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. Author manuscript; available in PMC: 2009 May 1.
Published in final edited form as: Am J Obstet Gynecol. 2008 May;198(5):570.e1–570.e5. doi: 10.1016/j.ajog.2008.01.044

TABLE 1.

PHYSICAL ACTIVITY QUESTIONS

  1. During the last three months, on average, how often each week do you usually do the exercises below (state number of days per week):

    1. Strenuous or very hard exercise (you work up a sweat and your heart beats fast). For example, aerobics, dancing, jogging, or tennis.

    2. Moderate exercise (not exhausting). For example, biking, using an exercise machine, easily swimming, brisk walking.

    3. Mild exercise. For example, bowling, golf, walking slowly.

  2. During the past three months, has your pelvic prolapse or its treatment interfered with your ability to do housework or yard work?

    Response categories for questions 2–4:

    1. None of the time

    2. Some of the time

    3. Most/all of the time

    4. No longer do these activities

    2A. Which one of the following contributed to this reason?

    Response categories for questions 2A–4A:

    1. My doctor advised me not to do these activities

    2. I am afraid my condition will recur if I do them

    3. Leakage of urine keeps me from doing them

    4. Recurrent prolapse keeps me from doing them

    5. Other medical problems keep me from doing them

  3. During the last three months, has your pelvic prolapse or its treatment interfered with your ability to perform your job outside the home the way you would like?

    3A. Which one of the following contributed to this reason?

  4. During the last three months, has your pelvic prolapse or its treatment interfered with your ability to participate in the exercise or recreation that you would like to?

    4A. Which one of the following contributed to this reason?

  5. During the past three months, how often did you perform physical activities that required a major effort, such as lifting heavy furniture, shoveling snow, or lifting people or objects weighing more than 25 lbs?

    1. Never

    2. Less than once per month

    3. Once per month

    4. 2–3 times per month

    5. Once per week

    6. More than once per week