ID

11095

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

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

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
Description

Header

CALGB Form
Description

Form ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3262252
NCI Thesaurus ObjectClass
C19464
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass-2
C25442
CALGB Study No
Description

Protocol ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Description

Trial subject ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Date form completed (MM DD YYYY)
Description

Date Form Completed

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
Are data amended
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient demographics
Description

Patient demographics

Patient Initials (Last, First Middle)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Hospital No.
Description

Medical Record Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group
Description

Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Study No.
Description

Study Number Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Description

Trial subject ID Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
During The Past Month, About How Much Time Did You Spend Doing These Recreational Activities Each Week?
Description

During The Past Month, About How Much Time Did You Spend Doing These Recreational Activities Each Week?

Walking for exercise or walking to work
Description

PhysicalActivityWalkingExerciseAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C16567
UMLS 2011AA Property-2
C0015259
NCI Thesaurus Property-3
C73554
UMLS 2011AA Property-3
C0080331
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Jogging (slower than 10-minute mile)
Description

PhysicalActivitySlowJoggingAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C64655
UMLS 2011AA Property-2
C0439834
NCI Thesaurus Property-3
C85398
UMLS 2011AA Property-3
C0022400
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Running (10-minute miles or faster)
Description

PhysicalActivityIncreaseJoggingAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C25533
UMLS 2011AA Property-2
C0442805
NCI Thesaurus Property-3
C85398
UMLS 2011AA Property-3
C0022400
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Bicycling (including stationary bicycle)
Description

PhysicalActivityBicyclingAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C85401
UMLS 2011AA Property-2
C0005377
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Tennis, squash, racquetball
Description

PhysicalActivityRacquetSportAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C85400
UMLS 2011AA Property-2
C0034512
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Lap swimming
Description

PhysicalActivityWaterExerciseAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C16567
UMLS 2011AA Property-2
C0015259
NCI Thesaurus Property-3
C65147
UMLS 2011AA Property-3
C0043047
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Other aerobic exercise (aerobic dancing, ski or stair machine, etc.)
Description

PhysicalActivityAerobicExerciseAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C39774
UMLS 2011AA Property-2
C0001701
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Any other vigorous activities (lawn mowing, etc.)
Description

PhysicalActivityOtherActivityAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C43431
UMLS 2011AA Property-2
C0441655
NCI Thesaurus Property-3
C25217
UMLS 2011AA Property-3
C1516048
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Lower intensity exercise (yoga, stretching, Pilates, toning)
Description

PhysicalActivityLowIntensityExerciseAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C54722
UMLS 2011AA Property-2
C0205251
NCI Thesaurus Property-3
C25539
UMLS 2011AA Property-3
C0522510
NCI Thesaurus Property-4
C16567
UMLS 2011AA Property-4
C0015259
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
Weight training or resistance exercises (including free weights or machines such as Nautilus)
Description

PhysicalActivityWeightExerciseAssessmentWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C25208
UMLS 2011AA Property-2
C0043100
NCI Thesaurus Property-3
C16567
UMLS 2011AA Property-3
C0015259
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C29844
UMLS 2011AA ValueDomain-2
C0439230
NCI Thesaurus ValueDomain-3
C25330
UMLS 2011AA ValueDomain-3
C0449238
During The Past Month, About How Much Time Did You Spend Doing These Activities Each Week?
Description

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
Description

PhysicalActivityStandingWalkingAssessmentHourWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C73554
UMLS 2011AA Property-2
C0080331
NCI Thesaurus Property-3
C62166
UMLS 2011AA Property-3
C0231472
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C25529
UMLS 2011AA ValueDomain-2
C0439227
NCI Thesaurus ValueDomain-3
C29844
UMLS 2011AA ValueDomain-3
C0439230
NCI Thesaurus ValueDomain-4
C25330
UMLS 2011AA ValueDomain-4
C0449238
Standing or walking around at home
Description

