The following questions are about activities you might do during a typical day. Does your health
limit you in these activities? If so, how much?

a) Vigorous activities, such as running, lifting
heavy objects, participating in strenuous sports
b) Moderate activities, such as moving a table,
pushing a vacuum, bowling or playing golf
c) Lifting or carrying groceries
d) Climbing several flights of stairs
e) Climbing one flight of stairs
f) Bending, kneeling or stooping
g) Walking more than a mile
h) Walking half a mile
i) Walking 100 yards
j) Bathing and dressing yourself

Response scale for all data items:
Yes, limited a lot
Yes, limited a little
No, not limited at all