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Walking & Bicycling Related Questions from PA Questionnaires

Note: brief instructions for filling out questions are included for some of the questionnaires. This list of walking/bicycling questions taken from various PAQs maintains the same question number and general format used in the original questionnaire. The source for the questions is listed beneath the questionnaire title.

  1. Ainsworth New Physical Activity Questionniare and Physical Activity Log
  2. Allied Dunbar Survey of Activity and Health
  3. Arizona Activity Frequency Questionnaire
  4. Auckland Heart Study (AHS) Physical Activity Questionnaire
  5. Baecke Physical Activity Questionnaire
  6. Modified Baecke Questionnaire for Older Adults
  7. Behavioral Risk Factor Surveillance System Historical Questions
  8. Breast Cancer Detection Demonstration Project (BCDDP)
  9. Campbell Survey on Well-Being in Canada PA Monitor
  10. Canada Fitness Survey Questionniare
  11. Cardia Seven-Day Physical Activity Recall Questionnaire - Form 19
  12. Cardia Physical Activity Questionnaire - Form 18
  13. Cardia VI Physical Activity Recall Questionnaire - Form 18R
  14. Central Sweden Physical Activity Questionnaire
  15. Champs Activities Questionnaire for Older Adults
  16. EPIC Physical Activity Questions
  17. EPIC-Norfolk Physical Activity Questionnaire
  18. The Familial Breast and Ovarian Cancer Study
  19. Framingham Study - Physical Activity Questions
  20. Godin Leisure-Time Exercise Questionnaire
  21. Green Script Study (GSS) Physical Activity Questionnaire
  22. Health Promotion/Disease Prevention Supplement to the NNHI Survey
  23. Health Insurance Plan of New York City Activity Questionnaire
  24. Historical Leisure Activity Questionnaire
  25. Historical Physical Activity Survey - 1988
  26. International Physical Activity Questionnaire
  27. International Physical Activity Questionnaire
  28. International Physical Activity Questionnaire
  29. International Physical Activity Questionnaire
  30. Kaiser Physical Activity Survey
  31. KIHD Seven-Day Physical Activity Questionnaire
  32. KIHD 12 Month Leisure-time Physical Activity History
  33. KIHD 24 Hour Total Physical Activity Record
  34. KIHD Occupational Physical Activity Interview
  35. Lifetime Physical Activity Questionnaire
  36. The Lipid Research Clinics Physical Activity Questionnaire
  37. Longitudinal Aging Study Amsterdam (LASA) Physical Activity Questionnaire (LAPAQ)
  38. Minnesota Leisure-time Physical Activity Questionnaire
  39. Modifiable Activity Questionnaire
  40. The Modifiable Activity Questionnaire/Pima Indian
  41. The Monica Optional Study of Physical Activity (MOSPA)
  42. 2002 National Health Interview Survey (Revised October 23, 2003
  43. 2001 National Health Interview Survey (Revised October 23, 2003)
  44. 1999 National Health Interview Survey
  45. 1997 National Health Interview Survey
  46. 1991 National Health Interview Survey
  47. Nhanes Physical Activity and Physical Fitness PAQ-SP 12-15 Version 12/9/98
  48. Nhanes Survey I And II
  49. Nhanes III
  50. Nurses Health Study II Activity And Inactivity Questionnaire
  51. One-page Questionnaire Of Physical Activity - Vitamins And Lifestyle (VITAL) Study
  52. Paffenbarger Physical Activity Questionnaire (College Alumnus Questionnaire)
  53. Perceived Functional Ability (PFA) Questionnaire/Physical Activity Rating (PA-R) Questionnaire
  54. Physical Activity Rating (PA-R) Questions
  55. Physical Activity Scale for the Elderly (PASE)
  56. Physical Activity Scale
  57. Postmenopausal Osteopenia PAQ
  58. Physical Activity Recall - Suzuki
  59. Quantitative Physical Activity Recall Questions - Aerobics Center Longitudinal Study - 1982 and Baseline
  60. Single Item 5-Point Rating of Usual Physical Activity
  61. Seven-day Physical Activity Recall Questionnaire - Kolonel and Henderson
  62. Seven-day Physical Activity Recall (PAR) - Used in Five City Project
  63. The Short Questionnaire To Assess Health–enhancing Physical Activity (SQUASH)
  64. Stanford Usual Physical Activity Questionnaire
  65. Stockholm Public Health Questionnaire
  66. Techumseh Occupational Physical Activity Questionnaire
  67. Walking Adherence Questionnaire
  68. Wise Study (NHLBI) Postmenopausal Estrogen/Progesterone Intervention Activity Questionnaire (PEPI-Q)
  69. Yale Physical Activity Survey for Older Adults
  70. Zutphen Physical Activity Questionnaire
  71. 2002 National Survey of Pedestrian and Bicyclist Attitudes and Behaviors (NSPBAB)

1. Ainsworth New Physical Activity Questionniare and Physical Activity Log

in: Ainsworth BE, Bassett DR Jr, Strath SJ, Swartz AM, O'Brien WL, Thompson RW, Jones DA, Macera CA, Kimsey CD. Comparison of three methods for measuring the time spent in physical activity. Med Sci Sports Exerc 2000 Sep;32(9 Suppl):S457-64.

PAQ:

Walking. I am going to ask you questions about three different levels of PA that you do when you are not at work. Last week, did you walk continuously for at least 10 minutes for recreation, exercise or to get to and from places? If yes, how many days last week did you spend walking each day? ____days

On average, how many total min did you spend walking each day? ___min

PA Log:

Fill this page out at the end of the day. For each activity, circle yes if you did the activity and no if you did not do the activity. For each activity you did, write down the number of hours and or minutes you were actually moving and the time you began the activity (am or pm). If you did an activity many times during the day, write down the total time you did that activity during the day. If you did many activities that are not on the list, please write them on the line labeled ‘other', circle yes and write tin the hours and /or minutes. Remember to record only the hours and /or minutes you were actively engaged in the activity.

