National Cancer Institute Home at the National Institutes of Health | www.cancer.gov
Please wait while this form is being loaded....

EPIC-Norfolk Physical Activity Questionnaire

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.srl.cam.ac.uk/epic/questionnaires/epaq2/epaq2.pdfExternal Web Site Policy

Section A   HOME ACTIVITIES

Getting About--Apart from going to work

Which form of transportation to you use most often apart from your journey to and from work?

Please tick (check) one box ONLY per line.

Distance of journeys Usual mode of transport
Car Walk Public transport Cycle
Less than 1 mile        
1-5 mile(s)        
More than 5 miles        

Section B   ACTIVITY AT WORK

Please answer this section only if you have been in paid employment at any time during the last 12 months or you have done regular, organized voluntary work.

ACTIVITY LEVELS AT YOUR WORK

Now we would like you to take the total number of hours you worked per week in each job and divide them up according to your activity level.

Please complete EACH line.

  Job 1 Job 2
No Yes Hours per week No Yes Hours per week
Walking at work -- carrying nothing heavier than a briefcase e.g. moving about a shop            
Walking -- carrying something heavy            

TRAVEL TO AND FROM WORK

JOB 1

Please complete EVERY line

Roughly how many miles was it from home to Job 1 ______
How many times a week did you travel from home to Job 1 _____

Please tick (check) one box ONLY per line

How did you normally travel to Job 1 Always Usually Occasionally Never or rarely
By bicycle        
Walking        
JOB 2

Please complete EVERY line

Roughly how many miles was it from home to Job 2 ______
How many times a week did you travel from home to Job 2_____

Please tick (check) one box ONLY per line

How did you normally travel to Job 2 Always Usually Occasionally Never or rarely
By bicycle        
Walking        

Section C   RECREATION

The following questions ask about how you spent your leisure time.

Please indicate how often you did each activity on average over the last 12 months.

For activities that are seasonal, e.g. cricket or moving the lawn, please put the average frequency during the season when you did the activity.

Please indicate the average length of time that you spent doing the activity on each occasion.

EXAMPLE: If you went walking for pleasure for 40 minutes once a week you would complete the table below as follows:

 

 

Number of times you did the activity
in the last 12 months
Average time
per episode
None Less than once a month Once a month 2-3 times a month Once a week 2-3 times a week 4-5 times a week Every day Hours Mins

Walking for pleasure

        X         40

 

 

Number of times you did the activity
in the last 12 months
Average time
per episode
None Less than once a month Once a month 2-3 times a month Once a week 2-3 times a week 4-5 times a week Every day Hours Mins

Walking for pleasure -- You should not include walking as a means of transportation as this was included in Sections A
and B

                   

Racing or rough terrain cycling

                   

Cycling for pleasure -- you should not include cycling as a means of transportation

                   

Last Modified: 11 Apr 2014