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Exercise & Physical Activity Survey
1.
How often do you engage in exercise or physical activity (walking, cycling, swimming, exercise classes, sport)?
Daily
2 or 3 times a week
Once a week
Occasionally
Rarely
Never
2.
If you do some physical activity or exercise, how long do you do it for?
10 - 15 minutes
30 minutes
One hour
More than an hour
Other (Please specify below):
3.
Other:
4.
What types of physical activity or exercise do you do? (Please specify):
5.
What types of physical activity or exercise do you enjoy most and why? (Please specify):
6.
Where do you usually exercise or do physical activity? Please specify the exact location:
7.
Where would you prefer to do exercise or physical activity? (Please specify):
8.
If you don’t do any exercise or physical activity at all, would you like to do some?
Yes
No
Maybe
Prefer not to say
9.
What prevents you from doing any exercise or doing physical activities? Tick all that apply:
Health issues
Lack of motivation
Lack of opportunities
Transport issues
Cost
Scared of injury
Lack of time
Other (Please specify below):
10.
Other:
11.
If you do some exercise, would you like to do more physical activity or exercise?
Yes
No
Maybe
Prefer not to say
12.
If you said yes, what prevents you from doing more?
13.
If you had the opportunity, what type of exercise or physical activity would you like to do?
14.
What motivates you to stay active? Tick all that apply:
Weight management
Social interaction
Stress relief
Pain management
Doctor's advice
Other (please specify below):
15.
Other:
16.
Do you have any suggestions on how we can encourage older people to exercise more?
17.
What could Redbridge Council do to help you to stay active and connected with others?
18.
Have you had a fall in the last year?
Yes
No
Don't know
Prefer not to say
19.
Would you be interested in having a falls assessment?
Yes
No
Maybe
Prefer not to say
20.
If you said yes, please leave your name and contact details:
21.
Would you be interested in participating in a free dance project, run by Colours of Redbridge?
Yes
No
Maybe
Prefer not to say
22.
If you said yes, please leave your name and contact details:
23.
Gender
Male
Female
Other
Prefer not to say
24.
Age
Under 50
50 - 64
65 - 74
75 - 89
90 or over
Prefer not to say
25.
Ethnicity
White British
White Irish
White Other
Asian Indian
Asian Pakistani
Asian British
Asian Other
Black Caribbean
Black African
Black British
Black Other
Mixed
Other
Prefer not to say
26.
Household
Just you
2 people
3 or 3 plus
Prefer not to say
27.
Accommodation
House
Flat
Supported housing
Rented room
28.
Physical Health
Good
Fair
Poor
Prefer not to say
29.
Mental Health
Good
Fair
Poor
Prefer not to say
30.
Employment
Employed
Unemployed
Retired
Prefer not to say
31.
Income
Receiving pension
Receiving wages
On benefits
Prefer not to say