Factors inhibiting the physical activity of middle aged adolescents resulting in early obesity
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How old are you?
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How much do you weigh? (don't worry if its not exact, provide the best estimate)
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Do you participate in a sport or form of fitness? List Them.
Why do you participate in these activities, or if you don’t why not?
Do you maintain a healthy diet?
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Do you have a job? if you do, what type of job is it?
Do you participate in any other extracurricular or out of school activity? (eg drama, band, art club) If yes, list them.
Are your friends physically active?
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From 1-10; how much do you enjoy exercise?
I hate exercise
I love exercise
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Are you currently or have you previously been injured?
If you have been injured, did this prevent you from physical activity?
Do you have an illness or medical/physical condition that inhibits your ability to participate in physical activity (eg asthma, epilepsy, diabetes etc)?
Is there a park, bicycle trail, or walking track within walking distance of your house?
Do you have a backyard?
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Do you have lots of free time?
If no, what takes up your time? (study, socialising, etc)
How do you get to school? (you may select multiple)
On average, how many hours do you spend on a screen a day?
1 hour
10 hours +
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Rate your energy levels from 1-10
No energy (may feel tired or unproductive, lack motivation, experience headaches, etc)
Lots of energy (rarely feel tired, high motivation levels, etc)
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Elaborate, why do you think you feel this way, what factors are influencing your energy levels?
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