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.
Stanford Brief Activity Survey of on-the-job Activity and Stanford Brief Activity Survey of Leisure-Time Activity
Taylor-Piliae RE, Norton LC, Haskell WL, Mahbouda MH, Fair JM, Iribarren C, Hlatky MA, Go AS, Fortmann SP.
Validation of a new brief physical activity survey among men and women aged 60-69 years.
Am J Epidemiol 2006 Sep 15;164(6):598-606.
Stanford Brief Activity Survey of on-the-job Activity
Please check the box next to the one statement that best describes the kinds of physical activity you usually performed while on the job this last year. If you are not gainfully employed outside the home but perform work around the home regularly, indicate that activity in this section.
- If you have no job or regular work, check box A and go on to Appendix Table 2.
- I spent most of the day sitting or standing. When I was at work, I did such things as writing, typing, talking on the telephone, assembling small parts, or operating a machine that takes very little exertion or strength. If I drove a car or truck while at work, I did not lift or carry anything for more that a few minutes each day.
- No other questions regarding walking/biking.
Stanford Brief Activity Survey of Leisure-Time Activity
Please check the box next to the one statement that best describes the way you spent your leisure time during most of the last year.
- Most of my leisure time was spent without very much physical activity. I mostly did things like watching television, reading, or playing cards. If I did anything else, it was likely to be light chores around the house or yard or some easy-going game like bowling or catch. Only occasionally, no more than once or twice a month, did I do anything more vigorous, like jogging, playing tennis, or active gardening.
- Weekdays, when I got home from work, I did few active things, but most weekends I was able to get outdoors for some light exercise -- going for walks, playing a round of golf (without motorized carts), or doing some active chores around the house.
- Three times per week, on average, I engaged in some moderate activity, such as brisk walking or slow jogging, swimming, or riding a bike for 15 - 20 minutes or more, or I spent 45 minutes to an hour or more doing moderately difficult chores, such as raking or washing windows, mowing the lawn or vacuuming, or playing games such a doubles tennis or basketball.
- During my leisure time over the past year, I engaged in a regular program of physical fitness involving some kind of heavy physical activity at least three times per week. Examples of heavy physical activity are jogging, running, or riding fast on a bicycle for 30 minutes or more; heavy gardening or other chores for an hour or more; active games or sports such as handball or tennis for an hour or more; or a regular program involving calisthenics and jogging or the equivalent for 30 minute or more.
- Over the past year, I engaged in a regular program of physical fitness along the lines described in the last paragraph (I), but I did it almost daily -- five or more times per week.