Common sense is your best quide when you answer these questions. Please read the question carefully and answer each one honestly: place a tick in the space to the left of the question to answer "yes" or "no". Please ask if you have any questions. Your responses will be treated in a confidential manner.
YESNO
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your blood pressure or heart condition?
Is your doctor currently prescribing drugs (for example, waterpills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
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 or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions your answered YES. You may be able to do any activity you wnat- as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those that are dafe fdor 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 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 fo ryou to live actively.
-If you are not feeling well because of a temporary illness such as a cold or a fever-wait until you feel better. -If you are of 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 weather you should change your physical actvity plan.
Informed use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity. If in doubt after completing this questionnaire, consult your doctor prior to physical activity.
I have read and understod and completed this questionnaire. Any questions I had were answered to my full satisfaction.
Name:___________________________________________
Signature:______________________________________
Todays Date:_____________/_____________/___________
Signature of Parent/Guardian___________________________________ (for participants under the age of majority)
Witness:______________________________
