Physical Activity Stages of Change Questionnaire

For each of the following questions, please circle Yes or No.  Please be sure to read the questions carefully.   Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or an other activity in which the exertion is at least as intense as these activities.

1. I am currently physically active.                                                        

2. I intend to become more physically active in the next 6 months.

For activity to be regular, it must add up to a total of 30 minutes or more per day and be done at least 5 days per week.  For example, you could take one 30-minute walk or take three 10-minute walks for a daily total of 30 minutes.     

3. I currently engage in regular physical activity.                                  

4. I have been regularly physically active for the past 6 months.  

Scoring:

 If (question 1 = 0 and question 2 = 0), then you are at Stage 1.

If (question 1 = 0 and question 2 = 1), then you are at Stage 2.

If (question 1 = 1 and question 3 = 0), then you are at Stage 3.

If (question 1 = 1 and question 3 = 1, and question 4 = 0), then you are at Stage 4.

If (question 1 = 1 and question 3 = 1, and question 4 = 1), then you are at Stage 5.