Registration Form for Walk Across Arkansas

Tell Us How to Reach You

Tell Us About Yourself and Your Goals

During the past month, which statement best describes the kinds of physical activity you usually did? Do not include the time you spent working at a job. Please read all six statements before selecting one.

Do any of the following apply to you? (Please select all that apply)

Please set a goal of minutes of walking (or other exercise) per week.

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*Age:

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18 and under

19-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

Activity:

I did not do much physical activity. I mostly did things like watching television, reading, playing cards, or playing computer games. Only occasionally, no more than once or twice a month, did I do anything more active such as going for a walk or playing tennis.

Once or twice a week, I did light activities such as getting outdoors on the weekends for an easy walk or stroll. Or once or twice a week, I did chores around the house such as sweeping floors or vacuuming.

About three times a week , I did moderate activities such as brisk walking, swimming, or riding a bike for about 15–20 minutes each time. Or about once a week, I did moderately difficult chores such as raking or mowing the lawn for about 45–60 minutes. Or about once a week, I played sports such as softball, basketball, or soccer for about 45–60 minutes.

Almost daily, that is five or more times a week, I did moderate activities such as brisk walking, swimming, or riding a bike for 30 minutes or more each time. Or about once a week, I did moderately difficult chores or played sports for 2 hours or more.

About three times a week, I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time.

Almost daily, that is five or more times a week, I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time.

Health:

I have chronic health problems such a heart disease or diabetes

I have been told by a doctor that I have high blood pressure

I have pains in my heart and/or chest area

I have physical conditions or problems that might require special attention in an exercise program

I feel dizzy or have spells of severe dizziness

I have a bone or joint condition, like arthritis, that might worsen by an exercise not accustomed to a vigorous exercise program

I am a male over 45 or a female over 50

For your safety, if any of the conditions above apply to you, please seek medical approval from your healthcare professional before participating in Walk Across Arkansas.

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