Your Par-Q

Physical Activity Readiness Questionnaire...

Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions below. This form will tell you if you should check with your doctor before you start.

Please read the question carefully and answer each one honestly : check YES or NO

1)Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

YES [ ] NO [ ]

2) Do you feel pain in your chest when you do physical activity? YES [ ] NO [ ]

3) In the past month, have you had chest pain when you were not doing physical activity? YES [ ] NO [ ]

4) Do you lose your balance because of dizziness or do you ever lose consciousness? YES [ ] NO [ ]

5) Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity? YES [ ] NO [ ]

6) Is your doctor currently prescribing drugs (for example: pills ) for your blood pressure or heart condition? YES [ ] NO [ ]

7) Do you know of any other reason why you should not do physical activity? YES [ ] NO [ ]

If you answered YES to one or more questions:

Talk with your doctor by phone or in person BEFORE you start becoming such more physically active or BEFORE you have a fitness appraisal. Tel your doctor about the PAR-Q and which questions you answered YES. · You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his /her advice

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

Start becoming much more physically active -begin slowly and build up gradually. This is the safest and easiest way to go. · Take part in a fitness appraisal -this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated Please note: IF your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

I have read, understood, and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Date

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