Baecke form

The questionnaire below returns a maximum score of 15 points. The returned score must then be converted into a fitness level from 1 to 5.

A score between 0 and 3 corresponds to a level of 1.
A score between 4 and 6 corresponds to a level of 2.
A score between 7 and 9 corresponds to a level of 3.
A score between 10 and 12 corresponds to a level of 4.
A score between 13 and 15 corresponds to a level of 5.

1- What is your usual physical exertion during the week?

Low level (e.g. few daily activities, office work, housework, teaching, studying, driving, ...)

Moderate level (e.g. average daily activities, agriculture, factory/workshop work, ...)

Important level (e.g.: intense daily activities, building trades, movers, ...)

2- During my daytime activities, I sit:

Never

Rarely

Sometimes

Often

Permanently

3- During my daytime activities, I am on my feet:

Never

Rarely

Sometimes

Often

Permanently

4- During my daytime activities, I walk:

Never

Rarely

Sometimes

Often

Permanently

5- During my daytime activities, I carry heavy loads:

Never

Rarely

Sometimes

Often

Very often

6- During my daytime activities, I sweat:

Very often

Often

Sometimes

Rarely

Never

7- After these activities, I am physically tired:

Never

Rarely

Sometimes

Often

Very often

8- Compared to others of my age, I consider my daily activities to be physically:

Much more important

More important

Also important

Less important

Much less important

9- How many minutes per day do you spend moving around (walking, stairs, biking, rollerblading, scootering, ... excluding motorized vehicles) to get to and from work, school, walking the dog or shopping?

Less than 5 minutes

Between 5 and 15 minutes

Between 15 and 30 minutes

Between 30 and 45 minutes

More than 45 minutes

10- Do you play any sport(s) regularly?

11- What sport do you play most frequently?

Low level of physical activity (e.g. bocce ball, yoga, billiards, gentle exercise, fishing, hunting, walking or cycling at a moderate pace, etc.)

Average level of physical activity (e.g. skiing, aqua-gym, horseback riding, dance, tonic gym, badminton, golf, brisk walking, etc.)

High level of physical activity (e.g. athletics, soccer, running, rollerblading, tennis, squash, swimming, basketball, field hockey, mountain biking, etc.)

12- How many hours per week:

Less than 1 hour

Between 1 and 2 hours

Between 2 and 3 hours

Between 3 and 4 hours

More than 4 hours

13- How many months per year:

Less than 1 month

Between 1 and 3 months

Between 3 and 6 months

Between 6 and 9 months

More than 9 months

14- Do you practice another sport?

15- What other sport do you play?

Low level of physical activity (e.g. bocce ball, yoga, billiards, gentle exercise, fishing, hunting, walking or cycling at a moderate pace, etc.)

Average level of physical activity (e.g. skiing, aqua-gym, horseback riding, dance, tonic gym, badminton, golf, brisk walking, etc.)

High level of physical activity (e.g. athletics, soccer, running, rollerblading, tennis, squash, swimming, basketball, field hockey, mountain biking, etc.)

16- How many hours per week

Less than 1 hour

Between 1 and 2 hours

Between 2 and 3 hours

Between 3 and 4 hours

More than 4 hours

17- How many months per year

Less than 1 month

Between 1 and 3 months

Between 3 and 6 months

Between 6 and 9 months

More than 9 months

18- During my leisure activities, I sit in front of the television, a console or a computer or I listen to music, I read, ...:

Never

Rarely

Sometimes

Often

Very often

19- During my leisure activities, I walk (alone, with my family, with my dog, ...):

Never

Rarely

Sometimes

Often

Very often

20- During my leisure activities, I have physical activities (DIY, gardening, shopping, ...):

Never

Rarely

Sometimes

Often

Very often

21- During my leisure time, in addition to my regular sports activities, I also do:

Never

Rarely

Sometimes

Often

Very often

22- During my leisure activities, I sweat (think of gardening, walking, DIY, ...):

Very often

Often

Sometimes

Rarely

Never

23- Compared to other people my age, I consider my leisure activities to be physically:

Much more important

More important

Also important

Less important

Much less important