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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: 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.

    OCCUPATIONAL PHYSICAL ACTIVITY:

    1. On a typical day at work, how much time do you spend walking?
      __ __ (hrs) __ __ (mins)

    TRANSPORTATION TO AND FROM WORK, SCHOOL, AND SHOPPING:

    1. Going to and from work, school or shopping, how much time do you spend walking each day? (Do not include hiking or walking for sport, exercise or pleasure)
      __ __ (hrs) __ __ (mins)
    2. Going to and from work, school, or shopping, how much time do you spend bicycling each day? (Do not include bicycling for sport, exercise or pleasure)
      __ __ (hrs) __ __ (mins)

    WALKING DURING LEISURE-TIME FOR PLEASURE OR EXERCISE

    1. During an average week, how many hours do you spend walking? (Do not include time spent at work or going to and from work, school or shopping.
      __ __ (hrs) __ __ (mins)
    2. When you are walking, what usually happens to the rate or depth or your breathing?
      1. no change
      2. small increase
      3. moderate increase
      4. large increase

    LEISURE TIME SPORT, SPORT TRAINING OR EXERCISE

    1. During the past 12 months, did you play any sports or do any exercises such as running, skiing, soccer, table tennis, gardening, aerobics, cycling, etc for exercise or pleasure at least 12 times?
    2. PRIOR to the past 12 months, did you play any sports or do any exercises such as running, skiing, soccer, table tennis, gardening, aerobics, or cycling for exercise or pleasure at least 12 times in one year?

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    42. 2002 National Health Interview Survey (Revised October 23, 2003)

    ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2002/qsamadlt.pdf

    There are no specific Walking/Biking questions.

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    43. 2001 National Health Interview Survey (Revised October 23, 2003)

    ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2001/qsamadlt.pdf

    There are no specific Walking/Biking questions.

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    44. 1999 National Health Interview Survey

    ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/1998/qsamadlt.pdf

    There are no specific Walking/Biking questions.

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    45. 1997 National Health Interview Survey

    ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/1997/qsamadlt.pdf

    There are no specific Walking/Biking questions.

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    46. 1991 National Health Interview Survey

    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.

    Hand Calendar:

    1.  
      1. In the past 2 weeks (outlined on that calendar) beginning Monday, (date) and ending this past Sunday, (date) have YOU done any of the following exercises, sports, or physically active hobbies --
        1. Walking for exercise? YES NO
        2. Riding a bicycle or exercise bike? YES NO
      2. How many times in the past 2 weeks did you go/do (activity in 2a)?
        ____ times
      3. On the average, about how many minutes did you actually spend (doing) (activity in 2a) each time?
        ____ minutes
      4. What usually happened to your heart rate or breathing when you [did/went] (activity in 2a)? Did you have a small, moderate or large increase, or no increase at all in your heart rate or breathing?
        1. small
        2. moderate
        3. large
        4. no inc.

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    47. NHANES Physical Activity and Physical Fitness PAQ-SP 12-15 Version 12/9/98

    http://www.cdc.gov/nchs/data/nhanes/cpaq.pdf

    PAQ.040

    The next series of questions are about physical activities that {you/SP} {have/has} done over the past 30 days. First I will ask about activities that are related to transportation. Then I'll ask about physical activities that {you/he/she} {do/does} at school or in {your/his/her} leisure time.

    Over the past 30 days, {have/has} {you/SP} walked or bicycled as part of getting to and from work, or school, or to do errands?

    CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS.

    YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.200) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.200) REFUSED . . . . . . . . . . . 7 (PAQ.200) DON'T KNOW . . . . . . . . . 9 (PAQ.200)

    PAQ.050

    [Over the past 30 days], how often did {you/SP} do this? [Walk or bicycle as part of getting to and from work, or school, or to do errands.]

    PROBE: How many times per day, per week, or per month did {you/s/he} do these activities?

    |___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 (PAQ.200) DON'T KNOW . . . . 999 (PAQ.200) ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 (PAQ.200) DON'T KNOW . . . . 9 (PAQ.200)

    PAQ.080

    On those days when {you/SP} walked or bicycled, about how long did {you/s/he} spend altogether doing this?

    |___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

    PAQ.200

    The next questions are about physical activities including exercise, sports, and physically active hobbies that {you/SP} may have done in {your/his/her} leisure time or at school over the past 30 days. (Information statement): First I will ask you about vigorous activities that cause heavy sweating or large increases in breathing or heart rate. Then I will ask you about moderate activities that cause only light sweating or a slight to moderate increase in breathing or heart rate.

