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hcs_2_clinic_8
HERTS 31-39 -PHYSICAL ACTIVITIY QUESTIONNAIRE

Name

Generic text

Date

Generic date
We would like to see how many of the following activities you have done anywhere (work, home, on holiday etc), over the last 12 months. Please read the list and tick "no" in column 2 if you have not done them or "yes" in column 3 if you have. If you tick "yes" to an activity, please tick which months you did it in, remembering that some of the months may be in the previous year. Looking back over the last 12 months, please estimate how many times you did it per month and the average duration for each occasion (see example).
Section A: Walking & related activities
Please read the list of activities and then answer for each one
cs_qA_Y Other activities cs_qA_X How many Hours Minutes Duration (minutes) cs_No_Yes cs_Month Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month How many cs_No_Yes cs_Month Hours Minutes Duration (minutes) Hours Minutes Duration (minutes) cs_No_Yes cs_Month How many Duration (minutes) cs_Month How many Hours Minutes cs_No_Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Did you perform this activity?
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Month of activity
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Average number of times per month
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Duration per occasion: Hrs
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Duration per occasion: Mins
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Did you perform this activity?
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Month of activity
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Average number of times per month
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Duration per occasion: Hrs
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Duration per occasion: Mins
Walking to and/or from work 1 Did you perform this activity?
Walking to and/or from work 1 Month of activity
Walking to and/or from work 1 Average number of times per month
Walking to and/or from work 1 Duration per occasion: Hrs
Walking to and/or from work 1 Duration per occasion: Mins
Walking to and/or from work 2 Did you perform this activity?
Walking to and/or from work 2 Month of activity
Walking to and/or from work 2 Average number of times per month
Walking to and/or from work 2 Duration per occasion: Hrs
Walking to and/or from work 2 Duration per occasion: Mins
Walking indoors (e.g at work or around the house) 1 Did you perform this activity?
Walking indoors (e.g at work or around the house) 1 Month of activity
Walking indoors (e.g at work or around the house) 1 Average number of times per month
Walking indoors (e.g at work or around the house) 1 Duration per occasion: Hrs
Walking indoors (e.g at work or around the house) 1 Duration per occasion: Mins
Walking indoors (e.g at work or around the house) 2 Did you perform this activity?
Walking indoors (e.g at work or around the house) 2 Month of activity
Walking indoors (e.g at work or around the house) 2 Average number of times per month
Walking indoors (e.g at work or around the house) 2 Duration per occasion: Hrs
Walking indoors (e.g at work or around the house) 2 Duration per occasion: Mins
Walking up stairs, or climbing a ladder 1 Did you perform this activity?
Walking up stairs, or climbing a ladder 1 Month of activity
Walking up stairs, or climbing a ladder 1 Average number of times per month
Walking up stairs, or climbing a ladder 1 Duration per occasion: Hrs
Walking up stairs, or climbing a ladder 1 Duration per occasion: Mins
Walking up stairs, or climbing a ladder 2 Did you perform this activity?
Walking up stairs, or climbing a ladder 2 Month of activity
Walking up stairs, or climbing a ladder 2 Average number of times per month
Walking up stairs, or climbing a ladder 2 Duration per occasion: Hrs
Walking up stairs, or climbing a ladder 2 Duration per occasion: Mins
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Did you perform this activity?
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Month of activity
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Average number of times per month
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Duration per occasion: Hrs
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Duration per occasion: Mins
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Did you perform this activity?
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Month of activity
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Average number of times per month
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Duration per occasion: Hrs
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Duration per occasion: Mins
Backpacking (walking & carrying pack weighing min of 20lb) 1 Did you perform this activity?
Backpacking (walking & carrying pack weighing min of 20lb) 1 Month of activity
Backpacking (walking & carrying pack weighing min of 20lb) 1 Average number of times per month
Backpacking (walking & carrying pack weighing min of 20lb) 1 Duration per occasion: Hrs
Backpacking (walking & carrying pack weighing min of 20lb) 1 Duration per occasion: Mins
Backpacking (walking & carrying pack weighing min of 20lb) 2 Did you perform this activity?
Backpacking (walking & carrying pack weighing min of 20lb) 2 Month of activity
Backpacking (walking & carrying pack weighing min of 20lb) 2 Average number of times per month
Backpacking (walking & carrying pack weighing min of 20lb) 2 Duration per occasion: Hrs
Backpacking (walking & carrying pack weighing min of 20lb) 2 Duration per occasion: Mins
Mountain or rock climbing 1 Did you perform this activity?
Mountain or rock climbing 1 Month of activity
Mountain or rock climbing 1 Average number of times per month
Mountain or rock climbing 1 Duration per occasion: Hrs
Mountain or rock climbing 1 Duration per occasion: Mins
Mountain or rock climbing 2 Did you perform this activity?
Mountain or rock climbing 2 Month of activity
Mountain or rock climbing 2 Average number of times per month
Mountain or rock climbing 2 Duration per occasion: Hrs
Mountain or rock climbing 2 Duration per occasion: Mins
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Did you perform this activity?
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Month of activity
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Average number of times per month
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Duration per occasion: Hrs
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Duration per occasion: Mins
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Did you perform this activity?
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Month of activity
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Average number of times per month
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Duration per occasion: Hrs
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Duration per occasion: Mins
Section B: Conditioning exercise
Please read the list of activities and then answer for each one
cs_qB_Y Other activities cs_qB_X How many Hours Minutes Duration (minutes) cs_No_Yes cs_Month Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month How many cs_No_Yes cs_Month Hours Minutes Duration (minutes) Hours Minutes Duration (minutes) cs_No_Yes cs_Month How many Duration (minutes) cs_Month How many Hours Minutes cs_No_Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

