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Yes
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No
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1. Has a doctor ever said that you have a heart condition and recommended only medically supervised activity?
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____
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2. Do you have chest pain brought on by physical activity?
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____
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____
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3. Have you developed chest pain in the past month?
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4. Have you on 1 or more occasions lost consciousness or fallen over as a result of dizziness?
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____
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5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?
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____
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6. Has a doctor ever recommended medication for you blood pressure or a heart condition?
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____
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7. Are you aware, through your own experience or a doctor?s advice, of any other physical reason that would prohibit you from exercising without medical supervision?
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If you answered ?yes? to any of these questions, call your personal physician or healthcare provider before increasing your physical activity.
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Please print this questionnaire and bring it to your physician if you have any further questions.
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The PAR-Q was created by the Canadian Society for Exercise Physiology.
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