Did you do this activity today? (only categories with walking/biking included here)
Yes
No
How Long?
Time start activity
(circle one)
__hrs __min
____AM or PM
Transportation (to and from)
Walk to work, school, shopping
Yes
No
___:___
____
Bicycle to work, school, shopping
Yes
No
___:___
____
Occupation
Walking at work
Yes
No
___:___
____
Conditioning Activities
Bicycling
Yes
No
___:___
____
Walking for Exercise
Yes
No
___:___
____
Leisure Activities
Walking for pleasure or social
Yes
No
___:___
____

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2. Allied Dunbar Survey of Activity and Health

From author, Rhonda Brownbill, via fax.

Walking:

Now, walking:

  1. Can you walk for a quarter of a mile on your own without stopping and without severe discomfort?
    Yes No
  2. For how long can you walk on your own without stopping or without severe discomfort? Would you say...
    1. less than 5 minutes
    2. 5, but less than 10 minutes
    3. 10, but less than 15 minutes
    4. 15, but less than 30 minutes
    5. 30 minutes or more?

IF YOU CAN WALK FOR 30 MINUTES OR MORE (Q9. code 5)

  1.  
    1. I'd like you to think now about all the walking you've done in the past 4 weeks, either locally or away from here including any country walks. First, I'm interested in walks of 2 miles or more. These are long continuous walks that would usually take at least 40 minutes. Don't include anything shorter than that. Did you do any walks of that kind during the past 4 weeks, that's from ...up to yesterday?
      Yes No

    2. IF ANY WALKS OF AT LEAST 2 MILES IN PAST 4 WEEKS

    1. During the past 4 weeks how many times did you do any long walks of 2 miles or more?
      No. of times ____
    2. And during the last week, that's to last ....day, how many times did you do any long walks of 2 miles or more?
      No. of times ____
    3. How long did you spend walking on the most recent occasion you did a long walk of 2 miles or more?
      __hours ___minutes

IF YOU CAN WALK FOR 15 MINUTES OR MORE (Q. 9 codes 4 and 5)

  1.  
    1. Now, I'd like to ask you to think about all the walking you've done in the past week, that's back to last .... day. Did you do any walks either locally or away from here of between 1 and 2 miles? That would usually be continuous walking for about 20 to 30 minutes.
      Yes No

    2. IF YES AT a)

    1. During the past week how many times did you do any of these walks?
      No. of times ____
    2. And yesterday, that is...(day of week) how many times did you do any of these walks?
      No. of times ____

IF YOU CAN WALK FOR 5 MINUTES OR MORE (Q9 codes 2-5)

  1. Have you done any (shorter) walks which lasted at least 5 minutes in the last week, that's back to last ....day?
    Yes No

Ask ALL

  1. Which of the following best describes your usual walking pace...
    1. a slow pace
    2. a steady average pace
    3. a fairly brisk pace
    4. or a fast pace -- at least 4 mph.

Now I'd like to talk about any sports or exercise activities you've done regularly at any time since you left school.

  1.  
    1. First, long walks. During the time from when you left school up to the present, have you, at any time, walked for 2 miles or more on a regular basis, for a period of at least 2 years?
      Yes No

    2. IF YES AT a)

    1. For about how many years in total did you do these long walks regularly?
      No. of years ____
    2. At what age did you stop doing long walks regularly or do you still do long walks at least once a week for a few months of the year?
      Age stopped___ Still regular____

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3. Arizona Activity Frequency Questionnaire

From author, Lisa Staten, via fax.

Please note:

  • Record only the amount of time you spent actually doing an activity. For example, if you take an aerobics class for exercise do not count the time you spend changing clothes or chatting before or after the class.
  • Remember if you select a Yes for an activity, THREE CIRCLES MUST BE FILLED IN ON THAT LINE. If you select NO, no other columns need to be marked on that line.
Recreational Activities
Did you do it in the last 4 weeks?
How many times did you do it in the last 4 weeks?
How much time did you spend on this activity each time (on average)?
Yes
No
1-3
5-10
11-19
≥20
<12 mins
13-29 mins
30-44 mins
≥45 mins
Walking upstairs or using a stair climber
O
O
O
O
O
O
O
O
O
O
Walking (include on a treadmill and walking to the store)
O
O
O
O
O
O
O
O
O
O

Other Recreational Activities
Did you do it in the last 4 weeks?
How many times did you do it in the last 4 weeks?
How much time did you spend on this activity each time (on average)?
Yes
No
1-2
3-5
6-11
≥12
<30 mins
>30 mins but <1.5 hrs
>1.5 hrs but < 3 hrs
≥3 hrs
Bicycling for pleasure or transportation (include riding exer-cycle or stationary bike)
O
O
O
O
O
O
O
O
O
O
Hiking
O
O
O
O
O
O
O
O
O
O

 

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4. Auckland Heart Study (AHS) Physical Activity Questionnaire

http://www.rnzcgp.org.nz/news/nzfp/June2003/Elley_June03.pdf

  1. How many minutes per day would you spend walking to and from work? _______
    (e.g. from home, car, bus). And how many days per week? ____________________
  2. Have you done any (other) brisk walking on a regular basis, (that is at least once per 2 weeks) in the last 3 months? e.g. to or around shops, library, or church?
    YES NO

    OFFICE USE
    If YES, minutes per day ________ Number of days walked per week ___________
  3. How many hours did you spend on the following activities in an average week?
    Hours
    Minutes

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5. Baecke Physical Activity Questionnaire

  1. At work I walk:
    never__ seldom__ sometimes__ often__ always__
  2. During leisure time I walk:
    never__ seldom__ sometimes__ often__ always__
  3. During leisure time I cycle:
    never__ seldom__ sometimes__ often__ always__
  4. How many minutes do you walk and/or cycle per day to and from work, school and shopping?
    <5 5-15 15-30 30-45 >45

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6. Modified Baecke Questionnaire For Older Adults

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.

