Cardia Physical Activity Questionnaire - Form 18

http://www.cardia.dopm.uab.edu/DOC/D10044.PDF

Please look at this card. I'll be asking you whether you do the activities listed. Only include the time spent actually doing the activity. For example, sitting by the pool does not count as time swimming; sitting in a chair lift does not count for skiing.

First, I'll ask you about vigorous activities. Vigorous activities increase your heart rate, or make you sweat doing them, or make you breathe hard or raise your body temperature. If you do an activity but not vigorously please include it later when I ask you about other non-strenuous sports.

C1) Did you bicycle faster than 10 miles/hour or exercise hard on an exercise bicycle in the past 12 months for at least one hour total time?
___no ___yes

C2) How many months did you do this activity?
___months

C3) How many of these months were for at least 2 hours per week?
___months

Now I'd like to ask you about leisurely activities.

I1) Did you do strenuous sports such as softball, shooting baskets, volleyball, ping pong or leisurely jogging, swimming or biking which we haven't included above in the past 12 months for a t least one hour total time?
___no ___yes

I2) How many months did you do this activity?
___months

I3) How many of these months were for at least 3 hours per week?
___months

J1) Did you take walks or hikes or walk to work in the past 12 months for at least one hour total time?
___no ___yes

J2) How many months did you do this activity?
___months

J3) How many of these months were for at least 4 hours per week?
___months