Lifestyle questionnaire - IRCM

2 – Physical activity sectionHere is a list of questions that is intended to evaluate your lifestyle.For each of them, circle the answer that best reflects your current lifestyle:DO YOU EXERCISE REGULARLY? Yes NoDescription : _________________________________________________________________________________________________QUESTIONS A B C D TOOLSHow often do you get around on foot or by bicycle?Most of thetime> 3 times aweek1-2 times a week Rarely 21, 23How often do you take the stairs instead of using the elevator? Always Often Sometimes Never 21, 23How many times a week do you exercise for at least 30minutes?5-7 times aweek4 times aweek2-3 times a week < once aweekDo you usually feel motivated to exercise? Always Often Sometimes Never 20, 21Does this statement apply to you?“Right now I’m not in shape and I don’t know where to start toimprove.”21, 22, 24, 25,26, 27Not at all A little A lot Completely 21, 23, 24, 26Are you too tired to exercise? Never Sometimes Often Always 20Do you enjoy exercise? Completely A lot A little Not at all 20, 21Do you organize your time so as to include exercise? Always Often Sometimes Never 20, 21, 23, 24Do you find alternative ways of staying active when theweather is bad and you don’t want to go outside to exercise?Do you adapt your exercise program to currentrecommendations on the basis of your cardiovascularcondition?Does the following statement apply to you?“I don’t exercise because I’m afraid of getting hurt.”When you have joint problems, do you find alternatives foradapting your exercise program and staying active?Check here if this question does not apply to you:  Always Often Sometimes Never 24, 26, 27Always Often Sometimes Never or Idon’t knowNot at all A little Completely Completely 3122, 25, 28,29, 30Always Often Sometimes Never 31, 32, 33Do you follow the physical activity recommendations to helpyou lose weight?Check here if this question does not apply to you:  Completely Completely A little Not at all 34Do you limit your physical activity for fear of being hungry atthe end of a training session?Never Sometimes Often Always 35Do you drink enough during and/or after a training session? Always Often Sometimes Never 36DO YOU EXERCISE REGULARLY (i.e. 3O MINUTES OF MODERATELY INTENSE ACTIVITY OVER THE COURSE OF THE DAY EVERY DAY, ORALMOST, OR ONE VIGOROUS PHYSICAL ACTIVITY THREE TIMES A WEEK FOR 20 MINUTES EACH TIME)?A. YES, for over 6 months MaintenanceB. YES, for less than 6 months ActionC. NO, but I plan to start doing so within the next 60 days PreparationD. NO, but I plan to within the next 6 months ContemplationE. NO, and I do NOT plan to within the next 6 months PrecontemplationF. My doctor recommended that I refrain from exercise for the time beingbecause of a serious physical limitation (e.g.: an injury). Not recommanded