Real Health Summer 2009: Tell us about your fitness habits

Speak Your Mind!

 
1. Name:
 
2. Organization (if you represent one)
 
3. Street address:
 
4. City & state:
 
5. Zip Code:
 
6. Email:
 
7. Phone:
 
8. What year were you born? (e.g., 1975)
 
9. What is your gender?
Female
Male
Transgender
Other
 
10. What is your household income?
Under $15,000
15,000–$34,999
35,000–$49,999
50,000–$74,999
75,000–$99,999
100,000 and over
 
11. What is the highest level of education attained?
Some high school
High school graduate
Some college
Bachelor's degree or higher
 
12. What is your ethnicity?
American Indian or Alaska Native
Arab or Middle Eastern
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
 
13. Where do you get Real Health?
I'm a subscriber
My doctor's office
My church
A community or college organization
It was mailed to my home or office
Other: (please specify): 
 
14. Do you have Internet access?
Yes
No
 
15. What part of your body do you think needs improving? (Check all that apply.)
Abs
Arms
Butt
Legs
My whole body
 
16. What fitness activities do you engage in each week? (Check all that apply.)
Strength training (at home or the gym)
Walking (specifically for exercise)
Bicycling
Running/jogging
Swimming
Tennis
Spinning
Interval training
Other: (Please specify): 
 
17. What motivates you to work out? (Check all that apply.)
Desire to lose weight
Desire to get fit
Desire to improve energy
Desire to relieve stress
Desire to eat anything I want
Desire to meet new people
Other: (please specify): 
 
18. What would make you skip a workout? (Check all that apply.)
Tiredness
Feeling sick
Socializing with friends
Working late
Not in the mood
Other: (please specify): 
 
19. How often do you work out (for at least 15 minutes)?
Once a day
4 to 6 times a week
1 to 3 times a week
2 to 3 times a month
Less than once a month
I don't work out
Other: (please specify): 
 
20. What time of day do you work out?
Morning (before work)
Afternoon (on my lunch hour)
Evening (after work)
Other: (please specify) 
 
21. Where do you workout?
Gym
Home
Outdoors (park, sports field, etc.)
Other: (please specify)