analysis (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.73).\u003c/p\u003e \u003cp\u003e \u003cem\u003eGeneral Well-Being Schedule (GWBS)\u003c/em\u003e [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]: The 18-item questionnaire assesses well-being over the past month across six domains: anxiety, depression, positive well-being, self-control, vitality, and general health. The first 14 items are rated on 6-point scales that measure intensity or frequency, with responses assigned numeric values from 0 to 5. The remaining four items use 0 to 10 rating scales defined by contrasting adjectives at each end. For scoring, the polarity of items 1, 3, 6, 7, 9, 11, 13, 15, and 16 is reversed. Subscale scores are summed to produce a total score ranging from 0 to 110. Higher scores indicate positive well-being, while lower scores reflect distress (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.89).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAssessing Emotions Scale (AES)\u003c/em\u003e [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]: Validated in Arabic (AES-Ar) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], this 33-item scale uses a 5-point Likert scale for responses, ranging from 1 (strongly agree) to 5 (strongly disagree). Three items (5, 28, and 33) are negatively worded, with agreement indicating lower emotional intelligence, and are reverse-coded. The total score is calculated by summing all item scores, with higher scores reflecting greater emotional intelligence (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.96).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Arabic Translation of the PAI\u003c/h2\u003e \u003cp\u003eThe forward-backward translation method was applied to the PAI per guidelines for the cross-cultural adaptation of self-report measures [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. A bilingual translator, whose native language is Arabic and who is proficient in English, translated the English version of the index into Arabic. An expert committee, consisting of the forward translator and healthcare professionals, then reviewed the Arabic translation to resolve any identified issues by consensus. Next, a translator, whose native language is English and who had no prior exposure to the original scale, translated the Arabic version back into English. An expert committee, which included both the forward and back translators along with healthcare professionals, compared the original English version and the back-translated version to detect and address any inconsistencies, ensuring semantic, idiomatic, experiential, and conceptual equivalence. Finally, the Arabic version was subjected to a pilot test with a group of 30 adults to assess its clarity and comprehensibility.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe SPSS software v.27 was used to analyze the data. An exploratory factor analysis was initially conducted to identify which items would load on which factor. The Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) and the \u003cem\u003ep\u003c/em\u003e-value obtained from Bartlett\u0026rsquo;s test of sphericity were computed to evaluate the adequacy of the data using the varimax rotation since items were not correlated. Factors with eigenvalues larger than one were retained and the scree plot method was used for determining the number of components to extract. Items with a loading\u0026thinsp;\u0026gt;\u0026thinsp;0.4 were kept. The reliability analysis using Cronbach\u0026rsquo;s alpha was recorded. Comparison of PAI scores between genders was done using the Student\u0026rsquo;s t test. The PAI total score was considered normally distributed, as the skewness and kurtosis values were between \u0026plusmn;\u0026thinsp;1; consequently, the Pearson test was used to assess the correlation between the PAI score and other scores (exercise, general physical condition, general well-being, and emotional intelligence).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants Characteristics\u003c/h2\u003e \u003cp\u003eFour hundred sixty-two participants completed the survey, with a mean age of 25.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.69 years and a mean HCI of 1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 persons/room, 70.3% females, 76.4% single, and 90.3% with a university education level. An active and healthy lifestyle characterized 7.4% of participants, whereas more than half of them (51.9%) were evaluated as sedentary, which means they are physically inactive. Results of all the descriptive variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive variables of the study population (N\u0026thinsp;=\u0026thinsp;462).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e325 (70.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e364 (78.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery active lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive and healthy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcceptable but could be better\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot good enough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 (51.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold crowding index (persons/room)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical activity index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;18.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral physical condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.40\u0026thinsp;\u0026plusmn;\u0026thinsp;17.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107.78\u0026thinsp;\u0026plusmn;\u0026thinsp;20.