Light/moderate effort exercises - light aerobics, home exercises 1 Did you perform this activity?
Light/moderate effort exercises - light aerobics, home exercises 1 Month of activity
Light/moderate effort exercises - light aerobics, home exercises 1 Average number of times per month
Light/moderate effort exercises - light aerobics, home exercises 1 Duration per occasion: Hrs
Light/moderate effort exercises - light aerobics, home exercises 1 Duration per occasion: Mins
Light/moderate effort exercises - light aerobics, home exercises 2 Did you perform this activity?
Light/moderate effort exercises - light aerobics, home exercises 2 Month of activity
Light/moderate effort exercises - light aerobics, home exercises 2 Average number of times per month
Light/moderate effort exercises - light aerobics, home exercises 2 Duration per occasion: Hrs
Light/moderate effort exercises - light aerobics, home exercises 2 Duration per occasion: Mins
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Did you perform this activity?
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Month of activity
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Average number of times per month
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Duration per occasion: Hrs
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Duration per occasion: Mins
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Did you perform this activity?
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Month of activity
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Average number of times per month
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Duration per occasion: Hrs
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Duration per occasion: Mins
Yoga, stretching exercises, pilates 1 Did you perform this activity?
Yoga, stretching exercises, pilates 1 Month of activity
Yoga, stretching exercises, pilates 1 Average number of times per month
Yoga, stretching exercises, pilates 1 Duration per occasion: Hrs
Yoga, stretching exercises, pilates 1 Duration per occasion: Mins
Yoga, stretching exercises, pilates 2 Did you perform this activity?
Yoga, stretching exercises, pilates 2 Month of activity
Yoga, stretching exercises, pilates 2 Average number of times per month
Yoga, stretching exercises, pilates 2 Duration per occasion: Hrs
Yoga, stretching exercises, pilates 2 Duration per occasion: Mins
Gym club workout - moderate effort, general gym workout 1 Did you perform this activity?
Gym club workout - moderate effort, general gym workout 1 Month of activity
Gym club workout - moderate effort, general gym workout 1 Average number of times per month
Gym club workout - moderate effort, general gym workout 1 Duration per occasion: Hrs
Gym club workout - moderate effort, general gym workout 1 Duration per occasion: Mins
Gym club workout - moderate effort, general gym workout 2 Did you perform this activity?
Gym club workout - moderate effort, general gym workout 2 Month of activity
Gym club workout - moderate effort, general gym workout 2 Average number of times per month
Gym club workout - moderate effort, general gym workout 2 Duration per occasion: Hrs
Gym club workout - moderate effort, general gym workout 2 Duration per occasion: Mins
Jogging 1 Did you perform this activity?
Jogging 1 Month of activity
Jogging 1 Average number of times per month
Jogging 1 Duration per occasion: Hrs
Jogging 1 Duration per occasion: Mins
Jogging 2 Did you perform this activity?
Jogging 2 Month of activity
Jogging 2 Average number of times per month
Jogging 2 Duration per occasion: Hrs
Jogging 2 Duration per occasion: Mins
Running - light/moderate effort outdoors &/or treadmill 1 Did you perform this activity?
Running - light/moderate effort outdoors &/or treadmill 1 Month of activity
Running - light/moderate effort outdoors &/or treadmill 1 Average number of times per month
Running - light/moderate effort outdoors &/or treadmill 1 Duration per occasion: Hrs
Running - light/moderate effort outdoors &/or treadmill 1 Duration per occasion: Mins
Running - light/moderate effort outdoors &/or treadmill 2 Did you perform this activity?
Running - light/moderate effort outdoors &/or treadmill 2 Month of activity
Running - light/moderate effort outdoors &/or treadmill 2 Average number of times per month
Running - light/moderate effort outdoors &/or treadmill 2 Duration per occasion: Hrs
Running - light/moderate effort outdoors &/or treadmill 2 Duration per occasion: Mins
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Did you perform this activity?
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Month of activity
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Average number of times per month
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Duration per occasion: Hrs
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Duration per occasion: Mins
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Did you perform this activity?
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Month of activity
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Average number of times per month
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Duration per occasion: Hrs
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Duration per occasion: Mins
Lifting weights/loads - any loads, light/moderate effort 1 Did you perform this activity?
Lifting weights/loads - any loads, light/moderate effort 1 Month of activity
Lifting weights/loads - any loads, light/moderate effort 1 Average number of times per month
Lifting weights/loads - any loads, light/moderate effort 1 Duration per occasion: Hrs
Lifting weights/loads - any loads, light/moderate effort 1 Duration per occasion: Mins
Lifting weights/loads - any loads, light/moderate effort 2 Did you perform this activity?
Lifting weights/loads - any loads, light/moderate effort 2 Month of activity
Lifting weights/loads - any loads, light/moderate effort 2 Average number of times per month
Lifting weights/loads - any loads, light/moderate effort 2 Duration per occasion: Hrs
Lifting weights/loads - any loads, light/moderate effort 2 Duration per occasion: Mins
Section C: Water activities
Please read the list of activities and then answer for each one
cs_qC_Y Other activities cs_qC_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Water skiing 1 Did you perform this activity?
Water skiing 1 Month of activity
Water skiing 1 Average number of times per month
Water skiing 1 Duration per occasion: Hrs
Water skiing 1 Duration per occasion: Mins
Water skiing 2 Did you perform this activity?
Water skiing 2 Month of activity
Water skiing 2 Average number of times per month
Water skiing 2 Duration per occasion: Hrs
Water skiing 2 Duration per occasion: Mins
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Did you perform this activity?
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Month of activity
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Average number of times per month
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Duration per occasion: Hrs
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Duration per occasion: Mins
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Did you perform this activity?
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Month of activity
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Average number of times per month
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Duration per occasion: Hrs
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Duration per occasion: Mins
Rowing or canoeing for pleasure (not including rowing at the gym) 1 Did you perform this activity?
Rowing or canoeing for pleasure (not including rowing at the gym) 1 Month of activity
Rowing or canoeing for pleasure (not including rowing at the gym) 1 Average number of times per month
Rowing or canoeing for pleasure (not including rowing at the gym) 1 Duration per occasion: Hrs
Rowing or canoeing for pleasure (not including rowing at the gym) 1 Duration per occasion: Mins
Rowing or canoeing for pleasure (not including rowing at the gym) 2 Did you perform this activity?
Rowing or canoeing for pleasure (not including rowing at the gym) 2 Month of activity
Rowing or canoeing for pleasure (not including rowing at the gym) 2 Average number of times per month
Rowing or canoeing for pleasure (not including rowing at the gym) 2 Duration per occasion: Hrs
Rowing or canoeing for pleasure (not including rowing at the gym) 2 Duration per occasion: Mins
Swimming - leisurely, including seaside swimming but not lap swimming 1 Did you perform this activity?
Swimming - leisurely, including seaside swimming but not lap swimming 1 Month of activity
Swimming - leisurely, including seaside swimming but not lap swimming 1 Average number of times per month
Swimming - leisurely, including seaside swimming but not lap swimming 1 Duration per occasion: Hrs
Swimming - leisurely, including seaside swimming but not lap swimming 1 Duration per occasion: Mins
Swimming - leisurely, including seaside swimming but not lap swimming 2 Did you perform this activity?
Swimming - leisurely, including seaside swimming but not lap swimming 2 Month of activity
Swimming - leisurely, including seaside swimming but not lap swimming 2 Average number of times per month
