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Health Insurance Plan of New York City 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.

In: Pereira MA, FitzGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM. A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc 1997 Jun;29(6 Suppl):S1-205.

The individual is asked to complete six occupational activity and five leisure time activity questions. The questions may be administered by an interviewer.

Calculations: each possible response on the questionnaire is assigned a weight. Occupational-related scores are obtained by summing the weights of the different categories and determining the class in which the total score falls. A similar system is used for leisure activities.

Physical Activity Connected with Job:
Question Answer Assigned weight
Time on job spent walking Almost none 0
Less than 1
About 2
More than 3
Practically all 4
Walking to get to and from work None or less than 1 block 0
1 or 2 blocks 1
3 or 4 blocks 2
5 to 9 blocks 3
10 to 19 blocks 4
20 to 39 blocks 5
40+ blocks (2+ miles) 6
Hours on job Less than 25 1
25-34 2
35-40 3
41-50 4
50+ 5

Physical Activity Off the Job :
Item Frequently Sometimes Very infrequently or never
Takes walks in good weather 2 1 0
Walks around house or apartment 2 1 0

Last Modified: 11 Apr 2014