  1. How many flights of stairs do you walk up per day? One flight is 10 steps.
    1. I never walk stairs
    2. 1-5
    3. 6-10
    4. More than 10
  2. If you go somewhere in your hometown, what kind of transportation do you use?
    1. I never go out
    2. Car
    3. Public transportation
    4. Bicycle
    5. Walking
  3. If you go out for shopping, what kind of transportation do you use?
    1. I never go out
    2. Car
    3. Public transportation
    4. Bicycle
    5. Walking

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7. Behavioral Risk Factor Surveillance System Historical Questions

http://apps.nccd.cdc.gov/BRFSSQuest/ResultsV.asp? StartPg=1&EndPg=10&TopicID=30&fromyr=Any&toyr=Any&Text=&Join=AND&SUBMIT1=+Go+

There are no specific Walking/Biking questions in the BRFSS. However, the following abstract describes a validation study of new global walking questions added to a BRFSS PA module: Yore MM, Ham SA, Kohl HW, Ainsworth BE, LaMonte M. Reliability and validity of BRFSS walking questions. Med Sci Sports Exerc 2004 May;36(5 Suppl):S111.

BRFSS Walking Questions obtained from correspondence with author, B. Ainsworth.

4_2. In a usual week, do you walk for at least 10 minutes at a time [if employed, insert: while at work,] for recreation, exercise, to get to and from places, or for any other reason? [BRFPA02]
1 Yes 2 No [Go to 4_5] 7 Don't know/not sure [Go to 4_6] 9 Refused [Go to 4_6]

4_3. How many days per week do you walk for at least 10 minutes at a time? [BRFPA03]
_____ __ Days/week (Range: 1-7) 77 Don't know/not sure 99 Refused

4_4. On days when you walk for at least 10 minutes at a time, how much total time per day do you spend walking? [BRFPA04]
__: __ ___ __ Hours and minutes per day (Range: 0-16 hours) (Range: 0-60 min) 7777 Don't know/not sure 9999 Refused

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8. Breast Cancer Detection Demonstration Project (BCDDP)

http://dceg2.cancer.gov/modules/Physical.pdf

No true validation studies were found for this group of questionnaires.

SECTION D. PHYSICAL ACTIVITY

D2. The following is a list of activities with which some people have difficulty because of a health or physical reason. Please read the activity, and then check for each activity whether you currently have no difficulty, some difficulty, much difficulty, or are unable to do the activity at all, when you are by yourself and without aid. (PLEASE CHECK ONE BOX FOR EACH ACTIVITY.)

 
1. NO DIFFICULTY
2. SOME DIFFICULTY
3. MUCH DIFFICULTY
4. UNABLE TO DO
5. NEVER DO THIS ACTIVITY
a. Walk a quarter of a mile (that is, two or three blocks)          
b. Walk up 10 steps without resting          

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9. Campbell Survey on Well-being in Canada PA Monitor

http://www.cflri.ca/pdf/e/88paquestion.pdf

PHYSICAL ACTIVITY IN YOUR SPARE TIME

  1. The following activities refer to physical activities that are not related to work. Have you done any of the following physical activities in the past 12 months? Please indicate whether you have done each activity listed below. Then for those activities which you have done, please complete the number of times done each month, and the average time spent on each occasion (not counting travel time, changing etc.)
     
    No
    Yes
    Number of times each month
    Average time per occasion
    J
    F
    M
    A
    M
    J
    J
    A
    S
    O
    N
    D
    Hrs
    min
    -Walking for exercise
    O
    O
    		 _ _ _ _ _ _ _ _ _ _ _ _ __ __
    -Bicycling
    O
    O
    		 _ _ _ _ _ _ _ _ _ _ _ _ __ __

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10. Canada Fitness Survey Questionniare

http://www.cflri.ca/pdf/e/81paquestion.pdf

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.

  1. Daily Activities
    For those daily activities which you do most days of the week (such as work, school and housework) how much time do you spend...
      Almost all of the time About 3/4 of the time About 1/2 of the time About 1/4 of the time Almost none of the time
    -Walking          
    -Walking up stairs          
  2. Weekly Activities
    The participant refers to the reference card for a list of activities and indicates the number of occasions, time and intensity of activities performed each week, no specific walking/ bicycling questions.
  3. Activities in the Last Month
    The participant refers to the reference card for a list of activities and indicates the number of occasions, time and intensity of activities performed at least once in the last month, no specific walking/ bicycling questions.
  4. Activities in the Last Year
    Please refer to the reference card of a list of activities. Answer the following for the physical activities you have done in the last 12 months.
      Months in which activity was done :
    J F M A M J J A S O N D    		 # of occasions in last 12 months Average # of minutes spent on each occasion:
    15 or less, 16-30, 31-60, 61 +
    -Walking for exercise      
    -Bicycling      

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11. Cardia Seven-day Physical Activity Recall Questionnaire - Form 19

http://www.cardia.dopm.uab.edu/DOC/D10049.PDF

No specific walking/biking questions.

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12. Cardia Physical Activity Questionnaire - Form 18

http://www.cardia.dopm.uab.edu/DOC/D10044.PDF

Please look at this card. I'll be asking you whether you do the activities listed. Only include the time spent actually doing the activity. For example, sitting by the pool does not count as time swimming; sitting in a chair lift does not count for skiing.

First, I'll ask you about vigorous activities. Vigorous activities increase your heart rate, or make you sweat doing them, or make you breathe hard or raise your body temperature. If you do an activity but not vigorously please include it later when I ask you about other non-strenuous sports.

C1) Did you bicycle faster than 10 miles/hour or exercise hard on an exercise bicycle in the past 12 months for at least one hour total time?
___no ___yes

C2) How many months did you do this activity?
___months

C3) How many of these months were for at least 2 hours per week?
___months

Now I'd like to ask you about leisurely activities.