PhysicalActivityStandingWalkingHomeAssessmentHourWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C18002
UMLS 2011AA Property-2
C0442519
NCI Thesaurus Property-3
C73554
UMLS 2011AA Property-3
C0080331
NCI Thesaurus Property-4
C62166
UMLS 2011AA Property-4
C0231472
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C25529
UMLS 2011AA ValueDomain-2
C0439227
NCI Thesaurus ValueDomain-3
C29844
UMLS 2011AA ValueDomain-3
C0439230
NCI Thesaurus ValueDomain-4
C25330
UMLS 2011AA ValueDomain-4
C0449238
Sitting at work or away from home or while driving
Description

PhysicalActivitySittingAssessmentHourWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C62122
UMLS 2011AA Property-2
C0277814
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C25529
UMLS 2011AA ValueDomain-2
C0439227
NCI Thesaurus ValueDomain-3
C29844
UMLS 2011AA ValueDomain-3
C0439230
NCI Thesaurus ValueDomain-4
C25330
UMLS 2011AA ValueDomain-4
C0449238
Sitting at home while watching TV/videos/DVDs
Description

PhysicalActivitySittingHomeAssessmentHourWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C18002
UMLS 2011AA Property-2
C0442519
NCI Thesaurus Property-3
C62122
UMLS 2011AA Property-3
C0277814
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C25529
UMLS 2011AA ValueDomain-2
C0439227
NCI Thesaurus ValueDomain-3
C29844
UMLS 2011AA ValueDomain-3
C0439230
NCI Thesaurus ValueDomain-4
C25330
UMLS 2011AA ValueDomain-4
C0449238
Other sitting at home (that is, not watching TV/videos/DVDs)
Description

PhysicalActivityOtherSittingHomeAssessmentHourWeekMonthDuration

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25217
UMLS 2011AA Property-2
C1516048
NCI Thesaurus Property-3
C18002
UMLS 2011AA Property-3
C0442519
NCI Thesaurus Property-4
C62122
UMLS 2011AA Property-4
C0277814
NCI Thesaurus ValueDomain
C29846
UMLS 2011AA ValueDomain
C0439231
NCI Thesaurus ValueDomain-2
C25529
UMLS 2011AA ValueDomain-2
C0439227
NCI Thesaurus ValueDomain-3
C29844
UMLS 2011AA ValueDomain-3
C0439230
NCI Thesaurus ValueDomain-4
C25330
UMLS 2011AA ValueDomain-4
C0449238
Vital status
Description

Vital status

What is your usual walking pace outdoors
Description

PhysicalActivityWalkingExerciseAssessmentRate

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C16567
UMLS 2011AA Property-2
C0015259
NCI Thesaurus Property-3
C73554
UMLS 2011AA Property-3
C0080331
NCI Thesaurus ValueDomain
C25636
UMLS 2011AA ValueDomain
C1521828
How many flights of stairs (not individual steps) do you climb daily
Description

PhysicalActivityStaircaseClimbingAssessmentDailyCount

Data type

text

Alias
NCI Thesaurus ObjectClass
C17708
UMLS 2011AA ObjectClass
C0026606
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C48960
UMLS 2011AA Property-2
C1710179
NCI Thesaurus Property-3
C81002
UMLS 2011AA Property-3
C2584300
NCI Thesaurus ValueDomain
C25473
UMLS 2011AA ValueDomain
C0332173
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
Comments
Description

Comments

Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Completed by (Last name, First name)
Description

Person Completing Form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Date form completed (MM DD YYYY)
Description