Swimming - leisurely, including seaside swimming but not lap swimming 2 Duration per occasion: Hrs
Swimming - leisurely, including seaside swimming but not lap swimming 2 Duration per occasion: Mins
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 1 Did you perform this activity?
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 1 Month of activity
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 1 Average number of times per month
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 1 Duration per occasion: Hrs
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 1 Duration per occasion: Mins
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 2 Did you perform this activity?
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 2 Month of activity
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 2 Average number of times per month
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 2 Duration per occasion: Hrs
Swimming - laps, lane, any stroke, freestyle, slow, light/moderate effort 2 Duration per occasion: Mins
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 1 Did you perform this activity?
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 1 Month of activity
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 1 Average number of times per month
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 1 Duration per occasion: Hrs
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 1 Duration per occasion: Mins
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 2 Did you perform this activity?
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 2 Month of activity
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 2 Average number of times per month
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 2 Duration per occasion: Hrs
Swimming - laps, lane, any stroke, freestyle, fast, vigorous effort 2 Duration per occasion: Mins
Scuba diving 1 Did you perform this activity?
Scuba diving 1 Month of activity
Scuba diving 1 Average number of times per month
Scuba diving 1 Duration per occasion: Hrs
Scuba diving 1 Duration per occasion: Mins
Scuba diving 2 Did you perform this activity?
Scuba diving 2 Month of activity
Scuba diving 2 Average number of times per month
Scuba diving 2 Duration per occasion: Hrs
Scuba diving 2 Duration per occasion: Mins
Snorkelling 1 Did you perform this activity?
Snorkelling 1 Month of activity
Snorkelling 1 Average number of times per month
Snorkelling 1 Duration per occasion: Hrs
Snorkelling 1 Duration per occasion: Mins
Snorkelling 2 Did you perform this activity?
Snorkelling 2 Month of activity
Snorkelling 2 Average number of times per month
Snorkelling 2 Duration per occasion: Hrs
Snorkelling 2 Duration per occasion: Mins
Section D: Winter activities
Please read the list of activities and then answer for each one
cs_qD_Y Other activities cs_qD_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Skiing 1 Did you perform this activity?
Skiing 1 Month of activity
Skiing 1 Average number of times per month
Skiing 1 Duration per occasion: Hrs
Skiing 1 Duration per occasion: Mins
Skiing 2 Did you perform this activity?
Skiing 2 Month of activity
Skiing 2 Average number of times per month
Skiing 2 Duration per occasion: Hrs
Skiing 2 Duration per occasion: Mins
Ice or roller skating 1 Did you perform this activity?
Ice or roller skating 1 Month of activity
Ice or roller skating 1 Average number of times per month
Ice or roller skating 1 Duration per occasion: Hrs
Ice or roller skating 1 Duration per occasion: Mins
Ice or roller skating 2 Did you perform this activity?
Ice or roller skating 2 Month of activity
Ice or roller skating 2 Average number of times per month
Ice or roller skating 2 Duration per occasion: Hrs
Ice or roller skating 2 Duration per occasion: Mins
Section E: Sports
Please read the list of activities and then answer for each one
cs_qE_Y Other activities cs_qE_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Bowling 1 Did you perform this activity?
Bowling 1 Month of activity
Bowling 1 Average number of times per month
Bowling 1 Duration per occasion: Hrs
Bowling 1 Duration per occasion: Mins
Bowling 2 Did you perform this activity?
Bowling 2 Month of activity
Bowling 2 Average number of times per month
Bowling 2 Duration per occasion: Hrs
Bowling 2 Duration per occasion: Mins
Table tennis, ping pong 1 Did you perform this activity?
Table tennis, ping pong 1 Month of activity
Table tennis, ping pong 1 Average number of times per month
Table tennis, ping pong 1 Duration per occasion: Hrs
Table tennis, ping pong 1 Duration per occasion: Mins
Table tennis, ping pong 2 Did you perform this activity?
Table tennis, ping pong 2 Month of activity
Table tennis, ping pong 2 Average number of times per month
Table tennis, ping pong 2 Duration per occasion: Hrs
Table tennis, ping pong 2 Duration per occasion: Mins
Tennis 1 Did you perform this activity?
Tennis 1 Month of activity
Tennis 1 Average number of times per month
Tennis 1 Duration per occasion: Hrs
Tennis 1 Duration per occasion: Mins
Tennis 2 Did you perform this activity?
Tennis 2 Month of activity
Tennis 2 Average number of times per month
Tennis 2 Duration per occasion: Hrs
Tennis 2 Duration per occasion: Mins
Horse riding 1 Did you perform this activity?
Horse riding 1 Month of activity
Horse riding 1 Average number of times per month
Horse riding 1 Duration per occasion: Hrs
Horse riding 1 Duration per occasion: Mins
Horse riding 2 Did you perform this activity?
Horse riding 2 Month of activity
Horse riding 2 Average number of times per month
Horse riding 2 Duration per occasion: Hrs
Horse riding 2 Duration per occasion: Mins
Slow dancing - slow ballroom, waltz, foxtrot 1 Did you perform this activity?
Slow dancing - slow ballroom, waltz, foxtrot 1 Month of activity
Slow dancing - slow ballroom, waltz, foxtrot 1 Average number of times per month
Slow dancing - slow ballroom, waltz, foxtrot 1 Duration per occasion: Hrs
Slow dancing - slow ballroom, waltz, foxtrot 1 Duration per occasion: Mins
Slow dancing - slow ballroom, waltz, foxtrot 2 Did you perform this activity?
Slow dancing - slow ballroom, waltz, foxtrot 2 Month of activity
Slow dancing - slow ballroom, waltz, foxtrot 2 Average number of times per month
Slow dancing - slow ballroom, waltz, foxtrot 2 Duration per occasion: Hrs
Slow dancing - slow ballroom, waltz, foxtrot 2 Duration per occasion: Mins
Fast dancing - fast ballroom, disco, folk, line, square, country 1 Did you perform this activity?
Fast dancing - fast ballroom, disco, folk, line, square, country 1 Month of activity
Fast dancing - fast ballroom, disco, folk, line, square, country 1 Average number of times per month
Fast dancing - fast ballroom, disco, folk, line, square, country 1 Duration per occasion: Hrs
Fast dancing - fast ballroom, disco, folk, line, square, country 1 Duration per occasion: Mins
Fast dancing - fast ballroom, disco, folk, line, square, country 2 Did you perform this activity?
Fast dancing - fast ballroom, disco, folk, line, square, country 2 Month of activity
Fast dancing - fast ballroom, disco, folk, line, square, country 2 Average number of times per month
Fast dancing - fast ballroom, disco, folk, line, square, country 2 Duration per occasion: Hrs
Fast dancing - fast ballroom, disco, folk, line, square, country 2 Duration per occasion: Mins
Football 1 Did you perform this activity?
Football 1 Month of activity
Football 1 Average number of times per month
Football 1 Duration per occasion: Hrs
Football 1 Duration per occasion: Mins
Football 2 Did you perform this activity?
Football 2 Month of activity
Football 2 Average number of times per month
Football 2 Duration per occasion: Hrs
Football 2 Duration per occasion: Mins
Badminton 1 Did you perform this activity?
Badminton 1 Month of activity
Badminton 1 Average number of times per month
Badminton 1 Duration per occasion: Hrs
Badminton 1 Duration per occasion: Mins
Badminton 2 Did you perform this activity?
Badminton 2 Month of activity
Badminton 2 Average number of times per month
Badminton 2 Duration per occasion: Hrs
Badminton 2 Duration per occasion: Mins
Cricket 1 Did you perform this activity?
Cricket 1 Month of activity
Cricket 1 Average number of times per month
Cricket 1 Duration per occasion: Hrs
Cricket 1 Duration per occasion: Mins
Cricket 2 Did you perform this activity?
Cricket 2 Month of activity
Cricket 2 Average number of times per month
Cricket 2 Duration per occasion: Hrs
Cricket 2 Duration per occasion: Mins
Darts 1 Did you perform this activity?
Darts 1 Month of activity
Darts 1 Average number of times per month
Darts 1 Duration per occasion: Hrs
Darts 1 Duration per occasion: Mins
Darts 2 Did you perform this activity?
Darts 2 Month of activity
Darts 2 Average number of times per month
Darts 2 Duration per occasion: Hrs
Darts 2 Duration per occasion: Mins
Squash 1 Did you perform this activity?
Squash 1 Month of activity
Squash 1 Average number of times per month
Squash 1 Duration per occasion: Hrs
Squash 1 Duration per occasion: Mins
Squash 2 Did you perform this activity?
Squash 2 Month of activity
Squash 2 Average number of times per month
Squash 2 Duration per occasion: Hrs
Squash 2 Duration per occasion: Mins
Golf carrying own clubs 1 Did you perform this activity?
