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64

Floor

Man Woman

63

Age

Under 40 years old 40–65 years old Over 65 years old

62

Your waist measurement (should be taken at the level of the navel)

I am a woman with a waist of less than 88 cm. I am a woman with a waist of 88 cm or more. I am a man with a waist size of less than 102 cm. I am a man with a waist size of 102 cm or more.

61

Body Mass Index (BMI)

BMI less than 18.5 BMI 18.5–24.9 BMI 25.0–29.9 BMI 30 and above

60

How many hours on average do you spend sitting at work?

Less than 3 hours a day 3–6 hours a day More than 6 hours a day

59

How many hours do you sleep on average at night?

Less than 4 hours 5–7 hours 7–8.5 hours More than 8.5 hours I don't know

58

Do you engage in physical exercise for at least 30 minutes 5 days a week on average or at an intense level?

Yes No

57

Do you brush your teeth twice a day or more?

Yes No

56

How often do you use dental floss?

Twice a day Once a day Less than once a day

55

How often do you engage in contemplative practices (yoga, meditation, tai chi, mindfulness, and others)?

5 times a week or more 1–4 times a week I am not engaged.

54

How much alcohol do you consume in a week?

I do not consume. 1–2 servings per week 3–7 servings per week More than 7 servings per week

53

How many hours of sleep do you think you need to be active during the day?

Less than 4 hours 5-6 hours 7–8.5 hours More than 8.5 hours I don't know

52

Have you smoked more than 100 cigarettes in your lifetime?

Yes No Not sure.

51

Do you rate your health higher than that of other people your age?

Yes No

50

Do you apply sunscreen, avoid the sun, and have a vitamin D deficiency?

Yes No

49

Have you been diagnosed with diabetes or prediabetes?

Yes No I don't know

48

Have you been diagnosed with depression?

Yes No I don't know

47

Have you been diagnosed with Alzheimer's disease?

Yes No I don't know

46

Have you had cancer (any type)?

Yes No I don't know

45

Have you been diagnosed with multiple sclerosis?

Yes No I don't know

44

Have you been diagnosed with gingivitis?

Yes No I don't know

43

Have you been diagnosed with high blood pressure?

Yes No I don't know

42

Have you been diagnosed with heart disease?

Yes No I don't know

41

Have you had unsatisfactory results from vaginal and cervical cytology?

Yes No I don't know

40

Have you had a stroke?

Yes No I don't know

39

Do you have seasonal affective disorder or winter depression?

Yes No I don't know

38

What is your resting pulse?

Less than 60 beats per minute 60–69 beats per minute 70–79 beats per minute 80 beats per minute and above I don't know

37

The most common fasting glucose level is between 3.8 and 4.7 mmol/L?

Yes No I don't know

36

Do you often catch colds or have infections like herpes, respiratory infections, bronchitis, or sinusitis?

Yes No

35

Do you have thin and brittle nails?

Yes No

34

Do you have white spots on your nails?

Yes No

33

Do you have skin issues such as eczema, rashes, or acne?

Yes No

32

Have you ever experienced hair loss?

Yes No

31

Have you experienced any major life upheavals in the last 12 months (such as the death of a loved one, divorce, job loss, relocation, etc.)?

Yes No

30

Do you feel that you often jump from one task to another and experience stress due to a lack of time?

Yes No

29

Do you consider your life to be filled with stress?

Yes No

28

How do you assess your ability to cope with stress in the past two weeks?

Weak Average Great

27

Do you eat food with wheat flour or sugar more than twice a week?

Yes No

26

Do you consume at least 7 servings of fruits and vegetables a day (1 serving is 100 grams)?

Yes No

25

Do you consume at least one serving of vegetables per day (100 g)?

Yes No

24

Do you eat packaged or factory-prepared food, fast food, or food with trans fats (doughnuts, cookies, crackers) once a week or more often?

Yes No

23

Have any of your close relatives had cases of Alzheimer's disease?

Yes No

22

Have any of your close relatives had heart diseases?

Yes No

21

Have any of your close relatives had strokes?

Yes No

20

Have any of your close relatives had cases of diabetes?

Yes No

19

Have any of your close relatives had cases of osteoporosis?

Yes No

18

Have any of your close relatives had cases of cancer?

Yes No

17

Are you married or in a relationship with someone you are willing to share your feelings with?

Yes No

16

Do you feel isolated and lonely?

Yes No

15

Do you feel enthusiasm and inspiration from what you do in life?

Yes No

14

Is there someone in your life who cares for you and loves you for no particular reason?

Yes No

13

Do you feel your significance as an individual and that you can influence the lives of others?

Yes No

12

Do you get tired on a regular basis?

Yes No

11

Do you feel tired after exercising?

Yes No

10

Are you sensitive to smoke, perfumes, cleaning products, and other chemicals?

Yes No

9

Do you experience pain in your muscles and joints?

Yes No

8

Are you currently smoking or are you a passive smoker?

Yes No

7

Are you exposed to heavy metals, toxins, pollutants, or chemicals at home or at work?

Yes No

6

Do you regularly take any prescription or psychoactive medications?

Yes No

5

Do you ever find it difficult to choose the right word or expression one or more times a week?

Yes No

4

Do you feel that over the past 5–10 years you have experienced a decline in mental sharpness, memory, and ability to focus?

Yes No

3

Do you feel that your brain is not functioning as well as it did 5 or 10 years ago?

Yes No

2

Do you have a decrease in taste, smell, and/or hearing?

Yes No

1

Do you believe that chocolate, wine, and guacamole can help you look and feel younger?

Yes No