Lifestyle Questionnaire

General Instructions

The Lifestyle Questionnaire is designed to measure your interest in a whole-body fitness program. If you are working with one of our trainers, this is a required document. There are no right or wrong answers. We want to know more about you so that our trainers can design a program that fits with your lifestyle.

Fill out this form as completely as possible. If you have any questions, do not guess. Ask one of our trainers or your family physician for assistance.

Questionnaire

1. Were you a high school and/or college athlete?

 yes no
If yes, please explain.

2. Do you have any negative feelings toward or have you had any bad experiences with physical activity programs?

 yes no
If yes, please explain.

3. Do you have any negative feelings toward or have you had any bad experiences with fitness testing and evaluation?

 yes no
If yes, please explain.

4. Rate yourself on a scale of 1 to 5 (1 indicating the lowest value and 5 the highest).




5. Do you start exercise programs but then find yourself unable to stick with them?

 yes no

6. How much are you willing to devote to an exercise program?


7. Are you currently involved in regular endurance (cardiovascular) exercise?

 yes no
If yes, specify the type of exercise(s):


 Light Fairly Light Somewhat Hard Hard

8. Are you currently involved in regular strength training exercise?

 yes no
If yes, specify the type of exercise(s):


Rate your perception of the exertion of your exercise program:
 Light Fairly Light Somewhat Hard Hard

9. Are you currently involved in a regular weight loss program?

 yes no
If yes, please explain.

10. How long have you been exercising regularly?

11. What other exercise, sport, or recreational activities have you participated in?



12. Can you exercise during your work day?

 yes no

13. What types of exercise interest you? (You may choose more than one.)

 Aerobics Bicycling Bowling Boxing Canoeing Hiking Jogging Martial Arts Pilates Stair Master Stationary Bike Swimming Team Sports Tennis Treadmill Walking Weight Training Yoga

14. Please list at least two fitness goals: