CHAMPS Activities Questionnaire - UnitingCare Ageing

Think about the past 4 weeks. For each activity please write HOW MANY TIMES each week, on average, you did it. Next, please circleone letter representing how much TOTAL TIME, on average, you spent doing that activity each week.Number ofLess than1 – 2½ hrs3 – 4½ hrs5 – 6½ hrs7 – 8½ hrs9 or moreRecreation and Hobbiestimes a week(if none, write “0”)1 hr / wk/ wk/ wk/ wk/ wkhrs / wkg. Use a computer (not workrelated).h. Dance - such as square, folk,line, ballroom (do not countaerobic dance here).i. Do woodwork, needlework,drawing or other arts and crafts.j. Play golf, riding a cart (countwalking time only).k. Play golf, carrying or pullingyour equipment (countl. Attend a concert, movie, lectureor sporting event.m. Play cards, bingo or boardgames with other people.Timesa week Timesa week Timesa week Timesa week Timesa week Timesa week Timesa week A B C D E FA B C D E FA B C D E FA B C D E FA B C D E FA B C D E FA B C D E FPHYSICAL ACTIVITY MONITORING & EVALUATION TOOLKIT