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* 1. For how many years have you been a physical therapist (PT)? (if student, reply "student")

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* 2. What is your primary practice setting (sample answers: outpatient or acute) (If study, reply "student")

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* 3. What are your secondary practice settings (if any)? (sample answer: home health or n/a)

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* 4. In what state (or states) are you licensed as a physical therapist (PT)? (if student, reply "student")

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* 5. Demographics: What is your age, gender, and race/ethnicity? (sample response: 55 yr/old, Female, Non-Hispanic / European-American)

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* 6. For items 7 through 10, please provide information about the MODES (aka TYPES) of moderate to high-intensity physical activity you engaged in during the PAST 7 DAYS. Please include the (1) MODE (aka type) of moderate to high-intensity physical activity (e.g., stationary bike or dig a ditch); (2) FREQUENCY (the # of times you did it during the past 7 days); (3) DURATION (average # of minutes/session); and (4) INTENSITY - please use Intensity Scale of 1 to 5, wherein 1 = rest, 2 = light activity, 3 = moderate activity, 4 = strenuous activity, 5 = exhaustive activity - you can state a single number (e.g., 3) or a range of numbers (e.g., 3-4). Only include those activities you can grade 3, 4, or 5 on a scale of 5. 
(Example response: Stationary bike, 3 times, 20 min average, intensity 3 to 4 on scale of 5.) Before you proceed, please acknowledge you understand these instructions. Thank you!

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* 7. First MODE of physical activity (intensity 3 to 5 on a scale of 5) during past 7 days? Frequency? Duration? Intensity?  (Example response: Stationary bike, 3 times, 20 min average, intensity 3 to 4 on scale of 5)

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* 8. Second MODE of physical activity (intensity 3 to 5 on a scale of 5) during past 7 days? Frequency? Duration? Intensity? (Example response: 'power' walk , 3 times, 30 min average, intensity 3 to 4 on scale of 5)

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* 9. Third MODE of physical activity (intensity 3 to 5 on a scale of 5) during past 7 days? Frequency? Duration? Intensity?  (Example response: mow lawn with push mower, once, 45 min, intensity 3 to 4 on scale of 5)

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* 10. Additional MODES of physical activity (intensity 3 to 5 on a scale of 5) during past 7 days? Frequency? Duration? Intensity? (Example response: jog, once, 10 min, intensity 4; dig ditch, once, 10 min, intensity 5)

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