7-Day Physical Activity Recall Questionnaire
Please provide details about your physical activities over the past 7 days to help us assess your activity levels.
Participant Information
Full Name
*
First Name
Last Name
Age
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Instructions
Please read: For each of the last 7 days (including today), recall all moderate, vigorous, and light physical activities you performed for at least 10 minutes at a time. Include walking, sports, exercise, and household activities.
Physical Activity Recall Table
*
Rows
Type of Activity
Duration (minutes)
Intensity
Day 1 (Today)
Light
Moderate
Vigorous
Day 2
Light
Moderate
Vigorous
Day 3
Light
Moderate
Vigorous
Day 4
Light
Moderate
Vigorous
Day 5
Light
Moderate
Vigorous
Day 6
Light
Moderate
Vigorous
Day 7
Light
Moderate
Vigorous
How would you rate your overall physical activity level in the past 7 days?
*
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
How many hours per day did you spend sitting (e.g., at work, watching TV, driving) on average in the past 7 days?
*
Did you experience any barriers to being physically active in the past week? (Select all that apply)
Lack of time
Lack of motivation
Health issues/injury
Weather conditions
No access to facilities
Other
How many hours of sleep did you get on average per night during the past 7 days?
Please provide any additional comments or notes about your physical activity over the past week.
Submit
Should be Empty: