Obesity is a worldwide epidemic that results from alterations in regulation of energy intake, energy expenditure, and storage [1]. Obesity is associated with an array of cardiometabolic conditions such as type 2 diabetes (T2D) [2]. In the USA, approximately 33 % of the population is obese [3] with variations in prevalence by region as well as race and ethnicity. Latinos living in the USA have a higher prevalence of obesity (38.7 %) and metabolic diseases compared to non-Hispanic Whites (32.8 %). [3–5] Latinas, in particular, are more negatively impacted with an obesity prevalence of 45.1 % compared to 35.5 % for all non-Latina women [3]. Physical inactivity is a known risk factor for obesity and diabetes [6]. Increasing the level of physical activity improves metabolic status, insulin sensitivity, and is an effective therapeutic strategy for management and prevention of obesity and T2D [7–12]. Understanding free-living physical activity patterns of Latinas could inform interventions aimed at reducing sedentary time and increasing physical activity in this vulnerable population.

The Centers for Disease Control and Prevention’s 2008 Physical Activity Guidelines for Americans suggest that adults should perform at least 150 min of moderate-intensity (i.e., brisk walking) or 75 min of vigorous-intensity (i.e., jogging or running) aerobic activity every week and 2 or more days a week of muscle-strengthening activities [13]. Less than half of adults in USA meet the 2008 Physical Activity Guidelines [14]. Overall, physical activity in Latinos was previously reported to be markedly less than non-Latinos in the USA [15–20]. This changed when nationally representative samples began using an accelerometer to objectively measure physical activity. More recent studies report that Latinos are more physically active compared to non-Latinos in the USA [21, 22].

Latinos are now the largest ethnic minority population in the USA and the fastest growing minority group in the Southeastern region of the USA [23]. Seven of the states with the largest percent increase in their Latino population are found in the Southeastern USA, where obesity rates are among the highest in the nation [23]. However, information about free-living physical activity levels of Latina women living in the USA is limited in general and is particularly absent with regard to those women living in emerging communities in the Southeast. Accelerometers are validated for physical activity measurement in Latina women, but cost and participant burden may be prohibitive [24]. The Global Physical Activity Questionnaire (GPAQ) is a self-report measure that has been validated in many populations to be a suitable assessment of physical activity and thus potentially provides a fast and affordable way to assess physical activity in community-based settings [25, 26]. The primary objective of this study was to assess the patterns of physical activity in a sample of overweight, Mexican, or Central American Latina immigrants in a Southeastern region of the USA using two methods of assessment, specifically the GPAQ as a self-report measure versus accelerometer data. In this study, we assessed patterns using each method and compared the results from each. We also evaluated the association of demographic and health parameters with physical activity in the women.

Methods

Participants

Foreign-born Latina women of at least 19 years of age with BMI ≥25, not pregnant, non-diabetic were recruited through a local safety-net hospital, multicultural center, and by word-of-mouth to participate in a weight loss/diabetes prevention program, ESENCIAL Para Vivir (in English, Essential for Life). Of the 147 women approached, 74 agreed to participate. However, 15 of those women did not meet eligibility requirements (BMI < 25, diagnosed diabetes, or taking weight loss medication). Top reasons for declining to participate included not having enough time and inflexible work hours. Baseline data used in this study were obtained during October 2010 and February 2011 prior to the program from women who wore the accelerometer for a minimum of 4 days (n = 44). All participants provided informed consent in their native language (Spanish). A trained bilingual member of the study staff completed informed consent and administered the survey instruments and measurements. The University of Alabama at Birmingham’s Institutional Review Board approved all study protocols and documents.

Height and Weight

Height and weight were measured using standardized protocols. Height was measured using a portable stadiometer (Seca 217, Seca, Columbia, MD) to the nearest centimeter. Weight was measured using an electronic scale (Health-O-Meter Professional 349KLX, Health-O-Meter, Boca Raton, FL) to the nearest 0.1 kg.

Questionnaires

Surveys were administered in-person by a trained bilingual/bicultural interviewer in 45 min or less. We measured self-rated health status with the following survey question, “compared to other people your age, would you say your health is excellent, very good, good, fair or poor?” [27]. For ease of interpretability and consistent with previous research, we collapsed responses to the self-rated health question into two categories: excellent/very good/good, and fair/poor [28, 29]. The Patient Health Questionnaire (PHQ-8) was used to assess depressive symptoms [30]. The Spanish version has been previously validated and widely used to assess depressive symptoms in the US Latino population [31]. A cut-point of 10 or greater was used to indicate moderate to severe depressive symptoms. The Global Physical Activity Questionnaire (GPAQ) was used to assess self-reported physical activity. The GPAQ assesses the following three domains of physical activity by intensity (moderate or vigorous) as minutes per week during a typical week: (1) occupational physical activity, (2) physical activity for transportation (walking, biking to work), and (3) recreational or leisure-time physical activity. Finally, the GPAQ assesses time spent in non-sleep sedentary activity (watching TV, traveling in a car, etc.). Minutes spent in moderate, vigorous, and sedentary intensities were summed. The GPAQ has been used in a number of different countries, including among Latinos living in the USA [26, 25].

