Background: Much research supports the physical activity (PA) and health-related quality of life (HRQOL) relationship. However, less is known about this association when advanced measurement techniques are used to assess HRQOL. The aim of this study was to use item response theory (IRT) to score HRQOL items and subsequently examine the extent to which PA relates to the new measure. Methods: Data from N = 6,245 adults 18+ years of age participating in the 2019 Montana Behavioral Risk Factor Surveillance System (BRFSS) were used. Four different 3-category HRQOL items were created from survey questions regarding general, physical, mental, and activity health. Two PA variables were created from survey questions regarding PA guidelines and PA quantity. A graded response IRT model (GRM) was used to assess the HRQOL scale and output ability scores. Multinomial logistic regression was used to examine the relationship between PA and HRQOL tertile membership while adjusting for sex, age, race, income, education, marital status, BMI, smoking status, and alcohol consumption. Results: Factor analysis retained a single HRQOL factor (loadings > .68) with ordinal alpha indicating acceptable internal consistency (α_ordinal = .83). The GRM analysis confirmed all HRQOL items fit a unidimensional construct with adequate discrimination (as: 1.17 to 5.13) and difficulty (bs: -2.052 to -0.07). Fully adjusted regression models showed increased odds of high HRQOL tertile membership (versus low tertile) for adults meeting aerobic PA (APA) (OR = 1.64, 95% CI: 1.28 – 2.09) and adults meeting both APA and muscle strengthening activity (MSA) (OR = 1.73, 95% CI: 1.34 – 2.23) guidelines, compared to those meeting neither APA nor MSA guidelines. Similarly, there was increased odds of high HRQOL tertile membership (versus low tertile) for adults considered sufficiently active (OR = 1.59, 95% CI: 1.16 – 2.19) and adults considered highly active (OR = 2.03, 95% CI: 1.58 – 2.61), compared to those considered inactive. Adults meeting MSA guidelines only and adults insufficiently active were no more likely to see high HRQOL tertile membership than their less active counterparts. Conclusion: The IRT-derived HRQOL score is a novel outcome measure and found to be associated with both PA guidelines and PA quantity among adults in Montana.

physical activity (PA), Health-related Quality of Life (HRQOL), item response theory (IRT), graded response model (GRM), rural health