Physical Activity and Wellbeing Questionnaire

Active Together Follow Up Form

In the past week, on how many days have you done a total of 30 mins or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job.

The following questions ask how you feel about your quality of life, health or other areas of your life. Please choose the answer that appears most appropriate. If you are unsure about which response to give a question, the first response you think of is often the best one. Please keen in mind your standards, hopes, pleasures and concerns. We ask that you think about your life in the last four weeks.