Mobility disability-PA-Barriers

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* Project Title: The role of barriers to participating in leisure time physical activity in adults with mobility impairments

Investigator: Dr. Byungmo Ku

Purpose: Mobility impairments include but are not limited to amputation, paralysis, cerebral palsy, stroke, multiple sclerosis, muscular dystrophy, arthritis, and spinal cord injury. Mobility impairments range from lower body impairments, which may require use of canes, walkers, or wheelchairs, to upper body impairments that may include limited or no use of the upper extremities and hands. The purpose of this research study is to examine the role of barriers to participating in physical activity in adults with mobility impairments.

Activities: Participants will be asked to fill out a survey, which consists of XX questions related to your physical activity and barriers.

Time: This survey takes approximately 8 – 10 minutes to complete.

Risks: There are no known risks associated with completing this questionnaire.

Benefits: There are no known benefits to completing this survey. However, it is possible that participants may enjoy thinking about their physical activity supports for their children.

Confidentiality: All subject information obtained from this research study will be kept confidential.

Payments: No compensation will be offered to participants.

Participant's Right: If you have read this form and have decided to participate in this project, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. You have the right to refuse to answer particular questions. Your individual privacy will be maintained in all published and written data resulting from the study.

If you have questions about your rights as a study participant or are dissatisfied at any time with any aspect of this study, you may contact - anonymously, if you wish - the Chair of the Institutional Research Board (IRB), InstitutionalReviewBoard@vanguard.edu.

The primary researcher conducting this study is Dr. Byungmo Ku. For questions or more information concerning this research, you may contact him at bmk@yiu.ac.kr

I agree to participate in this study.

I do not agree to participate in this study.

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* Thank you for your interest in completing our survey. Your participation is greatly appreciated to help gain a better understanding of barriers of physical activity in adults with mobility issues.

Questions have been separated into different categories with separate instructions for each different category. Please carefully read the instructions before starting each section. Please read each question carefully and mark one response for each question and/or sub-question. There are no right or wrong answers. Once again, thank you for your time and contribution.

By checking the box below, you are indicating that you are at least 18 years old and experience a mobility issue.

Yes

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* This section is composed of questions regarding your demographic information.

1. What is your impairment/disability label?

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* 2. What is your age?

100

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i We adjusted the number you entered based on the slider’s scale.

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* 3. What is your biological sex?

Men

Women

Don't want to answer

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* 4. What is your highest level of education?

No school at all

Elementary school

Middle school

High school

College (2 years)

College (4 years)

More than college level

Don't want to answer

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* 5. What is your race?

White

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Don't want to answer

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* 6. What is your annual household income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

Don't want to answer

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* INSTRUCTIONS: I am going to ask you about the time you spent engaging in mild, moderate, and heavy intensity LTPA in the last 7 days. **Leisure Time Physical Activity (LTPA) is physical activity that you choose to do during your free time, such as exercising, playing sports, gardening, and taking the dog for a walk (necessary physical activities such as physiotherapy, grocery shopping, pushing/wheeling for transportation are not considered LTPA).

Mild intensity** LTPA requires very light physical effort; mild intensity activities make you feel like you are working a little bit, but you can keep doing them for a long time without getting tired . . .

7. During the last 7 days, on how many days did you do mild intensity LTPA?

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* 8. On those days, how many minutes did you usually spend doing mild intensity LTPA?

180

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i We adjusted the number you entered based on the slider’s scale.

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* Moderate intensity LTPA requires some physical effort; moderate intensity activities make you feel like you are working somewhat hard, but you can keep doing them for a while without getting tired. . .

9. During the last 7 days, on how many days did you do moderate intensity LTPA?

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* 10. On those days, how many minutes did you usually spend doing moderate intensity LTPA?

180

Clear

i We adjusted the number you entered based on the slider’s scale.

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* Heavy intensity LTPA requires a lot of physical effort. Heavy intensity activities make you feel like you are working really hard, almost at your maximum. You cannot do these activities for very long without getting tired. These activities may be exhausting.

