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General Practice Physical Activity Questionnaire

This document is a General Practice Physical Activity Questionnaire. It collects information about a patient's physical activity through their work, leisure time activities in the last week, and usual walking pace. The patient is asked to provide their name, date of birth, and the date. They then select the option that best describes the physical demand of their work from options ranging from no employment to vigorous physical activity. Next, they indicate the number of hours in the last week spent on physical exercise, cycling, walking, housework, gardening/DIY by selecting none, some but less than 1 hour, 1-3 hours, or 3 hours or more. Finally, they select their usual walking pace as either slow, steady average,

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Anne Julia Agustin
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774 views1 page

General Practice Physical Activity Questionnaire

This document is a General Practice Physical Activity Questionnaire. It collects information about a patient's physical activity through their work, leisure time activities in the last week, and usual walking pace. The patient is asked to provide their name, date of birth, and the date. They then select the option that best describes the physical demand of their work from options ranging from no employment to vigorous physical activity. Next, they indicate the number of hours in the last week spent on physical exercise, cycling, walking, housework, gardening/DIY by selecting none, some but less than 1 hour, 1-3 hours, or 3 hours or more. Finally, they select their usual walking pace as either slow, steady average,

Uploaded by

Anne Julia Agustin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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General Practice Physical Activity Questionnaire

Name: __________________________ D/O/B:________________ Date: ___________

1.) Please tell us the type and amount of physical activity involved in your work:

please mark
one box only
a. I am not in employment (e.g. retired, retired for health reasons, unemployed,
full-time carer, etc.)

b. I spend most of my time at work sitting (such as in an office)

c. I spend most of my time at work standing or walking. However my work does


not require much intense physical effort (e.g. shop assistant, hairdresser,
security guard, childminder, etc.)
d. my work involves definite physical effort including handling of heavy objects
and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse,
gardener, postal delivery worker, etc.)
e. my work involves vigorous physical activity including handling of very heavy
objects (e.g. scaffolder, construction worker, refuse collector, etc.)

2.) During the last week, how many hours did you spend on each of the following activities?
Please answer this question whether you are in employment or not.

please mark one box only on each row

None some but 1 hour but 3 hours or


less than less than 3 more
1 hour hours
a. physical exercise such as swimming, jogging,
aerobics, football, tennis, gym workout, etc

b. cycling, including cycling to work and during


leisure time

c. walking, including walking to work, shopping,


for pleasure, etc.

d. housework, childcare

e. gardening, DIY

3.) How would you describe your usual walking pace? Please mark one box only.

Slow pace Steady average


ie: less than 3mph pace
Brisk pace Fast pace
ie: over 4mph

This General Practice Physical Activity Questionnaire (GPPAQ) is a UK Dept of Health publication.

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