Lifestyle Medicine Questionaire

1. Do you follow a specific dietary pattern?

SelectNo specific dietHigh-protein dietVegetarianVeganOther
Other:

2. How many portions of fruit and vegetables do you eat per day? (1 piece of fruit or vegetable)

Select0-12-34-55+

3. How often do you eat lean protein such as chicken or fish?

SelectRarely / Never1-2 times per week3-5 times per weekDaily or most days

4. How often do you eat red meat (e.g. beef, lamb, pork)?

SelectRarely / Never1-2 times per week3-5 times per weekDaily or most days

5. How would you describe your dairy intake (e.g. milk, butter, cream, cheese)?

SelectRarely / Never1-2 times per week3-5 times per weekDailyMultiple times daily

6. How would you describe your fibre intake (e.g. wholegrains, wholewheat, fruit, vegetables)?

SelectLow (rarely include fibre-rich foods)Moderate (include fibre-rich foods every other day)High (fibre-rich foods most days)Very high (fibre-rich foods at most meals)

7. How often do you consume ultra-processed foods? (e.g. fast food, packaged snacks, sweets, processed meals)

SelectRarely1-2 times per week3-5 times per weekDailyMultiple times daily

8. Where do you usually get most of your meals from?

SelectMostly home-cooked/meal prepped at homeMostly eating out / takeawaysMix of home-cooked and eating outVery irregular pattern

9. How regular are your meal patterns?

SelectVery consistent (regular meals daily)Mostly consistentIrregular but manageableHighly irregular/frequently skip meals

10. How often do you eat mindfully (without distraction such as TV/phone)?

SelectAlways or almost alwaysSometimesRarelyNever

11. How often do you eat in response to stress or emotions?

SelectRarelyNeverSometimesOftenVery often

12. Do you currently take supplements?

YesNo

If yes (tick all that apply):
Vitamin DOmega-3MultivitaminProtein SupplementsCreatineProbioticsIron

Other:

1. During the recent past, how many hours of actual sleep did you get at night?

SelectUnder 5 hours5-6 hours6-7 hours7-8 hours8-9 hoursMore than 9 hours

2. How satisfied/dissatisfied are you with the quality of your sleep?

SelectVery satisfiedSomewhat satisfiedNeither satisfied nor dissatisfiedSomewhat dissatisfiedVery dissatisfied

3. How long does it usually take you to fall asleep each night?

Select15 minutes or less16-30 minutes31-60 minutesLonger than 60 minutes

4. How often do you have trouble staying asleep?

SelectNoneOnce or twice per weekThree or four times per weekFive to seven times per week

5. How often do you take medication to help you sleep? (prescribed or over-the-counter)

SelectNoneOnce or twice per weekThree or four times per weekFive to seven times per week

6. Are you typically a loud snorer?

YesNo

7. Have you been told you choke, gasp, or stop breathing during sleep?

YesNo

8. How many caffeinated products do you consume per day? (Tea/coffee = 200ml fizzy drinks = 250ml can)

SelectLess than 1 per day1-2 per day3 per day4 per day5 or more per day

9. How often do you use electronic devices within 1 hour of bedtime?

SelectNot at all1-3 times per week4-6 times per weekEvery day

1. Have you had any absences from training/exercise due to injury or illness in the last year:

SelectNoneYes, once or twiceYes, three or four timesYes, five times or more

2. How do you currently monitor recovery?

SelectNoneMorning heart rateHRV monitoringWearable device (e.g. Garmin, Apple, Whoop)Subjective only (energy, fatigue, soreness)

1. How often have you been upset because of something that happened unexpectedly?

Select 0-401234

2. How often have you felt that you were unable to control the important things in your life?

Select 0-401234

3. How often have you felt nervous and stressed?

Select 0-401234

4. How often have you felt confident about your ability to handle your personal problems?

Select 0-401234

5. How often have you felt things were going your way?

Select 0-401234

6. How often have you found that you could not cope with all the things you had to do?

Select 0-401234

7. How often have you been able to control irritations in your life?

Select 0-401234

8. How often have you felt on top of things?

Select 0-401234

9. How often have you been angered by things outside your control?

Select 0-401234

10. How often have you felt difficulties were piling up so high you could not overcome them?

Select 0-401234

1. How often do you feel that you lack companionship

Select 0-30123

2. How often do you feel left out

Select 0-30123

3. How often do you feel isolated from others

Select 0-30123