Follow-Up Questionnaire:
Fitness Class Survey Study
Please enter your full name:
Please list in the table below the name (or description) of each fitness class that you attended, and how often you attended each class, in the past 7 days:
Fitness Class Name/Description
Number of times attended
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
0
1
2
3
4
5
6
7
8
9
Comments:
<Click here to enter text>
Visual Analog Scales
Please select a position on the slider that corresponds with your response for each question.
Activities of Daily Living:
Please indicate the average level of pain you have experienced in the last 24 hours while performing activities of daily living (walking, washing, stair-climbing, etc):
No Pain
Worst Pain Imaginable
During Exercise:
Indicate the worst level of pain you have experienced over the last 7 days while taking part in, or immediately after, an exercise session:
No Pain
Worst Pain Imaginable
Have you changed the footwear that you use when you participate in fitness classes in the
past 7 days?
Yes
No
If yes, please provide the brand and model name for your new shoe
Have you purchased any in-shoe arch/foot supports for the shoes that you use when you participate in fitness classes in the
past 7 days?
Yes
No
If yes, how would you describe your in-shoe foot/arch support?
Over-the-counter cushion only
Over-the-counter supportive with raised arch profile (brands: Superfeet, Sole)
Custom made (provided by health care professional)
Other:
If your in-shoe foot/arch supports were custom made, which of the following health care professionals provided them:
Podiatrist
Pedorthist
Physiotherapist
Chiropractor
I don't know
Other:
If your in-shoe foot/arch supports were custom made, did you have a referral (prescription) for the device?
Yes
No
I don't know
What was the primary reason for you to get an in-shoe foot/arch support?
To help address an ongoing injury (i.e. to relieve pain)
To help prevent an injury from occurring
To provide support for low arches only
To provide support for some other part of your lower extremity alignment, including low back and pelvis
Other:
Was there any recommendation from your health care professional as to when you should use the foot/arch support?
As often as possible
Only with sport participation
Only with activities of daily living (not with sport)
No recommendation was given
A health care professional did not provide my foot support
Other:
When do you wear your foot/arch supports?
All the time
Only during exercise
Only during activities of daily living (not during exercise)
I don`t wear them at all
Other:
Please indicate how much you agree with the following statement by selecting the appropriate response:
"My in-shoe foot/arch supports provide enough support to meet the demands of my sport participation."
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Please indicate how much you agree with the following statement by selecting the appropriate response:
"My in-shoe foot/arch supports are comfortable when I use them in the shoes that I wear for my sport."
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
When you are wearing your in-shoe foot/arch supports, would you complain of any of the following (check all that apply):
Heel slipping (heel comes out the back part of shoe)
Tightness in the fit of the toe-box (front of shoe) of your shoe
Tightness in the fit of the in-step (underneath laces) of your shoe
Feeling unbalanced during certain movements
Increase in pressure under the arch of your foot
Increase in pressure under your forefoot
Blisters on your feet
Feeling your ankles turning outward (rolling onto the outer or lateral part of your foot as in figure 1)
Other: