Let's Be Active Questionnaire 4

Participant Questionnaire 4

This questionnaire is part of the Let's Be Active project, a Europe wide physical activity intervention. This is an EU- Funded project delivered through Ireland Active.

The data recorded in this questionnaire will be analysed for the purposes of monitoring behavioral change through exercise and examining the most beneficial ways to get currently inactive people, active.

This is questionnaire number 4. This should be completed 6 months after completing the 6 week programme.

Your details and answers will be anonymous and only used for research purposes.

Question Title

* 1. Which of the following facilities are you participating in the project?

Coral Leisure Arklow

Coral Leisure Askeaton

Coral Leisure Ballinasloe

Coral Leisure Cobh

Coral Leisure Longford

Coral Leisure Monaghan

Coral Leisure Tuam

Coral Leisure Wicklow

GymPlus Swords

Kingfisher NUIG

Kingfisher Waterford

Swan Leisure Rathmines

Other (please specify)

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* 2. Name:

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* 3. During the last 7 days, on how many days did you do vigorous physical activity? e.g. Gardening, Aerobics, Running, Cycling

0 Days

1 Day

2 Days

3 Days

4 Days

5 Days

6 Days

7 Days

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* 4. How many minutes per day do you spend doing vigorous physical activity?

0 Minutes

90 Minutes

180 Minutes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 5. During the last 7 days, on how many days did you do moderate physical activity? e.g. Carrying light loads, Jogging, Yoga. Do not include walking.

0 Days

1 Day

2 Days

3 Days

4 Days

5 Days

6 Days

7 Days

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* 6. How many minutes per day do you spend doing moderate physical activity?

0 Minutes

90 Minutes

180 Minutes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. During the last 7 days, on how many days did you walk for at least 10 minutes?

0 Days

1 Day

2 Days

3 Days

4 Days

5 Days

6 Days

7 Days

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* 8. How much time do you usually spend walking daily?

0 Minutes

90 Minutes

180 Minutes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. During the last 7 days, how many hours did you spend sitting per day?

0 Hours

12 Hours

24 Hours

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 10. How does your health affect your relationship with your family?

My role in the family is unaffected by my health

There are some parts of my family role I cannot carry out

There are many parts of my family role I cannot carry out

I cannot carry out any part of my family role

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* 11. How would you describe your sleep?

I am able to sleep without difficulty most of the time

·My sleep is interrupted some of the time, but I am usually able to go back to sleep without difficulty

My sleep is interrupted most nights, but I am usually able to go back to sleep without difficulty

I sleep in short bursts only. I am awake most of the night

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* 12. How do you generaly feel?

I do not feel anxious, worried or depressed

I am slightly anxious, worried or depressed

I feel moderately anxious, worried or depressed

I am extremely anxious, worried or depressed

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* 13. Do you feel any pain or discomfort while undertaking daily activities?

None at all

I have moderate pain

I suffer from severe pain

I suffer unbearable pain