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Three Question Physical Activity Assessment

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: Smith BJ, Marshall AL, Huang N. Screening for physical activity in family practice: evaluation of two brief assessment tools. Am J Prev Med 2005 Nov;29(4):256-64. Erratum in: Am J Prev Med. 2006 Apr;30(4):363. [View Abstract]

  1. How many times a week do you usually do 20 minutes or more of vigorous-intensity physical activity that make you sweat or puff and pant? (e.g., heavy lifting digging, jogging, aerobics or fast bicycling)?

    3 or more times a week 1 to 2 times a week none

  2. How many times a week do you usually do 30 minutes or more walking? (e.g., walking from place to place for exercise, leisure or recreation)?

    5 or more times a week 3-4 times a week 1-2 times a week none

  3. How many times a week do you usually do 30 minutes or more of moderate-intensity physical activity that increases your heart rate or make you breathe harder than normal? (e.g., carrying light loads, bicycling at a regular pace or doubles tennis)?

    5 or more times a week 3-4 times a week 1-2 times a week none

Last Modified: 11 Apr 2014