PAR-Q

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q) AND YOU

If you are planning to become much more physically active than you are now, please answer the following questions. If you are between the ages of 14 and 69, the PAR-Q 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:

IF YOU ANSWERED:

YES TO ONE OR MORE QUESTIONS

Talk to your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell 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 which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

NO TO ALL QUESTIONS

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.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or
If you are or may be pregnant – talk to your doctor before you start becoming more active.

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.

Informed use of the PAR-Q : Total Fitness Gym and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.

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

NAME

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Printed Name and Signature

Date

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Signature of Parent or Guardian (for participants under the age of majority)

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? In the past month, have you had a chest pain when you were not doing physical activity?	Yes	No
Do you lose balance because of dizziness or do you ever lose consciousness?	Yes	No
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
Is your doctor currently prescribing medication for your blood pressure or heart condition?	Yes	No
Do you know of any other reason why you should not take part in physical activity?	Yes	No