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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.
Modifiable Activity Questionnaire
In:
Pereira MA, FitzGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM.
A collection of Physical Activity Questionnaires for health-related research.
Med Sci Sports Exerc 1997 Jun;29(6 Suppl):S1-205.
- Please circle all activities listed below that you have done more than 10 times in the past year:
- Bicycling (indoor, outdoor) .......... 3
- Walking for exercise (outdoor, indoor at mall or fitness center, treadmill) ..... 40
List each activity that you circled in the Activity box below, check the months you did each activity over the past year (12 months) and then estimate the average amount of time spent in that activity.
| Activity |
J |
F |
M |
A |
M |
J |
J |
A |
S |
O |
N |
D |
Average # of times per month |
Average # of minutes each time |
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- Have you had a job for more than one month over this past year, from last ___ to this ___ ?
- List all the jobs that the individual held over the past year for more than one month. Account for all 12 months of the past year. If unemployed /disabled /retired/homemaker/student during all or part of the past year, list as such and probe for job activities of a normal 8 hour day, 5 day week.
| Job Name |
Job Code |
Walk or bike to/from work
Min/Day |
Average Job Schedule
Mos/yr Dy/wk Hr/dy |
Hours spent sitting at work
Hr sitting |
Check the category that best describes job activities (not sit) |
| A |
B |
C |
| Category A activities: |
| -Occasional /short distance
walking |
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| Category B activities: |
| -Continuous walking |
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| Category C activities: |
| -no walking or biking activities
listed in this category |
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