National Cancer Institute Home at the National Institutes of Health | www.cancer.gov

Techumseh Occupational 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.

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.

Section B: Transportation To and From Work

  1. Check the months you worked each job. Then check the months you used each kind of transportation to and from each of your jobs.
      Job 1 Job 2 Job 3
    J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D
    Months worked each job:                                                                        
    Mode of Transportation:
    Bicycle:                                                                        
    Walk:                                                                        
  2. What is the approximate round trip distance that you walked or bicycled to and from each of your jobs in miles or blocks? If you never walked or bicycled enter 0 for distance. Do not include walking or bicycling on the job.
      Job 1 Job 2 Job 3
    Distance walked: miles __   blocks __ miles __   blocks __ miles __   blocks __
    Distance bicycled: miles __   blocks __ miles __   blocks __ miles __   blocks __
  3. In months that you walked to work, how many times per month did you usually do this?
      Job 1 Job 2 Job 3
    Average times per month walked to work:      
  4. In months that you bicycled to work, how many times per month did you usually do this?
      Job 1 Job 2 Job 3
    Average times per month bicycled to work:      

Section C: Physical Activity at Work

We are interested in the amount of activity that people do in different occupations. Think about the job related activities you mostly did in a work week during the time you worked in the past 12 months. First read each of the following categories and mark YES for the ones you usually did and NO for the ones you did not do Then go back through the list and record the number of hours per week you spent on each activity.

  Job 1
Hrs/wk
Job 2
Hrs/wk
Job 3
Hrs/wk
17. Walking at work, not carrying anything heavier than a briefcase
--between buildings/in hallways
--roving store clerk
1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no
18. Walking - carrying something
--trays, dishes
--gas station mechanic work, changing tires, wrecker work etc.
1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no
19. Standing or walking, carrying objects about 25 pounds 1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no
20. Standing or walking, carrying objects about 50 pounds 1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no
21. Standing or walking, carrying objects about 75 pounds 1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no
22. Standing or walking, carrying objects about 100 pounds 1. yes---__ __
2. no
1. yes---__ __
2. no
1. yes---__ __
2. no

Section D. Walking Up and Down Stairs or Ladders

  Job 1 Job 2 Job 3
29. Give the number of flights of stairs or steps per day. Use 10 stairs per flight and count up and down as one flight _____ _____ _____

Last Modified: 11 Apr 2014