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. Author manuscript; available in PMC: 2009 Sep 10.
Published in final edited form as: Arch Phys Med Rehabil. 2008 Jun 13;89(7):1262–1266. doi: 10.1016/j.apmr.2007.11.042
1. Because of a health problem do you have any difficulty with walking several blocks?
0=No 1=Yes 2=Can’t do 3=Don’t do 4=Don’t know 5=Refused
1a. Do you have any difficulty with walking 1 block?
0=No 1=Yes 2=Can’t do 3=Don’t do 4=Don’t know 5=Refused
2. Because of a health problem do you have any difficulty with running or jogging about a mile?
0=No 1=Yes 2=Can’t do 3=Don’t do 4=Don’t know 5=Refused
3. Because of a health problem do you have any difficulty with climbing several flights of stairs without resting?
0=No 1=Yes 2=Can’t do 3=Don’t do 4=Don’t know 5=Refused
3a. Do you have any difficulty with climbing 1 flight of stairs without resting?
0=No 1=Yes 2=Can’t do 3=Don’t do 4=Don’t know 5=Refused