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Exercise Questionnaire
- By Cancer Prevention Research Center
- Published 01/3/2006
- Self Tests and Checklists
- Unrated
Cancer Prevention Research Center
The primary mission of CPRC - the Cancer Prevention Research Center - is to enhance the quality and quantity of life through prevention of cancer, other chronic diseases and premature death.
View all articles by Cancer Prevention Research CenterPlease use the following definition of exercise when answering these questions:
Regular Exercise is any planned physical activity (e.g., brisk walking, aerobics, jogging, bicycling, swimming, rowing, etc.) performed to increase physical fitness. Such activity should be performed 3 to 5 times per week for 20-60 minutes per session. Exercise does not have to be painful to be effective but should be done at a level that increases your breathing rate and causes you to break a sweat.
Please enter the number in the box that indicates how strongly you agree or disagree with the following statements.
1 = Strongly Disagree
2 = Disagree
3 = Undecided
4 = Agree
5 = Strongly Agree
[self-scoring only]
1. As far as I'm concerned, I don't need to exercise regularly.
2. I have been exercising regularly for a long time and I plan to continue.
3. I don't exercise and right now I don't care.
4. I am finally exercising regularly.
5. I have been successful at exercising regularly and I plan to continue.
6. I am satisfied with being a sedentary person.
7. I have been thinking that I might want to start exercising regularly.
8. I have started exercising regularly within the last 6 months.
9. I could exercise regularly, but I don't plan to.
10. Recently, I have started to exercise regularly.
11. I don't have the time or energy to exercise regularly right now.
12. I have started to exercise regularly, and I plan to continue.
13. I have been thinking about whether I will be able to exercise regularly.
14. I have set up a day and a time to start exercising regularly within the next few weeks.
15. I have managed to keep exercising regularly through the last 6 months.
16. I have been thinking that I may want to begin exercising regularly.
17. I have lined up with a friend to start exercising regularly within the next few weeks.
18. I have completed 6 months of regular exercise.
19. I know that regular exercise is worthwhile, but I don't have time for it in the near future.
20. I have been calling friends to find someone to start exercising with in the next few weeks.
21 I think regular exercise is good, but I can't figure it into my schedule right now.
22. I really think I should work on getting started with a regular exercise program in the next 6 months.
23. I am preparing to start a regular exercise group in the next few weeks.
24 I am aware of the importance of regular exercise but I can't do it right now.



