Wearable Fitness Tracker Survey

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Eligibility Criteria Screening Question

This is to be completed in preparation for physical activity. It is important that you disclose ALL of you existing medical conditions so that we may determine whether to seek further medical advice before participating in this project. This questionnaire does not provide medical advice in any form and does not substitute advice from appropriately qualified professionals.

Email *

Are you between the ages of 18-45? *

Yes

Required

Do you need to limit physical activity because of an illness, injury, or handicap? *

Yes

Required

Are you being treated by a doctor for any medical conditions that might limit you from being physically active? *

Yes

Required

Are you considering being more physical activity within the next 6 months? *

Yes

Required

Are you currently physically active at least 150 minutes week? *

Yes

Other:

Required

Do you currently have a wearable fitness tracker? (e.g Apple Watch, Fitbit, Garmin) *

Yes

Required

Exercise Pre-Screening Questionnaire

(below)

Have you ever been told that you have a heart condition? *

Yes

Have you ever had a stroke? *

Yes

Do you ever have unexplained pains in your chest at rest or during physical exercise? *

Yes

Do you consistently feel faint or suffer from spells of dizziness? *

Yes

Do you suffer from asthma and require medication? *

Yes

Do you suffer from type 1 or 2 diabetes? *

Yes

Do you suffer from any major muscle or joint conditions that may limit you or be aggravated by physical activity? *

Yes

Do you suffer from any medical conditions that may be made worse by participating in physical activity? *

Yes

Do you suffer from high blood pressure over 140/90 or low blood pressure below 100/80? *

Yes

Disclaimer:

If you have answered no to all of the above questions and you are confident that you have no other concerns with your health then you may proceed to participate in physical activity. If you have answered yes to any of the questions above or are unsure, please seek a referral from your General Practitioner/Doctor or Allied Health Professional before participating in physical activity.I believe to the best of my knowledge that all of the information I have provided on this tool is accurate. In the case that my medical condition changes over the course of this project I will inform the project team and fill out a new exercise prescreening questionnaire.

Baseline and Follow -up Survey

(below)

Last Name: *

First Name: *

Date of Birth: *

YYYY

Age: *

Are you interested in a key informant interview?(please provide contact information) *

Phone number *

Gender: *

Female

Male

Prefer not to say

Race: *

Native American

African American

Caucasian

Hispanic/ Latino

Pacific Islander

Asian

Prefer not to say

Education Level: (completed) *

High School/GED

Associate Degree

Bachelor's Degree

Master's Degree

Doctorate Degree

Required

New section/ Exercise Motivation Inventory Survey

* The Exercise Motivation Inventory Survey was modified for the purpose of this project. The original survey was developed by Dr. David Markland author of the Exercise Motivations Inventory and the short international physical activity questionnaire developed by Canadian Fitness and Lifestyle Research Institute. *

Choose on a scale of 1-5 with 1 being not true at all, 3 being neutral , and 5 being very true of me

I like to exercise because it makes me more attractive *

Not true at all

Very true of me

I like to exercise because it makes me look younger *

Not true at all

Very true of me

I like to exercise because it makes me slim *

Not true at all

Very true of me

I like to exercise because it helps me lose weight *

Not true at all

Very true of me

I like to maintain my current weight *

Not true at all

Very true of me

I like to exercise because it improves my strength *

Not true at all

Very true of me

I like to exercise because it improves my stamina *

Not true at all

Very true of me

I exercise because my doctor advises it *

Not true at all

Very true of me

I like to exercise because it improves my heart health *

Not true at all

Very true of me

I like to exercise because it reduces my risk of getting diseases *

Not true at all

Very true of me

I like to exercise because it reduces my stress *

Not true at all

Very true of me

I like to exercise because it provides a healthy distraction to my daily worries *

Not true at all

Very true of me

I like to exercise because I get to spend time with friends/ family *

Not true at all

Very true of me

I exercise because I know it is good for my overall health ( physical and mental) *

Not true at all

Very true of me

I exercise because I am competitive, and I like to win *

Not true at all

Very true of me

I like to exercise because it is fun *

Not true at all

Very true of me

I like to exercise because it makes me feel better/ healthier *

Not true at all

Very true of me

I like to exercise because it makes me happier *

Not true at all

Very true of me

I like to exercise because it gives me more energy *

Not true at all

Very true of me

I like to exercise because it makes me sleep better *

Not true at all

Very true of me

I like to exercise because it is assisting me in recovering from something *

Not true at all

Very true of me

I like to exercise because I like to meet new people at the gym/class *

Not true at all

Very true of me

I like to exercise because I enjoy physical competition. *

Not true at all

Very true of me

I like to exercise because it makes me feel recharged and refreshed *

Not true at all

Very true of me

I like to exercise because it provides me with goals to work towards *

Not true at all

Very true of me

I like to exercise because it helps me develop personal skills *

Not true at all

Very true of me

I like to exercise because it helps me stay/ become more flexible *

Not true of me

Very true of me

I like to exercise because it helps with coordination and alertness *

Not true of me

Very true of me

Please list any other reasons why you enjoy exercising *

In this next section, I will ask you to think about the amount of time that you currently spend completing various activities: sitting, walking and being physical. Try your best think about last week and estimate the amount of spent at the various activities. *

Think about the time you spent sitting during the last 7 days including time spent at work, home, school, and during leisure time. This may include time spent sitting at a desk, visiting friends, reading, watching television, or laying down. During the last 7 days, how much time did you spend sitting during the day? *

Think about the time you spent walking in the last 7 days including time spent at work, home, school, traveling from place to place, and recreation activities (sports, exercise, and leisure). During the last 7 days how many days did you walk for at least 10 minutes at a time? *

How much time did you usually spend walking on one of those days? *

During the last 7 days, on how many days did you do moderate physical activities like gardening, cleaning, bicycling at a regular pace, swimming or other fitness activities (do not include walking). *

How much time did you usually spend doing moderate physical activities on one of those days? *

During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, heavier garden or construction work, chopping wood, aerobics, jogging/running or fast bicycling? *

How much time did you usually spend doing vigorous physical activities on one of those days? *

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