Golf carrying own clubs 1 Month of activity
Golf carrying own clubs 1 Average number of times per month
Golf carrying own clubs 1 Duration per occasion: Hrs
Golf carrying own clubs 1 Duration per occasion: Mins
Golf carrying own clubs 2 Did you perform this activity?
Golf carrying own clubs 2 Month of activity
Golf carrying own clubs 2 Average number of times per month
Golf carrying own clubs 2 Duration per occasion: Hrs
Golf carrying own clubs 2 Duration per occasion: Mins
Golf riding a power cart 1 Did you perform this activity?
Golf riding a power cart 1 Month of activity
Golf riding a power cart 1 Average number of times per month
Golf riding a power cart 1 Duration per occasion: Hrs
Golf riding a power cart 1 Duration per occasion: Mins
Golf riding a power cart 2 Did you perform this activity?
Golf riding a power cart 2 Month of activity
Golf riding a power cart 2 Average number of times per month
Golf riding a power cart 2 Duration per occasion: Hrs
Golf riding a power cart 2 Duration per occasion: Mins
Section F: Lawn & Garden activities
Pease read the list of activities and then answer for each one
cs_qF_Y Other activities cs_qF_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Mowing lawn (with hand or power mower) 1 Did you perform this activity?
Mowing lawn (with hand or power mower) 1 Month of activity
Mowing lawn (with hand or power mower) 1 Average number of times per month
Mowing lawn (with hand or power mower) 1 Duration per occasion: Hrs
Mowing lawn (with hand or power mower) 1 Duration per occasion: Mins
Mowing lawn (with hand or power mower) 2 Did you perform this activity?
Mowing lawn (with hand or power mower) 2 Month of activity
Mowing lawn (with hand or power mower) 2 Average number of times per month
Mowing lawn (with hand or power mower) 2 Duration per occasion: Hrs
Mowing lawn (with hand or power mower) 2 Duration per occasion: Mins
Mowing lawn riding mower 1 Did you perform this activity?
Mowing lawn riding mower 1 Month of activity
Mowing lawn riding mower 1 Average number of times per month
Mowing lawn riding mower 1 Duration per occasion: Hrs
Mowing lawn riding mower 1 Duration per occasion: Mins
Mowing lawn riding mower 2 Did you perform this activity?
Mowing lawn riding mower 2 Month of activity
Mowing lawn riding mower 2 Average number of times per month
Mowing lawn riding mower 2 Duration per occasion: Hrs
Mowing lawn riding mower 2 Duration per occasion: Mins
Raking lawn 1 Did you perform this activity?
Raking lawn 1 Month of activity
Raking lawn 1 Average number of times per month
Raking lawn 1 Duration per occasion: Hrs
Raking lawn 1 Duration per occasion: Mins
Raking lawn 2 Did you perform this activity?
Raking lawn 2 Month of activity
Raking lawn 2 Average number of times per month
Raking lawn 2 Duration per occasion: Hrs
Raking lawn 2 Duration per occasion: Mins
Weeding, cultivating garden, trimming shrubs or trees 1 Did you perform this activity?
Weeding, cultivating garden, trimming shrubs or trees 1 Month of activity
Weeding, cultivating garden, trimming shrubs or trees 1 Average number of times per month
Weeding, cultivating garden, trimming shrubs or trees 1 Duration per occasion: Hrs
Weeding, cultivating garden, trimming shrubs or trees 1 Duration per occasion: Mins
Weeding, cultivating garden, trimming shrubs or trees 2 Did you perform this activity?
Weeding, cultivating garden, trimming shrubs or trees 2 Month of activity
Weeding, cultivating garden, trimming shrubs or trees 2 Average number of times per month
Weeding, cultivating garden, trimming shrubs or trees 2 Duration per occasion: Hrs
Weeding, cultivating garden, trimming shrubs or trees 2 Duration per occasion: Mins
Digging, spading, filling garden, composting 1 Did you perform this activity?
Digging, spading, filling garden, composting 1 Month of activity
Digging, spading, filling garden, composting 1 Average number of times per month
Digging, spading, filling garden, composting 1 Duration per occasion: Hrs
Digging, spading, filling garden, composting 1 Duration per occasion: Mins
Digging, spading, filling garden, composting 2 Did you perform this activity?
Digging, spading, filling garden, composting 2 Month of activity
Digging, spading, filling garden, composting 2 Average number of times per month
Digging, spading, filling garden, composting 2 Duration per occasion: Hrs
Digging, spading, filling garden, composting 2 Duration per occasion: Mins
Sacking grass, leaves 1 Did you perform this activity?
Sacking grass, leaves 1 Month of activity
Sacking grass, leaves 1 Average number of times per month
Sacking grass, leaves 1 Duration per occasion: Hrs
Sacking grass, leaves 1 Duration per occasion: Mins
Sacking grass, leaves 2 Did you perform this activity?
Sacking grass, leaves 2 Month of activity
Sacking grass, leaves 2 Average number of times per month
Sacking grass, leaves 2 Duration per occasion: Hrs
Sacking grass, leaves 2 Duration per occasion: Mins
Planting seedlings, shrubs, flowers 1 Did you perform this activity?
Planting seedlings, shrubs, flowers 1 Month of activity
Planting seedlings, shrubs, flowers 1 Average number of times per month
Planting seedlings, shrubs, flowers 1 Duration per occasion: Hrs
Planting seedlings, shrubs, flowers 1 Duration per occasion: Mins
Planting seedlings, shrubs, flowers 2 Did you perform this activity?
Planting seedlings, shrubs, flowers 2 Month of activity
Planting seedlings, shrubs, flowers 2 Average number of times per month
Planting seedlings, shrubs, flowers 2 Duration per occasion: Hrs
Planting seedlings, shrubs, flowers 2 Duration per occasion: Mins
Section G: Domestic & maintenance activities
Pease read the list of activities and then answer for each one
cs_qG_Y Other activities cs_qG_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Shopping (include any shopping i.e for food & non food items) 1 Did you perform this activity?
Shopping (include any shopping i.e for food & non food items) 1 Month of activity
Shopping (include any shopping i.e for food & non food items) 1 Average number of times per month
Shopping (include any shopping i.e for food & non food items) 1 Duration per occasion: Hrs
Shopping (include any shopping i.e for food & non food items) 1 Duration per occasion: Mins
Shopping (include any shopping i.e for food & non food items) 2 Did you perform this activity?
Shopping (include any shopping i.e for food & non food items) 2 Month of activity
Shopping (include any shopping i.e for food & non food items) 2 Average number of times per month
Shopping (include any shopping i.e for food & non food items) 2 Duration per occasion: Hrs
Shopping (include any shopping i.e for food & non food items) 2 Duration per occasion: Mins
General cleaning (dust, tidy up, washing, changing linen etc) 1 Did you perform this activity?
General cleaning (dust, tidy up, washing, changing linen etc) 1 Month of activity
General cleaning (dust, tidy up, washing, changing linen etc) 1 Average number of times per month
General cleaning (dust, tidy up, washing, changing linen etc) 1 Duration per occasion: Hrs
General cleaning (dust, tidy up, washing, changing linen etc) 1 Duration per occasion: Mins
General cleaning (dust, tidy up, washing, changing linen etc) 2 Did you perform this activity?
General cleaning (dust, tidy up, washing, changing linen etc) 2 Month of activity
General cleaning (dust, tidy up, washing, changing linen etc) 2 Average number of times per month
General cleaning (dust, tidy up, washing, changing linen etc) 2 Duration per occasion: Hrs
General cleaning (dust, tidy up, washing, changing linen etc) 2 Duration per occasion: Mins
Vacuuming & mopping 1 Did you perform this activity?
Vacuuming & mopping 1 Month of activity
Vacuuming & mopping 1 Average number of times per month
Vacuuming & mopping 1 Duration per occasion: Hrs
Vacuuming & mopping 1 Duration per occasion: Mins
Vacuuming & mopping 2 Did you perform this activity?
Vacuuming & mopping 2 Month of activity
Vacuuming & mopping 2 Average number of times per month
Vacuuming & mopping 2 Duration per occasion: Hrs
Vacuuming & mopping 2 Duration per occasion: Mins
Cooking or food preparation, putting away groceries 1 Did you perform this activity?
Cooking or food preparation, putting away groceries 1 Month of activity
Cooking or food preparation, putting away groceries 1 Average number of times per month
Cooking or food preparation, putting away groceries 1 Duration per occasion: Hrs
Cooking or food preparation, putting away groceries 1 Duration per occasion: Mins
Cooking or food preparation, putting away groceries 2 Did you perform this activity?
Cooking or food preparation, putting away groceries 2 Month of activity
Cooking or food preparation, putting away groceries 2 Average number of times per month
Cooking or food preparation, putting away groceries 2 Duration per occasion: Hrs
Cooking or food preparation, putting away groceries 2 Duration per occasion: Mins
Scrubbing floors on hands & knees, scrubbing bathroom 1 Did you perform this activity?
Scrubbing floors on hands & knees, scrubbing bathroom 1 Month of activity
Scrubbing floors on hands & knees, scrubbing bathroom 1 Average number of times per month
Scrubbing floors on hands & knees, scrubbing bathroom 1 Duration per occasion: Hrs
