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Lifestyle and Wellbeing Questionnaire

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To be completed by all participants. Parents/carers please help your children to answer these questions. The following information will help us assess what impact the Fit 4 Life Programme has had on your eating habits, physical activity levels and quality of life. We will ask you to complete the same form after 10 weeks and also after 6 months, to compare the scores.
EATING HABITS
How many portions of fruit and vegetables do you currently eat per day?  *One adult portion of fruit or vegetables is 80g, or a handful for a child
How many snacks high in fat and sugar do you currently eat per day?  *Fat = >3g/100g and sugar = >5g/100g
PHYSICAL ACTIVITY IN A TYPICAL WEEK
Walking: During the last 7 days On how many days did you walk for at least 10 minutes at a time?  How long for? and at what pace? This includes walking at work/school/home, walking to travel to a place, and any other walking that you might do for recreation, sport or leisure.
Adult 1
Adult 2
Adult 3
Adult 4
Child 1
Child 2
Child 3
Child 4
PHYSICAL ACTIVITY IN A TYPICAL WEEK
Moderate activity: During the last 7 days On how many days did you do moderate physical activity? and for how long?  This could be carrying light loads, cycling at a regular pace, or playing doubles tennis.
Adult 1
Adult 2
Adult 3
Adult 4
Child 1
Child 2
Child 3
Child 4
PHYSICAL ACTIVITY IN A TYPICAL WEEK
Vigorous activity: During the last 7 days On how many days did you do vigorous activities? and for how long?   This could be heavy lifting, digging, aerobics, fast cycling.
Adult 1
Adult 2
Adult 3
Adult 4
Child 1
Child 2
Child 3
Child 4
For each of the five statements please indicate which is closest to how you have been feeling over the last 2 weeks.
I have felt cheerful and in good spirits
I have felt calm and relaxed
I have felt active and vigorous
I woke up feeling fresh and refreshed
My daily life has been filled with things that interest me

Data Protection

Halton Borough Council is the Data Controller for the personal information you provide. We collect and hold information about you in order to process your booking. For further information regarding data protection please visit our Data Protection and FOI web page