Department of Nutrition and Food Science Questionnaire On Exercise
Department of Nutrition and Food Science Questionnaire On Exercise
QUESTIONNAIRE ON EXERCISE
DEMOGRAPHICS:
1. Sex
2. Age
3. Level
4. Course of study
5. Type of sport
6. Religion
7. Ethnicity
The following questions are about effects of exercise on nutritional status. In some instances,
these questions may be difficult to answer and may require additional contributors to complete
the questionnaire. We are asking that you help in the best way you deem possible. Remember
that we are available and committed to assisting you in completing this questionnaire.
EXERCISE:
1a. In the past 2 weeks, beginning
Monday and ending this past Sunday, have you done
any exercises, sports, or physically active hobbies?
1 [ ] Yes
2 [ ] No (Jump to 3)
1 [ ] Yes
2 [ ] No (Jump to 4)
___________
Number
1[
2[
3[
4[
1[
2[
3[
4[
] Days
] Weeks
] Months
] Years
] More active
] Less active
] About as active
] Other (Specify)______________________
1[
2[
3[
4[
] A lot more
] A little more
] A lot less
] A little less
1[
2[
3[
4[
] Not at all
] Less often
] More often
] Very often
1[
2[
3[
4[
] No
] Sometimes
] Yes
] Dont know
1[
2[
3[
4[
] No
] Sometimes
] Yes
] Dont know
1 [ ] No
2 [ ] Yes
1[
2[
3[
4[
] No
] Maybe
] Yes
] Dont know