# IPAQ-L and CPET Usefulness in a North-Eastern Romanian Population Undergoing Cardiac Rehabilitation
## 4 Discussion

Table 5: Correlations between CPET parameters and IPAQ-L questionnaire. closer to the real ones than those who filled in the IPAQ questionnaire by themselves [17], we decided to use this approach in our evaluation. Although it has been reported that the IPAQ-L is associated with greater overestimation of total PA compared to the IPAQ Short Form [10], its advantage consists in its capacity to differentiate domain-related PA, offering a detailed picture of the study group's activity patterns. Such data may be useful in the creation of effective intervention programs to combat sedentary behavior [19]. Despite the fact that other authors have reported a negative correlation between physical activity levels and BMI [20], we did not find any significant correlation between BMI or AC and weekly PA in the analyzed domains. In 2019, [PERSON] et al. showed that males exert a greater amount of moderate to vigorous daily effort (mostly occupational and leisure-related) while females spend less time performing PA, and it is generally in household-related areas [20]. Although it has been reported that gender substantially influences the amount and type of PA, both males and females from our study group exerted similar physical effort, as assessed via the IPAQ questionnaire. In our study, moderate PA was the most common activity form for both genders and, although males reported a higher number of weekly METS than females, the difference did not achieve statistical significance. Females performed more moderate activities inside their homes and the total number of METS reported in the domestic and garden domain was not statistically significant. The difference between the amount of vigorous PA performed by males versus females in the domestic and garden domain reached borderline correlation. The time spent on leisure activities as evaluated by the IPAQ is considered to be the most consistent compared to the other domains [21]. Leisure time physical activity exhibits a north-to-south decline in the European Union, ranging from 24 MET-hours/week in Sweden to less than 10 MET-hours/week in southern countries such as Portugal, Spain, Italy and Greece. The average physical leisure activity time in our study group was 512.14 (\(\pm\)1049.75) MET-minutes/week, similar to other southern European countries [21; 22]. The utility of IPAQ-L in adults with type 2 diabetes, with and without peripheral neuropathy, has been studied by [PERSON] et al. [23]. The authors demonstrated that patients with type 2 diabetes and peripheral neuropathy were significantly less active than people with type 2 diabetes alone (\(p\) = 0.04). A recent study comparing direct assessment of PA with IPAQ and indirect assessment of PA with accelerometry in patients with type 2 diabetes showed that there was no significant difference between the two methods (\(p\) < 0.05). Therefore, their findings indicate that the IPAQ may serve as a potential tool for PA assessment in patients with type 2 diabetes [24]. In patients with hypertension, [PERSON] et al. [25] showed a low agreement between self-reporting of adherence to PA in the clinical setting and in IPAQ interviews. Moreover, the authors noted that the PA recommendation has a low association with BP control in the clinical setting, suggesting that medical advice alone is not able to translate the effectiveness of supervised PA demonstrated in clinical trials to clinical practice. For sedentary hypertensive females, [PERSON] et al. [26] showed that self-reported PA using IPAQ was predominantly related to domestic (\(p\) = 0.018) and work activities (\(p\) = 0.001) at moderate intensity. Therefore, IPAQ appears to be an adequate instrument to assess the energy expenditure of hypertensive patients and its impact on their aerobic capacity. Although previous studies have found an age-related decrease in PA [27; 28], the correlation only reached a borderline value in our analysis.