J Clin Epidemiol Vol. 52, No. 7, pp.

643–651, 1999 0895-4356/99/$–see front matter

Copyright © 1999 Elsevier Science Inc. All rights reserved. PII S0895-4356(99)00049-9

The Physical Activity Scale for the Elderly (PASE):

Evidence for Validity
Richard A. Washburn,* Edward McAuley, Jeffrey Katula, Shannon L. Mihalko,
Richard A. Boileau
Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana, Illinois

ABSTRACT. We assessed the validity of the Physical Activity Scale for the Elderly (PASE) in a sample of
sedentary adults (56 men, 134 women, mean age 6 [SD] 66.5 6 5.3 years) who volunteered to participate in a
randomized controlled trial on the effect of aerobic conditioning on psychological function. Construct validity
was established by correlating PASE scores with physiologic and performance characteristics: peak oxygen
uptake, resting heart rate and blood pressure, percent body fat, and balance. The mean PASE scores were higher
in men than in women (men 5 145.8 6 78.0; women 5 123.9 6 66.3, P , 0.05), and in those age 55–64 years
compared with those age 65 years and over (55–64 5 144.2 6 75.8; 65 and over 5 118.9 6 63.9, P , 0.05).
PASE scores were also significantly higher in those who did not report a chronic health condition
(cardiovascular disease, hypertension, cancer, or recent surgery). PASE scores were significantly associated (P ,
0.05) with peak oxygen uptake (r 5 0.20), systolic blood pressure (r 5 20.18) and balance score (r 5 0.20). No
significant associations of PASE score and diastolic blood pressure, resting heart rate, or percent body fat were
noted. These results provide additional evidence for the validity of the PASE as a measure of physical activity
suitable for use in epidemiology studies on the association of physical activity, health, and physical function in
older individuals. J CLIN EPIDEMIOL 52;7:643–651, 1999. © 1999 Elsevier Science Inc.