Date Form Completed

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C1115437
NCI Thesaurus ObjectClass
C40988
NCI Thesaurus Property
C25250
NCI Thesaurus ValueDomain-2
C25367
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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
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Form ID CALGB
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
Protocol ID CALGB
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Date Form Completed
Item
Date form completed (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Patient demographics
Patient Initials
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item Group
During The Past Month, About How Much Time Did You Spend Doing These Recreational Activities Each Week?
Item
Walking for exercise or walking to work
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C16567 (NCI Thesaurus Property-2)
C0015259 (UMLS 2011AA Property-2)
C73554 (NCI Thesaurus Property-3)
C0080331 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.2
Code List
Walking for exercise or walking to work
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Jogging (slower than 10-minute mile)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C64655 (NCI Thesaurus Property-2)
C0439834 (UMLS 2011AA Property-2)
C85398 (NCI Thesaurus Property-3)
C0022400 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.3
Code List
Jogging (slower than 10-minute mile)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Running (10-minute miles or faster)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25533 (NCI Thesaurus Property-2)
C0442805 (UMLS 2011AA Property-2)
C85398 (NCI Thesaurus Property-3)
C0022400 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.4
Code List
Running (10-minute miles or faster)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Bicycling (including stationary bicycle)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C85401 (NCI Thesaurus Property-2)
C0005377 (UMLS 2011AA Property-2)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.5
Code List
Bicycling (including stationary bicycle)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Tennis, squash, racquetball
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C85400 (NCI Thesaurus Property-2)
C0034512 (UMLS 2011AA Property-2)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.6
Code List
Tennis, squash, racquetball
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Lap swimming
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C16567 (NCI Thesaurus Property-2)
C0015259 (UMLS 2011AA Property-2)
C65147 (NCI Thesaurus Property-3)
C0043047 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.7
Code List
Lap swimming
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Other aerobic exercise (aerobic dancing, ski or stair machine, etc.)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C39774 (NCI Thesaurus Property-2)
C0001701 (UMLS 2011AA Property-2)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.8
Code List
Other aerobic exercise (aerobic dancing, ski or stair machine, etc.)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Any other vigorous activities (lawn mowing, etc.)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C43431 (NCI Thesaurus Property-2)
C0441655 (UMLS 2011AA Property-2)
C25217 (NCI Thesaurus Property-3)
C1516048 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.9
Code List
Any other vigorous activities (lawn mowing, etc.)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Lower intensity exercise (yoga, stretching, Pilates, toning)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C54722 (NCI Thesaurus Property-2)
C0205251 (UMLS 2011AA Property-2)
C25539 (NCI Thesaurus Property-3)
C0522510 (UMLS 2011AA Property-3)