    Over the past 30 days, did {you/SP} do any vigorous activities for at least 10 minutes that caused heavy sweating, or large increases in breathing or heart rate? Some examples are running, lap swimming, aerobics classes, or fast bicycling.

    CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS

    YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.320) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.320) REFUSED . . . . . . . . . . . 7 (PAQ.320) DON'T KNOW . . . . . . . . . 9 (PAQ.320)

    PAQ.220

    [Over the past 30 days], what vigorous activities did {you/SP} do?

    CODE ALL THAT APPLY

    BICYCLING . . . . . 13 WALKING . . . . . . 42 REFUSED . . . . . . 77 DON'T KNOW . . . . 99

    BOX 1

    LOOP 1:
    ASK PAQ.280 AND PAQ.300 FOR EACH ACTIVITY ENTERED IN PAQ.220.

    PAQ.280

    [Over the past 30 days], how often did {you/SP} {ACTIVITY}?

    PROBE: How many times per day, per week, or per month?

    CAPI INSTRUCTION: FILLS FOR ACTIVITY SHOULD BE AS FOLLOWS: 13. bicycle, 42. walk, 47. DISPLAY ACTIVITY IN 'OTHER SPECIFY'.

    |___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 DON'T KNOW . . . . 9

    PAQ.300

    [Over the past 30 days], on average about how long did {you/SP} {ACTIVITY} each time?

    |___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

    BOX 2

    END LOOP 1:
    ASK PAQ.280 AND PAQ.300 FOR NEXT ACTIVITY.
    IF NO NEXT ACTIVITY, CONTINUE WITH PAQ.320.

    PAQ.320

    Information Statement: [Over the past 30 days], did {you/SP} do moderate activities for at least 10 minutes that cause only light sweating or a slight to moderate increase in breathing or heart rate? Some examples are brisk walking, bicycling for pleasure, golf, or dancing.

    CODE 'UNABLE TO DO' ONLY IF RESPONDENT VOLUNTEERS

    YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 (PAQ.440) UNABLE TO DO ACTIVITY . . . . 3 (PAQ.440) REFUSED . . . . . . . . . . . 7 (PAQ.440) DON'T KNOW . . . . . . . . . 9 (PAQ.440)

    PAQ.340

    [Over the past 30 days], what activity or activities did {you/SP} do?

    CODE ALL THAT APPLY

    BICYCLING . . . . 13 WALKING . . . . . 42 REFUSED . . . . . 77 (PAQ.440) DON'T KNOW . . . . 99 (PAQ.440)

    BOX 3

    LOOP 2:
    ASK PAQ.400 AND PAQ.420 FOR EACH ACTIVITY ENTERED IN PAQ.340.

    PAQ.400

    [Over the past 30 days], how often did {you/SP} {ACTIVITY}?

    PROBE: How many times per day, per week, or per month?

    CAPI INSTRUCTION: FILLS FOR ACTIVITY SHOULD BE AS FOLLOWS: 13. bicycle, 42. walk,

    |___|___|___| ENTER NUMBER (OF DAYS, WEEKS OR MONTHS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT DAY . . . . . . . 1 WEEK . . . . . . . 2 MONTH . . . . . . 3 REFUSED . . . . . 7 DON'T KNOW . . . . 9

    PAQ.420

    [Over the past 30 days], on average about how long did {you/SP} {ACTIVITY} each time?

    |___|___|___| ENTER NUMBER (OF MINUTES OR HOURS) REFUSED . . . . . 777 DON'T KNOW . . . . 999 ENTER UNIT MINUTES . . . . . 1 HOURS . . . . . . 2 REFUSED . . . . . 7 DON'T KNOW . . . . 9

    BOX 4

    END LOOP 2:
    ASK PAQ.400 AND PAQ.420 FOR NEXT ACTIVITY.
    IF NO NEXT ACTIVITY, CONTINUE WITH PAQ.440.

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    48. NHANES Survey I And II

    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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    49. NHANES III

    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.

    Exercise (ages 17+ years)

    T1. In the past month, how often did you walk a mile or more at a time without stopping?
    ______ times number per-----1. day 2. week 3. month

    The next questions are about your leisure time physical activity during the past month. We are interested in the following exercises, sports, or physically active hobbies that you might have done. In the past month did you...