I1) Did you do strenuous sports such as softball, shooting baskets, volleyball, ping pong or leisurely jogging, swimming or biking which we haven't included above in the past 12 months for a t least one hour total time?
___no ___yes

I2) How many months did you do this activity?
___months

I3) How many of these months were for at least 3 hours per week?
___months

J1) Did you take walks or hikes or walk to work in the past 12 months for at least one hour total time?
___no ___yes

J2) How many months did you do this activity?
___months

J3) How many of these months were for at least 4 hours per week?
___months

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13. Cardia VI Physical Activity Recall Questionnaire - Form 18R

http://www.cardia.dopm.uab.edu/pdf/FORM18R.PDF

Now I would like you to think back to the year before your first CARDIA visit, fifteen years ago. That visit was in ___/___ (Mo/Year) You were ___ years old at that time. To help you focus on the period of time, President Reagan was elected to his second term in 1984. The first CARDIA visit included a treadmill test among other measurements. Picture where you lived and what you were doing during the year before your first CARDIA visit

Please look at this card. I'll be asking you whether you do the activities listed. Only include the time spent actually doing the activity. For example, sitting by the pool does not count as time swimming; sitting in a chair lift does not count for skiing.

First, I'll ask you about vigorous activities. Vigorous activities increase your heart rate, or make you sweat doing them, or make you breathe hard or raise your body temperature. If you do an activity but not vigorously please include it later when I ask you about other non-strenuous sports.

C1. Did you bicycle faster than 10 miles/hour or exercise hard on an exercise bicycle during those 12 months (before you first CARDIA exam) for at least one hour total time in any month?
___no ___yes

C2. How many months did you do these activities?
___months

C3. How many of these months did you do this activity for at least 2 hours per week?
___months

Now I'd like to ask you about leisurely activities.

J1. Did you take walks or hikes or walk to work during those 12 months (before your first CARDIA exam) for at least one hour total time in any month?
___no ___yes

J2. How many months did you do this activity?
___months

J3. How many of these months were for at least 4 hours per week?
___months

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14. Central Sweden Physical Activity Questionnaire

in: Norman A, Bellocco R, Bergstrom A, Wolk A. Validity and reproducibility of self-reported total physical activity--differences by relative weight. Int J Obes Relat Metab Disord 2001 May;25(5):682-8.

Physical Activity Questionnaire and assigned mean MET values

PHYSICAL ACTIVITY AND EXERCISE

Mark your usual physical activity during the previous year: Assigned mean MET values (not shown in the questionnaire)
Work/Occupationb  
Mostly walking, lifts, carry little O 2.6
Mostly walking, lifts, carry much O 3.0
Walking/bicycling 3.6
Hardly ever O  
Less than 20 min/day O  
20-40 min/day O  
40-60 min/day O  
1-1.5 h/day O  
More than 1.5 h/day O  

b Work/occupational activity levels were multiplied by 5.7 h of work per day (8 h per day, 5 days per week)

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15. CHAMPS Activities Questionnaire for Older Adults

http://www.ucsf.edu/champs/resources/qxn/pdfs/champs_englishqxn_26Dec02.doc

in: Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 2001 Jul;33(7):1126-41.

This questionnaire is about activities that you may have done in the past 4 weeks. The questions on the following pages are similar to the example shown below.

INSTRUCTIONS

If you DID the activity in the past 4 weeks:
      Step #1       Check the YES box.
      Step #2       Think about how many TIMES a week you usually did it, and write your response in the space provided.
      Step #3       Circle how many TOTAL HOURS in a typical week you did the activity.

In a typical week in the last 4 weeks did you:

25. Walk uphill or hike uphill (count only uphill part)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
 How many TOTAL hours a week did you usually do it?
→		 Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
26. Walk fast or briskly for exercise (do not count walking leisurely or uphill)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO
 How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
27. Walk to do errands (such as to/from a store or to take children to school (count walk time only)?
[ ] YES   How many TIMES a week? _____ →
[ ] NO		 How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
28. Walk leisurely for exercise or pleasure?
[ ] YES   How many TIMES a week? _____ →
[ ] NO		 How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours
29. Ride a bicycle or stationary cycle?
[ ] YES   How many TIMES a week? _____ →
[ ] NO		 How many TOTAL hours a week did you usually do it? → Less than 1 hour 1-2½ hours 3-4½ hours 5-6½ hours 7-8½ hours

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16. EPIC Physical Activity Questions

in: Wareham NJ, Jakes RW, Rennie KL, Schuit J, Mitchell J, Hennings S, Day NE. Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 2003 Jun;6(4):407-13.

  1. In a typical week during the past 12 months, how many hours did you spend on each of the following activities? (Put "0" if none)
    • Walking, including walking to work, shopping and leisure
      In summer ________ hours per week In winter ________ hours per week
    • Cycling, including to work and during leisure time
      In summer ________ hours per week In winter ________ hours per week
  2. In a typical week during the past year did you practice any of these activities vigorously enough to cause sweating or a faster heartbeat?
    Yes___ NO___ Don't know___
    • If Yes, for how many hours per week in total did you practice such vigorous physical activity (put "0" if none)
      ____ hours per week

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17. EPIC-Norfolk Physical Activity Questionnaire

http://www.srl.cam.ac.uk/epic/questionnaires/epaq2/epaq2.pdf

Section A   HOME ACTIVITIES

Getting About--Apart from going to work

Which form of transportation to you use most often apart from your journey to and from work?

Please tick (check) one box ONLY per line.

Distance of journeys Usual mode of transport
Car Walk Public transport Cycle
Less than 1 mile        
1-5 mile(s)        
More than 5 miles        

Section B   ACTIVITY AT WORK

Please answer this section only if you have been in paid employment at any time during the last 12 months or you have done regular, organized voluntary work.

