School Health Action, Planning and Evaluation System (SHAPES) Physical Activity Questionnaire
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You are browsing a database of standardized questionnaires that ask about respondents' walking and bicycling habits.
The survey on this page is presented for informational purposes only, and is not intended to be filled out by visitors to this Web site.
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.
In: Wong SL, Leatherdale ST, Manske SR. Reliability and validity of a school-based physical activity questionnaire. Med Sci Sports Exerc 2006 Sep;38(9):1593-600. [View Abstract]
In the last 7 days, how did you usually get to and from school?
- Actively (e.g., walk, bike, skateboard)
- Inactively (e.g., car, bus, public transit)
- Mixed (actively and inactively)
MODERATE physical activities are lower intensity activities such as walking, biking to school, and recreational swimming.
Mark how many minutes of MODERATE physical activity you did in the last 7 days. This includes physical activity during physical education class, lunch, recess, after school, evenings, and spare time.
For example: if you did 2 hours and 45 minutes of moderate activity on Monday, you will need to fill in the 2 hour circle and the 45 minute circle, as shown below:
|Monday||0 1 2 3 4||0 15 30 45|
|Tuesday||0 1 2 3 4||0 15 30 45|
|Wednesday||0 1 2 3 4||0 15 30 45|
|Thursday||0 1 2 3 4||0 15 30 45|
|Friday||0 1 2 3 4||0 15 30 45|
|Saturday||0 1 2 3 4||0 15 30 45|
|Sunday||0 1 2 3 4||0 15 30 45|
Last Modified: 18 Oct 2013