This survey is aimed at anyone 55 years and over

Please take a moment to complete the following survey on behalf of the Active Ageing Alliance which is a partnership of organisations interested in getting people aged 55 and over active in their local area.  Partners include: Lancashire Sport Partnership, local Age UKs, Lancashire Mind, Galloways Society for the Blind, Lancashire FA, Stroke Association, local NHS Clinical Commissioning Groups, local public health departments and local football trusts.  This information will only be used by partners to help ensure that suitable activities are provided.  Your honest answers will help to shape future activities.

* 4. Ethnic Origin

* 5. Living Arrangements

* 6. Employment Status

* 7. Are you a carer? 

* 8. Health Conditions

* 9. Do you have a limiting condition that is expected to last for 12 months or more?

* 10. Are you a smoker?

* 12. Do you currently engage in at least 30 minutes of moderate intensity physical activity per week?  
Moderate equivalent minutes means each minute where you raise your heart rate and feel a little out of breath counts as 1 minute or vigorous activity where you’re breathing hard and fast and your heart rate has increased significantly (you wont be able to say more than a few words without pausing for a breath) counts for double.  So each vigorous minute counts as two moderate minutes.  The 30 minutes can be achieved in chunks of 10 minutes across different days.

* 13. If you are active, what were your reasons for getting started?

* 14. What factors help or hinder you from keeping active?

* 15. What type of activities interest you?

* 16. If you're not active, what do you think is stopping you from becoming active? (please tick all that apply)

* 17. What factors would help you to become more active?

* 18. Where would you like to see local activities take place?

* 19. If you became active what factors would motivate you? 

* 20. Please use this space for any further comments

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