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Health Promoting Lifestyle Survey
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Email
*
Your email
Balance time between work and play.
*
Never
Sometimes
Often
Routinely
Reach my target heart rate when exercising.
*
Never
Sometimes
Often
Routinely
Read labels to identify nutrients, fats, and sodium content in packaged food.
*
Never
Sometimes
Often
Routinely
Eat breakfast.
*
Never
Sometimes
Often
Routinely
Gender
*
Female
Male
Take part in light to moderate physical activity (such as sustained walking 30-40 minutes 5 or more times a week).
*
Never
Sometimes
Often
Routinely
Take some time for relaxation each day.
*
Never
Sometimes
Often
Routinely
Practice relaxation or meditation for 15-20 minutes daily.
*
Never
Sometimes
Often
Routinely
Eat 3-5 servings of vegetables each day.
*
Never
Sometimes
Often
Routinely
Check my pulse rate when exercising.
*
Never
Sometimes
Often
Routinely
Eat 2-3 servings of milk, yogurt or cheese each day.
*
Never
Sometimes
Often
Routinely
Choose a diet low in fat, saturated fat, and cholesterol.
*
Never
Sometimes
Often
Routinely
Do stretching exercises at least 3 times per week.
*
Never
Sometimes
Often
Routinely
Exercise vigorously for 20 or more minutes at least three times a week (such as brisk walking, bicycling, aerobic dancing, using a stair climber).
*
Never
Sometimes
Often
Routinely
Limit use of sugars and food containing sugar (sweets).
*
Never
Sometimes
Often
Routinely
Get enough sleep.
*
Never
Sometimes
Often
Routinely
Take part in leisure-time (recreational) physical activities (such as swimming, dancing, bicycling).
*
Never
Sometimes
Often
Routinely
Report any unusual signs or symptoms to a physician or other health professional
*
Never
Sometimes
Often
Routinely
Write the name of the course you are attending on TEEL Moodle
*
Your answer
Eat only 2-3 servings from the meat, poultry, fish, dried beans, eggs, and nuts group each day.
*
Never
Sometimes
Often
Routinely
Read or browse internet about improving health.
*
Never
Sometimes
Often
Routinely
Attend educational programs on personal health care.
*
Never
Sometimes
Often
Routinely
Your name
*
Your answer
Follow a planned exercise program.
*
Never
Sometimes
Often
Routinely
Get exercise during usual daily activities (such as walking during lunch, using stairs instead of elevators, parking car away from destination and walking)
*
Never
Sometimes
Often
Routinely
Work toward long-term goals in my life.
*
Never
Sometimes
Often
Routinely
Eat 2-4 servings of fruit each day.
*
Never
Sometimes
Often
Routinely
Eat 6-11 servings of bread, cereal, rice and pasta each day.
*
Never
Sometimes
Often
Routinely
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