KEY WORDS. Aging, physical activity assessment, validity

INTRODUCTION (r 5 20.13), age (r 5 20.13) and sickness impact profile

score (r 5 20.42). There has been limited published infor-
Physical activity is thought to play an important role in the
mation relative to the validity of the PASE, mean values
maintenance of health and effective function in older peo-
for the PASE, or other PASE characteristics such as the
ple [1–6]. Recently, physical activity surveys specific to
sensitivity of PASE scores to change over time or the rela-
older adults have been developed [7–10] for assessing levels
tive contribution of leisure, household, and occupational
of physical activity, factors associated with physical activ-
activity to the total PASE score other than that from the
ity, and the association between physical activity and
initial development an evaluation study [9]. Schuit et al.
health and physical function in older people. One of these
[11] recently compared PASE scores from a slightly modi-
instruments, the Physical Activity Scale for the Elderly
fied version of the PASE with energy expenditure over a
(PASE) is a brief (5 minutes) and easily scored survey de-
2-week period measured by doubly labeled water in a sam-
signed specifically to assess physical activity in epidemio-
ple of 21 elderly Dutch men and women. They reported a
logic studies of persons age 65 years and older [9]. The
significant correlation of the modified PASE score with the
PASE score combines information on leisure, household,
residuals from a regression analysis using total energy ex-
and occupational activity and was systematically developed
penditure as the dependent and resting metabolic rate as
and validated in a sample of 277 community-dwelling older
the independent variable (r 5 0.58 [95% confidence inter-
adults, mean age 73 years [9]. Validity for the PASE was es-
val (CI) 5 0.50–0.81]). Schuit et al. [11] also noted higher
tablished by correlating PASE scores with health status and
PASE scores in women compared with men and suggested
physiologic measures. PASE scores were significantly (P ,
that this was due to a higher proportion of women partici-
0.05) associated with grip strength (r 5 0.37), static bal-
pating in housework and taking care of others, PASE items
ance (r 5 0.33), leg strength (r 5 0.25), resting heart rate
that have higher relative scoring weights. In addition, the
PASE is currently being used as a physical activity assess-
*Address correspondence to: Richard A. Washburn, Department of Kine- ment tool in samples that are younger and include a higher
siology, University of Illinois at Urbana-Champaign, Freer Hall, 906
South Goodwin Ave., Urbana, IL 61801. proportion of individuals who are employed compared with
Accepted for publication on 8 March 1999. the sample on which the PASE was originally developed
644
[12]. The purpose of the present analysis was to extend the
previous work to provide additional information relative to
the validity of the PASE in a sample of young-old individu-
als by comparing PASE scores with measures potentially af-
fected by physical activity (peak oxygen uptake, body fat
percent, resting heart rate, blood pressure, and balance [13–
23]). We were also interested in more closely examining
the PASE score to determine which components (leisure,
household, occupational) activity contribute most to the
total score and to determine how differences in the relative
importance of these components may differ by age and
gender.
METHODS
Participants
Sedentary, older adults were recruited through local media
advertising to participate in a 6-month randomized con-
trolled exercise trial to evaluate the effect of aerobic condi-
tioning on psychological function. Inclusion criteria were
as follows: (1) age 55 to 75 years; (2) sedentary, as defined
by a lack of regular involvement in exercise during the pre-
vious 6 months verified by exercise history and assessment
of aerobic capacity by maximal graded exercise testing; (3)
healthy to the degree that participation in exercise testing
and an exercise program would not exacerbate any existing
symptomology; (4) personal physician’s clearance; (5) ade-
quate mental status; (6) corrected (near and far) visual acuity
of 20/40 or better; and (7) no evidence of clinical depression.
An initial pool of 596 individuals indicated interest in
participation. Of the 596 potential participants, 363 indi-
viduals either chose not to participate or were ineligible
(incorrect age, already exercising, failed to meet other in-
clusion criteria). Of the remaining 233 potential partici-
pants, 28 were eligible and made appointments but changed
their minds, and 15 had positive exercise stress tests. The
remaining 190 individuals (56 men, 134 women) partici-
pated in subsequent physiological testing and assessment of
physical activity. Data collected at baseline on this group
are the basis for this report.
Measures
DEMOGRAPHICS/HEALTH AND PHYSICAL ACTIVITY. Subjects com-
pleted a brief inventory providing demographic information
and details of their medical history and lifestyle/exercise
habits. The health information obtained was used to deter-
mine supervisory requirements for exercise testing and
training and to identify potential contraindications for par-
ticipation in the study.
PHYSICAL ACTIVITY PARTICIPATION. Physical activity was as-
sessed using the PASE [9]. The PASE is a brief instrument
designed specifically to assess physical activity in older per-
sons over a 1-week time frame. Participation in leisure ac-
R. A. Washburn et al.
tivities, including walking outside the home; light, moder-
ate, and strenuous sport and recreation; and muscle
strengthening were recorded as never, seldom (1–2 days/
wk), sometimes (3–4 days/week), and often (5–7 days/
week). Duration was categorized as less than 1 hour, be-
tween 1 and 2 hours, 2–4 hours, or more than 4 hours. Paid
or unpaid work, other than work that involves mostly sit-
ting activity, was recorded in total hours per week. House-
work (light and heavy), lawn work/yard care, home repair,
outdoor gardening, and caring for others are recorded as
yes/no. Frequency and duration of household activities were
not requested. The total PASE score was computed by mul-
tiplying the amount of time spent in each activity (hours/
week) or participation (yes/no) in an activity by the empir-
ically derived item weights and summing over all activities.
The item weights were originally derived by regressing a
component score developed from a 3-day physical activity
monitor, 3-day physical activity diary, and a global self-report
of physical activity on responses to the PASE in a commu-
nity-dwelling sample of 277 older adults, mean age 74 years.
PEAK AEROBIC CAPACITY. Because many older individuals
are unable to attain an objective verifiable VO2max, in
which a plateau in VO2 is demonstrated between two or
more work levels during progressive graded incremental
treadmill walking [24], we assessed peak oxygen uptake
(VO2peak), at the point of test termination due to volitional
exhaustion or symptom limitations. Respiratory exchange
ratio $ 1.0 and/or a heart rate approaching the age-pre-
dicted maximum (i.e., 220 – age) were also used to monitor a
maximal effort. Peak VO2 was assessed on a motor-driven
treadmill using a modified Balke protocol [25]. The proto-
col involves walking at a speed of 3 mph, 0% grade, with a
2% increase in grade every 2 minutes. Oxygen uptake,
heart rate, and blood pressure were monitored continuously
throughout the test. Oxygen uptake was determined from
expired air sampled at 30-second intervals by open-circuit
spirometry using an on-line, computer-based acquisition
system. Subjects breathed through a two-way, high-velocity
non-rebreathing valve (Hans Rudolph Model 2700, Kansas
City, MO). The volume of expired air was measured by a
KL Engineering Model S-430 Ventilation system (Northridge,
CA). The oxygen and carbon dioxide concentrations of ex-
pired air were assessed by Ametek (Pittsburgh, PA) oxygen
(Model S-3A1) and carbon dioxide (Model CD-3A) ana-
lyzers. Analyzers were calibrated before each testing session
using verified gases of known concentrations. Data from the
gas analyzers and flow meter were converted to digital sig-
nals and sent to an IBM-compatible personal computer for
calculation of oxygen uptake on a minute-by-minute basis.
Heart rate and blood pressure were measured during each
work stage using a 12-lead electrocardiograph and a mer-
cury sphygmomanometer, respectively. Peak aerobic capac-
ity assessments were conducted under the supervision of a
physician assisted by a registered nurse and an exercise test
Validity of the Physical Activity Scale for the Elderly 645