    T4. Ride a bicycle or exercise bicycle?
    1. Y 2. N ______ times number per-----1. day 2. week 3. month

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    2002 National Survey of Pedestrian and Bicyclist Attitudes and Behaviors

    http://www.bts.gov/omnibus_surveys/targeted_survey/ 2002_national_survey_of_pedestrian_and_bicyclist_attitudes_and_behaviors/ survey_questionnaire/html/questionnaire.html

    This lengthy survey questionnaire has been moved to a separate document.

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    50. Nurses Health Study II Activity and Inactivity Questionnaire

    in: Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, Rosner B, Kriska A, Willett WC. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 1994 Oct;23(5):991-9.

    http://www.channing.harvard.edu/nhs/questionnaires/qx_physact.shtml

    1. During the past year, what was your average time per week spent at each of the following recreational activities? (1980)
        0 1-4 min 5-10 min 20-59 min 1 hr 1-1.5 hr 2-3 hr 4-6 hr 7-10 hr 11+ hr
      Walking or hiking outdoors (include walking to work)                    
      Bicycling (include stationary machine)                    
    2. On average, how many hours per week do you spend:
        0 1-4 min 5-10 min 20-59 min 1 hr 1-1.5 hr 2-3 hr 4-6 hr 7-10 hr 11+ hr
      Standing or walking around at work?                    
      Standing or walking around at home?                    
    3. What is your usual walking pace outdoors? (1986, 1988, 1990,1992, 1996, 1998)
      • Easy, casual (less than 2 mph)
      • Normal, average (2-2.9 mph)
      • Brisk pace (3-3.9 mph)
      • Very brisk/striding (4 mph or faster)
      • Unable to walk
    4. How many blocks do you walk daily? (1982)
      • 1 or less
      • 2-4
      • 5-9
      • 10-14
      • 15-19
      • 20 or more

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    51. One-Page Questionnaire of Physical Activity - Vitamins and Lifestyle (VITAL) Study

    in: Littman AJ, White E, Kristal AR, Patterson RE, Satia-Abouta J, Potter JD. Assessment of a one-page questionnaire on long-term recreational physical activity. Epidemiology 2004 Jan;15(1):105-13.

    1. In the past 10 years, did you WALK for exercise? Include walking on a treadmill.
      • Yes, at least once a week for a year:
        1. How many years in the past 10?
          • 1-3
          • 7-9
          • 4-6
          • 10+
        2. Days per week?
          • 1-2
          • 5-7
          • 3-4
        1. Minutes per day?
          • 10-25
          • 45-55
          • 30-40
          • 60+
        1. Usual pace?
          • Casual (each mile takes 30 minutes or more)
          • Moderate (each mile takes 20-29 minutes)
          • Fast (each mile takes 19 minutes or less)
      • No

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    52. Paffenbarger Physical Activity Questionnaire (College Alumnus Questionnaire)

    http://www.hhp.umd.edu/KNES/courses/knes260/documents/KNES260spring04%20Paffenbarger%20PA.pdf

    PLEASE ANSWER THE FOLLOWING QUESTIONS BASED ON YOUR AVERAGE DAILY PHYSICAL ACTIVITY HABITS FOR THE PAST YEAR.

    1. How many city blocks or their equivalent did you walk on an average day during the past year?
      _______________ blocks per day (12 blocks = 1 mile)
    2. Energy expenditure associated with walking
      _____ blocks walked/day * 7 days/week = ___ blocks walked/week _____ blocks walked/week * 8 kcal/block = kcal energy expended/week walking

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    53. Perceived Functional Ability (PFA) Questionnaire/Physical Activity Rating (PA-R) Questionnaire

    George JD, Stone WJ, Burkett LN. Non-exercise VO2max estimation for physically active college students. Med Sci Sports Exerc 1997 Mar;29(3):415-23.

    PFA Questions:

    Suppose you were going to exercise continuously on an indoor track for 1 mile. Which exercise pace is just right for you -- not too easy and not too hard?

    Circle the appropriate number (any number 1 to 13).

    1. Walking at a slow pace (18 minutes per mile or more)
    2. Walking at a medium pace (16 minutes per mile)
    3. Walking at a fast pace (14 minutes per mile)

    How fast could you cover a distance of 3 miles and NOT become breathless or overly fatigued? Be realistic.

    Circle the appropriate number (any number 1 to 13).

