Description:

CALGB-40502 PHYSICAL ACTIVITY QUESTIONNAIRE NCT00785291 Paclitaxel, Paclitaxel Albumin-Stabilized Nanoparticle Formulation, or Ixabepilone With or Without Bevacizumab in Treating Patients With Stage IIIC or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7B07C2F1-242E-5D8F-E040-BB89AD4327F7

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7B07C2F1-242E-5D8F-E040-BB89AD4327F7
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Versions (3)
  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/18/15 6/18/15 -
Uploaded on:

June 18, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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CALGB-40502 PHYSICAL ACTIVITY QUESTIONNAIRE NCT00785291

English
Details

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink.

1 forms  
Header
Are data amended
Patient demographics
During The Past Month, About How Much Time Did You Spend Doing These Recreational Activities Each Week?
Walking for exercise or walking to work
6 more items in the detailed view.
Jogging (slower than 10-minute mile)
6 more items in the detailed view.
Running (10-minute miles or faster)
6 more items in the detailed view.
Bicycling (including stationary bicycle)
6 more items in the detailed view.
Tennis, squash, racquetball
6 more items in the detailed view.
Lap swimming
6 more items in the detailed view.
Other aerobic exercise (aerobic dancing, ski or stair machine, etc.)
6 more items in the detailed view.
Any other vigorous activities (lawn mowing, etc.)
6 more items in the detailed view.
Lower intensity exercise (yoga, stretching, Pilates, toning)
6 more items in the detailed view.
Weight training or resistance exercises (including free weights or machines such as Nautilus)
6 more items in the detailed view.
During The Past Month, About How Much Time Did You Spend Doing These Activities Each Week?
Standing or walking around at work or away from home
5 more items in the detailed view.
Standing or walking around at home
5 more items in the detailed view.
Sitting at work or away from home or while driving
5 more items in the detailed view.
Sitting at home while watching TV/videos/DVDs
5 more items in the detailed view.
Other sitting at home (that is, not watching TV/videos/DVDs)
5 more items in the detailed view.
Vital status
What is your usual walking pace outdoors
How many flights of stairs (not individual steps) do you climb daily
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