TABLE 1. Descriptive characteristics by gender (mean 6 SD, or percentage)

Variable Men (n 5 56) Women (n 5 134)

Age (y) 66.6 6 5.1 66.4 6 5.4

Height (cm) 174.9 6 6.6 160.8 6 6.2*
Weight (kg) 93.2 6 14.1 75.7 6 15.9*
Systolic blood pressure (mmHg) 146.3 6 22.7 139.7 6 22.1
Diastolic blood pressure (mmHg) 84.9 6 17.2 82.2 6 10.3
Body fat (%) 33.8 6 .05 44.8 6 .06*
Resting heart rate (beats/min) 75.1 6 11.4 76.5 6 12.1
Peak oxygen uptake (mL/kg/min) 21.7 6 4.6 25.4 6 5.8
Balance score 55.2 6 1.5 55.2 6 1.3
Education (%)
High school graduate or less 1.9 3.0
Some college 37.0 51.1
College graduate 50.0 40.6
Graduate school 11.1 5.3
Marital status (%)
Married 89.1 46.6*
Single, separated, widowed, or divorced 10.9 53.4
Cigarette smoking (%) 5.4 3.8
Cardiovascular disease (%) 12.5 6.8
Hypertension (%) 10.6 25.0
Taking hypertensive medication (%) 8.0 19.7
Cancer (%) 3.7 6.9
Recent surgery (%) 7.4 19.0
Arthritis (%) 4.8 18.0
Hours worked per week (%)
0 29.9 39.6
1–39 27.7 33.0
$ 40 42.4 27.4

*P , 0.05.

technologist. Behavioral and electrocardiographic responses Procedures

were monitored during each test for evidence of cardiac ab-
normalities.
BODY COMPOSITION. Body composition was measured by
total body electrical conductivity (Model HA-2; EM-Scan,
Inc., Springfield, IL). This measure estimates the fat-free
body weight (FFB) by quantifying the perturbation of an
electrical magnetic field resulting from the content of con-
ductive components in the body (i.e., water and electrolyte).
Age- and gender-adjusted equations were used to estimate
the FFB developed by using a reference four-component
model of body composition. Body fat was calculated as the
difference between body weight and the estimate of FFB [26].
BALANCE. Balance was assessed using the Berg Balance
Scale, a 14-item instrument designed to assess subject’s
ability to successfully complete tasks such as standing from
a sitting position, turning to look behind, standing with
eyes closed, and standing on one foot. Each item is scored
on a 0–4 metric with possible total scores ranging from 0 to
56 [27].
Potential participants contacted the program office by tele-
phone and completed an initial screening interview to sat-
isfy inclusion/exclusion criteria. Those passing the initial
telephone screening were scheduled for two laboratory vis-
its. During the first visit, participants provided basic demo-
graphic and health status information, completed the
PASE (self-administered), performed the balance tests, and
were oriented to the exercise testing protocol, which in-
cluded a short trial walk on the treadmill while wearing
headgear, mouthpiece, and nose clip. Body composition
was assessed using whole body electromagnetic conductiv-
ity. During the second laboratory visit, participants com-
pleted the graded exercise test to determine peak aerobic
capacity. Resting blood pressure was measured using a stan-
dard mercury sphygmomanometer prior to the graded exer-
cise test.
Data Analysis
t-Tests and chi-square analysis were used to determine the
statistical significance between continuous and categorical
variables, respectively. Pearson product-moment correla-
tion coefficients were used to assess the association between
646
FIGURE 1. Distribution of PASE scores by age and gender. Young 5 55–64 years; old 5 65 and older.
physical measures and PASE scores. Ordinary least squares
linear regression was used to determine the independent effects
of sociodemographic and comorbidity factors on PASE
scores. All analysis were completed using SPSS-PC for
Windows Version 7.0 (SPSS Inc, Chicago, IL).
RESULTS
The descriptive characteristics of the study sample are dis-
played in Table 1. The sample was well-educated, predomi-
nantly white (95.5%) with an average age (6SD) of 66.5 6
5.3 years. More than 60% of men and 45% of women re-
ported a college education or more. Approximately 70% of
men and 60% of women were employed outside the home.
Women were more likely to be unmarried than men
(53.4% women, 10.9% men). Values for peak oxygen up-
take, resting heart rate, resting blood pressure, and balance
were similar to those reported in other samples of older
adults [13,18,28–30]. PASE scores for all subjects ranged
from 0 to 312; the distribution was skewed slightly to the
right (Figure 1).
The mean score was 131.3 6 70.4, median 123. PASE
scores were significantly higher in those under age 65 years,
R. A. Washburn et al.
in men, and in those in better health, that is, those who did
not report having cardiovascular disease, hypertension,
cancer, or recent surgery (Table 2). Age was significantly
and negatively correlated with PASE scores (r 5 20.21).
The contribution of each PASE questionnaire item to the
overall PASE score as calculated from the product of the
sample mean and the PASE item weight are presented in
Table 3 (total sample) and Table 4 (by age and gender). In
the total sample, approximately 30% of PASE points were
due to job-related physical activity, and was 60% due to
household-related activity (housework, home repair, lawn
work, outdoor gardening, caring for others), whereas only
10% of the total PASE scores were accounted for by leisure-
time exercise activity (walking, sports, muscular strength/
endurance). Men accumulated significantly more PASE
points for light sport, home repair, and lawn work activity
compared with women. Age group 55–64 had higher PASE
scores than those older than age 65 primarily due to higher
job-related physical activity in the younger age group.
Correlations between PASE scores and validation mea-
sures are presented in Table 5. PASE scores were signifi-
cantly associated with peak oxygen uptake and systolic
blood pressure in all subjects, in women, and in those older
Validity of the Physical Activity Scale for the Elderly 647