ACTIVITY LEVELS AT YOUR WORK

Now we would like you to take the total number of hours you worked per week in each job and divide them up according to your activity level.

Please complete EACH line.

  Job 1 Job 2
No Yes Hours per week No Yes Hours per week
Walking at work -- carrying nothing heavier than a briefcase e.g. moving about a shop            
Walking -- carrying something heavy            

TRAVEL TO AND FROM WORK

JOB 1

Please complete EVERY line

Roughly how many miles was it from home to Job 1 ______
How many times a week did you travel from home to Job 1 _____

Please tick (check) one box ONLY per line

How did you normally travel to Job 1 Always Usually Occasionally Never or rarely
By bicycle        
Walking        
JOB 2

Please complete EVERY line

Roughly how many miles was it from home to Job 2 ______
How many times a week did you travel from home to Job 2_____

Please tick (check) one box ONLY per line

How did you normally travel to Job 2 Always Usually Occasionally Never or rarely
By bicycle        
Walking        

Section C   RECREATION

The following questions ask about how you spent your leisure time.

Please indicate how often you did each activity on average over the last 12 months.

For activities that are seasonal, e.g. cricket or moving the lawn, please put the average frequency during the season when you did the activity.

Please indicate the average length of time that you spent doing the activity on each occasion.

EXAMPLE: If you went walking for pleasure for 40 minutes once a week you would complete the table below as follows:

 

 

 Number of times you did the activity
in the last 12 months		 Average time
per episode
None Less than once a month Once a month 2-3 times a month Once a week 2-3 times a week 4-5 times a week Every day Hours Mins

Walking for pleasure

         X         40

 

 

 Number of times you did the activity
in the last 12 months		 Average time
per episode
None Less than once a month Once a month 2-3 times a month Once a week 2-3 times a week 4-5 times a week Every day Hours Mins

Walking for pleasure -- You should not include walking as a means of transportation as this was included in Sections A
and B

                   

Racing or rough terrain cycling

                   

Cycling for pleasure -- you should not include cycling as a means of transportation

                   

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18. The Familial Breast and Ovarian Cancer Study

http://dceg2.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

  1. 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

  1. 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

  1. 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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19. Framingham Study - Physical Activity Questions

http://dceg2.cancer.gov/modules/Framingham.pdf

There are no specific Walking/Biking questions.

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20. Godin Leisure-time Exercise Questionnaire

http://dceg2.cancer.gov/modules/Godin.doc

There are no specific Walking/Biking questions.

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21. Green Script Study (GSS) Physical Activity Questionnaire

http://www.rnzcgp.org.nz/news/nzfp/June2003/Elley_June03.pdf

There are no specific Walking/Biking questions.

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22. Health Promotion/Disease Prevention Supplement to the NNHI Survey

Weiss, T. W. et al. "The validity of single-item, self-assessment questions as measures of adult physical activity." J.Clin.Epidemiol. 43.11 (1990): 1123-29.

There are no specific Walking/Biking questions.

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23. Health Insurance Plan of New York City 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.

The individual is asked to complete six occupational activity and five leisure time activity questions. The questions may be administered by an interviewer.

Calculations: each possible response on the questionnaire is assigned a weight. Occupational-related scores are obtained by summing the weights of the different categories and determining the class in which the total score falls. A similar system is used for leisure activities.

Physical Activity Connected with Job:
Question Answer Assigned weight
Time on job spent walking Almost none 0
Less than ½ 1
About ½ 2
More than ½ 3
Practically all 4
Walking to get to and from work None or less than 1 block 0
1 or 2 blocks 1
3 or 4 blocks 2
5 to 9 blocks 3
10 to 19 blocks 4
20 to 39 blocks 5
40+ blocks (2+ miles) 6
Hours on job Less than 25 1
25-34 2
35-40 3
41-50 4
50+ 5

Physical Activity Off the Job :
Item Frequently Sometimes Very infrequently or never
Takes walks in good weather 2 1 0
Walks around house or apartment 2 1 0

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24. Historical Leisure 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.

Historical Activities and code(s) Time/Age periods
  12-18 yrs no. yr mos/yr h/wk 19-34 yrs no. yr mos/yr h/wk 35-49 yrs no. yr mos/yr h/wk >50 yrs no. yr mos/yr h/wk
Codes and Activities:
03 Bicycling (indoor, outdoor)        
14 Walking for exercise (outdoor, indoor at mall or fitness center, treadmill)        

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25. Historical Physical Activity Survey - 1988

in: Kriska AM, Sandler RB, Cauley JA, LaPorte RE, Hom DL, Pambianco G. The assessment of historical physical activity and its relation to adult bone parameters. Am J Epidemiol 1988 May;127(5):1053-63.

  1. How many miles did you normally walk each day...
      Under 1 mile 1-2 miles 3-5 miles Greater than 5 miles
    Back and forth to grade school?        
    Back and forth to high school and college?        
    Back and forth to work during your 20s and 30s?        
    your 40s?        
    50s+?        
    Remember: 12 blocks or 20 minutes of brisk walking is equivalent to approximately 1 mile.
  2. Please indicated in the first section below all activities you have ever participated in with any regularity by placing a check in the YES column next to the activity. Fro each activity that you have identified participation , go across the entire row and answer for each time period: 1) the number of years you performed the activity out of the total number of years I that time period; 2) the average number of months per year you participated; 3) the average number of hours per month. If no regular participation in the activity in a particular time period, please indicate this by drawing a line through that time period.
      Participate regularly?
    Yes No     		Age period 14-21
    (8 years total)
    If yes, number of
    Yrs Mo/yr Hrs/mo     		Age period 23-34
    (8 years total)
    If yes, number of
    Yrs Mo/yr Hrs/mo
    		Age period 35-50
    (8 years total)
    If yes, number of
    Yrs Mo/yr Hrs/mo
    		50+

    If yes, number of
    Yrs Mo/yr Hrs/mo
    Activity
    Walking for exercise          
    Bicycling          

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26. International Physical Activity Questionnaire

All four versions found at: http://www.ipaq.ki.se/downloads.htm

(October 2002)

LONG: LAST 7 DAYS SELF-ADMINISTERED FORMAT

For use with Young and Middle-aged Adults (15-69 years)

  1. During the last 7 days, on how many days did you walk for at least 10 minutes at a time as part of your work? Please do not count any walking you did to travel to or from work.
    _____ days per week ____ No job-related walking
  2. How much time did you usually spend on one of those days walking as part of your work?
    _____ hours per day _____ minutes per day

Now think only about the bicycling and walking you might have done to travel to and from work, to do errands, or to go from place to place.

