General Practice Physical Activity Questionnaire
About This Form
Fields marked with an asterisk are compulsory.
Thank you for agreeing to complete this questionnaire. Please fill in all of the appropriate fields and click ‘Send’.
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Please read the following statements and check the most appropriate answer next to each:
Please tell us the type and amount of physical activity involved in your work.
During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not
Please read the following statements and check the most appropriate answer next to each
Physical exercise such as swimming, jogging, aerobics, football, tennis, gym, workout etc.
Housework / childcare.
Gardening / DIY.
Cycling, including cycling to work and during leisure time.
Walking, including walking to work, shopping, for pleasure etc.
Your Walking Pace
How would you describe your usual walking pace?