Physical Activity Self-Report Questionnaire Form
Complete this questionnaire to self-report your physical activity habits, frequency, duration, and related notes.
Respondent Profile
Age
*
Gender
Female
Male
Non-binary
Prefer to self-describe
Prefer not to say
Current activity level
*
Please Select
Sedentary
Lightly active
Moderately active
Very active
Extremely active
Physical Activity Frequency and Duration
Number of days per week of moderate activity
*
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Number of days per week of vigorous activity
*
0 days
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Average minutes of activity per active day
*
Typical sedentary time per day (hours)
*
Activity Type and Limiting Factors
Activity types performed
*
Walking
Running
Cycling
Strength training
Sports
Flexibility or stretching
Swimming
Yoga
Other
Were any activities limited or modified?
*
No limits reported
Yes, by pain or discomfort
Yes, by injury or recovery
Yes, by fatigue or low energy
Yes, by weather or environment
Yes, by time constraints
Other
Notes on limiting factors or reporting details
Submit
Should be Empty: