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Laurent
Le Bosse
FEEL - CHALLENGE - IMPROVE
First name
*
Last name
*
Email
*
General information
Age
*
Under 18
18 - 25
26 - 40
41 - 60
60 +
Gender
*
Female
Male
Current occupation
*
Student
Full-time job
Part time job
Stay at home
Other
Crrent occupation - Other - Specified
Current physical activity level
How would you describe your general activity level?
*
Sedentary (Little or no exercise)
Lightly active (Little exercise 1 - 2 days per week)
Moderately active (5 - 6 days per week)
Very active (5 - 6 days per week)
Athlete (intense training daily)
Do you practice regular exercise or sports?
Yes
No
If yes, what type (s) of activity?
*
Strengt training
Running / Jogging
Cycling
Swimming
Team sports
Martial arts
Yoga / Pilates
Hiking / Outdoors
Other
If other activity, specified
Exercise frequency & duration
How many days per week do you exercise?
*
0
1 - 2
3 - 4
5 - 6
7
Average duration of each workout
*
0 - 20 minutes
20 - 40 minutes
40 - 60 minutes
60 minutes +
Intensity of your typical workout ?
*
Low
Moderate
High
Goals & motivation
What are your primary goals ? (Select all that apply)
*
Improve general health
Lose weight / fat
Build muscle
Increase strength
Improve mobility
Improve cardio fitness
Improve posture
Sport performance
Reduce stress
Post injury rehabilitation
Other
Ij goals is other, specified
What motivates you the most to exercise ?
*
Health
Physical appearance
Mental wellbeing
Performance
Social interaction
Other
If motivation is other, specified
Health issues that may limit physical activity.
Do you have any diagnosed medical cardiovascular condition ? (Sellec all that apply)
*
High blood pressure
Low blood pressure
Heart disease
History of chest pain or heart discomfort
Irregular heartbeat / arrhythmia
Do you have any diagnosed medical respiratory condition ? (Sellec all that apply)
*
Asthma
Shortness of breath during light activity
Chronic respiratory conditions
Do you have any diagnosed medical metabolic condition ? (Sellec all that apply)
*
Diabetes (type 1 or 2)
Prediabetes
Thyroid disorders
Do you have any diagnosed medical musculoskeletal condition ? (Sellec all that apply)
*
Back pain (lower or upper)
Herniated disc
Knee pain or injury
hip issues
Shoulders injury
Ankle / foot instability
Arthritis or joint inflammation
Do you have any diagnosed medical neurological condition ? (Sellec all that apply)
*
Balance issues
Neuropathy
Dizziness / fainting episodes
Do you have any diagnosed medical other condition ? (Sellec all that apply)
*
Recent surgry
Pregnant /Postpartum
Chronic fatigue
Other
If other conditions, specified
Are you currently taking medication that may affect exercise ?
*
Yes
No
If yes you are currently taking medication, specified
Do you experience pain during exercise or daily activities ?
*
Never
Sometimes
Often
Yes, regulary
Lifestyle factors
How many hours of sleep do you get per night ?
*
Less than 5
5 - 6
7 - 8
More than 8
How would you rate your stress level ?
*
Low
Moderate
High
How much do you walk dayly ?
*
Less than 3 000 steps
3 000 - 6 000 steps
6 000 - 10 000 steps
More than 10 000 steps
Knowledge & Preferences
How would you rate your knowledge of exercise and training ?
*
Beginner
Intermadiate
Advanced
What kind of workouts do you prefer ?
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Strength
Cardio
Mixed
Low impact ( Mobility, stretch, yoga, pilates)
High intensity
Outdoor activities
Are you interested in receiving personalized training advice ?
*
Yes
Maybe
Not at the moment
Submit
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