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.
Physical Activity Scale for the Elderly (PASE)
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.
LEISURE TIME ACTIVITY
2. Over the past 7 days, how often did you take a walk outside your home or yard for any reason? For example, for fun or exercise, walking to work, walking the dog, etc?
- never
- seldom (1-2 days)
- sometimes (3-4 days)
- often (5-7 days)
If 1,2 or 3:
2a. On average, how many hours per day did you spend walking?
- less than 1 hour
- 1 but less than 2 hours
- 2-4 hours
- more than 4 hours
5. Over the past 7 days, how often did you engage in strenuous sport and recreational activities such as jobbing swimming, cycling, singles tennis, aerobic dance, skiing(downhill or cross country) or other similar activities?
- never
- seldom (1-2 days)
- sometimes (3-4 days)
- often (5-7 days)
If 1,2 or 3:
5a. What were these activities? ___________________________
5b. On average, how many hours per day did you engage in these strenuous sport and recreational activities?
- less than 1 hour
- 1 but less than 2 hours
- 2-4 hours
- more than 4 hours
HOUSEHOLD ACTIVITY
No walking or bicycling related questions in this section.
WORK RELATED ACTIVITY
10. During the past 7 days, did you work for pay or as a volunteer?
- NO
- YES
IF YES:
10a. How many hours per week did you work for pay and or as a volunteer?
___ hours
10b. Which of the following categories best describes the amount of physical activity required on your job and or volunteer work?
- Sitting or standing with some walking, Ex: cashier, general office worker, light tool and machinery worker
- Walking with some handling of materials generally weighing less than 50 pounds. Ex: mailman, waiter/waitress, construction worker, heavy tool and machinery worker
- Walking and heavy manual work often requiring handling of materials weighting over 50 pounds. Ex: lumberjack, stone mason, farm or general laborer.
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