    1. I could walk the entire distance at a slow pace (18 minutes per mile or more)
    2. I could walk the entire distance at a medium pace (16 minutes per mile)
    3. I could walk entire distance at a fast pace (14 minutes per mile)

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    54. Physical Activity Rating (PA-R) Questions

    in: George JD. Alternative approach to maximal exercise testing and VO2 max prediction in college students. Res Q Exerc Sport 1996 Dec;67(4):452-7.

    Select the number that best describes your overall level of physical activity for the previous 6 months:

    0 = avoid walking or exertion, e.g. always use the elevator, drive when possible instead of walking
    1 = light activity: walk for pleasure, routinely use stairs, occasionally exercise sufficiently to cause heavy breathing or perspiration.

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    55. 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?

    1. never
    2. seldom (1-2 days)
    3. sometimes (3-4 days)
    4. often (5-7 days)

    If 1,2 or 3:

    2a. On average, how many hours per day did you spend walking?

    1. less than 1 hour
    2. 1 but less than 2 hours
    3. 2-4 hours
    4. 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?

    1. never
    2. seldom (1-2 days)
    3. sometimes (3-4 days)
    4. 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?

    1. less than 1 hour
    2. 1 but less than 2 hours
    3. 2-4 hours
    4. 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?

    1. NO
    2. 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?

    1. Sitting or standing with some walking, Ex: cashier, general office worker, light tool and machinery worker
    2. Walking with some handling of materials generally weighing less than 50 pounds. Ex: mailman, waiter/waitress, construction worker, heavy tool and machinery worker
    3. 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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    56. Physical Activity Scale

    in: Aadahl M, Jorgensen T. Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 2003 Jul;35(7):1196-202.

    Examples Minutes Hours Time
    Bicycling to work or for pleasure, brisk walking, painting or plastering 15 30 45 1 2 3 4 5 6 7 8 9 10  
    O O O O O O O O O O O O O

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    57. Postmenopausal Osteopenia PAQ

    in: Suleiman S, Nelson M. Validation in London of a physical activity questionnaire for use in a study of postmenopausal osteopaenia. J Epidemiol Community Health 1997 Aug;51(4):365-72.

    ACTIVITY QUESTIONNAIRE

    Working life

    The following are questions about your activity NOW. Please answer as accurately as you can by putting a ring around the answers that apply best to you, or by entering the time spent in each activity.

    1c. At work, roughly how many HOURS PER WEEK do you spend:
    Walking ____

    Include time spent in lunch and tea breaks and exclude time spent on the journey to and from work. Please make sure that the total hours of activity add up to the total number of hours worked.

    1d. On your way TO AND FROM WORK (the round trip), how long do you spend per week:
    Walking _____ minutes per week Cycling _____ minutes per week

    Leisure time activities

    Think about how many times you go out during the week (including weekends) -- activities such as taking children to school, walking the dog, visiting friends, shopping trips, etc. Exclude the journey to work, any other trips already mentioned, and walking or cycling for pleasure.

    • How long do you spend walking in an average week? ____ hours per week
    • How long do you spend cycling in an average week? ____ hours per week

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    58. Physical Activity Recall - Suzuki

    in: Suzuki I, Kawakami N, Shimizu H. Reliability and validity of a questionnaire for assessment of energy expenditure and physical activity in epidemiological studies. J Epidemiol 1998 Aug;8(3):152-9.

    There are no specific Walking/Biking questions.

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    59. Quantitative Physical Activity Recall Questions - Aerobics Center Longitudinal Study - 1982 and Baseline

    in: Oliveria SA, Kohl HW 3rd, Trichopoulos D, Blair SN. The association between cardiorespiratory fitness and prostate cancer. Med Sci Sports Exerc 1996 Jan;28(1):97-104.

    For the last three months, which of the following activities have you performed regularly (please circle yes for all that apply and no if you do not perform the activity)
    YES NO

    Walking How many workouts per week?
    How many miles per workout?
    Average duration of workout?
    Average time per mile
    Bicycling (outdoors) How many workouts per week?
    How many miles per workout?
    Average duration of workout?
    Average time per mile

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    60. Single Item 5-Point Rating of Usual Physical Activity

    in: Li S, Carlson E, Holm K. Validation of a single-item measure of usual physical activity. Percept Mot Skills 2000 Oct;91(2):593-602.

    There are no specific Walking/Biking questions.

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    61. Seven-day Physical Activity Recall Questionnaire - Kolonel and Henderson

    in: Suzuki I, Kawakami N, Shimizu H. Reliability and validity of a questionnaire for assessment of energy expenditure and physical activity in epidemiological studies. J Epidemiol 1998 Aug;8(3):152-9.

