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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.
The Familial Breast and Ovarian Cancer Study
http://dceg.cancer.gov/modules/LongForm.pdf
No true validation studies were found for this questionnaire.
Following are questions about your physical activity at various times in your life. To answer these questions, please estimate the average amount of time each week and the average number of months each year that you spent in these activities.
Strenuous Exercise
- How often did you participate in STRENUOUS exercise activities or sports (e.g., swimming laps, aerobics, calisthenics, running, jogging, basketball, cycling on hills, racquetball)?
| |
Average hours per week |
Average months per year |
| None |
½ hr |
1 hr |
1 ½ hrs |
2 hrs |
3 hrs |
4-6 hrs |
7-10 hrs |
11 or more hrs |
1-3 |
4-6 |
7-9 |
10-12 |
| During high school |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 18 and 24 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 25 and 34 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 35 and 44 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 45 and 54 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Past 3 years * |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
* If you have been diagnosed with cancer in the past three years, please answer the question for the three years prior to the cancer diagnosis.
Moderate Exercise
- How often did you participate in MODERATE exercise activities or sports (e.g., brisk walking, golf, volley-ball, cycling on level streets, recreational tennis, or softball)?
| |
Average hours per week |
Average months per year |
| None |
½ hr |
1 hr |
1 ½ hrs |
2 hrs |
3 hrs |
4-6 hrs |
7-10 hrs |
11 or more hrs |
1-3 |
4-6 |
7-9 |
10-12 |
| During high school |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 18 and 24 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 25 and 34 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 35 and 44 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Between ages 45 and 54 |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
| Past 3 years * |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
Other Activities
- In the past year, on average, how many hours per day did you spend in each of the following activities?
| |
Average hours per day |
Days per week |
| None |
< 1 |
1 |
1-2 |
3-4 |
5-6 |
7-9 |
10 or more |
1 |
2-3 |
4-5 |
6-7 |
| Casual walking |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
O |
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