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How old are you?
 
12-20
 
21-29
 
30-40
 
41-50
 
55+
 
 
 
Are you male or female?
 
Male
 
Female
 
 
 
I know my fitness is important to my overall health.
 
True
 
False
 
 
 
I enjoy working out
 
Strongly agree
 
Agree
 
Disagree
 
Strongly Disagree
 
 
 
How many days a week do you exercise over 30 minutes a day?
 
0
 
1-2
 
3-4
 
5-6
 
7
 
 
 
Which of these exercises would you be most likely to participate in?
 
Walking
 
Water aerobics
 
Riding a bike on ground level
 
Jogging or running
 
Swimming laps
 
Riding a bike fast or on hills
 
Playing basketball
 
 
 
When you start to feel a burn while exercising do you
 
Continue
 
Slow down
 
Stop completely
 
 
 
How confident are you with you physical appearance?
Not confident
Rarely confident
Often confident
Confident
Very confident
 
 
 
How satisfied are you with your physical appearance?
Not satisfied
Rarely satisfied
Often satisfied
Satisfied
Very Satisfied
 
 
 
How important is your health and fitness to you?
Not important
Somewhat important
Neutral
Important
Very important
 
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