Page 237 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

Health and Wellness

97. Overall, how would you describe your health?

Other respondent: Overall, how would you describe this person’s health?
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other

□ 1. Excellent
□ 2. Very good
□ 3. Fairly good
□ 4. Poor
□ 99. Don’t know, no response, unclear response
98. How many times per week do you do moderate physical activity or exercise in which
you are active for at least 10 minutes at a time? For example, how often do you go
running, fast walking, dancing, biking, swimming and/or play basketball for at least 10
minutes at a time?
Other respondent: How many times per week does this person do sports, exercise or physical
activity for at least 10 minutes?

(Moderate physical activity is an activity that causes some increase in breathing or heart rate.
Examples include but are not limited to brisk walking, swimming, bicycling)
Check ONE.

Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other
□ 1. None
□ 2. One or two times

□ 3. Three or four times
□ 4. Five or more times
□ 99. Don’t know, no response, unclear response

99. How many times per week do you do physical activity or exercise that makes the
muscles in your arms, legs, back, and/or chest work hard – like lifting weights,
pushups, sit-ups, manual labor, physical therapy, etc.?
Other respondent: How many times per week does this person do physical activity designed to
work his/her muscles?

Check ONE.
Respondent: ( ) 1-individual ( ) 2-family/friend ( ) 3-staff ( ) 4-other

□ 1. None
□ 2. One or two times
□ 3. Three or four times
□ 4. Five or more times
□ 99. Don’t know, no response, unclear response

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