Scrubbing floors on hands & knees, scrubbing bathroom 1 Duration per occasion: Mins
Scrubbing floors on hands & knees, scrubbing bathroom 2 Did you perform this activity?
Scrubbing floors on hands & knees, scrubbing bathroom 2 Month of activity
Scrubbing floors on hands & knees, scrubbing bathroom 2 Average number of times per month
Scrubbing floors on hands & knees, scrubbing bathroom 2 Duration per occasion: Hrs
Scrubbing floors on hands & knees, scrubbing bathroom 2 Duration per occasion: Mins
Ironing 1 Did you perform this activity?
Ironing 1 Month of activity
Ironing 1 Average number of times per month
Ironing 1 Duration per occasion: Hrs
Ironing 1 Duration per occasion: Mins
Ironing 2 Did you perform this activity?
Ironing 2 Month of activity
Ironing 2 Average number of times per month
Ironing 2 Duration per occasion: Hrs
Ironing 2 Duration per occasion: Mins
Playing a musical instrument (please specify) 1 Did you perform this activity?
Playing a musical instrument (please specify) 1 Month of activity
Playing a musical instrument (please specify) 1 Average number of times per month
Playing a musical instrument (please specify) 1 Duration per occasion: Hrs
Playing a musical instrument (please specify) 1 Duration per occasion: Mins
Playing a musical instrument (please specify) 2 Did you perform this activity?
Playing a musical instrument (please specify) 2 Month of activity
Playing a musical instrument (please specify) 2 Average number of times per month
Playing a musical instrument (please specify) 2 Duration per occasion: Hrs
Playing a musical instrument (please specify) 2 Duration per occasion: Mins
Child Care - dressing, bathing, grooming, feeding, occasional lifting 1 Did you perform this activity?
Child Care - dressing, bathing, grooming, feeding, occasional lifting 1 Month of activity
Child Care - dressing, bathing, grooming, feeding, occasional lifting 1 Average number of times per month
Child Care - dressing, bathing, grooming, feeding, occasional lifting 1 Duration per occasion: Hrs
Child Care - dressing, bathing, grooming, feeding, occasional lifting 1 Duration per occasion: Mins
Child Care - dressing, bathing, grooming, feeding, occasional lifting 2 Did you perform this activity?
Child Care - dressing, bathing, grooming, feeding, occasional lifting 2 Month of activity
Child Care - dressing, bathing, grooming, feeding, occasional lifting 2 Average number of times per month
Child Care - dressing, bathing, grooming, feeding, occasional lifting 2 Duration per occasion: Hrs
Child Care - dressing, bathing, grooming, feeding, occasional lifting 2 Duration per occasion: Mins
Sitting playing with child(ren) - light effort 1 Did you perform this activity?
Sitting playing with child(ren) - light effort 1 Month of activity
Sitting playing with child(ren) - light effort 1 Average number of times per month
Sitting playing with child(ren) - light effort 1 Duration per occasion: Hrs
Sitting playing with child(ren) - light effort 1 Duration per occasion: Mins
Sitting playing with child(ren) - light effort 2 Did you perform this activity?
Sitting playing with child(ren) - light effort 2 Month of activity
Sitting playing with child(ren) - light effort 2 Average number of times per month
Sitting playing with child(ren) - light effort 2 Duration per occasion: Hrs
Sitting playing with child(ren) - light effort 2 Duration per occasion: Mins
Running/walking to play with child(ren) - moderate effort 1 Did you perform this activity?
Running/walking to play with child(ren) - moderate effort 1 Month of activity
Running/walking to play with child(ren) - moderate effort 1 Average number of times per month
Running/walking to play with child(ren) - moderate effort 1 Duration per occasion: Hrs
Running/walking to play with child(ren) - moderate effort 1 Duration per occasion: Mins
Running/walking to play with child(ren) - moderate effort 2 Did you perform this activity?
Running/walking to play with child(ren) - moderate effort 2 Month of activity
Running/walking to play with child(ren) - moderate effort 2 Average number of times per month
Running/walking to play with child(ren) - moderate effort 2 Duration per occasion: Hrs
Running/walking to play with child(ren) - moderate effort 2 Duration per occasion: Mins
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 1 Did you perform this activity?
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 1 Month of activity
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 1 Average number of times per month
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 1 Duration per occasion: Hrs
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 1 Duration per occasion: Mins
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 2 Did you perform this activity?
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 2 Month of activity
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 2 Average number of times per month
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 2 Duration per occasion: Hrs
Elderly or disabled adult care (lifting, dressing, bathing, grooming etc) 2 Duration per occasion: Mins
Carpentry, outside house - erecting shed, fences, laying patios etc 1 Did you perform this activity?
Carpentry, outside house - erecting shed, fences, laying patios etc 1 Month of activity
Carpentry, outside house - erecting shed, fences, laying patios etc 1 Average number of times per month
Carpentry, outside house - erecting shed, fences, laying patios etc 1 Duration per occasion: Hrs
Carpentry, outside house - erecting shed, fences, laying patios etc 1 Duration per occasion: Mins
Carpentry, outside house - erecting shed, fences, laying patios etc 2 Did you perform this activity?
Carpentry, outside house - erecting shed, fences, laying patios etc 2 Month of activity
Carpentry, outside house - erecting shed, fences, laying patios etc 2 Average number of times per month
Carpentry, outside house - erecting shed, fences, laying patios etc 2 Duration per occasion: Hrs
Carpentry, outside house - erecting shed, fences, laying patios etc 2 Duration per occasion: Mins
Carpentry, workshop - putting up shelves, general repairs etc 1 Did you perform this activity?
Carpentry, workshop - putting up shelves, general repairs etc 1 Month of activity
Carpentry, workshop - putting up shelves, general repairs etc 1 Average number of times per month
Carpentry, workshop - putting up shelves, general repairs etc 1 Duration per occasion: Hrs
Carpentry, workshop - putting up shelves, general repairs etc 1 Duration per occasion: Mins
Carpentry, workshop - putting up shelves, general repairs etc 2 Did you perform this activity?
Carpentry, workshop - putting up shelves, general repairs etc 2 Month of activity
Carpentry, workshop - putting up shelves, general repairs etc 2 Average number of times per month
Carpentry, workshop - putting up shelves, general repairs etc 2 Duration per occasion: Hrs
Carpentry, workshop - putting up shelves, general repairs etc 2 Duration per occasion: Mins
Plumbing &/or wiring 1 Did you perform this activity?
Plumbing &/or wiring 1 Month of activity
Plumbing &/or wiring 1 Average number of times per month
Plumbing &/or wiring 1 Duration per occasion: Hrs
Plumbing &/or wiring 1 Duration per occasion: Mins
Plumbing &/or wiring 2 Did you perform this activity?
Plumbing &/or wiring 2 Month of activity
Plumbing &/or wiring 2 Average number of times per month
Plumbing &/or wiring 2 Duration per occasion: Hrs
Plumbing &/or wiring 2 Duration per occasion: Mins
Painting indoors, wallpapering, plastering, scraping, waxing floors 1 Did you perform this activity?
Painting indoors, wallpapering, plastering, scraping, waxing floors 1 Month of activity
Painting indoors, wallpapering, plastering, scraping, waxing floors 1 Average number of times per month
Painting indoors, wallpapering, plastering, scraping, waxing floors 1 Duration per occasion: Hrs
Painting indoors, wallpapering, plastering, scraping, waxing floors 1 Duration per occasion: Mins
Painting indoors, wallpapering, plastering, scraping, waxing floors 2 Did you perform this activity?
Painting indoors, wallpapering, plastering, scraping, waxing floors 2 Month of activity
Painting indoors, wallpapering, plastering, scraping, waxing floors 2 Average number of times per month
Painting indoors, wallpapering, plastering, scraping, waxing floors 2 Duration per occasion: Hrs
Painting indoors, wallpapering, plastering, scraping, waxing floors 2 Duration per occasion: Mins
Painting outdoors - guttering, fascias, windows etc 1 Did you perform this activity?
Painting outdoors - guttering, fascias, windows etc 1 Month of activity
Painting outdoors - guttering, fascias, windows etc 1 Average number of times per month
Painting outdoors - guttering, fascias, windows etc 1 Duration per occasion: Hrs
Painting outdoors - guttering, fascias, windows etc 1 Duration per occasion: Mins
Painting outdoors - guttering, fascias, windows etc 2 Did you perform this activity?
Painting outdoors - guttering, fascias, windows etc 2 Month of activity
Painting outdoors - guttering, fascias, windows etc 2 Average number of times per month
Painting outdoors - guttering, fascias, windows etc 2 Duration per occasion: Hrs
Painting outdoors - guttering, fascias, windows etc 2 Duration per occasion: Mins

