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Move United Physical Activity Survey

About the Survey

This brief (5-10 minute) survey is being conducted by Move United. The purpose of this survey is to evaluate the effectiveness of adaptive sports programs and by using aggregate data, to help inform Americans about why sport and a healthy lifestyle is beneficial for people with disabilities. The survey should be ideally completed by a participant (in adaptive sports programs) with a disability; or a parent, legal guardian or aide where appropriate. Your participation in this survey is entirely voluntary and you may choose not to participate. If you decide to participate in this survey, you may withdraw at any time. Your future participation in adaptive sports programs will not be impacted should you choose not to participate in the survey. Your responses will be confidential, recording your name is optional and we do not collect your IP address. All data is stored in a password protected electronic format. To help protect your confidentiality, individual data or responses are never shared. The results of this survey are to measure the impact of adaptive sports programs and only employees of Move United have access to responses. If you have any questions about the survey, please contact jray@moveunitedsport.org.

About You

Type of Participant (select all that apply)(Required)
What is your primary disability (select all that apply)(Required)
How would you rate your quality of life?(Required)
How satisfied are you with your health?(Required)
Do you qualify or currently receive assistance from a state or federal financial assistance program?(Required)
i.e: Medicaid, Unemployment, Social Security Disability Benefits, Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, Free School Lunch Program, Aid for Dependent Children, Foster Care or other similar?

About Your Exercise and Workout Habits

Each week, what is the total amount of Moderate physical activity you participate in? This is an activity lasting 10 minutes or more and that causes slight - moderate increases in breathing or heart rate. For example: walking fast, leisurely bicycling, recreational swimming, hiking, gardening and yard work. Check the appropriate box below.(Required)
Each week, what is the total amount of Vigorous physical activity you participate in? This is an activity lasting 10 minutes or more and that causes large or heavy increases in breathing or heart rate. For example: running, bicycling fast or uphill, wheelchair basketball or tennis, hard sport/exercise workouts. Check the appropriate box below.(Required)

About the Program or Event

How expensive was the program or event you attended?(Required)

How satisfied were you with each of the following for the program/event you attended

Quality of instructors/coaches(Required)
Support from instructors/coaches(Required)
Quality of facilities/equipment(Required)
Opportunity to improve my sport skills(Required)
Opportunity to meet new people(Required)
Staff members' helpfulness and communication(Required)

How important were each of the following for the program/event you attended

Quality of instructors/coaches(Required)
Support from instructors/coaches(Required)
Quality of facilities/equipment(Required)
Opportunity to improve my sport skills(Required)
Opportunity to meet new people(Required)
Staff members' helpfulness and communication(Required)

By participating in this program/event, I have improved my:

Overall health(Required)
Physical fitness(Required)
Sport skills(Required)
Overall confidence(Required)
Ability to perform activities of daily living (i.e. self-care)(Required)
Ability to succeed at school/work(Required)
Network of friends(Required)
Ability to build meaningful relationships(Required)
Based on my experience, I would recommend this program/event to another person with a disability?(Required)

Please select "submit" to record your responses. Thank you for taking the time to complete this survey!