How do you manage the following activities? (If you do not do any of the activities, try to
estimate how well you would be able to do them. Circle the number that applies; please circle a
number on every line).

Scale from 0 (without difficulty) to 10 (impossible)
a) Dressing (without help)
b) Out-door walks
c) Climbing stairs
d) Sitting for a long time
e) Standing bent over a sink
f) Carrying a bag
h) Making a bed
i) Running
j) Light work
k) Heavy work
l) Lifting heavy objects
m) Participating in exercise/sports