Physical Activity Questionnaire

positive online weight reduction

Use POWeR to help you lose weight - new free online tool launched

A new, easy to use online tool has been launched in Hampshire to help anyone struggling to shift the pounds.

POWeR has been developed by experts at Southampton University and Hampshire County Council is now making this available, free of charge to Hampshire adults with a BMI 25+.

During trials, POWeR helped a number of people to lose weight. It enables you to become your own personal health coach, providing new tools to use each week. It supports you to work out which of these tools fit with your lifestyle and helps you to build healthy eating and physical activity into your routine. This means that you not only lose weight, but maintain a healthy weight going forward.

Anyone over the age of 18 can access POWeR for 12 months once they have registered for the programme. This is easy and quick to do by visiting the POWeR website.

In addition to POWeR, Hampshire County Council offers a 12 week free Weight Watchers programme to any adult with a Body Mass Index of 30+.

Work out your BMI using NHS BMI checker.

This easy to use patient questionnaire has been validated for use in Primary Care.

It is used by your doctor to assess your level of physical activity

Physical Activity Questionnaire

Title

First Name

Surname

Address

Post Code

Date of Birth

Home Telephone

Mobile Phone

Please tell us the type and amount of physical activity involved in your work.

I am not in employment (e.g. retired, retired for health reasons, unemployed, fulltime carer etc.)

I spend most of my time at work sitting (such as in an office)

I spend most of my time at work standing or walking. However, my work does not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder etc.)

My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.)

My work involves vigorous physical activity including handling of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.)

During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not

Physical exercise such as swimming, jogging, aerobics, football, tennis, gym, workout etc.

Cycling, including cycling to work and during leisure time

Walking, including walking to work, shopping, for pleasure etc.

Housework / childcare

Gardening / DIY

Your Walking Pace

How would you describe your usual walking pace?

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All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to Solent View Medical Practice • Manor Way, Lee-on-the-Solent , Hampshire , PO13 9JG.

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