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The Familial Breast and Ovarian Cancer Study

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://dceg.cancer.gov/modules/LongForm.pdf

No true validation studies were found for this questionnaire.

Following are questions about your physical activity at various times in your life. To answer these questions, please estimate the average amount of time each week and the average number of months each year that you spent in these activities.

Strenuous Exercise

  1. How often did you participate in STRENUOUS exercise activities or sports (e.g., swimming laps, aerobics, calisthenics, running, jogging, basketball, cycling on hills, racquetball)?
  Average hours per week Average months per year
None ½ hr 1 hr 1 ½ hrs 2 hrs 3 hrs 4-6 hrs 7-10 hrs 11 or more hrs 1-3 4-6 7-9 10-12
During high school O O O O O O O O O O O O O
Between ages 18 and 24 O O O O O O O O O O O O O
Between ages 25 and 34 O O O O O O O O O O O O O
Between ages 35 and 44 O O O O O O O O O O O O O
Between ages 45 and 54 O O O O O O O O O O O O O
Past 3 years * O O O O O O O O O O O O O

* If you have been diagnosed with cancer in the past three years, please answer the question for the three years prior to the cancer diagnosis.

Moderate Exercise

  1. How often did you participate in MODERATE exercise activities or sports (e.g., brisk walking, golf, volley-ball, cycling on level streets, recreational tennis, or softball)?
  Average hours per week Average months per year
None ½ hr 1 hr 1 ½ hrs 2 hrs 3 hrs 4-6 hrs 7-10 hrs 11 or more hrs 1-3 4-6 7-9 10-12
During high school O O O O O O O O O O O O O
Between ages 18 and 24 O O O O O O O O O O O O O
Between ages 25 and 34 O O O O O O O O O O O O O
Between ages 35 and 44 O O O O O O O O O O O O O
Between ages 45 and 54 O O O O O O O O O O O O O
Past 3 years * O O O O O O O O O O O O O

Other Activities

  1. In the past year, on average, how many hours per day did you spend in each of the following activities?
  Average hours per day Days per week
None < 1 1 1-2 3-4 5-6 7-9 10 or more 1 2-3 4-5 6-7
Casual walking O O O O O O O O O O O O

Last Modified: 11 Apr 2014