Sex | M | F | |
Date of birth | | | |
What is your profession? | | | |
If you are a student, are you doing examinations? | Yes | No | |
What is your main sport or game? | | | |
How many hours do you practise per week? | 6–8. | 8–10 | More than 10 |
If you play other sports or games, write them: | | | |
This month, has there been any significant event which may have disturbed | Yes | No | |
your private or professional life? |
This month |
1–My level of sports performance/my general form has decreased | Yes | No | |
2–I am not as attentive as before | Yes | No | |
3–My close friends think that my behaviour has changed | Yes | No | |
4–I have a sensation of pressure in my chest | Yes | No | |
5 –My heart seems to beat faster | Yes | No | |
6–I have a lump in my throat | Yes | No | |
7–I have less appetite than before | Yes | No | |
8–I eat more | Yes | No | |
9–I do not sleep as well as before | Yes | No | |
10–I drowse and yawn in the daytime | Yes | No | |
11–The time between training sessions seems to me too short | Yes | No | |
12–My sexual libido has decreased | Yes | No | |
13–My performances are poor | Yes | No | |
14–I frequently catch a cold | Yes | No | |
15–I have put on weight | Yes | No | |
16–I have memory problems | Yes | No | |
17–I often feel tired | Yes | No | |
18–I underestimate myself | Yes | No | |
19–I often have cramps, muscular pain | Yes | No | |
20–I suffer from headaches more frequently | Yes | No | |
21–I do not feel fit | Yes | No | |
22–I sometimes feel dizzy, on the point of fainting | Yes | No | |
23–I do not confide in others so easily | Yes | No | |
24–I often feel seedy | Yes | No | |
25–I have a sore throat more often | Yes | No | |
26–I feel nervous, insecure, anxious | Yes | No | |
27–I do not bear training so well | Yes | No | |
28–At rest, my heart rate is faster than before | Yes | No | |
29–During exercise, my heart rate is faster than before | Yes | No | |
30–I often feel rotten | Yes | No | |
31–I get tired more easily | Yes | No | |
32–I often have digestive disorders | Yes | No | |
33–I feel like staying in bed | Yes | No | |
34–I am not so confident in myself | Yes | No | |
35–I get injured more easily | Yes | No | |
36–I have more difficulties in organising my thoughts | Yes | No | |
37–I have more difficulties in concentrating in my sports activity | Yes | No | |
38–My sporting gestures are less precise, less skilful | Yes | No | |
39–I have lost force and aggressiveness | Yes | No | |
40–I feel as if I have no one to talk to | Yes | No | |
41–I sleep longer | Yes | No | |
42–I cough more often | Yes | No | |
43–I do not enjoy practising my sports as much | Yes | No | |
44–I do not enjoy my leisure activities as much | Yes | No | |
45–I get irritated more easily | Yes | No | |
46–I am less efficient in my school or professional activity | Yes | No | |
47–People around me think that I have become less pleasant | Yes | No | |
48–Training seems harder and harder | Yes | No | |
49–It is my fault if my results are worse | Yes | No | |
50–My legs feel heavy | Yes | No | |
51–I lose my personal things more easily (wallet, keys, etc) | Yes | No | |
52–I am pessimistic, I have the blues | Yes | No | |
53–I have lost weight | Yes | No | |
54–My motivation, will and tenacity are weaker | Yes | No | |
Put a cross to range between these two opposite states |
My physical level | | | |
Great form---------------------------------------------------------------Bad form | |
I feel fatigued | | | |
More slowly-------------------------------------------------------------More quickly | |
I recover from my state of tiredness | | | |
More quickly------------------------------------------------------------More slowly | |
I feel | | | |
Very relaxed-------------------------------------------------------------Very anxious | |
I feel that my muscular strength has | | | |
Increased-----------------------------------------------------------------Decreased | |
I feel that my endurance has | | | |
Increased-----------------------------------------------------------------Decreased | |
Have you had any difficulties in understanding some of the questions? | Yes | No | |
If Yes, which questions did you find difficult to understand (write the numbers) |