HHS 241 Stage of Exercise Scale PERSONAL ASSESSMENT of PHYSICAL ACTIVITY Name __________________________ Date _________________ I. Stage of Exercise Scale Please check the one statement that best describes your current feelings and habits about exercise. For the purpose of this survey, regular exercise is defined as participation at least 3 times per week for minimum of 20 minutes. Mark an "X" by one statement: _____ I presently do not exercise, and I do not plan to start exercising in the next 6 months. ______ I presently do not exercise, but I have been thinking about starting to exercise within the next 6 months. ______ I presently get some exercise, but not regularly. ______ I presently exercise on a regular basis, but I have only begun doing so within the past 6 months. ______ I presently exercise on a regular basis, and have been doing so for longer than 6 months. II. Reasons for Exercising If you have been regularly (3 times a week or more) physically active, what are your main reasons for continued involvement in physical activity? List your 3 main reasons, starting with your strongest reason. 1. ________________________________________ 2. ________________________________________ 3. ________________________________________ III. Barriers to Exercise If you have not been regularly physically active, what are your main reasons for your lack of regular involvement in physical activity? Please list 3 reasons, starting with your strongest reason. 1. ________________________________________ 2. ________________________________________ 3. ________________________________________ If you are not currently engaged in regular moderate physical activity at least 3 days per week, please list what you think would help you become more physically active on a regular basis. 1. ________________________________________ 2. ________________________________________ 3. ________________________________________