11. During the last 7 days, on how many days did you do heavy intensity LTPA?

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* 12. On those days, how many minutes did you usually spend doing heavy intensity LTPA?

180

Clear

i We adjusted the number you entered based on the slider’s scale.

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* INSTRUCTIONS: Physical activity barriers are factors or obstacles that can hinder individuals from participating in leisure time physical activity. These barriers can vary among individuals and significantly affect their capacity to sustain an active lifestyle. Please read the following instructions and then respond to the questions.

Thinking over the past 3 months, were there any times when you wanted to participate in physically activity but didn’t or was more difficult because …

13. ‘‘In general when you encounter [intrapersonal barrier], how much of a barrier was [intrapersonal barrier] on a scale from one to five, with one being very small and five being very big?’’

	Not experienced	Very small				Very big
You get tired or fatigued	You get tired or fatigued Not experienced	You get tired or fatigued Very small	You get tired or fatigued	You get tired or fatigued	You get tired or fatigued	You get tired or fatigued Very big
You were in pain	You were in pain Not experienced	You were in pain Very small	You were in pain	You were in pain	You were in pain	You were in pain Very big
You believe physical activity requires too much work/effort/energy	You believe physical activity requires too much work/effort/energy Not experienced	You believe physical activity requires too much work/effort/energy Very small	You believe physical activity requires too much work/effort/energy	You believe physical activity requires too much work/effort/energy	You believe physical activity requires too much work/effort/energy	You believe physical activity requires too much work/effort/energy Very big
You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability)	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability) Not experienced	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability) Very small	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability)	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability)	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability)	You didn’t have an appropriate fitness level to be physically active (e.g., lack of aerobic ability) Very big
You felt physical discomfort while being physically active	You felt physical discomfort while being physically active Not experienced	You felt physical discomfort while being physically active Very small	You felt physical discomfort while being physically active	You felt physical discomfort while being physically active	You felt physical discomfort while being physically active	You felt physical discomfort while being physically active Very big
You were afraid of getting injured while being physically active	You were afraid of getting injured while being physically active Not experienced	You were afraid of getting injured while being physically active Very small	You were afraid of getting injured while being physically active	You were afraid of getting injured while being physically active	You were afraid of getting injured while being physically active	You were afraid of getting injured while being physically active Very big
You were depressed	You were depressed Not experienced	You were depressed Very small	You were depressed	You were depressed	You were depressed	You were depressed Very big

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* Thinking over the past 3 months, were there any times when you wanted to participate in physically activity but didn’t or was more difficult because …

14. ‘‘In general when you encounter [interpersonal barrier], how much of a barrier was [interpersonal barrier] on a scale from one to five, with one being very small and five being very big?’’

	Not experienced	Very small				Very big
You did not have another person with a disability who was physically active to look up to	You did not have another person with a disability who was physically active to look up to Not experienced	You did not have another person with a disability who was physically active to look up to Very small	You did not have another person with a disability who was physically active to look up to	You did not have another person with a disability who was physically active to look up to	You did not have another person with a disability who was physically active to look up to	You did not have another person with a disability who was physically active to look up to Very big
Your friends didn’t assist you to be physically active	Your friends didn’t assist you to be physically active Not experienced	Your friends didn’t assist you to be physically active Very small	Your friends didn’t assist you to be physically active	Your friends didn’t assist you to be physically active	Your friends didn’t assist you to be physically active	Your friends didn’t assist you to be physically active Very big
Your friends are not physically active	Your friends are not physically active Not experienced	Your friends are not physically active Very small	Your friends are not physically active	Your friends are not physically active	Your friends are not physically active	Your friends are not physically active Very big
Your friends don’t talk about being physically active	Your friends don’t talk about being physically active Not experienced	Your friends don’t talk about being physically active Very small	Your friends don’t talk about being physically active	Your friends don’t talk about being physically active	Your friends don’t talk about being physically active	Your friends don’t talk about being physically active Very big
Your friends were not encouraging or supportive of your efforts to be physically active	Your friends were not encouraging or supportive of your efforts to be physically active Not experienced	Your friends were not encouraging or supportive of your efforts to be physically active Very small	Your friends were not encouraging or supportive of your efforts to be physically active	Your friends were not encouraging or supportive of your efforts to be physically active	Your friends were not encouraging or supportive of your efforts to be physically active	Your friends were not encouraging or supportive of your efforts to be physically active Very big
Your friend’s priorities take precedence/priority over you being physically active	Your friend’s priorities take precedence/priority over you being physically active Not experienced	Your friend’s priorities take precedence/priority over you being physically active Very small	Your friend’s priorities take precedence/priority over you being physically active	Your friend’s priorities take precedence/priority over you being physically active	Your friend’s priorities take precedence/priority over you being physically active	Your friend’s priorities take precedence/priority over you being physically active Very big

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* Thinking over the past 3 months, were there any times when you wanted to participate in physically activity but didn’t or was more difficult because …

15. ‘‘In general when you encounter [organizational barrier], how much of a barrier was [organizational barrier] on a scale from one to five, with one being very small and five being very big?’’

	Not experienced	Very small				Very big
Fitness center membership fees were too high	Fitness center membership fees were too high Not experienced	Fitness center membership fees were too high Very small	Fitness center membership fees were too high	Fitness center membership fees were too high	Fitness center membership fees were too high	Fitness center membership fees were too high Very big
Your health insurance plan do not cover membership fees	Your health insurance plan do not cover membership fees Not experienced	Your health insurance plan do not cover membership fees Very small	Your health insurance plan do not cover membership fees	Your health insurance plan do not cover membership fees	Your health insurance plan do not cover membership fees	Your health insurance plan do not cover membership fees Very big
Lack of inclusive marketing	Lack of inclusive marketing Not experienced	Lack of inclusive marketing Very small	Lack of inclusive marketing	Lack of inclusive marketing	Lack of inclusive marketing	Lack of inclusive marketing Very big
Lack of accessible classes/programs at fitness center	Lack of accessible classes/programs at fitness center Not experienced	Lack of accessible classes/programs at fitness center Very small	Lack of accessible classes/programs at fitness center	Lack of accessible classes/programs at fitness center	Lack of accessible classes/programs at fitness center	Lack of accessible classes/programs at fitness center Very big
Other fitness center members were mean or rude	Other fitness center members were mean or rude Not experienced	Other fitness center members were mean or rude Very small	Other fitness center members were mean or rude	Other fitness center members were mean or rude	Other fitness center members were mean or rude	Other fitness center members were mean or rude Very big
Lack of accessible walking/rolling paths at parks	Lack of accessible walking/rolling paths at parks Not experienced	Lack of accessible walking/rolling paths at parks Very small	Lack of accessible walking/rolling paths at parks	Lack of accessible walking/rolling paths at parks	Lack of accessible walking/rolling paths at parks	Lack of accessible walking/rolling paths at parks Very big
Lack of assistance from fitness center staff	Lack of assistance from fitness center staff Not experienced	Lack of assistance from fitness center staff Very small	Lack of assistance from fitness center staff	Lack of assistance from fitness center staff	Lack of assistance from fitness center staff	Lack of assistance from fitness center staff Very big
Lack of accessible sport opportunities at fitness center	Lack of accessible sport opportunities at fitness center Not experienced	Lack of accessible sport opportunities at fitness center Very small	Lack of accessible sport opportunities at fitness center	Lack of accessible sport opportunities at fitness center	Lack of accessible sport opportunities at fitness center	Lack of accessible sport opportunities at fitness center Very big
Signs showing where things are located were not accessible	Signs showing where things are located were not accessible Not experienced	Signs showing where things are located were not accessible Very small	Signs showing where things are located were not accessible	Signs showing where things are located were not accessible	Signs showing where things are located were not accessible	Signs showing where things are located were not accessible Very big
Lack of interpretive services (e.g., sign language)	Lack of interpretive services (e.g., sign language) Not experienced	Lack of interpretive services (e.g., sign language) Very small	Lack of interpretive services (e.g., sign language)	Lack of interpretive services (e.g., sign language)	Lack of interpretive services (e.g., sign language)	Lack of interpretive services (e.g., sign language) Very big

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* Thinking over the past 3 months, were there any times when you wanted to participate in physically activity but didn’t or was more difficult because …

16. ‘‘In general when you encounter [environmental barrier], how much of a barrier was [environmental barrier] on a scale from one to five, with one being very small and five being very big?’’

	Not experienced	Very small				Very big
Lack of access to public restrooms	Lack of access to public restrooms Not experienced	Lack of access to public restrooms Very small	Lack of access to public restrooms	Lack of access to public restrooms	Lack of access to public restrooms	Lack of access to public restrooms Very big
Uneven or crooked sidewalks	Uneven or crooked sidewalks Not experienced	Uneven or crooked sidewalks Very small	Uneven or crooked sidewalks	Uneven or crooked sidewalks	Uneven or crooked sidewalks	Uneven or crooked sidewalks Very big
The sidewalks have cracks, gaps, or are under construction	The sidewalks have cracks, gaps, or are under construction Not experienced	The sidewalks have cracks, gaps, or are under construction Very small	The sidewalks have cracks, gaps, or are under construction	The sidewalks have cracks, gaps, or are under construction	The sidewalks have cracks, gaps, or are under construction	The sidewalks have cracks, gaps, or are under construction Very big
Lack of rest areas (e.g., benches)	Lack of rest areas (e.g., benches) Not experienced	Lack of rest areas (e.g., benches) Very small	Lack of rest areas (e.g., benches)	Lack of rest areas (e.g., benches)	Lack of rest areas (e.g., benches)	Lack of rest areas (e.g., benches) Very big
Potholes in the street, driveways, or parking lot	Potholes in the street, driveways, or parking lot Not experienced	Potholes in the street, driveways, or parking lot Very small	Potholes in the street, driveways, or parking lot	Potholes in the street, driveways, or parking lot	Potholes in the street, driveways, or parking lot	Potholes in the street, driveways, or parking lot Very big
Sidewalk’s cross slope is too steep/slanted	Sidewalk’s cross slope is too steep/slanted Not experienced	Sidewalk’s cross slope is too steep/slanted Very small	Sidewalk’s cross slope is too steep/slanted	Sidewalk’s cross slope is too steep/slanted	Sidewalk’s cross slope is too steep/slanted	Sidewalk’s cross slope is too steep/slanted Very big
The crosswalks lack traffic lights	The crosswalks lack traffic lights Not experienced	The crosswalks lack traffic lights Very small	The crosswalks lack traffic lights	The crosswalks lack traffic lights	The crosswalks lack traffic lights	The crosswalks lack traffic lights Very big
Lack of accessible curb cuts in community	Lack of accessible curb cuts in community Not experienced	Lack of accessible curb cuts in community Very small	Lack of accessible curb cuts in community	Lack of accessible curb cuts in community	Lack of accessible curb cuts in community	Lack of accessible curb cuts in community Very big
Lack of accessible transportation to fitness center	Lack of accessible transportation to fitness center Not experienced	Lack of accessible transportation to fitness center Very small	Lack of accessible transportation to fitness center	Lack of accessible transportation to fitness center	Lack of accessible transportation to fitness center	Lack of accessible transportation to fitness center Very big
Sidewalks were not wide enough	Sidewalks were not wide enough Not experienced	Sidewalks were not wide enough Very small	Sidewalks were not wide enough	Sidewalks were not wide enough	Sidewalks were not wide enough	Sidewalks were not wide enough Very big

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* 17. INSTRUCTIONS: Sometimes we use strategies to help us to be physically active. Please use the following scale to answer the questions below.

