Physical Activity (0-20 points)

How often do you engage in moderate to vigorous exercise (e.g., brisk walking, cycling, swimming) per week?

A. Less than 1 time (0 points)

B. 1-2 times (5 points)

C. 3-4 times (10 points)

D. 5 or more times (15 points)

Can you comfortably walk up two flights of stairs without feeling excessively winded?

A. No (0 points)

B. Sometimes (5 points)

C. Yes, with ease (10 points)

Nutrition & Dietary Habits (0-20 points)

How often do you consume fresh fruits and vegetables daily?

A. Rarely (0 points)

B. 1-2 servings per day (5 points)

C. 3-5 servings per day (10 points)

D. More than 5 servings per day (15 points)

How often do you eat processed or fast food?

A. More than 4 times per week (0 points)

B. 2-3 times per week (5 points)

C. Once per week (10 points)

D. Rarely or never (15 points)

Heart Health & Medical History

(0-25 points)

Do you have a history of high blood pressure, high cholesterol, or heart disease?

A. Yes, currently managing (0 points)

B. Previously diagnosed but under control (5 points)

C. No, but at risk due to family history (10 points)

D. No history of these conditions (15 points)

Have you ever experienced chest pain, shortness of breath, or irregular heartbeats during physical activity?

A. Yes, frequently (0 points)

B. Occasionally (5 points)

C. Rarely (10 points)

D. Never (15 points)

Lifestyle & Stress Management

(0-15 points)

How would you describe your stress levels on a daily basis?

A. High (0 points)

B. Moderate (5 points)

C. Low (10 points)

How many hours of quality sleep do you get per night?

A. Less than 5 hours (0 points)

B. 5-6 hours (5 points)

C. 7+ hours (10 points)

Smoking & Alcohol Consumption

(0-20 points)

Do you smoke or use tobacco products?

A. Yes, regularly (0 points)

B. Occasionally (5 points)

C. No, I quit (10 points)

D. Never smoked (15 points)

How often do you consume alcohol?

A. More than 4 times per week (0 points)

B. 2-3 times per week (5 points)

C. Once per week (10 points)

D. Rarely or never (15 points)