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CHAMPS Activities Questionnaire for Older Adults

Questionnaires:

About This Database

You are browsing a database of standardized questionnaires that ask about respondents' walking and bicycling habits.

The survey on this page is presented for informational purposes only, and is not intended to be filled out by visitors to this Web site.

The Applied Research Program maintains this database, but, except where noted, did not create and does not maintain the questionnaires themselves. For more information about a specific questionnaire, please contact its author(s). When possible, we cite the source of each questionnaire near the top of the page.

http://www.ucsf.edu/champs/resources/qxn/pdfs/champs_englishqxn_26Dec02.docExternal Web Site Policy

In: Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 2001 Jul;33(7):1126-41.

This questionnaire is about activities that you may have done in the past 4 weeks. The questions on the following pages are similar to the example shown below.

INSTRUCTIONS

If you DID the activity in the past 4 weeks:
      Step #1       Check the YES box.
      Step #2       Think about how many TIMES a week you usually did it, and write your response in the space provided.
      Step #3       Circle how many TOTAL HOURS in a typical week you did the activity.

In a typical week in the last 4 weeks did you:

25. Walk uphill or hike uphill (count only uphill part)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
How many TOTAL hours a week did you usually do it?
Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
26. Walk fast or briskly for exercise (do not count walking leisurely or uphill)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
27. Walk to do errands (such as to/from a store or to take children to school (count walk time only)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
28. Walk leisurely for exercise or pleasure?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
29. Ride a bicycle or stationary cycle?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours

Last Modified: 11 Apr 2014