Sample Physical Activity Questionnaire to Determine Stage of Change

This scale was developed by Dr. Bess Marcus, Brown University Medical School, the Miriam Hospital Division o Beharioral Medicine. It was reproduced with minor adaptations with permission in: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. (2000). Promoting Physical Activity: A Guide for Community Action. Champaign-Urbana, IL: Human Kinetics Publishers, pgs 61-62. Permission has been granted by CDC to place this questionnaire at this web site. Questionnaire. Scoring Instructions.