The classes will be held at Mass General Hospital in Boston or at the University of Connecticut in Storrs. Which location will you attend?
* must provide value
Mass General Hospital in Boston MA
UConn in Storrs CT
What is your first name?
* must provide value
What is your phone number?
Must provide your phone number or email for us to contact you.
How did you hear about this study?
* must provide value
Posted flyer Friend Healthcare provider Online Other
How did you hear about this study?
* must provide value
Posted flyer T ad email from MGH Friend Healthcare provider Online Other
Please specify which online site
clinicaltrials.gov RSVP for Health Google Facebook
Please specify the location of the flyer
If other, please specify.
How old are you?
* must provide value
Are you able to speak, understand and read English?
* must provide value
Yes No
Are you able to hear and understand audio recordings?
* must provide value
Yes No
Do you plan to stay within the area for the next 8 months?
* must provide value
Yes No
Are you available to commit to completing up to 40 minutes of homework per day for various stress reduction techniques?
* must provide value
Yes
No
Do you consider yourself to be stressed?
* must provide value
Yes
No
Please list any medications that you are taking or that have been prescribed to you. If none, please write N/A.
* must provide value
Do you plan to take any medications over the next 8 months?
* must provide value
Yes
No
During the past 6 months, during a typical week, how many minutes per week have you exercised with MODERATE or VIGOROUS intensity? (Examples of MODERATE intensity includes: fast walking, easy biking or swimming, baseball, dancing, tennis, etc. Does NOT include bowling, golf, easy walking, etc.).
* must provide value
0-30
31-90
91-140
141-180
181-220
more than 220
What types of exercise do you typically engage in?
Have you ever practiced yoga, meditation, tai chi or other mind-body practices before? (e.g., qi gong, martial arts, the Feldenkrais Method, Alexander Technique, Pilates, etc)
* must provide value
Yes
No
Are you currently participating in any other lifestyle programs (e.g., programs to reduce stress, lose weight, etc), or plan to start one in the next 7 months?
* must provide value
Yes
No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
* must provide value
Yes
No
Do you feel pain in your chest when you do physical activity?
* must provide value
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
* must provide value
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
* must provide value
Yes
No
Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
* must provide value
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or a heart condition?
* must provide value
Yes
No
Do you know of any other reason why you should not do physical activity?
* must provide value
Yes
No
What is your height?
* must provide value
3 4 5 6 7
feet
1 2 3 4 5 6 7 8 9 10 11
inches
OR Enter centimeters if you don't know it in feet and inches
cm
What is your weight?
* must provide value
Are you pregnant, planning to become pregnant, post-partum, or breast-feeding within the previous 6 months?
* must provide value
Yes
No
Do you have any chronic (on-going) medical conditions?
* must provide value
Yes
No
I was bothered by things that usually don't bother me.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I did not feel like eating. My appetite was poor.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt that I could not shake off the blues even with help from my family or friends.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt that I was just as good as other people.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I had trouble keeping my mind on what I was doing.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt depressed.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt that everything I did was an effort.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt hopeful about the future.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I thought my life had been a failure.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt fearful.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
My sleep was restless.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I was happy.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I talked less than usual.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt lonely.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
People were unfriendly.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I enjoyed life.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I had crying spells.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt sad.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I felt that people dislike me.
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
I could not "get going."
* must provide value
Rarely or none of the time; less than 1 day
Some or a little of the time, 1-2 days
Occasionally or a moderate amount of time, 3-4 days
Most or all of the time, 5-7 days
Do you consider your ethnicity to be Hispanic or Latino/a?
* must provide value
Hispanic or Latino
Not Hispanic or Latino
Unknown (not reporting ethnicity)
What do you consider to be your racial background?
* must provide value
How would you identify your gender?
Male Female Other
Thank you!!
We will review your answers and contact you within a few days to discuss the results of these questions and describe the study in more detail.
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