General Practice Physical Activity Questionnaire (GPPAQ) Please complete the form below to let us know the amount of physical activity you do. GPPAQ Questionnaire Please select the practice location most relevant to this Online Form submission:Grange Medical Centre, 1 Horton Grange Road, Bradford, BD7 3AHOak Lane Surgery, Westbourne Green C H C Centre, 50 Heaton Road,Your DetailsName DrMissMrMrsMsProf.Rev. Prefix First Last Date of Birth DD slash MM slash YYYY NHS Number OptionalYour DetailsAddress Street Address Address Line 2 City Postcode PhoneEmail Optional ExercisePlease tell us the type and amount of physical activity involved in your work. I am not in employment (e.g. retired, retired for health reasons, unemployed, full-time carer etc.) I spend most of my time at work sitting (such as in an office) I spend most of my time at work standing or walking. However, my work does not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers etc.) My work involves vigorous physical activity including handling of very heavy objects (e.g. scaffolder, construction worker, refuse collector, etc.) During the last week, how many hours did you spend on each of the following activities? None Some but less than 1 hour 1 hour but less than 3 hours 3 hours or more Physical exercise such as swimming, jogging, aerobics, football, tennis, gym workout etc.Cycling, including cycling to work and during leisure time None Some but less than 1 hour 1 hour but less than 3 hours 3 hours or more Walking, including walking to work, shopping, for pleasure etc. None Some but less than 1 hour 1 hour but less than 3 hours 3 hours or more Housework/Childcare None Some but less than 1 hour 1 hour but less than 3 hours 3 hours or more Gardening/DIY None Some but less than 1 hour 1 hour but less than 3 hours 3 hours or more How would you describe your usual walking pace? Slow pace (i.e. less than 3 mph) Steady average pace Brisk pace Fast pace (i.e. over 4mph) Privacy Protection I consent to my information being used for the purposes described above and wish to submit this online form to Grange Medical Centre • 1 Horton Grange Road, Bradford, BD7 3AH.Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted. All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy. This information is not shared with any third party organisations. This information is retained for up to 28 days.