Are you active?

Where do you work out, and how often? If you’re not active, why? Real Health wants to know!

Real Health is giving away two instructional DVDs with burst-resistant stability balls (a $49 value) from Resist-A-Ball, a company that specializes in core fitness and stability equipment. For more information, visit resistaball.com. To enter our drawing, take the following reader survey. For the official contest rules, visit realhealthmag.com/survey/rules.
 
1. Name:
 
2. Organization (if you represent one):
 
3. Street address:
 
4. City & state:
 
5. ZIP code:
 
6. E-mail:
 
7. Phone:
 
8. How often are you physically active (such as walking, cleaning house or exercising) for at least 30 minutes?
Once a week
2-3 times a week
4-6 times a week
Every day
I am not active/don’t exercise (skip to question 6)
 
9. How vigorous is your activity?
Light (housework, cooking)
Moderate (walking, walking the dog, baseball, dancing)
Vigorous (running/jogging, basketball, aerobics)
 
10. Which activities do you engage in? (Check all that apply.)
Aerobics
Basketball
Boxing
Calisthenics (push-ups, pull-ups)
Cardio machines (exercise bike, elliptical)
Carrying groceries
Cleaning house
Climbing stairs
Cycling
Dancing
Football
Gardening/yard work
Golf
Gymnastics
Handball
Jumping rope
Martial arts/kickboxing/capoeira
Playing with children
Roller skating, ice skating, in-line skating
Running/jogging
Soccer
Tennis/racquetball
Yoga/Pilates
Walking or walking the dog
Water aerobics
Weight training
Workout tapes/DVDs
Other: 
 
11. Why do you exercise? (Check all that apply.)
I want to look good
I want to be healthy
It feels good/lifts my spirits
I want to be flexible
I want to lose weight
I want to be strong and/or fast
I want to lower blood sugar
I want to lower blood pressure
I want to decrease LDL cholesterol and increase HDL cholesterol
I want to prevent bone and muscle loss
I want to relieve arthritis pain
I want to maintain my weight
I like being around people and being social
It relaxes me/reduces tension or stress
Other: 
 
12. When you exercise, where do you do it? (Check all that apply.)
Outdoors
Home/indoors
Gym/health club/studio/YMCA
Other: 
 
13. What are your biggest obstacles with regard to exercise?
I don’t have enough time
I don’t have enough energy
Gym fees are expensive
There is no fitness facility near my home or work
The gym is not open at a convenient time
Getting childcare is a challenge
I don’t have the proper shoes, clothes or equipment
I don’t want to mess up my hair
I don’t like to sweat
I don’t like to exercise in front of others
Exercise is too uncomfortable or painful
I have physical injuries such as a bad back, bad knees or arthritis
I have a weak heart
I have asthma
My health care provider advised me against exercising
Other: (please explain) 
 
14. How many hours a week do you spend sitting at a desk?
 
15. How many hours a week do you spend relaxing in bed (not sleeping)?
 
16. How many hours a week do you spend relaxing on a bench or couch?
 
17. How many hours a week do you spend watching television?
 
18. How many hours a week do you spend reading?
 
19. How many hours a week do you spend riding in a car or public transportation?
 
20. What year were you born?
 
21. What is your gender?
Female
Male
Other: 
 
22. What is your household income?
 
23. What is your marital status?
Single, never married
Single, divorced or separated
Married
In a relationship, living together
In a relationship, not living together
Widowed