TABLE 2. PASE Scores by demographic and health charac- cant correlations in the hypothesized directions between
teristics (mean 6 SD) PASE scores and physiologic, as well as demographic and
Variable n PASE score health status, characteristics. Peak oxygen uptake, resting
systolic blood pressure, and balance were significantly asso-
Age group (y) ciated with PASE scores. Additional evidence for validity
55–64 87 144.2 6 75.8
$65 102 118.9 6 63.9* of the PASE comes from the observations that PASE scores
Gender were higher in younger participants, in males and in those
Men 56 145.8 6 78.0* not reporting a chronic health condition (heart disease,
Women 134 123.9 6 66.3 cancer, diabetes, hypertension).
Education As expected, the magnitude of the correlations between
HS graduate or less 5 105.8 6 64.7
Some college 88 128.6 6 70.6 our physiologic parameters and PASE scores were modest
College graduate 81 140.1 6 69.1 (range r 5 0.18 to r 5 0.30) given the influence of factors
Graduate school 13 108.0 6 72.3 other than physical activity on these variables. However,
Marital Status these correlations are similar in magnitude to those re-
Married 111 124.3 6 69.4 ported between other physical activity questionnaires and
Single, separated, widowed,
divorced 77 140.3 6 71.8 physiologic parameters in samples of both younger and
Cardiovascular disease older adults. For example, in earlier work, we reported cor-
Yes 16 96.2 6 85.6 relations ranging from 0.13 to 0.37 between PASE scores
No 172 134.1 6 68.4* and strength, balance and resting heart rate [9]. DiPietro et
Hypertension al. [10] reported a correlation of 0.20 between maximal aer-
Yes 67 116.4 6 69.1
No 121 138.9 6 70.4* obic capacity estimated from a submaximal treadmill test
Hypertensive medication and the Yale Physical Activity Survey in a small sample of
Yes 52 109.3 6 70.4 25 men and women, mean age approximately 69 years. Cor-
No 136 139.2 6 69.2** relations of similar magnitude have been reported between
Cancer aerobic capacity and physical activity as assessed by widely
Yes 20 101.3 6 69.1
No 168 134.4 6 70.1* used physical activity surveys. For example, Jacobs et al.
Recent surgery [31] reported correlations of 0.43 and 0.30 between maxi-
Yes 50 108.3 6 68.3 mal aerobic capacity and physical activity assessed by the
No 139 138.6 6 69.8** Minnesota Leisure Time Physical Activity Questionnaire
Arthritis and the Stanford Seven-Day recall, respectively, in 64 men
Yes 44 118.3 6 62.9
No 144 134.8 6 72.6 and women, age range 20–59 years. Although the magni-
tude of the correlations between PASE scores and our vali-
*P , 0.05. dation measures is not high, the consistency of results with
**P , 0.01. those reported by Washburn et al. [9] and Schuit et al. [11]
using other comparison measures adds to the accumulating
evidence for the validity of the PASE.
As evidenced from our descriptive data (Table 1), we en-
than age 65. PASE scores were significantly associated with countered a distinct restriction of range problem in the as-
balance in all subjects, women, and in those age 55–64 sessment of balance. We included the Berg balance scale
years. No significant associations between PASE scores and simply to determine whether the association between bal-
validation variables were apparent for men. ance and PASE scores that we observed in our original
Table 6 presents multiple regression results for sociode- PASE validation study in an older sample could be detected
mographic and health conditions that may influence physi- in a sample of young-old individuals. It is interesting to
cal activity. The model accounted for approximately 24% note that even with the restricted range of the Berg scale in
of the variation in PASE scores. Those reporting more the young-old sample, we still observed a statistically signif-
hours per week of employment and cigarette smoking had icant correlation between PASE score and balance (r 5
higher PASE scores, whereas recent surgery was associated 0.20), which was similar to that observed between balance
with lower PASE scores. as assessed by the one-leg stand test (eyes closed) (r 5 0.33)
in our earlier work [9]. The ceiling effect we observed is
most likely a function of our sample being relatively
DISCUSSION
healthy and free from disorders that might lead to balance
This study, in a sample of volunteers mean age 66 years, deficits. Moreover, in spite of relatively strict scoring crite-
provides additional evidence in support of the validity of ria, the Berg scale still relies on somewhat subjective assess-
the PASE as a useful measure of physical activity for epide- ment of raters. Other more useful approaches that might be
miologic studies of older individuals. We reported signifi- used in future investigations include the assessment of pos-
648 R. A. Washburn et al.