Accelerometer

Participants wore an MTI Actigraph accelerometer (GT1M, ActiGraph Health Services, Pensacola, FL) for 4 days (3 weekdays and 1 weekend day) to objectively measure physical activity levels. Epoch length was set at 1 min, and results were expressed as counts per minute (counts/min−1). Monitors were worn on an elastic belt at the waist over the right hip, with removal only occurring during activities such as sleeping, bathing, and swimming. Actigraph monitors have been shown to exhibit a high degree of inter-instrument reliability [24]. Outcome measures included time spent in four intensities of physical activity: non-sleep sedentary, light, moderate, and vigorous activity.

Statistical Analysis

Descriptive statistics were tabulated as the mean (SD) or number (%). The association between accelerometer data and the GPAQ for minutes per day of sedentary and active categories was analyzed with nonparametric Spearman partial correlations adjusting for age and BMI. Analysis of variance with Tukey’s post hoc test was utilized to compare mean accelerometer and GPAQ data between overweight (BMI 25–29.9), obese class I (BMI 30–34.9), and obese class II (BMI ≥ 35) participants. Unadjusted Spearman correlations were used to determine which population characteristics were associated with sedentary time, moderate and vigorous physical activity as measured by the accelerometer. All analyses were conducted using SAS version 9.3 (SAS Institute Inc., Cary, NC, USA) with a significance level of p < 0.05 (Fig. 1).

Fig. 1
figure 1

Spearman correlation between self-report minutes of physical activity (GPAQ) and accelerometer-determined minutes among Latina participants in ESENCIAL Para Vivir pilot intervention. Data adjusted for age and body mass index

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Results

Characteristics of the sample are shown in Table 1 as mean ± standard deviation or as proportions. Participants included 44 overweight and obese Latina immigrants age 36.6 ± 7.8 years with BMI 33.3 ± 5.2; 83.3 % of the sample were immigrants from Mexico. Average years in the USA were 12.8 ± 6.1 years, and average years in Alabama was 9.4 ± 5.3 years. Fifty percent of the sample was unemployed. Of the 16 women who completed their education at high school or a higher level, 2 were college graduates. According to self-report, 36.4 % of the sample met physical activity recommendations while only 20.5 % met recommendations according to the accelerometer.

Table 1 Demographic characteristics of Latina participants in the ESENCIAL Para Vivir pilot intervention in Alabama, 2010–2011 (n = 44)
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GPAQ and Accelerometer Data

Mean and standard deviations for minutes per week of physical activity by self-report determined by the GPAQ and by the accelerometer are shown in Table 2. On average, women underestimated sedentary/sitting time and time spent in vigorous activity, but reported more time spent in moderate activity as compared to accelerometer estimates. Self-report and accelerometer data for sedentary time (r = 0.06; p = 0.68), moderate activity (r = 0.08; p = 0.61), and vigorous activity (r = −0.04; p = 0.79) were not significantly correlated. Models adjusted for age and BMI yielded similar results for sedentary time (r = 0.07; p = 0.67), moderate activity (r = 0.08; p = 0.61), and vigorous activity (0.01; p = 0.94) (Fig. 1).

Table 2 Self-reported minutes of physical activity (GPAQ) and accelerometer-determined minutes of activity per day categorized by activity type and obesity category among Latina participants in ESENCIAL Para Vivir pilot intervention (n = 44)
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Physical Activity Measure by BMI Category

We examined physical activity measure by BMI category to determine whether self-report and accelerometer physical activity differed by BMI (Table 2). BMI category (overweight, obese class I, obese class II) was not associated with differences in self-report versus accelerometer physical activity and sedentary time. When comparing accelerometer results only between the groups, women in obese class I were more active than overweight women (p < 0.01). Obese class I women also had less sedentary time compared to overweight women, though this was not significantly different (p = 0.07).

