Personal Fitness Questionnaire

Please answer all questions by clicking in the appropriate circle/box or type your response in the designated area.

Name


A red asterisk (*) indicates required questions.


  1. Rate your overall activity level:*
    Very Active
    Active
    Moderately Active
    Sedentary


  1. What exercise, if any, do you currently do outside of PE class? Please give a detailed answer.*


  1. How would you rate your current muscular strength/endurance level?*
    Very Strong
    Strong
    Moderately Strong
    Not very strong


  1. How would you rate your current cardiovascular fitness level? Basically, when you perform cardiovascular activities like running, cycling, swimming, etc. how is your fitness?*
    Excellent
    Good
    Average
    Fair
    Very low


  1. How flexible are you?*
    Very Flexible
    Somewhat
    Not at all


  1. How would you rate your experience with exercise?*
    Advanced
    Intermediate
    Beginner


  1. Do you exercise regularly?*
    I exercise regularly
    I used to exercise regularly and am starting back on a program
    I am currently starting a program
    I have never exercised regularly


  1. What are your fitness goals? Mark all that apply.*
    Appearance
    Cardiovascular endurance
    Reduce body fat
    Get more flexible
    General Health
    Muscular definition
    Muscle size
    Muscle strength
    Self-esteem or confidence
    Speed
    Sports Performance
    Reduce my stress level
    Tone and shape my body
    Lose weight
    Improve posture
    Medical reasons


  1. What equipment do you have available on a regular basis? Mark all that apply.*
    Nothing
    Free Weights (dumbbells, etc.)
    Weight machines
    Treadmill or other home machines
    Resistance balls or other core home equipment
    Exercise Videos
    Jump Ropes
    Bicycle, Skateboards, Roller Blades, other
    Pedometer


  1. What time of day can you do most of your exercise?*
    Any time
    Morning
    Afternoon
    Evening


  1. Which of the following are your personal obstacles in adopting a regular fitness program?*
    I get bored pretty easily when I exercise
    I can’t really find the time to exercise
    Family obligations
    I get frustrated because I don’t see results right away
    Intimidated and embarrassed when I exercise.
    I have to exercise alone
    My exercise setting does not meet my needs
    I do not have personal obstacles, I am just lazy


  1. How would you rate your overall fitness?
    Excellent
    Above Average
    Average
    Needs a lot of improvement
    Not fit at all





Health and Physical Education
Eaton Middle School
Hampton , VA