Physical activity can occur at a range of intensities, such as the following: (2) LIGHT

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Kelly Bradford
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1 Active Participation On the following pages, you will find a series of statements about the general levels and types of physical activity you participate in. Read each statement/question and then decide on and write your response in the appropriate space, using the scale provided (for example: 1=strongly dis; 2=dis; 3=; 4=). Respond to every statement, even if you are not completely sure of your response. The Active Participation Survey will likely take you about 15 minutes to complete. The three general categories of Active Participation are Physical Activity Levels, Challenges to Being Physically Active, and Diverse Activities and Environments. Physical activity can occur at a range of intensities, such as the following: (1) INACTIVE Requires little or no movement, with slow breathing This is often in the form of sleeping, lying down, sitting, or standing still. Example: sitting in school, or to eat, or watch TV (2) LIGHT Requires some movement, with normal breathing Such activities can be done for a long time without feeling tired, or running out of breath, or sweating. Example: light walking as when shopping (3) MODERATE to INTENSE Requires more intense movement and effort Results in a noticeable increase in breathing, heart, and sweating rate Examples: jogging, bicycling, swimming, lifting, and fast walking Part A: Physical Activity Levels Circle one response below each of these statements/questions. 1. Which of the following most closely describes your current level of physical fitness (strength, endurance, flexibility )? very poor poor average good very good 1

2 2. How many day(s) in the last week did you perform strength training such as push-ups, sit-ups, or weight lifting? none 4 days 1 day 5 days 2 days 6 days 3 days every day 3. On most (typical) weekday nights, I get an average of approximately this many hours of sleep a night: 5 hours 10 hours 6 hours 11 hours 7 hours 12 hours 8 hours over 12 hours 9 hours 4. On most (typical) weekend nights, I get an average of approximately this many hours of sleep a night: 5 hours 10 hours 6 hours 11 hours 7 hours 12 hours 8 hours over 12 hours 9 hours 5. On most typical school days (Monday to Friday), I spend approximately the following number of hours f per day inactive and in front of a screen (e.g., phone, TV, video, computer, video game) during my own free time: 1 hour 7 hours 2 hours 8 hours 3 hours 9 hours 4 hours 10 hours 5 hours over 10 hours 6 hours 6. On most typical weekend (Saturday or Sunday), I spend approximately the following number of hours j f per day inactive and in front of a screen (e.g., phone, TV, video, computer, video game) during my own free time: 1 hour 7 hours 2 hours 8 hours 3 hours 9 hours 4 hours 10 hours 5 hours over 10 hours 6 hours 2

3 7. How many day(s) in the last week did you exercise/participate in moderate-to-intense physical activity k for at least 20 minutes? 1 day 5 days 2 days 6 days 3 days every day 8. On most typical school days (Monday to Friday), I spend approximately the following number of hours per day participating in moderate-to-intense physical activity: less than 30 minutes minutes minutes over 90 minutes 9. On most typical weekends (Saturday or Sunday), I spend approximately the following number of hours per day participating in moderate-to-intense physical activity: less than 30 minutes minutes minutes over 90 minutes Part B: Challenges to Being Physically Active People generally face a variety of challenges (barriers, obstacles) to being regularly physically active. The following items ask you to consider if any of these potential challenges exist for you. 10. The season when I experience the most difficulty being regularly physically active is the fall summer winter spring 11. My parent(s) or guardian(s) provides me with the encouragement and support I need to be physically active. strongly dis dis 3

4 Being regularly physically active is difficult for me because I have trouble getting to the various physical activities I want to participate in. strongly dis dis 13. I can t afford to pay for the physical activities I want to participate in. strongly dis dis 14. The weather keeps me indoors and unable to get to places. strongly dis dis 15. My closest friends are not physically active. strongly dis dis 16. I don t have the time to be physically active. strongly dis dis 17. I choose to do other things after school like use technology (e.g., phone, computer, TV). strongly dis dis 4

5 18. I have a job that takes up a lot of my time. strongly dis dis 19. The community I live in does not offer activities that I am interested in/ meet my needs. strongly dis dis Part C: Diverse Activities and Environments Think of the different types of physical activity that you do, both organized (a teacher, coach or official is involved) and unorganized (no teacher, coach or official is involved). Check the one response for each question that best fits your activity level. Keep in mind that it is your perception that counts. Use the examples as a guide but do not over think them. Never Sometimes Most of the Time Very Often You do not participate in any type of this activity. You may do this type of activity once a month throughout the year (e.g., swimming with the family, at a sports camp in the summer or during a unit in physical education). You do activities of this type one to two times a week on a regular basis but may skip some months of the year (e.g., dancing with friends at home). You do activities of this type three or more times a week for most of the year (e.g., regular team sports throughout the year or family fitness walks every second day after supper). Diverse Activities Dance Activities Example Dance Activities Free Style Ballet Folk (Circle, Square, Line...) Interactive Dance (Video) Gaming Hip Hop Social Dance (Ballroom, Swing, Jive...) Jazz 5