  1. During the last 7 days, on how many days did you bicycle for at least 10 minutes at a time to go from place to place?
    _____ days per week No bicycling from place to place
  2. How much time did you usually spend on one of those days to bicycle from place to place?
    _____ hours per day _____ minutes per day
  3. During the last 7 days, on how many days did you walk for at least 10 minutes at a time to go from place to place?
    _____ days per week No walking from place to place Skip to PART 3: HOUSEWORK, HOUSE MAINTENANCE, AND CARING FOR FAMILY
  4. How much time did you usually spend on one of those days walking from place to place?
    _____ hours per day _____ minutes per day
  5. Not counting any walking you have already mentioned, during the last 7 days, on how many days did you walk for at least 10 minutes at a time in your leisure time?
    _____ days per week No walking in leisure time Skip to question 22
  6. How much time did you usually spend on one of those days walking in your leisure time?
    _____ hours per day _____ minutes per day
  7. Think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do vigorous physical activities like aerobics, running, fast bicycling, or fast swimming in your leisure time?
    _____ days per week No vigorous activity in leisure time Skip to question 24
  8. How much time did you usually spend on one of those days doing vigorous physical activities in your leisure time?
    _____ hours per day _____ minutes per day
  9. Again, think about only those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do moderate physical activities like bicycling at a regular pace, swimming at a regular pace, and doubles tennis in your leisure time?
    _____ days per week No moderate activity in leisure time Skip to PART 5: TIME SPENT SITTING
  10. How much time did you usually spend on one of those days doing moderate physical activities in your leisure time?
    _____ hours per day _____ minutes per day

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27. International Physical Activity Questionnaire

(August 2002 version)

SHORT: LAST 7 DAYS TELEPHONE FORMAT

For use with Young and Middle-aged Adults (15-69 years)

  1. During the last 7 days, on how many days did you walk for at least 10 minutes at a time?
    ____ Days per week [WDAY; Range: 0-7, 8, 9] 8. Don't Know/Not Sure 9. Refused

    [Interviewer clarification: Think only about the walking that you do for at least 10 minutes at a time.]

    [Interviewer Note: If respondent answers zero, refuses or does not know, skip to Question 7]
  2. How much time did you usually spend walking on one of those days?
    __ __ Hours per day [WDHRS; Range: 0-16] __ __ __ Minutes per day [WDMIN; Range: 0-960, 998, 999] 998. Don't Know/Not Sure 999. Refused

    [Interviewer probe: An average time for one of the days on which you walk is being sought. If the respondent can't answer because the pattern of time spent varies widely from day to day, ask: “What is the total amount of time you spent walking over the last 7 days?”
    __ __ __ Hours per week [WWHRS; Range: 0-112] __ __ __ __Minutes per week [WWMIN; Range: 0-6720, 9998, 9999] 9998. Don't Know/Not Sure 9999. Refused

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28. International Physical Activity Questionnaire

(August 2002 version)

SHORT LAST 7 DAYS SELF-ADMINISTERED FORMAT

For use with Young and Middle-aged Adults (15-69 years)

Think about all the moderate activities that you did in the last 7 days. Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.

Think about the time you spent walking in the last 7 days. This includes at work and at home, walking to travel from place to place, and any other walking that you might do solely for recreation, sport, exercise, or leisure.

  1. During the last 7 days, on how many days did you walk for at least 10 minutes at a time?
    _____ days per week No walking Skip to question 7
  2. How much time did you usually spend walking on one of those days?
    _____ hours per day _____ minutes per day Don't know/Not sure

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29. International Physical Activity Questionnaire

(November 2002 version)

LONG LAST 7 DAYS TELEPHONE FORMAT

For use with Young and Middle-aged Adults (15-69 years)

READ: Now think about the time you spend walking for at least 10 minutes at a time as part of your work. Please do not count any walking you did to travel to or from work.

  1. During the last 7 days, on how many days did you walk as part of your work?
    [OWDAY; Range 0-7, 8, 9] _____ Days per week [If respondent answers 0, skip to PART 2] 8. Don't Know/Not Sure [Skip to PART 2] 9. Refused [Skip to PART 2]

    [Interviewer clarification: Think about only the walking that you did for at least 10 minutes at a time.]

    [Interviewer clarification: Include all jobs.]
  2. How much time did you usually spend on one of those days walking as part of your work?
    ___ ___ Hours per day [OWDHRS; Range 0-16] ___ ___ ___Minutes per day [OWDMIN; Range 0-960, 998, 999] 998. Don't Know/Not Sure 999. Refused

    [Interviewer clarification: Think about only the walking you did for at least 10 minutes at a time.]

    [Interviewer probe: An average time per day is being sought. If the respondent can't answer because the pattern of time spent varies widely from day to day, or includes time spent doing a variety of paid and unpaid work, ask: “What is the total amount of time you spent walking over the last 7 days as part of your work?”]
    ___ ___ Hours per week [OWWHRS; Range 0-112] ___ ___ ___ ___ Minutes per week [OWWMIN; Range 0-6720, 9998, 9999] 9998. Don't Know/Not Sure 9999. Refused

READ: Now, think about how you traveled from place to place, including to places like work, stores, movies and so on.

