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Physical Activity Scale for the Elderly (PASE)

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.

LEISURE TIME ACTIVITY

2. Over the past 7 days, how often did you take a walk outside your home or yard for any reason? For example, for fun or exercise, walking to work, walking the dog, etc?

  1. never
  2. seldom (1-2 days)
  3. sometimes (3-4 days)
  4. often (5-7 days)

If 1,2 or 3:

2a. On average, how many hours per day did you spend walking?

  1. less than 1 hour
  2. 1 but less than 2 hours
  3. 2-4 hours
  4. more than 4 hours

5. Over the past 7 days, how often did you engage in strenuous sport and recreational activities such as jobbing swimming, cycling, singles tennis, aerobic dance, skiing(downhill or cross country) or other similar activities?

  1. never
  2. seldom (1-2 days)
  3. sometimes (3-4 days)
  4. often (5-7 days)

If 1,2 or 3:

5a. What were these activities? ___________________________

5b. On average, how many hours per day did you engage in these strenuous sport and recreational activities?

  1. less than 1 hour
  2. 1 but less than 2 hours
  3. 2-4 hours
  4. more than 4 hours

HOUSEHOLD ACTIVITY

No walking or bicycling related questions in this section.

WORK RELATED ACTIVITY

10. During the past 7 days, did you work for pay or as a volunteer?

  1. NO
  2. YES

IF YES:

10a. How many hours per week did you work for pay and or as a volunteer?
___ hours

10b. Which of the following categories best describes the amount of physical activity required on your job and or volunteer work?

  1. Sitting or standing with some walking, Ex: cashier, general office worker, light tool and machinery worker
  2. Walking with some handling of materials generally weighing less than 50 pounds. Ex: mailman, waiter/waitress, construction worker, heavy tool and machinery worker
  3. Walking and heavy manual work often requiring handling of materials weighting over 50 pounds. Ex: lumberjack, stone mason, farm or general laborer.

Last Modified: 11 Apr 2014