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Exploratory Factor Analysis\u003c/h2\u003e \u003cp\u003eThe varimax rotation was applied since the items were not correlated as shown by the anti-image. The three items loaded on one factor (as confirmed by Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), explaining a total of 63.47% variance in the total sample. The KMO was modest (=\u0026thinsp;0.576), with a significant Bartlett\u0026rsquo;s test of sphericity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating the sample is acceptable and the data is suitable for factor analysis. The loading factors and communality values were adequate. The Cronbach\u0026rsquo;s α value (=\u0026thinsp;0.71) was satisfactory in the total sample (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLoading factors of the physical activity index (PAI) items deriving from the exploratory factor analysis using the varimax rotation in the total sample, and in males and females exclusively.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal sample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFactor loading\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCommunality\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAI frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAI duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAI intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.879\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercentage of variance explained\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e63.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e69.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e60.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCronbach\u0026rsquo;s α\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Physical Activity Index in Total Sample and Comparison between Males and Females\u003c/h2\u003e \u003cp\u003eIn the total sample, the mean PAI was 23.15\u0026thinsp;\u0026plusmn;\u0026thinsp;18.81, categorized as poor. No significant difference in PAI scores was found between males and females (25.85\u0026thinsp;\u0026plusmn;\u0026thinsp;21.32 vs 22.01\u0026thinsp;\u0026plusmn;\u0026thinsp;17.55, t(460)\u0026thinsp;=\u0026thinsp;1.86, p\u0026thinsp;=\u0026thinsp;0.064, Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.205).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Convergent and Concurrent Validity\u003c/h2\u003e \u003cp\u003eConvergent validity was assessed by examining the correlation between the PAI and exercise scores. Concurrent validity was assessed by examining the correlations between the PAI and general physical condition, well-being, and emotional intelligence. Higher PAI was significantly associated with higher exercise, general physical condition, general well-being, and emotional intelligence scores (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation matrix.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Physical activity index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.50***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. General physical condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. General well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Emotional intelligence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eTo our knowledge, this study is the first to assess the psychometric properties of the PAI among adults in Lebanon, providing the first validation of the instrument in a country within the Arabic-speaking Middle East and North Africa region. Overall, statistical results indicated that the Arabic PAI has a unidimensional factor structure, acceptable reliability, and gender invariance, and they supported its convergent and concurrent validity in a sample of adults within the Arabic-speaking Lebanese population.\u003c/p\u003e \u003cp\u003eTo address the objectives of the study, the factor structure of the PAI was analyzed. The EFA resulted in a single-factor solution for the three items, with a 63.47% of variance explained. The factor loadings for all three items exceeded the cut-off value of 0.4 [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], as did the communality values (with a cut-off value of 0.25) [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], suggesting that the factor is well-defined. In other words, the items are effective indicators of the physical activity construct. Beyond factor structure, another important psychometric property that we sought to assess is the internal consistency of the PAI. The obtained Cronbach\u0026rsquo;s alpha of 0.71 indicates acceptable reliability [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A comparison with the literature was not possible because we were not able to find previous studies reporting values related to the PAI psychometric properties.\u003c/p\u003e \u003cp\u003eTo examine gender invariance of the PAI, an EFA was conducted separately for males and females. The results revealed that the unidimensional factor structure was consistent across genders, with comparable factor loadings and communalities for the three items. The percentage of variance explained was higher for males (69.39%) than for females (60.96%), though both values exceeded the acceptable threshold of 60% [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additionally, while the Cronbach\u0026rsquo;s α value indicated higher internal consistency for males (0.78) compared to females (0.68), the reliability was deemed acceptable for both groups [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. These findings suggest that the PAI shows sufficient gender invariance and can be used for assessing physical activity in both genders.