Par Q

Physical Readiness Activity Questionnaire (Par-Q)

Please answer the following questions before undertaking any service with One 2 One Health & Fitness. If you are over 69 years of age, and/or not used to being very active, check with your doctor before beginning exercise. Common sense is the best guide when answering these questions. Please read all the questions carefully and answer each one honestly.

If you answered YES to one or more questions:

Talk with your Doctor by phone or in person BEFORE you start an exercise programme/evaluation. Tell your Doctor about this questionnaire 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 which are safe for you. Talk to your Doctor about the kinds of activities you wish to participate in and follow his/her advice. An information sheet for your Doctor is available from One 2 One Health & Fitness.

If you answered NO to all questions:

You can be reasonably sure that you can start to undertake an exercise programme/evaluation. However, if your health changes so that you answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

You should delay undertaking any exercise programme/evaluation if you have a temporary illness, such as a cold or fever. Please bring this form with you to your exercise programme/evaluation.

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

NOTE: This questionnaire may be used for legal and administrative purposes.

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?	□	Yes	□	No
Do you feel pain in your chest when you do physical activity?	□	Yes	□	No
In the past month, have you had chest pain when you were not doing physical activity?	□	Yes	□	No
Do you lose your balance because of dizziness or do you ever lose consciousness?	□	Yes	□	No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?	□	Yes	□	No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?	□	Yes	□	No
Is it possible that you are pregnant?	□	Yes	□	No
Do you know of any other reason why you should not do physical activity?	□	Yes	□	No

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