Consumer Focus Groups on Physical Activity Guidelines, Submission #8

Warm-Up Sheet

Under OMB No. 0990-0281, Prevention Communication Formative Research

OMB BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is #0990-0281. The time to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Date: __________

Location: __________

Time: ______

Participant’s Name: ______________________________________

Note to Focus Group Facility Staff:

Complete one Warm-up sheet per participant, after getting the Participant Consent form signed. Please read the questions aloud and help the participant respond appropriately.

I have been asked to record some information about your physical activity before you go into the group. May I ask you a few questions about your physical activity?

[If ‘yes’-proceed; if ‘no’-thank participant and do not ask questions below].

Great! I’d like you to think about moderate physical activity—that is activity that allows you to carry on a conversation comfortably while engaging in activities such as fast walking, cycling for pleasure, dancing and yard work.

1. Please think about a typical week in the past month. During that week, on how many days did you do moderate physical activities?

Number of days/week (1-7) ________

2. On those days that you did moderate physical activities, about how many minutes each day – on average – did you do those activities?

Average # of minutes/day ________

Now, I’d like you to think about vigorous physical activity—that is activity that causes you to be too out of breath to carry on a conversation while engaging in activities such as running, aerobics, fast bicycling, competitive sports or heavy yard work.

3. Now, thinking about that same typical week, on how many days did you do vigorous physical activities?

Number of days/week (1-7) ________

4. On those days that you did vigorous physical activities, about how many minutes each day – on average – did you do those activities?

Average # of minutes/day ________