Relationship Between PA Measures and Demographic and Health Factors

Table 3 shows sociodemographic and health-related factors associated with minutes per day spent in sedentary, light, moderate, and vigorous activity as measured by the accelerometer. Years lived in the USA was positively associated with vigorous activity (0.32; p = 0.03). There was a trend with more years in the USA associated with greater moderate activity and less light activity. There was a positive trend for years lived in Alabama and sedentary time and an inverse trend for moderate activity. These results suggest that the more years lived in the USA, the more moderate and vigorous activity the Latina women did. However, the more time lived in Alabama, they were more likely to be sedentary and do less moderate activity. Full- or part-time employment was associated with decreased sedentary time and a trend for increased light activity. The health comparison was inversely associated with vigorous activity, and there was a trend for moderate activity, suggesting feeling good to excellent is related to less vigorous and less moderate activity.

Table 3 Correlation [R (p value)] between demographic/health factors and accelerometer-measured physical activity type among Latina participants in ESENCIAL Para Vivir pilot intervention (n = 44)
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Discussion

This study is the first of which we are aware to evaluate physical activity patterns in overweight Latina immigrants living in Alabama using two validated methods, the GPAQ evaluating perceived physical activity and the accelerometer capturing actual physical activity. In this sample of overweight and obese Latina immigrants, approximately one in five meet current US guidelines for physical activity. According to the accelerometer, Latinas were very sedentary, averaging 575 min/week (9.6 h/day) that accounted for approximately 69 % of waking time. In addition, women reported a high amount of sedentary time by self-report (GPAQ); however, they still underestimated the extent to which they were sedentary. The women estimated about 3–4 h of sitting time, when they are actually sedentary 9–10 h according to the accelerometer.

Our results indicated that Latinas overestimated time spent in moderate and vigorous physical activity according to the GPAQ. The GPAQ was developed in 2002 under the World Health Organization (WHO) during the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS) [25]. It has been validated in many countries as an acceptable method of assessing physical activity patterns among adults [25]. The inaccuracy in self-report of moderate physical activity of women in our study may be due to a disconnect in perception of intensity and/or time spent in physical activity. Inaccuracy in perception of physical activity may be an important consideration because those who perceive activity as harder than it actually is may be less likely to engage in physical activity, even when increased physical activity is prescribed. In addition, participation in physical activity may be influenced by body weight and fitness status. For example, a study by Hoos et al. concluded that the GPAQ accurately estimated physical activity in non-obese Latina women living in California [26]. However, the women in our study were all overweight or obese; therefore, weight may influence perception of, or likelihood to participate in physical activity.

A study by Aadahl et al. investigated the association between self-rated physical fitness and perceived exertion of 42 types of physical activities. Their findings indicated that self-rated physical fitness was negatively related to the rating of perceived exertion of specific activities [32]. Therefore, a fit individual may perceive moderate-intensity activities to be truly moderate, while unfit individuals may perceive light-intensity occupational, transportation, and leisure-time physical activities as moderate intensity. Importantly, the GPAQ asks about amount of time spent sitting and in moderate activity however skips time spent in light activity. Therefore, while women in our study may have perceived light-intensity physical activity as moderate, we are not able to determine whether that is true. This may have contributed to the discrepancy between the GPAQ and accelerometer data. Consequently, the questionnaire on average may only capture about 6 h worth of daytime activity while the accelerometer is measuring about 12–15 h.

The finding that self-rated health (SRH) was inversely associated with vigorous and moderate physical activity was unexpected and somewhat contradicts previous findings from our own group and others linking higher levels of physical activity with better perceived health [33, 34]. In a study by Kepka et al. among Latinos living in North Carolina, SRH was positively associated with higher levels of self-reported leisure-time physical activity [33]. In the current study, women who reported fair to poor perceived health were more likely to engage in moderate to vigorous activity as measured by the accelerometer. It is possible that this association relates to environmental exposure. In a study by Parkes et al., individuals in active or strenuous jobs reported lower SRH [34]. Thus, it is conceivable that women in this study who reported lower SRH were engaged in physically demanding jobs. However, the small sample size in this study prohibited additional analyses examining sub-groups and limits our ability to generalize. Future larger studies are needed to confirm these findings and tease apart the etiology as it relates to leisure time versus occupational physical activity.