READ: Now think only about the bicycling you did to travel to and from work, to do errands, or to go from place to place. Only include bicycling that you did for at least 10 minutes at a time.

  1. During the last 7 days, on how many days did you bicycle to go from place to place?
    [TBDAY; Range 0-7, 8, 9] _____ Days per week [If respondent answers 0, skip to Question 12] 8. Don't Know/Not Sure [Skip to Question 12] 9. Refused [Skip to Question 12]

    [Interviewer clarification: Think only about the bicycling that you did for at least 10 minutes at a time.]
  2. How much time did you usually spend on one of those days to bicycle from place to place?
    ___ ___ Hours per day [TBDHRS; Range 0-16] ___ ___ ___Minutes per day [TBDMIN; Range 0-960, 998, 999] 998. Don't Know/Not Sure 999. Refused

    [Interviewer clarification: Think about only the bicycling that you did for at least 10 minutes at a time.]

    [Interviewer probe: An average time per day is being sought. If the respondent can't answer because the pattern of time spent varies widely from day to day, ask: “What is the total amount of time you spent bicycling over the last 7 days to travel from place to place?”]
    ___ ___ Hours per week [TBWHRS; Range 0-112] ___ ___ ___ ___ Minutes per week [TBWMIN; Range 0-6720] 9998. Don't Know/Not Sure 9999. Refused

READ: Now think only about the walking you did to travel to and from work, to do errands or to go from place to place. Only include walking that you did for at least 10 minutes at a time.

  1. During the last 7 days, on how many days did you walk to go from place to place?
    [TWDAY; Range 0-7, 8, 9] _____ Days per week [If respondent answers 0, skip to PART 3] 8. Don't Know/Not Sure [Skip to PART 3] 9. Refused [Skip to PART 3]

    [Interviewer clarification: Think only about the walking that you did for at least 10 minutes at a time.]
  2. How much time did you usually spend on one of those days walking from place to place?
    ___ ___ Hours per day [TWDHRS; Range 0-16] ___ ___ ___ Minutes per day [TWDMIN; Range 0-960, 998, 999] 998. Don't Know/Not Sure 999. Refused

    [Interviewer clarification: Think about only the walking that you did for at least 10 minutes at a time.]

    [Interviewer probe: An average time per day is being sought. If the respondent can't answer because the pattern of time spent varies widely from day to day, ask: “What is the total amount of time you spent over the last 7 days walking from place to place?”
    ___ ___ Hours per week [TWWHRS; Range 0-112] ___ ___ ___ ___ Minutes per week [TWWMIN; Range 0-6720, 9998, 9999] 9998. Don't Know/Not Sure 9999. Refused

PART 4: RECREATION, SPORT, AND LEISURE-TIME PHYSICAL ACTIVIITY

READ: Now, think about all the physical activities that you did in the last 7 days solely for recreation, sport, exercise or leisure. Please do not include any activities you have already mentioned.

  1. Not counting any walking you have already mentioned, during the last 7 days, on how many days did you walk for at least 10 minutes at a time in your leisure time?
    [LWDAY; Range 0-7, 8, 9] _____ Days per week [If respondent answers 0, skip to Question 22] 8. Don't Know/Not Sure [Skip to Question 22] 9. Refused [Skip to Question 22]

    [Interviewer clarification: Think about only the walking that you did for at least 10 minutes at a time.]
  2. How much time did you usually spend on one of those days walking in your leisure time?
    ___ ___ Hours per day [LWDHRS; Range 0-16] ___ ___ ___ Minutes per day [LWDMIN; Range 0-960, 998, 999] 998. Don't Know/Not Sure 999. Refused

    [Interviewer clarification: Think about only the walking that you did for at least 10 minutes at a time.]

    [Interviewer probe: An average time per day is being sought. If the respondent can't answer because the pattern of time spent varies widely from day to day, ask: “What is the total amount of time you spent over the last 7 days walking in your leisure time?”]
    ___ ___ Hours per week [LWWHRS; Range 0-112] ___ ___ ___ ___ Minutes per week [LWWMIN; Range 0-6720, 9998, 9999] 9998. Don't Know/Not Sure 9999. Refused

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30. Kaiser Physical Activity Survey

in:

  • Ainsworth BE, Sternfeld B, Richardson MT, Jackson K. Evaluation of the Kaiser Physical Activity Survey in women. Med Sci Sports Exerc 2000 Jul;32(7):1327-38.

    (Section I has no specific walking/biking questions.)

    Section II. Occupational Activities

    1. When you are working at your current occupation, how often do you do each of the following:
      1. Walk

    Section III. Active Living Habits

    This next section asks about the general level of physical activity involved in your daily routine during the past year.

    1. How many minutes a day do you usually walk and/or bicycle to and from work, school or errands?
      (<5 / >5 but <15 / >15but <30 / >30 but <45 / >45) 1-2-3-4-5
    2. Did you walk (for at least 15 minutes at a time)? 1-2-3-4-5
      (Never or less than once a month/Once a month/2-3 times a month/once a week/More than once a week)
    3. Did you bike (for at least 15 minutes at a time)? 1-2-3-4-5
      (Never or less than once a month/Once a month/2-3 times a month/once a week/More than once a week)

    Active Living Index=sum(q20, q22, q23, (6-Q21))/4

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    31. KIHD Seven-day Physical 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.

    No true validation studies were found for this group of questionnaires.

    1. How much of your leisure-time did you spend performing the following specific activities last week? Please estimate the time spend in each activity and the intensity class during the week.
        Intensity class
      (0-3)      		 Time/week
      ___hr___min
      Walking on work trips    
      Conditioning walking    
      Conditioning bicycling    
      Bicycling on work trips    
    2. Taking into account all leisure time during last week did the week differ considerably from a typical one for this time of the year?
      1. typical
      2. more activity than usual
      3. less activity than usual
    3. How many kilometers did you perform following physical activities during your leisure time last week?
      Walking.....___km Bicycling...___km

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    32. KIHD 12-Month Leisure-time Physical Activity History

    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.

