Item Number

ID*

Items**

1

PFA1

Does your health now limit you in doing vigorous activities, such as running, lifting heavy objects, participating in strenuous sports?

2

PFA3

Does your health now limit you in bending, kneeling, or stooping?

3

PFA4

Does your health now limit you in doing heavy work around the house like scrubbing floors, or lifting or moving heavy furniture?

4

PFA5

Does your health now limit you in lifting or carrying groceries?

5

PFA6

Does your health now limit you in bathing or dressing yourself?

6

PFA7

How much do physical health problems now limit your usual physical activities (such as walking or climbing stairs)?

7

PFA8

Are you able to move a chair from one room to another?

8

PFA9

Are you able to bend down and pick up clothing from the floor?

9

PFA10

Are you able to stand for one hour?

10

PFA11

Are you able to do chores such as vacuuming or yard work?

11

PFA12

Are you able to push open a heavy door?

12

PFA13

Are you able to exercise for an hour?

13

PFA14

Are you able to carry a heavy object (over 10 pounds)?

14

PFA15

Are you able to stand up from an armless straight chair?

15

PFA19

Are you able to run or jog for two miles?

16

PFA21

Are you able to go up and down stairs at a normal pace?

17

PFA23

Are you able to go for a walk of at least 15 minutes?

18

PFA25

Are you able to do yard work like raking leaves, weeding, or pushing a lawn mower?

19

PFA29

Are you able to pull heavy objects (10 pounds) towards yourself?

20

PFA30

Are you able to step up and down curbs?

21

PFA31

Are you able to get up off the floor from lying on your back without help?

22

PFA32

Are you able to stand with your knees straight?

23

PFA33

Are you able to exercise hard for half an hour?

24

PFA37

Are you able to stand for short periods of time?

25

PFA39

Are you able to run at a fast pace for two miles?

26

PFA41

Are you able to squat and get up?

27

PFA42

Are you able to carry a laundry basket up a flight of stairs?

28

PFA45

Are you able to get out of bed into a chair?

29

PFA49

Are you able to bend or twist your back?

30

PFA51

Are you able to sit on the edge of a bed?

31

PFA53

Are you able to run errands and shop?

32

PFA56

Are you able to get in and out of a car?

33

PFB1

Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries?

34

PFB3

Does your health now limit you in putting a trash bag outside?

35

PFB5

Does your health now limit you in hiking a couple of miles on uneven surfaces, including hills?

36

PFB7

Does your health now limit you in doing strenuous activities such as backpacking, skiing, playing tennis, bicycling or jogging?

37

PFB8

Are you able to carry two bags filled with groceries 100 yards?

38

PFB9

Are you able to jump up and down?

39

PFB10

Are you able to climb up five steps?

40

PFB11

Are you able to wash dishes, pots, and utensils by hand while standing at a sink?