C16567 (NCI Thesaurus Property-4)
C0015259 (UMLS 2011AA Property-4)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.10
Code List
Lower intensity exercise (yoga, stretching, Pilates, toning)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item
Weight training or resistance exercises (including free weights or machines such as Nautilus)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C25208 (NCI Thesaurus Property-2)
C0043100 (UMLS 2011AA Property-2)
C16567 (NCI Thesaurus Property-3)
C0015259 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C29844 (NCI Thesaurus ValueDomain-2)
C0439230 (UMLS 2011AA ValueDomain-2)
C25330 (NCI Thesaurus ValueDomain-3)
C0449238 (UMLS 2011AA ValueDomain-3)
CL.11
Code List
Weight training or resistance exercises (including free weights or machines such as Nautilus)
CL Item
1 Hour (1 hour)
CL Item
1 To 1.5 Hours (1 to 1.5 hours)
CL Item
1 To 4 Minutes (1 to 4 min.)
CL Item
11 Or More Hours (11 or more hours)
CL Item
2 To 3 Hours (2 to 3 hours)
CL Item
20 To 59 Minutes (20 to 59 min.)
CL Item
4 To 6 Hours (4 to 6 hours)
CL Item
5 To 19 Minutes (5 to 19 min.)
CL Item
7 To 10 Hours (7 to 10 hours)
CL Item
Zero (Zero)
C70430 (NCI Thesaurus)
C0919414 (UMLS 2011AA)
Item Group
During The Past Month, About How Much Time Did You Spend Doing These Activities Each Week?
Item
Standing or walking around at work or away from home
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C73554 (NCI Thesaurus Property-2)
C0080331 (UMLS 2011AA Property-2)
C62166 (NCI Thesaurus Property-3)
C0231472 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus ValueDomain-2)
C0439227 (UMLS 2011AA ValueDomain-2)
C29844 (NCI Thesaurus ValueDomain-3)
C0439230 (UMLS 2011AA ValueDomain-3)
C25330 (NCI Thesaurus ValueDomain-4)
C0449238 (UMLS 2011AA ValueDomain-4)
CL.12
Code List
Standing or walking around at work or away from home
CL Item
0 Hours (0 hours)
CL Item
1 Hour (1 hour)
CL Item
11 To 20 Hours (11 to 20 hours)
CL Item
2 To 5 Hours (2 to 5 hours)
CL Item
21 To 40 Hours (21 to 40 hours)
CL Item
40 To 60 Hours (40 to 60 hours)
CL Item
6 To 10 Hours (6 to 10 hours)
CL Item
61 To 90 Hours (61 to 90 hours)
CL Item
Over 90 Hours (over 90 hours)
Item
Standing or walking around at home
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C18002 (NCI Thesaurus Property-2)
C0442519 (UMLS 2011AA Property-2)
C73554 (NCI Thesaurus Property-3)
C0080331 (UMLS 2011AA Property-3)
C62166 (NCI Thesaurus Property-4)
C0231472 (UMLS 2011AA Property-4)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus ValueDomain-2)
C0439227 (UMLS 2011AA ValueDomain-2)
C29844 (NCI Thesaurus ValueDomain-3)
C0439230 (UMLS 2011AA ValueDomain-3)
C25330 (NCI Thesaurus ValueDomain-4)
C0449238 (UMLS 2011AA ValueDomain-4)
CL.13
Code List
Standing or walking around at home
CL Item
0 Hours (0 hours)
CL Item
1 Hour (1 hour)
CL Item
11 To 20 Hours (11 to 20 hours)
CL Item
2 To 5 Hours (2 to 5 hours)
CL Item
21 To 40 Hours (21 to 40 hours)
CL Item
40 To 60 Hours (40 to 60 hours)
CL Item
6 To 10 Hours (6 to 10 hours)
CL Item
61 To 90 Hours (61 to 90 hours)
CL Item
Over 90 Hours (over 90 hours)
Item
Sitting at work or away from home or while driving
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C62122 (NCI Thesaurus Property-2)
C0277814 (UMLS 2011AA Property-2)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus ValueDomain-2)
C0439227 (UMLS 2011AA ValueDomain-2)
C29844 (NCI Thesaurus ValueDomain-3)
C0439230 (UMLS 2011AA ValueDomain-3)
C25330 (NCI Thesaurus ValueDomain-4)
C0449238 (UMLS 2011AA ValueDomain-4)
CL.14
Code List
Sitting at work or away from home or while driving
CL Item
0 Hours (0 hours)
CL Item
1 Hour (1 hour)
CL Item
11 To 20 Hours (11 to 20 hours)
CL Item
2 To 5 Hours (2 to 5 hours)
CL Item
21 To 40 Hours (21 to 40 hours)
CL Item
40 To 60 Hours (40 to 60 hours)