Sedentary behavior is defined as activities eliciting an energy expenditure less than 1.5 times resting energy expenditure, such as sitting, reclining, and lying down during waking hours [35]. Importantly, sedentary behavior is associated with increased risk of obesity, cardiovascular disease, cognitive impairment, metabolic syndrome, and diabetes [36, 37]. Koster et al. used the National Health and Nutrition Examination Survey (NHANES) accelerometer data and reported that women over 50 years who spend more than 70.5 % of time in sedentary behavior had a five times greater risk of death compared to those who were less sedentary [38]. In comparison, Latina women in our study spent a close 69 % of waking time in sedentary behavior. Increased sedentary time prior to age 50 years may increase mortality above that reported by Koster et al. [38]. Our data reveal a lack of awareness regarding the extent of sedentary behavior among the women in our study and underscore the importance of promoting strategies aimed at decreasing sedentary time and increasing physical activity among Latina immigrants. Devices that provide feedback, such as pedometers, may heighten awareness of sedentary behavior and facilitate goal-setting behaviors for physical activity in this population.

Studies have shown a positive correlation between time spent in the USA and increased physical activity among Latino immigrants. Matthews et al. assessed overall activity in a nationally represented sample and found that Mexican-American adults were less sedentary than both non-Hispanic Whites and Blacks [21]. Mexican-American women age 20–39 years spent 6.75 h per day sedentary, which was less sedentary than non-Hispanic Whites and Blacks spending 7.49 and 7.8 h/day engaged in sedentary behavior, respectively [21]. In a similar study, Hawkins et al. reported that Hispanic women that were US residents age 40–59 years were more active than White and Black counterparts due to increased light physical activity [22]. This may be due to increased occupational physical activity as Latina immigrants commonly have non-sedentary jobs. Using the NHANES 2003–2004, Gay and Buchner reported Mexican-Americans with active occupations spent more time in light-intensity physical activity and less time engaged in sedentary activity compared to non-Hispanic White and Black adults [39]. In our cohort, 50 % were employed while 11 % were unemployed and 39 % were homemakers. We found an association between employment (full and part time) and decreased sedentary behavior and a trend for increased light activity. This suggests that those who are employed may spend less time sedentary, and instead spend that amount of time in light activity [40]. In agreement with previous studies [21, 22], we found time spent in the USA was associated with increased light, moderate, and vigorous activity by accelerometer. Interestingly though, years spent in Alabama was associated with increased sedentary time and decreased moderate physical activity. Our data are not surprising as Alabama and the Southeast region of the USA have a high prevalence of physical inactivity, obesity, and cardiometabolic disease [41]. According to the Centers for Disease and Prevention (CDC) and the self-report Behavioral Risk Factor Surveillance System (BRFSS), Alabama has a high incidence of overweight and obesity compared to other states in the USA. With 69 % of Alabamians overweight and 33 % obese, Alabama ranks 4th in obesity among the 50 states according to BRFSS and 14th according to the REsons for Geographic And Racial Differences in Stroke (REGARDS) study that directly measured BMI [42–44]. In 2010, Alabama had the highest percentage of US adults with diagnosed diabetes and prediabetes by state according to the CDC with 11.1 and 7 %, respectively [45]. Lifestyle behaviors are heavily influenced by socioeconomic, cultural, and contextual factors [46]. Physical activity patterns and dietary habits may be influenced as Latinas acculturate to attitudes, values, and behaviors typical of Alabama [47].

Our data suggest that patterns of physical activity among Latinos living in the USA should be examined by region before generalizations about trends related to length of stay in the USA are made. Further investigation of lifestyle factors that contribute to sedentary behavior among Latina immigrants in Alabama and areas in the southeast region of the USA is needed.

This study has several limitations. The study included a convenience sample of volunteers; therefore, generalizability of the findings are limited. In addition, the sample size was small and volunteers were overweight and obese further limiting generalizability. Our findings do however support future research evaluating physical activity patterns and validating self-report measures in Latina immigrants living in the southeastern region of the USA as there is a lack of research in current literature in this population. The accelerometer does not capture upper body movement that may have biased the assessment of the objective physical activity measure. Also, the current study provides estimates of physical activity patterns reported by average minutes per day that are influenced by both weekend days and weekdays. This is a potential limitation as patterns of behavior may vary on these days. Results of this study should be interpreted accordingly.

In summary, overweight and obese Latina immigrants living in Alabama are markedly more sedentary compared to national averages for women the same age. They overestimated the amount of time spent in moderate physical activity and underestimated time spent in sedentary activity suggesting that the GPAQ may not accurately reflect physical activity in this population. The disconnect between self-report of physical activity and actual physical activity as measured by the accelerometer suggests women may not be aware of the amount of time they spend active as compared to sedentary. A physical activity monitoring device, such as a pedometer, with a daily number of steps or activity level goal could provide women a simple self-assessment tool to increase awareness of and participation in physical activity. Future studies are needed to examine the extent to which self-monitoring could improve physical activity levels among Latinas living in emerging communities.