Pease read the list of activities and then answer for each one Playing a musical instrument (please specify)

Generic text
Section H: Fishing & Hunting
Please read the list of activities and then answer for each one
cs_qH_Y Other activities cs_qH_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Fishing from the river bank 1 Did you perform this activity?
Fishing from the river bank 1 Month of activity
Fishing from the river bank 1 Average number of times per month
Fishing from the river bank 1 Duration per occasion: Hrs
Fishing from the river bank 1 Duration per occasion: Mins
Fishing from the river bank 2 Did you perform this activity?
Fishing from the river bank 2 Month of activity
Fishing from the river bank 2 Average number of times per month
Fishing from the river bank 2 Duration per occasion: Hrs
Fishing from the river bank 2 Duration per occasion: Mins
Fishing in a stream, in waders 1 Did you perform this activity?
Fishing in a stream, in waders 1 Month of activity
Fishing in a stream, in waders 1 Average number of times per month
Fishing in a stream, in waders 1 Duration per occasion: Hrs
Fishing in a stream, in waders 1 Duration per occasion: Mins
Fishing in a stream, in waders 2 Did you perform this activity?
Fishing in a stream, in waders 2 Month of activity
Fishing in a stream, in waders 2 Average number of times per month
Fishing in a stream, in waders 2 Duration per occasion: Hrs
Fishing in a stream, in waders 2 Duration per occasion: Mins
Hunting (including small or large game) 1 Did you perform this activity?
Hunting (including small or large game) 1 Month of activity
Hunting (including small or large game) 1 Average number of times per month
Hunting (including small or large game) 1 Duration per occasion: Hrs
Hunting (including small or large game) 1 Duration per occasion: Mins
Hunting (including small or large game) 2 Did you perform this activity?
Hunting (including small or large game) 2 Month of activity
Hunting (including small or large game) 2 Average number of times per month
Hunting (including small or large game) 2 Duration per occasion: Hrs
Hunting (including small or large game) 2 Duration per occasion: Mins
Shooting game or trap shooting- duck, grouse etc 1 Did you perform this activity?
Shooting game or trap shooting- duck, grouse etc 1 Month of activity
Shooting game or trap shooting- duck, grouse etc 1 Average number of times per month
Shooting game or trap shooting- duck, grouse etc 1 Duration per occasion: Hrs
Shooting game or trap shooting- duck, grouse etc 1 Duration per occasion: Mins
Shooting game or trap shooting- duck, grouse etc 2 Did you perform this activity?
Shooting game or trap shooting- duck, grouse etc 2 Month of activity
Shooting game or trap shooting- duck, grouse etc 2 Average number of times per month
Shooting game or trap shooting- duck, grouse etc 2 Duration per occasion: Hrs
Shooting game or trap shooting- duck, grouse etc 2 Duration per occasion: Mins
THANK YOU FOR TAKING TIME TO COMPLETE THIS QUESTIONNAIRE
End

