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

Health-Enhancing Physical Activity (HEPA) and Office in Motion Questionnaire (OIMQ)

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: Mäder U, Martin BW, Schutz Y, Marti B. Validity of four short physical activity questionnaires in middle-aged persons. Med Sci Sports Exerc 2006 Jul;38(7):1255-66. [View Abstract]

HEPA

Telephone interview:

Think about moderate physical activities that make you breathe somewhat harder and may include continuous walking, hiking, dancing, gardening or sport activities.

Currently, do you do any physical activities that make you breathe somewhat harder?

<1> Yes
<2> No
<9> No statement
If 1, GO TO 10400.
If 2/9, GO TO 10300.
<10300>

Do you intend to do physical activities that make you breathe somewhat harder?

<1> Yes
<2> No
<8> Do not know
<9> No statement
Continue with 10700.
<10400>

Currently, do you do moderate physical activities that make you breathe somewhat harder for 30 minutes or more on every day or most days of the week?

Include all activities with a length of 10 minutes or more.

<1> Yes
<2> No
<8> Do not know
<9> No statement
If 1, GO TO 10600.
If 2/8/9, GO TO 10500.
<10500>

Do you intend to start with physical activities that make you breathe somewhat harder for 30 minutes or longer next month?

<1> Yes
<2> No
<8> Do not know
<9> No statement
Continue with 10700.
<10600>

Have you been doing physical activities that make you breathe somewhat harder for 30 minutes or more every day or most days of the week for half a year or longer?

<1> Yes
<2> No
<8> Do not know
<9> No statement
<10700>

Now think about sport or other physical activities that make you sweat. Do you work up a sweat during leisure time while being physically active at least once a week? For example: Brisk walking, running, bicycling etc.?

<1> Yes
<2> No
<9> No statement
If 1, GO TO 10800.
If 2/9, GO TO 10850.
<10800>

On how many days during a usual week you work up a sweat during leisure time while being physically active?

<1> 1 day per week
<2> 2 days per week
<3> 3 days per week
<4> 4 days per week
<5> 5 days per week
<6> 6 days per week
<7> 7 days per week
<9> No statement
Continue with 11000.
<10850>

Do you work up a sweat while being physically active off leisure time at least once a week? (For example: On the job?)

<1> Yes
<2> No
<9> No statement
IF 1, GO TO 11000.
IF 2/9, GO TO 10900.
<10900>

Do you intend to start with sport activities that make you work up a sweat?

<1> Yes
<2> No
<9> Do not know/No statement
GO TO END.
<11000>

Do you do sport activities that make you work up a sweat three times per week for 20 minutes or more on a regular basis?

<1> Yes
<2> No
<9> No statement
IF 1, GO TO 11200.
IF 2/9, GO TO 11100.
<11100>

Do you intend to start within the next month with sport activities that make you work up a sweat three times per week for 20 minutes or more?

<1> Yes
<2> No
<9> Do not know / No statement
GO TO END.
<11200>

Do you do sport activities that make you work up a sweat three times a week for 20 min or more since more than half a year?

<1> Yes
<2> No
<9> No statement

OIMQ

We are interested in knowing your physical activities during the last seven days. For each of the activities listed, please indicate by a check mark:

  1. Number of days: indicate "0" if you did not perform the activity. Indicate "1", if you performed it one day during the last seven days. If you performed the activity every day, indicate "7".
  2. Average duration per day: indicate the overall duration per day on the corresponding time-scale graduated in hours.
  3. Additional activities: At the end of the questionnaire, you have the possibility to add activities that are not listed.

Activities-during the last seven days:

  1. Q26. Walking normally

    Average duration per day (in hours): 0 1 2 3 4 5 6

  2. Q27. Walking quickly or uphill

    Average duration per day (in hours): 0 1 2 3 4 5 6

  3. Q30. Bicycling slowing (about 9 km/h)

    Average duration per day (in hours): 0 1 2 3 4 5 6

  4. Q31. Bicycling fast (about 15 km/h)

    Average duration per day (in hours): 0 1 2 3 4 5 6

During the last seven days, have you been normally, more, or less active:

  • More
  • Normally
  • Less

I. Domestic and Leisure Activities

There are no Walking/Biking questions.

II. Getting to Work or Elsewhere

Activities-during the last seven days

  1. Walking normally

    Average duration per day (in hours): 0 1 2 3 4 5 6

  2. Walking quickly or uphill

    Average duration per day (in hours): 0 1 2 3 4 5 6

  3. Walking while carrying heavy baggage

    Average duration per day (in hours): 0 1 2 3 4 5 6

  4. Climbing upstairs

    Number of floors per day floors

  5. Bicycling slowly (about 9 km/h)

    Average duration per day (in hours): 0 1 2 3 4 5 6

  6. Bicycling fast (about 15 km/h)

    Average duration per day (in hours): 0 1 2 3 4 5 6

III. Leisure Activities Including Sport

Activities-during the last seven days

  1. Bicycling (exercise, without bicycling mentioned in 11/12)

    Average duration per day (in hours): 0 1 2 3 4 5 6

  2. Athletic walking

    Average duration per day (in hours): 0 1 2 3 4 5 6

  3. Running

    Average duration per day (in hours): 0 1 2 3 4 5 6

Last Modified: 11 Apr 2014