Par-Q

To complete this form, please print, fill out and return to Sports & Fitness prior to making your appointment with a trainer.
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. 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. If you
are between the ages of 15 and 69, the PAR-Q (Physical Activity Readiness Questionnaire) will tell you if you should check with your
doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one
honestly: Check YES or NO.

1. 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity
   recommended by a doctor? YesNo
2. 2. Do you feel pain in your chest when you do physical activity? YesNo
3. 3. In the past month, have you had chest pain when you were not doing physical activity? YesNo
4. 4. Do you lose your balance because of dizziness or do you ever lose consciousness? YesNo
5. 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? YesNo
6. 6. Is your doctor currently prescribing drugs (ex. water pills) for your blood pressure or heart condition? YesNo
7. 7. Do you know of any other reason why you should not do physical activity?YesNo
8. If you answered:
   Yes to one or more questions
   • Talk with your doctor by phone or in person before you start becoming much more physically active and before you have a
   fitness appraisal. Tell your doctor about the PAR-Q and which question(s) you answered YES. UHD Sports &
   • 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 with your doctor about the kinds of activities you wish to
   participate in and follow his/her advise.
   No to all questions
   • If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
   - Start becoming 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.
   Delay becoming much more active:
   • If you are not feeling well because of a temporary illness such as a cold or fever - wait until you feel better.
   • If you are pregnant - talk to your doctor before you start becoming more active.
   • If your health changes so that you then answer YES to any of the above questions, consult your doctor.
   I have read, understood and completed the questionnaire. Any questions that I have were answered to my full satisfaction.

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