CL Item
6 To 10 Hours (6 to 10 hours)
CL Item
61 To 90 Hours (61 to 90 hours)
CL Item
Over 90 Hours (over 90 hours)
Item
Sitting at home while watching TV/videos/DVDs
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C18002 (NCI Thesaurus Property-2)
C0442519 (UMLS 2011AA Property-2)
C62122 (NCI Thesaurus Property-3)
C0277814 (UMLS 2011AA Property-3)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus ValueDomain-2)
C0439227 (UMLS 2011AA ValueDomain-2)
C29844 (NCI Thesaurus ValueDomain-3)
C0439230 (UMLS 2011AA ValueDomain-3)
C25330 (NCI Thesaurus ValueDomain-4)
C0449238 (UMLS 2011AA ValueDomain-4)
CL.15
Code List
Sitting at home while watching TV/videos/DVDs
CL Item
0 Hours (0 hours)
CL Item
1 Hour (1 hour)
CL Item
11 To 20 Hours (11 to 20 hours)
CL Item
2 To 5 Hours (2 to 5 hours)
CL Item
21 To 40 Hours (21 to 40 hours)
CL Item
40 To 60 Hours (40 to 60 hours)
CL Item
6 To 10 Hours (6 to 10 hours)
CL Item
61 To 90 Hours (61 to 90 hours)
CL Item
Over 90 Hours (over 90 hours)
Item
Other sitting at home (that is, not watching TV/videos/DVDs)
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25217 (NCI Thesaurus Property-2)
C1516048 (UMLS 2011AA Property-2)
C18002 (NCI Thesaurus Property-3)
C0442519 (UMLS 2011AA Property-3)
C62122 (NCI Thesaurus Property-4)
C0277814 (UMLS 2011AA Property-4)
C29846 (NCI Thesaurus ValueDomain)
C0439231 (UMLS 2011AA ValueDomain)
C25529 (NCI Thesaurus ValueDomain-2)
C0439227 (UMLS 2011AA ValueDomain-2)
C29844 (NCI Thesaurus ValueDomain-3)
C0439230 (UMLS 2011AA ValueDomain-3)
C25330 (NCI Thesaurus ValueDomain-4)
C0449238 (UMLS 2011AA ValueDomain-4)
CL.16
Code List
Other sitting at home (that is, not watching TV/videos/DVDs)
CL Item
0 Hours (0 hours)
CL Item
1 Hour (1 hour)
CL Item
11 To 20 Hours (11 to 20 hours)
CL Item
2 To 5 Hours (2 to 5 hours)
CL Item
21 To 40 Hours (21 to 40 hours)
CL Item
40 To 60 Hours (40 to 60 hours)
CL Item
6 To 10 Hours (6 to 10 hours)
CL Item
61 To 90 Hours (61 to 90 hours)
CL Item
Over 90 Hours (over 90 hours)
Item Group
Vital status
Item
What is your usual walking pace outdoors
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C16567 (NCI Thesaurus Property-2)
C0015259 (UMLS 2011AA Property-2)
C73554 (NCI Thesaurus Property-3)
C0080331 (UMLS 2011AA Property-3)
C25636 (NCI Thesaurus ValueDomain)
C1521828 (UMLS 2011AA ValueDomain)
CL.17
Code List
What is your usual walking pace outdoors
CL Item
Brisk Pace (3 To 3.9 Mph) (Brisk pace (3 to 3.9 mph))
CL Item
Easy, Casual (less Than 2 Mph) (Easy, casual (less than 2 mph))
CL Item
Normal, Average (Normal, average)
CL Item
Unable To Walk (Unable to walk)
CL Item
Very Brisk/striding (4 Mph Or Faster) (Very brisk/striding (4 mph or faster))
Item
How many flights of stairs (not individual steps) do you climb daily
text
C17708 (NCI Thesaurus ObjectClass)
C0026606 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C48960 (NCI Thesaurus Property-2)
C1710179 (UMLS 2011AA Property-2)
C81002 (NCI Thesaurus Property-3)
C2584300 (UMLS 2011AA Property-3)
C25473 (NCI Thesaurus ValueDomain)
C0332173 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
CL.18
Code List
How many flights of stairs (not individual steps) do you climb daily
CL Item
10 To 14 Flights Of Stairs (10 to 14 flights)
CL Item
15 Or More Flights Of Stairs (15 or more flights)
CL Item
2 Flights Of Stairs Or Less (2 flights or less)
CL Item
3 To 4 Flights Of Stairs (3 to 4 flights)
CL Item
5 To 9 Flights Of Stairs (5 to 9 flights)
Item Group
Comments
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Person Completing Form
Item
Completed by (Last name, First name)
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Date Form Completed
Item
Date form completed (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
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