TABLE 3. Contribution to total PASE Score by PASE components (n 5 190)

Contribution to
PASE component Sample mean Weight total PASE Score

Walking (h/day) 0.44 20 8.8

Light sports (h/day) 0.11 21 2.3
Moderate sports (h/day) 0.04 23 0.92
Strenuous sports (h/day) 0.03 23 0.69
Muscular strength/endurance (h/day) 0.04 30 1.2
Job—standing or walking (h/day) 1.81 21 38.0
Light housework (%) 90.5 25 22.6
Heavy housework (%) 74.2 25 18.6
Home repair (%) 17.4 30 5.2
Lawn work/yard care (%) 42.1 36 15.2
Outdoor gardening (%) 20.5 25 5.1
Caring for another person (%) 36.3 35 12.7
Total PASE Score 131.3

tural sway [32] and the use of clinical assessment tools such
as computerized dynamic posturography. In this latter ap-
proach, balance is assessed by perturbing the support surface
and visual surround in order to examine the contribution of
visual, vestibular, and somatosensory components involved
in balance control [33].
Subgroup analyses revealed no significant associations
between any validation measures and PASE scores in men.
This result is in partial agreement with the report by Wash-
burn et al. [9]. They also found no association between
PASE scores and systolic blood pressure or resting heart
rate in 120 men, age 65 years and older. However, Wash-
burn et al. [9] reported significant, but modest, correlations
between PASE scores and perceived health status, grip
strength, and static balance in men. Other gender differ-
ences in the association of PASE scores with validity mea-
sures were noted in the report of Washburn et al. [9]. For
example, women showed significant associations between
PASE scores and restricted activity days, systolic blood
pressure, and leg strength that were not shown in men. The
general lack of association between validation measures
and PASE scores and validation measures in the younger
age group (55–64 years) in the present study may be par-
tially explained expected by the fact that the scoring
scheme for the PASE was developed on a sample of individ-
uals that were, on average, 7 years older than participants
in the current study. These results suggest that the PASE
may not provide an adequate physical activity measure in
individuals younger than age 65, however they should be
interpreted cautiously owing to the limited number of indi-
viduals (n 5 87) in the younger age group.
The mean PASE score in the current study (131.3) is
higher than that reported by either Washburn et al. [9]
(102.9) or Schuit et al. [11] (84.9). The higher PASE scores

TABLE 4. Contribution to total PASE score by PASE component

Men Women Age 55–64 Age 651
PASE component (n 5 56) (n 5 134) (n 5 87) (n 5 102)

