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Lifetime 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://dceg.cancer.gov/modules/Lifetime_PA.pdf

Note: reliability, but not validity, studies are available for this questionnaire.

STEP 1: Please place a check mark in the first column next to each activity that you have ever participated in more than 10 times during your lifetime.

STEP 2: For those activities you have checked, proceed to the right answering the questions in the columns above.

Have you ever participated in any of the following? During the Past Year During ages 51-65 years (a 15-year span)
If younger than 51, skip to next column
During ages 35-50 years (a 15-year span) During ages 22-34 years (a 12-year span) and Between age of onset of menstruation to 21 years Between age of onset of menstruation to 21 years
Check if yes ↓ # of months Typical # of hours per week # of years (15 max) Typical # of months per year Typical # of hours per week # of years (15 max) Typical # of months per year Typical # of hours per week # of years (12 max) Typical # of months per year Typical # of hours per week # of years (10 max) Typical # of months per year Typical # of hours per week
Leisure Time Activities:                            
Walking for exercise (outdoor, indoor at mall, treadmill)                            
Bicycling (stationery/outdoor)                            

 

Last Modified: 11 Apr 2014