hcs_2_clinic_8

HERTS 31-39 -PHYSICAL ACTIVITIY QUESTIONNAIRE
Name
Generic text
Date
Generic date
We would like to see how many of the following activities you have done anywhere (work, home, on holiday etc), over the last 12 months. Please read the list and tick "no" in column 2 if you have not done them or "yes" in column 3 if you have. If you tick "yes" to an activity, please tick which months you did it in, remembering that some of the months may be in the previous year. Looking back over the last 12 months, please estimate how many times you did it per month and the average duration for each occasion (see example).
Section A: Walking & related activities

Please read the list of activities and then answer for each one

cs_qA_Y Other activities cs_qA_X How many Hours Minutes Duration (minutes) cs_No_Yes cs_Month Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month How many cs_No_Yes cs_Month Hours Minutes Duration (minutes) Hours Minutes Duration (minutes) cs_No_Yes cs_Month How many Duration (minutes) cs_Month How many Hours Minutes cs_No_Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Did you perform this activity?
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Month of activity
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Average number of times per month
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Duration per occasion: Hrs
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 1 Duration per occasion: Mins
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Did you perform this activity?
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Month of activity
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Average number of times per month
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Duration per occasion: Hrs
Walking for pleasure outdoors (inc. during work breaks & walking the dog) 2 Duration per occasion: Mins
Walking to and/or from work 1 Did you perform this activity?
Walking to and/or from work 1 Month of activity
Walking to and/or from work 1 Average number of times per month
Walking to and/or from work 1 Duration per occasion: Hrs
Walking to and/or from work 1 Duration per occasion: Mins
Walking to and/or from work 2 Did you perform this activity?
Walking to and/or from work 2 Month of activity
Walking to and/or from work 2 Average number of times per month
Walking to and/or from work 2 Duration per occasion: Hrs
Walking to and/or from work 2 Duration per occasion: Mins
Walking indoors (e.g at work or around the house) 1 Did you perform this activity?
Walking indoors (e.g at work or around the house) 1 Month of activity
Walking indoors (e.g at work or around the house) 1 Average number of times per month
Walking indoors (e.g at work or around the house) 1 Duration per occasion: Hrs
Walking indoors (e.g at work or around the house) 1 Duration per occasion: Mins
Walking indoors (e.g at work or around the house) 2 Did you perform this activity?
Walking indoors (e.g at work or around the house) 2 Month of activity
Walking indoors (e.g at work or around the house) 2 Average number of times per month
Walking indoors (e.g at work or around the house) 2 Duration per occasion: Hrs
Walking indoors (e.g at work or around the house) 2 Duration per occasion: Mins
Walking up stairs, or climbing a ladder 1 Did you perform this activity?
Walking up stairs, or climbing a ladder 1 Month of activity
Walking up stairs, or climbing a ladder 1 Average number of times per month
Walking up stairs, or climbing a ladder 1 Duration per occasion: Hrs
Walking up stairs, or climbing a ladder 1 Duration per occasion: Mins
Walking up stairs, or climbing a ladder 2 Did you perform this activity?
Walking up stairs, or climbing a ladder 2 Month of activity
Walking up stairs, or climbing a ladder 2 Average number of times per month
Walking up stairs, or climbing a ladder 2 Duration per occasion: Hrs
Walking up stairs, or climbing a ladder 2 Duration per occasion: Mins
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Did you perform this activity?
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Month of activity
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Average number of times per month
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Duration per occasion: Hrs
Cross-country hiking (on flat or hilly land for at least 1 hr) 1 Duration per occasion: Mins
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Did you perform this activity?
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Month of activity
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Average number of times per month
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Duration per occasion: Hrs
Cross-country hiking (on flat or hilly land for at least 1 hr) 2 Duration per occasion: Mins
Backpacking (walking & carrying pack weighing min of 20lb) 1 Did you perform this activity?
Backpacking (walking & carrying pack weighing min of 20lb) 1 Month of activity
Backpacking (walking & carrying pack weighing min of 20lb) 1 Average number of times per month
Backpacking (walking & carrying pack weighing min of 20lb) 1 Duration per occasion: Hrs
Backpacking (walking & carrying pack weighing min of 20lb) 1 Duration per occasion: Mins
Backpacking (walking & carrying pack weighing min of 20lb) 2 Did you perform this activity?
Backpacking (walking & carrying pack weighing min of 20lb) 2 Month of activity
Backpacking (walking & carrying pack weighing min of 20lb) 2 Average number of times per month
Backpacking (walking & carrying pack weighing min of 20lb) 2 Duration per occasion: Hrs
Backpacking (walking & carrying pack weighing min of 20lb) 2 Duration per occasion: Mins
Mountain or rock climbing 1 Did you perform this activity?
Mountain or rock climbing 1 Month of activity
Mountain or rock climbing 1 Average number of times per month
Mountain or rock climbing 1 Duration per occasion: Hrs
Mountain or rock climbing 1 Duration per occasion: Mins
Mountain or rock climbing 2 Did you perform this activity?
Mountain or rock climbing 2 Month of activity
Mountain or rock climbing 2 Average number of times per month
Mountain or rock climbing 2 Duration per occasion: Hrs
Mountain or rock climbing 2 Duration per occasion: Mins
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Did you perform this activity?
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Month of activity
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Average number of times per month
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Duration per occasion: Hrs
Bicycling outdoors (leisurely pace for pleasure & to work) 1 Duration per occasion: Mins
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Did you perform this activity?
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Month of activity
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Average number of times per month
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Duration per occasion: Hrs
Bicycling outdoors (leisurely pace for pleasure & to work) 2 Duration per occasion: Mins
Section B: Conditioning exercise

