Lifestyle Questionnaire

1. Were you a high school and/or college athlete?

yesno
If yes, please explain.

2. Do you have any negative feelings toward or have you had any bad experiences with physical activity programs?

yesno
If yes, please explain.

3. Do you have any negative feelings toward or have you had any bad experiences with fitness testing and evaluation?

yesno
If yes, please explain.

4. Rate yourself on a scale of 1 to 5 (1 indicating the lowest value and 5 the highest).

Characterize your present cardiovascular capacity.12345
Characterize your present muscular capacity.12345
Characterize your present flexibility capacity.12345
When you exercise, how important is competition?12345

5. Do you start exercise programs but then find yourself unable to stick with them?

yesno

6. How much are you willing to devote to an exercise program?

Minutes per Day
Days per Week

7. Are you currently involved in regular endurance (cardiovascular) exercise?

yesno
If yes, specify the type of exercise(s):

Minutes per Day
Days per Week

LightFairly LightSomewhat HardHard

8. Are you currently involved in regular strength training exercise?

yesno
If yes, specify the type of exercise(s):

Minutes per Day
Days per Week

Rate your perception of the exertion of your exercise program:
LightFairly LightSomewhat HardHard

9. Are you currently involved in a regular weight loss program?

yesno
If yes, please explain.

10. How long have you been exercising regularly?

11. What other exercise, sport, or recreational activities have you participated in?

Currently?
In the past 6 months?
In the past 5 years?

12. Can you exercise during your work day?

yesno

13. What types of exercise interest you? (You may choose more than one.)

AerobicsBicyclingBowlingBoxingCanoeingHikingJoggingMartial ArtsPilatesStair MasterStationary BikeSwimmingTeam SportsTennisTreadmillWalkingWeight TrainingYoga

14. Please list at least two fitness goals:

Fitness Goal 1:

Fitness Goal 2: