Take care of self (e.g. eating, dressing, bathing, using the toilet) Yes No
Walk indoors: Yes No
Walk 1-2 blocks on level ground: Yes No
Climb a flight of stairs or walk up a hill: Yes No
Run a short distance: Yes No
Do light work around the house (e.g. dusting, washing dishes): Yes No
Do moderate work around the house (e.g. vacuuming, sweeping floors, carrying in groceries): Yes No
Do heavy work around the house (e.g. scrubbing floors, lifting or moving heavy furniture): Yes No
Do yardwork (e.g. raking leaves, weeding, pushing a power mower): Yes No
Have sexual relations: Yes No
Participate in moderate recreational activities (e.g. golf, bowling, dancing, doubles tennis, throwing a baseball or football): Yes No
Participate in strenuous sports (e.g. swimming, singles tennis, football, basketball, skiing): Yes No
Calculate