T.W.U. Institute for Women's Health Pioneer Project

Year 1 Physical Activity Questionnaire

Most individuals find that the questionnaire can be completed in approximately 20-30 minutes. Replies are important from all Pioneer Project participants, regardless of health or exercise status. Be as accurate as possible, but provide your best estimate if you do not remember precisely. All responses will be kept strictly confidential like your other Pioneer project records.

This questionnaire is used with the permission of The Cooper Institute for Aerobics Research.

In this section we would like to ask you about your current physical activity and exercise habits that you perform regularly, at least once a week. Please answer as accurately as possible. Circle your answer or supply a specific number when asked.

EXERCISE/PHYSICAL ACTIVITY

For the last three months, which of the following moderate or vigorous activities have you performed regularly? (Please fill in the bubble for YES for all that apply and NO if you do not perform the activity; provide an estimate of the amount of activity for all marked YES. Be as complete as possible.)

1. Walking
Yes
No (Skip to Question 2)
 
1.1 How many sessions per week?
1.2 How many miles (or fractions) per session? (you may enter up to 2 decimal places)
1.3 Average duration per session? minutes
1.4 What is your usual pace of walking?
 
2. Stair Climbing
Yes
No (Skip to Question 3)
 
2.1 How many flights of stairs do you climb UP each day? (1 flight = 10 steps)?
 
3. Running or Jogging
Yes
No (Skip to Question 4)
 
3.1 How many sessions per week?
3.2 How many miles (or fractions) per session? (you may enter up to 2 decimal places)
3.3 Average duration per session? minutes
 
4. Treadmill
Yes
No (Skip to Question 5)
 
4.1 How many sessions per week?
4.2 Average duration per session? minutes
4.3 Speed? (up to 2 decimal places) (mph)
4.4 Grade? (up to 2 decimal places) (%)
 
5. Bicycling
Yes
No (Skip to Question 6)
 
5.1 How many sessions per week?
5.2 How many miles per session? (up to 2 decimal places)
5.3 Average duration per session? minutes
 
6. Swimming Laps
Yes
No (Skip to Question 7)
 
6.1 How many sessions per week?
6.2 How many miles per session? (up to 2 decimal places) (880 yds = 0.5 miles)
6.3 Average duration per session? minutes
 
7. Aerobic Dance/Calisthenics/Floor Exercise
Yes
No (Skip to Question 8)
 
7.1 How many sessions per week?
7.2 Average duration per session? minutes
 
8. Moderate Sports (e.g. Leisure volleyball, golf (not riding), social dancing, doubles tennis)
Yes
No (Skip to Question 9)
 
8.1 How many sessions per week?
8.2 Average duration per session? minutes
 
9. Vigorous Racquet Sports (e.g. racquetball, singles tennis)
Yes
No (Skip to Question 10)
 
9.1 How many sessions per week?
9.2 Average duration per session? minutes
 
10. Other Vigorous Sports or Exercise Involving Running (e.g. Basketball, soccer)
Yes (specify):
No (Skip to Question 11)
 
10.1 How many sessions per week?
10.2 Average duration per session? minutes
 
11. Other Activities
Yes (specify):
No (Skip to Question 12)
 
11.1 How many sessions per week?
11.2 Average duration per session? minutes
 
12. Weight Training (Machines, free weights)
Yes
No (Skip to Question 13)
 
12.1 How many sessions per week?
12.2 Average duration per session? minutes
 
13. Household Activities (Sweeping, vacuuming, washing clothes, scrubbing floors)
Yes
No (Skip to Question 14)
 
13.1 How many hours per week? (up to 2 decimal points)
 
14. Lawn Work & Gardening
Yes
No (Skip to Question 15)
 
14.1 How many hours per week? (up to 2 decimal points)
 
15. How many times a week do you engage in vigorous physical activity long enough to work up a sweat?