Walking 9.6 8.5 8.1 9.5

Light sports 4.6 1.5* 1.1 3.5**
Moderate sports 1.6 0.62 0.48 1.18
Strenuous sports 0.83 .55 0.55 0.71
Muscular strength/endurance 1.38 1.20 0.75 1.56
Job—standing or walking 39.7 37.4 54.4 24.2**
Light housework 20.1 23.7* 22.4 22.8
Heavy housework 18.3 18.7 17.3 19.6
Home repair 11.8 2.5* 5.9 4.7
Lawn work/yard care 24.4 11.3* 13.6 16.6
Outdoor gardening 6.7 4.5 4.3 5.9
Caring for another person 8.1 14.6 16.1 9.6**
Total PASE Score 147.1 125.1 144.9 119.9

*P , 0.05, men vs. women

**P , 0.05, age 55–64 vs. $65.
Validity of the Physical Activity Scale for the Elderly 649

TABLE 5. Correlations between PASE scores and validation measures for all participants
and for age and gender subgroups
All
Subjects Men Women Age 55–64 Age $65
Variable (n 5 190) (n 5 56) (n 5 134) (n 5 87) (n 5 102)

Peak oxygen uptake (mL/kg/min) 0.20** 0.06 0.25** 0.12 0.26*

Systolic blood pressure (mmHg) –0.18* –0.15 –0.23** 0.01 –0.30*
Diastolic bood pressure (mmHg) 0.003 0.12 –0.09 0.20 –0.17
Resting heart rate (beats/min) 0.02 0.07 0.01 –0.02 0.07
Body fat (%) –0.01 0.25 0.03 0.03 –0.08
Balance score 0.20** 0.15 0.23** 0.22* 0.13

*P , 0.05.
**P , 0.01.

in the current study are explained, in part, by the younger
age of the current sample (66 years) compared with 70 years
for the Schuit et al. [11] sample and 73 years for the sample
of Washburn et al. [9]. The younger age group of the current
sample resulted in a higher number of PASE points ac-
counted for by work activity.
In the current sample, approximately 38 points were ac-
counted for by work activity compared with 11.1 points and
6.3 points for the samples of Washburn et al. [9] and Schuit
et al. [11], respectively. Mean PASE scores were similar
when comparing both men and women aged 65–69 years in
the Washburn et al. [9] sample (men 5 144.3, women 5
112.7) with the men and women in our youngest age group;
55–65 years (men 144.2, women 123.9).
Results from the present study, and the reports by Wash-
burn et al. [9] and Schuit et al. [11], have all indicated that
leisure time activity (walking; moderate, light, and heavy
sport/recreation) contribute relatively little to the overall
PASE score. In the present sample, which were recruited to
be sedentary, only 10.7% of the total PASE score was ac-
counted for by leisure-time activity. Washburn et al. [9], in
a sample of community-dwelling older adults, reported 20%
of total PASE scores were due to leisure activity. Schuit et
al. [11] in a sample of older Dutch men and women, in
which 14 of 21 subjects participated in sport activity for an
average of 4 hours per week, reported that approximately
36% of the total PASE scores were due to leisure time ac-
tivity. The results of the available studies on the PASE gen-
erally support our earlier argument for use of age-specific,
rather than age-neutral physical activity surveys, in which
the focus is only on leisure time physical activity, in studies
of physical activity in older adults [34].
Non–leisure time activity accounts for a large proportion
of the PASE score across all three available studies. For ex-
ample, in the current study, work-related activity ac-
counted for 29% of the PASE score, followed by light

TABLE 6. Ordinary least squares regression of PASE scores on sociodemo-

graphic factors and comorbidity
Unstandardized Standard
Variable coeffcient error

Age (y) –0.46 1.09

Gender (1 5 male, 2 5 female) –14.5 11.9
Education
1 5 HS graduate or less 2.4 8.5
2 5 Some college
3 5 College graduate
4 5 Graduate school
Hours worked per week 1.4 0.29**
Current smoker (1 5 yes, 2 5 no) 78.7 30.5*
Heart disease (1 5 yes, 2 5 no) –13.9 21.0
Recent surgery (1 5 yes, 2 5 no) –30.1 13.3*
Hypertension (1 5 yes, 2 5 no) –20.1 11.9
Cancer (1 5 yes, 2 5 no) –18.8 17.3
Arthritis (1 5 yes, 2 5 no) 0.31 13.3