Please read the list of activities and then answer for each one

cs_qB_Y Other activities cs_qB_X How many Hours Minutes Duration (minutes) cs_No_Yes cs_Month Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month How many cs_No_Yes cs_Month Hours Minutes Duration (minutes) Hours Minutes Duration (minutes) cs_No_Yes cs_Month How many Duration (minutes) cs_Month How many Hours Minutes cs_No_Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

Light/moderate effort exercises - light aerobics, home exercises 1 Did you perform this activity?
Light/moderate effort exercises - light aerobics, home exercises 1 Month of activity
Light/moderate effort exercises - light aerobics, home exercises 1 Average number of times per month
Light/moderate effort exercises - light aerobics, home exercises 1 Duration per occasion: Hrs
Light/moderate effort exercises - light aerobics, home exercises 1 Duration per occasion: Mins
Light/moderate effort exercises - light aerobics, home exercises 2 Did you perform this activity?
Light/moderate effort exercises - light aerobics, home exercises 2 Month of activity
Light/moderate effort exercises - light aerobics, home exercises 2 Average number of times per month
Light/moderate effort exercises - light aerobics, home exercises 2 Duration per occasion: Hrs
Light/moderate effort exercises - light aerobics, home exercises 2 Duration per occasion: Mins
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Did you perform this activity?
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Month of activity
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Average number of times per month
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Duration per occasion: Hrs
Vigorous effort exercises - aerobics, pushups, situps, pullups 1 Duration per occasion: Mins
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Did you perform this activity?
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Month of activity
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Average number of times per month
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Duration per occasion: Hrs
Vigorous effort exercises - aerobics, pushups, situps, pullups 2 Duration per occasion: Mins
Yoga, stretching exercises, pilates 1 Did you perform this activity?
Yoga, stretching exercises, pilates 1 Month of activity
Yoga, stretching exercises, pilates 1 Average number of times per month
Yoga, stretching exercises, pilates 1 Duration per occasion: Hrs
Yoga, stretching exercises, pilates 1 Duration per occasion: Mins
Yoga, stretching exercises, pilates 2 Did you perform this activity?
Yoga, stretching exercises, pilates 2 Month of activity
Yoga, stretching exercises, pilates 2 Average number of times per month
Yoga, stretching exercises, pilates 2 Duration per occasion: Hrs
Yoga, stretching exercises, pilates 2 Duration per occasion: Mins
Gym club workout - moderate effort, general gym workout 1 Did you perform this activity?
Gym club workout - moderate effort, general gym workout 1 Month of activity
Gym club workout - moderate effort, general gym workout 1 Average number of times per month
Gym club workout - moderate effort, general gym workout 1 Duration per occasion: Hrs
Gym club workout - moderate effort, general gym workout 1 Duration per occasion: Mins
Gym club workout - moderate effort, general gym workout 2 Did you perform this activity?
Gym club workout - moderate effort, general gym workout 2 Month of activity
Gym club workout - moderate effort, general gym workout 2 Average number of times per month
Gym club workout - moderate effort, general gym workout 2 Duration per occasion: Hrs
Gym club workout - moderate effort, general gym workout 2 Duration per occasion: Mins
Jogging 1 Did you perform this activity?
Jogging 1 Month of activity
Jogging 1 Average number of times per month
Jogging 1 Duration per occasion: Hrs
Jogging 1 Duration per occasion: Mins
Jogging 2 Did you perform this activity?
Jogging 2 Month of activity
Jogging 2 Average number of times per month
Jogging 2 Duration per occasion: Hrs
Jogging 2 Duration per occasion: Mins
Running - light/moderate effort outdoors &/or treadmill 1 Did you perform this activity?
Running - light/moderate effort outdoors &/or treadmill 1 Month of activity
Running - light/moderate effort outdoors &/or treadmill 1 Average number of times per month
Running - light/moderate effort outdoors &/or treadmill 1 Duration per occasion: Hrs
Running - light/moderate effort outdoors &/or treadmill 1 Duration per occasion: Mins
Running - light/moderate effort outdoors &/or treadmill 2 Did you perform this activity?
Running - light/moderate effort outdoors &/or treadmill 2 Month of activity
Running - light/moderate effort outdoors &/or treadmill 2 Average number of times per month
Running - light/moderate effort outdoors &/or treadmill 2 Duration per occasion: Hrs
Running - light/moderate effort outdoors &/or treadmill 2 Duration per occasion: Mins
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Did you perform this activity?
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Month of activity
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Average number of times per month
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Duration per occasion: Hrs
Running - vigorous effort more than 7mph outdoors &/or treadmill 1 Duration per occasion: Mins
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Did you perform this activity?
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Month of activity
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Average number of times per month
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Duration per occasion: Hrs
Running - vigorous effort more than 7mph outdoors &/or treadmill 2 Duration per occasion: Mins
Lifting weights/loads - any loads, light/moderate effort 1 Did you perform this activity?
Lifting weights/loads - any loads, light/moderate effort 1 Month of activity
Lifting weights/loads - any loads, light/moderate effort 1 Average number of times per month
Lifting weights/loads - any loads, light/moderate effort 1 Duration per occasion: Hrs
Lifting weights/loads - any loads, light/moderate effort 1 Duration per occasion: Mins
Lifting weights/loads - any loads, light/moderate effort 2 Did you perform this activity?
Lifting weights/loads - any loads, light/moderate effort 2 Month of activity
Lifting weights/loads - any loads, light/moderate effort 2 Average number of times per month
Lifting weights/loads - any loads, light/moderate effort 2 Duration per occasion: Hrs
Lifting weights/loads - any loads, light/moderate effort 2 Duration per occasion: Mins
Section C: Water activities

Please read the list of activities and then answer for each one

cs_qC_Y Other activities cs_qC_X cs_No_Yes How many Duration (minutes) cs_Month Hours Minutes cs_Month How many Hours Minutes cs_No_Yes Duration (minutes) Duration (minutes) cs_No_Yes cs_Month How many Hours Minutes cs_Month Duration (minutes) Hours Minutes How many cs_No_Yes Duration (minutes) How many cs_No_Yes Hours Minutes cs_Month

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

0 - No

1 - Yes

0 - No

1 - Yes

1 - Jan

2 - Feb

3 - Mar

4 - Apr

5 - May

6 - June

7 - July

8 - Aug

9 - Sept

10 - Oct

11 - Nov

12 - Dec

Water skiing 1 Did you perform this activity?
Water skiing 1 Month of activity
Water skiing 1 Average number of times per month
Water skiing 1 Duration per occasion: Hrs
Water skiing 1 Duration per occasion: Mins
Water skiing 2 Did you perform this activity?
Water skiing 2 Month of activity
Water skiing 2 Average number of times per month
Water skiing 2 Duration per occasion: Hrs
Water skiing 2 Duration per occasion: Mins
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Did you perform this activity?
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Month of activity
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Average number of times per month
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Duration per occasion: Hrs
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 1 Duration per occasion: Mins
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Did you perform this activity?
Sailing for pleasure - boat & board sailing, windsurfing, ice sailing 2 Month of activity