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Unit 14 Assignment 2 Individual Lifestyle Analysis - QUESTIONNAIRE £3.49
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Unit 14 Assignment 2 Individual Lifestyle Analysis - QUESTIONNAIRE
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Unit 14 Assignment 2 Individual Lifestyle Analysis HIGHEST GRADE: DISTINCTION GRADE ACHIEVED: DISTINCTION This is the lifestyle questionnaire needed in assignment 2 in order to achieve a distinction. ...PLEASE USE THIS AS GUIDANCE...

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  • January 25, 2021
  • 7
  • 2019/2020
  • Other
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LIFESTYLE QUESTIONNAIRE


Name: Date:



1. Physical activity (9)

Healthy exercise or physical activity usually involves activity that lasts for at least 20
minutes, raises your pulse and produces hard breathing. For example: running, cycling
or sport.

How often do you take part in this type of exercise –

Daily []
3 times weekly []
Once weekly []
Once monthly []

Extremely rarely/never [ ]

I cannot take exercise because of disability [ ]



If you do exercise, how long are your workouts?

15 – 30 mins []

30 – 45 mins []

45 – 60 mins []

60 mins + []




-If you don’t take part in exercise, what is this the reason behind this?




- Have you ever done any structured exercise in the past?




- If so, what was it?




- How long did you stick with it?

, - Did you get the results you wanted from it?




- If you did stop, why did you stop?




- What types of physical activities do you enjoy doing the most/least?




2. Smoking (5)

Do you smoke? Yes [ ] No [ ]

If yes, do you –
Smoke less than 1 cigarette/day []
1-9 cigarettes/day []
10-19 cigarettes/day []
20-39 cigarettes/day []
More than 40 cigarettes/day []
Smoke a pipe [ ]
Smoke cigars [ ]


If No, have you –

Never ever smoked []

Given up smoking in the last year []

Not smoked for more than 1 year []




3. Stress (7)



Would you say that stress effects your daily life?



 On a scale of 1-10, 1 (being no stress) and 10 (being high stress), how much stress would
you say that you experience on a daily basis in your work/personal life?




 Do you know what factors in your life cause your stress, if so please rank the top three
contributors?

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