## EPIC-Norfolk Physical Activity Questionnaire

### Section A: HOME ACTIVITIES

#### Getting About--Apart from going to work

Which form of transportation to you use most often apart from your journey to and from work?

Please tick (check) one box ONLY per line.

Distance of journeys Usual mode of transport
Car Walk Public transport Cycle
Less than 1 mile
1-5 mile(s)
More than 5 miles

### Section B: ACTIVITY AT WORK

Please answer this section only if you have been in paid employment at any time during the last 12 months or you have done regular, organized voluntary work.

#### ACTIVITY LEVELS AT YOUR WORK

Now we would like you to take the total number of hours you worked per week in each job and divide them up according to your activity level.

Job 1 Job 2
No Yes Hours per week No Yes Hours per week
Walking at work -- carrying nothing heavier than a briefcase e.g. moving about a shop
Walking -- carrying something heavy

#### TRAVEL TO AND FROM WORK

##### JOB 1

Roughly how many miles was it from home to Job 1 ______
How many times a week did you travel from home to Job 1 _____

Please tick (check) one box ONLY per line

How did you normally travel to Job 1 Always Usually Occasionally Never or rarely
By bicycle
Walking
##### JOB 2

Roughly how many miles was it from home to Job 2 ______
How many times a week did you travel from home to Job 2_____

Please tick (check) one box ONLY per line

How did you normally travel to Job 2 Always Usually Occasionally Never or rarely
By bicycle
Walking

### Section C: RECREATION

Please indicate how often you did each activity on average over the last 12 months.

For activities that are seasonal, e.g. cricket or moving the lawn, please put the average frequency during the season when you did the activity.

Please indicate the average length of time that you spent doing the activity on each occasion.

EXAMPLE: If you went walking for pleasure for 40 minutes once a week you would complete the table below as follows:

Number of times you did the activity in the last 12 months Average timeper episode X 40