\u003c/p\u003e \u003cp\u003eIt is generally believed and consistently documented that men are more physically active than women [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which can be attributed to disparities in time availability, as women often shoulder greater family responsibilities, reducing the time they can dedicate to physical activity [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Additionally, men may exhibit higher intrinsic motivation, predictive of long-term exercise adherence, driven by factors like strength, competition, and desire to achieve mastery, compared to women, who are often motivated by extrinsic factors related to physical attractiveness and appearance [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Biological differences, such as variations in muscle mass and cardiovascular capacity, may also influence physical activity [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In our study, although the mean PAI scores were slightly higher for males than females, the difference was not statistically significant. Both genders had physical activity levels categorized as poor, aligning with findings from a 2020 pilot study reporting suboptimal physical activity levels among Lebanese adults [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], underscoring the need for public health strategies to promote physical activity engagement across the population. Previous research has identified several barriers to physical activity, such as lack of a safe environment, insufficient facilities, cost considerations, time constraints, lack of motivation, absence of a workout companion, and physical conditions, which may contribute to low physical activity levels [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the assessment of convergent validity, it was supported by a significant positive correlation between the PAI and Exercise scores. Additionally, concurrent validity was tested by showing that the PAI scores positively correlated, as theoretically expected, with other relevant constructs, including general physical condition, general well-being, and emotional intelligence. Our results align with existing literature reporting that higher levels of physical activity were associated with blood pressure reduction in adults with hypertension [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], improved glycemic control in patients with type 2 diabetes mellitus [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], alleviation of symptoms in constipation patients [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], enhanced memory function [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], increased emotional intelligence [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], greater life satisfaction [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], higher psychological well-being [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e], and a reduction in symptoms of depression [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study has some limitations that should be considered. First, the KMO value in the total sample was modest. However, it was higher than the bare minimum of 0.5 for factor analysis [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Second, sampling bias may have been introduced by the snowball sampling method, which often recruits interconnected participants, potentially resulting in a non-random sample and restricting its representativeness of the wider population. Third, the sample had a large percentage of female participants (70.3%), which could be explained by the fact that women tend to be more willing to participate in online surveys than men [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Additionally, the study was conducted on a sample of young adults from a single country and culture, Lebanon, which may limit the generalizability of the findings to other age groups and the entire Arab world. Therefore, further validation of the PAI is needed in different age groups and other Arab countries. Another limitation is the use of self-report measures, which may have led to information bias, as participants might have misinterpreted certain statements or underrated or overrated some items. Moreover, causality cannot be inferred as the study was conducted at a one-time point, restricting the analysis to identifying only correlations between the measures. Besides, the HLST and GWBS were not previously validated in Arabic, but showed acceptable internal reliability in this study. Lastly, while some psychometric properties were assessed for the Arabic PAI, other aspects, such as test-retest reliability, were not explored and still need to be considered in future research. Furthermore, the validity of the Arabic version of the PAI compared to a gold-standard criterion measure of physical activity could be studied in the future.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePractical Implications\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWith these preliminary findings supporting its validity, the Arabic version of the PAI appears to have potential for use by researchers and public health policymakers in large-scale population studies; its low cost, short completion time, easy scoring, and suitability for the adult Lebanese population make it a practical tool for assessing physical activity trends and informing evidence-based public health strategies. Additionally, it can benefit clinicians by enabling them to estimate physical activity levels, design tailored PA plans for individuals with low activity levels, and they can integrate this index into programs to track individuals' progress toward a more active lifestyle.