*P , 0.001.
**P , 0.05.
650
housework (17%), heavy housework (14%), and lawn work
(12%). Washburn et al. [9] in a community-dwelling sam-
ple reported only 11% of the total PASE score was due to
work-related activity, whereas the total of light housework,
heavy housework, lawn work, and walking accounted for
approximately 63% of the total PASE score. Schuit et al.
[11] in 21 elderly Dutch reported only 7% of total PASE
due to work activity, with the total of light and heavy
housework, and walking/cycling (modification) accounted
for more than 65% of the total PASE score. The current
PASE scoring algorithm considers all nonleisure activity
(work, housework, home repair, lawn work, outdoor gar-
dening, and caring of another person) as yes/no variables.
Given the magnitude of the contribution of these activity
categories to the total PASE score, it may be best to modify
the current PASE and obtain information on frequency
(times per week) and duration (time per occasion) for these
items as is currently done with the leisure-time activity
items. Studies should be completed to compare the validity
of an original PASE scoring scheme and a modified scheme
to determine whether this change results in a better classifi-
cation of physical activity as hypothesized.
The PASE is brief, easily scored, and can be administered
by mail or interview (telephone or in person). Results of
the current study, in conjunction with earlier reports on the
validity of the PASE, support the use of this instrument as a
measure of physical activity in epidemiologic studies of
older adults. To date, PASE scores have been associated
with physiologic measures, energy expenditure measured by
doubly labeled water, and demographic and health status
characteristics and have been shown to vary with outdoor
temperature [9,11]. Further work with the PASE using al-
ternative scoring schemes and additional validation criteria
should be undertaken in larger samples or varying socioeco-
nomic status and ethnicity.
This research was supported by grant # AG12113 from the National
Institute on Aging awarded to Dr. McAuley.
References
1. Rakowksi W, Mor V. The association of physical activity with
mortality among older adults in the Longitudinal Study of
Aging (1984–1988). J Gerontol 1992; 47: M122–M129.
2. Pescatello LS, DiPietro L. Physical activity in older adults. An
overview of health benefits. Sports Med 1993; 16: 353–364.
3. Stewart AL, Hays RD, Wells KB, Rogers WH, Spritzer KL,
Greenfield S. Long-term functioning and well-being out-
comes associated with physical activity and exercise in pa-
tients with chronic conditions in the Medical Outcomes
Study. J Clin Epidemiol 1994; 47: 719–730.
4. Nelson HD, Nevitt MC, Scott JC, Stone KL, Cummings SR.
Smoking, alcohol, and neuromuscular and physical function
of older women. JAMA 1994; 272: 1825–1831.
5. Phillips WT, Haskell WL. “Muscular fitness”—Easing the
burden of disability for elderly adults. J Aging Physical Activ-
ity 1995; 3: 261–289.
6. Clark DO. The effect of walking on lower body disability
R. A. Washburn et al.
among older blacks and whites. Am J Public Health 1996;
86: 57–61.
7. Caspersen CJ, Bloemberg BPM, Saris WHM, Merritt RK,
Kromhout D. The prevalence of selected physical activities
and their relation with coronary heart disease risk factors in
elderly men: The Zutphen study, 1985. Am J Epidemiol 1991;
133: 1078–1092.
8. Voorrips LE, Ravelli ACJ, Dongelmans PCA, Deurenberg P,
Van Staveren WA. A physical activity questionnaire for the
elderly. Med Sci Sports Exerc 1993; 23: 974–979.
9. Washburn RA, Smith KW, Jette AM, Janney CA. The physi-
cal activity scale for the elderly (PASE): Development and
evaluation. J Clin Epidemiol 1993; 46: 153–162.
10. DiPietro L, Caspersen CJ, Ostfeld AM, Nadel ER. A survey
for assessing physical activity among older adults. Med Sci
Sports Exer 1993; 25: 628–642.
11. Schuit AJ, Schouten E, Westerterp KR, Saris WHM. Validity
of the Physical Activity Scale for the Elderly (PASE): Ac-
cording to energy expenditure assessed by the doubly labeled
water method. J Clin Epidemiol 1997; 50: 541–546.