    Which of the following activities have you performed during the last 12 months? Please estimate the most usual intensity category of each activity by choosing one of the following classes:

    Class Activity Breathlessness Sweating
    0 recreational, outdoor activities no no
    1 conditioning exercise yes no
    2 brisk conditioning exercise yes some
    3 competitive, strenuous exercise yes a lot

      How Many Times per Month? Duration
    hr, min    		 Intensity class (0-3)
    J F M A M J J A S O N D
    Walking on work trips                            
    Conditioning walking                            
    Bicycling                            
    Bicycling on work trips                            

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    33. KIHD 24-hour Total Physical Activity Record

    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.

    No true validation studies were found for this group of questionnaires.

    Participants are asked to record all activity for each 30 minutes period on the questionnaire form.

    Activity:

    1. Other upright activities (also walking slowly)
    2. Walking (also creeping, squatting, light bicycling)
    3. Walking with heavy load and lifting

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    34. KIHD Occupational Physical Activity Interview

    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 think about your typical work-day. Estimate all the activities performed during a typical work-day (including lunch break) and the average duration with an accuracy of 15 minutes.

    Activity Duration
    Walking on a level ___ h   ___ min
    Walking on uneven ground ___ h   ___ min
    Climbing stairs ___ h   ___ min

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    35. Lifetime Physical Activity Questionnaire

    http://dceg2.cancer.gov/modules/Lifetime_PA.pdf

    Note: reliability, but not validity, studies are available for this questionnaire.

    STEP 1: Please place a check mark in the first column next to each activity that you have ever participated in more than 10 times during your lifetime.

    STEP 2: For those activities you have checked, proceed to the right answering the questions in the columns above.

    Have you ever participated in any of the following? During the Past Year During ages 51-65 years (a 15-year span)
    If younger than 51, skip to next column    		 During ages 35-50 years (a 15-year span) During ages 22-34 years (a 12-year span) and Between age of onset of menstruation to 21 years Between age of onset of menstruation to 21 years
    Check if yes ↓ # of months Typical # of hours per week # of years (15 max) Typical # of months per year Typical # of hours per week # of years (15 max) Typical # of months per year Typical # of hours per week # of years (12 max) Typical # of months per year Typical # of hours per week # of years (10 max) Typical # of months per year Typical # of hours per week
    Leisure Time Activities:                            
    Walking for exercise (outdoor, indoor at mall, treadmill)                            
    Bicycling (stationery/outdoor)                            

     

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    36. The Lipid Research Clinics Physical 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.

    There are no specific Walking/Biking questions.

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    37. Longitudinal Aging Study Amsterdam (LASA) Physical Activity Questionnaire (LAPAQ)

    http://ssg.scw.vu.nl/lasa/lasa_variables_physical_activity_lapaq_questionnaire_english.pdf

    1. Do you walk outside? (explanation: with walking outside we mean walking to go shopping or doing other daily activities, like visiting someone. We do not mean: a walking tour.
      1. no (go to question 5)
      2. yes
    2. Did you walk during the past two weeks?
      1. no (go to question 5)
      2. yes
    3. How many times did you walk during the past two weeks?
      • .............times
    4. How long did you usually walk each time?
      • ..........hours.............minutes
    5. Do you cycle? (explanation: with cycling we mean cycling to go shopping or doing other daily activities like visiting someone. With cycling we do not mean: a cycling tour.
      1. no (go to question 9)
      2. yes
    6. Did you cycle during the past two weeks?
      1. no (go to question 9)
      2. yes
    7. How many times did you cycle in the past two weeks?
      • .................times
    8. How long did you usually cycle each time?
      • ..........hours............minutes
    9. Did you do sports? (explanation: with sports we mean the activities on the list)
      • no specific walking/cycling questions, however distance walking, distance cycling, cycling on home trainer, fast walking are included on list.

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    38. Minnesota Leisure-time Physical 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.

    Listed below are a series of Leisure Time Activities. Related activities are grouped under general headings. Please read the list and check YES in column 3 for those activities which you have performed in the last 12 months and NO in column 21 for those you have not. Do not complete any of the other columns.

    ACTIVITY Did you perform this activity? Month of activity Average number of times per month Time per occasion
    NO YES J F M A M J J A S O N D hrs min
    Section A: Walking and Miscellaneous
    -Walking for pleasure                                  
    -Walking to work                                  
    -Walking during work breaks                                  
    -Using stairs when elevator is available                                  
    -Bicycling to work and/or for pleasure                                  
    Section B: Conditioning exercise
    -Jog/Walk combination                                  

     

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    39. 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.

    1. 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
                                 
                                 
    1. 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            
    Category B activities:
    -Continuous walking            
    Category C activities:
    -no walking or biking activities listed in this category            

     

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    40. The Modifiable Activity Questionnaire/Pima Indian

    in: Kriska AM, Knowler WC, LaPorte RE, Drash AL, Wing RR, Blair SN, Bennett PH, Kuller LH. Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care 1990 Apr;13(4):401-11.

    Activity Survey - occupational activities

    Occupational activity - Past year Age at start of job Walk or bike to work? Job schedule
    Average past year
    mo/yr
        min/day mo/yr days/wk hr/dy
    Job title*
    List all jobs held over past year for more than 1 mo (account for full 12 mo)    		          

    Activity Survey - leisure activities

    Leisure activity code 12-18 yr (7 yr total) 19-34 yr (15 yr total) 35-49 yr (16 yr total) >50 yr (__ yr total) Past year Past week
      No. yr Mo/yr hr/wk No. yr Mo/yr hr/wk No. yr Mo/yr hr/wk No. yr            
    04 (bicycling)                                
    19 (walking for exer-cise)                                

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    41. The Monica Optional Study of Physical Activity (MOSPA)

    in: Pere