    There are no specific Walking/Biking questions.

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    62. Seven-day Physical Activity Recall (PAR) - Used in Five City Project

    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 specific walking related questions in this interviewer administered questionnaire. The interviewer is instructed that if an activity seems to be about as strenuous to that individual as walking at a normal pace, then the activity should be coded as moderate. The Interviewer needs to be sensitive to walking.” Although people walk many times during the day, not all walks are counted. For example: we do not want to add up each time a person walks to the refrigerator. The specific rule for walking is that only walks of 5 min or longer are considered; count, then only walks of a 5 min duration. However, that 5 min bout of walking can only be counted if another 5 min bout occurs in the same segment of the day in the same intensity category. For any activity to be counted, it must add up to at least 10 min in one intensity category for one segment of the day.

    The following walking related instructions are provided by the interviewer in the SDPAR:

    I am going to ask you about eh physical activities your engaged in during the past 7 days, starting with yesterday going back 7 days. In doing so please remember this is a recall of actual activities for the past week not a history of what you usually do

    We are not considering light activities such as desk work, standing, light housework, softball, and bowling. We are considering occupational, household recreational and sports activities that make you feel similar to how you feel when you are walking at a normal pace. For example, slow stop and go walking such as window shopping is not included. However, walking at a normal pace to do an errand is included.

    I will ask you to categorize the intensity of each physical activity you do into one of three groups, moderate, hard or very hard:

    • The moderate category is similar to how you feel when you're walking at a normal pace.

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    63. The Short Questionnaire to Assess Health–Enhancing Physical Activity (SQUASH)

    in: Wendel-Vos GC, Schuit AJ, Saris WH, Kromhout D. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 2003 Dec;56(12):1163-9.

    Think about an average week in the past months. Please indicate how many days per week you performed the following activities, how much time on average you were engaged in this, and (if applicable) how strenuous this activity was for you?

    COMMUTING ACTIVITIES Days per week Average time per day Effort (circle please)
    Walking to/from work or school days hour minutes slow/moderate/fast
    Bicycling to/from work or school days hour minutes slow/moderate/fast
    Not applicable      

    LEISURE TIME ACTIVITIES Days per week Average time per day Effort (circle please)
    Walking days hour minutes slow/moderate/fast
    Bicycling days hour minutes slow/moderate/fast

     

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    64. Stanford Usual 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.

    1. Do you usually participate in any of the following activities?
      a. Climbing some stairs for exercise instead of taking the elevator? YES NO
      b. Walking instead of driving a short distance? YES NO
      c. Parking away from your destination so you have to walk more? YES NO
      d. Walking on your lunch hour or after dinner? YES NO
      e. Getting off at a bus stop which is not the one nearest your destination and walking? YES NO
    2. For at least the last three months, which of the following activities have you performed regularly?
      d. Ride a bicycle at least 50 miles per week YES NO

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    65. Stockholm Public Health Questionnaire

    in: Leijon O, Wiktorin C, Harenstam A, Karlqvist L; MOA Research Group. Validity of a self-administered questionnaire for assessing physical work loads in a general population. J Occup Environ Med 2002 Aug;44(8):724-35.

    There are no specific Walking/Biking questions.

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    66. Techumseh Occupational 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.

    Section B: Transportation To and From Work

    1. Check the months you worked each job. Then check the months you used each kind of transportation to and from each of your jobs.
        Job 1 Job 2 Job 3
      J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D
      Months worked each job:                                                                        
      Mode of Transportation:
      Bicycle:                                                                        
      Walk:                                                                        
    2. What is the approximate round trip distance that you walked or bicycled to and from each of your jobs in miles or blocks? If you never walked or bicycled enter 0 for distance. Do not include walking or bicycling on the job.
        Job 1 Job 2 Job 3
      Distance walked: miles __   blocks __ miles __   blocks __ miles __   blocks __
      Distance bicycled: miles __   blocks __ miles __   blocks __ miles __   blocks __
    3. In months that you walked to work, how many times per month did you usually do this?
        Job 1 Job 2 Job 3
      Average times per month walked to work:      
    4. In months that you bicycled to work, how many times per month did you usually do this?
        Job 1 Job 2 Job 3
      Average times per month bicycled to work:      

    Section C: Physical Activity at Work

    We are interested in the amount of activity that people do in different occupations. Think about the job related activities you mostly did in a work week during the time you worked in the past 12 months. First read each of the following categories and mark YES for the ones you usually did and NO for the ones you did not do Then go back through the list and record the number of hours per week you spent on each activity.

