1 Take care of yourself that is eat dress bathe or use the toilet275YesNo 2 Walk indoors such as around your house175YesNo 3 Walk a block or two on level ground275 YesNo 4 Climb a fl ID: 819299
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The DASI Score Sheet (to be used by staf
The DASI Score Sheet (to be used by staff)DUKE ACTIVITY STATUS INDEXScore sheetCan you:Scores are only given for yes replies1. Take care of yourself, that is, eat, dress, bathe or use the toilet?2.75Yes/No2. Walk indoors, such as around your house?1.75Yes/No3. Walk a block or two on level ground?2.75 Yes/No4. Climb a flight of stairs or walk up a hill?5.50 Yes/No5. Run a short distance? 8.00 Yes/No6. Do light work around the house like dusting or washing dishes?2.70 Yes/No7. Do moderate work around the house like vacuuming, 3.50 Yes/Nosweeping floors or carrying groceries? 8. Do heavy work around the house like scrubbing floors or liftingor moving heavy furniture?8.00 Yes/No9. Do garden work like raking leaves, weeding or pushing a lawn mower?4.50Yes/No10. Have sexual relations? 5.25 Yes/No11. Participate in moderate recreational activities like golf, bowling,dancing, doubles tennis or throwing a ball?6.00Yes/No12. Participate in strenuous sports like swimming, singles tennis, football, basketball or skiing?7.50Yes/No(To be completed by staff) Duke Activity Status Index(DASI) = The higher the score is, the more physically active a person is according to this set of activities of daily living.The DASI score should be completed every three months and the score entered into the back of the exercisediary to monitor progress.www.kidney.org.ukHelpline: 0845 601 02 09Supported by the NKF.Supported by ANSA.www.anaemianurse.orgHelpline: 01483 72447220944_Exercise DASI Score Sheet:20944_Exercise DASI Score Sheet 6/10/09 19:26 Page 1