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eTo our knowledge, this study is the first to cross-culturally validate the PAI in the Arabic language. The Arabic version of this index revealed a unifactorial structure with acceptable psychometric properties. Nevertheless, further research is needed to confirm its validity, ensure that it is gender invariant, explore additional psychometric properties, and validate the index across diverse age groups and Arab countries to expand its applicability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe Psychiatric Hospital of the Cross-ethics committee approved the study protocol (HPC-046-2020). Written informed consent was obtained from all patients upon submitting the online survey. All methods were performed in accordance with the relevant guidelines and regulations (in accordance with the Declaration of Helsinki).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are not publicly available due the restrictions from the ethics committee, but are available upon a reasonable request from the corresponding author (SH).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSO, FFR and SH\u0026nbsp;designed the study; MF collected the data, MA drafted the manuscript; SH carried out the analysis and interpreted the results; RH, DM and SEK reviewed the final manuscript; all authors approved the final version and gave their consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors would like to thank all participants and Dr Marwan Akel for his help in the data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCaspersen, C.J.; Powell, K.E.; Christenson, G.M. 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Int J Environ Res Public Health \u003cstrong\u003e2022\u003c/strong\u003e\u003cem\u003e, 19\u003c/em\u003e, 4282.\u003c/li\u003e\n\u003cli\u003eChen, C.; Beaunoyer, E.; Guitton, M.J.; Wang, J. Physical Activity as a Clinical Tool Against Depression: Opportunities and Challenges. J Integr Neurosci \u003cstrong\u003e2022\u003c/strong\u003e\u003cem\u003e, 21\u003c/em\u003e, 132.\u003c/li\u003e\n\u003cli\u003eUl Hadia, N.; Abdullah, N.; Sentosa, I. An Easy Approach to Exploratory Factor Analysis: Marketing Perspective. JESR \u003cstrong\u003e2016\u003c/strong\u003e\u003cem\u003e, 6\u003c/em\u003e, 215\u0026ndash;223.\u003c/li\u003e\n\u003cli\u003eSmith, W. Does Gender Influence Online Survey Participation? A Record-Linkage Analysis of University Faculty Online Survey Response Behavior. \u003cstrong\u003e2008\u003c/strong\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon","isAcceptedByJournal":false,"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":"Physical activity, physical activity index, PAI, psychometric properties, Arabic","lastPublishedDoi":"10.21203/rs.3.rs-5945662/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5945662/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Regular physical activity benefits both physical and mental health. Yet, physical inactivity remains widespread, including in Lebanon, with significant health consequences. While objective and subjective tools for measuring physical activity exist, self-report questionnaires like the Physical Activity Index (PAI) are practical and cost-effective for large-scale population studies. However, the PAI has not been validated in Arabic-speaking populations. This study intended to evaluate the psychometric properties of an Arabic translation of the PAI, with the aim of providing an adapted tool to assess physical activity, and support public health initiatives and research efforts in Arab-speaking regions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe forward-backward translation method was adopted.\u003cstrong\u003e \u003c/strong\u003eData was collected through a one-time online survey from a sample of Lebanese adults (N = 462; mean age = 25.85 ± 9.69 years; 70.3% females).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eExploratory factor analysis revealed a single-factor structure for the Arabic version of the PAI. A Cronbach’s alpha of 0.71 indicated acceptable internal consistency. The factor structure was invariant across gender, with acceptable internal consistency for males (α = 0.78) and females (α = 0.68). In the total sample, the mean PAI was 23.15 ± 18.81, indicating poor physical activity, with no significant gender differences (males: 25.85 ± 21.32, females: 22.01 ± 17.55; t(460) = 1.86, p = 0.064). Convergent validity was supported by a significant positive correlation between PAI and Exercise scores (r = 0.50; p\u0026lt; 0.001). Concurrent validity was confirmed through positive correlations between PAI scores and general physical condition (r = 0.14; p\u0026lt; 0.01), general well-being (r = 0.18; p\u0026lt; 0.001), and emotional intelligence scores (r = 0.15; p\u0026lt; 0.01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThese preliminary findings indicate that the Arabic version of the PAI has acceptable psychometric properties and holds potential for use in large-scale population studies due to its low cost, easy scoring, quick completion time, and suitability for the Lebanese young adult population. Further research is needed to confirm its validity and expand its applicability across different age groups and Arab countries.\u003c/p\u003e","manuscriptTitle":"Arabic Translation and Psychometric Testing of the Physical Activity Index (PAI)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-25 08:09:28","doi":"10.21203/rs.3.rs-5945662/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":"aa2f9133-802a-4bac-ad6d-1e308070676f","owner":[],"postedDate":"February 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44830144,"name":"Psychology"}],"tags":[],"updatedAt":"2025-02-25T08:09:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-25 08:09:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5945662","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5945662","identity":"rs-5945662","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}