	Strongly disagree	DIsagree	Neutral	Agree	Strongly agree
I kept track of my physical activity in a diary or log over the last month	I kept track of my physical activity in a diary or log over the last month Strongly disagree	I kept track of my physical activity in a diary or log over the last month DIsagree	I kept track of my physical activity in a diary or log over the last month Neutral	I kept track of my physical activity in a diary or log over the last month Agree	I kept track of my physical activity in a diary or log over the last month Strongly agree
I set short-term (daily or weekly) goals for leisure-time physical activity last month	I set short-term (daily or weekly) goals for leisure-time physical activity last month Strongly disagree	I set short-term (daily or weekly) goals for leisure-time physical activity last month DIsagree	I set short-term (daily or weekly) goals for leisure-time physical activity last month Neutral	I set short-term (daily or weekly) goals for leisure-time physical activity last month Agree	I set short-term (daily or weekly) goals for leisure-time physical activity last month Strongly agree
I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month	I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month Strongly disagree	I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month DIsagree	I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month Neutral	I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month Agree	I made regular plans concerning “when,” “where,” “how,” and “what” kind of physical activity I did last month Strongly agree
I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month	I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month Strongly disagree	I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month DIsagree	I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month Neutral	I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month Agree	I made plans regarding what to do if some-thing interfered with my engaging in physical activity last month Strongly agree
I reserved time in my daily schedule for regular leisure-time physical activity	I reserved time in my daily schedule for regular leisure-time physical activity Strongly disagree	I reserved time in my daily schedule for regular leisure-time physical activity DIsagree	I reserved time in my daily schedule for regular leisure-time physical activity Neutral	I reserved time in my daily schedule for regular leisure-time physical activity Agree	I reserved time in my daily schedule for regular leisure-time physical activity Strongly agree
If I did not reach a physical activity goal last month, I analysed what went wrong	If I did not reach a physical activity goal last month, I analysed what went wrong Strongly disagree	If I did not reach a physical activity goal last month, I analysed what went wrong DIsagree	If I did not reach a physical activity goal last month, I analysed what went wrong Neutral	If I did not reach a physical activity goal last month, I analysed what went wrong Agree	If I did not reach a physical activity goal last month, I analysed what went wrong Strongly agree

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* 18. INSTRUCTIONS: An intention is a mental state or determination to perform leisure time physical activity. Please use the following scale to answer the questions below.

	Extremely unlikely						Extremely likely
I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week. Extremely unlikely	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week.	I intend to do at least 30 minutes of leisure time physical activity on most days in the forthcoming week. Extremely likely

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* 19. INSTRUCTIONS: An intention is a mental state or determination to perform leisure time physical activity. Please use the following scale to answer the questions below.

	Definitely false						Definitely true
I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week Definitely false	I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week	I will try to do at least 30 min of leisure time physical activity on most days in the next week Definitely true

100% of survey complete.

Mobility disability-PA-Barriers

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* This section is composed of questions regarding your demographic information. 1. What is your impairment/disability label?

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* 2. What is your age?

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* 3. What is your biological sex?

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* 4. What is your highest level of education?

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* 5. What is your race?

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* 6. What is your annual household income?

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* 8. On those days, how many minutes did you usually spend doing mild intensity LTPA?

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* Moderate intensity LTPA requires some physical effort; moderate intensity activities make you feel like you are working somewhat hard, but you can keep doing them for a while without getting tired. . .9. During the last 7 days, on how many days did you do moderate intensity LTPA?

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* 10. On those days, how many minutes did you usually spend doing moderate intensity LTPA?

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* 12. On those days, how many minutes did you usually spend doing heavy intensity LTPA?

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* 17. INSTRUCTIONS: Sometimes we use strategies to help us to be physically active. Please use the following scale to answer the questions below.

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* 18. INSTRUCTIONS: An intention is a mental state or determination to perform leisure time physical activity. Please use the following scale to answer the questions below.

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* 19. INSTRUCTIONS: An intention is a mental state or determination to perform leisure time physical activity. Please use the following scale to answer the questions below.

* This section is composed of questions regarding your demographic information.

1. What is your impairment/disability label?

* Moderate intensity LTPA requires some physical effort; moderate intensity activities make you feel like you are working somewhat hard, but you can keep doing them for a while without getting tired. . .

9. During the last 7 days, on how many days did you do moderate intensity LTPA?