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Active Australia Physical Activity Survey (AAS)

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.alswh.org.au/Surveys_data/Surveys/6MF%20MAIN%20Survey%201.pdfExternal Web Site Policy

  1. The following questions are about activities you might do during a typical day. Does YOUR HEALTH NOW LIMIT YOU in these activities? If so, how much? (Mark one on each line)
    1. Walking MORE THAN ONE kilometer:
    2. Yes, limited a lot Yes, limited a little No, not limited at all

    3. Walking HALF a kilometre:
    4. Yes, limited a lot Yes, limited a little No, not limited at all

    5. . Walking 100 metres:
    6. Yes, limited a lot Yes, limited a little No, not limited at all

  1. How many times did you do each type of activity LAST WEEK? Only count the number of times when the activity lasted for 10 minutes or more. (If you did not do an activity, please write "0" in the box)
  2. Walking briskly (for recreation or exercise, or to get from place to place)
    __ __ times

  1. In the last month HAVE YOU HAD ANY DIFFICULTY (for example, needing to take extra time, changing the activity or using a device to help you) in completing any of these activities? (Mark one on each line)
    1. Walking inside the house:
    2. No difficulty Some difficulty Unable to do

  2. In the last month have you needed HELP FROM ANOTHER PERSON to carry out any of these activities? (Mark one on each line)
  3. Walking inside the house

    Yes No

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Last Modified: 11 Apr 2014