6 20. How often do you do dance activities at school (e.g., physical education class, clubs)? 21. How often do you do dance activities at home or in the community (e.g., with friends, with family, clubs)? 22. How interested are you in doing more dance? not at all interested a little interested interested very interested Active Team Sports and Games Example Team Sports and Games Tag (Chase) Games Softball Ball Hockey Team Handball Water Polo Baseball Ice Hockey Sepak Takraw Ultimate Frisbee Cricket Field Hockey Team Games (Capture the Flag) Ringette Kickball Volleyball Lacrosse Orienteering Soccer Basketball Football Rugby 23. How often do you do active team sports and games at school (e.g., physical education class, sports teams, clubs)? 6

7 24. How often do you do active team sports and games at home or in the community (e.g., with friends, with family, sports teams, clubs)? 25. How interested are you in doing more active team sports and games? not at all interested a little interested interested very interested Individual Sports Example Individual Sports Road Cycling Swimming (Racing) Curling Off-Road Cycling Track and Field Figure Skating Trampoline Gymnastics (Tumbling ) Cross Country Skiing Badminton Artistic Gymnastics Downhill Skiing Golf Rowing/Canoeing/Kayaking Beach Volleyball Tennis Skating (In-Line or Ice) Table Tennis Squash Martial Arts (Karate, Judo, Taekwondo) Jai Alai Racquetball Paddleball/Pickleball Hunting/Gathering Archery Off-Road Motorcycling Bowling Billiards/Pool Skateboarding Fishing Inuit/Dene Games Interactive Exercise (Video) Gaming 26. How often do you do individual sports at school (e.g., physical education class, sports teams, clubs)? 7

8 27. How often do you do individual sports at home or in the community (e.g., with friends, with family, sports teams, clubs)? 28. How interested are you in doing more individual sports? not at all interested a little interested interested very interested Fitness-Training Activities Example Fitness-Training Activities (for exercise) Jogging/Running Yoga/Pilates Body Weight Exercises (Pushups, Sit-ups ) Jump Rope (Skipping) Cycling/Spinning (for exercise) Ice or In-Line (Roller) Skating Cross Training Swimming Weight Training Aerobics (i.e., Step, Tai Bo) Cross Country Skiing Yoga Snowshoeing 29. How often do you do fitness-training activities at school (e.g., physical education class, sports teams, clubs)? 30. How often do you do fitness activities at home or in the community (e.g., with friends, with family, sports teams, clubs)? 8

9 31. How interested are you in doing more fitness activities? not at all interested a little interested interested very interested Activities of Daily Living Next to each Activity of Daily Living listed below, check the column that most accurately reflects how often you do it. Activities of Daily Living Never Sometimes Often Always 32. Walking or bicycling to and/or from school 33. Walking or bicycling to and/or from work 34. Walking or bicycling elsewhere (e.g., post office) 35. Household chores (vacuuming, cleaning, doing dishes ) 36. Yard work (raking leaves, mowing lawn, shoveling snow) 37. Gardening 38. Washing Clothes 39. Active hobbies (crafts, sewing, woodwork, auto mechanics) 40. Baking/Cooking 41. Shopping (for home and personal essentials) 42. Being physically active as an employee at work Diverse Environments You can be physically active in many environments (i.e., on land, in water, on snow/ice, in air). LAND activities involve contact with a dry surface (e.g., grass, gym floor, concrete) for the majority of the time. Examples include basketball, soccer, and archery. SNOW/ICE activities involve contact with snow and ice for the majority of the time. Examples are ice hockey, tobogganing, skiing, and broomball. WATER activities take place on or in the water for the majority of the time. Swimming, snorkeling, canoeing, and wake boarding are examples. 9

10 AIR activities take place in the air for the majority of the time. Dirt jumping on mountain bikes, diving, ski jumping, and trampoline are examples. Think about the environments in which your physical activities take place. For the next five items, circle one number in the space provided to best indicate how much you participate in physical activity in each environment. Statement Never Sometimes Most of the Very Often Time 43. How often did you participate in land g activities over the past year? How often did you participate in snow/ice g activities over the past year? How often did you participate in water g activities over the past year? How often did you participate in air g activities over the past year? I try to be outdoors regularly in order to relax, get fresh air, and be physically active. strongly dis dis 10

Use this info if you're counting steps and want to convert activities that are not easily measured by the pedometer.

1 of 9 Use this info if you're counting steps and want to convert activities that are not easily measured by the pedometer. PLEASE NOTE: Activity Conversions are estimates; your actual steps may vary Bicycling