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LIFT Program Post-Survey
Thank you for your contributions to LIFT. By providing information about you and your experience in the LIFT program we can continue to show how group-based physical activity contributes to health across the lifespan. All data collection is voluntary. Thank you for your efforts in ensuring our ability to report impacts to stakeholders.
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What are the first three letters of your
first
name
?
Your answer
What are the first three letters of your
last
name
?
Your answer
What is the two digit month of your birth?
Your answer
What are the first four letters of the county you live in?
Your answer
What is the two letter abbreviation of the state you live in?
Your answer
Age
Your answer
Height in feet and inches (i.e. 5'5")
Your answer
Weight (lbs)
Your answer
In general, compared to other persons your age, how would you rate your health?
Extremely Healthy
Somewhat Healthy
Not Healthy
Very Unhealthy
Don't Know
Clear selection
I used hand and ankle weights during the LIFT Program.
Never
Rarely
Sometimes
Often
Always
Clear selection
I plan to use the hand and ankle weights during physical activity after the LIFT program:
Never
Rarely
Sometimes
Often
Always
Clear selection
How confident are you that you can engage in moderate physical activities (e.g., not exhausting, light perspiration) for 30 minutes for 2 or more days a week?
Not at all
Somewhat
Moderately
Very
Completely
Clear selection
I intend to do physical activity at least 3 times each week:
Completely Disagree
Disagree
Neither Agree or Disagree
Agree
Completely Agree
Clear selection
How many members of the class do you feel that you are similar to?
None
A few
Some
Most
All
Clear selection
How were you recruited to the LIFT Program? Choose all that apply.
Newspaper
Online
Flyer
Friend
Extension Specialist
Community Newsletter
Family
Care Coordinator
Other:
On average, how many cups of fruit do you eat per day?
0
1
2
3
4
5
6
Clear selection
On average, how many cups of 100% fruit juice do you drink each day?
0
1
2
3
4
5
6
Clear selection
On average, how many cups of vegetables do you eat each day?
0
1
2
3
4
5
6
Clear selection
On average, how many cups of 100% vegetable juice do you drink each day?
0
1
2
3
4
5
6
Clear selection
How confident are you that you can engage in moderate physical activities (e.g. not exhausting, light perspiration) for 30 minutes for 2 or more days per week?
Not at all
Somewhat
Moderately
Very
Completely
Clear selection
How many times in a month do you talk with people in your family?
Not Applicable
Never
Rarely
Occasionally
Often
Very Often
Clear selection
How many times in a month do you talk with your friends?
Not Applicable
Never
Rarely
Occasionally
Often
Very Often
Clear selection
How many times in a month do you talk with people in your neighborhood?
Not Applicable
Never
Rarely
Occasionally
Often
Very Often
Clear selection
How many times in a month do you talk with people from your LIFT class outside of a LIFT session?
Not Applicable
Never
Rarely
Occasionally
Often
Very Often
Clear selection
During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, or fast bicycling?
No vigorous physical activities
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Clear selection
How much time did you usually spend doing vigorous physical activity on one of those days? Please answer in hours, minutes, or you can say not sure. (ex. 1 hour and 15 minutes)
Your answer
Think about all the moderate activities that you did in the last 7 days. Moderate Activities refer to the activities that take moderate physical effort and make you breathe somewhat harder than normal. Think only about those physical activities that you did for at least 10 minutes at a time.
During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or doubles tennis? Do not include walking.
No moderate activities
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Clear selection
How much time did you usually spend doing moderate physical activity on one of those days? Please answer in hours, minutes, or you can say not sure. (ex. 1 hour and 15 minutes)
Your answer
Think about the time you spent walking in the last 7 days. This includes at work and at home, walking to travel from place to place, and any other walking that you have done solely for recreation, sport, exercise, or leisure.
During the last 7 days, on how many days did you walk?
No Walking
1 day
2 days
3 days
4 days
5 days
6 days
7 days
Clear selection
How much time do you usually spend walking on one of those days? Please answer in hours, minutes, or you can say not sure. (ex. 1 hour and 15 minutes)
Your answer
How much time did you spend sitting on weekdays during the last 7 days? Include time spent at work, at home, while doing course work and during leisure time. This may include time spent sitting at a desk, visiting friends, reading, or sitting or laying down to watch television.
During the last 7 days, how much time did you spend sitting on a weekday?
Please answer in hours, minutes, or you can say not sure. (ex. 1 hour and 15 minutes)
Your answer
Did you attend LIFT virtually?
Yes
No
Clear selection
What were the best parts of attending LIFT online?
Your answer
What were the top challenges of attending LIFT online?
Your answer
Anything else you'd like to share with us?
Your answer
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