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1991 National Health Interview Survey

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.

Hand Calendar:

  1.  
    1. In the past 2 weeks (outlined on that calendar) beginning Monday, (date) and ending this past Sunday, (date) have YOU done any of the following exercises, sports, or physically active hobbies --
      1. Walking for exercise? YES NO
      2. Riding a bicycle or exercise bike? YES NO
    2. How many times in the past 2 weeks did you go/do (activity in 2a)?
      ____ times
    3. On the average, about how many minutes did you actually spend (doing) (activity in 2a) each time?
      ____ minutes
    4. What usually happened to your heart rate or breathing when you [did/went] (activity in 2a)? Did you have a small, moderate or large increase, or no increase at all in your heart rate or breathing?
      1. small
      2. moderate
      3. large
      4. no inc.

Last Modified: 11 Apr 2014