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Standardized Questionnaires of Walking & Bicycling Database:
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About This Database
You are browsing a database of standardized
questionnaires that ask about respondents' walking and bicycling habits. 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.
CHAMPS Activities Questionnaire for Older Adults
http://www.ucsf.edu/champs/resources/qxn/pdfs/champs_englishqxn_26Dec02.doc
In:
Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL.
CHAMPS physical activity questionnaire for older adults: outcomes for interventions.
Med Sci Sports Exerc 2001 Jul;33(7):1126-41.
This questionnaire is about activities that you may have done in the past 4 weeks. The questions on the following pages are similar to the example shown below.
INSTRUCTIONS
If you DID the activity in the past 4 weeks:
Step #1 Check the YES box.
Step #2 Think about how many TIMES a week you usually did it, and write your response in the space provided.
Step #3 Circle how many TOTAL HOURS in a typical week you did the activity.
In a typical week in the last 4 weeks did you:
25. Walk uphill or hike uphill (count only uphill part)?
[ ] YES How many TIMES a week? _____ →
[ ] NO
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How many TOTAL hours a week did you usually do it?
→ |
Less than
1 hour |
1-2½ hours |
3-4½ hours |
5-6½ hours |
7-8½ hours |
26. Walk fast or briskly for exercise (do not count walking leisurely or uphill)?
[ ] YES How many TIMES a week? _____ →
[ ] NO
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How many TOTAL hours a week did you usually do it?
→ |
Less than
1 hour |
1-2½ hours |
3-4½ hours |
5-6½ hours |
7-8½ hours |
27. Walk to do errands (such as to/from a store or to take children to school (count walk time only)?
[ ] YES How many TIMES a week? _____ →
[ ] NO |
How many TOTAL hours a week did you usually do it?
→ |
Less than
1 hour |
1-2½ hours |
3-4½ hours |
5-6½ hours |
7-8½ hours |
28. Walk leisurely for exercise or pleasure?
[ ] YES How many TIMES a week? _____ →
[ ] NO |
How many TOTAL hours a week did you usually do it?
→ |
Less than
1 hour |
1-2½ hours |
3-4½ hours |
5-6½ hours |
7-8½ hours |
29. Ride a bicycle or stationary cycle?
[ ] YES How many TIMES a week? _____ →
[ ] NO |
How many TOTAL hours a week did you usually do it?
→ |
Less than
1 hour |
1-2½ hours |
3-4½ hours |
5-6½ hours |
7-8½ hours |
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