Physical Activity Rating 

Complete the following questionnaire to obtain a rating for your level of physical activity.

1.
Do you take the stairs instead of the lift?
Always
Sometimes
Never
2.
Do you ever walk or ride a bike instead of driving?
Always
Sometimes
Never
3.
Do you ever go for a walk at lunchtime?
Always
Sometimes
Never
4.
How many organised sport activities do you participate in?
3 or more
2
1
0
5.
How many days per week would you exercise vigorously (which results in heavier breathing) for a minimum of 20 minutes (such as jogging, team sport, step reebok/stepper, treadmill, digging in the garden etc)?
Every day
Almost every day
2-3 days per week
Once a week
Rarely or never
6.
How many days per week would you do moderate physical activity for at least 30 minutes? (Moderate exercise means energetic activity that does not leave you out of breath such as walking, housecleaning, gardening)
Every day
Almost every day
2-3 days per week
Once a week
Rarely or never
7.
How many days per week would you do strength (resistance) exercises e.g using small weights to build your arm muscles, leg muscles etc or other activities like digging, carrying heavy objects?
Every day
Almost every day
2-3 days per week
Once a week
Rarely or never
8.
How would you describe the activity levels in your daily occupation?
Highly active (I am walking most of the day)
Moderately active (I am on my feet most of the day)
Slightly active (I am on my feet some of the day)
Sedentary (I am seated most of the day)
9.
How would you describe the activity levels in your overall lifestyle?
Highly active
Moderately active
Slightly active
Sedentary
10.
If you had a spare afternoon, would you most likely (tick one response only);
play a high intensity sport (eg: tennis, squash, aerobics, running, cycling)
play a moderate intensity sport (eg: golf, bowling, lawn bowls)
go for a walk
do housework/domestic chores
gardening
read a book
sit and relax
sleep

Personal Information (Required)

Gender   Male Female
Age Group  
Country  
Postcode
(Australia Only)
 
Have you completed this survey before? Yes No

References:

Khomko, N., Ling, M., Nguyen, T., Ong, K., Su, S., Hsu-Hage, B., Healthy Eating & Healthy Living, Prevention of Diabetes, for women with a history of diabetes in pregnancy. Melbourne: Chinese Health Foundation of Australia, 1998.