Cardia VI Physical Activity Recall Questionnaire - Form 18R

http://www.cardia.dopm.uab.edu/pdf/FORM18R.PDF

Now I would like you to think back to the year before your first CARDIA visit, fifteen years ago. That visit was in ___/___ (Mo/Year) You were ___ years old at that time. To help you focus on the period of time, President Reagan was elected to his second term in 1984. The first CARDIA visit included a treadmill test among other measurements. Picture where you lived and what you were doing during the year before your first CARDIA visit

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 during those 12 months (before you first CARDIA exam) for at least one hour total time in any month?
___no ___yes

C2. How many months did you do these activities?
___months

C3. How many of these months did you do this activity for at least 2 hours per week?
___months

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

J1. Did you take walks or hikes or walk to work during those 12 months (before your first CARDIA exam) for at least one hour total time in any month?
___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