      Job 1
    Hrs/wk    		 Job 2
    Hrs/wk    		 Job 3
    Hrs/wk
    17. Walking at work, not carrying anything heavier than a briefcase
    --between buildings/in hallways
    --roving store clerk    		 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no
    18. Walking - carrying something
    --trays, dishes
    --gas station mechanic work, changing tires, wrecker work etc.    		 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no
    19. Standing or walking, carrying objects about 25 pounds 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no
    20. Standing or walking, carrying objects about 50 pounds 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no
    21. Standing or walking, carrying objects about 75 pounds 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no
    22. Standing or walking, carrying objects about 100 pounds 1. yes---__ __
    2. no     		1. yes---__ __
    2. no     		1. yes---__ __
    2. no

    Section D. Walking Up and Down Stairs or Ladders

      Job 1 Job 2 Job 3
    29. Give the number of flights of stairs or steps per day. Use 10 stairs per flight and count up and down as one flight _____ _____ _____

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    67. Walking Adherence Questionnaire

    in: Konradi DB, Lyon BL. Measuring adherence to a self-care fitness walking routine. J Community Health Nurs 2000 Fall;17(3):159-69.

    The walking routine that I try to complete consists of walking:
    ____ day a week for ____ minutes
    (if you use miles as your measure, how many miles do you plan to walk per exercise session?)
    ____ miles

    LOG BOOK for Recording Fitness Walking:

    Week 1 Miles walked Minutes walked
    Sunday    
    Monday    
    Tuesday    
    Wednesday    
    (etc.)    

     

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    68. Wise Study (NHLBI) Postmenopausal Estrogen/Progesterone Intervention Activity Questionnaire (PEPI-Q)

    in: Bairey Merz CN, Olson M, McGorray S, Pakstis DL, Zell K, Rickens CR, Kelsey SF, Bittner V, Sharaf BL, Sopko G. Physical activity and functional capacity measurement in women: a report from the NHLBI-sponsored WISE study. J Womens Health Gend Based Med 2000 Sep;9(7):769-77.

    There are no specific Walking/Biking questions.

    [Return to the Top]

    69. Yale Physical Activity Survey 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.

    [read] Here is a list of common types of physical activities. Please tell me which of them you did during a typical week in the last month. Our interest is learning about the types of physical activities that are a part of your regular work and leisure routines.

    For each activity you do, please tell me how much time (hours) you spent doing this activity during a typical week.

      Time Intensity
    Work
    Stair climbing while carrying a load    
    Yard work
    No specific walking/bicycling questions    
    Caretaking
    No specific walking/bicycling questions    
    Exercise
    Brisk walking (10+ minutes in duration)    
    Cycling, exercycle    
    Recreational Activities
    Leisurely walking (10+ minutes in duration)    

    New section:

    1. Think about the walks you have taken during the past month. About how many times per month did you walk for at least 10 minutes or more without stopping which was not strenuous enough to cause large increases in breathing heart rate or leg fatigue, or cause you to perspire?

      2. Score:
      0= not at all (go to Q5)
      1= 1-3 times per month
      2= 1-2 times per week
      3= 3-4 times per week
      4= 5+ times per week
      7= refused
      8= don't know

    2. When you did this walking for how many minutes did you do it?

      Score:
      0= not applicable
      1= 10-30 minutes
      2= 31-60 minutes
      3= 60+ minutes
      7= refused
      8= don't know

    1. About how many flights of stairs do you climb up each day? (let 10 steps = 1 flight)

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    70. Zutphen 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.

    The questions asked on this part concern your daily activities.

    1. Can you walk indoors?
      • Yes
      • No, because I use a wheelchair
      • No, because I am bed ridden
      • No, for a different reason, namely __________

        If you are unable to walk or cycle, go to question 7.
    2. How often did you take a walk during the last week?   ___ times
    3. How long did such a walk last?   ___ minutes
    4. How would you describe your walking pace?   __Calm __Normal __Firm
    5. Did you take a walk that lasted longer than 1 hour during the last month?   NO   YES
      1. How often did you do that?   ____ times
    6. Do you bicycle?   NO   YES
      1. If yes, how often did you bicycle last week?   ___ times
      2. How long did you bicycle?   ____ minutes
      3. How would you describe your bicycling pace?   __Calm __Normal __Fast

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    		•

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    13 Aug 2008
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