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
Keywords:
  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

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.

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
Jogging (slower than 10-minute mile)
Running (10-minute miles or faster)
Bicycling (including stationary bicycle)
Tennis, squash, racquetball
Lap swimming
Other aerobic exercise (aerobic dancing, ski or stair machine, etc.)
Any other vigorous activities (lawn mowing, etc.)
Lower intensity exercise (yoga, stretching, Pilates, toning)
Weight training or resistance exercises (including free weights or machines such as Nautilus)
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
Standing or walking around at home
Sitting at work or away from home or while driving
Sitting at home while watching TV/videos/DVDs
Other sitting at home (that is, not watching TV/videos/DVDs)
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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