12. Marcus BH, Goldstein MG, Jette A, et al. Training physicians
to conduct physical activity counseling. Prev Med 1997; 26:
382–388.
13. Fitzgerald MD, Tanaka H, Tran ZV, Seals DR. Age-related
declies in maximal aerobic capacity in regularly exercising vs.
sedentary women: A meta-analysis. J Applied Physiol 1997;
83: 160–165.
14. Davy KP, Evans SL, Stevenson ET, Seals DR. Adiposity and
regional body fat distribution in physically active young and
middle aged women. Int J Obes 1996; 20: 777–783.
15. Going SB, Williams DP, Lohman TG, Hewitt MJ. Aging,
body composition, and physical activity: A Review. J Aging
Physical Activity 1994; 2: 38–66.
16. Rooks DS, Kiel DP, Parsons C, Hayes WC. Self-paced resis-
tance training and walking exercise in community-dwelling
older adults: Effects on neuromotor performance. J Gerontol
1997; 52A: M161–M168.
17. Astrand PO, Bergh U, Kilbom A. A 33-yr follow-up of peak
oxygen uptake and related variables of former physical educa-
tion students. J Appl Physiol 1997; 82: 1844–1852.
18. Jackson AS, Beard EF, Wier LT, Ross RM, Stuteville JE, Blair
SN. Changes in aerobic power of men, ages 25–70 yr. Med Sci
Sports Exerc 1995; 27: 113–120.
19. Kasch FW, Boyer JL, Van Camp S, Netti F, Verity LS, Wal-
lace JP. Cardiovascular changes with age and exercise: A 28-
year longitudinal study. Scand J Med Sci Sports 1995; 5:
147–151.
20. Rejeski WJ, Neal KM, Wurst ME, Brubaker PH, Ettinger WH
Jr. Walking, but not weight lifting, acutely reduces systolic
blood pressure in older, sedentary men and women. J Aging
Physical Activity 1995; 3: 163–177.
21. Pearson JD, Morrell CH, Brant LJ, Landis PK, Fleg JL. Age-
associated changes in blood pressure in a longitudinal study of
healthy men and women. J Gerontol 1997; 52A: M177–
M183.
22. Lord SR, Ward JA, Williams P, Strudwick M. The effect of a
12-month exercise trial on balance, strength, and falls in
older women: A randomized controlled trial. J Am Geriat
Soc 1995; 43: 1198–1206.
23. Voorrips LE, Lemmink KAPM, Van Heuvelen MJG, Bult P,
Van Staveren WA. The physical condition of elderly women
differing in habitual physical activity. Med Sci Sports Exerc
1993; 25: 1152–1157.
24. Wasserman K, Hansen JE, Sue DY, Whipp BJ. Pinciples of
Exercise Testing and Interpretation. Philadelphia: Lea & Fe-
biger; 1987.
Validity of the Physical Activity Scale for the Elderly
25. ACSM. The recommended quantity and quality of exercise for
developing and maintaining cardiorespiratory and muscular fit-
ness in healthy adults. Med Sci Sports Exerc 1991; 22: 265–274.
26. Boileau RA, Slaughter MH, Stillman RJ, Clasey J, Dykstra G,
Farrell-Lee K. Precision of fat and fat-free body (FFB) compo-
sition estimates: Comparison of four methods. FASEB J 1994;
8: A178.
27. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measur-
ing balance in the elderly: Validation of an instrument. Can J
Public Health 1992; 83: S7–S11.
28. McAuley E, Mihalko SL, Rosengren K. Self-efficacy and bal-
ance correlates of fear of falling in the elderly. J Aging Physi-
cal Activity 1997; 5: 329–340.
29. Cononie CC, Graves JE, Pollock ML, Phillips IM, Sumners
C, Hagberg JM. Effects of exercise training on blood pressure
in 70- to 79-yr-old men and women. Med Sci Sports Exerc
1991; 23: 505–511.
651
30. Ettinger WH, Burns R, Messier SP, et al. A randomized trial
comparing aerobic exercise and resistance exercise with a
health education program in older adults with knee osteoar-
thritis: The fitness arthritis and seniors trial (FAST). JAMA
1997; 277: 25–31.
31. Jacobs DR, Jr., Ainsworth BE, Hartman TJ, Leon AS. A si-
multaneous evaluation of 10 commonly used physical activity
questionnaires. Med Sci Sport Exerc 1993; 25: 81–91.
32. Maki BE, Holliday PJ, Topper AK. Fear of falling and postural
performance in the elderly. J Gerontol 1991; 46: M123–
M131.
33. Nashner LM. Computerized dynamic posturography. In: Ja-
cobson GP, Newman CW, Kartush KM, Eds. Handbook of
Balance Function Testing. St. Louis: Mosby; 1993: 280–305.
34. Washburn RA, Jette AM, Janney CA. Using age-neutral
physical activity questionnaires in research with the elderly. J
Aging Health 1990; 2: 341–356.