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

Women's Health Initiative Physical Activity Questions

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.

At: http://www.nhlbi.nih.gov/resources/deca/whios/studydoc/forms/

The following questions are about your usual physical activity and exercise. This includes walking and sports.

6. Think about the walking you do outside the home. How often do you walk outside the home for more than 10 minutes without stopping? (Mark only one.)

  • Rarely or never
  • 1-3 times each month
  • 1 time each week
  • 2-3 times each week
  • 4-6 times each week
  • 7 or more times each week

6.1 When you walk outside the home for more than 10 minutes without stopping, for how many minutes do you usually walk?

  • Less than 20 min.
  • 20-39 min.
  • 40-59 min.
  • 1 hour or more

6.2 What is your usual speed?

  • Casual strolling or walking (less than 2 miles an hour)
  • Average or normal (2-3 miles an hour)
  • Fairly fast (3-4 miles an hour)
  • Very fast (more than 4 miles an hour)
  • Don't know

7. Not including walking outside the home, how often each week (7 days) do you usually do the exercises below?

7.1 STRENUOUS OR VERY HARD EXERCISE (You work up a sweat and your heart beats fast.) For example, aerobics, aerobic dancing, jogging, tennis, swimming laps.

  • None
  • 2 days per week
  • 3 days per week
  • 4 days per week
  • 5 or more days per week

7.2 How long do you usually exercise like this at one time?

  • Less than 20 min.
  • 20-39 min.
  • 40-59 min.
  • 1 hour or more

7.3 MODERATE EXERCISE (Not exhausting). For example, biking outdoors, using an exercise machine (like stationary bike or treadmill), calisthenics, easy swimming, popular or folk dancing.

  • None
  • 2 days per week
  • 3 days per week
  • 4 days per week
  • 5 or more days per week

7.4 How long do you usually exercise like this at one time?

  • Less than 20 min.
  • 20-39 min.
  • 40-59 min.
  • 1 hour or more

7.5 MILD EXERCISE. For example, slow dancing, bowling, golf

  • None
  • 2 days per week
  • 3 days per week
  • 4 days per week
  • 5 or more days per week

7.6 How long do you usually exercise like this at one time?

  • Less than 20 min.
  • 20-39 min.
  • 40-59 min.
  • 1 hour or more

8. For each of the ages below, did you usually do strenuous or very hard exercises at least 3 days a week? This would include exercise that was long enough to work up a sweat and make your heart beat fast. (Be sure to mark "No" if you did not do very hard exercises at the ages listed below.)

  1. 8.1   18 years old........no yes
  2. 8.2   35 years old........no yes
  3. 8.3   50 years old........no yes

[Return to the Top]

Last Modified: 11 Apr 2014